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Gautam S, Kumar R, Bhadoria DP, Mawari G, Kumar N, Daga MK, Pandit S, Anuradha S, Pradhan GS, Garg S, Sharma G, Raghu RV, Ritchie N, Jayamsulekha D. Clinical profile of hospitalised moderate category COVID-19 patients: Short study from a Tertiary Care Centre in Delhi. J Family Med Prim Care 2023; 12:1644-1653. [PMID: 37767420 PMCID: PMC10521840 DOI: 10.4103/jfmpc.jfmpc_2245_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/28/2023] [Accepted: 05/29/2023] [Indexed: 09/29/2023] Open
Abstract
Background The clinical profile of hospitalized moderate-category COVID-19 patients has been understudied globally and in India. Aim The present study was conducted to study the clinical profile and assess the proportions of patients who progressed to severe disease and its predictors among moderate COVID-19 patients. Materials and Methods In this single-center observational study, 100 moderate-category COVID-19 patients as per Ministry of Health and Family Welfare (MoHFW) criteria of age ≥18 years of either sex, excluding pregnant females from February to November 2021, were studied by analyzing their clinical profiles and assessing Quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score 2 (NEWS-2), and chest computed-tomography severity score (CTSS) to predict progression to severe disease. Severe disease was defined as per MoHFW criteria. Results Out of 100 moderate-category COVID-19 patients, progression to severe disease was seen in 11 patients (11%), among which eight patients had expired, three patients were discharged, and the rest of the 89 patients (89%) who did not progress to severe disease were discharged. A higher age (62.2± 19.5 vs 54.8 ± 14.6 years), along with multivariate analysis revealing male sex (1.25 times), chronic kidney disease (2.86 times), leukocytosis (6.10 times), thrombocytopenia (1.04 times), anemia (9.3 times), a higher qSOFA score (3.6 times), and a higher NEWS-2 score on admission (1.56 times) had higher odds of progression to severe disease. A significant correlation (P < .05) of qSOFA score with serum LDH, ferritin, and hs-CRP levels; CT severity score with the serum ferritin, IL-6, and LDH levels; and NEWS-2 with serum LDH, hs-CRP, and ferritin levels were found. Moreover, the NEWS-2 score was found slightly better than qSOFA on receiver operating characteristic (ROC) curve analysis, with an area under the curve of 85.8% and 83.2%, respectively, predicting progression to severe disease. Conclusion Our study revealed male gender, chronic kidney disease, leukocytosis, anemia, thrombocytopenia, a higher qSOFA and NEWS-2 score on admission, and further, NEWS-2 score better than qSOFA on ROC curve analysis, with an area under the curve of 85.8% and 83.2%, respectively, in predicting severe disease among hospitalized moderate COVID-19 patients.
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Affiliation(s)
- Sachin Gautam
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Rahul Kumar
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Dharam Pal Bhadoria
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Govind Mawari
- Department of Centre for Occupational and Environmental Health (COEH), Maulana Azad Medical College, New Delhi, India
| | - Naresh Kumar
- Department of Pulmonary Medicine, Maulana Azad Medical College, New Delhi, India
| | - Mradul K. Daga
- Department of Internal Medicine and Infectious Disease, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Sanjay Pandit
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - S. Anuradha
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | | | - Sandeep Garg
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Gaurav Sharma
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - RV Raghu
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Nupur Ritchie
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Dasari Jayamsulekha
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
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Kunal S, Bagarhatta P, Palleda GM, Bansal A, Batra V, Daga MK, Tyagi S, Sharma A, Bansal K, Agarwal R, Gupta MD. Role of cardiovascular magnetic resonance imaging in COVID-19 recovered patients: A short-term follow-up study. Echocardiography 2022; 39:1401-1411. [PMID: 36266740 PMCID: PMC9874707 DOI: 10.1111/echo.15466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/26/2022] [Accepted: 09/19/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Cardiac involvement in recovered COVID-19 patients assessed by cardiac magnetic resonance imaging (MRI). METHODS Subjects recently recovered from COVID-19 and with an abnormal left ventricular global longitudinal strain were enrolled. Cardiac MRI in all the enrolled subjects was done at baseline (within 30-90 days following recovery from COVID-19) with a follow-up scan at 6 months in individuals with an abnormal baseline scan. Additionally, 20 age-and sex-matched individuals were enrolled as healthy controls (HCs). RESULTS All the 30 enrolled subjects were symptomatic during active COVID-19 disease and were categorized as mild: 11 (36.7%), moderate: 6 (20%), and severe: 13 (43.3%). Of the 30 patients, 16 (53.3%) had abnormal CMR findings. Myocardial edema was reported in 12 (40%) patients while 10 (33.3%) had late gadolinium enhancement (LGE). No difference was observed in terms of conventional left ventricular (LV) parameters; however, COVID-19-recovered patients had significantly lower right ventricular (RV) ejection fraction, RV stroke volume, and RV cardiac index compared to HCs. Follow-up scan was abnormal in 4/16 (25%) with LGE persisting in three patients (who had severe COVID-19 [3/4;75%]). Subjects with severe COVID-19 had a greater frequency of LGE (53.8%) and myocardial edema (61.5%) as compared to mild and moderate cases. Myocardial T1 (1284 ± 43.8 ms vs. 1147.6 ± 68.4 ms; p < .0001) and T2 values (50.8 ± 16.7 ms vs. 42.6 ± 3.6 ms; p = .04) were significantly higher in post COVID-19 subjects compared to HCs. Similarly, T1 and T2 values of severe COVID-19 patients were significantly higher compared to mild and moderate cases. CONCLUSIONS An abnormal CMR was seen in half of the recovered patients with persistent abnormality in one-fourth at 6 months. Our study suggests a need for closer follow-up among recovered subjects in order to evaluate for long-term cardiovascular sequelae. COVID-19 causes structural changes in the myocardium in a small segment of patients with partial spontaneous resolution.
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Affiliation(s)
- Shekhar Kunal
- Department of CardiologyGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | | | - Girish M. Palleda
- Department of CardiologyGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | - Ankit Bansal
- Department of CardiologyGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | - Vishal Batra
- Department of CardiologyGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | - Mradul K. Daga
- Department of MedicineMaulana Azad Medical CollegeDelhiIndia
| | - Sanjay Tyagi
- Department of CardiologyGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | - Ashok Sharma
- Department of RadiodiagnosisGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | - Kalpana Bansal
- Department of RadiodiagnosisGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
| | - Ritu Agarwal
- Department of RadiodiagnosisEternal Heart Care Center (EHCC)JaipurRajasthanIndia
| | - Mohit D. Gupta
- Department of CardiologyGovind Ballabh Pant Institute of Post Graduate Medical Education and ResearchDelhiIndia
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Das P, Dixit R, Prakash A, Daga MK, Singh R. Diffusion-weighted magnetic resonance imaging of abdominal tuberculosis: a new take on an old disease. Abdom Radiol (NY) 2022; 47:3446-3458. [PMID: 35864265 DOI: 10.1007/s00261-022-03607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
Abdominal tuberculosis is a major cause of mortality and morbidity in developing countries also re-emerging in western world due to the AIDS epidemic and population migration. Large proportion of the patients are young and hence radiation exposure is of concern. In addition, in some patients, contrast may be contraindicated or repeat studies may be required, where MR especially DWI may be useful. The aim of the study is to describe MRI features in abdominal tuberculosis including DWI in the involved bowel, lymphadenopathy, omental, and peritoneal thickening. Nodes being especially easy to appreciate on DWI, thus DWI in conjunction with routine noncontrast MR sequence can be useful technique to identify abdominal tubercular lesions in patients with contraindication to contrast.
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Affiliation(s)
- Prince Das
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Rashmi Dixit
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India.
| | - Anjali Prakash
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - M K Daga
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Rajdeep Singh
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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Nasa P, Chaudhry D, Govil D, Daga MK, Jain R, Chhallani AA, Krishna A, Jagiasi BG, Juneja D, Barthakur HS, Jha H, Gurjar M, Rangappa P, Aladakatti R, Mishra RC, Shetty RM, Yadav R, Garg S, Nandakumar SM, Samavedam S, Ray S, Hadda V, Javeri Y, Munjal M. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021. [PMID: 34866826 DOI: 10.5005/jp-journals-10071-23923.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction There is strong evidence for the use of corticosteroid in the management of severe coronavirus disease-2019 (COVID-19). However, there is still uncertainty about the timing of corticosteroids. We undertook a modified Delphi study to develop expert consensus statements on the early identification of a subset of patients from non-severe COVID-19 who may benefit from using corticosteroids. Methods A modified Delphi was conducted with two anonymous surveys between April 30, 2021, and May 3, 2021. An expert panel of 35 experts was selected and invited to participate through e-mail. The consensus was defined as >70% votes in multiple-choice questions (MCQ) on Likert-scale type statements, while strong consensus as >90% votes in MCQ or >50% votes for "very important" on Likert-scale questions in the final round. Results Twenty experts completed two rounds of the survey. There was strong consensus for the increased work of breathing (95%), a positive six-minute walk test (90%), thorax computed tomography severity score of >14/25 (85%), new-onset organ dysfunction (using clinical or biochemical criteria) (80%), and C-reactive protein >5 times the upper limit of normal (70%) as the criteria for patients' selection. The experts recommended using oral or intravenous (IV) low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days and monitoring of oxygen saturation, body temperature, clinical scoring system, blood sugar, and inflammatory markers for any "red-flag" signs. Conclusion The experts recommended against indiscriminate use of corticosteroids in mild to moderate COVID-19 without the signs of clinical worsening. Oral or IV low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days are recommended for patients with features of disease progression based on clinical, biochemical, or radiological criteria after 5 days from symptom onset under close monitoring. How to cite this article How to cite this article: Nasa P, Chaudhry D, Govil D, Daga MK, Jain R, Chhallani AA, et al. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021;25(11):1280-1285.
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Affiliation(s)
- Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
| | - Dhruva Chaudhry
- Professor and Head, Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Mradul K Daga
- Department of Medicine, Maulana Azad Medical College, Delhi, India
| | - Ravi Jain
- Department of Critical Care Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | | | - Apoorv Krishna
- Department of Pulmonology and Critical Care, Hospital Regency Health, Kanpur, Uttar Pradesh, India
| | - Bharat G Jagiasi
- Department of Critical Care, Reliance Hospital, Navimumbai, Maharashtra, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Delhi, India
| | | | - Hrishikesh Jha
- Incharge, ICU, MRPSH, Near RIMS, Ranchi, Jharkhand, India
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Pradeep Rangappa
- Consultant Intensive Care Physician, Columbia Asia Referral Hospitals, Yeshwantpur, Bengaluru, Karnataka, India
| | - Raghunath Aladakatti
- Department of Critical Care Medicine, Gopalagowda Shathaveri Memorial Hospital, Mysuru, Karnataka, India
| | - Rajesh C Mishra
- Department of MICU, Shaibya Comprehensive Care Clinic, Ahmedabad, Gujarat, India
| | - Rajesh M Shetty
- Department of Critical Care Medicine, Manipal Hospital Whitefield, Bengaluru, Karnataka, India
| | - Rohit Yadav
- Consultant Critical Care Medicine, Bansal Hospital, Bhopal, Madhya Pradesh, India
| | - Sandeep Garg
- Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, Delhi, India
| | - Sivakumar M Nandakumar
- Department of Critical Care, Royalcare Superspeciality Hospital, Coimbatore, Tamil Nadu, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
| | - Sumit Ray
- Department of Critical Care Medicine, Holy Family Hospital, Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, Delhi, India
| | - Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India
| | - Manish Munjal
- Medical Director, Mangalam Medicity Hospital, Jaipur, Chairman Jigyasa Foundation, Jaipur, Rajasthan, India
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Nasa P, Chaudhry D, Govil D, Daga MK, Jain R, Chhallani AA, Krishna A, Jagiasi BG, Juneja D, Barthakur HS, Jha H, Gurjar M, Rangappa P, Aladakatti R, Mishra RC, Shetty RM, Yadav R, Garg S, Nandakumar SM, Samavedam S, Ray S, Hadda V, Javeri Y, Munjal M. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021; 25:1280-1285. [PMID: 34866826 PMCID: PMC8608626 DOI: 10.5005/jp-journals-10071-23923] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION There is strong evidence for the use of corticosteroid in the management of severe coronavirus disease-2019 (COVID-19). However, there is still uncertainty about the timing of corticosteroids. We undertook a modified Delphi study to develop expert consensus statements on the early identification of a subset of patients from non-severe COVID-19 who may benefit from using corticosteroids. METHODS A modified Delphi was conducted with two anonymous surveys between April 30, 2021, and May 3, 2021. An expert panel of 35 experts was selected and invited to participate through e-mail. The consensus was defined as >70% votes in multiple-choice questions (MCQ) on Likert-scale type statements, while strong consensus as >90% votes in MCQ or >50% votes for "very important" on Likert-scale questions in the final round. RESULTS Twenty experts completed two rounds of the survey. There was strong consensus for the increased work of breathing (95%), a positive six-minute walk test (90%), thorax computed tomography severity score of >14/25 (85%), new-onset organ dysfunction (using clinical or biochemical criteria) (80%), and C-reactive protein >5 times the upper limit of normal (70%) as the criteria for patients' selection. The experts recommended using oral or intravenous (IV) low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days and monitoring of oxygen saturation, body temperature, clinical scoring system, blood sugar, and inflammatory markers for any "red-flag" signs. CONCLUSION The experts recommended against indiscriminate use of corticosteroids in mild to moderate COVID-19 without the signs of clinical worsening. Oral or IV low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days are recommended for patients with features of disease progression based on clinical, biochemical, or radiological criteria after 5 days from symptom onset under close monitoring. HOW TO CITE THIS ARTICLE How to cite this article: Nasa P, Chaudhry D, Govil D, Daga MK, Jain R, Chhallani AA, et al. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021;25(11):1280-1285.
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Affiliation(s)
- Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
- Prashant Nasa, Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates, Phone: +971501425022, e-mail:
| | - Dhruva Chaudhry
- Professor and Head, Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta–The Medicity, Gurgaon, Haryana, India
| | - Mradul K Daga
- Department of Medicine, Maulana Azad Medical College, Delhi, India
| | - Ravi Jain
- Department of Critical Care Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | | | - Apoorv Krishna
- Department of Pulmonology and Critical Care, Hospital Regency Health, Kanpur, Uttar Pradesh, India
| | - Bharat G Jagiasi
- Department of Critical Care, Reliance Hospital, Navimumbai, Maharashtra, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Delhi, India
| | | | - Hrishikesh Jha
- Incharge, ICU, MRPSH, Near RIMS, Ranchi, Jharkhand, India
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Pradeep Rangappa
- Consultant Intensive Care Physician, Columbia Asia Referral Hospitals, Yeshwantpur, Bengaluru, Karnataka, India
| | - Raghunath Aladakatti
- Department of Critical Care Medicine, Gopalagowda Shathaveri Memorial Hospital, Mysuru, Karnataka, India
| | - Rajesh C Mishra
- Department of MICU, Shaibya Comprehensive Care Clinic, Ahmedabad, Gujarat, India
| | - Rajesh M Shetty
- Department of Critical Care Medicine, Manipal Hospital Whitefield, Bengaluru, Karnataka, India
| | - Rohit Yadav
- Consultant Critical Care Medicine, Bansal Hospital, Bhopal, Madhya Pradesh, India
| | - Sandeep Garg
- Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, Delhi, India
| | - Sivakumar M Nandakumar
- Department of Critical Care, Royalcare Superspeciality Hospital, Coimbatore, Tamil Nadu, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
| | - Sumit Ray
- Department of Critical Care Medicine, Holy Family Hospital, Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, Delhi, India
| | - Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India
| | - Manish Munjal
- Medical Director, Mangalam Medicity Hospital, Jaipur, Chairman Jigyasa Foundation, Jaipur, Rajasthan, India
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Abstract
Leishmaniasis is one of the chronic debilitating vector-borne diseases caused by obligate intracellular protozoa. The global burden of disease although not increasing but potential risk of spread is there. At least 20 species of Leishmania are pathogenic to human beings. The transmission is from female sandfly through a blood meal. The disease pathogenesis is dependent on parasite and host mechanism-primarily cell-mediated immunity. The three common forms are visceral, cutaneous, and mucocutaneous. The diagnostic tests are mainly based on aspiration from the spleen or bone marrow. The use of K39 antibodies is the best serodiagnostic test. Antimonial, amphotericin B, miltefosine, and paromomycin are the drugs used to treat leishmaniasis. Amphotericin therapy shows the response within 7 to 10 days in most subjects, and 2 weeks of therapy is sufficient. However, those going into relapse need new treatment regimes. There is a definite benefit of combination therapy. However, there is still no breakthrough on a vaccine for prophylaxis. How to cite this article: Daga MK, Rohatgi I, Mishra R. Leishmaniasis. Indian J Crit Care Med 2021;25(Suppl 2):S166-S170.
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Affiliation(s)
- Mradul K Daga
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Ishan Rohatgi
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Rashmi Mishra
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
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Daga MK, Kumar L, Mawari G, Kumar N, Singh S, Mishra TK. Adrenomedullin and Its Possible Role in Improved Survival in Female Patients with Sepsis: A Study in the South East Asian Region. Indian J Crit Care Med 2020; 24:1180-1184. [PMID: 33446969 PMCID: PMC7775928 DOI: 10.5005/jp-journals-10071-23672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS AND OBJECTIVES Serum adrenomedullin (ADM) as a prognostic biomarker to study the gender-related differences in mortality pattern and its correlation with the sequential organ failure assessment (SOFA) and acute physiologic assessment and chronic health evaluation II (APACHE II) scores in patients of sepsis. MEASUREMENTS AND MAIN RESULTS Eighty patients of sepsis of which 36 were males and 44 were females, were taken in the study as per sepsis III guidelines. They were followed up for a period of 28 days. Serum ADM was measured on day 1 and day 5. The endpoint was mortality or survival at day 28 after admission. The death rate among males was higher, with 23 of the total 36 (63.89%) patients having died when compared with females in which 25 patients out of 44 (56.82%) had died. The observed mortality rates correlated well with average APACHE II scores. The average APACHE II score was slightly higher in males (29 ± 8.97) when compared with females (27.02 ± 8.69). Similarly, day 1 SOFA and mean SOFA values were higher in males (10.22 ± 5.36) and (10.73 ± 6.01) when compared with females (8.27 ± 4.79) and (8.89 ± 5.6), respectively. Males despite having higher mortality rates, higher APACHE II, SOFA, and mean SOFA values were still having less mean levels of serum ADM (454.40 ± 81.13 pg/mL) when compared with females (479.62 ± 126.97 pg/mL). CONCLUSION Adrenomedullin is a protective neurohormone with antibacterial and anti-inflammatory properties. It is elevated in all patients with sepsis but the rise is more so in the female when compared with males. Higher ADM levels in females may suggest the protective effect of ADM as a part of the general protective neurohormonal stress response, which may explain the low death rate in females in sepsis. HOW TO CITE THIS ARTICLE Daga MK, Kumar L, Mawari G, Kumar N, Singh S, Mishra TK. Adrenomedullin and Its Possible Role in Improved Survival in Female Patients with Sepsis: A Study in the South East Asian Region. Indian J Crit Care Med 2020;24(12):1180-1184.
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Affiliation(s)
- Mradul K Daga
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Lalit Kumar
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Govind Mawari
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Naresh Kumar
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Shashank Singh
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Tarun Kumar Mishra
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
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Daga MK, Chhoda A, Singh S, Mawari G, Kumar N, Mishra TK, Hira HS. Effect of Statin Supplementation on Pulmonary Function and Inflammatory Markers in Patients of Chronic Obstructive Pulmonary Disease. CRMR 2019. [DOI: 10.2174/1573398x15666190614154338] [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: 11/22/2022]
Abstract
Background:
COPD being a systemic inflammatory disease is accompanied by alteration
of various inflammatory cytokines which affect the metabolic equilibrium of body. Some therapeutic
options, mainly statins via their wide range of pharmacologic actions alter the level of proinflammatory
cytokines hence, helpful in attenuating various extra-pulmonary consequences of
COPD. We did a randomised case-control study to study the effect of statin supplementation on
pulmonary function and inflammatory markers in patients of COPD.
Methods:
We included 40 stable COPD subjects & randomized them in two groups, Intervention &
Non-intervention. Intervention group received 40 mg atorvastatin once daily for 3 months in addition
to the conventional treatment of COPD similar to the prior one. We studied levels of IL-6 & CRP
and correlated them with disease severity before and after the aforementioned intervention.
Results:
We observed that CRP levels decreased in both the groups after a follow up of 3 months,
but neither of them was statistically significant (p=0.57 & 0.63 respectively) nor the mean of their
difference (p=0.969). IL-6 levels showed a persistent decline in intervention group but, was not
significant (p=0.91). In this study, we noticed statistically significant improvement in FEV1
(p=0.008) in the intervention group which was in contrast to non-intervention group. Similarly, the
exercise capacity also statistically increased in the intervention group (p=0.002). There was also
evident negative correlation between exercise capacity and IL-6 as well CRP levels. FEV1 also
showed statistically significant negative correlation with IL-6 levels (p=0.023).
Conclusion:
We can improve the disease outcome and alter its natural progression by altering the
levels of inflammatory markers with the aid of some additional pharmacological interventions i.e., in
this study was atorvastatin.
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Affiliation(s)
- Mradul K. Daga
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi-11002, India
| | - Ankit Chhoda
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi-11002, India
| | - Shashank Singh
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi-11002, India
| | - Govind Mawari
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi-11002, India
| | - Naresh Kumar
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi-11002, India
| | - Tarun K. Mishra
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi-11002, India
| | - Harmanjit S. Hira
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi-11002, India
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Mohan A, Madan K, Hadda V, Tiwari P, Mittal S, Guleria R, Khilnani GC, Luhadia SK, Solanki RN, Gupta KB, Swarnakar R, Gaur SN, Singhal P, Ayub II, Bansal S, Bista PR, Biswal SK, Dhungana A, Doddamani S, Dubey D, Garg A, Hussain T, Iyer H, Kavitha V, Kalai U, Kumar R, Mehta S, Nongpiur VN, Loganathan N, Sryma PB, Pangeni RP, Shrestha P, Singh J, Suri T, Agarwal S, Agarwal R, Aggarwal AN, Agrawal G, Arora SS, Thangakunam B, Behera D, Jayachandra, Chaudhry D, Chawla R, Chawla R, Chhajed P, Christopher DJ, Daga MK, Das RK, D'Souza G, Dhar R, Dhooria S, Ghoshal AG, Goel M, Gopal B, Goyal R, Gupta N, Jain NK, Jain N, Jindal A, Jindal SK, Kant S, Katiyar S, Katiyar SK, Koul PA, Kumar J, Kumar R, Lall A, Mehta R, Nath A, Pattabhiraman VR, Patel D, Prasad R, Samaria JK, Sehgal IS, Shah S, Sindhwani G, Singh S, Singh V, Singla R, Suri JC, Talwar D, Jayalakshmi TK, Rajagopal TP. Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations. Lung India 2019; 36:S37-S89. [PMID: 32445309 PMCID: PMC6681731 DOI: 10.4103/lungindia.lungindia_108_19] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.
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Affiliation(s)
- Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - GC Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - SK Luhadia
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - RN Solanki
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - KB Gupta
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Swarnakar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - SN Gaur
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pratibha Singhal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Irfan Ismail Ayub
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shweta Bansal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prashu Ram Bista
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shiba Kalyan Biswal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashesh Dhungana
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Doddamani
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Dilip Dubey
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avneet Garg
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tajamul Hussain
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Venkatnarayan Kavitha
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Umasankar Kalai
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Swapnil Mehta
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Noel Nongpiur
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - N Loganathan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - PB Sryma
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Prasad Pangeni
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prajowl Shrestha
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jugendra Singh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tejas Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandip Agarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ritesh Agarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gyanendra Agrawal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Suninder Singh Arora
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Balamugesh Thangakunam
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - D Behera
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jayachandra
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Dhruva Chaudhry
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Chawla
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Chawla
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Chhajed
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Devasahayam J Christopher
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - MK Daga
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjan K Das
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - George D'Souza
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Dhar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sahajal Dhooria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aloke G Ghoshal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Goel
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bharat Gopal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajiv Goyal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neeraj Gupta
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - NK Jain
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Jain
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Jindal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - SK Jindal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Surya Kant
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Katiyar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - SK Katiyar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Parvaiz A Koul
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jaya Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Raj Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Lall
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Mehta
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Nath
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - VR Pattabhiraman
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Dharmesh Patel
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajendra Prasad
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - JK Samaria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shirish Shah
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Girish Sindhwani
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sheetu Singh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Virendra Singh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rupak Singla
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - JC Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Talwar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - TK Jayalakshmi
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - TP Rajagopal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Singh S, Daga MK, Kumar A, Husain SA, Kar P. Role of oestrogen and its receptors in HEV-associated feto-maternal outcomes. Liver Int 2019; 39:633-639. [PMID: 29979823 DOI: 10.1111/liv.13928] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 06/15/2018] [Accepted: 07/02/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pregnant women infected with HEV develops adverse pregnancy outcomes like, abortions, intrauterine fetal death, still births, neonatal deaths, preterm delivery and maternal mortality. AIM To correlate oestrogen and its receptors ESR1α and ESR2β levels with HEV-associated feto-maternal outcomes. MATERIAL & METHODS A total of 142 pregnant women with HEV infection and 142 pregnant controls were included in study from Department of Obstetrics & Gynaecology and Department of Medicine, Maulana Azad Medical College (MAMC) and associated Lok Nayak Hospital (LNH), New Delhi. Three millilitre of blood sample was collected in plain for quantification of oestrogen, and its receptors ESR1α and ESR2β using commercially available third-generation ELISA kits. RESULTS The levels of oestrogen, ESR1α and ESR2β were considerably higher in HEV-infected pregnant women (20.11 ± 18.19 ng/mL, 10.58 ± 3.27 ng/mL, 10.42 ± 4.71 ng/mL respectively) than pregnant controls (11.74 ± 6.42 ng/mL, 9.11 ± 1.63 ng/mL, 9.01 ± 1.18 ng/mL respectively)(P < 0.0001). It was found that oestrogen levels were significantly higher in pregnant women infected with HEV who had preterm delivery, low birth weight babies and fetal loss (19.64 ± 17.60 ng/mL, 19.71 ± 17.63 ng/mL, 33.62 ± 23.20 ng/mL respectively) than who had full term delivery, average birth weight babies and live babies (11.71 ± 8.77 ng/mL, 11.99 ± 9.44 ng/mL, 16.58 ± 14.98 ng/mL respectively)(P < 0.05). A significant negative correlation was observed between baby birth weight and oestrogen levels in HEV-infected pregnant women. CONCLUSION The high level of oestrogen plays an important role in preterm delivery, low birth weight babies and fetal mortality in pregnant women with HEV infection through placental dysfunction. Moreover, oestrogen level is a significant predictor for preterm delivery and maternal mortality and ESR2β levels is a significant predictor for maternal mortality in pregnant women infected with HEV.
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Affiliation(s)
- Swati Singh
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Mradul K Daga
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Ashok Kumar
- Department of Obstetrics & Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Syed A Husain
- Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - Premashis Kar
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
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Affiliation(s)
- Mradul K. Daga
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi 11002, India
| | - Shashank Singh
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi 11002, India
| | - Govind Mawari
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi 11002, India
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Daga MK, Kumar L, Mawari G. COPD and Gastroesophageal Reflux Disease: A Double Blow. CRMR 2018. [DOI: 10.2174/1573398x14666180910113545] [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: 11/22/2022]
Affiliation(s)
- Mradul K. Daga
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi-11002, India
| | - Lalit Kumar
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi-11002, India
| | - Govind Mawari
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi-11002, India
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Krishnamurthy K, Mishra TK, Saxena A, Daga MK, Khurana N, Masroor M, Jamatia E. Evaluating NISCH and CDH1 Promoter Hypermethylation in Nonsmokers, Cancer Free Smokers and Lung Cancer Patients: A Case Control Study. Indian J Clin Biochem 2018; 34:458-464. [PMID: 31686733 DOI: 10.1007/s12291-018-0767-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 06/09/2018] [Indexed: 11/26/2022]
Abstract
Lung cancer has very high mortality due to late stage diagnosis not amenable to curative resection. Cancer specific methylation patterns of tumor suppressor genes may precede precursor lesions of lung cancer. Our aim was to evaluate the promoter hypermethylation of tumor suppressor gene NISCH and CDH1 in cfDNA from plasma of lung cancer patients and its possible correlation with smoking status and various clinicopathological parameters. Forty histopathologically confirmed lung cancer cases, thirty smoker and thirty nonsmoker controls were enrolled. Plasma cfDNA was extracted and subjected to bisulfite treatment followed by MS-PCR. Serum nischarin levels were estimated by ELISA. The frequency of promoter hypermethylation of NISCH and CDH1 was significantly higher in lung cancer patients as compared to lifelong non-smoker controls (p < 0.05). It did not vary with smoking status among cancer cases. No significant association was found with staging or histological grading. NISCH methylation was found to be significantly higher among smoker controls. Pack years and packs per day were significantly higher in the methylated group. Serum nischarin levels showed no significant association with NISCH methylation or clinicopathological variables. NISCH is highly methylated in both high risk smoker controls as well as cancerousnon-smokers and may mark the convergence of varied etiologies of lung cancer. Hence NISCH and CDH1 are highly methylated in plasma cfDNA of lung cancer patients.
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Affiliation(s)
- Kritika Krishnamurthy
- 1Department of Biochemistry, Maulana Azad Medical College, 2 Bahadur Shah Zafar Marg, New Delhi, India
| | - T K Mishra
- 1Department of Biochemistry, Maulana Azad Medical College, 2 Bahadur Shah Zafar Marg, New Delhi, India
| | - Alpana Saxena
- 1Department of Biochemistry, Maulana Azad Medical College, 2 Bahadur Shah Zafar Marg, New Delhi, India
| | - M K Daga
- 2Department of Medicine, Maulana Azad Medical College, 2 Bahadur Shah Zafar Marg, New Delhi, India
| | - Nita Khurana
- 3Department of Pathology, Maulana Azad Medical College, 2 Bahadur Shah Zafar Marg, New Delhi, India
| | - Mirza Masroor
- 1Department of Biochemistry, Maulana Azad Medical College, 2 Bahadur Shah Zafar Marg, New Delhi, India
| | - Elvia Jamatia
- 1Department of Biochemistry, Maulana Azad Medical College, 2 Bahadur Shah Zafar Marg, New Delhi, India
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Krishnamurthy K, Mishra TK, Saxena A, Daga MK, Khurana N, Mirza M. Abstract A32: NISCH promoter hypermethylation, smoking and lung cancer: A case control study. Cancer Res 2016. [DOI: 10.1158/1538-7445.fbcr15-a32] [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: 11/16/2022]
Abstract
Abstract
Lung cancer is the most common cancer worldwide, both in terms of incidence and mortality. The high mortality of lung cancer is attributable to the presence of metastatic disease in nearly two thirds of patients at diagnosis. Detection of early stage lung cancer amenable to curative resection could potentially result in a manifold increase in survival rates.
Epigenetic alterations seemingly contribute to cancer initiation and progression. Cancer specific methylation patterns of tumor suppressor genes, which precede precursor lesions, could possibly herald earlier diagnosis of lung cancer and may even have important preventive or therapeutic implications.
Our aim was to evaluate the promoter hypermethylation of tumor suppressor gene NISCH in cfDNA from plasma of lung cancer patients and its possible correlation with smoking status and various clinicopathological parameters. NISCH codes for a nonadrenergic imidazoline-1 receptor protein nischarin that anchors to the inner layer of the plasma membrane. The orthologous mouse protein has been shown to bind alpha-5 beta-1 integrin and influence cytoskeletal organization.
Forty histopathologically confirmed lung cancer cases were enrolled along with thirty smoker and thirty nonsmoker controls. Plasma cfDNA was extracted and subjected to bisulfite treatment followed by conventional methylation specific PCR. DNA methylated using CpG methylase by the whole genome methylation protocol, was used as positive control and Nuclease free PCR grade water was used as negative control. The serum nischarin levels were estimated using commercially available ELISA kits. Statistical analysis was performed using SPSS 22.0 software.
We observed that frequency of promoter hypermethylation of tumor suppressor NISCH was significantly higher in lung cancer patients and in non-cancerous smokers as compared to lifelong nonsmoker controls. This difference in methylation status of NISCH between lung cancer cases, smoker and nonsmoker controls was found to be significant (P<0.05).
There was no significant association between methylation status of tumor suppressor gene NISCH and clinicopathologic variables- staging, tumor size, lymph node status, metastasis and histopathological grading. We observed a higher frequency of NISCH methylation in adenocarcinoma as compared to Squamous Cell Carcinoma.
Methylation status of tumor suppressor gene NISCH was found to be significantly higher among smokers as compared to nonsmokers. But there was no significant difference in the frequency of NISCH methylation between smoker lung cancer patients and nonsmoker lung cancer patients. There was no significant difference in methylation status of NISCH with type or duration of smoking. The pack years and packs per day were significantly higher in those with methylated NISCH as compared to the unmethylated group.
There was no significant association of serum nischarin levels with methylation status of NISCH, demographic variables or any clinicopathological parameters.
Our findings suggest that NISCH methylation occurs in high frequencies in cfDNA from plasma of lung cancer patients. Though it was not found to correlate with stage, tumor size, lymph node status, metastases or histological grade, it was found to be significantly associated with adenocarcinomas in our study. Hence, NISCH methylation could serve as a part of blood based biomarker panel for early diagnosis of lung cancer.
In addition, since NISCH is found to be highly methylated in both high risk heavy smoker controls as well as lung cancer cases irrespective of smoking status, it can be hypothesized that NISCH methylation may be the common primogenitor at which varied etiologies for lung cancer converge. Hence, in the future, it may be investigated as a universal therapeutic target for lung cancers regardless of clinicopathological heterogeneity.
Citation Format: Kritika Krishnamurthy, TK Mishra, Alpana Saxena, MK Daga, Nita Khurana, Masroor Mirza. NISCH promoter hypermethylation, smoking and lung cancer: A case control study. [abstract]. In: Proceedings of the Fourth AACR International Conference on Frontiers in Basic Cancer Research; 2015 Oct 23-26; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2016;76(3 Suppl):Abstract nr A32.
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Affiliation(s)
| | - TK Mishra
- Maulana Azad Medical College, New Delhi, India
| | | | - MK Daga
- Maulana Azad Medical College, New Delhi, India
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Khan NA, Kumar N, Daga MK. Effect of Dietary Supplementation on Body Composition, Pulmonary Function and Health-Related Quality of Life in Patients with Stable COPD. Tanaffos 2016; 15:225-235. [PMID: 28469679 PMCID: PMC5410119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Malnutrition is very common in patients with chronic obstructive pulmonary disease (COPD). Nutritional supplementation improves the patient's nutritional status by increasing the energy intake and providing anti-inflammatory elements which can relieve the patient's symptoms and delay the disease progression. This study sought to determine if energy and protein supplementation improves physical function, pulmonary function and health-related quality of life (HRQL) in stable COPD patients. MATERIALS AND METHODS The study was carried out in an outpatient setting on 60 stable COPD patients over a period of one year. Patients were randomized to intervention group (n=30), receiving supplemental nutrition in the form of additional protein and carbohydrates or control group (n=30), receiving only the usual standard diet. Lung function, body mass index (BMI), exercise capacity (6-minute walk test or 6MWT), mid-upper arm circumference (MUAC) and skin fold thickness (SFT) were evaluated, and clinical assessment was carried out at baseline and after completion of 12 weeks. The HRQL was assessed using Seattle obstructive lung disease questionnaire. RESULTS Twelve weeks of dietary supplementation resulted in a significant increase in weight and BMI of patients in the intervention group in comparison to the control group (P<0.005). Significant improvement was also observed in 6MWT and HRQL scores after nutritional intervention (P=0.002 and P=0.001, respectively). However, difference in MUAC, SFT and serum protein level after 12 weeks of follow up was not significant in any of the two groups. There was a similar degree of lung function improvement in both groups although it was not statistically significant. CONCLUSION Nutritional supplementation with high protein and energy diet during 12 weeks of intervention improved body weight and composition, exercise capacity and quality of life in stable COPD patients.
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Affiliation(s)
| | | | - Mradul K Daga
- Correspondence to: Kumar Daga M, Address: Department of Medicine, Maulana Azad Medical College, New Delhi, India, Email address:
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Pahwa S, Saksena A, Singh A, Daga MK, Singh T. Blastic Phase of CML with Microfilaria: A Rare Case Report. J Clin Diagn Res 2015; 9:ED09-10. [PMID: 25737999 DOI: 10.7860/jcdr/2014/10545.5424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/17/2014] [Indexed: 11/24/2022]
Abstract
Filariasis is a major public health concern in tropical and subtropical countries including India. There have been very few case reports of incidental filariasis in the bone marrow aspirate smears in patients with hematological malignancies. We present a case of blastic phase of chronic myeloid leukemia (CML) with associated filariasis with monocytosis. Such an association, to the best of our knowledge, is hitherto unreported. Moreover, eosinophilia was not a feature in our case. A 37-year-old male, diagnosed case of CML, presented with low grade fever, weight loss and abdominal distension for one month. Physical examination revealed massive splenomegaly and hepatomegaly. However, there was no lymphadenopathy. His hemoglobin was 10.5 g/dl, total leukocyte count was 52.31x 109 / L with platelet count of 30x 109/L .Differential leukocyte count on peripheral smear showed 21% blasts, 30% polymorphs, 16% lymphocytes, 1% myelocyte, 1%metamyelocyte, 30%monocytoid cells and 1% eosinophils. Bone marrow aspirate smears were diluted with peripheral blood and showed blasts and monocytoid cells constituting 25% and 15% of marrow nucleated cells respectively. In addition, occasional microfilaria of Wuchereria bancrofti were also seen both in the peripheral blood and aspirate smears. Based on the above findings, a diagnosis of blastic phase of CML with monocytosis with microfilaria of W.bancrofti. Hence this was an unusual case of CML blastic phase which was associated with filariasis. Moreover, inspite of having filariasis and CML, patient lacked eosinophilia and instead showed monocytosis, which is hitherto unreported.
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Affiliation(s)
- Suniti Pahwa
- Junior Resident, Departments of Pathology, Maulana Azad Medical College , New Delhi, India
| | - Annapurna Saksena
- Junior Resident, Departments of Pathology, Maulana Azad Medical College , New Delhi, India
| | - Ashu Singh
- Junior Resident, Departments of Pathology, Maulana Azad Medical College , New Delhi, India
| | - M K Daga
- Professor, Department of Medicine, Maulana Azad Medical College , New Delhi, India
| | - Tejinder Singh
- Director Professor, Department of Pathology, Maulana Azad Medical College , New Delhi, India
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Karnad DR, Bhadade R, Verma PK, Moulick ND, Daga MK, Chafekar ND, Iyer S. Intravenous administration of ulinastatin (human urinary trypsin inhibitor) in severe sepsis: a multicenter randomized controlled study. Intensive Care Med 2014; 40:830-8. [PMID: 24737258 PMCID: PMC4028549 DOI: 10.1007/s00134-014-3278-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 03/24/2014] [Indexed: 01/17/2023]
Abstract
Purpose Ulinastatin, a serine protease inhibitor, inhibits several pro-inflammatory proteases and decreases inflammatory cytokine levels and mortality in experimental sepsis. We studied the effect of ulinastatin on 28-day all-cause mortality in a double-blind trial in patients with severe sepsis in seven Indian hospitals. Methods Patients with sepsis were randomized within 48 h of onset of one or more organ failures to receive intravenous administration of ulinastatin (200,000 IU) or placebo 12 hourly for 5 days. Results Of 122 randomized subjects, 114 completed the study (55 receiving ulinastatin, 59 receiving placebo). At baseline, the mean APACHE II score was 13.4 (SD = 4.4), 48 (42 %) patients were receiving mechanical ventilation, 58 (51 %) were on vasopressors, and 35 % had multiple organ failure. In the modified intention-to-treat analysis (patients receiving six or more doses of study drugs), 28-day all-cause mortality was 7.3 % with ulinastatin (4 deaths) versus 20.3 % (12 deaths) with placebo (p = 0.045). On multivariate analysis too, treatment with ulinastatin (odds ratio 0.26, 95 % CI 0.07–0.95; p = 0.042) independently decreased 28-day all-cause mortality. However, the mortality difference did not reach statistical significance in the intention-to-treat analysis [10.2 % (6/59 deaths) with ulinastatin versus 20.6 % (13/63 deaths) in the placebo group; p = 0.11]. The ulinastatin group had lower incidence of new-onset organ failure (10 vs. 26 patients, p = 0.003), more ventilator-free days (mean ± SD 19.4 ± 10.6 days vs. 10.2 ± 12.5 days, p = 0.019), and shorter hospital stay (11.8 ± 7.1 days vs. 24.2 ± 7.2 days, p < 0.001). Conclusions In this pilot study, intravenous administration of ulinastatin reduced mortality in patients with severe sepsis in the modified intention-to-treat analysis, but not in the intention-to-treat analysis. Electronic supplementary material The online version of this article (doi:10.1007/s00134-014-3278-8) contains supplementary material, which is available to authorized users.
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Kumar B, Kumar P, Rajput R, Saxena L, Daga MK, Khanna M. Sequence-Specific Cleavage of BM2 Gene Transcript of Influenza B Virus by 10-23 Catalytic Motif Containing DNA Enzymes Significantly Inhibits Viral RNA Translation and Replication. Nucleic Acid Ther 2013; 23:355-62. [DOI: 10.1089/nat.2013.0432] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Binod Kumar
- Department of Respiratory Virology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Prashant Kumar
- Department of Respiratory Virology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Roopali Rajput
- Department of Respiratory Virology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Latika Saxena
- Department of Respiratory Virology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Mradul K. Daga
- Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Madhu Khanna
- Department of Respiratory Virology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Kamble NL, Khan NA, Kumar N, Nayak HK, Daga MK. Study of gastro-oesophageal reflux disease in patients with mild-to-moderate chronic obstructive pulmonary disease in India. Respirology 2013; 18:463-7. [PMID: 23062059 DOI: 10.1111/j.1440-1843.2012.02285.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE To study the incidence and pattern of gastro-oesophageal reflux disease (GORD) in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) using dual-probe 24-h oesophageal pH recording. METHODS This was a prospective study of 50 patients with mild-to-moderate stage COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. A detailed history of illness along with spirometry was done in all patients. In the study group, reflux symptoms were measured using a validated scoring system. All the patients underwent oesophageal manometry and dual-probe 24-h oesophageal pH recording. RESULTS Symptoms of gastro-oesophageal reflux were present in 38 patients. Twenty-four-hour oesophageal pH monitoring revealed pathological reflux in 31 out of 38 symptomatic and 8 out of 12 asymptomatic patients. The overall rate of GORD was 78% in our study. Only distal GORD was observed in 11 (28.9%), and both distal and proximal GORD was observed in 20 (52.6%) out of the 38 symptomatic subjects. In the remaining 12 asymptomatic patients, eight had GORD. Distal GORD was present in six (50%) patients, and two (16.6%) had both distal and proximal GORD in this group. Isolated proximal GORD was not observed in any patient. CONCLUSIONS There is an increased occurrence of GORD in patients with even mild-to-moderate COPD.
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Affiliation(s)
- Nitish L Kamble
- Department of Medicine, Maulana Azad Medical College Department of Biosciences, Jamia Millia Islamia, New Delhi, India
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Kumar B, Pati DR, Khanna M, Kumar P, Daga MK, Singh V, Khare S, Gaur S. Age-Sex Distribution and Seasonality Pattern among Influenza Virus Infected Patients in Delhi, 2009-2010. Indian J Community Med 2012; 37:57-8. [PMID: 22529542 PMCID: PMC3326810 DOI: 10.4103/0970-0218.94028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 12/03/2011] [Indexed: 11/20/2022] Open
Affiliation(s)
- Binod Kumar
- Department of Respiratory Virology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Kumar R, Daga MK, Kamble NL, Sothwal A, Singh T, Nayak HK, Raizada N. Rare association of Visceral leishmaniasis with Hodgkin's disease: A case report. Infect Agent Cancer 2011; 6:17. [PMID: 22011565 PMCID: PMC3206818 DOI: 10.1186/1750-9378-6-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 10/20/2011] [Indexed: 11/10/2022] Open
Abstract
We present here a case of young male with complaints of fever and swelling in the neck for eight months. History of progressive weakness associated with weight loss was present. Physical examination revealed pallor, multiple enlarged cervical lymph nodes and hepatosplenomegaly. Investigations showed pancytopenia, hyperglobinemia and Leishman-Donovan bodies on bone marrow aspiration. Serological test confirmed diagnosis of visceral leishmaniasis. However, cervical lymph node aspiration and biopsy were suggestive of Mixed cellularity Hodgkin's disease. This made it a very rare case of Leishmaniasis as an opportunistic infection in a patient of pre-chemotherapy Hodgkin's disease. There was marked improvement in haematological profile and regression of hepatosplenomegaly with Amphotericin B treatment followed by favourable response to chemotherapy. The case emphasizes the suspicion for leishmaniasis as a masquerader and as an opportunistic infection in haematological malignancies.
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Affiliation(s)
- Rakshit Kumar
- Department of Medicine, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
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Abstract
Aims: The study aims to determine the: 1. frequency of inappropriate catheterization in medical wards and the reasons for doing it. 2. various risk factors associated with inappropriate catheterization, catheter associated urinary tract infections (CAUTI) and bacterial colonization on Foley's catheters (BCFC). Settings and Design: Hospital-based prospective study. Materials and Methods: One hundred and twenty five patients admitted consecutively in the medical wards of a tertiary care hospital, who underwent catheterization with a Foley's catheter, at admission, have been included in the study. Patient profiles were evaluated using the following parameters: age, sex, diagnosis, functional status, mental status, indication, duration and place of catheterization, development of BCFC and CAUTI. Statistical tests used: Chi-square test. Results: Thirty-six out of 125 (28.8%) patients included were inappropriately catheterized. BCFC developed in 52.8% and 22.4% were diagnosed with a CAUTI. The most frequent indication for inappropriate catheterization was urinary incontinence without significant skin breakdown (27.8%). The risk factors for inappropriate catheterization were female sex (RR=1.29, 95% CI=0.99, 1.69, P<0.05) and catheterization in the emergency (RR=0.74, 95% CI=0.61, 0.90, P<0.05). The risk factors for developing a BCFC were age>60 years (RR=0.65, 95% CI=0.48, 0.89, P<0.05), non-ambulatory functional status (RR=0.57, 95% CI=0.39, 0.84, P<0.01), catheterization in the emergency (RR=2.01, 95% CI=1.17, 3.46, P<0.01) and duration of catheterization>3 days (RR=0.62, 95% CI=0.43, 0.89, P<0.01). The risk factors for acquiring a CAUTI were age>60 years (RR=0.47, 95% CI=0.25, 0.90, P<0.05), impaired mental status (RR=0.37, 95% CI=0.18, 0.77, P<0.01) and duration of catheterization>3 days (RR=0.24, 95% CI=0.10, 0.58, P<0.01). Conclusions: Inappropriate catheterization is highly prevalent in medical wards, especially in patients with urinary incontinence. The patients catheterized in the medical emergency and female patients in particular are at high risk. Careful attention to these factors can reduce the frequency of inappropriate catheterization and unnecessary morbidity.
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Daga MK, Sinha N, Mahapatra HS, Kumar R, Lalmalsawma R, Nayak HK, Raizada N. Paraphenylene diamine poisoning. J Indian Med Assoc 2011; 109:49. [PMID: 21894627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Kumar P, Kumar B, Gupta A, Sharma B, Vijayan VK, Khare S, Singh V, Daga MK, Chadha MS, Mishra AC, Kaur H, Khanna M. Diagnosis of Novel Pandemic Influenza Virus 2009 H1N1 in Hospitalized Patients. Indian J Virol 2010; 21:45-9. [PMID: 23637477 DOI: 10.1007/s13337-010-0005-0] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 04/20/2010] [Indexed: 10/19/2022]
Abstract
A real-time RT-PCR assay was standardized and evaluated for the detection of the recent pandemic 2009 H1N1 strain that circulated around the world causing colossal loss of human life. We amplified the conserved regions of the hemagglutinin (HA) gene of 438 clinical specimens using real-time RT-PCR assay for rapid identification of pandemic influenza virus. The real-time RT-PCR was optimized and the primers and probes were tested against a panel of known negative and positive controls. RNA isolated from the HeLa cell line served as quality control. The conventional RT-PCR which is an established method of influenza virus diagnosis was compared to real-time RT-PCR. Of 438 clinical specimens tested, 212 specimens were found positive for influenza A virus (SD 46.669) in which 139 specimens were diagnosed positive for the pandemic 2009 H1N1 while 73 were the seasonal influenza viruses. We report that the real-time RT-PCR assay offers both, a high sensitivity and specificity when compared with the traditional identification method. The real-time RT-PCR assay allows rapid identification of the pandemic swine 2009-H1N1 at very low viral loads that are negative by the traditional RT-PCR. This optimized assay can be a very useful tool to assist both epidemiologists and the clinicians.
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Affiliation(s)
- P Kumar
- Department of Respiratory Virology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Tarun K, Naresh K, Khullar RK, Daga MK. Endomyocardial fibrosis. Southeast Asian J Trop Med Public Health 2009; 40:327-329. [PMID: 19323018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We present a case report of a 26-year-old male from Bulandsahar, India. The patient presented with right heart failure. Evaluation revealed peripheral eosinophilia. An echocardiogram and MRI showed biventricular hypertrophy with obliteration of the ventricular apices, typical of endomyocardial fibrosis. This condition is rare in Bulandsahar, India.
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Affiliation(s)
- K Tarun
- Depertment of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, Delhi, India.
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Jain D, singh T, Kumar N, Daga MK. Metastatic malignant melanoma in bone marrow with occult primary site--a case report with review of literature. Diagn Pathol 2007; 2:38. [PMID: 17910749 PMCID: PMC2140052 DOI: 10.1186/1746-1596-2-38] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 10/02/2007] [Indexed: 11/14/2022] Open
Abstract
Background Metastases of malignant melanoma to the bone marrow are very rare. A few case reports are published in the literature with a known primary site. Case presentation Herein we present a case of metastatic malignant melanoma in bone marrow with occult primary site in a 22- year-old-male. Diagnosis was confirmed by morphology and immunohistochemistry. A pertinent review of literature is also presented by using relevant articles indexed in PubMed (National Library of Medicine) database. The search was based on the following terms: metastasis or metastases, malignant melanoma and bone marrow. Conclusion In this report we discuss a rare case of metastatic malignant melanoma to the bone marrow with an unknown primary. Clinicians must be aware of the varied clinical manifestations of disseminated malignant melanoma even if the primary site is not evident.
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Affiliation(s)
- Deepali Jain
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Tejindar singh
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Naresh Kumar
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Mradul K Daga
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
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Das B, Daga MK, Gupta SK. Lipid Pentad Index: A novel bioindex for evaluation of lipid risk factors for atherosclerosis in young adolescents and children of premature coronary artery disease patients in India. Clin Biochem 2007; 40:18-24. [PMID: 17052698 DOI: 10.1016/j.clinbiochem.2006.08.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2006] [Revised: 08/07/2006] [Accepted: 08/16/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the role of non-conventional lipid risk factors like Lipoprotein(a) [Lp(a)], Apolipoprotein A-I (Apo A-I) and Apolipoprotein B-100 (Apo B-100) and other conventional lipid profile parameters in children and adolescents of premature coronary artery disease (CAD) patients in India; and thereby explain the highest occurrence of premature CAD in this population. METHODS Forty-five children and adolescents of premature CAD patients (cases, mean age 12.08+/-3.71 years) and forty-five age and sex matched children and adolescents of healthy parents without any history or clinical evidence suggestive of CAD were studied (controls, mean age 12.14+/-3.91 years). RESULTS We found a significant increase in mean levels of Lp(a), Apo B-100, Total cholesterol (TC), Low Density Lipoprotein-Cholesterol (LDL-C) and Triglyceride (TG) in cases than controls. In contrast, Apo A-I and High Density Lipoprotein-Cholesterol (HDL-C) values decreased. Lipid Tetrad Index (LTI) and Atherogenic Index in Indian children and adolescents were also calculated. Kolmogorov D statistic and cumulative probability plot suggest that the new Lipid Pentad Index (LPI) defined by us is able to discriminate case and control populations more precisely than the existing LTI and Atherogenic Index. CONCLUSIONS The new proposed LPI appears to be a better indicator of lipid risk factors in children and adolescents of premature CAD patients from India, than the prior LTI and Atherogenic Index.
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Affiliation(s)
- Barnali Das
- Department of Biochemistry, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi-110002, India.
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Daga MK, Singh KJ, Kumar N. Emerging role of vasopressin. J Assoc Physicians India 2006; 54:376-80. [PMID: 16909734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Ionotropic agents are frequently used in vasodilatory shock like conditions of septic or nonseptic origin. Conventional catecholamines such as norepinephrine are used at a very high dose with possibility of adverse effects in many patients. One often encounters refractoriness to these drugs. Infusion of vasopressin (VP) which is detectable at inappropriately low level in advanced phase of septic shock might allow withdrawal of catecholamines, as it maintains adequate mean arterial pressure (MAP), improves urine output and leaves perfusion of vital organs unhindered. Vasopressin has been found to be superior to epinephrine in animal models and some human trials, especially in patients with resistant ventricular fibrillation (VF) while doing cardiopulmonary resuscitation (CPR). Analogues of VP have also been used for diuresis in patients of hepatorenal syndrome.
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Affiliation(s)
- M K Daga
- Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi
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Jain N, Singh V, Hedau S, Kumar S, Daga MK, Dewan R, Murthy NS, Husain SA, Das BC. Infection of human papillomavirus type 18 and p53 codon 72 polymorphism in lung cancer patients from India. Chest 2006; 128:3999-4007. [PMID: 16354872 DOI: 10.1378/chest.128.6.3999] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Infection with specific high-risk HPV types 16 and 18 and polymorphism of p53 codon 72 has been strongly associated with the genesis of various neoplasms in humans, but such study in lung cancer is limited and the results are controversial. In India, the role of these two factors has been strongly implicated in cervical and other cancers, but the occurrence of HPV or p53 codon 72 polymorphism has not been examined in lung cancer, which is the most common cause of cancer-related death in India. DESIGN AND PATIENTS A total of 40 tumor biopsy specimens from advanced lung cancer patients and blood samples from 40 matching control subjects were obtained for the analysis of high-risk HPV types 16 and 18 infection and p53 codon 72 polymorphism by polymerase chain reaction. RESULTS Only HPV type 18 was detected in 5% (2 of 40 lung cancer patients), but no other HPV could be detected. A significantly increased frequency of Arg/Arg homozygotes was observed in patients with advanced lung cancer when compared to that of control subjects (p = 0.004; odds ratio, 5.13; 95% confidence interval, 1.59 to 17.26). However, no significant correlation could be made between p53 polymorphism and different clinical stages, except for advanced stage IV patients, who showed a higher proportion of Arg/Pro heterozygous genotype. CONCLUSIONS HPV detected in a small proportion of lung cancer patients in India demonstrated an exclusive prevalence of HPV type 18, and there was a significantly higher frequency of p53 Arg/Arg genotype when compared to that of control subjects. Observation of a shorter duration of symptoms (< or = 4 months) in as many as 78% (seven of nine stage IV patients) with Arg/Pro genotype may be an indication that lung cancer patients with the heterozygous p53 genotype are more susceptible to early progression.
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Affiliation(s)
- Neeraj Jain
- Division of Molecular Oncology, Institute of Cytology and Preventive Oncology, I-7, Sector-39, Noida, 201301, India.
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Singh NP, Jhamb R, Agarwal SK, Gaiha M, Dewan R, Daga MK, Chakravarti A, Kumar S. The 2003 outbreak of Dengue fever in Delhi, India. Southeast Asian J Trop Med Public Health 2005; 36:1174-8. [PMID: 16438142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Dengue fever (DF) and Dengue hemorrhagic fever (DHF) are widespread in Southeast Asia. An outbreak of DF/DHF in Delhi in 2003 started during September, reached its peak in October-November, and lasted until early December. This study describes the clinical and laboratory data of the 185 cases of DF/DHF admitted to Lok Nayak Hospital, New Delhi. The mean age of the patients was 26 +/- 10 years. Fever was present in all the cases with an average duration of fever being 4.5 +/- 1.2 days with headache (61.6%), backache, (57.8%), vomiting (50.8%) and abdominal pain (21%) being the other presenting complaints. Hemorrhagic manifestations in the form of a positive tourniquet test (21%), gum bleeding and epistaxis (40%), hematemesis (22%), skin rashes (20%) and melena (14%) were also observed. Hepatomegaly and splenomegaly were observed in 10% and 5% of cases, respectively. Laboratory investigations revealed thrombocytopenia (with a platelet count of < 100,000/microl) in about 61.39% of cases, Leukopenia (WBC <3,000/mm2) and hemoconcentration (Hct >20% of expected for age and sex) were found in 68% and 52% of the cases, respectively. The mortality rate was 2.7%. Despite widespread measures taken to control outbreaks of DF, it caused major outbreaks. More stringent measures in the form of vector control, improved sanitation and health education are needed to decrease morbidity, mortality and health care costs caused by a preventable disease.
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Affiliation(s)
- N P Singh
- Departments of Medicine and Microbiology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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Sharma BK, Daga MK, Sharma M. A limited form of Churg-Strauss syndrome presenting without asthma and eosinophilia. Med J Aust 2004; 181:498-9. [PMID: 15516195 DOI: 10.5694/j.1326-5377.2004.tb06408.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 09/16/2004] [Indexed: 11/17/2022]
Abstract
We report a young woman presenting with digital gangrene, paranasal sinusitis, mononeuritis multiplex, and rapidly progressive glomerulonephritis without asthma and eosinophilia - an extremely rare variant of this disease.
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Daga MK, Chaudhary M, Sharma B, Bhattacharjee J, Ghambhir DS, Arora N, Sudha R. Effect of esmolol on oxidant status and antioxidant activity in acute myocardial infarction. J Assoc Physicians India 2003; 51:677-80. [PMID: 14621036] [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: 04/27/2023]
Abstract
AIMS AND OBJECTIVES The role of oxygen free radicals in reperfusion injury to the heart in myocardial infarction (MI) has been postulated. In this study, the clinical and antioxidant effects of esmolol, an ultra-short acting beta blocker in patients of acute MI was studied. MATERIAL AND METHODS This was a randomized, double-blind, controlled, prospective study. Total 30 patients with acute MI were included. All patients were thrombolysed with streptokinase. Fifteen of these patients were randomly selected to receive esmolol while other 15 patients served as controls. The parameters compared at 0, 2 and 24 hours between the esmolol group and the controls were--malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GPX). RESULTS Patients with MI had 5.16 times higher MDA level at 0 hours (20.34 +/- 6.12 nmol/ml vs. 3.94 +/- 0.70 nmol/ml, p < 0.0001) than MDA level in normal healthy population. At 2 hours, patients with MI had 5.71 times higher MDA level compared to normal healthy population (22.51 +/- 5.51 nmol/ml vs. 3.94 +/- 0.70 nmol/ml, p < 0.0001). A statistically significant difference in MDA levels at 2 and 24 hours was observed in MI patients given esmolol (mean change 2.06 +/- 5.39 nmol/ml vs. -4.47 +/- 6.93 nmol/ml, p = 0.009). Esmolol infusion also caused significant difference in GPX level at 2 hours compared to controls (23.79 + 14.68 U/gm Hb vs 38.3 +/- 8.95 U/gm Hb, p = 0.003). CONCLUSION Free radical levels are raised in patients with MI which may contribute to reperfusion injury. The antioxidant action of esmolol was clearly observed by significant difference in MDA level and GPX sparing effect. Large scale clinical trials may establish conclusively role of beta blockers as antioxidants as adjuvant to thrombolytic therapy in MI.
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Affiliation(s)
- M K Daga
- Maulana Azad Medical College and Associated Lok Nayak and GB Pant Hospitals, New Delhi 110 002
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Gupta D, Gaiha M, Siddaraju N, Daga MK, Anuradha S. Chronic myeloid leukemia presenting with avascular necrosis of femur head. J Assoc Physicians India 2003; 51:214-5. [PMID: 12725271] [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: 03/02/2023]
Abstract
We report the case of a 15 years girl in whom avascular necrosis (AVN) of right femur head was the presenting feature of chronic stable phase of chronic myeloid leukemia (CML). To date, only three case of CML with AVN have been reported. So, in view of rarity of this condition, a similar case of CML presenting as AVN of femur head is being reported.
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Affiliation(s)
- D Gupta
- Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi
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Daga MK, Chhabra R, Sharma B, Mishra TK. Effects of exogenous vitamin E supplementation on the levels of oxidants and antioxidants in chronic obstructive pulmonary disease. J Biosci 2003; 28:7-11. [PMID: 12682418 DOI: 10.1007/bf02970125] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Oxidative stress has been recognized as a central feature of smoke induced chronic obstructive pulmonary disease (COPD). Imbalance between oxidant and antioxidant enzymes is also an established fact in these patients. But studies in regard to stable COPD patients and effect of vitamin E supplementation are lacking. Thirty patients with COPD were included in the study. Their baseline clinical examination, spirometry, plasma malondialdehyde (MDA), alpha-tocopherol and red blood cell superoxide dismutase (SOD) levels were mea sured. Twenty healthy non-smokers who were matched for age and sex served as controls. All the above parameters were repeated after 12 weeks of supplementation with 400 IU of vitamin E daily. The mean malondialdehyde levels in the patients at baseline were higher than controls (5.91 +/- 1.23 nmol/ml vs 4.55 +/- 1.51 nmol/ml, P = 0 001), so also was plasma alpha-tocopherol levels (P < 0 001), while SOD levels were lower in the patients compared to controls (1692 +/- 259 units g/Hb vs 2451 +/- 131 units g/Hb, P < 0 001). Exogenous vitamin E (400 IU per day) supplementation did not bring about any significant change in plasma alpha-tocopherol and SOD levels. The Pearson s co-efficient of correlation between the levels of MDA, vitamin E, SOD; and spirometric measurements were not significant either on day 1 or after 12 weeks of vitamin E supplementation. The present study shows that initially the plasma lipid peroxide (MDA) levels are high and antioxidants (alpha-tocopherol and SOD) are low in patients with COPD. Exogenous supplementation with vitamin E does not have any significant effect on the spirometric measurements though it brings down the levels of MDA showing attenuation of further damage. However, inclusion of larger number of patients and supple mentation with vitamin E for longer periods may throw more light on free radical injury and protective effects of antioxidants.
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Affiliation(s)
- M K Daga
- Department of Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi 110 002, India.
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Sharma B, Daga MK, Sachdev GK, Kaushik M. Effect of Distal Esophageal Acid Infusion on Peak Expiratory Flow Rate (PEFR) in Adult Asthmatics With Gastroesophageal Reflux (GER). Chest 2003. [DOI: 10.1378/chest.124.4_meetingabstracts.137s] [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: 11/01/2022] Open
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Sharma B, Daga MK, Tiwari N, Kaushik M. Pulmonary Dysfunction in Type 2 Diabetes Mellitus Patients With Incipient Diabetic Nephropathy and Effect of Glycemic Control and Losartan Therapy on Pulmonary Functio. Chest 2003. [DOI: 10.1378/chest.124.4_meetingabstracts.162s] [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: 11/01/2022] Open
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Sharma B, Daga MK, Gambhir DS, Kaushik M. Effect of Esmolol, an Ultra-short Acting Beta Blocker on Oxidant Status and Antioxidant Activity in Acute Myocardial Infarction: Results of a Randomized Double-blind, Controlled, Prospective Clinical Study. Chest 2003. [DOI: 10.1378/chest.124.4_meetingabstracts.152s] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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40
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Sharma B, Daga MK, Sachdev GK, Kaushik M, Chhabra R. Adult Asthma and Gastroesophageal reflux - The Effects of Omeprazole Therapy on Asthm. Chest 2003. [DOI: 10.1378/chest.124.4_meetingabstracts.94s] [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: 11/01/2022] Open
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41
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Mahajan R, Daga MK, Bhattacharjee J. Hyperinsulinemia in subjects with and without coronary artery disease: a preliminary study from North India. Indian Heart J 2002; 54:687-91. [PMID: 12674181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Hyperinsulinemia has been associated with obesity, hypertension, diabetes, and coronary artery disease. However, it is not clear whether hyperinsulinemia by itself is a risk factor for coronary artery disease in the absence of obesity, diabetes, and hypertension. Therefore, we conducted a study to evaluate the role of hyperinsulinemia in coronary artery disease in the absence of diabetes, hypertension, and obesity. METHODS AND RESULTS A total of 80 cases and 50 controls were studied. Only non-diabetic, normotensive, nonobese men (body-mass index < or = 25) were included. The presence of valvular heart disease or an acute coronary event in the past 6 weeks were exclusion criteria. Serum insulin levels were measured in fasting samples by ELISA assay. The mean fasting insulin was 17.0+/-16.5 microIU/ml and 13.3+/-12.9 microIU/ml in the control and study groups, respectively (reference range 1.5-15.6 microIU/ml). There was no significant association between coronary artery disease and the surrogate markers of insulin resistance, namely, fasting insulin (p value 0.367) and homeostasis model assessment of insulin resistance (p value 0.589). CONCLUSIONS A high-normal fasting insulin level was present in non-diabetic, nonhypertensive, and nonobese men in the Indian population. We suggest that insulin resistance may not per se be an independent risk factor for coronary artery disease. It may be an innocent bystander in coronary artery disease in an obese, hypertensive, and diabetic population. However, due to our small sample size, further studies are required in this direction.
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Affiliation(s)
- Rajiv Mahajan
- Department of Medicine, Maulana Azad Medical College, GB Pant Hospital, New Delhi
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Mahajan R, Daga MK, Tiwari N. Diffuse parenchymal lung disease: an approach to diagnosis. J Assoc Physicians India 2002; 50:1285-94. [PMID: 12568216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- R Mahajan
- Department of Medicine, Maulana Azad Medical College, New Delhi
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Arora A, Chowdhury D, Daga MK, Arora N, Gaiha M. Reversible posterior leukoencephalopathy syndrome: a report of 2 cases. Neurol India 2001; 49:311-3. [PMID: 11593254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Reversible posterior leukoencephalopathy syndrome (RPLE) is an increasingly recognised disorder, most commonly associated with malignant hypertension, toxaemia of pregnancy or the use of immunosuppressive agents. Two cases of RPLE syndrome occurring in the setting of accelerated hypertension and eclampsia are described. Both patients had seizures, altered sensorium and typical findings on neuroimaging. They had complete clinical and radiological recovery. The clinical course, pathophysiology and neuroimaging features of RPLE syndrome are discussed.
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Affiliation(s)
- A Arora
- Department of Neurology, G.B. Pant Hospital, New Delhi-110019, India
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Arora N, Daga MK, Mahajan R, Prakash SK, Gupta N. Microbial pattern of acute infective exacerbation of chronic obstructive airway disease in a hospital based study. Indian J Chest Dis Allied Sci 2001; 43:157-62. [PMID: 11529434] [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: 02/21/2023]
Abstract
Chronic bronchitis is associated with acute exacerbation, most often infective in origin. In order to study the bacteriological profile in such cases a total of 58 patients were enrolled in this study from the chest clinic of our hospital. The male to female ratio was 2 to 1. Mean age of study group was 47 years. All patients had increased cough and sputum production. Barlett count, gram stain and sputum cultures were done for all patients. IgM and IgG antibodies for M. pneumoniae by ELISA were estimated in all cases. The etiological diagnosis could be established in 72% cases. S. pneumoniae (25.8%), P. aeruginosa (12%), Klebsiella sp (10.3%), B. catarrhalis (3.4%), S. aureus (1.7%) were isolated. Although M. pneumoniae was not cultured it was demonstrated serologically in 20% of cases. H. influenzae was not isolated in any case. The frequency of isolating an etiological agent increased with severity of dysponea.
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Affiliation(s)
- N Arora
- Department of Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi
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Gupta D, Gaiha M, Mahajan R, Daga MK. Atypical presentation of Sheehan's syndrome without postpartum haemorrhage. J Assoc Physicians India 2001; 49:386-7. [PMID: 11291989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- D Gupta
- Department of Medicine, Maulana Azad Medical College, New Delhi
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Daga MK, Prabash K. Chronobiology and chronotherapy: current perspectives. J Assoc Physicians India 2000; 48:617-21. [PMID: 11273543] [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: 02/19/2023]
Abstract
To summarise, one can say that with the time to come, chronotherapy might become the order of the day in treatment of many systemic diseases whether they are cardiovascular, respiratory, infectious etc. This approach will certainly help in better control of signs and symptoms while simultaneously protecting the individual from untoward side effects and providing them with a better quality of life.
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Affiliation(s)
- M K Daga
- Department of Medicine, Maualan Azad Medical College, New Delhi 110 002
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47
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Butler T, Sridhar CB, Daga MK, Pathak K, Pandit RB, Khakhria R, Potkar CN, Zelasky MT, Johnson RB. Treatment of typhoid fever with azithromycin versus chloramphenicol in a randomized multicentre trial in India. J Antimicrob Chemother 1999; 44:243-50. [PMID: 10473232 DOI: 10.1093/jac/44.2.243] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To compare the clinical and bacteriological efficacies of azithromycin and chloramphenicol for treatment of typhoid fever, 77 bacteriologically evaluable adults, with blood cultures positive for Salmonella typhi or Salmonella paratyphi A susceptible to their assigned drugs, were entered into a randomized open trial at four hospitals in India. Forty-two patients were randomized to receive azithromycin 500 mg p.o. od for 7 days and 35 to receive chloramphenicol 2-3 g p.o. od in four divided doses for 14 days. Thirty-seven patients (88%) in the azithromycin group responded with clinical cure or improvement within 8 days and 30 patients (86%) in the chloramphenicol group responded with cure or improvement. By day 14 after the start of treatment, all patients treated with azithromycin and all except two of the patients treated with chloramphenicol (94%) were cured or improved. Blood cultures repeated on day 8 after start of therapy showed eradication of organisms in 100% of patients in the azithromycin group and 94% of patients in the chloramphenicol group. By day 14 the eradication rate in the chloramphenicol group had increased to 97%. Stool cultures on days 21 and 35 after start of treatment showed no prolonged faecal carriage of Salmonella spp. in either group. These results indicate that azithromycin given once daily for 7 days was effective therapy for typhoid fever in a region endemic with chloramphenicol-resistant S. typhi infection and was equivalent in effectiveness to chloramphenicol given to patients with chloramphenicol-susceptible infections.
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Affiliation(s)
- T Butler
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, USA
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Daga MK, Prabash K, Malhotra R, Mishra TK. A study of lipid peroxide and alpha tocopherol in acute myocardial infarction. J Assoc Physicians India 1999; 47:676-9. [PMID: 10778585] [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: 02/16/2023]
Abstract
Thirty patients of acute myocardial infarction proven by electrocardiography (ECG) and enzymes were included in the study. All of them received streptokinase. A single lead showing the largest ST elevation, a proportional value for the shift in ST segment > or = 0.5 was taken as criteria for reperfusion. ECG was recorded at 0 hour, 3 hours and 72 hours. At the start of streptokinase and 3 hours after, marker of free radical activity malondialdehyde (MDA) and antioxidant alpha tocopherol was measured. Mean value of serum alpha tocopherol level at start of streptokinase (t0) 10.03 +/- 2.5 micrograms/ml and at (t3) 3 hours after streptokinase was 8.60 +/- 2.6 micrograms/ml (P < 0.001) and mean value of serum lipid peroxidation level was 6.86 +/- 2.92 nanomol/ml at t(o) and at t3 value was 8.4 +/- 3.88 (P < 0.012) in successfully reperfused patients. In unsuccessful reperfusion group serum alpha tocopherol level at t(o) was 8.89 +/- 2.55 micrograms/ml and at t3 8.23 +/- 2.9 micrograms/ml (p > 0.05). Serum lipid peroxidation level in the same group at t0 was 6.53 +/- 2.26 nanomol/ml and at t3 was 6.29 +/- 2.27 nanomol/ml (p > 0.05). The increase in free radical marker MDA and decrease in one of the important antioxidant alpha tocopherol suggest that free radicals are increased after coronary vessels open up. As a result reperfused patients may be at risk of free radical mediated injury which may deny him the full benefit of reperfusion.
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Affiliation(s)
- M K Daga
- Dept of Medicine and Biochemistry, Maulana Azad Medical College
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Jain S, Bhargava K, Sawlani KK, Daga MK, Gaiha M. Myoglobinuria and transient acute renal failure in a patient revealing hypothyroidism. J Assoc Physicians India 1999; 47:444-6. [PMID: 10778535] [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: 02/16/2023]
Abstract
Muscle involvement in hypothyroidism commonly manifests as fatigue, myalgias, stiffness and slowed reflexes. We report a case of transient acute renal failure related to rhabdomyolysis and myoglobinuria in a 40 year old man that revealed the diagnosis of hypothyroidism with myopathy. The patient had proximal muscle weakness and tenderness, markedly raised muscle enzymes and deranged renal functions that normalised with thyroid replacement therapy. Hypothyroidism, though rare, should be considered a definite and authentic cause of rhabdomyolysis.
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Affiliation(s)
- S Jain
- Dept. of Medicine, Maulana Azad Medical College, New Delhi
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Daga MK, Mishra TK, Mohan A. Lipid peroxide, beta-carotene and alpha-tocopherol in ischaemic stroke and effect of exogenous vitamin E supplementation on outcome. J Assoc Physicians India 1997; 45:843-6. [PMID: 11229181] [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: 02/19/2023]
Abstract
30 patients with CT proven infarct presenting within 24 hours of the acute event were included in the study with 20 age and sex matched controls. On day 1 and day 15 of stroke, levels of plasma lipid peroxide (oxidant) and plasma alpha-tocopherol and beta carotene (antioxidant) were estimated. The patients were randomly assigned to two groups, one group receiving 300 mg/day of vitamin E for 15 days. Neurological examination was conducted according to Mathew scale on day 1 and day 15 and rehabilitation assessment was done at day 15 and at 6 weeks according to Barthel Index. On day 1, the mean value of plasma lipid peroxidation in controls was 4.97 +/- 1.44 nmol/ml and in stroke patients 5.89 +/- 1.56 nmol/ml (p < 0.05). The plasma beta-carotene in controls was 2.35 +/- 1.09 mg/L while in stroke patients was 1.07 +/- 0.55 mg/L (p < 0.001) and plasma alpha-tocopherol in control 9.74 +/- 2.76 micrograms/ml as compared to 7.57 +/- 2.92 micrograms/ml in stroke patients (p < 0.02). Initially the plasma lipid peroxide levels are high and antioxidant levels are low in patients of ischemic stroke. Exogenous vitamin E supplementation does not have any significant effect on early neurological outcome but it does bring about significant changes in subsequent recovery and rehabilitation of patients of stroke.
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Affiliation(s)
- M K Daga
- Department of Medicine and Biochemistry, Maulana Azad Medical College and Associated, Lok Nayak Hospital, New Delhi-110002
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