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Gunjan D, Mahapatra SJ, Garg PK. Is acute necrotising pancreatitis a chronic disease? Gut 2024; 73:718-719. [PMID: 38531614 DOI: 10.1136/gutjnl-2024-331915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/09/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Soumya Jagannath Mahapatra
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Pramod Kumar Garg
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, Delhi, India
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2
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Binayke A, Zaheer A, Vishwakarma S, Singh S, Sharma P, Chandwaskar R, Gosain M, Raghavan S, Murugesan DR, Kshetrapal P, Thiruvengadam R, Bhatnagar S, Pandey AK, Garg PK, Awasthi A. A quest for universal anti-SARS-CoV-2 T cell assay: systematic review, meta-analysis, and experimental validation. NPJ Vaccines 2024; 9:3. [PMID: 38167915 PMCID: PMC10762233 DOI: 10.1038/s41541-023-00794-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
Measuring SARS-CoV-2-specific T cell responses is crucial to understanding an individual's immunity to COVID-19. However, high inter- and intra-assay variability make it difficult to define T cells as a correlate of protection against COVID-19. To address this, we performed systematic review and meta-analysis of 495 datasets from 94 original articles evaluating SARS-CoV-2-specific T cell responses using three assays - Activation Induced Marker (AIM), Intracellular Cytokine Staining (ICS), and Enzyme-Linked Immunospot (ELISPOT), and defined each assay's quantitative range. We validated these ranges using samples from 193 SARS-CoV-2-exposed individuals. Although IFNγ ELISPOT was the preferred assay, our experimental validation suggested that it under-represented the SARS-CoV-2-specific T cell repertoire. Our data indicate that a combination of AIM and ICS or FluoroSpot assay would better represent the frequency, polyfunctionality, and compartmentalization of the antigen-specific T cell responses. Taken together, our results contribute to defining the ranges of antigen-specific T cell assays and propose a choice of assay that can be employed to better understand the cellular immune response against viral diseases.
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Affiliation(s)
- Akshay Binayke
- Immunology Core Laboratory, Translational Health Science and Technology Institute, Faridabad, India
- Centre for Immunobiology and Immunotherapy, Translational Health Science and Technology Institute, Faridabad, India
- Jawaharlal Nehru University, New Delhi, India
| | - Aymaan Zaheer
- Immunology Core Laboratory, Translational Health Science and Technology Institute, Faridabad, India
| | - Siddhesh Vishwakarma
- Immunology Core Laboratory, Translational Health Science and Technology Institute, Faridabad, India
| | - Savita Singh
- Translational Health Science and Technology Institute, Faridabad, India
| | - Priyanka Sharma
- Immunology Core Laboratory, Translational Health Science and Technology Institute, Faridabad, India
| | - Rucha Chandwaskar
- Department of Microbiology, AMITY University Rajasthan, Jaipur, India
| | - Mudita Gosain
- Translational Health Science and Technology Institute, Faridabad, India
| | | | | | | | - Ramachandran Thiruvengadam
- Translational Health Science and Technology Institute, Faridabad, India
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | | | | | - Pramod Kumar Garg
- Translational Health Science and Technology Institute, Faridabad, India
- All India Institute of Medical Sciences, New Delhi, India
| | - Amit Awasthi
- Immunology Core Laboratory, Translational Health Science and Technology Institute, Faridabad, India.
- Centre for Immunobiology and Immunotherapy, Translational Health Science and Technology Institute, Faridabad, India.
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3
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Wadhwa K, Malik S, Balaji S, Thiruvengadam R, Bashyam MD, Bhattacharya PK, Behera B, Bhardwaj P, Biswas NK, Das A, Dey A, Dhotre D, Dias M, Dubey P, Dutta S, Gadepalli R, Gosain M, Goud KI, Gupta NK, Gupta N, Jana P, Jena D, John E, Karunanidhi A, Khan SMS, Khattar S, Paul APK, Kumar S, Maitra A, Modi N, Moorthy M, Nagaraj S, Palakodeti D, Pandey AK, Pandey A, Raghav SK, Ramasubban S, Raghavan S, Harikrishnan S, Krishnamoorthy S, Selvamurugan S, Sardana R, Shouche Y, Singh A, Singh AK, Ramasubramaniyan V, Yadav M, Zahoor D, Narreddy S, Bhatnagar S, Wadhwa N, Das B, Garg PK. Correlation of severity & clinical outcomes of COVID-19 with virus variants: A prospective, multicentre hospital network study. Indian J Med Res 2024; 159:91-101. [PMID: 38344919 PMCID: PMC10954099 DOI: 10.4103/ijmr.ijmr_1041_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND OBJECTIVES The clinical course of COVID-19 and its prognosis are influenced by both viral and host factors. The objectives of this study were to develop a nationwide platform to investigate the molecular epidemiology of SARS-CoV-2 (Severe acute respiratory syndrome Corona virus 2) and correlate the severity and clinical outcomes of COVID-19 with virus variants. METHODS A nationwide, longitudinal, prospective cohort study was conducted from September 2021 to December 2022 at 14 hospitals across the country that were linked to a viral sequencing laboratory under the Indian SARS-CoV-2 Genomics Consortium. All participants (18 yr and above) who attended the hospital with a suspicion of SARS-CoV-2 infection and tested positive by the reverse transcription-PCR method were included. The participant population consisted of both hospitalized as well as outpatients. Their clinical course and outcomes were studied prospectively. Nasopharyngeal samples collected were subjected to whole genome sequencing to detect SARS-CoV-2 variants. RESULTS Of the 4972 participants enrolled, 3397 provided samples for viral sequencing and 2723 samples were successfully sequenced. From this, the evolution of virus variants of concern including Omicron subvariants which emerged over time was observed and the same reported here. The mean age of the study participants was 41 yr and overall 49.3 per cent were female. The common symptoms were fever and cough and 32.5 per cent had comorbidities. Infection with the Delta variant evidently increased the risk of severe COVID-19 (adjusted odds ratio: 2.53, 95% confidence interval: 1.52, 4.2), while Omicron was milder independent of vaccination status. The independent risk factors for mortality were age >65 yr, presence of comorbidities and no vaccination. INTERPRETATION CONCLUSIONS The authors believe that this is a first-of-its-kind study in the country that provides real-time data of virus evolution from a pan-India network of hospitals closely linked to the genome sequencing laboratories. The severity of COVID-19 could be correlated with virus variants with Omicron being the milder variant.
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Affiliation(s)
- Komal Wadhwa
- Clinical Development Services Agency, Faridabad, Haryana, India
| | - Shilpa Malik
- Clinical Development Services Agency, Faridabad, Haryana, India
| | | | | | | | | | - Bijayini Behera
- Department of Microbilogy, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pankaj Bhardwaj
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Asim Das
- ESIC Medical College & Hospital, Faridabad, Haryana, India
| | - Anindya Dey
- Department of Microbiology, Apollo Hospitals, Kolkata, West Bengal, India
| | - Dhiraj Dhotre
- National Centre for Cell Science, Pune, Maharashtra, India
| | - Mary Dias
- National Centre for Cell Science, Pune, Maharashtra, India
| | - Pankaj Dubey
- Department of Critical Care, Apollo Hospitals, Ahmedabad, Gujarat, India
| | | | - Ravisekhar Gadepalli
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mudita Gosain
- Center for Maternal and Child Health, Faridabad, Haryana, India
| | - Kalal Iravaty Goud
- Molecular Biology and Cytogenetics, Apollo Hospitals, Hyderabad, Telangana, India
| | - Neeraj Kumar Gupta
- Department of Pulmonary Critical Care and Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Nitesh Gupta
- Department of Pulmonary Critical Care and Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | - Deepak Jena
- Department of Immunogenomics & Systems Biology Lab, Institute of Life Sciences, Bhubaneswar, Odisha, India
| | - Elizabeth John
- Institute for Stem Cell Science & Regenerative Medicine, Bengaluru, Karnataka, India
| | | | - S. Muhammad Salim Khan
- Department of Community Medicine, Government Medical College, Srinagar, Jammu & Kashmir, India
| | - Sahil Khattar
- Center for Data Management, Faridabad, Haryana, India
| | | | - Shakti Kumar
- Infection and Immunology, Faridabad, Haryana, India
| | - Arindam Maitra
- National Institute of Biomedical Genomics, Kalyani, India
| | - Nikhil Modi
- Department of Respiratory Critical Care and Sleep Medicine, Apollo Hospitals, New Delhi, India
| | - Mahesh Moorthy
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Savitha Nagaraj
- Department of Microbiology, St. Johns Medical College & Hospital, Bengaluru, Karnataka, India
| | - Dasaradhi Palakodeti
- Institute for Stem Cell Science & Regenerative Medicine, Bengaluru, Karnataka, India
| | - Anil Kumar Pandey
- Medical Superindent, ESIC Medical College & Hospital, Faridabad, Haryana, India
| | - Aparna Pandey
- Department of Microbiology, ESIC Medical College & Hospital, Faridabad, Haryana, India
| | - Sunil Kumar Raghav
- Department of Immunogenomics & Systems Biology Lab, Institute of Life Sciences, Bhubaneswar, Odisha, India
| | - Suresh Ramasubban
- Department of Critical care, Apollo Hospitals, Kolkata, West Bengal, India
| | | | - S. Harikrishnan
- Department of Pulmonology, Apollo Hospitals, Madurai, Tamil Nadu, India
| | - S. Krishnamoorthy
- Department of Internal Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - Raman Sardana
- Department of Microbiology, Apollo Hospitals, New Delhi, India
| | - Yogesh Shouche
- National Centre for Microbiol Resource, Pune, Maharashtra, India
| | - Akanksha Singh
- Clinical Development Services Agency, Faridabad, Haryana, India
| | - Arvind Kumar Singh
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - V. Ramasubramaniyan
- Department of Infectious Diseases and Tropical Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Monika Yadav
- Clinical Development Services Agency, Faridabad, Haryana, India
| | - Danish Zahoor
- Department of Microbiology, Government Medical College, Srinagar, Jammu & Kashmir, India
| | - Suneetha Narreddy
- Departments of Infectious Medicine, Apollo Hospitals, Hyderabad, Telangana, India
| | | | - Nitya Wadhwa
- Center for Maternal and Child Health, Faridabad, Haryana, India
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Gunjan D, Mahapatra SJ, Garg PK. Upfront necrosectomy for infected necrotising pancreatitis: a promising strategy? Lancet Gastroenterol Hepatol 2024; 9:2-3. [PMID: 37980920 DOI: 10.1016/s2468-1253(23)00369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Deepak Gunjan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India
| | | | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India.
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Mahapatra SJ, Garg PK. The Power of Population Cohorts and Modeling: Pancreatitis-A Case in Point. Gastroenterology 2023; 165:1329-1333. [PMID: 37806459 DOI: 10.1053/j.gastro.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023]
Affiliation(s)
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
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Thiruvengadam R, Rizvi ZA, Raghavan S, Murugesan DR, Gosain M, Dandotiya J, Ayushi, Samal S, Pandey AK, Wadhwa N, Bhatnagar S, Awasthi A, Garg PK. Clinical and experimental evidence suggest omicron variant of SARS-CoV-2 is inherently less pathogenic than delta variant independent of previous immunity. Eur J Med Res 2023; 28:421. [PMID: 37821945 PMCID: PMC10566023 DOI: 10.1186/s40001-023-01373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES To study clinical disease outcomes in both human and animal models to understand the pathogenicity of omicron compared to the delta variant. METHODS In this cross-sectional observational study, clinical outcomes of adults who tested positive at 2 testing centres in Delhi National Capital Region between January 2022 and March 2022 (omicron-infected; N = 2998) were compared to a similar geographical cohort (delta-infected; N = 3292). In addition, disease course and outcomes were studied in SARS-CoV-2-infected golden Syrian hamsters and K-18 humanized ACE2 transgenic mice. RESULTS Omicron variant infection was associated with a milder clinical course [83% (95% CI 61, 94) reduced risk of severity compared against delta] adjusting for vaccination, age, sex, prior infection and occupational risk. This correlated with lower disease index and vir comparing omicron with other variants in animal models. CONCLUSIONS Infections caused by the omicron variant were milder compared to those caused by the delta variant independent of previous immunity.
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Affiliation(s)
| | - Zaigham Abbas Rizvi
- Translational Health Science and Technology Institute, Faridabad, Delhi, India
| | - Sreevatsan Raghavan
- Translational Health Science and Technology Institute, Faridabad, Delhi, India
| | | | - Mudita Gosain
- Translational Health Science and Technology Institute, Faridabad, Delhi, India
| | - Jyotsna Dandotiya
- Translational Health Science and Technology Institute, Faridabad, Delhi, India
| | - Ayushi
- Translational Health Science and Technology Institute, Faridabad, Delhi, India
| | - Sweety Samal
- Translational Health Science and Technology Institute, Faridabad, Delhi, India
| | | | - Nitya Wadhwa
- Translational Health Science and Technology Institute, Faridabad, Delhi, India
| | - Shinjini Bhatnagar
- Translational Health Science and Technology Institute, Faridabad, Delhi, India
| | - Amit Awasthi
- Translational Health Science and Technology Institute, Faridabad, Delhi, India.
| | - Pramod Kumar Garg
- Translational Health Science and Technology Institute, Faridabad, Delhi, India.
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Agarwal A, Mahapatra SJ, Sethia R, Agarwal S, Elhence A, Mohta S, Gunjan D, Garg PK. Correction to: Universal prophylactic rectal nonsteroidal anti‑inflammatory drugs with a policy of selective pancreatic duct stenting significantly reduce post‑endoscopic retrograde cholangiopancreatography pancreatitis. Indian J Gastroenterol 2023; 42:746. [PMID: 37310615 DOI: 10.1007/s12664-023-01417-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Ashish Agarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, Jodhpur, 342 005, India
| | - Soumya Jagannath Mahapatra
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Rahul Sethia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Samagra Agarwal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Anshuman Elhence
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Srikanth Mohta
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Pramod Kumar Garg
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
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Mahapatra SJ, Garg PK. Percutaneous Endoscopic Necrosectomy. Gastrointest Endosc Clin N Am 2023; 33:737-751. [PMID: 37709408 DOI: 10.1016/j.giec.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Patients with acute pancreatitis might develop infected necrotic fluid collections which are associated with significant morbidity and mortality. Patients with infected necrotizing pancreatitis not responding to antibiotics require drainage and subsequent necrosectomy (Step-up approach). Percutaneous endoscopic necrosectomy (PEN) has evolved as a minimally invasive approach for necrosectomy through the percutaneous catheter route using a flexible endoscope and can be done under conscious sedation. It is best suited for predominantly laterally placed infected necrotic fluid collections and also can be performed at the bedside for sick patients admitted to an ICU. PEN has a clinical success rate of 80% with minimal adverse events.
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Affiliation(s)
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
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9
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Rizvi ZA, Dandotiya J, Sadhu S, Khatri R, Singh J, Singh V, Adhikari N, Sharma K, Das V, Pandey AK, Das B, Medigeshi G, Mani S, Bhatnagar S, Samal S, Pandey AK, Garg PK, Awasthi A. Omicron sub-lineage BA.5 infection results in attenuated pathology in hACE2 transgenic mice. Commun Biol 2023; 6:935. [PMID: 37704701 PMCID: PMC10499788 DOI: 10.1038/s42003-023-05263-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 08/20/2023] [Indexed: 09/15/2023] Open
Abstract
A recently emerged sub-lineage of Omicron, BA.5, together with BA.4, caused a fifth wave of coronavirus disease (COVID-19) in South Africa and subsequently emerged as a predominant strain globally due to its high transmissibility. The lethality of BA.5 infection has not been studied in an acute hACE2 transgenic (hACE2.Tg) mouse model. Here, we investigated tissue-tropism and immuno-pathology induced by BA.5 infection in hACE2.Tg mice. Our data show that intranasal infection of BA.5 in hACE2.Tg mice resulted in attenuated pulmonary infection and pathology with diminished COVID-19-induced clinical and pathological manifestations. BA.5, similar to Omicron (B.1.1.529), infection led to attenuated production of inflammatory cytokines, anti-viral response and effector T cell response as compared to the ancestral strain of SARS-CoV-2, Wuhan-Hu-1. We show that mice recovered from B.1.1.529 infection showed robust protection against BA.5 infection associated with reduced lung viral load and pathology. Together, our data provide insights as to why BA.5 infection escapes previous SARS-CoV-2 exposure induced-T cell immunity but may result in milder immuno-pathology and alleviated chances of re-infectivity in Omicron-recovered individuals.
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Affiliation(s)
- Zaigham Abbas Rizvi
- Centre for Immuno-biology and Immunotherapy, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India.
- Immunology-Core Lab, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India.
| | - Jyotsna Dandotiya
- Centre for Immuno-biology and Immunotherapy, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
| | - Srikanth Sadhu
- Centre for Immuno-biology and Immunotherapy, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
- Immunology-Core Lab, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
| | - Ritika Khatri
- Centre for Viral Therapeutics and Vaccines, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
| | - Janmejay Singh
- Bioassay Laboratory, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, 121001, India
| | - Virendra Singh
- Centre for Immuno-biology and Immunotherapy, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
- Immunology-Core Lab, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
| | - Neeta Adhikari
- Centre for Immuno-biology and Immunotherapy, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
| | - Kritika Sharma
- Centre for Immuno-biology and Immunotherapy, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
- Immunology-Core Lab, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
| | - Vinayake Das
- Centre for Immuno-biology and Immunotherapy, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
- Immunology-Core Lab, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
| | - Amit Kumar Pandey
- Centre for Tuberculosis and Bacterial Diseases Research, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
| | - Bhabatosh Das
- Centre for Microbiome and Anti-Microbial Resistance, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
| | - Guruprasad Medigeshi
- Bioassay Laboratory, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, 121001, India
| | - Shalendra Mani
- Centre for Viral Therapeutics and Vaccines, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
| | - Shinjini Bhatnagar
- Centre for Maternal and Child Health, Translational Health Science and Technology NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
| | - Sweety Samal
- Centre for Viral Therapeutics and Vaccines, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India
| | - Anil Kumar Pandey
- Department of Physiology, ESIC Medical College & Hospital, Faridabad, 121001, India
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Amit Awasthi
- Centre for Immuno-biology and Immunotherapy, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India.
- Immunology-Core Lab, Translational Health Science and Technology Institute, NCR-Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad, Haryana, 121001, India.
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10
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Agarwal A, Mahapatra SJ, Sethia R, Agarwal S, Elhence A, Mohta S, Gunjan D, Garg PK. Universal prophylactic rectal nonsteroidal anti-inflammatory drugs with a policy of selective pancreatic duct stenting significantly reduce post-endoscopic retrograde cholangiopancreatography pancreatitis. Indian J Gastroenterol 2023; 42:370-378. [PMID: 37160838 DOI: 10.1007/s12664-023-01354-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 02/03/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Although rectal nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to be effective for the prevention of post-ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis (PEP) in high-risk patients, the benefit in average-risk patients is unclear. We aimed at assessing the benefit of prophylactic rectal NSAIDs in unselected consecutive patients to prevent PEP. METHODS All patients undergoing index ERCP procedures from January 2018 until March 2020 were included. All patients received prophylactic rectal diclofenac. A prophylactic pancreatic duct (PD) stent was placed if there was repeated PD cannulation, at the discretion of the endoscopist. The frequency of PEP was compared with historical controls. RESULTS Of 769 patients who underwent ERCP, 34 (4.4%) developed PEP (mild in 29 [85.3%], moderate in four [11.8%] and severe in one [2.9%]). Female gender, precut sphincterotomy, inadvertent PD cannulation and procedural time of > 30 minutes predicted PEP in univariate analysis. Inadvertent PD cannulation (OR 4.6, 95% CI: 1.8-11.7; p < 0.001) and procedural time of > 30 minutes (OR 8.5, 95% CI: 3.7-10.1; p < 0.001) were independent risk factors on multivariate analysis. When compared with historical controls, the odds of PEP with prophylactic use of rectal NSAIDs and selective PD stenting was 0.54 (CI: 0.31-0.93, p = 0.027). The number needed to treat (NNT) was 22 to prevent one PEP with prophylactic rectal NSAIDs. CONCLUSION Routine use of prophylactic rectal NSAIDs effectively prevents the occurrence of PEP in unselected consecutive patients in a real-world scenario.
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Affiliation(s)
- Ashish Agarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, Jodhpur, 342 005, India
| | - Soumya Jagannath Mahapatra
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Rahul Sethia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Samagra Agarwal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Anshuman Elhence
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Srikanth Mohta
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Pramod Kumar Garg
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
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11
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Batra G, Murugesan DR, Raghavan S, Chattopadhyay S, Mehdi F, Ayushi, Gosain M, Singh S, Das SJ, Deshpande S, Sonar S, Jakhar K, Bhattacharya J, Mani S, Pandey AK, Sankalp, Goswami S, Das A, Dwivedi T, Sharma N, Kumar S, Sharma P, Kapoor S, Kshetrapal P, Wadhwa N, Thiruvengadam R, Kumar R, Gupta R, Garg PK, Bhatnagar S. Trends of humoral immune responses to heterologous antigenic exposure due to vaccination & omicron SARS-CoV-2 infection: Implications for boosting. Indian J Med Res 2023; 157:509-518. [PMID: 37322634 PMCID: PMC10466496 DOI: 10.4103/ijmr.ijmr_2521_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Indexed: 06/17/2023] Open
Abstract
Background & objectives Vaccination and natural infection can both augment the immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but how omicron infection has affected the vaccine-induced and hybrid immunity is not well studied in Indian population. The present study was aimed to assess the durability and change in responses of humoral immunity with age, prior natural infection, vaccine type and duration with a minimum gap of six months post-two doses with either ChAdOx1 nCov-19 or BBV152 prior- and post-emergence of the omicron variant. Methods A total of 1300 participants were included in this observational study between November 2021 and May 2022. Participants had completed at least six months after vaccination (2 doses) with either ChAdOx1 nCoV-19 or an inactivated whole virus vaccine BBV152. They were grouped according to their age (≤ or ≥60 yr) and prior exposure of SARS-CoV-2 infection. Five hundred and sixteen of these participants were followed up after emergence of the Omicron variant. The main outcome was durability and augmentation of the humoral immune response as determined by anti-receptor-binding domain (RBD) immunoglobulin G (IgG) concentrations, anti-nucleocapsid antibodies and anti-omicron RBD antibodies. Live virus neutralization assay was conducted for neutralizing antibodies against four variants - ancestral, delta and omicron and omicron sublineage BA.5. Results Before the omicron surge, serum anti-RBD IgG antibodies were detected in 87 per cent participants after a median gap of eight months from the second vaccine dose, with a median titre of 114 [interquartile range (IQR) 32, 302] BAU/ml. The levels increased to 594 (252, 1230) BAU/ml post-omicron surge (P<0.001) with 97 per cent participants having detectable antibodies, although only 40 had symptomatic infection during the omicron surge irrespective of vaccine type and previous history of infection. Those with prior natural infection and vaccination had higher anti-RBD IgG titre at baseline, which increased further [352 (IQR 131, 869) to 816 (IQR 383, 2001) BAU/ml] (P<0.001). The antibody levels remained elevated after a mean time gap of 10 months, although there was a decline of 41 per cent. The geometric mean titre was 452.54, 172.80, 83.1 and 76.99 against the ancestral, delta, omicron and omicron BA.5 variants in the live virus neutralization assay. Interpretation & conclusions Anti-RBD IgG antibodies were detected in 85 per cent of participants after a median gap of eight months following the second vaccine dose. Omicron infection probably resulted in a substantial proportion of asymptomatic infection in the first four months in our study population and boosted the vaccine-induced humoral immune response, which declined but still remained durable over 10 months.
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Affiliation(s)
- Gaurav Batra
- Centre for Bio Design and Diagnostics, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Deepika Rathna Murugesan
- Centre for Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Sreevatsan Raghavan
- Centre for Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Souvick Chattopadhyay
- Centre for Bio Design and Diagnostics, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Farha Mehdi
- Centre for Bio Design and Diagnostics, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Ayushi
- Centre for Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Mudita Gosain
- Centre for Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Savita Singh
- Centre for Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Soon Jyoti Das
- Centre for Bio Design and Diagnostics, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Suprit Deshpande
- Centre for Viral Therapeutics and Vaccine, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Sudipta Sonar
- Centre for Infection and Immunity, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Kamini Jakhar
- Centre for Infection and Immunity, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Jayanta Bhattacharya
- Centre for Viral Therapeutics and Vaccine, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Shailendra Mani
- Centre for Infection and Immunity, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Anil Kumar Pandey
- Department of Physiology, ESIC Medical College & Hospital, Faridabad, Haryana, India
| | - Sankalp
- Department of Physiology, ESIC Medical College & Hospital, Faridabad, Haryana, India
| | - Shweta Goswami
- Department of Community Medicine, ESIC Medical College & Hospital, Faridabad, Haryana, India
| | - Asim Das
- ESIC Medical College & Hospital, Faridabad, Haryana, India
| | - Tanima Dwivedi
- Department of Laboratory Medicine, National Cancer Center, All India Institute of Medical Science, Jhajjar, Haryana, India
| | - Nandini Sharma
- Department of Community Medicine, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India
| | - Suresh Kumar
- Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India
| | - Pragya Sharma
- Andaman & Nicobar Islands Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India
| | - Seema Kapoor
- Department of Pediatrics, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India
| | - Pallavi Kshetrapal
- Centre for Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Nitya Wadhwa
- Centre for Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Ramachandran Thiruvengadam
- Centre for Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Science, New Delhi, India
| | - Ritu Gupta
- Department of Laboratory Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, New Delhi, India
| | - Pramod Kumar Garg
- Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Shinjini Bhatnagar
- Centre for Maternal and Child Health, Translational Health Science and Technology Institute, Faridabad, Haryana, India
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12
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Deshpande S, Ansari MY, Sutar J, Das P, Hingankar N, Mukherjee S, Jayal P, Singh S, Anantharaj A, Singh J, Chattopadhyay S, Raghavan S, Gosain M, Chauhan S, Shrivas S, Prasad C, Chauhan S, Sharma N, Jana P, Thiruvengadam R, Kshetrapal P, Wadhwa N, Das B, Batra G, Medigeshi G, Sok D, Bhatnagar S, Garg PK, Bhattacharya J. Ancestral SARS-CoV-2-Driven Antibody Repertoire Diversity in an Unvaccinated Individual Correlates with Expanded Neutralization Breadth. Microbiol Spectr 2023; 11:e0433222. [PMID: 36946746 PMCID: PMC10100905 DOI: 10.1128/spectrum.04332-22] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/06/2023] [Indexed: 03/23/2023] Open
Abstract
Understanding the quality of immune repertoire triggered during natural infection can provide vital clues that form the basis for development of a humoral immune response in some individuals capable of broadly neutralizing pan-SARS-CoV-2 variants. In the present study, we report variations in neutralization potential against Omicron variants of two novel neutralizing monoclonal antibodies (MAbs), THSC20.HVTR11 and THSC20.HVTR55, isolated from an unvaccinated convalescent individual that represent distinct B cell lineage origins and epitope specificity compared to five MAbs we previously reported that were isolated from the same individual. In addition, we observed neutralization of Omicron variants by plasma antibodies obtained from this particular individual postvaccination with increased magnitude. Interestingly, this observation was found to be comparable with six additional individuals who initially were also infected with ancestral SARS-CoV-2 and then received vaccines, indicating that hybrid immunity can provide robust humoral immunity likely by antibody affinity maturation. Development of a distinct antigen-specific B cell repertoire capable of producing polyclonal antibodies with distinct affinity and specificities offers the highest probability of protecting against evolving SARS-CoV-2 variants. IMPORTANCE Development of robust neutralizing antibodies in SARS-CoV-2 convalescent individuals is known; however, it varies at the population level. We isolated monoclonal antibodies from an individual infected with ancestral SARS-CoV-2 in early 2020 that not only varied in their B cell lineage origin but also varied in their capability and potency to neutralize all the known variants of concern (VOCs) and currently circulating Omicron variants. This indicated establishment of unique lineages that contributed in forming a B cell repertoire in this particular individual immediately following infection, giving rise to diverse antibody responses that could complement each other in providing a broadly neutralizing polyclonal antibody response. Individuals who were able to produce polyclonal antibody responses with higher magnitude have a higher chance of being protected from evolving SARS-CoV-2 variants.
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Affiliation(s)
- Suprit Deshpande
- IAVI-Antibody Translational Research Program, Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Mohammed Yousuf Ansari
- IAVI-Antibody Translational Research Program, Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Jyoti Sutar
- IAVI-Antibody Translational Research Program, Translational Health Science & Technology Institute, Faridabad, Haryana, India
- IAVI, New York, New York, USA
| | - Payel Das
- IAVI-Antibody Translational Research Program, Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Nitin Hingankar
- IAVI-Antibody Translational Research Program, Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Sohini Mukherjee
- IAVI-Antibody Translational Research Program, Translational Health Science & Technology Institute, Faridabad, Haryana, India
- IAVI, New York, New York, USA
| | - Priyanka Jayal
- IAVI-Antibody Translational Research Program, Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Savita Singh
- Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Anbalagan Anantharaj
- Translational Health Science & Technology Institute, Faridabad, Haryana, India
- Bioassay Laboratory, Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Janmejay Singh
- Translational Health Science & Technology Institute, Faridabad, Haryana, India
- Bioassay Laboratory, Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | | | - Sreevatsan Raghavan
- Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Mudita Gosain
- Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Supriya Chauhan
- IAVI-Antibody Translational Research Program, Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Shweta Shrivas
- IAVI-Antibody Translational Research Program, Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Chaman Prasad
- IAVI-Antibody Translational Research Program, Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Sangeeta Chauhan
- IAVI-Antibody Translational Research Program, Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Neha Sharma
- IAVI-Antibody Translational Research Program, Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Pradipta Jana
- Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | | | - Pallavi Kshetrapal
- Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Nitya Wadhwa
- Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Bhabatosh Das
- Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Gaurav Batra
- Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Guruprasad Medigeshi
- Translational Health Science & Technology Institute, Faridabad, Haryana, India
- Bioassay Laboratory, Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Devin Sok
- IAVI-Neutralizing Antibody Center and the Collaboration for AIDS Vaccine Discovery (CAVD), The Scripps Research Institute, La Jolla, California, USA
- Scripps Consortium for HIV/AIDS Vaccine Development (CHAVD), The Scripps Research Institute, La Jolla, California, USA
- IAVI, New York, New York, USA
| | - Shinjini Bhatnagar
- Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Pramod Kumar Garg
- Translational Health Science & Technology Institute, Faridabad, Haryana, India
| | - Jayanta Bhattacharya
- IAVI-Antibody Translational Research Program, Translational Health Science & Technology Institute, Faridabad, Haryana, India
- IAVI, New York, New York, USA
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13
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Lluís N, Asbun H, Besselink MG, Capurso G, Garg PK, Gelrud A, Khannoussi W, Lee HS, Leppäniemi A, Löhr JM, Mahapatra SJ, Mancilla C, van Santvoort HC, Zapater P, Lluís F, de Madaria E, Ramia JM. International multidisciplinary survey on the initial management of acute pancreatitis: Perspective of point-of-care specialists focused on daily practice. J Hepatobiliary Pancreat Sci 2023; 30:325-337. [PMID: 35716156 DOI: 10.1002/jhbp.1201] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/17/2022] [Accepted: 05/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The initial management of patients with acute pancreatitis impacts both morbidity and mortality. Point-of-care decisions have been reported to differ from clinical guideline recommendations. METHODS An online anonymous questionnaire was distributed through scientific associations and social media using REDCap. Multivariable logistic regression was used to identify the characteristics of participants associated with compliance with the recommendations. RESULTS A total of 1054 participants from 94 countries completed the questionnaire; median age (IQR) was 39 (32-47) years; 30.7% were women. Among the participants, 37% opted for nonmoderate flow of i.v. fluid, 31% for fluid type other than Ringer's lactate; 73.4% were in favor of nil per os to patients who could eat, 75.5% for other than enteral feeding to patients with oral intolerance; 15.5% used prophylactic antibiotic in patients with severe acute pancreatitis, 34.1% in necrotizing acute pancreatitis, and 27.4% in patients with systemic inflammatory response syndrome; 27.8% delayed cholecystectomy after biliary acute pancreatitis. Participants with publications in PubMed on acute pancreatitis showed better compliance (OR, 1.62; 95% CI: 1.15-2.32; P = .007) with recommendations of the clinical guidelines. CONCLUSIONS Feeding and nutrition require the greatest improvement efforts, but also the use of prophylactic antibiotics and timing of cholecystectomy should be improved.
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Affiliation(s)
- Nuria Lluís
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Horacio Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Andres Gelrud
- Pancreatic Disease Center, Interventional Endoscopy, Miami Cancer Institute, Gastro Health, Miami, Florida, USA
| | - Wafaa Khannoussi
- Hepato-Gastroenterology Department, Mohammed VI University Hospital, Oujda, Morocco.,Laboratoire de Recherche des Maladies Digestives (LARMAD), Mohammed The First University, Oujda, Morocco
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ari Leppäniemi
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
| | | | | | - Carla Mancilla
- Gastroenterology Section and Critical Care Unit, University of Chile Clinical Hospital, Santiago, Chile
| | - Hjalmar C van Santvoort
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | - Pedro Zapater
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Felix Lluís
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Enrique de Madaria
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain.,Department of Gastroenterology, General University Hospital of Alicante, Alicante, Spain
| | - José Manuel Ramia
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain.,Department of Surgery, General University Hospital of Alicante, Alicante, Spain
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14
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Kaul P, Malhotra M, Arora V, Agarwal N, Singh MP, Garg PK. Prognostic significance of soft tissue deposits in head and neck squamous cell carcinoma: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2023:S0901-5027(23)00015-2. [PMID: 36781359 DOI: 10.1016/j.ijom.2023.01.014] [Citation(s) in RCA: 1] [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: 06/01/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 02/13/2023]
Abstract
Soft tissue deposits, also known as tumour deposits (TDs), have not been studied well in head and neck squamous cell carcinoma (HNSCC) and are not included in any of the staging systems or treatment guidelines. The aim of this systematic review was to determine the prevalence and prognostic implications of TDs in patients with HNSCC. This systematic review of the literature was conducted following the PRISMA guidelines. The PubMed, Embase, and Scopus electronic databases were searched for relevant studies, from inception to August 2022. Although 14 studies qualified for inclusion, only eight were finally included in the review due to the considerable overlap of patients in several studies. Data from 7127 patients were analysed. The pooled prevalence of TDs was 21% (95% confidence interval (CI) 9-33%). The presence of TDs was adversely associated with overall survival and disease-free survival, with hazard ratios of 2.08 (95% CI 1.60-2.70) and 2.56 (95% CI 1.97-3.32), respectively. TDs are detected in a significant number of patients with HNSCC and adversely affect survival. Longitudinal prospective studies are needed to evaluate the prognostic implications of TDs in HNSCC for their potential role in cancer staging and adjuvant treatment planning.
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Affiliation(s)
- P Kaul
- Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
| | - M Malhotra
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - V Arora
- Department of Otorhinolaryngology and Head-Neck Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - N Agarwal
- Section of Otolaryngology and Head-Neck Surgery, Department of Surgery, The University of Chicago, Chicago, Illinois, USA
| | - M P Singh
- Department of Surgical Oncology, Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India
| | - P K Garg
- Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India.
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15
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Parray HA, Narayanan N, Garg S, Rizvi ZA, Shrivastava T, Kushwaha S, Singh J, Murugavelu P, Anantharaj A, Mehdi F, Raj N, Singh S, Dandotiya J, Lukose A, Jamwal D, Kumar S, Chiranjivi AK, Dhyani S, Mishra N, Kumar S, Jakhar K, Sonar S, Panchal AK, Tripathy MR, Chowdhury SR, Ahmed S, Samal S, Mani S, Bhattacharyya S, Das S, Sinha S, Luthra K, Batra G, Sehgal D, Medigeshi GR, Sharma C, Awasthi A, Garg PK, Nair DT, Kumar R. A broadly neutralizing monoclonal antibody overcomes the mutational landscape of emerging SARS-CoV-2 variants of concern. PLoS Pathog 2022; 18:e1010994. [PMID: 36508467 PMCID: PMC9779650 DOI: 10.1371/journal.ppat.1010994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/22/2022] [Accepted: 11/08/2022] [Indexed: 12/14/2022] Open
Abstract
The emergence of new variants of SARS-CoV-2 necessitates unremitting efforts to discover novel therapeutic monoclonal antibodies (mAbs). Here, we report an extremely potent mAb named P4A2 that can neutralize all the circulating variants of concern (VOCs) with high efficiency, including the highly transmissible Omicron. The crystal structure of the P4A2 Fab:RBD complex revealed that the residues of the RBD that interact with P4A2 are a part of the ACE2-receptor-binding motif and are not mutated in any of the VOCs. The pan coronavirus pseudotyped neutralization assay confirmed that the P4A2 mAb is specific for SARS-CoV-2 and its VOCs. Passive administration of P4A2 to K18-hACE2 transgenic mice conferred protection, both prophylactically and therapeutically, against challenge with VOCs. Overall, our data shows that, the P4A2 mAb has immense therapeutic potential to neutralize the current circulating VOCs. Due to the overlap between the P4A2 epitope and ACE2 binding site on spike-RBD, P4A2 may also be highly effective against a number of future variants.
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Affiliation(s)
- Hilal Ahmad Parray
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Naveen Narayanan
- Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Sonal Garg
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Zaigham Abbas Rizvi
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Tripti Shrivastava
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Sachin Kushwaha
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | - Janmejay Singh
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Praveenkumar Murugavelu
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Anbalagan Anantharaj
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Farha Mehdi
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Nisha Raj
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Shivam Singh
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Jyotsna Dandotiya
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Asha Lukose
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Deepti Jamwal
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Sandeep Kumar
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Adarsh K. Chiranjivi
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Samridhi Dhyani
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Nitesh Mishra
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- ICGEB-Emory Vaccine Center, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Kamini Jakhar
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Sudipta Sonar
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Anil Kumar Panchal
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Manas Ranjan Tripathy
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Shirlie Roy Chowdhury
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Shubbir Ahmed
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Sweety Samal
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Shailendra Mani
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Sankar Bhattacharyya
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Supratik Das
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Subrata Sinha
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Kalpana Luthra
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Batra
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Devinder Sehgal
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | - Guruprasad R. Medigeshi
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Chandresh Sharma
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Amit Awasthi
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Pramod Kumar Garg
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Deepak T. Nair
- Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, Haryana, India
| | - Rajesh Kumar
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, Haryana, India
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Mahapatra SJ, Garg PK. Navigating the Stormy Sea of Infected Necrotizing Pancreatitis: Are We There Yet? Well Almost! Gastroenterology 2022; 163:578-581. [PMID: 35793777 DOI: 10.1053/j.gastro.2022.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/02/2022]
Affiliation(s)
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India; Translational Health Science and Technology Institute, Faridabad, India.
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Gaur AS, Sharma N, Garg PK. Chronic groin pain in Desarda versus Lichtenstein hernia repair - a randomised controlled study. S AFR J SURG 2022; 60:141-145. [PMID: 35851370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Chronic pain after inguinal hernia repair is a common complication. This study compared the difference between Desarda repair and Lichtenstein repair for inguinal hernia in chronic groin pain. METHODS One hundred patients with unilateral uncomplicated inguinal hernia were randomised to either Desarda repair (n = 50) or Lichtenstein repair (n = 50) under local anaesthesia and were evaluated for pain postoperatively. Operative time, surgical complications, time to return to normal gait and work, and overall patient satisfaction were recorded. The patient was blinded to the procedure. Any pain at three months (numerical rating scale 1 or more) was considered chronic pain. RESULTS Mean operation time was approximately 5 minutes less for Desarda (p = 0.33). There was no significant difference in terms of pain level postoperatively between Lichtenstein and Desarda groups. Twenty-two (44%) patients in the Lichtenstein group had chronic pain, and twenty-one (45.7%) patients had chronic pain in the Desarda group (p = 0.871). No significant difference was observed in haematoma formation, wound infection, recurrence rate, seroma, or foreign body sensation. The mean time for patients to return to normal gait was approximately 0.5 day earlier for the Desarda group (p = 0.29). The mean time for patients to return to normal work was comparable (p = 0.99). Desarda group had a slightly higher satisfaction rate than the Lichtenstein group (9.1%). CONCLUSION Desarda repair is not inferior to Lichtenstein repair in the short-term concerning complications or pain.
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Affiliation(s)
- A S Gaur
- Department of General Surgery, University College of Medical Sciences, India
| | - N Sharma
- Department of General Surgery, All India Institute of Medical Sciences Jodhpur, India
| | - P K Garg
- Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences and Shri Mahant Indiresh Hospital, India
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Garg PK, Thiruvengadam R. Effectiveness of SARS-CoV-2 vaccines in the post-natural infection world. The Lancet Infectious Diseases 2022; 22:745-747. [PMID: 35366961 PMCID: PMC8971269 DOI: 10.1016/s1473-3099(22)00207-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/10/2022] [Indexed: 11/25/2022]
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Medigeshi GR, Batra G, Murugesan DR, Thiruvengadam R, Chattopadhyay S, Das B, Gosain M, Ayushi, Singh J, Anbalagan A, Shaman H, Pargai K, Mehdi F, Das SJ, Kahlon N, Singh S, Kshetrapal P, Wadhwa N, Pandey AK, Bhatnagar S, Garg PK. Sub-optimal neutralisation of omicron (B.1.1.529) variant by antibodies induced by vaccine alone or SARS-CoV-2 Infection plus vaccine (hybrid immunity) post 6-months. EBioMedicine 2022; 78:103938. [PMID: 35305396 PMCID: PMC8923830 DOI: 10.1016/j.ebiom.2022.103938] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rapid spread of the omicron SARS-CoV-2 variant despite extensive vaccination suggests immune escape. The neutralising ability of different vaccines alone or with natural SARS-CoV-2 infection against omicron is not well-known. METHODS In this cross-sectional study, we tested the ability of vaccine and natural infection induced antibodies to neutralise omicron variant in a live virus neutralisation assay in four groups of individuals: (i) ChAdOx1 nCoV-19 vaccination, (ii) ChAdOx1 nCoV-19 vaccination plus prior SARS-CoV-2 infection, (iii) vaccination with inactivated virus vaccine (BBV152), and (iv) BBV152 vaccination plus prior SARS-CoV-2 infection. Primary outcome was fold-change in virus neutralisation titre against omicron compared with ancestral virus. FINDINGS We included 80 subjects. The geometric mean titre (GMT) of the 50% focus reduction neutralisation test (FRNT50) was 380·4 (95% CI: 221·1, 654·7) against the ancestral virus with BBV152 vaccination and 379·3 (95% CI: 185·6, 775·2) with ChAdOx1 nCov-19 vaccination alone. GMT for vaccination plus infection groups were 806·1 (95% CI: 478·5, 1357·8) and 1526·2 (95% CI: 853·2, 2730·0), respectively. Against omicron variant, only 5 out of 20 in both BBV152 and ChAdOx1 nCoV-19 vaccine only groups, 6 out of 20 in BBV152 plus prior SARS-CoV-2 infection group, and 9 out of 20 in ChAdOx1 nCoV-19 plus prior SARS-CoV-2 infection group exhibited neutralisation titres above the lower limit of quantification (1:20) suggesting better neutralisation with prior infection. A reduction of 26·6 and 25·7 fold in FRNT50 titres against Omicron compared to ancestral SARS-CoV-2 strain was observed for individuals without prior SARS-CoV-2 infection vaccinated with BBV152 and ChAdOx1 nCoV-19, respectively. The corresponding reduction was 57·1 and 58·1 fold, respectively, for vaccinated individuals with prior infection. The 50% neutralisation titre against omicron demonstrated moderate correlation with serum anti-RBD IgG levels [Spearman r: 0·58 (0·41, 0·71)]. INTERPRETATION Significant reduction in the neutralising ability of both vaccine-induced and vaccine plus infection-induced antibodies was observed for omicron variant which might explain immune escape. FUNDING Department of Biotechnology, India; Bill & Melinda Gates Foundation, USA.
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Affiliation(s)
| | - Gaurav Batra
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | | | | | - Souvick Chattopadhyay
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Bhabatosh Das
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Mudita Gosain
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Ayushi
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Janmejay Singh
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Anantharaj Anbalagan
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Heena Shaman
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Kamal Pargai
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Farha Mehdi
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Soon Jyoti Das
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Namrata Kahlon
- ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Savita Singh
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Pallavi Kshetrapal
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Nitya Wadhwa
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Anil K Pandey
- ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Shinjini Bhatnagar
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India
| | - Pramod Kumar Garg
- Translational Health Science and Technology Institute, Faridabad, Haryana 120001, India.
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Thiruvengadam R, Awasthi A, Bhatnagar S, Garg PK. Effectiveness of ChAdOx1 nCoV-19 vaccine during the delta (B.1.617.2) variant surge in India – Authors' reply. The Lancet Infectious Diseases 2022; 22:447. [PMID: 35338864 PMCID: PMC8942565 DOI: 10.1016/s1473-3099(22)00120-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Amit Awasthi
- Translational Health Science and Technology Institute, Faridabad 121001, India
| | - Shinjini Bhatnagar
- Translational Health Science and Technology Institute, Faridabad 121001, India
| | - Pramod Kumar Garg
- Translational Health Science and Technology Institute, Faridabad 121001, India.
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Samanta J, Mahapatra SJ, Kumar N, Elhence A, Dhar J, Gupta A, Dhooria A, Bhalla A, Prasad M, Das A, Sharma R, Kochhar R, Garg PK, Gupta A, Elhence A, Dhooria A, Das A, Bhalla A, Puri GD, Dhar J, Yegurla J, Samanta J, Vaishnav M, Prasad M, Kumar N, Garg PK, Sethia R, Bansal R, Rana R, Kochhar R, Golla R, Biswas S, Mundhra SK, Agarwal S, Prasad S, Mahapatra SJ. Virus related acute pancreatitis and virus superinfection in the 'Dual disease' model of acute pancreatitis and SARS-Co-V2 infection: A multicentre prospective study. Pancreatology 2022; 22:339-347. [PMID: 35131169 PMCID: PMC8786679 DOI: 10.1016/j.pan.2022.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/15/2021] [Accepted: 01/12/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND SARS-CoV-2 can cause acute pancreatitis (AP) and SARS-CoV-2 superinfection can occur in patients with AP during prolonged hospitalisation. Our objective was to characterize SARS-CoV-2 related AP and study the impact of SARS-CoV-2 superinfection on outcomes in AP. METHODS In this multicentre prospective study, all patients with AP and SARS-CoV-2 infection between August 2020 and February 2021 were divided into two groups: SARS-CoV-2-related AP and superadded SARS-CoV-2 infection in patients with AP. The two groups were compared with each other and the whole cohort was compared with a non-COVID AP cohort. RESULTS A total of 85 patients with SARS-CoV-2 and AP (SARS-CoV-2-related AP; n = 18 and AP with SARS-CoV-2 superadded infection; n = 67) were included during the study period. They had a higher mortality [28 (32.9%) vs. 44 (19.1%), aOR 2.8 (95% CI, 1.5-5.3)] than 230 propensity matched non-COVID AP patients. Mortality in SARS-CoV-2 and AP patients was due to critical COVID. SARS-CoV-2-related- AP (n = 18) had a higher but statistically insignificant mortality than SARS-CoV-2 superinfection in AP [8/18 (44.4%) vs 20/67 (29.8%), p = 0.24]. On multivariable analysis, infection with SARS-CoV-2 (aHR 2.3; 95% CI, 1.43.7) was a predictor of in-hospital mortality in addition to organ failure (OF) in patients with AP. CONCLUSION Patients with AP and SARS-CoV-2 infection had a higher mortality than matched non-COVID AP patients which was largely attributable to the severity of COVID-19. SARS-CoV-2 related AP had higher OF and in-hospital mortality.
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Affiliation(s)
- Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Naveen Kumar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anshuman Elhence
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Jahnvi Dhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anany Gupta
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anugrah Dhooria
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manya Prasad
- Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Aritra Das
- Consultant Epidemiologist, Bihar Technical Support Program, CARE India, Bihar, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Corresponding author. Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Pramod K. Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India,Corresponding author. Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India
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Thiruvengadam R, Awasthi A, Medigeshi G, Bhattacharya S, Mani S, Sivasubbu S, Shrivastava T, Samal S, Rathna Murugesan D, Koundinya Desiraju B, Kshetrapal P, Pandey R, Scaria V, Kumar Malik P, Taneja J, Binayke A, Vohra T, Zaheer A, Rathore D, Ahmad Khan N, Shaman H, Ahmed S, Kumar R, Deshpande S, Subramani C, Wadhwa N, Gupta N, Pandey AK, Bhattacharya J, Agrawal A, Vrati S, Bhatnagar S, Garg PK. Effectiveness of ChAdOx1 nCoV-19 vaccine against SARS-CoV-2 infection during the delta (B.1.617.2) variant surge in India: a test-negative, case-control study and a mechanistic study of post-vaccination immune responses. The Lancet Infectious Diseases 2022; 22:473-482. [PMID: 34838183 PMCID: PMC8616567 DOI: 10.1016/s1473-3099(21)00680-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 12/12/2022]
Abstract
Background SARS-CoV-2 variants of concern (VOCs) have threatened COVID-19 vaccine effectiveness. We aimed to assess the effectiveness of the ChAdOx1 nCoV-19 vaccine, predominantly against the delta (B.1.617.2) variant, in addition to the cellular immune response to vaccination. Methods We did a test-negative, case-control study at two medical research centres in Faridabad, India. All individuals who had a positive RT-PCR test for SARS-CoV-2 infection between April 1, 2021, and May 31, 2021, were included as cases and individuals who had a negative RT-PCR test were included as controls after matching with cases on calendar week of RT-PCR test. The primary outcome was effectiveness of complete vaccination with the ChAdOx1 nCoV-19 vaccine against laboratory-confirmed SARS-CoV-2 infection. The secondary outcomes were effectiveness of a single dose against SARS-CoV-2 infection and effectiveness of a single dose and complete vaccination against moderate-to-severe disease among infected individuals. Additionally, we tested in-vitro live-virus neutralisation and T-cell immune responses to the spike protein of the wild-type SARS-CoV-2 and VOCs among healthy (anti-nucleocapsid antibody negative) recipients of the ChAdOx1 nCoV-19 vaccine. Findings Of 2379 cases of confirmed SARS-CoV-2 infection, 85 (3·6%) were fully vaccinated compared with 168 (8·5%) of 1981 controls (adjusted OR [aOR] 0·37 [95% CI 0·28–0·48]), giving a vaccine effectiveness against SARS-CoV-2 infection of 63·1% (95% CI 51·5–72·1). 157 (6·4%) of 2451 of cases and 181 (9·1%) of 1994) controls had received a single dose of the ChAdOx1 nCoV-19 vaccine (aOR 0·54 [95% CI 0·42–0·68]), thus vaccine effectiveness of a single dose against SARS-CoV-2 infection was 46·2% (95% CI 31·6–57·7). One of 84 cases with moderate-to-severe COVID-19 was fully vaccinated compared with 84 of 2295 cases with mild COVID-19 (aOR 0·19 [95% CI 0·01–0·90]), giving a vaccine effectiveness of complete vaccination against moderate-to-severe disease of 81·5% (95% CI 9·9–99·0). The effectiveness of a single dose against moderate-to-severe disease was 79·2% (95% CI 46·1–94·0); four of 87 individuals with moderate-to-severe COVID-19 had received a single dose compared with 153 of 2364 participants with mild disease (aOR 0·20 [95% CI 0·06–0·54]). Among 49 healthy, fully vaccinated individuals, neutralising antibody responses were lower against the alpha (B.1.1.7; geometric mean titre 244·7 [95% CI 151·8–394·4]), beta (B.1.351; 97·6 [61·2–155·8]), kappa (B.1.617.1; 112·8 [72·7–175·0]), and delta (88·4 [61·2–127·8]) variants than against wild-type SARS-CoV-2 (599·4 [376·9–953·2]). However, the antigen-specific CD4 and CD8 T-cell responses were conserved against both the delta variant and wild-type SARS-CoV-2. Interpretation The ChAdOx1 nCoV-19 vaccine remained effective against moderate-to-severe COVID-19, even during a surge that was dominated by the highly transmissible delta variant of SARS-CoV-2. Spike-specific T-cell responses were maintained against the delta variant. Such cellular immune protection might compensate for waning humoral immunity. Funding Department of Biotechnology India, Council of Scientific and Industrial Research India, and Fondation Botnar.
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Affiliation(s)
| | - Amit Awasthi
- Translational Health Science and Technology Institute, Faridabad, India
| | | | | | - Shailendra Mani
- Translational Health Science and Technology Institute, Faridabad, India
| | - Sridhar Sivasubbu
- Council of Scientific and Industrial Research-Institute of Genomics and Integrative Biology, New Delhi, India
| | | | - Sweety Samal
- Translational Health Science and Technology Institute, Faridabad, India
| | | | | | | | - Rajesh Pandey
- Council of Scientific and Industrial Research-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Vinod Scaria
- Council of Scientific and Industrial Research-Institute of Genomics and Integrative Biology, New Delhi, India
| | | | - Juhi Taneja
- ESIC Medical College and Hospital, Faridabad, India
| | - Akshay Binayke
- Translational Health Science and Technology Institute, Faridabad, India
| | - Tarini Vohra
- Translational Health Science and Technology Institute, Faridabad, India
| | - Aymaan Zaheer
- Translational Health Science and Technology Institute, Faridabad, India
| | - Deepak Rathore
- Translational Health Science and Technology Institute, Faridabad, India
| | - Naseem Ahmad Khan
- Translational Health Science and Technology Institute, Faridabad, India
| | - Heena Shaman
- Translational Health Science and Technology Institute, Faridabad, India
| | - Shubbir Ahmed
- Translational Health Science and Technology Institute, Faridabad, India
| | - Rajesh Kumar
- Translational Health Science and Technology Institute, Faridabad, India
| | - Suprit Deshpande
- Translational Health Science and Technology Institute, Faridabad, India
| | | | - Nitya Wadhwa
- Translational Health Science and Technology Institute, Faridabad, India
| | | | | | - Jayanta Bhattacharya
- Translational Health Science and Technology Institute, Faridabad, India; International AIDS Vaccine Initiative, New Delhi, India
| | - Anurag Agrawal
- Council of Scientific and Industrial Research-Institute of Genomics and Integrative Biology, New Delhi, India
| | | | | | - Pramod Kumar Garg
- Translational Health Science and Technology Institute, Faridabad, India.
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Elhence A, Mahapatra SJ, Madhusudhan KS, Jain S, Sethia R, Teja V, Vajpai T, Malla S, Aggarwal P, Pandey S, Singh AN, Dash NR, Sahni P, Garg PK. Pancreatic hemorrhage contributes to late mortality in patients with acute necrotizing pancreatitis. Pancreatology 2022; 22:219-225. [PMID: 35034847 DOI: 10.1016/j.pan.2022.01.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/08/2021] [Accepted: 01/05/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The frequency, risk factors, and impact on survival of hemorrhage into (peri)pancreatic collections in patients with acute pancreatitis (AP) has not been well studied. The study was designed to evaluate the risk factors for hemorrhage, successful hemostasis and its effect on in-hospital mortality. METHODS In a prospective cohort study for prediction of severity of AP, the incidence, risk factors, and outcomes of pancreatic hemorrhage were analyzed. Patients with significant hemorrhage were managed according to a predefined protocol including endovascular intervention. RESULTS Out of 363 patients hospitalized during the study-period, 33(9%) patients developed hemorrhage. Median time from onset of AP to hemorrhage was 59(45-68) days. The cause of hemorrhage was arterial in 19(57.5%) patients and unlocalized in 14(42.5%) patients. Hemorrhage was managed by conservative approach in 7 (21.2%), radiographic angioembolisation in 16 (48.5%), radiographic angioembolisation followed by surgery in 3 (9.1%), and surgery in 7 (21.2%) patients. Persistent organ failure [aHR 2.3 (1.1-5.1), p = 0.03], use of large bore (>20 Fr) catheter for initial drainage [aHR 3.9 (1.7-9.1), p = 0.001] and extensive (>50%) necrosis [aHR 3.1 (1.4-6.9), p = 0.005] were significant risk factors for hemorrhage. Hemorrhage was an independent predictor of mortality [aHR 2.0 (1.2-3.4), p = 0.008] in addition to persistent organ failure (aHR 12.1 (5.7-25.8), p < 0.001). In-hospital mortality in patients with hemorrhage was 22/33 (66.7%) vs. 81/330 (25%) in no hemorrhage group [p <0.001]. CONCLUSION Pancreatic hemorrhage occurs later in the course of acute pancreatitis in relatively sicker group of patients with organ failure and extensive necrosis, and is independently associated with a higher risk of in-hospital mortality.
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Affiliation(s)
- Anshuman Elhence
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya Jagannath Mahapatra
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | | | - Saransh Jain
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Sethia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Varun Teja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Tanmay Vajpai
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sundeep Malla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Aggarwal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Narayan Singh
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India
| | - Nihar Ranjan Dash
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India
| | - Peush Sahni
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Kumar Garg
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
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Madhusudhan KS, Gopi S, Singh AN, Agarwal L, Gunjan D, Srivastava DN, Garg PK. Immediate and Long-Term Outcomes of Percutaneous Radiological Interventions for Hemorrhagic Complications in Acute and Chronic Pancreatitis. J Vasc Interv Radiol 2021; 32:1591-1600.e1. [PMID: 34416367 DOI: 10.1016/j.jvir.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate and compare the immediate and long-term outcomes of radiological interventions for hemorrhagic complications in patients with acute and chronic pancreatitis. MATERIALS AND METHODS This retrospective study, conducted between January 2014 and June 2020, included all patients with acute and chronic pancreatitis presenting with hemorrhagic complications who underwent angiography and/or embolization. Their clinical, angiographic, and embolization details were evaluated and correlated with procedure success, complications, recurrence, and mortality. The patients were subgrouped into groups A (acute pancreatitis) and C (chronic pancreatitis), and comparisons were made. RESULTS The study included 141 patients (mean age, 36.3 ± 11.2 years; 124 men), of whom 106 patients had abnormal angiography findings and underwent embolization. Of them, group A had 50 patients (56 lesions) and group C had 56 patients (61 lesions). All the patients in group A had severe acute pancreatitis, with a mean computed tomography severity index of 7.6. The technical and clinical success rates of embolization, complications, recurrence, and long-term outcomes were not significantly different between the groups. Group A had significantly higher mortality due to sepsis and organ failure. Embolic agents did not have any significant association with complications, recurrence, and mortality. After a mean follow-up of 2 years, 72.5% of the patients were asymptomatic, and none had symptoms attributable to embolization. CONCLUSIONS Success, complications, and recurrence after embolization for hemorrhagic complications were comparable between acute and chronic pancreatitis. Acute pancreatitis was associated with significantly higher mortality. Embolic agents did not significantly influence the outcomes. None had long-term adverse effects attributable to embolization.
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Affiliation(s)
- Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Srikanth Gopi
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Narayan Singh
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Lokesh Agarwal
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Deep N Srivastava
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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Bansal VK, Misra MC, Agarwal AK, Agrawal JB, Agarwal PN, Aggarwal S, Aslam M, Krishna A, Baksi A, Behari A, Bhattacharjee HK, Bhojwani R, Chander J, Chattopadhyay TK, Chintamani, Chowbey P, Dalvi A, Dash NR, Dhawan IK, Gamangatti S, Garg PK, Gupta NM, Gupta R, Gupta SK, Gupta V, Kaman L, Kapur BML, Kataria K, Khan M, Khanna AK, Khullar R, Kumar A, Kumar A, Kumar S, Kumar S, Lal P, Maurya SD, Moirangthem GS, Pal S, Panwar R, Parshad R, Pottakkat B, Prajapati OP, Puntambekar S, Ranjan P, Rathore YS, Sahni P, Sarangi R, Seenu V, Sharma R, Shukla VK, Singh DP, Singh J, Singh R, Sinha R, Sikora SS, Srivastava A, Srivastava A, Srivastava KN, Thomas S, Verma GR, Wig JD, Kapoor VK. SELSI Consensus Statement for Safe Cholecystectomy—Prevention and Management of Bile Duct Injury—Part B. Indian J Surg 2021. [DOI: 10.1007/s12262-019-01994-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Affiliation(s)
| | - Manya Prasad
- Department of Clinical Research and Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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Affiliation(s)
- Anshuman Elhence
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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Garg PK, Kumar R, Dixit P. Adjuvant nivolumab for the management of pathological residual disease in esophageal or junctional tumors: a word of caution. Ann Oncol 2021; 32:1189-1190. [PMID: 33957223 DOI: 10.1016/j.annonc.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- P K Garg
- Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India.
| | - R Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | - P Dixit
- Department of Gastroenterology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
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Mishra S, Ghatak S, Agrawal D, Singh P, Garg PK. Reference Charts of Fetal Biometric Parameters at Different Gestational Age Groups in Indian Population. Mymensingh Med J 2021; 30:538-546. [PMID: 33830140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
To develop, a reference charts of fetal abdominal circumference and femur length in normal pregnant women by using ultrasonography for Indian population. Further comparison of our findings with data derived from different population. This retrospective cross-sectional study included 300 normal singleton pregnancies and was carried out in the department of Anatomy, All India Institute of Medical Sciences, Jodhpur (Rajasthan), India from September 2017 to April 2019. Ultrasonography measurements included Abdominal circumference (AC) and Femur length (FL). Reference charts with mean AC and FL for corresponding Gestational age (GA) in weeks were developed. Also reference centiles (10th, 50th, 90th and 95th) were derived from this model and compared with similar studies done on different population. There was no statistically significant difference in age distribution of pregnant women (p=0.87). Both AC and FL were found to have statistically significant linear relationship with advancing gestational age (p=0.0005 & p=0.0003 respectively). There is significant difference observed between the values obtained in present study with studies concluded on Chinese and European population. Measurement of AC and FL are used to predict gestational age of fetus by using various regression formulae, also AC is known to be good predictor of nutritional status of fetus in utero. A separate chart is required for every different population because ethnicity, nutrition and environmental factor can have impact on normal values. Therefore, a reference chart for these parameters according to Indian population standards is essential to avoid misinterpretation of data. This would help to avoid misdiagnosis of intrauterine growth retardation or macrosomia during prenatal and perinatal period.
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Affiliation(s)
- S Mishra
- Dr Sanjay Mishra, Senior Resident (MD Anatomy), Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India; E-mail:
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Kumar S, Gupta A, Sagar S, Bagaria D, Kumar A, Choudhary N, Kumar V, Ghoshal S, Alam J, Agarwal H, Gammangatti S, Kumar A, Soni KD, Agarwal R, Gunjaganvi M, Joshi M, Saurabh G, Banerjee N, Kumar A, Rattan A, Bakhshi GD, Jain S, Shah S, Sharma P, Kalangutkar A, Chatterjee S, Sharma N, Noronha W, Mohan LN, Singh V, Gupta R, Misra S, Jain A, Dharap S, Mohan R, Priyadarshini P, Tandon M, Mishra B, Jain V, Singhal M, Meena YK, Sharma B, Garg PK, Dhagat P, Kumar S, Kumar S, Misra MC. Management of Blunt Solid Organ Injuries: the Indian Society for Trauma and Acute Care (ISTAC) Consensus Guidelines. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Colney L, Tandon N, Garg PK, Gupta N, Sagar S, Gupta A, Kumar A, Kumar S. Exocrine and endocrine functions and pancreatic volume in patients with pancreatic trauma. Eur J Trauma Emerg Surg 2021; 48:97-105. [PMID: 33715016 DOI: 10.1007/s00068-021-01638-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/03/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Injury to the pancreas may lead to significant morbidity and mortality. We aim to assess pancreatic endocrine and exocrine functions and evaluated morphological regenerations of pancreas following partial pancreatectomy in patients with pancreatic trauma. METHODS The study was performed between June 2016 and December 2017. Endocrine functions were assessed at the time of admission and at 6 months follow-up with 75 g oral glucose tolerance test (OGTT), serum insulin and C-peptide levels and HbA1c estimation and exocrine functions were assessed with fecal elastase test. Pancreatic volumetry was done with imaging scan at 1 month and 6 months post discharge. RESULTS Twenty patients were studied with a median age of 30 years (range18-48) at the time of injury. All the patients were normoglycemic on admission; only one patient who underwent pancreatic resection developed diabetes mellitus at follow-up. Eight patients (40%) were found to be prediabetic by American Diabetes Association (ADA) criteria. Eleven patients (55%) had pancreatic exocrine insufficiency. Pancreatic volume increment, from the mean pancreatic volume of 48.65 to 54.29 cm3, was noted in patients who underwent partial pancreatectomy. CONCLUSIONS Patients with pancreatic trauma may develop biochemical endocrine and exocrine insufficiencies following pancreatic resection. Pancreatic volume increment requires further research in a larger study.
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Affiliation(s)
- Lalchhandami Colney
- Division of Trauma Surgery and Critical Care, Department of Surgical Disciplines, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 29, India
| | - Nikhil Tandon
- Department of Endocrinology, Diabetes & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Kumar Garg
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Nandita Gupta
- Department of Endocrinology, Diabetes & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Sagar
- Division of Trauma Surgery and Critical Care, Department of Surgical Disciplines, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 29, India
| | - Amit Gupta
- Division of Trauma Surgery and Critical Care, Department of Surgical Disciplines, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 29, India
| | - Atin Kumar
- Department of Radiodiagnosis, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Division of Trauma Surgery and Critical Care, Department of Surgical Disciplines, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, 29, India.
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Affiliation(s)
- T S Ghosh
- Department of Diagnostic and Interventional RadiologyAll India Institute of Medical Sciences, JodhpurRajasthan, India
| | - S Tiwari
- Department of Diagnostic and Interventional RadiologyAll India Institute of Medical Sciences, JodhpurRajasthan, India
| | - P K Garg
- Department of Diagnostic and Interventional RadiologyAll India Institute of Medical Sciences, JodhpurRajasthan, India
| | - P S Khera
- Department of Diagnostic and Interventional RadiologyAll India Institute of Medical Sciences, JodhpurRajasthan, India
| | - P Elhence
- Department of PathologyAll India Institute of Medical Sciences, Jodhpur Rajasthan, India
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Elhence A, Mahapatra SJ, Vajpai T, Garg PK. Acute pancreatitis and nosocomial COVID-19: Cause specific host responses may determine lung injury. Pancreatology 2020; 20:1258-1261. [PMID: 32859545 PMCID: PMC7437538 DOI: 10.1016/j.pan.2020.08.008] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) presents with myriad extra-pulmonary manifestation and a high mortality in patients with comorbidities. Its effect on patients with pre-existing acute pancreatitis is not known. METHODS We hereby, present 3 cases with severe acute pancreatitis with persistent respiratory failure who acquired nosocomial COVID-19 during their hospital stay after recovery from respiratory failure. Their clinical course is highlighted which reflects on pathophysiology of organ dysfunction in these 2 disease states. RESULTS None of the 3 patients with severe acute pancreatitis who developed nosocomial COVID-19 redeveloped respiratory failure due to COVID-19 despite having recently recovered from pancreatitis induced acute hypoxemic respiratory failure. Only one patient developed SARS-CoV2 induced moderate pneumonia. CONCLUSION These cases highlight that host responses and mechanisms of lung injury might be different in severe acute pancreatitis and COVID-19.
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Garg PK, Kumar JR, Kumar R, Singh MP. Colostomy site recurrence in rectal cancer. Tech Coloproctol 2020; 24:1097-1098. [PMID: 32451804 DOI: 10.1007/s10151-020-02242-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/13/2020] [Indexed: 12/01/2022]
Affiliation(s)
- P K Garg
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - J R Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - R Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - M P Singh
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
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Jagannath S, Garg PK. Refractory Bergmann type A bile leak: effect of gravity and tube sizing. Endosc Int Open 2020; 8:E523-E524. [PMID: 32258374 PMCID: PMC7089789 DOI: 10.1055/a-1075-2054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Soumya Jagannath
- All India Institute of Medical Sciences, Gastroenterology, New Delhi, Inida
| | - Pramod Kumar Garg
- All India Institute of Medical Sciences, Gastroenterology, New Delhi, Inida
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Jain S, Padhan R, Bopanna S, Jain SK, Dhingra R, Dash NR, Madhusudan KS, Gamanagatti SR, Sahni P, Garg PK. Percutaneous Endoscopic Step-Up Therapy Is an Effective Minimally Invasive Approach for Infected Necrotizing Pancreatitis. Dig Dis Sci 2020; 65:615-622. [PMID: 31187325 DOI: 10.1007/s10620-019-05696-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 02/05/2019] [Accepted: 06/03/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Infected pancreatic necrosis (IPN) is a major complication of acute pancreatitis (AP), which may require necrosectomy. Minimally invasive surgical step-up therapy is preferred for IPN. AIM To assess the effectiveness of percutaneous endoscopic step-up therapy in patients with IPN and identify predictors of its success. METHODS Consecutive patients with AP hospitalized to our tertiary care academic center were studied prospectively. Patients with IPN formed the study group. The treatment protocol for IPN was percutaneous endoscopic step-up approach starting with antibiotics and percutaneous catheter drainage, and if required necrosectomy. Percutaneous endoscopic necrosectomy (PEN) was performed using a flexible endoscope through the percutaneous tract under conscious sedation. Control of sepsis with resolution of collection(s) was the primary outcome measure. RESULTS A total of 415 patients with AP were included. Of them, 272 patients had necrotizing pancreatitis and 177 (65%) developed IPN. Of these 177 patients, 27 were treated conservatively with antibiotics alone, 56 underwent percutaneous drainage alone, 53 required underwent PEN as a step-up therapy, 1 per-oral endoscopic necrosectomy, and 52 required surgery. Of the 53 patients in the PEN group, 42 (79.2%) were treated successfully-34 after PEN alone and 8 after additional surgery. Eleven of 53 patients died due to organ failure-7 after PEN and 4 after surgery. Independent predictors of mortality were > 50% necrosis and early organ failure. CONCLUSION Percutaneous endoscopic step-up therapy is an effective strategy for IPN. Organ failure and extensive pancreatic necrosis predicted a suboptimal outcome in patients with infected necrotizing pancreatitis.
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Affiliation(s)
- Saransh Jain
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Padhan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sawan Bopanna
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil Kumar Jain
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajan Dhingra
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Nihar Ranjan Dash
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Peush Sahni
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
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Mishra S, Ghatak S, Agrawal D, Singh P, Garg PK. Estimation of Fetal Weight: An Ultrasonography Study in Indian Population. Mymensingh Med J 2020; 29:215-221. [PMID: 31915361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To create a reference chart for estimated fetal weight (EFW) in normal pregnancy for use in Indian population and compare it with reference chart from other population. This retrospective cross-sectional study included 300 normal singleton pregnancies coming for routine antenatal ultrasonography examination and was carried out at All India Institute of Medical Sciences, Jodhpur from September 2017 to April 2019. Ultrasonographic measurements included fetal biparietal diameter (cm), head circumference (cm), abdominal circumference (cm) and femur length (cm). Estimated fetal weight was calculated by using Hadlock algorithm which is already fed into ultrasonography machine. Reference chart with mean EFW for corresponding Gestational age (GA) in weeks was developed. Also Reference centiles (10th, 50th, 90th and 95th) were derived from this model. There was no statistically significant difference in age distribution of pregnant women (p=0.87). Statistically significant linear relationship found between EFW and advancing gestational age (p=0.0004). Maximum gain in EFW (34.05%) was observed after second trimester (28 week). Maximum and minimum fetal weight at 38 weeks of GA in our study found to be 3389 grams and 2567 grams respectively, which has significant difference. This could be due to huge difference in socio-economic and nutritional status among Indian population which might have impacted on maternal and fetal health. Estimated fetal weight was found to be at lower range in Indian population compared to reference chart developed into western population. Fetal weight to their corresponding GA is an important factor in determining growth and development in fetus. In normally developing fetus the EFW has linear correlation with advancing GA. A separate reference chart is required for every different population because ethnicity, nutrition and environmental factor can have impact on normal EFW values. This would help to avoid misdiagnosis of intrauterine growth retardation or macrosomia in fetuses and hence unnecessary medical interventions can be prevented during prenatal and perinatal period.
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Affiliation(s)
- S Mishra
- Dr Sanjay Mishra, Post-graduate Student in MD Anatomy, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India; E-mail:
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Abstract
Introduction: Acute pancreatitis is an inflammatory condition of the pancreas, which runs a severe course in 20% of patients, wherein it is associated with high mortality. It is associated with several pleuro-pulmonary complications with variable severity that may occur either in isolation but are frequently present in combination. Clinicians need to be aware of these complications for early and appropriate management.Areas covered: We performed a systematic search of the PUBMED database (1970-2019) to identify relevant articles focusing on pleuro-pulmonary complications that may occur in patients with acute pancreatitis. We also retrieved articles describing the pathophysiological mechanisms and treatment approach of the various complications.Expert opinion: Acute pancreatitis is usually a self-limiting disease, but the development of organ failure during the course worsens the clinical outcome. Pulmonary complications usually occur early in the course of acute pancreatitis. Clinicians need to recognize the various pulmonary complications of acute pancreatitis, early during the disease, and manage them appropriately and aggressively to improve outcomes.
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Affiliation(s)
- Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine. All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anshuman Elhence
- Department of Gastroenterology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine. All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine. All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Garg PK, Meena D, Babu D, Padhan RK, Dhingra R, Krishna A, Kumar S, Misra MC, Bansal VK. Endoscopic versus laparoscopic drainage of pseudocyst and walled-off necrosis following acute pancreatitis: a randomized trial. Surg Endosc 2019; 34:1157-1166. [PMID: 31140002 DOI: 10.1007/s00464-019-06866-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 12/10/2018] [Accepted: 05/18/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pancreatic fluid collections (PFC) may develop following acute pancreatitis (AP). Endoscopic and laparoscopic internal drainage are accepted modalities for drainage of PFCs but have not been compared in a randomized trial. Our objective was to compare endoscopic and laparoscopic internal drainage of pseudocyst/walled-off necrosis following AP. PATIENTS AND METHODS Patients with symptomatic pseudocysts or walled-off necrosis suitable for laparoscopic and endoscopic transmural internal drainage were randomized to either modality in a randomized controlled trial. Endoscopic drainage comprised of per-oral transluminal cystogastrostomy. Additionally, endoscopic lavage and necrosectomy were done following a step-up approach for infected collections. Surgical laparoscopic cystogastrostomy was done for drainage, lavage, and necrosectomy. Primary outcome was resolution of PFCs by the intended modality and secondary outcome was complications. RESULTS Sixty patients were randomized, 30 each to laparoscopic and endoscopic drainage. Both groups were comparable for baseline characteristics. The initial success rate was 83.3% in the laparoscopic and 76.6% in the endoscopic group (p = 0.7) after the index intervention. The overall success rate of 93.3% (28/30) and 90% (27/30) in the laparoscopic and endoscopic groups respectively was also similar (p = 1.0). Two patients in the laparoscopic group required endoscopic cystogastrostomy for persistent collections. Similarly, two patients in the endoscopic group required laparoscopic drainage. Postoperative complications were comparable between the groups except for higher post-procedure infection in the endoscopic group (19 vs. 9; p = 0.01) requiring endoscopic re-intervention. CONCLUSIONS Endoscopic and laparoscopic techniques have similar efficacy for internal drainage of suitable pancreatic fluid collections with < 30% debris. The choice of procedure should depend on available expertise and patient preference.
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Affiliation(s)
- Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
| | - Danishwar Meena
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Babu
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Padhan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajan Dhingra
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh Chandra Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
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Ge N, Brugge WR, Saxena P, Sahai A, Adler DG, Giovannini M, Pausawasdi N, Santo E, Mishra G, Tam W, Kida M, de la Mora-Levy JG, Sharma M, Umar M, Katanuma A, Lee L, Garg PK, Eloubeidi MA, Yu HK, Raijman I, Arturo Arias BL, Bhutani M, Carrara S, Rai P, Mukai S, Palazzo L, Dietrich CF, Nguyen NQ, El-Nady M, Poley JW, Guaraldi S, Kalaitzakis E, Sabbagh LC, Lariño-Noia J, Gress FG, Lee YT, Rana SS, Fusaroli P, Hocke M, Dhir V, Lakhtakia S, Ratanachu-Ek T, Chalapathi Rao AS, Vilmann P, Okasha HH, Irisawa A, Ponnudurai R, Leong AT, Artifon E, Iglesias-Garcia J, Saftoiu A, Larghi A, Robles-Medranda C, Sun S. An international, multi-institution survey of the use of EUS in the diagnosis of pancreatic cystic lesions. Endosc Ultrasound 2019; 8:418-427. [PMID: 31552915 PMCID: PMC6927137 DOI: 10.4103/eus.eus_61_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background and Objectives: Currently, pancreatic cystic lesions (PCLs) are recognized with increasing frequency and have become a more common finding in clinical practice. EUS is challenging in the diagnosis of PCLs and evidence-based decisions are lacking in its application. This study aimed to develop strong recommendations for the use of EUS in the diagnosis of PCLs, based on the experience of experts in the field. Methods: A survey regarding the practice of EUS in the evaluation of PCLs was drafted by the committee member of the International Society of EUS Task Force (ISEUS-TF). It was disseminated to experts of EUS who were also members of the ISEUS-TF. In some cases, percentage agreement with some statements was calculated; in others, the options with the greatest numbers of responses were summarized. Results: Fifteen questions were extracted and disseminated among 60 experts for the survey. Fifty-three experts completed the survey within the specified time frame. The average volume of EUS cases at the experts' institutions is 988.5 cases per year. Conclusion: Despite the limitations of EUS alone in the morphologic diagnosis of PCLs, the results of the survey indicate that EUS-guided fine-needle aspiration is widely expected to become a more valuable method.
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Affiliation(s)
- Nan Ge
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - William R Brugge
- Department of Gastroenterology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Payal Saxena
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Anand Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Marc Giovannini
- Endoscopic Unit, Institut Paoli-Calmettes, Marseille, France
| | | | - Erwin Santo
- Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Girish Mishra
- Department of Gastroenterology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - William Tam
- Lyell McEwin Hospital, Elizabeth Vale, Adelaide, Australia
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan
| | | | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | | | - Akio Katanuma
- Center for Gastroenterology, Teine-Kenjinkai Hospital, Sapporo, Japan
| | - Linda Lee
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ho Khek Yu
- National University of Singapore, Singapore
| | - Isaac Raijman
- Digestive Associates of Houston, University of Texas, Houston, Texas, USA
| | | | - Manoop Bhutani
- Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Silvia Carrara
- Digestive Endoscopy Unit, Humanitas Research Hospital, Milan, Italy
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | | | - Christoph F Dietrich
- Medical Department, Caritas-Krankenhaus, Uhlandstr 7, D-97980 Bad Mergentheim, Germany
| | - Nam Q Nguyen
- Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia
| | - Mohamed El-Nady
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Jan Werner Poley
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Simone Guaraldi
- Participants of the Nucleus of Endoscopy of the Brazilian Society of Digestive Endoscopy (SOBED), São Paulo, Brazil
| | - Evangelos Kalaitzakis
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Jose Lariño-Noia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Yuk-Tong Lee
- Departments of Medicine & Therapeutics and Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Surinder S Rana
- Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Bologna, Italy
| | - Michael Hocke
- Department of Medical, Hospital Meiningen, Thuringia, Germany
| | - Vinay Dhir
- Department of Gastroenterology and Endoscopy, S L Raheja Hospital, Mumbai, Maharashtra, India
| | | | | | | | - Peter Vilmann
- GastroUnit, Department of Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hussein Hassan Okasha
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | - Atsushi Irisawa
- Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | | | - Ang Tiing Leong
- Departments of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Everson Artifon
- Department of Surgery, Ana Costa Hospital, Sao Paulo, Brazil
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Carlos Robles-Medranda
- Head of the Endoscopy Division, Ecuadorian Institute of Digestive Disease, Guayaquil, Ecuador
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Othman T, Tun H, Bainiwal JS, Andersen ES, Dharmavaram NL, Schwartzman WS, Baffo AN, Butera BC, Phuong NS, Xu PZ, Yasmeh B, Gertsvolf NA, Yoon AJ, Shavelle DM, Garg PK, Van Herle HM, Kahn JA, Kim B. Incidental Coronary Artery Calcification Seen on Low-Dose Computed Tomography Is a Risk Factor for Obstructive Coronary Artery Disease in Patients Undergoing Liver Transplant. Transplant Proc 2018; 50:3487-3495. [PMID: 30577226 DOI: 10.1016/j.transproceed.2018.11.001] [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: 11/15/2022]
Abstract
Incidental arterial calcification (Ca) on low-dose computed tomography (CT) prior to liver transplant (LT) may help identify those at risk for obstructive coronary artery disease (CAD). A single-center retrospective study of 358 consecutive patients who had undergone LT was performed. Of the 296 patients who met inclusion criteria, 193 patients (65.2%) had CT Ca. Aortic Ca was seen in 116 (39.2%), coronary Ca in 141 (47.6%), and peripheral Ca in 8 patients (2.7%). Patients with coronary Ca were assigned ordinal coronary artery Ca scores and classified as mild, moderate, and severe. All-cause mortality was higher in patients with Ca in any location (14.5% vs 6.8%, P = .05). Of the patients who underwent coronary angiography, those with obstructive CAD were more likely to have aortic and coronary Ca than patients with nonobstructive or no CAD (85.7% vs 50.0%, P = .02 and 92.9% vs 37.9%, P = < .001, respectively). Severe coronary artery Ca scores were more frequent in patients with obstructive CAD (35.7% vs 0%, P < .001). Any severity coronary Ca had an odds ratio of 11.57 (95% CI, 1.61-244.92; P = .04) for obstructive CAD. In conclusion, incidental coronary Ca seen on low-dose CT is a risk factor for obstructive CAD in patients undergoing LT.
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Affiliation(s)
- T Othman
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - H Tun
- Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - J S Bainiwal
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - E S Andersen
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - N L Dharmavaram
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - W S Schwartzman
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - A N Baffo
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - B C Butera
- Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - N S Phuong
- Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - P Z Xu
- Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - B Yasmeh
- Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - N A Gertsvolf
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - A J Yoon
- Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - D M Shavelle
- Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - P K Garg
- Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - H M Van Herle
- Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - J A Kahn
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - B Kim
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA.
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Jain S, Mahapatra SJ, Gupta S, Shalimar, Garg PK. Infected Pancreatic Necrosis due to Multidrug-Resistant Organisms and Persistent Organ failure Predict Mortality in Acute Pancreatitis. Clin Transl Gastroenterol 2018; 9:190. [PMID: 30287818 PMCID: PMC6172262 DOI: 10.1038/s41424-018-0056-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 01/26/2023] Open
Abstract
Background Organ failure determines outcome in acute pancreatitis (AP). It is controversial if infected pancreatic necrosis (IPN) is also an independent determinant of mortality. We hypothesized that the predictors of mortality in AP might have changed with advances in management and consequent decline in mortality over the past decades. Our objective was to study the predictors of mortality in patients with AP. Methods Consecutive patients with a first episode of AP hospitalized from January 2015 to December 2016 were included in an observational study. Patients with IPN were treated with a conservative first approach followed by intervention. Necrosectomy, if required, was delayed beyond 4 weeks and done primarily employing minimally invasive techniques. The primary outcome measure was independent predictors of in-hospital mortality. Results Of 209 patients with AP, 81 (39%) had persistent organ failure (OF) and 108 (52%) developed IPN. Overall, 46/209 (22%) patients died. Independent predictors of mortality were OF (odds ratio [OR]19; 95% CI: 6.1–58.8), and IPN due to infection with multidrug resistant (MDR) organisms (OR: 8.4; 95% CI:3.1–22.5). Infected pancreatic necrosis by itself was not found to be a significant predictor of mortality (OR 2; 95% CI: 0.4–9.5). Conclusion Persistent OF and complicated IPN due to MDR infection were independent predictors of mortality in patients with AP. Renewed efforts to prevent MDR infection with antibiotic stewardship and strategies for early control of sepsis are urgently required.
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Affiliation(s)
- Saransh Jain
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Swatantra Gupta
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
PURPOSE OF REVIEW There have been significant developments in the diagnosis, clinical approach, and management of patients with recurrent acute pancreatitis (RAP) in the last decade. This review systematically summarizes our current understanding of RAP. NEW FINDINGS Gallstones and alcohol are common causes of RAP. Non-alcohol non-biliary RAP (nAnB RAP) is a difficult group of patients after excluding these two causes because extensive workup is required to elucidate the etiology. Idiopathic RAP is diagnosed after excluding all the known causes and recurrence is noted to be higher in such patients. Patients with non-biliary RAP are prone to develop chronic pancreatitis (CP) suggesting a continuum from acute to recurrent to chronic pancreatitis. Often, patients destined to develop CP present at an earlier stage with RAP. Endoscopic ultrasound and magnetic resonance cholangiopancreatography (MRCP) are the investigations of choice to detect microlithiasis, choledocholithiasis, ductal abnormalities, peri-ampullary malignancies, and early changes of chronic pancreatitis. The role of pancreas divisum, sphincter of Oddi dysfunction, and anomalous pancreatobiliary union in causing RAP is controversial. Genetic testing may be advisable in younger patients. CONCLUSION With a focused approach and appropriate investigations, the etiology of RAP can be identified in a significant proportion of patients. Therapeutic options are limited and future research is needed to improve understanding of the disease.
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Affiliation(s)
- Soumya Jagannath
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
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Jain S, Midha S, Mahapatra SJ, Gupta S, Sharma MK, Nayak B, Jacob TG, Garg PK. Interleukin-6 significantly improves predictive value of systemic inflammatory response syndrome for predicting severe acute pancreatitis. Pancreatology 2018; 18:500-506. [PMID: 29779831 DOI: 10.1016/j.pan.2018.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 01/27/2018] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Predicting severe acute pancreatitis (AP) is important for triage, prognosis, and designing therapeutic trials. Persistent systemic inflammatory response syndrome (SIRS) predicts severe AP but its diagnostic accuracy is suboptimal. Our objective was to study if cytokine levels could improve the predictive value of clinical variables for the development of severe AP. METHODS Consecutive patients with AP were included in a prospective cohort study at a tertiary care center. Serum levels of IL-6, TNF-α, IL-10, MCP-1, GM-CSF and IL-1β were measured at day 3 of onset of AP. Variables such as age, co-morbidity, etiology, SIRS, and cytokines were modeled to predict severe AP by multivariable regression analysis. Genotyping was done to correlate IL-6, TNF-α and MCP-1 gene polymorphisms with cytokine levels. RESULTS Of 236 patients with AP, 115 patients admitted within 7 days of onset formed the study group. 37 of the 115 (32%) patients developed organ failure. Independent predictors of organ failure were persistent SIRS (OR 34; 95% CI: 7.2-159) and day 3 serum IL-6 of >160 pg/ml (OR 16.1; 95% CI:1.8-142). IL-6 gene (-174 G/C) GG genotype was associated with significantly higher levels of IL-6 compared to CC/CG genotype. Serum IL-6 >160 pg/ml increased the positive predictive value of persistent SIRS from 56% to 85% and specificity from 64% to 95% for predicting OF without compromising its sensitivity and negative predictive value. CONCLUSION Serum IL-6 of >160 ng/ml added significantly to the predictive value of SIRS for severe AP.
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Affiliation(s)
- Saransh Jain
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Shallu Midha
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya Jagannath Mahapatra
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Swatantra Gupta
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Kumar Sharma
- Department of Anatomy, 1st Floor, Teaching Block, All India Institute of Medical Sciences, New Delhi, India
| | - Baibaswata Nayak
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Tony George Jacob
- Department of Anatomy, 1st Floor, Teaching Block, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Kumar Garg
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
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Garg PK, Biggs ML, Kaplan R, Kizer JR, Heckbert SR, Mukamal KJ. Fasting and post-glucose load measures of insulin resistance and risk of incident atrial fibrillation: The Cardiovascular Health Study. Nutr Metab Cardiovasc Dis 2018; 28:716-721. [PMID: 29615289 PMCID: PMC6151262 DOI: 10.1016/j.numecd.2018.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/14/2018] [Accepted: 02/26/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Existing literature in individuals without diabetes has not demonstrated a relationship between IR and incident AF; however, data are limited and only fasting glucose measures of IR were assessed. We evaluated the relationship of both fasting and post-glucose load IR measures with the development of atrial fibrillation in nondiabetic older adults. METHODS AND RESULTS Among Cardiovascular Health Study participants, a population-based cohort of 5888 adults aged 65 years or older enrolled in two waves (1989-1990 and 1992-1993), those without prevalent AF or diabetes and with IR measures at baseline were followed for the development of AF, identified by follow-up visit electrocardiograms, hospital discharge diagnosis coding, or Medicare claims data, through 2014. Fasting IR was determined by the homeostatic model of insulin resistance (HOMA-IR) and post-glucose load IR was determined by the Gutt index. Cox proportional hazards models were used to determine the association of IR with risk of AF. Analyses included 3601 participants (41% men) with a mean age of 73 years. Over a median follow-up of 12.3 years, 1443 (40%) developed AF. After multivariate adjustment, neither HOMA-IR nor the Gutt index was associated with risk of developing AF [hazard ratios (95% confidence intervals): 0.96 (0.90, 1.03) for 1-SD increase in HOMA-IR and 1.03 (0.97, 1.10) for 1-SD decrease in the Gutt index]. CONCLUSIONS We found no evidence of an association between either fasting or post-glucose load IR measures and incident AF.
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Affiliation(s)
- P K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - M L Biggs
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - R Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - J R Kizer
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - S R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - K J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Padhan RK, Jain S, Agarwal S, Harikrishnan S, Vadiraja P, Behera S, Jain SK, Dhingra R, Dash NR, Sahni P, Garg PK. Primary and Secondary Organ Failures Cause Mortality Differentially in Acute Pancreatitis and Should be Distinguished. Pancreas 2018; 47:302-307. [PMID: 29401171 DOI: 10.1097/mpa.0000000000000998] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to study the development of early and late organ failure (OF) and their differential impact on mortality in patients with acute pancreatitis (AP). METHODS Consecutive patients (N = 805) with acute pancreatitis were included in an observational study. Organ failure was categorized as primary if it occurred early due to pancreatitis per se and secondary if it occurred late due to infected pancreatic necrosis (IPN). Primary outcome was a relative contribution of primary OF, secondary OF, and IPN to mortality. RESULTS Of the 614 patients (mean age, 38.8; standard deviation, 14.6 years; 430 males) in a derivation cohort, 274 (44.6%) developed OF, with 177 having primary OF and 97 secondary OF due to sepsis. Primary OF caused early mortality in 15.8% and was a risk factor for IPN in 76% of patients. Mortality in patients with primary OF and IPN was 49.5% versus 36% in those with IPN and secondary OF (P = 0.06) and 4% in those with IPN but without OF (P < 0.001). The results of the 191 patients in the validation cohort confirmed the relative contribution of primary and secondary OF to mortality. CONCLUSION Primary and secondary OF contributed to mortality independently and are distinct in their timing, window of opportunity for intervention, and prognosis.
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Padhan RK, Nongthombam SK, Venuthurimilli A, Dhingra R, Sahni P, Garg PK. Assessment of safety and efficacy of an indigenous self-expandable fully covered esophageal metal stent for palliation of esophageal cancer. Indian J Cancer 2018; 53:534-537. [PMID: 28485345 DOI: 10.4103/0019-509x.204760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with unresectable esophageal cancer require palliation for dysphagia. Placement of a self-expandable metal stent (SEMS) is the procedure of choice for palliation of dysphagia. OBJECTIVE To evaluate the safety and efficacy of an indigenous fully-covered SEMS in patients with esophageal cancer. METHODS Eligible patients with unresectable esophageal cancer requiring palliation for dysphagia were included in the study. An indigenous fully covered SEMS of appropriate length was placed under endoscopic and fluoroscopic guidance. Outcome measures assessed were adverse events and improvement in dysphagia. RESULTS Twenty one patients (mean age 57.71±13.14 years; 17 males) were included. After stenting, dysphagia score decreased from 3.2+0.4 to 0.35+0.74 at 4 weeks. Adverse events included retrosternal pain, respiratory distress and aspiration pneumonia in 12, 2 and 1 patients respectively. Five patients required repeat stenting due to stent migration in 4 (following radiotherapy in 3) and tumour ingrowth in 1. There was primary stent malfunction in one patient. The median survival of patients was 140 (76-199) days, which was higher in those who received radiotherapy. CONCLUSION The stent was reasonably safe and effective to relieve dysphagia due to unresectable esophageal cancer.
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Affiliation(s)
- R K Padhan
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
| | - S K Nongthombam
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
| | - A Venuthurimilli
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
| | - R Dhingra
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
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- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
| | - P Sahni
- Department of Gastrointestinal Surgery, All Institute of Medical Sciences, New Delhi, India
| | - P K Garg
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
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48
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Guo J, Giovannini M, Sahai AV, Saftoiu A, Dietrich CF, Santo E, Fusaroli P, Siddiqui AA, Bhutani MS, Bun Teoh AY, Irisawa A, Arturo Arias BL, Achanta CR, Jenssen C, Seo DW, Adler DG, Kalaitzakis E, Artifon E, Itokawa F, Poley JW, Mishra G, Ho KY, Wang HP, Okasha HH, Lachter J, Vila JJ, Iglesias-Garcia J, Yamao K, Yasuda K, Kubota K, Palazzo L, Sabbagh LC, Sharma M, Kida M, El-Nady M, Nguyen NQ, Vilmann P, Garg PK, Rai P, Mukai S, Carrara S, Parupudi S, Sridhar S, Lakhtakia S, Rana SS, Ogura T, Baron TH, Dhir V, Sun S. A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction. Endosc Ultrasound 2018; 7:356-365. [PMID: 30531022 PMCID: PMC6289007 DOI: 10.4103/eus.eus_53_18] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives: EUS-guided biliary drainage (EUS-BD) was shown to be useful for malignant biliary obstruction (MBO). However, there is lack of consensus on how EUS-BD should be performed. Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD. Results: Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stenting technique should be the First choice. Self-expandable metal stents (SEMSs) were recommended by most endoscopists. For EUS-guided hepaticogastrostomy (HGS), superiority of partially-covered SEMS over fully-covered SEMS was not in agreement. 6-Fr cystotomes were recommended for fistula creation. During the HGS approach, longer SEMS (8 or 10 cm) was recommended. During the choledochoduodenostomy approach, 6-cm SEMS was recommended. During the intrahepatic (IH) approach, the IH segment 3 was recommended. Conclusion: This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice, and randomized studies are urgently needed to establish the best approach for the management of this condition.
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Affiliation(s)
- Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Marc Giovannini
- Pathology Unit (Flora Poizat), Institute Paoli-Calmettes, Marseille, France
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Adrian Saftoiu
- Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania
| | | | - Erwin Santo
- Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Manoop S Bhutani
- Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan
| | | | | | | | - Dong-Wan Seo
- Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Douglas G Adler
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Evangelos Kalaitzakis
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Everson Artifon
- Department of Surgery, University of Sao Paulo, Sao Paulo, Brazil
| | - Fumihide Itokawa
- Department of Gastroenterology and Hepatology, Tokyo Adventist Hospital, Tokyo, Japan
| | - Jan Werner Poley
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Girish Mishra
- Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, China
| | | | | | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Spain
| | | | - Kenjiro Yasuda
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Kensuke Kubota
- Department of Endoscopy, Yokohama City University School of Medicine, Yokohama, Japan
| | | | | | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan
| | - Mohamed El-Nady
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nam Q Nguyen
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Peter Vilmann
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | | | - Subbaramiah Sridhar
- Section of Gastroenterology/Hepatology, Augusta University, Augusta, GA, USA
| | - Sundeep Lakhtakia
- Asian Institute of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Todd H Baron
- Division of Gastroenterology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vinay Dhir
- Department of Gastroenterology, SL Raheja Hospital, Mumbai, Maharashtra, India
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Jyotsna VP, Pal S, Kandasamy D, Gamanagatti S, Garg PK, Raizada N, Sahni P, Bal CS, Tandon N, Ammini AC. Evolving management of insulinoma: Experience at a tertiary care centre. Indian J Med Res 2017; 144:771. [PMID: 28361831 PMCID: PMC5393089 DOI: 10.4103/ijmr.ijmr_1477_14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND & OBJECTIVES Since our previous study in 2006, several new modalities for localization of cause of endogenous hyperinsulinemic hypoglycaemia such as multiphasic computed tomography (CT), multiphasic magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), intraoperative ultrasound, and intra-arterial calcium infusion with arterial stimulation venous sampling (ASVS) have become available. Therefore, to evaluate the relative usefulness of various imaging modalities to guide future management in terms of diagnosis and patient care, we analyzed presentation and management of patients of endogenous hyperinsulinemic hypoglycaemia. METHODS In this retrospective study, medical records of patients admitted with endogenous hyperinsulinemic hypoglycaemia were retrieved. Data pertaining to clinical features, diagnosis, imaging, surgery and patient outcome were extracted. The localization of insulinoma by preoperative imaging techniques was compared with the findings at surgery to assess the accuracy of localization. RESULTS Fasting hypoglycaemia was present in all, and post-prandial hypoglycaemia (plasma glucose ≤50 mg/dl within four hours of meal) in 25.8 per cent. Mean duration of symptoms before reaching a diagnosis of hyperinsulinemic hypoglycaemia was 3.9 years. Mean duration of provocative fast was 21.8 h (range 6-48 h). Among the currently used imaging modalities, the sensitivity of localizing tumour was 79.3 per cent for multiphasic CT, 85 per cent for multiphasic MRI and 95 per cent for EUS. EUS detected tumour missed by both CT and MRI. All, except one of the operated patients, were cured by surgery. INTERPRETATION & CONCLUSIONS Our results suggest that patients with insulinoma have a varied presentation. Multiphasic contrast-enhanced MRI/CT scan, EUS and ASVS may be complimentary in pre-operative localization.
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Affiliation(s)
- Viveka P Jyotsna
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Sujoy Pal
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - D Kandasamy
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - S Gamanagatti
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - P K Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - N Raizada
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Peush Sahni
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - C S Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - N Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - A C Ammini
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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50
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Bopanna S, Nayak B, Prakash S, Shalimar, Mahapatra SJ, Garg PK. Increased oxidative stress and deficient antioxidant levels may be involved in the pathogenesis of idiopathic recurrent acute pancreatitis. Pancreatology 2017; 17:529-533. [PMID: 28687456 DOI: 10.1016/j.pan.2017.06.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 01/31/2017] [Revised: 04/17/2017] [Accepted: 06/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increased Oxidative Stress (OS) is implicated in the pathogenesis of Chronic Pancreatitis (CP). Whether or not OS contributes to disease progression through the stages of Recurrent Acute Pancreatitis(RAP), to CP is not known. Increased OS, if present in RAP could be an important therapeutic target in preventing progression of RAP to CP. OBJECTIVE To assess the oxidative stress and antioxidant status in patients with idiopathic RAP. METHODS 50 consecutive patients with Idiopathic Recurrent Acute Pancreatitis (IRAP) were included. Markers of OS [4-hydroxynonenol (4-HNE), malondialdehyde (MDA) and serum SOD (S-SOD)] and antioxidant status [ferric reducing the ability of plasma (FRAP), Glutathione peroxidase (GPX) and Vitamin C (Vit C)] were measured in quiescent phase and during an episode of pancreatitis. Their levels were compared with those in age and sex matched healthy controls and patients with CP. RESULTS The mean age of patients with IRAP was 22.2 ± 7.7 years and 39 (78%) were males. Levels of 4-HNE were significantly increased in patients with IRAP compared with healthy controls (3.03 ± 2.35 vs. 2.12 ± 1.29 ng/ml; p = 0.03) and were even higher during an episode of acute pancreatitis (5.21 ± 3.51 ng/ml; p = 0.03). Antioxidant levels were reduced in IRAP compared with healthy controls as measured by FRAP (707.0 ± 144.9 vs. 528.8 ± 120.0 μmol/Fe2+liberated; p = 0.0001) and GPX (1472 ± 375.7 vs. 910.0 ± 558.5 pg/ml; p = 0.001). OS and antioxidant profiles were similar in IRAP and CP with no significant difference. CONCLUSION OS is increased in patients with IRAP, more so during an acute episode. Antioxidant levels are also reduced suggesting that OS may play a role in the pathogenesis of IRAP and its progression to CP.
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Affiliation(s)
- Sawan Bopanna
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Baibaswat Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Prakash
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
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