1
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Challa A, Maras JS, Nagpal S, Tripathi G, Taneja B, Kachhawa G, Sood S, Dhawan B, Acharya P, Upadhyay AD, Yadav M, Sharma R, Bajpai M, Gupta S. Multi-omics analysis identifies potential microbial and metabolite diagnostic biomarkers of bacterial vaginosis. J Eur Acad Dermatol Venereol 2024. [PMID: 38284174 DOI: 10.1111/jdv.19805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/06/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Bacterial vaginosis (BV) is a common clinical manifestation of a perturbed vaginal ecology associated with adverse sexual and reproductive health outcomes if left untreated. The existing diagnostic modalities are either cumbersome or require skilled expertise, warranting alternate tests. Application of machine-learning tools to heterogeneous and high-dimensional multi-omics datasets finds promising potential in data integration and may aid biomarker discovery. OBJECTIVES The present study aimed to evaluate the potential of the microbiome and metabolome-derived biomarkers in BV diagnosis. Interpretable machine-learning algorithms were used to evaluate the utility of an integrated-omics-derived classification model. METHODS Vaginal samples obtained from reproductive-age group women with (n = 40) and without BV (n = 40) were subjected to 16S rRNA amplicon sequencing and LC-MS-based metabolomics. The vaginal microbiome and metabolome were characterized, and machine-learning analysis was performed to build a classification model using biomarkers with the highest diagnostic accuracy. RESULTS Microbiome-based diagnostic model exhibited a ROC-AUC (10-fold CV) of 0.84 ± 0.21 and accuracy of 0.79 ± 0.18, and important features were Aerococcus spp., Mycoplasma hominis, Sneathia spp., Lactobacillus spp., Prevotella spp., Gardnerella spp. and Fannyhessea vaginae. The metabolome-derived model displayed superior performance with a ROC-AUC of 0.97 ± 0.07 and an accuracy of 0.92 ± 0.08. Beta-leucine, methylimidazole acetaldehyde, dimethylethanolamine, L-arginine and beta cortol were among key predictive metabolites for BV. A predictive model combining both microbial and metabolite features exhibited a high ROC-AUC of 0.97 ± 0.07 and accuracy of 0.94 ± 0.08 with diagnostic performance only slightly superior to the metabolite-based model. CONCLUSION Application of machine-learning tools to multi-omics datasets aid biomarker discovery with high predictive performance. Metabolome-derived classification models were observed to have superior diagnostic performance in predicting BV than microbiome-based biomarkers.
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Affiliation(s)
- A Challa
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - J S Maras
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S Nagpal
- TCS Research, Tata Consultancy Services Ltd, Pune, India
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - G Tripathi
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - B Taneja
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - G Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - S Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - B Dhawan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - P Acharya
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - A D Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - M Yadav
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - R Sharma
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - M Bajpai
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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2
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Pal P, Bhatta R, Bhattarai R, Acharya P, Singh S, Harries AD. Antimicrobial resistance in bacteria isolated from the poultry production system in Nepal. Public Health Action 2022; 12:165-170. [PMID: 36561909 PMCID: PMC9716825 DOI: 10.5588/pha.22.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
SETTING Twenty poultry farms in five provinces of Nepal were selected for studying bacterial pathogens and their antimicrobial resistance (AMR) patterns. OBJECTIVE To document the proportion of cloacal swabs collected from 3,230 broiler and 3,230 layer chickens from September to December 2021 that grew isolates of Escherichia coli, Enterococcus spp. and Salmonella spp. along with their AMR patterns. DESIGN This was a cross-sectional descriptive study. RESULTS In broiler birds, Enterococcus spp., Salmonella spp. and E. coli were identified in respectively 36%, 39% and 63% of swabs. In layer birds, Enterococcus spp., Salmonella spp. and E. coli were identified in respectively 31%, 48% and 60% of swabs. For both bird types, there was variation in bacterial prevalence between the regions. For all three bacterial isolates, the lowest antimicrobial resistance was found with amikacin. For the other nine antibiotics tested, >50% of bacterial isolates showed resistance; between 60% and 90% of isolates showed resistance to ciprofloxacin and trimethoprim-sulfamethoxazole. Multidrug resistance ranged from 45% to 46% for Salmonella spp., 37-44% for E. coli and 13-17% for Enterococcus spp. CONCLUSION This study shows that a large proportion of poultry in Nepal are infected with potentially pathogenic bacteria, and these are frequently resistant to commonly used antibiotics. Nepal urgently needs to implement corrective measures.
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Affiliation(s)
- P. Pal
- Agriculture and Forestry University, Chitwan, Nepal
| | - R. Bhatta
- Agriculture and Forestry University, Chitwan, Nepal
| | - R. Bhattarai
- Agriculture and Forestry University, Chitwan, Nepal
| | - P. Acharya
- Agriculture and Forestry University, Chitwan, Nepal
| | - S. Singh
- Agriculture and Forestry University, Chitwan, Nepal
| | - A. D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
, London School of Hygiene & Tropical Medicine, London, UK
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3
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Bagher-Ebadian H, Nagaraja T, Cabral G, Farmer K, Valadie O, Acharya P, Movsas B, Brown S, Chetty I, Ewing J. An Unsupervised Autoencoder Developed from Dynamic Contrast-Enhanced (DCE)-MRI Datasets for Classification of Acute Tumor Response in an Animal Model. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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4
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Dugani P, Mehta A, Furtado SV, Pradeep R, Javali M, Acharya P, Thyagaraj V, Srinivasa R. Spectrum of neurological manifestations among acute COVID-19 and long COVID-19 – A retrospective observational study. Ro J Neurol 2022. [DOI: 10.37897/rjn.2022.2.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective. Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological symptoms. To compare the clinical features, imaging and treatments in patients with and without COVID-19. To compare the mortality and in-hospital stay among patients with and without COVID-19 and negative patients. Materials and methods. In this retrospective, single-center study, we included all the patients who attended the department of neurology with neurologic symptoms with confirmed COVID-19 and long COVID-19 from June 2020 to January 2021. Data on clinical signs, diagnosis, laboratory findings were collected and analyzed from the records for positive patients and compared with neurologic patients without COVID-19 admitted in the same period. Statistical analysis: The mean values between study groups were compared using an independent sample t-test and Mann Whitney u test. Categorical outcomes were compared using the Chi square test. Data was analyzed using coGuide software. Results. Headache was the common neurologic manifestation present in COVID positive patients compared to COVID negative patients (39.13%). There was no statistically significant difference between the two groups in baseline parameters. Laboratory parameters like CRP, Serum Ferritin, LDH, D-dimer, ESR, and IL-6 showed a significant increase in COVID positive patients (P <0.05). In-hospital mortality was more in COVID positive patients than COVID negative patients (P <0.011). Conclusion. The study showed varied neurologic symptoms in COVID patients, with headache as the common symptom. Hospital stay, morbidity, mortality, and inflammatory parameters were more in COVID positive patients compared to COVID negative patients.
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5
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Birnbaum R, Barzilay R, Brusilov M, Acharya P, Malinger G, Krajden Haratz K. Early second-trimester three-dimensional transvaginal neurosonography of fetal midbrain and hindbrain: normative data and technical aspects. Ultrasound Obstet Gynecol 2022; 59:317-324. [PMID: 34002885 DOI: 10.1002/uog.23691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/11/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To provide a detailed description of the sonographic appearance and development of various fetal structures of the midbrain and hindbrain (MBHB) during the early second trimester, and to evaluate the impact of the frequency of the transvaginal sonography (TVS) transducer on the early recognition of these structures. METHODS This was a retrospective analysis of three-dimensional volumetric datasets of the MBHB from apparently normal fetuses at 14-19 gestational weeks, acquired by TVS in the midsagittal view through the posterior fontanelle. Using a multiplanar approach, we measured the tectal thickness and length, aqueductal thickness, tegmental thickness and width and height of the Blake's pouch (BP) neck. In addition, we assessed the existence of early vermian fissures, the linear shape of the brainstem and the components of the fastigium. The correlation between gestational age according to last menstrual period and sonographic measurements of MBHB structures was evaluated using Pearson's correlation (r). A subanalysis was performed to assess the performance of a 5-9-MHz vs a 6-12-MHz TVS transducer in visualizing the MBHB structures in the early second trimester. RESULTS Sixty brain volumes were included in the study, obtained at a mean gestational age of 16.2 weeks (range, 14.1-19.0 weeks), with a transverse cerebellar diameter range of 13.0-19.8 mm. We found a strong correlation between gestational age and all MBHB measurements, with the exception of the tectal, tegmental and aqueductal thicknesses, for which the correlation was moderate. There was good-to-excellent intraobserver and moderate-to-good interobserver correlation for most MBHB measurements. We observed that the BP neck was patent in all fetuses between 14 and 18 weeks with decreasing diameter, and that the aqueductal thickness was significantly smaller at ≥ 18 weeks compared with at < 16 weeks. The early vermian fissures and the linear shape of the brainstem were present in all fetuses from 14 weeks. We found that, in the early second trimester, the horizontal arm of the presumed 'fastigium' evolves from the fourth ventricular choroid plexus and not the posterior vermis, indicating that this is not the fastigium. Standard- and high-resolution TVS transducers performed similarly in the assessment of MBHB anatomy. CONCLUSION Detailed early second-trimester assessment of the MBHB is feasible by transvaginal neurosonography and provides reference data which may help in the early detection of brain pathology involving the MBHB. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Birnbaum
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Barzilay
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
| | - M Brusilov
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Acharya
- Paras Advanced Center for Fetal Medicine, Ahmedabad, India
| | - G Malinger
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Krajden Haratz
- Ob-Gyn Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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6
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Ampar N, Mehta A, Mahale RR, Javali M, Pradeep R, Acharya P, Srinivasa R. Electrophysiological Evaluation of Audiovestibular Pathway Dysfunction in Parkinson's Disease and Its Correlates: A Case Control Study. Ann Indian Acad Neurol 2021; 24:531-535. [PMID: 34728946 PMCID: PMC8513948 DOI: 10.4103/aian.aian_1011_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Parkinson's disease (PD) is associated with brainstem dysfunction causing non-motor symptoms. Vestibular evoked myogenic potential (VEMP) and brainstem auditory evoked potential (BAEP) are electrophysiological tests to assess the vestibular and auditory pathways in the brainstem. Objectives: To study the abnormalities of cervical VEMP (cVEMP) and BAEP in PD and to correlate the findings with the symptoms related to brainstem involvement. Patients and Methods: cVEMP and BAEP were recorded in 25 PD patients and compared 25 age matched controls. The PD patients were assessed with the following clinical scales: REM Sleep Disorder Screening Questionnaire (RBD-SQ), Epworth Sleepiness Scale (ESS), mini-BESTest, Geriatric Depression Scale (GDS-15) and MMSE (Mini-mental state examination). The P13 and N23 peak latencies and the P13/N23 amplitude of cVEMP, the latencies of waves I, III and V, and the inter-peak latencies (IPL) of waves I-III, III-V and I-V of BAEP were measured. Results: The PD patients showed prolonged latencies and reduced amplitude in cVEMP responses. They had abnormal BAEP in the form of prolonged absolute latencies of wave V, followed by wave III and I–V IPL with no significant difference in waves I and I–III IPL. The cVEMP abnormality was correlated directly with RBD-SQ and inversely with mini-BESTest scores. There were no correlations between cVEMP/BAEP abnormality and disease severity, GDS-15, ESS and MMSE. Conclusion: PD is associated with cVEMP and BAEP abnormalities that suggest auditory and vestibular pathway dysfunction in the brainstem and cVEMP correlates with the symptoms of brainstem degeneration like RBD and postural instability.
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Affiliation(s)
- Nikith Ampar
- Department of Neurology, Ramaiah Medical College, Bangalore, India
| | - Anish Mehta
- Department of Neurology, Ramaiah Medical College, Bangalore, India
| | - Rohan R Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Mahendra Javali
- Department of Neurology, Ramaiah Medical College, Bangalore, India
| | - R Pradeep
- Department of Neurology, Ramaiah Medical College, Bangalore, India
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7
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Venugopal A, Acharya P, Kishore MS. Extensive intracranial calcification in idiopathic hypoparathyroidism : Rare presentation in an adolescent. Indian J Radiol Imaging 2021. [DOI: 10.4103/0971-3026.29083] [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] [Indexed: 11/04/2022] Open
Affiliation(s)
- A Venugopal
- Department of Radodiagnosis, City hospital & Kasturba Medical Colllege, Mangalore-1, Karnataka, INDIA
| | - P Acharya
- Department of Radodiagnosis, City hospital & Kasturba Medical Colllege, Mangalore-1, Karnataka, INDIA
| | - M S Kishore
- Department of Radodiagnosis, City hospital & Kasturba Medical Colllege, Mangalore-1, Karnataka, INDIA
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8
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Miryala A, Javali M, Mehta A, Pradeep R, Acharya P, Srinivasa R. Study of Short Latency Somatosensory and Brain Stem Auditory Evoked Potentials Patients with Acute Ischemic Stroke Involving Middle Cerebral Artery Territory. J Neurosci Rural Pract 2021; 12:478-482. [PMID: 34295101 PMCID: PMC8289523 DOI: 10.1055/s-0041-1727558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background
The precise timings of evoked potentials in evaluating the functional outcome of stroke have remained indistinct. Few studies in the Indian context have studied the outcome of early prognosis of stroke utilizing evoked potentials.
Objective
The aim of this study was to determine somatosensory evoked potentials (SSEPs) and brain stem auditory evoked potentials (BAEPs), their timing and abnormalities in acute ischemic stroke involving the middle cerebral artery (MCA) territory and to correlate SSEP and BAEP with the functional outcome (National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS) and Barthel’s index) at 3 months.
Methods
MCA territory involved acute ischemic stroke patients (
n
= 30) presenting consecutively to the hospital within 3 days of symptoms onset were included. Details about clinical symptoms, neurological examination, treatment, NIHSS score, mRS scores were collected at the time of admission. All patients underwent imaging of the brain and were subjected to SSEP and BAEP on two occasions, first at 1 to 3 days and second at 4 to 7 days from the onset of stroke. At 3 months of follow-up, NIHSS, mRS, and Barthel’s index were recorded.
Results
P37 and N20 amplitude had a strong negative correlation (at 1–3 and 4–7 days) with NIHSS at admission, NIHSS at 3 months, mRS at admission, and mRS at 3 months and a significant positive correlation with Barthel’s index (
p
< 0.0001). BAEP wave V had a negative correlation (at 1–3 and 4–7 days) with NIHSS at admission, NIHSS at 3 months, mRS at admission, and mRS at 3 months and a positive correlation with Barthel’s index (
p
< 0.0001).
Conclusion
SSEP abnormalities recorded on days 4 to 7 from onset of stroke are more significant than those recorded within 1 to 3 days of onset of stroke; hence, the timing of 4 to 7 days after stroke onset can be considered as better for predicting functional outcome.
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Affiliation(s)
- Abhishek Miryala
- Department of Neurology, MS Ramaiah Medical College & Hospital, Bengaluru, Karnataka, India
| | - Mahendra Javali
- Department of Neurology, MS Ramaiah Medical College & Hospital, Bengaluru, Karnataka, India
| | - Anish Mehta
- Department of Neurology, MS Ramaiah Medical College & Hospital, Bengaluru, Karnataka, India
| | - R Pradeep
- Department of Neurology, MS Ramaiah Medical College & Hospital, Bengaluru, Karnataka, India
| | - Purushottam Acharya
- Department of Neurology, MS Ramaiah Medical College & Hospital, Bengaluru, Karnataka, India
| | - Rangasetty Srinivasa
- Department of Neurology, MS Ramaiah Medical College & Hospital, Bengaluru, Karnataka, India
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9
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Muduli PR, Kumar A, Kanuri VV, Mishra DR, Acharya P, Saha R, Biswas MK, Vidyarthi AK, Sudhakar A. Water quality assessment of the Ganges River during COVID-19 lockdown. Int J Environ Sci Technol (Tehran) 2021; 18:1645-1652. [PMID: 33758592 PMCID: PMC7970803 DOI: 10.1007/s13762-021-03245-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/07/2021] [Accepted: 02/25/2021] [Indexed: 05/24/2023]
Abstract
Ganges River water quality was assessed to record the changes due to the nation-wide pandemic lockdown. Satellite-based (Sentinel-2) water quality analysis before and during lockdown was performed for seven selected locations spread across the entire stretch of the Ganges (Rishikesh-Dimond Harbour). Results revealed that due to the lockdown, the water quality of the Ganges improved with reference to specific water quality parameters, but the improvements were region specific. Along the entire stretch of Ganges, only the Haridwar site showed improvement to an extent of being potable as per the threshold set by the Central Pollution Control Board, New Delhi, India. A 55% decline in turbidity at that site during the lockdown was attributed to the abrupt halt in pilgrimage activities. Absorption by chromophoric dissolved organic matter which is an indicator of organic pollution declined all along the Ganges stretch with a maximum decline at the downstream location of Diamond Harbour. Restricted discharge of industrial effluent, urban pollution, sewage from hotels, lodges, and spiritual dwellings along the Ganges are some of the reasons behind such declines. No significant change in the geographic trend of chlorophyll-a was observed. The findings of this study highlight the importance of regular monitoring of the changes in the Ganges water quality using Sentinel-2 data to further isolate the anthropogenic impact, as India continues the phase-wise opening amidst the pandemic.
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Affiliation(s)
- P. R. Muduli
- Wetland Research and Training Centre, Chilika Development Authority, Balugaon, 752030 India
| | - A. Kumar
- Department of Geography, University of Georgia, Athens, GA 30602 USA
| | - V. V. Kanuri
- Eastern Regional Directorate (ERD), Ministry of Environment, Forest and Climate Change, National Ganga River Basin Authority, Central Pollution Control Board, 5th and 6th floor, Southend conclave, Rajdanga Main Road, Kolkata, West Bengal 700107 India
| | - D. R. Mishra
- Department of Geography, University of Georgia, Athens, GA 30602 USA
| | - P. Acharya
- Wetland Research and Training Centre, Chilika Development Authority, Balugaon, 752030 India
| | - R. Saha
- Eastern Regional Directorate (ERD), Ministry of Environment, Forest and Climate Change, National Ganga River Basin Authority, Central Pollution Control Board, 5th and 6th floor, Southend conclave, Rajdanga Main Road, Kolkata, West Bengal 700107 India
| | - M. K. Biswas
- Eastern Regional Directorate (ERD), Ministry of Environment, Forest and Climate Change, National Ganga River Basin Authority, Central Pollution Control Board, 5th and 6th floor, Southend conclave, Rajdanga Main Road, Kolkata, West Bengal 700107 India
| | - A. K. Vidyarthi
- Central Pollution Control Board, Ministry of Environment, Forest and Climate Change, New Delhi, India
| | - A. Sudhakar
- Central Pollution Control Board, Ministry of Environment, Forest and Climate Change, New Delhi, India
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10
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Shankar AK, Javali M, Mehta A, Pradeep R, Mahale R, Acharya P, Srinivasa R. Role of High Frequency Oscillations of Somatosensory Evoked Potentials in Deciphering Pathophysiology of Migraine. J Neurosci Rural Pract 2021; 12:12-15. [PMID: 33531754 PMCID: PMC7846343 DOI: 10.1055/s-0040-1716793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Habituation deficit is considered as a neurophysiological abnormality among migraineurs in the interictal period. For clear comprehension and clarity about the mechanism underlying habituation in migraine, a sophisticated method, i.e., high frequency oscillations (HFOs) evoked potentials, have been utilized. However, studies pertaining to this in the Indian context are rare.
Objective
The aim of the study is to determine the utility of HFO of somatosensory evoked potential (SSEP) in deciphering the pathophysiology of migraine.
Materials and Methods
Sixty subjects including 30 migraineurs in the interictal period and 30 healthy controls were considered for the study. Median nerve SSEP was recorded in patients and controls by standard protocols. HFO was extracted offline using the Digital zero-phase shift band-pass filtering at 450 and 750 Hz. The early and late HFOs were determined with respect to the N20 peak and were compared between the groups.
Results
Of total 30 migraineurs, 18 had hemicranial headache and 12 had holocranial headache. N20 latency, P25 latency, N20 onset to peak amplitude, and N20 onset to P25 amplitude were comparable in migraineurs and controls. The intraburst frequency of early HFOs in migraineurs was significantly higher (
p
= 0.04), whereas the peak-to-peak amplitude was significantly lower (
p
= 0.001).
Conclusion
Early HFOs on SSEP represent the thalamocortical excitatory drive in migraineurs. Overall, the study reports that reduced amplitude of early HFOs in the interictal period suggest reduced thalamocortical drive in migraineurs.
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Affiliation(s)
- Abhinandan K Shankar
- Department of neurology, MS Ramaiah Medical College & Hospital, Bengaluru, Karnataka, India
| | - Mahendra Javali
- Department of neurology, MS Ramaiah Medical College & Hospital, Bengaluru, Karnataka, India
| | - Anish Mehta
- Department of neurology, MS Ramaiah Medical College & Hospital, Bengaluru, Karnataka, India
| | - R Pradeep
- Department of neurology, MS Ramaiah Medical College & Hospital, Bengaluru, Karnataka, India
| | - Rohan Mahale
- Department of neurology, MS Ramaiah Medical College & Hospital, Bengaluru, Karnataka, India
| | - Purushottam Acharya
- Department of neurology, MS Ramaiah Medical College & Hospital, Bengaluru, Karnataka, India
| | - Rangasetty Srinivasa
- Department of neurology, MS Ramaiah Medical College & Hospital, Bengaluru, Karnataka, India
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11
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Mastoris I, Acharya P, Haglund N, Sauer A, Shah Z. All cause 30 readmission in patients with history of sudden cardiac arrest. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1857] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Sudden cardiac arrest (SCA) remains a significant cause of morbidity and mortality. Current evidence on readmission rates and causes after SCA are scarce.
Purpose
To describe patient characteristics, predictors of readmission and outcomes patients with history of sudden cardiac arrest and 30-day readmission
Methods
We analyzed the National Readmission Database for years 2016 and 2017 to identify all patients with initial diagnosis of SCA and 30 days readmission after the initial event. We analyzed baseline characteristics and looked into predictors, outcomes and diagnoses of re-admission.
Results
We identified 79,844 patients with an initial diagnosis of SCA that were discharged alive after index admission. Of those 14,387 (18.01%) had one readmission and 3,978 (4.99%) had more than one readmission. The mean age was 64 years and 41.3% were females. Hypertension, dyslipidemia, diabetes, CAD, CHF and CKD were present in 76.5%, 42.4%, 46.3%, 50.4%, 62.3% and 43.5% respectively. Overall mortality was 9.1% and length of stay 7.8 days. (Table 1). Congestive heart failure was the predominant diagnosis for readmission (Figure). Female sex (HR=0.93; p=0.004) was the only independent risk factor for all cause readmission.
Conclusions
Patients with history of SCA that have a 30-day readmission have significantly more comorbidities and length of day. Congestive heart failure is the predominant diagnosis for readmission
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- I Mastoris
- University of Kansas Medical Center, Kansas City, United States of America
| | - P Acharya
- University of Kansas Medical Center, Kansas City, United States of America
| | - N Haglund
- University of Kansas Medical Center, Kansas City, United States of America
| | - A Sauer
- University of Kansas Medical Center, Kansas City, United States of America
| | - Z Shah
- University of Kansas Medical Center, Kansas City, United States of America
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12
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Mathur M, Acharya P, Karki A. Grouped Red Vesicles in the Axilla. Actas Dermo-Sifiliográficas (English Edition) 2020. [DOI: 10.1016/j.adengl.2020.09.002] [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: 10/23/2022] Open
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13
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Mathur M, Acharya P, Karki A. Vesículas rojas agrupadas en la axila. Actas Dermo-Sifiliográficas 2020; 111:681-682. [DOI: 10.1016/j.ad.2019.01.024] [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] [Received: 12/10/2018] [Accepted: 01/03/2019] [Indexed: 10/24/2022] Open
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14
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Dharel D, Bhattarai A, Paudel YR, Acharya P, Acharya K. Higher rates of early initiation of breastfeeding associated with health facility delivery in Nepal. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Initiation of breastfeeding within one hour from birth is one of the five key essential newborn care messages, implemented along with birth preparedness package since 2008. This study aimed to determine the trend of early initiation of breastfeeding (EIBF) and to assess the effect of health facility delivery on EIBF in Nepal.
Methods
We analyzed the data from the last four nationally representative Nepal Demographic and Health Surveys (NDHS) conducted in 2001,2006,2011 and 2016. Data on the early initiation of breastfeeding was obtained from the mothers of infants born within 24 months prior to the survey. The explanatory variable was the place of delivery, dichotomized as either the health facility, or home delivery. Survey year had a significant interaction with the place of delivery. Multivariable logistic regression was conducted separately on pooled samples before (NDHS 2001 and 2006) and after (NDHS 2011 and 2016) the program implementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) for EIBF was calculated after adjusting for predetermined covariates.
Results
The rate of EIBF increased by 26.5% points (from 32.8% in 2001 to 59.3% in 2016) among infants delivered in a health facility, compared to an increase by 17.1% points (from 29.9% to 47.0%) among home born infants. EIBF increased by 32.5% points before, compared to 49.7% points after BPP. Delivery in a health facility was associated with a higher odd of EIBF in later years (AOR2.3, 95% CI 2.0,2.8), but not in earlier years (AOR1.3, 95% CI 0.9,2.0). Delivery by caesarean section, first-born infant, and lack of maternal education were associated with a lower rate of EIBF in both periods.
Conclusions
Higher EIBF was associated with health facility delivery in Nepal, only after programmatic emphasis on essential newborn care messages. This implies the need for explicit focus on EIBF at birth, particularly when mother is less educated, primiparous or undergoing operative delivery.
Key messages
The rate of initiation of breastfeeding within an hour from birth is increasing in Nepal, with higher rates in health facility delivery, as shown by the recent four nationally representative surveys. Programmatic focus on essential newborn care messages may have contributed to significant association of higher rates of early initiation of breastfeeding when delivered in health facility.
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Affiliation(s)
- D Dharel
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - A Bhattarai
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Y R Paudel
- School of Public Health, University of Alberta, Edmonton, Canada
| | - P Acharya
- Nepal Development Society, Bharatpur, Nepal
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Acharya P, Lau AWC. Charge regulation of a surface immersed in an electrolyte solution. Eur Phys J E Soft Matter 2020; 43:54. [PMID: 32794084 DOI: 10.1140/epje/i2020-11978-3] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/15/2020] [Indexed: 06/11/2023]
Abstract
In this paper, we investigate theoretically a model of charge regulation of a single charged planar surface immersed in an aqueous electrolyte solution. Assuming that the adsorbed ions are mobile in the charged plane, we formulate a field theory of charge regulation where the numbers of adsorbed ions can be determined consistently by equating the chemical potentials of the adsorbed ions to that of the ions in the bulk. We analyze the mean-field treatment of the model for electrolyte of arbitrary valences, and then beyond, where correlation effects are systematically taken into account in a loop expansion. In particular, we compute exactly various one-loop quantities, including electrostatic potentials, ion distributions, and chemical potentials, not only for symmetric (1, 1) electrolyte but also for asymmetric (2, 1) electrolyte, and make use of these quantities to address charge regulation at the one-loop level. We find that correlation effects give rise to various phase transitions in the adsorption of ions, and present phase diagrams for (1, 1) and (2, 1) electrolytes, whose distinct behaviors suggest that charge regulation, at the one-loop level, is no longer universal but depends crucially on the valency of the ions.
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Affiliation(s)
- P Acharya
- Department of Physics, Florida Atlantic University, 33431, Boca Raton, FL, USA
| | - A W C Lau
- Department of Physics, Florida Atlantic University, 33431, Boca Raton, FL, USA.
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16
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Acharya P, Mathur M. Low‐dose naltrexone in Hailey–Hailey disease: the importance of dosing. Br J Dermatol 2020; 183:193. [DOI: 10.1111/bjd.19014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- P. Acharya
- College of Medical Sciences, Department of Dermatology Bharatpur Nepal 44200
| | - M. Mathur
- College of Medical Sciences, Department of Dermatology Bharatpur Nepal 44200
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Acharya P, Mathur M. Smartphone applications for the triage of skin lesions using machine learning: time to integrate the clinical information? J Eur Acad Dermatol Venereol 2020; 34:e424-e425. [DOI: 10.1111/jdv.16371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/24/2020] [Accepted: 03/06/2020] [Indexed: 01/13/2023]
Affiliation(s)
- P. Acharya
- College of Medical Sciences Bharatpur Nepal
| | - M. Mathur
- College of Medical Sciences Bharatpur Nepal
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18
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Affiliation(s)
- P. Acharya
- College of Medical Sciences, Department of Dermatology Bharatpur Nepal 44200
| | - M. Mathur
- College of Medical Sciences, Department of Dermatology Bharatpur Nepal 44200
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Acharya P, Mathur M. Artificial intelligence in dermatology: the "unsupervised" learning. Br J Dermatol 2020:bjd.18933. [PMID: 32030726 DOI: 10.1111/bjd.18933] [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: 06/10/2023]
Abstract
The potential areas of application of artificial intelligence in dermatology are ever-increasing. With the wide availability of smartphones equipped with high-resolution cameras and impressive processing powers, harnessing these capabilities using machine learning (ML) could open new prospects in the management of dermatological disorders. Du-Harpur et al. have done a commendable job reviewing the utility of artificial intelligence in dermatology in an easily understandable manner by most dermatologists1 .
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Affiliation(s)
- P Acharya
- College of Medical Sciences, Department of Dermatology, Bharatpur, Nepal, 44200
| | - M Mathur
- College of Medical Sciences, Department of Dermatology, Bharatpur, Nepal, 44200
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20
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Mehta A, Mahale R, Khanapure K, Jagannatha AT, Acharya P, Srinivasa R. Acute Hydrocephalus in a Case of Mumps Meningoencephalitis: A Rare Occurrence. J Pediatr Neurosci 2020; 15:34-37. [PMID: 32435304 PMCID: PMC7227755 DOI: 10.4103/jpn.jpn_58_19] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 11/23/2022] Open
Abstract
Mumps is an acute viral illness, which presents with glandular and/or nervous system involvement. The most common central nervous system manifestations of mumps include aseptic meningitis and meningoencephalitis. Mumps meningoencephalitis, which is characterized by fever, vomiting, nuchal rigidity, and altered sensorium, usually develops at least 3-10 days after mumps parotitis. Acute hydrocephalus secondary to mumps meningoencephalitis is rare. Here we report a child who developed acute hydrocephalus following mumps meningoencephalitis and who was treated with external ventricular drainage following which he showed exceptional recovery.
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Affiliation(s)
- Anish Mehta
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rohan Mahale
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India,Address for correspondence: Dr. Rohan Mahale, Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru 560054, Karnataka, India. E-mail:
| | - Kiran Khanapure
- Department of Neurosurgery, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Anirudh T Jagannatha
- Department of Neurosurgery, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Purushottam Acharya
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rangasetty Srinivasa
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
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Mehta A, Mahale R, Buddaraju K, Javali M, Acharya P, Srinivasa R. Efficacy of Neuroprotective Drugs in Acute Ischemic Stroke: Is It Helpful? J Neurosci Rural Pract 2019; 10:576-581. [PMID: 31831974 PMCID: PMC6906097 DOI: 10.1055/s-0039-1700790] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background
Out of several neuroprotective drugs (NPDs) studied in animals and humans, four NPDs (citicoline, edaravone, cerebrolysin, and minocycline) have been found to have beneficial effects in acute ischemic stroke (AIS).
Objective
The purpose is to evaluate the efficacy of citicoline, edaravone, minocycline, and cerebrolysin compared with placebo in patients with middle cerebral artery (MCA) territory AIS.
Materials and Methods
This was a prospective, single center, single-blinded, and hospital-based study. One hundred patients with MCA territory AIS with 20 patients in each group including control group were included. Barthel index (BI), National Institute of Health Stroke Scale (NIHSS) score, and modified Rankin Scale score were recorded at admission, at day 11 and after 90 days.
Results
The mean NIHSS score was significantly lesser at day 11 and after 90 days in citicoline, edaravone, and cerebrolysin group in comparison with placebo. Similarly, the mean BI score was significantly higher at day 11 and after 90 days in citicoline, edaravone, and cerebrolysin group in comparison with placebo. In minocycline group, there was no significant change in the NIHSS score and BI score at day 11 and after 90 days.
Conclusion
There was significant improvement in the functional outcome of patients with AIS involving MCA territory at 90 days receiving citicoline, edaravone, and cerebrolysin. However, minocycline did not offer the same efficacy as compared with other neuroprotective agents.
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Affiliation(s)
- Anish Mehta
- Department of Neurology, Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rohan Mahale
- Department of Neurology, Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Kiran Buddaraju
- Department of Neurology, Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Mahendra Javali
- Department of Neurology, Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Purushottam Acharya
- Department of Neurology, Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rangasetty Srinivasa
- Department of Neurology, Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
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Mathur M, Acharya P. Trichoscopy of primary cicatricial alopecias: an updated review. J Eur Acad Dermatol Venereol 2019; 34:473-484. [PMID: 31566830 DOI: 10.1111/jdv.15974] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 09/04/2019] [Indexed: 12/19/2022]
Abstract
Trichoscopy is an emerging technique for the evaluation of various hair and scalp disorders including primary cicatricial alopecias (PCAs). Early diagnosis of PCAs can lead to effective management and trichoscopy could be a useful aid during this process. Multiple studies have reported the trichoscopic features of PCAs, however, a focused review evaluating these disorders with their trichoscopic features is lacking. With the objective of evaluating the trichoscopic findings reported in the literature for various PCAs, we conducted a systematic literature search in PubMed and Embase. The search yielded 310 studies in a total of which 54 studies were included in our review. Majority of these studies originated from the Caucasian or Asian population. Through this review, we provide an overview of the frequent and specific trichoscopic findings in different PCAs with their clinical significance where applicable based on the current knowledge and identify the areas for future research.
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Affiliation(s)
- M Mathur
- Department of Dermatology, College of Medical Sciences, Bharatpur, Nepal
| | - P Acharya
- Department of Dermatology, College of Medical Sciences, Bharatpur, Nepal
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Mahale RR, Mehta A, Shankar AK, Miryala A, Acharya P, Srinivasa R. Bilateral Cerebral Hemorrhage in Herpes Simplex Encephalitis: Rare Occurrence. J Neurosci Rural Pract 2019; 7:S128-S130. [PMID: 28163530 PMCID: PMC5244048 DOI: 10.4103/0976-3147.196436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rohan R Mahale
- Department of Neurology, M.S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Anish Mehta
- Department of Neurology, M.S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Abhinandan K Shankar
- Department of Neurology, M.S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Abhishek Miryala
- Department of Neurology, M.S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Purushottam Acharya
- Department of Neurology, M.S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rangasetty Srinivasa
- Department of Neurology, M.S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
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Mahale R, Mehta A, Konnur A, Acharya P, Srinivasa R. Upper Limb Monochorea Due to Cerebral Venous Sinus Thrombosis: Rare Occurrence. Neurol India 2019; 67:1138-1139. [PMID: 31512659 DOI: 10.4103/0028-3886.266255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rohan Mahale
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Anish Mehta
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Akshay Konnur
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Purushottam Acharya
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - R Srinivasa
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
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Mehta A, Mahale R, Buddaraju K, Majeed A, Sharma S, Javali M, Acharya P, Srinivasa R. Intravenous Thrombolysis for Acute Ischemic Stroke: Review of 97 Patients. J Neurosci Rural Pract 2019; 8:38-43. [PMID: 28149079 PMCID: PMC5225719 DOI: 10.4103/0976-3147.193558] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Intravenous thrombolysis (IVT) has now become a standard treatment in eligible patients with acute ischemic stroke (AIS) who present within 4.5 h of symptom onset. OBJECTIVE To determine the usefulness of IVT and the subset of patients who will benefit from IVT in AIS within 4.5 h. MATERIALS AND METHODS Patients with AIS within 4.5 h of symptom onset who underwent IVT were studied prospectively. The study period was from October 2011 to October 2015. RESULTS A total of 97 patients were thrombolysed intravenously. The mean onset to needle time in all patients was 177.2 ± 62 min (range: 60-360). At 3 months follow-up, favorable outcome was seen in 65 patients (67.1%) and poor outcome including death in the remaining 32 patients (32.9%). Factors predicting favorable outcome was age <65 years (P = 0.02), the National Institute of Health Stroke Scale (NIHSS) <15 (P < 0.001), small vessel occlusion (P = 0.006), cardioembolism (P = 0.006), and random blood sugar (RBS) <250 mg/dl (P < 0.001). Factors predicting poor outcome was diabetes mellitus (P = 0.01), dyslipidemia (P = 0.01), NIHSS at admission >15 (P = 0.03), RBS >250 mg/dl (P = 0.01), Dense cerebral artery sign, age, glucose level on admission, onset-to-treatment time, NIHSS on admission score >5 (P = 0.03), and occlusion of large artery (P = 0.02). CONCLUSION Milder baseline stroke severity, blood glucose <250 mg/dL, younger patients (<65 years), cardioembolic stroke, and small vessel occlusion benefit from recombinant tissue plasminogen activator.
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Affiliation(s)
- Anish Mehta
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rohan Mahale
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Kiran Buddaraju
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Anas Majeed
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Suryanarayana Sharma
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Mahendra Javali
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Purushottam Acharya
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rangasetty Srinivasa
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
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Javali M, Acharya P, Shah S, Mahale R, Shetty P, Rangasetty S. Role of Biomarkers in Differentiating New-onset Seizures from Psychogenic Nonepileptic Seizures. J Neurosci Rural Pract 2019; 8:581-584. [PMID: 29204018 PMCID: PMC5709881 DOI: 10.4103/jnrp.jnrp_139_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Review of literature revealed very limited studies considering a combination of serum prolactin (PRL) and serum creatine kinase (CK) as markers for differentiating epileptic and psychogenic nonepileptic seizures (PNES). Therefore, in the present study, we analyzed the role of serum PRL and serum CK, individually and in combination. Methodology: This prospective study was conducted in a tertiary care medical teaching hospital over a period of 18 months. Patients aged over 15 years suspected to have new-onset seizures presenting within 5 h of ictus were included in this study. CK, serum PRL was measured at 0–1, 1–3, and 3–5 h after seizures. Results: Hundred subjects were studied for the role of serum PRL and serum CK in differentiating epileptic and PNES. The mean age was 42.24 years with a male:female ratio of 1.27:1. All patients of generalized tonic–clonic seizures (GTCS), who presented within 1 h, had elevated PRL, whereas 75% of patients with partial seizures had elevated PRL within 1 h of presentation. Nearly 91.66% of patients with GTCS who presented within 1 h had elevated CPK, whereas 70% of patients with partial seizures had elevated CPK. None of the patients diagnosed with PNES showed rise in either of the markers. Conclusion: In the present study, none of the patients with PNES showed raise in either serum PRL or CK. However, there was no correlation between the types of seizure and PRL or serum CK levels.
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Affiliation(s)
- Mahendra Javali
- Department of Neurology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Purushottam Acharya
- Department of Neurology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Shripal Shah
- Department of Neurology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Rohan Mahale
- Department of Neurology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Pushparaja Shetty
- Department of Neurology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Srinivasa Rangasetty
- Department of Neurology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
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Thongprayoon C, Acharya P, Acharya C, Chenbhanich J, Bathini T, Boonpheng B, Sharma K, Wijarnpreecha K, Ungprasert P, Gonzalez Suarez ML, Cheungpasitporn W. Hypocalcemia and bone mineral density changes following denosumab treatment in end-stage renal disease patients: a meta-analysis of observational studies. Osteoporos Int 2018; 29:1737-1745. [PMID: 29713798 DOI: 10.1007/s00198-018-4533-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 02/05/2018] [Accepted: 04/11/2018] [Indexed: 02/06/2023]
Abstract
The incidence of hypocalcemia and bone mineral density (BMD) changes in end-stage renal disease (ESRD) patients on denosumab remains unclear. We performed this meta-analysis to assess the incidence of denosumab-associated hypocalcemia and effects of denosumab on BMD in ESRD patients. A literature search was conducted using MEDLINE, EMBASE, and Cochrane Database from inception through November 2017 to identify studies evaluating incidence of denosumab-associated hypocalcemia and changes in serum calcium, phosphate, alkaline phosphatase (ALP), parathyroid hormone (PTH), and BMD from baseline to post-treatment course of denosumab in ESRD patients. Study results were pooled and analyzed using a random-effect model. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017081074). Six observational studies with a total of 84 ESRD patients were enrolled. The pooled estimated incidence of hypocalcemia during denosumab treatment was 42% (95% CI 29-55%, I2 = 0%). Hypocalcemia occurred approximately 7 to 20 days after the first dose and reached nadir of low calcium levels in the first 2 weeks up to 2 months. However, there were no significant changes in serum calcium or phosphate from baseline to post-treatment course (≥ 3 months after treatment) with mean differences [MDs] of 0.20 mg/dL (95% CI, - 0.30 to 0.69 mg/dL) and - 0.10 mg/dL (95% CI, - 0.70 to 0.49 mg/dL). There were significant reductions in ALP and PTH levels with standardized mean differences (SMDs) of - 0.65 (95% CI - 1.13 to - 0.16) and - 1.89 (95% CI - 3.44 to - 0.34), respectively. There were significant increases in T-scores with MDs of 0.39 (95% CI 0.10 to 0.69) and 0.79 (95% CI 0.60 to 0.98) for lumbar spine and femoral neck, respectively. Our study demonstrates the estimated incidence of denosumab-associated hypocalcemia in dialysis patients of 42%. From baseline to post-treatment course, although there are no differences in serum calcium and phosphate, our findings suggest significant reductions in ALP and PTH and a significant increase in BMD. Currently, denosumab should not be considered as the treatment of choice in ESRD patients until more safety and efficacy data are available.
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Affiliation(s)
- C Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - P Acharya
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Mississippi, 2500 N. State St., Jackson, MS, 39216, USA
| | - C Acharya
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Mississippi, 2500 N. State St., Jackson, MS, 39216, USA
| | - J Chenbhanich
- Department of Internal Medicine, Metrowest Medical Center, Framingham, MA, USA
| | - T Bathini
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - B Boonpheng
- Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - K Sharma
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - K Wijarnpreecha
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - P Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - M L Gonzalez Suarez
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Mississippi, 2500 N. State St., Jackson, MS, 39216, USA
| | - W Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Mississippi, 2500 N. State St., Jackson, MS, 39216, USA.
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Karmacharya RM, Devbhandari M, Tuladhar S, Shrestha B, Acharya P. Chest Trauma Requiring Admission: Differences in Earthquake Victims and other Modes of Injury. Kathmandu Univ Med J (KUMJ) 2018; 16:237-239. [PMID: 31719313] [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
Background The April 25, 2015 Nepal earthquake (7.8 Richter scale) followed by May 12, 2015 major aftershock (7.3 Richter scale) killed more than 9,000 people and injured more than 23,000 people. Dhulikhel Hospital situated at Kavre district of Nepal encountered major bulk of Earthquake victims residing at Sindhuplanchowk, Kavre and Dolakha districts during subsequent earthquake events. Objective To distinguish any significant differences in hospital admitted Earthquake and nonEarthquake chest trauma cases. Method Retrospective study was done comparing earthquake with non-earthquake chest trauma cases admitted in Dhulikhel Hospital. Study included parameters like mode of injury, time taken to reach health center, symptoms at presentation, involvement of chest area, presence and site of rib fracture, presence of hemothorax or pneumothorax, spectrum of treatment required, hospital admission days. Result There were total 23 earthquake victims of which 14 (61%) were female and rest of 9(39%) were male whereas out of total 95 non earthquake cases 23(24%) were female and 72 (76%) were male (p< 0.01). Mean age in earthquake victims was 53.73 (SD 18.33, range 19-84) while non earthquake cases was 46.83(SD 16.53, range 11-90), (p >0.05). Major mode of injuries in earthquake victims was hit by objects (82.60%) followed by fall (17.4 %). Incidence of rib fractures was 69.56% in earthquake victims and 85.26 % in non earthquake cases with average of 2-3 ribs in both cases (p>0.05). There was higher rates of pneumothorax in earthquake victims (52.17%) compared to non earthquake cases (30.52%), (p<0.05). There wasn't evidently major differences in incidence of pulmonary contusion, hemothorax and surgical emphysema. The mean duration of hospital admission days in earthquake victims was 7.78 days while non earthquake cases was 5.04 days (p >0.05). The total number of patients requiring chest tube insertion in earthquake victims was 16(69.56%) while that was 29(30.52 %) in non earthquake patients (p <0.01). Conclusion There was preponderance of female gender in earthquake related cases compared to non earthquake cases. Incidence of rib fracture was higher in earthquake victims. In earthquake victims, higher proportion of patient required chest tube drainage compared to non earthquake cases.
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Affiliation(s)
- R M Karmacharya
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - M Devbhandari
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Tuladhar
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B Shrestha
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - P Acharya
- Department of Surgery (CTVS), Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Kapil-Mani KC, Acharya P, Arun S. Precontoured Clavicular Locking Plate with Broad Lateral End: A Newly Designed Plate for Lateral Third Clavicle Fractures. Malays Orthop J 2018; 12:15-20. [PMID: 29725507 PMCID: PMC5920253 DOI: 10.5704/moj.1803.003] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction: Various treatment modalities are available but no consensus has been reached for optimal treatment of lateral third clavicle fractures. Precontoured locking plates with broad lateral end for multiple screws fixation is a newly designed plate for lateral third clavicle fractures. The objective of our study was to analyse the functional outcomes as well as complications of this technique in a significant number of cases with long follow-up duration. Materials and Methods: Forty-six patients with distal third clavicle fractures were treated by precontoured clavicular locking plate with broad lateral end. Functional outcomes were assessed on the basis of Constant-Murley Shoulder Outcome Score and University of California, Los Angeles (UCLA) Shoulder Rating Score, active shoulder range of motion, time for fracture union and coraco-clavicular distance. Results: The mean Constant-Murley score was 92.56±4.47 (range: 79-98) for injured side and 96.22±2.23 (range: 90-100) for normal side with p-Value 0.56. Mean coraco-clavicular distance at final follow-up was 10.52±1.13 mm (range 9.7 to 11.7 mm) in injured side and 10.25±0.98 mm (range 9.6 to 11.2 mm) in normal side. Mean UCLA Shoulder Rating Score was 32.55±2.12 (range: 27-34) for injured side and 33.46±1.88 (range: 31- 35) on normal side with p value 0.58. No major complications that necessitated revision of surgery occurred in our study. Conclusion: This newly designed plate seemed extremely useful in successful union of lateral third clavicle fractures, with reduced rate of complications like fixation failures, iatrogenic rotator cuff injury, AC joint osteoarthritis and sub-acromial bursitis, with good functional outcomes.
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Affiliation(s)
- K C Kapil-Mani
- Department of Orthopaedics, Civil Service Hospital, Kathmandu, Nepal
| | - P Acharya
- Department of Orthopaedics, Civil Service Hospital, Kathmandu, Nepal
| | - S Arun
- Department of Orthopaedics, Civil Service Hospital, Kathmandu, Nepal
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Javali M, Acharya P, Mehta A, John AA, Mahale R, Srinivasa R. Use of multiplex PCR based molecular diagnostics in diagnosis of suspected CNS infections in tertiary care setting-A retrospective study. Clin Neurol Neurosurg 2017; 161:110-116. [PMID: 28866263 DOI: 10.1016/j.clineuro.2017.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/22/2017] [Accepted: 08/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES CNS infections like meningitis and encephalitis pose enormous healthcare challenges due to mortality, sequelae and socioeconomic burden. In tertiary setting, clinical, microbiological, cytological and radiological investigations are not distinctive enough for diagnosing microbial etiology. Molecular diagnostics is filling this gap. We evaluated the clinical impact of a commercially available multiplex molecular diagnostic system - SES for diagnosing suspected CNS infections. PATIENTS AND METHODS This study was conducted in our tertiary level Neurology ICU. 110 patients admitted during Nov-2010 to April-2014 were included. CSF samples of patients clinically suspected of having CNS infections were subjected to routine investigation in our laboratory and SES test at XCyton Diagnostics. We studied the impact of SES in diagnosis of CNS infections and its efficacy in helping therapeutic management. RESULTS SES showed detection rate of 42.18% and clinical specificity of 100%. It had 10 times higher detection rate than conventional tests. Streptococcus pneumoniae and Mycobacterium tuberculosis were two top bacterial pathogens. VZV was most detected viral pathogen. SES results elicited changes in therapy in both positive and negative cases. We observed superior patient outcomes as measured by GCS scale. 75% and 82.14% of the patients positive and negative on SES respectively, recovered fully. CONCLUSION Detecting causative organism and ruling out infectious etiology remain the most critical aspect for management and prognosis of patients with suspected CNS infections. In this study, we observed higher detection rate of pathogens, target specific escalation and evidence based de-escalation of antimicrobials using SES. Institution of appropriate therapy helped reduce unnecessary use of antimicrobials.
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Affiliation(s)
| | | | - Aneesh Mehta
- Dept. of Neurology, MS Ramaiah Memorial Hospital, India
| | | | - Rohan Mahale
- Dept. of Neurology, MS Ramaiah Memorial Hospital, India
| | - R Srinivasa
- Dept. of Neurology, MS Ramaiah Memorial Hospital, India
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Mahale RR, Buddaraju K, Gireesh MS, Acharya P, Srinivasa R. Acute Generalized Chorea as Presenting Manifestation of Uremic Encephalopathy. J Neurosci Rural Pract 2017; 8:S156-S158. [PMID: 28936101 PMCID: PMC5602251 DOI: 10.4103/jnrp.jnrp_158_17] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rohan R. Mahale
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru - 560 054, Karnataka, India
| | - Kiran Buddaraju
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru - 560 054, Karnataka, India
| | - M. S. Gireesh
- Department of Nephrology, MS Ramaiah Medical College and Hospital, Bengaluru - 560 054, Karnataka, India
| | - Purushottam Acharya
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru - 560 054, Karnataka, India
| | - Rangasetty Srinivasa
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru - 560 054, Karnataka, India
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Mahale RR, Buddaraju K, Mehta A, Javali M, Acharya P, Srinivasa R. Acute Bilateral Supranuclear Vertical Gaze Palsy: Vertical One-and-a-one Syndrome - Report of Three Cases. J Neurosci Rural Pract 2017; 8:313-316. [PMID: 28479825 PMCID: PMC5402517 DOI: 10.4103/jnrp.jnrp_478_16] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rohan R Mahale
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Kiran Buddaraju
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Anish Mehta
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Mahendra Javali
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Purushottam Acharya
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rangasetty Srinivasa
- Department of Neurology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
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Mahale R, Mehta A, Shetty N, Buddaraju K, Acharya P, Srinivasa R. Upper limb monochorea in a patient with an acute pontine bleed. Neurol India 2017; 65:1414-1416. [DOI: 10.4103/0028-3886.217930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mahale RR, Mehta A, Rau T, Acharya P, Srinivasa R. Arterial Stroke as an Isolated Manifestation of Homocystinuria in an Infant. J Pediatr Neurosci 2017; 12:206-207. [PMID: 28904589 PMCID: PMC5588656 DOI: 10.4103/jpn.jpn_4_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rohan R Mahale
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Anish Mehta
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - T Rau
- Department of Paediatrics, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Purushottam Acharya
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rangasetty Srinivasa
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
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Dongol A, Acharya P, Prasad JN, Jaisani MR. A veil in the oral cavity: report of two cases of oral synechiae. Int J Oral Maxillofac Surg 2016; 46:286-288. [PMID: 28041885 DOI: 10.1016/j.ijom.2016.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 08/18/2016] [Revised: 09/29/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Abstract
An oral synechia is an adhesion between the maxilla and the mandible; these adhesions can be found at various locations in the oral cavity. The presence of oral synechiae associated with cleft palate represents a rare congenital deformity. Oral synechiae with cleft palate can have serious implications for airway management and feeding in babies, and hence requires early intervention to reduce morbidity. Two cases of congenital oral synechiae accompanied by cleft palate, in which the synechiae veiled the oral cavity restricting a detailed intraoral examination, are reported here.
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Affiliation(s)
- A Dongol
- Department of Oral and Maxillofacial Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.
| | - P Acharya
- Department of Oral and Maxillofacial Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - J N Prasad
- Department of Anaesthesiology and Critical Care, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - M R Jaisani
- Department of Oral and Maxillofacial Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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Kc KM, Acharya P, Sigdel A. Titanium Elastic Nailing System (TENS) for Tibia Fractures in Children: Functional Outcomes and Complications. JNMA J Nepal Med Assoc 2016; 55:55-60. [PMID: 28029668] [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] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION Closed reduction and cast application is still regarded as first line treatment for pediatric tibial fractures. Over the past few decades, management of pediatric tibial fractures has shifted more towards operative intervention because of quicker recovery, shorter rehabilitation period, less immobilization, lack of stiffness of adjoining joints, and less psychological impact to the children. Flexible intramedullary nails not only fulfill the above advantage but also maintain alignment and rotation. METHODS This was a retrospective study of pediatric tibial fractures fixed with two titanium elastic nails through proximal ends of bones. Alignment of fracture, any infection, delayed union, non union, limb length discrepancy, motion of knee joint, and fracture union time were measured during follow-up examination. RESULTS Forty-five patients were enrolled into the study out of which 28 (62.2%) were male and 17 (37.8%) were female. Average age of patient was 9.48±2.17 years and average time taken to heal the fractures (both clinical and radiological) was 11.17±2.81 weeks. There were 2 (4.4%) of malunion, 4 (8.8%) of delayed union, 3 (6.6%) of limb shortening, 2 (4.4%) of limb lengthening, 6 (13.6%) of nail prominence and skin irritation, 2 (4.4%) of superficial infection at nail entry site and one case of re-fracture. CONCLUSIONS Titanium elastic nail fixation is a simple, easy, rapid, reliable and effective method for management of pediatric tibial fractures in patients with operative indications. There may be the chances of complication following the TENS in tibia but these are avoidable as well as manageable with careful precautions.
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Affiliation(s)
- K M Kc
- Department of Orthopedics, Civil Service Hospital, Minbhawan, Kathmandu, Nepal
| | - P Acharya
- Department of Orthopedics, Civil Service Hospital, Minbhawan, Kathmandu, Nepal
| | - A Sigdel
- Department of Orthopedics, Civil Service Hospital, Minbhawan, Kathmandu, Nepal
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Mehta A, Mahale R, John AA, Abbas MM, Javali M, Acharya P, Rangasetty S. Odorless inhalant toxic encephalopathy in developing countries household: Gas geyser syndrome. J Neurosci Rural Pract 2016; 7:228-31. [PMID: 27114653 PMCID: PMC4821930 DOI: 10.4103/0976-3147.178656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Liquefied petroleum gas geysers are used very frequently for heating water in developing countries such as India. However, these gas geysers emit various toxic gases; one among them is colorless, odorless carbon monoxide (CO). In the past few years, there were reports of unexplained loss of consciousness in the bathroom. However, the exact cause for these episodes has been recognized as toxic encephalopathy due to toxic gases inhalation mainly CO. Objective: To analyze the clinical profile and outcome of patients brought with loss of consciousness in the bathroom while bathing using gas geyser. Materials and Methods: Case records of patients with the diagnosis of gas geyser syndrome from 2013 to 2015 were retrieved and analyzed. Twenty-four cases were identified and included in the study. This was a retrospective, descriptive study. Results: Twenty-four patients were brought to our Emergency Department with loss of consciousness in the bathroom while bathing. Twenty-one cases had loss of consciousness during bathing and recovered spontaneously. Two cases were found dead in the bathroom and were brought to the Department of Forensic Medicine for postmortem. One case was brought in deep altered state of consciousness and succumbed to illness within 1 week. Conclusion: Awareness regarding CO intoxication due to usage of ill-fitted, ill-ventilated gas geyser is necessary as they are entirely preventable conditions.
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Affiliation(s)
- Anish Mehta
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Rohan Mahale
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Aju Abraham John
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Masoom Mirza Abbas
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Mahendra Javali
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Purushottam Acharya
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Srinivasa Rangasetty
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
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Mahale R, Mehta A, Buddaraju K, Shankar A, Javali M, Acharya P, Srinivasa R. Recurrent isolated abducens nerve palsy – unusual manifestation of a known syndrome: Report of two cases. Neurol India 2016; 64:1313-1316. [DOI: 10.4103/0028-3886.193807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mahale RR, Javali M, Mehta A, Sharma S, Acharya P, Srinivasa R. A study of clinical profile, radiological and electroencephalographic characteristics of suspected Creutzfeldt-Jakob disease in a tertiary care centre in South India. J Neurosci Rural Pract 2015; 6:39-50. [PMID: 25552850 PMCID: PMC4244786 DOI: 10.4103/0976-3147.143189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Creutzfeldt-Jakob disease (CJD) is a progressive, fatal, neurodegenerative disease classified under transmissible spongiform encephalopathies (TSE) or prion diseases. It is characterized by long asymptomatic period followed by rapid clinical deterioration leading to the death within months. The disease is still under-reported in India. Objective: The aim of this study was to describe the clinical, radiological and electroencephalographic characteristics of eight cases of CJD encountered in MS Ramaiah Medical college and Hospital, Bangalore over the past 3 years (2010-2013). This was retrospective, observational, hospital-based study. Results: The mean age of patients was 66.6 years (range: 54-82) and there was female predominance (five patients). The main clinical manifestations were cognitive disturbance (8/8) and myoclonus (8/8), followed by behavioral disturbance (5/8), ataxia (5/8) and extra-pyramidal symptoms/signs (4/8). Time interval (mean) between onset of disease to death was 6.6 months (range: 3-14). Brain MRI abnormalities were noted in 6 patients: Fluid-attenuated inversion recovery hyperintensities with restriction on diffusion-weighted image/apparent diffusion coefficient (DWI/ADC) in caudate and putamen, and diffusion hyperintensities without restriction on ADC in parieto-occipital, frontal and temporal regions. Classical electroencephalogram (EEG) changes of periodic triphasic waves were seen in 87% of patients. The CSF 14-3-3 protein assay was positive in two patients (out of four). Seven cases were probable CJD and one was possible CJD. Conclusion: A strong clinical suspicion aided by characteristic brain MRI and EEG abnormalities is essential for timely diagnosis of this fatal disease.
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Affiliation(s)
- Rohan R Mahale
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
| | - Mahendra Javali
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
| | - Anish Mehta
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
| | - Suryanarayana Sharma
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
| | - Purushottam Acharya
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
| | - Rangasetty Srinivasa
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India
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Dwivedi R, Sah S, Dahal M, Acharya P, Gurung S. Close Versus Limited Open Method of Ender's Nail Fixation in Paediatric Femoral Shaft Fractures. JNMA J Nepal Med Assoc 2014; 52:806-810. [PMID: 26905709] [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] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION There are various surgical options for treating fracture of femoral shaft in children. Here we compare the results of close with limited open method of Ender's nails fixation of femoral shaft fractures in children. METHODS We studied 60 children with femoral shaft fractures in age group 5-15 years. Ender's nail fixation was done by close technique in 40 cases and in 20 cases by limited open technique. RESULTS The mean operative time was significantly high in limited open group being 64 minutes in comparison to 50 minutes in close group. There was no significant difference between close and limited open groups with respect to time for partial weight bearing and time for full weight bearing. Fracture united sooner in close group as compared to open group. Union was achieved in all patients within a mean of 11 weeks in close group in comparison to 12.4 weeks in open group. According to the Flynn criteria in close group 34 patients had excellent results, 6 had satisfactory and none poor. In limited open group outcome was excellent in 14 patients, satisfactory in 4 patients and 2 had poor result. There was no significant difference in outcome based on Flynn criteria between two groups. CONCLUSIONS Though operative time is more and healing is delayed in Ender's nail fixation by limited open technique, there is no statistical difference in final outcome as per Flynn criteria between close and limited open technique of Ender's nail fixation of femoral shaft fractures in children.
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Affiliation(s)
- R Dwivedi
- Department of Orthopaedics, Lumbini Medical College Teaching Hospital, Tansen Palpa, Nepal
| | - S Sah
- Department of Orthopaedics, Koshi Zonal Hospital, Biratnagar, Koshi, Nepal
| | - M Dahal
- Department of Orthopaedics, Koshi Zonal Hospital, Biratnagar, Koshi, Nepal
| | - P Acharya
- Department of Orthopaedics, Civil Service Hospital, Kathmandu, Nepal
| | - S Gurung
- Department of Orthopaedics, Nepalgunj Medical College, Kohalpur, Nepal
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Ghimire M, Karki P, Khanal B, Acharya P, Sharma SK, Pahari B. Clinicomicrobiological profile of infective endocarditis in a tertiary care center of Nepal. J Coll Med Sci-Nepal 2013. [DOI: 10.3126/jcmsn.v8i4.8698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Infective endocarditis is a common problem and data regarding its clinical and microbiological pattern from developing countries are sparse. We studied clinical features and the microbiological pathogens in patients with Infective Endocarditis in our Hospital. Objective To study the clinical profile and microbiological pathogens involved in patients with Infective Endocarditis, admitted under Department of Internal Medicine of B.P Koirala Institute of Health Sciences. Materials and methods A total of 54 patients with history of fever and underlying heart disease were studied. It was a hospital based cross sectional descriptive study done in patients with infective endocarditis presented to us from March 2007 to February 2008 in B.P Koirala Institute of Health Sciences. Results Out of 54 patients, 11 (20.4%) had Dukes definite IE. The male: female ratio was 1.2:1. The mean age of the study group was 27.3 years (range=16-55). In IE group, fever was present in 100% cases (n=11) as it was the inclusion criteria of the study, followed by SOB 81.8% (n=9). History of antibiotic therapy prior to the presentation was present in 36.7 % (n=4) patients. Pallor was the most common sign 63.6% (n=7). Splenomegaly was seen in 18.2% (n=2). Anaemia (Hb<10gm %) in 36.4% (n=4) and microscopic haematuria in 72.3% (n=8) cases. Blood culture positivity was seen in 36.4 %. The most common pathogens were Staphylococcus aureus in 27.3% (n=3) and Acinetobacter species in 9.1% (n=1). Conclusion In our study we found that the clinical spectrum of IE was different from the west in that the majority of patients being young in our study. However, RHD still is the commonest underlying heart disease and Staphylococcus aureus being the commonest isolate. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 34-41 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8698
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Bansal R, Guleria A, Acharya P. FT-IR Method Development and Validation for Quantitative Estimation of Zidovudine in Bulk and Tablet Dosage Form. Drug Res (Stuttg) 2013; 63:165-70. [DOI: 10.1055/s-0032-1333297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R. Bansal
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - A. Guleria
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - P. Acharya
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
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Abstract
Introduction: The surgical procedure by the anterior, posterior and combined antero-posterior approaches had applied for the treatment of cervical spondylotic myelopathy.
Methods: During the treatment process, all patients were pre-operatively as well post-operatively graded according to Japanese Orthopaedics Association. Several surgical methods such as anterior approach, posterior approach, and combined antero-posterior approach have been addressed for CSM patients, with the choice based on the pathogenesis of the myelopathy. The main indications for surgery were evidence of myelopathy on physical examinations, a JOA score below 13 points help with spinal cord compression observed on plain X-ray, CT scan, MRI studies.
Results: The pre-operative JOA scores were 7.60±1.23 in laminoplasty, 8.30±1.03 in diskectomy and corpectomy and 7.10±1.20 in combined antero-posterior approach patients. At the follow-up after three months the JOA scores were laminoplasty 13.30±1.30, diskectomy and corpectomy 13.55±1.15 and combined antero-posterior 13.50±1.08. The JOA recovery rate averaged, 61.08±11.25% in laminoplasty, 60.67±10.60% in diskectomy and corpectomy and 64.67±10.72% in combined anteroposterior approach. The high- signal intensity changed to normal in 18 out of 28 and no any kyphotic change and instability were found in cervical spine at the follow up.
Conclusions: Patients with OPLL (continuous, segmental and mixed type), stenosis of cervical spinal canal, multilevel cervical spondylosis, large and high ossification of IVDP with stenosis were improved with laminoplasty. Patients with PIVD, CSM with kyphosis, post laminectomy , OPLL herniated type, unstable vertebral alignment, stenosis by osteophytes, were improved with anterior approach . Ossified or deformed OPLL, unstable vertebral with stenosis ,OPLL or OYL with cervical meandearing (swan-neck) were improved with Combined anterior and posterior approach.
Keywords: cervical spondylotic mylopathy, anterior cervical diskectomy and fusion, corpectomy.
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Sah S, Wang L, Dahal M, Acharya P, Dwivedi R. Surgical management of cervical spondylotic myelopathy. JNMA J Nepal Med Assoc 2012; 52:172-177. [PMID: 23591248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION The surgical procedure by the anterior, posterior and combined antero-posterior approaches had applied for the treatment of cervical spondylotic myelopathy. METHODS During the treatment process, all patients were pre-operatively as well post-operatively graded according to Japanese Orthopaedics Association. Several surgical methods such as anterior approach, posterior approach, and combined antero-posterior approach have been addressed for CSM patients, with the choice based on the pathogenesis of the myelopathy. The main indications for surgery were evidence of myelopathy on physical examinations, a JOA score below 13 points help with spinal cord compression observed on plain X-ray, CT scan, MRI studies. RESULTS The pre-operative JOA scores were 7.60±1.23 in laminoplasty, 8.30±1.03 in diskectomy and corpectomy and 7.10±1.20 in combined antero-posterior approach patients. At the follow-up after three months the JOA scores were laminoplasty 13.30±1.30, diskectomy and corpectomy 13.55±1.15 and combined antero-posterior 13.50±1.08. The JOA recovery rate averaged, 61.08±11.25% in laminoplasty, 60.67±10.60% in diskectomy and corpectomy and 64.67±10.72% in combined antero-posterior approach. The high-signal intensity changed to normal in 18 out of 28 and no any kyphotic change and instability were found in cervical spine at the follow up. CONCLUSIONS Patients with OPLL (continuous, segmental and mixed type), stenosis of cervical spinal canal, multilevel cervical spondylosis, large and high ossification of IVDP with stenosis were improved with laminoplasty. Patients with PIVD, CSM with kyphosis, post laminectomy, OPLL herniated type, unstable vertebral alignment, stenosis by osteophytes, were improved with anterior approach. Ossified or deformed OPLL, unstable vertebral with stenosis, OPLL or OYL with cervical meandearing (swan-neck) were improved with Combined anterior and posterior approach.
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Affiliation(s)
- S Sah
- Department of Orthopaedic, Koshi Zonal Hospital, Biratnagar, Koshi, Nepal
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Georgiev I, Acharya P, Schmidt SD, Li Y, Wycuff D, Ofek G, Doria-Rose N, Luongo TS, Yang Y, Zhou T, Donald BR, Mascola JR, Kwong PD. Design of epitope-specific probes for sera analysis and antibody isolation. Retrovirology 2012. [PMCID: PMC3442034 DOI: 10.1186/1742-4690-9-s2-p50] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Acharya P, Luongo TS, Matz J, Schmidt SD, Chuang G, Georgiev I, Kessler P, Yang Y, Chames P, Martin L, Mascola JR, Kwong PD. Structural definition of a novel CD4-induced epitope that is targeted by a single-headed immunoglobulin to effect broad and potent HIV neutralization. Retrovirology 2012. [PMCID: PMC3441789 DOI: 10.1186/1742-4690-9-s2-p346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Acharya P. Operative oral and maxillofacial surgery, 2nd edition. Br Dent J 2011. [DOI: 10.1038/sj.bdj.2011.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Acharya P. The osteoperiosteal flap: a simplified approach to alveolar bone reconstruction. Br Dent J 2010. [DOI: 10.1038/sj.bdj.2010.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gupta N, Karki P, Sharma S, Shrestha N, Acharya P. Effect of haemodynamic and metabolic predictors on echocardiographic left ventricular mass in non-diabetic hypertensive patients. Kathmandu Univ Med J (KUMJ) 2010; 8:173-178. [PMID: 21209530 DOI: 10.3126/kumj.v8i2.3553] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Left ventricular hypertrophy is a forerunner of coronary heart disease, congestive cardiac failure, stroke and may also lead to sudden death. Estimation of left ventricular mass by echocardiography offers prognostic information better than the evaluation of traditional cardiovascular risk factors. OBJECTIVE The aim of this study was to determine the relative contributions of haemodynamic and metabolic factors affecting left ventricular mass in non-diabetic patients with essential hypertension. MATERIAL AND METHODS 100 non-diabetic hypertensive patients were taken. The association between age, gender, smoking, alcohol, height, weight, heart rate, clinic blood pressure, fasting blood glucose, lipid profile, haemoglobin, body mass index and stroke volume with LV mass was studied. Left ventricular mass was measured by using standard M-mode echocardiography measurement obtained by way of standard recommended by the American Society of Echocardiography. RESULTS Left ventricular mass was analyzed as a continuous variable. In males body mass index (r = .35, p < .004) and stroke volume(r = -.26, p<.039) were significantly correlated with LV mass. In females body weight was significantly related to left ventricular mass(r = .36, p < .02). The independent association between significant factors and left ventricular mass was assessed by stepwise multivariate logistic regression. Body mass index and systolic blood pressure came as independent determinants of left ventricular mass in all patients. A maximum of 13% of left ventricular mass variability could be explained by these two factors. CONCLUSION In untreated patients with hypertension patient's body mass index and systolic blood pressure are independent predictors of left ventricular mass after adjustment for other haemodynamic and metabolic factors. They explain a maximum of 13% of left ventricular mass variability. More knowledge is needed about factors that may alter cardiac morphology in the evolution of hypertensive patients.
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Affiliation(s)
- N Gupta
- Department of Internal Medicine and Cardiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Pandey S, Baral N, Majhi S, Acharya P, Karki P, Shrestha S, Das BKL, Chandra L. Prevalence of the metabolic syndrome in acute myocardial infarction and its impact on hospital outcomes. Int J Diabetes Dev Ctries 2010; 29:52-5. [PMID: 20142868 PMCID: PMC2812750 DOI: 10.4103/0973-3930.53120] [Citation(s) in RCA: 14] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Accepted: 03/06/2007] [Indexed: 11/04/2022] Open
Abstract
AIMS To ascertain the prevalence of the metabolic syndrome in patients with acute myocardial infarction; to study the impact of the metabolic syndrome on hospital outcomes; and to find out the association of each component of the metabolic syndrome with acute myocardial infarction (AMI). SETTING Coronary care unit, Department of Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal. DESIGN Hospital-based cross-sectional study. MATERIALS AND METHODS A total of 84 unselected consecutive patients hospitalized with AMI (diagnosed on the basis of WHO criteria) were categorized according to NCEP ATP III criteria. STATISTICAL ANALYSIS Data was analyzed by using the Student's t test and Chi-square test. RESULTS Among the 84 AMI patients, 22 (26.19%) fulfilled the criteria for metabolic syndrome. Patients with the metabolic syndrome were older (86% were >50 years of age) and females (27%) were more affected than males (25%). In-hospital case fatality was higher in patients having the metabolic syndrome (5/22) than in those without the syndrome (3/62). Among the five components of the metabolic syndrome, the triglyceride levels had the highest positive predictive value (62%) in AMI; this was followed by fasting blood glucose levels (55%). CONCLUSION The prevalence of the metabolic syndrome is 26.19%; it is associated with high mortality; among its components, the triglyceride level has the highest positive predictive value in AMI patients.
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Affiliation(s)
- S Pandey
- Department of Biochemistry, BP Koirala Institute of Health Sciences, Dharan, Nepal
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