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Gupta S, Ramam M, Sharma VK, Sethuraman G, Pandey RM, Bhari N. Reply to "Correspondence on Evaluation of a paraffin based moisturizer compared to a ceramide based moisturizer in children with atopic dermatitis: A double-blind, randomized controlled trial". Pediatr Dermatol 2024; 41:565. [PMID: 38743459 DOI: 10.1111/pde.15530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 12/29/2023] [Indexed: 05/16/2024]
Affiliation(s)
- Sachin Gupta
- Department of Dermatology, Amrita School of Medicine, Faridabad, India
| | - M Ramam
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Sharma
- School of Medical Science and Research, Sharda University, Greater Noida, India
| | - G Sethuraman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Setlur K, Sankar J, Kapil U, Pandey RM, Kabra SK, Lodha R. Development and Validation of a Weight Estimation Tool for Acutely Ill Children Who Cannot be Weighed. Indian J Pediatr 2024; 91:344-350. [PMID: 37402105 DOI: 10.1007/s12098-023-04600-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/17/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVES To develop and validate weight estimation tools using mid upper arm circumference (MUAC) and body length, and determine accuracy and precision of Broselow tape in children 6 mo to 15 y of age. METHODS Data of 18,456 children aged 6 mo to 5 y and 1420 children aged 5 to 15 y were used to develop linear regression equations using length and MUAC to estimate weight. These were validated on prospectively enrolled populations of 276 and 312 children, respectively. Accuracy was measured by Bland-Altman bias, median percentage errors, and percentage of predicted weight within 10% of true weight. Broselow tape was tested on the validation population. RESULTS Gender specific equations were developed which estimated weight within 10% of true weight in 69.9% (64.1-75.2%) and 65.7% (60.1-70.9%) of children aged 6 mo to 5 y, and 5 to 15 y, respectively. Broselow tape predicted weight within 10% of the true weight in 40.5% (34.7-46.6%) and 32.5% (26.7-38.7%) of children aged 6 mo to 5 y and 5 to 15 y, respectively. CONCLUSIONS The model developed from MUAC and length accurately estimated weight in children aged 6 mo to 15 y, and is potentially useful during emergencies. The Broselow tape frequently overestimated weight in authors' setting.
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Affiliation(s)
- Kritika Setlur
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Umesh Kapil
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Sharma S, Nehra A, Pandey S, Tripathi M, Srivastava A, Padma MV, Garg A, Pandey RM, Chandra S, Tripathi M. Neuropsychological Rehabilitation for Epilepsy in India: Looking Beyond the Basics. Epilepsy Behav 2024; 153:109703. [PMID: 38452517 DOI: 10.1016/j.yebeh.2024.109703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Neuropsychological Rehabilitation (NR) helps manage cognitive deficits in epilepsy. As internationally developed programs have limited applicability to resource-limited countries, we developed a program to bridge this gap. This 6-week caregiver-assisted, culturally suitable program has components of (1) psychoeducation, (2) compensatory training, and, (3) cognitive retraining and is called EMPOWER (Indigenized Home Based Attention and Memory Rehabilitation Program for Adult Patients with Drug Refractory Epilepsy). Its efficacy needs to be determined. METHODS We carried out an open-label parallel randomized controlled trial. Adults aged 18-45 years with Drug Refractory Epilepsy (DRE), fluency in Hindi and or English, with impaired attention or memory (n = 28) were randomized to Intervention Group (IG) and Control Group (CG). The primary outcomes were objective memory (Auditory Verbal Learning Test), patient and caregiver reported everyday memory difficulties (Everyday Memory Questionnaire-Revised), number of memory aids in use, depression (Hamilton Depression Rating Scale), anxiety (Hamilton Anxiety Rating Scale) and quality of life (Quality of Life in Epilepsy-31). Intention to treat was carried out for group analysis. In the absence of norms necessary for computing Reliable Change Indices (RCIs), a cut-off of +1.0 Standard Deviation (SD) was utilized to identify clinically meaningful changes in the individual analysis of objective memory. A cut-off of 11.8 points was used for quality of life. Feedback and program evaluation responses were noted. RESULTS The majority of the sample comprised DRE patients with temporal lobe epilepsy who had undergone epilepsy surgery. Group analysis indicated improved learning (p = 0.013), immediate recall (p = 0.001), delayed recall (p < 0.001), long-term retention (p = 0.031), patient-reported everyday memory (p < 0.001), caregiver-reported everyday memory (p < 0.001), anxiety (p = 0.039) and total quality of life (p < 0.001). Individual analysis showed improvement in 50 %, 64 %, 71 %, 57 %, and 64 % of patients on learning, immediate recall, delayed recall, long-term retention, and total quality of life respectively. Despite improvements, themes indicative of a lack of awareness and understanding of cognitive deficits were identified. Overall, the program was rated favorably by patients and caregivers alike. CONCLUSION NR shows promise for patients with DRE, however larger studies are warranted. The role of cognition in epilepsy needs to be introduced at the time of diagnosis to help lay the foundation for education and acceptance.
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Affiliation(s)
- Shivani Sharma
- Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Nehra
- Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Duraisamy AK, Logani A, Kumar V, Chawla A, Sharma S, Pandey RM. Influence of the severity of periodontal disease on the outcome of non-surgical endodontic therapy: A prospective cohort study. Clin Oral Investig 2024; 28:217. [PMID: 38489130 DOI: 10.1007/s00784-024-05611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To investigate the influence of severity of periodontal disease on periapical healing after non-surgical endodontic therapy (NSET). MATERIAL AND METHODS In this prospective study, subjects (n = 45) requiring NSET in a mandibular molar tooth with the diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting radiographic periapical index (PAI) score ≥ 3 and concomitant endodontic periodontal lesion (CEPL) without communication were enrolled. After dividing as per the classification of Periodontal and Peri-Implant Diseases and Conditions, subjects were equally allocated into three groups. Group I- only endodontic lesion {control: healthy periodontium (n = 15)}, Group II- CEPL having stage I and II periodontitis (n = 15) and Group III- CEPL having stage III periodontitis (n = 15). Standardized two-visit NSET was performed with 2% chlorhexidine gel as an intracanal medicament. Periodontal therapy was instituted wherever required. Subjects were recalled at 6-and 12-months for clinical and radiographic assessment. Chi-square test was performed to evaluate the difference between the groups. RESULTS At 12-month follow-up, all teeth in the three study groups were asymptomatic. On radiographic evaluation of the periapical region, healing was observed in 80%, 47% and 50% of teeth in Groups I, Group II and Group III, respectively. However, the difference was not statistically significant between the groups (p = 0.150). CONCLUSION The severity of periodontal disease had no influence on periapical healing after NSET in teeth with concomitant endodontic periodontal lesions without communication. CLINICAL RELEVANCE Periodontal disease has significant impact on apical periodontitis however severity of the periodontitis does not negatively impact the apical periodontitis.
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Affiliation(s)
- Arun Kumar Duraisamy
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India, 110029
| | - Ajay Logani
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India, 110029.
| | - Vijay Kumar
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India, 110029
| | - Amrita Chawla
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India, 110029
| | - Sidhartha Sharma
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India, 110029
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Science and Research, New Delhi, India, 110029
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Amariyil A, Pathy S, Sharma A, Kumar S, Pramanik R, Bhoriwal S, Pandey RM. Randomized Controlled Trial of Neoadjuvant Short-Course Radiotherapy Followed by Consolidation Chemotherapy Versus Long-Course Chemoradiotherapy in Locally Advanced Rectal Cancer: Comparison of Overall Response Rates. J Gastrointest Cancer 2024; 55:373-382. [PMID: 37702850 DOI: 10.1007/s12029-023-00966-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Management of locally advanced rectal cancer (LARC) is evolving with current emphasis on the addition of chemotherapy to short course radiotherapy (SCRT). We primarily aimed to analyse the difference in overall response rates between SCRT with sequential chemotherapy and standard long-course chemoradiotherapy (LCCRT)in LARC. METHODS After randomization, patients in arm A received 45 Gy in 25 fractions over 5 weeks with concurrent capecitabine while patients in arm B received 25 Gy in 5 fractions over 1 week followed by 3 cycles of CAPOX (capecitabine and oxaliplatin) chemotherapy. Clinical and radiological response assessment was made after the completion of neoadjuvant treatment, a week prior to surgery. Adjuvant chemotherapy was added to complete 6 months of peri-operative chemotherapy. Surgery was performed between 8 and 10 weeks of completion of radiation treatment in both arms. RESULTS Of the 33 patients recruited in this study between February 2020 to July 2021, 17 patients were randomized to arm A and 16 to arm B. The rates of complete tumour regression were 23.1% in arm A versus 35.7% in arm B (p-value = 0.683). Pathological complete response (pCR) rate was 20% arm A versus 30% in arm B (0.446). A higher number of patients in arm B experienced grade 3 diarrhoea, whereas acute skin toxicity was seen only in arm A. SCRT had fewer treatment interruptions compared to LCCRT. CONCLUSIONS SCRT followed by three cycles of CAPOX chemotherapy in the neoadjuvant setting is comparable to LCCRT in terms of tumour response. This may be a better alternative regimen with fewer treatment interruptions in a resource-limited setting.
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Affiliation(s)
- Adila Amariyil
- Department of Radiation Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sushmita Pathy
- Department of Radiation Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Pramanik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Santhosh A, Sharma A, Bakhshi S, Kumar A, Sharma V, Malik PS, Pramanik R, Gogia A, Prasad CP, Sehgal T, Gund S, Dev A, Cheung WY, Pandey RM, Kumar S, Gupta I, Batra A. Topical Diclofenac for Prevention of Capecitabine-Associated Hand-Foot Syndrome: A Double-Blind Randomized Controlled Trial. J Clin Oncol 2024:JCO2301730. [PMID: 38412399 DOI: 10.1200/jco.23.01730] [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] [Received: 08/10/2023] [Revised: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 02/29/2024] Open
Abstract
PURPOSE Hand-foot syndrome (HFS) is a dose-limiting side effect of capecitabine. Celecoxib prevents HFS by inhibiting cyclooxygenase-2 (COX-2) that is upregulated because of the underlying associated inflammation. However, systemic side effects of celecoxib have limited routine prescription. Topical diclofenac inhibits COX-2 locally with minimal risk of systemic adverse events. Therefore, we conducted this study to assess the efficacy of topical diclofenac in the prevention of capecitabine-induced HFS. METHODS In this single-site phase III randomized double-blind trial, we enrolled patients with breast or GI cancer who were planned to receive capecitabine-based treatment. Participants were randomly assigned in a 1:1 ratio to receive topical diclofenac or placebo gel for 12 weeks or until the development of HFS, whichever occurred earlier. The primary end point was the incidence of grade 2 or 3 HFS (Common Terminology Criteria for Adverse Events version 5), which was compared between the two groups using simple logistic regression. RESULTS In total, 264 patients were randomly assigned to receive topical diclofenac gel (n = 131) or placebo (n = 133). Grade 2 or 3 HFS was observed in 3.8% of participants in the diclofenac group compared with 15.0% in the placebo group (absolute difference, 11.2%; 95% CI, 4.3 to 18.1; P = .003). Grade 1-3 HFS was lower in the diclofenac group than in the placebo group (6.1% v 18.1%; absolute risk difference, 11.9%; 95% CI, 4.1 to 19.6). Capecitabine dose reductions because of HFS were less frequent in the diclofenac group (3.8%) than in the placebo group (13.5%; absolute risk difference, 9.7%; 95% CI, 3.0 to 16.4). CONCLUSION Topical diclofenac prevented HFS in patients receiving capecitabine. This trial supports the use of topical diclofenac to prevent capecitabine-associated HFS.
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Affiliation(s)
- Akhil Santhosh
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | - Akash Kumar
- Department of Medical Oncology, National Cancer Institute Jhajjar, AIIMS, New Delhi, India
| | - Vinod Sharma
- Department of Medical Oncology, National Cancer Institute Jhajjar, AIIMS, New Delhi, India
| | | | - Raja Pramanik
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | | | - Tushar Sehgal
- Department of Laboratory Medicine, AIIMS, Delhi, India
| | - Sneha Gund
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | - Arundhathi Dev
- Department of Medical Oncology (LAB), BRAIRCH, AIIMS, Delhi, India
| | - Winson Y Cheung
- Department of Medical Oncology, Tom Baker Cancer Centre Calgary, Calgary, Canada
| | - R M Pandey
- Department of Biostatistics, AIIMS, Delhi, India
| | - Saran Kumar
- Kusuma School of Biological Sciences, Indian Institute of Technology, Delhi, India
| | - Ishaan Gupta
- Department of Biomedical Engineering and Biotechnology, Indian Institute of Technology, Delhi, India
| | - Atul Batra
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
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Wander A, Chakrabarty B, Gulati S, Jauhari P, Pandey RM, Upadhyay A. Optimal duration for recording EEG in children and adolescents- a prospective interventional study. Seizure 2024; 115:14-19. [PMID: 38160513 DOI: 10.1016/j.seizure.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/16/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE This study aimed to determine the proportion of EEG recordings yielding diagnostic findings leading to a change in diagnosis beyond a 20-minute recording window, striking a balance between diagnostic yield and clinical practicability. METHODS At a tertiary care teaching hospital in North India, 225 subjects aged 1 month to 18 years undergoing outpatient EEG were enrolled. Patients with epileptic encephalopathies, nonepileptic phenomena, and breakthrough seizures in the last 24 hours were excluded. Two recording protocols were employed: Category A (n=163, awake recording with activation procedures for 15 minutes followed by an attempt at sleep for 60 minutes) and Category B (n=62, sleep recording for 55 minutes followed by 5 minutes of awake recording for younger children and those with impaired cognition). EEGs were prospectively reported at 20, 30, 40, 50, and 60-minute time points, with no retrospective changes allowed. RESULTS Among abnormal EEGs, the final diagnosis was changed beyond 20 minutes in 38.9% and 20.4% in categories A and B, respectively. A significant change in the final diagnosis among abnormal EEGs beyond 20 minutes was seen in - those who achieved sleep compared to those who didn't (45% versus 19%, p=0.03) in category A, and - focal compared to generalised seizures (Category A: 26.1% versus 8.3%, p=0.01; Category B: 23.8% versus 0%, p=0.02). CONCLUSION Forty minutes of awake EEGs with/without sleep and 30 minutes of sleep EEGs achieve a final diagnosis in nearly 90%. Prolonging awake records beyond 20 minutes, incorporating sleep, is particularly beneficial in focal epilepsies.
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Affiliation(s)
- Arvinder Wander
- Child Neurology Division, Department of Pediatrics, AIIMS, New Delhi, India
| | | | - Sheffali Gulati
- Centre of Excellence and Advanced Research on Childhood Neurodevelopmental Disorders, Chief, Child Neurology Division, Department of Pediatrics, AIIMS, New Delhi, India
| | - Prashant Jauhari
- Child Neurology Division, Department of Pediatrics, AIIMS, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Upadhyay
- Clinical Research Unit, All India Institute of Medical Sciences, New Delhi, India
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Rashid S, Rashid S, Das P, Malik N, Dash NR, Singh N, Pandey RM, Kumar L, Chauhan SS, Chosdol K, Gupta S, Saraya A. Elucidating the Role of miRNA-326 Modulating Hedgehog Signaling in Pancreatic Carcinoma. Pancreas 2024; 53:e42-e48. [PMID: 38019614 DOI: 10.1097/mpa.0000000000002274] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND AND AIM Pancreatic ductal adenocarcinoma (PDAC) is one of the lethal malignancies worldwide characterized by poor prognosis. MicroRNAs (miRNAs) function as the key regulators in carcinogenesis and may act as noninvasive biomarkers in various malignancies including PDAC. The present study aimed to elucidate the role of miR-326, a known modulator of hedgehog (Hh) pathway in PDAC. MATERIALS AND METHODS miR-326 circulating levels were assessed in 105 PDAC patients, 31 with chronic pancreatitis (CP) and 36 healthy controls by quantitative Polymerase chain reaction. The expression of miR-326 and smoothened (SMO) was checked in surgical PDAC tissue. SMO protein expression was analyzed by immunohistochemistry in different groups. Finally, the role of miR-326 as a modulator of Hh pathway was assessed in vitro. RESULTS Our results demonstrate that miR-326 is downregulated in both blood and tissue of PDAC patients as compared with controls. In contrast, the target gene/protein expression of SMO is upregulated in PDAC. Moreover, the tumor stromal expression of SMO was found to be clinically associated with lymph-node metastasis and vascular encasement in PDAC. Overexpression of miR-326 in Panc1 cell line was found to induce downregulation of SMO suggesting the tumor suppressor role of miR-326 in PDAC. CONCLUSIONS Taken together, miR-326 acts as a tumor suppressor in PDAC by modulating Hh pathway. It may be a promising target for the development of efficient drug therapies for the treatment of PDAC.
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Affiliation(s)
| | | | | | | | | | - Nidhi Singh
- From the Departments of Gastroenterology and HNU
| | | | | | | | | | - Surabhi Gupta
- Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Saraya
- From the Departments of Gastroenterology and HNU
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Joseph J, Jalal R, Sood M, Chellani H, Pandey RM, Goyal R, Ramji S, Dasgupta R. Turning the Gaze from Survive to Thrive for Children in India: Learnings from Two Case Studies. Indian J Pediatr 2023; 90:71-76. [PMID: 37540471 DOI: 10.1007/s12098-023-04712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/19/2023] [Indexed: 08/05/2023]
Abstract
Despite significant efforts and progress made in newborn care programs in India, implementation gaps persist across the continuum of care. The present case studies of two districts in Himachal Pradesh revealed that pathways of care were often fragmented with inconsistent linkages between facility and community due to poor documentation, lack of tiered referral, health system weaknesses, low utilization of primary level institutions, and inadequate post-natal home visits by Accredited Social Health Activists (ASHAs). Involvement of healthcare providers (HCPs) and frontline health workers (FHWs) was low and uneven in generating awareness across the districts with limited participation in supporting care in the community. Ensuring functionality of health centers and first-level care facilities; strengthening referral systems; adequate/trained human resources; strengthening routine health management systems, discharge processes and community-based care with adequate integration with facilities are necessary in closing access gaps.
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Affiliation(s)
- Jessy Joseph
- Global Access Research, International AIDS Vaccine Initiative (IAVI), New Delhi, India
| | - Ruchita Jalal
- Global Access Research, International AIDS Vaccine Initiative (IAVI), New Delhi, India
| | - Mangla Sood
- Department of Pediatrics, Indira Gandhi Medical College, Shimla, India
| | - Harish Chellani
- (Former) Department of Pediatrics, Vardhman Mahavir Medical College, New Delhi, India
| | - R M Pandey
- (Former) Department of Biostatistics, All India Institute of Medical Science (AIIMS), New Delhi, India
| | - Rajat Goyal
- International AIDS Vaccine Initiative (IAVI), New Delhi, India
| | - Siddarth Ramji
- (Former) Department of Neonatology, Maulana Azad Medical College, New Delhi, India
| | - Rajib Dasgupta
- Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, Room No 204, New Delhi, India.
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Gulati S, Israni A, Squires J, Singh A, Madaan P, Kamila G, Pandey RM. Socio-cultural Adaptation and Validation of Ages and Stages Questionnaire (ASQ 3) in Indian Children Aged 2 to 24 Months. Indian Pediatr 2023; 60:908-912. [PMID: 37551872] [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: 08/09/2023]
Abstract
OBJECTIVE To socio-culturally adapt and validate a Hindi language version of ASQ-3 in Indian children aged 2-24 months. METHODS This cross-sectional study was conducted at a tertiary-care center between March, 2017 and April, 2019. Children "at-risk" for developmental delay of either gender aged 2-24 months. Socio-cultural adaptation was done through interaction among 37 subject experts followed by validation. After piloting in 20 children, modified ASQ-3 was validated in 568 at-risk children (4 age-groups: 2-7, 7-13, 13-19 and 19-24 months). Validation was done against Development assessment scale for Indian infants (DASII). RESULTS Results: After screening 654 children, 568 were enrolled. Among these, 420 had developmental delay on DASII while 18 failed to be identified on ASQ (4.3%). Overall sensitivity and specificity of Hindi language Indian-adaptation of ASQ-3 in detecting developmental delay were 95.9% (95%CI: 93.6%-97.5%) and 81.7% (95%CI: 74%-87.9%), respectively with a positive predictive value (PPV) of 94.6% (95%CI: 92%-96.5%) and negative predictive value (NPV) of 85.6% (95%CI: 78.2%-92.2%). The sensitivity and specificity for motor delay were 96.1% (93.8%-97.7%) and 92.4% (86.4%-96.3%) [PPV: 97.7% (95.8%-98.9%); NPV: 87.7% (81%-92.7%)]. Sensitivity and specificity for mental delay were 95.5% (93.1%-97.2%)and 95.3% (90.1%-98.3%) [PPV: 98.6% (97%-99.5%); NPV: 85.9% (79.1%-91.2%)]. CONCLUSION The Hindi language Indian-adaptation of ASQ-3 had good psychometric properties with high sensitivity for developmental delay (95.9%), mental delay (95.5%), and motor delay (96.1%), suggesting it to be a good screening tool for neurodevelopmental delay.
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Affiliation(s)
- Sheffali Gulati
- Center of Excellence and Advanced Research on Childhood Neuro-developmental Disorders, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Prof Sheffali Gulati, Professor and Chief, Center of Excellence and Advanced Research on Childhood Neuro-developmental Disorders, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.
| | - Anil Israni
- Center of Excellence and Advanced Research on Childhood Neuro-developmental Disorders, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jane Squires
- Center on Human Development College of Education, University of Oregon, Oregon, US
| | - Ajay Singh
- College of Education, Texas A and M International University, Texas, US
| | - Priyanka Madaan
- Center of Excellence and Advanced Research on Childhood Neuro-developmental Disorders, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Gautam Kamila
- Center of Excellence and Advanced Research on Childhood Neuro-developmental Disorders, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi
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11
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Gupta S, Ramam M, Sharma VK, Sethuraman G, Pandey RM, Bhari N. Evaluation of a paraffin-based moisturizer compared to a ceramide-based moisturizer in children with atopic dermatitis: A double-blind, randomized controlled trial. Pediatr Dermatol 2023. [PMID: 37269189 DOI: 10.1111/pde.15355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/30/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Moisturizers are first-line therapy for treatment of atopic dermatitis (AD). Although there are multiple types of moisturizers available, head-to-head trials between different moisturizers are limited. OBJECTIVE To evaluate if a paraffin-based moisturizer is as effective as ceramide-based moisturizer in children with AD. MATERIALS AND METHODS In this double-blind, randomized comparative trial of pediatric patients with mild to moderate AD, subjects applied either a paraffin-based or ceramide-based moisturizer twice daily. Clinical disease activity using SCOring Atopic Dermatitis (SCORAD), quality of life using Children/Infants Dermatology Life Quality Index (CDLQI/IDLQI), and transepidermal water loss (TEWL) were measured at baseline and at follow-up at 1, 3, and 6 months. RESULTS Fifty-three patients were recruited (27 ceramide group and 26 paraffin group) with a mean age of 8.2 years and mean disease duration of 60 months. The mean change in SCORAD at 3 months in the ceramide-based and paraffin-based moisturizer groups was 22.1 and 21.4, respectively (p = .37). The change in CDLQI/IDLQI, TEWL over forearm and back, amount and days of topical corticosteroid required, median time to remission and disease-free days at 3 months were similar in both groups. As the 95% confidence interval (CI) of mean change in SCORAD at 3 months in both groups (0.78, 95% CI: -7.21 to 7.52) was not within the predefined margin of equivalence (-4 to +4), the conclusion of equivalence could not be proven. CONCLUSION Both the paraffin-based and ceramide-based moisturizers were comparable in improving the disease activity in children with mild to moderate AD.
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Affiliation(s)
- Sachin Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - M Ramam
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Sharma
- School of Medical Science and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - G Sethuraman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Titiyal JS, Goswami A, Kaur M, Sharma N, Maharana PK, Velpandian T, Pandey RM. Impact of Topical Cyclosporine-A or Topical Chloroquine on Post-LASIK Ocular Surface Stability - A Randomized Controlled Trial. Curr Eye Res 2023; 48:557-563. [PMID: 36800492 DOI: 10.1080/02713683.2023.2182747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 01/07/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
PURPOSE To compare effect of topical cyclosporine-A 0.05% (CsA) and chloroquine phosphate 0.03% (CHQ) as an adjunct to standard therapy in maintaining post-laser assisted in situ keratomileusis (LASIK) ocular surface stability. METHODS Randomized controlled trial on 100 eyes undergoing femtosecond-LASIK randomized into three groups: 33 eyes in Group I (Standard Treatment group), 34 eyes in Group II (CsA group) and 33 eyes in Group III (CHQ group). Standard treatment included topical moxifloxacin, topical prednisolone and carboxymethyl cellulose. Group II received topical CsA 0.05% twice daily for three months and group III received topical CHQ 0.03% twice daily for three months in addition to standard treatment. Primary outcome measure was change in ocular surface disease index (OSDI) at 6 months. Secondary outcome measures were tear break up time (TBUT), Schirmer-I score, tear film osmolarity, tear film MMP-9 and visual acuity. Follow-up was performed at postoperative 1, 3 and 6 months. RESULTS At 6 months, OSDI score, MMP-9, tear osmolarity, TBUT and Schirmer score were significantly better in both CsA and CHQ groups as compared with controls (p < 0.001). OSDI, Tear osmolarity, TBUT, MMP-9 levels were comparable in CsA and CHQ group (p > 0.05). In CsA group, tear film MMP-9 levels at 6 months were comparable to preoperative baseline (p = 0.09). There was no significant change in the Schirmer score from baseline in the CsA group; in addition, the Schirmer score was significantly better than the CHQ group at 6 months (p = 0.02). Visual acuity was comparable in all three groups. Adverse effects including burning sensation, stinging, pain and redness were reported by ten patients (CsA group- 3, CHQ group-7; p = 0.28). CONCLUSION Both CsA and CHQ are useful adjuncts to standard therapy in maintaining ocular surface stability after refractive surgery. Cyclosporine A has more potent and sustained anti-inflammatory effect with less ocular irritative effects.
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Affiliation(s)
- Jeewan Singh Titiyal
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ananya Goswami
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Kaur
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla Kumar Maharana
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - T Velpandian
- Department of Ocular Pharmacology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Mohan Lal B, Vyas S, Malhotra A, Ray A, Gupta G, Pandey S, Pandey RM, Aggarwal S, Sinha S. Ultrasonography of the neck in patients with obstructive sleep apnea. Sleep Breath 2023; 27:903-912. [PMID: 35871215 PMCID: PMC9868188 DOI: 10.1007/s11325-022-02682-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/09/2022] [Accepted: 07/11/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION In resource-limited settings, obstructive sleep apnea (OSA) often goes undiagnosed as polysomnography (PSG) is expensive, time-consuming, and not readily available. Imaging studies of upper airway have been tried as alternatives to PSG to screen for OSA. However, racial differences in upper airway anatomy preclude generalizability of such studies. We sought to test the hypothesis that ultrasonography (USG), an inexpensive, readily available tool to study soft tissue structures of the upper airway, would have predictive value for OSA in South Asian people. METHODS Adult patients with sleep-related complaints suspicious for OSA were taken for overnight PSG. After the PSG, consecutive patients with and without OSA were studied with submental ultrasonography to measure tongue base thickness (TBT) and lateral pharyngeal wall thickness (LPWT). RESULTS Among 50 patients with OSA and 25 controls, mean age was 43.9 ± 11.4 years, and 39 were men. Patients with OSA had higher TBT (6.77 ± 0.63 cm vs 6.34 ± 0.54 cm, P value = 0.004) and higher LPWT (2.47 ± 0.60 cm vs 2.12 ± 0.26 cm, P value = 0.006) compared to patients without OSA. On multivariate analysis, TBT, LPWT, and neck circumference were identified as independent factors associated with OSA. These variables could identify patients with severe OSA with a sensitivity of 72% and a specificity of 76%. CONCLUSION Patients with OSA have higher tongue base thickness and lateral pharyngeal wall thickness proportionate to the severity of the disease, independent of BMI and neck circumference. These findings suggest that sub-mental ultrasonography may be useful to identify patients with severe OSA in resource-limited settings.
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Affiliation(s)
- Bhavesh Mohan Lal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Malhotra
- Critical Care and Sleep Medicine, UC San Diego School of Medicine, San Diego, CA, 92121, USA
| | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
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Kappagantu V, Sinha TP, Agrawal D, Jamshed N, Kumar A, Kumar A, Pandey RM, Gopinath B, Bhushan V, Tiwari AK, Bhoi SK. Diagnostic Accuracy of Ocular Ultrasonography in Identifying Raised Intracranial Pressure among Pediatric Population. Pediatr Neurosurg 2023; 58:142-149. [PMID: 37231881 DOI: 10.1159/000530921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/11/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Role of CT scan, MRI, ophthalmoscopy, direct monitoring by a transducer probe in identifying raised intracranial pressure (ICP) in emergency department is limited. There are few studies correlating elevated optic nerve sheath diameter (ONSD) measured by point of care ultrasound (POCUS) with raised ICP in pediatrics emergencies. We studied the diagnostic accuracy of ONSD, crescent sign, and optic disc elevation in identifying increased ICP in pediatrics. METHODS Prospective observational study was done between April 2018 and August 2019 after ethics approval. Out of 125 subjects, 40 patients without clinical features of raised ICP were recruited as external controls and 85 with clinical features of raised ICP as study subjects. Their demographic profile, clinical examination, and ocular ultrasound findings were noted. This was followed by CT scan. Out of 85 patients, 43 had raised ICP (cases) and 42 had normal ICP (disease controls). Diagnostic accuracy of ONSD in identifying raised ICP was evaluated using STATA. RESULTS The mean ONSD in case group was 5.5 ± 0.6 mm, 4.9 ± 0.5 mm in disease control group and external control group was 4.8 ± 0.3 mm. Cut-off of ONSD for raised ICP at ≥4.5 mm had a sensitivity and specificity of 97.67% and 10.98%, while ≥5.0 mm showed a sensitivity and specificity of 86.05% and 71.95%. Crescent sign and optic disc elevation had good correlation with increased ICP. CONCLUSION ONSD ≥5 mm by POCUS identified raised ICP in pediatric population. Crescent sign and optic disc elevation may function as additional POCUS signs in identifying raised ICP.
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Affiliation(s)
- Vignan Kappagantu
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tej Prakash Sinha
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nayer Jamshed
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Bharath Gopinath
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vidhya Bhushan
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar Tiwari
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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15
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Sinha S, Abdul Samad S, Bansal G, Verma S, A Sangle S, Kamal Guha S, Rajput N, M Pandey R, Ranjan S, Salvi S, Mundhe S, More M, Modak D, Datta K, K Kabra S, Lodha R, Nischal N, K Das B. Survival of persons living with HIV/AIDS: A multicentric study from India. Curr HIV Res 2023; 21:81-87. [PMID: 36734902 DOI: 10.2174/1570162x21666230123151639] [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: 09/04/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND It has been more than 17 years since the introduction of free ART in India. At this point, it would be prudent to look at the factors associated with the survival of persons living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLHA) who are already enrolled in the ART program. METHODS PLHAs enrolled from antiretroviral therapy (ART) centers located in three different cities in India - Delhi, Pune and Kolkata, and were followed up at six monthly intervals monitoring the WHO stage, CD4 counts, complete blood counts, and liver and kidney function tests, for a duration of three years. RESULTS AND DISCUSSION The incidence of mortality among HIV/AIDS patients on ART was 5·0 per 1000 patient-years (21/1410, 1.4%). Age at initiation of ART, being above 35 years, was the only significant predictor of mortality (log-rank p = 0·018). Multivariable analysis showed a significant association of an unfavourable outcome (defined as mortality or development of opportunistic infection during follow-up) with male gender (adjusted odds ratio (AOR) = 5.26, p = <0.01) and being unmarried at ART initiation (AOR = 1.39, p = 0.005). CONCLUSION The survival of PLHA with good adherence to ART is independent of the WHO stage or CD4 counts at the initiation of ART. Initiation of ART after 35 years of age was a significant predictor of mortality.
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Affiliation(s)
- Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Abdul Samad
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Bansal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurav Verma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Neetu Rajput
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- All India Institute of Medical Sciences Medicine New Delhi India
| | - Sanjay Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sonali Salvi
- Department of Medicine, B J Government Medical College and SGH, Pune, India
| | - Sanjay Mundhe
- Department of Medicine, B J Government Medical College and SGH, Pune, India
| | - Monika More
- Department of Medicine, B J Government Medical College and SGH, Pune, India
| | - Dolanchampa Modak
- Centre of Excellence in HIV care, School of Tropical Medicine, Kolkata, India
| | - Kalpana Datta
- Centre of Excellence in HIV care, School of Tropical Medicine, Kolkata, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Neeraj Nischal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bimal K Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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16
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Bagri NK, Khan M, Pandey RM, Lodha R, Kabra SK, Angurana SK, Awasthi S, Bamnawat H, Bhat JI, Bhutia TD, Charoo BA, Choudhary A, Choudhary B, Das RR, Dwibedi B, Ghosh S, Girish M, Gulla KM, Goyal JP, Gupta P, I S, Jindal A, John J, Joshi P, Kaur R, Khera D, Kumar A, Kumar P, Kumar P, Lalitha AV, Maheshwari M, Malik S, Mondal R, Muralidharan J, Pawar G, Prasad A, Rao SK, Ratageri VH, Sarkar M, Satpathy AK, Sankar J, Sharma S, Singh A, Singh K, Singhal T, Sood M, Sudeepthi SV, Tiwari L, Verma N, Yonzon R. Initial Immunomodulation and Outcome of Children with Multisystem Inflammatory Syndrome Related to COVID-19: A Multisite Study from India. Indian J Pediatr 2022; 89:1236-1242. [PMID: 35699843 PMCID: PMC9192925 DOI: 10.1007/s12098-022-04254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the outcomes in children with MIS-C receiving different immunomodulatory treatment. METHODS In this multicentric, retrospective cohort study, data regarding treatment and outcomes of children meeting the WHO case definition for MIS-C, were collected. The primary composite outcome was the requirement of vasoactive/inotropic support on day 2 or beyond or need of mechanical ventilation on day 2 or beyond after initiation of immunomodulatory treatment or death during hospitalization in the treatment groups. Logistic regression and propensity score matching analyses were used to compare the outcomes in different treatment arms based on the initial immunomodulation, i.e., IVIG alone, IVIG plus steroids, and steroids alone. RESULTS The data of 368 children (diagnosed between April 2020 and June 2021) meeting the WHO case definition for MIS-C, were analyzed. Of the 368 subjects, 28 received IVIG alone, 82 received steroids alone, 237 received IVIG and steroids, and 21 did not receive any immunomodulation. One hundred fifty-six (42.39%) children had the primary outcome. On logistic regression analysis, the treatment group was not associated with the primary outcome; only the children with shock at diagnosis had higher odds for the occurrence of the outcome [OR (95% CI): 11.4 (5.19-25.0), p < 0.001]. On propensity score matching analysis, the primary outcome was comparable in steroid (n = 45), and IVIG plus steroid (n = 84) groups (p = 0.515). CONCLUSION While no significant difference was observed in the frequency of occurrence of the primary outcome in different treatment groups, data from adequately powered RCTs are required for definitive recommendations.
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Affiliation(s)
- Narendra Kumar Bagri
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - M Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Suresh Kumar Angurana
- Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shally Awasthi
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Harshita Bamnawat
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Javeed Iqbal Bhat
- Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
| | - Tsultem D Bhutia
- Department of Pediatrics, New STNMMS Hospital, Gangtok, Sikkim, India
| | - Bashir Ahmad Charoo
- Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
| | - Abhijit Choudhary
- Department of Pediatrics, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Bharat Choudhary
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bhagirathi Dwibedi
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sanajit Ghosh
- Department of Pediatrics, Medical College Kolkata, Kolkata, West Bengal, India
| | - Meenakshi Girish
- Department of Pediatrics, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Krishna Mohan Gulla
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prakriti Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Shivanand I
- Department of Pediatrics, KIMS, Hubbali, Karnataka, India
| | - Atul Jindal
- Department of Pediatrics, All India Institute of Medical Sciences, Raipur, India
| | - Joseph John
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Preetha Joshi
- Department of Pediatrics, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Ravleen Kaur
- Department of Pediatrics, Dr Rajendra Prasad Government Medical College Kangra at Tanda, Himachal Pradesh, India
| | - Daisy Khera
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Amit Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Pradeep Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - A V Lalitha
- Department of Pediatric Intensive Care, St. John's Medical College and Hospital, Bangalore, Karanataka, India
| | - Mahesh Maheshwari
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, India
| | - Shikha Malik
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, India
| | - Rakesh Mondal
- Department of Pediatrics, Medical College Kolkata, Kolkata, West Bengal, India
| | - Jayashree Muralidharan
- Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gayatri Pawar
- Department of Pediatrics, KIMS, Hubbali, Karnataka, India
| | - Arun Prasad
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Sunil Kumar Rao
- Department of Pediatrics, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
| | | | - Mihir Sarkar
- Department of Pediatrics, Medical College Kolkata, Kolkata, West Bengal, India
| | - Amit Kumar Satpathy
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Seema Sharma
- Department of Pediatrics, Dr Rajendra Prasad Government Medical College Kangra at Tanda, Himachal Pradesh, India
| | - Ankur Singh
- Department of Pediatrics, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Tanu Singhal
- Department of Pediatrics, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Mangla Sood
- Department of Pediatrics, IGMC, Shimla, Himachal Pradesh, India
| | | | - Lokesh Tiwari
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Nishant Verma
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ruth Yonzon
- Department of Pediatrics, New STNMMS Hospital, Gangtok, Sikkim, India
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Joseph J, Jalal R, Nagrath M, Dasgupta R, Chellani H, Pandey RM, Sood M, Goyal R, Ramji S. Growth Faltering Among Discharged Babies from Inpatient Newborn Care Facilities: Learnings from Two Districts of Himachal Pradesh. Indian Pediatr 2022; 59:763-768. [PMID: 35822489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine the burden of early growth faltering and understand the care practices for small and sick babies discharged from newborn units in the district. STUDY DESIGN Observational and follow-up study. PARTICIPANTS 512 babies discharged from two Special Newborn Care Units (SNCUs) and four Newborn Stabilization Units (NBSUs) in two districts of Himachal Pradesh. METHODS Anthropometric assessments, interview of mothers and Accredited Social Health Activists (ASHAs) conducted between August, 2018 and March, 2019. Change in weight-for-age z-score (DWAZ) of <-0.67SD between birth and assessment was used to define growth faltering. OUTCOMES Proportion of growth faltering (or catch-down growth) in small and sick babies discharged from SNCUs and NBSUs, and infant care practices. RESULTS Growth faltering was observed in a significant proportion of both term (30%) and preterm (52.6%) babies between 1 to 4 months of age. Among babies with growth faltering (n=180), 73.9% received a home visit by ASHA, and only 36.7% received a follow-up visit at a facility. There were 71.3% mothers counselled at discharge (mostly informed about breast feeding). Most (96.7%) mothers did not perceive inadequate weight gain in their babies post-discharge. During home visits, ASHAs weighed 61.6% of the infants with growth faltering. Amongst infants who had growth faltering, only 49.6% of mothers had been provided information about their infant's growth and 57.1% mothers had received breastfeeding counselling. CONCLUSION Small and sick newborn infants (both term and preterm babies) discharged from special care newborn units are at increased risk of early growth faltering. Follow-up care provided to these infants is inadequate. There is a need to strengthen both facility-based and home-based follow up of small and sick newborn infants discharged from newborn care facilities.
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Affiliation(s)
- Jessy Joseph
- International Aids Vaccine Initiative (IAVI), India
| | | | | | - Rajib Dasgupta
- Department of Community Health, Jawaharlal Nehru University, New Delhi
| | - Harish Chellani
- Department of Pediatrics, Vardhman Mahavir Medical College, New Delhi
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Science (AIIMS), New Delhi
| | - Mangla Sood
- Department of Pediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh
| | - Rajat Goyal
- International Aids Vaccine Initiative (IAVI), India
| | - Siddarth Ramji
- Department of Neonatology, Maulana Azad Medical College, New Delhi. Correspondence to: Dr Siddarth Ramji, 9/10 Chandrabagh Avenue 2nd Street, Dr RK Salai, Chennai 600004, Tamil Nadu.
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Chakrabarty B, Dogra AS, Toteja GS, Pandey RM, Paul VK, Gulati S. Serum Trace Elements in Children with Well-Controlled and Drug Refractory Epilepsy Compared to Controls: An Observational Study. Neurol India 2022; 70:1846-1851. [PMID: 36352577 DOI: 10.4103/0028-3886.359205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Trace elements have been implicated in pathogenesis of epilepsy. Studies till date have shown altered levels of serum trace elements in children with epilepsy. OBJECTIVE The objective of the current was to estimate serum levels of trace elements in children with well-controlled and drug refractory epilepsy and compare it with controls. METHODOLOGY In a tertiary care teaching hospital of North India, serum selenium, copper, zinc, and iron were estimated in well-controlled and drug refractory epileptic children aged 2-12 years and compared with age and gender matched controls. RESULTS A total of 106 children with epilepsy (55 drug refractory and 51 well controlled) and 52 age and gender matched controls were included in the study. Serum selenium and copper were significantly decreased in cases compared to controls. After classifying epilepsy into well-controlled and drug refractory cases, only in the latter the significant difference for serum selenium and copper levels remained compared to controls. Additionally, in the drug refractory cases, serum iron levels were significantly reduced compared to controls. CONCLUSIONS Serum trace elements are altered in children with epilepsy (more so in the drug refractory group) compared to controls. Monitoring of serum trace elements in children with epilepsy should be considered. Up to one-third of epilepsy is drug refractory of which only another third are amenable to surgery. It is worth investigating the therapeutic potential of altered micronutrient status in these patients.
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Affiliation(s)
- Biswaroop Chakrabarty
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ankush Singh Dogra
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - G S Toteja
- Indian Council of Medical Research, New Delhi, India
| | - R M Pandey
- Child Neurology Division, Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod K Paul
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sheffali Gulati
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Soni A, Khalil S, Pandey RM, Chellani H. Risk factors predicting early in-hospital mortality among underfive children and need for decentralization of pediatric emergency care services. Indian J Public Health 2022; 66:257-263. [PMID: 36149101 DOI: 10.4103/ijph.ijph_487_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Lack of pediatric triage and emergency care system in peripheral healthcare centers leads to unnecessary referral of low- and medium-risk patients. This study was conducted to study the risk factors predicting mortality within 48 h of admission in neonates and under-five children referred to the pediatric emergency of a tertiary care hospital in India. Methods This prospective study was conducted on children (0-5 years) referred to the pediatric emergency who were enrolled and followed up. The outcome was defined as "survival" or "death" at 48 hours. Logistic regression analysis was conducted to assess the predictors of early in-hospital mortality. Results A total of 246 consecutive pediatric (62 neonates, 52 young infants, and 132 children aged 1-5 years) referral cases were enrolled; mortality within 48 hours was 20%. Lack of pediatric intensive care (odds ratio [OR] 4.07, 95% confidence interval [CI] 2.0, 8.32, P = 0.02), lack of neonatal intensive care (OR 2.10, 95% CI 1.01,4.28, P ≤ 0.001), distance from referral center >20 km (OR 4.61, 95% CI 2.01, 10.58, P = 0.0003), >1 h taken during transport (OR 7.75, 95% CI 2.93, 20.46, P < 0.001), lack of ambulance facility (OR 0.04, 95% CI 0.009, 0.143, P < 0.0001), very sick condition on arrival (OR 210.1, 95% CI 12.1, 3643.41, P = 0.0002), and unstable temperature-oxygenation-perfusion-sugar on arrival were the independent risk factors predicting in early in-hospital mortality. Conclusion Developing a pediatric triage and monitoring system, tele-pediatric intensive care unit, regionalizing referral-back-referral services with robust interhospital communication, and strengthening pediatric emergency services are the need of the hour to reduce early in-hospital mortality.
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Affiliation(s)
- Aditya Soni
- Senior Resident, Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sumaira Khalil
- Assistant Professor, Department of Pediatrics, University College of Medical Science & GTB Hospital, New Delhi, India
| | - R M Pandey
- Professor and Head, Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Harish Chellani
- Professor, Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Fazal F, Gupta N, Soneja M, Mitra DK, Satpathy G, Panda SK, Chaturvedi PK, Vikram NK, Pandey RM, Wig N. Clinical Profile, Treatment, and Outcome of Patients with Secondary Hemophagocytic Lymphohistiocytosis in Critically Ill Patients: A Prospective Observational Study. Indian J Crit Care Med 2022; 26:564-567. [PMID: 35719456 PMCID: PMC9160626 DOI: 10.5005/jp-journals-10071-24136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The objective of the study was to evaluate the clinical profile and outcome of patients with secondary hemophagocytic lymphohistiocytosis (HLH) in critically ill patients. Materials and methods A prospective observational study was conducted where critically ill adult patients presenting with fever and bicytopenia were evaluated according to the HLH-2004 diagnostic criteria for the presence of secondary HLH. The underlying trigger, clinical profile, treatment, and outcome of patients with HLH were analyzed. Results Of the 76 critically ill patients with fever and bicytopenia, 33 (43%) patients were diagnosed with HLH. The following triggers for HLH were identified: bacterial infections (23%), fungal infections (10%), viral infections (10%), parasitic infections (10%), autoimmune diseases (13%), and malignancy (8%). A total of 78% of the HLH cases received steroids, but the use of steroids was not associated with improvement in mortality. Conclusion There is a high prevalence of HLH in patients presenting with fever and bicytopenia in critically ill adult patients. Infections were identified as the most common trigger of HLH. How to cite this article Fazal F, Gupta N, Soneja M, Mitra DK, Satpathy G, Panda SK, et al. Clinical Profile, Treatment, and Outcome of Patients with Secondary Hemophagocytic Lymphohistiocytosis in Critically Ill Patients: A Prospective Observational Study. Indian J Crit Care Med 2022;26(5):564–567.
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Affiliation(s)
- Farhan Fazal
- Department of Medicine and Microbiology, AIIMS, New Delhi, India
| | - Nitin Gupta
- Department of Medicine and Microbiology, AIIMS, New Delhi, India
| | | | - DK Mitra
- Department of Transplant Immunology and Immunogenetics, AIIMS, New Delhi, India
| | - G Satpathy
- Department of Microbiology, AIIMS, New Delhi, India
| | - SK Panda
- Department of Pathology, AIIMS, New Delhi, India
| | - PK Chaturvedi
- Department of Reproductive Biology, AIIMS, New Delhi, India
| | | | - RM Pandey
- Department of Biostatistics, AIIMS, New Delhi, India
| | - Naveet Wig
- Department of Medicine, AIIMS, New Delhi, India
- Naveet Wig, Department of Medicine, AIIMS, New Delhi, India, Phone: +91 9818449310, e-mail:
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Desai D, Khan AR, Soneja M, Mittal A, Naik S, Kodan P, Mandal A, Maher GT, Kumar R, Agarwal A, Gowda NR, H V, Kumar P, Pandey S, Pandey RM, Kumar A, Ray A, Jorwal P, Nischal N, Choudhary A, Brijwal M, Madan K, Lodha R, Sinha S, Dar L, Wig N, Guleria R. Effectiveness of an inactivated virus-based SARS-CoV-2 vaccine, BBV152, in India: a test-negative, case-control study. The Lancet Infectious Diseases 2022; 22:349-356. [PMID: 34826383 PMCID: PMC8610201 DOI: 10.1016/s1473-3099(21)00674-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/10/2021] [Accepted: 10/15/2021] [Indexed: 12/21/2022]
Abstract
Background BBV152 is a whole-virion inactivated SARS-CoV-2 vaccine that has been deployed in India. The results of the phase 3 trial have shown clinical efficacy of BBV152. We aimed to evaluate the effectiveness of BBV152 against symptomatic RT-PCR-confirmed SARS-CoV-2 infection. Methods We conducted a test-negative, case-control study among employees of the All India Institute of Medical Sciences (a tertiary care hospital in New Delhi, India), who had symptoms suggestive of COVID-19 and had an RT-PCR test for SARS-CoV-2 during the peak of the second wave of the COVID-19 pandemic in India between April 15 and May 15, 2021. Cases (test-positives) and controls (test-negatives) were matched (1:1) on the basis of age and gender. The odds of vaccination with BBV152 were compared between cases and controls and adjusted for level of occupational exposure (to COVID-19), previous SARS-CoV-2 infection, and calendar time, using conditional logistic regression. The primary outcome was effectiveness of two doses of BBV152 (with the second dose received at least 14 days before testing) in reducing the odds of symptomatic RT-PCR-confirmed SARS-CoV-2 infection, expressed as (1 – odds ratio) × 100%. Findings Between April 15 and May 15, 2021, 3732 individuals had an RT-PCR test. Of these, 2714 symptomatic employees had data on vaccination status, and 1068 matched case-control pairs were available for analysis. The adjusted effectiveness of BBV152 against symptomatic COVID-19 after two doses administered at least 14 days before testing was 50% (95% CI 33–62; p<0·0001). The adjusted effectiveness of two doses administered at least 28 days before testing was 46% (95% CI 22–62) and administered at least 42 days before testing was 57% (21–76). After excluding participants with previous SARS-CoV-2 infections, the adjusted effectiveness of two doses administered at least 14 days before testing was 47% (95% CI 29–61). Interpretation This study shows the effectiveness of two doses of BBV152 against symptomatic COVID-19 in the context of a huge surge in cases, presumably dominated by the potentially immune-evasive delta (B.1.617.2) variant of SARS-CoV-2. Our findings support the ongoing roll-out of this vaccine to help control the spread of SARS-CoV-2, while continuing the emphasis on adherence to non-pharmacological measures. Funding None. Translation For the Hindi translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Devashish Desai
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Adil Rashid Khan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Ankit Mittal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shivdas Naik
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Parul Kodan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ayan Mandal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rohit Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveen R Gowda
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas H
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Parmeshwar Kumar
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Jorwal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neeraj Nischal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aashish Choudhary
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Megha Brijwal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Dar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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Kaur H, Chaudhary S, Mohanty S, Sharma G, Kumaran SS, Ghati N, Bhatia R, Nehra A, Pandey RM. Comparing cognition, coping skills and vedic personality of individuals practicing yoga, physical exercise or sedentary lifestyle: a cross-sectional fMRI study. Integr Med Res 2022; 11:100750. [PMID: 34194974 PMCID: PMC8237306 DOI: 10.1016/j.imr.2021.100750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/02/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Nature and intensity of physical activity may influence cognition, coping mechanisms and overall personality of an individual. The objective of this cross-sectional study was to compare cognition, coping styles and vedic personality among individuals practicing different lifestyle. METHODS Thirty-nine healthy young adults of both gender (27.63±4.04 years) were recruited and categorized into three groups; i.e. yoga, physical activity or sedentary lifestyle groups. Participants were assessed on cognition, coping styles and Vedic personality inventory (VPI). Verbal-n-back and Stroop tasks were performed using 3 Tesla MRI scanner. Task Based Connectivity (TBC) analysis was done using CONN toolbox in SPM. RESULTS There were no significant differences in the cognitive domains across the groups. The planning (p=0.03) and acceptance domain (p=0.03) of the Brief COPE scale showed difference across the groups. Post-hoc analysis revealed that planning and acceptance scores were distinctly higher in the physical activity group, however, there was no difference between physical activity group and yoga practitioners. Similarly, in the VPI, Sattva (p=0.003), Rajas (p=0.05) and Tamas (p=0.01) were different across the groups, and the post hoc analysis showed superiority in Sattva scores in Yoga group, meanwhile, both Rajas and Tamas were higher in the physical activity group. Yoga practitioners preferentially recruited left Superior Frontal Gyrus in relation to the physically active group and precuneus in relation to the sedentary lifestyle group. CONCLUSION The study revealed that yoga practitioners had a distinct higher sattva guna and preferentially recruited brain areas associated with self-regulation and inhibitory control.
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Affiliation(s)
- Harsimarpreet Kaur
- Center for Integrative Medicine and Research, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shefali Chaudhary
- Department of NMR & MRI facility, All India Institute of Medical Sciences, New Delhi, India
| | - Sriloy Mohanty
- Center for Integrative Medicine and Research, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Gautam Sharma
- Center for Integrative Medicine and Research, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S Senthil Kumaran
- Department of NMR & MRI facility, All India Institute of Medical Sciences, New Delhi, India
| | - Nirmal Ghati
- Department of Cardiology, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Nehra
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - RM Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Sharma G, Sharma P, Mohan B, Agarwal A, Lama S, Jat M, Biju KC, Upadhyay P, Gupta A, Mohanty S, Miglani M, Sharma S, Sagar R, Prabhakaran D, Pandey RM. Prevalence of psychological outcomes and its associated factors in healthcare personnel working during COVID-19 outbreak in India. Indian J Psychiatry 2022; 64:151-158. [PMID: 35494318 PMCID: PMC9045337 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_60_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/24/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Care of COVID-19 patients has been shown to affect the mental health of healthcare personnel (HCP), however, there is little data reflecting psychological health of HCP in India. AIMS The present study was undertaken to assess the prevalence of psychological outcomes and its association with various sociodemographic and occupational factors among the HCP in India. METHODOLOGY A cross-sectional, online survey, using snowball sampling method was conducted between June 1, 2020, and June 22, 2020. The HCP working in COVID-19 designated hospitals across India were invited to participate. Patient Health Questionnaire-4 and 19-item stress-related questionnaire were used to evaluate symptoms of overall anxiety, depression, COVID-19 infection specific anxiety, exhaustion, and workload. RESULTS In this cross-sectional study with 2334 HCP from 27 states and 7 union territories of India; 17.9% of participants had depression, 18.7% had overall anxiety, 26.5% had exhaustion, 30.3% reported heavy workload, and 25.4% had COVID-19 infection-specific anxiety, respectively. The HCP working in states with higher caseload was a common risk factor for overall anxiety (odds ratio [OR], 1.7; P < 0.001), depression (OR, 1.6; P < 0.001), COVID-19 infection-specific anxiety (OR, 2.5; P < 0.001), exhaustion (OR, 3.1; P < 0.001), and heavy workload (OR, 2.6; P < 0.001). Nurses were more at risk for depression (OR, 2.2; P < 0.001), anxiety specific to COVID-19 infection (OR, 1.3; P = 0.034), and heavy workload (OR, 2.9; P < 0.001); while doctors were more at risk for overall anxiety (OR, 2.0; P = 0.001) and exhaustion (OR, 3.1; P < 0.001). CONCLUSIONS Frontline workers, specifically nurses and doctors, and those working in states with high COVID-19 caseload are more at risk for adverse psychological outcomes. The relatively less prevalence compared with other countries, is perhaps a reflection of measures undertaken, including early lockdown, ensuring better all-round preparedness and social norms.
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Affiliation(s)
- Gautam Sharma
- Center for Integrative Medicine and Research, New Delhi, India.,Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Payal Sharma
- Center for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Bishav Mohan
- Department of Cardiology, Ludhiana, Punjab, India
| | - Aman Agarwal
- Center for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Sudha Lama
- Center for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Mansingh Jat
- Center for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - K C Biju
- Center for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Palak Upadhyay
- Department of Clinical Psychology (Psychiatry), Ludhiana, Punjab, India
| | - Anupama Gupta
- Center for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Sriloy Mohanty
- Center for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sarit Sharma
- Department of SPM, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, Public Health Foundation of India, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Singh A, Gupta N, Khandakar H, Kaushal S, Seth A, Pandey RM, Sharma A. Autophagy-associated HMGB-1 as a novel potential circulating non-invasive diagnostic marker for detection of Urothelial Carcinoma of Bladder. Mol Cell Biochem 2022; 477:493-505. [PMID: 34796446 PMCID: PMC8601373 DOI: 10.1007/s11010-021-04299-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/04/2021] [Indexed: 01/04/2023]
Abstract
Urothelial carcinoma of bladder (UBC), a highly prevalent urological malignancy associated with high mortality and recurrence rate. Standard diagnostic method currently being used is cystoscopy but its invasive nature and low sensitivity stresses for identifying predictive diagnostic marker. Autophagy, a cellular homeostasis maintaining process, is usually dysregulated in cancer and its role is still enigmatic in UBC. In this study, 30 UBC patients and healthy controls were enrolled. Histopathologically confirmed tumor and adjacent normal tissue were acquired from patients. Molecular expression and tissue localization of autophagy-associated molecules (HMGB-1, RAGE, beclin, LC-3, and p62) were investigated. Serum HMGB-1 concentration was measured in UBC patients and healthy controls. ROC curves were plotted to evaluate diagnostic potential. Transcript, protein, and IHC expression of HMGB-1, RAGE, beclin, and LC-3 displayed upregulated expression, while p62 was downregulated in bladder tumor tissue. Serum HMGB-1 levels were elevated in UBC patients. Transcript and circulatory levels of HMGB-1 showed positive correlation and displayed a positive trend with disease severity. Upon comparison with clinicopathological parameters, HMGB-1 emerged as molecule of statistical significance to exhibit association. HMGB-1 exhibited optimum sensitivity and specificity in serum. The positive correlation between tissue and serum levels of HMGB-1 showcases serum as a representation of in situ scenario, suggesting its clinical applicability for non-invasive testing. Moreover, optimum sensitivity and specificity displayed by HMGB-1 along with significant association with clinicopathological parameters makes it a potential candidate to be used as diagnostic marker for early detection of UBC but requires further validation in larger cohort.
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Affiliation(s)
- Aishwarya Singh
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nidhi Gupta
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Hena Khandakar
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Seema Kaushal
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Alpana Sharma
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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25
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Sharma G, Ramakumar V, Sharique M, Bhatia R, Naik N, Mohanty S, Agarwal A, Meti M, Shukla A, Deepti S, Bansal R, Gupta A, Ahmed AS, Pandey RM, Narang R, Mishra S, Saxena A, Juneja R. Effect of Yoga on Clinical Outcomes and Quality of Life in Patients With Vasovagal Syncope (LIVE-Yoga). JACC Clin Electrophysiol 2022; 8:141-149. [PMID: 35210069 DOI: 10.1016/j.jacep.2021.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/01/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study aims to determine the impact of yoga as an adjunct to standard therapy versus standard therapy alone on the symptomatic burden in patients with recurrent vasovagal syncope (VVS). BACKGROUND There is a significant reduction in the quality of life (QoL) of patients with recurrent VVS. Existing management therapies have been largely ineffective. Recent trials have demonstrated the efficacy of yoga in diseases with autonomic imbalance, suggesting its possible utility in VVS. METHODS Patients with recurrent VVS were randomized to receive either a specialized yoga training program in addition to current guideline-based therapy (intervention arm, group 1) or current guideline-based therapy alone (control arm, group 2). The primary outcome was a composite of the number of episodes of syncope and presyncope at 12 months. Secondary outcomes included QoL assessment by World Health Organization Quality of Life Brief Field questionnaire (WHOQoL-BREF) scores and Syncope Functional Status Questionnaire scores at 12 months, head up tilt test, and heart rate variability at 6 weeks. RESULTS A total of 55 patients underwent randomization. The mean number of syncopal or presyncopal events at 12 months was 0.7 ± 0.7 in the intervention arm compared to 2.52 ± 1.93 in the control arm (P < 0.01). In the intervention arm, 13 (43.3%) patients remained free of events versus 4 (16.0%) patients in the control arm (P = 0.02). QoL at 12 months showed significant improvement of all Syncope Functional Status Questionnaire scores and 2 domains of WHOQoL-BREF scores (P < 0.05). CONCLUSIONS Yoga as adjunctive therapy is superior to standard therapy alone in reducing the symptomatic burden and improving QoL in patients with recurrent VVS.
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Affiliation(s)
- Gautam Sharma
- Department of Cardiology, Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Sharique
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Nitish Naik
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sriloy Mohanty
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Aman Agarwal
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Mohini Meti
- Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Akriti Shukla
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharthan Deepti
- Department of Cardiology, Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Raghav Bansal
- Department of Cardiology, Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Anunay Gupta
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - A Shaheer Ahmed
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Rajiv Narang
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sundeep Mishra
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajnish Juneja
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Sinha S, Dhooria S, Sasi A, Tomer A, Thejeswar N, Kumar S, Gupta G, Pandey RM, Behera D, Mohan A, Sharma S. A study on the effect of mobile phone use on sleep. Indian J Med Res 2022; 155:380-386. [DOI: 10.4103/ijmr.ijmr_2221_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sahni S, Gupta G, Sarda R, Pandey S, Pandey RM, Sinha S. Impact of metabolic and cardiovascular disease on COVID-19 mortality: A systematic review and meta-analysis. Diabetes Metab Syndr 2021; 15:102308. [PMID: 34673359 PMCID: PMC8492383 DOI: 10.1016/j.dsx.2021.102308] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS This meta-analysis aims to highlight the impact of cardio-metabolic comorbidities on COVID-19 severity and mortality. METHODS A thorough search on major online databases was done for studies describing the clinical outcomes of COVID-19 patients. We used random-effects model to compute pooled estimates for critical or fatal disease. RESULTS A total of 20,475 patients from 33 eligible studies were included. Maximum risk of development of critical or fatal COVID-19 disease was seen in patients with underlying cardiovascular disease [OR: 3.44, 95% CI: 2.65-4.48] followed by chronic lung disease, hypertension and diabetes mellitus. Of the total cases, 64% had one of the four comorbidities with the most prevalent being hypertension with a pooled prevalence of 27%. CONCLUSIONS Presence of comorbidities like cardiovascular disease, chronic lung disease, hypertension and diabetes mellitus led to a higher risk of development of critical or fatal COVID-19 disease, with maximum risk seen with underlying cardiovascular disease.
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Affiliation(s)
- Shubham Sahni
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - Gaurav Gupta
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - Radhika Sarda
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India.
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Batra P, Dhawan A, Pandey RM, Mehta M, Sagar R, Chopra A. Substance use and its associated factors among school students. Natl Med J India 2021; 34:79-83. [PMID: 34599116 DOI: 10.4103/0970-258x.326747] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background . There is lack of comprehensive data on substance use and associated factors among school students in Delhi, India. Methods . We used a cluster sampling method based on sections of classes in schools to conduct this study in two government-run schools in Delhi. All enrolled students from 8th, 9th and 11th grades participated (n = 405). The WHO Student Drug Use questionnaire was administered in a single session for a class section for assessing substance use. Results . The participation rate was 90.6%. The rates of past 12 months' use of tobacco, alcohol, cannabis and inhalants were 22%, 12.1%, 12.1% and 8.6%, respectively, while rates for 'sedatives and tranquillizers' were 4.9%, opium 2.7% and other opioids 1.2%. Lifetime use of heroin was reported by two students and use in the past 12 months by one student. Multiple substance use was high. Higher age was associated with the use of alcohol and cannabis. According to logistic regression model results, use by a family member significantly increased the probability of using tobacco (adjusted odds ratio [AOR] 11.3; 95% confidence interval (CI) 3.4-37.8) and alcohol (AOR 3.75; 95% CI 5.1-1059.3). Similarly, use by peers significantly increased the probability of tobacco (AOR 7.7; 95% CI 2.0-29.8) and cannabis use (AOR 5.7; 95% CI 1.5-21.5). Having poor harm perception significantly increased the chances of inhalant use by students (AOR 5.5; 95% CI 1.5-20.1). Conclusion . The study results bring to attention the prevalent and important problem of substance use among schoolchildren. We recommend that (i) intervention strategies for school settings are important and need to factor in the use of illicit substances (cannabis); (ii) psychosocial intervention by trained school counsellors in school settings is the mainstay for intervention for cannabis and inhalants; and (iii) heroin users should be referred to healthcare facilities for detoxification.
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Affiliation(s)
- Parvesh Batra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anju Dhawan
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi 110029, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Manju Mehta
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anita Chopra
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi 110029, India
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Roychoudhury A, Yadav P, Bhutia O, Kaur K, Dekyi T, Pandey RM. Growth Outcome and Jaw Functions Are Better After Gap Arthroplasty Plus Costochondral Graft Reconstruction Than Gap Arthroplasty Alone in Pediatric Temporomandibular Joint Ankylosis Patients: A Cluster Randomized Controlled Trial. J Oral Maxillofac Surg 2021; 79:2548-2561. [PMID: 34592135 DOI: 10.1016/j.joms.2021.08.164] [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] [Received: 12/02/2020] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE It is not known if the muscle matrix that becomes functional after gap arthroplasty (GA) in temporomandibular joint ankylosis (TMJA), induces growth of the mandible or the reconstructive arthroplasty with costochondral graft (CCG) is responsible for growth. The study aimed to evaluate the mandibular growth and functional outcome with the use of CCG/GA in the management of pediatric TMJA. METHODS The investigators designed a cluster randomized controlled trial on pediatric (3 to 16 years) TMJA patients. Treatment applied (CCG and GA), was the primary predictor variable. Patients were divided into CCG and GA groups. The primary outcome variable was growth. Secondary outcome variables included etiology and duration of ankylosis, maximal incisal opening (MIO), reankylosis, occlusion, laterotrusion, chin deviation, facial asymmetry, occlusal tilt, and complications. The distance condylion (Co) to gnathion (Gn) was used to measure mandibular length. Ramal height was measured from Co- gonion (Go). Lower facial height was measured from the anterior nasal spine to Gn. Generalized estimating equations were used to calculate the regression coefficient adjusted for the cluster. The patient was considered as a cluster and the unit of analysis was joint. RESULTS Fifty-six {n = 28 in each group, (n = 33 joint in the CCG group and n = 31 joints in GA group)} patients were analyzed. The median follow-up was 33-months (31.93 ± 15.24) in CCG and 32-months (32.85 ± 17.84) in the GA group. Intergroup comparison between the CCG and GA group showed a statistically significant difference in mandibular length (CCG = 77.51 ± 9.31 and GA = 66.66 ± 8.32 mm, P < .001), ramal height (CCG = 44.21 ± 7.3 and GA = 31.87 ± 8.4 mm, P < .001), and statistically insignificant difference in lower facial height (CCG = 52.53 ± 6.1 and GA = 50.19 ± 6.3 mm, P = 0.14) at follow-up. Statistically, significant improvement was seen in MIO in both groups (<.001). CONCLUSIONS The results of the present study concluded that growth and jaw functions were better in reconstructive arthroplasty with CCG than GA in pediatric TMJA.
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Affiliation(s)
- Ajoy Roychoudhury
- Professor and Head, Senior Resident, Professor, Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Poonam Yadav
- Professor and Head, Senior Resident, Professor, Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Professor and Head, Senior Resident, Professor, Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kamalpreet Kaur
- Professor and Head, Senior Resident, Professor, Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Tsering Dekyi
- Professor and Head, Senior Resident, Professor, Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Professor and Head, Senior Resident, Professor, Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Radhakrishnan R, Sood R, Wig N, Sethi P, Soneja M, Kumar A, Nischal N, Biswas A, Pandey RM. Effect of Training and Checklist Based Use of Ventilator Associated Pneumonia (VAP) Prevention Bundle Protocol on Patient Outcome: A Tertiary Care Centre Study. J Assoc Physicians India 2021; 69:11-12. [PMID: 34472810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE VAP prevention bundle includes daily sedation free interval, DVT prophylaxis, raising head end of bed, use of orogastric rather than nasogastric tube. This study aims to study the practices regarding VAP prevention bundle and its compliance, educating about the practices and effects on patients outcome. DESIGN Quasi-experimental study, conducted in 3 phases. SETTING Hospital based. PARTICIPANTS Invasive Mechanically ventilated patients in the Department of Medicine of a tertiary care hospital. 50 patients included in phase 1 and 3. INTERVENTION Phase 1 and Phase 3 were pre and post intervention phases respectively when compliance to VAP prevention bundle was assessed with intermediate Phase 2, the intervention phase where the residents and nurses were educated about VAP bundle through various means. A checklist was attached to patient records. OUTCOME MEASURES Incidence of VAP, total hospital and ICU stay, duration of mechanical ventilation and mortality. RESULTS On comparing the 2 phases, it was found that there was increase in the compliance to VAP bundle(p<0.001), use of orogastric tube (p<0.001) and use of daily sedation free interval (p<0.001). Statistically insignificant increase in the use of DVT prophylaxis (p= 0.996) and raising the head end of the bed (p=0.513), and decline in the number of days of ICU(p=0.804) and hospital stay(p=0.907), the duration of mechanical ventilation(p=0.909), mortality(p=0.315) and incidence of VAP(p=0.715) was noted. Among those who developed VAP, there was lower compliance to bundle. CONCLUSIONS Practices like use of VAP prevention bundle improve on teaching efforts and use of checklist which improves patient care.
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Affiliation(s)
| | | | | | | | - Manish Soneja
- Additional Professor, AIIMS, New Delhi Corresponding Author
| | | | | | | | - R M Pandey
- Professor of Biostatistics, AIIMS, New Delhi
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Sharma G, Gujral JS, Agarwal A, Jat M, Mohanty S, Pandey RM. Exploring knowledge, attitude and practice regarding yoga among patients attending cardiology and neurology clinics in a tertiary care hospital in northern India. Natl Med J India 2021; 34:201-205. [PMID: 35112541 DOI: 10.25259/nmji_11_20] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background The use of complementary and alternative medicine, particularly yoga is increasing in non-communicable diseases (NCDs). We assessed the overall awareness regarding yoga among patients and their opinion about it as an adjunct therapy for NCDs. Methods We included 384 patients attending the cardiology and neurology clinics at a tertiary care centre in northern India. A questionnaire was developed to assess the knowledge, attitude and practice of yoga as a therapy. Results Ninety per cent of patients were aware of yoga, mainly through print and electronic media. Of the surveyed patients, 22% practised yoga. Lack of time and knowledge were cited as the main reasons for non-practice among the non-practising patients (88%), of which 82% believed that yoga could be practised along with modern medicine. In addition, 61% were ready to accept treatment if offered at the surveyed tertiary care centre. Conclusions Adequate knowledge, awareness and attitude towards yoga appears to be present in contrast to the low practice among the patient population surveyed. If implemented in an integrated fashion, the patients were willing to accept yoga as an adjunct therapy for their cardiac and neurological disorders-an encouraging sign given the burden of NCDs in India.
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Affiliation(s)
- Gautam Sharma
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Jaskaran Singh Gujral
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Aman Agarwal
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Mansingh Jat
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sriloy Mohanty
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - R M Pandey
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Bajpai S, Nehra A, Pandey RM, Sati H, Singh RK, Vishnu VY, Rajan R, Singh M, Srivastava A, Srivastava P, Tripathi M. Cognitive Capacity Assessment: The Fundamental Element of Neurological Disability Guidelines in India. Neurol India 2021; 69:703-706. [PMID: 34169872 DOI: 10.4103/0028-3886.319214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Disability evaluation as per World Health Organization includes assessment of impairments, activity limitations, and participation restriction, which unfortunately is not assessed by the existing guidelines of disability in India. Aim The aim of this study wasto comparea new study criterion with the existing guidelines for assessing cognitive disability for chronic neurological conditions. Methodology A cross-sectional pilot study was conducted on 41 participants. They were assessed on an existing guideline (Gazette India 200,1 assessing physical domain and Intelligence Quotient[IQ]) and study criterion assessing three aspects of cognitive capacity: IQ, neurocognitive functioning, and QOL. Results The existing guideline underestimated 84% of cases for disability. The average percentage of disability measured by the study criterion was 33.2% more as compared to existing guidelines with S.D of 26.6. Conclusion Cognitive capacity assessment is an important element to be measured in chronic neurological disability certification. However, a large sample is required to make an affirmative claim for the same.
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Affiliation(s)
- Swati Bajpai
- Departments of Neurology, and Biostatistics, Division of Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Nehra
- Departments of Neurology, and Biostatistics, Division of Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Departments of Neurology, and Biostatistics, Division of Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - Hemchand Sati
- Departments of Neurology, and Biostatistics, Division of Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Singh
- Departments of Neurology, and Biostatistics, Division of Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Departments of Neurology, and Biostatistics, Division of Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Departments of Neurology, and Biostatistics, Division of Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Departments of Neurology, and Biostatistics, Division of Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Departments of Neurology, and Biostatistics, Division of Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - Padma Srivastava
- Departments of Neurology, and Biostatistics, Division of Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Departments of Neurology, and Biostatistics, Division of Neuropsychology, All India Institute of Medical Sciences, New Delhi, India
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Gupta K, Shivabalan, Kumar V, Vyas S, Pandey RM, Jagannathan NR, Sinha S. Cognitive Performance and Neuro-Metabolites in HIV Using 3T Magnetic Resonance Spectroscopy: A Cross-Sectional Study from India. Curr HIV Res 2021; 19:147-153. [PMID: 33106144 DOI: 10.2174/1570162x18666201026141729] [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: 06/19/2020] [Revised: 09/08/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cognitive impairment in patients with human immunodeficiency virus (HIV) is associated with higher morbidity. The prevalence of the metabolite changes in the brain associated with cognitive impairment in anti-retroviral therapy naïve patients with HIV is unknown. OBJECTIVE To estimate the prevalence of the neurometabolites associated with cognitive impairment in antiretroviral therapy (ART) naïve patients with HIV. METHODS We conducted a cross-sectional study among ART naïve patients with HIV aged 18-50 years in a tertiary care center in India. Cognition was tested using the Post Graduate Institute battery of brain dysfunction across five domains; memory, attention-information processing, abstraction executive, complex perceptual, and simple motor skills. We assessed the total N-acetyl aspartyl (tNAA), creatine (tCr) and glutamate + glutamine (Glx) using 3T magnetic resonance spectroscopy. Cognitive impairment was defined as an impairment in ≥2 domains. RESULTS Among 43 patients eligible for this study, the median age was 32 years (IQR 29, 40) and 30% were women. Median CD4 count and viral load were 317 cells/μL (IQR 157, 456) and 9.3 copies/ μL (IQR 1.4, 38), respectively. Impairment in at least one cognitive domain was present in 32 patients (74.4%). Impairment in simple motor skills and memory was present in 46.5% and 44% of patients, respectively. Cognitive impairment, defined by impairment in ≥2 domains, was found in 22 (51.2%) patients. There was a trend towards higher concentration of tNAA (7.3 vs. 7.0 mmol/kg), tGlx (9.1 vs. 8.2 mmol/kg), and tCr (5.5 vs. 5.2 mmol/kg) in the frontal lobe of patients with cognitive impairment vs. without cognitive impairment but it did not reach statistical significance (p>0.05 for all). There was no difference in the concentration of these metabolites in the two groups in the basal ganglia. CONCLUSION There is a high prevalence of cognitive impairment in ART naïve patients with HIV. There is no difference in metabolites in patients with or without cognitive impairment. Further studies, with longitudinal follow-up are required to understand the underlying pathophysiological mechanisms.
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Affiliation(s)
- K Gupta
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shivabalan
- Department of Nuclear Magnetic Resonance and Magnetic Resonance Imaging Facility, All India Institute of Medical Sciences, New Delhi, India
| | - V Kumar
- Department of Nuclear Magnetic Resonance and Magnetic Resonance Imaging Facility, All India Institute of Medical Sciences, New Delhi, India
| | - S Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - N R Jagannathan
- Department of Nuclear Magnetic Resonance and Magnetic Resonance Imaging Facility, All India Institute of Medical Sciences, New Delhi, India
| | - S Sinha
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
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Kaur H, Nehra A, Chopra S, Sati H, Bhatia R, Kumaran SS, Pandey RM, Padma Srivastava MV. Development and Validation of a Comprehensive Neuropsychological and Language Rehabilitation for Stroke Survivors: A Home-Based Caregiver-Delivered Intervention Program. Ann Indian Acad Neurol 2020; 23:S116-S122. [PMID: 33343135 PMCID: PMC7731686 DOI: 10.4103/aian.aian_500_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022] Open
Abstract
Context: Aphasia is a major disabling condition after a stroke that profoundly affects the quality of life of stroke survivors (SS) and their caregivers. Comprehensive neuropsychological rehabilitation has emerged as a complementary intervention that helps in improving the associated cognitive and psychological deficits and quality of life following a brain injury. A standardized, simple, and easy to administer intervention that can be delivered as a home-based intervention can assist in faster recovery. Aims: To describe the development, validation, and feasibility of a home-based, caregiver-delivered comprehensive neuropsychological and language rehabilitation for SS. Methods and Material: A culture-specific picture and task-based 8-week training workbook and manual were developed based on extensive review and focused group discussions. This intervention targeted areas of language (comprehension, fluency, and naming) and cognition (working memory, attention and concentration, executive functioning, and response inhibition). It was standardized on 40 healthy controls (HC) and 15 SS. Before recruitment, written informed consent was obtained from each patient, their primary caregiver, and the HCs. Results: All tasks were found to be effective in discriminating the performance of SS from the HC. The performance of the HC with respect to the errors and the time taken for each task was used for the hierarchical arrangement of the tasks. The developed intervention was later validated on 15 SS where they significantly improved in the pre-post assessment of language functioning (P < 0.001), quality of life (P < 0.001), and depression (P < 0.001). Conclusions: This intervention can be feasible to administer as a home-based intervention and may help to alleviate language and neuropsychological complaints after stroke in low-literate or mixed-cultural populations. Further, large sample size studies are recommended.
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Affiliation(s)
- Harsimarpreet Kaur
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashima Nehra
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sakshi Chopra
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Hemchandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Senthil S Kumaran
- Department of NMR, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Madaan P, Agrawal D, Gupta D, Kumar A, Jauhari P, Chakrabarty B, Pandey RM, Paul VK, Misra MC, Gulati S. Clinicoepidemiologic Profile of Pediatric Traumatic Brain Injury: Experience of a Tertiary Care Hospital From Northern India. J Child Neurol 2020; 35:970-974. [PMID: 32748676 DOI: 10.1177/0883073820944040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traumatic brain injury is an important cause of acquired brain injury. The current study brings to light the clinicoepidemiologic profile of pediatric traumatic brain injury in India. Retrospective record analysis of children (aged ≤ 16 years) with traumatic brain injury presenting to an apex-trauma-center in North India over 4 years was done. Of more than 15 000 patients with a suspected head injury, 4833 were children ≤16 years old. Of these, 1074 were admitted to the inpatient department; 65% were boys with a mean age at presentation being 6.6 years. Most patients (85%) had a Glasgow Coma Scale score of 13 to 15 at presentation while Glasgow Coma Scale scores of ≤8 was seen in 10% of patients. Neuroimaging (computed tomography [CT]) abnormalities were seen in 12% of patients, with the commonest abnormality being skull fracture, followed by contusions, and extradural hemorrhage. Around 2% of patients required decompressive craniotomy whereas 3% of patients succumbed to their illness.Among the inpatients with pediatric traumatic brain injury, two-thirds were boys with a mean age at presentation of 7.6 years. Severity of traumatic brain injury varied as mild (64%), moderate (11%), and severe (25%). The most common mode of injury was accidental falls (59%) followed by road traffic and rail accidents (34%). Neuroimaging abnormalities were seen in half of inpatients with pediatric traumatic brain injury, with the commonest abnormality being skull fracture. Pediatric head injuries are an important public health problem and constitute a third of all head injuries. They are more common in boys, and the most common modes of injury are accidental falls, followed by road traffic accidents.
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Affiliation(s)
- Priyanka Madaan
- Child Neurology Division, Department of Pediatrics, 29751All India Institute of Medical Sciences (AIIMS), New Delhi, India.,Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak Agrawal
- Department of Neurosurgery, 28730AIIMS, New Delhi, India
| | - Deepak Gupta
- Department of Neurosurgery, 28730AIIMS, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, 28730AIIMS, New Delhi, India
| | - Prashant Jauhari
- Child Neurology Division, Department of Pediatrics, 29751All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Biswaroop Chakrabarty
- Child Neurology Division, Department of Pediatrics, 29751All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - R M Pandey
- Department of Biostatistics, 28730AIIMS, New Delhi, India
| | | | - M C Misra
- Department of General Surgery, 28730AIIMS, New Delhi, India
| | - Sheffali Gulati
- Child Neurology Division, Department of Pediatrics, 29751All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Raut S, Gupta G, Narang R, Ray A, Pandey RM, Malhotra A, Sinha S. The impact of obstructive sleep apnoea severity on cardiac structure and injury. Sleep Med 2020; 77:58-65. [PMID: 33310689 DOI: 10.1016/j.sleep.2020.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 10/26/2020] [Accepted: 10/31/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is an important factor in the development and progression of heart failure (HF). The prevalence of OSA is higher in patients with HF than in the general population. We sought to test the hypothesis that OSA severity was predictive of ventricular function and cardiac injury [as assessed by high-sensitivity cardiac troponin I(hs-cTnI)]. METHODS A total of 60 patients were recruited after evaluation for sleep disturbances using the Jenkins Sleep Questionnaire (JSQ) and Epworth Sleepiness Scale (ESS). Subsequently, they underwent polysomnography thus confirming the diagnosis of OSA and were equally divided into three groups according to OSA severity grade. Following polysomnography, the next morning patients underwent venous blood sampling and echocardiography. RESULTS We observed a statistically significant association (P = 0.009) between diastolic dysfunction grades and severity grades of OSA. All the three diastolic dysfunction variables E/A ratio, deceleration time and E/e' ratio had a significant association(P < 0.05) with severity grades of OSA. There was a marginally significant positive correlation (ρ = 0.3244, p = 0.04) between AHI events per hour and mitral E/e' ratio. There was a statistically significant association(P < 0.001) between hs-cTnI value among different severity grades of OSA. CONCLUSIONS Here in our study, we found OSA a potential risk factor for development of myocardial injury and diastolic dysfunction. Severe grades of OSA are associated with higher grades of diastolic dysfunction and circulating levels of hs-cTnI. These data are consistent with the notion of a vicious cycle of frequent apnoea's or hypoxemia and recurrent myocardial injury, which could increase the risk of heart failure especially diastolic dysfunction in OSA.
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Affiliation(s)
- Sandeep Raut
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajiv Narang
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Malhotra
- Pulmonary, Critical Care and Sleep Medicine, UC San Diego School of Medicine, San Diego, 92121, CA, USA
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
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Mohan A, Ansari A, Masroor M, Saxena A, Pandey RM, Upadhyay A, Luthra K, Khilnani GC, Jain D, Kumar R, Guleria R. Measurement of Serum EGFR mRNA Expression is a Reliable Predictor of Treatment Response and Survival Outcomes in Non- Small Cell Lung Cancer. Asian Pac J Cancer Prev 2020; 21:3153-3163. [PMID: 33247670 PMCID: PMC8033130 DOI: 10.31557/apjcp.2020.21.11.3153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Indexed: 01/09/2023] Open
Abstract
Background: EGFR over-expression plays a key role in the development and progression of lung cancer. However, its status as a prognostic biomarker for survival outcomes is unclear. Objectives: To evaluate the prognostic utility of serum EGFR mRNA expression in Non-Small cell lung cancer (NSCLC) for treatment response and survival. Methods: EGFR mRNA levels were determined in serum using quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). Based on ROC curve, a cut off value of 16.0-fold increase was selected to categorize patients into low EGFR (≤ 16.0) and high EGFR (> 16.0) groups. Results: A total of 350 subjects were included (78.3% males), with mean (± SD) age of 57.1 (± 11.2) years, and including 247 (70.6%) adenocarcinoma (ADC). Majority (73.1%) had metastatic (stage IV) disease. Patients had higher pre-treatment serum EGFR mRNA levels than controls [median fold-increase (min, max), 16.2 (1.9, 66.7). Serum EGFR mRNA levels significantly reduced in those who achieved objective response and disease control. Significantly longer OS and PFS was observed in subjects having baseline EGFR mRNA expression ≤ 16.0 fold- increase compared to those with > 16.0 fold- increase [median (95% CI) OS: 25.0 (14.9, NR) versus 7.7 (6.3, 8.9) months; HR (95% CI) 2.9 (2.3, 4.0), p< 0.001; and PFS: 9.9 (7.1, 11.5) versus 6.0 (4.1, 7.5) months; HR (95% CI) 1.8 (1.3, 2.4), p< 0.001]. Conclusion: Serum EGFR mRNA expression is a useful parameter for predicting treatment response and survival outcomes in NSCLC.
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Affiliation(s)
- Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Ashraf Ansari
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Mirza Masroor
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
| | - Alpana Saxena
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi
| | - Ashish Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi
| | - Kalpana Luthra
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi
| | - G C Khilnani
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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Khatiwada S, Agarwal S, Kandasamy D, Jyotsna VP, Kumar R, Kumar Bansal V, Pandey RM, Gupta N, Tandon N. Diabetes mellitus in pheochromocytoma and paraganglioma: Prevalence, dynamics of insulin secretion / sensitivity and predictors of remission. Diabetes Metab Syndr 2020; 14:2169-2175. [PMID: 33395777 DOI: 10.1016/j.dsx.2020.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Pheochromocytoma and paraganglioma (PPGL) are associated with dysglycemia and diabetes mellitus (DM) much of which improves post operatively. In this study, we set out to ascertain pre and post-operative prevalence of DM in patients with PPGL based on oral glucose tolerance test (OGTT) and HbA1c and to evaluate effect of insulin secretion and sensitivity indices on DM pre-operatively. METHODS Clinical and anthropometric data collection, HbA1c, 75 g OGTT with serum insulin estimation were done pre-operatively (n = 34) and at follow-up after successful surgery (n = 24) in patients with PPGL. RESULTS Pre and post-operative prevalence of DM were 48%(18/37) and 17% (4/24) respectively. Comparison of patients with highest (Q4) and lowest (Q1) quartiles of insulinogenic index (IGI),a parameter of insulin secretion, revealed trends towards higher prevalence of DM in patients with lower IGI (Q4 to Q1: 29% versus 71%,n = 28, p = 0.24)but no association was observed with HOMA-IR (Q4 to Q1:50% versus 57%, n = 28, p = 1.00), an insulin sensitivity index. DM remitted in 77% patients post-operatively, predicted by duration of DM of<3 years. CONCLUSION There is high prevalence of DM in PPGL, with marked remission post-operatively, especially predicted by shorter duration of DM. Impaired insulin secretion is more strongly associated with pre-operative DM than increased insulin resistance.
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Affiliation(s)
- Saurav Khatiwada
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences(AIIMS), New Delhi, India
| | | | | | - V P Jyotsna
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences(AIIMS), New Delhi, India.
| | | | | | - R M Pandey
- Department of Biostatistics, AIIMS, New Delhi, India
| | - Nandita Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences(AIIMS), New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences(AIIMS), New Delhi, India
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Prakash S, Meena JP, Gupta AK, Bakhshi S, Velpandian T, Pandey RM, Seth R. Ketamine mouthwash versus placebo in the treatment of severe oral mucositis pain in children with cancer: A randomized double-blind placebo-controlled trial. Pediatr Blood Cancer 2020; 67:e28573. [PMID: 32648983 DOI: 10.1002/pbc.28573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIMS Oral mucositis (OM) is a common and distressing toxicity in children on chemotherapy. There are a limited number of safe and effective therapeutic options available for OM. Ketamine oral rinse has shown promising results in a few studies in adults. This randomized, double-blind placebo-controlled trial aimed to test the efficacy of ketamine mouthwash in reducing chemotherapy-induced severe OM pain in children. METHODS Children aged 8-18 years with severe OM were randomized to a single dose of ketamine mouthwash (4 mg/mL solution; dose 1 mg/kg) or a placebo. A sample size of 44 patients was determined. Pain score (6-point faces scale) was noted at baseline and 15, 30, 45, 60, 120, 180, and 240 min. The outcome variables were a reduction in pain score, need for rescue medications, and adverse events. RESULTS The baseline characteristics were comparable in the two groups. The mean OM pain at 60 min decreased by 1.64 points (CI 1.13-2.14) in the ketamine group and 1.32 points (CI 0.76-1.87) in the placebo group (P = 0.425), with a group difference of 0.32 points. Rescue pain medication (at 60 min) was required in 13.6% in the ketamine group and 18.2% in the placebo group (P = 1.000). No significant adverse events were observed. CONCLUSIONS Among children on cancer chemotherapy with severe OM, ketamine mouthwash at a dose of 1 mg/kg did not significantly reduce OM pain. It did not decrease the need for rescue pain medications. Further research is warranted to test higher doses of ketamine for a clinically significant effect.
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Affiliation(s)
- Satya Prakash
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jagdish Prasad Meena
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Kumar Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Thirumurthy Velpandian
- Ocular Pharmacology and Pharmacy Division, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Seth
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Lakshmanan S, Roychoudhury A, Bhutia O, Yadav R, Bhatt K, Pandey RM. Can costochondral grafts fulfil ramus-condyle unit reconstruction goals in children with temporomandibular joint ankylosis? Br J Oral Maxillofac Surg 2020; 59:184-190. [PMID: 32868125 DOI: 10.1016/j.bjoms.2020.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 08/10/2020] [Indexed: 01/31/2023]
Abstract
The purpose of this study was to analyse whether costochondral grafts (CCG) fulfil temporomandibular joint (TMJ) reconstructive goals in children with TMJ ankylosis. A total of 23 patients (12 male, 11 female, aged 3-16 years) with unilateral or bilateral TMJ ankylosis operated on between January 2014 to April 2018 were included in the study. Maximal incisal opening (MIO), frequency of reankylosis, and growth of CCG, were evaluated at one month and six months for one year, and after that once yearly. Mouth opening changes with time were assessed by the Friedman test and growth was compared at follow up and analysed using the paired t test. Mean (range) follow up was 18 (12-48) months. Study results revealed follow up MIO at 12 months was highly significant (p=0.001). Out of 27 CCG studied, only one graft had undergone re-ankylosis. Based on the predetermined criteria using condylion to gnathion (Co-Gn) measurement in the posteroanterior cephalogram, CCG were categorised into optimum, sub-optimum, and overgrowth. However, long-standing TMJ ankylosis cases still displayed mandibular asymmetry at the end of the study, even with "optimal growth" radiographically. Overall comparison between the immediate postoperative and last follow up Co-Gn measurements in either unilateral or bilateral cases was not significant. CCG with functional matrix maintained the growth of the mandible and MIO in TMJ ankylosis. It can be concluded that CCG partially fulfils reconstructive goals; however, patients need to be followed up till the end of puberty for a substantive conclusion.
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Affiliation(s)
- S Lakshmanan
- Department of Oral & Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - A Roychoudhury
- Department of Oral & Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
| | - O Bhutia
- Department of Oral & Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - R Yadav
- Department of Oral & Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - K Bhatt
- Department of Oral & Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Ghati N, Killa AK, Sharma G, Karunakaran B, Agarwal A, Mohanty S, Nivethitha L, Siddharthan D, Pandey RM. A randomized trial of the immediate effect of Bee-Humming Breathing exercise on blood pressure and heart rate variability in patients with essential hypertension. Explore (NY) 2020; 17:312-319. [PMID: 32620379 DOI: 10.1016/j.explore.2020.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Bee-Humming Breathing (BHB) exercise is a simple yogic practice recommended for its favorable effect on cardiac physiology, including blood pressure (BP) and autonomic nervous system. However, strong evidence supporting its effectiveness is lacking. The present study was designed to evaluate the immediate effect of BHB exercise on blood pressure parameters and heart rate variability (HRV) in patients with essential hypertension. STUDY METHODS We conducted a randomized control trial including 70 patients with essential hypertension, randomly allocated to perform either BHB exercise (n=35) or placebo slow breathing exercise (n = 35) for 5-minutes duration. Blood pressure and HRV were measured before, during, and after the practice. RESULTS There was no significant decrease in systolic [effect size (95% CI): 2.22 (-13.20, 17.64); p 0.77], diastolic [4.54 (-17.40, 26.48); p 0.68] and mean blood pressures [1.37 (-8.78, 11.52); p 0.78] after BHB exercise in comparison to the control group in our study. The HRV analysis showed a significant increase in the HF power [6.8 (1.47, 12.12); p 0.01], and decrease in the LF power [-26.47 (-34.25, -18.68); p < 0.01] during the recovery phase of the 5-minute BHB exercise in comparison to the control group. CONCLUSIONS This is the first randomized controlled trial to show that though a single short session of BHB exercise in hypertensive patients does not significantly reduce BP, it significantly augments the parasympathetic tone as indicated by a significant improvement in HRV parameters. CLINICAL TRIAL REGISTRATION NUMBER CTRI/2018/08/015215.
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Affiliation(s)
- Nirmal Ghati
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Avantika K Killa
- Center for Integrative Medicine and Research (CIMR), All India Institute of Medical Sciences, New Delhi, India
| | - Gautam Sharma
- Center for Integrative Medicine and Research (CIMR); Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Biju Karunakaran
- Center for Integrative Medicine and Research (CIMR), All India Institute of Medical Sciences, New Delhi, India
| | - Aman Agarwal
- Center for Integrative Medicine and Research (CIMR), All India Institute of Medical Sciences, New Delhi, India
| | - Sriloy Mohanty
- Center for Integrative Medicine and Research (CIMR), All India Institute of Medical Sciences, New Delhi, India
| | - L Nivethitha
- Center for Integrative Medicine and Research (CIMR), All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Siddharthan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Yadav CP, Lodha R, Kabra SK, Sreenivas V, Sinha A, Khan MA, Pandey RM. Comparison of statistical methods for recurrent event analysis using pediatrics asthma data. Pharm Stat 2020; 19:803-813. [PMID: 32484295 DOI: 10.1002/pst.2032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 11/10/2022]
Abstract
When the same type of event is experienced by a subject more than once it is called recurrent event, which possess two important characteristics, namely "within-subject correlation" and "time-varying covariate." As a result, the traditional statistical methods do not work well on recurrent event data. Over the past few decades, many alternatives methods have been proposed for the analysis of recurrent event data. In this article, the six most prominent methods for recurrent event analysis have been compared on pediatric asthma data. Three variance corrected models (viz "Anderson and Gill [AG] model," "Prentice, William, and Peterson-Counting Process [PWP-CP] model," and "Prentice, William, and Peterson-Gap Time [PWP-GT] model") and three corresponding frailty variants (AG-frailty, PWP-CP-frailty, and PWP-GT-frailty) were compared using three mathematical criterion (AIC, BIC, and log-likelihood) and one graphical criteria (Cox-Snell goodness of fit, visual test). All model comparison indices showed the PWP-GT model as the most appropriate model on asthma data over other models. By using PWP-GT model, seven predictors of asthma exacerbation (viz "abdominal pain at previous visit," "Z5 (%) at previous visit," "diagnosis of asthma at previous visit," "calendar month of exacerbation," "history of maternal asthma," "monthly per capita income," and "emotional stress") were identified. The PWP-GT model was identified as the most appropriate model over other models on pediatrics asthma data.
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Affiliation(s)
- C P Yadav
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India.,Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - V Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Abhinav Sinha
- ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
| | - M A Khan
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Abstract
Background & objectives: Thymomas are rare, but most common anterior mediastinal lesions. The histomorphologic spectrum of thymic epithelial tumours (TETs) in Indian population has not been explored in depth. This study was aimed to assess the histomorphology of TETs in the Indian patients and correlate clinical parameters with pathological features. Methods: It was a retrospective study conducted in a tertiary referral hospital in north India. All morphologically confirmed cases of TETs since 2009 were included. Clinical details and histology slides were reviewed using the Modified Masaoka-Koga staging system and WHO 2015 classification. Clinicopathological correlation and survival analysis were done. A comparative review from other published Indian studies was performed. Results: A total of 219 cases of TETs (138 resections and 81 biopsies) were identified. The most common histomorphologic type was B2, and the most frequent stage was I. Types A/AB were common in older age (P<0.01). Clinically, higher stage tumours were found mostly in men (P<0.01), and these were Type B thymomas (P<0.01). Myasthenia gravis was more common in women (P<0.02) and in lower stages (P<0.05). Survival analysis revealed significant association between recurrence and tumour stage. Although thymic carcinoma was diagnosed on biopsy, no resectable case was identified. Interpretation & conclusions: Our findings showed that the thymomas in Indian patients were most commonly Stage I tumours of B2 and AB histotypes. Resected thymic carcinomas were conspicuously absent in our study. More studies need to be done to establish the frequency and biology of TETs from India.
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Affiliation(s)
- Prerna Guleria
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder Parshad
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ruma Ray
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Bajpai S, Upadhyay A, Sati H, Pandey RM, Chaterjee P, Dey AB. Hindi Version of Addenbrooke's Cognitive Examination III: Distinguishing Cognitive Impairment Among Older Indians at the Lower Cut-Offs. Clin Interv Aging 2020; 15:329-339. [PMID: 32184582 PMCID: PMC7062397 DOI: 10.2147/cia.s244707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/13/2020] [Indexed: 12/28/2022] Open
Abstract
Background Screening and diagnostic tests provide an objective measure of cognitive performance and also aid in distinguishing mild cognitive impairment (MCI) from major neurocognitive disorder (MNCD). Further, when such tests are culturally and educationally unbiased, it strengthens their diagnostic utility. This study aimed to validate the Hindi version of Addenbrooke’s Cognitive Examination III (ACE-III) in Indian older adults and compare its validity with the Hindi Mini-Mental State Examination (HMSE). Methods A sample of 412 consenting older adults visiting a memory clinic was recruited into the study. They were categorized into three groups: healthy controls (n=222), MCI (n=70), and MNCD (n=120). The complete clinical protocol was followed. Hindi ACE-III and HMSE were administered and were statistically analyzed. Results The optimal cut-off values to detect MCI and MNCD with ACE-III were 71 and 62 (AUC: 0.849 and 0.884), respectively, which were slightly higher than with HMSE (AUC: 0.822, 0.861). Education- and age-stratified cut-offs were also computed. Conclusion Hindi ACE-III has good discriminating power at lower cut-offs than the standard scores in differentiating between MCI and MNCD.
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Affiliation(s)
- Swati Bajpai
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Upadhyay
- Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Hemchand Sati
- Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Prasun Chaterjee
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - A B Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
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Kumar V, Jorwal P, Soneja M, Sinha S, Nischal N, Sethi P, Mondal S, Abdullah Z, Pandey RM. Evaluation of rapid diagnostic tests and assessment of risk factors in drug-resistant pulmonary tuberculosis. J Family Med Prim Care 2020; 9:1028-1034. [PMID: 32318462 PMCID: PMC7113933 DOI: 10.4103/jfmpc.jfmpc_883_19] [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: 12/10/2019] [Revised: 01/10/2020] [Accepted: 01/29/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Early diagnosis and treatment of drug-resistant tuberculosis (TB) is crucial to halt the spread of drug resistance in the community. Aim: The aim of the study was to compare rapid diagnostic tests (GeneXpert and line probe assay, LPA) with conventional liquid culture for the diagnosis of drug-resistant TB and to assess the risk factors for it. Method: This cross-sectional study recruited 229 multidrug-resistant TB suspects who were sputum smear positive. They were evaluated by the rapid diagnostic tests and sensitivity, specificity, positive predictive value and negative predictive value were calculated for drug resistance detection as compared to liquid culture drug susceptibility testing. The risk factors for the development of drug resistance were also assessed and the P value of < 0.05 was considered significant. Results: In the final comparison, 193 samples were included. The sensitivity and specificity of GeneXpert for detection of drug resistance (rifampicin) was 100% (95% confidence interval, CI: 88.8–100%) and 99.4% (95% CI: 96.6–99.9%), respectively. Whereas sensitivity and specificity of LPA was 94.3% (95% CI: 80.8–99.3%) and 100% (95% CI: 97.7–100%), respectively. Only three discordant samples were observed. Defaulting to antitubercular therapy, contact with resistant TB, and disseminated disease were found to be significant risk factors for the development of drug-resistant TB with high statistical significance (P value < 0.05). Conclusion: Both rapid diagnostic tests have very high sensitivity and specificity for detection of drug resistance in sputum smear positive with the advantage of short turn-around time. Defaulting to antitubercular therapy, contact with resistant TB, and disseminated disease are significant risk factors for drug resistance.
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Affiliation(s)
- Vimal Kumar
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, New Delhi, India
| | - Pankaj Jorwal
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, New Delhi, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, New Delhi, India
| | - Neeraj Nischal
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, New Delhi, India
| | - Prayas Sethi
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, New Delhi, India
| | - Saikat Mondal
- Department of Emergency Medicine, JPN Trauma Centre, All India Institute of Medical Sciences, Ring Road, New Delhi, India
| | - Zia Abdullah
- Department of Cardiology, CN Centre, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Nayak S, Coshic P, Pandey RM, Chatterjee K. Frequent plateletpheresis donations & its effect on haematological parameters: An observational study. Indian J Med Res 2020; 150:468-476. [PMID: 31939390 PMCID: PMC6977367 DOI: 10.4103/ijmr.ijmr_512_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background & objectives: The well-being of donors undergoing frequent plateletpheresis has been a matter of concern. The aim of this study was to analyze the effect of frequent plateletpheresis on the haematological parameters (HP) of repeat donors. Methods: The study was conducted during February 2016 to March 2017 on all the repeat plateletpheresis donors undergoing the 2nd plateletpheresis within a month of the first in a tertiary care centre. Donors repeating plateletpheresis 3rd and 4th times were also studied. The values of the HP observed on follow up after plateletpheresis done on three different separators were compared. Results: HPs of the 98 donors were similar at follow up except mean platelet volume (P<0.05). Of the 98 donors, 35 were followed up within a week and 63 were followed up within 8-30 days. No significant alteration was found in the HPs except a significant difference in the variation of platelet counts of the two groups (P=0.025). In 34 donors who presented 3rd time for plateletpheresis (mean gap between 1st and 3rd plateletpheresis=31 days), no significant differences in the HPs were found except the platelet distribution width (P<0.05). Minimal difference in the HP was found in the baseline and the follow up of 3rd plateletpheresis i.e., at 4th plateletpheresis donation. Plateletpheresis through all the three cell separators used had similar effects on the follow up HPs. Interpretation & conclusions: Repeated plateletpheresis can be done without any detrimental effects on the cell counts of the plateletpheresis donors. The three cell separators yielded similar post-donation follow up haematological parameters.
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Affiliation(s)
- Sweta Nayak
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Poonam Coshic
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Kabita Chatterjee
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
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Mathew R, Jamshed N, Aggarwal P, Patel S, Pandey RM. Profile of acute poisoning cases and their outcome in a teaching hospital of north India. J Family Med Prim Care 2019; 8:3935-3939. [PMID: 31879639 PMCID: PMC6924236 DOI: 10.4103/jfmpc.jfmpc_832_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 09/27/2019] [Accepted: 10/11/2019] [Indexed: 01/02/2023] Open
Abstract
Objectives: Aim of this study was to characterize acute poisoning and snakebite cases and their outcome in the Emergency Department (ED). Methods: This was a prospective study done in the ED of a tertiary healthcare center. Study included 184 patients of acute poisoning and 16 cases of snakebite. Data regarding demographics, type, time, and mode of poisoning, lag time in reaching the hospital, initiation of treatment, first aid, in-hospital treatment, and comorbid illness were obtained. Data regarding requirement of antidote, duration of hospitalization, and outcome were also obtained. Results: Out of 200 cases, 181 (90.5%) were adults and 19 (9.5%) were of pediatric age group. Poisoning was common among males (57%) than females (43%). Majority (40%) were from the age group of 21–30 years. Out of 200, 115 (57.5%) poisonings were suicidal, 68 (34%) were accidental, and 17 (8.5%) were homicidal. Acute poisonings included corrosive 54 (27%), drug overdose 26 (13%), organophosphorus compounds 20 (10%), rodenticides 20 (10%), and symptomatic snakebite 16 (8%). Seventy-two (36%) were admitted with a median hospital stay of 6 days with 5 (2.5%) deaths. Logistic regression analysis revealed poorer outcome for 15–30 years age [OR 12.6 (1.6–97.5), P = 0.015], males [OR 2.5 (1.4–4.4) P = 0.04], patients coming from >30 km [OR 4.3 (1.5–12.1), P = 0.006]. Conclusion: Our study demonstrated an increased incidence of corrosive ingestion. With increasing rates of suicidal ingestions, there is a need for holistic approach to manage mental health issues at primary care level.
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Affiliation(s)
- Roshan Mathew
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nayer Jamshed
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shivam Patel
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Goyal A, Grover A, Gauba K, Gupta A, Mehta N, Dutta S, Pandey RM, Joshi A, Thakur JS, Mohanty U, Dhaliwal RS. A community-based pragmatic, controlled trial for preventing and reducing oral diseases among 1-6-year-old children visiting Anganwadi centers, under the Integrated Child Development Scheme, India. BMC Public Health 2019; 19:1626. [PMID: 31796028 PMCID: PMC6892135 DOI: 10.1186/s12889-019-7874-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early childhood caries (ECC) has reached epidemic proportions affecting millions of children worldwide. Its prevention becomes imperative owing to the significant morbidity and financial implications involved with its treatment. The Integrated Child Development Scheme (ICDS), launched in India to provide mid-day meals, pre-school education and primary healthcare to children, can be utilised to counsel and deliver oral health education to mothers. The purpose of the study is to compare the effect of an oral health care package (OHCP) with usual care on the change in dental disease status among 1 to 3-year-old children at Anganwadi centres (AWC) in periurban areas of Chandigarh and rural areas of Cuttack, Orissa over a follow-up period of three years. METHODS Two geographically distant ICDS blocks would be selected at each of the two study sites and would be randomly allocated to intervention and control group. Closely located AWCs under each of the selected blocks shall constitute the study setting. OHCP would be delivered to the mothers of the 1-6-year-old children enrolled in the AWCs of the experimental group whereas mothers under control group would receive usual care advice available at the AWCs. DISCUSSION ECC prevention had conventionally focused upon testing effectiveness of programs targeting behaviour change among the caregivers and children, but surprisingly minimal efforts have been made to seek translation of these efforts into reduction of ECC at the community level. The present study has two components; testing effect of altering maternal and child behavioral aspects on ECC incidence through cohort follow up of 1-3-year-old children for three consecutive years and cross-sectional follow up of all available 1-6-year old children at the selected AWCs at regular intervals to look for change in prevalence of ECC at community level. In other regions of the world surveys of ECC prevalence before and after the intensive educational programs have shown a significant reduction in ECC prevalence. A similar decline can be anticipated through this program. TRIAL REGISTRATION This trial has been prospectively registered at Clinical Trials Registry, India (CTRI/2019/02/017556, 08 February 2019).
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Affiliation(s)
- Ashima Goyal
- Oral Health Sciences Centre, PGIMER, Chandigarh, India.
| | - Ashoo Grover
- Indian Council of Medical Research, New Delhi, India
| | - Krishan Gauba
- Oral Health Sciences Centre, PGIMER, Chandigarh, India
| | - Arpit Gupta
- Oral Health Sciences Centre, PGIMER, Chandigarh, India
| | - Nishant Mehta
- Oral Health Sciences Centre, PGIMER, Chandigarh, India
| | - Sourabh Dutta
- Division of Neonatology, Department of Pediatrics, PGIMER, Chandigarh, India
| | - R M Pandey
- Department of Biostatistics, AIIMS, New Delhi, India
| | - Ashish Joshi
- Foundation of Healthcare Technologies Society, New Delhi, India
| | - J S Thakur
- Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Utkal Mohanty
- Department of Community Dentistry, SCB Dental College & Hospital, Cuttack, Odisha, India
| | - R S Dhaliwal
- Indian Council of Medical Research, New Delhi, India
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Ahmed SA, Kumar A, Sethi P, Kapil A, Pandey RM, Wig N. Effectiveness of education and antibiotic control programme at All India Institute of Medical Sciences, New Delhi. Natl Med J India 2019; 31:262-267. [PMID: 31267989 DOI: 10.4103/0970-258x.261176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background We aimed to assess the impact of antibiotic optimization education along with understanding the antibiogram on antibiotic-prescribing practices, antibiotic consumption, antimicrobial resistance and cost of antibiotics in a tertiary care hospital in New Delhi. Methods We divided the study into 3 phases-before and after intervention and a phase of education in between. We collected data on demographics, indication for antibiotic prescription, appropriateness or reasons for inappropriate antibiotic uses, antibiotic consumption (i.e. the rate and duration of antibiotic use), bacterial resistance and antibiotic cost. Interventions included education, introduction of an antibiogram and use of antibiotic prescription forms. Similar data were collected for the post-interventional phase. The study was conducted at the Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. Results There was an improvement in the number of patients who underwent de-escalation of antibiotics, 21/100 v. 36/100 (p = 0.019); appropriate antibiotic usage, 25/ 100 v. 46/100 (p = 0.002); switching from intravenous to oral promptly, 16/52 v. 1 9/36 (p = 0.003) and decrease in expenditure, ₹24 207.5 v. ₹16 51 7.5 per patient (p = 0.001 ); in the post-interventional phase. Significant reductions in the incidence of infections due to Acinetobacter (60% v. 31%; p<0.001) and improvement in sensitivity pattern with cephalosporin sulbactam (80% v. 100%; p<0.001) were seen. Multivariate analysis revealed that Acute Physiology and Chronic Health Evaluation (APACHE) score, hospital stay <10 days, ventilator-associated pneumonia and methicillin-resistant Staphylococcus aureus coverage were independent predictors of mortality with odds ratio of 1.14, 0.1, 9.7 and 1.14, respectively. Conclusion Education and an antibiotic control programme constituted an effective and cost-saving strategy to optimise antibiotic use at a tertiary care centre.
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Affiliation(s)
- Shaheer A Ahmed
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Prayas Sethi
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Angmo D, Shakrawal J, Gupta B, Yadav S, Pandey RM, Dada T. Comparative Evaluation of Phacoemulsification Alone versus Phacoemulsification with Goniosynechialysis in Primary Angle-Closure Glaucoma: A Randomized Controlled Trial. Ophthalmol Glaucoma 2019; 2:346-356. [PMID: 32672677 DOI: 10.1016/j.ogla.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 06/11/2023]
Abstract
PURPOSE Comparative evaluation of phacoemulsification (phaco) alone versus phacoemulsification combined with goniosynechialysis (phacoGSL) in primary angle-closure glaucoma (PACG). DESIGN Prospective, randomized, parallel group, active controlled trial. PARTICIPANTS Patients with PACG. METHODS A total of 120 consecutive patients with PACG were screened, of whom 80 met inclusion criteria, with PACG uncontrolled on maximal hypotensive therapy and were recruited. Patients were randomized into 2 groups and underwent phaco alone in group 1 or phacoGSL in group 2. The patients were examined at baseline and at 1 week and 1, 3, and 6 months. The anterior chamber angle parameters on swept-source anterior segment OCT (SS-ASOCT) were noted at 1 and 6 months. MAIN OUTCOME MEASURES The primary outcome measure was intraocular pressure (IOP) reduction. A reduction in IOP of ≥ 20% from baseline IOP with or without medications was considered a success. Secondary outcome measures included change in the anterior chamber angle temporal parameters, angle-opening distance, trabecular-iris space area and scleral spur angle, surgical safety, visual acuity, and reduction in the number of glaucoma medications postoperatively. RESULTS The average age of patients was 58.77±8.14 years and 56.50±9.17 years in groups 1 and 2, respectively (P = 0.31). The mean baseline IOP was 29.48±6.76 mmHg and 30.72±3.88 mmHg in groups 1 and 2, respectively (P = 0.13). Success was obtained in 93.33% of patients in group 1 and 91.18% of patients in group 2 at 6 months (P = 0.39). Mean IOP was 13.17±1.66 mmHg and 13.21±1.97 mmHg at 6 months in groups 1 and 2, respectively (P = 0.001). The reduction in IOP was 55.32% and 56.99% at 6 months in groups 1 and 2 (P = 0.48). Significant widening of the angle parameters was noted at 6 months with an increase compared with baseline values in both groups. In multivariate analysis, the significant predictor of decrease in IOP was the higher baseline IOP. CONCLUSIONS Both phaco and phacoGSL are associated with a significant reduction in IOP along with a noteworthy widening of the anterior chamber angle parameters. Both procedures succeeded in reducing the necessity of glaucoma medications postoperatively in PACG eyes. There is no additional benefit of phacoGSL over phaco in PACG.
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Affiliation(s)
- Dewang Angmo
- Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Jyoti Shakrawal
- Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Barkha Gupta
- Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh Yadav
- Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Tanuj Dada
- Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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