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Mv C, Thomas B, Biswas G, Gupta S, Dattatreya PS, Bhagat S, Patil S, Bhushan S, Barkate H. Correction: An Open-Label, Single-Arm, Multicenter, Observational Study Evaluating the Safety and Effectiveness of Akynzeo® in the Management of Chemotherapy-Induced Nausea and Vomiting in India. Cureus 2024; 16:c169. [PMID: 38651087 PMCID: PMC11033606 DOI: 10.7759/cureus.c169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
[This corrects the article DOI: 10.7759/cureus.56447.].
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Affiliation(s)
- Chandrakanth Mv
- Medical Oncology, Narayana Superspeciality Hospital, Kolkata, IND
| | - Boben Thomas
- Medical Oncology, Caritas Hospital, Kottayam, IND
| | - Ghanshyam Biswas
- Medical Oncology, Sparsh Hospital & Critical Care, Bhubaneswar, IND
| | - Sumant Gupta
- Medical Oncology, Sarvodaya Hospital & Research Centre, Faridabad, IND
| | | | - Sagar Bhagat
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Saiprasad Patil
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Sumit Bhushan
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
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Gupta S, Mv C, Thomas B, Biswas G, Gupta S, Dattatreya PS, Bhagat S, Patil S, Bhushan S, Barkate H. An Open-Label, Single-Arm, Multicenter, Observational Study Evaluating the Safety and Effectiveness of Akynzeo® in the Management of Chemotherapy-Induced Nausea and Vomiting in India. Cureus 2024; 16:e56447. [PMID: 38638750 PMCID: PMC11024873 DOI: 10.7759/cureus.56447] [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] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Background Chemotherapy-induced nausea and vomiting is a common and unpleasant treatment-related side effect reported by cancer patients receiving chemotherapy. Akynzeo® or NEPA (NEtupitant + PAlonosetron) is the first fixed combination of netupitant and palonosetron that targets both critical pathways involved in emesis while providing a convenient, single oral dose therapy. The current study aimed to assess the effectiveness and safety of NEPA in a real-world setting in India. Methodology This was an open-label, multicenter, prospective, single-arm study conducted at six different locations across India. The study included patients of either gender, aged ≥18 years, naive to chemotherapy, scheduled to receive highly or moderately emetogenic chemotherapy (HEC/MEC), and scheduled to receive oral NEPA, as determined by the investigator. Results A total of 360 people were screened and enrolled in the study. HEC was prescribed to 289 (81.64%) patients, while MEC was prescribed to 65 (18.36%) patients. Complete response was achieved in 94.92% of patients during the acute phase, 95.20% during the delayed phase, and 93.22% during the overall phase. During the overall phase, 92.73% and 95.38% of patients on the HEC and MEC regimens, respectively, achieved complete response. Adverse events were reported in 3.88% of patients. Conclusions Oral NEPA was found to be effective in the Indian real-world setting, eliciting a >90% complete response with HEC and MEC regimens across the acute, delayed, and overall phases.
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Affiliation(s)
- Sudeep Gupta
- Medical Oncology, Tata Memorial Centre/Hospital & Homi Bhabha National Institute, Mumbai, IND
| | - Chandrakanth Mv
- Medical Oncology, Narayana Superspeciality Hospital, Kolkata, IND
| | - Boben Thomas
- Medical Oncology, Caritas Hospital, Kottayam, IND
| | - Ghanshyam Biswas
- Medical Oncology, Sparsh Hospital & Critical Care, Bhubaneswar, IND
| | - Sumant Gupta
- Medical Oncology, Sarvodaya Hospital & Research Centre, Faridabad, IND
| | | | - Sagar Bhagat
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Saiprasad Patil
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Sumit Bhushan
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
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Sahoo TP, Desai C, Agarwal S, Rauthan A, Dhabhar B, Biswas G, Batra S, Saha R, Philip A, Agarwal V, Dattatreya PS, Mohapatra PN, Deshmukh C, Bhagat S, Patil S, Barkate H. ExPert ConsEnsus on the management of Advanced clear-cell RenaL celL carcinoma: INDIAn Perspective (PEARL-INDIA). BMC Cancer 2023; 23:737. [PMID: 37558975 PMCID: PMC10413514 DOI: 10.1186/s12885-023-11237-y] [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: 04/03/2023] [Accepted: 07/29/2023] [Indexed: 08/11/2023] Open
Abstract
In advanced Renal Cell Carcinoma (aRCC), systemic therapy is the mainstay of treatment, with no or little role for surgery in these patients. Tyrosine kinase inhibitors (TKIs) and immune-oncological (IOs) therapies, either alone or in combination, are recommended in these patients depending on patient and tumour factors. The sequencing of therapies is critical in RCC because the choice of subsequent line therapy is heavily dependent on the response and duration of the previous treatment. There are additional barriers to RCC treatment in India. Immunotherapy is the cornerstone of treatment in ccRCC, but it is prohibitively expensive and not always reimbursed, effectively putting it out of reach for the vast majority of eligible patients in India. Furthermore, in advanced RCC (particularly the clear cell variety), Indian oncologists consider the disease burden of the patients, which is particularly dependent on the quantum of the disease load, clinical symptoms, and performance status of the patient, before deciding on treatment. There are no India-specific guidelines for clear cell RCC (ccRCC) treatment or the positioning and sequencing of molecules in the management of advanced ccRCC that take these country-specific issues into account. The current consensus article provides expert recommendations and treatment algorithms based on existing clinical evidence, which will be useful to specialists managing advanced ccRCC.
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Affiliation(s)
| | - Chirag Desai
- Medical Oncology & Director Hemato-Oncology Clinic Vedanta, Ahmedabad, Ahmedabad, India
| | - Shyam Agarwal
- Medical Oncology, Sir Gangaram Hospital, Delhi, India
| | - Amit Rauthan
- Medical Oncology, Manipal Hospital, Bangalore, India
| | - Boman Dhabhar
- Medical & Hemat-Oncology, BND Onco Center, Mumbai, India
| | | | - Sandeep Batra
- Medical Oncology, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Rajat Saha
- Medical Oncology, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Arun Philip
- Medical Oncology Amrita Institute of Medical Sciences, Cochin, India
| | - Vijay Agarwal
- Medical Oncology Aster, CMI Hospital, Bangalore, India
| | | | | | - Chetan Deshmukh
- Medical Oncology, Deenanath Mangeshkar Hospital, Pune, India
| | - Sagar Bhagat
- DGM, Global Medical Affairs, Glenmark Pharmaceutical Limited, B D Sawant Marg, Chakala, Andheri East, Maharashtra, 400099, Mumbai, India.
| | - Saiprasad Patil
- GM, Global Medical Affairs, Glenmark Pharmaceutical Limited, Mumbai, India
| | - Hanmant Barkate
- Medical Affairs, Glenmark Pharmaceutical Limited, Mumbai, India
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Prabhudesai P, Singh BP, Agrawal G, Singh AK, Jadhav AY, Patil SR, Bhagat S, Patil S, Barkate H. Fluticasone Furoate/Vilanterol Use Trends and Characteristics in Patients With Obstructive Airway Disease: A Real-World Study of 10,374 Patients From India. Cureus 2023; 15:e34825. [PMID: 36919064 PMCID: PMC10008380 DOI: 10.7759/cureus.34825] [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] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
Introduction Obstructive Airway Diseases (OADs) are the leading cause of death among chronic respiratory diseases worldwide, and novel therapies are direly needed. Fluticasone furoate/vilanterol (FF/Vi) (100/25 µg) is the first once-daily ICS/uLABA marketed in India for COPD since 2021. Considering its limited real-world experience in OAD patients in Indian clinical settings, a large drug utilization study (DUS) was planned. Methodology We conducted a cross-sectional, observational DUS at 1900 outpatient clinics in India from October 2021 to March 2022. Prescription data and medical history of patients who were prescribed the FF/Vi combination were collected. Results It was observed that FF/Vi was prescribed in an almost equal number of patients with COPD (44.2%) and asthma (42.9%). The majority of the patients (74%) were switched from previous ICS/LABA to this ICS/uLABA, while 26% of patients were treatment naïve. The average CAT score was 19.5±7.8 (43.2% GOLD Group C and 32.2% GOLD Group B) in COPD patients, while the average ACQ-5 score was 2.6±1.3 (33.1% GINA Step 3, 29.5% GINA Step 2) in asthmatic patients. Most of the patients (63.9%) had raised biomarkers (Blood eosinophil count >300 cells/μl). Prior history of exacerbation was present in 65% of patients with annual exacerbation rates of 1.2 in COPD, 1.1 in asthma, and 1.2 in asthma-COPD overlap syndrome (ACOS). Leukotriene inhibitors (42%) and LAMAs (30.8%) were common add-on medications. Conclusion We observed a trend towards a shift to once-daily ICS/uLABA (FF/Vi) by physicians, especially in symptomatic and exacerbating OAD patients with underlying comorbidities.
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Affiliation(s)
| | | | | | | | - Amit Y Jadhav
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Saurabh R Patil
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Sagar Bhagat
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Saiprasad Patil
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
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Tiwaskar M, Dhar R, Talwar D, Ansari A, Lakhe M, Panchal S, Bhagat S, Patil S, Barkate H. Real-world Experience with Favipiravir for Treatment of COVID-19 among Indian Healthcare Professionals. J Assoc Physicians India 2022; 69:11-12. [PMID: 35057588] [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: 06/14/2023]
Abstract
INTRODUCTION Favipiravir has shown promising results for COVID-19 globally. Though many Indian patients have received favipiravir, there is a lack of realworld data for its clinical use by the practicing physicians. Hence, a qualitative survey was conducted to understand real-world use of favipiravir in management of COVID-19. METHODS A cross-sectional, web-based, qualitative survey was conducted between September 2020 to October 2020, among Indian physicians from various specialties involved in COVID-19 care and using favipiravir in their practice. Physicians were provided survey link having a structured questionnaire with 32 questions. They were enquired on- 1) demographics,practice information, 2) place of favipiravir in clinical practice, 3) treatment protocol for mild to moderate COVID-19, 4) dosage and duration of favipiravir, 5) effectiveness of favipiravir, 6) tolerability of favipiravir 7) global efficacy and safety assessment of favipiravir. RESULTS A total of 500 physicians were contacted, of which 50 physicians completed the questionnaire. 25(50.0%) were from south zone followed by 12(24.0%) from west. . Majority physicians (47, 97.9%) stated that favipiravir was used for COVID-19 in outpatient setting. Favipiravir was considered as the current drug of choice for ' mild COVID-19 with fever(86.6%). All physicians agreed that favipiravir was being used as per the recommended dose.. A total of 75% & 62.5% physicians agreed to observed clinical improvement by around 3-5 days & 5-7 days in symptomatic mild & moderate COVID-19 respectively. CONCLUSION Majority of the physicians considered favipiravir to be safe and effective in treatment of mild to moderate COVID-19.
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Affiliation(s)
- Mangesh Tiwaskar
- Consultant Physician & Diabetologist, Shilpa Medical Research Centre, Mumbai, Maharashtra
| | - Raja Dhar
- Director, Pulmonary Medicine, Fortis Hospital, Kolkata, West Bengal
| | - Deepak Talwar
- Director, Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh
| | - Abdul Ansari
- Director, Critical Care, Nanavati Hospital, Mumbai, Maharashtra
| | - Mahesh Lakhe
- Consultant ID Specialist, Columbia Asia Hospital, Pune, Maharashtra
| | - Sagar Panchal
- Manager Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra; Corresponding Author
| | - Sagar Bhagat
- Senior Manager,Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra
| | - Saiprasad Patil
- Team Lead,Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra
| | - Hanmant Barkate
- Senior Vice President, Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra
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Salvi S, Jain MK, Krishnamurthy S, Balki A, Kodgule R, Tandon M, Bhagat S, Panchal S, Khatri N, Wu W, Pendse A, Patil S, Barkate H. Comparative efficacy and safety of glycopyrronium/formoterol fixed-dose combination versus glycopyrronium monotherapy in patients with moderate-to-severe COPD. Lung India 2022; 39:517-524. [PMID: 36629230 PMCID: PMC9746267 DOI: 10.4103/lungindia.lungindia_136_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/04/2022] [Indexed: 01/12/2023] Open
Abstract
Background The safety and efficacy of fixed-dose combination (FDC) of glycopyrronium bromide 12.5 μg/formoterol fumarate 12 μg (GB/FF) twice daily as dry powder inhalers (DPIs) compared to glycopyrronium 50 μg monotherapy (GLY) once daily as DPI in subjects with moderate-to-severe chronic obstructive pulmonary disease (COPD) were evaluated. Methods This was a phase-3, randomized, double-blind, active-controlled, parallel-group, superiority study conducted in India. COPD patients aged ≥40 to ≤65 years, current or ex-smokers with FEV1/FVC <0.70, using ICS, LAMA, or LABA for ≥1 month were included. Subjects were randomized (1:1) to GB/FF or GLY for 12 weeks. The primary efficacy endpoint was the change from baseline in peak FEV1 at the end of 12 weeks. The study is registered with the Clinical Trials Registry of India (CTRI/2017/02/007814). Results Between March 2017 and July 2018, 331 patients were enrolled and randomized into GB/FF FDC (165 patients) and GLY monotherapy (166 patients) groups. At week 12, the difference in change from baseline in the peak FEV1 for GB/FF DPI versus GLY was 0.115 L (SE = 0.02; 95% CI = 0.061, 0.170; P < 0.0001). Trough FEV1 increased significantly in the GB/FF group compared to the GLY group with a treatment difference of 0.078 L (SE = 0.02; 95% CI = 0.015, 0.14; P = 0.01). There were no significant differences in adverse events between the groups. Conclusion FDC of GB/FF (12.5/12 μg twice daily) as a DPI provides superior bronchodilation and lung function improvement over GLY (50 μg once daily) monotherapy. It is safe and well tolerated in symptomatic COPD patients.
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Affiliation(s)
- Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, Maharashtra, India
| | - Manish K. Jain
- Department of Respiratory, Maharaja Agrasen Superspeciality Hospital, Jaipur, Rajasthan, India
| | - Srikanth Krishnamurthy
- Department of Pulmonary and Respiratory Medicine, Sri Bala Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | - Akash Balki
- Shree Hospital and Critical Care, Nagpur, Maharashtra, India
| | - Rahul Kodgule
- Clinical Development, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Monika Tandon
- Clinical Development, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Sagar Bhagat
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Sagar Panchal
- Ex-Employee, Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Nishtha Khatri
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Wen Wu
- Clinical Operations, Glenmark Pharmaceuticals Ltd., Waterford, UK
| | - Amol Pendse
- Clinical Operations, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Saiprasad Patil
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
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Joshi S, Vora A, Venugopal K, Dadhich P, Daxini A, Bhagat S, Patil S, Barkate H. Real-World Experience with Favipiravir for the Treatment of Mild-to-Moderate COVID-19 in India. Pragmat Obs Res 2022; 13:33-41. [PMID: 35656155 PMCID: PMC9154000 DOI: 10.2147/por.s364066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Favipiravir, an RNA-dependent RNA polymerase inhibitor (RdRp), is a broad-spectrum oral antiviral agent approved in India under emergency use authorization, for the treatment of mild-to-moderate coronavirus disease (COVID-19). The present study was planned to evaluate the effectiveness and safety of favipiravir in real-world clinical practice. Materials and Methods This was a multicentric, retrospective, single-arm study conducted across four centres in India, after obtaining permission from the independent ethics committee. Medical records were analysed to evaluate effectiveness and safety of patients who were prescribed favipiravir. Results The medical records of a total of 360 patients met the inclusion criteria, with 358 of them available for the final analysis. Males made up 58.46% of the study population. The average age of enrolled patients was 51.80 ± 16.45 years. The most common symptoms were fever, cough, and myalgia-fatigue. The median time to clinical cure and fever relief was five and four days, respectively. The average length of stay in the hospital was six days. In total, 8% of the patients experienced adverse events. Hepatic enzyme elevation, diarrhoea, decreased appetite, headache, fatigue, and giddiness were the common symptoms. Conclusion In our real-world study, favipiravir was found to have a clinical cure rate of more than 90% in mild-to-moderate COVID-19 patients. This supports the use of favipiravir in the treatment of COVID-19. Favipiravir was well tolerated, with only minimal side effects, which were transient in nature.
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Affiliation(s)
- Shashank Joshi
- Department of Endocrinology, Joshi Clinic and Lilavati Hospital and Research Centre, Mumbai, India
| | - Agam Vora
- Department of Pulmonology, Vora Clinic, Mumbai, India
| | - K Venugopal
- Department of Pulmonology, Sooriya Hospital, Chennai, India
| | | | - Anil Daxini
- Department of Medicine, Fortis Hospital, Mumbai, India
| | - Sagar Bhagat
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Saiprasad Patil
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
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Reddy PK, Patil S, Khobragade A, Balki A, Raj A, Kalikar M, Reddy R, Shinde R, CR J, Mutha A, Boyilla N, Rajadhyaksha GC, Karnik N, Bhagat S, Pendse A, Dhage P, Wu W, Rangwala S, Barkate H. Evaluation of the Safety and Efficacy of Favipiravir in Adult Indian Patients with Mild-to-Moderate COVID-19 in a Real-World Setting. Int J Gen Med 2022; 15:4551-4563. [PMID: 35535140 PMCID: PMC9078344 DOI: 10.2147/ijgm.s349241] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/09/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of favipiravir, which is prescribed for the treatment of patients with mild-to-moderate coronavirus disease 2019 (COVID-19) in India. Patients and Methods This was a prospective, open-label, multicenter, single-arm postmarketing study conducted in India. Patients with mild-to-moderate COVID-19 received favipiravir (3600 mg [1800 mg orally twice daily] on the first day, followed by 800 mg orally twice daily, up to a maximum of 14 days) as a part of their treatment. The primary endpoints were to evaluate the safety of favipiravir by assessing the number of adverse events (AEs) and treatment-related AEs. The secondary endpoints were to evaluate the efficacy of favipiravir by assessing time to clinical cure, rate of clinical cure, time to pyrexia resolution, rate of oxygen requirement, and all-cause mortality. Results A total of 1083 patients were enrolled in this study from December 2020 to June 2021. Adverse events were reported in 129 patients (11.9%), 116 (10.7%) of whom had mild AEs. Dose modification or withdrawal of favipiravir treatment was reported in four patients (0.37%). The median time to clinical cure and pyrexia resolution was 7 and 4 days, respectively. A total of 1036 patients (95.8%) exhibited clinical cure by day 14. Oxygen support was required by 15 patients (1.4%). One death was reported, which was unrelated to favipiravir. Conclusion In the real-world setting, favipiravir was well-tolerated, and no new safety signals were detected.
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Affiliation(s)
| | - Saiprasad Patil
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India
| | | | - Akash Balki
- Shree Hospital & Critical Care Center, Nagpur, Maharashtra, India
| | - Aneesh Raj
- NIMS Medicity, Trivandrum, Kerala, India
| | - Mrunalini Kalikar
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
| | | | - Ravindra Shinde
- Respiratory Medicine, Dr Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | - Jayanthi CR
- Bangalore Medical College, Bengaluru, Karnataka, India
| | | | | | - Girish C Rajadhyaksha
- Department of Medicine, BYL Medical college & Nair Hospital, Mumbai, Maharashtra, India
| | - Niteen Karnik
- Department of Medicine, LT Medical College & Sion Hospital, Mumbai, Maharashtra, India
| | - Sagar Bhagat
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India
| | - Amol Pendse
- Clinical Research Operations, Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India
| | - Priyanka Dhage
- Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India
| | - Wen Wu
- Glenmark Pharmaceuticals Ltd., Waterford, UK
| | - Shabbir Rangwala
- Clinical Research Operations, Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India
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Dhar R, Talwar D, Salvi S, Muralimohan BV, Panchal S, Patil S, Bhagat S, Khatri N, Barkate H. Use of single-inhaler triple therapy in the management of obstructive airway disease: Indian medical experts' review. ERJ Open Res 2022; 8:00556-2021. [PMID: 35350278 PMCID: PMC8958219 DOI: 10.1183/23120541.00556-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/07/2022] [Indexed: 11/05/2022] Open
Abstract
Obstructive airway disease (OAD), which includes COPD and asthma, is the leading cause of morbidity and mortality in India. Long-acting bronchodilators (long-acting β2 agonists (LABAs) and/or long-acting muscarinic antagonists (LAMAs)) and inhaled corticosteroids (ICS) have a vital role in the management of patients with OAD. While symptom burden and exacerbations are common amongst treated patients, poor adherence to inhaler therapy is a frequent challenge. Better treatment options that optimise symptom control, improve quality of life, reduce exacerbation risk and improve adherence are desired. Triple therapy (ICS/LABA/LAMA) is recommended in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2021 guidelines for symptomatic COPD patients on ICS/LABA or LABA/LAMA, and who are at increased risk for frequent or severe exacerbations. Similarly, add-on LAMA is recommended in uncontrolled asthma patients on medium- to high-dose ICS/LABA by the Global Initiative for Asthma (GINA) 2021 guideline. In the real world, high-risk and overlapping phenotypes exist, which necessitate early initiation of triple therapy. We aim to provide an expert review on the use of single-inhaler triple therapy (SITT) for OAD management in global and Indian settings, knowledge from which can be extrapolated for appropriate treatment of Indian patients. The OAD population in India may benefit from early optimisation to SITT characterised by a high burden of exacerbating OAD, nonsmoker COPD and asthma-COPD overlap.
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Affiliation(s)
- Raja Dhar
- Dept of Pulmonology, The Calcutta Medical Research Institute, Kolkata, India
| | - Deepak Talwar
- Metro Respiratory Center, Pulmonology and Sleep Medicine, Metro Hospitals and Heart Institute, Noida, India
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - B V Muralimohan
- Dept of Internal Medicine and Pulmonology, Narayana Hrudayalaya - Mazumdar Shaw Medical Center, Bengaluru, India
| | - Sagar Panchal
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Saiprasad Patil
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Sagar Bhagat
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Nishtha Khatri
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
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Zirpe KG, Mehta Y, Pandit R, Pande R, Deshmukh AM, Patil S, Bhagat S, Barkate H. A Real-world Study on Prescription Pattern of Fosfomycin in Critical Care Patients. Indian J Crit Care Med 2021; 25:1055-1058. [PMID: 34963727 PMCID: PMC8664030 DOI: 10.5005/jp-journals-10071-23958] [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: 11/23/2022] Open
Abstract
Background This study presents a real-world scenario for prescription pattern, efficacy, and safety data on the current clinical use of intravenous fosfomycin in critically ill patients in Indian settings. Patients and methods This was a retrospective cohort study conducted for a period of 10 months among critically ill patients admitted to hospital's critical care unit. The primary objective of the study was to analyze the prescription pattern of intravenous fosfomycin, and the secondary objective was to evaluate the safety profile and patient outcomes. Results A total of 309 patients were enrolled, and they were diagnosed with bacteremia (45.3%), pneumonia (15.85%), septic shock (14.24%), and urinary tract infections (UTI) (13.91%). The average dose of fosfomycin given was 11.7 ± 4.06 gm/day. The average duration of the therapy was 4.85 ± 3.59 days with a median duration of 4 days. Fosfomycin was given at 8 hourly dosing frequency to maximum (45.6%) cases. Hypokalemia was the most observed adverse event. The overall survival was seen in 55% of patients. Conclusion Our data suggest that UTI, infection caused by Escherichia coli, and a daily dose of >12 g were associated with better clinical outcomes. The overall survival of critically ill patients receiving fosfomycin was 55%. How to cite this article Zirpe KG, Mehta Y, Pandit R, Pande R, Deshmukh AM, Patil S, et al. A Real-world Study on Prescription Pattern of Fosfomycin in Critical Care Patients. Indian J Crit Care Med 2021;25(9):1055–1058.
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Affiliation(s)
- Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Yatin Mehta
- Institute of Critical Care and Anesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Rahul Pandit
- Department of Intensive Care, Fortis, Mumbai, Maharashtra, India
| | - Rajesh Pande
- Department of Critical Care Medicine, BLK Super Speciality Hospital, Delhi, India
| | - Abhijit M Deshmukh
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Saiprasad Patil
- Department of Global Medical Affairs, Glenmark Pharmaceutical Ltd, Mumbai, Maharashtra, India
| | - Sagar Bhagat
- Glenmark Pharmaceutical Ltd, Mumbai, Maharashtra, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceutical Ltd, Mumbai, Maharashtra, India
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Vaswani B, Dattatreya PS, Bhagat S, Patil S, Barkate H. The effectiveness of NEPA in the prevention of chemotherapy-induced nausea vomiting among chemo naive patients in an Indian setting. BMC Cancer 2021; 21:601. [PMID: 34034703 PMCID: PMC8145828 DOI: 10.1186/s12885-021-08342-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 05/11/2021] [Indexed: 02/08/2023] Open
Abstract
Background Chemotherapy induced nausea- vomiting (CINV) is considered as the most common, feared and most troublesome side effect of chemotherapy. NEPA (NEtupitant 300 mg + PAlonosetron 0.50 mg) is the first commercially available oral fixed-dose combination (FDC) of two active antiemetic agents in India. The present study was planned to evaluate the effectiveness of NEPA in the real world setting of India. Methods This was a multicentric retrospective study conducted in two centers in India. The data of all chemonaive patients, who were prescribed NEPA was analyzed. Effectiveness i.e. complete response and complete protection in controlling overall, acute and delayed phase was analyzed. Results A total of 329 patients were enrolled in the study. 260 received highly emetogenic chemotherapy (HEC) regimen and 69 received moderately emetogenic chemotherapy (MEC) regimen. Among all the enrolled patients, complete response in acute, delayed and overall phase was 93, 85.71 and 85.41% respectively; and completed protection was 88.44, 81.76 and 80.54% respectively. Those who received HEC regimen, the completed response and complete protection in overall phase was 84.61 and 79.61% respectively and those who received MEC regimen the completed response and complete control in overall phase was 84.05 and 84.05% respectively. Conclusion A single oral dose of NEPA targeting dual pathways showed effective control of nausea-vomiting in patients on the HEC and MEC regimens and had good control over nausea-vomiting in acute, delayed and overall phase of nausea-vomiting.
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Affiliation(s)
- Bharat Vaswani
- Consultant Oncologist and Hematologist, Yashoda Cancer Institute, Secunderabad, India
| | | | - Sagar Bhagat
- Medical Services, IF, Glenmark Pharmaceutical limited, B D Sawant Road, Andheri [East], Mumbai, 400099, India.
| | - Saiprasad Patil
- Medical Services, IF, Glenmark Pharmaceutical limited, B D Sawant Road, Andheri [East], Mumbai, 400099, India
| | - Hanmant Barkate
- Medical Services, IF, Glenmark Pharmaceutical limited, B D Sawant Road, Andheri [East], Mumbai, 400099, India
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Vaswani B, Bhagat S, Patil S, Barkate H. Effectiveness of a novel, fixed dose combination of netupitant and palonosetron in prevention of chemotherapy induced nausea and vomiting: A real-life study from India. World J Clin Oncol 2020; 11:606-613. [PMID: 32879847 PMCID: PMC7443837 DOI: 10.5306/wjco.v11.i8.606] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/09/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A new, oral fixed dose combination of highly selective neurokinin-1 receptor antagonist, netupitant with 5HT3 receptor antagonist, netupitant and palonosetron (NEPA) was approved in India for prevention of chemotherapy induced nausea and vomiting (CINV).
AIM To assess effectiveness of NEPA in real-world scenario.
METHODS We retrospectively assessed the medical records and patient dairies of adult patients who received highly emetogenic or moderately emetogenic chemotherapy (HEC/MEC) and treated with NEPA (Netupitant 300 mg + Palanosetron 0.50 mg) for prevention of CINV. Complete response (CR) was defined as no emesis or no requirement of rescue medication in overall phase (0 to 5 d), acute phase (0-24 h) and delayed phase (2 to 5 d).
RESULTS In 403 patients included in the analysis, mean age was 56.24 ± 11.11 years and 55.09% were females. Breast cancer (25.06%) was most common malignancy encountered. HEC and MEC were administered in 54.6% and 45.4% patients respectively. CR in overall phase was 93.79% whereas it was 98.01% in acute CINV and 93.79% in delayed CINV. Overall CR in HEC and MEC groups was 93.63% and 93.98% respectively. CR was more than 90% in different chemotherapy cycles except in group of patients of cycle 4 where CR was 88.88%.
CONCLUSION NEPA is a novel combination that is effective in preventing CINV in up to 93% cases treated with highly emetogenic or moderately emetogenic chemotherapy. This study brings the first real-life evidence of its effectiveness in India population.
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Affiliation(s)
- Bharat Vaswani
- Medical Oncology, Yashoda Cancer Institute, Secunderabad 500003, India
| | - Sagar Bhagat
- Medical Services, Glenmark Pharmaceutical limited, Mumbai 400099, India
| | - Saiprasad Patil
- Medical Services, Glenmark Pharmaceutical limited, Mumbai 400099, India
| | - Hanmant Barkate
- Medical Services, Glenmark Pharmaceutical limited, Mumbai 400099, India
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Vaid AK, Gupta S, Doval DC, Agarwal S, Nag S, Patil P, Goswami C, Ostwal V, Bhagat S, Patil S, Barkate H. Expert Consensus on Effective Management of Chemotherapy-Induced Nausea and Vomiting: An Indian Perspective. Front Oncol 2020; 10:400. [PMID: 32292721 PMCID: PMC7120415 DOI: 10.3389/fonc.2020.00400] [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: 09/30/2019] [Accepted: 03/05/2020] [Indexed: 11/25/2022] Open
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is one of the most common and feared side effects in cancer patients undergoing chemotherapy. Scientific evidence proves its detrimental impact on a patient's quality of life (QoL), treatment compliance, and overall healthcare cost. Despite the CINV-management landscape witnessing a radical shift with the introduction of novel, receptor-targeting antiemetic agents, this side effect remains a chink in the armor of a treating oncologist. Though global guidelines acknowledge patient-specific risk factors and chemotherapeutic agent emetogenic potential in CINV control, a “one-fit-for-all” approach cannot be followed across all geographies. Hence, in a pioneering attempt, India-based oncologists conveyed easily implementable, region-specific, consensus-based statements on CINV prevention and management. These statements resulted from integrating the analysis of scientific evidence and guidelines on CINV by the experts, with their clinical experience. The statements will strengthen decision-making abilities of Indian oncologists/clinicians and help in achieving consistency in CINV prevention and management in the country. Furthermore, this document shall lay the foundation for developing robust Indian guidelines for CINV prevention and control.
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Affiliation(s)
- Ashok K Vaid
- Medical Oncology and Hematology, Medanta - The Medicity, Gurugram, India
| | | | - Dinesh C Doval
- Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Shyam Agarwal
- Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Shona Nag
- Medical Oncology, Sahyadri Hospital, Pune, India
| | - Poonam Patil
- Medical Oncologist, Manipal Hospital, Bangalore, India
| | - Chanchal Goswami
- Oncology Services, MEDICA Super Speciality Hospital, Kolkata, India
| | - Vikas Ostwal
- Medical Oncology, TATA Memorial Hospital, Mumbai, India
| | - Sagar Bhagat
- Medical Services, HO IF, Glenmark Pharmaceuticals Ltd., Mumbai, India
| | - Saiprasad Patil
- Medical Services, IF, Glenmark Pharmaceuticals Ltd., Mumbai, India
| | - Hanmant Barkate
- Medical Services, IF & MEA, Glenmark Pharmaceuticals Ltd., Mumbai, India
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Khan G, Alam I, Bhagat S. P281Extracellular RNA is the novel player in hypoxic Stress induced myocardial injury. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Khan
- Fiji School of Medicin, Physiology, Suva, Fiji
| | - I Alam
- Jamia Hamdard (Hamdard University), Physiology, New Delhi, India
| | - S Bhagat
- Defence Institute of Physiology and Allied Sciences, Physiology, New Delhi, India
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Bhagat S, Kumari P, Sharma N, Kumar A, Mohapatra S. A Highly Efficient Approach for the Synthesis of Novel Trifluoroacetylated Enaminones using DBU as a Base. Synlett 2017. [DOI: 10.1055/s-0036-1588865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
An efficient methodology has been developed for the synthesis of a variety of novel trifluoroacetylated enaminones by using trifluoroacetic anhydride in DCE as solvent and DBU as a base via electrophilic trifluoroacetylation. X-ray crystallographic studies confirmed the trifluoroacetylation and E stereoisomeric form of the novel compounds. The synthetic strategy has the advantage of using an inexpensive and non-toxic base for producing excellent yields. Synthons bearing variety of functional groups may be further extended for the formation of heterocyclic compounds.
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Khanduri S, Bhagat S. Multi detector CT evaluation of suspicious malignant lung masses with its combined wash-in & wash-out features and their histopathological correlation. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx086.004] [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: 11/14/2022] Open
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Sharma N, Kumari P, Sharma P, Bhagat N, Bhagat S. Ultrasound-Accelerated Amide Coupling Reactions Directed toward the Synthesis of 1-Acetyl-3-carboxamide-β-carboline Derivatives of Biological Importance. SynOpen 2017. [DOI: 10.1055/s-0036-1588167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Several biologically important 1-acetyl-3-carboxamide-β-carboline derivatives were rapidly synthesized by ultrasound-promoted amide coupling of 1-acetyl-9H-pyrido[3,4-b]indole-3-carboxylic acid with substituted aromatic amines. The major advantages of the proposed method are that use of ultrasound irradiations afforded the desired products in a drastically reduced reaction time and in excellent yields compared with conventional stirring.
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Affiliation(s)
- N. Sharma
- Organic Synthesis research Laboratory, Department of Chemistry, A.R.S.D. College, University of Delhi
| | - P. Kumari
- Organic Synthesis research Laboratory, Department of Chemistry, A.R.S.D. College, University of Delhi
| | - P. Sharma
- Organic Synthesis research Laboratory, Department of Chemistry, A.R.S.D. College, University of Delhi
| | - N. Bhagat
- Instrumentation & Control Engineering, Netaji Subash Institute of Technology, University of Delhi
| | - S. Bhagat
- Organic Synthesis research Laboratory, Department of Chemistry, A.R.S.D. College, University of Delhi
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Sharma N, Kumari N, Chundawat TS, Kumar S, Bhagat S. Efficient trifluoromethylation of C(sp2)–H functionalized α-oxoketene dithioacetals: a route to the regioselective synthesis of functionalized trifluoromethylated pyrazoles. RSC Adv 2017. [DOI: 10.1039/c7ra01130j] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
An operationally simple approach for regioselective construction of substituted trifluoromethylated pyrazoles via ligand free nucleophilic trifluoromethylation of iodo-substituted α-oxoketene dithioacetals.
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Affiliation(s)
- N. Sharma
- Organic Synthesis Research Laboratory
- Department of Chemistry
- A. R. S. D. College
- University of Delhi
- New Delhi-110021
| | - N. Kumari
- Institute of Nuclear Medicine & Allied Sciences
- Defence Research & Development Organization
- Delhi-110054
- India
| | - T. S. Chundawat
- Department of Applied Sciences
- The Northcap University (formerly ITM University)
- Gurgaon-122001
- India
| | - S. Kumar
- Physical Chemistry Division
- CSIR-National Chemical Laboratory
- Pune-411008
- India
| | - S. Bhagat
- Organic Synthesis Research Laboratory
- Department of Chemistry
- A. R. S. D. College
- University of Delhi
- New Delhi-110021
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Affiliation(s)
- A. Dass
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College; Associated Irwin and G. B. Pant Hospitals; New Delhi India
| | - S. Bhagat
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College; Associated Irwin and G. B. Pant Hospitals; New Delhi India
| | - K. Bhargava
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College; Associated Irwin and G. B. Pant Hospitals; New Delhi India
| | - S. Golmei
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College; Associated Irwin and G. B. Pant Hospitals; New Delhi India
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Abstract
Despite the introduction of mass immunization, diphtheria continues to play a major role as a potentially lethal infectious disease in many countries. Delay in the specific therapy of diphtheria may result in death and, therefore, accurate diagnosis of diphtheria is imperative. This study was carried out at National Centre for Disease Control (NCDC), Delhi, India, on samples of suspected diphtheria cases referred from various government hospitals of Delhi and neighbouring areas during 2012-2014. Primary identification of Corynebacterium diphtheriae was done by standard culture, staining and biochemical tests followed by toxigenicity testing by Elek's test on samples positive for C. diphtheriae. The results showed persistence of toxigenic C. diphtheriae in our community indicating the possibility of inadequate immunization coverage.
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Affiliation(s)
- S Bhagat
- Department of Microbiology, National Centre for Disease Control, Delhi, India
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Affiliation(s)
- S Bhagat
- University Hospital Ayr, Ayr, UK
| | | | - N Boyle
- University Hospital Ayr, Ayr, UK
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Clunie GPR, Ginawi A, O'Conner P, Bearcroft PW, Garber SJ, Bhagat S, Grainger A, Gaston JSH. An open-label study of zoledronic acid (Aclasta 5 mg iv) in the treatment of ankylosing spondylitis. Ann Rheum Dis 2014; 73:1273-4. [PMID: 24521738 DOI: 10.1136/annrheumdis-2013-204938] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- G P R Clunie
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, , Cambridge, UK
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Khan A, Bhagat S, Hughes J, North J, O’Reilly D, Rajagopal V, Skingle S, Slack R. FRI0107 A comparison of two methods of assessing cardiovascular risk in rheumatoid arthritis in a secondary care setting. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kumar CHV, Kavitake S, Kumar SS, Cornwall P, Ashok M, Bhagat S, Manjunatha SG, Nambiar S. Development of an Efficient, Scalable Route for the Preparation of a Novel Insulin-Like Growth Factor-1 Receptor Modulator. Org Process Res Dev 2012. [DOI: 10.1021/op300120r] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- CH Vinod Kumar
- Pharmaceutical Development, AstraZeneca India Pvt. Ltd., Bellary Road, Hebbal, Bangalore 560 024, India
| | - Santosh Kavitake
- Pharmaceutical Development, AstraZeneca India Pvt. Ltd., Bellary Road, Hebbal, Bangalore 560 024, India
| | - Sythana Suresh Kumar
- Pharmaceutical Development, AstraZeneca India Pvt. Ltd., Bellary Road, Hebbal, Bangalore 560 024, India
| | - Philip Cornwall
- Medicines Evaluation Chemistry, Pharmaceutical
Development, AstraZeneca, Charter Way,
Macclesfield SK10 2NA, U.K
| | - Mithun Ashok
- Pharmaceutical Development, AstraZeneca India Pvt. Ltd., Bellary Road, Hebbal, Bangalore 560 024, India
| | - Sagar Bhagat
- Pharmaceutical Development, AstraZeneca India Pvt. Ltd., Bellary Road, Hebbal, Bangalore 560 024, India
| | - Sulur G. Manjunatha
- Pharmaceutical Development, AstraZeneca India Pvt. Ltd., Bellary Road, Hebbal, Bangalore 560 024, India
| | - Sudhir Nambiar
- Pharmaceutical Development, AstraZeneca India Pvt. Ltd., Bellary Road, Hebbal, Bangalore 560 024, India
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Kumar K, Amaresan N, Bhagat S, Madhuri K, Srivastava RC. Isolation and Characterization of Trichoderma spp. for Antagonistic Activity Against Root Rot and Foliar Pathogens. Indian J Microbiol 2012; 52:137-44. [PMID: 23729873 PMCID: PMC3386440 DOI: 10.1007/s12088-011-0205-3] [Citation(s) in RCA: 15] [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: 06/22/2010] [Accepted: 11/23/2010] [Indexed: 10/17/2022] Open
Abstract
Trichoderma, soil-borne filamentous fungi, are capable of parasitising several plant pathogenic fungi. Twelve isolates of Trichoderma spp. isolated from different locations of South Andaman were characterized for their cultural, morphological and antagonistic activity against soil borne and foliar borne pathogens. The sequencing of these isolates showed seven different species. The isolates revealed differential reaction patterns against the test pathogens viz., Sclerotium rolfsii, Colletotrichum gloeosporioides and C. capsici. However, the isolates, TND1, TWN1, TWC1, TGD1 and TSD1 were most effective in percentage inhibition of mycelial growth of test pathogens. Significant chitinase and β-1,3-glucanase activities of all Trichoderma isolates has been recorded in growth medium. T. viride was found with highest chitinase whereas T. harzianum was recorded with highest β-1,3-glucanase activities.
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Affiliation(s)
- Krishna Kumar
- Division of Field Crops, Central Agricultural Research Institute, Port Blair, 744 105 Andaman and Nicobar Islands India
| | - N. Amaresan
- Division of Field Crops, Central Agricultural Research Institute, Port Blair, 744 105 Andaman and Nicobar Islands India
| | - S. Bhagat
- Division of Field Crops, Central Agricultural Research Institute, Port Blair, 744 105 Andaman and Nicobar Islands India
| | - K. Madhuri
- Division of Field Crops, Central Agricultural Research Institute, Port Blair, 744 105 Andaman and Nicobar Islands India
| | - R. C. Srivastava
- Division of Field Crops, Central Agricultural Research Institute, Port Blair, 744 105 Andaman and Nicobar Islands India
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Bhagat S, Bernie C, Morgan A, Pilkington C, Maillard SM. The development of a new service for the management of Non-inflammatory Musculoskeletal Pain. Pediatr Rheumatol Online J 2011. [PMCID: PMC3194432 DOI: 10.1186/1546-0096-9-s1-o36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Raj MK, Rao HSP, Manjunatha SG, Sridharan R, Nambiar S, Keshwan J, Rappai J, Bhagat S, Shwetha B, Hegde D, Santhosh U. Corrigendum to “A mechanistic investigation of Biginelli reaction under base catalysis” [Tetrahedron Lett. 52 (2011) 3605–3609]. Tetrahedron Lett 2011. [DOI: 10.1016/j.tetlet.2011.07.062] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kamal Raj M, Rao HSP, Manjunatha SG, Sridharan R, Nambiar S, Keshwan J, Rappai J, Bhagat S, Shwetha B, Hegde D, Santhosh U. A mechanistic investigation of Biginelli reaction under base catalysis. Tetrahedron Lett 2011. [DOI: 10.1016/j.tetlet.2011.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nihtyanova S, Ong V, Black C, Denton C, Lutalo P, Shattles W, Jones H, Nouri R, Hepburn A, Chard M, Horwood N, Lynn M, Duke O, Kiely P, Zouita L, Davies U, Hughes R, Lloyd M, Nikitorowicz Buniak J, Shiwen X, Abraham D, Denton C, Black C, Stratton R, Hugle T, Schuetz P, Daikeler T, Tyndall A, Matucci-Cerinic M, Walker UA, van Laar JM, Pauling JD, Flower V, McHugh N, Liu S, Leask A, Nikitorowicz Buniak J, Aden N, Denton C, Abraham D, Stratton R, Khan K, Hoyles R, Shiwen X, Ong V, Abraham D, Denton C, Bhagat S, Drummond T, Goh C, Busch R, Hall F, Meyer P, Moinzadeh P, Krieg T, Hellmich M, Brinckmann J, Neumann E, Mueller-Ladner U, Kreuter A, Dumitresco D, Rosenkranz S, Hunzelmann N, Binai N, Huegle T, van Laar J, Shiwen X, Sonnylal S, Tam A, Jones H, Stratton R, Leask A, Norman J, Denton C, de Crombrugghe B, Abraham D, Chighizola CB, Luigi Meroni P, Coghlan G, Denton C, Ong V, Newton F, Shiwen X, Denton C, Abraham D, Stratton R, Derrett-Smith EC, Dooley A, Baliga R, Hobbs A, MacAllister R, Abraham D, Denton C, Futema M, Pantelidis P, Renzoni E, Schreiber BE, Ong V, Coghlan GJ, Denton C, Wells AU, Welsh K, Abraham D, Fonseca C, Futema M, Ponticos M, Pantelidis P, Wells A, Denton C, Abraham D, Fonseca C, Denton C, Guillevin L, Krieg T, Schwierin B, Rosenberg D, Silkey M, Matucci-Cerinic M, Parapuram S, Shi-wen X, Denton C, Abraham D, Leask A, Nihtyanova S, Ahmed Abdi B, Khan K, Abraham D, Denton C, Khan K, Denton C, Xu S, Ong V. Scleroderma and related disorders: 223. Long Term Outcome in a Contemporary Systemic Sclerosis Cohort. Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker033] [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: 11/14/2022] Open
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Varshney S, Nangia A, Bist SS, Singh RK, Gupta N, Bhagat S. Ossicular chain status in chronic suppurative otitis media in adults. Indian J Otolaryngol Head Neck Surg 2011; 62:421-6. [PMID: 22319706 DOI: 10.1007/s12070-010-0116-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 09/26/2010] [Indexed: 11/25/2022] Open
Abstract
This study was conducted to find out the status of the ossicles in cases of chronic suppurative otitis media (CSOM). One hundred and fifty cases of CSOM, who underwent surgery, were included and their intra-operative ossicular chain findings noted. Ossicular erosion was found to be much more common in unsafe CSOM than in safe CSOM. Malleus was found to be the most resistant ossicle to erosion whereas incus was found to be the most susceptible.
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Affiliation(s)
- Saurabh Varshney
- Department of E.N.T., Himalayan Institute of Medical Sciences, H.I.H.T. University, JollyGrant, Dehradun, 248140 Uttarakhand India
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Das L, Bowden A, Cooper RG, Mitchell W, O'Sullivan M, Herrick AL, Evans SJ, Lawson TM, Siebert S, Scott IC, Hajela V, Peffers GM, James S, Stirling A, Jobanputra P, Dubash SR, Tarique S, Pinto L, Ayas S, Fang B, Bhagat S, Busch R, Parfrey H, Simler N, Hall F. Concurrent Oral 2 - Case Reports [OP10-OP15]: OP10. Percutaneous Endoscopic Gastrostomy (PEG) Feeding: A Life-Saving Intervention in Systemic Sclerosis-Myositis Overlap with Pharyngeal Dysfunction. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq702] [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: 11/14/2022] Open
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Bhagat S, Mathieson C, Jandhyala R, Johnston R. Spondylodiscitis (disc space infection) associated with negative microbiological tests: comparison of outcome of suspected disc space infections to documented non-tuberculous pyogenic discitis. Br J Neurosurg 2009; 21:473-7. [PMID: 17852101 DOI: 10.1080/02688690701546155] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Discitis, an infection of the disc space, is an uncommon diagnosis that, if missed, can lead to spinal deformity and neurological deterioration, although as many as 30% of these patients will have negative microbiological cultures. It was unclear, however, whether the prognosis differed between patients who had positive or negative cultures. A retrospective case note review was carried out to assess the differences in presentation and outcome between these two groups. There were 26 and 43 patients in the negative and positive groups, respectively. Those with a positive culture were more likely to present with pyrexia, have a neurological deficit and not be independently mobile at presentation. The mean CRP recorded at the time of presentation was 96 and 157 in the negative and positive groups respectively (p = 0.004). Similarly, the mean ESR in the positive group was 88 compared with 69 in the negative group (p = 0.02). In conclusion, these patients may be at different ends of a clinical spectrum: those patients with a positive culture having a greater local and systemic inflammatory reaction to the disc space infection.
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Affiliation(s)
- S Bhagat
- Department of Neurosurgery, Institute of Neurological sciences, Southern General Hospital, Glasgow, UK.
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Abstract
PURPOSE To review various treatment modalities on outcome of patients with pelvic Ewing's sarcoma. METHODS Between January 1948 and December 2004, 18 male and 15 female patients aged 3 to 48 (mean, 20) years with pelvic Ewing's sarcoma were retrospectively reviewed from the Scottish Bone Tumour Registry. RESULTS The commonest site involved was the ilium. The main presenting symptom was pain, followed by swelling and restricted hip movements. Treatments included surgery, radiotherapy, chemotherapy, or any of them in combination. Patients who had no metastasis at presentation (p<0.01) and underwent chemotherapy with ifosfamide (p<0.01) had significantly longer survival. Age (p=0.09), gender (p=0.95), delay in presentation (p=0.31), tumour site (p=0.9), surgery (p=0.73), and radiotherapy (p=0.23) were not predictive of survival in the univariate analysis. The 5-year event-free survival rate in patients with no metastasis at presentation was 35%. CONCLUSION Intense multi-agent neo-adjuvant chemotherapy including ifosfamide followed by wide excision and postoperative radiation are recommended. Local therapy should not take precedence over or interfere with systemic chemotherapy.
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Affiliation(s)
- S Bhagat
- Department of Trauma and Orthopaedics, Wishaw General Hospital, Wishaw, United Kingdom.
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Bhagat S, Bansal M, Jandhyala R, Sharma H, Amin P, Pandit JP. Wide excision and ulno-carpal arthrodesis for primary aggressive and recurrent giant cell tumours. Int Orthop 2008; 32:741-5. [PMID: 17643243 PMCID: PMC2898956 DOI: 10.1007/s00264-007-0416-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 04/25/2007] [Accepted: 04/27/2007] [Indexed: 11/28/2022]
Abstract
Twenty-five patients underwent wide resection of the distal radial giant cell tumours (GCTs) followed by ulno-carpal arthrodesis. There were 15 male and ten female patients, with an average age of 21.5 years. Tumours included ten primary aggressive and 15 recurrent GCTs. Mean follow up was 2.4 years. Pain, swelling and reduced range of movement (ROM) were noted. Average time to fusion was 7.6 months. Five patients had persistent pain in the proximal forearm. Grip strength was 65% compared to the uninvolved side. Two patients had superficial wound infection, two underwent additional bone grafting and three implant removals due to hardware prominence were carried out. There was no evidence of carpal instability or arthritis on clinical or radiological examination at the time of final follow up. Fusion of the carpus to the ulna is a simple method of producing a painless stable wrist, though at the expense of mobility. The procedure allows wide resection with a lower rate of recurrence. Pain in the proximal forearm seems to persist for 3 to 4 months only to improve at subsequent follow up. The procedure provides a valid option for the management of primary aggressive and recurrent GCTs of distal radius.
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Affiliation(s)
- S Bhagat
- M.P. Shah Cancer Hospital, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India.
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Affiliation(s)
- U Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Bhagat S, Bansal M, Sharma H, Jandhyala R, Amin P, Pandit J. A rare case of progressive bilateral congenital abduction contracture with shoulder dislocations treated with proximal deltoid release. Arch Orthop Trauma Surg 2008; 128:293-6. [PMID: 17285270 DOI: 10.1007/s00402-007-0291-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2006] [Indexed: 11/30/2022]
Abstract
The contracture of the deltoid muscle is an uncommon disorder. Amongst the various causes reported, post intramuscular injection and trauma leading to the fibrosis of the muscle are common. However, congenital cases are extremely rare. We report a case of congenital progressive bilateral abduction contracture left untreated for a long time leading to anteroinferior subluxation. A proximal release was performed with satisfactory outcome on both sides.
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Affiliation(s)
- S Bhagat
- Kettering General Hospital, 1/2 Mawsley Crescent, Kettering, Northants, UK.
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Prakash S, Mathew C, Bhagat S. Locked-in syndrome in snakebite. J Assoc Physicians India 2008; 56:121-122. [PMID: 18472515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Two young patients are described who made complete recovery from locked-in syndrome (LIS) after snakebites. LIS was a presenting feature in a patient of presumed snake bite who showed complete response to polyvalent Anti-snake venom (ASV). This case suggests that elapid snake bite should be suspected in unresponsive patient found in early morning in endemic areas of snake bite in monsoon season. The second case was admitted in complete LIS state with history of rapidly progressive ptosis, diplopia, ophthalmoplegia, bulbar symptoms and quadriparesis, 6 hours after snake bite. Complete improvement by ASV in second patient highlights the need of differentiation of complete LIS from coma and brain death in patient of snake bite, as former have good prognosis.
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Affiliation(s)
- S Prakash
- Department of Neurology, Medical College, Baroda, Gujarat
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Abstract
PURPOSE To evaluate whether the operating time correlates with the survival and outcome in patients who underwent intramedullary nailing for metastatic femoral fractures. METHODS Records of 10 men and 11 women aged 43 to 86 (mean, 66) years who underwent intramedullary nailing (4 bilaterally) for metastatic femoral fractures between 1999 and 2003 were reviewed. The patients were followed up for at least 2 years or until their death. The main outcome measure was the correlation between operating time and survival. Operating time was categorised into 5 groups from 60 to 210 minutes, with 30-minute increments. RESULTS Operating time does not correlate with survival and outcome. The mean survival period was 9.4 months. Pain relief was achieved in 90% of the patients. There was no implant failure, but one loss of reduction. CONCLUSION Intramedullary nailing appears safe and effective for treatment of metastatic bone disease, and confers good functional results, pain relief, and mobility.
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Affiliation(s)
- H Sharma
- Wishaw General Hospital, Wishaw, Lanarkshire, United Kingdom.
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Sharma H, Bhagat S, Gaine WJ. Reducing Diagnostic Errors in Musculoskeletal Trauma by Reviewing Non-Admission Orthopaedic Referrals in the Next-Day Trauma Meeting. Ann R Coll Surg Engl 2007. [DOI: 10.1308/003588407x205305] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTIONDiagnostic errors in orthopaedics are usually caused by missing a fracture or misreading radiographs. The aim of this study was to document the pick-up rate of the wrong diagnoses by reviewing X-rays and casualty notes in the next-day trauma meeting.PATIENTS AND METHODSThe casualty notes and radiographs of 503 patients were prospectively reviewed in the daily trauma meeting between August 2002 and December 2002 in a district general hospital. The relevant data were collected and analysed by a single assessor.RESULTSThe false positive rate for making an orthopaedic diagnosis was 12.6% (i.e.) diagnosing a fracture, when none existed). The false negative (missing) rate was 4%, while 2.4% incidental findings were missed, or at least not documented, after reading the X-rays. There were 7.8% wrong diagnoses made. The majority of the patients were seen by the senior house officers.CONCLUSIONSThe medicolegal significance of false negative diagnosis is obviously greater. In a busy emergency department, where a large number of patients are seen, there is a greater risk. This study shows the importance in a small-to-medium sized accident and emergency unit as well, where there is no senior cover available out-of-hours for final radiological interpretation. A morning trauma meeting which covers reviewing admitted patients as well as non-admission orthopaedic referrals has an effective risk management solution to early detection of missed and wrong diagnoses.
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Affiliation(s)
- H Sharma
- Department of Trauma and Orthopaedics, Falkirk and District Royal Infirmary Falkirk, UK
| | - S Bhagat
- Department of Trauma and Orthopaedics, Falkirk and District Royal Infirmary Falkirk, UK
| | - WJ Gaine
- Department of Trauma and Orthopaedics, Falkirk and District Royal Infirmary Falkirk, UK
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Abstract
We describe a case of odontoid process fracture below the synchondrosis associated with delayed diagnosis and anterior subluxation of C1 over C2. This was treated with an in situ posterior occipitocervical fusion. Long-term follow-up of 7 years showed excellent remodelling of the deformity.
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Affiliation(s)
- S Bhagat
- Institute of Neurological Sciences, Department Of Neurosurgery, Southern General Hospital, Glasgow, UK.
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Abstract
This case report describes the discovery of a plastic foreign body in a patient's knee joint 21 years from the initial injury. The patient was thoroughly investigated radiologically with plain X-rays both immediately after the initial injury and years later in orthopaedic outpatients. He also subsequently received an MRI. All these were reported as normal. The patient's symptoms persisted and an arthroscopy was performed. At this procedure the presence of the foreign body was confirmed and the offending plastic was safely removed. The patient's symptoms of intermittent locking resolved. This experience stresses this importance of clinical suspicion despite apparently normal radiology.
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Affiliation(s)
- R Jandhyala
- Department of Plastic Surgery, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK
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Mohapatra MK, Abhishek PB, Bhagat S, Karua PC, Murmu M, Minz NT, Tripathy S. Polyostotic fibrous dysplasia. J Assoc Physicians India 2005; 53:947. [PMID: 16515233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- M K Mohapatra
- Department of Medicine and Radiology, VSS Medical College and Hospital, Burla
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Mohanty SC, Das AK, Tripathy B, Mohanty G, Bhagat S, Mishra S. Germinoma of the pineal gland. Neurol India 2003; 51:286-7. [PMID: 14571037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Bhagat S, Gaiha M, Sharma VK, Anuradha S. A comparative evaluation of C-reactive protein as a short-term prognostic marker in severe unstable angina--a preliminary study. J Assoc Physicians India 2003; 51:349-54. [PMID: 12723647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE The present study was done to evaluate the short-term prognostic significance of C-reactive protein (CRP) in unstable angina (UA) and to compare it with other known prognostic markers of UA, as there is a paucity of data from our country. METHODOLOGY This prospective study comprised of 44 UA patients (Braunwald Class II A, B) with age < 65 years, along with 40 age and sex matched healthy controls. Patients with h/o myocardial infarction (MI) in the preceding 1-month and evidence of infection, inflammation or neoplasm were excluded from the study. Complete clinical evaluation was done and presence of any prognostic variables of UA was noted (including Brauriwald high-risk variables). Apart from biochemical investigations and ECG, CRP was measured at the time of admission in the study group and controls using Microwell ELISA assay. Standard treatment protocol was followed for all patients and they were closely monitored during hospital stay and subsequently for 4 weeks for occurrence of any adverse cardiac events. RESULTS There was a statistically significant difference in the mean level of CRP between study group (6.12 +/- 6.134 mg/L) and controls (1.52 +/- 0.751 mg/L); p = 0.000. Among the 44 patients, 19 (43%) experienced any one or more outcome measures. Of the three variables (i.e. ongoing chest pain, ST depression > or = 1 mm and CRP > or = 4 mg/L) which showed statistical significance on univariate analysis with respect to adverse outcome measures (p = 0.001, 0.027 and 0.000 respectively), only CRP > or = 4 mg/L and ST depression > or = 1 mm showed independent prognostic significance on multiple logistic regression analysis (p = 0.000 and 0.002 respectively). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and relative risk (RR) for CRP > or = 4 mg/L were 78.9%, 96%, 93.75%, 85.74% and 6.56 (95% CI; 2.62 - 16.4) and that for ST depression > or = 1 mm were 89.47%, 64%, 65.38%, 88.89% and 5.88% (95% CI: 1.54 - 22.38), respectively. Trop T could be done in eight patients only. CONCLUSION CRP > or = 4 mg/L by ELISA is an independent predictor of adverse cardiac outcome in severe UA in the short-term follow up and, hence, is useful for risk stratification of these patients. CRP has a higher specificity, PPV and overall RR for prediction of an outcome than ST segment depression, although it is less sensitive.
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Affiliation(s)
- S Bhagat
- Department of Medicine, Maulana Azad Medical College, New Delhi
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Wadia RS, Pujari SN, Kothari S, Udhar M, Kulkarni S, Bhagat S, Nanivadekar A. Neurological manifestations of HIV disease. J Assoc Physicians India 2001; 49:343-8. [PMID: 11291974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
We report the results of neurological evaluation of 1,527 HIV positive subjects. Neurological complications were seen in 457 patients (481 neurological events). The prevalence was 20.24% of patients attending the out-patient clinic and in 44.57% of in-patients. Involvement of all levels of neuraxes was documented. The commonest manifestations were neuropathies, including herpes zoster (28.27%), meningitis (17.88%) and mass lesions (16%). Cryptococcal meningitis was clearly commoner than tubercular meningitis (67.44% vs 18.60% of all cases of meningitis, respectivelv). Amongst mass lesions, 14/24 single lesions and 27/38 multiple lesions responded to anti-toxoplasma treatment and were diagnosed as CNS toxoplasmosis. In abscence of biopsy, it would be prudent to initiate empirical anti-toxoplasma treatment for all HIV patients with mass lesions and assess clinical and radiological response. To our knowledge this is the largest series of neurological manifestations of HIV disease documented in Indian literature.
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Affiliation(s)
- R S Wadia
- Department of Neurology, Ruby Hall Clinic and Poona Medical Research Foundation, Pune
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Minakhin L, Bhagat S, Brunning A, Campbell EA, Darst SA, Ebright RH, Severinov K. Bacterial RNA polymerase subunit omega and eukaryotic RNA polymerase subunit RPB6 are sequence, structural, and functional homologs and promote RNA polymerase assembly. Proc Natl Acad Sci U S A 2001; 98:892-7. [PMID: 11158566 PMCID: PMC14680 DOI: 10.1073/pnas.98.3.892] [Citation(s) in RCA: 163] [Impact Index Per Article: 7.1] [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] [Indexed: 11/18/2022] Open
Abstract
Bacterial DNA-dependent RNA polymerase (RNAP) has subunit composition beta'betaalpha(I)alpha(II)omega. The role of omega has been unclear. We show that omega is homologous in sequence and structure to RPB6, an essential subunit shared in eukaryotic RNAP I, II, and III. In Escherichia coli, overproduction of omega suppresses the assembly defect caused by substitution of residue 1362 of the largest subunit of RNAP, beta'. In yeast, overproduction of RPB6 suppresses the assembly defect caused by the equivalent substitution in the largest subunit of RNAP II, RPB1. High-resolution structural analysis of the omega-beta' interface in bacterial RNAP, and comparison with the RPB6-RPB1 interface in yeast RNAP II, confirms the structural relationship and suggests a "latching" mechanism for the role of omega and RPB6 in promoting RNAP assembly.
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Affiliation(s)
- L Minakhin
- Waksman Institute, Department of Genetics, Department of Chemistry and Howard Hughes Medical Institute, Rutgers, The State University, Piscataway, NJ 08854, USA
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