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Suri TM, Hadda V, Ali S, Chopra A, Khan MA, Singh J, Ghosh T, Mittal S, Tiwari P, Madan K, Mohan A, Guleria R. Association of Leukocyte Subpopulations Identified by Flow Cytometry with Outcomes of Sepsis in a Respiratory Intensive Care Unit: An Observational Study. J Intensive Care Med 2024; 39:125-135. [PMID: 37554063 DOI: 10.1177/08850666231193962] [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] [Indexed: 08/10/2023]
Abstract
INTRODUCTION The dysregulated host immune response in sepsis is orchestrated by peripheral blood leukocytes. This study explored the associations of the peripheral blood leukocyte subpopulations with early clinical deterioration and mortality in sepsis. METHODS We performed a prospective observational single-center study enrolling adult subjects with sepsis within 48 h of hospital admission. Peripheral blood flow cytometry was performed for the patients at enrolment and after 5 days. The primary outcome was to explore the association between various leukocyte subpopulations at enrolment and early clinical deterioration [defined as an increase in the sequential organ failure assessment (SOFA) score between enrolment and day 5, or death before day 5]. Other pre-specified outcomes explored associations of leukocyte subpopulations at enrolment and on day 5 with in-hospital mortality. RESULTS A total of 100 patients, including 47 with septic shock were enrolled. The mean (SD) age of the patients was 53.99 (14.93) years. Among them, 26 patients had early clinical deterioration, whereas 41 died during hospitalization. There was no significant association between the leukocyte subpopulations at enrolment and early clinical deterioration on day 5. On multivariate logistic regression, a reduced percentage of CD8 + CD25+ T-cells at enrolment was associated with in-hospital mortality [odds ratio (OR), 0.82 (0.70-0.97); p-value = 0.02]. A reduced lymphocyte percentage on day 5 was associated with in-hospital mortality [OR, 0.28 (0.11-0.69); p-value = 0.01]. In a post-hoc analysis, patients with "very early" deterioration within 48 h had an increased granulocyte CD64 median fluorescent intensity (MFI) [OR, 1.07 (1.01-1.14); p-value = 0.02] and a reduced granulocyte CD16 MFI [OR, 0.97 (0.95-1.00); p-value = 0.04] at enrolment. CONCLUSIONS None of the leukocyte subpopulations showed an association with early clinical deterioration at day 5. Impaired lymphocyte activation and lymphocytopenia indicative of adaptive immune dysfunction may be associated with in-hospital mortality.
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Affiliation(s)
- Tejas Menon Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shadab Ali
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Chopra
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof Ahmad Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Jay Singh
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Tamoghna Ghosh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Agarwal S, Jat KR, Dhochak N, Mittal S, Naranje P, Nambirajan A, Bharti SJ, Pati I, Maheshwari Y, Kabra SK, Madan K. The first report of endobronchial ultrasound-guided transbronchial needle aspiration from an intraparenchymal lung mass in a child: Advances in pediatric EBUS. Pediatr Pulmonol 2024. [PMID: 38251856 DOI: 10.1002/ppul.26877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Sheetal Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Dhochak
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Naranje
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand Jee Bharti
- Department of Oncoanaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ipsita Pati
- Department of Oncoanaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Yashika Maheshwari
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Mittal S, Bhardwaj M, Shekhrajka P, Goyal VK, Nimje GR, Kanoji S, Danduri SK, Vishnoi A. An overview of unresolved issues in the perioperative management of liver transplant patients. Korean J Transplant 2023; 37:221-228. [PMID: 38115164 PMCID: PMC10772275 DOI: 10.4285/kjt.23.0061] [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: 10/26/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Over the past decade, the field of solid organ transplantation has undergone significant changes, with some of the most notable advancements occurring in liver transplantation. Recent years have seen substantial progress in preoperative patient optimization protocols, anesthesia monitoring, coagulation management, and fluid management, among other areas. These improvements have led to excellent perioperative outcomes for all surgical patients, including those undergoing liver transplantation. In the last few decades, there have been numerous publications in the field of liver transplantation, but controversies related to perioperative management of liver transplant recipients persist. In this review article, we address the unresolved issues surrounding the anesthetic management of patients scheduled for liver transplantation.
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Affiliation(s)
- Saurabh Mittal
- Department of Organ Transplant Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Medha Bhardwaj
- Department of Neuro-Anaesthesia, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | | | - Vipin Kumar Goyal
- Department of Organ Transplant Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Ganesh Ramaji Nimje
- Department of Organ Transplant Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Sakshi Kanoji
- Department of Organ Transplant Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Suma Katyaeni Danduri
- Department of Organ Transplant Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Anshul Vishnoi
- Department of Organ Transplant Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, India
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Reena K, Mittal S, Faizan M, Jahan I, Rahman Y, Khan R, Singh L, Alhalmi A, Noman OM, Alahdab A. Enhancement of Curcumin's Anti-Psoriatic Efficacy via Formulation into Tea Tree Oil-Based Emulgel. Gels 2023; 9:973. [PMID: 38131959 PMCID: PMC10743130 DOI: 10.3390/gels9120973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Psoriasis is a chronic inflammatory skin disease characterized by the hyperproliferation and aberrant differentiation of epidermal keratinocytes. It is a debilitating condition that can cause significant physical and emotional distress. Natural anti-psoriatic agents have been investigated as alternatives to conventional allopathic medications, as they have notable limitations and drawbacks. Curcumin and tea tree oil are cost-efficient and effective anti-inflammatory medicines with less adverse effects compared to synthetic psoriasis medications. Our research endeavors to harness the therapeutic potential of these natural compounds by developing an herbal anti-psoriatic topical drug delivery system. This novel method uses curcumin and tea tree oil to create a bi-phasic emulgel drug delivery system. Formulations F1 (gel) and F2 (emulgel) have high drug content percentages of 84.2% and 96.7%, respectively. The emulgel showed better spreadability for cutaneous applications, with a viscosity of 92,200 ± 943 cp compared to the gel's 56,200 ± 1725 cp. The emulgel released 94.48% of the drugs, compared to 87.58% for the gel. These formulations conform to the zero-order and Higuchi models, and their stability over a three-month period is crucial. In vivo, the emulgel healed psoriasis symptoms faster than the usual gel. The gathered results confirmed the emulgel's potential as a drug delivery method, emphasizing the complementary benefits of tea tree oil and curcumin as an effective new therapy for psoriasis.
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Affiliation(s)
- Km Reena
- Department of Pharmacy, Invertis University, Bareilly 243123, India;
| | - Saurabh Mittal
- Center of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida 201303, India;
| | - Mohammad Faizan
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India;
| | - Iram Jahan
- Department of Physiology, Hamdard Institute of Medical Science and Research, Jamia Hamdard, New Delhi 110062, India;
| | - Yasir Rahman
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India; (Y.R.); (R.K.); (A.A.)
| | - Rahmuddin Khan
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India; (Y.R.); (R.K.); (A.A.)
| | - Lalit Singh
- Faculty of Pharmacy, Future Institute of Medical Sciences, Bareilly 243202, India
| | - Abdulsalam Alhalmi
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India; (Y.R.); (R.K.); (A.A.)
| | - Omar M. Noman
- Department of Pharmacognosy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Ahmad Alahdab
- Institute of Pharmacy, Clinical Pharmacy, University of Greifswald, Friedrich-Ludwig-Jahn-Str. 17, 17489 Greifswald, Germany
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Mittal S, Goyal VK, Shekhrajka P, Bhardwaj M, Nimje GR, Singh P, Danduri SK. Role of Intrathecal Morphine for Acute Postoperative Pain Management in Patients Undergoing Kidney Transplant: A Randomized Controlled Study. EXP CLIN TRANSPLANT 2023; 21:939-945. [PMID: 38263780 DOI: 10.6002/ect.2023.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVES Postoperative pain after a major surgery continues to be a challenge. Regional anesthetic techniques make up a substantial part of interventions to decrease postoperative pain and the use of opioids. In this study, we aimed to evaluate the effectiveness of intrathecal morphine in patients undergoing kidney transplant, in terms of both duration and quality of postoperative analgesia. MATERIALS AND METHODS We conducted a prospective randomized double-blind study and analyzed 60 patients divided into 2 groups of 30 each who were scheduled for elective living-related (first-degree donor) kidney transplant. One group received intrathecal morphine, and the other group received intrathecal normal saline. We used the numeric rating scale to assess the postoperative pain score. We also recorded the postoperative consumption of fentanyl, time of first analgesia requirement, total rescue analgesia, catheter-related bladder discomfort, and related complications for 48 hours postoperatively. RESULTS Patients in the intrathecal morphine group had significantly lower pain scores both at rest and while coughing and less consumption of total fentanyl (P < .05). When we compared patient groups, patients in the intrathecal morphine group had significantly lower total rescue analgesia (P < .05) and significantly lower catheter-related bladder discomfort but significantly higher pruritus (P = .01). CONCLUSIONS Intrathecal morphine significantly reduces postoperative opioid consumption and can result in fewer incidences of catheter-related bladder discomfort.
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Affiliation(s)
- Saurabh Mittal
- From the Department of Organ Transplant Anaesthesia and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, India
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Rai D, Pattnaik B, Bangaru S, Tak J, Kumari J, Verma U, Vadala R, Yadav G, Dhaliwal RS, Kumar S, Kumar R, Jain D, Luthra K, Chosdol K, Palanichamy JK, Khan MA, Surendranath A, Mittal S, Tiwari P, Hadda V, Madan K, Agrawal A, Guleria R, Mohan A. microRNAs in exhaled breath condensate for diagnosis of lung cancer in a resource-limited setting: a concise review. Breathe (Sheff) 2023; 19:230125. [PMID: 38351949 PMCID: PMC10862127 DOI: 10.1183/20734735.0125-2023] [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: 06/24/2023] [Accepted: 11/30/2023] [Indexed: 02/16/2024] Open
Abstract
Lung cancer is one of the common cancers globally with high mortality and poor prognosis. Most cases of lung cancer are diagnosed at an advanced stage due to limited diagnostic resources. Screening modalities, such as sputum cytology and annual chest radiographs, have not proved sensitive enough to impact mortality. In recent years, annual low-dose computed tomography has emerged as a potential screening tool for early lung cancer detection, but it may not be a feasible option for developing countries. In this context, exhaled breath condensate (EBC) analysis has been evaluated recently as a noninvasive tool for lung cancer diagnosis. The breath biomarkers also have the advantage of differentiating various types and stages of lung cancer. Recent studies have focused more on microRNAs (miRNAs) as they play a key role in tumourigenesis by regulating the cell cycle, metastasis and angiogenesis. In this review, we have consolidated the current published literature suggesting the utility of miRNAs in EBC for the detection of lung cancer.
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Affiliation(s)
- Divyanjali Rai
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bijay Pattnaik
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Bangaru
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jaya Tak
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Kumari
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Umashankar Verma
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Vadala
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Geetika Yadav
- Indian Council of Medical Research, New Delhi, India
| | | | - Sunil Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Kalpana Luthra
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Kunzang Chosdol
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | | | - Maroof Ahmad Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Addagalla Surendranath
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anurag Agrawal
- Trivedi School of Biosciences, Ashoka University, Sonipat, India
| | - Randeep Guleria
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Breathomics in Respiratory Diseases Lab, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Suri TM, Ghosh T, Mittal S, Hadda V, Madan K, Mohan A. Prevalence of chronic obstructive pulmonary disease in Indian nonsmokers: a systematic review & meta-analysis. Rev Environ Health 2023; 0:reveh-2023-0135. [PMID: 38016010 DOI: 10.1515/reveh-2023-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Nonsmokers with chronic obstructive pulmonary disease (COPD) are neglected despite constituting half of all cases in studies from the developed world. Herein, we systematically reviewed the prevalence of COPD among nonsmokers in India. CONTENT We searched Embase, Scopus, and PubMed databases for studies examining the prevalence of COPD among nonsmokers in India. We used the Joanna Briggs Institute (JBI) checklist to assess included studies' quality. Meta-analysis was performed using random-effects model. SUMMARY Seven studies comprising 6,903 subjects were included. The quality of the studies ranged from 5/9 to 8/9. The prevalence of COPD varied between 1.6 and 26.6 %. Studies differed considerably in demographics and biomass exposure profiles of subjects. Among the four studies that enrolled both middle-aged and elderly Indian nonsmokers not screened based on biomass fuel exposure, the pooled prevalence of COPD was 3 % (95 % CI, 2-3 %; I2=50.52 %, p=0.11). The pooled prevalence of COPD among biomass fuel-exposed individuals was 10 % (95 % CI, 2-18 %; I2=98.8 %, p<0.001). OUTLOOK Limited evidence suggests a sizable burden of COPD among nonsmokers and biomass fuel-exposed individuals in India. More epidemiological studies of COPD in nonsmokers are needed from low and middle-income countries.
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Affiliation(s)
- Tejas M Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tamoghna Ghosh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Vadala R, Mittal S, Nambirajan A, Hadda V, Mohan A, Guleria R, Madan K. Transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA) for left adrenal gland (LAG) sampling: A report of three cases with a review of the literature. Lung India 2023; 40:550-554. [PMID: 37961966 PMCID: PMC10723211 DOI: 10.4103/lungindia.lungindia_381_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] [Received: 07/30/2022] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 11/15/2023] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard-of-care modality for evaluating mediastinal lymph nodes and masses. The EBUS bronchoscope may also be introduced through the oesophageal route to perform sampling of accessible lesions, a technique described as transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA). Because of the central oesophageal approach, EUS-B-FNA provides easy access to the left para-tracheal, subcarinal and para-oesophageal lymph nodes. In addition, the left adrenal gland (LAG) can also be imaged and sampled during the EUS-B-FNA procedure. In patients with suspected lung cancer, accurate staging is essential. Adrenal metastasis is relatively common and may often be a solitary metastatic site. We describe three cases where EUS-B-FNA was performed to safely sample the enlarged LAG in suspected lung cancer. We also review the literature on the performance characteristics of EUS-B-FNA for LAG aspiration.
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Affiliation(s)
- Rohit Vadala
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Baj BB, Goyal VK, Shekhrajka P, Nimje GR, Mittal S. Perioperative management of a severely thrombocytopenic kidney transplant recipient using thromboelastography. Med J Armed Forces India 2023; 79:718-721. [PMID: 37981936 PMCID: PMC10654360 DOI: 10.1016/j.mjafi.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/29/2023] [Indexed: 03/18/2023] Open
Abstract
Perioperative transfusion of blood and blood products can be avoided or reduced with bedside real time monitoring of coagulation in patients at risk. Thromboelastography (TEG), is a point of care coagulation monitor to assess dynamic progress of clot formation. We report a case of 26 years old female patient with end-stage kidney disease (ESKD) who underwent living donor kidney transplantation at our institute. On preoperative work-up, her complete blood count revealed severe thrombocytopenia. Etiology of thrombocytopenia could not be established except past history of hemolysis, elevated liver enzymes, and low platelets syndrome in her last pregnancy. Perioperative transfusion of blood and blood products was guided with TEG and transplant was conducted successfully without any transfusion. In conclusion, severe thrombocytopenia in patients with ESKD enhances the risk of perioperative bleeding and related complications in already compromised coagulation system. Kidney transplant without pre-emptive transfusion could be possible with perioperative use of TEG.
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Affiliation(s)
- Bir Bal Baj
- Professor, Organ Transplant Anaesthesia and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Vipin Kumar Goyal
- Professor & Head, Organ Transplant Anaesthesia and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Praveenkumar Shekhrajka
- Assistant Professor (Anaesthesia), Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Ganesh Ramaji Nimje
- Assistant Professor, Organ Transplant Anaesthesia and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Saurabh Mittal
- Senior Resident, Organ Transplant Anaesthesia and Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
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Suri TM, Ghosh T, Mittal S, Hadda V, Madan K, Mohan A. Systematic review and meta-analysis of the prevalence of obstructive sleep apnea in Indian adults. Sleep Med Rev 2023; 71:101829. [PMID: 37517357 DOI: 10.1016/j.smrv.2023.101829] [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: 04/15/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder associated with considerable morbidity. However, there is an underrepresentation of data from India and other developing countries in global reviews of OSA prevalence. This systematic review and meta-analysis examined the prevalence of OSA in India. The MEDLINE, Embase, and Scopus databases were searched for articles that reported the prevalence of OSA in the general Indian adult population using sleep studies. Eight studies were included comprising 11,009 subjects with mean age ranging from 35.5 to 47.8 years. On the Joanna Briggs Institute (JBI) checklist for prevalence studies, the study quality ranged from 3/9 to 9/9. Meta-analysis was performed using the random-effects model. The pooled prevalence of OSA (AHI ≥5 events/hour) was 11% overall (95% CI: 7%-15%; I2 = 98.0%, p<0.001), 13% in males (95% CI: 7%-18%; I2 = 96.0%, p<0.001), and 5% in females (95% CI: 3%-7%; I2 = 73.3%, p = 0.01). The pooled prevalence of moderate-to-severe OSA (AHI ≥15 events/hour) was 5% (95% CI: 2%-8%, I2 = 95.3%; p = 0.01). Based on these findings, approximately 104 million Indians of working age suffer from OSA, of whom 47 million have moderate-to-severe OSA. This represents a major public health problem in India with important implications for the global burden of the disease.
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Affiliation(s)
- Tejas Menon Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tamoghna Ghosh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
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Mittal S, Shah S, Yadav HN, Ali J, Gupta MM, Baboota S. Quality by design engineered, enhanced anticancer activity of temozolomide and resveratrol coloaded NLC and brain targeting via lactoferrin conjugation in treatment of glioblastoma. Eur J Pharm Biopharm 2023; 191:175-188. [PMID: 37648174 DOI: 10.1016/j.ejpb.2023.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/01/2023]
Abstract
The most dangerous type of high-grade astrocytoma is glioblastoma multiforme. The objective of the work was to engineer lactoferrin conjugated temozolomide and resveratrol co-loaded NLC for the treatment of glioblastoma using intranasal delivery for brain targeting. Synergistic activity of temozolomide and resveratrol was determined using combination index method and 1:1 ratio was selected. QbD approach was used to formulate and optimize NLC, with minimum particle size, maximum transmittance and entrapment efficiency using Central Composite Rotable Design (CCRD) method. The optimized LTR-NLC had desired average particle size (209.3 nm), narrow PDI along, high percentage transmittance (>95%) and better entrapment efficiency (95.26% of TEM and 87.59% of RES). From ex-vivo permeation studies it was found that the permeation at 24 h was 77.43 %, and 88.55 % from LTR-NLC and 25.76 % and 31.10% from suspension for resveratrol and temozolomide respectively. In comparison to drug suspension, NLC had nearly 3-fold increase in drug penetration. IC50 value was also significantly better in the groups treated with LTR-NLC. Hence it can be concluded that LTR-NLC may be an effective formulation for the treatment of glioblastoma, according to the findings of this investigation.
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Affiliation(s)
- Saurabh Mittal
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India; Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida 201303, U.P., India.
| | - Sadia Shah
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Harlokesh Narayan Yadav
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Javed Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India.
| | - Madan Mohan Gupta
- School of Pharmacy, Faculty of Medical Science, The University of the West Indies, St. Augustine, Trinidad & Tobago.
| | - Sanjula Baboota
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India.
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Tayal A, Shekh I, Karthik AR, Jat KR, Dhochak N, Mittal S, Gupta N, Kabra SK, Madan K. A "Cool" extraction technique for difficult pediatric airway foreign bodies: Report of two cases. Pediatr Pulmonol 2023; 58:2670-2674. [PMID: 37265423 DOI: 10.1002/ppul.26530] [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: 02/24/2023] [Revised: 04/19/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
Foreign body (FB) aspiration is a potentially life-threatening accident in children. Traditionally, rigid bronchoscopy has been the procedure of choice for FB removal, however it may miss distally lodged FBs. We report two pediatric cases with distal impacted FBs that could not be retrieved by rigid bronchoscopy (RB) and were mobilised using Fogarty balloon followed by flexible bronchoscopic cryoextraction. The advantage of a cryoprobe is lower risk of fragmentation of FB that may occur with forceps. Cryoextraction is particularly advantageous for removing water-containing FBs. In both patients, FB was removed more than 2 weeks following aspiration, leading to the formation of granulation tissue around the FB, which considerably hampered the process. Using a laryngeal mask airway to secure the airway, FB removal by flexible bronchoscopy may be a safe and effective technique in skilled hands, especially for FBs impacted in distal airways with granulation tissue where RB fails.
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Affiliation(s)
- Anshula Tayal
- Department of Pediatrics, Division of Pediatric Pulmonology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Irfan Shekh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - A R Karthik
- Department of Anaesthesia, Pain and Palliative Care, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | - Kana Ram Jat
- Department of Pediatrics, Division of Pediatric Pulmonology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Dhochak
- Department of Pediatrics, Division of Pediatric Pulmonology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil K Kabra
- Department of Pediatrics, Division of Pediatric Pulmonology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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13
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Iyer H, Mishra M, Sindhwani G, Mittal S, Tiwari P, Hadda V, Mohan A, Guleria R, Madan K. Five Versus 10 Pharyngeal Sprays of 10% Lignocaine for Topical Anesthesia During Flexible Bronchoscopy: A Multicenter, Randomized Controlled Trial. J Bronchology Interv Pulmonol 2023; 30:232-237. [PMID: 35698282 DOI: 10.1097/lbr.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ensuring adequate patient comfort is crucial during bronchoscopy. Although lidocaine spray is recommended for topical pharyngeal anesthesia, the optimum dose of sprays is unclear. We compared 5 versus 10 sprays of 10% lidocaine for topical anesthesia during bronchoscopy. METHODS In this investigator-initiated, prospective, multicenter, randomized clinical trial, subjects were randomized to receive 5 (group A) or 10 sprays (group B) of 10% lidocaine. The primary objective was to compare the operator-rated overall procedure satisfaction between the groups. RESULTS Two hundred eighty-four subjects were randomized (143 group A and 141 group B). The operator-rated overall procedure satisfaction, VAS [mean (SD)] was similar between the groups [group A, 74.1 (19.9) and group B, 74.3 (18.5), P =0.93]. The VAS scores of patient-rated cough [group A, 32.5 (22.9) and group B, 32.3 (22.2), P =0.93], and operator-rated cough [group A, 29.8 (22.3) and group B, 26.9 (21.5), P =0.26] were also similar. The time to reach vocal cords, overall procedure duration, mean doses of sedatives, the proportion of subjects willing to return for a repeat procedure (if required), and complications were not significantly different. Subjects in group A received significantly less cumulative lidocaine (mg) [group A, 293.9 (11.6) and group B, 343.5 (10.6), P <0.001]. CONCLUSION During bronchoscopy, topical anesthesia with 5 sprays of 10% lidocaine is preferred as it is associated with a similar operator-rated overall procedure satisfaction at a lower cumulative lidocaine dose compared with 10 sprays.
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Affiliation(s)
- Hariharan Iyer
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi
| | - Mayank Mishra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Girish Sindhwani
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi
| | - Vijay Hadda
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi
| | - Anant Mohan
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi
| | - Randeep Guleria
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi
| | - Karan Madan
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi
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14
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Mohan A, Madan K, Hadda V, Mittal S, Suri T, Shekh I, Guleria R, Khader A, Chhajed P, Christopher DJ, Swarnakar R, Agarwal R, Aggarwal AN, Aggarwal S, Agrawal G, Ayub II, Bai M, Baldwa B, Chauhan A, Chawla R, Chopra M, Choudhry D, Dhar R, Dhooria S, Garg R, Goel A, Goel M, Goyal R, Gupta N, Manjunath BG, Iyer H, Jain D, Khan A, Kumar R, Koul PA, Lall A, Arunachalam M, Madan NK, Mehta R, Loganathan N, Nath A, Nangia V, Nene A, Patel D, Pattabhiraman VR, Raja A, Rajesh B, Rangarajan A, Rathi V, Sehgal IS, Shankar SH, Sindhwani G, Singh PK, Srinivasan A, Talwar D, Thangakunam B, Tiwari P, Tyagi R, Chandra NV, Sharada V, Vadala R, Venkatnarayan K. Guidelines for endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA): Joint Indian Chest Society (ICS)/Indian Association for Bronchology (IAB) recommendations. Lung India 2023; 40:368-400. [PMID: 37417095 PMCID: PMC10401980 DOI: 10.4103/lungindia.lungindia_510_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/01/2022] [Revised: 12/30/2022] [Accepted: 01/31/2023] [Indexed: 07/08/2023] Open
Abstract
Over the past decade, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become an indispensable tool in the diagnostic armamentarium of the pulmonologist. As the expertise with EBUS-TBNA has evolved and several innovations have occurred, the indications for its use have expanded. However, several aspects of EBUS-TBNA are still not standardized. Hence, evidence-based guidelines are needed to optimize the diagnostic yield and safety of EBUS-TBNA. For this purpose, a working group of experts from India was constituted. A detailed and systematic search was performed to extract relevant literature pertaining to various aspects of EBUS-TBNA. The modified GRADE system was used for evaluating the level of evidence and assigning the strength of recommendations. The final recommendations were framed with the consensus of the working group after several rounds of online discussions and a two-day in-person meeting. These guidelines provide evidence-based recommendations encompassing indications of EBUS-TBNA, pre-procedure evaluation, sedation and anesthesia, technical and procedural aspects, sample processing, EBUS-TBNA in special situations, and training for EBUS-TBNA.
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Affiliation(s)
- Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tejas Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Irfan Shekh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abdul Khader
- Institute of Pulmonology, Allergy and Asthma Research, Calicut, India
| | | | | | | | | | - Ritesh Agarwal
- Department of Pulmonary Medicine, PGIMER, Chandigarh, India
| | | | - Shubham Aggarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gyanendra Agrawal
- Department of Internal Medicine, Respiratory and Critical Care Medicine, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - Irfan Ismail Ayub
- Department of Pulmonology, Sri Ramachandra, Medical Centre, Chennai, India
| | - Muniza Bai
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bhvya Baldwa
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Chauhan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Chawla
- Department of Pulmonary Medicine, Jaipur Golden Hospital, Delhi, India
| | - Manu Chopra
- Department of Medicine, Command Hospital Eastern Command Kolkata, India
| | - Dhruva Choudhry
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, India
| | - Raja Dhar
- Department of Pulmonology, Calcutta Medical Research Institute, Kolkata, India
| | | | - Rakesh Garg
- Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Goel
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Goel
- Department of Pulmonology, Fortis, Gurugram, India
| | - Rajiv Goyal
- Department of Respiratory Medicine, Rajiv Gandhi Cancer Institute, Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - BG Manjunath
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, India
| | - Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajmal Khan
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, India
| | - Raj Kumar
- Director, Vallabhbhai Patel Chest Institute, Delhi, India
| | - Parvaiz A. Koul
- Director, Sher-e-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ajay Lall
- Department of Pulmonary Medicine, Max Hospital, Saket, Delhi, India
| | - M. Arunachalam
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neha K. Madan
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ravindra Mehta
- Department of Pulmonary and Critical Care Medicine, Apollo Hospitals, Bengaluru, India
| | - N Loganathan
- Department of Pulmonary Medicine, Sri Ramakrishna Hospital, Coimbatore, India
| | - Alok Nath
- Department of Pulmonary Medicine, SGPGIMS, Lucknow, India
| | - Vivek Nangia
- Department of Pulmonology and Respiratory Medicine, Max Super Speciality Hospital Saket, New Delhi, India
| | - Amita Nene
- Bombay Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Arun Raja
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Benin Rajesh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Amith Rangarajan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vidushi Rathi
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sujay H. Shankar
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Girish Sindhwani
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Pawan K. Singh
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, India
| | | | | | | | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Tyagi
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naren V. Chandra
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - V. Sharada
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Vadala
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kavitha Venkatnarayan
- Department of Pulmonary Medicine, St. John’s National Academy of Health Sciences, Bengaluru, India
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Tyagi R, Mittal S, Madan K, Mohan A, Hadda V, Bhalla AS. A middle-aged male with necrotic lung mass. Lung India 2023; 40:360-361. [PMID: 37417091 PMCID: PMC10401988 DOI: 10.4103/lungindia.lungindia_81_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 07/08/2023] Open
Affiliation(s)
- Rahul Tyagi
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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16
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Singla R, Gupta A, Gothi D, Mittal S, Meena S, Gupta N. Basic spirometry and advanced pulmonary function tests - NATCON 2022. Indian J Tuberc 2023; 70:370-371. [PMID: 37562915 DOI: 10.1016/j.ijtb.2023.04.018] [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: 03/18/2023] [Revised: 04/03/2023] [Accepted: 04/20/2023] [Indexed: 08/12/2023]
Abstract
At the 77th National Conference on Tuberculosis and Chest Diseases, which took place on February 27, 2023, a pre-conference workshop on Basic Spirometry and Advanced Pulmonary Function Tests was held under the auspices of NATCON-2022. With the assistance of highly experienced faculty who are national and international level experts in their fields, the workshop covered all important aspects of basic spirometry and advanced Pulmonary Function Tests.
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Affiliation(s)
- Rupak Singla
- Department of Tuberculosis and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Disease, New Delhi, India.
| | - Amitesh Gupta
- Department of Pulmonary Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Dipti Gothi
- Department of Pulmonary and Critical Care Medicine, ESI PGIMSR, Basaidarapur, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Sleep and Critical Care Medicine, AIIMS, New Delhi, India
| | - Saroj Meena
- Department of Tuberculosis and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
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Tyagi R, Mittal S, Madan K, Pandey RM, Pandey A, Mohan A, Hadda V, Tiwari P, Guleria R. Association of air pollution and coronavirus disease 2019 (COVID-19) in India. Monaldi Arch Chest Dis 2023. [PMID: 37325971 DOI: 10.4081/monaldi.2023.2537] [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: 01/29/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023] Open
Abstract
The COVID-19 pandemic has affected the world, leading to significant morbidity and mortality. Various meteorological parameters are considered essential for the viability and transmission of the virus. Multiple reports from various parts of the world suggest a correlation between the disease spread and air pollution severity. This study was carried out to identify the relationship between meteorological parameters, air pollution, and COVID-19 in New Delhi, one of the worst-affected states in India. We studied air pollution and meteorological parameters in New Delhi, India. We obtained data about COVID-19 occurrence, meteorological parameters, and air pollution indicators from various sources from Apr 1, 2020, till Nov 12, 2020. We performed correlational analysis and employed autoregressive distributed lag models (ARDLM) for identifying the relationship between COVID-19 cases with air pollution and meteorological parameters. We found a significant impact of PM 2.5, PM 10, and meteorological parameters on COVID-19. There was a significant positive correlation between daily COVID-19 cases and COVID-19-related deaths with PM2.5 and PM10 levels. Increasing temperature and windspeed were associated with a reduction in the number of cases while increasing humidity was associated with increased cases. This study demonstrated a significant association of PM2.5 and PM10 with daily COVID-19 cases and COVID-19-related mortality. This knowledge will likely help us prepare well for the future and implement air pollution control measures for other airborne disease epidemics.
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Affiliation(s)
- Rahul Tyagi
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi; Department of Pulmonary Medicine, Army Institute of Cardiothoracic Sciences, Pune.
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - Karan Madan
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - Anjali Pandey
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - Anant Mohan
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - Vijay Hadda
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - Randeep Guleria
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.
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18
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Tyagi R, Arunachalam M, Mittal S, Hadda V, Mohan A, Guleria R, Madan K. COVID-19-Associated Tracheal Stenosis (COATS): A New Entity? J Bronchology Interv Pulmonol 2023; 30:176-179. [PMID: 35916435 DOI: 10.1097/lbr.0000000000000863] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rahul Tyagi
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
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19
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Thoker ZA, Madan K, Mittal S, Tiwari P, Shah TH, Mohan A, Hadda V, Guleria R. Clinical Profile and Quality of Life of Patients With Post-pulmonary Tuberculosis Sequelae Presenting to a Tertiary Care Hospital. Cureus 2023; 15:e36354. [PMID: 37082491 PMCID: PMC10112386 DOI: 10.7759/cureus.36354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/21/2023] Open
Abstract
Background and objective There is a dearth of studies on the clinical presentation of patients with post-pulmonary tuberculosis (PTB) sequelae and its impact on their quality of life (QoL). In light of this, we conducted this study to analyze the clinical profile and QoL in patients with post-PTB sequelae. Methods Patients with a history of treated PTB and evidence of radiological damage were enrolled prospectively from November 2018 till June 2020 to study their clinical profile and QoL as per the eligibility criteria. A detailed clinical history was taken along with posteroanterior-view chest X-rays and CT scans of the thorax with bronchial angiography in patients with hemoptysis. QoL was assessed using the Hindi version of St. George's Respiratory Questionnaire (SGRQ) for which permission was obtained from the St. George's University of London. SGRQ scores were calculated using score calculation algorithms (Microsoft Excel-based) and missing data imputation as recommended by its developer. Results A total of 174 patients were included in the analysis. The analyzed population was relatively younger (mean age: 44.27 years) with BMIs leaning toward the lower side of normal (median: 19.6 kg/m²); the majority of the patients were males (59%) and non-smokers (77%). PTB had been diagnosed clinico-radiologically in the majority (68%) of patients with non-compliance to antitubercular treatment (ATT) being reported by only 9% of patients. Multiple courses of ATT were received by about one-third of patients, mainly on a clinico-radiologic basis. Systemic hypertension (HTN) (11%) and diabetes mellitus (DM) (9%) were the most common comorbidities. The most common symptom complex found was cough, expectoration, and dyspnea (n=102, 59%). At least one incidence of massive hemoptysis was reported by 20% of patients. Bronchial artery embolization (BAE) was performed for moderate to massive hemoptysis in 26% of patients with a success rate of >90%. One-fifth of the study participants required hospitalization for exacerbation of respiratory symptoms with more than half of these (59%) requiring ventilatory support. Health-related QoL was significantly impaired as reflected by a median SGRQ total score of 45.53. The most affected domain of QoL was the activity domain (mean score: 45.47). Females had worse QoL as compared to males (p=0.0062), and so did underweight patients (p=0.048). The prolonged duration of the illness also significantly impaired the QoL (p<0.001, r=0.313). Conclusion The sequelae of PTB are under-recognized even among physicians and are frequently misdiagnosed as active PTB. The QoL is more severely affected due to residual damage. This study highlights the clinical profile of this patient population and underscores the need to recognize post-PTB sequelae as a separate entity. An important remedy to mitigate its long-term consequences is its inclusion and recognition in national and international TB guidelines to facilitate its early identification and promote further research to address its evidence-based management.
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20
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Vadala R, Pattnaik B, Bangaru S, Rai D, Tak J, Kashyap S, Verma U, Yadav G, Dhaliwal RS, Mittal S, Hadda V, Madan K, Guleria R, Agrawal A, Mohan A. A review on electronic nose for diagnosis and monitoring treatment response in lung cancer. J Breath Res 2023; 17. [PMID: 36720157 DOI: 10.1088/1752-7163/acb791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/31/2023] [Indexed: 02/02/2023]
Abstract
Lung cancer is one of the common malignancies with high mortality rate and a poor prognosis. Most lung cancer cases are diagnosed at an advanced stage either due to limited resources of infrastructure, trained human resources, or delay in clinical suspicion. Low-dose computed tomography (LDCT) has emerged as a screening tool for early lung cancer detection but may not be a feasible option for most developing countries. Electronic nose (eNOSE) is a unique non-invasive device that has been developed for lung cancer diagnosis and monitoring response by exhaled breath analysis of volatile organic compounds (VOCs). The breath-print have been shown to differ not only among lung cancer and other respiratory diseases, but also between various types of lung cancer. Hence, we postulate that the breath-print analysis by electronic nose could be a potential biomarker for the early detection of lung cancer along with monitoring treatment response in a resource-limited setting. In this review, we have consolidated the current published literature suggesting the use of an electronic nose in the diagnosis and monitoring treatment response of lung cancer.
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Affiliation(s)
- Rohit Vadala
- Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, Lab No-2, Breathomics Lab, Telemedicine wing, New Private Ward, Dept of Pulmonary, Critical Care & Sleep Medicine, AIIMS, New Delhi, India, 110029, New Delhi, Delhi, 110029, INDIA
| | - Bijay Pattnaik
- Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, Lab No-2, Breathomics Lab, Telemedicine wing, New Private Ward, Dept of Pulmonary, Critical Care & Sleep Medicine, AIIMS, New Delhi, India, 110029, New Delhi, 110029, INDIA
| | - Sunil Bangaru
- Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, Lab No-2, Breathomics Lab, Telemedicine wing, New Private Ward, Dept of Pulmonary, Critical Care & Sleep Medicine, AIIMS, New Delhi, India, 110029, New Delhi, Delhi, 110029, INDIA
| | - Divyanjali Rai
- Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, Lab No-2, Breathomics Lab, Telemedicine wing, New Private Ward, Dept of Pulmonary, Critical Care & Sleep Medicine, AIIMS, New Delhi, India, 110029, New Delhi, 110029, INDIA
| | - Jaya Tak
- Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, Lab No-2, Breathomics Lab, Telemedicine wing, New Private Ward, Dept of Pulmonary, Critical Care & Sleep Medicine, AIIMS, New Delhi, India, 110029, New Delhi, 110029, INDIA
| | - Seetu Kashyap
- Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, Lab No-2, Breathomics Lab, Telemedicine wing, New Private Ward, Dept of Pulmonary, Critical Care & Sleep Medicine, AIIMS, New Delhi, India, 110029, New Delhi, 110029, INDIA
| | - Umashankar Verma
- Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, Lab No-2, Breathomics Lab, Telemedicine wing, New Private Ward, Dept of Pulmonary, Critical Care & Sleep Medicine, AIIMS, New Delhi, India, 110029, New Delhi, 110029, INDIA
| | - Geetika Yadav
- Division of Non-Communicable Disease, Indian Council of Medical Research, V. Ramalingaswami Bhawan, P.O. Box No. 4911 Ansari Nagar, New Delhi - 110029, New Delhi, Delhi, 110029, INDIA
| | - R S Dhaliwal
- Division of Non-Communicable Disease, Indian Council of Medical Research, V. Ramalingaswami Bhawan, P.O. Box No. 4911 Ansari Nagar, New Delhi - 110029, New Delhi, Delhi, 110029, INDIA
| | - Saurabh Mittal
- Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, Room no-9, Porta cabin, New Private Ward, Dept of Pulmonary, Critical Care & Sleep Medicine, AIIMS, New Delhi, India, 110029, New Delhi, Delhi, 110029, INDIA
| | - Vijay Hadda
- Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, Room no-9, Porta cabin, New Private Ward, Dept of Pulmonary, Critical Care & Sleep Medicine, AIIMS, New Delhi, India, 110029, New Delhi, 110029, INDIA
| | - Karan Madan
- Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, Room No-9, Porta cabin, New Private Ward, Dept of Pulmonary, Critical Care & Sleep Medicine, AIIMS, New Delhi, India, 110029, New Delhi, Delhi, 110029, INDIA
| | - Randeep Guleria
- Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, Room No-9, Porta Cabin, New Private Ward, Dept of Pulmonary, Critical Care & Sleep Medicine, AIIMS, New Delhi, India, 110029, New Delhi, 110029, INDIA
| | - Anurag Agrawal
- Molecular Immunogenetics, CSIR Institute of Genomics & Integrative Biology, Room No-218, Near Jubilee Hall Hostel, Mall Road, New Delhi-110007, New Delhi, Delhi, 110007, INDIA
| | - Anant Mohan
- Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, Room No-9, Porta Cabin, New Private Ward, Dept of Pulmonary, Critical Care & Sleep Medicine, AIIMS, New Delhi, India, 110029, New Delhi, 110029, INDIA
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Iyer H, Ghosh T, Garg A, Agarwal H, Jain D, Pandey R, Bhalla AS, Kumar R, Vashistha V, Tiwari P, Mittal S, Hadda V, Madan K, Guleria R, Mohan A. Lung cancer in Asian Indian females: Identification of disease-specific characteristics and outcome measures over a 12-year period. Lung India 2023; 40:4-11. [PMID: 36695252 PMCID: PMC9894289 DOI: 10.4103/lungindia.lungindia_43_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: 01/18/2022] [Revised: 08/22/2022] [Accepted: 10/28/2022] [Indexed: 01/01/2023] Open
Abstract
Aim Globally, the incidence of lung cancer amongst women appears to be increasing. We aimed to compare the socio-epidemiological and clinical characteristics of lung cancer amongst men and women from a large cohort at a tertiary care hospital in Northern India. Methods Records of patients diagnosed with lung cancer between January 2008 and March 2020 were reviewed. Baseline epidemiological data, clinical characteristics, histologic profiles, treatment administered, and survival were compared between males and females. Results A total of 2054 male and 438 female patients were included in analysis. Compared to males, female patients were younger [median age, 56 vs. 60 years, P < 0.001)], less likely to be working, less educated beyond secondary level and less likely to be smokers (29.1% vs. 84.9%, P < 0.0001). No difference in baseline performance status was observed. Females were more frequently diagnosed with adenocarcinoma (54.2% vs. 30.2%, P = <0.0001), stage IV disease (70.8% vs. 63%, P = 0.001), and had higher rate of EGFR mutation (37.2% vs. 21.5%, P < 0.0001). There was no difference in the proportion of females receiving cancer-specific therapy. Multivariate Cox proportional hazards model revealed higher progression-free survival [median 9.17 vs. 7.23 months; P = 0.007] and overall survival [median 13.80 vs. 9.10 months respectively, P = 0.001] amongst females compared to males. Conclusion Amongst a large cohort of lung cancer, females demonstrated several distinct and characteristic demographics as well as disease-related features, especially better survival outcomes.
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Affiliation(s)
- Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tamoghna Ghosh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avneet Garg
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
- Department of Pulmonary Medicine and Sleep Disorders, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Harsh Agarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rambha Pandey
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vishal Vashistha
- Department of Pulmonary Medicine and Sleep Disorders, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
- Raymond G. Murphy New Mexico Veterans Affairs Healthcare System, Section of Hematology and Oncology, 1501 San Pedro Dr SE, Albuquerque, NM 87108, USA
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Madan K, Madan M, Mittal S, Tiwari P, Hadda V, Mohan A, Pandey RM, Guleria R. The Utility of the Ultrasonographic Characteristics in Differentiating Between Malignant and Tuberculous Mediastinal Lymphadenopathy During EBUS-TBNA. J Bronchology Interv Pulmonol 2023; 30:47-53. [PMID: 35361744 DOI: 10.1097/lbr.0000000000000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/22/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ultrasonographic characteristics may help differentiate between benign and malignant lymph nodes during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). There is limited data on the utility of various ultrasonographic lymph node features to differentiate between malignant and tuberculous mediastinal lymphadenopathy. METHODS We studied the various EBUS ultrasonographic lymph node characteristics (size, shape, margins, heterogeneous echotexture, calcification, central hilar structure, lymph node conglomeration, central intranodal vessel, and coagulation necrosis sign) from our available EBUS-TBNA database. RESULTS We extracted 1086 subjects [547 with tuberculosis (TB) and 539 with malignant diagnosis]. Comparing the 2 groups (multivariate analysis), presence of central hilar structure (8.2% vs. 2.6%), coagulation necrosis sign (37.5% vs. 13.7%), lymph node conglomeration (30.5% vs. 7.2%), calcification (5.1% vs. 1.5%), and distinct margins (83.5% vs. 69.8%), were significantly more common in TB ( P <0.05). On the other hand, malignant lymph nodes were larger and more likely to show the presence of a central intranodal vessel (20% vs. 15.8%, P =0.04, multivariate analysis). The absence of lymph node conglomeration had the highest overall diagnostic accuracy (0.61) for the differentiation between malignant and tuberculous lymph nodes. CONCLUSION Sonographic lymph node characteristics may help differentiate malignant and tuberculous mediastinal lymphadenopathy. Contrary to previously published literature, we observed coagulation necrosis sign, heterogeneous echotexture and absent central intranodal vessel, more commonly in TB than malignant nodes. These findings from a TB endemic setting are different from other settings, where the prevalence of lung cancer is high in patients undergoing EBUS-TBNA.
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Affiliation(s)
- Karan Madan
- Departments of Pulmonary, Critical Care and Sleep Medicine
| | - Manu Madan
- Departments of Pulmonary, Critical Care and Sleep Medicine
| | - Saurabh Mittal
- Departments of Pulmonary, Critical Care and Sleep Medicine
| | - Pavan Tiwari
- Departments of Pulmonary, Critical Care and Sleep Medicine
| | - Vijay Hadda
- Departments of Pulmonary, Critical Care and Sleep Medicine
| | - Anant Mohan
- Departments of Pulmonary, Critical Care and Sleep Medicine
| | - Ravindra M Pandey
- Departments of Pulmonary, Critical Care and Sleep Medicine
- Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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23
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Goyal V, Mittal S, Shekhrajka P, Nimje G. Anesthesia management in a patient with situs inversus totalis posted for kidney transplantation: A rare case report. Indian J Transplant 2023. [DOI: 10.4103/ijot.ijot_85_22] [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: 04/03/2023] Open
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24
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Sryma PB, Mittal S, Madan NK, Tiwari P, Hadda V, Mohan A, Guleria R, Madan K. Efficacy of Radial Endobronchial Ultrasound (R-EBUS) guided transbronchial cryobiopsy for peripheral pulmonary lesions (PPL...s): A systematic review and meta-analysis. Pulmonology 2023; 29:50-64. [PMID: 33441246 DOI: 10.1016/j.pulmoe.2020.12.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [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: 10/27/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLC) is frequently described for the diagnosis of diffuse parenchymal lung diseases (DPLD). A few studies have reported transbronchial cryobiopsy for the diagnosis of peripheral pulmonary lesions (PPL...s). We aimed to study the utility and safety of transbronchial cryobiopsy for the diagnosis of PPL...s. METHODS We performed a systematic search of the PubMed and Embase databases to extract the relevant studies. We then performed a meta-analysis to calculate the diagnostic yields of transbronchial cryobiopsy and bronchoscopic forceps biopsy. RESULTS Following a systematic search, we identified nine relevant studies (300 patients undergoing cryobiopsy). All used Radial Endobronchial Ultrasound (R-EBUS) for PPL localization. The pooled diagnostic yield of transbronchial cryobiopsy was 77% (95% CI, 71%...84%) (I^2=38.72%, p=0.11). The diagnostic yield of forceps biopsy was 72% (95% CI, 60%...83%) (I^2=78.56%, p<0.01). The diagnostic yield of cryobiopsy and forceps biopsy was similar (RR 1.05, 95% CI 0.96...1.15), with a 5% risk difference for diagnostic yield (95% CI, ...6% to 15%). There was significant heterogeneity (I^2=57.2%, p=0.017), and no significant publication bias. One severe bleeding and three pneumothoraxes requiring intercostal drain (ICD) placement (major complication rate 4/122, 1.8%) were reported with transbronchial cryobiopsy. CONCLUSIONS R-EBUS guided transbronchial cryobiopsy is a safe and efficacious modality. The diagnostic yields of TBLC and forceps biopsy are similar. More extensive multicentre randomized trials are required for the further evaluation and standardization of transbronchial cryobiopsy for PPL...s.
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Affiliation(s)
- P B Sryma
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - S Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - N K Madan
- Department of Pathology, VMMC and Safdarjung Hospital, New Delhi, India
| | - P Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - V Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - A Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - R Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - K Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
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25
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Vihari NS, Sinha NK, Tyagi A, Mittal S. Effect of mindfulness on online impulse buying: Moderated mediation model of problematic internet use and emotional intelligence. Front Psychol 2022; 13:1012331. [PMID: 36562054 PMCID: PMC9763727 DOI: 10.3389/fpsyg.2022.1012331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Online impulse buying behavior is an unplanned urge to buy a product or service in an online setting and it has several negative consequences for customers, such as guilt and financial distress, and e-commerce firms, such as higher returns and customer complaints. Evidently, it is important to examine the various psychological processes which may assist in a better understanding, therefore addressing the high prevalence of online impulse buying. This study builds upon self-regulation theory to explore how mindfulness influences online impulse buying, and examines problematic internet use as a mediator in the relationship between mindfulness and online impulse buying. Further, this study investigates how emotional intelligence as a moderator plays the role of a suppressant on the adverse impact of problematic Internet use which fuels online impulse buying. Method A total of 598 individuals working with various servicebased industries responded to the questionnaire. Multiple regression and moderated mediation analysis was used using SPSS and AMOS for analyzing the data. Result Problematic internet use mediates the relationship between mindfulness and online impulse buying behavior. Emotional intelligence negatively moderates the relationship between problematic internet use and online impulse buying behavior. Discussion This study findings outlined the inverse relationship of mindfulness & online impulse buying, along with the mediating effect of problematic internet use between mindfulness and online impulse buying. Further, this study showed how emotional intelligence played an important role as a moderator by suppressing the adverse impact of problematic Internet use and preventing online impulse buying. The study offers implications to online marketers in regulating the unplanned purchase process-while minimizing uninhibited buying behavior that leads to regret, and the subsequent intention to return products. Further, social and theoretical implications are discussed.
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Affiliation(s)
- Nitin Simha Vihari
- Middlesex University Dubai, Dubai, United Arab Emirates,*Correspondence: Nitin Simha Vihari,
| | | | - Akansha Tyagi
- Chitkara Business School, Chitkara University, Punjab, India,Akansha Tyagi,
| | - Saurabh Mittal
- Indian Institute of Management Lucknow, Lucknow, Uttar Pradesh, India
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26
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Iyer H, Ghosh T, Agarwal H, Garg A, Pandey R, Jain D, Tiwari P, Mittal S, Hadda V, Madan K, Guleria R, Mohan A. Clinical profile of small-cell lung cancer in North India: A 12-year analysis from a tertiary care center. Lung India 2022; 39:495-501. [PMID: 36629227 PMCID: PMC9746269 DOI: 10.4103/lungindia.lungindia_48_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: 01/20/2022] [Revised: 07/14/2022] [Accepted: 09/03/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction The small cell variant is a relatively uncommon but aggressive form of lung cancer. The present study aims to analyse the clinical characteristics, treatment outcomes and prognostic factors of an ambispectively enrolled large cohort of small cell lung cancer (SCLC) in the Indian population over a decade-long period. Materials and Methods All patients diagnosed with SCLC between 2008 and 2020 at a tertiary care lung cancer clinic were included. The clinical details, demographics, details of investigations, treatment and survival outcomes were recorded and analysed. Results A total of 361 patients were included. The majority were males (86.4%) with a mean (SD) age of 57.3 (12.3) years. Further, 34.9% were current smokers, with the median smoking index being 520 (interquartile range [IQR]: 260-1000). The majority had good performance status, that is, the Eastern Cooperative Oncology Group scale (ECOG) 0 or 1 (65%), and Karnofsky Performance Scale (KPS) ≥70 (85.9%). Also, 73.3% had extensive stage disease. The median time from symptom onset to definitive diagnosis was 91 days. Treatment details were available for 179 patients: chemotherapy only (n = 128), combined chemo-radiotherapy (n = 41) and radiotherapy only (n = 10). The median (IQR) progression-free survival (PFS) was 182 (94 to 306) days and the median (IQR) overall survival (OS) was 205 (94 to 429) days. On univariate analysis, factors that significantly affected survival included smoking index and performance status. However, on multivariate analysis, only the performance status significantly affected PFS, whereas none of these factors were significant for OS. Conclusions SCLC predominantly affects males with a heavy smoking index. The diagnosis is usually made late; survival remains poor and is predominantly affected by the performance status.
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Affiliation(s)
- Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tamoghna Ghosh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Harsh Agarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avneet Garg
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
- Department of Pulmonary Medicine and Sleep Disorders, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Rambha Pandey
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Madan M, Mittal S, Tiwari P, Hadda V, Mohan A, Guleria R, Pandey RM, Madan K. The diagnostic utility of ultrasound elastography to differentiate tuberculosis and sarcoidosis during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Lung India 2022; 39:532-536. [PMID: 36629232 PMCID: PMC9746265 DOI: 10.4103/lungindia.lungindia_214_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: 04/20/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Elastography is a non-invasive tool that may allow differentiation between benign and malignant lymph nodes during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In tuberculosis (TB) endemic areas, clinicoradiological features of mediastinal TB and sarcoidosis often overlap, rendering an accurate diagnosis challenging. There is interest in the identification of modalities to aid in this differentiation. There are currently no published data on the utility of EBUS-elastography in differentiating between TB and sarcoidosis. Methods Subjects undergoing EBUS-TBNA were prospectively enrolled, and elastography features were observed. Subjects with definitive diagnosis of TB or sarcoidosis were enrolled. The elastography features recorded included the three-colour classification patterns and strain ratio. Results We enrolled 96 subjects with a definitive diagnosis (53 with TB and 43 with sarcoidosis). Of the 27 patients in whom the lymph nodes were classified as type 1 on endobronchial ultrasound elastography colour pattern, 17 had a diagnosis of TB (62.9%), while 10 were sarcoidosis (37%). For type 2 lymph nodes, 20/45 (44.4%) were TB and 25/45 (55.6%) were sarcoidosis. Type 3 lymph nodes were TB in 16/24 (66.7%) and sarcoidosis in 8/24 (33.3%). In classifying type 1 as 'sarcoidosis' and Type 3 as 'tubercular', the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were 48.5%, 55.6%, 66.7%, 37%, and 0.51, respectively. The strain ratio (Median [IQR]) was 1.29 (0.37-5.98) in TB and 2.10 (0.83-4.52) in sarcoidosis group (P = 0.48). Conclusion Ultrasound elastographic lymph node characteristics have a poor diagnostic utility to differentiate between TB and sarcoidosis during EBUS-TBNA.
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Affiliation(s)
- Manu Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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28
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Dhochak N, Mittal S, Mohan A, Jain D, Jat KR, Jana M, Kabra SK, Madan K. Transbronchial lung cryobiopsy for diffuse lung diseases in children: A case series. Pediatr Pulmonol 2022; 57:2851-2854. [PMID: 35831951 DOI: 10.1002/ppul.26074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/25/2022] [Accepted: 07/12/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Nitin Dhochak
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
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29
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Dadhich JP, Kumar P, Mittal S, Dadhich CP. Adenomyomatosis of Gallbladder in a Neonate. Indian Pediatr 2022; 59:813-814. [PMID: 36263500] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- J P Dadhich
- Paediatrics and Neonatology, Fortis Escorts Hospital, Jaipur, Rajasthan.
| | - P Kumar
- Paediatrics and Neonatology, Fortis Escorts Hospital, Jaipur, Rajasthan
| | - S Mittal
- Radio-diagnosis, Fortis Escorts Hospital, Jaipur, Rajasthan
| | - C P Dadhich
- Obstetrics and Gynaecology, Fortis Escorts Hospital, Jaipur, Rajasthan
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Milstein N, Saberito M, Bhatt A, Habibi M, Sichrovsky T, Preminger M, Shaw R, Mittal S, Musat D. Absence of atrial fibrillation in the blanking period following cryoballoon pulmonary vein isolation – does it always portend a good prognosis? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted method for ablation in patients with paroxysmal and persistent atrial fibrillation (PAF, PeAF). Freedom from AF in the blanking period (BP), conventionally defined as the first 3-months post-PVI, has been associated with the best long-term outcomes. However, the influence of antiarrhythmic drugs (AADs) during the BP on long-term outcomes is not well understood.
Objective
To compare long-term outcomes between patients who were and were not on an AAD prior to ablation and remained free from AF during the 3-month BP post CB PVI.
Methods
We enrolled consecutive AF patients undergoing CB PVI; all pts had an implantable loop recorder (ILR). No patient had any AF in the first 90 days post CB PVI. We divided the patients into three groups: (1) never had exposure to an AAD; (2) were intolerant to/failed AAD and thus were not taking an AAD at time of ablation; and (3) were on AAD at time of ablation. In the latter group, every effort was made to stop the AAD before the end of the BP.
Results
The cohort included 96 pts (66±10 years; 60 [63%] male; 55 [57%] PAF; CHA2DS2-VASc 2.5±1.4). There were 23 (24%) patients in group 1, 13 (14%) patients in group 2, and 60 (63%) pts in group 3. Patients in group 3 were more likely to have PeAF; AADs were stopped at a median of 36 days IQR (27, 91) in this group. Patients were followed for 1-year during which time 28 (29%) patients had recurrent AF (despite having no AF during the BP). The best outcome was seen in patients who never used an AAD; the worst outcome was seen in patients who were on an AAD at time of ablation (Figure 1).
Conclusion
Our data show that absence of AF during a 3-month post CB PVI BP alone does not guarantee good-long term outcome, unless the patient was never treated with an AAD. In contrast, in patients ablated while taking an AAD, recurrent AF was observed in 37% even though they were completely AF-free during the BP.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Milstein
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - M Saberito
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - A Bhatt
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - M Habibi
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - T Sichrovsky
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - M Preminger
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - R Shaw
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - S Mittal
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - D Musat
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
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Milstein N, Saberito M, Bhatt A, Habibi M, Sichrovsky T, Preminger M, Shaw R, Mittal S, Musat D. Recurrence of atrial fibrillation following pulmonary vein isolation: impact of body mass index on one- and three-year outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted method for ablation in patients with paroxysmal and persistent atrial fibrillation (PAF, PeAF). However, there are a paucity of data about the impact of body mass index (BMI) on one-year and longer-term outcomes following ablation.
Objective
To objectively understand the impact of BMI on outcomes following CB PVI.
Methods
We enrolled consecutive AF patients undergoing CB PVI; all patients had an implantable loop recorder (ILR), which transmitted data wirelessly daily. We assessed AF recurrences after excluding an initial 3-month post-ablation blanking period.
Results
The cohort included 222 pts (66±9 years; 143 [64%] male; 120 [54%] PAF; CHA2DS2-VASc 2.6±1.6). The mean BMI was 30±5. Patients were followed for 763±347 days, during which time 50% and 68% had recurrent AF 1- and 3-years post ablation. We divided the cohort based on the mean BMI into 2 groups: BMI <30 and BMI >30. Heavier patients were younger and more likely to have PeAF. Over 1-year of follow-up, patients with a BMI <30 had similar likelihood of being free of AF to patients with a BMI >30 (46% vs, 56%, p=0.0.097, Figure 1, left). However, as patients were followed for 3-years, freedom from AF was significantly higher in patients with a BMI <30 (59% vs. 81% in BMI >30, p=0.002, Figure 1, right).
Conclusions
Our data show that although patients had similar outcomes 1-year post-ablation, during longer-term follow-up patients with a BMI >30 had a much worse outcome. Our study uniquely offers objective (using an ILR) assessment of the impact of BMI on long-term outcomes following CB PVI (homogenous ablation strategy). These data highlight the need to identify strategies to improve outcomes in obese patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Milstein
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - M Saberito
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - A Bhatt
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - M Habibi
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - T Sichrovsky
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - M Preminger
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - R Shaw
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - S Mittal
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
| | - D Musat
- The Valley Hospital, The Snyder Center for Comprehensive Atrial Fibrillation , Ridgewood , United States of America
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Sagiraju HKR, Elavarasi A, Gupta N, Garg RK, Paul SS, Vig S, Sirohiya P, Ratre B, Garg R, Pandit A, Singh R, Kumar B, Meena VP, Wig N, Mittal S, Pahuja S, Madan K, Das N, Dwivedi T, Gupta R, Wundavalli L, Singh AR, Singh S, Mishra A, Pandey M, Matharoo KS, Kumar S, Mohan A, Guleria R, Bhatnagar S. The Effectiveness of SARS-CoV-2 Vaccination in Preventing Severe Illness and Death - Real-world Data from a Cohort of Patients Hospitalized with COVID-19. Indian J Community Med 2022; 47:510-516. [PMID: 36742977 PMCID: PMC9891054 DOI: 10.4103/ijcm.ijcm_1388_21] [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: 11/15/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background While long-term studies on the correlates of protection, vaccine effectiveness, and enhanced surveillance are awaited for SARS-CoV-2 vaccine, studies on breakthrough infections help understand the nature and course of this illness among vaccinated individuals and guide in public health preparedness. This study aims to compare the differences in the hospitalization outcomes SARS-CoV-2 infection of fully vaccinated individuals with with those of unvaccinated and partially vaccinated individuals. Materials and Methods Single institution observational cohort study. This study compared the differences in clinical, biochemical parameters and the hospitalization outcomes of 53 fully vaccinated individuals with those of unvaccinated (1464) and partially vaccinated (231) individuals, among a cohort of 2,080 individuals hospitalized with SARS-CoV-2 infection. Descriptive statistics and propensity-score weighted multivariate logistic regression analysis adjusting for clinical and laboratory parameters were used to compare the differences and to identify factors associated with outcomes. Results Completing the course of vaccination protected individuals from developing severe COVID-19 as evidenced by lower proportions of those with hypoxia, abnormal levels of inflammatory markers, requiring ventilatory support, and death compared to unvaccinated and partially vaccinated individuals. There were no differences in these outcomes among patients who received either vaccine type approved in India. Conclusions Efforts should be made to improve the vaccination rates as a timely measure to prepare for the upcoming waves of this highly transmissible pandemic. Vaccination rates of the communities may also guide in the planning of the health needs and appropriate use of medical resources.
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Affiliation(s)
- Hari Krishna Raju Sagiraju
- Department of Preventive Oncology, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Arunmozhimaran Elavarasi
- Department of Neurology, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Kumar Garg
- Department of Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Saurav Sekhar Paul
- Department of Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Vig
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Sirohiya
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Brajesh Ratre
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Anuja Pandit
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Ram Singh
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Balbir Kumar
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Ved Prakash Meena
- Department of Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Sourabh Pahuja
- Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Nupur Das
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Tanima Dwivedi
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - LaxmiTej Wundavalli
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Angel Rajan Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sheetal Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav Mishra
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Pandey
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Karanvir Singh Matharoo
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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Sirohiya P, Kumar V, Mittal S, Gupta N, Garg R, Bharati SJ, Mishra S, Hadda V, Mohan A, Sagiraju HKR, Bhatnagar S, Madan K. Dexmedetomidine Versus Midazolam for Sedation During Medical Thoracoscopy: A Pilot Randomized-Controlled Trial (RCT). J Bronchology Interv Pulmonol 2022; 29:248-254. [PMID: 35029357 DOI: 10.1097/lbr.0000000000000818] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies comparing the utility of dexmedetomidine with other drugs for sedation during medical thoracoscopy are lacking. In this pilot study, we compared dexmedetomidine with midazolam for sedation in thoracoscopy. METHODS Consecutive subjects were randomized to receive either dexmedetomidine (n=30) (group D) or midazolam (n=30) (group M). All received fentanyl for procedural analgesia. The primary endpoint was pulmonologist-rated overall procedure satisfaction on the visual analog scale (satisfaction VAS). Key secondary outcomes were pulmonologist-rated cough on VAS (cough VAS), patient-rated faces pain scale scores, change in hemodynamic variables, total additional fentanyl dose, and adverse events during procedure. RESULTS The satisfaction VAS score (mean±SD) was significantly greater in group D versus group M (7.5±1.4 and 6.5±1.1, respectively) ( P =0.003). The cough VAS scores (mean±SD) were 2.1±1.5 (group D) and 3.1±1.3 (group M) ( P =0.014). The scores (mean±SD) for patient-rated faces pain scale were 2.9±1.8 and 4.2±2.3 ( P =0.019) in group D and group M, respectively. The additional dose of fentanyl administered in group M was significantly greater than in group D ( P =0.001). The responses at the local anesthesia infiltration, skin incision, thoracoscope insertion, and biopsy between both groups were similar. The hemodynamic parameters were comparable in both groups. Also, more patients were willing for repeat thoracoscopy if needed; in the dexmedetomidine group. CONCLUSION The findings of this pilot RCT indicate that dexmedetomidine may be more efficacious than midazolam for sedation in patients undergoing medical thoracoscopy. These observations need to be confirmed in an adequately powered RCT.
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Affiliation(s)
| | - Vinod Kumar
- Department of Oncoanaesthesia and Palliative Medicine, Dr B.R. Ambedkar Institute Rotary Cancer Hospital
| | - Saurabh Mittal
- Department of Pulmonary Medicine and Sleep Disorders, AIIMS, New Delhi, India
| | - Nishkarsh Gupta
- Department of Oncoanaesthesia and Palliative Medicine, Dr B.R. Ambedkar Institute Rotary Cancer Hospital
| | - Rakesh Garg
- Department of Oncoanaesthesia and Palliative Medicine, Dr B.R. Ambedkar Institute Rotary Cancer Hospital
| | - Sachidanand Jee Bharati
- Department of Oncoanaesthesia and Palliative Medicine, Dr B.R. Ambedkar Institute Rotary Cancer Hospital
| | - Seema Mishra
- Department of Oncoanaesthesia and Palliative Medicine, Dr B.R. Ambedkar Institute Rotary Cancer Hospital
| | - Vijay Hadda
- Department of Pulmonary Medicine and Sleep Disorders, AIIMS, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, AIIMS, New Delhi, India
| | | | - Sushma Bhatnagar
- Department of Oncoanaesthesia and Palliative Medicine, Dr B.R. Ambedkar Institute Rotary Cancer Hospital
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, AIIMS, New Delhi, India
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Sryma PB, Mittal S. Tuberculosis presenting with pneumomediastinum. Indian J Med Res 2022; 156:696. [PMID: 36926793 DOI: 10.4103/ijmr.ijmr_5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- P B Sryma
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India
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Hadda V, Suri TM, Iyer H, Jain A, Mittal S, Madan K, Mohan A, Seith Bhalla A, Sindhwani G, Dutt N, Venkatnarayan K, Nath A, Dhooria S, Kumar R, Marwah V, Karmakar S, Chaudhry D, Ayub II, Dwivedi DP, Tiwari P, Koul P, Behera AK, Saxena P, Sengupta A, Mohapatra PR, Goyal A, Christopher DJ, Guleria R. A Delphi consensus statement for the management of post-COVID interstitial lung disease. Expert Rev Respir Med 2022; 16:983-995. [PMID: 36154545 DOI: 10.1080/17476348.2022.2128770] [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: 01/08/2023]
Abstract
INTRODUCTION As millions of people worldwide recover from COVID-19, a substantial proportion continue to have persistent symptoms, pulmonary function abnormalities, and radiological findings suggestive of post-COVID interstitial lung disease (ILD). To date, there is limited scientific evidence on the management of post-COVID ILD, necessitating a consensus-based approach. AREAS COVERED A panel of experts in pulmonology and thoracic radiology was constituted. Key questions regarding the management of post-COVID ILD were identified. A search was performed on PubMed and EMBASE and updated till 1 March 2022. The relevant literature regarding the epidemiology, pathophysiology, diagnosis and treatment of post-COVID ILD was summarized. Subsequently, suggestions regarding the management of these patients were framed, and a consensus was obtained using the Delphi approach. Those suggestions which were approved by over 80% of the panelists were accepted. The final document was approved by all panel members. EXPERT OPINION Dedicated facilities should be established for the care of patients with post-COVID ILD. Symptom screening, pulmonary function testing, and thoracic imaging have a role in the diagnosis. The pharmacologic and non-pharmacologic options for the management of post-COVID ILD are discussed. Further research into the pathophysiology and management of post-COVID ILD will improve our understanding of this condition.
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Affiliation(s)
- Vijay Hadda
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tejas M Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Hariharan Iyer
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Jain
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Girish Sindhwani
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Kavitha Venkatnarayan
- Department of Pulmonary Medicine, St John's National Academy of Health Sciences, Bengaluru, India
| | - Alok Nath
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College, New Delhi, India
| | - Vikas Marwah
- Department of Respiratory Medicine, Armed Forces Medical College, Pune, India
| | - Saurabh Karmakar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Patna, India
| | - Dhruva Chaudhry
- Department of Pulmonary & Critical Care Medicine, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Irfan Ismail Ayub
- Department of Pulmonary Medicine, Sri Ramachandra Institute of Medical Sciences, Chennai, India
| | - Dharm Prakash Dwivedi
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Pawan Tiwari
- Department of Pulmonary Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, India
| | - Parvaiz Koul
- Department of Internal & Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ajoy Kumar Behera
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Raipur, India
| | - Puneet Saxena
- Department of Pulmonary Medicine, Army Hospital Research & Referral, New Delhi, India
| | - Amitabha Sengupta
- Department of Pulmonary Medicine, Institute of Post-Graduate Medical Education & Research, Kolkata, India
| | - Prasanta R Mohapatra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Abhishek Goyal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, India
| | | | - Randeep Guleria
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Mittal S, Madan K. Tuberculous lymphadenitis with endobronchial rupture. Indian J Med Res 2022; 156:560. [PMID: 36751752 PMCID: PMC10101370 DOI: 10.4103/ijmr.ijmr_6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Saurabh Mittal
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Karan Madan
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India
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Mittal S, Aljassem N. Retiform Hemagioendothelioma: Dermoscopic-pathological corelation. Dermatol Pract Concept 2022; 12:e2022122. [PMID: 36159153 PMCID: PMC9464550 DOI: 10.5826/dpc.1203a122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/24/2022] Open
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Shrivastava N, Parikh A, Dewangan RP, Biswas L, Verma AK, Mittal S, Ali J, Garg S, Baboota S. Solid Self-Nano Emulsifying Nanoplatform Loaded with Tamoxifen and Resveratrol for Treatment of Breast Cancer. Pharmaceutics 2022; 14:pharmaceutics14071486. [PMID: 35890384 PMCID: PMC9318459 DOI: 10.3390/pharmaceutics14071486] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 05/19/2022] [Revised: 07/05/2022] [Accepted: 07/14/2022] [Indexed: 02/04/2023] Open
Abstract
The solid self-nanoemulsifying drug delivery system (s-SNEDDS) is a growing platform for the delivery of drugs via oral route. In the present work, tamoxifen (TAM) was loaded in SNEDDS with resveratrol (RES), which is a potent chemotherapeutic, antioxidant, anti-inflammatory and P-gp inhibitor for enhancing bioavailability and to obtain synergistic anti-cancer effect against breast cancer. SNEDDS were developed using capmul MCM as oil, Tween 80 as surfactant and transcutol-HP as co-surfactant and optimized by central composite rotatable design. Neusilin US2 concentration was optimized for adsorption of liquid SNEDDS to prepare s-SNEDDS. The developed formulation was characterized and investigated for various in vitro and cell line comparative studies. Optimized TAM-RES-s-SNEDDS showed spherical droplets of a size less than 200 nm. In all in vitro studies, TAM-RES-s-SNEDDS showed significantly improved (p ˂ 0.05) release and permeation across the dialysis membrane and intestinal lumen. Moreover, TAM-RES-s-SNEDDS possessed significantly greater therapeutic efficacy (p < 0.05) and better internalization on the MCF-7 cell line as compared to the conventional formulation. Additionally, oral bioavailability of TAM from SNEDDS was 1.63 folds significantly higher (p < 0.05) than that of combination suspension and 4.16 folds significantly higher (p < 0.05) than TAM suspension. Thus, findings suggest that TAM- RES-s-SNEDDS can be the future delivery system that potentially delivers both drugs to cancer cells for better treatment.
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Affiliation(s)
- Nupur Shrivastava
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India; (N.S.); (S.M.); (J.A.)
| | - Ankit Parikh
- Pharmaceutical Innovation and Development (PIDG) Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia;
| | - Rikeshwer Prasad Dewangan
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India;
| | - Largee Biswas
- Nano Biotech Lab, Department of Zoology, Kirori Mal College, University of Delhi, New Delhi 110007, India; (L.B.); (A.K.V.)
| | - Anita Kamra Verma
- Nano Biotech Lab, Department of Zoology, Kirori Mal College, University of Delhi, New Delhi 110007, India; (L.B.); (A.K.V.)
| | - Saurabh Mittal
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India; (N.S.); (S.M.); (J.A.)
| | - Javed Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India; (N.S.); (S.M.); (J.A.)
| | - Sanjay Garg
- Pharmaceutical Innovation and Development (PIDG) Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia;
- Correspondence: (S.G.); (S.B.)
| | - Sanjula Baboota
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India; (N.S.); (S.M.); (J.A.)
- Correspondence: (S.G.); (S.B.)
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Katiyar SK, Gaur SN, Solanki RN, Sarangdhar N, Suri JC, Kumar R, Khilnani GC, Chaudhary D, Singla R, Koul PA, Mahashur AA, Ghoshal AG, Behera D, Christopher DJ, Talwar D, Ganguly D, Paramesh H, Gupta KB, Kumar T M, Motiani PD, Shankar PS, Chawla R, Guleria R, Jindal SK, Luhadia SK, Arora VK, Vijayan VK, Faye A, Jindal A, Murar AK, Jaiswal A, M A, Janmeja AK, Prajapat B, Ravindran C, Bhattacharyya D, D'Souza G, Sehgal IS, Samaria JK, Sarma J, Singh L, Sen MK, Bainara MK, Gupta M, Awad NT, Mishra N, Shah NN, Jain N, Mohapatra PR, Mrigpuri P, Tiwari P, Narasimhan R, Kumar RV, Prasad R, Swarnakar R, Chawla RK, Kumar R, Chakrabarti S, Katiyar S, Mittal S, Spalgais S, Saha S, Kant S, Singh VK, Hadda V, Kumar V, Singh V, Chopra V, B V. Indian Guidelines on Nebulization Therapy. Indian J Tuberc 2022; 69 Suppl 1:S1-S191. [PMID: 36372542 DOI: 10.1016/j.ijtb.2022.06.004] [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: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 06/16/2023]
Abstract
Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.
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Affiliation(s)
- S K Katiyar
- Department of Tuberculosis & Respiratory Diseases, G.S.V.M. Medical College & C.S.J.M. University, Kanpur, Uttar Pradesh, India.
| | - S N Gaur
- Vallabhbhai Patel Chest Institute, University of Delhi, Respiratory Medicine, School of Medical Sciences and Research, Sharda University, Greater NOIDA, Uttar Pradesh, India
| | - R N Solanki
- Department of Tuberculosis & Chest Diseases, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Nikhil Sarangdhar
- Department of Pulmonary Medicine, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India
| | - J C Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Raj Kumar
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, National Centre of Allergy, Asthma & Immunology; University of Delhi, Delhi, India
| | - G C Khilnani
- PSRI Institute of Pulmonary, Critical Care, & Sleep Medicine, PSRI Hospital, Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Dhruva Chaudhary
- Department of Pulmonary & Critical Care Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rupak Singla
- Department of Tuberculosis & Respiratory Diseases, National Institute of Tuberculosis & Respiratory Diseases (formerly L.R.S. Institute), Delhi, India
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
| | - Ashok A Mahashur
- Department of Respiratory Medicine, P. D. Hinduja Hospital, Mumbai, Maharashtra, India
| | - A G Ghoshal
- National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - D Behera
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepak Talwar
- Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India
| | | | - H Paramesh
- Paediatric Pulmonologist & Environmentalist, Lakeside Hospital & Education Trust, Bengaluru, Karnataka, India
| | - K B Gupta
- Department of Tuberculosis & Respiratory Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Haryana, India
| | - Mohan Kumar T
- Department of Pulmonary, Critical Care & Sleep Medicine, One Care Medical Centre, Coimbatore, Tamil Nadu, India
| | - P D Motiani
- Department of Pulmonary Diseases, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - P S Shankar
- SCEO, KBN Hospital, Kalaburagi, Karnataka, India
| | - Rajesh Chawla
- Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Randeep Guleria
- All India Institute of Medical Sciences, Department of Pulmonary Medicine & Sleep Disorders, AIIMS, New Delhi, India
| | - S K Jindal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Luhadia
- Department of Tuberculosis and Respiratory Medicine, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - V K Arora
- Indian Journal of Tuberculosis, Santosh University, NCR Delhi, National Institute of TB & Respiratory Diseases Delhi, India; JIPMER, Puducherry, India
| | - V K Vijayan
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, University of Delhi, Delhi, India
| | - Abhishek Faye
- Centre for Lung and Sleep Disorders, Nagpur, Maharashtra, India
| | | | - Amit K Murar
- Respiratory Medicine, Cronus Multi-Specialty Hospital, New Delhi, India
| | - Anand Jaiswal
- Respiratory & Sleep Medicine, Medanta Medicity, Gurugram, Haryana, India
| | - Arunachalam M
- All India Institute of Medical Sciences, New Delhi, India
| | - A K Janmeja
- Department of Respiratory Medicine, Government Medical College, Chandigarh, India
| | - Brijesh Prajapat
- Pulmonary and Critical Care Medicine, Yashoda Hospital and Research Centre, Ghaziabad, Uttar Pradesh, India
| | - C Ravindran
- Department of TB & Chest, Government Medical College, Kozhikode, Kerala, India
| | - Debajyoti Bhattacharyya
- Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences, Army Hospital (Research & Referral), New Delhi, India
| | | | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - J K Samaria
- Centre for Research and Treatment of Allergy, Asthma & Bronchitis, Department of Chest Diseases, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Jogesh Sarma
- Department of Pulmonary Medicine, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Lalit Singh
- Department of Respiratory Medicine, SRMS Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - M K Sen
- Department of Respiratory Medicine, ESIC Medical College, NIT Faridabad, Haryana, India; Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Mahendra K Bainara
- Department of Pulmonary Medicine, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi PostGraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nilkanth T Awad
- Department of Pulmonary Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, M.K.C.G. Medical College, Berhampur, Orissa, India
| | - Naveed N Shah
- Department of Pulmonary Medicine, Chest Diseases Hospital, Government Medical College, Srinagar, Jammu & Kashmir, India
| | - Neetu Jain
- Department of Pulmonary, Critical Care & Sleep Medicine, PSRI, New Delhi, India
| | - Prasanta R Mohapatra
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Parul Mrigpuri
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Pawan Tiwari
- School of Excellence in Pulmonary Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - R Narasimhan
- Department of EBUS and Bronchial Thermoplasty Services at Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R Vijai Kumar
- Department of Pulmonary Medicine, MediCiti Medical College, Hyderabad, Telangana, India
| | - Rajendra Prasad
- Vallabhbhai Patel Chest Institute, University of Delhi and U.P. Rural Institute of Medical Sciences & Research, Safai, Uttar Pradesh, India
| | - Rajesh Swarnakar
- Department of Respiratory, Critical Care, Sleep Medicine and Interventional Pulmonology, Getwell Hospital & Research Institute, Nagpur, Maharashtra, India
| | - Rakesh K Chawla
- Department of, Respiratory Medicine, Critical Care, Sleep & Interventional Pulmonology, Saroj Super Speciality Hospital, Jaipur Golden Hospital, Rajiv Gandhi Cancer Hospital, Delhi, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - S Chakrabarti
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | - Saurabh Mittal
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | | | - Surya Kant
- Department of Respiratory (Pulmonary) Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - V K Singh
- Centre for Visceral Mechanisms, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Vijay Hadda
- Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Kumar
- All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Virendra Singh
- Mahavir Jaipuria Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Vishal Chopra
- Department of Chest & Tuberculosis, Government Medical College, Patiala, Punjab, India
| | - Visweswaran B
- Interventional Pulmonology, Yashoda Hospitals, Hyderabad, Telangana, India
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Hadda V, Doddamani S, Mittal S, Tiwari P, Madan K, Mohan A, Khan MA, Bhalla AS, Guleria R. Efficacy of Intrabronchial Voriconazole Instillation for Inoperable Pulmonary Aspergilloma: A Pilot Randomized Controlled Trial. Respiration 2022; 101:833-840. [DOI: 10.1159/000525376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 05/13/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Endobronchial administration of voriconazole is a potential therapeutic option for inoperable aspergilloma. <b><i>Objective:</i></b> This study aimed to assess the efficacy of endobronchial instillation of voriconazole for inoperable pulmonary aspergilloma. <b><i>Method:</i></b> Patients with mild to moderate hemoptysis, due to inoperable aspergilloma, were randomized to receive either medical therapy (MT) alone or bronchoscopic instillation of voriconazole with MT and followed up till 3 months. The primary objective of this study was to compare the percentage of patients achieving reduction in the severity of hemoptysis assessed on visual analogue scale (VAS) in intervention and control arm at 3 months. <b><i>Results:</i></b> This study included 60 patients (female = 47) with mean (SD) age of 40.6 (13.2) years who were randomized to receive either bronchoscopic instillation of voriconazole (<i>n</i> = 30) or MT alone (<i>n</i> = 30). At 3-month follow-up, the primary objective was achieved in 26/30 (86.7%) patients in intervention group as compared to 11/30 (36.7%) in the control group (<i>p</i> value <0.0001). The VAS score at 3 months was significantly lower in voriconazole group 13.9 (9.3) mm as compared to MT alone group 22.3 (11.5) mm, <i>p</i> value of 0.003. Bronchoscopic instillation of voriconazole was also associated with reduction in cough severity and size of the aspergilloma; however, there was no benefit of this therapy in terms of requirement of hospitalization and BAE. <b><i>Conclusions:</i></b> Our study shows that for nonoperable aspergilloma, bronchoscopic instillation of voriconazole is associated with reduction in the severity of hemoptysis. This therapy should be evaluated in large multi-center trials.
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Ghosh T, Suri TM, Jat KR, Gupta AK, Bhatnagar S, Tiwari P, Mittal S, Mohan A. Clinical profile and in-hospital outcomes of COVID-19 among adolescents at a tertiary care hospital in India. Lung India 2022; 39:343-347. [PMID: 35848666 PMCID: PMC9390311 DOI: 10.4103/lungindia.lungindia_128_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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction We aimed to describe the clinical profile and risk factors for severe disease in adolescents hospitalised with coronavirus disease 2019 (COVID-19). Methods A retrospective analysis of an admitted cohort of COVID-19 patients was performed at a tertiary hospital in North India. Adolescents aged 12-18 years who were hospitalised during the first wave (March-December, 2020) and the second wave (March-June, 2021) were included. Data on the demographic details, clinical presentation, laboratory parameters, disease severity at admission, treatments received, and in-hospital outcomes were retrieved. Results The study included 197 adolescents with a median [inter-quartile range (IQR)] age of 15 (13-17) years, of whom 117 (59.4%) were male. Among these, 170 (86.3%) were admitted during the first wave. Underlying co-morbidities were present in nine (4.6%) patients. A total of 60 (30.9%) patients were asymptomatic. In the severity grading, 148 (84.6%) had mild, 16 (9.1%) had moderate, and 11 (6.3%) had severe disease. Fever (14.9%) and cough (14.9%) were the most commonly encountered symptoms. The median (IQR) duration of hospital stay was 10 (8-13) days, and six (3.1%) patients died in the hospital. Conclusion Adolescents admitted with COVID-19 had predominantly asymptomatic or mild disease, and the mortality rate was 3.1%.
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Affiliation(s)
- Tamoghna Ghosh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tejas M Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kana R Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya K Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Oncoanesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Madan M, Shareef I, Raja A, Dwivedi T, Mittal S, Sahoo B, Meena VP, Tiwari P, Mohan A, Mallick S. Covid-19 presenting as isolated severe thrombocytopenia in an HIV-lymphoma survivor. Natl Med J India 2022; 35:235-236. [PMID: 36715033 DOI: 10.25259/nmji_477_21] [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: 01/05/2023]
Abstract
Coronavirus disease has myriad manifestations and can present with predominantly extrapulmonary manifestations. We describe a 50-year-old man, a person living with HIV (PLHA), a non-Hodgkin lymphoma survivor, who presented with isolated severe thrombocytopenia. He was found to have immune-mediated thrombocytopenia, and showed excellent response to intravenous immunoglobulins.
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Affiliation(s)
- Manu Madan
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Imtiyaz Shareef
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Arun Raja
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Tanima Dwivedi
- Department of Laboratory Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Saurabh Mittal
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Biswajeet Sahoo
- Department of Laboratory Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Ved Prakash Meena
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Pawan Tiwari
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Anant Mohan
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Saumayaranjan Mallick
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Boppana TK, Mittal S, Madan K, Mohan A, Hadda V, Guleria R. Tuberculosis endemicity and BCG vaccination: Protection against COVID-19. Monaldi Arch Chest Dis 2022; 93. [PMID: 35754393 DOI: 10.4081/monaldi.2022.2281] [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: 03/30/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) has affected different countries in a differential manner. The host susceptibility and host factors are important parameters for this variability. This study aimed to assess the effect of tuberculosis (TB) endemicity and Bacille Calmette-Guerin (BCG) coverage on COVID-19. Available data regarding TB incidence, BCG coverage (as per the World Health Organization), and COVID-19 incidence of 168 countries as of 19th September 2021was collected. Countries were divided into four cohorts based upon annual TB incidence and BCG coverage and COVID-19 incidence and case fatality rates were compared using the Kruskal-Wallis test. Countries with low TB incidence and low BCG coverage had the highest COVID-19 incidence per lac population. However, no significant difference was seen in COVID-19 cases fatality rate. Higher TB incidence and BCG coverage were associated with lesser incidence of COVID-19. This result paves the way for research into pathogenesis and host immune response in COVID-19.
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Affiliation(s)
- Tarun Krishna Boppana
- Department of Pulmonary, Critical care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - Saurabh Mittal
- Department of Pulmonary, Critical care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - Karan Madan
- Department of Pulmonary, Critical care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - Anant Mohan
- Department of Pulmonary, Critical care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - Vijay Hadda
- Department of Pulmonary, Critical care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - Randeep Guleria
- Department of Pulmonary, Critical care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.
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44
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Garg A, Iyer H, Jindal V, Vashistha V, Chawla G, Tiwari P, Mittal S, Madan K, Hadda V, Guleria R, Sati HC, Mohan A. Evaluation of delays during diagnosis and management of lung cancer in India: A prospective observational study. Eur J Cancer Care (Engl) 2022; 31:e13621. [DOI: 10.1111/ecc.13621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/27/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Avneet Garg
- Department of Pulmonary Medicine Adesh Institute of Medical Sciences and Research Bathinda India
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Hariharan Iyer
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Vinita Jindal
- Department of Radiology Adesh Institute of Medical Sciences and Research Bathinda India
| | - Vishal Vashistha
- Department of Hematology and Oncology New Mexico Veterans Affairs Medical Center Albuquerque New Mexico USA
- United States‐India Educational Foundation‐Nehru Senior Scholarship Program Delhi India
| | - Gopal Chawla
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Pawan Tiwari
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Saurabh Mittal
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Karan Madan
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Vijay Hadda
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Randeep Guleria
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Hem C. Sati
- Department of Biostatistics All India Institute of Medical Sciences Delhi India
| | - Anant Mohan
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
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Delaney RD, Urmey MD, Mittal S, Brubaker BM, Kindem JM, Burns PS, Regal CA, Lehnert KW. Superconducting-qubit readout via low-backaction electro-optic transduction. Nature 2022; 606:489-493. [PMID: 35705821 DOI: 10.1038/s41586-022-04720-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/04/2022] [Indexed: 11/09/2022]
Abstract
Entangling microwave-frequency superconducting quantum processors through optical light at ambient temperature would enable means of secure communication and distributed quantum information processing1. However, transducing quantum signals between these disparate regimes of the electro-magnetic spectrum remains an outstanding goal2-9, and interfacing superconducting qubits, which are constrained to operate at millikelvin temperatures, with electro-optic transducers presents considerable challenges owing to the deleterious effects of optical photons on superconductors9,10. Moreover, many remote entanglement protocols11-14 require multiple qubit gates both preceding and following the upconversion of the quantum state, and thus an ideal transducer should impart minimal backaction15 on the qubit. Here we demonstrate readout of a superconducting transmon qubit through a low-backaction electro-optomechanical transducer. The modular nature of the transducer and circuit quantum electrodynamics system used in this work enable complete isolation of the qubit from optical photons, and the backaction on the qubit from the transducer is less than that imparted by thermal radiation from the environment. Moderate improvements in the transducer bandwidth and the added noise will enable us to leverage the full suite of tools available in circuit quantum electrodynamics to demonstrate transduction of non-classical signals from a superconducting qubit to the optical domain.
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Affiliation(s)
- R D Delaney
- JILA, National Institute of Standards and Technology and the University of Colorado, Boulder, CO, USA. .,Department of Physics, University of Colorado, Boulder, CO, USA.
| | - M D Urmey
- JILA, National Institute of Standards and Technology and the University of Colorado, Boulder, CO, USA.,Department of Physics, University of Colorado, Boulder, CO, USA
| | - S Mittal
- JILA, National Institute of Standards and Technology and the University of Colorado, Boulder, CO, USA.,Department of Physics, University of Colorado, Boulder, CO, USA
| | - B M Brubaker
- JILA, National Institute of Standards and Technology and the University of Colorado, Boulder, CO, USA.,Department of Physics, University of Colorado, Boulder, CO, USA
| | - J M Kindem
- JILA, National Institute of Standards and Technology and the University of Colorado, Boulder, CO, USA.,Department of Physics, University of Colorado, Boulder, CO, USA
| | - P S Burns
- JILA, National Institute of Standards and Technology and the University of Colorado, Boulder, CO, USA.,Department of Physics, University of Colorado, Boulder, CO, USA
| | - C A Regal
- JILA, National Institute of Standards and Technology and the University of Colorado, Boulder, CO, USA.,Department of Physics, University of Colorado, Boulder, CO, USA
| | - K W Lehnert
- JILA, National Institute of Standards and Technology and the University of Colorado, Boulder, CO, USA.,Department of Physics, University of Colorado, Boulder, CO, USA.,National Institute of Standards and Technology, Boulder, CO, USA
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Musat D, Milstein N, Saberito M, Bhatt A, Habibi M, Preminger M, Sichrovsky T, Shaw R, Mittal S. The impact of atrial fibrillation burden early post cryoballoon pulmonary vein isolation on long-term freedom from recurrent atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. A three-month blanking period (BP) is commonly used in clinical trials and practice. Early recurrence of AF portends worse ablation long-term outcome; however, the utility of using AF burden (AFB) early post cryoballoon (CB) PVI to predict long-term outcome is unknown.
Purpose
To determine, using ECG data acquired by an implantable loop recorder (ILR), the relationship between post-ablation AFB and long-term freedom from AF.
Methods
We enrolled consecutive patients with AF who had CB PVI and an ILR. We determined the monthly AFB for the first 3 months post CB PVI and assessed the relationship between AFB and 1-year freedom from AF. We defined 4 distinct AFB groups: (1) 0%, (2) > 0-0.1%, (3) > 0.1-0.5%, and (4) > 0.5%.
Results
There were 210 patients (66 ± 9 years; 138 [66%] male; 116 [55%] paroxysmal AF; CHA2DS2-VASc 2.5 ± 1.6). Following a 3-month BP, 101 (48%) patients had a recurrence of AF at 160 ± 86 days post-ablation. An AFB of > 0% over the first 3 months predicted AF recurrence (p < 0.0001, Figure 1). Patients with > 0.5% AF burden after 1st month and any AF after 2nd month post CB PVI have a very high long-term AF recurrence rate (Figure 2).
Conclusion
The best long term outcome post CB PVI is seen in pts who have no AF in the first 3 months post ablation. An AFB >0.5% after the first month and any AF after the second month portend ablation failure. These data define a clinical utility of using AFB to risk stratify patients post CB PVI.
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Affiliation(s)
- D Musat
- Valley Health System, Ridgewood, United States of America
| | - N Milstein
- Valley Health System, Ridgewood, United States of America
| | - M Saberito
- Valley Health System, Ridgewood, United States of America
| | - A Bhatt
- Valley Health System, Ridgewood, United States of America
| | - M Habibi
- Valley Health System, Ridgewood, United States of America
| | - M Preminger
- Valley Health System, Ridgewood, United States of America
| | - T Sichrovsky
- Valley Health System, Ridgewood, United States of America
| | - R Shaw
- Valley Health System, Ridgewood, United States of America
| | - S Mittal
- Valley Health System, Ridgewood, United States of America
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Musat D, Milstein N, Saberito M, Bhatt A, Habibi M, Preminger M, Sichrovsky T, Shaw R, Mittal S. Yearly incidence and pattern of very late recurrence of atrial fibrillation as detected by continuous electrocardiographic monitoring using an implantable loop recorder. Europace 2022. [DOI: 10.1093/europace/euac053.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A very late recurrence (VLR) of atrial fibrillation (AF) is considered present when patients have their first recurrence of AF > 12 months post-ablation. Little is known about the yearly rates and patterns of VLR AF recurrence.
Objective
To assess the yearly incidence and pattern of VLR in pts with AF who underwent cryoballoon (CB) pulmonary vein isolation (PVI).
Methods
We prospectively enrolled consecutive patients with AF who underwent CB PVI and had an implantable loop recorder (ILR) inserted up to 3 months post-ablation. Patients were followed for recurrent AF (excluding a 3-month post-ablation blanking period).
Results
Our cohort included 222 patients (66 ± 9 years; 143 [64%] male; 120 [54%] paroxysmal AF; CHA2DS2-VASc 2.6 ± 1.6). At 1-year, 111 (50%) patients remained free of AF. Two-year follow-up was available in 95 of these patients; 62 (65%) remained in sinus. Three-year follow-up was available in 42 of these patients; 36 (86%) remained in sinus (Figure). Of the 39 patients who developed AF after initially being free of AF for at least 1-year post ablation, 24 (62%) patients had either a frequent or persistent pattern of AF.
Conclusions
Our data show that the greatest likelihood of failure following a CB PVI occurs in the first year of ablation. The rate of failure becomes lower year by year. These data suggest that long term outcome may be driven more by the initial ablation as opposed to progressive evolution of the patient’s substrate
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Affiliation(s)
- D Musat
- Valley Health System, Ridgewood, United States of America
| | - N Milstein
- Valley Health System, Ridgewood, United States of America
| | - M Saberito
- Valley Health System, Ridgewood, United States of America
| | - A Bhatt
- Valley Health System, Ridgewood, United States of America
| | - M Habibi
- Valley Health System, Ridgewood, United States of America
| | - M Preminger
- Valley Health System, Ridgewood, United States of America
| | - T Sichrovsky
- Valley Health System, Ridgewood, United States of America
| | - R Shaw
- Valley Health System, Ridgewood, United States of America
| | - S Mittal
- Valley Health System, Ridgewood, United States of America
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Mittal S, Poole J, Kennergren C, Birgersdotter-Green U, Lustgarten DL, Tomassoni GF, Hilleren G, Lande J, Lensing C, Wilkoff B, Tarakji K. Risk factors of mortality after secondary procedures during the world-wide randomized antibiotic envelope infection prevention trial (WRAP-IT). Europace 2022. [DOI: 10.1093/europace/euac053.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic
Background
Previous analysis of WRAP-IT (World-wide Randomized Antibiotic Envelope Infection Prevention trial) data identified both patient and procedural characteristics as risk factors for cardiac implantable electronic device (CIED) infection. In the current analysis, we sought to similarly use prospectively collected WRAP-IT data to assess risk factors of all-cause mortality. Understanding if mortality risk can be modified and identifying baseline characteristics associated with high risk can help guide physician decision making.
Purpose
To identify modifiable and non-modifiable risk factors for 1-year all-cause mortality after a secondary (replacement, revision, or upgrade) CIED procedure.
Methods
This analysis included 5,461 secondary procedure patients from the WRAP-IT study. Included as candidate factors were patient and procedural characteristics. Patients with more than one year follow-up were censored at one year. A multivariate Cox Proportional Hazards model was reached by stepwise selection to minimize Akaike Information Criterion.
Results
The overall one-year mortality rate was 5.2% after secondary procedures. Of the 26 patient and 18 procedural characteristics analyzed, the following variables best predicted risk of a 1-year all-cause mortality: age, NYHA class, renal dysfunction, anticoagulant use, ischemic cardiomyopathy, diabetes, BMI, procedure time, myocardial infarction, valve surgery, and hypertrophic cardiomyopathy (Table).
Conclusion
In WRAP-IT patients undergoing secondary procedures, the only procedure characteristics that had any association with all-cause 1-year mortality risk was procedure time suggesting that most of the risk factors of mortality are non-modifiable. Baseline patient characteristics and co-morbidities were the principal risk factors of all-cause 1-year mortality. Specifically, increasing age, NYHA class, and a history of renal dysfunction were strongly associated with mortality.
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Affiliation(s)
- S Mittal
- The Valley Hospital, Ridgewood, United States of America
| | - J Poole
- University of Washington Medical Center, Seattle, United States of America
| | - C Kennergren
- Sahlgrenska Academy - University of Gothenburg, Goteborg, Sweden
| | | | - DL Lustgarten
- University of Vermont, Burlington, United States of America
| | - GF Tomassoni
- Baptist Health Lexington, Lexington, United States of America
| | - G Hilleren
- Medtronic, Mounds View, United States of America
| | - J Lande
- Medtronic, Mounds View, United States of America
| | - C Lensing
- Medtronic, Mounds View, United States of America
| | - B Wilkoff
- Cleveland Clinic, Cleveland, United States of America
| | - K Tarakji
- Cleveland Clinic, Cleveland, United States of America
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Musat D, Milstein N, Saberito M, Bhatt A, Habibi M, Preminger M, Sichrovsky T, Shaw R, Mittal S. Is there clinical utility to replacement of an implantable loop recorder in patients who have previously undergone cryoballoon pulmonary vein isolation? Europace 2022. [DOI: 10.1093/europace/euac053.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Implantable loop recorders (ILRs) are used for long-term ECG monitoring following catheter ablation in patients (pts) with atrial fibrillation (AF) to guide clinical management. However, little is known about what do when the ILR reaches end of service (EOS).
Purpose
To identify pts who underwent replacement of their ILR and determine the diagnostic yield and clinical utility of the replacement device.
Methods
We enrolled 222 consecutive pts with AF who underwent cryoballoon pulmonary vein isolation (CB PVI) and had an ILR. We identified pts who subsequently underwent ILR replacement. The diagnostic and clinical utility of the newly replaced ILR was determined.
Results
The cohort included 56 pts (64 + 9 years; 35 [63%] male; 27 [48%] PAF; CHA2DS2-VASc 2.3 ± 1.5) in whom the initial ILR reached EOS. They were followed for 3.7 ± 2.1 years. Recurrent AF was observed in 41 (73%) of these pts; this triggered an intervention in 17 (41%) pts (Figure). Of the other 15 (27%) pts without any documented AF, anticoagulation was withheld in 13 [87%] pts. Following ILR replacement, 33 (80%) of the 41 pts had more AF (n=11 [33%] required an intervention) and 5 additional pts had AF for the first time.
Conclusions
Our data show that after CB PVI, ILRs help guide decisions regarding rhythm management and oral anticoagulation. When the initial ILR was replaced by a second ILR, AF was detected (often for the first time) in some patients; the findings were used to guide clinical decision making in the entire cohort. Thus, at this time, it remains undefined when ECG monitoring of these pts can be stopped because it is no longer clinical meaningful.
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Affiliation(s)
- D Musat
- Valley Health System, Ridgewood, United States of America
| | - N Milstein
- Valley Health System, Ridgewood, United States of America
| | - M Saberito
- Valley Health System, Ridgewood, United States of America
| | - A Bhatt
- Valley Health System, Ridgewood, United States of America
| | - M Habibi
- Valley Health System, Ridgewood, United States of America
| | - M Preminger
- Valley Health System, Ridgewood, United States of America
| | - T Sichrovsky
- Valley Health System, Ridgewood, United States of America
| | - R Shaw
- Valley Health System, Ridgewood, United States of America
| | - S Mittal
- Valley Health System, Ridgewood, United States of America
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Ghosh T, Dwivedi T, Agarwal H, Iyer H, Tiwari P, Mittal S, Gupta R, Bhatnagar S, Vig S, Mohan A. Impact of various hematological and biochemical parameters on mortality in coronavirus disease 2019 (COVID-19): A single-center study from North India. Lung India 2022; 39:230-233. [PMID: 35488679 PMCID: PMC9200198 DOI: 10.4103/lungindia.lungindia_480_21] [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: 11/08/2022] Open
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), which causes coronavirus disease 2019 (COVID-19), has rapidly evolved into a pandemic, affecting more than 90 million people and more than 1.9 million deaths worldwide. Despite extensive study, the prognostic role of various hematological and biochemical parameters remains unclear. Methods: This study was carried out at a COVID care facility in Delhi. The demographic and clinical information, laboratory parameters (hematological, biochemical, and inflammatory), and the treatment of admitted COVID-19 patients during first wave were collected from electronic medical records and were subsequently analyzed. Results: Between March 2020 and November 2020, a total of 5574 patients were admitted to hospital due to COVID-19. Majority (77.2%) were male and had a mean (standard deviation [SD]) age of 38.9 (14.9) years. The mean (SD) duration of hospital stay was significantly higher in nonsurvivors. Out of the entire cohort, 8.7% of the patients had comorbidities, whereas 47.1% of the patients were asymptomatic at presentation. Compared to the survivors, the nonsurvivors had a significantly higher proportion of comorbidities and were more likely to be symptomatic. Patients who died during hospital stay had significantly higher relative neutrophil percent and neutrophil–lymphocyte ratio and lower lymphocyte percent. The patients who died had significantly higher levels of ferritin, D-dimer, and fibrinogen. Conclusions: Analysis of various hematological and inflammatory parameters can provide useful prognostic information among COVID-19-affected patients. It can also help in identifying patients who merit aggressive institutional care and thereby potentially mitigate the mortality.
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Affiliation(s)
- Tamoghna Ghosh
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tanima Dwivedi
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Harsh Agarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Vig
- Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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