Publications by authors named "A Aggarwal"

2,719 Publications

  • Page 1 of 1

Comparison of two dose escalation strategies of methotrexate in active rheumatoid arthritis: a multicentre, parallel group, randomised controlled trial.

Ann Rheum Dis 2021 Jun 10. Epub 2021 Jun 10.

Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Objectives: There are no head-to-head trials of different dose escalation strategies of methotrexate (MTX) in RA. We compared the efficacy, safety and tolerability of 'usual' (5 mg every 4 weeks) versus 'fast' (5 mg every 2 weeks) escalation of oral MTX.

Methods: This multicentre, open-label (assessor blinded) RCT included patients 18-55 years of age having active RA with disease duration <5 years, and not on DMARDs. Patients were randomized 1:1 into usual or fast escalation groups, both groups starting MTX at 15 mg/week till a maximum of 25 mg/week. Primary outcome was EULAR good response at 16 weeks, secondary outcomes were ΔDAS28 and adverse effects (AE). Analyses were intention-to-treat.

Results: 178 patients with mean DAS28-CRP of 5.4(1.1) were randomized to usual (n=89) or fast escalation groups (n=89). At 16 weeks, there was no difference in good EULAR response in the usual (28.1%) or fast escalation (22.5%) groups (p=0.8). There was no difference in mean ΔDAS28-CRP at 8 weeks (-0.9, -0.8, p=0.72) or 16 weeks (-1.3, -1.3, p=0.98). Even at 24 weeks (extended follow-up), responses were similar. There were no inter-group differences in ΔHAQ, or MTX-polyglutamates 1-3 levels at 8 or 16 weeks. Gastrointestinal AE were higher in the fast escalation group over initial 8 weeks (27%, 40%, p=0.048), but not over 16 weeks. There was no difference in cytopenias, transaminitis, or drug discontinuation/dose reduction between the groups. No serious AE were seen.

Conclusion: A faster MTX escalation strategy in RA was not more efficacious over 16-24 weeks, and did not significantly increase AE, except higher gastrointestinal AE initially.

Trial Registration Number: CTRI/2018/12/016549.
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http://dx.doi.org/10.1136/annrheumdis-2021-220512DOI Listing
June 2021

Alleviation of heat stress by Chlorophytum borivilianum: impact on stress markers, antioxidant, and immune status in crossbred cows.

Trop Anim Health Prod 2021 Jun 8;53(3):351. Epub 2021 Jun 8.

Animal Physiology Division, ICAR-National Dairy Research Institute, Karnal, Haryana, 132001, India.

Eighteen crossbred Karan Fries (KF) cows in mid-lactation (av. 130 days) were selected from the livestock herd of the institute. The treatment for the experimental cows was as follows: no supplement (control), a low dose of Chlorophytum borivilianum (CB) at a dose rate of 40 mg/kg BW/day (T1, n = 6), and a high dose of CB at a dose rate of 80 mg/kg BW/day (T2, n = 6) for a period of 90 days in hot-humid season. Physiological responses like respiration rate (RR), pulse rate (PR), and rectal temperature (RT) were recorded in the morning (8.00 A.M.) and afternoon (2.30 P.M.) at weekly intervals. The expression of pro-inflammatory (IL-1β and TNF-α) and anti-inflammatory cytokine (IL-10) in PBMCs, the plasma level of antioxidants (SOD, catalase, TBARS, and TAC), hormones (cortisol, prolactin), and energy metabolites (glucose, NEFA, urea, and creatinine) were determined. Dry and wet bulb temperatures and minimum and maximum temperatures were recorded, and the THI was calculated. The values of PR and RT were decreased (p < 0.01) in the T2 group in comparison to T1. Plasma glucose level was lower, and NEFA, urea, and creatinine level were higher (p < 0.01) in the control group as compared to T2 and T1 groups, respectively. Plasma cortisol and prolactin levels were significantly higher (p < 0.01) in the control group and were lower in T1 and T2 groups. Feeding of CB in high dose decreased (p < 0.01) plasma SOD, catalase, TBARS, and improved TAC levels in T2 over the T1 group. The dietary supplementation of CB at a dose rate of 80 mg/kg BW/day was more effective in lowering the stress level and augments the immunity by downregulating pro-inflammatory and anti-inflammatory cytokine levels. Therefore, dietary CB supplementation could be used as an effective heat stress ameliorator in dairy cows.
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http://dx.doi.org/10.1007/s11250-021-02796-yDOI Listing
June 2021

Adherence to Personal Protective Equipment Guidelines During the COVID-19 Pandemic Among Healthcare Personnel: A Louisiana Case Study.

Disaster Med Public Health Prep 2021 Jun 8:1-9. Epub 2021 Jun 8.

Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.

Objective: To determine the extent that appropriate personal protective equipment (PPE), per CDC guidance, was used during the COVID-19 pandemic by health care personnel (HCP) in Louisiana in five clinical settings.

Methods: An online questionnaire was distributed to the LA Nursery registry. Appropriate use of PPE in each of the five clinical scenarios was defined by the authors based on CDC guidelines. The scenarios ranged from communal hospital space to carrying out Aerosol Generating Procedures (AGP). 1760 HCP participated between June-July 2020.

Results: The average adherence in LA was lowest for carrying out AGPs scenario at 39.5% compliance and highest for patient contact when COVID-19 not suspected scenario at 82.8% compliance. Adherence among parishes varied widely. Commentary to suggest a shortage of PPE supply and the practice of re-using PPE was strong.

Conclusions: Use of appropriate PPE varied by setting. It was higher in scenarios where only face masks (or respirators) were the standard (i.e., community hospital or when COVID-19 not suspected) and lower in scenarios where additional PPE (e.g., gloves, eye protection, and isolation gown) were required.

Policy Implications: As HCP are at the forefront of efforts to contain the coronavirus, the factors underlying variable adherence to CDC protocols in LA need to be further analyzed and addressed.
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http://dx.doi.org/10.1017/dmp.2021.176DOI Listing
June 2021