Publications by authors named "Akshay Kumar"

108 Publications

Designing and Conducting Randomized Controlled Trials: Basic Concepts for Educating Early Researchers in the Field of Clinical Nutrition.

Cureus 2021 Aug 9;13(8):e17036. Epub 2021 Aug 9.

Internal Medicine, All India Institute of Medical Sciences, New Delhi, IND.

Randomized controlled trials (RCTs) provide the best quality evidence to steer patient care in the field of clinical nutrition. However, designing and conducting an RCT, analyzing data, interpreting and reporting its findings is rather complex for young researchers working in the field of clinical nutrition. This review article attempts to educate early researchers by offering a simple step by step guide on planning the key aspects (randomization, allocation concealment, blinding, outcome measures) of a trial, and highlighting the practical considerations (ethical clearance, trial registry, patient recruitment, trial monitoring) to be kept in mind while conducting a trial contextualised to clinical nutrition settings.
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http://dx.doi.org/10.7759/cureus.17036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8425776PMC
August 2021

Quercetin Mitigates Red Blood Cell Membrane Bound Na, K-ATPase Transporter During Human Aging.

J Membr Biol 2021 Sep 4. Epub 2021 Sep 4.

Department of Biochemistry, Central University of Haryana, Mahendergah, Haryana, 123031, India.

Increasing interest has recently focused on determining whether quercetin may exert anti-aging properties or not? The objective of this study was determination of Na, K -ATPase activity in quercetin-treated red blood cells during human aging. The study was carried out on human blood samples. The subjects were divided into different age groups, young, middle, and old. The effects of quercetin were evaluated by determining Na, K -ATPase activity by co-incubating the red blood cells in presence of quercetin (10 M to 10 M final concentration). Quercetin causes 15% increase in Na, K -ATPase activity at 10 M and 17% at 10 M as compared to the young control age group. The effect was insignificant at 10 M (7%) and 10 M (5%) in the young age group. Quercetin showed significant increase at 10 M to 10 M in Na, K -ATPase activity as compared to the middle control age group. A significant increase in Na, K -ATPase activity was observed at all concentrations [10 M (31%), 10 M (39%), 10 M (51%), and 10 M (61%)] in elderly population. We believe that these findings will help in further research against oxidative stress in red blood cells.
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http://dx.doi.org/10.1007/s00232-021-00200-2DOI Listing
September 2021

Free Amine, Hydroxyl and Sulfhydryl Directed C-H Functionalization and Annulation: Application to Heterocycle Synthesis.

Chem Rec 2021 Aug 26. Epub 2021 Aug 26.

Chemical Technology Division, CSIR- Institute of Himalayan Bioresource Technology, Palampur, 176061, H.P.

Transition metal-catalyzed direct C-H bond functionalization is recognized as an efficient strategy to assemble heterocyclic frameworks. For this purpose, directing groups (DGs) installation on an organic molecule has remained a widely exploited strategy for the years. The installation of directing groups, especially for the amine, alcohol and thiol containing reactants and their removal after the reaction need additional steps. In this regard, the use of free amine, hydroxyl and sulfhydryl as directing groups in native form is advantageous and in recent times, these transformations have stirred undisputable advancements for applications to heterocycle synthesis. In this review, the aromatic sp -C attached free amine, hydroxyl and sulfhydryl as native functionalities are shown to be useful for the construction of five to seven-membered N-, O- and S-heterocycles.
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http://dx.doi.org/10.1002/tcr.202100171DOI Listing
August 2021

Classification of error-related potentials evoked during stroke rehabilitation training.

J Neural Eng 2021 Sep 2;18(5). Epub 2021 Sep 2.

Department of Biomedical Engineering, College of Engineering, Shantou University, Guangdong, People's Republic of China.

Error-related potentials (ErrPs) are elicited in the human brain following an error's perception. Recently, ErrPs have been observed in a novel task situation, i.e. when stroke patients perform upper-limb rehabilitation exercises. These ErrPs can be used to develop(AAN) robotic stroke rehabilitation systems. However, to date, there is no reported research on assessing the feasibility of using the ErrPs to implement the AAN approach. Hence, in this study, we evaluated and compared the single-trial classification of novel ErrPs using various classical machine learning and deep learning approaches.Electroencephalogram data of 13 stroke patients recorded while performing an upper-limb physical rehabilitation exercise were used. Two classification approaches, one combining the xDAWN spatial filtering and support vector machines, and the other using a convolutional neural network-based double transfer learning, were utilized.Results showed that the ErrPs could be detected with a mean area under the receiver operating characteristics curve of 0.838, and a mean accuracy of 0.842, 0.257 above the chance level (< 0.05), for a within-subject classification. The results indicated the feasibility of using ErrP signals in real-time AAN robot therapy with evidence from the conducted latency analysis, cross-subject classification, and three-class asynchronous classification.The findings presented support our proposed approach of using ErrPs as a measure to trigger and/or modulate as required the robotic assistance in a real-timerobotic stroke rehabilitation system.
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http://dx.doi.org/10.1088/1741-2552/ac1d32DOI Listing
September 2021

Strengthening sepsis care at a tertiary care teaching hospital in New Delhi, India.

BMJ Open Qual 2021 07;10(Suppl 1)

Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.

Introduction: Failure of early identification of sepsis in the emergency department (ED) leads to significant delays in antibiotic administration which adversely affects patient outcomes.

Aim: The primary objective of our Quality Improvement (QI) project was to reduce the door-to-antibiotic time (DTAT) by 30% from the preintervention in patients with suspected sepsis. Secondary objectives were to increase the blood culture collection rate by 30% from preintervention, investigate the predictors of improving DTAT and study the effect of these interventions on 24-hour in-hospital mortality.

Methods: This QI project was conducted in the ED of a tertiary care teaching hospital of North India; the ED receives approximately 400 patients per day. Adult patients with suspected sepsis presenting to our ED were included in the study, between January 2019 and December 2020. The study was divided into three phases; preintervention phase (100 patients), intervention phase (100 patients) and postintervention phase (93 patients). DTAT and blood cultures prior to antibiotic administration was recorded for all patients. Blood culture yield and 24-hour in-hospital mortality were also recorded using standard data templates. Change ideas planned by the Sepsis QI Team were implemented after conducting plan-do-study-act cycles.

Results: The median DTAT reduced from 155 min in preintervention phase to 78 min in postintervention phase. Drawing of blood cultures prior to antibiotic administration improved by 67%. Application of novel screening tool at triage was found to be an independent predictor of reduced DTAT.

Conclusion: Our QI project identified the existing lacunae in implementation of the sepsis bundle which were dealt with in a stepwise manner. The sepsis screening tool and on-site training improved care of patients with sepsis. A similar approach can be used to deal with complex quality issues in other high-volume low-resource settings.
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http://dx.doi.org/10.1136/bmjoq-2020-001335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336124PMC
July 2021

Advancing emergency airway management by reducing intubation time at a high-volume academic emergency department.

BMJ Open Qual 2021 07;10(Suppl 1)

Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India

Background: Airway management is a life-saving procedure in the emergency department (ED). Hypoxia during rapid sequence intubation (RSI) is associated with high morbidity and mortality.

Aim: To decrease the median time of intubation (time from administration of paralytic agent to the successful passage of endotracheal tube) by 40% from baseline 300 s in patients undergoing RSI in the ED.

Methods: A multidisciplinary quality improvement team worked to improve the airway management. The bottle necks identified using process mapping and fish bone analysis were lack of formal training of residents and nursing officers, and communication gap between residents and nursing officers. Change ideas focused on training residents in laryngoscopy and intubation and nursing officers in facilitating airway management by preparation of drugs and equipment; on-site awareness of logistical issues to the residents and nursing officers, introducing airway drug checklist and ensuring availability of difficult airway equipment.

Results: After implementation of change ideas there was a significant reduction in intubation time. At the end of first Plan-Do-Study-Act (PDSA) cycle median intubation time was 165 s (IQR 125 s). By the end of last PDSA cycle, median intubation time reduced to 157 s (IQR 66 s). A shift was obtained on the run chart with a new median time of 141.5 s from mid-PDSA 1. The 8-week data after the end of PDSA 3 showed sustainability with median time of 126 s (IQR 42 s).

Conclusion: A well organised team effort, simple change ideas such as structured training of residents and nursing officers, introduction of airway drug checklist and improved communication can decrease the intubation time in a chaotic ED.
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http://dx.doi.org/10.1136/bmjoq-2021-001448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336199PMC
July 2021

Genetic portrait of 23 Y-STR loci in the Naga tribes of Nagaland, India.

Int J Legal Med 2021 Jul 22. Epub 2021 Jul 22.

DNA Fingerprinting Unit, State Forensic Science Laboratory, Department of Home (Police), Govt. of MP, Sagar, 470001, India.

To explore the genomic diversity and forensic characterization of Naga tribes, Nagaland, haplotypes for 23 Y-STR markers have been analyzed. In this study, 203 unrelated male individuals residing in the Northeast Indian state of Nagaland were selected. A total of 203 unique haplotypes were observed. The value of gene diversity (GD) and discrimination capacity (DC) was observed as 0.999999998927955 and 1 respectively. Forensic interest parameters viz., power of discrimination (PD), polymorphic information content (PIC), and matching probability (PM) were found to be 0.999999998695503, 0.999999976671191, and 1.3 × 10 respectively, for the studied population. Inter-population comparison study showed that the Naga tribes were found to have a distinct gene pool which is reflected in the neighbor-joining tree, principle coordinate analysis, and heat map. This is the first genetic study on Naga tribes based on 23 Y-STR markers. The Y chromosomal STR data will be useful for forensic DNA application and will enrich the existing Indian Y-STR database.
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http://dx.doi.org/10.1007/s00414-021-02662-4DOI Listing
July 2021

COVID-19 associated Mucormycosis Presenting to the Emergency Department - An Observational Study of 70 Patients.

QJM 2021 Jul 12. Epub 2021 Jul 12.

Professor and Head, All India Institute of Medical Sciences, Department of Medicine, Ansari Nagar, New Delhi, India.

Background: Mucormycosis is a deadly opportunistic fungal infection and a large surge in COVID-19 associated mucormycosis (CAM) is occurring in India.

Aim: Our aim was to delineate the clinico-epidemiological profile and identify risk factors of CAM patients presenting to the Emergency Department (ED).

Design: This was a retrospective, single center, observational study.

Methods: We included patients who presented with clinical features or diagnosed mucormycosis and who were previously treated for COVID-19 in last three months of presentation (recent COVID-19) or currently being treated for COVID-19 (active COVID-19). Information regarding clinical features of CAM, possible risk factors, examination findings, diagnostic workup including imaging and treatment details were collected.

Results: Seventy CAM patients (median age: 44.5 years, 60% males) with active (75.7%) or recent COVID-19 (24.3%) who presented to the ED in between 6th May 2021 to 1st June 2021, were included. A median duration of 20 days (IQR: 13.5 - 25) was present between the onset of COVID-19 symptoms and the onset of CAM symptoms. 93% patients had at least one risk factor. Most common risk factors were diabetes mellitus (70%) and steroid use for COVID-19 disease (70%). After clinical, microbiological, and radiological workup, final diagnosis of rhino-orbital CAM was made in most patients (68.6%). Systemic antifungals were started in the ED and urgent surgical debridement was planned.

Conclusion: COVID-19 infection along with its medical management have increased patient susceptibility to mucormycosis.
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http://dx.doi.org/10.1093/qjmed/hcab190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420631PMC
July 2021

Incidental Diagnosis of Multiple Paragangliomas by Ga-68 DOTANOC Positron Emission Tomography-Computed Tomography.

Asia Ocean J Nucl Med Biol 2021 ;9(2):173-176

Department of Nuclear Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

A 65-year-old man presented with intermittent abdominal pain for three months. Abdominal ultrasonography revealed a mass in the body of the pancreas. Moreover, abdominal contrast-enhancing computed tomography revealed a homogenously enhancing mass in the body of the pancreas. Scan findings were in favor of the neuroendocrine tumor, and the serum chromogranin level was slightly raised (111.9 ng/ml, normal <98). He had no history of vomiting, jaundice, melena, hematemesis, constipation, diarrhea, weight gain, weight loss, loss of appetite, and fever. He also had no symptoms related to the excessive production of catecholamines, such as hypertension. The patient was referred for Ga-68 DOTANOC positron emission tomography-computed tomography (Ga-68 DOTANOC PET-CT) for further evaluation. The scan was done to rule out metastatic disease or other synchronous lesions to plan surgical excision. The Ga-68 DOTANOC PET-CT revealed a pancreatic lesion with no other abdominal lesions. We noted multiple tracer avid soft tissue lesions on both sides of the neck that were not diagnosed previously. This case report demonstrates a rare case with multiple paragangliomas diagnosed by the Ga-68 DOTANOC PET-CT. This finding could lead to changes in patient management.
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http://dx.doi.org/10.22038/AOJNMB.2021.17883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255528PMC
January 2021

High-Dose Nitroglycerin Bolus for Sympathetic Crashing Acute Pulmonary Edema: A Prospective Observational Pilot Study.

J Emerg Med 2021 Jun 29. Epub 2021 Jun 29.

Department of Emergency Medicine, All India Institute of Medical Science (AIIMS), New Delhi, India.

Background: Sympathetic crashing acute pulmonary edema (SCAPE) is a severe form of hypertensive acute heart failure with a dramatic presentation. Rapid identification and management in the emergency department (ED) is key to saving these patients and preventing morbidity associated with endotracheal intubation and intensive care treatment. Use of high-dose nitroglycerin (NTG) and noninvasive ventilation (NIV) has been advocated in management of such patients.

Objective: To study the feasibility and safety of high-dose NTG combined with NIV in SCAPE.

Methods: This was a prospective observational pilot study done in the ED of a tertiary care hospital. All patients were treated with high-dose NTG and NIV. The primary objective was to study the feasibility and safety of the SCAPE management protocol in terms of the outcome of the patient. Resolution of symptoms in 6 h and need for intubation were recorded as endpoints. Any complications associated with high-dose NTG were also recorded.

Results: A total of 25 patients were recruited. The mean bolus dose of NTG given was 872 μg, and mean cumulative dose, 35 mg. There was no incidence of hypotension after the bolus dose of nitroglycerin. Eleven patients had resolution of symptoms at 3 h of therapy. Twenty-four patients were discharged from the ED itself after a brief period of observation, and one patient was intubated and shifted to the intensive care unit.

Conclusion: Use of our specific SCAPE treatment algorithm, which included high-dose NTG and NIV, was safe and provided rapid resolution of symptoms.
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http://dx.doi.org/10.1016/j.jemermed.2021.05.011DOI Listing
June 2021

Revealing genomic history and forensic features of Gurjars from western Uttar Pradesh and National Capital Region Delhi using 23 autosomal STRs.

Leg Med (Tokyo) 2021 Jun 13;53:101932. Epub 2021 Jun 13.

DNA Fingerprinting Unit, State Forensic Science Laboratory, Department of Home (Police), Govt. of MP, Sagar-470001, India. Electronic address:

Here we report the genomic history of Gurjars and framed the useful set of autosomal STRs for Gujjar population. We designed this study with a total number of 215 Gurjars from district Saharanpur (previously known as Gujarat due to presence of many Gujjar zamindars), Moradabad, Bulandshahr, Ghaziabad, Meerut, Noida and NCR Delhi. Locus SE33 was found the most polymorphic and discriminating marker for Gujjar population while locus TPOX is the least. Ancestral information of Gurjars was revealed by comparing the Gujjar's population data with 19 neighbouring populations. In Neighbor Joining (NJ) tree Gurjars were found closer to Gujjars of Jammu region, population of Rajasthan and Uttarkhand, due to the same stock of gene pool.
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http://dx.doi.org/10.1016/j.legalmed.2021.101932DOI Listing
June 2021

SARS-CoV-2 infection during pregnancy and pregnancy-related conditions: Concerns, challenges, management and mitigation strategies-a narrative review.

J Infect Public Health 2021 Jul 23;14(7):863-875. Epub 2021 Apr 23.

Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, 243122, Uttar Pradesh, India. Electronic address:

The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health problem. The SARS-CoV-2 triggers hyper-activation of inflammatory and immune responses resulting in cytokine storm and increased inflammatory responses on several organs like lungs, kidneys, intestine, and placenta. Although SARS-CoV-2 affects individuals of all age groups and physiological statuses, immune-compromised individuals such as pregnant women are considered as a highly vulnerable group. This review aims to raise the concerns of high risk of infection, morbidity and mortality of COVID-19 in pregnant women and provides critical reviews of pathophysiology and pathobiology of how SARS-CoV-2 infection potentially increases the severity and fatality during pregnancy. This article also provides a discussion of current evidence on vertical transmission of SARS-CoV-2 during pregnancy and breastfeeding. Lastly, guidelines on management, treatment, preventive, and mitigation strategies of SARS-CoV-2 infection during pregnancy and pregnancy-related conditions such as delivery and breastfeeding are discussed.
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http://dx.doi.org/10.1016/j.jiph.2021.04.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062420PMC
July 2021

Forensic characterization and genomic diversity of Assam population viewed from 23 autosomal STRs.

Int J Legal Med 2021 Jun 8. Epub 2021 Jun 8.

DNA Fingerprinting Unit, State Forensic Science Laboratory, Department of Home (Police), Govt. of MP, Sagar, 470001, India.

In order to find out the genetic structure and characterize the forensic features of 23 autosomal STRs in the population of Assam, PowerPlex® Fusion 6C amplification kit was employed to genotype 292 unrelated individuals from Assam, India. A total of 79 different alleles were observed across 23 autosomal STRs with the corresponding frequency of alleles, which ranges from 0.002 to 0.406. Selected 23 loci were observed useful together with the highest value of combined discrimination power (CPD = 1), combined exclusion power (CPE = 0.999999999914), combined paternity index (CPI = 3.04 × 10), and all studied loci combined showing the lowest matching probability which is (CPM = 1.29 × 10). Additionally, in comparison with neighboring population, Assam population showed genetic closeness with Indian population. The genetic data of the present study will enrich the existing Indian autosomal DNA database and be useful for forensic and genealogical applications.
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http://dx.doi.org/10.1007/s00414-021-02625-9DOI Listing
June 2021

Molecular characterization of 23 Y chromosomal STR markers in the Gurjar population of National Capital Region (NCR), India.

Int J Legal Med 2021 May 31. Epub 2021 May 31.

DNA Fingerprinting Unit, State Forensic Science Laboratory, Department of Home (Police), Govt. of MP, Sagar, 470001, India.

In the present study, DNA samples of 202 unrelated male individuals of Gurjar population were evaluated for the molecular diversity at 23 Y chromosomal Y-STR markers. Out of selected individuals, results showed 143 unique haplotypes. Highest degree of gene diversity (GD), polymorphic information content (PIC), and power of discrimination (PD) was observed as 0.7941, 0.7590, and 0.7902, respectively, for the locus DYS385a/b. Haplotype diversity (HD), gene diversity (GD), polymorphic information content (PIC), and power of discrimination (PD) was found to be 0.7079, 0.999999999989, 0.9999999996, and 0.999999999986, respectively, for the studied 23 Y-STR markers. Allele 11 of locus DYS392 was found to be the most frequent allele with the frequency of 0.762. In inter-population relationship, studied population showed genetic relatedness with the population of Jammu and Kashmir, India, and Ladakh, India. The haplotype data of the present study will not only enrich the existing Indian Y-STR data but will also be useful for forensic DNA application.
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http://dx.doi.org/10.1007/s00414-021-02623-xDOI Listing
May 2021

Predictors of mortality and the need of mechanical ventilation in confirmed COVID-19 patients presenting to the emergency department in North India.

J Family Med Prim Care 2021 Jan 30;10(1):542-549. Epub 2021 Jan 30.

Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.

Background And Objectives: As the number of COVID-19 cases keeps on rising, a better awareness of the nature and severity of the disease will aid in clinical decision-making and management. Hence, this study was conducted to find the predictors of mortality and the need for mechanical ventilation in COVID-19 patients.

Methods: This was a single centre, prospective observational study conducted in a tertiary care centre in north India. We included patients with influenza like illness who tested positive for COVID-19. Information regarding patient demography, symptoms, and vital signs on presentation, laboratory values, chest imaging findings, and disease severity was collected by the emergency physician. QSOFA score and National early warning score (NEWS) score were calculated using initial vital signs. Each patient was followed up till discharge or death.

Results: We included 116 COVID-19 patients with 33 patients having mild, 46 patients with severe and 37 patients with critical disease. The median age of our patients was 47 years (39-59) with 63% males. About 58% of patients had at least one comorbidity and shortness of breath was the most common presenting feature. The patients with severe and critical disease had a significantly higher respiratory rate and heart rate as compared to mild disease ( < 0.05). SpO2 of those with critical disease was significantly lower as compared to those with mild disease. Mechanical ventilation was required in around 36% of patients which included 67% of patients with critical disease. The overall mortality was 51% with 90% among critical disease. Lower SpO2 and GCS were the only parameters that showed a significant association with mortality and need for mechanical ventilation. The receiver operating characteristics analysis showed NEWS score as a better predictor of mortality and need for mechanical ventilation as compared to qSOFA score.

Conclusion: NEWS and qSOFA scores are useful tools in predicting fatal outcomes in COVID patients with NEWS score being a better score than qSOFA.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1775_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132819PMC
January 2021

Pesticidal efficacy, mode of action and safety limits profile of essential oils based nanoformulation against Callosobruchus chinensis and Aspergillus flavus.

Pestic Biochem Physiol 2021 Jun 6;175:104813. Epub 2021 Mar 6.

Centre of Advanced Study in Botany, Institute of Science, Banaras Hindu University, Varanasi, 221005, India. Electronic address:

The study explores the pesticidal efficacy, mode of action, and safety limit profile of essential oils-based formulation using the combination of Myristica fragrans (M), Bunium persicum (B), and Zanthoxylum alatum (Z) (1:1:1 v/v/v) and their nanoformulation (Ne-MBZ) against the Callosobruchus chinensis, Aspergillus flavus and aflatoxin B production. Linalool, γ-terpinene, and cuminaldehyde were identified as the major compounds of the formulation (MBZ) by Gas chromatography-mass spectrometry (GC-MS). Nanoencapsulation of developed formulation (Ne-MBZ) was prepared using chitosan and characterized by scanning electron microscopy (SEM), X-ray diffraction analysis (XRD), and Fourier transform infrared spectroscopy (FTIR). The pesticidal efficacy of nanoformulation (Ne-MBZ) against C. chinensis IC (0.14 μl/ml), A. flavus (0.8 μl/ml) and AFB (0.8 μl/ml) was significantly higher in both in-vitro and in-situ conditions than the sum of their individual revealing a notable synergistic effect. Besides, the detailed mode of pesticidal action and safety limit profile were explored using biochemical, in-silico and ADMET (absorption, distribution, metabolism, excretion, and toxicity) approaches.
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http://dx.doi.org/10.1016/j.pestbp.2021.104813DOI Listing
June 2021

Performance Evaluation of Machine Learning Frameworks for Aphasia Assessment.

Sensors (Basel) 2021 Apr 7;21(8). Epub 2021 Apr 7.

Department of Biomedical Engineering, College of Engineering, Shantou University, Shantou 515041, China.

Speech assessment is an essential part of the rehabilitation procedure for patients with aphasia (PWA). It is a comprehensive and time-consuming process that aims to discriminate between healthy individuals and aphasic patients, determine the type of aphasia syndrome, and determine the patients' impairment severity levels (these are referred to here as aphasia assessment tasks). Hence, the automation of aphasia assessment tasks is essential. In this study, the performance of three automatic speech assessment models based on the speech was investigated. Three types of datasets were used: healthy subjects' dataset, aphasic patients' dataset, and a combination of healthy and aphasic datasets. Two machine learning (ML)-based frameworks, classical machine learning (CML) and deep neural network (DNN), were considered in the design of the proposed speech assessment models. In this paper, the DNN-based framework was based on a convolutional neural network (CNN). Direct or indirect transformation of these models to achieve the aphasia assessment tasks was investigated. Comparative performance results for each of the speech assessment models showed that quadrature-based high-resolution time-frequency images with a CNN framework outperformed all the CML frameworks over the three dataset-types. The CNN-based framework reported an accuracy of 99.23 ± 0.003% with the healthy individuals' dataset and 67.78 ± 0.047% with the aphasic patients' dataset. Moreover, direct or transformed relationships between the proposed speech assessment models and the aphasia assessment tasks are attainable, given a suitable dataset-type, a reasonably sized dataset, and appropriate decision logic in the ML framework.
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http://dx.doi.org/10.3390/s21082582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067696PMC
April 2021

Sudden cardiac death: epidemiology, pathogenesis and management.

Rev Cardiovasc Med 2021 Mar;22(1):147-158

Division of Cardiothoracic Surgery, University of Kentucky, Lexington, KY 40506, USA.

Sudden cardiac death (SCD) is an unexpected sudden death due to a heart condition, that occurs within one hour of symptoms onset. SCD is a leading cause of death in western countries, and is responsible for the majority of deaths from cardiovascular disease. Moreover, SCD accounts for mortality in approximately half of all coronary heart disease patients. Nevertheless, the recent advancements made in screening, prevention, treatment, and management of the underlying causes has decreased this number. In this article, we sought to review established and new modes of screening patients at risk for SCD, treatment and prevention of SCD, and the role of new technologies in the field. Further, we delineate the current epidemiologic trends and pathogenesis. In particular, we describe the advancement in molecular autopsy and genetic testing, the role of target temperature management, extracorporeal membrane oxygenation (ECMO), cardiopulmonary resuscitation (CPR), and transvenous and subcutaneous implantable cardioverter devices (ICDs).
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http://dx.doi.org/10.31083/j.rcm.2021.01.207DOI Listing
March 2021

Systemic adverse effects and toxicities associated with immunotherapy: A review.

World J Clin Oncol 2021 Mar;12(3):150-163

Department of Hematology and Oncology, University of Rochester Medical Center, Rochester, NY 14642, United States.

Immunotherapy is rapidly evolving secondary to the advent of newer immunotherapeutic agents and increasing approval of the current agents by the United States Food and Drug Administration to treat a wide spectrum of cancers. Immunotherapeutic agents have gained immense popularity due to their tumor-specific action. Immunotherapy is slowly transforming into a separate therapeutic entity, and the fifth pillar of management for cancers alongside surgery, radiotherapy, chemotherapy, and targeted therapy. However, like any therapeutic entity it has its own adverse effects. With the increasing use of immuno-therapeutic agents, it is vital for physicians to acquaint themselves with these adverse effects. The aim of this review is to investigate the common systemic adverse effects and toxicities associated with the use of different classes of immunotherapeutic agents. We provide an overview of potential adverse effects and toxicities associated with different classes of immunotherapeutic agents organized by organ systems, as well as an extensive discussion of the current recommendations for treatment and clinical trial data. As we continue to see increasing usage of these agents in clinical practice, it is vital for physicians to familiarize themselves with these effects.
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http://dx.doi.org/10.5306/wjco.v12.i3.150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968107PMC
March 2021

Untangling the multi-regime molecular mechanism of verbenol-chemotype Zingiber officinale essential oil against Aspergillus flavus and aflatoxin B.

Sci Rep 2021 03 25;11(1):6832. Epub 2021 Mar 25.

Centre of Advanced Study in Botany, Institute of Science, Banaras Hindu University, Varanasi, 221005, India.

Aflatoxin B (AFB), the natural polyketide produced by Aspergillus flavus, has a potent carcinogenic effect on humans as well as animals. In the present study, the antifungal and anti-aflatoxigenic B activity of chemically characterized Zingiber officinale essential oil (ZOEO) was investigated via in vitro analysis aided with molecular dynamics (MD) approaches. The GC-MS results revealed verbenol (52.41%) as the major component of oil. The antifungal and anti-aflatoxigenic activity of ZOEO was found to be 0.6 µl/ml and 0.5 µl/ml respectively. In-vitro analysis targeting the cell membrane, mitochondria and carbohydrate catabolism elucidated the probable antifungal mode of action. Further, docking and MD simulation results confirmed the inhibitory action of verbenol on the structural gene products (Nor-1, Omt-1, and Vbs) of aflatoxin biosynthetic machinery. Biochemical assays revealed the fungitoxic potential of the ZOEO while, computational results infers the stabilizing effects on the gene products upon verbenol binding leads to the impairment in its functionality. This is the first attempt to assess the multi-regime anti-AFB mechanism of verbenol chemotype-ZOEO targeting the Nor-1, Omt-1, and Vbs via computational approaches.
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http://dx.doi.org/10.1038/s41598-021-86253-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994644PMC
March 2021

Foodborne illness outbreak linked to a rural community kitchen in a rural area of Patiala District, Punjab, India, 2018.

Indian J Public Health 2021 Jan;65(Supplement):S41-S45

Public Health Specialist, South Asia Field Epidemiology and Technology Network, Delhi, India.

Background: In December 2018, an acute gastroenteritis outbreak was reported from Faridpur-Gujjran village, Patiala district, Punjab, India.

Objective: The objective of this study was to describe the epidemiology and risk factors of the outbreak and recommend prevention measures.

Methods: We conducted a descriptive study and a retrospective cohort study in the village. We defined a case as vomiting or ≥3 loose feces in 24 h plus abdominal pain and/or fever in a resident of the village during December 23-28, 2018. To find cases, we conducted a house-to-house survey; to identify risk factors, we conducted a retrospective cohort study. Fecal specimens were tested for enteric pathogens; water samples were tested for fecal contamination. We also interviewed food handlers. We compared attack rates by level of exposure. From the cohort study, we calculated risk ratios with 95% confidence intervals.

Results: From the 261 residents of the village, we identified 116 cases (attack rate 44%) and no deaths. The median age of affected persons was 27.5 years (range 0.5-80 years). The illness was associated with eating in a community kitchen of a temple during December 23-24, 2018. Eating mixed vegetables was associated with illness. We found no pathogens in fecal specimens. All three water samples showed coliform contamination. Cooked food had been left at room temperature before serving.

Conclusion: Improper storage practices might have led to microbial proliferation of the food served. Our findings will help guide the enforcement of food safety policies for community kitchens.
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http://dx.doi.org/10.4103/ijph.IJPH_1112_20DOI Listing
January 2021

Efficacy of 2% Lignocaine and 4% Articaine in Oral Surgical Procedure: A Comparative Study.

J Contemp Dent Pract 2020 Oct 1;21(10):1146-1149. Epub 2020 Oct 1.

Department of Prosthodontics and Crown and Bridge, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India.

Aim And Objective: To compare the efficacy of 2% lignocaine and 4% articaine in the extraction of mandibular molars.

Materials And Methods: This study was conducted on 120 patients requiring surgical removal of tooth. Patients were categorized into 2 groups with 60 samples each. Group I patients were administered 2% lignocaine with 1:50,000 epinephrine and group II patients were administered 4% articaine with 1:100,000 epinephrine for the extraction of mandibular molar. Inferior alveolar nerve, lingual, and buccal nerve block used in both groups to anesthetize the area.

Results: The mean onset of action in group I was 85.2 seconds and in group II was 52.6 seconds, duration of anesthesia in group I was 170.2 minutes and in group II was 226.8 minutes, duration of procedure was 30.4 minutes in group I and 32.6 minutes in group II, pain during procedure in group I was 2.75 and in group II was 1.42, pain after procedure was 1.41 in group I and 0.82 in group II, pain during anesthesia insertion was 1.52 in group I and 1.04 in group II. Forty-six (76.7%) patients in group I and 52 (86.7%) patients in group II did not require re-anesthesia, while 12 (20%) in group I and 8 (13.3%) in group II required 1 time re-anesthesia and 2 (3.3%) patients required 2 times re-anesthesia in group I.

Conclusion: Articaine can be effectively used in oral surgical procedures as there is early onset of action, longer duration of anesthesia, and less need of re-anesthesia.

Clinical Significance: Articaine is more effective compared to lignocaine, hence it can be recommended alternatively for tooth extraction and other oral surgical procedures.
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October 2020

Strengthening emergency care by developing data collection systems in low- and middle-income countries.

Afr J Emerg Med 2021 Mar 1;11(1):111-112. Epub 2020 Oct 1.

Department of Emergency Medicine, AIIMS, New Delhi, India.

Emergency care surveillance as well as registries of emergency care are largely absent in most LMICs. Improper data systems in Emergency Department create an important gap in our understanding about the health of large portions of the population. Clinical data systems in LMICs and lower-resource settings will foster research and generation of contextualized evidence.
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http://dx.doi.org/10.1016/j.afjem.2020.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910185PMC
March 2021

Emerging therapeutics in the management of COVID-19.

World J Virol 2021 Jan;10(1):1-29

Department of Anesthesiology and Critical Care, Saraswathi Institue of Medical Sciences, Uttar Pradesh 245304, India.

The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019, COVID-19) pandemic has placed a tremendous burden on healthcare systems globally. Therapeutics for treatment of the virus are extremely inconsistent due to the lack of time evaluating drug efficacy in clinical trials. Currently, there is a deficiency of published literature that comprehensively discusses all therapeutics being considered for the treatment of COVID-19. A review of the literature was performed for articles related to therapeutics and clinical trials in the context of the current COVID-19 pandemic. We used PubMed, Google Scholar, and Clinicaltrials.gov to search for articles relative to the topic of interest. We used the following keywords: "COVID-19", "therapeutics", "clinical trials", "treatment", "FDA", "ICU", "mortality", and "management". In addition, searches through the references of retrieved articles was also performed. In this paper, we have elaborated on the therapeutic strategies that have been hypothesized or trialed to-date, the mechanism of action of each therapeutic, the clinical trials finished or in-process that support the use of each therapeutic, and the adverse effects associated with each therapeutic. Currently, there is no treatment that has been proven to provide significant benefit in reducing morbidity and mortality. There are many clinical trials for numerous different therapeutic agents currently underway. By looking back and measuring successful strategies from previous pandemics in addition to carrying out ongoing research, we provide ourselves with the greatest opportunity to find treatments that are beneficial.
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http://dx.doi.org/10.5501/wjv.v10.i1.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852573PMC
January 2021

Role of Platelet-rich Plasma in the Healing of Impacted Third Molar Socket: A Comparative Study on Central India Population.

J Contemp Dent Pract 2020 Sep 1;21(9):986-991. Epub 2020 Sep 1.

Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

Aim: The aim of the study was to compare the healing and osseous regeneration of mandibular third molar extraction sockets with and without platelet-rich plasma (PRP) with the evaluation of clinical objectives such as pain, swelling, trismus, soft tissue healing, pocket depth distal to second molar and radiological evaluation of the bony density in the postextracted third molar socket.

Materials And Methods: In this prospective study, 100 patients were selected by the random sampling method from the outpatient department of oral and maxillofacial surgery in the year 2016-2017. Patients were equally allocated into intervention (transalveolar extraction followed by PRP placement) and nonintervention (transalveolar extraction without PRP placement) group as group I and group II, respectively, and evaluation parameters were considered accordingly. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 (IBM, USA) statistical analysis software.

Results: The pain score of patients of group I (non-PRP) was found to be higher as compared to group II (with PRP). Mean trismus of patients of group II was found to be higher than that of group I at postoperative day 7, but this difference was not found to be statistically significant. Swelling at T-Sn (Tragus-Subnasale) and T-Pog (Tragus-Pogonion) was higher among patients of group I as compared to group II. Healing in group II was two to three times faster than group I. Healing among patients of group I and group II was found to be statistically significant. The mean pocket depth of patients of group I was found to be significantly higher than that of group II at follow-up of 1 and 2 months. The bone density of patients of group II was found to be significantly higher than that of group I at 3 months and 6 months follow-up.

Conclusion: The procedure of PRP preparation is simple and cost-effective, and can be prepared at the point of care. It had a significant impact on the postoperative healing of the third molar socket.

Clinical Significance: The use of PRP application increases the bone density, healing process, and improvement in the pain and swelling, and there was a definite reduction in trismus and periodontal probing depth after the impacted mandibular wisdom teeth extraction.
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September 2020

The influence of psychological and cognitive states on error-related negativity evoked during post-stroke rehabilitation movements.

Biomed Eng Online 2021 Feb 2;20(1):13. Epub 2021 Feb 2.

School of Engineering, Royal Melbourne Institute of Technology University, Melbourne, Australia.

Background: Recently, error-related negativity (ERN) signals are proposed to develop an assist-as-needed robotic stroke rehabilitation program. Stroke patients' state-of-mind, such as motivation to participate and active involvement in the rehabilitation program, affects their rate of recovery from motor disability. If the characteristics of the robotic stroke rehabilitation program can be altered based on the state-of-mind of the patients, such that the patients remain engaged in the program, the rate of recovery from their motor disability can be improved. However, before that, it is imperative to understand how the states-of-mind of a participant affect their ERN signal.

Methods: This study aimed to determine the association between the ERN signal and the psychological and cognitive states of the participants. Experiments were conducted on stroke patients, which involved performing a physical rehabilitation exercise and a questionnaire to measure participants' subjective experience on four factors: motivation in participating in the experiment, perceived effort, perceived pressure, awareness of uncompleted exercise trials while performing the rehabilitation exercise. Statistical correlation analysis, EEG time-series and topographical analysis were used to assess the association between the ERN signals and the psychological and cognitive states of the participants.

Results: A strong correlation between the amplitude of the ERN signal and the psychological and cognitive states of the participants was observed, which indicate the possibility of estimating the said states using the amplitudes of the novel ERN signal.

Conclusions: The findings pave the way for the development of an ERN based dynamically adaptive assist-as-needed robotic stroke rehabilitation program of which characteristics can be altered to keep the participants' motivation, effort, engagement in the rehabilitation program high. In future, the single-trial prediction ability of the novel ERN signals to predict the state-of-mind of stroke patients will be evaluated.
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http://dx.doi.org/10.1186/s12938-021-00850-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852291PMC
February 2021

Elucidation of antifungal and aflatoxin B inhibitory mode of action of Eugenia caryophyllata L. essential oil loaded chitosan nanomatrix against Aspergillus flavus.

Pestic Biochem Physiol 2021 Feb 14;172:104755. Epub 2020 Dec 14.

Centre for Advanced Study in Botany, Institute of Science, Banaras Hindu University, Varanasi 221005, India. Electronic address:

The present study investigated the novel antifungal, and anti-aflatoxin B mechanism of Eugenia caryophyllata L. essential oil (ECEO) loaded chitosan nanomatrix against the toxigenic strain of A. flavus (AFLV-DK-02). Phytochemical profiling of ECEO was done by GC-MS which revealed eugenol (73.6%) as the primary bioactive compound. ECEO was encapsulated inside the chitosan nanomatrix (ECEO-Np) and characterized using SEM, AFM, FTIR and XRD analysis. The ECEO-Np exhibited enhance antifungal (0.25 μL/mL) and anti-aflatoxin B inhibitory activity (0.15 μL/mL) than ECEO. Antifungal and antiaflatoxin B inhibitory activity was found to be related with impairment in the biological functioning of the plasma membrane (ergosterol synthesis, leakage of membrane ions, UV light (260, 280 nm) absorbing material, dead cell by propidium iodide assay, mitochondrial membrane potential (MMP), methylglyoxal and inhibition in essential carbon substrate utilization). ECEO-Np exhibited remarkable free radical scavenging activity with IC value of 0.002 μL/mL. ECEO-Np effectively preserves the sensory characteristics of exposed maize crop seed up to six months of storage and shows considerable safety profile (non-toxic, non-mutagenic, non-hepatotoxic, non-carcinogenic, non-tumorigenic and biodegradable) using computational ADMET (absorption, distribution, metabolism, excretion, and toxicity) analysis.
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http://dx.doi.org/10.1016/j.pestbp.2020.104755DOI Listing
February 2021

Utilization of extracorporeal membrane oxygenation during the COVID-19 pandemic.

World J Crit Care Med 2021 Jan 9;10(1):1-11. Epub 2021 Jan 9.

Department of Pulmonology and Critical Care, Northwell Health, Riverhead, NY 11901, United States.

The ongoing outbreak of severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2, or coronavirus disease 2019 (COVID-19)] was declared a pandemic by the World Health Organization on March 11, 2020. Worldwide, more than 65 million people have been infected with this SARS-CoV-2 virus, and over 1.5 million people have died due to the viral illness. Although a tremendous amount of medical progress has been made since its inception, there continues to be ongoing research regarding the pathophysiology, treatments, and vaccines. While a vast majority of those infected develop only mild to moderate symptoms, about 5% of people have severe forms of infection resulting in respiratory failure, myocarditis, septic shock, or multi-organ failure. Despite maximal cardiopulmonary support and invasive mechanical ventilation, mortality remains high. Extracorporeal membrane oxygenation (ECMO) remains a valid treatment option when maximal conventional strategies fail. Utilization of ECMO in the pandemic is challenging from both resource allocation and ethical standpoints. This article reviews the rationale behind its use, current status of utilization, and future considerations for ECMO in critically ill COVID-19 patients.
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http://dx.doi.org/10.5492/wjccm.v10.i1.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805254PMC
January 2021

Calming the storm - Stellate ganglion block in refractory ventricular arrhythmia in the emergency department.

Am J Emerg Med 2021 07 29;45:685.e5-685.e8. Epub 2020 Dec 29.

Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1016/j.ajem.2020.12.063DOI Listing
July 2021

Electrospun fibers based on botanical, seaweed, microbial, and animal sourced biomacromolecules and their multidimensional applications.

Int J Biol Macromol 2021 Feb 5;171:130-149. Epub 2021 Jan 5.

Regional Centre of Advanced Technologies and Materials, Palacký University in Olomouc, Šlechtitelů 27, 783 71 Olomouc, Czech Republic.. Electronic address:

This review summarizes and broadly classifies all of the major sustainable natural carbohydrate bio-macromolecular manifestations in nature - from botanical (cellulose, starch, and pectin), seaweed (alginate, carrageenan, and agar), microbial (bacterial cellulose, dextran, and pullulan), and animal (hyaluronan, heparin, chitin, and chitosan) sources - that have been contrived into electrospun fibers. Furthermore, a relative study of these biomaterials for the fabrication of nanofibers by electrospinning and their characteristics viz. solution behavior, blending nature, as well as rheological and fiber attributes are discussed. The potential multidimensional applications of nanofibers (filtration, antimicrobial, biosensor, gas sensor, energy storage, catalytic, and tissue engineering) originating from these polysaccharides and their major impacts on the properties, functionalities, and uses of these electrospun fibers are compared and critically examined.
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http://dx.doi.org/10.1016/j.ijbiomac.2020.12.205DOI Listing
February 2021
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