Publications by authors named "Amit Goyal"

304 Publications

Consume, Contribute, and Create: Succeeding as a Learner and Educator in the Digital Era.

Methodist Debakey Cardiovasc J 2022 3;18(3):59-66. Epub 2022 Jun 3.

Cleveland Clinic, Cleveland, Ohio, US.

From medical student to professorship, the practice of medicine requires lifelong learning. The unforgivingly rapid expansion of medical literature often renders traditional educational resources quickly outdated if not altogether obsolete. Conversely, increasingly popular digital platforms are easily accessible and quickly updated, offering vital adjuncts to traditional resources for the modern student. Further, platforms such as podcasts and social media may be particularly well suited for adult learners who tend to be problem centered, self-directed, internally motivated, and time constrained. Social media empowers all participants, thereby blurring the boundaries between learners and educators. Here we review novel digital educational platforms, discussing both potential benefits and pitfalls, and then provide a three-pillared approach-consume, contribute, and create-to help the modern medical professional harness the potential of both traditional and novel resources to succeed as both a learner and educator.
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http://dx.doi.org/10.14797/mdcvj.1083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9165679PMC
June 2022

Surface Engineered Dendrimers: A Potential Nanocarrier for the Effective Management of Glioblastoma Multiforme.

Curr Drug Metab 2022 Jun 16. Epub 2022 Jun 16.

Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Ajmer, Rajasthan 305817, India.

Gliomas are the most prevailing intracranial tumors, which account for approximately 36% of the primary brain tumors of glial cells. Glioblastoma multiforme (GBM) possesses a higher degree of malignancy among different gliomas. The blood-brain barrier (BBB) acts as a protective shield of the brain against infections and toxic substances by preventing foreign molecules or unwanted cells from entering to brain parenchyma. Nano-carriers such as liposomes, nanoparticles, dendrimers, etc., boost the brain permeability of various anticancer drugs or other drugs. The favourable properties like small size, better solubility, and modifiable surface of dendrimers have proven their wide applicability in the better management of GBM. However, in vitro and in vivo toxicities caused by dendrimers have been a major concern. The presence of multiple functionalities on the surface of dendrimers enables the grafting of targte ligand and/or therapeutic moieties. The surface engineering leads to the improvement of certain properties like targeting effiecieny, pharmackinetic profile, therapeutic effect, and toxicity reduction. This review will be focused on the role of different surface modified dendrimers in the effective management of GBM.
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http://dx.doi.org/10.2174/1389200223666220616125524DOI Listing
June 2022

Mechanistic Insights into Tricuspid Regurgitation Secondary to Pulmonary Arterial Hypertension.

Am J Cardiol 2022 Jul 18;175:97-105. Epub 2022 May 18.

Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address:

The simultaneous presence of pulmonary arterial hypertension (PAH) and secondary tricuspid regurgitation (STR) portends particularly poor outcomes. However, not all patients with PAH develop significant STR, and the mechanisms and clinical implications underlying this phenomenon remain unclear. We sought to describe the functional, anatomic, hemodynamic, and clinical characteristics of patients with PAH with and without STR. Patients diagnosed with PAH between 2007 and 2013 were included. STR, defined by absent primary tricuspid valve disease on transthoracic echocardiogram, was considered significant if ≥ moderate in severity. The characteristics of right-sided chambers and tricuspid valve annuli and leaflets were compared between patients with significant versus nonsignificant STR using a transthoracic echocardiogram, cardiac computed tomography, and right-sided cardiac catheterization. These features were then correlated with the composite outcome of all-cause mortality and PAH hospitalization. Of 88 included patients, 52 had significant STR. No baseline clinical differences, including atrial fibrillation, were observed. Patients with significant STR had worse right ventricular dysfunction (tricuspid annular planar systolic excursion = 1.5 vs 2.1 cm; p = 0.02) and increased right ventricular sphericity (sphericity index = 1.8 vs 2; p = 0.004), with similar annular dimensions/shape, lengths/angles of the mural and septal leaflets, and tenting height. After a median of 54 months, right atrial mean pressure was independently associated with the composite outcome on multivariable analysis (hazard ratio = 1.07, p = 0.02). In conclusion, anatomic and functional alterations in the right ventricle rather than the tricuspid valve are implicated in developing significant STR in PAH. Multimodality imaging provides mechanistic insight, and hemodynamic assessment may offer prognostic guidance in this population.
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http://dx.doi.org/10.1016/j.amjcard.2022.04.010DOI Listing
July 2022

New-onset hyperglycaemia and prolonged systemic corticosteroids therapy in mild COVID-19 patients as major risk factors for invasive mucormycosis: a preliminary study.

Curr Med Mycol 2021 Sep;7(3):22-28

Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India.

Background And Purpose: Rapid surge of invasive mucormycosis has surprised the Indian healthcare system amidst the coronavirus disease-19 (COVID-19) pandemic. Hence, there is an urgent need to find the risk factors for the sudden rise in cases of invasive mucormycosis among COVID-19 patients. This study aimed to find crucial risk factors for the sudden surge of invasive mucormycosis in India.

Materials And Methods: This case-control study included 77 cases of COVID-19 associated mucormycosis (CAM) who matched the controls (45 controls) in terms of age , gender, and COVID-19 disease severity. The control group included subjects that matched controls without mucormycosis confirmed by reverse transcription-polymerase chain reaction at our tertiary care center during April-May 2021. Probable predisposing factors, such as duration of diabetes mellitus (DM), history of recent hospitalization, duration of hospital stay, mode of the received oxygen supplementation, and use of steroids, zinc, vitamin c, and any other specific drugs were collected and compared between the two groups. Moreover, the laboratory parameters, like glycated hemoglobin (HbA1c), highly sensitive C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR) were analyzed to find out the significant association with CAM.

Results: DM (Odds ratio=7.7, 95% CI 3.30-18.12; =<0.0001) and high glycated hemoglobin level (HbA1c>7.5 gm %) (odds ratio=6.2, 95% CI 1.4-26.7; =0.014) were significant risk factors for the development of invasive mucormycosis among the COVID-19 cases. A higher number of mild COVID-19 cases developed CAM, compared to the moderate to severe cases (59.7% vs 40.3%). Use of systemic corticosteroids (odd ratio=5 with 95% CI 1.5-16.9; =0.007) was found to be a risk factor for invasive mucormycosis only in mild COVID-19 cases. Use of oxygen, zinc, and vitamin C supplementation, and proprietary medicine did not lead to a significant risk of invasive mucormycosis in cases, compared to controls. Cases with invasive mucormycosis had a higher level of inflammatory markers (hs-CRP and ESR, =<0.001 and 0.002, respectively), compared to the controls.

Conclusion: Uncontrolled and new-onset DM and the use of systemic corticosteroids in mild cases were significantly associated with a higher risk of invasive mucormycosis in COVID-19 cases. There should be a strong recommendation against the use of systemic corticosteroids in mild COVID-19 cases.
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http://dx.doi.org/10.18502/CMM.7.3.7254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9006735PMC
September 2021

Association of work and hypertension among middle-aged adults and elderly Indians.

Int Arch Occup Environ Health 2022 May 6. Epub 2022 May 6.

International Institute for Population Sciences, Mumbai, India.

Purpose: Over two-fifth of middle-aged adults and elderly (45 +) in India are hypertensive. Though studies examined prevalence, awareness and control of hypertension, little is known on the association of hypertension with work status in India. This study examines the variations of hypertension by types of work among middle-aged adults and the elderly in India.

Methods: Data were drawn from the Longitudinal Aging Survey of India (LASI), Wave 1, 2017-18, and analysis was restricted to participants aged 45 and above with complete information on employment and blood pressure (N = 59,196).

Results: We estimated the adjusted prevalence of hypertension at 49.2% (95% CI, 47.8-50.6) among the ever worked but not currently working and 44.5% (95% CI, 43.1-45.8) among currently working. Among eight broad categories of the currently working population, the adjusted estimates of hypertension were highest among legislators, senior officials and managers (71.5%; 95% CI, 41.9-101.0), followed by service and sales worker workers (44.7%; 95% CI, 41.2-48.2) and least among the professionals (37.1%; 95% CI, 27.1-47.2). Relative to never worked, legislators, senior officials and managers were twice more likely [adjusted OR (AOR) 2.00; 95% CI, 0.74-5.39] to be hypertensive, followed by plant and machine operators (AOR 1.33; 95% CI, 1.04-1.71). The odds of being hypertensive was least among those engaged in professional (engineering, health, education) activities. The other significant predictors are age, sex, residence, education level, household economic condition, family history of hypertension, chronic disease and depression.

Conclusion: The risk of hypertension varies with the types of work in which older Indians are engaged. Awareness and treatment of hypertension in high-risk occupation are recommended.
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http://dx.doi.org/10.1007/s00420-022-01861-9DOI Listing
May 2022

Emerging mucormycosis posing threat to community: Anesthetist's perspective in a tertiary care center.

Saudi J Anaesth 2022 Apr-Jun;16(2):200-203. Epub 2022 Mar 17.

Department of Otorhinolaryngology, AIIMS, Jodhpur, Rajasthan, India.

Mucormycosis has become an ever-growing threat to human health, particularly after the COVID-19 pandemic. As the number of cases of mucormycosis increased, it put a burden on anesthesiologists. Here we describe the etiopathogenesis, clinical presentation, and anesthesia management of patients suffering from mucormycosis.
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http://dx.doi.org/10.4103/sja.sja_604_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9009549PMC
March 2022

Atypical presentations of Fungal Osteomyelitis during post COVID-19 outbreak - Case series.

J Oral Maxillofac Surg Med Pathol 2022 Apr 4. Epub 2022 Apr 4.

Department of Dentistry, Endodontics, All India Institute of Medical Sciences, Jodhpur.

Introduction: Mucormycosis and Aspergillosis are opportunistic fungal infections causing significant morbidity and mortality. Post the outbreak of COVID-19, these fungal osteomyelitis have seen a global rise with few atypical presentations noted.

Case Report: Current case series reports three such atypical presentations of fungal osteomyelitis including mandibular fungal osteomyelitis in two patients, fungal osteomyelitis mimicking space infection in a middle aged male, and suspected mixed fungal osteomyelitis involving maxillary sinus. Aggressive surgical debridement was indicated along with institution of antifungal therapy (Liposomal Amphotericin B, and Posaconazole). The fungal osteomyelitis was successfully treated with surgical and medical management with no recurrence.

Discussion: The injudicious use of corticosteroids in COVID-19 patients along with their immunocompromised status increases their susceptibility to opportunistic fungal osteomyelitis. Prompt and aggressive surgical intervention along with antifungal therapy is important after diagnosing fungal osteomyelitis, as a delay could increase the mortality rate considerably.
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http://dx.doi.org/10.1016/j.ajoms.2022.03.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977445PMC
April 2022

Real-World Healthcare Resource Utilization and Cost Burden Assessment for Adults With Generalized Myasthenia Gravis in the United States.

Front Neurol 2021 18;12:809999. Epub 2022 Jan 18.

ZS Associates, Bangalore, India.

Introduction: Limited evidence exists for healthcare resource utilization (HCRU) and costs associated with generalized myasthenia gravis (gMG), a rare autoimmune disorder, for adults in the United States.

Methods: Adults with ≥1 diagnostic claim for MG between 2014 and 2019 were identified using Symphony Health's Integrated Dataverse®. Using a novel algorithm, HCRU and costs over 12 months following index dates were evaluated for patients with gMG including those with exacerbation events. For patients who experienced crisis events, HCRU and costs were analyzed during the 36 months preceding, during, and 12 months following the events.

Results: Mean HCRU and costs were higher for newly diagnosed patients compared with previously diagnosed patients (hospitalizations: 0.46 vs. 0.34; all-cause costs: $26,419.20 vs. $24,941.47; direct costs for gMG treatments: $9,890.37 vs. $9,186.47) and further increased for patients with exacerbation events (hospitalizations: 0.72; all-cause costs: $43,734.15; direct costs for gMG treatments: $21,550.02). For patients who experienced crisis events, HCRU and costs markedly increased during the 12 months immediately before the crisis event (hospitalizations: 1.35; all-cause costs: $49,236.68) compared with the 2 preceding years and increased further during the 12 months following the crisis index date (hospitalizations: 2.78; all-cause costs: $173,956.99). Cost increases were, in large part, attributed to treatments received.

Discussion: New diagnosis, exacerbation, and crisis events were drivers of HCRU and cost for patients with gMG. Particularly, high costs of gMG-specific medications associated with intervention for exacerbation and crisis events contributed to increased all-cause costs.
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http://dx.doi.org/10.3389/fneur.2021.809999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8805609PMC
January 2022

Erector Spinae Plane Block for Peri-operative Analgesia for Spine Instrumentation Surgery in a Paediatric Patient.

Turk J Anaesthesiol Reanim 2021 Jun;49(3):265-266

Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India.

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http://dx.doi.org/10.5152/TJAR.2021.120DOI Listing
June 2021

Tracheostomy outcomes in coronavirus disease 2019: a systematic review and meta-analysis.

Anaesthesiol Intensive Ther 2021 ;53(5):418-428

All India Institute of Medical Sciences, Jodhpur, India.

Tracheostomy is a standard surgical procedure that is used in critically ill patients who require sustained mechanical ventilation. In this article, we review the outcomes of coronavirus disease 2019 (COVID-19) patients who underwent tracheostomy. We searched for relevant articles on PubMed, Scopus, and Google Scholar, up to April 20, 2021. This meta- analysis examines ventilation liberation, decannulation, and hospital mortality rates in COVID-19 patients who have undergone tracheostomy. Two investigators evaluated the articles, and the differences of opinion were settled by consensus with a third author. A total of 4366 patients were included in 47 related articles for this meta-analysis. After data pooling, the proportions of ventilation liberation, decannulation and mortality were found to be 48% (95% CI: 31-64), 42% (95% CI: 17-69) and 18% (95% CI: 9-28) respectively. The Luis Furuya-Kanamori (LFK) index values for ventilation liberation, decannulation and mortality were 4.28, 1.32 and 0.69. No transmission of the disease attributable to participating in tracheostomy procedures was reported in most of the included articles.
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http://dx.doi.org/10.5114/ait.2021.111594DOI Listing
February 2022

Budget impact analysis of trilaciclib for decreasing the incidence of chemotherapy-induced myelosuppression in patients with extensive-stage small cell lung cancer in the United States.

J Manag Care Spec Pharm 2022 Apr 31;28(4):435-448. Epub 2022 Jan 31.

G1 Therapeutics, Inc, Research Triangle Park, NC.

Chemotherapy-induced myelosuppression, which commonly manifests as neutropenia, anemia, and/or thrombocytopenia, is a frequent and severe complication of standard treatment regimens for patients with extensive-stage small cell lung cancer (ES-SCLC). Trilaciclib is a first-in-class myeloprotective therapy indicated to decrease the incidence of chemotherapy-induced myelosuppression when administered prior to a platinum-/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC. To estimate the budget impact of administering trilaciclib prior to chemotherapy to manage chemotherapy-induced myelosuppression in adults with ES-SCLC from a US payer perspective. A budget impact model was developed to assess the impact of introducing trilaciclib to a hypothetical 1 million-member health insurance plan. The model compared 2 market scenarios: a current scenario of standard treatments for ES-SCLC without trilaciclib, and an alternative scenario of standard treatment plus trilaciclib. Population, clinical, and cost inputs were derived from published literature and trilaciclib clinical trial data. Model outcomes included the number of myelosuppressive adverse events (AEs), costs of treatment, costs of AE management, total cost, and per-member per-month (PMPM) costs. The budget impact of trilaciclib was calculated as the difference in cost (2021 US dollars) between the 2 scenarios over a 1- to 5-year time horizon. Scenario and deterministic sensitivity analyses were conducted to assess uncertainty around key model inputs. An estimated total of 301 patients were eligible for treatment with trilaciclib over a 5-year period. The use of trilaciclib was estimated to reduce the number of myelosuppressive AEs over a 5-year period (events avoided included 108 for neutropenia, 7 for febrile neutropenia, 23 for anemia, and 46 for thrombocytopenia) compared with the scenario without trilaciclib. The adoption of trilaciclib was associated with a cost saving of $801,254 ($0.013 PMPM) over 5 years. The acquisition cost for trilaciclib ($3,704,199) was offset by the reduction in AE management cost ($4,282,748) and reduction in prophylactic granulocyte colony-stimulating factor use ($222,704). The cost savings associated with trilaciclib began in year 1 (total $34,388; $0.003 PMPM) and accrued over time. The acquisition cost of trilaciclib is projected to be offset by a reduction in the costs of managing AEs related to myelosuppression when added to standard chemotherapy regimens for ES-SCLC. The net budget impact of trilaciclib is estimated to be a cost saving. This research was funded by G1 Therapeutics, Inc., and implemented by ZS Associates, an independent consultancy that collated the model inputs and performed the budget impact analysis. The study sponsor was involved in the study design; collection, analysis, and interpretation of data; writing of the report; and the decision to submit the report for publication. The journal open access fee was funded by G1 Therapeutics, Inc. Moran, Chioda, and Huang are employed by G1 Therapeutics, Inc. Chioda and Huang report stocks and stock options for G1 Therapeutics, Inc. Goyal and Deniz are employed by ZS Associates. Goyal reports consulting fees from G1 Therapeutics, Inc. Abraham reports consulting fees from Coherus, G1 Therapeutics, Inc. (unrelated to this study and manuscript), Mylan/Viatris, and Sandoz and participation on a data safety monitoring board or advisory board for G1 Therapeutics, Inc. MacDonald reports consulting fees from Coherus, G1 Therapeutics, Inc. (unrelated to this study and manuscript), Mylan/Viatris, and Sandoz. Deniz reports no disclosures. A synopsis of the current study was presented in poster format at the Virtual AMCP Annual Meeting, April 12-16, 2021.
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http://dx.doi.org/10.18553/jmcp.2022.21379DOI Listing
April 2022

Challenges in Management of Tracheobronchial Foreign Bodies with Delayed Presentation: An Institutional Experience.

Int Arch Otorhinolaryngol 2022 Jan 19;26(1):e005-e009. Epub 2021 Feb 19.

Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

 Airway foreign bodies are emergencies involving multidisciplinary departments like Pediatrics, Aneasthesiology and Otorhinolaryngology. It is always a challenge to diagnose and manage patients who present late to our emergencies.  In the present study, we aim to analyze the various challenges faced during the management of tracheobronchial foreign bodies with delayed presentation.  A retrospective hospital record-based analysis of patients who presented to us with tracheobronchial foreign bodies from January 2017 to February 2020 was performed. All patients until the age of 16 years old were included in the present study. We assessed the demographics, preoperative, intraoperative and postoperative data of the patients.  Seventeen patients were analyzed in the study. Among these, 44.4% of the patients had delayed presentation (> 1 month). The majority of the patients had an organic foreign body (Supari or betel nut). All patients underwent rigid bronchoscopy, followed by optical forceps-assisted removal of the foreign body. A total of 82% of the patients had granulations around the foreign body.  Management of delayed presentation tracheobronchial foreign body is a big challenge for Otorhinolaryngologists. The key factors for preventing complications in the definitive management of tracheobronchial foreign bodies are preoperative planning, multi-discipline teamwork, surgeon expertise and technique.
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http://dx.doi.org/10.1055/s-0040-1718964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8789503PMC
January 2022

Assessment of preoperative and postoperative cardiac function in children with adenotonsillar hypertrophy: a prospective cohort study.

Eur Arch Otorhinolaryngol 2022 Jun 12;279(6):3013-3019. Epub 2022 Jan 12.

Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342 005, India.

Purpose: Chronic upper airway obstruction caused by adenotonsillar hypertrophy is one of the major cause of morbidity in children. It can lead to Obstructive Sleep Apnoea Syndrome, Pulmonary Hypertension, Cor Pulmonale and right heart failure. The study aimed to evaluate and compare various parameters of cardiac function with the help of echocardiography preoperatively and postoperatively in children undergoing adenotonsillectomy.

Methodology: A prospective cohort study was conducted on 23 patients at an apex care institute, under the age group of 4-12 years, who were diagnosed with adenotonsillar hypertrophy. Preoperative symptom analysis and Echocardiographic examination were done. After the assessment, all patients underwent surgery in the form of adenotonsillectomy. Follow-up symptom analysis and echocardiographic examination was done after 3 months postoperatively.

Results: Significant improvement in the obstructive symptoms were noted in postoperative group as expected (p =  < 0.001) and also in parameters such as mPAP (p =  < 0.001), TAPSE (p =  < 0.001), TAV (p = 0.001), Ejection fraction (p = 0.027) and RVMPI (p = 0.044) were improved in postoperative group. 4 patients had Grade 1 Right ventricular diastolic dysfunction, which disappeared in three patients postoperatively.

Conclusion: We have concluded that there can be subclinical cardiac dysfunctions which occurs as a result of chronic upper airway obstruction due to untreated adenotonsillar hypertrophy. Routine cardiac screening in children presenting with sleep disordered breathing associated with adenotonsillar hypertrophy may be helpful in identifying and preventing the development of cardiopulmonary complication. These changes can be reversed by performing adenotonsillectomy.
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http://dx.doi.org/10.1007/s00405-022-07255-4DOI Listing
June 2022

Role of siRNA-based nanocarriers for the treatment of neurodegenerative diseases.

Drug Discov Today 2022 05 10;27(5):1431-1440. Epub 2022 Jan 10.

Amity Institute of Pharmacy, Amity University Madhya Pradesh, Gwalior, MP 474005, India. Electronic address:

Neurodegenerative disorders (NDs) lead to the progressive degeneration of the structural and physiological functions of the central and peripheral nervous systems, resulting in lifelong cognitive and motor dysfunction. Although comprehensive treatment of NDs is lacking, small interfering (si)RNA has shown therapeutic utility in the form of cellular nuclease-driven downregulation of mRNA levels. Various nanotechnologies have been used to modulate crucial physicochemical and biopharmaceutical properties of siRNA to provide protection and to enhance biomembrane interactions, residence times, tissue absorption, and cellular internalization for improved cytoplasm and/or nucleus interactions. In this review, we highlight advances in, and the role of, siRNA-based nanocarriers for the treatment of various NDs.
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http://dx.doi.org/10.1016/j.drudis.2022.01.003DOI Listing
May 2022

Surgical & medical management of ROCM (Rhino-orbito-cerebral mucormycosis) epidemic in COVID-19 era and its outcomes - a tertiary care center experience.

J Mycol Med 2022 May 25;32(2):101238. Epub 2021 Dec 25.

Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India.

Objective: To evaluate the outcome of patients with ROCM (Rhino-orbito-cerebral mucormycosis) following their medical and surgical management.

Materials And Methods: It is a prognostic study based in a tertiary care center in North-Western India. Patients who developed ROCM post COVID-19 infection from 1st September 2020 to 30th June 2021 were included in this study. Surgical debridement and administration of antifungal therapy was done for the post-COVID-19 ROCM patients. Disease progression and survival was studied up to 5 months of follow-up in the second wave.

Results: A total of 145 ROCM patients were included. The mean age at presentation, male: female ratio was 48.2 years and 2:1 respectively. As per our proposed new staging system and treatment strategy, the majority of patients belonged to stage II (31.72%) and stage III (31.03%). On a follow-up period of 5 months, 26 (18%) patients have lost their life and rest of the patients are on strict follow-up.

Conclusion: ROCM is an extremely aggressive fungal infection which rapidly became an epidemic following the COVID-19 pandemic. The diverse and unique presentation led us to evolve a new strategy to classify and manage these patients.
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http://dx.doi.org/10.1016/j.mycmed.2021.101238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8709922PMC
May 2022

Letter to the Editor.

J Card Fail 2022 02 30;28(2):348. Epub 2021 Dec 30.

Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.

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http://dx.doi.org/10.1016/j.cardfail.2021.11.026DOI Listing
February 2022

Mucormycosis: A Case Series of Patients Admitted in Non-COVID-19 Intensive Care Unit of a Tertiary Care Center during the Second Wave.

Indian J Crit Care Med 2021 Oct;25(10):1193-1196

Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Rhino-orbital-cerebral mucormycosis is an invasive fungal infection associated with mortality of 25-62%. There has been a surge in the number of cases during this second wave of coronavirus disease-2019 (COVID-19) in India. We report 10 cases of mucormycosis admitted to our adult intensive care unit. After reviewing the patient's information, we found that 60% of patients had received steroids, and most had uncontrolled blood sugar levels. Most patients received treatment with surgical debridement and antifungal, although the mortality rate was as high as 40%. We report two unique cases of renal and gastrointestinal mucormycosis as well. We concluded that poor glycemic control was the primary etiology behind the rise in the number of cases. Our report also stresses the importance of early surgical intervention and suggests further research comparing the efficacy of combination antifungal therapy versus single antifungal (amphotericin B) to help resource-limited settings in these times of drug crisis. Yadav S, Sharma A, Kothari N, Bhatia PK, Goyal S, Goyal A. Mucormycosis: A Case Series of Patients Admitted in Non-COVID-19 Intensive Care Unit of a Tertiary Care Center during the Second Wave. Indian J Crit Care Med 2021;25(10):1193-1196.
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http://dx.doi.org/10.5005/jp-journals-10071-23986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8645818PMC
October 2021

POSNOC-POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy: a randomised controlled trial of axillary treatment in women with early-stage breast cancer who have metastases in one or two sentinel nodes.

BMJ Open 2021 12 2;11(12):e054365. Epub 2021 Dec 2.

National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, UK.

Introduction: ACOSOG-Z0011(Z11) trial showed that axillary node clearance (ANC) may be omitted in women with ≤2 positive nodes undergoing breast conserving surgery (BCS) and whole breast radiotherapy (RT). A confirmatory study is needed to clarify the role of axillary treatment in women with ≤2 macrometastases undergoing BCS and groups that were not included in Z11 for example, mastectomy and those with microscopic extranodal invasion. The primary objective of POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy (POSNOC) is to evaluate whether for women with breast cancer and 1 or 2 macrometastases, adjuvant therapy alone is non-inferior to adjuvant therapy plus axillary treatment, in terms of 5-year axillary recurrence.

Methods And Analysis: POSNOC is a pragmatic, multicentre, non-inferiority, international trial with participants randomised in a 1:1 ratio. Women are eligible if they have T1/T2, unifocal or multifocal invasive breast cancer, and 1 or 2 macrometastases at sentinel node biopsy, with or without extranodal extension. In the intervention group women receive adjuvant therapy alone, in the standard care group they receive ANC or axillary RT. In both groups women receive adjuvant therapy, according to local guidelines. This includes systemic therapy and, if indicated, RT to breast or chest wall. The UK Radiotherapy Trials Quality Assurance Group manages the in-built radiotherapy quality assurance programme. Primary endpoint is 5-year axillary recurrence. Secondary outcomes are arm morbidity assessed by Lymphoedema and Breast Cancer Questionnaire and QuickDASH questionnaires; quality of life and anxiety as assessed with FACT B+4 and State/Trait Anxiety Inventory questionnaires, respectively; other oncological outcomes; economic evaluation using EQ-5D-5L. Target sample size is 1900. Primary analysis is per protocol. Recruitment started on 1 August 2014 and as of 9 June 2021, 1866 participants have been randomised.

Ethics And Dissemination: Protocol was approved by the National Research Ethics Service Committee East Midlands-Nottingham 2 (REC reference: 13/EM/0459). Results will be submitted for publication in peer-reviewed journals.

Trial Registration Number: ISRCTN54765244; NCT0240168Cite Now.
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http://dx.doi.org/10.1136/bmjopen-2021-054365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8640630PMC
December 2021

A Rare Case of Hearing Loss in a Patient With Ulcerative Colitis.

Inflamm Bowel Dis 2022 03;28(4):e53-e54

Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

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http://dx.doi.org/10.1093/ibd/izab272DOI Listing
March 2022

Magnetic Resonance Imaging in Coronavirus Disease - 2019 Associated Rhino-Orbital-Cerebral Mucormycosis (CA-ROCM) - Imaging Analysis of 50 Consecutive Patients.

Curr Probl Diagn Radiol 2022 Jan-Feb;51(1):112-120. Epub 2021 Nov 3.

Professor Department of Surgical Oncology, Director and CEO, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Background And Purpose: Rhino-orbital-cerebral mucormycosis has emerged as a major opportunistic infection in patients with COVID-19. High clinical suspicion and prompt imaging are crucial for early diagnosis and management. Our study evaluates imaging characteristics of patients with COVID-19 associated Rhino-orbital-cerebral Mucormycosis (CA-ROCM) in a tertiary care hospital in India.

Materials And Methods: A retrospective analysis of clinical and imaging data of patients with CA-ROCM who presented between December 2020 to June 2021 was performed. All patients had microbiologically or histologically proven sino-nasal mucormycosis along with documented SARS-CoV-2 positive RT-PCR test and/or classical lung imaging features of COVID-19 infection. The extent of sinus involvement, bony erosions, extra-sinus soft tissue extension, orbital-intracranial invasion, perineural spread, and vascular complications were assessed.

Results: Fifty patients were included for the final analysis. Diabetes was the most common associated comorbidity. Seven patients presented with stage I disease, 18 patients with stage II, and 25 patients with stage III disease. The stage of disease showed a positive statistical correlation with HbA1c levels using Pearson's correlation. The common imaging features were "Black turbinate sign" and nonenhancing sino-nasal mucosa (82%), orbital involvement (76%), and diffusion restriction in the optic nerve (24%). Intracranial involvement was seen as perineural extension into the brain (42%), cerebritis (30%), and internal carotid artery involvement (16%).

Conclusions: CA-ROCM is an acute invasive fungal sinusitis with an aggressive clinical course. Black-turbinate sign and peri-antral soft tissue infiltration are early features, whereas extra-nasal tissue infarction, optic nerve diffusion restriction, and vascular invasion are seen with advanced disease.
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http://dx.doi.org/10.1067/j.cpradiol.2021.09.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8564981PMC
December 2021

Large left ventricular thrombus with malignant left MCA infarct for emergency decompressive craniectomy.

J Anaesthesiol Clin Pharmacol 2021 Jul-Sep;37(3):489-490. Epub 2021 Oct 12.

Department of Neuroanaesthesia, NIMHANS, Bangalore, Karnataka, India.

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http://dx.doi.org/10.4103/joacp.JOACP_267_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8562450PMC
October 2021

Rilonacept for the treatment of recurrent pericarditis.

Expert Opin Biol Ther 2022 Jan 31;22(1):7-16. Epub 2022 Jan 31.

Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.

Introduction: Recurrent pericarditis (RP) is a debilitating disease that has an underlying autoinflammatory pathophysiology mediated by cytokine interleukin (IL)-1. Rilonacept, a recombinant dimeric fusion protein that blocks IL-1α and IL-1β signaling has emerged as a valuable therapeutic option of RP. Rilonacept has been evaluated in Phase 2 and 3 clinical trials and was recently approved for RP treatment.

Areas Covered: This article reviews available clinical trials assessing the efficacy and safety of rilonacept for the treatment of RP.

Expert Opinion: Findings from the Rhapsody study) trial suggest that rilonacept represents a promising new therapy for those patients with colchicine resistant or glucocorticoid-dependent disease. Treatment leads to rapid clinical response, with a median resolution of symptoms in 5 days, normalization of C-reactive protein (CRP) in a median of 7 days, and successful weaning from glucocorticoids. This novel therapy also reduces recurrence rates compared with placebo. Rilonacept has also demonstrated a good safety profile, with the most common adverse events including injection-site reactions and upper respiratory tract infections. This anti-IL 1 agent has emerged as an efficacious treatment for RP, with potential use for glucocorticoid-free regimens and as monotherapy. Future trials are needed to explore these treatment options and to clarify the appropriate therapy duration.
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http://dx.doi.org/10.1080/14712598.2022.2005024DOI Listing
January 2022

Applications of Adductomics in Chemically Induced Adverse Outcomes and Major Emphasis on DNA Adductomics: A Pathbreaking Tool in Biomedical Research.

Int J Mol Sci 2021 Sep 20;22(18). Epub 2021 Sep 20.

Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.

Adductomics novel and emerging discipline in the toxicological research emphasizes on adducts formed by reactive chemical agents with biological molecules in living organisms. Development in analytical methods propelled the application and utility of adductomics in interdisciplinary sciences. This review endeavors to add a new dimension where comprehensive insights into diverse applications of adductomics in addressing some of society's pressing challenges are provided. Also focuses on diverse applications of adductomics include: forecasting risk of chronic diseases triggered by reactive agents and predicting carcinogenesis induced by tobacco smoking; assessing chemical agents' toxicity and supplementing genotoxicity studies; designing personalized medication and precision treatment in cancer chemotherapy; appraising environmental quality or extent of pollution using biological systems; crafting tools and techniques for diagnosis of diseases and detecting food contaminants; furnishing exposure profile of the individual to electrophiles; and assisting regulatory agencies in risk assessment of reactive chemical agents. Characterizing adducts that are present in extremely low concentrations is an exigent task and more over absence of dedicated database to identify adducts is further exacerbating the problem of adduct diagnosis. In addition, there is scope of improvement in sample preparation methods and data processing software and algorithms for accurate assessment of adducts.
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http://dx.doi.org/10.3390/ijms221810141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8467560PMC
September 2021

Correlation Between the Expression of Matrix Metalloproteinase-9, Matrix Metalloproteinase-13, Tissue Inhibitor of Metalloproteinases-1, p16 and Differentiation of Head and Neck Squamous Cell Carcinoma: A Prospective Observational Study.

Ann Maxillofac Surg 2021 Jan-Jun;11(1):58-63. Epub 2021 Jul 24.

Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Introduction: The expression of matrix metalloproteinase-9 (MMP-9), MMP-13, and tissue inhibitor of metalloproteinases (TIMP-1) in head and neck squamous cell carcinoma (HNSCC) could be a useful predictor of tumour differentiation, nodal metastasis, and invasiveness. We conducted this study to ascertain the correlation between the expression of these markers and differentiation of tumour cells.

Materials And Methods: A prospective observational study was conducted in a tertiary care center. Forty-three cases of proven HNSCC were recruited after obtaining informed consent. Using the surgically excised specimen, tumour differentiation and invasiveness were assessed and correlated with rates of expression of the markers. Chi-square test was done to correlate immunohistochemical (IHC) marker positivity and the degree of differentiation of the tumour, lymph node metastasis, and invasiveness.

Results: MMP-9, MMP-13, and TIMP-1 were expressed in 72%, 34%, and 18% of cases, respectively. p16 expression was not found in any of the cases. MMP-13 expression correlated with poorer differentiation of the tumour ( = 0.03), and relatively younger age at diagnosis ( = 0.01). However, there was no correlation with lymphovascular or perineural invasion or lymph node metastasis.

Discussion: In our study, MMP-13 expression correlated with poorer tumour differentiation and younger age at diagnosis, giving indirect evidence of tumour aggressiveness. IHC markers can provide additional information to prognosticate HNSCC. Identifying potential targets for newer biological therapy is essential in the Indian population as there are biological differences in cancer behavior. Increased expression of the proteolytic MMP-13 correlated with poorer differentiation of HNSCC.
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http://dx.doi.org/10.4103/ams.ams_249_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8407626PMC
July 2021

Relative contributions of radiation and cisplatin-based chemotherapy to sensorineural hearing loss in head-and-neck cancer patients.

Acta Otolaryngol 2021 Sep 6;141(9):885-893. Epub 2021 Sep 6.

Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India.

Background: One of the debilitating complications of head and neck cancer radiotherapy is hearing loss.

Objective: To quantify the magnitude of sensory neural hearing loss (SNHL) in the head and neck cancer patients undergoing chemoradiation therapy.

Design And Methods: This is a prospective study. Eighty patients with head and neck cancers and undergoing volumetric arc therapy were taken up for the study. Regular audiological evaluation was done. The changes in audiological parameters from baseline are correlated with cochlear dose.

Results: Cochlea received maximum doses of up to 28.52 Gy without causing SNHL in the absence of chemotherapy. But in concurrent chemoradiotherapy, hearing loss was found at least dose of 9 Gy at frequency range of 4 KHz-8 KHz. The risk of SNHL is independent of cumulative doses of Cisplatin. In 106 ears receiving concurrent chemoradiation, 82.1% and 74.5% ears had sensorineural hearing loss at 4 KHz and 8 KHz respectively, following the completion of treatment. Otoacoustic emissions in the chemoradiation group showed a significant change at the completion of treatment.

Conclusion And Significance: Volumetric arc therapy have facilitated sparing of cochlea (< 40 Gy). This has resulted in better clinical outcome in terms of SNHL. The inclusion of concurrent cisplatin chemotherapy is a significant risk factor for the development of SNHL at higher frequencies.
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http://dx.doi.org/10.1080/00016489.2021.1969036DOI Listing
September 2021

Does Prolonged Use of N95 Masks Affect Nasal Mucociliary Clearance? A Single Group Pre-Post Study.

Ann Otol Rhinol Laryngol 2022 Jul 28;131(7):730-736. Epub 2021 Aug 28.

Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Objective: It has been shown that prolonged use of face masks results in physiological changes in the nasal cavity. The objective of this study was to examine the effect of prolonged use of face masks on nasal mucociliary clearance (NMC).

Methods: A single group pre-post study was conducted to determine the effects of prolonged use of N95 face mask (≥4 hours) on the NMC rates in health care workers. Saccharin transit time (STT) was used to measure the NMC. STT before and after using an N95 mask for at least 4 hours was measured for all participants in controlled conditions of temperature and humidity.

Results: Forty-eight volunteers (20 female and 28 male) completed the study after the enrollment of 57 volunteers. The mean STT before mask use was 580.27 ± 193.93 seconds (95% CI; 523.95-636.58 seconds) and after mask use was 667.47 ± 237.42 seconds (95% CI; 598.53-736.42 seconds). There was significant prolongation of the NMC after prolonged use of N95 mask on performing the paired -test ( = .002). The mean prolongation was 87.20 ± 184.97 seconds with an actual effect size of 0.40. Ambient temperature and humidity were not significantly different at the two test instances.

Conclusion: Use of the N95 face masks for 4 hours results in prolongation of the nasal mucociliary clearance as measured by STT. Susceptibility to any respiratory infection may be increased following doffing of the personal protective equipment, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) itself.
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http://dx.doi.org/10.1177/00034894211041821DOI Listing
July 2022

Tips and Pearls for Tracheostomy during the Covid-19 Pandemic.

Int Arch Otorhinolaryngol 2021 Jul 29;25(3):e459-e462. Epub 2021 Jul 29.

Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

The number of critically-ill coronavirus disease 2019 (Covid-19) patients requiring mechanical ventilation is on the rise. Most guidelines suggest keeping the patient intubated and delay elective tracheostomy. Although the current literature does not support early tracheostomy, the number of patients undergoing it is increasing. During the pandemic, it is important that surgeons and anesthesiologists know the different aspects of tracheostomy in terms of indication, procedure, tube care and complications. A literature search was performed to identify different guidelines and available evidence on tracheostomy in Covid-19 patients. The purpose of the present article is to generate an essential scientific evidence for life-saving tracheostomy procedures.
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http://dx.doi.org/10.1055/s-0041-1731723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321648PMC
July 2021

Rapid Response Preparedness for Management of Post-Covid Invasive Rhino-Orbito-Cerebral Fungal Infections: Experience from a Tertiary Care Government Institute in India.

Indian J Otolaryngol Head Neck Surg 2021 Jul 18:1-3. Epub 2021 Jul 18.

Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India.

Sudden surge of Post Covid-19 Rhino-orbito-mucormycosis cases has left entire ENT fraternity in the center of a war room. We present a quick administrative preparedness for this situation in a tertiary care Government Institute in India. This model may serve as a reference for other centers.
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http://dx.doi.org/10.1007/s12070-021-02753-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286846PMC
July 2021

Sensorineural Hearing Loss in Dengue: A Pilot Study.

Iran J Otorhinolaryngol 2021 May;33(116):157-161

Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur.

Introduction: Association of hearing loss has been found with a couple of febrile illnesses. Dengue fever is an arboviral febrile illness that is transmitted by Aedes mosquito. A case of sensorineural hearing was documented in the literature recently in dengue haemorrhagic fever. We are aiming to find if hearing loss occurs in dengue patients.

Methods And Methodology: We assessed the hearing of ten patients diagnosed with Dengue fever from August 2018 to October 2018, prospectively. Patients who had a prior history of hearing loss or chronic suppurative otitis media were excluded from the study. Brief history, clinical examination and audiological assessment were made for all patients. All patients were followed up for three months with repeat audiological evaluation.

Results: Two patients complained of hearing loss after the onset of fever. They had a bilateral mild sensorineural hearing loss on audiological evaluation. One other patient was found to have bilateral high-frequency hearing loss although there was no complaint of hearing impairment. On three months follow up, both patients had bilateral mild sensorineural hearing loss with no improvement.

Conclusion: Hearing loss in dengue fever, even though being mild in nature is irreversible. The cause of hearing loss in dengue is yet to be found. For the definitive association of hearing loss in dengue fever further studies are required.
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http://dx.doi.org/10.22038/ijorl.2020.39874.2314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8231302PMC
May 2021

Theranostic Applications of Nanomaterials in the Field of Cardiovascular Diseases.

Curr Pharm Des 2022 ;28(2):91-103

Department of Pharmacy, School of Chemical Sciences and Pharmacy, Central University of Rajasthan, Bandarsindri, Ajmer, Rajasthan 305817, India.

A large percentage of people are being exposed to mortality due to cardiovascular diseases. Convention approaches have not provided satisfactory outcomes in the management of these diseases. To overcome the limitations of conventional approaches, nanomaterials like nanoparticles, nanotubes, micelles, lipid-based nanocarriers, dendrimers, and carbon-based nanoformulations represent the new aspect of diagnosis and treatment of cardiovascular diseases. The unique inherent properties of the nanomaterials are the major reasons for their rapidly growing demand in the field of medicine. Profound knowledge in the field of nanotechnology and biomedicine is needed for the notable translation of nanomaterials into theranostic cardiovascular applications. In this review, the authors have summarized different nanomaterials which are being extensively used to diagnose and treat the diseases, such as coronary heart disease, myocardial infarction, atherosclerosis, stroke and thrombosis.
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http://dx.doi.org/10.2174/1381612827666210701154305DOI Listing
March 2022
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