Publications by authors named "Anand Kumar"

849 Publications

Association of Catechol-O-Methyltransferase Gene rs4680 Polymorphism and Levodopa Induced Dyskinesia in Parkinson's Disease: A Meta-Analysis and Systematic Review.

J Geriatr Psychiatry Neurol 2022 May 22:8919887221103580. Epub 2022 May 22.

Department of Neurology, Institute of Medical Sciences, 30117Banaras Hindu University, Varanasi, India.

Introduction: Long-term levodopa therapy for Parkinson's disease (PD) can cause levodopa induced dyskinesia (LID). Genetic predisposition has a significant role to play in inter-individual heterogeneity in the clinical manifestation of LID. Despite accumulating evidence for the role of COMT gene polymorphism (rs4680) as a genetic basis for LID, to date results have been inconsistent. Early assessment of the Catechol-O-Methyltransferase (COMT) genotype might be helpful to stratify PD patients concerning their individual risk for LID.

Method: In this meta-analysis, we have used 9 studies, which were selected through online databases. Statistical analysis was performed using R (v-3.6) software. 5 genetic models have been used in the present study: Allele model (A vs. G), Dominant model (AA+AG vs. GG), Homozygote model (AA vs. GG), Co-dominant/heterozygote model (AG vs. GG), and Recessive model (AA vs. AG + GG).

Results: The results indicated a significant association between COMT rs4680 (Val158Met) polymorphism and LID risk. The genotype AA of COMT rs4680 is a risk factor for LID in PD patients under the recessive model (AA vs GG+AG) in the random-effect model. Analysis based on ethnicity showed that COMT rs4680 SNP allele A is a risk factor for LID development in Asian PD patients, while GG genotype is a risk factor for LID development in non-Asian PD patients using different genetic models.

Conclusion: The results of the present meta-analysis support that the COMT Val158Met polymorphism is a risk factor for the development of LID in PD patients having ethnic variations.
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http://dx.doi.org/10.1177/08919887221103580DOI Listing
May 2022

ADCY5 Related Dyskinesia-A Rare Mutation.

Mov Disord Clin Pract 2022 May 16;9(4):553-555. Epub 2022 Feb 16.

Department of Neurology, Institute of Medical Science Banaras Hindu University Varanasi India.

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http://dx.doi.org/10.1002/mdc3.13419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9092730PMC
May 2022

Impact of family-centred postnatal training on maternal and neonatal health and care practices in district hospitals in two states in India: a pre-post study.

BMJ Open Qual 2022 May;11(Suppl 1)

Research, Aurora Health Innovations LLP, Bangalore, India

Background And Objectives: The Care Companion Program (CCP) is an in-hospital multitopic skill-based training programme provided to families to improve postdischarge maternal and neonatal health. The states of Punjab and Karnataka in India piloted the programme in 12 district hospitals in July 2017, and no study to date has evaluated its impact.

Methods: We compared telephonically self-reported maternal and neonatal care practices and health outcomes before and after the launch of the CCP programme in 11 facilities. Families in the preintervention group delivered between May to June 2017 (N=1474) while those in the intervention group delivered between August and October 2017 (N=3510). Programme effects were expressed as adjusted risk ratios obtained from logistic regression models.

Results: At 2-week postdelivery, the practice of dry cord care improved by 4% (RR=1.04, 95% CI 1.02 to 1.06) and skin-to-skin care by 78% (RR=1.78, 95% CI 1.37 to 2.27) in the postintervention group as compared with preintervention group. Furthermore, newborn complications reduced by 16% (RR=0.84, 95% CI 0.76 to 0.91), mother complications by 12% (RR=0.88, 95% CI 0.79 to 0.97) and newborn readmissions by 56% (RR=0.44, 95% CI 0.31 to 0.61). Outpatient visits increased by 27% (RR=1.27, 95% CI 1.10 to 1.46). However, the practice of exclusive breastfeeding, unrestricted maternal diet, hand-hygiene and being instructed on warning signs were not statistically different.

Conclusion: Postnatal care should incorporate predischarge training of families. Our findings demonstrate that it is possible to improve maternal and neonatal care practices and outcomes through a family-centered programme integrated into public health facilities in low and middle-income countries.
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http://dx.doi.org/10.1136/bmjoq-2021-001462DOI Listing
May 2022

First case report of anti-AMPA receptor encephalitis presenting with features of parkinsonism.

Neurol Sci 2022 May 11. Epub 2022 May 11.

Department of Neurology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidayapeetham, Ponekkara PO, Kochi, 682041, Kerala, India.

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http://dx.doi.org/10.1007/s10072-022-06072-1DOI Listing
May 2022

Understanding specific ion effects and the Hofmeister series.

Phys Chem Chem Phys 2022 May 11. Epub 2022 May 11.

Discipline of Chemistry, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, New South Wales 2308, Australia.

Specific ion effects (SIE), encompassing the Hofmeister Series, have been known for more than 130 years since Hofmeister and Lewith's foundational work. SIEs are ubiquitous and are observed across the medical, biological, chemical and industrial sciences. Nevertheless, no general predictive theory has yet been able to explain ion specificity across these fields; it remains impossible to predict when, how, and to what magnitude, a SIE will be observed. In part, this is due to the complexity of real systems in which ions, counterions, solvents and cosolutes all play varying roles, which give rise to anomalies and reversals in anticipated SIEs. Herein we review the historical explanations for SIE in water and the key ion properties that have been attributed to them. Systems where the Hofmeister series is perturbed or reversed are explored, as is the behaviour of ions at the liquid-vapour interface. We discuss SIEs in mixed electrolytes, nonaqueous solvents, and in highly concentrated electrolyte solutions - exciting frontiers in this field with particular relevance to biological and electrochemical applications. We conclude the perspective by summarising the challenges and opportunities facing this SIE research that highlight potential pathways towards a general predictive theory of SIE.
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http://dx.doi.org/10.1039/d2cp00847eDOI Listing
May 2022

Opercular Syndrome: A Rare Presentation of Schilder's Variant of Multiple Sclerosis.

Neurol India 2022 Mar-Apr;70(2):806-807

Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

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http://dx.doi.org/10.4103/0028-3886.344611DOI Listing
May 2022

Corneal Neurotization: A Meta-analysis of Outcomes and Patient Selection Factors.

Ann Plast Surg 2022 Apr 2. Epub 2022 Apr 2.

From the Departments of Plastic and Reconstructive Surgery.

Background: Corneal neurotization describes reinnervation of the anesthetic or severely hypoesthetic cornea with a healthy local nerve or graft. Preliminary evidence has shown corneal neurotization to improve corneal sensation, visual acuity, and ocular surface health. Factors that improve patient selection and lead to better neurotization outcomes have yet to be elucidated, limiting ability to optimize perioperative decision-making guidelines.

Methods: A systematic review with meta-analysis was performed of the MEDLINE and Embase databases using variations of "corneal," "nerve transfer," "neurotization," and "neurotization." The primary outcomes of interest were corrected visual acuity, NK Mackie stage, and central corneal sensation. Regression analyses were performed to identify the effects of surgical technique, duration of denervation, patient age, and etiology of corneal pathology on neurotization outcomes.

Results: Seventeen studies were included. Corneal neurotization resulted in significant improvement in NK Mackie stage (0.84 vs 2.46, P < 0.001), visual acuity (logarithm of minimum angle of resolution scale: 0.98 vs 1.36, P < 0.001), and corneal sensation (44.5 vs 0.7, P < 0.001). Nerve grafting was associated with greater corneal sensation improvement than nerve transfer (47.7 ± 16.0 vs 35.4 ± 18.76, P = 0.03). Denervation duration was predictive of preneurotization visual acuity (logarithm of minimum angle of resolution scale; R2 = 0.25, P = 0.001), and older age (ß = 0.30, P = 0.03) and acquired etiology (ß = 0.30, P = 0.03) were predictive of improved visual acuity.

Conclusions: Corneal neurotization provides significant clinical improvement in visual acuity, NK Mackie staging, and corneal sensation in patients who experience NK. Both nerve grafting and nerve transfer are likely to yield similar levels of benefit and ideally should be performed early to limit denervation time.
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http://dx.doi.org/10.1097/SAP.0000000000003117DOI Listing
April 2022

Post ChAdOx1 nCoV-19 vaccination frontal lobe syndrome.

Neurol Sci 2022 Apr 23. Epub 2022 Apr 23.

Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, 221005, Varanasi, India.

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http://dx.doi.org/10.1007/s10072-022-06086-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9034769PMC
April 2022

Gans repositioning maneuver for the posterior canal BPPV patients: systematic review and meta-analysis.

Eur Arch Otorhinolaryngol 2022 Apr 23. Epub 2022 Apr 23.

Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.

Background And Objectives: BPPV (benign paroxysmal positional vertigo) is a syndrome marked by brief bouts of vertigo accompanied by rapid changes in head position. Recent ongoing therapeutic approaches used are vestibular rehabilitation exercises and physical maneuvers like the Epley maneuver, Semont maneuver. Gans repositioning maneuver (GRM) is a new hybrid maneuver, consisting of safe and comfortable series of postures that can be conveniently applied on patients with any spinal pathology or even in elderly.

Methods: Randomized controlled/clinical trials of the Gans maneuver were identified. The proportion of patients who improved as a result of each intervention was assessed, as well as the conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test.

Results: Improvement was seen in almost all patients with the Gans maneuver and the Epley Maneuver in three trials with the pooled estimate for random effect model is 1.12 [0.87; 1.43: 100%]. There were no significant side effects from the treatment.

Discussion: This study shows that the Gans maneuver is a safe and effective treatment for patients suffering from posterior canal BPPV.

Trial Registration: The review is registered in Prospero with no. CRD42021234100.
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http://dx.doi.org/10.1007/s00405-022-07396-6DOI Listing
April 2022

Direct percutaneous endoscopic jejunostomy (DPEJ) and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) technical success and outcomes: Systematic review and meta-analysis.

Endosc Int Open 2022 Apr 14;10(4):E488-E520. Epub 2022 Apr 14.

Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States.

Endoscopic methods of delivering uninterrupted feeding to the jejunum include direct percutaneous endoscopic jejunostomy (DPEJ) or PEG with jejunal extension (PEG-J), validated from small individual studies. We aim to perform a meta-analysis to assess their effectiveness and safety in a variety of clinical scenarios. Major databases were searched until June 2021. Efficacy outcomes included technical and clinical success, while safety outcomes included adverse events (AEs) and malfunction rates. We assessed heterogeneity using and classic fail-safe to assess bias. 29 studies included 1874 patients (983 males and 809 females); mean age of 60 ± 19 years. Pooled technical and clinical success rates with DPEJ were 86.6 % (CI, 82.1-90.1, 73.1) and 96.9 % (CI, 95.0-98.0, 12.7). The pooled incidence of malfunction, major and minor AEs with DPEJ were 11 %, 5 %, and 15 %. Pooled technical and clinical success for PEG-J were 94.4 % (CI, 85.5-97.9, 33) and 98.7 % (CI, 95.5-99.6,  < 0.001). The pooled incidence of malfunction, major and minor AEs with DPEJ were 24 %, 1 %, and 25 %. Device-assisted DPEJ performed better in altered gastrointestinal anatomy. First and second attempts were 87.6 % and 90.2 %. DPEJ and PEG-J are safe and effective procedures placed with high fidelity with comparable outcomes. DPEJ was associated with fewer tube malfunction and failure rates; however, it is technically more complex and not standardized, while PEG-J had higher placement rates. The use of balloon enteroscopy was found to enhance DPEJ performance.
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http://dx.doi.org/10.1055/a-1774-4736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010104PMC
April 2022

EUS-guided gastroenterostomy versus surgical gastroenterostomy for the management of gastric outlet obstruction: a systematic review and meta-analysis.

Endosc Int Open 2022 Apr 14;10(4):E448-E458. Epub 2022 Apr 14.

Division of Gastroenterology, Lenox Hill Hospital, New York, New York, United States.

 Surgical gastroenterostomy (SGE) has been the mainstay treatment for gastric outlet obstruction (GOO). The emergence of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) presents a less invasive alternative for palliation of GOO. We conducted a comprehensive review and meta-analysis to compare the effectiveness and safety of EUS-GE compared to SGE.  Multiple electronic databases and conference proceedings up to April 2021 were searched to identify studies that reported on safety and effectiveness of EUS-GE in comparison to SGE. Pooled odds ratios (ORs) of technical success, clinical success, adverse events (AE) and recurrence, and pooled standardized mean difference (SMD) of procedure time and post-procedure length of stay (LOS) were calculated. Study heterogeneity was assessed using and Cochran Q statistics.  Seven studies including 625 patients (372 EUS-GE and 253 SGE) were included. EUS-GE had lower pooled odds of technical success compared with SGE (OR 0.19, 95 % confidence interval [CI] 0.06-0.60, 0 %). Among the technically successful cases, EUS-GE was superior in terms of clinical success (OR 4.73, 95 % CI 1.83-12.25, 18 %), lower overall AE (OR 0.20, 95 % CI 0.10-0.37, 39 %), and shorter procedure time (SMD -2.4, 95 % CI -4.1, -0.75, 95 %) and post-procedure LOS (SMD -0.49, 95 % CI -0.94, -0.03, 78%). Rates of severe AE (0.89, 95 % CI 0.11-7.36, 67 %) and recurrence (OR 0.49, 95 % CI 0.18-1.38, 49 %) were comparable.  Our results suggest EUS-GE is a promising alternative to SGE due to its superior clinical success, overall safety, and efficiency. With further evolution EUS-GE could become the intervention of choice in GOO.
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http://dx.doi.org/10.1055/a-1765-4035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010090PMC
April 2022

The Age of Next-Generation Therapeutic-Microbe Discovery: Exploiting Microbe-Microbe and Host-Microbe Interactions for Disease Prevention.

Infect Immun 2022 May 6;90(5):e0058921. Epub 2022 Apr 6.

B-10: Biosecurity and Public Health Group, Bioscience Division, Los Alamos National Laboratorygrid.148313.c, Los Alamos, New Mexico, USA.

Humans are considered "superorganisms," harboring a diverse microbial collective that outnumbers human cells 10 to 1. Complex and gravely understudied host- and microbe-microbe interactions-the product of millions of years of host-microbe coevolution-govern the superorganism in almost every aspect of life functions and overall well-being. Abruptly disrupting these interactions via extrinsic factors has undesirable consequences for the host. On the other hand, supplementing commensal or beneficial microbes may mitigate perturbed interactions or enhance the interactive relationships that ultimately benefit all parties. Hence, immense efforts have focused on dissecting the innumerable host- and microbe-microbe relationships to characterize if a "positive" or "negative" interaction is at play and to exploit such behavior for broader implications. For example, microbiome research has worked to identify and isolate naturally antipathogenic microbes that may offer therapeutic potential either in a direct, one-on-one application or by leveraging its unique metabolic properties. However, the discovery and isolation of such desired therapeutic microbes from complex microbiota have proven challenging. Currently, there is no conventional technique to universally and functionally screen for these microbes. With this said, we first describe in this review the historical (probiotics) and current (fecal microbiota or defined consortia) perspectives on therapeutic microbes, present the discoveries of therapeutic microbes through exploiting microbe-microbe and host-microbe interactions, and detail our team's efforts in discovering therapeutic microbes via our novel microbiome screening platform. We conclude this minireview by briefly discussing challenges and possible solutions with therapeutic microbes' applications and paths ahead for discovery.
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http://dx.doi.org/10.1128/iai.00589-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9119102PMC
May 2022

Aspirin resistance and blood biomarkers in predicting ischemic stroke recurrence: An exploratory study.

Brain Circ 2022 Jan-Mar;8(1):31-37. Epub 2022 Mar 21.

Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Background: Recurrent strokes cause greater complications and worse outcomes by adding to the existing neurological deficit. There is the paucity of data on serum markers of inflammation as predictors of recurrent stroke. This study was planned to analyze the clinico-etiological profile of recurrent noncardioembolic ischemic stroke, estimate aspirin resistance among regular aspirin users and evaluate blood biomarkers high-sensitivity C-reactive protein (hsCRP), Tumor necrosis factor-alpha (TNF-α), Lipoprotein-associated phospholipase A (Lp-PLA2) as probable predictors of stroke recurrence.

Methods: Patients of recurrent noncardioembolic ischemic stroke fulfilling the inclusion criteria were enrolled. Detailed history, clinical examination, and investigations were obtained as per protocol. Aspirin resistance was determined by light transmission aggregometry. Serum hsCRP, TNF-α, and Lp-PLA2 levels were estimated.

Results: This study included 34 males and 16 females. Majority of the patients were > 60 years ( = 30, 60%). Thirty (60%) cases had a repeat stroke after 1 year of primary event. Thirty-nine (78%) study participants had hypertension, while 15 (30%) had diabetes. Middle cerebral artery ( = 40, 80%) was the most common vascular territory. Thirty-one (62%) cases belonged to TOAST subtype 1 (large artery atherosclerosis). Seventy two percent cases were prescribed aspirin after index stroke, but only 36% were compliant. Median (range) hsCRP level was 7.5 (0.3-155) mg/L with 72% of patients having high hsCRP level (>3 mg/L). Median (range) serum PLA2 level was 11.98 (3.31-87.24) ng/ml in patients and 6.96 (0.15-61.42) ng/ml in controls ( = 0.029). Median (range) serum TNF-α level in patients was significantly higher than controls (68.22 [1.3-287] pg/ml versus 0.098 [0.002-36.31] pg/ml, < 0.001). Aspirin resistance was found in 41.7% patients while 16.7% were semi-resistant. Mean % platelet aggregation was 34.75 ± 21.58 in patients and 64.75 ± 16.98 for controls ( < 0.001).

Conclusions: Majority of patients with recurrent stroke were elderly (>60 years), hypertensive, and non-compliant with aspirin. Aspirin resistance was an important factor in patients with antiplatelet compliance. Inflammatory biomarkers hsCRP, PLA2, and TNF-α were found to be significantly elevated in patients compared to controls.
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http://dx.doi.org/10.4103/bc.bc_75_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8973447PMC
March 2022

Subacute Sclerosing Panencephalitis with An Atypical Presentation.

Ann Indian Acad Neurol 2021 Nov-Dec;24(6):946-947. Epub 2021 Jan 25.

Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

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http://dx.doi.org/10.4103/aian.AIAN_791_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8965937PMC
January 2021

Predictive Value of Combination of D-dimer and Fibrinogen in Diagnosing Acute CVST.

Ann Neurosci 2021 Jul 23;28(3-4):156-161. Epub 2021 Dec 23.

Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Background: Cerebral venous sinus thrombosis (CVST) is an uncommon subtype of stroke, and the role of D-dimer and fibrinogen in early diagnosis of CVST has been studied with varying results. The present study aims to study the role of the combination of D-dimer and fibrinogen in early diagnosis of acute CVST.

Methods: Forty consecutive confirmed acute CVST cases admitted at a tertiary care center were recruited for the study. D-dimer and fibrinogen were assessed by a rapid semiquantitative latex agglutination assay.

Results: Out of the 40 CVST patients, 21 (52.50%) were females. The mean age of the patients was 37.58 years ± 19.17 years. Common clinical features were headache ( = 38 [95%]), papilloedema ( = 15 [37.5%]), and seizures ( = 12 [30%]). Although the sensitivity (75%) of the combination of D-dimer and fibrinogen assay was lower than that of D-dimer or fibrinogen alone, the specificity and positive predictive value (75% each) was higher.

Conclusion: The combination of D-dimer and fibrinogen testing may aid in an early diagnosis of acute CVST and in better management.
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http://dx.doi.org/10.1177/09727531211063138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8948324PMC
July 2021

Response.

Gastrointest Endosc 2022 04;95(4):815-816

Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

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http://dx.doi.org/10.1016/j.gie.2021.12.012DOI Listing
April 2022

First clinical results of fluorescence lifetime-enhanced tumor imaging using receptor targeted fluorescent probes.

Clin Cancer Res 2022 Mar 18. Epub 2022 Mar 18.

Massachusetts General Hospital, Charlestown, Massachusetts, United States.

Purpose: Fluorescence molecular imaging, using cancer targeted near infrared (NIR) fluorescent probes, offers the promise of accurate tumor delineation during surgeries and the detection of cancer specific molecular expression in vivo. However, non-specific probe accumulation in normal tissue results in poor tumor fluorescence contrast, precluding widespread clinical adoption of novel imaging agents. Here we present the first clinical evidence that fluorescence lifetime (FLT) imaging can provide tumor specificity at the cellular level in patients systemically injected with panitumumab-IRDye800CW, an epidermal growth factor receptor (EGFR) targeted NIR fluorescent probe.

Experimental Design: We performed wide-field and microscopic fluorescence lifetime imaging of resection specimens from patients injected with panitumumab-IRDye800CW under an FDA directed clinical trial.

Results: We show that the FLT within EGFR overexpressing cancer cells is significantly longer than the FLT of normal tissue, providing high sensitivity (>98%) and specificity (>98%) for tumor vs. normal tissue classification, despite the presence of significant non-specific probe accumulation. We further show microscopic evidence that the mean tissue FLT is spatially correlated (r > 0.85) with tumor-specific EGFR expression in tissue and is consistent across multiple patients. These tumor cell-specific FLT changes can be detected through thick biological tissue, allowing highly specific tumor detection and non-invasive monitoring of tumor EFGR expression in vivo.

Conclusions: Our data indicate that FLT imaging is a promising approach for enhancing tumor contrast using an antibody targeted NIR probe with a proven safety profile in humans, suggesting a strong potential for clinical applications in image guided surgery, cancer diagnostics, and staging.
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http://dx.doi.org/10.1158/1078-0432.CCR-21-3429DOI Listing
March 2022

An age-related algorithm for management of micro-orbitism from anophthalmia: a systematic review with supplemental case reports.

Orbit 2022 Mar 17:1-10. Epub 2022 Mar 17.

Department of Plastic and Reconstructive Surgery, Case Western Reserve University, Cleveland, Ohio, USA.

Management of pediatric anophthalmia and resultant micro-orbitism is challenging. The efficacy and safety of treatment methods vary with age as bony changes grow recalcitrant to implants in those at skeletal maturity and osteotomies become technically challenging following frontal sinus pneumatization. This study aims to review methods for managing micro-orbitism and develop an age-based treatment approach. A systematic literature review was conducted. Data were screened and extracted by two investigators and relevant English-language primary-literature was analyzed. Information on sample-size, number of orbits, intervention, age, complications, and prosthetic retention was obtained. Representative case reports are presented, in addition. Nineteen studies met inclusion: 294 orbits in 266 patients were treated. Two studies reported distraction-osteogenesis. Two studies utilized bone grafting. Osteotomies were performed in 41 patients from three studies. Use of solid implants was detailed in two studies. Three studies described osmotic implant. Four studies described inflatable implants. Other techniques were described by three of the included studies, two of which utilized dermis-fat grafting. All but one study were observational case reports or case series. Across all studies regardless of surgical technique, risk of bias and heterogeneity was high due to attrition bias and selective outcomes-reporting. Selection of therapy should be tailored to skeletal-age to optimize outcomes; those 0-4 yrs are managed with dermis-fat grafts, 5-7 yrs managed with implants, and 8+ yrs managed with osteotomies. For those 8+ yrs with aerated frontal sinuses or insufficient bone stock, we propose onlay camouflage prosthetics which improve projection, increase orbital volume, and avoid risk for frontal sinus injury.
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http://dx.doi.org/10.1080/01676830.2022.2043391DOI Listing
March 2022

Clinical Profile and Diffusion Tensor Imaging in Patients of Subacute Sclerosing Pan Encephalitis: A Prospective Follow-up Study from Eastern Part of India.

Neurol India 2022 Jan-Feb;70(1):197-202

Department of Neurology, Banaras Hindu University, Varanasi, UP, India.

Background: Subacute Sclerosing Pan Encephalitis (SSPE) may present with atypical clinical features and lead to diagnostic dilemma. Conventional magnetic resonance imaging (MRI) may be normal in early stage of SSPE.

Objective: The aim of this work was to study the demography, clinical profile including atypical features of SSPE patients, and the utility of diffusion tensor imaging (DTI) as an adjunctive diagnostic tool to the anti-measles antibody and conventional MRI.

Material And Methods: Consecutive 25 patients of SSPE were included. Clinical details were recorded at baseline and 6 months follow-up. Anti-measles antibody in serum and CSF, CSF/Serum Quotient reference (CSQ ref), and radiological details including comparison of DTI between SSPE patients and controls were also noted.

Results: Of 25 patients, 17 (68%) were male. The most common presenting feature at onset was myoclonus with or without falls (13, 52%). Atypical features such as seizure, hemiparesis, and visual problems were present in 28% patients. At 6 months, 9 patients had progressive course (6 expired), 10 were static, and 6 lost to follow-up. MRI was normal in 8 (32%) patients (stage 2/3- 7/1). On comparison between SSPE patients (N = 10) and control (N = 10) groups, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) values were reduced and elevated, respectively, at most of the regions of interest with significant difference at many sites.

Conclusions: A significant number of patients (28%) had atypical features at onset. DTI is an adjunctive tool which supplements the conventional MRI and increase diagnostic yield. It may be a future option to assess disease progression and treatment response.
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http://dx.doi.org/10.4103/0028-3886.336333DOI Listing
March 2022

Pseudotumor Cerebri Syndrome (PTCS), Clinico-Radiological Profile: A Prospective Study.

Neurol India 2022 Jan-Feb;70(1):102-107

Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Objectives: The aim of the study was to classify patients of Pseudotumor Cerebri Syndrome (PTCS) on the basis of newer classification along with its clinico-radiological correlations.

Patients And Methods: A prospective study was conducted at a tertiary care teaching hospital. A total of 25 consecutive patients who fulfilled the new diagnostic criteria for PTCS were enrolled after taking informed written consent. A thorough clinical history, neurological examination and neuroimaging was carried out. Patients were classified into Primary and Secondary PTCS followed by Definite, Probable and Suggested as per new nomenclature.

Results: Out of 25 patients, there were 9 patients in the primary PTCS group and 16 in the secondary PTCS group. Mean duration of symptoms was 40.84 ± 45.68 days. Primary PTCS group patients were significantly overweight and had higher BMI as compared to the secondary group with significant number of patients reporting recent rapid weight gain. The CSF pressure and protein were non-significantly higher in the primary PTCS group. We could classify 17 (68%) patients in our study as definite PTCS, 7 (28%) as probable PTCS and suggested PTCS in one patient. In secondary PTCS group there were 16 (64%) patients. APLA positivity was found to be the most common etiology for secondary PTCS with statistical significance (P = 0.025).

Conclusions: Early recognition along with appropriate classification and prompt treatment can prevent vision loss in PTCS. Apart from obesity, recent weight gain is also closely related with primary PTCS.
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http://dx.doi.org/10.4103/0028-3886.336327DOI Listing
March 2022

Machine Learning Technique to Detect and Classify Mental Illness on Social Media Using Lexicon-Based Recommender System.

Comput Intell Neurosci 2022 26;2022:5906797. Epub 2022 Feb 26.

Department of Electrical Engineering, Tamale Technical University, Tamale, Ghana.

The emergence of social media has allowed people to express their feelings on products, services, films, and so on. The feeling is the user's view or attitude towards any topic, object, event, or service. Overall, feelings have always influenced people's decision-making. In recent years, emotions have been analyzed intensively in natural language, but many problems still have to be watched. One of the most important problems is the lack of precise classification resources. Most of the research into feeling gradation is concerned with the issue of polarity grading, although, in many practical applications, this relatively grounded feeling measure is insufficient. Design methods are therefore essential, which can accurately classify feelings into a natural language. The principal goal of the research is to develop an overflow of grammatical rules-based classification of Indian language tweets. In this work, three main challenges are identified to classify feelings in Indian language tweets and possible methods for tackling such issues. Firstly, it has been found that the informal nature of tweets is crucial for the classification of feelings. Based on the tweets, the mental illness of the person has been classified. Therefore, to categorize Indian language tweets, a combination of grammar rules based on adjectives and negations is proposed. Secondly, people often express their feelings with slang words, abbreviations, and mixed words. A technique called field tags is used to include nongrammatical arguments such as slang words and diverse words. Thirdly, if a tweet is more complex, the morphological richness of the Indian language results in a loss of performance. The grammar rules are embedded in N-gram techniques and machine learning methods. These methods are grouped into three approaches, which functionally predict Indian language tweets with syntactic words.
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http://dx.doi.org/10.1155/2022/5906797DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8898115PMC
March 2022

Progress in Alternative Strategies to Combat Antimicrobial Resistance: Focus on Antibiotics.

Antibiotics (Basel) 2022 Feb 4;11(2). Epub 2022 Feb 4.

AMR Insights, 1017 EG Amsterdam, The Netherlands.

Antibiotic resistance, and, in a broader perspective, antimicrobial resistance (AMR), continues to evolve and spread beyond all boundaries. As a result, infectious diseases have become more challenging or even impossible to treat, leading to an increase in morbidity and mortality. Despite the failure of conventional, traditional antimicrobial therapy, in the past two decades, no novel class of antibiotics has been introduced. Consequently, several novel alternative strategies to combat these (multi-) drug-resistant infectious microorganisms have been identified. The purpose of this review is to gather and consider the strategies that are being applied or proposed as potential alternatives to traditional antibiotics. These strategies include combination therapy, techniques that target the enzymes or proteins responsible for antimicrobial resistance, resistant bacteria, drug delivery systems, physicochemical methods, and unconventional techniques, including the CRISPR-Cas system. These alternative strategies may have the potential to change the treatment of multi-drug-resistant pathogens in human clinical settings.
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http://dx.doi.org/10.3390/antibiotics11020200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8868457PMC
February 2022

A Quality Improvement Initiative Is Associated With Reduced Time to Administer Biologics and Small Molecules and Emergency Room Visits in Inflammatory Bowel Disease.

J Clin Gastroenterol 2022 03;56(3):e176-e182

Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine.

Background: Delays in biologic or small molecule medication administration are associated with increased adverse events, hospitalization, and surgery in inflammatory bowel disease (IBD). We evaluated the impact of a quality improvement (QI) intervention on the time to administration of biologics or small molecules (TABS) in IBD.

Methods: Data were retrospectively extracted for IBD patients prescribed biologics or small molecules from a convenience sample of providers participating in an accredited QI educational intervention (baseline cohort). Subsequent to the intervention, data were prospectively collected from patients prescribed these medications (postintervention cohort). Dates related to steps between a treatment decision to medication administration were collected. The primary outcome compared TABS in baseline and postintervention cohorts.

Results: Eighteen physicians provided survey and patient data for 200 patients in each cohort (n=400). The median time to medication administration (TABS) decreased from baseline to postintervention cohorts (30 vs. 26 d, P=0.04). Emergency room visits before medication administration also decreased (25.5% vs. 12.5%, P=0.001). Similar numerical TABS reductions were observed in subgroups limited to physicians providing patients to both cohorts and for individual medications prescribed. Primary contributors to delays included filling prescriptions subsequent to insurance approval and dispensation subsequent to this.

Conclusions: A QI intervention successfully reduced medication administration times (TABS) by accelerating provider-dependent steps. This intervention was associated with reduced emergency room visits. We propose TABS as a quality metric to assess the effective delivery of therapies in IBD. Further evaluation of QI interventions, patient education on prescription drug insurance, and quality metrics are warranted.
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http://dx.doi.org/10.1097/MCG.0000000000001535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8857509PMC
March 2022

A Survey of Blind Modulation Classification Techniques for OFDM Signals.

Sensors (Basel) 2022 Jan 28;22(3). Epub 2022 Jan 28.

Engineering Product Development (EPD) Pillar, Singapore University of Technology and Design, Singapore 487372, Singapore.

Blind modulation classification (MC) is an integral part of designing an adaptive or intelligent transceiver for future wireless communications. Blind MC has several applications in the adaptive and automated systems of sixth generation (6G) communications to improve spectral efficiency and power efficiency, and reduce latency. It will become a integral part of intelligent software-defined radios (SDR) for future communication. In this paper, we provide various MC techniques for orthogonal frequency division multiplexing (OFDM) signals in a systematic way. We focus on the most widely used statistical and machine learning (ML) models and emphasize their advantages and limitations. The statistical-based blind MC includes likelihood-based (LB), maximum a posteriori (MAP) and feature-based methods (FB). The ML-based automated MC includes k-nearest neighbors (KNN), support vector machine (SVM), decision trees (DTs), convolutional neural networks (CNNs), recurrent neural networks (RNNs), and long short-term memory (LSTM) based MC methods. This survey will help the reader to understand the main characteristics of each technique, their advantages and disadvantages. We have also simulated some primary methods, i.e., statistical- and ML-based algorithms, under various constraints, which allows a fair comparison among different methodologies. The overall system performance in terms bit error rate (BER) in the presence of MC is also provided. We also provide a survey of some practical experiment works carried out through National Instrument hardware over an indoor propagation environment. In the end, open problems and possible directions for blind MC research are briefly discussed.
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http://dx.doi.org/10.3390/s22031020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8840120PMC
January 2022

Elastic stable intramedullary nailing versus submuscular plating in pediatric diaphyseal femur fractures: a randomized controlled trial among children in South India.

J Pediatr Orthop B 2022 Mar;31(2):e122-e129

Christian Medical College, Vellore, Tamil Nadu.

Elastic stable intramedullary nailing (ESIN) is the current preferred method for treating diaphyseal femur fractures in children. Introduction of the submuscular locked plate (SMP) fixation construct has opened the debate on treatment options for pediatric diaphyseal femur fractures in the older children and adolescents. A randomized controlled trial (RCT) protocol was designed to compare ESIN and SMP for diaphyseal femur fractures in children. An open-labelled RCT comparing SMP with ESIN was conducted from January 2013 to June 2016, for children aged 6-15 years with closed, acute femoral diaphyseal fractures. Randomization was done through computer-generated randomization sequence and opaque-sealed envelopes. Rate of adverse surgical events including unplanned re-operations was assessed as the primary outcome and secondary analysis was done for time to union, degree of malunion, limb length discrepancy, functional outcome at 2 years, surgical duration and blood loss, radiation exposure, hospital stay, cost incurred and secondary implant removal procedure. Forty children were randomized with allocation concealment. There were three adverse events in the SMP arm and five in the ESIN arm. Fifteen children with SMP underwent routine implant removal compared to only three children with ESIN (P < 0.001). Both ESIN and SMP are equally safe, viable and effective options for treating pediatric diaphyseal femoral fractures. However, the additional cost of secondary surgery for implant removal in the SMP group proved to be a deterrent factor, which led to ESIN being the preferred option in our resource-limited setting.
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http://dx.doi.org/10.1097/BPB.0000000000000933DOI Listing
March 2022

Protraction Headgear Compliance and Orthognathic Surgery in Patients With Cleft Lip and Palate.

Cleft Palate Craniofac J 2022 Jan 24:10556656221074890. Epub 2022 Jan 24.

6619UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.

Assess cephalometric parameters and the need for orthognathic surgery (OS) and its relationship with compliance in protraction headgear (PHG).

Retrospective case series.

Hospital cleft-craniofacial center.

23 patients with nonsyndromic cleft lip and palate and history of lip and palate repair.

Patients received PHG and orthodontic treatment. Compliant patients were compared to patients that were not. Protraction was applied with 170-gram elastics and patients were instructed to wear for at least 12 hours daily.

Cephalometric measurements at initial (T1), post-PHG (T2), and pre-surgical or post-orthodontic treatment (T3) of at least age 15 for females and 17 for males and the presence of OS were compared.

83% (19) of patients reported compliance with therapy. Of those compliant, 68% (13) had OS and 32% (6) did not ( = .99). Inter-group comparisons at T1 between compliant and noncompliant showed no significant differences and the non-OS patients started with larger nasolabial angles ( < .05). At T2, there were no significant cephalometric differences between groups. At T3, compliant patients showed significantly more upper incisor proclination than noncompliant patients. Between OS and non-OS, OS patients had significantly decreased ANB, Wits, convexity, overjet, and FMA and larger nasolabial angles ( < .05).

Patients compliant with PHG showed no difference in the need for OS. However, after orthodontic treatment, compliant patients showed more upper incisor proclination and OS patients with decreased ANB, Wits, convexity, overjet, FMA, and larger nasolabial angles.
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http://dx.doi.org/10.1177/10556656221074890DOI Listing
January 2022

Anti-rotavirus Properties and Mechanisms of Selected Gram-Positive and Gram-Negative Probiotics on Polarized Human Colonic (HT-29) Cells.

Probiotics Antimicrob Proteins 2022 Jan 16. Epub 2022 Jan 16.

Center for Food Animal Health, Ohio Agricultural Research and Development Center, Department of Animal Sciences, Ohio State University, 1680 Madison Avenue, Wooster, OH, 44691, USA.

Probiotics have been investigated to improve the universal rotavirus (RV) vaccination as well as to ameliorate the RV infection. However, underlying mechanisms how probiotics mediate beneficial effects needs more investigation. Thus, in the present study, we used polarized HT-29 cells to assess the anti-RV properties of Gram-positive, (Lactobacillus acidophilus, Lacticaseibacillus rhamnosus GG, and Bifidobacterium subsp. Lactis Bb12) and Gram negative, (Escherichia coli Nissle 1917) probiotics and study their underlying mechanisms. Our results showed that pre-treatment of HT-29 cells for 4 h with probiotics, significantly reduced (p < 0.05) human RV replication and this effect was most pronounced for E. coli Nissle followed by L. acidophilus and L. rhamnosus GG. Strikingly, only pre-treatment with live bacteria or their supernatants demonstrated anti-RV properties. Except Gram negative E. coli Nissle, the Gram-positive probiotics tested did not bind to RV. Ingenuity pathway analysis of tight junction (TJ)- and innate immune-associated genes indicated that E. coli Nissle or E. coli Nissle + RV treatments improved cell-cell adhesion and cell contact, while L. acidophilus or L. acidophilus + RV treatments also activated cell-cell contact but inhibited cell movement functions. RV alone inhibited migration of cells event. Additionally, E. coli Nissle activated pathways such as the innate immune and inflammatory responses via production of TNF, while RV infection activated NK cells and inflammatory responses. In conclusion, E. coli Nissle's ability to bind RV, modulate expression of TJ events, innate immune and inflammatory responses, via specific upstream regulators may explain superior anti-RV properties of E. coli Nissle. Therefore, prophylactic use of E. coli Nissle might help to reduce the RV disease burden in infants in endemic areas.
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http://dx.doi.org/10.1007/s12602-021-09884-3DOI Listing
January 2022

Comparative Evaluation of Salivary Biomarker Levels in e-Cigarette Smokers and Conventional Smokers.

J Pharm Bioallied Sci 2021 Nov 10;13(Suppl 2):S1642-S1645. Epub 2021 Nov 10.

Department of Oral Pathology and Microbiology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra. India.

Background: The cigarette smoking and its effect on the inflammatory cytokine levels in the smoker's saliva depicted the influence of electronic cigarettes on oral cytokine levels in oral fluids are scarce in the literature.

Objectives: The present trial was conducted to compare and determine the proinflammatory and anti-inflammatory cytokines in whole stimulated saliva samples of electronic cigarette smokers, conventional smokers, and participants with no smoke exposure.

Materials And Methods: Sixty adult participants were divided into the following four groups of nonsmokers, current smokers, smokers smoking both conventional and e-cigarettes, and e-cigarette smokers. The saliva samples were assessed for Interleukins (IL-1B, 6, 8, 10, and IL-1RA), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) using enzyme-linked immunosorbent assay. Plaque scores and Gingival Index, and body mass index were also calculated.

Results: Statistically significant ( < 0.05) and remarkable relationship was seen in plaque scores and IL 1RA, 1 β, and 10 with the respective values as-0.285, 0.268, and 0.267. Regarding anti-inflammatory cytokines, CRP, IL-10, and IL-RA had the P-value of 0.073, 0.945, and 0.834 respectively. When these values were evaluated for proinflammatory cytokines, the P values were 0.0001, 0.019, 0.991, and 903 for TNF-α, IL-1 β, IL-6, and IL-8, respectively. These results were statistically significant for TNF-α ( = 0.001).

Conclusion: Within its limitations, the present study concludes that smoking e-cigarettes whether solely or in combination with conventional smoking increases the levels of proinflammatory cytokines such as TNF-α and IL-1 β with decreased counter IL-1RA levels.
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http://dx.doi.org/10.4103/jpbs.jpbs_393_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8686896PMC
November 2021

Analyzing Effects of Sickle Cell Disease on Morphometric and Cranial Growth in Indian Population.

J Pharm Bioallied Sci 2021 Nov 10;13(Suppl 2):S1402-S1405. Epub 2021 Nov 10.

Professor, Department Of Oral Pathology And Microbiology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India.

Background: Sickle cell disease is the most pervasive autosomal recessive hereditary blood diseases and is characterized by the presence of sickle hemoglobin (HbS), which in turn gives rise to pathophysiological consequences. This HbS reduces the agility of erythrocytes plummeting their ability to pass through small vascular channels, which in turn results in increased blood viscosity and congestion of vascular beds, causing ischemia, local infarction, and hemolysis.

Objectives: The current study was conducted to carry out the morphometric analysis in patients with sickle cell disease.

Materials And Methods: This study was conducted on 75 subjects detected with sickle cell disease aged between 8 and 16.5 years. The study involved 38 males and 37 females. All the subjects were subjected to lateral cephalogram for the calculation of various angular and linear dimensions of the craniofacial structures. The linear measurements made were nasion-menton height, anterior nasal spine (ANS)-menton height, and nasion-ANS height, whereas the angular measurements made were Frankfurt mandibular plane angle, Frankfort mandibular incisor angle, and incisor mandibular plane angle.

Results: Major chunk of the subjects had retruded mandible and vertical growth pattern. Few subjects exhibited with maxillary protrusion.

Conclusion: It is concluded that early diagnosis and management of dental malocclusion in patients with sickle cell disease plays a pivotal role in an attempt to endow with a better quality of life to these individuals.
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http://dx.doi.org/10.4103/jpbs.jpbs_227_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8686964PMC
November 2021

Design of fractional order PID controller for load frequency control system with communication delay.

ISA Trans 2021 Dec 28. Epub 2021 Dec 28.

Department of Electrical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad 826004, India. Electronic address:

This work explores a frequency-domain approach to design a fractional order proportional-integral-derivative (FO-PID) controller cascaded with a first-order filter for the load frequency control (LFC) system with communication delay. The proposed method is based on suitable reference model development in the direct synthesis (DS) approach, followed by frequency response matching technique. The reference model is developed for robust control-loop performance using the stability-margin and time-domain specifications. The values of the fractional orders of the integral and derivative terms are obtained according to the dynamics of the nominal system. The proposed controllers have been designed for some LFC systems taken from the literature that have different dynamics with reheat, non-reheat and hydraulic turbines and performances with non-linearity like generation rate constraint (GRC), generation dead band (GDB) along with noise have been compared favorably with that of some controllers prevalent in the literature. The proposed controllers have been shown to work efficaciously for the decentralized multi-area IEEE 39-bus New England test system along with variable communication delay. To show the efficacy of the proposed controllers the load-disturbance responses along with the frequency and time domain performance indices have been evaluated for comparison.
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http://dx.doi.org/10.1016/j.isatra.2021.12.033DOI Listing
December 2021
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