Publications by authors named "Anupam Singh"

122 Publications

Comparative transcriptome analyses revealed different heat stress responses in pigeonpea (Cajanus cajan) and its crop wild relatives.

Plant Cell Rep 2021 Apr 10. Epub 2021 Apr 10.

ICAR-National Institute for Plant Biotechnology, New Delhi, 110012, India.

Key Message: Comparative transcriptome analyses accompanied by biochemical assays revealed high variability in heat stress response in Cajanus species. Among the studied species, C. scarabaeoides was the most thermotolerant followed by C. cajanifolius, C. cajan, and C. acutifolius. Pigeonpea is one of the climate-resilient grain legumes. Though the optimum temperature for cultivated pigeonpea is ~ 25-35 °C, its wild relatives grow in temperatures ranging between 18 and 45 °C. To gain insight into molecular mechanisms responsible for the heat stress tolerance in pigeonpea, we conducted time-series transcriptome analysis of one pigeonpea cultivar (Cajanus cajan) and two wild relatives, Cajanus acutifolius, and Cajanus scarabaeoides subjected to heat stress at 42 ± 2 ºC for 30 min and 3 h. A total of 9521, 12,447, and 5282 identified transcripts were differentially expressed in C. cajan, C. acutifolius, and C. scarabaeoides, respectively. In this study, we observed that a significant number of genes undergo alternative splicing in a species-specific pattern during heat stress. Gene expression profiling analysis, histochemical assay, chlorophyll content, and electrolyte leakage assay showed that C. scarabaeoides has adaptive features for heat stress tolerance. The gene set enrichment analyses of differentially expressed genes in these Cajanus species during heat stress revealed that oxidoreductase activity, transcription factor activity, oxygen-evolving complex, photosystem-II, thylakoid, phenylpropanoid biosynthetic process, secondary metabolic process, and flavonoid biosynthetic process were highly affected. The histochemical assay showed more lipid peroxidation in C. acutifolius compared to other Cajanus species inferring the presence of higher quantities of polyunsaturated fatty acids in the plasma membrane which might have led to severe damage of membrane-bound organelles like chloroplast, and high electrolyte leakage during heat stress. This study paves the way for the identification of candidate genes, which can be useful for the development of thermo-tolerant pigeonpea cultivars.
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http://dx.doi.org/10.1007/s00299-021-02686-5DOI Listing
April 2021

Antibiotics for induction and maintenance of remission in ulcerative colitis: Systematic review and meta-analysis.

Expert Rev Gastroenterol Hepatol 2021 Apr 7. Epub 2021 Apr 7.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

: To ascertain the role of antibiotics in induction and maintenance of remission in ulcerative colitis (UC): We searched electronic databases for keywords ulcerative colitis or inflammatory bowel disease and antibiotics or antimicrobials. We did a meta-analysis of randomized trials comparing antibiotics with control/placebo for clinical response, need for second line therapy, colectomy, and adverse effects. Subgroup analysis to clarify the mode of administration, number of antibiotics or the setting of use (acute severe UC or active non-severe UC) were also performed.: Thirteen trials with 785 patients were included. The pooled odds ratio of achieving clinical response with antibiotic use was 1.74 (95% CI, 1.17-2.58). No differences were noted in the relapse rates, need for second line therapy, colectomy or, adverse effects with the use of antibiotics. Subgroup analysis showed no differences with use of single or combination of antibiotics. Analysis of trials only in the setting of acute severe colitis did not demonstrate any benefit.: The use of oral antibiotics in the setting of non-severe active UC could have some benefit in clinical response. The use of antibiotics is not of benefit in acute severe colitis, but oral antibiotics need to be evaluated in adult patients.
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http://dx.doi.org/10.1080/17474124.2021.1914586DOI Listing
April 2021

Protocol for in-vitro purification and refolding of hexachlorocyclohexane degrading enzyme haloalkane dehalogenase LinB from inclusion bodies.

Enzyme Microb Technol 2021 May 11;146:109760. Epub 2021 Feb 11.

Molecular Biology Lab., Department of Zoology, University of Delhi, New Delhi, 110007, India; The Energy and Resources Institute Darbari Seth Block, IHC Complex, Lodhi Road, New Delhi, 110003, India. Electronic address:

LinB is an important haloalkane dehalogenase involved in the degradation pathway of different isomers of hexachlorocyclohexane (HCH), mainly in catalyzing degradation of the notorious β-HCH. The HCH isomers are known to have neurotoxic, carcinogenic and estrogenic effects. Enzymatic bioremediation for decontamination of β- as well as other HCH isomers can prove to be a potential remediation strategy. For any bioremediation technology that is to be developed, apart from having high turnover number, the candidate enzyme must also be available in sufficient amounts. In this direction, the LinB variants reported in database were tested in laboratory studies. The variant LinBSSO4-3 however could not be obtained in soluble fraction by using standard procedures. The protein LinBSSO4-3 was cloned in pDEST17 vector and codon optimized for better expression in Escherichia coli BL21AI using a strong T7 promoter. However, the over-expression of this protein in ectopic host E. coli, led to aggregation of the protein in form of inclusion bodies, which are insoluble aggregates of misfolded or partially folded proteins. SEM analysis of the inclusion bodies showed them as aggregated spherical particles. The inclusion bodies were isolated using high speed sonication and homogenization. This was followed by solubilization in the strong denaturing agent urea. Refolding into its native state was done by using pulsatile refolding. This was done by slowly decreasing the denaturant concentration in the presence of sucrose. The turnover number of the refolded protein was then determined for different isomers of HCH. The protein was found to have a turnover number of ∼43 molecules min on β-HCH and ∼13 molecules min on δ-HCH. Additionally, a mutation I253 M in the active site of the enzyme was found to drastically decrease the enzyme activity on β-HCH. Taking into consideration the wide range of substrates of haloalkane dehalogenases, such a protocol for inclusion body refolding will contribute to the field of bioremediation technology development for organochlorines, specifically HCH. Such a protocol for refolding of haloalkane dehalogenases from inclusion bodies has not been developed or reported before.
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http://dx.doi.org/10.1016/j.enzmictec.2021.109760DOI Listing
May 2021

Sex Assessment by Morphological Analysis of Palatal Rugae Patterns in a South Indian Adult Population.

Clin Cosmet Investig Dent 2021 17;13:77-81. Epub 2021 Mar 17.

Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India.

Background: Palatal rugae are asymmetric and irregular ridges on the anterior palatal region, which have proven to be useful in the field of forensic dentistry. This study aims to use morphological analysis of palatal rugae patterns to assess sex in a South Indian adult population.

Materials And Methods: This cross-sectional study was undertaken to evaluate a total of 300 maxillary dental casts (150 males and 150 females). The rugae patterns were marked by one observer and classified as per Thomas and Kotze criteria by another observer. The rugae patterns were classified based on the total number of rugae, shape, predominant direction of rugae, and unification of rugae.

Results: The palatal rugae in female participants showed a higher incidence of circular rugae and backward directed rugae, while male participants showed more forward-directed rugae. The logistic regression analysis showed a significant association of with circular (OR=1.48; 95% CI= 1.02-2.13), forward (OR=0.87; 95% CI= 0.78-0.97) and backward (OR=1.23; 95% CI= 1.08-1.41) palatal rugae with sex.

Conclusion: Certain palatal rugae patterns can be used for the assessment of sex with limited accuracy.
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http://dx.doi.org/10.2147/CCIDE.S304599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982778PMC
March 2021

Timing and Use of Capsule Endoscopy in the Acute Care Setting.

Gastrointest Endosc Clin N Am 2021 Apr 15;31(2):307-316. Epub 2021 Feb 15.

Division of Gastroenterology, University of Massachusetts Medical School, Memorial Medical Center, 55 Lake Avenue, North Worcester, MA 01650, USA.

Video capsule endoscopy (VCE) is a crucial adjunct to conventional endoscopy in small intestinal bleeding, with a high positive and negative predictive value. Timing is critical in VCE, with earlier deployment associated with improved diagnostic yield. VCE is also useful as a first-line diagnostic modality in the evaluation of acute gastrointestinal bleeding, with accumulating evidence demonstrating expedited VCE can increase diagnostic yield, reduce unneeded admissions, and overall improve patient care. In resource-limited settings, first-line VCE also can reduce unneeded procedures and protect staff from dangerous exposures.
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http://dx.doi.org/10.1016/j.giec.2020.12.006DOI Listing
April 2021

Left ventricular tamponade- pathophysiology determines the therapeutic approach: a case series.

Eur Heart J Case Rep 2021 Feb 11;5(2):ytaa502. Epub 2020 Dec 11.

Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India.

Background: Left ventricular (LV) tamponade is rare. LV tamponade can occur in cases of a loculated pericardial effusion overlying the LV and in cases of circumferential pericardial effusions in patients with severe pulmonary arterial hypertension (PAH). Both causes of LV tamponade share the common feature of not presenting with the classical features of cardiac tamponade. However, the therapeutic approach of the two is different.

Case Summary: Here, we report two cases of LV tamponade. The first patient was a case of post-mitral valve replacement who presented with loculated posterior pericardial effusion with LV tamponade. Due to the loculated and posterior nature of the effusion, his pericardial fluid was drained from the axilla by echocardiographic and fluoroscopic guidance. The second patient presented with features of severe PAH with a circumferential pericardial effusion and LV tamponade. Due to the circumferential nature of the effusion, the pericardiocentesis was performed from the subxiphoid route.

Discussion: The pathophysiology of LV tamponade must be determined accurately before performing pericardiocentesis. Left ventricular tamponade in patients with severe PAH and non-loculated circumferential effusion can be drained from the subxiphoid route, while LV tamponade due to loculated effusion overlying LV must be drained by echocardiographic and fluoroscopic guidance from the axilla.
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http://dx.doi.org/10.1093/ehjcr/ytaa502DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954379PMC
February 2021

Ultrafast melting and recovery of collective order in the excitonic insulator TaNiSe.

Nat Commun 2021 Mar 16;12(1):1699. Epub 2021 Mar 16.

Cavendish Laboratory, University of Cambridge, Cambridge, UK.

The layered chalcogenide TaNiSe has been proposed to host an excitonic condensate in its ground state, a phase that could offer a unique platform to study and manipulate many-body states at room temperature. However, identifying the dominant microscopic contribution to the observed spontaneous symmetry breaking remains challenging, perpetuating the debate over the ground state properties. Here, using broadband ultrafast spectroscopy we investigate the out-of-equilibrium dynamics of TaNiSe and demonstrate that the transient reflectivity in the near-infrared range is connected to the system's low-energy physics. We track the status of the ordered phase using this optical signature, establishing that high-fluence photoexcitations can suppress this order. From the sub-50 fs quenching timescale and the behaviour of the photoinduced coherent phonon modes, we conclude that electronic correlations provide a decisive contribution to the excitonic order formation. Our results pave the way towards the ultrafast control of an exciton condensate at room temperature.
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http://dx.doi.org/10.1038/s41467-021-21929-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966769PMC
March 2021

Perception among ophthalmologists about webinars as a method of continued medical education during COVID-19 pandemic.

Indian J Ophthalmol 2021 Apr;69(4):951-957

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

Purpose: To ascertain ophthalmologist's perceptions about webinars as a method of continued medical education during the COVID-19 pandemic.

Methods: In a cross-sectional study, a 21-question survey was circulated using digital media platform to approximately 1400 ophthalmologists in India between 16 August 2020 to 31 August 2020. The questionnaire focussed on the quality and usefulness of webinars based on the Bloom's taxonomy. The responses (on 4- or 5-point Likert scale) were analyzed among three professional groups- ophthalmologists in-training, consultants in public sector, and private practitioners.

Results: 393 ophthalmologists participated in the survey, with a response rate of 28%. The mean age was 34.6 ± 9.7 years, and males constituted 49.6% (199/393) of the respondents. Forty-seven percent of the respondents perceived the quality of webinars as good or excellent (185/393), 72.8% reported knowledge gain from webinars (286/393), and 63.9% felt that webinars are important in clinical practice and should continue post-COVID-19 pandemic (251/393), with distinct responses among the professional groups. The drawbacks perceived were overt number of webinars (371; 94.4%), confusion regarding which webinars to attend (313; 79.6%), repetition of the information (296; 75.3%), limited opportunity for participant interaction (146; 37.2%) and disparate weightage to the core disciplines of Ophthalmology.

Conclusion: Most respondents had favorable perceptions of Ophthalmology webinars happening during the COVID-19 pandemic. However, there is need for improvisation in the volume of webinars, target-audience-based delivery, and participant interaction to add value to this new dimension of teaching-learning.
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http://dx.doi.org/10.4103/ijo.IJO_3136_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012965PMC
April 2021

Expression of p53 and Ki-67 proteins in patients with increasing severity and duration of pterygium.

Indian J Ophthalmol 2021 Apr;69(4):847-850

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

Purpose: Pterygium is a triangular fibrovascular subepithelial ingrowth of degenerative bulbar conjunctival tissue over the cornea. It is now considered to be a result of uncontrolled cellular proliferation as overexpression of p53 protein and Ki-67 nuclear protein was found in the epithelium. This study was done to find the expression of p53 and Ki-67 with the severity and duration of the pterygium to explain the etiopathogenesis.

Methods: Data were analyzed from 43 Indian participants of all age groups. All patients were divided according to the severity of pterygium (mild, moderate, and severe groups) and according to the duration of pterygium (<4 years and >4 years). The samples were studied by immunohistochemistry by using antibodies against p53 and Ki-67 proteins considering >5% expression as significant.

Results: Of 43 cases, p53 and Ki-67 expression were positive in 33 cases. In mild, moderate, and severe cases p53 positivity was 33.3%, 78.4%, 100%, respectively. P53 expression increased with duration, 79.3% positive in <4 years, and 92.9% positive in >4 years. With increasing severity of pterygium, mild, moderate, and severe cases, Ki-67 positivity was 66.7%, 78.37%, 66.7%, respectively. Ki-67 expression with duration, 79.3% positive in <4 years, and 85.7% positive in >4 years of the duration of pterygium with no statistical significance.

Conclusion: Our study revealed that with increasing duration and severity of pterygium, p53 expression was observed to be increasing. Ki-67 expression increased with the duration of pterygium but not with the severity.
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http://dx.doi.org/10.4103/ijo.IJO_1034_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012974PMC
April 2021

Prevalence of polymorphisms in thiopurine metabolism and association with adverse outcomes: a South Asian region-specific systematic review and meta-analysis.

Expert Rev Clin Pharmacol 2021 Mar 15:1-11. Epub 2021 Mar 15.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

: Prevalence and impact of thiopurine S-methyltransferase () and Nudix hydrolase () minor allele frequencies in South Asian population is unclear.: We searched PubMed and Embase with keywords- and combined with South Asian countries. We included studies reporting frequency of and polymorphisms. We estimated the pooled prevalence of and polymorphisms and their impact on pooled odds ratio of adverse events with thiopurines.: We included 26 studies in our analysis. The pooled prevalence of and polymorphisms was 16.5% (95% CI: 13.09-20.58) and 4.57% (95% CI: 3.66-5.68), respectively. In patients with adverse effects, the pooled prevalence of and polymorphism was 49.51% (95% C.I. 21.69-77.64) and 9.47% (95% C.I. 5.39-16.11), respectively. The odds ratio (OR) of adverse events with presence of polymorphisms was 3.65 (95% C.I., 1.43-9.28). The pooled OR for adverse events in presence of polymorphism was 12.63 (95% C.I., 3.68-43.26).: were reported more frequently than the polymorphisms in South Asian population and were more frequently associated with adverse events. These findings may have implications for preemptive testing amongst South Asian population and immigrants prior to starting thiopurines.
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http://dx.doi.org/10.1080/17512433.2021.1900729DOI Listing
March 2021

Response letter to the editor.

Authors:
Anupam Singh

Strabismus 2021 Mar 3. Epub 2021 Mar 3.

Ophthalmology, All India Institute of medical sciences, Rishikesh.

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http://dx.doi.org/10.1080/09273972.2020.1706947DOI Listing
March 2021

"Orofacial Dystonia-A Silent Killer": Mandibular Fractures with Orofacial Dystonia, A Report of a Case and Review.

Case Rep Dent 2021 25;2021:6675961. Epub 2021 Jan 25.

Department of Oral and Maxillofacial Surgery, MCODS, Manipal, India.

Mandibular parasymphysis fracture is very commonly observed especially in old age when there is resorptions of the alveolar ridges. In cervical dystonia, there is centrally mediated disease in which there is uncontrolled and spasmodic contraction of the facial and the masticatory muscles. Due to the application of this sudden and uncontrolled force, there is a tendency of the bone to unfavourably remodel and weaken. The case presented here is of a geriatric patient who presented to us with a fracture at the right parasymphysis and left dentoalveolar region of the mandible and was suffering from cervical dystonia. Management of this case posed a challenge in every step, and it needed a resurgery where the fracture was managed by the placement of reconstruction plate. Not many cases in the literature have been reported where dystonic movements have resulted in the fracture of the mandible.
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http://dx.doi.org/10.1155/2021/6675961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857896PMC
January 2021

MRSA infection of masticatory spaces in a paediatric patient.

BMJ Case Rep 2021 Feb 10;14(2). Epub 2021 Feb 10.

Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal; Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India

Diagnosis of source of maxillofacial infection in paediatric patients can be challenging due to difficulty in eliciting a proper history and multiple potential sources of infection. Identification and removal of the nidus of infection with decompression and institution of antibiotic therapy as per the culture-sensitivity report form the mainstay treatment of the infection. Deviation from it may result in persistence or even progression of infection, resulting in significant morbidity and mortality. In the past decade, the incidence of community-acquired methicillin-resistant infection in the oral cavity has seen an upward trend. This has further led to an increase in complexity in the diagnosis of maxillofacial infections. In this case, the authors want to bring to light the challenges faced in managing a paediatric patient with persistent fascial space infection even after removal of the offending tooth, which signifies the importance of managing the infection by the time-tested protocol.
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http://dx.doi.org/10.1136/bcr-2020-236766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878156PMC
February 2021

Clinical presentation of COVID-19 in patients with inflammatory bowel disease: a systematic review and meta-analysis.

Intest Res 2021 Jan 18. Epub 2021 Jan 18.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background/aims: Coronavirus disease 2019 (COVID-19) is recognized to have variable clinical manifestations. The clinical presentation of patients with inflammatory bowel disease (IBD) having COVID-19 is unclear.

Methods: We identified articles reporting about the clinical presentation of COVID-19 in those with underlying IBD from PubMed and Embase. The studies, irrespective of design or language, were included. The overall pooled frequency of various symptoms was estimated. Joanna Briggs Institute Critical appraisal checklist was used to assess the quality of studies.

Results: Eleven studies, including 1,325 patients, were included in the pooled analysis. The pooled estimates for clinical presentation were; fever: 67.53% (95% confidence interval [CI], 45.38-83.88), cough: 59.58% (95% CI, 45.01-72.63), diarrhea: 27.26% (95% CI, 19.51-36.69), running nose: 27% (95% CI, 15.26-43.19) and dyspnea: 25.29% (95% CI, 18.52-33.52). The pooled prevalence rates for abdominal pain, nausea and vomiting were 13.08% (95% CI, 9.24-18.19), 10.08% (95% CI, 5.84-16.85) and 8.80% (95% CI, 4.43-16.70) per 100 population, respectively.

Conclusions: The clinical presentation of COVID-19 in IBD patients is similar to the general population.
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http://dx.doi.org/10.5217/ir.2020.00108DOI Listing
January 2021

Efficacy of Lignocaine with Buprenorphine versus Lignocaine in the Management of Postoperative Pain after Minor Oral Surgical Procedures: A Systematic Review and Meta-analysis.

J Int Soc Prev Community Dent 2020 Nov-Dec;10(6):686-691. Epub 2020 Nov 24.

Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.

We aimed to review the efficacy of lignocaine with buprenorphine versus lignocaine alone in the management of postoperative pain after minor oral surgical procedures. Randomized controlled trials evaluating the efficacy of use of lignocaine with buprenorphine versus lignocaine for intra-oral procedures were included by searching multiple databases. Outcomes assessed were onset of the time of anesthesia in seconds, duration of postoperative analgesia, postoperative pain (maximal follow-up), the number of rescue analgesics required, and adverse events. The search strategy yielded 167 publications for the title and abstract screening out of which only two trials were included for full-text screening. There was considerable heterogeneity among the included studies with regards to the outcomes assessed. The need for rescue analgesics was the only outcome that was included for meta-analyses. Forest plot showed that lignocaine with buprenorphine compared to lignocaine showed a significantly lower requirement of rescue analgesics (-0.22[-2.9,-1.55]). No trial reported any adverse effects. The results show that lignocaine with buprenorphine is effective in reducing the number of rescue analgesics required by the patient.
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http://dx.doi.org/10.4103/jispcd.JISPCD_316_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791576PMC
November 2020

Mild COVID-19 infection-predicting symptomatic phase and outcome: A study from AIIMS, New Delhi.

J Family Med Prim Care 2020 Oct 5;9(10):5360-5365. Epub 2020 Oct 5.

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

Context: Comprehensive management of mild COVID infection calls for better understanding of symptomatology in these group of patients as well as early identification and close monitoring of patients at risk, data on which is limited.

Aim: To study association between inflammatory markers and clinical presentation with progression of disease and the duration of resolution of symptoms.

Settings And Design: This is a retrospective study that has been conducted at a designated COVID -19 medical ward at AIIMS, New Delhi.

Methods And Material: Fifty healthcare workers and their dependents who were admitted with asymptomatic and mild COVID-19 infection were included. Their records were retrospectively reviewed, entered into a predesigned proforma and analyzed.

Results: A total of 50 participants were included in the study of which 70% were healthcare workers. The patients were admitted with mild COVID illness out of which 22 (44%) were males. Most common symptom at presentation was fever (72%). Among patients who had mild disease versus those who progressed to moderate illness ( = 3), the patients with moderate illness were older [mean (SD): 57.33 (10.21) vs. 36.13 (14.05); = 0.014] and had a longer duration of hospital stay [17 (1.41) days vs. 11.20 (3.86) days; = 0.04]. Inflammatory markers, C-Reactive Protein (CRP) [2.46 vs. 0.20 ( = 0.024)], and Ferritin [306.15 vs. 72.53 ( = 0.023)] were higher in patients with moderate illness. There is also a significant correlation between the number of days taken for symptoms to resolve with Serum Ferritin ( = 0.007), CRP ( = 0.0256), and neutrophil lymphocyte ratio (NLR) ( = 0.044).

Conclusions: Acute phase reactants/Inflammatory markers serve as good indicators of time taken to resolution of symptoms in acute COVID infection. NLR is a simple and inexpensive method to provide insight into symptomatic phase. These may be utility tools for primary care physician in the management in periphery and timely decision.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1610_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773059PMC
October 2020

Risk factors and outcome among COVID-19 exposed and quarantined healthcare workers: A study on the status of existing practices of standard precautions.

J Family Med Prim Care 2020 Oct 5;9(10):5355-5359. Epub 2020 Oct 5.

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

Context: Health care workers (HCWs) are at high risk of COVID-19 infection but data on the risk factors for exposure and infection rate among Indian HCWs are limited.

Aims: Our study aims to identify the risk factors and behavior of HCWs which make them high risk for COVID-19 infection and the infection rate among them.

Settings And Design: This is a retrospective study conducted at All India Institute of Medical Sciences, New Delhi.

Methods And Material: Fifty HCWs quarantined at our institute in April and May 2020 following exposure to confirmed or suspected COVID-19 cases, or due to development of Influenza-Like Illness (ILI) were included. Data was collected from medical records in a predesigned proforma and analyzed.

Results: Thirty-eight (76%) of the 50 quarantined HCWs had high-risk exposure and there was a significant breach in personal protective measures. N-95 masks were worn by 59.6%, gloves by 61.7%, and goggles or face shields by 2%. Exposures were more common in non-COVID areas of the hospital. Hydroxychloroquine pre-exposure prophylaxis was taken by 7 (14%). 3 (6%) were confirmed to be COVID-19 positive during the quarantine period.

Conclusions: Our study has shown leniency among HCWs in adhering to infection control and personal protective measures resulting in an increased quarantine and infection rate and loss of manpower. The safety of our HCWs must be given paramount importance during this pandemic and should be ensured by educating them about infection control, and persistently reinforcing and strictly adhering to standard precautions.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1579_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773095PMC
October 2020

Comparison of home-based pencil push-up therapy and office-based orthoptic therapy in symptomatic patients of convergence insufficiency: a randomized controlled trial.

Int Ophthalmol 2021 Apr 4;41(4):1327-1336. Epub 2021 Jan 4.

Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, India.

Purpose: To assess and compare the effectiveness of home-based pencil push-up therapy (PPT) and office-based orthoptic therapy (OBOT) in patients with convergence insufficiency.

Methods: In this randomized clinical trial, 176 symptomatic patients with convergence insufficiency, aged between 9 to 30 years, were randomly assigned to receive 6 weeks of home-based PPT (Group I) or OBOT (Group II) after determining refractive error, near point of convergence (NPC), convergence insufficiency symptom survey (CISS) score, near phoria and positive fusional vergences (PFV) at near. The participants of Group I underwent home-based PPT (pencil push-ups exercises15 minutes per day, daily for 6 weeks) and those of Group II OBOT (convergence fusional exercises on synoptophore for 20 min per day, 3 days a week, for 6 weeks) without home reinforcement. Patients were re-examined at 3 and 6 weeks after initiation of treatment. NPC and CISS score were the primary and secondary outcome measures, respectively. Statistical analysis was performed with the independent samples t-test, Friedman test and the analysis of variance (ANOVA). Statistical significance was indicated by p-value < 0.05.

Results: Participants of both the groups had statistically significant improvement in NPC, CISS score, PFV and near phoria (p < 0.001), but there was no statistically significant difference between the two groups (p > 0.05). However, patients of Group II had significantly better PFV after final visit than those of Group I (p < 0.001).

Conclusion: Home-based PPT with good suppression control and with compliance ensured by log book entries, is a simple, cheap, less time consuming and comparably effective alternative to more expensive OBOT for patients suffering from CI. CTRI registration number: REF/2016/11/012,732, Date of registration 25/04/ 2016, Retrospectively Registered.
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http://dx.doi.org/10.1007/s10792-020-01689-7DOI Listing
April 2021

Cryptic Myiasis by : A Case Report and Literature Review.

Turk J Ophthalmol 2020 12;50(6):381-386

All India Institute of Medical Sciences, Department of Ophthalmology, Rishikesh, India.

Myiasis is the invasion of living animal tissue by fly larvae. Orbital tissue infestation involvement occurs in 5% of all myiasis cases and is potentially destructive. Infection by is very rare in clinical practice. A 65-year-old woman with history of left eye evisceration presented to the emergency department due to a creeping sensation in the left eye socket and underwent medical and surgical treatment for ophthalmomyiasis. A systematic review was performed to identify ophthalmomyiasis cases caused by published in PubMed and Embase until December 2019. can cause major destruction to both vital and non-vital tissues. It should be treated promptly to prevent extensive damage and life-threatening conditions. This report provides an overview of the epidemiology, causes, risk factors, diagnosis, and treatment options that could assist clinicians in diagnosis and management of this condition.
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http://dx.doi.org/10.4274/tjo.galenos.2020.69360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802101PMC
December 2020

Splenic abscess in a tertiary care centre in India: clinical characteristics and prognostic factors.

ANZ J Surg 2020 Dec 28. Epub 2020 Dec 28.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Splenic abscess has been an uncommon entity which is now being encountered more frequently due to increased prevalence of immunodeficiency disorders and chronic illnesses. This study was aimed to audit our experience with splenic abscesses at a tertiary care centre in India highlighting usefulness of an algorithmic approach.

Methods: Retrospective analysis of data of patients (January 2014 to December 2019) with splenic abscess was done. Data were retrieved for clinical characteristics, radiological findings, organism spectra, abscess characteristics, therapeutic measures and clinical outcome.

Results: The mean age of the study population (n = 36) was 41.3 ± 19.0 years with 50% males. Comorbidities were identified in 17 (47.2%) patients, with diabetes mellitus being the commonest. Fever and abdominal pain were the most common presenting features. Multiple splenic abscesses were present in 21 (58.3%) patients. Extra-splenic abscesses in liver were seen in five (13.9%) patients while nine (25%) patients had ruptured splenic abscess. Microorganisms were identified in 24 (66.7%) patients, with Salmonella typhi being the commonest (n = 9, 25%) followed by Escherichia coli (n = 7, 19.4%) and Staphylococcus aureus (n = 4, 11.1%). Six patients received only antimicrobials, 24 were managed with percutaneous aspiration or catheter drainage and six required surgery. Five (13.9%) patients died, with highest mortality being seen in those who received only antimicrobial (50%), compared to percutaneous aspiration or catheter drainage (8.3%) and surgery (0%), P = 0.017.

Conclusion: Using percutaneous aspiration or drainage in conjunction with antibiotics, followed by surgery in non-responder, patients with splenic abscesses can be managed successfully with acceptable mortality.
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http://dx.doi.org/10.1111/ans.16517DOI Listing
December 2020

Time to rethink: Conscious sedation in an obese during pacemaker implantation.

J Cardiol Cases 2020 Dec 6;22(6):280-282. Epub 2020 Aug 6.

Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, Uttarakhand, India.

We report a case of pulmonary embolism while performing pacemaker implantation in an obese patient and its management as well as certain precautions that one must consider in an obese patient especially under conscious sedation. Air embolism during pacemaker implantation although rare can be life-threatening in certain conditions such as massive pulmonary embolism. Air embolism during this procedure mainly occurs through open sheath just before inserting the lead. Certain risk factors associated with this condition include deep inspiration, frequent coughing, advanced age, sheath with larger diameter, and sedatives. Obesity along with associated factors including sleep apnea, restrictive lung disease, and challenges during airway management can create troubles during pacemaker implantation. Conscious sedation is usually required when a patient becomes restless during the procedure either due to pain or prolonged supine position. At times a patient can transiently go into the deep sedation and a deep inspiration during this phase can be detrimental in a procedure where it is undesirable and adds to the risk of air embolism. Here we discuss the management and alternative methods which can be used to avoid such complications. < Pacemaker implantation procedure can be performed with minimal sedation instead of conscious sedation. Although conscious sedation seems more suitable, it carries the risk of complications such as air embolism that can be precipitated by involuntary deep inspiration during the procedure. When conscious sedation is required one must reconsider the need as well as alternatives so as to avoid such complications.>.
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http://dx.doi.org/10.1016/j.jccase.2020.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718507PMC
December 2020

Cryo-EM Structures Reveal Transcription Initiation Steps by Yeast Mitochondrial RNA Polymerase.

Mol Cell 2021 01 4;81(2):268-280.e5. Epub 2020 Dec 4.

Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium. Electronic address:

Mitochondrial RNA polymerase (mtRNAP) is crucial in cellular energy production, yet understanding of mitochondrial DNA transcription initiation lags that of bacterial and nuclear DNA transcription. We report structures of two transcription initiation intermediate states of yeast mtRNAP that explain promoter melting, template alignment, DNA scrunching, abortive synthesis, and transition into elongation. In the partially melted initiation complex (PmIC), transcription factor MTF1 makes base-specific interactions with flipped non-template (NT) nucleotides "AAGT" at -4 to -1 positions of the DNA promoter. In the initiation complex (IC), the template in the expanded 7-mer bubble positions the RNA and NTP analog UTPαS, while NT scrunches into an NT loop. The scrunched NT loop is stabilized by the centrally positioned MTF1 C-tail. The IC and PmIC states coexist in solution, revealing a dynamic equilibrium between two functional states. Frequent scrunching/unscruching transitions and the imminent steric clashes of the inflating NT loop and growing RNA:DNA with the C-tail explain abortive synthesis and transition into elongation.
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http://dx.doi.org/10.1016/j.molcel.2020.11.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7855493PMC
January 2021

Outcome of percutaneous drainage in patients with pancreatic necrosis having organ failure.

HPB (Oxford) 2020 Nov 21. Epub 2020 Nov 21.

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. Electronic address:

Background: Percutaneous catheter drainage (PCD) is an effective way of drainage in acute pancreatitis (AP) and its role in persistent organ failure (OF) has not been studied. This study assessed the outcome of severe AP managed with PCD.

Methods: We retrospectively analysed outcome of AP patients undergoing PCD for persistent OF with respect to success of PCD, etiology, severity scores, OF, imaging features and PCD parameters. Success of PCD was defined as resolution of with PCD and survived without surgical necrosectomy.

Results: Between January 2016 and May 2018, 83 patients underwent PCD for persistent OF at a mean duration of 25.59 ± 21.2 days from pain onset with successful outcome in 47 (56.6%) patients. Among PCD failures, eleven (13.25%) patients underwent surgery. Overall mortality was 31 (37.3%). On multivariate analysis, pancreatic necrosis <50% and absence of extrapancreatic infection (EPI) predicted the success of PCD. Presence of infected necrosis did not affect the outcome of PCD in organ failure.

Conclusion: PCD improves the outcome in patients with OF even when done early irrespective of the status of infection of necrosis. Therefore, PCD may be considered early in the course of patients with OF.
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http://dx.doi.org/10.1016/j.hpb.2020.10.021DOI Listing
November 2020

Risk and outcomes of coronavirus disease (COVID-19) in patients with inflammatory bowel disease: a systematic review and meta-analysis.

United European Gastroenterol J 2020 Nov 19:2050640620972602. Epub 2020 Nov 19.

Hull University Teaching Hospitals NHS Trust, Hull, UK.

Background: The risk of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection and clinical outcomes of coronavirus disease (COVID-19) in inflammatory bowel disease are unclear.

Methods: We searched PubMed and Embase with the keywords: inflammatory bowel disease, Crohn's disease, ulcerative colitis and COVID-19, novel coronavirus and SARS-CoV-2. We included studies reporting the frequency of COVID-19 infection and outcomes (hospitalisation, need for intensive care unit care and mortality) in patients with inflammatory bowel disease. We estimated the pooled incidence of COVID-19 in inflammatory bowel disease and comparative risk vis-a-vis the general population. We also estimated the pooled frequency of outcomes and compared them in patients who received and did not receive drugs for inflammatory bowel disease.

Results: Twenty-four studies were included. The pooled incidence rate of COVID-19 per 1000 patients of inflammatory bowel disease and the general population were 4.02 (95% confidence interval (CI) 1.44-11.17) and 6.59 (3.25-13.35), respectively, with no increase in relative risk (0.47, 0.18-1.26) in inflammatory bowel disease. The relative risk of the acquisition of COVID-19 was not different between ulcerative colitis and Crohn's disease (1.03, 0.62-1.71). The pooled proportion of COVID-19-positive inflammatory bowel disease patients requiring hospitalisation and intensive care unit care was 27.29% and 5.33% while pooled mortality was 4.27%. The risk of adverse outcomes was higher in ulcerative colitis compared to Crohn's disease. The relative risks of hospitalisation, intensive care unit admission and mortality were lower for patients on biological agents (0.34, 0.19-0.61; 0.49, 0.33-0.72 and 0.22, 0.13-0.38, respectively) but higher with steroids (1.99, 1.64-2.40; 3.41, 2.28-5.11 and 2.70, 1.61-4.55) or 5-aminosalicylate (1.59, 1.39-1.82; 2.38, 1.26-4.48 and 2.62, 1.67-4.11) use.

Conclusion: SARS-CoV-2 infection risk in patients with inflammatory bowel disease is comparable to the general population. Outcomes of COVID-19-positive inflammatory bowel disease patients are worse in ulcerative colitis, those on steroids or 5-aminosalicylates but outcomes are better with biological agents.
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http://dx.doi.org/10.1177/2050640620972602DOI Listing
November 2020

Intraocular pressure and tear production changes in pregnant women at term pregnancy and immediate post-partum: A pilot study.

J Family Med Prim Care 2020 Sep 30;9(9):5010-5017. Epub 2020 Sep 30.

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

Aim: To study the intraocular pressure (IOP) and tear production changes in uncomplicated pregnant women at term pregnancy and immediate postpartum.

Materials And Methods: The patients admitted in the Department of Obstetrics and Gynaecology for delivery were included in the study. A total of 106 participants who were at term uncomplicated pregnancy were selected according to the inclusion and exclusion criteria. They were subjected to type 1 Schirmer's testing and intraocular pressure measurement by Perkin's tonometer before and after delivery.

Result: There was no significant pre- and postdelivery IOP difference between the different age groups (<30 and ≥30 years), mode of delivery, and parity. There was a statistically significant ( < 0.001) increase in mean tear production (Schirmer's test) after delivery, irrespective of age group, mode of delivery, and gravida status. However, no significant intergroup difference was observed.

Conclusion: There was no significant change in IOP before and after delivery in uncomplicated pregnancies. However, a statistically significant increase in tear production was observed in the immediate postpartum period.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_795_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652146PMC
September 2020

Reconstruction of buccal mucosa: A minimalist symbiotic approach with local flaps.

Oral Oncol 2021 Mar 6;114:105081. Epub 2020 Nov 6.

Department of Oral & Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Udupi, Karnataka 576104, India.

Background: Buccal mucosa defects following resection of premalignant or malignant lesions require adequate reconstruction. Both locoregional and microvascular flaps have been extensively used based on operator and patient factors. This paper focuses on the outcomes of a simplified approach for reconstruction of large buccal mucosa defects with posterior extent using a combination of two loco regional flaps.

Method: A combination of buccal fat pad graft and nasolabial flap was used to reconstruct large defects spanning the buccal mucosa extending to the soft palate or retromolar trigone areas. Post operative outcomes were noted in patients who underwent reconstruction using this combination technique.

Result: This paper highlights the favourable results and ease of technique with this combination of flaps, i.e complete coverage of large buccal mucosa defects extending to critical areas such as soft palate, retromolar trigone or tonsillar pillars; avoiding sophisticated free flaps. Satisfactory healing with adequate functional and esthetic outcomes were seen.

Conclusion: Defects post ablation of buccal mucosa lesions, larger than 5 cm × 5 cm, can be reconstructed using double local flaps. Buccal fat pad and nasolabial flaps heal excellently with nil morbidities and their combination provides a simple and an economical alternative option for reconstructive surgeons.
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http://dx.doi.org/10.1016/j.oraloncology.2020.105081DOI Listing
March 2021

A new model to predict response to direct-acting antiviral therapy in decompensated cirrhotics due to hepatitis C virus.

Clin Exp Hepatol 2020 Sep 30;6(3):253-262. Epub 2020 Sep 30.

TNMC & BYL Nair Charitable Hospital, Mumbai, India.

Aim: Decompensated hepatitis C virus (HCV) cirrhosis is a difficult to treat cohort, and there is no gold standard predictor of response to direct-acting antiviral (DAA) therapy. We conducted this study to look for factors responsible for improvement in post-therapy status, i.e. attainment of Child-Turcotte-Pugh (CTP) class A from B or C, and devise a new model to predict post-therapy response.

Material: Prospective analysis of data from decompensated HCV cirrhotics was done and association of each parameter with patient outcomes at 36 weeks after treatment was assessed.

Results: 34 patients (54.8%) attained CTP class A after treatment. Factors that were independently associated with disease outcome included albumin (odds ratio [OR] = 4.84, 95% confidence interval [CI]: 1.43-20.15, = 0.018), alanine transaminase (ALT) (OR = 1.02, 95% CI: 1-1.04, = 0.049), bilirubin (OR = 0.41, 95% CI: 0.2-0.75, = 0.007) and estimated glomerular filtration rate (eGFR) (OR = 1.03, 95% CI: 1.0-1.06, = 0.045). On multivariate analysis, bilirubin was significantly associated with treatment outcome (OR = 0.28, 95% CI: 0.1-0.64, = 0.006). A composite model was devised using demographic, biochemical, and clinical features, which has sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 67.86%, 79.41%, 73.08%, 75%, and 73.63% respectively in predicting response to therapy. Only 7.6% of patients with a Model for End-Stage Liver Disease (MELD) score > 15 and none of the patients with CTP class C met the primary end-point of our study.

Conclusions: 55% of our cohort met the primary end-point at 36 weeks. Patients with CTP class C and a MELD score > 15 should be referred for liver transplantation followed by DAA therapy. Our model was good at predicting improvement in post-therapy liver function.
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http://dx.doi.org/10.5114/ceh.2020.99525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592091PMC
September 2020

Accuracy of anterior segment optical coherence tomography for pre-operative localization of insertions of extraocular recti muscles.

Eur J Ophthalmol 2020 Nov 3:1120672120971192. Epub 2020 Nov 3.

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

Introduction: To study the accuracy of anterior segment optical coherence tomography (AS-OCT) function of Cirrus HD-OCT 500 (Carl Zeiss Meditec, Dublin, CA) in calculating the insertion of rectus muscles from the limbus in patients undergoing primary squint surgery.

Methodology: A prospective, double-masked, observational study was conducted on 128 muscles of 46 patients with strabismus who were planned for strabismus surgery between January 2019 and December 2019. Insertion distance from limbus was measured using AS-OCT function of Cirrus HD-OCT 500 preoperatively. Intraoperative measurements were taken using Castroviejo caliper. A Bland-Altman analysis was performed to determine the agreement between the readings.

Results: A total of 128 muscles were successfully imaged and evaluated, including 13 superior recti (10.15%), 23 inferior recti (17.96%), 35 medial recti (27.34%) and 57 lateral recti (44.53%). 124 muscles (96.9%) were within 1mm difference, which was considered clinically acceptable. Bland-Altman plots showed the level of agreement between the two methods was good.

Conclusion: Anterior segment scan function of Cirrus HD-OCT 500 is an accurate method to detect the insertion of extraocular recti muscles in patients of primary strabismus surgery.
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http://dx.doi.org/10.1177/1120672120971192DOI Listing
November 2020

Fecal calprotectin levels in COVID-19: Lessons from a systematic review on its use in inflammatory bowel disease during the pandemic.

Dig Liver Dis 2021 03 19;53(3):295-297. Epub 2020 Oct 19.

Department of Gastroenterology and Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address:

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http://dx.doi.org/10.1016/j.dld.2020.10.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572109PMC
March 2021

Retinal astrocytic hamartoma and systemic spectrum of disease in successive generations with tuberous sclerosis complex.

Indian J Ophthalmol 2020 Nov;68(11):2504-2507

Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India.

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http://dx.doi.org/10.4103/ijo.IJO_891_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774128PMC
November 2020