Publications by authors named "Arun Gupta"

545 Publications

Thyroid tuberculosis.

Indian J Tuberc 2021 Apr 12;68(2):272-278. Epub 2020 Sep 12.

Department of General Surgery, Dr Ram Manohar Lohia Hospital and Post Graduate, Institute of Medical Education and Research, New Delhi, India. Electronic address:

Thyroid tuberculosis is a rare disease. Its incidence is low even in countries where prevalence of pulmonary tuberculosis is high (0.1-0.4%). In literature, there are only a few cases which were diagnosed as thyroid tuberculosis. It can be explained by a high resistance of the thyroid gland to infectious processes. However, the prevalence of tuberculosis has increased worldwide and thyroid involvement can be a primary manifestation of the disease. The incidence of extrapulmonary tuberculosis has been showing a progressive increase in the recent years(Barnes and Weatherstone, 1979). The most frequent clinical presentation is a solitary thyroid nodule that may present as a cystic nodule. It may also present as thyroid abscess with pain, fever and other non-specific signs and symptoms. ATT results in complete cure therefore it is important to differentiate it from other form of thyroiditis. Patients are usually euthyroid, but cases of hypothyroidism and hyperthyroidism are described. For accurate diagnosis of thyroid tuberculosis, clinical and radiological features are nonspecific and histological examination is required for confirmation of diagnosis. PCR may help in diagnosis. The authors encounter 3 cases of thyroid tuberculosis in last 5 year which are described in this article. The aim of this study is to review all the cases published in literature to describe clinical presentation, appropriate diagnostic method and possible treatment options of the disease.
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http://dx.doi.org/10.1016/j.ijtb.2020.09.006DOI Listing
April 2021

Analysis of the Association Between Lung Function and Brain Tissue Oxygen Tension in Severe Traumatic Brain Injury.

Acta Neurochir Suppl 2021 ;131:27-30

Neurosciences Critical Care, University of Cambridge, Cambridge, UK.

Introduction: Low brain tissue oxygen tension (PbtO) has been shown to be an independent factor associated with unfavourable outcomes in traumatic brain injury (TBI). Although PbtO provides clinicians with an understanding of ischaemic and non-ischaemic derangements of brain physiology, the value alone can be the result of several factors, including partial arterial oxygenation pressure (PaO), haemoglobin levels (Hb) and cerebral perfusion pressure (CPP).

Methods: This chapter presents a single-centre, retrospective cohort study of 70 adult patients with severe TBI who were admitted to the Neurocritical Care Unit (NCCU) at Addenbrooke's Hospital (Cambridge, UK) between October 2014 and December 2017. A total of 303 simultaneous measurements of different variables that included (but were not limited to) intracranial pressure (ICP), PaO, PbtO, CPP and the fraction of inspired oxygen (FiO) were considered in this work. We conducted a correlation analysis between all of the variables. We also implemented a longitudinal data analysis of the PbtO and PaO/FiO ratio (PF ratio).

Results: There were strong and independent correlations between PbtO and the PF ratio, and between PbtO and PaO, with adjusted p values of <0.001 for both correlations. After adjustment for ICP, age, sex and the Glasgow Coma Scale (GCS) score, a PF ≤ 330 was shown to be an independent risk factor for a compromised PbtO value of <20, with an adjusted odds ratio of 1.94 (95% confidence interval 1.12-3.34) and a p value of 0.02.

Conclusion: Brain and lung interactions in patients with TBI patients have complex interrelationships. Our results confirm the importance of employing lung-protective strategies to prevent brain hypoxia in patients with TBI.
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http://dx.doi.org/10.1007/978-3-030-59436-7_6DOI Listing
January 2021

LIFR-α-dependent adipocyte signaling in obesity limits adipose expansion contributing to fatty liver disease.

iScience 2021 Mar 24;24(3):102227. Epub 2021 Feb 24.

Center for Human Nutrition, University of Texas Southwestern Medical Center, 5300 Harry Hines Boulevard, Dallas, TX, USA.

The role of chronic adipose inflammation in diet-induced obesity (DIO) and its sequelae including fatty liver disease remains unclear. Leukemia inhibitory factor (LIF) induces JAK-dependent adipocyte lipolysis and altered adipo/cytokine expression, suppressing adipose expansion in normal and obese mouse models. To characterize LIF receptor (LIFR-α)-dependent cytokine signaling in DIO, we created an adipocyte-specific knockout mouse model ( ). Differentiated adipocytes derived from this model blocked LIF-induced triacylglycerol lipolysis. mice on a high-fat diet (HFD) displayed reduced adipose STAT3 activation, 50% expansion in adipose, 20% body weight increase, and a 75% reduction in total hepatic triacylglycerides compared with controls. To demonstrate that LIFR-α signals adipocytes through STAT3, we also created an model that showed similar findings when fed a HFD as mice. These findings establish the importance of obesity-associated LIFR-α/JAK/STAT3 inflammatory signaling in adipocytes, blocking further adipose expansion in DIO contributing to ectopic liver triacylglyceride accumulation.
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http://dx.doi.org/10.1016/j.isci.2021.102227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970148PMC
March 2021

Spine radiograph in dysplasias: A pictorial essay.

Indian J Radiol Imaging 2020 Oct-Dec;30(4):436-447. Epub 2021 Jan 13.

Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Spine radiograph is an essential component of a skeletal survey. It provides important diagnostic clues to various types of skeletal dysplasia. In some conditions, a spine radiograph alone may be diagnostic and characteristic; but mostly, it yields more value as a part of the complete skeletal survey. In this article we will discuss about a few common lethal and non-lethal skeletal dysplasias and their characteristic imaging findings; primarily focusing on the spine radiograph.
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http://dx.doi.org/10.4103/ijri.IJRI_395_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954163PMC
January 2021

Comparison of 4DMRI and 4DCT for the preoperative evaluation of patients with primary hyperparathyroidism.

Eur J Radiol 2021 May 5;138:109625. Epub 2021 Mar 5.

Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.

Background: Minimally invasive parathyroid surgery is the standard of care in patients with Primary Hyperparathyroidism (PHPT) which requires accurate preoperative localization. Of all the available imaging modalities, 4DCT is considered the best modality for localization, however it entails the risk of ionizing radiation. To circumvent this 4DMRI was evaluated for parathyroid lesion localization.

Purpose: To evaluate and compare the accuracy of 4DCT and 4DMRI in the localization of parathyroid Lesions.

Materials And Methods: In this ethically approved observational diagnostic study, 135 patients (age range: 10-75 years, male: female ratio - 1:2.1) with clinically and biochemically suspected PHPT were recruited. Of these, 56 patients underwent both 4DCT and 4DMRI. Six patients with positive imaging who didn't undergo surgery were excluded. A total of 50 patients with 61 proven parathyroid lesions were included for analysis. 48 patients had surgical and histopathological findings for the confirmation of imaging findings.

Results: Both 4DCT and 4DMRI correctly detected 59/61 lesions in 48 patients. There was one false positive and two true negatives. In addition, 2 (3.22 %) lesions which were not detected by 4DCT and 4DMRI were found on surgery. The sensitivity of both 4DCT and 4DMRI was 96.7 %; specificity was 66.6 % and accuracy was 95.2 %.

Conclusion: 4DMRI and 4DCT had similar accuracy for the detection of parathyroid lesions. However, 4DMRI has the advantage of lack of exposure to ionizing radiation, which can be beneficial in younger patients.
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http://dx.doi.org/10.1016/j.ejrad.2021.109625DOI Listing
May 2021

A Prospective Randomised Controlled Study Comparing Ultrasonic Dissector with Electrocautery for Axillary Dissection in Patients of Carcinoma Breast.

Malays J Med Sci 2021 Feb 24;28(1):97-104. Epub 2021 Feb 24.

Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India.

Background: Axillary dissection is one of the important components of modified radical mastectomy (MRM). The present study was conducted to compare surgical outcomes by using monopolar electrocautery and ultrasonic dissector for axillary dissection in MRM.

Methods: A parallel randomised controlled single blinded study was conducted with a sample size of 70 patients who were randomised into two groups. One group underwent MRM using ultrasonic dissector (Group A) and the other one using electrocautery (Group B). Intra- and post-operative outcomes were compared.

Results: Group A had an average operating time of 30.86 min, which was statistically less than that of Group B. The mean mop count and the daily drain output in Group A were less as compared to Group B and the differences were statistically significant. Drain was removed early in Group A as compared to Group B. However, post-operative pain scores and seroma formation were not statistically significant among the two groups.

Conclusion: Ultrasonic dissector group had significantly lesser intra-operative bleeding, operating time and post-operative drain output when compared to electrocautery group. However, the two groups had no significant difference in post-operative pain scores and seroma formation.
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http://dx.doi.org/10.21315/mjms2021.28.1.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909355PMC
February 2021

A kaleidoscopic view of male urethral pathologies on 64-slice multidetector computed tomographic urethrography: A novel technique.

SA J Radiol 2021 29;25(1):1964. Epub 2021 Jan 29.

Department of Surgery, University College of Medical Sciences and GTB Hospital, Delhi, India.

Pathologies of the male urethra are mostly obstructive in nature and require imaging to delineate the lesion type, site, extent and associated abnormality of the urinary bladder. Contrast urethrography (CU) is the gold standard investigation for urethral assessment but has many limitations. Cross-sectional imaging is infrequently used for the evaluation of the urethra but has been gaining importance recently. Multidetector computed tomographic urethrography (MDCTU) has the capability of evaluating the entire length of a male urethra in a single setting and overcomes many technical and patient limitations of CU. Being a novel technique, most radiologists are not familiar with MDCTU and the imaging spectrum of various urethral and bladder pathologies. This pictorial review attempts to present the imaging appearance of the normal male urethra and spectrum of pathological findings, with highlights on its advantages over the CU technique.
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http://dx.doi.org/10.4102/sajr.v25i1.1964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876774PMC
January 2021

Tricyclic-Carbocyclic RORγt Inverse Agonists-Discovery of BMS-986313.

J Med Chem 2021 Mar 16;64(5):2714-2724. Epub 2021 Feb 16.

Research and Early Development, Bristol Myers Squibb Company, Princeton, New Jersey 08543-4000, United States.

SAR efforts directed at identifying RORγt inverse agonists structurally different from our clinical compound (BMS-986251) led to tricyclic-carbocyclic analogues represented by - and culminated in the identification of (BMS-986313), with structural differences distinct from . The X-ray co-crystal structure of with the ligand binding domain of RORγt revealed several key interactions, which are different from . The in vitro and in vivo PK profiles of are described. In addition, we demonstrate robust efficacy of in two preclinical models of psoriasis-the IMQ-induced skin lesion model and the IL-23-induced acanthosis model. The efficacy seen with in these models is comparable to the results observed with .
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http://dx.doi.org/10.1021/acs.jmedchem.0c01992DOI Listing
March 2021

Emerging approaches to determine maturity of citrus fruit.

Crit Rev Food Sci Nutr 2021 Feb 13:1-22. Epub 2021 Feb 13.

Department of Food Engineering and Technology, Tezpur University, Tezpur, Assam, India.

Owing to their health-boosting properties and other appreciable properties, citrus fruit is widely consumed and commercialized worldwide. Destination markets around the world vary in their fruit quality requirements and are also highly influenced by climatic conditions, agronomical and postharvest practices. Hence, harvesting decisions are arduous. Maturity indices in citrus fruit are highly variable and dependent on the species and varieties, growing regions, and destination markets. For decades, determination of the maturity of citrus fruit and predicting the near time of harvesting was a challenge for producers, researchers, and food safety agencies. Thus, the current review provides a correlation between maturity and internal components and an overview of techniques of maturity determination for citrus fruits. Also, stress has been given to the destructive and nondestructive methods to determine the maturity level of different citrus species. The techniques presented in this review portray continuous productiveness as an excellent quality assessment, particularly as ripening and maturity analysis tools for citrus fruits. Traditional techniques are time-consuming, laborious, costly, destructive, and tedious. Thus, these nondestructive techniques hold great potential to replace conventional procedures.
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http://dx.doi.org/10.1080/10408398.2021.1883547DOI Listing
February 2021

Scrotal Migration of Two Ventriculoperitoneal Shunts Presenting as Hydrocele.

J Indian Assoc Pediatr Surg 2020 Nov-Dec;25(6):414-416. Epub 2020 Oct 27.

Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India.

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http://dx.doi.org/10.4103/jiaps.JIAPS_195_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815041PMC
October 2020

Currarino Syndrome Variant: Revisited.

J Indian Assoc Pediatr Surg 2020 Sep-Oct;25(5):328-329. Epub 2020 Sep 1.

Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India.

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http://dx.doi.org/10.4103/jiaps.JIAPS_148_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732002PMC
September 2020

Congenital Pouch Colon with Segmental Dilatation of Ileum: Congenital Pouch Colon Type 6.

J Indian Assoc Pediatr Surg 2020 Sep-Oct;25(5):319-322. Epub 2020 Sep 1.

Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India.

Congenital pouch colon (CPC) is classified on the basis of anatomic morphology into five types. Congenital segmental intestinal dilatation associated with anorectal malformation (ARM) is very rare. We are adding two neonates of CPC type 2 associated with segmental dilatation of the ileum to single similar case described in the literature till date. Temporary stomas with excision of either of the pouches should be considered. "Defective mesenchyme formation during organogenesis" due to abnormal mesenchymal precursor cells is hypothesized as the cause for both ARM and different types of CPC.
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http://dx.doi.org/10.4103/jiaps.JIAPS_190_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732013PMC
September 2020

Identification of QTLs/Defense Genes Effective at Seedling Stage Against Prevailing Races of Wheat Stripe Rust in India.

Front Genet 2020 27;11:572975. Epub 2020 Nov 27.

Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, New Delhi, India.

Resistance in modern wheat cultivars for stripe rust is not long lasting due to the narrow genetic base and periodical evolution of new pathogenic races. Though nearly 83 genes conferring resistance to stripe rust have been cataloged so far, few of them have been mapped and utilized in breeding programs. Characterization of wheat germplasm for novel sources of resistance and their incorporation into elite cultivars is required to achieve durable resistance and thus to minimize the yield losses. Here, a genome-wide association study (GWAS) was performed on a set of 391 germplasm lines with the aim to identify quantitative trait loci (QTL) using 35K Axiom® array. Phenotypic evaluation disease severity against four stripe rust pathotypes, i.e., 46S119, 110S119, 238S119, and 47S103 (T) at the seedling stage in a greenhouse providing optimal conditions was carried out consecutively for 2 years (2018 and 2019 winter season). We identified, a total of 17 promising QTl which passed FDR criteria. Moreover these 17 QTL identified in the current study were mapped at different genomic locations i.e. 1B, 2A, 2B, 2D, 3A, 3B, 3D, 4B, 5B and 6B. These 17 QTLs identified in the present study might play a key role in marker-assisted breeding for developing stripe rust resistant wheat cultivars.
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http://dx.doi.org/10.3389/fgene.2020.572975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728992PMC
November 2020

Pial arteriovenous fistula: A clinical and neuro-interventional experience of outcomes in a rare entity.

Indian J Radiol Imaging 2020 Jul-Sep;30(3):286-293. Epub 2020 Oct 15.

Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.

Purpose: Pial arteriovenous fistulae (PAVF) are rare intracranial vascular malformations, predominantly seen in children and distinct from arteriovenous malformations and dural arteriovenous fistulae. PAVF often leads to high morbidity and mortality. The aim of our study was to describe the clinical features and endovascular management of PAVF at various intracranial locations; to analyze the use of liquid embolic agents and coils alone or in combination in the treatment of PAVF and to analyze the outcome of embolization.

Materials And Methods: Retrospective review of diagnostic angiography and neurointerventional database of our institution identified a cohort of 15 patients with non-galenic PAVF from 2008 to 2014 out of 6750 patients. Fourteen patients were treated endovascularly with coils and liquid embolic materials in combination or alone. Patients were followed up for evaluation of prognosis.

Results: Age of the patients ranged from 3 to 37 years. Most patients were male and most common presentation was headache followed by seizure. Most common location of fistula was frontal lobe. The most common type was single artery single hole fistula with venous varix. Satisfactory obliteration was seen in all cases. One patient developed intraparenchymal hematoma on the first post procedural day and outcome was poor.

Conclusions: PAVF are rare intracranial vascular malformations which can effectively be managed endovascularly with liquid embolic, coils alone, or in combination. Complete occlusion of the fistula can be achieved in most cases in a single sitting with a reasonable morbidity related to the procedure, compared with the natural history of this disease.
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http://dx.doi.org/10.4103/ijri.IJRI_26_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694735PMC
October 2020

Unusual Primary Neoplasms of the Adult Liver: Review of Imaging Appearances and Differential Diagnosis.

Curr Probl Diagn Radiol 2020 Nov 2. Epub 2020 Nov 2.

Department of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India.

The radiological appearance of common primary hepatic tumors such as hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) is widely recognized. Hepatic masses with unusual histology are occasionally encountered, but seldom suspected on imaging. However, many possess characteristic imaging findings, which when assessed along with the clinical and demographic background and serum tumor markers, may enable a prospective diagnosis. This review attempts to familiarize the reader with the clinicopathological characteristics, imaging manifestations, and differential diagnosis of these unusual liver tumors in adults. Biphenotypic primary liver carcinoma is suspected in masses showing distinct areas of HCC and CCA-type enhancement pattern in cirrhotic livers. Fibrolamellar carcinoma occurs in young individuals without underlying chronic liver disease and shows a characteristic T2-hypointense scar frequently showing calcification. Perivascular epithelioid cell tumors are differentials for any arterial hyperenhancing mass in the noncirrhotic liver, particularly in patients with tuberous sclerosis. Multifocal subcapsular tumors showing target-like morphology, capsular retraction and "lollipop" sign are suspicious for epithelioid hemangioendothelioma. On the other hand, multiple hemorrhagic lesions showing patchy areas of bizarre-shaped arterial phase hyperenhancement are suspicious for angiosarcoma. Primary hepatic lymphoma (PHL) is suspected when patients with immunosuppression present with solitary or multifocal masses that insinuate around vessels and bile ducts without causing luminal narrowing. Intense diffusion restriction and low-level homogeneous or target-like enhancement are also ancillary features of PHL. Primary hepatic neuroendocrine tumor shows uptake on Ga-68 DOTANOC PET/CT. Although a straightforward diagnosis may be difficult in these cases, awareness of the characteristic imaging appearances is helpful in suspecting the diagnosis.
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http://dx.doi.org/10.1067/j.cpradiol.2020.10.001DOI Listing
November 2020

Dissecting aneurysms of the posterior cerebral artery - A retrospective review of imaging, angiographic characteristics, endovascular management and outcome.

Interv Neuroradiol 2021 Apr 28;27(2):152-162. Epub 2020 Oct 28.

Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India.

Purpose: To review management, clinical and imaging outcomes of dissecting posterior cerebral artery (PCA) aneurysms with emphasis on endovascular management in the form of parent vessel occlusion (PVO) at a tertiary care center.

Methods: Thirty-six dissecting PCA aneurysms (19 ruptured) encountered at our center between January 2013 and November 2019 were reviewed for aneurysm location/size/presence of fetal PCA/management. Postprocedural imaging of patients who underwent endovascular intervention was reviewed for PCA territory infarcts and clinical records assessed for presence of neuro-deficits and outcome. None of the patients underwent a balloon test occlusion (BTO) prior to PVO.

Results: The location of the aneurysms was as follows-P1 = 8/P1-P2 = 11/P2 = 5/P2-P3 = 10/P3 = 2. The mean size was 11.7x6.8 mm. Endovascular intervention was carried out in 20 patients in the form of PVO with coiling in 16 patients, coiling alone in 3 patients, and reconstruction of the left PCA with flow diverter deployment in one patient. Postprocedural PCA territory infarct was seen in 5 cases of PVO out of which 4 had a good functional recovery. Overall, 15/16 patients (93.7%) who underwent PVO had mRS ≤ 2 on follow-up. The single case with flow diverter also developed an infarct and had adverse outcome on follow up.

Conclusion: Among the various management strategies for dissecting PCA aneurysms, PVO is feasible and relatively safe even in absence of BTO in scenarios like critically ill patients with ruptured aneurysms, difficult access and financial constraints. Thromboembolic complications and antiplatelet therapy is a concern in reconstructive strategies.
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http://dx.doi.org/10.1177/1591019920967572DOI Listing
April 2021

JAK Inhibitors Suppress Cancer Cachexia-Associated Anorexia and Adipose Wasting in Mice.

JCSM Rapid Commun 2020 Jul-Dec;3(2):115-128. Epub 2020 Jul 21.

Department of Molecular Genetics, University of Texas (UT) Southwestern Medical Center, Dallas, Texas, USA.

Background: Cachexia, a syndrome of muscle atrophy, adipose loss, and anorexia, is associated with reduced survival in cancer patients. The colon adenocarcinoma C26c20 cell line secretes the cytokine leukemia inhibitory factor (LIF) which induces cachexia. We characterized how LIF promotes cachexia-associated weight loss and anorexia in mice through JAK-dependent changes in adipose and hypothalamic tissues.

Methods: Cachexia was induced with the heterotopic allotransplanted administration of C26c20 colon adenocarcinoma cells or the intraperitoneal administration of recombinant LIF in the absence or presence of JAK inhibitors. Blood, adipose, and hypothalamic tissues were collected and processed for cyto/adipokine ELISAs, immunoblot analysis, and quantitative RT-PCR. Cachexia-associated lipolysis was induced by stimulating differentiated adipocytes with recombinant LIF or IL-6 in the absence or presence of lipase or JAK inhibitors. These adipocytes were processed for glycerol release into the media, immunoblot analysis, and RT-PCR.

Results: Tumor-secreted LIF induced changes in adipose tissue expression and serum levels of IL-6 and leptin in a JAK-dependent manner influencing cachexia-associated adipose wasting and anorexia. We identified two JAK inhibitors that block IL-6 family-mediated adipocyte lipolysis and IL-6 induction using an cachexia lipolysis assay. JAK inhibitors administered to the C26c20 cancer cachexia mouse models led to 1) a decrease in STAT3 phosphorylation in hypothalamic and adipose tissues, 2) a reverse in the cachexia serum cyto/adipokine signature, 3) a delay in cancer cachexia-associated anorexia and adipose loss, and 4) an improvement in overall survival.

Conclusions: JAK inhibitors suppress LIF-associated adipose loss and anorexia in both and models of cancer cachexia.
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http://dx.doi.org/10.1002/rco2.24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7580845PMC
July 2020

Optimization of debittering and deacidification parameters for Pomelo juice and assessment of juice quality.

J Food Sci Technol 2020 Dec 3;57(12):4726-4732. Epub 2020 Sep 3.

Department of Food Engineering and Technology, Tezpur University, Tezpur, Assam India.

Bitterness and tartness are one of the crucial reasons for the poor commerciality of Pomelo fruits. The present study intends to optimize the process variables such as resin concentration (Amberlite IRA-400) (3-10 g), time exposure (10-60 s), and stirring speed (300-1000 rpm) for removal of naringin content and tartness using response surface methodology. All the independent variables have shown a significant effect on naringin content, titrable acidity, and vitamin C content of pomelo juice. The optimized process variables for debittering and deacidification were 3.27 g resin concentration, 60 s time and 1000 rpm stirring speed, and the naringin content and titrable acidity at these optimized conditions were 0.22 mg ml and 0.64% citric acid equivalent respectively. The treated juice under optimum conditions was analyzed for physicochemical properties where pH, clarity, and value of juice increased. In contrast, total soluble solids, vitamin C content, and value decreased slightly. The finding of present investigation will be helpful to improve the commercial acceptability of the sour variety of citrus fruit juice.
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http://dx.doi.org/10.1007/s13197-020-04687-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550523PMC
December 2020

Roxb. and Lam. Flowers: New Sources of Bioactive Compounds.

Plants (Basel) 2020 Oct 9;9(10). Epub 2020 Oct 9.

Department of Molecular and Translational Medicine, Division of Pharmacology, University of Brescia, 25123 Brescia, Italy.

Lam. () and Roxb. () are two endemic plants that grow on the Asian continent. To date, their applications have been aimed at using their fruit as a food source or for some of their therapeutic virtues. In this study, attention was given to the flowers of and . Initially, the cytotoxicity of the phytoextracts was assessed, and the content of minerals, phenols, and flavonoids was determined. Furthermore, some antioxidant components were identified by HPLC. Furthermore, the ability of and extracts to modulate the gene expression of some targets involved in the antioxidant response was studied. The results obtained highlighted the nutritional and antioxidant value of the and flower extracts. This study will contribute to enhancing the use of and flowers as potential supplements in human nutrition.
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http://dx.doi.org/10.3390/plants9101329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600190PMC
October 2020

Prevalence of smooth muscle dysfunction among children with Duchenne muscular dystrophy.

Muscle Nerve 2020 12 7;62(6):699-704. Epub 2020 Oct 7.

Center of Excellence and Advanced Research on Childhood Neurodevelopmental Disorders, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

Smooth muscle dysfunction in Duchenne muscular dystrophy (DMD) has been rarely studied. A cross-sectional study was conducted to estimate the prevalence of smooth muscle dysfunction (vascular, upper gastrointestinal, and bladder smooth muscle) in children with DMD using questionnaires (Pediatric Bleeding Questionnaire, Pediatric Gastroesophageal Symptom Questionnaire, and Dysfunctional Voiding Symptom Score). Investigations included bleeding time estimation, nuclear scintigraphy for gastroesophageal reflux, and uroflowmetry for urodynamic abnormalities. Ninety-nine subjects were included in the study. The prevalence of vascular, upper gastrointestinal, and bladder smooth muscle dysfunction was 27.2%. Mean bleeding time was prolonged by 117.5 seconds. The prevalence of gastroesophageal reflux was 21%. Voided volume/estimated bladder capacity over 15% and abnormal flow curves on uroflowmetry were seen in 18.2% and 9.7% of the subjects, respectively. Our study highlights the need for addressing issues related to smooth muscle dysfunction in the routine clinical care of patients with DMD.
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http://dx.doi.org/10.1002/mus.27077DOI Listing
December 2020

Possible Role for Bacteriophages in the Treatment of SARS-CoV-2 Infection.

Int J Microbiol 2020 19;2020:8844963. Epub 2020 Sep 19.

Department of Neurology, Banaras Hindu University, Varanasi 221005, India.

An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan City, China, in December 2019. Since then, the outbreak has grown into a global pandemic, and neither a vaccine nor a treatment for the disease, termed coronavirus disease 2019 (COVID-19), is currently available. The slow translational progress in the field of research suggests that a large number of studies are urgently required. In this context, this review explores the impact of bacteriophages on SARS-CoV-2, especially concerning phage therapy (PT). Bacteriophages are viruses that infect and kill bacterial cells. Several studies have confirmed that in addition to their antibacterial abilities, bacteriophages also show antiviral and antifungal properties. It has also been shown that PT is effective for building immunity against viral pathogens by reducing the activation of NF kappa B; additionally, phages produce the antiviral protein phagicin. The Ganges river in India, which originates from the Himalayan range, is known to harbor a large number of bacteriophages, which are released into the river gradually by the melting permafrost. Water from this river has traditionally been considered a therapeutic agent for several diseases. In this review, we hypothesize that the Ganges river may play a therapeutic role in the treatment of COVID-19.
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http://dx.doi.org/10.1155/2020/8844963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502124PMC
September 2020

Kluth Type IIIb Variant of Esophageal Atresia.

J Indian Assoc Pediatr Surg 2020 Jul-Aug;25(4):248-250. Epub 2020 Jun 24.

Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India.

We, herein, present an extremely rare case of an esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) with additional perforated membrane at the lower one-third of fistula. A neonate presented with difficulty in breathing and excessive frothing from the mouth. Radiograph with red rubber catheter (obstruction at 10 cm from the gum margins) suggested EA with distal TEF. During thoracotomy, after ligation of fistula, a 6 Fr infant feeding tube was introduced into the distal esophagus which revealed obstruction at the lower one-third. An esophagotomy was performed; a membrane with opening at the center was identified. Following its excision, the esophageal end became dusky necessitating esophagostomy and feeding gastrostomy. A high index of suspicion for membranous obstruction at the lower one-third of fistula should be kept in mind while dealing with EA with distal TEF.
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http://dx.doi.org/10.4103/jiaps.JIAPS_134_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478272PMC
June 2020

Novel Use of Ultrasound in Evaluation of Adenoid Hypertrophy in Children.

Indian J Pediatr 2020 11 10;87(11):885-886. Epub 2020 Sep 10.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.

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http://dx.doi.org/10.1007/s12098-020-03487-6DOI Listing
November 2020

High Resolution Transthoracic Ultrasound in Evaluation of Pediatric Mediastinal Lymphadenopathy.

Indian J Pediatr 2021 Jan 2;88(1):105. Epub 2020 Sep 2.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.

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http://dx.doi.org/10.1007/s12098-020-03485-8DOI Listing
January 2021

Ultrasonography in Early Rheumatoid Arthritis of Hand and Wrist Joints: Comparison with Magnetic Resonance Imaging.

Indian J Orthop 2020 Sep 2;54(5):695-703. Epub 2020 Jul 2.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029 India.

Background: The aim of the study was to evaluate the use of ultrasonography (USG) including power Doppler in detecting hand and wrist joint changes in early rheumatoid arthritis (RA) and to compare USG findings with magnetic resonance imaging (MRI).

Materials And Methods: Thirty-four patients diagnosed as RA by 2010 ACR/EULAR criteria; with the onset of symptoms within last one year, were included in the study after institute ethical clearance and informed consent to undergo USG and contrast-enhanced MRI of the dominant affected hand. Second to fifth metacarpophalangeal (MCP) joints, second to fifth proximal interphalangeal (PIP) joints and wrist joints (total nine joints) were evaluated for synovitis, erosions along with tenosynovitis. USG and MRI features were compared; agreement on the two imaging modalities as well as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of ultrasonography compared to MRI (gold standard) was calculated.

Results: One hundred thirty-six MCP, 136 PIP and 34 wrist joints (total 306 joints) and 136 flexor tendons were evaluated. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of USG for diagnosing synovitis was 78.6%, 91.1%, 86.1%, 85.8%, 86.3%; for erosions 67.2%, 97.5%, 84.8%, 90.5%, 91.5%; for tenosynovitis 86.5%, 100%, 100%, 92.3% and 94.8% respectively. The overall agreement between USG and MRI for detection of synovitis was achieved in 83% joints and for erosions in 89.5% joints.

Conclusion: In early RA, USG was nearly as effective in diagnosing features of joint and tendon sheath involvement, with relatively better performance of USG for tenosynovitis. The performance of USG in diagnosing erosions was limited likely due to difficult access of three-dimensional joint structure.
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http://dx.doi.org/10.1007/s43465-020-00178-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429602PMC
September 2020

Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury.

Front Neurol 2020 7;11:771. Epub 2020 Aug 7.

Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, United Kingdom.

A major contributor to unfavorable outcome after traumatic brain injury (TBI) is secondary brain injury. Low brain tissue oxygen tension (PbtO2) has shown to be an independent predictor of unfavorable outcome. Although PbtO2 provides clinicians with an understanding of the ischemic and non-ischemic derangements of brain physiology, its value does not take into consideration systemic oxygenation that can influence patients' outcomes. This study analyses brain and systemic oxygenation and a number of related indices in TBI patients: PbtO2, partial arterial oxygenation pressure (PaO2), PbtO2/PaO2, ratio of PbtO2 to fraction of inspired oxygen (FiO2), and PaO2/FiO2. The primary aim of this study was to identify independent risk factors for cerebral hypoxia. Secondary goal was to determine whether any of these indices are predictors of mortality outcome in TBI patients. A single-centre retrospective cohort study of 70 TBI patients admitted to the Neurocritical Care Unit (NCCU) at Cambridge University Hospital in 2014-2018 and undergoing advanced neuromonitoring including invasive PbtO2 was conducted. Three hundred and three simultaneous measurements of PbtO2, PaO2, PbtO2/PaO2, PbtO2/FiO2, PaO2/FiO2 were collected and mortality at discharge from NCCU was considered as outcome. Generalized estimating equations were used to analyse the longitudinal data. Our results showed PbtO2 of 28 mmHg as threshold to define cerebral hypoxia. PaO2/FiO2 found to be a strong and independent risk factor for cerebral hypoxia when adjusting for confounding factor of intracranial pressure (ICP) with adjusted odds ratio of 1.78, 95% confidence interval of (1.10-2.87) and -value = 0.019. With respect to TBI outcome, compromised values of PbtO2, PbtO2/PaO2, PbtO2/FiO2, and PaO2/FiO2 were all independent predictors of mortality while considered individually and adjusting for confounding factors of ICP, age, gender, and cerebral perfusion pressure (CPP). However, when considering all the compromised values together, only PaO2/FiO2 became an independent predictor of mortality with adjusted odds ratio of 3.47 (1.20-10.04) and -value = 0.022. Brain and Lung interaction in TBI patients is a complex interrelationship. PaO2/FiO2 seems to be a major determinant of cerebral hypoxia and mortality. These results confirm the importance of employing ventilator strategies to prevent cerebral hypoxia and improve the outcome in TBI patients.
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http://dx.doi.org/10.3389/fneur.2020.00771DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426476PMC
August 2020

An innovative approach for iron fortification of rice using cold plasma.

Food Res Int 2020 10 28;136:109599. Epub 2020 Jul 28.

Department of Food Engineering and Technology, Tezpur University, Tezpur, Assam 784028, India. Electronic address:

In the present study, an innovative cold plasma treatment was used as a tool to fortify the white rice. The amounts of ferrous sulphate and ascorbic acid were optimized for improving the bioavailability of iron. White rice samples were treated with plasma at a constant voltage of 20 kV for varying time (10 min and 15 min). The exposure time of plasma was selected based on the surface characteristics, hydrophilicity and thermal properties. Significant improvement was observed in the characteristics of hydrophilicity, surface energy, cooking time and hardness of plasma-treated rice. Plasma treated rice was fortified with the optimum concentrations of iron and ascorbic acid solution. Optimum concentrations of iron and ascorbic acid per 100 g of rice (862.93 mg and 1398.27 mg) were found by conducting experiments using Central Composite Design of Response Surface Methodology. Further, rice was blended with untreated rice in the ratio of 1:100 and 1:200 and was packed in LDPE and PP pouches and was stored at ambient temperature for further storage analysis. The in vitro bioavailability of iron was significantly higher in the plasma-treated fortified rice at both 1.35 and 7.5 pH than in the control sample, and plasma treatment significantly reduced the rate of oxidation of iron during storage.
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http://dx.doi.org/10.1016/j.foodres.2020.109599DOI Listing
October 2020

A comparative analysis of control measures on-board ship against COVID-19 and similar novel viral respiratory disease outbreak: Quarantine ship or disembark suspects?

Med J Armed Forces India 2020 Jun 30. Epub 2020 Jun 30.

Classified Specialist (ENT), 166 Military Hospital, C/o 56 APO, India.

Background: Management of novel viral respiratory disease outbreak on-board a ship with person-to-person transmission can be a public health challenge because of close proximity of inhabitants due to confined space and air-conditioned environment. It has a potential to be explosive, with high secondary attack rate (SAR) and cause significant morbidity and mortality. This study compares control measures instituted on-board two ships with similar outbreaks and recommends a standardized evidence-based outbreak response against them.

Methods: This is a descriptive study, showing comparative analysis of control measures instituted on-board two ships, a cruise ship in case of COVID-19 and a warship in case of H1N1 influenza, with novel viral respiratory disease outbreak, at different span of time. Data of the date of onset, clinical details, laboratory results, history of travel, history of contact with positive case and control measures initiated were collected, analysed and compared.

Results: Of the two ships compared, one was a cruise ship with 712 COVID-19 cases, with an attack rate (AR) of 19.2% and 13 deaths, and other a warship with 14 cases of H1N1 influenza and an AR of 4.83%. The epidemic curve for both the outbreaks was plotted to study time distribution.

Conclusion: Active surveillance, early self-reporting and immediate disembarkation of the suspects, along with strict compliance of hand hygiene, cough etiquettes and disinfection enhancement, will help in early mitigation of the outbreak. Health education should be undertaken to impart evidence-based knowledge and alleviate fear of the unknown. Vaccination may not be present but if available should only be administered after strict risk-benefit, cost-benefit and effectiveness analysis.
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http://dx.doi.org/10.1016/j.mjafi.2020.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326407PMC
June 2020

Cavernous carotid artery large aneurysm treated with a new flow diverter - Xcalibur aneurysm occlusion device (AOD).

Interv Neuroradiol 2020 Oct 18;26(5):586-592. Epub 2020 Aug 18.

Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India.

We report a case of an unruptured, symptomatic, large right cavernous internal carotid artery aneurysm successfully treated with a new balloon-expandable flow diverter - Xcalibur Aneurysm Occlusion Device (AOD). Follow up imaging performed at six months demonstrated complete exclusion of the aneurysm and regression in dimensions, resulting in resolution of mass effect and clinical improvement.
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http://dx.doi.org/10.1177/1591019920951314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645174PMC
October 2020

Ultrasound Imaging of Renal Cysts in Children.

J Ultrasound Med 2021 Mar 14;40(3):621-635. Epub 2020 Aug 14.

Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.

Renal cysts can be focal or diffuse and unilateral or bilateral. In childhood, most renal cysts are due to hereditary diseases rather than simple cysts or acquired cystic diseases, unlike adults. Inherited cystic diseases can be ciliopathies due to a primary ciliary defect (as in polycystic kidney diseases and nephronophthisis). Acquired causes include obstructive cystic dysplasia, dyselectrolytemia, and acquired cysts in renal replacement therapy. The final diagnosis requires a multispecialty approach, including radiology, pathology, and genetics. Imaging is a very important component in treating patients with cystic renal diseases. This article discusses the ultrasound findings of cystic renal diseases in children, along with a brief discussion of other imaging modalities and a suggested ultrasound reporting format.
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http://dx.doi.org/10.1002/jum.15435DOI Listing
March 2021