Publications by authors named "Kamal Sharma"

153 Publications

"Assessing the hemodynamic impact of various inotropes combination in patients with cardiogenic shock with Non-ST elevation myocardial infarction -the ANAPHOR study".

Indian Heart J 2021 Sep-Oct;73(5):572-576. Epub 2021 May 5.

Department of Research, U. N. Mehta Institute of Cardiology and Research Centre, B. J. Medical College, Ahmedabad, 380016, India. Electronic address:

Background: Various inotropic agents/vasopressors combinations are used in patients of cardiogenic shock. We performed this study to observe hemodynamic effects of various inotrope/vasopressor combinations in patients with NSTEMI cardiogenic shock (CS) at tertiary cardiac centre METHODS AND MATERIALS: Of 3832 NSTEMI, we studied 59 consecutive such patients with CS who hadn't undergone revascularization in the first 24 h in a prospective, open label, observational study. Group 1 comprised of background Dopamine with Noradrenaline titration(N = 38), Group 2 had background Dobutamine and Noradrenaline titration(N = 15) and Group 3 comprised of triple combination of Dopamine, Noradrenaline & Adrenaline(N = 6).

Results: The mean change in hemodynamic parameters between these groups from baseline to 24 h showed no statistical difference. Cardiac output(CO), mean arterial pressure(MAP), central venous pressure(CVP) and cardiac power output(CPO) in group 2 were favorable at 6 and 24 h compared to baseline but mean change was insignificant as compared to others. In group 3, the increase in MAP was significant. IABP use did not change CO, CPO or SVR in any group except lower dosages of Dobutamine (49%) in IABP group. Lower in-hospital mortality in group 2 compared to others (P = 0.004) may be reflective of sicker patients in group 1 and 3.

Conclusion: The mean changes in hemodynamic parameters were not significant between all groups. All regimes of inotropes when selected as per clinical indication in CS with ACS resulted in similar hemodynamic effects. The mortality difference may not truly be reflective of regimes rather reflect sicker patients in the higher mortality group.
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http://dx.doi.org/10.1016/j.ihj.2021.04.005DOI Listing
May 2021

Impact of malignancy on In-hospital mortality, stratified by the cause of admission: An analysis of 67 million patients from the National Inpatient Sample.

Int J Clin Pract 2021 Sep 7:e14758. Epub 2021 Sep 7.

Keele Cardiovascular Research Group, Keele University, Stoke on Trent, United Kingdom.

Objective: To describe the patient characteristics and the reason for admission of patients with malignancy by malignancy, and to study mortality rates for the different causes of admissions among the different types of cancer.

Patients And Methods: Using the nationwide Inpatient Sampling (2015-2017) we examined the cause of admission and associated in-hospital mortality, stratified by presence and type of malignancy. Multivariable logistic regression models were used to examine the association between in-hospital mortality and malignancy sites for different primary admission causes.

Results: Out of 67 819 693 inpatient admissions, 8.8% had malignancy. Amongst those with malignancy, haematological malignancy was the most common (20.2%). The most common cause of admission amongst all cancers were malignancy-related admissions, where up to 57% of all colorectal admissions were malignancy-related. The most common non-malignancy cause of admission was infectious causes, which were most frequent among patients with haematological malignancy (18.4%). Patients with malignancy had higher crude mortality rates (5.7% vs 1.9%). Mortality rates were highest among patients with lung cancer (8.7%). Among all admissions, the adjusted rates of mortality were higher for patients with lung (OR 3.65, 95% CI [3.59-3.71]), breast (OR 2.06, 95% CI [1.99-2.13]), haematological (OR 1.79, 95% CI [1.76-1.82]) and colorectal (OR 1.71, 95% CI [1.66-1.76]) malignancies compared with patients with no malignancy.

Conclusion: Our work highlights the need to consider the burden of cancer on our hospital services and consider how the prognostic impact of different types of admissions may relate to the type of cancer diagnosis and understand whether these differences relate to disparities in clinical care/treatments.
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http://dx.doi.org/10.1111/ijcp.14758DOI Listing
September 2021

How does clinical profile and outcome differ in patients with Chronic Kidney Disease undergoing percutaneous coronary revascularization according to the severity of CKD? - CHANNEL Study.

Indian Heart J 2021 Jul-Aug;73(4):476-480. Epub 2021 Jun 25.

Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat, India. Electronic address:

Background: Chronic kidney disease (CKD) is an independent risk factor for the development of coronary artery disease. We evaluated outcomes amongst patients of CKD undergoing percutaneous coronary intervention (PCI) as assessed on severity of CKD based on estimated glomerular filtration rate (eGFR) at the time of PCI.

Method And Materials: We analyzed 100 consecutive CKD patients who underwent PCI and were followed up for 1 year; an observational, prospective, open-label study. Multivariate and Receiver operator characteristics (ROC) analysis was used to determine the cut point ofeGFR for predicting 4-P major adverse cardiac events (MACE) outcomes defined as the composite of Cardiovascular (CV) mortality, heart failure hospitalization (HHF), repeat revascularization and non-fatal MI over 1 year follow up.

Results: According to eGFR cut-off value derived from ROC, patients were divided in to two groups based on eGFR cut-off of 36.25 mL/min/1.73 m. Majority of patients (79%) were in Group 1 (eGFR >36.25 mL/min/1.73 m). Group 2 had Lower HbA1C, hemoglobin and elevated level of urea as compared to group:1 (p=0.002,<0.0001 respectively). All-cause mortality had trend forbeing higher (6.3 vs. 19%) in group:2, but statistically non-significant (p = 0.17). Lower baseline LVEF (39 ± 10.08%) across the cohort was independent predictor of higher risk for HHF. eGFR <36.25 mL/mim/1.73 m was the most robust predictor of MACE, carrying a 3-fold increase in risk of 4-P MACE with significant association (0.69, CI 0.59 to 0.78, p = 0.0009).

Conclusions: Lower baseline eGFR was associated with higher incidence of 4 P MACE with best cut-off being eGFR <36.25 mL/min/1.73 m. Lower Baseline LVEF was independent predictor from HHF across the cohort.
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http://dx.doi.org/10.1016/j.ihj.2021.06.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424264PMC
June 2021

Two-year safety and efficacy of Indigenous Abluminus Sirolimus Eluting Stent. Does it differ amongst diabetics? - Data from en-ABLe- REGISTRY.

J Cardiovasc Thorac Res 2021 19;13(2):162-168. Epub 2021 May 19.

Zydus Hospital, Anand (Gujarat), India.

To evaluate the efficacy/safety profile of the Abluminus DES+ over 2-years follow-up in the "real-world" scenario in diabetics as compared to non-diabetics. In prospective, all-comers, open-label registry conducted at 31 sites, patients were analyzed for 1 & 2-year outcomes with the primary endpoint defined as 3P-MACE of CV death, target vessel related myocardial infarction (TV-MI), ischemia-driven target lesion revascularization (TLR)/target vessel revascularization (TVR) apart from Stent thrombosis (ST). Of 2500 patients of PCI with 3286 Abluminus-DES+, 1641 (65.64%) were non-diabetics while859 (34.36%) were diabetics. The 3-P MACE for the cohort at 1 & 2 years were 2.9%, and 3.16%; TLR/TVR - 1.4% at both the intervals for 2493 patients at 2 yrs. follow-up. TV-MI & ST were 0.36% and0.56% at 1st and 2nd year respectively. The 3P-MACE was lower in non-diabetics at 1 & 2 years (2.3%vs 4.2%; 2.4% vs 4.7% respectively). For components of MACE, CV mortality (0.9 vs 1.9% at 1 yr ; 1.0vs 2.1% at 2 years) was significant ( < 0.05) while TLR (1.1 vs 1.9% at 1 yr. & 1.1 vs 2.1% at 2 yrs.) and TV-MI (0.9 vs 1.9% at 1 yr. & 1 vs 2.1% at 2 years) were similar for diabetics and non-diabetics so was ST ( > 0.05). Abluminus-DES+ showed excellent 2-year safety and efficacy with low 3-P MACE which was higher in diabetics driven by higher CV death but similar TLR, TV-MI and ST.
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http://dx.doi.org/10.34172/jcvtr.2021.31DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8302901PMC
May 2021

"Impact of pentaglobin in severe COVID 19 pneumonia- a prospective study."

Int Immunopharmacol 2021 Oct 10;99:107968. Epub 2021 Jul 10.

Department of Cardiology U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016, India.

Background: The current COVID-19 pandemic has become a global public health crisis and presents a serious challenge in treatment of severe COVID pneumonia patients. With an imperative need for an effective treatment, we aimed to study the effectiveness of Pentaglobin, an intravenous immunoglobin in the treatment of severe Covid-19 pneumonia patients.

Methods: This is an open-label non-randomised controlled study. Patients in the study group (n = 17) received Pentaglobin in addition to standard therapy and the control group (n = 19) received only the standard of care treatment. Severity of illness were quantified by severity scores and inflammatory laboratory parameters were compared between the two groups.

Results: The average length of hospital stay in pentaglobin group were 12.35 ± 6.98 days compared to 10.94 ± 4.62 days in standard treatment group with mean difference of 1.4 days (p value = 0.4). Pentaglobin did not provide an added advantage in terms of reducing the duration of hospital stay. There was no significant difference between both the groups in terms of requirement of invasive ventilation (p = 0.56) and mortality (p = 0.86). CT Severity score (OR = 1.39 95% CI = 1.09-1.77, P = 0.01), APACHE II score (OR = 1.16 95% CI = 0.99-1.35, P = 0.05) and the SOFA score (OR = 2.11 95% CI = 1.13-3.93, P = 0.02) were independent predictors of mortality.

Conclusion: The administration of pentaglobin in COVID -19 patients has no significant effect in reducing the risk of mechanical ventilation or death, in disease worsening or in reduction of inflammation.
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http://dx.doi.org/10.1016/j.intimp.2021.107968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270756PMC
October 2021

Utilization of solar energy for wastewater treatment: Challenges and progressive research trends.

J Environ Manage 2021 Nov 20;297:113300. Epub 2021 Jul 20.

Center of Research Excellence in Renewable Energy and Power Systems, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; School of Energy Management, Shri Mata Vaishno Devi University, Katra, 182320, Jammu and Kashmir, India. Electronic address:

This article offers a trend of inventions and implementations of photocatalysis process, desalination technologies and solar disinfection techniques adapted particularly for treatment of industrial and domestic wastewater. Photocatalysis treatment of wastewater using solar energy is a promising renewable solution to reduce stresses on global water crisis. Rendering to the United Nation Environment Programme, 1/3 of world population live in water-stressed countries, while by 2025 about 2/3 of world population will face water scarcity. Major pollutants exhibited from numerous sources are critically discussed with focus on potential environmental impacts & hazards. Treatment of wastewater by photocatalysis technique, solar thermal electrochemical process, solar desalination of brackish water and solar advanced oxidation process have been presented and systematically analysed with challenges. Both heterogenous and homogenous photocatalysis techniques employed for wastewater treatment are critically reviewed. For treating domestic wastewater, solar desalination technologies adopted for purifying brackish water into potable water is presented along with key challenges and remedies. Advanced oxidation process using solar energy for degradation of organic pollutant is an important technique to be reviewed due to their effectiveness in wastewater treatment process. Present article focused on three key issues i.e. major pollutants, wastewater treatment techniques and environmental benefits of using solar power for removal of pollutants. The review also provides close ideas on further research needs and major concerns. Drawbacks associated with conventional wastewater treatment options and direct solar energy-based wastewater treatment with energy storage systems to make it convenient during day and night both listed. Although, energy storage systems increase the overall cost of the wastewater treatment plant it also increases the overall efficiency of the system on environmental cost. Cost-efficient wastewater treatment methods using solar power would significantly ensure effective water source utilization, thereby contributing towards sustainable development goals.
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http://dx.doi.org/10.1016/j.jenvman.2021.113300DOI Listing
November 2021

'Omics' approaches in developing combined drought and heat tolerance in food crops.

Plant Cell Rep 2021 Jul 5. Epub 2021 Jul 5.

Department of Botany, Panjab University, Chandigarh, India.

Global climate change will significantly increase the intensity and frequency of hot, dry days. The simultaneous occurrence of drought and heat stress is also likely to increase, influencing various agronomic characteristics, such as biomass and other growth traits, phenology, and yield-contributing traits, of various crops. At the same time, vital physiological traits will be seriously disrupted, including leaf water content, canopy temperature depression, membrane stability, photosynthesis, and related attributes such as chlorophyll content, stomatal conductance, and chlorophyll fluorescence. Several metabolic processes contributing to general growth and development will be restricted, along with the production of reactive oxygen species (ROS) that negatively affect cellular homeostasis. Plants have adaptive defense strategies, such as ROS-scavenging mechanisms, osmolyte production, secondary metabolite modulation, and different phytohormones, which can help distinguish tolerant crop genotypes. Understanding plant responses to combined drought/heat stress at various organizational levels is vital for developing stress-resilient crops. Elucidating the genomic, proteomic, and metabolic responses of various crops, particularly tolerant genotypes, to identify tolerance mechanisms will markedly enhance the continuing efforts to introduce combined drought/heat stress tolerance. Besides agronomic management, genetic engineering and molecular breeding approaches have great potential in this direction.
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http://dx.doi.org/10.1007/s00299-021-02742-0DOI Listing
July 2021

The association of a novel digital tool for assessment of early childhood cognitive development, 'DEvelopmental assessment on an E-Platform (DEEP)', with growth in rural India: A proof of concept study.

EClinicalMedicine 2021 Jul 18;37:100964. Epub 2021 Jun 18.

Child Development Group, Sangath, Goa, India.

Background: There is an urgent need to fill the gap of scalable cognitive assessment tools for preschool children to enable identification of children at-risk of sub-optimal development and to support their timely referral into interventions. We present the associations between growth in early childhood, a well-established marker of cognitive development, and scores on a novel digital cognitive assessment tool called DEvelopmental Assessment on an E-Platform (DEEP) on a sample of 3-year old pre-schoolers from a rural region in north India.

Methods: Between February 2018 and March 2019, 1359 children from the Sustainable Programme Incorporating Nutrition and Games (SPRING) programme were followed up at 3-years age and data on DEEP, anthropometry and a clinical developmental assessment, the Bayley's Scale of Infant and Toddler Development, 3rd edition (BSID-III) was collected. DEEP data from 200 children was used to train a machine learning algorithm to predict their score on the cognitive domain of BSID-III. The DEEP score of the remaining 1159 children was then predicted using this algorithm to examine the cross-sectional and prospective association of growth with the DEEP score.

Findings: The magnitude of the concurrent positive association between height-for-age and cognitive -scores in 3-year olds was similar when cognition was measured by BSID-III (0.20 standard deviations increase for every unit change in specifically age-adjusted height (HAZ), 95% CI = 0.06-0.35) and DEEP (0.26 CI, 0.11-0.41). A similar positive prospective relationship was found between growth at 18 (0.21 CI, 0.17-0.26) and 12-months (0.18 CI, 0.13-0.23) and DEEP score measured at 3-years. Additionally, the relationship between growth and cognitive development was found to be dependant on socioeconomic status (SES).

Interpretation: In this study, we suggest the utility of DEEP, a scalable, digital cognitive assessment tool, to measure cognition in preschool children. Further validation in different and larger datasets is necessary to confirm our findings.

Funding: The SPRING Programme was funded through a Wellcome Trust programme grant and the follow-up study by the Corporate Social Responsibility initiative grant from Madura Microfinance Ltd.
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http://dx.doi.org/10.1016/j.eclinm.2021.100964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225699PMC
July 2021

A Rare Case of Isolated Intramedullary Spinal Cord Cysticercosis.

Cureus 2021 May 6;13(5):e14864. Epub 2021 May 6.

Department of Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, IND.

Neurocysticercosis is a parasitic disease often involving the central nervous system by and is commonly seen in developing countries. The majority of these cases have either isolated brain involvement or combined involvement of the brain and spinal cord. Isolated involvement of the spinal cord is very rare. We report the case of a 20-year-old Indian man who was hospitalized for progressive weakness in all extremities. Magnetic resonance imaging showed a well-defined, round, thick-walled, peripherally enhancing lesion in the intramedullary region, a provisional diagnosis of isolated cysticercosis of the intramedullary region of the spinal cord was made. The patient improved upon needle aspiration of the cystic lesion after surgery, which on post-surgical histological examination confirmed the diagnosis by showing the presence of cysticerci.
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http://dx.doi.org/10.7759/cureus.14864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184098PMC
May 2021

Symptomatic reinfection with COVID-19: A first from Western India.

J Family Med Prim Care 2021 Mar 8;10(3):1496-1498. Epub 2021 Apr 8.

Graduate Medical Doctor, Gujarat Adani Institute of Medical Sciences, Affiliated to K S K V University, Bhuj, Gujarat, India.

The reinfection of recovered COVID-19 patient is one of the major concerns worldwide. Here we report a case of previously recovered patient from Covid-19 who presented with symptomatic reinfection beyond 3 months. We report a case of 58 year old female patient who after presenting with symptomatic episode of RT-PCR confirmed COVID-19 in April 2020, presented with a new symptomatic infection by SARS-CoV-2 four months later. These 2 episodes of infection were caused by different sources as evident from her epidemiological correlates. This is the first epidemiologically, RAT, RT-PCR and antibody confirmed COVID-19 case of re-infection of SARS CoV-2 reported from Western India.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_2002_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8140233PMC
March 2021

Dengue virus 2 capsid protein chaperones the strand displacement of 5'-3' cyclization sequences.

Nucleic Acids Res 2021 06;49(10):5832-5844

Centre for Bioimaging Sciences, National University of Singapore, 14 Science Drive 4, Singapore 117557, Singapore.

By virtue of its chaperone activity, the capsid protein of dengue virus strain 2 (DENV2C) promotes nucleic acid structural rearrangements. However, the role of DENV2C during the interaction of RNA elements involved in stabilizing the 5'-3' panhandle structure of DENV RNA is still unclear. Therefore, we determined how DENV2C affects structural functionality of the capsid-coding region hairpin element (cHP) during annealing and strand displacement of the 9-nt cyclization sequence (5CS) and its complementary 3CS. cHP has two distinct functions: a role in translation start codon selection and a role in RNA synthesis. Our results showed that cHP impedes annealing between 5CS and 3CS. Although DENV2C does not modulate structural functionality of cHP, it accelerates annealing and specifically promotes strand displacement of 3CS during 5'-3' panhandle formation. Furthermore, DENV2C exerts its chaperone activity by favouring one of the active conformations of cHP. Based on our results, we propose mechanisms for annealing and strand displacement involving cHP. Thus, our results provide mechanistic insights into how DENV2C regulates RNA synthesis by modulating essential RNA elements in the capsid-coding region, that in turn allow for DENV replication.
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http://dx.doi.org/10.1093/nar/gkab379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191770PMC
June 2021

Prevalence and cross states comparison of case fatality rate and recovery rate of COVID 19/SARS-COV-2 in India.

J Family Med Prim Care 2021 Jan 30;10(1):475-480. Epub 2021 Jan 30.

Graduate Medical Doctor, Gujarat Adani Institute of Medical Sciences and K.S.K.V. University, Bhuj-Kutch, Gujarat, India.

Background And Aim: CFR and RR are important indicator of disease pandemic. As of now no data is available about cross-states analysis of these. We aimed to evaluate CFR and RR of COVID-19 across majorly affected States in India.

Method: We observed and compared data of confirmed COVID-19 cases, number of deaths, number of recovered/discharged cases and calculated CFR and RR across majorly affected States/UT in India from official database of Government of India, State Government official bulletin, accurate database worldometer.

Results: The data showed that Gujarat, Madhya Pradesh, West Bengal reported highest CFR on 8th April, 22nd April, 6th May, 1st June 2020 (95% CI 4.91 - 6.99). Kerala showed encouraging recovery rates 24.32%, 70.31%, 93.24%, 45.81% on 8th and 22nd April, 6th May and 1st June 2020 respectively. India had an average estimated weekly Recovery rate of newly discharged/recovered cases was 32.68% from 19th March to 1st June 2020. (95% CI 20- 45.4%). (The Recovery rate across India was 80.83% as on 22nd September 2020.).

Conclusion: The CFR of a disease varies greatly in different regions of the same Country and is influenced by numerous factors such as health control policies, medical standards, and detection efficiency and protocols apart from number of screening tests done. This comparison discusses need of evaluating policies with optimal reporting of medical history of affected persons when comparing COVID-19 case and fatality rates in different regions of the Country.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1088_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132753PMC
January 2021

Positive SARS-CoV-2 RNA with Significant Inflammatory State and Thrombophilia after 12 Weeks of Initial Diagnosis of COVID-19 Infection.

J Glob Infect Dis 2021 Jan-Mar;13(1):42-43. Epub 2021 Feb 26.

Department of Hematology, BayCare Winter Haven Hospital, Jacksonville, Florida, USA.

The ongoing COVID-19 pandemic has affected most countries in the world, with significant economic and public health implications. There is rising concern that patients who recover from COVID-19 may be at risk of reinfection. Another potential concern is the uncommon clinical scenario of a patient having persistent SARS-CoV-2 RNA test over 3 months after the initial COVID-19 infection, as the patient presented. Whether presenting as a long-term infection (12 weeks) or reinfection, patients with COVID-19 will continue to have a severe inflammatory and prothrombotic state that could carry potential life-threatening thrombosis.
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http://dx.doi.org/10.4103/jgid.jgid_286_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054786PMC
February 2021

Olive oil consumption can prevent non-communicable diseases and COVID-19 : Review.

Curr Pharm Biotechnol 2021 Apr 12. Epub 2021 Apr 12.

Center for Nanofibers and Nanotechnology National University Singapore. Singapore.

The Mediterranean diet is appraised as the premier dietary regimen and its espousal is correlated with the prevention of degenerative diseases and extended longevity. The consumption of olive oil stands out as the most peculiar feature of the Mediterranean diet. Olive oil rich in various bioactive compounds like oleanolic acid, oleuropein, oleocanthal, and hydroxytyrosol is known for its anti-inflammatory as well as cardioprotective property. Recently in silico studies have indicated that phytochemicals present in olive oil are a potential candidate to act against SARS-CoV-2. Although extensive studies on olive oil and its phytochemical composition; still, some lacunas persist in understanding how the phytochemical composition of olive oil is dependent on upstream processing. The signaling pathways regulated by olive oil in the restriction of various diseases is also not clear. To answer these queries, a detailed search of research and review articles published between 1990 to 2019 were reviewed in this effect. Olive oil consumption was found to be advantageous for various chronic non-communicable diseases. Olive oil's constituents are having potent anti-inflammatory activities and thus restrict the progression of various inflammation-linked diseases ranging from arthritis to cancer. But it is also notable that the amount and nature of phytochemical composition of household olive oil are regulated by its upstream processing and the physicochemical properties of this oil can give a hint regarding the manufacturing method as well as its therapeutic. Moreover, daily uptake of olive oil should be monitored as excessive intake can cause body weight gain and change in the basal metabolic index. So, it can be concluded that olive oil consumption is beneficial for human health, and particularly for the prevention of cardiovascular diseases, breast cancer, and inflammation. The simple way of processing olive oil maintains the polyphenol constituents and provides more protection against non-communicable diseases and SARS-CoV-2.
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http://dx.doi.org/10.2174/1389201022666210412143553DOI Listing
April 2021

Does the extent of collaterals influence the severity of the myocardial injury as assessed by elevation in biomarkers?

J Cardiovasc Thorac Res 2021 28;13(1):49-53. Epub 2021 Jan 28.

Department of Cardiology, U.N.Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad-380016, Gujarat, India.

Quantitative analysis of cardiac biomarkers, troponin I and CPK-MB, estimates the extent of myocardial injury while extent of benefit from coronary collateral circulation (CCC) to protect myocardium during acute myocardial infarction (AMI) needs validation. We analysed if the extent of collaterals had impact on baseline biomarkers at the time of coronary angiogram. We analysed 3616 consecutive patients who presented with AMI and underwent invasive coronary angiography (CAG) with intent to revascularisation with biomarkers assessment at the time of CAG. CCC to Infarct related artery (IRA) were graded as per Rentrop grading viz. poorly-developed CCC (Grade 0/1 as Group A) and well-developed CCC (Grade 2/3 as Group B). Both groups (A and B) were matched for demographics, traditional risk factors, SYNTAX 1 Score, time to CAG from onset of angina and eGFR. 36.59% of patients had Non-ST segment elevation myocardial infarction (NSTEMI) as compared to 63.41% ST -segment elevation infarction (STEMI). Overall Troponin I ( =0.01, =0.01) and CPK MB ( =0.00, =0.002) values were lower in group B in both NSTEMI and STEMI groups respectively. Troponin I and CPK-MB were significantly lower in group B [with NSTEMI for SVD (Single vessel disease) ( =0.05) and DVD (Double vessel disease) ( =0.04),but not for TVD (Triple vessel disease) and with STEMI in SVD ( =0.01), DVD ( =0.01) and TVD ( =0.001)]. Patients with well-developed coronary collaterals had a lower rise in biomarkers in AMI as compared to those with poor collaterals amongst both NSTEMI and STEMI groups.
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http://dx.doi.org/10.34172/jcvtr.2021.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007895PMC
January 2021

Demographic and clinico-radiological profile on High-Resolution Computerized Tomography (HRCT) thorax in mild or asymptomatic clinically suspected COVID-19 patients in high-endemicity area of India-Can HRCT be the first screening tool? -The DECRYPTION study.

Indian J Radiol Imaging 2021 Jan 23;31(Suppl 1):S122-S127. Epub 2021 Jan 23.

Gujarat Adani Institute of Medical Sciences, Affiliated to K S K V University, Bhuj, Gujarat, India.

Background: With COVID-19 cases rising, despite CT chest being of value in diagnosis and prognostication in COVID-19, its role in mild or asymptomatic suspected COVID-19, before RT-PCR test is lacking.

Method: This is a retrospective observational study involving asymptomatic or mildly symptomatic clinically suspected COVID-19 infection in a high endemicity area. Of 2532 HRCT chest database, 376 eligible cases were analyzed for clinico-radiological correlation for CT findings based CORADS and CT severity score between positive vs negative group.

Results: Of 376, 186 (48.46%) had COVID-19 features on HRCT in mild and asymptomatic suspected patients. 98 (26.06%) had CO-RARDS - 5, 88 (23.40%) had CO-RADS - 4. 48 (12.76%), 128 (34.04%), 14 (3.72%) had CO-RADS score of 3,2,1, respectively. Positive CT findings were more likely beyond 3 days of symptoms compared to those presenting earlier {days: (Mean) 4.2 vs 2.76} Positive CT was significantly associated with patients with anosmia and dyspnea. The common presenting symptoms were Fever 196 (52.12%) and followed by sore throat in 173 (46.01%). The common HRCT findings were Ground glass opacity (GGO) (74.60%), followed by Lymphadenopathy (LN) (27.92%). LN which was more prevalent in symptomatic patients {99/343 (28.86%) vs {6/33 (18.18%)} asymptomatics (: 0.04)}. Consolidation was significantly more in asymptomatics with COPD (: 0.004). 6 (3.22%) patients had CT score >17/25.

Conclusion: Chest HRCT picked 48.46% positive cases in mildly symptomatic and asymptomatic patients of which 3.22% had severe involvement (>17). Being a noninvasive, rapid, sensitive, low risk of cross infection with high reproducibility, chest CT is worth evaluating as screening modality even in asymptomatic and mildly symptomatic clinically suspected COVID-19.
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http://dx.doi.org/10.4103/ijri.IJRI_796_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996708PMC
January 2021

Clinicobiochemical Parameters and Predictors of Liver Disease in Hospitalized Asian Indian Pregnant Women in a Tertiary Care Center in Northern India.

Cureus 2021 Feb 17;13(2):e13405. Epub 2021 Feb 17.

Medicine, C U Shah Medical College, Surendranagar, IND.

Introduction  During pregnancy, liver dysfunction is more frequent than expected and may require specialized care. For the early diagnosis, it is important to determine if changes in liver physiology may develop into liver disease. Liver disease during pregnancy may require intervention from a hepatologist for adequate monitoring of mother-fetus health outcomes. This study was aimed to evaluate the clinical profile and predictors of maternal mortality in patients with liver diseases among Asian-Indian-females. Methods We conducted a prospective, open-label, consecutive all-comers study of 2,663 pregnant Asian Indian women admitted in the hospital, which included 92 with liver dysfunction. The medical aspects of the pregnancy were then followed prospectively with laboratory and clinical data during the hospital stay and analyzed. The current study was approved by the Institutional Ethical Committee. Results We found that 92 out of 2,663 patients had liver dysfunction with a prevalence of 3.45%. Fifty-four (58.7%) patients had icterus followed by fever in 23 (25.0%), hypertension in 22 (23.9%), central nervous system manifestations in 21 (22.8%), abdominal pain in 19 (20.6%), vomiting in 19 (20.6%), and pruritus in six (6.5%). Predictors of maternal mortality were icterus (p = 0.04), hepatomegaly (p = 0.04), presenting serum-bilirubin greater than 10 milligram% (mg%) (p = 0.008). The most common etiology was acute viral hepatitis (45.6%), followed by a hypertensive disorder of pregnancy (29.3%), acute fatty liver of pregnancy (1.1%), cholestatic jaundice (9.8%), hyperemesis gravidarum (2.2%), septicemic hepatitis (3.3%), dengue immunoglobulin M (IgM), and plasmodium vivax malaria antigen positive in (2.2%) each. Four patients (4.3%) were leptospira IgM reactive and had co-infection with hepatitis E virus. There was one patient (1.1%) with underlying chronic liver disease. Idiopathic liver disease was present in 5.4% of patients. Conclusion Liver disease is relatively common in Indian pregnant women. It is associated with high maternal and perinatal mortality, even in a tertiary referral center. When managing pregnancy in a tertiary care center, for adequate follow-up of the disease and to prevent adverse consequences for mother and child, it is important to discard liver alterations early. For this purpose, liver disease during pregnancy needs early diagnosis for proper management. Furthermore, it is difficult to manage patients with preexisting liver disease, and it may require specialized intervention from a hepatologist and a gastroenterologist.
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http://dx.doi.org/10.7759/cureus.13405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978133PMC
February 2021

Role of Self-Measured Home Blood Pressure Monitoring (HBPM) and Effectiveness of Telemedicine During the Era of COVID-19 Pandemic.

SN Compr Clin Med 2021 Mar 10:1-3. Epub 2021 Mar 10.

Graduate Medical Education, Gujarat Adani Institute of Medical Sciences, Affiliated to K.S.K.V University, Bhuj, 370001 Gujarat India.

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http://dx.doi.org/10.1007/s42399-021-00852-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943330PMC
March 2021

Predictors of Mortality Amongst Tocilizumab Administered COVID-19 Asian Indians: A Predictive Study From a Tertiary Care Centre.

Cureus 2021 Feb 4;13(2):e13116. Epub 2021 Feb 4.

Graduate Medical Education, Gujarat Adani Institute of Medical Sciences, Bhuj, IND.

Introduction Hyper-cytokinemia is a dreaded complication of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection and an important predictor of mortality in coronavirus disease 2019 (COVID-19). The current evidence at best is still ambiguous for use of tocilizumab in cytokine storm in COVID-19. Moreover, the factors that are associated with beneficial response from tocilizumab are unknown in COVID-19. We aimed to study the clinical outcomes especially mortality vis-à-vis clinical and laboratory characteristics of patients administered tocilizumab and identify predictors of mortality benefits amongst deceased vs recovered COVID-19 patients. Methods The present study is a retrospective observation of the demographic, clinical, and biological data of all the consecutive patients treated with tocilizumab for COVID-19 pneumonia at the COVID tertiary care centre from July 2020 to October 2020 at Ahmedabad, India. We compared the deceased group with those who recovered/discharged and evaluated patient-level demographics, clinical attributes, and laboratory investigations available to identify subgroups in whom tocilizumab reduced mortality. Results Of the 112 patients included, the mean (SD) age was 56.84 ± 13.56 years and 80 (71.4%) were male. There were 97 (86.6%) patients in the survivors and 15 (13.39%) in the deceased group. Deceased were older than the recovered group (mean: 66.14, SD: 14.41 vs mean: 55.36, SD: 12.98; p=0.04). Hypertension (33.03%) was the commonest comorbidity observed. Mortality was significantly higher in patients with cancer and type-2 diabetes (p=0.05 and p=0.01, respectively). Level of D-dimer and lactate dehydrogenase (LDH) showed trends towards significance as a predictor of mortality (p=0.07 and p=0.08, respectively) not reaching significance. D-dimer level > 5,000 nanograms per millilitre (ng/mL) was the significant predictor of subsequent deaths (p<0.0001). Fourteen patients reported adverse events of tocilizumab. Patients who developed in-hospital complications (such as septic or vasodilatory shock and/or sepsis, acute kidney injury, multiorgan dysfunction) had significantly higher mortality (p<0.0001, p=0.009, and p=0.03, respectively). Conclusion Tocilizumab might be more beneficial in younger patients without sepsis/ septic shock, acute kidney injury, multiorgan dysfunction, and who were non-ventilated. The predictors of mortality amongst Asian Indians treated with tocilizumab were older patients, the presence of type-2 diabetes, cancer, in-hospital complication (such as acute kidney injury, sepsis/septic shock, multiorgan dysfunction), higher D-dimer > 5,000 ng/mL. A larger study with pre-defined inclusion cut-offs of these variables may aid in defining patient's characteristics of Asian Indians who may benefit from tocilizumab in COVID-19.
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http://dx.doi.org/10.7759/cureus.13116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939533PMC
February 2021

Lesioning of the pedunculopontine nucleus reduces rapid eye movement sleep, but does not alter cardiorespiratory activities during sleep, under hypoxic conditions in rats.

Respir Physiol Neurobiol 2021 06 11;288:103653. Epub 2021 Mar 11.

Department of Anatomy and Cell Biology, University of Illinois Chicago, 808 S Wood St (MC 512), Room 666, Chicago, IL, United States. Electronic address:

To determine how partial lesioning of the pedunculopontine nucleus (PPT) affects sleep, breathing, and blood pressure in rats, ibotenic acid (IBO) was injected bilaterally into the PPT. Sham-injected (saline) and IBO-lesioned rats were first studied under normoxic conditions (40 recordings were obtained from 15 rats, with each recording lasting for 6 daytime hours). Rats were then exposed to intermittent hypoxia for 4 ± 2 days (51 recordings from 12 rats, each lasting 6 daytime hours). The intermittent hypoxia protocol involved an oxygen decline lasting 35 s (to a nadir of 10 %) followed by a 50 s increase to normoxia. The IBO caused an estimated 53 % reduction in PPT neurons. When normoxic, IBO-lesioned rats had remarkedly normal sleep architecture, respiratory rates, and mean arterial pressure. The exposure to intermittent hypoxia evoked tachypnea in both the IBO-lesioned and sham-injected rats. When intermittently hypoxic, IBO-lesioned rats demonstrated a significant reduction in the duration of rapid eye movement (REM) sleep. We conclude that partial lesions of the PPT do not disrupt cardiorespiratory activities, but a reduction in PPT neurons impairs the ability to sustain REM sleep under hypoxic conditions.
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http://dx.doi.org/10.1016/j.resp.2021.103653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112452PMC
June 2021

A Rare Case of Varicella-Zoster Virus Reactivation Following Recovery From COVID-19.

Cureus 2021 Jan 1;13(1):e12423. Epub 2021 Jan 1.

Graduate Medical Education, BJ Medical College, Ahmedabad, IND.

In patients with coronavirus disease 2019 (COVID-19), various cutaneous symptoms have been observed. Herpes zoster (HZ) is an infectious skin disease caused by the varicella-zoster virus (VZV) that, after a primary chickenpox infection, persists dormant in the dorsal root ganglia of cutaneous nerves. Unusual prolonged dermatological symptoms from recovered COVID-19 patients have rarely been recorded. In this report, we describe a case of HZ following recovery from COVID-19.
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http://dx.doi.org/10.7759/cureus.12423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849932PMC
January 2021

Predictors of Arterial Stiffness Amongst the 24-Hour Ambulatory Blood Pressure Variables in Hypertensive Patients.

Cureus 2020 Dec 21;12(12):e12207. Epub 2020 Dec 21.

Cardiology, Medanta Hospital, Gurgaon, IND.

Objective The objective of the study is to identify the predominant determinants of arterial stiffness as assessed by pulse-wave-velocity (PVW) amongst various 24-hour ambulatory blood pressure monitoring (ABPM) parameters in Indian hypertensive subjects. Method Subjects of both genders between 18-60 years with hypertension and who were either drug naïve or on stable anti-hypertensive treatment for at least three months were included in the study. All subjects underwent clinical evaluation with a medical history, biochemical investigations, and assessment of arterial stiffness by PWV along with 24-hour ABPM. Results We found the males were younger than females amongst hypertensive cohort (41.53 ± 10.89 years vs. 52.2 ± 5.17 years, respectively; p=0.001) and had shorter duration of hypertension (41.42 ± 49.14 months vs. 87.8 ± 74.55 months, respectively; p=0.012) and had lower 24-hour average pulse pressure (aPP; 49.1 ± 7.8 mm Hg vs. 57.83 ± 8.92 mm Hg, respectively; p=0.001) at baseline. Younger people (<40-years) as compared to those >40-years of age had the lower carotid-femoral (cf) PWV (972.8 ± 125.0 cm/sec vs. 1165.0 ± 208.4 cm/sec, respectively; p=0.001) and average brachial-ankle (ba) PWV (1413.7 ± 160.4 cm/sec and 1640.0 ± 227.1 cm/sec, respectively; p=0.001). Bivariate analysis revealed that amongst all the 24-hour ABPM parameters, 24-hour aPP had the strongest correlation (r=0.414, p=0.003) with arterial stiffness as assessed by PWV. Also, statistically significant correlation was found in age group <40 years between cf-PWV and both 24-hour aPP (r=0.54, p=0.025) as well as night-time aPP (r=0.59, p=0.013) Conclusion We conclude that 24-hour aPP showed the strongest correlation with arterial stiffness parameters and best correlated with arterial stiffness variables amongst 24-hour ABPM parameters, especially amongst subjects <40 years of age. The pulsatile blood pressure (BP) was a better predictor of aortic PWV than the continuous part of BP.
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http://dx.doi.org/10.7759/cureus.12207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818675PMC
December 2020

Takotsubo Syndrome a Rare Entity in COVID-19: a Systemic Review-Focus on Biomarkers, Imaging, Treatment, and Outcome.

SN Compr Clin Med 2021 Jan 11:1-11. Epub 2021 Jan 11.

Smt NHL Municipal Medical College, Ahmedabad, India.

Takotsubo syndrome(TTS) is attributed to catecholamine surge, which is also observed in COVID-19 disease due to the cytokine storm. We performed a systematic literature search using PubMed, Embase, and the Cochrane Central Register of Controlled Trials retrospectively to identify COVID-19-associated TTS case reports and evaluated patient-level demographics, laboratory markers clinical attributes, treatment given, and outcomes. There are 27 cases reported of TTS associated with COVID-19 infection of which 44.5% were male. Reported median age was 57 years (IQR: 39-65) and 62.95 years (IQR: 50.5-73.5) in case series and individual patients' cases in database, respectively. The time interval from the symptom onset to TTS diagnosis was median 6.5 days (IQR: 1.0-8.0) in case series and 6.7 days (IQR: 4-10) in individual patients' database. The median LVEF was 36% (IQR: 35-37) and 38.15%(IQR: 30-42.5%-[male: 40.33% (IQR: 33-44.2)] and female [37.15% (IQR: 30-40)] in case series and individual-patients' database, respectively. Troponin was elevated in all patients except one patient. 77.2% patients of TTS with COVID-19 had an elevated C-reactive protein and/or D-dimer. Twelve out of 22 (54.5%) patients developed cardiac complication such as cardiogenic-shock, atrial fibrillation, acute heart failure, supraventricular tachycardia, and biventricular heart failure. Nineteen out of 26 (73.07%) patients were discharged, and three were hospitalized due to acute respiratory distress syndrome and needed extracorporeal membrane oxygenation or ongoing maternal age. There were 4 (14.8%) mortality. There was no major gender difference observed in development of TTS in COVID-19 unlike COVID-19 per se. Older median age group for TTS in COVID-19 patients irrespective of cardiovascular comorbidities and gender probably reflects age as an independent risk factor. Patients who developed TTS had higher mortality rate especially if they developed cardiogenic shock.
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http://dx.doi.org/10.1007/s42399-021-00743-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7799869PMC
January 2021

Dengue virus strain 2 capsid protein switches the annealing pathway and reduces intrinsic dynamics of the conserved 5' untranslated region.

RNA Biol 2021 05 7;18(5):718-731. Epub 2021 Jan 7.

Centre for Bioimaging Sciences, National University of Singapore, Singapore, Singapore.

The capsid protein of dengue virus strain 2 (DENV2C) promotes nucleic acid structural rearrangements using chaperone activity. However, the role of DENV2C during the interaction of RNA elements in the conserved 5' untranslated region (5'UTR) to the 3' untranslated region (3'UTR) is still unclear. Thus, we investigated the effect of DENV2C on the annealing mechanism of two RNA hairpin elements from the 5'UTR to their complementary sequences during (+)/(-) ds-RNAformation and (+) RNA circularization. DENV2C was found to switch the annealing pathway for RNA elements involved in (+)/(-) ds-RNA formation, but not for RNA elements related to (+) RNA circularization. In addition, we also determined that DENV2C modulates intrinsic dynamics and reduces kinetically trapped unfavourable conformations of the 5'UTR sequence. Thus, our results provide mechanistic insights by which DENV2C chaperones the interactions between RNA elements at the 5' and 3' ends during genome recombination, a prerequisite for DENV replication.
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http://dx.doi.org/10.1080/15476286.2020.1860581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078513PMC
May 2021

Prevalence and Patterns of Obstructive Sleep Apnea in Asian Indians With Congestive Heart Failure.

Cureus 2020 Nov 11;12(11):e11438. Epub 2020 Nov 11.

Interventional Cardiology, Tagore Hospital & Heart Care Centre Private Limited, Jalandhar, IND.

Background Sleep-disordered breathing (SDB) has a potential association with the pathogenesis of congestive heart failure (CHF). We assessed the prevalence and patterns of obstructive sleep apnea (OSA) in patients presenting with CHF. Method This was a prospective, observational, all-comers study of consecutive 77 confirmed cases of CHF. All these patients were clinically assessed and evaluated for OSA with sleep study after routine blood testing, electrocardiogram (ECG), chest X-ray, and echocardiography. Results Of 77 patients with CHF 38 (49.4%) had apnea-hypopnea index (AHI) <5 while 39 (50.6%) had AHI >5. Of these 39, 37 (94.8%) patients showed the clinical features of OSA. The majority (64.9%) of them were males. The majority of OSA (64.9%) had coronary artery disease (CAD) (p<0.05) as the etiology of CHF, followed by dilated cardiomyopathy (32.4%) and valvular heart disease (2.7%). The prevalence of OSA was higher amongst New York Heart Association (NYHA) class 2 (51.4%) as compared to NYHA class 3 (37.8%) and NYHA class 4 (10.8%). There were 12 (32.8%) patients, each having OSA with a heart rate between 71 and 80 bpm and 81 and 90 bpm. Twenty-two (59.5%) had systolic blood pressure (BP) more than 120 mmHg and 20 (54.1%) had diastolic BP more than 80 mmHg. The majority (64.9%) patients had the lowest O saturation between 80% and 90%. A significantly large number of patients (62.2%) had ejection fraction 21%-30% (p<0.05). The majority (62.16%) of patients with OSA had AHI between 5 and 15. With 5-15 AHI, 20 (87%) patients with OSA had a snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-Bang) score between 3 and 7 with AHI 5-15 (p<0.05). Conclusions In our cohort, the prevalence of OSA in CHF was 50.6%. Predictors of OSA in CHF were left ventricular ejection fraction (LVEF) 20%-30% and NYHA class 2. The majority had AHI between 5 and 15. Sleep apnea screening should be routinely implemented in the evaluation and follow-up of heart failure patients.
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http://dx.doi.org/10.7759/cureus.11438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732783PMC
November 2020

Cardiometabolic vigilance in COVID-19 and resource husbandry in resource-challenged times: Clinical practice- based expert opinion.

Diabetes Metab Syndr 2021 Jan-Feb;15(1):55-62. Epub 2020 Nov 20.

Department of Diabetology, Arthur Asirvatham Hospital, Madurai, Tamil Nadu, India.

Background And Aims: The ongoing pandemic of coronavirus disease 2019 (COVID-19) is rapidly evolving, thereby posing a profound challenge to the global healthcare system. Cardiometabolic disorders are associated with poor clinical outcomes in persons with COVID-19. Healthcare challenges during the COVID-19 pandemic are linked to resource constraints including shortage of Personal Protective Equipment's (PPE), laboratory tests and medication. In this context, a group of clinical experts discussed the endocrine and cardiology vigilance required in times of COVID-19. Further, the group proposed certain resource husbandry recommendations to be followed during the pandemic to overcome the constraints.

Method: The clinical experts discussed and provided their inputs virtually. The expert panel included clinical experts comprising endocrinologists, Consultant Physicians and cardiologists from India. The panel thoroughly reviewed existing literature on the subject and proposed expert opinion.

Results: The expert panel put forward clinical practice-based opinion for the management of cardiometabolic conditions including diabetes mellitus and hypertension. As these conditions are associated with poor clinical outcomes, the expert panel recommends that these persons be extra-cautious and take necessary precautions during the ongoing pandemic. Further, experts also provided appropriate, affordable, available and accessible solution to the resource constraint situations in times of COVID-19 pandemic.

Conclusion: The clinical expert opinion put forward in this article will serve as a reference for clinicians treating diabetes and cardiovascular disease during the COVID-19 pandemic.
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http://dx.doi.org/10.1016/j.dsx.2020.11.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677048PMC
March 2021

Role of graphene in biosensor and protective textile against viruses.

Med Hypotheses 2020 Nov 10;144:110253. Epub 2020 Sep 10.

Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad 826004, India.

Coronavirus disease (COVID-19) is a recently discovered infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Graphene is an emerging material due to its extraordinary performance in the field of electronics and antimicrobial textiles. Special attention devoted to graphene oxide-based materials due to its surface to volume ratio is very high which make it easy to attach biomolecules by simple adsorption or by crosslinking between reactive groups and the graphene surface. In response to the COVID-19 pandemic, we have summarized the recent developments of graphene and its derivatives with possible virus detection and textile applications. Moreover, graphene strain sensors can be executed on high-performance textiles and high-throughput drug efficacy screening.
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http://dx.doi.org/10.1016/j.mehy.2020.110253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481315PMC
November 2020

Identification and Characterization of Contrasting Genotypes/Cultivars for Developing Heat Tolerance in Agricultural Crops: Current Status and Prospects.

Front Plant Sci 2020 22;11:587264. Epub 2020 Oct 22.

Department of Botany, Panjab University, Chandigarh, India.

Rising global temperatures due to climate change are affecting crop performance in several regions of the world. High temperatures affect plants at various organizational levels, primarily accelerating phenology to limit biomass production and shortening reproductive phase to curtail flower and fruit numbers, thus resulting in severe yield losses. Besides, heat stress also disrupts normal growth, development, cellular metabolism, and gene expression, which alters shoot and root structures, branching patterns, leaf surface and orientation, and anatomical, structural, and functional aspects of leaves and flowers. The reproductive growth stage is crucial in plants' life cycle, and susceptible to high temperatures, as reproductive processes are negatively impacted thus reducing crop yield. Genetic variation exists among genotypes of various crops to resist impacts of heat stress. Several screening studies have successfully phenotyped large populations of various crops to distinguish heat-tolerant and heat-sensitive genotypes using various traits, related to shoots (including leaves), flowers, fruits (pods, spikes, spikelets), and seeds (or grains), which have led to direct release of heat-tolerant cultivars in some cases (such as chickpea). In the present review, we discuss examples of contrasting genotypes for heat tolerance in different crops, involving many traits related to thermotolerance in leaves (membrane thermostability, photosynthetic efficiency, chlorophyll content, chlorophyll fluorescence, stomatal activity), flowers (pollen viability, pollen germination, fertilization, ovule viability), roots (architecture), biomolecules (antioxidants, osmolytes, phytohormones, heat-shock proteins, other stress proteins), and "omics" (phenomics, transcriptomics, genomics) approaches. The traits linked to heat tolerance can be introgressed into high yielding but heat-sensitive genotypes of crops to enhance their thermotolerance. Involving these traits will be useful for screening contrasting genotypes and would pave the way for characterizing the underlying molecular mechanisms, which could be valuable for engineering plants with enhanced thermotolerance. Wherever possible, we discussed breeding and biotechnological approaches for using these traits to develop heat-tolerant genotypes of various food crops.
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http://dx.doi.org/10.3389/fpls.2020.587264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642017PMC
October 2020

A Case of Hemolytic Anemia With Acute Myocarditis and Cardiogenic Shock: A Rare Presentation of COVID-19.

Cureus 2020 Sep 25;12(9):e10657. Epub 2020 Sep 25.

Graduate Medical Education, Gujarat Adani Institute of Medical Sciences, Bhuj, IND.

Coronavirus disease 2019 (COVID-19) cases are on the rise globally, and mortality- and survival-related data are emerging every day. In addition, upcoming reports are suggestive of increased risk of cardiac ailments in high-risk patients. In the context of cardiac involvement, acute myocarditis has become one of the unexplored areas in COVID-19 patients, which could influence the long-term outcomes. In this report, we present a rare case that warrants further study on the subject due to the paucity of data in the literature. To date, no case of severe hemolytic anemias with stress cardiomyopathy/acute myocarditis in a patient of COVID-19 has been formally reported in the literature. The bedside echocardiogram had shown a possibility of acute myocarditis. The patient's marked left ventricular (LV) functional recovery without coronary intervention further corroborates the same. Clinicians should be aware of the diversity of cardiovascular/hematological complications, as well as focused cardiac ultrasound study and the importance of echocardiography as a good screening modality for cardiovascular and hematological complications of COVID-19 infection.
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http://dx.doi.org/10.7759/cureus.10657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7587209PMC
September 2020

Long-term Follow-Up of Patients with Heart Failure and Reduced Ejection Fraction Receiving Autonomic Regulation Therapy in the ANTHEM-HF Pilot Study.

Int J Cardiol 2021 01 7;323:175-178. Epub 2020 Oct 7.

University of Minnesota, Minneapolis, MN, United States of America. Electronic address:

Background: The ANTHEM-HF pilot study was an open-label study that evaluated the safety and feasibility of autonomic regulation therapy (ART) utilizing cervical vagus nerve stimulation (VNS) for patients with chronic HF with reduced EF (HFrEF). Patients in NYHA class II-III with EF ≤40% (n = 60) received ART for 6 months post-titration. ART was associated with sustained improvement in left ventricular (LV) function and HF symptoms at 6 and 12 months.

Methods: Continuously cyclic VNS was maintained to determine longer-term safety and chronic effects of ART. Echocardiographic parameters and HF symptoms were assessed throughout a follow-up period of at least 42 months.

Results: Between 12 and 42 months after initial titration, there were no device-related SAEs or malfunctions. There were 10 SAEs adjudicated to be unrelated to VNS, including 5 deaths. There were 6 non-serious adverse events that were adjudicated to be device-related (2 oropharyngeal pain, 1 implant site pain, 2 voice alteration, and 1 hoarseness). At 42 months, there was significant improvement from baseline in LVEF, NYHA class, 6-min walk distance, and MLHFQ score. However, these improvements at 42 months were not significantly different from mean values at 6 and 12 months.

Conclusions: In a 42-month follow-up, ART was durable, safe, and was associated with beneficial effects on LVEF and 6-min walk distance. Long term, chronic, open-loop ART continued to be well-tolerated in patients with HFrEF. The open label, randomized, controlled, ANTHEM-HFrEF Pivotal Study is currently underway to further evaluate ART in patients with advanced HF.
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http://dx.doi.org/10.1016/j.ijcard.2020.09.072DOI Listing
January 2021
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