Publications by authors named "Narinder P Singh"

27 Publications

  • Page 1 of 1

From wipeout to drill out: a history of exostosis management and Australian surfing.

Med J Aust 2022 05 7;216(8):401-404. Epub 2022 Apr 7.

St Vincent's Hospital, Sydney, NSW.

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http://dx.doi.org/10.5694/mja2.51496DOI Listing
May 2022

Fascia iliaca block for hip fractures in the emergency department: meta-analysis with trial sequential analysis.

Am J Emerg Med 2021 12 25;50:654-660. Epub 2021 Sep 25.

Department of Anaesthesia, Washington University in Saint Louis, MO, USA.

Background: Fascia iliaca block (FICB) has been used to reduce pain and its impact on geriatric patients with hip fractures.

Objective: We conducted this meta-analysis to investigate the analgesic efficacy of this block in comparison to standard of care (SOC) when performed by non-anesthesiologist in the emergency department.

Methods: Search on PubMed, SCOPUS, EMBASE, Google Scholar and Cochrane database for randomized and quasi-randomized trials were performed. The primary outcome was to compare pain relief at rest at 2-4 h. The pain relief at various time intervals, reduction in opioid use, the incidence of nausea/ vomiting, delirium and length of hospital stay were the secondary outcomes studied. Trial Sequential Analysis (TSA) was performed for the primary outcome.

Results: Eleven trials comprising 895 patients were included in the meta-analysis. Patients receiving FICB had significant better pain relief at rest at 2-4 h with mean difference of 1.59 (95% CI, 0.59-2.59, p = 0.002) with I = 96%. However, the certainty of the evidence was low and TSA showed that the sample size could not reach the requisite information size. A significant difference in pain relief at rest and on movement started within 30 min and lasted till 4 h of the block. Use of FICB was associated with a significant reduction in post-procedure parenteral opioid consumption, nausea and vomiting and length of hospital stay.

Conclusions: FICB is associated with significant pain relief both at rest and on movement lasting up to 4 h as well as a reduction in opioid requirement and associated nausea and vomiting in geriatric patients with hip fracture. However, the quality of evidence is low and additional trials are necessary.
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http://dx.doi.org/10.1016/j.ajem.2021.09.038DOI Listing
December 2021

Effect of balanced anaesthesia with and without modified pectoralis nerve block on postoperative analgesia after breast surgeries: A randomised controlled trial.

Indian J Anaesth 2021 Sep 15;65(Suppl 3):S110-S114. Epub 2021 Sep 15.

Department of Neuroanaesthesia, Health Sciences Centre, Winnipeg, Manitoba, Canada.

Background And Aims: Modified pectoral nerve block (PEC) has been reported to have variable effects on perioperative pain in patients undergoing surgery for carcinoma breast. This randomised controlled trial was conducted to study the effect of modified PEC on postoperative pain relief in patients undergoing breast surgery.

Methods: Fifty patients with carcinoma breast undergoing breast surgery were randomised to receive a modified PEC block consisting of 30 ml of ropivacaine 0.2% after induction of anaesthesia (PEC group) or no block (GA group) in this prospective randomised trial. Time to first rescue analgesia was recorded as primary outcome. Other secondary outcomes recorded were postoperative visual analogue scale (VAS) scores, number of rescue boluses and 24-h fentanyl consumption.

Results: There was no significant difference in time to first rescue analgesia between the two groups, with mean difference (95% confidence interval) of 22.91 (-6.8 to 52.69) min. Amount of fentanyl required to keep pain VAS less than 3 was also comparable between the two groups, mean (standard deviation) of 42.0 μg (17.42) in GA group versus 43.24 μg (17.22) in PEC group; = 0.830.20/25 patients required rescue analgesia in GA group as compared to 17/25 in PEC group ( = 0.334). The postoperative VAS scores were also comparable between the groups at all time intervals.

Conclusion: Balanced anaesthesia supplemented with modified PEC block performed after general anaesthesia did not improve the postoperative pain in patients undergoing modified radical mastectomy.
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http://dx.doi.org/10.4103/ija.IJA_125_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500198PMC
September 2021

The Regional Cerebral Oxygen Saturation Effect of Inotropes/Vasopressors Administered to Treat Intraoperative Hypotension: A Bayesian Network Meta-analysis.

J Neurosurg Anesthesiol 2021 Jun 10. Epub 2021 Jun 10.

Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA Department of Anesthesiology, MMIMSR, MM (DU), Mullana, Haryana, India Bernard Becker Medical Library Department of Anesthesiology, Perioperative and Pain Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO.

One of the main concerns of intraoperative hypotension is adequacy of cerebral perfusion, as cerebral blood flow decreases passively when mean arterial pressure falls below the lower limit of cerebral autoregulation. Treatment of intraoperative hypotension includes administration of drugs, such as inotropes and vasopressors, which have different pharmacological effects on cerebral hemodynamics; there is no consensus on the preferred drug to use. We performed a network meta-analysis (NMA) to pool and analyze data comparing the effect on cerebral oxygen saturation (ScO2) measured by cerebral oximetry of various inotropes/vasopressors used to treat intraoperative hypotension. We searched randomized control trials in Embase, Ovid Medline, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science. We included studies that enrolled adult patients undergoing surgery under general/spinal anesthesia that compared at least 2 inotropes/vasopressors to treat hypotension. We reviewed 51 full-text manuscripts and included 9 randomized controlled trials in our study. The primary outcome was change in ScO2. Our results showed the likelihood that dopamine, ephedrine, and norepinephrine had the lowest probability of decreasing ScO2. The suggested rank order to maintain ScO2, from higher to lower, was dopamine
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http://dx.doi.org/10.1097/ANA.0000000000000783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9142214PMC
June 2021

Pectoral block versus paravertebral block: methodological concerns.

Reg Anesth Pain Med 2021 12 2;46(12):1119-1120. Epub 2021 Apr 2.

Department of Anaesthesia and Intensive Care, Post Graduate Institue of Medical Education and Reseach, Chandigarh, India.

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http://dx.doi.org/10.1136/rapm-2021-102549DOI Listing
December 2021

The analgesic effectiveness of ilioinguinal-iliohypogastric block for caesarean delivery: A meta-analysis and trial sequential analysis.

Eur J Anaesthesiol 2021 08;38(Suppl 2):S87-S96

From the Department of Anaesthesia, MMIMSR, MM (DU), Mullana-Ambala (NPS), the Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India (JKM, NB) and the Department of Anesthesia, Washington University, Saint Louis, Missouri, USA (PMS).

Background: An effective analgesia strategy following caesarean delivery should be designed to improve fetomaternal outcomes. Much recent research has focused on the efficacy of ilioinguinal-iliohypogastric (II-IH) block for providing such analgesia.

Design: A systematic review and meta-analysis of randomised controlled trials.

Objectives: To investigate the effectiveness of II-IH block in patients undergoing caesarean delivery. The primary outcome was the cumulative parenteral morphine equivalents at 24 h. Pain scores at 4 to 6 and 24 h postsurgery, time to first rescue analgesia and adverse effects were the secondary outcomes analysed.

Data Sources: Two reviewers searched independently PubMed, Embase, Google Scholar and the Cochrane central registers of a controlled trial from their inception until June 2020.

Methodology: Prospective randomised control trials comparing II-IH block with either systemic analgesia alone or a placebo block (non-active controls) were eligible for inclusion. Only trials that reported their methods comprehensibly and transparently were included. Cochrane methodology was used to assess the risk of bias. Data are presented as mean difference with 95% confidence interval (CI).

Results: Thirteen trials comprising a total of 858 patients were included. Opioid (intravenous morphine equivalents) consumption was reduced by 15.57 mg (95% CI -19.87 to -11.28; P < 0.00001; I2 = 95%) during the first 24 h in patients receiving II-IH block when compared with placebo or no block. Patients receiving general anaesthesia showed a greater reduction in morphine requirement at 24 h than those receiving neuraxial anaesthesia. Adequate 'information size' for the above outcome was confirmed with trial sequential analysis to rule out the possibility of a false-positive result. II-IH also significantly reduced pain scores at rest more so at 4 to 6 h than at 24 h.

Conclusions: Our study suggests that the use of II-IH blocks is associated with a lower 24 h requirement for intravenous morphine equivalents in patients undergoing caesarean delivery. However, given the methodological limitations, data should be interpreted with caution until more studies are available.
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http://dx.doi.org/10.1097/EJA.0000000000001379DOI Listing
August 2021

Efficacy of topical agents for prevention of postoperative sore throat after single lumen tracheal intubation: a Bayesian network meta-analysis.

Can J Anaesth 2020 Nov 20;67(11):1624-1642. Epub 2020 Aug 20.

Department of Anesthesia, Washington University in Saint Louis, Saint Louis, MO, USA.

Background: The optimal choice of prophylactic drugs to decrease postoperative sore throat is unclear. The objective of this network meta-analysis (NMA) was to compare and rank 11 topical agents used to prevent postoperative sore throat.

Methods: Various databases were searched independently for randomized-controlled trials (RCTs) comparing topical agents used for the prevention of postoperative sore throat. Inclusion criteria were parallel group studies comparing intervention with active or inactive control and reporting postoperative sore throat. The primary outcome was postoperative sore throat at 24 hr. Secondary outcomes were early sore throat at 4-6 hr, cough, and hoarseness at 24 hr.

Results: Evidence was synthesized from 70 RCTs reporting 7,141 patients. Topical application of lidocaine, corticosteroids, ketamine, magnesium, benzydamine, water-based lubricant, and liquorice applied along the tracheal tube, to the tracheal tube cuff, gargled or sprayed were compared with intracuff air and each other. Bayesian NMA showed that magnesium (odds ratio [OR], 0.10; 95% credible interval [CrI], 0.03 to 0.26), liquorice (OR, 0.14; 95% CrI, 0.03 to 0.55), and steroid application (OR, 0.11; 95% CrI, 0.06 to 0.22) most effectively prevented postoperative sore throat at 24 hr. Topical lidocaine was the least effective intervention.

Conclusion: Topical application of magnesium followed by liquorice and corticosteroids most effectively prevented postoperative sore throat 24 hr after endotracheal intubation.
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http://dx.doi.org/10.1007/s12630-020-01792-4DOI Listing
November 2020

Analgesic efficacy of erector spinae plane block for oncologic breast surgery: A meta-analysis and trial sequential analysis.

Breast J 2020 11 1;26(11):2295-2298. Epub 2020 Aug 1.

Department of Anesthesia, Washington University in Saint Louis, Saint Louis, MO, USA.

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http://dx.doi.org/10.1111/tbj.14001DOI Listing
November 2020

The analgesic efficacy of quadratus lumborum block in caesarean delivery: a meta-analysis and trial sequential analysis.

J Anesth 2020 12 8;34(6):814-824. Epub 2020 Jul 8.

Department of Anesthesia, Washington University in Saint Louis, Saint Louis, MO, USA.

Purpose: Quadratus lumborum block (QLB) has recently gained popularity for postoperative analgesia after cesarean delivery (CD) as it provides both visceral and somato-sensory blockade of the abdomen. Aim of this meta-analysis was to evaluate the analgesic potential of QLB after CD.

Methods: Electronic database from inception to December 2019 was searched systematically for randomized-controlled trials comparing QLB with injection of inactive solution in women undergoing CD. Primary outcome was consumption of morphine at 24 h. Morphine consumption at 48 h, dynamic and static pain scores at various time intervals were the secondary outcomes studied.

Results: Seven trials met the inclusion criteria. Morphine consumption was reduced significantly with QLB in comparison to sham or no block at 24 h (mean difference [MD] - 9.84 mg; 95% confidence interval [CI] - 18.16, - 0.50; p = 0.04; I = zero). Adequate "information size" for above outcome was confirmed with trial sequential analysis, ruling out any possibility of a false-positive result. QLB significantly reduced pain scores at rest (MD - 1.13; 95% CI - 1.75, - 0.56; p = 0.00) and on movement (MD - 1.48; 95% CI - 2.5, - 0.46; p = 0.01) at 6 h. However, statistically significant difference in pain scores persisted only for dynamic pain at 24 h (MD - 0.55; 95% CI - 1.04, - 0.06; p = 0.03). QLB does not provide any additional analgesic benefit to the parturient receiving intrathecal morphine.

Conclusion: QLB significantly reduces opioid requirements in CD and may have analgesic effects lasting 24 h.
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http://dx.doi.org/10.1007/s00540-020-02822-7DOI Listing
December 2020

Atheroembolic Renal Disease.

Indian J Nephrol 2020 Jan-Feb;30(1):1-2. Epub 2019 Sep 9.

Department of Nephrology, Emory University Atlanta, Georgia, US.

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http://dx.doi.org/10.4103/ijn.IJN_382_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977374PMC
September 2019

A case of acute unilateral maxillary atelectasis following endoscopic pituitary surgery.

Int J Surg Case Rep 2020 14;66:394-397. Epub 2020 Jan 14.

Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia.

Introduction: Chronic maxillary atelectasis (CMA) is traditionally described as a rare, acquired condition of persistent and progressive antral wall collapse causing a reduction in maxillary sinus volume. In a handful of cases, CMA has been identified in patients with previously normal computed tomography (CT) imaging. However, maxillary atelectasis occurring rapidly after pituitary surgery, despite a normal pre-operative CT scan, has not previously been described in the literature.

Presentation Of Case: A 29-year-old male presented two months post endoscopic transnasal, transsphenoidal excision of a Rathke's cleft cyst with facial pain and pressure, unresponsive to medical treatment. CT of the paranasal sinuses at five months post-operatively demonstrated evidence of a left CMA, which was not present on pre-operative imaging. He underwent endoscopic uncinectomy and middle meatal antrostomy with complete resolution of symptoms.

Discussion: To our knowledge, this is the first case in the literature describing acute development of maxillary atelectasis. While lateralisation of the middle turbinate causing ostiomeatal obstruction may lead to sinus atelectasis, it is typically a slow process and often seen in the context of chronic disease. Review of the literature demonstrates six cases of documented rapid-onset atelectasis of maxillary sinuses. Four of these cases were post-operative, with one involving direct surgery on the affected sinus.

Conclusion: This case represents the first in the literature of acute, post-operative unilateral maxillary atelectasis following pituitary surgery, where the affected sinus was not directly involved in the initial operation. Consideration should be made to incorporate acute cases into the current classification system.
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http://dx.doi.org/10.1016/j.ijscr.2019.12.041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6974698PMC
January 2020

Vasopressor drugs for the prevention and treatment of hypotension during neuraxial anaesthesia for Caesarean delivery: a Bayesian network meta-analysis of fetal and maternal outcomes.

Br J Anaesth 2020 Mar 4;124(3):e95-e107. Epub 2019 Dec 4.

Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA.

Background: The optimal choice of vasopressor drugs for managing hypotension during neuraxial anaesthesia for Caesarean delivery is unclear. Although phenylephrine was recently recommended as a consensus choice, direct comparison of phenylephrine with vasopressors used in other healthcare settings is largely lacking. Therefore, we assessed this indirectly by collating data from relevant studies in this comprehensive network meta-analysis. Here, we provide the possible rank orders for these vasopressor agents in relation to clinically important fetal and maternal outcomes.

Methods: RCTs were independently searched in MEDLINE, Web of Science, Embase, The Cochrane Central Register of Controlled Trials, and clinicaltrials.gov (updated January 31, 2019). The primary outcome assessed was umbilical arterial base excess. Secondary fetal outcomes were umbilical arterial pH and Pco. Maternal outcomes were incidences of nausea, vomiting, and bradycardia.

Results: We included 52 RCTs with a total of 4126 patients. Our Bayesian network meta-analysis showed the likelihood that norepinephrine, metaraminol, and mephentermine had the lowest probability of adversely affecting the fetal acid-base status as assessed by their effect on umbilical arterial base excess (probability rank order: norepinephrine > mephentermine > metaraminol > phenylephrine > ephedrine). This rank order largely held true for umbilical arterial pH and Pco. With the exception of maternal bradycardia, ephedrine had the highest probability of being the worst agent for all assessed outcomes. Because of the inherent imprecision when collating direct/indirect comparisons, the rank orders suggested are possibilities rather than absolute ranks.

Conclusion: Our analysis suggests the possibility that norepinephrine and metaraminol are less likely than phenylephrine to be associated with adverse fetal acid-base status during Caesarean delivery. Our results, therefore, lay the scientific foundation for focused trials to enable direct comparisons between these agents and phenylephrine.
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http://dx.doi.org/10.1016/j.bja.2019.09.045DOI Listing
March 2020

Role of topical magnesium in post-operative sore throat: A systematic review and meta-analysis of randomised controlled trials.

Indian J Anaesth 2019 Jul;63(7):520-529

Department of Anesthesia, Washington University, St Louis, MO, USA.

Background And Aims: Post-operative sore throat (POST) is a common undesirable consequence of tracheal intubation. Magnesium, an N-methyl-D-aspartate receptor antagonist, has anti-nociceptive and anti-inflammatory properties, and has been found to be useful in POST prevention in various trials. We conducted this systematic review and meta-analysis to study the efficacy of topical magnesium in preventing POST in adult patients undergoing surgery under general anaesthesia with single lumen tracheal tube.

Methods: Comprehensive literature search was performed in PubMed, Google Scholar, EMBASE, Scopus and the Cochrane central registers of controlled trial databases through July, 2018 and data were pooled using fixed effect modelling followed by random-effect methods (after assessing heterogeneity with fixed modelling). The primary outcome was the incidence of POST at 24 h after surgery/extubation. Comparative results were deliberated as pooled mean difference for continuous variables and Mantel-Haenszel (MH) odds ratio for dichotomous variables. Statistical analysis was done using Comprehensive Meta-Analysis-Version 3 (Biostat Inc., USA).

Results: Seven trials involving 726 study participants were included in the final analysis. Incidence of POST at 24 hours was significantly lower in magnesium group (26/363) in comparison to active and non-active control group (89/363); = 0.00- RR 0.22 (95%CI = 0.12-0.39, I = 0%). No significant adverse events were reported with the use of topical magnesium.

Conclusion: Prophylactic use of topical magnesium before the induction of general anaesthesia seems to be an effective measure to decrease the incidence of POST.
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http://dx.doi.org/10.4103/ija.IJA_856_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6644199PMC
July 2019

Frontal Sinus Osteoma: From Direct Excision to Endoscopic Removal.

J Craniofac Surg 2019 Sep;30(6):e494

Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital.

Frontal sinus osteomas are benign bone-forming neoplasms. Ongoing advancements in endoscopic surgery have allowed less invasive surgical approaches to be adopted for removal. The authors systematically reviewed the literature to provide analysis and recommendations for management.One hundred ninety-three publications encompassing 1399 patients met inclusion, with mean age 42.1 ± 13.8 years and a male predominance (59.2%). Symptoms included pain (70.8%); orbital/ocular (20.7%); sinonasal (36.4%); neurologic (6.0%); other (14.5%); and asymptomatic (4.8%). Osteoma was isolated to the frontal sinus (82.9%) or extended into the ethmoid (16.6%), maxillary (0.3%), and sphenoid sinuses (0.2%). There was intracranial extension in 9.5% and intraorbital extension in 18.7%. Of those proceeding to surgery, majority (59.8%) underwent open approaches, followed by endoscopic (25.0%) and combined (11.5%). A significant (P < 0.01) increase in proportion of cases utilizing endoscopic approaches versus open/combined was observed over the period studied. Seventy-one postoperative complications were reported, in 7.5% of endoscopic cases, 27% of open, and 8.8% of combined. Complications were more likely in open/combined surgery, compared with endoscopic (22.3% versus 7.5%, P < 0.001). In 181 patients, completeness of resection was reported (complete resection; 87.8%) and found to be a significant predictor (P < 0.01) for disease recurrence/progression. Mean length of stay for the endoscopic group was 3.1 ± 1.3 days, compared with 7.9 ± 3.1 for open/combined (P < 0.0001).In the management of frontal sinus osteoma, indications for selecting endoscopic versus open approaches have expanded over the past 30 years, as techniques, equipment, and understanding of pathophysiology have evolved. Where endoscopic approaches are possible, they are associated with reduced morbidity and length of stay compared with open approaches.
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http://dx.doi.org/10.1097/SCS.0000000000005371DOI Listing
September 2019

Forty years of "Waltzing Matilda": the history of the multichannel cochlear implant.

Med J Aust 2018 12;209(11):476-478

Westmead Clinical School, University of Sydney, Sydney, NSW.

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http://dx.doi.org/10.5694/mja18.00365DOI Listing
December 2018

Reporting of time to rescue analgesia: Would it have made a difference in results?

Eur J Anaesthesiol 2018 12;35(12):986-987

From the Department of Anaesthesia, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada (NPS), Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India (JKM) and Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India (PMS).

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http://dx.doi.org/10.1097/EJA.0000000000000847DOI Listing
December 2018

An inexpensive blue filter for fluorescein-assisted repair of cerebrospinal fluid rhinorrhea.

Laryngoscope 2014 May 10;124(5):1103-5. Epub 2013 Dec 10.

Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1002/lary.24502DOI Listing
May 2014

ED50 of sevoflurane for LMA Supreme insertion: reliability!

Eur J Anaesthesiol 2014 Jan;31(1):54

From the Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (JKM), Alchemist Hospital (NPS), Chandigarh, India.

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http://dx.doi.org/10.1097/EJA.0b013e328363944aDOI Listing
January 2014

Prevalence of low glomerular filtration rate, proteinuria and associated risk factors in North India using Cockcroft-Gault and Modification of Diet in Renal Disease equation: an observational, cross-sectional study.

BMC Nephrol 2009 Feb 17;10. Epub 2009 Feb 17.

Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India.

Background: Chronic kidney disease (CKD) is increasingly being recognized as an emerging public health problem in India. However, community based estimates of low glomerular filtration rate (GFR) and proteinuria are few. Validity of traditional serum creatinine based GFR estimating equations in South Asian subjects is also debatable. We intended to estimate and compare the prevalence of low GFR, proteinuria and associated risk factors in North India using Cockcroft-Gault (CG) and Modification of Diet In Renal Disease (MDRD) equation.

Methods: A community based, cross-sectional study involving multistage random cluster sampling was done in Delhi and its surrounding regions. Adults > or = 20 years were surveyed. CG and MDRD equations were used to estimate GFR (eGFR). Low GFR was defined as eGFR < 60 ml/min/1.73 m2. Proteinuria (> or = 1+) was assessed using visually read dipsticks. Odds ratios, crude and adjusted, were calculated to ascertain associations between renal impairment, proteinuria and risk factors.

Results: The study population had 3,155 males and 2,097 females. The mean age for low eGFR subjects was 54 years. The unstandardized prevalence of low eGFR was 13.3% by CG equation and 4.2% by MDRD equation. The prevalence estimates of MDRD equation were lower across gender and age groups when compared with CG equation estimates. There was a strong correlation but poor agreement between GFR estimates of two equations. The survey population had a 2.25% prevalence of proteinuria. In a multivariate logistic regression analysis; age above 60 years, female gender, low educational status, increased waist circumference, hypertension and diabetes were associated with low eGFR. Similar factors were also associated with proteinuria. Only 3.3% of subjects with renal impairment were aware of their disease.

Conclusion: The prevalence of low eGFR in North India is probably higher than previous estimates. There is a significant difference between GFR estimates derived from CG and MDRD equations. These equations may not be useful in epidemiological research. GFR estimating equations validated for South Asian populations are needed before reliable estimates of CKD prevalence can be obtained. Till then, primary prevention and management targeted at CKD risk factors must play a critical role in controlling rising CKD magnitude. Cost-benefit analysis of targeted screening programs is needed.
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http://dx.doi.org/10.1186/1471-2369-10-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2663556PMC
February 2009

Effect of pharmacological suppression of secondary hyperparathyroidism on cardiovascular hemodynamics in predialysis CKD patients: A preliminary observation.

Hemodial Int 2007 Oct;11(4):417-23

Division of Nephrology, Maulana Azad Medical College and Associated Lok Nayak Hospital, G. B. Pant Hospital and Guru Nanak Eye Hospital, New Delhi, India.

Cardiovascular events are the principal cause of mortality in patients with chronic kidney disease (CKD). Secondary hyperparathyroidism (SHPT), a common complication of CKD, contributes to cardiac dysfunction. This study is an attempt to demonstrate the effects of parathyroid hormone suppression with oral calcitriol on cardiovascular hemodynamics. Twenty predialysis CKD patients with SHPT were given calcitriol therapy for 12 weeks. Ten similar patients received placebo. Echocardiographic assessment of cardiac function was performed at baseline and after 12 weeks of treatment. Calcitriol therapy effectively suppressed SHPT. Baseline left ventricular (LV) end diastolic diameter and LV end systolic diameter were 4.86+/-0.48 and 2.86+/-0.33 cm, and the mean FS was 41.02+/-4.79%. Left ventricular end systolic and end diastolic volumes were normal (42.30+/-9.07 and 91.40+/-19.68 mL). The ejection fraction was slightly reduced (53.54+/-3.57%). Pretreatment Doppler indices including E velocity (0.816+/-0.087 m/s), A velocity (0.696+/-0.089 m/s), and E/A ratio (1.193+/-0.210) were significantly impaired. After 12 weeks of calcitriol therapy, there was no significant change in the LV dimensions or ejection fraction, but there was a significant improvement in the diastolic parameters, namely the A velocity (0.680+/-0.084) and E/A ratio (1.238+/-0.180). Secondary hyperparathyroidism is an important factor in the pathogenesis of cardiovascular complications in CKD. There is evidence to support that correction of hyperparathyroidism can improve the systolic dysfunction seen in advanced kidney disease. This study shows that diastolic dysfunction seen in predialysis CKD patients may also be possibly improved with calcitriol therapy.
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http://dx.doi.org/10.1111/j.1542-4758.2007.00211.xDOI Listing
October 2007

Acute demyelinating encephalitis after jequirity pea ingestion (Abrus precatorius).

Clin Toxicol (Phila) 2007 ;45(1):77-9

Dept. of Internal Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.

Introduction: Castor and jequirity beans are uncommon causes of poisoning. The more common but less severe castor poisoning is well described, but jequirity bean (Abrus Precatorius) poisoning is rare. The toxicity is attributed to toxalbumins (ricin and abrin) that act by inhibiting protein synthesis. Their use as agents of biological warfare, mechanisms of action, and clinical features of poisoning are summarized.

Case Report: A 30-year-old previously healthy female presented with bloody diarrhea and deep coma following ingestion of 3-4 seeds of a plant called 'ratti.' Investigations, including an MRI brain scan, showed evidence of acute demyelinating encephalitis. The patient died three days later due to progressive central nervous system depression.

Discussion: This is a previously unreported manifestation of jequirity bean poisoning. Demyelination is immune-mediated, and Abrus is a well-known immuno-modulator and stimulator. A possible immunological pathogenic mechanism is hypothesized.
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http://dx.doi.org/10.1080/15563650601006116DOI Listing
March 2007

Effect of improvement in anemia on electroneurophysiological markers (P300) of cognitive dysfunction in chronic kidney disease.

Hemodial Int 2006 Jul;10(3):267-73

Department of Medicine, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi, India.

Our aim is to study the effect of improvement in anemia on event-related potentials (ERPs; P300) as markers of cognitive dysfunction in predialysis and dialysis patients of chronic kidney disease (CKD). Thirty anemic patients of CKD (hemoglobin [Hb] < 9 g%), 15 in the predialysis group (Group A), and 15 patients on biweekly hemodialysis (Group B) were recruited for the study. Patients of uremic encephalopathy, dyselectrolytemia, and those with hearing problems were excluded. Both groups were given recombinant human erythropoietin (rhuEPO) 100 IU/kg biweekly for 6 weeks by the subcutaneous route. No intervention was performed in the third control group (Group C), which consisted of 30 normal healthy volunteers. The improvement in Hb was assessed every 2 weeks, and the amplitude and latency of the P300 component of the ERPs were studied before initiating treatment and after 6 weeks of rhuEPO administration. There was a significant increase in Hb in both the study groups without any significant alteration in kidney functions. A significant reduction in P300 latency was noted in both the study groups after intervention. Similarly, the amplitude of P300 also increased in both study groups, but attained statistical significance for the dialysis group only. No significant changes were observed in the control group. Administration of EPO in patients of anemia with CKD resulted in a significant improvement in the electrophysiological markers of cognitive function in the form of increased amplitudes and decreased latencies of P300 in both predialysis and dialysis patients.
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http://dx.doi.org/10.1111/j.1542-4758.2006.00107.xDOI Listing
July 2006

Rare thoracic mass lesion--myofibrobastoma.

Indian J Cancer 2005 Jul-Sep;42(3):161-4

Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, G. B. Pant Hospital and Guru Nanak Eye Hospital, New Delhi-110 002, India.

Mesenchymal soft tissue masses are uncommon tumours of the chest. Myofibroblastoma is a recently described entity consisting of cells with origin from the myoepethelial cell, mostly seen as benign well-circumscribed neoplasms of the breast tissue. Though usually classified as a benign lesion, rarely it can be multifocal and prone to recurrence. We describe below the case of a 26-year-old female who presented with exertional dyspnoea and evidence of a massive mass lesion in the left hemithorax causing mediastinal displacement to the opposite side. On histological and immunophenotypic analysis, a diagnosis of the very rare thoracic myofibroblastoma was made. The incidence, salient features, pathological differential diagnoses and treatment are reviewed.
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http://dx.doi.org/10.4103/0019-509x.17063DOI Listing
February 2006

Renal and systemic amyloidosis in systemic lupus erythematosus.

Ren Fail 2003 Jul;25(4):671-5

Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.

A young male presented with oral ulceration for two years; swelling face and feet of seven days duration; diffuse goiter without signs of thyroid disease; normocytic normochromic anemia, thrombocytopenia, deranged renal functions, albuminuria of 2.5 g/24h with active urinary sediment. ANA and anti-ds DNA were positive, sonography of abdomen suggested medical renal disease. Testing for HIV, HBV, VDRL, CRP, rheumatoid factor, p-ANCA and c-ANCA were negative. Thyroid hormone assays were normal. Kidney biopsy done to stage lupus nephritis did not show any evidence of lupus involvement but staining for SAA amyloid was positive. Subsequent biopsies from the liver and rectum also stained positive for amyloid. Diagnosis of "Systemic lupus erythematosus with renal and systemic secondary amyloidosis with euthyroid diffuse goiter" was made. The case is being reported and discussed because of the interesting and rare association between amyloidosis and systemic lupus erythematosus.
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http://dx.doi.org/10.1081/jdi-120022561DOI Listing
July 2003
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