Publications by authors named "Neha Singh"

435 Publications

A novel perspective of associativity of upper limb motor impairment and cortical excitability in sub-acute and chronic stroke.

Front Neurosci 2022 25;16:832121. Epub 2022 Jul 25.

Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.

Background: The global inclination of stroke onset in earlier years of life and increased lifespan have resulted in an increased chronic post-stroke-related disability. The precise and simplistic approach such as the correlation of Fugl-Meyer Assessment (FMA) with Transcranial Magnetic Stimulation (TMS) parameters, Resting Motor Threshold (RMT) and Motor Evoked Potential (MEP), in patients with stroke might play a critical role, given the prognostic value of MEP, a measure of cortical excitability, and might be the key point in prescribing appropriate therapeutic strategies.

Objective: The study aimed to determine the correlation of FMA-based impairment in the upper extremity function specifically of the wrist and hand with respect to the neurophysiological parameters of corticospinal tract integrity.

Materials And Methods: The Institutional Review Board approved the study and 67 (n) patients with stroke were enrolled in the Department of Neurology, AIIMS, New Delhi, India. The motor assessment was performed on patients by the upper extremity subset of Fugl-Meyer Assessment (FMA) and the clinical history was obtained. RMT and MEP of Extensor Digitorum Communis (EDC) muscle were measured TMS.

Results: A significant positive correlation was observed between Fugl-Meyer Assessment Wrist/Hand (FMA W/H) and MEP scores ( = 0.560, <0.001). Also, Fugl-Meyer Assessment Upper Extremity (FMA UE) scores demonstrated a moderate positive association with MEP responsiveness ( = 0.421, <0.001).

Conclusion: MEP of the EDC muscle was found to be associated with sensorimotor control as measured by FMA. Moreover, FMA W/H score values might be a better prognostic indicator of EDC MEP responsiveness. Interestingly, a novel element comprising the range of FMA UE and FMA W/H components was observed to be a potential indicator of MEP responsiveness and could also indicate establishing FMA as a surrogate for TMS in resource-limited settings for prognostification.
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http://dx.doi.org/10.3389/fnins.2022.832121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9358254PMC
July 2022

Comparison of endotracheal intubation with Macintosh versus King Vision video laryngoscope using coronavirus disease 2019 barrier box on manikins: A randomized crossover study.

Turk J Emerg Med 2022 Jul-Sep;22(3):149-155. Epub 2022 Jul 1.

Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India.

Background: Coronavirus disease 2019 (COVID-19) virus usually spreads through aerosol and close contact. Frontline health-care workers handle aerosol-generating procedures like endotracheal intubation. To reduce this risk, COVID-19 barrier box came into the picture. However, the COVID-19 barrier box may compromise easy and successful intubation, and their limitation must be studied.

Objectives: The objective of this study was to assess the time to successful intubation with or without the COVID-19 barrier box using the Macintosh laryngoscope and King Vision video laryngoscope (KVVL). We also assessed the first-pass success rate, ease of intubation, Cormack-Lehane (CL) grade, and requirement of external laryngeal manipulation.

Methods: We conducted this manikin-based randomized crossover study to assess the time to successful intubation by anesthesiologists (22) and emergency physicians (11) having 1 year or more experience with or without COVID-19 barrier box by using the Macintosh laryngoscope and KVVL. Our study randomized the sequence of the four different intubation scenarios.

Results: The comparison of mean duration of intubation between KVVL (13.21 ± 4.05 s) and Macintosh laryngoscope (12.89 ± 4.28 s) with COVID-19 barrier box was not statistically significant (95% confidence interval: 1.21-0.97). The ease of intubation, number of attempts, and requirement of external laryngeal manipulation were not statistically significant. Intubations were statistically significant more difficult with barrier box in view of higher CL grade.

Conclusion: Time to intubation was longer with COVID-19 barrier box using KVVL as compared to Macintosh laryngoscope which was statistically not significant.
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http://dx.doi.org/10.4103/2452-2473.348436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9355073PMC
July 2022

The Top 100 Most-Cited Publications in Musculoskeletal Rehabilitation: A Bibliometric Analysis.

Authors:
Neha Singh

Indian J Orthop 2022 Aug 22;56(8):1327-1338. Epub 2022 Jun 22.

Division of Interventional Pain Management, OrthoAlabama Spine and Sports, AB Birmingham, USA.

Background: Musculoskeletal conditions are the leading contributor to global healthcare expenditure and with an increase in ageing global population, this number is projected to rise further.

Objectives: To determine the top 100 most-cited studies in field of musculoskeletal rehabilitation and to conduct their bibliometric analysis.

Design: Scopus was used for identification of studies, published in the field of musculoskeletal rehabilitation over last five decades.

Methods: Literature search was conducted in February 2021 with final Boolean search phrases being: [(musculoskeletal) and (rehabilitation) and (musculoskeletal rehabilitation)]. In addition to number of citations, data was also collected for other variables such as title of study, topic of discussion, subdivisions of clinical and applied science involved in conduction of study, study design, journal and its impact factor, year of publication, and country where study was conducted.

Results: The top 100 most-cited articles in musculoskeletal rehabilitation over the last 50 years were published between 1973 and 2015. Total number of citations was 24,366, with an average of 243.66 citations per paper. Highest citation was reported by a paper on treatment of low back pain by Waddell G. The decade of 2000-2009 contributed maximum articles with highest number of publications from journal "Archives of Physical Medicine and Rehabilitation". Most of the publications were from United States and most common topic to feature among these articles was "Strength training".

Conclusions: This study identifies the top 100 most-cited articles in musculoskeletal rehabilitation and provides insight into its historical trends while serving as a guide for future research.
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http://dx.doi.org/10.1007/s43465-022-00672-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283631PMC
August 2022

How to do (or not to do)…Using Causal Loop Diagrams for Health System Research in Low- and Middle-Income Settings.

Health Policy Plan 2022 Aug 3. Epub 2022 Aug 3.

Geneva Centre of Humanitarian Studies, University of Geneva and the Graduate Institute, Rue Rothschild 22, 1211, Genève, Switzerland.

Causal loop diagrams (CLDs) are a systems thinking method that can be used to visualise and unpack complex health system behaviour. They can be employed prospectively or retrospectively to identify the mechanisms and consequences of policies or interventions designed to strengthen health systems and inform discussion with policymakers and stakeholders on actions that may alleviate sub-optimal outcomes. Whilst the use of CLDs in health systems research has generally increased, there is still limited use in low- and middle-income settings. In addition to their suitability for evaluating complex systems, CLDs can be developed where opportunities for primary data collection may be limited (such as in humanitarian or conflict settings) and instead be formulated using secondary data, published or grey literature, health surveys/reports and policy documents. The purpose of this paper is to provide a step-by-step guide for designing a health system research study that uses CLDs as their chosen research method, with particular attention to issues of relevance to research in low- and middle-income countries (LMICs). The guidance draws on examples from the LMIC literature and authors' own experience of using CLDs in this research area. This paper guides researchers in addressing the following four questions in the study design process; (1) What is the scope of this research? (2) What data do I need to collect or source? (3) What is my chosen method for CLD development? (4) How will I validate the CLD? In providing supporting information to readers on avenues for addressing these key design questions, authors hope to promote CLDs for wider use by health system researchers working in LMICs.
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http://dx.doi.org/10.1093/heapol/czac064DOI Listing
August 2022

Re: Ethyl chloride spray, a local anesthetic in arterial blood gas sampling: A randomized, controlled, double-blinded study.

Am J Emerg Med 2022 Jul 21. Epub 2022 Jul 21.

Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

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http://dx.doi.org/10.1016/j.ajem.2022.07.028DOI Listing
July 2022

C1 lateral mass reduction screws for treating atlantoaxial dislocations: Bringing ease by modification.

J Craniovertebr Junction Spine 2022 Apr-Jun;13(2):140-145. Epub 2022 Jun 13.

Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Objective: The C1-C2 fixation technique revolutionized the management of complex craniovertebral junction (CVJ) anomalies. Presently used polyaxial screw and rod systems have inadvertent technical difficulties in rod fitting and reduction of atlantoaxial dislocations (AAD) requiring forceful joint handling. The purpose of this study is to analyze the use of a specially designed "reduction screw" in C1 lateral mass in C1-C2 fixation for treating AAD with or without basilar invagination (BI).

Study Design: This is a retrospective cohort study in which long lateral mass reduction screws were used for C1-C2 fixation.

Materials And Methods: Eighteen patients diagnosed with congenital AAD with or without BI treated with C1-C2 fixations using C1 reduction lateral mass were included in the study. The outcome was measured clinically by the modified Japanese Orthopedic Association score and radiologically by conventional craniometric indices.

Results: Among all cases included in the study, 72% (13/18) are males and 18% (5/18) are females with average age at presentation of 33.5 years. Among 18 cases of AAD, 84% (15/18) of patients have BI, 22% (4/18) have Chiari Type 1 malformation, and one patient has Klipple-Feil syndrome. Symptomatic improvement is noted in all patients following surgery. Adequate reduction of AAD with normalization of radiological indices was also achieved in all 18 (100%) patients.

Conclusion: C1 lateral mass reduction screw in C1-C2 fixation helps in reduction of AAD and BI (Type A) even in difficult cases of CVJ anomalies with intraoperative technical ease, reduced operative time, no need for special instruments or complex maneuvers, and avoiding potential neurological injury.
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http://dx.doi.org/10.4103/jcvjs.jcvjs_8_22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9274681PMC
June 2022

Incidental Gallbladder Neoplasms: A Growing Global Burden.

Cureus 2022 Jun 9;14(6):e25805. Epub 2022 Jun 9.

Pathology, Maharishi Markandeshwar Institute of Medical Science and Research, Ambala, IND.

Background The increasing trend of laparoscopic procedures has made cholecystectomies one of the most common surgical specimens received for histopathological evaluation. This has also led to an increasing trend of finding incidental gallbladder malignancies for a presumed benign disease. The present study describes the histopathological spectrum of neoplastic lesions of the gallbladder along with the historadiological correlation with special emphasis on incidental gallbladder carcinomas (IGBC). Materials and methods All the cholecystectomies received over a span of two and a half years were studied. Demographic details, imaging findings, gross features, and microscopic findings of premalignant and malignant lesions were noted. Special stains were done as and when required. Results Of the 1253 cholecystectomies received during the study period, 50 gallbladders (3.9%) showed neoplastic pathology and were included in the present study. The age range was 40 to 60 years with female predominance. Ultrasonography revealed nonspecific wall thickness in both premalignant and incidental gallbladder carcinomas. Gallstones were seen in 74% of the cases (37/50). Gross and imaging findings in 17 (34%) of the malignant cases were in concordance with microscopic features, whereas the dysplastic lesions (21) and IGBC cases showed evidence of chronic cholecystitis on the same. Microscopic examination revealed focal dysplasia (low and high grade) in 21/50 (42%) cases. Invasive malignancy was seen in 28/50 (56%) of the cases, of which 11 cases (22%) were IGBC. Pancreaticobiliary type of adenocarcinoma was the most common morphology seen in almost all the cases. There was also one case each of intracholecystic papillary neoplasm (ICPN) and carcinosarcoma. Conclusion GBC is an unusual malignancy and its preoperative diagnosis is not so definitive. The incidental form of GBC presents as a radiological disguise and a histopathological surprise. Hence, the present study warrants a complete and scrupulous histopathological examination of all the cholecystectomy specimens for proper and further management of the case.
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http://dx.doi.org/10.7759/cureus.25805DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9271173PMC
June 2022

Fetomaternal Outcomes in Women Affected With Preterm Premature Rupture of Membranes: An Observational Study From a Tertiary Care Center in Eastern India.

Cureus 2022 May 31;14(5):e25533. Epub 2022 May 31.

Obstetrics and Gynecology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.

Introduction: Preterm premature rupture of membranes (PPROM) is the spontaneous rupture of the fetal membranes before the completion of 37 weeks of pregnancy. PPROM occurs in 3% of pregnancies.

Methodology: This prospective observational study was conducted between September 2019 and March 2021, involving 150 antenatal patients attending our outpatient department or labor room. All pregnant women with a singleton pregnancy between 28 and 37 weeks of gestational age with PPROM were included in our study.

Results: A total of 44% of women were admitted to the hospital within 6-11 hours of the onset of PPROM, while 34% of women were admitted within five hours and 15.33% were admitted within 12-23 hours of the onset of PPROM. The most common organisms isolated in high vaginal swabs were (18%), (12%), (12.66%), (6.66%), and  (4.66%). Around 74.66% of women were delivered within 24 hours of the onset of PPROM, whereas only 2.6% of patients were delivered after 72 hours and the rest 34% were delivered between 25 and 72 hours. Of our study subjects, 10% were febrile, 4% were having urinary tract infections, 2.5% had postpartum hemorrhage, and 2% had chorioamnionitis. As far as neonatal morbidity and mortality are concerned, birth asphyxia and jaundice were seen in 12% of patients each, whereas septicemia was found in 4% of study subjects.

Conclusion: Owing to the association of higher maternal and perinatal morbidity and mortality, cases, especially in the early PPROM group, should be strictly monitored for clinical and laboratory signs of chorioamnionitis while opting for conservative management.
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http://dx.doi.org/10.7759/cureus.25533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246467PMC
May 2022

A systematic review of newborn health interventions in humanitarian settings.

BMJ Glob Health 2022 07;7(7)

Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK

Background: Almost half of the under-5 deaths occur in the neonatal period and most can be prevented with quality newborn care. The already vulnerable state of newborns is exacerbated in humanitarian settings. This review aims to assess the current evidence of the interventions being provided in these contexts, identify strategies that increase their utilisation and their effects on health outcomes in order to inform involved actors in the field and to guide future research.

Methods: Searched for peer-reviewed and grey literature in four databases and in relevant websites, for published studies between 1990 and 15 November 2021. Search terms were related to newborns, humanitarian settings, low-income and middle-income countries and newborn health interventions. Quality assessment using critical appraisal tools appropriate to the study design was conducted. Data were extracted and analysed using a narrative synthesis approach.

Results: A total of 35 articles were included in this review, 33 peer-reviewed and 2 grey literature publications. The essential newborn care (ENC) interventions reported varied across the studies and only three used the Newborn Health in Humanitarian Settings: Field Guide as a guideline document. The ENC interventions most commonly reported were thermal care and feeding support whereas delaying of cord clamping and administration of vitamin K were the least. Training of healthcare workers was the most frequent strategy reported to increase utilisation. Community interventions, financial incentives and the provision of supplies and equipment were also reported.

Conclusion: There is insufficient evidence documenting the reality of newborn care in humanitarian settings in low-income and middle-income countries. There is a need to improve the reporting of these interventions, including when there are gaps in service provision. More evidence is needed on the strategies used to increase their utilisation and the effect on health outcomes.

Prospero Registration Number: CRD42020199639.
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http://dx.doi.org/10.1136/bmjgh-2022-009082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9252185PMC
July 2022

miR-590-5p: A double-edged sword in the oncogenesis process.

Cancer Treat Res Commun 2022 Jun 12;32:100593. Epub 2022 Jun 12.

Department of Zoology, Central University of Punjab, Bathinda, 151401, Punjab, India. Electronic address:

Accumulating evidence suggests the critical role of miR-590-5p in various aspects of cellular homeostasis, including cancer. Furthermore, we and others have recently demonstrated that miRNA-590-5p acts as an oncogene in some cancers while it acts as a tumor-suppressor in others. However, the role of miR-590-5p in oncogenesis is more complex, like a double-edged sword. Thus, this systematic review introduces the concept, mechanism, and biological function of miR-590-5p to resolve this apparent paradox. We have also described the involvement of miR-590-5p in crucial cancer-hallmarks processes like proliferation, invasion, metastasis, and chemo radioresistance. Finally, we have presented the possible genes/pathways targets of miR-590-5p through bioinformatics analysis. This review may help in designing better biomarkers and therapeutic targets for cancers.
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http://dx.doi.org/10.1016/j.ctarc.2022.100593DOI Listing
June 2022

Adenosquamous Carcinoma of the Breast: Case Report and Literature Review.

Cureus 2022 Jun 14;14(6):e25940. Epub 2022 Jun 14.

Hematology and Oncology, Capital Region Medical Center, Jefferson City, USA.

Low-grade adenosquamous breast carcinoma (LGASC) is an atypical variant of metaplastic breast cancer. It differs from metaplastic carcinoma and has an indolent behavior. It usually presents as a palpable lump, unlike in our case, which had an incidental presentation. Because of its rarity, it often creates a clinical and diagnostic challenge. With the risk of local recurrence, the current management is aggressive with excision. Chemoradiation has been used in a few cases, but optimal management is unclear. Our manuscript aims to add to the existing knowledge on LGASC.
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http://dx.doi.org/10.7759/cureus.25940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9197327PMC
June 2022

APOE ε4 influences medial temporal atrophy and tau deposition in atypical Alzheimer's disease.

Alzheimers Dement 2022 Jun 12. Epub 2022 Jun 12.

Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.

Introduction: Apolipoprotein E (APOE) ε4 is an important genetic risk factor for typical Alzheimer's disease (AD), influencing brain volume and tau burden. Little is known about its influence in atypical presentations of AD.

Methods: An atypical AD cohort of 140 patients diagnosed with either posterior cortical atrophy or logopenic progressive aphasia underwent magnetic resonance imaging and positron emission tomography. Linear mixed effects models were fit to assess the influence of APOE ε4 on cross-sectional and longitudinal regional metrics.

Results: At baseline, APOE ε4 carriers had smaller hippocampal and amygdala volumes and greater tau standardized uptake volume ratio in the hippocampus and entorhinal cortex compared to non-carriers while longitudinally, APOE ε4 non-carriers showed faster rates of atrophy and tau accumulation in the entorhinal cortex, with faster tau accumulation in the hippocampus.

Discussion: APOE ε4 influences patterns of neurodegeneration and tau deposition and was associated with more medial temporal involvement, although there is evidence that non-carriers may be catching up over time.
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http://dx.doi.org/10.1002/alz.12711DOI Listing
June 2022

Effect of Dexmedetomidine as an adjuvant in quadratus lumborum block in patient undergoing caesarean section - A randomised controlled study.

J Clin Anesth 2022 10 4;81:110892. Epub 2022 Jun 4.

Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India.

Study Objective: This study was conducted to evaluate the effect of Dexmedetomidine as an adjuvant in quadratus lumborum block (QLB) for postoperative pain relief at rest in patients undergoing caesarean section (CS). The primary objective was to compare the time to the first request of rescue analgesia. Secondary objectives were to compare the amount of rescue analgesia, patient satisfaction, Numeric rating scale (NRS), and Ramsay sedation score (RSS) during the first 24 h.

Design: A randomised, double-blinded study.

Setting: The study was conducted at AIIMS Bhubaneswar from December 2019 to February 2021in the Operating Theatre complex (for the immediate postoperative follow-up) and in the Obstetric Ward (for follow-up at the later time points).

Patients: A total of 70 patients were enrolled with singleton term pregnancies scheduled for CS under spinal anaesthesia after written informed consent.

Intervention: Bilateral QLB was given in the recovery area. Group A received 30 ml of 0.25% Bupivacaine and group B received 30 ml 0.25% bupivacaine with Dexmedetomidine 1 μg/kg. They received inj. Paracetamol 15 mg/kg intravenously TDS and Inj. Tramadol 1 mg/kg as rescue analgesia (if Numeric rating scale (NRS) Score ≥ 4). We also compared the rescue analgesia in the first 24 h, patient satisfaction scores, Ramsay sedation score (RSS), and NRS scores at 2, 4, 6, 8, 12, 18, and 24 h.

Main Results: The time to request the first rescue analgesia was significantly prolonged in group B [Mean ± SD (95% CI)] 880 ± 351 (720-1040) min. vs group A 439 ± 208 (368-510) min., p < 0.001). There was a significant decrease in the amount of rescue analgesia [(Inj. Tramadol (1 mg/ kg)] used in the group with dexmedetomidine [group B Mean ± SD (95% CI) (57 ± 18 (49-65) mg. vs group A - 81 ± 25 (73-90)] mg., p < 0.001]. A significant difference was seen in patient satisfaction scores and pain scores between the groups up to 18 h. (p < 0.05) but not in RSS.

Conclusion: Dexmedetomidine can be considered an effective adjuvant for QLB in CS in the absence of intrathecal morphine.
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http://dx.doi.org/10.1016/j.jclinane.2022.110892DOI Listing
October 2022

Potential of Desert Medicinal Plants for Combating Resistant Biofilms in Urinary Tract Infections.

Appl Biochem Biotechnol 2022 Jun 6. Epub 2022 Jun 6.

Amity Institute of Microbial Technology, Amity University Rajasthan, Jaipur, 303002, India.

Urinary tract infections (UTIs) are among the most prevalent bacterial infections worldwide, with 11% of the global population getting infected every year. These infections are largely attributed to quorum sensing (QS)-dependent ability of pathogens to form biofilms in the urinary tract. Antimicrobial resistance is increasing, and the use of antimicrobial medicines in the future is yet uncertain. The desert medicinal plants have great potential to treat several diseases as per the available ethnobotanical database. Some of these plants have been used in folklore medicines to treat urinary tract infections also. There are many bioactive compounds derived from these desert medicinal plants that have been documented to possess antimicrobial as well as antibiofilm activity against uropathogens. The minimum biofilm inhibitory concentration (MBIC) of these plant extracts have been reported in the range of 31.5-250 μg/mL. The rising prevalence of drug-resistant diseases necessitates standardised modern analytical technologies to detect and isolate novel bioactive compounds from medicinal plants. This review seeks to combine the studies of desert plants with antimicrobial and anti-quorum sensing properties, supporting their sustainable use in treatment of urinary tract infections.
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http://dx.doi.org/10.1007/s12010-022-03950-4DOI Listing
June 2022

A mixed methods study to assess the impact of COVID-19 on maternal, newborn, child health and nutrition in fragile and conflict-affected settings.

Confl Health 2022 Jun 3;16(1):30. Epub 2022 Jun 3.

Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK.

Background: The impacts of COVID-19 are unprecedented globally. The pandemic is reversing decades of progress in maternal, newborn, child health and nutrition (MNCHN), especially fragile and conflict-affected settings (FCAS) whose populations were already facing challenges in accessing basic health and nutrition services. This study aimed to investigate the collateral impact of COVID-19 on funding, services and MNCHN outcomes in FCAS, as well as adaptations used in the field to continue activities.

Methods: A scoping review of peer-reviewed and grey literature published between 1st March 2020-31st January 2021 was conducted. We analysed 103 publications using a narrative synthesis approach. 39 remote semi-structured key informant interviews with humanitarian actors and donor staff within 12 FCAS were conducted between October 2020 and February 2021. Thematic analysis was undertaken independently by two researchers on interview transcripts and supporting documents provided by key informants, and triangulated with literature review findings.

Results: Funding for MNCHN has been reduced or suspended with increase in cost of continuing the same activities, and diversion of MNCHN funding to COVID-19 activities. Disruption in supply and demand of interventions was reported across different settings which, despite data evidence still being missing, points towards likely increased maternal and child morbidity and mortality. Some positive adaptations including use of technology and decentralisation of services have been reported, however overall adaptation strategies have been insufficient to equitably meet additional challenges posed by the pandemic, and have not been evaluated for their effectiveness.

Conclusions: COVID-19 is further exacerbating negative women's and children's health outcomes in FCAS. Increased funding is urgently required to re-establish MNCHN activities which have been deprioritised or halted. Improved planning to sustain routine health services and enable surge planning for emergencies with focus on the community/service users throughout adaptations is vital for improved MNCHN outcomes in FCAS.
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http://dx.doi.org/10.1186/s13031-022-00465-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9162897PMC
June 2022

The risks of RELN polymorphisms and its expression in the development of otosclerosis.

PLoS One 2022 3;17(6):e0269558. Epub 2022 Jun 3.

Institute of Life Sciences, Nalco Square, Chandrasekharpur, Bhubaneswar, India.

Otosclerosis (OTSC) is the primary form of conductive hearing loss characterized by abnormal bone remodelling within the otic capsule of the human middle ear. A genetic association of the RELN SNP rs3914132 with OTSC has been identified in European population. Previously, we showed a trend towards association of this polymorphism with OTSC and identified a rare variant rs74503667 in a familial case. Here, we genotyped these variants in an Indian cohort composed of 254 OTSC cases and 262 controls. We detected a significant association of rs3914132 with OTSC (OR = 0.569, 95%CI = 0.386-0.838, p = 0.0041). To confirm this finding, we completed a meta-analysis which revealed a significant association of the rs3914132 polymorphism with OTSC (Z = 6.707, p<0.0001) across different ethnic populations. Linkage analysis found the evidence of linkage at RELN locus (LOD score 2.1059) in the OTSC family which has shown the transmission of rare variant rs74503667 in the affected individuals. To understand the role of RELN and its receptors in the development of OTSC, we went further to perform a functional analysis of RELN/reelin. Here we detected a reduced RELN (p = 0.0068) and VLDLR (p = 0.0348) mRNA levels in the otosclerotic stapes tissues. Furthermore, a reduced reelin protein expression by immunohistochemistry was confirmed in the otosclerotic tissues. Electrophoretic mobility shift assays for rs3914132 and rs74503667 variants revealed an altered binding of transcription factors in the mutated sequences which indicates the regulatory role of these variations in the RELN gene regulation. Subsequently, we showed by scanning electron microscopy a change in stapes bone morphology of otosclerotic patients. In conclusion, this study evidenced that the rare variation rs74503667 and the common polymorphism rs3914132 in the RELN gene and its reduced expressions that were associated with OTSC.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269558PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9165908PMC
June 2022

Breast calcifications on mammography: A pictorial essay.

Indian J Cancer 2022 Jan-Mar;59(1):136-139

Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.4103/ijc.IJC_1361_20DOI Listing
June 2022

Do we really want to know? The journey to implement empirical research recommendations in ICRC's responses in Myanmar and Lebanon.

Disasters 2022 May 26. Epub 2022 May 26.

MPH, PhD, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom.

Efforts to reduce the gap between the research evidence base and humanitarian responses have focused on producing quality evidence and ensuring its use for decision-making. Yet how evidence translates to field-level implementation is not well understood in humanitarian contexts. This study analysed how recommendations produced through academic research partnerships were implemented by the International Committee of the Red Cross (ICRC) in Lebanon and Myanmar. Based on implementation theory, the methodology included social network analysis to represent collective dynamics; document reviews to assess implementation; qualitative interviews to understand why actors engaged; and a critical appraisal of these combined results. The application of implementation theory provided information on 'anticipation of constraints' (access to information, staff turnover, context specificity and the need to engage a cohesive group). Future research efforts should explicitly focus on identifying and tackling implementation barriers such as power imbalances and ethical dilemmas related to service delivery by humanitarian actors.
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http://dx.doi.org/10.1111/disa.12549DOI Listing
May 2022

The development of Afghanistan's Integrated Package of Essential Health Services: Evidence, expertise and ethics in a priority setting process.

Soc Sci Med 2022 Jul 6;305:115010. Epub 2022 May 6.

Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK; Geneva Centre of Humanitarian Studies, University of Geneva, Switzerland. Electronic address:

Health systems in fragile states need to respond to shifting demographics, burden of disease and socio-economic circumstances in the revision of their health service packages. This entails making difficult decisions about what is and is not included therein, especially in resource-constrained settings offering or striving for universal health coverage. In this paper we turn the lens on the 2017-2021 development of Afghanistan's Integrated Package of Essential Health Services (IPEHS) to analyse the dynamics of the priority setting process and the role and value of evidence. Using participant observation of meetings and interviews with 25 expert participants, we conducted a qualitative study of the consultation process aimed at examining the characteristics of its technical, socio-cultural and organisational aspects, in particular data use and expert input, and how they influenced how evidence was discussed, taken up, and used (or not used) in the process. Our analysis proposes that the particular dynamics shaped by the context, information landscape and expert input shaped and operationalized knowledge sharing and its application in such a way to constitute a sort of "vernacular evidence". Our findings underline the importance of paying attention to the constellation of the priority setting processes in order to contribute to an ethical allocation of resources, particularly in contexts of resource scarcity and humanitarian need.
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http://dx.doi.org/10.1016/j.socscimed.2022.115010DOI Listing
July 2022

Genetic Association of rs1021188 and DNA Methylation Signatures of in the Risk of Conductive Hearing Loss.

Front Med (Lausanne) 2022 18;9:870244. Epub 2022 Apr 18.

Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia.

Otosclerosis (OTSC) is a complex bone disorder of the otic capsule, which causes conductive hearing impairment in human adults. The dysregulation of the signaling axis mediated by the receptor activator of nuclear factor-kappa-B (RANK), RANK ligand (RANKL), and osteoprotegerin has been widely attributed to the context of metabolic bone disorders. While genetic associations and epigenetic alterations in the gene (RANKL) have been well-linked to metabolic bone diseases of the skeleton, particularly osteoporosis, they have never been addressed in OTSC. This study aimed to assess whether the genetic association of rs1021188 polymorphism in the upstream of and the DNA methylation changes in its promoter CpG-region reveal the susceptibility of OTSC. Peripheral blood DNA samples were collected from unrelated Tunisian-North African subjects for genotyping (109 cases and 120 controls) and for DNA methylation analysis (40 cases and 40 controls). The gender-stratified analysis showed that the rs1021188 C/T was associated with OTSC in men ( = 0.023), but not in women ( = 0.458). Individuals with CC genotype were more susceptible to OTSC, suggesting an increased risk to disease development. Using publicly available data, the rs1021188 was within a cluster grouping the subpopulations with African ethnicity. Moreover, 26 loci in the gene were in linkage disequilibrium with rs1021188, revealing relative similarities between different populations. Significant differences in both DNA methylation and unmethylation status were detected with 4.53- and 4.83-fold decreases in the global DNA methylation levels in female and male OTSC groups, respectively. These changes could contribute to an increased risk of OTSC development. Bioinformatic analyses indicated that each of the rs1021188 variations and the DNA methylation changes in the promoter CpG-sites within may play an important role in its transcription regulation. To our knowledge, this is the first study that investigates an independent effect of the rs1021188 polymorphism and DNA hypomethylation of promoter in OTSC. Genetic and epigenetic changes in the regulatory regions of could offer new molecular insights into the understanding of the complexity of OTSC.
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http://dx.doi.org/10.3389/fmed.2022.870244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9058115PMC
April 2022

Re: "Ultrasound-Guided Subgluteal Sciatic Nerve Block for Pain Management during Endovascular Treatment for Below-the-Knee Arterial Occlusions".

J Vasc Interv Radiol 2022 Aug 29;33(8):1001. Epub 2022 Apr 29.

College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

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http://dx.doi.org/10.1016/j.jvir.2022.04.020DOI Listing
August 2022

Alveolar soft part sarcoma: A case report and review of the literature.

Cytopathology 2022 Sep 26;33(5):622-627. Epub 2022 May 26.

Department of Orthopedics, Atal Bihari Vajpayee institute of medical sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Alveolar soft part sarcoma (ASPS) is a rarely diagnosed tumour of deep soft tissue origin. This tumour is more common in adolescents and young adults and has a slowly progressive clinical course, which often leads to delayed diagnosis and treatment. It is highly vascular, can be confused with other entities like haemangiomas and arteriovenous malformations clinically and radiologically and is thus challenging to report on fine needle aspiration cytology (FNAC). Diagnosing the tumour is difficult on cytology, so knowledge of this entity and the differentials with its morphological mimics on cytology is required for timely diagnosis and early management of the patient. We report a case of ASPS in a young female who presented with a large, painless swelling in the thigh, diagnosed on cytology combined with ancillary testing with immunohistochemical markers.
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http://dx.doi.org/10.1111/cyt.13134DOI Listing
September 2022

Re: Ultrasound-guided interscalene block versus intravenous analgesia and sedation for reduction of first anterior shoulder dislocation.

Am J Emerg Med 2022 08 14;58:347-348. Epub 2022 Apr 14.

College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, India.

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http://dx.doi.org/10.1016/j.ajem.2022.04.015DOI Listing
August 2022

What lithium holds in epilepsy?

Curr Neuropharmacol 2022 Apr 11. Epub 2022 Apr 11.

Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India.

Lithium is a well-known FDA approved treatment for bipolar and mood disorders. Lithium has been an enigmatic drug with multifaceted actions involving various neurotransmitters and intricate cell signalling cascades. Recent studies highlight the neuroprotective and neurotrophic actions of lithium in amyotrophic lateral sclerosis, Alzheimer's disease, intracerebral hemorrhage, and epilepsy. Of note, lithium holds a significant interest in epilepsy, where the past reports expose its non-specific proconvulsant action, followed lately by numerous studies for anti-convulsant action. However, the exact mechanism of action of lithium for any of its effects is still largely unknown. The present review integrates findings from several reports and provides detailed possible mechanisms of how a single molecule exhibits marked pro-epileptogenic as well as anti-convulsant action per se. This review also provides clarity regarding the safety of lithium therapy in epileptic patients.
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http://dx.doi.org/10.2174/1570159X20666220411081728DOI Listing
April 2022

Recent updates on innovative approaches to overcome drug resistance for better outcomes in cancer.

J Control Release 2022 06 8;346:43-70. Epub 2022 Apr 8.

Division of Pharmaceutics & Pharmacokinetics, CSIR-Central Drug Research Institute, Lucknow, UP, India. Electronic address:

The multi-dimensional challenge of drug resistance is one of the pivotal hindrances for cancer chemotherapy. A reductive approach to define and distinguish the main aspects of drug resistance, such as tumor growth kinetics about tumor micro-environment (tumor multifariousness), therapeutic pressure, physical barricades, irreversible genetic mutation, as well as role of the immune system, are the main causes of failure in cancer therapy are presented systematically. We are focusing on general approaches to reduce drug resistance: earlier diagnosis of tumors allowing for cancer halting; dynamic surveillance throughout treatment; the adding of new therapeutic strategies and improve pharmacodynamics precepts resulting in profound effects; and identification of cancerous cells repositories using high-throughput monitoring, as well as the interoperability of clinical- gene mapping statics are described in detail. These strategies could be potentially constructed for any tumor at any precise moment and used to guide therapy selection. Chemotherapeutic agents results in mild improved survival in clinical trials owing to several pathophysiologic obstacles, such as intra-tumoral dispersion, invasion & intra-cellular transportation. This review highlights recent advancements in developing new therapeutic innovations to combat drug resistance in cancer therapy by overcoming various barricades in the tumor microenvironment.
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http://dx.doi.org/10.1016/j.jconrel.2022.04.007DOI Listing
June 2022

Recombinant expression and biophysical characterization of Mrt4 protein that involved in mRNA turnover and ribosome assembly from .

Bioengineered 2022 04;13(4):9103-9113

MSB Division, CSIR-Central Drug Research Institute, Lucknow, India.

The mRNA turnover and ribosome assembly are facilitated by Mrt4 protein from . In present study, we are reporting the cloning, expression and homogeneous purification of recombinant Mrt4. Mrt4 is a 236-amino-acid-long nuclear protein that plays a very crucial role in mRNA turnover and ribosome assembly during the translation process. gene was amplified by polymerase chain reaction and cloned in expression vector pET23a (+) under the bacteriophage T7-inducible promoter and lac operator. Furthermore, protein was purified to homogeneity using immobilized metal affinity chromatography (IMAC) and its homogeneous purification was further validated by immunoblotting with anti-His antibody. The far-UV CD spectra represent that Mrt4 has a typical α helix with characteristic negative minima at 222 and 208 nm. At physiological pH, the fluorescence spectra and CD spectra showed properly folded tertiary and secondary structures of Mrt4, respectively. Mrt4 protein possesses putative bipartite NLS (nuclear localization signal) at the N-terminal part followed by two well-conserved domains, rRNA-binding domains and translation factor (TF) binding domain. PIPSA analysis evaluates electrostatic interaction properties of proteins and concluded that Mrt4 protein can be used as a fingerprint for classifying Mrt4-like mRNA turnover protein from various species. The availability of an ample amount of protein may help in its biochemical and biophysical characterization, crystallization and identification of new interacting partners of Mrt4.
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http://dx.doi.org/10.1080/21655979.2022.2055951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9161856PMC
April 2022

Effect of Normalizing eGFR to Standard Body Surface Area on Rates of Obesity-Related Hyperfiltration among Diverse Female Adolescents.

Am J Nephrol 2022 4;53(4):282-289. Epub 2022 Apr 4.

The Rockefeller University Center for Clinical and Translational Science, New York, New York, USA.

Introduction: Obesity is more prevalent among African American individuals, increasing the risk for cardiorenal morbidity. We explored interactions between race, BMI, and the risk of hyperfiltration associated with obesity-related glomerulopathy (ORG).

Methods: We created a cohort of female adolescents from electronic health records. Glomerular filtration rate (GFR) was estimated in two ways: (A) using standard age recommended formulae and (B) absolute eGFR - adjusted to individual body surface area (BSA). Multivariate logistic regression was used to analyze the contribution of risk factors for ORG-associated hyperfiltration defined as 135 mL/min/1.73 m2 or 135 mL/min, according to BMI group. Pearson's coefficient was used to assess correlation with creatinine clearance (CrCl).

Results: The final cohort included 7,315 African American and 15,102 non-African American adolescent females, with CrCl available for internal validation in 207 non-African American and 107 African American individuals. Compared with non-African American ethnicity, African American ethnicity was independently associated with a lower risk of hyperfiltration with standard eGFR calculations (odds ratio [OR] = 0.57, 95% confidence intervals [CIs] 0.45-0.71), associations were enhanced for absolute eGFR (OR = 0.81, 95% CI 0.69-0.95). Absolute eGFR values agreed better with CrCl (r = 0.63), compared to standard indexed eGFR formulae. Proportions classified as hyperfiltration changed with standard versus absolute eGFR; they were similar across BMI groups with the first and reflected obesity with the later.

Conclusion: Adjusting to individual BSA improves estimation of GFR and identification of obesity-related hyperfiltration. More accurate and earlier ascertainment of obesity-related hyperfiltration may have important consequences for preservation of kidney function.
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http://dx.doi.org/10.1159/000522475DOI Listing
April 2022

Analysis of health overseas development aid for internally displaced persons in low- and middle-income countries.

J Migr Health 2022 19;5:100090. Epub 2022 Mar 19.

Department of War Studies, King's College London, United Kingdom.

Background: There are an estimated 55 million internally displaced persons (IDPs) globally. IDPs commonly have worse health outcomes than host populations and other forcibly displaced populations such as refugees. Official development assistance (ODA) is a major source of the global financial response for health in low- and middle-income countries (LMICs), including for populations affected by armed conflict and forced displacement. Analysis of ODA supports efforts to improve donor accountability, transparency and the equitable use of ODA. The aim of this study is to examine international donor support and responsiveness to IDP health needs through analysis of ODA disbursements to LMICs between 2010 and 2019.

Methods: ODA disbursement data to LMICs from 2010 to 2019 were extracted from the Creditor Reporting System (CRS) database and analysed with Stata software using a combination of: (i) text searching for IDP and refugee related terms; and (ii) relevant health and humanitarian CRS purpose codes. Descriptive analysis was used to examine patterns of ODA disbursement, and nonlinear least squared regression analysis was used to examine responsiveness of ODA disbursement to recipient country IDP population size and health system capacity and health characteristics.

Findings: The study highlighted declining per IDP capita health ODA from USD 5.34 in 2010 to USD 3.72 in 2019 (with annual average decline of -38% from the 2010 baseline). In contrast, health ODA for refugees in LMICs increased from USD 18.55 in 2010 to USD 23.31 in 2019 (with an annual average increase of +14%). Certain health topics for IDPs received very low ODA, with only 0.44% of IDP health ODA disbursed for non-communicable diseases (including mental health). There was also weak evidence of IDP health ODA being related to recipient country IDP population size, and health system capacity and health characteristics. The paper highlights the need for increased investment by donors in IDP health ODA and to ensure that it is responsive to their health needs.
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http://dx.doi.org/10.1016/j.jmh.2022.100090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8965138PMC
March 2022

Obesity Related Glomerulopathy in Adolescent Women: The Effect of Body Surface Area.

Kidney360 2022 01 11;3(1):113-121. Epub 2021 Nov 11.

The Rockefeller University Center for Clinical and Translational Science, New York, New York.

Background: Adolescent obesity, a risk factor for cardiorenal morbidity in adulthood, has reached epidemic proportions. Obesity-related glomerulopathy (ORG) has an early reversible stage of hyperfiltration. Age-appropriate formulae for eGFR, which are standardized to ideal body surface area (BSA) and provide assessment of kidney function in ml/min/1.73 m, may underestimate prevalence of early ORG. We investigated whether adjusting eGFR to actual BSA more readily identifies early ORG.

Methods: We studied a cohort of 22,417 young individuals, aged 12-21 years, from a New York metropolitan multi-institutional electronic health records clinical database. eGFR was calculated in two ways: BSA-standardized eGFR, and absolute eGFR. Hyperfiltration was defined above a threshold of 135 ml/min per 1.73 m or 135 ml/min, respectively. The prevalence of hyperfiltration according to each formula was assessed in parallel to creatinine clearance.

Results: Serum creatinine values and hyperfiltration prevalence according to BSA-standardized eGFR were similar, 13%-15%, across body mass index (BMI) groups. The prevalence of hyperfiltration determined by absolute eGFR differed across BMI groups: underweight, 2%; normal weight, 6%; overweight, 17%; and obese, 31%. This trend paralleled the rise in creatinine clearance across BMI groups.

Conclusions: Absolute eGFR more readily identifies early ORG than the currently used formulae, which are adjusted to a standardized BSA and are not representative of current population BMI measures. Using absolute eGFR in clinical practice and research may improve the ability to identify, intervene, and reverse early ORG, which has great importance with increasing obesity rates.
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http://dx.doi.org/10.34067/KID.0005312021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8967610PMC
January 2022
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