Publications by authors named "Nitin Gupta"

363 Publications

Carbamazepine-associated Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome.

J Pediatr Neurosci 2021 Jan-Mar;16(1):55-57. Epub 2021 Jun 25.

Department of Anaesthesiology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana (Ambala), Haryana, India.

Drug reaction with eosinophilia and systemic symptoms syndrome is a severe type IV (delayed T-cell-dependent reaction) hypersensitivity reaction, characterized by fever, mucocutaneous eruptions, eosinophilia, and systemic inflammatory involvement. It usually begins a few weeks after the exposure to offending drug. Commonly implicated drugs are aromatic anticonvulsants (phenytoin, phenobarbitone, and carbamazepine) and sulfa drugs (sulfonamides, sulfasalazine, and dapsone). It is a potentially life-threatening hypersensitivity reaction. Here we report a case of drug reaction with eosinophilia and systemic symptoms syndrome associated with carbamazepine, which was successfully treated with intravenous methylprednisolone.
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http://dx.doi.org/10.4103/jpn.JPN_126_15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276952PMC
June 2021

Disseminated Cryptococcosis in an Immunocompetent Child.

Cureus 2021 May 31;13(5):e15362. Epub 2021 May 31.

Oncopathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, IND.

Disseminated cryptococcosis in children is a classic affliction associated with human immunodeficiency virus (HIV) infection or primary inherited immunodeficiency disorders (PID) with central nervous system being the most common site of dissemination. We report a rare case of disseminated cryptococcosis in an 11-year-old girl who presented with pulmonary involvement, hepatosplenomegaly, and generalized lymphadenopathy. No known inherited or acquired immune deficiencies were identified after a comprehensive laboratory work-up including genetic sequencing. She responded well to anti-fungal therapy (flucytosine and amphotericin followed by fluconazole) and is on regular follow-up.
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http://dx.doi.org/10.7759/cureus.15362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245827PMC
May 2021

Development and testing of a game-based digital intervention for working memory training in autism spectrum disorder.

Sci Rep 2021 Jul 5;11(1):13800. Epub 2021 Jul 5.

Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, Uttar Pradesh, 208016, India.

Autism spectrum disorder (ASD) is prevalent globally, yet it lacks cost-effective treatment approaches. Deficits in executive functions occur frequently in autism spectrum disorder and present a target for intervention. Here we report the design and development of five smartphone-based games for training working memory in children with ASD. These open-source games, available free of cost to the community, were designed to match the behavioral preferences and sensorimotor abilities of children with ASD. We then conducted a preliminary trial to test the effectiveness of a month-long intervention using these games. Although we did not see a significant change in the working memory of all children with a month-long training, children who performed better on the games also showed more improvement in their working memory, suggesting that a longer intervention with the games might be useful in improving working memory. Using a Hindi translation of the autism treatment evaluation checklist, we also tested the collateral gains of the training in reducing autistic symptoms. We found no significant change in the autistic symptoms after the intervention. Further, there was no correlation between the change in the working memory and the change in the autistic symptoms.
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http://dx.doi.org/10.1038/s41598-021-93258-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257736PMC
July 2021

Current and New Drugs for COVID-19 Treatment and Its Effects on the Liver.

J Clin Transl Hepatol 2021 Jun 19;9(3):436-446. Epub 2021 Apr 19.

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

Corona virus disease (COVID)-19 is caused by the novel severe acute respiratory syndrome coronavirus-2 (commonly referred to as SARS-CoV-2). In March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. Though the target organ for the virus is primarily the lungs, with the recent understanding of the pathobiology of this disease and the immune dysregulation associated with it, it is now clear that COVID-19 affects multiple organ systems. Several drugs and therapies have been tried or repurposed to combat the wrath posed by this disease. On October 22, 2020, the USA Food and Drug Administration approved remdesivir for use in adults and pediatric patients (12 years of age and older). Several of the drugs being tried against COVID-19 have hepatotoxicity as their potential side effect. This review aims to provide the latest insights on various drugs being used in the treatment of COVID-19 and their effects on the liver.
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http://dx.doi.org/10.14218/JCTH.2020.00174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237135PMC
June 2021

Clinical and laboratory evidence of Lyme disease in North India, 2016-2019.

Travel Med Infect Dis 2021 Jun 30;43:102134. Epub 2021 Jun 30.

Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

Background: Lyme disease is endemic to parts of the Americas, Europe and Asia. However, only a handful of sporadic cases have been reported from India. In this study, we systematically evaluated the clinical and epidemiological features of Lyme disease in North India.

Method: All samples were tested by using the standard two-tiered testing algorithm (STTA). Paired serum and cerebrospinal fluid (CSF) were used for demonstrating Borrelia burgdorferi specific intrathecal IgG antibody synthesis (AI). In addition, a commercial tick-borne bacterial flow chip (TBFC) system and a real-time PCR were also used to detect Borrelia species and Anaplasma phagocytophilum in patients who were positive by STTA.

Results: The diagnosis of Lyme disease was confirmed in 18 (7.14%) of the 252 clinically suspected cases by STTA. Neurological involvement was reported in 14 (77.78%) patients, whereas joint and heart involvement was reported in five (27.78%) and three (16.67%) patients, respectively. Lymphocytic pleocytosis (median 37.5 cells/mm; range 12-175 cells/mm) in the CSF was seen in 11 of 14 Lyme neuroborreliosis (LNB) patients. Intrathecal production of Borrelia specific IgG antibodies was demonstrated in 9 (64.28%, n = 14) patients, a highly specific finding for neuroborreliosis. Two patients (11.11%) were also found to be co-infected with human granulocytic anaplasmosis.

Conclusions: The results of this study show clinical and laboratory evidence of endemic Lyme disease in North India and thus, highlight the importance for travel medicine practitioners and physicians to evaluate for Lyme disease in patients with compatible symptoms and a history of travel to tick risk areas.
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http://dx.doi.org/10.1016/j.tmaid.2021.102134DOI Listing
June 2021

COVID-19 and manifest psychological morbidity: A case series.

Indian J Psychiatry 2021 May-Jun;63(3):294-296. Epub 2021 Jun 17.

Gupta Mind Healing and Counselling Centre, Chandigarh, India.

The COVID-19 pandemic in India has been reported to be associated with numerous major mental health issues globally; the most common is - stress, anxiety, depressive symptoms, insomnia, denial, anger, and fear. This case series presents three different cases, wherein the COVID-19 pandemic resulted not only in deterioration of previous symptoms experienced by patients (obsessive-compulsive disorder and depression) but also led to the development of new symptoms specifically related to coronavirus (Psychosis). Authors highlight the need to develop preventive strategies for vulnerable groups and try to understand the etiopathogenesis of illnesses so developing, in order to identify support systems and management strategies during the pandemicrelated crisis.
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http://dx.doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_152_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221209PMC
June 2021

Viral Dynamics and Real-Time RT-PCR Ct Values Correlation with Disease Severity in COVID-19.

Diagnostics (Basel) 2021 Jun 15;11(6). Epub 2021 Jun 15.

Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, India.

Real-time RT-PCR is considered the gold standard confirmatory test for coronavirus disease 2019 (COVID-19). However, many scientists disagree, and it is essential to understand that several factors and variables can cause a false-negative test. In this context, cycle threshold (Ct) values are being utilized to diagnose or predict SARS-CoV-2 infection. This practice has a significant clinical utility as Ct values can be correlated with the viral load. In addition, Ct values have a strong correlation with multiple haematological and biochemical markers. However, it is essential to consider that Ct values might be affected by pre-analytic, analytic, and post-analytical variables such as collection technique, specimen type, sampling time, viral kinetics, transport and storage conditions, nucleic acid extraction, viral RNA load, primer designing, real-time PCR efficiency, and Ct value determination method. Therefore, understanding the interpretation of Ct values and other influential factors could play a crucial role in interpreting viral load and disease severity. In several clinical studies consisting of small or large sample sizes, several discrepancies exist regarding a significant positive correlation between the Ct value and disease severity in COVID-19. In this context, a revised review of the literature has been conducted to fill the knowledge gaps regarding the correlations between Ct values and severity/fatality rates of patients with COVID-19. Various databases such as PubMed, Science Direct, Medline, Scopus, and Google Scholar were searched up to April 2021 by using keywords including "RT-PCR or viral load", "SARS-CoV-2 and RT-PCR", "Ct value and viral load", "Ct value or COVID-19". Research articles were extracted and selected independently by the authors and included in the present review based on their relevance to the study. The current narrative review explores the correlation of Ct values with mortality, disease progression, severity, and infectivity. We also discuss the factors that can affect these values, such as collection technique, type of swab, sampling method, etc.
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http://dx.doi.org/10.3390/diagnostics11061091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232180PMC
June 2021

Pain threshold and pain tolerance as a predictor of deliberate self-harm among adolescents and young adults.

Indian J Psychiatry 2021 Mar-Apr;63(2):142-145. Epub 2021 Apr 14.

Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India.

Background: Recently, the assessment of pain has been used as a parameter to differentiate adolescents who indulge in deliberate self-harm from healthy individuals.

Aims And Objectives: The present study was conducted to compare pain sensitivity between three groups, i.e., nonsuicidal self-injury/nonsuicidal self-harm (NSSI), suicide attempters (SA), and matched healthy control (NSSI, SA, and healthy controls).

Materials And Methods: Ninety participants (30-NSSI, 30-SA, and 30 matched control) between the age of 10 and 25 years were inducted from the individuals who came for help at the outdoor and emergency services for recent self-harm. Pain sensitivity was assessed by cold pain stimulation test through a cold pressor task.

Results: Pain threshold, pain tolerance, total pain index as well as pain experience intensity were significantly different in the three groups.

Conclusion: Participants who indulge in NSSI and SA have significantly higher pain threshold, pain tolerance, total pain index, and pain experience intensity as compared to healthy control. Although all the pain parameters were higher in the NSSI group as compared to SA group, the difference did not reach to significant level.
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http://dx.doi.org/10.4103/psychiatry.IndianJPsychiatry_348_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214128PMC
April 2021

Neutrophil-Lymphocyte Ratio in Patients with COVID-19 as a Simple Tool to Predict Requirement of Admission to a Critical Care Unit.

Indian J Crit Care Med 2021 May;25(5):535-539

Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Introduction: Coronavirus disease-2019 (COVID-19) pandemic has overloaded the healthcare system beyond its functional capacity. Late referral to higher levels of care may be one of the factors associated with higher mortality. Therefore, we aimed to find simple demographic and laboratory parameters which predict the requirement of admission to a critical care unit.

Materials And Methods: A case-control study was undertaken in adult age population >18 years, admitted in a dedicated COVID hospital in South India. A total of 50 patients with severe disease (cases) were compared with 143 mild or asymptomatic cases (controls). Those demographic and laboratory parameters that were found to be significant on univariate analysis were used for multiple logistic regression analysis.

Results: Univariate analysis of demographic and laboratory data showed higher age, male sex, presence of diabetes mellitus, higher values of C-reactive protein, ferritin, D-dimer, neutrophil-lymphocyte ratio (NLR), and lactate dehydrogenase to be significantly associated with cases. Multivariate logistic regression analysis of these significant variables showed NLR and ferritin to be the independent predictors of the requirement of admission to a critical care unit. The receiver-operating characteristic curve showed an NLR value of 5.2 and a ferritin value of 462 μg/L that were able to predict the requirement of admission in critical care units.

Conclusion: High ferritin and NLR were independent predictors of the requirement of admission in critical care units. NLR is a simple tool that can be used in resource-limited settings for triage and early referral to higher levels of care.

How To Cite This Article: Maddani SS, Gupta N, Umakanth S, Joylin S, Saravu K. Neutrophil-Lymphocyte Ratio in Patients with COVID-19 as a Simple Tool to Predict Requirement of Admission to a Critical Care Unit. Indian J Crit Care Med 2021;25(5):535-539.
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http://dx.doi.org/10.5005/jp-journals-10071-23801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196394PMC
May 2021

Neonate with chikungunya.

Clin Case Rep 2021 Jun 9;9(6):e04351. Epub 2021 Jun 9.

Neonatology SGPGI Lucknow Lucknow India.

Chikungunya although rare should be considered in any neonate presenting with fever and facial hyperpigmentation or encephalopathy especially in endemic areas.
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http://dx.doi.org/10.1002/ccr3.4351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190531PMC
June 2021

Infective Endocarditis Following Chicken Pox: A Rare Association.

Kurume Med J 2021 Jul 18;66(2):127-133. Epub 2021 Jun 18.

Department of Medicine, All India Institute of Medical Sciences.

A 38-year old immunocompetent male presented to us with chicken pox complicated by development of Guillain-Barre syndrome (GBS) and left-sided native valve endocarditis due to methicillin resistant Staphylococcus aureus (MRSA). This was further complicated by embolization to various vital organs including the brain. The patient was treated with vancomycin for four weeks but did not respond to the treatment. We present this case to highlight the rare complications associated with chicken pox and the challenges faced in management of such a case.
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http://dx.doi.org/10.2739/kurumemedj.MS662004DOI Listing
July 2021

Letter to the editor regarding "The outcome of fluticasone nasal spray on anosmia and triamcinolone oral paste in dysgeusia in COVID-19 patients".

Am J Otolaryngol 2021 Jun 5:103103. Epub 2021 Jun 5.

Department of Otorhinolaryngology, Head and Neck Surgery, Government Medical College and Hospital, Sector 32, Chandigarh, India.

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http://dx.doi.org/10.1016/j.amjoto.2021.103103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178533PMC
June 2021

Isolated Splenic Tuberculosis Masquerading as Disease Progression of Hodgkin's Lymphoma on InterimF-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scan.

Indian J Nucl Med 2021 Jan-Mar;36(1):100-102. Epub 2021 Mar 4.

Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India.

F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) scan is the imaging modality of choice in the management of lymphoma. However, 18F-FDG is a nonspecific tracer for tumoral metabolic activity and infective pathology, thus posing a challenge in accurate response assessment. Here, we present a case of Hodgkin's lymphoma, referred for staging PET/CT scan which showed FDG-avid disease in the mediastinum, and on interim F-FDG PET/CT in addition to the mediastinal mass lesion, a FDG-avid lesion was also noted in the spleen suggestive of disease progression. The biopsy report of the lesion was tuberculosis, which was masquerading as disease progression on interim F-FDG PET/CT.
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http://dx.doi.org/10.4103/ijnm.IJNM_145_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130692PMC
March 2021

Rare thyroid Cartilage Metastases Detected on F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scan.

Indian J Nucl Med 2021 Jan-Mar;36(1):39-42. Epub 2021 Mar 4.

Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India.

Metastatic lesions to thyroid cartilage are very rare and can be often missed on conventional imaging. Anatomical and functional fused positron emission tomography/computed tomography (PET/CT) imaging has higher sensitivity as compared to conventional CT imaging and can thus identify such atypical sites of metastasis. Here, we present four cases of thyroid cartilage metastases detected on fluorodeoxyglucose PET/CT scan from carcinoma lung, breast, stomach and urinary bladder.
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http://dx.doi.org/10.4103/ijnm.IJNM_143_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130698PMC
March 2021

Corticosteroid therapy for COVID-19: A systematic review and meta-analysis of randomized controlled trials.

Medicine (Baltimore) 2021 May;100(20):e25719

Superior Medical Experts, St. Paul.

Background: Corticosteroid treatment is an effective and common therapeutic strategy for various inflammatory lung pathologies and may be an effective treatment for coronavirus disease 2019 (COVID-19). The purpose of this systematic review and meta-analysis of current literature was to investigate the clinical outcomes associated with corticosteroid treatment of COVID-19.

Methods: We systematically searched PubMed, medRxiv, Web of Science, and Scopus databases through March 10, 2021 to identify randomized controlled trials (RCTs) that evaluated the effects of corticosteroid therapies for COVID-19 treatment. Outcomes of interest were mortality, need for mechanical ventilation, serious adverse events (SAEs), and superinfection.

Results: A total of 7737 patients from 8 RCTs were included in the quantitative meta-analysis, of which 2795 (36.1%) patients received corticosteroids plus standard of care (SOC) while 4942 (63.9%) patients received placebo and/or SOC alone. The odds of mortality were significantly lower in patients that received corticosteroids as compared to SOC (odds ratio [OR] = 0.85 [95% CI: 0.76; 0.95], P = .003). Corticosteroid treatment reduced the odds of a need for mechanical ventilation as compared to SOC (OR = 0.76 [95% CI: 0.59; 0.97], P = .030). There was no significant difference between the corticosteroid and SOC groups with regards to SAEs and superinfections.

Conclusion: Corticosteroid treatment can reduce the odds for mortality and the need for mechanical ventilation in severe COVID-19 patients.
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http://dx.doi.org/10.1097/MD.0000000000025719DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137023PMC
May 2021

Revealing the WEDM Process Parameters for the Machining of Pure and Heat-Treated Titanium (Ti-6Al-4V) Alloy.

Materials (Basel) 2021 Apr 28;14(9). Epub 2021 Apr 28.

Department of Mechanical Engineering, Imperial College of London, Exhibition Road, London SW72AZ, UK.

Ti-6Al-4V is an alloy that has a high strength-to-weight ratio. It is known as an alpha-beta titanium alloy with excellent corrosion resistance. This alloy has a wide range of applications, e.g., in the aerospace and biomedical industries. Examples of alpha stabilizers are aluminum, oxygen, nitrogen, and carbon, which are added to titanium. Examples of beta stabilizers are titanium-iron, titanium-chromium, and titanium-manganese. Despite the exceptional properties, the processing of this titanium alloy is challenging when using conventional methods as it is quite a hard and tough material. Nonconventional methods are required to create intricate and complex geometries, which are difficult with the traditional methods. The present study focused on machining Ti-6Al-4V using wire electrical discharge machining (WEDM) and conducting numerous experiments to establish the machining parameters. The optimal setting of the machining parameters was predicted using a multiresponse optimization technique. Experiments were planned using the response surface methodology (RSM) technique and analysis of variance (ANOVA) was used to determine the significance and contribution of the input parameters to changes in the output characteristics (cutting speed and surface roughness). The cutting speed obtained during the processing of the annealed titanium alloy using WEDM was quite large as compared to the cutting speed obtained in the case of processing the pure, quenched, and hardened titanium alloys using WEDM. The maximum cutting speed obtained while processing the annealed titanium alloy was 1.75 mm/min.
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http://dx.doi.org/10.3390/ma14092292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124989PMC
April 2021

Xanthogranulomatous cholecystitis mimicking gallbladder cancer on F-fluorodeoxyglucose positron emission tomography/computed tomography scan.

World J Nucl Med 2021 Jan-Mar;20(1):93-95. Epub 2020 Dec 12.

Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India.

The abnormal thickening of the gallbladder (GB) wall can be caused by a malignant condition like gallbladder carcinoma or by benign lesions such as chronic cholecystitis or xanthogranulomatous cholecystitis (XGC). Mural thickening is a common finding between them as fluorodeoxyglucose (FDG) can be taken up by inflammatory cells also. Here, we present a patient with irregular thickening of the GB wall which was suspected to of GB carcinoma since FDG positron emission tomography/computed tomography scan showed increased tracer uptake in the lesion. However, after surgery the histopathological report was suggestive of XGC.
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http://dx.doi.org/10.4103/wjnm.WJNM_118_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034788PMC
December 2020

A diagnostic randomised controlled trial to study the impact of rapid diagnostic tests in patients with Acute febrile illness when compared to conventional diagnostics (DRACO study).

J Infect 2021 06 8;82(6):e6-e8. Epub 2021 Apr 8.

Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India; Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.

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http://dx.doi.org/10.1016/j.jinf.2021.04.001DOI Listing
June 2021

Human immunodeficiency virus infection with multiple opportunistic infections: lessons learnt from a non-adherent patient.

Oxf Med Case Reports 2021 Mar 8;2021(3):omaa147. Epub 2021 Mar 8.

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

We report a case of advanced human immunodeficiency virus (HIV) infection with multiple opportunistic infections ( pneumonia, cryptosporidiosis, oesophagal candidiasis and cytomegalovirus infection). The patient was presumed to be adherent on antiretroviral therapy (ART) and was initiated on respective treatments for the opportunistic infections but continued to deteriorate. On further reviewing, he was found to be poorly adherent to ART and was advised enhanced adherence counselling after which his condition improved. We report this case to emphasize the importance of adherence to ART medications in the management of patients with HIV.
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http://dx.doi.org/10.1093/omcr/omaa147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947269PMC
March 2021

Correlation of fine needle aspiration cytology with histopathology in patients undergoing thyroid surgery.

Otolaryngol Pol 2020 Aug;75(2):1-5

Department of Ear Nose Throat, Chandigarh, India.

<b>Introduction:</b> Thyroid swellings are one of the most common swellings in the neck. They pose a major problem in developing countries like India, considering the high endemicity for iodine deficiency disorders. Thyroid gland is affected in many conditions. Out of these, majority are benign while less than 5% are malignant. Multiple noninvasive and invasive diagnostic tests are available for the diagnosis of thyroid swelling. However, at present, FNAC is considered the gold standard investigation. Despite the high sensitivity and specificity, FNAC has its limitations. Histopathological examination of surgically excised thyroid swelling is the confirmatory gold standard to determine the pathology of the thyroid gland. <br><b>Material and method:</b> This prospective and observational study was conducted in the Department of Otorhinolaryngology (ENT) in collaboration with the Department of Pathology in a tertiary care hospital and medical school. A total of seventy patients were included. <br><b>Results:</b> The diagnosis on FNAC was correlated with histopathology. Statistical analysis showed FNAC had a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 96.7%. However, the overall accuracy in this study was determined to be 95.71%. Results were found to be statistically significant (P < 0.05). <br><b>Conclusions:</b> The diagnostic role of FNAC in thyroid lesions is of utmost importance in making preoperative diagnosis. FNAC was found to be highly sensitive and specific for diagnosing thyroid lesions but the final HPE is considered as a gold standard.
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http://dx.doi.org/10.5604/01.3001.0014.3433DOI Listing
August 2020

The Journey of Primary Myelofibrosis to Splenic Marginal Zone Lymphoma on the Wheels of Ruxolitinib.

Indian J Hematol Blood Transfus 2021 Jan 16;37(1):186-188. Epub 2020 Jul 16.

Clinical Hematology and Bone Marrow Stem Cell Transplant, Sir Ganga Ram Hospital, New Delhi, India.

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http://dx.doi.org/10.1007/s12288-020-01320-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900293PMC
January 2021

Paraparesis in a patient with advanced HIV infection: a diagnostic conundrum.

BMJ Case Rep 2021 Mar 9;14(3). Epub 2021 Mar 9.

Department of Infectious Diseases, Kasturba Medical College Manipal, Manipal, Karnataka, India

In patients with HIV infection, lower limb weakness is a result of the pathological involvement of the brain, spinal cord or peripheral nervous system. The pathological process can be opportunistic infections, nutrient deficiencies, neoplastic infiltration or HIV itself. Here, we present the case of a 50-year-old manual labourer who presented with gradually progressive lower limb weakness, sensory disturbances, impotence and urinary urgency. He was diagnosed with HIV during evaluation. Based on the presentation and other supportive laboratory and radiological evidence, the following differentials were considered: vacuolar myelopathy, amyotrophic lateral sclerosis and myeloradiculopathy. The patient was initiated on antiretroviral therapy, and he showed significant improvement of symptoms on follow-up. We report this case to discuss the diagnostic puzzle.
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http://dx.doi.org/10.1136/bcr-2020-240725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944965PMC
March 2021

Clinical profile and treatment outcomes of patients with brucellosis: a hospital-based cohort study from Southern India.

Infez Med 2021 Mar;29(1):65-69

Department of Infectious diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India; Manipal McGill Center for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka, India.

The clinical epidemiology of patients with brucellosis in India has not been well described. The aim of this study was therefore to delineate the demographic and clinical characteristics, complications and treatment outcomes of patients diagnosed with brucellosis. A prospective cohort study was conducted from January 2015 to June 2017. All patients above the age of 18 years with a confirmed diagnosis of brucellosis were enrolled and followed up for six months to study the outcomes of treatment. Of the 94 patients enrolled, 77% were male. A total of 38% of the patients had a history of animal contact, and 24% had a history of consumption of unpasteurized dairy products. Acute brucellosis was found in 65% of the patients, and sub-acute presentation was seen in the rest. Fever (94%) and arthralgia (54%) were the most predominant symptoms. The most common focal complication was osteoarticular involvement (34%). Except for three patients, all those who were available for follow-up showed a complete response to therapy. In conclusion, brucellosis should be suspected in patients with fever and osteoarticular involvement in endemic areas. Early identification and prompt initiation of treatment are associated with high cure rates.
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March 2021

Follow-upF-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Evaluation of a Torsion of Uterine Fibroid in an Elderly Female.

Indian J Nucl Med 2020 Oct-Dec;35(4):330-332. Epub 2020 Oct 21.

Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India.

Fibroids are rare in postmenopausal females. Torsion of pedunculated uterine fibroid is also a very rare occurrence in elderly females. We report a rare case of an 84-year-old multiparous, postmenopausal female, a treated case of non-Hodgkin's lymphoma, presenting with a large abdominal mass. The comparative positron emission tomography/computed tomography scan study of the patient revealed that a new mass in the abdomen and pelvis connected with the left adnexa with a pedicle and previously seen fibroid was not visualized on the present scan, thus raising suspicion of torsion of subserosal fibroid. Histopathology confirmed the diagnosis of fibroid.
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http://dx.doi.org/10.4103/ijnm.IJNM_104_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905289PMC
October 2020

Positron-emission-tomography in tubercular lymphadenopathy: A study on its role in evaluating post-treatment response.

Drug Discov Ther 2021 Mar 27;15(1):35-38. Epub 2021 Feb 27.

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

Lymph node tuberculosis is one of the most common forms of extrapulmonary tuberculosis worldwide. The study aimed to evaluate the role of positron emission tomography-computed tomography (PET-CT) in determining post-treatment response in lymph node tuberculosis. A PET-CT was done in all treatment naïve tubercular lymphadenitis adults at baseline and after six months of therapy. The post-treatment clinical response was compared with the metabolic response on PET-CT. Of the 25 patients with tubercular lymphadenitis, 9/25 patients showed a complete metabolic response (CMR) at six months, while 16 patients had a partial metabolic response (PMR). All patients with CMR had a good clinical response. However, discordance between clinical and PET findings was noticed in those with PMR. The role of PET-CT in evaluating post-treatment response in patients with tubercular lymphadenitis needs further evaluation with a larger sample size.
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http://dx.doi.org/10.5582/ddt.2020.03042DOI Listing
March 2021

Clinical profile and outcomes of asymptomatic vs. symptomatic travellers diagnosed with COVID-19: An observational study from a coastal town in South India.

Drug Discov Ther 2021 Mar 28;15(1):1-8. Epub 2021 Feb 28.

Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Despite the high number of coronavirus disease-19 (COVID-19) cases from India, there are few reports from India describing the clinical epidemiology of COVID-19. This study aimed to describe the clinical/epidemiological characteristics and outcomes of asymptomatic vs. symptomatic COVID-19 patients. This was a retrospective chart review of all admitted patients with COVID-19 above 18 years with a history of travel within one month of the admission. The patients were categorized into asymptomatic and symptomatic. The symptomatic patients were further classified into mild, moderate and severe. The demographic profile, risk factors, clinical features, laboratory parameters, treatment details and outcome of all patients were recorded. The clinical and laboratory parameters were compared between symptomatic patients and asymptomatic patients. Of the 127 recruited patients, 75 were asymptomatic. Of the 52 symptomatic patients, 41 patients were classified as a mild illness. The mean age of the patients was 44.5 ± 15 years. A total of 73 patients had one or more risk factors. The male patients were more commonly found to be symptomatic compared to female patients. Neutrophil-lymphocyte ratio, C-reactive protein and lactate dehydrogenase were significantly elevated in symptomatic patients. A total of five individuals required supplemental oxygen therapy, and one of them required mechanical ventilation. All the patients had favourable outcomes. Asymptomatic and mild illness form a significant proportion of positive patients and have excellent outcomes without therapeutic interventions.
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http://dx.doi.org/10.5582/ddt.2020.03068DOI Listing
March 2021

Isolated Unilateral Orbital Metastasis From Ewing Sarcoma Detected on FDG PET/CT Scan.

Clin Nucl Med 2021 Jul;46(7):e391-e392

Department of Nuclear Medicine, Sir Ganga Ram Hospital, New Delhi, India.

Abstract: Ewing sarcoma is the second most common primary malignant bone tumor that usually affects diaphysis of long bones during the second decade of life. Isolated unilateral orbital metastasis from this tumor presenting as proptosis is extremely rare. Here we report a case of 11-year-old boy where whole-body FDG PET/CT scan detected primary an Ewing sarcoma site in the left femur and isolated orbital metastasis in the left eye. Follow-up PET/CT scan after 6 cycles of chemotherapy showed resolution of the previously seen lesions.
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http://dx.doi.org/10.1097/RLU.0000000000003546DOI Listing
July 2021

Efficacy of convalescent plasma therapy for COVID-19: A systematic review and meta-analysis.

J Clin Apher 2021 Jun 5;36(3):470-482. Epub 2021 Feb 5.

Department of Neuroradiology, Valley Baptist Medical Center, Harlingen, Texas, USA.

The purpose of this systematic review and meta-analysis was to examine clinical outcomes associated with convalescent plasma therapy in COVID-19 patients. We performed a literature search on PubMed, medRxiv, Web of Science, and Scopus to identify studies published up to December 10th, 2020 that examined the efficacy of convalescent plasma treatment for COVID-19. The primary endpoints were mortality, clinical improvement, and hospital length of stay. We screened 859 studies that met the search criteria, performed full-text reviews of 56 articles, and identified 15 articles that fulfilled inclusion criteria for meta-analysis. The odds of mortality were significantly lower in the convalescent plasma group compared to the control group (OR = 0.59 [95% CI = 0.44; 0.78], P < .001), although results from two key randomized controlled trials did not support the mortality benefit. The odds of clinical improvement were significantly higher in the convalescent plasma group compared to the control group (OR = 2.02 [95% CI = 1.54; 2.65], P < .001). There was no difference in hospital length of stay between the convalescent plasma group and the control group (MD = -0.49 days [95% CI = -3.11; 2.12], P = .713). In all, these data indicate that a mortality benefit with convalescent plasma is unclear, although there remain benefits with convalescent plasma therapy for COVID-19.
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http://dx.doi.org/10.1002/jca.21881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014691PMC
June 2021

Diphtheritic myocarditis: A case series and review of literature.

J Family Med Prim Care 2020 Nov 30;9(11):5769-5771. Epub 2020 Nov 30.

Department of Paediatrics, Grant Government Medical College, Mumbai, Maharashtra, India.

Myocarditis in patients with diphtheria is a toxin-mediated complication that sets in after one week of onset of respiratory illness. Early administration of antidiphtheritic serum in patients with clinical diphtheria before the onset of myocarditis is of utmost importance to prevent this fatal complication. We report three patients who presented late in illness after the myocarditis had set in, to stress on the need of prompt administration of antitoxins by primary care physicians and highlight the importance of immunization.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1396_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842443PMC
November 2020

Systemic corticosteroid use in UK Uveitis practice: results from the ocular inflammation steroid toxicity risk (OSTRICH) study.

Eye (Lond) 2021 Feb 2. Epub 2021 Feb 2.

Oxford Eye Hospital, Oxford University Hospitals NHS Trust, Oxford, England.

Objectives: To ascertain adherence to an international consensus target of ≤7.5 mg/day of prednisolone for maintenance systemic corticosteroid (CS) prescribing in uveitis and report the frequency of courses of high-dose systemic CS in the UK.

Methods: We conducted a national, multicentre audit of systemic CS prescribing for uveitis at 11 UK sites between November 2018 and March 2019. High-dose CS was defined as (1) maintenance >7.5 mg prednisolone for >3 consecutive months, or (2) >1 course ≥40 mg oral CS or ≥500 mg intravenous (IV) methylprednisolone in the past 12 months. Case notes of patients exceeding threshold CS doses were reviewed by an independent uveitis specialist and judged as avoidable or not, based upon a scoring matrix.

Results: Of 667 eligible patients, 285 (42.7%) were treated with oral or IV CS over the preceding 12 months; 96 (33.7%) of these exceeded the threshold for high-dose CS. Twenty-five percent of prescribing in patients on excess CS was judged avoidable; attributed to either prescribing long-term CS without evidence of consideration of alternative strategies, prescribing error or miscommunication. More patients received immunomodulatory therapy (IMT) in the group treated with CS above threshold than below threshold (p < 0.001) but there was no significant difference in doses of IMT.

Conclusion: 33% of patients had been prescribed excessive corticosteroid when compared to the reference standard. An analysis of decision-making suggests there may be opportunity to reduce excess CS prescribing in 25% of these patients.
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http://dx.doi.org/10.1038/s41433-020-01336-6DOI Listing
February 2021
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