Publications by authors named "Rahul Jain"

249 Publications

A narrative review of chronic alcohol-induced atrial fibrillation.

Future Cardiol 2021 Apr 16. Epub 2021 Apr 16.

Department of Internal Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA 17033, USA.

Alcohol use disorder (AUD) is highly prevalent and can lead to many cardiovascular complications, including arrhythmias. Chronic alcohol use has a dose-dependent relationship with incidence of atrial fibrillation (AF), where higher alcohol intake (>3 drinks a day) is associated with higher risk of AF. Meanwhile, low levels of chronic alcohol intake (<1 drink a day) is not associated with increased risk of AF. Mechanistically, chronic alcohol intake alters the structural, functional and electrical integrity of the atria, predisposing to AF. Increased screening can help identify AUD patients early on and provide the opportunity to educate on chronic alcohol use related risks, such as AF. The ideal treatment to reduce risk of incident or recurrent AF in AUD populations is abstinence.
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http://dx.doi.org/10.2217/fca-2021-0007DOI Listing
April 2021

COVID-19: Automatic detection from X-ray images by utilizing deep learning methods.

Expert Syst Appl 2021 Aug 16;176:114883. Epub 2021 Mar 16.

Department of Computer Science and Engineering, National Institute of Technology Karnataka, Surathkal, India.

In recent months, a novel virus named Coronavirus has emerged to become a pandemic. The virus is spreading not only humans, but it is also affecting animals. First ever case of Coronavirus was registered in city of Wuhan, Hubei province of China on 31st of December in 2019. Coronavirus infected patients display very similar symptoms like pneumonia, and it attacks the respiratory organs of the body, causing difficulty in breathing. The disease is diagnosed using a Real-Time Reverse Transcriptase Polymerase Chain reaction (RT-PCR) kit and requires time in the laboratory to confirm the presence of the virus. Due to insufficient availability of the kits, the suspected patients cannot be treated in time, which in turn increases the chance of spreading the disease. To overcome this solution, radiologists observed the changes appearing in the radiological images such as X-ray and CT scans. Using deep learning algorithms, the suspected patients' X-ray or Computed Tomography (CT) scan can differentiate between the healthy person and the patient affected by Coronavirus. In this paper, popular deep learning architectures are used to develop a Coronavirus diagnostic systems. The architectures used in this paper are VGG16, DenseNet121, Xception, NASNet, and EfficientNet. Multiclass classification is performed in this paper. The classes considered are COVID-19 positive patients, normal patients, and other class. In other class, chest X-ray images of pneumonia, influenza, and other illnesses related to the chest region are included. The accuracies obtained for VGG16, DenseNet121, Xception, NASNet, and EfficientNet are 79.01%, 89.96%, 88.03%, 85.03% and 93.48% respectively. The need for deep learning with radiologic images is necessary for this critical condition as this will provide a second opinion to the radiologists fast and accurately. These deep learning Coronavirus detection systems can also be useful in the regions where expert physicians and well-equipped clinics are not easily accessible.
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http://dx.doi.org/10.1016/j.eswa.2021.114883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962920PMC
August 2021

β-Carbolines as potential anticancer agents.

Eur J Med Chem 2021 Apr 24;216:113321. Epub 2021 Feb 24.

School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India. Electronic address:

β-Carbolines are indole alkaloids having a tricyclic pyrido[3,4-b]indole ring in their structure. Since the isolation of first β-carboline from Peganum harmala in 1841, the isolation and synthesis of various β-carboline derivatives surged in the following centuries. β-Carboline derivatives due to their widespread availability from natural sources, structural flexibility, quick reactivity and interaction with varied anticancer targets such as DNA (intercalation, groove binding, etc.), enzymes (GPX4, topoisomerases, kinases, etc.) and proteins (tubulin, ABCG2/BRCP1, etc.) have established themselves as promising lead compounds for the synthesis of various anticancer active agents. The current review covers the synthesis and isolation, anticancer activity, mechanism of action and SAR of various β-carboline containing molecules, its derivatives and congeners.
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http://dx.doi.org/10.1016/j.ejmech.2021.113321DOI Listing
April 2021

A thermostable Fe/Mn SOD of Geobacillus sp. PCH100 isolated from glacial soil of Indian trans-Himalaya exhibits activity in the presence of common inhibitors.

Int J Biol Macromol 2021 May 5;179:576-585. Epub 2021 Mar 5.

Biotechnology Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur 176061, Himachal Pradesh, India. Electronic address:

Superoxide dismutases are the enzymes involved in dismutation of superoxide radicals into oxygen and hydrogen peroxide. The present work reports a thermostable Fe/Mn SOD of Geobacillus sp. strain PCH100 (GsSOD) isolated from glacial soil. Purified recombinant GsSOD is a dimeric protein of ~57 kDa that exhibited highest activity at a temperature of 10 °C and pH of 7.8. Maximum enzyme velocity and Michaelis constant of the GsSOD were 1098.90 units/mg and 0.62 μM, respectively. At 80 °C, thermal inactivation rate constant and half-life of GsSOD were 3.33 × 10 min and 208 min, respectively. Interestingly, GsSOD tolerated a temperature of 100 °C and 130 °C up to 15 min and 5 min, respectively. Circular dichroism and differential scanning calorimetry confirmed thermostable nature of GsSOD. Apoenzyme of GsSOD regained enzymatic activity in the presence of Fe and Mn as metal ion cofactors. GsSOD was stable under varying concentrations of chemicals, namely ethylenediaminetetraacetic acid, potassium cyanide, hydrogen peroxide, chloroform-ethanol, 3-[(3-cholamidopropyl)-dimethylammonio]-1-propanesulfonate, Tween-20, Triton X-100, urea, and guanidine hydrochloride. The enzyme exhibited >70% activity in presence of 10 mM metal ions. Owing to its thermostable nature and resistance to chemical inhibitors, GsSOD is a potential enzyme for industrial applications.
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http://dx.doi.org/10.1016/j.ijbiomac.2021.03.019DOI Listing
May 2021

Feasibility of Customised Polymethyl Methacrylate Implants Fabricated Using 3D Printed Flexible Moulds for Correction of Facial Skeletal Deformities.

J Craniofac Surg 2021 Jan 12. Epub 2021 Jan 12.

Department of Plastic, Aesthetic and Reconstructive Surgery, Medanta, The Medicity, Gurugram, India.

Introduction: Use of patient specific Polymethyl methacrylate (PMMA) implants for the reconstruction of cranial defects has become a standard practice with excellent long-term results. However, for the reconstruction of midface and mandibular osseous defects other alloplastic materials are preferred but their use is limited due to high cost. This is a report of our experience with the use of low-cost patient specific PMMA implants fabricated using 3D printed moulds in the reconstruction of osseous defects involving different areas of the facial skeleton not limited to cranium.

Methods: The 25 consecutive patients with craniofacial osseous defects who underwent reconstruction using customized PMMA implants were analyzed. All PMMA implants were fabricated intraoperatively with the use of 3D printed flexible moulds or templates.

Results: A total of 34 implants were used in 25 consecutive patients. Out of 34 implants 25 were used for midface and mandibular osseous defects. Most common etiology was post-traumatic deformity (n = 19) followed by tumor (n = 3), craniofacial anomalies (n = 2) and post-craniotomy (n = 1). One patient out of 25 (n = 1) had postoperative implant exposure. The follow-up was ranged from 3 to 19 months with an average of 12 months. The aesthetic outcome was found to be good to excellent with mean visual analogue score of 4.08.

Conclusions: Polymethyl methacrylate implants fabricated intraoperatively using 3D printed moulds provide accurate and precise reconstruction at an exceptionally low cost. PMMA has an excellent moulding property with low infection rates. As shown in our study its application may be easily extended to all areas of the craniofacial skeleton.
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http://dx.doi.org/10.1097/SCS.0000000000007383DOI Listing
January 2021

Performance analysis of multi-gap V-roughness with staggered elements of solar air heater based on artificial neural network and experimental investigations.

Environ Sci Pollut Res Int 2021 Feb 26. Epub 2021 Feb 26.

Department of Mechanical Engineering, Rajasthan Technical University, Kota, 324010, India.

Among all renewable energy sources, solar power is one of the major sources which contributes for pollution control and protection of environment. For a number of decades, technologies for utilizing the solar power have been the area of research and development. In the current research, thermal performance parameters of multi-gap V-roughness with staggered elements of a solar air heater (SAH) are experimentally investigated. The artificial neural network (ANN) is also utilized for predicting the thermal performance parameters of SAH. Experiments were executed in a rectangular channel with one roughened side at the top exposed to a uniform heat flux. A significant rise in thermal efficiency performance was reported under a predefined range of Reynolds number (Re) from 3000 to 14000 with an optimized value of relative roughness pitch ratio (P/e) and relative staggered rib length (w/g) as 12 and 1, respectively. The maximum thermal efficiency was attained in the range from 42.15 to 87.02% under considered Reynolds numbers for optimum value of P/e as 12 and w/g as 1. A multilayered perceptron (MLP) feed-forward ANN trained by the Broyden-Fletcher-Goldfarb-Shanno (BFGS) algorithm was utilized to predict the thermal efficiency (η), friction (f), and Nusselt number (Nu). The thermal performance parameters such as P/e, w/g, Re, and temperature at the inlet, outlet, and plate were the critical input parameters/signals used in the ANN method. The optimum ANN arrangement/structure to predict the Nu, f, and η demonstrate higher accurateness in assessing the performance characteristics of SAH by attaining the root mean squared error (RMSE) in prediction and the Pearson coefficient of association (R) of 1.591 and 0.994; 0.0012 and 0.851; and 0.025 and 0.981, respectively. The prediction profile plots of the ANN demonstrate the influence of various input parameters on the thermal performance parameters.
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http://dx.doi.org/10.1007/s11356-021-12875-0DOI Listing
February 2021

Sports injury and illness incidence among South Korean elite athletes in the 2018 Asian Games: a single-physician prospective study of 782 athletes.

BMJ Open Sport Exerc Med 2021 5;7(1):e000689. Epub 2021 Feb 5.

Orthopedic Surgery, CM General Hospital, Seoul, Korea (the Republic of).

Objective: The increasing incidence of sports injury among athletes calls for systemic surveillance of injuries and illnesses in this field to develop preventive measures. The patterns of injuries and illnesses that occurred among Korean athletes during the 2018 Asian Games held in Indonesia were studied.

Methods: We recorded the occurrence of all injuries and illnesses reported to the chief medical officer, coordinated with the help of an instant social messaging application in real time.

Results: A total of 782 elite athletes participated in 46 sporting events. A total of 141 (18.03%) injuries were recorded, with 121 (15.47%) athletes suffering at least one injury. Out of 141 injuries 80 (56.74%) were in male athletes and 61 (43.26%) were in female athletes. The highest number of injuries was seen among sport climbing athletes (n=10, 71.43%), followed by sepak takraw. A total of 16 (11.35%) injuries were expected to prevent athletes from participation in competition/training. Most of the injuries occurred during training (46.10%), with lower lumbar spine being the most common part injured. A total of 209 (26.72%) illnesses were reported, with at least one illness in 170 (21.73%) athletes. The incidence among female athletes (26.90%) was comparable with that of male athletes (26.90%). Maximum illness rate was reported in table tennis (100%). The most common system involved was gastrointestinal (n=93, 44.49%), followed by respiratory (n=53, 25.36%). Environmental factors were causative in 111 athletes (53.11%) and infection in 79 (37.79%). Illnesses resulted in loss of at least 1 day among 30 (14.35%) athletes.

Conclusion: Overall 15.47% of athletes suffered at least one injury and 21.73% suffered at least one illness; the incidence of injury and illness varied depending on the type of sports.
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http://dx.doi.org/10.1136/bmjsem-2019-000689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871279PMC
February 2021

Microbiology of bile in extrahepatic biliary obstruction: A tropical experience.

Indian J Med Microbiol 2021 Jan 4;39(1):54-58. Epub 2020 Dec 4.

Military Hospital, Shillong, Meghalaya, India.

Purpose: Bile is considered sterile, but in obstructed biliary system, growth of micro-organisms results in bacteraemia and toxaemia. We analysed bacterial profile of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and evaluated antibiotic resistance patterns to formulate strategy for antibiotics in patients undergoing ERCP.

Materials And Methods: Patients with cholestasis who underwent ERCP were enrolled. Bile, collected aseptically, was cultured. Positive cultures were processed for isolate identification and antibiotic susceptibility.

Results: One hundred and sixty-three patients (78 females; mean age - 55.1 ± 15.8 years) were enrolled and divided into two groups: Group I (n = 99) were naïve and Group II (n = 64) had undergone ERCP and stenting previously. Positive culture was seen in 68.1% (n = 111) with monomicrobial growth in 74.8% (n = 83) and poly-microbial growth in 25.2% (n = 28). Culture positivity was common in Group II vis-a-vis Group I (84.4% vs. 57.5%). Poly-microbial growth was significantly more common in Group II (35.2% vs. 15.8%, P = 0.028). Gram-negative bacilli were the predominant organisms isolated with Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae comprising 70% of the isolates. The most sensitive antibiotics were piperacillin-tazobactam and imipenem. The sensitivity of vancomycin, against Enterococcus spp. was in the range of 60%-70%.

Conclusion: Cholestasis leads to bacterial colonisation in most cases, regardless of the presence of a biliary stent. Biliary stent however predisposes to a polymicrobial growth. Most of the commonly used antibiotics continue to have significant sensitivity and may be used empirically. However, previously stented patients may have a higher incidence of infection with Enterococcus spp. and may require specific therapy.
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http://dx.doi.org/10.1016/j.ijmmb.2020.10.002DOI Listing
January 2021

Cardiac amyloidosis-A review of current literature for the practicing physician.

Clin Cardiol 2021 Mar 17;44(3):322-331. Epub 2021 Feb 17.

Dept of Medicine, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.

The amyloidoses are a family of diseases in which misfolded precursor proteins aggregate to form amyloid and deposit in body tissues. A very serious yet underrecognized form of this disease is cardiac amyloidosis, in which amyloid deposits into the extracellular space of the myocardium, resulting in thickening and stiffening of ventricular walls with resultant heart failure and conductive dysfunction. This review provides a discussion of the pathogenesis and clinical presentation of cardiac amyloidosis subtypes, as well as an up-to-date approach to diagnosis and treatment. Significant progress has been made in recent years regarding diagnosis and treatment of this condition, but prognosis remains heavily reliant on early detection of the disease. Two types of precursor protein are responsible for most cardiac amyloidosis cases: transthyretin amyloid, and immunoglobulin-derived light chain amyloid. An early diagnosis of cardiac amyloidosis can allow for novel treatment modalities to be initiated with the potential to improve prognosis.
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http://dx.doi.org/10.1002/clc.23572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943900PMC
March 2021

An integrated multi-criteria decision-making approach for identifying the risk level of musculoskeletal disorders among handheld device users.

Soft comput 2021 Feb 3:1-11. Epub 2021 Feb 3.

Department of Mechanical Engineering, Malaviya National Institute of Technology, JLN Marg, Malaviya Nagar, Jaipur, Rajasthan 302017 India.

In work-from-home (WFH) situation due to coronavirus (COVID-19) pandemic, the handheld device (HHD) users work in awkward postures for longer hours because of unavailability of ergonomically designed workstations. This problem results in different type of musculoskeletal disorders (MSDs) among the HHD users. An integrated multi-criteria decision-making approach was offered for identifying the risk level of MSDs among HHD users. A case example implemented the proposed approach in which, firstly, the best-worst method (BWM) technique was used to prioritize and determine the relative importance (weightage) of the risk factors. The weightages of the risk factors further used to rank the seven alternatives (HHD users) using Vlse Kriterijumska Optimizacija Kompromisno Resenje (VIKOR) technique. The outcomes of the BWM investigation showed that the three most significant risk factors responsible for MSDs are duration of working, poor working posture and un-ergonomic design. The outcome of the VIKOR technique exhibited that computer professionals were at the highest risk among all users. The risk factor priority must be used for designing a working strategy for the WFH situation which will help to mitigate the risks of MSDs.
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http://dx.doi.org/10.1007/s00500-021-05592-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856850PMC
February 2021

Plant Growth Promotion at Low Temperature by Phosphate-Solubilizing Pseudomonas Spp. Isolated from High-Altitude Himalayan Soil.

Microb Ecol 2021 Jan 29. Epub 2021 Jan 29.

Center for Environmental Assessment and Climate Change, G.B. Pant National Institute of Himalayan Environment, Almora, Uttarakhand, 263643, India.

Scarcity of arable land, limited soil nutrient availability, and low-temperature conditions in the Himalayan regions need to be smartly managed using sustainable approaches for better crop yields. Microorganisms, able to efficiently solubilize phosphate at low temperatures, provide an opportunity to promote plant growth in an ecofriendly way. In this study, we have investigated the ability of psychrotolerant Pseudomonas spp., isolated from high altitudes of Indian Himalaya to solubilize P at low temperature. Quantitative estimation of phosphate solubilization and production of relevant enzymes at two different temperatures (15 and 25 °C) was performed for 4 out of 11 selected isolates, namely, GBPI_506 (Pseudomonas sp.), GBPI_508 (Pseudomonas palleroniana), GBPI_Hb61 (Pseudomonas proteolytica), and GBPI_CDB143 (Pseudomonas azotoformans). Among all, isolate GBPI_CDB143 showed highest efficiency to solubilize tri-calcium phosphate (110.50 ± 3.44 μg/mL) at 25 °C after 6 days while the culture supernatants of isolate GBPI_506 displayed the highest phytase activity (15.91 ± 0.35 U/mL) at 15 °C and alkaline phosphatase (3.09 ± 0.07 U/mL) at 25 °C in 6 and 9 days, respectively. Out of five different organic acids quantified, oxalic acid and malic acid were produced in maximum quantity by all four isolates. With the exception of GBPI_508, inoculation of bacteria promoted overall growth (rosette diameter, leaf area, and biomass) of Arabidopsis thaliana plants as compared to uninoculated control plants in growth chamber conditions. The plant growth promotion by each bacterial isolate was further validated by monitoring root colonization in the inoculated plants. These bacterial isolates with low-temperature phosphate solubilization potential along with phosphatases and phytase activity at low temperature could be harnessed for sustainable crop production in P-deficient agricultural soils under mountain ecosystems.
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http://dx.doi.org/10.1007/s00248-021-01702-1DOI Listing
January 2021

Postural orthostatic tachycardia syndrome in patients of orthostatic intolerance symptoms: an ambispective study.

AIMS Neurosci 2021 8;8(1):74-85. Epub 2020 Dec 8.

Department of Neurology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, M.P. India.

Background: A Postural orthostatic tachycardia syndrome (POTS) is infrequently diagnosed in routine practice because of the variable range of symptoms that could be seen in cardiac rhythm disorders, vertigo, chronic fatigue syndrome and anxiety panic disorder. POTS is a chronic debilitating condition that affects day to day efficient working of an individual. We have planned a study to look for POTS in patients who are having orthostatic intolerance symptoms and underwent a head-up tilt table test (HUTT).

Aim: To study the prevalence of POTS in patients of orthostatic intolerance (OI) symptoms and to analyze symptomatology, its association with neurocardiogenic syncope (NCS), and its outcome.

Methods: We reviewed the medical records of 246 patients presented with symptoms of OI seen at our centre from January 2010 till March 2019. Out of them, 40 patients included, those qualifying the criteria for POTS on HUTT.

Results: The mean age of the cohort was 25.90 ± 10.33 years with a range of 15 to 55 years, and males comprised 52.5% (21/40) of total patients. The most frequent presenting orthostatic symptoms of POTS patients are loss of consciousness (77.5%), lightheadedness (75%), and palpitation (67.5%). A total of 18 patients (45%) had coexisting neurocardiogenic syncope.

Conclusion: POTS is a prevalent condition and have a significant impact on the quality of life, and the majority of patients may not present with OI symptoms during HUTT. We have to keep this possibility in young patients of transient loss of consciousness because it may coexist with NCS.
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http://dx.doi.org/10.3934/Neuroscience.2021004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815479PMC
December 2020

Structural and mechanistic insights into the inhibition of amyloid-β aggregation by Aβ fragment derived synthetic peptides.

Eur J Med Chem 2021 Feb 28;212:113126. Epub 2020 Dec 28.

Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research, Sector 67, S.A.S Nagar, Punjab, 160 062, India. Electronic address:

The inhibition of amyloid-β (Aβ) aggregation is a promising approach towards therapeutic intervention for Alzheimer's disease (AD). Thirty eight tetrapeptides based upon AβC-terminus fragment of the parent Aβ peptide were synthesized. The sequential replacement/modification employing unnatural amino acids imparted scaffold diversity, augmented activity, enhanced blood brain barrier permeability and offered proteolytic stability to the synthetic peptides. Several peptides exhibited promising protection against Aβ aggregation-mediated-neurotoxicity in PC-12 cells at doses ranged between 10 μM and 0.1 μM, further confirmed by the thioflavin-T fluorescence assay. CD study illustrate that these peptides restrict the β-sheet formation, and the non-appearance of Aβ fibrillar structures in the electron microscopy confirm the inhibition of Aβ aggregation. HRMS and ANS fluorescence spectroscopic analysis provided additional mechanistic insights. Two selected lead peptides 5 and 16 depicted enhanced blood-brain penetration and stability against serum and proteolytic enzyme. Structural insights into ligand-Aβ interactions on the monomeric and proto-fibrillar units of Aβ were computationally studied. Promising inhibitory potential and short sequence of the lead peptides offers new avenues for the advancement of peptide-derived therapeutics for AD.
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http://dx.doi.org/10.1016/j.ejmech.2020.113126DOI Listing
February 2021

Newer diagnostic criteria for identification of epicardial origin of ventricular tachycardia/premature ventricular complex.

Future Cardiol 2020 Dec 11. Epub 2020 Dec 11.

Department of Cardiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

The study defines criteria for localization of ventricular arrhythmias. Data from 40 premature ventricular complex (PVC)/ventricular tachycardia (VT) were studied. The interval from PVC QRS onset to His potential and ratio of this interval to PVC/VT QRS duration was analyzed. Patients were divided into epicardial and endocardial groups based on mapping/successful ablation site. The interval from PVC QRS onset to His potential in the epicardial versus endocardial group was 99 ± 21 ms and 64 ± 37 ms (p = 0.002). A cut off of 88 ms had a sensitivity of 73% and specificity of 76%. A cut off of 0.50 for the ratio had a sensitivity of 82% and specificity of 72%. Two new parameters can help localization of PVC/VTs origin.
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http://dx.doi.org/10.2217/fca-2020-0155DOI Listing
December 2020

Neurological Symptoms as Initial Manifestation of Covid-19 - An Observational Study.

Ann Indian Acad Neurol 2020 Jul-Aug;23(4):482-486. Epub 2020 Aug 14.

Department of Neurology, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India.

Background: Respiratory system involvement and fever are considered as a cardinal manifestation of Covid-19 infection for the screening of case detection. We (India) are into the fourth month of Covid-19 and cases are still rising, this could mean that fever and respiratory symptoms may not be the only initial symptoms. Therefore, we intend to investigate whether neurological symptoms can precede the cardinal symptoms.

Methods: Totally, 391 Covid-19 RTPCR positive hospitalized patients were enrolled. All included subjects were presented with a questionnaire pertaining to systemic symptoms. For analysis of the chronology of symptoms, the study population was sub-grouped according to onset of their systemic involvement e.g., (1) Fever (2) Respiratory symptoms (3) Neurological symptoms (4) Gastrointestinal symptoms.

Results: New-onset neurological symptoms were found in 106 (27.1%) out of 391 patients irrespective of their chronology to the onset of other symptoms. Of these 106 patients, altered taste (33.1%), altered smell (24.5%), and headache (22.6%) were the most common neurological symptoms. However, 38 (9.7%) subjects recognized neurological symptoms, as the initial manifestation of their illness. Mean duration of neurological symptoms before the onset of respiratory symptoms or fever was 2 ± 1.57 days.

Conclusion: New-onset headache, altered taste, and smell were the most common neurological symptoms. In the context of the current pandemic, a high index of suspicion should be kept in patients presenting with these symptoms even in the absence of fever and respiratory symptoms. To the best of our knowledge, this is the first study from India comparing chronology of neurological symptoms with cardinal symptoms.
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http://dx.doi.org/10.4103/aian.AIAN_560_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657287PMC
August 2020

Mechanical suppression of premature ventricular complexes during catheter ablation procedures.

Indian Pacing Electrophysiol J 2021 Jan-Feb;21(1):29-35. Epub 2020 Nov 19.

Department of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA.

Introduction: Mechanical suppression of premature ventricular complexes (PVCs) is not a well-known observation. We retrospectively reviewed this phenomenon in the Ventricular Arrhythmia (VA) ablation procedures performed at Richard L. Roudebush Veterans Health Administration (VHA) center.

Methods: Data from 40 consecutive patients who underwent VA ablation at VHA, Indianapolis, IN, with 44 VA was included in the study. Demographic and electrophysiological parameter data was collected.

Results: Overall the mean age of the population was 64 ± 11 years. The phenomenon of mechanical suppression was seen in 11 PVCs. The mean age was 59 ± 15 years in the group in which mechanical suppression was seen. Of the 11 cases, the site of earliest activation was seen in the coronary sinus in 8 and in the pulmonary artery in 3. In one case catheter ablation was not performed because of proximity to the left coronary artery system. However, sustained pressure at the site with earliest electrograms (-35 ms) and 95% pacematch resulted in long-term suppression of PVCs. In the cases in which mechanical suppression was seen, there was a statistically significant reduction in PVC burden compared to pre ablation PVC load (1.1% ± 1.50% (post ablation) versus 24.04% ± 13.07% (pre ablation) versus p < 0.05). In all the 11 cases the site of mechanical suppression was also the site with earliest electrograms.

Conclusion: This case series illustrates phenomenon of mechanical suppression of PVCs as an indication for good site for successful ablation in unique veteran patient population.
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http://dx.doi.org/10.1016/j.ipej.2020.11.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854373PMC
November 2020

"Hybrid Reconstruction" for Zygomaticomaxillary Complex Defect Using CAD/CAM: A Case Report.

Plast Reconstr Surg Glob Open 2020 Sep 21;8(9):e3140. Epub 2020 Sep 21.

Department of Plastic, Aesthetic & Reconstructive Surgery, Medanta, The Medicity, Gurgaon, Haryana, India.

In this unique case report, we present a patient of left zygomatico maxillary complex reconstruction with a combination of autogenous tissue (osteocutaneous free fibula flap) and alloplastic implant [patient-specific templated polymethyl methacrylate (PMMA)]. In such large defects, reconstruction using either autogenous tissue or alloplastic implant alone is inadequate and leads to poor functional and aesthetic outcomes. In this case we used osteocutaneous free fibula flap for left alveolus and patient-specific templated PMMA implant for reconstruction of orbital wall and zygoma. Osseointegrated implants were placed secondarily in the fibula for complete dental rehabilitation. With the use of virtual surgical planning and 3D printing we were able to achieve a good result for a complex defect. Since both autogenous tissue and alloplastic implant were used for complete reconstruction, we have named this as "hybrid reconstruction."
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http://dx.doi.org/10.1097/GOX.0000000000003140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544311PMC
September 2020

Cardiology and COVID-19: do we have sufficient information?

Future Cardiol 2020 Oct 30. Epub 2020 Oct 30.

Department of Hospital Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA.

Novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2, which originated in Wuhan (China), transformed into a worldwide pandemic. The short span associated with the spread of the virus and its varied manifestations presents a steep learning curve for many clinicians on the front-line of treatment. Cardiology is one such affected area. This paper details the signs and symptoms of cardiovascular disease resulting from COVID-19, including its proposed pathophysiology, signs and symptoms, treatments and outcomes under investigation. The consensus is that COVID-19 patients with cardiovascular injury have a shorter duration from symptom onset to deterioration, higher mortality and higher prevalence in older populations. Diagnosis and intervention for patients with underlying cardiovascular comorbidities is critical.
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http://dx.doi.org/10.2217/fca-2020-0126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597579PMC
October 2020

Evidence-based management of arrhythmogenic right ventricular cardiomyopathy in pregnancy.

Future Cardiol 2020 Oct 22. Epub 2020 Oct 22.

Penn State Health Milton S Hershey Medical Center, Hershey, PA 17033, USA.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder resulting in fibrofatty replacement of the myocardium. Genetic mutations in genes encoding for desmosome proteins result in a ventricular myocardium prone to arrhythmias and heart failure. Although ARVC is known for a few decades, most of the outcomes in pregnancy are reported recently. Pregnancy leads to significant physiological changes with excess mechanical stress on the myocardium. All the retrospective studies suggest that pregnancy is well tolerated in these patients despite the high risk of arrhythmias and heart failure. Our review focuses on the most up-to-date evidence on the management of ARVC patients during the antepartum and postpartum period.
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http://dx.doi.org/10.2217/fca-2020-0127DOI Listing
October 2020

CAD-CAM vs conventional technique for mandibular reconstruction with free fibula flap: A comparison of outcomes.

Surg Oncol 2020 Sep 16;34:284-291. Epub 2020 Jun 16.

Department of Head and Neck Oncology, Medanta-The Medicity, Gurugram, India.

Introduction: Mandibular reconstruction always pose a challenge to the reconstructive surgeon. With the use of Computer aided designing and computer aided manufacturing (CAD-CAM) it is now possible to reconstruct mandibular defects to near normal configuration with good function and aesthetic outcomes.

Aims/objectives: To compare the efficacy of CAD-CAM technique vs conventional technique in mandibular reconstruction with free fibula flap.

Materials And Methods: 40 consecutive patients that required mandibular reconstruction using free fibula flap were included in the study. All patients were treated using CAD-CAM technique and then compared retrospectively with 40 patients treated with conventional technique. Comparison was done between total intraoperative time, aesthetic outcome and post-operative occlusion.

Results: Total intraoperative time in the CAD-CAM group was significantly reduced (562 min) as compared to the conventional group (662 min). Patients in the CAD-CAM group also obtained a better Aesthetic score (3.6/5) when compared to the conventional group (2.5/5). Postoperative malocclusion was noted in 1 patient in the CAD-CAM group as opposed to 6 patients in the conventional group.

Conclusion: Use of CAD-CAM technology in mandibular reconstruction with free fibula flap offers reduced surgical time with precise and accurate reconstruction that produces better functional and aesthetic outcomes.
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http://dx.doi.org/10.1016/j.suronc.2020.04.012DOI Listing
September 2020

Compromised Vitamin B12 Status of Indian Infants and Toddlers.

Food Nutr Bull 2020 12 2;41(4):430-437. Epub 2020 Sep 2.

75299Chacha Nehru Bal Chikitsalaya, New Delhi, India.

Background: Vitamin B12 deficiency is prevalent worldwide especially in vegetarian communities. Its deficiency in early childhood may result in serious neurological and cognitive deficits. It is important to know the prevalence among our infants and toddlers so that nutritional policy changes could be suggested in this regard.

Objective: To evaluate the vitamin B12 status of apparently healthy Indian children between 6 and 23 months of age.

Methods: Apparently healthy Indian children (n = 210), of age 6 to 23 months, attending pediatric outpatient department were recruited and samples obtained to evaluate their hemogram and levels of vitamin B12, folate, and ferritin. Data were analyzed to obtain the mean levels and the proportion of participants deficient in vitamin B12. The dietary habits of the children were also analyzed and correlated with their vitamin B12 status.

Results: Vitamin B12 deficiency was observed in 37.6% of the participants.

Conclusions: There is a high prevalence of vitamin B12 deficiency in our infants and toddlers, and there is need to initiate supplement to prevent any possible neurological consequences. Early initiation of animal milk had a positive effect on the vitamin B12 status of the child, though it was not significant.
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http://dx.doi.org/10.1177/0379572120950886DOI Listing
December 2020

Uncommon cause of fever in a child with steroid-dependent nephrotic syndrome.

Clin Nephrol Case Stud 2020 7;8:49-52. Epub 2020 Jul 7.

Akron General Medical Center, and.

Background: Children with nephrotic syndrome are vulnerable to developing infections due to a state of relative immunodeficiency, malnourishment, and use of immunosuppression. Case characteristics: We herein report the case of a 3-year-old child with steroid-dependent nephrotic syndrome who presented to us with fever of unknown origin.

Observation: The child was found to have an atypical mixed infection with mycoplasma and cytomegalovirus.

Outcome: The infection completely resolved with appropriate treatment and lowering of immunosuppression. Message: Persistently febrile pediatric patients, especially in the setting of recent immunosuppression and absence of otherwise-identified infectious pathogens, should be screened for atypical mixed infections.
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http://dx.doi.org/10.5414/CNCS110062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344764PMC
July 2020

ACTH Treatment for Management of Nephrotic Syndrome: A Systematic Review and Reappraisal.

Int J Nephrol 2020 4;2020:2597079. Epub 2020 Jun 4.

Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH, USA.

Background: In recent years, the use of adrenocorticotropic hormone (ACTH) therapy for treatment of proteinuria due to nephrotic syndrome (NS) has been heavily explored. ACTH therapy, which comes in the natural (H. P. Acthar Gel) or synthetic (tetracosactide) form, has resulted in remission in patients with immunosuppressive and steroid-resistant NS. However, the exact efficacy of ACTH therapy in the NS etiologies, such as membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS), minimal change disease (MCD), lupus nephritis (LN), IgA nephropathy (IgAN), and membranoproliferative glomerulonephritis (MPGN), has not been determined.

Objective: This systematic review analyzed the published literature on ACTH therapy in various NS etiologies to determine its efficacy.

Methods: A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was conducted for articles through June 2019. An additional search was performed on clinicaltrials.gov to search for additional trials and cross reference the results of our database search. The literature which studied synthetic or natural ACTH treatment in patients with known etiologies of NS was included. Studies were excluded when they consisted of a single case report or did not analyze the lone effect of ACTH in NS.

Results: The initial search yielded a total of 411 papers, and 22 papers were included. In 214 MN patients, there was an overall remission of 40% (85/214) and an overall remission of 43% (42/98) in FSGS patients. In other etiologies, there were overall remissions of 78% (11/14), 31% (5/16), 40% (16/40), and 62% (8/13) in MCD, LN, IgAN, and MPGN patients, respectively.

Conclusion: ACTH showed benefits in proteinuria reduction across all etiologies of NS. However, more randomized controlled studies with larger population sets and longer follow-ups are imperative to establish causal benefits. New studies into its efficacy in children are also necessary.
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http://dx.doi.org/10.1155/2020/2597079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292987PMC
June 2020

Novel electrocardiographic criteria for diagnosis of premature ventricular complexes arising from the base of left ventricle.

J Electrocardiol 2020 May - Jun;60:148-150. Epub 2020 Apr 23.

Department of Cardiology, Indiana University School of Medicine, Indianapolis, IN, United States of America; Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States of America.

Purpose: We report new electrocardiographic criteria (ECG) for localizing premature ventricular complexes (PVCs) originating from the base of the left ventricle (LV).

Methods: QRS deflection (positive negative or negative positive) in lead aVR and aVL respectively, were evaluated in 41 PVC/VT cases.

Results: There were a total of 41 patients, age 64 ± 11 years. Twelve patients had QRS deflection in aVR which were completely opposite to the deflection in aVL. If the PVC originated from basal septum, aVR was negative while aVL positive and vice versa when it was from the baso-lateral LV. PVCs from other LV sites had aVR and aVL deflection in the same direction. The ECG criteria had a sensitivity and specificity of 91% and 84%, respectively.

Conclusion: We propose a new ECG criterion to localize PVCs originating from the base of the LV.
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http://dx.doi.org/10.1016/j.jelectrocard.2020.04.013DOI Listing
April 2020

Occupational risk factors for musculoskeletal disorders among railroad maintenance-of-way workers.

Am J Ind Med 2020 05 7;63(5):402-416. Epub 2020 Mar 7.

State University of New York (SUNY)-Downstate Health Sciences University, Brooklyn, New York.

Background: Our objective was to examine occupational risk factors for musculoskeletal disorders of the neck, back, and knee among railroad maintenance-of-way (MOW) workers.

Methods: Four thousand eight-hundred sixteen active, retired, and disabled members of the Brotherhood of Maintenance of Way Employes Division (BMWED) completed a survey. We computed adjusted prevalence ratios (aPRs) using Poisson regression for neck, back, and knee musculoskeletal symptoms by work exposures, adjusted for age, region, race/ethnicity, smoking, and potential second job and spare time vehicle vibration exposure.

Results: Among active male BMWED members, we found associations between use of high-vibration vehicles and neck pain (aPR = 1.47, 95% confidence interval (CI): 1.07-2.03) and knee pain (aPR = 1.38, 95% CI: 1.04-1.82) for more than 1.9 years (vs 0) of full-time equivalent use; but not back pain. Back pain radiating below the knee (sciatica indicator) was associated with high-vibration vehicle use greater than 0.4 and less than 1.9 years (aPR = 1.58, 95% CI: 1.15-2.18). We also found significant associations between often or always lifting, pushing, pulling, or bending on the job (vs seldom or never) and neck pain (aPR = 2.43, 95% CI: 1.20-4.90), back pain (aPR = 1.94, 95% CI: 1.24-3.03), the sciatica indicator (aPR = 5.18, 95% CI: 1.28-20.95), and knee pain (aPR = 2.84, 95% CI: 1.47-5.51), along with positive gradients in the outcome by exposure time.

Conclusions: Biomechanical work exposures, including force and nonneutral postures, were associated with neck, lower back, and knee pain. Whole-body vibration, as measured by the duration of use of high-vibration vehicles, was associated with neck pain, knee pain, and sciatica. Prevention programs should address occupational risk factors for musculoskeletal disorders among MOW workers.
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http://dx.doi.org/10.1002/ajim.23099DOI Listing
May 2020

Unique features of epicardial ventricular arrhythmias/premature ventricular complexes ablated from coronary venous system in veteran population.

Indian Pacing Electrophysiol J 2020 May - Jun;20(3):97-104. Epub 2020 Feb 18.

Department of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA; Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA.

Introduction: Ventricular arrhythmias/premature ventricular complexes (VA/PVCs) that can be ablated from within the coronary venous system (CVS) have not been described in the United States Veterans Health Administration (VHA) population. We retrospectively studied the VA/PVCs ablations that were performed in the VHA population.

Methods: Data from 42 consecutive patients who underwent VA/PVCs ablation at Veterans Affairs Hospital, Indianapolis, IN, with 44 VA/PVCs was included in the study. Patients were divided into two groups (CVS group [n = 10], and non-CVS group [n = 32]) based on where the earliest pre-systolic activation was seen with >95% pacematch.

Results: The mean age in CVS group was 65 ± 8 years versus 64 ± 12 years (p = 0.69) in non-CVS group. Overall there was a statistically significant reduction in PVC burden post ablation (27.7% (pre-ablation) versus 4.7% (post-ablation). In the 10 patients in the CVS group, either ablation or catheter-related mechanical trauma resulted in complete (n = 6 [60%]) or partial (n = 4 [40%]) long-term suppression of VA/PVCs. Right bundle branch block-type VA/PVC (9/11: 82%) was the most common morphology in the CVS group, whereas in the non-CVS group, this type was seen in only 3/33 (9%). The CVS group (25% of total VA/PVCs) had shorter activation time compared to non CVS group.

Conclusion: In our experience VA/PVCs with electrocardiograms suggestive of epicardial origin can often be safely and successfully ablated within the coronary venous system. These arrhythmias have unique features in Veterans patient population.
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http://dx.doi.org/10.1016/j.ipej.2020.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244881PMC
February 2020

Outcome of implantable cardioverter defibrillator in cardiac sarcoidosis: a systematic review and meta-analysis.

J Interv Card Electrophysiol 2020 Aug 15;58(2):233-242. Epub 2020 Feb 15.

Division of Cardiovascular Medicine, University of Missouri-Columbia, Columbia, MO, USA.

Purpose: Cardiac sarcoidosis is a multisystem inflammatory disorder characterized by ventricular arrhythmias. Implantable cardioverter defibrillator (ICD) is used to prevent sudden cardiac death.

Methods: We performed literature search for studies that addressed the outcome and complications of ICD in Cardiac Sarcoidosis (CS). Multiple search sites were reviewed from January 1, 2000 until December 1, 2018. We then performed a meta-analysis using a random effects model. Two investigators independently extracted the data and assessed studies' quality.

Results: Ten studies with 585 patients qualified for the analysis. In the pooled analysis, 57% were male with mean left ventricular ejection fraction (LVEF) of 38.4%. Appropriate and inappropriate ICD treatments (AT and IAT) were reported in 39% and 15% of patients respectively over mean follow-up period of 25 months and mortality rate of 8%. A sub-analysis of four studies indicated that patients with appropriate therapy did not differ from the rest of CS population in LVEF% (mean difference (MD) = - 7.37%, 95% confidence interval (CI) - 16.89 to 2.15, p = 0.12), age (MD = - 3.87 years, 95% CI - 10.19 to 2.46, p = 0.23), primary prevention (range difference (RD) = - 0.11, 95% CI - 0.31 to 0.10, p = 0.31) or secondary prevention indication (RD = 0.09, 95% CI - 0.12 to 0.3, p = 0.37). High degree AV block was more common in patients with AT (RD = 0.07, 95% CI 0.00 to 0.14 p = 0.05).

Conclusions: ICD placement in CS is associated with high incidence of both appropriate and inappropriate therapy. High degree AV block appears to be predictive of appropriate ICD therapy.
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http://dx.doi.org/10.1007/s10840-020-00705-1DOI Listing
August 2020

Neonatal Acute Kidney Injury: A Survey of Perceptions and Management Strategies Amongst Pediatricians and Neonatologists.

Front Pediatr 2019 14;7:553. Epub 2020 Jan 14.

Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, United States.

Neonatal Acute Kidney Injury (AKI) occurs in 40-70% of critically ill newborn infants and is independently associated with increased morbidity and mortality. Understanding the practice patterns of physicians (neonatologists and pediatricians), caring for neonates in India is important to optimize care and outcomes in neonatal AKI. The aim of this study was to identify differences in physician's perception and practice variations of diagnosis, management, and follow-up of newborn infants with AKI in India. An online survey of neonatologists and pediatricians in India caring for newborn infants with AKI. Out of 800 correspondents, 257 (135 neonatologists and 122 pediatricians) completed the survey, response rate being 32.1%. Resources available to the respondents included level III NICU (59%), neonatal surgery (60%), dialysis (11%), and extracorporeal membrane oxygenation (ECMO, 3%). Most respondents underestimated the risk of AKI due to various risk factors such as prematurity, asphyxia, sepsis, cardiac surgery, and medications. Less than half the respondents were aware of the AKIN or KDIGO criteria, which are the current standard criteria for defining neonatal AKI. Only half of the respondents were aware of the risk of CKD in preterm neonates and nearly half were unaware of the need to follow up with a pediatric nephrologist. Similar to other regions worldwide, there exists a knowledge gap in early recognition, optimal management and follow up of newborn infants with AKI amongst Indian physicians.
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http://dx.doi.org/10.3389/fped.2019.00553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6972501PMC
January 2020

Parallel Device-Independent Quantum Key Distribution.

IEEE Trans Inf Theory 2020 ;66(9)

Aliyun Quantum Laboratory, Alibaba, USA.

A prominent application of quantum cryptography is the distribution of cryptographic keys that are provably secure. Recently, such security proofs were extended by Vazirani and Vidick (, 113, 140501, 2014) to the device-independent (DI) scenario, where the users do not need to trust the integrity of the underlying quantum devices. The protocols analyzed by them and by subsequent authors all require a sequential execution of multiplayer games, where is the security parameter. In this work, we prove unconditional security of a protocol where all games are executed in parallel. Besides decreasing the number of time-steps necessary for key generation, this result reduces the security requirements for DI-QKD by allowing arbitrary information leakage of each user's inputs within his or her lab. To the best of our knowledge, this is the first parallel security proof for a fully device-independent QKD protocol. Our protocol tolerates a constant level of device imprecision and achieves a linear key rate.
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http://dx.doi.org/10.1109/tit.2020.2986740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918288PMC
January 2020