Publications by authors named "Rajinder Bansal"

14 Publications

  • Page 1 of 1

Antiepileptic Drug Prices, Availability and Affordability in a Resource-Limited Setting.

Ann Indian Acad Neurol 2020 Sep-Oct;23(5):674-680. Epub 2020 Dec 8.

Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background: The availability and affordability of antiepileptic drugs (AEDs) are critical to the success of public health initiatives enabling care for people with epilepsy in the community.

Objective: To pilot survey the availability and affordability of AEDs in the community.

Methods: Field workers used standard WHO-Health Action International approaches and collected data on the availability of, and maximum retail prices of originator brands and least price generics of AEDs in 46 randomly selected public ( = 29), private ( = 8), and charitable ( = 9) pharmacy outlets. Median price ratios were computed apropos international reference prices of corresponding medications and affordability gauged with reference to daily wage of lowest paid worker.

Results: Only 10 outlets (7 - private, 3 - public, and none - charitable) stocked at least one essential AED. Median price ratios varied between 1.1 and 1.5 essentially reflecting the difference between the least price generics and originator brands. Of note, carbamazepine-retard, 200 mg put up the slightest difference in prices of originator and least price generic brands and also was the most affordable AED.

Conclusions: The availability and affordability of most AEDs were poor and hence, this needs to be studied on a wider scale and thereafter efforts to improve both the availability and affordability are desirable in order to address the huge treatment gap for epilepsy in India.
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http://dx.doi.org/10.4103/aian.AIAN_264_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887484PMC
December 2020

Mortality implications and factors associated with nonengagement in a public epilepsy care initiative in a transient population.

Epilepsy Behav 2020 11 22;112:107438. Epub 2020 Sep 22.

NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, Netherlands. Electronic address:

Background: Community-based, public care programs are a requisite to close the epilepsy treatment gap in disadvantaged communities in low- and middle-income countries (LMICs). Potential beneficiaries may, however, choose not to engage in these programs.

Aims: The aim of the study was to describe factors associated with and mortality consequences of nonacceptance of a public epilepsy care initiative.

Methods: In this cross-sectional study, we contacted 207 (36%) people out of 575 who screened positive for epilepsy during a population-based survey of 59,509 people. They were invited for neurological evaluation and care provision (including antiseizure medications (ASMs)) but chose not to engage. Structured questionnaires and qualitative interviews were conducted to determine reason for their nonengagement. Factors associated with nonengagement were evaluated by univariate and multivariate analysis. We conducted verbal autopsies for those who had died.

Results: Ten (5%) of the 207 individuals died since the initial screening; six with epilepsy-related causes. Of those who could be contacted (n = 48), 40 (19%) were confirmed to have epilepsy. Nonengaging individuals were likely to be older (odds ratio (OR): 1.02; 95% confidence interval (CI), 1.01, 1.11), locals (OR: 4.32; 95% CI, 1.55, 12.03), and earn less than US$ 78/month (OR: 3.6; 95% CI, 1.62, 8.06). Reasons for not engaging included a belief that epilepsy is inconsequential, loss of daily wages owing to healthcare facility visit and physical infirmity.

Conclusions: Nonacceptance of a community-based public epilepsy care initiative is associated with high premature mortality, mostly attributed to epilepsy-related causes. Older age, ethnic status, and economic deprivation are factors associated with nonacceptance, though the underlying reasons may be varied.
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http://dx.doi.org/10.1016/j.yebeh.2020.107438DOI Listing
November 2020

2019-NCoV: What Every Neurologist Should Know?

Ann Indian Acad Neurol 2020 Apr 17;23(Suppl 1):S28-S32. Epub 2020 Apr 17.

Department of Neurology, Dayanand Medical College, Ludhiana, Punjab, India.

The 2019 novel Corona Virus pandemic beginning from Wuhan, China primarily affects the respiratory tract but its has impacted clinical practice across a range of specialities including neurology. We review the bearing of the 2019 NCoV infection on neurological practice. Neurological manifestations are less common than respiratory manifestations, yet conspicuous, affecting nearly over a third of hospitalized individuals. These may be classified in to early - headache, dizziness, hyposmia and hypogeusia and late - encephalopathy. Rarely but surely, a very small proportion of infected individuals might present with stroke. Certain neurological conditions, including cerebrovascular disease in both China and Italy and dementia in Italy predispose to infection and more severe manifestations, requiring intensive care unit admission. There is no convincing evidence that the manifestations, course and outcome of various neurological disorders is impacted by 2019 nCoV infection. Concerns of an increased risk of febrile seizures offset by a reduced frequency of infection in the paediatric age group. Individuals with multiple sclerosis might potentially experience both true and pseudorelapses. Besides a direct effect, 2019 nCoV has tremendously affected neurological care by disrupting the continuity of care and the availability of neurological medicines worldwide. Neurologists should respond to this challenge by developing and sustaining innovative methods of providing care as well as alerting the society at large to adopt measures to contain the spread of 2019 nCoV.
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http://dx.doi.org/10.4103/aian.AIAN_210_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213032PMC
April 2020

Stroke profile and outcome between urban and rural regions of Northwest India: Data from Ludhiana population-based stroke registry.

Eur Stroke J 2017 Dec 27;2(4):377-384. Epub 2017 Jul 27.

Stroke Unit, Department of Neurology, Christian Medical College, Ludhiana, India.

Introduction: The objective of this study is to compare the clinical profile, risk factors, type and outcome of stroke patients in urban and rural areas of Punjab, India.

Methods: The primary data source was from the Ludhiana urban population-based stroke registry. The data of first-ever stroke patients with age ≥18 years were collected using WHO stepwise approach from all hospitals, general practitioners, physiotherapy and scan centres between 26 March 2011 and 25 March 2013.

Results: A total of 4989 patients were included and out of 4989 patients, 3469 (69%) were from urban areas. Haemorrhagic stroke was seen more in rural as compared to urban regions (urban 1104 (32%) versus rural 552 (36%); p = 0.01). There were significant differences seen in stroke risk factors; hypertension (urban 1923 (84%) versus rural 926 (89%); p = 0.001) and hyperlipidaemia (urban 397 (18%) versus rural 234 (23%); p = 0.001) between two groups. In the multivariable analysis the rural patients were more likely to be younger (age < 40 years) (OR: 1.82; 95% CI: 1.24-2.68; p = 0.002), Sikhs (OR: 2.57; 95% CI: 1.26-5.22; p = 0.009), farmers (OR: 9.41; 95% CI: 5.36-16.50; p < 0.001), housewives (OR: 2.71; 95% CI: 1.45-5.06; p = 0.002), and consumed alcohol (OR: 1.57; 95% CI: 1.19-2.06; p = 0.001) as compared to urban patients. In addition, use of imaging was higher in rural patients (OR: 1.99; 95% CI: 1.06-3.74; p = 0.03) as compared to urban patients.

Discussion And Conclusion: In this large cohort of patients, rural and urban differences were seen in risk factors and type of stroke. Stroke prevention strategies need to take into consideration these factors including regional sociocultural practices.
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http://dx.doi.org/10.1177/2396987317724052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453185PMC
December 2017

Clinical Features, Risk Factors, and Short-term Outcome of Ischemic Stroke, in Patients with Atrial Fibrillation: Data from a Population-based Study.

Ann Indian Acad Neurol 2017 Jul-Sep;20(3):289-293

Department of Neurology, Christian Medical College, Ludhiana, India.

Objectives: Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder associated with stroke. This study was done to describe risk factors, clinical features, and short-term outcomes of stroke patients with AF.

Materials And Methods: This study was a part of the Indian Council of Medical Research funded "Ludhiana urban population based Stroke Registry." Data were collected using WHO STEPS stroke method. All patients ≥18 years of age, who developed ischemic stroke between March 26, 2011, and March 25, 2013, were included in this study. Data about demographic details, clinical features, and risk factors were collected. The outcome was assessed at 28 days using modified Rankin scale (mRs) (good outcome: mRS ≤2; poor outcome >2). The statistical measures calculated were descriptive statistics, Chi-square test, Fischer's exact test, and independent -test.

Results: Of the total 7199 patients enrolled in the registry, data of 1942 patients who fulfilled inclusion criteria were analyzed, and AF was seen in 203 (10%) patients. AF patients were older (AF 62 ± 14 vs. non-AF 60 ± 15 years, = 0.01), had more hypertension (AF 176 [87%] vs. non-AF 1396 [80%], = 0.03), hyperlipidemia (AF 60 [32%] vs. non-AF 345 [21%], = 0.001), coronary artery disease (AF 60 [30%] vs. non-AF 195 [11%], < 0.0001), and carotid stenosis (AF 14 [7%] vs. non-AF 57 (3%), = 0.02). They had worse outcome (mRS >2; AF 90 [50%] vs. non-AF 555 [37%], = 0.001).

Conclusions: Ten percent of stroke patients had AF. They were older, had multiple risk factors and worse outcome. There was no gender difference in this large cohort.
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http://dx.doi.org/10.4103/aian.AIAN_16_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586127PMC
September 2017

The dilemma of arranged marriages in people with epilepsy. An expert group appraisal.

Epilepsy Behav 2016 08 8;61:242-247. Epub 2016 Jul 8.

Samvedana Epilepsy Group, Pune, India.

Introduction: Matrimony remains a challenging psychosocial problem confronting people with epilepsy (PWE). People with epilepsy are less likely to marry; however, their marital prospects are most seriously compromised in arranged marriages.

Aims: The aim of this study was to document marital prospects and outcomes in PWE going through arranged marriage and to propose optimal practices for counseling PWE contemplating arranged marriage.

Methods: A MEDLINE search and literature review were conducted, followed by a cross-disciplinary meeting of experts to generate consensus.

Results: People with epilepsy experience high levels of felt and enacted stigma in arranged marriages, but the repercussions are heavily biased against women. Hiding epilepsy is common during marital negotiations but may be associated with poor medication adherence, reduced physician visits, and poor marital outcome. Although divorce rates are generally insubstantial in PWE, divorce rates appear to be higher in PWE undergoing arranged marriages. In these marriages, hiding epilepsy during marital negotiations is a risk factor for divorce.

Conclusions: In communities in which arranged marriages are common, physicians caring for PWE are best-equipped to counsel them about their marital prospects. Marital plans and aspirations should be discussed with the family of the person with epilepsy in a timely and proactive manner. The benefits of disclosing epilepsy during marital negotiations should be underscored.
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http://dx.doi.org/10.1016/j.yebeh.2016.05.034DOI Listing
August 2016

Incidence, short-term outcome, and spatial distribution of stroke patients in Ludhiana, India.

Neurology 2016 Feb 6;86(5):425-33. Epub 2016 Jan 6.

From the Stroke Unit (J.D.P., P.K., S.J.V., P.M., G.M., A. Sharma), Department of Neurology, Christian Medical College and Hospital; Department of Neurology (G. Singh, R.B., B.S.P., M. Singla), Dayanand Medical College and Hospital; Departments of Community Medicine (S. Singh, C.J.S.) and Neurosurgery (S.S.G., S.S.J.), Christian Medical College; Arora Neuro Center (O.P.A.); Deep Hospital (A.K.D.); Sobti Neuro and Super Specialty Hospital (M.K.S.); Guru Teg Bahadur Charitable Hospital (H.S.); Shree Raghunath Hospital (M.K.); Deepak Hospital (T.N.S., T.A.); Mediciti Hospital (A. Saxena, G. Sachdeva); Delta Heart Center (J.S.G., R.S.B.); Heart Beat Diagnostic Center (A.G.); Ace Healthways (S.S.B.); Kuka Diagnostic Center (S.S.P.); Civil Hospital (G. Singh); ESIC Hospital (P.S.); Geology, Water Resources and Geoinformatic Division (P.K.L.), Punjab Remote Sensing Center, Ludhiana; and Non Communicable Diseases Division (M. Sharma), Indian Council of Medical Research, New Delhi.

Objective: To estimate the incidence, short-term outcome, and spatial distribution of stroke patients and to evaluate the completeness of case ascertainment in Ludhiana.

Methods: This population-based prospective cohort study was conducted in Ludhiana, Punjab, Northwest India. All first-ever stroke patients (≥18 years) were included between March 2010 and March 2013 using WHO Stepwise Approach Surveillance methodology from the city. Stroke patient data were obtained from hospitals, scan centers, and general practitioners, and details of deaths from the Municipal Corporation.

Results: Out of 7,199 stroke patients recruited, 3,441 were included in final analysis. The mean age was 59 ± 15 years. The annual incidence rate was 140/100,000 (95% confidence interval [CI] 133-147) and age-adjusted incidence rate was 130/100,000 (95% CI 123-137). The annual incidence rate for stroke in the young (18-49 years) was 46/100,000 (95% CI 41-51). The case fatality at 28 days was 22%. Patients above 60 years of age (p = 0.03) and patients who were managed in public hospitals had poor survival (p = 0.01). Hot spots for cumulative incidence were seen in central and southern parts of the city, and hot spots for poor outcome were seen in the outskirts of the city.

Conclusions: The incidence rates are similar to other studies from India. Stroke patient survival is poor in public hospitals. The finding of spatial analysis is of public health significance for stroke prevention and strengthening of stroke services.
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http://dx.doi.org/10.1212/WNL.0000000000002335DOI Listing
February 2016

Establishment of population-based stroke registry in Ludhiana city, northwest India: feasibility and methodology.

Neuroepidemiology 2015 5;44(2):69-77. Epub 2015 Mar 5.

Department of Neurology, Stroke Unit, Christian Medical College and Hospital, Ludhiana, India.

Background/aims: The Indian Council of Medical Research (ICMR) initiated the Task Force Project to evaluate the feasibility of conducting a population-based stroke registry in Ludhiana city, Punjab, Northwest India.

Methods: All first-ever, stroke patients over 18 years from the city of Ludhiana were included in the study from March 26th 2010 to March 25th 2011. Stroke information was collected based on the WHO STEPS approach from the participating hospitals, scan centres and doctors. Modified Rankin Scale (mRS) was administered by telephonic interview at 28 days after stroke. The information on stroke deaths was obtained from the Municipal Corporation (MC) office.

Results: A total of 905 first-ever stroke patients were documented. After excluding duplicate cases and patients from outside the city, 493 patients were included. The practical issues identified in data collection from these centres were reluctance to take informed consent, lack of willingness to share the data, difficulty to identify key persons from each centre, retrieving medical records from public hospitals and poor documentation of deaths in MC office.

Conclusion: Population-based stroke registry was feasible in an urban population with the above methodology. The issues related to feasibility were identified and necessary changes were made for the main phase of the registry.
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http://dx.doi.org/10.1159/000371520DOI Listing
January 2016

Qualitative and quantitative comparative evaluation of sealing ability of guttaflow, thermoplasticized gutta percha and lateral compaction for root canal obturation: a cohort, controlled, ex-vivo study.

Oral Health Dent Manag 2013 Sep;12(3):155-61

Department of Conservative Dentistry and Endodontics, Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India, Tel: +91 8427466489; e-mail:

Aims: To compare and evaluate the apical sealing ability of Guttaflow, Thermoplasticized Gutta percha and Lateral Compaction technique using dye penetration method, Robertson's clearing technique and triocular stereomicroscopy.

Methods: A total of eighty extracted human mandibular molars were decoronated, sectioned and instrumented with rotary protapers size F1. Teeth were randomly divided into three experimental groups of 20 each labeled as Group G1 (Guttaflow), G2 (E&Q plus - mechanized thermoplasticized gutta-percha), and G3 (laterally compacted gutta percha). Group G4 containing 20 teeth served as positive control. All the teeth were given two coats of nail varnish leaving 2 mm at the apex. Teeth were immersed in India ink for 48 hrs, demineralized and cleared (rendered translucent) with methyl salicylate using Robertson's technique. The apical dye penetration was examined using a triocular stereomicroscope.

Results: The mean dye penetration was recorded to be maximum for E&Q Plus i.e. 0.69 mm whereas the mean dye penetration value for all canals obturated with Guttaflow was found to be minimum i.e. 0.35 mm which was comparable to that of Lateral compaction technique i.e. 0.36. On statistical analysis (T variance and ANOVA tests), no statistical significant differences were revealed in terms of sealing ability of different obturating materials.

Conclusion: Guttaflow exhibited an acceptable sealing ability, better than thermoplasticized gutta-percha, and comparable to lateral compaction, though the mean comparative leakage scores were found to be statistically insignificant.
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September 2013

A rare case of survival from primary amebic meningoencephalitis.

Indian J Crit Care Med 2012 Jan;16(1):34-6

Intensivist, Critical Care Division, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Primary amebic meningoencephalitis (PAM) is a rare and fatal disease of central nervous system (CNS) caused by Naegleria fowleri, an ameba found in soils and warm waters. It enters the CNS after insufflation of infected water by attaching itself to the olfactory nerves. The infection is usually difficult to diagnose and has a poor prognosis. The present case is one such case in which CSF examination led us to the diagnosis of PAM and finally to a favorable outcome when treated with Amphoterracin B and antibiotics.
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http://dx.doi.org/10.4103/0972-5229.94432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338237PMC
January 2012

Isaac's syndrome associated with myasthenia gravis and thymoma.

Indian J Med Sci 2010 Jul;64(7):320-4

Deparment of Neurology, Dayanad Medical College and Hospital, Ludhiana, Punjab, India.

A 65-year-old male developed fatigable weakness of ocular and bulbar muscle and positive anti-acetyl cholinesterase antibodies suggesting the diagnosis of myasthenia gravis. His condition responded to anticholinesterase and immunotherapy. However, 18 months later, he developed painful paresthesiae, muscle cramps with hyperhiderosis, and was diagnosed as having Isaac's syndrome (neuromyotonia, continuous muscle fibre activity). Computed tomography of the chest revealed a thymic mass, which was confirmed after surgery and histopathology as thymic cell carcinoma. The co-occurrence of myasthenia gravis and continuous muscle fiber activity should prompt the consideration of the occurrence of these disorders as one of the paraneoplastic manifestations, most often due to a thymic neoplasm. Both these conditions respond to treatment of underlying thymoma. This case is a very rare presentation worth reporting.
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http://dx.doi.org/10.4103/0019-5359.99866DOI Listing
July 2010

Unexplained neurological events during bathing in young people: Possible association with the use of gas geysers.

Ann Indian Acad Neurol 2008 Apr;11(2):103-5

Department of Neurology, Dayanand Medical College, Ludhiana - 141 001, Punjab, India.

Here, we report sudden, unexplained neurological collapse in 14 young people while bathing with hot water associated with the use of liquefied petroleum gas (LPG)-based water heaters (gas geysers) in ill-ventilated bathrooms. None of the patients reported any circumstantial evidence of seizures or prior epilepsy. One patient developed cortical blindness and demonstrated posterior leucoencephalopathy on imaging studies. The remaining patients made rapid and excellent recovery without any residual neurological sequelae. In these cases, the results of all routine investigations, i.e., serum chemistry, brain imaging (computed tomography in 2 and magnetic resonance imaging in 10) and electroencephalography were normal. The clinical clustering of these cases in winter months with similar presentations of reversible encephalopathy probably indicates an inhalational toxin exposure. Therefore, we postulate a hypothesis that harmful emissions consisting of carbon monoxide (CO), hydrocarbon gases (HC) and nitrogen oxides (NOx), produced by incomplete combustion of LPG might be responsible for the cellular injury and subsequent transient neurological deficits. Physicians should be aware of this entity in order to avoid misdiagnosis of this condition as seizures, and a public awareness should also be created regarding the proper use of these devices.
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http://dx.doi.org/10.4103/0972-2327.41877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771966PMC
April 2008

Hippocampal sclerosis in association with neurocysticercosis.

Epileptic Disord 2007 Sep 20;9(3):292-9. Epub 2007 Sep 20.

Neurology Unit, Dayanand Medical College, Ludhiana, India.

Objective: To discuss the possible mechanisms underlying a dual pathology combining neurocysticercosis and hippocampal atrophy, illustrated by the observation of four patients with epilepsy.

Case Reports: The first patient presented at the age of four years with a first episode of status epilepticus, presumably due to an inflamed, calcified, parenchymal cysticercus granuloma. Thereafter, he had occasional seizures. Routine MRI undertaken several years later revealed unilateral hippocampal atrophy and sclerosis. Two other patients with initial imaging evidence of active neurocysticercosis located close to the hippocampus, and occasional seizures, developed ipsilateral hippocampal sclerosis. The seizure disorder of our fourth patient, with medically intractable epilepsy, was initially attributed to a calcified cysticercus granuloma. Clinical description, video-EEG telemetry and imaging work-up suggested a diagnosis of mesial temporal lobe epilepsy due to hippocampal sclerosis.

Conclusions: Definitive conclusions as to the underlying mechanisms cannot be derived from the present, retrospective series of only four patients. However, the following suggestions can be made: 1) seizures due to neurocysticercosis may constitute the initial precipitating illness for the development of hippocampal sclerosis, 2) the hippocampus may be involved in host brain inflammation and gliosis in response to a nearby, degenerating cysticercus, 3) the seizure focus formed by the degenerating cysticercus, engenders epileptogenic changes in the hippocampus through kindling, and 4) the two conditions may coexist purely by chance. Systematic and prospective, serial MRI evaluations of hippocampal structures in patients with neurocysticercosis should contribute to further clarify the underlying mechanisms.
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http://dx.doi.org/10.1684/epd.2007.0122DOI Listing
September 2007

Landry-Guillaine-Barré syndrome as presentation of celiac disease.

Indian J Gastroenterol 2007 Jan-Feb;26(1):42-3

Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Celiac disease has been associated with a variety of neurological illnesses, most frequently cerebellar ataxia and peripheral neuropathy. We report presentation as Landry-Guillaine-Barré syndrome in a 28-year-old woman with previously unsuspected celiac disease.
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June 2007
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