Publications by authors named "Rakesh Kumar"

1,720 Publications

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Fungal central skull-base osteomyelitis: atypical presentation and management issues.

BMJ Case Rep 2021 Sep 16;14(9). Epub 2021 Sep 16.

Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Mucormycosis is a very commonly encountered disease in the sinonasal region in patients with diabetes and immunocompromised status specially in the northern part of the Indian continent. Due to its fulminant nature and involvement in the rhino-orbital-cerebral region, prognosis is poor even after extensive debridement and amphotericin-B therapy. We present a case with diagnosis of sarcoidosis being treated with systemic steroids who developed sudden-onset ptosis and left lateral rectus palsy. On radiological evaluation with MRI, a heterogenously peripherally enhancing lesion was seen in the nasopharynx suggestive of nasopharyngeal abscess. The patient was taken up for emergency surgery; a necrotic lesion with destruction of sphenoid bone, pterygoids and clivus was seen originating in the nasopharynx. The lesion on fungal staining came out to be broad aseptate hyphae suggestive of mucormycosis.
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http://dx.doi.org/10.1136/bcr-2021-243530DOI Listing
September 2021

Establishment of Repertoire of Placentome-Associated MicroRNAs and Their Appearance in Blood Plasma Could Identify Early Establishment of Pregnancy in Buffalo ().

Front Cell Dev Biol 2021 26;9:673765. Epub 2021 Aug 26.

Animal Genomics Laboratory, Animal Biotechnology Centre, National Dairy Research Institute, Karnal, India.

Precise early pregnancy diagnosis in dairy animals is of utmost importance for an efficient dairy production system. Not detecting a dairy animal pregnant sufficiently early after the breeding results to extending the unproductive time of their milk production cycle and causes substantial economic loss for a dairy producer. At present, the most conventional and authentic pregnancy confirmation practice in cows and buffaloes is rectal palpation of the reproductive organs at Days 35-40 after insemination, which sometime leads to considering an animal as false pregnant. Other alternative methods available for early pregnancy diagnosis lack either accuracy or reproducibility or require elaborate instrumentation and laboratory setup not feasible to practice at farmers' doorstep. The present study was aimed at establishment of the microRNA (miRNA) repertoire of the placentome in buffaloes, which could capture the event of the cross talk between a growing embryo and a dam, through fetal cotyledons and maternal caruncles, and thus could hint at the early pregnancy establishment event in ruminants. Total RNA was isolated from buffalo placentome tissues during early stages of pregnancy (at Day < 25 and Days 30-35), and global small RNA analysis was performed by using Illumina single-end read chemistry and genome. A total of 2,199 miRNAs comprising 1,620 conserved and 579 non-conserved miRNAs were identified. Stringent functional miRNA selection criteria could predict 20 miRNAs worth evaluating for their abundance in the plasma of pregnant, non-pregnant, cyclic non-bred, and non-cyclic prepubertal animals. Eight of them (viz., miR-195-5p, miR-708-3p, miR-379-5p, miR-XX1, miR-XX2, miR-130a-3p, miR-200a-3p, and miR-27) displayed typical abundance patterns in the plasma samples of the animals on Day 19 as well as Day 25 post-insemination, thus making them ambiguous candidates for early pregnancy detection. Similarly, higher abundance of miR-200a-3p and miR130a-3p in non-pregnant animals was indicative of their utility for detecting the animals as not pregnant. Most interestingly, miR-XX1 and miR-XX2 were very characteristically abundant only in pregnant animals. target prediction analysis confirmed that these two miRNAs are important regulators of cyclooxygenase-2 (COX-2) and cell adhesion molecule-2 (CADM-2), both of which play a significant role in the implantation process during feto-maternal cross talk. We interpret that circulatory miR-XX1 and miR-XX2 in blood plasma could be the potential biomarkers for early pregnancy detection in buffaloes.
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http://dx.doi.org/10.3389/fcell.2021.673765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8427669PMC
August 2021

Acute-onset isolated bilateral palatal palsy in an adolescent.

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

Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.

A 16-year-old patient presented with sudden-onset difficulty in swallowing food especially for liquids with nasal regurgitation and rhinolalia with no history of fever and limb weakness. Examination revealed bilateral palatal palsy with absence of gag reflex. Other neurological examinations were normal. Investigations were done to rule out any known pathology leading to such a presentation. The symptoms were attributed to an idiopathic acute-onset-acquired bilateral palatal palsy, in the absence of any identifiable cause. This is a rare presentation in adolescent age with no case reported in the literature so far in this age group. Medical management was started and patient showed complete improvement within 2 weeks of his symptoms. Early diagnosis and aggressive management of this condition lead to a favourable prognosis.
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http://dx.doi.org/10.1136/bcr-2021-243467DOI Listing
September 2021

Tobacco use and nicotine dependence among patients with diabetes and hypertension in Ballabgarh, India.

Monaldi Arch Chest Dis 2021 Aug 10. Epub 2021 Aug 10.

Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi.

 Tobacco use is one of the most important modifiable risk factors for cardiovascular mortality and has a synergistic effect with diabetes and hypertension. This study was conducted to estimate the prevalence of tobacco use and nicotine dependence among adult diabetic and/or hypertensive patients. We conducted a cross-sectional study among 419 consecutively enrolled patients from the non-communicable diseases (NCDs) outpatient clinic of a secondary level hospital in Ballabgarh, India between July 2018 and January 2019. We administered a pre-tested questionnaire to assess tobacco use and Fagerstrom Test for Nicotine Dependence (FTND) to assess nicotine dependence. Current tobacco users were defined as those who smoked in the past seven days. Nicotine dependence was classified as low, moderate or high for the FTND score of 0 -3, 4-6, and 7-10, respectively. Seventy-nine patients had diabetes, 226 had hypertension, and 114 had both. The prevalence of tobacco use was 20.8% (95% CI : 17.1 - 24.9); prevalence of smoking was 15% (95% CI: 11.9 â€" 18.8) and smokeless tobacco use was 7.2% (95% CI: 5 - 10.1). Moderate to high nicotine dependence was found among 59.7% of tobacco users; 75.9% tobacco users attempted to quit tobacco in the past one month. One-fifth of attendees of a NCD clinic in a secondary level hospital used tobacco, most of whom had moderate-to-high nicotine dependence.  High level of nicotine dependence and inability to quit despite making an attempt for it necessitates the inclusion of tobacco cessation services in the management of patients with non-communicable diseases.
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http://dx.doi.org/10.4081/monaldi.2021.1799DOI Listing
August 2021

Association of Optimal Lamotrigine Serum Levels and Therapeutic Efficacy in Mood Disorders: A Systematic Review.

J Clin Psychopharmacol 2021 Aug 26. Epub 2021 Aug 26.

From the Department of Psychiatry and Deaddiction, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India Department of Psychiatry and Psychology, Mayo Clinic Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, MN.

Purpose: The aim of the study was to appraise the current evidence on the optimal serum level for lamotrigine (LAM) in the treatment of mood disorders (major depressive disorder, bipolar disorder).

Methods: Major databases were searched for randomized controlled trials, open-label trials, and observational studies reporting serum LAM levels in adult patients treated with LAM for mood disorders.

Results: A total of 814 abstracts were screened and 24 articles were selected for full-text review. Seven studies (226 bipolar disorder and 17 major depressive disorder patients) including 1 randomized controlled trial (n = 43), 3 prospective (n = 53), and 3 retrospective (n = 147) studies met the study criteria with a study duration range from 6 to 96 weeks. Lamotrigine daily dosage varied from 25 to 425 mg/d among the studies. Studies reported inconsistent findings between LAM concentration and efficacy. Three studies did not identify a relationship between LAM levels and a significant improvement in mood symptoms. Two studies (n = 99) reported higher response rates with LAM serum levels of greater than 3.25 μg/mL and 1 study (n = 25) reported a wide therapeutic window of 5 to 11 μg/mL. Overall, LAM was well tolerated with no major significant adverse effects.

Conclusions: Most studies showed a minimum LAM threshold level of 3 μg/mL in patients with mood disorders; however, the data are inconsistent regarding the therapeutic range for LAM. Based on the pooled data, there is inconsistent evidence to make conclusive recommendations on therapeutic LAM serum levels for mood improvement. Further studies including larger sample sizes are required to address this relevant clinical question.
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http://dx.doi.org/10.1097/JCP.0000000000001475DOI Listing
August 2021

Development of polyclonal antibodies using bacterially expressed recombinant coat protein for the detection of (OYDV) and identification of virus free onion genotypes.

3 Biotech 2021 Aug 29;11(8):388. Epub 2021 Jul 29.

Division of Plant Pathology, ICAR-Indian Agricultural Research Institute, New Delhi, 110012 India.

Onion yellow dwarf virus (OYDV) belonging to the genus , family is one of the widely distributed viruses of species worldwide. It causes dwarfing, yellow striping, crinkling and flaccidity of the leaves of onion and garlic. To see the occurrence and incidence of OYDV on crop, an attempt was made to develop antibody based diagnostic assay which would be useful for routine indexing and screening of the germplasm. The total RNA was isolated from the symptomatic leaves of onion and the gene encoding coat protein (CP) was cloned. The nucleotide sequencing analysis of the cloned RT-PCR product revealed ~ 774 bp amplicon (OYDV CP) and it was further cloned in pET-28a ( +) expression vector which yielded ~ 30 kDa fusion protein with Histidine tag (HisBP). The expression of fusion CP was primarily checked on SDS-PAGE and further confirmed by Western blot. The HisBP-OYDV-CP was obtained in soluble state after purification and was used to immunize New Zealand white rabbit for the production of polyclonal antibody (PAb). The produced PAb against the purified fusion protein successfully detected OYDV from onion and garlic samples at 1:2000 dilutions in indirect-enzyme linked immunosorbent assay (DAC-ELISA). Thus, this study presents first report that Histidine tag (HisBP) fusion OYDV-CP based antibody production and its successful application in identification of virus free onion and garlic genotypes.
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http://dx.doi.org/10.1007/s13205-021-02921-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322188PMC
August 2021

Long-Range Augmented Reality with Dynamic Occlusion Rendering.

IEEE Trans Vis Comput Graph 2021 Aug 27;PP. Epub 2021 Aug 27.

Proper occlusion based rendering is very important to achieve realism in all indoor and outdoor Augmented Reality (AR) applications. This paper addresses the problem of fast and accurate dynamic occlusion reasoning by real objects in the scene for large scale outdoor AR applications. Conceptually, proper occlusion reasoning requires an estimate of depth for every point in augmented scene which is technically hard to achieve for outdoor scenarios, especially in the presence of moving objects. We propose a method to detect and automatically infer the depth for real objects in the scene without explicit detailed scene modeling and depth sensing (e.g. without using sensors such as 3D-LiDAR). Specifically, we employ instance segmentation of color image data to detect real dynamic objects in the scene and use either a top-down terrain elevation model or deep learning based monocular depth estimation model to infer their metric distance from the camera for proper occlusion reasoning in real time. The realized solution is implemented in a low latency real-time framework for video-see-though AR and is directly extendable to optical-see-through AR. We minimize latency in depth reasoning and occlusion rendering by doing semantic object tracking and prediction in video frames.
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http://dx.doi.org/10.1109/TVCG.2021.3106434DOI Listing
August 2021

Clinical Profile and Outcome of Critically Ill COVID-19 Patients With Malignancy Admitted in Intensive Care Unit of a Tertiary COVID Center, India.

Cureus 2021 Jul 22;13(7):e16553. Epub 2021 Jul 22.

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, IND.

Introduction There is a dearth of literature describing the clinical profile of coronavirus disease 2019 (COVID-19) in patients with malignancy. Patients with associated malignancy can have a more severe course of the disease. The aim was to study clinical course and outcome of critically ill patients admitted in ICU with associated malignancy. Methods The study was a single-center, retrospective, study conducted at a tertiary care hospital. Patients with active or recent malignancy on follow-up and with confirmed COVID-19 infection who were admitted to the Intensive care unit of COVID-19 dedicated hospital between November 1, 2020 to January 15, 2021 were included. Demographic data, clinical features, clinical course and outcome were retrieved from the hospital electronic medical records. Results A total of 24 patients with malignancy and COVID-19 were admitted to the ICU of COVID-19 center. There were 20 patients with solid organ malignancy and four patients with hematological malignancy. The most common malignancy was breast carcinoma in six (25 %) patients. Fifty percent of the patients were diagnosed with malignancy within the previous six months. Among the presenting symptoms, 13 (54.1%) patients presented with symptoms of severe acute respiratory infection (SARI), eight (33.3%) patients presented with altered sensorium, and three (12.5%) with pain abdomen. Regarding the severity of COVID-19, six (25%) patients had moderate COVID-19 and 18 (75%) had severe COVID-19. Out of 24 patients, six survived and 18 died, the mortality being 75%. The most common cause of death was sepsis with multiorgan dysfunction syndrome (MODS) in 10 (42.6 %) patients followed by severe acute respiratory distress syndrome (ARDS) and neurological cause in four (16.6 %) patients each. When survivors were compared with non-survivors, advanced age and presence of altered sensorium were more in non-survivors. Conclusion Severe COVID-19 and advanced malignancy is a sinister combination that has high mortality. These patients require close monitoring and aggressive care. Presence of altered sensorium and advanced age predicts poorer outcome.
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http://dx.doi.org/10.7759/cureus.16553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8378308PMC
July 2021

The Role of Religiosity and Guilt in Symptomatology and Outcome of Obsessive Compulsive Disorder.

Psychopharmacol Bull 2021 Jun;51(3):38-49

Rakesh, MD, Arvind, MD, Dutt, MD, Mamta, PhD, Bhavneesh, MD, Kavita, MD, Navneet, MBBS, Shrutika, MD, Priyanka, MD, Arun, MD, Harkamal, MD, Jagdeep, MD, Department of Psychiatry, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Punjab, India.

Importance: Religiosity and guilt are commonly featured in obsessive-compulsive disorders (OCD). The role of religiosity and guilt in OCD has been frequently studied in the literature and suggested that greater religiosity/spirituality, paranormal beliefs, and magical ideation have often been associated with enhanced obsessive-compulsive behavior. India being a multi-religious country, it is particularly notable that a research was required to assess the role of religiosity and guilt in symptomatology and outcome in OCD, a condition in which religious themes are often present. It has also been documented that the fear of guilt for doing something irresponsibly may lead to OCD symptoms.

Objective: The study aimed to seek the role of religiosity and guilt in symptomatology and outcome of OCD. This study also aimed to assess the pattern of symptomatology of patients with OCD and the relation between religiosity and guilt.

Settings And Design: This was a single-centered, prospective study for one year with six months follow-up.

Methods And Material: Fifty OCD subjects of either gender, aged between 18 years and 45 years were included in this study and were assessed using Yale-Brown Obsessive Compulsive Scale, Belief into Action Scale, and The Guilt Inventory instruments for the measurement of OCD severity, religiosity, and guilt, respectively. All the recorded data were analyzed using IBM SPSS version 20.1.

Results: At baseline, OCD severity was positively correlated with religiosity and guilt, while after 6-month follow-up, OCD severity was negatively correlated with religiosity and positively correlated with guilt.

Conclusion: Religiosity and guilt have significant effect on the symptomatology and outcome of OCD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374933PMC
June 2021

Can yield, soil C and aggregation be improved under long-term conservation agriculture in the eastern Indo-Gangetic plain of India?

Eur J Soil Sci 2021 Jul 18;72(4):1742-1761. Epub 2021 Feb 18.

International Maize and Wheat Improvement Center (CIMMYT) Patna India.

Deteriorating soil health, diminishing soil organic carbon (SOC), development of subsurface hard compact layer and declining system productivity are barriers to achieving sustainable production in the traditional rice-wheat cropping system (TA) in the eastern Indo-Gangetic Plain of India. Conservation agriculture (CA), which favours minimum soil disturbance, crop residue retention and crop diversification could be a viable alternative to the TA to address most of those major problems. With that in mind, a long-term experiment is being implemented at ICAR-RCER, Patna, Bihar, India, with four treatments: (a) TA, (b) full CA (fCA) and (c and d) partial CA (pCA1 and pCA2), differing in crop establishment methods, cropping system and crop residue management in a randomized complete block design. Measurement of soil health parameters was carried out in the 11th year of the experiment. The results revealed a beneficial effect of CA and 46 and 40% increase in SOC concentration and stock, respectively, under fCA over TA in the 0-7.5-cm soil layer. The effect of partial CA (pCA1 and pCA2) was variable, but an increasing trend was always observed under pCA compared to TA. There was an enrichment in SOC content of aggregates under CA irrespective of size class; however, no relation was found between SOC content and aggregate diameter. The contribution of macroaggregates to SOC stock was larger (36-66%) under CA in the 0-7.5-cm soil layer. Adoption of CA improved the macroaggregate content, MWD and GMD of aggregates, and aggregation ratio. Soil macropore content was greater under fCA, whereas other parameters were similar among treatments. The impact of CA was mostly limited to 0-7.5 cm soil layer and a maximum up to 15 cm soil depth while evaluation until 60 cm soil depth was realized. The yield of rice in CA was comparable to or higher than in TA, whereas the system rice equivalent yield was always higher (38-53%) under CA than under the conventional practices. Therefore, a CA-based cropping system must be encouraged, to increase SOC status, improve aggregation stability and, consequently, sustain or increase system productivity, in order to achieve food and nutritional security in the eastern Indo-Gangetic Plain of India.

Highlights: Effects of long-term conservation agriculture (CA) on soil C, aggregation and yield were evaluated.CA improved SOC concentration and stock by 46 and 40%, as well as macroaggregate SOC stock by 36-66%.Macro-aggregation and mean weight diameter improved in CA but was mostly limited to a shallow soil depth.CA can be promoted for sustainability of a rice-wheat system due to higher productivity (38-53%).
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http://dx.doi.org/10.1111/ejss.13092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359171PMC
July 2021

Euglenaspecies; Bioactive Compoundsand their Varied Applications.

Curr Top Med Chem 2021 Aug 13. Epub 2021 Aug 13.

Department of Biochemistry, Faculty of Science, University of Allahabad, 211002, UP. India.

Euglena, a microalga, has gained a great attention as it contains several bioactive compounds including food supplements, drugs and biofuels. The genus Euglena includes >300 species of unicellular, freshwater flagellates. The objective of this review article concerns the presentation of updated information on pharmacological and therapeutic properties and industrial implications of molecules isolated from Euglena species. A bibliographic search of scientific literature published till March, 2020 was made from scientific databases using different search engines.Euglenaproduces several antioxidant molecules, such as β-carotene, L-ascorbic acid, polymers of unsaturated fatty acids and phytotoxins useful in manufacturing many pharmaceutical, cosmetics, and nutraceutical compounds. It is a rich source of antimicrobial, anticancer, immunomodulatorycompounds.Though, several studies have indicated its therapeutic applications, extensive research is needed to explore its efficacy against many pathophysiological conditions including toxicity assessment of compound(s). Nevertheless, the biotechnological influence on industrial production of Euglena has been less exploited.
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http://dx.doi.org/10.2174/1568026621666210813111424DOI Listing
August 2021

Haralick texture features extracted from Ga-68 PSMA PET/CT to differentiate normal prostate from prostate cancer: a feasibility study.

Nucl Med Commun 2021 Aug 17. Epub 2021 Aug 17.

Department of Urology Department of Nuclear Medicine, All India Institute of Medical Sciences Department of Nuclear Medicine, VMMC & SH Diagnostic Nuclear Medicine Division, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

Objective: Role of texture parameters on the basis of Ga-68 PSMA PET/CT in prostate cancer (Pca) is largely unexplored. Present work done is a preliminary study that aims to evaluate the role of Haralick texture features on the basis of Ga-68 PSMA PET/CT in Pca in which texture features were used to differentiate between normal prostate and Pca tissue.

Methods: The study retrospectively enrolled patients in two groups: group 1 included 30 patients with biopsy-proven adenocarcinoma prostate and median age 64 years (range: 50-82 years) who underwent baseline Ga-68 PSMA PET/CT prior to therapy; group 2 included 24 patients with pathologies other than Pca and median age 53.5 years (range: 18-80 years) who underwent Ga-68 PSMA PET/CT as part of another study in our department. Patients in group 2 did not have any prostate pathology and served as controls for the study. The segmented images of prostate (3-D image) were used to calculate 11 Haralick texture features in MATLAB. SUVmax was also evaluated. All parameters were compared among the two groups using appropriate statistical analysis and P value <0.05 was considered significant.

Results: All 11 Haralick texture features, as well as SUVmax, were significantly different among Pca and controls (P < 0.05). Among the texture features, contrast was most significant (P value of Mann-Whitney U <0.001) in differentiating Pca from normal prostate with AUROC curve of 82.9% with sensitivity and specificity 83.30% and 73.30%, respectively at cut-off 0.640. SUVmax was also significant with AUROC curve 94.0% and sensitivity and specificity 62.5% and 90%, respectively at cut-off 5.7. A significant negative correlation of SUVmax was observed with contrast.

Conclusion: Haralick texture features have a significant role in differentiating Pca and normal prostate.
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http://dx.doi.org/10.1097/MNM.0000000000001469DOI Listing
August 2021

"Puddles on the Road": Hurdles in the Pathway from Symptoms to Diagnosis and Treatment in Children with Type 1 Diabetes.

Indian J Endocrinol Metab 2021 Jan-Feb;25(1):23-30. Epub 2021 Jul 21.

Endocrinology and Diabetes Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Introduction: This study was conducted to investigate the pathway from first symptoms to initiation of insulin regimen in children with new-onset Type 1 Diabetes Mellitus (T1DM) and explore the reasons behind diabetes ketoacidosis (DKA) at onset among children with T1DM.

Materials And Methods: An exploratory study was conducted using a pretested questionnaire, among parents of children diagnosed with T1DM within preceding 3 months.

Results: Out of the total 105 children, 56.1% were males. The median age was 7 years. The commonest reported symptoms were polydipsia (97.8%), polyuria (75.2%), and nocturia (75.2%). The mean time taken by parents from onset of symptoms to decide to visit the physician (appraisal gap) was 7.85 ± 7.95 days. The help-seeking gap (from decision-making to visiting a physician) was 3.01 ± 8.31 days, diagnostic gap (from first visit to diagnosis) was 4.19 ± 6.72 days, and the treatment gap (from diagnosis to the start of insulin) was 2.12 ± 6.87 days. The DKA at onset (was present in 39 out of 105 children 37.1%) and was higher among children with lower per-capita income (-0.017), lack of previous experience among parents (-0.017), longer appraisal (-0.023), and treatment gap (-0.009).

Conclusion: Increasing awareness about the diabetes among children among the public and primary healthcare workers can help prevent DKA at onset.
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http://dx.doi.org/10.4103/ijem.IJEM_519_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323632PMC
July 2021

Designing and Comparing Performances of Image Processing Pipeline for Enhancement of I-131-metaiodobenzylguanidine Images.

Indian J Nucl Med 2021 Apr-Jun;36(2):125-133. Epub 2021 Jun 21.

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

Objective: An image processing pipeline can have more than one image processing technique in sequence, and the output of the first technique becomes input for the next technique and so on. In this study, we have designed and compared the performances of image processing pipelines for enhancement of I-131-metaiodobenzylguanidine (mIBG) images.

Materials And Methods: Five different image processing pipelines (A [Gaussian filter, normalization], B [histogram specification (image 1), Gaussian filter, normalization], C [histogram specification (image 2), Gaussian filter, normalization], D [{histogram specification (image 3), Gaussian filter, and normalization], and E [histogram specification (image 4), Gaussian filter, normalization]) were designed and their performances were evaluated on I-131-mIBG images ( = 122). The image quality was assessed objectively using Perception-based Image Quality Evaluator (PIQE) score and subjectively (on scale 1-4) by two nuclear medicine physician. Sign test was applied to find the statistically significant difference between the image quality obtained using image processing pipelines. We applied test of proportion to compute difference in proportion of image quality score assigned to images obtained using image processing pipelines.

Results: Based on PIQE score, the quality of images obtained using all the five image processing pipelines were significantly better than that of input images ( < 0.001). The highest image quality score (=4) was assigned maximum number of times ( = 90) to the images obtained using image processing pipeline D and was significantly different from that of the second best image processing pipeline E ( = 0.015).

Conclusions: The image processing pipeline D was found to be better for enhancement of I-131-mIBG images.
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http://dx.doi.org/10.4103/ijnm.ijnm_231_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8320825PMC
June 2021

Sorghum polyphenols: plant stress, human health benefits, and industrial applications.

Planta 2021 Aug 10;254(3):47. Epub 2021 Aug 10.

Department of Plant Breeding and Genetics, COA, CCS Haryana Agricultural University, Hisar, 125004, Haryana, India.

Main Conclusion: Various phenolic compounds of sorghum are effective in the management of abiotic stress (salt, nutrients) and biotic stress (caused by birds, fungi and aphids). The health and industrial application of phenolics is mainly contributed by inherent antioxidant and nutraceutical potential. In a natural environment, plant growth is affected by various biotic and abiotic stresses. In every ecosystem, the presence of a wide range of harmful biological agents (bacteria, fungi, nematodes, mites, and insects) and undesirable environmental factors (drought, salinity, heat, excessive or low rainfall, etc.) may cause a heavy loss in crop productivity. Being sessile during evolution, plants have evolved multiple defense mechanisms against various types of microbial pathogens and environmental stresses. A plant's natural defense system produces some compounds named secondary metabolites, which include phenolics, terpenes, and nitrogen. The phenolic profile of grain sorghum, the least utilized staple crop, is unique, more diverse, and more abundant than in any other common cereal grain. It mainly contains phenolic acids, 3-deoxyanthocyanidins and condensed tannins. Sorghum polyphenols play a major role in plant defense against biotic and abiotic stresses and have many additional health benefits along with various industrial applications. The objective of this review is to discuss the phenolic compounds derived from grain sorghum and describe their role in plant defense, human health, and industrial applications.
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http://dx.doi.org/10.1007/s00425-021-03697-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353607PMC
August 2021

Budesonide: A promising candidate therapeutic for early COVID-19.

Ann Med Surg (Lond) 2021 Aug 2;68:102605. Epub 2021 Aug 2.

Veterinary Assistant Surgeon, Veterinary Hospital Aswar, Bhind, Madhya Pradesh, India.

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http://dx.doi.org/10.1016/j.amsu.2021.102605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327609PMC
August 2021

The impact of pediatric tracheostomy on the quality of life of caregivers.

Int J Pediatr Otorhinolaryngol 2021 Oct 27;149:110854. Epub 2021 Jul 27.

Department of Otolaryngology, Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.

Objective: Pediatric tracheostomy is a challenge in otolaryngology practice and it is associated with greater morbidity and mortality than in adults; hence, constant vigilance by the designated family caregiver is critical. This study was designed to assess the impact of on quality of life of caregivers in a homecare setting as a result of the presence of child with a tracheostomy.

Methods: This was a combined retrospective and prospective cohort study with caregivers of children younger than 16 years who had undergone a tracheostomy, had been discharged home with a tracheostomy tube and completed 6 months of domiciliary tracheostomy care. The consenting primary caregivers were assessed for their quality of life based on the PedsQL v 4.0 questionnaires across various domains.

Results: We identified the primary caregivers of 85 children who had undergone a tracheostomy during the study period. The children's median age was 3.5 years (range, 9 months to 14 years). The mean caregiver health-related quality of life (HRQOL) score was 59.3, the mean family functioning score was 62.8, and the mean total family impact score was 54.7 with relative deficits seen in caregiver's social functioning (56.9) and emotional functioning (53.2). Good or average quality of physical and social function was seen among 74 % and 65 % of caregivers respectively while only 55 % were reported having good or average emotional function. Emotional disturbance, interfering with everyday family activities, and sleep disturbance were the major concerns among caregivers.

Conclusion: The biopsychosocial consequences of caring for a child with a tracheostomy are profound for the family, affecting the quality of life of caregivers and adding to the emotional and social burden of the child's family.
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http://dx.doi.org/10.1016/j.ijporl.2021.110854DOI Listing
October 2021

Nutritional and physiological responses of broiler chicken to the dietary supplementation of Moringa oleifera aqueous leaf extract and ascorbic acid in tropics.

Trop Anim Health Prod 2021 Aug 5;53(4):428. Epub 2021 Aug 5.

Department of Animal Nutrition, Bihar Veterinary College, Patna, 800 014, India.

This study was intended to determine the comparative effects of Moringa oleifera aqueous leaf extract (MOALE) and ascorbic acid supplementation in the drinking water on growth performance, haemato-biochemical profile, antioxidant status and immune response of broiler chickens under tropical climate. All 135-day-old broiler chicks were divided into 3 different treatment groups. T0 served as control, T1 were fed basal ration with MOALE (90 ml/L drinking water), and T2 offered basal ration with ascorbic acid (15 mg/L drinking water) for 35-day experiment. All the standard managemental practices were followed during the experimental period. The 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity of MOALE was calculated with reference to different ascorbic acid concentration as standard. The antioxidant activity percentage of MOALE (90 µl) was 93.89%, and ascorbic acid (15 µg) was 98.76%, respectively, which was nearer to cent percent. Therefore, 90 ml MOALE and 15 mg ascorbic acid per litre drinking water, respectively, were used for supplementation in broiler chicken. The growth performance and feed efficiency were better in MOALE group followed by ascorbic acid supplemented birds without affecting the metabolism of nutrients. However, 10.71% better FCR was noted in MOALE supplemented group followed by ascorbic acid group (6.28%) in comparison with control. Most of the haemato-biochemical profiles were unaffected by the treatment except creatinine, while antioxidant profile was improved in the treatment group. Immunity status of broiler chicken against NDV was enhanced in both treatment groups; however, maximum profit is obtained in MOALE group followed by ascorbic acid supplemented birds.
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http://dx.doi.org/10.1007/s11250-021-02864-3DOI Listing
August 2021

Checklist to aid young physicians managing obstetric emergencies in rural India: a quality improvement initiative.

BMJ Open Qual 2021 07;10(Suppl 1)

Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Background: The decision to admit or refer a patient presenting with an obstetric emergency is extremely crucial. In rural India, such decisions are usually made by young physicians who are less experienced and often miss relevant data points required for appropriate decision making. In our setting, before the quality improvement (QI) initiative, this information was recorded on loose blank sheets (first information sheets (FIS)) where an initial clinical history, physical examination and investigations were recorded. The mean FIS completeness, at baseline, was 73.95% (1-5 January 2020) with none of the FIS being fully complete. Our objective was to increase the FIS completeness to >90% and to increase the number of FIS that were fully complete over a 9-month period.

Methods: With the help of a prioritisation matrix, the QI team decided to tackle the problem of incomplete FIS. The team then used fishbone analysis and identified that the main causes of incomplete FIS were that the interns did not know what to document and would often forget some data points. Change ideas to improve FIS completeness were implemented using Plan-Do-Study-Act (PDSA) cycles, and ultimately, a checklist (referred to as antenatal care (ANC) checklist) was implemented. The study was divided into six phases, and after every phase, a few FIS were conveniently sampled for completeness.

Results: FIS completeness improved to 86.34% (p<0.001) in the post implementation phase (1 Feb to 31 August 2020), and in this phase, 69.72% of the FIS were documented using the ANC checklist. The data points that saw the maximum improvement were relating to the physical examination.

Conclusion: The use of ANC checklist increased FIS completeness. Interns with no prior clinical and QI experience can effectively lead and participate in QI initiatives. The ANC checklist is a scalable concept across similar healthcare settings in rural India.
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http://dx.doi.org/10.1136/bmjoq-2021-001435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336185PMC
July 2021

Metabolic complications of childhood obesity.

J Family Med Prim Care 2021 Jun 2;10(6):2325-2330. Epub 2021 Jul 2.

Department of Pediatrics, PGIMER, Chandigarh, India.

Context: Childhood obesity is a global health problem. A percentage of 2.3 of Indian boys and 2.5 of Indian girls are obese. Childhood obesity is associated with many morbidities like diabetes mellitus, coronary artery disease, musculoskeletal problems, and increased mortality.

Aims: The aim of this study is to estimate burden of metabolic complications of obesity in child and parents of obese children and compare it with normal-weight children.

Settings And Design: The study was done at a tertiary health center in northern India. It was a cross-sectional study.

Methods And Material: We enrolled 60 obese children and age- and sex-matched 26 controls, based on Indian Academy of Pediatrics (IAP)2015 body mass index (BMI) charts. Anthropometric parameters and metabolic complications in family were compared between cases and controls. Clinical markers of metabolic derangements and laboratory metabolic profile were assessed for obese children.

Statistical Analysis Used: Descriptive statistics was used to describe frequencies. Chi-square test and Mann-Whitney test and Spearman correlation were used for comparison.

Results: The prevalence of obesity and obesity-related complications was high in families of obese children. Ten percent of obese children had impaired fasting glucose and 30% had Haemoglobin A1c (HbA1c) in prediabetes category. Forty percent of obese children had dyslipidemia, 45% had transaminitis, and 46.7 were vitamin D deficient. A percentage of 41.7 of obese children had fatty liver on ultrasound.

Conclusions: The family health and child weight are linked through home environment and genetics. The metabolic complications of obesity prediabetes, dyslipidemia, fatty liver, and lower vitamin D level are common in childhood obesity. Regular screening and interventions of metabolic complications are essential for saving child's future health.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_975_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284196PMC
June 2021

Comparison of analgesic efficacy of the conventional approach and mid-transverse process to pleura approach of the paravertebral block in video-assisted thoracoscopy surgeries: A randomised controlled trial.

Indian J Anaesth 2021 Jul 23;65(7):512-518. Epub 2021 Jul 23.

Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Background And Aims: The paravertebral block (PVB) is an effective alternative to thoracic epidural analgesia for post-operative analgesia in thoracic surgeries. Despite the use of ultrasound in PVB, the search for a safer approach continues. This study was conducted to compare the analgesic efficacy of conventional and mid-transverse process to the pleura (MTP) approach of the PVB.

Methods: Forty patients aged between 18-60 years, posted for video-assisted thoracoscopic surgery, were enroled for this study. Patients were randomised into two groups using a random number table, and group allocation was done by the sealed opaque envelope method. One group received PVB by conventional approach (group CP). In contrast, patients in the other group (group MP) received PVB by the mid-transverse process to pleura (MTP) approach before induction of general anaesthesia under ultrasound guidance. The study's primary aim was to compare analgesic consumption in the first 24 hours. Secondary aims were comparing the Visual Analogue Scale (VAS) score, block performance time, dermatomal spread, haemodynamic parameters such as heart rate (HR), oxygen saturation (SpO), and non-invasive blood pressure (NIBP), patient satisfaction scores, and complications observed. Data were analysed using Statistical Package for the Social Sciences version 23.

Results: Demographic parameters, block performance time, and dermatomal distribution were comparable in both groups. We did not find any statistical difference in the analgesic consumption in the first 24 hours ( = 0.38), VAS at rest or on movement, complication rates, and patient satisfaction scores between the groups.

Conclusion: The MTP approach of the PVB is as effective as the conventional thoracic paravertebral approach for post-operative analgesia in video-assisted thoracoscopic surgeries.
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http://dx.doi.org/10.4103/ija.IJA_64_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8312384PMC
July 2021

Genetic analysis of colorectal carcinoma using high throughput single nucleotide polymorphism genotyping technique within the population of Jammu and Kashmir.

Mol Biol Rep 2021 Aug 28;48(8):5889-5895. Epub 2021 Jul 28.

School of Biotechnology, Shri Mata Vaishno Devi University, Jammu and Kashmir 182320, Katra, India.

Background: SNP genotyping has become increasingly more common place to understand the genetic basis of complex diseases like cancer. SNP-genotyping through MassARRAY™ is a cost-effective method to quantitatively analyse the variation of gene expression in multiple samples, making it a potential tool to identify the underlying causes of colorectal carcinogenesis.

Methods: In the present study, SNP genotyping was carried out using Agena MassARRAY™, which is a cost-effective, robust, and sensitive method to analyse multiple SNPs simultaneously. We analysed 7 genes in 492 samples (100 cases and 392 controls) associated with CRC within the population of Jammu and Kashmir. These SNPs were selected based on their association with multiple cancers in literature.

Results: This is the first study to explore these SNPs with colorectal cancer within the J&K population.7 SNPs with a call rate of 90% were selected for the study. Out of these, five SNPs rs2234593, rs1799966, rs2229080, rs8034191, rs1042522 were found to be significantly associated with the current study under the allelic model with an Odds Ratio OR = 2.981(1.731-5.136 at 95% CI); p value = 4.81E-05 for rs2234593,OR = 1.685(1.073-2.647 at 95% CI);; p value = 0.02292 for rs1799966, OR = 1.5 (1.1-2.3 at 95% CI), p value = 0.02 for rs2229080, OR = 1.699(1.035-2.791 at 95% CI); p value = 0.03521 for rs8034191, OR = 20.07 (11.26-35.75); p value = 1.84E-34 for rs1042522 respectively.

Conclusion: This is the first study to find the relation of Genetic variants with the colorectal cancer within the studied population using high throughput MassARRAY™ technology. It is further anticipated that the variants should be evaluated in other population groups that may aid in understanding the genetic complexity and bridge the missing heritability.
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http://dx.doi.org/10.1007/s11033-021-06583-8DOI Listing
August 2021

Clinicoepidemiological Features and Mortality Analysis of Deceased Patients with COVID-19 in a Tertiary Care Center.

Indian J Crit Care Med 2021 Jun;25(6):622-628

Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India.

Background And Objective: A large number of studies describing the clinicoepidemiological features of coronavirus disease-2019 (COVID-19) patients are available but very few studies have documented similar features of the deceased. This study was aimed to describe the clinicoepidemiological features and the causes of mortality of COVID-19 deceased patients admitted in a dedicated COVID center in India.

Methodology: This was a retrospective study done in adult deceased patients admitted in COVID ICU from April 4 to July 24, 2020. The clinical features, comorbidities, complications, and causes of mortality in these patients were analyzed. Pediatric deceased were analyzed separately.

Results: A total of 654 adult patients were admitted in the ICU during the study period and ICU mortality was 37.7% (247/654). Among the adult deceased, 65.9% were males with a median age of 56 years [interquartile range (IQR), 41.5-65] and 94.74% had one or more comorbidities, most common being hypertension (43.3%), diabetes mellitus (34.8%), and chronic kidney disease (20.6%). The most common presenting features in these deceased were fever (75.7%), cough (68.8%), and shortness of breath (67.6%). The mean initial sequential organ failure assessment score was 9.3 ± 4.7 and 24.2% were already intubated at the time of admission. The median duration of hospital stay was 6 days (IQR, 3-11). The most common cause of death was sepsis with multi-organ failure (55.1%) followed by severe acute respiratory distress syndrome (ARDS) (25.5%). All pediatric deceased had comorbid conditions and the most common cause of death in this group was severe ARDS.

Conclusion: In this cohort of adult deceased, most were young males with age less than 65 years with one or more comorbidities, hypertension being the most common. Only 5% of the deceased had no comorbidities. Sepsis with multi-organ dysfunction syndrome was the most common cause of death.

How To Cite This Article: Aggarwal R, Bhatia R, Kulshrestha K, Soni KD, Viswanath R, Singh AK, Clinicoepidemiological Features and Mortality Analysis of Deceased Patients with COVID-19 in a Tertiary Care Center. Indian J Crit Care Med 2021; 25(6):622-628.
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http://dx.doi.org/10.5005/jp-journals-10071-23848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286396PMC
June 2021

Gastric emptying time of two different quantities of clear fluids in children: A double-blinded randomized controlled study.

Paediatr Anaesth 2021 Jul 27. Epub 2021 Jul 27.

Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, India.

Background: Perioperative pulmonary aspiration risk increases with increased preoperative gastric volume; hence traditionally, healthy children are kept fasted overnight before surgery. Current guidelines recommend 2-h clear fluids fasting prior to anesthesia. However, emerging evidence favors allowing 3 ml/kg clear fluids up to 1-h before anesthesia. We compared the gastric volume and gastric emptying time after ingestion of 3 ml/kg and 5 ml/kg of clear fluids.

Methods: The present study enrolled 44 children, aged between 6 and 14 years. On the day of surgery, baseline gastric volume was estimated using ultrasound and patients were randomly allocated into two groups of equal number, that is, Group 3 and Group 5 (patients received 3 ml/kg and 5 ml/kg 5% Dextrose respectively). Repeated gastric ultrasound was performed at every 5 min until the gastric volume reached baseline levels. The primary objective of the study was to compare gastric emptying time. Secondary objectives included comparison of antral cross-sectional area and gastric volume.

Results: The demographic profile, preoperative fasting duration for clear fluids, and baseline gastric volume were comparable between groups. In both groups, compared to baseline the antral cross-sectional area and gastric volume increased significantly following fluid ingestion and then decreased exponentially to reach baseline within 1-h. The median (IQR) (range) gastric emptying time (minutes) [35.0 (28.8, 40.0) (20.0-45.0) in group 3 and 40.0 (28.8, 45.0) (20.0-50.0) in group 5] and emptying half-time (minutes) [17.0 (15.7, 21.5) (14.4-24.0) in group 3 and 18.6 (16.0, 22.0) (15.1-23.8) in group 5] were comparable [median difference -5 (95% CI -7.8 to 2.1) and -1.5 (95% CI -2.3 to 1.0), respectively] (p = .16 and p = .44, respectively).

Conclusion: As the gastric volume returned to baseline within 1-h even after ingesting 5 ml/kg clear fluids, the preoperative fasting time can be reduced to 1-h and healthy children undergoing elective procedure can be safely allowed to drink up to 5 ml/kg clear fluids.
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http://dx.doi.org/10.1111/pan.14261DOI Listing
July 2021

Bartter syndrome and hypothyroidism masquerading cystinosis in a 3-year-old girl: rare manifestation of a rare disease.

BMJ Case Rep 2021 Jul 26;14(7). Epub 2021 Jul 26.

Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Cystinosis is a multisystem disorder with varied presentations secondary to deposition of cystine crystals in different organ systems. Children with cystinosis typically present with renal tubular acidosis and failure to thrive. We report a 3-year-old girl, born to a third-degree consanguineous couple, who presented with failure to thrive and polyuria. Laboratory investigations showed metabolic alkalosis suggestive of a Bartter-like syndrome and acquired hypothyroidism. Although metabolic alkalosis is a rare manifestation of cystinosis, the presence of renal tubular dysfunction and hypothyroidism prompted consideration of a probable diagnosis of cystinosis in the index child. Slit-lamp examination revealed cystine crystals in the cornea and genetic analysis showed a mutation in exon 9 of the CTNS (cystinosin, lysosomal cystine transporter) gene on chromosome 17. We highlight the importance of considering cystinosis as a differential diagnosis for Bartter syndrome and hypothyroidism.
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http://dx.doi.org/10.1136/bcr-2021-242954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8314690PMC
July 2021

Structural insights into the mechanism of human methyltransferase hPRMT4.

J Biomol Struct Dyn 2021 Jul 24:1-14. Epub 2021 Jul 24.

Translational Bioinformatics Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India.

Human PRMT4, also known as CARM1, is a type I arginine methyltransferase protein that catalyse the formation of asymmetrical dimethyl arginine product. Structural studies done to date on PRMT4 have shown that the N-terminal region, Rossmann fold and dimerization arm play an important role in PRMT4 activity. Elucidating the functions of these regions in catalysis remains to be explored. Studies have shown the existence of communication pathways in PRMT4, which need further elucidation. The molecular dynamics (MD) simulations performed in this study show differences in different monomeric and dimeric forms of hPRMT4, revealing the role of the N-terminal region, Rossmann fold and dimerization arm. The study shows the conformational changes that occur during dimerization and SAM binding. Our cross-correlation analysis showed a correlation between these regions. Further, we performed PSN and network analysis to establish the existence of communication networks and an allosteric pathway. This study shows the use of MD simulations and network analysis to explore the aspects of PRMT4 dimerization, SAM binding and demonstrates the existence of an allosteric network. These findings shed novel insights into the conformational changes associated with hPRMT4, the mechanism of its dimerization, SAM binding and clues for better inhibitor designs.Communicated by Ramaswamy H. Sarma.
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http://dx.doi.org/10.1080/07391102.2021.1950567DOI Listing
July 2021

Pre treatment and post treatment positron emission tomography-computed tomography (PET-CT) to evaluate treatment response in tuberculous Tubo-Ovarian masses.

Eur J Obstet Gynecol Reprod Biol 2021 Sep 16;264:128-134. Epub 2021 Jul 16.

Department of Nuclear Medicine, AIIMS, Delhi, India.

Purpose: Female genital Tuberculosis (FGTB) causes infertility and formation of Tubo-ovarian (TO) masses. The study showed treatment response of PET-CT in evaluation of anti-tubercular treatment response in patients of infertility with tuberculous TO masses.

Method: It's a Prospective study on 47 confirmed cases of FGTB with infertility having TO masses. All patients were subjected to 18F-FDGPET/CT to see the glucose uptake by the TO mass and extent of the disease. Category I treatment under DOTS was given for 6 months. All underwent follow-up of PET/CT to see the response to ATT. Results of pre ATT PET/CT were compared with post ATT PET/CT.

Results: TO masses was in 42 (89.36%); bilateral in 18 (38.29%) FDG uptake in 14 (29.78%) and without FDG uptake in 4 (8.51%) cases. Right sided mass in 13 (27.65%) FDG uptake in 9 (19.14%) and without FDG uptake in 4 (8.51%) cases. Left sided mass in 11 (23.40%) FDG uptake in 7 (14.89%) and without FDG uptake in 4 (8.51%) cases. Post ATT, there was significant decrease in most parameters. Repeat PET-CT done in 44 cases showed TO mass in 9 (20.45%); bilateral in 4 (9.09%) (FDG uptake in 2.27%) (p < 0.001), right sided in 3 (6.85%) (FDG uptake in 2.27%) (p < 0.002) and left side in 2 (2.27%) FDG uptake in 1 case (p < 0.004). Pelvic and mesenteric lymphadenopathy without FDG uptake was in 1 case (p value = 0.03) while omental and peritoneal deposits without FDG uptake in 1 and 2 cases, respectively.

Conclusion: PET-CT is useful in treatment response evaluation of tubercular TO masses.
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http://dx.doi.org/10.1016/j.ejogrb.2021.07.013DOI Listing
September 2021

Letter re 'Breakthrough COVID-19 infections among health care workers after two doses of ChAdOx1 nCoV-19 vaccine'.

QJM 2021 Jul 23. Epub 2021 Jul 23.

Department of Anaesthesia & Critical Care Medicine, All India Institute of Medical Sciences.

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http://dx.doi.org/10.1093/qjmed/hcab205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344412PMC
July 2021

A Prospective Study Comparing the Role of 18 FDG PET-CT with Contrast-Enhanced Computed Tomography and Tc99m Bone Scan for Staging Locally Advanced Breast Cancer.

Indian J Surg Oncol 2021 Jun 2;12(2):266-271. Epub 2021 Mar 2.

Department of Pathology, All India Institute of Medical Science, New Delhi, India.

Locally advanced breast cancer (LABC) patients require an accurate staging of the disease to rule out distant metastases. Various imaging investigations are used to stage LABC patients. The present study is a prospective comparison of conventional imaging (CI) with fusion positron-emission tomography and computed tomography (PET-CT) scans in the staging of LABC patients. Seventy-three consecutive LABC patients presenting to the breast cancer clinic of the tertiary care cancer institute were included in the study. All patients underwent contrast-enhanced computed tomography, Tv99m bone scintigraphy, and fusion PET-CT. Histology of the metastatic site was confirmed wherever possible. The disparity between the two imaging findings was compared. Doubtful lesions were observed clinically for at least 2 years to confirm their nature. PET-CT detected a higher number of lymph nodes in the axilla, internal mammary, and supraclavicular region as compared to CI. PET-CT upstaged 36.98% and downstaged 5.4% of the patients respectively leading to a change in the management in 30.13% of the patients. Sensitivity, specificity, positive predictive value, and negative predictive value of CI and PET-CT were 71.87%, 87.80%, 82.14%, and 80%, and 90.90%, 90%, 88.23%, and 92.30% respectively. PET-CT was more accurate in staging the LABC patients as compared to CI. PET-CT is more accurate then contrast-enhanced CT and bone scintigraphy for staging locally advanced breast carcinoma patients. It can replace multiple organ-directed imaging in staging breast cancer. It can provide accurate staging of the disease so that patients can be prognosticated and can be directed to the most appropriate treatment plans.
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http://dx.doi.org/10.1007/s13193-021-01299-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8272774PMC
June 2021
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