Publications by authors named "V Y Vishnu"

75 Publications

Efficacy of Bacopa Monnieri (Brahmi) and Donepezil in Alzheimer's Disease and Mild Cognitive Impairment: A Randomized Double-Blind Parallel Phase 2b Study.

Ann Indian Acad Neurol 2020 Nov-Dec;23(6):767-773. Epub 2020 Dec 18.

Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Objectives: Alzheimer's disease (AD) is the most common cause of dementia worldwide in the older population. There is no disease-modifying therapy available for AD. The current standard of care drug therapy for AD is cholinesterase inhibitors, including donepezil. or brahmi is used in traditional Indian medicine for memory loss. We conducted a phase 2b randomized controlled trial (RCT) to find out the efficacy of brahmi and donepezil in AD and mild cognitive impairment (MCI).

Patients And Methods: The study was planned as a 52 week, randomized, double-blind, parallel-group, phase-2 single-center clinical trial comparing the efficacy and safety of (brahmi) 300 mg OD and donepezil 10 mg OD for 12 months in 48 patients with AD and MCI-AD including cognitive and quality of life outcomes. The primary outcome was differences in the change from baseline of the neuropsychological tests [Alzheimer's disease assessment scale-cognitive subscale (ADAS-Cog) and postgraduate institute (PGI) memory scale] at 12 months between the intervention group (brahmi) and active comparison group (donepezil).

Results: The study was terminated after 3 years and 9 months, after recruiting 34 patients, because of slow recruitment and a high dropout rate. Intention to treat analysis after adjusting for baseline confounders showed no difference in the rate of change in ADAS-Cog score from baseline at any time point, including the last follow-up. There was no difference in the rate of change in PGI Memory scale (PGIMS) at 3, 6, and 9 months. In the last follow-up, there was a significant difference in the change in total PGIMS score between brahmi and donepezil, while there was no difference in individual scores of the PGI memory scale.

Conclusion: This phase-2 RCT on the efficacy of brahmi vs. donepezil showed no significant difference between them after 1 year of treatment. Larger phase-3 trials, preferably multicentric, are required to find the superiority of brahmi over donepezil.
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http://dx.doi.org/10.4103/aian.AIAN_610_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900738PMC
December 2020

BRASH Syndrome: A Case Report.

J Emerg Med 2021 Feb 24. Epub 2021 Feb 24.

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

Background: BRASH syndrome, a relatively new entity, has been described in the recent literature. It is defined as a combination of bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia. Although it is apparent that clinical symptomatology includes shock, it is still unclear whether all patients will initially present with all five components mentioned in the BRASH acronym.

Case Report: An elderly woman presented to our Emergency Department (ED) with hyperkalemia, acute renal failure, and metabolic acidosis with bradycardia, which was refractory to antikalemic measures and atropine. The montage of clinical features put together showed a clear picture of BRASH syndrome, which helped us to streamline the management and achieve a better patient outcome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Renal failure with various metabolic derangements is commonly seen in the ED. We should be aware of this new clinical entity, as its incidence will certainly increase, and the management is a bit different. Prognosis is excellent with timely recognition and management of this rare clinical entity.
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http://dx.doi.org/10.1016/j.jemermed.2021.01.033DOI Listing
February 2021

C3G Regulates STAT3, ERK, Adhesion Signaling, and Is Essential for Differentiation of Embryonic Stem Cells.

Stem Cell Rev Rep 2021 Feb 23. Epub 2021 Feb 23.

CSIR-Centre for Cellular and Molecular Biology, Uppal Road, Hyderabad, 500 007, India.

C3G (RAPGEF1), engaged in multiple signaling pathways, is essential for the early development of the mouse. In this study, we have examined its role in mouse embryonic stem cell self-renewal and differentiation. C3G null cells generated by CRISPR mediated knock-in of a targeting vector exhibited enhanced clonogenicity and long-term self-renewal. They did not differentiate in response to LIF withdrawal when compared to the wild type ES cells and were defective for lineage commitment upon teratoma formation in vivo. Gene expression analysis of C3G KO cells showed misregulated expression of a large number of genes compared with WT cells. They express higher levels of self-renewal factors like KLF4 and ESRRB and show high STAT3 activity, and very low ERK activity compared to WT cells. Reintroduction of C3G expression in a KO line partially reverted expression of ESRRB, and KLF4, and ERK activity similar to that seen in WT cells. The expression of self-renewal factors was persistent for a longer time, and induction of lineage-specific markers was not seen when C3G KO cells were induced to form embryoid bodies. C3G KO cells showed poor adhesion and significantly reduced levels of pFAK, pPaxillin, and Integrin-β1, in addition to downregulation of the cluster of genes involved in cell adhesion, compared to WT cells. Our results show that C3G is essential for the regulation of STAT3, ERK, and adhesion signaling, to maintain pluripotency of mouse embryonic stem cells and enable their lineage commitment for differentiation.
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http://dx.doi.org/10.1007/s12015-021-10136-8DOI Listing
February 2021

Steroid Responsive Acute Isolated Ophthalmoplegia: A Rare Presentation of Anti-Gq1b Antibodies Syndrome.

Ann Indian Acad Neurol 2020 Sep-Oct;23(5):739-740. Epub 2020 Dec 8.

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

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http://dx.doi.org/10.4103/aian.AIAN_287_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887498PMC
December 2020

Clinodactyly - A Clinical Clue to Diagnose a Hereditary Periodic Paralysis.

Ann Indian Acad Neurol 2020 Sep-Oct;23(5):738-739. Epub 2020 Oct 7.

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

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http://dx.doi.org/10.4103/aian.AIAN_400_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887508PMC
October 2020

Efficacy of Low-Frequency Repetitive Transcranial Magnetic Stimulation in Ischemic Stroke: A Double-Blind Randomized Controlled Trial.

Arch Rehabil Res Clin Transl 2020 Mar 11;2(1):100039. Epub 2020 Jan 11.

Department of Neurology, All India Institutes of Medical Sciences, New Delhi.

Objective: To investigate the role of low-frequency repetitive transcranial magnetic stimulation (rTMS) along with conventional physiotherapy in the functional recovery of patients with subacute ischemic stroke.

Design: Double-blind, parallel group, randomized controlled trial.

Setting: The outpatient department of a tertiary hospital participants: first ever ischemic stroke patients (N=96) in the previous 15 days were recruited and were randomized after a run-in period of 75±7 days into real rTMS (n=47) and sham rTMS (n=49) groups.

Intervention: Conventional physical therapy was given to both the groups for 90±7 days postrecruitment. Total 10 sessions of low-frequency rTMS on contralesional premotor cortex was administered to real rTMS group (n=47) over a period of 2 weeks followed by physiotherapy regime for 45-50 minutes.

Main Outcome Measures: The primary efficacy outcomes were change in modified Barthel Index (mBI) score (pre- to postscore) and proportion of participants with mBI score more than 90, measured at 90±7 days postrecruitment. The secondary outcomes were change in Fugl-Meyer Assessment-upper extremity, Fugl-Meyer Assessment-lower extremity, Hamilton Depression Scale, modified Rankin Scale, and National Institute of Health and Stroke Scale (pre- to post-rTMS) scores at 90±7 days post recruitment.

Results: Modified intention to treat analysis showed a significant increase in the mBI score from pre- to post-rTMS in real rTMS group (4.96±4.06) versus sham rTMS group (2.65±3.25). There was no significant difference in proportion of patients with mBI>90 (55% vs 59%; =.86) at 3 months between the groups.

Conclusion: In patients with subacute ischemic stroke, 1-Hz low-frequency rTMS on contralesional premotor cortex along with conventional physical therapy resulted in significant change in mBI score.
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http://dx.doi.org/10.1016/j.arrct.2020.100039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853333PMC
March 2020

Low Back Pain and Foot Drop Associated with Dog Tapeworm Infection.

Am J Trop Med Hyg 2021 01;104(1)

2Department of Neuroradiology, AIIMS, New Delhi, India.

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http://dx.doi.org/10.4269/ajtmh.20-1011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790067PMC
January 2021

Case Report: Isolated Central Nervous System Melioidosis from a Non-Endemic Area.

Am J Trop Med Hyg 2021 Jan 11. Epub 2021 Jan 11.

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

Central nervous system (CNS) melioidosis is a rare neurological infectious disease which carries a high mortality. We describe a previously healthy middle-aged female, who presented to us with left-sided hemiparesis and was on antitubercular therapy from a previous presumed diagnosis of CNS tuberculoma. Non-characteristic imaging picture, multiple negative body fluid cultures, and positive Cerebrospinal fluid galactomannan led to a further delay in diagnosis. Gram stain of the tissue obtained from brain biopsy revealed Gram-negative rods in "safety pin" appearance. By picking up the colonies that appeared on blood agar and MacConkey agar, the identification of the clinical isolates was performed using VITEK matrix (BioMerieux)-assisted laser desorption ionization time-of-flight mass spectrometry (VITEK MALDI TOF MS database version 3.2) which revealed . After the institution of appropriate treatment, she survived but with significant morbidity. A high index of suspicion should be kept for such previously healthy individuals belonging to non-endemic areas, where presentation is suspicious of an infective etiology, but not improving despite appropriate therapy. This may help in early recognition and institution of recommended treatment so that mortality can be avoided.
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http://dx.doi.org/10.4269/ajtmh.20-1166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045644PMC
January 2021

Systemic lupus erythematosus presenting with holocord myelitis.

J Postgrad Med 2021 Jan-Mar;67(1):33-35

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

This is a report of a case of a 25-year-old woman, who presented with a rapidly progressive sensory-motor flaccid quadriparesis which had developed over a few days along with bladder and bowel involvement. She had a past history of photosensitive rash and joint pains along with mild-to-moderate grade fever; for which she had never been evaluated. Serological markers for systemic lupus erythematosus (SLE) were strongly positive and helped in establishing the diagnosis of SLE-related holocord myelitis. High-dose intravenous glucocorticoid followed by intravenous pulse cyclophosphamide was used to treat her and there was a significant improvement. In this case report, the diagnosis of SLE was made for the first time in a patient presenting with holocord myelitis.
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http://dx.doi.org/10.4103/jpgm.JPGM_716_20DOI Listing
March 2021

Assessment of Botulinum Neurotoxin Injection for Dystonic Hand Tremor: A Randomized Clinical Trial.

JAMA Neurol 2021 Mar;78(3):302-311

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

Importance: There is an unmet need for safe and efficacious treatments for upper-extremity dystonic tremor (DT). To date, only uncontrolled retrospective case series have reported the effect of botulinum neurotoxin (BoNT) injections on upper-extremity DT.

Objective: To assess the effect of BoNT injections on tremor in patients with upper-extremity DT.

Design, Setting, And Participants: In this placebo-controlled, parallel-group randomized clinical trial, 30 adult patients with upper-extremity DT treated at a movement disorder clinic in a tertiary care university hospital were randomized in a 1:1 ratio to BoNT or saline injection, 0.9%, using a computer-generated randomization sequence. Randomization was masked using opaque envelopes. The participant, injector, outcome assessor, and statistician were blinded to the randomization. Participants were recruited between November 20, 2018, and December 12, 2019, and the last follow-up was completed in March 2020.

Interventions: Participants received electromyographically guided intramuscular injections of BoNT or placebo into the tremulous muscles of the upper extremity. Injection patterns and doses were individualized according to tremor phenomenologic findings.

Main Outcomes And Measures: The primary outcome was the total score on the Fahn-Tolosa-Marin Tremor Rating Scale 6 weeks after the intervention. Outcomes were assessed at baseline, 6 weeks, and 12 weeks. All patients were offered open-label BoNT injections after 12 weeks and reassessed 6 weeks later.

Results: A total of 48 adult patients with a diagnosis of brachial dystonia with DT were screened. Fifteen were ineligible and 3 refused consent; therefore, 30 patients (mean [SD] age, 46.0 [18.6] years; 26 [86.7%] male) were recruited, with 15 randomized to receive BoNT and 15 to receive placebo. In the intention-to-treat group, the Fahn-Tolosa-Marin Tremor Rating Scale total score was significantly lower in the BoNT group at 6 weeks (adjusted mean difference, -10.9; 95% CI, -15.4 to -6.5; P < .001) and 12 weeks (adjusted mean difference, -5.7; 95% CI, -11.0 to -0.5; P = .03). More participants in the BoNT group reported global improvement on the Global Impression of Change (PGIC) assessment (PGIC 1, 2, and 3: BoNT: 4 [26.7%], 6 [40.0%], and 5 [33.3%]; placebo: 5 [33.3%], 10 [66.7%], and 0, respectively; P = .047). Subjective hand weakness (BoNT: 6 [40.0%]; placebo: 4 [28.6%], P = .52) and dynamometer-assessed grip strength (mean difference, -0.2 log10[kgf/m2]2/Hz-Hz; 95% CI, -0.9 to 0.4 log10[kgf/m2]2/Hz-Hz; P = .45) were similar in both groups.

Conclusions And Relevance: In this randomized clinical trial, botulinum neurotoxin injections were superior to placebo in reducing tremor severity in upper-extremity DT. An individualized approach to muscle selection and dosing was beneficial without unacceptable adverse effects.

Trial Registration: Clinical Trials Registry of India (http://ctri.nic.in) Identifier: CTRI/2018/02/011721.
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http://dx.doi.org/10.1001/jamaneurol.2020.4766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754081PMC
March 2021

An Acquired Neuro-Nephrology Syndrome.

J Clin Rheumatol 2020 Dec 14. Epub 2020 Dec 14.

From the Departments of Neurology.

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http://dx.doi.org/10.1097/RHU.0000000000001663DOI Listing
December 2020

Synthesis, characterization, molecular docking and anticancer studies of fluoroaniline derivatives of hydroxybenzoquinone and hydroxynaphthoquinone.

J Biomol Struct Dyn 2020 Dec 14:1-11. Epub 2020 Dec 14.

Department of Chemistry, Government Arts College, Thiruvananthapuram, Kerala, India.

Two series of fluoro substituted-anilino derivatives of naturally occurring hydroxybenzoquinone and hydroxynaphthoquinone were synthesized using TFA as catalyst to improve the product yield. Recently, fluorine containing compounds are being used as anticancer drugs. The aim of this study is to find compounds that are active against melanoma cells. This six new fluoro substituted quinone compounds were synthesized and characterized. All of these compounds were then subjected to molecular docking studies against B-raf protein using Discovery Studio 4.0 and the binding affinities were calculated. The energy scores of analysis revealed that all the compounds exhibited better binding affinity towards B-raf protein. Moreover, all the derivatives and the parent compounds, embelin and plumbagin along with standard drug, PLX4032 were investigated for its cytotoxicity in A375 cell lines (Melanoma) and ELISA assay in B-raf isolated from melanoma cells. Among them, 5-(3-chloro-4-trifluoromethoxy-phenylamino)-2-hydroxy-3-undecyl-[1,4]benzoquinone exhibited lower cell viability with lowest LC of 12.25 μg/mL and thus poses suitability to be a lead molecule for further drug discovery. Communicated by Ramaswamy H. Sarma.
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http://dx.doi.org/10.1080/07391102.2020.1852116DOI Listing
December 2020

Cysticidal Therapy for Diffuse Parenchymal and Calcific Neurocysticercosis.

Am J Trop Med Hyg 2020 Nov 16. Epub 2020 Nov 16.

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

Antiparasitic treatment improves the prognosis for neurocysticercosis (NCC)-induced seizures. However, patients with high lesion loads are typically denied the possible benefit of cysticidal therapy because of fear of complications, and such patients are not represented in clinical trials involving cysticidal therapy. We provide proof of concept for combination treatment with dual antiparasitic therapy and corticosteroids in patients with diffuse lesions, including starry sky patterns, or calcific NCC. The safety and efficacy of treating patients with high lesion loads or calcific NCC should be tested in a randomized controlled trial.
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http://dx.doi.org/10.4269/ajtmh.20-1124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866306PMC
November 2020

CADASIL and Cavernomas: A Common Mechanism.

Ann Indian Acad Neurol 2020 Jul-Aug;23(4):570-572. Epub 2020 Jul 16.

Department of Neurology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/aian.AIAN_684_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657275PMC
July 2020

Conduct of Virtual Neurology DM Final Examination during COVID-19 Pandemic.

Ann Indian Acad Neurol 2020 Jul-Aug;23(4):429-432. Epub 2020 Jul 17.

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

Medical training programs are witnessing immense disruptions worldwide due to the ongoing COVID-19 pandemic. Keeping in mind the trainees' future prospects, it is important to provide continuity of teaching and timely certification assessments. Overcoming the obstacles to routine functioning presented by SARS-CoV-2 spread, we recently conducted the DM Neurology exit examination in a hybrid virtual format. We created a curated case repository with history and clinical examination findings followed by structured questions that could be built upon for case discussions. The external examiners assessed the candidates virtually through a video conferencing platform. The end results were well accepted by all key stake holders. The concerns, logistics and experience of conducting the DM Neurology exit exam in a virtual format are summarized here.
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http://dx.doi.org/10.4103/aian.AIAN_593_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657290PMC
July 2020

Primary Central Nervous System Vasculitis Presenting with Isolated Headache.

J Neurosci Rural Pract 2020 Oct 4;11(4):678-679. Epub 2020 Sep 4.

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

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http://dx.doi.org/10.1055/s-0040-1715999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595778PMC
October 2020

Letter by Agarwal et al Regarding Article, "Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era".

Stroke 2020 11 26;51(11):e342. Epub 2020 Oct 26.

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

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http://dx.doi.org/10.1161/STROKEAHA.120.031678DOI Listing
November 2020

A novel approach to correlate the salivary exosomes and their protein cargo in the progression of cognitive impairment into Alzheimer's disease.

J Neurosci Methods 2021 01 17;347:108980. Epub 2020 Oct 17.

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

Background: Cognition is the ability of a person to think, remember, and interconnect ideas from various dimensions to strive for solutions. Cognitive defects accompany all forms of dementia and the decline in cognition is a most feared aspect. Mild cognitive impairment is considered as a transitional phase and the progressive loss in cognition can finally lead to Alzheimer's disease.

New Method: In this study, we demonstrated a novel method based on nanoparticle tracking analysis (NTA) technique to directly correlate salivary exosomes concentration with the progression of cognitive impairment (CI) in Alzheimer's disease (AD).This could open up the possibility for an early and cost-effective screening of Alzheimer's disease.

Results: Using our novel method, the total salivary exosomes concentration was measured by NTA technique, followed by validation of key exosomal cargo proteins through an automated western blot analyzer. We observed significant differences in salivary exosomes concentration among the groups of cognitively impaired and Alzheimer's disease patients (p = 0.0023) compared to the healthy control cohort. The method was validated through CD63 (exosomes surface marker) fluorescent antibody based quantification, which yielded a similar outcome (p = 0.0286). We further corroborated our findings with the expression level of oligomeric amyloid-beta, phosphorylated-tau protein from salivary exosomes. The Aβ oligomer/fibril abundance (p = 0.0291), phospho-tau (p = 0.0325) and Aβ protein abundance (p = 0.0198) was significantly higher in Alzheimer's and cognitively impaired patients in comparison to the healthy controls.

Comparison With Existing Method(s): There are few molecular biomarkers available to differentiate between various stages of cognitive impairment. Moreover, the current methodologies utilizing the few biomarkers available are either invasive or expensive; also, for a patient with mild cognitive complains, it is impractical to use these as a screening tool.

Conclusion: Our initial results indicate that the salivary exosomes concentration based on the nano-tracking technique has the potential to be used as a cost-effective screening method for early disease detection.
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http://dx.doi.org/10.1016/j.jneumeth.2020.108980DOI Listing
January 2021

Anticholinergics May Carry Significant Cognitive and Gait Burden in Parkinson's Disease.

Mov Disord Clin Pract 2020 Oct 29;7(7):803-809. Epub 2020 Aug 29.

Department of Neurology All India Institute of Medical Sciences New Delhi India.

Background: Anticholinergic drugs are associated with significant cognitive and other adverse events in older adults, including those with Parkinson's disease (PD). Anticholinergic effects are considered lesser in younger individuals and the burden and outcomes in younger patients with PD are unknown.

Objectives: To determine the cumulative anticholinergic burden in a cohort of younger of patients with PD and to correlate the same with cognitive impairment and freezing of gait (FOG).

Methods: We conducted a cross-sectional study to identify the cumulative anticholinergic burden from medications prescribed to patients with PD. Two standard scales, the Anticholinergic Cognitive Burden (ACB) scale and the ACB score, were used to calculate the anticholinergic burden from prescriptions. We identified commonly prescribed drugs contributing to anticholinergic effects and correlated the cumulative ACB score with cognitive impairment (Movement Disorder Society-Unified Parkinson's Disease Rating Scale item 1.1) and FOG (Movement Disorder Society-Unified Parkinson's Disease Rating Scale items 2.13 and 3.11).

Results: We recruited 287 patients with PD (68.9% male) with a mean age of 56.9 ± 11.8 years and a duration of symptoms 6.3 ± 6.9 years. Median ACB score was 4 (range 0-12). A total of 164 (58.4%) patients had total ACB score > 3. ACB score > 3 was independently associated with cognitive impairment (Odds Ratio, 2.55; 95% confidence interval, 1.43-4.53; < 0.001) and FOG using patient-reported measures (Odds Ratio, 3.192; 95% Confidence Interval, 1.68-6.07; < 0.001) and objective measures (odds ratio, 2.41; 95% confidence interval, 1.27-4.6, = 0.007).

Conclusion: Patients with PD are exposed to significant anticholinergic burden from drugs prescribed for PD and non-PD indications. Higher anticholinergic burden is associated with cognitive impairment and FOG even in younger patients with PD.
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http://dx.doi.org/10.1002/mdc3.13032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533974PMC
October 2020

Generation of iPSC from fetal fibroblast cells obtained from an abortus with type-I tri-allelic variants.

Stem Cell Res 2020 10 27;48:101963. Epub 2020 Aug 27.

Centre for Cellular and Molecular Biology, Hyderabad, India. Electronic address:

An integration free iPSC line was generated from fibroblast obtained from the skin of an aborted fetus in feeder free conditions using episomal based vectors expressing the pluripotency factors. The cell line generated was characterized and tested for pluripotency both in vitro and in vivo by teratoma formation and differentiation into defined lineages and brain organoids. Cell line reported here is shown to be mycoplasma free.
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http://dx.doi.org/10.1016/j.scr.2020.101963DOI Listing
October 2020

Quantification of geographical proximity of sugarcane bagasse ash sources to ready-mix concrete plants for sustainable waste management and recycling.

Waste Manag Res 2021 Feb 13;39(2):279-290. Epub 2020 Aug 13.

Department of Civil Engineering, Birla Institute of Technology and Science Pilani, Hyderabad, India.

As stated in the European Commission's waste framework directive, the geographic proximity of wastes to the potential recovery/disposal site is of paramount importance in attaining an effective resource recycling paradigm. The global interest in achieving an end-of-waste scenario encourages the recovery of useful products/secondary raw materials from locally available waste materials. Sugarcane bagasse ash is an abundantly available waste (44,200 tonnes day) from sugar plants in India which has the potential to be used as a partial replacement to cement in ready-mix concrete plants. Although pozzolanic performance of sugarcane bagasse ash and its ability in reducing the carbon emissions associated with concrete production have been reported in earlier research studies, its use in concrete is hindered due to the lack of availability and accessibility data. In this study, the geographical distribution of sugar plants and the available quantity of sugarcane bagasse ash in India have been determined. In addition, a detailed network analysis using a geographic information system was conducted to quantify the geographic proximity of bagasse ash, fly ash and slag sources to ready-mix concrete plants. The study results indicate that for most of the ready-mix concrete plants in India, the probability of having a bagasse ash source in proximity is higher than the probability of encountering slag/fly ash sources.
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http://dx.doi.org/10.1177/0734242X20945375DOI Listing
February 2021

Teaching NeuroImages: An oculocerebral metameric syndrome.

Neurology 2020 10 20;95(17):e2458-e2459. Epub 2020 Jul 20.

From the Departments of Neurology (B.M., V.Y.V., A. Gupta, R.R., R.B., M.B.S., M.V.P.S.), Neuroradiology (A. Garg), and Ophthalmology (R.S.), All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1212/WNL.0000000000010425DOI Listing
October 2020

Intracerebral Hemorrhage and SARS-CoV-2: Association or Causation.

Ann Indian Acad Neurol 2020 May-Jun;23(3):261-264. Epub 2020 Jun 5.

Department of Neurology, AIIMS, New Delhi, India.

Background: Recent respiratory infection including SARS-CoV-2 is an independent risk factor for acute cerebrovascular disease.

Purpose: There have been reports linking haemorrhagic strokes to SARS-CoV-2 infection during this pandemic, which lead us to evaluate if SARS-CoV-2 infection could be associated with increased risk of intracerebral haemorrhage (ICH).

Methods: A retrospective observational study evaluating all stroke cases admitted in our centre in the past one month.

Results: More than half (56%) had ICH, compared to 22% last year. Two patients with ICH were SARS-CoV-2 positive and they had no or mild respiratory symptoms and had higher occurrence of renal dysfunction.

Conclusion: There could be possible association between ICH and SARS-CoV-2 infections. However, a prospective study with larger sample size is needed to elucidate the pathogenesis.
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http://dx.doi.org/10.4103/aian.AIAN_362_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313569PMC
June 2020

Essential Workflow and Performance Measures for Optimizing Acute Ischemic Stroke Treatment in India.

Stroke 2020 07 17;51(7):1969-1977. Epub 2020 Jun 17.

Department of Radiology, Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Canada (M.G.).

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http://dx.doi.org/10.1161/STROKEAHA.119.026733DOI Listing
July 2020

Plasma Cell Gingivitis Mimicking Granulomatous Disease: A Diagnostic Dilemma.

Clin Adv Periodontics 2020 May 7. Epub 2020 May 7.

Department of Periodontics, Government Dental College, Thrissur, Kerala, India.

Introduction: Plasma cell gingivitis is an uncommon benign inflammatory condition of the gingiva which is considered to arise as a hypersensitivity reaction to certain allergens. The distinguishing feature of this condition is massive infiltration of plasma cells into the subepithelial connective tissue. This case report discusses a case of plasma cell gingivitis which produced a diagnostic dilemma due to its unusual histopathologic appearance.

Case Presentation: A 13-year-old female patient presented with diffuse gingival enlargement in relationship to upper anterior teeth. The case was managed successfully by gingivectomy following phase I therapy. Histopathological examination showed presence of epithelioid granulomas and foreign body giant cells along with plasma cells which is an uncommon finding in plasma cell gingivitis. Further tests conducted excluded granulomatous disease and the diagnosis was confirmed as plasma cell gingivitis.

Conclusion: Plasma cell gingivitis can present a diagnostic dilemma and should be included in the differential diagnosis of patients presenting with non-specific gingival enlargements.
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http://dx.doi.org/10.1002/cap.10108DOI Listing
May 2020

Delayed bilateral internal carotid artery dissection following motor vehicle accident: time to make its screening a part of trauma protocol?

QJM 2020 Sep;113(9):672-673

Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.

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http://dx.doi.org/10.1093/qjmed/hcaa037DOI Listing
September 2020

A split-mouth clinico-radiographic comparative study for evaluation of crestal bone and peri-implant soft tissues in immediately loaded implants with and without platelet-rich plasma bioactivation.

J Dent Res Dent Clin Dent Prospects 2019 14;13(2):117-122. Epub 2019 Aug 14.

Department of Prosthodontics and Crown & Bridge, School of Dental Sciences, KIMSDU, Karad, India.

This study evaluated the viability of platelet-rich plasma for enhancement of osseous and associated soft tissue healing around single-piece implants, subjected to immediate loading and to compare it with a control site not treated with PRP. Twenty completely edentulous patients were selected and 2 one-piece implants with O-ball head were placed for mandibular overdenture. The implant on the right side was treated with PRP whereas the left side implant served as a control. All the cases were immediately loaded and marginal bone loss, probing depth, percussion, implant mobility and peri-implantitis were assessed and compared at 3, 6, 9 and 12 months. Overall analysis of the results showed less marginal bone loss, probing depth, percussion, implant mobility and periimplantitis around implants treated with PRP; however, the results were insignificant statistically. PRP can be used as a viable treatment adjunct in immediately loaded one-piece implants.
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http://dx.doi.org/10.15171/joddd.2019.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773920PMC
August 2019

CADASIL syndrome and stroke in young people.

QJM 2020 Feb;113(2):118-119

From the Department of Neurology, New Delhi 110029, India.

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http://dx.doi.org/10.1093/qjmed/hcz243DOI Listing
February 2020

Genomics of rare genetic diseases-experiences from India.

Hum Genomics 2019 09 25;14(1):52. Epub 2019 Sep 25.

CSIR Institute of Genomics and Integrative Biology, Delhi, 110025, India.

Home to a culturally heterogeneous population, India is also a melting pot of genetic diversity. The population architecture characterized by multiple endogamous groups with specific marriage patterns, including the widely prevalent practice of consanguinity, not only makes the Indian population distinct from rest of the world but also provides a unique advantage and niche to understand genetic diseases. Centuries of genetic isolation of population groups have amplified the founder effects, contributing to high prevalence of recessive alleles, which translates into genetic diseases, including rare genetic diseases in India.Rare genetic diseases are becoming a public health concern in India because a large population size of close to a billion people would essentially translate to a huge disease burden for even the rarest of the rare diseases. Genomics-based approaches have been demonstrated to accelerate the diagnosis of rare genetic diseases and reduce the socio-economic burden. The Genomics for Understanding Rare Diseases: India Alliance Network (GUaRDIAN) stands for providing genomic solutions for rare diseases in India. The consortium aims to establish a unique collaborative framework in health care planning, implementation, and delivery in the specific area of rare genetic diseases. It is a nation-wide collaborative research initiative catering to rare diseases across multiple cohorts, with over 240 clinician/scientist collaborators across 70 major medical/research centers. Within the GUaRDIAN framework, clinicians refer rare disease patients, generate whole genome or exome datasets followed by computational analysis of the data for identifying the causal pathogenic variations. The outcomes of GUaRDIAN are being translated as community services through a suitable platform providing low-cost diagnostic assays in India. In addition to GUaRDIAN, several genomic investigations for diseased and healthy population are being undertaken in the country to solve the rare disease dilemma.In summary, rare diseases contribute to a significant disease burden in India. Genomics-based solutions can enable accelerated diagnosis and management of rare diseases. We discuss how a collaborative research initiative such as GUaRDIAN can provide a nation-wide framework to cater to the rare disease community of India.
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http://dx.doi.org/10.1186/s40246-019-0215-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6760067PMC
September 2019

Adult onset type II citrullinemia--a great masquerader.

QJM 2020 Jan;113(1):49-51

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

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http://dx.doi.org/10.1093/qjmed/hcz238DOI Listing
January 2020