Publications by authors named "Vishal Kumar"

201 Publications

Cellular antioxidant potential and inhibition of foodborne pathogens by a sesquiterpene ilimaquinone in cold storaged ground chicken and under temperature-abuse condition.

Food Chem 2021 Oct 13;373(Pt A):131392. Epub 2021 Oct 13.

TERI-Deakin Nanobiotechnology Centre, The Energy and Resources Institute, Gwal Pahari, Gurugram, Haryana 122003, India. Electronic address:

A sesquiterpene quinone, ilimaquinone, was accessed for its cellular antioxidant efficacy and possible antimicrobial mechanism of action against foodborne pathogens (Staphylococcus aureus and Escherichia coli) in vitro and in vivo. Ilimaquinone was found to be protective against HO-induced oxidative stress as validated by the reduction in the ROS levels, including increasing expression of SOD1 and SOD2 enzymes. Furthermore, ilimaquinone evoked MIC against S. aureus and E. coli within the range of 125-250 µg/mL. Ilimaquinone established its antimicrobial mode of action against both tested pathogens as evident by bacterial membrane depolarization, loss of nuclear genetic material, potassium ion, and release of extracellular ATP, as well as compromised membrane permeabilization and cellular component damage. Also, ilimaquinone showed no teratogenic effect against zebrafish, suggesting its nontoxic nature. Moreover, ilimaquinone significantly reduced the S. aureus count without affecting the sensory properties and color values of cold-storaged ground chicken meat even under temperature abuse condition.
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http://dx.doi.org/10.1016/j.foodchem.2021.131392DOI Listing
October 2021

Zebrafish an experimental model of Huntington's disease: molecular aspects, therapeutic targets and current challenges.

Mol Biol Rep 2021 Dec 19;48(12):8181-8194. Epub 2021 Oct 19.

Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, 142001, India.

Huntington disease (HD) is a lethal autosomal dominant neurodegenerative disease whose exact causative mechanism is still unknown. It can transform from one generation to another generation. The CAG triplet expansion on polyglutamine (PolyQ) tract on Huntingtin protein primarily contributes in HD pathogenesis. Apart from this some another molecular mechanisms are also involved in HD pathology such as loss of Brain derived neurotrophic factor in medium spiny neurons, mitochondrial dysfunction, and alterations in synaptic plasticity are briefly discussed in this review. However, several chemicals (3-nitropropionic acid, and Quinolinic acid) and genetic (mHTT-ΔN17-97Q over expression) experimental models are used to explore the exact pathogenic mechanism and finding of new drug targets for the development of novel therapeutic approaches. The zebrafish (Danio rerio) is widely used in in-vivo screening of several central nervous system (CNS) diseases such as HD, Alzheimer's disease (AD), Parkinson's disease (PD), and in memory deficits. Thus, this makes zebrafish as an excellent animal model for the development of new therapeutic strategies against various CNS disorders. We had reviewed several publications utilizing zebrafish and rodents to explore the disease pathology. Studies suggested that zebrafish genes and their human homologues have conserved functions. Zebrafish advantages and their characteristics over the other experimental animals make it an excellent tool for the disease study. This review explains the possible pathogenic mechanism of HD and also discusses about possible treatment therapies, apart from this we also discussed about possible potential therapeutic targets which will helps in designing of novel therapeutic approaches to overcome the disease progression.  Diagrammatic depiction shows prevention of HD pathogenesis through attenuation of various biochemical alterations.
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http://dx.doi.org/10.1007/s11033-021-06787-yDOI Listing
December 2021

Integration of proteomic and genetic approaches to assess developmental muscle atrophy.

J Exp Biol 2021 Nov 5;224(21). Epub 2021 Nov 5.

Department of Biochemistry and Molecular Biophysics, Kansas State University, Manhattan, KS 66506, USA.

Muscle atrophy, or a decline in muscle protein mass, is a significant problem in the aging population and in numerous disease states. Unraveling molecular signals that trigger and promote atrophy may lead to a better understanding of treatment options; however, there is no single cause of atrophy identified to date. To gain insight into this problem, we chose to investigate changes in protein profiles during muscle atrophy in Manduca sexta and Drosophila melanogaster. The use of insect models provides an interesting parallel to probe atrophic mechanisms as these organisms undergo a normal developmental atrophy process during the pupal transition stage. Leveraging the inherent advantages of each model organism, we first defined protein signature changes during M. sexta intersegmental muscle (ISM) atrophy and then used genetic approaches to confirm their functional importance in the D. melanogaster dorsal internal oblique muscles (DIOMs). Our data reveal an upregulation of proteasome and peptidase components and a general downregulation of proteins that regulate actin filament formation. Surprisingly, thick filament proteins that comprise the A-band are increased in abundance, providing support for the ordered destruction of myofibrillar components during developmental atrophy. We also uncovered the actin filament regulator ciboulot (Cib) as a novel regulator of muscle atrophy. These insights provide a framework towards a better understanding of global changes that occur during atrophy and may eventually lead to therapeutic targets.
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http://dx.doi.org/10.1242/jeb.242698DOI Listing
November 2021

Outcomes of cauda equina syndrome due to lumbar disc herniation after surgical management and the factors affecting it: a systematic review and meta-analysis of 22 studies with 852 cases.

Eur Spine J 2021 Sep 28. Epub 2021 Sep 28.

Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Purpose: This study aimed to investigate the long-term clinical outcomes after surgical decompression in cauda equina syndrome (CES) and see if any preoperative patient-related factors contributed to this outcome.

Methods: A systematic literature search was conducted in the electronic databases of PubMed, Embase, Scopus, and Ovid. Data regarding outcome parameters from eligible studies were extracted. Meta-analysis was performed using a random-effect model.

Results: A total of 852 patients (492 males and 360 females), with a mean age of 44.6 ± 5.5 years from 22 studies diagnosed with cauda equina syndrome and undergoing surgical decompression, were included in the meta-analysis; however, not all studies reported every outcome. The mean follow-up period was 39.2 months, with a minimum follow-up of 12 months in all included studies. Meta-analysis showed that on long-term follow-up, 43.3% [29.1, 57.5] (n=708) of patients had persistent bladder dysfunction. Persistent bowel dysfunction was observed in 31.1% [14.7, 47.6] (n=439) cases, sensory deficit in 53.3% [37.1, 69.6] (n=519), motor weakness in 38.4% [22.4, 54.4] (n=490), and sexual dysfunction in 40.1% [28.0, 52.1] (n=411). Decompression within 48 hours of the onset of symptoms was associated with a favourable outcome in terms of bladder function with 24.6% [1.6, 50.9] (n=75) patients having persistent dysfunction, whereas 50.3% [10.3, 90.4] (n=185) of patients in studies with a mean time to decompression after 48 hours had persistent bladder dysfunction. Other factors such as speed of onset and sex of the patients were not found to significantly impact long-term bladder outcomes.

Conclusion: The long-term outcomes of CES after decompression are enumerated. Decompression within 48 hours of the onset of symptoms appears to result in fewer patients with persistent bladder dysfunction. However, a randomized controlled trial is required to conclusively determine whether early decompression leads to better outcomes.
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http://dx.doi.org/10.1007/s00586-021-07001-0DOI Listing
September 2021

Epitranscriptomic Approach: To Improve the Efficacy of ICB Therapy by Co-Targeting Intracellular Checkpoint CISH.

Cells 2021 08 30;10(9). Epub 2021 Aug 30.

Department of Biological Sciences, Sungkyunkwan University, Jangan-gu, Suwon 16419, Gyeonggi-do, Korea.

Cellular immunotherapy has recently emerged as a fourth pillar in cancer treatment co-joining surgery, chemotherapy and radiotherapy. Where, the discovery of immune checkpoint blockage or inhibition (ICB/ICI), anti-PD-1/PD-L1 and anti-CTLA4-based, therapy has revolutionized the class of cancer treatment at a different level. However, some cancer patients escape this immune surveillance mechanism and become resistant to ICB-therapy. Therefore, a more advanced or an alternative treatment is required urgently. Despite the functional importance of epitranscriptomics in diverse clinico-biological practices, its role in improving the efficacy of ICB therapeutics has been limited. Consequently, our study encapsulates the evidence, as a possible strategy, to improve the efficacy of ICB-therapy by co-targeting molecular checkpoints especially NA-modification machineries which can be reformed into RNA modifying drugs (RMD). Here, we have explained the mechanism of individual RNA-modifiers (editor/writer, eraser/remover, and effector/reader) in overcoming the issues associated with high-dose antibody toxicities and drug-resistance. Moreover, we have shed light on the importance of suppressor of cytokine signaling (SOCS/CISH) and microRNAs in improving the efficacy of ICB-therapy, with brief insight on the current monoclonal antibodies undergoing clinical trials or already approved against several solid tumor and metastatic cancers. We anticipate our investigation will encourage researchers and clinicians to further strengthen the efficacy of ICB-therapeutics by considering the importance of epitranscriptomics as a personalized medicine.
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http://dx.doi.org/10.3390/cells10092250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8466810PMC
August 2021

Ruptured Popliteal Cysts Mimicking Deep Vein Thrombosis in Well-Functioning Total Knee Replacements: Report of Two Cases and Review of Literature.

J Orthop Case Rep 2021 May;11(5):18-23

Department of Orthopaedics, Postgraduate Institute of Medical Education and Re-search, Chandigarh India.

Background: Implant wear and loosening with eluding metal/polythene debris are commonly implicated in the occurrence of Baker's cysts in post-operative total knee replacement (TKR) patients, who present with post-operative pain and swelling, mimicking deep venous thrombosis. However, we present two symptomatic cases presenting with ruptured Baker's cysts post-TKRs, with no evidence of implant loosening or wear.

Cases Report: The 1st patient was a 55-year-old male, who underwent TKR for Grade 4 bilateral knee osteoarthritis and presented with acute onset of pain and swelling over the left popliteal fossa, which progressed to involve the calf. Radiographs showed no sign of infection or loosening, and venous color Doppler and magnetic resonance imaging (MRI) showed a hy-poechoic collection in the intermuscular plane at the upper part of popliteal fossa. Histological examination of the aspirated fluid showed mixed features of cystic fluid and a resolving hematoma. There was complete resolution of the 4 months with rest and graduated physiotherapy.The 2nd patient was a 51-year-old female who developed the cystic swelling 2 years after the surgery, and the ultrasound showed hypoechoic echoes in a Baker's cyst-like collection. Cytological findings were suggestive of hemorrhagic nature of the aspirate, without any evi-dence of polyethylene debris, and the cultures were sterile. She became asymptomatic over 4 weeks with conservative management; the swelling resolved after 3 months.

Conclusion: Majority of the cases in literature show implant loosening as cause of popliteal cysts after TKRs, however present cases highlight alternative mechanisms, and there are good chances of self-resolution of cysts with conservative treatment in such cases.
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http://dx.doi.org/10.13107/jocr.2021.v11.i05.2188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422003PMC
May 2021

The Increased Burden of SARS-CoV-2 Infection in Orthopaedic Trauma Patients: Comparison of Demographics of Both the Waves of the Pandemic-An Indian Tertiary Center Experience.

Indian J Orthop 2021 Sep 13:1-6. Epub 2021 Sep 13.

Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: The second wave of SARS-CoV-2 pandemic has posed new challenges in the management of Orthopedic trauma patients due to the overburdened healthcare facilities and we aim to present the differences in demographics between the first wave and the initial part of the second wave.

Methodology: This study was a retrospective cross-sectional study of our trauma registry from June 19, 2020 to October 13, 2020 (1st study period) and from April 1, 2021 to the first week of May 2021 (2nd study period). We looked into differences in the following three parameters: (1) infection rate among Orthopaedic patients in the first and second study period of SARS-CoV-2 pandemic, (2) infection rate among the Health Care Workers and (3) hospital-acquired SARS-CoV-2 infections in admitted Orthopaedic trauma patients.

Results: 35 out of 852 patients (4.1%) were positive for SARS-CoV-2 infection in 1st study period as compared to 48 out of 262 patients (18.3%) in the 2nd study period ( < 0.001). 23 HCW's involved in management of Orthopaedic trauma patients tested positive in the second study period compared to none in the first study period. 17 patients had Hospital-acquired SARS-CoV-2 infection in 2nd study period compared to 7 in 1st study period. There were more asymptomatic patients for SARS-CoV-2 infection in the 2nd study period.

Conclusion: Significant increase in the number of SARS-CoV-2 infection in Orthopaedic trauma patients, and the increased number of HCW's affected with SARS-CoV-2 infection have been the challenges in 2nd study period.
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http://dx.doi.org/10.1007/s43465-021-00509-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436012PMC
September 2021

Towards Endovascular Treatment of Type A Aortic Dissection with Smaller Landing Zones and More Patient Eligibility.

J Vasc Surg 2021 Sep 6. Epub 2021 Sep 6.

Department of Surgery, University of California San Francisco, San Francisco, CA, United States.

Objective: Type A or ascending aortic dissection is an acute life-threatening condition with high morbidity and mortality. Open surgery remains standard-of-care. Development of minimally invasive endografts for Type A aortic dissection (TAAD) will require detailed understanding of dissection and aortic root anatomy to determine patient eligibility and optimal device specifications.

Methods: Computed tomography images of TAAD cases at our institution from 2012-2019 were identified and three-dimensional reconstructions were performed using OsiriX 10.0 (Bernex, Switzerland). Analysis of key anatomic structures including centerline length measurements, ascending aorta/aortic root dimensions, as well as location and extent of dissection were determined in relation to coronary ostia.

Results: A total of 53 patients were identified (mean±SD age 60.4±17.1 years; 36 male, 17 female), 46 of whom underwent surgery for TAAD. Four patients died within 30 days of surgery. In 47 patients (88.7%), the entry tear was distal to the highest coronary ostium. These cases were retrospectively considered for endovascular intervention with a non-branched, single endograft stent. Proximal landing zone (LZ) was defined as distance from the highest coronary ostium to entry tear: 35/53 (66.0%) had a proximal LZ length ≥2.0cm, 38/53 (71.7%) had proximal LZ length ≥1.5cm, and 42/53 (79.2%) had proximal LZ length ≥1.0cm. Proximal and distal LZ diameters of the sinotubular junction (STJ) and distal ascending aorta regions were (median [1 quartile-3 quartile]) 3.29cm [2.73-4.10cm] and 3.49cm [3.09-3.87cm], respectively, with length from STJ to innominate takeoff 8.08cm [6.96-9.40cm]. Ascending aorta radius of curvature was 6.48cm [5.27-8.00cm]. 47.2% (25/53) of patients could be treated with a straight tube graft with ≤20% diameter mismatch between the proximal and distal LZ.

Conclusions: Almost 80% of patients with TAAD had a proximal LZ ≥1.0cm, and of these, 47.2% had anatomy amenable to endovascular therapy with a non-tapered straight tube graft commercially available devices. To increase patient eligibility for TAAD endovascular intervention, enhanced precision deployment with adequate seal in shorter LZs will be required. Our results serve as a guide for endovascular device specifications designed to treat this devastating condition.
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http://dx.doi.org/10.1016/j.jvs.2021.08.054DOI Listing
September 2021

The Relative Merits of Posterior Surgical Treatments for Multi-Level Degenerative Cervical Myelopathy Remain Uncertain: Findings from a Systematic Review.

J Clin Med 2021 Aug 18;10(16). Epub 2021 Aug 18.

Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB0 0GG, UK.

Objectives: To assess the reporting of study design and characteristics in multi-level degenerative cervical myelopathy (DCM) treated by posterior surgical approaches, and perform a comparison of clinical and radiographic outcomes between different approaches.

Methods: A literature search was performed in Embase and MEDLINE between 1995-2019 using a sensitive search string combination. Studies were selected by predefined selection criteria: Full text articles in English, with >10 patients (prospective) or >50 patients (retrospective), reporting outcomes of multi-level DCM treated by posterior surgical approach.

Results: A total of 75 studies involving 19,510 patients, conducted worldwide, were identified. Laminoplasty was described in 56 studies (75%), followed by laminectomy with (36%) and without fusion (16%). The majority of studies were conducted in Asia (84%), in the period of 2016-2019 (51%), of which laminoplasty was studied predominantly. Twelve (16%) prospective studies and 63 (84%) retrospective studies were identified. The vast majority of studies were conducted in a single centre (95%) with clear inclusion/exclusion criteria and explicit cause of DCM. Eleven studies (15%) included patients with ossification of the posterior longitudinal ligament exclusively with cohorts of 57 to 252. The clinical and radiographic outcomes were reported with heterogeneity when comparing laminoplasty, laminectomy with and without fusion.

Conclusions: Heterogeneity in the reporting of study and sample characteristics exists, as well as in clinical and radiographic outcomes, with a paucity of studies with a higher level of evidence. Future studies are needed to elucidate the clinical effectiveness of posterior surgical treatments.
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http://dx.doi.org/10.3390/jcm10163653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397218PMC
August 2021

Novel thiomorpholine tethered isatin hydrazones as potential inhibitors of resistant Mycobacterium tuberculosis.

Bioorg Chem 2021 10 3;115:105133. Epub 2021 Jul 3.

Department of Pharmaceutical Chemistry, Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal (Westville), Durban 4000, South Africa.

Novel chemotherapeutic agents against multidrug resistant-tuberculosis (MDR-TB) are urgently needed at this juncture to save the life of TB-infected patients. In this work, we have synthesized and characterized novel isatin hydrazones 4(a-o) and their thiomorpholine tethered analogues 5(a-o). All the synthesized compounds were initially screened for their anti-mycobacterial activity against the HRv strain of Mycobacterium tuberculosis (MTB) under level-I testing. Remarkably, five compounds 4f, 4h, 4n, 5f and 5m (IC = 1.9 µM to 9.8 µM) were found to be most active, with 4f (IC = 1.9 µM) indicating highest inhibition of HRv. These compounds were further evaluated at level-II testing against the five drug-resistant strains such as isoniazid-resistant strains (INH-R1 and INH-R2), rifampicin-resistant strains (RIF-R1 and RIF-R2) and fluoroquinolone-resistant strain (FQ-R1) of MTB. Interestingly, 4f and 5f emerged as the most potent compounds with IC of 3.6 µM and 1.9 µM against RIF-R1 MTB strain, followed by INH-R1 MTB strain with IC of 3.5 µM and 3.4 µM, respectively. Against FQ-R1 MTB strain, the lead compounds 4f and 5f displayed excellent inhibition at IC 5.9 µM and 4.9 µM, respectively indicating broad-spectrum of activity. Further, molecular docking, ADME pharmacokinetic and molecular dynamics simulations of the compounds were performed against the DNA gyrase B and obtained encouraging results.
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http://dx.doi.org/10.1016/j.bioorg.2021.105133DOI Listing
October 2021

Is Minimally Invasive Plating Osteosynthesis Better Than Conventional Open Plating for Humeral Shaft Fractures? A Systematic Review and Meta-Analysis of Comparative Studies.

Indian J Orthop 2021 Jul 9;55(Suppl 2):283-303. Epub 2021 May 9.

Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226029 India.

Introduction: The aim of systematic review and meta-analysis was to find out whether minimally invasive plate osteosynthesis (MIPO) is better than open reduction and internal plate fixation (ORIF) in terms of functional outcome, achieving union (union time and incidence of non-union), intraoperative parameters (surgical duration, blood loss, and radiation exposure), and complications (iatrogenic radial nerve palsy and infection) for humeral shaft fractures.

Materials And Methods: We searched online databases (Pubmed, Embase, Scopus, and The Cochrane Library) from inception till 3rd September 2020 for articles comparing MIPO with ORIF for humeral shaft fractures. The methodological quality of randomized controlled trials (RCTs) was done by Cochrane Risk of Bias assessment tool 2 (RoB2) and of non-randomized studies (case-control and cohort studies) by Methodological Index for non-randomized studies (MINORS). Meta-analysis was performed using Review Manager 5.4 software.

Results: 11 studies (5 RCTs and 6 non-randomized comparative studies) involving a total of 582 patients (MIPO-290, ORIF-292) meeting our inclusion criteria were included in the study. There was no statistically significant difference in pooled analysis of functional outcome scores between MIPO and ORIF. Union time was significantly lesser (mean difference = 3.12 weeks) and incidence of non-union lower (odd's ratio = 0.27) in MIPO group. Surgical duration and intraoperative blood loss were significantly lesser in MIPO group. Iatrogenic radial nerve palsy and infection were higher in ORIF group.

Conclusions: This study showed that MIPO gives similar functional outcomes as compared to ORIF but causes significantly lesser blood loss, requires lesser operative duration and has a lesser incidence of major complications.

Trial Registration: International prospective register of systematic reviews (PROSPERO)-CRD42020208346, Date of registration 09/10/2020.

Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-021-00413-6.
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http://dx.doi.org/10.1007/s43465-021-00413-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275817PMC
July 2021

Methods to address metal artifacts in post-processed CT images - A guide for orthopedic surgeons.

J Clin Orthop Trauma 2021 Sep 1;20:101493. Epub 2021 Jul 1.

Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Computed tomography (CT) scans are often used for postoperative imaging in orthopedics. In the presence of metallic hardware, artifacts are generated, which can hamper visualization of the CT images, and also render the study ineffective for 3-D printing. Various solutions are available to minimize metal artifacts, and radiologists can employ these before or after processing the CT study. However, the orthopedic surgeon may be faced with situations where the metal artifacts were not addressed. To counter such problems, we present three (DIY) techniques that can be used to manage metal artifacts.
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http://dx.doi.org/10.1016/j.jcot.2021.101493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267498PMC
September 2021

Targeting N17 domain as a potential therapeutic target for the treatment of Huntington disease: An opinion.

EXCLI J 2021 9;20:1086-1090. Epub 2021 Jun 9.

Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab, India.

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http://dx.doi.org/10.17179/excli2021-3670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278213PMC
June 2021

TO THE EDITOR.

Spine (Phila Pa 1976) 2021 Oct;46(19):E1066

PGIMER: Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India.

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http://dx.doi.org/10.1097/BRS.0000000000004165DOI Listing
October 2021

Auscl-D: a mercury-free digital auscultatory sphygmomanometer.

J Med Eng Technol 2021 Nov 13;45(8):656-663. Epub 2021 Jul 13.

Department of Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar, India.

More than quarter of world's population is consumed by hypertension, leading to premature death of thousands of people per year across the globe. One of the major reasons behind hypertension misdiagnosis is inaccurate blood pressure (BP) measurements, which can be attributed to various human or instrumentation errors. Currently used BP measuring sphygmomanometers, suffers from poor reliability, performance deterioration over time or are unable to meet environmental protection protocols. In this article, we propose a low-cost, highly portable, light-weight, easily manufacturable, battery operated, mercury free, auscultation based digital sphygmomanometer - Auscl-D, for easy and accurate BP measurements. The proposed device can be made from easily available components with cheap manufacturing processes available throughout globe, even in remote areas. The device demonstrated to have accuracy comparable to mercury sphygmomanometer, which is the gold-standard for BP measurements. The preliminary clinical trials were conducted at Dayanand Medical College & Hospital (DMCH) (Ludhiana, India), to compare the performance of proposed device with commonly used aneroid sphygmomanometers employing the auscultatory method and validated oscillometric sphygmomanometers from MicroLife. The test results show good agreement for systolic and diastolic BP measurements taken using Auscl-D device compared to the aneroid and oscillometric types. This shows the potential of proposed design to serve as low-cost, highly portable replacement for conventionally used sphygmomanometers, without the toxicity and reliability issues.
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http://dx.doi.org/10.1080/03091902.2021.1946182DOI Listing
November 2021

TO THE EDITOR.

Spine (Phila Pa 1976) 2021 Sep;46(18):E1014

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http://dx.doi.org/10.1097/BRS.0000000000004158DOI Listing
September 2021

Tuberculosis of the spine and drug resistance: a review article.

Neurosurg Rev 2021 Jun 26. Epub 2021 Jun 26.

Department of Orthopedics, PGIMER, Chandigarh, India.

Pott's spine is tuberculosis of spine caused due to hematogenous spread of mycobacterium from a primary focus. It constitutes about 50% of skeletal tuberculosis cases. Paradiscal type is the most common type of spinal tuberculosis. Untreated cases can lead to complications like a cold abscess, paraplegia, and deformity which may require surgical intervention. Rapid molecular methods have made the diagnosis of spinal tuberculosis and drug resistance faster and easier but it still remains a problem due to difficulties in sample collection and the paucibacillary nature of the Pott spine. Antitubercular drug therapy forms the mainstay of management. The emergence of MDR TB and XDR TB has posed a big challenge in the management of spinal tuberculosis. The literature regarding drug resistance in spinal tuberculosis and its management is lacking. We conducted a literature review of 29 studies and presented information on pathogenesis, diagnosis, and management of spinal tuberculosis and drug resistance. New shorter regimens for MDR and XDR TB are under trial in different parts of the world. We believe this article will provide information on spinal tuberculosis and drug resistance and help clinicians outline important research areas.
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http://dx.doi.org/10.1007/s10143-021-01595-1DOI Listing
June 2021

Understanding the role of histone deacetylase and their inhibitors in neurodegenerative disorders: Current targets and future perspective.

Curr Neuropharmacol 2021 Jun 9. Epub 2021 Jun 9.

Neuroscience Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India.

Neurodegenerative diseases are the group of pathological conditions that cause motor inc-ordination (jerking movements), cognitive and memory impairments result due to degeneration of neurons in a specific area of the brain. Oxidative stress, mitochondrial dysfunction, excitotoxicity, neuroinflammation, neurochemical imbalance and histone deacetylase enzymes (HDAC) are known to play a crucial role in neurodegeneration. HDAC is classified into four categories (class I, II, III and class IV) depending upon their location and functions. HDAC1 and 2 are involved in neurodegeneration while HDAC3-11 and class III HDACs are beneficial as neuroprotective. HDACs are localized in different parts of the brain- HDAC1 (hippocampus and cortex), HDAC2 (nucleus), HDAC3, 4, 5, 7 and 9 (nucleus and cytoplasm), HDAC6 & HDAC7 (cytoplasm) and HDAC11 (Nucleus, Cornus ammonis 1 and spinal cord). In pathological conditions, HDAC up-regulates glutamate, phosphorylation of tau, and glial fibrillary acidic proteins while down-regulates BDNF, Heat shock protein 70, Gelsolin. Class III HDACs are divided into seven sub-classes (SIRT1-SIRT7). Sirtuins are localized in the different parts of the brain and neuron -Sirt1 (nucleus), Sirt2 (cortex, striatum, hippocampus and spinal cord), Sirt3 (mitochondria and cytoplasm), Sirt4, Sirt5 & Sirt6 (mitochondria), Sirt7 (nucleus) and Sirt8 (nucleolus). SIRTs (1, 3, 4, and 6) are involved in neuronal survival, proliferation and modulating stress response, and SIRT2 is associated with Parkinsonism, Huntington disease and Alzheimer's disease, whereas, SIRT6 is only associated with Alzheimer's disease. In this critical review, we have discussed the mechanisms and therapeutic targets of HDACs would be beneficial for the management of neurodegenerative disorders.
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http://dx.doi.org/10.2174/1570159X19666210609160017DOI Listing
June 2021

Letter to the editor: Dural Leak: Is It Deterrent to Outcomes in Spine Surgery?: 10 Years Retrospective Analysis of Incidence, Management Protocol, and Surgical Outcomes.

Spine (Phila Pa 1976) 2021 Sep;46(17):E954-E955

Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

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http://dx.doi.org/10.1097/BRS.0000000000004150DOI Listing
September 2021

Letter to the Editor on "Low Body Mass Index Is a Predictor for Mortality and Increased Length of Stay Following Total Joint Arthroplasty".

J Arthroplasty 2021 07;36(7):e63-e64

Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1016/j.arth.2021.03.014DOI Listing
July 2021

Does the use of intraoperative CT scan improve outcomes in Orthopaedic surgery? A systematic review and meta-analysis of 871 cases.

J Clin Orthop Trauma 2021 Jul 15;18:216-223. Epub 2021 May 15.

Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India.

Background: Intraoperative imaging is frequently made use of in Orthopaedic surgery. Historically, conventional 2-dimensional fluoroscopy has been extensively used for this purpose. However, 2D imaging falls short when it is required to visualise complex anatomical regions such as pelvis, spine, foot and ankle etc. Intraoperative 3D imaging was introduced to counter these limitations, and is increasingly being employed in various sub-specialities of Orthopaedic Surgery.

Objectives: This review aims to outline the clinical and radiological outcomes of surgeries done under the guidance of intraoperative 3D imaging and compare them to those done under conventional 2D fluoroscopy.

Methods: Three electronic databases (PubMed, Embase and Scopus) were searched for relevant studies that directly compared intraoperative 3D imaging with conventional fluoroscopy. Case series on intraoperative 3D imaging were also included for qualitative synthesis. The outcomes evaluated included accuracy of implant placement, mean surgical duration and rate of revision surgery due to faulty implants.

Results: A total of 31 studies from sub-specialities of spine surgery, pelvi-acetabular surgery, foot and ankle surgery and trauma surgery, having data on a total of 658 patients were analysed. The study groups which had access to intraoperative 3D imaging was found to have significantly increased accuracy of implant positioning (Odds Ratio 0.35 [0.20, 0.62], p = 0.0002) without statistically significant difference in mean surgical time (p = 0.57). Analysis of the studies that included clinical follow up showed that the use of intraoperative 3D imaging led to a significant decrease in the need for revision surgeries due to faulty implant placement.

Conclusion: There is sufficient evidence that the application of intraoperative 3D imaging leads to precise implant positioning and improves the radiological outcome. Further research in the form of prospective studies with long term follow up is required to determine whether this superior radiological outcome translates to better clinical results in the long run.
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http://dx.doi.org/10.1016/j.jcot.2021.04.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138210PMC
July 2021

TO THE EDITOR.

Spine (Phila Pa 1976) 2021 Jul;46(14):E798-E799

Senior Resident, Department of Community Medicine, PGIMER, Chandigarh India.

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http://dx.doi.org/10.1097/BRS.0000000000004103DOI Listing
July 2021

TO THE EDITOR.

Spine (Phila Pa 1976) 2021 Jul;46(14):E797-E798

Additional Professor, Department of Orthopaedics, PGIMER, Chandigarh, India.

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http://dx.doi.org/10.1097/BRS.0000000000004102DOI Listing
July 2021

Minimally Invasive Surgery versus Open Surgery for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis.

Asian Spine J 2021 May 11. Epub 2021 May 11.

Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Minimally invasive surgery (MIS) is being recommended over more invasive methods. MIS advantages are less time in the operating room, less blood loss, a shorter recovery time, and shorter length of stay. A systematic review and meta-analysis were performed using the literature from minimally invasive and open surgery for adolescent idiopathic scoliosis (AIS). We conducted this analysis to see whether MIS has advantages over traditional surgery. A systematic review was conducted using PubMed, Embase, and Scopus to find articles comparing minimally invasive and open surgery techniques for AIS patients. Data extraction and meta-analysis were completed. The primary data points collected were correction rate and functional outcomes, including perioperative and postoperative parameters. A total of six studies were included in the final analysis. The MIS group had 123 patients, and the open surgery group had 150 patients. The correction rate and functional outcomes favored the open surgery group with a mean difference of 4.60 (95% confidence interval [CI], 0.08 to 9.12) and 0.11 (95% CI, 0.04 to 0.17), respectively. The duration of surgery, blood loss, number of patients requiring transfusion, and analgesic requirements favored the MIS group with a significant difference. Open surgery is better than MIS in achieving a better correction rate and good functional outcomes. MIS is better over open surgery when perioperative parameters are considered.
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http://dx.doi.org/10.31616/asj.2020.0605DOI Listing
May 2021

Recent Advances in Chalcone-Based Anticancer Heterocycles: A Structural and Molecular Target Perspective.

Curr Med Chem 2021 Oct;28(33):6805-6845

School of Chemistry and Physics, University of KwaZulu-Natal (Westville Campus), Private Bag X01, Scottsville, Durban, South Africa.

Chalcones are an interesting class of compounds endowed with a plethora of biological activities beneficial to human health. These chemotypes have continued to attract increased research attention over the years; hence, numerous natural and synthetic chalcones have found with interesting anticancer activities through the inhibition of various molecular targets including ABCG2, BCRP, P-glycoprotein, 5α-reductase, Androgen Receptor (AR), Histone Deacetylases (HDAC), Sirtuin 1, proteasome, Vascular Endothelial Growth Factor (VEGF), Cathepsin-K, tubulin, CDC25B phosphatase, Topoisomerase, EBV, NF-κB, mTOR, BRAF, and Wnt/β-catenin. Moreover, the study of intrinsic mechanisms of action, particularly relating to specific cellular pathways and modes of engagement with molecular targets, may help medicinal chemists to develop more effective, selective, and cost-effective chalcone-based anticancer drugs. This review, therefore, sheds light on the effect of structural variations on the anticancer potency of chalcone hybrids reported in 2018-2019 alongside their mechanism of action, molecular targets, and potential impacts on effective cancer chemotherapy.
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http://dx.doi.org/10.2174/0929867328666210322102836DOI Listing
October 2021

Need for Testing and Supplementation of Vitamin D3 After Release of COVID-19 Lockdown in Patients with Increased Musculoskeletal Pain.

Indian J Orthop 2021 Mar 6:1-4. Epub 2021 Mar 6.

Department of Orthopedics, PGIMER, Chandigarh, India.

Aims: To evaluate vitamin D3 levels in patients who presented with increased musculo-skeletal pain after release of lockdown period when compared to pre-lockdown status.

Introduction: During this COVID pandemic, many countries have implemented lockdown measures and people have to work from home and many students and workers have to restrict themselves to home. During this period, their outdoor activities were limited. After the partial release of this lockdown many of them started to have some kind of physical activity and started experiencing body pains. We evaluated such patients for vitamin D3 levels and symptoms of fibromyalgia.

Methods: This is a retrospective analysis of patients from age group 18-60 presented to outpatient department or on telephonic consultation after partial release of lockdown. All patients who had mild back ache before lockdown and had symptoms exaggerated during this lockdown release were included. All patients were investigated for vitamin D3, PTH, thyroid profile, liver functional and kidney functional tests.

Results: Out of 120 patients presented to us in a period of 3 months, 31 patients had increased symptoms when compared to pre-lockdown status. 20 out of 31 patients had low vitamin D3 levels. 14 patients also developed symptoms of fibromyalgia.

Conclusion: There might be many reasons for increased pain during lockdown, but we focussed specially only on vitamin D3 because of its association with increased symptoms of COVID-19. This is a gentle reminder to test for vitamin D3 levels and supplement if found deficient.

Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-021-00376-8.
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http://dx.doi.org/10.1007/s43465-021-00376-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936236PMC
March 2021

30-Day Mortality Rate in Hip Fractures Among the Elderly with Coexistent COVID-19 Infection: A Systematic Review.

Indian J Orthop 2021 Mar 3:1-11. Epub 2021 Mar 3.

Department of Orthopaedics, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh India.

Purpose: Hip fractures in the elderly require a multi-disciplinary approach and are associated with increased morbidity and mortality. The current COVID-19 pandemic has affected substantially this high-risk population group. This present review was done to ascertain whether or not the pandemic has affected the 30-day mortality and outcomes of hip fracture in the elderly.

Research Question: Does the coexistence of COVID-19 infection and hip fractures in the elderly increase the mortality rates?

Methodology: A systematic review and meta-analysis were conducted using three databases (PubMed, EMBASE and SCOPUS) to compare the mortality rates between COVID-19 positive/suspect and COVID-19 negative patients. The secondary outcomes included comparison of in-hospital mortality, complication rate and length of hospital stay. Risk of bias assessment was done using the MINORS tool.

Results: The present review included 20 studies. : A significantly higher 30 day mortality rate was seen in COVID-19 positive/suspect patients with an Odds ratio of 6.09 (95% CI 4.75-8.59,  < 0.00001). : We observed significantly higher rates of inpatient mortality [OR 18.22, (95% CI 7.10-46.75], complication rate (OR 9.28, 95% CI 4.46-19.30), and length of hospital stay (MD: 4.96, 95% CI 2.86-7.05) in COVID-19 positive/suspect patients as compared to COVID-19 negative patients.

Conclusion: COVID-19 has deteriorated the outcomes in elderly patients with hip fractures and associated with higher rates of mortality in the short term. A multidisciplinary approach is needed to contain this "pandemic within a pandemic" and improve the overall outcome to survival.
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http://dx.doi.org/10.1007/s43465-021-00386-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926082PMC
March 2021

Median Effective Volume of 0.5% Ropivacaine for Ultrasound-guided Costoclavicular Block.

Anesthesiology 2021 04;134(4):617-625

Background: The median effective dose of ropivacaine required for producing an effective costoclavicular block has not yet been determined. The authors conducted this dose-finding study with the objective of determining the median effective dose of 0.5% ropivacaine required to produce a successful costoclavicular block for surgical anesthesia in 50% of the patients (ED50) as well as the calculated dose required for effective blockade in 95% of the patients (ED95).

Methods: This single-armed prospective study was conducted on 40 American Society of Anesthesiologists physical status I or II patients, aged 18 to 60 yr, with a body mass index of 18 to 30 kg/m2, scheduled to undergo forearm and hand surgeries under ultrasound-guided costoclavicular block. A volume of 0.5% ropivacaine administered in the costoclavicular space was determined using the sample up-and-down sequential allocation study design of binary response variables. The first patient received a volume of 26 ml of 0.5% ropivacaine. After a successful or unsuccessful block, the volume of local anesthetic was decreased or increased, respectively, by 2 ml in the next patient. Evaluation of sensory and motor block was performed every 5 min for 30 min and graded using a 3-point scale. Surgical anesthesia was considered to be successful if a minimum score of 14 was achieved and the surgeon was able to proceed with surgery without needing to supplement anesthesia.

Results: The volume of local anesthetic administered ranged from 8 to 26 ml. Centered isotonic regression with a bias-corrected Morris 95% CI derived by bootstrapping showed ED50 of 13.5 ml (95% CI, 11.5 to 15.4 ml) and ED95 of 18.9 ml (95% CI, 17.9 to 27.5 ml).

Conclusions: A 19-ml dose of 0.5% ropivacaine is likely to produce an effective ultrasound-guided costoclavicular block for providing adequate surgical anesthesia to 95% of the patients.

Editor’s Perspective:
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http://dx.doi.org/10.1097/ALN.0000000000003731DOI Listing
April 2021

Cadaveric anatomy of the lumbar triangular safe zone of Kambin's in North West Indian population.

Anat Cell Biol 2021 Mar;54(1):35-41

Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

A three dimensional triangular space 'the Kambin's triangle (KT)' present on the dorsolateral aspect of the intervertebral disc, is considered to be a safe area for transforaminal approaches. It allows access to the exiting and traversing nerve roots, the thecal sac and to the intervertebral disc spaces. Our aim was to calculate the area of the triangle by measuring the height and base at all the intervertebral spaces bilaterally in the lumbar region in North West Indian cadavers and to assess the diameter of circle inscribed within this triangle which will correspond to the size of cannula inserted for the minimally invasive transforaminal approaches in this population. Five randomly chosen adult cadavers were used for this study. After clearing the area, the exiting nerve was identified. The height and base of the bony KTs (n=40) were measured with the help of digital Vernier's calliper (accuracy 0.02 mm) to calculate the area of the KT. There is a steady increase in the area of the bony KT reaching maximum at the level of L4-5 intervertebral space. Statistically there were no differences in the calculated areas between right and left side. The mean diameter of inscribed circle within the triangle also showed gradual increase from 5.82 mm at L1-2 level, reaching maximum value of 7.26 mm at L4-5 level on the right side while on the left side the values were 5.66 mm and 8.16 mm respectively. Careful anatomical consideration is of utmost importance in transforaminal approaches during surgical or interventional procedures in this region. Cannula having external diameter ranging 6-8 mm is recommended for any interventional approach through Kambin's space.
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http://dx.doi.org/10.5115/acb.20.243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017462PMC
March 2021
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