Publications by authors named "Vishwajeet Singh"

218 Publications

Mycoplasma pneumoniae among Hospitalized Patients with Acute Respiratory Tract Infections in an Indian Tertiary Care Hospital: an Underreported Health Problem.

Microbiol Spectr 2022 Jul 14:e0158922. Epub 2022 Jul 14.

Department of Microbiology, All India Institute of Medical Sciencesgrid.413618.9, New Delhi, India.

The epidemiology of Mycoplasma pneumoniae (Mp) is poorly understood in India. The present study was conducted to identify the prevalence of Mp in a large set of patients with acute respiratory tract infections (ARI) in an Indian tertiary hospital. During 2015-2020, we tested throat swab specimens from patients with the clinical diagnosis of ARI ( = 1,098) by a real-time PCR and compared the demographic, clinical, laboratory, and outcome data of Mp-positive and Mp-negative patients. During the study period, 5% (55/1,098) of the tested samples were positive for Mp by PCR. School-aged children and young adults represented 36% (20/55) of the cases and 47.3% (26/55) of the cases were registered during the summer and monsoon. Among the Mp-positive patients, 61.8% (34/55) had underlying conditions; the most common were malignancy ( = 12; 21.8%) and hypertension ( = 6; 10.9%). Fever (98.2% versus 84.9%;  = 0.006), and pharyngitis (27.3% versus 16.3%;  = 0.034) were significantly common in the Mp-positive group than Mp-negative group. Among the Mp-positive group, 20% (11/55) of patients were admitted to an intensive care unit and a total of 7/55 (12.7%) patients received ventilatory support. The mortality in the Mp-positive cohort was 13.3%. The study provides baseline data regarding Mp prevalence and clinical characteristics. The application of molecular assays for diagnosing this pathogen among hospitalized patients with ARI could reduce inappropriate empirical antibiotic treatment and improve patient outcomes. Further large-scale studies are required to avoid the underdiagnosis of Mp infections in India and such studies should address some research gaps, such as macrolide resistance and molecular typing. M. pneumoniae (Mp) is a significant pathogen causing atypical pneumonia but by far these infections are underreported clinical entities in India. In the present study, we report the prevalence of Mp and describe the demographic and baseline clinical data of Mp-positive cases in an Indian tertiary care hospital. Our study may improve the clinician's awareness of this important agent of respiratory infection therefore timely and accurate diagnostic tools can be applied for patient management decisions and outcomes.
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http://dx.doi.org/10.1128/spectrum.01589-22DOI Listing
July 2022

Association of geriatric syndromes in older adults with chronic obstructive pulmonary disease.

Aging Med (Milton) 2022 Jun 12;5(2):106-112. Epub 2022 May 12.

Department of Geriatric Medicine All India Institute of Medical Sciences New Delhi India.

Background: Geriatric syndromes (GS) are multi-factorial conditions that make older adults vulnerable to morbidities and poor outcomes. The main objective was to observe the frequency of GS in older patients with COPD.

Methods: A case-control study was conducted in the Geriatric department of a tertiary care hospital in India to evaluate geriatric syndromes including falls, cognitive impairment, frailty, functional impairment, urinary incontinence, malnutrition, and depression in patients with COPD and controls without COPD. The factors having a significant association with the occurrence of these GS in COPD patients were observed.

Results: In this study, 150 cases and 150 controls were included. The mean age of the participant was 65.85±5.54, with 76% males. Functional impairment, cognitive impairment, frailty, urinary incontinence, and malnutrition were significantly higher in COPD patients. The independent variables which increased the odds of geriatric syndromes were dyspnoea (≥2 mMRC grade) (AOR:3.54,95% CI:1.06-11.8) and low socioeconomic status (AOR: 4.14, 95% CI: 1.03-16.54), while male gender showed inverse association (AOR: 0.08,95% CI: 0.01-0.99).

Conclusion: Geriatric syndromes are common in older COPD patients, and assessment for them should be done routinely in these patients.
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http://dx.doi.org/10.1002/agm2.12208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245167PMC
June 2022

Inclusion of Perineural Invasion with AJCC-TNM Staging: Outcomes from a South Asian Cohort of Curatively Treated Gastric Cancer Patients.

J Gastrointest Cancer 2022 Jun 24. Epub 2022 Jun 24.

Department of Radiotherapy, All India Institute of Medical Sciences, Bhubaneswar, India.

Background: The incidence of perineural invasion (PNI) in patients with gastric cancer (GC) is high, and patients with PNI positive disease have a poor prognosis compared to PNI-negative disease. The present study aims to study the incidence and evaluate the impact of PNI on the survival outcome of a cohort of South Asian GC patients.

Material And Methods: All consecutive patients undergoing curative gastrectomy were included in the study. The incidence of PNI and correlation with different clinico-pathological features and overall survival was performed.

Results: A total of 59.54% had PNI-positive disease and the median OS of PNI + ve patients was 29.3 months, while it was not reached in PNI-ve patients. The PNI positivity was a significant prognostic factor for overall survival both on univariate and multivariate analysis. On TNM-PNI staging, those with TNM stage I/II patients with PNI + ve disease had similar OS to all stage III patients (p = 0.835) and were worse than that of PNI-ve patients (p < 0.05).

Conclusion: The incidence of PNI in gastric cancer is high. The inclusion of PNI with AJCC-TNM staging may better stratify prognostic staging in curatively treated gastric cancer patients.
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http://dx.doi.org/10.1007/s12029-022-00838-8DOI Listing
June 2022

Identification of mycobacterial MPT-64 and ESAT-6 proteins in urogenital tuberculosis patients by real-time immuno-PCR.

Future Microbiol 2022 Jul 15;17:829-842. Epub 2022 Jun 15.

Centre for Biotechnology, Maharshi Dayanand University, Rohtak, 124001, India.

Diagnosis of urogenital tuberculosis (UGTB) is difficult and there is an immediate need to develop a reliable diagnostic test. A real-time immuno-PCR (RT-I-PCR) was developed to identify a cocktail of MPT-64 + ESAT-6 in both male/female UGTB patients comprising five confirmed cases, 40 clinically suspected cases and 37 non-TB controls, from whom mid-stream urine specimens were collected, while endometrial biopsies of female patients were obtained on day 1 of their menstrual cycle. Results obtained by RT-I-PCR were compared with I-PCR/ELISA and GeneXpert. A wide range (500 fg/ml-10 ng/ml) of MPT-64 + ESAT-6 was detected in UGTB specimens by RT-I-PCR, although ELISA showed a narrow range (2.5-11 ng/ml). Sensitivities of 80% and 82.2% were obtained by RT-I-PCR in clinically suspected and total UGTB cases, respectively, whereas 94.6% specificity was obtained. Concurrently, RT-I-PCR revealed significantly higher (p < 0.05-0.001) sensitivity than I-PCR/ELISA and GeneXpert. After improving the specificity, the authors may develop RT-I-PCR into a diagnostic kit.
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http://dx.doi.org/10.2217/fmb-2022-0037DOI Listing
July 2022

Lateral Lumbar Interbody Fusion With rhBMP-2 can Achieve High Fusion Rates in Adult Spine Deformity Surgeries.

Global Spine J 2022 May 18:21925682221103512. Epub 2022 May 18.

Division of Orthopedic Surgery Spine Program, Department of Surgery, 70401University of Calgary, Calgary, Alberta, Canada.

Study Design: An ambispective, observational study of the prospective, institutional adult spine deformity (ASD) database.

Objectives: The study investigates the clinical and radiographic fusion rates with lateral interbody approach and rhBMP-2 in multiple-level lumbar fusion in the ASD population. Previous studies have reported over 10% pseudoarthrosis rate with multiple segment fusions. Lateral lumbar interbody fusion (LLIF) allows multiple-level, less-invasive access to the anterior lumbar spine. We hypothesized that fusion rates with lateral approach with rhBMP-2 use are superior to the published data on lumbar fusion in ASD patients.

Methods: The institutional ASD database was searched to identify eligible patients with two or more levels of LLIF (T12-L5), >4 levels of posterior instrumentations and >2 years of follow-up between the years 2010 and 2018. Antero-posterior and lateral 36-inch standing radiographs for each patient and computed tomography scans in select patients were studied to ascertain fusion status and patients were divided into two groups based on fusion status.

Results: The study included 179 patients with a mean age of 65.3 years and 74% female patients. The median number of interbody fusions was performed at 3 (IQR 3-4) levels. The mean follow-up duration was 4.4 years (SD = 1.9). 169 patients (94.5%) had successful arthrodesis, while 10 patients (5.5%) had radiological pseudoarthrosis at one level. Of the 10 patients, 8 (4.4%) were either clinically asymptomatic or had manageable back pain. Two patients (1.1%) required revision surgery for symptomatic pseudoarthrosis.

Conclusion: This is the largest known series of ASD patients investigating the fusion rates with multiple-level LLIFs. LLIF along with rhBMP-2 can achieve high fusion success across interbody fusion levels in multi-segmental ASD surgeries.
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http://dx.doi.org/10.1177/21925682221103512DOI Listing
May 2022

Spectrum of Neuroimaging Abnormalities in Brain in Patients of Acute-on-Chronic Liver Failure.

J Clin Exp Hepatol 2022 Mar-Apr;12(2):343-352. Epub 2021 Aug 21.

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

Background And Aims: Acute-on-chronic liver failure (ACLF) is associated with high short-term mortality. There is a paucity of data about the spectrum of neuroimaging abnormalities in the brain in ACLF patients. The present study was aimed to study the prevalence of cerebral edema and other parenchymal changes in MR imaging of the brain in patients with ACLF.

Methods: In this prospective observational study, MR imaging was done in patients with ACLF (n = 41), and findings were compared with age and sex-matched patients with acute decompensation (AD) (n = 13) and those with cirrhosis but without any decompensation at recruitment (n = 21).

Results: Forty-one patients with ACLF (24.4% Grade 1 and Grade 2, 51.2% Grade 3) with 14 (34.1%) having cerebral failure were included in the study. T2-weighted (T2W) diffuse white matter hyperintensities (WMHs) and focal WMHs were seen in 17 (41.4%) and 7 (17%) patients, respectively. T1W basal ganglia hyperintensities in 20 (48.7%), cerebral microbleeds (CMBs) in 6 (14.6%), and 2 (4.8%) patients had cerebral edema. In patients with AD, T2W diffuse WMHs were seen in 3 (23%), T2W focal WMHs in 3 (23%) patients. None of the patients with AD had cerebral edema or CMBs. In compensated cirrhosis patients, T2W diffuse WMHs were present in 7 (33.3%), T2W focal WMHs in 5 (23.8%), while 3 (14.2%) patients had CMBs. T1 weighted hyperintensities in basal ganglia were more common in AD [9 (69.2%)] and compensated cirrhosis [15 (71.4%)] as compared to ACLF patients [20 (48.7%)],  = 0.174. The survival time of 30 and 90 days for patients with diffuse T2W WMHs was significantly lesser than patients without T2W WMHs ( = 0.007).

Conclusion: Cerebral edema is uncommon in ACLF patients, and T2-weighted diffuse white matter hyperintensities may be associated with worse outcomes. However, due to the limited scope of the present study, the same needs to be explored further in larger cohorts.
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http://dx.doi.org/10.1016/j.jceh.2021.08.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9077188PMC
August 2021

Effect of intensive weight-loss intervention on metabolic, ultrasound and anthropometric parameters among patients with obesity and non-alcoholic fatty liver disease: an RCT.

Eur J Clin Nutr 2022 Apr 20. Epub 2022 Apr 20.

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

Background: Lifestyle intervention is the mainstay therapy for Non-Alcoholic Fatty Liver Disease (NAFLD). We aimed to assess the efficacy of an intensive (9 contact points in 6 months) weight-loss intervention among patients with obesity (BMI 25-39.9 kg/m) and NAFLD in north India.

Methods: A total of 140 patients (18-60 years) with obesity and NAFLD were randomized into intervention (n = 70) and control (n = 70) groups, at a tertiary-care hospital. Weight, anthropometric parameters, Controlled Attenuation Parameter (CAP), Liver Stiffness Measurement (LSM), liver enzymes, grade of fatty liver and HOMA-IR were measured at baseline (T) and 6 months (T). There was a high drop-out, exacerbated by the Covid-19 pandemic. Completers comprised of 59 participants (n = 30 intervention, n = 29 control). Intention to treat analysis was done.

Results: At T, ALT normalized in significantly higher (p = 0.03) number of cases in the intervention arm (66.7%) versus control arm (18.2%). No significant improvement was seen in other metabolic, ultrasound or anthropometric outcomes. Weight (p < 0.001), AST (p = 0.01), ALT (p = 0.02), body fat% (p < 0.001), WC (p < 0.001) and CAP (p < 0.001) significantly improved within the intervention arm along with a trend of improvement in steatosis and HOMA-IR. Control group showed significant decrease in weight (p < 0.001), WC (p < 0.001) and CAP (p = 0.02). Twice the number of patients in intervention arm (46.7%) lost ≥5% weight, compared to control arm (24.1%) (p = 0.07).

Conclusion: The intensive weight-loss intervention was not effective in improving the treatment outcomes among patients with obesity and NAFLD. However, given the potential of our intervention, we recommend larger trials with more intensive weight-loss interventions.
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http://dx.doi.org/10.1038/s41430-022-01111-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020151PMC
April 2022

Patient perception and satisfaction with a smartphone-based teledermatology service initiated during the COVID-19 pandemic at a tertiary care hospital in North India.

Indian J Dermatol Venereol Leprol 2022 Mar 11:1-10. Epub 2022 Mar 11.

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.

Background: Telemedicine is being increasingly used to provide healthcare to patients, particularly during the COVID-19 pandemic.

Aims: The study aimed to study patient perception and satisfaction with a smartphone-based hybrid teledermatology service initiated during the COVID-19 pandemic.

Methods: This was a cross-sectional telephonic survey including patients ≥18 years of age who had received a teledermatology consultation. After noting the demographic, clinical and teleconsultation details, patients were administered the Telemedicine Satisfaction Questionnaire and an additional 6-item questionnaire. Patients were also asked to give qualitative feedback and suggestions for improvement using a semi-structured interview guide.

Results: We interviewed 201 subjects. The most common diagnoses were pemphigus (27, 13.4%), superficial fungal infections (24, 11.8%), psoriasis (22, 10.9%) and dermatitis (21, 10.4%). The overall mean Telemedicine Satisfaction Questionnaire score was 4.20± 0.71. One hundred seventy-one (85.1%) patients responded that they would use teledermatology services again, while 168 (83.6%) reported satisfaction with the quality of services. A majority of the patients were largely satisfied with the various components involved, though some concerns were raised about the care perceived as not at par with physical consultations, difficulty in procuring medicines, lack of confidence in photographic diagnoses and the lack of a personal touch. Patients with urticaria (P=0.020), those who were advised a change in treatment (P=0.029) and those with improvement in their skin disease (P=0.026) were more likely to be satisfied.

Limitations: Our study was conducted during the COVID-19 pandemic when patient acceptability was likely to be higher. Only follow-up patients were included in the study.

Conclusion: Patient satisfaction levels were generally high with teledermatology. Addressing lacunae that negatively impact patient perception and satisfaction will help in greater acceptance of teledermatology services.
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http://dx.doi.org/10.25259/IJDVL_608_2021DOI Listing
March 2022

Six-minute walk test and its predictability in outcome of COVID-19 patients.

J Educ Health Promot 2022 26;11:58. Epub 2022 Feb 26.

Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India.

Background: The world is worsely hit by the COVID-19 pandemic resulting in increased morbidity and mortality. Increased mortality has been observed in older adults with multiple comorbidities. Six-minute walk distance (6MWD) at admission can help us to guide the requirement of oxygen during hospital stay that can be used to determine which patient can be managed at home.

Materials And Methods: This study was a prospective observational study conducted on COVID-19 patients admitted at AIIMS, New Delhi, from October to December 2020. Patients aged more than 60 years were included in the study and underwent 6-min walk tests. Polypharmacy and multimorbidity were also assessed along with dyspnea which was measured on BORG scale. < 0.05 was considered statistically significant. Statistical software STATA (version 14.2) was used for all the analyses.

Results: The mean age of the study population was 68.76 (7.4). Oxygen saturation prior to the 6-MWT was normal and has significantly higher than the post test ( ≤ 0.001). 6MWD was significantly correlated with pre values of oxygen saturation. 6MWD was observed more in patients who did not require oxygen during hospital stay. Self-reported dyspnea, pulse rate, oxygen saturation, and systolic blood pressure were significantly associated with the patients who had an oxygen requirement during the hospital stay.

Conclusion: Self-reported dyspnea after 6MWT was found to be associated with oxygen requirement during hospital stay. Patients who have covered more distance in 6-min walk test have less oxygen requirement during hospital stay hence can be managed at home. This will reduce the health-care burden and will help to tackle the outburst during the ongoing pandemic.
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http://dx.doi.org/10.4103/jehp.jehp_544_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8975019PMC
February 2022

Association of severity and mortality of Covid-19 cases among acute kidney injury and sexual dimorphism.

Mol Biol Rep 2022 Jul 6;49(7):6753-6762. Epub 2022 Mar 6.

Department of Urology, King George's Medical University, Chowk, Lucknow, Uttar Pradesh, 226003, India.

Introduction: The outbreak of coronavirus disease 2019 (Covid-19) severely impacted global health and economic status. The native receptor-ligand interaction of Angiotensin-converting enzyme 2 (ACE2) and S protein induces host cell pathogenesis via immunosuppression.

Material And Methods: The emerging evidence reports the sex disparity in Covid-19 induced mortality rate which affects abundantly men population. Although the biological interaction of Covid-19 with receptor upregulates the viral genome protein interactions and initiates the predictive multiorgan failure followed by acute kidney injury (AKI) in Covid-19 infected male population.

Conclusion: Besides, the knowledge and lessons learned from the study depict that cellular and molecular links may explain the risk and severity of Covid-19 and AKI in the male population and lead to management of Covid-19 induced AKI. Therefore, this review explored the pathways associated with the pathogenesis of two diseased conditions with sex disparity.
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http://dx.doi.org/10.1007/s11033-022-07308-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8898193PMC
July 2022

Diagnostic Relevance of GATA 3 Expression in Urinary Bladder Carcinoma of Divergent Differentiation and Other Histological Variants.

Indian J Surg Oncol 2021 Dec 18;12(4):678-685. Epub 2021 Aug 18.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh India.

GATA , , has now been demonstrated as a valuable and sensitive marker for conventional urothelial carcinoma with sparse literature related to its expression in various histological variants. It is a prospective study where 74 consecutive cases of bladder carcinoma were included between August 2016 and January 2017 followed by immunohistochemistry to assess GATA 3 expression in conventional as well as different urothelial carcinoma (UC) variants. Overall, 57 of the 74 lesions (77%) demonstrated nuclear staining for GATA 3. GATA 3 expression significantly correlated with histological grade ( < 0.001) and muscle invasion ( = 0.005). Divergent differentiation was observed in 54% (40/74) of the total cases. The study included 12 different variants of urothelial carcinoma. All or majority of the cases of clear cell (6/6, 100%), glandular (6/8, 75%), and sarcomatoid (4/6, 66.7%) variants expressed GATA 3 in a moderate to strong fashion and belonged to group III or IV. Nested variant, small cell carcinoma, pure squamous cell carcinoma, and squamous component of urothelial carcinoma with squamous differentiation do not show any GATA 3 expression. GATA 3 was expressed more intensely as well as in greater number of tumor cells at lymph node metastatic tumor deposits as compared to the primary tumor. GATA 3 expression was not significantly associated with tumor stage or patients' clinical outcomes. GATA 3 is expressed in majority of variants of UC albeit with variable staining; however, situation is challenging in some variants known to be associated with poor prognosis like nested variant, small cell carcinoma, and squamous cell carcinoma where it is not expressed. Hence, the sensitivity of this determinant is diminished in these variants, which may affect the interpretation of GATA 3 stains at metastatic sites as well as their distinction from secondary bladder involvement, by tumors of non-urothelial origin.
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http://dx.doi.org/10.1007/s13193-021-01394-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8764006PMC
December 2021

Xanthogranulomatous cystitis with malakoplakia leading to recurrent spontaneous bladder perforation in a young girl.

Urol Case Rep 2022 Mar 16;41:101984. Epub 2021 Dec 16.

Department of Urology, King George's Medical University, Chowk, Lucknow, Uttar Pradesh, 226003, India.

Recurrent bladder perforation due to xanthogranulomatous cystitis with malakoplakia is rare entity and can lead to spontaneous bladder perforation. A 15 years girl presented with sudden pain abdomen with reduced urine output. Her exploratory laparotomy revealed, perforation of 2 cm at the dome of bladder with unhealthy margins. Excisional bladder biopsy and repair of bladder perforation by 3-0 polyglactin suture was done. The histopathology showed xanthogranulomatous cystitis with malakoplakia. Her records revealed the same histopathology in bladder perforation at age of 9 with lost follow-up till age of 15. Exploratory laparotomy and bladder repair should be done to save the patient.
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http://dx.doi.org/10.1016/j.eucr.2021.101984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8728461PMC
March 2022

Outcome of older adults at risk of frailty.

Aging Med (Milton) 2021 Dec 12;4(4):266-271. Epub 2021 Nov 12.

Department of Geriatric Medicine All India Institute of Medical Sciences New Delhi India.

Background: The integral part of the definition of frailty is the outcome associated with it. Older adults at risk of frailty are in the process of becoming frail. This study looked at the clinical characteristics and outcomes of older adults at risk of frailty.

Methodology: The study population was selected from outpatient department of the geriatric medicine department in a tertiary care hospital. Older adults identified as at risk of frailty were assessed at baseline and then followed up after 1 year for the composite primary outcome of death, falls, hospitalization, and self-rated poor quality of life in the follow-up period.

Results: The study included 324 older adults who had completed 1-year follow up. Mean (SD) age was 74.49 (4.58) years, and males were 241 (74.15%). Frail and pre-frail at baseline among the study population were 31.17% and 61.11%, respectively. The primary outcome occurred in 43 (13.27%) patients. Poor baseline IADL was significantly associated with primary outcome at the end of 1 year.

Conclusion: An unfavorable outcome in older adults at risk of frailty was significantly higher and independent of their baseline frailty status. Poor baseline IADL value may be considered as a predictor for primary outcome at 1 year of follow up.
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http://dx.doi.org/10.1002/agm2.12181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8711216PMC
December 2021

Effect of Meditation and Breathing Exercises on the Well-being of Patients with SARS-CoV-2 Infection under Institutional Isolation: A Randomized Control Trial.

Indian J Palliat Care 2021 Oct-Dec;27(4):490-494. Epub 2021 Nov 26.

Department of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, New Delhi, India.

Objectives: The corona virus disease-19 (COVID-19) pandemic has affected every domain of human health be it physical or mental. The uncertainty of disease progression in patients with SARS-CoV-2 infection can lead to major psychological and psychiatric concerns that should not be overlooked. The interventions should be directed to the vulnerable population to help them mitigate the stress and anxiety caused by the infection and isolation. We evaluated the effect of meditation and breathing exercises on the well-being of patients with SARS-CoV-2 infection under institutional isolation.

Materials And Methods: We conducted a randomized control trial on 84 subjects, 18 years and above, asymptomatic, or mildly symptomatic SARS-CoV-2 infected patients under institutional isolation. Subjects were randomly and equally divided into a control group and interventional group. We measured the depression, anxiety, and stress levels as well as quality of sleep in patients after 7 days of meditation and breathing exercises in the intervention group versus standard care in the control group.

Results: Meditation and breathing exercises had a statistically significant effect on the depression level (P < 0.001), stress level (P = 0.004), and the quality of sleep [trouble falling asleep (P = 0.007), trouble staying asleep (P = 0.004), and feel tired after waking up in the morning (P = 0.003)]. Further, the positive effect of intervention on the level of anxiety in patients under isolation was also observed; however, the difference was not found to be statistically significant (P = 0.528).

Conclusion: Meditation and breathing exercises have positive effects on depression, stress levels, and quality of sleep in COVID-19 positive patients under strict institutional isolation.
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http://dx.doi.org/10.25259/IJPC_40_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655642PMC
November 2021

The Outcome in Cirrhosis after Hospital Discharge is Not Worsened with COVID-19 Infection: A Propensity Score-matched Analysis.

J Clin Exp Hepatol 2022 May-Jun;12(3):830-840. Epub 2021 Nov 24.

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

Background: Patients with cirrhosis and coronavirus disease-2019 (COVID-19) have high in-hospital mortality. The information on the outcome of cirrhosis patients in the posthospitalization period is limited.

Aims: We aimed to study the outcome of cirrhosis patients with COVID-19 after hospital discharge.

Methods: The records of the cirrhosis patients discharged after COVID-19 were reviewed. Their data were compared with a similar number of cirrhosis patients without COVID-19 after propensity score matching for age, sex, etiology of cirrhosis, and model for end-stage liver disease (MELD) score.

Results: Cirrhosis patients with (n = 92) or without (n = 92) COVID-19 were included in 1:1 ratio. The mortality among COVID-19 (22; 23.9%) and non-COVID-19 (19; 20.7%) were comparable (HR 1.224; 95% CI 0.663-2.263,  = 0.520), over a similar duration of follow-up [186 (86-271) vs. 183 (103-274)]. Among COVID-19 patients, 45; 48.9% developed a new acute decompensation-increased ascites (40; 43.5%), hepatic encephalopathy (20; 21.7%), or variceal bleeding (8; 8.7%) whereas 25 (27.2%) patients needed rehospitalization. A proportion of participants continued to have either fatigue/weakness (24/80; 30.0%), sleep disturbances (11/80; 13.7%), or joint pains (16/80; 20.0%). The most common causes of death in patients of both groups were end-stage liver disease: 16 (72.7%) vs. 9 (47.4%), followed by multiorgan dysfunction: 4 (18.2%) vs. 6 (31.6%), GI bleeding: 2 (9.1%) vs. 4 (21.0%),  = 0.484. A lower albumin level, higher international normalized ratio, bilirubin, Child-Turcotte-Pugh, and MELD scores at discharge predicted mortality in the COVID-19 group.

Conclusion: Short-term outcomes of patients with cirrhosis who survive the initial insult of COVID-19 are not different from patients without COVID-19, and survival is determined by the severity of liver disease at discharge.
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http://dx.doi.org/10.1016/j.jceh.2021.11.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8610830PMC
November 2021

Clinical Utility of Transient Elastography in the Management of Patients with Budd-Chiari Syndrome Undergoing Endovascular Intervention.

J Vasc Interv Radiol 2022 03 16;33(3):268-277.e3. Epub 2021 Nov 16.

Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

Purpose: To quantify liver stiffness measurement (LSM) changes after endovascular intervention for Budd-Chiari syndrome (BCS) and evaluate whether LSM changes predict restenosis after endovascular intervention.

Materials And Methods: Patients with BCS who underwent endovascular intervention and had at least 2 LSM values available after the intervention were included. ΔLSM was the difference between LSMs estimated at the last and second last hospital visits. In patients with restenosis, 2 LSM values before restenosis were included. ΔLSM% was calculated as the ratio of ΔLSM to the LSM at the second last visit and expressed as a percentage. Odds ratio (OR) with confidence interval (CI) and area under the receiver operating characteristic curves (AUROCs) were calculated for the predictors of restenosis.

Results: The median baseline and postinterventional 1-week, 3-month, 6-month, and 12-month LSM values were 47.2 kPa (33.8-68.4 kPa), 29.2 kPa (24.5-43.0 kPa), 26.2 kPa (18.6-38.9 kPa), 20.9 kPa (13.3-29.8 kPa), and 17.3 kPa (11.8-25.4 kPa), respectively. Of the 118 patients, including 67 men, restenosis developed in 10 patients after a median (interquartile range) duration of 19 months (11-46 months). ΔLSM% was higher (more positive) in patients with restenosis than in those without restenosis (44.7 [8.3-134.3] vs -6.6 [-19.4 to 14.9], P = .001). ΔLSM% was a significant predictor of restenosis with an OR of 1.032 (95% CI, 1.015-1.050; P < .001). The AUROC for ΔLSM% was 0.831 (95% CI, 0.750-0.893; P = .001), and a ΔLSM% increment of 13.2% predicted restenosis with a sensitivity and specificity of 80.0% and 74.1%, respectively.

Conclusions: LSM gradually decreases after endovascular intervention, and transient elastography is a promising test for detecting restenosis after the endovascular treatment of patients with BCS.
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http://dx.doi.org/10.1016/j.jvir.2021.11.003DOI Listing
March 2022

A meta-analysis of the diagnostic performance of quiescent-interval-single-shot magnetic resonance angiography in peripheral arterial disease.

Eur Radiol 2022 Apr 12;32(4):2393-2403. Epub 2021 Nov 12.

All India Institute of Medical Sciences, Department of Cardiovascular Radiology and Endovascular Interventions, New Delhi, 110029, India.

Objectives: To evaluate by meta-analysis the diagnostic accuracy of non-contrast quiescent-interval-single-shot (QISS) magnetic resonance angiography (MRA) in patients with peripheral arterial disease (PAD) using digital subtraction angiography (DSA) or contrast-enhanced magnetic resonance angiography (CE-MRA) as reference standard.

Methods: This study was performed and reported according to the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines. A systematic literature search of MEDLINE, Embase and Scopus was done for studies reporting the diagnostic accuracy of QISS in PAD published up to 31 May 2021. The pooled sensitivity, specificity and diagnostic accuracy of QISS were calculated on a per-segment basis for the entire arterial tree.

Results: Seventeen studies including 459 patients were found eligible for the meta-analysis. There was significant heterogeneity among studies as depicted by chi-square test (p = 0.02) and moderate heterogeneity by I statistic (I: 69 [95% CI: 30-100]). The pooled sensitivity and specificity of QISS on a per-segment basis with DSA/CE-MRA as reference standard was 0.88 (95% CI: 0.85-0.91) and 0.94 (95% CI: 0.92-0.96) respectively. The area under hierarchical summary receiver-operating characteristic reflected a high accuracy of 0.96 (95% CI: 0.94-0.98). There was a low likelihood of publication bias as indicated by Deeks' funnel plot.

Conclusions: The present meta-analysis has consolidated the evidence that QISS has high accuracy for identifying as well as excluding arterial stenosis/occlusions in patients with symptoms of PAD. It can thus be considered the test of choice in patients with renal failure and in "at-risk patients" including pregnant women and patients with contrast allergy.

Key Points: • The pooled sensitivity and specificity of QISS magnetic resonance angiography on a per-segment basis with DSA or contrast-enhanced MRA as reference standard are 88% and 94% respectively. • The diagnostic accuracy of QISS in patients with peripheral arterial disease as reflected by area under hierarchical summary receiver-operating characteristic is high (0.96 (95% CI: 0.94-0.98)). • There is moderate to significant heterogeneity among studies as depicted by I statistic and chi-square test.
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http://dx.doi.org/10.1007/s00330-021-08349-zDOI Listing
April 2022

Associated pathogenesis of bladder cancer and SARS-CoV-2 infection: a treatment strategy.

Virusdisease 2021 Dec 24;32(4):613-615. Epub 2021 Sep 24.

Department of Urology, King George's Medical University, Lucknow, 226003 India.

Coronavirus disease 19 (Covid-19) is a pandemic that affects every human on Earth. Mortality rates are greater in people with both cancer and Covid-19. In comparison, patients with non-Muscle-Invasive Bladder Cancer (NMIBC) had reduced susceptibility to moderate Covid-19 mortality. The treatment and clinical management of NMIBC are consistent with BCG-mediated intravesical adjuvant therapy as a protective function against tumors. BCG vaccination exhibits a non-specific protective role against respiratory infections. This non-specific effect of BCG is partially mediated by innate immune memory due to epigenetic changes in innate and adaptive immune system cells induced by the microbe. This editorial suggests that regularly test repurposed drugs include anti-cancer drugs till the proper antiviral drugs or vaccines will be developed.
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http://dx.doi.org/10.1007/s13337-021-00742-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475482PMC
December 2021

Atypical bacterial co-infections among patients with COVID-19: A study from India.

J Med Virol 2022 01 15;94(1):303-309. Epub 2021 Sep 15.

Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Emerging evidence shows co-infection with atypical bacteria in coronavirus disease 2019 (COVID-19) patients. Respiratory illness caused by atypical bacteria such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila may show overlapping manifestations and imaging features with COVID-19 causing clinical and laboratory diagnostic issues. We conducted a prospective study to identify co-infections with SARS-CoV-2 and atypical bacteria in an Indian tertiary hospital. From June 2020 to January 2021, a total of 194 patients with laboratory-confirmed COVID-19 were also tested for atypical bacterial pathogens. For diagnosing M. pneumoniae, a real-time polymerase chain reaction (PCR) assay and serology (IgM ELISA) were performed. C. pneumoniae diagnosis was made based on IgM serology. L. pneumophila diagnosis was based on PCR or urinary antigen testing. Clinical and epidemiological features of SARS-CoV-2 and atypical bacteria-positive and -negative patient groups were compared. Of the 194 patients admitted with COVID-19, 17 (8.8%) were also diagnosed with M. pneumoniae (n = 10) or C. pneumoniae infection (n = 7). Confusion, headache, and bilateral infiltrate were found more frequently in the SARS CoV-2 and atypical bacteria co-infection group. Patients in the M. pneumoniae or C. pneumoniae co-infection group were more likely to develop ARDS, required ventilatory support, had a longer hospital length of stay, and higher fatality rate compared to patients with only SARS-CoV-2. Our report highlights co-infection with bacteria causing atypical pneumonia should be considered in patients with SARS-CoV-2 depending on the clinical context. Timely identification of co-existing pathogens can provide pathogen-targeted treatment and prevent fatal outcomes of patients infected with SARS-CoV-2 during the current pandemic.
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http://dx.doi.org/10.1002/jmv.27324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8661859PMC
January 2022

Diagnosis of osteoarticular tuberculosis: multi-targeted loop-mediated isothermal amplification assay versus multiplex PCR.

Future Microbiol 2021 09 20;16:935-948. Epub 2021 Aug 20.

Centre for Biotechnology, Maharshi Dayanand University, Rohtak, 124001, India.

Diagnosis of osteoarticular tuberculosis (OATB) is quite challenging and there is an urgent need to design a prompt and precise diagnostic test. We developed a multi-targeted loop-mediated isothermal amplification (LAMP) assay using (Rv1980c) and (Rv0934) targets for the detection of in OATB patients. The sensitivities of 100 and 82.4% were obtained in confirmed (n = 10) and suspected (n = 57) OATB cases, respectively by multi-targeted LAMP with a specificity of 96.9% (n = 33). Moreover, the sensitivities attained by multi-targeted LAMP in total OATB cases were significantly higher (p < 0.05-0.01) than multiplex PCR ( + ) and GeneXpert assay. Our LAMP is simple, reliable and cost-effective method, which may develop into an attractive diagnostic kit for early detection of OATB cases.
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http://dx.doi.org/10.2217/fmb-2021-0030DOI Listing
September 2021

Coinfections with Other Respiratory Pathogens among Patients with COVID-19.

Microbiol Spectr 2021 09 21;9(1):e0016321. Epub 2021 Jul 21.

Department of Microbiology, All India Institute of Medical Sciencesgrid.413618.9, New Delhi, India.

Emerging evidence indicates that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected individuals are at an increased risk for coinfections; therefore, physicians need to be cognizant about excluding other treatable respiratory pathogens. Here, we report coinfection with SARS-CoV-2 and other respiratory pathogens in patients admitted to the coronavirus disease (COVID) care facilities of an Indian tertiary care hospital. From June 2020 through January 2021, we tested 191 patients with SARS-CoV-2 for 33 other respiratory pathogens using an fast track diagnostics respiratory pathogen 33 (FTD-33) assay. Additionally, information regarding other relevant respiratory pathogens was collected by reviewing their laboratory data. Overall, 13 pathogens were identified among patients infected with SARS-CoV-2, and 46.6% (89/191) of patients had coinfection with one or more additional pathogens. Bacterial coinfections (41.4% [79/191]) were frequent, with Staphylococcus aureus being the most common, followed by Klebsiella pneumoniae. Coinfections with SARS-CoV-2 and Pneumocystis jirovecii or Legionella pneumophila were also identified. The viral coinfection rate was 7.3%, with human adenovirus and human rhinovirus being the most common. Five patients in our cohort had positive cultures for Acinetobacter baumannii and K. pneumoniae, and two patients had active Mycobacterium tuberculosis infection. In total, 47.1% (90/191) of patients with coinfections were identified. The higher proportion of patients with coinfections in our cohort supports the systemic use of antibiotics in patients with severe SARS-CoV-2 pneumonia with rapid de-escalation based on respiratory PCR/culture results. The timely and simultaneous identification of coinfections can contribute to improved health of COVID-19 patients and enhanced antibiotic stewardship during the pandemic. Coinfections in COVID-19 patients may worsen disease outcomes and need further investigation. We found that a higher proportion of patients with COVID-19 were coinfected with one or more additional pathogens. A better understanding of the prevalence of coinfection with other respiratory pathogens in COVID-19 patients and the profile of pathogens can contribute to effective patient management and antibiotic stewardship during the current pandemic.
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http://dx.doi.org/10.1128/Spectrum.00163-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552727PMC
September 2021

Acquired labial synechia in a virgin reproductive-aged woman: presentation and management.

Int Urogynecol J 2021 Dec 9;32(12):3317-3319. Epub 2021 Jul 9.

Department of Urology, King George's Medical University, Lucknow, U.P., 226003, India.

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http://dx.doi.org/10.1007/s00192-021-04905-9DOI Listing
December 2021

Do Imaging Markers of Cerebral Small Vessel Disease Predict Hematoma Volume and Outcome in Acute Intracerebral Hemorrhage?

Ann Indian Acad Neurol 2021 Mar-Apr;24(2):204-210. Epub 2020 Jul 24.

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

Background And Purpose: Cerebral small vessel disease (CSVD) markers have not been widely studied in relation to hematoma volume and growth in hypertensive intracerebral hemorrhage (ICH). The objectives to assess the relationship of white matter hyperintense lesions (WMHL), microbleeds (MBs), and cortical siderosis (CSS) with hematoma volume, hematoma expansion (HE), and 3 months outcome in patients with hypertensive ICH.

Methods: All consecutive acute hypertensive supratentorial ICH presenting to the emergency were prospectively recruited. Baseline and 24 hours computed tomography (CT) to assess hematoma volume and magnetic resonance imaging (MRI) for CSVD markers were performed in all subjects. WMHL (graded using Fazekas's scale), MBs, and CSS were assessed and compared with baseline variables and outcomes. All the images were assessed by an experienced stroke neurologist/neuroradiologist.

Results: One hundred and fifty-seven patients were screened and 60 were included. Mean age was 54.08 ± 11.57 years and 47 (78%) were males. Of 60, 19 (28.1%) had HE, 31 (51.6%) had major bleed (>30 ml), and 28 (47.46%) had poor 3 month outcome (mRS 4-6). On univariate analysis, high grade WMHL was associated with greater HE [odds ratio (OR): 2.65, confidence interval (CI) 1.48-4.72, = 0.001), greater proportion with volume >30 ml (OR: 7.16, CI: 1.09-47.13, = 0.001) and poor outcome (OR: 2.1, CI: 0.05-3.27, = 0.001). MBs were associated with poor outcome ( = 0.029) but not with HE/volume. CSS was related to HE ( = 0.031), a large volume bleed ( = 0.023), and poor outcome ( = 0.021). On multivariate model, only WMHL independently predicted HE ( = 0.034), greater proportion with bleed volume >30 ml ( = 0.041), and poor outcome ( = 0.042).

Conclusions: WMHL in MRI serves as a predictor of hematoma expansion, a large volume bleed, and poor outcome in hypertensive ICH and may be incorporated into existing prediction models.
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http://dx.doi.org/10.4103/aian.AIAN_183_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232507PMC
July 2020

A matched pair analysis of oncological outcomes in human papillomavirus-negative oropharyngeal squamous cell carcinoma: Transoral surgery versus radiotherapy or concurrent chemoradiation.

Head Neck 2021 10 29;43(10):2896-2906. Epub 2021 May 29.

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

Background: With the termination of RTOG 1221, there remains a lacuna regarding the optimal treatment for human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma (OPSCC).

Methods: Matched pair analysis with propensity score matching (PSM) between Arm I (transoral surgery [TOS] + risk-stratified adjuvant treatment) and Arm II (nonsurgical treatment - radiation/chemoradiation) in HPV(-) OPSCC.

Results: Unmatched comparison of Arm I (n = 57) and Arm II (n = 89) indicated significantly better overall survival (OS) and disease-free survival (DFS) for Arm I. PSM by matched pairs (n = 48, 24 each arm) indicated 5-year OS at 80% and 72.1%, respectively, for Arm I and II (p > 0.05) and corresponding DFS at 65.3% and 33.4% (p > 0.05). Subgroup analysis did not demonstrate statistical difference in outcomes in stage II and III, but stage IV tumors had significantly better outcomes in Arm I than Arm II (4-year OS: 100% vs. 21%, p = 0.04; DFS: 75% vs. 14.3%, p = 0.04).

Conclusions: TOS +/- adjuvant was found to have oncological outcomes at par with nonsurgical modalities in stage I-III OPSCC, whereas a distinct survival advantage was noted in case of stage IV tumors.
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http://dx.doi.org/10.1002/hed.26771DOI Listing
October 2021

Mental health issues and coping among health care workers during COVID19 pandemic: Indian perspective.

Asian J Psychiatr 2021 Jul 14;61:102685. Epub 2021 May 14.

Senior Resident, Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India. Electronic address:

Objectives: We assessed mental health issues among Indian health care workers (HCWs) and their coping strategies during COVID 19 pandemic.

Methodology: An online survey was conducted in 348 HCWs using PHQ-SADS and Brief-COPE inventory.

Results: Depression, anxiety and somatic symptoms were present in 54 %, 44.3 % and 54.6 % of HCWs and were more in those working in COVID19 areas. The nurses and female HCWs had more moderate to severe somatic symptoms. HCWs with moderate to severe symptoms used simultaneously both maladaptive and adaptive coping strategies.

Conclusion: The HCWs during COVID19 pandemic have significant mental health issues and use multiple coping strategies.
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http://dx.doi.org/10.1016/j.ajp.2021.102685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8118704PMC
July 2021

Variation in Lifestyle-Related Behavior Among Obese Indian Patients With Non-alcoholic Fatty Liver Disease.

Front Nutr 2021 14;8:655032. Epub 2021 Apr 14.

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

Lifestyle modification is the mainstay of treatment in Non-Alcoholic Fatty Liver Disease (NAFLD). Published Indian data on the diet and lifestyle of Indian NAFLD patients is scarce. This study explored variation in lifestyle-related behavior among obese patients with NAFLD. Ultrasonography (USG) diagnosed obese NAFLD patients ( = 140) were assessed for dietary intake [1-day 24 hours recall, food-frequency questionnaire (FFQ)] and physical activity (PA) [Global Physical Activity Questionnaire (GPAQ)]. Diet quality score (0-30) and physical activity (PA) levels were used to study variation in lifestyle and assess the effect of lifestyle on the severity of NAFLD. Compared to the recommendation, calorie consumption was 25.2% higher in nearly half (53.6%) of the subjects and mean macronutrient intake was imbalanced (60.3% carbohydrates, 12.4% protein, 25.5% fats). Variation was seen in terms of diet quality-good (3%), moderate (54.3%), or poor (43.5%) and intensity of PA-high (15%), moderate (47.9%), or low (37.1%). No patient had a combination of high PA and good diet quality within all grades of NAFLD. Our study suggests wide variation in lifestyles of obese patients with NAFLD and need for a more flexible and individualized modification of their diet and PA.
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http://dx.doi.org/10.3389/fnut.2021.655032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079655PMC
April 2021

Acute Kidney Injury in COVID-19: a Brief Review.

Indian J Surg 2021 Apr 23;83(2):398-402. Epub 2021 Apr 23.

Department of Urology, King George's Medical University, Lucknow, UP 226003 India.

The contemporary evolution of the coronavirus disease 2019 (COVID-19) outbreak from the Wuhan, China, with a high rate of transmission will act the global medical emergency with immense morbidity and mortality rate across the world. The cell entry of COVID-19 via angiotensin-converting enzyme 2 receptor (ACE-2 receptor) will damage the respiratory system by the cytopathic effect induced by replication of the virus genome in the host and respond respiratory failure with an elevation of cytokine factor-like interleukin (IL) IL-6, IL-8, tumor necrosis factor-alpha (TNF-alpha), etc. However, the lung-kidney cross talk will evidence the activation of molecular mechanisms from pro-inflammatory cytokines and concerned with kidney damage, though the elevated rate of ACE-2 receptor in the kidney will enhance the possibility of mortality with consideration of acute kidney injury. This review provides relevant information which suggests the rate of mortality in COVID-19 patient associated with acute kidney injury (AKI) which lacks critical monitoring of kidney function with a clinical consideration of intervention to avoid kidney damage in the initial stage of the disease.
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http://dx.doi.org/10.1007/s12262-020-02697-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064702PMC
April 2021

Development and Psychometric Validation of a New Scale for Assessment and Screening of Frailty Among Older Indians.

Clin Interv Aging 2021 25;16:537-547. Epub 2021 Mar 25.

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

Background: Frailty is a major challenge for healthcare systems in ageing societies. This dynamic state of health is a reflection of reduced reserve in various organ systems and enhanced vulnerability to stressors. Research in this area of geriatrics and gerontology is limited in low- and middle-income countries (LMICs) like India. This study is directed at development of a culturally appropriate and validated assessment scale for frailty among older Indians.

Methods: After extensive review of the literature on existing scales, a preliminary draft scale was formed. This draft was pre- and pilot-tested to check feasibility and modified accordingly. The final scale was validated on 107 older adults by confirmatory factor analysis and was named the Frailty Assessment and Screening Tool (FAST). The Fried's frailty phenotype was also administered on the same 107 older adults and scores of both were co-related. Suitable cut-off scores were found for frail and pre-frail older adults.

Results: The final version of the FAST consisted of 14 questions pertaining to 10 domains. It has good reliability. Cronbach's alpha co-efficient was 0.99; test-retest reliability was 0.97 and validity by confirmatory factor analysis was adequate. The Kaiser-CMeyer-Olkin (KMO) of sampling adequacy was 0.699, and Bartlett's test of sphericity was significant ( = 353.471, p < 0.001). FAST scores had a cut-off of ≥ 7/14 for frail and ≥ 5/14 for pre-frail elderly.

Conclusion: The FAST is a validated tool with good psychometric properties. It is expected that it will be helpful in screening pre-frail and frail older adults in India and other LMICs and guide in clinical decision making for intervention.
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http://dx.doi.org/10.2147/CIA.S292969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007478PMC
June 2021

Stemless total shoulder arthroplasty in elderly patients with primary osteoarthritis of shoulder - a developing country experience.

Expert Rev Med Devices 2021 Apr 30;18(4):407-411. Epub 2021 Mar 30.

Bhatia Hospital, Mumbai, India.

Background: We evaluated the imaging and functional outcomes of anatomic stemless shoulder arthroplasty (ECLIPSE) in elderly patients with primary osteoarthritis of the glenohumeral joint in Asian developing countries.

Methods: Thirty patients were treated using stemless TSA in 26 months period (years 2017 and 2019), and were followed for a minimum of 24 months. Functional outcomes were assessed using Constant and ASES scores. Radiolucent lines and osteopenia were analyzed on radiographs.

Results: Pre-surgery Constant and ASES scores improved from 27.33(21-38) and 29.67(22-38) to 68(54-78) and 71(71.4(56-79) at final follow up. Around the humeral component, one patient had calcar thinning and a radiolucent line thicker than 2 mm, while six patients had radiolucent lines less than 2 mm. The mean glenoid radiolucency score was 2± 1.1.

Conclusion: In our setting, stemless total shoulder arthroplasty demonstrated significant improvement in functional scores at short- to mid-term follow-up. Radiographic findings did not correlate with functional scores.
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http://dx.doi.org/10.1080/17434440.2021.1908885DOI Listing
April 2021
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