1.Correlation of ApoB/ApoA1 with diabetic nephropathy
Ravi UNIYAL ; Ramesh AHUJA ; Pallavi OJHA ; Shrikant SHARMA ; Deepak UNIYAL
Brunei International Medical Journal 2012;8(4):179-184
Introduction: Diabetic nephropathy is a microvascular complication and is the leading cause of diabetes related morbidity, mortality and important cause of end-stage kidney disease. Both microalbuminuria and macroalbuminuria are associated with increased risk of cardiovascular disease. Evidence has been accumulating from clinical trials that assessing the levels of apolipoprotein B (ApoB), a constituent of atherogenic lipoproteins: ApoA1, a component of anti-atherogenic high density lipoprotein (HDL) cholesterol; and the ApoB/ApoA1 ratio will provide better prediction of future cardiovascular events than measuring serum low-density lipoprotein (LDL)-cholesterol levels. There is paucity of published data linking ApoB/ApoA1 ratio to diabetic nephropathy especially from developing countries, hence this study was carried out. Materials and Methods: The present study was conducted in the Department of Medicine, CSM Medical University, Lucknow between August 2009 and July 2010. Patients with type 2 Diabetes Mellitus (DM) attending the Diabetic and Medical Out-Patient clinics or who were admitted to the medical wards of Gandhi Memorial and Association Hospital CSM University, Lucknow were included. One hundred patients were enrolled; 64 of those were cases (Micro- and Macroalbuminuria groups) and 36 without nephropathy (Normoalbuminuria) were controls. The cut-off value for higher ApoB/ApoA1 ratio for male was 0.97 and for female was 0.86. Results: Older age, durations and control of DM were significantly correlated with degree of albuminuria. Fifty-six patients (56%) had raised ApoB/ApoA1 ratio, 19.4% in the Normoalbuminuria group (n=7/36), 71.4% in the Microalbuminuria group (n=30/42), and 86.4% in the Macroalbuminuria group (n=19/22). There were no statistical differences in the mean total cholesterol, HDL, LDL, triglycerides among the groups. Conclusion: In our study higher ApoB/ApoA1 ratio was significantly correlated with diabetic nephropathy.
Apolipoprotein A-I
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Apolipoproteins B
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Complications
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Diabetes Mellitus
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Kidney Diseases
2.Cost-effective analysis of dual therapy in epilepsy, a study from India
Sarita Goyal ; DC Dhasmana ; Deepak Goel ; MC Gupta ; Taruna Sharma
Neurology Asia 2011;16(4):309-314
Background and Objective: For improving overall care in epileptic patients, careful evaluation of
pharmacotherapy, seizure control, quality of life (QOL) and cost effectiveness are helpful but such
data are relatively meagre from developing countries. The present study was undertaken to audit all
these said factors with different drug combinations comparing older with newer drugs in the setting
of a tertiary care epilepsy hospital in India. Methods: Forty patients were divided into four treatment
groups, of ten each which were valproic acid + lamotrigine (Group-I), valproic acid+ clonazepam
(Group-II), oxcarbazepine + clobazam (Group-III) and phenobarbitone + phenytoin (Group-IV), based
on most commonly used dual therapy in local clinical practice. The patients were followed at monthly
intervals for six months. Effi cacy was assessed by reduction in seizure frequency, QOL was assessed
by using an adapted version of 31- items questionnaire QOLIE-31 (quality of life in epilepsy) and
cost effectiveness was calculated as ratio of direct cost of medicine and improvement in quality of
life. Results: There was a signifi cant reduction in seizure frequency and improvement in QOL in all
four groups at 2nd and 6th months. Cost-effectiveness analysis at the end showed that group-IV paid
the least for same improvement in QOL.
Conclusion: Older drugs are equally effi cacious as compared to newer in controlling seizure frequency
and improving QOL, but are more cost effective.
3.Validated HPTLC analysis method for quantification of variability in content of curcumin in Curcuma longa L (turmeric) collected from different geographical region of India
Ashraf Kamran ; Mujeeb Mohd ; Ahmad Altaf ; Amir Mohd ; Mallick Nasar Md ; Sharma Deepak
Asian Pacific Journal of Tropical Biomedicine 2012;(z2):584-588
Objective: To develop a simple, sensitive, precise, and accurate stability-indicating high performance thin-layer chromatographic method for analysis of curcumin (the main active constituent of turmeric). Methods: The separation was achieved on TLC aluminum plates precoated with silica gel 60F254 using toluene-chloroform-methanol (5:4:1, v/v/v) as a mobile phase. Densitometric analysis was performed at 430 nm. Results: This system was found to have compact spot of curcumin at RF value of (0.31±0.02). For the proposed procedure, linearity (r2= 0.99354 ± 0.00120), limit of detection (50 ng/spot), limit of quantification (200 ng/spot), recovery (ranging from 98.35% - 100.68%), and precision (≤2.25%) were found to be satisfactory. Statistical analysis reveals that the content of curcumin in different geographical region varied significantly.Conclusions:The highest and lowest concentration of curcumin in Turmeric was found to be present in sample of Erode (Tamilnadu) and Surat (Gujrat) respectively which inferred that the variety of turmeric found in Erode (Tamilnadu) is much superior to other region of India.
4.Is hypothalamic involvement truly a red flag for multiple sclerosis?
Chandra Mohan Sharma ; Alok Jain ; BL Kumawat ; Dinesh Khandelwal ; Deepak Jain
Neurology Asia 2013;18(3):323-325
Any hypothalamic disturbance manifesting clinically is considered a major red flag for multiple
sclerosis, whereas MRI lesions involving deep grey matter structures are considered an intermediate
red flag. However, hypothalamic lesions manifesting clinically with hypersomnia have been described
in some patients of multiple sclerosis. We report a case where the first and presenting feature of
multiple sclerosis was acute onset hypersomnia with bilateral hypothalamic lesions. On review of
recent literature, we also question whether clinical or radiological hypothalamic involvement is really
so unusual that it should be considered a red flag for multiple sclerosis
5.Evaluation of Traumatic Spine by Magnetic Resonance Imaging and Correlation with Neurological Recovery.
Sarita MAGU ; Deepak SINGH ; Rohtas Kanwar YADAV ; Manju BALA
Asian Spine Journal 2015;9(5):748-756
STUDY DESIGN: Prospective study. PURPOSE: To compare magnetic resonance imaging (MRI) findings with clinical profile and neurological status of the patient and to correlate the MRI findings with neurological recovery of the patients and predict the outcome. OVERVIEW OF LITERATURE: Previous studies have reported poor neurological recovery in patients with cord hemorrhage, as compared to cord edema in spine injury patients. High canal compromise, cord compression along with higher extent of cord injury also carries poor prognostic value. METHODS: Neurological status of patients was assessed at the time of admission and discharge in as accordance with the American Spine Injury Association (ASIA) impairment scale. Mean stay in hospital was 14.11+/-5.74 days. Neurological status at admission and neurological recovery at discharge was compared with various qualitative cord findings and quantitative parameters on MRI. In 27 patients, long-term follow-up was done at mean time of 285.9+/-43.94 days comparing same parameters. RESULTS: Cord edema and normal cord was associated with favorable neurological outcome. Cord contusion showed lesser neurological recovery, as compared to cord edema. Cord hemorrhage was associated with worst neurological status at admission and poor neurological recovery. Mean canal compromise (MCC), mean spinal cord compression (MSCC) and lesion length values were higher in patients presenting with ASIA A impairment scale injury and showed decreasing trends towards ASIA E impairment scale injury. Patients showing neurological recovery had lower mean MCC, MSCC, and lesion length, as compared to patients showing no neurological recovery (p<0.05). CONCLUSIONS: Cord hemorrhage, higher MCC, MSCC, and lesion length values have poor prognostic value in spine injury patients.
Asia
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Contusions
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Edema
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Follow-Up Studies
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Hemorrhage
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Humans
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Magnetic Resonance Imaging*
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Prospective Studies
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Spinal Cord Compression
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Spine*
6.Conjoint Nerve Root an Intraoperative Challenge in Minimally Invasive Tubular Discectomy
Ayush SHARMA ; Vijay SINGH ; Romit AGRAWAL ; Nilesh MANGALE ; Priyank DEEPAK ; Jeet SAVLA ; Ajay JAISWAL
Asian Spine Journal 2021;15(4):545-549
Conjoint nerve root (CNR) is an embryological nerve root anomaly that mainly involves the lumbosacral region. The presence of CNR during tubular discectomy raises the chances of failure in spinal surgery and the risk of neural injuries. Tubular discectomy can be challenging in the presence of CNR owing to limited visualization. Here, we present a technical note on two cases of L5–S1 disc prolapse in the presence of conjoint S1 nerve root that was operated via a minimally invasive tubular approach. Any intraoperative suspicion of CNR while using the tubular approach should prompt the surgeon to perform a thorough tubular decompression prior to nerve root retraction. In patients with a large disc, disc should be approached via the axilla because the axillary area between the dura and the medial boarder of the root is very easy to approach in the presence of CNR. Safe performance of tubular discectomy is possible even in the presence of CNR in the lumbar spine.
7.Ruptured mirror DACA aneurysm: A rare case report and review of literature
Deepak Kumar SINGH ; Prevesh Kumar SHARMA ; Arun Kumar SINGH ; Vipin Kumar CHAND
Journal of Cerebrovascular and Endovascular Neurosurgery 2023;25(3):340-346
Bilateral distal anterior cerebral artery (DACA) aneurysms also called “kissing aneurysms” or “mirror aneurysm” are extremely rare, accounting for only 0.2% of all intracranial aneurysms. There have only been a few examples of mirror DACA aneurysms reported in the literature. Here, we report a rare case of mirror DACA aneurysm in a middle aged female with its successful clipping. Patient was admitted with severe headache and altered sensorium. Computed tomography (CT) head was suggestive of anterior inter-hemispheric hematoma. Digital subtraction angiography (DSA) was done which was suggestive of two distal anterior cerebral artery aneurysms located at same anatomical position. It was treated through microsurgical clipping. Mirror image DACA aneurysms are rare occurrence. All patients with ruptured DACA aneurysms should have angiography with 3D reconstruction studies. This aids in determining the aneurysm’s morphology and planning treatment accordingly.
8.Incidence of Dural Tears in Open versus Minimally Invasive Spine Surgery: A Single-Center Prospective Study
Ayush SHARMA ; Akash SHAKYA ; Vijay SINGH ; Priyank DEEPAK ; Nilesh MANGALE ; Ajay JAISWAL ; Nandan MARATHE
Asian Spine Journal 2022;16(4):463-470
Methods:
This study included 420 operated cases of degenerative lumbar pathology with a prospective follow-up of at least 6 months. Patients were divided into the open surgery and MIS groups, and the incidences of DT, early return to work, and various demographic and operative factors were compared.
Results:
A total of 156 and 264 patients underwent MIS and open surgery, respectively. Incidental durotomy was documented in 52 cases (12.4%); this was significantly less in the MIS group versus the open surgery group (6.4% vs. 15.9%, p <0.05). In the open surgery group, four patients underwent revision for persistent dural leak or pseudomeningocele, but none of the cases in the MIS group had revision surgery due to DT-related complications. The incidence of DT was higher among patients with high body mass index, patients with diabetes mellitus, and patients who underwent revision surgery (p <0.05) regardless of the approach. The MIS group returned to work significantly earlier.
Conclusions
MIS was associated with a significantly lower incidence of DT and earlier return to work compared with open surgery among patients with degenerative lumbar pathology.
9.Use of covered stent (CGuard) in the treatment of post-traumatic internal carotid artery pseudoaneurysm
Deepak SINGH ; Diwakar SHANKAR ; Gaurav SHARMA ; Kuldeep YADAV ; Mohammad KAIF
Journal of Cerebrovascular and Endovascular Neurosurgery 2022;24(3):257-262
Post-traumatic internal carotid artery pseudoaneurysm (ICA PSA) is a rare occurrence with high mortality rates, and with the advent of endovascular therapy, its treatment has shown drastic improvement in clinical as well as radiological outcomes. Here we are describing our experience with the CGuard embolic protection system (InspireMD, Tel Aviv, Israel) for the treatment of post-traumatic left ICA PSA in a 49-year-old male. New improved biomechanics and navigability have proven it to be a safe and efficient treatment modality for ICA PSA. However, a multicentric large-scale randomized trial is recommended to support this modality.
10.Efficacy and Safety of the Novel Dipeptidyl Peptidase-4 Inhibitor Gemigliptin in the Management of Type 2 Diabetes: A Meta-Analysis
Deep DUTTA ; Anshita AGARWAL ; Indira MAISNAM ; Rajiv SINGLA ; Deepak KHANDELWAL ; Meha SHARMA
Endocrinology and Metabolism 2021;36(2):374-387
Background:
No meta-analysis has holistically analysed and summarised the efficacy and safety of gemigliptin in type 2 diabetes. The meta-analysis addresses this knowledge gap.
Methods:
Electronic databases were searched for randomised controlled trials (RCTs) involving diabetes patients receiving gemigliptin in the intervention arm and placebo/active comparator in the control arm. The primary outcome was change in haemoglobin A1c (HbA1c). The secondary outcomes were alterations in glucose, glycaemic targets, lipids, insulin resistance, and adverse events.
Results:
Data from 10 RCTs involving 1,792 patients were analysed. Four had an active control group (ACG), with metformin/dapagliflozin/sitagliptin/glimepiride as the active comparator; six had a passive control group (PCG), with placebo/rosuvastatin as controls. HbA1c reduction by gemigliptin at 24 weeks was comparable to ACG (mean difference [MD], 0.09%; 95% confidence interval [CI], –0.06 to 0.23; P=0.24; I2=0%; moderate certainty of evidence [MCE]), but superior to PCG (MD, –0.91%; 95% CI, –1.18 to –0.63); P<0.01; I2=89%; high certainty of evidence [HCE]). Gemigliptin was superior to PCG regarding achieving HbA1c <7% (12 weeks: odds ratio [OR], 5.91; 95% CI, 1.34 to 26.08; P=0.02; I2=74%; 24 weeks: OR, 4.48; 95% CI, 2.09 to 9.60; P<0.01; I2=69%; HCE). Gemigliptin was comparable to ACG regarding achieving HbA1c <7% after 24 weeks (OR, 0.92; 95% CI, 0.52 to 1.63; P=0.77; I2=66%; MCE). Adverse events were similar between the gemigliptin and control groups (risk ratio [RR], 1.06; 95% CI, 0.82 to 1.36; P=0.66; I2=35%; HCE). The gemigliptin group did not have increased hypoglycaemia (RR, 1.19; 95% CI, 0.62 to 2.28; P=0.61; I2=19%; HCE).
Conclusion
Gemigliptin has good glycaemic efficacy and is well-tolerated over 6 months of use.