1.The Effects of Repetitive Transcranial Magnetic Stimulation at Dorsolateral Prefrontal Cortex in the Treatment of Migraine Comorbid with Depression: A Retrospective Open Study
Saurabh KUMAR ; Swarndeep SINGH ; Nand KUMAR ; Rohit VERMA
Clinical Psychopharmacology and Neuroscience 2018;16(1):62-66
OBJECTIVE: The literature on managing migraine non-responsive to pharmacological approaches and that co-occurring with depression is scanty. The comorbid condition predicts a poorer prognosis for migraine as well as depression. The present report assesses efficacy and tolerability of high frequency repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex as a treatment modality for migraine with comorbid depression. METHODS: The current retrospective chart review assesses effectiveness of high frequency rTMS over left dorsolateral prefrontal cortex as a treatment modality to manage migraine occurring comorbid with depression in 14 subjects. RESULTS: The mean scores on Migraine Disability Assessment Test (MIDAS) and depression rating scale reduced significantly from 21.14±3.01 and 20.71±3.95 at baseline to 13.93±6.09 and 14.21±5.52 respectively, after rTMS. There was significant improvement in migraine frequency, severity and functional disability assessed using MIDAS scores (p < 0.05) following high frequency rTMS compared to baseline. CONCLUSION: There is a role of applying rTMS as a potential therapeutic modality in the integrated management of a distinct subgroup of migraine patients with comorbid depression.
Depression
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Humans
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Migraine Disorders
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Prefrontal Cortex
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Prognosis
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Retrospective Studies
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Transcranial Magnetic Stimulation
2.Prognostic value of TNF-α-308 and IFN-γ-874 single nucleotide polymorphisms and their plasma levels in patients with aplastic anemia
Saurabh SHUKLA ; Anil Kumar TRIPATHI ; Shailendra PRASAD VERMA ; Nidhi AWASTHI
Blood Research 2020;55(4):193-199
Background:
Aplastic anemia (AA), an unusual hematological disease, is characterized by hypoplasia of the bone marrow and failure to form blood cells of all three lineages resulting in pancytopenia. This study aimed to investigate TNF-α-308 and IFN-γ-874 gene polymorphisms and their respective plasma protein levels in patients with AA and healthy controls.
Methods:
Two hundred and forty individuals were included in this study; the case group comprised 120 AA patients, while 120 healthy individuals served as controls. Genotyping was performed using the PCR-restriction length fragment polymorphism method and TNF-α-308 and IFN-γ-874 plasma levels were evaluated using an ELISA kit.
Results:
There was a significantly higher prevalence of the IFN-γ-874 genotype in patients with AA than in healthy controls, while the TNF-α-308 genotype was associated with lower risk of developing AA. Furthermore, the levels of both TNF-α-308 and IFN-γ-874 were higher in the plasma of AA patients.
Conclusion
Our findings suggest that the IFN-γ-874 genotype may be a greater risk factor in the causation of AA, whereas the TNF-α-308 genotype has a protective role in the North Indian population.
3.Nitric Oxide Metabolite Concentration in Cerebrospinal Fluid: Useful as a Prognostic Marker?.
Saurabh SINGH ; Jyoti PRAKASH ; Rakesh SINGH ; Ashish VERMA ; Hemant BANSAL
Asian Spine Journal 2016;10(5):828-833
STUDY DESIGN: Prospective study. PURPOSE: To establish the significance of cerebrospinal fluid (CSF) nitric oxide metabolite (NOx) concentration in acute spinal cord injury (SCI) patients to assess the neurological severity and prognosis. OVERVIEW OF LITERATURE: Quantitative analysis of specific biomarkers in CSF will assess neurological severity more accurately and permit the formulation of a more precise management plan. METHODS: Forty SCI patients represented the cases and 20 lower limb injury patients were the controls. NOx concentration in CSF was measured at week 1, 2, and 4 by Griess method. Magnetic resonance imaging (MRI, T2-weighted) done in each case to measure cord edema and neurological severity was assessed using the Frankel classification. RESULTS: CSF NOx concentration peaked at week 2 and declined to normal by week 4. The concentration remained normal in controls. Mean NOx concentration was directly proportional to the severity of acute SCI as correlated with cord edema seen in MRI and neurological severity assessed. CONCLUSIONS: CSF NOx concentration can be considered a specific quantitative biomarker in acute stage of SCI to predict the severity and prognosis of SCI patients.
Biomarkers
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Cerebrospinal Fluid*
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Classification
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Edema
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Humans
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Lower Extremity
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Magnetic Resonance Imaging
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Methods
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Nitric Oxide*
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Prognosis
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Prospective Studies
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Spinal Cord Injuries
4.Subacute posttraumatic ascending myelopathy: A case report and review of literature.
Mukul MOHINDRA ; V-K GAUTAM ; Lalit MAINI ; Santosh KUMAR ; Saurabh VERMA
Chinese Journal of Traumatology 2015;18(1):48-50
Subacute posttraumatic ascending myelopathy is a rare disorder, unrelated to syrinx formation or mechanical instability, which may gradually emerge within the first 1-2 weeks after a spinal cord injury and may lead to diagnostic and prognostic dilemmas. We present a case of 24-year-old female with unstable wedge compression fracture of L1 vertebrae with signal changes in the upper lumbar cord causing complete paraplegia below D9 with bladder and bowel involvement. In the subsequent week, she developed a delayed progressively increasing neurological deficit with cord signal abnormality on MRI extending cephalad from the injury site to the upper dorsal cord. The patient had no initial clinical improvement initially but showed a delayed recovery over months.
Adult
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Female
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Humans
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Spinal Cord Diseases
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etiology
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therapy
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Spinal Cord Injuries
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complications
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Spinal Fractures
;
complications
5.New Onset Obsessive Compulsive Disorder Following High Frequency Repetitive Transcranial Magnetic Stimulation over Left Dorsolateral Prefrontal Cortex for Treatment of Negative Symptoms in a Patient with Schizophrenia
Harshit GARG ; Saurabh KUMAR ; Swarndeep SINGH ; Nand KUMAR ; Rohit VERMA
Clinical Psychopharmacology and Neuroscience 2019;17(3):443-445
Obsessive-compulsive symptoms and/or obsessive-compulsive disorders (OCD) are frequently comorbid with schizophrenia, though the exact clinical and etiological relationship between them is poorly understood. Here we describe a case that, to the best of our knowledge, is the first report of new-onset OCD in a patient who was receiving high-frequency repetitive transcranial magnetic stimulation over left dorsolateral pre-frontal cortex as an adjuvant therapy for negative symptoms of schizophrenia. Thisreport supports our understanding of OCD as a brain disorder involving hyper-activity of pre-frontal cortex and cortico-striatal-thalamo-cortical circuit dysfunction.
Brain Diseases
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Humans
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Obsessive-Compulsive Disorder
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Prefrontal Cortex
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Schizophrenia
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Transcranial Magnetic Stimulation
6.Interferon-gamma release assay has poor diagnostic accuracy in differentiating intestinal tuberculosis from Crohn’s disease in tuberculosis endemic areas
Karan SACHDEVA ; Peeyush KUMAR ; Bhaskar KANTE ; Sudheer K. VUYYURU ; Srikant MOHTA ; Mukesh K. RANJAN ; Mukesh K. SINGH ; Mahak VERMA ; Govind MAKHARIA ; Saurabh KEDIA ; Vineet AHUJA
Intestinal Research 2023;21(2):226-234
Background/Aims:
Intestinal tuberculosis (ITB) and Crohn’s disease (CD) frequently present with a diagnostic dilemma because of similar presentation. Interferon-gamma release assay (IGRA) has been used in differentiating ITB from CD, but with sparse reports on its diagnostic accuracy in tuberculosis endemic regions and this study evaluated the same.
Methods:
Patients with definitive diagnosis of ITB (n=59) or CD (n=49) who underwent IGRA testing (n=307) were retrospectively included at All India Institute of Medical Sciences, New Delhi (July 2014 to September 2021). CD or ITB was diagnosed as per standard criteria. IGRA was considered positive at >0.35 IU/mL.Relevant data was collected and IGRA results were compared between ITB and CD to determine its accuracy.
Results:
Among 59 ITB patients (mean age, 32.6±13.1 years; median disease duration, 1 year; male, 59.3%), 24 were positive and 35 tested negative for IGRA. Among 49 CD patients (mean age, 37.8±14.0; median disease duration, 4 years; male, 61.2%), 12 were positive and 37 tested negative for IGRA. Hence, for diagnosing ITB, IGRA showed a sensitivity, specificity, positive and negative predictive values of 40.68%, 75.51%, 66.67%, and 51.39%, respectively. The area under the curve of IGRA for ITB diagnosis was 0.66 (95% confidence interval, 0.55–0.75). In a subset (n=64), tuberculin skin test (TST) showed sensitivity, specificity, positive and negative predictive values of 64.7%, 73.3%, 73.3%, and 64.71%, respectively. IGRA and TST were concordant in 38 (59.4%) patients with κ=0.17.
Conclusions
In a tuberculosis endemic region, IGRA had poor diagnostic accuracy for differentiating ITB from CD, suggesting a limited value of IGRA in this setting.
7.Use of thiopurines in inflammatory bowel disease: an update
Arshdeep SINGH ; Ramit MAHAJAN ; Saurabh KEDIA ; Amit Kumar DUTTA ; Abhinav ANAND ; Charles N. BERNSTEIN ; Devendra DESAI ; C. Ganesh PAI ; Govind MAKHARIA ; Harsh Vardhan TEVETHIA ; Joyce WY MAK ; Kirandeep KAUR ; Kiran PEDDI ; Mukesh Kumar RANJAN ; Perttu ARKKILA ; Rakesh KOCHHAR ; Rupa BANERJEE ; Saroj Kant SINHA ; Siew Chien NG ; Stephen HANAUER ; Suhang VERMA ; Usha DUTTA ; Vandana MIDHA ; Varun MEHTA ; Vineet AHUJA ; Ajit SOOD
Intestinal Research 2022;20(1):11-30
Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.