184 results on '"Sudhir Bhandari"'
Search Results
2. Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19
- Author
-
Balram Bhargava, Ashish Sharma, Rajnish Joshi, Amit Patel, Deepak Kumar, Ashish Pathak, Sudhir Bhandari, Manoj Kumar Panigrahi, Prasanta Raghab Mohapatra, Aparna Mukherjee, Pankaj Bhardwaj, Priyanka Ghosh, Gunjan Kumar, Simmi Dube, Nehal M Shah, Hemang M Purohit, Vikas Suri, Arti D Shah, Alka Turuk, Akhil Dhanesh Goel, Manoj Kumar Gupta, Ritin Mohindra, Ashish Bhalla, Star Pala, Balkishan Gupta, Damodar Sahu, Sourin Bhuniya, Abhishek Agrawal, Samiran Panda, Deepak Jain, Arunansu Talukdar, Janakkumar R Khambholja, Nikita Sharma, Geetha R Menon, Subhasis Mukherjee, Puspender Misra, Lokesh Kumar Sharma, Samita S, Himadri Das, Debasis Sarkar, Soumyadeep Ghosh, Moumita Dutta, Shreetama Chakraborty, Tridip Dutta Baruah, Pankaj Kumar Kannauje, Arvind Kumar Shukla, Nitesh Shah, Mary John, Kiranpreet Kaur, Vijay Nongpiur, Sachin K Shivnitwar, Bobba Rohil Krishna, Naveen Dulhani, Jigyasa Gupta, H K Aggarwal, Parshwa Naik, Manisha Panchal, Mayank Anderpa, Nyanthung Kikon, Christina Nzani Humtsoe, Rajaat Vohra, Lipilekha Patnaik, Jagdish Prasad Sahoo, Arun Kokane, Yogiraj Ray, Kruti Rajvansh, Arun Madharia, Neha Shrivastava, Sushila Kataria, Mohammad Shameem, Nazish Fatima, Saumitra Ghosh, Avijit Hazra, Himanshu D, Veeresh B Salgar, Santosh Algur, Kala Yadhav M L, Pavan Kumar M, and Mendu Vishnu Vardhana Rao
- Subjects
Medicine (General) ,R5-920 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Introduction The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities.Methods Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020–October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting.Results Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30–60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6–7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03).Conclusion Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.
- Published
- 2023
- Full Text
- View/download PDF
3. Impact of COVID-19 on rheumatic diseases in india: Determinants of mortality and adverse outcome: A retrospective, cross-sectional cohort study
- Author
-
Avinash Jain, Vineeta Shobha, S Chandrashekara, Padmanabha Shenoy, Sapan C Pandya, Prakash Chotalia, Sharath Kumar, Sourabh Malviya, Yogesh Preet Singh, Abhishek Patil, Vikas Gupta, Puja Srivastava, Vijaya Prasanna Parimi, Chanakya Kodishala, Ramya Janardana, Benzeeta Pinto, Sudhir Bhandari, Govind Rankawat, Praveen Pratap Jadhav, Damodaram Potugari, Vishnu Sharma, Alpana Parmar, Sunitha Kayidhi, Paul T Antony, Ashish Badika, and Amit Sharma
- Subjects
adverse outcome ,autoimmune rheumatic disease ,covid-19 ,mortality ,severe acute respiratory syndrome coronavirus 2 infection ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Introduction: There is varying impact of COVID19 on world population depending on ethnicity, age and underlying co-morbidities. However, the lack of data regarding the effect of COVID on patients with rheumatological disorders (RDs) from different nations adds to uncertainty on disease outcome. Across the world, many rheumatology associations have joined hands to collate-related information. A national database under Indian Rheumatology Associations (IRAs) was developed to understand the impact of underlying RD and immunosuppressants during the COVID pandemic on its severity and outcome in our country. Methods: All registered members of IRA were invited to participate in this registry and provide information of reverse transcription–polymerase chain reaction confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)-infected RD patients using an online platform https://iradatabaseard.in/iracovid/index.php. The results of the data were analyzed using the appropriate statistics. Multivariate logistic regression was used to analyze the impact of different variables on mortality. Odds ratio and 95% confidence interval were used to define risk of death. Results: In this retrospective cross-sectional study, data for 447 RD patients who were infected with SARS-CoV2 data were available as of December 1, 2020. The mean age was 47.9 ± 14.4 years, including two children and 93 (20.8%) geriatric age group patients, male: female ratio was 0.4:1 and mean disease duration was 79.3 ± 77.1 months. Rheumatoid arthritis was the most common RD. Underlying disease was quiescent in 54.7% and active in 18.4% patients. Most common medications at the time of COVID diagnosis were steroids (57.76%) and hydroxychloroquine (67.34%). Fever and cough were the most common symptoms. More than half of the patients (54.4%) needed hospitalization. Oxygen requirement was noted in 18.8%, intensive care unit admission, and invasive ventilation was needed in 6.0%, and 2.9% patients, respectively. Complete recovery was seen in 95.5% of patients and 4.47% (n = 20) expired due to COVID. The presence of comorbidity, dyspnea, and a higher neutrophil count was statistically significantly associated with death (P < 0.05). None of the other factors affected COVID-19 outcome. Conclusion: This is the largest cohort from a single nation looking at the interface between RD and COVID. The results indicate that patients with RD do not show increased mortality despite current use of disease-modifying anti-rheumatic drugs/immunosuppressants.
- Published
- 2023
- Full Text
- View/download PDF
4. Multicenter Case–Control Study of COVID-19–Associated Mucormycosis Outbreak, India
- Author
-
Valliappan Muthu, Ritesh Agarwal, Shivaprakash Mandya Rudramurthy, Deepak Thangaraju, Manoj Radhakishan Shevkani, Atul K. Patel, Prakash Srinivas Shastri, Ashwini Tayade, Sudhir Bhandari, Vishwanath Gella, Jayanthi Savio, Surabhi Madan, Vinay Kumar Hallur, Venkata Nagarjuna Maturu, Arjun Srinivasan, Nandini Sethuraman, Raminder Pal Singh Sibia, Sanjay Pujari, Ravindra Mehta, Tanu Singhal, Puneet Saxena, Varsha Gupta, Vasant Nagvekar, Parikshit Prayag, Dharmesh Patel, Immaculata Xess, Pratik Savaj, Naresh Panda, Gayathri Devi Rajagopal, Riya Sandeep Parwani, Kamlesh Patel, Anuradha Deshmukh, Aruna Vyas, Srinivas Kishore Sistla, Priyadarshini A Padaki, Dharshni Ramar, Saurav Sarkar, Bharani Rachagulla, Pattabhiraman Vallandaramam, Krishna Prabha Premachandran, Sunil Pawar, Piyush Gugale, Pradeep Hosamani, Sunil Narayan Dutt, Satish Nair, Hariprasad Kalpakkam, Sanjiv Badhwar, Kiran Kumar Kompella, Nidhi Singla, Milind Navlakhe, Amrita Prayag, Gagandeep Singh, Poorvesh Dhakecha, and Arunaloke Chakrabarti
- Subjects
Mucormycosis ,Mucorales ,COVID-19 ,Zygomycosis ,invasive molds ,coronavirus disease ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
We performed a case–control study across 25 hospitals in India for the period of January–June 2021 to evaluate the reasons for an COVID-19–associated mucormycosis (CAM) outbreak. We investigated whether COVID-19 treatment practices (glucocorticoids, zinc, tocilizumab, and others) were associated with CAM. We included 1,733 cases of CAM and 3,911 age-matched COVID-19 controls. We found cumulative glucocorticoid dose (odds ratio [OR] 1.006, 95% CI 1.004–1.007) and zinc supplementation (OR 2.76, 95% CI 2.24–3.40), along with elevated C-reactive protein (OR 1.004, 95% CI 1.002–1.006), host factors (renal transplantation [OR 7.58, 95% CI 3.31–17.40], diabetes mellitus [OR 6.72, 95% CI 5.45–8.28], diabetic ketoacidosis during COVID-19 [OR 4.41, 95% CI 2.03–9.60]), and rural residence (OR 2.88, 95% CI 2.12–3.79), significantly associated with CAM. Mortality rate at 12 weeks was 32.2% (473/1,471). We emphasize the judicious use of COVID-19 therapies and optimal glycemic control to prevent CAM.
- Published
- 2023
- Full Text
- View/download PDF
5. A Comparative Analysis of Procalcitonin for Sepsis in Diabetic Ketoacidosis
- Author
-
Sudhir Bhandari , Govind Rankawat , Anurag Lohmror , Lalit Wadhawan , Shiven Bhandari , Mukesh Gehlot
- Subjects
Diabetic ketoacidosis, Diabetes mellitus, Procalcitonin, Sepsis. ,Medicine - Abstract
Introduction: Diabetic ketoacidosis (DKA) is one of the most serious complications of diabetes mellitus (DM). Infections are the most common triggers of DKA. The early recognition of infection and its severity in DKA patients serves an important role in improving infection control and prognosis. Methodology: A total of 240 patients of DKA were recruited. After a complete history and clinical examination, investigations including hemogram, HbA1c, procalcitonin (PCT), blood, urine or infection site culture, chest radiograph, urine ketone by urinary ketone strip test, ABG, malaria by slide, serum amylase and lipase were carried out as per standard protocol. Results: The observed parameters viz. HbA1c, temperature at day two, total leucocyte count (TLC) at day two, PCT at admission and day two, and length of hospital stay were found to be significantly higher in patients with proven bacterial infection (PBI) as compared to patients without PBI (p
- Published
- 2023
- Full Text
- View/download PDF
6. Reversal of Type 2 Diabetes Mellitus
- Author
-
Sudhir Bhandari
- Subjects
NA ,Medicine - Abstract
NA
- Published
- 2023
- Full Text
- View/download PDF
7. COVID-19 Journey: From Initial Learning to Vaccine
- Author
-
Sudhir Bhandari
- Subjects
Not Available ,Medicine - Abstract
Not Available
- Published
- 2023
- Full Text
- View/download PDF
8. Evidence-Based Medicine: Fountainhead of Medical Sciences
- Author
-
Sudhir Bhandari
- Subjects
Medicine - Published
- 2023
- Full Text
- View/download PDF
9. Chest HRCT Assessment of COVID-19 Patients in Vaccinated versus Nonvaccinated Patients: A Comparative Study in a Tertiary Care Hospital
- Author
-
Kuldeep Mendiratta, Shubham Solanki, Bhavyansh Rathi, Sudhir Bhandari, Ashwini Bellamkondi, Bineeta Singh Parihar, Apoorva Singh, and Pradeep Parakh
- Subjects
computed tomography severity score ,covid-19 ,delta variant ,herd immunity ,high-resolution computed tomography ,vaccine ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Coronavirus disease 2019 (COVID-19) has turned out to be the most devastating viral disease that the world has encountered for the past century. The World Health Organization (WHO) declared it a pandemic on March 11, 2020. The disease mainly spreads through respiratory droplets which makes social distancing a primary tool of prevention. Many variant strains have emerged up since the pandemic started and the Delta variant is responsible for recent surge of cases in second wave of COVID-19 in India. Mass vaccination is the most efficacious precautionary measure that can be applied to stop the transmission and generate herd immunity. Vaccination does not give 100% prevention from infection, but it halts the severity of infection. Vaccine is the boon amidst the mayhem. Our study highlights that those vaccinated (particularly two doses) had clinically mild symptoms and mild computed tomography severity score (CTSS) with a speedy recovery. Those unvaccinated had moderate to severe symptoms with moderate to severe CTSS (>8) often requiring hospital admission and having poor prognosis. Thus, vaccine helps reduce the health burden of the already strained health care system. Immunization visit can also be used as an opportunity to disseminate message to encourage behavior, to reduce transmission risk of COVID-19 virus, to identify the signs and symptoms of disease, and to provide guidance on what to do.
- Published
- 2022
- Full Text
- View/download PDF
10. Mucormycosis Infections during the Second Wave of COVID-19: Experience from a Tertiary Care Centre in India
- Author
-
Sudhir BHANDARI, Shivankan KAKKAR, Amitabh DUBE, Mohnish GROVER, Shruti BHARGAVA, Amit TAK, Bhoopendra PATEL, and Minal KACHHAWA
- Subjects
covid-19 ,coronavirus disease associated mucormycosis (cam) ,corticosteroids ,diabetes mellitus ,Medicine ,Medicine (General) ,R5-920 - Abstract
Background: Mucormycosis is an uncommon fungal infection with high morbidity and mortality. There had been a sudden surge in the cases of mucormycosis during the second wave of Coronavirus Disease 2019 (COVID-19) in India. Objective: The etiology, pathophysiology, and correlations of mucormycosis at tertiary hospital in India is explored in the present study. Methods: In this retrospective observational study, all coronavirus disease associated mucormycosis (CAM) cases admitted at this center between April 2021 to June 2021 were included. The cases were evaluated in terms of their background, most common presentations, chief underlying etiologies, severity of disease, comorbidities, investigation profiles, prognosis, and treatment provided. Results: Among the total 231 cases reported with mucormycosis, age group of 40 - 50 years (28%) was the most afflicted and the 20 30 year was the least. Men (68%) were more afflicted than Women. 66% patients had a history of vaccination against COVID-19. 63% patients presented with a High-Resolution Computerized Tomography (HRCT) score of 9-16. 60% required oxygen support and 71% required steroids. Diabetes mellitus was the most prevalent comorbidity. Conclusion: The salience of the second inferno wave of COVID-19 was witness to COVID-19 patients who had pre existing diabetes mellitus. Individuals with diabetes in general foster more extreme COVID-19 infections and end up using corticosteroids. In any case, the corticosteroids – alongside diabetes – increment the danger of getting mucormycosis. The specific pathophysiology of COVID-19 may represent co-morbidity with Invasive Fungal diseases (IFI).
- Published
- 2021
- Full Text
- View/download PDF
11. RAPIDIRON: Reducing Anaemia in Pregnancy in India—a 3-arm, randomized-controlled trial comparing the effectiveness of oral iron with single-dose intravenous iron in the treatment of iron deficiency anaemia in pregnant women and reducing low birth weight deliveries
- Author
-
Richard J. Derman, Shivaprasad S. Goudar, Simal Thind, Sudhir Bhandari, Zubair Aghai, Michael Auerbach, Rupsa Boelig, Umesh S. Charantimath, Rosemary Frasso, M. S. Ganachari, Kusum Lata Gaur, Michael K. Georgieff, Frances Jaeger, S Yogeshkumar, Parth Lalakia, Benjamin Leiby, Mita Majumdar, Amarjeet Mehta, Seema Mehta, Sudhir Mehta, Stephen T. Mennemeyer, Amit P. Revankar, Dharmesh Kumar Sharma, Vanessa Short, Manjunath S. Somannavar, Dennis Wallace, Hemang Shah, Manjula Singh, Sufia Askari, Mrutyunjaya B. Bellad, and the RAPIDIRON Trial Group
- Subjects
Anaemia ,Iron deficiency anaemia ,Anaemia in pregnancy ,Intravenous iron ,Oral iron ,Low birth weight infants ,Medicine (General) ,R5-920 - Abstract
Abstract Background Anaemia is a worldwide problem and iron deficiency is the most common cause. In pregnancy, anaemia increases the risk of adverse maternal, foetal and neonatal outcomes. India’s anaemia rate is among the highest in the world with India’s National Family Health Survey indicating over 50% of pregnant women were affected by anaemia. India’s Anaemia Mukt Bharat-Intensified National Iron Plus Initiative aims to reduce the prevalence of anaemia among reproductive-age women, adolescents and children by 3% per year and facilitate the achievement of a Global World Health Assembly 2025 objective to achieve a 50% reduction of anaemia among women of reproductive age. However, preliminary results of the NFHS-5 survey completed in 2020 indicate that anaemia rates are increasing in some states and these targets are unlikely to be achieved. With oral iron being the first-line treatment for iron deficiency anaemia (IDA) in pregnancy, these results are likely to be impacted by the side effects, poor adherence to tablet ingestion and low therapeutic impact of oral iron. These reports suggest a new approach to treating IDA, specifically the importance of single-dose intravenous iron infusions, may be the key to India effectively reaching its targets for anaemia reduction. Methods This 3-arm, randomized controlled trial is powered to report two primary outcomes. The first is to assess whether a single dose of two different intravenous formulations administered early in the second trimester of pregnancy to women with moderate IDA will result in a higher percentage of participants achieving a normal for pregnancy Hb concentration at 30–34 weeks’ gestation or just prior to delivery when compared to participants taking standard doses of oral iron. The second is a clinical outcome of low birth weight (LBW) (< 2500 g), with a hypothesis that the risk of LBW delivery will be lower in the intravenous iron arms when compared to the oral iron arm. Discussion The RAPIDIRON trial will provide evidence to determine if a single-dose intravenous iron infusion is more effective and economically feasible in reducing IDA in pregnancy than the current standard of care. Trial registration Clinical Trials Registry – India CTRI/2020/09/027730. Registered on 10 September 2020, http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=46801&EncHid=&userName=anemia%20in%20pregnancy
- Published
- 2021
- Full Text
- View/download PDF
12. Gain of Function Research: the Clairvoyant Lens on Pandemics
- Author
-
Sudhir BHANDARI, Amitabh DUBE, Bhoopendra PATEL, Amit TAK, Minal KACHHAWA, Jitendra Kumar GUPTA, Kapil GUPTA, and Shivankan KAKKAR
- Subjects
gofr ,influenza ,microorganisms ,pandemic ,vaccines ,Medicine ,Medicine (General) ,R5-920 - Abstract
Pandemic influenza viruses have emerged three times in this century. It is important to examine the potential risk of novel microorganisms/viruses through the add-on research mechanism of Gain of Function Research (GoFR). This mechanism consists of the practice of serial passaging of microorganisms to increase their transmissibility, virulence, immunogenicity, and host tropism through the inclusive feature of selective pressure of culture medium. Although, the GoFR can be a double-edged sword that has the potential to give an insight and better appreciation of current and future pandemics with antecedent apprehension of initiating a pandemic, itself. Moreover, with its inherent potential to give a head start on a virus, GoFR has the potential to develop vaccines or therapeutics, before the virus emerges in its true virulent form. Likewise, the GoFR studies can be vital in research on antivirals and antimicrobial agents and can help inform the development of combination therapies. Passive immunotherapy, which often includes a combination of products, is particularly dependent on GoFR experiments for evaluating efficacy. GoFR if made use of meticulously and with caution could help Medical Sciences and Humankind tremendously.
- Published
- 2021
- Full Text
- View/download PDF
13. Genomic profile of SARS-CoV-2 Omicron variant and its correlation with disease severity in Rajasthan
- Author
-
Ravi P. Sharma, Swati Gautam, Pratibha Sharma, Ruchi Singh, Himanshu Sharma, Dinesh Parsoya, Farah Deeba, Neha Bhomia, Nita Pal, Varsha Potdar, Pragya D. Yadav, Nivedita Gupta, Sudhir Bhandari, Abhinendra Kumar, Yash Joshi, Priyanka Pandit, and Bharti Malhotra
- Subjects
SARS-CoV-2 ,NGS ,Omicron ,pandemic ,BA.2 ,BA.1 ,Medicine (General) ,R5-920 - Abstract
BackgroundOmicron, a new variant of Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2), was first detected in November 2021. This was believed to be highly transmissible and was reported to evade immunity. As a result, an urgent need was felt to screen all positive samples so as to rapidly identify Omicron cases and isolate them to prevent the spread of infection. Genomic surveillance of SARS-CoV-2 was planned to correlate disease severity with the genomic profile.MethodsAll the SARS-CoV-2 positive cases detected in the state of Rajasthan were sent to our Lab. Samples received from 24 November 2021 to 4 January 2022 were selected for Next-Generation Sequencing (NGS). Processing was done as per protocol on the Ion Torrent S5 System for 1,210 samples and bioinformatics analysis was done.ResultsAmong the 1,210 samples tested, 762 (62.9%) were Delta/Delta-like and other lineages, 291 (24%) were Omicron, and 157 (12.9%) were invalid or repeat samples. Within a month, the proportion of Delta and other variants was reversed, 6% Omicron became 81%, and Delta and other variants became 19%, initially all Omicron cases were seen in international travelers and their contacts but soon community transmission was seen. The majority of patients with Omicron were asymptomatic (56.7%) or had mild disease (33%), 9.2% had moderate symptoms, and two (0.7%) had severe disease requiring hospitalization, of which one (0.3%) died and the rest were (99.7%) recovered. History of vaccination was seen in 81.1%, of the previous infection in 43.2% of cases. Among the Omicron cases, BA.1 (62.8%) was the predominant lineage followed by BA.2 (23.7%) and B.1.529 (13.4%), rising trends were seen initially for BA.1 and later for BA.2 also. Although 8.9% of patients with Delta lineage during that period were hospitalized, 7.2% required oxygen, and 0.9% died. To conclude, the community spread of Omicron occurred in a short time and became the predominant circulating variant; BA.1 was the predominant lineage detected. Most of the cases with Omicron were asymptomatic or had mild disease, and the mortality rate was very low as compared to Delta and other lineages.
- Published
- 2022
- Full Text
- View/download PDF
14. COVID-19 and Its Impact on Undergraduate Students in an Indian Medical Institute: Learning Is in Full Swing
- Author
-
Sudhir Bhandari, Monica Jain, Amarjeet Mehta, Shruti Bhargava, Deepali Pathak, Mohnish Grover, and Ishwar Gupta
- Subjects
covid-19 pandemic ,medical education ,online classes ,tele-teaching ,undergraduate learning ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Background: The emergence of COVID-19 pandemic posed a serious challenge to undergraduate medical education. With the principles of social distancing in place, all classroom sessions had to be suspended during the lockdown. Therefore, tele-teaching was planned and live online classes were regularly held for all undergraduate medical students at our institute. This study was conducted to gather the students’ perception of tele-teaching through live online classes. Methods: The present descriptive cross-sectional study enrolled 680 undergraduate students in Sawai Man Singh Medical College, Jaipur, India. It was conducted after two months of regular live teleteaching during April-May 2020, immediately after the lockdown was announced. The classes were held through video conference platform, Cisco WebEx software, for all medical undergraduates at our institute. Two sessions were held every day for each of the four batches of Bachelor of Medicine and Bachelor of Surgery (MBBS). The students’ perception was collected at the end of two months of such teaching, through a pre-validated open-ended questionnaire using Google Form platform. Result: Majority of students [n=493, (72.5%)] found the online classes beneficial and were satisfied with the content and relevance of the courses delivered. The most common challenges were internet connectivity issues and limited interaction with the faculty, yet the students’ general perceptions reflect that they have benefitted from these online classes during the pandemic period and want them to continue even after the lockdown. Conclusion: This study described the undergraduate medical students’ response to the live online classes and the encountered challenges. It concluded that this endeavour was a welcome note for the students as well as the medical teachers, in the time of COVID-19 pandemic, when all undergraduate teaching/learning had come to a standstill.
- Published
- 2021
- Full Text
- View/download PDF
15. Demystifying COVID-19 lung pathology: A clinicopathological study of postmortem core needle biopsy
- Author
-
Sudhir Bhandari, Ranjana Solanki, Arpita Jindal, Govind Rankawat, Deepali Pathak, Meenu Bagarhatta, and Ajeet Singh
- Subjects
covid-19 pathology ,lung biopsy ,reverse transcription-polymerase chain reaction ,Diseases of the respiratory system ,RC705-779 - Abstract
Background: Atypical presentation of coronavirus disease-19 (COVID-19) from classic acute respiratory distress syndrome needs to be extensively evaluated to understand the pathophysiology to optimize the management protocol for severely ill patients to abrogate the terminal event. Methods: Autopsy core needle biopsies of lungs were obtained from 12 patients who died with COVID-19. Routine histopathological examination of lung tissue along with immunohistochemical analysis of C4d complement staining was studied. Formalin-fixed paraffin-embedded biopsy material was also subjected to real-time reverse transcription-polymerase chain reaction for severe acute respiratory syndrome – coronavirus (SARS-CoV2) gene. Results: In the study, all the deceased patients were symptomatic with two-thirds suffering from isolated SARS-CoV2-related pneumonia while remaining one-third had secondary COVID-19 infection. Histopathological evaluation highlights diffuse alveolar damage as the predominant pattern; however, complement-mediated endothelial injury of septal microvasculature, and microthrombi was also distinctly observed with increased serum levels of D-Dimer and fibrinogen-degradation products. The patients who had extrapulmonary manifestations at the time of presentation also showed pulmonary vascular lesions on histopathologic examination. Our study confirms the presence of coagulopathy and immune-mediated microthrombi in pulmonary septal microvasculature in patients with severe disease. Conclusion: The results of our small series of patients highlight the possibility of immune-mediated pulmonary vascular injury and thrombosis which has the potential to evolve into large vessel thrombosis and pulmonary embolism in critically ill patients. Definitive therapeutic management protocol including thromboembolic prophylaxis and development of effective immune-modulatory target could possibly reduce mortality in severely ill patients.
- Published
- 2021
- Full Text
- View/download PDF
16. Evaluating the presence of SARS-CoV-2 in the intraocular fluid of COVID-19 patients
- Author
-
Maya Hada, Kamlesh Khilnani, Nitya Vyas, Jugal Kishore Chouhan, Kulveer S Dharawat, Sudhir Bhandari, and Koushik Tripathy
- Subjects
aqueous humor ,sars-cov-2 ,vitreous humor ,Ophthalmology ,RE1-994 - Abstract
Purpose: To detect the presence of SARS-CoV-2 in aqueous and vitreous humor of COVID-19 patients in a pilot study. Methods: Consecutive patients planned for emergency ophthalmic surgeries after ocular trauma were subjected to naso-oropharyngeal RT-PCR test for SARS-CoV-2. Laboratory-confirmed cases were enrolled for the study. During surgery, 0.1 mL aqueous and vitreous each was aspirated. The vitreous tap was collected on clinical suspicion of endophthalmitis. RT-PCR test was used to detect SARS-COV-2 nucleotide in the samples. Cycle threshold (Ct) for E gene of ≤35 along with confirmatory results on one of the two target genes (RdRp or ORF1b) was considered as positive. Results: One hundred and thirty two patients were found positive on naso-oropharyngeal RT-PCR test for SARS-CoV-2 preoperatively. Seven patients with ocular trauma were studied. The mean age was 31.8 years. There were six male and one female patient. Two patients had symptoms of mild COVID-19 disease and the rest were asymptomatic. The mean Ct value of the E gene on naso-oropharyngeal RT-PCR was 23.14 ± 4.7. Corneal and corneoscleral laceration repair was done in five patients, intracorneal wooden foreign body was removed in one patient, and injection of intravitreal antibiotics was done in one patient. Aqueous and vitreous tap was collected in 7 and 5 patients, respectively. None of the aqueous or vitreous samples was found positive for SARS-CoV-2. Conclusion: SARS-CoV-2 was not detected by RT-PCR in aqueous or vitreous humor in this pilot study. Future studies with a larger sample size are needed to further explore the presence of SARS-CoV-2 in intraocular fluids.
- Published
- 2021
- Full Text
- View/download PDF
17. Clinico-epidemiological and genomic profile of first Zika Virus outbreak in India at Jaipur city of Rajasthan state
- Author
-
Bharti Malhotra, Veenu Gupta, Pratibha Sharma, Ruchi Singh, Himanshu Sharma, Madhavi Vyas, Ravi P. Mathur, Virender K. Mathur, Deepa Meena, Hemant Malhotra, Pragya D. Yadav, Gajanan Sapkal, Ullas PT, Gururaj Rao Deshpande, Rashmi Gunjikar, Heena Shaman, Devendra T. Mourya, Nivedita Gupta, Sujit Singh, P. Ravindran, Jitender Tiwari, Dimpal A. Nyayanit, Neeraj Kumar, Sameer Phalke, Anup Chugani, Sudhir Bhandari, Prashanth Suravajhala, Pooran Singh Solanki, and Manila Salaria
- Subjects
Zika virus ,real-time RT-PCR ,Virus Research Diagnostic Laboratory ,Clinical ,India ,Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Background: First Zika virus (ZIKV) positive case from North India was detected on routine surveillance of Dengue-Like Illness in an 85-year old female. Objective of the study was to conduct an investigation for epidemiological, clinical and genomic analysis of first ZIKV outbreak in Rajasthan, North India and enhance routine ZIKV surveillance. Method: Outbreak investigation was performed in 3 Km radius of the index case among patient contacts, febrile cases, and pregnant women. Routine surveillance was enhanced to include samples from various districts of Rajasthan. Presence of ZIKV in serum and urine samples was detected by real time PCR test and CDC trioplex kit. Few ZIKV positive samples were sequenced using the next-generation sequencing method for genomic analysis. Result: On outbreak investigation 153/2043 (7.48%) cases were found positive: 1/153 (0.65%) among contacts, 90/153 (58.8%) in fever cases, 62/153(40.5%) in pregnant females. In routine surveillance, 6/4722 (0.12%) serum samples were ZIKV positive.Majority of patients had mild signs and symptoms, no case of microcephaly and Guillain- Barre Syndrome was seen, 25 (40.3%) pregnant females delivered healthy babies, four (6.4%) reported abortion and three (4.8%) had intrauterine death, one (1.6%) child had colorectal malformation and died after few days of birth. ZIKV was found to belong to Asian lineage, mutation related to enhanced neuro-virulence and transmission in animal models was not found. Conclusion: ZIKV was endogenous to India belonging to Asian Lineage. Disease profile of the ZIKV was asymptomatic to mild. No major anomaly was observed in infants born to ZIKV positive mothers; however, long term follow up of these children is required. There is need to scale up surveillance in the virology lab network of India for early detection and control. Summary line: Zika virus infection was endogenous due to Asian Lineage with mild disease, no case of microcephaly or Guillain- Barre Syndrome was seen but children need to be followed for anomalies and surveillance of ZIKV needs to be enhanced in the country.
- Published
- 2020
- Full Text
- View/download PDF
18. Cardiovascular complications and its impact on outcomes in COVID-19
- Author
-
Shekhar Kunal, Shashi Mohan Sharma, Sohan Kumar Sharma, Dinesh Gautam, Harnish Bhatia, Himanshu Mahla, Sandeep Sharma, and Sudhir Bhandari
- Subjects
Acute cardiac injury ,Acute coronary syndrome ,Cardiogenic shock ,COVID-19 ,Heart failure ,Myocarditis ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Coronavirus disease 2019 (COVID-19) has led to a widespread morbidity and mortality. Limited data exists regarding the involvement of cardiovascular system in COVID-19 patients. We sought to evaluate the cardiovascular (CV) complications and its impact on outcomes in symptomatic COVID-19 patients. Methods: This was a single center observational study among symptomatic COVID-19 patients. Data regarding clinical profile, laboratory investigations, CV complications, treatment and outcomes were collected. Cardiac biomarkers and 12 lead electrocardiograms were done in all while echocardiography was done in those with clinical indications for the same. Corrected QT-interval (QTc) at baseline and maximum value during hospitalization were computed. Results: Of the 108 patients, majority of them were males with a mean age of 51.2 ± 17.7 years. Hypertension (38%) and diabetes (32.4%) were most prevalent co-morbidities. ECG findings included sinus tachycardia in 18 (16.9%), first degree AV block in 5 (4.6%), VT/VF in 2 (1.8%) and sinus bradycardia in one (0.9%). QTc prolongation was observed in 17.6% subjects. CV complications included acute cardiac injury in 25.9%, heart failure, cardiogenic shock and acute coronary syndrome in 3.7% each, “probable” myocarditis in 2.8% patients. Patients with acute cardiac injury had higher mortality than those without (16/28 [57.1%] vs 14/78 [17.5%]; P
- Published
- 2020
- Full Text
- View/download PDF
19. Efficacy of moderate-intensity physical activity in lowering non- high-density lipoprotein cholesterol in stage 2 essential hypertensive patients
- Author
-
Barkha Gupta, Sonali Sharma, Sudhir Bhandari, and Sapna Jangir
- Subjects
hypertension ,low-density lipoprotein cholesterol cholesterol ,non-hdl cholesterol ,physical activity ,Medicine - Abstract
Background: Hypertension and non–high-density lipoprotein cholesterol (non-HDL-c) measure is a useful evaluation tool to assess heart disease risk. Increasing physical activity (PA) is considered to reduce blood pressure (BP) and non-HDL-c in patients with hypertension. Objective: This study assesses the influence of moderate and regular PA on non-HDL cholesterol in essential hypertension. Subjects and methods: We studied 100 patients of either gender, aged 40–69 years of stage 2 essential hypertension in this interventional study. Patients were enrolled for 12 weeks of PA intervention (10,000 footsteps per day) and were followed at 15 days interval in the first month and after that 1-month duration. Lipid profile was estimated at baseline and at the final assessment visit (after 12 weeks). Results: The data included in this study confirm the beneficial effects of regular PA on non-HDL-c levels (P < 0.000001). It was found that after 12 weeks of intervention program, the cholesterol, triglycerides; low-density lipoprotein cholesterol (LDL), very low-density lipoprotein cholesterol (VLDL), and non-HDL-c were lowered from 276.53 to 194.19, 191.17 to 110.58, 196.07 to 120.72, 38.23 to 22.12, and 234.32 to 142.84, respectively. It was also noted that high-density lipoprotein cholesterol (HDL) was increased from 42.21 to 51.35 following the interventional program. All the results were highly significant (P < 0.000001). Conclusions: A non-pharmacological activity like PA is beneficial for better management of hypertension to avoid cardiovascular co-morbidities. Twelve weeks of physical exercise program (walking of 10,000 footsteps/day) decreases the risk associated with BP elevation by improving non-HDL-c in hypertensive patients.
- Published
- 2020
- Full Text
- View/download PDF
20. Odontogenic cutaneous sinus tracts: A clinician's dilemma
- Author
-
Muthu Sendhil Kumaran, Tarun Narang, Sunil Dogra, and Sudhir Bhandari
- Subjects
facial sinus ,investigations ,odontogenic sinus ,pulp necrosis ,root canal ,Dermatology ,RL1-803 - Abstract
Background: Odontogenic cutaneous sinus tract (OCST) is one of the rare manifestations of chronic dental infections. Although well reported in literature, it is often misdiagnosed or under diagnosed. Apart from isolated case reports especially in dental literature there is a paucity of comprehensive case series on OCST. Aims and Objectives: We undertook this study to observe the prevalence, clinico epidemiological features and management issues in these patients from a dermatological perspective. Methods: A retrospective study was undertaken analyzing the clinical records of patients registered at our outpatient department (OPD) from 2011 to 2018. Cases with a clinical and radiological diagnosis of odontogenic cutaneous sinus were included in the study. We studied the following variables: frequency, gender, age, localization, morphology, mean time of evolution and treatment response. Results: 21 patients with OCST were identified from our records. Females outnumbered males; patients in the age group between 31-40 years were more commonly affected. Three morphological presentations were noted in the form of flesh-colored dry nodules with sinus, adherent plaques with mucopurulent discharge and ulcer. Posterior set of teeth were commonly affected and mandible was the commonest site for location of sinus. The time taken for appropriate diagnosis in these cases ranged from 7-16 months. Almost all the patients responded to endodontal or root canal treatment and there were no recurrences. Conclusion: A CST of dental origin is often a diagnostic challenge, especially in cases with minimal or no dental symptoms. A thorough skin and dental examination is required for sinuses on the head and neck area with a high index of suspicion for OCST. Most cases respond to conservative, root canal therapy. An early diagnosis can save the patient from unnecessary and ineffective therapies and sometimes surgeries.
- Published
- 2020
- Full Text
- View/download PDF
21. A preliminary clinico-epidemiological portrayal of COVID-19 pandemic at a premier medical institution of North India
- Author
-
Sudhir Bhandari, Ajit Singh Shaktawat, Raman Sharma, Amitabh Dube, Shivankan Kakkar, S Banerjee, Prakash Keshwani, Shrikant Sharma, Sunil Mahavar, C L Nawal, Sudhir Mehta, Abhishek Agarwal, Vishal Gupta, Ashwin Mathur, Amita Kashyap, A S Dua, Dilip Raj, Kapil Gupta, Jitendra Kumar Gupta, Neeraj Verma, and Amit Tak
- Subjects
clinical and epidemiological parameters ,covid-19 ,pandemic ,severe acute respiratory syndrome coronavirus 2 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Diseases of the respiratory system ,RC705-779 - Abstract
CONTEXT: The outbreak and spread of severe acute respiratory syndrome coronavirus 2 has led to a global exigency of colossal and monstrous proportions in terms of public health and economic crisis. Till date, no pharmaceutical agent is known to manage in terms of prevention and treatment of coronavirus disease 2019 (COVID-19), the disease caused by a novel virus. AIMS: The aim of the present work was to understand the underlying disease profile and dynamics that could provide relevant inputs and insight into pathophysiology and prevent further spread and evolve management strategies of COVID-19 patients from data-driven techniques. SETTINGS AND DESIGN: A retrospective observational descriptive study was conducted on 29 COVID-19 patients admitted at a premier medical institution of North India in the months of February and March 2020. METHODS: The patients were diagnosed with reverse transcription-polymerase chain reaction test. Demographic, clinical, and laboratory data were collected. RESULTS: The mean age of population was 38.8 years with male preponderance, of which two patients were residents of Italy, and others hailed from semi-arid and Western sandy arid regions of Rajasthan (urban population). The major presenting symptom complex of said COVID-19 sample population included fever (48%), cough (31%), and shortness of breath (17%). Most of the patients (83%) had no comorbidity. No clinical correlation (r) could be appreciated between the duration of test positivity and age of afflicted COVID-19 patients (r = −0.0976). CONCLUSIONS: The present evaluation of various facets of the ongoing global pandemic of COVID-19 is an attempt to portray early clinical and epidemiological parameters of the menace of COVID-19 patients admitted at SMS Medical College and Attached Hospitals, Jaipur.
- Published
- 2020
- Full Text
- View/download PDF
22. Utilizing DICOM data to generate custom computer-aided designing and computer-aided machining polyetheretherketone healing abutments for an ear prosthesis
- Author
-
Mohit Dhiman, Sudhir Bhandari, and Sunil Gaba
- Subjects
auricular prosthesis ,computer-aided designing and computer-aided machining ,custom healing abutments ,polyetheretherketone extraoral use ,polyetheretherketone ,Dentistry ,RK1-715 - Abstract
Soft tissue healing around implants may turn out to be the most decisive factor in the success or failure of the prosthesis. Dimension, configuration, and material of the healing abutments play a pivotal role in achieving optimal soft tissue architecture around implants. Digital imaging with computer-aided designing and computer-aided machining (CAD-CAM) technology, has made it easier to illustrate, design, replicate maxillofacial structures, and generate its supporting elements in a reliable, faster, and more convenient manner. This case report highlights the issue relevant to the implant-supported prosthetic replacement, on a site previously attempted for surgical reconstruction of the missing ear. Presurgical DICOM data were used to obtain custom CAD-CAM polyetheretherketone (PEEK) healing abutments on implants in a patient with an excessive amount of tissue in the missing right ear region. It is probably the first extraoral use of PEEK as a healing abutment in the workflow of implant retained maxillofacial prosthetics. No issue warranting the removal of the PEEK component was observed during the duration of its use.
- Published
- 2020
- Full Text
- View/download PDF
23. The epidemiological and trending pattern of nCOVID-19 in the state of Rajasthan, India
- Author
-
Sudhir Bhandari, Ajeet Singh, Subrata Banerjee, Raman Sharma, Govind Rankawat, Vishal Gupta, Prakash Keswani, Ashwin Mathur, Abhishek Agarwal, Shrikant Sharma, and P D Meena
- Subjects
coronavirus disease 2019 ,epidemiology ,mortality ,recovery ,time trend distribution ,Immunologic diseases. Allergy ,RC581-607 - Abstract
PURPOSE: The present study was undertaken to investigate the behavioral distribution pattern and progression of coronavirus disease 2019 (COVID-19) across age and gender in the state of Rajasthan, India, inherently distinctive and native to localized part of the globe giving requisite information and paraphernalia to designate advisory board of the state to design and frame customized policy for demands of the state as per the trending pattern relative to age and sex distribution, profile of new infected cases, recovery rate, and case fatality rate. METHODS: The present ongoing study assessed patients admitted till April 22, 2020, across the state of Rajasthan, India, with reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 test. Analyses of the patients included characteristic age and gender distribution through the geographic identities of state along with the time trending pattern of newly infected patients, recovered patients, and case fatality rate. RESULTS: A total of 1888 sample patient population of RT-PCR-confirmed COVID-19 was evaluated, with the majority of sample patient population being in young adult age group with a mean age of 34.42 years. Nearly 11.65% of the patients were below 15 years of age, 34.79% were in the age range of 16–30 years, 25.90% were in the age group of 31–45 years, and 17.69% were in the age group of 46–60 years, with only 9.95% of the patient population being in the age group of above 60 years. Interestingly, 11.65% of patients with COVID-19 were in the pediatric age group. The percent of affected females (37.35%) was much less than that compared to males (62.65%), with an average sex ratio of 0.59. Across the sample patient population of 1888, 543 patients recovered fully, 25 patients died, and 1320 cases were active in the said time frame, with an average recovery rate of 28.76% and a case fatality rate of 1.32%, and the remaining 69.91% of the patient population made up the active case group. The timeline and the trending pattern of COVID-19 in the state of Rajasthan was suggestive of an increasing rise of number of new cases with antecedent mortality, though a reassuring concomitant rise in the recovery rate of patients could also be appreciated. The infective COVID-19 dictum of spread through contact could very well be appreciated in select geographic hotspots and/or zones, and 108 sample patient population was from out of Rajasthan. CONCLUSION: It was interesting to observe that majority of the resident population of the state of Rajasthan that was COVID-19 positive was in the young adult age group of 30–50 years inclusive of pediatric patients, an observation that is different from reports as documented from across the world. Male population seemed to be more prone to infection. The time frame in which the evaluation was done is suggestive of an increasing trend in the number of new cases with antecedent case fatality, though recovery was also on the rise indicative of a potential decreasing load. The geographic mapping of COVID-19 patients could be established through contact tracing.
- Published
- 2020
- Full Text
- View/download PDF
24. No evidence of recent Zika virus transmission among the cohort of pregnant women after the 2018 outbreak in Jaipur city, Rajasthan, India, 2019-20
- Author
-
Tarun Bhatnagar, Gururaj Rao Deshpande, Bharti Malhotra, Padinjaremattathil Thankappan Ullas, Rutuja Dhawde, Sharada Sharma, Mukesh Mittal, Jyotsna Vyas, Ponnaiah Manickam, Gajanan Sapkal, Sudhir Bhandari, and Manoj Murhekar
- Subjects
Infectious and parasitic diseases ,RC109-216 - Published
- 2021
- Full Text
- View/download PDF
25. Very late stent thrombosis associated with COVID-19 infection: a case report and review of the literature
- Author
-
Shekhar Kunal, Vijay Pathak, Keshav Pathak, Monika Mishra, Shashi Mohan Sharma, and Sudhir Bhandari
- Subjects
Acute coronary syndrome ,coronavirus ,COVID-19 ,pneumonia ,stent thrombosis ,Medicine - Abstract
Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 has varied manifestation with multisystem involvement. Acute coronary syndrome in COVID-19 as a result of stent thrombosis is an uncommon entity and is often due to hypercoagulable state. A 40-year-old male was referred to us with acute onset chest pain. He also reported fever, sore throat and dry cough for six days which mandated testing for COVID-19 which turned out to be positive. He had a prior history of coronary artery disease with a drug eluting stent implanted two years back. An electrocardiogram was suggestive of acute anterior wall myocardial infarction while echocardiogram revealed hypokinesia of left anterior descending (LAD) artery territory. Coronary angiogram revealed non-occlusive thrombus in proximal LAD stent. A Thrombolysis in Myocardial Infarction (TIMI) III flow was restored following balloon angioplasty with a non-compliant balloon and use of glycoprotein (GP) IIb-IIIa receptor antagonist. A diagnosis of very late stent thrombosis subsequent to COVID-19 was made.
- Published
- 2021
- Full Text
- View/download PDF
26. Clinical and epidemiological profile of Indian COVID-19 patients from Jaipur: a descriptive study
- Author
-
Sunil Mahavar, Princy Tyagi, Abhishek Agrawal, Sudhir Bhandari, Subrata Banerjee, Raman Sharma, and Prakash Keshwani
- Subjects
COVID-19 ,severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) ,asymptomatic ,clinical characteristic ,India ,Medicine - Abstract
We analyzed the data of 102 confirmed patients with novel Coronavirus 2 infection (COVID-19) during the early period of nationwide lockdown announced in India after the declaration of pandemic. We analyzed epidemiological, clinical characteristics and outcome of hospitalization in 102 patients with positive results for novel corona virus (SARS-CoV-2) RNA testing which were traced on the basis of history of travel, contact with a confirmed COVID-19 case, resident of hotspot areas or presence of symptoms, thus providing an accurate estimate of the proportion of asymptomatic cases in the initial population. Of 102 patients enrolled in the study, 83.3% (85/102) were asymptomatic and 16.67% (17/102) were symptomatic. Seventy-seven (75.49%) were males and 24.50% (25/102) were females. Eighteen (17.6%) patients had associated comorbidities, the most prevalent of which were diabetes mellitus 10.8% (11/102), hypertension 7.8% (8/102), chronic obstructive pulmonary disease (COPD) in 3.92% (4/102), chronic kidney Disease (CKD) 0.98% (1/102), coronary artery Disease (CAD) 0.98% (1/102) and cerebro-vascular disease (CVD) 0.98% (1/102). The clinical spectrum among symptomatic COVID-19 patients varied from dry cough and fever to respiratory failure and multi-organ failure. Twelve (11.76%) patients were kept in intensive care unit (ICU). Ninety-nine (97.05%) patients recovered while three (2.94%) died during hospital stay. With majority of COVID-19 cases in India being asymptomatic, changes in biochemical and inflammatory profile were small and insignificant in asymptomatic patients when compared to symptomatic patients. Elevated NLR, lymphopenia, age and presence of comorbidities were associated with increased severity and poor outcome.
- Published
- 2021
- Full Text
- View/download PDF
27. Consensus and recommendations on continuous glucose monitoring
- Author
-
Manoj Chawla, Banshi Saboo, Sujeet Jha, Sudhir Bhandari, Prasanna Kumar, Jothydev Kesavadev, Yash Pal Munjal, Viswanathan Mohan, Ranjit Unnikrishnan, Vishal Katswar, Nanditha Arun, Bhavana Sosale, Ranjit Mohan Anjana, and Dhruvi Hasnani
- Subjects
Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Published
- 2019
- Full Text
- View/download PDF
28. Use of Diode Lasers to Enhance Aesthetics of Anterior Implant Supported Prosthesis: A Report of Two Cases
- Author
-
MOHIT DHIMAN, GUNJAN PRUTHI, TEJOMAYA D SHASTRY, and SUDHIR BHANDARI
- Subjects
dental implant ,gingivectomy ,gingival zenith ,second stage surgery ,Medicine - Abstract
Diode lasers have been used for multiple applications in dentistry; however, its use for soft tissue management around dental implants has not been reported much. The role of symmetrical gingival tissue with properly positioned zenith is paramount to achieving aesthetics. The gingival zenith can be described as the most apical point on the marginal gingiva; its ideal placement should be at the crest of the curvature of the gingival margin for the central incisors, canines, and premolars, this should be ideally located slightly distal to the middle of the long axis on these teeth. This produces a slight inclination of the distal root which plays a vital role in the foundation of a beautiful smile. If this gingival complex is malpositioned in maxillary anterior region, it may result in an unaesthetic appearance even if the artificial teeth are perfectly aligned. Here, authors are presenting two patients with missing anterior teeth, who were not satisfied with the final aesthetic outcome of their implant supported prostheses. Due to history of trauma and painful course of treatment, patients were not comfortable with one more exposure to injectable anaesthesia, use of scalpel, or long healing process when they were almost nearing completion of their treatment. So, Diode laser was used for soft tissue excision around implants followed by gingival contouring in pontic region to achieve the desired gingival zenith and contour. The procedure was painless, blood free, followed by quick healing and effective in achieving optimal aesthetic outcome for both the patients.
- Published
- 2021
- Full Text
- View/download PDF
29. Role of portable chest radiography in management of COVID-19: Experience of 422 patients from a tertiary care center in India
- Author
-
Alka Goyal, Raghav Tiwari, Meenu Bagarhatta, B Ashwini, Bhavyansh Rathi, and Sudhir Bhandari
- Subjects
ct-computed tomography ,cxr-chest radiography ,ggo-ground glass opacity ,rt-pcr – reverse transcriptase polymerase chain reaction ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Objective: To analyze radiological changes in portable chest radiographs in coronavirus disease-19(COVID-19) patients to optimize the management of hospitalized patients. Methods: We retrospectively reviewed 638 portable radiographs of 422 hospitalized COVID-19 patients with RT-PCR confirmed COVID-19 infection. All the radiographs were reported in a structured format by two experienced radiologists. A severity score was assigned to every Chest Xray (CXR) and correlation was done with the CT scans whenever available. Results: Out of 422 baseline portable radiographs assessed,the ratio of male: female patients was 337:85 that is 79.8% were males and 20.14% were females.The mean age was 50.5 years and the range was 17–84 years.Of these 422 patients, 187 patients (44.3%) had abnormal baseline CXR. 161 out of 187 (86%) had either typical or indeterminate findings for COVID-19 pneumonia, rest 26 (13.9%) patients had CXR findings not consistent with COVID-19, like pleural effusion, hydropneumothorax, or lung cavity.Most commonly observed CXR findings in COVID 19 pneumonia were bilateral, multifocal air space opacities (consolidation and ground-glass opacities) predominantly involving lower zones and peripheral lung fields. X-ray identifiable lung changes of COVID-19 were mostly seen at 9-11 days after symptom onset. Conclusion: The presence of multifocal air-space opacities with bilateral, peripheral distribution on chest radiograph is highly suggestive of COVID-19 pneumonia in this pandemic setting.Portable chest radiography is a widely available and quicktool for estimating the evolution and assessing the severity of lung involvement of COVID-19 pneumonia in hospitalized symptomatic patients.
- Published
- 2021
- Full Text
- View/download PDF
30. High throughput detection and genetic epidemiology of SARS-CoV-2 using COVIDSeq next-generation sequencing.
- Author
-
Rahul C Bhoyar, Abhinav Jain, Paras Sehgal, Mohit Kumar Divakar, Disha Sharma, Mohamed Imran, Bani Jolly, Gyan Ranjan, Mercy Rophina, Sumit Sharma, Sanjay Siwach, Kavita Pandhare, Swayamprabha Sahoo, Maheswata Sahoo, Ananya Nayak, Jatindra Nath Mohanty, Jayashankar Das, Sudhir Bhandari, Sandeep K Mathur, Anshul Kumar, Rahul Sahlot, Pallavali Rojarani, Juturu Vijaya Lakshmi, Avileli Surekha, Pulala Chandra Sekhar, Shelly Mahajan, Shet Masih, Pawan Singh, Vipin Kumar, Blessy Jose, Vidur Mahajan, Vivek Gupta, Rakesh Gupta, Prabhakar Arumugam, Anjali Singh, Ananya Nandy, Ragavendran P V, Rakesh Mohan Jha, Anupama Kumari, Sheetal Gandotra, Vivek Rao, Mohammed Faruq, Sanjeev Kumar, Betsy Reshma G, Narendra Varma G, Shuvra Shekhar Roy, Antara Sengupta, Sabyasachi Chattopadhyay, Khushboo Singhal, Shalini Pradhan, Diksha Jha, Salwa Naushin, Saruchi Wadhwa, Nishu Tyagi, Mukta Poojary, Vinod Scaria, and Sridhar Sivasubbu
- Subjects
Medicine ,Science - Abstract
The rapid emergence of coronavirus disease 2019 (COVID-19) as a global pandemic affecting millions of individuals globally has necessitated sensitive and high-throughput approaches for the diagnosis, surveillance, and determining the genetic epidemiology of SARS-CoV-2. In the present study, we used the COVIDSeq protocol, which involves multiplex-PCR, barcoding, and sequencing of samples for high-throughput detection and deciphering the genetic epidemiology of SARS-CoV-2. We used the approach on 752 clinical samples in duplicates, amounting to a total of 1536 samples which could be sequenced on a single S4 sequencing flow cell on NovaSeq 6000. Our analysis suggests a high concordance between technical duplicates and a high concordance of detection of SARS-CoV-2 between the COVIDSeq as well as RT-PCR approaches. An in-depth analysis revealed a total of six samples in which COVIDSeq detected SARS-CoV-2 in high confidence which were negative in RT-PCR. Additionally, the assay could detect SARS-CoV-2 in 21 samples and 16 samples which were classified inconclusive and pan-sarbeco positive respectively suggesting that COVIDSeq could be used as a confirmatory test. The sequencing approach also enabled insights into the evolution and genetic epidemiology of the SARS-CoV-2 samples. The samples were classified into a total of 3 clades. This study reports two lineages B.1.112 and B.1.99 for the first time in India. This study also revealed 1,143 unique single nucleotide variants and added a total of 73 novel variants identified for the first time. To the best of our knowledge, this is the first report of the COVIDSeq approach for detection and genetic epidemiology of SARS-CoV-2. Our analysis suggests that COVIDSeq could be a potential high sensitivity assay for the detection of SARS-CoV-2, with an additional advantage of enabling the genetic epidemiology of SARS-CoV-2.
- Published
- 2021
- Full Text
- View/download PDF
31. Patient Flow Dynamics in Hospital Systems During Times of COVID-19: Cox Proportional Hazard Regression Analysis
- Author
-
Sudhir Bhandari, Amit Tak, Sanjay Singhal, Jyotsna Shukla, Ajit Singh Shaktawat, Jitendra Gupta, Bhoopendra Patel, Shivankan Kakkar, Amitabh Dube, Sunita Dia, Mahendra Dia, and Todd C. Wehner
- Subjects
COVID-19 ,cox proportion hazards models ,evidence based decision making ,hospital beds ,public health ,hospital management ,Public aspects of medicine ,RA1-1270 - Abstract
Objectives: The present study is aimed at estimating patient flow dynamic parameters and requirement for hospital beds. Second, the effects of age and gender on parameters were evaluated.Patients and Methods: In this retrospective cohort study, 987 COVID-19 patients were enrolled from SMS Medical College, Jaipur (Rajasthan, India). The survival analysis was carried out from February 29 through May 19, 2020, for two hazards: Hazard 1 was hospital discharge, and Hazard 2 was hospital death. The starting point for survival analysis of the two hazards was considered to be hospital admission. The survival curves were estimated and additional effects of age and gender were evaluated using Cox proportional hazard regression analysis.Results: The Kaplan Meier estimates of lengths of hospital stay (median = 10 days, IQR = 5–15 days) and median survival rate (more than 60 days due to a large amount of censored data) were obtained. The Cox model for Hazard 1 showed no significant effect of age and gender on duration of hospital stay. Similarly, the Cox model 2 showed no significant difference of age and gender on survival rate. The case fatality rate of 8.1%, recovery rate of 78.8%, mortality rate of 0.10 per 100 person-days, and hospital admission rate of 0.35 per 100,000 person-days were estimated.Conclusion: The study estimates hospital bed requirements based on median length of hospital stay and hospital admission rate. Furthermore, the study concludes there are no effects of age and gender on average length of hospital stay and no effects of age and gender on survival time in above-60 age groups.
- Published
- 2020
- Full Text
- View/download PDF
32. Evidence-based decision making and covid-19: what a posteriori probability distributions speak
- Author
-
Sudhir Bhandari, Ajit Singh Shaktawat, Amit Tak, Jyotsna Shukla, Bhoopendra Patel, Sanjay Singhal, Jitentdra Gupta, Shivankan Kakkar, Amitabh Dube, Sunita Dia, Mahendra Dia, and Todd C. Wehner
- Subjects
COVID-19, a posteriori Probability Distributions, Epidemiology, Evidence-Based Decision Making, Public Health, SARS CoV-2, India ,Medicine ,Medicine (General) ,R5-920 - Abstract
Background: In the absence of any pharmaceutical interventions, the management of the COVID-19 pandemic is based on public health measures. The present study fosters evidence-based decision making by estimating various “a posteriori probability distributions" from COVID-19 patients. Methods: In this retrospective observational study, 987 RT-PCR positive COVID-19 patients from SMS Medical College, Jaipur, India, were enrolled after approval of the institutional ethics committee. The data regarding age, gender, and outcome were collected. The univariate and bivariate distributions of COVID-19 cases with respect to age, gender, and outcome were estimated. The age distribution of COVID-19 cases was compared with the general population's age distribution using the goodness of fit c2 test. The independence of attributes in bivariate distributions was evaluated using the chi-square test for independence. Results: The age group ‘25-29’ has shown highest probability of COVID-19 cases (P [25-29] = 0.14, 95% CI: 0.12- 0.16). The men (P [Male] = 0.62, 95%CI: 0.59-0.65) were dominant sufferers. The most common outcome was recovery (P [Recovered] = 0.79, 95%CI: 0.76-0.81) followed by admitted cases (P [Active]= 0.13, 95%CI: 0.11-0.15) and death (P [Death] = 0.08, 95%CI: 0.06-0.10). The age distribution of COVID-19 cases differs significantly from the age distribution of the general population (c2 =399.04, P < 0.001). The bivariate distribution of COVID-19 across age and outcome was not independent (c2 =106.21, df = 32, P < 0.001). Conclusion: The knowledge of disease frequency patterns helps in the optimum allocation of limited resources and manpower. The study provides information to various epidemiological models for further analysis.
- Published
- 2020
- Full Text
- View/download PDF
33. The sequel to COVID-19: the antithesis to life
- Author
-
Sudhir Bhandari, Ajit Singh Shaktawat, Bhoopendra Patel, Amitabh Dube, Shivankan Kakkar, Amit Tak, Jitendra Gupta, and Govind Rankawat
- Subjects
Psychosocial, Mental Health, COVID-19, Social Isolation, Quarantine, Infodemic, India ,Medicine ,Medicine (General) ,R5-920 - Abstract
The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. References • World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. Available at: https://covid19.who.int/ [Accessed on 23 August 2020] • Sim K, Chua HC. The psychological impact of SARS: a matter of heart and mind. CMAJ. 2004; 170:811e2. https://doi.org/10.1503/cmaj.1032003. • Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatr. 2009; 54:302e11. https://doi.org/10.1177/070674370905400504. • Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020; 395:912e20. https://doi.org/10.1016/S0140-6736(20)30460-8. • Robertson E, Hershenfield K, Grace SL, Stewart DE. The psychosocial effects of being quarantined following exposure to SARS: a qualitative study of Toronto health care workers. Can J Psychiatr. 2004; 49:403e7. https://doi.org/10.1177/070674370404900612. • Barbisch D, Koenig KL, Shih FY. Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster Med Public Health Prep. 2015; 9:547e53. https://doi.org/10.1017/dmp.2015.38. • Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, et al. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health. 2016;38: e2016048. https://doi.org/10.4178/epih.e2016048. • Liu X, Kakade M, Fuller CJ, Fan B, Fang Y, Kong J, et al. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatr. 2012; 53:15e23. https://doi.org/10.1016/j.comppsych.2011.02.003 • Chadda RK, Deb KS. Indian family systems, collectivistic society and psychotherapy. Indian J Psychiatry. 2013;55: S299‑ https://dx.doi.org/10.4103%2F0019-5545.105555. • Grover S, Sahoo S, Mehra A, Avasthi A, Tripathi A, Subramanyan A, et al. Psychological impact of COVID‑19 lockdown: An online survey from India. Indian J Psychiatry. 2020; 62:354-62. https://doi.org/ 10.4103/psychiatry.IndianJPsychiatry _427_20. • Hawkley LC, Cacioppo JT. Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Ann Behav Med. 2010; 40: 218–27. https://dx.doi.org/10.1007%2Fs12160-010-9210-8. • Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/10.1016/S0140-6736(20)30211-7. • Bhandari S, Sharma R, Singh Shaktawat A, Banerjee S, Patel B, Tak A, et al. COVID-19 related mortality profile at a tertiary care centre: a descriptive study. Scr Med. 2020;51(2):69-73. https://doi.org/10.5937/scriptamed51-27126. • Baumeister RF, Leary MR. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull. 1995; 117: 497–529. https://doi.org/10.1037/0033-2909.117.3.497. • Caspi A, Harrington H, Moffitt TE, Milne BJ, Poulton R. Socially isolated children 20 years later: risk of cardiovascular disease. Arch Pediatr Adolesc Med. 2006; 160(8):805-11. https://doi.org/10.1001/archpedi.160.8.805. • Eaker ED, Pinsky J, Castelli WP. Myocardial infarction and coronary death among women: psychosocial predictors from a 20-year follow-up of women in the Framingham Study. Am J Epidemiol. 1992; 135(8):854-64. https://doi.org/10.1093/oxfordjournals.aje.a116381. • Luo Y, Hawkley LC, Waite LJ, Cacioppo JT. Loneliness, health, and mortality in old age: a national longitudinal study. Soc Sci Med. 2012 Mar; 74(6):907-14. https://dx.doi.org/10.1016%2Fj.socscimed.2011.11.028. • Olsen RB, Olsen J, Gunner-Svensson F, Waldstrøm B. Social networks and longevity. A 14-year follow-up study among elderly in Denmark. Soc Sci Med. 1991; 33(10):1189-95. https://doi.org/10.1016/0277-9536(91)90235-5. • Patterson AC, Veenstra G. Loneliness and risk of mortality: a longitudinal investigation in Alameda County, California. Soc Sci Med. 2010; 71(1):181-6. https://doi.org/10.1016/j.socscimed.2010.03.024. • Savikko N, Routassalo P, Tilvis RS, Strandberg TE, Pitkalla KH. Predictors and subjective causes of loneliness in an aged population. Arch Gerontol Geriatrics. 2005; 41:3;223-33. https://doi.org/10.1016/j.archger.2005.03.002. • Health Advisory for Elderly Population of India during COVID19. Available at: https://www.mohfw.gov.in/pdf/AdvisoryforElderlyPopulation.pdf [Accessed on 13 August 2020]. • Dicks D, Myers R, Kling A. Uncus and amygdala lesions: effects on social behavior in the free-ranging rhesus monkey. Science. 1969; 165:69–71. https://doi.org/10.1126/science.165.3888.69. • Kanai R, Bahrami B, Duchaine B, Janik A, Banissy MJ, Rees G. Brain structure links loneliness to social perception. Curr Biol. 2012; 22(20):1975-9. https://dx.doi.org/10.1016%2Fj.cub.2012.08.045. • Bender AR, Daugherty A, Raz N. Vascular risk moderates associations between hippocampal subfield volumes and memory. J Cogn Neurosci. 2013; 25:1851–62. https://doi.org/10.1162/jocn_a_00435. • Raz N. Diabetes: brain, mind, insulin–what is normal and do we need to know? Nat Rev Endocrinol. 2011; 7:636–7. https://doi.org/10.1038/nrendo.2011.149. • Colcombe SJ, Erickson KI, Naftali R, Andrew GW, Cohen NJ, McAuley E, et al. Aerobic fitness reduces brain tissue loss in aging humans. J Gerontol A Biol Sci Med Sci. 2003; 58:176–80. https://doi.org/10.1093/gerona/58.2.m176. • Maass A, Düzel S, Goerke M, Becke A, Sobieray U, Neumann K, et al. Vascular hippocampal plasticity after aerobic exercise in older adults. Mol Psychiatry. 2015; 20, 585–93. https://doi.org/10.1038/mp.2014.114. • Wilson RS, Krueger KR, Arnold SE, Schneider JA, Kelly JF, Barnes LL, et al. Loneliness and Risk of Alzheimer Disease. Arch Gen Psychiatry. 2007;64(2):234–240. https://doi.org/10.1001/archpsyc.64.2.234. • Kogan JH, Frankland PW, Silva AJ. Long-term memory underlying hippocampus-dependent social recognition in mice. Hippocampus. 2000;10(1):47-56. https://doi.org/10.1002/(sici)1098-1063(2000)10:1%3C47::aid-hipo5%3E3.0.co;2-6. • Yorgason JT, España RA, Konstantopoulos JK, Weiner JL, Jones SR. Enduring increases in anxiety-like behavior and rapid nucleus accumbens dopamine signaling in socially isolated rats. Eur J Neurosci. 2013;37(6):1022-31. https://doi.org/10.1111/ejn.12113. • Bledsoe AC, Oliver KM, Scholl JL, Forster GL. Anxiety states induced by post-weaning social isolation are mediated by CRF receptors in the dorsal raphe nucleus. Brain Res Bull. 2011;85(3-4):117-22. https://dx.doi.org/10.1016%2Fj.brainresbull.2011.03.003. • Lukkes JL, Engelman GH, Zelin NS, Hale MW, Lowry CA. Post-weaning social isolation of female rats, anxiety-related behavior, and serotonergic systems. Brain Res. 2012; 1443:1-17. https://dx.doi.org/10.1016%2Fj.brainres.2012.01.005. • Ago Y, Araki R, Tanaka T, Sasaga A, Nishiyama S, Takuma K, et al. Role of social encounter-induced activation of prefrontal serotonergic systems in the abnormal behaviors of isolation-reared mice. Neuropsychopharmacology. 2013; 38(8):1535-47. https://doi.org/10.1038/npp.2013.52. • Veenema AH. Early life stress, the development of aggression and neuroendocrine and neurobiological correlates: what can we learn from animal models? Front Neuroendocrinol. 2009;30(4):497-518. https://doi.org/10.1016/j.yfrne.2009.03.003. • Zhao X, Sun L, Jia H, Meng Q, Wu S, Li N, et al. Isolation rearing induces social and emotional function abnormalities and alters glutamate and neurodevelopment-related gene expression in rats. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33(7):1173-1177. https://doi.org/10.1016/j.pnpbp.2009.06.016. • Sciolino NR, Bortolato M, Eisenstein SA, Fu J, Oveisi F, Hohmann AG, et al. Social isolation and chronic handling alter endocannabinoid signaling and behavioral reactivity to context in adult rats. Neuroscience. 2010;168(2):371-86. https://dx.doi.org/10.1016%2Fj.neuroscience.2010.04.007. • Ghasemi M, Phillips C, Trillo L, De Miguel Z, Das D, Salehi A. The role of NMDA receptors in the pathophysiology and treatment of mood disorders. Neurosci Biobehav Rev. 2014; 47:336-358. https://doi.org/10.1016/j.neubiorev.2014.08.017. • Olivenza R, Moro MA, Lizasoain I, Lorenzo P, Fernández AP, Rodrigo J, et al. Chronic stress induces the expression of inducible nitric oxide synthase in rat brain cortex. J Neurochem. 2000;74(2):785-791. https://doi.org/10.1046/j.1471-4159.2000.740785.x. • Maeng S, Zarate CA Jr, Du J, Schloesser RJ, McCammon J, Chen G, et al. Cellular mechanisms underlying the antidepressant effects of ketamine: role of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptors. Biol Psychiatry. 2008;63(4):349-352. https://doi.org/10.1016/j.biopsych.2007.05.028. • Kalia LV, Kalia SK, Salter MW. NMDA receptors in clinical neurology: excitatory times ahead. Lancet Neurol. 2008;7(8):742-755. https://dx.doi.org/10.1016%2FS1474-4422(08)70165-0. • Waxman EA, Lynch DR. N-methyl-D-aspartate Receptor Subtypes: Multiple Roles in Excitotoxicity and Neurological Disease. The Neuroscientist. 2005; 11(1), 37–49. https://doi.org/10.1177/1073858404269012. • Hermes G, Li N, Duman C, Duman R. Post-weaning chronic social isolation produces profound behavioral dysregulation with decreases in prefrontal cortex synaptic-associated protein expression in female rats. Physiol Behav. 2011;104(2):354-9. https://dx.doi.org/10.1016%2Fj.physbeh.2010.12.019. • Sestito RS, Trindade LB, de Souza RG, Kerbauy LN, Iyomasa MM, Rosa ML. Effect of isolation rearing on the expression of AMPA glutamate receptors in the hippocampal formation. J Psychopharmacol. 2011;25(12):1720-1729. https://doi.org/10.1177/0269881110385595. • Toua C, Brand L, Möller M, Emsley RA, Harvey BH. The effects of sub-chronic clozapine and haloperidol administration on isolation rearing induced changes in frontal cortical N-methyl-D-aspartate and D1 receptor binding in rats. Neuroscience. 2010;165(2):492-499. https://doi.org/10.1016/j.neuroscience.2009.10.039. • Alò R, Avolio E, Mele M, Storino F, Canonaco A, Carelli A et al. Excitatory/inhibitory equilibrium of the central amygdala nucleus gates anti-depressive and anxiolytic states in the hamster. Pharmacol Biochem Behav. 2014; 118:79-86. https://doi.org/10.1016/j.pbb.2014.01.007. • St JP, Petkov VV. Changes in 5-HT1 receptors in different brain structures of rats with isolation syndrome. General pharmacology. 1990;21(2):223-5. https://doi.org/10.1016/0306-3623(90)90905-2. • Miachon S, Rochet T, Mathian B, Barbagli B, Claustrat B. Long-term isolation of Wistar rats alters brain monoamine turnover, blood corticosterone, and ACTH. Brain Res Bull. 1993;32(6):611-614. https://doi.org/10.1016/0361-9230(93)90162-5. • Van den Berg CL, Van Ree JM, Spruijt BM, Kitchen I. Effects of juvenile isolation and morphine treatment on social interactions and opioid receptors in adult rats: behavioural and autoradiographic studies. Eur J Neurosci. 1999;11(9):3023-3032. https://doi.org/10.1046/j.1460-9568.1999.00717.x. • Vanderschuren LJ, Stein EA, Wiegant VM, Van Ree JM. Social play alters regional brain opioid receptor binding in juvenile rats. Brain Res. 1995;680(1-2):148-156. https://doi.org/10.1016/0006-8993(95)00256-p. • Moles A, Kieffer BL, D'Amato FR. Deficit in attachment behavior in mice lacking the mu-opioid receptor gene. Science. 2004;304(5679):1983-1986. https://doi.org/10.1126/science.1095943. • Panksepp J, Herman BH, Vilberg T, Bishop P, DeEskinazi FG. Endogenous opioids and social behavior. Neurosci Biobehav Rev. 1980;4(4):473-487. https://doi.org/10.1016/0149-7634(80)90036-6. • Gong JP, Onaivi ES, Ishiguro H, Liu Q, Tagliaferro PA, Brusco A, et al. Cannabinoid CB2 receptors: immunohistochemical localization in rat brain. Brain Res. 2006;1071(1):10-23. https://doi.org/10.1016/j.brainres.2005.11.035. • Breivogel CS, Sim-Selley LJ. Basic neuroanatomy and neuropharmacology of cannabinoids. Int Rev Psychiatry 2009; 21:2:113-121. https://doi.org/10.1080/09540260902782760. • Haj-Mirzaian A, Amini-Khoei H, Haj-Mirzaian A, Amiri S, Ghesmati M, Zahir M, et al. Activation of cannabinoid receptors elicits antidepressant-like effects in a mouse model of social isolation stress. Brain Res Bull. 2017; 130:200-210. https://doi.org/10.1016/j.brainresbull.2017.01.018. • Banach M, Piskorska B, Czuczwar SJ, Borowicz KK. Nitric Oxide, Epileptic Seizures, and Action of Antiepileptic Drugs. CNS & Neurological Disorders - Drug Targets 2011;10: 808. https://doi.org/10.2174/187152711798072347. • Förstermann U, Sessa WC. Nitric oxide synthases: regulation and function. Eur Heart J. 2012;33(7):829-37, 837a-837d. https://dx.doi.org/10.1093%2Feurheartj%2Fehr304. • Hu Y, Wu D, Luo C, Zhu L, Zhang J, Wu H, et al. Hippocampal nitric oxide contributes to sex difference in affective behaviors. PNAS. 2012, 109 (35) 14224-14229. https://doi.org/10.1073/pnas.1207461109. • Khan MI, Ostadhadi S, Zolfaghari S, Mehr SE, Hassanzadeh G, Dehpour, A et al. The involvement of NMDA receptor/NO/cGMP pathway in the antidepressant like effects of baclofen in mouse force swimming test. Neuroscience Letters. 2016; 612:52-61. https://doi.org/10.1016/j.neulet.2015.12.006. • Matsumoto K, Puia G, Dong E, Pinna G. GABAA receptor neurotransmission dysfunction in a mouse model of social isolation-induced stress: Possible insights into a non-serotonergic mechanism of action of SSRIs in mood and anxiety disorders. Stress. 2007; 10:1:3-12. https://doi.org/10.1080/10253890701200997. • Zlatković J, Filipović D. Chronic social isolation induces NF-κB activation and upregulation of iNOS protein expression in rat prefrontal cortex. Neurochem Int. 2013;63(3):172-179. https://doi.org/10.1016/j.neuint.2013.06.002. • Haj-Mirzaian A, Amiri S, Kordjazy N, Momeny M, Razmi A, Balaei MR, et al. Lithium attenuated the depressant and anxiogenic effect of juvenile social stress through mitigating the negative impact of interlukin-1β and nitric oxide on hypothalamic-pituitary-adrenal axis function. Neuroscience. 2016; 315:271-285. https://doi.org/10.1016/j.neuroscience.2015.12.024. • Larson HJ. The biggest pandemic risk? Viral misinformation. Nature 2018; 562:309. https://doi.org/10.1038/d41586-018-07034-4. • Zarocostas J. How to fight an infodemic. Lancet 2020; 395:676. https://doi.org/10.1016/S0140-6736(20)30461-X. • World Health Organization, 2019. Ebola Virus Disease – Democratic Republic of the Congo. Geneva, Switzerland: WHO. Available at: https://www.who.int/csr/don/28-november-2019-ebola-drc/en/ [Accessed on August 8, 2020] • Times of India. Covid-19: doctors gone to collect samples attacked in Indore. Available at: https://timesofindia.indiatimes.com/videos/news/covid-19-doctors-goneto- collect-samples-attacked-in-indore/videoshow/74942153.cms; 2020 [Accessed on August 8, 2020]. • Withnall A. Coronavirus: why India has had to pass new law against attacks on healthcare workers. The Independent. April 23, 2020. • Semple K. “Afraid to be a nurse”: health workers under attack. The New York Times. 2020 Apr 27. • The Economist. Health workers become unexpected targets during COVID-19. The Economist. May 11, 2020. • Turan B, Budhwani H, Fazeli PL, Browning WR, Raper JL, Mugavero MJ, et al. How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS Behav. 2017; 21: 283–291. https://doi.org/10.1007/s10461-016-1451-5. • James PB, Wardle J, Steel A, Adams J. An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross sectional study. BMC Public Health. 2020; 20: 182. https://doi.org/10.1186/s12889-020-8279-7. • Aljazeera, 2020. Iran: Over 700 Dead after Drinking Alcohol to Cure Coronavirus. Aljazeera. Available at: https://www.aljazeera.com/ news/2020/04/iran-700-dead-drinking-alcohol-cure-coronavirus200427163529629.html. (Accessed June 4, 2020) • Delirrad M, Mohammadi AB, 2020. New methanol poisoning outbreaks in Iran following COVID-19 pandemic. Alcohol Alcohol. 55: 347–348. https://doi.org/10.1093/alcalc/agaa036. • Hassanian-Moghaddam H, Zamani N, Kolahi A-A, McDonald R, Hovda KE. Double trouble: methanol outbreak in the wake of the COVID-19 pandemic in Iran-a cross-sectional assessment. Crit Care. 2020; 24: 402. https://doi.org/10.1186/s13054-020-03140-w. • Soltaninejad K. Methanol Mass Poisoning Outbreak: A Consequence of COVID-19 Pandemic and Misleading Messages on Social Media. Int J Occup Environ Med. 2020;11(3):148-150. https://dx.doi.org/10.34172%2Fijoem.2020.1983. • Islam MS, Sarkar T, Khan SH, Kamal AM, Hasan SMM, Kabir A, et al. COVID-19–Related Infodemic and Its Impact on Public Health: A Global Social Media Analysis. Am J Trop Med Hyg. 2020; 00(0):1–9. https://doi.org/10.4269/ajtmh.20-0812. • Hawryluck L, Gold W, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis. 2004;10(7):1206–1212. https://dx.doi.org/10.3201%2Feid1007.030703. • Lee S, Chan LYY, Chau AAM, Kwok KPS, Kleinman A. The experience of SARS-related stigma at Amoy Gardens. Soc Sci Med. 2005; 61(9): 2038-2046. https://doi.org/10.1016/j.socscimed.2005.04.010. • Yoon MK Kim SY Ko HS Lee MS. System effectiveness of detection, brief intervention and refer to treatment for the people with post-traumatic emotional distress by MERS: a case report of community-based proactive intervention in South Korea. Int J Ment Health Syst. 2016; 10: 51. https://doi.org/10.1186/s13033-016-0083-5. • Reynolds DL, Garay JR, Deamond SL, Moran MK, Gold W, Styra R. Understanding, compliance and psychological impact of the SARS quarantine experience. Epidemiol Infect. 2008; 136: 997-1007. https://dx.doi.org/10.1017%2FS0950268807009156. • Marjanovic Z, Greenglass ER, Coffey S. The relevance of psychosocial variables and working conditions in predicting nurses' coping strategies during the SARS crisis: an online questionnaire survey. Int J Nurs Stud. 2007; 44(6): 991-998. https://doi.org/10.1016/j.ijnurstu.2006.02.012. • Bai Y, Lin C-C, Lin C-Y, Chen J-Y, Chue C-M, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv. 2004; 55: 1055-1057. https://doi.org/10.1176/appi.ps.55.9.1055. • Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/Guidelinesforhomequarantine.pdf [Accessed on 25 August 2020]. • Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/RevisedguidelinesforHomeIsolationofverymildpresymptomaticCOVID19cases10May2020.pdf [Accessed on 25 August 2020]. • Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/AdvisoryformanagingHealthcareworkersworkinginCOVIDandNonCOVIDareasofthehospital.pdf (Accessed on 25 August 2020). • Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/RevisedguidelinesforInternationalArrivals02082020.pdf [Accessed on 25 August 2020]. • Cost of the lockdown? Over 10% of GDP loss for 18 states. Available at: https://timesofindia.indiatimes.com/india/cost-of-the-lockdown-over-10-of-gdp-loss-for-18-states/articleshow/76028826.cms [Accessed on 21 August 2020]. • Jorda O, Singh SR, Taylor AM. Longer-Run Economic Consequences of Pandemics. Federal Reserve Bank of San Francisco Working Paper. 2020-09. https://doi.org/10.24148/wp2020-09. • Firdaus G. Mental well‑being of migrants in urban center of India: Analyzing the role of social environment. Indian J Psychiatry. 2017; 59:164‑ https://doi.org/10.4103/psychiatry.indianjpsychiatry_272_15. • National Crime Record Bureau. Annual Crime in India Report. New Delhi, India: Ministry of Home Affairs; 2018. • 198 migrant workers killed in road accidents during lockdown: Report. Available at: https://www.hindustantimes.com/india-news/198-migrant-workers-killed-in-road-accidents-during-lockdown-report/story-hTWzAWMYn0kyycKw1dyKqL.html [Accessed on 25 August 2020]. • Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020; 20:689-96. https://doi.org/10.1016/S1473-3099(20)30198-5. • Dalton L, Rapa E, Stein A. Protecting the psychological health of through effective communication about COVID-19. Lancet Child Adolesc Health. 2020;4(5):346-347. https://doi.org/10.1016/S2352-4642(20)30097-3. • Centre for Disease Control. Helping Children Cope with Emergencies. Available at: https://www.cdc.gov/childrenindisasters/helping-children-cope.html [Accessed on 25 August 2020]. • Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. Lancet Child & Adolesc Health. 2020; 4(5):347-349. https://doi.org/10.1016/S2352-4642(20)30096-1. • Sprang G, Silman M. Posttraumatic Stress Disorder in Parents and Youth After Health-Related Disasters. Disaster Med Public Health Prep. 2013;7(1):105-110. https://doi.org/10.1017/dmp.2013.22. • Rehman U, Shahnawaz MG, Khan NH, Kharshiing KD, Khursheed M, Gupta K, et al. Depression, Anxiety and Stress Among Indians in Times of Covid-19 Lockdown. Community Ment Health J. 2020:1-7. https://doi.org/10.1007/s10597-020-00664-x. • Cao W, Fang Z, Hou, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research. 2020; 287:112934. https://doi.org/10.1016/j.psychres.2020.112934. • Wang C, Zhao H. The Impact of COVID-19 on Anxiety in Chinese University Students. Front Psychol. 2020; 11:1168. https://dx.doi.org/10.3389%2Ffpsyg.2020.01168. • Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry 2020;7(3): e14. https://doi.org/10.1016/s2215-0366(20)30047-x. • Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3(3): e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976. • Lancee WJ, Maunder RG, Goldbloom DS, Coauthors for the Impact of SARS Study. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv. 2008;59(1):91-95. https://dx.doi.org/10.1176%2Fps.2008.59.1.91. • Tam CWC, Pang EPF, Lam LCW, Chiu HFK. Severe acute respiratory syndrome (SARS) in Hongkong in 2003: Stress and psychological impact among frontline healthcare workers. Psychol Med. 2004;34 (7):1197-1204. https://doi.org/10.1017/s0033291704002247. • Lee SM, Kang WS, Cho A-R, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018; 87:123-127. https://dx.doi.org/10.1016%2Fj.comppsych.2018.10.003. • Koh D, Meng KL, Chia SE, Ko SM, Qian F, Ng V, et al. Risk perception and impact of severe acute respiratory syndrome (SARS) on work and personal lives of healthcare workers in Singapore: What can we learn? Med Care. 2005;43(7):676-682. https://doi.org/10.1097/01.mlr.0000167181.36730.cc. • Verma S, Mythily S, Chan YH, Deslypere JP, Teo EK, Chong SA. Post-SARS psychological morbidity and stigma among general practitioners and traditional Chinese medicine practitioners in Singapore. Ann Acad Med Singap. 2004; 33(6):743e8. • Yeung J, Gupta S. Doctors evicted from their homes in India as fear spreads amid coronavirus lockdown. CNN World. 2020. Available at: https://edition.cnn.com/2020/03/25/asia/india-coronavirus-doctors-discrimination-intl-hnk/index.html. [Accessed on 24 August 2020] • Violence Against Women and Girls: the Shadow Pandemic. UN Women. 2020. May 3, 2020. Available at: https://www.unwomen.org/en/news/stories/2020/4/statement-ed-phumzile-violence-against-women-during-pandemic. [Accessed on 24 August 2020]. • Gearhart S, Patron MP, Hammond TA, Goldberg DW, Klein A, Horney JA. The impact of natural disasters on domestic violence: an analysis of reports of simple assault in Florida (1999–2007). Violence Gend. 2018;5(2):87–92. https://doi.org/10.1089/vio.2017.0077. • Sahoo S, Rani S, Parveen S, Pal Singh A, Mehra A, Chakrabarti S, et al. Self-harm and COVID-19 pandemic: An emerging concern – A report of 2 cases from India. Asian J Psychiatr 2020; 51:102104. https://dx.doi.org/10.1016%2Fj.ajp.2020.102104. • Ghosh A, Khitiz MT, Pandiyan S, Roub F, Grover S. Multiple suicide attempts in an individual with opioid dependence: Unintended harm of lockdown during the COVID-19 outbreak? Indian J Psychiatry 2020; [In Press]. • The Economic Times. 11 Coronavirus suspects flee from a hospital in Maharashtra. March 16 2020. Available at: https://economictimes.indiatimes.com/news/politics-and-nation/11-coronavirus-suspects-flee-from-a-hospital-in-maharashtra/videoshow/74644936.cms?from=mdr. [Accessed on 23 August 2020]. • Xiang Y, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry 2020;(3):228–229. https://doi.org/10.1016/S2215-0366(20)30046-8. • Van Bortel T, Basnayake A, Wurie F, Jambai M, Koroma A, Muana A, et al. Psychosocial effects of an Ebola outbreak at individual, community and international levels. Bull World Health Organ. 2016;94(3):210–214. https://dx.doi.org/10.2471%2FBLT.15.158543. • Kumar A, Nayar KR. COVID 19 and its mental health consequences. Journal of Mental Health. 2020; ahead of print:1-2. https://doi.org/10.1080/09638237.2020.1757052. • Gupta R, Grover S, Basu A, Krishnan V, Tripathi A, Subramanyam A, et al. Changes in sleep pattern and sleep quality during COVID-19 lockdown. Indian J Psychiatry. 2020; 62(4):370-8. https://doi.org/10.4103/psychiatry.indianjpsychiatry_523_20. • Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry. 2020;7(4): P300-302. https://doi.org/10.1016/S2215-0366(20)30073-0. • Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr. 2020; 14(5): 779–788. https://dx.doi.org/10.1016%2Fj.dsx.2020.05.035. • Wright R. The world's largest coronavirus lockdown is having a dramatic impact on pollution in India. CNN World; 2020. Available at: https://edition.cnn.com/2020/03/31/asia/coronavirus-lockdown-impact-pollution-india-intl-hnk/index.html. [Accessed on 23 August 2020] • Foster O. ‘Lockdown made me Realise What’s Important’: Meet the Families Reconnecting Remotely. The Guardian; 2020. Available at: https://www.theguardian.com/keep-connected/2020/apr/23/lockdown-made-me-realise-whats-important-meet-the-families-reconnecting-remotely. (Accessed on 23 August 2020) • Bilefsky D, Yeginsu C. Of ‘Covidivorces’ and ‘Coronababies’: Life During a Lockdown. N. Y. Times; 2020. Available at: https://www.nytimes.com/2020/03/27/world/coronavirus-lockdown-relationships.html [Accessed on 23 August 2020]
- Published
- 2020
- Full Text
- View/download PDF
34. Pulmonary Thromboembolism in COVID-19: Initial Experience from India
- Author
-
Shekhar Kunal, Harnish Bhatia, Sohan Kumar Sharma, Shashi Mohan Sharma, and Sudhir Bhandari
- Subjects
anticoagulation ,d-dimer ,pneumonia ,Medicine - Abstract
Pulmonary thromboembolic complications are increasingly being recognised in Coronavirus Disease 2019 (COVID-19) infections. Most of the cases of Pulmonary Embolism (PE) are often missed in presence of non-specific symptoms. The present report is about a 90-year-old COVID-19 positive male, asymptomatic on presentation, with no prior co-morbidities who developed acute onset shortness of breath along with elevated D-dimer levels four days post admission. Subsequently, a Computed Tomography Pulmonary Angiogram (CTPA) was done which revealed segmental and sub-segmental thromboembolism in upper and middle lobar branches of right pulmonary artery along with bilateral lower lobe ground-glass opacities consistent with COVID-19 pneumonia. As the patient was haemodynamically stable, he was managed conservatively on low molecular weight heparin and subsequently discharged on oral anti-coagulants. This report highlights the need for prompt evaluation of symptoms such as dyspnoea in COVID-19 patients and to rule out thromboembolic complications in them. In resource limited countries such as India with most of the COVID-19 centres having limited access to CT scans, triaging patients based on clinical suspicion and serially rising D-dimer levels may help identify those with thromboembolic complications.
- Published
- 2020
- Full Text
- View/download PDF
35. Curbing COVID-19: the quest continues in time
- Author
-
Sudhir Bhandari, Ajit Singh Shaktawat, Jitendra Gupta, Shivankan Kakkar, and Amitabh Dube
- Subjects
Containment strategies, COVID-19, Treatment guidelines, India. ,Medicine ,Medicine (General) ,R5-920 - Abstract
The menace of Coronavirus Disease-19 (COVID-19) has made life more and more challenging throughout the world. Amidst these difficult times, doctors have proved their exceptional worth. They have performed their duties with notable dedication, diligence, resilience, and compassion. Here we share our experiences from the State of Rajasthan in Northern India. We were benefitted by very early lockdown by the Government, preventive strategies of containment, and the most effective contact tracing program. The creation of hundreds of surveillance teams and rapid response teams (RRT) was instrumental for the containment program. This was coupled with outstanding medical care exemplified by Sawai Man Singh Medical College Hospital (SMSMCH) at Jaipur, the capital city of Rajasthan. The mortality rate-limiting to 1.98% in Rajasthan has been an outcome of the amalgamation of brisk administrative action, government support, and visionary action and the best of health care facilities. Our COVID-19 management program strategy was based on the advanced treatment guidelines from the Indian Council of Medical Research, New Delhi, India, and the Ministry of Health and Family Welfare, Government of India. References • Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020;92(7):791-796. https://doi.org/10.1002/jmv.25770. • Covid-19 data for Rajasthan, India. Available from: https://www.covid19india.org/state/RJ. [Accessed on 17 July 2020]. • Clinical Management Protocol: Covid-19. Version 5, 03/07/20. Available from: http://www.rajswasthya.nic.in/PDF/COVID%20-19/FOR%20HOSPITALS/03.07.2020.pdf. [Accessed on 17 July 2020] • Brown BL, McCullough J. Treatment for emerging viruses: Convalescent plasma and COVID-19. Transfus Apher Sci. 2020;59(3):102790. https://doi.org/10.1016/j.transci.2020.102790. • Bhatnagar T, Murhekar MV, Soneja M, Gupta N, Giri S, Wig N, et al. Lopinavir/ritonavir combination therapy amongst symptomatic coronavirus disease 2019 patients in India: Protocol for restricted public health emergency use. Indian J Med Res. 2020;151(2 & 3):184-189. https://doi.org/10.4103/ijmr.IJMR_502_20.
- Published
- 2020
- Full Text
- View/download PDF
36. From birth till palatoplasty: Prosthetic procedural limitations and safeguarding infants with palatal cleft
- Author
-
Sudhir Bhandari, Bhavita Wadhwa Soni, and Shiv Sajan Saini
- Subjects
Clefts of lip and palate ,feeding plate ,obturator ,Dentistry ,RK1-715 - Abstract
The most imminent issue to be addressed in a child born with cleft lip and/or palate is restoration of normal feeding. Early surgical treatment for cleft repair is crucial but may need to be postponed until certain age and weight gain is attained in an infant. When other feeding interventions fail in these children, prosthetic obturation of the defect with feeding instructions in the interim period is indicated to ward off the prevailing concerns. However, the entire prosthetic management presents a significant challenge with respect to the child's age, scope of iatrogenic injury to the delicate oral tissues, and potential for life-threatening situation during the procedures. This article draws attention toward preemptive measures which should be undertaken in the clinical setting during the fabrication of obturator to ascertain a desirable outcome without experiencing a grave complication that may arise due to ignorance and/or lack of facilities.
- Published
- 2018
- Full Text
- View/download PDF
37. Clinical outcome of tooth-supported fixed partial dentures in unilateral cleft lip and palate patients: A case series
- Author
-
Sudhir Bhandari
- Subjects
Cleft lip and palate ,complications ,fixed partial dentures ,Dentistry ,RK1-715 - Abstract
Introduction: Cleft lip and palate (CLP) is the most frequent congenital facial abnormality and multidisciplinary treatment extending over many years is necessary to rehabilitate the affected individuals to normal function and esthetics. Objective: To evaluate the clinical treatment outcome for missing teeth with tooth supported fixed partial dentures in unilateral cleft lip and palate patients. Patients and Methods: Tooth supported fixed partial denture (T-FPD) was utilized for restoration of missing teeth in the cleft area for 9 non syndromic, unilateral cleft lip and palate patients (U-CLP). The mean age of the patients was 25±4 years. The edentulous sites were prepared to receive ovate pontic for best possible esthetic results. Survival and complications were recorded following various biologic, technical and esthetic parameters up to 10 years of follow up. A clinical comparison was also made with respect to the periodontal status and development of new carious lesion between the restored cleft side teeth and corresponding teeth of the normal side with in the same patient. Results: Three failures experienced with fixed partial dentures were a result of ceramic chipping after 10 years, functional fracture after 3 years, and fracture due to external trauma after 2 years. Discussion: CLP patients undergo a lot of treatment; therefore understanding their opinions, expectations, and perspectives towards the prosthodontic intervention was given due importance. The provisional phase was utilized to educate the patients on the achievable treatment outcome and its limitation. In the present case series, out of three failed FPDs, only one restoration failed relatively early due to functional factors. Re-treatment was successfully achieved without change in the original material and extent of the FPDs. Conclusion: The outcome accomplished endorses the integral role of T-FPDs in the overall cleft care and it will remain a viable treatment alternative in select few patients in meeting their esthetic and functional desires.
- Published
- 2017
- Full Text
- View/download PDF
38. Why is pre-exposure prophylaxis with hydroxychloroquine a safe and rationale approach against SARS-CoV-2 infection?
- Author
-
Sudhir Mehta, Sudhir Bhandari, and Shaurya Mehta
- Subjects
Microbiology ,QR1-502 - Abstract
The potentiality of Hydroxychloroquine (HCQ) for pre-exposure prophylaxis against SARS-CoV-2 has not been explored in randomized controlled trials. However, there is rationale behind this potentiality in terms of demonstrated in-vitro effect of HCQ against SARS-CoV-2, safety profile of HCQ in healthy individuals and a recent observational study demonstrating benefits of HCQ prophylaxis in terms of a significant reduction (>80%) in the odds of SARS-CoV-2 infection in the health-care workers (HCWs) with the intake of six or more doses of HCQ prophylaxis as per the guidelines of the National Task Force for COVID-19 in India.Hence, pre-exposure prophylaxis with HCQ in appears to be a reasonable strategy in the current scenario for prevention of SARS-CoV-2 infection in healthy HCWs.
- Published
- 2020
- Full Text
- View/download PDF
39. Cluster containment strategy: addressing Zika virus outbreak in Rajasthan, India
- Author
-
Sujeet Singh, Nivedita Gupta, Ruchi Singh, Veenu Gupta, Bharti Malhotra, P Ravindran, Deepa Meena, Jyoti Gupta, VK Mathur, Ravi Prakash Mathur, Sunil Singh, Pratibha Sharma, Himanshu Sharma, Sudhir Bhandari, Gajanan Sapkal, Devendera T Mourya, and Maclane Davis Speer
- Subjects
Medicine (General) ,R5-920 ,Infectious and parasitic diseases ,RC109-216 - Abstract
India is at risk of Zika virus transmission due to high prevalence of its vector Aedes aegypti. Rajasthan, a state in the north-west region of India, has also high prevalence of Aedes mosquito. First laboratory confirmed case of Zika virus disease in Rajasthan was reported on 21 September 2018 in Jaipur. The Government of Rajasthan quickly implemented a containment strategy to contain the outbreak and prevent further spread of this disease. Strategy included active human and mosquito surveillance, laboratory testing and sequencing of the virus, integrated vector control measures, intersectoral coordination, risk communication and social mobilisation, all in a predefined geographic area around the epicentre. Timely action with appropriate coordination at all levels with multiple stakeholders contained the outbreak successfully. In all, 159 confirmed cases were reported from in and around the 3 km containment zone in Shastri Nagar area of Jaipur City and routine surveillance. Following this, a specially developed laboratory-based surveillance strategy was put in place to ensure that the disease does not spread beyond the containment zone. No fresh case was reported subsequently within or beyond the containment zone.
- Published
- 2019
- Full Text
- View/download PDF
40. Outcome of single maxillary complete dentures opposing mandibular teeth: A need to introspect on the prosthodontic treatment protocol
- Author
-
Sudhir Bhandari
- Subjects
Complete denture ,dental implants ,denture base ,edentulous maxilla ,metal denture base ,midline fracture ,Dentistry ,RK1-715 - Abstract
Introduction: In the era of implant supported restorations, conventional complete denture (CD) for isolated edentulous maxilla still remains the first choice of treatment despite being its frequent mechanical failures. Statement of Problem: Edentulous maxillary arch restored with polymethyl methacrylate (PMMA) based CDs when opposed by natural and/or restored dentition is biomechanically and functionally a compromised rehabilitation. Materials and Methods: Seven patients (4 males, 3 females) in the age range of 55–75 years were treated for their frequent fracture of the single maxillary denture. They were asked to rate their prosthodontic experience on a scale of 1–10. They were further inquired about the awareness of their clinical condition and knowledge on the alternative treatment options available to them, number of different dentists they have been treated by and frequency of their re-visits to the dental office after being edentulous. Results: Removable PMMA based CD in maxilla was the first choice of treatment for all the restorative dentists who treated these patients. No attempt was ever made to treat the opposing dentition in any of the seven patients. Despite being under regular prosthodontic care for fabrication and repairs by as many as 23 dentists, none of the patients was aware of their clinical situation and the alternative treatment options available. Conclusion: It is imperative that the restorative dentist be aware of the perils of such inter-arch relationships. Appropriate treatment done on time may avert a situation where the oral conditions become incompatible for the longevity of treatment done even with the aid of dental implants.
- Published
- 2016
- Full Text
- View/download PDF
41. Survival and complications of unconventional fixed dental prosthesis for maintaining diastema and splint pathologically migrated teeth: A case series up to 8 years follow-up
- Author
-
Sudhir Bhandari and Sonika Bakshi
- Subjects
Diastema ,fixed dental prosthesis ,loop connectors ,splinting ,Dentistry ,RK1-715 - Abstract
Spacing in dentition negatively interferes with harmony of the smile. A lot of literature has been devoted to prosthetic closure of such space(s) in the dentition; however, the only option for maintaining space(s) in tooth-supported fixed dental prosthesis (FDP) is with the aid of loop connectors. Eleven patients (seven males and four females) with mean age of 45.18 years (range 22-70 years), previously treated with porcelain fused to metal full coverage restorations joined with loop connectors, were evaluated clinically to assess the clinical status and longevity of treatment provided. All the patients were asked to fill a simple close-ended questionnaire to provide their perspective on the limitations and outcome of the treatment and rate their satisfaction level on the scale of 1-10. The cumulative survival of the FDPs with the aid of loop connectors was 90.9%. There was no reported esthetic failure and, at the time of responding to the questionnaire, none of the patients had active complaint with respect to the prosthesis and all but one of the patients were satisfied with the treatment provided. Clinical survivability and the patient feedback suggests that customized designing of loop connectors for each patient is an excellent treatment modality to successfully maintain excessive (single/generalized) spacing between teeth and effectively splint pathologically migrated and mobile teeth. The reported problems with this treatment option are all transient in nature.
- Published
- 2013
- Full Text
- View/download PDF
42. Immediate natural tooth pontic: A viable yet temporary prosthetic solution: A patient reported outcome
- Author
-
Sudhir Bhandari and Rashi Chaturvedi
- Subjects
Fixed prosthesis ,immediate dentures ,implants ,natural tooth pontic ,splinting ,Dentistry ,RK1-715 - Abstract
Introduction: In patients with hopeless prognosis of the anterior teeth there is still a strong desire to save them for the sake of esthetics. If not grossly carious, broken down or discolored the extracted tooth after suitable modifications can be placed back in its original site by splinting it to the adjacent stable teeth. Materials and Methods: Fifteen patients (10 males, 5 females) in the age range of 40-65 years with pathologically migrated, unsalvageable teeth were treated by splinting the extracted teeth immediately with the stable adjacent teeth. After 12 weeks, all the patients were explained various treatment options available for replacement of the lost teeth. The patients were asked to fill out a simple closed ended questionnaire citing the various difficulties encountered during this transitional period, selection of further treatment modalities and the reasons for their choice. The feedback obtained was then analyzed statistically. Results: Hundred percent of patients were happy with the esthetics; however, 60% of them were dissatisfied with the function that it provided. The primary problem being apprehension of splint fracture and difficulty while incising and the data was found to be statistically significant (P=0.01FNx08). All patients demanded a permanent treatment option following this with a fixed prosthesis. None of the patients were interested in the implant supported prosthesis due to cost, treatment time involved, and need for surgery. Conclusion: The concept of immediate pontic placement is surely a viable treatment option and promises an excellent transient esthetic solution for a lost tooth as well as enables good preparation of the extraction site for future prosthetic replacement.
- Published
- 2012
- Full Text
- View/download PDF
43. Interim obturator in an infant with Treacher Collins syndrome: Review and chairside modification in impression making
- Author
-
Sudhir Bhandari, Meena Aras, and Sonika Bakshi
- Subjects
Branchial arches ,interim obturator ,treacher collins syndrome ,Dentistry ,RK1-715 - Abstract
Treacher Collins syndrome has been described as a syndrome involving 1st and 2nd branchial arches, affecting various organs in the craniofacial region. Affected infants report with nasal regurgitation and minimal dietary intake due to cleft palate, consequently show delayed and retarded growth. The situation is further complicated when the repair of the palatal defect is postponed due to delayed milestones. At this juncture, it is of paramount importance to intervene prosthetically and close the defect with the aid of an interim obturator. Herein we describe a simple, yet successful, chairside approach to make an impression of an infant without the aid of any kind of anesthesia.
- Published
- 2011
- Full Text
- View/download PDF
44. An interdisciplinary approach to reconstruct a fractured tooth under an intact all ceramic crown: Case report with four years follow up
- Author
-
Sudhir Bhandari, Praveen Rajagopal, and Sonika Bakshi
- Subjects
All ceramic ,biologic width ,crown lengthening ,retreatment ,retrograde ,Dentistry ,RK1-715 - Abstract
Trauma causing the fracture of a restored tooth with the extracoronal full coverage prosthesis remaining intact is a common occurrence in dental practice. Reconstruction of the damaged tooth foundation and recementation of the crown can pose quite a challenge for the restorative dentist. This case report describes an innovative interdisciplinary chairside technique for the recementation of an all-ceramic crown on a fractured maxillary central incisor. The course of care described is effective, affordable, and saves time in comparison with other treatment options for such clinical situations.
- Published
- 2011
- Full Text
- View/download PDF
45. Time required for prophylactic oral care in head and neck cancer patients scheduled for radiotherapy: A single center, prospective cohort study
- Author
-
Sudhir Bhandari, Bhavita Wadhwa Soni, Ankita Gupta, and Sushmita Ghoshal
- Subjects
Otorhinolaryngology - Published
- 2023
46. Post-COVID Syndrome: The Stranger Ghost of Culprit COVID-19
- Author
-
Sudhir Bhandari, Govind Rankawat, Shashank Joshi, Mangesh Tiwaskar, Anurag lohmror, and Shiven Bhandari
- Subjects
General Medicine - Abstract
Background: Post-COVID syndromes are the most abundant sequel of coronavirus disease of 2019 (COVID-19) infection, which affects millions of people around the whole world. There is a significant difference observed during the acute phase as well as during the post-COVID period between patients hospitalized with (alpha, delta, or omicron) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant. In the present scenario, when most people are vaccinated, COVID-19 disease is less likely, but the remnants of previous COVID-19 infections are still a vast health burden. Materials and methods: This prospective, observational, comparative, and analytical study included a total of 3,840 COVID-19-infected patients who visited the hospital. We included 1,150 patients of alpha variants, 1,845 patients of delta variants, and 815 patients of omicron variants, from June 2020 to November 2020, March 2021 to July 2021, and January 2022 to May 2022, respectively. All medical data of the study population, including hospital stay and vaccination status, were collected, and all patients were followed up for 6 months of duration. All collected data were compiled and analyzed to compare the post-COVID thrombotic and other events among different variants of COVID-19. Results: Patients infected during the delta variant are the most symptomatic at onset (higher prevalence of fever, dyspnea, cough, myalgia, headache, or gastrointestinal problems) than those infected with the alpha or omicron variant (p < 0.01). A total of 2,830 patients (7.48%) [1,520 (82.38%) of delta variant, 598 (73.37%) of omicron variant, and 712 (60.34%) of omicron variant] developed post-COVID syndrome during their follow-up period out of 3,220 enrolled patients and the difference was statistically significant when compared among variants (p < 0.05). In this study, the highly prevalent post-COVID syndrome was mucormycosis (11.41%), followed by new-onset diabetes (9.89%), pulmonary fibrosis (7.67%), ischemic heart disease (6.46%), brain stroke (3.29%), and other thromboembolic disorders (2.37%). Conclusion: COVID-19-associated onset symptoms during the delta variant were more severe and highly prevalent, while neurological symptoms (aguesia and anosmia) were more common during the alpha variant. Patients infected with the delta variant of COVID-19 are more prone to develop post-COVID-associated complications with minimal risk in the omicron variant and intermediate risk in the alpha variant. Long COVID-19 requires specific attention for management, irrespective of the SARS-CoV-2 variant.
- Published
- 2023
47. Management and Maxillofacial Rehabilitation of COVID 19 associated Mucormycosis
- Author
-
Aishwarya Chatterjee, Sudhir Bhandari, Satish Jain, Mohnish Grover, Debopriya Chatterjee, and Subrata Banerjee
- Abstract
Objectives: To study and present a management protocol formulated to treat coronavirus disease-associated invasive fungal sinusitis (mucormycosis) (CAM) and related defects. Methods: A prospective interventional study was conducted at a tertiary care centre over three months, involving patients with mucormycosis of the paranasal sinuses suffering from or having a history of Coronavirus Disease infection (COVID-19) who underwent debridement surgery. A protocol was formulated incorporating all the departments involved in the management of post-COVID-19 Associated Mucormycosis (CAM) patients. A separate protocol for early prosthetic rehabilitation was also developed. Results: Twenty patients underwent surgical and medical intervention along with prosthetic rehabilitation for CAM. All of the patients were post COVID-19 infected and had developed acute symptoms. The maxillary sinus was affected in all these patients and 25% of the patients had involvement of the orbit along with the maxillary sinus. All patients had been administered steroids during the treatment for COVID-19-associated illness. Infrastructure maxillectomy of the right side was done in 35% of patients, bilateral maxillectomy was done in 30% of patients, and two patients underwent infrastructure maxillectomy and orbital exenteration of the right side. Six patients received a surgical obturator inserted on the second-day post-maxillectomy, 8 patients received an intermediate obturator inserted on the 10th-12th day post-maxillectomy and 6 patients received a silicone obturator inserted on the 14th-18th day after bilateral maxillectomy. Conclusions: Early management, prompt treatment and post-operative comprehensive rehabilitation towards an optimum Quality of Life (QOL) can be achieved for good prognosis in patients affected by CAM. The prosthetic rehabilitation protocol provided prosthesis earlier and faster to the patients that improved their QOL.
- Published
- 2022
48. Establishment of SMS Dengue Severity Score
- Author
-
Sudhir, Bhandari, Govind, Rankawat, Barkha, Goyal, Anurag, Lohmror, Vishal, Gupta, and Ajeet, Singh
- Subjects
Dengue ,Cross-Sectional Studies ,Humans ,Severe Dengue ,General Medicine ,Severity of Illness Index - Abstract
Background: Dengue infection is a disease that progresses rapidly to life-threatening conditions. Our goal was to develop a practical scoring system based on clinical profiles and routine tests to predict the severity of infection. Methods: This cross-sectional observational study included 500 patients with dengue infection. Patient demographics, clinical symptoms, regular laboratory tests, and results were collected. Dengue infections are divided into three classes, depending on their severity: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Based on the total score, patients were divided into three severities. Results: Patients with DSS and DHF scored higher with worsening clinical features and routine laboratory tests compared to DF. Clinical predictors of severity include older age, increased white blood cell (WBC) count, increased hematocrit, increased prothrombin time, decreased platelet count, decreased blood pressure, presence of peri-gallbladder (GB) edema, third space loss, hepatomegaly, and other organ involvement. The severity range is 0–12, and the score is 0–3 for DF, 4–8 for DHF, and 9–12 for DSS. Based on the derived scores, patients were classified according to their original severity in 63% of cases. Conclusion: This dengue infection severity scores correctly classified patients according to their original severity grade of DF, DHF, or DSS. This scoring system helps to quickly assess dengue infections and start treatment according to the correct severity category.
- Published
- 2022
49. Discharge Planning for People with Inpatient Hyperglycaemia: A Review on Pharmacological Management
- Author
-
Kalyan Kumar Gangopadhyay, Rakesh Sahay, Sunil Gupta, Vageesh Ayyar, Sambit Das, Saptarshi Bhattacharya, Sudhir Bhandari, and Arpandev Bhattacharyya
- Subjects
Endocrinology ,Endocrinology, Diabetes and Metabolism - Abstract
Abstract: Inadequate glycaemic control post-discharge is the root cause of readmission in people with diabetes mellitus (DM) and is often linked to improper discharge planning (DP). A structured DP plays a crucial role in ensuring continuing home care and avoiding readmissions. DP should help patients in self-care and provide appropriate guidance to maintain optimal glycaemic control. There is a scarcity of reports and recommendations on the proper DP for people with DM on insulin therapy. The present review provides important consideration based on experts’ opinions from the National Insulin and Incretin summit (NIIS), focusing on the effective treatment strategies at the time of discharge, especially for insulin therapy. A review of literature from PubMed and Embase was conducted. The consensus was derived, and recommendations were made on effective DP for patients with DM. Recommendations arrived at the NIIS for post-discharge treatment for medical and surgical cases, stress-induced hyperglycaemia, elderly, pregnant women, and coronavirus disease 2019 (COVID-19) cases. The committee also recommended a comprehensive checklist to assist the physicians during discharge.
- Published
- 2023
50. Influence of speech aid prosthesis with speech therapy on speech outcomes in adult patients with persisting velopharyngeal insufficiency: A retrospective analysis
- Author
-
Bhavita Wadhwa, Uvashri Selvaraj, Sudhir Bhandari, Anuradha Sharma, and Satinder Pal singh
- Subjects
Oral Surgery - Abstract
Prosthetic intervention with a speech aid prosthesis (SAP) along with speech therapy has been reported to improve speech outcomes in patients with persisting velopharyngeal insufficiency (VPI). However, little is known regarding the impact of this treatment on different speech parameters over time in adult patients with VPI.The purpose of this retrospective study was to evaluate the change in speech parameters after rehabilitation with an SAP and speech therapy in adult patients with VPI using subjective and objective tests.Patients above 16 years of age who had received prosthetic treatment for VPI and had complete speech assessment records between 2017 and 2020 were included in the analysis. After completion of the prosthetic treatment, speech therapy comprising 2 sessions per week of 45 minutes was provided by a speech pathologist. Speech evaluation was performed using tests that included speech intelligibility calculation, nasal pinch test, audible nasal air emissions, acoustic analysis, and the nasalance check. Assessments were done at 4 time intervals: T0: without an SAP; T1: 1 week with an SAP; T2: 1 month with an SAP; and T3: 3 months with an SAP. A descriptive analysis was followed by a comparison between groups using the Friedman test for subjective assessments and repeated measures ANOVA for objective tests (α=.05).Of 10 individuals who had received an SAP, 5 participants, 2 men and 3 women with a mean age of 38 years were included in the analysis. Statistically significant improvement in mean scores was observed from T0 to T3 concerning speech intelligibility (P.001), hypernasality (P.001), audible nasal air emission (P.001), mean fundamental frequency (P=.034), shimmer percentage (P=.004), and nasalance (P=.004). Improvement in jitter percentage was not statistically significant (P=.218).An SAP along with speech therapy should be considered as a conservative and effective treatment option for addressing speech issues in adult patients with VPI.
- Published
- 2023
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.