Heart failure in children and adolescents: an update on diagnostic approaches and management

Amit Agrawal,Dalwinder Janjua,Abdulrahman Ahmed Alsayed Ali Zeyada,Ahmed Taher Elsheikh 대한소아청소년과학회 2024 Clinical and Experimental Pediatrics (CEP) Vol.67 No.4

Cardiac failure is a clinical syndrome that may develop in children owing to cardiac dysfunction or underlying structural heart diseases. Considering the differences indiagnostic and therapeutic approaches for pediatric heart failure (PHF) and adult heart failure, we have reviewed the current literature on PHF. Relevant studies wereextracted from MEDLINE/PubMed, Google Scholar, and Clinical Trial Registries using the terms “pediatric heart failure” or “heart failure in children” and “management” or “decongestive therapy.” Recent advances in diagnosticapproaches, such as cardiac magnetic resonance, speckletracking echocardiography, tissue Doppler imaging, and molecular diagnostic techniques, have increased our understanding of PHF.Itis imperative that clinicians evaluate the interrelated factors responsible for the development of PHF, including myocardial function, pulmonary and systemic blood flow, heart rhythm, valve function, and nutritional status. Although recent advances have demonstrated the efficacy of many new drugs in adult heart failure trials, it cannot be concluded that these drugs will show similar efficacy in children, considering the heterogeneous nature of the underlying mechanisms and variable pharmacodynamics and pharmacokinetics. Therefore, the underlying pathophysiology of PHF and the mechanisms of actionof different drugs should be considered when selecting appropriate therapies.Further trials areneededto establish the efficacy and safety of these drugs, and a combined multidisciplinary strategy will help enhance PHF outcome

Rapid Detection of Cadmium-Resistant Plant Growth Promotory Rhizobacteria: A Perspective of ELISA and QCM-Based Immunosensor

( Agrawal Ruchi ),( Alok Satlewal ),( Manav Chaudhary ),( Amit Verma ),( Rachna Singh ),( A. K. Verma ),( Rajesh Kumar ),( K. P. Singh ) 한국미생물 · 생명공학회 2012 Journal of microbiology and biotechnology Vol.22 No.6

Plant growth-promoting rhizobacteria (PGPR) pseudomonads have a large number of lipopolysaccharides on the cell surface, which induces immune responses. Cd-resistant PGPR prevalent at the Cd-affected sites under biophytostabilization was monitored. Transmissiom electron microscopy was used to the study the behavior of tolerance of PGPR to cadmium level and its effect on pseudomonad strains (Z9, S2, KNP2, CRPF, and NBRI). An immunosensor was developed by immobilizing antibody (anti-Z9 or anti-S2) against selected PGPR on a piezoelectric quartz crystal microbalance (QCM). Immunosensors were found to supplement the inherent specificity of antigen-antibody reactions with the high sensitivity of a physical transducer. On comparison of the efficiency of detection with ELISA, the spectrophotometric technique, the developed immunosensor was found to be more sensitive, fast, and reliable even after regeneration for several times. Thus, the immunosensor may be used for future detection of PGPR strains after automation of the screening process.

Comparison of Different Screening Methods in Estimating the Prevalence of Precancer and Cancer Amongst Male Inmates of a Jail in Maharashtra, India

Chaudhari, Amit,Hegde-Shetiya, Sahana,Shirahatti, Ravi,Agrawal, Deepti Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.2

Aim: To compare the effectiveness of self-examination, clinical examination and screening methods using 1% toluidine blue and Lugol's iodine in estimating the prevalence of lesions at risk of malignancy and oral malignant disease amongst the male inmates of Yerwada Central Jail, Pune. Material and Methods: Study was carried out on male inmates in two phases. In the first phase self-examination and clinical examination was carried out on 2,257 male inmates. 164 suspicious cases were subjected to phase II of the study out of whom, 82 participants were screened with 1% toluidine blue and 2% Lugol's iodine followed by biopsy procedure. Results: Sensitivity and specificity for self-examination with clinical examination was 92.2% and 96.6% respectively. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and positive (+LR) and negative likelihood ratio (-LR) for Toluidine Blue were 88.1%, 66.6% 97.1%, 30%, 2.63 and 0.17 respectively while for Lugol's Iodine they were 94.7%, 83.8%, 98.6%, 55.5%, 5.67 and 0.06 respectively. Conclusions: Prevalence of lesions at risk of malignancy and oral malignant disease by self-examination was 7.8% and by clinical examination was 6.3%. Self-examination is an effective tool in early detection of oral cancer. Use of Lugol's iodine as a screening tool for oral lesions is highly effective in inmate populations.

Commentary to: Ticagrelor Use in Indian Patients Undergoing Neuroendovascular Procedures: A Single-Center Experience

Harsh Deora,Amit Agrawal,Luis Rafael Moscote-Salazar 대한신경중재치료의학회 2020 Neurointervention Vol.15 No.1

Association of Cytochrome-17 (MspA1) Gene Polymorphism with Risk of Gall Bladder Stones and Cancer in North India

Dwivedi, Shipra,Agrawal, Sarita,Singh, Shraddha,Madeshiya, Amit Kumar,Singh, Devendra,Mahdi, Abbas Ali,Chandra, Abhjeet Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.13

Background: Cholelithiasis is associated in 54%-98% of patients with carcinoma of the gallbladder, and a high incidence among females suggests a role of female hormones in the etiology of the disease. Cytochrome $P450C17{\alpha}$ (CYP-17) is a key enzyme involved in estrogen metabolism and polymorphisms in CYP-17 are associated with altered serum levels of estrogens. Thus, we investigated whether the CYP-17 MspA1 gene polymorphism might impact on risk of gall bladder cancers or gallstones, as well as to determine if this gene polymorphism might be linked with estrogen serum levels and lipid profile among the North Indian gall bladder cancer or gallstone patients. Materials and Methods: CYP-17 gene polymorphisms (MspA1) were genotyped with PCR-RFLP in cancer patients (n=96), stone patients (n=102), cancer + stone patients (n=52) and age/sex matched control subjects (n= 256). Lipid profile was estimated using a commercial kit and serum estrogen was measured using ELISA. Results: The majority of the patients in all groups were females. The lipid profile and estrogen level were significantly higher among the study as compared to control groups. The frequency of mutant allele A2 of CYP17 MspA1 gene polymorphism was higher among cancer (OR=5.13, 95% CI+3.10-8.51, p=0.0001), stone (OR=5.69, 95%CI=3.46-9.37, p=0.0001) and cancer + stone (OR=3.54, 95%CI=1.90-6.60, p=0.0001) when compared with the control group. However there was no significant association between genotypes of CYP17 MspA1 gene polymorphism and circulating serum level of estrogen and lipid profile. Conclusions: A higher frequency of mutant genotype A1A2 as well as mutant allele A2 of CYP-17 gene polymorphism is significantly associated with risk of gallbladder cancer and stones. Elevated levels of estrogen and an altered lipid profile can be used as predictors ofgall bladder stones and cancer in post menopausal females in India.

Estimating the prevalence of oral manifestations in COVID-19 patients: a systematic review

Ankita Gupta,Kriti Shrivastav,Amit Agrawal,Abhishek Purohit,Roshan Chanchlani 질병관리본부 2023 Osong Public Health and Research Persptectives Vol.14 No.5

Objectives: Patients with coronavirus disease 2019 (COVID-19) present with a variety of oral manifestations. Therefore, we conducted a systematic review to estimate the prevalence of oral lesions among COVID-19 patients. Methods: An extensive literature search of several electronic bibliographic databases (PubMed, Scopus, Science Direct, Litcovid) was conducted to retrieve all articles published in the English language from January 1, 2020 to March 31, 2023 that reported the prevalence of oral manifestations among COVID-19 patients. A meta-analysis of pooled prevalence was performed using Jamovi ver. 2.3 (2022). The I2 and Q statistics were used to assess heterogeneity between studies, and p-values <0.01 were considered statistically significant. Results: In total, 79 studies with data from 13,252 patients were included. The articles were predominantly published in 2020 (n=33), and Italy was the most common country (n=14). Most of the affected patients more than 50 years old and women (56.6%). The most common sites of involvement were the tongue (n=65), followed by the oral mucosa (n=37) and lips (n=19). High heterogeneity was found between studies. The most common oral manifestation was taste alteration, followed by xerostomia and ulceration, showing pooled prevalence rates of 48%, 35%, and 21%, respectively. Conclusion: COVID-19 patients show various oral manifestations that may help clinicians identify the disease promptly. Recognition of the signs and symptoms of COVID-19 is critical for an early diagnosis and better prognosis.

Predictors of discogenic pain in magnetic resonance imaging: a retrospective study of provocative discography performed by posterolateral approach

( Anuj Jain ),( Suruchi Jain ),( Swapnil Kumar Barasker ),( Amit Agrawal ) 대한통증학회 2021 The Korean Journal of Pain Vol.34 No.4

Background: Provocative discography (PD) is a test that is useful in diagnosing discogenic pain (DP). In this study, to diagnose DP, we used a posterolateral approach of needle placement and followed pressure criteria laid down by the Spine Intervention Society. The aim was to identify the correlation between magnetic resonance imaging (MRI) findings (desiccation, high intensity zone and change in shape and size of the disc) and the results of PD. Methods: Records of 50 patients who underwent PD for DP were analyzed. A total of 109 PDs were performed, with 54 suspect and 55 control discs. Alternate pain generators were ruled out. Results: A total of 35 suspect discs were positive on PD. The mean disc pressure in the suspect disc was 31.9 ± 7.9 psi (range, 15-44). Of the 50 patients who underwent PD, 35 had positive MRI findings. A significant positive correlation was found only between disc desiccation and discography result (r = 0.6, P < 0.001). Logistic regression analysis revealed that only desiccation successfully predicted the result of discography (OR = 26.5, P < 0.001); a high intensity zone and a disc protrusion/ extrusion had an OR 2.3 and 1.24, respectively. Disc desiccation of Pfirmann grade 3 or more had a sensitivity and specificity of 0.93 and 0.64 respectively in identifying painful discs; the positive likelihood ratio was 2.58 while the negative likelihood ratio was 0.11. Conclusions: In patients with DP, disc desiccation is the most useful MRI feature that predicts a painful disc on PD.

Cervical Perineural Cyst Masquerading as a Cervical Spinal Tumor

Vijay P Joshi,Atul Zanwar,Anuradha Karande,Amit Agrawal 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.2

Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor.

Re: Comparison of the Surgical Approaches for Frontal Traumatic Intracerebral Hemorrhage

( Luis Rafael Moscote-salazar ),( Ezequiel Garcia-ballestas ),( Pradeep Chouksey ),( Amit Agrawal ) 대한외상학회 2020 大韓外傷學會誌 Vol.33 No.1

Dear editor, in an interesting article, Park et al. [1] report their experience with minimally invasive surgery for the management of frontal traumatic intracranial hematomas. We all know that cerebral contusions are dynamic lesions and the size of the lesions and peri-lesional edema can increase over a period of time. The management of these lesions not only aims to remove radiologically visible lesions (parenchymal hematoma and/or contused brain), but also to reduce the intracranial pressure. The literature suggests that techniques that require minimal access may not be a good option in non-elderly patients if the size of the contusion is moderate or massive or follow-up imaging suggests an increase in lesion size [2]. Thus, it is important that while planning the evacuation of these lesions, we should make sure that there will also be a sufficient reduction in intracranial pressure [2]. Additionally, as an alternative to the burr hole as a minimally invasive approach, trephination has been suggested as a surgical procedure that can be used to evacuate intracerebral hematoma, particularly in elderly patients [3]. We suggest that if the surgical approach presented by Park et al. [1] could be supplemented with intracranial pressure monitoring to show that the minimally invasive approach is safe and effective for evacuating the intracerebral hematoma/ contusion and also reduces the intracranial pressure, then it will be a good adjunct in the neurosurgical armamentarium.

Silk® Flow Diverter Device for Intracranial Aneurysm Treatment: A Systematic Review and Meta-Analysis

William A Florez,Ezequiel Garcia-Ballestas,Gabriel Alexander Quiñones-Ossa,Tariq Janjua,Subhas Konar,Amit Agrawal,Luis Rafael Moscote-Salazar 대한신경중재치료의학회 2021 Neurointervention Vol.16 No.3

Flow diverters have become a critical instrument for complex aneurysms treatment. However, limited data are currently available regarding short and long-term outcomes for the Silk flow diverter. The objective of the study is to determine neurological prognosis and mortality rates for the Silk flow diversion device used in intracranial aneurysms. A systematic review with meta-analysis was performed using databases. The following descriptors were used for the search: “SILK”, “Flow Diverter”, “Mortality”, and “Prognosis”. The following data were extracted: mortality, good functional outcome, Glasgow outcome scale, complete or near-complete occlusion rates, rate of retreatment, and complications (thromboembolic and hemorrhagic complications). A total of 14 studies were selected. Among the 14 studies, 13 were retrospective observational cohort studies and 1 was a prospective observational cohort study. The mortality rate was 2.84%. The clinical good outcomes rate was 93.3%. The poor outcome rate was 6.6%. The overall thromboembolic complication rate was 6.06% (95% confidence interval [CI] 0.00–6.37, P=0.12, I2=3.13%). The total hemorrhagic complication rate was 1.62% (95% CI 0.00–5.34, P=0.28, I2=1.56%). The complete aneurysm occlusion rate was 80.4% (95% CI 8.65–9.38, P<0.0001, I2=9.09%). The Silk diverter device has a good safety and efficacy profile for treating intracranial aneurysms with high complete occlusion rates.