Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver

( Ashish Agarwal ),( Alka Singh ),( Wajiha Mehtab ),( Vipin Gupta ),( Ashish Chauhan ),( Mahendra Singh Rajput ),( Namrata Singh ),( Vineet Ahuja ),( Govind K. Makharia ) 대한장연구학회 2021 Intestinal Research Vol.19 No.1

Background/Aims: Gluten-free diet has an excess of fats and simple sugars and puts patients with celiac disease at risk of metabolic complications including metabolic syndrome and fatty liver. We assessed prevalence of metabolic syndrome and fatty liver in two cohorts of celiac disease. Methods: Study was done in 2 groups. In group 1, 54 treatment naïve patients with celiac disease were recruited. Of them, 44 returned after 1-year of gluten-free diet and were reassessed. In group 2, 130 celiac disease patients on gluten-free diet for ≥1 year were recruited. All patients were assessed for anthropometric and metabolic parameters and fatty liver. Metabolic syndrome was defined as per consensus definition for Asian Indians. Fatty liver was defined as controlled attenuation parameter value >263 decibels by FibroScan. Results: In group 1, of 44 treatment naïve patients with celiac disease, metabolic syndrome was present in 5 patients (11.4%) at baseline and 9 (18.2%) after 1 year of gluten-free diet. Patients having fatty liver increased from 6 patients (14.3%) at baseline to 13 (29.5%) after 1year of gluten-free diet (P=0.002). In group 2, of 130 patients with celiac disease on gluten-free diet for a median duration of 4 years, 30 out of 114 (26.3%) and 30 out of 130 patients (23%) had metabolic syndrome and fatty liver, respectively. Conclusions: Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver, which increases further with gluten-free diet. These patients should be assessed for nutritional and metabolic features and counseled about balanced diet and physical activity regularly. (Intest Res 2021;19:106-114)

High risk of tuberculosis during infliximab therapy despite tuberculosis screening in inflammatory bowel disease patients in India

( Ashish Agarwal ),( Saurabh Kedia ),( Saransh Jain ),( Vipin Gupta ),( Sawan Bopanna ),( Dawesh P Yadav ),( Sandeep Goyal ),( Venigalla Pratap Mouli ),( Rajan Dhingra ),( Govind Makharia ),( Vineet A 대한장연구학회 2018 Intestinal Research Vol.16 No.4

Background/Aims: The data on the risk of tuberculosis (TB) reactivation with infliximab (IFX) in patients with inflammatory bowel disease (IBD) from TB endemic countries, like India, is limited. The risk of TB reactivation on IFX and its predictors in patients with IBD was assessed. Methods: This retrospective review included consecutive patients with IBD who received IFX, and were on follow-up from January 2005 to November 2017. The data was recorded on age/disease duration, indications for IFX, screening for latent tuberculosis (LTB) before IFX, response to IFX, incidence and duration when TB developed after IFX, and type of TB (pulmonary [PTB]/extra-pulmonary [EPTB]/disseminated). Results: Of 69 patients (22 ulcerative colitis/47 Crohn’s disease; mean age, 35.6±14.5 years; 50.7% males; median follow-up duration after IFX, 19 months [interquartile range, 5.5-48.7 months]), primary non-response at 8 weeks and secondary loss of response at 26 and 52 weeks were seen in 14.5%, 6% and 15% patients respectively. Prior to IFX, all patients were screened for LTB, 8 (11.6%) developed active TB (disseminated, 62.5%; EPTB, 25%; PTB, 12.5%) after a median of 19 weeks (interquartile range, 14.0-84.5 weeks) of IFX. Of these 8 patients’ none had LTB, even when 7 of 8 were additionally screened with contrast-enhanced chest tomography. Though not statistically significant, more patients with Crohn’s disease than ulcerative colitis (14.9% vs. 4.5%, P=0.21), and those with past history of TB (25% vs. 9.8%, P=0.21), developed TB. Age, gender, disease duration, or extraintestinal manifestations could not predict TB reactivation. Conclusions: There is an extremely high rate of TB with IFX in Indian patients with IBD. Current screening techniques are ineffective and it is difficult to predict TB after IFX. (Intest Res 2018;16:588-598)

Advent and Maturation of Regenerative Medicine

Ashish Agarwal 한국조직공학과 재생의학회 2013 조직공학과 재생의학 Vol.10 No.4

The field of regenerative medicine (RM), encompassing stem cell (SC) technologies, therapeutics, tissue engineering (TE), biomaterials, scaffolds and other enabling technologies provides a wide gamut of tools and tracks to combat, manage and hopefully cure serious human and animal injuries, dysfunctions and diseases. This review illustrates the trends that are becoming the major platforms in this field. The last 10 years in itself has seen major definitive observations, including multi-track directives of adult stem cell translational technologies, tissue and organ engineering protocols, iPS cell applications and understanding of the role of cancer stem cells to develop effective anti-cancer regimens. With the rapid advances of RM translational research, further advances are expected to be implemented for personalized repair and curative outcomes. RM future is bright although laden with challenges of global fragmentation which needs coherent consolidation, stringent cost and time effective regulation and long-term funding mechanisms, so clinical and diagnostic solutions are realized and recognized to combat unmet medical needs.

Effect of Ba and Ho co-doping on crystal structure, phase transformation, magnetic properties and dielectric properties of BiFeO3

Jogender Singh, Ashish Agarwal,Ashish Agarwal,Sujata Sanghi,Tanvi Bhasin,Manisha Yadav,Umesh Bhakar,Ompal Singh 한국물리학회 2019 Current Applied Physics Vol.19 No.3

Multiferroics having composition Bi0.80-xBa0.20HoxFeO3 (BBFO, BBHFO5, BBHFO10, BBHFO15 and BBHFO20 for x=0.0, 0.05, 0.10, 0.15 and 0.20 respectively) were synthesized by method of solid state reaction. The crystal structure has been studied using X-ray diffraction technique. The X-ray patterns show enormous transform in crystal structure at concentration x=0.20. The Rietveld refinement of XRD patterns indicates that at concentration x=0.0 sample have rhombohedral structure with R3c space group while for the concentration x=0.05, 0.10, 0.15 and 0.20, the mixed phase including rhombohedral R3c and triclinic P1 space groups were obtained with best fitting. This phase transformation in crystal structure is observed due to mismatching of ionic radii of doped ions and parent ions. Magnetic properties of all samples were carried out by using vibrating sample magnetometry. M-H hysteresis loops shows that with doping of Ba and Ho antiferromagnetic BiFeO3 (BFO) transforms into ferromagnetic. The dielectric and ferroelectric measurements were carried out which shows that dielectric constant, dielectric loss and ferroelectric properties are enhanced with co-doping of Ho in comparison of the pristine BFO due to structure deformation and decrease in oxygen vacancies with higher concentration of Ho. Significant improvement has been observed in dielectric constant and remnant magnetization values with increasing content of Ho and decrease in the dielectric loss.

Dielectric relaxation, conductivity behavior and magnetic properties of Mg substituted Zn―Li ferrites

Navneet Singh,Ashish Agarwal,Sujata Sanghi 한국물리학회 2011 Current Applied Physics Vol.11 No.3

Spinel ferrites having compositions Zn_0.5Li_(1-2x)Mg_xFe_2O_4 (0 ≤ x ≤ 0.5) have been prepared by sol-gel auto combustion technique. The dielectric properties of these ferrites have been studied using impedance measurements in the frequency range 10 Hz―10 MHz and in the temperature range 310―473 K. The effect of temperature, frequency and composition on dielectric constant (ε´), dielectric loss (tanδ) and conductivity (σ) have been discussed in terms of hopping of charge carriers (Fe^2+↔Fe^3+). The occurrence of peak in the dielectric loss (tanδ) spectra is found to be temperature and composition dependent. The electrical modulus formulism has also been employed to study the relaxation dynamics of charge carriers and the results indicate the presence of non-Debye type of relaxation in these ferrites. Identical values of activation energy for dc conduction (E_dc) and for conductivity relaxation (E_M˝) reveal that the charge carriers have to overcome the same energy barrier while conducting and relaxing. A single ‘master curve’for normalized plots of all the modulus isotherms observed for a given composition indicates the temperature independence of dynamical process for charge carriers in the present ferrites. The absence of hysteresis and non-attainment of saturation magnetization (even at 8 kOe) suggests the super paramagnetic behaviour of these ferrites.

Step-Cut Subtrochanteric Osteotomy Combined with Total Hip Arthroplasty for Neglected Traumatic Hip Dislocations

Jatin Talwar,Saumya Agarwal,Sarang Agarwal,Loveneesh G. Krishna,Ashish Rustagi 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.2

Background: Total Hip Arthroplasty remains the standard treatment protocol for patients with neglected traumatic dislocations of the hip with arthritis. A total hip arthroplasty needs to be frequently combined with a subtrochanteric shortening femoral osteotomy to aid in the reduction of the hip joint in such cases. Still long-term stable implant fixation, rigid construct, and favorable functional outcome remain a challenge. In respect to subtrochanteric shortening osteotomy, various techniques have been described in the literature, including the step-cut, double chevron, transverse, and oblique osteotomies. Out of these types, a subtrochanteric step-cut osteotomy provides a better rotational stability and a larger surface of contact to aid in union. As there is a paucity in the literature regarding the step-cut osteotomy for traumatic dislocations of the hip, we designed this study to evaluate the outcomes of this procedure. Methods: We prospectively evaluated 24 patients with neglected traumatic dislocations of the hip, who underwent total hip arthroplasty with a step-cut subtrochanteric shortening osteotomy using a long modular stem within a span of 4 years. The indications were severe pain and difficulty in walking and performing activities of daily living. Patients fulfilling the inclusion criteria were evaluated in terms of Harris Hip Score, leg length discrepancy, neurological status, union of the osteotomy, and implant stability. Results: The mean Harris Hip Score significantly improved from 33.4 preoperatively to 89.2 postoperatively at the latest follow-up. At the final follow-up, all patients showed union at the osteotomy site and there were no cases of implant loosening or instability. No neurological complications were reported. Conclusions: Total hip arthroplasty combined with a step-cut subtrochanteric femoral shortening osteotomy in patients with neglected dislocations of the hip was associated with good functional outcome and higher success rates in terms of stable implant fixation and union at the site of osteotomy.

Laparoscopic transperitoneal heminephrectomy for treatment of the nonfunctioning moiety of duplex kidney in adults: A case series

Manmeet Singh,Samarth Agarwal,Apul Goel,Manoj Kumar,Ashish Sharma,Siddharth Pandey,Satynarayan Sankhwar 대한비뇨의학회 2019 Investigative and Clinical Urology Vol.60 No.3

Purpose: We report the results and experience of a tertiary care center in laparoscopic transperitoneal heminephrectomy for the treatment of a non-functioning upper pole moiety of duplex kidney in adults. Materials and Methods: The key point of the technique included the placement of a 6-Fr ureteric catheter in the healthy ureter at the beginning of the procedure under fluoroscopic guidance cystoscopically. A standard laparoscopic 3- to 4-port placement was done after placing the patient in a 45 to 90 degrees lateral decubitus position. The upper pole was mobilized transperitoneally and transected using a harmonic scalpel. Results: A total of 17 patients aged 19 to 44 years underwent laparoscopic upper pole heminephrectomy. All patients had a complete duplicated renal collecting system on the ipsilateral side. Three patients were found to have ureterocele. The average blood loss was minimal (50–150 mL) with a mean of 95 ml. None of the patients required any blood transfusions. The mean operative time was 220 minutes (range, 160–315 minutes). The average length of hospital stay was 3 days (range, 2–4 days). Only 2 patients had Clavien-Dindo grade 3a complications, which were managed by double J stenting and percutaneous aspiration, respectively. Conclusions: Laparoscopic heminephrectomy is playing a cornerstone role in the treatment of the non-functioning moiety of duplex kidneys. The procedure is safe, efficient and offers the typical preoperative and postoperative benefits of laparoscopic surgery. The rate of complications in adults is acceptable and is similar to that reported in pediatric patients.

Rietveld refinement and impedance spectroscopy of calcium titanate

Monica Sindhu,Neetu Ahlawat,Sujata Sanghi,Ashish Agarwal,Reetu Dahiya,Navneet Ahlawat 한국물리학회 2012 Current Applied Physics Vol.12 No.6

Single phase perovskite CaTiO3 has been synthesized by conventional solid state reaction technique. The ceramic was characterized by XRD at room temperature and its Rietveld refinement inferred orthorhombic crystal structure with the space group Pbnm. The field dependence of dielectric relaxation and conductivity was measured over a wide frequency range from room temperature to 673 K. Analysis of Nyquist plots of CaTiO3 revealed the contribution of many electrically active regions corresponding to bulk mechanism, distribution of grain boundaries and electrode processes. The dc conductivity depicted a semiconductor to metal type transition. Frequency dependence of dielectric constant (ε') and tangent loss (tan δ) show a dispersive behavior at low frequencies and is explained on basis of Maxwell-Wagner model and Koop’s theory. Both conductivity and electric modulus formalisms have been employed to study the relaxation dynamics of charge carriers. The variation of ac conductivity with frequency at different temperatures obeys the universal Jonscher’s power law (σac α ωs). The values of exponent ‘s’ lie in the range 0.13 ≤ s ≤ 0.33, which in light of CBH model suggest a large polaron hopping type of conduction mechanism.

Unplanned 30-day readmission rates in patients undergoing endo-urological surgeries for upper urinary tract calculi

Manoj Kumar,Siddharth Pandey,Ajay Aggarwal,Deepanshu Sharma,Gaurav Garg,Samarth Agarwal,Ashish Sharma,Satyanarayan Sankhwar 대한비뇨의학회 2018 Investigative and Clinical Urology Vol.59 No.5

Purpose: To see the 30-day unplanned readmission rates in patients underdoing endo-urological surgeries for upper urinary tract calculi we conducted this retrospective study at King George's Medical University, Lucknow, India. Unplanned readmissions not only add to healthcare costs but also are bothersome for the patients. There are many studies on 30-day unplanned readmissions in general surgical patients. Although similar studies have been done in certain urological procedures, no study has reported readmission rates or its risk factors in patients undergoing surgeries for upper urinary tract calculi. Materials and Methods: We retrospectively reviewed our prospectively maintained database from 1st January 2009 to 31st December 2017, for the patients who underwent endo-urological procedures for upper urinary tract calculi and identified the patients who were re-admitted within 30 days of discharge. Results: Out of the total 3,209 patients undergoing endo-urological procedures for upper urinary tract calculi 56 were re-admitted. The readmission rate was 1.74% over the study period. The most common etiology for readmission was sepsis followed by hematuria. The significant risk factors for readmission in bivariate analysis included male gender, age >65 years, current smoking, chronic obstructive pulmonary disease, diabetes mellitus, bleeding disorder, prior cardiac disease, and American Society of Anesthesiologists (ASA) class ≥3. In multivariate risk adjusted logistic regression analysis ASA class ≥3 was the only independent risk factor for readmission. Conclusions: The readmission rates in endo-urological procedures for urolithiasis are less compared to other procedures. ASA class ≥3 is the most important independent predictor of unplanned 30-day readmissions.

Are there any predictive risk factors for failure of ureteric stent in patients with obstructive urolithiasis with sepsis?

Siddharth Pandey,Deepanshu Sharma,Satyanarayan Sankhwar,Manmeet Singh,Gaurav Garg,Ajay Aggarwal,Ashish Sharma,Samarth Agarwal 대한비뇨의학회 2018 Investigative and Clinical Urology Vol.59 No.6

Purpose: To compare patients with sepsis due to obstructive urolithiasis (Sep-OU) and underwent drainage by percutaneous nephrostomy (PCN) or a double-J (DJ)-ureteral stent and to identify predictive risk factors of DJ stent failure in these patients. Materials and Methods: We reviewed our records from January 2013 to July 2018 and identified 286 adult patients with Sep-OU out of which 36 had bilateral involvement, thus total 322 renal units were studied. Urologic residents in training carried out both ureteral stenting and PCN tube placement. Demographic data and stone characteristics were recorded along with Charlson comorbidity index. For predicting risk factors of DJ stent failure, those variables that had a p-value <0.1 in univariate analysis were combined in a multinomial regression analysis model. Results: The patients with PCN placement were significantly older than those with DJ stent placement (p=0.001) and also had significant number of units with multiple calculi (p=0.018). PCN was also placed more frequently in those patients with a upper ureteric calculi (p<0.05). On multinomial regression analysis multiple calculi (p=0.014; odds ratio [OR], 4.878; 95% confidence interval [CI], 1.377–17.276) and larger calculi size (p=0.040; OR, 0.974; 95% CI, 0.950–0.999) were the significant predictors of DJ stent failure. Conclusions: In patients with sepsis from obstructive urolithiasis due to larger and multiple calculi a PCN placement might be better suited although this data requires further prospective randomized studies to be extrapolated.