Behavior of eccentrically inclined loaded footing resting on fiber reinforced soil

Kaur, Arshdeep,Kumar, Arvind Techno-Press 2016 Geomechanics & engineering Vol.10 No.2

A total of 104 laboratory model tests on a square footing subjected to eccentrically inclined loads supported by sand reinforced with randomly distributed polypropylene fibers were conducted in order to compare the results with those obtained from unreinforced sand and with each other. For conducting the model tests, uniform sand was compacted in a test box at one particular relative density of compaction. The effect of percentage of reinforcement used, thickness of the reinforced layer, angle of inclination of load to vertical and eccentricity of load applied on various prominent factors such as ultimate load, vertical settlement, horizontal deformation and tilt were investigated. An improvement in ultimate load, vertical settlement, horizontal deformation and tilt of foundation was observed with an increase in the percentage of fibers used and thickness of reinforced sand layer under different inclinations and eccentricities of load. A statistical model using non-linear regression analysis based on present experimental data for predicting the vertical settlement ($s_p$), horizontal deformation ($hd_p$) and tilt ($t_p$) of square footing on reinforced sand at any load applied was done where the dependent variable was predicted settlement ($s_p$), horizontal deformation ($hd_p$) and tilt ($t_p$) respectively.

Inflammatory bowel disease (IBD)-disk accurately predicts the daily life burden and parallels disease activity in patients with IBD

( Arshdeep Singh ),( Yogesh Kumar Gupta ),( Ashvin Singh Dhaliwal ),( Bhavjeet Kaur Kahlon ),( Vasu Bansal ),( Ramit Mahajan ),( Varun Mehta ),( Dharmatma Singh ),( Ramandeep Kaur ),( Namita Bansal ) 대한장연구학회 2023 Intestinal Research Vol.21 No.3

Background/Aims: The inflammatory bowel disease (IBD)-disk is a validated, visual, 10-item, self-administered questionnaire used to evaluate IBD-related disability. The present study aimed to evaluate IBD-disk in assessment of IBD daily life burden and its relation with disease activity. Methods: A cross-sectional study was conducted between June 2021 and December 2021. Patients with IBD were asked to complete the IBD-disk and a visual analogue scale of IBD daily-life burden (scored from 0-10, score >5 indicative of high burden). The internal consistency of IBD-disk, correlation with IBD daily life burden and disease activity (assessed by partial Mayo score and Harvey Bradshaw Index in patients with ulcerative colitis [UC] and Crohn’s disease [CD], respectively) and diagnostic performance of IBD-disk to detect high burden were analyzed. Results: Out of the 546 patients (mean age 40.33±13.74 years, 282 [51.6%] males) who completed the IBD-disk, 464 (84.98%) had UC and the remaining (n=82, 15.02%) had CD. A total of 311 patients (291 UC and 20 CD; 56.95%) had active disease. The mean IBD-disk total score and IBD daily life burden were 18.39±15.23 and 2.45±2.02, respectively. The IBD-disk total score correlated strongly with the IBD daily life burden (ρ=0.94, P< 0.001), moderately with partial Mayo score (ρ=0.50) and weakly with Harvey Bradshaw Index (ρ=0.34). The IBD-disk total score >30 predicted high IBD daily-life burden. Conclusions: The IBD-disk accurately predicts the daily life burden and parallels disease activity in patients with IBD and can be applied in clinical practice. (Intest Res 2023;21:375-384)

Pregnancy-Related Health Information-Seeking Behavior of Rural Women of Selected Villages of North India

Harmeet Kaur Kang,Arshdeep Kaur,Shania Saini,Rayees Ahmad,Wani Shubhleen Kaur 숙명여자대학교 아시아여성연구원 2022 Asian Women Vol.38 No.2

Maternal health improvement is one of the main targets of India's national health programs; however, maternal mortality reduction has not yet reached satisfactory levels. Maternal health outcomes depend on the health literacy of pregnant women. The exploration of areas in which women seek information can help in a better understanding of their health information needs. A cross-sectional study assessed health information-seeking behavior during pregnancy, health information resources used, and related barriers perceived by rural women in North India. Rural women who were pregnant or had a live birth in the past six months (N=100) were selected using purposive sampling techniques from five selected villages in the Patiala district of Punjab state, India. The majority were aged 26–30 years and reported dependence on their husbands and family members in choosing sources of health information. They reported doctors, nurses, and the Internet as valuable resources for seeking health information during pregnancy. The essential topics on which women seek information are fetal growth, delivery setting, body changes during pregnancy, and other related concerns. Women reported the significant barriers to important health information as long queues and inconvenient service hours during antenatal check-ups in health settings. The findings of the study point toward the need for strengthening and improving the existing services for availability of verified and reliable information, education and communication (IEC) resources, and maternal services in the public health sector.

Low prevalence of primary sclerosing cholangitis in patients with inflammatory bowel disease in India

Arshdeep Singh,Vandana Midha,Vikram Narang,Saurabh Kedia,Ramit Mahajan,Pavan Dhoble,Bhavjeet Kaur Kahlon,Ashvin Singh Dhaliwal,Ashish Tripathi,Shivam Kalra,Narender Pal Jain,Namita Bansal,Rupa Banerje 대한장연구학회 2023 Intestinal Research Vol.21 No.4

Background/Aims: Primary sclerosing cholangitis (PSC) represents the most common hepatobiliary extraintestinal manifestation of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). Limited data exist on PSC in patients with IBD from India. We aimed to assess the prevalence and disease spectrum of PSC in Indian patients with IBD. Methods: Database of IBD patients at 5 tertiary care IBD centers in India were analyzed retrospectively. Data were extracted and the prevalence of PSC-IBD was calculated. Results: Forty-eight patients out of 12,216 patients with IBD (9,231 UC, 2,939 CD, and 46 IBD unclassified) were identified to have PSC, resulting in a prevalence of 0.39%. The UC to CD ratio was 7:1. Male sex and pancolitis (UC) or colonic CD were more commonly associated with PSC-IBD. The diagnosis of IBD preceded the diagnosis of PSC in most of the patients. Majority of the patients were symptomatic for liver disease at diagnosis. Eight patients (16.66%) developed cirrhosis, 5 patients (10.41%), all UC, developed malignancies (3 colorectal cancer [6.25%] and 2 cholangiocarcinoma [4.16%]), and 3 patients died (2 decompensated liver disease [4.16%] and 1 cholangiocarcinoma [2.08%]) on follow-up. None of the patients mandated surgical therapy for IBD. Conclusions: Concomitant PSC in patients with IBD is uncommon in India and is associated with lower rates of development of malignancies.

Exclusive enteral nutrition for induction of remission in anti-tumor necrosis factor refractory adult Crohn’s disease: the Indian experience

( Ajit Sood ),( Arshdeep Singh ),( Ritu Sudhakar ),( Vandana Midha ),( Ramit Mahajan ),( Varun Mehta ),( Yogesh Kumar Gupta ),( Kirandeep Kaur ) 대한장연구학회 2020 Intestinal Research Vol.18 No.2

Background/Aims: Exclusive enteral nutrition (EEN) is recommended for induction of remission in pediatric Crohn’s disease (CD). However, it is not currently recommended for inducing remission in adults. This report describes the use of 12-week EEN for induction of remission in anti-tumor necrosis factor (anti-TNF) refractory adult CD. Methods: This is a retrospective analysis of adults with moderate to severe active (Crohn’s Disease Activity Index [CDAI] >220) anti-TNF refractory CD, who received EEN for 12 weeks between April 2018 and March 2019 at Dayanand Medical College and Hospital, Ludhiana, India. Primary outcomes included achievement of clinical remission and fistula healing at 12 weeks. Improvement in inflammatory markers and nutritional status were the secondary end points. Results: Out of 23 patients who received anti-TNF agents, 7 (30.4%) were refractory and were offered EEN as a salvage therapy. Six patients (66.7% females, mean age 25.6±6.5 years) consented. Four patients (66.6%) achieved clinical remission (CDAI <150). Mean CDAI of patients decreased significantly after 12 weeks of EEN (388.8±74.8 vs. 160.0±25.2, P< 0.001). Perianal fistulas showed clinical response (drainage decreased by >50%), though none achieved remission. Entero-enteric fistulae showed complete healing. Mean body mass index improved from 15.6±3.1 to 18.9±1.9 kg/m2 at week 12 (P=0.003). Hemoglobin and serum albumin also improved from 8.2±1.1 g/dL and 2.8±0.3 g/dL at baseline to 12.6±0.6 g/dL and 3.6±0.5 g/dL post-EEN respectively (P<0.001 and P=0.006 respectively). Conclusions: EEN appears to be an effective and well tolerated therapy for induction of remission in anti-TNF refractory adult CD. More data from prospective trials with larger number of patients is required. (Intest Res 2020;18:184-191)

Maintaining infliximab induced clinical remission with azathioprine and 5-aminosalicylates in acute severe steroid-refractory ulcerative colitis has lower cost and high efficacy (MIRACLE): a multicenter study

( Ramit Mahajan ),( Arshdeep Singh ),( Saurabh Kedia ),( Kirandeep Kaur ),( Vandana Midha ),( Pabitra Sahu ),( Varun Mehta ),( Dharmatma Singh ),( Namita Bansal ),( Khushdeep Dharni ),( Sandeep Kausha 대한장연구학회 2022 Intestinal Research Vol.20 No.1

Background/Aims: Infliximab (IFX) has been used to induce and maintain remission in patients with severe steroid-refractory ulcerative colitis (UC). Long-term use of biologics in developing countries is limited by high cost and frequent side effects. An optimal maintenance strategy in these patients needs to be established. Methods: A retrospective analysis of maintenance of clinical remission with combination of azathioprine (AZA) and 5-aminosalicylates (5-ASA) in patients with severe steroid-refractory UC where IFX (5 mg/kg intravenously at weeks 0, 2, 6) had been used only as an induction therapy was done at 2 centers in India. Primary outcome was the proportion of patients maintaining corticosteroid-free sustained clinical remission (SCR) at the end of study period. Rates of relapse and cost of therapy were also analyzed. Results: Of the 137 patients who received rescue IFX induction therapy, 77 (56.2%) achieved clinical remission (mean age 34.81±13.32 years, 68.83% males, median follow-up 4 years, range 3 months to 6 years) and were included. Cumulative corticosteroid-free SCR was maintained in 68%, 59%, 42%, and 35% patients at 1, 2, 4, and 6 years respectively. Sixty-seven relapses were observed in 33 patients. Majority of the relapses (45/67, 67.16%) occurred within first 2 years of follow-up. Two relapses were managed with re-induction with IFX, one required colectomy, whereas all other responded to repeat course(s) of corticosteroids. Annual per capita maintenance therapy with 5-ASA and AZA was cheaper by US$ 4,526 compared to maintaining remission with IFX. Conclusions: Clinical remission achieved with IFX induction therapy in severe steroid-refractory UC can be sustained over long time with a combination of AZA and 5-ASA. (Intest Res 2022;20:64-71)

Colitis and Crohn’s Foundation (India): a first nationwide inflammatory bowel disease registry

( Ajit Sood ),( Kirandeep Kaur ),( Ramit Mahajan ),( Vandana Midha ),( Arshdeep Singh ),( Sarit Sharma ),( Amarender Singh Puri ),( Bhabhadev Goswami ),( Devendra Desai ),( C. Ganesh Pai ),( Kiran Ped 대한장연구학회 2021 Intestinal Research Vol.19 No.2

Background/Aims: The national registry for inflammatory bowel disease (IBD) was designed to study epidemiology and prescribing pattern of treatment of IBD in India. Methods: A multicenter, cross-sectional, prospective registry was established across four geographical zones of India. Adult patients with ulcerative colitis (UC) or Crohn’s disease (CD) were enrolled between January 2014 and December 2015. Information related to demographics; disease features; complications; and treatment history were collected and analyzed. Results: A total of 3,863 patients (mean age, 36.7±13.6 years; 3,232 UC [83.7%] and 631 CD [16.3%]) were enrolled. The majority of patients with UC (n=1,870, 57.9%) were from north, CD was more common in south (n=348, 55.5%). The UC:CD ratio was 5.1:1. There was a male predominance (male:female=1.6:1). The commonest presentation of UC was moderately severe (n=1,939, 60%) and E2 disease (n=1,895, 58.6%). Patients with CD most commonly presented with ileocolonic (n=229, 36.3%) inflammatory (n=504, 79.9%) disease. Extraintestinal manifestations were recorded among 13% and 20% of patients in UC and CD respectively. Less than 1% patients from both cohorts developed colon cancer (n=26, 0.7%). The commonly used drugs were 5-aminosalicylates (99%) in both UC and CD followed by azathioprine (34.4%). Biologics were used in only 1.5% of patients; more commonly for UC in north and CD in south. Conclusions: The national IBD registry brings out diversities in the 4 geographical zones of India. This will help in aiding research on IBD and improving quality of patient care. (Intest Res 2021;19:206-216)

Incidental benefits after fecal microbiota transplant for ulcerative colitis

( Ramit Mahajan ),( Vandana Midha ),( Arshdeep Singh ),( Varun Mehta ),( Yogesh Gupta ),( Kirandeep Kaur ),( Ritu Sudhakar ),( Anmol Singh Pannu ),( Dharmatma Singh ),( Ajit Sood ) 대한장연구학회 2020 Intestinal Research Vol.18 No.3

Gut dysbiosis can result in several diseases, including infections (Clostridium difficile infection and infectious gastroenteritis), autoimmune diseases (inflammatory bowel disease, diabetes, and allergic disorders), behavioral disorders and other conditions like metabolic syndrome and functional gastrointestinal disorders. Amongst various therapies targeting gut microbiome, fecal microbiota transplantation (FMT) is becoming a focus in the public media and peer reviewed literature. We have been using FMT for induction of remission in patients with moderate to severe active ulcerative colitis (UC) and also for subsequent maintenance of remission. Four cases reported incidental benefits while being treated with FMT for UC. These included weight loss (n = 1), improvement in hair loss (n = 1), amelioration of axial arthritis (n = 1) and improvement in allergic rhinitis (n = 1), thereby suggesting potential clinical applications of FMT in treating extraintestinal diseases associated with gut dysbiosis. (Intest Res 2020;18:337-340)

Trends of inflammatory bowel disease at a tertiary care center in northern India

( Ajit Sood ),( Kirandeep Kaur ),( Arshdeep Singh ),( Vandana Midha ),( Ramit Mahajan ),( Namita Bansal ),( Varun Mehta ),( Dharmatma Singh ) 대한장연구학회 2021 Intestinal Research Vol.19 No.3

Background/Aims: Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is increasingly being reported from India and other Asian countries. This study looks into the changing trends of IBD at a tertiary care center in north India over last two decades. Methods: Retrospective analysis of a prospectively maintained database of patients diagnosed with IBD between January 1991 and December 2015 was conducted. The study period was divided into five times cohorts (1991-1995, 1996-2000, 2001-2005, 2006-2010, 2011-2015). Results: During the study period, 2,467 patients (UC [n=2,137, 86.6%], CD [n=330, 13.3%], mean age 38.5±13.3 years; 55.9% males) were registered. The proportion of patients with CD increased (ratio of UC to CD declined from 15.7:1 to 4:1). The mean age at diagnosis decreased for UC (45.7±12.1 years in 1991-1995 vs. 37.6±13.0 years in 2011-2015; P=0.001) and remained consistent for CD (41.3±13.6 years in 1996-2000 vs. 41.3±16.9 years in 2011-2015, P=0.86). Patients with proctitis in UC and isolated ileal disease in CD increased over the study period (P=0.001 and P=0.007, respectively). Inflammatory CD increased (P=0.009) whereas stricturing CD decreased (P=0.01) across all cohorts. There was a trend towards less severe presentation of both UC and CD. The use of thiopurines (P=0.02) and biologics increased (P=0.001) with no significant change in trends for requirements of surgery (P=0.9). Conclusions: Increasing prevalence of CD, younger age at diagnosis, diagnosis at an earlier and milder stage, greater use of thiopurines and biologics were observed. (Intest Res 2021;19:282-290)

Efficacy and safety of the adalimumab biosimilar Exemptia as induction therapy in moderate-to-severe ulcerative colitis

Vandana Midha,Ramit Mahajan,Varun Mehta,Vikram Narang,Arshdeep Singh,Kirandeep Kaur,Ajit Sood 대한장연구학회 2018 Intestinal Research Vol.16 No.1

Background/Aims: Data on the efficacy and safety of the adalimumab biosimilar Exemptia are limited. Methods: Patients with moderate-to-severe active steroid-refractory ulcerative colitis (UC) treated at Dayanand Medical College and Hospital,India were offered cyclosporine A, biologicals or biosimilars, or surgery. A retrospective analysis was conducted on patients who were treated with the adalimumab biosimilar, Exemptia. These patients were administered an induction dosing scheduleof 160 mg Exemptia at week 0, 80 mg at week 2, and then 40 mg every other week from week 4 to 8. The clinical response andremission were assessed at week 8 using Mayo score. Results: A total of 29 patients (62.1% male; mean age, 34.9 ± 9.7 years)with moderate-to-severe steroid-refractory active UC (mean disease duration, 6.3±5.1 years; pancolitis in 9 patients [31.1%];left-sided colitis in 20 patients [68.9%]) were treated with the Exemptia induction dosing schedule. The mean Mayo score at presentation was 8.2±1.4. At week 8, clinical response was observed in 7 patients (24.1%), whereas clinical remission was observed only in 1 patient (3.5%). Among the non-responders (n=21), 4 patients required colectomy, 1 died, 1 was lost to follow-up, 10 were offered fecal microbiota transplant, 3 were administered infliximab, and 2 patients were administered cyclosporineand tacrolimus, respectively. Four patients (13.8%) developed extrapulmonary tuberculosis. Conclusions: The adalimumab biosimilar Exemptia has limited efficacy for the attainment of clinical response and remission in moderate-to-severe steroid-refractory UC, with a significant risk of acquisition or reactivation of tuberculosis in developing countries such as India.