Browsing by Author "Akash Mishra"

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Active Telephonic Follow-up During COVID-19 Lockdown: Initial Experience
(Springer, 2020) Vaibhav Pandey; Vivek Srivastava; Mohammed Imran; Akash Mishra
[No abstract available]
Adverse Drug Reactions Following Propranolol in Infantile Hemangioma
(Springer, 2021) Vaibhav Pandey; Preeti Tiwari; Mohammed Imran; Akash Mishra; Deepak Kumar; S.P. Sharma
Objectives: To assess the adverse effects of propranolol therapy in infantile hemangioma. Methods: An ambispective study was conducted from August 2011 to December 2019. In retrospective arm all children managed for infantile hemangioma with propranolol were included and case records were assessed for adverse reactions. In prospective arm the adverse reactions were identified on the basis of predefined criteria. Results: A total of 514 patients (358 retrospective records) were included. A majority, 378 (73.5%) patients had an excellent response, 75 (14.5%) had partial response and 61 (11.8 %) had no response. A total of 82 (15.9%) patients experienced at least one adverse effect. Diarrhea with weight loss (27, 32.9%) and irritability with decreased sleep (21, 25.6%) were the most common adverse effects. The adverse effects in 22 (4.2%) cases lead to the discontinuation of propranolol. Younger age, low body weight and early onset were risk factors for development of severe adverse reactions. Conclusion: Young children with low body weight were at higher risk for adverse effects of propranolol. © 2021, Indian Academy of Pediatrics.
Classification Accuracy of Linear Discriminant Function using Principal Components with Multiple Correlated Variables: A Simulation based Exploration
(Wolters Kluwer Medknow Publications, 2025) Akash Mishra; Sachit Ganapathy; Narayanapillai Sreekumaran Nair; Durgesh Shukla; Ashish Kumar Yadav; Rajaat Vohra; Kuldeep Soni
Background: Linear Discriminant Analysis (LDA) is a powerful and widely used technique for classification with correlated variables. Principal Components (PCs) group these variables into linear combinations and produce independent variables. The LDA on these PC’s may provide better classification accuracy in clinical diagnostics than on usual measurements. Methodology: Two datasets were utilized for demonstration: one from a Sudden Sensorineural Hearing Loss (SSNHL) case-control study and the other from a Gall Bladder (GB) case-control study. Linear Discriminant Analysis (LDA) was conducted on the actual correlated measured variables for group classification, as well as on the derived principal component variables, to compare their classification accuracies. Performance metrics including Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Classification Accuracy, and F1 Score were assessed. For validation, a third simulated dataset was employed. Additionally, LDA was performed on each dataset using eigenvectors of the control group applied to the cases and vice versa, revealing a strong agreement in classification as measured by the kappa statistic. Results: When LDA was applied to the actual lipid measurements in the SSNHL dataset, the classification accuracy was 57.2%, and the F1 score was 39.7%. However, when LDA was performed using principal components (PCs), the classification accuracy markedly improved to 99.2%, with an F1 score of 98.5%. Similarly, for the GB cancer dataset, the classification accuracy and F1 score were initially 77.2% and 77.3%, respectively. Upon applying LDA with the PCs, these metrics were significantly enhanced to 98.4% and 98.3%, respectively. For the simulated dataset, both the classification accuracy and F1 score were 99.1%. The study also demonstrated that the classification accuracy and F1 score remained consistent regardless of whether the eigenvectors from the cases or controls were used to classify new subjects (Kappa Statistic = 0.962, P < 0.001). Conclusion: In group separation, utilizing principal components significantly improves classification accuracy and overall performance metrics, outperforming the use of the original correlated predictors. © 2025 Medical Journal of Dr. D.Y. Patil Vidyapeeth.
Comparing the efficacy of oral apremilast, intralesional corticosteroids, and their combination in patients with patchy alopecia areata: a randomized clinical controlled trial
(Springer Nature, 2025) Sankalp Awasthi; Manisha Nijhawan; Akash Mishra; Anviti Gupta
Introduction: Alopecia areata (AA) is a chronic, immune-mediated inflammatory disorder characterized by nonscarring hair loss. The management of AA poses challenges due to its unpredictable course and variable response to treatment. In this comparative study, we evaluated the efficacy and safety of oral apremilast, intralesional corticosteroids (ILC) and a combination of both in patients with patchy AA. Methods: Sixty patients with patchy AA were randomly assigned to three treatment groups: oral apremilast (Group A), ILC (Group B), and a combination of both (Group C). The Severity of Alopecia Tool (SALT) score was used to assess the extent of hair loss before treatment, after 3 months, and at 6 months of follow-up. Adverse events and complications were also monitored. The changes in SALT score from baseline between the three groups were assessed by using non-parametric statistical tests. The statistical significance was judged at 5% level of significance. Results: Findings demonstrated significant higher reduction in median SALT scores after treatment i.e., 2.47 (1.76, 5.07), p < 0.001 as well as after six months follow up 5.08 (3.80, 7.53), p < 0.001 in patients treated with ILC compared to other two groups. Neither apremilast monotherapy nor its combination with ILC demonstrated statistically significant improvement, although individual responses were observed. Complications were minimal, with transient pain and burning sensation reported during ILC injections and a few cases of gastritis and relapse in the oral apremilast group. Conclusion: These findings suggest that ILC remains an effective treatment option for patchy AA. This study did not demonstrate statistically significant efficacy of oral apremilast, either as monotherapy or in combination with ILC, though larger studies may be needed to evaluate potential benefits in specific patient subgroups. Further research with larger sample sizes and longer-term follow-up is needed to validate these findings and optimize treatment approaches for AA. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.
Desfechos de crianças com síndrome nefrótica idiopática córtico-resistente: um estudo observacional de centro único; [Outcomes of children with idiopathic steroid resistant nephrotic syndrome: a single centre observational study]
(Sociedade Brasileira de Nefrologia, 2023) Om P. Mishra; Minketan Sidar; Vineeta V. Batra; Rajniti Prasad; Ankur Singh; Abhishek Abhinay; Akash Mishra; Ashish K. Yadav
Introduction: Idiopathic steroid resistant nephrotic syndrome (SRNS) has variable outcomes in children. The primary objective of the present study was to assess the cumulative remission rate and the secondary objectives were to assess factors affecting the remission status, kidney function survival, and adverse effects of medications. Methods: One hundred fourteen patients with SRNS were included. Calcineurin inhibitor-based treatment protocol along with prednisolone and angiotensin-converting enzyme inhibitor were used, and patients were followed over 5 years. Results: Median age was 4.5 years; 53.5% of cases were between 1 to 5 years of age. Sixty-two patients (54.4%) were at initial stage and 52 (45.6%) were at a late SRNS stage. Median eGFRcr was 83.5 mL/min/1.73m2 at presentation. Of the 110 patients, 63 (57.3%) achieved remission [complete remission 30 (27.3%), partial remission 33 (30%)], and 47 (42.7%) had no remission. Kidney function survival was 87.3% and 14 cases (12.7%) had progression to CKD (G3-8, G4-3, G5-1, and G5D-2). Median duration of follow up was 36 months (IQR 24, 60). Age of onset, cyclosporine/tacrolimus, eGFRcr, and histopathology (MCD/FSGS) did not affect remission. Similarly, remission status in addition to age of onset, drug protocol, and histopathology did not significantly affect kidney function during a period of 5 years. Hypertension, cushingoid facies, short stature, cataract, and obesity were observed in 37.7, 29.8, 25.5, 17.5, and 0.7% of cases, respectively. Conclusion: About half of the cases achieved remission. Age of onset of disease, cyclosporine/tacrolimus use, and histopathological lesion neither affected remission status nor short-term kidney function survival in SRNS. © 2023 The Author(s).
Determinants of school enrolment of children in slums of Varanasi
(Indian Association of Preventive and Social Medicine, 2016) Pallavi Nayak; Payal Singh; Neeraj Tripathi; Akash Mishra; R.N. Mishra
Introduction: Education plays a vital role to developing a nation. In India, urban slums constituting about 22.6% of the urban population are the poor and socially disadvantaged. This slum community is least concerned for school enrolment of their children inspite of the fact that primary education is compulsory and is free in public schools. In urban areas schools available are mostly of private sector that are not free and beyond affordability to slums; government and corporation schools are few, but beyond reach. Motive of the parents is to involve children in income generating activities and the girls are more deprived of school enrolment in poorer society. The, present analysis aim to: 1) assess the enrolment status of slum children and 2) determine the factors influencing school enrolment. Methodology: The data was collected during 2011-12 from 15 randomly selected slums out of 227 in which a total of 893 families were contacted and mothers with children aged 5-15 years interrogated. In addition to child history on age, sex and school enrolment, the family background characteristics were e.g. religion, caste, and family size as well as age, education and occupation of both mother & father were recorded. Results: Out of 1145 children, male and female equal represented; mostly (90.9%) were Hindus and half were SC/ST class. About 30% father and 57.2% mothers were illiterate; about half fathers were unskilled-worker and 96.0% mother’s house wife. Overall 31.3% children were not enrolled and were decreasing from 49.2% to 24.3% to 21.4% in the age groups 5-6, 7-9 and 10-15 years respectively. Enrolment was poor in Muslims (50.0%) compared to Hindus (29.4%); enrolment was similar irrespective of child sex among Hindus, but in Muslims 62.5% male and 35.4% female children were only enrolled. Similar was the situation as one move from SC/ST (67.6%) to OBC (73.4%) and general caste (77.9%). Education of father and mother had significant role to enrolment but not the age and occupation of father and mother. Female child enrolment was poor if father was in business and mother was aged. Logistic regression analysis indicated that school enrolment of children aged 5-7 years was associated with age of mother and educational combination of father and mother, while of children 8-15 years caste/religion, family size, sex of child and educational combination of father and mother were found associated. Conclusion: Findings suggest that slum community as a whole is the pocket constituted by habitats of socially disadvantaged class has to be promoted with attitudinal change to schooling of their children without discriminating child sex. © 2016, Indian Association of Preventive and Social Medicine. All rights reserved.
Evaluating the effects of back massage during labour on delivery outcomes: A prospective study on primigravida mothers
(IP Innovative Publication Pvt. Ltd., 2024) Anitha Moncy; Madhu Jain; Ashok Kumar; Shuchi Jain; Akash Mishra; Sangeeta Kansal
Background and Objectives: The labor and delivery process can be stressful for parturient women, especially for primigravida mothers. Birth companions providing massage and emotional support can help make more pleasant birthing experience. This study aimed to assess the impact of back massage by trained birth companions on reducing analgesic use, pain intensity scores, and labor duration. Materials and Methods: The study was conducted on primigravida women. During antenatal care visits, companions in the intervention group were trained in massage techniques, while no training was imparted to companions in the control group. Data were collected using a pre-tested questionnaire during antenatal clinic visits and delivery A multivariable logistic regression model was used to assess the impact of massage on delivery outcomes while adjusting for significant confounding variables. Results: The study demonstrated a positive impact of back massaging on labor and delivery outcomes. Mothers in the massaged group were 2.27 times less likely to receive analgesics and 3.71 times more likely to experience a reduction in pain intensity scores of > 2 compared to those receiving usual care. Additionally, the massaged group had a 2.24 times higher likelihood of reducing labor duration to < 12 hours compared to the usual care group. Conclusion: Back massaging by trained birth companions is an effective intervention for reducing the use of analgesics, pain intensity scores, and the length of labor in primigravida women. © 2024 Author(s).
High-resolution ultrasonography as an adjuvant diagnostic tool in preoperative assessment of acute forearm lacerations
(Elsevier Ltd, 2025) Umesh Kumar; Sudipta Bera; Shikha Jaiswal; Shivi Jain; Akash Mishra
Background/purpose: Forearm lacerations are frequently associated with involvement of tendon, nerve, and vessel injuries. An accurate diagnosis and timely intervention are critical to avoid any functional impairment, but clinical examination alone may not always be reliable, particularly in combined injuries or uncooperative patients. High-resolution ultrasound (USG) is a useful tool for the rapid assessment of these injuries. This study aims to evaluate the effectiveness of pre-operative USG in diagnosing tendon, nerve, and vascular injuries in acute trauma cases, using surgical exploration as the gold standard. Methods: This prospective observational study was conducted at the Department of Plastic Surgery of a tertiary care Trauma centre, between April 2022 and July 2024. Thirty-eight patients with forearm lacerations were included. All patients underwent clinical examination followed by USG (3–15 MHz) for injury assessment. The cases were examined by the operating surgeon. USG findings were compared with intraoperative findings to assess the diagnostic accuracy. Results: USG demonstrated diagnostic accuracy of 99.62 % in tendon injuries, with a high sensitivity (98.61 %) and specificity (100 %). It identified nerve injuries with a accuracy of 96.49 %, and interpreting arterial injuries was more challenging, with an accuracy of 90.7 %. The outcome of evaluation with high resolution USG with clinical examination was better than that of isolated clinical examination for tendon and neurovascular injuries. The mean time for an USG diagnosis in forearm laceration was 9.53 min. Conclusion: High-resolution ultrasound is an effective, non-invasive tool for a quick assessment of forearm lacerations. It offers a high sensitivity and specificity for tendon and nerve injuries, aiding in targeted surgical interventions. While it is less sensitive for vascular injuries, it remains valuable for surgical planning in combined injuries. This study supports its integration into routine trauma care to improve diagnostic accuracy and better outcomes. Level of evidence: Level IIIA, Prospective observational study. © 2025 Elsevier Ltd
Identifying the clinical relative importance of each correlated outcome variables in multivariate approach: an exploration using ACCORD trial data
(Taylor and Francis Ltd., 2025) Akash Mishra; Narayanapillai Sreekumaran Nair; Kottenyen Thazhath Harichandrakumar; Binu Vs; Santhosh Satheesh
In scenarios involving correlated endpoints, multivariate methods offer increased robustness for comparisons. However, understanding the individual contribution of each variable toward multivariate hypothesis rejection remains underexplored. Usually, this question is sidelined, and separate univariate analyses are performed. This paper addresses this gap by demonstrating the relative importance and contribution of variables toward the rejection of multivariate hypotheses, comparing it against a univariate approach using clinical trial data. Using the ACCORD lipid trial dataset, which includes lipid measurements of triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL), we employed Hotelling’s T2 multivariate statistic for two-group comparisons. We showcased the significance and relative importance of contributions through standardized discriminant function coefficients and partial F tests. Additionally, we investigated the impact of varying correlation levels on the significance of each variable’s contribution in multivariate versus univariate approaches. Our results revealed significant lipid differences in a multivariate context at the 12th and 36th months. Across both follow-ups, TG exhibited the highest relative importance and contribution, followed by HDL and LDL. Notably, in the 36th month, the univariate approach rendered LDL’s contribution insignificant for group separation, contrasting with the significant contribution identified in the multivariate approach. Furthermore, the significance likelihood of variable contributions in group separation within the multivariate approach increased with rising correlation levels. The simulation technique and the power analysis was also adopted to characterize the features of the proposed method. Our approach enables the evaluation of the relative importance and significance of each variable’s contribution within the multivariate framework. This methodology holds promise for enhancing the interpretation of clinical trial analysis outcomes, particularly when dealing with multiple correlated endpoints. © 2025 Taylor & Francis Group, LLC.
Incidence, prevalence and mortality of HIV/AIDS across different levels of human development index: A global perspective
(Institute of Medico-Legal Publications, 2018) Ravi Prakash Jha; Krittika Bhattacharyya; Rabindra Nath Mishra; Akash Mishra
Background: HIV/AIDS has asserted its pandemic status by claiming more than 35 million lives so far. The disproportionate burden of HIV/AIDS across the globe in terms of mortality, incidence and prevalence rates intrigued researchers to examine and evaluate the degree and direction of a two-way association between the global HIV/AIDS epidemic and national development across different levels of HDI to formulate the policies. The present analysis is to concentrate directional influence of HDI on these rates. Data and Method: Age-standardized HIV/AIDS mortality, prevalence, and incidence rates of 179 countries were extracted from Global Burden of Disease Study 2015. The human development index along with its 4 components were obtained from Human Development Report 2016. The association between each of the rates and HDI was judged by Spearman correlation, Linear and Quantile regression analysis, and the Kruskal-Wallis test. Results: HIV/AIDS mortality, prevalence, and incidence rates were found to be inversely correlated with national HDI (r =-0.707,-0.677,-0.557 respectively; P < .001), as well as the 4 indicators of HDI. Countries in Low HDI group were found to experience higher burden of HIV/AIDS in terms of these rates than that of Medium, High, and Very high HDI countries. Conclusions: Lower development status characterized by low HDI values was found to increase the burden of HIV/AIDS around the world. Higher levels of deprivation in terms of Health, Education, and Economy were not only found to affect the overall well-being but might just raise the severity of HIV/AIDS across the regions. Hence for HIV/AIDS control or eradication, development could be the key aspect; hence recommended that special attention should be paid to develop an enabling environment in the countries of lower HDI groups. © 2018, Indian Journal of Public Health Research and Development. All rights reserved.
Inverted-Y Ureteric Duplication With Paraureteric Diverticulum Presenting With Bladder Outlet Obstruction in an Infant- A Diagnostic Dilemma
(Elsevier Inc., 2023) Sunil Kumar Singh Gaur; Maharani Adhikari; Akash Mishra; Deepak Kumar; Amrita Ghosh Kar; Shivi Jain; Sarita Chawdhary; Kanika Sharma
The ectopic ureter and paraureteric diverticulum are 2 known common urological anomalies of pediatric patients. Another rare entity is inverted-Y ureteric duplication. We report a case of a 3-month-old boy presented with bladder outlet obstruction, where surgical excision of large bladder diverticulum with left ureter and small kidney was done. Histopathology confirmed the presence of inverted-Y ureteric duplication with left dysplastic kidney. The report defines the first case of infantile bladder outlet obstruction having the co-existing congenital genitourinary anomaly of inverted Y-partial ureteric duplication with obstructive ectopic ureter and ipsilateral paraureteric diverticula. © 2022 Elsevier Inc.
Knowledge, source and practice of spacing methods of contraception among eligible women of varanasi slums
(Indian Association of Preventive and Social Medicine, 2019) Payal Singh; Akash Mishra; Ravindra Nath Mishra
Background: Still many Indian states observe low spaced births and high fertility; mostly contributed by disadvantaged society. Factors influencing are entrenched in ignorance, male child desire and traditional culture to some extent. Aim and Objectives: To determine knowledge and practice of spacing methods of contraception and the associated socio-demographic variables. Methods and Material: A community based cross-sectional study on 590 eligible couples of slum of Varanasi, by two stage stratified random sampling. Statistical analysis used: Knowledge and practice were described in percent and the associated factors identified by logistic regression. Significance was judged at α = 0.05. Results: Overall knowledge of any spacing methods was in only 61.2% women and practice ever in married life was 44.4%; those knowing methods, ever practice was only 66.2%. Knowledge was mostly through husband for condom, health professional for Cu-T and oral pills. Conclusion: Eligible couples of slum community need knowledge of contraception as well as motivation to practice spacing methods to reduce higher level of fertility. © 2019, Indian Association of Preventive and Social Medicine. All rights reserved.
Markers of oxidative stress in children with iron deficiency anemia
(Pediatric Hematology Oncology Chapter of Indian Academy of Pediatrics, 2024) Kusumlata Yadav; Om P. Mishra; Ketki Khandhadiya; Surendra P. Mishra; Arpita Mishra; Ashok Singh; Ritesh K. Agrawal; Nirali Sanghvi; Akash Mishra
Background: Oxidative stress can occur in iron deficiency anemia (IDA), causing cellular injury. The primary objective of the study was to assess serum malondialdehyde (MDA), protein carbonyl as oxidants and glutathione reductase catalase, superoxide dismutase (SOD), and vitamin C levels as antioxidants in patients with IDA and healthy controls; and secondary objectives were to observe the levels among the mild, moderate and severe category of IDA and their correlations with serum iron and ferritin. Material and methods: Fifty-five patients of IDA and 50 healthy controls were enrolled. Diagnosis of IDA was made based on the cut-off values of low hemoglobin as per age, serum iron <30 μg/dL, ferritin <12 ng/mL, and transferrin saturation <16 %. Serum levels of MDA, protein carbonyl, glutathione reductase, catalase, SOD, and vitamin C were estimated. Results: The median age of patients and controls was 6 years. IDA patients had significantly raised mean levels of MDA (p < 0.001) and protein carbonyl (p < 0.001) and decreased glutathione reductase (p < 0.001), catalase (p < 0.001), SOD (p = 0.014) and vitamin C (p = 0.010) than controls. Parameters were comparable among mild, moderate, and severe degrees of IDA. Significantly negative correlations of MDA (r = −0. 713, p < 0.001, −0.683 p < 0.001) and protein carbonyl (r = −0.500, p < 0.001, - 0.519, p < 0.001) and positive correlations of glutathione reductase (r = 0.607, p < 0.001, 0.629, p < 0.001), catalase (r = 0.447, p < 0.001, 0.436, p < 0.001), SOD (r = 0.209, p = 0.032, 0.175, p = 0.075) and vitamin C (r = 0.233,p = 0.017, 0.197, p = 0.044) were observed with serum iron and ferritin, respectively. Conclusion: Oxidative stress exists in patients with IDA, unaffected by the severity of anemia, and has significant correlations with serum iron and ferritin concentrations. © 2024 Pediatric Hematology Oncology Chapter of Indian Academy of Pediatrics
Median Scrotal Mass in a Child Masquerading as Third Testis: A Diagnostic Dilemma
(Wolters Kluwer Medknow Publications, 2025) K. Sharma; Akash Mishra; Rajat Kumar Singh; Ajit Kumar Vidhyarthy; Sarita Chowdhary
[No abstract available]
Optimizing surgical management of acetabulum fractures involving both columns using buttress plating of posterior column through AIP approach
(Elsevier B.V., 2024) Sandeep Kumar; Shataayu Gugale; Rohit Goyal; Akash Mishra; Vivek Bhambhu; Ganpat Choudhary
Introduction: Acetabulum fractures involving both columns are complicated injuries to treat, and achieving satisfactory post operative reduction with less extensile approaches is difficult. These injuries often require dual approaches, associated with their own share of complications. The anterior intrapelvic approach (AIP) addresses both columns through a single approach, minimizing these complications. Specifically, posterior column fixation is of utmost importance. This study aims to evaluate functional outcomes and complications of posterior column fixation using medial surface buttress plate in fractures involving both columns. Materials and methods: Between 2017 and 2024, 366 patients had fractures involving both columns, out of which 64 were operated using the AIP approach. Excluding patients with displaced posterior wall fractures, transverse fractures, delayed treatment, or aged under 18 years. Out of 64, we collected data from 60 patients, as 4 patients could not be followed up. All patients were operated using the AIP approach, and posterior column fixation was done using 3.5 mm reconstruction plates. Patients were followed for minimum 6 months–70 months, with an average of 29 months. The associations between variables and functional outcomes were examined using the Chi-Square Test or Fisher's Exact Test. Results: The study included 60 patients, with 48.3 % under 40 years old and 51.7 % older. Males comprised 68.3 % of the cohort. 46.7 % sustained road traffic accidents and 53.3 % had fall from height. T-type fractures were most common (50.0 %), with high posterior column fractures in 66.7 % of patients. Post-operative reductions less than 1 mm were achieved in 80.0 % of patients. Functional outcomes using the Harris hip Scores were found to be excellent to good in 90.0 % of patients. Conclusion: We conclude that medial surface buttress plating of the posterior column using the standard AIP approach can be utilised to treat even the most complex of acetabular fracture patterns involving both anterior as well as posterior columns, excluding those that contain a displaced posterior wall. © 2024 Delhi Orthopedic Association
Outcomes of children with idiopathic steroid resistant nephrotic syndrome: a single centre observational study; [Desfechos de crianças com síndrome nefrótica idiopática córtico-resistente: um estudo observacional de centro único]
(Sociedade Brasileira de Nefrologia, 2023) Om P. Mishra; Minketan Sidar; Vineeta V. Batra; Rajniti Prasad; Ankur Singh; Abhishek Abhinay; Akash Mishra; Ashish K. Yadav
Introduction: Idiopathic steroid resistant nephrotic syndrome (SRNS) has variable outcomes in children. The primary objective of the present study was to assess the cumulative remission rate and the secondary objectives were to assess factors affecting the remission status, kidney function survival, and adverse effects of medications. Methods: One hundred fourteen patients with SRNS were included. Calcineurin inhibitor-based treatment protocol along with prednisolone and angiotensin-converting enzyme inhibitor were used, and patients were followed over 5 years. Results: Median age was 4.5 years; 53.5% of cases were between 1 to 5 years of age. Sixty-two patients (54.4%) were at initial stage and 52 (45.6%) were at a late SRNS stage. Median eGFRcr was 83.5 mL/ min/1.73 m2 at presentation. Of the 110 patients, 63 (57.3%) achieved remission [complete remission 30 (27.3%), partial remission 33 (30%)], and 47 (42.7%) had no remission. Kidney function survival was 87.3% and 14 cases (12.7%) had progression to CKD (G3-8, G4-3, G5-1, and G5D-2). Median duration of follow up was 36 months (IQR 24, 60). Age of onset, cyclosporine/tacrolimus, eGFRcr, and histopathology (MCD/FSGS) did not affect remission. Similarly, remission status in addition to age of onset, drug protocol, and histopathology did not significantly affect kidney function during a period of 5 years. Hypertension, cushingoid facies, short stature, cataract, and obesity were observed in 37.7, 29.8, 25.5, 17.5, and 0.7% of cases, respectively. Conclusion: About half of the cases achieved remission. Age of onset of disease, cyclosporine/tacrolimus use, and histopathological lesion neither affected remission status nor short-term kidney function survival in SRNS. © 2023 Sociedade Brasileira de Nefrologia. All rights reserved.
Persistence of behavioral abnormalities following corticosteroid therapy in children with initial episode of idiopathic nephrotic syndrome: A prospective longitudinal observation; [Persistência de anormalidades comportamentais após corticoterapia em crianças com episódio inicial de síndrome nefrótica idiopática: Uma observação longitudinal prospectiva]
(Sociedade Brasileira de Nefrologia, 2022) Parichay Singh; Om P. Mishra; Shashi K. Upadhyay; Rajniti Prasad; Ankur Singh; Abhishek Abhinay; Akash Mishra; Franz Schaefer
Introduction: Treatment of nephrotic syndrome with corticosteroid can cause several side- effects including behavioral abnormalities. The objectives of the study were to observe the proportion of non-relapsers having persistence of behavioral abnormalities after completion of treatment of initial episode and compare the abnormalities with relapsers, and to determine risk factors for persistence. Methods: Seventy-five children with a first episode of idiopathic nephrotic syndrome and 60 normal children were rated by parents for behavioral problems using the Child Behavior Checklist. The Parenting Stress Index was also evaluated. The children were rated before treatment and 12 and 36 weeks after. Results: Both relapsers and non-relapsers showed abnormalities in internalizing and externalizing domains at 12 weeks of steroid therapy. Non-relapsers had abnormal scores in the internalizing domain in 63.5 % and externalizing domain in 48.1% of cases at 36 weeks. Relapsers had abnormal scores in all the three behavior domains, but a significantly higher proportion of relapsers had abnormal scores regarding total behavior (65.2% vs 28.8%, p<0.01) and child domains (100% vs 57.7%, p<0.001) of Parenting Stress Index in comparison to non-relapsers at 36 weeks. Occurrence of relapse increased the risk (odds ratio 5.76, 95% CI 1.35-10.76, p< 0.001) for persistence of abnormal total behavior at 36 weeks follow-up. Conclusion: Persistence of abnormalities was observed not only in relapsers but also in non-relapsers. Relapse was found to be a significant risk factor for persistence of abnormal behaviors in these patients. Copyright © 2021 Metallurgia Italiana. All rights reserved.
Predictors of third and higher order births in India
(Indian Association of Preventive and Social Medicine, 2015) Payal Singh; Akash Mishra; O.P. Mishra
Background: Total fertility rate (TFR) reflecting population growth is closely related to higher order parity progression. Many Indian states reached replacement level of TFR, but still states constituting nearly 40% population are with TFR ≥ 3. The predictors are the desire of son’s, poor contraceptives practices, younger age at marriage, child loss and shorter birth spacing. Objective: This analysis assessed the degree of relation of 3rd and higher order parity progression with the above mentioned predictors. Material and Methods: State/Union Territories wise proportions of women: progressing to ≥3 births, more sons desire, birth spacing <24 months, adopting modern contraception and median marriage age <18 years along with infant mortality rate (IMR) were taken from NFHS-III report. Correlation matrix and stepwise forward multiple regression carried. Significance was seen at 5%. Results: Hindi speaking states constituting 38.92% nation population recorded TFR ≥3. Positive correlation of mothers progressing ≥ 3 births was highest (0.746) with those desiring more sons followed by IMR (0.445); while maximum negative correlation with those practicing modern contraceptives (-0.565) followed by median age at marriage (-0.391). Multiple regression analysis in order identified desire of more sons, practicing modern contraception and shorter birth spacing as the significant predictors and jointly explained 77.9% of the total variation with gain of 15.5% by adding modern contraceptive practice and 8.3% by adding shorter birth spacing. Conclusions: Desire of more sons appeared the most important predictor to progress ≥3 births that is governed by society culture and educational attainment, require attitudinal change. Further, mothers need motivation to practice both spacing and terminal methods once family is complete. © 2015, Indian Association of Preventive and Social Medicine. All rights reserved.
Sandwich therapy in the management of propranolol resistant infantile hemangioma of the lip
(Elsevier Masson s.r.l., 2022) Preeti Tiwari; Vaibhav Pandey; Rathindra Nath Bera; Narendra Tiwary; Akash Mishra; Shiv Prasad Sharma
Rationale: Propranolol has evolved as a first line management of infantile haemangiomas. Nevertheless, the resistance to propranolol has warranted alternative treatment modalities. We hypothesize that combination of medical and surgical therapy (sandwich therapy) to be beneficial in the management. Methods: Patients were divided into three groups (total=31), Group A (bleomycin sclerotherapy), Group B (surgical group), Group C (sandwich therapy). A p value <0.05 was taken as significant. Results: In Group A 54.5% of patients had excellent response, 27.3% partial response and 18.2% had no response. Comparing cosmetic outcome, 25% of patients in Group B and 16.7% of patients in Group C had excellent upshot. On the contrary 18.2% of patients in bleomycin had unsatisfactory and 18.2% had poor cosmetic outcome. Sandwich therapy was cosmetically more acceptable than Bleomycin sclerotherapy (p- value = 0.049). In terms of recurrence, sandwich therapy differed significantly from surgical therapy with fewer recurrences (p-value= 0.049). Conclusion: Sandwich therapy is superior to bleomycin sclerotherapy in terms of cosmetic outcome and has fewer recurrences compared to surgical group and requires single stage resection. However, further studies with the help of Doppler ultrasound are required in this regard. © 2022 Elsevier Masson SAS
Survivorship of hip after acetabulum fracture fixation – Analysing risk factors associated with early THR
(Elsevier B.V., 2025) Sandeep Kumar; Priya Yadav; Akash Mishra; Shataayu Gugale; Rohit Goyal; Vivek Bhambhu
Introduction: Acetabular fracture fixation principles stated by Letournel and Judet have contributed significantly towards advancement in treatment methodologies. Current day techniques helps to achieve anatomical reduction, still post-traumatic arthritis ensues in some patients. A meta-analysis by Giannoudis et al. revealed osteoarthritis incidence of 13 % in patients with satisfactory reductions (<2 mm) and 44 % with unsatisfactory reductions (>2 mm). Predicting poor outcomes before treatment could improvise patient counselling and treatment selection. This study aims to assess the functional outcomes and analyze risk factors for early total hip replacement (THR) in acetabulum fractures. Materials and methods: From 2017 to 2024, 560 patients with acetabulum fractures were managed surgically. Out of them 316 had more than 2 years follow up, and were included in this study. Fracture patterns involved 5 elementary and 5 associated types, treated through various surgical approaches and followed up for an average of 3 years. Data collection included demographics, lab investigations, radiographs, and CT scans. Statistical analysis using SPSS version 29.0.2.0 employed Chi-square tests, Fisher's exact tests and Cox proportional hazards regression to identify significant predictors of THR, with P-values <0.05 considered significant. Results: The study involved 316 patients, with a mean age of 43 years, followed up for 2–7 years. 81 % were males. Most fractures were T-type (17.1 %) and treated using the Modified Stoppa Approach (43.7 %). Anatomic reduction was achieved in 77.2 % patients. Overall, 75.3 % patients had excellent to good outcomes. 32 (10.12 %) of the patients were converted to THR, while 46 (14.5 %) had fair outcomes, and were considered as cases of impending THR. Significant predictors for THR included age, surgical delay, fracture pattern and reduction quality. Age 60 and above, and poor reduction quality were associated with higher THR rates (Hazard ratio = 1.00). Conclusion: Survivorship of the hip joint post-acetabulum fracture is influenced by age, fracture pattern, surgical delay, and post operative reduction quality. Addressing modifiable factors such as anatomical reductions of the fracture and surgical intervention within one week of injury are crucial for improving long-term outcomes, further reducing the need for THR after acetabular fracture fixation. © 2024 Delhi Orthopedic Association