Browsing by Author "Neetu Rani Dhiman"

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A comprehensive and critical narrative review on movement disorders linked through dengue virus based infection
(Springer-Verlag Italia s.r.l., 2025) Niraj Kumar Srivastava; Nikhil Pandey; Janki Makani; Ibrahim Hussain; Neetu Rani Dhiman; Anand Kumar; Deepika Srivastava Joshi
Background: Dengue virus (DENV) has emerged as a significant cause of neurological complications, including movement disorders, which fall under the broader category of neurological manifestations associated with DENV infection. These disorders can have serious implications for patient’s quality of life, especially in tropical and subtropical regions where dengue is endemic. The neurological complications of DENV, while less commonly recognized when compared to its classical features (like fever, haemorrhagic manifestations, or shock), are increasingly being reported thus warranting an exhaustive exploration. Methods: We undertook a comprehensive and critical review to investigate the emerging link between movement disorders and DENV infections. An in depth and broad range search was performed across leading scientific databases (PubMed, Scopus, Embase and Google Scholar). We collected and analyzed a wide spectrum of relevant studies and case reports. This detailed methodology ensured a systematic and authoritative exploration of the neurological consequences associated with DENV, creating the foundation for deeper clinical insight and future research. Results: The analysis encompassed 80 studies on movement disorders linked to DENV infections. These studies were thoroughly reviewed and critically evaluated, with the findings presented in an inclusive and investigative manner. Conclusion: This narrative review provides a comprehensive analysis of movement disorders linked to DENV infections, enveloping their epidemiology, clinical features, neuropathogenesis, current therapeutic strategies, and outlining extensive directions for future research. © Fondazione Società Italiana di Neurologia 2025.
Clinical Spectrum of Non-motor Symptoms in Correlation with Quality of Life in Parkinson’s Disease and Atypical Parkinsonism: Evidence in Reaching Consensus
(SAGE Publications Inc., 2025) Madhusudan Rajendrakumar Tapdia; Anand Kumar; Ajay Kumar Yadav; Varun Kumar Singh; Abhishek Pathak; Rameshwar Nath Chaurasia; Vijay Nath Mishra; Navneet Kumar Dubey; Neetu Rani Dhiman; Monika Shailesh; Deepika Srivastava Joshi
Background: Non-motor symptoms (NMS) are frequently overlooked, yet they significantly contribute to the progression of Parkinson’s disease (PD) or atypical parkinsonism (AP), which include multiple system atrophy (MSA), progressive supranuclear palsy (PSP). Moreover, discrepancies exist in non-motor symptom scale (NMSS) scores for AP and PD, and no consensus has yet been reached. Purpose: We evaluated and compared the NMS and their association with life quality in patients with AP and PD. Methods: This cross-sectional observational report at a single-centre enrolling 204 patients (155 PD, 49 AP (27 MSA), and 22 PSP) from a tertiary care hospital’s movement disorder clinic. We used Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS UPDRS)-III and modified Hoehn and Yahr (H&Y) to compute a motor score and disease severity, respectively. We assessed patients’ mental capabilities, such as cognitive impairment, through a Mini-Mental State Examination (MMSE). Meanwhile, the NMSS determined the NMSs. Quality of life (QoL) was estimated by PD Questionnaire-39 (PDQ-39). Results: We observed insignificant differences between the PD and atypical parkinsonian syndrome (APS) groups based on disease duration and gender. Worsened motor disability and disease severity were observed in AP (PSP>MSA) (P <.001). The mean NMSS scores for PD, PSP and MSA were 23.7 ± 27.9, 47.6 ± 41.3 and 65.6 ± 35.5, respectively (P <.05). MSA had a comparatively high score for sexual, cardiovascular and urinary domains, while PSP scored higher for memory/attention domains. In contrast, PD group revealed significantly lower scores for perceptual and sexual domains. Conclusion: Compared to PD, NMS was severe and highly prevalent among AP (MSA > PSP), which could be confirmed through the prevalence of sexual cardiovascular and urinary domains in MSA, while attention and mood/cognition, and sleep in PSP. © The Author(s) 2025.
Epley Maneuver Versus Gans Repositioning Maneuver in Treating Posterior Canal BPPV and Familial Incidence of BPPV: Protocol for A Randomized Controlled Trial
(Springer, 2022) Deepika Joshi; Vyom Gyanpuri; Abhishek Pathak; Rameshwar Nath Chaurasia; Vishwambhar Singh; Neetu Rani Dhiman
Benign paroxysmal positional vertigo (BPPV) is a widely recognized vestibular disorder which occurs with short periods of paroxysmal vertigo produced in specific positions. This investigation targets contrasting the adequacy of two unique moves utilized in the management of posterior canal BPPV (PC-BPPV). One is traditional procedure, Epley repositioning maneuver (ERM) and another is Gans Repositioning maneuver (GRM). To compare the efficacy of maneuvers on vertigo and dizziness for people with posterior canal BPPV using Dix hallpike test, Vertigo Analogue Scale (VAS) and Dizziness Handicap Inventory (DHI), 100 people will be recruited confirming to eligibility criteria for this two group (ERM group and GRM group) participant and assessor blinded randomized control study. After Participants will be randomly assigned to either group, the respective maneuver will be performed one or two times until the symptoms resolve. Post maneuver instructions will be demonstrated to each subject nicely. Then, family history will be taken using a questionnaire. Outcomes will be taken once after giving maneuver and then, once after 1 month of treatment. Main outcome variables include VAS, DHI, and Dix hallpike test negativity. If the results indicate that Gans Manoeuvre is equivalent to Epley manoeuvre, then in older and postural compromised BPPV patients who has cervical related neck stiffness and pain or any other disorder, where Epley manoeuvre can not be given as it involves neck extension and rotation, Gans manoeuvre can be given. Trial registration: Clinical Trials Registry (CTRI/2019/10/021681). October 16, 2019. © 2021, Association of Otolaryngologists of India.
Evaluating the Diagnostic Accuracy of the Side-Lying Test for Posterior Canal BPPV: Sensitivity and Specificity Analysis
(Lippincott Williams and Wilkins, 2025) Neetu Rani Dhiman; Dharma Raj; Vyom Gyanpuri; Anand Kumar; Varun Kumar Singh; Abhishek Pathak; Rameshwar Nath Chaurasia; Vijay Nath Mishra; Deepika Srivastava Joshi
Background & Objective: The side-lying (SL) test is a diagnostic maneuver used to identify posterior canal benign paroxysmal positional vertigo (PC-BPPV). It is often used as an alternative to the Dix-Hallpike (DH) test, particularly for patients who have mobility limitations. The objective of this study is to evaluate the sensitivity and specificity of the SL test in diagnosing PC-BPPV compared with the DH test. Methods: A cohort of 320 patients presenting with symptoms of vertigo underwent both the SL test and the DL maneuver. Two groups—group A and group B—were randomly formed. Group A patients were assessed with first DL test, then SL test and group B patients were assessed with first SL then DH. The diagnostic accuracy of the SL test was assessed by determining its sensitivity and specificity in relation to the DH test, which served as the reference standard. Results: The SL test demonstrated 95.1% sensitivity and 96.97% specificity in detecting posterior canal BPPV, with comparable diagnostic accuracy to the DH test. Chi-square test (140.34) also emphasized the statistical significance of these results. The DH test's AUC of 0.902 shows a high capacity to differentiate between cases with and without BPPV. On the other hand, the SL test shows even greater performance in distinguishing between BPPV and non-BPPV cases, as seen by its higher AUC of 0.960. Conclusion: The SL test is a viable alternative to the DH test, offering similar sensitivity and specificity in diagnosing posterior canal BPPV. Its use may benefit patients with physical limitations. © 2025, Otology & Neurotology, Inc.
Gans repositioning maneuver for the posterior canal BPPV patients: systematic review and meta-analysis
(Springer Science and Business Media Deutschland GmbH, 2022) Deepika Joshi; Vyom Gyanpuri; Abhishek Pathak; Rameshwar Nath Chaurasia; Vijay Nath Mishra; Anand Kumar; Varun Kumar Singh; Dharma Raj; Neetu Rani Dhiman
Background and objectives: BPPV (benign paroxysmal positional vertigo) is a syndrome marked by brief bouts of vertigo accompanied by rapid changes in head position. Recent ongoing therapeutic approaches used are vestibular rehabilitation exercises and physical maneuvers like the Epley maneuver, Semont maneuver. Gans repositioning maneuver (GRM) is a new hybrid maneuver, consisting of safe and comfortable series of postures that can be conveniently applied on patients with any spinal pathology or even in elderly. Methods: Randomized controlled/clinical trials of the Gans maneuver were identified. The proportion of patients who improved as a result of each intervention was assessed, as well as the conversion of a ‘positive’ Dix–Hallpike test to a ‘negative’ Dix–Hallpike test. Results: Improvement was seen in almost all patients with the Gans maneuver and the Epley Maneuver in three trials with the pooled estimate for random effect model is 1.12 [0.87; 1.43: 100%]. There were no significant side effects from the treatment. Discussion: This study shows that the Gans maneuver is a safe and effective treatment for patients suffering from posterior canal BPPV. Trial registration: The review is registered in Prospero with no. CRD42021234100. © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
“Gans repositioning maneuver is the original one” in “Gans repositioning maneuver for the posterior canal BPPV patients: a systematic review and meta-analysis”
(Springer Science and Business Media Deutschland GmbH, 2024) Neetu Rani Dhiman; Deepika Joshi
[No abstract available]
Myofascial release versus other soft tissue release techniques along superficial back line structures for improving flexibility in asymptomatic adults: A systematic review with meta-analysis
(Churchill Livingstone, 2021) Neetu Rani Dhiman; Bismay Das; C. Mohanty; O.P. Singh; Vyom Gyanpuri; Dharma Raj
Objective: Our review is aimed to find out the efficacy of Myofascial Release Technique (MFRT) based on the Randomised Controlled Trials, on flexibility when given along superficial back line (SBL) structures and to compare it with other soft tissue release techniques. Data sources: A systematic literature search on MEDLINE (Pubmed), Google Scholar, Science direct, Cochrane Library, Physiotherapy Evidence Database (PEDro) and Clinical Trial Database in English; up to April 2020 was undertaken. Study selection: PRISMA (The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) was used for screening the relevant citations and reviewing the relevant studies. The literature searched total of 6,938 articles, however, only 68 were screened for eligibility. In the further screening, 16 studies fulfilled the inclusion criteria for our systematic review. Data extraction: Data were extracted into a table containing sample size, mean age of subjects, types of intervention, area to be treated, outcome measures used, and results of the accepted studies. Data synthesis: 16 randomized controlled trials and cross-over trials were found to be eligible for our review. Quality assessment of the RCTs was done with the PEDro scoring method. Randomised clinical trials that studied the comparative effect of Myofascial Release (MFRT) technique with different MFRT techniques, control/sham, and other soft tissue release techniques like stretching, were included. Results of this analysis showed little evidence proving the additional effectiveness of MFRT treatment compared to other soft tissue release techniques for improving flexibility so as to consider it as the preferred treatment. Methodological aspects of selected studies for further research are suggested. Study was registered in the PROSPERO database (CRD42020179118). Conclusion: MFRT appears to be a good technique for improving flexibility. However, in comparison with other soft tissue release techniques, this therapy becomes less successful. More research is needed regarding its effectiveness. © 2021 Elsevier Ltd
Neuropathic Pain Associated with COVID-19: a Systematic Review of Case Reports
(Springer, 2022) Deepika Joshi; Vyom Gyanpuri; Abhishek Pathak; Rameshwar Nath Chaurasia; Vijay Nath Mishra; Anand Kumar; Varun Kumar Singh; Neetu Rani Dhiman
Purpose of Review: Researchers suggests that patients with COVID-19 develop neuropathic pain within weeks or months following infection and that patients with neuropathic pain and COVID-19 sometimes present with deterioration of neurologic complications and pain exacerbation. The objective of this systematic review is to discuss the case-reports having neuropathic pain during and after COVID-19 infection. Recent Findings: Case reports that has described about patients getting neuropathy or neuropathic pain around the disease either immediately or late post COVID were included. The data was extracted and qualitatively synthesised. Literature was searched and 939 articles were found. 12 articles were screened as per the eligibility criteria and finally, 6 case reports on neuropathic pain in Covid-19 were selected from the database and manual search and finalised for analysis. 2 cases of herpes zoster and post herpetic neuralgia, 2 cases of intense burning pain, 1 case of trigeminal neuralgia and 1 of brachial plexopathy included for the review. Summary: Covid 19 viral neurogenic invasion is something very newly discovered topic of discussion in the field of research. With the passage of time, more cases will emerge and more data will be available for research. The review is registered in Prospero with no. CRD42021257060. © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Omicron-COVID-19-Related Knowledge in Parkinson’s Disease Patients and Their Caregivers: A Cross-sectional Study
(SAGE Publications Inc., 2025) Neetu Rani Dhiman; Vyom Gyanpuri; Anand Kumar; Deepika Srivastava Joshi
IntroductionThe Omicron variant of SARS-CoV-2 (COVID-19) became the global community’s third major cause of worry. In the current study, we deployed a self-reported survey questionnaire to investigate the degree of comprehension, awareness and perception of the Omicron variant of COVID-19 in patients with Parkinson’s disease (PD) and their respective caregivers (CGs).Materials and MethodsUsing a standardised questionnaire, we conducted a prospective study on PD patients attending the neurology outpatient department prior to and during the COVID-19 pandemic. The study period was between February and August of 2022.ResultsA total of 114 CGs and 134 disease-affected patients were evaluated. Approximately 1.8% of the CGs and 4.5% of the patients contracted the Omicron-COVID-19. Over half of the patients (77.6%) were aware of the Omicron variant, and approximately 40.3% of them were aware of its symptoms. After receiving the Covid immunisation, patients (94.02%) reported no change in symptoms. The percentage of patients and CGs who had no symptoms of the viral infection and were not even got tested ever was 95.5% and 98.2%, respectively. Further, patients (95.5%) opted for the ‘offline’ as a preferred mode of consultation, citing the precision of treatment being the main reason.ConclusionNo definite correlation between the Omicron variant infection and symptoms of PD could be established. The awareness regarding Omicron variant was largely unknown. More patient-centred research on larger population groups, incorporating literate and urban groups would unravel the knowledge gaps. © The Author(s) 2024. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Omicron-COVID-19-Related Knowledge in Parkinson’s Disease Patients and Their Caregivers: A Cross-sectional Study
(SAGE Publications Inc., 2024) Neetu Rani Dhiman; Vyom Gyanpuri; Anand Kumar; Deepika Joshi
Introduction: The Omicron variant of SARS-CoV-2 (COVID-19) became the global community’s third major cause of worry. In the current study, we deployed a self-reported survey questionnaire to investigate the degree of comprehension, awareness and perception of the Omicron variant of COVID-19 in patients with Parkinson’s disease (PD) and their respective caregivers (CGs). Materials and Methods: Using a standardised questionnaire, we conducted a prospective study on PD patients attending the neurology outpatient department prior to and during the COVID-19 pandemic. The study period was between February and August of 2022. Results: A total of 114 CGs and 134 disease-affected patients were evaluated. Approximately 1.8% of the CGs and 4.5% of the patients contracted the Omicron-COVID-19. Over half of the patients (77.6%) were aware of the Omicron variant, and approximately 40.3% of them were aware of its symptoms. After receiving the Covid immunisation, patients (94.02%) reported no change in symptoms. The percentage of patients and CGs who had no symptoms of the viral infection and were not even got tested ever was 95.5% and 98.2%, respectively. Further, patients (95.5%) opted for the ‘offline’ as a preferred mode of consultation, citing the precision of treatment being the main reason. Conclusion: No definite correlation between the Omicron variant infection and symptoms of PD could be established. The awareness regarding Omicron variant was largely unknown. More patient-centred research on larger population groups, incorporating literate and urban groups would unravel the knowledge gaps. © The Author(s) 2024.
Post-COVID-19 headache- NDPH phenotype: a systematic review of case reports
(Frontiers Media SA, 2024) Neetu Rani Dhiman; Deepika Joshi; Royana Singh; vyom Gyanpuri; Anand Kumar
Background and objectives: Post-acute COVID-19 syndrome or “long COVID” affects patients even after the recovery from Covid infection in various ways. Persistent headache or New Daily Persistent Headache (NDPH) is one of such symptoms. In this review, we will discuss about the case-reports of post covid-19 headache- NDPH phenotype both after and in the course of COVID-19 infection. Methods: Case reports/studies talked about patients having NDPH around the disease either immediately or late post COVID were included. Data was taken from the source and synthesised on a qualitative basis. Results: Literature search showed 3,538 articles, out of which 12 were screened as per the eligibility criteria and finally, 4 case reports on NDPH and Covid-19 were chosen for analysis from the database and by human search. All case reports justify the criteria for acceptability in quality for this systematic review. Conclusion: NDPH in and around Covid 19 infection is something that is currently an ingenious debated topic in the scientific community. More case studies should be written and published on the same subject so that a large systematic review could be conducted. Trial Registration Information: The review is registered in Prospero with no. Identifier (CRD42022354912). Systematic Review Registration: https://www.crd.york.ac.uk/, PROSPERO (CRD42022354912). 2024 Dhiman, Joshi, Singh, Gyanpuri and Kumar.
Relationship between side of hemiparesis and functional independence using activities of daily living index
(Reed Elsevier India Pvt. Ltd., 2014) Neetu Rani Dhiman; Girdhari Lal Shah; Deepika Joshi; Vyom Gyanpuri
Introduction: Stroke is the third most common cause of death in the Western Hemisphere and the most common cause of adult disability and balance problems. The purpose of this study was to find the relation between dependency of performing functional activities of daily living (ADL) with side of hemiparesis in patients with stroke using Barthel Index. Methods: This was a study of 130 patients with onset of first stroke in their life. Barthel (ADL) Index was used to assess functional ability and independence of stroke patients. The Barthel Index consists of 10 items assessing the ability to achieve certain activities without assistance. This scale gives a score between 0 and 20 in one point increments. The top score of 20 implies functional independence (slight dependency), not necessarily normality. Patients were divided into 5 categories according to their score: totally dependent (0-4), severely dependent (5-9), moderately dependent (10-14), mildly or slightly dependent (15-19) and independent (20). Then, we analyzed the results to find the relation between side of hemiparesis and functional independence. Results: Of 130 patients with stroke, 61 patients were having right-sided hemiparesis and 69 had left sided. Out of 69 patients with left-sided hemiparesis, 16 were independent (mildly and moderately dependent) and out of 61 with right-sided hemiparesis, 35 were independent (mildly and moderately dependent). Cross tabulation and chi-square tests revealed significant relationship between side of hemiparesis and functional independence in patients with stroke (χ2=18.779, p<0.001). Phi-square test value (0.380) is also significant (p<0.001). Discussions: This suggests that side of hemiparesis/weakness could be taken into consideration as a factor in functional independence assessment and further retraining of hemiparetic stroke survivors. Strong relationship exists between side of hemiparesis and functional independence in patients with stroke. © 2014 Anatomical Society of India.
Unravelling limb-girdle muscular dystrophy in an HIV patient: a diagnostic odyssey
(Springer Science and Business Media Deutschland GmbH, 2025) Sanchit Shailendra Chouksey; Neetu Rani Dhiman; Anand Kumar; Varun Kumar Singh; Monika Shailesh; Deepika Srivastava Joshi
Background: Neuromuscular complications are common in patients with HIV/AIDS at any stage of the disease process. Myopathies can be secondary to antiretroviral therapy, HIV myositis itself or other aetiologies. Progressive muscle weakness in an HIV patient often poses a diagnostic challenge. Case presentation: A 35-year-old lady with a 4-year history of progressive proximal weakness of both lower limbs, followed upper limbs for about 2 years duration associated with muscle pain, was referred to us with a tentative diagnosis of polymyositis. There was no history of diplopia, dysphagia, dysarthria, neck muscle, facial muscles or respiratory muscle weakness. Her medical history was also notable for HIV (prior CD4 nadir was 419 cells/mm3), diagnosed 10 years ago. She was on antiretroviral therapy (ART) regimen of tenofovir, lamivudine and efavirenz. There was no muscle atrophy/fasciculations; sensory system was normal, with preserved deep tendon reflexes. After extensive workup including clinical history, physical examination, laboratory markers and electromyography, a possibility of a genetic aetiology was considered. Whole exome sequencing showed compound heterozygous pathogenic variants in DYSF gene. Finally, the patient was diagnosed as LGMDR2 clinically and genetically. Conclusion: This case illustrates the importance of a good clinical history coupled with appropriate diagnostic workup, in clinching the diagnosis of muscular dystrophy in an HIV patient. © The Author(s) 2025.
Urinary based biomarkers identification and genetic profiling in Parkinson’s disease: a systematic review of metabolomic studies
(Frontiers Media SA, 2025) Neetu Rani Dhiman; Surbhi Singh; Royana Singh; Anand Kumar; Varun Kumar Singh; Abhishek Pathak; Rameshwar Nath Chaurasia; Vijay Nath Mishra; Niraj Kumar Srivastava; Swati Sahu; Nikhil Pandey; Deepika Srivastava Joshi
Background: Parkinson’s disease is a complex, age-related, neurodegenerative disease associated with dopamine deficiency and both motor and nonmotor deficits. Therapeutic pathways remain challenging in Parkinson’s disease due to the low accuracy of early diagnosis, the difficulty in monitoring disease progression, and the limited availability of treatment options. Objectives: Few data are present to identify urinary biomarkers for various ailments, potentially aiding in the diagnosis and tracking of illness progression in individuals with Parkinson’s disease. Thus, the analysis of urinary metabolomic biomarkers (UMB) for early and mid-stage idiopathic Parkinson’s disease (IPD) is the main goal of this systematic review. Methods: For this study, six electronic databases were searched for articles published up to 23 February 2024: PubMed, Ovid Medline, Embase, Scopus, Science Direct, and Cochrane. 5,377 articles were found and 40 articles were screened as per the eligibility criteria. Out of these, 7 controlled studies were selected for this review. Genetic profiling for gene function and biomarker interactions between urinary biomarkers was conducted using the STRING and Cytoscape database. Results: A total of 40 metabolites were identified to be related to the early and mid-stage of the disease pathology out of which three metabolites, acetyl phenylalanine (a subtype of phenylalanine), tyrosine and kynurenine were common and most significant in three studies. These metabolites cause impaired dopamine synthesis along with mitochondrial disturbances and brain energy metabolic disturbances which are considered responsible for neurodegenerative disorders. Furoglycine, Cortisol, Hydroxyphenylacetic acid, Glycine, Tiglyglycine, Aminobutyric acid, Hydroxyprogesterone, Phenylacetylglutamine, and Dihydrocortisol were also found commonly dysregulated in two of the total 7 studies. 158 genes were found which are responsible for the occurrence of PD and metabolic regulation of the corresponding biomarkers from our study. Conclusion: The current review identified acetyl phenylalanine (a subtype of phenylalanine), tyrosine and kynurenine as potential urinary metabolomic biomarkers for diagnosing PD and identifying disease progression. © © 2025 Dhiman, Singh, Singh, Kumar, Singh, Pathak, Chaurasia, Mishra, Srivastava, Sahu, Pandey and Joshi.