Browsing by Author "Ram Chandra Shukla"

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A CT-based comparative study of radiological patterns of pulmonary tuberculosis in patients with type 2 diabetes versus non-diabetics
(Springer India, 2017) Amit Nandan Dhar Dwivedi; Kamlakar Tripathi; Jai Krishna Mishra; Ashish Upadhyay; Rajeev Singh; Ram Chandra Shukla
The diabetic epidemic, although apparent across the world, has been most pronounced in non-European populations. Type II diabetes in children, teenagers and adolescents is a serious aspect to the epidemic and is an emerging public health problem. Patients with diabetes mellitus are also at higher risk of tuberculosis. We aim to study the differences in radiological pattern of pulmonary tuberculosis using high-resolution and contrast-enhanced CT scans in patients with concomitant diabetes mellitus as compared to those without diabetes and study the atypical radiological manifestations of pulmonary tuberculosis in diabetics. All the patients included in this study were scanned using VCT LIGHT SPEED 64-slice multidetector CT scanner of GE. A non-contrast scan was acquired followed by a contrast-enhanced scan. Brief history of patients was taken with regard to possibility of adverse reaction to the iodinated contrast media. Features like cavity, consolidation, centrilobular nodules, tree-in-bud pattern, pleural effusion and lymphadenopathy were noted. The patients of tuberculosis (50) with diabetes tended to be older than the patients without diabetes (50). No significant difference was seen in the frequency of upper lobe involvement between the two groups. Consolidation in lower lobes is more common in patients with diabetes. Cavitary lesions are also more common in lower lobes in patients with diabetes. No significant difference was seen in terms of bilateral involvement between the two groups. No significant difference was also seen in terms of pleural effusion and lymphadenopathy. Patients of tuberculosis with diabetes showed a significantly higher prevalence of endobronchial spread (51%) compared to non-diabetics (30%). Diabetes mellitus alters the radiological appearance of pulmonary tuberculosis. In a patient with tuberculosis, a radiological appearance of lower lobe consolidation and lower lobe cavitation should alert the clinician towards the presence of concomitant diabetes mellitus. © 2016, Research Society for Study of Diabetes in India.
Age-Specific Nomograms for Antral Follicle Count in Fertile and Infertile Indian Women: A Comparative Study
(Thieme Medical Publishers, Inc., 2023) Shivi Jain; Ram Chandra Shukla; Madhu Jain; Rabindra Nath Mishra
Objectives: The aim of this study was to develop age-specific nomograms for antral follicle count (AFC) in fertile and infertile Indian women and (2) to compare the influence of age on AFC in both groups. Setting and Design: It is a prospective cross-sectional study in a tertiary-care hospital in north-central India. Methods and Material: One-thousand four-hundred seventy-eight fertile and 1,447 infertile women (primary infertility) of reproductive age (18-49 years) were recruited. One-thousand one-hundred eighty-one fertile and 1,083 infertile women fulfilled the selection criteria for the study. Transvaginal ultrasonography was done on the second or third day of the menstrual cycle. Statistical Analysis: Age-specific nomograms for AFC were built for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles in both groups. Correlation and regression analysis was done to estimate the relationship between the study variables. Statistical analysis was done by using IBM SPSS Statistics for Windows, version 20. Results: At every age, each percentile value of AFC was lower in infertile than in fertile women. The decline of AFC with increasing age was linear in both fertile (r = - 0.431, p < 0.001) and infertile (r = - 0.520, p < 0.001) women; however, the rate was higher in the latter (0.50 follicle/year) than in former (0.44 follicle/year) group. The variation in AFC explained by age was 16.3% in fertile and 22.7% in infertile women. Conclusion: AFC decreased linearly with advancing age in both fertile and infertile women, but more rapidly in the latter. The age only modestly explained the decline of AFC. The age-specific percentile thresholds for AFC should be used instead of age-independent constant thresholds in infertility counselling. © 2023. Indian Radiological Association. All rights reserved.
Antral follicle count in normal (fertility-proven) and infertile Indian women
(Georg Thieme Verlag, 2014) Arjit Agarwal; Ashish Verma; Shubhra Agarwal; Ram Chandra Shukla; Madhu Jain; Arvind Srivastava
Background: Antral follicle count (AFC) has been labeled as the most accurate biomarker to assess female fecundity. Unfortunately, no baseline Indian data exists, and we continue using surrogate values from the Western literature (inferred from studies on women, grossly different than Indian women in morphology and genetic makeup). Aims: (1) To establish the role of AFC as a function of ovarian reserve in fertility-proven and in subfertile Indian women. (2) To establish baseline cut-off AFC values for Indian women. Settings and Design: Prospective observational case-control study. Materials and Methods: Thirty patients undergoing workup for infertility were included and compared to equal number of controls (women with proven fertility). The basal ovarian volume and AFC were measured by endovaginal. USG the relevant clinical data and hormonal assays were charted for every patient. Statistical Analysis Used: SPSS platform was used to perform the Student's t-test and Mann-Whitney U-test for intergroup comparisons. Correlations were determined by Pearson's ranked correlation coefficient. Results: Regression analysis revealed the highest correlation of AFC and age in fertile and infertile patients with difference in mean AFC of both the groups. Comparison of the data recorded for cases and controls showed no significant difference in the mean ovarian volume. Conclusions: AFC has the closest association with chronological age in normal and infertile Indian women. The same is lower in infertile women than in matched controls. Baseline and cut-off values in Indian women are lower than that mentioned in the Western literature.
Approach to Acute Respiratory Illness in Children with Hematological Malignancy: A Prospective Study Evaluating Utility of CT Scan
(Georg Thieme Verlag, 2022) Priyanka Aggarwal; Tapish Raipa; Ishan Kumar; Ashish Verma; Ram Chandra Shukla; Vineeta Gupta
Introduction Various pulmonary complications can occur in children with hematological malignancies including both infection and malignant disease infiltration of pulmonary parenchyma. Objectives To assess the role of CT scan in determining the etiology of acute pulmonary complications in children with hematological malignancies. Materials and Methods All children < 17 years with newly diagnosed hematological malignancy with respiratory symptoms (Group A) along with children who developed fever with persistent respiratory symptoms as well as worsening chest radiographs during treatment (Group B) and underwent CECT thorax, from February 2019 to July 2020 were enrolled. The final diagnosis was made on the basis of clinical history, laboratory as well as radiological investigations and treatment response. Results Thirty-seven children with mean age of 7.5 ± 3.5 years and male to female ratio of 1.3:1 who underwent CECT thorax were included in our study. For newly diagnosed cases, i.e., Group A (n = 8), the most common cause of respiratory symptoms as identified on CECT thorax was pulmonary tumoral infiltration (n = 5) followed by tuberculosis (n = 3). However, in Group B (n = 29) the cause of persistent respiratory symptoms was identified as infection (n = 17) followed by leukemic infiltration (n = 12). Thus, chest CT could accurately identify pulmonary tuberculosis, fungal pneumonia, bacterial infection, and pulmonary tumoral infiltrates. Conclusion CT scan can be used as an adjunctive tool for prompt diagnosis and management of pulmonary complications in children with persistent respiratory symptoms as they are often non-specific. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
Bimanual compression therapy of uterine Pseudoaneurysm
(2011) Ashish Verma; Madhavi Verma; Shivi Jain; Ram Chandra Shukla; Anuradha Khanna; Sonali Gupta; Shikha Sachan; Arvind Srivastava
[No abstract available]
Cerebral blood flow velocity in asymptomatic premature neonates exposed to clinical chorioamnionitis
(Elsevier, 2014) Sriparna Basu; Shashikant Dewangan; Sandeep Barman; Shampa Anupurba; Ram Chandra Shukla; Ashok Kumar
Aims: To test the hypothesis that cerebral blood flow velocity (CBFV) is altered in asymptomatic premature neonates exposed to clinical chorioamnionitis. Methods: This prospective observational study included 30 premature (<34 weeks) neonates who were exposed to clinical chorioamnionitis but did not develop any feature of early-onset neonatal sepsis. Thirty gestational-age matched healthy neonates served as controls. Cord blood interleukin (IL)-6 concentrations were measured at birth. Resistance index (RI), pulsatility index (PI), peak systolic flow velocity and vascular diameter of internal carotid, vertebral and middle cerebral arteries were measured by transcranial color doppler ultrasonography within 48h of delivery. The infants were followed up clinically after discharge and magnetic resonance imaging (MRI) was done at the corrected age of 6 months. Results: Conventional sepsis screen and blood culture was negative in all. Significantly higher cord blood IL-6 concentrations, lower resistance (RI and PI) and higher blood flow with vasodilation were recorded in all cerebral arteries of the chorioamnionitis group. Significant correlation was observed between the increase in CBFV and the increase of IL-6 concentrations. At the age of 6 months, two cases showed features of delayed developmental milestone and periventricular leucomalacia in MRI. Conclusions: Asymptomatic premature neonates exposed to clinical chorioamnionitis had significantly increased cord blood IL-6 concentrations and CBFV. The utility of increased CBFV as a predictor of adverse neurodevelopmental outcome may be tested in a well designed longitudinal study with larger sample size. © 2013 INDIACLEN.
Cerebral blood flow velocity in early-onset neonatal sepsis and its clinical significance
(2012) Sriparna Basu; Shashikant Dewangan; Ram Chandra Shukla; Shampa Anupurva; Ashok Kumar
Chorioamnionitis is a known risk factor for neurological damage in newborns. The present study aimed at assessing the changes in cerebral blood flow velocity (CBFV) in early-onset neonatal sepsis (EONS) and determining its predictive value as well as prognostic significance. Inborn neonates with antenatal risk factors for chorioamnionitis were followed up for development of EONS, diagnosed by presence of clinical signs along with positive blood culture and/or elevated interleukin-6 (IL-6) concentrations (=50 pg/mL) in umbilical cord blood. Comparison group was formed by asymptomatic neonates who had risk factors for chorioamnionitis but did not develop EONS and cord blood IL-6 concentrations were <50 pg/mL. CBFV (resistance and pulsatility indices, peak systolic flow velocity, and vascular diameter) of internal carotid, vertebral, and middle cerebral arteries was assessed by transcranial Doppler ultrasonography within 24 h of birth. The babies were kept under clinical and radiological follow-up for a minimum period of 6 months. Data were analyzed by SPSS 16.0. Final study group contained 55 neonates with sepsis and 35 asymptomatic control neonates. Blood culture was positive in 27 babies of the sepsis group with a preponderance of Gram-negative bacterial isolation. Significantly lower resistance, vasodilatation, and higher blood flow were noted in all the cerebral arteries of the sepsis group. Increase in CBFV was correlated with elevated IL-6 concentrations. CBFV parameters showed significant predictive accuracy as early diagnostic markers of EONS. Among the sepsis group, 14 patients showed signs of intracranial hemorrhage during the hospital stay of which four expired and six showed signs of ventricular dilatation during follow-up. These patients had significantly higher CBFV compared to those who survived. Assessment of CBFV at early hours of birth can be adopted as an additional bedside, non-invasive investigation with immediate diagnostic and late prognostic significance. © The Author(s) 2011.
Chest radiograph findings in children aged 2-59 months hospitalised with community-acquired pneumonia, prior to the introduction of pneumococcal conjugate vaccine in India: a prospective multisite observational study
(NLM (Medline), 2020) Shally Awasthi; Tuhina Rastogi; Neha Mishra; Abhishek Chauhan; Namita Mohindra; Ram Chandra Shukla; Monika Agarwal; Chandra Mani Pandey; Neera Kohli; Cap Study Group
OBJECTIVES: The current study was a hospital-based surveillance of cases hospitalised with WHO-defined community-acquired pneumonia in children aged 2-59 months, to assess the radiological abnormalities in chest X-rays and to identify the demographic and clinical correlates of specific radiological abnormalities, in residents of prespecified districts of Uttar Pradesh and Bihar, India. DESIGN: Prospective, active, hospital-based surveillance. SETTING: Multisite study conducted in a network of 117 secondary/tertiary care hospitals in four districts of Uttar Pradesh and Bihar, India. PARTICIPANTS: Included were children aged 2-59 months, hospitalised with community-acquired pneumonia, residing in the project district, with duration of illness <14 days and who had not been hospitalised elsewhere for this episode nor had been recruited previously. MAIN OUTCOME MEASURE: Concordant radiological abnormalities in the chest X-rays. RESULTS: From January 2015 to April 2017, 3214 cases were recruited and in 99.40% (3195/3214) chest X-rays were available, among which 88.54% (2829/3195) were interpretable. Relevant radiological abnormalities were found in 34.53% (977/2829, 95% CI 32.78 to 36.28). These were primary end point pneumonia alone or with other infiltrates in 22.44% (635/2829, 95% CI 20.90% to 23.98%) and other infiltrates in 12.09% (342/2829; 95% CI 10.88% to 13.29%). There was a statistically significant interdistrict variation in radiological abnormalities. Statistically significantly higher proportion of abnormal chest X-rays were found in girls, those with weight-for-age z-score ≤-3SD, longer duration of fever, pallor and with exposure to biomass fuel. CONCLUSIONS: Among hospitalised cases of community-acquired pneumonia, almost one-third children had abnormal chest radiographs, which were higher in females, malnourished children and those with longer illnesses; and an intra-district variation was observed. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
Clinico-immunological response to intratumoral versus intravenous neoadjuvant chemotherapy in advanced pediatric solid malignancies
(Georg Thieme Verlag, 2013) Vijayendra Kumar; Nandini Ramaswami; Anand Pandey; Ram Chandra Shukla; Maloy Ranjan Sen; Shiv Prasad Sharma; Dinesh Kumar Gupta; Ajay Narayan Gangopadhyay
Background: There is minimal literature on the use of intralesional chemotherapy in the pediatric age group. We undertook this present study to evaluate the two modalities (intratumoral and intravenous) of giving chemotherapy in terms of toxicity of chemotherapy, hematological parameters, efficacy of chemotherapy in reduction in volume of the tumor as well as resectability of tumor with special emphasis on immunological parameters. Materials and Methods: Advanced cases of Wilms′ tumor and Neuroblastoma were included in the study. Intratumoral chemotherapy was given through 25 G spinal needle under aseptic precautions and ultrasound guidance in the same dose as in systemic chemotherapy. Intravenous group was given chemotherapy in the usual way. Reassessment was carried out after every course of chemotherapy. Results: Group A included 16 cases of Wilms′ tumor and 6 cases of neuroblastoma. In group B, there were 14 cases of Wilms′ tumor and 8 of neuroblastoma. Vomiting, diarrhea, mucositis, and thrombophlebitis were more common in the intravenous group (P<0.05). The fall in Immunoglobulin A, Immunogloblulin G, Immunoglobulin M, and T-cell rosetting was more common in the intravenous group (P<0.05). Seventy percent of patients had completely resectable tumor at the end of 6 doses of intratumoral chemotherapy as compared to 50% resectability in the intravenous group (P<0.05). Conclusion: Intratumoral chemotherapy, besides causing less of the adverse effects and increasing the resecability rate, also causes less suppression of the immune system. This may be offered as an alternative safe and effective modality of treatment for advanced solid tumors.
Color Doppler ultrasonography for treatment response prediction and evaluation in breast cancer
(2010) Anand Kumar; Vivek Srivastava; Seema Singh; Ram Chandra Shukla
Primary systemic therapy is a well-established modality of treatment in locally advanced breast cancer. Assessment of tumor response to chemotherapy not only helps in assessing the efficacy of the regimen used but also predicts the overall outcome of the patient. The tumor vascularity is a surrogate marker of tumor burden and this can be readily assessed by color Doppler ultrasound using various indices (resistivity index, pulsatility index and maximum flow velocity). The pre- and post-chemotherapy indices can be compared with in order assess the response to chemotherapy. Among various imaging modalities, MRI and PET have the highest sensitivity in detecting the tumor response, but they are not cost effective. Color Doppler ultrasound is a promising alternative for tumor response assessment owing to its availability, reproducibility and cost-effectiveness. © 2010 Future Medicine Ltd.
Color Doppler ultrasound as an objective assessment tool for chemotherapeutic response in advanced breast cancer
(2005) Seema Singh; Satyajit Pradhan; Ram Chandra Shukla; Mumtaz Ahmad Anson; Anand Kumar
Background: In our part of the world, the majority of the patients with breast cancer present with locally advanced disease and require neo-adjuvant chemotherapy as the primary treatment modality. It is essential to monitor the response to chemotherapy in these patients. Clinical examination as the sole criterion of response assessment is entirely subjective and fallacious. Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) are expensive. The role of Doppler ultrasonography as an imaging modality for this purpose is therefore being evaluated. Methods: A prospective study was undertaken of 25 cases of locally advanced breast carcinoma (LABC) and Color Doppler sonography was used for the sequential assessment of chemotherapeutic response. The response assessed on the basis of clinical examination and Color Doppler was compared with the histological response. The parameters assessed on color Doppler were a change in the number of flow signals, maximum flow velocity (V max), pulsatility index (PI) and resistivity index (RI). Responses were analysed statistically using the Pearson correlation coefficient and Kappa statistics (κ). The sensitivity, specificity, positive predictive & negative predictive values for predicting complete histological response were calculated. Results: Color Doppler showed a sensitivity of 88.88% for predicting complete histological response. The negative predictive value of color Doppler was 92.3%. A significant correlation was obtained between color Doppler & histopathological response. Conclusions: Color Doppler was found to be an objective and effective tool or modality compared with clinical evaluation in sequential response assessment, especially for predicting complete histological response.
Correlation between antral follicle count and anti-Mullerian hormone in infertile Indian women
(Regional Institute of Medical Sciences, 2021) Shivi Jain; Ram Chandra Shukla; Madhu Jain; Usha Singh; Tej Bali Singh
Background: Antral follicle count (AFC) and anti-Mullerian hormone (AMH) have been used as indicators of ovarian reserve in infertile women. There still exists a debate about the association between the two parameters. Objective: The objective of the study was to find out the relationship between AFC and AMH in infertile women. Methods: This was a prospective, hospital-based, cross-sectional study, in which 1083 infertile women (aged 20– 40 years) with primary infertility were included. They were divided into four age groups, i.e., Group I (20–24 years), Group II (25–29 years), Group III (30–34 years), and Group IV (35–40 years). AMH and AFC were measured on 3rd day of menstrual cycle. Pearson correlation and linear regression analysis were done to find out the relationship between age, AFC, and AMH. Statistical analysis was done using IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, N.Y., USA). A P < 0.05 was considered statistically significant. Results: There was modest negative correlation of AFC with age (r = −0.476, P < 0.001). AMH showed strong negative correlation with age (r = −0.844, P < 0.001) and modest positive correlation with AFC (r = 0.400, P < 0.001). For separate age groups also, statistically significant correlations (P < 0.05–P < 0.001) were noted between age, AFC, and AMH. Age explained 22.7% variation in AFC and 71.2% variation in AMH. Conclusion: There was a significant correlation between AMH and AFC in infertile women. AFC showed a continuous decline with increasing age. However, AMH increased with age till third decade of life and showed negative correlation with AFC. Thereafter, AMH started decreasing with age and showed positive correlation with AFC. © The Authors.
COVID-19 Vaccines: A Radiological Review of the Good, the Bad, and the Ugly
(Thieme Medical Publishers, Inc., 2024) Ishan Kumar; Mohammad Sharoon Ansari; Ashish Verma; Pramod Kumar Singh; Sankha Shubhra Chakrabarti; Ram Chandra Shukla
The World Health Organization has declared “with great hope” an end to COVID-19 as a public health emergency. The vaccination drive that started in December 2020 played a crucial role in controlling the pandemic. However, the pace at which COVID-19 vaccines were developed and deployed for general population use led to vaccine hesitancy, largely owing to concerns regarding the safety and efficacy of the vaccines. Radiology has been instrumental in demonstrating the extent of pulmonary involvement and identification of the complications of COVID-19, and the same holds true for vaccine-related complications. This review summarizes the existing body of radiological literature regarding the efficacy, adverse events, and imaging pitfalls that accompany the global rollout of various COVID-19 vaccines. © 2024. Indian Radiological Association. All rights reserved.
Determinants of intravascular resistance in indian diabetic nephropathy patients: A hospital-based study
(Hindawi Publishing Corporation, 2011) Anubhav Thukral; Manish Mishra; Vaibhava Srivastava; Hemant Kumar; Amit Nandan Dhar Dwivedi; Ram Chandra Shukla; Kamlakar Tripathi
Aims and Objectives. Metabolic dysregulation has failed to explain clinical variability of patients with diabetic nephropathy and hence a renewed interest emerged in haemodynamic factors as determinant of progression and development of diabetic nephropathy. We therefore studied for various factors which can correlate with raised renal vascular resistance in diabetic nephropathy. Material and Methods. Renal vascular resistance was measured in patients with established and incipient diabetic nephropathy and compared with controls using noninvasive color Doppler examinations of intrarenal vasculature. Results. Renal vascular resistance correlated with age, duration of disease, GFR, serum creatinine, and stage of retinopathy. Renal vascular resistance was significantly reduced in patients on treatment with RAAS inhibitors and insulin, than those on OHA and antihypertensives other than RAAS inhibitors. Conclusion. The study implies that renal vascular resistance may help identify diabetics at high risk of developing nephropathy, and these set of patients could be candidates for RAAS inhibition and early insulin therapy even in patients without albuminuria. © 2011 Anubhav Thukral et al.
Diagnostic Role of Transvaginal Sonography and Magnetic Resonance Imaging in Adenomyosis of the Uterus and its Correlation with Histopathology
(Wolters Kluwer Medknow Publications, 2023) Shivi Jain; Kamlesh Kumar; Ram Chandra Shukla; Madhu Jain
Background and Objective: The prevalence of adenomyosis of the uterus varies from 5% to 70%, and there is no clear consensus on its imaging diagnostic criteria. The objective of this study was to evaluate the role of transvaginal sonography (TVS), combined TVS and color Doppler (TVS-CD), and magnetic resonance imaging (MRI) in the diagnosis of adenomyosis. Materials and Methods: This was a tertiary care hospital-based prospective study, in which 365 clinically suspected cases of adenomyosis were enrolled. All three types of imaging (TVS, TVS-CD, and MRI) were done in 233/365 patients, followed by hysterectomy in 50. Imaging features were correlated with the histopathological examination (HPE), which was taken as the gold standard for the diagnosis. The diagnostic performance of each imaging modality was assessed. Results: Among patients who underwent hysterectomy, 36/50 (72%) had adenomyosis on HPE, with or without associated benign gynecological abnormalities. Sensitivity, specificity, positive predictive value (PPV), negative PV (NPV), and diagnostic accuracy (DA) of MRI were higher than that of TVS-CD (91.67% vs. 77.78%, 85.71% vs. 78.57%, 94.29% vs. 90.32%, 80% vs. 57.89%, and 90% vs. 78%, respectively). TVS alone had lower diagnostic performance (specificity: 64.29%, PPV 84.85%, NPV 52.94%, and DA74%) than TVS-CD, but equal sensitivity (77.78%). Heterogeneous myometrium was the most sensitive (80.56%), while myometrial cyst was the most specific (92.86%) TVS feature. The maximum junctional zone thickness ≥12 mm was the most sensitive (97.22%), while the hyperintense myometrial focus was the most specific (100%) MRI feature. Conclusion: TVS-CD should be used as an initial diagnostic imaging modality in clinically suspected cases of adenomyosis; however, MRI due to better diagnostic efficacy should be the imaging modality of choice before subjecting such patients to hysterectomy. © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
Difference in cerebral blood flow velocity in neonates with and without hyperbilirubinemia
(Elsevier Ltd, 2014) Sriparna Basu; Dibyajyoti De; Ram Chandra Shukla; Ashok Kumar
Purpose: To evaluate the difference in cerebral blood flow velocity (CBFV) in neonates with and without hyperbilirubinemia. Methods: CBFV of 70 healthy late-preterm and term newborns with unconjugated hyperbilirubinemia (UCH) reaching the threshold of phototherapy requirement was compared with 70 gestational- and postnatal age-matched controls without hyperbilirubinemia. Resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV) and vascular diameter were measured in internal carotid, vertebral and middle cerebral arteries by transcranial color Doppler ultrasound at the beginning of phototherapy, after 48-72. h of starting phototherapy and at 5-7. days after its stoppage. In controls CBFV was assessed once at inclusion. Results: Both the groups were comparable. An increase in CBFV (decreased RI and PI, increased PSV and vasodilation) was observed in the UCH group. A further increase in CBFV was noticed after 48. h of phototherapy. After 5-7. days of stoppage of phototherapy, though there was a significant reduction in CBFV in mild-to-moderate UCH (serum bilirubin ≤25. mg/dL), in severe UCH (serum bilirubin >25. mg/dL), CBFV remained increased. Four neonates developed features of acute bilirubin encephalopathy and had significantly higher CBFV compared to those with normal outcome. Conclusions: An increase in CBFV was observed in neonates with UCH compared to those without hyperbilirubinemia. © 2013 Ministry of Health, Saudi Arabia.
Effectiveness of 13-valent pneumococcal conjugate vaccine on radiological primary end-point pneumonia among cases of severe community acquired pneumonia in children: A prospective multi-site hospital-based test-negative study in Northern India
(Public Library of Science, 2022) Shally Awasthi; Neera Kohli; Monika Agarwal; Chandra Mani Pandey; Tuhina Rastogi; Anuj Kumar Pandey; Chittaranjan Roy; Kripanath Mishra; Neelam Verma; Chandra Bhushan Kumar; Pankaj Kumar Jain; Rajesh Yadav; Puneet Dhasmana; Abhishek Chauhan; Namita Mohindra; Ram Chandra Shukla
Introduction Community acquired pneumonia (CAP) is a leading cause of under-five mortality in India and Streptococcus pneumoniae is the main bacterial pathogen for it. Pneumococcal Conjugate Vaccine 13 (PCV13) has been introduced in a phased manner, in the national immunization program of India since 2017/2018. The primary objective of this study was to evaluate the effectiveness of PCV13 on chest radiograph (CXR)-confirmed pneumonia, in children hospitalized with WHO-defined severe CAP. Methods This prospective, multi-site test-negative study was conducted in a hospital-network situated in three districts of Northern India where PCV13 had been introduced. Children aged 2–23 months, hospitalized with severe CAP and with interpretable CXR were included after parental consent. Clinical data was extracted from hospital records. CXRs were interpreted by a panel of three independent blinded trained radiologists. Exposure to PCV13 was defined as >2 doses of PCV13 in children aged < 12 months and > 1 dose(s) in children > 12 months of age. Our outcome measures were CXR finding of primary endpoint pneumonia with or without other infiltrates (PEP±OI); vaccine effectiveness (VE) and hospital mortality. Results From 1st June 2017-30th April 2021, among 2711 children included, 678 (25.0%) were exposed to PCV1. CXR positive for PEP±OI on CXR was found in 579 (21.4%), of which 103 (17.8%) were exposed to PCV. Adjusted odds ratio (AOR) for PEP±OI among the exposed group was 0.69 (95% CI, 0.54–0.89, p = 0.004). Adjusted VE was 31.0% (95% CI: 11.0–44.0) for PEP±OI. AOR for hospital mortality with PEP±OI was 2.65 (95% CI: 1.27–5.53, p = 0.01). Conclusion In severe CAP, children exposed to PCV13 had significantly reduced odds of having PEP ±OI. Since PEP±OI had increased odds of hospital mortality due to CAP, countrywide coverage with PCV13 is an essential priority. © 2022 Public Library of Science. All rights reserved.
Epidemiology of Hypoxic Community-Acquired Pneumonia in Children Under 5 Years of Age: An Observational Study in Northern India
(Frontiers Media S.A., 2022) Shally Awasthi; Tuhina Rastogi; Anuj Kumar Pandey; Chittaranjan Roy; Kripanath Mishra; Neelam Verma; Chandra Bhushan Kumar; Pankaj Kumar Jain; Rajesh Yadav; Abhishek Chauhan; Namita Mohindra; Ram Chandra Shukla; Monika Agarwal; Chandra Mani Pandey; Neera Kohli
Background: Community-acquired pneumonia (CAP) is the leading cause of under-five mortality in India. An increased risk of mortality has been reported in cases of hypoxic pneumonia. Methods: The primary objective of this study was to assess the proportion of children aged 2–59 months, hospitalized with hypoxic CAP, as well as socio-demographic, clinical, and radiological features associated with it. The secondary objective was to determine the risk of mortality among hospitalized cases of hypoxic CAP. This prospective, observational study was conducted in four districts of Northern India, between January 2015 and April 2021. A hospital-based surveillance network was established. Inclusion criteria were as follows: (a) child between 2 and 59 months, (b) hospitalization with symptoms of WHO-defined CAP, (c) resident of project district, (d) illness of <14 days, and (e) child had neither been hospitalized for this illness nor recruited previously. Children whose chest x-rays (CXRs) were either unavailable/un-interpretable and those that received any dose of pneumococcal conjugate vaccine-13 were excluded. Hypoxic pneumonia was defined as oxygen saturation <90% on pulse oximetry or requiring oxygen supplementation during hospital stay. Results: During the study period, 71.9% (7,196/10,006) children of severe pneumonia were eligible for inclusion, of whom 35.9% (2,580/7,196) were having hypoxic pneumonia. Female gender and use of biomass fuel for cooking increased the odds of hypoxic CAP. Clinical factors like wheezing, pallor, tachypnea, low pulse volume, presence of comorbidity, general danger signs, severe malnutrition, and radiological finding of primary end-point pneumonia ± other infiltrates (PEP±OI) also increased the odds of hypoxic CAP in a conditional logistic regression model. Adjusted odds ratio for mortality with hypoxia was 2.36 (95% CI: 1.42–3.92). Conclusion: Almost one-third of cases hospitalized with severe CAP had hypoxia, which increased chances of mortality. Besides known danger signs, certain newer clinical signs such as pallor and wheezing as well as PEP+OI were associated with hypoxic CAP. Therefore, objective assessment of oxygen saturation must be done by pulse oximetry in all cases of CAP at the time of diagnosis. Copyright © 2022 Awasthi, Rastogi, Pandey, Roy, Mishra, Verma, Kumar, Jain, Yadav, Chauhan, Mohindra, Shukla, Agarwal, Pandey and Kohli.
Initial comparative analysis of pulmonary involvement on HRCT between vaccinated and non-vaccinated subjects of COVID-19
(Springer Science and Business Media Deutschland GmbH, 2022) Ashish Verma; Ishan Kumar; Pramod Kumar Singh; Mohammad Sharoon Ansari; Harsh Anand Singh; Shashank Sonkar; Adity Prakash; Ritu Ojha; Ram Chandra Shukla
Objectives: To compare the high-resolution computed tomography (HRCT)–derived severity score in COVID-19 patients between those who had earlier received the vaccine against the SARS-CoV-2 and those who did not. Methods: A retrospective cross-sectional analysis of HRCT of the chest was done in correlation with the vaccination status of clinically diagnosed COVID-19 patients. The variable under evaluation was the CT severity score, whereby differential analysis of the variability on this parameter between incompletely (single dose) vaccinated, completely (both doses) vaccinated, and non-vaccinated individuals was the outcome. Results: The analysis included 826 patients of which 581 did not receive any vaccination whereas 196 patients received incomplete (single dose) vaccination and 49 received complete vaccination. Mean CT severity score was lower in completely vaccinated patients (3.5 ± 6.3) vis-à-vis incompletely vaccinated (10.1 ± 10.5) and non-vaccinated (10.1 ± 11.4) individuals. The mean CT score was significantly lower in completely vaccinated patients of lower ages (≤ 60 years) compared to patients above that age. The incidence of severe disease (CT score ≥ 20) was significantly higher in the incompletely vaccinated and non-vaccinated patients compared to that in the completely vaccinated group. Conclusions: CT severity scores in individuals receiving both doses of SARS-CoV-2 vaccination were less severe in comparison to those receiving a single dose of vaccine or no vaccine at all. Key Points: • Patients who received complete two doses of vaccination had significantly low mean CT scores compared to the partially vaccinated patients and non-vaccinated patients. • The mean CT scores were significantly lower in completely vaccinated patients of lower ages (< 60 years) while patients > 60 years did not show significantly different CT scores between the vaccinated and non-vaccinated groups. • Consolidations and ground-glass opacities were significantly lower in the group receiving complete vaccination as compared to the unvaccinated and incompletely vaccinated patients. © 2022, The Author(s), under exclusive licence to European Society of Radiology.
Magnetic Resonance Fistulogram Demonstration of Urethrovesicovaginal Fistula in a Case of Müllerian Agenesis Due to Traumatic Urethral Coitus
(2012) Ashish Verma; Surabhi Vyas; Sriram Patwari; Madhvi Verma; Arvind Srivastava; Ram Chandra Shukla
Vesicovaginal fistula is not uncommon in women of childbearing age, and can occur due to a multitude of causes, the chief ones being infection and neoplasia. An extensive PUBMED search yielded only a few reports describing causation of such a lesion due to traumatic urethral coitus. The classic method to demonstrate such fistulas is by direct contrast-enhanced fistulography. Herein we report a case of urethrovesicovaginal fistula with müllerian agenesis caused by traumatic urethral coitus, as demonstrated using indirect magnetic resonance fistulography. © 2012 AAGL.