Browsing by Author "Randeep Guleria"

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Clinical profile of hospitalized COVID-19 patients in first & second wave of the pandemic: Insights from an Indian registry based observational study
(Wolters Kluwer Medknow Publications, 2021) Gunjan Kumar; Aparna Mukherjee; Ravendra K. Sharma; Geetha R. Menon; Damodar Sahu; Naveet Wig; Samiran Panda; Vishnu Vardhan Rao; Sujeet Singh; Randeep Guleria; Balram Bhargava; Abhijit Pakhare; Rajnish Joshi; Sourin Bhuniya; Manoj Kumar Panigrahi; Pankaj Bhardwaj; Sanjeev Misra; Manoj Gupta; Akhil D. Goel; Netto George Mundadan; Adil Rashid Khan; Manish Soneja; Tridip Dutta Baruah; Pankaj Kumar Kannauje; Ajit Kumar; Kala M.L. Yadhav; Manoj Kumar; Mary John; Sangeetha Mohan; Amit Patel; Surabhi Madan; Subhasis Mukherjee; Amitava Pal; Saikat Banerjee; Arti D. Shah; Yash Rana; Arun Madharia; Ankit Madharia; Rajiv Kumar Bandaru; Archana Mavoori; Simmi Dube; Nitin Nahar; Thrilok Chander Bingi; Rajarao Mesipogu; Vinaya Sekhar Aedula; Manisha Panchal; Mansuri Amirsohil Mohammedrafiq; Rashmi Upadhyay; Saurabh Srivastava; Veeresh B. Salgar; Rizwan Desai; Nyanthung Kikon; Rhondemo Kikon; Lisa Sarangi; Mahesh Rath; Anup Agarwal; Alka Turuk; Lokesh Kumar Sharma; Tanu Anand; Tarun Bhatnagar; Saumitra Ghosh; Avijit Hazra; Yogiraj Ray; Rammohan Ray; Lipilekha Patnaik; Jagdish Prasad Sahoo; Jaya Chakravarty; Sangeeta Kansal; Mohammad Shameem; Nazish Fatima; M. Pavan Kumar; Bikshapathi Rao; D. Himanshu; Amit Kumar; Naveen Dulhani; Amar Deepak Toppo; Nikita Sharma; Rajat Vohra; Sushila Kataria; Pooja Sharma; Arunansu Talukdar; Gargi Dasgupta; Anita Desai; S.N. Nityasri; Yashmin Panchal; K. Manohar; Y.S. Raju; Star Pala; Md. Jamil; V.K. Katyal; Sandeep Goyal; U.K. Ojha; Ravi Ranjan Jha; Ashish Bhalla; G.D. Puri; S. Samita; Vikas Suri; Ritin Mohindra; Ashish Pathak; Ashish Sharma; Janakkumar R. Khambholja; Nehal M. Shah; Paltial N. Palat; Kruti Rajvansh; Sudhir Bhandari; Abhishek Agrawal; Bal Kishan Gupta; Jigyasa Gupta; Ratnamala Choudhury; Mangala Rao; Soumyadip Chatterji; Sudipta Mukherjee
Background & objectives: India witnessed a massive second surge of COVID-19 cases since March 2021 after a period of decline from September 2020. Data collected under the National Clinical Registry for COVID-19 (NCRC) were analysed to describe the differences in demographic and clinical features of COVID-19 patients recruited during these two successive waves. Methods: The NCRC, launched in September 2020, is an ongoing multicentre observational initiative, which provided the platform for the current investigation. Demographic, clinical, treatment and outcome data of hospitalized, confirmed COVID-19 patients were captured in an electronic data portal from 41 hospitals across India. Patients enrolled during September 1, 2020 to January 31, 2021 and February 1 to May 11, 2021 constituted participants of the two successive waves, respectively. Results: As on May 11, 2021, 18961 individuals were recruited in the registry, 12059 and 6903 reflecting in-patients from the first and second waves, respectively. Mean age of the patients was significantly lower in the second wave [48.7 (18.1) yr vs. 50.7 (18.0) yr, P<0.001] with higher proportion of patients in the younger age group intervals of <20, and 20-39 yr. Approximately 70 per cent of the admitted patients were ≥ 40 yr of age in both waves of the pandemic. The proportion of males were slightly lower in second wave as compared to the first [4400 (63.7%) vs. 7886 (65.4%), P=0.02]. Commonest presenting symptom was fever in both waves. In the second wave, a significantly higher proportion [2625 (48.6%) vs. 4420 (42.8%), P<0.003] complained of shortness of breath, developed ARDS [422(13%) vs. 880 (7.9%), P<0.001], required supplemental oxygen [1637 (50.3%) vs. 4771 (42.7%), P<0.001], and mechanical ventilation [260 (15.9%) vs. 530 (11.1%), P<0.001]. Mortality also significantly increased in the second wave [OR: 1.35 (95% CI: 1.19, 1.52)] in all age groups except in <20 yr. Interpretation & conclusions: The second wave of COVID-19 in India was slightly different in presentation than the first wave, with a younger demography, lesser comorbidities, and presentation with breathlessness in greater frequency. © 2021 BioMed Central Ltd.. All rights reserved.
Exhaled breath temperature and systemic biomarkers for assessment of airway inflammation in asthmatics
(Journal of Association of Physicians of India, 2021) Bhupendra Singh Yadav; Geetanjali Bade; Randeep Guleria; Anjana Talwar
Objectives: Asthma is characterised by chronic airway inflammation and remodelling. Inflammation may alter the thermal balance of the affected tissues secondary to changes in the blood flow. Measurement of exhaled breath temperature (EBT) is a simple, safe and non-invasive technique to detect airway inflammation. The objective of this study was to measure EBT in asthma patients and compare it with healthy controls and also to correlate it with serum biomarkers of inflammation and remodelling. Methods: 24 male asthma patients and 23 age and gender matched healthy controls were recruited in the study. EBT and core body temperature were recorded followed by spirometry to measure forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR). Serum levels of interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) were quantified by ELISA. Results: Asthmatics had significantly lower FEV1% predicted compared to healthy subjects. EBT in asthma patients was significantly higher as compared to healthy controls while rate of rise of EBT was not significantly different. Serum biomarker of inflammation i.e. IL-6 and of tissue remodelling i.e. VEGF, MMP-9 and TIMP-1 were significantly raised in asthma patients while the ratio of MMP-9/TIMP-1 was comparable between two groups. But no correlation was observed between EBT and serum biomarkers. Conclusion: EBT may be used as an adjunct tool for non-invasive assessment of airway inflammation and remodelling in asthma patients. © 2021 Journal of Association of Physicians of India. All rights reserved.
Exhaled Breath Temperature and Systemic Biomarkers for Assessment of Airway Inflammation in Asthmatics
(NLM (Medline), 2021) Bhupendra Singh Yadav; Geetanjali Bade; Randeep Guleria; Anjana Talwar
OBJECTIVES: Asthma is characterised by chronic airway inflammation and remodelling. Inflammation may alter the thermal balance of the affected tissues secondary to changes in the blood flow. Measurement of exhaled breath temperature (EBT) is a simple, safe and non-invasive technique to detect airway inflammation. The objective of this study was to measure EBT in asthma patients and compare it with healthy controls and also to correlate it with serum biomarkers of inflammation and remodelling. METHODS: 24 male asthma patients and 23 age and gender matched healthy controls were recruited in the study. EBT and core body temperature were recorded followed by spirometry to measure forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR). Serum levels of interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) were quantified by ELISA. RESULTS: Asthmatics had significantly lower FEV1% predicted compared to healthy subjects. EBT in asthma patients was significantly higher as compared to healthy controls while rate of rise of EBT was not significantly different. Serum biomarker of inflammation i.e. IL-6 and of tissue remodelling i.e. VEGF, MMP-9 and TIMP-1 were significantly raised in asthma patients while the ratio of MMP-9/TIMP-1 was comparable between two groups. But no correlation was observed between EBT and serum biomarkers. CONCLUSION: EBT may be used as an adjunct tool for non-invasive assessment of airway inflammation and remodelling in asthma patients. © Journal of the Association of Physicians of India 2011.
Indian Guidelines on Nebulization Therapy
(Tuberculosis Association of India, 2022) S.K. Katiyar; S.N. Gaur; R.N. Solanki; Nikhil Sarangdhar; J.C. Suri; Raj Kumar; G.C. Khilnani; Dhruva Chaudhary; Rupak Singla; Parvaiz A. Koul; Ashok A. Mahashur; A.G. Ghoshal; D. Behera; D.J. Christopher; Deepak Talwar; Dhiman Ganguly; H. Paramesh; K.B. Gupta; Mohan Kumar T; P.D. Motiani; P.S. Shankar; Rajesh Chawla; Randeep Guleria; S.K. Jindal; S.K. Luhadia; V.K. Arora; V.K. Vijayan; Abhishek Faye; Aditya Jindal; Amit K. Murar; Anand Jaiswal; Arunachalam M; A.K. Janmeja; Brijesh Prajapat; C. Ravindran; Debajyoti Bhattacharyya; George D'Souza; Inderpaul Singh Sehgal; J.K. Samaria; Jogesh Sarma; Lalit Singh; M.K. Sen; Mahendra K. Bainara; Mansi Gupta; Nilkanth T. Awad; Narayan Mishra; Naveed N. Shah; Neetu Jain; Prasanta R. Mohapatra; Parul Mrigpuri; Pawan Tiwari; R. Narasimhan; R. Vijai Kumar; Rajendra Prasad; Rajesh Swarnakar; Rakesh K. Chawla; Rohit Kumar; S. Chakrabarti; Sandeep Katiyar; Saurabh Mittal; Sonam Spalgais; Subhadeep Saha; Surya Kant; V.K. Singh; Vijay Hadda; Vikas Kumar; Virendra Singh; Vishal Chopra; Visweswaran B
Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated. © 2022 Tuberculosis Association of India
Management of interstitial lung diseases: A consensus statement of the Indian Chest Society (ICS) and National College of Chest Physicians (NCCP)
(Wolters Kluwer Medknow Publications, 2020) Sheetu Singh; Bharat Sharma; Mohan Bairwa; Dipti Gothi; Unnati Desai; Jyotsna Joshi; Deepak Talwar; Abhijeet Singh; Raja Dhar; Ambika Sharma; Bineet Ahluwalia; Daya Mangal; Nirmal Jain; Khushboo Pilania; Vijay Hadda; Parvaiz Koul; Shanti Luhadia; Rajesh Swarnkar; Shailender Gaur; Aloke Ghoshal; Amita Nene; Arpita Jindal; Bhavin Jankharia; Chetambath Ravindran; Dhruv Choudhary; Digambar Behera; D. Christopher; Gopi Khilnani; Jai Samaria; Harpreet Singh; Krishna Gupta; Manju Pilania; Manohar Gupta; Narayan Misra; Nishtha Singh; Prahlad Gupta; Prashant Chhajed; Raj Kumar; Rajesh Chawla; Rajendra Jenaw; Rakesh Chawla; Randeep Guleria; Ritesh Agarwal; R. Narsimhan; Sandeep Katiyar; Sanjeev Mehta; Sahajal Dhooria; Sushmita Chowdhury; Surinder Jindal; Subodh Katiyar; Sudhir Chaudhri; Neeraj Gupta; Sunita Singh; Surya Kant; Zarir Udwadia; Virendra Singh; Ganesh Raghu
Background: Interstitial lung disease (ILD) is a complex and heterogeneous group of acute and chronic lung diseases of several known and unknown causes. While clinical practice guidelines (CPG) for idiopathic pulmonary fibrosis (IPF) have been recently updated, CPG for ILD other than IPF are needed. Methods: A working group of multidisciplinary clinicians familiar with clinical management of ILD (pulmonologists, radiologist, pathologist, and rheumatologist) and three epidemiologists selected by the leaderships of Indian Chest Society and National College of Chest Physicians, India, posed questions to address the clinically relevant situation. A systematic search was performed on PubMed, Embase, and Cochrane databases. A modified GRADE approach was used to grade the evidence. The working group discussed the evidence and reached a consensus of opinions for each question following face-to-face discussions. Results: Statements have been made for each specific question and the grade of evidence has been provided after performing a systematic review of literature. For most of the questions addressed, the available evidence was insufficient and of low to very low quality. The consensus of the opinions of the working group has been presented as statements for the questions and not as an evidence-based CPG for the management of ILD. Conclusion: This document provides the guidelines made by consensus of opinions among experts following discussion of systematic review of evidence pertaining to the specific questions for management of ILD other than IPF. It is hoped that this document will help the clinician understand the accumulated evidence and help better management of idiopathic and nonidiopathic interstitial pneumonias. © 2020 Wolters Kluwer Medknow Publications. All rights reserved.
NCCP-ICS joint consensus-based clinical practice guidelines on medical thoracoscopy
(Wolters Kluwer Medknow Publications, 2024) Rakesh K. Chawla; Mahendra Kumar; Arun Madan; Raja Dhar; Richa Gupta; Dipti Gothi; Unnati Desai; Manoj Goel; Rajesh Swarankar; Amita Nene; Radha Munje; Dhruv Chaudhary; Randeep Guleria; Vijay Hadda; Vivek Nangia; Girish Sindhwani; Rajesh Chawla; Naveen Dutt; Yuvarajan; Sonia Dalal; Shailendra Nath Gaur; Subodh Katiyar; Jai Kumar Samaria; K.B. Gupta; Parvaiz A. Koul; Suryakant; D.J. Christopher; Dhrubajyoti Roy; Basant Hazarika; Shanti Kumar Luhadia; Anand Jaiswal; Karan Madan; Prem Parkash Gupta; B.N.B.M. Prashad; Nasser Yusuf; Prince James; Amit Dhamija; Veerotam Tomar; Ujjwal Parakh; Ajmal Khan; Rakesh Garg; Sheetu Singh; Vinod Joshi; Nikhil Sarangdhar; Sushmita Roy Chaudhary; Sandeep Nayar; Anand Patel; Mansi Gupta; Rama Kant Dixit; Sushil Jain; Pratibha Gogia; Manish Agarwal; Sandeep Katiyar; Aditya Chawla; Hari Kishan Gonuguntala; Ravi Dosi; Vijya Chinnamchetty; Apar Jindal; Shubham Sharma; Vaibhav Chachra; Utsav Samaria; Avinash Nair; Shruti Mohan; Gargi Maitra; Ashish Sinha; Rishabh Kochar; Ajit Yadav; Gaurav Choudhary; M. Arunachalam; Amith Rangarajan; Ganesh Sanjan
Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes. © 2024 Indian Chest Society.
Update on Coronavirus 2019 Vaccine Guidelines for Transplant Recipients
(Elsevier Inc., 2022) Vivek Kute; Hari Shankar Meshram; Ashish Sharma; Arpita Ray Chaudhury; S. Sudhindran; AllaGopala Krishna Gokhale; Milind Hote; Randeep Guleria; Devinder Singh Rana; Jai Prakash; Vasanthi Ramesh
The coronavirus disease 2019 (COVID-19) vaccine and its utility in solid organ transplantation need to be timely revised and updated. These guidelines have been formalized by the experts—the apex technical committee members of the National Organ and Tissue Transplant Organization and the heads of transplant societies—for the guidance of transplant communities. We recommend that all personnel involved in organ transplantation should be vaccinated as early as possible and continue COVID-19–appropriate behavior despite a full course of vaccination. For specific guidelines of recipients, we suggest completing the full schedule before transplantation whenever the clinical condition permits. We also suggest a single dose, rather than proceeding unvaccinated for transplant, in case a complete course is not feasible. If vaccination is planned before surgery, we recommend a gap of at least 2 weeks between the last dose of vaccine and surgery. For those not vaccinated before transplant, we suggest waiting 4 to 12 weeks after transplant. For the potential living donors, we recommend the complete vaccination schedule before transplant. However, if this is not feasible, we suggest receiving at least a single dose of the vaccine 2 weeks before donation. We suggest that suitable transplant patients and those on the waiting list should accept a third dose of the vaccine when one is offered to them. We recommend that organs from a deceased donor with suspected/proven vaccine-induced thrombotic thrombocytopenia should be avoided and are justified only in cases of emergency situations with informed consent and counseling. © 2021 Elsevier Inc.