Browsing by Author "Rohit Bhatia"

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Educational and Socioeconomic Correlates of Stroke Risk Behaviors: Findings from the SPRINT INDIA Trial
(Wolters Kluwer Medknow Publications, 2025) Shweta Jain Verma; Gurnoor Kaur; Arya Devi; Deepti Arora; Aneesh Dhasan; Padmavathyamma Narayanapillai Sylaja; Dheeraj Khurana; Vijaya Pamidimukkala; Biman Kanti Ray; Vivek Keshavan Nambiar; Sanjith Aaron; Gaurav Kumar Mittal; Sundarachary Nagarjunakonda; Aparna Ramakrishna Pai; Sankar Prasad Gorthi; Somasundaram Kumaravelu; Yerasu Muralidhar Reddy; Sunil K. Narayan; Nomal Chandra Borah; Rupjyoti Das; Girish Baburao Kulkarni; Vikram Huded; Thomas Mathew; Mv Padma Srivastava; Rohit Bhatia; Pawan Kumar Ojha; Jayanta Roy; Sherly Mary Abraham; Anand Girish Vaishnav; Arvind Kumar Sharma; Sheikh Jabeen; Abhishek Pathak; Sanjeev Kumar Bhoi; Sudhir Sharma; Sulena Sulena; Aralikatte Onkarappa Saroja; Neetu Ramrakhiani; Madhusudhan Byadarahalli Kempegowda; Mahesh Pundlik Kate; Tina K. George; Ivy Anne Sebastian; Meenakshi Sharma; Rupinder Singh Dhaliwal; Rahul Huilgol; Jeyaraj Durai Pandian
Background and Objectives: Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA) trial was a randomized control trial that enrolled 4298 stroke patients and administered educational interventions at 31 centers across India, with the aim to reduce recurrent stroke through increased stroke knowledge. This SPRINT INDIA trial post hoc study aims to investigate the incidence of recurrent stroke, high-risk transient ischemic attack (TIA), acute coronary syndrome (ACS), death, and lifestyle behavioral factors at 1 year. In addition, it examines the relationship between patients' baseline characteristics and education levels, risk factors, and outcomes and performs subgroup analysis within the intervention and control groups. Methods: Participants were randomly assigned (1:1) to either intervention or control group through computer-based randomization on web. Intervention included stroke prevention Short Message Service messages, short-duration videos, and printed workbooks. Baseline assessments captured demographic and educational data, classifying patients into three categories: no schooling, less than high school, and high school or above. Primary outcome was a composite of recurrent stroke, high-risk TIA, ACS, and mortality at 1 year. Chi-square tests and analysis of variance were used to evaluate educational disparities across various variables. Results: The intervention did not reduce primary outcomes at 1 year among patients with different educational levels. Higher educational group was associated with enhanced medication adherence (94.3% vs 85.4%; P < 0.001), increased physical activity (5497.91 ± 4117.7 vs 6169.91±4828.8; P < 0.001), lower triglyceride levels, and decreased engagement in behavioral risk factors like alcohol intake (5.1% vs 6.8%; P = 0.013) and tobacco use (smoked and chewed) (4% vs 7.9%; P < 0.001 and 5.8% vs 11.6%; P = 0.020). Conclusions: Personalized secondary stroke prevention, tailored to educational levels, is crucial for effective stroke management. © 2025 Annals of Indian Academy of Neurology.
Impact of COVID-19 on Guillain-Barre Syndrome in India: A Multicenter Ambispective Cohort Study
(Wolters Kluwer Medknow Publications, 2022) Yareeda Sireesha; Ritu Shree; Madhu Nagappa; Anuja Patil; Monika Singla; M.V. Padma Srivastava; R.K. Dhamija; Neetha Balaram; Abhishek Pathak; Dileep Ramachandran; Sujit Kumar; Inder Puri; Sudhir Sharma; Samhita Panda; Soaham Desai; Priyanka Samal; Aditya Choudhary; Pamidimukkala Vijaya; Teresa Ferreira; S.S. Nair; H.P. Sinha; S.K. Bhoi; Joseph Sebastian; Sanjay Sharma; Aneesh Basheer; Manish Bhartiya; N.L. Mathukumalli; Shaikh Afshan Jabeen; Vivek Lal; Manish Modi; Praveen Sharma P; Subash Kaul; Gagandeep Singh; Ayush Agarwal; Divyani Garg; James Jose; Priya Dev; Thomas Iype; Maya Gopalakrishnan; Ashish Upadhyay; Rohit Bhatia; Awadh K. Pandit; Rajesh K. Singh; Manish Salunkhe; P.M. Yogeesh; Alisha Reyaz; Nishant Nadda; Menkha Jha; Bismay Kumar; P.K. Kushwaha; Harshadkumar Chovatiya; Bhavani Madduluri; P. Ramesh; Abeer Goel; Rahul Yadav; Venugopalan Y. Vishnu
Introduction/Aims: Studies conducted during the coronavirus disease 2019 (COVID-19) pandemic have reported varied data regarding the incidence of Guillain-Barre syndrome (GBS). The present study investigated demographic and clinical features, management, and outcomes of patients with GBS during a specified period of the COVID-19 pandemic, and compared these features to those of GBS in the previous year. Methods: A multicenter, ambispective cohort study including 26 centers across India was conducted. Data from a pre-COVID-19 period (March 1 to August 31, 2019) were collected retrospectively and collected ambispectively for a specified COVID-19 period (March 1 to August 31, 2020). The study was registered with the Clinical Trial Registry India (CTRI/2020/11/029143). Results: Data from 555 patients were included for analysis: pre-COVID-19 (n = 334) and COVID-19 (n = 221). Males were more commonly affected during both periods (male:female, 2:1). Gastroenteritis was the most frequent antecedent event in 2019 (17.4%), whereas fever was the most common event in 2020 (10.7%). Paraparesis (21.3% versus [vs.] 9.3%, P = 0.001) and sensory involvement (51.1% vs. 41.3%; P = 0.023) were more common during COVID-19 in 2020, whereas back pain (26.3% vs. 18.4%; P = 0.032) and bowel symptoms (20.7% vs. 13.7%; P = 0.024) were more frequent in the pre-COVID period. There was no difference in clinical outcomes between the two groups in terms of GBS disability score at discharge and 3 months after discharge. Independent predictors of disability in the pre-COVID period included areflexia/hyporeflexia, the requirementfor intubation, and time to bulbar weakness; in the COVID-19 period, independent predictors included time from onset to admission, intubation, and intubation requirement. The mortality rate was 2.3% during the entire study period (13/555 cases). Discussion: Results of this study revealed an overall reduction in the frequency of GBS during the pandemic. The lockdown likely reduced the risk for antecedent infections due to social distancing and improved hygiene, which may have resulted in the reduction of the frequency of GBS. © 2022 Annals of Indian Academy of Neurology.
Impact of the COVID-19 pandemic on the frequency, clinical spectrum and outcomes of pediatric guillain-Barré syndrome in India: A multicentric ambispective cohort study
(Wolters Kluwer Medknow Publications, 2022) Divyani Garg; Rajinder K. Dhamija; Aditya Choudhary; Ritu Shree; Sujit Kumar; Priyanka Samal; Abhishek Pathak; Pamidimukkala Vijaya; Yareeda Sireesha; Sruthi S. Nair; Sanjay Sharma; Soaham Desai; Human P. Sinha; Ayush Agarwal; Ashish Upadhyay; M. V. Padma Srivastava; Rohit Bhatia; Awadh K. Pandit; Rajesh K. Singh; Alisha Reyaz; P.M. Yogeesh; Manish Salunkhe; Vivek Lal; Manish Modi; Gagandeep Singh; Monika Singla; Samhita Panda; Maya Gopalakrishnan; Inder Puri; Sudhir Sharma; Bismay Kumar; Prashant K. Kushwaha; Harshadkumar Chovatiya; Teresa Ferreira; Sanjeev K. Bhoi; Manish Bhartiya; Subhash Kaul; Anuja Patil; Neeharika L. Mathukumalli; Madhu Nagappa; P. Praveen Sharma; Aneesh Basheer; Dileep Ramachandran; Neetha Balaram; Jospeh Sebastian; Venugopalan Y. Vishnu
Objective: To study impact of COVID-19 pandemic on frequency, clinical/electrophysiological profile and treatment outcomes in pediatric Guillain-Barré syndrome (GBS). Background: GBS is the most frequent cause of pediatric acute flaccid paralysis. The effect of the COVID-19 pandemic on pediatric GBS is unclear in the literature. Methods: We conducted an ambispective, multicentric, cohort study involving 12 of 27 centres in GBS Consortium, during two periods: pre-COVID-19 (March-August 2019) and during COVID-19 (March-August 2020). Children ≤12 years who satisfied National Institute of Neurological Diseases and Stroke criteria for GBS/variants were enrolled. Details pertaining to clinical/laboratory parameters, treatment and outcomes (modified Rankin Scale (mRS) at discharge, GBS Disability score at discharge and 3 months) were analysed. Results: We enrolled 33 children in 2019 and 10 in 2020. Children in 2020 were older (median 10.4 [interquartile range 6.75-11.25] years versus 5 (2.5-8.4) years; P = 0.022) and had more sensory symptoms (50% versus 18.2%; P = 0.043). The 2020 group had relatively favourable mRS at discharge (median 1 (1-3.5) versus 3 (2-4); P = 0.042) and GBS disability score at 3 months (median 0 (0-0.75) versus 2 (0-3); P = 0.009) compared to 2019. Multivariate analysis revealed bowel involvement (P = 0.000) and ventilatory support (P = 0.001) as independent predictors of disability. No child in 2020 had preceding/concurrent SARS-CoV2 infection. Conclusions: The COVID-19 pandemic led to a marked decline in pediatric GBS presenting to hospitals. Antecedent illnesses, clinical and electrophysiological profile of GBS remained largely unchanged from the pre-pandemic era. © 2021 Annals of Indian Academy of Neurology.
Indian Trial of Tranexamic acid in Spontaneous Intracerebral Hemorrhage study protocol
(SAGE Publications Inc., 2025) Jeyaraj Durai Pandian; Atul Phillips; Shweta Jain Verma; Deepti Arora; Aneesh Dhasan; Pheba Susan Raju; Padmavathyamma Narayanapillai Sylaja; Biman Kanti Ray; Uddalak Chakraborty; Jacob Johnson; Praveen Kumar Sharma; Sanjeev Kumar Bhoi; Menka Jha; Thomas Iype; Chithra P; Dheeraj Khurana; Sucharita Ray; Dwijen Das; Naurima Kalita; Sweekriti Adhikari; Ashish K. Sharma; Jayanta Roy; Rajeshwar Sahonta; Sulena Singh; Vikram Chaudhary; Girish Ramachandran Menon; Sanjith Aaron; Deepti Bal; Rajinder Kumar Dhamija; Monali Chaturvedi; Siddharth Maheshwari; Aralikatte Onkarappa Saroja; Karkal Ravishankar Naik; Neeraj Bhutani; Kailash Dhankhar; Dinesh Sharma; Rohit Bhatia; Sankar Prasad Gorthi; Binod Sarmah; Vijaya Pamidimukkala; Sankaralingam Saravanan; Sunil K. Narayan; Lakshya Jyoti Basumatary; Nagarjunakonda Venkata Sundarachary; Aruna K. Upputuri; Ummer Karadan; Vayyattu Govindankutty Pradeep Kumar; Rajsrinivas Parthasarathy; Darshan Doshi; Satish Wagh; Tirppur C.R. Ramakrishnan; Saleem Akhtar; Soaham Dilip Desai; Nomal Chandra Borah; Rupjyoti Das; Gaurav Kumar Mittal; Agam Jain; Paul J. Alapatt; Girish Baburao Kulkarni; Deepak Menon; Pritam Raja; Inder Puri; Vivek Keshavan Nambiar; Muralidhar Reddy Yerasu; Shyam Krishnakumar Jaiswal; Kapil Gangadhar Zirpe; Sushma Kirtikumar Gurav; Sudheer Sharma; Somasundaram Kumaravelu; M. Bk; Vicky V. Thakkar; Abhishek Pathak; Madhusudhan Byadarahalli Kempegowda; Praveen Chander; Neetu Ramrakhiani; Arya Devi Ks; Prabhakaran Sankara Sarma; Rahul Huilgol; Meenakshi Sharma; Rupinder Singh Dhaliwal
Rationale: Early mortality in intracerebral hemorrhage (ICH) is due to hematoma volume (HV) expansion, and there are no effective treatments available other than reduction in blood pressure. Tranexamic acid (TXA) a hemostatic drug that is widely available and safe can be a cost-effective treatment for ICH, if proven efficacious. Hypothesis: Administration of TXA in ICH patients when given within 4.5 h of symptom onset will reduce early mortality at 30 days. Design: Indian Trial of Tranexamic acid in Spontaneous Intracerebral Haemorrhage (INTRINSIC trial) is a multicenter, randomized, open-label, trial enrolling patients aged more than 18 years presenting with non-traumatic ICH within 4.5 h of symptom onset or when last seen well. Study participants received 2 g of TXA administered within 45 min while control group received standard of care. Intensive blood pressure reduction as per INTERACT 2 protocol is followed is done in both groups. Study plans to recruit 3400 patients. Primary outcome is mortality at day 30. Secondary outcomes are radiological reduction in HV at 24 h from baseline, neurological impairment at day 7 or earlier (if discharged), and assessments of dependency and quality of life at day 90. Summary: If proven to be beneficial, TXA will have a major impact on medical management of ICH. Trial registration: Clinical Trial Registry India (CTRI/2023/03/050224) and Clinical Trials.gov (NCT05836831). © 2025 World Stroke Organization
INSTRuCT: Protocol, Infrastructure, and Governance
(Wolters Kluwer Health, 2021) Jeyaraj Durai Pandian; Shweta Jain Verma; Deepti Arora; Meenakshi Sharma; Rupinder Dhaliwal; Himani Khatter; Rahul Huilgol; P.N. Sylaja; Aneesh Dhasan; Vishnu Renjith; Abhishek Pathak; Aparna Pai; Arvind Sharma; Anand Vaishnav; Biman Ray; Dheeraj Khurana; Gaurav Mittal; Girish Kulkarni; Ivy Sebastian; Jayanta Roy; Somasundaram Kumaravelu; Lydia John; Mahesh Kate; M.V. Srivastava; Madhusudhan Byadarahalli Kempegowda; Nomal Borah; Neetu Ramrakhiani; Nirendra Rai; Pawan Ojha; Rohit Bhatia; Rupjyoti Das; Sachin Sureshbabu; Shaikh Afshan Jabeen; Sanjeev Bhoi; Sanjith Aaron; Prabhakaran Sarma; Aralikatte Onkarappa Saroja; Sherly Abraham; Sudhir Sharma; Sulena Sulena; Sankar Gorthi; Sundarachary Nagarjunakonda; Sunil Narayan; Thomas Mathew; Tina George; Pamidimukkala Vijaya; Vikram Huded; Vivek Nambiar; Y. Muralidhar Reddy
Background and Purpose: Very few large scale multicentric stroke clinical trials have been done in India. The Indian Council of Medical Research funded INSTRuCT (Indian Stroke Clinical Trial Network) as a task force project with the objectives to establish a state-of-the-art stroke clinical trial network and to conduct pharmacological and nonpharmacological stroke clinical trials relevant to the nation and globally. The purpose of the article is to enumerate the structure of multicentric stroke network, with emphasis on its scope, challenges and expectations in India. Methods: Multiple expert group meetings were conducted by Indian Council of Medical Research to understand the scope of network to perform stroke clinical trials in the country. Established stroke centers with annual volume of 200 patients with stroke with prior experience of conducting clinical trials were included. Central coordinating center, standard operating procedures, data and safety monitoring board were formed. Discussion: In first phase, 2 trials were initiated namely, SPRINT (Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India) and Ayurveda treatment in the rehabilitation of patients with ischemic stroke in India (RESTORE [Rehabilitation of Ischemic stroke Patients in India: A Randomized controlled trial]). In second phase, 4 trials have been approved. SPRINT trial was the first to be initiated. SPRINT trial randomized first patient on April 28, 2018; recruited 3048 patients with an average of 128.5 per month so far. The first follow-up was completed on May 27, 2019. RESTORE trial randomized first patient on May 22, 2019; recruited 49 patients with an average of 3.7 per month so far. The first follow-up was completed on August 30, 2019. Conclusions: In next 5 years, INSTRuCT will be able to complete high-quality large scale stroke trials which are relevant globally. © 2021 American Heart Association, Inc.
Multi-Target Directed Ligands (MTDLs): Promising Coumarin Hybrids for Alzheimer’s Disease
(Bentham Science Publishers, 2021) Rohit Bhatia; Sankha S. Chakrabarti; Upinder Kaur; Gaurav Parashar; Anindita Banerjee; Ravindra K. Rawal
Alzheimer’s disease (AZD) is an age-associated neurodegenerative disorder and is one of the common health issues around the globe. It is characterized by memory loss and a decline in other cognitive domains, including executive function. The progression of AZD is associated with complex events, and the exact pathogenesis is still unrevealed. Various mechanisms which are thought to be associated with the initiation of AZD include a decreased concentration of acetylcholine (ACh), deposition of amyloid-β (Aβ) peptide, dyshomeostasis of redox metal ions, and prolonged oxidative stress. Due to the simultaneous progression of diverse pathogenetic pathways, no ideal therapeutic agent has been developed to date. The drugs which are available against AZD provide only symptomatic benefits and do not have disease-modifying activity. Therefore, in search of ideal therapeutic candidates, the concept of molecular hybrids has been under keen investigation for the past few years. Hybrid molecules are able to inhibit or activate or modify the physiology of more than one target simultaneously. Coumarin scaffold have shown the excellent potential of ACh esterase inhibition, MAO-B inhibition, and anti-Aβ aggregation. In the present review, we have focused on different reported coumarin hybrids as multi-target-directed agents against AZD. These include hybrids of coumarin with carbazole, benzofuran, dithiocarbamate, quinoline, pargyline, tacrine, N-benzyl pyridinium, donepezil, purine, piperidine, morpholine, aminophenol, benzylamino, halophenylalkylamidic, thiazole, thiourea, hydroxypyridinone, triazole, piperazine, chalcone, etc. Along with the therapeutic potentials of these hybrids, important clinical investigations and the structure-activity relationship have also been discussed in this compilation. © 2021 Bentham Science Publishers.
SPRINT INDIA: Regional Variations in Primary and Secondary Stroke Outcomes Based on Baseline Characteristics in North and South Indian Sites
(Wolters Kluwer Medknow Publications, 2025) Somasundaram Kumaravelu; Shweta Jain Verma; Rimpi Arora; Deepti Arora; K. S. Arya Devi; Aneesh Dhasan; Padmavathyamma Narayanapillai Sylaja; Dheeraj Khurana; Pamidimukkala Vijaya; Biman Kanti Ray; Vivek Keshavan Nambiar; Sanjith Aaron; Gaurav Kumar Mittal; Sundarachary Nagarjunakonda; Aparna Ramakrishna Pai; Yerasu Muralidhar Reddy; Sunil K. Narayan; Nomal Chandra Borah; Rupjyoti Das; Girish Baburao Kulkarni; Vikram Huded; Thomas Mathew; Madakasira Vasantha Padma Srivastava; Rohit Bhatia; Pawan T. Ojha; Jayanta Roy; Sherly Mary Abraham; Anand Girish Vaishnav; Arvind Kumar Sharma; Shaikh Afshan Jabeen; Abhishek Pathak; Sanjeev Kumar Bhoi; Sudhir Sharma; Sulena Sulena; Aralikatte Onkarappa Saroja; Neetu Ramrakhiani; Madhusudhan Byadarahalli Kempegowda; Sankar Prasad Gorthi; Mahesh Pundlik Kate; Tina K. George; Ivy Anne Sebastian; Meenakshi Sharma; Rupinder Singh Dhaliwal; Rahul Huilgol; Jeyaraj Durai Pandian
Background and Objectives: Regional differences in stroke prevalence and outcomes in India, driven by demographic and risk factors, are crucial for guiding effective prevention and management strategies. This subanalysis of Secondary prevention with a structured semi-interactive stroke prevention package in INDIA (SPRINT INDIA) randomized controlled trial compared the demographics, risk factors, and clinical outcomes of stroke patients from North and South India to identify regional differences and inform targeted interventions for stroke prevention. Methods: The study analyzed data of 4298 participants from 31 stroke centers across India, focusing on demographics, stroke types, and risk factors. In this study, Mumbai, located at 19.07°N in western India, serves as the dividing line between North and South India. One-year follow-up data from 3038 patients were utilized to examine regional disparities between North and South India. Results: South Indian stroke patients were predominantly rural (60.1%) and less educated (58.2%), while North Indian patients were mostly urban (64.2%). South Indian patients had higher incidence of ischemic stroke (91.1% vs. 73.5%, P = 0.001) and higher rates of large artery atherosclerosis (33.6% vs. 19.7%, P = 0.001), hypertension, type 2 diabetes, smoking, and alcohol consumption, but better medication adherence. In contrast, North Indian patients had higher high-density lipoprotein, drug use, and tobacco use. At 1-year follow-up, North Indian patients had more high-risk transient ischemic attacks and poorer lifestyle-related outcomes, despite South Indians having higher systolic blood pressure and fasting glucose levels. Conclusion: Region-specific strategies are crucial. Block randomization may help. South India needs better lifestyle modification programs, while North India requires improved health education and medication adherence strategies. © 2025 Annals of Indian Academy of Neurology.