Browsing by Author "Varun K. Singh"

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A randomized controlled trial of high rate rtms versus rtms and amitriptyline in chronic migraine
(American Society of Interventional Pain Physicians, 2021) Jayantee Kalita; Sumit Kumar; Varun K. Singh; Usha K. Misra
Background: The patients with chronic migraine (CM) respond poorly to pharmacological agents including tricyclic antidepressants, β-blockers, anticonvulsants, calcium channel blockers, flunarizine, and melatonin. The combination of 2 or more pharmacological agents has not shown better efficacy but increased side effects. High rate repetitive transcranial magnetic stimulation (rTMS) has been reported effective in episodic migraine and converts CM to episodic migraine. A combination of high rate rTMS with a pharmacological agent may be more effective compared to rTMS alone. Objectives: We evaluate the efficacy and safety of 10 Hz rTMS compared to rTMS and amitriptyline in CM. Study Design: Randomized controlled trial. Setting: Tertiary care teaching institute in India. Methods: Patients with CM as per International Classification of Headache Disorder third edition (ICHD-3) beta criteria were included whose age was between 18 years and 55 years. CM was defined if there were 15 headache days per month and at least 8 of these attacks having migraine characteristics for a period of more than 3 months. Patients with major psychiatric, other neurological or systemic disease, and those on migraine prophylaxis were excluded. The demographic details, frequency of headache attacks and headache days per month, migraine triggers, and associated symptoms were noted. The severity of headache was noted using a 0-10 Visual Analog Scale and the number of abortive drugs per month was noted. CM patients were randomly assigned to rTMS (group I) or rTMS and amitriptyline (group II). 10 Hz rTMS was applied using a figure of eight magnetic stimulation coil. The coil was placed over the left frontal cortex corresponding to the hot spot of the right abductor digiti minimi, which is approximately 7 cm lateral from the midline and 2 cm anterior to interaural line. The motor threshold was measured, and 70% of it was used for rTMS. Ten trains of 10 Hz rTMS, each train comprising of 60 pulses with an inter-train interval of 45 seconds were delivered in one session. Three such sessions were delivered on an alternate day and were repeated every month for 3 months. Amitriptyline was prescribed in a dose of 10mg, increased to 25mg after 2 weeks; thereafter increase in dose to 50 mg was optional. The primary outcome was > 50% reduction in headache days, and secondary outcomes were the reduction in severity of headache, abortive drug, and side effects. Results: Forty-one patients were included in group I and 42 in group II, and their baseline characteristics were comparable. A higher proportion of group II patients had more than 50% reduction in headache days at 3 months (76.2 vs 31.7%; P < 0.001) compared to group I. More than 50% reduction in headache severity was also greater in group II compared to group I at 3 months (47.6% vs 19.5%; P = 0.01). Side effects were comparable, and none had to be withdrawn. Limitations: A higher proportion of patients was shifted from group I to group II. Conclusion: Combination of rTMS and amitriptyline is safe and more effective in CM compared to rTMS alone. © 2021, American Society of Interventional Pain Physicians. All rights reserved.
Assessment of non-motor symptoms of Parkinson's disease and their impact on the quality of life: An observatiobnal study
(Wolters Kluwer Medknow Publications, 2022) Anand Kumar; Sooraj Patil; Varun K. Singh; Abhishek Pathak; Rameshwar Nath Chaurasia; Vijaya N. Mishra; Deepika Joshi
Background: During the past decade the view of Parkinson's disease (PD) as a motor disorder has changed significantly and currently it is recognized as a multisystem disorder with diverse non-motor symptoms (NMS). Aims: The present study aimed to evaluate and characterize the NMS and study their impact on quality of life (QoL) in a PD patient cohort. Material and Methods: This was a cross-sectional study where 92 PD patients fulfilling the UK Parkinson's disease society brain bank criteria were enrolled from a movement disorder clinic. All patients were evaluated using unified Parkinson's disease rating scale, non-motor symptoms scale (NMSS) for the non-motor symptoms, and Parkinson's disease questionnaire-39 (PDQ-39) for the QoL. The impact of NMS on QoL was assessed statistically. Results: A total of 92 patients were enrolled with a mean age of 55.40 ± 7.37 years, mean age of onset of disease 51.62 ± 6.38 years, and mean disease duration of 3.78 ± 1.54 years. Type of disease was akinetic rigid variant in 29.3% (n = 27), tremor predominant type in 36.9%(n = 34), and mixed type in 33.6% (n = 31). Mean Hoehn and Yahr stage was 2.12 ± 0.54. In the NMSS, most common symptom was sleep and fatigue (83%), followed by urinary tract symptoms (63%), mood and cognition (51%), cardiovascular symptoms and falls (43%), gastrointestinal tract symptoms (38%), and sexual function (33%). Univariate analyses showed that all NMS domains had a significant correlation with PDQ-39 with P < 001. Conclusion: Our study shows that NMS in PDare fairly common and significantly impact the QoL. © 2022 Annals of Indian Academy of Neurology.
Association of Catechol-O-Methyltransferase Gene rs4680 Polymorphism and Levodopa Induced Dyskinesia in Parkinson’s Disease: A Meta-Analysis and Systematic Review
(SAGE Publications Inc., 2023) Archana Dwivedi; Nidhi Dwivedi; Anand Kumar; Varun K. Singh; Abhishek Pathak; R.N. Chaurasia; V.N. Mishra; Sujata Mohanty; Deepika Joshi
Introduction: Long-term levodopa therapy for Parkinson’s disease (PD) can cause levodopa induced dyskinesia (LID). Genetic predisposition has a significant role to play in inter-individual heterogeneity in the clinical manifestation of LID. Despite accumulating evidence for the role of COMT gene polymorphism (rs4680) as a genetic basis for LID, to date results have been inconsistent. Early assessment of the Catechol-O-Methyltransferase (COMT) genotype might be helpful to stratify PD patients concerning their individual risk for LID. Method: In this meta-analysis, we have used 9 studies, which were selected through online databases. Statistical analysis was performed using R (v-3.6) software. 5 genetic models have been used in the present study: Allele model (A vs. G), Dominant model (AA+AG vs. GG), Homozygote model (AA vs. GG), Co-dominant/heterozygote model (AG vs. GG), and Recessive model (AA vs. AG + GG). Results: The results indicated a significant association between COMT rs4680 (Val158Met) polymorphism and LID risk. The genotype AA of COMT rs4680 is a risk factor for LID in PD patients under the recessive model (AA vs GG+AG) in the random-effect model. Analysis based on ethnicity showed that COMT rs4680 SNP allele A is a risk factor for LID development in Asian PD patients, while GG genotype is a risk factor for LID development in non-Asian PD patients using different genetic models. Conclusion: The results of the present meta-analysis support that the COMT Val158Met polymorphism is a risk factor for the development of LID in PD patients having ethnic variations. © The Author(s) 2022.
Development of gel polymer electrolyte based on LiTFSI and EMIMFSI for application in rechargeable lithium metal battery with GO-LFP and NCA cathodes
(Springer New York LLC, 2019) Liton Balo; Himani Gupta; Shishir K. Singh; Varun K. Singh; Alok K. Tripathi; Nitin Srivastava; Rupesh K. Tiwari; Raghvendra Mishra; Dipika Meghnani; Rajendra K. Singh
In this paper, we report the effect of ionic liquid 1-ethyl-3-methylimidazolium bis(fluorosulfonyl)imide (EMIMFSI) on polymer poly(ethylene oxide) (PEO) and salt lithium bis(trifluoromethylsulfonyl)imide (LiTFSI) electrolyte system. The glass transition temperature and degree of crystallinity decreased with an increasing amount of EMIMFSI resulting in an increase in the ionic conductivity. The highest room temperature ionic conductivity and Li+ transference number are observed for PEO + 20 wt% LiTFSI + 10 wt% EMIMFSI. These prepared gel polymer electrolytes (GPEs) are thermally and electrochemically stable enough for battery application. Two different cells with graphene oxide-doped lithium iron phosphate, LiFePO4 (GO-LFP) and lithium nickel cobalt aluminum oxide, LiNi0.80Co0.15Al0.05O2 (NCA) cathodes were tested with prepared GPEs. GO-LFP showed more predictable and consistent nature of capacity fading and good discharge capacity. However, NCA showed higher discharge capacity, better cyclic performance, lower capacity fading, and better performance at high C rates. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
Development of polymer electrolyte and cathode material for Li-batteries
(Electrochemical Society Inc., 2019) Himani Gupta; Shishir K. Singh; Varun K. Singh; Alok K. Tripathi; Nitin Srivastava; Rupesh K. Tiwari; Raghvendra Mishra; Dipika Meghnani; Rajendra Kumar Singh
Enhancing the capacity and energy density of Li-battery along with maintaining its cycle life is the major challenge for electrochemical devices. Focusing on the positive electrode of Li-battery, specific capacity and cycle life of the layered oxide active material is studied thoroughly. On comparing their properties it could be found that Ni-rich layered oxide cathode materials give the best performance in terms of specific capacity and energy density but LiNi0.6Mn0.2Co0.2O2 cathode provides good capacity along with sufficient cycling performance. So, it is optimized as cathode material with our prepared ionic liquid (IL) based polymer electrolyte for Li cell. The structure and morphology of synthesized cathode material along with the electrochemical performance of polymer electrolyte and cell are investigated by using X-ray diffraction (XRD), scanning electron microscopy (SEM) and electrochemical analyzer. Good specific discharge capacity (∼137 mAh g-1) and cyclability (upto 150 cycles) of the cell is observed. Experimental results suggest that the synthesized polymer electrolyte and cathode material is a promising candidate for Li battery. © The Author(s) 2018. Published by ECS.
Does gender difference matter in cerebral venous thrombosis?
(Churchill Livingstone, 2022) Jayantee Kalita; Usha K. Misra; Varun K. Singh; Sunil Kumar; Neeraj Jain
Female specific risk factors (FSRFs) in cerebral venous thrombosis (CVT) may have difference in clinical, imaging and outcome parameters compared to those females with additional risk factors and males. We compare the clinical, MRI and outcome between male and female patients with CVT. We also compare female patients with and without female specific risk factors. 172 patients were included from a prospectively maintained CVT registry. The diagnosis was confirmed on magnetic resonance venography (MRV). Clinical details, risk factors, MRI and MRV findings were noted. The risk factors in the females were categorized as 1) Isolated FSRF (oral contraceptive, pregnancy, puerperium), 2) FSRF in addition to other risk factor, 3) non FSRF only, and 4) no risk factor groups. Outcome at 6 months was assessed using modified Rankin Scale (mRS) as death, poor (mRS 3–5) and good (mRS ≤ 2). There were 80 (46.5%) females; 24 (30%) had FSRFs and 18 (75%) of whom also had other risk factors leaving only 6(25%) females with isolated FSRF. The frequency of other prothrombotic risk factors, and clinical and imaging findings were similar in males and females except more frequent hyperhomocysteinemia in males (59% vs 41%; P = 0.036) and altered sensorium in females (66% vs 40%; P = 0.001). 17(9.9%) patients died, 12(7%) had poor and 143(83.1%) had good outcome, which were similar in both the gender, and in the females with and without FSRF. Isolated FSRF is rare in CVT, and there is no gender difference in terms of non FSRFs, clinico-radiological severity and outcome. © 2022 Elsevier Ltd
Effect of Exercise on β-Endorphin and Its Receptors in Myasthenia Gravis Patients
(Springer, 2023) Gyanesh M. Tripathi; Usha K. Misra; Jayantee Kalita; Varun K. Singh; Abhilasha Tripathi
This is a prospective observational study evaluating the change in β-endorphin (BE) and its receptors following exercise in patients with myasthenia gravis (MG) and their association with clinical improvement. Fifteen patients with mild to moderate MG, aged 16–70 years, who were able to do 6-Minute Walk Test (6-MWT) and had MG Quality of Life-15 (MGQoL-15) ≤ 45 without any contraindication for exercise were included. The patients walked 30 min daily for 3 months. The primary outcome at 3 months was > 50% improvement in MGQoL-15 from the baseline, and the secondary outcomes were MG Activities of Daily Living (MGADL), Hospital Anxiety and Depression Scale (HADS), number of steps, and distance covered on 6-MWT and adverse events. Plasma BE level, μ-opioid receptor (MOR), and δ-opioid receptor (DOR) were measured on admission and at 1 and 3 months. Twelve age- and gender-matched healthy controls who were not on regular exercise were included for comparison of BE, MOR, and DOR levels. Plasma BE level (P = 0.007) and DOR expression (P = 0.001) were lower in MG patients compared to the healthy controls. After 3 months of exercise, 6 patients improved. Plasma BE, MOR, and DOR levels increased in the first and decreased in the third month. MGQoL-15 (P < 0.001), HADS (P < 0.0001), number of steps (P < 0.007), distance (P = 0.030), and MGADL (P < 0.001) significantly improved compared to baseline. At 3 months, MGQoL-15 was associated with HADS score (P = 0.001), reduced depression (P = 0.013), MGADL (P = 0.035), and distance travelled on the 6-WMW test (P = 0.050). The improvement in depression was associated with higher BE level. Graphical Abstract: [Figure not available: see fulltext.] © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Harlequin Syndrome: A Rare Association With Migraine
(Lippincott Williams and Wilkins, 2024) Anand Kumar; Deepika Joshi; Varun K. Singh
[No abstract available]
Inclusion of mechanical ventilation in severity staging of tuberculous meningitis improves outcome prediction
(American Society of Tropical Medicine and Hygiene, 2020) Jayantee Kalita; Usha K. Misra; Varun K. Singh; Prakash C. Pandey; Justin Thomas
Patients with tuberculous meningitis (TBM) in any stage of the British Medical Research Council (BMRC) scale, if requiring mechanical ventilation (MV), are likely to have a poor outcome. We report the usefulness of BMRC, BMRC-MV, and BMRC-hydrocephalus (BMRC-HC) staging, and Haydarpasa Meningitis Severity Index (HAMSI) scoring in predicting the outcome of TBM. One hundred ninety-seven TBM patients were analyzed from a prospectively maintained TBM registry. The severity of meningitis was categorized using BMRC (stages I-III), BMRC-MV (I-IV [MV patients were grouped as stage IV]), and BMRC-HC (I-IV [BMRC stage III patients with hydrocephalus were grouped as stage IV]). Haydarpasa Meningitis Severity Index scoring was categorized as < 6 and 3 6. The outcome was defined at 6 months using the modified Rankin Scale (mRS) as death, poor (mRS score > 2), or good (mRS score £ 2). Forty-nine (25%) patients died. BMRC-mechanical ventilation stage IV had the highest predictive value for defining death, with a sensitivity of 88% and a specificity of 86%. About 81.7% of surviving patients had a good outcome at 6 months. BMRC-mechanical ventilation stages I-III had the highest predictive value for defining good outcome, with a sensitivity of 93% and a specificity of 61%. In TBM, BMRC-MV staging has the best predictive value for defining death and disability. Copyright © 2020 by The American Society of Tropical Medicine and Hygiene
Myositis in H1N1 Infection Compounds to Myasthenic Crisis
(Wolters Kluwer Medknow Publications, 2024) Jayantee Kalita; Sarvesh K. Chaudhary; Prakash C. Pandey; Varun K. Singh; Usha K. Misra
Infection is an important trigger of myasthenic crisis (MC), and those infections manifest with pneumonia and muscle involvement may result in more frequent MC. We report two myasthenia gravis (MG) patients with H1N1 infection, and highlight the reasons for deterioration. Two patients with MG had H1N1 infection. The diagnosis of MG was confirmed by neostigmine, repetitive nerve stimulation, and anti‑acetylcholine receptor antibody tests. H1N1 was confirmed by nucleic acid detection study, and myositis by creatinine kinase. The patient with pneumonia and myositis had MC needing mechanical ventilation for 10 days, and the other patient without myositis did not have MC. They were treated with oseltamivir 75 mg twice daily for 5 days, and the patients with MC received ceftriaxone intravenously. Both the patients were on prednisolone and azathioprine, and none received prior H1N1 vaccination. The lady with MC with myositis was discharged on day 27 in wheelchair bound state, and the other one patient without myositis or MC was discharged on 6th day with full recovery. These patients highlight the need for evaluation for myositis along with pneumonia in the MG patients with H1N1 infection. Vaccination in MG patients on immunosuppression may be useful. © 2024 Neurology India, Neurological Society of India.
Prolonged coma in scrub typhus: Consider non-convulsive status epilepticus
(Oxford University Press, 2021) Jayantee Kalita; Mahesh S. Jadhav; Varun K. Singh; Usha K. Misra
Background: Scrub typhus is prevalent in the Tsutsugamushi belt and may manifest with meningoencephalitis and seizures. We report a patient with scrub typhus who had non-convulsive status epilepticus (NCSE). Methods: A 50-y-old female with fever and altered sensorium for 5 d was diagnosed as scrub typhus based on serum IgM ELISA. She was on mechanical ventilation and received doxycycline and ceftriaxone, but did not improve until the third day of admission. Results: An EEG revealed >2.5 Hz generalised epileptiform discharges, which were suppressed by intravenous lorazepam suggesting NCSE. Following valproate and levetiracetam, she became conscious and had a full recovery. Conclusion: A scrub typhus patient recovers even after prolonged NCSE. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
Rest or 30-Min Walk as Exercise Intervention (RESTOREX) in Myasthenia Gravis: A Randomized Controlled Trial
(S. Karger AG, 2021) Usha K. Misra; Jayantee Kalita; Varun K. Singh; Aditya Kapoor; Abhilasha Tripathi; Prabhakar Mishra
Introduction: There is a lack of evidence about the usefulness of exercise or rest in myasthenia gravis (MG). This study is aimed to evaluate the efficacy and safety of exercise or rest in MG. Methods: In a single-center open-labeled randomized controlled trial, the patients with mild to moderate MG were randomized to 30-min walk or rest in addition to the standard treatment. The primary endpoint was 50% improvement in the MG Quality of Life (MG-QOL15), and secondary endpoints were change in the Myasthenic Muscle Score (MMS), MG Activities of Daily Living (MGADL), grip strength, dose of acetylcholine esterase inhibitor and prednisone, 6-min walk test (6MWT), decrement in trapezius on the low-rate repetitive nerve stimulation test, and adverse events. The outcomes were defined at 3 months, by >50% improvement in these outcome parameters. Results: Forty patients with MG were randomized to the exercise or rest arm. The 2 arms were matched for demographic and clinical parameters. The patients in the exercise arm had significantly better QOL evidenced by MG-QOL15 (p = 0.02). The secondary endpoints, distance covered in 6MWT (p = 0.007), were also better in the exercise arm without any adverse event. Conclusion: Regular exercise for 30 min in mild and moderate MG improves quality of life and walking distance compared to rest and is safe. Clinical Trial Registration: The clinical trial registration number is CTRI/2019/11/021869. © 2021 S. Karger AG, Basel. Copyright: All rights reserved.
Spastic Paraparesis in Donnai-Barrow Syndrome: A Rare Case Report from India
(Wolters Kluwer Medknow Publications, 2024) Swati Parida; Nikhil A. Kumar; Rameshwar N. Chaurasia; Anand Kumar; Abhishek Pathak; Varun K. Singh
[No abstract available]
Toxins in neuro-ophthalmology
(CRC Press, 2022) Varun K. Singh; Usha K. Misra
[No abstract available]
Vascular Parkinsonism and Parkinson's disease: A prospective, clinico-radiological comparative study
(Wolters Kluwer Medknow Publications, 2021) Shivani Rath; Anand Kumar; Abhishek Pathak; Ashish Verma; Varun K. Singh; Rameshwar N. Chaurasia; Vijay N. Mishra; Deepika Joshi
Background: Vascular parkinsonism (VP) is an atypical Parkinsonian syndrome that is believed to have a temporal association with cerebrovascular disease. However, now it is evolving as a heterogeneous entity with no clear consensus on the definition and diagnostic criteria. Aim and Objectives: This study aimed at evaluating the clinico-radiological profile of patients with VP and Parkinson's disease (PD). Materials and Methods: The present study was conducted at a tertiary care university hospital. A total of 80 patients, with a diagnosis of probable VP (40) and PD (40), were evaluated and compared with Unified Parkinson's Disease Rating Scale (UPDRS) part III, gait scale, Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and MRI brain. Results: Significantly older age of onset (P = 0.005), higher vascular risk factors (P < 0.001), and motor scores in UPDRS part III (P < 0.001), gait scale (P < 0.001), and modified Hoehn and Yahr (P < 0.001) were seen in the VP as compared with the PD. On the cognitive scales, patients with VP scored significantly lower in MMSE (19.92 ± 6.0 vs. 24.90 ± 3.34; P < 0.001) and FAB (7.75 ± 4.27 vs. 11.22 ± 2.75; P < 0.001); on the modified Hachinski scale (7.77 ± 3.19 vs. 3.30 ± 1.97; P < 0.001), they scored higher compared with patients with PD. Periventricular ischemic changes, generalized brain atrophy, and multiple lacunar infarcts were the most common radiological abnormality found significantly more in patients with VP. Conclusion: An older age, worse cognitive scores and motor scores, and more profound periventricular and subcortical lesions on MRI favored VP. © 2021 Annals of Movement Disorders.