Publications

BACKGROUND: Contrast-induced nephropathy (CIN) is an iatrogenic impairment to the kidneys that can occur in susceptible persons after intravascular injections of contrast agents. Individuals undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) often bear the risk of developing CIN. The likelihood of CIN can be predicted using several techniques, although none of them are very accurate. CHA2DS2-VASc score is used to predict unfavorable clinical outcomes in patients with ACS and atrial fibrillation. The score comprises preprocedural variables and is simple to calculate and can be used for predicting CIN. This study aims to validate CHA2DS2-VASc score to predict occurrence of CIN among patients undergoing PCI.

MATERIALS AND METHODS: This cross-sectional research has been carried out at a tertiary care hospital. The study comprised a total of 182 patients who were admitted with ACS and underwent PCI. CIN incidence was computed. The study population was divided into two groups (the CIN group and the non-CIN group) based on the incidence of CIN. The CHA2DS2-VASc score was computed for every patient. The best cutoff values of the CHA2DS2-VASc score to predict the development of CIN were found using receiver operating characteristic (ROC) curve analysis. The incidence of CIN was computed both above and below the CHA2DS2-VASc score's optimal cutoff point.

RESULTS: The incidence of CIN among patients undergoing PCI was 14.3%, and the ROC value for the CHA2DS2-VASc score was 0.896. Statistically significant increases in the incidence of CIN were observed in patients undergoing PCI who had a CHA2DS2-VASc score of >2. Additionally, a significant relationship was discovered between CIN and age, diabetes, hypertension, prior coronary artery disease (CAD), and Killip class ≥2.

CONCLUSION: Patients with CHA2DS2-VASc score of >2 had higher incidence of CIN. CHA2DS2-VASc score was found to be useful in predicting contrast nephropathy among patients with acute myocardial infarction undergoing angiography.

AIM: To study the perception of nonintensivists of Indian intensive care units (ICUs) about the role of intensivists as leaders of the ICU, their impact on patient outcomes, including length of stay on the ventilator, cost of care, and evidence-driven quality care using a survey questionnaire.

MATERIALS AND METHODS: This study employed an online survey conducted using a Google Form and distributed via WhatsApp to nonintensivists taking care of ICU/high dependency unit (HDU) patients in public and private hospitals all over India. It consisted of 24 questions related to perceptions about the role of an intensivist in the ICU, their impact on patient-driven outcomes, ICU processes, and ICU structure.

RESULTS: There was a statistically significant difference in responses from respondents working in closed and semi-open ICUs vs open ICUs. Overall, the presence of an intensivist was perceived to be associated with improvements in patient outcomes, smoother decision-making for complex cases, reduced costs by avoiding unnecessary tests, and reduced litigation by patient families, especially in closed and semi-open ICUs vs open ICUs.

CONCLUSION: This is the first-ever survey done to understand the role of an intensivist in the ICU in India in the eyes of a nonintensivist/admitting physician or surgeon. It shows that intensivists are considered to play a significant role in impacting patient outcomes, such as facilitating smoother decision-making in complex cases, improving decision-making efficiency, reducing costs associated with unnecessary tests, and preventing litigation by families. The survey results are very encouraging and should pave the way for conducting large-scale surveys in the developing world.

Poor nutritional status prior to surgery in cardiac patients is one of the risk factors for acute kidney injury (AKI), morbidity, and mortality. There is a lack of data in patients undergoing cardiac surgery with regard to nutritional status and risk of AKI. This study was conducted with the objective of assessment of the nutritional status of cardiac surgery patients using body composition measures (BCM) and other biochemical parameters. This study was conducted at Madras Medical Mission Hospital, Chennai. Before enrolling, informed consent from the patients and ethical authorization were obtained. All patients >18 years of age undergoing cardiac surgery had a BCM analysis done on the pre- and postoperative day 5. Paired t-test was used to compare the pre- and postoperative data. Preoperative body mass index (BMI) of the patients showed that the majority of them were overweight, with a mean BMI of ±26.55 kg/m2. There were no significant changes in the BCM results for protein weight in either study group (no AKI group-preop: mean ± SD, 9.0316 ± 2.39, p = 0.67; postop: mean ± SD, 9.1919 ± 2.57, p = 0.77; AKI group-preop: mean ± SD, 9.57 ± 8.00, p = 0.67; postop: mean ± SD, 9.56 ± 8.07, p = 0.77). There was a significant loss of body fat in all patients, but it was higher in patients who developed AKI (preop: mean ± SD, 33.28 ± 10.96, p = 0.11 vs postop: mean ± SD, 31.83 ± 10.94, p = 0.53). The skeletal muscle mass in both groups showed no significant changes. Those who developed AKI postoperatively had a higher preoperative visceral fat area (VFA) (mean ± SD, 116.87) and percentage body fat (PBF) (33%) compared to patients who did not develop AKI (VFA ±102.36 and PBF 30%). We found that patients had lost body fat postsurgically. Those who were diagnosed with AKI had overhydration, high waist circumference, and VFA preoperatively.

BACKGROUND/INTRODUCTION: The Indian subcontinent faces a substantial healthcare challenge with allergic bronchopulmonary aspergillosis (ABPA). While numerous investigations have explored ABPA's occurrence in the general asthmatic population, there remains a significant knowledge gap regarding its specific prevalence among individuals with severe asthma. Current Indian research demonstrates considerable variation in reported ABPA prevalence rates among severe asthmatics, highlighting the need for more comprehensive investigation.

OBJECTIVE: This research initiative aimed to determine the precise prevalence of ABPA among severe asthma patients seeking treatment at a tertiary healthcare institution in northwestern India, with the goal of enhancing our understanding of this complex condition's burden in this specific patient population.

METHODOLOGY: We conducted a comprehensive cross-sectional investigation spanning August 2022 through July 2023. The study encompassed 247 patients diagnosed with severe asthma. Each participant underwent thorough clinical evaluation and provided blood samples for comprehensive analysis, including absolute eosinophil count measurement, total IgE quantification, and specific testing for Aspergillus fumigatus-related IgE antibodies. When clinically indicated, additional diagnostic procedures included Aspergillus-specific IgG testing and detailed chest imaging through X-ray or high-resolution computed tomography (HRCT).

RESULTS: Our investigation revealed that 63.2% (156 out of 247) of severe asthma patients met the diagnostic criteria for ABPA. The affected population showed a mean age of 41.6 years, with a relatively balanced gender distribution (80 females, 76 males). Among those diagnosed with ABPA, we observed a notably higher prevalence of ABPA-B (92.3%, 144 patients) compared to ABPA-S (7.7%, 12 patients).

CONCLUSION: This research represents one of the most extensive investigations to date documenting such a high ABPA prevalence (63.2%) among severe asthma patients in northern India. These findings underscore the critical need for expanded research initiatives to investigate the underlying factors contributing to such elevated ABPA rates in this geographical region, ultimately aiming to develop and implement effective preventive strategies at the community level.

BACKGROUND: The National Medical Commission (NMC) of India requires medical postgraduate students to conduct research in the form of a thesis or dissertation. However, students often face challenges throughout the process, including topic selection, protocol approval, data collection, and thesis writing. This study aimed to assess the effectiveness of a 1-day focused thesis writing workshop in improving the knowledge and confidence of medical postgraduate students.

METHODS: A cross-sectional mixed-methods study was conducted involving 68 postgraduate students from various medical disciplines who participated in a thesis writing workshop. Participants were administered pre- and post-test questionnaires to assess their knowledge of key thesis writing components, including literature review, results, discussion, and conclusion. The workshop included interactive sessions on each of these topics. Descriptive and inferential statistics were used to analyze the results, and qualitative feedback was gathered to assess participant satisfaction and perceived improvements in confidence.

RESULTS: The pre- and post-test scores showed a significant improvement in knowledge, particularly in the areas of literature review, results, and discussion (p < 0.05). However, the improvement in knowledge regarding thesis conclusions was not statistically significant. Feedback from participants indicated high satisfaction with the workshop, with 85% reporting increased confidence in their thesis writing skills. The majority of students (78%) found the workshop relevant and helpful in enhancing their understanding of thesis writing.

CONCLUSION: A focused, 1-day workshop significantly improved the knowledge and confidence of medical postgraduate students in thesis writing. This suggests that such workshops can be an effective intervention to support postgraduate students in completing their research. The study advocates for the integration of similar workshops into postgraduate curricula. Further research with larger, multicenter studies is needed to evaluate the long-term impact and feasibility of institutionalizing such programs.

BACKGROUND: Diabetes mellitus (DM) is a global health concern with rising prevalence, particularly in India, where undiagnosed cases are significant. A common yet often overlooked complication, diabetic gastroparesis impairs gastric motility and significantly reduces quality of life. Current treatments focus on symptom management, but the relationship between gastric motility patterns and therapeutic outcomes remains underexplored. This study evaluates the efficacy of levosulpiride in managing diabetic gastroparesis and its impact on gastric scintigraphy patterns.

METHODS: This analytical observational study included 27 adult patients with type 2 DM (T2DM) and gastroparesis, conducted at a tertiary care hospital in North India from April 2021 to 2022. Patients received 25 mg levosulpiride thrice daily for 4 weeks. Gastroparesis symptoms were assessed using the Gastroparesis Cardinal Symptom Index (GCSI). Gastric motility was evaluated via gastric scintigraphy before and after treatment. Changes in GCSI scores and scintigraphy patterns were analyzed using paired t-tests and the Stuart-Maxwell test.

RESULTS: Participants (mean age 56.41 ± 9.48 years) showed significant improvement in GCSI scores (11.48 ± 3.02 to 6.04 ± 2.08, p < 0.001). Gastric scintigraphy revealed significant changes, with 66.7% of patients demonstrating normalized motility patterns posttreatment (χ2 = 14.000, p = 0.016). While delayed gastric emptying persisted in some cases, levosulpiride alleviated key symptoms like nausea, vomiting, and early satiety.

CONCLUSION: Levosulpiride significantly alleviated symptoms of diabetic gastroparesis, as evidenced by reduced GCSI scores and improvements in gastric scintigraphy patterns. Despite minimal changes in delayed gastric emptying, the drug's effect on motility dysfunction highlights its therapeutic potential. This study underscores the importance of focusing on motility patterns in symptom management, suggesting levosulpiride as a promising option for targeted treatment of diabetic gastroparesis.

PURPOSE: To compare the visibility of fundus lesions between RGB and RG images obtained with an ultra-widefield (UWF) fundus imaging device (Optos) for 10 types of fundus lesions.

METHODS: UWF images from 30 patients representing 10 types of fundus lesions were analyzed: vessel sheathing, optic disc cupping, cotton wool spots, epiretinal membrane, laser photocoagulation scars, retinal drusen, retinal hemorrhage, retinal/choroidal detachment, chorioretinal atrophy, and macular degeneration. Three images of each type of lesion were used, and 26 board-certified ophthalmologists compared them. The raters compared the visibility of lesions on a five-point scale: RG significantly better = -2; RG slightly better = -1; equal = 0; RGB slightly better = +1; and RGB significantly better = +2. The Wilcoxon signed-rank test was used to determine the significance of the differences.

RESULTS: RGB images were rated significantly more visually favorable than the RG images for all 10 lesions (P < 0.01). The greatest improvements in perceived visibility in RGB images were observed for vessel sheathing (50.7%), optic disc cupping (49.8%), cotton wool spots (46.9%), and an epiretinal membrane (46.7%). Conversely, macular degeneration (22.7%) and chorioretinal atrophy (25.1%) had minimal advantages in RGB images.

CONCLUSIONS: RGB imaging improves the visibility of white and superficial fundus lesions but adds little benefit for deeper located lesions.

TRANSLATIONAL RELEVANCE: The results indicate that RGB imaging, which includes blue laser light, improves the visibility of superficial and white retinal lesions. These findings support the optimized use of color imaging modalities in clinical practice based on lesion characteristics.

Visual crowding is the disruptive effect of nearby details on the perception of a target. This influence is dependent on both spatial separation and perceived similarity between target and flanker elements. However, it is not clear how these simultaneous influences combine to produce the final "crowded" percept as flankers traverse the limits of the crowding zone. We investigated the reported appearance of a peripherally presented Landolt-C target flanked by a pair of simultaneously presented Landolt-Cs across different levels of target-flanker similarity (relative orientation), spatial separation, and target eccentricity. The distributions of errors in reported target orientation were fitted with a pooling model that simulated errors using a weighted combination of target and flanker orientation signals. The change in error distribution with target-flanker spacing (the "spatial profile") was fitted with a logistic function, estimating both the rate at which target- and flanker-signal weighting varies as target-flanker spatial separation decreases (slope) and the spatial separation at which signals were balanced (midpoint). We found that the slope of the spatial profile increases as target-flanker similarity decreases, with similar modulation patterns across target eccentricities. In contrast, spatial profile midpoints increased linearly with eccentricity, in line with Bouma's law, but were invariant of target-flanker similarity. This suggests similarity-related modulation may operate within a fixed spatial extent at each eccentricity. Investigating the spatial profile of crowding disentangles effects related to the appearance of targets and flankers (i.e., similarity) from appearance-independent influences, which can be confounded when using other common measures to define crowding zone extent.

What is the impact of dynamic changes in facial visibility on identifying the eye and forehead region? This study examines how wearing or removing a mask affects the ability to visually identify the eyes. We investigate whether these changes impact the recognition of upper facial features and alter sensitivity to the misalignment of the face's upper and lower halves, which disrupts holistic face processing. Results show that removing a mask generally impairs visual identification, suggesting that the perception of the whole face hinders recognition of the upper half. This hindering is evident from the fact that the interference decreases when the face is misaligned. In contrast, the impairment in identification caused by adding a mask to a target face rises from losing original support of the holistic processing, given that it was not diminished when the upper and bottom halves were misaligned. Additional findings show that misalignment negatively affects the identification of faces where a mask was either maintained or added, suggesting that masks may actually help direct attention to relevant facial features, rather than being integrated into a holistic representation. We discuss these results in light of their theoretical and practical implications for visual identification, particularly in the context of dynamic changes to facial appearance.