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Article ; Online: Early Functional Outcome of Osteoporotic Intertrochantric Fractures in Elderly Managed with Proximal Femoral Nail and Proximal Femoral Nail Antirotation

Ankit Mittal / Simrat P.S Gill / Dinesh Kumar / Jasveer Singh / Harish Kumar / Ajay Rajput

MAMC Journal of Medical Sciences, Vol 7, Iss 1, Pp 63-

A Comparative Study

2021 Volume 71

Abstract: Introduction: The choice of an implant in the management of intertrochanteric fractures of the femur has evolved from extramedullary devices to intramedullary ones. The proximal femoral nail antirotation (PFNA) that employs a helical blade is a recent ... ...

Abstract	Introduction: The choice of an implant in the management of intertrochanteric fractures of the femur has evolved from extramedullary devices to intramedullary ones. The proximal femoral nail antirotation (PFNA) that employs a helical blade is a recent and promising advancement but there is a paucity of data in the literature to prove its superiority over its predecessor nails in terms of functional gains. Aim: To compare the functional outcome of PFNA with proximal femoral nail (PFN). Materials and Methods: In this prospective randomized control study in osteoporotic elderly patients, 32 patients managed with PFNA were compared with a similar number treated with PFN and compared in terms of demography, intraoperative variables (duration of surgery, fluoroscopy time, and blood loss), time to union, and functional outcome utilizing Harris hip scores (HHS) at 6 and 12 months follow-up. Results: Both the groups were comparable in terms of age, gender, type of fracture, and Singh’s osteoporosis index. Although the duration of surgery and fluoroscopy time was significantly less in the PFNA group, it did not translate into any functional gains to the patients as the time to union and the HHS, at 6 and 12 months did not reveal any significant difference. Implant-related complications were significantly more in the PFN group with five patients having varus collapse, one having screw cut-out, two having screw pull-out, and one having Z-effect. Conclusion: Although there was no significant difference in terms of functional aspect, with lesser implant-related complication and shorter operative time, PFNA can prove to be a better substitute for the management of these fractures in osteoporotic elderly debilitated patients.
Keywords	helical blade ; singh’s ; osteoporotic index ; varus collapse ; z-effect ; Medicine ; R
Subject code	616
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Coronavirus disease 2019-associated mucormycosis – A syndemic

Megha Priyadarshi / Tirlangi Praveen / Ankit Mittal / Gagandeep Singh / Immaculata Xess / Naveet Wig

Journal of Clinical and Scientific Research, Vol 10, Iss 4, Pp 240-

2021 Volume 245

Abstract: Coronavirus disease 2019 (COVID-19) and COVID-associated mucormycosis (CAM) came as a syndemic that not only severely increased morbidity and mortality but also posed a serious challenge for the healthcare system of a developing country like India. ... ...

Abstract	Coronavirus disease 2019 (COVID-19) and COVID-associated mucormycosis (CAM) came as a syndemic that not only severely increased morbidity and mortality but also posed a serious challenge for the healthcare system of a developing country like India. Although mucormycosis is a rare disease with a worldwide incidence of 0.43 cases per million population/year, these two COVID-19 waves caused a total of more than 14,000 cases in India itself. Mucormycosis is an angio-invasive fungal infection with rapid progression. The three major modalities of treatment involve early surgical debridement, initiation of antifungal therapy and controlling the predisposing risk factor. A complex interplay of factors, including pre-existing disease such as diabetes mellitus, use of immunosuppressants and immunomodulators, risk of hospital-acquired infection and immune dysregulation post-COVID-19, may all predispose to the development of CAM. Future research regarding the efficiency of newer antifungal with lower side effect profiles and evidence-based establishment of risk factors for adopting preventing strategies is the need of the hour. The disease is known to have high mortality despite the best treatment. We review in this article the aetiopathogenesis, various diagnostic modalities and treatment considerations for this disease.
Keywords	covid-19 ; covid-19–associated mucormycosis ; mucormycosis ; Medicine ; R
Subject code	610
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Osteoporotic Intertrochanteric Fractures in the Elderly Managed with Proximal Femoral Nail Antirotation-The Functional Outcome

SPS Gill / Ankit Mittal / Manish Raj / Satosh Singh / Ajay Rajpoot / Akashdeep Singh

Journal of Clinical and Diagnostic Research, Vol 15, Iss 1, Pp RC05-RC

2021 Volume 09

Abstract: Introduction: Despite recent evolution in the operating techniques and surgical implants, debate continues around the choice of implant for the management of intertrochanteric fractures of femur bone. There is a paucity of clinical data on the results ... ...

Abstract	Introduction: Despite recent evolution in the operating techniques and surgical implants, debate continues around the choice of implant for the management of intertrochanteric fractures of femur bone. There is a paucity of clinical data on the results with Proximal Femoral Nail Antirotation (PFNA). Aim: To evaluate the functional and radiological outcome of reduction and fixation of these fractures with PFNA. Materials and Methods: This prospective interventional study was conducted from december 2015 to november 2018. A total of 62 patients of more than 50 years of age with intertrochanteric fracture were managed with internal fixation using PFNA. All the pateints were evaluated with respect to the mean operative time, blood loss. Fluoroscopy exposure, time to union and development of any complication. The statistical analysis involved calculation of the mean and Standard Deviations (SD) of above parameters which was done using the Microsoft excel chart sheet. Functional evaluation was done using the Harris Hip Score (HHS). Results: A total of 62 patients with age ranging from 54 to 94 years (mean 78.2, SD 09.11) were evaluated. The mean duration of follow-up was 14.3 months. The average operative time, the mean blood loss and the average fluoroscopy time were 61.4 (range 45-90 minutes, SD 11.6) minutes, 103.9 (range 60-200 mL, SD 36.4) mL and 74.0 (range 41 to 98, SD 13.5) seconds respectively. About 100% union rate with the average time to union being 16.1 (SD 3.3) weeks and ranging from 12 weeks to 24 weeks was reported. Varus collapse and limb shortening >1 cm were observed in 3 patients. The average HHS at the end of study showed a mean value of 82.8 (SD 8.6) and ranged from 65 to 94 with 46 (74.2%) patients having excellent to good outcome. Conclusion: Owing to easy insertion, reduced operative time and blood loss, stable fixation, less complications and good functional and radiological outcome, PFNA can prove to be an implant of choice for the management of intertrochantric fractures of the femur.
Keywords	cephalomedullary nails ; fracture union ; intramedullary devices ; internal fixation ; reduction ; sliding hip devices ; Medicine ; R
Subject code	616
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	JCDR Research and Publications Private Limited
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Development and validation of a questionnaire to evaluate the knowledge, attitude and practices regarding travel medicine amongst physicians in an apex tertiary hospital in Northern India

Arvind Kumar / Anand Rajendran / Mohd Usman / Jatin Ahuja / Sameer Samad / Ankit Mittal / Prerna Garg / Upendra Baitha / Piyush Ranjan / Naveet Wig

Tropical Diseases, Travel Medicine and Vaccines, Vol 8, Iss 1, Pp 1-

2022 Volume 9

Abstract: Abstract Objectives Travel medicine focuses primarily on pre-travel preventive care and the conditions and diseases acquired during or after travel. There is a paucity of validated tools to assess the knowledge, attitude and practises of physicians with ... ...

Abstract	Abstract Objectives Travel medicine focuses primarily on pre-travel preventive care and the conditions and diseases acquired during or after travel. There is a paucity of validated tools to assess the knowledge, attitude and practises of physicians with regard to travel medicine. We attempted to develop a tool to assess existing expertise among Medicine and Infectious Diseases resident doctors with respect to travel medicine. Methods Item level content validity index (I-CVI) and scale level content validity index (S-CVI/Ave) were estimated for each of the items to establish the content validity. Refined measures of inter-rater agreement (Brennan and Prediger Agreement Coefficient and Gwet’s Agreement Coefficient) were estimated for the tool. Results The final version of the questionnaire had satisfactory content validity (I-CVI > 0∙6 and S-CVI/Ave > 0∙9) and possessed high agreement among the raters (Brennan and Prediger AC > 0∙7, p < 0∙01 and Gwet's AC > 0∙8, p < 0∙01) with regard to necessity, clarity and relevance of the scale. Conclusions This tool covers a wide range of questions and is scientifically validated. The final version of the tool can be used largely for the assessment of knowledge, attitude and practices among medical practitioners. This is instrumental to build targeted intervention programs to enhance the knowledge regarding travel medicine among health care providers.
Keywords	Travel Medicine ; Knowledge ; Practice ; Questionnaire ; Development ; Validation ; Arctic medicine. Tropical medicine ; RC955-962
Subject code	300
Language	English
Publishing date	2022-06-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Is there antibody-dependent enhancement in SARS Coronavirus 2?

Rohit Kumar / Nitin Gupta / Parul Kodan / Ankit Mittal / Manish Soneja / Naveet Wig

Journal of Family Medicine and Primary Care, Vol 9, Iss 5, Pp 2589-

2020 Volume 2590

Keywords	Medicine ; R
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Battling COVID-19

Rohit Kumar / Nitin Gupta / Parul Kodan / Ankit Mittal / Manish Soneja / Naveet Wig

Tropical Diseases, Travel Medicine and Vaccines, Vol 6, Iss 1, Pp 1-

using old weapons for a new enemy

2020 Volume 10

Abstract: Abstract Coronavirus disease-19 (COVID-19) has reached pandemic proportions. Most of the drugs that are being tried for the treatment have not been evaluated in any randomized controlled trials. The purpose of this review was to summarize the in-vitro ... ...

Abstract	Abstract Coronavirus disease-19 (COVID-19) has reached pandemic proportions. Most of the drugs that are being tried for the treatment have not been evaluated in any randomized controlled trials. The purpose of this review was to summarize the in-vitro and in-vivo efficacy of these drugs on Severe Acute Respiratory Syndrome (SARS-CoV-2) and related viruses (SARS and Middle East Respiratory Syndrome) and evaluate their potential for re-purposing them in the management of COVID-19.
Keywords	SARS-CoV-2 ; Hydroxychloroquine ; Lopinavir/ritonavir ; Remdisivir ; Nitazoxanide ; Tocilizumab ; Arctic medicine. Tropical medicine ; RC955-962
Language	English
Publishing date	2020-05-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: An Optimized Machine Learning Model Accurately Predicts In-Hospital Outcomes at Admission to a Cardiac Unit

Sandeep Chandra Bollepalli / Ashish Kumar Sahani / Naved Aslam / Bishav Mohan / Kanchan Kulkarni / Abhishek Goyal / Bhupinder Singh / Gurbhej Singh / Ankit Mittal / Rohit Tandon / Shibba Takkar Chhabra / Gurpreet S. Wander / Antonis A. Armoundas

Diagnostics, Vol 12, Iss 241, p

2022 Volume 241

Abstract: Risk stratification at the time of hospital admission is of paramount significance in triaging the patients and providing timely care. In the present study, we aim at predicting multiple clinical outcomes using the data recorded during admission to a ... ...

Abstract	Risk stratification at the time of hospital admission is of paramount significance in triaging the patients and providing timely care. In the present study, we aim at predicting multiple clinical outcomes using the data recorded during admission to a cardiac care unit via an optimized machine learning method. This study involves a total of 11,498 patients admitted to a cardiac care unit over two years. Patient demographics, admission type (emergency or outpatient), patient history, lab tests, and comorbidities were used to predict various outcomes. We employed a fully connected neural network architecture and optimized the models for various subsets of input features. Using 10-fold cross-validation, our optimized machine learning model predicted mortality with a mean area under the receiver operating characteristic curve (AUC) of 0.967 (95% confidence interval (CI): 0.963–0.972), heart failure AUC of 0.838 (CI: 0.825–0.851), ST-segment elevation myocardial infarction AUC of 0.832 (CI: 0.821–0.842), pulmonary embolism AUC of 0.802 (CI: 0.764–0.84), and estimated the duration of stay (DOS) with a mean absolute error of 2.543 days (CI: 2.499–2.586) of data with a mean and median DOS of 6.35 and 5.0 days, respectively. Further, we objectively quantified the importance of each feature and its correlation with the clinical assessment of the corresponding outcome. The proposed method accurately predicts various cardiac outcomes and can be used as a clinical decision support system to provide timely care and optimize hospital resources.
Keywords	machine learning ; mortality ; duration of stay ; heart failure ; STEMI ; pulmonary embolism ; Medicine (General) ; R5-920
Subject code	610 ; 310
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Technical and Alarm signs for referral in adult patients with acute febrile illness

Nitin Gupta / Ankit Mittal / Sharada V Kutty / Arvind Kumar / Naveet Wig

Journal of Family Medicine and Primary Care, Vol 7, Iss 4, Pp 832-

A study from a tertiary care hospital in North India

2018 Volume 835

Abstract: Context: There is a huge burden of patients with acute febrile illness (AFI) during the post-monsoon season in India. It is very important to have a functioning triage system, whereby patients with high likelihood of developing a severe illness are ... ...

Abstract	Context: There is a huge burden of patients with acute febrile illness (AFI) during the post-monsoon season in India. It is very important to have a functioning triage system, whereby patients with high likelihood of developing a severe illness are referred to higher levels of care. Aim: The objective of this study was to identify the alarm signs which would help in triaging of those patients with AFI without any specific diagnosis. Methods: This was a retrospective review of records, whereby clinical and laboratory parameters of patients with AFI admitted in our tertiary care center between July 2016 and October 2016 were reviewed. Statistical Analysis Used: Appropriate tests of significance were applied using SPSS 21(Chicago, IL, USA) to find statistically significant differences between those who required mechanical ventilation, intensive care, ionotropic support, or higher intravenous antibiotics and those who recovered with minimal supportive care. Results: Presence of comorbidities, dyspnea, altered sensorium, features of myocarditis, hypotension, leukocytosis (>11,000/μL), and acute kidney injury were significantly associated with requirement of higher levels of care, while presence of arthralgia, serositis, and leucopenia indicated a higher likelihood of recovery with minimal support. Conclusion: This article highlights the possibility of identification of simple alarm signs in patients with AFI which would indicate the need for higher levels of care.
Keywords	Chikungunya ; dengue ; malaria ; Medicine ; R
Subject code	610
Language	English
Publishing date	2018-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Histoplasmosis, heart failure, hemolysis and haemophagocytic lymphohistiocytosis

Nitin Gupta / Kutty Sharada Vinod / Ankit Mittal / Aswin Pius Ajay Kumar / Arvind Kumar / Naveet Wig

The Pan African Medical Journal, Vol 32, Iss

2019 Volume 43

Abstract: Histoplasmosis is an endemic mycosis with global distribution, primarily reported in immunocompromised individuals. A 29-year old immunocompetent male presented with fever, hepatosplenomegaly and pancytopenia. His peripheral blood showed features ... ...

Abstract	Histoplasmosis is an endemic mycosis with global distribution, primarily reported in immunocompromised individuals. A 29-year old immunocompetent male presented with fever, hepatosplenomegaly and pancytopenia. His peripheral blood showed features suggestive of intravascular hemolysis and echocardiography showed features suggestive of pulmonary arterial hypertension. Bone marrow showed yeast with morphology suggestive of Histoplasma capsulatum. Further investigations revealed hyperferritinemia, hypofibrinogenemia and increased triglycerides. With a diagnosis of progressive disseminated histoplasmosis with secondary Haemophagocytic lymphohistiocytosis, he was successfully treated with amphotericin B followed by itraconazole. We report this case to highlight the atypical and rare manifestations of histoplasmosis.
Keywords	pulmonary arterial hypertension ; immunocompetent ; pancytopenia ; Medicine ; R
Language	English
Publishing date	2019-01-01T00:00:00Z
Publisher	The Pan African Medical Journal
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Hydroxychloroquine pre-exposure prophylaxis for COVID-19 among healthcare workers

Harshith B Kadnur / Anivita Aggarwal / Manish Soneja / Komal Singh / Ankit Mittal / Neeraj Nischal / Praveen Tirlangi / Adil Rashid Khan / Devashish Desai / Ankesh Gupta / Arvind Kumar / Pankaj Jorwal / Ashutosh Biswas / Ravindra Mohan Pandey / Naveet Wig / Randeep Guleria

Journal of Family Medicine and Primary Care, Vol 11, Iss 3, Pp 1140-

Initial experience from India

2022 Volume 1145

Abstract: Background: Hydroxychloroquine (HCQ) had generated considerable interest for coronavirus disease 2019 (COVID-19) prophylaxis. We conducted a prospective observational study at a tertiary care hospital in India, with dedicated COVID-19 care facilities. ... ...

Abstract	Background: Hydroxychloroquine (HCQ) had generated considerable interest for coronavirus disease 2019 (COVID-19) prophylaxis. We conducted a prospective observational study at a tertiary care hospital in India, with dedicated COVID-19 care facilities. Objectives: Primary objective was incidence of adverse effects, secondary objective being efficacy in preventing COVID-19. Methods: Healthcare workers were recruited and grouped based on voluntary HCQ prophylaxis as per national guidelines. Side effects in HCQ group were graded in accordance with national cancer institute-common terminology criteria for adverse events (NCI-CTCAE) version 5.0. At 3–7-week follow-up, groups were compared for COVID-19 exposure, symptoms development and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR results. Results: Among 358 participants recruited, 216 (60.3%) were males and mean age was 31.2 ± 6.6 years. Chemoprophylaxis was initiated by 258 (72%) participants. After loading dose, 7 (2.7%) reported grade 2 and 1 (0.4%) grade 3 adverse effects. Discontinuation of HCQ due to side effects was reported in 11 (4.3%) participants. Electrocardiogram was done by 50 (19.4%) participants on HCQ; no abnormalities were noted. A total of 106 (41%) among those taking and 63 (63%) among those not taking HCQ were tested for SARS-CoV-2 due to influenza-like illness or significant exposure. Among all participants, 25 (6.9%, 95% confidence interval [CI] 4.3–9.6) developed COVID-19 during the study period. In the group taking HCQ, 10 (3.9%) tested positive compared to 15 (15%) in the group not taking HCQ (P < 0.001). Odds ratio with HCQ intake was 0.34 (95% CI 0.13–0.83, P = 0.01) and the number needed to treat was 12. Conclusion: HCQ is safe at the recommended dose for pre-exposure prophylaxis of COVID-19.
Keywords	covid-19 ; healthcare workers ; hydroxychloroquine ; pre-exposure prophylaxis ; sars-cov-2 ; Medicine ; R
Subject code	150
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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