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Article: Association Between Blood Lead Levels and Hypertension in a South Indian Population: A Case-Control Study.

Maslekar, Anirudh / Kumar, Anil / Krishnamurthy, Vishwanath / Kulkarni, Ashwin / Reddy, Megha

2022 Volume 14, Issue 2, Page(s) e22277

Abstract: Background Exposure to lead and its accumulation in the body can lead to progressive adverse effects, including increased blood pressure which is associated with the onset of cardiovascular diseases. In this study, we aimed to determine the relationship ... ...

Abstract	Background Exposure to lead and its accumulation in the body can lead to progressive adverse effects, including increased blood pressure which is associated with the onset of cardiovascular diseases. In this study, we aimed to determine the relationship between blood lead levels and blood pressure. In addition, we compared blood lead levels between hypertensives and normotensives to determine relationships, if any, between lead exposure and high blood pressure. Methodology This was a hospital-based, case-control study. In total, 102 individuals (hypertensives = 51, normotensives = 51) were included in this study. Hypertensive patients (defined as systolic blood pressure (SBP) of ≥140 mmHg, diastolic blood pressure (DBP) of ≥90 mmHg, or taking antihypertensive medication for regulating blood pressure) were considered to be study cases and normotensive individuals were considered to be study controls. Blood lead levels were compared between the two groups, and the effects of blood lead levels on SBP and DBP were estimated. The blood lead levels were measured using optical emission spectrometry. Results The mean blood lead level among hypertensive individuals (5.5743 ± 1.77 µg/dL) was significantly higher compared to normotensive individuals (4.5029 ± 1.3213 µg/dL, P = 0.001). A positive correlation was detected between blood lead levels and SBP (r = 0.304, P = 0.002). However, no significant correlation was found between blood lead levels and DBP. Conclusions Blood lead levels were significantly higher in hypertensive patients compared to normotensive individuals. A significant positive correlation was observed between blood lead levels and SBP.
Language	English
Publishing date	2022-02-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.22277
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Serum Cystatin C Levels as a Predictor of Severity and Mortality Among Patients With COVID-19 Infection.

Prasad, Kavya / Kulkarni, Ashwin / K, Navikala / Gowda, Vanitha / Shaikh, Mohammed Aslam

Cureus

2023 Volume 15, Issue 7, Page(s) e42003

Abstract: Introduction: The pandemic caused by SARS Corona Virus-2 (COVID-19) has caused widespread mortality globally. The hallmark of the disease is the "cytokine storm," which is caused due to dysregulated immune system activation. Numerous inflammatory ... ...

Abstract	Introduction: The pandemic caused by SARS Corona Virus-2 (COVID-19) has caused widespread mortality globally. The hallmark of the disease is the "cytokine storm," which is caused due to dysregulated immune system activation. Numerous inflammatory markers are used to predict the severity and mortality of the infection. Serum Cystatin C levels are associated with immune responses to exogenous and endogenous antigens. Our study was done to assess serum cystatin C as a marker of severity and mortality among patients admitted with COVID-19 infection. Methodology: This cross-sectional study was conducted in a tertiary care center in South India. Sixty-nine patients with mild and severe COVID-19 infection admitted to the hospital were included in the study. Serum Cystatin C levels were estimated at admission. The levels were correlated with disease severity and mortality. Receiver operating characteristic curves (ROCs) was constructed for Cystatin C to predict severity and mortality. The computation of sensitivity, specificity, and positive and negative predictive values was done using optimal cut-off points. SPSS 18 was used for the statistical analysis. Version 18.0 of PASW Statistics for Windows. SPSS Inc., Chicago. Results: Out of 69 patients, 28 (40.5%) had a mild illness, and 41 patients (59.4%) had severe COVID-19 illness. Mean serum Cystatin C levels measured at the time of admission among patients with mild illness was 1.83 (SD-1.53), and among patients with severe illness was 3.84 (SD- 2.59) (p<0.001). The area under receiver operating characteristic curves (ROC) for serum cystatin C for predicting COVID-19 severity and mortality was 0.904 and 0.768, respectively (p<0.001). Conclusion: Patients with severe COVID-19 disease had considerably higher serum levels of Cystatin C than those with mild COVID-19 illness. Cystatin C levels can be useful for predicting mortality and severity among patients admitted with COVID-19 infection.
Language	English
Publishing date	2023-07-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.42003
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Article: Study of Serum Uric Acid Levels in Patients of Metabolic Syndrome in a Tertiary Care Centre in South India.

N, Rohith / T, Anil Kumar / Kulkarni, Ashwin / Subhash, Nagarjun

The Journal of the Association of Physicians of India

2022 Volume 70, Issue 4, Page(s) 11–12

Abstract: The prevalence of Hyperuricemia is increasing even in developing countries. Hyperuricemia may be asymptomatic in many cases. It has been known to be associated with metabolic syndrome. In this study we have tried to see the association between serum uric ...

Abstract	The prevalence of Hyperuricemia is increasing even in developing countries. Hyperuricemia may be asymptomatic in many cases. It has been known to be associated with metabolic syndrome. In this study we have tried to see the association between serum uric acid levels and the components of metabolic syndrome in a tertiary care centre in South India. Material: It was a case-control, observational study carried out in the Medicine OPD of Ramaiah Medical College and Hospital. 40 subjects who were found to be having metabolic syndrome as per NCEP-ATP III criteria and 40 age and gender matched controls were enrolled in the study. They were subjected to detailed history taking, clinical examination, investigations like fasting and 2-hour blood glucose levels, fasting lipid profile and serum uric acid levels. Mean serum uric acid levels were assessed in both cases and controls. The association between serum uric acid levels and the components of metabolic syndrome was also studied. Observation: Mean serum uric acid levels in cases were 7.9 mg/dL in men and 6.8 mg/dL in women. Mean serum uric acid levels in controls were 4.8 mg/dL in men and 3.9 mg/dL in women. This difference was statistically significant (p= 0.001). Among the subjects having metabolic syndrome, 28 subjects (65%) had hyperuricemia. Among the controls 10 subjects (25%) had hyperuricemia. Conclusion: The above study shows that serum uric acid levels are significantly elevated in patients with metabolic syndrome. The association of elevated levels of uric acid was seen with all the components of metabolic syndrome.
MeSH term(s)	Female ; Humans ; Hyperuricemia/complications ; Hyperuricemia/epidemiology ; Male ; Metabolic Syndrome ; Prevalence ; Tertiary Care Centers ; Uric Acid
Chemical Substances	Uric Acid (268B43MJ25)
Language	English
Publishing date	2022-04-20
Publishing country	India
Document type	Journal Article ; Observational Study
ZDB-ID	800766-4
ISSN	0004-5772
ISSN	0004-5772
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Article ; Online: Prehospital hemorrhage management in low- and middle-income countries: A scoping review.

Kulkarni, Ashwin J / Batra, Amber / Eisner, Zachary J / Delaney, Peter G / Pine, Haleigh / Klapow, Maxwell C / Raghavendran, Krishnan

World journal of surgery

2024 Volume 48, Issue 3, Page(s) 547–559

Abstract: Introduction: Low- and middle-income countries (LMICs) account for 90% of deaths due to injury, largely due to hemorrhage. The increased hemorrhage mortality burden in LMICs is exacerbated by absent or ineffective prehospital care. Hemorrhage management ...

Abstract	Introduction: Low- and middle-income countries (LMICs) account for 90% of deaths due to injury, largely due to hemorrhage. The increased hemorrhage mortality burden in LMICs is exacerbated by absent or ineffective prehospital care. Hemorrhage management (HM) is an essential component of prehospital care in LMICs, yet current practices for prehospital HM and outcomes from first responder HM training have yet to be summarized. Methods: This review describes the current literature on prehospital HM and the impact of first responder HM training in LMICs. Articles published between January 2000 and January 2023 were identified using PMC, MEDLINE, and Scopus databases following PRISMA-ScR guidelines. Inclusion criteria spanned first responder training programs delivering prehospital care for HM. Relevant articles were assessed for quality using the Newcastle-Ottawa scale. Results: Of the initial 994 articles, 20 met inclusion criteria representing 16 countries. Studies included randomized control trials, cohort studies, case control studies, reviews, and epidemiological studies. Basic HM curricula were found in 15 studies and advanced HM curricula were found in six studies. Traumatic hemorrhage was indicated in 17 studies while obstetric hemorrhage was indicated in three studies. First responders indicated HM use in 55%-76% of encounters, the most frequent skill they reported using. Mean improvements in HM knowledge acquisition post-course ranged from 23 to 58 percentage points following training for pressure and elevation, gauze application, and tourniquet application. Conclusions: Our study summarizes the current literature on prehospital HM in LMICs pertaining to epidemiology, interventions, and outcomes. HM resources should be a priority for further development.
MeSH term(s)	Humans ; Emergency Medical Services ; Developing Countries ; Hemorrhage/etiology ; Hemorrhage/therapy ; Curriculum ; Emergency Responders
Language	English
Publishing date	2024-01-24
Publishing country	United States
Document type	Systematic Review ; Review ; Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1002/wjs.12054
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Article: Study of Disease Severity and Outcomes in COVID-19 Patients With Chronic Kidney Disease at a Tertiary Care Hospital in South India.

Ramamurthy, Pranav / R, Rajashekhar / Kulkarni, Ashwin / Prabhu, Divya / Kumar, Anil / Ravindra, Rahul / Ramamurthy, Prakriti

Cureus

2022 Volume 14, Issue 1, Page(s) e21413

Abstract: Background: Coronavirus disease 2019 (COVID-19) disproportionately affects individuals with various comorbidities. Among these, chronic kidney disease (CKD) has been shown to be strongly associated with the progression to severe disease. This study ... ...

Abstract	Background: Coronavirus disease 2019 (COVID-19) disproportionately affects individuals with various comorbidities. Among these, chronic kidney disease (CKD) has been shown to be strongly associated with the progression to severe disease. This study aimed to assess the severity and disease outcomes in patients with COVID-19 infection and CKD. Methods: This is a retrospective study conducted at a tertiary care hospital from July 2021 to September 2021. The case records of patients with CKD and COVID-19 were studied. They were compared with age and gender-matched controls equally. The presenting symptoms, clinical course, severity of illness, laboratory markers, need for ventilator support, and mortality outcomes were studied. Results: In total, 40 CKD and 40 non-CKD patients with COVID-19 were included in the study. It was also observed that among the patients with CKD, more patients had fever, breathlessness, and diarrhea. The requirement for noninvasive ventilation, ventilator, and inotropes was on the higher average for patients with CKD. Overall mortality was 27.5% in the CKD group and 2.5% in the non-CKD group, which was statistically significant (p = 0.002). Conclusions: COVID-19 patients with CKD had more severe illnesses with a requirement of ventilator support and had higher mortality than the patients without CKD. Patients with CKD are a key subset of patients with COVID-19 for whom more aggressive early treatment and stricter preventive measures may be beneficial.
Language	English
Publishing date	2022-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.21413
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Article: Platelet Indices and Platelet to Lymphocyte Ratio (PLR) as Markers for Predicting COVID-19 Infection Severity.

Ravindra, Rahul / Ramamurthy, Prakriti / Aslam S, Shaikh Mohammed / Kulkarni, Ashwin / K, Suhail / Ramamurthy, Pranav S

Cureus

2022 Volume 14, Issue 8, Page(s) e28206

Abstract: Background Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (or coronavirus disease 2019; COVID-19) has caused a large number of infections across the globe. Numerous markers are being used to predict the severity of infection. This ... ...

Abstract	Background Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (or coronavirus disease 2019; COVID-19) has caused a large number of infections across the globe. Numerous markers are being used to predict the severity of infection. This study was undertaken to assess the utility of platelet count, mean platelet volume (MPV), platelet distribution width (PDW), and platelet lymphocyte ratio (PLR) as markers of severity and mortality among patients with COVID-19 infection. Methodology This is a retrospective study conducted in a tertiary care center in India from April 2021 to June 2021. Patients admitted with COVID-19 infection were included in the study. Based on the severity, patients were categorized into the mild and severe (moderate severity included) groups. Platelet count, MPV, PDW, and PLR done at admission were studied and correlated with the disease severity and mortality. Statistics The independent t-test was used to compare the variables. The receiver operating characteristic (ROC) curve was done to identify the cut-off value. Statistical analysis was performed using SPSS 18 software (SPSS Inc. Released 2009. PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc). Results One hundred patients admitted with COVID-19 infection were studied. 51 patients had a mild and 49 had a severe infection. The mean PLR was 141.40 among patients with mild illness and 252.6 with severe infection (P<0.001). The mean PLR among survivors was 104.4 (SD-23.56) and among nonsurvivors was 302.78 (SD-34.5) (P<0.001). There was no statistically significant difference between the two groups with respect to platelet count, MPV, and PDW. Conclusion PLR was found to be a reliable marker of severity and mortality among patients with COVID-19 illness.
Language	English
Publishing date	2022-08-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.28206
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Article: A study to assess the outcome in COVID-19 confirmed cases receiving Remdesivir as compared to conventional therapy: Medical records-based audit.

Prabhu, Divya / Kulkarni, Ashwin / Thyagaraj, Vijayashree / Balaji, Vijay / Kumar, Thimmaiah Anil / Rao, Medha Y

Journal of family medicine and primary care

2022 Volume 11, Issue 6, Page(s) 3133–3137

Abstract: Introduction: COVID-19 infection caused by SARS-Corona virus-2 (SARS-CoV-2) has caused large number of infections and mortality globally. There are no proven medications to prevent and treat COVID-19, nevertheless several potential pharmacotherapeutic ... ...

Abstract	Introduction: COVID-19 infection caused by SARS-Corona virus-2 (SARS-CoV-2) has caused large number of infections and mortality globally. There are no proven medications to prevent and treat COVID-19, nevertheless several potential pharmacotherapeutic agents have been tried. Remdesivir was found to be effective in few studies. Aims: To assess the outcome in COVID-19 confirmed cases receiving Remdesivir as compared to conventional therapy. Methodology: This study was conducted in a tertiary hospital in South India after the approval of the Institutional ethical committee. It was a medical records-based retrospective, longitudinal study. Medical records of the inpatients with confirmed COVID-19 infection were reviewed from the period of June 15, 2020 to September 15, 2020. This study was conducted to assess the clinical and laboratory profile and outcome in the patients admitted with moderate and severe COVID-19 disease who received Remdesivir. Statistical analysis: The analysis was done using SPSS Inc. released 2009, PASW statistics for Windows version 18.0, Chicago. Results: One hundred eleven (N = 111) patients were included in the study. 56 patients received the conventional treatment (Hydroxychloroquine HCQ) and 55 patients received Remdesivir. It was seen that among patients treated with HCQ, 24 (42.9%) required non-invasive ventilation and seven (12.7%) patients treated with Remdesivir required it ( Conclusion: The study demonstrates that Remdesivir does have benefit in reducing the mortality and duration of hospital stay. There was reduced requirement of non-invasive and invasive ventilation among patients treated with Remdesivir.
Language	English
Publishing date	2022-06-30
Publishing country	India
Document type	Journal Article
ZDB-ID	2735275-4
ISSN	2278-7135 ; 2249-4863
ISSN (online)	2278-7135
ISSN	2249-4863
DOI	10.4103/jfmpc.jfmpc_1780_21
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Article: Evaluation of Uric Acid to Albumin Ratio as a Marker of Coronary Artery Disease Severity in Acute Coronary Syndrome: A Cross-Sectional Study.

Sultana, Sana / K, Mohammed Suhail / Prakash, Varsha Rakshitha / Karthikeyan, Aditya / Aslam S, Shaikh Mohammed / C, Suhas G / Kulkarni, Ashwin

Cureus

2023 Volume 15, Issue 11, Page(s) e49454

Abstract: Background: Coronary artery disease (CAD) is a widespread cause of morbidity and mortality. Serum uric acid, a mediator of endothelial dysfunction and inflammation in vascular disease, can increase the risk of atherosclerosis, contributing to CAD. As ... ...

Abstract	Background: Coronary artery disease (CAD) is a widespread cause of morbidity and mortality. Serum uric acid, a mediator of endothelial dysfunction and inflammation in vascular disease, can increase the risk of atherosclerosis, contributing to CAD. As serum albumin inhibits platelet activation and aggregation, low levels of it can contribute to platelet-induced coronary artery stenosis. Limited studies have been conducted worldwide in evaluating the role of uric acid to albumin ratio (UAR) in predicting severity or poor outcomes in acute coronary syndrome (ACS) patients. This study was undertaken to assess the role of UAR as a predictor of CAD severity, which can facilitate the identification of high-risk patients. Methodology: A hospital-based analytical cross-sectional study was conducted in an urban tertiary healthcare center for a period of two months between June and August of 2022. A total of 100 ACS patients were included in the study. The study population included patients above the age of 18 years diagnosed with ACS who underwent a coronary angiography. Coronary angiograms were used to diagnose the presence of CAD, and its severity was assessed using Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores (SS). The correlation of UAR with CAD severity using SS was studied and compared between three varieties of ACS: ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). Statistics: Chi-squared tests were used to determine statistical significance for qualitative data. Independent t-tests were used to identify the mean difference between two quantitative variables. Receiver operating characteristic (ROC) curves were constructed for UAR and high SS. A comparison between UAR and neutrophil to lymphocyte ratio (NLR) as a predictor of disease severity was done. ROC and optimal cutoff points were chosen to calculate sensitivity, specificity, and positive and negative predictive values. Microsoft Excel (Microsoft, Redmond, WA, USA) and SPSS V22.0 (IBM Corp., Armonk, NY, USA) were used to analyze the data. Results: A total of 100 ACS patients were included in the study and divided into two groups on the basis of SS, with 74% showing low severity and 26% showing intermediate-high severity. There was a statistically significant difference found between older age and SS (p=0.017). Our study showed 74% (n=74) of the patients were male and 26% (n=26) were female. It also revealed that 75.7% (n=56) of the male patients were in the low-severity group, and 24.3% (n=18) of males were in the intermediate-high severity group. 69.2% (n=18) of the female patients were in the low-severity group, and 30.8% (n=8) were in the intermediate-high severity group. Of the 100 patients, 55% were diagnosed with STEMI, of which 69.1% were in the low-severity group, and 30.9% were in the intermediate-high severity group. Among all the patients 33% of the patients were diagnosed as NSTEMI, of which 72.7% were in the low-severity group, and 27.3% were in the intermediate-high severity group. Twelve percent of the patients were diagnosed with UA, and 100% of these patients were in the low-severity group. The mean UAR was 1.40 ± 0.38 in the low-severity group and 1.29 ± 0.46 in the intermediate-high severity group (p=0.22). Conclusion: Our study yielded no statistically significant difference in UAR among varying severities of CAD.
Language	English
Publishing date	2023-11-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.49454
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Article: Neuromyelitis optica spectrum disorder with AQP4-IgG presenting as area postrema syndrome and progressing to myelitis: A rare case report.

Jagannath, Preethi / K, Mohammed Suhail / S, Shaikh Mohammed Aslam / Kulkarni, Ashwin / Prashanth, Polasu Sri Satya Sai / Madan, Hritik / Anand, Ayush

Clinical case reports

2023 Volume 11, Issue 7, Page(s) e7636

Abstract: Key clinical message: Neuromyelitis optica spectrum disorders can less commonly present with area postrema syndrome progressing to myelitis. Management involves intravenous glucocorticoids, plasma exchange, and preventive immunotherapy.: Abstract: ... ...

Abstract	Key clinical message: Neuromyelitis optica spectrum disorders can less commonly present with area postrema syndrome progressing to myelitis. Management involves intravenous glucocorticoids, plasma exchange, and preventive immunotherapy. Abstract: Neuromyelitis optica spectrum disorders can less commonly present with area postrema syndrome progressing to myelitis. The majority of patients have positive AQP4-Ab. Diagnosis is based on clinical and imaging findings. These patients can be treated with intravenous glucocorticoids, plasma exchange, and preventive immunotherapy.
Language	English
Publishing date	2023-07-04
Publishing country	England
Document type	Case Reports
ZDB-ID	2740234-4
ISSN	2050-0904
ISSN	2050-0904
DOI	10.1002/ccr3.7636
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Article ; Online: Biomechanical Comparison of Periprosthetic Femoral Fracture Risk in Three Femoral Components in a Sawbone Model.

Windell, Logan / Kulkarni, Ashwin / Alabort, Enrique / Barba, Daniel / Reed, Roger / Singh, Harvinder P

The Journal of arthroplasty

2020 Volume 36, Issue 1, Page(s) 387–394

Abstract: Background: The increasing use of orthopedic total hip arthroplasty implants has led to a consequent rise in the incidence of associated periprosthetic fractures (PPFs). Analysis of the National Joint Registry data showed the choice of cemented hip stem ...

Abstract	Background: The increasing use of orthopedic total hip arthroplasty implants has led to a consequent rise in the incidence of associated periprosthetic fractures (PPFs). Analysis of the National Joint Registry data showed the choice of cemented hip stem influenced the risk of a PPF occurring. However, the effect of implant design in relation to the risk of PPFs has not been investigated. Methods: The main objective is to compare the biomechanics of PPFs as a failure of the Exeter V40, CPT, and DePuy C-Stem stems in a composite Sawbone model to identify whether a difference in the risk of fracture exists between them. Twenty-six Sawbones were divided into 3 groups, cemented with the Stryker Exeter, Zimmer CPT, or DePuy C-Stem and then torqued to fracture. Results: When compared with the Exeter, the CPT- and C-Stem-implanted Sawbone models would sustain PPFs at a statistically significantly lower rotation to failure (20.1° and 26.7° vs 33.6°, P < .01) and torque to failure (124 Nm and 143 Nm vs 174 Nm, P < .01) values. The energy release rate at failure for the Exeter was significantly higher than that for the CPT and C-Stem (61.2 Nm vs 21.8 Nm and 38.6 Nm, P < .01), which led to more comminution. Conclusion: The CPT- and C-Stem-implanted femurs, although fracturing earlier, fractured in a simple pattern with less comminution. The differences in stem design mean higher stress at the critical point of failure in the CPT implanted femur compared with the Exeter and DePuy, which is likely the reason behind the observed increased risk of PPFs with the CPT implant.
MeSH term(s)	Arthroplasty, Replacement, Hip/adverse effects ; Femoral Fractures/epidemiology ; Femoral Fractures/etiology ; Femoral Fractures/surgery ; Femur/surgery ; Hip Prosthesis/adverse effects ; Humans ; Periprosthetic Fractures/epidemiology ; Periprosthetic Fractures/etiology ; Periprosthetic Fractures/surgery ; Prosthesis Design
Language	English
Publishing date	2020-07-30
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2020.07.061
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