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Article ; Online: Comparison of local versus intramuscular steroid injection in patients with carpal tunnel syndrome: A prospective open label randomized clinical trial.

Kumar, Mritunjai / Singh, Jagbir / Singh, Rajni / Tiwari, Ashutosh / Kumar, Niraj

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2024 Volume 123, Page(s) 55–61

Abstract: Aim: This study compared the efficacy and safety of local corticosteroid injection (LCI) vs intramuscular (IM) corticosteroid injection in mild to moderate carpal tunnel syndrome (CTS).: Methods: This is an open labeled, randomized controlled trial ... ...

Abstract	Aim: This study compared the efficacy and safety of local corticosteroid injection (LCI) vs intramuscular (IM) corticosteroid injection in mild to moderate carpal tunnel syndrome (CTS). Methods: This is an open labeled, randomized controlled trial conducted during December 2021 to August 2023. Eighty-six patients with CTS were randomized in 1:1 ratio to receive either single 40 mg methylprednisolone (MP) injection at the wrist (LCI arm), or single 40 mg MP intramuscular injection (IM arm) in the deltoid. Primary outcome was absolute Symptom Severity Scale (SSS) at 3 months. Secondary outcomes were SSS score at 1-month, Functional Status Scale (FSS) score at 1 and 3 months, and recurrence at 3 months and injection site pain assessed on visual analog (VAS) scale. Results: Median age was 45 (range 22 - 80) years, and 86 % were females. Baseline characteristics were comparable between groups. Mean SSS score at 3 months was similar in two arms (1.72 ± 0.71 vs 2.0 ± 0.93) with mean difference (MD) -0.03 (-0.31 to 0.25, p = 0.83) after adjusting for baseline SSS scores. LCI, however, resulted in significantly better SSS (1.48 ± 0.51 vs 1.88 ± 0.69, adjusted p = 0.04), and FSS scores (1.57 ± 0.44 vs 1.80 ± 0.66, adjusted p = 0.03) at 1 month compared to IM arm. Response rate (67.4 % vs 55.8 %; p = 0.30) and recurrence rate (17.1 % vs 22.6 %, p = 0.74) at 3 months were similar. Injection site pain was severe in LCI arm[median 5 (range 3 - 8) vs median 3 (range 2 - 6)]. Conclusions: In patients with mild to moderate CTS, LCI resulted in better improvement in the BCTQ scores at 1 month compared to IM steroid. However, 3-month's outcome was similar. Intramuscular steroid injection was better tolerated.
MeSH term(s)	Humans ; Carpal Tunnel Syndrome/drug therapy ; Female ; Male ; Middle Aged ; Injections, Intramuscular/methods ; Adult ; Aged ; Methylprednisolone/administration & dosage ; Prospective Studies ; Aged, 80 and over ; Treatment Outcome ; Young Adult ; Glucocorticoids/administration & dosage
Chemical Substances	Methylprednisolone (X4W7ZR7023) ; Glucocorticoids
Language	English
Publishing date	2024-03-26
Publishing country	Scotland
Document type	Journal Article ; Randomized Controlled Trial ; Comparative Study
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2024.03.023
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Article: Dose-Effect Relationship of Motor Nerve Inexcitability on Outcome in Guillain-Barré Syndrome: A Prospective Cohort Study.

Kumar, Mritunjai / Tiwari, Ashutosh / Kumar, Shakti / Singh, Rajni

Annals of Indian Academy of Neurology

2023 Volume 26, Issue 6, Page(s) 936–942

Abstract: Objective: One or more inexcitable motor (IM) nerves are common during electrodiagnostic (EDx) study in Guillain-Barré syndrome (GBS). This study assessed the dose-effect relationship of IM nerves on outcome in patients with acute inflammatory ... ...

Abstract	Objective: One or more inexcitable motor (IM) nerves are common during electrodiagnostic (EDx) study in Guillain-Barré syndrome (GBS). This study assessed the dose-effect relationship of IM nerves on outcome in patients with acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor and/or sensory axonal neuropathy (AMAN and AMSAN). Materials and methods: Eighty-eight GBS patients admitted during May 2018-June 2023 underwent detailed clinical evaluation and EDx study. Admission and follow-up disability were assessed on a 0-10 Clinical Grading Scale (CGS). Outcome was recovery at 6 months, defined as good (CGS <3) and poor (CGS ≥3). Binary multivariate logistic regression with backward elimination was used to calculate independent predictors of outcome. Results: Proportion of patients with complete recovery decreased significantly with increasing numbers of IM nerves ( Conclusion: Although increasing numbers of IM nerves were associated with poor outcome on univariate analysis, they did not predict 6 months' outcome independently. Outcome did not differ between axonal GBS and AIDP among those with IM nerves. IVIg improved outcome in patients with IM nerves.
Language	English
Publishing date	2023-11-26
Publishing country	India
Document type	Journal Article
ZDB-ID	2240174-X
ISSN	1998-3549 ; 0972-2327
ISSN (online)	1998-3549
ISSN	0972-2327
DOI	10.4103/aian.aian_641_23
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Article: Migraine and Tension-type Headache in Parkinson's Disease and Progressive Supranuclear Palsy/Corticobasal Syndrome.

Jatale, Vinayak / Tiwari, Ashutosh / Kumar, Mritunjai / Gupta, Ravi / Kumar, Niraj

Annals of Indian Academy of Neurology

2023 Volume 26, Issue 5, Page(s) 708–714

Abstract: Objective: To compare the prevalence and characteristics of migraine and tension-type headache (TTH) among patients with Parkinson's disease (PD), progressive supranuclear palsy/corticobasal syndrome (PSP/CBS), and healthy controls (HCs).: Methods: ... ...

Abstract	Objective: To compare the prevalence and characteristics of migraine and tension-type headache (TTH) among patients with Parkinson's disease (PD), progressive supranuclear palsy/corticobasal syndrome (PSP/CBS), and healthy controls (HCs). Methods: This cross-sectional study involved the collection of data from consecutive PD (n = 81) and PSP/CBS (n = 21) patients along with 104 HCs. Migraine and TTH were diagnosed using the International Classification of Headache Disorders 3 Results: A comparable proportion of PD and PSP/CBS patients reported lifetime headache (46.9% vs 23.8%; Conclusion: The prevalence and characteristics of migraine and TTH were comparable in PD, PSP/CBS, and HCs. Headache was associated with greater motor severity in PD. Following parkinsonism onset, headache improved in the majority of PD and PSP/CBS patients with lifetime headache.
Language	English
Publishing date	2023-09-25
Publishing country	India
Document type	Journal Article
ZDB-ID	2240174-X
ISSN	1998-3549 ; 0972-2327
ISSN (online)	1998-3549
ISSN	0972-2327
DOI	10.4103/aian.aian_604_23
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Article ; Online: Clinical and Electrophysiological Characteristics of Very Early Guillain-Barré Syndrome.

Kumar, Mritunjai / Dhar, Nikita / Tiwari, Ashutosh / Singh, Jagbir / Jatale, Vinayak

Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society

2023

Abstract: Purpose: This study compared the clinical and electrodiagnostic (EDX) features and long-term outcomes of patients with very early Guillain-Barré syndrome (VEGBS, duration of illness ≤4 days) and those with early/late (>4 days)-presenting GBS.: Methods! ...

Abstract	Purpose: This study compared the clinical and electrodiagnostic (EDX) features and long-term outcomes of patients with very early Guillain-Barré syndrome (VEGBS, duration of illness ≤4 days) and those with early/late (>4 days)-presenting GBS. Methods: One hundred patients with GBS were clinically evaluated and categorized into VEGBS and early/late GBS groups. Electrodiagnostic studies were performed on the bilateral median, ulnar, and fibular motor nerves and the bilateral median, ulnar, and sural sensory nerves. Admission and peak disability were assessed using the 0 to 6 Guillain-Barré Syndrome Disability Scale (GBSDS). The primary outcome was disability at 6 months, which was categorized as complete (GBSDS ≤1) or poor (GBSDS ≥2). The secondary outcomes were frequencies of abnormal electrodiagnostic findings, in-hospital progression, and mechanical ventilation (MV). Results: Patients with VEGBS had higher peak disability (median 5 vs. 4; P = 0.02), frequent in-hospital disease progression (42.9% vs. 19.0%, P < 0.01), needed MV (50% vs. 22.4%; P < 0.01), and less frequent albuminocytologic dissociation (52.4% vs. 74.1%; P = 0.02) than those with early/late GBS. Thirteen patients were lost to follow-up at 6 months (nine patients with VEGBS and four patients with early/late GBS). The proportion of patients with complete recovery at 6 months was comparable (60.6% vs. 77.8%; P = ns). Reduced d-CMAP was the most common abnormality, noted in 64.7% and 71.6% of patients with VEGBS and early/late GBS, respectively (P = ns). Prolonged distal motor latency (≥130%) was more common in early/late GBS than in VEGBS (36.2% vs. 25.4%; P = 0.02), whereas absent F-waves were more frequent in VEGBS (37.7% vs. 28.7%; P = 0.03). Conclusions: Patients with VEGBS were more disabled at admission than those with early/late GBS. However, 6 month's outcomes were similar between the groups. F-wave abnormalities were frequent in VEGBS, and distal motor latency prolongation was common in early/late GBS.
Language	English
Publishing date	2023-04-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	605640-4
ISSN	1537-1603 ; 0736-0258
ISSN (online)	1537-1603
ISSN	0736-0258
DOI	10.1097/WNP.0000000000001001
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Article ; Online: Prognostic Significance of Serial Nerve Conduction in GB Syndrome.

Kalita, Jayantee / Kumar, Mritunjai / Misra, Usha K

Neurology India

2022 Volume 70, Issue 5, Page(s) 1995–2002

Abstract: Background and aims: We evaluated dynamic changes in neurophysiology of Guillain-Barré syndrome (GBS) at different time points and the role of demyelination and axonal burden in predicting outcome.: Methods: Nerve conduction study (NCS) was done in ... ...

Abstract	Background and aims: We evaluated dynamic changes in neurophysiology of Guillain-Barré syndrome (GBS) at different time points and the role of demyelination and axonal burden in predicting outcome. Methods: Nerve conduction study (NCS) was done in 44 GBS patients at admission and at 1 and 3 months, and were categorized into acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor sensory axonal neuropathy (AMSAN), equivocal and in-excitable motor nerve (IMN). The demyelinating and axonal burden on motor NCS at admission, 1 and 3 months were computed and correlated with disability at 3 and 6 months. Disability was assessed using Clinical Grading Scale. Results: Twenty-four (54.3%) had AIDP, 5 (11.4%) AMAN, 12 (27.3%) equivocal and 3 (6.8%) had IMN at admission. Maximum instability was noted in equivocal group; majority of whom became AIDP at three months. Neurophysiological subtypes at different time points did not correlate with 6 months disability, but demyelination burden at admission (r = -0.42; P = 0.005) and axonal burden at one month (r = 0.43; P = 0.04) correlated with six months disability. Conclusion: Inverse correlation of axonal burden at one and three months with disability suggests role of secondary axonal damage in predicting outcome. Repeat NCS at one month helps in categorizing GBS and also in prognostication.
MeSH term(s)	Humans ; Prognosis ; Neural Conduction/physiology ; Guillain-Barre Syndrome/diagnosis ; Guillain-Barre Syndrome/complications ; Axons ; Amantadine
Chemical Substances	Amantadine (BF4C9Z1J53)
Language	English
Publishing date	2022-09-15
Publishing country	India
Document type	Journal Article
ZDB-ID	415522-1
ISSN	1998-4022 ; 0028-3886
ISSN (online)	1998-4022
ISSN	0028-3886
DOI	10.4103/0028-3886.359245
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Zs.A 698: Show issues

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Article: Guillain-Barre Syndrome Associated with Scrub Typhus Infection: Uncommon or Under-Reported!

Kumar, Mritunjai / Dhar, Nikita / Madhaw, Govind / Tiwari, Ashutosh / Kumar, Niraj

Annals of Indian Academy of Neurology

2022 Volume 25, Issue 6, Page(s) 1231–1233

Language	English
Publishing date	2022-12-03
Publishing country	India
Document type	Journal Article
ZDB-ID	2240174-X
ISSN	1998-3549 ; 0972-2327
ISSN (online)	1998-3549
ISSN	0972-2327
DOI	10.4103/aian.aian_559_22
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Article: Sleep Disorders in Patients with Parkinson's Disease during COVID-19 Pandemic: A Case-Control Study.

Desai, Ishita / Gupta, Ravi / Kumar, Mritunjai / Tiwari, Ashutosh / Kumar, Niraj

Annals of Indian Academy of Neurology

2022 Volume 25, Issue 3, Page(s) 394–400

Abstract: Objective: To assess the impact of coronavirus disease 2019 (COVID-19) pandemic on sleep disorders among Parkinson's disease (PD) patients using validated questionnaires.: Materials and methods: This prospective study involved 50 PD patients and 50 ... ...

Abstract	Objective: To assess the impact of coronavirus disease 2019 (COVID-19) pandemic on sleep disorders among Parkinson's disease (PD) patients using validated questionnaires. Materials and methods: This prospective study involved 50 PD patients and 50 age, gender, and body mass index-matched controls. All participants underwent assessment of cognition using Montreal Cognitive Assessment scale, sleep quality using Parkinson's disease sleep scale-2 (PDSS-2; for PD patients) and Pittsburgh Sleep Quality Index (PSQI; for PD patients and healthy controls), excessive daytime sleepiness (EDS) using Epworth sleepiness scale (ESS), insomnia symptoms and severity using insomnia severity index (ISI), restless legs syndrome (RLS) using International RLS Study Group criteria, rapid eye movement sleep behavior disorder (RBD) using RBD Single-Question Screen (RBD1Q), and depression using Patient Health Questionnaire-9 scale. Results: Eighty-eight percent of PD patients reported one or more sleep disorders, compared to 28% controls. While 72% of PD patients reported poor sleep quality (PDSS-2 ≥15, PSQI >5), 60% had insomnia, 58% reported RBD, 50% had EDS, and 36% reported RLS. Depressive symptoms were reported by 70% patients. PD patients with and without poor sleep quality were comparable with regards to demographic and clinical variables, except for depressive symptoms ( Conclusion: Prevalence of sleep disorders increased in PD patients during the COVID-19 pandemic. Prevalence of EDS, RBD, and RLS in PD patients was higher compared to that reported in studies during the pre-COVID-19 times. Presence of depressive symptoms was a significant correlate of presence of sleep disorders in PD patients.
Language	English
Publishing date	2022-06-24
Publishing country	India
Document type	Journal Article
ZDB-ID	2240174-X
ISSN	1998-3549 ; 0972-2327
ISSN (online)	1998-3549
ISSN	0972-2327
DOI	10.4103/aian.aian_255_22
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Article ; Online: Standard versus sequential anti-tubercular treatment in patients with tuberculous meningitis: a randomized controlled trial.

Misra, Usha Kant / Kumar, Mritunjai / Kalita, Jayantee

Transactions of the Royal Society of Tropical Medicine and Hygiene

2020 Volume 115, Issue 1, Page(s) 94–102

Abstract: Background: To compare the safety and efficacy of sequential anti-tubercular treatment (ATT) regimen with the standard regimen in tuberculous meningitis (TBM).: Methods: This single-centre, open-label, parallel group randomized controlled trial was ... ...

Abstract	Background: To compare the safety and efficacy of sequential anti-tubercular treatment (ATT) regimen with the standard regimen in tuberculous meningitis (TBM). Methods: This single-centre, open-label, parallel group randomized controlled trial was conducted from May 2017 to June 2019 in India. Treatment-naïve patients with TBM fulfilling the inclusion criteria were randomized to four drug ATT regimens (rifampicin, isoniazid, ethambutol and pyrazinamide) administered either simultaneously (standard arm) or one after another (sequential arm) in a 1 : 1 ratio. The primary endpoint was drug-induced hepatitis (DIH) and the secondary endpoints were in-hospital death and disability at 3 and 6 months using a modified Rankin Scale. Results: A total of 97 patients with TBM were recruited; 15 did not meet the inclusion criteria and 2 refused to participate. The median age of the patients was 26 y (range 15-75) and 37 (46.2%) were males. The patients in the sequential arm had fewer cases of DIH (20% vs 42.5%; p=0.03). The patients in the sequential arm had lower in-hospital mortality (2.5% vs 17.5%; p=0.025) and better 6-month outcomes (25.0% vs 50.0%; p=0.02) compared with the standard arm. Conclusions: Sequential ATT was associated with a lower frequency of DIH, lower in-hospital mortality and better 6-month outcome. Trial registration: Clinical Trials Registry of India (ctri.nic.in) identifier: REF/2016/09/012214/CTRI/2017/10/010072.
MeSH term(s)	Antitubercular Agents/adverse effects ; Hospital Mortality ; Humans ; India ; Isoniazid/adverse effects ; Male ; Treatment Outcome ; Tuberculosis, Meningeal/drug therapy
Chemical Substances	Antitubercular Agents ; Isoniazid (V83O1VOZ8L)
Language	English
Publishing date	2020-11-17
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	441375-1
ISSN	1878-3503 ; 0035-9203
ISSN (online)	1878-3503
ISSN	0035-9203
DOI	10.1093/trstmh/traa144
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Article ; Online: Serial single breath count is a reliable tool for monitoring respiratory functions in Guillain-Barré Syndrome.

Kalita, Jayantee / Kumar, Mritunjai / Misra, Usha K

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2020 Volume 72, Page(s) 50–56

Abstract: In this study, we correlate single breath count (SBC) with arterial blood gas (ABG) parameters to derive a cutoff point for intubation and mechanical ventilation (MV) in Guillain-Barré Syndrome (GBS). Ninety-four GBS patients underwent serial SBC at 2 Hz ...

Abstract	In this study, we correlate single breath count (SBC) with arterial blood gas (ABG) parameters to derive a cutoff point for intubation and mechanical ventilation (MV) in Guillain-Barré Syndrome (GBS). Ninety-four GBS patients underwent serial SBC at 2 Hz using an audio program. ABG was done at admission, and repeated if SBC declined. The patients were intubated based on "the modified intubation criteria" as follows (a + b or c): (a) hypoxia (PaO
MeSH term(s)	Blood Gas Analysis/instrumentation ; Blood Gas Analysis/methods ; Blood Gas Analysis/standards ; Female ; Guillain-Barre Syndrome/complications ; Guillain-Barre Syndrome/diagnosis ; Guillain-Barre Syndrome/therapy ; Humans ; Hypoxia/diagnosis ; Hypoxia/etiology ; Hypoxia/therapy ; Male ; Middle Aged ; Reproducibility of Results ; Respiration, Artificial/methods ; Spirometry/instrumentation ; Spirometry/methods ; Spirometry/standards
Language	English
Publishing date	2020-01-22
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2020.01.032
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Zs.A 3999: Show issues

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Article ; Online: Prediction models for mechanical ventilation and outcome in Guillain-Barré syndrome.

Kumar, Mritunjai / Kalita, Jayantee / Kant Misra, Usha / Dhar, Nikita

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2021 Volume 92, Page(s) 131–135

Abstract: Various prediction models have been formulated to predict the need for mechanical ventilation (MV). In this study, we compare the sensitivity and specificity of Erasmus GBS Respiratory Insufficiency Score (EGRIS) and Sharshar score with single breath ... ...

Abstract	Various prediction models have been formulated to predict the need for mechanical ventilation (MV). In this study, we compare the sensitivity and specificity of Erasmus GBS Respiratory Insufficiency Score (EGRIS) and Sharshar score with single breath count (SBC) at 2 Hz to assess their usefulness in predicting MV and functional outcome. The primary outcome was prediction of MV and relative usefulness of all three models based on sensitivity and specificity. The secondary outcome was functional recovery at 6 months using the cut off points for MV and functional outcome at 6months was assessed using Hughes scale and categorized as good (<2) and poor (≥2). The median age was 30 years, and 64 (69.6%) were males. The sensitivity and specificity of EGRIS score was 78.1% and 67.2%, Sharshar score was 75.0% and 64.1%, and SBC at 2 Hz was 78.1% and 75.0%. The area under the receiver operating curves was maximum for SBC at 2 Hz (0.86) compared to other models, although insignificant. EGRIS score < 5 had better functional recovery compared to those with score ≥ 5 (66% vs 34%, p = 0.001). Similarly, in Sharshar score, 23/59 (39%) with score ≥ 4 had good recovery compared to 36 (61%) with score < 4 (p = 0.01). All the three models have comparable predictive values for MV. Outcome prediction is the best with EGRIS.
MeSH term(s)	Adult ; Guillain-Barre Syndrome/diagnosis ; Guillain-Barre Syndrome/therapy ; Humans ; Male ; Prognosis ; Recovery of Function ; Respiration, Artificial ; Respiratory Insufficiency/diagnosis ; Respiratory Insufficiency/etiology ; Respiratory Insufficiency/therapy
Language	English
Publishing date	2021-08-14
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2021.07.060
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