Publications by authors named "Neeraj Kumar Gupta"

Tuberculosis (TB) regained its position globally as the leading cause of mortality from a single infectious agent after being surpassed by COVID-19 for 3 years consecutively. Host genetic factors, particularly cytokine gene polymorphisms, play a significant role in influencing susceptibility to TB. Interleukin-18 (IL-18) is a proinflammatory cytokine involved in immune regulation against Mycobacterium tuberculosis.

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Pleural biopsies are often required to establish a diagnosis in exudative pleural effusions, which remain undiagnosed after initial pleural fluid analysis. Medical thoracoscopy offers a high diagnostic yield but has limited availability in resource-constrained settings. This prospective comparative study evaluated the diagnostic yield between ultrasound-guided closed pleural biopsy and medical thoracoscopy among patients with undiagnosed exudative pleural effusions with pleural-based lesions at least 10 mm in size.

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Patients undergoing endobronchial ultrasound-guided fine needle aspiration may have multiple comorbidities, contributing to higher risks of hypoxia and adverse events, such as arrhythmias. The current study compared the efficacy of two oxygenation modalities: the high-flow nasal cannula (HFNC) vs. conventional oxygen therapy (CNC).

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Article Synopsis
  • - This study aimed to investigate the relationship between SARS-CoV-2 variants and the severity of COVID-19 across India, using a nationwide platform for molecular epidemiology analysis.
  • - Conducted from September 2021 to December 2022, the cohort included nearly 5,000 participants, with successful sequencing of 2,723 samples, revealing key insights about different virus variants and their impacts on health outcomes.
  • - Findings demonstrated that the Delta variant significantly raised the risk of severe disease, while Omicron presented a milder illness, with age, comorbidities, and lack of vaccination identified as major risk factors for mortality.
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Increased susceptibility to bacterial infections like tuberculosis (TB) is one of the complications of type 2 diabetes, however the underlying mechanisms remains poorly characterized. To explore how chronic hyperglycemia in diabetes affects progression of active TB, we examined mRNA expression of M1 (proinflammatory) and M2 (anti-inflammatory) cytokines/markers, in monocyte-derived macrophages obtained from patients with PTB + DM (pulmonary TB + diabetes mellitus type 2), patients with DM alone, patients with PTB alone, and healthy individuals (controls). Our findings indicate a dysregulated cytokine response in patients with both PTB and DM, characterized by decreased expression levels of interferon-gamma (IFN-γ) and inducible nitric oxide synthase (iNOS), along with increased expression levels of interleukin-1 beta (IL-1β) and CD206.

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Endobronchial ultrasound (EBUS)-guided mediastinal cryobiopsy and intranodal forceps biopsy are newer modalities for sampling mediastinal lymph nodes. The data regarding the diagnostic yield of both modalities is scarce. Patients were recruited retrospectively from our existing database.

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Chronic pulmonary aspergillosis (CPA) is a progressive, debilitating clinical condition associated with significant morbidity. Surgery is the mainstay of treatment for life-threatening hemoptysis in symptomatic patients with simple aspergillomas. However, in patients with chronic cavitary pulmonary aspergillosis, surgical removal of aspergillomas is fraught with difficulty due to debilitating nature of the illness.

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  • Monitoring the thickness of the parasternal intercostal muscles can provide important insights into a patient's ability to wean off mechanical ventilation.
  • The study aimed to assess the effectiveness of parasternal intercostal muscle thickness fraction (PICTF%) as a predictor for weaning outcomes in patients who were intubated for over 48 hours.
  • Results showed that a PICTF% of 15.38% or higher accurately predicted extubation failure, with a sensitivity of 75% and specificity of 87.8%.
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  • - The study aimed to compare immediate withdrawal of non-invasive ventilation (NIV) versus a stepwise reduction in patients with chronic obstructive pulmonary disease (COPD) experiencing acute hypercapnic respiratory failure (AHcRF).
  • - A total of 60 COPD patients were divided into two groups: Group A underwent immediate NIV withdrawal, while Group B had a gradual reduction in NIV duration.
  • - Results showed that both methods had similar success rates for NIV withdrawal, but Group A required less NIV time and had a shorter hospital stay compared to Group B, making immediate withdrawal a feasible option.
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Double network sodium alginate/chitosan hydrogels were prepared using calcium chloride (CaCl) and glutaraldehyde as the crosslinking agents by the ionotropic interaction method for controlled metronidazole release. The effect of polymer ratios and CaCl amount is investigated by the developing porosity, gel fraction, and extent of swelling in simulated physiological fluids. Interaction between the polymers with the formation of crosslinked structures, good stability, phase nature, and morphology of the hydrogels is revealed by Fourier-transform infrared spectroscopy, thermogravimetric analysis, X-ray diffraction, and scanning electron microscopy.

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Article Synopsis
  • The study investigates the effectiveness of high-flow nasal cannula (HFNC) compared to non-invasive ventilation (NIV) for weaning patients with hypercapnic respiratory failure after extubation.
  • A total of 62 patients were analyzed, with treatment failure rates being similar between the two groups (26.67% for HFNC and 25% for NIV), indicating that HFNC is as effective as NIV.
  • Additionally, HFNC offered better patient tolerance and a slightly shorter mean ICU stay, suggesting it could be a preferable option in managing respiratory failure in chronic obstructive pulmonary disease patients.
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Unlabelled: To mitigate malnutrition among tuberculosis burden, Government of India launched Nikshay Poshan Yojana in 2018, providing incentive of INR500 per month to each enrolled patient. Our study tried to find out the status of the scheme and its target benefits amongst the beneficiaries in a tertiary care hospital in Delhi, and also the facilitating factors and barriers towards enrolment, and their knowledge, attitude and practice towards nutrition in TB.

Methods: A cross-sectional study was undertaken at a tertiary care hospital involving a calculated sample of 188 patients.

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Objective: The aims of this study were to compare threshold and suprathreshold ictal electroencephalograms (EEGs) in right unilateral (RUL) ultrabrief (UB) electroconvulsive therapy (ECT) and to identify the differences between these EEGs.

Methods: This study is a retrospective review of 125 pairs EEGs from titration and subsequent sessions across a 2-year period. All EEGs were independently rated for by 2 assessors using a scale based on qualities of an EEG used to guide ECT treatment dose adequacy, for example, midictal amplitude, regularity, interhemispheric coherence, seizure end point, and postictal suppression.

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  • Diabetes mellitus (DM) affects immune responses, potentially increasing the risk for developing active tuberculosis (TB) in individuals with hyperglycemia.
  • A study examined the immune function of macrophages in DM patients with and without TB, as well as in non-diabetic TB patients and controls, revealing that those with PTB+DM showed a significant reduction in phagocytic capacity.
  • Key immune receptors (PRRs) were altered in expression among PTB+DM patients, leading to higher reactive oxygen species (ROS) but lower nitric oxide (NO) levels, which were linked to more severe disease outcomes.
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  • * A notable finding was that 87.9% of patients treated at home were fully vaccinated, compared to 26% of those hospitalized, correlating with much higher survival rates for home-isolated patients (99.4% recovery) versus hospitalized patients (26.5% mortality).
  • * The research emphasizes the effectiveness of vaccines in reducing COVID-19 severity and calls for ongoing monitoring of new variants, precautionary actions, and increased vaccination efforts.
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Silica is a commercially significant material due to its extensive use in widespread applications and products. Synthetic amorphous silica (SAS) is a form of SiO that is intentionally manufactured and has been produced and marketed for decades without significant changes in its physico-chemical properties. The industrial production of nanostructured SiO is nowadays challenged by the expensive raw material use and high energy consumption.

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COVID-19 vaccination was initially started in India on 16th January 2021 after approval from national authorities. This study was carried out to assess the effect of vaccination status on the severity and clinical outcome among patients infected with COVID-19. The study included all adult COVID-19 patients admitted to our hospital from 1st April to 30th June 2021.

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Early identification and treatment of active tuberculosis disease among high risk household contacts could limit new transmission and better clinical outcome, thus decreasing TB burden. Host iron homeostasis is an important yet underevaluated factor in pathophysiology of tuberculosis (TB). One such protein is hepcidin which internalizes ferroportin (membrane iron transporter), thus inhibiting iron export from macrophages which is utilised by bacteria leading to disease severity.

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  • In India, guidelines for managing drug-resistant tuberculosis recommend using rapid tests like CBNAAT and LPA for quick diagnosis, despite inconsistencies between these tests and traditional methods.
  • To address these discrepancies, clinicians often start treatment based on initial test results and later adjust based on culture and drug susceptibility testing, which are more reliable but take longer to process.
  • Emerging DNA sequencing techniques like pyrosequencing and next-generation sequencing, while expensive and not widely available, hold promise for improving the detection of drug resistance in tuberculosis, and plans are in place to integrate them into national testing protocols.
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Tuberculosis is an uncommon cause of acute hypoxemic respiratory failure. We present a case of a middle-aged women with near-fatal respiratory failure due to underlying tuberculosis with favorable clinical recovery. Early diagnosis and treatment are imperative to prevent morbidity, mortality, and disease transmission.

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