Indraprastha Apollo Hospital Research Articles

Frequency of EGFR mutation and EML4-ALK fusion genes in patients with non-small cell lung carcinoma

Lung cancer ranks among the top causes of mortality worldwide. Non-small cell lung cancer (NSCLC) accounts for the majority of cases. Advances in genomics have identified potential biomarkers to predict therapeutic strategies in lung cancer. Despite the availability of targeted drugs such as tyrosine kinase inhibitors, a substantial proportion of patients still experience problems such as drug resistance. Mutations in genes like epidermal growth factor receptor (EGFR) and EML4ALK have already been established with altered clinical outcomes in NSCLC patients. With a focus on non-small cell lung cancer (NSCLC),the study was conducted at indraprastha apollo hospital in new delhi. With their informed agreement, 90 patients who were admitted between january 2012 and december 2015 and who had been diagnosed with fine-needle aspiration cytology (FNAC)/biopsy utilizing computed tomography (CT) guidance were included in the study. Excluded from the study were those receiving radiation therapy or chemotherapy concurrently. Information on age, gender, a thorough medical history, a history of smoking, and any additional co-morbidities were taken from medical records. Investigation of EGFR mutation and EML4-ALK gene fusion in NSCLC patients was done. Eleven (11% ) were positive and (89%) were negative for EGFR mutations. The positive cases were analyzed for exon 19 deletion and exon 21 (L858R) substitution and found positive for (60%) and (40%) of cases, respectively. Amongst 90 EGFR-negative patients, 4 (4.4%) had the EML4-ALK fusion gene, while 86 (95.5%) were negative for EML4-ALK. This study’s EML4-ALK fusion gene incidence was only (4%). Females have a higher occurrence of EGFR mutations than males (p=0.003) and the frequency of EGFR mutation was higher in non-smokers. The overall incidence of the EML4-ALK fusion gene was (4.44%) and was higher in patients below 60 years of age.

Liver Transplantation Research from India During the Last 25 Years: 1998–2022

Liver transplant surgery has been performed in India for the last 25 years. We aimed to analyse the trends, characteristics, and key elements in the field of liver transplantation research from India. On April 23, 2023, we conducted a search of the Scopus database for the literature on liver transplantation research, using a well-defined search strategy. MS Excel and VOS viewersoftware programs were used to examine the articles for organisation, author, journal, keywords, and high-cited literature. This analysis examined a total of 556 papers, which constituted only a 1.55% share of the global output. These papers involved 442 organizations, 1575 authors, and 147 journals. External funding was received in 4.13% and 23.56% were involved in international collaboration. Three Delhi-NCR organizations, namely the Medanta-The Medicity (n=63), Institute of Liver & Biliary Sciences (n=60), and Indraprastha Apollo Hospital (n=48) led in publication productivity. M. Rela (n=90) and A.S. Soin (n=63) were the leading authors in publication productivity, while S. Sudhindran and P. Bhangui were the most impactful authors. Liver Transplantation (n=96) and Journal of Clinical & Experimental Hepatology (n=65) published the maximum number of these papers, whereas, Annals of Surgery and Journal of Hepatology led in the citation impact per paper. The most significant keywords were "Liver Transplantation" (n=484), and "Living Donor" (n=254). Only 1.80% (n=10) of the papers were highly cited papers that received 50 to 142 citations and they together registered 69.9 citations per paper. Although the number of publications on liver transplantation from India started growing recently, it forms only 1.55% of the global report. There is an unmet need to increase government-supported research and multicenter collaborative studies at national and international levels for high-quality patient care.

A comparative study to assess the weight gain among breast-fed, formula-fed and mix-fed preterm babies

Body weight is a crucial indicator of a baby's development and growth. The connection between nursing and body weight is extremely important for the health of newborns. This study compares the weight gain among breastfed, formula-fed, and mixed-fed preterm babies (weight between 1-2 kilograms) admitted to the neonatal ICU of the Indraprastha Apollo hospital in New Delhi. Thirty-five newborn babies, ranging in age from 28 to 35 weeks, with a weight of 1-2 kg, were selected using the purposive sampling technique. The data collection was done for 3 months, from August to October 2022, by biomarkers and in vivo weight measurement. The weight was assessed for 17 days following the commencement of the first feed, and the weight was measured at the same time every day. The demographic characteristics of the sample revealed that 54.28 percent of the newborns included in the study were born in Apollo hospitals. Out of 35 babies, 31 were born through a cesarean session and the remaining four through a complicated vaginal delivery. The majority of the babies are between 34 and 35 weeks of gestation. The most common maternal complications observed were hypertension and oligohydramnios, and only a few neonates had fetal complications. The inferential analysis showed that there was no significant weight gain among the three categories during the first 17 days of feeding. The study can be repeated in different settings with more stringent inclusion criteria and for a longer duration.

Intraoperative portal vein stenting through umbilical vein approach: An innovative salvage procedure for portal vein thrombosis in pediatric liver transplant.

IPVS is considered a last resort or a salvage procedure in the event of recurrent PV thrombosis despite multiple attempts at redo PV anastomosis. We employed the opened umbilical vein approach to place the stent in the PV and deliver anticoagulation through a catheter. From Jan 2017 to Feb 2022, 150 patients underwent pediatric transplantation at department of liver transplant and hepatobiliary surgery unit, Indraprastha Apollo hospitals, New Delhi. Age, weight, PELD Score, diagnosis, portal vein diameter on preoperative CT, Portal flow after stenting, decrease in spleen size after stenting in follow-up CT were collected from a prospectively maintained data base and reviewed. Eight patients underwent IPVS following LDLT (mean age-10.6 ± 2.2 months, mean weight 8.1 ± 1.6, mean PELD score 32.7 ± 7.3). The mean PV diameter on preoperative CT scan was 3.6 mm (range 2.7-5.6 mm). The mean portal flow following stenting was 718.75 cc/min. Percentage reduction in size of the spleen was 26.35% beyond 2nd post-operative week. No patient had recurrent PV thrombosis following IPVS and all maintained an adequate portal flow throughout the immediate postoperative period. Two patients had in-hospital mortality secondary to septic complications. Umbilical vein approach is technically feasible, easy to manipulate the stent and catheter placement after stenting helps to deliver anticoagulants locally.

A case of severe bone-marrow suppression due to azathioprine in a patient of kidney transplant

Azathioprine is one of the triple therapy immunosuppressive agents used in patients of renal transplant. Azathioprine is being used successfully in majority of patients of renal graft. But one of the dreaded complications caused by it is severe bone-marrow suppression. Here I am reporting a case of severe, life- threatening bone-marrow suppression in a 30 years old male patient of renal transplant. The case is very important and attention is needed to be given by health care professionals and by clinicians. The patient underwent renal transplant surgery in Indraprastha Apollo hospital, New Delhi. The patient was on immunosuppressive agents: prednisolone, cyclosporine and mycophenolate mofetil. After 10 months of renal transplant surgery, the patient was switched over azathioprine due to complains of GI upset due to mycophenolate mofetil. In initial 2 months there was moderate bone-marrow suppression, but afterwards there was severe bone-marrow suppression. Lastly TLC reached 300 /mm3 and Hb was 3.8 g/dL and that was life-threatening condition. The patient was managed in ICU with inj. Grafeel under strict hygienic conditions. The patient was recovered successfully with necessary conservative managements during admission. In my case, causality of azathioprine was “definite/ certain” as per Narenjo scale. Seriousness of the reaction was “life- threatening”.

A scientometric analysis of India's publications in arthroplasty in the last two decades from the SCOPUS database

ObjectivesThis study evaluates the publication output of the Indian authors on the topic of Arthroplasty research from 2002 to 2021, using bibliometric methods. MethodsThe Indian publications as listed in the Scopus database were identified by using “Arthroplasty” or “Joint Replacement” in the keyword (“Key”) tag. ResultsIndia contributed 872 publications on Arthroplasty research, constituting a 1.36% share of global output, in the last two decades. Knee Arthroplasty accounted for the largest share (52.4%) in India's output, followed by Hip (35.7%) and others. 841 authors from 413 organizations participated unevenly in the research on this topic, with IISc-Bangalore contributing the largest number of publications (97), followed by Indraprastha Apollo Hospitals (46), Breach Candy Hospital, Bombay(40), and PGIMER, Chandigarh(38). R. Malhotra contributed the largest number of publications (55), followed by R. Vaishya (35 papers) and G.M. Shetty (23 papers). S. Bhan (31.0 and 3.17), A.B. Mullaji (30,13 and 3.08), N.P. Jain (25.75 and 2.63) and H.Pandit (21.88 and 2.24) registered the highest CPP & RCI. The journals which published the highest number of Arthroplasty articles were the Journal of Arthroplasty (123), followed by the Journal of Clinical Orthopaedics & Trauma (50) and International Orthopaedics (32). ConclusionIndia's contribution in the field of Arthroplasty-related publication is still low on a global platform, however, has shown a positive and increasing trend in the last two decades. The maximum publications were related to knee and hip arthroplasty and were from institutions in the major Indian cities of Delhi and Mumbai. More international and multicentric collaboration and external funding may help improve the number of arthroplasty publications in the future.

Effect of intradialytic exercises (IDE) on maximal oxygen consumption and quality of life undergoing hemodialysis in Indian population—a pilot study

BackgroundEnd stage renal disease (ESRD) is emerging as a major health issues across developing countries with limited access and awareness about the importance of exercises in daily life. People on prolong hemodialysis has difficulty in performing their activities of daily living (ADL). Loss of muscle mass is inevitable among patients on hemodialysis that leads to morbidity and mortality. Exercise is feasible during dialysis and can enhance quality of life. Increase in aerobic endurance by various combined protocol of aerobic and resistive exercises can improve compliance to regular exercise that underlines the theme of present study.MethodsA total of 31 participants were recruited during November 2019 to February 2020, after screening of 65 participants for selection criteria from Indraprastha Apollo Hospital’s dialysis unit. The average age of the participants was 52.36 ± 11.56 years. A single-blinded, pre-test–post-test quasi-experimental clinical trial for intradialytic exercise program involving lower limb ergometer and resistance training for lower limbs and non-fistula hand for 24 sessions, in 3 months, twice a week was conducted.ResultsThe exercise program was well tolerated and all patients completed it. Aerobic and resistance intradialytic exercises (IDE) had a positive effect on maximal oxygen consumption (VO2 Max), quality of life (SF 36), and sleep quality (PSQI). IDE showed statistically significant difference from pre- to post-intervention for maximal oxygen consumption, quality of life boosting their sleep quality.ConclusionsIDE found to benefit the patient and results showed a significant improvement in maximal oxygen consumption, sleep quality, quality of life and fatigue over a span of 12 weeks.Trial registrationCTRI, CTRI/2019/08/020848. Registered on 22 August 2019.

Comparing the outcome of doublet therapy (gemcitabine and cisplatin) with triplet therapy (gemcitabine, cisplatin and nab paclitaxel) in locally advanced or metastatic gall bladder carcinoma patients: An open-label randomized control trial.

TPS497 Background: There are various studies evaluating the role of dual agent chemotherapy like gemcitabine and cisplatin in locally advanced or metastatic gall bladder cancer (1). This has been the standard of treatment up till now. Also there has been a single arm phase II trial of gemcitabine, cisplatin and nab-paclitaxel (triplet therapy) by Shroff et al (2) reporting an impressive data with RR (response rate) of 45 %, median PFS (progression free survival) of 11.8 months (5% CI; 6.0-15.6) and median OS (overall survival) was 19.2 months. This data was promising when compared to historical data of dual agents like gemcitabine and cisplatin. So it would be informative to conduct an RCT comparing doublet chemotherapy in locally advanced or metastatic GBC with triplet regimen chemotherapy. Methods: It is an open label randomized control study conducted in Indraprastha Apollo hospital New Delhi, India in newly diagnosed locally advanced or metastatic gall bladder cancer patients proven histologically and on imaging. The sample size calculated using the appropriate formula is, 27 in each arm that is total of 54 patients, but 60 patients will be enrolled in the study keeping in view 10% drop out rate. For simple randomization, we will use online computer generated random number table and then patients will be assigned in two groups, arms A and B. Arm A receiving two drugs gemcitabine 1,000mg/m2 i.v and cisplatin 25mg/m2 i.v on Day 1 and Day 8 of 21-day cycle and arm B receiving three drugs gemcitabine, 1,000 mg/m2, cisplatin, 25 mg/m2, and nab-paclitaxel, 125 mg/m2, on days 1 and 8 of 21-day cycle. Primary end point was response rates based on radiological response as per RECIST or PRECIST. Secondary end points were to determine median progression free survival and median overall survival and to evaluate the toxicities according to NCI-CTC v 4.0.Then response [on basis of RECIST or PRECIST criteria] will be seen after 3 and 6 cycles of chemotherapy are completed and at follow up of every 6 months for 2 years period for assessment of primary and secondary end points of the study. Statistical analysis for correlation between clinical and laboratory features and treatment outcomes will be done using the SPSS software. Till now we have enrolled 1 patient in each arm. CTRI/2021/09/036362.

Observational Study on Outcomes after Radioiodine Ablation in Hyperthyroid Patients.

Introduction:Radio-active Iodine (RAI) is a safe, definitive, and cost-effective modality of treatment that is used as the first line of treatment for Graves’ hyperthyroidism by most endocrinologists. Very few reports are available from India, observational follow-up data is needed to determine the meaningful prognostic outcomes of RAI ablation in the Indian population.Aims:To study the outcomes in hyperthyroid patients undergoing RAI ablation.Materials and Methods:This observational cohort study was conducted at Department of Endocrinology at Indraprastha Apollo Hospital, New Delhi. A total of 82 hyperthyroid patients who underwent RAI ablation between June 2014 to June 2018 were enrolled. RAI dose was calculated arbitrarily in most cases; often by an empirical fixed dose based on the goiter size and RAIU. The patients were reviewed at 1, 3 and 6 months post-RAI ablation. During follow-up, along with a detailed clinical examination, free T4, free T3 and TSH were checked.Results:The dose of I-131 varied from 6 mCi to 14 mCi. Most of the patients were given RAI in the dose of 7.1-10 mci. About 63.4% of patients achieved hypothyroidism in 6 months, 6.1% in 1 month, 37.8% in 3 months, and 19.5% in 6 months. Gender, age, etiology of hyperthyroidism, baseline thyroid function, goiter, and ophthalmopathy did not affect outcomes after RAI ablation. Those who were not treated with antithyroid drugs prior to RAI therapy were found to have higher rates of conversion to a hypothyroid state.Conclusion:RAI can be given safely as the first line of treatment in Graves’ disease and antithyroid drug naïve patients respond better to therapy.

Bibliometric analysis of COVID-19 related publications in Indian orthopaedic journals

BackgroundThe COVID-19 pandemic has resulted in an infodemic about the novel coronavirus SARS-CoV-2 outbreak to build knowledge and develop mitigation strategies. In addition, scientific journals across the world have studied the impact of COVID-19 on trauma and orthopaedics. MethodsA cross-sectional, bibliometric analysis of the literature was undertaken on COVID-19 related articles from three Pubmed and Scopus indexed orthopaedic journals from India, namely, Indian Journal of Orthopaedics(IJO),Journal of Clinical Orthopaedics and Trauma(JCOT), and Journal of Orthopaedics (JOO), in May 2021. All the article types and study designs were included for this review. The authors, institutions, countries, keywords, and co-authorship mapping were studied. ResultsA total of 112 COVID-19 related documents were retrieved. Period of these publications was from 2nd April 2020 to 31st May 2021. Vaishya R. (n = 16) was the most cited author, and Indraprastha Apollo Hospitals (n = 16) was the most cited research Institution. India led the list of countries in academic publication output. On keyword mapping, telemedicine was the most prominent Medical Subject Headings (MeSH) search word. ConclusionThe Indian orthopedic journals have addressed the impact of COVID-19 on orthopaedic practice in India and aborad whilst continuing to publish knowledge about basic science and clinical orthopaedic research studies. The JCOT has outperformed and become the most leading orthopaedic journal from India during the pandemic. COVID -19 articles have been fast tracked, open accessed and attracted more citations in reduced duration of time compared to non-COVID-19 papers.

Bibliometric analysis of the top 50 most cited publications of the Journal of Clinical Orthopaedics and Trauma

BackgroundThe Journal of Clinical Orthopaedics and Trauma (JCOT) is one of the top three orthopaedic journals from India. We set out to analyse the top 50 cited articles from JCOT since indexing in PubMed and Scopus. MethodsWe looked into the bibliometrics of the top 50 cited articles and compared citations from PubMed and Scopus, and depicted outputs from VOS viewer analysis on co-authorship and keywords. ResultsTotal citations for top-cited articles were 1076 in numbers, with a maximum of 103.2016 and 2018 were the most productive years. The major contribution was from India with 74%, followed by the USA. New Delhi published maximally at 72%. Clinical topics and narrative reviews were the most common types of studies. Trauma and Adult reconstruction was the most common sub-specialities, and Level 4 was the most frequent level of study. The basic science and COVID-19 related articles received the maximum citations. The authors from Indraprastha Apollo Hospitals published the maximum number of top-50 cited articles in the JCOT. ConclusionsThere is a steady increase in the number of publications in the JCOT, with an increasing number of citation counts. Both the Indian and foreign authors have been publishing in this journal at a comparative rate. Although the citation counts in Scopus are more than those in PubMed for given articles, more than 80% of articles are listed in both databases as top 50 cited articles. The majority of top-cited articles belonged to trauma and adult reconstruction, level III studies, and narrative reviews.

COVID-19—The Pandemic of the 21st Century and Correlation With Cardiovascular System—A Single Center Experience

Objective: To analyze the data of the cardiac comorbidities, investigational modalities, laboratory parameters, and outcomes of patients with COVID-19 related to cardiovascular system hospitalized in our center. Methods: Confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19 infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample, who were admitted to Indraprastha Apollo Hospital, Delhi, were included in the study. Demographics, baseline comorbidities, and test results related to cardiovascular diseases were collected and analyzed. Results: The study included 1012 patients, admitted in our institute with a COVID-19 positive report. The mean age of the patients was 54.6 ± 6.8 years. The male to female ratio was 1.7:1. The demographic characteristics included diabetes in 38%, hypertensives 45%, history of coronary artery disease 22%, and chronic kidney disease 30%. A total of 426 patients were all treated on HCQS. A total of 7 patients were primigravida with full term pregnancy. The patients were also stratified according to age and demographic characteristics were noted. The total number deceased were 41 with 971 patients making complete recovery. The results showed no change in QTc interval in survivors and nonsurvivors. D-dimer, ferritin, and LDH were raised in all nonsurvivors compared to survivors. Even thrombocytopenia and low albumin levels were noted in nonsurvivors. Conclusions: The study revealed no significant change in QTc interval in survivors and nonsurvivors on HCQS. Critically ill patients showed the trends of being underweight, low albumin levels, thrombocytopenia, raised D-dimer, lactate dehydrogenase (LDH), and ferritin levels. Further studies on larger numbers are needed to confirm these findings.

A CASE OF VIBRIO CHOLERAE MENINGITIS IN A NEONATE

Bacteraemia resulting due to vibrio cholera can lead to invasive disease such as septicemia and meningitis in the neonatal age group especially in immunosuppressed population. Vibrio cholera is known to cause diarrhoeal illness in adults and children but very rarely, it causes infection in neonates. We report a case of septicemia with meningitis due to vibrio cholera in a neonate at Indraprastha Apollo Hospital (IAH), New Delhi.

Nursing Contribution to Cope COVID-19 Infection with Courage and Compassion

The advent of COVID-19 pandemic has suddenly changed the world and influenced the nursing profession as well. Nurses were among the first group of “COVID duty frontline warriors.” We briefly report the organization of services for the management of COVID affected or suspected patients at Indraprastha Apollo Hospital. The experiences of some of the nurses are described, highlighting their various problems when caring for these patients.

Aesthetic Practice in Covid Times-Evolving Guidelines at the Cosmetic Clinic

Background: The coronavirus disease 19 (COVID-19) pandemic has led to an almost complete initial halt of all elective surgical and medical procedures, more so in the practice of esthetic surgery and medicine, globally. As practices are trying to open up, the when, how, and what services can be scheduled again are the questions which arise in front of all service providers. Stringent infection control measures are the need of the hour in response to the current continuing COVID-19 pandemic. In esthetic clinics, guidelines for infection control measures as well as protocols for performing procedures are of particular importance for their safe and smooth functioning. Methods: A Medline/PubMed search was conducted for any and all possible publications on esthetic guidelines for safe functioning during the COVID pandemic. Advisories by the governments of the day, the World Health Organization, as well as those issued by various national and international esthetic societies were also taken into consideration. A set of protocols and preferred practice guidelines were drafted to allow functioning of the esthetic clinics as well as protect the doctors, clinic staff, and patients from the SARS-CoV-2 infection. Results: “Standard operating procedure (SOP)” guidelines for esthetic clinics were drafted and put into place in our Aesthetic Clinic at Indraprastha Apollo Hospital after going through all possible recommendations for scheduling patients, screening at entry, declaration and esthetic consultations, and for safety precautions about the different procedures and later categorized into low risk, moderate risk, and high risk based on the possibility of the transmission of SARS-CoV-2 virus from a possible infected patient to the treating physician or therapist, and the other way around. Conclusions: The SOP provides sound infection control measures for esthetic practices. There are guidelines regarding safety measures and use of personal protective equipment during scheduling, distancing, and risk-wise categorization, and also what procedures are permitted. These may vary from country to country, but local and national guidelines should be incorporated and followed to prevent the COVID-19 infection in esthetic clinics.

Minimal Access Laparoscopic and Robotic Surgery during the COVID-19 Era

COVID-19, the novel coronavirus, has affected all aspects of life including the way we do surgery. While patients are being tested with real-time reverse trancriptase-polymerase chain reaction before admission for elective surgeries, there are a good number of false-negative tests. This has led to the concept of a minimum standard precautions in all the negative cases too. In our unit at Indraprastha Apollo Hospitals, New Delhi, we have done 84 minimally access laparoscopic and robotic surgeries during the lockdown. This included benign and malignant diseases. No staff in the operation theater (OT) was infected during any of these surgeries. Wearing personal protective equipment and use of smoke evacuation system in a pressure-adjusted OT is the key to safety.

Fertility preservation for patients on gonadotoxic treatment recommendations for clinical practice by Fertility Preservation Society (India)

Aim: Objective of this document is to provide guidance to health care professionals on fertility preservation (FP) for Indian patients undergoing cancer treatment. Participants: Extensive deliberations, discussion and brain storming was done with different reproductive medicine (RM) specialists, medical, radiation, surgical, gynaecological and oncologists and haematologists to develop the recommendations. Evidence: A systematic review of the literature published up to December 2020 was carried out using PubMed and Cochrane Collaboration Library. International guidelines, cohort studies, case series, observational studies and randomized controlled trials currently available in literature were reviewed. Supplemental searches were made for individual conditions like lymphoma, leukaemia, haematological conditions, breast cancer, gynaecological cancers, immune disorders. Indian data on fertility preservation was limited to case series, hence opinion of experts was taken into account for the recommendations on fertility preservation in India. Cancer incidence and survival rates were taken from the Indian cancer registry (ICR). A panel of RM specialists across India reviewed the evidence and offered recommendations for Indian patients. Process: Meetings were held with leading oncologists from major cancer institutes in India – Delhi: AIIMS, Medanta, Indraprastha Apollo hospital, Max SS hospital, Mumbai: Bombay Hospital; Miraj: Siddhivinayak hospital; Kolkata: Tata Medical Centre; Bangalore: Mazumdar Shaw Cancer Centre; Narayana Health City and HCG; The working group for the recommendation committee included members from the Fertility Preservation Society (India) and participating oncology experts. Conclusions: The Fertility Preservation Society (India) recommends that oncologists should discuss the risk of infertility resulting from cancer treatment with patients of reproductive age group, at the earliest opportunity and provide initial information regarding the availability of FP. Patients with a good oncological prognosis at risk of infertility and interested in preservation of their fertility, should be referred to a reproductive medicine expert as early as possible after confirmatory diagnosis. Details of FP procedures including risks and subsequent reproductive outcome should be explained in detail by the reproductive medicine specialist. Genetic and social counselling should be made available to the patient to aid in taking an informed decision. Limiting factors in India include lack of awareness of FP options and availability, cost, lack of insurance coverage, experimental nature of some FP procedures.

P53 and STAT3 Dependent Expression of a Novel microRNA Restricts Hepatitis C Virus Infection Through Hyper-β-Oxidation of Fatty Acids by Impeding Cytosolic CAP350

Background: The underlying complex molecular mechanism of Hepatitis C virus (HCV) mediated liver disease progression is still unresolved. Next generation sequencing of small RNAs provides genome-wide data about regulatory microRNAs. Here, we have identified undiscovered low abundant regulatory miRNAs and investigated the role of a novel human liver specific miRNAs in HCV mediated liver disease development. Methods: To discover unannotated miRNAs, unmapped sequences from small RNA transcriptome profiling of HCV infected and un-infected liver tissues were subjected to miRDeep2.pl pipeline. Targets predicted using MiRanda and Ingenuity pathway analysis (IPA). Northern-blot, Dicer knock down (K/D), Ago2-RNA immunoprecipitation (RIP), Stem-loop Real-time PCR (SLRTPCR), immunoblot (IB) analysis, luciferase assay, Chromatin immunoprecipitation (ChIP) etc. were used as required. Findings: Among seven predicted novel miRNAs, miR-c12 was found human liver specific miRNA. Dicer K/D and RIP assays showed that miR-c12 followed canonical miRNA biogenesis pathways. Its low expression in chronic HCV infected (CHC) tissues than normal liver indicated its protective role against HCV infection. Furthermore, upon HCV infection downregulation of p53 expression and hypermethylation of STAT3 binding site in the promoter of miR-c12 restricted its expression in CHC. IPA analysis revealed miR-c12 controlled mostly the fatty acid metabolism pathway. Reduced triglyceride accumulation and enhanced PPARα mediated fatty-acid catabolism upon miR-c12 retention in cells by targeting CAP350, a suppressor of PPARα, confirmed its role in lipid metabolism pathways. Interpretations: We discovered a previously unidentified low abundant human-liver specific miRNA having role in lipid homeostasis maintenance. Hence, miR-c12 together with anti-virals might be more effective therapeutic in restricting HCV infection. Funding Statement: Department of Biotechnology (DBT), Government of India [BT/PR11971/MED/29/890/2014]. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: Ethics committee of the Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, India and Indraprastha Apollo Hospital, New Delhi had approved the study. Blood and tissues were collected from patients who were willing to participate in the study with prior written consent.

Prospective Study on Physiological Intorsion of Lower Limbs in Children

Background: Rotational profiles vary widely among healthy children. Rotation of the long bones refers to the twist of the bone about its long axis. Rotational deformity of the lower limb in the transverse plane is associated with many clinical settings ranging from harmless to excessive intoeing in children. Materials and Methods: This study was conducted at the Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi. Children presenting to the outpatient department during the period of April to September 2013 were followed up. It is a prospective study conducted over 14 months. A total of 27 children (54 lower limbs) were included and followed up. Results: Twenty-seven children were selected as per the inclusion criteria and assessed for the thigh-transmalleolar axis, thigh-foot angle, femoral anteversion (FA), foot progression angles (FPA), and hip rotations at 4-month interval for 2 follow-ups. There were very few studies of such type which have been conducted in India. Conclusions: In our study, there was a definite and significant decrease in FPA and internal tibial torsion with increasing age. The values of clinical anteversion also decreased with age along with a gradual decrease of internal rotation and an increase of external rotation (ER). The decrease of FA with age correlated better with increase of hip ER. FPA was a significant clinical parameter which gave us an objective picture of the change in both femoral and tibial torsions with age.

Fecal Microbial Transplant- A New Hope of Treatment for Ulcerative Colitis

International Journal of Medicine and Public Health,2018,8,1,07-10.DOI:10.5530/ijmedph.2018.1.2Published:March 2018Type:Original ArticleFecal Microbial Transplant- A New Hope of Treatment for Ulcerative ColitisHena Butta, Akshay Kapoor, Anupam Sibal, Raman Sardana, Vidyut Bhatia, and Leena Mendiratta Hena Butta1*, Akshay Kapoor2, Anupam Sibal2, Raman Sardana1, Vidyut Bhatia2, Leena Mendiratta1 1Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, INDIA. 2Department of Pediatric Gastroenterology and Hepatology, Indraprastha Apollo Hospitals, New Delhi, INDIA. Abstract:Purpose: Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disease of intestines. The high cost of second line drugs along with the need for lifelong therapy are the most distressing factors demanding innovative therapy for treating this disease. Fecal microbial transplantation (FMT) can be used as an adjunct for treating UC. We performed FMT in a six year old male child who was being treated for ulcerative colitis with conventional therapy for the last two years with variable response to therapy. This therapy also has good potential as salvage therapy for refractory multidrug resistant Gram negative organisms and Clostridium difficile infection. Methods: After taking appropriate informed consent, a healthy adult donor from the family was thoroughly screened for various infections (as per protocol). Donor fecal preparation was done taking strict aseptic precautions and FMT was given as retention enema for 1 h (60 ml enema every 15 min) daily for 5 days. Patient was monitored for adverse event (as per protocol). Results: The patient tolerated the enema well. The Paediatric Ulcerative Colitis Activity Index (PUCAI) reduced from 35 to 15 after completion of five days of therapy. There has been no relapse since FMT and the child continues to be asymptomatic with a stable low PUCAI score 6 months post therapy. Conclusion: Our study is a step and encouragement towards the usage of FMT for pediatric patients with ulcerative colitis showing variable response to conventional treatment. However, more future studies are required to authenticate this treatment modality. Keywords:Enema, Fecal Microbial Transplantation (FMT), PUCAI score, Ulcerative colitisView:PDF (120.53 KB)