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Fulltext Needle Aspiration and Cytology for Suspected Osteoarticular Tuberculosis in Children

Agarwal A, Singh S, Agarwal S, Gupta S

Malays Orthop J, 2018 Nov;12(3):31-37.
PMID: 30555644 DOI: 10.5704/MOJ.1811.007

Introduction: Early diagnosis of osteoarticular tuberculosis (OATB) is essential to prevent significant functional disability. There is no single test for diagnosis. Despite an array of investigations available, definitive diagnosis at early stage before starting antitubercular drugs is still a challenge. Materials and Methods: A cross sectional study was carried out between February 2016 and October 2017. All children less than 18 years of age with suspected osteoarticular tuberculosis were included. The cases were subjected to simple needle aspiration from whichever site was accessible. Multiple sample aspirations were done at site of involvement. Smears were prepared from the aspirated material. Results: Ziehl-Neelsen staining for Acid Fast Bacilli (AFB) showed deep pink red rods under light microscopy. Features suggestive of tuberculosis can be seen by May-Grünwald-Giemsa (MGG) staining. Auramine-O staining method of detecting AFB under fluorescent microscope shows the bacilli as greenish yellow slender curved rods in dark background. Fluorescent microscopy has higher sensitivity and comparable specificity. In our study, microbiological confirmation of OATB could be done in 100% cases where the lesion could be accessed for aspiration. The molecular techniques are relatively more expensive and not available everywhere. Conclusion: Meticulous search for AFB in a well stained smear using three different staining methods provides a direct evidence of infection over costly imaging especially in poor patients seen in resource limited settings.
Fulltext Morphology of Proximal Femur in South-West Coast of India

Kamath SU, Agarwal S, Austine J

Malays Orthop J, 2020 Nov;14(3):143-150.
PMID: 33403075 DOI: 10.5704/MOJ.2011.022

Introduction: With a higher proportion of young individuals undergoing uncemented hip arthroplasty, a close match in the dimension of the proximal femur and the implanted prosthesis is paramount. This is a study to gain insight into geographical variation in proximal femur morphology to determine the reference values to design uncemented femoral stems for a south Indian population, and also the effect of ageing and gender on the proximal femur morphology.
Materials and Methods: The study comprised of two groups. For the first group, 50 unpaired dry femur bones were obtained from adult human cadavers; and the second group was a clinical group of 50 adult patients. Standardised radiographic techniques were used to measure the extra-cortical and intra-cortical morphometric parameters. Based on these, dimensionless ratios were calculated to express the shape of the proximal femur. The data were expressed in terms of mean and standard deviation and a comparison made with other studies.
Results: A significant difference was noted across various population subsets within the Indian subcontinent and also in comparison to the Western population, suggestive of regional variation. The measurements made in cadaveric bone differed significantly from those in live patients, especially the femoral head diameter and extra-cortical and intra-cortical width. Femoral offset, head height and diameter were significantly less in females.
Conclusion: The south Indian population needs customised implants with an increase in neck shaft angle and a decrease in intra-cortical and extra-cortical width for press fit in hip arthroplasty. The variation between the two sexes must also be accounted for during prosthesis design.
Fulltext Association between Psychological Status and Functional Outcome in Surgically Managed Fractures around Hip in Geriatric Patients - A Prospective Study

Bishnoi S, Huda N, Islam S, Pant A, Agarwal S, Dholariya R

Malays Orthop J, 2021 Jul;15(2):18-25.
PMID: 34429818 DOI: 10.5704/MOJ.2107.004

Introduction: Fractures around the hip in the geriatric population not only lead to functional but also psychological impairment. Psychiatric disturbances can be associated with poor participation in rehabilitation, increased risk of falling again, and higher rates of mortality. The present study was undertaken to assess the association between the psychological status and functional outcome of surgically managed elderly Indian patients who had sustained fractures around the hip.
Material and Methods: The present study was a hospital based prospective, single centre study. One hundred and two geriatric patients who had sustained hip fracture and had been managed surgically, having no cognitive dysfunction, living independently, having unhindered walking capability before the fracture, were included in the study. They were called for follow-up at 3rd, 6th, and 12th month after the hip surgery. Psychological assessment was done by the Hospital Anxiety and Depression Scale (HADS) and functional outcome by using the Harris hip score (HHS).
Results: Our study did not show association between psychological status and functional outcome except in one sub-group. Significant correlation was observed between the psychological status and functional outcome in most of the patients in the extra-capsular group. We have identified improvement in the depression, anxiety and functional scores during the follow-up.
Conclusion: We conclude that psychiatric disturbances in a geriatric patient after undergoing a surgery for hip fracture may lead to poor recovery. We recommend that all such geriatric patients should undergo a psychological assessment and proper therapy should be instituted to achieve good functional recovery.
Application of an optimal class of antisymmetric wavelet filter banks for obstructive sleep apnea diagnosis using ECG signals

Sharma M, Agarwal S, Acharya UR

Comput Biol Med, 2018 09 01;100:100-113.
PMID: 29990643 DOI: 10.1016/j.compbiomed.2018.06.011

Obstructive sleep apnea (OSA) is a sleep disorder caused due to interruption of breathing resulting in insufficient oxygen to the human body and brain. If the OSA is detected and treated at an early stage the possibility of severe health impairment can be mitigated. Therefore, an accurate automated OSA detection system is indispensable. Generally, OSA based computer-aided diagnosis (CAD) system employs multi-channel, multi-signal physiological signals. However, there is a great need for single-channel bio-signal based low-power, a portable OSA-CAD system which can be used at home. In this study, we propose single-channel electrocardiogram (ECG) based OSA-CAD system using a new class of optimal biorthogonal antisymmetric wavelet filter bank (BAWFB). In this class of filter bank, all filters are of even length. The filter bank design problem is transformed into a constrained optimization problem wherein the objective is to minimize either frequency-spread for the given time-spread or time-spread for the given frequency-spread. The optimization problem is formulated as a semi-definite programming (SDP) problem. In the SDP problem, the objective function (time-spread or frequency-spread), constraints of perfect reconstruction (PR) and zero moment (ZM) are incorporated in their time domain matrix formulations. The global solution for SDP is obtained using interior point algorithm. The newly designed BAWFB is used for the classification of OSA using ECG signals taken from the physionet's Apnea-ECG database. The ECG segments of 1 min duration are decomposed into six wavelet subbands (WSBs) by employing the proposed BAWFB. Then, the fuzzy entropy (FE) and log-energy (LE) features are computed from all six WSBs. The FE and LE features are classified into normal and OSA groups using least squares support vector machine (LS-SVM) with 35-fold cross-validation strategy. The proposed OSA detection model achieved the average classification accuracy, sensitivity, specificity and F-score of 90.11%, 90.87% 88.88% and 0.92, respectively. The performance of the model is found to be better than the existing works in detecting OSA using the same database. Thus, the proposed automated OSA detection system is accurate, cost-effective and ready to be tested with a huge database.
Fulltext Candida sake--a rare cause of fungal endocarditis

Anuradha S, Agarwal SK, Prakash A, Singh NP, Kaur R

Med J Malaysia, 2008 Mar;63(1):75-6.
PMID: 18935744
Fulltext Successful pregnancy in untreated limited Wegener's granulomatosis

Sahni V, Agarwal SK, Singh NP, Sikdar S, Yadav A, Wadhwa A, et al.

Med J Malaysia, 2005 Oct;60(4):492-4.
PMID: 16570714

A thirty four year old female presented with upper and lower respiratory symptoms in the third trimester of pregnancy. After the delivery of a healthy baby, the symptoms progressed to involve multiple organ systems and eventually a diagnosis of limited Wegener's Granulomatosis (Carrington-Liebow syndrome) was made. The extremely rare combination of WG and pregnancy, especially the onset of disease in late pregnancy is discussed. The successful outcome of pregnancy even without treatment of WG is the highlight of the case.
Assessment of antimicrobial activity of different concentrations of Tinospora cordifolia against Streptococcus mutans: An in vitro study

Agarwal S, Ramamurthy PH, Fernandes B, Rath A, Sidhu P

Dent Res J (Isfahan), 2019 2 13;16(1):24-28.
PMID: 30745915

Background: The antimicrobial property of Tinospora cordifolia has been tested against a variety of microorganisms in the literature. The present study aimed to assess the antimicrobial activity of different concentrations of commercially available T. cordifolia powder against Streptococcus mutans.
Materials and Methods: An in vitro study was undertaken in which extract of T. cordifolia was obtained using 100% ethanol by maceration. Seven different concentrations were prepared and tested against S. mutans in brain-heart infusion agar medium. Plates were incubated aerobically at 37°C for 48 h, and zone of inhibition was measured using Vernier caliper. 0.2% chlorhexidine and dimethylformamide were used as positive and negative controls respectively. The data were analysed by descriptive analytic tests.
Results: The maximum antibacterial activity of T. cordifolia was observed with a volume of 40 μl at 2% concentration with a zone of inhibition of 19 mm. A 30 μl volume of 0.2% chlorhexidine showed a zone of inhibition of 28 mm, and no zone of inhibition was observed with dimethylformamide.
Conclusion: Tinospora exhibited antimicrobial activity against S. mutans. However, it needs to be confirmed further with in vivo studies.
Fulltext Air Quality Prediction Using the Fractional Gradient-Based Recurrent Neural Network

Arora S, Sawaran Singh NS, Singh D, Rakesh Shrivastava R, Mathur T, Tiwari K, et al.

Comput Intell Neurosci, 2022;2022:9755422.
PMID: 36531923 DOI: 10.1155/2022/9755422

In this study, the air quality index (AQI) of Indian cities of different tiers is predicted by using the vanilla recurrent neural network (RNN). AQI is used to measure the air quality of any region which is calculated on the basis of the concentration of ground-level ozone, particle pollution, carbon monoxide, and sulphur dioxide in air. Thus, the present air quality of an area is dependent on current weather conditions, vehicle traffic in that area, or anything that increases air pollution. Also, the current air quality is dependent on the climate conditions and industrialization in that area. Thus, the AQI is history-dependent. To capture this dependency, the memory property of fractional derivatives is exploited in this algorithm and the fractional gradient descent algorithm involving Caputo's derivative has been used in the backpropagation algorithm for training of the RNN. Due to the availability of a large amount of data and high computation support, deep neural networks are capable of giving state-of-the-art results in the time series prediction. But, in this study, the basic vanilla RNN has been chosen to check the effectiveness of fractional derivatives. The AQI and gases affecting AQI prediction results for different cities show that the proposed algorithm leads to higher accuracy. It has been observed that the results of the vanilla RNN with fractional derivatives are comparable to long short-term memory (LSTM).
Fulltext Gastric ulcer healing by chebulinic acid solid dispersion-loaded gastroretentive raft systems: preclinical evidence

Negi P, Gautam S, Sharma A, Rathore C, Sharma L, Upadhyay N, et al.

Ther Deliv, 2022 Feb;13(2):81-93.
PMID: 35075915 DOI: 10.4155/tde-2021-0062

Background: Chebulinic acid (CA), a component in Terminalia chebula, exhibits antiulcer activity, but has poor aqueous solubility. Raft-forming systems incorporating solid dispersions (SDs) of CA, were developed to overcome its poor biopharmaceutical properties and to prolong the gastric residence time for maximum activity. Methods: SDs were formulated by a solvent evaporation method using Eudragit EPO. Raft formulations consisted of sodium alginate as a polymer. Results: Release of CA in the dissolution medium was 40%, whereas SDs showed 95.45% release. The CA raft system (20 mg/kg) showed curative efficacy in an alcohol-induced gastric ulcer model and increased protection when compared with omeprazole (10 mg/kg) and CA suspension (20 mg/kg). Conclusion: These studies demonstrated SD raft systems to be a promising approach for antiulcer therapy by CA.
Recent advancements in xanthan gum-based gastroretentive floating formulations: Chemical modification, production and applications

Bhardwaj BY, Vihal S, Pahwa R, Agarwal S, Gupta B, Yang JC, et al.

Carbohydr Polym, 2025 Jan 15;348(Pt A):122809.
PMID: 39562084 DOI: 10.1016/j.carbpol.2024.122809

Non-toxic, biocompatible, biodegradable, and bioadhesive, characteristics, of natural polysaccharides, are widely recognized and well accepted. Their usage in dietary, medicinal, biomedical, and cosmetic, applications is due to their unique and fascinating attributes. Xanthan gum, a microbial polysaccharide possesses diverse-wonderful features. It is a naturally occurring heteropolysaccharide, with large molecular weight, derived from the Gram-negative bacteria, Xanthomonas Campestris. This biopolymer has been studied extensively as a matrix for tablets, nanoparticles, microparticles, hydrogels, and various other formulation types. However, indigenous xanthan gum has its own set of restrictions, which may be overcome by chemical modification, to fine-tune the characteristics of the native gum, for attaining unmet demands. This approach has huge potential in the drug delivery and numerous other promising applications. The objective of this review is to provide a consolidated source of information on xanthan gum-based gastroretentive systems. Several approaches of floating techniques, with recent research avenues and patents, utilizing the natural polysaccharide xanthan gum is also discussed.
Celiac disease care differs significantly between high- and low-middle-income countries: a global survey of celiac experts from 63 countries

Agarwal S, Prasad S, Agarwal A, Raja Ali RA, Leffler DA, Green PHR, et al.

J Gastroenterol Hepatol, 2024 Nov 11.
PMID: 39528309 DOI: 10.1111/jgh.16793

BACKGROUND AND AIM: Celiac disease (CeD) is increasingly diagnosed but significant disparities exist in awareness, practices, resources, and legislation worldwide. We conducted a global online survey with CeD experts to assess this disparity internationally.
METHODS: A 55 questions survey encompassing nine domains relevant to CeD care (awareness, gluten-free [GF] foods availability/cost/quality, GF labeling, CeD dietician availability, insurance for CeD patients, medical training, research funding, patient support groups, and unmet needs) was generated and sent to CeD experts worldwide electronically. Countries were stratified based on per capita income as high-income (HIC) and lower-income countries (LIC) (including upper-middle-, lower-middle-, and low-income countries). Survey responses were summarized as a single score using principal component analysis.
RESULTS: Valid responses were obtained from 131(37.4%) [HIC: 71; LIC: 60] of contacted CeD experts from 63 countries. Compared with HIC, LIC experts perceived worse availability (HIC:80% vs LIC: 47%; P
Fulltext Cobalt containing glass fibres and their synergistic effect on the HIF-1 pathway for wound healing applications

Solanki AK, Autefage H, Rodriguez AR, Agarwal S, Penide J, Mahat M, et al.

Front Bioeng Biotechnol, 2023;11:1125060.
PMID: 36970616 DOI: 10.3389/fbioe.2023.1125060

Introduction and Methods: Chronic wounds are a major healthcare problem, but their healing may be improved by developing biomaterials which can stimulate angiogenesis, e.g. by activating the Hypoxia Inducible Factor (HIF) pathway. Here, novel glass fibres were produced by laser spinning. The hypothesis was that silicate glass fibres that deliver cobalt ions will activate the HIF pathway and promote the expression of angiogenic genes. The glass composition was designed to biodegrade and release ions, but not form a hydroxyapatite layer in body fluid. Results and Discussion: Dissolution studies demonstrated that hydroxyapatite did not form. When keratinocyte cells were exposed to conditioned media from the cobalt-containing glass fibres, significantly higher amounts of HIF-1α and Vascular Endothelial Growth Factor (VEGF) were measured compared to when the cells were exposed to media with equivalent amounts of cobalt chloride. This was attributed to a synergistic effect of the combination of cobalt and other therapeutic ions released from the glass. The effect was also much greater than the sum of HIF-1α and VEGF expression when the cells were cultured with cobalt ions and with dissolution products from the Co-free glass, and was proven to not be due to a rise in pH. The ability of the glass fibres to activate the HIF-1 pathway and promote VEGF expression shows the potential for their use in chronic wound dressings.
Identifying the early predictors of non-response to steroids in patients with flare of autoimmune hepatitis causing acute-on-chronic liver failure

Sharma S, Agarwal S, Saraya A, Choudhury AK, Saigal S, Soin AS, et al.

Hepatol Int, 2023 Aug;17(4):989-999.
PMID: 36790652 DOI: 10.1007/s12072-023-10482-4

BACKGROUND AND AIMS: Early identification of non-response to steroids is critical in patients with autoimmune hepatitis (AIH) causing acute-on-chronic liver failure (ACLF). We assessed if this non-response can be accurately identified within first few days of treatment.
METHODS: Patients with AIH-ACLF without baseline infection/hepatic encephalopathy were identified from APASL ACLF research consortium (AARC) database. Diagnosis of AIH-ACLF was based mainly on histology. Those treated with steroids were assessed for non-response (defined as death or liver transplant at 90 days for present study). Laboratory parameters, AARC, and model for end-stage liver disease (MELD) scores were assessed at baseline and day 3 to identify early non-response. Utility of dynamic SURFASA score [- 6.80 + 1.92*(D0-INR) + 1.94*(∆%3-INR) + 1.64*(∆%3-bilirubin)] was also evaluated. The performance of early predictors was compared with changes in MELD score at 2 weeks.
RESULTS: Fifty-five out of one hundred and sixty-five patients (age-38.2 ± 15.0 years, 67.2% females) with AIH-ACLF [median MELD 24 (IQR: 22-27); median AARC score 7 (6-9)] given oral prednisolone 40 (20-40) mg per day were analyzed. The 90 day transplant-free survival in this cohort was 45.7% with worse outcomes in those with incident infections (56% vs 28.0%, p = 0.03). The AUROC of pre-therapy AARC score [0.842 (95% CI 0.754-0.93)], MELD [0.837 (95% CI 0.733-0.94)] score and SURFASA score [0.795 (95% CI 0.678-0.911)] were as accurate as ∆MELD at 2 weeks [0.770 (95% CI 0.687-0.845), p = 0.526] and better than ∆MELD at 3 days [0.541 (95% CI 0.395, 0.687), p 6, MELD score > 24 with SURFASA score ≥ - 1.2, could identify non-responders at day 3 (concomitant- 75% vs either - 42%, p

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