Browsing by Author "Gupta, Varun"
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Item The Bethesda system for reporting of thyroid cytopathology and its category wise management(Medip Academy, 2019-10) Gupta, Varun; Singh, PoojaBackground: Fine-needle aspiration cytology (FNAC) of thyroid is a rapid diagnostic test for thyroid nodules. The Bethesda system classifies thyroid FNAC into six categories. Each category is linked to a malignancy risk and has recommended clinical management. The aim of this study was to analyze the thyroid cytology smears by Bethesda system and to assess the frequency of various categories and to correlate it previous published studies. Category wise management is also discussed in detail.Methods: A total of 388 thyroid FNAC samples were examined from January 2017 to June 2018 in the Department of Pathology, in Medanta- The Medicity Gurugram.Results: A total of 388 cases were reported according to Bethesda system of reporting. Categories were as follows: I (14.69%), II (61.85%), III (11.34%), IV (2.57%), V (2.660%), VI (4.91%) nodules.Conclusions: The Bethesda System for reporting thyroid cytopathology proved to be an excellent reporting system and it puts clinician and the cytopathologist on the same page and easier to communicate regarding diagnosis.Item Effect of controlled breathing exercises on the psychological status and the cardiac autonomic tone : Sudarshan Kriya and Prana-Yoga.(2014-07) Kharya, Chhaya; Gupta, Varun; Deepak, Kishore Kumar; Sagar, Rajesh; Upadhyay, Ashish; Kochupillai, Vinod; Sneh, AnandObjective : The objective of the study was to observe the effect of controlled breathing exercises including Sudarshan Kriya (SK) and Prana-Yoga (PY) on the psycho-physiological status. Methods : The study group included 60 healthy volunteers (M:30, F:30) in the age group of 18 to 30 years (21.3±3.2 yrs), randomly divided in to three groups of 20 subjects each – (1) The SK group (2) the PY group and the (3) Control group. The psycho-physiological data was collected at the following four time interventions: Baseline, 6th, 60th and the 150th day. Psychological assessment was done using questionnaires and for the autonomic tone quantification Heart Rate Variability (HRV) analysis was done using the standard lead II electrocardiogram recordings. In a post-hoc analysis each group was further sub divided in to the following two patterns, based on the baseline values of normalized Low Frequency (LF) power (cutoff 64 ms2) : (i) Pattern A-Subjects with low level LF power, and (ii) Pattern B- subjects with high level LF power. Results : The stress management skills have shown significant increase in SK group but not in PY and Control group. Subjects of SK, PY, and control group showed significant increase in LF value and LF:HF ratio for pattern A and significant decrease for pattern B. Plotted LF value for pattern A & B in SK and PY practitioners showed convergence, coming to a mean value over the period of 150 days.The LF:HF ratio curve plotted over time for pattern A & B showed convergence in SK group only. No such convergence in LF value & LF/HF ratio for pattern A & B was seen in control group. Conclusion : In conclusion, Sudarshan Kriya positively modifies stress coping behavior and initiates appropriate balance in cardiac autonomic tone.Item A prospective study of risk factor profile & incidence of deep venous thrombosis among medically-ill hospitalized patients at a tertiary care hospital in northern India.(2009-12) Sharma, Surendra K; Gupta, Varun; Kadhiravan, Tamilarasu; Banga, Amit; Seith, Ashu; Kumar, Atin; Saxena, Renu; Thabah, Molly M; Gulati, Vandana; Bhatia, Indrish; Kavimandan, Amit ABackground & objectives: Hospitalization for medical-illness is associated with an increased risk of deep venous thrombosis (DVT). However, there are no published data from India addressing at this issue. We sought to study the risk factor profile and the incidence of DVT among hospitalized medically-ill patients, a tertiary care hospital in northern India. Methods: All adults admitted to the medical wards and intensive care unit with level 1 or 2 mobility over a period of two years (July 2006 to July 2008) at the All India Institute of Medical Sciences hospital, New Delhi, were prospectively studied. Patients having DVT at admission or an anticipated hospital stay less than 48 h were excluded. The presence of clinical risk factors for DVT was recorded and laboratory evaluation was done for hypercoagulable state. A routine surveillance venous compression Doppler ultrasonography was performed 12 ± 8 days after hospital admission. Results: Of the 163 patients, 77 (47%) had more than one risk factor for DVT. Five (3%) patients developed DVT; none of them had symptomatic DVT. None of these patients received anticoagulation prior to the development of DVT. The mean age of those who developed DVT was 40 ± 13 (25-50) yr; two of five were male. The incidence rate of DVT was 2.7 per 1000 person-days of hospital stay [95% confidence interval (CI): 0.87 to 6.27]. None of the factors was found to be significantly associated with the risk of DVT. Interpretation & conclusions: In our setting, although many hospitalized medically-ill patients had risk factors for DVT, the absolute risk of DVT was low compared to the western population but clearly elevated compared to non hospitalized patients. Large studies from India are required to confirm our findings.Item A Review on the Current Classification and Regulatory Provisions for Medicines in Drug & Cosmetic Act, in the light of Present Day Context(Ibn Sina Academy of Medieval Medicine & Sciences, 2017-07) Tandon, Prashant; Gupta, Varun; Ranjan, Ashish; Gandhi, Purav; Kotiyal, Anand; Kapoor, AasthaBackground: Current classification of medicines in India under Drug and Cosmetic Act into Schedule G, H, H1, X is outdated, evolved through patchwork over the years and needs to be thoroughly updated. The primary aim of the scheduling system is to ensure appropriate access to medicines while balancing public health and safety. India is experiencing a rapid transition with the rising burden of chronic non-communicable diseases where regular access of affordable medicines is critical for chronic disease management to prevent complications. Methods: We analyzed drugs commonly selling across India, through multiple information sources including 1mg drug database, PharmaTrac (AIOCD-AWACS), inventory data from distributors and retailers, performed extensive literature review and expert interviews. We studied different regulatory systems globally to understand best-practices and identify recommendations. Results: We identified series of lacunae in current drug classification system and its implementation. Out of approximately 1,600 commonly prescribed medicines, only 656 are currently covered under the four Schedules. There are multiple overlaps in terms of drug substances covered under these schedules resulting in ambiguity. Conclusions: We have recommended a revised drug classification system that is more comprehensive in coverage and eliminates the overlaps between classes. Moreover, considering the implementation challenges for such a drug classification system in the diverse and fragmented ecosystem in India, we recommend a technology backed platform to help monitor the implementation.Item A short term evaluation of effect on serum urea, creatinine and potassium levels with use of angiotensin II receptor blockers (olmesartan or telmisartan) in stage 1 hypertensive patients(Medip Academy, 2019-10) Gupta, Varun; Singh, PoojaBackground: Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (ARBs) are being used as first line agents for the treatment of hypertension in haemodialysis patients as well as in the general population. Serious hyperkalemia is common in patients with end-stage renal disease, and is observed in about 10% of haemodialysis patients. Although many research have been done so far to compare the antihypertensive efficacy of ARBs, but such studies to evaluate the effect on serum urea, creatinine and potassium levels are not so common in North India region.Methods: In this open label, prospective, randomized study, we evaluated the effect on serum urea, creatinine and potassium levels with use of ARB’s (olmesartan or telmisartan) in stage 1 hypertensive patients (JNCVII). 60 patients were randomized in to two groups. The odd numbers will be allotted olmesartan 20 mg (group A) and even numbers to telmisartan 40 mg (group B). Impacts on serum urea, creatinine and potassium levels were evaluated after 12 weeks.Results: Our results indicates that there was no statistically significant alterations in mean serum creatinine, blood urea and in mean serum potassium levels compared to baseline within the two groups as well as when mean of both groups were compared, olmesartan showed a better reduction in blood pressure as compared to telmisartan.Conclusions: Olmesartan showed a better reduction in blood pressure with similar effects in biochemical parameters as telmisartan.Item Study of the Efficacy of Automated Oscillometry in Evaluating Ankle-Brachial Index for the Assessment of Peripheral Arterial Disease in Diabetes Mellitus(JK Science, 2019-10) Gupta, Abhinav; Gupta, Varun; Kudyar, RP; Gupta, Anil KPeripheral arterial disease (PAD) is defined as a clinical disorder in which there is stenosis or occlusion in the aorta orarteries of the limbs. Type 2 diabetes is a strong risk factor for atherosclerotic diseases including cardiovascular aswell as peripheral arteries. The risk of development of peripheral arterial disease increases three to four folds inpatients with diabetes.Most diabetic amputations are due to peripheral arterial disease (PAD), peripheral neuropathyand infection. Ankle-brachial index is helpful in assessing the prognosis in the symptomatic as well as asymptomaticpatients in contrast to the variability of pulse assessment and the physical examination. The present study included50 patients with diabetes mellitus for more than ten years, irrespective of their symptoms. ABI was calculated bydividing the ankle systolic blood pressure by the brachial systolic blood pressure of the respective sides. The lowerof the two ABI values for the legs was used to define ankle brachial index. Of 50 patients, 20 had signs of PAD amongwhom 11 (55.0%) had abnormal ABI and 9 (45.0%) had normal ABI. Out of 30 patients with no signs of PAD, 8 (26.7%)had abnormal ABI and 22 (73.3%) had normal ABI. Automated oscillometry method for evaluating ankle-brachialindex for the assessment of peripheral arterial disease in diabetes mellitus had a sensitivity of 68.18%, a specificity of85.71%, positive predictive value (PPV) of 78.95% and negative predictive value (NPV) of 77.42%. The Accuracy ofthe test was 78.0%. Thus, our study has proved that the oscillometric method of ABI is a very useful procedure fordetecting PAD. By repeating the test the sensitivity and specificity may probably increase. The oscillometric methodof performing ABI is a simple procedure, automated, easy to perform, negligible cost of the instrument, does notrequire training and can be performed as an outpatient procedure.