IMSEAR Repository :: Browsing by Author "Joshi, A."

Browsing by Author "Joshi, A."

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Assessment of HIV-TB co-infection in newly diagnosed HIV positive patients and their correlation with CD4 and viral load
(Medip Academy, 2023-06) Visawale, V. C.; Patil, S.; Joshi, A.
Background: Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) constitute a major burden of infectious diseases in India. TB is the most common opportunistic infection and a leading cause of death among HIV positive patients. This study was conducted to assess the HIV–TB co-infection in newly diagnosed HIV patients and correlate co-infection with CD4 and viral load (VL). Methods: A prospective observational study was carried out from January 2021 to June 2022 at ART center of a tertiary care hospital. Screening for TB was done by GeneXpert and Radiology. These patients were monitored for absolute CD4 count by flow cytometer and VL by Real time PCR. Results: Among 380 newly diagnosed HIV patients screened, 94 (24.70%) had HIV-TB coinfection. Of these, 42 (44.6%) were pulmonary tuberculosis (PTB) and 52 (55.3%) were extrapulmonary tuberculosis (EPTB) of 42 patients with PTB, 31 (73.80%) were microbiologically confirmed by GeneXpert whereas of 52 patients with EPTB, 33 (63.46%) were diagnosed clinically and radio-logically. Of 94 patients, only 55 patients could be followed up further at 6 months. Of 55 patients, 33 (60%) had CD4 count <350 cells/mm3 and 2 (3.6%) had baseline VL?1000 copies/ml. 46.80% patients completed their anti-tubercular treatment. Conclusions: EPTB was more as compared to PTB. Co-infection was more with low CD4 counts. Hence, CD4 test can be used as a good immunological marker in co-infection. The study highlights the need of periodic screening of newly diagnosed HIV patients for TB and their monitoring for CD4 and VL.
Assessment of HIV-TB co-infection in newly diagnosed HIV positive patients and their correlation with CD4 and viral load
(Medip Academy, 2023-06) Visawale, V. C.; Patil, S.; Joshi, A.
Background: Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) constitute a major burden of infectious diseases in India. TB is the most common opportunistic infection and a leading cause of death among HIV positive patients. This study was conducted to assess the HIV–TB co-infection in newly diagnosed HIV patients and correlate co-infection with CD4 and viral load (VL). Methods: A prospective observational study was carried out from January 2021 to June 2022 at ART center of a tertiary care hospital. Screening for TB was done by GeneXpert and Radiology. These patients were monitored for absolute CD4 count by flow cytometer and VL by Real time PCR. Results: Among 380 newly diagnosed HIV patients screened, 94 (24.70%) had HIV-TB coinfection. Of these, 42 (44.6%) were pulmonary tuberculosis (PTB) and 52 (55.3%) were extrapulmonary tuberculosis (EPTB) of 42 patients with PTB, 31 (73.80%) were microbiologically confirmed by GeneXpert whereas of 52 patients with EPTB, 33 (63.46%) were diagnosed clinically and radio-logically. Of 94 patients, only 55 patients could be followed up further at 6 months. Of 55 patients, 33 (60%) had CD4 count <350 cells/mm3 and 2 (3.6%) had baseline VL?1000 copies/ml. 46.80% patients completed their anti-tubercular treatment. Conclusions: EPTB was more as compared to PTB. Co-infection was more with low CD4 counts. Hence, CD4 test can be used as a good immunological marker in co-infection. The study highlights the need of periodic screening of newly diagnosed HIV patients for TB and their monitoring for CD4 and VL.
The clinical efficacy of integrating dolutegravir into the conventional therapeutic regimen for HIV management
(MRI Publication Pvt. Ltd., 2024-12) Doke, N; Hajgude, S; Dhande, A; Tole, S; Gunjegaonkar, S; Joshi, A.
This study investigates the efficacy of transitioning from Tenofovir/Lamivudine/Efavirenz (TLE) to Tenofovir/ Lamivudine/ Dolutegravir (TLD) as a first-line antiretroviral therapy for the management of HIV. A retrospective analysis was conducted involving 261 individuals in whom 145 patients were initially treated with TLE in 2017 who were transitioned to TLD in 2020 and 116 patients were given TLD as first-line therapy from 2020 onwards. Clinical parameters like viral load (VL), CD4 cell count, and WHO clinical stage were evaluated at baseline to study the effectiveness of the treatment. In addition, the non- clinical variables like age, sex, weight, mode of transmission and body mass index (BMI) were analyzed. The results signified enhancements in CD4 count, viral load and weight across both groups (TLE to TLD transition and TLD initiated as first-line therapy) with a statistical significance of p < 0.001***. The median BMI for patients transitioning from TLE to TLD was 21.63 (IQR 19.62-24.37) with a p-value of 0.004**, while the median BMI for patients on TLD as a first-line therapy was 20.83 (IQR 18.95-23.87), exhibiting a p-value of 0.115ns indicating no substantial difference between both groups. The findings showed effective viral suppression, with viral loads categorized as target not detected (TND) and CD4 counts exceeding 500 cells/mm3. Overall, the integration of TLD into the ART regimen resulted in improved clinical outcomes and sustained viral suppression among the patients showing the advantage of this therapeutic transition in HIV management.
Cultivating Empathy in Medical Education: Unlocking the Heart of Compassionate Care
(Medsci Publications, 2024-01) Shrivastava, S; Shrivastava, P; Inkane, S; Mendhe, H; Joshi, A.
In the context of medical education, empathy goes way beyond the delivery of effective patient care as it also remains one of the core competencies that medical students must cultivate during the course of their undergraduate training. The findings of different studies have reported a gradual decline in empathy among medical students during the course of their undergraduate training. A number of challenges and barriers have been identified in the development of empathy in medical education, which together can hinder the process of delivery of empathetic healthcare. In order to address these identified challenges, we will require collaborative efforts from administrators and teachers to enable the creation of a supportive environment, wherein empathy development is prioritized. In conclusion, the incorporation of empathy into medical practice has been linked with multiple benefits to patients, healthcare providers, and healthcare delivery system. However, considering the fact that a number of factors influence the development of empathy among medical students, it is the need of the hour to implement strategies to nurture empathy during medical education, which will enable the delivery of patient-centered care and the formation of strong doctor-patient relationships.
Dirofilariasis presenting as subcutaneous nodule: a case report and review of literature
(Medip Academy, 2024-04) Vaishnav, P. D.; Nayak, C.; Joshi, A.; Kalangutkar, A.
Dirofilariasis is an emerging rare zoonotic disease in which man is a dead-end host and it is transmitted by mosquitoes. The cases of dirofilariasis are increasing over the past few years. Several species of the genera Culex spp., Aedes spp., and Anopheles spp. are involved in the transmission of this parasite. These species represent a constant risk of infection because they feed on both animal and human hosts. For this reason, dirofilariasis is considered an emerging public health problem because of its zoonotic potential. Most of the cases are ocular and subcutaneous presentations are rare. Here, we present a rare case of dirofilariasis presenting as a subcutaneous swelling near the knee joint. Dirofilariasis should be kept in mind as one of the differential diagnosis of subcutaneous nodule. In endemic areas, it can present in atypical forms like rash similar to this case; therefore, clinicians should be aware about this disease.
Fabrication and Optimization of Glibenclamide Drug Delivery System Using Pulsatile Approach for Hyperglycemia
(MRI Publication Pvt. Ltd., 2024-12) Desai, S; Thakkar, V; Gandhi, T; Gandhi, A; Parekh, K; Joshi, A.
Diabetes mellitus is characterized by persistently high blood sugar levels, and Glibenclamide is commonly used to manage these levels. Pulsatile formulations of Glibenclamide offer controlled timed release to address early morning hyperglycemia, enhancing glucose management and reducing complications. Incorporating Aloe barbadensis miller spray-dried powder as a solid plug in the pulsatile capsule design may help control morning glucose spikes and reduce elevated triglyceride levels in diabetic patients. The present study utilized the Pulsincap® system, which incorporates ethyl cellulose (EC)--coated capsules containing optimized glibenclamide tablets and a swellable plug. Solid dispersions (SDs) were developed using Soluplus® to enhance the poor aqueous solubility of glibenclamide, with compatibility confirmed via Fourier transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC). Capsules (size ‘000’), coated with 10% w/v ethyl cellulose in methanol and dibutyl phthalate solution, achieved sustained release over 12 hrs. Immediate-release (IR) tablets, formulated via wet granulation, exhibited rapid disintegration within 2 mins. Sustained-release (SR) tablets, optimized using a 3² full factorial design with varying concentrations of HPMC K4M and HPMC K100M CR, demonstrated release profiles of 16-37% at 1 hr, 33-74% at 4 hrs, and 44-100% at 8 hrs. The erodible plug, composed of HPMC K15M, guar gum, and aloe vera, provided swelling and controlled lag times ranging from 7 to 12 hrs. The pulsatile delivery system effectively enhanced glibenclamide bioavailability and modulated its release, offering potential improvements in glycemic management for diabetic patients.
Iatrogenic small bowel perforation during elective laparoscopic intraperitoneal onlay meshplasty leading to intraoperative change of plan: a case report with review of literature
(Medip Academy, 2024-10) Balar, RK; Joshi, A.
Iatrogenic bowel injury during any surgery, be it open or laparoscopic; is associated with significant morbidity. Moreover, if the said injury occurs in a surgery in which a foreign material is planned to be implanted in the patient’s body as a prosthesis e.g., hernia surgery; the surgical team may have to deviate from its original plan of action. Even in the best of hands, iatrogenic bowel trauma can occur inspite of following best recommended practices. This usually occurs in the setting of dense adhesions of bowel to the parietes. Herein, we present one such case of a 72-year-old lady who was planned for laparoscopic incisional mesh hernioplasty, but had to be subjected to an intraoperative change in plan, due to an iatrogenic enterotomy.
Laparoscopic low anterior resection of rectum: A case report with review ofliterature
(Mansa STM Publishers, 2024-09) Shandilaya, U; Joshi, A.
Low anterior resection (LAR) is the standard operative treatment for rectal cancer. Laparoscopic anterior resections were first attempted in the 1990s. With the passage of time, laparoscopic instrumentation, energy sources, and laparoscopic techniques underwent a significant improvement. With all the above advancements, at the turn of the 20th century, there emerged strong evidence in the literature in favor of laparoscopic therapy for rectal cancer. Large-volume multicenter studies, various randomized controlled trials, and many review analyses of large databases, for example, Cochrane; conclusively showed that laparoscopy was not inferior to open surgery in oncological completeness of the resection; in colorectal cancer. Given its cosmetic superiority, lesser post-operative pain, and earlier resumption of routine day-to-day activity, laparoscopic radical colorectal cancer surgery has become standard practice in advanced laparoscopic health-care setups all over the world. Herein, we present the case of a 77-year-old gentleman who was diagnosed with low rectal cancer, underwent a laparoscopic LAR, and is disease-free until date, on serial surveillance investigations; over a post-operative follow-up period of just over 9 years.
Laparoscopic management of double moiety: A case report with review of literature
(Mansa STM Publishers, 2024-03) Agarwal, NSK; Shetty, PC; Joshi, A.
Duplication of the ureter is one of the most common anomalies of the urinary tract. Ureterocele is a developmental anomaly with cystic dilation of the distal aspect of the ureter and is often associated with some urological anomaly, such as a duplicated system or stenotic ureteric orifice. Early detection of these anomalies during the antenatal period has dramatically increased due to advances in imaging technology. However, a few undiagnosed adults also exist. It may remain asymptomatic but may cause repeated urinary tract infections or calculi. This is a case report of a 47-year-old female who had bilateral duplex collecting systems with right ureterocele. The patient had a recurrent urinary tract infection. She underwent cystoscopic deroofing and a laparoscopic right total nephrectomy. Congenital anomalies of the urogenital system should be considered in patients with chronic or recurrent infections. Multimodal imaging techniques such as ultrasonography, computed tomography, or magnetic resonance imaging should be used to confirm the diagnosis, especially before surgical management. The rationale for reporting this case is to highlight this rare condition and the feasibility of its minimally invasive therapy.
Laparoscopic therapy for Mirizzi syndrome: A case report with review of literature
(Mansa STM Publishers, 2024-03) Raj, M; Joshi, A.
Mirizzi syndrome (MS) is a rare entity and is due to extrinsic biliary compression. It is a rare complication of cholecystitis and chronic cholelithiasis. The impacted calculi at the infundibulum of the gall bladder or cystic duct lead to compression of the adjacent biliary structures, resulting in total or subtotal obstruction of the common hepatic duct (CHD). This leads to liver dysfunction. We, herein, present one such case of a 50-year-old female patient who was diagnosed to have MS. During surgery, at laparoscopy, she was unexpectedly also found to have a cholecysto-duodenal fistula. Both conditions were successfully treated laparoscopically.
Optic nerve sheath diameter as a non-invasive indicator of intracranial hypertension in traumatic brain injury: correlation with CT head and prognostic implications
(Medip Academy, 2023-11) Chauhan, V.; Raina, P.; Kumar, M.; Kumar, S.; Joshi, A.; Chauhan, N.; Kumari, U.
Background: Ultrasound guided measurement of optic nerve sheath diameter (ONSD) is an emerging non invasive bedside tool that is being used to detect raised intracranial pressure (ICP) in patients with traumatic brain injury(TBI). Early detection of raised ICP can guide in the timely management of such patients with raised ICP due to TBI. Methods: A prospective, observational, open labelled study planned with a 30 patients of TBI of both genders, aged between 18 to 70 years. ONSD readings were taken 3 times a day for three days from the time of admission with portable SonoSite ultrasound machine. Data was expressed as mean ±standard deviation. Values were compared using T test and P value was calculated. Results: Highest reading recorded in patients with GCS <8 was 6.26±0.73 in comparison to 5.38±0.56 (p=0.001) in patients with GCS >8. Highest reading of ONSD correlating with a positive CT finding at admission was 6.22±.81 and was 5.46±.57 (p=0.006) in patients with negative findings on CT. ROC curve with average cut off of 6 mm correlated with positive CT findings with sensitivity of 80%, specificity of 70% and negative predictive value of 87% was found. Conclusions: Ultrasound-guided ONSD monitoring shows promise for diagnosing intracranial hypertension in traumatic brain injury. Correlations with CT, GCS, and outcomes emphasize its clinical relevance, warranting further validatio.
Prevalence of diabetes distress and its psychosocial determinants among Indian population with type II diabetes
(Medip Academy, 2024-03) Purushottaman, S.; Joshi, A.; Dalal, D.; Fahaad, M.; Rao, N.; Gore, S.; Vijay, R.
Background: Diabetes distress (DD) refers to the negative emotional or affective experience resulting from the challenge of living with the demands of diabetes, regardless of the type of diabetes. In addition to the chronic treatment of diabetes, patients with type 2 diabetes mellitus (T2DM) often experience psychosocial difficulties which can go unnoticed. Hence, it is necessary to identify DD at an early stage to prevent its effect on the patients� long-term self-care and management plan. This study was conducted to assess the prevalence of DD and its psychosocial determinants among T2DM at a tertiary care centre. Methods: This was a cross sectional, observational study which included patients of either gender, who were between 18-65 years of age with T2DM for more than 3 months to 12 years. DD was assessed using the diabetes distress scale (DDS17) scale. In addition, association between the level of DD with the sociodemographic and clinical characteristics of the patients was assessed. Results: The prevalence of DD in type II diabetic patients in suburban population was found to be 17.69%. The psychosocial determinants which influence DD were found to be age, treatment modality, hypothyroidism, hypertension, and smoking. Conclusions: This study signifies the importance of identifying DD by the primary care physician which often remain unrecognized in clinical practice and to implement the interventions at early stages to improve the quality of life of diabetic patients.
A prospective study on emergence of mucormycosis in recently recovered COVID-19 patients
(Medip Academy, 2023-07) Landge, S.; Menon, S.; Chande, C.; Kulkarni, M.; Bhilkar, K.; Bade, J.; Joshi, A.
Background: Mucormycosis is an angio-invasive fungal infection with high morbidity and mortality. This infection seems to be increasing during the second wave of COVID-19. Objectives of this study were to identify and characterise the fungal species causing post-covid-mycosis, to analyze the cases for underlying co-morbidities if any and to correlate the associated risk factors with the progression of disease. Methods: Prospective observational study which constituted conventional fungal culture of 188 tissue specimens collected from clinically suspected mucormycosis patients who had history of COVID. Results: This study noted the occurrence of disease with predominance of males (72.03%). Most common symptoms were facial/periorbital swelling, followed by facial pain and headache. Among co-morbid conditions, diabetes mellitus was the most common (71.17%). Use of steroids (65.25%), antivirals therapy (22.86%), oxygen support (11.86%) used in management of COVID patients were found to be risk factors in post-covid-mucormycosis. radiological diagnosis showed involvement of paranasal sinuses (77.11%), followed by orbit (16.94%) and brain (5.90%). Mucor spp. was isolated in 21 cases. Although commonest fungus isolated was Aspergillus, analysis of the data for last 5 years showed a significant rise of Mucormycosis cases. Mortality was seen in 17.79% cases. Conclusions: Fungal aetiology should be kept in mind in patients with above clinical presentations with history of recent COVID-19 infection especially who received steroids.
Study of impact of screen exposure time on behavioural and growth parameters in urban Indian children
(Medip Academy, 2024-10) Garg, S; Rani, RPG; Mistry, V; Mehta, S; Joshi, A.
Background: The American academy of paediatrics (AAP) recommends 2 hours of screen time (ST) daily for children and teenagers, with no exposure for those under 2 years old. However, research shows children often exceed these limits, leading to behavioural issues, obesity, and unhealthy eating habits. This study aimed to evaluate STs impact on behaviour, growth, and eating habits in children aged 1.5 to 8 years. Methods: This cross sectional, observational study, conducted in the paediatric department, enrolled 401 children aged 1.5 to 8 years. Demographic details, weight, height, and BMI of the children were recorded. Parents provided information of their child's ST, screens at home, their own ST, and child抯 eating habits. Behavioural parameters were evaluated using the child behaviour checklist (CBCL). Internalizing and Externalizing behaviours were also recorded in which internalizing factors comprised of anxious and somatic behaviours, while externalizing factors encompassed aggression and rule-breaking behaviours. Data analysis was performed using SPSS V.23. Results: In our study, 401 children were enrolled, comprising 233 females (58.10%) and 168 males (41.90%). Out of 401, 201 (50.12%) exceeded 2 hours of ST, while 159 (39.65%) had 1 to 2 hours, and only 41 (10.22%) had less than 1 hour. There was a strong significant association between children's ST and their internalizing (p=0.00034), externalizing (p=0.009), withdrawn (p=0.001), rule breaking (p=0.03) and aggressive (p<0.01) behaviour. Additionally, children weight had a positive correlation between ST and BMI (p=0.015). Conclusions: Excessive ST use correlates well with higher BMIs, behavioural issues like withdrawal, somatic complaints, rule-breaking, aggression. Urgent interventions are needed to reduce ST and promote healthier lifestyles among children, involving parents, caregivers, and policymakers.Top of Form
Study of pulmonary functions in male current smokers and never smokers
(Medip Academy, 2024-02) Joshi, A.; Vagadiya, A.; Patel, V.; Muley, A.; Ladumor, P.; Shahi, A.
Background: Cigarettes smoking is the principal cause of preventable disease, disability, and premature death in the world. Tobacco smoking affects multiple organ systems resulting in numerous tobacco-related diseases. The study aimed to investigate interrelationship of pulmonary functions between current smokers and never smokers. Methods: Asymptomatic, 50 males current tobacco smokers and 50 healthy never smokers aged between 25 to 50 years were selected as cases and controls. Detailed description of the subject抯 selection, data collection and methods used for performing the test. Results: Maximum incidence was seen in >31 yrs of age with mean of 38.681�5. The study found that never smokers had significantly higher pulmonary functions as compared to current smokers:- FVC in liters (3.43�55 Vs 2.44�58; p<0.05); FEV1 in liters (2.86�57 Vs 1.76�32; p<0.05); FEV1/FVC in percentage (82.72�67 Vs 73.72�.40; p<0.05); FEF 25-75 ratio in percentage (3.18�91 Vs 1.60�45; p<0.05); PEFR in liters per second (6.63�00 Vs 3.16�26; p<0.05); breath holding time in seconds (25.54�14 Vs 21.36�10; p<0.05); 40mm endurance test in seconds (22.36�58 Vs 17.70�01; p<0.05); MEP in mmHg (83.48�28 Vs 64.38�31; p<0.05) were found significant. Conclusions: The strong relationship between cigarette smoking and respiratory disease has been seen independent of the other risk factors in a number of well-designated epidemiologic studies. Spirometry is an excellent screening test to detect chronic airflow obstruction, but may be useful in detecting restrictive disorders as well to study the effect of tobacco smoking on pulmonary functions.

Browsing by Author "Joshi, A."

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