31 results on '"Varun Mehta"'
Search Results
2. Inflammatory bowel disease (IBD)-disk accurately predicts the daily life burden and parallels disease activity in patients with IBD
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Arshdeep Singh, Yogesh Kumar Gupta, Ashvin Singh Dhaliwal, Bhavjeet Kaur Kahlon, Vasu Bansal, Ramit Mahajan, Varun Mehta, Dharmatma Singh, Ramandeep Kaur, Namita Bansal, Vandana Midha, and Ajit Sood
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crohn disease ,ulcerative colitis ,inflammatory bowel diseases ,disability ,patient reported outcome measures ,Medicine ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims The inflammatory bowel disease (IBD)-disk is a validated, visual, 10-item, self-administered questionnaire used to evaluate IBD-related disability. The present study aimed to evaluate IBD-disk in assessment of IBD daily life burden and its relation with disease activity. Methods A cross-sectional study was conducted between June 2021 and December 2021. Patients with IBD were asked to complete the IBD-disk and a visual analogue scale of IBD daily-life burden (scored from 0–10, score >5 indicative of high burden). The internal consistency of IBD-disk, correlation with IBD daily life burden and disease activity (assessed by partial Mayo score and Harvey Bradshaw Index in patients with ulcerative colitis [UC] and Crohn’s disease [CD], respectively) and diagnostic performance of IBD-disk to detect high burden were analyzed. Results Out of the 546 patients (mean age 40.33±13.74 years, 282 [51.6%] males) who completed the IBD-disk, 464 (84.98%) had UC and the remaining (n=82, 15.02%) had CD. A total of 311 patients (291 UC and 20 CD; 56.95%) had active disease. The mean IBD-disk total score and IBD daily life burden were 18.39±15.23 and 2.45±2.02, respectively. The IBD-disk total score correlated strongly with the IBD daily life burden (ρ=0.94, P30 predicted high IBD daily-life burden. Conclusions The IBD-disk accurately predicts the daily life burden and parallels disease activity in patients with IBD and can be applied in clinical practice. (Intest Res, Published online )
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- 2023
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3. Clinical spectrum of elderly-onset inflammatory bowel disease in India
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Yogesh Kumar Gupta, Arshdeep Singh, Vikram Narang, Vandana Midha, Ramit Mahajan, Varun Mehta, Dharmatma Singh, Namita Bansal, Madeline Vithya Barnaba Durairaj, Amit Kumar Dutta, and Ajit Sood
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crohn disease ,colitis, ulcerative ,inflammatory bowel diseases ,elderly ,aged ,Medicine ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims Inflammatory bowel disease (IBD) is increasingly being recognized in elderly patients. Data on clinical spectrum of elderly-onset IBD patients is lacking from India. Methods A cross-sectional retrospective analysis of a prospectively maintained database of patients diagnosed with IBD was conducted at 2 centers in India. The clinical spectrum of elderly-onset IBD including demographic profile (age and sex), clinical presentation, disease characteristics (disease behavior and severity, extent of disease), and treatment were recorded and compared with adult-onset IBD. Results During the study period, 3,922 (3,172 ulcerative colitis [UC] and 750 Crohn’s disease [CD]) patients with IBD were recorded in the database. A total of 186 patients (4.74%; 116 males [62.36%]) had elderly-onset IBD (69.35% UC and 30.64% CD). Diarrhea, blood in stools, nocturnal frequency and pain abdomen were the commonest presentations for UC, whereas pain abdomen, weight loss and diarrhea were the most frequent symptoms in CD. For both elderly onset UC and CD, majority of the patients had moderately severe disease. Left-sided colitis was the commonest disease location in UC. Isolated ileal disease and inflammatory behavior were the most common disease location and behavior, respectively in CD. 5-Aminosalicylates were the commonest prescribed drug for both elderly onset UC and CD. Thiopurines and biologics were used infrequently. Prevalence of colorectal cancer was higher in elderly onset IBD. Conclusions Elderly onset IBD is not uncommon in India. Both the elderly onset UC and CD were milder, with no significant differences in disease characteristics (disease extent, location and behavior) when compared to adult-onset IBD. Colorectal cancer was more common in elderly onset IBD.
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- 2023
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4. Endoscopy for assessment of mucosal healing in ulcerative colitis: time bound or response guided?
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Ajit Sood, Ramit Mahajan, Arshdeep Singh, Vandana Midha, and Varun Mehta
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colitis, ulcerative ,colonoscopy ,fecal calprotectin ,Medicine ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
The timing of colonoscopy in patients with active ulcerative colitis (UC) lacks coherence. The published guidelines and recommendations advocate time-bound colonoscopy in patients with active UC to assess for mucosal healing. However, the practice of performing colonoscopies at fixed time frames lacks reasoning. The time to achieve mucosal healing in UC is not uniform across the patient populations and is influenced by the disease severity and efficacy and time to therapeutic response of the drugs being used. Additionally, with the availability of sensitive noninvasive inflammatory biomarkers such as fecal calprotectin, that parallel the disease activity and correlate with mucosal healing, the notion of performing colonoscopy at fixed intervals sounds unjustifiable. The authors express their view that a response-guided colonoscopy (driven by normalization of clinical symptoms and inflammatory biomarkers), rather than a time-bound colonoscopy, would be more logical, apart from being cost-effective and patient-friendly.
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- 2022
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5. Maintaining infliximab induced clinical remission with azathioprine and 5-aminosalicylates in acute severe steroid-refractory ulcerative colitis has lower cost and high efficacy (MIRACLE): a multicenter study
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Ramit Mahajan, Arshdeep Singh, Saurabh Kedia, Kirandeep Kaur, Vandana Midha, Pabitra Sahu, Varun Mehta, Dharmatma Singh, Namita Bansal, Khushdeep Dharni, Sandeep Kaushal, Vineet Ahuja, and Ajit Sood
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colitis, ulcerative ,maintenance ,infliximab ,azathioprine ,mesalamine ,Medicine ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims Infliximab (IFX) has been used to induce and maintain remission in patients with severe steroid-refractory ulcerative colitis (UC). Long-term use of biologics in developing countries is limited by high cost and frequent side effects. An optimal maintenance strategy in these patients needs to be established. Methods A retrospective analysis of maintenance of clinical remission with combination of azathioprine (AZA) and 5-aminosalicylates (5-ASA) in patients with severe steroid-refractory UC where IFX (5 mg/kg intravenously at weeks 0, 2, 6) had been used only as an induction therapy was done at 2 centers in India. Primary outcome was the proportion of patients maintaining corticosteroid-free sustained clinical remission (SCR) at the end of study period. Rates of relapse and cost of therapy were also analyzed. Results Of the 137 patients who received rescue IFX induction therapy, 77 (56.2%) achieved clinical remission (mean age 34.81 ± 13.32 years, 68.83% males, median follow-up 4 years, range 3 months to 6 years) and were included. Cumulative corticosteroid-free SCR was maintained in 68%, 59%, 42%, and 35% patients at 1, 2, 4, and 6 years respectively. Sixty-seven relapses were observed in 33 patients. Majority of the relapses (45/67, 67.16%) occurred within first 2 years of follow-up. Two relapses were managed with re-induction with IFX, one required colectomy, whereas all other responded to repeat course(s) of corticosteroids. Annual per capita maintenance therapy with 5-ASA and AZA was cheaper by US$ 4,526 compared to maintaining remission with IFX. Conclusions Clinical remission achieved with IFX induction therapy in severe steroid-refractory UC can be sustained over long time with a combination of AZA and 5-ASA.
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- 2022
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6. Use of thiopurines in inflammatory bowel disease: an update
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Arshdeep Singh, Ramit Mahajan, Saurabh Kedia, Amit Kumar Dutta, Abhinav Anand, Charles N. Bernstein, Devendra Desai, C. Ganesh Pai, Govind Makharia, Harsh Vardhan Tevethia, Joyce WY Mak, Kirandeep Kaur, Kiran Peddi, Mukesh Kumar Ranjan, Perttu Arkkila, Rakesh Kochhar, Rupa Banerjee, Saroj Kant Sinha, Siew Chien Ng, Stephen Hanauer, Suhang Verma, Usha Dutta, Vandana Midha, Varun Mehta, Vineet Ahuja, and Ajit Sood
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inflammatory bowel disease ,azathioprine ,mercaptopurine ,6-thioguanine ,developing countries ,Medicine ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.
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- 2022
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7. Trends of inflammatory bowel disease at a tertiary care center in northern India
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Ajit Sood, Kirandeep Kaur, Arshdeep Singh, Vandana Midha, Ramit Mahajan, Namita Bansal, Varun Mehta, and Dharmatma Singh
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inflammatory bowel disease ,ulcerative colitis ,trends ,crohn disease ,india ,Medicine ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is increasingly being reported from India and other Asian countries. This study looks into the changing trends of IBD at a tertiary care center in north India over last two decades. Methods Retrospective analysis of a prospectively maintained database of patients diagnosed with IBD between January 1991 and December 2015 was conducted. The study period was divided into five times cohorts (1991–1995, 1996–2000, 2001–2005, 2006–2010, 2011–2015). Results During the study period, 2,467 patients (UC [n = 2,137, 86.6%], CD [n = 330, 13.3%], mean age 38.5 ± 13.3 years; 55.9% males) were registered. The proportion of patients with CD increased (ratio of UC to CD declined from 15.7:1 to 4:1). The mean age at diagnosis decreased for UC (45.7 ± 12.1 years in 1991–1995 vs. 37.6 ± 13.0 years in 2011–2015; P= 0.001) and remained consistent for CD (41.3 ± 13.6 years in 1996–2000 vs. 41.3 ± 16.9 years in 2011–2015, P= 0.86). Patients with proctitis in UC and isolated ileal disease in CD increased over the study period (P= 0.001 and P= 0.007, respectively). Inflammatory CD increased (P= 0.009) whereas stricturing CD decreased (P= 0.01) across all cohorts. There was a trend towards less severe presentation of both UC and CD. The use of thiopurines (P= 0.02) and biologics increased (P= 0.001) with no significant change in trends for requirements of surgery (P= 0.9). Conclusions Increasing prevalence of CD, younger age at diagnosis, diagnosis at an earlier and milder stage, greater use of thiopurines and biologics were observed.
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- 2021
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8. Colitis and Crohn’s Foundation (India) consensus statements on use of 5-aminosalicylic acid in inflammatory bowel disease
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Ajit Sood, Vineet Ahuja, Vandana Midha, Saroj Kant Sinha, C. Ganesh Pai, Saurabh Kedia, Varun Mehta, Sawan Bopanna, Philip Abraham, Rupa Banerjee, Shobna Bhatia, Karmabir Chakravartty, Sunil Dadhich, Devendra Desai, Manisha Dwivedi, Bhabhadev Goswami, Kirandeep Kaur, Rajeev Khosla, Ajay Kumar, Ramit Mahajan, S. P. Misra, Kiran Peddi, Shivaram Prasad Singh, and Arshdeep Singh
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inflammatory bowel disease ,5-aminosalicylic acid ,crohn disease ,colitis, ulcerative ,mesalamine ,Medicine ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Despite several recent advances in therapy in inflammatory bowel disease (IBD), 5-aminosalicylic acid (5-ASA) therapy has retained its place especially in ulcerative colitis. This consensus on 5-ASA is obtained through a modified Delphi process, and includes guiding statements and recommendations based on literature evidence (randomized trials, and observational studies), clinical practice, and expert opinion on use of 5-ASA in IBD by Indian gastroenterologists. The aim is to aid practitioners in selecting appropriate treatment strategies and facilitate optimal use of 5-ASA in patients with IBD.
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- 2020
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9. Incidental benefits after fecal microbiota transplant for ulcerative colitis
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Ramit Mahajan, Vandana Midha, Arshdeep Singh, Varun Mehta, Yogesh Gupta, Kirandeep Kaur, Ritu Sudhakar, Anmol Singh Pannu, Dharmatma Singh, and Ajit Sood
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fecal microbiota transplantation ,colitis, ulcerative ,incidental findings ,Medicine ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Gut dysbiosis can result in several diseases, including infections (Clostridium difficile infection and infectious gastroenteritis), autoimmune diseases (inflammatory bowel disease, diabetes, and allergic disorders), behavioral disorders and other conditions like metabolic syndrome and functional gastrointestinal disorders. Amongst various therapies targeting gut microbiome, fecal microbiota transplantation (FMT) is becoming a focus in the public media and peer reviewed literature. We have been using FMT for induction of remission in patients with moderate to severe active ulcerative colitis (UC) and also for subsequent maintenance of remission. Four cases reported incidental benefits while being treated with FMT for UC. These included weight loss (n=1), improvement in hair loss (n=1), amelioration of axial arthritis (n=1) and improvement in allergic rhinitis (n=1), thereby suggesting potential clinical applications of FMT in treating extraintestinal diseases associated with gut dysbiosis.
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- 2020
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10. Exclusive enteral nutrition for induction of remission in anti-tumor necrosis factor refractory adult Crohn’s disease: the Indian experience
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Ajit Sood, Arshdeep Singh, Ritu Sudhakar, Vandana Midha, Ramit Mahajan, Varun Mehta, Yogesh Kumar Gupta, and Kirandeep Kaur
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exclusive enteral nutrition ,adult crohn’s disease ,inflammatory bowel disease ,fistulizing crohn’s disease ,Medicine ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims Exclusive enteral nutrition (EEN) is recommended for induction of remission in pediatric Crohn’s disease (CD). However, it is not currently recommended for inducing remission in adults. This report describes the use of 12-week EEN for induction of remission in anti-tumor necrosis factor (anti-TNF) refractory adult CD. Methods This is a retrospective analysis of adults with moderate to severe active (Crohn’s Disease Activity Index [CDAI] >220) anti-TNF refractory CD, who received EEN for 12 weeks between April 2018 and March 2019 at Dayanand Medical College and Hospital, Ludhiana, India. Primary outcomes included achievement of clinical remission and fistula healing at 12 weeks. Improvement in inflammatory markers and nutritional status were the secondary end points. Results Out of 23 patients who received anti-TNF agents, 7 (30.4%) were refractory and were offered EEN as a salvage therapy. Six patients (66.7% females, mean age 25.6±6.5 years) consented. Four patients (66.6%) achieved clinical remission (CDAI 50%), though none achieved remission. Entero-enteric fistulae showed complete healing. Mean body mass index improved from 15.6±3.1 to 18.9±1.9 kg/m2 at week 12 (P=0.003). Hemoglobin and serum albumin also improved from 8.2±1.1 g/dL and 2.8±0.3 g/dL at baseline to 12.6±0.6 g/dL and 3.6±0.5 g/dL post-EEN respectively (P
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- 2020
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11. Clinical profile and outcomes of opioid abuse gastroenteropathy: an underdiagnosed disease entity
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Ramit Mahajan, Yogesh Gupta, Arshdeep Singh, Pulkit Dhiman, Vandana Midha, Chandan Kakkar, Vikram Narang, Varun Mehta, Kavita Saggar, and Ajit Sood
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opium ,opioid abuse gastroenteropathy ,ulcer ,stricture ,intestinal obstruction ,Medicine ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims Opioid-induced bowel dysfunction includes nausea, vomiting, constipation and abdominal distension. We describe patients presenting with gastrointestinal (GI) ulcers and ulcerated strictures secondary to opioid abuse, an entity not well described in literature. Methods This retrospective observational study included patients with opioid abuse gastroenteropathy presenting to Dayanand Medical College and Hospital, Ludhiana, India between January 2013 and December 2018. Opioid abuse gastroenteropathy was defined as gastric or small bowel ulcers and ulcerated strictures in patients abusing opioids, where all other possible etiologies of GI ulcers/strictures were excluded. Clinical, biochemical, endoscopic, radiological and histological parameters as well as response to treatment were assessed. Results During the study period, 20 patients (mean age, 38.5±14.2 years; 100% males) were diagnosed to have opioid induced GI ulcers and/or ulcerated strictures. The mean duration of opioid consumption was 6.2±3.4 years. The mean duration of symptoms at presentation was 222.1±392.3 days. Thirteen patients (65%) had gastroduodenal involvement, 6 (30%) had a jejunoileal disease and 1 (5%) had an ileocecal stricture. Two patients (10%) presented with upper GI bleeding, 11 (55%) had features of gastric outlet obstruction and 7 (35%) presented with small bowel obstruction. Abdominal pain and iron deficiency anemia were the most common presentations. Only 1 patient (5%) responded to proton pump inhibitors, 3 (15%) had a lasting response to endoscopic balloon dilatation, while all other (80%) required surgical intervention. Conclusions Opioid abuse gastroenteropathy presents as ulcers and ulcerated strictures which respond poorly to medical management and endoscopic balloon dilatation. A majority of these cases need surgical intervention.
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- 2020
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12. A Real-Time Respiration Monitoring and Classification System Using a Depth Camera and Radars
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Shan He, Zixiong Han, Cristóvão Iglesias, Varun Mehta, and Miodrag Bolic
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respiration rate ,respiration patterns ,IR-UWB radars ,Kinect ,contactless respiration monitoring ,remote sensing ,Physiology ,QP1-981 - Abstract
Respiration rate (RR) and respiration patterns (RP) are considered early indicators of physiological conditions and cardiorespiratory diseases. In this study, we addressed the problem of contactless estimation of RR and classification of RP of one person or two persons in a confined space under realistic conditions. We used three impulse radio ultrawideband (IR-UWB) radars and a 3D depth camera (Kinect) to avoid any blind spot in the room and to ensure that at least one of the radars covers the monitored subjects. This article proposes a subject localization and radar selection algorithm using a Kinect camera to allow the measurement of the respiration of multiple people placed at random locations. Several different experiments were conducted to verify the algorithms proposed in this work. The mean absolute error (MAE) between the estimated RR and reference RR of one-subject and two-subjects RR estimation are 0.61±0.53 breaths/min and 0.68±0.24 breaths/min, respectively. A respiratory pattern classification algorithm combining feature-based random forest classifier and pattern discrimination algorithm was developed to classify different respiration patterns including eupnea, Cheyne-Stokes respiration, Kussmaul respiration and apnea. The overall classification accuracy of 90% was achieved on a test dataset. Finally, a real-time system showing RR and RP classification on a graphical user interface (GUI) was implemented for monitoring two subjects.
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- 2022
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13. An open-label randomised pilot trial on safety of wheat variety C273 in patients with adult celiac disease
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Jasmine Grover, Parveen Chhuneja, Vandana Midha, Arshdeep Singh, Ramit Mahajan, Varun Mehta, Ramneek Verma, Ekta Bansal, Dipak Deka, Namita Bansal, Neena Sood, Vikram Narang, and Ajit Sood
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background: The only effective treatment for celiac disease (CeD) is gluten free diet (GFD). However, GFD is restrictive and efforts are being made to explore alternative therapies including safer wheat varieties. Wheat variety C273 has been previously identified to have reduced load of intact T-cell stimulatory epitopes via in silico and in vitro analysis. Methods: Adult patients diagnosed with CeD and recovered on GFD were included in the study. Patients were randomised into two groups in a 2:1 ratio. Patients in group I had graded introduction of C273 wheat in diet, maintained for 24 weeks; in Group II, wheat was restricted with continuation of GFD. Clinical symptoms, serology [anti-tissue transglutaminase (anti-tTG), anti-endomysial antibody (anti-EMA)], circulating inflammatory biomarkers [intestinal fatty-acid binding protein (I-FABP), plasma citrulline, interferon-γ (IFN-γ)] and histology were evaluated periodically. Final evaluation was performed at week 28. Results: A total of 15 patients were enrolled (Group I: n = 10, Group II: n = 5). All patients except two in Group I remained compliant. None of the remaining eight patients in group I developed symptoms. No significant changes in serology (anti-tTG, anti-EMA) and histology were observed between the two groups at 28 weeks ( p > 0.05). Significant changes in plasma citrulline(29.87 ± 8.98 versus 36.58 ± 3.09, p = 0.049) and IFN-γ (44.56 ± 9.74 versus 33.50 ± 3.68; p = 0.031) were observed in Group I. Conclusion: Consumption of C273 wheat did not result in development of symptoms or evident changes in serology and histology at 28 weeks. However, variations in circulating inflammatory markers were noted. Larger randomised trials are needed to corroborate these findings. Clinical Trials Registry-India: CTRI/2018/06/014521.
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- 2020
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14. Efficacy of fecal microbiota therapy in steroid dependent ulcerative colitis: a real world intention-to-treat analysis
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Ajit Sood, Ramit Mahajan, Garima Juyal, Vandana Midha, Charanpreet Singh Grewal, Varun Mehta, Arshdeep Singh, Mohan C Joshi, Vikram Narang, Kirandeep Kaur, and Hasrat Sidhu
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Fecal microbiota transplantation ,Colitis, ulcerative ,Real world analysis ,Medicine ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims Four high-quality randomized controlled trials have proven the efficacy of fecal microbiota transplantation (FMT) in active ulcerative colitis (UC). We assessed the efficacy of FMT in a real-world setting involving steroid-dependent patients with UC. Methods This was a single-center prospective analysis of data from steroid-dependent patients with UC treated with FMT from September 2015 to September 2017 at the Dayanand Medical College, a tertiary care center in India. Fecal samples from random unrelated donors were administered through colonoscopy at weeks 0, 2, 6, 10, 14, 18, and 22. The primary outcome was achievement of steroid-free clinical remission, and the secondary outcomes were clinical response and endoscopic remission at 24 weeks. Modified intention-to-treat analysis was performed, which included subjects who underwent at least 1 FMT. Results Of 345 patients with UC treated during the study period, 49 (14.2%) had steroid-dependent UC. Of these 49 patients, 41 underwent FMT: 33 completed 7 sessions over 22 weeks according to the protocol, and 8 discontinued treatment (non-response, 5; lost to follow-up, 2; and fear of adverse effects, 1). At week 24, steroid-free clinical remission was achieved in 19 out of 41 (46.3%) patients, whereas clinical response and endoscopic remission were achieved in 31 out of 41 (75.6%) and 26 out of 41 (63.4%) patients, respectively. All patients with clinical response were able to withdraw steroids. There were no serious adverse events necessitating discontinuation. Conclusions A multisession FMT via the colonoscopic route is a promising therapeutic option for patients with steroid-dependent UC, as it can induce clinical remission and aid in steroid withdrawal.
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- 2019
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15. Impact of 'Sambhav' Program (Financial Assistance and Counselor Services) on Hepatitis C Pegylated Interferon Alpha Treatment Initiation in India
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Ajit Sood, Vandana Midha, Shivalingappa S. Halli, Vikram Narang, Ramit Mahajan, Varun Mehta, Kirandeep Kaur, Vijay Surlikar, Subodh Kanchi, and Dharmatma Singh
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sambhav program ,hepatitis c ,pegylated interferon gamma ,treatment access ,india ,Public aspects of medicine ,RA1-1270 - Abstract
Background Financial constraints, social taboos and beliefs in alternative medicine are common reasons for delaying or not considering treatment for hepatitis C in India. The present study was planned to analyze the impact of non-banking interest free loan facility in patients affected with hepatitis C virus (HCV) in North India. Methods This one year observational, retrospective study was conducted in Department of Gastroenterology (January 2012-December 2013), Dayanand Medical College and Hospital Ludhiana, to evaluate the impact of program titled “Sambhav” (which provided non-banking financial assistance and counselor services) on treatment initiation and therapeutic compliance in HCV patients. Data of fully evaluated patients with chronic hepatitis, and/or cirrhosis due to HCV infection who were treated with Peginterferon alfa and ribavirin (RBV) combination during this duration (2012-2013) was collected from patient medical records and analyzed. In the year 2012, eligible patients who were offered antiviral treatment paid for treatment themselves, while in 2013, ‘Sambhav’ program was launched and this provided interest free financing by non-banking financial company (NBFC) for the treatment of HCV in addition to free counselor services for disease management. The treatment initiation and compliance rates were compared between the patients (n = 585) enrolled in 2013 who were offered ‘Sambhav’ assistance and those enrolled in 2012 (n = 628) when ‘Sambhav’ was not available. Results Introduction of Sambhav program improved the rates of treatment initiation (59% in 2013 vs. 51% in 2012, P = .004). Of the 585 eligible patients offered ‘Sambhav’ assistance in 2013, 233 patients (39.8%) applied but 106/233 (45.4%) received assistance. Antiviral therapy was started in 93/106 (87.7%) of these patients, while only 52 (42.5%) of 127 patients whose applications were rejected underwent treatment. Compliance to antiviral therapy also improved with the introduction of ‘Sambhav’ program (87.7% vs. 74.1%, P = .001). Conclusion ‘Sambhav’ program had significant impact on the initiation of antiviral therapy by overcoming the financial hurdles. The free counselor services helped to mitigate social taboos and imparted adequate awareness about the disease to the patients. Initiatives like ‘Sambhav’ can be utilized for improving healthcare services in developing countries, especially for chronic diseases.
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- 2018
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16. A simple phenotypic classification for celiac disease
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Ajit Sood, Vandana Midha, Govind Makharia, B. K. Thelma, Shivalingappa S Halli, Varun Mehta, Ramit Mahajan, Vikram Narang, Kriti Sood, and Kirandeep Kaur
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Celiac disease ,Classification ,Presentation ,Complications ,Medicine ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/AimsCeliac disease is a global health problem. The presentation of celiac disease has unfolded over years and it is now known that it can manifest at different ages, has varied presentations, and is prone to develop complications, if not managed properly. Although the Oslo definitions provide consensus on the various terminologies used in literature, there is no phenotypic classification providing a composite diagnosis for the disease.MethodsVarious variables identified for phenotypic classification included age at diagnosis, age at onset of symptoms, clinical presentation, family history and complications. These were applied to the existing registry of 1,664 patients at Dayanand Medical College and Hospital, Ludhiana, India. In addition, age was evaluated as below 15 and below 18 years. Cross tabulations were used for the verification of the classification using the existing data. Expert opinion was sought from both international and national experts of varying fields.ResultsAfter empirical verification, age at diagnosis was considered appropriate in between A1 (
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- 2018
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17. Entamoeba histolytica: A surprising coexistence with adenocarcinoma – Never brush aside brushings for biopsy
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Palvi Goel, Ruchita Tyagi, Gursheen Kaur, Bhavna Garg, Pavneet Kaur Selhi, Harpreet Kaur, Varun Mehta, and Neena Sood
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adenocarcinoma ,brushings ,entamoeba ,rectal ,superadded ,Medicine - Abstract
Entamoeba histolytica has been rarely reported as superadded infection over carcinomatous growth on rectal brushings. We present a case of 68-year-old male who presented with abdominal pain and bleeding per rectum who was found to have an ulceroproliferative growth on sigmoidoscopy. Rectal brushings revealed coexistence of E. histolytica with malignant cells of adenocarcinoma. No organism was detected on biopsy of the tumor, which also showed adenocarcinoma, because of possible surface colonization of the tumor by Entamoeba. This case highlights the role of rectal brushings in detecting superadded infection in a case where both brushings and biopsy were performed. It is always important to report infection superadded on malignancies for optimum management of the patients.
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- 2018
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18. Compartment syndrome of the hand: A case report and review of literature
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Varun Mehta, MD, Varun Chowdhary, MD, Cheryl Lin, MD, Marlena Jbara, MD, and Shirley Hanna, MD
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Myonecrosis ,MRI ,Compartment ,Rhabdomyolysis ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Elevation of pressure within tightly bound myofascial compartments has detrimental consequences if not treated promptly, leading to a loss of circulation, ischemia, myonecrosis, nerve damage, and limb loss. They are commonly seen in the distal upper and lower extremities; however, compartment syndrome of the hand is rarely encountered and prompt recognition can prevent permanent damage and tissue loss. This case study presents a complicated case of compartment syndrome of the hand and discusses the interrelationship between compartment syndrome and rhabdomyolysis. An emphasis is placed on pathophysiology of this relationship to allow a better understanding of the imaging features as well as early clinical recognition of compartment syndrome. Magnetic resonance imaging findings are specifically discussed as it remains the best imaging tool to evaluate the extent of the damage and surgical planning.
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- 2018
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19. Rested and Restless Bandits With Constrained Arms and Hidden States: Applications in Social Networks and 5G Networks
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Varun Mehta, Rahul Meshram, Kesav Kaza, Shabbir N. Merchant, and Uday B. Desai
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Restless multi-armed bandits ,Gittins index ,Whittle index ,partially observable Markov process ,5G networks ,social networks ,Electrical engineering. Electronics. Nuclear engineering ,TK1-9971 - Abstract
The problem of rested and restless multi-armed bandits with constrained availability (RMAB-CA) of arms is considered. The states of arms evolve in Markovian manner and the exact states are hidden from the decision maker. First, some structural results on value functions are claimed. Following these results, the optimal policy turns out to be a threshold policy. Furthermore, indexability is established for both rested and restless RMAB-CAs. An index formula is derived for the rested model, while an algorithm is provided for restless case.
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- 2018
- Full Text
- View/download PDF
20. Efficacy and safety of the adalimumab biosimilar Exemptia as induction therapy in moderate-to-severe ulcerative colitis
- Author
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Vandana Midha, Ramit Mahajan, Varun Mehta, Vikram Narang, Arshdeep Singh, Kirandeep Kaur, and Ajit Sood
- Subjects
Adalimumab biosimilar ,Exemptia ,Steroid-refractory ulcerative colitis ,Medicine ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/AimsData on the efficacy and safety of the adalimumab biosimilar Exemptia are limited.MethodsPatients with moderate-to-severe active steroid-refractory ulcerative colitis (UC) treated at Dayanand Medical College and Hospital, India were offered cyclosporine A, biologicals or biosimilars, or surgery. A retrospective analysis was conducted on patients who were treated with the adalimumab biosimilar, Exemptia. These patients were administered an induction dosing schedule of 160 mg Exemptia at week 0, 80 mg at week 2, and then 40 mg every other week from week 4 to 8. The clinical response and remission were assessed at week 8 using Mayo score.ResultsA total of 29 patients (62.1% male; mean age, 34.9 ± 9.7 years) with moderate-to-severe steroid-refractory active UC (mean disease duration, 6.3±5.1 years; pancolitis in 9 patients [31.1%]; left-sided colitis in 20 patients [68.9%]) were treated with the Exemptia induction dosing schedule. The mean Mayo score at presentation was 8.2±1.4. At week 8, clinical response was observed in 7 patients (24.1%), whereas clinical remission was observed only in 1 patient (3.5%). Among the non-responders (n=21), 4 patients required colectomy, 1 died, 1 was lost to follow-up, 10 were offered fecal microbiota transplant, 3 were administered infliximab, and 2 patients were administered cyclosporine and tacrolimus, respectively. Four patients (13.8%) developed extrapulmonary tuberculosis.ConclusionsThe adalimumab biosimilar Exemptia has limited efficacy for the attainment of clinical response and remission in moderate-to-severe steroid-refractory UC, with a significant risk of acquisition or reactivation of tuberculosis in developing countries such as India.
- Published
- 2018
- Full Text
- View/download PDF
21. Rare imaging of a known entity: fat embolism seen on CT in lower extremity vein after trauma
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Varun Chowdhary, MD, Varun Mehta, MD, Tushar Bajaj, BS, and Jonathan Scheiner, MD
- Subjects
Fat embolism ,Trauma ,CT ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Fat embolism occurs in the vast majority of patients who have had trauma (approximately 90%). The most common occurrence is after long bone fracture. It has also been noted in cases after orthopedic surgery. Fat embolism is most often diagnosed when the clinical manifestations of fat embolism syndrome become apparent. Reported cases of fat emboli in transit are unusual. In our case, we present the rare finding of fat embolism seen on computed tomography in the lower extremity after a trauma.
- Published
- 2017
- Full Text
- View/download PDF
22. Symptomatic isolated terminal ileal ulcers: etiology and clinical significance
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Varun Mehta, Ankita Gupta, Ramit Mahajan, Vikram Narang, Vandana Midha, Neena Sood, Harpreet Kaur, Kirandeep Kaur, and Ajit Sood
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background With an increasing number of ileal intubations, isolated terminal ileal ulcers (ITIU) are frequently found during colonoscopies. The present study aimed at studying the etiology and clinical significance of these ulcers in patients having gastrointestinal symptoms. Methods This was a prospective observational study performed on consecutive patients who underwent ileocolonoscopy for various gastrointestinal symptoms between 1 January 2014 and 31 December 2014. Clinical, endoscopic, and histological findings of patients with ITIUs were assessed to determine the etiology and they were treated accordingly. Symptom resolution was assessed within 3 – 6 months of initial diagnosis, and colonoscopy was repeated for consenting patients. Results Among 74 (4.9 %) of 1497 patients who had ITIUs on ileocolonoscopy, 41 (55.4 %) had specific etiologies on initial testing. After 3 – 6 months follow-up, definitive diagnosis was ascertained in 44 (59.5 %) patients [Crohn’s disease (CD): 19 (25.7 %), NSAID-induced ulcers: 11 (14.9 %), intestinal tuberculosis (ITB): 9 (12.2 %), and eosinophilic enteritis: 5 (6.8 %)], and 30 patients (40.5 %) had nonspecific ulcers. After treatment, symptomatic and endoscopic resolution were noted in 55/60 patients (91.7 %) and 28/36 patients (77.8 %), respectively. Of 5/60 patients who remained symptomatic, three were initially diagnosed with nonspecific ulcers and two with CD, and they were finally diagnosed with CD and ITB respectively, and treated accordingly. Conclusions In patients with gastrointestinal symptoms, more than half of the ITIUs have specific etiologies, and timely diagnosis and appropriate treatment can prevent serious complications. Nonspecific ulcers can be managed with symptomatic treatment, but need close monitoring and re-evaluation in the case of persistence of symptoms.
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- 2017
- Full Text
- View/download PDF
23. An Intent Modeling and Inference Framework for Autonomous and Remotely Piloted Aerial Systems.
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Kesav Kaza, Varun Mehta, Hamid Azad, Miodrag Bolic, and Iraj Mantegh
- Published
- 2024
- Full Text
- View/download PDF
24. Sequential Decision Making With Limited Observation Capability: Application to Wireless Networks.
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Kesav Kaza, Rahul Meshram, Varun Mehta, and Shabbir N. Merchant
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- 2019
- Full Text
- View/download PDF
25. Sequential Decision Making under Uncertainty with Dynamic Resource Constraints.
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Kesav Kaza, Rahul Meshram, Varun Mehta, and S. N. Merchant
- Published
- 2019
26. Restless Bandits with Constrained Arms: Applications in Social and Information Networks.
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Varun Mehta, Rahul Meshram, Kesav Kaza, and S. N. Merchant
- Published
- 2018
27. Lazy Restless Bandits for Decision Making with Limited Observation Capability: Applications in Wireless Networks.
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Kesav Kaza, Rahul Meshram, Varun Mehta, and S. N. Merchant
- Published
- 2018
28. Multi-armed Bandits with Constrained Arms and Hidden States.
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Varun Mehta, Rahul Meshram, Kesav Kaza, and S. N. Merchant
- Published
- 2017
29. Diagnostic utility of multiple site duodenal biopsies in celiac disease.
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Narang, Vikarm, Jindal, Akriti, Singh, Aminder, Varun Mehta, Bhavna, Sood, Neena, Sood, Ajit, and Varun Mehta, Bhavna Garg
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- 2021
- Full Text
- View/download PDF
30. Diagnostic utility of multiple site duodenal biopsies in celiac disease
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Vikarm Narang, Akriti Jindal, Aminder Singh, Bhavna Garg Varun Mehta, Neena Sood, and Ajit Sood
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celiac disease ,diagnosis ,duodenum ,multiple biopsies ,tissue transglutaminase ,Pathology ,RB1-214 ,Microbiology ,QR1-502 - Abstract
Background: Celiac Disease involves the small intestine patchily affecting more frequently the proximal small bowel but the histological changes have been observed till terminal ileum. Of late in addition to D2, the duodenal bulb (D1 region) biopsies have been found helpful in identifying a small group of patients with CD. Therefore, multiple site biopsies are recommended as histological changes are not uniform throughout small intestine. Methods: During this present 1.5 years prospective study, we evaluated 84 cases of suspected celiac disease with respect to the light microscopy (D1, D2, and D3 biopsy) and serology (anti tTg and or EMA). Histological examination was done according to Modified Marsh grading system. Results: Out of 84 cases with raised anti tTg, the segmental biopsies significantly increased the diagnostic accuracy from 39/44 cases (88.6%) to 43/44 cases (97.7%) and 44/44 cases (100%) when D2 alone, D1 + D2 and D1 + D2 + D3 biopsies were evaluated, respectively. Of the suspected cases of celiac disease patients (tTg > 10 ULN and associated weight loss, diarrhea), additional D3 biopsy increased the diagnostic yield by 2.1%, compared to D1, D2 region biopsy and 6.38% compared to standard D2 biopsy alone. Of the 28 cases (tTg > 10 times ULN + EMA positive and associated weight loss, diarrhea), the potential celiac disease (histologically Type 1/Normal) cases reduced from 28.5% (standard D2 region alone) to 21.4% and 17.8% when additional biopsies were taken from D1 region and D3 region, respectively, and additional D3 biopsy increased the diagnostic yield by 10.8% (compared to standard D2 biopsy alone) and 3.7% (compared to D1 and D2 biopsy). Conclusion: We believe multiple sites duodenal biopsies including D3 region biopsies might increase the diagnostic accuracy of adult celiac disease in addition to sensitive and specific serologic tests.
- Published
- 2021
- Full Text
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31. Haloperidol-Induced Acute Generalized Exanthematous Pustulosis: A Rare Side Effect.
- Author
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Roy C, Jaiswal S, B P J, Paliwal S, Dey P, and Mehta V
- Subjects
- Haloperidol adverse effects, Humans, Acute Generalized Exanthematous Pustulosis diagnosis, Acute Generalized Exanthematous Pustulosis etiology
- Published
- 2022
- Full Text
- View/download PDF
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