shaurya mehta - Academia.edu (original) (raw)

Papers by shaurya mehta

Indian Journal of Transplantation

Cladophialophora bantiana is the most common cause of cerebral phaeohyphomycosis. A case of live-... more Cladophialophora bantiana is the most common cause of cerebral phaeohyphomycosis. A case of live-related renal allograft recipient complained of high-grade continuous fever on the 5th postoperative day (POD). No organism was isolated on cultures and no foci were found on chest X-ray. He was started on broad-spectrum antibiotics. The patient thereafter developed acute antibody-mediated plus acute cellular rejection on the 7th POD. He received a high dose methylprednisolone with plasmapheresis. On the 18th POD, the patient was diagnosed with right frontotemporal and basal ganglionic region abscess on magnetic resonance imaging of the brain. Urgent neurosurgical intervention was done and the sample was sent for investigation. Initially, there was suspicion of Aspergillus on culture. Injection of liposomal amphotericin B was given for 14 days, after which oral voriconazole was started. The patient improved initially but multiple abscesses recurred on the 46th POD. Abscess was drained. O...

Annals of Clinical Nephrology, 2021

Solid organ transplant recipients are at increased risk of COVID-19. Remdesivir has shown clinica... more Solid organ transplant recipients are at increased risk of COVID-19. Remdesivir has shown clinical benefit in COVID19. However, there is paucity of data on Remdesivir in solid organ transplant recipients. In this non-randomized interventional study on 12 renal transplant recipients admitted in our institute with COVID 19 infection. Eight patients gave consent for Remdesivir and remaining 4 patients who declined consent for Remdesivir were categorised to control (only standard of care given). Mean hospital stay (10.38 ± 2.62 days) was significantly less in Remdesivir group as compared to mean 18.5 ± 2.08 in control group (p<0.001). Mean duration of oxygen support (in days) was 6.98 ± 2.63 and 12.85 ± 0.91 in the Remdesivir and control groups respectively (p= 0.002) suggesting significantly fewer days of oxygen requirement in Remdesivir group. Magnitude of reduction in CRP was significant (p 0.029) in Remdesivir group. Likewise, LDH reduced significantly in Remdesivir group as compared to controls (p 0.047). There was significant improvement in creatinine (p=0.006) and ferritin (p=0.043) on day 5 in patients who received Remdesivir. No side-effects were observed with Remdesivir. Our small data show that Remdesivir was efficacious and safe in renal transplant recipients with Covid19.

Annals of Clinical Nephrology, 2020

Background: Diabetes mellitus is a chronic metabolic disease characterised by hyperglycemia resul... more Background: Diabetes mellitus is a chronic metabolic disease characterised by hyperglycemia resulting from defects in insulin secretion, action or both. Based on etiopathogenesis it is divided into 2 types, Type 1 and 2. There are histopathological evidence suggestive undertaken to evaluate the impact of Type 2 diabetes on pulmonary functions and compare the results with healthy age and sex matched individuals. healthy age and sex matched individuals. of which 40 are diabetics and 40 are controls.

Indian Journal of Critical Care Medicine, 2022

Background: Diagnosing sepsis early is important for its successful management. Various biomarker... more Background: Diagnosing sepsis early is important for its successful management. Various biomarkers are being used currently, but mostly they are either expensive or not readily available. This study aims to evaluate usefulness of automated immature granulocyte count (IG#) and immature granulocyte percentage (IG%) as early diagnostic markers of sepsis and compares it to other established predictive markers. Patients and methods: In this prospective observational study, 137 eligible, critically ill, nonseptic intensive care unit patients were analyzed for automated IG#, IG%, serum procalcitonin (PCT), and blood lactate (Lac), daily for 7 days after recruitment. Patients were followed for the development of sepsis, defined by the new Sepsis-3 criteria. The study was divided into four time periods of 24 hours each with respect to the day of developing organ dysfunction. Using area under receiver operator characteristic and diagnostic odds ratio (DOR) methods, the best biomarker for the prediction of sepsis in each time period was calculated. Results: IG# and IG% were the earliest biomarkers to have a significant discriminating value with area under the curve of 0.81 and 0.82, respectively, as early as 24 hours before clinical sepsis is diagnosed by Sepsis-3 criteria. Both IG# and IG% have a high DOR of 34.91 and 18.11, respectively, when compared to others like PCT and Lac having a DOR of 27.06 and 4.78, respectively. Conclusion: IG# and IG% are easily available, rapid, and inexpensive tools to differentiate between septic and nonseptic patients with high specificity and sensitivity. It is the earliest biomarker to show a significant rise in patients developing sepsis.

Journal of Clinical Pathology, 2020

Hemorrhagic diathesis can be caused by disorders in primary hemostasis (von Willebrand disease, i... more Hemorrhagic diathesis can be caused by disorders in primary hemostasis (von Willebrand disease, inherited platelet function disorders), secondary hemostasis (hemophilia A, B, other coagulant factor deficiencies) and fibrinolysis, and in connective tissue or vascular formation. This review summarizes the approach to a bleeding patient starting from structured patient history, to applying bleeding assessment tools (BATs), the utilization of currently available diagnostic methods for bleeding disorders and finally investigating with highly specialized tests. A comprehensive framework for a genetic diagnostic work up to inherited bleeding disorders is the need of the hour. The discovery of a wide spectrum of mutations in the various genes associated with coagulation and their association with different severity of the disease has allowed for the development of a rational strategy for mutation detection in clinical settings. Characterization of the genetic defects is also required for ca...

The Journal of the Association of Physicians of India, 2019

Aim To assess effect of low dose prophylaxis in hemophilics in terms of bleeding, joint function,... more Aim To assess effect of low dose prophylaxis in hemophilics in terms of bleeding, joint function, QoL and cost-effectiveness. Methods Analytic study done during one year among 70 adult hemophilics. In observation period (12 weeks), on-demand factor and during prophylaxis (12 weeks), low dose factor was given (Factor VIII 10 IU/KgBW biweekly for haemophilia A and Factor IX 20 IU/KgBW weekly for haemophilia B). Clinical joint assessment was done by Gilbert score and improvement by WFH definitions. Results Bleed reduced by 68.99% in moderate hemophilics (40 v/s 129) and 64.86% in severe hemophilics (26 v/s74) (p<0.05). During observation in moderate hemophilics, joint, soft tissue and mucosal bleeds occurred in frequency of 120, 1 and 8. This was reduced to 39 joint bleeds, 1 soft tissue bleed and no mucosal bleed during prophylaxis. In severe hemophilics, 70 joint, 2 soft tissue bleeds and 2 mucosal bleeds occurred during observation which reduced to 26 joint bleeds without soft ti...

The Journal of the Association of Physicians of India, 2020

Aim To assess effect of daily vis-a-vis alternate day oral iron therapy in terms of hemoglobin, r... more Aim To assess effect of daily vis-a-vis alternate day oral iron therapy in terms of hemoglobin, reticulocyte hemoglobin equivalent (RET-He) and GI side effects using hepcidin as a biomarker. Methods A hospital based randomized interventional two-arm analytical study was done among patients of IDA (20 in each group). The study population was divided into two groups by randomisation. Group 1 received oral iron supplements on alternate day and Group 2 received iron supplements daily. Hemoglobin, RET-He, Serum ferritin and Hepcidin level were assessed. Results On day 2nd, the rise in Hepcidin was not significant from base line in alternate day therapy group but was significantly increased in daily therapy group. On day 3, the rise in hepcidin was significant from base line in both the groups but the mean change in hepcidin was more in daily therapy group. RET-He began increasing on day 2nd in both the groups. In alternate day therapy group, the rise in RET-He was significant from base l...

The Journal of the Association of Physicians of India, 2018

:Iron deficiency anemia (IDA) is one of the most common nutritional anemia worldwide. Anemia impo... more :Iron deficiency anemia (IDA) is one of the most common nutritional anemia worldwide. Anemia imposes a significant hypoxic environment in different organs and tissues including the testes. This study evaluated the effect of treatment of IDA on the pituitary gonadal axis (Serum FSH, LH, Testosterone) and sperm parameters in adult eugonadal males. Methodology A hospital based interventional, analytic study was conducted at a tertiary care center among 25 eugonadal males (fully sexually developed, fertile) with newly diagnosed and untreated IDA, admitted in medicine wards and not suffering from any inflammatory disorders (excluded by C-reactive protein) after exclusion of patients having other forms of anemia/ hemoglobinopathies/ any malignancy/having MCV >80 fL, aplastic anemia and primary hypogonadism. Sexual maturation was assessed according to maturity stages 5. Investigations were performed before and 6 weeks after treatment of IDA with intravenous iron sucrose included CBC, pe...

Clinica Chimica Acta, 2020

Currently, there are few data on Antiphospholipid antibodies (aPL Ab) in COVID-19 and it is uncle... more Currently, there are few data on Antiphospholipid antibodies (aPL Ab) in COVID-19 and it is unclear if they represent an epiphenomenon or are involved in pathogenesis of COVID-19 disease. The presence of aPL Ab alone is not a specific indication for anticoagulation and nor does the presence of aPL Ab represent a clinical diagnosis of antiphospholipid syndrome (APS) Bowles et al. [1] performed coagulation screening in 216 Covid-19 patients, out of which 44(20%) had increased activated partial thromboplastin time (aPTT). 91% of patients with prolonged aPTT tested positive for lupus anticoagulant (LAC). Clinical characteristics and laboratory findings did not suggest diagnosis of APS. In a recent study, Zhang et al. [2] described three severely ill COVID-19 patients with multisystem thrombosis and ischemic strokes, prior risk factors for cardiovascular disease and positive aPL Abs, anticardiolipin IgA and anti-beta-2 glycoprotein-1 IgG and IgA antibodies. The titer of antibody positivity was not reported. Two of the three reported cases with aPL Abs had disseminated intravascular coagulation as per the criteria of the International Society on Hemostasis and Thrombosis (ISTH) [3]. Moreover, criteria for diagnosis of APS were not met in terms of high titres of IgG and IgM of anticardiolipin and antibeta-2-glycoprotein-1which preclude any role in the thrombotic episodes. During the COVID-19 outbreak in Mulhouse, France, Harzallah et al. [4] studied 56 Covid-19 patients for the presence of LAC with dilute Russell's viper venom time and sensitive activated partial thromboplastin time tests. Twenty-five cases (45%) were LAC positive, whereas anticardiolipin or anti-β2GlycoproteinI was detected in only 5 of 50 tested patients (10%, three associated to LAC) but titers of IgM & IgG were not reported. Helms et al. [5] reported the occurrence of thrombotic events among 150 patients with Covid-19 and acute respiratory distress syndrome (ARDS) admitted to the ICU. Lupus anticoagulants were detected in 50 of 57 patients tested (87.7%) due to prolonged aPTT. None of the patients developed disseminated intravascular coagulation (DIC). Anticardiolipin and anti-β2-glycoprotein-1 antibodies were not determined. Above observations suggest that aPL antibodies may have little clinical relevance to thrombosis occurring in COVID-19. Moreover, analytical variations in detection of LAC should be borne in mind. Caution should be exercised when interpreting LAC results on patients receiving anticoagulants [6]. Given common use of low molecular weight heparin (LMWH) for thromboprophylaxis in COVID-19

Journal of Global Antimicrobial Resistance, 2020

The potentiality of Hydroxychloroquine (HCQ) for pre-exposure prophylaxis against SARS-CoV-2 has ... more The potentiality of Hydroxychloroquine (HCQ) for pre-exposure prophylaxis against SARS-CoV-2 has not been explored in randomized controlled trials. However, there is rationale behind this potentiality in terms of demonstrated in-vitro effect of HCQ against SARS-CoV-2, safety profile of HCQ in healthy individuals and a recent observational study demonstrating benefits of HCQ prophylaxis in terms of a significant reduction (>80%) in the odds of SARS-CoV-2 infection in the health-care workers (HCWs) with the intake of six or more doses of HCQ prophylaxis as per the guidelines of the National Task Force for COVID-19 in India. Hence, pre-exposure prophylaxis with HCQ in appears to be a reasonable strategy in the current scenario for prevention of SARS-CoV-2 infection in healthy HCWs.

Nephrology and Renal Diseases, 2020

Journal of the Indian Academy of Geriatrics, 2018

Anemia is common among elderly and is associated with increased morbidity and mortality in this v... more Anemia is common among elderly and is associated with increased morbidity and mortality in this vulnerable age group. Anaemia hampers functional capacity and cognition, increases risk for frequent falls, frailty, dementia, hospitalization, mortality and mobility and ultimately affects the quality of life. Anemia in elderly is divided in three major types: nutritional deficiency, anemia of chronic disease including chronic renal disease and unexplained anemia. A high index of suspicion is required to manage anemia in elders. The symptoms (easy fatigue, decrease appetite, pallor) are usually taken as consequences of advance age. The onset of signs and symptoms are insidious and elders adjust their routine activities to the remaining physical capabilities and physiological adaptations. Anemia may present as worsening of associated disorder like worsening congestive heart failure, cognitive impairment, dizziness and apathy. The evaluation of anemia in elderly involves complete history including dietary, medical illness and medication history and through physical examination to detect any sign suggestive of etiology followed by further investigations accordingly. The treatment of anemia depends on its etiology and severity. In severe anemia, red cell transfusion is required along with treatment of underlying etiology. In unexplained anemia, erythropoietin replacement in higher dose than usual may be needed due to blunted response to erythropoietin. Anabolic steroid supplementation is also beneficial in elderly with anemia.