Himanshu Jindal | Chhatrapati Shahu Ji Maharaj University, Kanpur (CSJM) (original) (raw)

Papers by Himanshu Jindal

Annals of Medicine & Surgery

The eve of 3 November 2022 witnessed the first case in about 3 years of the viral-borne disease J... more The eve of 3 November 2022 witnessed the first case in about 3 years of the viral-borne disease Japanese encephalitis (JE) in the city of Pune, a nonendemic A region for the virus. A 4-year-old boy from the Wadgaonsheri area was admitted to the Pediatric ICU at Sassoon General Hospital with complaints of fever, convulsions, spastic paralysis, and altered sensorium. The child received treatment with little effect and was kept on ventilator support for 9 days. Blood and cerebrospinal fluid samples were sent for scrutinization to the National Institute of Virology (NIV), Pune. Considering suspicions of an infectious pathology, the sera of seven household members, 16 nearby residents, 18 dogs, and pigs were also sampled and reported. The samples tested positive for JE on 29 November 20221. This raises concerns for a potential outbreak when considering the geographical, climatic, and sociocultural conditions of the population in the area.

Cureus

Sheehan syndrome is often a sequela of massive postpartum hemorrhage in resource-poor healthcare ... more Sheehan syndrome is often a sequela of massive postpartum hemorrhage in resource-poor healthcare settings where blood loss during delivery is often neglected. The diagnosis of this rare but fatal disease is often delayed because the symptoms are vague and the pituitary dysfunction is insidious in nature. We report the case of a 35-year-old multiparous female with anhedonia and raised serum transaminases. She presented with constitutional symptoms. Her last vaginal delivery, six years back, was the last obstetric event that yielded a stillbirth child. She had had amenorrhea since then. Upon further evaluation, she was found to have a massive pericardial effusion, hypopituitarism, and a partially empty sella. This case report highlights the uncharacteristic symptoms that a patient presents with which ultimately lead to delayed diagnosis. Early diagnosis can go miles in improving the quality of life of the patient besides saving the patient from an adrenal crisis.

Tropical Doctor

Zika virus is an RNA virus belonging to the Flavivirus family that is chiefly transmitted by the ... more Zika virus is an RNA virus belonging to the Flavivirus family that is chiefly transmitted by the female Aedes mosquito. The Zika virus first infected humans in Uganda and Tanzania in 1952. Since, it has spread to several parts of the world causing outbreaks of variable extent. In India, these outbreaks have been reported from Gujarat, Tamil Nadu, Madhya Pradesh, Rajasthan, Kerala, and Maharashtra. The most recent outbreak is from the most populous state of India, Uttar Pradesh, where the climate is conducive to the breeding and transmission of other arboviral infections such as Dengue, Chikungunya, and Malaria. These infections also happen to share similar incubation periods and overlapping clinical manifestations with Zika virus (ZIKV) infection, leading to misdiagnoses or delayed diagnosis. We aim to provide an account of the outbreak, its repercussions, errors made in attempting to contain the spread of the disease, and, measures to be taken in the future.

Cureus, 2023

Sheehan syndrome is often a sequela of massive postpartum hemorrhage in resource-poor healthcare ... more Sheehan syndrome is often a sequela of massive postpartum hemorrhage in resource-poor healthcare settings where blood loss during delivery is often neglected. The diagnosis of this rare but fatal disease is often delayed because the symptoms are vague and the pituitary dysfunction is insidious in nature. We report the case of a 35-year-old multiparous female with anhedonia and raised serum transaminases. She presented with constitutional symptoms. Her last vaginal delivery, six years back, was the last obstetric event that yielded a stillbirth child. She had had amenorrhea since then. Upon further evaluation, she was found to have a massive pericardial effusion, hypopituitarism, and a partially empty sella. This case report highlights the uncharacteristic symptoms that a patient presents with which ultimately lead to delayed diagnosis. Early diagnosis can go miles in improving the quality of life of the patient besides saving the patient from an adrenal crisis.

SN Comprehensive Clinical Medicine, 2021

RT-PCR is considered to be the standard gold diagnostic test for detecting COVID-19 causing SARS-... more RT-PCR is considered to be the standard gold diagnostic test for detecting COVID-19 causing SARS-CoV-2. Recent reports and recent pieces of evidence from scientific literature, however, tell a different story. There have been speculations of SARS-CoV-2 escaping the RT-PCR because of the series of mutations it has gone through. It is possible that host-dependent RNA editing and high person-to-person transmission have equipped the virus with mutations enabling it to spread faster and even evade the RT-PCR. Added to this is burnout among healthcare workers and technicians handling the RT-PCR machines and sampling. All of these factors may be working in unison to result in the deluge of false-negative cases India is facing during the second COVID-19 wave. The mutant strains are spreading to other parts, posing challenges to the whole world. These circumstances warrant supplementary diagnostic tests such as serological and radiological findings to deal with cases of high clinical suspicion. Even one misdiagnosed COVID-19 patient poses a risk to hundreds of others in the vicinity. Healthcare workers' burnout also has to be dealt with. Erroneous staff should be retrained. Keywords COVID-19 • Double mutant • Second wave • SARS-CoV-2 • India Abbreviations COVID-19 Coronavirus disease 2019 WHO World Health Organization SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 RT-PCR Reverse transcription-polymerase chain reaction CDC Centers for Disease Control and Prevention HIV Human immunodeficiency virus

Current Tropical Medicine Reports, 2023

Purpose of Review This review aims to comprehensively analyse recent Zika outbreaks and their imp... more Purpose of Review This review aims to comprehensively analyse recent Zika outbreaks and their implications on public health. It discusses the evolving dynamics of the Zika virus transmission, factors contributing to outbreaks, health consequences, clinical manifestations, diagnosis, treatment, and challenges in controlling its spread. The goal is to provide a multidisciplinary understanding of Zika virus and guide public health strategies for effective outbreak prevention and management. Recent Findings Recent findings reveal sporadic Zika cases with mild symptomatology. Major outbreaks occurred in the Yap Islands (2007), French Polynesia (2013-2014), and the Americas (2015-2016) with increased microcephaly cases. Recent research focuses on vaccine development, antiviral drugs, and point-of-care diagnostics. However, knowledge gaps remain in transmission dynamics, immune response, and long-term outcomes of Zika virus infection. Summary Zika virus, which has sporadically prevailed in regions of Africa and Asia and causes mild febrile illness to asymptomatic cases, has expanded, leading to major outbreaks. Recent outbreaks include Yap Islands (2007), the first to occur outside Asia and Africa. In 2013, the Oceania outbreak showed neurological manifestations for the first time. The Americas outbreak (2015-2016) is considered the largest Zika epidemic with a spike in microcephaly cases, resulting in WHO declaring Zika-associated microcephaly a public health emergency of international concern. The burden of control of outbreaks falls primarily on public health interventions due to no effective vaccine or antivirals currently available, leaving major research lacunae.

Tropical Doctor, 2022

Zika virus is an RNA virus belonging to the Flavivirus family that is chiefly transmitted by the ... more Zika virus is an RNA virus belonging to the Flavivirus family that is chiefly transmitted by the female Aedes mosquito. The Zika virus first infected humans in Uganda and Tanzania in 1952. Since, it has spread to several parts of the world causing outbreaks of variable extent. In India, these outbreaks have been reported from Gujarat, Tamil Nadu, Madhya Pradesh, Rajasthan, Kerala, and Maharashtra. The most recent outbreak is from the most populous state of India, Uttar Pradesh, where the climate is conducive to the breeding and transmission of other arboviral infections such as Dengue, Chikungunya, and Malaria. These infections also happen to share similar incubation periods and overlapping clinical manifestations with Zika virus (ZIKV) infection, leading to misdiagnoses or delayed diagnosis. We aim to provide an account of the outbreak, its repercussions, errors made in attempting to contain the spread of the disease, and, measures to be taken in the future.

Orthoplastic Surgery, 2022

Hand transplantation is a new and highly complex solid organ transplantation procedure. Hand Tra... more Hand transplantation is a new and highly complex solid organ transplantation procedure.

Hand Transplantation is associated with multiple challenges especially in the developing countries.

There have been substantial advances in research, acceptance and policies.

Low cost of procedure, immunosuppression and rehabilitation has made India an emerging hub for such procedures.

Global collaboration for funding and research is critical to achieve patient centric outcomes.

Annals of Medicine and Surgery, 2023

The eve of 3 November 2022 witnessed the first case in about 3 years of the viral-borne disease J... more The eve of 3 November 2022 witnessed the first case in about 3 years of the viral-borne disease Japanese encephalitis (JE) in the city of Pune, a nonendemic A region for the virus. A 4-year-old boy from the Wadgaonsheri area was admitted to the Pediatric ICU at Sassoon General Hospital with complaints of fever, convulsions, spastic paralysis, and altered sensorium. The child received treatment with little effect and was kept on ventilator support for 9 days. Blood and cerebrospinal fluid samples were sent for scrutinization to the National Institute of Virology (NIV), Pune. Considering suspicions of an infectious pathology, the sera of seven household members, 16 nearby residents, 18 dogs, and pigs were also sampled and reported. The samples tested positive for JE on 29 November 20221. This raises concerns for a potential outbreak when considering the geographical, climatic, and sociocultural conditions of the population in the area.

World Neurosurgery, 2024

BACKGROUND: Patients in low-and middle-income countries (LMICs) have substantial treatment abando... more BACKGROUND: Patients in low-and middle-income countries (LMICs) have substantial treatment abandonment and non-adherence with outpatient oral medications. This work sought to investigate outcomes of postoperative discitis treated with debridement and a novel technique focused on reducing outpatient antibiotic requirement in an LMIC setting.-METHODS: This study, conducted and reported following STROBE guidelines, reviewed outcomes of all patients with postoperative discitis who had been debrided by 1 neurosurgeon in a resource-limited setting during 2008e2020. Patients had undergone single-level L4-L5 or L5-S1 discectomy elsewhere, later developing magnetic resonance imagingeconfirmed discitis. After non-response or deterioration following intravenous antibiotics, patients underwent early debridement, followed by in-patient antibiotic instillation into disc space for 2 weeks via drain. Study outcomes were modified Kirkaldy-Willis Grade, Japan Orthopaedic Association (JOA) score, and visual analog scale (VAS) score, all assessed at 1 year.-RESULTS: Twelve patients were included, 10 male and 2 female, with median age of 46 (IQR 3.5) years. Debridement was done after median 82.5 (IQR 35) days and took median time of 105 (IQR 17.5) minutes. VAS scores (mean AE SD) decreased from 9.25 AE 0.75 preoperatively to 0.67 AE 0.89 1 year postoperatively (mean difference 8.58, 95% CI 8.01e 9.15, P < 0.001). JOA scores (mean AE SD) improved from 4.5 AE 2.94 to 26.42 AE 1.31 1 year postoperatively (mean difference 21.92, 95% CI 20.57e23.26, P < 0.001). Kirkaldy-Willis grade was excellent in 6 (50%) patients, good in 5 (41.7%), and fair in 1 (8.3%). Patients became ambulatory within 2 weeks, with no major complications during 4.15 (IQR 3.45) years of median follow-up.-CONCLUSIONS: In LMICs, patients with medically refractory postoperative discitis potentially have good outcomes after debridement plus 2-week local antibiotic instillation.

Clinical Infection in Practice

Dear Editor Human Metapneumovirus (HMPV), a respiratory virus with symptoms resembling the common... more Dear Editor Human Metapneumovirus (HMPV), a respiratory virus with symptoms resembling the common cold, exhibits distinct seasonal patterns. HMPV can cause both upper and lower respiratory tract infections. Symptoms are similar to those of the common cold and may include cold, runny nose, sore throat, or shortness of breath. HMPV often circulates in Australia in late winter-early spring and is a major cause of Lower Respiratory Tract Infections (LRTI) as well as hospitalizations due to respiratory illnesses. The purpose of this letter is to highlight the historical trends and recent surges in HMPV infections in Australia. We also intend to assess the challenges in diagnosis, risks of infections, need for a vaccine, and to develop mitigation strategies against the virus. HMPV was first discovered by a group of Dutch scientists in 2001. The group isolated the virus from clinical samples of 28 unrelated children presenting respiratory tract infections, collected over the past 20 years (van den Hoogen et al., 2001). Following the discovery, other research groups in Australia and Europe reported the presence of viruses with similar genetic sequencing. Metapneumovirus epidemics occur generally in late winter to early spring in temperate sites with a more diverse spread in tropical regions (Li et al., 2019). Globally, HMPV accounts for an estimated 14.2 million Acute lower respiratory infections (ALRI) cases in children below 5 years of age (UR-10.2 million to 20.1 million) and about 643,000 (UR-425,000 to 927,000) hospital admissions (Wang et al., 2018). While in the 5-14 years age group, HMPV accounts for about 2 % of (ALRI) related hospital admissions at about 105,500 cases globally (Wang et al., 1995). Michael Nissen and his team were the first to confirm the presence of HMPV in samples of children with unexplained respiratory illness. This reinforces the view that HMPV is also present in the Australian population. Further studies were done to determine the dominant strain in infections, with results yielding subtype B1 to be the most common lineage (Mackay et al., 2006). Aligning with the global increase in HMPV cases, there has been an observed recent surge in HMPV cases in Australia, where the New South Wales (NSW) authorities have reported a huge increase from 648 cases to 1245 cases from the beginning of September and the 24th of September, respectively (COVID-19, 2023). Moreover, the positivity test for HMPV has been recorded at 4.7 % on the 24th of September after being at 2.9 % on September 3rd, 2023 (COVID-19, 2023). Such rates have also demonstrated that the virus has been largely increasing, as shown from the 6th, 20th, and 27th of August, reporting 1.6 %, 2.1 %, and 2.7 %, respectively (COVID-19, 2023). HMPV infection occurs periodically around the world yet is not endemic (Human Metapneumovirus, 2023). According to the Centers for Disease Control & Prevention (CDC), HMPV is most frequently encountered and active in late winter and early spring in temperate climates (Metapneumovirus, 2023). Boehm et al. have demonstrated

Research Square

Takayasu’s arteritis (TA) and systemic lupus erythematosus (SLE) are distinct autoimmune disorder... more Takayasu’s arteritis (TA) and systemic lupus erythematosus (SLE) are distinct autoimmune disorders with similar age and gender predisposition. However, their coexistence is exceedingly rare, and presents unique diagnostic and therapeutic challenges. Here, we report the case of a 44-year-old female with nodular episcleritis, breathlessness, and palpitations who was ultimately diagnosed with both TA and SLE. The presence of a range of antibodies in various cases underscores the heterogeneity of the disease presentation and the need for comprehensive testing. While many patients with this dual diagnosis experience symptom improvement and complete recovery, some face severe outcomes. In our case, aortic root replacement surgery was planned because of severe aortic regurgitation; however, the patient's condition deteriorated, resulting in death. This case underscores the need for clinicians to recognise and thoroughly evaluate patients with overlapping symptoms of TA and SLE. Although challenging, the coexistence of these autoimmune diseases provides valuable insights into the complexities of autoimmune conditions. Further research and collaboration are essential to advance our understanding and to improve patient outcomes in these complex clinical scenarios.

Sheehan syndrome, also referred to as postpartum hypopituitarism is often a sequela of massive po... more Sheehan syndrome, also referred to as postpartum hypopituitarism is often a sequela of massive post-partum hemorrhage in resource poor healthcare settings where blood loss during delivery is often neglected. The diagnosis of this rare but fatal is disease is often delayed because the symptoms are vague and the pituitary dysfunction is insidious in nature. This condition sometimes takes more than a decade before it is diagnosed. The classic signs and symptoms include agalactia, secondary amenorrhea and dry wrinkling skin. Often an empty or a partially empty sella is seen on magnetic resonance imaging of the brain. We present the case of a 35-year-old multiparous female with anhedonia and raised serum transaminases who presented to our side with mild hyponatremia and hypothyroidism. She got diagnosed with Sheehan syndrome at our set up six years after her last obstetric event. Through this case report, we intend to provide a clinical account of the patient’s condition and management.

Cureus, 2022

Laryngectomy is a common surgery for an oncosurgeon, but underlying carotid compromise is a serio... more Laryngectomy is a common surgery for an oncosurgeon, but underlying carotid compromise is a serious concern for anesthesiologists, making this routine procedure a high-risk one. The utmost vigilance of the anesthesiologist is demanded by the surgery to prevent morbidities such as hemiplegia, hemiparesis, or speech abnormalities that may occur due to perfusion insufficiency secondary to the mechanical blockage of the carotid arteries. Hence, an undiagnosed case of carotid artery block may result in disastrous consequences for the patient, surgeon, and anesthesiologist. Hence, it is imperative to perform all the preoperative investigations with due diligence. We present the case of a 74-year-old male who was admitted to our setup for laryngeal carcinoma surgery. The patient had received chemoradiotherapy (CRT) six months earlier. He complained of hoarseness in his voice and a painless neck mass. He was a known case of hypertension for 14 years, controlled by oral medication, and had a history of stroke five years ago, when he was also diagnosed with a completely blocked right common carotid artery (CCA) and a partially blocked left common carotid artery.

American Journal of Gastroenterology, 2021

Cureus, 2021

Antisynthetase syndrome is an autoimmune condition that manifests clinically through signs and sy... more Antisynthetase syndrome is an autoimmune condition that manifests clinically through signs and symptoms, such as interstitial lung disease, myositis, Raynaud's phenomenon, fever, hyperkeratotic fingertips (mechanic's hands), and arthritis. It is associated with antibodies against aminoacyl tRNA synthetase enzyme, the most common autoantibody being the anti-Jo-1. An 18-year-old girl presented with weakness of both the upper and lower limb, swelling and generalized body pain, difficulty in swallowing. MRI of the thigh was highly suggestive of myositis with symmetrical bilateral involvement. Based on proximal muscle weakness, elevated creatine phosphokinase (CPK), and lactate dehydrogenase (LDH), strongly positive anti-nuclear antibodies human epithelial cell type-2 (ANA-HEp2), and a normal nerve conduction velocity test with precise MRI findings, a diagnosis of polymyositis was made. She was given bolus intravenous methylprednisolone for five days, followed by oral methylprednisolone with subcutaneous methotrexate weekly. She reported a 50% improvement in muscle weakness; however, partial bulbar weakness persisted at the time of discharge. On her next follow-up, her blood investigations for autoantibodies were done. The autoantibodies anti-Jo-1 (3+), Ro-52 (2+), and Mi-2β (2+) were found to be positive. These investigations, coupled with the clinical features she was presenting, finally led us to conclude that it was a case of polymyositis complicated by the antisynthetase syndrome.

Cureus, 2021

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease that can affect almost e... more Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease that can affect almost every organ in the body. Its complications can often be fatal. The fatal complications include lupus cerebritis, lupus nephritis, and cardiac manifestations such as pericardial effusion. In this report, we discuss the case of a 23-year-old female who presented with complaints of high-grade fever, seizures, and altered mental state (AMS) and was found to have generalized lymphadenopathy (LAP). Various blood and urine analyses and radiological findings (chest X-ray, MRI of the head) were suggestive of lupus nephritis, lupus cerebritis, massive pericardial effusion, and thrombocytopenia. Her anti-double stranded DNA (anti-dsDNA) antibody was positive, and her pericardial fluid was positive for anti-nuclear antibodies (ANAs). She was administered IV glucocorticoids and phenytoin. She reported improvements in her symptoms gradually for a few days but eventually succumbed to the disease. Although generalized LAP is a rare initial presentation of SLE, it should be included in the differential diagnosis of the disease.

Research and Humanities in Medical Education, 2020

Books by Himanshu Jindal

Springer Link, 2024

Gracile Bone Dysplasia (GCLEB) is a perinatally fatal condition with fewer than 30 cases reported... more Gracile Bone Dysplasia (GCLEB) is a perinatally fatal condition with fewer than 30 cases reported to date. It is characterized by severe abnormalities in bone development and growth. It is linked to heterozygous mutations in the FAM111A gene, this autosomal dominant disorder presents at birth or infancy with brittle, slender bones, and cranial abnormalities. Diagnosis relies on radiological and histopathological assessments, with genetic testing confirming FAM111A mutations. Unfortunately, no treatment currently exists, leading to a poor prognosis, with most patients stillborn or succumbing shortly after birth. The rarity of GCLEB and its poorly understood molecular mechanisms emphasize the imperative for further research into this devastating condition. This chapter provides a comprehensive overview of GCLEB, encompassing its historical background, etiology, clinical manifestations, diagnosis, and current management strategies.

Springer Link, 2024

Greig cephalopolysyndactyly syndrome (GCPS), also known as cephalopolysyndactyly syndrome, is a r... more Greig cephalopolysyndactyly syndrome (GCPS), also known as cephalopolysyndactyly syndrome, is a rare genetic disorder characterized by diverse craniofacial and limb anomalies. GCPS is primarily caused by mutations in the GLI3 gene, a crucial regulator of embryonic development, particularly in the Sonic Hedgehog pathway. Clinical manifestations vary widely, encompassing features such as polydactyly, craniofacial dysmorphism including macrocephaly and ocular hypertelorism, and, less commonly, neurological abnormalities. Diagnosis relies on clinical evaluation and molecular testing for GLI3 mutations. Management involves supportive care, with surgical intervention often necessary for limb malformations. Genetic counselling is imperative due to the autosomal dominant inheritance pattern. Prognosis varies depending on the severity of phenotypic features, with most individuals leading normal lives, although neurological complications can influence outcomes. Early recognition and comprehensive management are essential for optimizing the quality of life for individuals affected by GCPS.

Annals of Medicine & Surgery

The eve of 3 November 2022 witnessed the first case in about 3 years of the viral-borne disease J... more The eve of 3 November 2022 witnessed the first case in about 3 years of the viral-borne disease Japanese encephalitis (JE) in the city of Pune, a nonendemic A region for the virus. A 4-year-old boy from the Wadgaonsheri area was admitted to the Pediatric ICU at Sassoon General Hospital with complaints of fever, convulsions, spastic paralysis, and altered sensorium. The child received treatment with little effect and was kept on ventilator support for 9 days. Blood and cerebrospinal fluid samples were sent for scrutinization to the National Institute of Virology (NIV), Pune. Considering suspicions of an infectious pathology, the sera of seven household members, 16 nearby residents, 18 dogs, and pigs were also sampled and reported. The samples tested positive for JE on 29 November 20221. This raises concerns for a potential outbreak when considering the geographical, climatic, and sociocultural conditions of the population in the area.

Cureus

Sheehan syndrome is often a sequela of massive postpartum hemorrhage in resource-poor healthcare ... more Sheehan syndrome is often a sequela of massive postpartum hemorrhage in resource-poor healthcare settings where blood loss during delivery is often neglected. The diagnosis of this rare but fatal disease is often delayed because the symptoms are vague and the pituitary dysfunction is insidious in nature. We report the case of a 35-year-old multiparous female with anhedonia and raised serum transaminases. She presented with constitutional symptoms. Her last vaginal delivery, six years back, was the last obstetric event that yielded a stillbirth child. She had had amenorrhea since then. Upon further evaluation, she was found to have a massive pericardial effusion, hypopituitarism, and a partially empty sella. This case report highlights the uncharacteristic symptoms that a patient presents with which ultimately lead to delayed diagnosis. Early diagnosis can go miles in improving the quality of life of the patient besides saving the patient from an adrenal crisis.

Tropical Doctor

Zika virus is an RNA virus belonging to the Flavivirus family that is chiefly transmitted by the ... more Zika virus is an RNA virus belonging to the Flavivirus family that is chiefly transmitted by the female Aedes mosquito. The Zika virus first infected humans in Uganda and Tanzania in 1952. Since, it has spread to several parts of the world causing outbreaks of variable extent. In India, these outbreaks have been reported from Gujarat, Tamil Nadu, Madhya Pradesh, Rajasthan, Kerala, and Maharashtra. The most recent outbreak is from the most populous state of India, Uttar Pradesh, where the climate is conducive to the breeding and transmission of other arboviral infections such as Dengue, Chikungunya, and Malaria. These infections also happen to share similar incubation periods and overlapping clinical manifestations with Zika virus (ZIKV) infection, leading to misdiagnoses or delayed diagnosis. We aim to provide an account of the outbreak, its repercussions, errors made in attempting to contain the spread of the disease, and, measures to be taken in the future.

Cureus, 2023

Sheehan syndrome is often a sequela of massive postpartum hemorrhage in resource-poor healthcare ... more Sheehan syndrome is often a sequela of massive postpartum hemorrhage in resource-poor healthcare settings where blood loss during delivery is often neglected. The diagnosis of this rare but fatal disease is often delayed because the symptoms are vague and the pituitary dysfunction is insidious in nature. We report the case of a 35-year-old multiparous female with anhedonia and raised serum transaminases. She presented with constitutional symptoms. Her last vaginal delivery, six years back, was the last obstetric event that yielded a stillbirth child. She had had amenorrhea since then. Upon further evaluation, she was found to have a massive pericardial effusion, hypopituitarism, and a partially empty sella. This case report highlights the uncharacteristic symptoms that a patient presents with which ultimately lead to delayed diagnosis. Early diagnosis can go miles in improving the quality of life of the patient besides saving the patient from an adrenal crisis.

SN Comprehensive Clinical Medicine, 2021

RT-PCR is considered to be the standard gold diagnostic test for detecting COVID-19 causing SARS-... more RT-PCR is considered to be the standard gold diagnostic test for detecting COVID-19 causing SARS-CoV-2. Recent reports and recent pieces of evidence from scientific literature, however, tell a different story. There have been speculations of SARS-CoV-2 escaping the RT-PCR because of the series of mutations it has gone through. It is possible that host-dependent RNA editing and high person-to-person transmission have equipped the virus with mutations enabling it to spread faster and even evade the RT-PCR. Added to this is burnout among healthcare workers and technicians handling the RT-PCR machines and sampling. All of these factors may be working in unison to result in the deluge of false-negative cases India is facing during the second COVID-19 wave. The mutant strains are spreading to other parts, posing challenges to the whole world. These circumstances warrant supplementary diagnostic tests such as serological and radiological findings to deal with cases of high clinical suspicion. Even one misdiagnosed COVID-19 patient poses a risk to hundreds of others in the vicinity. Healthcare workers' burnout also has to be dealt with. Erroneous staff should be retrained. Keywords COVID-19 • Double mutant • Second wave • SARS-CoV-2 • India Abbreviations COVID-19 Coronavirus disease 2019 WHO World Health Organization SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 RT-PCR Reverse transcription-polymerase chain reaction CDC Centers for Disease Control and Prevention HIV Human immunodeficiency virus

Current Tropical Medicine Reports, 2023

Purpose of Review This review aims to comprehensively analyse recent Zika outbreaks and their imp... more Purpose of Review This review aims to comprehensively analyse recent Zika outbreaks and their implications on public health. It discusses the evolving dynamics of the Zika virus transmission, factors contributing to outbreaks, health consequences, clinical manifestations, diagnosis, treatment, and challenges in controlling its spread. The goal is to provide a multidisciplinary understanding of Zika virus and guide public health strategies for effective outbreak prevention and management. Recent Findings Recent findings reveal sporadic Zika cases with mild symptomatology. Major outbreaks occurred in the Yap Islands (2007), French Polynesia (2013-2014), and the Americas (2015-2016) with increased microcephaly cases. Recent research focuses on vaccine development, antiviral drugs, and point-of-care diagnostics. However, knowledge gaps remain in transmission dynamics, immune response, and long-term outcomes of Zika virus infection. Summary Zika virus, which has sporadically prevailed in regions of Africa and Asia and causes mild febrile illness to asymptomatic cases, has expanded, leading to major outbreaks. Recent outbreaks include Yap Islands (2007), the first to occur outside Asia and Africa. In 2013, the Oceania outbreak showed neurological manifestations for the first time. The Americas outbreak (2015-2016) is considered the largest Zika epidemic with a spike in microcephaly cases, resulting in WHO declaring Zika-associated microcephaly a public health emergency of international concern. The burden of control of outbreaks falls primarily on public health interventions due to no effective vaccine or antivirals currently available, leaving major research lacunae.

Tropical Doctor, 2022

Zika virus is an RNA virus belonging to the Flavivirus family that is chiefly transmitted by the ... more Zika virus is an RNA virus belonging to the Flavivirus family that is chiefly transmitted by the female Aedes mosquito. The Zika virus first infected humans in Uganda and Tanzania in 1952. Since, it has spread to several parts of the world causing outbreaks of variable extent. In India, these outbreaks have been reported from Gujarat, Tamil Nadu, Madhya Pradesh, Rajasthan, Kerala, and Maharashtra. The most recent outbreak is from the most populous state of India, Uttar Pradesh, where the climate is conducive to the breeding and transmission of other arboviral infections such as Dengue, Chikungunya, and Malaria. These infections also happen to share similar incubation periods and overlapping clinical manifestations with Zika virus (ZIKV) infection, leading to misdiagnoses or delayed diagnosis. We aim to provide an account of the outbreak, its repercussions, errors made in attempting to contain the spread of the disease, and, measures to be taken in the future.

Orthoplastic Surgery, 2022

Hand transplantation is a new and highly complex solid organ transplantation procedure. Hand Tra... more Hand transplantation is a new and highly complex solid organ transplantation procedure.

Hand Transplantation is associated with multiple challenges especially in the developing countries.

There have been substantial advances in research, acceptance and policies.

Low cost of procedure, immunosuppression and rehabilitation has made India an emerging hub for such procedures.

Global collaboration for funding and research is critical to achieve patient centric outcomes.

Annals of Medicine and Surgery, 2023

The eve of 3 November 2022 witnessed the first case in about 3 years of the viral-borne disease J... more The eve of 3 November 2022 witnessed the first case in about 3 years of the viral-borne disease Japanese encephalitis (JE) in the city of Pune, a nonendemic A region for the virus. A 4-year-old boy from the Wadgaonsheri area was admitted to the Pediatric ICU at Sassoon General Hospital with complaints of fever, convulsions, spastic paralysis, and altered sensorium. The child received treatment with little effect and was kept on ventilator support for 9 days. Blood and cerebrospinal fluid samples were sent for scrutinization to the National Institute of Virology (NIV), Pune. Considering suspicions of an infectious pathology, the sera of seven household members, 16 nearby residents, 18 dogs, and pigs were also sampled and reported. The samples tested positive for JE on 29 November 20221. This raises concerns for a potential outbreak when considering the geographical, climatic, and sociocultural conditions of the population in the area.

World Neurosurgery, 2024

BACKGROUND: Patients in low-and middle-income countries (LMICs) have substantial treatment abando... more BACKGROUND: Patients in low-and middle-income countries (LMICs) have substantial treatment abandonment and non-adherence with outpatient oral medications. This work sought to investigate outcomes of postoperative discitis treated with debridement and a novel technique focused on reducing outpatient antibiotic requirement in an LMIC setting.-METHODS: This study, conducted and reported following STROBE guidelines, reviewed outcomes of all patients with postoperative discitis who had been debrided by 1 neurosurgeon in a resource-limited setting during 2008e2020. Patients had undergone single-level L4-L5 or L5-S1 discectomy elsewhere, later developing magnetic resonance imagingeconfirmed discitis. After non-response or deterioration following intravenous antibiotics, patients underwent early debridement, followed by in-patient antibiotic instillation into disc space for 2 weeks via drain. Study outcomes were modified Kirkaldy-Willis Grade, Japan Orthopaedic Association (JOA) score, and visual analog scale (VAS) score, all assessed at 1 year.-RESULTS: Twelve patients were included, 10 male and 2 female, with median age of 46 (IQR 3.5) years. Debridement was done after median 82.5 (IQR 35) days and took median time of 105 (IQR 17.5) minutes. VAS scores (mean AE SD) decreased from 9.25 AE 0.75 preoperatively to 0.67 AE 0.89 1 year postoperatively (mean difference 8.58, 95% CI 8.01e 9.15, P < 0.001). JOA scores (mean AE SD) improved from 4.5 AE 2.94 to 26.42 AE 1.31 1 year postoperatively (mean difference 21.92, 95% CI 20.57e23.26, P < 0.001). Kirkaldy-Willis grade was excellent in 6 (50%) patients, good in 5 (41.7%), and fair in 1 (8.3%). Patients became ambulatory within 2 weeks, with no major complications during 4.15 (IQR 3.45) years of median follow-up.-CONCLUSIONS: In LMICs, patients with medically refractory postoperative discitis potentially have good outcomes after debridement plus 2-week local antibiotic instillation.

Clinical Infection in Practice

Dear Editor Human Metapneumovirus (HMPV), a respiratory virus with symptoms resembling the common... more Dear Editor Human Metapneumovirus (HMPV), a respiratory virus with symptoms resembling the common cold, exhibits distinct seasonal patterns. HMPV can cause both upper and lower respiratory tract infections. Symptoms are similar to those of the common cold and may include cold, runny nose, sore throat, or shortness of breath. HMPV often circulates in Australia in late winter-early spring and is a major cause of Lower Respiratory Tract Infections (LRTI) as well as hospitalizations due to respiratory illnesses. The purpose of this letter is to highlight the historical trends and recent surges in HMPV infections in Australia. We also intend to assess the challenges in diagnosis, risks of infections, need for a vaccine, and to develop mitigation strategies against the virus. HMPV was first discovered by a group of Dutch scientists in 2001. The group isolated the virus from clinical samples of 28 unrelated children presenting respiratory tract infections, collected over the past 20 years (van den Hoogen et al., 2001). Following the discovery, other research groups in Australia and Europe reported the presence of viruses with similar genetic sequencing. Metapneumovirus epidemics occur generally in late winter to early spring in temperate sites with a more diverse spread in tropical regions (Li et al., 2019). Globally, HMPV accounts for an estimated 14.2 million Acute lower respiratory infections (ALRI) cases in children below 5 years of age (UR-10.2 million to 20.1 million) and about 643,000 (UR-425,000 to 927,000) hospital admissions (Wang et al., 2018). While in the 5-14 years age group, HMPV accounts for about 2 % of (ALRI) related hospital admissions at about 105,500 cases globally (Wang et al., 1995). Michael Nissen and his team were the first to confirm the presence of HMPV in samples of children with unexplained respiratory illness. This reinforces the view that HMPV is also present in the Australian population. Further studies were done to determine the dominant strain in infections, with results yielding subtype B1 to be the most common lineage (Mackay et al., 2006). Aligning with the global increase in HMPV cases, there has been an observed recent surge in HMPV cases in Australia, where the New South Wales (NSW) authorities have reported a huge increase from 648 cases to 1245 cases from the beginning of September and the 24th of September, respectively (COVID-19, 2023). Moreover, the positivity test for HMPV has been recorded at 4.7 % on the 24th of September after being at 2.9 % on September 3rd, 2023 (COVID-19, 2023). Such rates have also demonstrated that the virus has been largely increasing, as shown from the 6th, 20th, and 27th of August, reporting 1.6 %, 2.1 %, and 2.7 %, respectively (COVID-19, 2023). HMPV infection occurs periodically around the world yet is not endemic (Human Metapneumovirus, 2023). According to the Centers for Disease Control & Prevention (CDC), HMPV is most frequently encountered and active in late winter and early spring in temperate climates (Metapneumovirus, 2023). Boehm et al. have demonstrated

Research Square

Takayasu’s arteritis (TA) and systemic lupus erythematosus (SLE) are distinct autoimmune disorder... more Takayasu’s arteritis (TA) and systemic lupus erythematosus (SLE) are distinct autoimmune disorders with similar age and gender predisposition. However, their coexistence is exceedingly rare, and presents unique diagnostic and therapeutic challenges. Here, we report the case of a 44-year-old female with nodular episcleritis, breathlessness, and palpitations who was ultimately diagnosed with both TA and SLE. The presence of a range of antibodies in various cases underscores the heterogeneity of the disease presentation and the need for comprehensive testing. While many patients with this dual diagnosis experience symptom improvement and complete recovery, some face severe outcomes. In our case, aortic root replacement surgery was planned because of severe aortic regurgitation; however, the patient's condition deteriorated, resulting in death. This case underscores the need for clinicians to recognise and thoroughly evaluate patients with overlapping symptoms of TA and SLE. Although challenging, the coexistence of these autoimmune diseases provides valuable insights into the complexities of autoimmune conditions. Further research and collaboration are essential to advance our understanding and to improve patient outcomes in these complex clinical scenarios.

Sheehan syndrome, also referred to as postpartum hypopituitarism is often a sequela of massive po... more Sheehan syndrome, also referred to as postpartum hypopituitarism is often a sequela of massive post-partum hemorrhage in resource poor healthcare settings where blood loss during delivery is often neglected. The diagnosis of this rare but fatal is disease is often delayed because the symptoms are vague and the pituitary dysfunction is insidious in nature. This condition sometimes takes more than a decade before it is diagnosed. The classic signs and symptoms include agalactia, secondary amenorrhea and dry wrinkling skin. Often an empty or a partially empty sella is seen on magnetic resonance imaging of the brain. We present the case of a 35-year-old multiparous female with anhedonia and raised serum transaminases who presented to our side with mild hyponatremia and hypothyroidism. She got diagnosed with Sheehan syndrome at our set up six years after her last obstetric event. Through this case report, we intend to provide a clinical account of the patient’s condition and management.

Cureus, 2022

Laryngectomy is a common surgery for an oncosurgeon, but underlying carotid compromise is a serio... more Laryngectomy is a common surgery for an oncosurgeon, but underlying carotid compromise is a serious concern for anesthesiologists, making this routine procedure a high-risk one. The utmost vigilance of the anesthesiologist is demanded by the surgery to prevent morbidities such as hemiplegia, hemiparesis, or speech abnormalities that may occur due to perfusion insufficiency secondary to the mechanical blockage of the carotid arteries. Hence, an undiagnosed case of carotid artery block may result in disastrous consequences for the patient, surgeon, and anesthesiologist. Hence, it is imperative to perform all the preoperative investigations with due diligence. We present the case of a 74-year-old male who was admitted to our setup for laryngeal carcinoma surgery. The patient had received chemoradiotherapy (CRT) six months earlier. He complained of hoarseness in his voice and a painless neck mass. He was a known case of hypertension for 14 years, controlled by oral medication, and had a history of stroke five years ago, when he was also diagnosed with a completely blocked right common carotid artery (CCA) and a partially blocked left common carotid artery.

American Journal of Gastroenterology, 2021

Cureus, 2021

Antisynthetase syndrome is an autoimmune condition that manifests clinically through signs and sy... more Antisynthetase syndrome is an autoimmune condition that manifests clinically through signs and symptoms, such as interstitial lung disease, myositis, Raynaud's phenomenon, fever, hyperkeratotic fingertips (mechanic's hands), and arthritis. It is associated with antibodies against aminoacyl tRNA synthetase enzyme, the most common autoantibody being the anti-Jo-1. An 18-year-old girl presented with weakness of both the upper and lower limb, swelling and generalized body pain, difficulty in swallowing. MRI of the thigh was highly suggestive of myositis with symmetrical bilateral involvement. Based on proximal muscle weakness, elevated creatine phosphokinase (CPK), and lactate dehydrogenase (LDH), strongly positive anti-nuclear antibodies human epithelial cell type-2 (ANA-HEp2), and a normal nerve conduction velocity test with precise MRI findings, a diagnosis of polymyositis was made. She was given bolus intravenous methylprednisolone for five days, followed by oral methylprednisolone with subcutaneous methotrexate weekly. She reported a 50% improvement in muscle weakness; however, partial bulbar weakness persisted at the time of discharge. On her next follow-up, her blood investigations for autoantibodies were done. The autoantibodies anti-Jo-1 (3+), Ro-52 (2+), and Mi-2β (2+) were found to be positive. These investigations, coupled with the clinical features she was presenting, finally led us to conclude that it was a case of polymyositis complicated by the antisynthetase syndrome.

Cureus, 2021

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease that can affect almost e... more Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease that can affect almost every organ in the body. Its complications can often be fatal. The fatal complications include lupus cerebritis, lupus nephritis, and cardiac manifestations such as pericardial effusion. In this report, we discuss the case of a 23-year-old female who presented with complaints of high-grade fever, seizures, and altered mental state (AMS) and was found to have generalized lymphadenopathy (LAP). Various blood and urine analyses and radiological findings (chest X-ray, MRI of the head) were suggestive of lupus nephritis, lupus cerebritis, massive pericardial effusion, and thrombocytopenia. Her anti-double stranded DNA (anti-dsDNA) antibody was positive, and her pericardial fluid was positive for anti-nuclear antibodies (ANAs). She was administered IV glucocorticoids and phenytoin. She reported improvements in her symptoms gradually for a few days but eventually succumbed to the disease. Although generalized LAP is a rare initial presentation of SLE, it should be included in the differential diagnosis of the disease.

Research and Humanities in Medical Education, 2020

Springer Link, 2024

Gracile Bone Dysplasia (GCLEB) is a perinatally fatal condition with fewer than 30 cases reported... more Gracile Bone Dysplasia (GCLEB) is a perinatally fatal condition with fewer than 30 cases reported to date. It is characterized by severe abnormalities in bone development and growth. It is linked to heterozygous mutations in the FAM111A gene, this autosomal dominant disorder presents at birth or infancy with brittle, slender bones, and cranial abnormalities. Diagnosis relies on radiological and histopathological assessments, with genetic testing confirming FAM111A mutations. Unfortunately, no treatment currently exists, leading to a poor prognosis, with most patients stillborn or succumbing shortly after birth. The rarity of GCLEB and its poorly understood molecular mechanisms emphasize the imperative for further research into this devastating condition. This chapter provides a comprehensive overview of GCLEB, encompassing its historical background, etiology, clinical manifestations, diagnosis, and current management strategies.

Springer Link, 2024

Greig cephalopolysyndactyly syndrome (GCPS), also known as cephalopolysyndactyly syndrome, is a r... more Greig cephalopolysyndactyly syndrome (GCPS), also known as cephalopolysyndactyly syndrome, is a rare genetic disorder characterized by diverse craniofacial and limb anomalies. GCPS is primarily caused by mutations in the GLI3 gene, a crucial regulator of embryonic development, particularly in the Sonic Hedgehog pathway. Clinical manifestations vary widely, encompassing features such as polydactyly, craniofacial dysmorphism including macrocephaly and ocular hypertelorism, and, less commonly, neurological abnormalities. Diagnosis relies on clinical evaluation and molecular testing for GLI3 mutations. Management involves supportive care, with surgical intervention often necessary for limb malformations. Genetic counselling is imperative due to the autosomal dominant inheritance pattern. Prognosis varies depending on the severity of phenotypic features, with most individuals leading normal lives, although neurological complications can influence outcomes. Early recognition and comprehensive management are essential for optimizing the quality of life for individuals affected by GCPS.

Springer Link, 2024

Myotonic dystrophy, comprising type 1 (DM1) and type 2 (DM2), is the most common form of muscular... more Myotonic dystrophy, comprising type 1 (DM1) and type 2 (DM2), is the most common form of muscular dystrophy, characterized by multisystemic involvement and progressive hereditary traits. It manifests variably across ages, with onset typically in the 20s and 30s. Genetic mutations in the DMPK gene (DM1) and CNBP gene (DM2) lead to toxic RNA accumulation, disrupting cellular processes. Clinical presentation encompasses a spectrum of manifestations affecting various bodily systems. Diagnosis relies on genetic testing and may involve ancillary tests like serum CK levels, electromyogram, and muscle biopsy. Management focuses on symptomatic relief through multidisciplinary care, including physiotherapy, cardiac monitoring, respiratory function tests, and genetic counselling. Regular follow-up is essential due to the progressive nature of the disease, impacting prognosis and necessitating lifelong monitoring for potential complications. Though incurable, appropriate management enhances the quality of life for individuals affected by myotonic dystrophy.