Dheeraj Khurana | PGIMER,CHD,India - Academia.edu (original) (raw)

Papers by Dheeraj Khurana

Stroke, 2020

Background: Post stroke care is a major challenge in resource poor settings due to lack of traine... more Background: Post stroke care is a major challenge in resource poor settings due to lack of trained caregivers. Mobile application(m-app) based care strategy may provide low cost solution to counter this burden.MAPSS tested m- app in a pilot randomised control study on bed ridden stroke patients. Objectives: To develop smartphone based medical application for delivering post stroke care strategies and to evaluate its efficacy in reducing post stroke complications. Methods: Patients within 3 months of stroke were randomised to either routine care (Controls) or App based care (MAPPS). Major inclusions were: Modified Rankin Score(mRS) >3, caregivers/patients with smartphone and internet facility and willing to use an app as health care tool.Major exclusion: Patients with no caregiver or hired /illiterate caregiver. MAPSS group was additionally given routine care with booklet. "Stoke Home Care" app was installed in caregiver smartphone and explained its use.Follow up was at ...

Stroke, 2017

Background: Cerebral microbleeds(CMBs) represent microangiopathy in intracerebral hemorrhage(ICH)... more Background: Cerebral microbleeds(CMBs) represent microangiopathy in intracerebral hemorrhage(ICH). Their association with BP control-ability in ICH has not been studied. Objectives: To study influence of CMBs on blood pressure control in acute ICH presenting within 24 hours of symptom onset Methods: Acute ICH presenting within 24 hours of symptom onset were prospectively enrolled from April ’15 to May ’16 if they fulfilled major inclusion [age>18, GCS >8 (M >4)] and exclusion (Lobar bleed,ICH due to anticoagulants,Pregnancy, Contraindications for MRI) criteria.A baseline brain CT and CT angio was done.Brain MRI(3T) was done within 24 hours of admission to assess CMBs. Blood pressure lowering was carried out as per guidelines with a target SP<140mmHg.The target BP was attempted to be achieved in 24 hours.Based on BP control,patients were divided into two groups: a)Easy(E) and b)Difficult(D) based on control achieved within 7 hours.CMB assessor was blinded to the clinical ...

Stroke, 2018

Background: Although major stroke burden occurs in developing countries, there is lack of compara... more Background: Although major stroke burden occurs in developing countries, there is lack of comparable assessment of patient characteristics, adherence to guideline-recommended performance measures, and outcomes in acute ischemic stroke (AIS). We compared data from Indo-US Stroke Registry (ISR) and China National Stroke Registry-II (CNSR-II). Methods: The ISR prospectively enrolled N=2066 over 2 years across five large academic hospitals in different geographic regions in India. From CNSR-II we selected 31 large academic hospitals mainland provinces in China, where N=1973 were prospectively enrolled over an overlapping 9-month period. In-hospital patient characteristics, adherence to guideline-recommended performance measures, in-hospital mortality, and 3-month outcomes were compared. Results: As compared to ISR, patients in the CNSR-II were significantly older (mean age 63.9 vs. 58.3 years, p=0.001), had less diabetes mellitus and dyslipidemia but more hypertension and atrial fibrill...

Journal of the Neurological Sciences, 2021

Background: As the health systems around the world struggled to meet the challenges of COVID-19 p... more Background: As the health systems around the world struggled to meet the challenges of COVID-19 pandemic, care of many non-COVID emergencies was affected. Aims: The present study examined differences in the diagnosis, evaluation and management of stroke patients during a defined period in the ongoing pandemic in 2020 when compared to a similar epoch in year 2019. Methods: The COVID stroke study group (CSSG) India, included 18 stroke centres spread across the country. Data was collected prospectively between February and July 2020 and retrospectively for the same period in 2019. Details of demographics, stroke evaluation, treatment, in-hospital and three months outcomes were collected and compared between these two time points. Results: A total of 2549 patients were seen in both study periods; 1237 patients (48.53%) in 2019 and 1312 (51.47%) in 2020. Although the overall number of stroke patients and rates of thrombolysis were comparable, a significant decline was observed in the month of April 2020, during the initial period of the pandemic and lockdown. Endovascular treatment reduced significantly and longer door to needle and CT to needle times were observed in 2020. Although mortality was higher in 2020, proportion of patients with good outcome were similar in both the study periods. Conclusions: Although stroke admissions and rates of thrombolysis were comparable, some work flow metrics were delayed, endovascular stroke treatment rates declined and mortality was higher during the pandemic study period. Reorganization of stroke treatment pathways during the pandemic has likely improved the stroke care delivery across the globe.

Annals of the New York Academy of Sciences, 2020

Stroke care in India has evolved rapidly in the last decade with a focus on stroke awareness, pre... more Stroke care in India has evolved rapidly in the last decade with a focus on stroke awareness, prevention, rapid triage, treatment, and rehabilitation. But acute stroke care and poststroke rehabilitation in the country have limitations owing to the economic constraints and poor access to health care. The SARS-CoV-2/COVID-19 pandemic has made stroke care even more challenging. We outline the unfavorable circumstances in stroke care induced by the pandemic; propose mitigating measures; crisis management; and provide a comparative evaluation of stroke care between India and the United States during the pandemic. There is a need for public health systems in both developed and developing countries to improve awareness, implement proper strategies of triage, acute treatment, well-defined rehabilitation plans, telemedicine services, and virtual check-ins.

Annals of Indian Academy of Neurology, 2020

Knowledge related to SARS-CoV-2 or 2019 novel coronavirus (2019-nCoV) is still emerging and rapid... more Knowledge related to SARS-CoV-2 or 2019 novel coronavirus (2019-nCoV) is still emerging and rapidly evolving. We know little about the effects of this novel coronavirus on various body systems and its behaviour among patients with underlying neurological conditions, especially those on immunomodulatory medications. The aim of the present consensus expert opinion document is to appraise the potential concerns when managing our patients with underlying CNS autoimmune demyelinating disorders during the current COVID-19 pandemic.

Journal of Clinical Neuroscience, 2020

Clopidogrel (CLP) is a second generation thienopyridine drug commonly used in secondary preventio... more Clopidogrel (CLP) is a second generation thienopyridine drug commonly used in secondary prevention of ischemic stroke (IS). Its antiplatelet response maybe variable due to genetic and non-genetic factors. Adipokines may affect platelet aggregation through ADP mediated platelet signalling. However, the combined effect of CYP genetic variants and adipokines on antiplatelet response of clopidogrel is unclear. Patients of IS/Transient ischemic attack (TIAs) within 3 months were prospectively screened following clopidogrel treatment. Major exclusions were cardioembolic and non atherosclerotic strokes. Antiplatelet effect of clopidogrel along with adipokine (Leptin and adiponectin) levels and genotyping of CYP, P2Y12 gene were investigated. Rare genetic variants were confirmed by DNA sequencing. 204 patients with ischemic stroke/TIAs were screened and 163 were recruited. 85 (52.1%) patients were poor responders to clopidogrel. Antiplatelet response to clopidogrel was weaker in females [Median 8.0 (IQR: 3.0-14.0)] compared to males [Median 5.0 (IQR: 2.0-10.0)]. In female subgroup analysis, association was found among high leptin levels and PPI (+) usage in poor responders. None of the genetic variants (CYP2C19*2,*3,*4*, CYP2C9*3, CYP2B6 and P2Y12) were found to influence the antiplatelet effects (p > 0.05). On multivariable logistic regression, a poor clopidogrel response was associated with female gender (Adjusted OR 2.55, 95% CI: 1.05-6.18) and PPI usage (Adjusted OR 2.42, 95% CI: 1.09-5.34). Despite a high prevalence of clopidogrel resistance in the North Indian stroke patients, female gender rather than genetic polymorphisms of CYP and P2Y12 genes may influence its antiplatelet effect. Further research may ascertain the role of gender on clopidogrel response.

Neurology, 2018

ObjectiveTo understand stroke risk factors, status of stroke care, and opportunities for improvem... more ObjectiveTo understand stroke risk factors, status of stroke care, and opportunities for improvement as China and India develop national strategies to address their disproportionate and growing burden of stroke.MethodsWe compared stroke risk factors, acute management, adherence to quality performance measures, and clinical outcomes among hospitalized ischemic stroke patients using data from the Indo-US Collaborative Stroke Project (IUCSP) and China National Stroke Registry-II (CNSR-II). The IUCSP included 5 academic stroke centers from different geographic regions (n = 2,066). For comparison, the CNSR-II dataset was restricted to 31 academic hospitals among 219 participating sites from 31 provinces (n = 1,973).ResultsIndian patients were significantly younger, had health insurance less often, and had significantly different risk factors (more often diabetes mellitus, dyslipidemia, and coronary heart disease; less often prior stroke, hypertension, atrial fibrillation, and smoking). H...

Stroke, Jan 22, 2017

The Indo-US Collaborative Stroke Project was designed to characterize ischemic stroke across 5 hi... more The Indo-US Collaborative Stroke Project was designed to characterize ischemic stroke across 5 high-volume academic tertiary hospitals in India. From January 2012 to August 2014, research coordinators and physician coinvestigators prospectively collected data on 2066 patients with ischemic stroke admitted <2 weeks after onset. Investigator training and supervision and data monitoring were conducted by the US site (Massachusetts General Hospital, Boston). The mean age was 58.3±14.7 years, 67.2% men. The median admission National Institutes of Health Stroke Scale score was 10 (interquartile range, 5-15) and 24.5% had National Institutes of Health Stroke Scale ≥16. Hypertension (60.8%), diabetes mellitus (35.7%), and tobacco use (32.2%, including bidi/smokeless tobacco) were common risk factors. Only 4% had atrial fibrillation. All patients underwent computed tomography or magnetic resonance imaging; 81% had cerebrovascular imaging. Stroke etiologic subtypes were large artery (29.9%...

Reviews in the Neurosciences, 2017

Stroke is a multifactorial disease contributing to significant noncommunicable disease burden in ... more Stroke is a multifactorial disease contributing to significant noncommunicable disease burden in developing countries. Risk of stroke is largely a consequence of morbidities of diabetes, obesity, hypertension, and heart diseases. Incidence of stroke is directly proportional to body mass index. Adipose tissue stores energy as well as acts as an active endocrine organ, which secretes numerous humoral factors. Adiponectin and leptin are the commonest adipocytokines and have been invariably linked to the development of coronary heart disease and may be involved in the underlying biological mechanism of stroke. Leptin and adiponectin mediate proatherogenic and antiatherogenic responses, respectively, and hence, determining the plasma or serum levels of leptin and adiponectin alone or in combination may act as a novel prognostic biomarker for inflammation and atherosclerosis in stroke. This review addresses leptin- and adiponectin-mediated inflammatory mechanism in ischemic stroke and the...

Annals of Indian Academy of Neurology, 2016

Recent data have provided overwhelming evidence in favor of benefits of emergent endovascular int... more Recent data have provided overwhelming evidence in favor of benefits of emergent endovascular intervention in large vessel acute ischemic stroke (AIS). India with its large population has a huge burden of AIS. Hence, neurologists need to gear up to the new challenge of providing interventional care to huge populations of AIS in the country. The best way to cover this unprecedented unmet need is to encourage neurologists to take up interventional subspecialty interests through new but sound training pathways.

Differential Diagnosis in Neurology, 2016

Neurology India, 2003

A patient with small cell lung cancer presented with a rare presentation of an acute onset pancer... more A patient with small cell lung cancer presented with a rare presentation of an acute onset pancerebellar dysfunction. His clinical condition markedly improved following the surgical removal of the tumor and chemo- and radiotherapy.

Neurology India, 1999

An overwhelming majority of disappearing CT lesions in India have been aetiologically linked to c... more An overwhelming majority of disappearing CT lesions in India have been aetiologically linked to cysticercosis. We report 4 patients with disappearing CT lesions in whom the lesion later reappeared at the same (3 patients) or different site (1 patient). One patient was a Taenia carrier. Serial MRI evaluation in one patient revealed a persisting lesion in the interval period. The contribution of these observations towards the understanding of the aetiology of disappearing CT lesions is discussed.

Indian journal of endocrinology and metabolism, 2014

Accumulating evidence suggests that vitamin D deficiency is associated with increased risk of str... more Accumulating evidence suggests that vitamin D deficiency is associated with increased risk of stroke. Contributing mechanisms have been linked to the association of vitamin D deficiency with the presence of hypertension, diabetes mellitus, and atherosclerosis, however, the evidence is conflicting. This study sought to determine the association of vitamin D deficiency with ischemic stroke and its risk factors. Cross-sectional case control study. We measured serum 25-hydroxyvitamin D [25(OH) D] and intact parathyroid hormone (iPTH) levels in 73 patients of ischemic stroke, presenting within 7 days of onset of stroke and compared with 70 age and gender matched controls. The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, version 17.0 for Windows). The mean age of patients and controls was 59.9 ± 11.2 years and 57.9 ± 9.7 years, respectively (P = 0.26). Of 67.1% patients were men as compared to 65.7% controls (P = 0.86). There ...

Objectives: To validate the transcranial Doppler(TCD) variables which serve as predictor of outco... more Objectives: To validate the transcranial Doppler(TCD) variables which serve as predictor of outcome in supratentorial spontaneous intracerebral hemorrhage(SICH). Methods: Patients with SICH ( Age > 18years) within 24 hours of symptom onset were prospectively recruited. Following detailed clinical examination baseline cranial CT scan was done followed by TCD study using a 2Mhz probe.The hematoma volume was measured (A X B X C/2 method). Bilateral MCA velocities were recorded by trans temporal insonation at a depth of 55 mm-mean, peak systolic ,end diastolic velocities(MV,PSV,EDV),Pulsatility index(PI) were recorded. Follow up CT scan and TCD variables were recorded within 24 hours of the baseline. All patients were managed as per standard guidelines.Good outcomes were defined as modified rankin scale (0-2) at 3 months. Results: 25 patients were recruited from July 2010-September 2011.Mean age was 52.44+11.35years,72% males, time from symptom onset ranged from 180-990 mins (mean-49...

Annals of Indian Academy of Neurology, 2014

aseptic meningitis is a conundrum with varying causes including immunological drugs and unidentif... more aseptic meningitis is a conundrum with varying causes including immunological drugs and unidentified infections. It is imperative to do complete CSF workup before implicating the symptoms to disease activity or drugs, as untreated infections cause significant mortality in SLE. [1] We present, a case of young female with SLE who presented with chronic meningitis of an uncommon etiology.