Vishal Gupta

All India Institute of Medical Sciences

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Jagadeesh K Kalavakunta

Western Michigan University

Sourabh Aġġarwal

Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences

Yashwant Agrawal

Banner Desert Medical Center

Vaishali Teli

Govind Rankawat

Sawai ManSingh Medical College and Hospital

Niteen D Karnik

Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College

Sudhir Bhandari

Sawai ManSingh Medical College and Hospital

Anshu B. Mathur

Indian Institute of Technology Roorkee

Anandbir Bath

Borgess Health

Ajeet Singh

Maharani Laxmi Bai Medical College

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Sawai ManSingh Medical College and Hospital

King Edward Memorial Hospital and Seth G.S. Medical College

All India Institute of Medical Sciences

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Post Graduate Institute of Medical Education and Research

Michigan State University

Institute of Medical Sciences

Western Michigan University

Stryker (United States)

Marymount University

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An analysis of the cost-effectiveness of switching from biphasic human insulin 30, insulin glargine, or neutral protamine Hagedorn to biphasic insulin aspart 30 in people with type 2 diabetes

Journal of Medical Economics (2014)

Vishal Gupta Ranya Baabbad E. Hammerby Annie Nikolajsen Asrul Akmal Shafie

The aim of this analysis was to assess the cost-effectiveness of switching from biphasic human insulin 30 (BHI), insulin glargine (IGlar), or neutral protamine Hagedorn (NPH) insulin (all ± oral glucose-lowering drugs [OGLDs]) to biphasic insulin aspart 30 (BIAsp 30) in people with type 2 diabetes in India, Indonesia, and Saudi Arabia.The IMS CORE Diabetes Model was used to determine the clinical outcome, costs, and cost-effectiveness of switching from treatment with BHI, IGlar, or NPH to BIAsp 30 over a 30-year time horizon. A 1-year analysis was also performed based on quality-of-life data and treatment costs. Incremental cost-effectiveness ratios (ICERs) were expressed as a fraction of gross domestic product (GDP) per capita, and cost-effectiveness was defined as ICER <3-times GDP per capita.Switching treatment from BHI, IGlar, or NPH to BIAsp 30 was associated with an increase in life expectancy of >0.7 years, reduction in all diabetes-related complications, and was considered as cost-effective or highly cost-effective in India, Indonesia, and Saudi Arabia (BHI to BIAsp 30, 0.26 in India, 1.25 in Indonesia, 0.01 in Saudi Arabia; IGlar to BIAsp 30, -0.68 in India, -0.21 in Saudi Arabia; NPH to BIAsp 30, 0.15 in India, -0.07 in Saudi Arabia; GDP per head per annum/quality-adjusted life-year). Cost-effectiveness was maintained in the 1-year analyses.Switching from treatment with BHI, IGlar, or NPH to BIAsp 30 (all ± OGLDs) was found to be cost-effective in India, Indonesia, and Saudi Arabia, both in the long and short term.

NPH insulin

10.3111/13696998.2014.991791

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Abstract 101: Association Of Cardiovascular Disorder Requiring Intubation To In-hospital Mortality And Discharge Status Of The Patients: Analysis Of 17,128 Hospitalizations

Circulation Cardiovascular Quality and Outcomes (2014)

Sourabh Aġġarwal Amy Attaway Vishal Gupta

Introduction: Endotracheal intubations are a vital cornerstone of care for critically ill patients. The decision to intubate a critically ill patient is often complicated secondary to long term prognosis of underlying illness and extent of aggressive treatment a patient would desire. This study was done to identify association of cardiovascular disorder requiring endotracheal intubation to in-hospital mortality and discharge status of the patients. Methods: Nationwide Inpatient Sample data (which represents 20% of all the hospitals data in US) was used for the study and data related to all the intubations for the year 2011 was extracted. Patients with complete data on endotracheal intubations associated with primary cardiovascular diagnosis of acute myocardial infarction (MI), cardiac arrest and ventricular fibrillation (CA/VFib), congestive heart failure (CHF), acute cerebrovascular accident (CVA) and cardiac dysrhythmia were included in the study. Statistical analysis was done using SPSS. Results: A total of 17,128 intubations associated with primary cardiovascular diagnosis were identified. In-hospital mortality for endotracheal intubations secondary to cardiovascular etiology was significantly higher than intubations secondary to non-cardiovascular etiology (58.5 % vs 29.43%, p value <0.001). CA/VFib (84.39%), MI (61.74%) and CVA (60.67%) were associated with significantly higher in-hospital mortality than cardiac dysrhythmia (49.44%) and CHF (42.11%) (p value <0.001). Patients with CHF were associated with significantly higher routine discharges (15.33%) or transfer to another short term hospital (12.53%) and patients with CVA were associated with discharge to another health care institution (23.42%) (p value <0.001). Conclusions: Our study reports that patients who are intubated secondary to cardiovascular etiology have higher in-hospital mortality. Among these patients, patients having cardiac arrest/ventricular fibrillation have high in-hospital mortality and patients with CHF have higher routine discharges. This data can help clinicians to have well informed discussion with the family and weigh the risk and benefits of aggressively treating certain populations of critically ill cardiac patients with endotracheal intubation.

Etiology

Endotracheal intubation

10.1161/circoutcomes.7.suppl_1.101

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Primary AL (kappa-light chain) amyloidosis manifesting as peripheral neuropathy in a young male without increase in serum and urine immunoglobulin load: a diagnostic challenge.

PubMed (2005)

Chitra Sarkar M. Sharma Anupama Nayak Angela Ralte Vishal Gupta

Primary systemic or AL amyloidosis is a multisystem disorder characterized by diffuse extracellular infiltration of a fibrillar protein of monoclonal light chain origin (AL). Majority of the patients have monoclonal immunoglobulin in serum and/or urine and some have clonal proliferation of plasma cells in their bone marrow. This disease has the widest spectrum of organ involvement, most commonly affecting the kidneys, heart and liver. Involvement of peripheral nervous system is not infrequent and may be the presenting feature of the disease process. Thus, recognition of peripheral neuropathy and affecting the kidney as an early symptom of AL amyloidosis may widen the scope for therapeutic intervention. We describe here a rare case of primary amyloidosis (AL) kappa-light chain presenting with clinical features of peripheral neuropathy and affecting the kidney and heart at an early age of 18 years, hitherto unreported in literature. The case was further interesting as it was not associated with increased serum/urine immunoglobulins or plasma cells in bone marrow. Diagnosis was confirmed using immuno-electron microscopy on sural nerve biopsy.

AL amyloidosis

Serum protein electrophoresis

Primary systemic amyloidosis

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A quantitative polymerase chain reaction assay for detecting and identifying fungal contamination in human allograft tissue

Cell and Tissue Banking (2007)

Vishal Gupta Ronald R. Cobb Lauren Brown Laraine Fleming Nilay Mukherjee

10.1007/s10561-007-9059-7

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Evidence for autonomic dysregulation in the irritable bowel syndrome.

Digestive Diseases and Sciences (2002)

Vishal Gupta David Sheffield G. Nicholas Verne

Visceral pain

10.1023/a:1016424007454

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DEMOGRAPHIC FACTORS AND CAUSES RELATED TO EARLY READMISSION OF PATIENT WITH ACUTE CEREBROVASCULAR DISEASE: ANALYSIS OF 2,366,178 HOSPITALIZATIONS

Journal of the American College of Cardiology (2018)

Dominika Zoltowska Yashwant Agrawal Jagadeesh K Kalavakunta Vishal Gupta

Stroke

Acute stroke

Acute care

Medical care

10.1016/s0735-1097(18)32638-x

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Long-Term Outcomes of Patients Undergoing TAVI in Australia

Heart Lung and Circulation (2018)

Julia Stehli Vishal Gupta Hashrul Rashid K. Be Catherine Martin

10.1016/j.hlc.2018.06.945

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An Unusual Cause of Transient Ischemic Attack in a Patient with Pacemaker

Case Reports in Cardiology (2014)

Jagadeesh K Kalavakunta Vishal Gupta Basil Paulus William F. Lapenna

Pacemaker lead malposition in various locations has been described in the literature. Lead malposition in left ventricle is a rare and an underdiagnosed complication. We present a 77-year-old man with history of atrial fibrillation and pacemaker placement who was admitted for transient ischemic attack. He was on aspirin, beta blocker, and warfarin with subtherapeutic international normalized ratio. His paced electrocardiogram showed right bundle-branch block, rather than the typical pattern of left bundle-branch block, suggesting pacemaker lead malposition. Further, his chest X-ray and echocardiogram confirmed the pacemaker lead position in the left ventricle instead of right ventricle. He refused surgical removal of the lead and we increased his warfarin dose. Diagnosis of lead malposition in left ventricle, though easy to identify in echocardiogram, requires high index of clinical suspicion. In asymptomatic patients, surgical removal may be deferred for treatment with lifelong anticoagulation.

Transthoracic echocardiogram

Transesophageal echocardiogram

10.1155/2014/265759

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Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Mumbai cohort of the A ₁ chieve study

Indian Journal of Endocrinology and Metabolism (2013)

PG Talwalkar Vishal Gupta Rajiv Kovil

The A1chieve, a multicentric (28 countries), 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726) in routine clinical care across four continents.Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from Mumbai, India.A total of 2112 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Patients had started on or were switched to biphasic insulin aspart (n = 1561), insulin detemir (n = 313), insulin aspart (n = 144), basal insulin plus insulin aspart (n = 53) and other insulin combinations (n = 41). At baseline glycaemic control was poor for both insulin naïve (mean HbA1c: 8.7%) and insulin user (mean HbA1c: 9.2%) groups. After 24 weeks of treatment, both the groups showed improvement in HbA1c (insulin naïve: -1.4%, insulin users: -1.8%). SADRs including major hypoglycaemic events or episodes did not occur in any of the study patients.Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia.

Insulin aspart

Insulin detemir

Basal (medicine)

10.4103/2230-8210.122107

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Hydroxychloroquine in Rheumatological Disorders: The Potential Buffer Against COVID-19

SSRN Electronic Journal (2020)

Sudhir Bhandari Govind Rankawat Bhoopendra Patel Avinash Jai Jitendra Gupta

Background: Hydroxychloroquine (HCQ) is a well prescribed drug in rheumatological disorders. The repurposed drug HCQ was also used for SARS-CoV-2 as prophylactic and therapeutic strategy in Indian context. The present study aimed to describe that either rheumatological disorder had threatening effect on COVID-19 or advantageous particularly with the use of HCQ.Methods: The present retrospective, observational study included 4100 COVID-19 patients of SMS Medical college and Hospitals, Jaipur, India. The patient's data (after anonymizing and de-linking) concerning underlying chronic medical illness especially focused on rheumatological disorders was extracted from their medical records. The data from rheumatological patients concerning medical history, clinical manifestation, severity of COVID-19, extension of disease, treatment history and outcome were collected and analyzed.Results: Out of large study cohort of 4100 patients of COVID-19, rheumatological disorders found only in seven patients (0.17%) including rheumatoid arthritis (RA) in four patients, systemic lupus erythematous (SLE) in two patients and Wegener granulomatosis in one patient. All rheumatologic patients of study group had symptomatic presentations with one patient had critical, another one had severe, two had moderate and three patients had mild illness. Only one patient was on hydroxychloroquine (HCQ) treatment (200 mg daily) who presented with mild illness of COVID-19. One patient of SLE with lupus nephritis on glucocorticoids and immunosuppressive agents but not on HCQ, developed critical illness and later on succumbed to life.Conclusion: The present study showed that patients with rheumatological disorders might not be at increased risk of acquiring COVID-19 or a more severe disease. Moreover, HCQ has some protective role against COVID-19 in patients of rheumatological disorders and it also play an important role in reducing the disease severity.Funding Statement: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not for profit sectors.Declaration of Interests: All authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential.Ethics Approval Statement: This study approved by ethical and research committee of SMS medical college and Hospital, Jaipur, India.

Hydroxychloroquine

2019-20 coronavirus outbreak

10.2139/ssrn.3668410

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