AMITESH AGGARWAL
@ucms.ac.in
Director Professor & Unit Head, Department of Medicine
University College of Medical Sciences & GTB Hospital, Delhi
RESEARCH, TEACHING, or OTHER INTERESTS
Health Professions, General Medicine, Internal Medicine
Scopus Publications
Scopus Publications
Vrinda Goel, Alpana Raizada, Amitesh Aggarwal, SV Madhu, Rajarshi Kar, Ananya Agrawal, Vikash Mahla, and Ashish Goel
American Society of Tropical Medicine and Hygiene
ABSTRACT. Although the short-term mortality of patients with COVID-19 infection and hyperglycemia has been well documented, there is little available data regarding longer-term prognosis. The presence of diabetes has not only influenced disease severity but has also impacted its transmission dynamics. In this study, we followed a historical cohort of patients without previous history of diabetes who presented with moderate to severe COVID-19 and were found to have hyperglycemia (random blood glucose > 140 mg/dL) at the time of admission. We evaluated the need for antidiabetic therapy in these patients at the end of 6 months and the risk factors associated with persistent hyperglycemia determined by monthly values of self-monitored blood glucose. Of the seventy participants who were followed telephonically, 54 (77%) continued to receive antidiabetic therapy or have persistent hyperglycemia (> 140 mg/dL) at the end of 6 months. Persistent hyperglycemia at the end of follow-up, was found to be associated with a higher blood glucose at presentation.
Phibakordor Lyngdoh Nonglait, Sri Venkata Madhu, Nishant Raizada, Amitesh Aggarwal, Rafat Ahmed, and Mohammad Aslam
Frontiers Media SA
BackgroundStudy aimed to assess stress in COVID-19 recovered individuals using a validated questionnaire PSS-10 score and stress biomarkers – salivary cortisol and serum copeptin.MethodsA total of 83 subjects of which 54 subjects (66.3%) who were hospitalized were recruited 8–20 weeks following recovery from COVID-19. Stress was assessed by PSS-10 stress-scale after a mean duration of 14.5 weeks after recovery. Sixty-eight subjects (81.9%) had new or persistent symptoms after recovery. Subjects were divided into two groups on the basis of PSS score; mild stress (PSS:0–13) and moderate to severe stress (PSS:>14) and levels of biomarkers (serum copeptin, DHEAS and salivary cortisol) were compared in the two groups.ResultsForty-four subjects (53%) had moderate to severe stress and 39 subjects (47%) had mild stress. Subjects with post COVID symptoms had significantly higher stress levels as compared to subjects who were asymptomatic [15 vs. 9; p = 0.003]. Serum copeptin levels were significantly higher among subjects with moderate to severe stress as compared to those with mild stress [0.41 vs. 0.67 ng/mL; p = 0.031]. Subjects with moderate to severe stress had higher median salivary cortisol compared to subjects with mild stress [1.03 vs. 1.44 nmol/L; p = 0.448].ConclusionOur study demonstrated moderate to severe stress in over half and some level of stress in nearly all COVID recovered individuals even after 3 months. Serum copeptin was found to be a useful biomarker to objectively measure stress in these subjects.
FNU Anamika, Ashish Goel, Amitesh Aggarwal, and Ramansh Bandhu Gupta
Forum for Medical Ethics Society
The conventional sharing of information and education between doctor and patient is no longer what it used to be prior to Dr. Google’s entry into the mix with voluminous data, not only transforming but often threatening the patient-doctor relationship. While patients no longer seek basic information from their physicians since they’ve already consulted Dr. Google, the wise physician accepts that patients are now more aware, more involved in their own care, and more empowered with information. The good old doctor who knew everything is now more a myth that exists largely in folklore. While doctors may be well versed in a variety of fields, they have often narrowed down their areas of specialisation, while they continue to apply what they learn from their daily encounters with patients, establishing a stronger relationship over time. The challenge arises when a patient, having consulted Dr. Google, starts to question their doctor with the little knowledge gained from the internet. Biased opinions based on prior knowledge, have lately placed the doctor-patient relationship in jeopardy.
A Aggarwal, A Kumar, R Sharma, A Goel, R Kar, R Avasthi, and AK Gupta
Medknow
Objective: The primary objective was to determine the occurrence of frailty in elderly patients presenting with the acute coronary syndrome (ACS). The secondary objective was to study the association between the deficits in health with the severity of ACS at presentation among them. Methods: A cross-sectional study conducted in the Departments of Medicine, Community Medicine and Biochemistry in a tertiary care teaching hospital, Delhi, India between November 2014 and April 2016. Patients (≥60 years age) presenting with any one of the spectra of ACS (STEMI, UA, NSTEMI) and giving informed written consent were assessed for frailty and health deficits using questionnaires. ACS assessed by ECG within 24 h and other relevant investigations. Appropriate statistical tests of significance like the Chi-square test were used and correlation coefficients were analyzed. A value of P < 0.05 was considered significant. Results: Seven risk factors apart from old age were studied, in which smoking and dyslipidemia played a major role. 44% of the subjects were frail with the range of frailty scores between 3 and 5. Every one-unit increase in hemoglobin was associated with a reduction in the odds (OR 0.72) for being frail. No association was noted between the severity of ACS and established risk factors like smoking, hypertension, diabetes, family history of CAD, increased waist circumference, dyslipidemia, and male gender. On multivariable linear regression, presence of frailty and depression were associated with severe disease. Conclusions: Nearly one in two patients presenting with ACS were found frail. Depression and frailty were associated with poorer ejection fraction and severe disease. Correction of anemia and improvement of low-normal hemoglobin levels could reduce frailty and in-turn improve outcomes in ACS.
Renu Gupta, Rajeev Thakur, Suman Kushwaha, Nupur Jalan, Pumanshi Rawat, Piyush Gupta, Amitesh Aggarwal, Meena Gupta, and Vikas Manchanda
Elsevier BV
Archana Singal, Kumari Asha, SumanBala Sharma, VinodKumar Arora, and Amitesh Aggarwal
Medknow
Background & objectives: Psoriasis is a recurrent hyper-proliferative skin disease which is often associated with free radical generation, abnormal lipid metabolism and increased inflammatory secretion that induce cardiovascular risk in these patients. The present study was intended to evaluate serum lipids, lipoprotein and oxidants-antioxidants status and to establish their relationship with atherogenic risk markers [oxidized low-density lipoprotein (oxLDL) and high-sensitivity C-reactive protein (hsCRP)] in patients with psoriasis. Methods: The study was conducted on 150 psoriasis patients and 150 age- and sex-matched healthy controls. Overnight fasting blood samples were obtained for lipids, lipoproteins, lipid oxidation and peroxidation products [oxLDL, malondialdehyde (MDA)], antioxidant enzymes [reduced glutathione (GSH) and total antioxidant status] levels and hsCRP estimations. Results: The mean levels of atherogenic lipids [total cholesterol (P<0.001), triacylglycerol (P<0.01)], lipid peroxidation products (P<0.001) and oxLDL and hsCRP (P<0.001) levels in patients with psoriasis were found to be significantly higher than those of healthy controls. On the other hand, ferric-reducing ability of plasma (FRAP, P<0.001) and antioxidant enzyme activities (reduced GSH, P<0.01) were significantly lower when compared to healthy controls. The plasma oxLDL was positively correlated to LDL cholesterol (P<0.001) and MDA (P<0.001) and negatively associated with antioxidant status in these patients. Serum MDA, FRAP and oxLDL were correlated with risk of atherosclerosis in the patients with psoriasis; however, no significant association was found between reduced GSH and hsCRP. Interpretation & conclusions: The study results suggest that LDL oxidation and reactive oxygen species in addition to inflammatory markers may play a pivotal role in inducing atherosclerosis in patients of psoriasis.
Renu Gupta, Suman Kushwaha, Rajeev Thakur, Nupur Jalan, Pumanshi Rawat, Piyush Gupta, Amitesh Aggarwal, Meena Gupta, and Vikas Manchanda
Elsevier BV
Laxmikant Ramkumarsingh Tomar, Amit Kumar Dhawan, Sonal Sharma, and Amitesh Aggarwal
SAGE Publications
Nail changes are often considered a mirror of internal disease. Here, we present a case report of a 16-year-old girl whose primary complaint was nail hyperpigmentation, and who was later diagnosed as having megaloblastic anaemia. Melanonychia is defined as blackish discoloration of the nail plate. It has been reported rarely in vitamin B12 deficiency, in the form of longitudinal melanonychia, with a diffuse bluish discoloration and reticular pattern. This is reversible with vitamin B12 treatment.
Kapil Dev, Suman B. Sharma, Seema Garg, Amitesh Aggarwal, and S.V. Madhu
Elsevier BV
Amitesh Aggarwal, Nitin Bansal, and Raghav Aggarwal
Elsevier BV
L.R. Tomar and A. Aggarwal
Elsevier BV
Laxmikant Ramkumarsingh Tomar, Sundaram Thondikulam Gopalakrishnan, and Amitesh Aggarwal
SynthesisHub Advance Scientific Research
Thyroid disorders, both hyperthyroidism and hypothyroidism, have been known to cause many cardiovascular effects however; hyperthyroidism has been known to be an important factor in the aetiology of paroxysmal supraventricular tachycardias. Here, we report a case of young female who was a known case of hypothyroidism for one year, on thyroxin 25 mcg once a day, presented with acute onset palpitations and diaphoresis with electrocardiography (ECG) findings suggestive of Paroxysmal Supraventricular Tachycardia (PSVT). Since there is a paucity of cases reported on tachyarrhythmias associated with hypothyroidism, we wish to add this rare case to the literature.
Amitesh Aggarwal, LaxmikantRamkumarsingh Tomar, Velmurugan Mannar, and Sonal Pruthi
Medknow
The chest radiography revealed bronchiectatic lesions in left lung lower zone, which was consistent with clinical findings and surprisingly revealed a cystic lesion on left side of trachea, just below carina [Figure 1], which led to possibility of a mass lesion in the thorax. In view of this, contrast‐enhanced computed tomography of thorax was done and it revealed a tubular cystic lesion measuring 9.1 × 3.1 × 2.9 cm in the left paratracheal region with minimal fluid and thin enhancing wall causing slight deviation of trachea and esophagus to the right side. There were cystic and tubular bronchiectatic changes in all segments of left lower lobe with large cavity formation of 3.5 × 4.4 × 2.8 cm in superior segment [Figures 2 and 3]. INTRODUCTION
A Aggarwal, S Srivastava, MP Agarwal, and S Dwivedi
African Journals Online (AJOL)
Laxmikant Ramkumarsingh Tomar, Amitesh Aggarwal, Piyush Jain, Surender Rajpal, and Mukul P Agarwal
SAGE Publications
The association of acute hepatitis E viral (HEV) infection with glucose-6-phosphate dehydrogenase (G6PD) deficiency leading to extensive intravascular haemolysis is a very rare clinical entity. Here we discuss such a patient, who presented with acute HEV illness, developed severe intravascular haemolysis and unusually high levels of bilirubin, complicated by acute renal failure (ARF), and was later on found to have a deficiency of G6PD. The patient recovered completely with haemodialysis and supportive management.
Laxmikant Ramkumarsingh Tomar, Ranjith Rajendran, Santosh Kumar Pandey, and Amitesh Aggarwal
SAGE Publications
Splenic abscess is a rare clinical entity as described in literature. The incidence is in the range of 0.14–0.7% and it has a high mortality rate. Hence, it is important to know its clinical presentation and complications, so that it can be treated early. We report a 40-year-old diabetic man who presented with fever with chills and rigor for the last 9 days and heaviness in the left hypochondrium for the last 6 days. He was initially diagnosed as having splenomegaly due to Plasmodium vivax ( P. vivax), but was later found to have a splenic abscess due to Escherichia coli ( E. coli). This was successfully managed by catheter drainage (CD) and antibiotic treatment.
Renu Gupta, Rajeev Thakur, Prerna Gupta, Nupur Jalan, Suman Kushwaha, Meena Gupta, Piyush Gupta, Amitesh Aggarwal, and Vikas Manchanda
Medknow
Background: Molecular methods which allow for rapid and reliable detection of drug resistance have yet not been sufficiently evaluated for timely management of patients with tuberculous meningitis. Aims: We aimed to evaluate Geno Type MTBDRplus line probe assay for early detection of drug resistance in Mycobacterium tuberculosis isolates and CSF samples of confirmed tuberculous meningitis patients. Settings and Design: This was a multicentric prospective study carried out from July 2011 to December 2013 in tertiary care hospitals of Delhi. Materials and Methods: The assay was performed on 89 M. tuberculosis isolates and 31 direct CSF samples from microbiologically confirmed tuberculous meningitis patients. The sensitivity and specificity of this assay was calculated in comparison to drug susceptibility testing by BACTEC MGIT 960 system. Results: The sensitivity, specificity for detection of resistance to Isoniazid was 93%, 97% and to Rifampicin was 80%, 98.8%, respectively by this assay in comparison with the phenotypic drug susceptibility testing. The line probe assay could detect M. tuberculosis in 55% of CSF samples from patients with microbiologically confirmed tuberculous meningitis. Only 5/89 isolates (5.6%) were resistant to both Isoniazid and Rifampicin while 9/89 (10%) isolates were additionally resistant to Isoniazid. Resistance to any of the drugs, namely Isoniazid, Rifampicin, Streptomycin or Ethambutol, was seen in 24.7% of strains. Conclusion: The line probe assay has a good sensitivity and specificity for detection of drug resistance to Isoniazid and Rifampicin in M. tuberculosis culture isolates. However, this assay has limited role in detection of M. tuberculosis and drug resistance from direct samples with confirmed diagnosis of tuberculous meningitis.
A. Aggarwal, A. Raoot, S. Srivastava, and S. Dwivedi
Hindawi Limited
References 1 Chirumbolo S. Bias and adverse effects of homeopathy: is scientific criticism in homeopathy a “mission impossible”? Int J Clin Pract 2013; 67: 923–6. 2 Magnani P, Conforti A, Zanolin E, Marzotto M, Bellavite P. Dose-effect study of Gelsemium sempervirens in high dilutions on anxiety-related responses in mice. Psychopharmacology 2010; 210: 533–45. 3 Bellavite P, Magnani P, Zanolin E, Conforti A. Homeopathic doses of Gelsemium sempervirens improve the behavior of mice in response to novel environments. Evid Based Complement Alternat Med 2011; 2011: 1–10. 4 Chirumbolo S. Gelsemine and Gelsemium sempervirens L. extracts in animal behavioral test: comments and related biases. Front Neurol 2011; 2: 31. 5 Chirumbolo S. Plant-derived extracts in the neuroscience of anxiety on animal models: biases and comments. Int J Neurosci 2012; 122: 177–88. 6 Chirumbolo S. Homeopathy: bias, mis-interpretation and other. J Med Pers 2013; 11: 37–44. 7 Bellavite P, Magnani P, Conforti A, Marzotto M, Zanolin ME. Effects of high-dilutions in behavioural models: a commentary on critical issues, from reproducibility to plausibility. Int J High Dil Res 2011; 10: 325–37. 8 Bellavite P. Gelsemium sempervirens and animal behavioral models. Front Neurol 2011; 2: 56. 9 Bellavite P, Conforti A, Marzotto M et al. Testing homeopathy in mouse emotional response models: pooled data analysis of two series of studies. Evid Based Complement Alternat Med 2012; 2012: 954374. 10 Bellavite P. Homeopathic bias and misinterpretations. J Med Pers 2013; 11: 45–6. 11 Cervo L, Torri V. Comment on: “Dose-effect study of Gelsemium sempervirens in high dilutions on anxiety-related responses in mice” (Magnani P, Conforti A, Zanolin E, Marzotto M and Bellavite P, Psychopharmacology, 2010). Psychopharmacology 2012; 220: 439–40. 12 Bellavite P, Magnani P, Conforti A, Marzotto M, Zanolin M. Response to a comment by Luigi Cervo and Valter Torri on: “Dose-effect study of Gelsemium sempervirens in high dilutions on anxiety-related responses in mice” (Magnani P. et al., Psychopharmacology, 2010). Psychopharmacology 2012; 220: 441–2. 13 Endrizzi C, Rossi E, Crudeli L, Garibaldi D. Harm in homeopathy: aggravations, adverse drug events or medication errors? Homeopathy 2005; 94: 233–40. 14 Davidson JR, Crawford C, Ives JA, Jonas WB. Homeopathic treatments in psychiatry: a systematic review of randomized placebo-controlled studies. J Clin Psychiatry 2011; 72: 795–805. 15 Marzotto M, Conforti A, Magnani P, Zanolin ME, Bellavite P. Effects of Ignatia amara in mouse behavioural models. Homeopathy 2012; 101: 57–67. 16 Venard C, Boujedaini N, Mensah-Nyagan AG, Patte-Mensah C. Comparative analysis of gelsemine and Gelsemium sempervirens activity on neurosteroid allopregnanolone formation in the spinal cord and limbic system. Evid Based Complement Alternat Med 2011; 2011: 407617. 17 Gahlot K, Abid M, Sharma A. Pharmacological evaluation of Gelsemium sempervirens roots for CNS depressant activity. Int J Pharm Tech Res 2012; 3: 693–7. 18 Liu M, Huang HH, Yang J et al. The active alkaloids of Gelsemium elegans Benth. are potent anxiolytics. Psychopharmacology 2013; 225: 839–51. 19 Griebel G, Belzung C, Misslin R, Vogel E. The free exploratory paradigm: an effective method for measuring neophobic behaviour in mice and testing potential neophobia reducing drugs. Behav Pharmacol 1993; 4: 637–44. 20 Hascoet M, Bourin M, Dhonnchadha BA. The mouse light-dark paradigm: a review. Prog Neuropsychopharmacol Biol Psychiatry 2001; 25: 141–66. 21 Prut L, Belzung C. The open field as a paradigm to measure the effects of drugs on anxiety-like behaviors: a review. Eur J Pharmacol 2003; 463: 3–33. 22 Bourin M, Petit-Demouliere B, Dhonnchadha BN, Hascoet M. Animal models of anxiety in mice. Fundam Clin Pharmacol 2007; 21: 567–74. 23 Bellavite P, Magnani P, Marzotto M, Cristofoletti M, Zanolin ME, Conforti A. Mice behavioural models with pooled data analysis of Gelsemium studies and new findings about Ignatia and Aconitum. Int J High Dil Res 2011; 10: 198–200. 24 Dutt V, Dhar VJ, Sharma A. Antianxiety activity of Gelsemium sempervirens. Pharm Biol 2010; 48: 1091–6. 25 Meyer L, Boujedaini N, Patte-Mensah C, Mensah-Nyagan AG. Pharmacological effect of gelsemine on anxiety-like behavior in rat. Behav Brain Res 2013; 253: 90–4. 26 Calabrese EJ, Jonas WB. Homeopathy: clarifying its relationship to hormesis. Hum Exp Toxicol 2010; 29: 531–6. 27 Bell IR, Schwartz GE. Adaptive network nanomedicine: an integrated model for homeopathic medicine. Front Biosci (Schol Ed) 2013; 5: 685–708. 28 Bell IR, Koithan M. A model for homeopathic remedy effects: low dose nanoparticles, allostatic cross-adaptation, and time-dependent sensitization in a complex adaptive system. BMC Complement Altern Med 2012; 12: 191. 29 Betti L, Trebbi G, Olioso D, Marzotto M, Bellavite P. Basic research in homeopathy and ultra-high dilutions: what progress is being made? Homeopathy 2013; 102: 151–4. 30 Bellavite P, Marzotto M, Olioso D, Moratti E, Conforti A. High-dilution effects revisited. 1. Physicochemical aspects. Homeopathy 2014; 103: (in press) doi: 10.1016/j.homp.2013.08.003. 31 Bellavite P, Marzotto M, Olioso D, Moratti E, Conforti A. High-dilution effects revisited. 2. Pharmacodynamic aspects. Homeopathy 2014; 103: (in press) doi: 10.1016/j.homp.2013.08.002. 32 Bellavite P, Ortolani R, Pontarollo F, Pitari G, Conforti A. Immunology and homeopathy. 5. The rationale of the ‘Simile’. Evid Based Complement Alternat Med 2007; 4: 149–63. 33 Bellavite P, Magnani P, Marzotto M, Conforti A. Assays of homeopathic remedies in rodent behavioural and psychopathological models. Homeopathy 2009; 98: 208–27. 34 Bellavite P. On the plausibility of the homeopathic “similitudine”. Bioethics 2012; 26: 506–7. 35 Bellavite P, Marzotto M, Olioso D et al. Cellular and transcriptional responses of SH-SY5Y human neurocytes following in vitro exposure to Gelsemium sempervirens. Int J High Dilution Res 2012; 11: 144–6.
Kumari Asha, Suman B. Sharma, Archana Singal, and Amitesh Aggarwal
Charles University in Prague, Karolinum Press
Psoriasis patients are often susceptible to cardiovascular diseases (CVD), including atherosclerosis. Traditional markers (biochemical and inflammatory) and diagnostic tools could detect occlusive but not subclinical atherosclerosis. Carotid intima-media thickness (CIMT), has recently been recognised as a non invasive diagnostic tool for identification of premature atherosclerosis. Therefore we evaluated 80 psoriasis patients and 80 age sex matched healthy controls for serum leptin levels and apolipoprotein B/apolipoprotein A-I ratio (apoB/apoA-I ratio) in relation with CIMT of carotid artery. Carotid intima-media thickness and carotid plaques were simultaneously measured by carotid sonography. Serum concentration of leptin and apolipoprotein were measured using enzyme-linked immuno sorbent assay (ELISA) and nephelometry respectively. Raised CIMT correlated to age of onset of the disease, serum leptin and apoB/apoA-I ratio in psoriasis patients. Taking into account, values that were above the 75 percentile of the three markers (leptin, apoB/apoA-I ratio and CIMT) the odds ratio was 4.26 (2.06–8.80 CI). Leptin and apoB/apoA-I ratio showed significant cumulative association with CIMT. Results of predictive analysis supports measurement of CIMT along with estimation of serum leptin and apoB/apoA-I ratio for prediction of premature atherosclerosis in psoriasis patients.