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| 1 | Euglycemic diabetic ketoacidosis:A missed diagnosis显示文摘Euglycemic diabetic ketoacidosis(DKA)is an acute life-threatening metabolic emergency characterized by ketoacidosis and relatively lower blood glucose(less than 11 mmol/L).The absence of hyperglycemia is a conundrum for physicians in the emergency department and intensive care units;it may delay diagnosis and treatment causing worse outcomes.Euglycemic DKA is an uncommon diagnosis but can occur in patients with type 1 or type 2 diabetes mellitus.With the addition of sodium/glucose cotransporter-2 inhibitors in diabetes mellitus management,euglycemic DKA incidence has increased.The other causes of euglycemic DKA include pregnancy,fasting,bariatric surgery,gastroparesis,insulin pump failure,cocaine intoxication,chronic liver disease and glycogen storage disease.The pathophysiology of euglycemic DKA involves a relative or absolute carbohydrate deficit,milder degree of insulin deficiency or resistance and increased glucagon/insulin ratio.Euglycemic DKA is a diagnosis of exclusion and should be considered in the differential diagnosis of a sick patient with a history of diabetes mellitus despite lower blood glucose or absent urine ketones.The diagnostic workup includes arterial blood gas for metabolic acidosis,serum ketones and exclusion of other causes of high anion gap metabolic acidosis.Euglycemic DKA treatment is on the same principles as for DKA with correction of dehydration,electrolytes deficit and insulin replacement.The dextrosecontaining fluids should accompany intravenous insulin to correct metabolic acidosis,ketonemia and to avoid hypoglycemia. | Prashant Nasa Sandeep Chaudhary Pavan Kumar Shrivastava Aanchal Singh | 2021 | World Journal of Diabetes2021，12，5： | 11 |
| 2 | Anti-diabetic vanadyl complexes reduced Alzheimer's disease pathology independent of amyloid plaque deposition显示文摘Association of Alzheimer's disease(AD) with cerebral glucose hypometabolism, likely due to impairments of insulin signaling,has been reported recently, with encouraging results when additional insulin is provided to AD patients. Here, we tested the potential effects of the anti-diabetic vanadium, vanadyl(IV) acetylacetonate(VAC), on AD in vitro and in vivo models. The experimental results showed that VAC at sub-micromolar concentrations improved the viability of neural cells with or without increased β-amyloid(Aβ) burden; and in APP/PS1 transgenic mice, VAC treatment(0.1 mmol kg-1 d-1) preserved cognitive function and attenuated neuron loss, but did not reduce brain Aβ plaques. Further studies revealed that VAC attenuated Aβpathogenesis by(i) activation of the PPARγ-AMPK signal transduction pathway, leading to improved glucose and energy metabolism;(ii) up-regulation of the expression of glucose-regulated protein 75(Grp75), thus suppressing p53-mediated neuronal apoptosis under Aβ-related stresses; and(iii) decreasing toxic soluble Aβ peptides. Overall, our work suggested that vanadyl complexes may have great potential for effective therapeutic treatment of AD. | Yaqiong Dong TessANDra Stewart Yue Zhang Min Shi Chang Tan Xue Li Lan Yuan Aanchal Mehrotra Jing Zhang Xiaoda Yang | 2019 | Science China(Life Sciences)2019，62，1： | 8 |
| 3 | Therapeutic plasma exchange in liver failure显示文摘The multi-organ failure syndrome associated with acute and acute-on-chronic liver failure(ACLF)is thought to be mediated by overwhelming systemic inflammation triggered by both microbial and non-microbial factors.Therapeutic plasma exchange(TPE)has been proven to be an efficacious therapy in autoimmune conditions and altered immunity,with more recent data supporting its use in the management of liver failure.Few therapies have been shown to improve survival in critically ill patients with liver failure who are not expected to survive until liver transplantation(LT),who are ineligible for LT or who have no access to LT.TPE has been shown to reduce the levels of inflammatory cytokines,modulate adaptive immunity with the potential to lessen the susceptibility to infections,and reduce the levels of albumin-bound and water-bound toxins in liver failure.In patients with acute liver failure,high volume TPE has been shown to reduce the vasopressor requirement and improve survival,particularly in patients not eligible for LT.Standard volume TPE has also been shown to reduce mortality in certain sub-populations of patients with ACLF.TPE may be most favorably employed as a bridge to LT in patients with ACLF.In this review,we discuss the efficacy and technical considerations of TPE in both acute and acute-on-chronic liver failure. | Abimbola Chris-Olaiya Aanchal Kapoor Kristin S Ricci Christina C Lindenmeyer | 2021 | World Journal of Hepatology2021，13，8： | 2 |
| 4 | ED50 of Hyperbaric Bupivacaine With Fentanyl for Cesarean Delivery Under Combined Spinal Epidural in Normotensive and Preeclamptic Patients显示文摘 | Asha Tyagi Aanchal Kakkar Surendra Kumar Ashok K. Sethi Rashmi Salhotra | 2012 | Regional Anesthesia and Pain Medicine2012，，1： | 1 |
| 5 | Mitomycin C in- duces bystander killing in homogeneous and heterogeneous hepatoma cellular models 显示文摘 | Ratna K Aanchal S Amrendra K | 2009 | Mol Cancer2009，8，： | 1 |
| 6 | SWI/SNF chromatin remodeling enzymes are associated with cardiac hypertrophy in a genetic rat model of hypertension显示文摘 | Aanchal Mehrotra Bina Joe Ivana L. de la Serna | 2013 | J Cell Physiol2013，，12： | 1 |
| 7 | Evaluation of a protocol for rifaximin discontinuation in critically ill patients with liver disease receiving broad-spectrum antibiotic therapy显示文摘BACKGROUND Rifaximin is frequently administered to critically ill patients with liver disease and hepatic encephalopathy,but patients currently or recently treated with antibiotics were frequently excluded from studies of rifaximin efficacy.Due to overlapping spectrums of activity,combination therapy with broad-spectrum antibiotics and rifaximin may be unnecessary.A pharmacist-driven protocol was piloted to reduce potentially overlapping therapy in critically ill patients with liver disease.It was hypothesized that withholding rifaximin during broad-spectrum antibiotic therapy would be safe and reduce healthcare costs.AIM To determine the clinical,safety,and financial impact of discontinuing rifaximin during broad-spectrum antibiotic therapy in critically ill liver patients.METHODS This was a single-center,quasi-experimental,pre-post study based on a pilot pharmacist-driven protocol.Patients in the protocol group were prospectively identified via the medical intensive care unit(ICU)(MICU)protocol to have rifaximin withheld during broad-spectrum antibiotic treatment.These were compared to a historical cohort who received combination therapy with broadspectrum antibiotics and rifaximin.All data were collected retrospectively.The primary outcome was days alive and free of delirium and coma(DAFD)to 14 d.Safety outcomes included MICU length of stay,48-h change in vasopressor dose,and ICU mortality.Secondary outcomes characterized rifaximin cost savings and protocol adherence.Multivariable analysis was utilized to evaluate the association between group assignment and the primary outcome while controlling for potential confounding factors.RESULTS Each group included 32 patients.The median number of delirium-and coma-free days was similar in the control and protocol groups[3 interquartile range(IQR 0,8)vs 2(IQR 0,9.5),P=0.93].In multivariable analysis,group assignment was not associated with a reduced ratio of days alive and free of delirium or coma at 14 d.The protocol resulted in a reduced median duration of rifaximin use during broad-spectrum antibiotic therapy[6 d control(IQR 3,9.5)vs 1 d protocol(IQR 0,1);P<0.001].Rates of other secondary clinical and safety outcomes were similar including ICU mortality and 48-h change in vasopressor requirements.Overall adherence to the protocol was 91.4%.The median estimated total cost of rifaximin therapy per patient was reduced from$758.40(IQR$379.20,$1200.80)to$126.40(IQR$0,$126.40),P<0.01.CONCLUSION The novel pharmacist-driven protocol for rifaximin discontinuation was associated with significant cost savings and no differences in safety outcomes including DAFD. | Jessica A Ward Jason Yerke Mollie Lumpkin Aanchal Kapoor Christina C Lindenmeyer Stephanie Bass | 2023 | World Journal of Hepatology2023，15，11： | 0 |
| 8 | Correlations of Handgrip Strength with Selected Anthropometric Variables and Flexibility Measure in Indian Inter-university Handball Players显示文摘 | Shyamal Koley Aanchal | 2016 | Journal of Sports Science2016，4，2： | 0 |
| 9 | LIV-4:A novel model for predicting transplant-free survival in critically ill cirrhotics显示文摘BACKGROUND Critically ill patients with cirrhosis,particularly those with acute decompensation,have higher mortality rates in the intensive care unit(ICU)than patients without chronic liver disease.Prognostication of short-term mortality is important in order to identify patients at highest risk of death.None of the currently available prognostic models have been widely accepted for use in cirrhotic patients in the ICU,perhaps due to complexity of calculation,or lack of universal variables readily available for these patients.We believe a survival model meeting these requirements can be developed,to guide therapeutic decision-making and contribute to cost-effective healthcare resource utilization.AIM To identify markers that best identify likelihood of survival and to determine the performance of existing survival models.METHODS Consecutive cirrhotic patients admitted to a United States quaternary care center ICU between 2008-2014 were included and comprised the training cohort.Demographic data and clinical laboratory test collected on admission to ICU were analyzed.Area under the curve receiver operator characteristics(AUROC)analysis was performed to assess the value of various scores in predicting inhospital mortality.A new predictive model,the LIV-4 score,was developed using logistic regression analysis and validated in a cohort of patients admitted to the same institution between 2015-2017.RESULTS Of 436 patients,119(27.3%)died in the hospital.In multivariate analysis,a combination of the natural logarithm of the bilirubin,prothrombin time,white blood cell count,and mean arterial pressure was found to most accurately predict in-hospital mortality.Derived from the regression coefficients of the independent variables,a novel model to predict inpatient mortality was developed(the LIV-4 score)and performed with an AUROC of 0.86,compared to the Model for End-Stage Liver Disease,Chronic Liver Failure-Sequential Organ Failure Assessment,and Royal Free Hospital Score,which performed with AUROCs of 0.81,0.80,and 0.77,respectively.Patients in the internal validation cohort were substantially sicker,as evidenced by higher Model for End-Stage Liver Disease,Model for End-Stage Liver Disease-Sodium,Acute Physiology and Chronic Health Evaluation III,SOFA and LIV-4 scores.Despite these differences,the LIV-4 score remained significantly higher in subjects who expired during the hospital stay and exhibited good prognostic values in the validation cohort with an AUROC of 0.80.CONCLUSION LIV-4,a validated model for predicting mortality in cirrhotic patients on admission to the ICU,performs better than alternative liver and ICU-specific survival scores. | Christina C Lindenmeyer Gianina Flocco Vedha Sanghi Rocio Lopez Ahyoung J Kim Fadi Niyazi Neal A Mehta Aanchal Kapoor William D Carey Eduardo Mireles-Cabodevila Carlos Romero-Marrero | 2020 | World Journal of Hepatology2020，12，6： | 0 |
| 10 | Comparison of fungal vs bacterial infections in the medical intensive liver unit:Cause or corollary for high mortality?显示文摘BACKGROUND Due to development of an immune-dysregulated phenotype,advanced liver disease in all forms predisposes patients to sepsis acquisition,including by opportunistic pathogens such as fungi.Little data exists on fungal infection within a medical intensive liver unit(MILU),particularly in relation to acute on chronic liver failure.AIM To investigate the impact of fungal infections among critically ill patients with advanced liver disease,and compare outcomes to those of patients with bacterial infections.METHODS From our prospective registry of MILU patients from 2018-2022,we included 27 patients with culture-positive fungal infections and 183 with bacterial infections.We compared outcomes between patients admitted to the MILU with fungal infections to bacterial counterparts.Data was extracted through chart review.RESULTS All fungal infections were due to Candida species,and were most frequently blood isolates.Mortality among patients with fungal infections was significantly worse relative to the bacterial cohort(93%vs 52%,P<0.001).The majority of the fungal cohort developed grade 2 or 3 acute on chronic liver failure(ACLF)(90%vs 64%,P=0.02).Patients in the fungal cohort had increased use of vasopressors(96%vs 70%,P=0.04),mechanical ventilation(96%vs 65%,P<0.001),and dialysis due to acute kidney injury(78%vs 52%,P=0.014).On MILU admission,the fungal cohort had significantly higher Acute Physiology and Chronic Health Evaluation(108 vs 91,P=0.003),Acute Physiology Score(86 vs 65,P=0.003),and Model for End-Stage Liver Disease-Sodium scores(86 vs 65,P=0.041).There was no significant difference in the rate of central line use preceding culture(52%vs 40%,P=0.2).Patients with fungal infection had higher rate of transplant hold placement,and lower rates of transplant;however,differences did not achieve statistical significance.CONCLUSION Mortality was worse among patients with fungal infections,likely attributable to severe ACLF development.Prospective studies examining empiric antifungals in severe ACLF and associations between fungal infections and transplant outcomes are critical. | Sarah Khan Hanna Hong Stephanie Bass Yifan Wang Xiao-Feng Wang Omar T Sims Christine E Koval Aanchal Kapoor Christina C Lindenmeyer | 2024 | World Journal of Hepatology2024，16，3： | 0 |
| 11 | Sex differences in SARS-CoV-2 infections,anti-viral immunity and vaccine responses显示文摘The COVID-19 pandemic has revealed sex-based differences in anti-viral responses,with a higher rate of SARS-CoV-2 infections as well as a higher rate of morbidity and mortality in men than in women.Males and females also show disparate immune responses to COVID-19 infection,which may be important contributors to lower rates of infection,disease severity and deaths in women than in men.Here,the authors review sex differences in SARS-CoV-2 infections,anti-viral immunity and vaccine responses,putting forth the importance of sex,the underappreciated variables in vaccine response and disease infectivity. | Abhishek Mohanty Aanchal Sawhney Shefali Gupta Vishal Rao Periyasamy Govindaraj Sambit Mohanty Vandana Jain | 2022 | Asian Pacific Journal of Tropical Medicine2022，15，3： | 0 |
| 12 | The Age of Camelot显示文摘Several historians confirm that John Fitzgerald Kennedy has been dead longer than he lived.Alan Brinkley says,“On the morning of 22 November,1963,he woke up as President with admirers and detractors,a man with a record-some of it good,some of it not.He became a legend posthumously”(John F.Kennedy Presidential Library and Museum,2012).A charismatic Kennedy unveiled an optimistic American dream that captivated the hearts of every American citizen.He used the TV to channel his sentiments about civil rights,communism,and made the United States strong to resist evil in the world.By speaking directly to the national audience,“he made the television more famous than it was”(Gillon,2019).His presidency is intertwined to the visionary ideal of Camelot(symbolizing idyllic happiness,high hopes,and humanitarianism)that makes his American promise an attractive calling and continues to entice Democrats to emulate his destiny. | Aanchal Bharti | 2023 | International Relations and Diplomacy2023，11，6： | 0 |
| 13 | Lessons for intensive care units in COVID-19 pandemic-moving towards sustainability显示文摘The Coronavirus disease-2019(COVID-19)pandemic has inundated critical care services globally.The intensive care units(ICUs)and critical care providers have been forefront of this pandemic,evolving continuously from experiences and emerging evidence.In this review,we discuss the key lessons from the ongoing wave of COVID-19 pandemic and preparations for a future surge or second wave.The model of sustainable critical care services should be based on 1)infrastructure development,2)preparation and training of manpower,3)implementing standard of care and infection control,4)sustained supply-chain and finally,and 5)surge planning. | Prashant Nasa Ruchi Nasa Aanchal Singh | 2020 | Discussion of Clinical Cases2020，7，3： | 0 |
| 14 | Clinical profile of mechanically ventilated COVID-19 patients:A retrospective observational study from Dubai显示文摘Background:We did a retrospective analysis of critical coronavirus disease 2019(COVID-19)patients admitted to our intensive care unit(ICU).The objective was to evaluate the outcome,risk factors and effect of prone position in critically ill patients requiring invasive mechanical ventilation(IMV).Patients and methods:The data were collected regarding demographics,comorbidities,laboratory parameters and treatment.Logistic regression was used for analysis of the association of risk factors to the outcome.Results:From 15 March to 30 May 2020,35(59.3%)out of 59 critical COVID-19 requiring IMV were admitted to a tertiary care hospital in Dubai.The day-28 ICU mortality was 28.8% and 48.6% in patients requiring IMV.Prone position(PP)was used in 17(48.6%)patients for median duration of 19(5-20)hours with significant PaO_(2)/FiO_(2) improvement.Acute kidney injury was common(30.5%),and half of the patients required renal replacement therapy(RRT)with higher mortality(77.8%).Lactate dehydrogenase(LDH)odd ratio(OR)-1.006[95%CI-1.00-1.01],D-dimer(OR-1.003[1.000-1.000]),low total leucocyte count(OR-1.135[1.01-1.28]),and lymphopenia(OR-0.909[0.84-0.98])were independently associated with increased risk of IMV.Conclusions:IMV requirement in patients with COVID-19 is associated with higher mortality.Inflammatory markers like LDH,D-dimer,and lymphopenia can be used to predict the prognosis.The patients with COVID-19 on IMV respond significantly with prone position,and it should be considered early with a longer duration. | Prashant Nasa Aanchal Singh Habib Talal Syed Saroj Patidar Vishal Sapakale Kandy Koul Rajesh Kumar | 2021 | Discussion of Clinical Cases2021，8，1： | 0 |
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