Medicine

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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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Author: search.filters.author.Gupta, S.

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    APASL clinical practice guidelines on the management of acute kidney injury in acute-on-chronic liver failure.
    (Springer, 2024) Maiwall, R.; Singh, S.P.; Angeli, P.; Moreau, R.; Krag, A.; Singh, V.; Singal, A.K.; Tan, S.S.; Puri, P.; Mahtab, M.; Lau, G.; Ning, Q.; Sharma, M.K.; Rao, P.N.; Kapoor, D.; Gupta, S.; Duseja, A.; Wadhawan, M.; Jothimani, D.; Saigal, S.; Taneja, S.; Shukla, A.; Govil, D.; Pandey, G.; Madan, K.; Eapen, C.E.; Benjamin, J.; Chowdhury, A.; Salao, V.; Yang, J.M.; Hamid, S.; Shalimar; Jasuja, S.; Kulkarni, A.V.; Niriella, M.A.; Tevethia, H.V.; Arora, V.; Mathur, R.P.; Roy, A.; Jindal, A.; Saraf, N.; Verma, N.; Arka, D.; Choudhary, N.S.; Mehtani, R.; Chand, P.; Rudra, O.; Sarin, S.K.; Puri, P.; Singh, S.
    Acute-on-chronic liver failure (ACLF) is a syndrome that is characterized by the rapid development of organ failures predisposing these patients to a high risk of short-term early death. The main causes of organ failure in these patients are bacterial infections and systemic inflammation, both of which can be severe. For the majority of these patients, a prompt liver transplant is still the only effective course of treatment. Kidneys are one of the most frequent extrahepatic organs that are affected in patients with ACLF, since acute kidney injury (AKI) is reported in 22.8-34% of patients with ACLF. Approach and management of kidney injury could improve overall outcomes in these patients. Importantly, patients with ACLF more frequently have stage 3 AKI with a low rate of response to the current treatment modalities. The objective of the present position paper is to critically review and analyze the published data on AKI in ACLF, evolve a consensus, and provide recommendations for early diagnosis, pathophysiology, prevention, and management of AKI in patients with ACLF. In the absence of direct evidence, we propose expert opinions for guidance in managing AKI in this very challenging group of patients and focus on areas of future research. This consensus will be of major importance to all hepatologists, liver transplant surgeons, and intensivists across the globe.
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    Electroconvulsive therapy in South Asia: Past, present, and future
    (Elsevier, 2024) Menon, V.; Kar, S.K.; Gupta, S.; Baminiwatta, A.; Mustafa, A.B.; Sharma, P.; Abhijita, B.; Arafat, S.M.Y.
    The practice of electroconvulsive therapy (ECT) varies both between and within countries. We aimed to review historical and current trends in ECT practices, perceptions, and legislations in South Asia, a region with a high burden of mental illness and suicide. We searched MEDLINE (PubMed) and Google Scholar databases for relevant literature on ECT from each country. Additionally, a team of country-specific investigators performed supplemental searches and contacted key country contacts for relevant information. Relevant data were abstracted under the following headings: ECT practices, perceptions, and legislations. Knowledge gaps and research priorities were synthesized. Modified bitemporal ECT, delivered using brief pulse devices, was most commonly offered across institutions. Schizophrenia, not affective illness, was the most common indication. Electroencephalographic monitoring of seizures was rarely practiced. Thiopentone or propofol was preferred for anesthetic induction, while the favored muscle relaxant was succinylcholine. In India and Sri Lanka, perceptions about ECT were largely favorable; not so in Pakistan and Nepal. Only India and Pakistan had laws that governed any aspect of ECT practice; ECT practice guidelines were available only in India. There is a lack of research on efficacy, ECT in special populations, continuation ECT practices, and interventions to improve ECT-related perceptions. Most regional institutions offered modified brief-pulse ECT, and schizophrenia was the most common indication. Knowledge of and attitude towards ECT varied between countries. There is a need to develop a regional ECT consortium to facilitate uniform training, advocacy efforts, and the development of regional practice guidelines.
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    Correction to: Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update
    (Springer, 2019) Sarin, S.K.; Choudhury, A.; Sharma, M.K.; Maiwall, R.; Al Mahtab, M.; Rahman, S.; Saigal, S.; Saraf, N.; Soin, A.S.; Devarbhavi, H.; Kim, D.J.; Dhiman, R.K.; Duseja, A.; Taneja, S.; Eapen, C.E.; Goel, A.; Ning, Q.; Chen, T.; Ma, K.; Duan, Z.; Yu, C.; Treeprasertsuk, S.; Hamid, S.S.; Butt, A.S.; Jafri, W.; Shukla, A.; Saraswat, V.; Tan, S.S.; Sood, A.; Midha, V.; Goyal, O.; Ghazinyan, H.; Arora, A.; Hu, J.; Sahu, M.; Rao, P.N.; Lee, G.H.; Lim, S.G.; Lesmana, L.A.; Lesmana, C.R.; Shah, S.; Prasad, V.G.M.; Payawal, D.A.; Abbas, Z.; Dokmeci, A.K.; Sollano, J.D.; Carpio, G.; Shresta, A.; Lau, G.K.; Karim, M.F.; Shiha, G.; Gani, R.; Kalista, K.F.; Yuen, M.F.; Alam, S.; Khanna, R.; Sood, V.; Lal, B.B.; Pamecha, V.; Jindal, A.; Rajan, V.; Arora, V.; Yokosuka, O.; Niriella, M.A.; Li, H.; Qi, X.; Tanaka, A.; Mochida, S.; Chaudhuri, D.R.; Gane, E.; Win, K.M.; Chen, W.T.; Rela, M.; Kapoor, D.; Rastogi, A.; Kale, P.; Rastogi, A.; Sharma, C.B.; Bajpai, M.; Singh, V.; Premkumar, M.; Maharashi, S.; Olithselvan, A.; Philips, C.A.; Srivastava, A.; Yachha, S.K.; Wani, Z.A.; Thapa, B.R.; Saraya, A.; Shalimar; Kumar, A.; Wadhawan, M.; Gupta, S.; Madan, K.; Sakhuja, P.; Vij, V.; Sharma, B.C.; Garg, H.; Garg, V.; Kalal, C.; Anand, L.; Vyas, T.; Mathur, R.P.; Kumar, G.; Jain, P.; Pasupuleti, S.S.R.; Chawla, Y.K.; Chowdhury, A.; Alam, S.; Song, D.S.; Yang, J.M.; Yoon, E.L.; APASL ACLF Research Consortium (AARC) for APASL ACLF working Party
    The article Acute-on-chronic liver failure: consensus recommendations of the Asian Pacifc association for the study of the liver (APASL): an update, written by [Shiv Sarin], was originally published electronically on the publisher’s internet portal (currently SpringerLink) on June 06, 2019 without open access. This corrects the article "Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update" in Hepatol Int, volume 13 on page 353. Hepatology International. 2019 ;13(4):353-390.
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    Acute-on-chronic liver failure:consensus recommendations of the Asian Pacific association for the study of the liver (APASL):an update.
    (Springer,, 2019) Sarin, S.K.; Choudhury, A.; Sharma, M.K.; Maiwall, R.; Al Mahtab, M.; Rahman, S.; Saigal, S.; Saraf, N.; Soin, A.S.; Devarbhavi, H.; Kim, D.J.; Dhiman, R.K.; Duseja, A.; Taneja, S.; Eapen, C.E.; Goel, A.; Ning, Q.; Chen, T.; Ma, K.; Duan, Z.; Yu, C.; Treeprasertsuk, S.; Hamid, S.S.; Butt, A.S.; Hamid, S.S.; Butt, A.S.; Jafri, W.; Shukla, A.; Saraswat, V.; Tan, S.S.; Sood, A.; Midha, V.; Goyal, O.; Ghazinyan, H.; Arora, A.; Hu, J.; Sahu, M.; Rao, P.N.; Lee, G.H.; Lim, S.G.; Lesmana, L.A.; Lesmana, C.R.; Shah, S.; Prasad, V.G.M.; Payawal, D.A.; Abbas, Z.; Dokmeci, A.K.; Sollano, J.D.; Carpio, G.; Shresta, A.; Lau, G.K.; Fazal Karim, M.; Shiha, G.; Gani, R.; Kalista, K.F.; Yuen, M.F.; Alam, S.; Khanna, R.; Sood, V.; Lal, B.B.; Pamecha, V.; Jindal, A.; Rajan, V.; Arora, V.; Yokosuka, O.; Niriella, M.A.; Li, H.; Qi, X.; Tanaka, A.; Mochida, S.; Chaudhuri, D.R.; Gane, E.; Win, K.M.; Chen, W.T.; Rela, M.; Kapoor, D.; Rastogi, A.; Kale, P.; Rastogi, A.; Sharma, C.B.; Bajpai, M.; Singh, V.; Premkumar, M.; Maharashi, S.; Olithselvan, A.; Philips, C.A.; Srivastava, A.; Yachha, S.K.; Wani, Z.A.; Thapa, B.R.; Saraya, A.; Shalimar; Kumar, A.; Wadhawan, M.; Gupta, S.; Madan, K.; Sakhuja, P.; Vij, V.; Sharma, B.C.; Garg, H.; Garg, V.; Kalal, C.; Anand, L.; Vyas, T.; Mathur, R.P.; Kumar, G.; Jain, P.; Pasupuleti, S.S.R.; Chawla, Y.K.; Chowdhury, A.; Alam, S.; Song, D.S.; Yang, J.M.; Yoon, E.L.; APASL ACLF Research Consortium (AARC) for APASL ACLF working Party
    The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the "APASL ACLF Research Consortium (AARC)" was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during the interim period were carefully analyzed and areas of contention and new developments in the field of ACLF were prioritized in a systematic manner. The AARC database was also approached for answering some of the issues where published data were limited, such as liver failure grading, its impact on the 'Golden Therapeutic Window', extrahepatic organ dysfunction and failure, development of sepsis, distinctive features of acute decompensation from ACLF and pediatric ACLF and the issues were analyzed. These initiatives concluded in a two-day meeting in October 2018 at New Delhi with finalization of the new AARC consensus. Only those statements, which were based on evidence using the Grade System and were unanimously recommended, were accepted. Finalized statements were again circulated to all the experts and subsequently presented at the AARC investigators meeting at the AASLD in November 2018. The suggestions from the experts were used to revise and finalize the consensus. After detailed deliberations and data analysis, the original definition of ACLF was found to withstand the test of time and be able to identify a homogenous group of patients presenting with liver failure. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information and areas requiring future studies are presented here.
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