Manish Modi

Biomedical Informatics Centre, Chandigarh, Chandigarh, India

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Publications (67)122.11 Total impact

  • 23rd Annual Conference of Indian Academy of Neurology, Agra, India; 10/2015
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    The Journal of the Association of Physicians of India 09/2015; 63.
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    ABSTRACT: Objective Being a common cause of epilepsy in endemic areas, neurocysticercosis (NCC) is expected to account for a sizable proportion of patients with drug-refractory epilepsy (DRE) as well. However, data regarding prevalence of DRE in NCC are sparse. This study aimed to determine the prevalence of DRE as well as identification of clinical and radiologic factors that lead to DRE in patients with NCC.Methods This study was conducted in a tertiary-care postgraduate teaching institute in Northern India from July 2011 to July 2013. Two hundred patients with epilepsy due to NCC (definite [n = 59, 29.5%] or probable [n = 141, 70.5%]) based on diagnostic criteria by Del Brutto et al. were enrolled in the study in both a prospective (n = 51 [25.5%]) and a retrospective manner (n = 149 [74.5%]), and were followed for a minimum period of 1 year.ResultsThirteen patients with NCC were found to be refractory to drug therapy. Prevalence of DRE was found to be 65 of 1,000 NCC patients with epilepsy in the present study. The risk factors associated with high risk of DRE were male sex (p = 0.035), older age (p = 0.016), pig-raising practices (p = 0.003), pork eating (p = 0.04), and presence of multiple (>2) (p = 0.0001) or mixed stage lesions (p = 0.007) on neuroimaging. On multivariate analysis, it was found that residing in an area where pig raising is prevalent (p = 0.01) and presence of multiple (>2) (p = 0.004) lesions on neuroimaging are associated with increased risk of DRE.SignificanceNCC is only rarely associated with the development of DRE. The common risk factors associated with increased chance of DRE include pig-rearing practices and presence of multiple (>2) lesions on neuroimaging.
    Epilepsia 09/2015; DOI:10.1111/epi.13130 · 4.57 Impact Factor
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    ABSTRACT: Timely and rapid diagnosis of multidrug resistance in tuberculous meningitis (TBM) is a challenge both for a microbiologist and neurologist. The present study was conducted to evaluate role of real-time polymerase chain reaction (PCR) using rpoB, IS6110, and MPB64 as targets in diagnosis of TBM in 110 patients and subsequent high-resolution melt (HRM) curve analysis of rpoB gene amplicons for screening of drug resistance. The sensitivity of smear, culture, and real-time PCR was 1.8%, 10.9%, and 83.63%, respectively. All 120 control patients showed negative results. With HRM rpoB analysis, rifampicin resistance was detected in 3 out of 110 cases of TBM (3.33%). Subsequently, results of HRM analysis were confirmed by rpoB gene sequencing, and mutations were observed at 516 (2 patients) and 531 (1 patient) codons, respectively. rpoB HRM analysis can be a promising tool for rapid diagnosis and screening of drug resistance in TBM patients in 90minutes. Copyright © 2015. Published by Elsevier Inc.
    Diagnostic microbiology and infectious disease 06/2015; 83(2). DOI:10.1016/j.diagmicrobio.2015.06.010 · 2.46 Impact Factor
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    ABSTRACT: The purpose of this study was to compare safety and efficacy of intravenous (IV) levetiracetam (LEV) with IV phenytoin (PHT) in management of status epilepticus (SE). The second-line treatment of SE is limited to a few drugs available in an IV formulation such as PHT, fosphenytoin and valproate. The relative lack of serious side effects and favourable pharmacokinetics of LEV made it a promising option in management of SE. Randomized trials comparing relative efficacy of second-line agents are remarkably lacking. In this study, consecutive patients of SE (n=44) were randomized to receive either IV PHT (20mg/kg) or IV LEV (20mg/kg). The primary end point was successful clinical termination of seizure activity within 30min after the beginning of the drug infusion. Secondary end points included recurrence of seizures within 24hours, drug related adverse effects, neurological outcome at discharge, need for ventilatory assistance, and mortality during hospitalization. Both LEV and PHT were equally effective with regard to primary and secondary outcome measures. PHT achieved control of SE in 15 (68.2%) patients compared to LEV in 13 (59.1%; p=0.53). Both the groups showed comparable results with respect to recurrence of seizures within 24hours (p=0.34), outcome at discharge as assessed by functional independence measure (p=0.68), need of ventilatory assistance (p=0.47) and death (p=1). From this study it can be concluded that LEV may be an attractive and effective alternative to PHT in management of SE. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Clinical Neuroscience 04/2015; 22(6). DOI:10.1016/j.jocn.2014.12.013 · 1.38 Impact Factor
  • AAN 2015, Neurology April 6, 2015 vol. 84 no. 14 Supplement P5.027; 04/2015
  • Anu Gupta · Manoj Kumar Goyal · Manish Modi · Vivek Lal
    Journal of the neurological sciences 03/2015; 352(1-2). DOI:10.1016/j.jns.2015.03.028 · 2.47 Impact Factor
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    Anu Gupta · Manoj Kumar Goyal · Manish Modi · Vivek Lal
    Journal of the Neurological Sciences 03/2015; DOI:10.1016/j.jns.2015.03.028. · 2.47 Impact Factor
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    ABSTRACT: To assess the clinical profile, laboratory and neuroimaging data of adult tuberculous meningitis (TBM) patients and to determine the predictors of mortality. A total of 55 TBM patients and 60 controls were enrolled in this prospective study. Detailed clinical, radiological, biochemical and microbiological evaluation was performed. Done using SPSS 15.0 for Windows. P value of <0.05 was considered to be significant. 61.8% were males and majority of the study subjects belonged to age group of 21-40 years. Duration of symptoms in all cases was >14 days and commonly included fever, headache, neck rigidity, altered sensorium and vomiting. Biochemical features of cerebrospinal fluid (CSF) showed significant results where 94.5%, 85.45%,83.63% and 81.81% of patients showed CSF sugar levels <2/3 corresponding blood sugar, proteins>100mg%, CSF total leucocyte count of >20 cells/mm(3) and ADA >9.5IU/L respectively while neuroimaging revealed hydrocephalus, basal exudates and meningeal enhancement as significant findings. More than half of TBM patients presented in stage II of disease and overall mortality was 43.63%. A model for prediction of mortality in TBM cases was framed which included variables of age>40 years, past history of tuberculosis (TB), presence of basal exudates and hydrocephalus. TBM is a serious extrapulmonary form of TB and should arise suspicion in mind of clinician based on clinical, laboratory and radiologic results. Further, a model for prediction of mortality in such patients may be helpful for early intervention and better prognosis.
    03/2015; 9(1):DC15-9. DOI:10.7860/JCDR/2015/11456.5454
  • Article: Snake eyes
    The spine journal: official journal of the North American Spine Society 02/2015; 15(6). DOI:10.1016/j.spinee.2015.02.020 · 2.43 Impact Factor
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    ABSTRACT: Prompt and accurate diagnosis of extra-pulmonary tuberculosis (TB) is highly challenging. Current conventional techniques lack sensitivity and are time-consuming. Here, we report our experience with multiplex polymerase chain reaction (MPCR) using two targets namely IS6110 and protein antigen b in the diagnosis of extra-pulmonary TB. A total of 150 patients of extra-pulmonary TB visiting tertiary care center in north India between September 2008 and December 2009 were included in the study. Sixty-six biopsy samples and 84 were body fluids from these patients were subjected for microscopy (Ziehl-Neelsen), culture on LJ medium and for Multiplex PCR using IS6110 and Protein b antigen. Smear positivity was noted in 11 samples (7.33%), and LJ culture yielded Mycobacterium tuberculosis in 8 biopsies and 9 body fluids with overall positivity of 11.3%. The multi-targeted PCR could detect M. tuberculosis in a total of 112 samples. Of 112 positive samples, only Protein b band was detected in 7 samples and only IS6110 was detected in 5 samples. Overall Protein b, PCR could detect 71.33% of the cases, whereas IS6110 was positive in 66.6% of the cases. Overall the sensitivities of microscopy, culture, IS6110 PCR, Protein b PCR and MPCR were 7.33%, 11.3%, 66.67%, 71.3% and 74.6%, respectively. Thus by using more than two targets the sensitivity increased from 66.67% of IS6110 to 74.6% in MPCR. Multiplex polymerase chain reaction using IS6110 and Protein b antigen is a highly sensitive and specific tool in the diagnosis of pauci-bacillary conditions like extra-pulmonary TB.
    Indian Journal of Pathology and Microbiology 02/2015; 58(1):27-30. DOI:10.4103/0377-4929.151164 · 0.47 Impact Factor
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    ABSTRACT: Abstract Amyotrophic lateral sclerosis (ALS) is a devastating neurological disease that rapidly progresses from mild motor symptoms to severe motor paralysis and premature death. There is currently no cure for this devastating disease; most ALS patients die of respiratory failure generally within 3-5 years from the onset of signs and symptoms. Approximately 90% of ALS cases are sporadic in nature, with no clear associated risk factors. It is reported that ALS is a complex and multifaceted neurodegenerative disease. Less is known about the key factors involved in the sporadic form of the disease. The intricate pathogenic mechanisms that target motor neurons in ALS includes oxidative stress, glutamate excitotoxicity, mitochondrial damage, protein aggregation, glia and neuroinflammation pathology, defective axonal transport, and aberrant RNA metabolism. Despite aggressive research, no therapy has been yet proven to completely reverse the core symptoms of the disease. Riluzole is the only drug approved by the Food and Drug Administration and recommended by the National Institute for Clinical Excellence so far proven to be successful against ALS and may prevent progression and extend life for a few months or so. This article provides a novel understanding in key findings of pathogenesis and interventions currently under investigation to slow disease progression in ALS.
    Reviews in the neurosciences 01/2015; 26(2). DOI:10.1515/revneuro-2014-0057 · 3.33 Impact Factor
  • 22nd Annual Conference of Indian Academy of Neurology 2014; 11/2014
  • Indian Journal of Rheumatology 11/2014; 9. DOI:10.1016/j.injr.2014.10.019
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    ABSTRACT: Chronic contained rupture of the aorta is a rare condition that may present with varied patient symptomatology. We present a case of contained rupture of an abdominal aortic aneurysm causing vertebral erosion in an elderly male patient who had chronic backache and presented to the emergency services with a recently developed throbbing epigastric mass. Early use of computed tomography enabled prompt diagnosis and the condition was managed by endovascular stenting. The clinical and imaging findings of this potentially fatal condition are described, awareness of which is important to the physicians, orthopaedicians, surgeons and radiologists.
    Annals of Vascular Surgery 11/2014; 28(8). DOI:10.1016/j.avsg.2014.07.006 · 1.17 Impact Factor
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    ABSTRACT: Chronic aseptic meningitis is a rare manifestation of systemic lupus erythematosus (SLE). Apart from immunological causes and drugs, the aseptic meningitis group can include some unidentified viral infections that cannot be detected by routine microbiological testing. It is imperative to do complete cerebrospinal fluid (CSF) workup before implicating the symptoms to disease activity or drugs, as untreated infections cause significant mortality in SLE. We present a case of young female with SLE who presented with chronic meningitis of an uncommon etiology.
    Annals of Indian Academy of Neurology 10/2014; 17(4):426-8. DOI:10.4103/0972-2327.144019 · 0.60 Impact Factor
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    ABSTRACT: Context: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.Aims:This study sought to determine the association of vitamin D deficiency with ischemic stroke and its risk factors.Settings and Design:Cross-sectional case control study.Subjects and Methods: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.Statistical Analysis Used:The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, version 17.0 for Windows).Results: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 was no significant difference in the prevalence of vitamin D deficiency/insufficiency (P = 0.25), mean 25(OH) D levels (P = 0.75), and iPTH levels (P = 0.10) between cases and controls. No association of vitamin D deficiency/insufficiency was found with the prevalent risk factors in cases of ischemic stroke.Conclusions:Vitamin D deficiency does not bear an association with ischemic stroke or its risk factors.
    09/2014; 18(5):721-5. DOI:10.4103/2230-8210.139241
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    ABSTRACT: Background During the global H1N1 pandemic, neurological complications were reported in approximately 6–10% of children suffering from H1N1 infection, but only rarely in adults. Generalized convulsive status epilepticus (GCSE) as a presenting manifestation of H1N1 infection in an adult is exceedingly rare and has not been reported in literature. We report a patient who presented to us with GCSE as a presenting manifestation of H1N1 infection who improved following appropriate antiviral treatment. Methods and results This 20-year-old gentleman presented to us with history of fever followed by GCSE of 24 h duration. He was treated symptomatically and was evaluated in detail. He was diagnosed to be suffering from H1N1 infection based on appropriate serological tests. After start of antiviral therapy, he improved and is doing well at 4 months follow up. Conclusion This case report further expands the spectrum of clinical findings associated with sporadic H1N1 infection. A possibility of H1N1 infection should be considered in all patients who present with GCSE without any obvious cause so that appropriate diagnostic tests and treatment can be carried out at the earliest.
    08/2014; DOI:10.1016/j.ijep.2014.06.002
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    ABSTRACT: Objective: To assess the effectiveness of transnasal trans-sphenoid endoscopic optic nerve fenestration for the reversal of vision loss in pediatric idiopathic intracranial hypertension (IIH). Material and methods: This is a single center observational retrospective case series. Fifteen diagnosed pediatric patients of IIH satisfying the modified Dandy criteria and reported to the out-patient services of otolaryngology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India were included in this study. All children underwent thorough clinical examination, complete neuro-ophthalmological work up including visual acuity (V/A), visual field charting(V/F), fundus venogram and radiological work up with MRI for special optic nerve sections in sagittal reconstruction. cerebro-spinal fluid pressure (CSF) measured pre operatively for all children. Standard endoscopic optic nerve sheath fenestration was performed on all children. Visual improvement was assessed by comparing pre-operative ophthalmological findings. Results: Improvement in vision was taken as a positive outcome. Vision improved in all except two children, who had pre-existing optic nerve atrophy. Conclusion: Endoscopic optic nerve fenestration is an effective minimally invasive procedure to revert visual loss in pediatric Idiopathic Intracranial Hypertension.
    International Journal of Pediatric Otorhinolaryngology 07/2014; 78(10). DOI:10.1016/j.ijporl.2014.07.019 · 1.19 Impact Factor
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    ABSTRACT: Importance: Post-encephalitic parkinsonism (PEP) is believed to be caused by a viral illness which causes degeneration of the nerve cells in the substantia nigra, resulting in clinical parkinsonism. Although common during the period of the First World War, the diagnosis of PEP is rarely entertained today. Observation: We report an adolescent boy of PEP, who was bedridden due to severe parkinsonism following the encephalitis attack. After relevant imaging and investigation, he was treated with levodopa which made him independent from a year long total dependent condition. Relevance and conclusion: Encephalitis lethargica or PEP is one of the rare parkinsonian syndromes which may be amenable to treatment. Proper diagnosis and treatment may help the patient become ambulatory from the dreaded lethargic condition.
    Journal of the Neurological Sciences 06/2014; 343(1-2). DOI:10.1016/j.jns.2014.05.062 · 2.47 Impact Factor