Randeep Guleria

Publications (73)184.39 Total impact

• Source

  Available from: Jaya Kumar

  Dataset: 07 Iham AMİR

  Randeep Guleria, Jaya Kumar
• Article: Volitional pursed lips breathing in patients with stable chronic obstructive pulmonary disease improves exercise capacity.

  Surya P Bhatt, T K Luqman-Arafath, Arun K Gupta, Anant Mohan, Jill C Stoltzfus, Tanujit Dey, Sudip Nanda, Randeep Guleria
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  ABSTRACT: Pursed lips breathing (PLB) is used by a proportion of patients with chronic obstructive pulmonary disease (COPD) to alleviate dyspnea. It is also commonly used in pulmonary rehabilitation. Data to support its use in patients who do not spontaneously adopt PLB are limited. We performed this study to assess the acute effects of PLB on exercise capacity in nonspontaneously PLB patients with stable COPD. We performed a randomized crossover study comparing 6-min walk test (6MWT) at baseline without PLB with 6WMT using volitional PLB. Spirometry, maximal inspiratory and expiratory mouth pressures, and diaphragmatic excursion during tidal and vital capacity breathing using B-mode ultrasonography were measured at baseline and after 10 min of PLB. A Visual Analog Scale (VAS) assessed subjective breathlessness at rest, after 6MWT and after 6MWT with PLB. p ≤ 0.01 was considered significant. Mean ± SD age of patients was 53.1 ± 7.4 years. Forced expiratory volume in 1second was 1.1 ± 0.4 L/min (38.4 ± 13.2% predicted). Compared with spontaneous breathing, all but one patient with PLB showed a significant increment in 6MW distance (+34.9 ± 26.4 m; p = 0.002). There was a significant reduction in respiratory rate post 6MWT with PLB compared with spontaneous breathing (-4.4 ± 2.8 per minute; p = 0.003). There was no difference in VAS scores. There was a significant correlation between improvement in 6MWT distance and increase in diaphragmatic excursion during forced breathing. The improvement was greater in patients who had poorer baseline exercise performance. PLB has an acute benefit on exercise capacity. Sustained PLB or short bursts of PLB may improve exercise capacity in stable COPD.
  Chronic Respiratory Disease 11/2012;
• Article: A Study of Incidence of AKI in Critically Ill Patients.

  Mukesh Sharma Paudel, Naveet Wig, Sandeep Mahajan, Ravindra Mohan Pandey, Randeep Guleria, Surendra K Sharma
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  ABSTRACT: Background: There have been many studies to estimate the incidence of acute kidney injury (AKI) in critically ill patients. However, results were variable due to the non-usage of uniform criteria and retrospective design of most studies. There are no new studies from the developing countries looking at AKI in these patients since adoption of uniform Acute Kidney Injury Network (AKIN) criteria. Methods: In this prospective observational study from a tertiary care hospital in India, we enrolled 100 consecutively admitted critically ill patients and followed them during hospital stay. AKI was defined by AKIN criteria. Both the groups of patients, those who developed AKI and those who did not develop AKI, were then followed during the course of their hospital stay. Results: AKI occurred in 33 patients with an incidence rate of 17.3 per person year. Thirty-one out of 33 (93.9%) patients died in the AKI group, whereas 31 out of 67 (53.7%) patients died in the non-AKI group. Independent risk factors for AKI were older age (adjusted relative risk (RR) = 4.42, 95% CI = 2.57-5.23), septic shock (adjusted RR = 2.82, 95% CI = 1.43-3.80), prolonged duration of mechanical ventilation (adjusted RR = 2.35, 95% CI = 1.09-3.6), higher acute physiology and chronic health evaluation II (APACHE II) score (adjusted RR = 2.74, 95% CI = 1.28-4.13), and higher sequential organ failure assessment (SOFA) score (adjusted RR = 2.53, 95% CI = 1.04-4.08). Development of AKI was an independent risk factor for mortality (adjusted RR = 1.76, 95% CI = 1.25-1.84). Conclusion: Older patients, those with septic shock, and those requiring prolonged mechanical ventilation had increased risk for AKI. AKI was an independent predictor of mortality.
  Renal Failure 10/2012; 34(10):1217-22. · 0.82 Impact Factor
• Article: Association of peroxisome proliferator activated receptor-γ gene with non-alcoholic fatty liver disease in Asian Indians residing in north India.

  Surya Prakash Bhatt, Priyanka Nigam, Anoop Misra, Randeep Guleria, Kalpana Luthra, Ravindra Mohan Pandey, M A Qadar Pasha
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  ABSTRACT: BACKGROUND: Genetics of non-alcoholic fatty liver (NAFLD) in Asian Indians has been inadequately studied. We investigated the association of polymorphisms C161T and Pro12Ala of peroxisome proliferator-activated receptor gamma (PPARγ) with clinical and biochemical parameters in Asian Indians with NAFLD. METHODS: In this case-control study, 162 NAFLD cases and 173 controls were recruited. Abdominal ultrasound, clinical and biochemical profiles, fasting insulin levels and value of homeostasis model assessment of insulin resistance were determined. Polymerase chain reaction-restriction fragment length polymorphisms of two polymorphisms were performed. The association of these polymorphisms with clinical and biochemical parameters was analysed. RESULTS: Higher frequency of Ala and T alleles of PPARγ was obtained in cases. Ala/Ala genotype of PPARγ (Pro12Ala) was associated with significantly higher triglycetides (TG), alkaline phosphatase (ALK) and waist-hip ratio in cases as compared to controls. In C161T polymorphism, TT genotype was significantly increased TG (p=0.04), total cholesterol (p=0.01), ALK (p=0.04) and gamma-glutamyl transpeptidase (p=0.007) in cases. The linkage disequilibrium for these two single-nucleotide polymorphisms of PPARγ was differed in cases (D1=0.1; p=0.006) and controls (D1=0.07; p=0.1). Using a multivariate analysis after adjusting for age, sex and body mass index, the presence of NAFLD was linked to two polymorphisms [PPARγ [(Pro12Ala and C161T) (odds ratio 1.64 (95% CI: 1.09-2.45, p=0.05)]. CONCLUSION: Asian Indians in north India carrying the alleles Ala and T of PPARγ (Pro12Ala and C161T) polymorphisms are predisposed to develop NAFLD.
  Gene 09/2012; · 2.34 Impact Factor
• Article: Genetic characterization of UCS region of Pneumocystis jirovecii and construction of allelic profiles of Indian isolates based on sequence typing at three regions.

  Rashmi Gupta, Bijay Ranjan Mirdha, Randeep Guleria, Lalit Kumar, Kalpana Luthra, Sanjay Kumar Agarwal, Vishnubhatla Sreenivas
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  ABSTRACT: Pneumocystis jirovecii is an opportunistic pathogen that causes severe pneumonia in immunocompromised patients. To study the genetic diversity of P. jirovecii in India the upstream conserved sequence (UCS) region of Pneumocystis genome was amplified, sequenced and genotyped from a set of respiratory specimens obtained from 50 patients with a positive result for nested mitochondrial large subunit ribosomal RNA (mtLSU rRNA) PCR during the years 2005-2008. Of these 50 cases, 45 showed a positive PCR for UCS region. Variations in the tandem repeats in UCS region were characterized by sequencing all the positive cases. Of the 45 cases, one case showed five repeats, 11 cases showed four repeats, 29 cases showed three repeats and four cases showed two repeats. By running amplified DNA from all these cases on a high-resolution gel, mixed infection was observed in 12 cases (26.7%, 12/45). Forty three of 45 cases included in this study had previously been typed at mtLSU rRNA and internal transcribed spacer (ITS) region by our group. In the present study, the genotypes at those two regions were combined with UCS repeat patterns to construct allelic profiles of 43 cases. A total of 36 allelic profiles were observed in 43 isolates indicating high genetic variability. A statistically significant association was observed between mtLSU rRNA genotype 1, ITS type Ea and UCS repeat pattern 4.
  Infection, genetics and evolution: journal of molecular epidemiology and evolutionary genetics in infectious diseases 08/2012; · 3.22 Impact Factor
• Article: Delayed resolution of inflammatory response compared with clinical recovery in patients with acute exacerbations of chronic obstructive pulmonary disease.

  Anant Mohan, Dharmendra Prasad, Alpana Sharma, Sneh Arora, Randeep Guleria, Surendra K Sharma, Ravinder M Pandey
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  ABSTRACT: Background and objective:  The temporal profile of inflammatory markers during acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and their relationship to clinical response are not well characterized. The aim was to assess the changes in levels of inflammatory markers in AECOPD and correlate these with clinical and laboratory indices of recovery. Methods:  Serum levels of C-reactive protein (CRP), interleukin (IL)-6 and fibrinogen were measured in patients with AECOPD within 24 h of hospitalization and pre-discharge (stable state). Results:  Ninety-seven patients were evaluated (79 males; mean (SD) age, 61.4 (10.3) years). Eighty eight (90.7%) were current or former smokers, with a median consumption of 15 (0-75) packs/year. The median duration of COPD was 8 (2-25) years. Forty-six patients (56.9%) required mechanical ventilation for a median of 5 days (1-34) while in hospital. The median duration of hospital stay was 13 days (1-77). At reassessment before planned discharge, the levels of dyspnoea, leucocyte counts, erythrocyte sedimentation rate, creatinine, partial pressure of oxygen, and albumin normalized. The levels of CRP, IL-6 and fibrinogen reduced significantly but did not reach the normal range. Changes in IL-6 and fibrinogen levels correlated significantly with the acute physiologic assessment and chronic health evaluation II score, smoking history, blood pressure and leucocyte counts. Baseline IL-6 and fibrinogen levels significantly predicted a prolonged duration of mechanical ventilation. Conclusions:  During AECOPD, the inflammatory response lags behind clinical and biochemical improvement. Fibrinogen and IL-6 are potentially useful markers for monitoring clinical response following an acute episode.
  Respirology 07/2012; 17(7):1080-5. · 2.42 Impact Factor
• Article: Nonalcoholic fatty liver disease is associated with subclinical atherosclerosis independent of obesity and metabolic syndrome in Asian Indians.

  Manik Lal Thakur, Sanjay Sharma, Atin Kumar, Surya Prakash Bhatt, Kalpana Luthra, Randeep Guleria, Ravindra M Pandey, Naval K Vikram
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  ABSTRACT: We examined the association of subclinical atherosclerosis and endothelial dysfunction with nonalcoholic fatty liver disease (NAFLD) in Asian Indians. This study included 40 non-diabetic subjects with NAFLD and 40 apparently healthy controls without NAFLD with similar age, gender and body mass index. Measurements included anthropometric parameters, oral glucose tolerance test, fasting and 2 h insulin, lipid profile, C-reactive protein, sICAM-1, VCAM-1, carotid intima-media thickness (CIMT) and brachial artery flow mediated dilatation (FMD). Subjects with NAFLD had higher average and maximum CIMT (0.6 ± 0.12 and 0.684 ± 0.16 mm, respectively, vs 0.489 ± 0.1 and 0.523 ± 0.1 mm, respectively; p < 0.05), and had higher prevalence of atherosclerotic plaques (20% vs 5%, p < 0.05) than controls. Significantly greater degree of impairment in FMD and higher levels of hs-CRP and sICAM-1 were observed in NAFLD patients than controls. The presence of NAFLD was observed to be the independent predictor of having high average CIMT (OR 4.8; 95% CI: 1.8-12.8), high maximum CIMT (OR 5.4; 95% CI: 2.0-14.4) and impaired FMD (OR 11.7; 95% CI: 1.4-96.5) even after adjusting for obesity, metabolic syndrome, insulin resistance and lipid parameters. In Asian Indians NAFLD is significantly associated with subclinical atherosclerosis and endothelial dysfunction independent of obesity and metabolic syndrome. Elevated levels of hs-CRP and sICAM-1 may be useful as indicators of liver injury in NAFLD.
  Atherosclerosis 06/2012; 223(2):507-11. · 3.79 Impact Factor
• Article: Ala/Ala genotype of Pro12Ala polymorphism in the peroxisome proliferator-activated receptor-γ2 gene is associated with obesity and insulin resistance in Asian Indians.

  Surya Prakash Bhatt, Anoop Misra, Mukti Sharma, Kalpana Luthra, Randeep Guleria, Ravindra Mohan Pandey, Naval K Vikram
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  ABSTRACT: We determined the association of the Pro12Ala polymorphism of the peroxisome proliferator activated receptor (PPAR)-γ2 gene with obesity, insulin resistance (IR), and lipids in Asian Indians without diabetes in north India. In this cross-sectional study (n = 495; 279 males and 216 females, 18-60 years of age), anthropometric (body mass index, waist and hip circumferences, and skinfold thickness) and biochemical (fasting glucose, lipid profile, fasting insulin, leptin, and adiponectin) parameters were assessed. Polymerase chain reaction-restriction fragment length polymorphism analysis was used for identification of individual genotypes. Frequencies of the Pro and Ala alleles were 0.89 and 0.11, respectively. The genotype frequencies (%) of Pro/Pro, Pro/Ala, and Ala/Ala were 82.6, 14.7, and 2.7, respectively, without any gender differences. The frequency of the Ala/Ala genotype was higher in obese than in nonobese subjects (4.9% vs. 1.5%, P = 0.06). The Ala/Ala genotype was associated with higher values of hip circumference, subscapular skinfold thickness, and sum of four skinfold thickness than the Pro/Pro and Pro/Ala genotypes (P<0.05). Using a multivariate logistic regression model after adjusting for age, sex, and insulin, subjects with the Ala/Ala genotype showed a high risk of obesity (odds ratio [OR], 3.2, 95% confidence interval [CI] 1.2-12.9) and IR (OR, 3.6, 95% CI: 1.04-12.4). The Ala/Ala genotype of the PPAR-γ2 gene is associated with obesity and IR in Asian Indians without diabetes living in north India.
  Diabetes Technology &amp Therapeutics 06/2012; 14(9):828-34. · 1.93 Impact Factor
• Article: Association of the Myostatin gene with obesity, abdominal obesity and low lean body mass and in non-diabetic Asian Indians in north India.

  Surya Prakash Bhatt, Priyanka Nigam, Anoop Misra, Randeep Guleria, Kalpana Luthra, S K Jain, M A Qadar Pasha
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  ABSTRACT: To determine the association of the A55T and K153R polymorphisms of the Myostatin gene with obesity, abdominal obesity and lean body mass (LBM) in Asian Indians in north India. A total of 335 subjects (238 men and 97 women) were assessed for anthropometry, % body fat (BF), LBM and biochemical parameters. Associations of Myostatin gene polymorphisms were evaluated with anthropometric, body composition and biochemical parameters. In A55T polymorphism, BMI (p=0.04), suprailiac skinfold (p=0.05), total skinfold (p=0.008), %BF (p=0.002) and total fat mass (p=0.003) were highest and % LBM (p=0.03) and total LBM (Kg) were lowest (p=0.04) in subjects with Thr/Thr genotype as compared to other genotypes. Association analysis of K153R polymorphism showed that subjects with R/R genotype had significantly higher BMI (p=0.05), waist circumference (p=0.04), %BF (p=0.04) and total fat mass (p=0.03), and lower %LBM (p=0.02) and total LBM [(Kg), (p=0.04)] as compared to other genotypes. Using a multivariate logistic regression model after adjusting for age and sex, subjects with Thr/Thr genotype of A55T showed high risk for high %BF (OR, 3.92, 95% Cl: 2.61-12.41), truncal subcutaneous adiposity (OR, 2.9, 95% Cl: 1.57-6.60)] and low LBM (OR, 0.64, 95% CI: 0.33-0.89) whereas R/R genotype of K153R showed high risk of obesity (BMI; OR, 3.2, 95% CI: 1.2-12.9; %BF, OR, 3.6, 95% CI: 1.04-12.4), abdominal obesity (OR, 2.12, 95% CI: 2.71-14.23) and low LBM (OR, 0.61, 95% CI: 0.29-0.79). We report that variants of Myostatin gene predispose to obesity, abdominal obesity and low lean body mass in Asian Indians in north India.
  PLoS ONE 01/2012; 7(8):e40977. · 4.09 Impact Factor
• Article: Management of community acquired pneumonia.

  Randeep Guleria, Jaya Kumar
  The Journal of the Association of Physicians of India 01/2012; 60 Suppl:21-4.
• Article: Association of functionally important polymorphism of microsomal epoxide hydrolase gene (EPHX1) with lung cancer susceptibility.

  Anup R Tilak, Sachin Kumar, Meenu Jain, Mohan C Pant, Bhudev C Das, Randeep Guleria, Balraj Mittal, Neeraj Mathur, Ashwani Kumar
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  ABSTRACT: Distribution and gene-environment interaction of EPHX1 polymorphism was evaluated in 175 lung cancer patients and 322 controls from north India. Two novel non-synonymous, Lys117Arg and Leu263Phe, and twelve single nucleotide polymorphisms were identified in the present study. Binary logistic regression analysis showed association of polymorphism Tyr113His with increased risk of lung cancer (OR = 2.2, 95% CI = 1.2-4.0, p < .05). Gene-environment interaction revealed that patients with His113His and smoking habit had significantly greater risk of lung cancer (OR = 4.52, 95% CI = 0.93-43.05, p < .05). Present study provided evidence that EPHX1 polymorphism is associated with lung cancer susceptibility in Indian population.
  Cancer Investigation 07/2011; 29(6):411-8. · 1.85 Impact Factor
• Article: Multidetector CT evaluation of central airways stenoses: Comparison of virtual bronchoscopy, minimal-intensity projection, and multiplanar reformatted images.

  Dinesh K Sundarakumar, Ashu S Bhalla, Raju Sharma, Smriti Hari, Randeep Guleria, Gopi C Khilnani
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  ABSTRACT: To evaluate the diagnostic utility of virtual bronchoscopy, multiplanar reformatted images, and minimal-intensity projection in assessing airway stenoses. It was a prospective study involving 150 patients with symptoms of major airway disease. Fifty-six patients were selected for analysis based on the detection of major airway lesions on fiber-optic bronchoscopy (FB) or routine axial images. Comparisons were made between axial images, virtual bronchoscopy (VB), minimal-intensity projection (minIP), and multiplanar reformatted (MPR) images using FB as the gold standard. Lesions were evaluated in terms of degree of airway narrowing, distance from carina, length of the narrowed segment and visualization of airway distal to the lesion. MPR images had the highest degree of agreement with FB (Κ = 0.76) in the depiction of degree of narrowing. minIP had the least degree of agreement with FB (Κ = 0.51) in this regard. The distal visualization was best on MPR images (84.2%), followed by axial images (80.7%), whereas FB could visualize the lesions only in 45.4% of the cases. VB had the best agreement with FB in assessing the segment length (Κ = 0.62). Overall there were no statistically significant differences in the measurement of the distance from the carina in the axial, minIP, and MPR images. MPR images had the highest overall degree of confidence, namely, 70.17% (n = 40). Three-dimensional reconstruction techniques were found to improve lesion evaluation compared with axial images alone. The technique of MPR images was the most useful for lesion evaluation and provided additional information useful for surgical and airway interventions in tracheobronchial stenosis. minIP was useful in the overall depiction of airway anatomy.
  The Indian journal of radiology and imaging 07/2011; 21(3):191-4.
• Article: Efficacy of plasma TGF-β1 level in predicting therapeutic efficacy and prognosis in patients with advanced non-small cell lung cancer.

  Sachin Kumar, Randeep Guleria, Anant Mohan, Vikas Singh, Alok C Bharti, Bhudev C Das
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  ABSTRACT: We hypothesized that serial assessment of TGF-β1 during chemotherapy might predict therapeutic response and prognosis in non-small cell lung cancer (NSCLC) patients. Plasma TGF-β1 levels were quantified before first, second, and third cycles of chemotherapy in 42 advanced NSCLC patients and correlated with therapeutic response. Plasma TGF-β1 levels measured before first and second cycles of chemotherapy failed to predict response to therapy. The increased presence of TGF-β1 measured before second and third cycles of chemotherapy was associated with poor survival. Estimation of plasma TGF-β1 during the course of chemotherapy might not be a reliable biomarker for predicting therapeutic efficacy in NSCLC.
  Cancer Investigation 03/2011; 29(3):202-7. · 1.85 Impact Factor
• Article: Genotypic variation of Pneumocystis jirovecii isolates in India based on sequence diversity at mitochondrial large subunit rRNA.

  Rashmi Gupta, Bijay Ranjan Mirdha, Randeep Guleria, Sanjay Kumar Agarwal, Jyotish Chandra Samantaray, Lalit Kumar, Sushil Kumar Kabra, Kalpana Luthra, Vishnubhatla Sreenivas, Venkateswaran K Iyer
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  ABSTRACT: Pneumocystis pneumonia (PCP), a common and serious opportunistic infection in immunocompromised patients, is caused by Pneumocystis jirovecii (formerly known as Pneumocystis carinii f. sp. hominis). The aim of the present study was to describe the prevalence and distribution of genotypes of P. jirovecii based on sequence polymorphisms at mitochondrial large subunit ribosomal RNA (mt LSU rRNA) region in both HIV and non-HIV immunocompromised individuals with a positive PCR result for PCP in a tertiary health care centre in northern India. From January 2005 to October 2008, 50 patients [22 HIV-seropositive individuals, 10 post-renal transplant (PRT) recipients, 3 cancer patients, and 15 patients with various other kinds of immunosuppression] were found to be positive for P. jirovecii using PCR at the mt LSU rRNA gene. Genotyping of the positive samples was performed at the mt LSU rRNA locus. Genotype 2 was the most common accounting for 42% of total types. This was followed by the genotypes 3 (24%), 1 (20%), and 4 (8%). Mixed infection was observed in 3 cases (6%). The rates of genotype distribution were similar in HIV-seropositive individuals, cancer patients, and in patients with other kinds of immunosuppression. In the PRT recipients, genotype 1 was the most prevalent type (80%). This is the first study describing the prevalence of genotypes in HIV-infected and HIV-uninfected, immunocompromised patients based on the mt LSU rRNA gene from the Indian subcontinent. The most prevalent genotype observed was type 2 in contrast to many studies from other parts of the world where genotype 1 was the most prevalent type, suggesting geographical variation.
  International journal of medical microbiology: IJMM 03/2011; 301(3):267-72. · 2.80 Impact Factor
• Article: Evaluation of the current management protocols for prophylaxis against Pneumocystis jiroveci pneumonia and other opportunistic infections in patients living with HIV/AIDS.

  Sheel Bhadra Jain, Naveet Wig, Sajan Jiv Singh Nagpal, Nitin Mishra, Madhu Vajpayee, Randeep Guleria, Ravindra Mohan Pandey, Surendra K Sharma
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  ABSTRACT: Opportunistic infections (OIs) are a leading cause of mortality and morbidity in patients living with HIV/AIDS. Data on the proper administration of prophylactic regimes for the prevention of OIs in such patients are scarce. A total of 205 confirmed HIV-infected patients were enrolled in the study from the inpatient wards and outpatient services. The treatment given to them for the prevention of Pneumocystis carinii (jiroveci) pneumonia was compared with the established guidelines and the proportions of those receiving proper treatment were calculated. Primary prophylaxis was seen to be satisfactory in the case of P. carinii (jiroveci) pneumonia. The prophylaxis was not given properly for tuberculosis and other common OIs. Secondary prophylaxis was up to the mark. Prophylaxis in AIDS patients seems to be a major problem area and a lot of efforts need to be directed toward it since patients suffering from AIDS are bound to have a downhill course despite provision of all available treatment options.
  AIDS Care 03/2011; 23(7):846-50. · 1.60 Impact Factor
• Article: Association of PPARγ2 (Pro12Ala) and neuropeptide Y (Leu7Pro) gene polymorphisms with obstructive sleep apnea in obese Asian Indians.

  Bharat Bhushan, Randeep Guleria, Anoop Misra, Kalpana Luthra, Guresh Kumar
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  ABSTRACT: Obstructive sleep apnea (OSA) is prevalent in 7.5% in urban Asian Indians. Peroxisome proliferator activated receptor gamma2 (PPARγ2) has been implicated in adipocyte differentiation. Neuropeptide Y (NPY) is also considered as a candidate gene for excess body fat accumulation. The association of PPARγ2 (Pro12Ala)} and NPY (Leu7Pro) gene polymorphisms with OSA has not been studied in Asian Indians. To study the distribution of PPARγ2 (Pro12Ala) and NPY (Leu7Pro) polymorphism in Asian Indians with and without OSA. This study was carried out in 252 obese subjects [(body mass index (BMI > 25 kg/m2]; 142 with OSA and 110 without OSA. Measurements included anthropometric and biochemical parameters (fasting blood glucose, lipid profile, various circumferences and skin-fold thicknesses). PPARγ2 (Pro12Ala) and NPY (Leu7Pro) gene} polymorphisms were studied in all subjects. The frequency of the variant allele (Ala12) of PPARγ2 gene was significantly higher in subjects with OSA (14.4%) when compared with subjects without OSA (5.5%; χ2= 9.7; p = 0.001). The distribution of the variant allele (Pro7) of NPY gene was comparable in subjects with OSA (3.5%) and without OSA (3.6%; χ2= 0.001, p = 0.94). This study reveals a significantly higher frequency of PPARγ2 (Ala12) allele in obese Asian Indians with OSA when compared to obese Asian Indians without OSA.
  Disease markers 01/2011; 30(1):31-8. · 1.64 Impact Factor
• Article: Associations of -308G/A polymorphism of tumor necrosis factor (TNF)-α gene and serum TNF-α levels with measures of obesity, intra-abdominal and subcutaneous abdominal fat, subclinical inflammation and insulin resistance in Asian Indians in north India.

  Naval K Vikram, Surya Prakash Bhatt, Bharat Bhushan, Kalpana Luthra, Anoop Misra, Pawan K Poddar, Ravindra M Pandey, Randeep Guleria
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  ABSTRACT: Obesity is associated with high levels proinflammatory cytokines like tumour necrosis factor alpha (TNF-α), which may play an important role in the genesis of insulin resistance. We evaluated the relationship of -308G/A polymorphism of TNF-α gene with obesity and insulin resistance in Asian Indians in north India. This cross-sectional study included 151 apparently healthy individuals (79 males, 72 females) 18-50 yrs of age from New Delhi, India. Body composition by dual-energy x-ray absorptiometry (DEXA) and abdominal fat by magnetic resonance imaging (MRI) were measured. Biochemical measurements included OGTT, lipids, fasting insulin, hs-CRP and TNF-α levels. We analysed -308G/A polymorphism of TNF-α gene and studied its association with obesity and biochemical parameters. At comparable BMI, abdominal obesity was more prevalent in females (50%) as compared to males (20%). The wild genotype (GG) was present in 78.8%, GA in 17.9%, and AA in 3.3% subjects. Measures of body composition, abdominal fat distribution, lipids, insulin, hs-CRP and TNF-α levels were not influenced by the presence of -308G/A polymorphism. Serum TNF-α levels correlated significantly with fasting insulin in both genders. TNF-α levels correlate with fasting insulin but not with indicators of body composition in Asian Indians. The -308G/A polymorphism of TNF-α gene is not associated with differences in the serum levels of TNF-α in Asian Indians.
  Disease markers 01/2011; 31(1):39-46. · 1.64 Impact Factor
• Article: SREBP-2 1784 G/C genotype is associated with non-alcoholic fatty liver disease in north Indians.

  Surya Prakash Bhatt, Priyanka Nigam, Anoop Misra, Randeep Guleria, Kalpana Luthra, M Vaidya, S K Jain, M A Qadar Pasha
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  ABSTRACT: Genetics of non-alcoholic fatty liver (NAFLD) in Asian Indians has been inadequately investigated. This study aims to determine the association of the 1784G>C polymorphism in the SREBP-2 gene with NAFLD in Asian Indians in north India. In this study, (n=335); 162 obese with NAFLD, 91 obese without NAFLD and 82 non-obese without NAFLD subjects were recruited. Abdominal ultrasound, clinical profile, anthropometry, metabolic profile, serum levels of alanine aminotransferase, aspartate aminotransferase, fasting insulin and high sensitivity C-reactive protein (hs-CRP) were analysed. Polymerase chain reaction and restriction fragment length polymorphism were used to identify individual genotypes, and the association of this polymorphism with clinical and biochemical parameters was assessed. The observed frequency of G allele was 0.73 and C allele was 0.27. Frequency of C/C genotype was higher in NAFLD as compared to obese and non-obese subjects (p=0.003). In NAFLD subjects 57.4% were G/G homozygous, 31.5% G/C heterozygous and 11.1% were C/C homozygous. The SREBP-2 genotype frequencies deviated from the Hardy Weinberg Equilibrium (X² = 6.39, p = 0.0114). Mean values of TG (p = 0.002), TC (p =0.002), ALT (p =0.04) and AST (p =0.03) levels were significantly higher in NAFLD subjects with G/C genotype as compared to G/G genotypes in obese and non-obese groups. Fasting insulin (p =0.03), HOMA (p =0.009) and hs-CRP levels were significantly higher in NAFLD subjects with G/C genotype as compared to obese and non obese subjects with G/G genotypes. In this study, conducted for the first time in Asian Indians, SREBP-2 1784 G>C genotype was associated with NAFLD.
  Disease markers 01/2011; 31(6):371-7. · 1.64 Impact Factor
• Article: Obstructive sleep apnea is independently associated with the metabolic syndrome in obese Asian Indians in northern India.

  Bharat Bhushan, Anoop Misra, Randeep Guleria
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  ABSTRACT: Obesity and the metabolic syndrome are rapidly increasing in developing countries. Whether the metabolic syndrome is independently associated with obstructive sleep apnea (OSA) is not clear. This study investigated the association between OSA and the metabolic syndrome in obese Asian Indians. We studied 240 obese subjects [body mass index (BMI) >25 kg/m2], 121 with OSA and 119 without OSA, matched for age, BMI, and percentage body fat (%BF). Full-montage digital polysomnography, fasting blood glucose (FBG), lipid levels, and blood pressure (BP) were done in all subjects. Subjects with OSA showed higher prevalence of the metabolic syndrome as compared to subjects without OSA [67.8% vs. 42.02%; χ2 = 16.08, P < 0.0001, odds ratio (OR) = 2.90, 95% confidence interval (CI)]. Prevalence of the metabolic syndrome was significantly higher in the severe OSA group as compared to the moderate OSA group (78.7% vs. 40.9%; χ2 = 11.57; P < 0.001; OR = 0.19, 95% CI). Fasting insulin levels were significantly higher in subjects with OSA as compared to subjects without OSA [median (range); 84.03(12.5-541.7) pmol/L vs. 64.4(10.4-520.8) pmol/L; P = 0.002)]. Regression analysis suggested that OSA was independently and positively associated with the metabolic syndrome, male gender, and fasting insulin levels. OSA is independently associated with the metabolic syndrome in Asian Indians in northern India.
  Metabolic syndrome and related disorders 10/2010; 8(5):431-5.
• Article: Lack of utility of plasma TNF-alpha level in predicting therapeutic efficacy in patients with advanced non-small cell lung cancer.

  Sachin Kumar, Randeep Guleria, Vikas Singh, Anant Mohan, Alok C Bharti, Bhudev C Das
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  ABSTRACT: Accumulating evidence suggests a change in cytokine profile after cytotoxic therapies. We hypothesized that change in plasma levels of tumor necrosis factor-alpha (TNF-alpha) during the course of chemotherapy in lung cancer may predict therapeutic efficacy at an early stage. Plasma TNF-alpha levels were quantified before first, second, and third cycle of chemotherapy in 42 patients with advanced non-small cell lung cancer and correlated with response to therapy as assessed by computed tomography after the third chemotherapy cycle. Plasma levels of TNF-alpha measured before various treatment cycles could not differentiate among patients with remission, no change, and progression. For predicting inadequate therapeutic response, a sensitivity of 11.5% and 23.1% was achieved at 100% specificity using plasma TNF-alpha levels measured before first and second therapy cycle, respectively. Prediction of disease progression was achieved with a sensitivity of 14.3% at 100% specificity for plasma TNF-alpha levels measured before second therapy cycle. Plasma levels of TNF-alpha measured before various treatment cycles was not correlated with survival. Measurement of plasma TNF-alpha may not prove to be a good biomarker for predicting therapeutic efficacy at an early stage in NSCLC. Additional, more specific, and more sensitive blood-based biomarkers will be required to further improve the diagnostic power of current imaging tools for indicating early therapeutic efficacy.
  Cytokine 09/2010; 51(3):245-8. · 3.02 Impact Factor