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Han M, Yildiz E, Bozuyuk U, Aydin A, Yu Y, Bhargava A, Karaz S, Sitti M. Janus microparticles-based targeted and spatially-controlled piezoelectric neural stimulation via low-intensity focused ultrasound. Nat Commun 2024; 15:2013. [PMID: 38443369 PMCID: PMC10915158 DOI: 10.1038/s41467-024-46245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
Electrical stimulation is a fundamental tool in studying neural circuits, treating neurological diseases, and advancing regenerative medicine. Injectable, free-standing piezoelectric particle systems have emerged as non-genetic and wireless alternatives for electrode-based tethered stimulation systems. However, achieving cell-specific and high-frequency piezoelectric neural stimulation remains challenging due to high-intensity thresholds, non-specific diffusion, and internalization of particles. Here, we develop cell-sized 20 μm-diameter silica-based piezoelectric magnetic Janus microparticles (PEMPs), enabling clinically-relevant high-frequency neural stimulation of primary neurons under low-intensity focused ultrasound. Owing to its functionally anisotropic design, half of the PEMP acts as a piezoelectric electrode via conjugated barium titanate nanoparticles to induce electrical stimulation, while the nickel-gold nanofilm-coated magnetic half provides spatial and orientational control on neural stimulation via external uniform rotating magnetic fields. Furthermore, surface functionalization with targeting antibodies enables cell-specific binding/targeting and stimulation of dopaminergic neurons. Taking advantage of such functionalities, the PEMP design offers unique features towards wireless neural stimulation for minimally invasive treatment of neurological diseases.
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Affiliation(s)
- Mertcan Han
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
- Institute for Biomedical Engineering, ETH Zurich, 8092, Zurich, Switzerland
| | - Erdost Yildiz
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
| | - Ugur Bozuyuk
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
| | - Asli Aydin
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Yan Yu
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
| | - Aarushi Bhargava
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
| | - Selcan Karaz
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany
- Institute for Biomedical Engineering, ETH Zurich, 8092, Zurich, Switzerland
| | - Metin Sitti
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569, Stuttgart, Germany.
- Institute for Biomedical Engineering, ETH Zurich, 8092, Zurich, Switzerland.
- School of Medicine and College of Engineering, Koç University, 34450, Istanbul, Türkiye.
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2
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Bhargava A, Huang S, McPherson DD, Bader KB. Assessment of bubble activity generated by histotripsy combined with echogenic liposomes. Phys Med Biol 2022; 67:215015. [PMID: 36220055 DOI: 10.1088/1361-6560/ac994f] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
Abstract
Objective.Histotripsy is a form of focused ultrasound therapy that uses the mechanical activity of bubbles to ablate tissue. While histotripsy alone degrades the cellular content of tissue, recent studies have demonstrated it effectively disrupts the extracellular structure of pathologic conditions such as venous thrombosis when combined with a thrombolytic drug. Rather than relying on standard administration methods, associating thrombolytic drugs with an ultrasound-triggered echogenic liposome vesicle will enable targeted, systemic drug delivery. To date, histotripsy has primarily relied on nano-nuclei inherent to the medium for bubble cloud generation, and microbubbles associated with echogenic liposomes may alter the histotripsy bubble dynamics. The objective of this work was to investigate the interaction of histotripsy pulse with echogenic liposomes.Approach.Bubble clouds were generated using a focused source in anin vitromodel of venous flow. Acoustic emissions generated during the insonation were passively acquired to assess the mechanical activity of the bubble cloud. High frame rate, pulse inversion imaging was used to track the change in echogenicity of the liposomes following histotripsy exposure.Main results.For peak negative pressures less than 20 MPa, acoustic emissions indicative of stable and inertial bubble activity were observed. As the peak negative pressure of the histotripsy excitation increased, harmonics of the excitation were observed in OFP t-ELIP solutions and plasma alone. Additional observations with high frame rate imaging indicated a transition of bubble behavior as the pulse pressure transitioned to shock wave formation.Significance.These observations suggest that a complex interaction between histotripsy pulses and echogenic liposomes that may be exploited for combination treatment approaches.
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Affiliation(s)
- Aarushi Bhargava
- Department of Radiology, University of Chicago, Chicago, IL, United States of America
| | - Shaoling Huang
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Texas Health Sciences Center-Houston, Houston, TX, United States of America
| | - David D McPherson
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Texas Health Sciences Center-Houston, Houston, TX, United States of America
| | - Kenneth B Bader
- Department of Radiology, University of Chicago, Chicago, IL, United States of America
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3
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Zhang C, Butnari V, Anber A, Bhargava A. P-056 ELECTIVE OPEN INGUINAL HERNIA REPAIRS- ARE WE DISCLOSING ALL THE RISKS? Br J Surg 2022. [DOI: 10.1093/bjs/znac308.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction and Aim
Elective open inguinal hernia repairs are one of the most common procedures carried out in the NHS with over 78000 operations per year. There are many risks associated with this procedure and so obtaining informed consent is imperative to patient care and patient choice. The aim of this study is to compare the quality of consent forms for elective open inguinal hernia repairs to the guidance provided by the Royal College of Surgeons (RCS) and the British Hernia Society (BHS).
Method
60 patients (50 male, 10 female) undergoing elective open inguinal hernia repair between 01/09/2021–20/12/2021 were identified retrospectively. Their consent forms were audited against modified guidelines from RCS and BHS. The grade of the consenting surgeon was also noted.
Results
Sepsis (95%), recurrence (85%), and chronic pain (82%) were the most consented risks. Least consented serious risks were persistent numbness (47%), nerve injury (47%), and mesh infection (40%). Notable disparities existed between rates of consent and grade of surgeon: 64% of registrars consented for nerve injury compared to 9% of SHOs and 82% of SHOs consented for haematoma compared to 20% of consultants.
Conclusion
Serious risks such mesh infection and nerve injury were often missed from consent forms. There is inconsistency in consented risks between different grades of surgeon. A standardised consent form would improve consent consistency and potentially reduce rate of litigation for doctors and the trust. Comprehensive pre-made consent forms were therefore designed to better facilitate a standardised approach to the consenting process.
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Affiliation(s)
- C Zhang
- Colorectal Surgery, Barking Havering Redbridge University Trust , London , United Kingdom
| | - V Butnari
- Colorectal Surgery, Barking Havering Redbridge University Trust , London , United Kingdom
| | - A Anber
- Colorectal Surgery, Barking Havering Redbridge University Trust , London , United Kingdom
| | - A Bhargava
- Colorectal Surgery, Barking Havering Redbridge University Trust , London , United Kingdom
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4
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Adams ST, Bedwani NH, Massey LH, Bhargava A, Byrne C, Jensen KK, Smart NJ, Walsh CJ. Physical activity recommendations pre and post abdominal wall reconstruction: a scoping review of the evidence. Hernia 2022; 26:701-714. [PMID: 35024980 DOI: 10.1007/s10029-022-02562-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/31/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE There are no universally agreed guidelines regarding which types of physical activity are safe and/or recommended in the perioperative period for patients undergoing ventral hernia repair or abdominal wall reconstruction (AWR). This study is intended to identify and summarise the literature on this topic. METHODS Database searches of PubMed, CINAHL, Allied & Complementary medicine database, PEDro and Web of Science were performed followed by a snowballing search using two papers identified by the database search and four hand-selected papers of the authors' choosing. Inclusion-cohort studies, randomized controlled trials, prospective or retrospective. Studies concerning complex incisional hernia repairs and AWRs including a "prehabilitation" and/or "rehabilitation" program targeting the abdominal wall muscles in which the interventions were of a physical exercise nature. RoB2 and Robins-I were used to assess risk of bias. Prospero CRD42021236745. No external funding. Data from the included studies were extracted using a table based on the Cochrane Consumers and Communication Review Group's data extraction template. RESULTS The database search yielded 5423 records. After screening two titles were selected for inclusion in our study. The snowballing search identified 49 records. After screening one title was selected for inclusion in our study. Three total papers were included-two randomised studies and one cohort study (combined 423 patients). All three studies subjected their patients to varying types of physical activity preoperatively, one study also prescribed these activities postoperatively. The outcomes differed between the studies therefore meta-analysis was impossible-two studies measured hernia recurrence, one measured peak torque. All three studies showed improved outcomes in their study groups compared to controls however significant methodological flaws and confounding factors existed in all three studies. No adverse events were reported. CONCLUSIONS The literature supporting the advice given to patients regarding recommended physical activity levels in the perioperative period for AWR patients is sparse. Further research is urgently required on this subject.
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Affiliation(s)
- S T Adams
- Department of General Surgery, Wirral University Teaching Hospitals NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Rd, Upton, CH49 5PE, Wirral, UK.
- Department of General Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Rainhill, Prescot, UK.
- Department of Plastic Surgery, St Helen's and Knowsley Teaching Hospitals NHS Trust, Rainhill, Prescot, UK.
| | - N H Bedwani
- Department of General Surgery, North Middlesex University Hospital NHS Trust, London, UK
| | - L H Massey
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - A Bhargava
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - C Byrne
- College of Life and Environmental Sciences, Sport and Health Sciences, University of Exeter, Exeter, UK
| | - K K Jensen
- Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark
| | - N J Smart
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - C J Walsh
- Department of General Surgery, Wirral University Teaching Hospitals NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Rd, Upton, CH49 5PE, Wirral, UK
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Sinha P, Bhargava A, Carwile M, Cintron C, Cegielski JP, Lönnroth K, Bhargava M, Carter EJ, Koura KG, Hochberg NS. Undernutrition can no longer be an afterthought for global efforts to eliminate TB. Int J Tuberc Lung Dis 2022; 26:477-480. [PMID: 35650703 DOI: 10.5588/ijtld.22.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- P Sinha
- Boston Medical Center, Boston, MA, Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - A Bhargava
- Department of Medicine, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India, Department of Medicine, McGill University, Montreal, QC, Canada, Center for Nutrition Studies, Yenepoya (deemed University), Mangalore, India
| | | | | | - J P Cegielski
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - K Lönnroth
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - M Bhargava
- Center for Nutrition Studies, Yenepoya (deemed University), Mangalore, India, Department of Community Medicine, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India
| | - E J Carter
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep, Warren Alpert Medical School, Brown University, RI, USA
| | - K G Koura
- International Union Against Tuberculosis and Lung Disease, Paris, France, Communauté d´universités et établissements Sorbonne Paris Cité, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France, École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Epidémiologique, Université de Parakou, Parakou, Benin
| | - N S Hochberg
- Boston Medical Center, Boston, MA, Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA;, Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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6
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Hendley SA, Bhargava A, Holland CK, Wool GD, Ahmed O, Paul JD, Bader KB. (More than) doubling down: Effective fibrinolysis at a reduced rt-PA dose for catheter-directed thrombolysis combined with histotripsy. PLoS One 2022; 17:e0261567. [PMID: 34982784 PMCID: PMC8726487 DOI: 10.1371/journal.pone.0261567] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/04/2021] [Indexed: 02/07/2023] Open
Abstract
Deep vein thrombosis is a major source of morbidity and mortality worldwide. For acute proximal deep vein thrombosis, catheter-directed thrombolytic therapy is an accepted method for vessel recanalization. Thrombolytic therapy is not without risk, including the potential for hemorrhagic bleeding that increases with lytic dose. Histotripsy is a focused ultrasound therapy that generates bubble clouds spontaneously in tissue at depth. The mechanical activity of histotripsy increases the efficacy of thrombolytic therapy at doses consistent with current pharmacomechanical treatments for venous thrombosis. The objective of this study was to determine the influence of lytic dose on histotripsy-enhanced fibrinolysis. Human whole blood clots formed in vitro were exposed to histotripsy and a thrombolytic agent (recombinant tissue plasminogen activator, rt-PA) in a venous flow model perfused with plasma. Lytic was administered into the clot via an infusion catheter at concentrations ranging from 0 (control) to 4.54 μg/mL (a common clinical dose for catheter-directed thrombolysis). Following treatment, perfusate samples were assayed for markers of fibrinolysis, hemolysis, and intact red blood cells and platelets. Fibrinolysis was equivalent between the common clinical dose of rt-PA (4.54 μg/mL) and rt-PA at a reduction to one-twentieth of the common clinical dose (0.23 μg/mL) when combined with histotripsy. Minimal changes were observed in hemolysis for treatment arms with or without histotripsy, potentially due to clot damage from insertion of the infusion catheter. Likewise, histotripsy did not increase the concentration of red blood cells or platelets in the perfusate following treatment compared to rt-PA alone. At the highest lytic dose, a refined histotripsy exposure scheme was implemented to cover larger areas of the clot. The updated exposure scheme improved clot mass loss and fibrinolysis relative to administration of lytic alone. Overall, the data collected in this study indicate the rt-PA dose can be reduced by more than a factor of ten and still promote fibrinolysis when combined with histotripsy.
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Affiliation(s)
- Samuel A. Hendley
- Committee on Medical Physics, University of Chicago, Chicago, Illinois, United States of America
| | - Aarushi Bhargava
- Department of Radiology, University of Chicago, Chicago, Illinois, United States of America
| | - Christy K. Holland
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Geoffrey D. Wool
- Department of Pathology, University of Chicago, Chicago, Illinois, United States of America
| | - Osman Ahmed
- Department of Radiology, University of Chicago, Chicago, Illinois, United States of America
| | - Jonathan D. Paul
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Kenneth B. Bader
- Committee on Medical Physics, University of Chicago, Chicago, Illinois, United States of America
- Department of Radiology, University of Chicago, Chicago, Illinois, United States of America
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7
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Sinha P, Bhargava A, Carwile M, Cintron C, Cegielski J, Lönnroth K, Bhargava M, Carter EJ, Koura KG, Hochberg N. Avoiding pitfalls in calculating the population attributable fraction of undernutrition for TB. Int J Tuberc Lung Dis 2022; 26:80. [PMID: 34969436 PMCID: PMC9795805 DOI: 10.5588/ijtld.21.0634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- P. Sinha
- Boston Medical Center, Boston, MA,,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - A. Bhargava
- Department of Medicine, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India;,Department of Medicine, McGill University, Montreal, QC, Canada;,Center for Nutrition Studies, Yenepoya (deemed University), Mangalore, India
| | | | | | - J.P. Cegielski
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - K. Lönnroth
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - M. Bhargava
- Center for Nutrition Studies, Yenepoya (deemed University), Mangalore, India;,Department of Community Medicine, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India
| | - E. J. Carter
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep, Warren Alpert Medical School, Brown University, RI, USA
| | - K. G. Koura
- International Union Against Tuberculosis and Lung Disease, Paris,,Communauté d’universités et établissements Sorbonne Paris Cité, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France;,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Epidémiologique, Université de Parakou, Parakou, Benin
| | - N.S. Hochberg
- Boston Medical Center, Boston, MA,,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA;,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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8
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Hendley SA, Dimov A, Bhargava A, Snoddy E, Mansour D, Afifi RO, Wool GD, Zha Y, Sammet S, Lu ZF, Ahmed O, Paul JD, Bader KB. Assessment of histological characteristics, imaging markers, and rt-PA susceptibility of ex vivo venous thrombi. Sci Rep 2021; 11:22805. [PMID: 34815441 PMCID: PMC8610976 DOI: 10.1038/s41598-021-02030-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/08/2021] [Indexed: 12/27/2022] Open
Abstract
Venous thromboembolism is a significant source of morbidity and mortality worldwide. Catheter-directed thrombolytics is the primary treatment used to relieve critical obstructions, though its efficacy varies based on the thrombus composition. Non-responsive portions of the specimen often remain in situ, which prohibits mechanistic investigation of lytic resistance or the development of diagnostic indicators for treatment outcomes. In this study, thrombus samples extracted from venous thromboembolism patients were analyzed ex vivo to determine their histological properties, susceptibility to lytic therapy, and imaging characteristics. A wide range of thrombus morphologies were observed, with a dependence on age and etymology of the specimen. Fibrinolytic inhibitors including PAI-1, alpha 2-antiplasmin, and TAFI were present in samples, which may contribute to the response venous thrombi to catheter-directed thrombolytics. Finally, a weak but significant correlation was observed between the response of the sample to lytic drug and its magnetic microstructure assessed with a quantitative MRI sequence. These findings highlight the myriad of changes in venous thrombi that may promote lytic resistance, and imaging metrics that correlate with treatment outcomes.
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Affiliation(s)
- Samuel A Hendley
- Committee on Medical Physics, University of Chicago, Chicago, IL, 60637, USA
| | - Alexey Dimov
- Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Aarushi Bhargava
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Erin Snoddy
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Daniel Mansour
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Rana O Afifi
- Department of Cardiothoracic and Vascular Surgery, University of Texas at Houston, Houston, TX, 77030, USA
| | - Geoffrey D Wool
- Department of Pathology, University of Chicago, Chicago, IL, 60637, USA
| | - Yuanyuan Zha
- The Human Immunological Monitoring Facility, University of Chicago, Chicago, IL, 60637, USA
| | - Steffen Sammet
- Committee on Medical Physics, University of Chicago, Chicago, IL, 60637, USA.,Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Zheng Feng Lu
- Committee on Medical Physics, University of Chicago, Chicago, IL, 60637, USA.,Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Osman Ahmed
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Jonathan D Paul
- Department of Medicine, University of Chicago, Chicago, IL, 60637, USA
| | - Kenneth B Bader
- Committee on Medical Physics, University of Chicago, Chicago, IL, 60637, USA. .,Department of Radiology, University of Chicago, Chicago, IL, 60637, USA.
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9
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Kaul S, Rao C, Mane R, Tan KL, Khan AHA, Hussain MS, Shafi MA, Buettner F, Banerjee S, Boulton R, Bhargava A, Huang J, Hanson M, Raouf S, Ball S, Rajendran N. Is the Management of Rectal Cancer Using a Watch and Wait Approach Feasible, Safe and Effective in a Publicly Funded General Hospital? Clin Oncol (R Coll Radiol) 2021; 34:e25-e34. [PMID: 34454807 DOI: 10.1016/j.clon.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/03/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
AIMS Although there is emerging evidence to suggest equivalent oncological outcomes using a watch and wait approach compared with primary total mesorectal excision surgery, there is a paucity of evidence about the safety and efficacy of this approach in routine clinical practice. Here we report the long-term outcomes and quality of life from patients managed with watch and wait following a clinical complete response (cCR) to neoadjuvant therapy. MATERIALS AND METHODS Patients with adenocarcinoma of the rectum with cCR following neoadjuvant therapy managed using watch and wait were retrospectively identified. Demographic data, performance status, pretreatment staging information, oncological and surgical outcomes were obtained from routinely collected clinical data. Quality of life was measured by trained clinicians during telephone interviews. RESULTS Over a 7-year period, 506 patients were treated for rectal cancer, 276 had neoadjuvant therapy and 72 had a cCR (26.1%). Sixty-three were managed with watch and wait. Thirteen patients had mucosal regrowth. There was no significant difference in the incidence of metastatic disease between the surgical and watch and wait cohorts (P = 0.38). The 13 patients with mucosal regrowth underwent salvage surgery. Eleven of the patients who underwent surgical resection had R0 resections. There was also a statistically and clinically significant improvement in the Functional Assessment of Cancer Therapy - Colorectal (FACT-C) trial outcome index (P = 0.022). CONCLUSION This study shows that watch and wait is safe and effective outside of tertiary referral centres. It suggests that an opportunistic cCR is durable and when mucosal regrowth occurs it can be salvaged. Finally, we have shown that quality of life is probably improved if a watch and wait approach is adopted.
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Affiliation(s)
- S Kaul
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - C Rao
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK; Department of Surgery and Cancer, Imperial College London, London, UK; North Cumbria Integrated Care NHS Foundation Trust, UK.
| | - R Mane
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - K L Tan
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - A H A Khan
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - M S Hussain
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - M A Shafi
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - F Buettner
- German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Centre (DKFZ), Heidelberg, Germany; Department of Medicine, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - S Banerjee
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - R Boulton
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - A Bhargava
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK; Institute of Health, Barts and London Medical School, Queen Mary University of London (QMUL), London, UK
| | - J Huang
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - M Hanson
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - S Raouf
- Barts Health NHS Trust, London, UK
| | - S Ball
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - N Rajendran
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK.
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10
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Abstract
Deep vein thrombosis (DVT) is a global health concern. The primary approach to achieve vessel recanalization for critical obstructions is catheter-directed thrombolytics (CDT). To mitigate caustic side effects and the long treatment time associated with CDT, adjuvant and alternative approaches are under development. One such approach is histotripsy, a focused ultrasound therapy to ablate tissue via bubble cloud nucleation. Pre-clinical studies have demonstrated strong synergy between histotripsy and thrombolytics for clot degradation. This report outlines a benchtop method to assess the efficacy of histotripsy-aided thrombolytic therapy, or lysotripsy. Clots manufactured from fresh human venous blood were introduced into a flow channel whose dimensions and acousto-mechanical properties mimic an iliofemoral vein. The channel was perfused with plasma and the lytic recombinant tissue-type plasminogen activator. Bubble clouds were generated in the clot with a focused ultrasound source designed for the treatment of femoral venous clots. Motorized positioners were used to translate the source focus along the clot length. At each insonation location, acoustic emissions from the bubble cloud were passively recorded, and beamformed to generate passive cavitation images. Metrics to gauge treatment efficacy included clot mass loss (overall treatment efficacy), and the concentrations of D-dimer (fibrinolysis) and hemoglobin (hemolysis) in the perfusate. There are limitations to this in vitro design, including lack of means to assess in vivo side effects or dynamic changes in flow rate as the clot lyses. Overall, the setup provides an effective method to assess the efficacy of histotripsy-based strategies to treat DVT.
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Affiliation(s)
| | | | - Kenneth B Bader
- Department of Radiology, University of Chicago; Graduate Program in Medical Physics, University of Chicago
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11
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Habib Bedwani NAR, Kelada M, Smart N, Szydlo R, Patten DK, Bhargava A. Glue versus mechanical mesh fixation in laparoscopic inguinal hernia repair: meta-analysis and trial sequential analysis of randomized clinical trials. Br J Surg 2021; 108:14-23. [PMID: 33640918 DOI: 10.1093/bjs/znaa002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The optimal choice for mesh fixation in laparoscopic inguinal hernia repair (LIHR) has not been well established. This review compared the effects of glue versus mechanical mesh fixation in LIHR on incidence of chronic postoperative inguinal pain (CPIP) and other secondary outcomes, including acute pain, seroma, haematoma, hernia recurrence and other postoperative complications. METHODS A systematic review of English/non-English studies using MEDLINE, the Cochrane Library, OpenGrey, OpenThesis and Web of Science, and searching bibliographies of included studies was completed. Search terms included laparoscopic, hernia, fibrin glue, Tisseel, Tissucol, cyanoacrylate, Glubran and Liquiband. Only RCTs comparing mechanical with glue-based fixation in adult patients (aged over 18 years) that examined CPIP were included. Two authors independently completed risk-of-bias assessment and data extraction against predefined data fields. All pooled analyses were computed using a random-effects model. RESULTS Fifteen RCTs met the inclusion criteria; 2777 hernias among 2109 patients were assessed. The incidence of CPIP was reduced with use of glue-based fixation (risk ratio (RR) 0.36, 95 per cent c.i. 0.19 to 0.69; P = 0.002), with moderate heterogeneity that disappeared with sensitivity analysis (8 d.f.) for patient-blinded studies (RR 0.43, 0.27 to 0.86). Trial sequential analysis provided evidence for a relative risk reduction of at least 25 per cent. The incidence of haeamtoma was reduced by using glue-based fixation (RR 0.29, 0.10 to 0.82; P = 0.02) with no significant effects on seroma formation or hernia recurrence (RR 1.07, 0.46 to 2.47; P = 0.88). CONCLUSION Glue-based mesh fixation appears to reduce the incidence of CPIP and haematoma after LIHR compared with mechanical fixation, with comparable recurrence rates.
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Affiliation(s)
- N A R Habib Bedwani
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - M Kelada
- Imperial College School of Medicine, Imperial College London, London, UK
| | - N Smart
- Department of General Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Department of Gastrointestinal Surgery, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - R Szydlo
- Imperial College School of Medicine, Imperial College London, London, UK
| | - D K Patten
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK.,Imperial College School of Medicine, Imperial College London, London, UK.,Deparment of Surgery and Cancer, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK
| | - A Bhargava
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK.,Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK
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Bhargava A, Trakroo A, Dash D, Pandey R, Singh J, Singh Thakur A, Agarwala P. First comprehensive study on neonatal septicaemia at secondary-level public health-care facilities in Central India: An eye opener. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Bhargava M, Shewade HD, Bhargava A. TB in Indian adolescents: results from a nationally representative survey, 2015-2016. Int J Tuberc Lung Dis 2020; 24:1247-1253. [PMID: 33317667 DOI: 10.5588/ijtld.20.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Adolescents (age: 15-19 years) from the National Family Health Survey-4 (2015-2016), India.OBJECTIVE: To examine the sociodemographic and nutritional characteristics of adolescents with reported TB and those with a reported household TB exposure.METHODS: This was a cross-sectional study using secondary data. We assessed the factors associated with TB (reported in adolescents, or in a household member) using log binomial regression. We used height-for-age and body mass index for age Z-scores for stunting and thinness, respectively.RESULTS: Of the total 277 059 adolescents, 377 (136/100 000, 95%CI 123-151) were reported with TB and this was similar in both sexes. Another 4528 adolescents (1.6%, 95%CI 1.6-1.7) reported household TB exposure. Poverty and urban residence were associated with higher prevalence of TB and household TB exposure. The proportion of stunting was 40.7% (95%CI 33.5-48.0) in adolescents with reported TB and 38.2% (95%CI 36.2-40.2) (P = 0.248) in those with household TB exposure.CONCLUSION: Prevalence of reported adolescent TB was lower than adult TB. Poverty and urban residence were risk factors for both TB and household TB exposure. Chronic undernutrition was highly prevalent among those reported to have TB and in those at risk of TB by virtue of having household TB exposure.
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Affiliation(s)
- M Bhargava
- Centre for Nutrition Studies, Yenepoya (deemed) University, Mangalore, Department of Community Medicine, Yenepoya Medical College, Mangalore, India
| | - H D Shewade
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union South-East Asia Office, New Delhi
| | - A Bhargava
- Centre for Nutrition Studies, Yenepoya (deemed) University, Mangalore, Department of General Medicine, Yenepoya Medical College, Mangalore, India
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14
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Lomakin AJ, Cattin CJ, Cuvelier D, Alraies Z, Molina M, Nader GPF, Srivastava N, Sáez PJ, Garcia-Arcos JM, Zhitnyak IY, Bhargava A, Driscoll MK, Welf ES, Fiolka R, Petrie RJ, De Silva NS, González-Granado JM, Manel N, Lennon-Duménil AM, Müller DJ, Piel M. The nucleus acts as a ruler tailoring cell responses to spatial constraints. Science 2020; 370:eaba2894. [PMID: 33060332 PMCID: PMC8059074 DOI: 10.1126/science.aba2894] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/29/2020] [Accepted: 08/28/2020] [Indexed: 12/12/2022]
Abstract
The microscopic environment inside a metazoan organism is highly crowded. Whether individual cells can tailor their behavior to the limited space remains unclear. In this study, we found that cells measure the degree of spatial confinement by using their largest and stiffest organelle, the nucleus. Cell confinement below a resting nucleus size deforms the nucleus, which expands and stretches its envelope. This activates signaling to the actomyosin cortex via nuclear envelope stretch-sensitive proteins, up-regulating cell contractility. We established that the tailored contractile response constitutes a nuclear ruler-based signaling pathway involved in migratory cell behaviors. Cells rely on the nuclear ruler to modulate the motive force that enables their passage through restrictive pores in complex three-dimensional environments, a process relevant to cancer cell invasion, immune responses, and embryonic development.
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Affiliation(s)
- A J Lomakin
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria.
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases (LBI-RUD), Vienna, Austria
- CeMM Research Center for Molecular Medicine, Austrian Academy of Sciences (ÖAW), Vienna, Austria
- Medical University of Vienna (MUV), Vienna, Austria
- Centre for Stem Cells and Regenerative Medicine, School of Basic and Medical Biosciences, King's College London, London, UK
- Institut Curie, PSL Research University, CNRS, UMR 144, Paris, France
| | - C J Cattin
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
| | - D Cuvelier
- Institut Curie, PSL Research University, CNRS, UMR 144, Paris, France
- Institut Pierre Gilles de Gennes, PSL Research University, Paris, France
| | - Z Alraies
- Institut Curie, PSL Research University, CNRS, UMR 144, Paris, France
- Institut Pierre Gilles de Gennes, PSL Research University, Paris, France
- Institut Curie, PSL Research University, INSERM, U 932, Paris, France
| | - M Molina
- Centre for Stem Cells and Regenerative Medicine, School of Basic and Medical Biosciences, King's College London, London, UK
| | - G P F Nader
- Institut Curie, PSL Research University, CNRS, UMR 144, Paris, France
- Institut Pierre Gilles de Gennes, PSL Research University, Paris, France
| | - N Srivastava
- Institut Curie, PSL Research University, CNRS, UMR 144, Paris, France
- Institut Pierre Gilles de Gennes, PSL Research University, Paris, France
| | - P J Sáez
- Institut Curie, PSL Research University, CNRS, UMR 144, Paris, France
- Institut Pierre Gilles de Gennes, PSL Research University, Paris, France
| | - J M Garcia-Arcos
- Institut Curie, PSL Research University, CNRS, UMR 144, Paris, France
- Institut Pierre Gilles de Gennes, PSL Research University, Paris, France
| | - I Y Zhitnyak
- Institut Curie, PSL Research University, CNRS, UMR 144, Paris, France
- Institut Pierre Gilles de Gennes, PSL Research University, Paris, France
- N.N. Blokhin Medical Research Center of Oncology, Moscow, Russia
| | - A Bhargava
- Institut Curie, PSL Research University, INSERM, U 932, Paris, France
| | - M K Driscoll
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - E S Welf
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R Fiolka
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R J Petrie
- Department of Biology, Drexel University, Philadelphia, PA, USA
| | - N S De Silva
- Institut Curie, PSL Research University, INSERM, U 932, Paris, France
| | - J M González-Granado
- LamImSys Lab, Departamento de Fisiología, Facultad de Medicina, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - N Manel
- Institut Curie, PSL Research University, INSERM, U 932, Paris, France
| | | | - D J Müller
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland.
| | - M Piel
- Institut Curie, PSL Research University, CNRS, UMR 144, Paris, France.
- Institut Pierre Gilles de Gennes, PSL Research University, Paris, France
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15
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Sinha P, Carwile M, Bhargava A, Cintron C, Acuna-Villaorduna C, Lakshminarayan S, Liu AF, Kulatilaka N, Locks L, Hochberg NS. How much do Indians pay for tuberculosis treatment? A cost analysis. Public Health Action 2020; 10:110-117. [PMID: 33134125 DOI: 10.5588/pha.20.0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/25/2020] [Indexed: 11/10/2022] Open
Abstract
Setting India's National Tuberculosis Elimination Programme (NTEP) covers diagnostic and therapeutic costs of TB treatment. However, persons living with TB (PLWTB) continue to experience financial distress due to direct costs (payment for testing, treatment, travel, hospitalization, and nutritional supplements) and indirect costs (lost wages, loan interest, and cost of domestic helpers). Objective To analyze the magnitude and pattern of TB-related costs from the perspective of Indian PLWTB. Design We identified relevant articles using key search terms ('tuberculosis,' 'India,' 'cost,' 'expenditures,' 'financing,' 'catastrophic' and 'out of pocket') and calculated variance-weighted mean costs. Results Indian patients incur substantial direct costs (mean: US$46.8). Mean indirect costs (US$666.6) constitute 93.4% of the net costs. Mean direct costs before diagnosis can be up to four-fold that of costs during treatment. Treatment in the private sector can result in costs up to six-fold higher than in government facilities. As many as one in three PLWTB in India experience catastrophic costs. Conclusion PLWTB in India face high direct and indirect costs. Priority interventions to realize India's goal of eliminating catastrophic costs from TB include decreasing diagnostic delays through active case finding, reducing the need for travel, improving awareness and perception of NTEP services, and ensuring sufficient reimbursement for inpatient TB care.
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Affiliation(s)
- P Sinha
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA
| | - M Carwile
- Department of Global Health, Boston University School of Public Health, MA, USA
| | - A Bhargava
- Department of Medicine, Yenepoya Medical College, Mangalore, India.,Department of Medicine, McGill University, Montreal, Quebec, Canada.,Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, India
| | - C Cintron
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA
| | - C Acuna-Villaorduna
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA
| | - S Lakshminarayan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - A F Liu
- Department of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA
| | - N Kulatilaka
- Susilo Institute for Ethics in a Global Economy, Boston University Questrom School of Business, Boston, MA, USA
| | - L Locks
- Department of Health Sciences, Sargent College, Boston University College of Health & Rehabilitation Sciences, Boston, MA, USA
| | - N S Hochberg
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA.,Department of Epidemiology, Boston University School of Public Health, MA, USA
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16
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Barrett K, Habib Bedwani N, Arya S, Bhargava A. Colorectal cancer referrals during the COVID-19 pandemic - a model for the faster diagnosis standard? Br J Surg 2020; 107:e531-e532. [PMID: 32871025 PMCID: PMC7929102 DOI: 10.1002/bjs.12008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022]
Affiliation(s)
- K Barrett
- Department of Surgery, Digestive Diseases Centre, King George Hospital, Barking Havering and Redbridge University Hospitals NHS Trust (BHRUT), Barley Lane, Goodmayes, London, IG3 8YB
| | - N Habib Bedwani
- Department of Surgery, Digestive Diseases Centre, King George Hospital, Barking Havering and Redbridge University Hospitals NHS Trust (BHRUT), Barley Lane, Goodmayes, London, IG3 8YB
| | - S Arya
- Department of Surgery, Digestive Diseases Centre, King George Hospital, Barking Havering and Redbridge University Hospitals NHS Trust (BHRUT), Barley Lane, Goodmayes, London, IG3 8YB
| | - A Bhargava
- Department of Surgery, Digestive Diseases Centre, King George Hospital, Barking Havering and Redbridge University Hospitals NHS Trust (BHRUT), Barley Lane, Goodmayes, London, IG3 8YB
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17
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Bhargava A, Subash P, Singh A. Novel method for mandibular fracture reduction using inter-fragmentary screw - report of a surgical technique. Br J Oral Maxillofac Surg 2020; 58:e328-e329. [PMID: 32819748 DOI: 10.1016/j.bjoms.2020.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/21/2020] [Indexed: 11/15/2022]
Affiliation(s)
- A Bhargava
- Global SNG Hospital, Indore, M.P., India
| | - P Subash
- Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - A Singh
- Manipal College of Dental Sciences, Manipal, Karnataka, India.
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18
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Bhargava A, Meesala VC, Hajj MR, Shahab S. Nonlinear effects in high-intensity focused ultrasound power transfer systems. Appl Phys Lett 2020. [DOI: 10.1063/5.0019721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Aarushi Bhargava
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - Vamsi C. Meesala
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - Muhammad R. Hajj
- Department of Civil, Environmental and Ocean Engineering, Davidson Laboratory, Stevens Institute of Technology, Hoboken, New Jersey 07030, USA
| | - Shima Shahab
- Department of Mechanical Engineering, Virginia Tech, Blacksburg, Virginia 24061, USA
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19
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Linton E, Walkden A, Steeples LR, Bhargava A, Williams C, Bailey C, Quhill FM, Kelly SP. Retinal burns from laser pointers: a risk in children with behavioural problems. Eye (Lond) 2019; 33:492-504. [PMID: 30546136 PMCID: PMC6460723 DOI: 10.1038/s41433-018-0276-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/21/2018] [Accepted: 11/04/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To explore self-inflicted retinal burns from laser pointers in children. METHODS Literature review of laser pointer retinal injuries in childhood and online survey of UK Consultant Ophthalmologists. A cohort of local children with self-inflicted injury is described. The matter is topical. We review progress in recent legislation and policy change in the UK. RESULTS Four of 77 case reports of laser burns in childhood analysed reported psychological or behavioural issues. Three of four children in our cohort had such issues. Delay in diagnosis occurred in two of our patients. Structural retinal damage persisted for over 12 months in all four children (seven eyes). Our survey of UK ophthalmologists found 159 cases of injury (85% male), 80% under 20 years of age. The majority of the laser pointers were purchased online. Many patients (36%) suffered moderate vision loss (6/18 to 6/60 Snellen), while 17% (at least 11 patients) suffered severe vision loss (<6/60 Snellen). CONCLUSION We highlight the risk of macular damage and vision loss from handheld lasers specifically in children with behavioural, learning or mental health issues. The diagnosis may be difficult or delayed in such children. In children with uncertain macular changes, ophthalmologists should explore the history for possible instances of exposure to handheld lasers pointers. Regulatory authorities and manufacturers of handheld lasers need to be aware of the risk to children. Furthermore, there is a need to better inform parents, carers and teachers of the risk of ocular self-injury from such lasers pointers.
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Affiliation(s)
- E Linton
- Department of Ophthalmology, Bolton Hospitals NHS Foundation Trust, Bolton, UK
| | - A Walkden
- Department of Ophthalmology, Lancashire Teaching Hospitals NHS Foundation Hospital, Preston, UK
| | - L R Steeples
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - A Bhargava
- Department of Ophthalmology, Lancashire Teaching Hospitals NHS Foundation Hospital, Preston, UK
| | - C Williams
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - C Bailey
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - F M Quhill
- Department of Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Kelly
- Department of Ophthalmology, Bolton Hospitals NHS Foundation Trust, Bolton, UK.
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20
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Bhargava M, Bhargava A, Akshaya KM, Shastri SG, Bairy R, Parmar M, Sharath BN. Nutritional assessment and counselling of tuberculosis patients at primary care in India: do we measure up? Int J Tuberc Lung Dis 2019; 23:147-150. [PMID: 30621811 DOI: 10.5588/ijtld.18.0333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Dakshina Kannada District, coastal South India, under the Revised National Tuberculosis Control Programme (RNTCP). OBJECTIVE To identify the potential and practices at primary health centres (PHCs) for the assessment of nutritional status of patients with tuberculosis (TB), the basic tools used to measure height and weight and the type of nutritional counselling provided. DESIGN A cross-sectional study was conducted with physical verification of availability of height and weight measuring equipment. Information was collected on the method used by medical officers for assessing nutritional status in PHCs, action taken in case the patient is undernourished and any formal training in nutritional assessment and counselling. RESULTS Of 37 PHCs assessed, weighing machines were available in all and stadiometers in 38%. Medical officers were not calculating body mass index for nutritional assessment even when height and weight were being uniformly measured. Nutritional classification was mostly based on the appearance and physique of the patient. Counselling included advice to take milk, eggs and protein powders with efforts to arrange funds from village health, sanitation and nutrition committees. CONCLUSION There is a need to equip the PHCs and their medical officers with necessary tools and training for nutritional assessment and counselling of patients with tuberculosis.
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Affiliation(s)
- M Bhargava
- Centre for Nutrition Studies, Yenepoya University, Mangalore, Department of Community Medicine
| | - A Bhargava
- Centre for Nutrition Studies, Yenepoya University, Mangalore, Department of General Medicine, Yenepoya Medical College, Mangalore
| | | | - S G Shastri
- State TB Office, Lady Willingdon Hospital, Bengaluru
| | - R Bairy
- State TB Office, Lady Willingdon Hospital, Bengaluru
| | - M Parmar
- World Health Organization, Country Office for India, New Delhi
| | - B N Sharath
- Department of Community Medicine, Employees State Insurance Corporation Medical College and Post Graduate Institute of Medical Science and Research, Bengaluru, India
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Bhargava A. Retrospective study to determine the effectiveness of combining pre-procedure clinical evaluation with fluoroscopy before diagnostic facet joint injection for evaluating the source of neck pain. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bhargava M, Bhargava A. Pyridoxine for patients suffering from drug-susceptible tuberculosis in India. Public Health Action 2018; 8:97. [PMID: 29946528 DOI: 10.5588/pha.18.0017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/20/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- M Bhargava
- Department of Community Medicine, Yenepoya Medical College, Mangalore, India.,Centre for Nutrition Studies, Yenepoya University, Mangalore, India
| | - A Bhargava
- Centre for Nutrition Studies, Yenepoya University, Mangalore, India.,Department of Internal Medicine, Yenepoya Medical College, Mangalore, India
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23
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Saxena S, Singh A, Singh P, Sundaragiri KS, Sankhla B, Bhargava A. Evaluating the Role of Immunological Cells (Tissue Eosinophils and Mast Cells) in Progression of Oral Squamous Cell Carcinoma. Mymensingh Med J 2018; 27:382-388. [PMID: 29769506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Mast cells and eosinophils are increased in oral squamous cell carcinoma. The significance of such an association has been variably thought to be either a potential diagnostic tool for stromal invasion or as a prognostic indicator. The aim of the study was to study the mast cells and eosinophils between normal oral mucosa, leukoplakia and oral squamous cell carcinoma and to study the significance of mast cells in the progression of the lesion. A retrospective study was done on archival tissue received from January 2015 to December 2015, in the Department of Oral Pathology, RUHS College of Dental Sciences, Jaipur, Rajasthan, India. Seventy (70) cases were studied (30 cases each of leukoplakia and carcinoma and 10 cases of control group), sections were stained with toluidine blue solution to reveal mast cells. Eosinophils were studied in Haematoxylin & Eosin stained sections. Mast cell density significantly increased from: normal mucosa to oral leukoplakia to carcinoma, suggesting a role of the mast cells in the development of these lesions. The higher eosinophil counts in carcinoma group compared to dysplasia group proved that they might have a role in stromal invasion. The assessment of these could become, in the future, useful for therapeutic approaches in this subset of the patient.
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Affiliation(s)
- S Saxena
- Dr Shikha Saxena, Assistant Professor, Department of Oral Pathology, RUHS College of Dental Sciences, Jaipur, Rajasthan, India; E-mail:
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Su C, Bhargava A, Shah C, Halmos B, Gucalp R, Packer S, Ohri N, Haramati L, Perez-Soler R, Cheng H. P2.13-008 Lung Cancer Screening Improves Mortality: Examining Screening Patterns in an Urban Underserved Community. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Liu S, Hagiwara SI, Bhargava A. Early-life adversity, epigenetics, and visceral hypersensitivity. Neurogastroenterol Motil 2017; 29:10.1111/nmo.13170. [PMID: 28782197 PMCID: PMC5576863 DOI: 10.1111/nmo.13170] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/27/2017] [Indexed: 12/12/2022]
Abstract
Abdominal pain is associated with many gastrointestinal dysfunctions, such as irritable bowel syndrome (IBS), functional dyspepsia, and inflammatory bowel disease (IBD). Visceral hypersensitivity is a key reason for development of abdominal pain that presents in these gastrointestinal disorders/diseases. The pathogenesis of visceral hypersensitivity is complex and still far from being fully understood. In animal studies, visceral hypersensitivity has been linked to several early-life adverse (ELA) events. In humans, IBD, functional dyspepsia, and IBS can have adult onset, though the adverse events that lead to visceral hypersensitivity are largely uncharacterized. In this issue of the journal, Aguirre et al. report the interesting finding that epigenetics underlies the effects of ELA events on visceral hypersensitivity. This mini-review examines models of ELA events leading to visceral hypersensitivity and the potential role of epigenetics, as reported by Aguirre et al. and others.
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Affiliation(s)
- S. Liu
- Department of Biology, College of Science and Health, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - SI. Hagiwara
- The Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - A. Bhargava
- The Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143, USA,Department of Ob-Gyn, University of California San Francisco, San Francisco, CA 94143, USA
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26
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Jaeckel E, Wysham C, Bhargava A, Chaykin L, de la Rosa R, Handelsman Y, Troelsen LN, Kvist K, Norwood P. Insulin degludec 100 E/ml (IDeg) zeigte gegenüber Insulin glargin 100 E/ml (IGlar) einen konsistenten Vorteil in Bezug auf Hypoglykämien bei Patienten mit T2D mit hohem Risiko für schwere Hypoglykämien: Eine randomisierte, doppelblinde Crossover-Studie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- E Jaeckel
- Medizinische Hochschule Hannover, Hannover, Germany
| | - C Wysham
- Rockwood Clinic, Spokane, United States
| | - A Bhargava
- Iowa Diabetes and Endocrinology Research Center, Des Moines, United States
| | - L Chaykin
- Meridien Research, Brandenton, United States
| | | | - Y Handelsman
- Metabolic Institute of America, Tarzana, United States
| | | | - K Kvist
- Novo Nordisk A/S, Søborg, Denmark
| | - P Norwood
- Valley Research, Fresno, United States
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27
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Bhargava A, Peng K, Stieg J, Mirzaeifar R, Shahab S. Focused ultrasound actuation of shape memory polymers; acoustic-thermoelastic modeling and testing. RSC Adv 2017. [DOI: 10.1039/c7ra07396h] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Controlled drug delivery (CDD) technologies have received extensive attention recently.
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Affiliation(s)
- Aarushi Bhargava
- Department of Biomedical Engineering and Mechanics
- Virginia Polytechnic Institute and State University
- Blacksburg
- USA
| | - Kaiyuan Peng
- Department of Mechanical Engineering
- Virginia Polytechnic Institute and State University
- Blacksburg
- USA
| | - Jerry Stieg
- Department of Mechanical Engineering
- Virginia Polytechnic Institute and State University
- Blacksburg
- USA
| | - Reza Mirzaeifar
- Department of Mechanical Engineering
- Virginia Polytechnic Institute and State University
- Blacksburg
- USA
| | - Shima Shahab
- Department of Biomedical Engineering and Mechanics
- Virginia Polytechnic Institute and State University
- Blacksburg
- USA
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28
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Garg S, Selam JL, Bhargava A, Schloot N, Luo J, Zhang Q, Jacobson JG, Hoogwerf BJ. Similar HbA1c reduction and hypoglycaemia with variable- vs fixed-time dosing of basal insulin peglispro in type 1 diabetes: IMAGINE 7 study. Diabetes Obes Metab 2016; 18 Suppl 2:43-49. [PMID: 27393722 DOI: 10.1111/dom.12740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/03/2016] [Indexed: 11/26/2022]
Abstract
AIMS To compare 24-hour fixed-time basal insulin peglispro (BIL) dosing with 8- to 40-hour variable-time BIL dosing for glycaemic control and safety in patients with type 1 diabetes. Primary outcome was non-inferiority of BIL variable-time dosing compared with fixed-time dosing for glycated haemoglobin (HbA1c) change after 12-week treatment (margin = 0.4%). MATERIALS AND METHODS This Phase 3, open-label, randomized, cross-over study (N = 212) was conducted at 20 centres in the United States. During the 12-week lead-in phase, patients received BIL daily at fixed-times. Two 12-week randomized cross-over treatment phases followed, where patients received BIL dosed at either fixed- or variable-times. During the 4-week safety follow-up, patients received conventional insulins. RESULTS During the lead-in period, least-squares mean HbA1c decreased from 7.5% to 6.8%. For BIL, variable-time dosing was non-inferior to fixed-time dosing for HbA1c change [least-squares mean difference = 0.06%, 95% confidence interval (-0.01, 0.13)]. In both regimens, HbA1c increased slightly during the cross-over periods, but remained significantly below baseline. Variable- and fixed-time dosing regimens had similar rates of total hypoglycaemia (10.4 ± 0.62 and 10.5 ± 0.67 events/patient/30 days, P = .947) and nocturnal hypoglycaemia (1.3 ± 0.11 and 1.5 ± 0.13 events/patient/30days, P = .060). Comparable proportions of patients achieved HbA1c < 7.0% with variable- [91 (54.5%)] and fixed-time dosing [101 (60.5%)]. CONCLUSIONS Treatment with BIL allows patients to use flexible dosing intervals from 8 to 40 hours. Glycaemic efficacy (HbA1c), glycaemic variability and hypoglycaemia are similar to fixed-time dosing, suggesting that BIL could potentially provide flexibility in dosing for patients who miss their daily basal insulin.
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Affiliation(s)
- S Garg
- Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora
| | - J-L Selam
- Diabetes Research Center, Tustin, California
| | - A Bhargava
- Iowa Diabetes and Endocrinology Research Center, Des Moines, Iowa
| | - N Schloot
- Lilly Deutschland GmbH, Bad Homburg, Germany
| | - J Luo
- Eli Lilly and Company, Indianapolis, Indiana
| | - Q Zhang
- Eli Lilly and Company, Indianapolis, Indiana
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29
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Kumar R, Jaiswal G, Bhargava A, Kundu J. Superior Mesenteric Artery Syndrome: Diagnosis and Management. Kathmandu Univ Med J (KUMJ) 2016; 14:288-291. [PMID: 28814697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Superior mesenteric artery syndrome is a life-threatening rare acquired upper gastrointestinal disorder due to mechanical compression of third part of duodenum by the acute angulation of Superior mesenteric artery, leading to obstruction. Acute loss of intervening mesenteric fat as a result of a variety of debilitating conditions is believed to be the etiologic factor causing the reduced aortomesenteric angle. Abdominal CT angiography showed the dilatation of second part of duodenum and vascular compression of the proximal third part of the duodenum between the aorta and superior mesenteric artery. We report a case of 15 year old young boy who presented with recurrent postprandial pain in the epigastric region, accompanied by epigastric fullness, nausea, postprandial bilious vomiting and weight loss. When conservative measures were ineffective, laparoscopic retrocolic duodenojejunostomy, side to side anastomosis, was performed in the patient to relieve the obstruction. This case report is unusual as it is concerned with the description of a rare disease entity and its radiological appearances for early preoperative diagnosis, better understanding and management of the disease are discussed in the pertinent light of literature.
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Affiliation(s)
- R Kumar
- Department of Radiodiagnosis, Geetanjali Medical College and Hospital, Geetanjali University, Udaipur, India
| | - G Jaiswal
- Department of Radiodiagnosis, Geetanjali Medical College and Hospital, Geetanjali University, Udaipur, India
| | - A Bhargava
- Department of Radiodiagnosis, Geetanjali Medical College and Hospital, Geetanjali University, Udaipur, India
| | - J Kundu
- Department of Prosthodontics, Geetanjali Dental and Research Institute, Geetanjali University, Udaipur, India
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30
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Gaikwad U, Arora R, Gade N, Kombade S, Das P, Negi S, Bhargava A. Corynebacterium diphtheriae: An emerging cause of chronic suppurative otitis media. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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31
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LeBlanc K, Jensen K, Krarup PM, Jorgensen L, Mynster T, Zappa B, Begolli L, Quazi S, Bhargava A, Luque JB, Suarez Gráu JM, Menchero JG, Moreno JG, Juraro JG, Ferreras ID, Nardi M, Millo P, Usai A, Lorusso R, Grivon M, Persico F, Allieta R, Christoffersen M, Brandt E, Helgstrand F, Westen M, Rosenberg J, Kehlet H, Strandfeit P, Bisgaard T, Vanini P, Kabbara S, Elia E, Piancastelli A, Guglielminetti D, Katsumoto F, Ahlqvist S, Björk D, Jänes A, Weisby-Enbom L, Israelsson L, Cengiz Y, Ndungu B, Kiragu P, Odende K, Jovanovic S, Pejcic V, Filipovic N, Trenkic M, Pavlovic A, Jovanovc B, Tatic M, Jovanovic A, Misra MC, Bansal VK, Subodh H, Krishna A, Bansal D, Ray S, Rajeshwari S, Björklund I, Burman A, Riccio PA, Vetrone G, Linguerri R, Liotta S, Antor M, Scottá M, Khalil H, Ichihara K, Takuo H, Ogawa M, Hidaka S, Hara K, Taki T, Ohashi S, Yoshida K, Galimov O, Shkundin A, Khanov V, Sarik J, Basta M, Bauder A, Kovach S, Fischer J, Tang L, Fei X, Xu M. Incisional Hernia: Daily Cases. Hernia 2015; 19 Suppl 1:S85-92. [PMID: 26518867 DOI: 10.1007/bf03355332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- K LeBlanc
- Our Lady of the Lake Physician Group, Baton Rouge, Louisiana, USA.,Department of Surgery, Louisiana State University School of Medicine, Baton Rouge, Louisiana, USA
| | - K Jensen
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - P-M Krarup
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark.,Danish Colorectal Cancer Group, Denmark
| | - L Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - T Mynster
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark.,Danish Colorectal Cancer Group, Denmark
| | - B Zappa
- King George Hospital, London, UK
| | | | - S Quazi
- King George Hospital, London, UK
| | | | | | | | | | | | | | | | - M Nardi
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - P Millo
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - A Usai
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - R Lorusso
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - M Grivon
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - F Persico
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - R Allieta
- Division of General Surgery, USL Valle D'Aosta - Umberto Parini Regional Hospital, Aosta, Italy
| | - M Christoffersen
- Gastro Unit, Surgical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - E Brandt
- Department of Gastrointestinal Surgery, Køge Hospital, University of Copenhagen, Køge, Denmark
| | - F Helgstrand
- Department of Gastrointestinal Surgery, Køge Hospital, University of Copenhagen, Køge, Denmark
| | - M Westen
- Gastro Unit, Surgical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - J Rosenberg
- Gastro Unit, Surgical Division, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - H Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - P Strandfeit
- Gastro Unit, Surgical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - T Bisgaard
- Gastro Unit, Surgical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - P Vanini
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | - S Kabbara
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | - E Elia
- Casa di Cura Privata Malatesta Novello, Cesena, Italy
| | | | | | - F Katsumoto
- Katsumoto Day Surgery Clinic, Kitakyusyu, Japan
| | - S Ahlqvist
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - D Björk
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - A Jänes
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - L Weisby-Enbom
- Department of Radiology, Sundsvall Hospital, Sundsvall, Sweden
| | - L Israelsson
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden.,Department of Surgery and Perioperative, Umeå University, Umeå, Sweden
| | - Y Cengiz
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden.,Department of Surgery and Perioperative, Umeå University, Umeå, Sweden
| | - B Ndungu
- The University of Nairobi, Nairobi, Kenya
| | - P Kiragu
- Maralal County Hospital, Maralal, Kenya
| | - K Odende
- Kenyatta National Hospital, Nairobi, Kenya
| | - S Jovanovic
- Center for minimally invasive surgery, Nis, Serbia
| | - V Pejcic
- Center for minimally invasive surgery, Nis, Serbia
| | - N Filipovic
- Center for minimally invasive surgery, Nis, Serbia
| | - M Trenkic
- Center for minimally invasive surgery, Nis, Serbia
| | - A Pavlovic
- Center for minimally invasive surgery, Nis, Serbia
| | - B Jovanovc
- Center for minimally invasive surgery, Nis, Serbia
| | - M Tatic
- Center for minimally invasive surgery, Nis, Serbia
| | - A Jovanovic
- Center for minimally invasive surgery, Nis, Serbia
| | - M C Misra
- All India Institute of Medical Sciences, New Delhi, India
| | - V K Bansal
- All India Institute of Medical Sciences, New Delhi, India
| | - H Subodh
- All India Institute of Medical Sciences, New Delhi, India
| | - A Krishna
- All India Institute of Medical Sciences, New Delhi, India
| | - D Bansal
- All India Institute of Medical Sciences, New Delhi, India
| | - S Ray
- All India Institute of Medical Sciences, New Delhi, India
| | - S Rajeshwari
- All India Institute of Medical Sciences, New Delhi, India
| | | | - A Burman
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | | | | | | | | | - M Antor
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | | | | | | | - H Takuo
- Katsusika Medical Center, Tokyo, Japan
| | - M Ogawa
- Katsusika Medical Center, Tokyo, Japan
| | - S Hidaka
- Katsusika Medical Center, Tokyo, Japan
| | - K Hara
- Katsusika Medical Center, Tokyo, Japan
| | - T Taki
- Katsusika Medical Center, Tokyo, Japan
| | - S Ohashi
- Katsusika Medical Center, Tokyo, Japan
| | - K Yoshida
- Katsusika Medical Center, Tokyo, Japan
| | - O Galimov
- Bashkir State Medical University, Ufa, Russia
| | - A Shkundin
- Bashkir State Medical University, Ufa, Russia
| | - V Khanov
- Bashkir State Medical University, Ufa, Russia
| | - J Sarik
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - M Basta
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - A Bauder
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - S Kovach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - J Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - L Tang
- Shaoxing people' hospital, Shaoxing, China
| | - X Fei
- Shaoxing people' hospital, Shaoxing, China
| | - M Xu
- Shaoxing people' hospital, Shaoxing, China
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Bhargava A, Arora S, Marcus RJ, Sureshkumar KK. Outcomes of paired-exchange live-donor kidney transplantation: a single-center experience. Transplant Proc 2015; 46:3420-2. [PMID: 25498064 DOI: 10.1016/j.transproceed.2014.06.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/17/2014] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Paired-exchange kidney transplantation (PEKT) enables recipients with willing but incompatible donors to find potential matches from a larger pool of donors. It involves transportation of donor kidneys to the intended recipient with a consequent increase in the cold ischemia time (CIT). PATIENTS AND METHODS Our single-center study compared the outcomes of PEKT versus traditional in-center live-donor kidney transplants (ICKT). Retrospective chart review of adult patients who underwent PEKT and ICKT from January 2009 to February 2012 at our institution was performed. Delayed graft function, acute rejection rates, incidence of proteinuria, trends in serum creatinine, and graft and patient survival rates were compared between groups. RESULTS Baseline demographic data were similar between the PEKT group (n = 15) and the ICKT group (n = 30) except that CIT (13.1 vs 3.8 hours; P < .001) and panel reactive antibody titers (12.6% ± 22.9% vs 0.9% ± 4.9%; P = .01) were significantly higher in the PEKT group. No patient developed delayed graft function. At a median follow-up of 12.4 months (range: 2-27.5 months), graft and patient survival rates were 100% in both groups. Serial creatinine levels were similar between the groups. There were no significant differences between groups in acute rejection rates (3 of 15 vs 3 of 30) and development of proteinuria posttransplantation (8 of 15 vs 22 of 30). CONCLUSIONS Our study found similar outcomes between the PEKT and ICKT groups despite longer CIT and higher panel reactive antibody titers in the PEKT group. These findings support the current practice of PEKT with transporting of donor kidneys, with the resultant increase in the chances of living-donor kidney transplantation.
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Affiliation(s)
- A Bhargava
- Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - S Arora
- Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - R J Marcus
- Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - K K Sureshkumar
- Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania.
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33
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Rosenstock J, Hollander P, Bhargava A, Ilag LL, Pollom RK, Zielonka JS, Huster WJ, Prince MJ. Similar efficacy and safety of LY2963016 insulin glargine and insulin glargine (Lantus®) in patients with type 2 diabetes who were insulin-naïve or previously treated with insulin glargine: a randomized, double-blind controlled trial (the ELEMENT 2 study). Diabetes Obes Metab 2015; 17:734-41. [PMID: 25931141 DOI: 10.1111/dom.12482] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/22/2015] [Accepted: 04/27/2015] [Indexed: 11/26/2022]
Abstract
AIMS To compare the efficacy and safety of LY2963016 insulin glargine (LY IGlar) and the reference product (Lantus(®)) insulin glargine (IGlar) in combination with oral antihyperglycaemic medications in patients with type 2 diabetes (T2D). METHODS This phase III, randomized, double-blind, 24-week study enrolled patients with T2D who were insulin-naïve [glycated haemoglobin (HbA1c) ≥7 and ≤11.0%] or previously on IGlar (HbA1c ≤11%) and treated with ≥2 oral antihyperglycaemic medications. Patients were randomized to receive once-daily LY IGlar (n = 376) or IGlar (n = 380) for 24 weeks. The primary efficacy outcome was to test the non-inferiority (0.4% and then 0.3% margin) of LY IGlar to IGlar, as measured by change in HbA1c from baseline to 24 weeks. RESULTS Both treatment groups had similar and significant (p < 0.001) within-group decreases in mean HbA1c values from baseline. LY IGlar met non-inferiority criteria compared with IGlar for change in HbA1c from baseline [-1.29 vs -1.34%; respectively, least-squares mean difference 0.052% (95% confidence interval -0.070 to 0.175); p > 0.05]. There were no treatment differences (p > 0.05) in fasting plasma glucose, proportion of patients reaching HbA1c <7% or insulin dose at 24 weeks. Adverse events, allergic reactions, weight change, hypoglycaemia and insulin antibodies were similar between treatment groups. Similar findings were observed in patients who were insulin-naïve or previously treated with IGlar at baseline. CONCLUSIONS Both LY IGlar and IGlar, when used in combination with oral antihyperglycaemic medications, provided effective and similar glucose control with similar safety profiles in patients with T2D.
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Affiliation(s)
- J Rosenstock
- Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX, USA
| | | | - A Bhargava
- Iowa Diabetes and Endocrinology Research Center, Des Moines, IA, USA
| | - L L Ilag
- Eli Lilly and Company, Indianapolis, IN, USA
| | - R K Pollom
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - W J Huster
- Eli Lilly and Company, Indianapolis, IN, USA
| | - M J Prince
- Eli Lilly and Company, Indianapolis, IN, USA
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Lee LH, Al-Maiyah M, Al-Bahrani RZ, Bhargava A, Auyeung J, Stothard J. Outcome of carpal tunnel release--correlation with wrist and wrist-palm anthropomorphic measurements. J Hand Surg Eur Vol 2015; 40:186-92. [PMID: 24554691 DOI: 10.1177/1753193414523900] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Wrist and wrist-palm measurements have been associated with the diagnosis of carpal tunnel syndrome. We found no reported study about how this correlation affects the outcome after surgery. We investigated the role of the measurements in predicting outcome after open carpal tunnel release. A total of 131 patients (88 female, 43 male) responded to our postal questionnaire using the Boston Carpal Tunnel assessment (65% response rate) at a minimum of 9 months post-operatively. Symptom and functional scores showed a strong correlation. There was no statistical difference in the outcome between wrist ratio (≥0.7 vs <0.7), wrist-palm ratio (≥0.41 vs <0.41) and gender, but a better functional score was very weakly correlated with a higher wrist ratio. A very large study would be needed to show any statistical correlation between both measurement and outcome.
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Affiliation(s)
- L H Lee
- Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - M Al-Maiyah
- Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - R Z Al-Bahrani
- Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - A Bhargava
- Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - J Auyeung
- Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - J Stothard
- Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK
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Holme JA, Nyvold HE, Tat V, Arlt VM, Bhargava A, Gutzkow KB, Solhaug A, Låg M, Becher R, Schwarze PE, Ask K, Ekeren L, Øvrevik J. Mechanisms linked to differences in the mutagenic potential of 1,3-dinitropyrene and 1,8-dinitropyrene. Toxicol Rep 2014; 1:459-473. [PMID: 28962260 PMCID: PMC4547165 DOI: 10.1016/j.toxrep.2014.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/07/2014] [Accepted: 07/08/2014] [Indexed: 11/22/2022] Open
Abstract
This study explores and characterizes the toxicity of two closely related carcinogenic dinitro-pyrenes (DNPs), 1,3-DNP and 1,8-DNP, in human bronchial epithelial BEAS-2B cells and mouse hepatoma Hepa1c1c7 cells. Neither 1,3-DNP nor 1,8-DNP (3–30 μM) induced cell death in BEAS-2B cells. In Hepa1c1c7 cells only 1,3-DNP (10–30 μM) induced a mixture of apoptotic and necrotic cell death after 24 h. Both compounds increased the level of reactive oxygen species (ROS) in BEAS-2B as measured by CM-H2DCFDA-fluorescence. A corresponding increase in oxidative damage to DNA was revealed by the formamidopyrimidine-DNA glycosylase (fpg)-modified comet assay. Without fpg, DNP-induced DNA damage detected by the comet assay was only found in Hepa1c1c7 cells. Only 1,8-DNP formed DNA adduct measured by 32P-postlabelling. In Hepa1c1c cells, 1,8-DNP induced phosphorylation of H2AX (γH2AX) and p53 at a lower concentration than 1,3-DNP and there was no direct correlation between DNA damage/DNA damage response (DR) and induced cytotoxicity. On the other hand, 1,3-DNP-induced apoptosis was inhibited by pifithrin-α, an inhibitor of p53 transcriptional activity. Furthermore, 1,3-DNP triggered an unfolded protein response (UPR), as measured by an increased expression of CHOP, ATF4 and XBP1. Thus, other types of damage possibly linked to endoplasmic reticulum (ER)-stress and/or UPR could be involved in the induced apoptosis. Our results suggest that the stronger carcinogenic potency of 1,8-DNP compared to 1,3-DNP is linked to its higher genotoxic effects. This in combination with its lower potency to induce cell death may increase the probability of causing mutations.
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Key Words
- 1,3-DNP, 1,3-dinitropyrene
- 1,3-Dinitropyrene
- 1,8-DNP, 1,8-dinitropyrene
- 1,8-Dinitropyrene
- 1-NP, 1-nitropyrene
- 3-NBA, 3-nitrobenzanthrone
- AhR, aromatic hydrocarbon receptor
- Apoptosis
- B[a]P, benzo[a]pyrene
- CM-H2DCFDA or H2DCFDA, 5-(and 6-)chloromethyl-2,7-dichlorodihydrofluorescein diacetate
- CYP, cytochrome P450
- Chk, checkpoint kinases
- DDR, DNA damage response
- DHE, dihydroethidium
- DMSO, dimethyl sulfoxide
- DNA damage
- ER, endoplasmic reticulum
- Hoechst 33258, 2(2-(4-hydroxyphenyl)-6-benzimidazole-6-(1-methyl-4-piperazyl)benzimidazole hydrochloride)
- Hoechst 33342, 2′-(4-ethoxyphenyl)-2′,5′-bis-1H-benzimidazole hydrochloride)
- NR, nitro-reductasesnitro-PAHnitro substituted-polycyclic aromatic hydrocarbon
- Nitro-PAHs
- PAH, polycyclic aromatic hydrocarbon
- PARP, poly(ADP-ribose) polymerase
- PFT, pifithrin
- PI, propidium iodide
- PM, particular matter
- RNS, reactive nitrogen species
- ROS, reactive oxygen species
- SSB, single strand breaks
- UPR, unfolded protein response
- fpg, formamidopyrimidine-DNA glycosylase
- zVAD-FMK, benzyolcarbonayl-Val-Ala-Asp-fluoromethyl ketone
- γH2AX, phosphorylated H2AX
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Affiliation(s)
- J A Holme
- Division of Environmental Medicine, Norwegian Institute of Public Health, N-0403 Oslo, Norway
| | - H E Nyvold
- Division of Environmental Medicine, Norwegian Institute of Public Health, N-0403 Oslo, Norway
| | - V Tat
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - V M Arlt
- Analytical and Environmental Sciences Division, MRC-PHE Centre for Environment and Health, King's College London, London, United Kingdom
| | - A Bhargava
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - K B Gutzkow
- Division of Environmental Medicine, Norwegian Institute of Public Health, N-0403 Oslo, Norway
| | - A Solhaug
- Norwegian Veterinary Institute, Oslo, Norway
| | - M Låg
- Division of Environmental Medicine, Norwegian Institute of Public Health, N-0403 Oslo, Norway
| | - R Becher
- Division of Environmental Medicine, Norwegian Institute of Public Health, N-0403 Oslo, Norway
| | - P E Schwarze
- Division of Environmental Medicine, Norwegian Institute of Public Health, N-0403 Oslo, Norway
| | - K Ask
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - L Ekeren
- Division of Environmental Medicine, Norwegian Institute of Public Health, N-0403 Oslo, Norway
| | - J Øvrevik
- Division of Environmental Medicine, Norwegian Institute of Public Health, N-0403 Oslo, Norway
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Soni S, Bhargava A. Revisiting peripheral osteoma of the mandible with case series and review of literature. Indian J Otolaryngol Head Neck Surg 2014; 66:212-8. [PMID: 24822166 PMCID: PMC4016348 DOI: 10.1007/s12070-012-0583-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 10/17/2012] [Indexed: 10/27/2022] Open
Abstract
Osteomas are benign lesions composed of mature compact and cancellous bone usually arising from craniofacial region. They can be central or peripheral, solitary or multiple. We are presenting few cases of giant peripheral osteoma's of the mandible along with review literature of other jaw lesions with their diagnostic features and differential diagnosis. The purpose of presenting this paper is to evaluate radiopaque lesions of the jaw which require proper clinical and histological evaluation to reach a final diagnosis.
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Affiliation(s)
- S. Soni
- />Department of ENT, Gandhi Medical College, F-1 Doctor’s Quarter Idgah Hills, Bhopal, 462001 India
| | - A. Bhargava
- />Department of Dental Surgery, Gandhi Medical College, Bhopal, 462001 India
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Bhargava A, Gleason S, Vaughan AG, Johnson JF, Yarlagadda KVSN. The effect of pioglitazone and extended-release niacin on HDL-cholesterol in diabetes patients in a real-world setting. Int J Clin Pract 2013; 67:1151-8. [PMID: 24165429 DOI: 10.1111/ijcp.12199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 04/20/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This retrospective study was designed to assess the effects of the combination of pioglitazone and extended-release niacin on the lipid panel, particularly HDL-cholesterol, when used in patients with type 2 diabetes in an endocrinology specialty practice. METHODS The electronic medical records of 434 adult patients with type 2 diabetes receiving extended-release niacin and pioglitazone were screened for review. Patients with type 2 diabetes and hyperlipidemia were included for review if they received the combination of pioglitazone at doses ≥ 15 mg/day and extended-release niacin (Niaspan) at doses ≥ 1000 mg/day for ≥6 months. Statistical analysis used paired t-tests with p < 0.05 as statistically significant. Both ANOVA and the Tukey-Kramer test for multiple comparisons (α = 0.05) were also used. RESULTS A total of 47 patients, 83% were men with average age of 58, met all eligibility criteria for the study. Compared with baseline, a statistically significant increase in HDL-C (+ 25.13%, p < 0.0001) was observed at the conclusion of combination therapy. The HDL-C levels progressively increased with duration of combination treatment, and were not correlated with concomitant statin use. Significant decreases in total cholesterol and triglycerides were detected, and HbA1c decreased 0.84% during combination therapy for all therapies combined. CONCLUSION The combination of pioglitazone and extended-release niacin in patients with type 2 diabetes and hyperlipidemia, used in commonly prescribed doses for at least 6 months, resulted in statistically significant improvements in HDL-C, total cholesterol, and triglycerides, and did not result in deteriorations in glycemic control.
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Affiliation(s)
- A Bhargava
- Iowa Diabetes & Endocrinology Research Center, Des Moines, Iowa
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Philis-Tsimikas A, Del Prato S, Satman I, Bhargava A, Dharmalingam M, Skjøth TV, Rasmussen S, Garber AJ. Effect of insulin degludec versus sitagliptin in patients with type 2 diabetes uncontrolled on oral antidiabetic agents. Diabetes Obes Metab 2013; 15:760-6. [PMID: 23577643 PMCID: PMC3799217 DOI: 10.1111/dom.12115] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/08/2013] [Accepted: 04/03/2013] [Indexed: 11/26/2022]
Abstract
AIM The efficacy and safety of insulin degludec (IDeg), a new basal insulin with an ultra-long duration of action, was compared to sitagliptin (Sita) in a 26-week, open-label trial. METHODS Insulin-naïve subjects with type 2 diabetes [n = 458, age: 56 years, diabetes duration: 7.7 years, glycosylated haemoglobin (HbA1c): 8.9% (74 mmol/mol)] were randomized (1 : 1) to once-daily IDeg or Sita (100 mg orally) as add-on to stable treatment with 1 or 2 oral antidiabetic drugs (OADs). RESULTS Superiority of IDeg to Sita in improving HbA1c and fasting plasma glucose (FPG) was confirmed [estimated treatment difference (ETD) IDeg-Sita for HbA1c: -0.43%-points [95% confidence interval (CI): -0.61; -0.24, p < 0.0001] and for FPG: -2.17 mmol/l (95% CI: -2.59; -1.74, p < 0.0001)]. HbA1c < 7% (<53 mmol/mol) was achieved by 41% (IDeg) versus 28% (Sita) of patients, estimated odds ratio IDeg/Sita: 1.60 (95% CI: 1.04; 2.47, p = 0.034). There was no statistically significant difference in the rate of nocturnal confirmed hypoglycaemia between IDeg and Sita [0.52 vs. 0.30 episodes/patient-year, estimated rate ratio (ERR): IDeg/Sita: 1.93 (95% CI: 0.90; 4.10, p = 0.09)]. Rates of overall confirmed hypoglycaemia were higher with IDeg than with Sita [3.1 vs. 1.3 episodes/patient-year, ERR IDeg/Sita: 3.81 (95% CI: 2.40; 6.05, p < 0.0001)]. IDeg was associated with a greater change in body weight than Sita [ETD IDeg-Sita: 2.75 kg (95% CI: 1.97; 3.54, p < 0.0001)]. The overall rates of adverse events were low and similar for both groups. CONCLUSIONS In patients unable to achieve good glycaemic control on OAD(s), treatment intensification with IDeg offers an effective, well-tolerated alternative to the addition of a second or third OAD.
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Affiliation(s)
- A Philis-Tsimikas
- Scripps Whittier Diabetes InstituteSan Diego, CA, USA
- Correspondence to: Dr. Athena Philis-Tsimikas, MD, Scripps Whittier Diabetes Institute, 9894 Genesee Ave, La Jolla, CA 92037,USA., E-mail:
| | - S Del Prato
- Department of Endocrinology and Metabolism, Section of Metabolic Diseases, University of PisaPisa, Italy
| | - I Satman
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul UniversityIstanbul, Turkey
| | - A Bhargava
- Iowa Diabetes & Endocrinology Research CenterDes Moines, IA, USA
| | - M Dharmalingam
- Bangalore Endocrinology & Diabetes Research CenterMalleswaram, Bangalore, India
| | - T V Skjøth
- Medical & Science, Novo Nordisk A/SSøborg, Denmark
| | - S Rasmussen
- Biostatistics, Novo Nordisk A/SSøborg, Denmark
| | - A J Garber
- Division of Endocrinology, Diabetes and Metabolism, Baylor College of MedicineHouston, TX, USA
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Gharti KP, Thapa P, Budhathoki U, Bhargava A. Formulation and in vitro evaluation of floating tablets of hydroxypropyl methylcellulose and polyethylene oxide using ranitidine hydrochloride as a model drug. J Young Pharm 2012; 4:201-8. [PMID: 23493037 PMCID: PMC3573371 DOI: 10.4103/0975-1483.104363] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The present study was carried out with an objective of preparation and in vitro evaluation of floating tablets of hydroxypropyl methyl cellulose (HPMC) and polyethylene oxide (PEO) using ranitidine hydrochloride as a model drug. The floating tablets were based on effervescent approach using sodium bicarbonate a gas generating agent. The tablets were prepared by dry granulation method. The effect of polymers concentration and viscosity grades of HPMC on drug release profile was evaluated. The effect of sodium bicarbonate and stearic acid on drug release profile and floating properties were also investigated. The result of in vitro dissolution study showed that the drug release profile could be sustained by increasing the concentration of HPMC K15MCR and Polyox WSR303. The formulation containing HPMC K15MCR and Polyox WSR303 at the concentration of 13.88% showed 91.2% drug release at the end of 24 hours. Changing the viscosity grade of HPMC from K15MCR to K100MCR had no significant effect on drug release profile. Sodium bicarbonate and stearic acid in combination showed no significant effect on drug release profile. The formulations containing sodium bicarbonate 20 mg per tablet showed desired buoyancy (floating lag time of about 2 minutes and total floating time of >24 hours). The present study shows that polymers like HPMC K15MCR and Polyox WSR303 in combination with sodium bicarbonate as a gas generating agent can be used to develop sustained release floating tablets of ranitidine hydrochloride.
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Affiliation(s)
- KP Gharti
- Department of Pharmacy, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - P Thapa
- Department of Pharmacy, Kathmandu University, Dhulikhel, Kavre, Nepal
| | - U Budhathoki
- Department of Pharmacy, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - A Bhargava
- Ranbaxy Research Labs, Udhyog Vihar, Gurgaon, Haryana, India
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Abstract
Our life span is genetically programmed and it is possible that a defect in produced proteins encoded by the longevity gene is a cause of aging. Progeria which is a rare, fatal genetic condition which affects between one in four million and one in eight million children of both sexes equally and characterized by premature and accelerated aging. The appearance and physiology of these children resembles to elderly people but they typically have life span to their mid teens. It is also known as the Hutchinson-Gilford syndrome, which was initially reported by Johnathan Hutchinson in 1886 and further described by Hastings Gilford in 1904. It is an autosomal recessive disorder, which means an individual has inherited a mutated gene from both parents. It is added to the expanding catalogue of laminopathies, diseases caused by mutations affecting nuclear lamina proteins known as lamin A (LMNA). In oral manifestation primary finding is micrognathia with delayed tooth eruption and incomplete formation of root of permanent tooth. Presently there are no known cures for this abnormality.
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Affiliation(s)
- S Saigal
- Department of Oral Pathology, Government Dental College, Raipur(Chhattisgarh), India.
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Mishra PK, Bhargava A, Khan S, Pathak N, Punde RP, Varshney S. Prevalence of hepatitis C virus genotypes and impact of T helper cytokines in achieving sustained virological response during combination therapy: a study from Central India. Indian J Med Microbiol 2011; 28:358-62. [PMID: 20966569 DOI: 10.4103/0255-0857.71813] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Characterisation of host immune response to hepatitis C virus (HCV) genotypes may have an important prognostic and therapeutic implication. Genotype-3 was more prevalent in the examined cohort and demonstrated a significantly higher response to combination therapy than genotype-1. Sustained virological response (SVR) was 94.74% in genotype-3 and 45.45% in genotype-1. The patients who achieved SVR reported higher levels of circulating T helper 1 cytokines in comparison to subjects with no SVR in both the studied groups. Besides providing local prevalence, our study might also assist in understanding the host immune mechanisms involved to achieve SVR during combination therapy in chronic HCV patients.
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Affiliation(s)
- P K Mishra
- Bhopal Memorial Hospital and Research Centre, Bhopal, India.
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Mishra A, Kumar S, Bhargava A, Sharma B, Pandey AK. Studies on in vitro antioxidant and antistaphylococcal activities of some important medicinal plants. Cell Mol Biol (Noisy-le-grand) 2011. [PMID: 21366958 DOI: 10.1170/t897] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Oxidative stress is initiated by free radicals, which seek stability through electron pairing with biological macromolecules in healthy human cells and cause protein and DNA damage along with lipid peroxidation. Many phytochemicals have been found to play as potential antioxidants and antimicrobials. In the present study antioxidant and antistaphylococcal activities of Bauhinia variegata, Tinospora cardifolia and Piper longum have been determined. Total phenolic contents in plant extracts were estimated and different amounts of phenolic contents were found in B. variegata, T. cardifolia and P. longum extracts. The antioxidant activity of the extracts was compared with standard antioxidants such as, BHA, BHT, quercetin, ascorbic acid and propyl gallate. The % scavenging activity gradually increased with increasing concentrations of the test extracts in DPPH radical scavenging assay. Dose dependent antioxidant activity pattern was also observed in phosphomolybdate assay. Antioxidant activity was directly correlated with the amount of total phenolic contents in the extracts. As compared to B. variegata, the extracts from other two plants exhibited higher antioxidant activity. In disc diffusion assays several solvent extracts derived from test plants inhibited the growth of Staphylococcus aureus. Maximum inhibitory efficacy was observed in T. cardifolia extracts. However, the lowest minimum bactericidal concentration (MBC) (0.43 mg/ml) was recorded for ethyl acetate and acetone extracts of P. longum. This study demonstrates notable antioxidant and anti-staphylococcal roles assigned to some plant extracts tested.
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Affiliation(s)
- A Mishra
- University of Allahabad, Department of Biochemistry, Allahabad, India
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Kubat E, Lyo V, Liao M, Kirkwood K, Bhargava A. De Novo Expression Of Urocortin 1 In Acinar Cells: Urocortin 1 Exerts Inflammatory Effect Via CRF-R2 During Pancreatitis. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Samak G, Suzuki T, Bhargava A, Rao RK. c-Jun NH2-terminal kinase-2 mediates osmotic stress-induced tight junction disruption in the intestinal epithelium. Am J Physiol Gastrointest Liver Physiol 2010; 299:G572-84. [PMID: 20595622 PMCID: PMC3774214 DOI: 10.1152/ajpgi.00265.2010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Gastrointestinal epithelium faces osmotic stress, both at physiological and pathophysiological conditions. JNK activation is an immediate cellular response to osmotic stress. We investigated the effect of osmotic stress on intestinal epithelial barrier function and delineated the role of JNK2 in osmotic stress-induced tight junction (TJ) regulation in Caco-2 cell monolayers and ileum of Jnk(-/-) and Jnk2(-/-) mice. The role of JNK activation in osmotic stress-induced TJ disruption was evaluated using JNK-specific inhibitor and antisense oligonucleotides. Furthermore, the effect of cold restraint stress in vivo on TJ integrity was determined in rats. Osmotic stress disrupted TJs and barrier function in Caco-2 cell monolayers without affecting cell viability. Osmotic stress activated JNK1 and JNK2 and the inhibition of JNK by SP600125 attenuated osmotic stress-induced TJ disruption. TJ disruption and barrier dysfunction by osmotic stress was associated with JNK-dependent remodeling of actin cytoskeleton. Knockdown of JNK2 accelerated TJ assembly and attenuated osmotic stress-induced TJ disruption in Caco-2 cell monolayers. In mouse ileum in vitro, osmotic stress increased paracellular permeability, which was attenuated by SP600125. Osmotic stress disrupted actin cytoskeleton and TJs and increased paracellular permeability in the ileum of wild-type and JNK1(-/-) mice, but not in JNK2(-/-) mouse ileum. Cold restraint stress activated JNK in rat ileum and caused JNK-dependent remodeling of actin cytoskeleton and redistribution of occludin and zona occluden-1 from the intercellular junctions. These results reveal the role of JNK2 in the mechanism of osmotic stress-induced TJ disruption in the intestinal epithelium.
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Affiliation(s)
- G. Samak
- 1Department of Physiology, University of Tennessee Health Science Center, Memphis, Tennessee; ,2Department of Zoology, DVS College, Shimoga, India; and
| | - T. Suzuki
- 1Department of Physiology, University of Tennessee Health Science Center, Memphis, Tennessee;
| | - A. Bhargava
- 3Department of Surgery, University of California, San Francisco, California
| | - R. K. Rao
- 1Department of Physiology, University of Tennessee Health Science Center, Memphis, Tennessee;
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Mishra PK, Bhargava A, Punde RP, Pathak N, Desikan P, Jain A, Varshney S, Maudar KK. Diagnosis of gastrointestinal tuberculosis: Using cytomorphological, microbiological, immunological and molecular techniques - A study from Central India. Indian J Clin Biochem 2010; 25:158-63. [PMID: 23105903 DOI: 10.1007/s12291-010-0029-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The present study included three groups: (A) age and gender matched control (n=24) with no previous signs of M. tuberculosis complex (MTBC) infection, (B) patients (n=28) diagnosed with gastro-intestinal TB (GITB), (C) patients (n=50) with clinical and histo-pathological signs of GITB, but were culture and AFB negative. Real time assay performed using fluorescence resonance energy transfer hybridization probes showed a positivity index of 36 % in group C, i.e. 18 were found reactive from the total 50 cases studied. In addition, immune characterization of these 18 cases showed depleted CD(4) (+) count and increased levels of IFN-γ and TNF-α cytokines. No positive case was found in group A, while in group B, out of total 28 cases studied 27 were found positive. A combinatorial diagnostic approach for rapid detection and characterization of GITB might provide specific therapeutic strategies for prevention and treatment of the infection in future.
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Affiliation(s)
- Pradyumna Kumar Mishra
- Department of Research, Bhopal Memorial Hospital & Research Centre, Bhopal, India ; Department of Research & Training, Bhopal Memorial Hospital & Research Centre, Bhopal, India
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Nahleh ZA, Abrams J, Bhargava A, Nirmal K, Graff JJ. Outcome of patients with nonmetastatic breast cancer receiving nitrogen-containing bisphosphonates: A comparative analysis from the Metropolitan Detroit Cancer Surveillance System (MDCSS). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zacharski LR, McKernan L, Metzger ME, Malone MG, Samnotra V, Bhargava A, Steiner PR, Rauwerdink CA, Ornstein DL, Cornell CJ. Remission of paroxysmal atrial fibrillation with iron reduction in haemophilia A. Haemophilia 2010; 16:726-30. [PMID: 20236353 DOI: 10.1111/j.1365-2516.2010.02218.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
SUMMARY Two male first cousins with mild haemophilia A had baseline factor VIII levels of 12-15% and experienced bleeding requiring coagulation factor infusion therapy with trauma and surgical procedures. Both the patients with haemophilia A also had electrocardiographically documented symptomatic paroxysmal atrial fibrillation (PAF) for several years that had become resistant to pharmacological suppression. Radiofrequency ablation was considered in both the cases but deferred considering refusal of consent by the patients to undergo the procedure. Remission of arrhythmias has been reported in patients with iron-overload syndromes. Body iron stores assessed by serum ferritin levels were elevated in both men but neither had the C282Y or H63D genes for haemochromatosis. Calibrated reduction of iron stores by serial phlebotomy, avoiding iron deficiency, was followed by remission of symptomatic PAF in both cases. Iron reduction may be an effective treatment for arrhythmias apart from the classic iron-overload syndromes and deserves further study particularly in patients with bleeding disorders who might be at risk for arrhythmias and other diseases of ageing.
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Affiliation(s)
- L R Zacharski
- Section of Hematology/Oncology, Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
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Singh RK, Rai D, Yadav D, Bhargava A, Balzarini J, De Clercq E. Synthesis, antibacterial and antiviral properties of curcumin bioconjugates bearing dipeptide, fatty acids and folic acid. Eur J Med Chem 2010; 45:1078-86. [PMID: 20034711 PMCID: PMC7115498 DOI: 10.1016/j.ejmech.2009.12.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 12/01/2009] [Accepted: 12/04/2009] [Indexed: 12/25/2022]
Abstract
Curcumin bioconjugates, viz. di-O-tryptophanylphenylalanine curcumin (2), di-O-decanoyl curcumin (3), di-O-pamitoyl curcumin (4), di-O-bis-(γ,γ)folyl curcumin (6), C4-ethyl-O-γ-folyl curcumin (8) and 4-O-ethyl-O-γ-folyl curcumin (10) have been synthesized and tested for their antibacterial and antiviral activities. The conjugates 2, 3, 4, 6 and 8 have shown very promising antibacterial activity with MIC ranging between 0.09 and 0.67 μM against Gram-positive cocci and Gram-negative bacilli. Further, the conjugates 2, 3, 6, 8 and 10 have been screened for their antiviral activities against HSV, VSV, FIPV, PIV-3, RSV and FHV and the molecules 2 and 3 have shown good results with EC50 0.011 μM and 0.029 μM against VSV and FIPV/FHV, respectively. However, the molecules did not show expected results against HIV-1 IIIB and ROD strains in MTT assay.
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Affiliation(s)
- Ramendra K. Singh
- Nucleic Acids Research Laboratory, Department of Chemistry, University of Allahabad, Allahabad 211002, India
- Corresponding author. Tel./fax: +91 0532 2461005.
| | - Diwakar Rai
- Nucleic Acids Research Laboratory, Department of Chemistry, University of Allahabad, Allahabad 211002, India
| | - Dipti Yadav
- Nucleic Acids Research Laboratory, Department of Chemistry, University of Allahabad, Allahabad 211002, India
| | - A. Bhargava
- Department of Microbiology, MLN Medical College, Allahabad, India
| | - J. Balzarini
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium
| | - E. De Clercq
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium
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Chatterjee B, Kulathinal S, Bhargava A, Jain Y, Kataria R. Anti-microbial resistance stratified by risk factor among Escherichia coli strains isolated from the urinary tract at a rural clinic in Central India. Indian J Med Microbiol 2009; 27:329-34. [PMID: 19736402 DOI: 10.4103/0255-0857.55449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The failure of empirical therapy is frequently observed, even in community-acquired urinary tract infections. We, therefore, conducted a prospective, clinic-based study in 2004-2005 to document anti-microbial resistance rates and correlate them with possible risk factors to assist empirical decision-making. MATERIALS AND METHODS Symptomatic patients with pyuria underwent urine culture. Isolates were identified using standard methods and anti-microbial resistance was determined by disk-diffusion. Ultrasonography was used to detect complicating factors. Patients were stratified by the presence of complicating factors and history of invasive procedures for comparison of resistance rates. STATISTICAL METHOD USED: Chi-square or Fisher exact tests, as appropriate. RESULTS There were 156 E. coli isolates, of which 105 were community-acquired. Twenty-three community-acquired isolates were from patients with complicating factors while 82 were from patients without any. Fifty-one isolates were from patients who had recently undergone invasive procedures on the urinary tract. Thirty-two community-acquired isolates from reproductive-age women without apparent complicating factors had resistance rates of 50% or above against tetracyclines, Co-trimoxazole, aminopenicillins, Nalidixic acid, Ciprofloxacin and 1 st generation cephalosporins. Resistance rates were significantly higher among isolates from patients subjected to invasive procedures, except against Co-trimoxazole, tetracyclines and Amikacin. CONCLUSION High rates of anti-microbial resistance in community-acquired uropathogens have made antimicrobial sensitivity testing necessary even in a rural, primary-care setting.
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Affiliation(s)
- B Chatterjee
- Jan Swasthya Sahyog, Village and P. O. Ganiyari - 495 112, District Bilaspur, Chhattisgarh, India.
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