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Kumar AS, Prema D, Rao RG, Prakash J, Balashanmugam P, Devasena T, Venkatasubbu GD. Fabrication of poly (lactic-co-glycolic acid)/gelatin electro spun nanofiber patch containing CaCO 3/SiO 2 nanocomposite and quercetin for accelerated diabetic wound healing. Int J Biol Macromol 2024; 254:128060. [PMID: 37963500 DOI: 10.1016/j.ijbiomac.2023.128060] [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: 03/29/2023] [Revised: 10/09/2023] [Accepted: 11/10/2023] [Indexed: 11/16/2023]
Abstract
An open wound or sore on the bottom of the foot caused by diabetes is known as a diabetic foot ulcer. Preventive measures are essential, including consistent foot care and glycemic management. The dangers associated with diabetic foot ulcers can be reduced via early identification and timely treatment. The risk of foot ulcers and limb amputation increases with age and duration of diabetes. Quercetin contains anti-inflammatory and antioxidant properties. Furthermore, the calcium carbonate/silica (CaCO3/SiO2) nanocomposite has a good anti-inflammatory property due to the presence of calcium, which will aid in wound healing. As a result, combining quercetin (plant based anti-inflammatory drug) and CaCO3/SiO2 nanocomposite will boost the wound healing rate. We have synthesized CaCO3/SiO2 nanocomposite in sol-gel method and characterized using XRD, FTIR and TEM. Cell line tests and the MTT assay revealed that the PLGA/gelatin/CaCO3/SiO2/quercetin patch enhanced the proliferation of cells. Its anti-bacterial efficacy against four major bacterial strains often found in wound locations, as well as its water retention, make it an ideal material for diabetic wound healing. In-vivo trials confirms the enhanced diabetic wound healing potential of the patch.
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Affiliation(s)
- Ajay S Kumar
- Department of Nanotechnology, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu District, Tamil Nadu 603 203, India
| | - D Prema
- Department of Biomedical engineering, Karpagam academy of higher education, Pollachi Main Road, Eachanari Post, Coimbatore 641 021, Tamil Nadu, India
| | - R Gagana Rao
- Department of Nanotechnology, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu District, Tamil Nadu 603 203, India
| | - J Prakash
- Translational Health Science and Technology Institute, Faridabad 121001, Haryana, India
| | | | - T Devasena
- Centre for Nanoscience and Technology, Anna University, Chennai, Tamil Nadu, India
| | - G Devanand Venkatasubbu
- Department of Nanotechnology, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu District, Tamil Nadu 603 203, India.
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Manjunatha HA, Prashanth KB, Ranjani SK, Kumar AS, Divya KP. A clinical comparative study of thyroid surgeries with and without drain. Indian J Otolaryngol Head Neck Surg 2023; 75:1681-1686. [PMID: 37636765 PMCID: PMC10447735 DOI: 10.1007/s12070-023-03700-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Most of the thyroid surgeries are accompanied by drain placement. The possibility of hematoma or seroma formation postoperatively is of concern to surgeons, as, thyroid is a highly vascular structure and a minor hemorrhage might also turn out to be life threatening, despite actual incidence of it being only 0.3-1%. Thus, drains are placed with an intention to obliterate dead space and clear the collecting blood or serum. Conversely, several studies have indicated chances of clots blocking the drainage tube and resulting in missing out of early detection of a massive bleed. Drains have also been known to add more discomfort to the patient, increase chances of infection, increase post operative pain, scar formation and longer duration of hospital stay. Thus, some surgeons believe in not placing a drain. To compare the outcomes of thyroid surgeries done with drain versus those thyroid surgeries done without drain. 40 patients, of either sex, between 18 and 70 years of age, who underwent thyroid surgeries for various thyroid disorders over a period of 6 months, were randomly allocated to either 'with drain' (group A) or 'without drain' (group B). The surgeon was made aware of drain status only intraoperatively. Patients were assessed for post-operative pain based on Visual Analogue Scale (VAS) at 6 and 24 h post-operatively. Post-operative complications including hematoma, seroma, and wound infection, if any, along with duration of hospitalization, were also documented. Patient was followed up one week post-operatively for wound check and suture removal. Both groups were homogenous according to age, sex, TIRADS, Bethesda, diagnosis and surgery performed. Postoperative pain at 6 and 24 h was significantly higher in group A than in group B [6.15 ± 1.31 vs 3.50 ± 0.88 (p = 0.001) (6 h), 4.45 ± 0.99 vs 1.20 ± 1.10 (p = 0.001) (24 h)]. Mean duration of hospitalization following thyroid surgery was significantly higher among group A than group B [3.80 ± 1.15 vs 2.15 ± 0.36 days (p = 0.001)]. Though not statistically significant, wound pain at 1 week and overall complications were higher in Group A than in Group B (p = 0.182, p = 0.127 respectively). Thyroid surgeries done without drain placement are likely to cause significantly lesser post-operative pain and shorter duration of hospitalization.
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Affiliation(s)
- H. A. Manjunatha
- Department of Otorhinolaryngology, J J M Medical College, Davangere, Karnataka India
| | - K. B. Prashanth
- Department of Otorhinolaryngology, J J M Medical College, Davangere, Karnataka India
| | - S. K. Ranjani
- Department of Otorhinolaryngology, J J M Medical College, Davangere, Karnataka India
| | - Ajay S. Kumar
- Department of Otorhinolaryngology, J J M Medical College, Davangere, Karnataka India
| | - K. Purna Divya
- Department of Otorhinolaryngology, J J M Medical College, Davangere, Karnataka India
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Enumah ZO, Bolman RM, Zilla P, Boateng P, Wilson B, Kumar AS, Chotivatanapong T, Beyersdorf F, Pomar J, Sliwa K, Eiselé JL, Dearani J, Higgins R. United in earnest: First pilot sites for increased surgical capacity for rheumatic heart disease announced by Cardiac Surgery Intersociety Alliance. Asian Cardiovasc Thorac Ann 2021; 29:729-734. [PMID: 33829870 DOI: 10.1177/02184923211005667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rheumatic heart disease affects more than 33,000,000 individuals, mostly from low- and middle-income countries. The Cape Town Declaration on Access to Cardiac Surgery in the Developing World was published in August 2018, signaling the commitment of the global cardiac surgery and cardiology communities to improving care for rheumatic heart disease patients. METHODS As the Cape Town Declaration formed the basis for which the Cardiac Surgery Intersociety Alliance was formed, the purpose of this article is to describe the history of the Cardiac Surgery Intersociety Alliance, its formation, ongoing activities, and future directions, including the announcement of selected pilot sites. RESULTS The Cardiac Surgery Intersociety Alliance is an international alliance consisting of representatives from major cardiothoracic surgical societies and the World Heart Federation. Activities have included meetings at annual conferences, exhibit hall participation for advertisement and recruitment, and publication of selection criteria for cardiac surgery centers to apply for Cardiac Surgery Intersociety Alliance support. Criteria focused on local operating capacity, local championing, governmental and facility support, appropriate identification of a specific gap in care and desire to engage in future research. Eleven applications were received for which three finalist sites were selected and site visits conducted. The two selected sites were Hospital Central Maputo (Mozambique) and King Faisal Hospital Kigali (Rwanda). CONCLUSIONS Substantial progress has been made since the passing of the Cape Town Declaration and the formation of the Cardiac Surgery Intersociety Alliance, but ongoing efforts with collaboration of all committed parties-cardiac surgery, cardiology, industry, and government-will be necessary to improve access to life-saving cardiac surgery for rheumatic heart disease patients.
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Sheetal S, Thomas R, Kumar AS, Tomy LG. Plus-minus lid syndrome with ataxia and severe apathy-A rare manifestation of midbrain infarct. J Postgrad Med 2020; 66:162-164. [PMID: 32675453 PMCID: PMC7542061 DOI: 10.4103/jpgm.jpgm_709_19] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Plus-minus lid syndrome is a rare manifestation of midbrain infarct, characterized by ptosis of one eye and lid retraction in the other eye. It has also been described in ocular myasthenia gravis, orbital myositis, or after lesions of the oculomotor nerve. Our patient was a 55-year-old man with hypertension and atrial fibrillation, who presented to us with acute onset left-sided ptosis and right-sided eyelid retraction. He was apathic and had right-sided ataxia. His MRI of the brain showed acute infarct involving the paramedian midbrain. To our knowledge, severe apathy and resultant executive function disorder have not been described previously in a patient having plus-minus lid syndrome with ataxia.
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Affiliation(s)
- S Sheetal
- Department of Neurology, Pushpagiri Institute of Medical Sciences and Research, Tiruvalla, Kerala, India
| | - R Thomas
- Department of Neurology, Pushpagiri Institute of Medical Sciences and Research, Tiruvalla, Kerala, India
| | - A S Kumar
- Department of Neurology, Pushpagiri Institute of Medical Sciences and Research, Tiruvalla, Kerala, India
| | - L G Tomy
- Department of Neurology, Pushpagiri Institute of Medical Sciences and Research, Tiruvalla, Kerala, India
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Gnaneshwar R, Kumar AS, Carol F, Martis J, Jerajani HR, Kuruvila M, Latha MS, Krishnankutty B. The Efficacy and Safety of Eberconazole Nitrate 1% and Mometasone Furoate 0.1% w/w Cream in Subjects with Inflamed Cutaneous Mycoses. Rev Recent Clin Trials 2015. [PMID: 26216438 DOI: 10.2174/157488711002150714141234] [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: 11/22/2022]
Abstract
BACKGROUND Topical antifungal agents along with the steroids may provide not only rapid symptomatic relief but also clearance of disease causing fungi in inflamed cutaneous mycoses (ICM). AIM To assess the efficacy and safety of fixed dose combination (FDC) of Eberconazole nitrate 1% and Mometasone furoate 0.1% w/w cream, in subjects with ICM. METHODS This was a multi-centric, non-comparative study conducted in 155 eligible adult Indian subjects with ICM. They were treated with study medication for 21 days (D21) and followed up on day 35 (D35). Efficacy (by Investigator's Static Global Assessment-ISGA, symptom severity scores) and safety were assessed to evaluate the therapeutic response. RESULTS Of 155 subjects, 129 completed the study. Lesions healed completely in 77.52% and improved markedly in 22.48% patients by D21. There was a statistically significant reduction (p<0.001) in total symptom score (TSS) and mean severity scores of erythema, scaling and pruritus on days 7 and 21 compared to baseline. There was no treatment failure. Only 11 patients remained culture positive on D21 compared to 68 at baseline. Physicians evaluated the drug as 'Good' in 72% and 'Excellent' in 28% of subjects; adverse events were reported in 27.74% subjects and none was severe. There was a decrease in serum cortisol level in 4.52% (7/155) subjects and was considered clinically significant in three subjects. On D35, 18.55% and 24.20% subjects had greater ISGA score and TSS respectively, compared to D21. CONCLUSION Tested FDC demonstrated efficacy and was well tolerated by study population. It offers an effective and safe therapeutic option for the management of ICM.
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Affiliation(s)
| | | | | | | | | | | | - M S Latha
- G 5, Mount Meru Apts, Road 5, Avenue 7, Banjara Hills, Hyderabad 500 034, India.
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Ram CVS, Kumar AS. Renal denervation therapy for resistant hypertension: a clinical update. J Hum Hypertens 2014; 28:699-704. [PMID: 24599151 DOI: 10.1038/jhh.2014.6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/17/2013] [Accepted: 12/26/2013] [Indexed: 01/25/2023]
Abstract
Severe hypertension (systolic blood pressure (BP) ⩾160 mm Hg) resistant to treatment with multiple antihypertensive medications, poses a serious challenge to therapeutic treatment. Catheter-based renal denervation (RDN) is being increasingly proposed and researched as a safe and effective method of treating this condition. This article evaluates the existing evidence on the effects of RDN on BP reduction and other conditions with increased sympathetic tone. Findings indicate that RDN is a safe and effective treatment for severe hypertension. Moreover, the antihypertensive response to RDN is sustained for up to 3 years of follow-up. RDN decreases office BP more than ambulatory BP, which may be explained by the white-coat effect that causes an increase in office BP. Findings indicate that although reinnervation may occur following RDN, it does not appear to attenuate or reverse the BP response over 24-36 months. There is also evidence that patients with milder forms of hypertension may benefit from RDN. Furthermore, there is emerging evidence that RDN may have a role in the treatment of heart failure, obstructive sleep apnea, insulin resistance, atrial fibrillation and hypertension associated with end-stage renal disease. Taking into account that resistant hypertension and other diseases associated with elevated sympathetic tone are associated with significant morbidity and mortality rates, RDN therapy may be expected to have a significant impact on public health.
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Affiliation(s)
- C V S Ram
- 1] Apollo Institute for Blood Pressure Management, Apollo Blood Pressure Clinics, Apollo Hospitals, Hyderabad, India [2] Texas Blood Pressure Institute, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - A S Kumar
- Cardiology Department, Continental Hospitals, Hyderabad, India
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Ahmed K, Amreen S, Bhagyalaxmi, Rao TN, Swarnalatha G, Kumar AS. Direct immunofluorescence in autoimmune vesiculobullous disorders: A study of 59 cases. J NTR Univ Health Sci 2014. [DOI: 10.4103/2277-8632.140935] [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: 11/04/2022] Open
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Kumar AS, Sidani SM, Kolli K, Stahl TJ, Ayscue JM, Fitzgerald JF, Smith LE. Transanal endoscopic microsurgery for rectal carcinoids: the largest reported United States experience. Colorectal Dis 2012; 14:562-6. [PMID: 21831099 DOI: 10.1111/j.1463-1318.2011.02726.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM Rectal carcinoids are often inadequately resected by snare excision during colonoscopy. Transanal endoscopic microsurgery is a minimally invasive procedure with low morbidity that offers full-thickness excision with a low rate of negative margins. It presents an excellent alternative to radical surgery for mid and proximally located lesions. We report the largest United States (US) experience in the use of transanal endoscopic microsurgery for rectal carcinoids. METHOD Data of patients who had undergone transanal endoscopic microsurgery for rectal carcinoids were prospectively collected and retrospectively analyzed. Patient and tumour characteristics, operative and perioperative details, as well as oncological outcomes were reviewed. RESULTS Over a 12-year period, 24 patients underwent transanal endoscopic microsurgery for rectal carcinoids. Of these, six (25%) were primary surgical resections and 18 (75%) were performed after incomplete snare excisions during colonoscopy. Three (17%) patients who underwent full-thickness resection after snare excision had residual tumour on histopathological examination. Negative margins were obtained in all cases. No recurrences were noted. CONCLUSION Transanal endoscopic microsurgery is effective and safe for the surgical resection of rectal carcinoids<2 cm in diameter, with typical features and located more than 5 cm from the anal verge. Transanal endoscopic microsurgery can be used for primary resection or for resection after incomplete colonoscopic snare excision.
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Affiliation(s)
- A S Kumar
- Division of Colon and Rectal Surgery, Department of Surgery, Washington Hospital Center, Washington, DC, USA.
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Jerajani HR, Kumar AS, Kuruvila M, Nataraja HV, Philip M, Pratap DVS, Sumathy TK, Krishnankutty B, Dhawan S, Thomas D. Efficacy and safety of topical halometasone in eczematous dermatoses in Indian population: an open label, noncomparative study. Indian J Dermatol 2012; 56:652-6. [PMID: 22345764 PMCID: PMC3276890 DOI: 10.4103/0019-5154.91822] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Topical steroids remain the mainstay of treatment in eczema, an inflammatory skin reaction characterized by pruritus, redness, scaling, and clustered oozing papulovesicles. Halometasone is a new potent corticosteroid approved in the Indian market for topical application in the treatment of dermatitis. AIMS To evaluate the efficacy and safety of halometasone in the treatment of acute or chronic noninfected eczematous dermatosis in Indian population. MATERIALS AND METHODS A prospective, open, multicentric, phase 3, noncomparative clinical trial conducted at outpatient departments of seven centres. Two hundred endogenous eczema patients meeting study criteria were enrolled. Halometasone 0.05% cream was applied twice daily for 30 days in chronic and 20 days in acute eczema patients. Calculation of eczema area and severity index, and assessment of investigator's global assessment of severity of eczema and severity of pruritus score were done at each visit and compared with baseline. All adverse events (AE) were captured and documented. Laboratory investigations including haematological tests, urinalysis, renal and liver function tests were performed at baseline and at end of treatment. RESULTS Of the 200 patients enrolled, 180 were chronic and 20 were acute eczema patients. It was found that there was a significant (P<0.001) improvement in all efficacy parameters compared with baseline. The treatment was shown to be successful in 91% patients. AE were reported in 30 patients and there was no serious AE reported. There was no clinically significant difference in laboratory investigations with treatment. CONCLUSIONS Halometasone was shown to be safe and very effective in Indian patients with acute and chronic eczema and the drug was well tolerated.
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Affiliation(s)
- H R Jerajani
- Department of Dermatology, LTM Medical College and LTM General Hospital, Mumbai, India
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Ahmed K, Singh H, Kumar AS, Ahmed I. A case of a large verrucous swelling over the scrotum. Indian J Sex Transm Dis AIDS 2012. [PMID: 23188943 PMCID: PMC3505295 DOI: 10.4103/2589-0557.102133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kamal Ahmed
- Departmant of Dermatology and STD, Owaisi Hospital and Research Centre, DCMS, Hyderabad, Andhra Pradesh, Departmant of Plastic Surgery, Bangalore Medical College, Bangalore, Karnataka, India,Address for correspondence: Dr. Kamal Ahmed, 12-2-709/C/191, Padmanabaha Nagar, Hyderabad, Andhra Pradesh, India. E-mail:
| | - Hardeep Singh
- Departmant of Dermatology and STD, Owaisi Hospital and Research Centre, DCMS, Hyderabad, Andhra Pradesh, Departmant of Plastic Surgery, Bangalore Medical College, Bangalore, Karnataka, India
| | - AS Kumar
- Departmant of Dermatology and STD, Owaisi Hospital and Research Centre, DCMS, Hyderabad, Andhra Pradesh, Departmant of Plastic Surgery, Bangalore Medical College, Bangalore, Karnataka, India
| | - Iqbal Ahmed
- Departmant of Dermatology and STD, Owaisi Hospital and Research Centre, DCMS, Hyderabad, Andhra Pradesh, Departmant of Plastic Surgery, Bangalore Medical College, Bangalore, Karnataka, India
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Kumar AS, Kumar S, Abraham S, Rao PSS. Leprosy among tribal population of Chhattisgarh state, India. Indian J Lepr 2011; 83:23-29. [PMID: 21638980] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Chhattisgarh state is still endemic for leprosy and has a large tribal population. During 2003-2009, a total of 1530 untreated leprosy cases reported to the Leprosy Mission Referral Hospital in Champa, of which 151(9%) were classified as belonging to the scheduled tribes. The characteristics of these new tribal patients are described and compared with other patients and to the demographics of the tribals in the general population of the State. While tribals were accessing the leprosy services similar to the other social groups, the delay in reporting, high BI and other features pose more serious problems in the transmission of leprosy and in management of complications due to the harsh environment and occupational patterns of the tribals. Appropriate strategies and more community based approaches will be necessary if these groups are also targeted for eradication of leprosy.
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Affiliation(s)
- A S Kumar
- TLM Community Hospital, Champa-495 671, Chhatisgarh, India
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Abstract
Context: An epidemic of chikungunya disease occurred in India during late 2005 through 2006 affecting nearly 1,400,000 people. Aim: To study the cutaneous manifestations in suspected cases of chikungunya disease. Settings and Design: Patients who attended our outpatient departments from January 2006 to September 2006 were prospectively included if they had symptoms of chikungunya disease according to the ‘case definition’ of the National Institute of Communicable Diseases, Directorate General of Health Services, Government of India. The criteria were an acute illness characterized by the sudden onset of fever and several symptoms such as joint pain, headache, backache, photophobia, and eruption during an epidemic of chikungunya fever in the absence of confirmatory serological tests. Materials and Methods: A total of 115 patients (65 men and 50 women) who satisfied the above criteria were enrolled for the study. Results: An erythematous maculopapular rash subsiding without any sequelae in 3-4 days was the most common cutaneous finding in our patients. Genital ulcers distributed predominantly over the scrotum and base of the penile shaft in men and labia majora in women were the second most common manifestation. Other manifestations included tenderness/edema of hands and feet, grouped hyperpigmented macules over the nose and cheeks, fixed drug eruptions, erythema nodosum, erythema multiformae, generalized urticarial eruptions, and flare up of pre-existing psoriasis and lichen planus. Conclusions: To conclude, a plethora of cutaneous manifestations were noted in suspected cases of chikungunya disease. Genital ulcers, to the best of our knowledge, have not been reported during the earlier epidemics but have been reported by others during the present one.
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Affiliation(s)
- Soma Prashant
- Department of Dermatology and Venereology, Deccan College of Medical Sciences and Allied Institutes i.e., OwaisiHospital and Princess Esra Hospital, India.
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Garwood ER, Kumar AS, Baehner F, Garber JE, Troyan S, Olopade OI, Moore D, Au A, Flowers C, Campbell M, Hylton N, Esserman LJ, Rush-Port E. Fluvastatin has biologic effects on stage 0 and 1 breast cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-4122] [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: 11/16/2022]
Abstract
Abstract
Abstract #4122
Introduction: Statins are safe, reduce cardiovascular risk, and impact pathways critical to cancer progression. We and others have shown lipophilic statins cause apoptosis and growth suppression in vitro and in vivo, and though epidemiologic data are mixed, statin effect appears most evident in estrogen receptor (ER) negative or grade 3 disease. To look for a direct biologic effect of lipophilic statins, we conducted a perioperative pilot window trial in women with breast cancer (BC).
 Methods: 40 subjects with stage 0,1 BC were randomized to high dose (80mg/day) or low dose (20mg/day) fluvastatin for 3-6 weeks prior to surgery. Paired tissue (core biopsy and surgical specimen), peripheral blood and MRI were obtained. Primary endpoint was Ki-67 (proliferation) change. Secondary endpoints included cleaved caspase-3 (CC3, apoptosis), longest diameter (LD) by MRI, and C-reactive protein (CRP) change. Subgroup analyses was planned by grade (3 vs. 1,2), statin dose; and ER status. Immunohistochemistry (IHC) on paraffin tissue used standard streptavidin biotin methods. A single breast pathologist reviewed all slides; a single radiologist read all MRIs, both blinded to timepoint.
 Results: Median serum cholesterol decreased by 16% (-23% and -12% for high and low dose, respectively p=0.012), indicating drug effect and compliance. 29 patients had sufficient tumor for paired IHC, 14 and 15 were grade 3 and 1,2, and 10 and 19 were ER - and +, respectively. In grade 3 (73% of which were ER-) vs. 1,2 tumors, there was a significant decrease in Ki-67, -7.2% (interquartile range (IQR) -13.4%, 0% ) vs. -0.3% (IQR -3%, .8%), respectively, p=0.04. CC3 (apoptosis) increased, 60% vs. 13% for grade 3 vs. 1,2 tumors, respectively, p=0.015. ER- and ER+ cases had a similar reduction in Ki67 with a median drop of 2% (IQR -13.4%, 1%) and 1.2% (IQR -6.6%,0.8%), respectively, p=0.56. While CC3 was increased in ER- vs. + (55% vs. 29%), the difference was not statistically significant. There was no dose dependent effect on Ki-67or CC3.There was no evidence of Ki67 or CC3 change when all grades were analyzed together (median drop 1.2%) and no change in CRP. Of 14 subjects with paired MRIs, 4 grade 3 cases showed a significant decrease in LD, marked ductal dilatation and increased necrosis.with statin exposure.
 Conclusions: A lipophilic statin, fluvastatin, reduced cholesterol and had measurable biologic changes (reduced proliferation, size and increased apoptosis) in stage 0,1 BC after only 3-6 weeks of exposure, specifically in the grade 3 subset. Results support the study of statins for chemoprevention for women at risk for or with stage 0 grade 3 BC, where new agents are needed.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4122.
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Affiliation(s)
- ER Garwood
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - AS Kumar
- 2 Surgery, UC - East Bay, Oakland, CA
| | - F Baehner
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - JE Garber
- 3 Medicine, Dana-Farber Cancer Inst, Boston, MA
| | - S Troyan
- 4 Surgery, Beth Israel Deaconess Med Ctr, Boston, MA
| | - OI Olopade
- 5 Medicine, Univ of Chicago, Chicago, IL
| | - D Moore
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - A Au
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - C Flowers
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - M Campbell
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - N Hylton
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | - LJ Esserman
- 1 Depts of Surgery, Pathology, Radiology, Epidemiology & Biostatistics, UCSF, San Francisco, CA
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Rajendran R, Kumari KR, Kumar AS. Liver ultrasound and faecal copper estimation in oral submucous fibrosis. Indian J Dent Res 2003; 14:13-21. [PMID: 12800753] [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: 03/03/2023] Open
Abstract
There is no evidence of an increased quantity of ingestion of copper in areca nut chewers by way of habitually swallowing the 'quid juice' allegedly contain 'appreciable quantity' of soluble copper. Our experimental findings are favour of assuming that the amount of copper ingested, if at all, is well within the threshold limit of tolerance and therefore of no clinical significance. In conjunction with our earlier observation this study again proved the absence of visible and clinically/diagnostically detectable fibrosis in visceral organs, that includes liver, in patients suffering from advanced oral submucous fibrosis.
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Affiliation(s)
- R Rajendran
- Department of Oral Pathology and Microbiology, Dental Wing, Medical College, Trivendrum-695 011, India.
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Abstract
The importance of the absolute configuration of cholesterol for its function in vivo is unknown. To directly test this question in vivo, we synthesized the enantiomer of cholesterol (ent-cholesterol) and tested its ability to substitute for natural cholesterol (nat-cholesterol) in the growth, viability, and behavior of Caenorhabditis elegans, a cholesterol auxotroph. First-generation animals grown on ent-cholesterol were viable with only mild behavioral defects. However, ent-cholesterol produced 100% lethality/arrest of their second generation progeny. Isotopically labeled ent-cholesterol incorporated into animals, indicating that its lethality was not secondary to cholesterol starvation. When mixed with nat-cholesterol, ent-cholesterol was not inert; rather, it antagonized the activity of nat-cholesterol. These results demonstrate for the first time that the absolute configuration of cholesterol, not just its physical properties, is essential for its functions in vivo.
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Affiliation(s)
- C M Crowder
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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16
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Abstract
An artificial enzyme analogue of Nafion/lead-ruthenium oxide pyrochlore (Py) chemically modified electrode (NPyCME) is synthesized by in situ precipitation through blocking of Nafion's hydrophilic zones. The catalytically active Py sites covered with a hydrophobic core of Nafion resemble an enzymatic structure. Moreover, the NPyCME obeys the Michaelis-Menten mechanism for the oxidation of many organic and biological molecules. This Account highlights aspects of the preparation, characterization, and application of the NPyCME.
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Affiliation(s)
- J M Zen
- Department of Chemistry, National Chung-Hsing University, Taichung 402, Taiwan.
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Abstract
OBJECTIVE This study was performed to assess the long-term outcome of untreated mild aortic valve disease present at the time of initial mitral valve intervention. METHODS A total of 284 patients with rheumatic heart disease aged 7 to 62 years (mean, 23.5 +/- 12.2 years) who underwent mitral valve intervention and had mild aortic valve disease initially were followed up for 2 to 18 years (mean, 10.8 +/- 3.7 years). At initial intervention, 232 patients had pure mild aortic regurgitation, and 52 patients had mild aortic stenosis with or without aortic regurgitation. RESULTS Among patients with mild aortic regurgitation initially, 11 (5%) patients progressed to moderate (n = 6) or severe (n = 5) regurgitation over an interval of 9 to 17 years (mean, 12.1 +/- 2.8 years), and 1 patient had moderate aortic stenosis and severe aortic regurgitation after 10 years. Freedom from development of moderate-severe aortic valve disease in patients who initially had mild aortic regurgitation was 100%, 97.0% +/- 1.7%, and 87.4% +/- 4.6% at 5, 10, and 15 years, respectively. Seventeen (35%) patients with initial mild aortic stenosis (with or without regurgitation) had moderate or severe stenosis (with or without moderate-severe regurgitation) after an interval of 4.9 +/- 3.8 years. Freedom from development of moderate-severe aortic valve disease in patients who initially had mild aortic stenosis was 75.6% +/- 6.2%, 61.5% +/- 8.5%, and 46.1% +/- 11.2% at 5, 10, and 15 years, respectively. Ten patients required aortic valve replacement for aortic valve dysfunction. CONCLUSIONS Mild aortic regurgitation present at the time of mitral valve intervention progresses very slowly and less frequently requires reintervention. However, mild aortic stenosis diagnosed initially progresses more often and more rapidly and thus needs closer follow-up.
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Affiliation(s)
- S K Choudhary
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Zen JM, Kumar AS, Chen JC, Jayachithra K, Balamurugan K, Chin DH. Electrocatalytic cyclization of dithiothreitol on a chemically modified electrode by analogy with protein action. Analyst 2001; 126:1409-13. [PMID: 11534615 DOI: 10.1039/b102767k] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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]
Abstract
Electrocatalytic oxidative cyclization of dithiothreitol (DTT(SH)2) to a disulfide product was demonstrated on a Nafion/lead-ruthenium oxide pyrochlore chemically modified electrode (NPyCME). The process at the NPyCME with DTT(SH)2 is similar to the behaviour of protein in a disulfide linkage, which can be demonstrated by product analysis using HPLC coupled with UV spectroscopy. A possible electrocatalytic mechanism for DTT(SH)2 oxidation to dihydroxydithiane [i.e. cyclized DTT(S-S)] on the NPyCME was proposed in terms of Py-Ru(IV)/Py-Ru(VI) redox active sites. This physical aspect was further utilized for high precision analytical assays using flow injection analysis (FIA), with a linearity up to 50 microM and a detection limit (S/N = 3) of 28 nM (8.64 pg) in a 20 microL sample loop. This is the most sensitive method ever reported for DTT(SH)2 detection assays. The interference from dissolved oxygen, disulfide and glucose is almost negligible. The present method offers an easy route for extension to redox-related protein studies.
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Affiliation(s)
- J M Zen
- Department of Chemistry, National Chung-Hsing University, Taichung, Taiwan.
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Affiliation(s)
- A S Kumar
- Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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Anjaneyulu A, Reddy VK, Raju PK, Rajagopalaraju A, Kumar AS, Ravichandra R. Acute reversible left ventricular dysfunction following general anesthesia. Indian Heart J 2001; 53:508-10. [PMID: 11759947] [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: 02/23/2023] Open
Abstract
Acute reversible left ventricular dysfunction due to myocardial stunning is a known phenomenon during acute myocardial infarction, coronary angiography, coronary angioplasty or after coronary artery bypass surgery. We report a rare case of acute reversible dysfunction of the myocardium as a complication of general anesthesia in a patient with normal coronary arteries. This is a potentially fatal complication unless recognized early and treated aggressively.
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Affiliation(s)
- A Anjaneyulu
- Department of Cardiology, Care Hospital, Hyderabad.
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22
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Abstract
Atrial septal aneurysms (ASA) are not uncommonly detected in patients with rheumatic mitral stenosis and pose problems during transeptal puncture in patients undergoing balloon mitral valvotomy. From a period of August 1995 to May 1998, we performed a total of 680 Inoue Balloon Mitral Valvotomy (IBMV) procedures with ASA noted in 30 patients, 13 of diffuse and 17 localized type. Transesophageal echocardiography (TOE) was used in all patients with suspected aneurysm on transthoracic echo (TTE) for exact three-dimensional delineation of the location and extent of the aneurysm. The localized type of aneurysms were further subcategorized into five types viz. antero-superior and leftwards (6), postero-superior and rightwards (2), antero-inferior and leftwards (2), postero-inferior and rightwards (5), and central (2), depending on their location in the atrial septum. The site for transeptal puncture was decided after this localization and the remainder of the IBMV procedure was as usual. In the set of thirteen patients with diffuse type of atrial septal aneurysms all but one case had a successful transeptal puncture using standard technique except for a somewhat inferior puncture site so as to be perpendicular to the plane of atrial septum and a successful mitral valve dilatation was possible at first attempt. In the set of 17 patients with localized type of aneurysms, all had a successful transeptal puncture except one. In patients with aneurysms localized antero-superiorly and leftwards the septal puncture was done in a slightly inferior location with transeptal needle pointing some what more posterior, i.e. 5 or 6 o'clock position and in patients with aneurysms localized postero-inferiorly the puncture was done more cephalic with needle directed somewhat anterior, i.e. 3-2 o'clock position. In the two patients with Atrial septal aneurysms located postero-superiorly and to the right the puncture was done slightly inferior but with transeptal needle pointing to about 3 or 2 o'clock position and in the single patient with antero-inferior location the puncture was done in slightly higher but with a more posterior directed needle, i.e. 5-6 o'clock position. The two patients with centrally located localized type of aneurysms had successful transeptal puncture with standard needle direction (4 o'clock) but at a slightly inferior location. We conclude that a good localization of atrial septal aneurysms using transesophageal echocardiography and our technique of transeptal puncture leads to a successful outcome in majority of cases undergoing Inoue balloon mitral valvotomy with associated atrial septal aneurysms.
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Affiliation(s)
- P K Goel
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, 226014, Lucknow, India.
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Choudhary SK, Talwar S, Dubey B, Chopra A, Saxena A, Kumar AS. Mitral valve repair in a predominantly rheumatic population. Long-term results. Tex Heart Inst J 2001; 28:8-15. [PMID: 11330754 PMCID: PMC101122] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Valve repair in rheumatic patients poses special problems due to valve deformity and mixed lesions. We present our experience from January 1988 through June 1999, in this retrospective study of 818 patients (377 males). The mean age was 22.8 +/- 11.3 years (range, 2 to 70 years). The cause of mitral regurgitation was rheumatic in 718 (88%) patients, congenital in 51, myxomatous in 34, infective in 7, and ischemic in 8. Most patients (64%) were in New York Heart Association functional class III or IV. Congestive heart failure was present in 116 patients (14%). Reparative procedures included posterior collar annuloplasty (n=710), commissurotomy (n=482), cusp-level chordal shortening (n=237), cusp thinning (n=222), cleft suture (n= 166), and cusp excision/plication (n=42). Operative mortality was 4% (32 patients). Preoperative left ventricular dysfunction, presence of congestive heart failure, and advanced functional class were associated with greater mortality. Follow-up ranged from 1 to 144 months (mean, 44.9 +/- 33.2 months) and was 96% complete. Most survivors (70%) had no or trivial mitral regurgitation. Forty patients required reoperation for valve dysfunction. There were 23 (2.8%) late deaths. Actuarial, reoperation-free, and event-free survival at 11 years were 92.6% +/- 1.0%, 65.0% +/- 10%, and 38% +/- 6.0%, respectively Among the survivors, 85% were in New York Heart Association functional class I. We conclude that mitral valve repair in rheumatic patients, using current techniques, can effectively correct hemodynamic and functional abnormalities with satisfactory results.
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Affiliation(s)
- S K Choudhary
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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Wasir H, Choudhary SK, Airan B, Srivastava S, Kumar AS. Mitral valve replacement with chordal preservation in a rheumatic population. J Heart Valve Dis 2001; 10:84-9. [PMID: 11206773] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Mitral valve replacement (MVR) with preservation of the subvalvular apparatus may maintain postoperative left ventricular (LV) function better than conventional MVR. A prospective study was undertaken to assess the advantages of chordal preservation in rheumatic patients undergoing isolated MVR. METHODS Between January 1996 and January 1999, 240 patients with rheumatic etiology and normal LV ejection fraction (>50%) underwent isolated MVR using a St. Jude Medical prosthesis. Patients were allocated to two groups: in group I (n = 168), both the anterior and posterior chordae were preserved; in group II (n = 72), the entire native mitral valve apparatus was excised. Patients from both groups were evaluated postoperatively (mean 12.5 months) by echocardiography and treadmill testing. RESULTS Demographic and clinical profiles were comparable in both groups. There were three early deaths in group I, and one in group II. There were no late deaths. One patient in group I required reoperation for a stuck mitral prosthesis. LV function (ejection fraction >50%) was better in group I (94%) than in group II (82%) (p <0.05). No patient in either group had LV outflow tract obstruction on echocardiography. Patients in group I showed better exercise performance on treadmill (Bruce protocol): 92% of group I patients versus 88% of group II patients (p >0.05) completed stage I; 16% of group I patients, but no group II patients, were able to complete stage IV (p <0.05). CONCLUSION Mitral valve replacement with preservation of the subvalvular apparatus maintains LV function, and does not cause LV outflow tract obstruction.
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Affiliation(s)
- H Wasir
- Department of Cardio-Thoracic and Vascular Surgery, Cardio-Thoracic Sciences Centre, All India Institute of Medical Sciences, Anisari Nagar, New Delhi
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Green PS, Yang SH, Nilsson KR, Kumar AS, Covey DF, Simpkins JW. The nonfeminizing enantiomer of 17beta-estradiol exerts protective effects in neuronal cultures and a rat model of cerebral ischemia. Endocrinology 2001; 142:400-6. [PMID: 11145603 DOI: 10.1210/endo.142.1.7888] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Estrogens are potent neuroprotective compounds in a variety of animal and cell culture models, and data indicate that estrogen receptor (ER)-mediated gene transcription is not required for some of these effects. To further address the requirement for an ER in estrogen enhancement of neuronal survival, we assessed the enantiomer of 17beta-estradiol (ENT-E(2)), which has identical chemical properties but interacts only weakly with known ERs, for neuroprotective efficacy. ENT-E(2) was both as potent and efficacious as 17beta-estradiol in attenuating oxidative stress-induced death in HT-22 cells, a murine hippocampal cell line. Further, ENT-E(2) completely attenuated H(2)O(2) toxicity in human SK-N-SH neuroblastoma cells at a 10 nM concentration. In a rodent model of focal ischemia, 17beta-estradiol (100 microgram/kg) or ENT-E(2) (100 microgram/kg), injected 2 h before middle cerebral artery occlusion, resulted in a 60 and 61% reduction in lesion volume, respectively. ENT-E(2), at the doses effective in this study, did not stimulate uterine growth or vaginal opening in juvenile female rats when administered daily for 3 days. These data indicate that the neuroprotective effects of estrogens, both in vitro and in vivo, can be disassociated from the peripheral estrogenic actions.
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Affiliation(s)
- P S Green
- Center for the Neurobiology of Aging, Department of Pharmacodynamics, University of Florida, Gainesville, Florida 32610, USA.
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27
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Abstract
Nafion/lead-ruthenate pyrochlore chemically modified electrode (NPyCME) showed a remarkable dual sensing activity toward NO2- oxidation and NO reduction as demonstrated by cyclic voltammetry (CV), ac-impedance spectroscopy and flow injection analysis (FIA). The mechanistic parameters of current function, charge transfer resistance and exchange current for the NPyCME, GCE and Nafion-coated GCE were evaluated and compared. The disproportionation reaction of NIIIO2- into NIVO3- + NIIO in acidic solution was used as a model system for testing the dual sensing ability of the NPyCME. The obtained crossover peak response for NO2- oxidation and NO reduction in pH 1.65 buffer solution gave the direct proof for the applicability of the NPyCME in the dual electrocatalytic action. By flow injection analysis, under optimized conditions, the calibration curve was linear in the range of 100 nM-100 microM and 800 nM-63.3 microM and the detection limit (S/N = 3) was 4.8 nM and 15.6 nM for NO2- and NO, respectively.
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Affiliation(s)
- J M Zen
- Department of Chemistry, National Chung-Hsing University, Taichung 402, Taiwan.
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Abstract
OBJECTIVE Results of mitral valve replacement with a mitral homograft were evaluated at 5 years to assess the suitability of the procedure. METHODS Thirty-seven patients (25 male subjects) aged 10 to 49 years (mean, 32 +/- 10 years) with rheumatic mitral valve disease underwent total (n = 35) or partial (n = 2) mitral valve replacement with a fresh antibiotic-preserved (n = 23) or cryopreserved (n = 14) mitral homograft. The predominant lesion was mitral stenosis (n = 30). RESULTS There were 5 early deaths. Operative survivors were followed up for 1 to 60 months (mean, 26.6 +/- 12 months). Among these, 21 patients had severe mitral regurgitation during the follow-up period; 3 died and 8 underwent reoperation. The homograft failure rate was not affected by preoperative physiologic lesion (stenosis vs regurgitation, P =.4), type of homograft (antibiotic-preserved vs cryopreserved homograft, P =.9), papillary muscle pretreatment (yes vs no, P =.9), or addition of posterior collar annuloplasty (yes vs no, P =.2). Among the remaining patients, 5 had moderate mitral regurgitation, 4 had either trivial or mild mitral regurgitation, and 2 were lost to follow-up. Study of the explanted mitral homografts (n = 8) revealed that disruption of one of the donor papillary muscles was responsible for early failures (n = 2), whereas cuspal and chordal degeneration was responsible for late failures (n = 6). Microscopically, the explanted valve lacked any viable cellular elements, and there was no evidence of immunologic injury to the homografts. CONCLUSION The mitral homograft did not fulfill our expectations as a suitable substitute for the diseased mitral valve.
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Affiliation(s)
- A S Kumar
- Department of Cardiothoracic and Vascular Surgery, Department of Cardiology, and the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Umesan CV, Kapoor A, Sinha N, Kumar AS, Goel PK. Effect of Inoue balloon mitral valvotomy on severe pulmonary arterial hypertension in 315 patients with rheumatic mitral stenosis: immediate and long-term results. J Heart Valve Dis 2000; 9:609-15. [PMID: 11041172] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND AIMS OF THE STUDY Despite advances in surgical techniques, mitral valve surgery in patients with severe pulmonary arterial hypertension (PAH) causes considerable mortality and morbidity. Balloon mitral valvotomy (BMV) is an established alternative to treat high-risk surgical patients with mitral stenosis (MS). The study aims were to evaluate immediate and long-term efficacy of BMV in patients with MS and severe PAH, compared to those with mild/moderate PAH. METHODS Among 1,125 patients who underwent Inoue BMV, 315 had severe PAH (mean pulmonary artery (PA) pressure > or = 50 mmHg (group I; 79 of these patients had suprasystemic PAH). Results from this group were compared with those of patients with mild/moderate PAH (group II). RESULTS Group I patients were younger and more symptomatic (mean PA pressure 62 +/- 10.6 mmHg versus 32.6 +/- 8.2 mmHg in group II). Before BMV, mean transmitral gradient (17.8 +/- 6.5 versus 14.4 +/- 5.4 mmHg) and pulmonary capillary wedge pressure (PCWP) (31.6 +/- 6.1 versus 22.8 +/- 6.2 mmHg) were significantly higher, while mitral valve area (MVA) (0.66 +/- 0.2 versus 0.85 +/- 0.2 cm2) was significantly lower in group I. After BMV, PA mean pressure was significantly reduced (34.8 +/- 11.2 and 21.1 +/- 8.4 mmHg), transmitral gradient (8.0 +/- 3.9 and 6.9 +/- 3.2 mmHg) and mean PCWP (12.8 +/- 5.8 and 11.0 +/- 5.1 mmHg) in groups I and II, respectively, with a comparable increase in MVA (1.77 +/- 0.4 and 1.84 +/- 0.5 cm2). Group I patients had worse baseline hemodynamic parameters than group II, but the former had a higher absolute gain in hemodynamic parameters. Residual severe PAH after BMV was seen in 9.8% of patients, with PA pressures normalized in 9.5%. Among 79 patients with suprasystemic PA pressure (mean PA systolic pressure 116.6 +/- 28.2 mmHg), 16.5% normalized their PA pressures and 25.3% had residual severe PAH. At mean follow up of 33 months, 80.4% were in NYHA class I. Mean PA systolic pressure in 161 patients was 39.0 +/- 14.2 mmHg compared with a post-BMV value of 55.0 +/- 16.9 mmHg; thus, a sustained fall in pressure was demonstrated at follow up. CONCLUSION Inoue BMV is safe and effective in patients with MS and severe PAH. Although these patients have worse clinical and hemodynamic parameters before BMV, they achieve a greater absolute gain in terms of improvement in all hemodynamic parameters.
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Affiliation(s)
- C V Umesan
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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31
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Covey DF, Han M, Kumar AS, de La Cruz MA, Meadows ES, Hu Y, Tonnies A, Nathan D, Coleman M, Benz A, Evers AS, Zorumski CF, Mennerick S. Neurosteroid analogues. 8. Structure-activity studies of N-acylated 17a-aza-D-homosteroid analogues of the anesthetic steroids (3alpha, 5alpha)- and (3alpha,5beta)-3-hydroxypregnan-20-one. J Med Chem 2000; 43:3201-4. [PMID: 10966737 DOI: 10.1021/jm0002477] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D F Covey
- Departments of Molecular Biology and Pharmacology, Anesthesiology, Psychiatry, and Anatomy and Neurobiology, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110, USA
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Luker GD, Pica CM, Kumar AS, Covey DF, Piwnica-Worms D. Effects of cholesterol and enantiomeric cholesterol on P-glycoprotein localization and function in low-density membrane domains. Biochemistry 2000; 39:7651-61. [PMID: 10869171 DOI: 10.1021/bi9928593] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [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] [Indexed: 11/29/2022]
Abstract
Multidrug resistance P-glycoprotein (Pgp) has been reported to localize in low-density, cholesterol-enriched membranes. However, effects of low-density membrane domains on function of Pgp remain unexplored in whole cell systems. In cells that express modest levels of the protein endogenously or through drug selection, Pgp predominantly localized to low-density membranes following separation on a sucrose gradient. When highly overexpressed in NIH 3T3 cells, a prominent amount of Pgp also was detected in high-density membranes. Removing cholesterol from cells with beta-methylcyclodextrin (CD), a sterol acceptor molecule, shifted fractions that contained Pgp from low toward high density, and this effect was reversed to a similar extent by restoring sterols with either cholesterol or enantiomeric cholesterol. However, function of human MDR1 Pgp as probed with Tc-Sestamibi, a transport substrate for Pgp, was not dependent on localization of Pgp in cholesterol-enriched membranes. Specific inhibition of MDR1 Pgp with GF120918 or LY335979 also was independent of cholesterol. Cell-type-specific effects of cholesterol content on function of human Pgp were detected by use of daunomycin, another substrate for Pgp, although efficacy of inhibitors remained independent of cholesterol. Conversely, both function and inhibition of hamster Pgp as measured with Tc-Sestamibi and daunomycin were in part dependent on normal cell content of cholesterol. These data show that Pgp preferentially localizes to low-density, cholesterol-enriched membrane domains, but acute depletion of cholesterol impacts Pgp-mediated drug transport in a substrate- and cell-type-specific manner.
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Affiliation(s)
- G D Luker
- Laboratory of Molecular Radiopharmacology, Mallinckrodt Institute of Radiology, and Department of Molecular Biology and Pharmacology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Abstract
OBJECTIVE Retrospective analysis was performed to determine the suitability of pulmonary homograft as an aortic valve substitute. METHODS From January 1994 through June 1999, 147 patients (mean age, 32.2 +/- 17.3 years) underwent aortic valve replacement with either an aortic homograft (group 1: n = 103, 25 fresh antibiotic preserved and 78 cryopreserved) or a pulmonary homograft (group 2: n = 44, 11 antibiotic preserved and 33 cryopreserved). In group 1 a scalloped subcoronary technique was used in 64 patients, and a root replacement technique was used in 39 patients. In group 2 the scalloped subcoronary technique was used in 34 patients, and the root replacement technique was used in 10 patients. RESULTS There were 131 operative survivors (group 1 = 91; group 2 = 40). Follow-up ranged from 2 to 62 months. In group 1 none of the patients had significant aortic regurgitation during the hospital stay. Three patients (all having undergone the scalloped subcoronary technique) had moderate aortic regurgitation after 6 to 32 months. In group 2, 10 patients (9 having undergone the scalloped subcoronary technique and 1 having undergone the root replacement technique) developed significant regurgitation: 2 intraoperatively, 5 in the early postoperative period before discharge from the hospital, and 3 during late follow-up 6 to 12 months postoperatively. Among the various risk factors analyzed for overall homograft failure, use of a pulmonary homograft was the single independent predictor of valve failure (odds ratio, 8.6; 95% confidence interval, 1.9-39; P =.006). CONCLUSION Pulmonary homograft, when inserted by means of a scalloped subcoronary technique, is not a suitable aortic valve substitute.
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Affiliation(s)
- S K Choudhary
- Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Kumar AS, Gonzales LW, Ballard PL. Transforming growth factor-beta(1) regulation of surfactant protein B gene expression is mediated by protein kinase-dependent intracellular translocation of thyroid transcription factor-1 and hepatocyte nuclear factor 3. Biochim Biophys Acta 2000; 1492:45-55. [PMID: 11004479 DOI: 10.1016/s0167-4781(00)00058-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The transforming growth factor-beta (TGF beta) polypeptides control a variety of cellular processes including organogenesis and cellular proliferation and differentiation. In the developing lung, TGF beta(1) treatment inhibits airway branching and expression of the genes for surfactant proteins (SP). Many effects of TGF beta are mediated at the level of gene transcription but there is limited information regarding signaling pathways and target transcription factors. In this study with human pulmonary adenocarcinoma H441 cells, we investigated TGF beta(1) effects on SP-B, a protein which is essential for normal function of pulmonary surfactant. TGF beta(1) (10 ng/ml) reduced SP-B mRNA content in a time-dependent fashion, and transient transfection studies localized responsiveness to the region of the SP-B promoter (-112/-72 bp) containing binding sites for thyroid transcription factor-1 (TTF-1) and hepatocyte nuclear factor 3 (HNF3), transcription factors that are important enhancers of SP gene expression. Using electrophoretic mobility shift assay and immunofluorescence, we demonstrated rapid accumulation of these transcription factors in the cytoplasm and subsequent loss from the nucleus on TGF beta(1) treatment of both adenocarcinoma cells and cultured human fetal lung. TGF beta(1) treatment caused intracellular translocation of protein kinase C and effects of TGF beta(1) were mostly abrogated in the presence of the protein kinase inhibitor calphostin C. We conclude that TGF beta(1), acting via protein phosphorylation, blocks nuclear translocation of TTF-1 and HNF3 which results in down-regulation of the SP-B gene and presumably other pulmonary genes which are transactivated by these factors.
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Affiliation(s)
- A S Kumar
- Institute for Environmental Medicine, University of Pennsylvania School of Medicine, Philadelphia, 19104-6068, USA
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Kumar AS, Saxena A. Intraoperative transoesophageal echocardiography in aortic valve surgery. Indian Heart J 2000; 52:50-3. [PMID: 10820934] [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: 02/16/2023] Open
Abstract
From January 1994 to May 1998, 272 patients underwent homograft aortic valve replacement (n = 139), Ross procedure (n = 100) and aortic valve repair (n = 33). Transoesophageal echocardiography was performed intraoperatively before and after cardiopulmonary bypass. Aortic valve morphology, aortic root diameter, pulmonary valve morphology, pulmonary annulus diameter and mitral valve morphology were assessed by two-dimensional imaging. Colour flow mapping was used for assessing severity of aortic regurgitation before and after the procedure. There were no complications related to the procedure. The accuracy of aortic annular diameter measured in the long axis view was confirmed at surgery. The aortic valve morphology was thought suitable for repair and a satisfactory repair was performed in 33 patients as assessed by transoesophageal echocardiography. Post-operative transoesophageal echocardiography showed a competent aortic valve in all but four of the remaining 239 patients. Intraoperative transoesophageal echocardiography is easy to learn and provides the surgeon additional information necessary to decide a particular procedure. In addition, intraoperative transoesophageal echocardiography provides accurate assessment of the results of surgery on the table.
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Affiliation(s)
- A S Kumar
- Department of Cardiology and Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi
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Choudhary SK, Talwar S, Kumar AS. Bentall operation with valved homograft conduit. Tex Heart Inst J 2000; 27:366-8. [PMID: 11198310 PMCID: PMC101106] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Lesions of the ascending aorta associated with aortic valve disease are usually treated by implanting a prosthetic valved conduit (Bentall procedure). In this report, we present our experience in which a valved homograft conduit was used for the procedure. Six patients underwent a Bentall procedure with the use of a cryopreserved valved homograft conduit. Two of the patients had annuloaortic ectasia, 2 had Marfan syndrome, and 1 had an atherosclerotic aneurysm of the aorta. One patient had severe aortic stenosis due to a bicuspid aortic valve, along with an aneurysm and localized dissection of the ascending aorta. In all of the patients, the aortic annulus was substantially dilated, with accompanying moderate-to-severe aortic regurgitation. A standard procedure was performed with moderate hypothermia, cardiopulmonary bypass, and aortic and bicaval cannulation. The ascending aorta and the aortic valve were replaced with a cryopreserved valved homograft conduit (aortic in 5 patients and pulmonary in 1). The native coronary ostia were anastomosed directly to the homograft. Echocardiography, which was performed intraoperatively, before discharge from the hospital, and at follow-up visits (1 to 36 months), revealed good valve function without dilatation of the homograft conduits. There was 1 late death due to Aspergillus fumigatus endocarditis, 6 months postoperatively. In 1 patient, magnetic resonance imaging performed at 24 months revealed normal caliber of the homograft conduit. We conclude that the Bentall procedure can be performed, safely and with excellent results, using cryopreserved homograft conduits.
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Affiliation(s)
- S K Choudhary
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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Chowdhury UK, Airan B, Kumar AS, Sharma R, Bhan A, Kothari SS, Saxena A, Juneja R, Venugopal P. Management of tetralogy of Fallot with absent pulmonary valve: early and mid-term results of a uniform approach. Indian Heart J 2000; 52:54-9. [PMID: 10820935] [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: 02/16/2023] Open
Abstract
The operative management of absent pulmonary valve syndrome remains controversial regarding palliative or one-stage correction, the need for pulmonary valve implantation and pulmonary arterioplasty. This retrospective report summarises the experience of a single centre with a view to provide some answers to this controversy. Forty-six consecutive patients including five infants, aged 2 months to 43 years, underwent primary surgical correction during the last 8.5 years. All the patients underwent two-dimensional echocardiography and cardiac catheterisation. Nine patients had mild and 10 moderate pulmonary artery hypertension. Repair consisted of patch closure of the ventricular septal defect and reconstruction of the right ventricular outflow tract. A valve was incorporated in the pulmonary position in 19 patients. Pulmonary arterioplasty was performed only in infants. Overall hospital mortality was 4 out of 46 patients (8.6%). Two out of five infants died accounting for 40 percent mortality. Forty-two survivors were followed up from 4 to 101 months; 40 patients are in functional class I and two in class II. Actuarial survival at 8.5 years was 91 percent. It is concluded that reconstruction of the right ventricular outflow tract with a transannular patch is sufficient in majority of patients. A selective approach to pulmonary valve insertion is recommended in patients with pulmonary hypertension or other anomalies. Pulmonary arterioplasty should be performed as the primary treatment in infants.
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Affiliation(s)
- U K Chowdhury
- Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi
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Abstract
The Bacillus thuringiensis insecticidal delta-endotoxins have a three-domain structure, with the seven amphipathic helices which comprise domain I being essential for toxicity. To better define the function of these helices in membrane insertion and toxicity, either site-directed or random mutagenesis of two regions was performed. Thirty-nucleotide segments in the B. thuringiensis cry1Ac1 gene, encoding parts of helix alpha4 and the loop connecting helices alpha4 and alpha5, were randomly mutagenized. This hydrophobic region of the toxin probably inserts into the membrane as a hairpin. Site-directed mutations were also created in specific surface residues of helix alpha3 in order to increase its hydrophobicity. Among 12 random mutations in helix alpha4, 5 resulted in the total loss of toxicity for Manduca sexta and Heliothis virescens, another caused a significant increase in toxicity, and one resulted in decreased toxicity. None of the nontoxic mutants was altered in toxin stability, binding of toxin to a membrane protein, or the ability of the toxin to aggregate in the membrane. Mutations in the loop connecting helices alpha4 and alpha5 did not affect toxicity, nor did mutations in alpha3, which should have enhanced the hydrophobic properties of this helix. In contrast to mutations in helix alpha5, those in helix alpha4 which inactivated the toxin did not affect its capacity to oligomerize in the membrane. Despite the formation of oligomers, there was no ion flow as measured by light scattering. Helix alpha5 is important for oligomerization and perhaps has other functions, whereas helix alpha4 must have a more direct role in establishing the properties of the channel.
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Affiliation(s)
- A S Kumar
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana 47907, USA
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Choudhary SK, Bhan A, Sharma R, Talwar S, Airan B, Kumar AS, Chopra A, Venugopal P. Post-infarction ischaemic mitral regurgitation: what determines the outcome. Indian Heart J 1999; 51:508-14. [PMID: 10721641] [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: 02/15/2023] Open
Abstract
Ischaemic mitral regurgitation is an important determinant of survival in patients with coronary artery disease. A retrospective analysis was performed to evaluate the overall outcome and its determinants in patients with ischaemic mitral regurgitation. Over a period of 10 years, 72 patients underwent operations for mitral regurgitation of ischaemic origin. Age ranged from 37 to 68 years (mean 54.6 +/- 10.4 years), and 62 (86.1%) were male. Thirteen (18%) patients had acute and 59 (82%) had chronic ischaemic mitral regurgitation. Twenty-one patients were in New York Heart Association class II, 32 in class III and 19 in class IV. Moderate to severe left ventricular dysfunction was present in 42 patients. Valve prolapse was present in 35 (48.6%) patients and restricted leaflet motion secondary to myocardial dysfunction was present in 37 (51.4%) patients. All the patients were operated using standard cardiopulmonary bypass technique. Mitral valve was replaced in 33 patients and repaired in 39. Repair included a combination of techniques: chordal transposition (n = 2), chordal shortening (n = 18), leaflet resection (n = 2), posterior collar annuloplasty (n = 35) and annuloplasty with flexible Duran's ring (n = 3). Operative mortality was 18.1 percent (13/72). Low cardiac output was the cause of death in the majority (n = 10). Acute presentation and presence of restricted leaflet motion were the significant predictors of early mortality. Follow-up ranged from 3 to 84 months (mean 41.6 +/- 10.2 months). Late mortality was 46.2 percent. Actuarial survival in operative survivors at five years was 44.4 +/- 8.8 percent. To conclude, ischaemic mitral regurgitation carries a poor early and late outcome, with left ventricular dysfunction and presence of restricted leaflet motion being important contributors to it. In addition, acute presentation also reflects greater early mortality.
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Affiliation(s)
- S K Choudhary
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi
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Choudhary SK, Mathur A, Sharma R, Saxena A, Chopra P, Roy R, Kumar AS. Pulmonary autograft: should it be used in young patients with rheumatic disease? J Thorac Cardiovasc Surg 1999; 118:483-90; discussion 490-1. [PMID: 10469964 DOI: 10.1016/s0022-5223(99)70186-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [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] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although pulmonary autograft is being increasingly used to replace the diseased aortic valve with excellent long-term results, its use in the population with rheumatic disease still needs careful evaluation. PATIENTS AND METHODS From October 1993 through March 1998, 102 patients underwent aortic valve replacement with a pulmonary autograft (Ross procedure). The mean age was 27.9 +/- 4.2 years (range, 0.8-56 years). The cause was rheumatic disease in 75 patients (73%), bicuspid aortic valve in 26 patients (26%), and myxomatous aortoarteritis in 1 patient (1%). The root replacement technique was used in all. In addition, 31 patients had 33 associated procedures: mitral valve repair (n = 15 patients), open mitral commissurotomy (n = 15 patients), tricuspid repair (n = 2 patients), and homograft mitral valve replacement (n = 1 patient). RESULTS Operative mortality was 6.9% (7 patients). Late mortality was 7.8% (8 patients). Follow-up ranged from 1 to 60 months (mean, 25.3 +/- 15.4 months) and was 98% complete. Two patients required reoperation for failed mitral valve repair, and 2 other patients underwent reoperation for failure of both the autograft and mitral valve repair. Echocardiographic assessment showed moderate to severe aortic regurgitation in 13 patients, along with thickening of the autograft. All of these patients had rheumatic disease and were young (<30 years). Ten of these patients had undergone associated mitral valve procedure. Morphologic and histopathologic examination of explanted autografts showed features compatible with rheumatic valvulitis. CONCLUSION Pulmonary autograft is susceptible to rheumatic involvement. Young age (<30 years) and associated mitral valve disease are significant risk factors for autograft failure in patients with rheumatic disease. Use of pulmonary autograft in this subgroup of patients requires a cautious approach.
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Affiliation(s)
- S K Choudhary
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi
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Kumar AS. Valvular heart disease--repair or replacement? J Indian Med Assoc 1999; 97:282-6. [PMID: 10643193] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
An estimated 3 million patients in India need treatment for valvular heart disease. Rheumatic heart disease continues to be the major aetiologic factor. The mitral valve is best conserved with valvotomy or repair. The aortic valve is difficult to repair and is best replaced by a biological substitute (autograft or homograft). The tricuspid valve can be repaired in all patients. Prosthetic valves offer good long term durability but introduce additional risks to the patients. Experience over the past three decades suggests that conservation of natural valve mechanism is currently the best option.
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Affiliation(s)
- A S Kumar
- Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi
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Mohanty SR, Airan B, Bhan A, Sharma R, Kumar AS, Kothari SS, Saxena A, Venugopal P. Adult cyanotic congenital heart disease: surgical experience. Indian Heart J 1999; 51:186-92. [PMID: 10407548] [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: 02/13/2023] Open
Abstract
Cyanotic congenital heart diseases constitute about 10 percent of total congenital heart disease cases in adults in the developing world. Prolonged cyanosis and old age adversely affect the outcome of surgery, thus posing a challenge to the cardiac surgeons. This study was conducted to assess the feasibility, safety and outcome of surgery in this group of patients. From January 1991 to December 1997, a total of 303 patients, aged 14 to 54 years (mean 19.8 +/- 1.5 years) with diagnosis of various cyanotic congenital heart diseases were operated at our institute. There were 210 males (69.3%). Two hundred and forty-seven patients (81.5%) had tetralogy of Fallot's physiology, 51 patients (16.8%) had single ventricle physiology and five (1.6%) had other lesions. Sixty-six patients (21.7%) had pre-operative complications such as haemoptysis, epistaxis, cerebrovascular accidents, brain abscess and infective endocarditis. Sixty patients (19.8%) had previous palliative shunts and 26 patients (8.5%) had coil embolisation of major aortopulmonary collaterals prior to surgery; 229 patients (75.5%) underwent biventricular repair, 52 (17.1%) had univentricular repair, 22 (7.7%) had palliative shunts and one patient had open ligation of a major aortopulmonary collateral in addition. In-hospital mortality was 3.3 percent. Follow-up period ranged from five months to seven years (mean 4.2 +/- 1.8 years). There were two late deaths. Of the 291 survivors, 11 were lost to follow-up. Two hundred and fifty-eight patients (92.1%) are in New York Heart Association class I. Significant residual defects warranting reoperation were present in four patients (1.3%). It is concluded that congenital heart surgery in older cyanotic patients can be performed safely with satisfactory results.
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Affiliation(s)
- S R Mohanty
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi
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Mohanty SR, Choudhary SK, Ramamurthy S, Kumar AS. Isolated congenital anterior mitral leaflet cleft: a rare cause of mitral insufficiency. J Heart Valve Dis 1999; 8:67-70. [PMID: 10096485] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Isolated cleft of the anterior mitral leaflet is a rare cause of mitral insufficiency. Although an established entity, due to its rarity the exact anatomic diagnosis is difficult to establish unless sought specifically. METHODS Four patients (age range: 16 to 26 years) with isolated cleft of the anterior mitral leaflet were treated at the authors' institute. Clinical symptoms were typical of mitral insufficiency; the exact anatomic diagnosis was not established preoperatively in any patient. The cleft was directly sutured in all four patients and additional annuloplasty was performed in three. RESULTS Postoperative echocardiography confirmed satisfactory results. After a mean follow up of 46.7 months (range: 3 to 84 months), one patient had mild mitral insufficiency and the remaining patients had no mitral regurgitation. CONCLUSION In severe mitral insufficiency with no obvious mitral valve pathology and an intact atrial septum, a cleft of the anterior mitral leaflet should be sought. Repair of the cleft can restore normal mitral valve function.
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Affiliation(s)
- S R Mohanty
- Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi
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Ghosh P, Kumar S, Pandey S, Kumar AS, Sinha N. Small aortic annulus: a functional definition. Ann Thorac Cardiovasc Surg 1998; 4:251-61. [PMID: 9828282] [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: 02/09/2023] Open
Abstract
BACKGROUND & OBJECTIVE Small aortic annulus is conventionally associated with poor outcome after aortic valve replacement (AVR). Contrarily, several patients have excellent follow-up results after AVR with 19, 20 or 21 size Medtronic Hall (MH) or Sorin Carbocast (SC) prostheses. This disparity prompted a relook at the semantics of a small aortic annulus. METHODS Available survivors of isolated AVR with #19, #20 or #21 prostheses - 13 with 19 SC or 20 MH valves (Group A) and 29 with 21 SC or MH valves (Group B) were studied. Disparity between actually implanted prostheses versus predicted prosthetic size (tissue annulus diameter) was analysed according to nomograms of Rowlatt et al, NIH Plehn, Kishimoto formula and Sievers composite criteria. Preoperative and follow-up echocardiographic assessments were used for hemodynamic and prosthetic function indices. RESULTS Both groups were similar in age, height, weight, BSA, BMI, mean NYHA class, CTR, preoperative peak gradient (PG) (92. 0 +/- 29.55 vs 102.88 +/- 33.65), mean gradient (MG) (56.8 +/- 24.6 vs 61.55 +/- 16.56), LVEDD (50.75 +/- 10.92 vs 56.0 +/- 13.5), LVESD (34.37 +/- 13.32 vs 38.52 +/- 13.85) and LVEF (67.5 +/- 12.5 vs 63.9 +/- 14.3). By developmental indices of Rowlatt et al. and NIH, no valve annulus could be designated as narrow. By Sievers composite nomogram all implanted valves were undersized by echocardiographic parameters, in normal range by angiographic criteria and oversized by anatomic autopsy data. Implanted valves in both groups were bigger than Plehn-predicted size (18.16 +/- 1.48 in GrA, 19.46 +/- 1. 10 in GrB). Valve size indices (VSI) (GrA 16.16 +/- 2.85 GrB 14.24 +/- 1.64) and geometric orifice area indices (VAI: valve area index) (GrA 1.50 +/- 0.28 vs 1.41 +/- 0.19) and postoperative rest PG (GrA 47.2 +/- 18.6 GrB 33.8 +/- 9.9) and MG (GrA 27.2 +/- 12.9 vs 19.0 +/- 9.9) were acceptable. LVEDD and LVESD regressed in both groups. LV mass indices regressed from 218.56 +/- 100.85 to 128.17 +/- 27.7 in GrA and 238.94 +/- 102.5 to 134.22 +/- 34.72 in GrB. Performance indices of implanted valves and postoperative aortic valve resistances were correlative. CONCLUSIONS The size of the implanted prostheses per se does not denote narrowness. Patient-prosthesis mismatch may be considered if predicted prosthesis has VSI <12 mm/m2, VAI <1.31 cm2/m2 or prosthesis orifice diameter <19 mm which may indicate annular enlargement.
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Affiliation(s)
- P Ghosh
- Cardiac Sciences Center, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Abstract
BACKGROUND Myxomas are the most common benign intracardiac tumors. This report summarizes our 20-year experience with these tumors. METHODS Sixty-six patients (25 male) with a median age of 39 years (range, 6 to 70 years) underwent surgical excision of primary or recurrent intracardiac myxomas during the years 1976 to 1996. Symptom duration ranged from 2 to 8 months. There were 55 left atrial myxomas, 10 right atrial myxomas, and 1 biatrial myxoma. Three of the patients were in one family. The surgical approach comprised complete wide excision. RESULTS There were two early deaths. Late follow-up is 89% (57/64) complete. There was one late death, which was not due to a cardiac cause. Echocardiography at a mean follow-up of 66.9 months (range, 7 to 241 months) showed no recurrence of sporadic myxomas. However, 2 of the 3 patients with familial myxomas had recurrence. CONCLUSIONS Surgical excision of atrial myxoma gives excellent short-term and long-term results leading to eventual cure of nonfamilial myxomas. However, familial myxomas retain a strong tendency to recur even 20 years after excision.
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Affiliation(s)
- A Bhan
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi
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Kumar AS. Serum level of furazolidone. Indian Pediatr 1998; 35:923-7. [PMID: 10216610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Chauhan S, Gaurishankar R, Choudhary SK, Kumar L, Kumar AS. Normothermic cardiopulmonary bypass & post-operative blood loss. Indian J Med Res 1998; 108:66-70. [PMID: 9785682] [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: 02/09/2023] Open
Abstract
Normothermic cardiopulmonary bypass (CPB) has been shown to have less disruptive effects on coagulation factors and platelet function. Ninety patients undergoing valvular heart surgery were randomly divided into two groups of 45 patients each to undergo normothermic (35 degrees C-37 degrees C) or hypothermic (28 degrees C) bypass. We found normothermic bypass to significantly reduce bypass time and requirements of fluid and blood post-operatively. However, there was no reduction in post-operative blood loss, re-exploration rate or blood product requirements by use of normothermic cardiopulmonary bypass.
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Affiliation(s)
- S Chauhan
- Cardio Thoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi
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Kumar AS. Salmeterol in exercise induced asthma. Indian Pediatr 1998; 35:681-2. [PMID: 10216682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Umre MA, Choudhary SK, Chander H, Venugopal P, Kumar AS. Surgery for aortic valve endocarditis. Indian Heart J 1998; 50:318-20. [PMID: 9753855] [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: 02/08/2023] Open
Abstract
From March 1994 to March 1997, 36 patients with aortic valve endocarditis were managed surgically. Of these, 30 patients had native valve endocarditis and six had prosthetic valve endocarditis. In patients with native valve endocarditis, surgical procedures included aortic valve repair (n=6), homograft aortic valve replacement (n=9), Ross procedure (n=5) and prosthetic aortic valve replacement (n=10). There were three early and two late deaths in this group. In patients with prosthetic valve endocarditis, aortic valve replacement with a homograft was performed in all. Active infection and prosthetic valve endocarditis were the most important predictors of early mortality. The availability of a homograft valve provides an alternative to prosthetic valve replacement in patients with aortic valve endocarditis.
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Affiliation(s)
- M A Umre
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi
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Kumar AS, Kumar DA, Chander H, Saxena A. Experience with homograft mitral valve replacement. J Heart Valve Dis 1998; 7:225-8. [PMID: 9587866] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS OF THE STUDY Homograft mitral valve replacement may offer a superior alternative to replacement with a prosthetic valve. The authors' early experience with this technique is reported. METHODS Between May 1994 and May 1995, 24 patients (19 males, five females; age range 17 to 49 years) underwent homograft mitral valve replacement (HMVR) at the authors' institution. The etiology was rheumatic in all patients; 22 had severe calcific mitral stenosis (MS) and two had combined MS and severe mitral regurgitation (MR). RESULTS There were three early deaths (12%) and two late deaths (8%). In three patients the homograft had to be explanted due to severe MR at six weeks, 10 weeks and 12 months, respectively. Mean follow up was 18 months (range: 12 to 25 months). Postoperative echocardiography showed trivial or mild MR in 12 patients and moderate MR in four. Mitral stenosis was absent in all patients (mean mitral valve area 2.5 cm2). Sixteen patients showed satisfactory homograft valve function at follow up. The valve explanted after six weeks showed normal cusp architecture, endothelial growth and incorporation of the pericardial strip and complete healing of the papillary muscle junction. Magnetic resonance imaging in 12 patients showed normal appearance and function of the homografts. CONCLUSIONS The authors' experience suggests that homograft mitral valve replacement can be performed with good early results.
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Affiliation(s)
- A S Kumar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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