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Mishra A, Begley SL, Shah HA, Santhumayor BA, Ramdhani RA, Fenoy AJ, Schulder M. Why are clinical trials of deep brain stimulation terminated? An analysis of clinicaltrials.gov. World Neurosurg X 2024; 23:100378. [PMID: 38595675 PMCID: PMC11002890 DOI: 10.1016/j.wnsx.2024.100378] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
Background Although deep brain stimulation (DBS) has established uses for patients with movement disorders and epilepsy, it is under consideration for a wide range of neurologic and neuropsychiatric conditions. Objective To review successful and unsuccessful DBS clinical trials and identify factors associated with early trial termination. Methods The ClinicalTrials.gov database was screened for all studies related to DBS. Information regarding condition of interest, study aim, trial design, trial success, and, if applicable, reason for failure was collected. Trials were compared and logistic regression was utilized to identify independent factors associated with trial termination. Results Of 325 identified trials, 79.7% were successful and 20.3% unsuccessful. Patient recruitment, sponsor decision, and device issues were the most cited reasons for termination. 242 trials (74.5%) were interventional with 78.1% successful. There was a statistically significant difference between successful and unsuccessful trials in number of funding sources (p = 0.0375). NIH funding was associated with successful trials while utilization of other funding sources (academic institutions and community organizations) was associated with unsuccessful trials. 83 trials (25.5%) were observational with 84.0% successful; there were no statistically significant differences between successful and unsuccessful observational trials. Conclusion One in five clinical trials for DBS were found to be unsuccessful, most commonly due to patient recruitment difficulties. The source of funding was the only factor associated with trial success. As DBS research continues to grow, understanding the current state of clinical trials will help design successful future studies, thereby minimizing futile expenditures of time, cost, and patient engagement.
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Affiliation(s)
- Akash Mishra
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Sabrina L. Begley
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Harshal A. Shah
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Brandon A. Santhumayor
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Ritesh A. Ramdhani
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Albert J. Fenoy
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Michael Schulder
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
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Sharma J, Deo SVS, Kumar S, Barwad AW, Rastogi S, Sharma DN, Singh G, Bhoriwal S, Mishra A, K R, Saikia J, Mandal A, Bansal B, Gaur M. Clinicopathological Profile and Survival Outcomes in Patients with Localised Extremity Synovial Sarcomas. Clin Oncol (R Coll Radiol) 2024; 36:e97-e104. [PMID: 38326122 DOI: 10.1016/j.clon.2024.01.018] [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: 07/18/2023] [Revised: 12/11/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
AIMS Synovial sarcoma is a rare but aggressive variant of soft-tissue sarcoma. Literature is sparse and reported mostly from the West. We analysed the clinical profiles and prognostic factors of extremity synovial sarcoma patients in order to study their clinical journey. MATERIALS AND METHODS This was a retrospective analysis. All patients with extremity synovial sarcoma treated between 1992 and 2020 were included. Patients with metastases at presentation were excluded. A descriptive analysis of demographic and clinicopathological features of patients undergoing limb salvage surgery (LSS) or amputation was carried out. Overall survival and disease-free survival were calculated for the entire cohort as well as for the LSS and amputation groups. Factors prognostic for survival were identified. RESULTS In total, 157 patients had localised extremity synovial sarcoma. Predominantly, young adults (median 31 years) and males (61%) were affected. Over 70% of patients presented after recurrence or unplanned surgeries. Sixty-seven per cent of tumours were >5 cm, 69% were deep and 23% involved bone. The limb salvage rate was 64%. In the LSS group, adjuvant radiotherapy and chemotherapy were given to 72% and 68% of patients, respectively. In the amputation group, 72% of patients received adjuvant chemotherapy. In a median follow-up of 59 months, 39.4% of patients had recurrences, the majority (61.2%) were systemic. Five-year overall survival and disease-free survival were 53.4% and 49.8%, respectively. Overall survival was 63.9% and 29.7% in the LSS and amputation groups, respectively. On multivariate analysis, tumour size, depth, omission of radiotherapy and bone invasion were found to be the adverse prognostic factors. CONCLUSION This is one of the largest studies on extremity synovial sarcoma. Mostly males and young adults were affected. The limb salvage rate was 64%, despite most being referred after unplanned surgery. Almost 70% of patients received radiotherapy and chemotherapy. Overall survival was inferior in the amputation group. Tumour size >5 cm, depth and bone invasion were negative, whereas adjuvant radiotherapy was a positive prognostic factor for survival. Chemotherapy had no impact on survival.
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Affiliation(s)
- J Sharma
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - A W Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S Rastogi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - D N Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - G Singh
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S Bhoriwal
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - A Mishra
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - R K
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - J Saikia
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - A Mandal
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - B Bansal
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - M Gaur
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
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Mishra A, Unadkat P, McBriar JD, Schulder M, Ramdhani RA. An Institutional Experience of Directional Deep Brain Stimulation and a Review of the Literature. Neuromodulation 2024; 27:544-550. [PMID: 36658078 DOI: 10.1016/j.neurom.2022.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/01/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Directional deep brain stimulation (dDBS) has been suggested to have a similar therapeutic effect when compared with the traditional omnidirectional DBS, but with an improved therapeutic window that yields optimized clinical effect owing to the ability to better direct, or "steer," electric current. We present our single-center, retrospective analysis of our experience in the use of dDBS in patients with movement disorders and provide a review of the literature. MATERIALS AND METHODS We identified all patients with Parkinson disease (PD) and essential tremor (ET) who received a dDBS system between 2018 and 2022 and retrospectively examined characteristics of their longitudinal treatment. A total of 70 leads were identified across 42 patients (28 PD, 14 ET). RESULTS Three types of systems were implemented (single-segment activation, 45.2% of patients; multiple independent current control, 50.0%; and local field potential sensing-enabled, 4.7%). The subthalamic nucleus or globus pallidus internus was targeted in PD, and the ventral intermediate nucleus of the thalamus in ET. Across the entire cohort (n = 70 leads), at initial programming, 54.2% of leads (n = 38) were programmed using directional stimulation. At the most recent reprogramming, 58.6% of leads (n = 41) implemented directionality. In patients with PD, the average decrease in levodopa-equivalent daily dose at six months after implantation was 35.4% ± 39.2%. Despite the ability to steer current to relieve stimulation-induced side effects, ten leads in six patients required surgical revision owing to electrode malposition. CONCLUSIONS We show wide adaptability and implementation of directional stimulation, adding to the growing compendium of real-world uses of dDBS therapy. We used directionality to improve clinical response in both patients with PD and patients with ET and found that its programming flexibility was used at high rates long after implantation and initial programming. In patients with PD, dDBS led to a significant reduction in dopaminergic medication, suggesting sustained clinical improvement. Nonetheless, accurate surgical placement remains necessary to ensure optimal clinical outcomes.
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Affiliation(s)
- Akash Mishra
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA; Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA
| | - Prashin Unadkat
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA; Elmezzi Graduate School of Molecular Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Joshua D McBriar
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA; Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA
| | - Michael Schulder
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA
| | - Ritesh A Ramdhani
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA.
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Mishra A, Ramdhani RA. Response to: "Directional Deep Brain Stimulation in Parkinson's Disease and Essential Tremor: A Retrospective Analysis". Neuromodulation 2024; 27:591-592. [PMID: 38569804 DOI: 10.1016/j.neurom.2023.02.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 04/05/2024]
Affiliation(s)
- Akash Mishra
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA; Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Ritesh A Ramdhani
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
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Swan AL, Broadbent A, Singh Gaur P, Mishra A, Gurwitz K, Mithani A, Morgan SL, Malhotra G, Brooksbank C. Making bioinformatics training FAIR: the EMBL-EBI training portal. Front Bioinform 2024; 4:1347168. [PMID: 38357576 PMCID: PMC10866141 DOI: 10.3389/fbinf.2024.1347168] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
EMBL-EBI provides a broad range of training in data-driven life sciences. To improve awareness and access to training course listings and to make digital learning materials findable and simple to use, the EMBL-EBI Training website, www.ebi.ac.uk/training, was redesigned and restructured. To provide a framework for the redesign of the website, the FAIR (findable, accessible, interoperable, reusable) principles were applied to both the listings of live training courses and the presentation of on-demand training content. Each of the FAIR principles guided decisions on the choice of technology used to develop the website, including the details provided about training and the way in which training was presented. Since its release the openly accessible website has been accessed by an average of 58,492 users a month. There have also been over 12,000 unique users creating accounts since the functionality was added in March 2022, allowing these users to track their learning and record completion of training. Development of the website was completed using the Agile Scrum project management methodology and a focus on user experience. This framework continues to be used now that the website is live for the maintenance and improvement of the website, as feedback continues to be collected and further ways to make training FAIR are identified. Here, we describe the process of making EMBL-EBI's training FAIR through the development of a new website and our experience of implementing Agile Scrum.
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Affiliation(s)
- A. L. Swan
- EMBL’s European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Cambridge, United Kingdom
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Mishra A, Dongre S, Kulkarni G, Deshmane R, Thappa D, Ghade N, Lona J, Kokatam S, Deo A, Sonar S, Krishnan A. Comparative assessment of immunogenicity of recombinant insulin Aspart from BioGenomics and its originator NovoRapid® in adult patients with type 2 diabetes mellitus. J Endocrinol Invest 2023:10.1007/s40618-023-02263-5. [PMID: 38147290 DOI: 10.1007/s40618-023-02263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES To assess and compare the immunogenicity of recombinant Insulin Aspart [manufactured by BioGenomics Limited (BGL-ASP)] with its originator NovoRapid® (manufactured by Novo Nordisk) in adult patients with type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS BGL-IA-CTP301 study was a randomized, open label, parallel group, multicenter phase-III clinical study to compare the efficacy and safety of recombinant Insulin Aspart 100 U/mL [manufactured by BioGenomics Limited (BGL-ASP)] with its reference medicinal product (RMP); NovoRapid® [manufactured by Novo Nordisk], in adult patients with Type 2 diabetes mellitus (T2DM). The primary objective of the study was to compare the immunogenicity of BGL-ASP and RMP; NovoRapid® in patient serum samples collected from phase-III clinical study. Immunogenicity was studied as the incidence of patients positive for anti-insulin Aspart (AIA) antibodies, developed against BGL-ASP/RMP at baseline, end of 12 week and end of 24 week of the treatment period. The changes in incidence of patients positive for AIA antibodies post-baseline were also studied to assess and compare the treatment-emergent antibody response (TEAR) between the treatment groups (BGL-ASP and RMP). Statistical evaluation was done by Fisher's exact test to compare the overall incidence of patients positive for AIA antibodies and the TEAR positives observed post-baseline in both the treated groups. An in-vitro neutralizing antibody assay (Nab assay) was also performed to study the effect of AIA antibodies in neutralizing the biological activity/metabolic function of the insulin. The neutralizing potential of AIA was studied by its effect on %glucose uptake. We also evaluated the association between AIA antibody levels and its impact on biological activity by studying the correlation between them. RESULTS Analysis of immunogenicity data suggested that the percentage of patients positive for AIA antibodies until week 24 was similar and comparable in both the treatment groups, BGL-ASP and RMP; NovoRapid®. The changes in incidence of patients positive for AIA post-baseline in terms of TEAR positives were also similar and comparable between the treatment groups. The results of the Nab assay with confirmed positive AIA samples from BGL-ASP- and RMP-treated groups did not have any negative impact on %glucose uptake by the cells in Nab assay, confirming the absence of neutralizing antibodies in both the treatment groups. The correlation studies also showed absence of association between AIA antibody levels and percentage glucose uptake in both BGL-ASP and RMP-NovoRapid® treatment groups. CONCLUSIONS: The immunogenicity assessment based on the overall incidence of patients positive for AIA, changes in incidence of patients positive for AIA post-baseline, TEAR rates and absence of neutralizing antibodies, were found to be apparently similar and comparable in both the treatment groups (BGL-ASP and RMP). We conclude from our studies that the immunogenicity of BGL-ASP is similar and comparable to RMP and the observed immunogenicity in terms of anti-insulin Aspart antibody levels had no impact on the biological activity of insulin.
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Affiliation(s)
| | | | | | | | | | - N Ghade
- BioGenomics Ltd, Thane, India
| | - J Lona
- BioGenomics Ltd, Thane, India
| | | | - A Deo
- BioGenomics Ltd, Thane, India
| | - S Sonar
- BioGenomics Ltd, Thane, India
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Kumar R V, Gosipatala SB, Kumar R, Srivastava D, Singh V, Suman K, Tripathi DK, Verma A, Mishra A, Vishwakarma KK, Singh SA, Pandey T, Agarwal S, Elyies M, Singh I, Sah PK, Sharma C, Parag R, Saxena P, Raj A, Tripathi A, Devi P, Poluri KM. Characterization, Antioxidant, and Antimicrobial Properties of Mulberry Lattices. ACS Omega 2023; 8:47758-47772. [PMID: 38144072 PMCID: PMC10733998 DOI: 10.1021/acsomega.3c06069] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023]
Abstract
In order to find the most advantageous bioactive compounds from mulberry latex for drug development in the near future, this study was conducted to characterize and evaluate antioxidant and antimicrobial properties from four different mulberry lattices (BR-2, S-1, AR-14, and S-146). The characterization of the lattices was performed by scanning electron microscopy with energy-dispersive X-ray spectroscopy, gas chromatography coupled to mass spectroscopy, and Fourier transform infrared spectroscopy. Further, screenings of the antioxidant and antimicrobial potential of selected lattices were performed in vitro using 2,2-diphenyl-1-picrylhydrazyl assay and agar well diffusion methods, respectively. Interestingly, the outcome of the current study revealed that tested mulberry lattices contain a considerable amount of bioactive phytoconstituents, particularly antimicrobial and antioxidant compounds, as revealed by chromatographic analysis. BR-2 latex was found to have significant antioxidant activity (75%) followed by S-146 (64.6%) and AR-14 (52.9%). The maximum antimicrobial activity was found in BR-2 latex compared to other tested latex varieties. The results of this investigation showed that mulberry latex from the BR-2 type may successfully control both bacterial and fungal infections, with the added benefit of having enhanced antioxidant capabilities.
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Affiliation(s)
- Venkatesh Kumar R
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Sunil Babu Gosipatala
- Departmentof
Biotechnology, Babasaheb Bhimrao Ambedkar
University, Lucknow, Uttar Pradesh 226025, India
| | - Ram Kumar
- Department
of Zoology, Shri Venkateshwara University, Gajraula, Uttar Pradesh 244236, India
| | - Devika Srivastava
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Vandana Singh
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Kusumala Suman
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Deepak Kumar Tripathi
- Department
of Biosciences and Bioengineering, Indian
Institute of Technology Roorkee, Roorkee, Uttarakhand 247667, India
| | - Abhishek Verma
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Akash Mishra
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Karan Kumar Vishwakarma
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Stuti Annapurna Singh
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Tripti Pandey
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Sanskrati Agarwal
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Mohd Elyies
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Ishani Singh
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Pinky Kumari Sah
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Chaya Sharma
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Rishabh Parag
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Pragya Saxena
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Akanksha Raj
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Anshika Tripathi
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Poonam Devi
- Department
of Zoology, Babasaheb Bhimrao Ambedkar University, Lucknow, Uttar Pradesh 226025, India
| | - Krishna Mohan Poluri
- Department
of Biosciences and Bioengineering, Indian
Institute of Technology Roorkee, Roorkee, Uttarakhand 247667, India
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Mishra A, Begley SL, Chen A, Rob M, Pelcher I, Ward M, Schulder M. Exploring the Intersection of Artificial Intelligence and Neurosurgery: Let us be Cautious With ChatGPT. Neurosurgery 2023; 93:1366-1373. [PMID: 37417886 DOI: 10.1227/neu.0000000000002598] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/14/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES ChatGPT is a novel natural language processing artificial intelligence (AI) module where users enter any question or command and receive a single text response within seconds. As AI becomes more accessible, patients may begin to use it as a resource for medical information and advice. This is the first study to assess the neurosurgical information that is provided by ChatGPT. METHODS ChatGPT was accessed in January 2023, and prompts were created requesting treatment information for 40 common neurosurgical conditions. Quantitative characteristics were collected, and four independent reviewers evaluated the responses using the DISCERN tool. Prompts were compared against the American Association of Neurological Surgeons (AANS) "For Patients" webpages. RESULTS ChatGPT returned text organized in paragraph and bullet-point lists. ChatGPT responses were shorter (mean 270.1 ± 41.9 words; AANS webpage 1634.5 ± 891.3 words) but more difficult to read (mean Flesch-Kincaid score 32.4 ± 6.7; AANS webpage 37.1 ± 7.0). ChatGPT output was found to be of "fair" quality (mean DISCERN score 44.2 ± 4.1) and significantly inferior to the "good" overall quality of the AANS patient website (57.7 ± 4.4). ChatGPT was poor in providing references/resources and describing treatment risks. ChatGPT provided 177 references, of which 68.9% were inaccurate and 33.9% were completely falsified. CONCLUSION ChatGPT is an adaptive resource for neurosurgical information but has shortcomings that limit the quality of its responses, including poor readability, lack of references, and failure to fully describe treatment options. Hence, patients and providers should remain wary of the provided content. As ChatGPT or other AI search algorithms continue to improve, they may become a reliable alternative for medical information.
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Affiliation(s)
- Akash Mishra
- Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success , New York , USA
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Aruparayil N, Gnanaraj J, Mishra A, Bains L, Corrigan N, Brown J, Ensor T, King R, Shinkins B, Jayne D. Gasless laparoscopy in rural India-registry outcomes and evaluation of the learning curve. Surg Endosc 2023; 37:8227-8235. [PMID: 37653156 PMCID: PMC10615921 DOI: 10.1007/s00464-023-10392-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/13/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND A program of gasless laparoscopy (GL) has been implemented in rural North-East India. To facilitate safe adoption, participating rural surgeons underwent rigorous training prior to independent clinical practice. An online registry was established to capture clinical data on safety and efficacy and to evaluate initial learning curves for gasless laparoscopy. METHODS Surgeons who had completed the GL training program participated in the online RedCap Registry. Patients included in the registry provided informed consent for the use of their data. Data on operative times, conversion rates, perioperative complications, length of stay, and hospital costs were collected. Fixed reference cumulative sum (CUSUM) model was used to evaluate the learning curve based on operative times and conversion rates published in the literature. RESULTS Four surgeons from three rural hospitals in North-East India participated in the registry. The data were collected over 12 months, from September 2019 to August 2020. One hundred and twenty-three participants underwent GL procedures, including 109 females (88.6%) and 14 males. GL procedures included cholecystectomy, appendicectomy, tubal ligation, ovarian cystectomy, diagnostic laparoscopy, and adhesiolysis. The mean operative time was 75.3 (42.05) minutes for all the surgeries. Conversion from GL to open surgery occurred in 11.4% of participants, with 8.9% converted to conventional laparoscopy. The main reasons for conversion were the inability to secure an operative view, lack of operating space, and adhesions. The mean length of stay was 3 (2.1) days. The complication rate was 5.7%, with one postoperative death. The CUSUM analysis for GL cholecystectomy showed a longer learning curve for operative time and few conversions. The learning curve for GL tubal ligation was relatively shorter. CONCLUSION Gasless laparoscopy can be safely implemented in the rural settings of Northeast India with appropriate training programs. Careful case selection is essential during the early stages of the surgical learning curve.
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Affiliation(s)
- N Aruparayil
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
- St. James's University Hospital, Level 7, Clinical Sciences Building, Leeds, LS9 7TF, UK.
| | | | - A Mishra
- Maulana Azad Medical College, Delhi, India
| | - L Bains
- Maulana Azad Medical College, Delhi, India
| | - N Corrigan
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - J Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - T Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - R King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - B Shinkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - D Jayne
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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Wang J, Vaddu S, Bhumanapalli S, Mishra A, Applegate T, Singh M, Thippareddi H. A systematic review and meta-analysis of the sources of Campylobacter in poultry production (preharvest) and their relative contributions to the microbial risk of poultry meat. Poult Sci 2023; 102:102905. [PMID: 37516002 PMCID: PMC10405099 DOI: 10.1016/j.psj.2023.102905] [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: 05/12/2023] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 07/31/2023] Open
Abstract
A systematic review and meta-analysis were conducted to idetnify the relative contributions of the sources of Campylobacter in poultry live production to Campylobacter prevalence of broiler meat. The keywords of Campylobacter, prevalence, live production, and broiler were used in Google Scholar to address the research interest. A total of 16,800 citations were identified, and 63 relevant citations were included in the meta-analysis after applying predetermined inclusion and exclusion criteria. A generalized linear mixed model approach combined with logit transformation was used in the current meta-analysis to stabilize the variance. The analysis revealed that Campylobacter is ubiquitous in the poultry house exterior environment including surroundings, wildlife, domestic animals, and farm vehicle, with a predicted prevalence of 14%. The recovery of Campylobacter in the interior environment of the poultry house is far less abundant than in the exterior, with a prevalence of 2%, including litter, water, insects, mice, feed, and air. A lack of evidence was observed for vertical transmission due to the day-old chicks being free of Campylobacter from 4 studies identified. Live birds are the predominant carrier of Campylobacter, with a predicted prevalence of 41%. Transportation equipment used for live haul had an overall prevalence of 39%, with vehicles showing a predicted prevalence of 44% and crates with a predicted prevalence of 22%. The results of this meta-analysis highlight the need to implement effective biosecurity measures to minimize the risk of Campylobacter in poultry meat, as human activity appears to be the primary factor for Campylobacter introduction.
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Affiliation(s)
- J Wang
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - S Vaddu
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - S Bhumanapalli
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - A Mishra
- Department of Food Science and Technology, University of Georgia, Athens, GA 30602, USA
| | - T Applegate
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - M Singh
- Department of Food Science and Technology, University of Georgia, Athens, GA 30602, USA
| | - H Thippareddi
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA.
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Mishra AK, Anjali K, Singh H, Mishra A, Kumar A. Synthesis and in silico studies of some new pyrrolidine derivatives and their biological evaluation for analgesic and anti-inflammatory activity. Ann Pharm Fr 2023; 81:801-813. [PMID: 36931432 DOI: 10.1016/j.pharma.2023.03.002] [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: 12/15/2022] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND An array of commercially viable intermediate molecules necessary for the synthesis of a variety of bioactive molecules are chemically synthesized by pyrrolidine and its derivatives, which play a significant role in drug design and development process. AIM The aim of the present research work was to explore the synthesis of some new pyrrolidine derivatives and to perform their in silico studies and finally evaluation of analgesic and anti-inflammatory activity. OBJECTIVE The purpose of this study was to synthesis new pyrrolidine derivatives, examine how they affected the COX-1 and COX-2 enzymes computationally, and to screen their in vivo analgesic and anti-inflammatory activity on laboratory animals. METHOD The new pyrrolidine derivatives were synthesized by condensing N-(3-acetylphenyl)-2-(pyrrolidin-1-yl)acetamide with substituted aniline in ethanol in the presence of catalytic amounts of glacial acetic acid. The structures of novel pyrrolidine derivatives were characterised using IR, NMR, and mass spectroscopy. Several molecular properties of the newly synthesized derivatives were calculated in order to evaluate the nature of the drug-like candidate. A specific reference cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzyme was used to dock the newly synthesized pyrrolidine derivatives. RESULTS From the observed data, it was noted that amongst all newly synthesized compounds, A-1 and A-4 exhibited the highest anti-inflammatory and analgesic effects, respectively. CONCLUSION On the basis of findings of present research, it was concluded that A-1 and A-4 might be utilized as a promising new lead compound for Non-Steroidal Anti-Inflammatory Drug (NSAIDs) development.
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Affiliation(s)
- A K Mishra
- Drug Design Laboratory, Pharmacy Academy, IFTM University, 244001 Moradabad, India.
| | - Km Anjali
- Drug Design Laboratory, School of Pharmaceutical Sciences, IFTM University, 244001 Moradabad, India
| | - H Singh
- Drug Design Laboratory, School of Pharmaceutical Sciences, IFTM University, 244001 Moradabad, India
| | - A Mishra
- School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences & Research University, 110017 New Delhi, India
| | - A Kumar
- Drug Design Laboratory, School of Pharmaceutical Sciences, IFTM University, 244001 Moradabad, India
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12
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Mishra A, Srivastava VK, Prakash R, Mishra NK, Agarwal J, Kabi S. Perioperative Anxiolysis and Analgesic Effect after Premedication with Melatonin and Pregabalin in Total Hip Arthroplasty under Spinal Anaesthesia: A Prospective Comparative Trial. Adv Biomed Res 2023; 12:185. [PMID: 37694243 PMCID: PMC10492595 DOI: 10.4103/abr.abr_323_22] [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: 09/20/2022] [Revised: 03/13/2023] [Accepted: 04/04/2023] [Indexed: 09/12/2023] Open
Abstract
Background Preoperative anxiety plays a critical role in post-operative pain response and other outcomes. Melatonin is a naturally secreted hormone which has anxiolytic, sedative, and analgesic properties. Pregabalin, analogue of gabapentin which has property of anxiolytic and analgesic effects. Materials and Methods Total 96 patients undergoing total hip arthroplasty, divided into 3 groups of 32 each and were given placebo (group I), melatonin 6 mg (group II), and pregabalin 150 mg (group III). Anxiety level, postoperative pain score, sedation level and duration as well as characteristics of spinal anaesthesia were assessed with other vital parameters. Results Group I showed an increment in the anxiety score from baseline whereas in group II and group III, there was a decline in pre-operative anxiety score from baseline at all the periods of observation and more significantly in group III. Visual analogue scale (VAS) score and total dose of rescue analgesia were highest in group I, but group II and group III were comparable to each other. However, the durations of spinal anaesthesia and motor blockade showed a statistically significant difference with maximum duration in group III followed by II and then I. The level of sedation among the three groups were comparable at all the periods of observation. Conclusions Pregabalin was found better for perioperative anxiolysis, post-operative analgesia and for prolongation of duration of spinal anaesthesia when compared to melatonin.
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Affiliation(s)
- Akash Mishra
- Department of Anaesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Vinod Kumar Srivastava
- Department of Anaesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ravi Prakash
- Department of Anaesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Neel Kamal Mishra
- Department of Anaesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Jyotsna Agarwal
- Department of Anaesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Shruti Kabi
- Department of Anaesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India
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Mishra A, Koffler D, Calugaru E, Rowe N, Viswanatha SD, Begley S, Bajaj V, Schulder M, Goenka A. Let's make size not matter: tumor control and toxicity outcomes of hypofractionated Gamma Knife radiosurgery for large brain metastases. J Neurooncol 2023; 163:587-595. [PMID: 37410346 DOI: 10.1007/s11060-023-04365-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/03/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Management of patients with large brain metastases poses a clinical challenge, with poor local control and high risk of adverse radiation events when treated with single-fraction stereotactic radiosurgery (SF-SRS). Hypofractionated SRS (HF-SRS) may be considered, but clinical data remains limited, particularly with Gamma Knife (GK) radiosurgery. We report our experience with GK to deliver mask-based HF-SRS to brain metastases greater than 10 cc in volume and present our control and toxicity outcomes. METHODS Patients who received hypofractionated GK radiosurgery (HF-GKRS) for the treatment of brain metastases greater than 10 cc between January 2017 and June 2022 were retrospectively identified. Local failure (LF) and adverse radiation events of CTCAE grade 2 or higher (ARE) were identified. Clinical, treatment, and radiological information was collected to identify parameters associated with clinical outcomes. RESULTS Ninety lesions (in 78 patients) greater than 10 cc were identified. The median gross tumor volume was 16.0 cc (range 10.1-56.0 cc). Prior surgical resection was performed on 49 lesions (54.4%). Six- and 12-month LF rates were 7.3% and 17.6%; comparable ARE rates were 1.9% and 6.5%. In multivariate analysis, tumor volume larger than 33.5 cc (p = 0.029) and radioresistant histology (p = 0.047) were associated with increased risk of LF (p = 0.018). Target volume was not associated with increased risk of ARE (p = 0.511). CONCLUSIONS We present our institutional experience treating large brain metastases using mask-based HF-GKRS, representing one of the largest studies implementing this platform and technique. Our LF and ARE compare favorably with the literature, suggesting that target volumes less than 33.5 cc demonstrate excellent control rates with low ARE. Further investigation is needed to optimize treatment technique for larger tumors.
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Affiliation(s)
- Akash Mishra
- Department of Radiation Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
| | - Daniel Koffler
- Department of Radiation Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
| | - Emel Calugaru
- Department of Radiation Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
| | - Niara Rowe
- Department of Radiation Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
| | - Sirisha Devi Viswanatha
- Department of Radiation Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
| | - Sabrina Begley
- Department of Radiation Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
| | - Vikram Bajaj
- Department of Radiation Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
| | - Michael Schulder
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
| | - Anuj Goenka
- Department of Radiation Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA.
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Gupta S, Mishra A, Singh S. Corrigendum to "Cardinal role of eukaryotic initiation factor 2 (eIF2α) in progressive dopaminergic neuronal death & DNA fragmentation : implication of PERK:IRE1α:ATF6 axis in Parkinson's pathology" [Cell Signal (2021) 109922]. Cell Signal 2023:110765. [PMID: 37331864 DOI: 10.1016/j.cellsig.2023.110765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Affiliation(s)
- S Gupta
- Department of Neuroscience and Ageing Biology, Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute, Lucknow 226031, India; Academy of Scientific & Innovative Research (AcSIR), CSIR-Central Drug Research Institute, India
| | - A Mishra
- Cellular and Molecular Neurobiology Unit, Indian Institute of Technology, Jodhpur, Rajasthan 342011, India
| | - S Singh
- Department of Neuroscience and Ageing Biology, Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute, Lucknow 226031, India; Academy of Scientific & Innovative Research (AcSIR), CSIR-Central Drug Research Institute, India.
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15
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Wang J, Vaddu S, Bhumanapalli S, Mishra A, Applegate T, Singh M, Thippareddi H. A systematic review and meta-analysis of the sources of Salmonella in poultry production (pre-harvest) and their relative contributions to the microbial risk of poultry meat. Poult Sci 2023; 102:102566. [PMID: 36996513 PMCID: PMC10074252 DOI: 10.1016/j.psj.2023.102566] [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: 01/08/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Salmonella is a major foodborne pathogen associated with poultry and poultry products and a leading cause for human salmonellosis. Salmonella is known to transmit in poultry flocks both vertically and horizontally. However, there is a lack of knowledge on relative contribution of the factors on Salmonella prevalence in poultry live production system including hatchery, feed, water, environment-interior, and -exterior. Therefore, a systematic review and meta-analysis was conducted to quantify the potential sources of Salmonella during preharvest and their relative contributions to the microbial risk of poultry meat. A total of 16,800 studies identified from Google Scholar and 37 relevant studies were included in the meta-analysis for relative contributions to Salmonella positivity on broilers after applying exclusion criteria. A generalized linear mixed model approach combined with logit transformation was used in the current study to stabilize the variance. The analysis revealed that the hatchery is the most significant contributor of Salmonella with a prevalence of 48.5%. Litter, feces, and poultry house internal environment were the other 3 major contributing factors with a prevalence of 25.4, 16.3, and 7.9%, respectively. Moreover, poultry house external environment (4.7%), feed (4.8%), chicks (4.7%), and drinker water also contributed to the Salmonella positivity. Results from this meta-analysis informed the urgent need for controls in live production to further reduce Salmonella in fresh, processed poultry. The control strategies can include eliminating the sources of Salmonella and incorporating interventions in live production to reduce Salmonella concentrations in broilers.
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Affiliation(s)
- J Wang
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - S Vaddu
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - S Bhumanapalli
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - A Mishra
- Department of Food Science and Technology, University of Georgia, Athens, GA 30602, USA
| | - T Applegate
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - M Singh
- Department of Food Science and Technology, University of Georgia, Athens, GA 30602, USA
| | - H Thippareddi
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA.
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Agarwal G, Sattavan S, Kumar A, Agrawal V, Chanthar V, Mayilvaghanan S, Chand G, Mishra A. P051 Cost-efficacy Analysis of Use of Frozen Section Histology for Margin Assessment During Breast Conservation Surgery in Breast Cancer Patients. Breast 2023. [DOI: 10.1016/s0960-9776(23)00170-4] [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: 03/18/2023] Open
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17
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Mishra OP, Sidar M, Batra VV, Prasad R, Singh A, Abhinay A, Mishra A, Yadav AK. Outcomes of children with idiopathic steroid resistant nephrotic syndrome: a single centre observational study. J Bras Nefrol 2023; 45:199-209. [PMID: 36179014 PMCID: PMC10627125 DOI: 10.1590/2175-8239-jbn-2022-0073en] [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: 04/20/2022] [Accepted: 06/20/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Idiopathic steroid resistant nephrotic syndrome (SRNS) has variable outcomes in children. The primary objective of the present study was to assess the cumulative remission rate and the secondary objectives were to assess factors affecting the remission status, kidney function survival, and adverse effects of medications. METHODS One hundred fourteen patients with SRNS were included. Calcineurin inhibitor-based treatment protocol along with prednisolone and angiotensin-converting enzyme inhibitor were used, and patients were followed over 5 years. RESULTS Median age was 4.5 years; 53.5% of cases were between 1 to 5 years of age. Sixty-two patients (54.4%) were at initial stage and 52 (45.6%) were at a late SRNS stage. Median eGFRcr was 83.5 mL/min/1.73m2 at presentation. Of the 110 patients, 63 (57.3%) achieved remission [complete remission 30 (27.3%), partial remission 33 (30%)], and 47 (42.7%) had no remission. Kidney function survival was 87.3% and 14 cases (12.7%) had progression to CKD (G3-8, G4-3, G5-1, and G5D-2). Median duration of follow up was 36 months (IQR 24, 60). Age of onset, cyclosporine/tacrolimus, eGFRcr, and histopathology (MCD/FSGS) did not affect remission. Similarly, remission status in addition to age of onset, drug protocol, and histopathology did not significantly affect kidney function during a period of 5 years. Hypertension, cushingoid facies, short stature, cataract, and obesity were observed in 37.7, 29.8, 25.5, 17.5, and 0.7% of cases, respectively. CONCLUSION About half of the cases achieved remission. Age of onset of disease, cyclosporine/tacrolimus use, and histopathological lesion neither affected remission status nor short-term kidney function survival in SRNS.
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Affiliation(s)
- Om P. Mishra
- Banaras Hindu University, Institute of Medical Sciences, Department
of Pediatrics, Division of Pediatric Nephrology, Varanasi, India
| | - Minketan Sidar
- Banaras Hindu University, Institute of Medical Sciences, Department
of Pediatrics, Division of Pediatric Nephrology, Varanasi, India
| | - Vineeta V. Batra
- G. B. Pant Institute of Post Graduate Medical Education &
Research, Department of Pathology, New Delhi, India
| | - Rajniti Prasad
- Banaras Hindu University, Institute of Medical Sciences, Department
of Pediatrics, Division of Pediatric Nephrology, Varanasi, India
| | - Ankur Singh
- Banaras Hindu University, Institute of Medical Sciences, Department
of Pediatrics, Division of Pediatric Nephrology, Varanasi, India
| | - Abhishek Abhinay
- Banaras Hindu University, Institute of Medical Sciences, Department
of Pediatrics, Division of Pediatric Nephrology, Varanasi, India
| | - Akash Mishra
- Jawahar Lal Institute of Postgraduate Medical Education and
Research, Department of Biostatistics, Puducherry, India
| | - Ashish K. Yadav
- Banaras Hindu University, Institute of Medical Sciences, Center of
Biostatistics, Varanasi, India
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Saha A, Mishra A, Manna S, Ghosh T, Bhattacharya J, Goswami S, Biswas L, Mitra S, Sarkar B, Banik A, Chowdhury S, Biswal S, Mandal S, George K, Soren P, Gazi M. 109P Setting up 4D-CT based image guided radiotherapy (IGRT) for locally advanced lung cancer: Is it safe to reduce PTV margin for dosimetric benefit? J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00364-7] [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: 04/03/2023]
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Agarwal G, Chanthar K, Katiyar S, Kumari N, Krishnani N, Lal P, Mayilvaghanan S, Chand G, Mishra A. P171 Do Tumor Infiltrating Lymphocytes and Programmed Cell Death Ligand -1 have a Predictive and Prognostic Role in Advanced Triple Negative Breast Cancers – Results of a Study from a Developing Country. Breast 2023. [DOI: 10.1016/s0960-9776(23)00288-6] [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: 03/15/2023] Open
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20
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Hocine S, Duchamp E, Mishra A, Fourquez JM, Hanessian S. Synthesis of Aza-Bridged Perhydroazulene Chimeras of Tropanes and Hederacine A. J Org Chem 2023; 88:4675-4686. [PMID: 36940388 DOI: 10.1021/acs.joc.3c00169] [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: 03/22/2023]
Abstract
We report the synthesis of two novel azaperhydroazulene tropane-hederacine chimeras A and B, which contain an 8-azabicyclo[3.2.1]octane ring and a 7-azabicyclo[4.1.1]octane ring, respectively. The synthesis of both chimeras was achieved by epoxide ring opening and was governed by the stereochemistry of the hydroxy-epoxide unit. Finally, a density functional theory study was conducted to explain the regioselectivity of the cyclization and the importance of the stereochemistry of the hydroxyl group.
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Affiliation(s)
- Sofiane Hocine
- Department of Chemistry, Université de Montréal, Station Centre-Ville, C.P. 6128, Montreal, Quebec H3C 3J7, Canada
| | - Edouard Duchamp
- Department of Chemistry, Université de Montréal, Station Centre-Ville, C.P. 6128, Montreal, Quebec H3C 3J7, Canada
| | - Akash Mishra
- Department of Chemistry, Université de Montréal, Station Centre-Ville, C.P. 6128, Montreal, Quebec H3C 3J7, Canada
| | | | - Stephen Hanessian
- Department of Chemistry, Université de Montréal, Station Centre-Ville, C.P. 6128, Montreal, Quebec H3C 3J7, Canada
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Mishra A, Lal B. Assessment of groundwater quality in Ranchi district, Jharkhand, India, using water evaluation indices and multivariate statistics. Environ Monit Assess 2023; 195:472. [PMID: 36928681 DOI: 10.1007/s10661-023-11101-3] [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] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Groundwater is the most abundant liquid freshwater on earth. Rapid urbanization in developing nations (like India) has led to increased groundwater withdrawal, adversely affecting the physicochemical characteristics. Ranchi district, Jharkhand, is a part of the smart city mission development plan of the government of India. Hence, to ensure safe and clean drinking water, it is necessary to assess groundwater quality and devise development plans. Seventeen physicochemical properties and metal(loid)s contents were analyzed to determine the groundwater quality. Various pollution indices such as water quality index (WQI), metal evaluation index (MI), heavy metal pollution index (HPI), and modified degree of contamination (mCd) are evaluated using arithmetic weighted value index and presented in a map using Arc GIS inverse distance weighting interpolation method. Chemometric analyses such as correlation, principal component, and cluster analysis were done to identify the source and determine the pollution state. A multiple linear regression model is employed to predict the impact of heavy metal and metalloid concentration on the WQI of the region. WQI shows that groundwater quality in Khelari (100.95) and Bundu (92.52) regions are highly degraded, whereas MI and HPI suggest that Ormanjhi (MI = 53.98) and Rahe (HPI = 109.20) are highly affected by metal contamination. The mCd suggests that Ormanjhi (97.15) has the highest degree of contamination. The contaminant sources were natural (geogenic processes) and anthropogenic (mining and industrial emissions). The high metal(loid)s concentration may soon result in groundwater quality degradation in the metal-affected regions.
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Affiliation(s)
- Akash Mishra
- Department of Civil and Environmental Engineering, Birla Institute of Technology Mesra, Ranchi, Jharkhand, 835215, India.
| | - Bindhu Lal
- Department of Civil and Environmental Engineering, Birla Institute of Technology Mesra, Ranchi, Jharkhand, 835215, India
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Shakir S, Mishra A, Kalaiselvi S. An analysis of the dynamic role of lipids in the progression and development of cardiovascular disease. CM 2023. [DOI: 10.18137/cardiometry.2023.26.390397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
The main cause of mortality around the globe is cardiovascular disease (CVD). There are several indications followed by experimental validation that dysfunctional lipotoxicity is one of the primary causes of cardiovascular illnesses such as atherosclerosis, “coronary heart disease”, (CHD), and hypertension. Obesity and diabetes raise the number of circulating lipids, which may enhance the production of harmful intermediates and cause issues related to cardiovascular disorders. Effective and affordable medicines to lower cardiovascular risk are desperately required. Lipids or lipoprotein particles play a critical role in atherosclerosis, the pathophysiology behind CVD. They also have an effect on inflammatory processes, vascular or cardiac cell function, leukocyte activity, and ultimately the health of the heart and blood arteries. In this paper, an attempt was made to identify the cause of lipid buildup that led to the pathophysiology of cardiovascular disorders as well as the processes behind lipotoxicity. A summary of current and developing treatment approaches to decrease the incidence of lipid-induced cardiovascular disease is also compiled through previous studies.
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23
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Mishra A, Kumari K, Singh S. Potential protective effects of isoflavones in effective management of cardiovascular diseases. CM 2023. [DOI: 10.18137/cardiometry.2023.26.383389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
For human life, health, and biological growth, nutrition is crucial. A prominent example of a food that is nutrient rich at the moment is "Soybean”. In Asian nations, it is thought to be a significant source of proteins and may be used in place of dairy products and meat. When compared to other food legumes, soybeans offer several nutritional benefits in terms of their composition in macro- and micronutrients. As more information on negative effects of chemical treatments is being available to people, they are now is search of potential phytocompounds. The aim of the present review is to provide potential evidence of isoflavones in management of cardiovascular diseases like heart failure, myocardial infarction, hypertension and coronary artery disease. Nevertheless, soy isoflavones can have certain adverse consequences since they are endocrine disruptors. Thyroid function abnormalities have sparked concerns. In light of the aforementioned findings, an effort has been undertaken to examine the literature on the beneficial and harmful roles of isoflavones, soy-derived bioactive compounds.
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Gaur SKS, Adhikari M, Mishra A, Kumar D, Ghosh Kar A, Jain S, Chawdhary S, Sharma K. Inverted-Y Ureteric Duplication With Paraureteric Diverticulum Presenting With Bladder Outlet Obstruction in an Infant- A Diagnostic Dilemma. Urology 2023; 173:168-171. [PMID: 36283504 DOI: 10.1016/j.urology.2022.10.005] [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] [Received: 08/10/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
The ectopic ureter and paraureteric diverticulum are 2 known common urological anomalies of pediatric patients. Another rare entity is inverted-Y ureteric duplication. We report a case of a 3-month-old boy presented with bladder outlet obstruction, where surgical excision of large bladder diverticulum with left ureter and small kidney was done. Histopathology confirmed the presence of inverted-Y ureteric duplication with left dysplastic kidney. The report defines the first case of infantile bladder outlet obstruction having the co-existing congenital genitourinary anomaly of inverted Y-partial ureteric duplication with obstructive ectopic ureter and ipsilateral paraureteric diverticula.
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Affiliation(s)
- Sunil Kumar Singh Gaur
- Department of Pediatric Surgery, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India
| | - Maharani Adhikari
- Department of Pediatric Surgery, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India
| | - Akash Mishra
- Department of Pediatric Surgery, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India
| | - Deepak Kumar
- Department of Pediatric Surgery, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India
| | - Amrita Ghosh Kar
- Department of Pathology, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India
| | - Shivi Jain
- Department of Radiodiagnosis, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Uttar Pradesh, Varanasi, India
| | - Sarita Chawdhary
- Department of Pediatric Surgery, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India
| | - Kanika Sharma
- Department of Pediatric Surgery, Institute of Medical Sciences-Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India.
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Schulder M, Mishra A, Mammis A, Horn A, Boutet A, Blomstedt P, Chabardes S, Flouty O, Lozano AM, Neimat JS, Ponce F, Starr PA, Krauss JK, Hariz M, Chang JW. Advances in Technical Aspects of Deep Brain Stimulation Surgery. Stereotact Funct Neurosurg 2023; 101:112-134. [PMID: 36809747 PMCID: PMC10184879 DOI: 10.1159/000529040] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/19/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Deep brain stimulation has become an established technology for the treatment of patients with a wide variety of conditions, including movement disorders, psychiatric disorders, epilepsy, and pain. Surgery for implantation of DBS devices has enhanced our understanding of human physiology, which in turn has led to advances in DBS technology. Our group has previously published on these advances, proposed future developments, and examined evolving indications for DBS. SUMMARY The crucial roles of structural MR imaging pre-, intra-, and post-DBS procedure in target visualization and confirmation of targeting are described, with discussion of new MR sequences and higher field strength MRI enabling direct visualization of brain targets. The incorporation of functional and connectivity imaging in procedural workup and their contribution to anatomical modelling is reviewed. Various tools for targeting and implanting electrodes, including frame-based, frameless, and robot-assisted, are surveyed, and their pros and cons are described. Updates on brain atlases and various software used for planning target coordinates and trajectories are presented. The pros and cons of asleep versus awake surgery are discussed. The role and value of microelectrode recording and local field potentials are described, as well as the role of intraoperative stimulation. Technical aspects of novel electrode designs and implantable pulse generators are presented and compared.
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Affiliation(s)
- Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Akash Mishra
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA,
| | - Antonios Mammis
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Andres Horn
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,MGH Neurosurgery and Center for Neurotechnology and Neurorecovery (CNTR), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, Universität zu Berlin, Berlin, Germany
| | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Patric Blomstedt
- Department of Clinical Neuroscience, University of Umea, Umea, Sweden
| | - Stephan Chabardes
- Department of Neurosurgery, Grenoble-Alpes University Hospital, Grenoble, France
| | - Oliver Flouty
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joseph S Neimat
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Francisco Ponce
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Marwan Hariz
- Department of Clinical Neuroscience, University of Umea, Umea, Sweden.,UCL-Queen Square Institute of Neurology, London, UK
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Dubey P, Mishra A, Singh NA, Mishra R, Ganapathy S. Identification of Predictors for Late or No Registration of Pregnancy by Selecting an Appropriate Logistic Model after Comparing ANC Visits and Skilled Birth Attendant. J Clin Diagn Res 2023. [DOI: 10.7860/jcdr/2023/57506.17190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: India is a major contributor to both maternal and neonatal death worldwide. Majority of these fatalities can be averted by adequate utilization of Antenatal care (ANC) services. Large scale surveys like National Family Health Survey follow hieratical characters in which subjects within the clusters are often correlated. The ordinary logistic model ignores this correlation and provide compromised estimate of effect size of predictors. Multilevel model that incorporates correlation is the appropriate method. Aim: To demonstrate the adequacy of multilevel logistic model over ordinary logistic model in hieratical data sets with ANC visits >4 and delivery assisted by Skilled Birth Attendant (SBA). Materials and Methods: This retrospective, cross-sectional study was conducted at the Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from October 2021 to March 2022. The data of 174607 women, who delivered the children within five years, obtained using cluster sampling, from country wide survey during 20th January 2015 to 4th December 2016 (India’s National Family Health Survey-IV) was used. Firstly, the model adequacy of ordinary and multilevel logistic models was evaluated for ANC >4 visits and delivery assisted by SBA, the same data set of fourth round National Family Health Survey by considering the outcomes;. Thereafter, predictors of late or no registration of pregnancy were identified using three level logistic model. Results: Because of high Variance Partition Coefficients (VPC) at state and district levels, the multilevel model applied on components ANC >4 visits and delivery assisted by SBA suggested better accuracy of the multilevel logistic model (-2Log L=189334 for ANC >4 visits and 141148 for delivery assisted by SBA) than the ordinary logistic model (-2Log L=220268 for ANC >4 visits and 151978 for delivery assisted by SBA). For the late (registration in third trimester of pregnancy) or no registration of pregnancy, each predictor was found significantly associated in which the most important were women’s education, child birth order, caste and wealth quintile. Conclusion: The present study concluded that multilevel logistic model in clustered design data was useful instead of individual level for more precise estimate of effect size of the predictors.
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Rani M, Chauhan R, Sharma S, Singh A, Badwik H, Mishra A, Dwivedi J, Sharma S. Synthesis, Cannabinoid Receptor Targeted Molecular Docking of Some New Pyrazole Derivatives as Hypolipidemic and Anti- Obesity Agents. Indian J Pharm Sci 2023. [DOI: 10.36468/pharmaceutical-sciences.1084] [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: 03/02/2023] Open
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Iyengar K, Mishra A, Vaish A, Kurisunkal V, Vaishya R, Botchu R. Primary synovial chondromatosis of the hip joint (PrSC of the hip): A retrospective cohort analysis and review of the literature. J Clin Orthop Trauma 2022; 35:102068. [PMID: 36420107 PMCID: PMC9676389 DOI: 10.1016/j.jcot.2022.102068] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/16/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Primary synovial osteochondromatosis (SOCM) or Synovial chondromatosis (SC) of the hip is a benign metaplastic condition of the synovium that is rare and may present with a spectrum of clinical features and radiological findings. Patients and methods A retrospective search using the keyword 'Synovial chondromatosis' (SC) of the hip was performed at a tertiary care orthopaedic referral centre in the UK and a hospital in India. The radiology images were collected from our Picture Archiving and Communication System (PACS) and Radiology Information System (RIS), over 15 years. The patient's data was collated with Electronic Patient Records (EPR), RIS, and correlated with histo-pathology laboratory records where available. The demographic details of the patients, their clinical symptoms, imaging details, and management outcomes were collected. Results We found 15 cases, with a mean age of 36.53 years (range: 14-50 years). There were 9 male and 6 female patients. The follow-up ranged from 1 year to 6 years. Predominantly unilateral presentation with insidious onset of symptoms was found. A spectrum of radiological Imaging was undertaken. Management strategies included supervised observation, arthroscopic or open synovectomy, and hip arthroplasty. No malignant transformation was found in the analysed cohort. Conclusion Primary 'Synovial chondromatosis' of the hip had a male preponderance in our cohort, presenting with a range of clinical features. Radiologically, Magnetic Resonance Imaging (MRI) was the commonest modality of cross-sectional imaging utilised and crucial for the diagnosis, evaluating underlying articular involvement including guiding appropriate patient management presenting with Primary 'Synovial chondromatosis' of the hip.
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Affiliation(s)
- K.P. Iyengar
- Department of Orthopaedics, Southport and Ormskirk, Southport, UK
| | - A. Mishra
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - A. Vaish
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - V. Kurisunkal
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R. Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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Vítek P, Mishra KB, Mishra A, Veselá B, Findurová H, Svobodová K, Oravec M, Sahu PP, Klem K. Non-destructive insights into photosynthetic and photoprotective mechanisms in Arabidopsis thaliana grown under two light regimes. Spectrochim Acta A Mol Biomol Spectrosc 2022; 281:121531. [PMID: 35863186 DOI: 10.1016/j.saa.2022.121531] [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] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
Probing insights into understanding photosynthetic processes via non-invasive means has an added advantage when used in phenotyping or precision agriculture. We employed Raman spectroscopy and fluorescence-based methods to investigate both the changes in the photosynthetic processes and the underlying protective mechanisms on Arabidopsis thaliana wild-type (WT), and ros1, which is a mutant of a repressor of transcriptional gene silencing, both grown under low light (LL: 100 μmol m-2s-1) and high light (HL: 400 μmol m-2s-1) regimes. Raman imaging detected a lower carotenoid intensity after two weeks in those plants grown under HL, compared to those grown under the LL regime; we interpret this as the result of oxidative damage of β-carotene molecules. Further, the data revealed a significant depletion in carotenoids with enhanced phenolics around the midrib and tip of the WT leaves, but not in the ros1. On the contrary, small necrotic zones appeared after two weeks of HL in the ros1 mutant, pointing to the starting oxidative damage. The lower maximum quantum yield of the photochemistry (Fv/Fm) in the WT as well as in the ros1 mutant grown in HL (compared to those in the LL two weeks post-exposure), indicates the HL partially inactivated photosystems. Chlorophyll a fluorescence imaging further showed high non-photochemical quenching (NPQ) in the plants grown under the HL regime for both the WT and the ros1 mutant, but the spatial heterogeneity of NPQ images was much higher in the HL-grown ros1 mutant. Fluorescence screening methods revealed significantly high values of chlorophyll proxies in the WT as well as in the ros1 mutant two weeks after in the HL compared to those under LL. The data generally revealed an increased accumulation of phenolics under HL in both the WT and ros1 mutant plants, but the proxies of anthocyanin and flavonols were significantly lower in the ros1 mutant than in the WT. The comparatively low accumulation of anthocyanin in the ros1 mutant compared to the WT supports the Raman data. We conclude that integrated use of these techniques can be efficiently applied for a better understanding of insights into photosynthetic mechanisms.
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Affiliation(s)
- P Vítek
- Global Change Research Institute of the Czech Academy of Sciences, Bělidla 4a, 603 00 Brno, Czech Republic.
| | - K B Mishra
- Global Change Research Institute of the Czech Academy of Sciences, Bělidla 4a, 603 00 Brno, Czech Republic.
| | - A Mishra
- Global Change Research Institute of the Czech Academy of Sciences, Bělidla 4a, 603 00 Brno, Czech Republic.
| | - B Veselá
- Global Change Research Institute of the Czech Academy of Sciences, Bělidla 4a, 603 00 Brno, Czech Republic.
| | - H Findurová
- Global Change Research Institute of the Czech Academy of Sciences, Bělidla 4a, 603 00 Brno, Czech Republic.
| | - K Svobodová
- Global Change Research Institute of the Czech Academy of Sciences, Bělidla 4a, 603 00 Brno, Czech Republic.
| | - M Oravec
- Global Change Research Institute of the Czech Academy of Sciences, Bělidla 4a, 603 00 Brno, Czech Republic.
| | - P P Sahu
- Global Change Research Institute of the Czech Academy of Sciences, Bělidla 4a, 603 00 Brno, Czech Republic.
| | - K Klem
- Global Change Research Institute of the Czech Academy of Sciences, Bělidla 4a, 603 00 Brno, Czech Republic.
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Shah H, Mishra A, Gouzoulis M, Ben-Shalom N, D'Amico R. QLTI-06. CHARACTERISTICS OF TERMINATED GLIOBLASTOMA-RELATED CLINICAL TRIALS: A REVIEW OF THE CLINICALTRIALS.GOV DATABASE. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.908] [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] Open
Abstract
Abstract
Glioblastoma multiforme (GBM) is a devastating primary central nervous system tumor. Although past clinical trials have incrementally improved prognosis overall survival remains poor, emphasizing a need for further successful clinical trials. Terminated clinical trials are an inefficient use of financial, medical, and administrative resources and fruitlessly expose patients to the risks of experimental treatments. Therefore, premature trial terminations should be minimized whenever possible. GBM-related clinical trials in particular are known to suffer several inefficiencies in study design resulting in premature termination, and a 2019 Think Tank held by the Society of Neuro-Oncology intended to address this issue, suggesting optimizing participant accrual and efficacy assessments. The primary aims of the present study are to quantify terminated and completed GBM-related clinical trials and analyze reasons for premature trial termination. Using univariate and multivariate analysis we demonstrate factors associated with greater odds of trial termination. ClinicalTrials.gov, a clinical trial registry maintained by the National Library of Medicine, was queried to identify all completed and terminated GBM-related clinical trials. Trial characteristics pertaining to study design were abstracted from reported information on ClinicalTrials.gov for all trials, and the reason for trial termination was determined for those trials that were terminated early. Univariate analysis by Pearson’s chi-square and a multivariate logistic regression were performed to identify independent predictors of early trial termination. We identified 886 completed and terminated GBM-related trials between 2003 and 2020. Of these, 175 (19.8%) were terminated prior to completion. The most common reason for termination was participant accrual difficulties, accounting for 63 (36.0%) terminated trials. Trial termination was associated with trials that reported a primary purpose of diagnosis relative to treatment (OR = 2.952, p = 0.001). The identified predictors of trial termination should be considered when designing GBM-related clinical trials to minimize the odds of early trial termination.
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Affiliation(s)
- Harshal Shah
- Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell , Boyds, MD , USA
| | - Akash Mishra
- Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell , Hempstead , USA
| | | | - Netanel Ben-Shalom
- Department of Neurological Surgery, Lenox Hill Hospital/ Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell , New York , USA
| | - Randy D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital/ Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell , New York , USA
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Jain M, Mishra A, Shyam H, Yadav V, Ramakant P, Mishra S, Kumar S. 287P Long-term yoga enhances the quality of life and symptomatic scale in breast cancer patients undergoing treatment. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.313] [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: 12/05/2022] Open
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Chavda J, Yadav S, Mishra A, Sharma D, Silodia A, Sharma D, Khandare M. Validation Sentinel Lymph Node Biopsy Study in post NACT cN0 Axilla using low-cost dual dye technique: Potential Solution for Resource Poor Settings. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01397-1] [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: 11/19/2022]
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Mishra A, Jain M, Kumar S. 307P Differential expression profiling of transcripts in stage IIIA non-small cell lung cancer (NSCLC) of smokers and non-smokers cases of north India: A geneto-environmental study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.336] [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: 12/07/2022] Open
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Jain M, Mishra A, Yadav V, Shyam H, Kumar S, Ramakant P, Mishra S. Long-term yogic intervention improves the level of TNF-α, IFN-γ, MDA, and NO in breast cancer patients undergoing chemotherapy and/or radiotherapy: A randomized control study. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01444-7] [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: 11/19/2022]
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Mishra A, Mishra A, Shrivastava A. GC-MS based untargeted approach reveals metabolic perturbation in Tamoxifen resistant breast cancer cells. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01554-4] [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: 11/19/2022]
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Tiwari P, Pandey V, Bera RN, Tiwary N, Mishra A, Sharma SP. Sandwich therapy in the management of propranolol resistant infantile hemangioma of the lip. J Stomatol Oral Maxillofac Surg 2022; 123:e499-e505. [PMID: 35217221 DOI: 10.1016/j.jormas.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/15/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
RATIONALE Propranolol has evolved as a first line management of infantile haemangiomas. Nevertheless, the resistance to propranolol has warranted alternative treatment modalities. We hypothesize that combination of medical and surgical therapy (sandwich therapy) to be beneficial in the management. METHODS Patients were divided into three groups (total=31), Group A (bleomycin sclerotherapy), Group B (surgical group), Group C (sandwich therapy). A p value <0.05 was taken as significant. RESULTS In Group A 54.5% of patients had excellent response, 27.3% partial response and 18.2% had no response. Comparing cosmetic outcome, 25% of patients in Group B and 16.7% of patients in Group C had excellent upshot. On the contrary 18.2% of patients in bleomycin had unsatisfactory and 18.2% had poor cosmetic outcome. Sandwich therapy was cosmetically more acceptable than Bleomycin sclerotherapy (p- value = 0.049). In terms of recurrence, sandwich therapy differed significantly from surgical therapy with fewer recurrences (p-value= 0.049). CONCLUSION Sandwich therapy is superior to bleomycin sclerotherapy in terms of cosmetic outcome and has fewer recurrences compared to surgical group and requires single stage resection. However, further studies with the help of Doppler ultrasound are required in this regard.
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Affiliation(s)
- Preeti Tiwari
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University Varanasi 221005, India
| | - Vaibhav Pandey
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Rathindra Nath Bera
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University Varanasi 221005, India.
| | - Narendra Tiwary
- Department of Community Medicine, RG KAR medical college and hospital, Kolkata, India
| | - Akash Mishra
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Shiv Prasad Sharma
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
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Mishra OP, Sidar M, Batra VV, Prasad R, Singh A, Abhinay A, Mishra A, Yadav AK. Desfechos de crianças com síndrome nefrótica idiopática córtico-resistente: um estudo observacional de centro único. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-0073pt] [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] Open
Abstract
RESUMO Introdução: A síndrome nefrótica idiopática córtico-resistente (SNICR) apresenta desfechos variáveis em crianças. O objetivo principal deste estudo foi avaliar a taxa de remissão cumulativa. Os objetivos secundários foram avaliar fatores que afetam status de remissão, sobrevida da função renal e efeitos adversos de medicamentos. Métodos: Foram incluídos 114 pacientes com SNCR. Utilizou-se protocolo de tratamento baseado em inibidores de calcineurina juntamente com prednisolona e inibidor da enzima conversora de angiotensina. Os pacientes foram acompanhados durante 5 anos. Resultados: A idade mediana foi 4,5 anos; 53,5% dos casos tinham entre 1 e 5 anos. 62 pacientes (54,4%) estavam em estágio inicial; 52 (45,6%) em estágio tardio da SNCR. A TFGecr mediana foi 83,5 mL/min/1,73 m2 na apresentação. Dos 110 pacientes, 63 (57,3%) alcançaram remissão [remissão completa 30 (27,3%), remissão parcial 33 (30%)], e 47 (42,7%) não apresentaram remissão. A sobrevida da função renal foi 87,3%; 14 casos (12,7%) progrediram para DRC (G3-8, G4-3, G5-1, G5D-2). A duração mediana do acompanhamento foi 36 meses (IIQ 24, 60). Idade no início, ciclosporina/tacrolimus, TFGecr e histopatologia (DLM/GESF) não afetaram a remissão. Igualmente, status de remissão, além da idade no início, protocolo de medicamentos e histopatologia não afetaram significativamente a função renal por 5 anos. Observou-se hipertensão, fácies cushingoide, baixa estatura, catarata e obesidade em 37,7; 29,8; 25,5; 17,5; e 0,7% dos casos, respectivamente. Conclusão: Aproximadamente metade dos casos alcançou remissão. Idade no início, uso de ciclosporina/tacrolimus e lesão histopatológica não afetaram o status de remissão nem a sobrevida da função renal a curto prazo na SNICR.
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Affiliation(s)
| | | | - Vineeta V. Batra
- G. B. Pant Institute of Post Graduate Medical Education & Research, India
| | | | | | | | - Akash Mishra
- Jawahar Lal Institute of Postgraduate Medical Education and Research, India
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Krishna A, Mishra SK, Mishra A, Kumar S, Rao RN, Yadav S, Mayilvaganan S, Chand G, Agarwal G, Agarwal A. Feasibility and impact of a one-stop thyroid clinic in a low- and middle-income country. S AFR J SURG 2022; 60:189-194. [PMID: 36155374 DOI: 10.17159/2078-5151/sajs3633] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The study was done to evaluate the feasibility, safety and outcomes of a one-stop thyroid clinic (OSTC) in a low- and middle-income country (LMIC) setting. METHODS This was a prospective non-randomised case control study consisting of patients with thyroid nodules evaluated and managed at a tertiary referral centre in an LMIC between February 2019 and January 2020. Patients were divided into two groups based on the kind of preoperative evaluation protocol: OSTC group (n = 118) - OSTC protocol, and control group (CG, n = 108) - routine protocol. RESULTS Baseline clinical characteristics of the two groups including median age (p = 0.13) and gender distribution (p = 0.76) were comparable. The majority of patients in both groups belonged to a low-income group (46.6% vs 47.3%; p = 0.91), followed by a middle-income group (35.6% vs 30.5%; p = 0.41). The median number of outpatient department visits (1 vs 3 days; p = < 0.001), waiting time for neck ultrasonography (1 vs 3 days; p = < 0.0001), fine needle aspiration cytology (1 vs 2 days; p = < 0.0001), and out of pocket expenditure (INR 3 965 vs 6 624; p = < 0.001) was significantly less in the OSTC group compared to the CG. Patients in the OSTC group reported better satisfaction levels (p = < 0.0001). Accuracy of diagnosis did not differ between the two groups (p = 0.14). CONCLUSION OSTC practice is feasible, provides comparative clinical outcomes and seems cost effective in an LMIC. This protocol can be adopted as a routine practice in any health system.
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Affiliation(s)
- A Krishna
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
| | - S K Mishra
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
| | - A Mishra
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
| | - S Kumar
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
| | - R N Rao
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
| | - S Yadav
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
| | - S Mayilvaganan
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
| | - G Chand
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
| | - G Agarwal
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
| | - A Agarwal
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
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Chawdhary S, Panigrahi PK, Sharma K, Yadav M, Ranjan R, Mishra A, Kumar D, Gaur SK, Ashish A, Sharma SP. Prognostic Role of Procalcitonin and C-reactive Protein in Surgical Neonates: A Single-Institution Experience. Cureus 2022; 14:e28319. [PMID: 36158418 PMCID: PMC9499833 DOI: 10.7759/cureus.28319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Neonatal sepsis is a dynamic process where the rigorous evaluation of clinical signs along with appropriately selected biomarkers guides the diagnosis of sepsis. Procalcitonin (PCT) and C-reactive protein (CRP) are the two most commonly used diagnostic biomarkers used in sepsis. Sepsis remains the most important cause of mortality and morbidity in surgical neonates. A cross-sectional study was conducted to assess the prognostic predictability of PCT and CRP in neonatal surgical sepsis. Methods All the neonates admitted to the neonatal surgical intensive care unit between January 2019 and December 2020 with features of sepsis were included in the study. Blood cultures, CRP, and PCT on Day one (PCT1) and Day three (PCT3) of suspicion of sepsis were evaluated. The receiver operating characteristics curve was studied to estimate the probability of two markers to predict the mortality in neonatal sepsis. Results Of 102 surgical neonates, 63 neonates had early-onset sepsis while 23 (22.5%) neonates died and 30 neonates reported positive blood culture. There was a decline in the overall PCT trend from PCT1 and PCT3, while a significant PCT rise was noted for the non-survival group (p= 0.003). At cut-off of 5 mg/dl for CRP and 2.5 ng/dl for PCT1 and PCT3, the sensitivity (36.0%, 25.8%, 100%), specificity (84.1%, 83.3%, 97.5%), positive predictive value (52.2%, 73.9%, 91.3%), and negative predictive values (73.4%, 38.0%, 100%) were observed. Conclusion PCT on Day three of suspected sepsis has higher sensitivity, specificity, and accuracy for prognostication of surgical neonatal sepsis at the cut-off value of 2.5 ng/ml. The rising trend of PCT levels is indicative of a poor prognosis.
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Banerjee B, Kamale C, Suryawanshi A, Mishra A, Gupta R, Noronha S, Bhaumik P. Structural and biochemical studies on a GH5 cellulase from Aspergillus oryzae with β-glucosidase activity. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322093482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Neumann-Spallart M, Singh P, Paušová Š, Mishra A, Bhagat D, Krýsová H, Mukhopadhyay I, Krýsa J. p-CuO films and photoelectrochemical corrosion. J Electroanal Chem (Lausanne) 2022. [DOI: 10.1016/j.jelechem.2022.116555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lal R, Chanotiya C, Gupta P, Mishra A. Influences of traits associations for essential oil yield stability in multi-environment trials of vetiver (Chrysopogon zizanioides L. Roberty). BIOCHEM SYST ECOL 2022. [DOI: 10.1016/j.bse.2022.104448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Ghosh S, Kumar M, Santiana M, Mishra A, Zhang M, Labayo H, Chibly AM, Nakamura H, Tanaka T, Henderson W, Lewis E, Voss O, Su Y, Belkaid Y, Chiorini JA, Hoffman MP, Altan-Bonnet N. Enteric viruses replicate in salivary glands and infect through saliva. Nature 2022; 607:345-350. [PMID: 35768512 PMCID: PMC9243862 DOI: 10.1038/s41586-022-04895-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 05/23/2022] [Indexed: 12/22/2022]
Abstract
Enteric viruses like norovirus, rotavirus and astrovirus have long been accepted as spreading in the population through fecal-oral transmission: viruses are shed into feces from one host and enter the oral cavity of another, bypassing salivary glands (SGs) and reaching the intestines to replicate, be shed in feces and repeat the transmission cycle1. Yet there are viruses (for example, rabies) that infect the SGs2,3, making the oral cavity one site of replication and saliva one conduit of transmission. Here we report that enteric viruses productively and persistently infect SGs, reaching titres comparable to those in the intestines. We demonstrate that enteric viruses get released into the saliva, identifying a second route of viral transmission. This is particularly significant for infected infants, whose saliva directly transmits enteric viruses to their mothers' mammary glands through backflow during suckling. This sidesteps the conventional gut-mammary axis route4 and leads to a rapid surge in maternal milk secretory IgA antibodies5,6. Lastly, we show that SG-derived spheroids7 and cell lines8 can replicate and propagate enteric viruses, generating a scalable and manageable system of production. Collectively, our research uncovers a new transmission route for enteric viruses with implications for therapeutics, diagnostics and importantly sanitation measures to prevent spread through saliva.
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Affiliation(s)
- S Ghosh
- Laboratory of Host-Pathogen Dynamics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - M Kumar
- Laboratory of Host-Pathogen Dynamics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - M Santiana
- Laboratory of Host-Pathogen Dynamics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - A Mishra
- Laboratory of Host-Pathogen Dynamics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - M Zhang
- Laboratory of Host-Pathogen Dynamics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - H Labayo
- Laboratory of Host-Pathogen Dynamics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - A M Chibly
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - H Nakamura
- AAV Biology Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - T Tanaka
- AAV Biology Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - W Henderson
- Faculty of Nursing, University of Connecticut, Storrs, CT, USA
| | - E Lewis
- Metaorganism Immunity Section, Laboratory of Host Immunity and Microbiome, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Microbiome Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - O Voss
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Y Su
- Advanced Imaging and Microscopy Resource, National Institutes of Health, Bethesda, MD, USA
- Laboratory of High Resolution Optical Imaging, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Y Belkaid
- Metaorganism Immunity Section, Laboratory of Host Immunity and Microbiome, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Microbiome Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - J A Chiorini
- AAV Biology Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - M P Hoffman
- Matrix and Morphogenesis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - N Altan-Bonnet
- Laboratory of Host-Pathogen Dynamics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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Green R, Mishra A, Schneider D, Najjar S, D'Amico RS, Sciubba DM, Lo SF, Silverstein JW. Subdural Direct Wave Intraoperative Neurophysiological Monitoring in Intramedullary Spinal Cord Tumor Resection: Case Report. Neurodiagn J 2022; 62:87-98. [PMID: 35709516 DOI: 10.1080/21646821.2022.2060011] [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: 12/18/2021] [Accepted: 03/26/2022] [Indexed: 06/15/2023]
Abstract
Direct wave (D-wave) intraoperative neurophysiological monitoring (IONM) is used during intramedullary spinal cord tumor (IMSCT) resection to assess corticospinal tract (CST) integrity. There are several obstacles to obtaining consistent and reliable D-wave monitoring and modifications to standard IONM procedures may improve surgical resection. We present the case of a subependymoma IMSCT resection at the T2-T6 spinal levels where subdural D-wave monitoring was implemented. A 47-year-old male was presented with a five-year history of numbness in his right foot eventually worsening to sharp upper back pain with increased lower extremity spasticity. MRI revealed an expansile non-contrast enhancing multi-loculated cystic lesion spanning T2-T6 as well as a separate T1-T2 lesion. A T2-T6 laminoplasty was performed for intramedullary resection of the lesion. A spinal electrode was placed in the epidural space caudal to the surgical site to monitor CST function; however, action potentials could not be obtained. Post durotomy, the electrode was placed in the subdural space under direct visualization. This resulted in a reliable D-wave recording, which assisted surgical decision-making during the procedure upon D-wave and limb motor evoked potential attenuation. Surgical intervention led to the recovery of the D-wave recording. Subdural D-wave monitoring serves as an alternative in patients where reliable D-waves from the epidural space are unable to be obtained. Further investigation is required to improve the recording technique, including exploring various types of contacts and lead placement locations.
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Affiliation(s)
- Ross Green
- Department of Neurosurgery, Northshore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York
| | - Akash Mishra
- Department of Neurosurgery, Northshore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York
| | - Daniel Schneider
- Department of Neurosurgery, Northshore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York
| | - Salem Najjar
- Department of Neurosurgery, Northshore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York
| | - Daniel M Sciubba
- Department of Neurosurgery, Northshore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York
| | - Sheng-Fu Lo
- Department of Neurosurgery, Northshore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York
| | - Justin W Silverstein
- Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York
- Department of Neurology, Northshore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, New York, New York
- Department of Clinical Neurophysiology Neuro Protective Solutions, New York, New York
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gv A, Choubey A, Nanda S, Mukherji A, Pradhan S, Kapoor A, Mishra A, S D, Devalla A. PO-1101 Early NGT insertion prevents weight loss & treatment breaks in post-op CTRT and QoL assessment. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03065-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mishra A, Pant A. W262 Proportion of different ABO and Rh phenotypes in voluntary blood donors at Tribhuvan university teaching hospital blood bank. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.504] [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: 11/15/2022]
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Mishra A, Yadav B, Budhathoki U, Pokhrel R, Sharma V, Tuladhar E, Bhattarai A, Raut M. M128 Use of six-sigma for quality control for biochemistry parameters. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.227] [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: 11/03/2022]
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Mishra A. Abstract No. : ABS3660: Comparative study of perioperative effect of premedication with melatonin versus pregabalin total hip arthroplasty under spinal anaesthesia. Indian J Anaesth 2022; 66. [PMCID: PMC9116828 DOI: 10.4103/0019-5049.340796] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background & Aims: The aim of the present study was to compare the efficacy of melatonin and pregabalin in reducing perioperative anxiety and postoperative pain along with effects on onset and duration of spinal anaesthesia and level of sedation in patient undergoing total hip arthroplasty under Spinal anaesthesia Methods: The present study was a randomised double blind placebo controlled studyand included96 American society of Anesthesiologists (ASA) I and II patients of either sex, aged between 30 to 60 years scheduled for total hip replacement under spinal anaesthesia. The patients were randomly allocated to one of three groups of 32 each to receive placebo (group 1), melatonin 6 mg (group 2), pregabalin 150 mg (group 3) orally 2 hours before spinal anesthesia. Perioperative anxiety using Beck anxiety inventory, postoperative pain along with onset and duration of spinal anaesthesia and sedation were assessed at multiple time points in the first 24 hours after surgery. Results: Perioperative anxiety scores was significantly decreased in group 2 (11.08) and group 3 (7.26) when compared to group1(17.25) and significant decrease in group 3 when compared to group 2. Post operative Visual analogue scale VAS scores were decreased in group 2 and 3 when compared to gropup1. Request for rescue analgesic during the first post operative 24 hour were lower among groups 2 and 3. The duration of sensory and motor blockade was prolonged in groups 2 and 3. Conclusion: Premedication with single dose of melatonin 6mg and pregabalin 150mg 2 hours before surgery decreases perioperative anxiety and postoperative pain in patients undergoing total hip arthroplasty under spinal anaesthesia and pregabalin has an added advantage of anxiolysis when compared to melatonin.
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Pokhrel R, Yadav BK, Sharma N, Sharma VK, Tuladhar ET, Raut M, Bhattarai A, Dubey RK, Niraula A, Mishra A, Budhathoki U. Comparison of Her2/Neu Oncoprotein in Serum and Tissue Samples in Women with Breast Cancer. Asian Pac J Cancer Prev 2022; 23:429-433. [PMID: 35225453 PMCID: PMC9272608 DOI: 10.31557/apjcp.2022.23.2.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background and objectives: Human Epidermal Growth Factor Receptor 2 (HER2/neu) is one of the most extensively studied proto-oncogens in breast cancer patients. Accurate and timely assessment of the HER2/neu over expression is pivotal for the identification of breast cancer patients that could benefit from HER2-targeted therapy. The present study was undertaken to investigate the diagnostic utility of serum HER2/neu testing by chemiluminescent immunoassay (CLIA) in breast cancer patients and compare it with the immunohistochemistry (IHC) method of HER2/neu expression. Methods: Serum sample and tissue/paraffin block was collected from 52 patients with breast cancer before start of any anticancer regimen or hormonal therapy. The tissue specimens were processed in Histopathology lab. Sections were immunostained with anti –estrogen receptor (ER) , anti –progesteron receptor (PR) and anti HER2/neu receptor mouse monoclonal antibodies.) Serum HER2/neu was estimated using the chemiluminiscent immunoassay using 15ng/ml as the cut off. Results: Out of 52 patients with breast cancer, serum HER2/neu was found elevated in 25(48.1%) patients and remaining 27(51.9%) showed normal serum HER2/neu concentrations. On IHC HER2/neu score was 3+ in 9(17.3%), 2+ in 10(19.2%), 1+ in 1(1.9%); while 32(61.5%) showed no HER2/neu expression. 31(59.6%) patients were ER positive and 28(53.8%) were PR positive. There was a significant correlation (P<0.001) of serum HER2 concentration with tissue expression of HER2/neu and Histological tumor grade. Serum HER2/neu levels showed a negative correlation with ER status (P=0.047) but no correlation with PR status. Conclusion: The result showed that the elevated serum HER2/neu was correlated with the IHC expression of HER2/neu in tissue and the histological grade of the tumor. Findings suggest that post initial tissue diagnosis (IHC HER2/neu), serum HER2 assay may supplement subsequent tissue tests to monitor disease status and response to therapy.
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Affiliation(s)
- Rakesh Pokhrel
- Department of Biochemistry Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Binod Kumar Yadav
- Department of Biochemistry Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Nisha Sharma
- Department of Pathology Institute of Medicine Maharajgunj , Kathmandu, Nepal
| | - Vijay Kumar Sharma
- Department of Biochemistry Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Eans Tara Tuladhar
- Department of Biochemistry Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Mithileshwor Raut
- Department of Biochemistry Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Aseem Bhattarai
- Department of Biochemistry Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Raju Kumar Dubey
- Department of Biochemistry Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Aapekshya Niraula
- Department of Biochemistry Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Akash Mishra
- Department of Biochemistry Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Uttam Budhathoki
- Department of Biochemistry Institute of Medicine Maharajgunj, Kathmandu, Nepal
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Singh NA, Mishra A, Mishra RN, Shukla D. Comparision of Low Birth Weight Babies in Mothers Seeking Antenatal Care Services at a Tertiary Care Hospital and at Other Healthcare Facilities: A Cross-sectional Study. J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/52731.16042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: The high prevalence of Low Birth Weight (LBW) due to Preterm Birth (PTB) and Intrauterine Growth Restriction (IGUR) still persist a challenge in India. This happens due to poor and infrequent utilisation of Antenatal Care (ANC) service. Aim: To assess the difference of PTB and LBW in mothers, who availed ANC at a tertiary care hospital against those who availed ANC at other healthcare facility. Materials and Methods: This cross-sectional study was conducted at Gynaecology Department in Sir Sundarlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. The data was obtained from the delivery register maintained at the Labour Room of the Department. The age of the mother, place where ANC services availed, birth weight of the newborn and the gestational age were recorded on a master chart. The newborn were considered LBW, if birth weight was <2500 gm, PTB if birth occurred <37 completed weeks of gestation and Intrauterine Growth Restriction (IUGR), if birth weight was below the expected weight at birth for the gestational age. The prevalence of PTB, LBW and mean with SD of LBW were obtained. The association of PTB and LBW with place of ANC services availed was judged using Chi-square test. The 95% confidence interval of the prevalence was obtained by using logit transformation. Results: Out of total 2420 deliveries, 1858 mothers and their newborn were analysed. The mean age of mothers was 26.4±4.3 years. Half (50.1%) of the mothers had taken ANC at SS Hospital and the rest at other healthcare facilities. The prevalence of LBW and PTB babies were 29.2% (95% CI: 27.1-31.3) and 28.8% (95% CI: 26.7-30.9), respectively. Overall, both PTB and LBW were found to be significantly associated with the place of ANC services. Prevalence of LBW born in mothers who received ANC at tertiary care hospital was 19.4%; while it was 39.0% in those receiving at other healthcare facilities. The prevalence of PTB and LBW was more than 1.6 times and twice in those taken ANC at other health care facilities than those at TCH irrespective of gestational age. Among the PTB, the LBW were 42.2% in mothers receiving ANC at the Tertiary Care Center (TCH) against 65.6% in those receiving at other healthcare facilities. Among the full-term deliveries also, the LBW born were 13.1% in mothers receiving ANC at tertiary care as against 24.3% in those receiving at other healthcare facilities. Conclusion: The mothers seeking ANC services at other healthcare facilities need education about the advantage of ANC by the service providers, for timely and better adherence to ANC.
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