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Malhotra S, Mani K, Lodha R, Bakhshi S, Mathur VP, Gupta P, Kedia S, Sankar MJ, Kumar P, Kumar A, H V, Ahuja V, Sinha S, Guleria R, Dua A, Ahmad S, Upadhyay AD, Sati HC, Mani K, Lokade AK, Devi KP, Johnson RM, Gowthaman K, Kumari M, Singh R, Kalra D, Swetambri, Vasudha, Sharma S, Singh A, Sharma V, Kanswal S, Sharma R, Giri T, Rajput S, Mehra G, Sharma A, Madan D, Singh M, Gupta A, Sharma S, Sachdeva S, Kumar M, Sachin, Singh AK, Gohar N, Kumar R, Kanojia N, Singhania J, Dubey R, Shukla S, G A, Sarkar S, Gupta I, Rai S, Tummala S, Reddy T, Vadodaria V, Sharma A, Gupta A, Vats M, Deori TJ, Jaiswal A, Pandit S. COVID-19 infection, and reinfection, and vaccine effectiveness against symptomatic infection among health care workers in the setting of omicron variant transmission in New Delhi, India. Lancet Reg Health Southeast Asia 2022; 3:100023. [PMID: 35769163 PMCID: PMC9167830 DOI: 10.1016/j.lansea.2022.100023] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Surge of SARS CoV-2 infections ascribed to omicron variant began in December 2021 in New Delhi. We determined the infection and reinfection density in a cohort of health care workers (HCWs) along with vaccine effectiveness (VE) against symptomatic infection within omicron transmission period (considered from December 01, 2021 to February 25, 2022. Methods This is an observational study from the All India Institute of Medical Sciences, New Delhi. Data were collected telephonically. Person-time at risk was counted from November 30, 2021 till date of infection/ reinfection, or date of interview. Comparison of clinical features and severity was done with previous pandemic periods. VE was estimated using test-negative case-control design [matched pairs (for age and sex)]. Vaccination status was compared and adjusted odds ratios (OR) were computed by conditional logistic regression. VE was estimated as (1-adjusted OR)X100-. Findings 11474 HCWs participated in this study. The mean age was 36⋅2 (±10⋅7) years. Complete vaccination with two doses were reported by 9522 (83%) HCWs [8394 (88%) Covaxin and 1072 Covishield (11%)]. The incidence density of all infections and reinfection during the omicron transmission period was 34⋅8 [95% Confidence Interval (CI): 33⋅5-36⋅2] and 45⋅6 [95% CI: 42⋅9-48⋅5] per 10000 person days respectively. The infection was milder as compared to previous periods. VE was 52⋅5% (95% CI: 3⋅9-76⋅5, p = 0⋅036) for those who were tested within 14-60 days of receiving second dose and beyond this period (61-180 days), modest effect was observed. Interpretation Almost one-fifth of HCWs were infected with SARS CoV-2 during omicron transmission period, with predominant mild spectrum of COVID-19 disease. Waning effects of vaccine protection were noted with increase in time intervals since vaccination. Funding None.
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Affiliation(s)
- Sumit Malhotra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Prakash Mathur
- Division of Pedodontics and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Pooja Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mari Jeeva Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Parmeshwar Kumar
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas H
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Subrata Sinha
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | | | - Aman Dua
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shafi Ahmad
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Hem Chandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Kiruba Mani
- Dr. Rajendra Prasad Centre For Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Amol Kumar Lokade
- Centre For Dental Education And Research, All India Institute of Medical Sciences, New Delhi, India
| | - K Pavithra Devi
- Centre For Dental Education And Research, All India Institute of Medical Sciences, New Delhi, India
| | - Riya Marie Johnson
- Centre For Dental Education And Research, All India Institute of Medical Sciences, New Delhi, India
| | - Keerthana Gowthaman
- Centre For Dental Education And Research, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Kumari
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ritika Singh
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Devanshi Kalra
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Swetambri
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vasudha
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shubhangi Sharma
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Singh
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Sharma
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Sunita Kanswal
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Sharma
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Tanika Giri
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Simple Rajput
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Geeta Mehra
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Sharma
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Madan
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Singh
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Anvita Gupta
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Shilpi Sharma
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Surbhi Sachdeva
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mayank Kumar
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Kumar Singh
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Naveen Gohar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ramu Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Kanojia
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Singhania
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Dubey
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sakshi Shukla
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Abishek G
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Swarnabha Sarkar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ishan Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - Sabin Rai
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Thrisha Reddy
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Ajay Sharma
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Vats
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Trideep Jyoti Deori
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Jaiswal
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sabitri Pandit
- Medical Device Monitoring Center, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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Mendonca S, Rao A, Dogra M, Sood V, Prakash S, Batta G, Dua A, Joshi A, Sharma UK, Tiwari R. Plasma cell rich acute rejection: Risk factors, treatment and outcomes. Saudi J Kidney Dis Transpl 2022; 32:387-397. [PMID: 35017333 DOI: 10.4103/1319-2442.335451] [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: 11/04/2022] Open
Abstract
Plasma cell-rich rejection is a rare and poorly defined entity. Its treatment is not clearly defined and has universally poor prognosis. More data should be published from various transplant centers around the world to identify the treatment that has the best outcomes and to formulate treatment guidelines for these cases. It is a retrospective analysis of kidney biopsies form 2008 to 2018. Four hundred biopsied were screened and 55 were found to have features of rejection and among them, 13 had plasma cell-rich rejection. Data of treatment given and the graft survival outcomes in these cases were retrieved by medical records. One patient had complete recovery, three had graft loss and the remaining nine had permanent decline in glomerular filtration rate. Decrease in immunosuppression and presence of infection are risk factors for plasma cell-rich acute rejection (PCAR). It can be acute cell-mediated rejection (ACR)/antibody-mediated rejection (AMR)/ACR+AMR. Resistant rejection, ACR+AMR, C4d positivity, and severe interstitial inflammation are poor prognostic factors. Overzealous decrease in immunosuppression should not be done. Management of immunosuppression during infection is most critical for the development of PCAR. Bortezomib is emerging as a therapeutic modality for the treatment of PCAR.
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Affiliation(s)
- Satish Mendonca
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - Ananth Rao
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - Manu Dogra
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - Vivek Sood
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - S Prakash
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - G Batta
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - A Dua
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - A Joshi
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - U K Sharma
- Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India
| | - R Tiwari
- Department of Pathology, Army Hospital (Research and Referral), New Delhi, India
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Abstract
Beard and moustache reconstruction has gained more popularity and acceptance over the last decade. The procedure is done for the correction of facial areas with hair density deficit and also for the cosmetic enhancement of pre-existing facial hair. The surgical technique includes the harvesting of grafts from the scalp by the follicular unit excision (FUE) or follicular unit transplantation (FUT) technique and then placing them in either premade slits or by stick and place method. The advancement and refinement of procedure over the years has aided in achieving the optimal aesthetic results, with minimal side effects.
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Affiliation(s)
| | | | - Aman Dua
- AK Clinics, Ludhiana, Punjab, India
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Dua A, Bhardwaj B. Delayed Onset Nodules After Hyaluronic Acid Fillers: A Case Series. J Cutan Aesthet Surg 2022; 15:91-94. [PMID: 35655648 PMCID: PMC9153319 DOI: 10.4103/jcas.jcas_200_20] [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] [Indexed: 11/11/2022] Open
Abstract
Non-surgical techniques with hyaluronic acid fillers to rejuvenate face are very popular treatment due to ease of administration and achievement of faster improvement. Although they are considered to be safe procedures, few rare adverse effects have been reported in literatures. The number of these cosmetic procedures being performed is increasing every year. Simultaneously, the rate of filler complications has also increased. This case series presents three clinical cases of delayed onset nodules after hyaluronic acid fillers after 1-5 months post-procedure. Juvederm Volift was used in all the mentioned patients. Granulomatous reactions can occur with any of the hyaluronic acid fillers. These are generally localized immunological reactions. An awareness about these rare side effects helps us in the assessment and ensurance of accurate diagnosis and treatment.
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Affiliation(s)
- Aman Dua
- A. K. Clinics, Ludhiana, Punjab, India
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Mysore V, Kumaresan M, Garg A, Dua A, Venkatram A, Dua K, Singh M, Madura C, Chandran R, Rajput RS, Sattur S, Singh S. Hair Transplant Practice Guidelines. J Cutan Aesthet Surg 2021; 14:265-284. [PMID: 34908769 PMCID: PMC8611706 DOI: 10.4103/jcas.jcas_104_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The field of hair transplant (HT) has grown exponentially in the past decade, especially after the introduction of follicular unit excision (FUE). There is much variation in criteria for case selection, the technique, pre- and post-procedure protocols, by different surgeons. Techniques continue to evolve and evidence in the form of controlled data is not available for all techniques and protocols being used; there is also a debate as to who can do what, what should be the training for staff, role of technicians. This has led to a situation wherein medico legal issues have cropped up as to what is minimum acceptable. An attempt is made to summarize standard protocols with the available evidence. It is emphasized that the objective of these guidelines is to recommend minimum standards for practice of hair transplantation. The principles outlined in these guidelines are of a general nature only, minimal in their level and are not meant to cover all situations. It should be understood that these recommendations are by no means binding and universal, represent minimum standards only and as in all surgical techniques, variations in techniques are possible. It is also further clarified that these are based on current literature, and as science evolves, these guidelines could also change in future. Where published evidence is not available, consensus expert opinion is presented. The task force emphasizes that each patient has to be treated on his/her own merit and that these guidelines do not limit the physician from making an appropriate choice or the necessary innovation for a given patient. The task force recognizes that the treating surgeon is best suited to decide what is needed for a given patient in a given situation. Innovations in medicine need flexibility in approach and these guidelines do not limit the surgeon from undertaking innovative research.
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Affiliation(s)
- Venkatram Mysore
- The Venkat Center for Skin and Plastic Surgery, Bengaluru, Karnataka, India
| | - Muthuvel Kumaresan
- Cutis Skin Clinic & Hair Transplant Center, Coimbatore, Tamil Nadu, India
| | - Anil Garg
- Rejuvenate Hair Transplant Center, Indore, Madhya Pradesh, India
| | - Aman Dua
- AK Clinics & Hair Transplant Center, Delhi, India
| | - Aniketh Venkatram
- Cutis Skin Clinic & Hair Transplant Center, Coimbatore, Tamil Nadu, India
| | - Kapil Dua
- AK Clinics & Hair Transplant Center, Delhi, India
| | | | - C Madura
- Cutis Academy of Cutaneous Sciences, Bangalore, India
| | - Ram Chandran
- Apollo Speciality Center, Chennai, Tamil Nadu, India
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Dua A, Ford K, Fiore S, Pappas DA, Janak J, Blachley T, Roberts-Toler C, Emeanuru K, Kremer J, Kivitz A. POS0606 DISEASE ACTIVITY AND PATIENTS-REPORTED OUTCOMES AFTER SWITCHING BETWEEN IL-6 RECEPTOR INHIBITORS AND JAK INHIBITORS: AN ANALYSIS FROM THE CORRONA REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1298] [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: 11/04/2022]
Abstract
Background:Rheumatoid arthritis (RA) patients who fail therapy may be switched to any of the five classes of biological disease-modifying antirheumatic drugs (DMARDs) and targeted synthetic DMARDs, to meet treatment goals. Physicians may hesitate to switch between Janus Kinase inhibitors (JAKi) and interleukin-6 receptor inhibitors (IL-6Ri) since they both impact IL-6 signalling and due to limited data on switching between the two classes.Objectives:This retrospective, observational study based on the real-world Corrona RA registry aimed to describe the response in RA patients switching between IL-6Ri and JAKi.Methods:Adult RA patients who initiated either IL-6Ri or JAKi after November 2012 and had a six-month post-initiation follow-up visit were eligible. Patients in ‘Cohort A’ initiated an IL-6Ri following discontinuation of a JAKi and those in ‘Cohort B’ initiated a JAKi following discontinuation of an IL-6Ri. Disease activity measures and patient-reported outcomes (PROs) were evaluated at baseline and at six-month follow-up. Within each group, change from baseline was assessed for Clinical Disease Activity Index (CDAI), Health Assessment Questionnaire (HAQ), pain, fatigue, tender joint count (TJC), swollen joint count (SJC), physician global assessment (MDGA), patient global assessment (PtGA) and morning stiffness duration. Proportion of patients achieving CDAI low disease activity (LDA), CDAI remission and minimal clinically important difference (MCID) for HAQ, pain, fatigue, MDGA, PtGA were assessed. Adjusted linear and logistic regression models were performed for between-group comparisons (Cohort A vs Cohort B) excluding initiators who switched therapy prior to six-month visit.Results:Cohorts A and B included 122 and 144 initiators, respectively. Patients who switched toIL-6Ri (vs JAKi) were younger (mean [SD] age, 56.2 [11.3] vs 58.9 [12.6] years), had higher baseline CDAI (23.2 [12.9] vs 20.2 [12.8]), had higher prior use of ≥2 csDMARDs (75% vs 65%), and were less likely to initiate therapy as monotherapy (44% vs 50%).In Cohort A, significant changes from baseline were observed for all continuous outcomes except HAQ and fatigue. In Cohort B, a significant improvement was observed only for patient-reported pain (Table 1).Table 1.Unadjusted Within-Group Change from Baseline to Six Months, Mean (95% CI), nOutcomesCohort A, N = 122Cohort B, N = 144CDAI-4.7 (-7.6, -1.9), 109-2.4 (-5.2, 0.4), 116HAQ-0.0 (-0.1, 0.1), 105-0.1 (-0.1, 0.0), 118Patient-reported pain-8.2 (-13.4, -3.0), 109-5.9 (-11.5, -0.2), 120Patient-reported fatigue-4.4 (-9.0, 0.2), 109-1.7 (-6.6, 3.3), 117TJC-1.6 (-3.0, -0.1), 112-1.2 (-2.6, 0.3), 117SJC-1.5 (-2.5, -0.4), 112-0.4 (-1.3, 0.6),117MDGA-10.9 (-15.6, -6.3), 112-4.3 (-8.7, 0.2), 117PtGA-6.0 (-11.2, -0.8), 109-4.8 (-10.5, 0.8), 120Morning stiffness durationa-1.3 (-2.2, -0.5), 109-0.1 (-1.1, 0.8), 118aAmong those reporting morning stiffness at baseline.In the adjusted between-group comparison (data not shown) of change from baseline, there were no significant differences in clinical outcomes between Cohorts A and B.In both cohorts, patients achieved CDAI LDA, CDAI remission, and MCIDs across other PROs (Figure 1). In the adjusted between-group comparison (data not shown), the results were similar with the exception of achievement of CDAI LDA among patients with moderate to high disease activity at baseline.Figure 1.Rates of CDAI LDA, CDAI Remission, and MCID for PROsa at Six MonthsConclusion:In general, in both cohorts a substantial proportion of patients achieved CDAI LDA and MCID across PROs. Despite some overlap of JAKi and IL-6Ri therapies’ on the IL-6 pathway, there are some distinct mechanisms of action which may result in meaningful improvements for a subset of patients.Acknowledgements:Amy Praestgaard (Sanofi) contributed to the interpretation of the statistical analysis for this abstract. Medical writing support for this abstract was provided by Nupur Chaubey (Sanofi).Disclosure of Interests:Anisha Dua Speakers bureau: AbbVie, Consultant of: Consulting/advisory board for AbbVie, Novartis, and Chemocentryx, Employee of: Board member of Vasculitis foundation and Chicago Rheumatism Society, Kerri Ford Shareholder of: Sanofi, Employee of: Sanofi, Stefano Fiore Shareholder of: Sanofi, Employee of: Sanofi. In addition, Stefano Fiore has a patent EP 19306553.9; USPTO #s 62/799,698; 62/851,474; 62/935,395 issued, Dimitrios A Pappas Shareholder of: Corrona LLC, Consultant of: Sanofi, AbbVie, Gtech, Roche Hellas, and Novartis, Employee of: Corrona LLC. Board of directors, Corrona Research Foundation, Judson Janak: None declared, Taylor Blachley: None declared, Carla Roberts-Toler: None declared, Kelechi Emeanuru: None declared, Joel Kremer Consultant of: AbbVie, Lilly, Novartis, Pfizer, BMS, Genentech, Regeneron, Sanofi, and Corrona, Grant/research support from: AbbVie, Lilly, Novartis, and Pfizer, Alan Kivitz Shareholder of: Pfizer, Sanofi, GlaxoSmithKline, Gilead Sciences, Inc., and Novartis, Speakers bureau: Celgene, Merck, Lilly, Novartis, Pfizer, Sanofi, Flexion, and AbbVie, Consultant of: AbbVie, Boehringer Ingelheim, Flexion, Janssen, Pfizer, Sanofi, Regeneron, SUN Pharma Advanced Research, Gilead Sciences, Inc. In addition, Alan Kivitz reports other from Altoona Center for Clinical Research, PC, during the conduct of the study.
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Zodpey S, Negandhi H, Dua A, Vasudevan A, Raja M. Our Fight Against the Rapidly Evolving COVID-19 Pandemic: A Review of India's Actions and Proposed Way Forward. Indian J Community Med 2020; 45:117-124. [PMID: 32905145 PMCID: PMC7467203 DOI: 10.4103/ijcm.ijcm_221_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/08/2020] [Indexed: 01/25/2023] Open
Abstract
A new strain of coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has overwhelmed the world with its rapid spread and high number of cases. SARS-CoV-2 causes COVID-19 disease which may present with mild, moderate, or severe illness. In severe cases, pneumonia, acute respiratory distress syndrome, sepsis, and septic shock can occur. Individuals above 60 years and people with preexisting comorbidities are at higher risk for developing serious complications. The incubation period of this new pathogen ranges from 1 to 14 days and there is no preexisting immunity to the disease. Countries across the globe have adopted various prevention and control measures to minimize negative health impacts. India has adopted various public health measures which include social distancing measures, nationwide lockdown to reduce risk of exposure, widespread IEC messaging regarding hand-washing, usage of masks, and recommending avoidance of unnecessary travel to combat the spread of disease. This manuscript reviews the global situation, contextualizes India's disease control efforts, and outlines the possible way forward by identifying specific actions under the following headings: enhancing district preparedness, enabling care for patients, and broadening community and stakeholder engagement for India.
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Affiliation(s)
- Sanjay Zodpey
- Vice-President (Academics), Public Health Foundation of India, New Delhi, India
| | - Himanshu Negandhi
- Additional Professor, Indian Institute of Public Health, New Delhi, India
| | - Aman Dua
- PhD student, Centre for Community Medicine, AIIMS, New Delhi, India
| | | | - Mitali Raja
- Project Officer- GAVI (Health Systems Strengthening Project ) UNDP, New Delhi, India
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Rathi B, Maskey D, Dua A. Antisynthetase Syndrome : A rare entity. J Assoc Physicians India 2020; 68:79. [PMID: 31979775] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- B Rathi
- NHMMI Narayana Multispeciality Hospital, Raipur
| | - D Maskey
- NHMMI Narayana Multispeciality Hospital, Raipur
| | - A Dua
- NHMMI Narayana Multispeciality Hospital, Raipur
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Abstract
Dilated cardiomyopathy (DCM) is an idiopathic condition that results from impaired ventricular systolic function. Thyroid diseases have been known to cause myriad changes in the structure and function of the heart. Diastolic dysfunction is a common abnormality reported in hypothyroidism. However, hypothyroidism-induced DCM and systolic dysfunction is an uncommon phenomenon, especially as the initial presenting manifestation of hypothyroidism. The current article describes the case of a young female who presented with symptoms of heart failure and was diagnosed as having DCM as echocardiography revealed left ventricular global hypokinesia and severely depressed systolic function. Thyroid profile revealed a grossly elevated thyroid-stimulating hormone (TSH) value of 313 μIU/ml; free thyroxine (fT4) was 0.220 ng/dl. The present case presented with DCM as the initial presentation of hypothyroidism and improved significantly after five months of levothyroxine replacement therapy.
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Affiliation(s)
- P Rastogi
- Department of Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - A Dua
- Department of Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - S Attri
- Department of Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - H Sharma
- Department of Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
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Dua A, Venu M. Associated risks of proton pump inhibitors and their influence on prescribing habits: is change truly warranted? Dis Esophagus 2019; 32:5212867. [PMID: 30496546 DOI: 10.1093/dote/doy103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- A Dua
- Loyola University Medical Center, Division of Gastroenterology , Stritch School of Medicine, Maywood, Illinois, USA
| | - M Venu
- Loyola University Medical Center, Division of Gastroenterology , Stritch School of Medicine, Maywood, Illinois, USA
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Abstract
The twin paradigm of e-commerce and just-in-time has impelled the global markets for door-to-door service. Shippers do not particularly seek special modes of transport but rather demand performance of transport such as door-to-door service from the multimodal transport service (MTS) operators. Door-to-door service has also led to shift in common terms of trade such as free on board (FOB) and cost insurance freight (CIF) to delivery at place (DAP) or delivery duty paid (DDP) International Commercial Terms (incoterms). In such a case, the sellers are required to plan end-to-end rather than concentrate on port-to-port leg of the delivery process. Multimodal transportation (MMT) includes multiple modes of transport, multiple nodes (terminals) and numerous stakeholders. So far, researchers have focused on the attributes of MTS providers that affect expectations of customers. The present study looks into factors affecting performance of MTS. The approach cuts across the spectrum of qualitative to quantitative assessment. The authors, here, propose opinion mining to decipher the sentiments of clients of logistics service providers followed by open discussion (in a semi-structured format) to collate the soft and hard aspects of MMT chain. The findings of these exercises are used to frame a structured questionnaire for quantitative analysis. Four dimensions affecting quality of MMT have been identified, and one of them is found to be significant only under certain conditions. This article suggests implementation of an integrated digital ecosystem to enhance the quality of MMT in emerging markets like India.
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Affiliation(s)
- Aman Dua
- Assistant Professor, International Management Institute, Bhubaneswar, India
| | - Deepankar Sinha
- Associate Professor, Indian Institute of Foreign Trade, Kolkata Campus, Kolkata, India
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Dua A, Bhardwaj B. A Case Report on Use of Cog Threads and Dermal Fillers for Facial-Lifting in Facioscapulohumeral Muscular Dystrophy. J Cutan Aesthet Surg 2019; 12:52-55. [PMID: 31057270 PMCID: PMC6484573 DOI: 10.4103/jcas.jcas_128_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Long-standing facial paralysis induces degenerative facial muscle changes on the involved side, thus making the individual seem older than their actual age. Furthermore, contralateral facial hypertrophy aggravates facial asymmetry (Sulamanidze MA, Fournier PF, Paikidze TG, Sulamanidze GM. Removal of facial soft tissue ptosis with special threads. Dermatol Surg 2002;28:367-71). The introduction of absorbable barbed thread has proved to be a good alternative for treating facial asymmetry. It also allows the association with other nonsurgical procedures, such as botulinum toxin use and/or dermal fillers in facial remodeling (Atiyeh BS, Dibo SA, Costagliola M, Hayek SN. Barbed sutures "lunch time" lifting: evidence-based efficacy. J Cosmet Dermatol 2010;9:132-41 and Kaminer MS, Bogart M, Choi C, Wee SA. Long-term efficacy of anchored barbed sutures in the face and neck. Dermatol Surg 2008;34:1041-7.). The aim of the treatment (threads) of the mid and lower third of the face was to promote the mechanical effect (lifting) and biological effect (neocollagenesis) with the improvement of the nasolabial folds, jaw, and jawbone contour.
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Affiliation(s)
- Aman Dua
- Consultant Dermatologist, AK Clinics, Ludhiana (Punjab), India,Address for correspondence: Dr. Aman Dua, Consultant Dermatologist, AK Clinics, Ludhiana (Punjab), India. E-mail:
| | - Bhawna Bhardwaj
- Consultant Dermatologist, AK Clinics, Ludhiana (Punjab), India
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Abstract
Hair transplant is a constantly evolving science. From the time that it was conceived by Dr. Norman Orentreich to the present state, the procedure of hair transplant has undergone multiple advancements. In this article, we discuss in brief regarding the strip follicular unit transplantation. We summarize the major points regarding the procedure of strip follicular unit transplantation along with some nuggets of experience that we have gathered over time. We briefly deal with the indications, anesthesia, procedure, and complications of strip follicular unit transplantation and some special scenarios like the repeat excision of strip.
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Affiliation(s)
- Kapil Dua
- AK Clinics, Greater Kailash, New Delhi, India
| | | | - Aman Dua
- AK Clinics, Sarabha Nagar, Ludhiana, Punjab, India
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Davis J, Dua A, Siddharamesh G. Incidence of hypotension in neuro anaesthesia practice in a tertiary care hospital - A retrospective analysis. Journal of Neuroanaesthesiology and Critical Care 2017. [DOI: 10.1055/s-0038-1646214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- J. Davis
- Department of Anaesthesia, Command Hospital, AFMC, Pune, Maharashtra, India
| | - A. Dua
- Department of Anaesthesia, Command Hospital, AFMC, Pune, Maharashtra, India
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Dua A, Shepherd J, Bahadur S, Martin D. (475) Pulsed radiofrequency of brachial plexus for the treatment of refractory shoulder pain. The Journal of Pain 2016. [DOI: 10.1016/j.jpain.2016.01.452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dua A, Ali FG, Cronin D, Hong J. A rare anomaly in the donor vena cava. Am J Transplant 2015; 15:1118-20. [PMID: 25801866 DOI: 10.1111/ajt.13208] [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: 01/25/2023]
Affiliation(s)
- A Dua
- Division of Transplantation, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
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Affiliation(s)
- A Dua
- Medical College of Wisconsin, Milwaukee, Wisc
| | - S S Desai
- Southern Illinois University, Springfield, Ill
| | - J A Heller
- Johns Hopkins Vein Center, Baltimore, Md
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Dua A, Sethi A, Seth A, Kler T, Bhandari S, Chandra S, Mathur A, Agarwal P, Jetly V, Rastogi V, Kumar V, Kaul U. Efficacy and safety of heparin, heparin+GPI, bivalirudin during PCI – A prospective real world study. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.270] [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: 12/01/2022] Open
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Dua A, Jain N, Duggal L. Systemic lupus Erythematosus and kikuchi fujimoto disease – A rare association. Indian Journal of Rheumatology 2014. [DOI: 10.1016/j.injr.2014.10.090] [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: 10/24/2022] Open
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Brar SS, Aharonian V, Mansukhani P, Moore N, Shen AYJ, Jorgensen M, Dua A, Short L, Kane K. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial. Lancet 2014; 383:1814-23. [PMID: 24856027 DOI: 10.1016/s0140-6736(14)60689-9] [Citation(s) in RCA: 256] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The administration of intravenous fluid remains the cornerstone treatment for the prevention of contrast-induced acute kidney injury. However, no well-defined protocols exist to guide fluid administration in this treatment. We aimed to establish the efficacy of a new fluid protocol to prevent contrast-induced acute kidney injury. METHODS In this randomised, parallel-group, comparator-controlled, single-blind phase 3 trial, we assessed the efficacy of a new fluid protocol based on the left ventricular end-diastolic pressure for the prevention of contrast-induced acute kidney injury in patients undergoing cardiac catheterisation. The primary outcome was the occurrence of contrast-induced acute kidney injury, which was defined as a greater than 25% or greater than 0·5 mg/dL increase in serum creatinine concentration. Between Oct 10, 2010, and July 17, 2012, 396 patients aged 18 years or older undergoing cardiac catheterisation with an estimated glomerular filtration rate of 60 mL/min per 1·73 m(2) or less and one or more of several risk factors (diabetes mellitus, history of congestive heart failure, hypertension, or age older than 75 years) were randomly allocated in a 1:1 ratio to left ventricular end-diastolic pressure-guided volume expansion (n=196) or the control group (n=200) who received a standard fluid administration protocol. Four computer-generated concealed randomisation schedules, each with permuted block sizes of 4, were used for randomisation, and participants were allocated to the next sequential randomisation number by sealed opaque envelopes. Patients and laboratory personnel were masked to treatment assignment, but the physicians who did the procedures were not masked. Both groups received intravenous 0·9% sodium chloride at 3 mL/kg for 1 h before cardiac catheterisation. Analyses were by intention to treat. Adverse events were assessed at 30 days and 6 months and all such events were classified by staff who were masked to treatment assignment. This trial is registered with ClinicalTrials.gov, number NCT01218828. FINDINGS Contrast-induced acute kidney injury occurred less frequently in patients in the left ventricular end-diastolic pressure-guided group (6·7% [12/178]) than in the control group (16·3% [28/172]; relative risk 0·41, 95% CI 0·22-0·79; p=0·005). Hydration treatment was terminated prematurely because of shortness of breath in three patients in each group. INTERPRETATION Left ventricular end-diastolic pressure-guided fluid administration seems to be safe and effective in preventing contrast-induced acute kidney injury in patients undergoing cardiac catheterisation. FUNDING Kaiser Permanente Southern California regional research committee grant.
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Affiliation(s)
- Somjot S Brar
- Department of Cardiology, Kaiser Permanente, Los Angeles, CA, USA; Regional Cardiac Cath Lab, Kaiser Permanente, Los Angeles, CA, USA; Department of Research and Evaluations, Kaiser Permanente, Pasadena, CA, USA.
| | - Vicken Aharonian
- Regional Cardiac Cath Lab, Kaiser Permanente, Los Angeles, CA, USA
| | | | - Naing Moore
- Regional Cardiac Cath Lab, Kaiser Permanente, Los Angeles, CA, USA
| | - Albert Y-J Shen
- Department of Cardiology, Kaiser Permanente, Los Angeles, CA, USA
| | | | - Aman Dua
- Department of Cardiology, Kaiser Permanente, Los Angeles, CA, USA
| | - Lindsay Short
- Regional Cardiac Cath Lab, Kaiser Permanente, Los Angeles, CA, USA
| | - Kevin Kane
- Regional Cardiac Cath Lab, Kaiser Permanente, Los Angeles, CA, USA
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Dua A, Shapiro M, Desai S. Incorporation of Lung Hernia into the Chest Wall Injury Scale. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.1055] [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: 10/25/2022]
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Vij M, Bombieri L, Dua A, Freeman R. Long-term follow-up after colpocleisis: regret, bowel, and bladder function. Int Urogynecol J 2014; 25:811-5. [PMID: 24448725 DOI: 10.1007/s00192-013-2296-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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: 09/11/2013] [Accepted: 12/01/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Colpocleisis is not a popular option amongst surgeons, possibly due to concern about long-term regret. This study assessed a cohort of women who underwent colpocleisis 2-5 years previously to determine the regret rate, the effect on quality of life (QOL) and bladder and bowel function. METHODS This was a longitudinal study of patients who underwent colpocleisis at least 2 years previously. Participants were asked to complete the Prolapse QOL (P-QOL), International Consultation on Incontinence-Urinary Incontinence (ICIQ-UI Short Form) and Colorectal Anal Distress Inventory questionnaires (CRADI). Two additional questions were asked: (1) Do you regret having vaginal closure surgery for prolapse? (never, sometimes, often, all the time), and (2) Would you recommend this surgery to a relative or friend who is not sexually active? (yes, no.) RESULTS Thirty-four women were identified. Six had died by the time of follow-up, and five declined to answer the questionnaires because of ill health. Twenty-three women responded (67 %). Mean age was 78.68 years. One woman regretted having had the surgery, as the colpocleisis had failed. Twenty-one women (91.3 %) would recommend this surgery; one would not (4.3 %), and another was not sure (4.5 %). Low P-QOL [8 (0-37) ± 9.41), ICIQ-UI (7 (0-17) ± 5.44) and CRADI (10; 0-28 ± 8.13] scores suggest a positive impact on QOL, bladder and bowel function. CONCLUSION In this cohort, colpocleisis produced a good outcome with low regret rate (4.3 %), good QOL and minimal effect on bladder and bowel function at 2-5 years.
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Affiliation(s)
- M Vij
- Derriford Hospital, Plymouth, UK,
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Dua A, Patel B, Kuy S, Seabrook GR, Tondravi N, Brown KR, Lewis BD, Rossi PJ. Asymptomatic 50% to 75% Internal Carotid Artery Stenosis in 288 Patients: Risk Factors for Disease Progression and Ipsilateral Neurological Symptoms. ACTA ACUST UNITED AC 2013; 24:165-70. [DOI: 10.1177/1531003513491986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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Scerbo M, Radhakrishnan H, Cotton B, Dua A, DelJunco D, Wade C, Holcomb J. Utilization of the Random Forest Algorithm to Predict Trauma Patient Disposition Based on Pre-hospital Variables. J Surg Res 2013. [DOI: 10.1016/j.jss.2012.10.525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dua A. Role of routine vault drainage at vaginal hysterectomy. BJOG 2012. [DOI: 10.1111/j.1471-0528.2012.03317.x] [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: 11/29/2022]
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Dua A, Galimberti A. The effects of vault drainage on postoperative morbidity after vaginal hysterectomy for benign gynaecological disease: a randomised controlled trial. BJOG 2012. [DOI: 10.1111/j.1471-0528.2012.03365.x] [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: 12/01/2022]
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Liaw C, Lim A, Koh W, Loh J, Kan C, Chan K, Ting P, Ng S, Chew S, Dua A, Tan C, Gao Q, Ho H, lee V, Tan B. Epidemiology of the four human coronaviruses 229E, HKU1, NL63 and OC43 detected over 30 months in the Singapore military. Int J Infect Dis 2012; 16. [PMCID: PMC7173272 DOI: 10.1016/j.ijid.2012.05.305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- C.W.J. Liaw
- DSO NATIONAL LABORATORIES, Singapore, Singapore,Corresponding author
| | - A.S.E. Lim
- DSO NATIONAL LABORATORIES, Singapore, Singapore
| | - W.H.V. Koh
- DSO NATIONAL LABORATORIES, Singapore, Singapore
| | - J.P. Loh
- DSO NATIONAL LABORATORIES, Singapore, Singapore
| | - C. Kan
- DSO NATIONAL LABORATORIES, Singapore, Singapore
| | - K.W. Chan
- DSO NATIONAL LABORATORIES, Singapore, Singapore
| | - P.J. Ting
- DSO NATIONAL LABORATORIES, Singapore, Singapore
| | - S.H. Ng
- DSO NATIONAL LABORATORIES, Singapore, Singapore
| | - S.W.J. Chew
- DSO NATIONAL LABORATORIES, Singapore, Singapore
| | - A. Dua
- DSO NATIONAL LABORATORIES, Singapore, Singapore
| | - C.H. Tan
- Ministry of Defence, Singapore, Singapore
| | - Q.H.C. Gao
- Ministry of Defence, Singapore, Singapore
| | - H.P.V. Ho
- Ministry of Defence, Singapore, Singapore
| | - V. lee
- Ministry of Defence, Singapore, Singapore
| | - B.H. Tan
- DSO NATIONAL LABORATORIES, Singapore, Singapore
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Dua A, Weigelt J. Successful Treatment Regimens for Hospital and Community Acquired MRSA. J Surg Res 2012. [DOI: 10.1016/j.jss.2011.11.821] [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: 11/28/2022]
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Dua A, Galimberti A, Subramaniam M, Popli G, Radley S. The effects of vault drainage on postoperative morbidity after vaginal hysterectomy for benign gynaecological disease: a randomised controlled trial. BJOG 2011; 119:348-53. [DOI: 10.1111/j.1471-0528.2011.03170.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Khatib T, Dua A, Singh AD, Dua HS. Peacock-eyed: hundred eyes on a peacock's tail. Br J Ophthalmol 2011. [DOI: 10.1136/bjophthalmol-2011-300631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Hair transplantation has come a long way from the days of Punch Hair Transplant by Dr. Orentreich in 1950s to Follicular Unit Hair Transplant (FUT) of 1990s and the very recent Follicular Unit Extraction (FUE) technique. With the advent of FUE, the dream of ‘no visible scarring’ in the donor area is now looking like a possibility. In FUE, the grafts are extracted as individual follicular units in a two-step or three-step technique whereas the method of implantation remains the same as in the traditional FUT. The addition of latest automated FUE technique seeks to overcome some of the limitations in this relatively new technique and it is now possible to achieve more than a thousand grafts in one day in trained hands. This article reviews the methodology, limitations and advantages of FUE hair transplant.
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Affiliation(s)
- Aman Dua
- Department of Dermatology, Venereology and Leprology, AK Clinics, Ludhiana, Punjab, India
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Dua A, Dang P, Shaker R, Varadarajan P, Pai RG. Barriers to surgery in severe aortic stenosis patients with Class I indications for aortic valve replacement. J Heart Valve Dis 2011; 20:396-400. [PMID: 21863651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Despite a dismal natural history of severe aortic stenosis (AS) in patients with symptoms, there is a high non-surgical rate. The study aim was to analyze in detail the decision-making process for aortic valve replacement (AVR) that follows the diagnosis of severe AS with Class I indications, in order to identify the barriers to surgery. METHODS A total of 187 consecutive patients (105 men, 82 women; mean age 74 +/- 14 years) with severe AS, defined as aortic valve area (AVA) <1.0 cm2, was evaluated. Detailed reviews were performed for patient symptoms, and actions by physicians. The sources and reasons for non-surgical management were analyzed. RESULTS The mean AVA was 0.72 +/- 0.19 cm2 and the left ventricular ejection fraction 54 +/- 21%. A Class I indication for AVR was present in 174 patients (93%), of whom 125 (72%) were referred for AVR, which was performed in 93 cases (53%). The reasons for no AVR (n = 81) were patient refusal in 29 cases (36%), comorbidities in 28 (35%), while in 19 patients (23%) the AS was considered as 'not severe', despite being categorized as severe by ACC/AHA guidelines. The predominant factors in making the non-surgical decision were the patient or family (36%), the cardiologist (33%), and the surgeon (21%). CONCLUSION Class I indications for AVR are present in most patients with severe AS referred for echocardiography to a tertiary care center. Despite a Class I indication, the non-surgical rate remains high and attributable to patient reluctance, comorbidities and physician reluctance to offer AVR. It is speculated that patient discussions of the dismal natural history of severe AS and the major benefit of AVR, preferably conducted within a specialized valve clinic set-up, may help to improve the surgical rates.
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Affiliation(s)
- Aman Dua
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
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Dua A, Eachempati KK, Malhotra R, Sharma L, Gidaganti M. Closed reduction and percutaneous pinning of displaced supracondylar fractures of humerus in children with delayed presentation. Chin J Traumatol 2011; 14:14-9. [PMID: 21276362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Supracondylar fractures of the humerus account for 60% of all the fractures around the pediatric elbow and even in developed countries 18% of patients undergo surgery 48 hours or longer following presentation in the hospital. Management guidelines are not clear yet for these patients who present late. The aim of this prospective study was to evaluate the clinical, radiological and functional outcome following closed reduction and percutaneous pinning of widely displaced supracondylar fractures of the humerus presenting 12 hours or more after injury. METHODS We reviewed the functional and radiological results of closed reduction and percutaneous pinning using crossed K-wires in 40 patients with displaced extension type supracondylar fracture of the humerus (Gartland type III) with a delay of more than 12 hours in presentation. The average age of patients was 4.5 years and the mean delay in presentation was 17.55 hours. RESULTS Closed reduction and percutaneous pinning was successful in 90% of patients. The mean follow up period was 15 months. The Baumann's angle was restored within 4 degrees of the unaffected side in all patients. Use of a small medial incision in patients with severe swelling helped us avoid ulnar nerve injury. Using Flynn's criteria, 38 patients (95%) had an excellent result. Two patients had mild myositis and both had a poor result. None of the patients developed cubitus varus. CONCLUSION Closed reduction and crossed pinning of displaced supracondylar fractures of humerus in children is a safe and effective method even with delayed presentation.
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Affiliation(s)
- Aman Dua
- All India Institute of Medical Sciences, New Delhi, India.
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Bansal RC, Khazai B, Bansal N, Dua A. Left ventricular pseudoaneurysm due to embolic myocardial infarction in infective endocarditis: real time three-dimensional transesophageal echocardiographic evaluation. Echocardiography 2010; 28:E28-30. [PMID: 21138474 DOI: 10.1111/j.1540-8175.2010.01260.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report a case of a 63-year-old woman who presented with infective endocarditis and developed a pseudoaneurysm (PA) of the left ventricle presumably as a result of an embolic infarct. The diagnosis was made by typical features of PA on tranesophageal echocardiography and color Doppler studies. In addition, three-dimensional transesophageal echocardiography showed the narrow neck of the PA. Findings were confirmed at surgery and she was discharged after successful repair.
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Affiliation(s)
- Ramesh C Bansal
- Division of Cardiology Division of Internal Medicine, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA.
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Tandon A, Gupta A, Yateesh S, Dua A, Kumar S. Necrotising fasciitis of the cervicofacial region: a bizarre presentation. J Wound Care 2010; 19:454-6. [PMID: 20948494 DOI: 10.12968/jowc.2010.19.10.79093] [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: 11/11/2022]
Abstract
The following paper presents the case of a middle-aged woman, who presented with a necrotising soft tissue infection of the cervicofacial region with maggots in situ. She was managed with aggressive surgical debridement, but eventually succumbed to the disease because of erosion of the great vessels of the neck by the maggots. The purpose of this case report is to emphasise the severity of this disease and also to present an unusual case, which had a fatal outcome.
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Affiliation(s)
- A Tandon
- Department of General Surgery, University College of Medical Sciences and Associated, Guru Teg Bahdur Hospital, New Delhi, India
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Abstract
The success of total hip arthroplasty has led to a move toward operating on a wider and younger population. All implants have a finite useful life, and bone loss is associated with all major causes of failure. The use bone allograft, either morselized or structural has the aim of reconstituting the bone stock. We retrospectively reviewed the clinical and radiological results of 72 acetabular reconstructions both primary and revision, done at our institute between May 1999 and October 2004 with a minimum follow-up of one year. The Harris Hip Score (HHS) was calculated and follow-up radiographs were evaluated for graft incorporation; evidence of loosening and migration. Preoperatively 28 acetabular defects were type III (AAOS), 18 were type II, 16 were type I and 10 were type IV. 60 reconstructions were done using cementless acetabular prostheses, and the remaining twelve had cemented implants. Patients were followed up for an average of 30.69 months (range 12 - 64 months). The mean preoperative HHS was 36.13 points which improved to a mean of 81.6 points (range 61 to 91) at final follow-up. None of the patients required reoperation. Dislocation was the commonest complication (8 hips). Short and medium term results were encouraging with the use of this technique.
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Affiliation(s)
- Aman Dua
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
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Saini A, Dua A, Mohindra V. Genetic variability analysis of Giant river cattish (Sperata seenghala) populations from Indus river system by RAPD-PCR. RUSS J GENET+ 2010. [DOI: 10.1134/s1022795410080107] [Citation(s) in RCA: 7] [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: 11/23/2022]
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Saini A, Dua A, Mohindra V. Genetic variability analysis of Giant river catfish (Sperata seenghala) populations from Indus river system by RAPD-PCR. Genetika 2010; 46:1102-1107. [PMID: 20873207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The Giant river catfish, Sperata seenghala (Sykes) is commercially very important fish species of South Asia. Genetic variability between its populations collected from two rivers i.e. river Sutlej and river Beas of Indus river system in India were examined using randomly amplified polymorphic DNA analysis. Total 38 fish samples were collected from river Sutlej whereas 46 fish samples were collected from river Beas. Total 40 primers were screened, out of these 7 were selected for studying polymorphism which produced a total of 64 RAPD loci in two populations. Percentage polymorphic loci calculated following 95% criterion was 89.06% for Beas population as compared to 95.31% for Sutlej population. Moderate level of genetic divergence (genetic distance of 0.0486) between both the populations suggests distinct population substructure of giant river catfish in both the rivers.
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Affiliation(s)
- A Saini
- Aquatic Biology Laboratory, Department of Zoology, Guru Nanak Dev University, Amritsar-143005 Pb, India.
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Dua A, Dang P, Shaker R, Varadarajan P, Pai RG. FACTORS AFFECTING MANAGEMENT DECISIONS IN SEVERE AORTIC STENOSIS PATIENTS WITH CLASS I INDICATIONS FOR AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61359-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Coronal plane fractures of the femoral condyle are infrequent injuries and are often missed. Unilateral bicondylar coronal plane fractures are even rarer, with only eight reported cases in scientific literature, and are often associated with other injuries. We present here a case of unilateral bicondylar Hoffa fracture that presented in our emergency department and was managed with open reduction and internal fixation by lateral parapatellar arthrotomy using the swashbuckler approach with satisfactory results.
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Affiliation(s)
- Aman Dua
- Department of Orthopaedics, Punjab Institute of Medical Sciences, Jalandhar, Punjab, India.
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Abstract
Apotemnophilia is a condition that causes those who have it to not feel "correct" in their own bodies. As a result, an intense obsession develops with removing the limb; this obsession hinders tremendously the patients' social behaviour and societal integration. These patients, in some respects resembling transgendered individuals, feel that the body part (limb) in question is simply "not a part of themselves", causing them to feel uncomfortable in their own bodies. Whether amputations should be performed on apotemnophiles or not is a question that poses a significant medical ethical dilemma. It is argued that observing an apotemnophile's request for amputation is the ethical action. The major arguments opposing such amputations and supporting such amputations are examined and critically analysed with regard to ethical principles-namely, patient autonomy, beneficence, non-maleficence and justice with regard to every person's "right to happiness". Finally, a discourse on how the accepted notion of harm does not apply to apotemnophilia is developed to justify the position that amputation is indeed medically the ethical choice.
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Affiliation(s)
- A Dua
- University of Aberdeen Medical School, Mealmarket Exchange, Mealmarket Street, Aberdeen AB24-5SW, Scotland.
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Dua HS, Dua A, Singh AD. The Eye of God--the Helix Nebula. Br J Ophthalmol 2009; 93:1556. [DOI: 10.1136/bjo.2009.174664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dua A, Schram C. An investigation into the applicability of customised charts for the assessment of fetal growth in antenatal population at Blackburn, Lancashire, UK. J OBSTET GYNAECOL 2009; 26:411-3. [PMID: 16846865 DOI: 10.1080/01443610600720071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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: 10/24/2022]
Abstract
The antenatal population at Blackburn, Lancashire, UK is diverse, with 35% non-Caucasian, mainly of Indo-Pakistani origin. The department currently uses standard growth charts, based on the Caucasian population for assessment of fetal growth. This study was designed to ascertain whether the use of customised growth charts (CGCs) in our antenatal population can improve the identification of true growth restriction and decrease the number of interventions for suspected growth restriction. CGCs were generated for 109 women induced for intrauterine growth retardation (IUGR) and fetal biometry plotted. The centile range on the CGC was compared with standard charts. Results showed that women of Indian and Pakistani origin were greatly over-represented in the study group. A total of 58% of the cases induced for IUGR had babies within the normal range on CGC. Had CGC been used 54.4% of growth scans and 53% of antenatal day unit (ADU) appointments for fetal monitoring would have been unnecessary. Our study shows that introduction of CGC in our practice could lead to a very significant reduction in interventions for suspected growth restriction.
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Affiliation(s)
- A Dua
- Department of Obstetrics and Gynaecology, Queens Park Hospital, Blackburn, Lancashire, UK.
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Abstract
INTRODUCTION Cementless femoral revision has become increasingly popular because the cementless implants provide the potential for long-term biologic implant fixation. The IOTA interlocking femoral stem is a hydroxyapatite-coated stem with the option of interlocking the stem distally. The aim of the current study was to evaluate the short-term results of IOTA interlocking stem. MATERIALS AND METHODS We retrospectively reviewed the results of 18 total hip arthroplasties in 17 patients performed between July 2002 and 2004 using the IOTA interlocking stem. In-patient records were retrieved and in addition to demographic data the indication for revision, the preoperative and postoperative Harris Hip scores, need for allografts were noted. The bone deficiency was classified based on the AAOS classification. Intraoperative complications and problems if any were retrieved from the authors' operative notes. Radiographs at the final follow up were evaluated by the criteria described by Engh et al. (Clin Orthop 257:107-128, 1990) RESULTS Average age at the time of revision was 57 years. Preoperatively five femora showed type I deficiency, type II deficiency was seen in three, type III in nine and type IV deficiency in one femur. In five hips the calcar replacing prosthesis was implanted to manage the proximal calcar defect, in one hip allograft was used to reconstruct the calcar. One patient sustained intraoperative fracture of the shaft of the femur while implanting the trial prosthesis and one patient had a perforation of the posterior cortex of femur while trying to remove the cement. The mean follow up period was 33.5 months (range 27-45 months). The mean preoperative Harris Hip score was 36 (range 23-50), which improved to 77 (range 68-92) at the time of final follow up. None of the stems required revision and at minimum 27 months follow up, bony ingrowth was noted in 83.33% of the stems. CONCLUSION IOTA interlocking stem has shown promising short-term results for femoral revisions. The advantages are initial axial and rotational stability and consistent bony in growth owing to hydroxyapatite coating. Intraoperative fracture is a potential drawback because of the straight nature of the stem. The calcar replacing option of the stem is especially useful in patients with deficient calcar as a substitute for the allograft.
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Affiliation(s)
- R Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
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Cheung L, Han J, Beilhack A, Joshi S, Wilburn P, Dua A, An A, Rockson SG. An experimental model for the study of lymphedema and its response to therapeutic lymphangiogenesis. BioDrugs 2007; 20:363-70. [PMID: 17176124 DOI: 10.2165/00063030-200620060-00007] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [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: 12/30/2022]
Abstract
BACKGROUND Evaluation of the efficacy of molecular treatment strategies for lymphatic vascular insufficiency requires a suitable preclinical animal model. Ideally, the model should closely replicate the untreated human disease in its pathogenesis and pathological expression. OBJECTIVE We have undertaken a study of the time course of the development and resolution of acquired, experimental lymphedema and of its responses to vascular endothelial growth factor (VEGF)-C lymphangiogenesis in the mouse tail model. STUDY DESIGN We provoked post-surgical lymphedema in the mouse tail model and assessed the effects of exogenously administered human recombinant VEGF-C. Quantitative assessment of immune traffic function was performed through sequential in vivo bioluminescent imaging. RESULTS In untreated lymphedema, tail edema was sustained until day 21. Exogenous administration of human recombinant VEGF-C produced a significant decrease in volume. Untreated lymphedema in the mouse tail model was characterized by the presence of dilated cutaneous lymphatics, marked acute inflammatory changes, and hypercellularity; VEGF-C produced a substantial reversion to the normal pattern, with notable regression in the size and number of cutaneous lymphatic vessels that express lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1). In vivo imaging confirmed the presence of an impairment of immune traffic in lymphedema that was ameliorated after VEGF-C administration. CONCLUSION The post-surgical murine tail model of lymphedema closely simulates attributes of human lymphedema and provides the requisite sensitivity to detect therapeutically induced functional and structural alterations. It can, therefore, be used as an investigative platform to assess mechanisms of disease and its responses to candidate therapies, such as therapeutic lymphangiogenesis.
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Affiliation(s)
- Lauren Cheung
- Division of Cardiovascular Medicine, Stanford Center for Lymphatic and Venous Disorders, Stanford University School of Medicine, Falk Cardiovascular Research Center, Stanford, California 94305, USA
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Abstract
OBJECTIVE To compare the results of endoscopic carpal tunnel release (CTR) with open CTR in patients with idiopathic Carpal tunnel syndrome (CTS). MATERIALS AND METHODS Seventy-one patients with CTS were enrolled in a prospective randomized study from May 2003 to December 2005. All patients had clinical signs or symptoms and electro-diagnostic findings consistent with carpal tunnel syndrome and had not responded to nonoperative management. Sixty-one cases were available for follow-up. Endoscopic CTR was performed in 30 CTS patients and open CTR was performed in 31 wrists (30 patients). Various parameters were evaluated, including each patient's symptom amelioration, complications, operation time, time needed to resume normal lifestyle and the frequency of revision surgery. All the patients were followed up for six months. RESULTS During the initial months after surgery, the patients treated with the endoscopic method were better symptomatically and functionally. Local wound problems in terms of scarring or scar tenderness were significantly more pronounced in patients undergoing open CTR compared to patients undergoing endoscopic CTR. Average delay to return to normal activity was appreciably less in group undergoing endoscopic CTR. No significant difference was observed between the endoscopic CTR group and open CTR group in regard to symptom amelioration, electromyographic testing and complications at the end of six months. CONCLUSION Short-term results were better with the endoscopic method as there was no scar tenderness. Results at six months were comparable in both groups.
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Affiliation(s)
- R Malhotra
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India,Correspondence: Dr. Rajesh Malhotra, Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India. E-mail:
| | - E Krishna Kiran
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Aman Dua
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - S G Mallinath
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - S Bhan
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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Abstract
The indication for surgery in most children with posttraumatic cubitus varus is the presence of an unsightly deformity. The function of the limb is generally not impaired. Lateral closing-wedge supracondylar osteotomy, although a widely used corrective procedure, tends to produce lateral condylar prominence, thus jeopardizing the cosmetic outcome. The authors used the dome supracondylar osteotomy, as described by Tien et al, as the corrective procedure for cubitus varus in 12 consecutive children. The average follow-up was 2.3 (range 1-4) years. The objective evaluation was done by one of the authors by measuring the pre- and postoperative lateral condylar prominence index, carrying angle, and the range of movement at the elbow. The patients and parents were also asked to self-assess the cosmetic outcome. There were seven excellent and five good results. None of the children showed a prominent lateral humeral condyle. Hypertrophic scar formation and ulnar neurapraxia were seen in one patient each. These results were comparable to the published results of lateral closing-wedge osteotomy in terms of correction of carrying angle and preservation of elbow motion and were superior to those of the lateral closing-wedge osteotomy in terms of the prominence of lateral humeral condyle, acceptability of the scar, and cosmesis. The authors offer independent verification of the observation that the technique of dome osteotomy as described by Tien et al for the correction of the posttraumatic cubitus varus is a simple, safe, and technically sound procedure that prevents the lateral condyle from becoming prominent and yields an excellent cosmetic outcome.
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Affiliation(s)
- Amite Pankaj
- Department of Orthopedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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