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Ravat S, Rohatgi A, Kulkarni R, Jabeen SA, Patil B, Dash A, Malhotra M. Efficacy and Safety of adjunctive Perampanel in a prospective, real-world, Phase IV study in Indian patients aged ≥12 years for Treatment of focal-onset Epilepsy: Study 508. Epilepsia Open 2023. [PMID: 38124551 DOI: 10.1002/epi4.12885] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE ESPRITE (Study 508; NCT03836924) evaluated the real-world safety, tolerability, and efficacy of adjunctive perampanel in patients aged ≥12 years with focal-onset seizures (FOS), with or without focal to bilateral tonic-clonic seizures (FBTCS), in India. METHODS ESPRITE was a prospective, multicenter, single-arm, observational, Phase IV study with a 6-month Treatment Period. Patients were aged ≥12 years and had been prescribed perampanel for adjunctive treatment of FOS, with or without FBTCS. Assessments included incidence of treatment-emergent adverse events (TEAEs; primary endpoint), median percent reduction in seizure frequency per 28 days from baseline, 50% responder rates, and seizure-freedom rates. RESULTS Overall, 200 patients were enrolled (199 patients in the Safety Analysis Set and 174 patients who completed all visits in the main efficacy analyses). TEAEs (all mild or moderate in severity) were reported in 18.1% (n = 36/199) of patients (the most common were dizziness [3.0%] and irritability [2.0%]). TEAEs leading to discontinuation of perampanel were reported in 2.0% of patients; no deaths or serious TEAEs occurred. At 6 months, median percent reduction in seizure frequency was 100.0%, 50% responder rate was 83.3%, and seizure-freedom rate was 49.4%. SIGNIFICANCE Adjunctive perampanel (at a mean daily dose of 4 mg/day) was shown to be well tolerated and effective in patients aged ≥12 years with FOS, with or without FBTCS, from India. PLAIN LANGUAGE SUMMARY Many patients do not receive adequate treatment for epilepsy and need effective seizure control medications. In this 6-month clinical study, 199 patients from India, aged 12 years or older, added perampanel to the anti-seizure medications they were already taking. At 6 months, 49% of patients experienced no seizures since starting perampanel and seizure frequency was reduced by half in 83% of patients. Side effects occurred in 18% of patients (most commonly dizziness and irritability) and caused 2% to stop perampanel; no deaths were reported. Perampanel was an effective and generally safe added medication for patients with epilepsy from India.
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Affiliation(s)
| | | | - Rahul Kulkarni
- Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Shaik A Jabeen
- Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Balaji Patil
- Eisai Pharmaceuticals India Pvt. Ltd., Mumbai, India
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Patel B, Pepin K, Li S, Davies S, Rohatgi A, Herzog B, Ward J, Baggstrom M, Waqar S, Morgensztern D, Govindan R, Devarakonda S. PP01.28 Tumor Engraftment is Prognostic for Disease Recurrence in Resected Non-Small Cell Lung Cancer. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.054] [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: 01/29/2023]
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Wechsler R, Coppola A, Rohatgi A, Patten A, Goldman S, Gentile A, Patil B, Dash A, Ngo LY, Malhotra M. 069 Real-world evidence on the safety and efficacy of adjunctive perampanel across different geographical regions. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.113] [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
BackgroundWe report data from three Phase IV, observational studies (Studies 506 [US;NCT03208660], 508 [India;NCT03836924] and 501 [Italy;NCT04257604]), which assessed real-world safety and efficacy of adjunctive perampanel across different regions.MethodsStudy 506 included patients with any seizure type. Studies 508/501 included patients with focal- onset seizures.Endpoints included: retention rate (Studies 506/501), median percent reduction in seizure frequency/28 days, seizure-freedom rates and safety.ResultsIn Study 506, the 12-month retention rate was 58.5% (n=876/1498). At Months 10–12, the median percent reduction in seizure frequency/28 days was 75.0% (n=123) and the seizure-freedom rate was 30.9% (n=38/123). In Study 508, the 6-month median percent reduction in seizure frequency/28 days was 100.0% (n=174) and seizure-freedom rate was 49.4% (n=86/174). In Study 501, the 6-month median percent reduction in seizure frequency/28 days, retention rate and seizure-freedom rate were 55.4% (n=198), 72.6% (n=170/234) and 18.0% (n=36/200), respectively. Treatment-emergent adverse events occurred in 704/1703 (41.3%; Study 506), 36/199 (18.1%; Study 508) and 132/234 (56.4%; Study 501) patients; the most common was dizziness/vertigo.ConclusionsPerampanel is efficacious and well tolerated during real-world use regardless of geographi- cal region; no unexpected safety signals emerged.FundingEisai Inc., Eisai Pharmaceuticals India Pvt., Ltd., and Eisai s.r.l.
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Mathew T, Kamath V, John SK, Netravathi M, Iyer RB, Raghavendra S, Kumar S, Neeharika ML, Gupta S, Murgod U, Shivakumar R, Annadure RK, Ichaporia N, Rohatgi A, Nair SS, Yareeda S, Anand B, Singh P, Renukaradhya U, Arulselvan V, Reddy YM, Surya N, Sarma GRK, Nadig R, Deepalam S, Sharath Kumar GG, Satishchandra P, Singhal BS, Parry G. A real world multi center study on efficacy and safety of natalizumab in Indian patients with multiple sclerosis. Mult Scler Relat Disord 2022; 66:104059. [PMID: 35908446 DOI: 10.1016/j.msard.2022.104059] [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: 06/18/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Natalizumab (NTZ) is increasingly being used in Indian multiple sclerosis (MS) patients. There are no reports on its safety and efficacy, especially with respect to the occurrence of progressive multifocal leukoencephalopathy (PML). OBJECTIVES To describe the patient characteristics, treatment outcomes, and adverse events, especially the occurrence of PML in NTZ-treated patients. METHODS A multicentre ambispective study was conducted across 18 centres, from Jan 2012 to Dec 2021. Patients at and above the age of 18 years treated with NTZ were included. Descriptive and comparative statistics were applied to analyze data. RESULTS During the study period of 9 years, 116 patients were treated with NTZ. Mean age of the cohort was 35.6 ± 9.7 years; 83/116 (71.6%) were females. Relapse rate for the entire cohort in the year before NTZ was 3.1 ± 1.51 while one year after was 0.20±0.57 (p = 0.001; CI 2.45 -3.35). EDSS of the entire cohort in the year before NTZ was 4.5 ± 1.94 and one year after was 3.8 ± 2.7 (p = 0.013; CI 0.16-1.36). At last follow up (38.3 ± 22.78 months) there were no cases of PML identified. CONCLUSIONS Natalizumab is highly effective and safe in Indian MS patients, with no cases of PML identified at last follow up.
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Affiliation(s)
- Thomas Mathew
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India.
| | - Vikram Kamath
- Department of Neurology, Trustwell Hospitals, Chandrika tower 5 JC Road Sudama Nagar, Bengaluru, Karnataka 560002, India
| | - Saji K John
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - M Netravathi
- Department of Neurology, NIMHANS, Hosur Road, Near Banglore Milk Dairy, Hombegowda Nagar, Bengaluru 560029, India
| | - Rajesh B Iyer
- Department of Neurology, Manipal Hospital, Millers Road 71/1 Millers Road Opp to St Annes College, Vasant Nagar, Bengaluru 560052
| | - S Raghavendra
- Department of Neurology, Manipal Hospital, Millers Road 71/1 Millers Road Opp to St Annes College, Vasant Nagar, Bengaluru 560052
| | - Suresh Kumar
- Department of Neurology, Renai Medicity Multi Super Speciality Hospital, Palarivattom Edapally, Road Near Palarivattom Metro Station Palarivattom, Kochi, Kerala 682025, India
| | - M L Neeharika
- Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta rd, Punjagutta market, Hyderabad, Telengana 500082
| | - Salil Gupta
- Department of Neurology, Command Hospital Air force, Agram post, Bengaluru 560007, India
| | - Uday Murgod
- Department of Neurology, Manipal Hospital, HAL Airport Road, Banglore 560017, India
| | - R Shivakumar
- Department of Neurology, Sakra World Hospital, Devarabeesanahalli Varthur Hobli Opp intel, Outer Ring Road, Marathahalli, Bengaluru 560103, India
| | - Ravi K Annadure
- Department of Neurology, AFC Delhi, Defence Office Complex, Central Vista, KG Marg, New Delhi 110011
| | - Nasli Ichaporia
- Department of Neurology, Sahyadri Super Speciality Hospital Nagar Raod Shastrinagar, Yerawada, Pune, Maharashtra 411006, India
| | - Anshu Rohatgi
- Department of Neurology, Sir Ganga Ram Hospital, Rajinder Nagar New Delhi 110060, India
| | - Sruthi S Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, GWCG, Jai nagar w Rd chalakkuzhi, Thiruvananthapuram, Kerala 695011, India
| | - Sireesha Yareeda
- Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta rd, Punjagutta market, Hyderabad, Telengana 500082
| | - Bawani Anand
- Department of Neurology, Manipal Hospital, HAL Airport Road, Banglore 560017, India; Department of Neurology, Sakra World Hospital, Devarabeesanahalli Varthur Hobli Opp intel, Outer Ring Road, Marathahalli, Bengaluru 560103, India
| | - Prabhjeet Singh
- Department of Neurology, Dr Prabhjeets Neuro Centre, F-1/338, Kashmir Avenue, Amritsar 143001, India
| | - Umashankar Renukaradhya
- Department of Neurology, Bengaluru Neuro Centre, 10th Cross Margosa road, Malleshwaram, Banglore 560003, India
| | - V Arulselvan
- Department of Neurology, Royal Care Super Speciality Hospital, NO 1/520, L&T Road Neelambur, Coimbatore 641062, India
| | - Y Muralidhar Reddy
- Department of Neurology, Care Hospital, Rd Number 1 Prem Nagar, Banjara Hills, Hyderabad, Telangana 500034, India
| | - Nirmal Surya
- Department of Neurology, Bombay Hospital and Medical Research Centre, 12 Vitthaldas, Thackersey Marg, Near Liberty Cinema, New Marine Lines Mumbai 400020, India
| | - G R K Sarma
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - Raghunandan Nadig
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - Saikanth Deepalam
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - G G Sharath Kumar
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - P Satishchandra
- Department of Neurology, Apollo Speciality Hospital, 14 th Cross 3rd Block Near Madhavan Park, Jaynagar, Bengaluru 560011, India
| | - Bhim Sen Singhal
- Department of Neurology, Bombay Hospital and Medical Research Centre, 12 Vitthaldas, Thackersey Marg, Near Liberty Cinema, New Marine Lines Mumbai 400020, India
| | - Gareth Parry
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
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Dalal J, Poncha F, Bansal S, Das A, Gupta P, Ghosh D, Rohatgi A, Hiremath MS, Bhargava K, Gopi A, Mali M. Expert Opinion on the Use of Novel Oral Anticoagulants for Stroke Prevention in Non-valvular Atrial Fibrillation for the Primary Care Setting in India: A Literature Review. Cureus 2022; 14:e25102. [PMID: 35733454 PMCID: PMC9205292 DOI: 10.7759/cureus.25102] [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: 05/14/2022] [Indexed: 11/29/2022] Open
Abstract
Atrial fibrillation (AF), the most prevalent cardiac arrhythmia encountered in clinical practice, is linked with substantial morbidity and mortality due to accompanying risk of stroke and thromboembolism. Patients with AF are at a five-fold higher risk of suffering from a stroke. Anticoagulation therapy, with either vitamin K antagonists or novel oral anticoagulants (NOACs), is a standard approach to reduce the risk. Consultant physicians (CPs) in India are the primary point of contact for the majority of patients before they approach a specialist. The CPs may face challenges in screening and diagnosing AF patients. The apprehensions associated with managing AF patients with anticoagulants, further add to the challenges of a CP. This review aimed to identify the key decision points for the CPs to diagnose AF and initiate anticoagulation in patients with non-valvular AF (NVAF) and bring to the table a simplified recommendation supported by expert opinion and guidelines for stroke prevention in NVAF patients.
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Gomathy S, Panigrahi B, Tirlangi PK, Wig N, Brijwal M, Sharma MC, Garg A, Tripathi M, Mohta S, Doddamani R, Vibha D, Singh RK, Yadav R, Sahu S, Suri V, Kaur K, Tripathi M, Rohatgi A, Elavarasi A. Progressive multifocal leukoencephalopathy in a patient with systemic lupus erythematosus and autoimmune hepatitis. Int J Rheum Dis 2022; 25:705-713. [PMID: 35535671 DOI: 10.1111/1756-185x.14331] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/15/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating central nervous system illness encountered in the setting of immunosuppressive conditions like human immunodeficiency virus / acquired immunodeficiency syndrome, autoimmune diseases and hematologic malignancies. We had a 54-year-old woman with systemic lupus erythematosus and coexisting autoimmune hepatitis who presented with progressive cognitive decline, right hemiparesis and ataxia who was found to have PML. She had severe CD4 lymphopenia. She was managed with low-dose prednisolone and plasma exchange after which she showed significant clinical improvement. This case highlights the diagnostic and therapeutic challenges encountered in managing a case of PML in the setting of autoimmune conditions with profound lymphopenia.
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Affiliation(s)
- Saranya Gomathy
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Baikuntha Panigrahi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Megha Brijwal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Srikant Mohta
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajni Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Saumya Sahu
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Kavneet Kaur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anshu Rohatgi
- Department of Neurology, Sir Ganga Ram Hospital, New Delhi, India
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Das UK, Theisen R, Hua A, Upadhyaya A, Lam I, Mouri TK, Jiang N, Hauschild D, Weinhardt L, Yang W, Rohatgi A, Heske C. Efficient passivation of n-type and p-type silicon surface defects by hydrogen sulfide gas reaction. J Phys Condens Matter 2021; 33:464002. [PMID: 34407514 DOI: 10.1088/1361-648x/ac1ec8] [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] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
An efficient surface defect passivation is observed by reacting clean Si in a dilute hydrogen sulfide-argon gas mixture (<5% H2S in Ar) for both n-type and p-type Si wafers with planar and textured surfaces. Surface recombination velocities of 1.5 and 8 cm s-1are achieved on n-type and p-type Si wafers, respectively, at an optimum reaction temperature of 550 °C that are comparable to the best surface passivation quality used in high efficiency Si solar cells. Surface chemical analysis using x-ray photoelectron spectroscopy shows that sulfur is primarily bonded in a sulfide environment, and synchrotron-based soft x-ray emission spectroscopy of the adsorbed sulfur atoms suggests the formation of S-Si bonds. The sulfur surface passivation layer is unstable in air, attributed to surface oxide formation and a simultaneous decrease of sulfide bonds. However, the passivation can be stabilized by a low-temperature (300 °C) deposited amorphous silicon nitride (a-Si:NX:H) capping layer.
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Affiliation(s)
- U K Das
- Institute of Energy Conversion, University of Delaware, Newark, United States of America
| | - R Theisen
- Institute of Energy Conversion, University of Delaware, Newark, United States of America
| | - A Hua
- Department of Chemistry and Biochemistry, University of Nevada Las Vegas, Las Vegas, United States of America
| | - A Upadhyaya
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, United States of America
| | - I Lam
- Institute of Energy Conversion, University of Delaware, Newark, United States of America
| | - T K Mouri
- Institute of Energy Conversion, University of Delaware, Newark, United States of America
| | - N Jiang
- Department of Chemistry and Biochemistry, University of Nevada Las Vegas, Las Vegas, United States of America
| | - D Hauschild
- Department of Chemistry and Biochemistry, University of Nevada Las Vegas, Las Vegas, United States of America
- Institute for Photon Science and Synchrotron Radiation, Karlsruhe Institute of Technology, Karlsruhe, Germany
- Institute for Chemical Technology and Polymer Chemistry, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - L Weinhardt
- Department of Chemistry and Biochemistry, University of Nevada Las Vegas, Las Vegas, United States of America
- Institute for Photon Science and Synchrotron Radiation, Karlsruhe Institute of Technology, Karlsruhe, Germany
- Institute for Chemical Technology and Polymer Chemistry, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - W Yang
- Advanced Light Source, Lawrence Berkeley National Laboratory, Berkeley, United States of America
| | - A Rohatgi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, United States of America
| | - C Heske
- Department of Chemistry and Biochemistry, University of Nevada Las Vegas, Las Vegas, United States of America
- Institute for Photon Science and Synchrotron Radiation, Karlsruhe Institute of Technology, Karlsruhe, Germany
- Institute for Chemical Technology and Polymer Chemistry, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Ramkumarsingh Tomar L, Jatinbhai Shah D, Agarwal U, Gogia A, Rohatgi A, Agrawal CS. Scrub typhus meningoencephalitis presenting as opsoclonus myoclonus syndrome: A video-based case. Trop Doct 2021; 52:192-195. [PMID: 34355588 DOI: 10.1177/00494755211034381] [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] [Indexed: 11/16/2022]
Abstract
Opsoclonus myoclonus syndrome secondary to scrub typhus infection is a rare clinical entity. Hence, it is important to know its clinical manifestations and complications, so that it can be properly managed. We report a 28-year-old female whose initial manifestation was only fever, which subsided in four days. Two days later, she developed opsoclonus myoclonus syndrome. This was managed with doxycycline and clonazepam, but as it persisted, intravenous immunoglobulin was added. She showed excellent response to treatment.
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Affiliation(s)
| | | | - Utkarsh Agarwal
- Department of Neurology, Sir Ganga Ram Hospital, Old Rajendra Nagar, New Delhi, India
| | - Atul Gogia
- Department of Internal Medicine, Sir Ganga Ram Hospital, Old Rajendra Nagar, New Delhi, India
| | - Anshu Rohatgi
- Department of Neurology, Sir Ganga Ram Hospital, Old Rajendra Nagar, New Delhi, India
| | - C S Agrawal
- Department of Neurology, Sir Ganga Ram Hospital, Old Rajendra Nagar, New Delhi, India
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Abstract
Diabetic autonomic neuropathy is an under-recognised complication of diabetes and the prediabetic state. A wide range of manifestations can be seen due to involvement of cardiovascular, gastrointestinal, genitourinary, sudomotor and neuroendocrine systems. Cardiac autonomic neuropathy is the most dreaded complication carrying significant mortality and morbidity. Early detection and control of diabetes and other cardiovascular risk factors is the key to treat and prevent progression of autonomic neuropathy. Recently, a new entity of treatment-induced neuropathy (TIND) of diabetes mellitus causing autonomic neuropathy is being increasingly recognised.
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Affiliation(s)
- Jugal Kishor Sharma
- Central Delhi Diabetes Centre, 34/34, Old Rajinder Nagar, New Delhi 110060, India,
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Tomar LR, Shah DJ, Ranjan R, Rohatgi A, Agrawal CS. An Unusual Case of Muscle Twitching: Its LGI1. Neurol India 2021; 69:493-494. [PMID: 33904485 DOI: 10.4103/0028-3886.314549] [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] [Indexed: 11/04/2022]
Abstract
A 50-year-old male, presented with a two-months history of ascending paresthesias, with continuous twitchings over the body, associated with insomnia. His electromyography (EMG) revealed neuromyotonia and was diagnosed as a case of peripheral nerve hyperexcitability (PNH) syndrome due to Leucin-rich glioma-inactivated 1 (LGI1) antibody. He showed significant improvement with intravenous immunoglobulin and carbamazepine.
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Affiliation(s)
| | | | - Rajeev Ranjan
- Department of Neurology, Sir Ganga Ram Hospital, Old Rajendra Nagar, New Delhi, India
| | - Anshu Rohatgi
- Department of Neurology, Sir Ganga Ram Hospital, Old Rajendra Nagar, New Delhi, India
| | - C S Agrawal
- Department of Neurology, Sir Ganga Ram Hospital, Old Rajendra Nagar, New Delhi, India
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Tomar L, Shah D, Agarwal P, Rohatgi A, Agrawal CS. Tubercular rhombencephalitis: A clinical challenge. Ann Indian Acad Neurol 2021; 24:960-962. [PMID: 35359542 PMCID: PMC8965917 DOI: 10.4103/aian.aian_685_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 12/03/2022] Open
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Chan J, Mann A, Chan C, Lee D, Rohatgi A, Abel M, Argueta C, Kapp D. Human papillomavirus vaccination in heterosexual and sexual minority individuals in the United States. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.529] [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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Sagvekar Y, Shah V, Rohatgi A, Pandita N, Sharma R, Rajan R, Shah D. Short-Course Self-Medication of Metronidazole Leading to Acute Toxic Encephalopathy and Ataxia. Ann Indian Acad Neurol 2019; 22:543-545. [PMID: 31736605 PMCID: PMC6839312 DOI: 10.4103/aian.aian_43_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/07/2019] [Accepted: 03/18/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Yatin Sagvekar
- Department of Neurology, The Ganga Ram Institute for Post-Graduate Medical Education and Research, New Delhi, India
| | - Virti Shah
- Department of Neurology, The Ganga Ram Institute for Post-Graduate Medical Education and Research, New Delhi, India
| | - Anshu Rohatgi
- Department of Neurology, The Ganga Ram Institute for Post-Graduate Medical Education and Research, New Delhi, India
| | - Neha Pandita
- Department of Neurology, The Ganga Ram Institute for Post-Graduate Medical Education and Research, New Delhi, India
| | - Rahul Sharma
- Department of Neurology, The Ganga Ram Institute for Post-Graduate Medical Education and Research, New Delhi, India
| | - Rajeswari Rajan
- Department of Neurology, The Ganga Ram Institute for Post-Graduate Medical Education and Research, New Delhi, India
| | - Dhrumil Shah
- Department of Neurology, The Ganga Ram Institute for Post-Graduate Medical Education and Research, New Delhi, India
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Sagvekar YC, Rohatgi A, Shah V, Patel S, Sharma R, Pandita N. A Case of Rare Inflammatory Brainstem Syndrome: Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids. Ann Indian Acad Neurol 2019; 22:219-220. [PMID: 31007440 PMCID: PMC6472233 DOI: 10.4103/aian.aian_370_18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Yatin Chandrakant Sagvekar
- Department of Neurology, The Ganga Ram Institute of Post-graduate Medical Education and Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Anshu Rohatgi
- Department of Neurology, The Ganga Ram Institute of Post-graduate Medical Education and Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Virti Shah
- Department of Neurology, The Ganga Ram Institute of Post-graduate Medical Education and Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Samir Patel
- Department of Neurology, The Ganga Ram Institute of Post-graduate Medical Education and Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Rahul Sharma
- Department of Neurology, The Ganga Ram Institute of Post-graduate Medical Education and Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Neha Pandita
- Department of Neurology, The Ganga Ram Institute of Post-graduate Medical Education and Research, Sir Ganga Ram Hospital, New Delhi, India
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Abstract
Multiple sclerosis (MS) is a chronic neurological disease which often leads to disability. The complex etiology and progressive nature pose challenges in the management of patients with MS, particularly in developing countries like India. Lack of data on prevalence further complicates estimation of the magnitude of MS in India. There are various other challenges associated with management of patients with MS due to which the therapy is utilized by only a small segment of population in India. This article encapsulates the gaps and challenges in the management of patients with MS and presents suggestions and recommendations of the members of advisory boards held to discuss these challenges. The advisory board members suggested that an early diagnosis of MS and an early initiation of treatment are essential to achieve better results for tackling MS-related challenges. In addition, awareness and education about MS among people, regular training to physicians, emphasis on the use of revised 2010 McDonald criteria, and utilization of advanced diagnostic modalities in magnetic resonance imaging would help to achieve desirable as well as effective therapeutic outcomes. Further, access to an easy-to-use therapy delivery system could also be beneficial in attaining an adequate treatment adherence and related health benefits.
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Affiliation(s)
- Sudhir Kumar
- Department of Neurology, Apollo Hospitals, Hyderabad, Telangana, India
| | - Anshu Rohatgi
- Department of Neurology, Sir Ganga Ram Hospital, New Delhi, India
| | - Harshal Chaudhari
- Medical Affairs, Merck Ltd., Merck Specialties Pvt. Ltd., Mumbai, Maharashtra, India
| | - Priti Thakor
- Medical Affairs, Merck Ltd., Merck Specialties Pvt. Ltd., Mumbai, Maharashtra, India
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16
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Hart T, Sinitsky D, Shamsiddinova A, Rohatgi A. Refractory hypercalcaemia secondary to localised gastrointestinal stromal tumour. Ann R Coll Surg Engl 2018; 100:e136-e138. [PMID: 29658339 DOI: 10.1308/rcsann.2018.0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Gastrointestinal stromal tumours are a rare form of intra-abdominal neoplasm derived from mesenchymal tissue, typically presenting with abdominal pain, anaemia or bleeding into the bowel or abdominal cavity. Hypercalcaemia is an unusual complication, having been documented in only seven previous patients, all of whom had advanced metastatic disease. We present a case of treatment-resistant hypercalcaemia in a patient with non-metastatic gastrointestinal stromal tumour, which resolved following excision of the tumour.
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Affiliation(s)
- T Hart
- Royal Brompton and Harefield NHS Trust , London , UK
| | - D Sinitsky
- Whipps Cross University Hospital, Barts Health NHS Trust , London , UK
| | - A Shamsiddinova
- East Kent University Hospitals NHS Trust , Canterbury, Kent , UK
| | - A Rohatgi
- Whipps Cross University Hospital, Barts Health NHS Trust , London , UK
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17
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Rana DS, Rohatgi A, Patel S, Dave N, Agarwal R, Gupta P. Longitudinally Extensive Transverse Myelitis as Presenting Manifestation of Lung Adenocarcinoma. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_55_16] [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
AbstractLongitudinally extensive transverse myelitis (LETM) is an unusual manifestation of systemic malignancy. It has been mainly reported with lung cancers and lymphoproliferative malignancy. LETM in systemic malignancy can be caused by either intramedullary metastases or paraneoplastic syndrome. Occurrence of LETM as the first manifestation of malignancy has been rarely reported. We present clinical, laboratory, and imaging findings of a 66-year-old man with nonsmall-cell lung (adeno) carcinoma, who presented with LETM without having any cardinal manifestations of lung malignancy. The rarity of the disease and especially such a presentation can cause considerable delay in the diagnosis and treatment.
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Affiliation(s)
| | - Anshu Rohatgi
- Department of Neurology, Sir Ganga Ram Hospital, New Delhi, India
| | - Samir Patel
- Department of Neurology, Sir Ganga Ram Hospital, New Delhi, India
| | - Nikhil Dave
- Department of Neurology, Sir Ganga Ram Hospital, New Delhi, India
| | - Rajat Agarwal
- Department of Neurology, Sir Ganga Ram Hospital, New Delhi, India
| | - Pooja Gupta
- Department of Neurology, Sir Ganga Ram Hospital, New Delhi, India
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18
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Gupta P, Rohatgi A, Patel S. Post-Partum Angiopathy presenting as Ischemic Stroke. J Assoc Physicians India 2016; 64:89-90. [PMID: 27762527] [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: 06/06/2023]
Abstract
Post-partum angiopathy is grouped within the category of reversible cerebral vasoconstriction syndromes. It is considered to be a rare but under-recognized cause of stroke especially in pregnancy. We present the case of a 24 year old female who presented with hemiparesis and seizure, and turned out to be a case of post partum angiopathy.
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Affiliation(s)
| | | | - Samir Patel
- DNB Neurology Student, Sir Gangaram Hospital, New Delhi
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19
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Affiliation(s)
- Samir Patel
- Department of Neurology, Sir Ganga Ram Hospital, New Delhi, India
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20
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Gupta P, Patel S, Rohatgi A, Chugh M. Dural Arterio-venous Malformation. J Assoc Physicians India 2016; 64:64. [PMID: 27730784] [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: 06/06/2023]
Affiliation(s)
| | | | | | - M Chugh
- Consultant Intervention Neurologist, Sir Gangaram Hospital, New Delhi
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21
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Khanna L, Rohatgi A, Jha NK. Dural arteriovenous fistula. J Assoc Physicians India 2013; 61:740-741. [PMID: 24772732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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22
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Khanna L, Rohatgi A, Jha N. Chylothorax after esophagectomy. J Assoc Physicians India 2012; 60:46. [PMID: 23405540] [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: 06/01/2023]
Affiliation(s)
- L Khanna
- Department of Neurology, Sir Gangaram Hospital, N Delhi
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23
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Abstract
Localized and multisystem nocardiosis is an opportunistic disease that occurs commonly in immunocompromised patients. Rarely, it is also seen in immunocompetent individuals. The lungs and brain are commonly involved. Typical, but nonspecific, findings are often seen on imaging and the presence of concomitant lesions in these two systems often suggests this diagnosis. We report two cases of cerebral and pulmonary involvement by nocardiosis.
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Abstract
AbstractThe potential use of porous silicon as an antireflective coating on solar cells has recently been recognized. This study investigates the effect of current density, anodization time, and surface conditions on the reflectance of porous silicon which was fabricated by anodizing (100) float zone single crystal Si wafers. The wafers were coated on one side with Al prior to anodization, and a HFbased solution was used as the electrolyte. Current densities of 5 – 100 mA/cm2 were used to anodize both polished and unpolished wafers over time intervals ranging from 2sec - 30 minutes. Reflectance properties were tested over the 400 - 1100 nm range, and minimum reflectances of 3 – 5% were achieved. The reflectance of the best porous Si sample normalized with respect to the sun's spectrum compares favorably with the reflectance of a double layer ZnS/ MgF2 with prior texturing.
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Abstract
A 53 year old man developed upper body swelling, hypotension, anuria and a metabolic acidosis within 24 h following an Ivor-Lewis oesophagectomy. His co-morbidities included hypertension, hypercholesterolaemia, ischaemic heart disease and he was a smoker. He did not have radiotherapy but had received neo-adjuvant chemotherapy through an in-dwelling right subclavian central venous catheter. Azygous vein ligation during oesophagectomy resulted in acute upper body venous hypertension and signs of hypovolaemic shock which were attributed to undiagnosed thrombotic occlusion of the superior vena cava. The patient was anticoagulated and made a full recovery after a period of stay in intensive care.
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Affiliation(s)
- A Hay
- St Thomas' Hospital, Lambeth, London, UK.
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Gupta A, Batra AM, Rohatgi A, Goya S. Myotonia congenita (Becker's variant). J Assoc Physicians India 2009; 57:707. [PMID: 20329429] [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: 05/29/2023]
Affiliation(s)
- Aparna Gupta
- Department of Neurology, Sir Ganga Ram Hospital, New Delhi
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27
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Abstract
e15572 Background: Early and node negative oesophageal cancers do not undergo chemotherapy as it is felt that as the risk of lymph node metastasis is small, early operative intervention is considered the best option. We analysed a prospective database in a tertiary referral centre to see, with current preoperative staging modalities, if a significant number of patients were under staged and hence under treated preoperatively. Methods: Four hundred and fifteen patients underwent esophagectomies for cancer in our unit between March 2000 and December 2006. 117 were preoperatively staged as either T1/T2 N0. Pre-operative staging was by gastroscopy, endoscopic ultrasound (EUS), CT scan and PET-CT. These were discussed in a multi-disciplinary meeting and as per current evidence did not undergo preoperative chemotherapy. Results: 115 patients were analysed as two were excluded. Preoperatively there were 35 T0N0, 30 T1N0, and 50 T2N0. There were 42 (36.5%) patients who were under staged utilising the standard preoperative staging protocol. These were preoperatively staged as T0N0 –2, T1N0 –6, T2N0 –34. 6 did not have EUS, only 4 had a PET- CT and 1 had a staging laparoscopy. Gastroscopy, CT scan and EUS was the staging protocol in 87%. Post op staging was T1N1–7, T2N1–12, T2N2–1, T3N0–10, T3N1–11, T3N2–1. Conclusions: Utilising current preoperative staging methods one third of patients were under staged. Looking specifically at T2N0 68% were under staged. We feel that early oesophageal cancer especially T2N0 disease may benefit from neoadjuvant chemotherapy based on the current staging protocols. No significant financial relationships to disclose.
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Affiliation(s)
- A. Rohatgi
- Guy's and St Thomas’ Hospital, London, United Kingdom
| | - S. Naji
- Guy's and St Thomas’ Hospital, London, United Kingdom
| | - A. Hamouda
- Guy's and St Thomas’ Hospital, London, United Kingdom
| | - P. J. Ross
- Guy's and St Thomas’ Hospital, London, United Kingdom
| | - R. C. Mason
- Guy's and St Thomas’ Hospital, London, United Kingdom
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Abstract
AIM To demonstrate our technique and valuable tips for transhiatal oesophagectomies. METHOD 215 patients underwent transhiatal oesophagectomies in our unit between 2000 and 2006. RESULTS In-hospital mortality was 0.9%. Anastomotic leak in 12 patients (5.6%). Chyle leak was seen in five patients and recurrent nerve neuropraxia in six patients. Iatrogenic splenectomy rate was 6%. The median operative time was 151 minutes (range 93-276 minutes). Overall median length of hospital stay was 15 days (range 8-95 days). The median survival for all patients undergoing transhiatal oesophagectomy for invasive malignancy was 42.9 months and the one-year and five-year survival were 81% and 48% respectively. CONCLUSION This is a safe and oncologically sound procedure. We feel that the tips can be helpful for anyone performing this procedure.
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Affiliation(s)
- A Rohatgi
- Department of General Surgery, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
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29
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Goyal S, Batra AM, Rohatgi A, Acharya R, Sharma AG. Tension pneumocephalus: a neurosurgical emergency. J Assoc Physicians India 2008; 56:985. [PMID: 19322978] [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: 05/27/2023]
Affiliation(s)
- S Goyal
- Department of Neurosurgery, Sir Ganga Ram Hospital, New Delhi
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30
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Sutcliffe RP, Forshaw MJ, Tandon R, Rohatgi A, Strauss DC, Botha AJ, Mason RC. Anastomotic strictures and delayed gastric emptying after esophagectomy: incidence, risk factors and management. Dis Esophagus 2008; 21:712-7. [PMID: 18847448 DOI: 10.1111/j.1442-2050.2008.00865.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this study was to report the incidence, risk factors, and management of gastric conduit dysfunction after esophagectomy in 177 patients over a 3-year period in a single center. Patients with anastomotic strictures or delayed gastric emptying (DGE) were identified from a prospective database. Anastomotic strictures occurred in 48 patients (27%). Eighty-three percent of early anastomotic strictures (<1 year) were benign, and all late strictures (>1 year) were malignant. Dilatation was effective in 98% of benign and 64% of malignant strictures. DGE occurred in 21 patients (12%), and was associated with both anastomotic leak (P = 0.001) and anastomotic stricture (P = 0.001). 4/8 patients with late DGE (>3 months postesophagectomy) were tumor-related. Pyloric dilatation was effective in 92% of early and 63% of late DGE. Pyloric stents were inserted in 3 patients with tumor-related DGE. After esophagectomy, early anastomotic strictures (within 1 year) and early delayed gastric emptying (within 3 months) are usually benign and respond to dilatation. However, patients presenting later with tumor-related obstruction are unlikely to respond to anastomotic or pyloric dilatation and should be stented.
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Affiliation(s)
- R P Sutcliffe
- Department of Surgery, St Thomas' Hospital, London, UK.
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Rohatgi A, Sutcliffe R, Forshaw MJ, Strauss D, Mason RC. Training in oesophageal surgery--the gold standard: a prospective study. Int J Surg 2008; 6:230-3. [PMID: 18499545 DOI: 10.1016/j.ijsu.2008.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 04/08/2008] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Competency in complex oesophagogastric surgery, within the current climate of changes to medical training and reduced hours, requires repeated, focused, hands-on training. We describe the training methods for oesophagectomy in our institution. METHODS All oesophageal resections under the care of one consultant surgeon are regarded as training cases. When trainees start they are shown the first resection; subsequently, the trainees then perform every case with the consultant scrubbed. Consultant input consists of retraction and tips in difficult situations. All data were collected on a prospective database. RESULTS Two hundred and seventy patients (215 males, median age=64 years) underwent primary oesophagectomy under the consultant, between January 2000 and May 2007. Fifteen resections (6%) were performed solely by the consultant. ASA grading was: I=15, II=154, III=95, IV=5, and unrecorded=1. In-hospital mortality and clinically apparent leak rate was 1.9% (5 deaths) and 6.2% (n=17), respectively. Reoperation was required in 15 patients (5.5%). The median length of hospital stay was 14 days (range=8-95 days). Median lymph node yield was 13 (range=0-64). CONCLUSIONS Trainees under supervision can competently perform an oesophagectomy without compromising patient care. An early hands-on approach leads to a rapid ascent of the learning curve and is essential in today's climate of limited training opportunity.
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Affiliation(s)
- A Rohatgi
- Oesophagogastric Unit, St Thomas' Hospital, Lambert Road, London, United Kingdom.
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32
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Singh KK, Rohatgi A, Rybinkina I, McCulloch P, Mudan S. Laparoscopic gastrectomy for gastric cancer: early experience among the elderly. Surg Endosc 2007; 22:1002-7. [PMID: 17768658 DOI: 10.1007/s00464-007-9561-9] [Citation(s) in RCA: 18] [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] [Received: 01/11/2007] [Revised: 05/28/2007] [Accepted: 06/13/2007] [Indexed: 01/05/2023]
Abstract
BACKGROUND The data are scarce on the outcome for elderly patients presenting with resectable gastric cancer in the West who have been treated with minimally invasive surgery. This report presents the authors' early experience with totally laparoscopic gastric resections for cancer in elderly patients. METHODS A total of 20 patients underwent laparoscopic gastrectomy procedures: 14 distal, 5 subtotal, and 1 total gastrectomy. The male-to-female ratio was 15 to 5. The ages ranged from 75 to 88 years (mean, 80 years). RESULTS All cases were managed laparoscopically with R0 resection. Four patients needed high-dependency unit care postoperatively. There were no perioperative deaths. The median time required for the procedure was 212 min, and time to diet was 4 days. The hospital stay was 8 days. Four patients experienced significant complications, with two patients requiring reoperation. The pathology was adenocarcinoma for 17 patients and high-grade dysplasia for 3 patients. CONCLUSION Among elderly patients for whom conventional gastric surgery carries a high morbidity and mortality risk, minimal access surgery may offer equivalent oncologic integrity but with superior safety and economy. The primary aim is to remove the tumor with at least a D1 lymphadenectomy.
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Affiliation(s)
- K K Singh
- Worthing Hospital, Lyndhurst Road, Worthing, West Sussex, BN11 2HR, UK.
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Padmanabhan J, Rohatgi A, Niaz A, Chojnowska E, Baig K, Woods WGA. Does rectus sheath infusion of bupivacaine reduce postoperative opioid requirement? Ann R Coll Surg Engl 2007; 89:229-32. [PMID: 17394704 PMCID: PMC1964741 DOI: 10.1308/003588407x168398] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this work was to assess the effect of intermittent bupivacaine infusion into rectus sheath space on postoperative opioid requirement, postoperative pain score and peak expiratory flow rate. PATIENTS AND METHODS A prospective, randomised study involving patients undergoing midline laparotomy. Patients were randomised to receive either intermittent infusion of bupivacaine 0.25% or normal saline via catheters placed in the rectus sheath for 48 h after operation. All patients received intravenous morphine infusion on demand with a patient-controlled analgesic device (PCAD). RESULTS Forty ASA I-III patients were studied. Nineteen were randomised to receive bupivacaine and 21 patients received normal saline. Patient characteristics and surgical variables were comparable in the two groups. The mean wound lengths were similar. There was no statistically significant difference in postoperative opioid requirement, postoperative pain score and peak expiratory flow rate between the two groups. CONCLUSIONS Intermittent bupivacaine infusion into the rectus sheath space after midline laparotomy does not reduce postoperative opioid requirement nor does it affect postoperative pain score or peak expiratory flow rate.
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Affiliation(s)
- J Padmanabhan
- Department of Surgery, Worthing Hospital, West Sussex, UK.
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35
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Abstract
This article reports on two cases in which porcine dermal collagen grafts were used successfully alongside topical negative pressure therapy in order to close open abdominal wounds in which severe infection was present.
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Affiliation(s)
- K S Jehle
- Department of General Surgery, Worthing and Southlands NHS Trust, Worthing, UK.
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36
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Abstract
Torted appendices are a rare occurrence but should be considered when encountering a haemorrhagic congested appendix on laparoscopy. As adhesions are rarely present, laparoscopic excision is usually a feasible option.
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Abstract
BACKGROUND The authors present their experience with laparoscopic subtotal cholecystectomy for the management of Mirizzi's syndrome and their review of the literature. METHODS Over a period of 24 months, five cases of Mirizzi's syndrome were encountered, representing 1.5% of all the laparoscopic cholecystectomies performed in the authors' unit. The sex ratio was 4 females to 1 male, and the mean age of the patients was 66 years. All underwent a subtotal cholecystectomy. RESULTS All procedures were completed laparoscopically. Morbidities involved one case of biliary peritonitis and a one case of biliary leak requiring endoscopic stenting. CONCLUSION Mirizzi's syndrome cannot always be anticipated on the basis of preoperative staging, and often is encountered during the procedure. The "anatomic scenario" of this condition should be suspected for patients presenting with conditions such as empyema or mucocoele when there is a likelihood of stone impaction in the infundibulum of the gallbladder. Subtotal cholecystectomy with secure intraperitoneal biliary drainage appears to be a safe option for these patients.
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Affiliation(s)
- A Rohatgi
- Hospital Worthing Hospital, Lyndhurst Road, Worthing, West Sussex, BN11 2HR, UK
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38
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Abstract
BACKGROUND Cystic duct leak is an infrequent but potentially serious complication of laparoscopic cholecystectomy. The aims of this audit were to assess the efficacy of locking absorbable clips for closing the cystic duct and to compare the results with those for simple clips used previously. METHODS The records for all laparoscopic cholecystectomies performed in one hospital over a 5-year period were reviewed. The results were compared using Fisher's exact test. RESULTS Of 518 laparoscopic cholecystectomies attempted, 24 were excluded. There was no difference in age or sex ratio between the two groups. Cystic duct leaks were identified either on endoscopic retrograde choloangio pancreatography or at laparotomy. No cystic duct leak occurred in any of the 344 locking clip cases, as compared with 3 leaks in the 146 (2%) simple clip cases (p < 0.03). CONCLUSION Locking clips are a safe and effective method for cystic duct closure. They are associated with a reduced cystic duct leak rate, as compared with that for simple clips.
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Affiliation(s)
- A Rohatgi
- Department of Surgery, Royal Cornwall Hospital, Treliske TR1 3LJ, Cornwall, United Kingdom
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40
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Abstract
BACKGROUND The left subcostal closed approach utilizing the Veress needle has been the preferred method at one surgical practice for the past 5 years. The aims of this study were to determine whether this was a safe method for creating a pneumoperitoneum and its success rate. METHODS The medical records for all laparoscopic procedures performed at one practice from 1996 through 2001 were reviewed. RESULTS A total of 352 laparoscopic cases were reviewed. The median age of the patients was 55 years (range, 14-72), with a sex ratio of 1 male to 3.5 females. The left subcostal closed approach was not attempted in 8 patients (2%) due to left subcostal surgical scars. The left subcostal approach was successful in 342 of 344 attempts (99%). In 2 patients the method failed because the Veress needle hole could not be placed in the peritoneal cavity. An omental hematoma in one patient was the only complication. CONCLUSION The left subcostal closed approach is a safe and effective method for creating a pneumoperitoneum.
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Affiliation(s)
- A Rohatgi
- Royal Cornwall Hospital, Treliske, Truro, United Kingdom
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41
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Rohatgi A, Pardasani V, Sharma SK, Gupta AK, Gurtoo A. Louis Bar syndrome. J Assoc Physicians India 2003; 51:286. [PMID: 12839353] [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: 03/03/2023]
Affiliation(s)
- A Rohatgi
- Department of Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi-110 001
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Gupta AK, Rohatgi A. IgA myeloma presenting as diabetes mellitus with refractory anaemia. J Assoc Physicians India 2003; 51:237-8; author reply 238. [PMID: 12725284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Rohatgi A, Cherian T. Spontaneous rupture of a left gastroepiploic artery aneurysm. J Postgrad Med 2002; 48:288-9. [PMID: 12571386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Gastroepiploic aneurysms are extremely rare. They occur mainly in elderly men and in 90% of cases are ruptured at presentation. Visceral aneurysms though rare should be borne in mind in cases of unexplained haemorrhagic shock. We present a case of a 79-year-old man who presented with abdominal pain, hypotension and anaemia but no obvious source of bleeding. He had undergone a prior aorto-bifemoral graft. The patient refused an operation and died the following day.
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Affiliation(s)
- A Rohatgi
- Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK.
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Yadav KK, Rohatgi A, Sharma SK, Kulshrestha M, Sachdeva S, Pardasani V. Oculomotor palsy associated with hepatitis E infection. J Assoc Physicians India 2002; 50:737. [PMID: 12186141] [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: 02/26/2023]
Affiliation(s)
- K K Yadav
- Department of Medicine, Lady Hardinge Medical College, New Delhi
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45
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Chakraborty D, Agarwal CS, Rohatgi A, Ranjan R, Rai D. A case of a destructive lesion of sphenoidal sinus. Indian J Otolaryngol Head Neck Surg 2002; 54:146-7. [PMID: 23119878 DOI: 10.1007/bf02968736] [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: 11/25/2022] Open
Abstract
This interesting case deals with the possible origin of pituitary tumor from cell rests located outside the pituitary gland. In the present case we found an elderly lady presenting with a suspected mass lesion of the sphenoidal sinus, clinically suspected to be either an infective granuloma or a chordoma which finally turned out to be an adenoma of the pituitary gland.
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Affiliation(s)
- D Chakraborty
- Dept. of Neurology, Sir Gangaram Hospital, New Delhi
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46
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Rohatgi A, Houghton PW. Duodenal tamponade in the treatment of an intractable peptic ulcer bleed. Ann R Coll Surg Engl 2001; 83:335-6. [PMID: 11806560 PMCID: PMC2503396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
- A Rohatgi
- Department of Surgery, Torbay Hospital, Torquay, UK
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47
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Rohatgi A, Sachdeva S, Kulshrestha M. An unusual clinical presentation of cobalamine deficiency. J Assoc Physicians India 2001; 49:496. [PMID: 11762639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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48
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Rohatgi A, Monga R, Goyal D. Japanese encephalitis with movement disorder and atypical magnetic resonance imaging. J Assoc Physicians India 2000; 48:834-5. [PMID: 11273482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
With the advent of magnetic resonance imaging, brain lesions associated with Japanese encephalitis are increasingly being recognized and correlated with movement disorder. Bilateral haemorrhagic thalamic infarcts on MRI, suggested as a characteristic finding in Japanese encephalitis were conspicuous by their absence in this case report of Japanese encephalitis.
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Affiliation(s)
- A Rohatgi
- Department of Medicine, Lady Hardinge Medical College and Smt SK Hospital, New Delhi
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Rohatgi A, Kulshrestha M, Sachdeva S. Familial parkinsonism with peripheral neuropathy. J Assoc Physicians India 2000; 48:752-3. [PMID: 11273520] [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: 02/19/2023]
Affiliation(s)
- A Rohatgi
- Department of Medicine, Lady Hardinge Medical College, New Delhi 110 001
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50
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Rohatgi A, Monga R, Goyal D. Metronidazole induced acute confusional agitated state. J Assoc Physicians India 2000; 48:261. [PMID: 11229167] [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: 02/19/2023]
Affiliation(s)
- A Rohatgi
- Department of Medicine, Lady Hardinge Medical College and Smt SK Hospital, New Delhi
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