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Tripathi SH, Min S, Cody AS, Shukla G, Houssein FA, Howard JS, Hu A, Previtera MJ, Phillips KM, Sedaghat AR. Variability in Minimal Clinically Important Difference Calculation and Reporting in the Otolaryngology Literature. Laryngoscope 2024; 134:2059-2069. [PMID: 37933798 DOI: 10.1002/lary.31145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/21/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Best practices for calculation of the minimal clinically important difference (MCID) of outcome measures include the use of complementary methodologies (broadly classified as anchor-based and distribution-based) and reporting of the MCID's predictive ability. We sought to determine MCID calculation and reporting patterns within the otolaryngology literature. METHODS A systematic search strategy of Embase, PubMed, and Web of Science databases was developed and implemented to identify studies reporting the determination of an MCID for an outcome measure. Studies specifically within the otolaryngology literature (defined as journals classified as "otorhinolaryngology" in the Journal Citation Reports database) were included. All those journals were additionally searched for relevant articles. RESULTS There were 35 articles that met the inclusion criteria. Of these studies, 88.6% reported MCID of a patient-reported outcome measure and the remainder were for objective outcome measurements. Anchor-based methods were used by 82.9% of studies and distribution-based methods were used by 68.6% of studies. Of all studies, 31.4% utilized anchor-based methods alone, 17.1% utilized distribution-based methods alone, and 51.4% used both methods. Only 25.7% of studies reported the sensitivity (median: 60.8%, range: 40.5%-86.7%) and specificity (median: 80.4%, range: 63.5%-88.0%) of the MCID to detect patients experiencing clinically important change. CONCLUSION Deviation from best practices in MCID calculation and reporting exists within the otolaryngology literature, with almost half of all studies only using one method of MCID calculation and almost three-quarters not reporting the predictive ability (sensitivity/specificity) of the calculated MCID. When predictive ability is reported, however, MCIDs appear to be more specific than sensitive. LEVEL OF EVIDENCE NA Laryngoscope, 134:2059-2069, 2024.
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Affiliation(s)
- Siddhant H Tripathi
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Susie Min
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Alexander S Cody
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Geet Shukla
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Firas A Houssein
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - John S Howard
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Alex Hu
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Melissa J Previtera
- Health Sciences Library, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
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Shukla G, Matur AV, Tao X, Khalid S, Garner R, Gibson J, Cass D, Wu A, Street S, Garcia-Vargas J, Mehta J, Childress K, Duah HO, Motley B, Cheng J, Adogwa O. Synthetic Interbody Devices and Traditional Bone Graft Are Associated With a Similar Rate of Surgical Complications After 1-2 Level Anterior Cervical Discectomy and Fusions. Spine (Phila Pa 1976) 2024; 49:615-620. [PMID: 37661823 DOI: 10.1097/brs.0000000000004819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare the rates of all-cause surgical complications of synthetic interbody devices versus allograft or autograft in patients undergoing 1-2 levels anterior cervical discectomy and fusion (ACDF) procedures. SUMMARY OF BACKGROUND DATA Cervical degenerative disorders affect up to 60% of older adults in the United States. Both traditional allograft or autograft and synthetic interbody devices (polyetheretherketone or titanium) are used for decompression and arthrodesis, with increasing utilization of the latter. However, the differences in their postsurgical complication profiles are not well-characterized. PATIENTS AND METHODS Patients who underwent 1-2 level ACDFs for cervical radiculopathy or myelopathy between 2010 and 2022 were identified using the PearlDiver Mariner all-claims insurance database. Patients undergoing surgery for nondegenerative pathologies, such as tumors, trauma, or infection, were excluded. 1:1 exact matching was performed based on factors that were significant predictors of all-cause surgical complications in a linear regression model. The primary outcome measure was the development of all-cause surgical complications after 1-2 level ACDFs. The secondary outcome was all-cause medical complications. RESULTS 1:1 exact matching resulted in two equal groups of 11,430 patients who received treatment with synthetic interbody devices or allograft/autograft. No statistically significant difference in all-cause surgical complications was found between the synthetic cohort and the allograft or autograft cohort after 1-2 level ACDFs (Relative Risk: 0.86, 95% confidence interval: 0.730-1.014, P = 0.079). No significant differences were observed regarding any specific surgical complications except for pseudoarthrosis (Relative Risk: 0.73, 95% confidence interval: 0.554-0.974, P = 0.037), which was higher in the allograft/autograft cohort. CONCLUSION After 1:1 exact matching to control for confounding variables, the findings of this study suggest that all-cause surgical complications are similar in patients undergoing ACDFs with synthetic interbody devices or allograft/autographs. However, the rate of pseudarthrosis appears to be higher in patients with allograft/autographs. Future prospective studies are needed to corroborate these findings.
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Affiliation(s)
- Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Syed Khalid
- Department of Neurosurgery, University of Illinois, Chicago, IL
| | - Rebecca Garner
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Seth Street
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jay Mehta
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Henry O Duah
- Institute for Nursing Research and Scholarship, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Tao X, Matur AV, Khalid S, Shukla G, Vorster P, Childress K, Garner R, Gibson J, Cass D, Mejia Munne JC, McGrath K, Ivey N, Garcia-Vargas J, Wu A, Street S, Mehta J, Onyewadume L, Duah HO, Motley B, Cheng JS, Adogwa O. Cannabis Use is Associated With Higher Rates of Pseudarthrosis Following TLIF: A Multi-Institutional Matched-Cohort Study. Spine (Phila Pa 1976) 2024; 49:412-418. [PMID: 37417709 DOI: 10.1097/brs.0000000000004768] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE To compare the rates of pseudarthrosis in patients undergoing 1 to 3 level transforaminal lumbar interbody fusion (TLIF) procedures between cannabis users and noncannabis users. SUMMARY OF BACKGROUND DATA Recreational use of cannabis is common, though it remains poorly studied and legally ambiguous in the United States. Patients with back pain may turn to adjunctive use of cannabis to manage their pain. However, the implications of cannabis use on the achievement of bony fusion are not well-characterized. METHODS Patients who underwent 1 to 3 level TLIF for degenerative disc disease or degenerative spondylolisthesis between 2010 and 2022 were identified using the PearlDiver Mariner all-claims insurance database. Cannabis users were identified with ICD 10 code F12.90. Patients undergoing surgery for nondegenerative pathologies such as tumors, trauma, or infection were excluded. 1:1 exact matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with pseudarthrosis in a linear regression model. The primary outcome measure was development of pseudarthrosis within 24 months after 1 to 3 level TLIF. The secondary outcomes were the development of all-cause surgical complications as well as all-cause medical complications. RESULTS A 1:1 exact matching resulted in two equal groups of 1593 patients who did or did not use cannabis and underwent 1 to 3 level TLIF. Patients who used cannabis were 80% more likely to experience pseudarthrosis compared with patients who do not [relative risk (RR): 1.816, 95% CI: 1.291-2.556, P <0.001]. Similarly, cannabis use was associated with significantly higher rates of all-cause surgical complications (RR: 2.350, 95% CI: 1.399-3.947, P =0.001) and all-cause medical complications (RR: 1.934, 95% CI: 1.516-2.467, P <0.001). CONCLUSION After 1:1 exact matching to control for confounding variables, the findings of this study suggest that cannabis use is associated with higher rates of pseudarthrosis, as well as higher rates of all-cause surgical and all-cause medical complications. Further studies are needed to corroborate our findings.
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Affiliation(s)
- Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Syed Khalid
- University of Texas Southwestern Medical School, Dallas, TX
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rebecca Garner
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Juan C Mejia Munne
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kyle McGrath
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Natalie Ivey
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Seth Street
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jay Mehta
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Louisa Onyewadume
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, MA
| | - Henry O Duah
- Institute of Nursing Research, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph S Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Wu A, Matur AV, Childress K, Khalid S, Garner RM, Vorster P, Tao X, Shukla G, Onyewadume L, Motley B, Virojanapa J, Cheng JS, Adogwa O. Ehlers-Danlos Syndrome is Associated with Increased Rates of Adjacent Segment Disease Following TLIF: A Propensity Matched Study. World Neurosurg 2024; 183:e51-e58. [PMID: 37925152 DOI: 10.1016/j.wneu.2023.10.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Ehlers-Danlos syndrome (EDS) is a collection of connective tissue disorders which are often associated with tissue laxity and disc degeneration. However, the implications of EDS on the risk of adjacent segment disease (ASD) after transforaminal lumbar interbody fusion (TLIF) are not well described. The objective of this study is to compare the rates of ASD among patients with EDS and those without EDS. METHODS Patients who underwent 1-3 level TLIF for degenerative disc disease between 2010-2022 were identified using the PearlDiver Mariner all-claims insurance database. Patients with all types of EDS were included. Patients undergoing surgery for tumors, trauma, or infection were excluded. 1:1 propensity matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with ASD in a linear regression model. The primary outcome measure was the development of ASD. The secondary outcomes were the development of pseudoarthrosis, medical complications, and surgical complications. RESULTS Propensity matching resulted in 2 equal groups of 85 patients who did or did not have EDS and underwent 1-3 level TLIF. Patients without EDS were less likely to experience ASD (RR 0.18, 95% CI 0.09-0.35, P < 0.001). There was no significant difference between the 2 patient groups with regards to a diagnosis of pseudoarthrosis, and there was no significant difference for all-cause medical and surgical complications between the 2 patient groups. CONCLUSIONS After propensity matching to control for confounding variables, the findings of this study suggest that EDS may be associated with an increased risk of ASD following TLIF. Future studies are needed to corroborate these findings.
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Affiliation(s)
- Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Syed Khalid
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Rebecca M Garner
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Louisa Onyewadume
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Justin Virojanapa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joseph S Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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5
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Street S, Matur AV, Tao X, Shukla G, Garcia-Vargas J, Mehta J, Childress K, Gibson J, Cass D, Wu A, Duah HO, Motley B, Webb D, Cheng J, Adogwa O. Correlation Between Rod Fracture and Shear Stress: A Novel Parameter. World Neurosurg 2024; 183:e268-e275. [PMID: 38128759 DOI: 10.1016/j.wneu.2023.12.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND We sought to assess the accuracy of a novel parameter proportional to the rod shear stress (RSS) in identifying patients at risk of rod fracture (RF) after surgery for correction of adult spinal deformity. METHODS We performed a retrospective medical record review of patients aged ≥18 years treated for adult spinal deformity between 2004 and 2014 with ≥24 months of follow-up. The primary outcome was RFs identified radiographically. Patient weight (w), number of instrumented levels (N), and minimum rod diameter (d) were recorded and used to calculate the RSS parameter (RSS=Nwd2). Receiver operating characteristic curves were produced and the area under the curve (AUC ± 95% confidence interval [CI]) was calculated to compare this parameter's discriminative accuracy to that of its constituent variables. The sensitivity, specificity, and likelihood ratios (LRs) were calculated. RESULTS A total of 28 RF-positive and 154 RF-negative patients were included. The average age was 59.2 ± 9.6 years, and 93.4% were women. The RSS parameter produced the greatest AUC (0.73 ± 0.11). At an RSS cutoff of 30.1, it achieved a sensitivity of 71.4% and specificity of 71.4% (LR, 2.5; 95% CI, 1.8-3.5). The number of instrumented levels produced the next-greatest AUC (0.65 ± 0.12), with a sensitivity of 78.6% and specificity of 50.0% at a cutoff of 15 (LR, 1.6; 95% CI, 1.2-2.0). CONCLUSIONS The RSS is calculated using easily obtainable information and shows potential as a tool for predicting patient-specific risk of RF after spinal fusion. The number of instrumented levels also correlates strongly with the occurrence of RFs and is not significantly less accurate than the RSS. A larger sample size and prospective validation would be useful in determining with greater confidence which parameter is superior for predicting RFs after spinal fusion.
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Affiliation(s)
- Seth Street
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jay Mehta
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Henry O Duah
- Institute for Nursing Research and Scholarship, University of Cincinnati College of Nursing, Cincinnati, Ohio, USA
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel Webb
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Shah K, Ghosh J, Patel S, Chowdhuri MB, Jadeja KA, Shukla G, Macwan T, Kumar A, Dolui S, Singh K, Tanna RL, Patel KM, Dey R, Manchanda R, Ramaiya N, Kumar R, Aich S, Yadava N, Purohit S, Gupta MK, Nagora UC, Pathak SK, Atrey PK, Mayya KBK. Author Correction: Role of pinch in Argon impurity transport in ohmic discharges of Aditya-U Tokamak. Sci Rep 2023; 13:19969. [PMID: 37968383 PMCID: PMC10651834 DOI: 10.1038/s41598-023-47362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India.
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India.
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India.
| | - S Patel
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Department of Nano Science and Advanced Materials, Saurashtra University, Rajkot, 360 005, India
| | - G Shukla
- ITER-India, Institute for Plasma Research, Koteshwar, Ahmedabad, 380 005, India
| | - T Macwan
- University of California, Los Angeles, CA, 90095, USA
| | - A Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S Dolui
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - K Singh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Dey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - S Aich
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Yadava
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - S Purohit
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - M K Gupta
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - U C Nagora
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S K Pathak
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - P K Atrey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
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Shukla G, Parks K, Smith DW, Hartings JA. Impact of Hypo- and Hyper-capnia on Spreading Depolarizations in Rat Cerebral Cortex. Neuroscience 2023; 530:46-55. [PMID: 37640133 DOI: 10.1016/j.neuroscience.2023.08.029] [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: 06/19/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
Patients with traumatic brain injury are typically maintained at low-normal levels of arterial partial pressure of carbon dioxide (PaCO2) to counteract the risk of elevated intracranial pressure during intensive care. However, several studies suggest that management at hypercarbic levels may have therapeutic benefit. Here we examined the impact of CO2 levels on spreading depolarizations (SD), a mechanism and marker of acute lesion development in stroke and brain trauma. In an acute preparation of mechanically ventilated (30/70 O2/N2) female rats, SDs were evoked by cortical KCl application and monitored by electrophysiology and laser doppler flowmetry; CO2 levels were adjusted by ventilator settings and supplemental CO2. During 90 min of KCl application, rats were maintained at hypocapnia (end-tidal CO2 22 ± 2 mmHg) or hypercapnia (57 ± 4 mmHg) but did not differ significantly in arterial pH (7.31 ± 0.10 vs. 7.22 ± 0.08, p = 0.31) or other variables. Surprisingly, there was no difference between groups in the number of SDs recorded (10.7 ± 4.2 vs. 11.7 ± 3.1; n = 3 rats/group; p = 0.75) nor in SD durations (64 ± 27 vs. 69 ± 37 sec, p = 0.54). In separate experiments (n = 3), hypoxia was induced by decreasing inhaled O2 to 10% and single SDs were induced under interleaved conditions of hypo-, normo-, and hypercapnia. No differences in SD duration were observed. In both normoxia and hypoxia experiments, however, mean arterial pressures were negatively correlated with SD durations (normoxia R2 = -0.29; hypoxia R2 = -0.61, p's < 0.001). Our results suggest that any therapeutic benefit of elevated CO2 therapy may be dependent on an acidic shift in pH or may only be observed in conditions of focal brain injury.
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Affiliation(s)
- Geet Shukla
- University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Ken Parks
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | | | - Jed A Hartings
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
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Tao X, Matur AV, Khalid S, Onyewadume L, Garner R, McGrath K, Owen B, Gibson J, Cass D, Mejia Munne JC, Vorster P, Shukla G, Gupta S, Wu A, Childress K, Palmisciano P, Duah HO, Motley B, Cheng J, Adogwa O. TLIF is Associated With Lower Rates of Adjacent Segment Disease and Complications Compared to ALIF: A Matched-Cohort Analysis. Spine (Phila Pa 1976) 2023; 48:1335-1341. [PMID: 37146059 DOI: 10.1097/brs.0000000000004694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/10/2023] [Indexed: 05/07/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare the rate of adjacent segment disease (ASD) in patients undergoing anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF) for the treatment of degenerative stenosis and spondylolisthesis. SUMMARY OF BACKGROUND DATA ALIF and TLIF are frequently used to treat Lumbar stenosis and spondylolisthesis. While both approaches have distinct advantages, it is unclear whether there are any differences in rates of ASD and postoperative complications. METHODS A retrospective cohort study of patients who underwent index 1-3 levels ALIF or TLIF between 2010 and 2022, using the PearlDiver Mariner Database, an all-claims insurance database (120 million patients). Patients with a history of prior lumbar surgery and those undergoing surgery for cancer, trauma, or infection were excluded. Exact 1:1 matching was performed using demographic factors, medical comorbidities, and surgical factors found to be significantly associated with ASD in a linear regression model. The primary outcome was a new diagnosis of ASD within 36 months of index surgery, and secondary outcomes were all-cause medical and surgical complications. RESULTS Exact 1:1 matching resulted in 2 equal groups of 106,451 patients undergoing TLIF and ALIF. The TLIF approach was associated with a lower risk of ASD (RR 0.58, 95% CI 0.56-0.59, P < 0.001) and all-cause medical complications (RR 0.94, 95% CI 0.91-0.98, P =0.002). All-cause surgical complications were not significantly different between both groups. CONCLUSION After 1:1 exact matching to control for confounding variables, this study suggests that for patients with symptomatic degenerative stenosis and spondylolisthesis, a TLIF procedure (compared to ALIF) is associated with a decreased risk of developing ASD within 36 months of index surgery. Future prospective studies are needed to corroborate these findings. LEVEL OF EVIDENCE Level-3.
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Affiliation(s)
- Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Syed Khalid
- Department of Neurosurgery, University of Illinois College of Medicine, Chicago, IL
| | - Louisa Onyewadume
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, MA
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Rebecca Garner
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kyle McGrath
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Bryce Owen
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Juan C Mejia Munne
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sahil Gupta
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Henry O Duah
- Institute for Nursing Research & Scholarship, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Tao X, Matur AV, Shukla G, Adogwa O. Response to Letter to the Editor Regarding "Preoperative HbA1c and Postoperative Outcomes in Spine Surgery: A Systematic Review and Meta-Analysis". Spine (Phila Pa 1976) 2023; 48:E340. [PMID: 37259200 DOI: 10.1097/brs.0000000000004739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Shah K, Ghosh J, Patel S, Chowdhuri MB, Jadeja KA, Shukla G, Macwan T, Kumar A, Dolui S, Singh K, Tanna RL, Patel KM, Dey R, Manchanda R, Ramaiya N, Kumar R, Aich S, Yadava N, Purohit S, Gupta MK, Nagora UC, Pathak SK, Atrey PK, Mayya KBK. Role of pinch in Argon impurity transport in ohmic discharges of Aditya-U Tokamak. Sci Rep 2023; 13:16087. [PMID: 37752170 PMCID: PMC10522584 DOI: 10.1038/s41598-023-42746-2] [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: 05/28/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
We present experimental results of the trace argon impurity puffing in the ohmic plasmas of Aditya-U tokamak performed to study the argon transport behaviour. Argon line emissions in visible and Vacuum Ultra Violet (VUV) spectral ranges arising from the plasma edge and core respectively are measured simultaneously. During the experiments, space resolved brightness profile of Ar1+ line emissions at 472.69 nm (3p44s 2P3/2-3p44p 2D3/2), 473.59 nm (3p44s 4P5/2-3p44p 4P3/2), 476.49 nm (3p44s 2P1/2-3p44p 2P3/2), 480.60 nm (3p44s 4P5/2-3p44p 4P5/2) are recorded using a high resolution visible spectrometer. Also, a VUV spectrometer has been used to simultaneously observe Ar13+ line emission at 18.79 nm (2s22p 2P3/2-2s2p2 2P3/2) and Ar14+ line emission at 22.11 nm (2s2 1S0-2s2p 1P1). The diffusivity and convective velocity of Ar are obtained by comparing the measured radial emissivity profile of Ar1+ emission and the line intensity ratio of Ar13+ and Ar14+ ions, with those simulated using the impurity transport code, STRAHL. Argon diffusivities ~ 12 m2/s and ~ 0.3 m2/s have been observed in the edge (ρ > 0.85) and core region of the Aditya-U, respectively. The diffusivity values both in the edge and core region are found to be higher than the neo-classical values suggesting that the argon impurity transport is mainly anomalous in the Aditya-U tokamak. Also, an inward pinch of ~ 10 m/s mainly driven by Ware pinch is required to match the measured and simulated data. The measured peaked profile of Ar density suggests impurity accumulation in these discharges.
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Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India.
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India.
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India.
| | - S Patel
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Department of Nano Science and Advanced Materials, Saurashtra University, Rajkot, 360 005, India
| | - G Shukla
- ITER-India, Institute for Plasma Research, Koteshwar, Ahmedabad, 380 005, India
| | - T Macwan
- University of California, Los Angeles, CA, 90095, USA
| | - A Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S Dolui
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - K Singh
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Dey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - R Kumar
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - S Aich
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - N Yadava
- Institute of Science, Nirma University, Ahmedabad, 382 481, India
| | - S Purohit
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - M K Gupta
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - U C Nagora
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - S K Pathak
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400 094, India
| | - P K Atrey
- Institute for Plasma Research, Bhat, Gandhinagar, 382 428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382 007, India
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Tao X, Matur AV, Street S, Shukla G, Garcia-Vargas J, Mehta J, Childress K, Duah HO, Gibson J, Cass D, Wu A, Motley B, Cheng J, Adogwa O. No Difference in Surgical Outcomes between Stand-Alone Devices and Anterior Plating for 1-2 level Anterior Cervical Discectomy and Fusion: A 1:1 Exact Matched Analysis. Spine (Phila Pa 1976) 2023:00007632-990000000-00452. [PMID: 37661800 DOI: 10.1097/brs.0000000000004813] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE Compare rates of all-cause surgical and medical complications between zero-profile (stand-alone) implants versus any graft type with anterior plate in patients undergoing 1-2 level anterior cervical discectomy and fusion (ACDF) for treatment of degenerative cervical myeloradiculopathy. SUMMARY OF BACKGROUND DATA Degenerative cervical myeloradiculopathy is increasingly prevalent in older adults. ACDF is a common surgical procedure for decompression of neural structures and stabilization and has been shown to have excellent outcomes. While ACDFs performed with a graft and plate has been the gold standard, more recently, zero-profile implants were developed to decrease implant related complications, such as severe postoperative dysphagia. However, there is a paucity of papers comparing the surgical and medical complications profile of zero-profile (stand-alone) implants to grafts with plating systems. METHODS Data was extracted from the PearlDiver Mariner Database using CPT codes to classify patients into 1-level, 2-levels, and total 1-2 level ACDFs. Patients undergoing surgery for non-degenerative pathologies such as tumors, trauma, or infection were excluded. RESULTS 1:1 exact matching created two equal groups of 7,284 patients that underwent 1-2 level ACDF with either grafting with a plate or zero-profile (standalone) implant. There were no statistically significant difference in all-cause surgical complications, pseudarthrosis rate, dysphagia or need for revision surgery between both cohorts (RR 0.99, 95% CI 0.80-1.21, P = 0.95). Additionally, all-cause medical complications were similar between both cohorts (RR 1.07, 95% CI 0.862-1.330, P = 0.573) or any specific surgical or medical complication included in this study. CONCLUSION After 1:1 exact matching, the results of this study suggest that zero-profile (stand-alone) implants have similar outcomes compared to grafts with plating systems, with no observed differences in all-cause surgical or medical complications profile.
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Affiliation(s)
- Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Seth Street
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jay Mehta
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Henry O Duah
- Institute for Nursing Research & Scholarship, University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Gupta S, Tao X, Matur AV, Wu A, Chilakapati SS, Palmisciano P, Conteh FS, Duah HO, Shukla G, Vorster P, Garcia-Vargas J, Kwan D, Adogwa O. Bariatric Surgery Before Spine Surgery is Associated With Fewer Postsurgical Complications: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2023; 48:944-949. [PMID: 37075380 DOI: 10.1097/brs.0000000000004682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/29/2023] [Indexed: 04/21/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To perform a systematic review and meta-analysis investigating the rate of adverse events after spine surgery in patients who underwent bariatric surgery (BS). SUMMARY OF BACKGROUND DATA Obesity is an established risk factor for postoperative complications after spine surgery. BS has been associated with improvements in health in patients with severe obesity. However, it is not known whether undergoing BS before spine surgery is associated with reduced adverse outcomes. MATERIALS AND METHODS PubMed, EMBASE, Scopus, and Web-of-Science were systematically searched according to "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. The search included indexed terms and text words from database inception to the date of the search (May 27, 2022). Data and estimates were pooled using the Mantel-Haenszel method for random-effects meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute risk of bias tool. The primary outcome was an all-cause complication rate after surgery. Relative risks for surgical and medical complications were assessed. RESULTS A total of 4 studies comprising 177,273 patients were included. The pooled analysis demonstrated that the all-cause medical complication rate after spine surgery was lower in patients undergoing BS (relative risk: 0.54, 95% CI: 0.39, 0.74, P < 0.01). There was no difference in rates of surgical complications and 30-day hospital readmission rates between the cohort undergoing BS before spine surgery and the cohort that did not. CONCLUSION These analyses suggest that obese patients undergoing BS before spine surgery have significantly lower adverse event rates. Future prospective studies are needed to corroborate these findings. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Sahil Gupta
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Fatu S Conteh
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Henry O Duah
- Institute of Nursing Research, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - David Kwan
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Tao X, Matur AV, Palmisciano P, Conteh FS, Onyewadume L, Duah HO, Shukla G, Vorster P, Gupta S, Chilakapati SS, Adogwa O. Preoperative HbA1c and Postoperative Outcomes in Spine Surgery: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2023:00007632-990000000-00342. [PMID: 37146102 DOI: 10.1097/brs.0000000000004703] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/28/2022] [Indexed: 05/07/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To perform a systematic review and meta-analysis of previous studies on HbA1c in preoperative risk stratification in patients undergoing spinal procedures and provide an overview of the consensus recommendations. SUMMARY OF BACKGROUND DATA Diabetes mellitus (DM) and hyperglycemia have been shown to be independent risk factors for increased surgical complications. Glycated Hemoglobin A1C (HbA1c), a surrogate for long term glycemic control, is an important preoperative parameter that may be optimized to reduce surgical complications and improve patient-reported outcomes. However, comprehensive systematic reviews on preoperative HbA1c and postoperative outcomes in spine surgery have been limited. METHODS We systematically searched PubMed, EMBASE, Scopus, and Web-of-Science for English-language studies from inception through April 5th, 2022, including references of eligible articles. The search was conducted according to PRISMA guidelines. Only studies in patients undergoing spine surgery with preoperative HbA1c values and postoperative outcomes available were included. RESULTS A total of 22 articles (18 retrospective cohort studies, 4 prospective observational studies) were identified with level of evidence III or greater. The majority of studies (n=17) found that elevated preoperative HbA1c was associated with inferior outcomes or increased risk of complications. Random-effect meta-analysis demonstrated that patients with preoperative HbA1c >8.0% had increased risk(s) of postoperative complications (RR: 1.85, 95% CI: [1.48, 2.31], P<0.01) and that patients with surgical site infection (SSI) had higher preoperative HbA1c (Mean Difference: 1.49%, 95% CI: [0.11, 2.88], P=0.03). CONCLUSION The findings of this study suggest that HbA1c >8.0% is associated with an increased risk of complications. HbA1c was higher by 1.49% on average among patients with SSI when compared to patients who did not experience SSI. These results suggest that elevated HbA1c is associated with less favorable outcomes following spine surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abhijith V Matur
- Department of Radiology, University of Kentucky, Lexington, KY, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Fatu S Conteh
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Louisa Onyewadume
- Department of Neurosurgery, Ruby Memorial Hospital, Morgantown, WV, USA
| | - Henry O Duah
- Department of Nursing Research, University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sahil Gupta
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Shukla G, Parks K, Hartings J. 133 Evaluating the Neuroprotectivity of Hypercapnia on Spreading Depolarizations. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Min S, Zhang G, Hu A, Petito G, Tripathi S, Shukla G, Kumar A, Shah S, Phillips K, Forbes JA, Zuccarello M, Andaluz N, Sedaghat AR. A comprehensive analysis of tobacco smoking history as a risk for outcomes after endoscopic transsphenoidal resection of pituitary adenoma. J Neurol Surg B Skull Base 2023. [DOI: 10.1055/a-2043-0263] [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: 02/27/2023] Open
Abstract
Objectives: This study seeks to comprehensively analyze the impact of smoking history on outcomes after endoscopic transsphenoidal hypophysectomy (TSH) for pituitary adenoma.
Design: Retrospective.
Setting: Tertiary care center.
Participants: 398 adult patients undergoing TSH for a pituitary adenoma.
Main outcome measures: Clinical and tumor characteristics and operative factors were collected. Patients were categorized as never, former, or active smokers, and the pack-years of smoking history was collected. Years since cessation of smoking was obtained for former smokers. Specific outcomes included post-operative CSF leak, length of hospitalization, 30-day return to the operating room, and 30-day readmission. Smoking history details were comprehensively analyzed for association with outcomes.
Results: Any history of smoking tobacco was associated with return to the operating room (OR=2.67, 95%CI: 1.05–6.76, p=0.039), which was for persistent CSF leak in 58.3%. Among patients with post-operative CSF leak, any history of smoking was associated with need for return to the operating room to repair the CSF leak (OR=5.25, 95%CI: 1.07–25.79, p=0.041). Pack-years of smoking was positively associated with a return to the operating room (OR=1.03, 95%CI: 1.01–1.06, p=0.048). In all multivariable models, all negative outcomes were significantly associated with the covariate occurrence of intra-operative CSF leak.
Conclusion: This is the first study to show smoking may have a negative impact on healing of CSF leak repairs after TSH, requiring a return to the operating room. This effect appears to be dose-dependent on the smoking history. Secondarily, intra-operative CSF leak as covariate in multivariable models was significantly associated with all negative outcomes.
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Affiliation(s)
- Susie Min
- University of Cincinnati College of Medicine, Cincinnati, United States
| | - Grace Zhang
- University of Cincinnati College of Medicine, Cincinnati, United States
| | - Alex Hu
- University of Cincinnati College of Medicine, Cincinnati, United States
| | - Gabrielle Petito
- University of Cincinnati College of Medicine, Cincinnati, United States
| | - Siddhant Tripathi
- University of Cincinnati College of Medicine, Cincinnati, United States
| | - Geet Shukla
- University of Cincinnati College of Medicine, Cincinnati, United States
| | - Adithya Kumar
- University of Cincinnati College of Medicine, Cincinnati, United States
| | - Sanjit Shah
- University of Cincinnati College of Medicine, Cincinnati, United States
| | - Katie Phillips
- University of Cincinnati College of Medicine, Cincinnati, United States
| | | | - Mario Zuccarello
- Neurosurgery, University of Cincinnati, Cincinnati, United States
| | - Norberto Andaluz
- Neurosurgery, University of Cincinnati Medical Center, Cincinnati, United States
| | - Ahmad R Sedaghat
- University of Cincinnati College of Medicine, Cincinnati, United States
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Charlesworth L, Winston G, Boissé Lomax L, Driver H, Shukla G. Periodic limb movements among persons with epilepsy – a retrospective polysomnography study. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.622] [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: 11/16/2022]
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Shukla G, Chowdhuri MB, Shah K, Manchanda R, Ramaiya N, Tanna RL, Mayya KBK, Ghosh J. Impurity toroidal rotation profile measurement using upgraded high-resolution visible spectroscopic diagnostic on ADITYA-U tokamak. Rev Sci Instrum 2021; 92:063517. [PMID: 34243548 DOI: 10.1063/5.0043789] [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] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/28/2021] [Indexed: 06/13/2023]
Abstract
A high-resolution spectroscopic diagnostic for the measurement of spatial profiles of impurity ion toroidal rotation velocities on the ADITYA-U tokamak has been upgraded to cover the complete plasma minor radius. Earlier, the coverage of diagnostics toward the plasma edge was restricted due to the placement of collection optics on the tangential port outside the vacuum vessel. The coverage of the full plasma minor radius, from 0 to 24 cm, has been achieved using the newly designed and developed collection optics that have seven lines of sight to view the tokamak plasma mounted inside a customized re-entrant view port which is installed in the shadow of the limiter inside the vacuum vessel. The upgraded diagnostic also includes a faster charged coupled device detector with a smaller pixel size for the detection of a small wavelength shift. The complete spatial profile has been measured using the Doppler shifted passive change exchange spectral line at 529.0 nm from the C5+ ion. In this article, we present the collection optics' design, installation, calibration, and results obtained using the upgraded diagnostic.
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Affiliation(s)
- G Shukla
- Department of Science, Pandit Deendayal Petroleum University, Gandhinagar 382 007, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K Shah
- Department of Science, Pandit Deendayal Petroleum University, Gandhinagar 382 007, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K B K Mayya
- Department of Science, Pandit Deendayal Petroleum University, Gandhinagar 382 007, India
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
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Shah K, Ghosh J, Shukla G, Chowdhuri MB, Manchanda R, Yadava N, Ramaiya N, Jadeja KA, Patel KM, Tanna RL, Mayya KBK. Observations of visible argon line emissions and its spatial profile from Aditya-U tokamak plasma. Rev Sci Instrum 2021; 92:053548. [PMID: 34243287 DOI: 10.1063/5.0043877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/07/2021] [Indexed: 06/13/2023]
Abstract
The spectroscopic studies of medium and high Z impurities have been the subject of interest in fusion research due to their role in mitigating plasma disruption and reducing heat load on the plasma facing components. Line emissions from these impurities provide the rotation velocity and ion temperature measurements along with the understanding of the overall impurity behavior in plasma. In the Aditya-U tokamak, the spatially resolved Ar II line emissions have been observed using a high resolution multi-track spectroscopic diagnostic consisting of a 1 m Czerny-Turner spectrometer coupled with a charge coupled device (CCD) detector using seven lines of sight viewing plasma tangentially along the toroidal direction. The spatially resolved Ar II lines at 458.96 nm have been observed. The singly ionized Ar emission peaks at the radial location of ρ = 0.8 of the plasma having a minor radius of 25 cm. Moreover, a 0.5 m UV-visible spectrometer coupled with a CCD detector and having a line of sight passing through the plasma midplane from the radial port was used to record visible Ar survey spectra within the 670-810 nm wavelength range, and all these lines have been identified for further analysis.
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Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - G Shukla
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - N Yadava
- The National Institute of Engineering, Mysuru 570 008, Karnataka, India
| | - N Ramaiya
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K M Patel
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - R L Tanna
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
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Gupta A, Shukla G, Poornima S, Mohd A, Katoch J, Taneja D, Singhal N. 0969 Early Life Sleep Disturbance Among Children With Autism Spectrum Disorders: A Questionnaire-based Retrospective Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Autism spectrum disorders(ASD) and sleep has hand to hand relationship and few recently published studies have shown that, disturbed infant sleep is associated with Attention deficit hyperactive disorder and Autism. The aim of the study is to evaluate the sleep disturbance in first year of life among the children with ASD.
Methods
In this case control study, pre-diagnosed ASD children between 3-12 year of age (group 1) and controls; sibling of autistic children and community dwelling children(group 2), were enrolled in between June 2014 to November 2017. After giving consent every child underwent, Detailed Clinical [Childhood Autism rating scale-2(CARS-2)] and Sleep evaluation [Brief Infant sleep Questionnaire (BISQ) - Retrospectively, Child sleep habits questionnaire (CSHQ)].
Results
Sixty children in group1 and 60 in group 2 were enrolled and both groups were age [Median 7(2.5-12) vs. 8.5 (2.5-12), p = 0.14] and sex [53(88.33%) vs. 45(75.00 %), p=0.15] matched. On CHSQ poor sleepers are more common among the group 1[40(66.66%) vs. 20(33.33%), p=.003, respectively]. On BISQ children had severe sleep problems during infancy were significantly more among the group 1 [46(76.66%) vs. 6(10%), p=<.001, respectively]. Duration of nocturnal awakening was significantly correlated (r=0.87, p=.001) with the T score of the CARS-2.
Conclusion
Sleep is significantly disturbed since infancy among children with autism spectrum disorder and duration of nocturnal awakenings during infancy is strongly correlated with severity of autism.
Support
NA
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Affiliation(s)
- A Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, New Delhi, INDIA
| | - G Shukla
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, New Delhi, INDIA
| | - S Poornima
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, New Delhi, INDIA
| | - A Mohd
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, New Delhi, INDIA
| | - J Katoch
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, New Delhi, INDIA
| | - D Taneja
- Action for Autism, New Delhi, INDIA
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Gupta A, Shukla G, Srivastava A, Singh M, Mohammed A, Poornima S. Cognitive phenotypes of patients with temporal lobe epilepsy: sleep may have its own role to play. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Gupta A, Shukla G, Sharma G, Roy A, Bhargava B, Goyal V, Behari M, Vivekanandhan S. Is the obstructive sleep apnea phenotype in stroke different from that in refractory hypertension? Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.384] [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: 11/25/2022]
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22
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Garg D, Kumar AS, Kumar AJ, Rajan R, Kishor AP, Vibha D, Shukla G, Mohan RP, Prasad K. Autonomic symptoms do not correlate with motor severity in multiple system atrophy subtypes. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Shah K, Chowdhuri MB, Shukla G, Manchanda R, Mayya KBK, Jadeja KA, Pablant NA, Ghosh J. Design of tangential x-ray crystal spectrometer for Aditya-U tokamak. Rev Sci Instrum 2018; 89:10F115. [PMID: 30399683 DOI: 10.1063/1.5039359] [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] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
A tangential soft x-ray crystal spectrometer has been designed to measure the x-ray spectrum of He-like argon for the Aditya-U tokamak plasma. The system enables to measure electron temperature using the intensity ratio of the resonance line to the satellite line. For this purpose, an x-ray spectral line at 3.9494 Å from He-like argon, Ar16+, is considered. The spectrometer consists of a cylindrically bent silicon (111) crystal and a CCD detector to measure the resonance spectral line and its satellite lines in the wavelength region of 3.94-4.0 Å, viewing the plasma tangentially at an angle of 26° with respect to the toroidal direction in the magnetic axis. Considering Aditya-U tokamak plasma parameters and its geometrical constraints, plasma to crystal and crystal to detector distances have been kept at 1.47 m and 0.5 m, respectively, to detect a sufficient signal. The engineering design has been optimized after adequately addressing the issues related to port geometry and machine accessibility. Details on the design of the crystal spectrometer are presented in this paper.
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Affiliation(s)
- K Shah
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - G Shukla
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - K B K Mayya
- Department of Physics, Pandit Deendayal Petroleum University, Raisan, Gandhinagar 382421, India
| | - K A Jadeja
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
| | - N A Pablant
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382428, India
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Shukla G, Chowdhuri MB, Shah K, Manchanda R, Mayya KBK, Ghosh J. Plasma rotation measurement using UV and visible spectroscopy on Aditya-U tokamak. Rev Sci Instrum 2018; 89:10D132. [PMID: 30399770 DOI: 10.1063/1.5039333] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/12/2018] [Indexed: 06/08/2023]
Abstract
A high resolution spectroscopic diagnostic for the measurement of the spatial profile of toroidal rotation velocity (vt) and temperature (Ti) of carbon ions has been developed and implemented on the Aditya-U tokamak. The diagnostic consists of a high resolution 1 m (f/8.7) spectrometer having an 1800 grooves/mm grating coupled with a charged couple device. The setup allows measurements from 5 toroidal lines-of-sights passing through different minor radii in the horizontal mid-plane of the Aditya-U tokamak. The carbon line emissions at 529 nm in visible and 229.6 and 227.09 nm in the ultra violet spectral range are recorded using the setup. Initial results show that typical Aditya-U plasmas have a maximum carbon ion temperature (Ti) of ∼120 eV and a rotation velocity (vt) of ∼-14 km/s in the counter plasma-current direction.
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Affiliation(s)
- G Shukla
- Department of Science, Pandit Deendayal Petroleum University, Gandhinagar 382 421, India
| | - M B Chowdhuri
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K Shah
- Department of Science, Pandit Deendayal Petroleum University, Gandhinagar 382 421, India
| | - R Manchanda
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
| | - K B K Mayya
- Department of Science, Pandit Deendayal Petroleum University, Gandhinagar 382 421, India
| | - J Ghosh
- Institute for Plasma Research, Bhat, Gandhinagar 382 428, India
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Radhakrishnan DM, Goyal V, Shukla G. Nocardia: a rare cause of brain abscess. QJM 2018; 111:561-562. [PMID: 29660069 DOI: 10.1093/qjmed/hcy073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 03/31/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - V Goyal
- From the Department of Neurology, AIIMS, New Delhi, India
| | - G Shukla
- From the Department of Neurology, AIIMS, New Delhi, India
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26
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Chandan S, Shukla G, Gupta A, Srivastava A, Vibha D, Prasad K. Acute-onset Restless legs syndrome in acute neurological conditions-a prospective study on patients with the Guillain-Barre syndrome and acute stroke. Acta Neurol Scand 2018; 137:488-499. [PMID: 29359321 DOI: 10.1111/ane.12890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES While the Restless legs syndrome (RLS) is usually recognized as a chronic condition, it has often been diagnosed among patients with acute neurological illnesses, in which limb discomfort is reported. This study was conducted to determine how many among these, actually have acute-onset RLS, and also to evaluate characteristics of this subgroup of patients with Guillain-Barre syndrome (GBS) and stroke developing acute-onset RLS. METHODS Consecutive patients diagnosed with GBS and eligible stroke patients, admitted to our Neurology services over a 1-year period, were enrolled. They were evaluated for symptoms of RLS based on IRLSSG consensus criteria and the AIIMS RLS Questionnaire for Indian patients (ARQIP). RESULTS Forty adults with GBS and 58 with stroke were included. A total of 10 of the 40 (25%) patients with GBS developed definite acute RLS, which was mostly monophasic. Seven (70%) of these had demyelinating type of GBS, a significant association with acute RLS (P = .024). Six of the 58 stroke patients (10%) developed definite acute-onset, often persistent RLS. Subcortical location showed significant association with increased risk of developing acute RLS (P < .001). All patients diagnosed with acute-onset RLS had an immediate and good response to dopamine agonists. CONCLUSION This is the first study showing that acute-onset RLS is common, affecting nearly 25% of patients with GBS and 10% patients with acute stroke. Recognizing and treating it can majorly contribute toward symptom relief and early improvement in the quality of life for this population.
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Affiliation(s)
- S. Chandan
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - G. Shukla
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - A. Gupta
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - A. Srivastava
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - D. Vibha
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - K. Prasad
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
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Palmer J, Bhamidipati D, Shukla G, James E, Farrell C, Judy K, Kim L, Glass J, Andrews D, Werner-Wasik M, Shi W. PO-0728: Pre-Radiation Tumor Progression Improves Prognostic Stratification In Glioblastoma Patients. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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28
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Madathiparambil Radhakrishnan D, Goyal V, Srivastava A, Behari M, Shukla G. Evaluation of various movement disorders in patients of genetically proven Spino Cerebellar Ataxia: A study from a tertiary care center in Northern India. Parkinsonism Relat Disord 2018. [DOI: 10.1016/j.parkreldis.2017.11.076] [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: 11/25/2022]
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29
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Shukla G, Alexander G, Nettleton V, Williams N, Ad VB. The Dosimetry Curriculum in Radiation Oncology Residency: A Single Institution Quality Improvement Project. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Shukla G, Luminais C, Williams N, Keith S, Dabbish N, Andrews D, Judy K, Farrell C, Werner-Wasik M, Johnson J. Outcomes and Treatment Patterns in Patients with Oligometastatic Non-Small Cell Lung Cancer (NSCLC) Diagnosed at Craniotomy: A Single Institution Study. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1788] [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: 11/27/2022]
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31
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Shukla G, Bakas S, Rathore S, Akbari H, Sotiras A, Davatzikos C. Radiomic Features from Multi-Institutional Glioblastoma MRI Offer Additive Prognostic Value to Clinical and Genomic Markers: Focus on TCGA-GBM Collection. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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32
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Palmer J, Shukla G, Bhamidipati D, Skowronski J, Kim H, Judy K, Evans J, Farrell C, Andrews D, Kim L, Glass J, Werner-Wasik M, Shi W. Early Tumor Progression Prior to Adjuvant Therapy May Predict Survival in Newly Diagnosed Glioblastoma. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.886] [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: 11/25/2022]
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33
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Du S, Zhou L, Shukla G, Wang N, Yang L, Ma X, Wang Y, Dicker A, Lu Y, Lu B. Pharmacological Inhibition of PD-1 Exacerbates Radiation-Induced Cardiac Toxicity Through Cytotoxic T Cell–Mediated Myocarditis. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.221] [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: 11/28/2022]
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34
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Gupta A, Shukla G, Afsar M, Poornima S, Goyal, Vibha D, Behari. Prevention of new vascular events in patients with obstructive sleep apnea and stroke, using CPAP: A randomized controlled trial. Sleep Med 2015. [DOI: 10.1016/j.sleep.2015.02.064] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Palmer J, Barsoom R, Shukla G, Skowronski J, Andrews D, Kim L, Glass J, Werner-Wasik M, Farrell C, Shi W. Patterns of Failure Following Reirradiation in Patients With Recurrent High Grade Glioma. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.720] [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: 10/22/2022]
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36
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Shukla G, Palmer J, Werner-Wasik M. Outcomes After Whole-Brain Reirradiation for Brain Metastases: A Single-Institution Experience. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.759] [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: 11/25/2022]
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37
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Shukla G. Sleep and refractory epilepsy: mechanisms impacting treatment outcomes. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.09.237] [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: 11/30/2022]
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38
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Bajpai G, Shukla G, Pandey R, Gupta A, Goyal V, Behari AM. Validation of a modified hindi version of the Epworth Sleepiness Scale in a north Indian population. Sleep Med 2013. [DOI: 10.1016/j.sleep.2013.11.133] [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: 11/30/2022]
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39
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Shukla G, Gupta A, Gupta N, Kabra M. Spectrum of sleep disordered breathing among patients with mucopolysaccharidoses: a clinico-polysomnographic study. Sleep Med 2013. [DOI: 10.1016/j.sleep.2013.11.649] [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: 11/26/2022]
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40
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Shukla G, Rosen M, Both S, Vapiwala N, Bekelman J, Christodouleas J, Tochner Z, Deville C. Dominant Intraprostatic Lesion Size Is Correlated With Rate of Biochemical Relapse in Patients With High- and Intermediate-Risk Prostate Cancer Treated With Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.445] [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: 11/30/2022]
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41
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Hollebeek R, Newcomer M, Mayers G, Delgado B, Shukla G, Maughan R, Dolney D. TU-C-108-12: A New Technology for Fast Two-Dimensional Detection of Proton Therapy Beams. Med Phys 2013. [DOI: 10.1118/1.4815376] [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: 11/07/2022] Open
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42
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Gambhir H, Vivekanandhan S, Goyal V, Shukla G, Mathur R, Behari M. 3.252 RETINAL PIGMENT EPITHELIAL (RPE) CELL TRANSPLANTATION RESTORES MOTOR COORDINATION IN THE RAT MODEL OF PARKINSON'S DISEASE (PD). Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70924-5] [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: 11/26/2022]
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43
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Srijithesh P, Shukla G, Srivastav A, Goyal V, Singh S, Behari M. Validity of the Berlin Questionnaire in identifying obstructive sleep apnea syndrome when administered to the informants of stroke patients. J Clin Neurosci 2011; 18:340-3. [DOI: 10.1016/j.jocn.2010.04.048] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 04/18/2010] [Indexed: 11/29/2022]
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44
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Chadha R, Gupta S, Shukla G, Jain DS, Singh S. Characterization, thermodynamic parameters and in vivo antimalarial activity of inclusion complexes of artemether. Drug Discov Ther 2010; 4:190-201. [PMID: 22491183] [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: 05/31/2023]
Abstract
The present study aimed to improve solubility, dissolution and ultimate bioavailability of poorly soluble artemether, an antimalarial drug, by encapsulating it in β-cyclodextrin (β-CD) and its methyl and hydroxylpropyl derivatives. The effect of these complexes was confirmed by in vivo studies. Phase solubility studies indicated 1:1 stoichiometry and were supported by mass spectrometry and proton nuclear magnetic resonance ((1)H-NMR) spectroscopy. True inclusion of artemether into the cyclodextrin cavity was observed in lyophilized complexes by differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD) and Fourier transform infrared spectroscopy (FT-IR) studies. The mode of inclusion was supported by two-dimensional (2D) NMR. Solution calorimetry was used to confirm 1:1 stiochiometry by determining the enthalpy of interaction between the drug and cyclodextrins. The stability constant (K) of inclusion and other thermodynamic parameters such as enthalpy (ΔH) as well as entropy (ΔS) of binding accompanying the encapsulation were determined. The calculated value of K indicated that M-β-CD has maximum complexing efficiency. Dissolution studies indicated that the highest release rate was observed for lyophilized complexes. In vivo studies of lyophilized complexes of M-β-CD showed a 3-fold increase in antimalarial activity compared to artemether and resulted in 100% eradication of parasite. However, 83% and 50% survival rates were achieved in 40 days using HP-β-CD and β-CD complexes respectively. The study concludes that encapsulation of artemether by cyclodextrins is a good alternative to enhance the bioavailability of the drug.
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Affiliation(s)
- R Chadha
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
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45
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Shukla G, Goyal V, Singh S, Srivastava A, Behari M. 186 SHORT SLEEP LATENCIES IN PATIENTS WITH EPILEPSY: AN MSLT STUDY. Sleep Med 2009. [DOI: 10.1016/s1389-9457(09)70188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Shukla G, Goyal V, Singh S, Srivastava A, Behari M. 120 VARIED CLINICAL CHARACTERISTICS OF RESTLESS LEGS SYNDROME IN INDIA: AN OBSERVATIONAL STUDY. Sleep Med 2009. [DOI: 10.1016/s1389-9457(09)70122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Sachin S, Shukla G, Goyal V, Singh S, Aggarwal V, Behari M. Clinical speech impairment in Parkinson's disease, progressive supranuclear palsy, and multiple system atrophy. Neurol India 2009; 56:122-6. [PMID: 18688134 DOI: 10.4103/0028-3886.41987] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT Speech abnormalities are common to the three Parkinsonian syndromes, namely Parkinson's disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), the nature and severity of which is of clinical interest and diagnostic value. AIM To evaluate the clinical pattern of speech impairment in patients with PD, PSP and MSA and to identify significant differences on quantitative speech parameters when compared to controls. DESIGN AND SETTING Cross-sectional study conducted in a tertiary medical teaching institute. MATERIALS AND METHODS Twenty-two patients with PD, 18 patients with PSP and 20 patients with MSA and 10 age-matched healthy controls were recruited over a period of 1.5 years. The patients were clinically evaluated for the presence and characteristics of dysarthria. This was followed by quantitative assessment of three parameters: maximum phonation time (MPT), semantic fluency and reading speed. The outcome measures were compared between the patient groups and with controls. RESULTS Patients with PD had hypophonic monotonous speech with occasional rushes of speech while patients with MSA and PSP had mixed dysarthria with ataxic and spastic elements respectively. All quantitative parameters were affected when compared to controls (P values<0.001, 0.012 and 0.008 respectively). Maximum phonation time was significantly less in PSP when compared to MSA and PD (P=0.015). Reading speed also showed a similar trend which was not statistically significant. Semantic fluency was comparable in all three groups. CONCLUSION Dysarthria in PD, PSP and MSA have many overlapping but certain distinctive features as well which could serve as a diagnostic clue. Patients with PSP had profound speech impairment probably indicative of the more severe frontostriatial pathology.
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Affiliation(s)
- S Sachin
- Department of Neurology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029, India
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Sachin S, Senthil Kumaran S, Singh S, Goyal V, Shukla G, Mahajan H, Behari M. Functional mapping in PD and PSP for sustained phonation and phoneme tasks. J Neurol Sci 2008; 273:51-6. [DOI: 10.1016/j.jns.2008.06.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 06/11/2008] [Accepted: 06/13/2008] [Indexed: 11/30/2022]
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Shukla G, . PC, . LS, . PC, . R. In vitro Evaluation of Uranium Induced Immunotoxicity in Chicken Lymphocytes. J of Pharmacology and Toxicology 2007; 2:473-480. [DOI: 10.3923/jpt.2007.473.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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