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Paul PK, Umarvaish S, Bajaj S, S. RF, Mohan H, Annaert W, Chaudhary V. Maintenance of proteostasis by Drosophila Rer1 is essential for competitive cell survival and Myc-driven overgrowth. PLoS Genet 2024; 20:e1011171. [PMID: 38408084 PMCID: PMC10919865 DOI: 10.1371/journal.pgen.1011171] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 03/07/2024] [Accepted: 02/05/2024] [Indexed: 02/28/2024] Open
Abstract
Defects in protein homeostasis can induce proteotoxic stress, affecting cellular fitness and, consequently, overall tissue health. In various growing tissues, cell competition based mechanisms facilitate detection and elimination of these compromised, often referred to as 'loser', cells by the healthier neighbors. The precise connection between proteotoxic stress and competitive cell survival remains largely elusive. Here, we reveal the function of an endoplasmic reticulum (ER) and Golgi localized protein Rer1 in the regulation of protein homeostasis in the developing Drosophila wing epithelium. Our results show that loss of Rer1 leads to proteotoxic stress and PERK-mediated phosphorylation of eukaryotic initiation factor 2α. Clonal analysis showed that rer1 mutant cells are identified as losers and eliminated through cell competition. Interestingly, we find that Rer1 levels are upregulated upon Myc-overexpression that causes overgrowth, albeit under high proteotoxic stress. Our results suggest that increased levels of Rer1 provide cytoprotection to Myc-overexpressing cells by alleviating the proteotoxic stress and thereby supporting Myc-driven overgrowth. In summary, these observations demonstrate that Rer1 acts as a novel regulator of proteostasis in Drosophila and reveal its role in competitive cell survival.
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Affiliation(s)
- Pranab Kumar Paul
- Cell and developmental signaling laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhopal, Madhya Pradesh, India
| | - Shruti Umarvaish
- Cell and developmental signaling laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhopal, Madhya Pradesh, India
| | - Shivani Bajaj
- Cell and developmental signaling laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhopal, Madhya Pradesh, India
| | - Rishana Farin S.
- Cell and developmental signaling laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhopal, Madhya Pradesh, India
| | - Hrudya Mohan
- Cell and developmental signaling laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhopal, Madhya Pradesh, India
| | - Wim Annaert
- Laboratory for Membrane Trafficking, VIB-Center for Brain and Disease Research, KU Leuven, Leuven, Belgium, and Department of Neurosciences, KU Leuven, Gasthuisberg, Leuven, Belgium
| | - Varun Chaudhary
- Cell and developmental signaling laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhopal, Madhya Pradesh, India
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Brock H, Lambrineas L, Ong HI, Chen WY, Das A, Edsell A, Proud D, Carrington E, Smart P, Mohan H, Burgess A. Preventative strategies for low anterior resection syndrome. Tech Coloproctol 2023; 28:10. [PMID: 38091118 DOI: 10.1007/s10151-023-02872-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND A common and debilitating complication of low anterior resection for rectal cancer is low anterior resection syndrome (LARS). As a multifactorial entity, LARS is poorly understood and challenging to treat. Despite this, prevention strategies are commonly overlooked. Our aim was to review the pathophysiology of LARS and explore current evidence on the efficacy and feasibility of prophylactic techniques. METHODS A literature review was performed between [1st January 2000 to 1st October 2023] for studies which investigated preventative interventions for LARS. Mechanisms by which LARS develop are described, followed by a review of prophylactic strategies to prevent LARS. Medline, Cochrane, and PubMed databases were searched, 189 articles screened, 8 duplicates removed and 18 studies reviewed. RESULTS Colonic dysmotility, anal sphincter dysfunction and neorectal dysfunction all contribute to the development of LARS, with the complex mechanism of defecation interrupted by surgery. Transanal irrigation (TAI) and pelvic floor rehabilitation (PFR) have shown benefits in preventing LARS, but may be limited by patient compliance. Intraoperative nerve monitoring (IONM) and robotic-assisted surgery have shown some promise in surgically preventing LARS. Nerve stimulation and other novel strategies currently used in treatment of LARS have yet to be investigated in their roles prophylactically. CONCLUSIONS To date, there is a limited evidence base for all preventative strategies including IONM, RAS, PFP and TAI. These strategies are limited by either access (IONM, RAS and PFP) or acceptability (PFP and TAI), which are both key to the success of any intervention. The results of ongoing trials will serve to assess acceptability, while technological advancement may improve access to some of the aforementioned strategies.
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Affiliation(s)
- H Brock
- Austin Health, Department of Surgery, University of Melbourne, Melbourne, Australia
- Department of Colorectal Surgery, Austin Health, Melbourne, Australia
- Western General, Melbourne, Australia
| | - L Lambrineas
- Austin Health, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - H I Ong
- Austin Health, Department of Surgery, University of Melbourne, Melbourne, Australia.
- Department of Colorectal Surgery, Austin Health, Melbourne, Australia.
| | - W Y Chen
- Austin Health, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - A Das
- Department of Colorectal Surgery, Austin Health, Melbourne, Australia
| | - A Edsell
- Austin Health, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - D Proud
- Austin Health, Department of Surgery, University of Melbourne, Melbourne, Australia
- Department of Colorectal Surgery, Austin Health, Melbourne, Australia
| | | | - P Smart
- Austin Health, Department of Surgery, University of Melbourne, Melbourne, Australia
- Department of Colorectal Surgery, Austin Health, Melbourne, Australia
| | - H Mohan
- Austin Health, Department of Surgery, University of Melbourne, Melbourne, Australia
- Department of Colorectal Surgery, Austin Health, Melbourne, Australia
| | - A Burgess
- Austin Health, Department of Surgery, University of Melbourne, Melbourne, Australia
- Department of Colorectal Surgery, Austin Health, Melbourne, Australia
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Smith HG, Schlesinger NH, Qvortrup C, Chiranth D, Lundon D, Ben-Yaacov A, Caballero C, Suppan I, Kok JH, Holmberg CJ, Mohan H, Montagna G, Santrac N, Sayyed R, Schrage Y, Sgarbura O, Ceelen W, Lorenzon L, Brandl A. Variations in the definition and perceived importance of positive resection margins in patients with colorectal cancer - an EYSAC international survey. Eur J Surg Oncol 2023; 49:107072. [PMID: 37722286 DOI: 10.1016/j.ejso.2023.107072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/03/2023] [Accepted: 09/09/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Microscopically positive resection margins (R1) are associated with poorer outcomes in patients with colorectal cancer. However, different definitions of R1 margins exist. It is unclear to what extent the definitions used in everyday clinical practice differ within and between nations. This study sought to investigate variations in the definition of R1 margins in colorectal cancer and the importance of margin status in clinical decision-making. MATERIALS AND METHODS A 14-point survey was developed by members of The European Society of Surgical Oncology (ESSO) Youngs Surgeons and Alumni Club (EYSAC) Research Academy targeting all members of the multidisciplinary team (MDT) treating patients with colorectal cancer. The survey was distributed on social media, in ESSO's monthly newsletter and via national societies. RESULTS In total, 137 responses were received. Most respondents were from Europe (89.7%), with the majority from Denmark (56.9%). Less than 2/3 of respondents defined R1 margins as the presence of viable cancer cells ≤1 mm of the margin. Only 60% reported that subdivisions of R1 margins (primary tumour vs tumour deposit vs metastatic lymph node) are routinely available. More than 20% of respondents reported that pathology reports are not routinely reviewed at MDT meetings. Less than half of respondents considered margin status in decision-making for type and duration of adjuvant chemotherapy in Stage III colon cancer. CONCLUSION The definitions and perceived clinical importance of microscopically positive margins in patients with colorectal cancer appear to vary. Adoption of an international dataset for pathology reporting may help to standardise current practices.
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Affiliation(s)
- H G Smith
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Abdominal Center K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark.
| | - N H Schlesinger
- Abdominal Center K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark
| | - C Qvortrup
- Department of Oncology, Rigshospital, University of Copenhagen, Denmark
| | - D Chiranth
- Department of Pathology, Rigshospital, University of Copenhagen, Denmark
| | - D Lundon
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Mount Sinai Department of Urology, New York, United States
| | - A Ben-Yaacov
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel-Hashomer, Israel
| | - C Caballero
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Breast International Group, Brussels, Belgium
| | - I Suppan
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Breast Center, Department of Gynaecology, Rottal-Inn-Kliniken Eggenfelden, Germany
| | - J Herrera Kok
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Upper GI Unit, University Hospital of Leon, Spain
| | - C J Holmberg
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sweden
| | - H Mohan
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Peter MacCallum Cancer Centre in Melbourne, Australia
| | - G Montagna
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N Santrac
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - R Sayyed
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Department of Surgical Oncology, Patel Hospital, Karachi, Pakistan
| | - Y Schrage
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - O Sgarbura
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Department of Surgical Oncology, Institut du Cancer Montpellier, University of Montpellier, France
| | - W Ceelen
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Department of GI Surgery and Cancer Research Institute Ghent (CRIG), Ghent University Hospital, Belgium
| | - L Lorenzon
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - A Brandl
- European Society of Surgical Oncology Young Surgeons and Alumni Club (EYSAC), Italy; Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Germany
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Beamish A, Rabie M, Johnston M, Nally D, Humm G, Mohan H. SP2.1.11Real-world use of workplace-based assessments in surgical training: a UK nationwide exploration of trainee perspectives and consensus recommendations from the Association of Surgeons in Training. Br J Surg 2021. [DOI: 10.1093/bjs/znab361.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
The utility of Workplace-Based Assessments (WBAs) in surgical training depends on the way they are completed. This study aims to ascertain the real-world usage of WBAs, as perceived by UK surgical trainees.
Methods
An anonymous national online questionnaire was conducted via the Association of Surgeons in Training (ASiT). The evaluation employed mixed methods to interpret quantitative and qualitative data. Suggestions for improvement were identified from free-text comments and considered through a formal two-round modified Delphi consensus process by ASiT council members.
Results
Analysis included 906 complete responses from all surgical specialities across all training levels. WBA use was perceived to deviate markedly from the Joint Committee on Surgical Training standards with significantly identified misuse across all surgical specialities. Inaccurate completion was acknowledged by 89.6% of respondents, and some trainers appear complicit with 40.9% of respondents aware of 'unobserved sign-off', and 33.6% aware of 'password disclosure' by trainers.
Most trainees felt the Annual Review of Competency Progression (ARCP) respected WBA quantity above quality (55.4%), and a third felt pressure to overstate the number completed (32.0%). Main reasons for misuse were time restraints, lack of engagement and the will to achieve career progression targets.
Conclusions
UK surgical trainees perceive a significant deviation from WBAs standards due to multiple factors. The frequency and nature of misuse are worrying and undermines the existing evidence for the WBAs role in training. We present consensus recommendations from ASiT for the improvement of WBA use in UK surgical training.
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Affiliation(s)
| | - M Rabie
- The Association of Surgeons in Training
- Ain Shams University, Egypt
| | | | - D Nally
- The Association of Surgeons in Training
| | - G Humm
- The Association of Surgeons in Training
| | - H Mohan
- The Association of Surgeons in Training
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Thorpe C, Liokati I, Boyle E, Mohan H, Bates N, Martin S, Kennelly R, Hanly A, Winter D, Carrington EV. 935 Identification and Management of Electrolyte Abnormalities in Surgical Patients Requiring Total Parenteral Nutrition: An Audit of Current Practice at A University Hospital. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Electrolyte abnormalities are a common and serious consequence of nutritional deficiencies when patients are nil-by-mouth. Timely intervention with a multidisciplinary approach is known to improve outcome. This audit aimed to assess adequacy of initial electrolyte management and timing of dietetics referral in acute surgical patients requiring total parenteral nutrition in a university hospital.
Method
A retrospective audit of all general surgery patients referred to dietetics for total parenteral nutrition between January-December 2019 was performed. The following audit standards (from the time following admission) were applied: monitoring of electrolytes every 48-hours, treatment of electrolyte abnormalities within 24-hours of discovery; and referral to the dietetics service within 48-hours of nil-by-mouth being commenced.
Results
Data from 52 patients (27 females, median age 66) were analysed. Fifty-one (98%) had electrolytes measured every 48-hours, however magnesium, phosphate and/or calcium were not measured prior to dietetics input in 9 (17%). Forty electrolyte abnormalities requiring treatment were found in 28 patients (54%), though only 18 (64%) commenced treatment within 24-hours. The most common electrolyte abnormalities not corrected within 24-hours were phosphate and calcium (50%). 46% of patients were referred to dietetics after 48-hours of nil-by-mouth status.
Conclusions
In our unit, we found that basic electrolytes were frequently monitored in patients placed nil-by-mouth, however calcium, phosphate and magnesium were often omitted prior to dietetics input, and correction of abnormalities was sometimes delayed. Introduction of a local protocol-based approach for electrolyte monitoring with streamlined dietetics referrals is likely to improve adherence to best practice.
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Affiliation(s)
- C Thorpe
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - I Liokati
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - E Boyle
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - H Mohan
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - N Bates
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - S Martin
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - R Kennelly
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - A Hanly
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - D Winter
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - E V Carrington
- Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin, Ireland
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
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Mohan H, Guzman Lenis M, Laurette EY, Tejada O, Sanghvi T, Leung KY, Cahill LS, Sled JG, Delgado-Olguín P, Greene NDE, Copp AJ, Serghides L. In response to the Letter to the Editor by Romach et al. re our publication "Dolutegravir in pregnant mice is associated with increased rates of fetal defects at therapeutic but not at supratherapeutic levels". EBioMedicine 2021; 66:103334. [PMID: 33862586 PMCID: PMC8054139 DOI: 10.1016/j.ebiom.2021.103334] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- H Mohan
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - M Guzman Lenis
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - E Y Laurette
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - O Tejada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - T Sanghvi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - K-Y Leung
- Developmental Biology & Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - L S Cahill
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Chemistry, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - J G Sled
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Translational Medicine, The Hospital for Sick Children, Toronto, Ontario M5G 0A4, Canada
| | - P Delgado-Olguín
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario M5G 0A4, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Heart & Stroke Richard Lewar Centre of Excellence, Toronto, Ontario M5S 3H2, Canada
| | - N D E Greene
- Developmental Biology & Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - A J Copp
- Developmental Biology & Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - L Serghides
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada; Department of Immunology and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
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Heeney A, Rogers AC, Mohan H, Mc Dermott F, Baird AW, Winter DC. Prostaglandin E 2 receptors and their role in gastrointestinal motility - Potential therapeutic targets. Prostaglandins Other Lipid Mediat 2020; 152:106499. [PMID: 33035691 DOI: 10.1016/j.prostaglandins.2020.106499] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/20/2020] [Accepted: 10/01/2020] [Indexed: 12/19/2022]
Abstract
Prostaglandin E2 (PGE2) is found throughout the gastrointestinal tract in a diverse variety of functions and roles. The recent discovery of four PGE2 receptor subtypes in intestinal muscle layers as well as in the enteric plexus has led to much interest in the study of their roles in gut motility. Gut dysmotility has been implicated in functional disease processes including irritable bowel syndrome (IBS) and slow transit constipation, and lubiprostone, a PGE2 derivative, has recently been licensed to treat both conditions. The diversity of actions of PGE2 in the intestinal tract is attributed to its differing effects on its downstream receptor types, as well as their varied distribution in the gut, in both health and disease. This review aims to identify the role and distribution of PGE2 receptors in the intestinal tract, and aims to elucidate their distinct role in gut motor function, with a specific focus on functional intestinal pathologies.
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Affiliation(s)
- A Heeney
- Department of Physiology, College of Life Sciences, University College Dublin, Dublin, Ireland; Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - A C Rogers
- Department of Physiology, College of Life Sciences, University College Dublin, Dublin, Ireland; Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - H Mohan
- Department of Physiology, College of Life Sciences, University College Dublin, Dublin, Ireland; Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - F Mc Dermott
- Department of Physiology, College of Life Sciences, University College Dublin, Dublin, Ireland
| | - A W Baird
- Department of Physiology, College of Life Sciences, University College Dublin, Dublin, Ireland
| | - D C Winter
- Institute for Clinical Outcomes, Research and Education (ICORE), St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Beamish AJ, Johnston MJ, Harries RL, Mohan H, Fitzgerald JEF, Humm G, Rabie M, Nally DM, Gokani VJ. Use of the eLogbook in surgical training in the United Kingdom: A nationwide survey and consensus recommendations from the Association of Surgeons in Training. Int J Surg 2020; 84:199-206. [PMID: 32169575 DOI: 10.1016/j.ijsu.2020.02.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Accurate recording of operative cases is essential during training to demonstrate experience. However, indicative numbers delineating minimum desirable experience may incentivise exaggeration or misrepresentation of experience. This study aimed to determine perceptions of real-world eLogbook use among UK surgeons in training. MATERIAL AND METHODS An anonymous online questionnaire was disseminated electronically using a pre-planned yield-maximisation strategy, incorporating regional champions, email and social media. Evaluation employed mixed methods in a combined interpretation of quantitative and qualitative data from the questionnaire. Recommendations for development of the eLogbook were itemised from respondents' free text items and a modified Delphi process, conducted within the Council of the UK national trainee representative body, the Association of Surgeons in Training, determined the strength of each recommendation. RESULTS Analysis included 906 complete responses from training-grade surgeons (34.8% female) from all UK recognised specialties and all grades of training. More than two-thirds (68.5%) believed that overstatement or misrepresentation of case involvement occurs. A fifth (20.8%) reported witnessing trainees logging cases they had not actually participated in and almost a third (32.7%) had witnessed overstatement, yet few (15.1%) had raised such an issue with a supervisor. Most (85.2%) respondents had few or no eLogbook entries validated. More than a quarter of respondents felt pressure to overstate their involvement in cases (28.6%) and the number recorded (28.1%). Almost a third (31.5%) felt the required case number for completion of training was not achievable. Female trainees were less likely to feel well supervised (p = 0.022) and to perceive targets for completion of training were achievable (p = 0.005). Thematic analysis identified four key themes to explain logbook misuse: Pressure to achieve training milestones; eLogbook functionality issues; training deficiencies and probity. CONCLUSIONS Inaccurate operative recording was widely reported, primarily in response to perceived pressure to achieve targets for career progression. Operative logbooks may not be as accurate as intended. Consensus recommendations are made for improvement in the eLogbook and its use.
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Affiliation(s)
- A J Beamish
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, Holborn, London, WC2A 3PE, UK.
| | - M J Johnston
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, Holborn, London, WC2A 3PE, UK
| | - R L Harries
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, Holborn, London, WC2A 3PE, UK
| | - H Mohan
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, Holborn, London, WC2A 3PE, UK
| | - J E F Fitzgerald
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, Holborn, London, WC2A 3PE, UK
| | - G Humm
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, Holborn, London, WC2A 3PE, UK
| | - M Rabie
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, Holborn, London, WC2A 3PE, UK
| | - D M Nally
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, Holborn, London, WC2A 3PE, UK
| | - V J Gokani
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, Holborn, London, WC2A 3PE, UK
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9
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Walker NR, Deekonda P, Glasbey JC, Rashid S, Gokani VJ, Humm G, Mohan H, Harries RL. Attracting medical students and doctors into surgical training in the UK and Ireland. Int J Surg 2019; 67:107-112. [PMID: 30668992 DOI: 10.1016/j.ijsu.2019.01.007] [Citation(s) in RCA: 6] [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] [Received: 12/29/2018] [Accepted: 01/11/2019] [Indexed: 12/23/2022]
Abstract
AIMS Core surgical training (CST) programmes in the UK have seen a significant reduction in competition ratios over the past five years. This study aimed to determine motivating factors and perceived barriers to pursuing a career in surgery amongst junior doctors in training and medical students attending an annual conference. METHODS A self-reported, electronic questionnaire was distributed to medical students, foundation year doctors, and doctors in postgraduate surgical training programmes (DIPST) who attended the Association of Surgeons in Training (ASiT) Conference in 2016. Respondents ranked factors attracting them to a career in surgery and factors that could improve perceptions of surgical careers. Chi-square test was used to test for differences between groups (a = 0.05, R Studio, V3.3.1). RESULTS Of 394 respondents (response rate = 50.9%), 44.9% were medical students or foundation doctors ('Pre-CST') and 55.1% were DIPST ('Peri/post-CST'). Practical application of skills (97.4%), enjoyment of the theatre environment (95.4%) and positive experiences in surgical firms (84.7%) were primary driving factors towards a surgical career. Availability of private practice (32.2%), and sustainability of consultant jobs (49.0%) had less influence. For 'Pre-CST' respondents, role models (82.8% pre-CST v 74.9% peri-post CST, p < 0.05) and defined career progression (67.2% pre-CST v 47.0% peri-post CST, p < 0.001) were particularly important. 91% of all respondents agreed that a better balance of training and service within worked hours would improve perceptions of surgery. CONCLUSION Addressing the motivating factors and perceived barriers to surgical careers will help bolster recruitment of the future surgical workforce.
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Affiliation(s)
- N R Walker
- Association of Surgrons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom
| | - P Deekonda
- Association of Surgrons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom
| | - J C Glasbey
- Association of Surgrons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom
| | - S Rashid
- Association of Surgrons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom
| | - V J Gokani
- Association of Surgrons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom
| | - G Humm
- Association of Surgrons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom
| | - H Mohan
- Association of Surgrons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom
| | - R L Harries
- Association of Surgrons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom.
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- Association of Surgrons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom
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Reid C, Mohan H, Cahill R. A case of caecal perforation treated by laparoscopic caecectomy - a video vignette. Colorectal Dis 2017; 19:784. [PMID: 28561438 DOI: 10.1111/codi.13749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/23/2017] [Indexed: 02/08/2023]
Affiliation(s)
- C Reid
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - H Mohan
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - R Cahill
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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O'Carroll L, Mohan H, Cahill RA. Damage control surgery and extended interval GI reconstruction after trauma - a video vignette. Colorectal Dis 2017; 19:506. [PMID: 28295979 DOI: 10.1111/codi.13651] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/12/2017] [Indexed: 02/08/2023]
Affiliation(s)
- L O'Carroll
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - H Mohan
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - R A Cahill
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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O'Carroll L, Mohan H, Scarlett S, Cahill RA. Reformatting of PACS images as video for convenient electronic dissemination - a video vignette. Colorectal Dis 2017; 19:397. [PMID: 28214363 DOI: 10.1111/codi.13634] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/09/2017] [Indexed: 02/08/2023]
Affiliation(s)
- L O'Carroll
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - H Mohan
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - S Scarlett
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - R A Cahill
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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O'Connell E, Mihu R, Mohan H, Fulton G, Manning B. Intervention for Superficial Venous Insufficency in Patients with Venous Ulcers: Early Experience from an Ambulatory Venous Clinic. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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O’Callaghan J, Mohan H, Sharrock A, Gokani V, Fitzgerald J, Harries R. ASiT cost of surgical training survey preliminary results. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.375] [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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Harries R, Gokani V, McGoldrick C, Mohan H, Smitham P, Fitzgerald J. A cross sectional study of pregnancy and maternity and paternity leave among surgical trainees in the United Kingdom and Republic of Ireland. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.371] [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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Gupta N, Doss J, Mohan H, Nair A, Sebastian T, Danda D. AB0149 Associations of Anti Nucleosome Antibody in Systemic Lupus Erythematosus in India. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Donlon N, Mohan H, Finn I, Mealy K. Predictive value of CRP/albumin ratio in major abdominal surgery. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Burke T, Fenelon C, Dalton D, Mohan H, Schmidt K. Availability of accessible and high-quality information on the internet for patients undergoing laparoscopic cholecystectomy. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- Rhiannon L Harries
- Association of Surgeons in Training, Royal College of Surgeons, London WC2A 3PE, UK
| | - H Mohan
- Association of Surgeons in Training, Royal College of Surgeons, London WC2A 3PE, UK
| | - P Sinclair
- Association of Surgeons in Training, Royal College of Surgeons, London WC2A 3PE, UK
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Lyons M, Mohan H, Winter DC, Simms CK. Biomechanical abdominal wall model applied to hernia repair. Br J Surg 2015; 102:e133-9. [PMID: 25627126 DOI: 10.1002/bjs.9687] [Citation(s) in RCA: 19] [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] [Received: 06/30/2014] [Revised: 08/08/2014] [Accepted: 09/29/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Most surgical innovations require extensive preclinical testing before employment in the operative environment. There is currently no way to develop and test innovations for abdominal wall surgery that is cheap, repeatable and easy to use. In hernia repair, the required mesh overlap relative to defect size is not established. The aims of this study were to develop a biomechanical model of the abdominal wall based on in vivo pressure measurements, and to apply this to study mesh overlap in hernia repair. METHODS An observational study of intra-abdominal pressure (IAP) levels throughout abdominal surgery was conducted to identify the peak perioperative IAP in vivo. This was then applied in the development of a surrogate abdominal wall model. An in vitro study of mesh overlap for various defect sizes was then conducted using this clinically relevant surrogate abdomen model. RESULTS The mean peak perioperative IAP recorded in the clinical study was 1740 Pa, and occurred during awakening from anaesthesia. This was reproduced in the surrogate abdomen model, which was also able to replicate incisional hernia formation. Using this model, the mesh overlap necessary to prevent hernia formation up to 20 kPa was found, independent of anatomical variations, to be 2 × (defect diameter) + 25 mm. CONCLUSION This study demonstrated that a surgically relevant surrogate abdominal wall model is a useful translational tool in the study of hernia repair. Surgical relevance This study examined the mesh overlap requirements for hernia repair, evaluated in a biomechanical model of the abdomen. Currently, mesh size is selected based on empirical evidence and may underpredict the requirement for large meshes. The study proposes a relationship between the defect size and mesh size to select the appropriate mesh size. Following further trials and investigations, this could be used in clinical practice to reduce the incidence of hernia recurrence.
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Affiliation(s)
- M Lyons
- Trinity Centre for Bioengineering, Department of Mechanical and Manufacturing Engineering, Parsons Building, Trinity College, Dublin, Ireland
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Foley J, Mullan D, Mohan H, Schmidt K. Abdominal aortitis on PET CT: A case report and review of the literature. Int J Surg Case Rep 2015; 10:104-6. [PMID: 25827296 PMCID: PMC4429952 DOI: 10.1016/j.ijscr.2015.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/09/2015] [Accepted: 02/16/2015] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Aortitis often occurs in patients with systemic vasculitis. PRESENTATION OF CASE We reported a 73 year old man with giant cell arteritis who was presented with abdominal pain and weight loss. DISCUSSION Aortitis was diagnosed on PET-CT scan performed because initial investigations raised the possibility of pancreatic pathology. CONCLUSION This case highlights the utility of PET-CT in the diagnosis of abdominal aortitis and the need to consider aortitis as a differential in patients with abdominal pain with a history of vasculitis.
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Affiliation(s)
- J Foley
- Department of Surgery, Wexford General Hospital, Wexford, Ireland.
| | - D Mullan
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
| | - H Mohan
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
| | - K Schmidt
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
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Handa U, Kundu R, Mohan H. Cytological diagnosis of desmoplastic malignant melanoma of the great toe. Cytopathology 2015; 27:76-8. [PMID: 25809940 DOI: 10.1111/cyt.12238] [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: 11/27/2022]
Affiliation(s)
- U Handa
- Department of Pathology, Government Medical College & Hospital, Sector 32, Chandigarh, 160032, India
| | - R Kundu
- Department of Pathology, Government Medical College & Hospital, Sector 32, Chandigarh, 160032, India
| | - H Mohan
- Department of Pathology, Government Medical College & Hospital, Sector 32, Chandigarh, 160032, India
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Garg G, Thami GP, Mohan H. Sporotrichoid pattern of nerve abscesses in borderline tuberculoid leprosy: A Case Report (sporotrichoid like abscesses in leprosy). Indian J Lepr 2014; 86:161-163. [PMID: 26411249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Linear distribution of multiple subcutaneous nodules or ulcers along the course of lymphatics, classically seen in lymphocutaneous sporotrichosis, has been observed in a number of other infections like localized cutaneous leishmaniasis, cutaneous tuberculous and non tuberculous mycobacterial infections, Pasteurella tularensis, Scopulariopsis blochi, Nocardia brasiliensis, yaws and syphilis. A case of borderline tuberculoid leprosy with multiple cutaneous nodules corresponding to resolving nerve abscesses in a sporotrichoid pattern is being reported.
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Armfield JM, Mohan H, Luzzi L, Chrisopoulos S. Dental anxiety screening practices and self-reported training needs among Australian dentists. Aust Dent J 2014; 59:464-72. [PMID: 25091082 DOI: 10.1111/adj.12211] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 01/29/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is recommended that dentists screen for dental anxiety (DA) so that fearful patients may be better managed. The main aim of this study was to determine what dentists are being taught in relation to DA as well as whether and how anxious patients are identified in the clinic. METHODS Two hundred and forty-six practising dentists (adjusted response rate = 40.1%), from a random sample of registered Australian dentists, completed a mailed questionnaire. RESULTS Dentists estimated that high DA affected 23.3% of children and 19.4% of adults seen. Only 3.7% of dentists reported using a published scale for screening DA, with the most common reason being lack of awareness (56.5%). Approximately one-half of responding dentists directly asked their patients about DA and this was more common among younger dentists (χ(2) = 7.75, p = 0.021). There were few differences in DA screening by other practitioner or practice characteristics (p > 0.05). Only one-third of dentists had received undergraduate training related to DA and only 41.7% considered this to be 'good' or better. Almost 37% of respondents expressed an interest in future training opportunities. CONCLUSIONS The use of formal, validated scales for screening DA is minimal. Training in anxiety management appears to be low and is an area that could be expanded upon.
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Affiliation(s)
- J M Armfield
- Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, South Australia
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Goel R, Mohan H, Kabeerdoss J, Jayaseelan V, Jude J, Joseph G, Danda D. SAT0289 Serum Soluble HLA E: A Biomarker of Disease Activity and Coronary Arteritis in Takayasu Arteritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Owens M, Mohan H, Moloney MA, Roche-Nagle G, Baker J, Sheehan S, Mehigan D, Barry M. Patient knowledge of peripheral vascular disease in an outpatient setting: an Achilles heel? Ir Med J 2013; 106:116-118. [PMID: 23691846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Peripheral vascular disease (PVD) has numerous modifiable risk factors. This study aimed to establish patients' awareness of risk factors and causes of PVD and their understanding of mechanisms of secondary prevention. A prospective survey of awareness of PVD among patients attending a tertiary vascular clinic for management of peripheral vascular disease was undertaken. Institutional review board approval was granted. Statistical analysis was performed using SPSS version 18.0 software. There was a 100% response rate, with 97 participants (53 male). Seventeen patients (19%) reported an interval of greater than six months from the onset of symptoms to first seeking medical attention with their General Practitioner. Only 19 (20%) could correctly identify 3 or more risk factors for peripheral vascular disease. Patients have limited awareness of PVD and its consequences. Educational initiatives are needed to encourage patients to seek early medical attention and raise awareness of modifiable risk factors in the community.
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Affiliation(s)
- M Owens
- St Vincent's University Hospital, Elm Park, Dublin 4.
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Gaikwad P, Naik GH, Priyadarsini KI, Mohan H, Rao BSM. Radiation induced oxidation of hydroxy indoles by NO 2• and Br 2•− radicals: effect of pH. J PHYS ORG CHEM 2010. [DOI: 10.1002/poc.1805] [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: 11/09/2022]
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Chander J, Kaur J, Attri A, Mohan H. Primary cutaneous zygomycosis from a tertiary care centre in north-west India. Indian J Med Res 2010; 131:765-770. [PMID: 20571164] [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: 05/29/2023] Open
Abstract
BACKGROUND & OBJECTIVES Zygomycosis is highly invasive fungal infection, with high mortality rate. In most of patients, diabetes mellitus is an underlying factor but in primary cutaneous zygomycosis, presentation may be different. Here we present the description of clinical presentation, fungi isolated and management of cases with cutaneous zygomycosis seen in a tertiary care hospital in north India during 2001-2007. METHODS All patients diagnosed with primary cutaneous zygomycosis between November 2001 and September 2007 presenting with clinical diagnosis of necrotizing fasciitis were included. Detailed history of each patient was taken, clinical presentation, site of involvement, underlying illness and risk factor, if any were noted. The diagnosis was established by direct microscopic evidence of broad, aseptate or sparsely septate ribbon-like hyphae with right angle branching in KOH wet mount and histopathological examination of stained sections. Cultures were put up for fungal isolation and species identification. Outcome of the therapy was analysed. RESULTS Of the nine patients reviewed, only one had diabetes mellitus. Commonest risk factor was injection abscess (33.3%). Apophysomyces elegans was isolated in four cases, Saksenaea vasiformis and Absidia corymbifera in one each. The fungal culture was sterile in three cases. Mortality rate was high with only four patients responded well to surgical and/or medical therapy. INTERPRETATION & CONCLUSION Primary cutaneous zygomycosis appears to be on rise in India that calls for high index of clinical suspicion and an early biopsy of the affected area for timely diagnosis. The standard treatment is a combination of amphotericin B therapy, surgical debridement, and reversal of the underlying disease or immunosuppression.
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Affiliation(s)
- J Chander
- Departments of Microbiology, Government Medical College & Hospital Chandigarh, India.
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Mohan H, Ryan J, Whelan B, Wakai A. The end of the line? The Visual Analogue Scale and Verbal Numerical Rating Scale as pain assessment tools in the emergency department. Emerg Med J 2010; 27:372-5. [DOI: 10.1136/emj.2007.048611] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chander J, Kaur J, Gulati N, Arora V, Nagarkar N, Sood S, Mohan H. Sudden vision loss caused by rhino-orbital zygomycosis in diabetic patients: case series. Mycoses 2009; 54:e228-32. [PMID: 20028465 DOI: 10.1111/j.1439-0507.2009.01831.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Rhino-orbital zygomycosis is a life-threatening fungal infection generally occurring in patients with an underlying disorder, such as diabetes mellitus with ketoacidosis or with immunocompromising factors, although it may rarely appear in healthy individuals. The study has been undertaken to discuss the clinical presentation, pathogenesis, diagnostic work up and management of this rapidly progressive disease. Four male patients having uncontrolled diabetes and presenting with signs and symptoms of rhino-orbital zygomycosis were studied to illustrate the serious nature of the disease. All the four patients had rapidly deteriorating vision loss either unilateral or bilateral along with other nasal and orbital signs and symptoms. All the patients were put on liposomal amphotericin B and underwent orbital exenteration and pansinusectomy. One patient died, while the other three were successfully treated. Early diagnosis is critical in the prevention of morbidity and mortality associated with the disease. There is need for a high index of clinical suspicion in immunocompromised patients. Timely medical-surgical treatment proves extremely important for prognosis.
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Shirdhonkar M, Mohan H, Maity D, Rao B. Oxidation of phenyl vinyl sulphide and phenyl vinyl sulphoxide in aqueous solution: A pulse radiolysis and theoretical study. Chem Phys Lett 2009. [DOI: 10.1016/j.cplett.2009.07.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Handa U, Chhabra S, Mohan H. Plasma cell tumours: cytomorphological features in a series of 12 cases diagnosed on fine needle aspiration cytology. Cytopathology 2009; 21:186-90. [DOI: 10.1111/j.1365-2303.2009.0641.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kulkarni MS, Kumbhar AS, Mohan H, Rao BSM. Synthesis, characterization and redox chemistry of Ru(II) complexes of N-methyl pyridyl quinoxaline. Dalton Trans 2009:6185-91. [DOI: 10.1039/b903446c] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mitra AK, Gawandi VB, George K, Mohan H, Mukherjee T. Investigations on the antioxidant activity of 5,8-dihydroxy-1,4-dihydro-1,4-methanonaphthalene (DDMN). Res Chem Intermed 2009. [DOI: 10.1007/s11164-008-0007-3] [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: 10/21/2022]
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Mohan H, Beddy D, Latif A, Bangash T, Quill D, Traynor O. The "flying" bile duct: avulsion of the common bile duct in a plane crash survivor. Ir J Med Sci 2008; 178:523-5. [PMID: 18839268 DOI: 10.1007/s11845-008-0225-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 09/10/2008] [Indexed: 11/28/2022]
Abstract
Blunt trauma is an unusual cause of extrahepatic bile duct injury. This is a case of a 51-year-old gentleman who sustained a significant seatbelt injury in a plane crash. Laparotomy, performed due to persistent abdominal pain, revealed that the common bile duct (CBD) was completely avulsed from the duodenum. Following insertion of drains and transfer to a hepatobiliary centre, the devascularised CBD was excised and replaced with a roux-en-y hepaticojejunostomy. Necrotic tissue was debrided from the pancreatic head. A persistent bile leak developed from the sub-hepatic drain. Repeat laparotomy revealed a bile leak from small ducts on the liver surface. Ligation of the ducts and bioglue sealing of the area were successfully performed. Subsequent to this a pancreatic fistula developed from the main pancreatic duct, which has since resolved. This unusual case illustrates the need for prompt recognition and early repair to optimise outcomes in traumatic CBD injury.
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Affiliation(s)
- H Mohan
- Department of Surgery, St. Vincent’s University Hospital, Dublin, Ireland.
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Singhal N, Dhingra N, Handa U, Mohan H, Singhal S. Fine needle aspiration cytology of spindle cell carcinoma of the tongue: a case report with emphasis on the diagnostic difficulties. Cytopathology 2008; 21:130-2. [PMID: 18691220 DOI: 10.1111/j.1365-2303.2008.00596.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Singhal
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
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Shirdhonkar M, Mohan H, Maity D, Rao B. Oxidation of phenyl trifluoromethyl sulphide: A pulse radiolysis and theoretical study. J Photochem Photobiol A Chem 2008. [DOI: 10.1016/j.jphotochem.2007.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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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Handa U, Garg S, Mohan H. Aspiration cytology of rheumatoid nodules: report of two cases. Cytopathology 2008; 19:263-4. [PMID: 18241205 DOI: 10.1111/j.1365-2303.2007.00547.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mitra AK, Gawandi VB, George K, Mohan H, Mukherjee T. Antioxidant activity of 5,8-dihydroxy-1,4-dihydro-1,4-methanonaphthalene. Res Chem Intermed 2008. [DOI: 10.1007/bf03039137] [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: 10/20/2022]
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Shukla S, Agarwal V, Lawrence A, Aggarwal A, Chauhan S, Singh R, Mohan H, Krishnani N, Misra R. P1 Arthropathy in primary amyloidosis: not so rare. Indian Journal of Rheumatology 2007. [DOI: 10.1016/s0973-3698(10)60328-7] [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: 10/19/2022] Open
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Abstract
PURPOSE There are limited data concerning the reasons for surgical removal of eyeball. The present retrospective study was undertaken to evaluate the frequency of diseases requiring surgical removal of eyeball and to study the histopathologic changes in these specimens. METHODS Forty-eight surgical eyeball specimens received between January 1999 and June 2005 were included in the study. Age, sex, and clinical diagnoses were recorded in each case. Specimens were classified on the basis of surgical procedure. Gross and microscopic findings were noted for all the specimens. RESULTS Between January 1995 and June 2005, there were 139,092 outpatients, 6,574 hospital admissions, 12,044 ophthalmic operations, and a total of 48 enucleations in 47 patients. Of these 47 patients, 24 were male and 23 female with almost equal male:female ratio. Right eye was involved in 29 cases while left was involved in 17 cases. Bilateral eye involvement was seen in one case. Surgical specimens included enucleation (28 cases, 58.3%), exenteration (12 cases, 25%), and evisceration (8 cases, 16.6%). On histopathologic examination, the lesions were categorized into two broad groups: neoplastic (8 cases, 16.6%) and non-neoplastic (40 cases, 83.4%). Both groups were further subcategorized and correlated with clinical diagnosis. CONCLUSIONS In our setting, non-neoplastic lesions are the main cause of eyeball surgery, as compared to the West, where trauma followed by neoplasms constitute important causes. Pathologic examination of eyeballs is a must for proper postoperative management of the patient.
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Affiliation(s)
- A Bal
- Department of Pathology, Govt. Medical College and Hospital, Chandigarh 160 030, India
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Abstract
OBJECTIVE Renal angiomyolipoma is an uncommon benign tumour composed of smooth muscle cells, blood vessels and adipose tissue. The cytological findings of this tumour are described. METHODS A retrospective analysis of four cases of angiomyolipoma diagnosed on fine-needle aspiration cytology (FNAC) during the period 1998-2004 was carried out. All the aspirations were carried out under ultrasonographic image guidance. RESULTS Smears from three cases showed oval- to spindle-shaped tumour cells, cohesive stromal fragments embedded in adipose tissue and branching blood vessels in a haemorrhagic background. No mitotic figures were seen. Smears from one case showed adipose tissue and blood. In this case, sections from the cell block showed mature adipose tissue and small blood vessels. CONCLUSION The diagnosis of angiomyolipoma can be made by FNAC under image guidance and a cell block may be quite helpful in making a correct diagnosis. It is important to establish a correct preoperative diagnosis as treatment of these tumours is conservative and this obviates the need for total nephrectomy.
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Affiliation(s)
- U Handa
- Department of Pathology, Government Medical College & Hospital, Sector 32A, Chandigarh, India
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Dubey K, Bhardwaj Y, Chaudhari C, Sabharwal S, Mohan H. Structure–reactivity studies on the polymerization and crosslinking behavior of tri(propylene glycol) diacrylate in aqueous solutions. REACT FUNCT POLYM 2007. [DOI: 10.1016/j.reactfunctpolym.2007.01.001] [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: 10/23/2022]
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