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Dwivedi K, Rajpal A, Rajpal S, Kumar V, Agarwal M, Kumar N. XL 1R-Net: Explainable AI-driven improved L 1-regularized deep neural architecture for NSCLC biomarker identification. Comput Biol Chem 2024; 108:107990. [PMID: 38000327 DOI: 10.1016/j.compbiolchem.2023.107990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/29/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Non-small cell lung cancer (NSCLC) exhibits intrinsic molecular heterogeneity, primarily driven by the mutation of specific biomarkers. Identification of these biomarkers would assist not only in distinguishing NSCLC into its major subtypes - Adenocarcinoma and Squamous Cell Carcinoma, but also in developing targeted therapy. Medical practitioners use one or more types of omic data to identify these biomarkers, copy number variation (CNV) being one such type. CNV provides a measure of genomic instability, which is considered a hallmark of carcinoma. However, the CNV data has not received much attention for biomarker identification. This paper aims to identify biomarkers for NSCLC using CNV data. METHODS An eXplainable AI (XAI)-driven L1-regularized deep learning architecture, XL1R-Net, is proposed that introduces a novel modification of the standard L1-regularized gradient descent algorithm to arrive at an improved deep neural classifier for NSCLC subtyping. Further, XAI-based feature identification has been used to leverage the trained classifier to uncover a set of twenty NCSLC-relevant biomarkers. RESULTS The identified biomarkers are evaluated based on their classification performance and clinical relevance. Using Multilayer Perceptron (MLP)-based model, a classification accuracy of 84.95% using 10-fold cross-validation is achieved. Moreover, the statistical significance test on the classification performance also revealed the superiority of the MLP model over the competitive machine learning models. Further, the publicly available Drug-Gene Interaction Database reveals twelve of the identified biomarkers as potentially druggable. The K-M Plotter tool was used to verify eighteen of the identified biomarkers with a high probability of predicting NSCLC patients' likelihood of survival. While nine of the identified biomarkers confirm the recent literature, five find mention in the OncoKB Gene List. CONCLUSION A set of seven novel biomarkers that have not been reported in the literature could be investigated for their potential contribution towards NSCLC therapy. Given NSCLC's genetic diversity, using only one omics data type may not adequately capture the tumor's complexity. Multiomics data and its integration with other sources will be examined in the future to better understand NSCLC heterogeneity.
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Affiliation(s)
- Kountay Dwivedi
- Department of Computer Science, University of Delhi, Delhi, India.
| | - Ankit Rajpal
- Department of Computer Science, University of Delhi, Delhi, India.
| | - Sheetal Rajpal
- Department of Computer Science, Dyal Singh College, Delhi, India.
| | - Virendra Kumar
- Department of Nuclear Magnetic Resonance, All India Institute of Medical Sciences, New Delhi, India.
| | - Manoj Agarwal
- Department of Computer Science, Hans Raj College, University of Delhi, Delhi, India.
| | - Naveen Kumar
- Department of Computer Science, University of Delhi, Delhi, India.
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Dwivedi K, Rajpal A, Rajpal S, Kumar V, Agarwal M, Kumar N. Enlightening the path to NSCLC biomarkers: Utilizing the power of XAI-guided deep learning. Comput Methods Programs Biomed 2024; 243:107864. [PMID: 37866126 DOI: 10.1016/j.cmpb.2023.107864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND OBJECTIVE The early diagnosis of Non-small cell lung cancer (NSCLC) is of prime importance to improve the patient's survivability and quality of life. Being a heterogeneous disease at the molecular and cellular level, the biomarkers responsible for the heterogeneity aid in distinguishing NSCLC into its prominent subtypes-adenocarcinoma and squamous cell carcinoma. Moreover, if identified, these biomarkers could pave the path to targeted therapy. Through this work, a novel explainable AI (XAI)-guided deep learning framework is proposed that assists in discovering a set of significant NSCLC-relevant biomarkers using methylation data. METHODS The proposed framework is divided into two blocks- the first block combines an autoencoder and a neural network to classify NSCLC instances. The second block utilizes various eXplainable AI (XAI) methods, namely IntegratedGradients, GradientSHAP, and DeepLIFT, to discover a set of seven significant biomarkers. RESULTS The classification performance of the biomarkers discovered using the proposed framework is evaluated by employing multiple machine learning algorithms, among which the Multilayer Perceptron (MLP) algorithm-based model outperforms others, yielding a 10-fold cross-validation accuracy of 91.53%. An improved accuracy of 96.37% is achieved by integrating RNA-Seq, CNV, and methylation data. On performing statistical analysis using the Friedman and Nemenyi tests, the MLP model is found to be significantly better than other machine learning-based models. Further, the clinical efficacy of the resultant biomarkers is established based on their potential druggability, the likelihood of predicting NSCLC patients' survival, gene-disease association, and biological pathways targeted by them. While the biomarkers C18orf18, CCNT2, THOP1, and TNPO2, are found potentially druggable, the biomarkers CCDC15, SNORA9, THOP1, and TNPO2 are found prognostically relevant. On further analysis, some of the discovered biomarkers are found to be associated with around 104 diseases. Moreover, five KEGG, ten Reactome, and three Wiki pathways are found to be triggered by the biomarkers discovered. CONCLUSION In summary, the proposed framework uncovers a set of clinically effective biomarkers that accurately classify NSCLC. As a future course of work, efforts would be made to combine a variety of omics data with histopathological data to unveil more precise biomarkers for devising personalized therapy.
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Affiliation(s)
- Kountay Dwivedi
- Department of Computer Science, University of Delhi, Delhi, India.
| | - Ankit Rajpal
- Department of Computer Science, University of Delhi, Delhi, India.
| | - Sheetal Rajpal
- Department of Computer Science, Dyal Singh College, Delhi, India.
| | - Virendra Kumar
- Department of Nuclear Magnetic Resonance, All India Institute of Medical Sciences, New Delhi, India.
| | - Manoj Agarwal
- Department of Computer Science, Hans Raj College, University of Delhi, Delhi, India.
| | - Naveen Kumar
- Department of Computer Science, University of Delhi, Delhi, India.
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Reiter K, Butts AM, Janecek JK, Correro AN, Nencka A, Agarwal M, Franczak M, Glass Umfleet L. Relationship between cognitive reserve, brain volume, and neuropsychological performance in amnestic and nonamnestic MCI. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2023; 30:940-956. [PMID: 36573001 DOI: 10.1080/13825585.2022.2161462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
Cognitive Reserve (CR) is a theoretical construct that influences the onset and course of cognitive and structural changes that occur with aging and mild cognitive impairment (MCI). There is a paucity of research that examines the relationship of CR and brain volumes in amnestic (aMCI) and nonamnestic (naMCI) separately. This study is a retrospective chart review of MCI patients who underwent neuropsychological evaluation and brain MRI with NeuroReader™ (NR). NR is an FDA-cleared software that standardizes MRI volumes to a control sample. Classifications of aMCI and naMCI were based on Petersen criteria. CR was measured as education, occupation, and word reading. Data analysis included bivariate correlations between CR, neuropsychological test scores, and NR-brain volumes by MCI subtype. The Benjamini-Hochberg method corrected for multiple comparisons. The sample included 91 participants with aMCI and 41 with naMCI. Within naMCI, positive correlations were observed between CR and whole brain volume, total gray matter, bifrontal, left parietal, left occipital, and bilateral cerebellum. Within aMCI, no significant correlations were observed between CR and brain volumes. Positive correlations with CR were observed in language, attention, and visual learning in both aMCI and naMCI groups. The current study adds to the minimal literature on CR and naMCI. Results revealed that CR is associated with volumetrics in naMCI only, though cognitive findings were similar in both MCI groups. Possible explanations include heterogeneous disease pathologies, disease stage, or a differential influence of CR on volumetrics in MCI. Additional longitudinal and biomarker studies will better elucidate this relationship.
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Affiliation(s)
- K Reiter
- Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - A M Butts
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J K Janecek
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - A N Correro
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - A Nencka
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Agarwal
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Franczak
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - L Glass Umfleet
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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Dwivedi K, Rajpal A, Rajpal S, Agarwal M, Kumar V, Kumar N. An explainable AI-driven biomarker discovery framework for Non-Small Cell Lung Cancer classification. Comput Biol Med 2023; 153:106544. [PMID: 36652866 DOI: 10.1016/j.compbiomed.2023.106544] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/08/2022] [Revised: 12/17/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
Non-Small Cell Lung Cancer (NSCLC) exhibits intrinsic heterogeneity at the molecular level that aids in distinguishing between its two prominent subtypes - Lung Adenocarcinoma (LUAD) and Lung Squamous Cell Carcinoma (LUSC). This paper proposes a novel explainable AI (XAI)-based deep learning framework to discover a small set of NSCLC biomarkers. The proposed framework comprises three modules - an autoencoder to shrink the input feature space, a feed-forward neural network to classify NSCLC instances into LUAD and LUSC, and a biomarker discovery module that leverages the combined network comprising the autoencoder and the feed-forward neural network. In the biomarker discovery module, XAI methods uncovered a set of 52 relevant biomarkers for NSCLC subtype classification. To evaluate the classification performance of the discovered biomarkers, multiple machine-learning models are constructed using these biomarkers. Using 10-Fold cross-validation, Multilayer Perceptron achieved an accuracy of 95.74% (±1.27) at 95% confidence interval. Further, using Drug-Gene Interaction Database, we observe that 14 of the discovered biomarkers are druggable. In addition, 28 biomarkers aid the prediction of the survivability of the patients. Out of 52 discovered biomarkers, we find that 45 biomarkers have been reported in previous studies on distinguishing between the two NSCLC subtypes. To the best of our knowledge, the remaining seven biomarkers have not yet been reported for NSCLC subtyping and could be further explored for their contribution to targeted therapy of lung cancer.
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Affiliation(s)
- Kountay Dwivedi
- Department of Computer Science, University of Delhi, Delhi, India.
| | - Ankit Rajpal
- Department of Computer Science, University of Delhi, Delhi, India.
| | | | | | - Virendra Kumar
- Department of Nuclear Magnetic Resonance Imaging, All India Institute of Medical Sciences, New Delhi, India.
| | - Naveen Kumar
- Department of Computer Science, University of Delhi, Delhi, India.
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5
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Koontz NA, Tomblinson CM, Shatzkes DR, Glastonbury CM, Phillips CD, Dean K, Strauss S, Agarwal M, Robson CD, Wiggins RH. A Gamified Social Media-Based Head and Neck Radiology Education Initiative of the American Society of Head and Neck Radiology: Viewership and Engagement Trends at 3 Years. AJNR Am J Neuroradiol 2022; 43:1784-1791. [PMID: 36456082 DOI: 10.3174/ajnr.a7711] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/21/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND PURPOSE Social media has made inroads in medical education. We report the creation and 3-year (2018-2021) longitudinal assessment of the American Society of Head and Neck Radiology Case of the Week (#ASHNRCOTW), assessing viewership, engagement, and impact of the coronavirus disease 2019 (COVID-19) pandemic on this Twitter-based education initiative. MATERIALS AND METHODS Unknown cases were tweeted from the American Society of Head and Neck Radiology account weekly. Tweet impressions (number of times seen), engagements (number of interactions), and new followers were tabulated. A social media marketing platform identified worldwide distribution of Twitter followers. Summary and t test statistics were performed. RESULTS #ASHNRCOTW was highly visible with 2,082,280 impressions and 203,137 engagements. There were significantly greater mean case impressions (9917 versus 6346), mean case engagements (1305 versus 474), case engagement rates (13.06% versus 7.76%), mean answer impressions (8760 versus 5556), mean answer engagements (908 versus 436), answer engagement rates (10.38% versus 7.87%), mean total (case + answer) impressions (18,677 versus 11,912), mean total engagements (2214 versus 910), and total engagement rates (11.79% versus 7.69%) for cases published after the pandemic started (all P values < .001). There was a significant increase in monthly new followers after starting #ASHNRCOTW (mean, 134 versus 6; P < .001) and significantly increased monthly new followers after the pandemic started compared with prepandemic (mean, 178 versus 101; P = .003). The American Society of Head and Neck Radiology has 7564 Twitter followers throughout 130 countries (66% outside the United States). CONCLUSIONS Social media affords substantial visibility, engagement, and global outreach for radiology education. #ASHNRCOTW viewership and engagement increased significantly during the COVID-19 pandemic.
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Affiliation(s)
- N A Koontz
- From the Department of Radiology and Imaging Sciences (N.A.K.), Indiana University School of Medicine, Indianapolis, Indiana
| | - C M Tomblinson
- Department of Radiology and Radiological Sciences (C.M.T.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - D R Shatzkes
- Department of Radiology (D.R.S.), Lenox Hill Hospital, New York, New York
| | - C M Glastonbury
- Department of Radiology and Biomedical Imaging (C.M.G.), University of California San Francisco, San Francisco, California
| | - C D Phillips
- Department of Radiology (C.D.P., K.D., S.S.), Weill Cornell Medicine, New York, New York
| | - K Dean
- Department of Radiology (C.D.P., K.D., S.S.), Weill Cornell Medicine, New York, New York
| | - S Strauss
- Department of Radiology (C.D.P., K.D., S.S.), Weill Cornell Medicine, New York, New York
| | - M Agarwal
- Department of Radiology (M.A.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - C D Robson
- Department of Radiology and Harvard Medical School (C.D.R.), Boston Children's Hospital, Boston, Massachusetts
| | - R H Wiggins
- Department of Radiology and Imaging Sciences (R.H.W.), University of Utah School of Medicine, Salt Lake City, Utah
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Agarwal M, Liu A, Langlais B, Leventakos K, Yu N, Almquist D, Manochakian R, Ernani V. EP14.05-001 Chemoimmunotherapy as First-Line Treatment for Extensive-Stage Small-Cell Lung Cancer and ECOG Performance Status of 2 or 3. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.976] [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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7
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Tiwari S, Dass J, Vishwanathan G, Dhawan R, Agarwal M, Kumar P, Seth T, Tyagi S, Mahapatra M. P693: DIAGNOSTIC ROLE OF CD26+ LEUKEMIC STEM CELLS IN CHRONIC MYELOID LEUKEMIA. Hemasphere 2022. [DOI: 10.1097/01.hs9.0000845656.78528.24] [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] Open
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Soman B, Cheong MLH, Makuloluwa K, Salem A, Agarwal M, Chattopadhyay S. Does pre-diabetes predict the extent of coronary artery disease? Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.044] [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] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Extensive coronary artery disease (CAD) is common in diabetes mellitus. This relation between the extent of CAD and prediabetes (pDM)is less well established.
Purpose
To explore whether non-diabetic hyperglycaemia, assessed by HbA1c, is associated with extent of angiographic CAD, independent of traditional cardiovascular risk factors.
Methods
Retrospective cohort analysis of consecutive patients, without known DM undergoing coronary angiography for stable angina, who were screened for hyperglycaemia over 18 months. HbA1c was measured; pre-diabetes was defined as HbA1c 5.7-6.4%.Extent of CAD was assessed using the SYNTAX score. Presence of CAD was defined as visually estimated ≥50% luminal obstruction in arteries ≥1.5 mm diameter. Age, BMI, risk factors for CAD, HbA1c, total and LDL-cholesterol were recorded. The pre-diabetes and normal groups were compared using Mann-Whitney test for continuous variables and chi-squared test for categorical variables. Multiple logistic and linear regressions were used to assess the effect variables on SYNTAX score. Spearman rank correlation was used to assess the relation between HbA1c and SYNTAX score.
Results
1071 patients had angiograms done. 207 had DM, 19 had new diagnosis of DM and 181 missed the screening leaving 664 who had HbA1c measured. 51 poor quality angiograms were excluded from SYNTAX calculation. Data was analysed for 613 (306 normal, 307 pDM) patients. The patients with prediabetes were older, had higher prevalence of risk factors, BMI, fasting glucose and SYNTAX score. HbA1c (OR 2.07, 95% CI 1.32 to 3.25, p=0.002) and the presence of pDM (OR 1.89, 95% CI 1.32 to 2.69, p<0.001) independently predicted the presence of CAD. HbA1c (Coefficient 2.42, SE 1.09, p=0.027) and the presence of pDM (Coefficient 2.25, SE 0.92, p=0.015) independently predicted the SYNTAX score. The correlation between HbA1c and SYNTAX score was weak but significant (Spearman's coefficient 0.206, 95% CI 0.129 to 0.281, p<0.0001).
Conclusion
HbA1c predicts the extent of CAD as measured by SYNTAX score in patients without known diabetes. Presence of pre-diabetes is an independent predictor of extent of CAD.
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Affiliation(s)
- B Soman
- Milton Keynes University Hospital NHS Trust, Cardiology, Milton Keynes, United Kingdom of Great Britain & Northern Ireland
| | - MLH Cheong
- Milton Keynes University Hospital NHS Trust, Cardiology, Milton Keynes, United Kingdom of Great Britain & Northern Ireland
| | - K Makuloluwa
- Milton Keynes University Hospital NHS Trust, Cardiology, Milton Keynes, United Kingdom of Great Britain & Northern Ireland
| | - A Salem
- Milton Keynes University Hospital NHS Trust, Cardiology, Milton Keynes, United Kingdom of Great Britain & Northern Ireland
| | - M Agarwal
- Milton Keynes University Hospital NHS Trust, Cardiology, Milton Keynes, United Kingdom of Great Britain & Northern Ireland
| | - S Chattopadhyay
- Milton Keynes University Hospital NHS Trust, Cardiology, Milton Keynes, United Kingdom of Great Britain & Northern Ireland
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9
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Bobholz SA, Lowman AK, Brehler M, Kyereme F, Duenweg SR, Sherman J, McGarry SD, Cochran EJ, Connelly J, Mueller WM, Agarwal M, Banerjee A, LaViolette PS. Radio-Pathomic Maps of Cell Density Identify Brain Tumor Invasion beyond Traditional MRI-Defined Margins. AJNR Am J Neuroradiol 2022; 43:682-688. [PMID: 35422419 PMCID: PMC9089258 DOI: 10.3174/ajnr.a7477] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 10/08/2021] [Accepted: 02/07/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Currently, contrast-enhancing margins on T1WI are used to guide treatment of gliomas, yet tumor invasion beyond the contrast-enhancing region is a known confounding factor. Therefore, this study used postmortem tissue samples aligned with clinically acquired MRIs to quantify the relationship between intensity values and cellularity as well as to develop a radio-pathomic model to predict cellularity using MR imaging data. MATERIALS AND METHODS This single-institution study used 93 samples collected at postmortem examination from 44 patients with brain cancer. Tissue samples were processed, stained with H&E, and digitized for nuclei segmentation and cell density calculation. Pre- and postgadolinium contrast T1WI, T2 FLAIR, and ADC images were collected from each patient's final acquisition before death. In-house software was used to align tissue samples to the FLAIR image via manually defined control points. Mixed-effects models were used to assess the relationship between single-image intensity and cellularity for each image. An ensemble learner was trained to predict cellularity using 5 × 5 voxel tiles from each image, with a two-thirds to one-third train-test split for validation. RESULTS Single-image analyses found subtle associations between image intensity and cellularity, with a less pronounced relationship in patients with glioblastoma. The radio-pathomic model accurately predicted cellularity in the test set (root mean squared error = 1015 cells/mm2) and identified regions of hypercellularity beyond the contrast-enhancing region. CONCLUSIONS A radio-pathomic model for cellularity trained with tissue samples acquired at postmortem examination is able to identify regions of hypercellular tumor beyond traditional imaging signatures.
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Affiliation(s)
- S A Bobholz
- From the Departments of Biophysics (S.A.B., S.R.D., J.S., S.D.M.)
| | | | - M Brehler
- Radiology (A.L., M.B., M.A., P.S.L.)
| | | | - S R Duenweg
- From the Departments of Biophysics (S.A.B., S.R.D., J.S., S.D.M.)
| | - J Sherman
- From the Departments of Biophysics (S.A.B., S.R.D., J.S., S.D.M.)
| | - S D McGarry
- From the Departments of Biophysics (S.A.B., S.R.D., J.S., S.D.M.)
| | | | | | | | - M Agarwal
- Radiology (A.L., M.B., M.A., P.S.L.)
| | | | - P S LaViolette
- Radiology (A.L., M.B., M.A., P.S.L.)
- Biomedical Engineering (P.S.L.), Medical College of Wisconsin, Milwaukee, Wisconsin
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Hoda Siddiqui A, Agarwal M, Dixit N. Nocardial pneumonia as an opportunistic infection in Covid treated patient. Indian J Tuberc 2022; 69:120-122. [PMID: 35074145 PMCID: PMC8378014 DOI: 10.1016/j.ijtb.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/12/2021] [Indexed: 11/04/2022]
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11
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Agarwal M, Shukla R, Dwivedi S, Saxena R, Luthra K, Kabra M, Seth R. Gene copy number alterations in Indian children with B-acute Lymphoblastic Leukemia: Correlation with survival outcome. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2021.11.006] [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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12
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Salerno M, Williams G, Scheuermann R, Kennedy C, Agarwal M, Green W, Gu W, Zhang Z, Lin H, Carlson D, Dong L, Metz J, Li T. Deploying a Single-Energy O-Ring Linac as the Sole Treatment Machine in a Community Setting: A Feasibility Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1408] [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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13
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Agarwal D, Agarwal M, Chandra M, Mishra A, Agarwal R. Knowledge assessment and outcomes of otolaryngology practice amidst the COVID-19 pandemic in a busy ENT department. Ann R Coll Surg Engl 2021; 103:589-598. [PMID: 34464553 DOI: 10.1308/rcsann.2021.0004] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Otolaryngology health personnel are at high risk of acquiring COVID-19 disease and, hence, are likely to have high stress levels. This study was designed to evaluate the feedback of otolaryngology healthcare workers in ENT departments who are managing patients in the coronavirus pandemic. METHODS A questionnaire focused on all aspects of healthcare delivery was completed by otolaryngology healthcare workers. RESULTS The findings, based on statistical analyses, included high stress levels and inadequate disease-related information in these workers. CONCLUSIONS Healthcare authorities need to take care of issues related to mental health in healthcare professionals in addition to spreading awareness about safe practices. Further studies are needed to continuously monitor feedback from personnel as the coronavirus pandemic unravels in the future.
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Affiliation(s)
- D Agarwal
- King George's Medical University, Lucknow, India
| | - M Agarwal
- Intern, Era's Lucknow Medical College, Lucknow, India
| | - M Chandra
- King George's Medical University, Lucknow, India
| | - A Mishra
- King George's Medical University, Lucknow, India
| | - R Agarwal
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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14
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Agarwal M, Pandey S, Kumar P, Gupta L. Shunt in scrotum: unusual shunt complication in an operated case of post TBM hydrocephalus. roneuro 2021. [DOI: 10.33962/roneuro-2021-037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The role of shunt placement is to divert cerebrospinal fluid (CSF) from within the ventricles to an alternative location most commonly peritoneal space. Ventriculo Peritoneal Shunt (VPS) is associated with many complications viz over drainage, valve failure, breaking of catheter, catheter obstruction, coiling of catheter, spontaneous knot formation, infection and migration of distal catheter and all of them finally leading to obstructive hydrocephalus. One such complication is distal catheter migration to a rare but possible site i.e. scrotum. We reported a case of scrotal migration of shunt as a late complication of VPS insertion.
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15
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Affiliation(s)
- A Agarwal
- Department of Internal Medicine, Fortis Escorts Hospital, Jaipur, India
| | - M Agarwal
- All India Institute of Medical Sciences, New Delhi, India
| | - A Sharma
- Department of Internal Medicine, Fortis Escorts Hospital, Jaipur, India
| | - R Jakhar
- Department of Internal Medicine, Fortis Escorts Hospital, Jaipur, India
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16
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Agarwal M, Muthunagai R, Nautiyal VP, Singh A. Re: Intraconal orbital displacement of a dental implant treated with an endoscopically-assisted approach. Br J Oral Maxillofac Surg 2020; 59:614. [PMID: 33863592 DOI: 10.1016/j.bjoms.2020.12.004] [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] [Received: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Affiliation(s)
- M Agarwal
- Department of Oral & Maxillofacial Surgery, Seema Dental College & Hospital, Rishikesh, Uttrakhand, India.
| | - R Muthunagai
- Department of Oral & Maxillofacial Surgery, Seema Dental College & Hospital, Rishikesh, Uttrakhand, India
| | - V P Nautiyal
- Manya Dental Hospital, Dehradun, Uttrakhand, India
| | - A Singh
- Department of Dentistry, Dr. Yaswant Singh Parmar Government Medical College, Nahan, Himachal Pradesh, India
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Gosain P, Agarwal M, Bhargava M. Development and characterization of an aerodynamic system for pulmonary delivery of influenza vaccine. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1266] [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] Open
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Jajodia A, Amrith B, Madhukar A, Chaturvedi A, Mehta A, Kapur R, Dewan A, Agarwal M, Mahwar V, Yadav V, Pasricha S, Koyyala V. 286P Improved diagnostic accuracy on MR imaging in post-surgical recurrent head and neck SCC lesions using decision tree classification system. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.280] [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] Open
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BL, Tseu B, Wei R, Yang N, Britton N, Leinhardt D, Mahfooz M, Palkhi A, Price M, Sheikh S, Barker M, Bowley D, Cant M, Datta U, Farooqi M, Lee A, Morley G, Amin MN, Parry A, Patel S, Strang S, Yoganayagam N, Adlan A, Chandramoorthy S, Choudhary Y, Das K, Feldman M, France B, Grace R, Puddy H, Soor P, Ali M, Dhillon P, Faraj A, Gerard L, Glover M, Imran H, Kim S, Patrick Y, Peto J, Prabhudesai A, Smith R, Tang A, Vadgama N, Dhaliwal R, Ecclestone T, Harris A, Ong D, Patel D, Philp C, Stewart E, Wang L, Wong E, Xu Y, Ashaye T, Fozard T, Galloway F, Kaptanis S, Mistry P, Nguyen T, Olagbaiye F, Osman M, Philip Z, Rembacken R, Tayeh S, Theodoropoulou K, Herman A, Lau J, Saha A, Trotter M, Adeleye O, Cave D, Gunwa T, Magalhães J, Makwana S, Mason R, Parish M, Regan H, Renwick P, Roberts G, Salekin D, Sivakumar C, Tariq A, Liew I, McDade A, Stewart D, Hague M, Hudson-Peacock N, Jackson CES, James F, Pitt J, Walker EY, Aftab R, Ang JJ, Anwar S, Battle J, Budd E, Chui J, Crook H, Davies P, 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M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Bhatt RK, Agarwal M. Study of Spectrum of Chromosomal Rearrangements in Recurrent Pregnancy Loss. J Obstet Gynaecol India 2020; 70:189-194. [PMID: 32476764 DOI: 10.1007/s13224-020-01305-9] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/20/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Recurrent pregnancy losses (RPLs) are seen in up to 15-20% of all clinically recognized pregnancies, 1-2% of women in general population. Repeated losses are seen in 5-10% of women. The prevalence of chromosomal rearrangements is 6.65% in couples with repeated pregnancy losses. Two to 4% of RPL are associated with parental balanced reciprocal and Robertsonian translocations. Materials and Methods The study was conducted at a tertiary care hospital in New Delhi, and in total, 204 couples with RPL enrolled in the study. Results In total, 4490 couples presented to the obstetric clinic, of which 204 (4.5%) couples had repeated pregnancy losses. Cytogenetic analysis was done in 198 couples. Out of total 198 patients, 14 patients (7.1%) had cytogenetic alterations. Most common aberrations observed were structural rearrangements, of which reciprocal translocations were more common. In our study cohort, all the couples had maternal age of ≤ 35 years and all the alterations were seen either in mother or in both parents. Discussion Our study highlights that cytogenetic alterations not only are common in first trimester miscarriages, but are an important event in miscarriages presenting at later period of gestation and in young mothers as well.
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Affiliation(s)
- R K Bhatt
- 1Department of Obstetrics and Gynaecology, Army Hospital Research and Referral, New Delhi, India
| | - M Agarwal
- 2Department of Lab Sciences and Molecular Medicine, Army Hospital Research and Referral, New Delhi, India
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Agarwal M, Tewari R, Shijith K, Guleria P, Tathagata C. Congenital infantile myofibroma; case report and review of literature. Human Pathology: Case Reports 2020. [DOI: 10.1016/j.ehpc.2020.200363] [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] Open
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Rosenthal VD, Bat-Erdene I, Gupta D, Rajhans P, Myatra SN, Muralidharan S, Mehta Y, Rai V, Hung NV, Luxsuwong M, Tapang ARD, Guo X, Trotter A, Kharbanda M, Rodrigues C, Dwivedy A, Shah S, Poojary A, Todi SK, Chabukswar S, Bhattacharyya M, Ramachandran B, Ramakrishnan N, Purkayasta SK, Sakle AS, Kumar S, Warrier AR, Kavathekar MS, Sahu S, Mubarak A, Modi N, Jaggi N, Gita N, Mishra SB, Sahu S, Jawadwala B, Zala D, Zompa T, Mathur P, Nirkhiwale S, Vadi S, Singh S, Agarwal M, Sen N, Karlekar A, Punia DP, Kumar S, Gopinath R, Nair PK, Gan CS, Chakravarthy M, Sandhu K, Kambam C, Mohanty SK, Varaiya A, Pandya N, Subhedar VR, Vanajakshi MR, Singla D, Tuvshinbayar M, Patel M, Ye G, Lum LCS, Zaini RHM, Batkhuu B, Dayapera KM, Nguyet LT, Berba R, Buenaflor MCS, Ng JA, Siriyakorn N, Thu LTA. Six-year study on peripheral venous catheter-associated BSI rates in 262 ICUs in eight countries of South-East Asia: International Nosocomial Infection Control Consortium findings. J Vasc Access 2020; 22:34-41. [PMID: 32406328 DOI: 10.1177/1129729820917259] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Short-term peripheral venous catheter-associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter-associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available. METHODS Prospective, surveillance study on peripheral venous catheter-associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. RESULTS We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter-associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter-associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter-associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: Escherichia coli (22.9%), Klebsiella spp (10.7%), Pseudomonas aeruginosa (5.3%), Enterobacter spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were Staphylococcus aureus (11.4%). CONCLUSIONS Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter-associated bloodstream infections.
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Affiliation(s)
| | - Ider Bat-Erdene
- Infection Control Professionals of Mongolia, and Intermed Hospital, Ulaanbaatar, Mongolia
| | - Debkishore Gupta
- BM Birla Heart Research Centre, Kolkata, India.,The Calcutta Medical Research Institute, Kolkata, India
| | | | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - S Muralidharan
- G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | | | - Vineya Rai
- Adult Intensive Care Unit, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | - Xiuqin Guo
- Dong E Peoples Hospital, Shandong, P.R. China
| | | | | | - Camilla Rodrigues
- P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | - Sweta Shah
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | | | | | | | | | | | | | | | - Siva Kumar
- Kovai Medical Center and Hospital, Coimbatore, India
| | | | | | | | - Aisha Mubarak
- Kerala Institute of Medical Sciences, Thiruvananthapuram, India
| | - Nikhil Modi
- Indraprastha Apollo Hospital, New Delhi, India
| | | | | | | | | | | | | | - Tenzin Zompa
- Max Super Speciality Hospital, Dehradun, Dehradun, India
| | | | | | | | - Sanjeev Singh
- Amrita Institute of Medical Sciences and Research Center, Kochi, India
| | | | | | - Anil Karlekar
- Escorts Heart Institute & Research Centre, New Delhi, India
| | - D P Punia
- Mahatma Gandhi Hospital, Jaipur, India
| | | | | | | | - Chin Seng Gan
- Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Kavita Sandhu
- Max Super Speciality Hospital, Saket, New Delhi, India
| | | | | | - Ami Varaiya
- Dr. Balabhai Nanavati Super Speciality Hospital, Mumbai, India
| | | | | | - M R Vanajakshi
- Columbia Asia Referral Hospital-Yeshwanthpur, Bangalore, India
| | | | | | - Mayur Patel
- Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | | | - Lucy Chai See Lum
- Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | | | - Regina Berba
- Philippine General Hospital, Manila, Philippines
| | | | | | | | - Le Thi Anh Thu
- Cho Ray Hospital, Ho Chi Minh City, Vietnam.,For a list of the remaining co-authors of this study, see Appendix 1
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Rosenthal VD, Bat-Erdene I, Gupta D, Belkebir S, Rajhans P, Zand F, Myatra SN, Afeef M, Tanzi VL, Muralidharan S, Gurskis V, Al-Abdely HM, El-Kholy A, AlKhawaja SAA, Sen S, Mehta Y, Rai V, Hung NV, Sayed AF, Guerrero-Toapanta FM, Elahi N, Morfin-Otero MDR, Somabutr S, De-Carvalho BM, Magdarao MS, Velinova VA, Quesada-Mora AM, Anguseva T, Ikram A, Aguilar-de-Moros D, Duszynska W, Mejia N, Horhat FG, Belskiy V, Mioljevic V, Di-Silvestre G, Furova K, Gamar-Elanbya MO, Gupta U, Abidi K, Raka L, Guo X, Luque-Torres MT, Jayatilleke K, Ben-Jaballah N, Gikas A, Sandoval-Castillo HR, Trotter A, Valderrama-Beltrán SL, Leblebicioglu H, Riera F, López M, Maurizi D, Desse J, Pérez I, Silva G, Chaparro G, Golschmid D, Cabrera R, Montanini A, Bianchi A, Vimercati J, Rodríguez-del-Valle M, Domínguez C, Saul P, Chediack V, Piastrelini M, Cardena L, Ramasco L, Olivieri M, Gallardo P, Juarez P, Brito M, Botta P, Alvarez G, Benchetrit G, Caridi M, Stagnaro J, Bourlot I, García M, Arregui N, Saeed N, Abdul-Aziz S, ALSayegh S, Humood M, Mohamed-Ali K, Swar S, Magray T, Aguiar-Portela T, Sugette-de-Aguiar T, Serpa-Maia F, Fernandes-Alves-de-Lima L, Teixeira-Josino L, Sampaio-Bezerra M, Furtado-Maia R, Romário-Mendes A, Alves-De-Oliveira A, Vasconcelos-Carneiro A, Anjos-Lima JD, Pinto-Coelho K, Maciel-Canuto M, Rocha-Batista M, Moreira T, Rodrigues-Amarilo N, Lima-de-Barros T, Guimarães KA, Batista C, Santos C, de-Lima-Silva F, Santos-Mota E, Karla L, Ferreira-de-Souza M, Luzia N, de-Oliveira S, Takeda C, Azevedo-Ferreira-Lima D, Faheina J, Coelho-Oliveira L, do-Nascimento S, Machado-Silva V, Bento-Ferreira, Olszewski J, Tenorio M, Silva-Lemos A, Ramos-Feijó C, Cardoso D, Correa-Barbosa M, Assunção-Ponte G, Faheina J, da-Silva-Escudero D, Servolo-Medeiros E, Andrade-Oliveira-Reis M, Kostadinov E, Dicheva V, Petrov M, Guo C, Yu H, Liu T, Song G, Wang C, Cañas-Giraldo L, Marin-Tobar D, Trujillo-Ramirez E, Andrea-Rios P, Álvarez-Moreno C, Linares C, González-Rubio P, Ariza-Ayala B, Gamba-Moreno L, Gualtero-Trujill S, Segura-Sarmiento S, Rodriguez-Pena J, Ortega R, Olarte N, Pardo-Lopez Y, Luis Marino Otela-Baicue A, Vargas-Garcia A, Roncancio E, Gomez-Nieto K, Espinosa-Valencia M, Barahona-Guzman N, Avila-Acosta C, Raigoza-Martinez W, Villamil-Gomez W, Chapeta-Parada E, Mindiola-Rochel A, Corchuelo-Martinez A, Martinez A, Lagares-Guzman A, Rodriguez-Ferrer M, Yepes-Gomez D, Muñoz-Gutierrez G, Arguello-Ruiz A, Zuniga-Chavarria M, Maroto-Vargas L, Valverde-Hernández M, Solano-Chinchilla A, Calvo-Hernandez I, Chavarria-Ugalde O, Tolari G, Rojas-Fermin R, Diaz-Rodriguez C, Huascar S, Ortiz M, Bovera M, Alquinga N, Santacruz G, Jara E, Delgado V, Salgado-Yepez E, Valencia F, Pelaez C, Gonzalez-Flores H, Coello-Gordon E, Picoita F, Arboleda M, Garcia M, Velez J, Valle M, Unigarro L, Figueroa V, Marin K, Caballero-Narvaez H, Bayani V, Ahmed S, Alansary A, Hassan A, Abdel-Halim M, El-Fattah M, Abdelaziz-Yousef R, Hala A, Abdelhady K, Ahmed-Fouad H, Mounir-Agha H, Hamza H, Salah Z, Abdel-Aziz D, Ibrahim S, Helal A, AbdelMassih A, Mahmoud AR, Elawady B, El-sherif R, Fattah-Radwan Y, Abdel-Mawla T, Kamal-Elden N, Kartsonaki M, Rivera D, Mandal S, Mukherjee S, Navaneet P, Padmini B, Sorabjee J, Sakle A, Potdar M, Mane D, Sale H, Abdul-Gaffar M, Kazi M, Chabukswar S, Anju M, Gaikwad D, Harshe A, Blessymole S, Nair P, Khanna D, Chacko F, Rajalakshmi A, Mubarak A, Kharbanda M, Kumar S, Mathur P, Saranya S, Abubakar F, Sampat S, Raut V, Biswas S, Kelkar R, Divatia J, Chakravarthy M, Gokul B, Sukanya R, Pushparaj L, Thejasvini A, Rangaswamy S, Saini N, Bhattacharya C, Das S, Sanyal S, Chaudhury B, Rodrigues C, Khanna G, Dwivedy A, Binu S, Shetty S, Eappen J, Valsa T, Sriram A, Todi S, Bhattacharyya M, Bhakta A, Ramachandran B, Krupanandan R, Sahoo P, Mohanty N, Sahu S, Misra S, Ray B, Pattnaik S, Pillai H, Warrier A, Ranganathan L, Mani A, Rajagopal S, Abraham B, Venkatraman R, Ramakrishnan N, Devaprasad D, Siva K, Divekar D, Satish Kavathekar M, Suryawanshi M, Poojary A, Sheeba J, Patil P, Kukreja S, Varma K, Narayanan S, Sohanlal T, Agarwal A, Agarwal M, Nadimpalli G, Bhamare S, Thorat S, Sarda O, Nadimpalli P, Nirkhiwale S, Gehlot G, Bhattacharya S, Pandya N, Raphel A, Zala D, Mishra S, Patel M, Aggarwal D, Jawadwal B, Pawar N, Kardekar S, Manked A, Tamboli A, Manked A, Khety Z, Singhal T, Shah S, Kothari V, Naik R, Narain R, Sengupta S, Karmakar A, Mishra S, Pati B, Kantroo V, Kansal S, Modi N, Chawla R, Chawla A, Roy I, Mukherjee S, Bej M, Mukherjee P, Baidya S, Durell A, Vadi S, Saseedharan S, Anant P, Edwin J, Sen N, Sandhu K, Pandya N, Sharma S, Sengupta S, Palaniswamy V, Sharma P, Selvaraj M, Saurabh L, Agarwal M, Punia D, Soni D, Misra R, Harsvardhan R, Azim A, Kambam C, Garg A, Ekta S, Lakhe M, Sharma C, Singh G, Kaur A, Singhal S, Chhabra K, Ramakrishnan G, Kamboj H, Pillai S, Rani P, Singla D, Sanaei A, Maghsudi B, Sabetian G, Masjedi M, Shafiee E, Nikandish R, Paydar S, Khalili H, Moradi A, Sadeghi P, Bolandparvaz S, Mubarak S, Makhlouf M, Awwad M, Ayyad O, Shaweesh A, Khader M, Alghazawi A, Hussien N, Alruzzieh M, Mohamed Y, ALazhary M, Abdul Aziz O, Alazmi M, Mendoza J, De Vera P, Rillorta A, de Guzman M, Girvan M, Torres M, Alzahrani N, Alfaraj S, Gopal U, Manuel M, Alshehri R, Lessing L, Alzoman H, Abdrahiem J, Adballah H, Thankachan J, Gomaa H, Asad T, AL-Alawi M, Al-Abdullah N, Demaisip N, Laungayan-Cortez E, Cabato A, Gonzales J, Al Raey M, Al-Darani S, Aziz M, Al-Manea B, Samy E, AlDalaton M, Alaliany M, Alabdely H, Helali N, Sindayen G, Malificio A, Al-Dossari H, Kelany A, Algethami A, Mohamed D, Yanne L, Tan A, Babu S, Abduljabbar S, Al-Zaydani M, Ahmed H, Al Jarie A, Al-Qathani A, Al-Alkami H, AlDalaton M, Alih S, Alaliany M, Gasmin-Aromin R, Balon-Ubalde E, Diab H, Kader N, Hassan-Assiry I, Kelany A, Albeladi E, Aboushoushah S, Qushmaq N, Fernandez J, Hussain W, Rajavel R, Bukhari S, Rushdi H, Turkistani A, Mushtaq J, Bohlega E, Simon S, Damlig E, Elsherbini S, Abraham S, Kaid E, Al-Attas A, Hawsawi G, Hussein B, Esam B, Caminade Y, Santos A, Abdulwahab M, Aldossary A, Al-Suliman S, AlTalib A, Albaghly N, HaqlreMia M, Kaid E, Altowerqi R, Ghalilah K, Alradady M, Al-Qatri A, Chaouali M, Shyrine E, Philipose J, Raees M, AbdulKhalik N, Madco M, Acostan C, Safwat R, Halwani M, Abdul-Aal N, Thomas A, Abdulatif S, Ali-Karrar M, Al-Gosn N, Al-Hindi A, Jaha R, AlQahtani S, Ayugat E, Al-Hussain M, Aldossary A, Al-Suliman S, Al-Talib A, Albaghly N, Haqlre-Mia M, Briones S, Krishnan R, Tabassum K, Alharbi L, Madani A, Al-Hindi A, Al-Gethamy M, Alamri D, Spahija G, Gashi A, Kurian A, George S, Mohamed A, Ramapurath R, Varghese S, Abdo N, Foda-Salama M, Al-Mousa H, Omar A, Salama M, Toleb M, Khamis S, Kanj S, Zahreddine N, Kanafani Z, Kardas T, Ahmadieh R, Hammoud Z, Zeid I, Al-Souheil A, Ayash H, Mahfouz T, Kondratas T, Grinkeviciute D, Kevalas R, Dagys A, Mitrev Z, Bogoevska-Miteva Z, Jankovska K, Guroska S, Petrovska M, Popovska K, Ng C, Hoon Y, Hasan YM, Othman-Jailani M, Hadi-Jamaluddin M, Othman A, Zainol H, Wan-Yusoff W, Gan C, Lum L, Ling C, Aziz F, Zhazali R, Abud-Wahab M, Cheng T, Elghuwael I, Wan-Mat W, Abd-Rahman R, Perez-Gomez H, Kasten-Monges M, Esparza-Ahumada S, Rodriguez-Noriega E, Gonzalez-Diaz E, Mayoral-Pardo D, Cerero-Gudino A, Altuzar-Figueroa M, Perez-Cruz J, Escobar-Vazquez M, Aragon D, Coronado-Magana H, Mijangos-Mendez J, Corona-Jimenez F, Aguirre-Avalos G, Lopez-Mateos A, Martinez-Marroquin M, Montell-Garcia M, Martinez-Martinez A, Leon-Sanchez E, Gomez-Flores G, Ramirez M, Gomez M, Lozano M, Mercado V, Zamudio-Lugo I, Gomez-Gonzalez C, Miranda-Novales M, Villegas-Mota I, Reyes-Garcia C, Ramirez-Morales M, Sanchez-Rivas M, Cureno-Diaz M, Matias-Tellez B, Gonzalez-Martinez J, Juarez-Vargas R, Pastor-Salinas O, Gutierrez-Munoz V, Conde-Mercado J, Bruno-Carrasco G, Manrique M, Monroy-Colin V, Cruz-Rivera Z, Rodriguez-Pacheco J, Cruz N, Hernandez-Chena B, Guido-Ramirez O, Arteaga-Troncoso G, Guerra-Infante F, Lopez-Hurtado M, Caleco JD, Leyva-Medellin E, Salamanca-Meneses A, Cosio-Moran C, Ruiz-Rendon R, Aguilar-Angel L, Sanchez-Vargas M, Mares-Morales R, Fernandez-Alvarez L, Castillo-Cruz B, Gonzalez-Ma M, Zavala-Ramír M, Rivera-Reyna L, del-Moral-Rossete L, Lopez-Rubio C, Valadez-de-Alba M, Bat-Erdene A, Chuluunchimeg K, Baatar O, Batkhuu B, Ariyasuren Z, Bayasgalan G, Baigalmaa S, Uyanga T, Suvderdene P, Enkhtsetseg D, Suvd-Erdene D, Chimedtseye E, Bilguun G, Tuvshinbayar M, Dorj M, Khajidmaa T, Batjargal G, Naranpurev M, Bat-Erdene A, Bolormaa T, Battsetseg T, Batsuren C, Batsaikhan N, Tsolmon B, Saranbaatar A, Natsagnyam P, Nyamdawa O, Madani N, Abouqal R, Zeggwagh A, Berechid K, Dendane T, Koirala A, Giri R, Sainju S, Acharya S, Paul N, Parveen A, Raza A, Nizamuddin S, Sultan F, Imran X, Sajjad R, Khan M, Sana F, Tayyab N, Ahmed A, Zaman G, Khan I, Khurram F, Hussain A, Zahra F, Imtiaz A, Daud N, Sarwar M, Roop Z, Yusuf S, Hanif F, Shumaila X, Zeb J, Ali S, Demas S, Ariff S, Riaz A, Hussain A, Kanaan A, Jeetawi R, Castaño E, Moreno-Castillo L, García-Mayorca E, Prudencio-Leon W, Vivas-Pardo A, Changano-Rodriguez M, Castillo-Bravo L, Aibar-Yaranga K, Marquez-Mondalgo V, Mueras-Quevedo J, Meza-Borja C, Flor J, Fernandez-Camacho Y, Banda-Flores C, Pichilingue-Chagray J, Castaneda-Sabogal A, Caoili J, Mariano M, Maglente R, Santos S, de-Guzman G, Mendoza M, Javellana O, Tajanlangit A, Tapang A, Sg-Buenaflor M, Labro E, Carma R, Dy A, Fortin J, Navoa-Ng J, Cesar J, Bonifacio B, Llames M, Gata H, Tamayo A, Calupit H, Catcho V, Bergosa L, Abuy M, Barteczko-Grajek B, Rojek S, Szczesny A, Domanska M, Lipinska G, Jaroslaw J, Wieczoreka A, Szczykutowicza A, Gawor M, Piwoda M, Rydz-Lutrzykowska J, Grudzinska M, Kolat-Brodecka P, Smiechowicz K, Tamowicz B, Mikstacki A, Grams A, Sobczynski P, Nowicka M, Kretov V, Shalapuda V, Molkov A, Puzanov S, Utkin I, Tchekulaev A, Tulupova V, Vasiljevic S, Nikolic L, Ristic G, Eremija J, Kojovic J, Lekic D, Simic A, Hlinkova S, Lesnakova A, Kadankunnel S, Abdo-Ali M, Pimathai R, Wanitanukool S, Supa N, Prasan P, Luxsuwong M, Khuenkaew Y, Lamngamsupha J, Siriyakorn N, Prasanthai V, Apisarnthanarak A, Borgi A, Bouziri A, Cabadak H, Tuncer G, Bulut C, Hatipoglu C, Sebnem F, Demiroz A, Kaya A, Ersoz G, Kuyucu N, Karacorlu S, Oncul O, Gorenek L, Erdem H, Yildizdas D, Horoz O, Guclu E, Kaya G, Karabay O, Altindis M, Oztoprak N, Sahip Y, Uzun C, Erben N, Usluer G, Ozgunes I, Ozcelik M, Ceyda B, Oral M, Unal N, Cigdem Y, Bayar M, Bermede O, Saygili S, Yesiler I, Memikoglu O, Tekin R, Oncul A, Gunduz A, Ozdemir D, Geyik M, Erdogan S, Aygun C, Dilek A, Esen S, Turgut H, Sungurtekin H, Ugurcan D, Yarar V, Bilir Y, Bayram N, Devrim I, Agin H, Ceylan G, Yasar N, Oruc Y, Ramazanoglu A, Turhan O, Cengiz M, Yalcin A, Dursun O, Gunasan P, Kaya S, Senol G, Kocagoz A, Al-Rahma H, Annamma P, El-Houfi A, Vidal H, Perez F, D-Empaire G, Ruiz Y, Hernandez D, Aponte D, Salinas E, Vidal H, Navarrete N, Vargas R, Sanchez E, Ngo Quy C, Thu T, Nguyet L, Hang P, Hang T, Hanh T, Anh D. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module. Am J Infect Control 2020; 48:423-432. [PMID: 31676155 DOI: 10.1016/j.ajic.2019.08.023] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. METHODS During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied. RESULTS Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher. CONCLUSIONS Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.
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Dorritie R, Quigley DD, Agarwal M, Tark A, Dick A, Stone PW. Support of nursing homes in infection management varies by US State Departments of Health. J Hosp Infect 2020; 105:258-264. [PMID: 32068013 DOI: 10.1016/j.jhin.2020.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/09/2019] [Accepted: 02/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In many countries, healthcare-associated infections (HAIs) are problematic in long-term aged care living facilities. In the United States (US), HAIs occur frequently in nursing homes (NHs). Identifying effective practices for state Departments of Health (DOHs) to help NHs improve infection prevention and control and reduce HAIs is necessary. AIM As a first step, the objective was to systematically examine and catalogue the variations in state intentions and activities related to HAI prevention in NHs. METHODS An environmental scan of state DOH websites, HAI plans, and HAI state infographics was conducted. Data were collected on 16 items across three domains: (1) intentions to reduce HAIs in NHs, (2) actions to reduce HAIs in NHs, and (3) website usability. FINDINGS State infection control support for NHs varied widely. Most states (92%) mentioned NHs in their HAI plans and 76% included NHs in their infographic. Half has an HAI prevention advisory council, while one-third had a state HAI prevention collaborative. Only 57% of HAI plans that mentioned NHs included training materials on HAI reduction. The most common training available was on antibiotic stewardship. CONCLUSION Many US states have room for improvement in the support they provide NHs regarding infection prevention and control. Specific areas of improvement include: (1) increased provision of training materials on HAI reduction, (2) focusing training materials on common HAIs, and (3) NH engagement in collaboratives aimed at HAI reduction. More research is needed linking DOH activities to resident outcomes.
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Affiliation(s)
- R Dorritie
- Helene Fuld College of Nursing, New York, NY, USA
| | | | - M Agarwal
- Helene Fuld College of Nursing, New York, NY, USA
| | - A Tark
- Helene Fuld College of Nursing, New York, NY, USA
| | - A Dick
- RAND Corporation, Boston, MA, USA
| | - P W Stone
- Helene Fuld College of Nursing, New York, NY, USA
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Kumar N, Agarwal M, Deshmukh S, Gupta S. MOEA for discovering Pareto-optimal process models: an experimental comparison. IJCSE 2020. [DOI: 10.1504/ijcse.2020.10027621] [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: 11/21/2022]
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Saxena A, Tiwari M, Kumar R, Aprajita, Kumar A, Singh C, Agarwal M. Research Article Impact of the Y-chromosome gene on SOX9 stem cell expression in non-obstructive azoospermic cases. Genet Mol Res 2020. [DOI: 10.4238/gmr18464] [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: 11/10/2022]
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Franchi F, Rollini F, Kairouz V, Rivas J, Rivas A, Agarwal M, Briceno M, Wali M, Nawaz A, Silva G, Shaikh Z, Soffer D, Zenni MM, Bass TA, Angiolillo DJ. P1930Pharmacodynamic effects of vorapaxar as an add-on antiplatelet therapy in patients with and without diabetes mellitus: the optimizing anti-platelet therapy in diabetes mellitus (OPTIMUS)-5 study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0677] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vorapaxar (Vora) is a protease-activated receptor (PAR)-1 inhibitor which when added to dual antiplatelet therapy (DAPT) in patients with a history of myocardial infarction (MI) or with peripheral arterial (PAD) reduces thrombotic cardiovascular events at the expense of increased bleeding. The efficacy of Vora is enhanced in patients with diabetes mellitus (DM) compared to non-DM. However, the differential pharmacodynamic (PD) effects of Vora in DM vs non-DM patients are unknown. Moreover, although withdrawal of aspirin has emerged as a strategy to reduce bleeding when adjunctive antithrombotic therapies are used, the PD effects of Vora after stopping aspirin in DAPT treated patients is unknown.
Purpose
To assess the PD effects of Vora in addition to standard DAPT as well as in combination with clopidogrel following aspirin withdrawal in patients with and without DM.
Methods
This was a prospective parallel-design PD study conducted in post-MI or PAD patients with and without DM. Patients on DAPT with aspirin (81mg/qd) and clopidogrel (75mg/qd) were divided in two groups according to DM status. Each cohort was treated with Vora (2.5mg/qd) in addition to DAPT (i.e., triple therapy) for 30 days and afterwards stopped aspirin and maintained treatment with Vora plus clopidogrel (i.e., dual therapy) for other 30 days. PD testing using 5 different assays was conducted at 3 time-points: baseline (while on DAPT); after 30 days of triple therapy; after 30 days of dual therapy. The primary endpoint was the non-inferiority of CAT (Collagen-ADP-TRAP)-induced aggregation, a marker of global platelet reactivity, of Vora plus clopidogrel (dual therapy) vs Vora plus DAPT (triple therapy).
Results
The PD population was composed of a total of 64 patients (DM, n=30; non-DM, n=34). Although adding Vora to DAPT significantly reduced CAT-induced aggregation, stopping aspirin was associated with an increase in CAT-induced aggregation in both DM (mean difference=12; 95% CI: 3 to 21; p=0.010) and non-DM (mean difference=10; 95% CI: 4 to 16; p=0.003), thus not meeting the primary endpoint of non-inferiority (Figure). The magnitude of such increase was higher in DM compared with non-DM (p=0.036). Although Vora abolished TRAP-induced aggregation in both DM and non-DM patients, it did not affect markers of clot kinetics including speed of thrombin generation. Aspirin withdrawal was associated with a marked increase in makers sensitive to cyclooxygenase-1 (COX-1) blockade; markers of P2Y12 signaling were higher in DM compared to not DM after aspirin withdrawal.
CAT-induced aggregation
Conclusion
Adjunctive treatment with Vora reduces platelet-mediated thrombogenicity without affecting clot kinetics in both DM and non-DM patients while on DAPT. However, platelet-mediated thrombogenicity is increased after aspirin withdrawal, a phenomenon which is enhanced in DM patients underscoring the pivotal contribution of the COX-1 signaling pathway in these high risk patients.
Acknowledgement/Funding
The study was supported in part by an investigator initiated study grant from Merck
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Affiliation(s)
- F Franchi
- University of Florida College of Medicine, Jacksonville, United States of America
| | - F Rollini
- University of Florida College of Medicine, Jacksonville, United States of America
| | - V Kairouz
- University of Florida College of Medicine, Jacksonville, United States of America
| | - J Rivas
- University of Florida College of Medicine, Jacksonville, United States of America
| | - A Rivas
- University of Florida College of Medicine, Jacksonville, United States of America
| | - M Agarwal
- University of Florida College of Medicine, Jacksonville, United States of America
| | - M Briceno
- University of Florida College of Medicine, Jacksonville, United States of America
| | - M Wali
- University of Florida College of Medicine, Jacksonville, United States of America
| | - A Nawaz
- University of Florida College of Medicine, Jacksonville, United States of America
| | - G Silva
- University of Florida College of Medicine, Jacksonville, United States of America
| | - Z Shaikh
- University of Florida College of Medicine, Jacksonville, United States of America
| | - D Soffer
- University of Florida College of Medicine, Jacksonville, United States of America
| | - M M Zenni
- University of Florida College of Medicine, Jacksonville, United States of America
| | - T A Bass
- University of Florida College of Medicine, Jacksonville, United States of America
| | - D J Angiolillo
- University of Florida College of Medicine, Jacksonville, United States of America
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Franchi F, Rollini F, Rivas J, Rivas A, Agarwal M, Briecno M, Wali M, Nawaz A, Silva G, Shaikh Z, Pineda A, Soffer D, Zenni MM, Bass TA, Angiolillo DJ. P1934Platelet inhibitory profiles of prasugrel versus ticagrelor in patients with CYP2C19 loss-of-function genotypes undergoing percutaneous coronary intervention: results of a randomized feasibility study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0681] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although clopidogrel is the most widely used P2Y12 inhibitor, loss-of-function (LOF) allelic variants located within the hepatic cytochrome P450 (CYP) 2C19 gene lead to attenuated bioactivation, increased rates of high platelet reactivity (HPR), and worse outcomes in patients undergoing percutaneous coronary intervention (PCI). Drug regulating authorities have suggested using alternative P2Y12 inhibitors (i.e., prasugrel or ticagrelor) in these patients. However, tailoring antiplatelet therapy in clinical practice according to results of genetic testing has been limited due to lack of access to promptly available results. Moreover, there are no head-to-head pharmacodynamic (PD) comparisons of prasugrel vs ticagrelor among patients with CYP2C19 LOF alleles.
Purpose
The aim of this study was to evaluate the feasibility of using rapid genetic testing in clinical practice and to compare the PD effects of prasugrel vs ticagrelor in patients undergoing PCI with CYP2C19 LOF alleles.
Methods
This was a prospective, randomized study conducted in patients with stable coronary artery disease and non-ST elevation acute coronary syndrome scheduled for left heart catheterization (LHC) with the intent to undergo PCI. Patients underwent rapid genetic testing using the Spartan RX assay, which defines CYP2C19 genetic status within 1 hour, allowing patients to be genotyped the same day of their LHC. Patients who were carriers of at least one LOF (*2 or *3) allele were randomized to receive either prasugrel [60mg loading dose (LD) - 10mg/day maintenance dose (MD)] or ticagrelor (180mg LD - 90mg b.i.d MD). Blood samples for PD analysis by VerifyNow were collected at 5 time points: baseline (prior to PCI), 30 minutes, 2 hours, 24 hours (or at hospital discharge whichever came first), and 1–4 weeks post-LD. All patients were treated with aspirin. The primary endpoint of our study was the non-inferiority in platelet reactivity, measured as PRU, at 24 hours of prasugrel vs ticagrelor in LOF allele carriers.
Results
A total of 781 consecutive patients scheduled for LHC were genotyped, of whom 223 (28.5%) were carriers of at least one LOF. Of these, 65 patients underwent PCI and randomized to prasugrel (n=32) vs ticagrelor (n=33). PRU levels at 24 hours were 33 vs 36 (prasugrel vs ticagrelor; mean difference = −3; 95% CI: −28 to 22; p=0.814) meeting the primary endpoint of non-inferiority. Both prasugrel and ticagrelor significantly reduced PRU to a similar extent with no differences between groups at all other time points (Figure). Accordingly, HPR rates were low and similar between groups.
PRU by VerifyNow
Conclusion
Rapid genetic testing using the Spartan assay is feasible providing results in a timely fashion in a real-world clinical practice of patients undergoing PCI. Among patients with CYP2C19 LOF carrier status, prasugrel and ticagrelor are associated with similar levels of platelet inhibition.
Acknowledgement/Funding
Genetic testing was provided by Spartan RX
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Affiliation(s)
- F Franchi
- University of Florida College of Medicine, Jacksonville, United States of America
| | - F Rollini
- University of Florida College of Medicine, Jacksonville, United States of America
| | - J Rivas
- University of Florida College of Medicine, Jacksonville, United States of America
| | - A Rivas
- University of Florida College of Medicine, Jacksonville, United States of America
| | - M Agarwal
- University of Florida College of Medicine, Jacksonville, United States of America
| | - M Briecno
- University of Florida College of Medicine, Jacksonville, United States of America
| | - M Wali
- University of Florida College of Medicine, Jacksonville, United States of America
| | - A Nawaz
- University of Florida College of Medicine, Jacksonville, United States of America
| | - G Silva
- University of Florida College of Medicine, Jacksonville, United States of America
| | - Z Shaikh
- University of Florida College of Medicine, Jacksonville, United States of America
| | - A Pineda
- University of Florida College of Medicine, Jacksonville, United States of America
| | - D Soffer
- University of Florida College of Medicine, Jacksonville, United States of America
| | - M M Zenni
- University of Florida College of Medicine, Jacksonville, United States of America
| | - T A Bass
- University of Florida College of Medicine, Jacksonville, United States of America
| | - D J Angiolillo
- University of Florida College of Medicine, Jacksonville, United States of America
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Amin N, Desai N, Mohindra P, Snider J, Simone C, Agarwal M, Nichols E, Bergom C, Amin N. Cardiac Monitoring for Thoracic Radiotherapy: Survey of Practice Patterns in the United States. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1381] [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: 10/26/2022]
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Babu BV, Sharma Y, Kusuma YS, Sivakami M, Lal DK, Marimuthu P, Geddam JB, Khanna A, Agarwal M, Sudhakar G, Sengupta P, Borhade A, Khan Z, Kerketta AS, Brogen A. Patient experiences and health system responsiveness among internal migrants: A nationwide study in 13 Indian cities. J Healthc Qual Res 2019; 34:167-175. [PMID: 31713527 DOI: 10.1016/j.jhqr.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/06/2018] [Revised: 04/02/2019] [Accepted: 04/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To report various components of health system responsiveness among poor internal migrants who availed the government health facilities in 13 Indian cities. MATERIALS AND METHODS Cluster random sampling was used to select 50,806 migrant households, of which 14,263 households avail the government health facility in last six months. In addition, 5072 women, who sought antenatal care and 3946 women who had delivery in government health facility during last six months were also included. Data on different domains of health system responsiveness were collected using an interviewer-administered questionnaire, developed based on the World Health Survey of WHO. RESULTS Of the eight domains of responsiveness, namely, autonomy, communication, confidentiality, dignity, choice, quality of basic facilities, prompt attention and access to family and community, seven domains, except the 'choice', are assessed, and they are moderate. Only about 30% of participants said that doctor discussed on treatment options (autonomy). And 50-60% of participants said positively for questions of clarity of communication. About 59% of participants acknowledged the confidentiality. Not more than 40% of participants said they were treated with dignity, and privacy is respected (dignity). The responses to quality basic amenities, prompt attention and access to family and community domains are fairly satisfactory. CONCLUSIONS This study has implications as many urban poor, including migrants do not utilize the services of public healthcare facilities. Hence, a responsive health system is required. There should be a policy in place to train and orient healthcare workers on some of the domains of health system responsiveness.
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Affiliation(s)
- B V Babu
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India.
| | - Y Sharma
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India
| | - Y S Kusuma
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - M Sivakami
- Centre for Health and Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - D K Lal
- International Institute of Health Management Research, New Delhi, India
| | - P Marimuthu
- Department of Biostatistics, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - J B Geddam
- National Institute of Nutrition of Indian Council of Medical Research, Hyderabad, India
| | - A Khanna
- Indian Institute of Health Management Research, Jaipur, India
| | - M Agarwal
- Department of Community Medicine & Public Health, KG Medical University, Lucknow, India
| | - G Sudhakar
- Department of Human Genetics, Andhra University, Visakhapatnam, India
| | - P Sengupta
- Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - A Borhade
- Indian Institute of Public Health, Public Health Foundation of India, Gurgaon, India
| | - Z Khan
- Department of Community Medicine, JN Medical College, Aligarh Muslim University, Aligarh, India
| | - A S Kerketta
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
| | - A Brogen
- Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, India
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Rajappa SK, Ram D, Shukla H, Mandal G, Venkatasubramaniyan M, Dubey A, Agarwal M, Kumar R, Dewan AK. Oncological benefits of postoperative radiotherapy in node-negative early stage cancer of the oral cavity with isolated perineural invasion. Br J Oral Maxillofac Surg 2019; 57:454-459. [PMID: 31031061 DOI: 10.1016/j.bjoms.2019.04.002] [Citation(s) in RCA: 9] [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: 05/17/2018] [Accepted: 04/04/2019] [Indexed: 12/28/2022]
Abstract
Perineural invasion has been widely regarded as a poor prognostic factor in cancer of the oral cavity, but adjuvant treatment based only on this is still debatable. We have made an effort to address the question in a retrospective analysis of data from 2009-15 of patients with early node-negative cancers of the oral cavity. Patients with perineural invasion were divided into those who were treated with radiotherapy and those who were not. The records of a total of 169 patients were analysed, and 118 were given adjuvant radiotherapy and 51 were not. The median (range) duration of follow up was 45 (26-86) months. Of 169 patients, 47 (28%) developed recurrence, 28 in the treated, and 19 in the untreated, group. There was a significant disease-free survival benefit for adjuvant treatment (p = 0.047) but no overall survival benefit (p = 0.54). We conclude that adjuvant radiotherapy should be considered for patients with perineural invasion, even in early cancers of the oral cavity.
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Affiliation(s)
- S K Rajappa
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India.
| | - D Ram
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India.
| | - H Shukla
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India.
| | - G Mandal
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India.
| | - M Venkatasubramaniyan
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India.
| | - A Dubey
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India.
| | - M Agarwal
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India.
| | - R Kumar
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India.
| | - A K Dewan
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi 110085, India.
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Chatterjee I, Kumar V, Sharma S, Dhingra D, Rana B, Agarwal M, Kumar N. Identification of brain regions associated with working memory deficit in schizophrenia. F1000Res 2019; 8:124. [PMID: 31069066 PMCID: PMC6480944 DOI: 10.12688/f1000research.17731.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Schizophrenia, a severe psychological disorder, shows symptoms such as hallucinations and delusions. In addition, patients with schizophrenia often exhibit a deficit in working memory which adversely impacts the attentiveness and the behavioral characteristics of a person. Although several clinical efforts have already been made to study working memory deficit in schizophrenia, in this paper, we investigate the applicability of a machine learning approach for identification of the brain regions that get affected by schizophrenia leading to the dysfunction of the working memory. Methods: We propose a novel scheme for identification of the affected brain regions from functional magnetic resonance imaging data by deploying group independent component analysis in conjunction with feature extraction based on statistical measures, followed by sequential forward feature selection. The features that show highest accuracy during the classification between healthy and schizophrenia subjects are selected. Results: This study reveals several brain regions like cerebellum, inferior temporal gyrus, superior temporal gyrus, superior frontal gyrus, insula, and amygdala that have been reported in the existing literature, thus validating the proposed approach. We are also able to identify some functional changes in the brain regions, such as Heschl gyrus and the vermian area, which have not been reported in the literature involving working memory studies amongst schizophrenia patients. Conclusions: As our study confirms the results obtained in earlier studies, in addition to pointing out some brain regions not reported in earlier studies, the findings are likely to serve as a cue for clinical investigation, leading to better medical intervention.
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Affiliation(s)
- Indranath Chatterjee
- Department of Computer Science, University of Delhi, Delhi, DELHI, 110007, India
| | - Virendra Kumar
- Department of NMR and MRI Facility, All India Institute of Medical Sciences, Delhi, DELHI, 110029, India
| | - Sahil Sharma
- Department of Computer Science, University of Delhi, Delhi, DELHI, 110007, India
| | - Divyanshi Dhingra
- Department of Computer Science, University of Delhi, Delhi, DELHI, 110007, India
| | - Bharti Rana
- Department of Computer Science, Hans Raj College, University of Delhi, Delhi, DELHI, 110007, India
| | - Manoj Agarwal
- Department of Computer Science, Hans Raj College, University of Delhi, Delhi, DELHI, 110007, India
| | - Naveen Kumar
- Department of Computer Science, University of Delhi, Delhi, DELHI, 110007, India
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Rathi S, Chopra M, Chouduri G, Sharma P, Madan K, Chhabra M, Rai RR, Govil A, Konar A, Goenka M, Agarwal M, Mukherjee J, Thorat V, Salunkhe S, Abraham P, Nagral A, Jhaveri A, Bhat N, Varghese J, R.S. A, Ravishankar, Reddy DC, Dhiman RK. Prevalence of Minimal Hepatic Encephalopathy in Patients With Liver Cirrhosis: A Cross-Sectional, Clinicoepidemiological, Multicenter, Nationwide Study in India: The PREDICT Study. J Clin Exp Hepatol 2019; 9:476-483. [PMID: 31516264 PMCID: PMC6728606 DOI: 10.1016/j.jceh.2018.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 09/19/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The study aimed at assessing the prevalence and clinical profile of minimal hepatic encephalopathy (MHE) in patients with cirrhosis using neuropsychological assessment and at understanding the management practices of MHE in the Indian clinical setting. METHODS This cross-sectional, clinicoepidemiological study conducted at 20 sites enrolled liver cirrhosis patients with Grade 0 hepatic encephalopathy according to West-Haven Criteria. Patients were subjected to mini-mental state examination and those with a score of ≥24 were assessed using psychometric hepatic encephalopathy score. Short Form-36 questionnaire was administered to assess the impact on health-related quality of life. RESULTS Of the 1260 enrolled patients, 1114 were included in the analysis. The mean age was 49.5 years and majority were males (901 [81%]). The prevalence of MHE was found to be 59.7% (665/1114) based on the psychometric hepatic encephalopathy score of ≤-5. Alcohol-related liver disease was the most common etiology (482 [43.27%]) followed by viral infection (239 [21.45%]). Past smokers as well as those currently smoking were more likely to have MHE than nonsmokers. A significant association was found between tobacco chewing, smoking, alcohol consumption, diabetes, and the presence of MHE. Multivariable analysis revealed smoking as the only parameter associated with MHE. A total of 300 (26.9%) patients were on prophylaxis with lactulose/lactitol or rifaximin. These patients were less likely to have MHE as compared to those not on prophylaxis (odds ratio, 0.67; 95% confidence interval, 0.50-0.88; P = 0.005). CONCLUSION The disease burden of MHE is quite substantial in patients with cirrhosis with no apparent cognitive defect. Smoking, whether past or current, has significant association with the presence of MHE. Although MHE has been shown to adversely affect quality of life, prophylaxis for MHE is not routinely practiced in the Indian setting.The study has been registered under clinical trials registry of India (CTRI/2014/01/004306).
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Key Words
- ALD, alcohol-related liver disease
- CI, confidence interval
- DST, Digit Symbol Test
- FCT, figure connection test
- HE, hepatic encephalopathy
- HRQL, health-related quality of life
- MCS, mental component summary
- MELD, model for end-stage liver disease
- MHE, minimal hepatic encephalopathy
- MMSE, mini-mental state examination
- NCT, number connection test
- PCS, physical component summary
- PHES
- PHES, psychometric hepatic encephalopathy score
- SF-36, Short Form-36
- cirrhosis
- covert hepatic encephalopathy
- hepatic encephalopathy
- lactulose
- minimal hepatic encephalopathy
- quality of life
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Affiliation(s)
- Sahaj Rathi
- Postgraduate Institute of Medical Research, Chandigarh, India
| | - Madhu Chopra
- Postgraduate Institute of Medical Research, Chandigarh, India
| | | | | | - Kaushal Madan
- Institute of Digestive and Hepatobiliary Sciences, Medanta – The Medicity, Gurgoan, India
| | | | | | - Anurag Govil
- Santokba Durlabhji Memorial Hospital, Jaipur, India
| | | | | | | | | | | | | | - Philip Abraham
- PD Hinduja Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Naresh Bhat
- Columbia Asia Referral Hospital, Bangalore, India
| | | | - Arun R.S.
- Madras Medical Mission, Chennai, India
| | | | | | - Radha K. Dhiman
- Postgraduate Institute of Medical Research, Chandigarh, India,Address for correspondence: Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Verma A, Jain A, Kumar C, Agarwal M, Kumar R. Effect of prior dengue infection on severity and outcome of Japanese encephalitis. Eur J Clin Microbiol Infect Dis 2018; 37:519-525. [PMID: 29411187 DOI: 10.1007/s10096-018-3207-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/29/2018] [Indexed: 11/24/2022]
Abstract
Japanese encephalitis (JE) virus and dengue virus are closely related flaviviruses but interaction between them is scarcely studied in humans. The objective of this study was to compare the outcome of JE patients who are positive and negative for dengue IgG antibodies. Patients of acute encephalitis syndrome (AES) fulfilling predecided inclusion and exclusion criteria underwent a detailed standardized workup incorporating JE IgM testing in cerebrospinal fluid (CSF) or serum. Dengue IgG in serum was tested in all. Outcomes and clinical features were compared between JE patients who were dengue IgG positive and negative in hospital and after 3 months. A total of 182 patients of JE were enrolled over 3 seasons. After excluding equivocal cases, hospital outcome was compared between 105 dengue IgG-positive and 50 dengue IgG-negative patients. Dengue IgG-positive patients had a significantly better outcome (relative risk 1.4; 95% confidence interval 1.1-1.8). On follow-up after 3 months, again, outcome was significantly better among 95 dengue IgG-positive patient than 47 dengue IgG-negative patients (relative risk 1.3; 95% confidence interval 1.01-1.8). Presence of pre-existing dengue IgG antibodies in JE patients is associated with improved outcomes.
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Affiliation(s)
- A Verma
- Departments of Pediatrics, King George's Medical University, Lucknow, UP, 226003, India
| | - A Jain
- Microbiology, King George's Medical University, Lucknow, India
| | - C Kumar
- Departments of Pediatrics, King George's Medical University, Lucknow, UP, 226003, India
| | - M Agarwal
- Community Medicine, King George's Medical University, Lucknow, India
| | - R Kumar
- Departments of Pediatrics, King George's Medical University, Lucknow, UP, 226003, India.
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Wadoo O, Shah AJ, Jehaanandan N, Laing M, Agarwal M, Kinderman P. Knowledge of mental health legislation in junior doctors training in psychiatry. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.110.030320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodTo assess junior doctors' knowledge of the procedures involved in involuntary admission of patients detained under Sections 5(2), 2 and 3 of the Mental Health Act 1983. A semi-quantitative research study of junior trainees affiliated to two psychiatry training schemes was carried out.ResultsTrainees' knowledge of professionally relevant sections of the Mental Health Act was patchy. Knowledge correlated significantly with experience in clinical practice and with experience of using mental health legislation. Surprisingly, in-service training in mental health legislation had no effect on participants' knowledge.Clinical implicationsLack of knowledge and understanding raises the possibility of inappropriate use of the mental health legislation. This threatens patients' fundamental rights and can lead to complaints or litigation. There is a clear need to address this at an early stage in psychiatry training.
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Agarwal M, Chaudhary M, Bakhshi S, Saxena R, Dwivedi S, Kabra M, Lall M, Shukla R, Seth R. Gene copy number alterations in Indian children with acute lymphoblastic leukemia. Pediatric Hematology Oncology Journal 2018. [DOI: 10.1016/j.phoj.2018.11.006] [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: 10/27/2022] Open
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Abstract
While opioid drug toxicity and side effects of long-term opioid use during medical care are well studied, there is little information regarding effects of ingestion of raw opium. Characterization of the effects to a particular alkaloid is difficult since raw opium contains a number of alkaloids. Here, we present a case of poisoning due to ingestion of raw opium leading to severe myocardial suppression.
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Affiliation(s)
- Piyush Garg
- Department of Anesthesiology and Critical Care Medicine, Medical Intensive Care Unit, Udaipur, Rajasthan, India
| | - Asif Ali Hitawala
- Department of Anesthesiology and Critical Care Medicine, Medical Intensive Care Unit, Udaipur, Rajasthan, India
| | - Manoj Agarwal
- Department of Pediatrics, GBH American Hospital, Udaipur, Rajasthan, India
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Agarwal M, Bafna A, Sabnsis G, Shah H, Lanjewar C, Kerkar P. Immediate maternal and fetal outcome of percutaneous balloon mitral valvoplasty during pregnancy – Ten year single center experience. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.207] [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] Open
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40
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Chhabra A, Agarwal M, Braccioforte M, Bentzen S, Moran B. Long-Term Outcomes Analysis of Low Dose Rate Brachytherapy (LDR-BT) in Clinically T3 High-Risk Prostate Carcinoma. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1129] [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: 11/24/2022]
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41
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Chhabra A, Agarwal M, Braccioforte M, Bentzen S, Moran B. Outcomes Analysis Comparing Trimodality Therapy Versus Definitive Low-Dose-Rate Brachytherapy Plus ADT in Patients with cT3 High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1130] [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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42
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Agarwal M, Garg L, Aggarwal S, Reed G. 5803Contemporary trends of incidence, management and outcomes of non-acute coronary syndrome associated cardiogenic shock: data from 2003 to 2011. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5803] [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: 11/12/2022] Open
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43
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Batra U, Goyal P, Jain P, Upadhyay A, Sachdeva N, Agarwal M, Bhurani D, Talwar V, Gupta SK, Doval DC. Epidemiology and resistance pattern of bacterial isolates among cancer patients in a Tertiary Care Oncology Centre in North India. Indian J Cancer 2017; 53:448-451. [PMID: 28244481 DOI: 10.4103/0019-509x.200647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the epidemiology of microbiologically documented bacterial infection and the resistance pattern, among cancer patients undergoing treatment at RGCIRC, Delhi. DESIGN AND SETTING Retrospective observational study in which culture reports obtained over 1 year in 2013, were analyzed. RESULTS 13329 cultures were obtained over 1 year in 2013 and were analyzed. 23.6 % samples showed positive culture with majority being gram negative isolates (67.9 %). E. coli was the commonest gram negative isolate (49.4%) followed by klebsella (29.7%) and Staph. aureus was the commonest gram positive isolate. There was high incidence of ESBL in blood and urine (87.2% & 88.5%) and BLBLI were also high (78% & 83.9%). Carbapenem resistance was comparatively low (10%) and colistin sensitivity was quiet high (> 95%). CONCLUSIONS Prevalence of MRSA and VRE in our institute is very less, whereas prevalence of ESBLs and BLBLI isolates amongst gram negative infections is around 80%. Gram negative isolates had poor sensitivity to cephalosporins and fluoroquinolones.
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Affiliation(s)
- U Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - P Goyal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - P Jain
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - A Upadhyay
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - N Sachdeva
- Department of Lab Medicine, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - M Agarwal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - D Bhurani
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - V Talwar
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - S K Gupta
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - D C Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
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Bhargava S, Bhargava V, Agarwal M. P2.03a-057 Ligand Mediated Solid Lipid Nanoparticle of Paclitaxel for Effective Management of Bronchogenic Carcinoma. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1267] [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: 10/20/2022]
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Batra U, Sharma M, Jain A, Agarwal M, Goyal P. 469P Clinical outcome study of crizotinib in IHC proven EML4-ALK fusion gene among Indian patients with adenocarcinoma lung. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw594.033] [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: 11/14/2022] Open
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Abstract
Background and objectives There is a paucity of information about the epidemiology of systemic lupus erythematosus (SLE) amongst Arabs. The objective of this study was to determine the incidence and prevalence of SLE among the native Arab population of United Arab Emirates (UAE). Methods Patients with SLE were identified from three sources: medical records of two local tertiary hospitals (four years; 2009 to 2012), laboratory requests for serum double stranded deoxyribonucleic acid and serum anti-nuclear antibody and confirmed histopathologic diagnosis of SLE (skin and kidney biopsy specimens). All the patients identified with SLE met the criteria of the American College of Rheumatology. Incidence and prevalence were calculated using the state records of the UAE native population as the denominator. The age-adjusted incidence was calculated by direct standardization using the World Health Organization world standard population 2000-2025. Results Sixteen new cases (13 females and three males) fulfilled the American College of Rheumatology SLE criteria. The mean (±SD) age at time of diagnosis was 28.6 ± 12.4 years. The crude incidence ratio (per 100,000 population) was 3.5, 1.1, 2.1 and 2.1 in years 2009, 2010, 2011, 2012, respectively. The age-standardized incidence per 100,000 population for the four years was 8.6 (95% confidence interval 4.2-15.9). The age-standardized prevalence of SLE among the native population according to the 2012 population consensus was 103/100,000 population (95% confidence interval 84.5-124.4). Conclusion The age-adjusted incidence and prevalence among UAE Arabs is higher than has been reported among most other Caucasian populations. Furthermore, the prevalence of SLE in UAE seems much higher than other similar Arab countries in the Gulf region.
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Affiliation(s)
- A M Al Dhanhani
- 1 UAE University, College of Medicine & Health Science, Department of Internal Medicine, Al Ain, UAE
| | - M Agarwal
- 2 UAE University, College of Medicine & Health Science, Department of Pathology, Al Ain, UAE
| | - Y S Othman
- 3 Tawam Hospital, Medical Affairs, Al Ain, UAE
| | - O Bakoush
- 1 UAE University, College of Medicine & Health Science, Department of Internal Medicine, Al Ain, UAE
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Ghatak S, Gulati S, Agarwal M. Gastrocele: a rare cause of pain abdomen after colonic bypass for corrosive stricture esophagus. Dis Esophagus 2016; 29:1162-1163. [PMID: 25872414 DOI: 10.1111/dote.12366] [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] [Indexed: 12/11/2022]
Affiliation(s)
- S Ghatak
- Department of Surgical Gastroenterology, Bellevue Clinic, Kolkata, India
| | - S Gulati
- Department of Surgical Gastroenterology, Bellevue Clinic, Kolkata, India
| | - M Agarwal
- Department of Gastroenterology, Bellevue Clinic, Kolkata, India
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Saxena D, Agarwal M, Gupta D, Agrawal S, Das V, Phadke SR. Utility and limitations of multiplex ligation-dependent probe amplification technique in the detection of cytogenetic abnormalities in products of conception. J Postgrad Med 2016; 62:239-241. [PMID: 27763481 PMCID: PMC5105209 DOI: 10.4103/0022-3859.192664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Introduction: Chromosomal abnormality is found in about half of first-trimester abortions. Karyotype is the gold standard to detect chromosomal abnormalities. Multiplex ligation-dependent probe amplification (MLPA) offers advantage over karyotype in terms of lower failure rate, faster turnaround time, and much higher resolution than conventional karyotyping and found to be 98% concordant with conventional karyotype. AIM We performed this study to look for the utility of MLPA in diagnosing chromosomal abnormalities in first-trimester abortions. MATERIALS AND METHODS MLPA using subtelomeric SALSA probe sets (P036 and P070) was used to detect cytogenetic abnormalities in products of conception in missed/spontaneous abortions. RESULTS A total of ninety abortus samples were analyzed by MLPA. Successful results were provided in (67) 74.4% of the cases while no conclusion could be drawn in 25.6% (23) of the cases. Fifty-five (82.1%) cases were cytogenetically normal and 17.9% (12) had some abnormality. Aneuploidy was detected in 8 (66.7%) cases, 3 (25%) had double-segment imbalance, and one (8.3%) had partial aneuploidy. CONCLUSION We suggest that MLPA is a good substitute to traditional karyotype.
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Affiliation(s)
- D Saxena
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M Agarwal
- GenePath Dx Causeway Healthcare Ltd., Pune, Maharashtra, India
| | - D Gupta
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - S Agrawal
- Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - V Das
- Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - S R Phadke
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Dawodu A, Dawson KP, Amirlak I, Kochiyil J, Agarwal M, Badrinath P. Diet, clothing, sunshine exposure and micronutrient status of Arab infants and young children. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/02724930124951] [Citation(s) in RCA: 5] [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: 10/26/2022]
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50
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Jain Y, Falcioni M, Agarwal M, Taibah A, Sanna M. Total Facial Paralysis after Vestibular Schwannoma Surgery: Probability of Regaining Normal Function. Ann Otol Rhinol Laryngol 2016; 113:706-10. [PMID: 15453527 DOI: 10.1177/000348940411300906] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the present study was to ascertain the precise fraction of vestibular schwannoma cases that recover to normal function after postoperative total facial nerve paralysis and to compare our results with those presented in the literature. This was a retrospective case review of 631 cases. Among the 132 cases with immediate postoperative facial nerve palsy (House Brackmann [HB] grade VI), only 2 (1.5%) recovered to normal function (HB grade I). In an attempt to compare our results with those of other series in the literature, we found a large variation in the incidence of recovery of this group of patients to grade I, ranging from 0% to 50%. Our analysis of the reported data revealed widely varying methods of data collection and presentation, making a scientifically valid comparison particularly difficult. According to our data, complete (HB grade I) or near-complete (HB grade II) facial nerve function recovery from an immediate postoperative grade VI palsy is extremely rare.
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Affiliation(s)
- Yogesh Jain
- Gruppo Otologico, Via Emmanueli 42, 29100 Piacenza, Italy
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