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Khanduri A, Gusain D, Bansal N, Koli J, Gupta R. Axillary Cystic Lymphangioma in an Adult: A Case Report. Cureus 2024; 16:e55390. [PMID: 38562317 PMCID: PMC10984246 DOI: 10.7759/cureus.55390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
Lymphangioma is a congenital malformation of the lymphatic system most often reported in children. Its occurrence in adults is rare. It usually develops in the head, neck, and axillary region. It mimics other conditions, such as cold abscess, simple cyst, hydatid cyst, and hemangioma, on clinical examination. Here, we report a case of cystic lymphangioma in the axillary region of a 32-year-old male. The patient underwent surgical excision and histopathology confirmed cystic lymphangioma. Although it is very rare in adults, cystic lymphangioma should be considered in the differential diagnosis of an axillary mass.
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Affiliation(s)
- Archana Khanduri
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Deepak Gusain
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Nalini Bansal
- Pathology, Institute of Gastro and Hepatopathology (IGHP), Gurugram, IND
| | - Jyoti Koli
- Internal Medicine, Indresh Hospital, Dehradun, IND
| | - Rahul Gupta
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
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2
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Gupta R, Gusain D, Bansal N, Varshney R, Singh A. Gastric Neuroendocrine Tumor With Cystic Hepatic Metastases Mimicking Hepatic Echinococcosis: A Case Report. Cureus 2024; 16:e54507. [PMID: 38516491 PMCID: PMC10955437 DOI: 10.7759/cureus.54507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Metastatic gastrointestinal neuroendocrine tumors classically appear as contrast-enhancing lesions on computed tomography. However, in a small percentage of patients, these lesions can be cystic in nature, leading to false diagnoses of benign or infectious lesions such as echinococcosis. Hence, every cystic lesion of the liver must be carefully investigated before making the treatment plan. We report a patient with hematemesis caused by a large gastric ulcer with multiple cystic lesions in the left lobe of the liver abutting the stomach. The liver lesions were misdiagnosed as hepatic echinococcosis, and the patient was started on medical therapy. However, when medical therapy failed, the patient underwent surgical excision and the histopathology showed cystic metastases of a gastric neuroendocrine tumor.
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Affiliation(s)
- Rahul Gupta
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Deepak Gusain
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Nalini Bansal
- Pathology, SGT (Shree Guru Gobind Singh Tricentenary) University, Gurugram, IND
| | - Rahul Varshney
- Anesthesia and Critical Care, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Arvind Singh
- Gastroenterology, Synergy Institute of Medical Sciences, Dehradun, IND
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3
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Parikh R, Bansal N, Sen R. Liver histopathology in scope of hematological disorders. INDIAN J PATHOL MICR 2023; 66:683-693. [PMID: 38084516 DOI: 10.4103/ijpm.ijpm_856_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Liver involvement is commonly seen in various haematological disorders. They present clinically with elevation of liver enzymes and organomegaly, with or without mass lesions. However, liver involvement may be silent in many hematological disorders or there may be specific findings in liver biopsy that can lead to the diagnosis of clinically inapparent hematological disorders. Present review highlights features of hepatic manifestations in various hematological diseases with special emphasis on histopathological findings. Among RBC disorders, secondary hemochromatosis is the commonest among patients with hemolytic anemia; whereas Sickle Cell Hepatopathy is a well known complication in Sickle Cell Disease, characterised by sequestration of sickled RBCs in sinusoids. Vascular complications such as Budd Chiari syndrome and portal venopathy with portal vein thrombosis are seen in patients with myeloproliferative neoplasms. However, sometimes primary hematological disease may remain occult. Various lymphomas show characteristic pattern of hepatic involvement, most common being sinusoidal and portal infiltration. Pattern of infiltration may give clues to different types of lymphomas. Amongst all lymphomas, Diffuse large B cell lymphoma is the most common lymphoma involving liver. Disseminated intravascular coagulation is a fatal systemic condition and liver involvement by widespread fibrin thrombi, is not an exception. Assessing liver histopathology in context of hematological conditions makes better understanding of pathophysiology and progress of these diseases. It is important for hematologists and hepatologist to be aware of possible liver involvement in various hematological diseases presenting with elevated LFTs and have a logical approach to abnormal LFTs.
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Affiliation(s)
- Rashmi Parikh
- Observer in GI and Hepatopathology, SGT University, Gurugram, Haryana; Consultant Pathologist, Sahyadri Speciality Labs, Pune, Maharashtra, India
| | - Nalini Bansal
- Lead Gastrointestinal and Hepatopathologist, SGT University, Gurugram, Haryana, India
| | - Rajeev Sen
- Professor and Head of the Department of Pathology, SGT University, Gurugram, Haryana, India
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4
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Bansal N, Tiwari P, Dev P. Wide-awake local anesthesia and no tourniquet (WALANT) in upper limb fractures. Acta Orthop Belg 2023; 89:547-550. [PMID: 37935241 DOI: 10.52628/89.3.11357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Wide-awake local anesthesia and no tourniquet (WALANT), first used for hand surgery, has been sparingly described for use in fracture fixation of the upper limb. We present our experience using this technique. 26 patients with upper limb fractures (3 distal radius, 6 radial shaft, 11 ulnar shaft, and 6 olecranon fractures) were operated on using WALANT by three orthopedic surgeons. We used 35-40ml of 2% Lignocaine with 1:80000 Adrenaline(7mg/kg) diluted with normal saline. Numeric Pain Rating (NPR) scoring was done during injection and per-operatively, and the Likert scale was used for the surgeon's satisfaction. The average NPR score was reported as 0.65 (1-3) during injection and 0.15 (0-2) preoperatively. All three surgeons reported excellent satisfaction in all the cases operated on. No complication occurred due to anesthesia. WALANT is a much simpler option and can be safely used in place of general anesthesia or regional blocks for fixation of fractures of the upper limb, with added advantages of no need for a tourniquet and better intraoperative assessment of fracture fixation.
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5
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Sehrawat R, Bansal N, Srivastava A, Malik D, Vij V. Hepatic basidiobolomycosis masquerading as cholangiocarcinoma: a case report and literature review. J Liver Cancer 2023; 23:389-396. [PMID: 37587037 PMCID: PMC10565554 DOI: 10.17998/jlc.2023.06.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/13/2023] [Accepted: 06/07/2023] [Indexed: 08/18/2023]
Abstract
Basidiobolus ranarum is known to cause subcutaneous mycoses; however, rare cases of hepatic and gastrointestinal involvement by basidiobolomycosis have been reported. Hepatic basidiobolomycosis may be confused with a carcinoma on imaging, and histological examination and fungal culture can help distinguish between these two. We report a rare case of basidiobolomycosis in a 16-year-old male with liver and gastrointestinal involvement.
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Affiliation(s)
- Roopali Sehrawat
- Department of Pathology, SGT University, Budhera, Gurugram, India
| | - Nalini Bansal
- Department of Pathology, SGT University, Budhera, Gurugram, India
| | - Ajitabh Srivastava
- Department of Liver Transplant Surgery, Aakash Healthcare Super Speciality Hospital, Dwarka, New Delhi, India
| | - Dharmender Malik
- Department of Nuclear Medicine & PET-CT, Fortis Memorial Research Institute (FMRI), Gurugram, India
| | - Vivek Vij
- Department of Liver Transplant Surgery, Fortis Healthcare, Budhera, Gurugram, India
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6
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Spinner J, D'Souza N, Duganiero T, Stark S, Lorts A, Almond C, Simpson K, Wright L, Nandi D, Wilkens S, Bansal N, Conway J, Broda K, Lal A, Lytrivi I, Hunter T, Gralia N, Parent J, Butts R. A Pediatric Heart Failure Registry is Needed: A Time for ACTION. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1626] [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: 04/05/2023] Open
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7
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Nandi D, Wright L, Sublett-Smith J, Brax A, Almond C, Bansal N, Azeka E, Butts R, Conway J, Chen C, Cunningham C, Fisher L, Hall E, Hunter T, Kobayashi R, Patterson D, Peng D, Simpson K, Ryan T, Spinner J, Wisotzkey B, Zangwill S, Gajarski R, O'Connor M. Suboptimal Titration of Heart Failure Medications in Pediatric Patients: Baseline Data from the ACTION Network. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1627] [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: 04/05/2023] Open
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8
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Varma M, Zuckerman W, Sutcliffe D, Mokshagundam D, Magnetta D, Laks J, Spinner J, Bansal N, Butto A, Rosenthal D, Singh R. Training and Early Career Experience in Pediatric Heart Failure and Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1341] [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: 04/05/2023] Open
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9
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Sehrawat R, Bansal N, Kour H, Sinha A. A Giant Pediatric Chylolymphatic Cyst: An Extremely Rare Entity. JPGN Rep 2023; 4:e274. [PMID: 37181923 PMCID: PMC10174740 DOI: 10.1097/pg9.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/06/2022] [Indexed: 05/16/2023]
Abstract
Chylolymphatic cyst, variant of mesenteric cyst, is a rare entity. Clinical presentation and radiological features are not characteristic, so diagnosis can be made finally on histopathology. We report an extremely rare case of giant chylolymphatic cyst measuring >15 cm. A 2-year-old female presented with abdominal pain and vomiting. On examination, a ill-defined and firm mass was palpable just below umbilicus. Positron emission tomography-computed tomography scan revealed a large ill-defined lesion, which measured 16 × 13.2 × 6.7 cm in size and was seen in relation to the abdominal mesentery. Provisional diagnosis of mesenteric cyst was made. Laparotomy revealed multiple lymphatic cysts of variable size arising from the mesentery of proximal ileum. Histopathology examination confirmed the presence of a giant chylolymphatic cyst. Chylolymphatic cysts are rare entity and should be kept in mind while diagnosing a pediatric case of abdominal cysts.
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Affiliation(s)
- Roopali Sehrawat
- From the Department of Pathology, SGT University, Gurugram, Haryana
| | - Nalini Bansal
- From the Department of Pathology, SGT University, Gurugram, Haryana
| | - Harshita Kour
- Department of Paediatrics Surgery, Fortis Memorial Research Institute, Gurugram, Haryana
| | - Anand Sinha
- Department of Paediatrics Surgery, Fortis Memorial Research Institute, Gurugram, Haryana
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10
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Gupta RK, Chorasiya VK, Vij V, Wadhawan M, Kumar A, Bansal N. Small Cell Type Undifferentiated Carcinoma of Gall Bladder with Pas Positive Hyaline Globule Masquerading as Liver Mass: A Case Report and Literature Review. Korean J Gastroenterol 2023; 81:40-45. [PMID: 36695066 DOI: 10.4166/kjg.2022.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 01/26/2023]
Abstract
An undifferentiated carcinoma (UC) of the gall bladder behaves aggressively and has a grave prognosis. Small cell type undifferentiated carcinoma of the gall bladder is a rare variant. This paper reports a case of UC of gall bladder with PAS-positive diastase- resistant eosinophilic hyaline globules present as liver mass (on imaging) in a male patient. The microscopic findings of the liver and gall bladder after a right tri-segmentectomy showed an un-differentiated malignant neoplasm composed of cells with round to oval nuclei, prominent nucleoli, and scanty neoplasm. No definite cell pattern was identified with these neoplastic cells. A section from the gall bladder revealed a tumor arising from the lining epithelium and infiltrating through the muscularis. This tumor was infiltrating the adherent liver tissue directly and forming a mass of undifferentiated malignant cells. The focal area within the tumor mass showed the presence of PAS-positive, diastase-resistant, eosinophilic hyaline globules within the neoplastic cells. The immunohistochemistry test was diffusely positive for perinuclear anti-neutrophil cytoplasmic antibodies and negative for chromogranin, vimentin, Desmin, alpha-fetoprotein, leukocyte common antigen, CD34, and bcl2. When the clinical and radiological data are inconclusive, careful analysis of the histological and immunophenotypic features is needed to make the final diagnosis of UC of the gall bladder. The biological behavior and prognosis of this tumor remain unclear because of its rarity. Further studies will be needed to understand the characteristics of this deadly tumor and to establish an effective therapy for it.
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Affiliation(s)
- Raman K Gupta
- Department of Liver Transplantation & GI Surgery, Fortis Escort Liver and Digestive Institute, FEHI, New Delhi, India
| | - Vishal K Chorasiya
- Department of Liver Transplantation & GI Surgery, Fortis Escort Liver and Digestive Institute, FEHI, New Delhi, India
| | - Vivek Vij
- Department of Liver Transplantation & GI Surgery, Fortis Escort Liver and Digestive Institute, FEHI, New Delhi, India
| | - Manav Wadhawan
- Department of Gastroenterology and Hepatology, Fortis Escort Liver and Digestive Institute, FEHI, New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology and Hepatology, Fortis Escort Liver and Digestive Institute, FEHI, New Delhi, India
| | - Nalini Bansal
- Department of Histopathology, SGT University Gurgaon, India
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11
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Sharma S, Sharma A, Surya M, Guleria S, Bansal N. Clinician's dilemma: Naproxen-induced liver injury. INDIAN J PATHOL MICR 2023; 66:168-170. [PMID: 36656233 DOI: 10.4103/ijpm.ijpm_766_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Naproxen is a widely used nonsteroidal anti-inflammatory drug (NSAID) in pediatric population, used for mild-to-moderate pains, arthritis, and other immune-mediated disorders. It rarely causes clinically apparent liver injury in the adult population taking high doses of the drug over a prolonged period and is reported even rarer in pediatric population. We present a case of drug-induced liver injury (DILI) in a 13-year-old girl taking naproxen in therapeutic doses for juvenile rheumatoid arthritis. There was a complete recovery of liver function following discontinuation of naproxen therapy.
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Affiliation(s)
- Shruti Sharma
- Department of Pediatric Gastroenterology Cell, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Akshi Sharma
- Department of Pediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Mukesh Surya
- Department of Radiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sandesh Guleria
- Department of Paediatric Rheumatology, Dr Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
| | - Nalini Bansal
- Department of Pathology, SRL Ltd., Fortis Escorts, Okhla, New Delhi, India
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12
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Mitra S, Simson D, Khurana H, Tandon S, Ahlawat P, Bansal N, Barik S, Sethi J, Chufal K, Gairola M. Impact of Radiation Treatment Delay Due to COVID-19 Pandemic. Int J Radiat Oncol Biol Phys 2022. [PMCID: PMC9595463 DOI: 10.1016/j.ijrobp.2022.07.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose/Objective(s) To study the effect of radiation treatment delay due to COVID-19 infection. Materials/Methods This study is a descriptive analysis. We studied all patients who were COVID-19 positive while undergoing radiation treatment. In addition, those COVID-19 positive patients before the start of radiation during their neoadjuvant treatment period or surgery were also analyzed. However, patients detected with COVID-19 infection after the radiation treatment course were excluded. The study period was from June 2020 to May 2021. A radiation treatment delay was defined as a delay in starting the treatment, a break in therapy during their scheduled radiation course, or treatment discontinuation. Patients who had a radiation treatment delay were followed-up till December 2021. Results Ninety-four patients who met the criteria were identified for the analysis. Seventy-seven of them had a mild infection, while 17 had a moderate or severe infection. Of the 94 patients identified, 83 patients had a treatment delay. The median treatment delay (MTD) was 18 (6 to 47) days and the median follow-up period was 13 months. In this cohort, 66 patients were treated with a curative intent, of which 51 are on follow-up {34 patients are disease-free (MTD – 18.5, 10 to 43), seven had either a residual disease or locoregional recurrence (MTD – 22, 10 to 32), seven had distant metastasis (MTD – 18, 15 to 47), and three patients died (MTD – 20, 8 to 27)}. Amongst the three patients who died, only one died of COVID-19 infection or sequel (Case Fatality Rate, CFR – 1.06%). Conclusion The CFR due to COVID-19 infection amongst those who underwent radiotherapy was low. At the same time, higher MTD might have been the reason for residual or locoregional recurrences. However, a longer follow-up is required to confirm this. Till then, it will remain debatable whether it was worth delaying radiotherapy for mild to moderate COVID-19 infection for a significant time to cause a potential cancer treatment failure.
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13
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Bansal N, Raturi M, Bansal Y. SARS-CoV-2 variants in immunocompromised COVID-19 patients: The underlying causes and the way forward. Transfus Clin Biol 2022; 29:161-163. [PMID: 34973463 PMCID: PMC8714679 DOI: 10.1016/j.tracli.2021.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 01/25/2023]
Affiliation(s)
- N. Bansal
- Department of Transfusion Medicine, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand, India,Corresponding author
| | - M. Raturi
- Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India
| | - Y. Bansal
- Department of Microbiology, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand, India
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14
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Bansal N, Jeewa A, Richmond M, Watanabe K, Lorts A, Rosenthal D, Taylor K, O'Shea C, Smyth L, Koehl D, Zhao H, Hollander S. Reducing Donor Acceptance Practice Variation- Learnings from a Discussion Forum. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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15
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Gupta D, Cantor R, Zhao H, Clifford S, Bansal N, Hope K, Albers E, Prada-Ruiz A, Reinhardt Z, Sorabella R, Kirklin J, Ramakrishnan K. Use of Donor Hearts with Low Ejection Fraction in Pediatric Heart Transplantation: A PHTS Analysis. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.156] [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: 11/17/2022] Open
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16
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Dykes J, Zafar F, Almond C, Sofilos M, Lytrivi I, Szugye N, Plasencia J, Edelson J, Ghosh R, Shah J, Shugh S, Bansal N, Choueiter N, Romanowicz J, Zhang Y, Moore R, Rosenthal D, Zangwill S. Inter-Rater Reliability of Total Cardiac Volume Measurement for Heart Transplantation: An ACTION Collaborative Study. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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17
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Singh A, Khanduri A, Bansal N, Pokharia P, Gupta R. Pancreatoduodenal Tuberculosis: A Rare Site of a Common Disease. Cureus 2022; 14:e23275. [PMID: 35449685 PMCID: PMC9012567 DOI: 10.7759/cureus.23275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/26/2022] Open
Abstract
The most common site of abdominal tuberculosis (TB) is the ileocecal region. The duodenum and pancreas are rare sites of abdominal TB. It is usually observed in immunocompromised patients with miliary or disseminated TB. Pancreatoduodenal TB is often misdiagnosed as malignancy due to a lack of specific symptoms. Here, we present a case of a 55-year-old immunocompetent man having abdominal pain, bilious vomiting, weight loss, and high-grade fever for three months. Contrast-enhanced computed tomography of the abdomen showed a localized abscess with air foci in the pancreatic head and duodenopancreatic groove. Additionally, there was retroperitoneal lymphadenopathy and mild ascites. Upper gastrointestinal endoscopy revealed an ulceroproliferative lesion in the second part of the duodenum suspicious of a malignant tumor. However, the endoscopic biopsy showed epitheloid-like histiocytes, Langerhans type of giant cells, and granuloma formation suggestive of TB. The patient responded to antitubercular treatment and became symptom-free.
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18
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Rastogi M, Jagdish RK, Vij V, Bansal N. Herbal Immune Booster-Induced Liver Injury in the COVID-19 Pandemic. J Clin Exp Hepatol 2022; 12:258-259. [PMID: 34376959 PMCID: PMC8337010 DOI: 10.1016/j.jceh.2021.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Affiliation(s)
| | - Rakesh K. Jagdish
- Address for correspondence: Rakesh Kumar Jagdish, Consultant, Department of Hepatology, Gastroenterology and Liver transplant Medicine, Fortis Hospital, Noida, India.
| | - Vivek Vij
- Department of GI Surgery and Liver transplant, Fortis Hospital, Noida
| | - Nalini Bansal
- Department of Pathology, SRL, Fortis Escort Heart Institute, Delhi
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19
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Abstract
Abdominal liposarcoma is most often located in the retroperitoneum. Small bowel mesentery is a rare site of liposarcoma. Dedifferentiated liposarcoma (DDLS) is a rare variant of mesenteric liposarcoma with only 12 cases reported in the literature. DDLS has a worse prognosis compared to a well-differentiated liposarcoma. Here, we present a case of giant liposarcoma located in the jejunal mesentery diagnosed on the contrast-enhanced computed tomography of the abdomen. The patient underwent complete surgical excision with uneventful postoperative recovery. DDLS was confirmed on histopathological examination of the resected specimen. The patient is currently receiving adjuvant therapy with doxorubicin and ifosfamide in view of close resection margin, mitotic rate and high rate of recurrence.
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Affiliation(s)
- Archana Khanduri
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Nalini Bansal
- Histopathology, SRL Ltd, Fortis Escorts Heart Institute, New Delhi, IND
| | - Arvind Singh
- Gastroenterology, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Jyoti Gupta
- Radiation Oncology, Swami Rama Himalayan University, Dehradun, IND
| | - Rahul Gupta
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
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20
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Bansal N, Raturi M, Bansal Y. Seroprevalence of SARS-CoV-2 among blood donors: A practical serosurveillance tool for COVID-19. Transfus Clin Biol 2021; 29:182-183. [PMID: 34961672 PMCID: PMC8673919 DOI: 10.1016/j.tracli.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 11/19/2022]
Affiliation(s)
- N Bansal
- Department of Transfusion Medicine, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand, India.
| | - M Raturi
- Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India
| | - Y Bansal
- Department of Microbiology, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand, India
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21
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Bansal N, Raturi M, Bansal Y. COVID-19convalescent plasma use in the oncology and geriatric patients: Ethical aspects in transfusion medicine. Transfus Clin Biol 2021; 29:184-185. [PMID: 34961671 PMCID: PMC8665838 DOI: 10.1016/j.tracli.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- N Bansal
- Department of Transfusion Medicine, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand, India.
| | - M Raturi
- Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India
| | - Y Bansal
- Department of Microbiology, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand, India
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22
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Bansal N, Satapathy B. Primary multifocal cystic signet ring neuroendocrine tumor of liver: a case report. J Liver Cancer 2021; 21:187-193. [PMID: 37383080 PMCID: PMC10035681 DOI: 10.17998/jlc.2021.09.17] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/11/2021] [Accepted: 09/17/2021] [Indexed: 06/30/2023]
Abstract
Primary signet ring neuroendocrine tumors of the liver are extremely rare tumors. Morphologically, they mimic signet ring cell adenocarcinomas; however, the absence of mucin by special stains and the expression of neuroendocrine markers help to diagnose these tumors. We herein report a case of a 47-year-old female who presented with multiple solid and cystic lesions in both liver lobes, which were initially suggested to be biliary cystadenocarcinoma on imaging. Liver biopsy of the lesion revealed the presence of a signet ring neoplasm with diffuse expression of synaptophysin and pan-cytokeratin. The case was subsequently diagnosed as a primary hepatic signet ring neuroendocrine tumor. The patient was offered 3 cycles of chemotherapy and is well preserved after 14 months of diagnosis. Although this is an extremely rare entity, its possibility should be considered in the differential diagnosis of neoplasms characterized by signet ring cell morphology.
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Affiliation(s)
- Nalini Bansal
- Department of Histopathology, SRL Ltd., Fortis Escorts Heart Institute, New Delhi
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Ezeanuna M, Prince D, Alexander SA, Richards JS, Kerr G, Jala D, Bansal N, Liew J, Singh N. POS0487 ASSOCIATION OF RHEUMATOID ARTHRITIS WITH MORTALITY IN A COHORT OF CHRONIC KIDNEY DISEASE PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3222] [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: 11/03/2022]
Abstract
Background:Rheumatoid Arthritis (RA) is associated with an increased risk of cardiovascular disease. RA is also associated with increased risk of chronic kidney disease (CKD) (1, 2), which is a known cardiovascular risk factor (3). We hypothesized that RA (compared with no RA) would be associated with increased risk of mortality among a cohort of patients with CKD.Objectives:To determine the risk of mortality in RA patients with CKD.Methods:This study was conducted using participants from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) prospective Chronic Renal Insufficiency Cohort (CRIC) study. Approximately 3600 participants were enrolled from seven US clinical centers. Patients aged 21 – 74 years with mild to moderate CKD were eligible for enrollment. The primary outcome of interest was all-cause mortality. Secondary outcomes of interest included: kidney event defined as end stage renal disease (ESRD) or 50% decline in estimated glomerular filtration rate (eGFR), myocardial infarction (MI), cerebrovascular accident (CVA), heart failure and a composite cardiovascular endpoint. The association of RA mortality over time was examined using Cox multivariate proportional hazards regression, adjusting for potential covariates (age, sex, race/ethnicity, BMI, current smoker, education).Results:The study cohort included 492 participants with self-reported RA with a mean follow up of 9.5 years. Compared to the non-RA group, RA patients tended to be older, female, Black. Hypertension, diabetes, use of prednisone was more prevalent among the RA cohort. The unadjusted hazards ratio (HR) for mortality based on RA status was 1.45 (1.26, 1.67) but this association was attenuated after adjusting for the confounding factors [aHR 1.09 (0.94, 1.27)] (Table 1). Participants with RA had a significantly higher risk for heart failure than those without RA [aHR 1.17 (1.02, 1.34)]. We did not observe a statistically significant association between RA status and other secondary outcomes.Conclusion:RA was not associated with higher mortality among participants with CKD. However, RA was associated with higher rates of heart failure. Further studies evaluating the mechanisms behind this association are needed.References:[1]Kochi M, Kohagura K, Shiohira Y, Iseki K, Ohya Y. Chronic kidney disease, inflammation, and cardiovascular disease risk in rheumatoid arthritis. J Cardiol. 2018;71(3):277-83.[2]Sumida K, Molnar MZ, Potukuchi PK, Hassan F, Thomas F, Yamagata K, et al. Treatment of rheumatoid arthritis with biologic agents lowers the risk of incident chronic kidney disease. Kidney Int. 2018;93(5):1207-16.[3]Chiu HY, Huang HL, Li CH, Chen HA, Yeh CL, Chiu SH, et al. Increased Risk of Chronic Kidney Disease in Rheumatoid Arthritis Associated with Cardiovascular Complications - A National Population-Based Cohort Study. PLoS One. 2015;10(9):e0136508.[4]Muthukumar P, Dhanapriya J, Gopalakrishnan N, Dineshkumar T, Sakthirajan R, Balasubramaniyan T. Evaluation of renal lesions and clinicopathologic correlation in rheumatoid arthritis. Saudi J Kidney Dis Transpl. 2017;28(1):44-50.Table 1.Estimated hazard ratios (HR) for various outcomes from Cox proportional hazards regression for RA statusUnadjustedModel 1Model 2HR (95% CI)HR (95% CI)HR (95% CI)Death1.45 (1.26, 1.67)1.09 (0.94, 1.27)1.13 (0.97, 1.32)MI or death1.43 (1.25, 1.63)1.09 (0.95, 1.26)1.15 (0.99, 1.33)CVA or death1.42 (1.24, 1.63)1.07 (0.92, 1.24)1.11 (0.95, 1.29)CHF or death1.54 (1.35, 1.75)1.17 (1.02, 1.34)1.22 (1.06, 1.40)Composite1.49 (1.31, 1.69)1.13 (0.99, 1.30)1.18 (1.03, 1.35)Kidney event1.09 (0.94, 1.27)0.91 (0.78, 1.07)1.01 (0.85, 1.20)Model 1 adjusted for: age, sex, race/ethnicity, BMI, current smoker, educationModel 2 adjusted for: model 1 + cardiovascular risk factors (urine albumin creatinine ratio, systolic blood pressure, estimated glomerular filtration rate)Disclosure of Interests:None declared
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Bansal N, Kushwaha K, Rajput J, Narula AS. A Rare Case of Kayexalate and CMV Colitis in a Patient of Sarcoidosis and Chronic Kidney Disease. Indian J Nephrol 2021; 31:73-74. [PMID: 33994695 PMCID: PMC8101678 DOI: 10.4103/ijn.ijn_357_19] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/04/2020] [Accepted: 02/17/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Nalini Bansal
- Department of Histopathology, SRL Ltd, Fortis Escort Heart Institute [FEHI], Okhla, New Delhi, India
| | - Kuldeep Kushwaha
- Department of Nephrology, Fortis Escort Heart Institute Okhla, New Delhi, India
| | - Jitendra Rajput
- Department of Nephrology, Fortis Escort Heart Institute Okhla, New Delhi, India
| | - Ajit Singh Narula
- Department of Nephrology, Fortis Escort Heart Institute Okhla, New Delhi, India
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Bansal N, Puri P, Nagpal N, Naithani R, Gupta R. Lambda-Restricted Crystal-Storing Histiocytosis of Stomach: A Case Report and Review of Literature. Cureus 2021; 13:e15009. [PMID: 34131544 PMCID: PMC8197172 DOI: 10.7759/cureus.15009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Crystal-storing histiocytosis (CSH) is a rare tissue phenomenon that is usually associated with lympho-proliferative diseases. The disease is characterized by prominent collections of macrophages with abundant eosinophilic cytoplasm and fibrillary cytoplasmic inclusions. The inclusions appear as linear crystals within the macrophages which are usually kappa restricted. The disease usually involves lungs, lymph nodes, bone marrow, thymus and spleen with rare involvement of the gastrointestinal tract. We report a rare case of lambda-restricted CSH of the stomach. The diagnosis of CSH triggered further hematological evaluation. The patient was later diagnosed to have diffuse large B-cell lymphoma involving lymph nodes and bone marrow. He received chemotherapy for the same and is on regular follow up. The index case highlights the need to identify CSH of stomach prompting evaluation for hematological malignancies and to increase its awareness among clinicians and pathologists.
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Affiliation(s)
- Nalini Bansal
- Histopathology, Fortis Escorts Heart Institute, New Delhi, IND
| | - Pankaj Puri
- Gastroenterology and Hepatology, Fortis Escorts Heart Institute, New Delhi, IND
| | - Nishant Nagpal
- Gastroenterology and Hepatology, Fortis Escorts Heart Institute, New Delhi, IND
| | - Rahul Naithani
- Hematology and Oncology, Max Hospital Saket, New Delhi, IND
| | - Rahul Gupta
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
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Bansal N, Raturi M, Bansal Y. COVID-19 vaccination: The impact on the selection criteria of the convalescent plasma donors. Transfus Clin Biol 2021; 28:308-309. [PMID: 33971319 PMCID: PMC8103736 DOI: 10.1016/j.tracli.2021.05.002] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022]
Abstract
Clinical management protocols for COVID-19 are evolving rapidly as more information about the epidemiology and pathophysiological changes in COVID-19 become available. However, no definite treatment of COVID-19 has been found till date. The COVID-19 convalescent plasma (CCP) therapy has emerged as an important investigational therapy in the management of COVID-19 patients. Additionally, the regulatory agencies, in particular, the Indian blood transfusion council must release some interim recommendations for the blood centres on the CCP blood donor eligibility criteria after COVID-19 vaccination. More clinical trials are needed to know the efficacy of the CCP harvested from COVID-19 recovered individuals who have been vaccinated against those COVID-19 recovered individuals who are not vaccinated to understand the vaccine impact on the IgG titres of anti-SARS-CoV-2 antibodies.
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Affiliation(s)
- N Bansal
- Department of Transfusion Medicine, VCSG Government Institute of Medical Sciences and Research, Srinagar, Uttarakhand, India
| | - M Raturi
- Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun-248016, Uttarakhand, India.
| | - Y Bansal
- Department of Microbiology and Immunology, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand, India
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Abstract
Initially considered to be a respiratory disease, coronavirus disease 2019 (COVID-19) is now recognized as a multisystem disease known to affect all the major organs, including the gastrointestinal system. Based on recent studies, severe acute respiratory syndrome coronavirus 2 causes dysregulation of multiple biological pathways, triggers an exaggerated immune response, and affects multiple organs. The gastrointestinal symptoms in COVID-19 are common but often overlooked. We report the case of a 50-year-old female with a recent history of COVID-19 presenting with complaints of abdominal pain and constipation. Initially, the patient was treated for respiratory symptoms and discharged home. Subsequently, she was re-admitted and diagnosed with colonic obstruction on radiology. Laparotomy revealed descending and sigmoid colonic gangrene requiring left colectomy. This case highlights the uncommon but severe gastrointestinal manifestations of COVID-19.
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Affiliation(s)
- Rahul Varshney
- Anesthesia and Critical Care, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Nalini Bansal
- Department of Histopathology, SRL Limited, Fortis Escorts Heart Institute, New Delhi, IND
| | - Archana Khanduri
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Jyoti Gupta
- Radiation Oncology, Himalayan Institute of Medical Sciences, Dehradun, IND
| | - Rahul Gupta
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
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Bansal N, Raturi M. COVID-19 vaccination in the Indian blood donors: Adjudging the impact on the deferral period. Transfus Clin Biol 2021; 28:310-312. [PMID: 33857620 PMCID: PMC8040337 DOI: 10.1016/j.tracli.2021.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/05/2021] [Indexed: 01/28/2023]
Abstract
The only efficacious way to provide people with herd immunity against the novel corona virus [nCoV] is to administer an appropriate vaccine and help check the current pandemic. With the genetic sequence data of the nCoV already available since January 10, 2020, leading pharmaceutical companies, world over, in turn, have started working on the clinical trials to produce vaccines against this nCoV. In fact, many vaccines under the Phase III trial have claimed to demonstrate their efficacy to be as high as 95% against the nCoV. In January, the central drugs standard control organization, India had granted the emergency-use authorization [EUA] to two vaccines namely, Covishield (live vaccine, Oxford-AstraZeneca, United Kingdom being manufactured by the Serum Institute of India, Pune) and Covaxin (inactivated vaccine, Bharat Biotech, India). Although, most of the countries offer no deferral period for the donors who have been administered an inactivated vaccine against this nCoV. However, the national blood transfusion council of India has recently recommended a donor deferral period of 28 days from the last dose of vaccination. This could essentially lead to a massive loss of eligible blood donors and jeopardize the already disrupted blood supply management due to the COVID-19 outbreak. The authors, herein, propose a thorough redefining of this deferral period post-vaccination amongst the Indian blood donors.
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Affiliation(s)
- N Bansal
- Department of transfusion medicine, VCSG government institute of medical science and research, Srinagar, Uttarakhand, India
| | - M Raturi
- Department of immunohematology and blood transfusion, Himalayan institute of medical sciences, Swami Rama Himalayan University, Swami Ram Nagar, Jolly Grant Dehradun, 248016 Uttarakhand, India.
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29
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Nandi D, Auerbach S, Bansal N, Kaufman B, Lal A, Law S, Lorts A, May L, Mehegan M, Mokshagundam D, O'connor M, Rosenthal D, Shezad M, Simpson K, Sutcliffe D, VanderPluym C, Wittlieb-Weber C, Zafar F, Cripe L, Villa C. Ventricular Assist Device Outcomes in Children and Young Adults with Muscular Dystrophy: An ACTION Analysis. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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30
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Lal A, Bansal N, Cantor R, Koehl D, Urschel S, Asante-Korang A, Carlo W, Conway J, Deal N, Kirklin J, Kleinmahon J, Everitt M. Impact of Insurance and Race on Pediatric Heart Transplant Outcomes- An Analysis of the Pediatric Heart Transplant Society (PHTS) Registry. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.703] [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] Open
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31
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Bansal N, Rastogi M, Vij V. Progressive familial CD10 deficient ductopenic disorder; Hitherto an unnamed entity! - A case report. Indian J Transplant 2021. [DOI: 10.4103/ijot.ijot_29_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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32
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Pokorney S, Garonzik S, Chertow G, Washam J, Mussina K, Bansal N, Gadegbeku C, Garcia D, Lopes R, Mahaffey K, Middleton J, Thadhani R, Thomas K, Winkelmayer W, Granger C. Pharmacokinetics of apixaban in patients with end stage renal disease on hemodialysis and atrial fibrillation: results from the RENAL-AF trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background/Introduction
Apixaban use is increasing for stroke prevention in patients with atrial fibrillation (AF) and end stage renal disease (ESRD) on hemodialysis. There is uncertainty as to the optimal dose in this population in part related to the limited available pharmacokinetic (PK) data.
Purpose
We comprehensively evaluated the PK of apixaban collected over 1 month of apixaban dosing in 63 patients with AF and ESRD on hemodialysis.
Methods
Patients with AF and ESRD on hemodialysis were randomized to warfarin versus apixaban within the RENAL-AF trial with 5 mg BID dosing, except for 2.5 mg BID in those age ≥80 years or weight ≤60 kg. The 5 mg BID dose could be reduced to 2.5mg BID for minor bleeding. Day 1 PK data was collected on all patients pre- and post-hemodialysis. Day 3 and 1 month pre- and post-hemodialysis PK samples were collected in 49 patients. The timing of apixaban dosing and hemodialysis relative to PK samples was recorded. Dosing history, hemodialysis, and PK samples were chronologically integrated with patient specific data such as body size, age, race and gender. This dataset was combined with the ARISTOTLE dataset, and the published PK model from ARISTOTLE describing exposures in the AF population was updated to incorporate an additional clearance term for hemodialysis. The model estimated apixaban exposures (AUC) in RENAL-AF were compared to ARISTOLTE AUC values.
Results
There were 285 PK concentrations collected among 63 patients in the RENAL-AF trial. Patients had median age 69 years with 41% women (N=26) and a median weight of 84 kg (49, 157). The median AUCs for patients with ESRD on hemodialysis were 5,452 and 2,990 for patients treated with 5mg BID and 2.5mg BID doses, respectively. The median AUCs for patients treated with 5mg BID from ARISTOTLE increased from 2,802 for patients with class 1 CKD to 5,863 for class 4 CKD, while they increased from 2,392 for class 1 CKD to 2,881 for class 4 CKD in patients treated with 2.5mg BID. The median AUC for patients with ESRD on hemodialysis were within 50% of the exposure of patients from ARISTOTLE for all classes of CKD for the 2.5mg BID dose and for classes 2, 3A, 3B, and 4 CKD for the 5mg BID dose (Figure).
Conclusions
The steady state apixaban exposure data in patients with AF and ESRD on hemodialysis were modestly higher but consistent with the results of non-ESRD patients from ARISTOTLE, using 5 mg BID unless patients had age ≥80 years or weight ≤60 kg. Additional clinical outcomes data on the use of apixaban in patients with AF and ESRD on hemodialysis are needed.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Investigator sponsored grant from Bristol-Myers Squibb and Pfizer
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Affiliation(s)
- S Pokorney
- Duke University, Durham, United States of America
| | - S Garonzik
- Bristol Myers Squibb, Princeton, United States of America
| | - G.M Chertow
- Stanford University, Palo Alto, United States of America
| | - J.B Washam
- Duke University, Durham, United States of America
| | - K Mussina
- Frenova Renal Research, Waltham, United States of America
| | - N Bansal
- University of Washington, Seattle, United States of America
| | - C Gadegbeku
- Temple University School of Medicine, Philadelphia, United States of America
| | - D Garcia
- University of Washington, Seattle, United States of America
| | - R.D Lopes
- Duke University, Durham, United States of America
| | - K.W Mahaffey
- Stanford University, Palo Alto, United States of America
| | - J Middleton
- Duke University, Durham, United States of America
| | - R Thadhani
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - K.L Thomas
- Duke University, Durham, United States of America
| | - W Winkelmayer
- Baylor College of Medicine, Houston, United States of America
| | - C.B Granger
- Duke University, Durham, United States of America
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Batra U, Sharma M, Jain P, Soni S, Nathany S, Bansal N. 330P COVID and cancer: Choosing between hammer and anvil. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.324] [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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34
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Gupta R, Verma P, Bansal N, Semwal T. A Case of Ruptured Perineal Epidermal Cyst. Cureus 2020; 12:e11099. [PMID: 33240695 PMCID: PMC7681750 DOI: 10.7759/cureus.11099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Epidermal cysts are common skin lesions. They are usually seen in the chronic sun-exposed areas of the skin. They can get complicated by inflammation, infection, rupture, or malignancy. Epidermal cyst in the perineal region is rare. We report a case of an infected ruptured perineal epidermal cyst mimicking gluteal abscess. The patient was successfully treated by complete surgical excision. Histology revealed epidermal cyst with foreign body giant cell reaction and no evidence of malignancy.
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Affiliation(s)
- Rahul Gupta
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Piyush Verma
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Nalini Bansal
- Department of Histopathology, Fortis Escorts Heart Institute, New Delhi, IND
| | - Tushar Semwal
- Radiology, Synergy Institute of Medical Sciences, Dehradun, IND
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35
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Gupta R, Gupta J, Bansal N, Ammar H. Metastatic prostate cancer: a rare cause of colonic obstruction. ANZ J Surg 2020; 91:E343-E345. [PMID: 33010193 DOI: 10.1111/ans.16371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Jyoti Gupta
- Department of Radiation Oncology, Himalayan Institute of Medical Sciences, Dehradun, India
| | - Nalini Bansal
- Department of Histopathology, SRL Ltd., Fortis Escorts Hospital, Okhla, India
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, The University of Sousse, Sahloul Hospital, Sousse, Tunisia
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Vadher P, Agarwal P, Mistry A, Gajjar K, Bansal N, Neazee S. Angiokeratoma Corporis Diffusum: An Uncommon Case with Suspected Anderson Fabry Disease. Indian Dermatol Online J 2020; 11:212-215. [PMID: 32477981 PMCID: PMC7247653 DOI: 10.4103/idoj.idoj_136_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Angiokeratomas are variable sized hyperkeratotic vascular papules that are characterized histologically by superficial dilated capillaries in papillary dermis with epidermal proliferation. They can occur as a single lesion to a generalized form (angiokeratoma corporis diffusum). Angiokeratoma corporis diffusum though initially synonymous with Anderson Fabry disease, is now known to occur in a variety of lysosomal enzyme deficiencies. We report a case of 22 year old male with angiokeratoma corporis diffusum associated with acroparesthesias, febrile episodes, sensorineural hearing loss and renal involvement. Histopathological evaluation showed characteristic ectatic blood vessels with vacuolated endothelial cells in papillary dermis. Based on the clinical evaluation and available investigations, we suspected him to be having to Anderson fabry disease. Resource constraints limited our ability to confirm our diagnosis with enzyme assay and electron microscopy. We report this unusual case in desire of re emphasizing the importance of clinical evaluation for reaching a diagnosis in a resource poor setting.
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Affiliation(s)
- Priyanka Vadher
- Department of Skin and VD, Smt SCL General Hospital, Ahmedabad, Gujarat, India
| | - Pooja Agarwal
- Department of Skin and VD, Smt SCL General Hospital, Ahmedabad, Gujarat, India
| | - Amit Mistry
- Department of Skin and VD, Smt SCL General Hospital, Ahmedabad, Gujarat, India
| | - Krishna Gajjar
- Department of Skin and VD, Smt SCL General Hospital, Ahmedabad, Gujarat, India
| | - Nalini Bansal
- Department of Histopathology, Fortis Escorts Heart Institute, New Delhi, India
| | - Sabha Neazee
- Department of Skin and VD, Smt SCL General Hospital, Ahmedabad, Gujarat, India
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37
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Affiliation(s)
- Nalini Bansal
- Department of Histopathology, SRL Ltd Fortis Escort Heart Institute [FEHI], Okhla, New Delhi, India
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38
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Gupta A, Singh G, Patil V, Bansal N. Balloon Mitral Valvotomy in Patients with Mitral Stenosis and Left Atrial Thrombus. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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39
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Sweeney EL, Al-Shehri SS, Cowley DM, Liley HG, Bansal N, Charles BG, Shaw PN, Duley JA, Knox CL. The effect of breastmilk and saliva combinations on the in vitro growth of oral pathogenic and commensal microorganisms. Sci Rep 2018; 8:15112. [PMID: 30310099 PMCID: PMC6181944 DOI: 10.1038/s41598-018-33519-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/24/2018] [Indexed: 01/12/2023] Open
Abstract
Neonates are exposed to microbes in utero and at birth, thereby establishing their microbiota (healthy microbial colonisers). Previously, we reported significant differences in the neonatal oral microbiota of breast-fed and formula-fed babies after first discovering a primal metabolic mechanism that occurs when breastmilk (containing the enzyme xanthine oxidase) and neonatal saliva (containing highly elevated concentrations of the substrates for xanthine oxidase: xanthine and hypoxanthine). The interaction of neonatal saliva and breast milk releases antibacterial compounds including hydrogen peroxide, and regulates the growth of bacteria. Using a novel in vitro experimental approach, the current study compared the effects of this unique metabolic pathway on a range of bacterial species and determined the period of time that microbial growth was affected. We demonstrated that microbial growth was inhibited predominately, immediately and for up to 24 hr following breastmilk and saliva mixing; however, some microorganisms were able to recover and continue to grow following exposure to these micromolar amounts of hydrogen peroxide. Interestingly, growth inhibition was independent of whether the organisms possessed a catalase enzyme. This study further confirms that this is one mechanism that contributes to the significant differences in the neonatal oral microbiota of breast-fed and formula-fed babies.
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Affiliation(s)
- E L Sweeney
- The Institute of Health and Biomedical Innovation, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, 4059, Australia.
| | - S S Al-Shehri
- School of Applied Medical Science, Taif University, Taif, 21974, Saudi Arabia
| | - D M Cowley
- Mater Research Institute, The University of Queensland, Woolloongabba, 4102, Australia
| | - H G Liley
- Mater Research Institute, The University of Queensland, Woolloongabba, 4102, Australia
| | - N Bansal
- School of Pharmacy, PACE, The University of Queensland, St Lucia, 4072, Australia.,School of Agriculture and Food Science, The University of Queensland, St Lucia, 4072, Australia
| | - B G Charles
- School of Pharmacy, PACE, The University of Queensland, St Lucia, 4072, Australia
| | - P N Shaw
- School of Pharmacy, PACE, The University of Queensland, St Lucia, 4072, Australia
| | - J A Duley
- School of Pharmacy, PACE, The University of Queensland, St Lucia, 4072, Australia.,Mater Research Institute, The University of Queensland, Woolloongabba, 4102, Australia
| | - C L Knox
- The Institute of Health and Biomedical Innovation, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, 4059, Australia
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40
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Ghosh I, Hamedani GG, Bansal N, Maadooliat M. On the mixtures of Weibull and Pareto (IV) distribution: An alternative to Pareto distribution. COMMUN STAT-THEOR M 2018. [DOI: 10.1080/03610926.2016.1171353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- I. Ghosh
- Department of Mathematics and Statistics, University of North Carolina, Wilmington, USA
| | - G. G. Hamedani
- Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee, USA
| | - N. Bansal
- Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee, USA
| | - M. Maadooliat
- Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee, USA
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41
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Bansal N, Wadhawan M, Vij V. Graft versus host disease occurring in living donor liver transplant. Indian J Transplant 2018. [DOI: 10.4103/ijot.ijot_17_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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42
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Jhorawat R, Bansal N, Beniwal P, Agarwal D, Malhotra V. Factors Affecting Insulin Resistance and Its Relation to Vitamin D Status and Clinical Nutritional Parameters in Dialysis Patients: A Single-center Indian Study. Indian J Nephrol 2018; 28:41-45. [PMID: 29515300 PMCID: PMC5830808 DOI: 10.4103/ijn.ijn_361_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to measure insulin resistance (IR) in dialysis patients and its relation to Vitamin D status and nutritional parameters. We included patients on maintenance dialysis, both hemodialysis and peritoneal dialysis (HD and PD). IR was measured by homeostatic model assessment (HOMA)-IR index defined as fasting serum insulin (μU/L) × fasting blood sugar (mmol/L)/22.5. Baseline Vitamin D levels were measured by chemiluminescence immunoassay (CLIA) method. HOMA-IR index correlated with nutritional parameters such as 7-point subjective global assessment (SGA) and anthropometric measures, for example, body fat percentage, lean body weight (LBW), mid-arm circumference (MAC), and mid-arm muscle circumference (MAMC). A total of 55 patients were studied, of them 74.55% were male with mean age of the study population being 37.44 ± 14.96 years. The prevalence values of Vitamin D deficiency <30 ngm/ml, <20 ngm/ml, and <10 ngm/ml levels were 96.36%, 70.91%, and 23.64%, respectively. Mean HOMA-IR index was 3.14 ± 3.86. The correlation of HOMA-IR with Vitamin D was negative (r = -0.140, 95% confidence interval [CI] = -0.397-0.138 and P = 0.309); however, in subgroup analysis, patients with Vitamin D level <20 ng/ml had significantly high IR compared to those with Vitamin D >20 ng/ml, i.e., 3.74 ± 4.37 and 1.67 ± 1.47, respectively (P = 0.018). The other measured parameter which had a significant positive correlation with IR was serum uric acid (r = 0.303, 95% CI = 0.021-0.534, and P = 0.025). In nutritional assessment, body mass index, MAC, and MAMC had statistically significant positive correlation with HOMA-IR index (P ≤ 0.001, 0.004, and 0.004, respectively) unlike SGA (P = 0.480). The mode of dialysis did not have a significant effect on IR (HD vs. PD, P = 0.227). The majority of the patients on maintenance dialysis are Vitamin D deficient. Low Vitamin D level, especially <20 ng/ml, muscle mass, and high serum uric acid level are likely to have more IR in dialysis-dependent patients.
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Affiliation(s)
- R. Jhorawat
- Department of Nephrology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - N. Bansal
- Department of Nephrology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - P. Beniwal
- Department of Nephrology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - D. Agarwal
- Department of Nephrology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - V. Malhotra
- Department of Nephrology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
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43
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Bansal N. Liver transplant pathology: When the things are grave! Indian J Transplant 2018. [DOI: 10.4103/ijot.ijot_3_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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44
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Bansal N, Vij V, Rastogi M, Wadhawan M, Kumar A. Retrospective analysis of explants liver pathology: Experience from a tertiary care center in India. Indian J Transplant 2018. [DOI: 10.4103/ijot.ijot_67_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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45
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Park M, Katz R, Shlipak MG, Weiner D, Tracy R, Jotwani V, Hughes-Austin J, Gabbai F, Hsu CY, Pfeffer M, Bansal N, Bostom A, Gutierrez O, Sarnak M, Levey A, Ix JH. Urinary Markers of Fibrosis and Risk of Cardiovascular Events and Death in Kidney Transplant Recipients: The FAVORIT Trial. Am J Transplant 2017; 17:2640-2649. [PMID: 28371433 PMCID: PMC5620109 DOI: 10.1111/ajt.14284] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 11/13/2016] [Revised: 03/13/2017] [Accepted: 03/18/2017] [Indexed: 01/25/2023]
Abstract
Cardiovascular risk remains high in kidney transplant recipients (KTRs) despite improved kidney function after transplant. Urinary markers of kidney fibrosis and injury may help to reveal mechanisms of this risk. In a case-cohort study among stable KTRs who participated in the FAVORIT trial, we measured four urinary proteins known to correlate with kidney tubulointerstitial fibrosis on biopsy (urine alpha 1 microglobulin [α1m], monocyte chemoattractant protein-1 [MCP-1], procollagen type I [PINP] and type III [PIIINP] N-terminal amino peptide) and evaluated associations with cardiovascular disease (CVD) events (n = 300) and death (n = 371). In adjusted models, higher urine α1m (hazard ratio [HR] per doubling of biomarker 1.40 [95% confidence interval [CI] 1.21, 1.62]), MCP-1 (HR 1.18 [1.03, 1.36]), and PINP (HR 1.13 [95% CI 1.03, 1.23]) were associated with CVD events. These three markers were also associated with death (HR per doubling α1m 1.51 [95% CI 1.32, 1.72]; MCP-1 1.31 [95% CI 1.13, 1.51]; PINP 1.11 [95% CI 1.03, 1.20]). Higher concentrations of urine α1m, MCP-1, and PINP may identify KTRs at higher risk for CVD events and death. These markers may identify a systemic process of fibrosis involving both the kidney and cardiovascular system, and give new insights into mechanisms linking the kidney with CVD.
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Affiliation(s)
- M Park
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - R Katz
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | - M G Shlipak
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California,General Internal Medicine Section, San Francisco Veterans Affairs Hospital, San Francisco, California,Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - D Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - R Tracy
- Department of Pathology, University of Vermont, Burlington, Vermont
| | - V Jotwani
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - J Hughes-Austin
- Division of Preventive Medicine, Department of Preventive Medicine and Public Health, University of California San Diego, San Diego, California
| | - F Gabbai
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California,Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - CY Hsu
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - M Pfeffer
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - N Bansal
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | - A Bostom
- Rhode Island Hospital, Providence, Rhode Island
| | - O Gutierrez
- Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - M Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - A Levey
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - J H Ix
- Division of Preventive Medicine, Department of Preventive Medicine and Public Health, University of California San Diego, San Diego, California,Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California,Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
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46
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Bansal N, Hampe CS, Rodriguez L, Smith EO, Kushner J, Balasubramanyam A, Redondo MJ. DPD epitope-specific glutamic acid decarboxylase (GAD)65 autoantibodies in children with Type 1 diabetes. Diabet Med 2017; 34:641-646. [PMID: 26802570 PMCID: PMC4958605 DOI: 10.1111/dme.13077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 12/18/2022]
Abstract
AIM To study whether DPD epitope-specific glutamate decarboxylase autoantibodies are found more frequently in children with milder forms of Type 1 diabetes. METHODS We prospectively evaluated 75 children with new-onset autoimmune Type 1 diabetes, in whom we collected demographic, anthropometric and clinical data and measured islet autoantibodies. Glutamate decarboxylase 65 autoantibody-positive samples were analysed for epitope specificities using recombinant Fab against the DPD-defined epitope of glutamate decarboxylase 65. RESULTS After adjustment for age, positive DPD epitope recognition was significantly associated with higher C-peptide levels at onset (P = 0.02, r2 =0.21, n = 35), and high DPD recognition in the highest quartile tended to be associated with HbA1c ≤ 53 mmol/mol (7%) at the last follow-up [mean (sd) follow-up 1.3 (0.4) years; P = 0.07; for the model, P = 0.044, n = 30)]. Age- and sex-adjusted BMI percentile was significantly correlated with recognition of the DPD-defined epitope (P < 0.03, r2 =0.14, n = 34), but this correlation was driven by the older age group (age ≥ 10 years; P = 0.016, r2 =0.27, n = 21) and was not significant in younger children (P = 0.93, n = 13). There were no independent associations with sex, race/ethnicity, diabetic ketoacidosis, HbA1c , HLA DR3-DQ2/DR4-DQ8 or autoantibody number. CONCLUSIONS Our findings suggest that recognition of the DPD-defined glutamate decarboxylase 65 autoantibody epitope at Type 1 diabetes onset is directly associated with β-cell function, BMI and age, which supports the hypothesis that immunological factors contribute to the clinical heterogeneity of Type 1 diabetes. Larger studies relating epitope-specific glutamate decarboxylase 65 autoantibody to clinical phenotype in children with Type 1 diabetes are warranted.
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Affiliation(s)
- N. Bansal
- Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - C. S. Hampe
- Department of Medicine, University of Washington, Seattle, WA
| | - L. Rodriguez
- Department of Pediatrics, Section of Pediatric Endocrinology, Children’s Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX
| | - E. O’Brian Smith
- Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - J. Kushner
- Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - A. Balasubramanyam
- Translational Metabolism Unit, Diabetes Research Center, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA
| | - M. J. Redondo
- Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
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47
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Bansal N, Mohan S. Pemphigus Foliaceus with Herpes Simplex Virus;A Case Report. CMRA 2017. [DOI: 10.29387/ms.2017.4.4.343-348] [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: 11/09/2022]
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48
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Wadhawan M, Vij V, Makki K, Bansal N, Kumar A. Early Acute Severe HCV Recurrence After Transplantation: From Universal Mortality to Cure. J Clin Exp Hepatol 2017; 7:28-32. [PMID: 28348468 PMCID: PMC5357714 DOI: 10.1016/j.jceh.2016.10.004] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 10/21/2016] [Indexed: 12/12/2022] Open
Abstract
Acute severe recurrence of hepatitis C virus (HCV) after solid organ transplant is associated with high mortality. Pegylated interferon and ribavirin are suboptimal in treatment of this severe form of recurrence. We report 4 cases of acute severe HCV recurrence (within 6 months after transplant), including 3 cases with fibrosing cholestatic hepatitis treated with sofosbuvir and ribavirin. All four patients achieved a rapid suppression of HCV RNA with a normalization of liver function tests within 4 weeks of starting therapy. All patients were HCV RNA negative at 12 weeks after stopping therapy. The combination was found to be safe as anemia was the only adverse effect, which developed in 2 patients (1 patient required blood transfusion, while another managed with erythropoietin). Sofosbuvir and ribavirin appear to be safe and efficacious in treatment of acute severe HCV recurrence after organ transplant.
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Key Words
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- DAA's, sofosbuvir
- FCH, fibrosing cholestatic hepatitis
- Fibrosing cholestatic hepatitis
- GGTP, gamma glutamyl transpeptidase
- HCV, hepatitis C virus
- IHBR, intrahepatic biliary radicals
- Kidney transplant
- LFT, liver function tests
- LRLT, living-related liver transplant
- Liver transplant
- MMF, mycophenolate mofetil
- MRCP, magnetic resonance cholangiopancreatography
- POD, postoperative day
- TND, target not detected
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Affiliation(s)
- Manav Wadhawan
- Department of Gastroenterology & Hepatology, Fortis Escorts Liver & Digestive Diseases Institute, Delhi/NCR, India,Address for correspondence: Manav Wadhawan, Department of Gastroenterology & Hepatology, Fortis Escorts Liver & Digestive Diseases Institute, Delhi/NCR, India.Department of Gastroenterology & Hepatology, Fortis Escorts Liver & Digestive Diseases InstituteDelhi/NCRIndia
| | - Vivek Vij
- Department of Surgical Gastroenterology & Liver Transplant, Fortis Hospitals (Escorts & Noida), Delhi/NCR, India
| | - Kausar Makki
- Department of Surgical Gastroenterology & Liver Transplant, Fortis Hospitals (Escorts & Noida), Delhi/NCR, India
| | - Nalini Bansal
- Department of Pathology, Fortis Escorts Hospital, Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology & Hepatology, Fortis Escorts Liver & Digestive Diseases Institute, Delhi/NCR, India
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49
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Maan S, Kumar A, Gupta AK, Dalal A, Chaudhary D, Gupta TK, Bansal N, Kumar V, Batra K, Sindhu N, Kumar A, Mahajan NK, Maan NS, Mertens PPC. Concurrent infection of Bluetongue and Peste-des-petits-ruminants virus in small ruminants in Haryana State of India. Transbound Emerg Dis 2017; 65:235-239. [PMID: 28116836 DOI: 10.1111/tbed.12610] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Indexed: 11/27/2022]
Abstract
Bluetongue (BT) and peste-des-petits-ruminants (PPR) are major transboundary diseases of small ruminant, which are endemic in India. Testing of bluetongue virus (BTV) and peste-des-petits-ruminants virus (PPRV) from recent outbreaks (2015-2016) in different regions of Haryana State of India revealed that 27.5% of the samples showed the presence of dual infection of BTV and PPRV. Analysis of Seg-2 of BTV (the serotype-determining protein) showed the presence of BTV-12w in several isolates. However, analysis of N gene fragment amplicons showed that viruses belong to lineage IV were most closely related to a pathogenic strain of PPRV from Delhi. This is the first report of co-circulation of PPRV lineage IV and bluetongue virus serotype 12 in the state.
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Affiliation(s)
- S Maan
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - Aman Kumar
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - A K Gupta
- Department of Veterinary Microbiology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - A Dalal
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India.,Department of Veterinary Microbiology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - D Chaudhary
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - T K Gupta
- Teaching Veterinary Clinical Complex, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - N Bansal
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - V Kumar
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - K Batra
- Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - N Sindhu
- Teaching Veterinary Clinical Complex, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - Ankit Kumar
- TVCC Regional Centre, Uchani (Karnal), College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - N K Mahajan
- Veterinary Public Health & Epidemiology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - N S Maan
- Department of Animal Nutrition and Resource faculty, Department of Animal Biotechnology, College of Veterinary Sciences, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - P P C Mertens
- The Pirbright Institute, Pirbright, Surrey, UK.,School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, UK
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Bansal P, Bansal N, Sehgal A, Singla S. Flexible ureteroscopy for lower calyceal stones in a horseshoe kidney – Is it the new treatment of choice? African Journal of Urology 2016. [DOI: 10.1016/j.afju.2016.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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