1
|
Le Neveu M, Nicholson R, Agrawal P, Early M, Patterson D. Determining health-related quality of life and health state utility values of recurrent urinary tract infections in women. Int Urogynecol J 2023; 34:1831-1835. [PMID: 36752848 DOI: 10.1007/s00192-023-05468-7] [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: 11/12/2022] [Accepted: 01/06/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Health state utility values estimate an individual's valuation of their health-related quality of life. Despite prevalence of recurrent urinary tract infections (rUTIs), the health state utility value of rUTIs is unknown. The primary aim was to determine the utility value of rUTIs using the standard gamble (SG). The secondary aim was to compare the SG utility value with that derived from the EuroQol 5 dimensions (EQ-5D) and visual analog scale (VAS). We hypothesized that a utility value would be successfully derived from the SG and would differ from that derived using the EQ-5D and VAS. METHODS Nonpregnant, adult English-speaking female patients with a diagnosis of rUTI were recruited and completed the EQ-5D, VAS, and SG (n = 25). Utility values were evaluated using Wilcoxon signed-rank tests and Spearman's rho correlation. RESULTS Health state utility values varied depending on the assessment tool used: EQ-5D 0.76 (IQR 0.52), VAS 0.70 (IQR 0.30), and SG 0.85 (IQR 0.25). There were differences between VAS and the other two assessment methods (p<0.001), as well as between EQ-5D and SG (p=0.013). Spearman correlation demonstrated a moderately positive correlation between EQ-5D and VAS values (r(25) = 0.59, p=0.0019). CONCLUSIONS Our data suggest that 0.85 reflects the true health state utility value of rUTIs among nonpregnant adult English-speaking women. The utility value for recurrent UTIs is worse (lower) than that previously published for nonrecurrent UTIs, reflecting the ability of the SG to convey the compounding impact of recurrent disease. In this study, neither the EQ-5D nor the VAS produced results consistent with those found using the SG, which suggests limited validity in this population.
Collapse
Affiliation(s)
- M Le Neveu
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - R Nicholson
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P Agrawal
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M Early
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Patterson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
2
|
Agrawal P, Agrawal A, Patel AK. Community Level Physiological Profiling of Microbial Communities Influencing Mine Spoil Genesis in Chronosequence Coal Mine Overburden Spoil. Nat Env Poll Tech 2022. [DOI: 10.46488/nept.2022.v21i04.045] [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: 12/05/2022] Open
Abstract
Ecological restoration through mine spoil genesis should be dogmatic and the strategies involved a holistic approach, which emphasizes the role of microbial community composition that varies in accordance with the physiological and nutritional status of mine spoil profiles. This is because the patterns observed aboveground is being driven by the belowground diversity and processes. Thus, the relationship between microbial community structure and mine spoil genesis in chronosequence coal mine spoil has attracted considerable research attention. The occurrence of higher microbial diversity and difficulties in culturing microbes necessitate the use of a culture-independent approach through community-level physiological profiling based on the patterns of carbon source utilization using BIOLOG Ecoplate and thereby the functional diversity of microbial communities in different age series coal mine spoil was determined. The average well-color development exhibited an increasing trend with a minimum in OB0 (0.0640) and a maximum in OB15 (0.5060) over time. The patterns of substrate utilization (carbohydrates, carboxylic and ketonic acids, amino acids, polymers, amines, and amides) reflect the shift in microbial community composition in different age series coal mine spoil over time. Gradual increase in species richness and Shannon diversity index with the increase in age of mine spoil substantiated relatively higher microbial diversity reflecting the sign of mine spoil genesis. Principal component analysis and redundancy analysis based on the differential patterns of substrate utilization discriminate different age series coal mine spoil into independent clusters, which evaluated the broad-scale patterns of microbial community dynamics influencing the pace and progress of mine spoil genesis.
Collapse
|
3
|
Ramrakhiani N, Bhutani N, Chaudhary D, Parab P, Singh K, Agrawal P, Gupta V. A Retrospective Observational Study of Neurological Manifestations in COVID-19 (SON-CoV). J Assoc Physicians India 2022; 70:11-12. [PMID: 37355862 DOI: 10.5005/japi-11001-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19) has neurologic manifestations associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to retrospectively analyze SARS COVID-19 patients with neurological manifestations and identify patterns of presentation including the site of neuroaxis involvement, neuroimaging, and associated systemic involvement. METHODS AND SUBJECTS This retrospective observational study was conducted at two tertiary care hospitals in western Rajasthan. Data on age, sex, presenting symptoms, and comorbidities (hypertension, diabetes, cardiac, cerebrovascular disease, and cancer) were collected from 28th February 2020 to 31st December 2020 through medical records, discharge summaries, and radiological studies. Verbal/written patient consent was obtained due to the prevailing COVID-19 norms at the time of the first wave. Major inclusion criteria were as follows: age >18 years, consent from patient/surrogate, positive RT-PCR report in case of active COVID cases, or positive COVID antibody test in case of post-COVID neurological sequelae. All neurological manifestations were reviewed by at least two neurologists and were divided into central nervous system (CNS) and peripheral nervous system (PNS) manifestations. Systemic features and their temporal relationship with neurological features were recorded. Various other specialized assessments and therapeutic interventions were conducted. Statistical analysis was performed using the SPSS software. A Chi-square test was performed to determine the association between variables. Student's t-test and one-way analysis of variance were used to determine differences in mean values. Statistical significance was set at p < 0.05. RESULTS The mean age was 57.32 years for the CNS group and 40 years for the PNS group (p = 0.025). Age was significantly lower in the PNS group than in the CNS group (p = 0.025). Anemia, leucocytosis, and elevated serum creatinine were more commonly seen in the CNS group, although the difference was not statistically significant. The most common CNS manifestations were stroke (41.8%), of which ischemic stroke constituted 83% of cases, followed by seizure (22%), encephalopathy (20.9%), headache (15.1%), and vertigo (3.8%). The most common PNS manifestation was neuropathy (57%), which included Guillain-Barré syndrome (GBS), critical illness neuropathy, and autonomic neuropathy Conclusion: CNS symptoms of COVID-19 are more common than PNS symptoms. Stroke is the most frequent (46%) COVID-CNS symptom, which occurs in people of age above 35 years and is associated with high mortality.
Collapse
Affiliation(s)
- Neetu Ramrakhiani
- Director, Department of Neurology and Internal Medicine, Fortis Escorts Hospital
| | - Neeraj Bhutani
- Senior Consultant, Department of Neurology, Santokba Durlabhji Memorial Hospital, Jaipur; Corresponding Author
| | - Deepak Chaudhary
- Senior Consultant, Department of Community Medicine, Government Medical College, Bharatpur
| | - Pooja Parab
- Senior Consultant, Department of Neurology and Internal Medicine, Fortis Escorts Hospital
| | - Karni Singh
- Senior Consultant, Department of Neurology, Santokba Durlabhji Memorial Hospital
| | - Priya Agrawal
- Senior Consultant, Department of Neurology, Santokba Durlabhji Memorial Hospital
| | - Vikas Gupta
- Senior Consultant, Department of Neurology and Internal Medicine, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| |
Collapse
|
4
|
Marttila M, Birsoy Ö, Gupta V, Amr S, Funke B, Hynes H, Genetti C, Swanson L, Agrawal P, Rehm H, Beggs A. VP.04 Ryanodine receptor - related disorders. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
5
|
Leff R, Agrawal P, Tibbetts C, Smith M, Cordone A, Brackett A, Moran T, Smith R, Zeidan A. 120 Inclusion of Non-English Language Preference Patients in Trauma and Emergency Medicine Related Motor Vehicle Collision Research. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.144] [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: 11/01/2022]
|
6
|
Umphrey L, Lenhard N, Lam SK, Hayward NE, Hecht S, Agrawal P, Chambliss A, Evert J, Haq H, Lauden SM, Paasi G, Schleicher M, McHenry MS. Virtual global health in graduate medical education: a systematic review. Int J Med Educ 2022; 13:230-248. [PMID: 36057978 PMCID: PMC9911141 DOI: 10.5116/ijme.62eb.94fa] [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] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To synthesize recent virtual global health education activities for graduate medical trainees, document gaps in the literature, suggest future study, and inform best practice recommendations for global health educators. METHODS We systematically reviewed articles published on virtual global health education activities from 2012-2021 by searching MEDLINE, EMBASE, Cochrane Library, ERIC, Scopus, Web of Science, and ProQuest Dissertations & Theses A&I. We performed bibliography review and search of conference and organization websites. We included articles about primarily virtual activities targeting for health professional trainees. We collected and qualitatively analyzed descriptive data about activity type, evaluation, audience, and drivers or barriers. Heterogeneity of included articles did not lend to formal quality evaluation. RESULTS Forty articles describing 69 virtual activities met inclusion criteria. 55% of countries hosting activities were high-income countries. Most activities targeted students (57%), with the majority (53%) targeting trainees in both low- to middle- and high-income settings. Common activity drivers were course content, organization, peer interactions, and online flexibility. Common challenges included student engagement, technology, the internet, time zones, and scheduling. Articles reported unanticipated benefits of activities, including wide reach; real-world impact; improved partnerships; and identification of global health practice gaps. CONCLUSIONS This is the first review to synthesize virtual global health education activities for graduate medical trainees. Our review identified important drivers and challenges to these activities, the need for future study on activity preferences, and considerations for learners and educators in low- to middle-income countries. These findings may guide global health educators in their planning and implementation of virtual activities.
Collapse
Affiliation(s)
- Lisa Umphrey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nora Lenhard
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Suet Kam Lam
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Shaina Hecht
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Priya Agrawal
- Mid-Atlantic Permanente Medical Group, Washington, DC, USA
| | - Amy Chambliss
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jessica Evert
- Child Family Health International, El Cerrito, California, USA
| | - Heather Haq
- Department of Pediatrics, Baylor College of Medicine, Texas, USA
| | - Stephanie M. Lauden
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - George Paasi
- Mbale Clinical Research Institute, Mbale, Uganda
| | - Mary Schleicher
- Cleveland Clinic Floyd D. Loop Alumni Library, Cleveland, OH, USA
| | | |
Collapse
|
7
|
Vydyanathan A, Agrawal P, Shetty N, Nair S, Shilian N, Shaparin N. The Use of a New Device-Assisted Needle Guidance versus Conventional Approach to Perform Ultrasound Guided Brachial Plexus Blockade: A Randomized Controlled Study. Local Reg Anesth 2022; 15:61-69. [PMID: 35915616 PMCID: PMC9338390 DOI: 10.2147/lra.s363563] [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] [Received: 03/04/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Ultrasound guidance during nerve blockade poses the challenge of maintaining in-plane alignment of the needle tip. The needle guidance device maintains needle alignment and assists with in-plane needle visualization. The purpose of this study is to evaluate the utility of this device by comparing procedure performance during brachial plexus blockade with the conventional approach. Methods After the Institutional Review Board approval and obtaining informed consent, 70 patients receiving either interscalene or supraclavicular nerve blocks were randomly assigned into 2 groups, a conventional approach versus utilizing the needle guidance device. An independent observer recorded: total procedure time; needle insertion time; number of unplanned redirections; and number of reinsertions. Additionally, physician satisfaction and ease of needle visualization were assessed. Results Data from seventy patients were analyzed. The median [25th percentile-75th percentile] time to complete the block by the device assisted needle guidance group was 3 (2–3.75) minutes and 4 (3–6) minutes in the conventional approach group (p < 0.001). Additionally, subgroup analyses were performed in the supraclavicular block and interscalene block. Supraclavicular blockade, needle insertion time (median [25th percentile-75th percentile] in seconds) (106 [92–162] vs 197 [140–278]), total procedure time (3 [2–3] vs 4.5 [4–6] in minutes) and unplanned needle redirections (2 [1–5] vs 5.5 [3–9]) were significantly lower in needle guidance group (p < 0.001). With interscalene blockade, needle insertion time (86 [76–146] vs 126 [94–295]) and unplanned needle redirections (2 [1–3] vs 4 [2–8.5]) were significantly lower with needle guidance (p < 0.001), but total procedure time was similar. All the physicians reported that they would use the needle guidance again, and 90% would prefer it for in-plane blocks. Conclusion Performing regional blocks using the needle guidance device reduces needle insertion time and unplanned needle redirections in brachial plexus blockade. Moreover, physician satisfaction also improved compared to the use of the conventional technique.
Collapse
Affiliation(s)
- Amaresh Vydyanathan
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, Bronx, NY, USA
| | | | - Naveen Shetty
- Department of Anesthesiology, New York University, New York, NY, USA
| | - Singh Nair
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, Bronx, NY, USA
| | - Nancy Shilian
- Department of Family Medicine, Mount Sinai South Nassau Hospital, Oceanside, NY, USA
| | - Naum Shaparin
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
8
|
Kohn T, Dumas K, Kohn J, Agrawal P, Clifton M. Characteristics of Systemic Testosterone Therapy for Female Hypoactive Sexual Desire Disorder – A Claims Database Analysis. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.05.123] [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: 10/16/2022]
|
9
|
Häuser K, Azmi R, Agrawal P, Jakoby R, Maune H, Hoffmann M, Binder J. Sintering behavior and electrical properties of the paraelectric/dielectric composite system BST/MBO. Ann Ital Chir 2021. [DOI: 10.1016/j.jeurceramsoc.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
10
|
Marttila M, Gupta V, Birsoy Ö, Amr S, Funke B, Hynes H, Genetti C, Swanson L, Agrawal P, Rehm H, Beggs A. CONGENITAL MYOPATHIES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.071] [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]
|
11
|
David KA, Sundaram S, Kim S, Vaca R, Lin Y, Singer S, Malecek M, Carter J, Zayac A, Kim MS, Reddy N, Ney D, Habib A, Strouse C, Graber J, Bachanova V, Salman S, Vendiola JA, Hossain N, Tsang M, Major A, Bond DB, Agrawal P, Mier‐Hicks A, Torka P, Rajakumar P, Venugopal P, Berg S, Glantz M, Goldlust S, Kumar P, Ollila T, Cai J, Spurgeon S, Sieg A, Cleveland J, Epperla N, Karmali R, Naik S, Martin P, Smith SM, Rubenstein J, Kahl B, Evens AM. OLDER PATIENTS WITH PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA (PCNSL): REAL WORLD (RW) OUTCOMES OF POST‐INDUCTION THERAPY IN THE MODERN ERA. Hematol Oncol 2021. [DOI: 10.1002/hon.69_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
12
|
Munir M, Khan M, Agrawal P, Benjamin M, Syed M, Farjo P, Patel K, Ghaffar Y, Khan M, Khan S, Balla S. Catheter ablation for atrial fibrillation in patients with reduced systolic function: a national perspective. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0558] [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
Randomized trials have shown improvement in hard clinical end points when catheter ablation (CA) was employed as a management strategy for certain atrial fibrillation (AF) patients with heart failure and reduced ejection fraction (HFrEF). We sought to determine real world data on mortality and complications after utilization of CA in such patients.
Methods and results
Data were derived from National Inpatient Sample from January 2008 to August 2015. Patients were identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Baseline characteristics and outcomes were compared among AF and HFrEF patients undergoing CA or not. Propensity matching was done to mitigate selection bias and balance confounding variables. Various CA related complications were assessed. Logistic regression was done to determine predictors of mortality in our study cohort. A total of 2,569,919 patients were enrolled and out of these approximately 7773 patients underwent CA. Mortality was significantly better in CA group in both unmatched (1.2% vs. 4.9%, p<0.01) and propensity matched cohorts (1.2% vs. 3.6%, p<0.01). Overall complication rate was 10.2% in CA cohort and were primarily cardiac and neurological in origin. In regression analysis, CA remains a strong predictor of reduced mortality (OR 0.301, 95% CI 0.184–0.494).
Conclusion
CA is associated with improved mortality in admitted AF patients with concomitant HFrEF. Overall complication rate after CA was modest at 10.2%.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- M Munir
- University of California, San Diego, San Diego, United States of America
| | - M.Z Khan
- West Virginia Institute Heart and Vascular Institute, Morgantown, United States of America
| | - P Agrawal
- West Virginia Institute Heart and Vascular Institute, Morgantown, United States of America
| | - M.M Benjamin
- West Virginia Institute Heart and Vascular Institute, Morgantown, United States of America
| | - M Syed
- West Virginia Institute Heart and Vascular Institute, Morgantown, United States of America
| | - P Farjo
- West Virginia Institute Heart and Vascular Institute, Morgantown, United States of America
| | - K Patel
- West Virginia Institute Heart and Vascular Institute, Morgantown, United States of America
| | - Y.A Ghaffar
- West Virginia Institute Heart and Vascular Institute, Morgantown, United States of America
| | - M.U Khan
- West Virginia Institute Heart and Vascular Institute, Morgantown, United States of America
| | - S Khan
- West Virginia Institute Heart and Vascular Institute, Morgantown, United States of America
| | - S Balla
- West Virginia Institute Heart and Vascular Institute, Morgantown, United States of America
| |
Collapse
|
13
|
Marothiya S, Jain U, Bharti C, Polke P, Agrawal P, Shah R, Mishra P. Evaluation of Changes in Microbiology and Periodontal Parameters During and After Fixed Orthodontic Appliances. Mymensingh Med J 2020; 29:983-990. [PMID: 33116106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The objective of the study was to evaluate the changes in microbiology through quantitative analysis of aerobic and anaerobic colonies and periodontal measurements during and after 1 month of removal of fixed orthodontic appliances. This prospective study comprised 30 patients, aged 12-30 years seeking orthodontic treatment in the department of Orthodontics and Dentofacial Orthopaedics of People's College of Dental Sciences and Research Centre, Bhopal from May 2016 to November 2017. Microbiological samples (supra- and subgingival plaque) and periodontal measurements like bleeding on probing (BOP), periodontal pocket depth (PPD) with oral hygiene assessment indices {plaque index (PI), gingival index (GI)} were used at 2 time interval: when patient undergoing orthodontic treatment >12 month (baseline, T₁) and 1 month after the removal of appliance (T₂). Bacterial culture method used to detect aerobic and anaerobic colony forming units (CFU) and their ratio (aerobic/anaerobic). Data analyzed using paired t-test and chi-square test. There was a significant decrease in an aerobic and anaerobic CFU (both supra- and subgingivally) and increase in CFU ratio (relatively less anaerobes) (p≤0.05) at T₂. Supragingival plaque sampling showed greater diminution in the CFU count as compared to the subgingival CFU, as these sites are more accessible for maintaining hygiene. Also, periodontal measurements showed significant decrement (PI, GI, PPD and BOP) at T₂ (p≤0.05). Fixed orthodontic treatment has transient effect on periodontium as supra- and subgingival CFU count decreases and periodontal health was ameliorated after removal of appliances which was accompanied with periodontopathic bacteria and clinical periodontal signs of inflammation during treatment.
Collapse
Affiliation(s)
- S Marothiya
- Dr Sunita Marothiya, Assistant Professor, Department of Orthodontics and Dentofacial Orthopaedics, Sri Aurobindo College of Dentistry, Indore (MP), India; E-mail:
| | | | | | | | | | | | | |
Collapse
|
14
|
Dadheech PK, Agrawal P, Mebarek-Oudina F, Abu-Hamdeh NH, Sharma A. Comparative Heat Transfer Analysis of MoS2/C2H6O2 and SiO2-MoS2/C2H6O2 Nanofluids with Natural Convection and Inclined Magnetic Field. j nanofluids 2020. [DOI: 10.1166/jon.2020.1741] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article explores the comparative analysis of MoS2/C2H6O2 nanofluid and SiO2-MoS2/C2H6O2 hybrid nanofluid natural convective boundary layer flow through a stretching area. Uniform
inclined magnetic field is applied together with viscous dissipation. The governing model of the flow is solved by Runga-Kutta fourth orde method using appropriate similarity transformations. Temperature and velocity field are presented for various flow pertinent parameters. It is conclude
that if we give an increment in the convection parameter the velocity profile increases and opposite effect is noticed for the temperature profile for both fluids. Also with increased volume fraction parameter Φ2, we get increased velocity and temperature profiles for
both nanofluids.
Collapse
Affiliation(s)
- P. K. Dadheech
- Department of Mathematics, University of Rajasthan, Jaipur 302004, India
| | - P. Agrawal
- Department of Mathematics, University of Rajasthan, Jaipur 302004, India
| | - F. Mebarek-Oudina
- Department of Physics, Faculty of Sciences, University of 20 Août 1955-Skikda, Skikda 21000, Algeria
| | - N. H. Abu-Hamdeh
- Center of Research Excellence in Renewable Energy and Power Systems, and Department of Mechanical Engineering, Faculty of Engineering, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - A. Sharma
- Department of Mathematics, University of Rajasthan, Jaipur 302004, India
| |
Collapse
|
15
|
Esmail S, Agrawal P, Aly S. A novel analytical approach for advection diffusion equation for radionuclide release from an area source. Nuclear Engineering and Technology 2020. [DOI: 10.1016/j.net.2019.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
16
|
Gritsenko K, Polshin V, Agrawal P, Nair S, Shaparin N, Gruson K, Tan-Geller M. Incidence of vocal cord paresis following ultrasound-guided interscalene nerve block: An observational cohort study. Best Pract Res Clin Anaesthesiol 2019; 33:553-558. [PMID: 31791570 DOI: 10.1016/j.bpa.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Interscalene brachial plexus block (IBPB) has become a standard practice for perioperative analgesia for shoulder procedures. However, several side effects may occur owing to its anatomic location. We have chosen to evaluate vocal cord paresis and dysphonia following interscalene blocks. METHODS After IRB approval, eight patients undergoing arthroscopic shoulder procedures were recruited into this prospective cohort study. Following informed consent, vocal cords were assessed by standardized fiberoptic evaluation. Subsequently, IBPB was performed under ultrasound (US) guidance. Patients were re-evaluated for vocal cord changes by a repeat fiberoptic assessment one hour following IBPB. Our primary outcome measure was incidence of vocal cord immobility. RESULTS No patients had diminished vocal cord motion, dysphonia, or dysphagia. CONCLUSIONS Although larger studies are required to determine the true incidence of vocal cord paresis following US-guided IBPB, our results suggest that incidence of unwanted nerve blockade other than brachial plexus is much lower than that previously described.
Collapse
Affiliation(s)
- Karina Gritsenko
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, 1250 Waters Pl, Tower II, 8th Floor, Bronx, 10461, NY, USA
| | - Victor Polshin
- Department of Anesthesiology and Perioperative Medicine, UMASS Memorial Medical Center, 119 Belmont St, Worcester, 01605, MA USA.
| | - Priya Agrawal
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, 1250 Waters Pl, Tower II, 8th Floor, Bronx, 10461, NY, USA.
| | - Singh Nair
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, 1250 Waters Pl, Tower II, 8th Floor, Bronx, 10461, NY, USA
| | - Naum Shaparin
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, 1250 Waters Pl, Tower II, 8th Floor, Bronx, 10461, NY, USA
| | - Konrad Gruson
- Department of Orthopedics, Department of Anesthesiology and Pain Management, Montefiore Medical Center, 1250 Waters Pl, 11th Floor, Suite B, Bronx, 10461, NY, USA.
| | - Melin Tan-Geller
- Department of Otolaryngology, Montefiore Medical Center, 222 Bloomingdale Rd, Suite 205, White Plains, 10605, Bronx, NY, USA.
| |
Collapse
|
17
|
Agrawal P, Nada R, Ramachandran R, Rayat CS, Kumar A, Kohli HS. Loss of Subpodocytic Space Predicts Poor Response to Tacrolimus in Steroid-Resistant Calcineurin Inhibitor-Naïve Adult-Onset Primary Focal Segmental Glomerulosclerosis. Indian J Nephrol 2019; 29:90-94. [PMID: 30983748 PMCID: PMC6440328 DOI: 10.4103/ijn.ijn_422_17] [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] [Indexed: 11/06/2022] Open
Abstract
Focal segmental glomerulosclerosis (FSGS) is the most common cause of adult-onset nephrotic syndrome, but its pathophysiology is poorly understood. The question as to why only a subset of patients responds to treatment in unanswered. In the past few years, change of podocytic phenotype from stationary type in health to migratory type in disease has been described, of which loss of subpodocytic space is a surrogate marker. Diagnostic biopsies of adult-onset steroid-resistant calcineurin inhibitor-naïve primary FSGS cases, which were subsequently treated with tacrolimus were included in this retrospective study conducted from 2011 to 2013. The ultrastructure of all cases was studied in detail, especially in context to the presence or absence of subpodocytic space. In the present study, we have compared presence or absence of subpodocytic space in tacrolimus-responsive versus tacrolimus-resistant cases to identify potential electron microscopic features predictive of response to treatment, of which loss of subpodocytic space indicating migratory phenotype is the most important and consistent feature. The present series included 7 tacrolimus responsive cases (includes two cases with partial response) and seven tacrolimus-resistant cases. The tacrolimus-resistant patients were of older age, had a longer duration of illness, and a lower eGFR as compared to tacrolimus responsive cases. The subpodocytic space was preserved in patients on tacrolimus with complete remission and lost in patients with partial response and tacrolimus-resistant cases.
Collapse
Affiliation(s)
- P Agrawal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - C S Rayat
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kumar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - H S Kohli
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
18
|
Abstract
Monoclonal gammopathy of undetermined significance does not have end organ damage, but a proportion of cases manifest with renal injury when it is called monoclonal gammopathy of renal significance (MGRS). Herein, we describe a case of acute hepatitis E infection, which precipitated the development of MGRS. The patient underwent kidney biopsy for elevated creatinine with clinical suspicion of drug-induced interstitial nephritis. On light microscopy, there were periodic acid–Schiff negative-fractured casts in tubules with giant cell reaction around them. The tubular epithelial cells showed intracytoplasmic bile pigment. On direct immunofluorescence, casts showed kappa restriction. A diagnosis of bilirubin proximal tubulopathy and light chain cast nephropathy was made, and possibility of myeloma was suggested. On further evaluation, κ:λ ratio was 27, β2 microglobulin was 8036 ng/ml, and bone marrow examination showed 5% plasma cells. There were no bony lesions, and serum calcium was 8.6 mg/dl. The present case is unique in two aspects. First, the patient developed MGRS triggered by acute hepatitis E in less than a month. Second, the MGRS lesion was manifested in the form of light chain cast nephropathy.
Collapse
Affiliation(s)
- P Agrawal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - V Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kumar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M U S Sachdeva
- Department of Hematopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
19
|
Huntoon V, Widrick J, Sanchez C, Kutchukian C, Cao S, Beggs A, Jacquemond V, Agrawal P. SPEG deficiency is associated with muscle weakness, triad defect, abnormal calcium handling and EC coupling. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.488] [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]
|
20
|
Puri L, Das J, Pai M, Agrawal P, Fitzgerald JE, Kelley E, Kesler S, Mate K, Mohanan M, Okrainec A, Aggarwal R. Enhancing quality of medical care in low income and middle income countries through simulation-based initiatives: recommendations of the Simnovate Global Health Domain Group. BMJ STEL 2017. [DOI: 10.1136/bmjstel-2016-000180] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BackgroundQuality of medical care in low income and middle income countries (LMICs) is variable, resulting in significant medical errors and adverse patient outcomes. Integration of simulation-based training and assessment may be considered to enhance quality of patient care in LMICs. The aim of this study was to consider the role of simulation in LMICs, to directly impact health professions education, measurement and assessment.MethodsThe Simnovate Global Health Domain Group undertook three teleconferences and a direct face-to-face meeting. A scoping review of published studies using simulation in LMICs was performed and, in addition, a detailed survey was sent to the World Directory of Medical Schools and selected known simulation centres in LMICs.ResultsStudies in LMICs employed low-tech manikins, standardised patients and procedural simulation methods. Low-technology manikins were the majority simulation method used in medical education (42%), and focused on knowledge and skills outcomes. Compared to HICs, the majority of studies evaluated baseline adherence to guidelines rather than focusing on improving medical knowledge through educational intervention. There were 46 respondents from the survey, representing 21 countries and 28 simulation centres. Within the 28 simulation centres, teachers and trainees were from across all healthcare professions.DiscussionBroad use of simulation is low in LMICs, and the full potential of simulation-based interventions for improved quality of care has yet to be realised. The use of simulation in LMICs could be a potentially untapped area that, if increased and/or improved, could positively impact patient safety and the quality of care.
Collapse
|
21
|
Agrawal P, Ganeriwal V. Dexmedetomidine as anesthetic adjuvant in moyamoya patients for EDAS procedure: Our institutional experience. Journal of Neuroanaesthesiology and Critical Care 2017. [DOI: 10.4103/2348-0548-199956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- P. Agrawal
- Department of Anesthesiology, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, Maharashtra, India
| | - V. Ganeriwal
- Department of Anesthesiology, Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, Maharashtra, India
| |
Collapse
|
22
|
Affiliation(s)
- M Razmi T
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Mahajan
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P Agrawal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
23
|
Garg R, Singh S, Dhiman S, Agrawal P, Prakash P. Novel Bio-Markers for Prediction of Preeclampsia. Nepal j obstet gynaecol 2016. [DOI: 10.3126/njog.v11i1.16237] [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: 11/18/2022] Open
Abstract
Pre-eclampsia (PE) is a pregnancy related disorder. It is an important cause of maternal and perinatal morbidity and mortality worldwide. Two to eight percent of pregnancies were affected by PE. It is characterized by de novo hypertension and proteinuria after 20 weeks of gestation. The etiology and pathogenesis of the disease is unknown, but recent studies have revealed that placenta is the place of origin of this disorder and widespread maternal endothelial dysfunction is the characteristic feature of the disease. Some biochemical molecules are identified recently which are involved in the pathogenesis of the disease, which may help in early identification of patients at risk and help in providing proper prenatal care. Several promising biomarkers have been proposed, alone or in combination. Maternal serum concentrations of these biomarkers either increase or decrease in PE during gestation. This review focuses on the various biomarkers available and their utility in prediction and diagnosis of pre-eclampsia.
Collapse
|
24
|
Affiliation(s)
- Priya Agrawal
- Merck for Mothers, Merck & Co. Inc., 1 Merck Drive, Mail Stop WS2A-56, Whitehouse Station, New Jersey, 08889, United States of America
| |
Collapse
|
25
|
Agrawal P, Barton I, Bianco RD, Hovig D, Sarley D, Yadav P. Moving Medicine, Moving Minds: Helping Developing Countries Overcome Barriers to Outsourcing Health Commodity Distribution to Boost Supply Chain Performance and Strengthen Health Systems. Glob Health Sci Pract 2016; 4:359-65. [PMID: 27688714 PMCID: PMC5042692 DOI: 10.9745/ghsp-d-16-00130] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/26/2016] [Indexed: 11/23/2022]
Abstract
Senegal and other developing countries are improving access to health commodities by outsourcing supply chain logistics to private providers. To achieve broader, lasting reform, we must support further adoption of the outsourced model; assist country-led cost-benefit analyses; and help governments build capacity to manage contracts and overcome other barriers.
Collapse
Affiliation(s)
- Priya Agrawal
- Merck & Co., Inc., Kenilworth, NJ, USA. Merck & Co., Inc. is known as MSD outside the United States and Canada
| | - Iain Barton
- Imperial Health Sciences, Gauteng, South Africa
| | - Roberto Dal Bianco
- Merck & Co., Inc., Kenilworth, NJ, USA. Merck & Co., Inc. is known as MSD outside the United States and Canada
| | - Dana Hovig
- The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - David Sarley
- The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | |
Collapse
|
26
|
|
27
|
Rao JP, Agrawal P, Mohammad R, Rao SK, Reddy GR, Dechamma HJ, S Suryanarayana VV. Expression of VP1 protein of serotype A and O of foot-and-mouth disease virus in transgenic sunnhemp plants and its immunogenicity for guinea pigs. Acta Virol 2016; 56:91-9. [PMID: 22720698 DOI: 10.4149/av_2012_02_91] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED Recently, transgenic plants expressing immunogenic proteins of foot-and-mouth disease virus (FMDV) have been used as oral or parenteral vaccines against foot-and-mouth disease (FMD). They exhibit advantages like cost effectiveness, absence of processing, thermostability, and easy oral application. FMDV VP1 protein of single serotype has been mostly used as immunogen. Here we report the development of a bivalent vaccine with tandem-linked VP1 proteins of two serotypes, A and O, present in transgenic forage crop Crotalaria juncea. The expression of the bivalent protein in the transgenic plants was confirmed by Western blot analysis. Guinea pig reacted to orally or parenterally applied vaccine by humoral as well as cell-mediated immune responses including serum antibodies and stimulated lymphocytes, respectively. The vaccine protected the animals against a challenge with the virus of serotype A as well as O. This is the first report on the development of a bivalent FMD vaccine using a forage crop. KEYWORDS foot-and-mouth disease; sunnhemp; Agrobacterium tumefaciens; FMDV-VP1 gene; serotype O and A; in planta transformation; transgenic plants; bivalent vaccine.
Collapse
|
28
|
Rodricks D, Gupta A, Phulambrikar T, Singh SK, Sharma BK, Agrawal P. Anatomical and Morphological Characterization of the Nasopalatine Canal: A Cone-Beam Computed Tomography Study. Mymensingh Med J 2016; 25:349-356. [PMID: 27277370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The anterior maxilla, also called pre-maxilla, is an area frequently requiring surgical interventions. Rehabilitation of this area remains a complex restorative challenge. The most prominent anatomical structure within the anterior maxilla is the Nasopalatine Canal. Thorough knowledge about this anatomical structure plays an important role in the successful outcomes of surgical procedures. This retrospective study was done to evaluate the anatomy and morphology of the Nasopalatine Canal using cone-beam computed tomography (CBCT). The study included 125 subjects aged between 15 and 78 years who were divided into the following 5 groups: i) 15-30 years, ii) 30-45 years, iii) 45-60 years, iv) 60-75 years, v) ≥75 years in the Department of Oral Medicine & Radiology, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India from January 2012 to January 2015. Cone-beam computed tomography (CBCT) was performed using a standard exposure and patient positioning protocol. The data of the CBCT images were sliced in three dimensions. Image planes on the three axes (X, Y, and Z) were sequentially analyzed for the location, morphology and dimensions of the Nasopalatine Canal. The correlation of age and gender with all the variables were evaluated. ANOVA and Z-test was used. P value <0.05 was considered statistically significant. Males and females showed significant differences in the length of the canal and anterior bone width in the sagittal sections. Inverted L was identified as a new dimension to the morphological shape of Nasopalatine Canal in central Madhya Pradesh population. The present study highlighted important variability observed in the anatomy and morphology of the Nasopalatine Canal.
Collapse
Affiliation(s)
- D Rodricks
- Dr Deepshikha Rodricks, Post Graduate Student, Department of Oral Medicine & Radiology, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India; E-mail: deepshikha.rodricks@ gmail.com
| | | | | | | | | | | |
Collapse
|
29
|
Vishnoi J, Gupta S, Kumar V, Jamal N, Agrawal P, Misra S, Kori C, Rajan S, Dontula P. 2847 Importance of tumor thickness using intraoral ultrasound in predicting nodal metastasis in early oral cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31587-8] [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]
|
30
|
Agrawal P, George R, Thomas M, Has C, Pas H, Schmidt E, Leverkus M. A childhood subepidermal autoimmune bullous disease resembling mechanobullous epidermolysis bullosa acquisita. Br J Dermatol 2015; 173:871-4. [DOI: 10.1111/bjd.13833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P. Agrawal
- Department of Dermatology, Venereology and Leprosy; Christian Medical College and Hospital; Vellore 632004 India
| | - R. George
- Department of Dermatology, Venereology and Leprosy; Christian Medical College and Hospital; Vellore 632004 India
| | - M. Thomas
- Department of Pathology; Christian Medical College and Hospital; Vellore 632004 India
| | - C. Has
- Department of Dermatology; University of Freiburg; Freiburg Germany
| | - H. Pas
- Department of Dermatology; University Medical Centre Groningen; Groningen the Netherlands
| | - E. Schmidt
- Department of Dermatology; University Hospital Schleswig-Holstein; Campus Lübeck Ratzeburger Allee 160 Lübeck 23538 Germany
| | - M. Leverkus
- Section of Molecular Dermatology; Department of Dermatology, Venereology and Allergology; University Hospital Mannheim; University of Heidelberg; Theodor-Kutzer-Ufer 1-3 Mannheim 68167 Germany
| |
Collapse
|
31
|
Moucheraud C, Gass J, Lipsitz S, Spector J, Agrawal P, Hirschhorn LR, Gawande A, Kodkany B. Bedside Availability of Prepared Oxytocin and Rapid Administration After Delivery to Prevent Postpartum Hemorrhage: An Observational Study in Karnataka, India. Glob Health Sci Pract 2015; 3:300-4. [PMID: 26085025 PMCID: PMC4476866 DOI: 10.9745/ghsp-d-14-00239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postpartum hemorrhage is a leading cause of maternal death worldwide. Rapid provision of uterotonics after childbirth is recommended to reduce the incidence and severity of postpartum hemorrhage. Data obtained through direct observation of childbirth practices, collected in a study of the World Health Organization's Safe Childbirth Checklist in Karnataka, India, were used to measure if oxytocin prepared for administration and available at the bedside before birth was associated with decreased time to administration after birth. This was an observational study of provider behavior: data were obtained during a baseline assessment of health worker practices prior to introduction of the Safe Childbirth Checklist, representing behavior in the absence of any intervention. Analysis was based on 330 vaginal deliveries receiving oxytocin at any point postpartum. Oxytocin was prepared and available at bedside for approximately 39% of deliveries. We found that advance preparation and bedside availability of oxytocin was associated with increased likelihood of oxytocin administration within 1 minute after delivery (adjusted risk ratio = 4.89, 95% CI = 2.61, 9.16), as well as with decreased overall time to oxytocin administration after delivery (2.9 minutes sooner in adjusted models, 95% CI = -5.0, -0.9). Efforts to reduce postpartum hemorrhage should include recommendations and interventions to ensure advance preparation and bedside availability of oxytocin to facilitate prompt administration of the medicine after birth.
Collapse
Affiliation(s)
- Corrina Moucheraud
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA
| | - Jonathon Gass
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stuart Lipsitz
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, MA, USA
| | | | - Priya Agrawal
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | - Lisa R Hirschhorn
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA
| | - Atul Gawande
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, MA, USA
| | - Bhala Kodkany
- Jawaharlal Nehru Medical College, Women's and Children's Health Research Unit, Karnataka, India
| |
Collapse
|
32
|
Agrawal P. Re: widespread non-adherence to evidence-based maternity care guidelines: a population-based cluster randomised household survey. BJOG 2015; 122:883-884. [PMID: 25892470 DOI: 10.1111/1471-0528.13307] [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] [Accepted: 11/25/2014] [Indexed: 11/28/2022]
Affiliation(s)
- P Agrawal
- MSD for Mothers, Merck, Sharp & Dohme, Kenilworth, NJ, USA
| |
Collapse
|
33
|
Soni S, Agrawal P, Kumar N, Mittal G, Nishad DK, Chaudhury NK, Bhatnagar A, Basu M, Chhillar N. Salivary biochemical markers as potential acute toxicity parameters for acute radiation injury: A study on small experimental animals. Hum Exp Toxicol 2015; 35:221-8. [PMID: 25813962 DOI: 10.1177/0960327115579433] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Researchers have been evaluating several biodosimetric/screening approaches to assess acute radiation injury, related to mass causality. Keeping in mind this background, we hypothesized that effect of whole-body irradiation in single fraction in graded doses can affect the secretion of various salivary components that could be used as acute radiation injury/toxicity marker, which can be used in screening of large population at the time of nuclear accidents/disaster. Thirty Sprague Dawley rats treated with whole-body cobalt-60 gamma irradiation of dose 1-5 Gy (dose rate: 0.95 Gy/min) were included in this study. Whole mixed saliva was collected from all animals before and after radiation up to 72 h postradiation. Saliva was analyzed for electrolytes, total protein, urea, and amylase. Intragroup comparison of salivary parameters at different radiation doses showed significant differences. Potassium was significantly increased as the dose increased from 1 Gy to 5 Gy (p < 0.01) with effect size of difference (r > 0.5). Sodium was significantly altered after 3-5 Gy (p < 0.01, r > 0.5), except 1 and 2 Gy, whereas changes in sodium level were nonsignificant (p > 0.5). Urea, total protein, and amylase levels were also significantly increased as the radiation dose increased (p < 0.01) with large effect size of difference (r > 0.5). This study suggests that salivary parameters were sensitive toward radiation even at low radiation dose which can be used as a predictor of radiation injury.
Collapse
Affiliation(s)
- S Soni
- Department of Nuclear Medicine, Department of Radiation Biosciences, Division of Health, Institute of Nuclear Medicine and Allied Sciences (INMAS), Defence Research & Development Organization (DRDO), Brig. SK Mazumdar Road, Delhi, India
| | - P Agrawal
- Department of Nuclear Medicine, Department of Radiation Biosciences, Division of Health, Institute of Nuclear Medicine and Allied Sciences (INMAS), Defence Research & Development Organization (DRDO), Brig. SK Mazumdar Road, Delhi, India
| | - N Kumar
- Department of Nuclear Medicine, Department of Radiation Biosciences, Division of Health, Institute of Nuclear Medicine and Allied Sciences (INMAS), Defence Research & Development Organization (DRDO), Brig. SK Mazumdar Road, Delhi, India
| | - G Mittal
- Department of Nuclear Medicine, Department of Radiation Biosciences, Division of Health, Institute of Nuclear Medicine and Allied Sciences (INMAS), Defence Research & Development Organization (DRDO), Brig. SK Mazumdar Road, Delhi, India
| | - D K Nishad
- Department of Nuclear Medicine, Department of Radiation Biosciences, Division of Health, Institute of Nuclear Medicine and Allied Sciences (INMAS), Defence Research & Development Organization (DRDO), Brig. SK Mazumdar Road, Delhi, India
| | - N K Chaudhury
- Department of Nuclear Medicine, Department of Radiation Biosciences, Division of Health, Institute of Nuclear Medicine and Allied Sciences (INMAS), Defence Research & Development Organization (DRDO), Brig. SK Mazumdar Road, Delhi, India
| | - A Bhatnagar
- Department of Nuclear Medicine, Department of Radiation Biosciences, Division of Health, Institute of Nuclear Medicine and Allied Sciences (INMAS), Defence Research & Development Organization (DRDO), Brig. SK Mazumdar Road, Delhi, India
| | - M Basu
- Department of Nuclear Medicine, Department of Radiation Biosciences, Division of Health, Institute of Nuclear Medicine and Allied Sciences (INMAS), Defence Research & Development Organization (DRDO), Brig. SK Mazumdar Road, Delhi, India
| | - N Chhillar
- Department of Neurochemistry, Institute of Human Behavior and Allied Sciences, Dilshad Garden, Delhi, India
| |
Collapse
|
34
|
Abstract
INTRODUCTION Vitamin A deficiency (VAD) is recognized as a major cause of blindness among children in India. OBJECTIVE To find out the prevalence of VAD in rural children of Uttar Pradesh, India. MATERIALS AND METHODS This cross-sectional study was undertaken amongst children (0-15 years) in a rural area of Bareilly (Uttar Pradesh) where the study population was selected by simple random sampling out of villages under a Primary Health Centre. Out of 844 children, 802 participated in the study. The WHO classification of xerophthalmia was used. RESULTS Overall, the prevalence of xerophthalmia was 5.4 %. The prevalence of Bitot's spots was 0.9 % in children under six years of age and 3.3 % in children above six years. The prevalence of xerophthalmia was significantly more in older children. Overall, the prevalence of anemia was found to be 11.8 % in the study population. A significantly high prevalence of xerophthalmia (OR= 5.7; 95 % CI = 2.8 - 11.5) was observed in children suffering from anemia. CONCLUSION The presence of a milder manifestation of xerophthalmia and a 0.9 % prevalence of Bitot's spot in children under six years of age in the present study shows a declining trend of VAD although it is still a public health problem. The higher prevalence in children above six years of age shows that apart from strengthening of Vitamin A prophylaxis programs, health education is needed for dietary diversification to include vegetables and fruits in the diet for long-term sustainability in improving the vitamin A status of children of all age groups.
Collapse
|
35
|
Agrawal P, Venkatesh AK. Impact of the Affordable Care Act on health insurance access, coverage, and cost for refugees resettled in the USA. The Lancet Global Health 2015. [DOI: 10.1016/s2214-109x(15)70128-2] [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: 10/23/2022] Open
|
36
|
Agrawal P, Vegda R, Laddha K. Simultaneous Estimation of Withaferin A and Z-Guggulsterone in Marketed Formulation by RP-HPLC. J Chromatogr Sci 2015; 53:940-4. [DOI: 10.1093/chromsci/bmu153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Indexed: 11/13/2022]
|
37
|
Rajeshkumar B, Agrawal P, Rashighi M, Saidi RF. Mesenchymal Stem Cells and Co-stimulation Blockade Enhance Bone Marrow Engraftment and Induce Immunological Tolerance. Int J Organ Transplant Med 2015; 6:55-60. [PMID: 26082829 PMCID: PMC4464279] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Organ transplantation currently requires long-term immunosuppression. This is associated with multiple complications including infection, malignancy and other toxicities. Immunologic tolerance is considered the optimal solution to these limitations. OBJECTIVE To develop a simple and non-toxic regimen to induce mixed chimerism and tolerance using mesenchymal stem cell (MSC) in a murine model. METHODS Wild type C57BL6 (H2D(k)) and Bal/C (H2D(d)) mice were used as donors and recipients, respectively. We studied to achieve tolerance to skin grafts (SG) through mixed chimerism (MC) by simultaneous skin graft and non-myeloablative donor bone marrow transplantation (DBMT) +/- MSC. All recipients received rapamycin and CTLA-4 Ig without radiation. RESULTS DBMT+MSC combined with co-stimulation blockage and rapamycin led to stable mixed chimerism, expansion of Tregs population and donor-specific skin graft tolerance. The flow cytometry analysis revealed that recipient mice developed 15%-85% chimerism. The skin allografts survived for a long time. Elimination of MSC failed to induce mixed chimerism and tolerance. CONCLUSION Our results demonstrate that donor-specific immune tolerance can be effectively induced by non-myeloablative DBMT-MSC combination without any additional cytoreductive treatment. This approach provides a promising and non-toxic allograft tolerance strategy.
Collapse
Affiliation(s)
- B. Rajeshkumar
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - P. Agrawal
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - M. Rashighi
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - R. F. Saidi
- Division of Organ Transplantation, Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA,Correspondence:Reza F. Saidi, MD, FICS, FACS, Assistant Professor of Surgery, Division of Organ Transplantation, Department of Surgery, Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA Tel: +98-401-444-4861, Fax: +98-401-444-3283, E-mail:
| |
Collapse
|
38
|
Maruthappu M, Ng KYB, Williams C, Atun R, Agrawal P, Zeltner T. The association between government healthcare spending and maternal mortality in the European Union, 1981-2010: a retrospective study. BJOG 2014; 122:1216-24. [PMID: 25492692 DOI: 10.1111/1471-0528.13205] [Citation(s) in RCA: 20] [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] [Accepted: 10/08/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the association between reductions in government healthcare spending (GHS) on maternal mortality in 24 countries in the European Union (EU) over a 30-year period, 1981-2010. DESIGN Retrospective study. SETTING AND POPULATION Twenty-four EU countries (a total population of 419 million as of 2010). METHODS We used multivariate regression analysis, controlling for country-specific differences in healthcare, infrastructure, population size and demographic structure. GHS was measured as a percentage of gross domestic product. Five-year lag-time analyses were performed to estimate longer standing effects. MAIN OUTCOME MEASURES Maternal mortality rates. RESULTS An annual 1% decrease in GHS is associated with significant rises in maternal mortality rates [regression coefficient [R] 0.0177, P = 0.0021, 95% confidence interval [95% CI] 0.0065-0.0289]. For every annual 1% decrease in GHS, we estimate 89 excess maternal deaths in the EU, a 10.6% annual increase in maternal mortality. The impact on maternal mortality was sustained for up to 1 year (R 0.0150, P = 0.0034, 95% CI 0.0050-0.0250). The associations remained significant after accounting for economic, infrastructure and hospital resource controls, in addition to out-of-pocket expenditure, private health spending and total fertility rate. However, accounting for births attended by skilled staff removed the significance of these effects. CONCLUSIONS Reductions in GHS were significantly associated with increased maternal mortality rates, which may occur through changes in the provision of skilled health professionals attending births. Examples of reduced GHS such as the implementation of austerity measures and budgetary reductions are likely to worsen maternal mortality in the EU.
Collapse
Affiliation(s)
| | - K Y B Ng
- Imperial College London, London, SW7 2AZ, UK.,Chelsea and Westminster Hospital, London, UK
| | - C Williams
- The Economist, London, UK.,Faculty of History, University of Oxford, Oxford, UK
| | - R Atun
- Imperial College London, London, SW7 2AZ, UK.,Harvard School of Public Health, Harvard University, Boston, MA, USA
| | - P Agrawal
- Women and Health Initiative, Harvard School of Public Health, Boston, MA, USA
| | - T Zeltner
- Special Envoy for Financing to the Director General of the World Health Organization (WHO), Geneva, Switzerland.,University of Bern, Bern, Switzerland
| |
Collapse
|
39
|
Merali HS, Lipsitz S, Hevelone N, Gawande AA, Lashoher A, Agrawal P, Spector J. Audit-identified avoidable factors in maternal and perinatal deaths in low resource settings: a systematic review. BMC Pregnancy Childbirth 2014; 14:280. [PMID: 25129069 PMCID: PMC4143551 DOI: 10.1186/1471-2393-14-280] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [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: 12/17/2013] [Accepted: 08/05/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Audits provide a rational framework for quality improvement by systematically assessing clinical practices against accepted standards with the aim to develop recommendations and interventions that target modifiable deficiencies in care. Most childbirth-associated mortality audits in developing countries are focused on a single facility and, up to now, the avoidable factors in maternal and perinatal deaths cataloged in these reports have not been pooled and analyzed. We sought to identity the most frequent avoidable factors in childbirth-related deaths globally through a systematic review of all published mortality audits in low and lower-middle income countries. METHODS We performed a systematic review of published literature from 1965 to November 2011 in Pubmed, Embase, CINAHL, POPLINE, LILACS and African Index Medicus. Inclusion criteria were audits from low and lower-middle income countries that identified at least one avoidable factor in maternal or perinatal mortality. Each study included in the analysis was assigned a quality score using a previously published instrument. A meta-analysis was performed for each avoidable factor taking into account the sample sizes and quality score from each individual audit. The study was conducted and reported according to PRISMA guidelines for systematic reviews. RESULTS Thirty-nine studies comprising 44 datasets and a total of 6,205 audited deaths met inclusion criteria. The analysis yielded 42 different avoidable factors, which fell into four categories: health worker-oriented factors, patient-oriented factors, transport/referral factors, and administrative/supply factors. The top three factors by attributable deaths were substandard care by a health worker, patient delay, and deficiencies in blood transfusion capacity (accounting for 688, 665, and 634 deaths attributable, respectively). Health worker-oriented factors accounted for two-thirds of the avoidable factors identified. CONCLUSIONS Audits provide insight into where systematic deficiencies in clinical care occur and can therefore provide crucial direction for the targeting of interventions to mitigate or eliminate health system failures. Given that the main causes of maternal and perinatal deaths are generally consistent across low resource settings, the specific avoidable factors identified in this review can help to inform the rational design of health systems with the aim of achieving continued progress towards Millennium Development Goals Four and Five.
Collapse
Affiliation(s)
- Hasan S Merali
- The Hospital for Sick Children, 555 University Avenue, Toronto ON M5G 1X8, Canada.
| | | | | | | | | | | | | |
Collapse
|
40
|
Jalota A, Scarabelli TM, Saravolatz L, Bakhsh MU, Agrawal P, Jalota R, Chen-Scarabelli C, Fuster V, Halperin J. Novel Anticoagulants for Stroke Prevention in Patients with Atrial Fibrillation. Cardiovasc Drugs Ther 2014; 28:247-62. [DOI: 10.1007/s10557-014-6524-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
41
|
Agrawal P, Pandey A, Sompura S, Khandelwal G, Yadav S. A rare case report showing direct association between hepatitis B and bulbar palsy. J Assoc Physicians India 2014; 62:267-268. [PMID: 25327074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Bulbar Palsy is B/L impairment of function of cranial N. 9, 10, 11, 12 at lower motor neuron level either at nuclear or fascicular level in medulla or B/L lesion of lower cranial N. outside brainstem. We present case of viral hepatitis who initially presented with classical signs and symptoms of hepatitis B followed by characteristic features of bulbar palsy in form of difficulty in swallowing and slurring of speech reduced gag reflex, weak palatal movement. Other causes for bulbar palsy were excluded and indirect laryngoscopy confirmed presence of bulbar palsy. Patient had no previous neurological abnormality, there are many studies in the past for association of hepatitis B and bulbar palsy but no one confirmed about a direct association between hepatitis B and bulbar palsy. To best of knowledge this is the first case report which shows direct association between hepatitis B and bulbar palsy.
Collapse
|
42
|
Batura N, Pulkki-Brännström AM, Agrawal P, Bagra A, Haghparast-Bidgoli H, Bozzani F, Colbourn T, Greco G, Hossain T, Sinha R, Thapa B, Skordis-Worrall J. Collecting and analysing cost data for complex public health trials: reflections on practice. Glob Health Action 2014; 7:23257. [PMID: 24565214 PMCID: PMC3929994 DOI: 10.3402/gha.v7.23257] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 11/08/2013] [Revised: 01/14/2014] [Accepted: 01/20/2014] [Indexed: 11/28/2022] Open
Abstract
Background Current guidelines for the conduct of cost-effectiveness analysis (CEA) are mainly applicable to facility-based interventions in high-income settings. Differences in the unit of analysis and the high cost of data collection can make these guidelines challenging to follow within public health trials in low- and middle- income settings. Objective This paper reflects on the challenges experienced within our own work and proposes solutions that may be useful to others attempting to collect, analyse, and compare cost data between public health research sites in low- and middle-income countries. Design We describe the generally accepted methods (norms) for collecting and analysing cost data in a single-site trial from the provider perspective. We then describe our own experience applying these methods within eight comparable cluster randomised, controlled, trials. We describe the strategies used to maximise adherence to the norm, highlight ways in which we deviated from the norm, and reflect on the learning and limitations that resulted. Results When the expenses incurred by a number of small research sites are used to estimate the cost-effectiveness of delivering an intervention on a national scale, then deciding which expenses constitute ‘start-up’ costs will be a nontrivial decision that may differ among sites. Similarly, the decision to include or exclude research or monitoring and evaluation costs can have a significant impact on the findings. We separated out research costs and argued that monitoring and evaluation costs should be reported as part of the total trial cost. The human resource constraints that we experienced are also likely to be common to other trials. As we did not have an economist in each site, we collaborated with key personnel at each site who were trained to use a standardised cost collection tool. This approach both accommodated our resource constraints and served as a knowledge sharing and capacity building process within the research teams. Conclusions Given the practical reality of conducting randomised, controlled trials of public health interventions in low- and middle- income countries, it is not always possible to adhere to prescribed guidelines for the analysis of cost effectiveness. Compromises are frequently required as researchers seek a pragmatic balance between rigor and feasibility. There is no single solution to this tension but researchers are encouraged to be mindful of the limitations that accompany compromise, whilst being reassured that meaningful analyses can still be conducted with the resulting data.
Collapse
Affiliation(s)
- Neha Batura
- Institute for Global Health, University College London, London, UK;
| | | | | | | | | | - Fiammetta Bozzani
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Giulia Greco
- Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Jolene Skordis-Worrall
- Institute for Global Health, University College London, London, UK; Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
43
|
Kalra N, Agrawal P, Mittal V, Kochhar R, Gupta V, Nada R, Singh R, Khandelwal N. Spectrum of imaging findings on MDCT enterography in patients with small bowel tuberculosis. Clin Radiol 2013; 69:315-22. [PMID: 24290774 DOI: 10.1016/j.crad.2013.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 11/16/2022]
Abstract
Abdominal tuberculosis (TB) is the sixth most common extrapulmonary site of involvement. The sites of involvement in abdominal tuberculosis, in descending order of frequency, are lymph nodes, genitourinary tract, peritoneal cavity, and gastrointestinal tract. The radiological armamentarium for evaluating tuberculosis of the small bowel (SBTB) includes barium studies (small bowel follow-through, SBFT), CT (multidetector CT, CT enterography, and CT enteroclysis), ultrasound (sonoenteroclysis), and magnetic resonance imaging (MRI; enterography and enteroclysis). In this review, we illustrate the abnormalities at MDCT enterography in 20 consecutive patients with SB TB and also describe extraluminal findings in these patients. MDCT enterography allows non-invasive good-quality assessment of well-distended bowel loops and the adjacent soft tissues. It displays the thickness and enhancement of the entire bowel wall in all three planes and allows examination of all bowel loops, especially the ileal loops, which are mostly superimposed. The terminal ileum and ileocaecal junction are the most common sites of small bowel involvement in intestinal TB. The most common abnormality is short-segment strictures with symmetrical concentric mural thickening and homogeneous mural enhancement. Other findings include lymphadenopathy, ascites, enteroliths, peritoneal thickening, and enhancement. In conclusion, MDCT enterography is a comprehensive technique for the evaluation of SB TB.
Collapse
Affiliation(s)
- N Kalra
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - P Agrawal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Mittal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Gupta
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Singh
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - N Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
44
|
Firoz T, Chou D, von Dadelszen P, Agrawal P, Vanderkruik R, Tunçalp O, Magee LA, van Den Broek N, Say L. Measuring maternal health: focus on maternal morbidity. Bull World Health Organ 2013; 91:794-6. [PMID: 24115804 DOI: 10.2471/blt.13.117564] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 06/07/2013] [Accepted: 06/12/2013] [Indexed: 11/27/2022] Open
|
45
|
Agrawal P, Pandey A, Sompura S, Pursnani ML. Role of blood C - reactive protein levels in upper urinary tract infection and lower urinary tract infection in adult patients (>16 years). J Assoc Physicians India 2013; 61:462-463. [PMID: 24772749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Role of blood C - reactive protein levels in upper urinary tract infection and lower urinary tract infection in adult patients (>16 years). MATERIAL AND METHODS Study included 2 groups of patients -Test group (n=58). Control group (n=28).Test group further classified into 2 groups- a). Patients having upper urinary tract infection b). Patients having lower urinary tract infection. Patients were subjected to following tests - complete hemogram, blood C-reactive protein levels, urinalysis. RESULTS The mean value of C-reactive protein in the cases of upper urinary tract infection 127.33 mg/L which is statistically significantly raised when compared to control(t-value 12.370 and p-value<0.01). C-reactive protein was significantly raised in upper urinary tract infection in comparison to control group( p<0.01), while in lower urinary tract infection this difference was insignificant (p<0.05). CONCLUSION C-reactive protein has a good diagnostic role in differentiating upper and lower urinary tract infection. The simple size of our study is very small to say these authentically, hence, further studies of large number of cases is required.
Collapse
|
46
|
Spector JM, Lashoher A, Agrawal P, Lemer C, Dziekan G, Bahl R, Mathai M, Merialdi M, Berry W, Gawande AA. Designing the WHO Safe Childbirth Checklist program to improve quality of care at childbirth. Int J Gynaecol Obstet 2013; 122:164-8. [PMID: 23742897 DOI: 10.1016/j.ijgo.2013.03.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/12/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Poor-quality care during institutional births in low- and middle-income countries is a major contributing factor to preventable maternal and newborn harm, but progress has been slow in identifying effective methods to address these deficiencies at scale. Based on the success of checklist programs in other disciplines, WHO led the design and field testing of the WHO Safe Childbirth Checklist-a 29-item tool that targets the major causes of maternal and newborn mortality globally. METHODS The development process consisted of comprehensive evidence and guideline review, in-person consultation with content experts and other key stakeholders, iterative refinement through ongoing discussions with a wide collaborator network, and field evaluation for usability in 9 countries, primarily in Africa and Asia. Pilot testing in South India demonstrated major improvement in health workers' delivery of essential safety practices after introduction of the program. RESULTS WHO has launched a global effort to support further evaluation of the program in a range of contexts, and a randomized trial is underway in North India to measure the effectiveness of the program in reducing severe maternal, fetal, and newborn harm. CONCLUSION A novel checklist program has been developed to support health workers in low-resource settings to prevent avoidable childbirth-related deaths.
Collapse
Affiliation(s)
- Jonathan M Spector
- Department of Health Policy and Management, Harvard School of Public Health, Boston, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Thomas TO, Agrawal P, Guitart J, Rosen ST, Rademaker AW, Querfeld C, Hayes JP, Kuzel TM, Mittal BB. Outcome of patients treated with a single-fraction dose of palliative radiation for cutaneous T-cell lymphoma. Int J Radiat Oncol Biol Phys 2012; 85:747-53. [PMID: 22818412 DOI: 10.1016/j.ijrobp.2012.05.034] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 05/18/2012] [Accepted: 05/22/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE Cutaneous T-cell lymphoma (CTCL) is a radiosensitive tumor. Presently, treatment with radiation is given in multiple fractions. The current literature lacks data that support single-fraction treatment for CTCL. This retrospective review assesses the clinical response in patients treated with a single fraction of radiation. METHODS AND MATERIALS This study reviewed the records of 58 patients with CTCL, primarily mycosis fungoides, treated with a single fraction of palliative radiation therapy (RT) between October 1991 and January 2011. Patient and tumor characteristics were reviewed. Response rates were compared using Fisher's exact test and multiple logistic regressions. Survival rates were determined using the Kaplan-Meier method. Cost-effectiveness analysis was performed to assess the cost of a single vs a multifractionated treatment regimen. RESULTS Two hundred seventy individual lesions were treated, with the majority (97%) treated with ≥ 700 cGy; mean follow-up was 41.3 months (range, 3-180 months). Response rate by lesion was assessed, with a complete response (CR) in 255 (94.4%) lesions, a partial response in 10 (3.7%) lesions, a partial response converted to a CR after a second treatment in 4 (1.5%) lesions, and no response in 1 (0.4%) lesion. The CR in lower extremity lesions was lower than in other sites (P=.0016). Lesions treated with photons had lower CR than those treated with electrons (P=.017). Patients with lesions exhibiting large cell transformation and tumor morphology had lower CR (P=.04 and P=.035, respectively). Immunophenotype did not impact response rate (P=.23). Overall survival was significantly lower for patients with Sézary syndrome (P=.0003) and erythroderma (P<.0001). The cost of multifractionated radiation was >200% higher than that for single-fraction radiation. CONCLUSIONS A single fraction of 700 cGy-800 cGy provides excellent palliation for CTCL lesions and is cost effective and convenient for the patient.
Collapse
Affiliation(s)
- Tarita O Thomas
- Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
|
49
|
Gentile MS, Thomas TO, Agrawal P, Guitart J, Rosen ST, Kuzel T, Mittal BB. Outcome of patients treated with a single-fraction dose of radiation for lymphomatoid papulosis. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e18523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18523 Background: Lymphomatoid Papulosis (LYP) is a primary cutaneous CD30+ lymphoproliferative disorder and a radiosensitive tumor. Treatment with radiation is typically given in multiple fractions for patients presenting with symptomatic unilesional or multilesional disease. However, a single fraction of radiation is more convenient to the patient. The purpose of this retrospective review was to evaluate the clinical response to a single fraction of radiation for palliation of symptomatic LYP lesions. Methods: The records of 8 (5 female, 3 male) patients with LYP, treated with a single or multi-fractionated palliative radiation therapy between 10/2001 and 9/2011, were reviewed. All patients had received multiple previous treatments such as chemotherapy, PUVA, topical nitrogen mustard, and UVB. A total of 19 sites with disease were given the following single doses: 700 (n=3) and 800 (n=16). In the earlier years, a total of 6 sites with disease were given 250 cGy in 18 fractions for a total dose of 4500 cGy. Radiation therapy was administered with electrons to 20 sites and with photons to 5. A bolus was used in most cases to increase the radiation dosage to the skin. Results: Minimum and median follow-up were 1 and 43 months (range, 1 - 120), respectively. Median age of the patients was 65 (range, 24 - 83). For disease sites receiving a single fraction therapy, a complete response (CR) was seen in 17 of the 19 sites (89.5%), and a partial response (PR) was seen in an additional 2 of the 19 sites (10.5%). Therefore, the overall response rate was 100%. For the disease sites receiving multi-fractionated therapy, a CR was seen in 6 of the 6 sites (100%). Evaluation of patient characteristics and treatment did not reveal any differences between patients achieving a CR or PR. Conclusions: For previously treated, radiation-naıve LYP lesions, palliative radiation therapy with single fractions of 700 - 800 cGy is associated with an excellent CR and is a convenient and cost effective strategy.
Collapse
Affiliation(s)
| | - Tarita O. Thomas
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL
| | - Priya Agrawal
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL
| | - Joan Guitart
- Department of Dermatology, Northwestern Memorial Hospital, Chicago, IL
| | - Steven T. Rosen
- Section of Medical Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Timothy Kuzel
- Section of Medical Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | |
Collapse
|
50
|
Spector JM, Agrawal P, Kodkany B, Lipsitz S, Lashoher A, Dziekan G, Bahl R, Merialdi M, Mathai M, Lemer C, Gawande A. Improving quality of care for maternal and newborn health: prospective pilot study of the WHO safe childbirth checklist program. PLoS One 2012; 7:e35151. [PMID: 22615733 PMCID: PMC3353951 DOI: 10.1371/journal.pone.0035151] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 03/08/2012] [Indexed: 11/26/2022] Open
Abstract
Background Most maternal deaths, intrapartum-related stillbirths, and newborn deaths in low income countries are preventable but simple, effective methods for improving safety in institutional births have not been devised. Checklist-based interventions aid management of complex or neglected tasks and have been shown to reduce harm in healthcare. We hypothesized that implementation of the WHO Safe Childbirth Checklist program, a novel childbirth safety program for institutional births incorporating a 29-item checklist, would increase delivery of essential childbirth practices linked with improved maternal and perinatal health outcomes. Methods and Findings A pilot, pre-post-intervention study was conducted in a sub-district level birth center in Karnataka, India between July and December 2010. We prospectively observed health workers that attended to women and newborns during 499 consecutively enrolled birth events and compared these with observed practices during 795 consecutively enrolled birth events after the introduction of the WHO Safe Childbirth Checklist program. Twenty-nine essential practices that target the major causes of childbirth-related mortality, such as hand hygiene and uterotonic administration, were evaluated. The primary end point was the average rate of successful delivery of essential childbirth practices by health workers. Delivery of essential childbirth-related care practices at each birth event increased from an average of 10 of 29 practices at baseline (95%CI 9.4, 10.1) to an average of 25 of 29 practices afterwards (95%CI 24.6, 25.3; p<0.001). There was significant improvement in the delivery of 28 out of 29 individual practices. No adverse outcomes relating to the intervention occurred. Study limitations are the pre-post design, potential Hawthorne effect, and focus on processes of care versus health outcomes. Conclusions Introduction of the WHO Safe Childbirth Checklist program markedly improved delivery of essential safety practices by health workers. Future study will determine if this program can be implemented at scale and improve health outcomes.
Collapse
Affiliation(s)
- Jonathan M Spector
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|