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Halle-Smith JM, Bage T, Kamarajah SK, Siddaiah-Subramanya M, Pande R, Whiting JL, Griffiths EA. A preoperative predictive tool to assess the need for staging laparoscopy in oesophagogastric cancer patients. Ann R Coll Surg Engl 2024; 106:369-376. [PMID: 37642164 PMCID: PMC10981985 DOI: 10.1308/rcsann.2022.0140] [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] [Accepted: 10/26/2022] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Staging laparoscopy (SL) has become commonplace in the preoperative staging pathway for oesophagogastric (OG) cancer. SL is often performed before curative treatment to examine for macroscopic peritoneal metastases (PM) or positive peritoneal cytology (PPC). The aim of this study was to develop an objective risk scoring system to predict both PM and PPC at SL. METHODS A prospectively collected and maintained database of all OG cancer patients treated between 2006 and 2020 was reviewed. Univariate and multivariate analyses were performed to identify risk factors for both PM and PPC at SL. A risk score was produced for both PM and PPC, and then validated internally. RESULTS Among 968 patients who underwent SL, 96 (9.9%) had PM and 81 (8.4%) had PPC at SL. Tumour site (p < 0.001), computed tomography (CT) T stage (p < 0.001) and N stage (p = 0.029) were significantly associated with PM at SL (p < 0.001). Tumour site (p < 0.001), biopsy histology (p = 0.041), CT T stage (p < 0.001) and N stage (p < 0.001) were significantly associated with PPC. The risk scoring model for PM included cancer site and CT T stage. This was successfully tested on the validation set (area under the receiver operating characteristic [AUROC] = 0.730). The risk scoring model for PPC included cancer site, CT T and N stage. This was successfully tested on the validation set (AUROC = 0.773). CONCLUSIONS The current risk scores are valid tools with which to predict the risk PM and PPC in patients undergoing SL for OG cancer and may help to avoid subjecting patients to unnecessary SL.
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Affiliation(s)
| | - T Bage
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
| | | | | | - R Pande
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
| | - JL Whiting
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
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Powell-Brett S, Hodson J, Pande R, Mann S, Freer A, Wyrko Z, Hughes C, Isaac J, Sutcliffe RP, Roberts K. Are physical performance and frailty assessments useful in targeting and improving access to adjuvant therapy in patients undergoing resection for pancreatic cancer? Langenbecks Arch Surg 2023; 408:88. [PMID: 36787026 PMCID: PMC9928938 DOI: 10.1007/s00423-023-02828-1] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Many patients fail to receive adjuvant chemotherapy following pancreatic cancer surgery. This study implemented a multimodal, multidisciplinary approach to improving recovery after pancreatoduodenectomy (the 'Fast Recovery' programme) and measured its impact on adjuvant chemotherapy uptake and nutritional decline. The predictive accuracies of a bundle of frailty and physical performance assessments, with respect to the recipient of adjuvant chemotherapy, were also evaluated. RESULTS The N = 44 patients treated after the introduction of the 'Fast Recovery' programme were not found to have a significantly higher adjuvant chemotherapy uptake than the N = 409 treated before the pathway change (80.5 vs. 74.3%, p = 0.452), but did have a significantly lower average weight loss at six weeks post-operatively (mean: 4.3 vs. 6.9 kg, p = 0.013). Of the pre-operative frailty and physical performance assessments tested, the 6-min walk test was found to be the strongest predictor of the receipt of adjuvant chemotherapy (area under the ROC curve: 0.91, p = 0.001); all patients achieving distances ≥ 360 m went on to receive adjuvant chemotherapy, compared to 33% of those walking < 360 m. CONCLUSIONS The multimodal 'Fast Recovery' programme was not found to significantly improve access to adjuvant chemotherapy, but did appear to have benefits in reducing nutritional decline. Pre-operative assessments were found to be useful in identifying patients at risk of non-receipt of adjuvant therapies, with markers of physical performance appearing to be the best predictors. As such, these markers could be useful in targeting pre- and post-habilitation measures, such as physiotherapy and improved dietetic support.
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Affiliation(s)
- S Powell-Brett
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK.
| | - J Hodson
- Research Development and Innovation, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - R Pande
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK
| | - S Mann
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK
| | - Alice Freer
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK
| | - Zoe Wyrko
- Department of Geriatric Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Clare Hughes
- Department of Geriatric Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - J Isaac
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK
| | - R P Sutcliffe
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK
| | - K Roberts
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Ahn K, Khan N, Desai N, Abdu M, Hiddema L, Odogwu S, Cheetham M, Pande R. 822 Lessons Learnt During the COVID-19 Pandemic on Emergency Surgical Admissions in A District General Hospital. Br J Surg 2021. [PMCID: PMC8135730 DOI: 10.1093/bjs/znab134.090] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction Coronavirus disease (COVID-19) is an acute severe respiratory distress syndrome which resulted in an unprecedented impact on NHS service provision. We aimed to assess the impact of COVID-19 on general surgical services in a district general hospital. Method Electronic health care record data was retrospectively collected from 6th of April to 6th of May for both 2019 and 2020. Results Despite fewer referrals and admissions in 2020 (133 vs 177 admissions in 2019), there were more failed discharges (29 vs 17 in 2019) and higher associated costs. Higher numbers of biliary related pathologies and pancreatitis (50 in 2020 vs 25 in 2019), and fewer complaints of non-specific abdominal pain (10 in 2020 vs 22 in 2019) were observed. The use of outpatient investigations decreased by approximately 40% in 2020; however, utilisation of inpatient investigations was comparable. Conclusions Better utilisation of outpatient investigations and virtual clinic services may surmount pressures from further peaks of COVID-19. The increase in biliary related cases and pancreatitis may be consequent upon lifestyle changes during lockdown. This merits further investigation and if appropriate, public health intervention. In the absence of an efficacious vaccine, further research would be essential to streamline general surgical services based on clinical risk stratification.
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Affiliation(s)
- K Ahn
- Walsall Healthcare NHS Trust, Walsall, United Kingdom
| | - N Khan
- Walsall Healthcare NHS Trust, Walsall, United Kingdom
| | - N Desai
- Walsall Healthcare NHS Trust, Walsall, United Kingdom
| | - M Abdu
- Walsall Healthcare NHS Trust, Walsall, United Kingdom
| | - L Hiddema
- Walsall Healthcare NHS Trust, Walsall, United Kingdom
| | - S Odogwu
- Walsall Healthcare NHS Trust, Walsall, United Kingdom
| | - M Cheetham
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom
| | - R Pande
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Ozer F, Irmak O, Yakymiv O, Mohammed A, Pande R, Saleh N, Blatz M. Three-year Clinical Performance of Two Giomer Restorative Materials in Restorations. Oper Dent 2021; 46:E60-E67. [PMID: 33882138 DOI: 10.2341/17-353-c] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 11/23/2022]
Abstract
CLINICAL RELEVANCE The clinical performance of both conventional and flowable giomer restorative materials was particularly good in Class I restorations after three years of service. SUMMARY This study evaluated and compared the clinical performance of a flowable and a conventional giomer restorative material after three years. Forty-four pairs of restorations (total n=88) were placed in Class I cavities with either a flowable giomer (Beautifil Flow Plus F00; Shofu Inc, Kyoto, Japan) or a conventional giomer restorative material (Beautifil II; Shofu Inc) after the application of a dentin adhesive (FL-Bond II; Shofu Inc) and a flowable liner (Beautifil Flow Plus F03; Shofu Inc). After 3 years, 39 pairs of restorations were evaluated with the modified United States Public Health Service criteria, and digital color photographs of restorations were taken at each patient visit. The evaluation parameters were as follows: color match, marginal integrity, marginal discoloration, retention, secondary caries formation, anatomic form, surface texture, and postoperative sensitivity. Evaluations were recorded as a clinically ideal situation (Alpha), a clinically acceptable situation (Bravo), or a clinically unacceptable situation (Charlie). Data were analyzed with Fisher's exact and McNemar tests (α=0.05).None of the restorations showed retention loss, postoperative sensitivity, secondary caries, or color change. The performance of Beautifil II in terms of marginal integrity, marginal discoloration, and surface anatomic form was significantly lower at the 36-month follow-up than at baseline (p=0.007). There were no significant differences between the baseline and 36-month follow-up scores for the other criteria for Beautifil II (p>0.05). No differences were found between the baseline and the 36-month follow-up scores for any of the criteria for Beautifil Flow Plus F00 (p>0.05). No statistically significant difference in overall clinical performance was found between the 2 materials after 36 months (p>0.05).The three-year clinical performance of both restorative materials (Beautifil Flow Plus F00 and Beautifil II) was very good and not significantly different for any of the parameters evaluated.
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Parmer C, De Sousa-Coelho AL, Cheng HS, Daher G, Burkart A, Dreyfuss JM, Pan H, Prenner JC, Keilson JM, Pande R, Henkin S, Feinberg MW, Patti ME, Creager MA. Skeletal muscle expression of adipose-specific phospholipase in peripheral artery disease. Vasc Med 2020; 25:401-410. [PMID: 32853041 DOI: 10.1177/1358863x20947467] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Flow-limiting atherosclerotic lesions of arteries supplying the limbs are a cause of symptoms in patients with peripheral artery disease (PAD). Musculoskeletal metabolic factors also contribute to the pathophysiology of claudication, which is manifest as leg discomfort that impairs walking capacity. Accordingly, we conducted a case-control study to determine whether skeletal muscle metabolic gene expression is altered in PAD. Calf skeletal muscle gene expression of patients with PAD and healthy subjects was analyzed using microarrays. The top-ranking gene differentially expressed between PAD and controls (FDR < 0.001) was PLA2G16, which encodes adipose-specific phospholipase A2 (AdPLA) and is implicated in the maintenance of insulin sensitivity and regulation of lipid metabolism. Differential expression was confirmed by qRT-PCR; PLA2G16 was downregulated by 68% in patients with PAD (p < 0.001). Expression of Pla2g16 was then measured in control (db/+) and diabetic (db/db) mice that underwent unilateral femoral artery ligation. There was significantly reduced expression of Pla2g16 in the ischemic leg of both control and diabetic mice (by 51%), with significantly greater magnitude of reduction in the diabetic mice (by 79%). We conclude that AdPLA is downregulated in humans with PAD and in mice with hindlimb ischemia. Reduced AdPLA may contribute to impaired walking capacity in patients with PAD via its effects on skeletal muscle metabolism. Further studies are needed to fully characterize the role of AdPLA in PAD and to investigate its potential as a therapeutic target for alleviating symptoms of claudication.
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Affiliation(s)
- Caitlin Parmer
- Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | | | - Henry S Cheng
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Grace Daher
- Research Division, Joslin Diabetes Center, and Harvard Medical School, Boston, MA, USA
| | - Alison Burkart
- Research Division, Joslin Diabetes Center, and Harvard Medical School, Boston, MA, USA
| | - Jonathan M Dreyfuss
- Research Division, Joslin Diabetes Center, and Harvard Medical School, Boston, MA, USA
| | - Hui Pan
- Research Division, Joslin Diabetes Center, and Harvard Medical School, Boston, MA, USA
| | - Joshua C Prenner
- Department of Medicine, McGaw Medical Center of Northwestern University, Chicago, IL, USA
| | | | - Reena Pande
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Mark W Feinberg
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Mary Elizabeth Patti
- Research Division, Joslin Diabetes Center, and Harvard Medical School, Boston, MA, USA
| | - Mark A Creager
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Halle-Smith JM, Pande R, Griffiths EA. Urgent surgical repair of symptomatic Bochdalek hernia containing an intrathoracic kidney. Ann R Coll Surg Engl 2020; 103:e10-e12. [PMID: 32829650 DOI: 10.1308/rcsann.2020.0190] [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] [Indexed: 11/22/2022] Open
Abstract
Bochdalek hernias rarely contain an intrathoracic kidney, and there are few reports of their operative repair. A woman presented with progressive dyspnoea limiting her quality of life. Imaging showed a Bochdalek hernia containing omentum, large bowel and the left kidney. The woman was unexpectedly admitted to the intensive care unit with respiratory failure secondary to gallstone pancreatitis whilst awaiting elective repair of her hernia. Surgical repair of the hernia was performed via laparotomy with cholecystectomy to treat both problems. The woman recovered well and is independently mobile without any exertional dyspnoea.
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Affiliation(s)
| | - R Pande
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - E A Griffiths
- University Hospitals Birmingham NHS Foundation Trust, UK
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Walther A, Tsao C, Pande R, Kirschbaum C, Field E, Berkman L. Do dehydroepiandrosterone, progesterone, and testosterone influence women's depression and anxiety levels? Evidence from hair-based hormonal measures of 2105 rural Indian women. Psychoneuroendocrinology 2019; 109:104382. [PMID: 31374371 PMCID: PMC6842697 DOI: 10.1016/j.psyneuen.2019.104382] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 06/16/2019] [Accepted: 07/16/2019] [Indexed: 01/19/2023]
Abstract
Depressive and anxiety disorders substantially contribute to the global burden of disease, particularly in poor countries. Higher prevalence rates for both disorders among women indicate sex hormones may be integrated in the pathophysiology of these disorders. The Kshetriya Gramin Financial Services study surveyed a random sample of 4160 households across 876 villages in rural Tamil Nadu, India. An interviewer-administered questionnaire was conducted to quantify depressive (K6-D) and anxiety (K6-A) symptoms. Alongside, hair samples for sex hormone profiling were collected from a subsample of 2105 women aged 18-85 years. Importantly, 5.9%, 14.8%, and 46.3% of samples contained non-detectable hormone levels for dehydroepiandrosterone, progesterone, and testosterone, respectively. Our primary analysis imputes values for the non-detectable sample and we check robustness of results when non-detectable values are dropped. In this cohort of women from rural India, higher depressive symptomatology is associated with lower levels of dehydroepiandrosterone and higher depressive and anxiety symptoms are associated with higher levels of testosterone. Progesterone shows no clear association with either depressive or anxiety symptoms. These results support a potential protective effect of higher endogenous dehydroepiandrosterone levels. An important caveat on the potential negative effect of hair testosterone levels on women's mental health is that the testosterone analysis is sensitive to how non-detectable values are treated.
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Affiliation(s)
- A Walther
- Biological Psychology, TU Dresden, Germany.
| | - C Tsao
- Princeton University, USA
| | - R Pande
- Department of Economics, Yale University, USA
| | | | - E Field
- Economics Department, Duke Trinity College of Arts & Sciences, USA
| | - L Berkman
- Center for Population and Development Studies, Harvard University, USA
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Moni-Nwinia W, Zaman S, Caddick V, Pande R, Torrance A. Suspected Pancreatitis - An Audit of Chronically Poor Management. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sivakumar S, Taccone FS, Desai KA, Lazaridis C, Skarzynski M, Sekhon M, Henderson W, Griesdale D, Chapple L, Deane A, Williams L, Strickland R, Lange K, Heyland D, Chapman M, Rowland MJ, Garry P, Westbrook J, Corkill R, Antoniades CA, Pattinson KT, Fatania G, Strong AJ, Myers RB, Lazaridis C, Jermaine CM, Robertson CS, Rusin CG, Hofmeijer J, Sondag L, Tjepkema-Cloostermans MC, Beishuizen A, Bosch FH, van Putten MJAM, Carteron L, Patet C, Solari D, Oddo M, Ali MA, Dias C, Almeida R, Vaz-Ferreira A, Silva J, Monteiro E, Cerejo A, Rocha AP, Elsayed AA, Abougabal AM, Beshey BN, Alzahaby KM, Pozzebon S, Ortiz AB, Cristallini S, Lheureux O, Brasseur A, Vincent JL, Creteur J, Taccone FS, Hravnak M, Yousef K, Chang Y, Crago E, Friedlander RM, Abdelmonem SA, Tahon SA, Helmy TA, Meligy HS, Puig F, Dunn-Siegrist I, Pugin J, Gupta S, Govil D, Srinivasan S, Patel SJ, N JK, Gupta A, Tomar DS, Shafi M, Harne R, Arora DP, Talwar N, Mazumdar S, Papakrivou EE, Makris D, Manoulakas E, Tsolaki B, Karadodas B, Zakynthinos E, Garcia IP, Martin AD, Encinares VS, Ibañez MP, Montero JG, Labrador G, Cangueiro TC, Poulose V, Koh J, Kam JW, Yeter H, Stepinska J, Pérez AG, Ordoñez PF, Giribet A, Cuervo MAA, Cuervo RA, Esteban MAR, Fraile LI, Mittelbrum CP, Albaiceta GM, Kara A, Koeze J, Keus F, Dieperink W, van der Horst ICC, van Meurs M, Zijlstra JG, Roberts S, Caballero CH, Isgro G, Hall D, Aktepe O, Beitland S, Trøseid AMS, Brusletto BS, Waldum-Grevbo BE, Berg JP, Sunde K, Huertas DG, Manzano F, Quintana MMJ, Osuna A, Topeli A, Santiago-Ruiz F, Rodríguez-Mejías C, Wangensteen R, Jamaati HR, Masjedi M, Zand F, Hashemian SMR, Sabetian G, Abbasi G, Khaloo V, Tsolakoglou I, Tabei SH, Kafilzadeh A, Bakhodaei HH, Diaz JA, Silva R, Garcia DJ, Luis E, Gomez MN, Soriano R, Gonzalez PL, Intas G, Ibrahim IA, Rafik MM, Al-Ansary AM, Algendi MA, Ali AA, Fuhrmann V, Roedl K, Horvatits T, Drolz A, Rutter K, Stergiannis P, Benten D, Kluwe J, Siedler S, Kluge S, Adedugbe I, Bird GT, Kennedy RM, Sharma S, Butler MB, Yugi G, Kolaros AA, Haroon BA, Witter T, Khaliq W, Singer M, Havaldar AA, Krishna B, Sriram S, Espinoza EDV, Pozo MO, Edul VSK, Chalari E, Furche M, Motta MF, Vazquez AR, Birri PNR, Ince C, Dubin A, Dogliotti A, Ramos A, Lovesio C, Delile E, Athanasiadou E, Nevière R, Thiébaut PA, Maupoint J, Mulder P, Coquerel D, Renet S, do Rego JC, Rieusset J, Richard V, Tamion F, Martika A, Khaliq W, Andreis DT, Singer M, Smit B, Smulders YM, de Waard MC, van Straaten HMO, Girbes ARJ, Eringa EC, Man AMESD, Fildisis G, Alegría L, Soto D, Luengo C, Gomez J, Jarufe N, Bruhn A, Castro R, Kattan E, Tapia P, Rebolledo R, Faivre V, Achurra P, Ospina-Tascón G, Bakker J, Hernández G, Bertini P, Guarracino F, Baldassarri R, Pinsky MR, Alegría L, Vera M, Mengelle C, Dreyse J, Carpio D, Henriquez C, Gajardo D, Bravo S, Castro R, Ospina-Tascón G, Bakker J, Hernández G, Kim S, Favier B, Lee M, Park SY, So S, Lee H, Kačar MB, Kačar SM, Uddin I, Belhaj AM, Aydın MA, Avsec D, Payen D, Kapuağası A, Kaymak Ç, Kovach L, Şencan İ, Meço B, Özçelik M, Ünal N, Lazaridis C, Jenni-Moser B, Jeitziner MM, Poppe A, Galassi MS, Sales FL, de Moraes KCL, Batista CL, Júnior JADS, Marcari TB, Lobato R, Castro CSAA, de Souza LM, Rodrigues FFP, Winkler MS, Correa NG, Pelegrini AM, Eid RAC, Timenetsky KT, Cazati D, Lobato M, Diniz PS, Rocha LL, Cavalheiro AM, Lucinio NM, Mudersbach E, Santos ER, Norrenberg M, Gleize A, Preiser JC, Simón IF, Carmona SA, Valhonrat IL, Domínguez JP, Abellán AN, Almudévar PM, Schreiber J, Dávila F, Rubio JJ, Ramos AJ, Reina ÁJR, López NP, Pérez MA, Apolo DXC, Villén LM, López FMP, García IP, Wruck ML, Izurieta JRN, Guerrero JJE, Calvert S, Quint M, Adeniji K, Young R, Shevill DD, Robertson E, Garside P, Walter E, Schwedhelm E, Isotti P, De Vecchi MM, Perduca AE, Negro A, Villa G, Manara DF, Cabrini L, Zangrillo A, Frencken JF, van Baal L, Kluge S, Peelen LM, Donker DW, Horn J, van der Poll T, van Klei WA, Bonten MJM, Cremer OL, Menard CE, Kumar A, Rimmer E, Zöllner C, Doucette S, Turgeon AF, Houston BL, Houston DS, Zarychanski R, Pinto BB, Carrara M, Ferrario M, Bendjelid K, Nunes J, Tavladaki T, Diaz P, Silva G, Escórcio S, Chaves S, Jardim M, Fernandes N, Câmara M, Duarte R, Pereira CA, Vieira J, Spanaki AM, Nóbrega JJ, Robles CMC, de Oca-Sandoval MAM, Sánchez-Rodríguez A, Joya-Galeana JG, Correa-Morales A, Camarena-Alejo G, Aguirre-Sánchez J, Franco-Granillo J, Soliman M, Dimitriou H, Al Azab A, El Hossainy R, Nagy H, Nirmalan M, Crippa IA, Cavicchi FZ, Vincent JL, Creteur J, Taccone FS, Chaari A, Kondili E, Hakim KA, Hassanein H, Etman M, El Bahr M, Bousselmi K, Khalil ES, Kauts V, Casey WF, Imahase H, Sakamoto Y, Choulaki C, Inoue S, Yamada KC, Koami H, Miike T, Nagashima F, Iwamura T, Boscolo A, Lucchetta V, Piasentini E, Bertini D, Meleti E, Manesso L, Spiezia L, Simioni P, Ori C, Souza RB, Martins AM, Liberatore AMA, Kang YR, Nakamae MN, Vieira JCF, Kafetzopoulos D, Koh IHJ, Hanslin K, Wilske F, Skorup P, Sjölin J, Lipcsey M, Long WJ, Zhen CE, Vakalos A, Avramidis V, Georgopoulos D, Wu SH, Shyu LJ, Li CH, Yu CH, Chen HC, Wang CH, Lin KH, Aray ZE, Gómez CF, Tejero AP, Briassoulis G, Monge DD, Losada VM, Tarancón CM, Cortés SD, Gutiérrez AM, Álvarez TP, Rouze A, Jaffal K, Six S, Stolz K, la Torre AGD, Cattoen V, Nseir S, Arnal JM, Saoli M, Novotni D, Garnero A, Becher T, Buchholz V, Schädler D, Frerichs I, de la Torre-Prados MV, Weiler N, Eronia N, Mauri T, Gatti S, Maffezzini E, Bronco A, Alban L, Sasso T, Marenghi C, Grasselli G, Tsvetanova-Spasova T, Pesenti A, Bellani G, Al-Fares A, Del Sorbo L, Anwar S, Facchin F, Azad S, Zamel R, Ferguson N, Cypel M, Nuevo-Ortega P, Keshavjee S, Fan E, Durlinger E, Spoelstra-de Man A, Smit B, de Grooth HJ, Girbes A, Straaten HOV, Smulders Y, Alfaro MA, Rueda-Molina C, Parrilla F, Meli A, Pellegrini M, Rodriguez N, Goyeneche JM, Morán I, Aguirre H, Mancebo J, Heines SJH, Strauch U, Fernández-Porcel A, Bergmans DCJJ, Blankman P, Shono A, Hasan D, Gommers D, Chung WY, Lee KS, Jung YJ, Park JH, Sheen SS, Camara-Sola E, Park KJ, Worral R, Denham S, Isherwood P, Rees SE, Larraza S, Dey N, Spadaro S, Brohus JB, Winding RW, Salido-Díaz L, Volta CA, Karbing DS, Ampatzidou F, Vlachou A, Kehagioglou G, Karaiskos T, Madesis A, Mauromanolis C, Michail N, Drossos G, García-Alcántara A, Saraj N, Rijkenberg S, Feijen HM, Endeman H, Donnelly AAJ, Morgan E, Garrard H, Buckley H, Russell L, Haase N, Tavladaki T, Perner A, Goh C, Mouyis K, Woodward CLN, Halliday J, Encina GB, Ros J, Lagunes L, Tabernero J, Bosch F, Spanaki AM, Rello J, Huertas DG, Manzano F, Morente-Constantin E, Rivera-Ginés B, Colmenero-Ruiz M, Abellán AN, Pérez LP, Lucendo AP, Almudévar PM, Dimitriou H, Domínguez JP, Villamizar PR, Sanz JG, Simon IF, Valbuena BL, Carmona SA, Pais M, Ramalingam S, Díaz C, Fox L, Kondili E, Santafe M, Barba P, García M, Leal S, Pérez M, Pérez MLP, Abellán AN, Lucendo AP, Almudevar PM, Domínguez JP, Choulaki C, Villamizar PR, Veganzones J, Simón IF, Valbuena BL, Martínez N, 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ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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ESICM LIVES 2016: part one. Intensive Care Med Exp 2016. [PMCID: PMC5042924 DOI: 10.1186/s40635-016-0098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pande R, Saratzis A, Winter Beatty J, Doran C, Kirby R, Harmston C. Contemporary characteristics of blunt abdominal trauma in a regional series from the UK. Ann R Coll Surg Engl 2016; 99:82-87. [PMID: 27490986 DOI: 10.1308/rcsann.2016.0223] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Blunt abdominal trauma (BAT) is a common injury in recent trauma series. The characteristics of patients with BAT have changed following the reconfiguration of UK trauma services. The aim of this study was to build a new profile for BAT patients undergoing immediate or delayed laparotomy. METHODS All 5,401 consecutive adults presenting with major trauma between April 2012 and April 2014 in the 3 major trauma centres in the West Midlands were analysed to identify all patients with BAT. A total of 2,793 patients with a mechanism of injury or symptomatology consistent with BAT were identified (52%). Outcomes were analysed using local electronic clinical results systems and notes. RESULTS Of the 2,793 patients, 179 (6.4%) had a mesenteric or hollow viscus injury, 168 (6.0%) had a hepatobiliary injury, 149 (5.4%) had a splenic injury and 46 (1.6%) had a vascular injury. Overall, 103 patients (3.7%) underwent an early (<12 hours) laparotomy while 30 (1.1%) underwent a delayed (>12 hours) laparotomy. Twenty (66.7%) of those undergoing a delayed laparotomy had a hollow viscus injury. In total, 170 deaths occurred among the BAT patients (6.1%). In the early laparotomy group, 53 patients died (51.5%) whereas in the delayed laparotomy group, 6 patients died (20.0%). CONCLUSIONS This series has attempted to provide the characteristics of patients with BAT in a large contemporary UK cohort. BAT was found to be a common type of injury. Early and delayed laparotomy occurred in 3.7% and 1.1% of these patients respectively, mostly because of hollow viscus injury in both cases. Outcomes were comparable with those in the international literature from regions with mature trauma services.
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Affiliation(s)
- R Pande
- University Hospitals Coventry and Warwickshire NHS Trust , UK.,Contributed equally
| | - A Saratzis
- University of Leicester , UK.,Contributed equally
| | - J Winter Beatty
- University Hospitals Coventry and Warwickshire NHS Trust , UK
| | - C Doran
- University Hospitals Birmingham NHS Foundation Trust , UK
| | - R Kirby
- University Hospitals of North Midlands NHS Trust , UK
| | - C Harmston
- University Hospitals Coventry and Warwickshire NHS Trust , UK
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Saratzis A, Winter-Beatty J, El-Sayed C, Pande R, Harmston C. Colorectal cancer screening characteristics of patients presenting with symptoms of colorectal cancer and effect on clinical outcomes. Ann R Coll Surg Engl 2015; 97:369-74. [PMID: 26264089 DOI: 10.1308/003588415x14181254789565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION National colorectal cancer screening, utilising a faecal occult blood test (FOBT), is now well established in the UK. The aim of this study was to define the screening characteristics of patients presenting to secondary care with symptoms of colorectal cancer and to assess the effect of screening outcome on subsequent symptomatic presentation. METHODS This was a retrospective analysis of all patients of screening age presenting within one calendar year in a tertiary trust via a two-week wait (2WW) pathway owing to suspicion of colorectal cancer. Colorectal cancer related outcomes were compared between patients in the cohort who had previously accepted bowel cancer screening and patients who had previously declined bowel cancer screening. The primary endpoint was overall incidence of colorectal neoplasia. Secondary endpoints included incidence of colorectal malignancy, cancer related mortality, cancer related outcomes and polyp related outcomes. RESULTS Overall, 2,227 patients presented via the 2WW pathway; 955 were aged 60-75 years. Among the latter, 411 (43%) had been screened previously and had a negative FOBT, and 544 (57%) had declined screening. Incidence of colorectal neoplasia did not differ between the two groups (113 [27%] vs 143 [26%], p=0.7). Of those with a negative FOBT and subsequent symptomatic presentation, 16 (3.9%) were diagnosed with a colorectal malignancy compared with 36 (6.6%) of those who declined screening and had subsequent symptomatic presentation (relative risk: 1.7, 95% confidence interval: 0.96-3.02, p=0.08). There were no differences between the two groups with regard to TNM (tumour, lymph nodes, metastasis) stage, Dukes' stage, metastases, number of polyps or cancer related mortality (median follow-up duration: 20 months). CONCLUSIONS The incidence of colorectal neoplasia was similar among patients who previously had a negative FOBT and those who declined screening. There was a higher incidence of colorectal cancer detected among those who declined screening but it did not reach statistical significance. All other cancer and polyp outcomes were similar between the groups.
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Affiliation(s)
- A Saratzis
- University Hospitals Coventry and Warwickshire NHS Trust , UK
| | - J Winter-Beatty
- University Hospitals Coventry and Warwickshire NHS Trust , UK
| | - C El-Sayed
- University Hospitals Coventry and Warwickshire NHS Trust , UK
| | - R Pande
- University Hospitals Coventry and Warwickshire NHS Trust , UK
| | - C Harmston
- University Hospitals Coventry and Warwickshire NHS Trust , UK
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Hale A, Lee C, Annis S, Min PK, Pande R, Creager MA, Julian CG, Moore LG, Mitsialis SA, Hwang SJ, Kourembanas S, Chan SY. An Argonaute 2 switch regulates circulating miR-210 to coordinate hypoxic adaptation across cells. Biochim Biophys Acta 2014; 1843:2528-42. [PMID: 24983771 DOI: 10.1016/j.bbamcr.2014.06.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 06/05/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
Complex organisms may coordinate molecular responses to hypoxia by specialized avenues of communication across multiple tissues, but these mechanisms are poorly understood. Plasma-based, extracellular microRNAs have been described, yet their regulation and biological functions in hypoxia remain enigmatic. We found a unique pattern of release of the hypoxia-inducible microRNA-210 (miR-210) from hypoxic and reoxygenated cells. This microRNA is also elevated in human plasma in physiologic and pathologic conditions of altered oxygen demand and delivery. Released miR-210 can be delivered to recipient cells, and the suppression of its direct target ISCU and mitochondrial metabolism is primarily evident in hypoxia. To regulate these hypoxia-specific actions, prolyl-hydroxylation of Argonaute 2 acts as a molecular switch that reciprocally modulates miR-210 release and intracellular activity in source cells as well as regulates intracellular activity in recipient cells after miR-210 delivery. Therefore, Argonaute 2-dependent control of released miR-210 represents a unique communication system that integrates the hypoxic response across anatomically distinct cells, preventing unnecessary activity of delivered miR-210 in normoxia while still preparing recipient tissues for incipient hypoxic stress and accelerating adaptation.
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Affiliation(s)
- Andrew Hale
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Changjin Lee
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, 02215, USA
| | - Sofia Annis
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Pil-Ki Min
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Reena Pande
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Mark A Creager
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Colleen G Julian
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO, 80045, USA
| | - Lorna G Moore
- Department of Medicine, and Obstetrics-Gynecology, University of Colorado Denver School of Medicine, Aurora, CO, 80045, USA
| | - S Alex Mitsialis
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, 02215, USA
| | - Sarah J Hwang
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Stella Kourembanas
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, 02215, USA
| | - Stephen Y Chan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA.
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Denninger JW, Bhasin M, Huffman J, Niles H, Creager M, Pande R, Liberman T, Fricchione G, Benson H, Zusman R. Clinical and Genomic Effects of a Relaxation Response-Based Mind-Body Intervention in Stage I Hypertension. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5141.abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John W. Denninger
- (1) Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA, USA
- (2) Beth Israel Deaconess Medical Center, Boston, MA, USA
- (3) Massachusetts General Hospital, Boston, MA, USA
- (4) Brigham and Women's Hospital, Boston, MA, USA
| | - Manoj Bhasin
- (1) Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA, USA
- (2) Beth Israel Deaconess Medical Center, Boston, MA, USA
- (3) Massachusetts General Hospital, Boston, MA, USA
- (4) Brigham and Women's Hospital, Boston, MA, USA
| | - Jeff Huffman
- (1) Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA, USA
- (2) Beth Israel Deaconess Medical Center, Boston, MA, USA
- (3) Massachusetts General Hospital, Boston, MA, USA
- (4) Brigham and Women's Hospital, Boston, MA, USA
| | - Halsey Niles
- (1) Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA, USA
- (2) Beth Israel Deaconess Medical Center, Boston, MA, USA
- (3) Massachusetts General Hospital, Boston, MA, USA
- (4) Brigham and Women's Hospital, Boston, MA, USA
| | - Mark Creager
- (1) Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA, USA
- (2) Beth Israel Deaconess Medical Center, Boston, MA, USA
- (3) Massachusetts General Hospital, Boston, MA, USA
- (4) Brigham and Women's Hospital, Boston, MA, USA
| | - Reena Pande
- (1) Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA, USA
- (2) Beth Israel Deaconess Medical Center, Boston, MA, USA
- (3) Massachusetts General Hospital, Boston, MA, USA
- (4) Brigham and Women's Hospital, Boston, MA, USA
| | - Towia Liberman
- (1) Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA, USA
- (2) Beth Israel Deaconess Medical Center, Boston, MA, USA
- (3) Massachusetts General Hospital, Boston, MA, USA
- (4) Brigham and Women's Hospital, Boston, MA, USA
| | - Gregory Fricchione
- (1) Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA, USA
- (2) Beth Israel Deaconess Medical Center, Boston, MA, USA
- (3) Massachusetts General Hospital, Boston, MA, USA
- (4) Brigham and Women's Hospital, Boston, MA, USA
| | - Herbert Benson
- (1) Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA, USA
- (2) Beth Israel Deaconess Medical Center, Boston, MA, USA
- (3) Massachusetts General Hospital, Boston, MA, USA
- (4) Brigham and Women's Hospital, Boston, MA, USA
| | - Randall Zusman
- (1) Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, MA, USA
- (2) Beth Israel Deaconess Medical Center, Boston, MA, USA
- (3) Massachusetts General Hospital, Boston, MA, USA
- (4) Brigham and Women's Hospital, Boston, MA, USA
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Barman P, Sengupta S, Pande R, Puri M. P208: Detection of an outbreak through routine surveillance and its control. Antimicrob Resist Infect Control 2013. [PMCID: PMC3687713 DOI: 10.1186/2047-2994-2-s1-p208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
AIM The national Bowel Cancer Screening Programme has been rolled out nationwide following pilot screening in two health authorities in the UK. The aim of this study was to define overall 5-year survival of screen detected cancers and to compare the overall survival outcome of screened vs symptomatic patients over a 10-year period. METHOD All patients with colorectal cancer treated at one trust in patients of screening age (50-69 years) during the pilot screening programme (2000-2008) were analysed. Patients were defined as screen detected or symptomatically detected. Disease pathology and recurrence data were obtained from the hospital's computerized results reporting system and mortality was cross-matched with data from the West Midlands Cancer Intelligence Network. RESULTS In all, 633 patients aged 50-69 were identified in the study period; 155 patients had a screen detected cancer and 478 did not. A log-rank test completed on survival outcomes indicated that survival was significantly worse in the symptomatic group. This difference persisted if only patients treated with curative intent were considered. CONCLUSION Survival outcome was significantly better in the screened vs the symptomatic population in all groups and also in those treated for curative intent. There was a trend towards better survival for screen detected cancer when compared stage for stage.
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Affiliation(s)
- R Pande
- Department of Colorectal Surgery, University Hospital Coventry, Coventry, UK
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17
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Abstract
Retrograde intussusception is a rare complication of a Roux-en-Y gastric bypass. With the rising number of gastric bypass operations being performed in the UK, the incidence of retrograde intussusception is likely to increase. We report the first case in the UK and highlight its insidious presentation and the importance of considering intussusception in any patient with a history of a Roux-en-Y gastric bypass.
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Affiliation(s)
- R Pande
- Department of General Surgery, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK.
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18
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Abstract
Retrograde intussusception is a rare complication of a Roux-en-Y gastric bypass. With the rising number of gastric bypass operations being performed in the UK, the incidence of retrograde intussusception is likely to increase. We report the first case in the UK and highlight its insidious presentation and the importance of considering intussusception in any patient with a history of a Roux-en-Y gastric bypass.
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Affiliation(s)
- R Pande
- University Hospitals Coventry and Warwickshire NHS Trust UK
| | - I Fraser
- University Hospitals Coventry and Warwickshire NHS Trust UK
| | - C Harmston
- University Hospitals Coventry and Warwickshire NHS Trust UK
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Ho KJ, Spite M, Owens CD, Lancero H, Kroemer AHK, Pande R, Creager MA, Serhan CN, Conte MS. Aspirin-triggered lipoxin and resolvin E1 modulate vascular smooth muscle phenotype and correlate with peripheral atherosclerosis. Am J Pathol 2010; 177:2116-23. [PMID: 20709806 DOI: 10.2353/ajpath.2010.091082] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Atherosclerosis is a chronic inflammatory disease of the vessel wall. Recent evidence suggests that chronic vascular inflammation ensues as an imbalance between pro- and anti-inflammatory mediators. Recently identified lipid mediators (eg, lipoxins and resolvins) play active roles in promoting the resolution of inflammation. Alterations in vascular smooth muscle cell (VSMC) phenotype, which manifest as a loss of contractile protein expression and increased proliferation and migration, are prominent mechanistic features of both atherosclerosis and restenosis following various interventions (eg, angioplasty and bypass grafting). We sought to determine whether human atherosclerosis is associated with a "resolution deficit" and whether lipoxins and resolvins influence VSMC phenotype. Here we report that plasma levels of aspirin-triggered lipoxin are significantly lower in patients with symptomatic peripheral artery disease than in healthy volunteers. Both aspirin-triggered lipoxin and resolvin E1 block platelet-derived growth factor-stimulated migration of human saphenous vein SMCs and decrease phosphorylation of the platelet-derived growth factor receptor-β. Importantly, receptors for aspirin-triggered lipoxin and resolvin E1 (ALX and ChemR23, respectively) were identified in human VSMCs. Overall, these results demonstrate that stimulatory lipid mediators confer a protective phenotypic switch in VSMCs and elucidate new functions for these mediators in the regulation of SMC biology. These results also suggest that peripheral artery disease is associated with an inflammation-resolution deficit and highlight a potential therapeutic opportunity for the regulation of vascular injury responses.
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Affiliation(s)
- Karen J Ho
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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21
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Abstract
Essential thrombocythemia (ET) is a chronic myeloproliferative neoplasm which can cause thrombohaemorrhagic complications usually involving microvasculature. Medium-sized arterial thrombosis has been reported, but coronary occlusion usually occurs with additional risk factors, for example, smoking, hyperlipidaemia and so on. We present a case of acute myocardial infarction (AMI) in a young man (29 years) with ET but without any coronary artery associated risk factors. He was successfully treated for his AMI and ET with cytoreductive treatment and has recovered well. Due to automated platelet counting, ET is being increasingly identified; early detection can prevent long-term complications, and patients can have normal life span.
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Affiliation(s)
- S Pande
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore.
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22
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Abstract
Adder bites are common in the UK usually manifesting with localised swelling and gastrointestinal symptoms. We report a rare case of acute pancreatitis secondary to an adder bite in Wales and highlight this serious complication which was managed with standard treatment.
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Affiliation(s)
- R Pande
- Department of General Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK.
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Baral PR, Bhattarai B, Pande R, Bhadani U, Bhattacharya A, Tripathi M. Breathing comfort associated with different modes of ventilation: a comparative study in non-intubated healthy Nepalese volunteers. Kathmandu Univ Med J (KUMJ) 2007; 5:302-306. [PMID: 18604044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To compare subjective experience of comfort associated with various commonly used supportive modes of mechanical ventilation for weaning in the intensive care unit (ICU). SUBJECTS AND METHODS The study was carried out in general ICU of a community-based teaching hospital in 30 healthy adult Nepalese volunteers of either sex and 19-37 years of age. The subjects were randomly made to experience breathing via anatomical facemask through ventilator circuit with synchronized intermittent mandatory ventilation (SIMV), assisted spontaneous breathing (ASB), biphasic positive airway pressure (BiPAP), and continuous positive airway pressure (CPAP) modes of ventilation with parameters set at intermediate level of respiratory support. Subjective comfort of breathing was noted using a 10 cm visual analogue scale (VAS) with no discomfort at one end and maximum imaginable discomfort at the other. Inspiratory and expiratory experience of discomfort was also noted using a four point ranking scale (0-no discomfort, 1-mild discomfort, 2-moderate discomfort and 3-severe discomfort). In addition, presence or absence of feeling of breathlessness and inflation was also noted. RESULTS BiPAP was the most comfortable mode of ventilation (p<0.01) on visual analogue scale. SIMV and CPAP modes were associated with higher discomfort than other modes during inspiratory and expiratory phases respectively. Breathlessness and inflation were least felt in BiPAP and SIMV modes respectively. CONCLUSION Perception of breathing comfort can vary widely with various supportive modes of ventilation in the ICU. Hence, no single supportive mode should be used in all patients during weaning from mechanical ventilation. Key words: assisted spontaneous breathing; biphasic positive airway pressure; breathing comfort; continuous positive airway pressure; mechanical ventilation; supportive modes synchronized intermittent mandatory ventilation; weaning.
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Affiliation(s)
- P R Baral
- Department of Anaesthesiology, Kathmandu University Medical School, B & B Teaching Hospital, Susnari, Nepal.
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25
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Abstract
An Approach to Aplastic Anemia
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Pande R, Teuteberg JJ, Tsang SW, Lewis EF, Nohria A, Fang JC, Givertz M, Jarcho JA, Mudge GH, Baughman KL, Stevenson LW. Delayed disease progression is not associated with more clinical compromise. J Card Fail 2004. [DOI: 10.1016/j.cardfail.2004.06.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rao BK, Pande R, Sharma SC, Ray S, Lakshmi B, Singh VK, Gupta RK, Suri S. Percutaneous tracheostomy. Ann Card Anaesth 2003; 6:19-26. [PMID: 17827587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
The purpose of this review is to discuss the various techniques of percutaneous tracheostomy and to assess their safety and efficacy profile, indications and contraindications, early and late complications. Literature was reviewed from Medline and MD Consult databases. Early techniques by Sheldon, toye and Schachner have been abandoned due to their high complication rates. Percutaneous dilational tracheostomy using the Ciaglia kit (Wiliam Cook Europe Bjaeverskov) and a Griggs kit (Portex PDT kit, POrtex, Hythe, Kent, UK) has been used most often. Griggs guide Wire Dilator Forceps kit (SIMS, Portex, Hythe, Kent, UK) is the next most common in use but its long-term studies are few. Fantoni (TLT set, Mallinckrodt Medical) and PercuTwist device (Riisch, Kernen, Germany) are two new techniques currently under study. Percutaneous dilational tracheostomy and conventional surgical tracheostomy are still competing methods to provide an airway for intensive care patient requiring assisted ventilation. Review of literature shows that percutaneous tracheostomy is safe, cost-effective and compares favourably with the open surgical tracheostomy. Many intensive care units now use the percutaneous tracheostomy as a procedure of choice. Percutaneous tracheostomy has a learning curve and requires appropriate case selection and meticulous attention to the technique by all those who want to use this method.
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Affiliation(s)
- B K Rao
- Department of Anaesthesiology and Critical Care Medicine, Sir Gangaram Hospital, New Delhi, India.
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Tiwari N, Pande R. Protonation and Salting-in Behaviour of Weak Organic Bases in HClO4. Z PHYS CHEM 2002. [DOI: 10.1524/zpch.2002.216.12.1411] [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: 11/24/2022]
Abstract
Various protonation parameters (p
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Abstract
Male rats were given 50 mg/kg molybdenum (Mo; as sodium molybdate) in drinking water for eight consecutive doses. The feeding of Mo was associated with an increased concentration of Mo in body tissues. The highest concentrations of metal were found in the kidney while it was least in blood cells. The accumulation was considered to be significant.
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Affiliation(s)
- R Pande
- Department of Zoology, University of Lucknow, Uttar Pradesh, India.
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30
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Abstract
Apparent molar volumes (φ
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Pande R, Pande M, Bhadani U, Pandey CK, Bhattacharya A. A reply. Anaesthesia 2001. [DOI: 10.1046/j.1365-2044.2001.01870-31.x] [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: 11/20/2022]
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Pande R, Pande M, Bhadani U, Pandey CK, Bhattacharya A. Supraclavicular brachial plexus block as a sole anaesthetic technique in children: an analysis of 200 cases. Anaesthesia 2000; 55:798-802. [PMID: 10947696 DOI: 10.1046/j.1365-2044.2000.01330.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Classical supraclavicular brachial plexus block was used as the sole anaesthetic technique in 200 children aged between 5 and 12 years undergoing closed reduction of arm fractures. The local anaesthetic used was lidocaine 1.5% with epinephrine. The block was graded as satisfactory if surgical manipulation could be performed without discomfort and unsatisfactory if general anaesthesia had to be given. In 182 children, the procedure was carried out under the block alone, whereas the remaining 18 patients required general anaesthesia. The mean (SD) time required for performing the block was 9.1 (3.7) min and the mean (SD) time to sensory blockade was 8.3 (2.3) min. The mean duration of analgesia was approximately 3.5 h. There were few complications, with no incidence of pneumothorax in any patient. The acceptability of the block by the children and the parents was 72 and 85%, respectively. The classical supraclavicular brachial plexus block was found to be acceptable, effective and with a good success rate.
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Affiliation(s)
- R Pande
- Department of Anaesthesiology and Critical Care, B P Koirala Institute of Health Sciences, Dharan, Nepal
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Pande R. From anti-arrack to total prohibition: the women's movement in Andhra Pradesh, India. Gend Technol Dev 2000; 4:131-144. [PMID: 12179945 DOI: 10.1177/097185240000400109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Abstract
Intestinal pseudo-obstruction occurs rarely in patients with myasthenia gravis (MG) and thymoma. The etiology of the intestinal pseudo-obstruction remains to be elucidated, although an autoimmune mechanism is postulated. We present the first report of neuronal nicotinic acetylcholine receptor (AChR)-specific antibody in a patient with seropositive MG, malignant thymoma, and intestinal pseudo-obstruction. This finding provides evidence that intestinal pseudo-obstruction associated with thymoma and possibly other neoplasms may be related to antibodies against the neuronal nicotinic receptors at autonomic ganglia.
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Affiliation(s)
- R Pande
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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35
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Abstract
We have studied the time-dependent uptake of 35S radiolabeled DNA with electrochemically prepared polypyrrole films. The two distinct polypyrrole film surfaces, a rough (solution polymeric growth face, R) and a smooth surface (electrode face, S) were characterized by low-resolution AFM and high-resolution transmission electron microscopy (TEM). These studies showed the presence of steep contours and defects in the form of large and small surface holes and valleys on the rough surface of polypyrrole. The void dimensions ranged from the nanoscale to micron size. By contrast, the smooth surface was flatter and largely devoid of significant structural defects and exhibited closer packing of the polypyrrole chains over large areas. Both surfaces were comprised largely of chains whose average diameters were 1.0-1.2 +/- 0.3 nm. The surface characterization studies were complemented by time-dependent DNA uptake studies which showed a t1/2-dependent total uptake of 35S DNA at higher levels on the rough surface compared to the smooth surface. This is consistent with the apparent higher effective surface area of the rough surface compared to the smooth. Using a proportional counter the time-dependent ratio (R/S) of the 35S DNA detected from the rough surface of the polypyrrole disk to that detected from the smooth surface suggested that DNA was migrating into the disk interior from its uptake surface. The rough side defect dimensions measured by TEM were more than sufficient to allow for the penetration and migration of DNA into the disk interior. Both R/S ratios were extrapolated and found to intersect at an R/S value close to 1.0, suggesting a kinetic process leading ultimately towards a nearly uniform radiolabeled DNA distribution in the disk. These kinetic results were in agreement with the surface characterization studies and suggest a model in which sizeable internal pores exist throughout the electrochemically prepared polypyrrole, that could account for the DNA migration effect. This was confirmed by TEM of the interior of a polypyrrole disk produced by Argon ion milling.
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Affiliation(s)
- R Pande
- Department of Chemistry, Center for Intelligent Biomaterials, University of Massachusetts Lowell, 01854, USA
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Salahudeen A, Poovala V, Parry W, Pande R, Kanji V, Ansari N, Morrow J, Roberts J. Cisplatin induces N-acetyl cysteine suppressible F2-isoprostane production and injury in renal tubular epithelial cells. J Am Soc Nephrol 1998; 9:1448-55. [PMID: 9697667 DOI: 10.1681/asn.v981448] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In the low intracellular chloride milieu, chloride ions of cisplatin may exchange for cellular SH moieties resulting in glutathione depletion, H2O2 accumulation, and lipid peroxidation. Cisplatin-induced lipid peroxidation, in addition to causing direct cellular injury, may further contribute to cisplatin-induced renal dysfunction by generating vasoconstrictive E2- and F2-isoprostanes. The aim of this study was to determine whether cisplatin-induced renal epithelial (LLC-PK1 and primary human proximal tubular) cell injury is associated with increased production of isoprostanes, and whether this can be suppressed with a thiol donor, N-acetyl cysteine. It was confirmed that incubation of renal epithelial cells with cisplatin resulted in N-acetyl cysteine-inhibitable glutathione depletion, H2O2 accumulation, lipid degradation, and lactate dehydrogenase release. In additional experiments, incubation of cells with cisplatin for 48 h was accompanied by a dose-related increase in total (free plus esterified) F2-isoprostanes. An increase in F2-isoprostanes was discernible at 16.5 microM cisplatin and doubled at 66.0 microM. N-Acetyl cysteine at 50 microM concentration effectively suppressed 66.0 microM cisplatin-induced increase in isoprostanes. Similar findings were also obtained in human cells. Thus, cisplatin-induced tubular cell injury is accompanied by increased isoprostane production through a mechanism involving thiol depletion. On the basis of this new finding, it is hypothesized that these arachidonic acid peroxidation products may be partially responsible for the cisplatin-induced renal vasoconstriction demonstrable in the in vivo models.
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Affiliation(s)
- A Salahudeen
- Department of Medicine, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Pande R, Kamtekar S, Ayyagari MS, Kamath M, Marx KA, Kumar J, Tripathy SK, Kaplan DL. A biotinylated undecylthiophene copolymer bioconjugate for surface immobilization: creating an alkaline phosphatase chemiluminescence-based biosensor. Bioconjug Chem 1996; 7:159-64. [PMID: 8742005 DOI: 10.1021/bc950086z] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Methodology is described for the creation of a molecular assembly consisting of the enzyme alkaline phosphatase immobilized onto a glass surface using a biotinylated conjugated copolymer, poly(3-undecylthiophene-co-3-thiophenecarboxaldehyde) 6-biotinamidohexanohydrazone. The biotinylated polymer is attached to the inside walls of a silanized glass capillary via hydrophobic interactions, and a streptavidin-conjugated alkaline phosphatase is interfaced with the polymer through the classical biotin-streptavidin interaction. Utilizing a simple optical setup, we can detect the activity of as little as approximately 0.1 fmol of alkaline phosphatase with this molecular assembly. The assembly is mechanically robust and retains the majority of bound enzyme activity for up to 30 days. We have utilized this molecular assembly for the detection of organophosphorus-based pesticides. Both paraoxon and methyl parathion inhibit the enzyme-mediated generation of chemiluminescence signal. We are able to detect paraoxon and methyl parathion concentrations down to 500-700 ppb.
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Affiliation(s)
- R Pande
- Department of Chemistry, University of Massachusetts, Lowell 01854, USA
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Ayyagari MS, Kamtekar S, Pande R, Marx KA, Kumar J, Tripathy SK, Akkara J, Kaplan DL. Chemiluminescence-based inhibition kinetics of alkaline phosphatase in the development of a pesticide biosensor. Biotechnol Prog 1995; 11:699-703. [PMID: 8541020 DOI: 10.1021/bp00036a015] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The use and application of the enzyme alkaline phosphatase in a chemiluminescence assay are discussed. The enzyme catalyzes the hydrolysis of a macrocyclic phosphate compound generating a chemiluminescence signal. On the basis of inhibition of this signal, a methodology for the detection and quantitation of organophosphorus-based pesticides has been developed. The methodology is studied with alkaline phosphatase in the bulk aqueous phase, and detection of the signal is accomplished by a simple optical setup. Parts per billion level detection of paraoxon and methyl parathion in bulk solutions is achieved. The technique is rapid and sensitive and is applicable to the detection of most organophosphorus-based pesticides. The results from kinetic studies indicate a mixed type of inhibition of the enzyme by paraoxon and methyl parathion. The detection methodology forms an integral part of a biosensor under development and is adaptable to incorporating optical fibers for remote detection of pesticides.
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Affiliation(s)
- M S Ayyagari
- Department of Chemistry, University of Massachusetts Lowell 01854, USA
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Abstract
A 5-year-old girl with GAPO syndrome from India lacked PAS-positive hyaline material in the skin biopsy from thigh and scalp. The role of this pathological change, earlier reported by Wajntal et al. [1990] in the pathogenesis of GAPO syndrome, needs to be reexamined.
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Affiliation(s)
- S R Phadke
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Antarkar DS, Pande R, Athavale AV, Shubhangi R, Saoji SR, Shah KN, Jakhmola AT, Vaidya AB. Phase I tolerability study of Yogaraj-guggulu--a popular ayurvedic drug. J Postgrad Med 1984; 30:111-5. [PMID: 6527293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Pande R. A Clinical Study of Congestive Cardiac Failure in Rheumatic Heart Disease. Med J Shree Birendra Hosp 1970. [DOI: 10.3126/mjsbh.v9i2.5019] [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
Introduction: Congestive cardiac failure is the failure of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissue and or its ability to do so requires an abnormally elevated pressure. CCF once sets in, pressure with malignant progression with one year mortality of 38% and 15% and six year mortality of 80% and 65% in men and women respectively. Acute rheumatic fever(ARF) and its sequel Rheumatic Heart Disease(RHD) may impair myocardial function to precipitate failure. Aim: To study clinical features of Congestive Cardiac Failure in Rheumatic Heart Disease. Methods: A prospective study with 50 patients admitted between August 2006 and September 2008 in Shree Birendra Hospital formed the subject of this study.Patients of rheumatic valvular heart disease of both sexes in congestive cardiac failure at the time of admission or who developed failure during hospitalization were taken into the study. Detailed history was taken from all patients. Detailed examination was done in all patients with emphasis in cardiovascular and relevant system. Modified Framingham heart study criteria was used for the diagnosis of CCF. Results: A total of 50 patients with RHD in CCF were the subject of study. The average age was 33.78 years. The presenting clinical features of the patients were breathlessness on exertion and it was the commonest presenting complaint and was present in all patients. Palpitation was present 37 of 50 patients(74%). Basal crepitation was the commonest clinical sign present and 29 of 50 patients(58%) had the raised jugular venous pressure. Mitral valve was the commonest valve involved (with/without) other valves) and was seen in 94% (47) patients. Key words: Congestive Cardiac Failure; Rheumatic Heart Disease DOI: http://dx.doi.org/10.3126/mjsbh.v9i2.5019 Medical Journal of Shree Birendra Hospital Vol.9(2) 2010: 8-12
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