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Tuderti G, Mastroianni R, Anceschi U, Bove AM, Brassetti A, Ferriero M, Misuraca L, Guaglianone S, Costantini M, Torregiani G, Saidian A, Mari A, Narasimhan R, Derweesh I, Minervini A, Gallucci M, Simone G. Assessing the Trade-off Between the Safety and Effectiveness of Off-clamp Robotic Partial Nephrectomy for Renal Masses with a High RENAL Score: A Propensity Score-matched Comparison of Perioperative and Functional Outcomes in a Multicenter Analysis. Eur Urol Focus 2023; 9:1037-1043. [PMID: 37263828 DOI: 10.1016/j.euf.2023.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/13/2023] [Revised: 04/23/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Tumors with a high nephrometry score represent a challenging surgical scenario for which robotic partial nephrectomy (RPN) is a primary option in expert hands. OBJECTIVE To compare perioperative and functional outcomes of off-clamp and on-clamp RPN in patients with renal masses with a high RENAL score (≥9). DESIGN, SETTING, AND PARTICIPANTS For this retrospective analysis, an RPN data set including 1604 patients treated at three institutions between 2003 and 2021 was queried for cases with a RENAL score ≥9. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We used 1:1 propensity score matching (PSM) to select a cohort in which imbalances between the off-clamp and on-clamp groups were minimized. We used χ2 and Student t tests to compare categorical and continuous variables, respectively. The Kaplan-Meier method was used to compare the probability of having an estimated glomerular filtration rate (eGFR) ≥45 ml/min during follow-up. Univariable and multivariable analyses were performed to identify predictors of a trifecta outcome (negative surgical margin status, no Clavien-Dindo grade ≥3 complications, eGFR decline ≤30%) and of retaining eGFR ≥45 ml/min over time. RESULTS AND LIMITATIONS From an overall cohort of 354 patients (142 on-clamp, 212 off-clamp), a homogeneous PSM cohort of 78 patients in each group was selected (p ≥ 0.17). In the PSM cohort, operative time was significantly shorter in the off-clamp group (p < 0.001). There were no differences between the groups in the rates of severe complications (p = 0.32) and positive surgical margins (p = 0.24). The rate of trifecta achievement was significantly higher in the off-clamp group (83.3% vs 67.9%; p = 0.03). Warm ischemia time >20 min was independently negatively associated with trifecta achievement (odds ratio 0.32, 95% confidence interval 0.14-0.74). Moreover, the off-clamp group had a significantly higher probability of retaining eGFR ≥45 ml/min over time (3 yr: 95.9% vs 81.6%; p = 0.03); every 1-min increase in warm ischemia time reduced this probability by 1.3%. CONCLUSIONS We found a favorable trade-off between the benefits and risks of off-clamp RPN, with similar perioperative outcomes and a net benefit in terms of trifecta achievement and long-term renal function outcomes in comparison to on-clamp RPN. PATIENT SUMMARY The complexity of surgery for kidney tumors can be assessed using the RENAL score, which is a measure of the location and size of a kidney tumor. In a multicenter series of patients with tumors with a high RENAL score, we compared outcomes between strategies with (on-clamp) and without (off-clamp) clamping of kidney blood vessels during robot-assisted removal of part of the affected kidney. We found that off-clamp surgery results in better postoperative kidney function.
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Affiliation(s)
- Gabriele Tuderti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - Riccardo Mastroianni
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Leonardo Misuraca
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Manuela Costantini
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Torregiani
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ava Saidian
- Department of Urology, University of California-San Diego Health System, La Jolla, CA, USA
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Rekha Narasimhan
- Department of Urology, University of California-San Diego Health System, La Jolla, CA, USA
| | - Ithaar Derweesh
- Department of Urology, University of California-San Diego Health System, La Jolla, CA, USA
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Michele Gallucci
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Nguyen MV, Walia A, Saidian A, Puri D, Meagher MF, Hakimi K, Tanaka H, Patil D, Yasuda Y, Saito K, Dhanji S, Cerrato C, Narasimhan R, Perry J, Master V, Fujii Y, Derweesh IH. Impact of worsening surgically induced chronic kidney disease (CKD-S) in preoperative CKD-naïve patients on survival in renal cell carcinoma. BJU Int 2023; 131:219-226. [PMID: 35876044 DOI: 10.1111/bju.15861] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/27/2023]
Abstract
OBJECTIVES To evaluate effects of worsening surgically induced chronic kidney disease (CKD-S) on oncological and non-oncological survival outcomes in renal cell carcinoma (RCC). PATIENTS AND METHODS We performed a retrospective analysis of patients who underwent partial (PN) or radical nephrectomy (RN) and were free of preoperative CKD (estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 m2 ). Patients were stratified by CKD stage at last follow-up: no CKD-S (eGFR ≥60 mL/min/1.73 m2 ), de novo CKD-S 3a (eGFR 45-59 mL/min/1.73 m2 ), CKD-S 3b (eGFR <45 and ≥30 mL/min/1.73 m2 ) and CKD-S 4 (eGFR <30 and ≥15 mL/min/1.73 m2 ). The primary outcome was all-cause mortality (ACM). Secondary outcomes included non-cancer mortality (NCM), cancer-specific mortality (CSM) and de novo CKD-S Stage 3/4. Multivariable analysis (MVA) was utilised to identify risk factors for outcomes. Kaplan-Meier analysis (KMA) was utilised to evaluate overall (OS), non-cancer (NCS), and cancer-specific survival with respect to CKD-S categories. RESULTS We analysed 3239 patients. The mean preoperative and last-follow-up eGFRs were 87.4 and 69.5 mL/min/1.73 m2 , respectively. On last follow-up, 57.9% (n = 1876) had no CKD-S, 18.7% (n = 606) had CKD-S 3a, 15.1% (n = 489) had CKD-S 3b and 8.3% (n = 268) had CKD-S 4. On MVA, de novo CKD-S 3b and 4 were independently associated with ACM (hazard ratios [HRs] 1.3-2.1, P = 0.003-0.001) and NCM (HRs 1.5-2.8, P = 0.021-0.001), but not CSM (P = 0.219-0.909); de novo CKD-S 3a was not predictive for any mortality outcomes (P = 0.102-0.81). RN was independently associated with CKD-S 3-4 (HRs 1.78-1.99, P < 0.001-0.035). Comparing no CKD-S, CKD-S 3a, CKD-S 3b and CKD-S 4, KMA demonstrated worsening outcomes with progressive CKD-S stage: 5-year OS 84% vs 78% vs 71% vs 60% (P < 0.001) and 5-year NCS 93% vs 87% vs 83% vs 72% (P < 0.001). CONCLUSION Development of CKD-S Stage 3b and 4, but not 3a, was associated with worsened ACM and NCM. The decision to proceed with nephron preservation via PN should be individualised based on oncological risk and risk of functional decline to CKD-S 3b or 4, and not CKD-S 3a.
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Affiliation(s)
- Mimi V Nguyen
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Arman Walia
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Ava Saidian
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Dhruv Puri
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret F Meagher
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Kevin Hakimi
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yosuke Yasuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sohail Dhanji
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Clara Cerrato
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Rekha Narasimhan
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - John Perry
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Viraj Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
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Tuderti G, Mastroianni R, Mari A, Saidian A, Narasimhan R, Anceschi U, Brassetti A, Ferriero M, Bove A, Misuraca L, Costantini M, Guaglianone S, Autorino R, Derweesh I, Minervini A, Gallucci M, Simone G. Assessing the trade-off between safety and effectiveness of off-clamp robotic partial nephrectomy in patients with high RENAL score: A propensity score-matched comparison of perioperative and functional outcomes in a multicenter analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01059-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: 02/12/2023]
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Katiyar SK, Gaur SN, Solanki RN, Sarangdhar N, Suri JC, Kumar R, Khilnani GC, Chaudhary D, Singla R, Koul PA, Mahashur AA, Ghoshal AG, Behera D, Christopher DJ, Talwar D, Ganguly D, Paramesh H, Gupta KB, Kumar T M, Motiani PD, Shankar PS, Chawla R, Guleria R, Jindal SK, Luhadia SK, Arora VK, Vijayan VK, Faye A, Jindal A, Murar AK, Jaiswal A, M A, Janmeja AK, Prajapat B, Ravindran C, Bhattacharyya D, D'Souza G, Sehgal IS, Samaria JK, Sarma J, Singh L, Sen MK, Bainara MK, Gupta M, Awad NT, Mishra N, Shah NN, Jain N, Mohapatra PR, Mrigpuri P, Tiwari P, Narasimhan R, Kumar RV, Prasad R, Swarnakar R, Chawla RK, Kumar R, Chakrabarti S, Katiyar S, Mittal S, Spalgais S, Saha S, Kant S, Singh VK, Hadda V, Kumar V, Singh V, Chopra V, B V. Indian Guidelines on Nebulization Therapy. Indian J Tuberc 2022; 69 Suppl 1:S1-S191. [PMID: 36372542 DOI: 10.1016/j.ijtb.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 06/16/2023]
Abstract
Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.
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Affiliation(s)
- S K Katiyar
- Department of Tuberculosis & Respiratory Diseases, G.S.V.M. Medical College & C.S.J.M. University, Kanpur, Uttar Pradesh, India.
| | - S N Gaur
- Vallabhbhai Patel Chest Institute, University of Delhi, Respiratory Medicine, School of Medical Sciences and Research, Sharda University, Greater NOIDA, Uttar Pradesh, India
| | - R N Solanki
- Department of Tuberculosis & Chest Diseases, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Nikhil Sarangdhar
- Department of Pulmonary Medicine, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India
| | - J C Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Raj Kumar
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, National Centre of Allergy, Asthma & Immunology; University of Delhi, Delhi, India
| | - G C Khilnani
- PSRI Institute of Pulmonary, Critical Care, & Sleep Medicine, PSRI Hospital, Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Dhruva Chaudhary
- Department of Pulmonary & Critical Care Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rupak Singla
- Department of Tuberculosis & Respiratory Diseases, National Institute of Tuberculosis & Respiratory Diseases (formerly L.R.S. Institute), Delhi, India
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
| | - Ashok A Mahashur
- Department of Respiratory Medicine, P. D. Hinduja Hospital, Mumbai, Maharashtra, India
| | - A G Ghoshal
- National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - D Behera
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepak Talwar
- Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India
| | | | - H Paramesh
- Paediatric Pulmonologist & Environmentalist, Lakeside Hospital & Education Trust, Bengaluru, Karnataka, India
| | - K B Gupta
- Department of Tuberculosis & Respiratory Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Haryana, India
| | - Mohan Kumar T
- Department of Pulmonary, Critical Care & Sleep Medicine, One Care Medical Centre, Coimbatore, Tamil Nadu, India
| | - P D Motiani
- Department of Pulmonary Diseases, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - P S Shankar
- SCEO, KBN Hospital, Kalaburagi, Karnataka, India
| | - Rajesh Chawla
- Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Randeep Guleria
- All India Institute of Medical Sciences, Department of Pulmonary Medicine & Sleep Disorders, AIIMS, New Delhi, India
| | - S K Jindal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Luhadia
- Department of Tuberculosis and Respiratory Medicine, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - V K Arora
- Indian Journal of Tuberculosis, Santosh University, NCR Delhi, National Institute of TB & Respiratory Diseases Delhi, India; JIPMER, Puducherry, India
| | - V K Vijayan
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, University of Delhi, Delhi, India
| | - Abhishek Faye
- Centre for Lung and Sleep Disorders, Nagpur, Maharashtra, India
| | | | - Amit K Murar
- Respiratory Medicine, Cronus Multi-Specialty Hospital, New Delhi, India
| | - Anand Jaiswal
- Respiratory & Sleep Medicine, Medanta Medicity, Gurugram, Haryana, India
| | - Arunachalam M
- All India Institute of Medical Sciences, New Delhi, India
| | - A K Janmeja
- Department of Respiratory Medicine, Government Medical College, Chandigarh, India
| | - Brijesh Prajapat
- Pulmonary and Critical Care Medicine, Yashoda Hospital and Research Centre, Ghaziabad, Uttar Pradesh, India
| | - C Ravindran
- Department of TB & Chest, Government Medical College, Kozhikode, Kerala, India
| | - Debajyoti Bhattacharyya
- Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences, Army Hospital (Research & Referral), New Delhi, India
| | | | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - J K Samaria
- Centre for Research and Treatment of Allergy, Asthma & Bronchitis, Department of Chest Diseases, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Jogesh Sarma
- Department of Pulmonary Medicine, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Lalit Singh
- Department of Respiratory Medicine, SRMS Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - M K Sen
- Department of Respiratory Medicine, ESIC Medical College, NIT Faridabad, Haryana, India; Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Mahendra K Bainara
- Department of Pulmonary Medicine, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi PostGraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nilkanth T Awad
- Department of Pulmonary Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, M.K.C.G. Medical College, Berhampur, Orissa, India
| | - Naveed N Shah
- Department of Pulmonary Medicine, Chest Diseases Hospital, Government Medical College, Srinagar, Jammu & Kashmir, India
| | - Neetu Jain
- Department of Pulmonary, Critical Care & Sleep Medicine, PSRI, New Delhi, India
| | - Prasanta R Mohapatra
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Parul Mrigpuri
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Pawan Tiwari
- School of Excellence in Pulmonary Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - R Narasimhan
- Department of EBUS and Bronchial Thermoplasty Services at Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R Vijai Kumar
- Department of Pulmonary Medicine, MediCiti Medical College, Hyderabad, Telangana, India
| | - Rajendra Prasad
- Vallabhbhai Patel Chest Institute, University of Delhi and U.P. Rural Institute of Medical Sciences & Research, Safai, Uttar Pradesh, India
| | - Rajesh Swarnakar
- Department of Respiratory, Critical Care, Sleep Medicine and Interventional Pulmonology, Getwell Hospital & Research Institute, Nagpur, Maharashtra, India
| | - Rakesh K Chawla
- Department of, Respiratory Medicine, Critical Care, Sleep & Interventional Pulmonology, Saroj Super Speciality Hospital, Jaipur Golden Hospital, Rajiv Gandhi Cancer Hospital, Delhi, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - S Chakrabarti
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | - Saurabh Mittal
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | | | - Surya Kant
- Department of Respiratory (Pulmonary) Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - V K Singh
- Centre for Visceral Mechanisms, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Vijay Hadda
- Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Kumar
- All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Virendra Singh
- Mahavir Jaipuria Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Vishal Chopra
- Department of Chest & Tuberculosis, Government Medical College, Patiala, Punjab, India
| | - Visweswaran B
- Interventional Pulmonology, Yashoda Hospitals, Hyderabad, Telangana, India
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Tanaka H, Fukuda S, Yasuda Y, Patil D, Saidian A, Walia A, Meagher M, Perry J, Nguyen M, Narasimhan R, Yoshida S, Yokoyama M, Matsuoka Y, Master V, Derweesh I, Saito K, Fujii Y. Disparities in cancer-specific mortality between Asian and Caucasian patients with non-metastatic renal cell carcinoma: Analysis of the INMARC registry. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00223-8] [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: 11/25/2022]
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Narasimhan R, Narasimhan NA, Narasimhan A. Radiological imaging and its utility in lung transplantation: Our experience and review of literature. J Assoc Pulmonologist Tamilnadu 2022; 5:49. [DOI: 10.4103/japt.japt_36_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Coras R, Pedersen B, Narasimhan R, Brandy A, Mateo L, Prior-Español A, Kavanaugh A, Armando AM, Jain M, Quehenberger O, Martínez-Morillo M, Guma M. Imbalance Between Omega-6- and Omega-3-Derived Bioactive Lipids in Arthritis in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:415-425. [PMID: 32361743 DOI: 10.1093/gerona/glaa113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Indexed: 12/13/2022] Open
Abstract
Elderly-onset rheumatoid arthritis (EORA) and polymyalgia rheumatica (PMR) are common rheumatic diseases in older adults. Oxylipins are bioactive lipids derived from omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acids (PUFAs) that serve as activators or suppressors of systemic inflammation. We hypothesized that arthritis symptoms in older adults were related to oxylipin-related perturbations. Arthritis in older adults (ARTIEL) is an observational prospective cohort with 64 patients older than 60 years of age with newly diagnosed arthritis. Patients' blood samples at baseline and 3 months posttreatment were compared with 18 controls. A thorough clinical examination was conducted. Serum oxylipins were determined by mass spectrometry. Data processing and statistical analysis were performed in R. Forty-four patients were diagnosed with EORA and 20 with PMR. At diagnosis, EORA patients had a mean DAS28CRP (Disease Activity Score 28 using C-reactive protein) of 5.77 (SD 1.02). One hundred percent of PMR patients reported shoulder pain and 90% reported pelvic pain. Several n-6- and n-3-derived oxylipin species were significantly different between controls and arthritis patients. The ratio of n-3/n-6 PUFA was significantly downregulated in EORA but not in PMR patients as compared to controls. The top two candidates as biomarkers for differentiating PMR from EORA were 4-HDoHE, a hydroxydocosahexaenoic acid, and 8,15-dihydroxy-eicosatrienoic acid (8,15-diHETE). The levels of n-3-derived anti-inflammatory species increased in EORA after treatment. These results suggest that certain oxylipins may be key effectors in arthrtis in older adults and that the imbalance between n-6- and n-3-derived oxylipins might be related to pathobiology in this population.
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Affiliation(s)
- Roxana Coras
- Department of Medicine, School of Medicine, University of California, San Diego.,Department of Medicine, Autonomous University of Barcelona, Bellaterra, Spain
| | - Brian Pedersen
- Department of Medicine, School of Medicine, University of California, San Diego
| | - Rekha Narasimhan
- Department of Medicine, School of Medicine, University of California, San Diego
| | - Anahy Brandy
- Department of Rheumatology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Lourdes Mateo
- Department of Rheumatology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Agueda Prior-Español
- Department of Rheumatology, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Arthur Kavanaugh
- Department of Medicine, School of Medicine, University of California, San Diego
| | - Aaron M Armando
- Department of Pharmacology, School of Medicine, University of California, San Diego
| | - Mohit Jain
- Department of Medicine, School of Medicine, University of California, San Diego.,Department of Pharmacology, School of Medicine, University of California, San Diego
| | - Oswald Quehenberger
- Department of Pharmacology, School of Medicine, University of California, San Diego
| | | | - Monica Guma
- Department of Medicine, School of Medicine, University of California, San Diego.,Department of Medicine, Autonomous University of Barcelona, Bellaterra, Spain
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Selvaraj N, Narasimhan R, Addla S, Kumar G. Perioperative outcomes of open, laparoscopic and robotic adrenalectomy: A multicenter experience. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01072-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Sridhar R, Narasimhan R, Sundararajan L, Singh R. Clinicoradiopathological features among mediastinal masses. Indian J Respir Care 2021. [DOI: 10.4103/ijrc.ijrc_48_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sunder T, Chinnasamy S, Thangaraj P, Kuppuswamy M, Narasimhan R. Radiological imaging and its utility in lung transplantation: Our experience and review of literature. J Assoc Pulmonologist Tamilnadu 2021; 4:31. [DOI: 10.4103/japt.japt_27_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
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Bustamante MF, Agustín-Perez M, Cedola F, Coras R, Narasimhan R, Golshan S, Guma M. Design of an anti-inflammatory diet (ITIS diet) for patients with rheumatoid arthritis. Contemp Clin Trials Commun 2020; 17:100524. [PMID: 32025586 PMCID: PMC6997513 DOI: 10.1016/j.conctc.2020.100524] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 09/26/2019] [Revised: 01/01/2020] [Accepted: 01/11/2020] [Indexed: 12/17/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that affects synovial joints, leading to inflammation, joint destruction, loss of function, and disability. Although recent pharmaceutical advances have improved treatment of RA, patients with RA often inquire about dietary interventions to improve RA symptoms, as they perceive rapid changes in their symptoms after consumption of certain foods. There is evidence that some ingredients have pro- or anti-inflammatory effects. In addition, recent literature has shown a link between diet and microbiome changes. Both diet and the gut microbiome are linked to circulating metabolites that may modulate inflammation. However, evidence of the effects of an anti-inflammatory and probiotic-rich diet in patients with RA is scarce. There is also a need for biological data to support its anti-inflammatory effects. Methods The main goal of this study is to delineate the design process for a diet tailored to our RA population. To achieve this goal, we collected information on diet, supplements, cooking methods, and intake of different ingredients for each patient. Different groups were interviewed, and their feedback was assessed to design a diet that incorporates suggested anti-inflammatory ingredients in a manner that was easy for patients to adopt based on their lifestyles and backgrounds. Results We designed a diet that includes a high intake of potential anti-inflammatory ingredients. Feedback from highly motivated patients was critical in constructing an anti-inflammatory diet (ITIS diet) with elevated adherence. Conclusion In order to tailor our diet, we surveyed our patients on several different parameters. We obtained important feedback on how feasible our ITIS diet is for RA patients. Using this feedback, we made minor improvements and finalized the design of the ITIS diet. This diet is being used in an on-going pilot study to determine their anti-inflammatory effect in pain and joint swelling in RA patients. Trial registration Not applicable.
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Affiliation(s)
- Marta F Bustamante
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Francesca Cedola
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Roxana Coras
- Department of Medicine, University of California San Diego, San Diego, CA, USA.,Department of Medicine, Autonomous University of Barcelona, Plaça Cívica, 08193, Bellaterra, Barcelona, Spain
| | - Rekha Narasimhan
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Shahrokh Golshan
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Monica Guma
- Department of Medicine, University of California San Diego, San Diego, CA, USA.,Department of Medicine, Autonomous University of Barcelona, Plaça Cívica, 08193, Bellaterra, Barcelona, Spain
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Coras R, Narasimhan R, Guma M. Liquid biopsies to guide therapeutic decisions in rheumatoid arthritis. Transl Res 2018; 201:1-12. [PMID: 30092207 PMCID: PMC6309446 DOI: 10.1016/j.trsl.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/29/2018] [Accepted: 07/10/2018] [Indexed: 12/18/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic, immune-mediated inflammatory disease that has transitioned from a debilitating disease to a chronic, controllable disease. This has been possible due to the introduction of new treatment strategies like "treat-to-target," in which the clinician treats the patient aggressively enough to reach low disease activity or remission, and the introduction of new therapeutic agents, such as biological therapies, which can lead to the prevention of damage by early diagnosis and initiation of treatment. Attention is now being directed toward identifying the optimal treatment for each patient, one that will be the most efficient and have the least number of side effects. Much work has been done to find serologic and synovial biomarkers of response to various RA treatments. Proteomics, genomics and, in the past few years, metabolomics, have all been used in the quest of identifying these biomarkers. Blood-based liquid biopsies provide a minimally invasive alternative to synovial biopsies to identify cellular and molecular signatures that can be used to longitudinally monitor response and allow for personalized medicine approach. Liquid biopsies are comprised of cell-free DNA, immune circulating cells, and extracellular vesicles, and are being increasingly and successfully used in the field of oncology for diagnosis, progression, prognosis, and prediction of response to treatment. Recently, researchers have also begun investigating the usefulness of liquid biopsies in the field of rheumatology; in this review, we will focus on the potential of liquid biopsy blood samples as biomarkers of response to treatment in patients with RA.
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Affiliation(s)
- Roxana Coras
- Department of Medicine, School of Medicine, La Jolla, California; University of California San Diego, San Diego, California; Department of Medicine, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain
| | - Rekha Narasimhan
- Department of Medicine, School of Medicine, La Jolla, California; University of California San Diego, San Diego, California
| | - Monica Guma
- Department of Medicine, School of Medicine, La Jolla, California; University of California San Diego, San Diego, California; Department of Medicine, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain.
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Thapa S, Ghosh A, Ghartimagar D, Prasad T, Narasimhan R, Talwar O. Clinicopathological Study of Malignant Melanoma at Tertiary Care Centre. JNMA J Nepal Med Assoc 2017; 56:132-136. [PMID: 28598449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Malignant melanoma, which causes three fourth of all deaths related to skin cancer, is more common in Caucasian population compared to Asian population. There is no reliable information about malignant melanoma in Nepal hence an effort has been made to assess the clinical and pathological features of melanoma patients. METHODS This was a retrospective hospital based study done in the department of Pathology. All cases of malignant melanoma diagnosed on biopsy during a period of 13 years were retrieved, reviewed and collated. RESULTS We had 35 cases with age range from 15 to 84 years with the mean of 51.4 years and M: F of 1.3:1. The predominant site was lower extremities. Most cases were less than 3 cm. Majority of histologic subtypes were nodular melanoma 29 (82.8%) followed by mucosal lentiginous melanoma 3 (8.6%), superficial spreading melanoma 2 (5.7%) and acral lentiginous melanoma 1 (2.9%). Half (50%) of the excisional biopsies were at Clark's level IV and 75% were at high Breslow thickness. CONCLUSIONS The most frequent site in males and females were lower extremities and trunk respectively in contrast to Western studies where it is opposite. Nodular melanoma was the commonest histologic subtype while in other Asian studies and in Western studies majority were acral lentiginous melanoma and superficial spreading melanoma respectively.
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Affiliation(s)
- S Thapa
- Department of Pathology, Manipal Teaching Hospital, Pokhara, Nepal
| | - A Ghosh
- Department of Pathology, Manipal Teaching Hospital, Pokhara, Nepal
| | - D Ghartimagar
- Department of Pathology, Manipal Teaching Hospital, Pokhara, Nepal
| | - T Prasad
- Department of Pathology, Manipal Teaching Hospital, Pokhara, Nepal
| | - R Narasimhan
- Department of Pathology, Manipal Teaching Hospital, Pokhara, Nepal
| | - O Talwar
- Department of Pathology, Manipal Teaching Hospital, Pokhara, Nepal
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Thapa S, Ghosh A, Ghartimagar D, Narasimhan R, Prasad T, Talwar OP. Histopathological Analysis of Non-Neoplastic Superficial Lymphadenopathies. Kathmandu Univ Med J (KUMJ) 2017; 15:51-55. [PMID: 29446363] [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: 06/08/2023]
Abstract
Background Lymphadenopathies are the clinical manifestation of enlargement of lymph nodes which are a common occurrence and are processes of lymph nodes in response to a variety of exogenous and endogenous stimulants. The vast majority of enlarged lymph nodes are non- neoplastic. Objective The objective of the study is to analyze the spectrum of non-neoplastic lesions of superficial lymphadenopathies with their histomorphological features. Method This was a retrospective hospital based study done in the department of Pathology. All cases of superficial lymph node biopsies received during a period of 7 years were retrieved and divided into 2 broad categories: neoplastic and non-neoplastic. The latter group is the material for the present study. The diagnosis was made on morphological basis. Result Of all the 268 superficial lymph node biopsies, 25.4% (68 cases) were neoplastic and 74.6% (200 cases) were non-neoplastic. The non-neoplastic cases were further categorized into non-infectious 60.5% (121 cases) and infectious 39.5% (79 cases). Neck node (70%) was the most common site of involvement. There were 102 male and 98 female patients with male to female ratio 1.04:1. The age range of the patients was 2 years to 83 years with a mean of 27.16 years and most common being 11-20 years 29% (58 cases). Majority of the cases were non-specific reactive lymphadenitis 84.3% (102 cases) followed by tuberculosis 36.5% (73 cases). Conclusion The major cause for the superficial lymphadenopathy was found to be non-neoplastic etiology with slight male predominance. Reactive lymphadenitis was the leading cause unlike the studies done in other Asian and Tropical countries where tuberculosis was more common.
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Affiliation(s)
- S Thapa
- Department of Pathology, Manipal Teaching Hospital, Manipal College of Medical Sciences, Pokhara, Nepal
| | - A Ghosh
- Department of Pathology, Manipal Teaching Hospital, Manipal College of Medical Sciences, Pokhara, Nepal
| | - D Ghartimagar
- Department of Pathology, Manipal Teaching Hospital, Manipal College of Medical Sciences, Pokhara, Nepal
| | - R Narasimhan
- Department of Pathology, Manipal Teaching Hospital, Manipal College of Medical Sciences, Pokhara, Nepal
| | - T Prasad
- Department of Pathology, Manipal Teaching Hospital, Manipal College of Medical Sciences, Pokhara, Nepal
| | - O P Talwar
- Department of Pathology, Manipal Teaching Hospital, Manipal College of Medical Sciences, Pokhara, Nepal
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Singh I, Narasimhan R, Ramamurty U. Cavitation-Induced Fracture Causes Nanocorrugations in Brittle Metallic Glasses. Phys Rev Lett 2016; 117:044302. [PMID: 27494475 DOI: 10.1103/physrevlett.117.044302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Indexed: 06/06/2023]
Abstract
Brittle metallic glasses exhibit a unique and intriguing fracture morphology of periodic nanocorrugations whose spacing and amplitude are of the order of tens of nanometers. We show through continuum simulations that they fail by spontaneous and simultaneous cavitation within multiple weak zones arising due to intrinsic atomic density fluctuations ahead of a notch tip. Dynamic crack growth would then occur along curved but narrowly confined shear bands that link the growing cavities. This mechanism involves little dissipation and also explains the formation of nanocorrugations.
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Affiliation(s)
- I Singh
- Department of Mechanical Engineering, Indian Institute of Science, Bangalore 560012, India
| | - R Narasimhan
- Department of Mechanical Engineering, Indian Institute of Science, Bangalore 560012, India
| | - Upadrasta Ramamurty
- Department of Materials Engineering, Indian Institute of Science, Bangalore 560012, India
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Ghosh A, Ghartimagar D, Thapa S, Sathian B, Narasimhan R, Talwar OP. Ovarian Tumors: Pattern of Histomorphological Types- A 10 Years Study in a Tertiary Referral Center and Review of Literature. Kathmandu Univ Med J (KUMJ) 2016; 14:153-158. [PMID: 28166073] [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
Background Ovarian cancer accounts for 6% of all cancers in females. Among cancers of female genital tract, the incidence of ovarian cancers ranks below only carcinoma of the cervix and the endometrium. Objective To find the frequency of different types of histomorphological types and their association with age, side and size distribution. Method This study is a hospital based retrospective study carried out in the Department of Pathology, Manipal Teaching Hospital over a time period from Jan. 2006 to Sep. 2015. Specimens were received from the Manipal Teaching Hospital and other hospitals within the Himalayan valley of Pokhara. All the clinical and histolpathological data were retrieved from the departmental data bank and were analyzed. Result A total of 409 cases of ovarian tumors have been reported in the same period. Among them, 215 cases were of surface epithelial origin including 172 benign, 07 borderline and 36 malignant cases. Among the surface epithelial tumors, the commonest was serous cystadenoma (119 cases) followed by mucinous cyst adenoma (40 cases). There were 176 cases of tumors with germ cell origin which included 170 cases of teratoma, four dysgerminoma and one each case of choriocarcinoma and yolk sac tumor. Among seven metastatic tumors, one case was of Krukenberg tumor. Age range was 12 to 90 years and the size range from 3 to 36 cm. Conclusion In our study, we analyzed all the spectrum of ovarian tumors diagnosed on morphological bases and most of the findings were similar to other national and international studies. However, we have reported increased percentage of mucinous tumors and less sex cord stromal tumors.
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Affiliation(s)
- A Ghosh
- Department of Pathology, Manipal Teaching Hospital, Manipal College of Medical Science, Pokhara, Nepal
| | - D Ghartimagar
- Department of Pathology, Manipal Teaching Hospital, Manipal College of Medical Science, Pokhara, Nepal
| | - S Thapa
- Department of Pathology, Manipal Teaching Hospital, Manipal College of Medical Science, Pokhara, Nepal
| | - B Sathian
- Department of Community Medicine, Manipal Teaching Hospital, Manipal College of Medical Science, Pokhara, Nepal
| | - R Narasimhan
- Department of Pathology, Manipal Teaching Hospital, Manipal College of Medical Science, Pokhara, Nepal
| | - O P Talwar
- Department of Pathology, Manipal Teaching Hospital, Manipal College of Medical Science, Pokhara, Nepal
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Khan S, Narasimhan R, Mandil A. Knowledge of Breast Cancer and its Screening Methods in the Women of Pokhara Valley: A Community Based Study from Western Nepal. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.040] [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: 11/13/2022] Open
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Sindhu VA, Babu A, Narasimhan R. Tablet in the bronchus--an unusual cause for persistent cough in a 64 year old gentleman. J Assoc Physicians India 2014; 62:63-65. [PMID: 25906528] [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
Foreign body aspiration in adults without any background risk factors is uncommon. We report a 64 year gentleman evaluated for persistent cough incidentally detected to have a foreign body (FB) in the left main bronchus (LMB), which after removal by rigid bronchoscopy turned out to be a tablet. This demonstrates the possible risk of silent aspiration of solid foreign bodies and in our case presenting as a persistent cough after months of aspiration. Bronchoscopic evaluation should be carried out in the differential diagnosis of persistent or recurrent pulmonary symptoms.
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Ghartimagar D, Ghosh A, Gautam K, Thapa S, Shrestha SR, Narasimhan R. Clinicopathological features of pilomatricoma cases: Analysis of 21 cases. J Pathol Nep 2014. [DOI: 10.3126/jpn.v4i7.10293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Background: Pilomatricoma is a slow-growing, asymptomatic tumour originating from outer sheath cells of hair follicle. In this study, we describe the clinical presentation and histopathological features of pilomatricoma. Materials and Methods: This was a hospital based retrospective study carried out in all patients who were diagnosed as pilomatricoma over a period of January 2001 to December 2013. The study was done in department of pathology, Manipal Teaching Hospital, Nepal. Results: A total of 21 cases of pilomatricoma were reported with age range of 9-53 years (mean age 23.7) and male female ratio of 1:1.1. The most common site of occurrence was neck and preauricular region. The size of the tumour ranged from 0.3 to 4.7cm with a mean of 1.2cm. Multiple occurrences were seen in 3 patients and ossifying pilomarticoma was seen in 4 cases. Conclusion: Pilomatricoma is a benign skin neoplasm of hair follicle matrix cells. Calcification is a common finding while dystrophic ossification also can occur in the tumour. Histopathology gives the definite diagnosis as fine needle aspiration cytology and clinical impression may be misleading. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10293 Journal of Pathology of Nepal (2014) Vol. 4, 530-533
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Abstract
Tuberculosis (TB) presenting with Hodgkin's Lymphoma is a rare and difficult clinical situation for any physician to identify and to manage because of very similar clinical presentation. Herein we report a case of 29 year old woman who presented with enlarged lymph nodes, diagnosed and initiated on therapy for TB, based on the cervical node biopsy that showed granulomatous lymphadenitis suggestive of TB. Despite being on regular isoniazid, rifampicin, pyrazinamide and ethambutol regimen, she did not improve but worsened clinically! After an extensive work up that included endobronchial ultrasound (EBUS) and mediastinoscopy, a diagnosis of Hodgkin's disease of nodular sclerosis type was made. She was treated with chemotherapy and radiotherapy along with her TB therapy. Patient showed significant improvement following therapy.
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Affiliation(s)
- Ramanjula C Reddy
- Department of Respiratory Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Meghena Mathew
- Department of Respiratory Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - R Narasimhan
- Department of Respiratory Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
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Udwadia Z, Narasimhan R, Ratnavelu VK, Kotnis M. P167 Efficacy and safety of omalizumab in real–world clinical practice in Indian patients with allergic (IgE-mediated) asthma: analysis by baseline severity of asthma: Abstract P167 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ghosh A, Gharti DM, Sathian B, Narasimhan R, Talwar O. Ovarian Germ Cell Tumor – Histopathological and statistical analysis. J Pathol Nep 2013. [DOI: 10.3126/jpn.v3i6.8990] [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
Background: Ovarian cancers are common among females. The ovarian tumors are classified according to its histogenesis. In the present study, we analyzed the germ cell ovarian tumors reported in our institute. Materials and Methods: This study was a hospital based retrospective study. All ovarian germ cell tumor reported from Jan 2001 to Feb 2013 were retrieved and analyzed. The specimens were routinely processed and the slides were stained with H&E and special stains wherever required. Results: A total of 340 cases of ovarian tumors were reported and 150 cases (44%) were of germ cell origin. We had 137 cases of benign and 13 cases of malignant germ cell tumors. Most common subtype was mature cystic teratoma comprising 125 cases. Among the malignant cases, the most common was immature teratoma (5 cases). Age range in our series was from 8 to 82 years (mean 28 years). The most common age group affected was 21-30 years. Most of the malignant cases (76.9%) were in less than 30 years. Among the malignant cases majority (84.6%) were more than 10 cm in size. None of the malignant germ cell tumors were bilateral. Conclusion: Among germ cell tumors of ovary, mature cystic teratoma is the most common tumor and malignant subtypes are uncommon. Malignant tumors tend to occur in younger age group. DOI: http://dx.doi.org/10.3126/jpn.v3i6.8990 Journal of Pathology of Nepal (2013) Vol. 3, 441-446
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Abstract
Aims: To find the diagnostic yield of a pleuroscopic pleural biopsy and to find the complication rates. Settings and Design: Institutional based prospective study. Materials and Methods: Sixty-eight consecutive patients who had undiagnosed exudative pleural effusion were recruited for pleuroscopy from September 2007 to August 2010. Results: A total of 68 patients (55 males and 13 females; mean age 49 years) underwent pleuroscopy. Malignancy was diagnosed in 24 patients, 22 patients had non-specific inflammation, tuberculosis was found in 16 patients, empyema was found in 2 patients, 1 patient had sarcoidosis, 1 patient had normal pleura and it was non-diagnostic in 2 patients. The diagnostic yield was 97%. There were no major complications, only four patients had minor complication like subcutaneous emphysema (three patients) and prolonged air leak (one patient). Conclusions: Pleuroscopy is a safe, simple, and valuable tool in the diagnosis of undiagnosed exudative pleural effusion with minimal complication rates.
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Affiliation(s)
- V G Prabhu
- Department of Respiratory Medicine, Apollo Hospitals, Chennai, India
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Ghartimagar D, Ghosh A, Narasimhan R, Talwar OP. Patterns of hematological and non-hematological malignancies in bone marrow in a tertiary care hospital in Nepal--11 years study. Nepal Med Coll J 2012; 14:187-192. [PMID: 24047012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Developing countries bear more than half of the global cancer burden and the leukemia comprises of 3% of all malignancies with an incidence of 300,500 per year. The patterns of subtypes of leukemias vary in different populations and geographic areas. Here, we analyze both the hematological and non-hematological malignancies in the Western region of Nepal. This is a retrospective study done from Janauary 2000 to June 2011. All cases of bone marrow malignancies including leukemias, multiple myeloma and infiltration/metastasis to bone marrow were included in the study. Morphological subtypes {FAB (French, American and British) classification}, gender, age at diagnosis and peripheral blood counts of all the cases were analyzed. A total of 155 cases of hematological and non-hematological malignancies were reported during this period. Age ranged from 1 year to 82 years. Among 123 leukemia cases, acute myeloid leukemia (AML) was the commonest (80 cases) followed by chronic myeloid leukemia (CML) (20 cases), acute lymphoid leukemia (ALL) (16 cases) and chronic lymphoid leukemia (CLL) (7 cases). The commonest childhood leukemia below 15 years was AML followed by ALL. The commonest subtypes of AML and ALL were M2 and L2 respectively. CML cases in our study were less common and females were more affected than other parts of the country. There were 23 cases of multiple myeloma and 9 cases of infiltration/metastasis to marrow. Males were more affected by multiple myeloma in our study. Our data reflects bone marrow malignancies in the Western region of Nepal which is more comparable to the Central than Eastern region of Nepal.
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Affiliation(s)
- D Ghartimagar
- Department of Pathology, Manipal College of Medical Sciences and Manipal Teaching Hospital, Pokhara, Nepal.
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Prabhu Ramnath VG, Narasimhan R. Authors′ Reply. Lung India 2012. [DOI: 10.4103/0970-2113.99132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ramnath VP, Narasimhan R. Authors' reply. Lung India 2012; 29:302. [PMID: 22919181 PMCID: PMC3424881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- V.G. Prabhu Ramnath
- Department of Respiratory Medicine, Apollo Hospitals, Chennai, India E-mail:
| | - R. Narasimhan
- Department of Respiratory Medicine, Apollo Hospitals, Chennai, India E-mail:
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Murali P, Guo TF, Zhang YW, Narasimhan R, Li Y, Gao HJ. Atomic scale fluctuations govern brittle fracture and cavitation behavior in metallic glasses. Phys Rev Lett 2011; 107:215501. [PMID: 22181893 DOI: 10.1103/physrevlett.107.215501] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Indexed: 05/31/2023]
Abstract
We perform atomistic simulations on the fracture behavior of two typical metallic glasses, one brittle (FeP) and the other ductile (CuZr), and show that brittle fracture in the FeP glass is governed by an intrinsic cavitation mechanism near crack tips in contrast to extensive shear banding in the ductile CuZr glass. We show that a high degree of atomic scale spatial fluctuations in the local properties is the main reason for the observed cavitation behavior in the brittle metallic glass. Our study corroborates with recent experimental observations of nanoscale cavity nucleation found on the brittle fracture surfaces of metallic glasses and provides important insights into the root cause of the ductile versus brittle behavior in such materials.
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Affiliation(s)
- P Murali
- Department of Engineering Mechanics, Institute of High Performance Computing, Singapore, Singapore
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Abstract
A 26-year-old male presented with complaints of dry cough of six months and progressive breathlessness of three months duration. He was coughing out milky white sputum for two months and had lost 12 kg weight in two months. He had an evening rise in temperature of one month duration. Clinically, the patient was in respiratory distress and the respiratory system examination revealed bilateral velcro crackles. High resolution computed tomography chest showed bilateral diffuse reticulonodular opacities and "Crazy Paving" pattern suggestive of alveolar proteinosis. Broncho alveolar lavage showed eosinophilic granular material, which was periodic acid-Schiff positive. Open lung biopsy was done to confirm the diagnosis and the histopathologic examination revealed eosinophilic secretions with granular appearance suggestive of pulmonary alveolar proteinosis. Subsequently, patient underwent bilateral sequential whole lung lavage under general anesthesia. Patient showed marked clinical and radiological improvement after sequential whole lung lavage.
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Affiliation(s)
- S Jayaraman
- Department of Respiratory Medicine, Apollo Hospitals, Chennai - 600 006, India
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Gayathri AR, Narasimhan R. An unusual presentation of a common disease. Lung India 2011; 28:226-7. [PMID: 21886964 PMCID: PMC3162767 DOI: 10.4103/0970-2113.83988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Narasimhan R, Moorcraft J, Latif AHA. Car seat safety for premature and LBW infants. Arch Dis Child 2005; 90:1205-6. [PMID: 16243892 PMCID: PMC1720173 DOI: 10.1136/adc.2005.080614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
OBJECTIVE To study tuberculin reactivity in childhood tuberculous meningitis both in clinical and histopathological (HP) context. METHODOLOGY Children with tuberculous meningitis (TBM) were given tuberculin test by Mantoux technique, which was read at the end of 72 hours after the placement of skin test. Histopathological examination of the punch biopsy specimen of the tuberculin test site was performed and histopathological grading of the tuberculin reaction was compared with clinical reaction and clinical parameters. RESULTS Of the 50 children studied, 68% of them were malnourished and 42% had BCG scar. Tuberculin test was positive in 22 (44%) cases. Spearman analysis showed negative correlation between stage of TBM and the size of tuberculin reaction. BCG status did not affect the size of tuberculin reaction. Histopathological grade of the tuberculin reaction was found to be directly proportional to the size of the tuberculin reaction and it was not affected by the stage of TBM. CONCLUSION Tuberculin positivity is low in TBM irrespective of the nutritional status. At least some degree of inflammatory reaction can be seen at the site of tuberculin administration. In tuberculin negative cases, varying grades of cellular response in the absence of clinical induration can be seen in histopathology.
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Affiliation(s)
- B Mahadevan
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
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Rekha A, Sundaram S, Ravi A, Narasimhan R. Extra-Articular Pigmented Villonodular Synovitis. INT J LOW EXTR WOUND 2004; 3:107-9. [PMID: 15866798 DOI: 10.1177/1534734604266567] [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: 11/15/2022]
Abstract
Villonodular synovitis are a group of idiopathic lesions that affect the synovial surfaces of joints, tendon sheaths, and bursae, causing tumor-like lesions. Pigmented villonodular synovitis rarely affects the tendon sheaths; its occurrence in extra-articular sites is uncommon. This case is presented for the rarity of occurrence. The literature is also reviewed.
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Affiliation(s)
- A Rekha
- Sri Ramachandra Medical College and Research Institute, Chennai, India.
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Abbaszadegan M, Ghatpande P, Brereton J, Alum A, Narasimhan R. Laboratory testing protocol to identify critical factors in bacterial compliance monitoring. Water Sci Technol 2003; 47:131-136. [PMID: 12639017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This research focused on providing guidelines for water utilities on the collection and handling of routine bacteriological samples and in developing scientifically-based approaches in selecting the most representative sampling locations. A laboratory-scale pilot distribution system was designed comprising two parallel loops, one using unlined cast-iron pipe and one using PVC pipe. Each loop contained six sampling ports, including (1) a distribution main dead end faucet, (2) one long (5.5 m; 18 feet) and (3) one short (0.3 m; 1 foot) household copper service line with threaded hose-bibb taps, (4) one hose-bibb with welded faucet, (5) one dedicated sampling port (modeled after a manufacturer's specifications) and (6) one laboratory-style (PVC) stop-cock sampling port. Residual chlorine concentrations were maintained at 0, 0.5, 1.5 and 2.0 mg/L stages during the course of the experiment. Bacterial samples were collected from the different sampling ports and assayed by membrane filtration and/or spread plate. Nutrient and R2A agars were used for heterotrophic plate counts (HPC), m-Endo agar for total coliform (TC) counts and Chromocult agar for injured bacterial analyses. Several methods of sample collection were tested using various combinations of flushing and tap disinfection, including "first flush" (no flushing, without tap disinfection), flushing only, tap disinfection only (using alcohol or hypochlorite solution) and flushing coupled with tap disinfection. The results indicated that the bacterial counts in samples drawn from dead ends were not significantly different from counts in samples from the other sample port configurations. First flush samples consistently produced the highest bacterial count results. Bacterial counts in samples from the long household copper service line were typically three orders of magnitude higher than in samples from the other sample ports. Thus, there is evidence that long copper household service connections may be unsuitable sample tap configurations for collecting samples intended to represent microbial quality in the distribution system.
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Affiliation(s)
- M Abbaszadegan
- Arizona State University, Civil and Environmental Engineering, Room ECG 252, PO Box 875306, Tempe, AZ 85287-5308, USA.
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Narasimhan R, Mittal BR, Gupta NM. Effect of erythromycin and cisapride on emptying of the vagally denervated intrathoracic stomach. Trop Gastroenterol 2002; 23:122-4. [PMID: 12693153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Subsequent to esophagectomy and reconstruction among patients with esophageal cancers, the intrathoracic denervated stomach acts as a passive conduit without peristalsis. OBJECTIVE The study was designed to assess the impact of two prokinetic drugs viz. erythromycin and cisapride on the emptying of vagally denervated intrathoracic stomach. METHODS Twenty consecutive patients of carcinoma esophagus, who had undergone one stage transhiatal oesophagectomy with cervical esophagogastrostomy and were disease free at three months postoperative follow-up, were included in the study. These patients were randomised into two groups of ten each. The patients in group A received erythromycin, while patients in group B received cisapride. The gastric emptying was studied by scintigraphy, using a standard test meal containing 99m Tc sulphur colloid labelled 'IDLIS' [rice based radio labelled food] before and after the drug treatment. RESULTS The pre and post treatment mean gastric half emptying time of the patients in the erythromycin group was 52.6 min and 49.7 min (p > 0.1) and in cisapride group it was 53.76 and 26.4 min respectively (p < 0.05). Intergroup comparison of the difference was not statistically significant. CONCLUSION Cisapride is an effective prokinetic agent in the treatment of gastric stasis of the vagally denervated intrathoracic stomach.
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Affiliation(s)
- R Narasimhan
- Department of Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh-160 012
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Jones VS, Chandra S, Smile SR, Narasimhan R. A unique case of metastatic penile basal cell carcinoma. INDIAN J PATHOL MICR 2000; 43:465-6. [PMID: 11344615] [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: 02/20/2023] Open
Abstract
Basal cell carcinoma rarely arises in the penis and metastasizes infrequently. This article presents probably the first case report of a metastatic penile basal cell carcinoma.
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Affiliation(s)
- V S Jones
- Departments of Surgery and Pathology, Medical Education and Research, Pondicherry
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Duncan KE, Kolhatkar R, Subramaniam G, Narasimhan R, Jennings E, Hettenbach S, Brown A, McComas C, Potter W, Sublette K. Microbial Dynamics in Oil-Impacted Prairie Soil. Appl Biochem Biotechnol 1999; 77-79:421-34. [PMID: 15304712 DOI: 10.1385/abab:78:1-3:421] [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: 11/11/2022]
Abstract
A remote site in the Tallgrass Prairie Preserve (Osage County, OK) was contaminated with crude oil by a pipeline break in 1992. In 1996, the contaminated soil was bioremediated by blending with uncontaminated soil, prairie hay, buffalo manure, and commercial fertilizers, and spreading in a shallow layer over uncontaminated soil to create a landfarm. The landfarm was monitored for two years for aerobic and anaerobic bacteria, soil gases indicative of microbial activity, and for changes in the concentration of total petroleum hydrocarbons (TPH). Levels of hydrocarbon degraders and soil gas indicators of aerobic degradation were stimulated in the landfarm during the first warm season relative to uncontaminated prairie soil. However, these same indicators were less conclusive during the second warm season, indicating depletion of the more easily degradable hydrocarbons, although the landfarm still contained 6,800 mg/kg TPH on the average at the beginning of the second warm season. Methane formation and methanogen counts were clearly stimulated in the first warm season relative to uncontaminated prairie soil, indicating that methanogenesis plays an important role in the mineralization of hydrocarbons even in these shallow soils.
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Affiliation(s)
- K E Duncan
- Department of Biological Sciences, University of Tulsa, 600 S. College Avenue, Tulsa, OK 74104, USA.
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Agrawal K, Mekhala A, Chitra S, Narasimhan R, Ratnakar C. Wuchereria bancrofti microfilariae in the dentigerous cystic fluid: an unusual presentation. Ann Plast Surg 1998; 41:205-7. [PMID: 9718157 DOI: 10.1097/00000637-199808000-00016] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An unexpected and unusual presence of Wuchereria bancrofti microfilariae in the cystic fluid of a maxillary dentigerous cyst in an 8-year-old boy is being reported for the first time. This was an incidental finding during routine fine-needle aspiration cytological examination.
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Affiliation(s)
- K Agrawal
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Narasimhan R. Knowledge processing and commonsense. Knowl Based Syst 1997. [DOI: 10.1016/s0950-7051(97)00025-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
During a period of 5 yr, 2,418 fine-needle aspirations (FNA) were performed on 2,216 patients with superficial lymphadenopathy. Chronic nonspecific lymphadenitis was the commonest inflammatory lesion followed by tuberculosis. Among malignant lesions, metastatic tumors were most common followed by non-Hodgkin's lymphoma. The FNAC findings were correlated with subsequent histopathological diagnosis in 1,041 cases. The sensitivity rates of FNAC in tuberculosis, metastatic tumors, Hodgkin's disease, and non-Hodgkin's lymphoma were found to be 83.3, 97, 30, and 80.3%, respectively, the specificity being 94.3, 98.9, 98.6, and 95.4% in the same order. Immunocytochemical tests performed on the aspirated material helped in classifying the metastatic poorly differentiated tumors and confirming the diagnosis of non-Hodgkin's lymphomas. Effects of FNA on subsequent biopsy in 81 lymph nodes with benign hyperplasia were studied and showed that aspiration does not interfere with subsequent histologic assessment. Thus FNAC is a simple, inexpensive procedure, and when complemented by appropriate immunocytochemical studies is accurate and reliable for routine diagnosis of lymphadenopathy.
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Affiliation(s)
- R R Prasad
- Department of Pathology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry, India
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Venkateswaran S, Garg BR, Reddy BS, Narasimhan R. Cutaneous lymphoma mimicking seborrhoeic dermatitis. Indian J Dermatol Venereol Leprol 1995; 61:45-47. [PMID: 20952875] [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: 05/30/2023]
Abstract
A case of non Hodgkins lymphoma presenting with cutaneous lesions mimicking seborrhoeic dermatitis is reported. Clinician should have a high index of suspicion to diagnose lymphoma in its early stage, since it can mimic many benign dermatoses.
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Affiliation(s)
- S Venkateswaran
- Departments of Dermatology, Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry-605 006, India,
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Krishna SR, Ananthakrishnan N, Narasimhan R, Veliath AJ. Accuracy of fine needle aspiration cytology of abdominal masses without radiological guidance. INDIAN J PATHOL MICR 1993; 36:442-52. [PMID: 8157314] [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: 01/29/2023] Open
Abstract
This study was undertaken to evaluate the accuracy of FNAC of abdominal masses without the help of radiological guidance and to determine factors which affect the outcome of the procedure. Five hundred consecutive patients were studied. FNAC was reported by a single cytopathologist without knowledge of subsequent histology. In calculating indices of accuracy of FNAC only those patients in whom both FNAC and histology reports were available (N = 383) were considered. The overall incidence of unsatisfactory specimens was 5.6%. Consistency of the mass did not affect accuracy of FNAC. However, age (below 12 years) plane of the swelling, mobility of mass and size of the swelling, all significantly affected the adequacy of cytological yield. The overall true positive rate was 100.0% and there were no false positives. The true negative rate was 40.2% and false negative rate was 70.9%. The high false negative rates in hepatic and pancreatic lesions can be reduced by imaging techniques. Luminal organs had poor accuracy rates. The overall accuracy rate was 73.5%, comparable to that reported in literature. A positive diagnosis of malignancy had a 100% predictive value. Overall, it appears that nonguided FNAC is as accurate as guided FNAC except for very small lesions or discrete lesions such as hepatic secondaries where guidance may be useful.
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Affiliation(s)
- S R Krishna
- Jawarharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Abstract
Four cases of coexisting tuberculosis and carcinoma of the colon (CTCC) are reported. All the patients were female and the mean age was 49 +/- 11 years. The tumour involved the right colon in three patients and the distal transverse colon in the other. The two lesions coexisted at the same site in two patients. Mucinous carcinoma was the predominant type seen in three patients. The characteristics of patients with CTCC were compared with those of 54 patients who had carcinoma of the colon (CC) and 17 patients with tuberculosis of the colon (TC) seen during the same period. All the four CTCC patients were female, compared with 13 of 54 patients with CC (P less than 0.001). These two groups were similar in mean age, anatomic sites and histopathological tumour types. The CTCC patients were significantly older than the TC patients (49 +/- 11 years vs 34 +/- 10 years, P less than 0.05). The sex distribution of TC patients was similar to that of CTCC patients, 14 of 17 patients being female. All TC lesions were confined to the right colon. The present study showed a high frequency of carcinoma in patients with colonic tuberculosis, signifying the need for epidemiological and histopathological investigations into the aetiological relationship between the two diseases, the possibility of which was suggested recently by Japanese researchers. The relevant literature on 58 previously reported patients with CTCC was reviewed.
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Affiliation(s)
- B K Jain
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Abstract
Fine needle aspiration cytology was performed on 121 occasions in 100 patients with various thoracic lesions. The investigation was performed chiefly with the help of straight and lateral chest skiagrams regardless of the size or depth of the lesion. The cellular yield was 87.6%. Positive diagnosis of malignancy could be made in 50 cases. The histopathological correlation in malignant cases was 80%. Non-malignant cytology including neoplastic and inflammatory pathology was also found useful in patient management. This report highlights the versatile role of this procedure in arriving at a diagnosis and planning the treatment for malignant as well as non-malignant thoracic diseases.
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Affiliation(s)
- M Nachiappan
- Department of Cardiothoracic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Ananthakrishnan N, Rao KM, Narasimhan R, Veliath AJ. Problems and limitations with fine needle aspiration cytology of solitary thyroid nodules. Aust N Z J Surg 1990; 60:35-9. [PMID: 2327906 DOI: 10.1111/j.1445-2197.1990.tb07350.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fine needle aspiration cytology (FNAC) is a widely employed tool in the investigative work-up of patients with single thyroid nodules. Although its advantages are well documented, the limitations and problems in interpretation of FNAC in this condition are not well known. Experience with FNAC in 150 patients with solitary thyroid nodules is presented, highlighting the pitfalls of this technique. There was an inadequate specimen rate of 22.7% which declined with increasing experience. Follicular carcinomas could not be differentiated from follicular adenomas by cytology. Difficulties may arise in the detection of papillary carcinomas due to occult lesions, mixed papillary and follicular carcinomas or due to associated thyroid pathology. False positivity is, however, much rarer and is generally due to cellular adenomatous goitres with marked papillary activity. In view of these cytologic limitations, care must be exercised by the treating physician in interpreting cytological results.
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Affiliation(s)
- N Ananthakrishnan
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Chandra S, Rajaram P, Veliath AJ, Oumachigui A, Narasimhan R, Aurora AL. Sex cord tumour with annular tubules--a case report. Indian J Cancer 1984; 20:289-94. [PMID: 6469278] [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]
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Hsu LH, Narasimhan R, Levine M, Norwich KH, Murray RK. Studies of the biosynthesis and metabolism of rat testicular galactoglycerolipids. Can J Biochem Cell Biol 1983; 61:1272-81. [PMID: 6671145 DOI: 10.1139/o83-164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
1-O-Alkyl-2-O-acyl-3-O-beta-D-(3'-sulfatoxygalactopyranosyl)-sn- glcerol (SGG) and its nonsulfated analog (GG) are the major glycolipids of rat testis. Aspects of the biosynthesis and metabolism of these two lipids have been investigated by determining their specific activities at various times after injection of [16-14C]palmitic acid, [1-14C]cetyl alcohol, and D-[1-14C]galactose into the testes of the adult rats. Evidence was obtained from studies with each of these three radioactive compounds that is consistent with the interpretation that GG exhibits a precursor relationship to SGG in vivo. The turnover time of GG, as estimated from the use of each of the three precursors, ranged between 21 and 69 h. In contrast, a slow increase of radioactivity in SGG was observed following injection of each of the three precursors, a plateau value being reached between 72 and 168 h. The radioactivity in the acyl, alkyl, and galactosyl moieties of SGG thereafter remained quite constant for another 21 days. Small amounts of monoalkylmonoacylglycerol were detected in rat testis. Radioactive studies indicated that this compound could be a precursor of GG and (or) monoalkyldiacylglycerol, another lipid that was also detected in rat testis. The results are consistent with the concept that the synthesis of SGG occurs primarily at an early stage of spermatogenesis and that the various moieties of this lipid exhibit almost complete metabolic stability during the subsequent complex stages of this process.
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Narasimhan R, Bennick A, Palmer B, Murray RK. Studies on the glycolipids of human saliva and gastric juice. J Biol Chem 1982; 257:15122-8. [PMID: 7174688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
It has been reported that both human saliva and gastric juice (cf. Slomiany, B. L., and Slomiany, A. (1980) in Cell Surface Glycolipids (Sweeley, C. C., ed) American Chemical Society Symposium, No. 128, pp. 149-176, American Chemical Society, Washington, D.C.) contain substantial amounts of certain members of a series of novel glucoglycerolipids with a 1-O-alkyl glyceryl ether backbone. We have analyzed the glycolipids present in samples of saliva obtained from 10 individuals and in samples of gastric juice obtained from 5 individuals. In both fluids, compounds corresponding in the properties studied to standards of glucosyl- and lactosylceramides were found to be the major glycolipids. Other more complex glycosphingolipids were also present in smaller amounts. Human saliva was found to contain two glucoglycerolipids that were not detected in gastric juice. Analyses of these compounds indicated that they were mono- and diglucosyl diglycerides and were probably of bacterial origin. Methanolysis of the glycolipid fractions of saliva and gastric juice failed to reveal the presence of any more than traces of 1-O-alkyl glyceryl ethers. Our results do not exclude the possibility that glyceryl ether-containing glucoglycerolipids occur in human saliva and gastric juice. However, at most they would appear to be rather minor components of either fluid.
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