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Arora S, Dash SK, Dhawan D, Sahoo PK, Jindal A, Gugulothu D. Freeze-drying revolution: unleashing the potential of lyophilization in advancing drug delivery systems. Drug Deliv Transl Res 2024; 14:1111-1153. [PMID: 37985541 DOI: 10.1007/s13346-023-01477-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
Lyophilization also known as freeze-drying is a technique that has been employed to enhance the long-term durability of nanoparticles (NPs) that are utilized for drug delivery applications. This method is used to prevent their instability in suspension. However, this dehydration process can cause stress to the NPs, which can be alleviated by the incorporation of excipients like cryoprotectants and lyoprotectants. Nevertheless, the freeze-drying of NPs is often based on empirical principles without considering the physical-chemical properties of the formulations and the engineering principles of freeze-drying. For this reason, it is crucial to optimize the formulations and the freeze-drying cycle to obtain a good lyophilizate and ensure the preservation of NPs stability. Moreover, proper characterization of the lyophilizate and NPs is of utmost importance in achieving these goals. This review aims to update the recent advancements, including innovative formulations and novel approaches, contributing to the progress in this field, to obtain the maximum stability of formulations. Additionally, we critically analyze the limitations of lyophilization and discuss potential future directions. It addresses the challenges faced by researchers and suggests avenues for further research to overcome these limitations. In conclusion, this review is a valuable contribution to the understanding of the parameters involved in the freeze-drying of NPs. It will definitely aid future studies in obtaining lyophilized NPs with good quality and enhanced drug delivery and therapeutic benefits.
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Affiliation(s)
- Sanchit Arora
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, 110017, India
| | - Sanat Kumar Dash
- Department of Pharmacy, Birla Institute of Technology and Science (BITS PILANI), Pilani, Rajasthan, 333031, India
| | - Dimple Dhawan
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, 110017, India
| | - Prabhat Kumar Sahoo
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, 110017, India
| | - Anil Jindal
- Department of Pharmacy, Birla Institute of Technology and Science (BITS PILANI), Pilani, Rajasthan, 333031, India
| | - Dalapathi Gugulothu
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, 110017, India.
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Singh G, Mehra A, Arora S, Gugulothu D, Vora LK, Prasad R, Khatri DK. Exosome-mediated delivery and regulation in neurological disease progression. Int J Biol Macromol 2024; 264:130728. [PMID: 38467209 DOI: 10.1016/j.ijbiomac.2024.130728] [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: 12/08/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/13/2024]
Abstract
Exosomes (EXOs), membranous structures originating from diverse biological sources, have recently seized the attention of researchers due to their theranostic potential for neurological diseases. Released actively by various cells, including stem cells, adipose tissue, and immune cells, EXOs wield substantial regulatory influence over the intricate landscape of neurological complications, exhibiting both positive and negative modulatory effects. In AD, EXOs play a pivotal role in disseminating and breaking down amyloid-β protein. Moreover, EXOs derived from mesenchymal stem cells showcase a remarkable capacity to mitigate pro-inflammatory phenotypes by regulating miRNAs in neurodegenerative diseases. These vesicles possess the unique ability to traverse the blood-brain barrier, governing the aggregation of mutant huntingtin protein. Understanding the exosomal functions within the CNS holds significant promise for enhancing treatment efficacy in neurological diseases. This review intricately examines the regulatory mechanisms involving EXOs in neurological disease development, highlighting therapeutic prospects and exploring their utility in exosome-based nanomedicine for various neurological complications. Additionally, the review highlights the challenges associated with drug delivery to the brain, emphasizing the complexities inherent in this critical aspect of neurotherapeutics.
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Affiliation(s)
- Gurpreet Singh
- Molecular and cellular neuroscience lab, Department of pharmacology and toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Hyderabad, India
| | - Ankit Mehra
- Molecular and cellular neuroscience lab, Department of pharmacology and toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Hyderabad, India
| | - Sanchit Arora
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi Pharmaceutical Sciences and Research University (DPSRU), M.B. Road, Pushp Vihar, Sector-3, New Delhi 110017, India
| | - Dalapathi Gugulothu
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi Pharmaceutical Sciences and Research University (DPSRU), M.B. Road, Pushp Vihar, Sector-3, New Delhi 110017, India.
| | - Lalitkumar K Vora
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, BT9 7BL, UK.
| | - Renuka Prasad
- Department of Anatomy, Korea University College of Medicine, Moonsuk Medical Research Building, 516, 5th floor, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Dharmendra Kumar Khatri
- Molecular and cellular neuroscience lab, Department of pharmacology and toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Hyderabad, India; Department of Pharmacology, Shobhaben Pratapbai Patel School of Pharmacy & Technology Management, SVKM's Narsee Monjee Institute of Management Studies (NMIMS) Deemed-to-University, Mumbai 400056, India.
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Yu D, Arora S, Kuipers L. Impact of Transforming Interface Geometry on Edge States in Valley Photonic Crystals. Phys Rev Lett 2024; 132:116901. [PMID: 38563926 DOI: 10.1103/physrevlett.132.116901] [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] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/29/2024] [Indexed: 04/04/2024]
Abstract
We investigate how altering the interface geometry from a zigzag to a glide plane interface between two topologically distinct valley Hall emulating photonic crystals (VPC), profoundly affects edge states. We experimentally observe a transition from gapless to gapped edge states, accompanied by the occurrence of slow light within the Brillouin zone, rather than at its edge. We numerically simulate the propagation and measure the transmittance of the modified edge states through a specially designed valley-conserving defect. The robustness to backscattering gradually decreases, suggesting a disruption of valley-dependent transport. We demonstrate the significance of interface geometry to gapless edge states in a VPC.
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Affiliation(s)
- D Yu
- Kavli Institute of Nanoscience, Delft University of Technology, 2600 GA, Delft, The Netherlands
| | - S Arora
- Kavli Institute of Nanoscience, Delft University of Technology, 2600 GA, Delft, The Netherlands
| | - L Kuipers
- Kavli Institute of Nanoscience, Delft University of Technology, 2600 GA, Delft, The Netherlands
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Garg R, Krishna A, Daga R, Arora S, Puri S, Kumar M. Is Quadriceps-Strengthening Exercises (QSE) in Medial-Compartment Knee Osteoarthritis with Neutral and Varus Malalignment a Paradox? - A Risk-Appraisal of Strength-Training on Disease Progression. Malays Orthop J 2024; 18:73-83. [PMID: 38638654 PMCID: PMC11023347 DOI: 10.5704/moj.2403.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/06/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction The present inquiry seeks to investigate whether the current regimens of QSEs (Quadriceps-Strengthening Exercises) aggravate the disease while mitigating symptoms. Materials and methods A comparative study was conducted on 32 patients with medial compartment osteoarthritis of knees. While the neutral group of 16 patients was constituted of those with an anatomical-lateral-femoro-tibial-angle (aFTA) 176-180º, varus group comprised an equal number of patients with an aFTA >180º. A home-based 12-week strength-training program involving weekly visits to hospital for supervised sessions was administered. The outcome measures were visual-analog-scale (VAS), medial patello-femoral joint tenderness (MPFJT), time-up-and-go-test (TUGT), stair-climb test, step test, WOMAC, IKDC scores, aFTA, hip-knee-ankle (HKA) angle, lateral-tibio-femoral-joint-separation (LTFJS), and horizontal-distance-from-centre-of-knee-to-Mikulicz-line. Results There was a significant increase in quadriceps strength (p<0.01) in both groups. Values for neutral group with VAS score (p=0.01), MPFJT (p=0.01), TUGT (p=0.01), timing of the stair climb test (p=0.01), WOMAC (p<0.01), and IKDC (p=0.03) were better compared to varus group with VAS score (p=0.13), MPFJT (p=0.03), TUGT (p=0.90), timing of stair climb test (p=0.68), WOMAC (p<0.02), and IKDC (p=0.05). Varus group also showed an increase in aFTA and LTFJS in 12 patients, increase in HKA in 11, and increase in horizontal distance from the centre of knee to the Mikulicz line in 7 patients. Conclusion The present study brings to the fore the paradoxical role played by QSEs in management of medial knee OA. While there is a radiological progression of the disease in both neutral and varus mal-aligned knees more so in the latter than the former.
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Affiliation(s)
- R Garg
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
| | - A Krishna
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
| | - R Daga
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - S Arora
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
| | - S Puri
- Department of Radiodiagnosis, Govind Ballabh Pant Hospital, New Delhi, India
| | - M Kumar
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
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Arora S, Bajaj T, Kumar J, Goyal M, Singh A, Singh C. Recent Advances in Delivery of Peptide and Protein Therapeutics to the Brain. J Pharmacol Exp Ther 2024; 388:54-66. [PMID: 37977811 DOI: 10.1124/jpet.123.001690] [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] [Received: 01/10/2023] [Revised: 10/05/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
The classes of neuropharmaceuticals known as proteins and peptides serve as diagnostic tools and are involved in specific communication in the peripheral and central nervous systems. However, due to tight junctions resembling epithelial cells found in the blood-brain barrier (BBB) in vivo, they are typically excluded from transport from the blood to the brain. The drugs having molecular weight of less than 400 Dalton are able to cross the BBB via lipid-mediated free diffusion. However, large molecule therapeutics are devoid of these characteristics. As an alternative, these substances may be carried via chimeric peptide drug delivery systems, and assist in transcytosis through BBB with the aid of linker strategies. With their recent developments, several forms of nanoparticles, including poly (ethylene glycol)-poly(ε-caprolactone) copolymers, nanogels, liposomes, nanostructured lipid carriers, poly (D, L-lactide-co-glycolide) nanoparticles, chitosan, and solid lipid nanoparticles, have also been considered for their therapeutic applications. Moreover, the necessity for physiologic optimization of current drug delivery methods and their carriers to deliver therapeutic doses of medication into the brain for the treatment of various neurologic illnesses has also been emphasized. Therapeutic use of proteins and peptides has no neuroprotective impact in the absence of all these methods. Each tactic, however, has unique drawbacks and considerations. In this review, we discuss different drug delivery methods for therapeutic distribution of pharmaceuticals, primarily neuroproteins and neuropeptides, through endothelial capillaries via blood-brain barrier. Finally, we have also discussed the challenges and future perspective of protein and peptide therapeutics delivery to the brain. SIGNIFICANCE STATEMENT: Very few reports on the delivery of therapeutic protein and peptide nanoformulations are available in the literature. Herein, we attempted to discuss these nanoformulations of protein and peptide therapeutics used to treat brain diseases.
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Affiliation(s)
- Sanchit Arora
- Maa Saraswati College of Pharmacy, Abohar-Sito Road, VPO Kala Tibba, Punjab, India (S.A.); Department of Pharmaceutics, ISF College of Pharmacy, Punjab, India Affiliated to I.K. Gujral Punjab Technical University, formerly Punjab Technical University, Punjab, India (T.B., C.S.); Department of Pharmaceutical Sciences, School of Sciences, Hemvati Nandan Bahuguna Garhwal University (A Central University), Uttarakhand, India (J.K., M.G., C.S.); and Department of Pharmacology, ISF College of Pharmacy, Punjab, India (A.S.)
| | - Tania Bajaj
- Maa Saraswati College of Pharmacy, Abohar-Sito Road, VPO Kala Tibba, Punjab, India (S.A.); Department of Pharmaceutics, ISF College of Pharmacy, Punjab, India Affiliated to I.K. Gujral Punjab Technical University, formerly Punjab Technical University, Punjab, India (T.B., C.S.); Department of Pharmaceutical Sciences, School of Sciences, Hemvati Nandan Bahuguna Garhwal University (A Central University), Uttarakhand, India (J.K., M.G., C.S.); and Department of Pharmacology, ISF College of Pharmacy, Punjab, India (A.S.)
| | - Jayant Kumar
- Maa Saraswati College of Pharmacy, Abohar-Sito Road, VPO Kala Tibba, Punjab, India (S.A.); Department of Pharmaceutics, ISF College of Pharmacy, Punjab, India Affiliated to I.K. Gujral Punjab Technical University, formerly Punjab Technical University, Punjab, India (T.B., C.S.); Department of Pharmaceutical Sciences, School of Sciences, Hemvati Nandan Bahuguna Garhwal University (A Central University), Uttarakhand, India (J.K., M.G., C.S.); and Department of Pharmacology, ISF College of Pharmacy, Punjab, India (A.S.)
| | - Manoj Goyal
- Maa Saraswati College of Pharmacy, Abohar-Sito Road, VPO Kala Tibba, Punjab, India (S.A.); Department of Pharmaceutics, ISF College of Pharmacy, Punjab, India Affiliated to I.K. Gujral Punjab Technical University, formerly Punjab Technical University, Punjab, India (T.B., C.S.); Department of Pharmaceutical Sciences, School of Sciences, Hemvati Nandan Bahuguna Garhwal University (A Central University), Uttarakhand, India (J.K., M.G., C.S.); and Department of Pharmacology, ISF College of Pharmacy, Punjab, India (A.S.)
| | - Arti Singh
- Maa Saraswati College of Pharmacy, Abohar-Sito Road, VPO Kala Tibba, Punjab, India (S.A.); Department of Pharmaceutics, ISF College of Pharmacy, Punjab, India Affiliated to I.K. Gujral Punjab Technical University, formerly Punjab Technical University, Punjab, India (T.B., C.S.); Department of Pharmaceutical Sciences, School of Sciences, Hemvati Nandan Bahuguna Garhwal University (A Central University), Uttarakhand, India (J.K., M.G., C.S.); and Department of Pharmacology, ISF College of Pharmacy, Punjab, India (A.S.)
| | - Charan Singh
- Maa Saraswati College of Pharmacy, Abohar-Sito Road, VPO Kala Tibba, Punjab, India (S.A.); Department of Pharmaceutics, ISF College of Pharmacy, Punjab, India Affiliated to I.K. Gujral Punjab Technical University, formerly Punjab Technical University, Punjab, India (T.B., C.S.); Department of Pharmaceutical Sciences, School of Sciences, Hemvati Nandan Bahuguna Garhwal University (A Central University), Uttarakhand, India (J.K., M.G., C.S.); and Department of Pharmacology, ISF College of Pharmacy, Punjab, India (A.S.)
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Cai Y, Philips EC, Arora S, Sim JXY, Chow W, Nazeha N, Whiteley S, Auw MYX, Tiang DC, Neo SL, Hong W, Venkatachalam I, Graves N. Cost-effectiveness of a real-time spatiotemporal mapping surveillance system for meticillin-resistant Staphylococcus aureus prevention. J Hosp Infect 2024; 143:178-185. [PMID: 37774929 DOI: 10.1016/j.jhin.2023.09.010] [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: 08/22/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES An infection surveillance system based on a hospital's digital twin [4D-Disease Outbreak Surveillance System (4D-DOSS)] is being developed in Singapore. It offers near-real-time infection surveillance and mapping capabilities. This early economic modelling study was conducted, using meticillin-resistant Staphylococcus aureus (MRSA) as the pathogen of interest, to assess the potential cost-effectiveness of 4D-DOSS. METHODS A Markov model that simulates the likelihood of MRSA colonization and infection was developed to evaluate the cost-effectiveness of adopting 4D-DOSS for MRSA surveillance from the hospital perspective, compared with current practice. The cycle duration was 1 day, and the model horizon was 30 days. Probabilistic sensitivity analysis was conducted, and the probability of cost-effectiveness was reported. Scenario analyses and a value of information analysis were performed. RESULTS In the base-case scenario, with 10-year implementation/maintenance costs of 4D-DOSS of $0, there was 68.6% chance that 4D-DOSS would be cost-effective. In a more pessimistic but plausible scenario where the effectiveness of 4D-DOSS in reducing MRSA transmission was one-quarter of the base-case scenario with 10-year implementation/maintenance costs of $1 million, there was 47.7% chance that adoption of 4D-DOSS would be cost-effective. The value of information analysis showed that uncertainty in MRSA costs made the greatest contribution to model uncertainty. CONCLUSIONS This early-stage modelling study revealed the circumstances for which 4D-DOSS is likely to be cost-effective at the current willingness-to-pay threshold, and identified the parameters for which further research will be worthwhile to reduce model uncertainty. Inclusion of other drug-resistant organisms will provide a more thorough assessment of the cost-effectiveness of 4D-DOSS.
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Affiliation(s)
- Y Cai
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - E C Philips
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - S Arora
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - J X Y Sim
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - W Chow
- Department of Cardiology, Changi General Hospital, Singapore
| | - N Nazeha
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | | | | | - D C Tiang
- Office for Service Transformation, SingHealth, Singapore
| | - S L Neo
- Office of Digital Strategy, SingHealth, Singapore
| | - W Hong
- Office for Service Transformation, SingHealth, Singapore
| | - I Venkatachalam
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - N Graves
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
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Shore XW, Soller B, Mickel N, Wiskur B, Morales D, Arora S, Dominguez N, Tigges B, Helitzer D, Myers O, Sood A. Curriculum-based Faculty Training in Networking: Knowledge and Self-efficacy Outcomes. Chron Mentor Coach 2023; 7:453-458. [PMID: 38187462 PMCID: PMC10768928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Although the advantages of developmental networks are well-known, most faculty do not know how to participate in such networks actively. Additionally, institutions face challenges in teaching faculty the best practices of networking. This deficiency constitutes a critical gap in the literature, which may slow career advancement for faculty, particularly from underrepresented groups. The study's purpose was to examine the effectiveness of a curriculum-based faculty training in developmental networks, utilizing the Extension for Community Health Outcomes (ECHO) platform. In this pre-post study, 33 faculty members participated in the intervention utilizing eight modules involving four competencies. Each module followed a standard format, including a short didactic, two facilitated case study discussions based on real-life scenarios, and self-reading of selected literature. Outcomes included (i) change in knowledge scores obtained from two questions per module and (ii) self-efficacy scores measured on a scale of 0-100. Paired student's t-test and mixed model regression analyses were used. A significant increase in knowledge score was documented using mixed model regression for 4 of the eight modules (mean change score 0.4-0.8, p≤0.03 for all analyses). The proportion of faculty participants reporting correct knowledge items for all modules increased from 49.8% (pre) to 64.3% (post), which was statistically significant (p<0.001). Significant increases in paired self-efficacy scores were reported for each of the eight modules (mean change score 17-37, p<0.05 for all analyses). This study highlights the importance of curriculum-based training in networking. Participants showed a significant increase in pre-post networking self-efficacy and knowledge scores. Our ECHO-based curriculum, facilitator training, and manual enable easy implementation in other institutions, ensuring scalability and adaptability. Our analysis provides the evidence basis for examining the impact of a developmental network intervention in enhancing individual career networks.
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Affiliation(s)
- X W Shore
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - B Soller
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - N Mickel
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - B Wiskur
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - D Morales
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - S Arora
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - N Dominguez
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - B Tigges
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - D Helitzer
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - O Myers
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
| | - A Sood
- University of New Mexico-Health Sciences, University Of Maryland at Baltimore County, Oklahoma University-Health Sciences Center, National Institutes of Health, University of New Mexico-Central Campus, Arizona State University
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Singh B, Arora S, Sandhu N. Emerging trends and insights in acute flaccid myelitis: a comprehensive review of neurologic manifestations. Infect Dis (Lond) 2023; 55:653-663. [PMID: 37368373 DOI: 10.1080/23744235.2023.2228407] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/08/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023] Open
Abstract
Acute Flaccid Myelitis (AFM) is a neurological condition in the anterior portion of the spinal cord and can be characterised as paraplegia (paralysis of the lower limbs), and cranial nerve dysfunction. These lesions are caused by the infection due to Enterovirus 68 (EV-D68); a member of the Enterovirus (EV) family belongs to the Enterovirus species within the Picornavirus family and a Polio-like virus. In many cases, the facial, axial, bulbar, respiratory, and extraocular muscles were affected, hence reducing the overall quality of the patient's life. Moreover, severe pathological conditions demand hospitalisation and can cause mortality in a few cases. The data from previous case studies and literature suggest that the prevalence is high in paediatric patients, but careful clinical assessment and management can decrease the risk of mortality and paraplegia. Moreover, the clinical and laboratory diagnosis can be performed by Magnetic resonance imaging (MRI) of the spinal cord followed by Reverse transcription polymerase chain reaction (rRT-PCR) and VP1 seminested PCR assay of the cerebrospinal fluid (CSF), stool, and serum samples can reveal the disease condition to an extent. The primary measure to control the outbreak is social distancing as advised by public health administrations, but more effective ways are yet to discover. Nonetheless, vaccines in the form of the whole virus, live attenuated, sub-viral particles, and DNA vaccines can be an excellent choice to treat these conditions. The review discusses a variety of topics, such as epidemiology, pathophysiology, diagnosis/clinical features, hospitalisation/mortality, management/treatment, and potential future developments.
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Affiliation(s)
- Baljinder Singh
- Centre for Pharmaceutical Innovation, University of South Australia, North Terrace, Adelaide, SA, Australia
| | - Sanchit Arora
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, India
| | - Navjot Sandhu
- Department of Quality Assurance, ISF College of Pharmacy, Moga, Affiliated to IK Gujral Punjab Technical University, Jalandhar, India
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Walti L, Arora S, Donahoe L, Almansour S, Sorbo LD, Mazzulli T, Sidhu A, Martinu T, Keshavjee S, Chaparro C, Husain S. Donor Urease Producing Bacteria (DU) Detection and Serum Ammonium Screening for Hyperammonemia Syndrome (HS) Post-Lung Transplant: A Prospective Observational Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Runyo F, Almansour S, Arora S, Singer L, Aversa M, Keshavjee S, Bitterman R, Mazzulli T, Husain S. Aspergillus Droplet Digital PCR (ddPCR)in Exhaled Breath Condensate for the Diagnosis of Invasive Aspergillosis (IA) in Lung Transplant Recipients (LTRs). J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Tisekar O, Lalani M, Rahulan V, Arora S, M M, Dutta P, Attawar S. Airway Stenting for Tracheal Anastomotic Dehiscence after a Combined Heart-Lung Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Lalani M, Tisekar O, Rahulan V, Arora S, Dutta P, Menander M, Mohandas A, Attawar S. Short Term Outcomes of Combined Heart-Lung Transplant Patients from India. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Arora S, Kumar V, Kapil L, Agrawal AK, Singh A, Singh C. Piperine loaded metal organic frameworks reverse doxorubicin induced chemobrain in adult zebrafish. J Control Release 2023; 355:259-272. [PMID: 36739910 DOI: 10.1016/j.jconrel.2023.01.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
The study's primary goal was to enhance medicinal potential of piperine (PIP)-loaded zeolitic imidazolate frameworks-8 (PIP@ZIF-8) against doxorubicin (DOX)-induced cognitive impairments in zebrafish. Herein, PIP@ZIF-8 was synthesized via easy, economical and reproducible ultrasonication method followed by spray drying technology. ZIF-8's structural integrity has been confirmed by PXRD, and even after PIP was encapsulated, the structure of ZIF-8 remained unchanged. Pure ZIF-8 and PIP@ZIF-8 were subjected to TEM analysis, which revealed hexagonal morphology with a nanosize range. FTIR and UV-Visible spectroscopy studies confirmed the drug loading of ZIF-8. Studies on in vitro release revealed 71.48 ± 7.21% and 34.56 ± 5.35% PIP release from PIP@ZIF-8 and unformulated PIP, respectively in pH 7.4. The highest antioxidant scavenging results were obtained with vitamin C (73.77 ± 6.7%) at an intensity of 200 μg/ml, though it was 65.09 ± 2.5% and 57.99 ± 3.1% for PIP@ZIF-8 and PIP, respectively. In vivo studies on zebrafish showed that DOX administration remarkably impaired cognitive activity in T-Maze, and downregulated spatial memory and locomotor activity in the open field test. In addition, DOX administration caused a downregulation in GSH and SOD levels and increase in LPO, AChE and TNF-α levels compared to the vehicle group along with changes in brain histopathology. Further, PIP@ZIF-8 reversed the DOX-induced cognitive impairments by its antioxidant and neuroprotective properties. It can be concluded that PIP@ZIF-8 has a promising therapeutic potential against the chemotherapy-induced cognitive impairments in zebrafish.
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Affiliation(s)
- Sanchit Arora
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab 142001, India
| | - Vishal Kumar
- Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab 142001, India
| | - Lakshay Kapil
- Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab 142001, India
| | - Ashish Kumar Agrawal
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology, Banaras Hindu University Campus, Uttar Pradesh 221005, India
| | - Arti Singh
- Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab 142001, India.
| | - Charan Singh
- Department of Pharmaceutics, ISF College of Pharmacy, Moga, Punjab 142001, India; Department of Pharmaceutical Sciences, School of Sciences, Hemvati Nandan Bahuguna Garhwal University (A Central University), Srinagar, Uttarakhand 246174, India.
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Raman S, Arora S, Macura K, Oto A, Futterer J, Staruch R, Tirkes T, Bonekamp D, Haider M, Cool D, Nandalur K, Nicolau C, Costa D, Persigehl T, Clarke G, Chin J, Klotz L, Eggener S. Abstract No. 9 ▪ FEATURED ABSTRACT Pivotal Study of Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation (TULSA) of the Prostate: 4-year Follow-up. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.048] [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: 02/27/2023] Open
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Lee J, Ghanouni P, Costa D, Shin C, Khalighinejad P, Sprenkle P, Staruch R, Beserra A, Arora S. Abstract No. 160 MR Susceptibility-Weighted Imaging During Transurethral Prostate Sono-Ablation Procedures for Guidance of Device Placement to Counter Effect of Intra-Prostatic Calcifications. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.214] [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: 02/26/2023] Open
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Arora S, Wilder S, Butaney M, Rogers C, Jeong W. Outcomes of precision prostatectomy procedure for localized prostate cancer, and step-by-step technique of single port transvesical precision prostatectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01372-6] [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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17
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Davis M, Stephens A, Morrison C, Majdalany S, Affas R, Arora S, Corsi N, Rakic I, Sood A, Rogers C, Abdollah F. Racial disparities in future development of lethal prostate cancer based on PSA levels in midlife. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01236-8] [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: 02/12/2023]
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18
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Srivastava PK, Singh A, Kumari S, Arora S, Choubey AK, Sinha ASK. Production and characterization of sustainable vermimanure derived from poultry litter and rice straw using tiger worm Eisenia fetida. Bioresour Technol 2023; 369:128377. [PMID: 36423761 DOI: 10.1016/j.biortech.2022.128377] [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] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
Poultry litter (PL) and rice straw (RS), commonly available waste materials, pose severe threat to environment, if not properly managed. As viable waste treatment method, vermi-transformation of PL into enriched vermimanure was done using RS and cow dung (CD) with different feedstocks (FS) combinations like FS0(CD without earthworm), FS1(CD), FS2(1CD: 1RS), FS3(1CD: 1PL) and FS4(1CD: 1RS: 1PL) for 110 days. Increased growth performance (P < 0.05) of Eisenia fetida, macronutrient levels, and a consistently lower carbon-to-nitrogen ratio (C/N) emphasize the importance of RS and PL in the vermimanuring process. Several analytical techniques have revealed the presence of functional groups, nitrate (NO3-), phosphate (PO43-), and potassium ions (K+) as well as the high porosity of the matured vermimanures. Therefore, using earthworms, the feedstock FS4(1CD: 1RS: 1PL) could be successfully biotransformed into sustainable manure lowering the usage of chemical fertilizers and rice straw burning.
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Affiliation(s)
- P K Srivastava
- Rajiv Gandhi Institute of Petroleum Technology, Jais, Amethi 229304, India.
| | - A Singh
- Rajiv Gandhi Institute of Petroleum Technology, Jais, Amethi 229304, India
| | - S Kumari
- Rajiv Gandhi Institute of Petroleum Technology, Jais, Amethi 229304, India
| | - S Arora
- ICAR-Central Soil Salinity Research Institute, Regional Research Station, Lucknow 226002, India
| | - A K Choubey
- Rajiv Gandhi Institute of Petroleum Technology, Jais, Amethi 229304, India
| | - A S K Sinha
- Rajiv Gandhi Institute of Petroleum Technology, Jais, Amethi 229304, India
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Davis M, Stephens A, Morrison C, Majdalany S, Affas R, Arora S, Corsi N, Rakic I, Sood A, Rogers C, Abdollah F. Baseline PSA levels in midlife & future development of lethal prostate cancer: A diverse North American cohort analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00307-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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20
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Rakic I, Davis M, Corsi N, Stephens A, Arora S, Rakic N, Morrison C, Malchow T, Affas R, Sood A, Rogers C, Abdollah F. Evaluating the role of lymphvascular invasion as an indicator for adverse outcomes for patients with upper tract urothelial carcinoma and its histological subtypes. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00960-0] [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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Corsi N, Stephens A, Malchow T, Piontkowski A, Corsi M, Davis M, Arora S, Rakic I, Morrison C, Autorino R, Sood A, Rogers C, Abdollah F. Testing the external validity of the pout III trial (adjuvant platnium-based chemotherapy in upper tract urothelial carcinoma) in a North American cohort. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00558-4] [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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22
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Klotz L, Chin J, Futterer J, Hatiboglu G, Pavlovich C, Koch M, Penson D, Relle J, Raman S, Lotan Y, Serrallach M, Heidenreich A, Oto A, Sedelaar J, Tirkes T, Arora S, Macura K, Costa D, Pantuck A, Bomers J, Bonekamp D, Persigehl T, Clarke G, Eggener S. Four-year follow-up of MRI-guided Transurethral Ultrasound Ablation (TULSA) in men with localized prostate cancer. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01004-7] [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: 02/12/2023]
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Das P, Arora S, Sharma P, Nath SK, Sivasami K, Singh GK, Bahuguna A, Sapra D, Singh N, Sharma AK, Verma P, Bellad P, Gupta A, G B P, Ranjan Das DS. Gastrointestinal: IgA vasculitis as a rare cause of acute pancreatitis. J Gastroenterol Hepatol 2022; 37:2027. [PMID: 35315539 DOI: 10.1111/jgh.15814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/11/2022] [Accepted: 02/08/2022] [Indexed: 12/09/2022]
Affiliation(s)
- P Das
- Department of Dermatology, Base Hospital Delhi Cantt and Army College of Medical Sciences, New Delhi, India
| | - S Arora
- Department of Dermatology, Base Hospital Delhi Cantt and Army College of Medical Sciences, New Delhi, India
| | - P Sharma
- Department of Lab Sciences and Molecular Medicine, Army Hospital Research and Referral, New Delhi, India
| | - S K Nath
- Department of Radiodiagnosis, Military Hospital Meerut, Uttar Pradesh, India
| | - K Sivasami
- Department of Rheumatology, Army Hospital Research and Referral, New Delhi, India
| | - G K Singh
- Department of Dermatology, Base Hospital Delhi Cantt and Army College of Medical Sciences, New Delhi, India
| | - A Bahuguna
- Department of Dermatology, Base Hospital Delhi Cantt and Army College of Medical Sciences, New Delhi, India
| | - D Sapra
- Department of Dermatology, Base Hospital Delhi Cantt and Army College of Medical Sciences, New Delhi, India
| | - N Singh
- Department of Dermatology, Base Hospital Delhi Cantt and Army College of Medical Sciences, New Delhi, India
| | - A K Sharma
- Office of Director General Medical Services, New Delhi, India
| | - P Verma
- Department of Dermatology, Base Hospital Delhi Cantt and Army College of Medical Sciences, New Delhi, India
| | - P Bellad
- Department of Dermatology, Base Hospital Delhi Cantt and Army College of Medical Sciences, New Delhi, India
| | - A Gupta
- Department of Dermatology, Base Hospital Delhi Cantt and Army College of Medical Sciences, New Delhi, India
| | - P G B
- Department of Dermatology, Base Hospital Delhi Cantt and Army College of Medical Sciences, New Delhi, India
| | - D S Ranjan Das
- Department of Radiodiagnosis and Imaging, Military Hospital Jabalpur, Madhya Pradesh, India
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Neale F, Watson M, Hargreaves D, Arora S. Healthcare use by children in North West London 2015-2019 by deprivation and integrated care access. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.112] [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: 11/13/2022] Open
Abstract
Abstract
Background
England has a health system offering universal coverage, but disparities in healthcare use are increasing. Between 2007-2017, children living in more deprived areas had higher rates of unplanned care (Emergency Department (ED) attendance and hospital admissions), whereas children from less deprived areas had higher rates of planned care (General Practitioner (GP) contact and outpatient appointments). More detailed research to find solutions for this divergent pattern is required.
Aim
To assess the rates of GP contact, outpatient appointments, hospital admissions and ED attendance in North West London, by Index of Multiple Deprivation (IMD) decile of home postcode and access to an integrated care service providing linked care between multiple child health professionals ‘Connecting Care for Children (CC4C)', for children aged 0-18 years between 2015-2019.
Methods
Retrospective analysis of a de-identified database of integrated care records for 495,357 children.
Results
Children from the most deprived decile had higher rates of emergency admissions (0.070 per child per year vs. overall mean 0.040), elective admissions (0.076 vs. 0.032), ED attendances (0.754 vs. 0.358) and outpatient appointments (1.702 vs. 0.756) between 01.01.2015- 31.12.2019. Children from the least deprived decile had the second highest rates of outpatient appointments (0.911 vs. 0.756) and GP contact (8.192 vs. 5.390) between 01.01.2015- 31.12.2019. Children with access to the CC4C service, despite being from more deprived backgrounds, had lower rates of emergency admissions (0.028 vs. 0.037) compared to patients with access to usual care. P values <0.001 in all cases.
Conclusions
Greater deprivation was linked to higher rates of emergency admissions, but this was partially mitigated by access to more integrated healthcare models. Children from the least deprived decile continued to have disproportionately higher use of planned care.
Key messages
• Despite universal health coverage, children from more deprived areas continue to have disproportionately higher use of unplanned care.
• Further research is required to explore whether integrated care solutions can reduce the burden on unplanned health services and inequalities in access to care.
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Affiliation(s)
- F Neale
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - M Watson
- Department of Paediatrics, St Mary’s Hospital , London, UK
| | - D Hargreaves
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - S Arora
- Department of Primary Care and Public Health, Imperial College London , London, UK
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Singh H, Tanwar V, Kalra A, Saini A, Arora S, Govil N. Implication and utility of DAS-28 squeeze in rheumatoid arthritis: an Indian experience. Reumatismo 2022; 74. [PMID: 36101988 DOI: 10.4081/reumatismo.2022.1501] [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] [Received: 05/03/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to compare and correlate disease activity score including 28 joints counts (DAS-28) Squeeze with DAS-28 and clinical disease activity index (CDAI) to assess disease activity (DA) in rheumatoid arthritis (RA) patients. A total of 100 RA patients were included in the study. All subjects were evaluated for disease activity using the DAS-28 Squeeze, DAS-28, and CDAI. Spearman’s rho (ρ) was calculated to determine the correlation between DAS-28 Squeeze, DAS-28, and CDAI. Cross-tabulation was performed to compare and calculate the kappa coefficient for the link between two indices. For each scale, Cronbach’s alpha was also calculated to test dependability. The average age of the study group was 43.9±11.3. The mean scores on the DAS-28 Squeeze, DAS-28, and CDAI were, respectively, 3.58±1.06, 5.06±1.56, and 22.81±14.92. p=0.001 indicated a significant correlation between DAS-28 Squeeze and DAS-28 (ρ=0.986) and CDAI (ρ=0.939) for DAS-28 Squeeze. There was a considerable correlation between all three measures at various DA levels. Cronbach’s alpha for DAS-28 Squeeze, DAS-28, and CDAI were respectively 0.716, 0.663, and 0.734. DAS-28 Squeeze exhibited a substantial positive association with DAS-28 and CDAI for assessing disease activity and appears to be a more useful and reliable method than DAS-28 and CDAI for monitoring disease activity in RA patients.
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Arora S, Bauer T, Parappurath N, Barczyk R, Verhagen E, Kuipers L. Breakdown of Spin-to-Helicity Locking at the Nanoscale in Topological Photonic Crystal Edge States. Phys Rev Lett 2022; 128:203903. [PMID: 35657901 DOI: 10.1103/physrevlett.128.203903] [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] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/24/2022] [Indexed: 06/15/2023]
Abstract
We measure the local near-field spin in topological edge state waveguides that emulate the quantum spin Hall effect. We reveal a highly structured spin density distribution that is not linked to a unique pseudospin value. From experimental near-field real-space maps and numerical calculations, we confirm that this local structure is essential in understanding the properties of optical edge states and light-matter interactions. The global spin is reduced by a factor of 30 in the near field and, for certain frequencies, flipped compared to the pseudospin measured in the far field. We experimentally reveal the influence of higher-order Bloch harmonics in spin inhomogeneity, leading to a breakdown in the coupling between local helicity and global spin.
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Affiliation(s)
- S Arora
- Kavli Institute of Nanoscience, Delft University of Technology, 2600 GA Delft, Netherlands
| | - T Bauer
- Kavli Institute of Nanoscience, Delft University of Technology, 2600 GA Delft, Netherlands
| | - N Parappurath
- Center for Nanophotonics, AMOLF, Science Park 104, 1098 XG Amsterdam, Netherlands
| | - R Barczyk
- Center for Nanophotonics, AMOLF, Science Park 104, 1098 XG Amsterdam, Netherlands
| | - E Verhagen
- Center for Nanophotonics, AMOLF, Science Park 104, 1098 XG Amsterdam, Netherlands
| | - L Kuipers
- Kavli Institute of Nanoscience, Delft University of Technology, 2600 GA Delft, Netherlands
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Das P, Guria S, Debnath S, Singh J, Shekhar C, Lamba Y, M., Hooda S, Saini D, Gopal S, Arora S, Dutt S, Nair L, Singh A, Patil P, Sharma A, Mallick S, Sharma D. PD-0658 Understanding and improving awareness among Radiation Technologists for research: An Indian survey. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02905-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: 10/18/2022]
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Arora S, Zimmermann F, Solberg O, Nytroen K, Aaberge L, Okada K, Ahn J, Honda Y, Khush K, Pijls N, Angeras O, Karason K, Gullestad L, Fearon W. Multicenter Evaluation of Volumetric Intravascular Ultrasound Early After Heart Transplantation and Long-Term Prognosis. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Singh P, Arora S, Goyal A, Mittal N, Singh A, Sharma S, Shanthaiah D, Dardi I. INFLUENCE OF THE DURATION OF DIABETES AND VIBRATION PERCEPTION THRESHOLD ON THE SEVERITY OF ERECTILE DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. Acta Endocrinol (Buchar) 2022; 18:174-180. [PMID: 36212268 PMCID: PMC9512378 DOI: 10.4183/aeb.2022.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Erectile dysfunction(ED) in men is a frequent under-reported complication of diabetes mellitus, which is becoming significant health problem worldwide. AIMS The study aims to determine the prevalence and risk factors for development of ED in North Indian patients with type 2 diabetes mellitus. METHODS We used international index of erectile function (IIEF-5) for the assessment of ED in 796 patients with type 2 diabetes mellitus. We recorded the age, duration of diabetes, glycemic status, body mass index, diabetes medications, microvascular and macrovascular complications. RESULTS The mean age of patients in the study was 49.38 ± 9.52 years. The prevalence of ED in patients with type 2 diabetes mellitus was 79.4%. Logistic regression analysis revealed that age, body mass index, glycemic control, insulin therapy, retinopathy and nephropathy was not significantly associated with erectile dysfunction in patients with type 2 diabetes mellitus. Duration of diabetes (OR = 1.054, 95% CI 1.007 to 1.102, P=0.023) and vibration perception threshold (OR = 1.071, 95% CI 1.042 to 1.102, P=0.000) were identified as key risk factors for development of ED. CONCLUSION Duration of diabetes and peripheral neuropathy emerged as significant risk factors for development of severe erectile dysfunction.
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Affiliation(s)
- P. Singh
- Dayanand Medical College and Hospital, Dept. of Endocrinology
| | - S. Arora
- Dayanand Medical College and Hospital, Dept. of Endocrinology
| | - A. Goyal
- Dayanand Medical College and Hospital, Dept. of Urology
| | - N. Mittal
- Dayanand Medical College and Hospital, Dept. of Endocrinology
| | - A. Singh
- Dayanand Medical College and Hospital, Dept. of Endocrinology
| | - S. Sharma
- Dayanand Medical College and Hospital, Dept. of social and preventive medicine, Ludhiana, Punjab
| | - D.M. Shanthaiah
- Institute of Medical Sciences, Dept. of Endocrinology and Metabolism, Banaras Hindu University, Varanasi, Uttar Pradesh
| | - I.K. Dardi
- Columbia Asia Hospital, Patiala, Punjab, India
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Kumar S, Shah U, Ravipati S, Rahulan V, Kamath A, Kumar P, Panda S, Kori S, John P, Nagaraju M, Arora S, Dutta P, Attawar S. Airway Complications After Lung Transplant for Post Coronaviral Disease (COVID-19) Acute Respiratory Distress Syndrome (ARDS) Related End Stage Lung Disease: Single Centre Experience. J Heart Lung Transplant 2022. [PMCID: PMC8988571 DOI: 10.1016/j.healun.2022.01.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose Severe COVID-19 ARDS related end stage lung fibrosis with irreversible changes is a newer indication for lung transplantation with acceptable survival rate. Airway complication post lung transplant is a major source of morbidity and mortality with incidence as high as 25 to 49 percent. Patients with end stage COVID-19 fibrosis are likely to be clinically deconditioned with long duration of extracorporeal oxygenator (ECMO) support, high burden of sepsis and prolonged respiratory support which may affect the airways post lung transplantation. Methods This is a retrospective observational study after obtaining institutional ethical clearance. We reviewed electronic medical data of patients who underwent lung transplantation for post COVID-19 ARDS related fibrosis. We evaluated the incidence and type of airway complications and the various therapeutic interventions applied for its management. Results Between May 2020 and September 2021 our centre performed 23 bilateral lung transplants for end stage COVID-19 ARDS related fibrosis. 22 patients were on ECMO support with mean duration of 50.9 days before transplantation. All patients underwent lung transplantation with central Veno-Arterial ECMO support with mean organ ischaemia time of 360±154 minutes. The incidence of airway complication in our study group was 56%. We observed anastomotic narrowing in 3(13%), distal airway narrowing in 4(17%) and sloughing/coating of anastomotic site in 5(22%) patients. Nonspecific inflammatory polypi around the bronchial anastomotic site were noticed in 4(17%) and mild airway anastomotic dehiscence in 2 subjects. 8(34%) patients required serial bronchoscopy and balloon dilatation; 2 among them mandated additional cautery usage. 2 cases underwent polypectomy, further 4 subjects needed bronchial stent placement. 5 (21%) recipients were discharged with Tracheostomy while rest were successfully decannulated in the ward. Conclusion We observed a high incidence of airway complications in post lung transplant for COVID-19 ARDS related fibrosis. Early detection, timely management and serial follow up is of paramount importance in this subset of patients.
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Abdollah F, Piontkowski A, Morisetty S, Corsi N, Majdalany S, Rakic I, Sood A, Jamil M, Dalela D, Arora S, Rogers C. The impact of adjuvant chemotherapy on overall survival in patients with node-positive Upper Tract Urothelial Carcinoma (UTUC): Improving precision in medicine with a risk-stratified approach. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Piontkowski A, Corsi N, Morisetty S, Majdalany S, Rakic I, Arora S, Jamil M, Dalela D, Rogers C, Abdollah F. Benefit of lymph node dissection in cn+ patients in the treatment of upper tract urothelial carcinoma: Analysis of ncdb registry. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00382-7] [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: 11/04/2022]
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Arora S, Singh GK, Das P, Rahman R, Bellad P, Shrivastav R, Bahuguna A, Sapra D, Gupta A. A study of COVID‐19 vaccine (Covishield) induced dermatological adverse effects from India. J Eur Acad Dermatol Venereol 2022; 36:e402-e404. [DOI: 10.1111/jdv.17951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/25/2021] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Affiliation(s)
- S Arora
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - G K Singh
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - P Das
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - R Rahman
- Department of Physiology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - P Bellad
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | | | - Amit Bahuguna
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - Devyani Sapra
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - Akanksha Gupta
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
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Yunus Khan TM, Badruddin IA, Saquib SA, Mohamed R, Arora S, Mohammed MAK, Shamsuddin SV, Khateeb S, Khan AA, Grover V, Saluja P. Convalescent Plasma Therapy: A Treatment of Choice for COVID-19 during Current Pandemic. Indian J Pharm Sci 2022. [DOI: 10.36468/pharmaceutical-sciences.spl.438] [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: 11/22/2022] Open
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Joshi R, Medhi B, Prakash A, Chandy S, Ranjalkar J, Bright HR, Basker J, Govindraj L, Chugh PK, Tripathi CD, Badyal DK, Balakrishnan S, Jhaj R, Shukla AK, Atal S, Najmi A, Banerjee A, Kamat S, Tripathi RK, Shetty YC, Parmar U, Rege N, Dikshit H, Mishra H, Roy SS, Chatterjee S, Hazra A, Bhattacharya M, Das D, Trivedi N, Shah P, Chauhan J, Desai C, Gandhi AM, Patel PP, Shah S, Sheth S, Raveendran R, Mathaiyan J, Manikandan S, Jeevitha G, Gupta P, Sarangi SC, Yadav HN, Singh S, Kaushal S, Arora S, Gupta K, Jain S, Cherian JJ, Chatterjee NS, Kaul R, Kshirsagar NA. Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity. Indian J Pharmacol 2022; 54:321-328. [PMID: 36537400 PMCID: PMC9846909 DOI: 10.4103/ijp.ijp_976_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates. METHODS Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees. RESULTS Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation. CONCLUSION Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.
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Affiliation(s)
- R Joshi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Medhi B, Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
| | - A Prakash
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Chandy
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Ranjalkar
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - HR Bright
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Basker
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - L Govindraj
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - PK Chugh
- Vardhman Mahavir Medical College, New Delhi, India
| | - CD Tripathi
- Vardhman Mahavir Medical College, New Delhi, India
| | - DK Badyal
- Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India
| | - S Balakrishnan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - R Jhaj
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - AK Shukla
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - S Atal
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - A Najmi
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - A Banerjee
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - S Kamat
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - RK Tripathi
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - YC Shetty
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - U Parmar
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Rege
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - H Dikshit
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - H Mishra
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - SS Roy
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - S Chatterjee
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - A Hazra
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - M Bhattacharya
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - D Das
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - N Trivedi
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - P Shah
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - J Chauhan
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - C Desai
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - AM Gandhi
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - PP Patel
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - S Shah
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - S Sheth
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - R Raveendran
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - J Mathaiyan
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - S Manikandan
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - G Jeevitha
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - P Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - SC Sarangi
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - HN Yadav
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - S Singh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kaushal
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Arora
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - K Gupta
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Jain
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - JJ Cherian
- Indian Council of Medical Research, New Delhi, India
| | - NS Chatterjee
- Indian Council of Medical Research, New Delhi, India
| | - R Kaul
- Indian Council of Medical Research, New Delhi, India
| | - NA Kshirsagar
- Indian Council of Medical Research, New Delhi, India
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Arora S, Shah B, Kiran S, Kumar N. SPIS-F score:a score based on screen time, physical activity, sleep hours, energy intake and family history of obesity in children aged 5-12 year and its correlation with bmi and childhood obesity in indian children. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Marciano S, Dirchwolf M, Torres MC, Allevato J, García Dans C, García B, Pollarsky F, Gaite L, Sirotinsky E, Rios B, Anselmo MN, Peche M, Hurtado E, Haddad L, Narvaez A, Mauro E, Martinez A, Bellizzi C, Ratusnu N, D'Amico C, Arora S, Gadano A. Fibrosis assessment in patients with nonalcoholic fatty liver disease: Adherence to proposed algorithms and barriers to complying with them. Rev Gastroenterol Mex (Engl Ed) 2021; 87:4-12. [PMID: 34690105 DOI: 10.1016/j.rgmxen.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Fibrosis staging in patients with nonalcoholic fatty liver disease (NAFLD) is carried out through the application of stepwise algorithms but there is little real-world data on their use. Our aim was to calculate the number of patients with NAFLD and indeterminate or high risk for fibrosis, assessed through noninvasive scores, that consequently underwent further staging evaluation. MATERIALS AND METHODS A cross-sectional multicenter cohort study was conducted on patients with NAFLD evaluated by hepatologists within the time frame of June 1 and July 31, 2018. The FIB-4 and NAFLD fibrosis scores were calculated in all the patients, and if at least one of the scores suggested indeterminate or high risk for fibrosis, we believed the patient should have undergone additional fibrosis staging assessment. RESULTS The study included 238 patients. The median time interval from NAFLD diagnosis and inclusion in the analysis was 12.2 months (IQR 3.0-36.5). A total of 128 (54%) patients had at least one noninvasive score that suggested indeterminate or high risk for fibrosis but studies to confirm the fibrosis grade (elastography, biopsy, etc.) were performed on only 72 (56%). The main barriers encountered by the physicians for applying the staging algorithms were related to health insurance coverage and imaging study costs. CONCLUSIONS A high percentage of patients with NAFLD were at indeterminate or high risk for fibrosis, according to noninvasive scores, but additional studies were carried out on only half of them, showing low adherence to current recommendations.
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Affiliation(s)
- S Marciano
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - M Dirchwolf
- Sección Hepatología, Hospital Privado de Rosario, Rosario, Argentina
| | - M C Torres
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Allevato
- Unidad de Diagnóstico y Tratamiento para Enfermedades Hepáticas de Neuquén, Neuquén, Argentina
| | - C García Dans
- Sección Hepatología, Hospital Zonal Bariloche Dr. Ramón Carrillo, Bariloche, Argentina
| | - B García
- Sección Hepatología, Centro de Estudios Digestivos de Mendoza, Mendoza, Argentina
| | - F Pollarsky
- Sección Hepatología, Hospital Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - L Gaite
- Sección Hepatología, Clínica de Nefrología, Santa Fe, Argentina
| | - E Sirotinsky
- Centro de Estudios Digestivos, Comodoro Rivadavia, Argentina
| | - B Rios
- Hepatología, Centro de Investigación, Neuquén, Argentina
| | - M N Anselmo
- Sección Gastroenterología y Hepatología, Hospital Zonal Esquel, Esquel, Argentina
| | - M Peche
- Hospital López Lima Gral Roca, Rio Negro, Argentina
| | - E Hurtado
- Hospital Municipal Coronel Suárez, Buenos Aires, Argentina
| | - L Haddad
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Narvaez
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - E Mauro
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Martinez
- Sección Gastroenterología, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - C Bellizzi
- Sección Gastroenterología, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - N Ratusnu
- Hospital Regional de Ushuaia, Ushuaia, Tierra del Fuego, Argentina
| | - C D'Amico
- Hepatología, CEMA - Centro de Especialidades Médicas Ambulatoria, Mar del Plata, Argentina
| | - S Arora
- Project ECHO, School of Medicine, University of New Mexico, Albuquerque, New Mexico, United States
| | - A Gadano
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Chunawala Z, Qamar A, Arora S, Pandey A, Fudim M, Vaduganathan M, Mentz R, Caughey M. Prognostic significance of polyvascular disease in patients admitted with acute decompensated heart failure: the ARIC Study Community Surveillance. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The prevalence and outcomes of polyvascular disease (PVD) in patients admitted with acute decompensated heart failure (ADHF) have not been previously reported, nor is it known whether associations differ for heart failure (HF) with reduced vs. preserved ejection fraction (HFrEF vs HFpEF, respectively).
Purpose
To investigate the relationship between atherosclerotic involvement of multiple arterial territories and mortality in patients hospitalized with ADHF.
Methods
The Atherosclerosis Risk in Communities (ARIC) study conducted hospital surveillance of adjudicated heart failure in 4 US areas from 2005–2014, with events verified by physician review. Medical histories were abstracted from the hospital record. PVD was defined by coexisting disease in ≥2 arterial beds, identified by prevalent coronary artery disease, peripheral arterial disease, and cerebrovascular disease. Mortality hazards of PVD vs. no PVD were analyzed separately for HFpEF and HFrEF, with adjustment for age, race, sex, year of admission and geographic region. All analyses were weighted by the inverse of the sampling probability.
Results
Of 24,936 ADHF hospitalizations (52% female, 32% Black, mean age 75 years), 19% had PVD (22% among HFrEF hospitalizations, 17% among HFpEF hospitalizations), Figure 1. There was an increasing trend in 1-year mortality with 0, 1 and ≥2 arterial bed involvement, both for patients with HFrEF (29% to 32% to 38%; P-trend=0.0006) and HFpEF (26% to 32% to 37%; P-trend <0.0001). After adjustments, PVD was associated with a 20% higher hazard of 1-year mortality in patients with HFrEF (HR=1.23; 95% CI: 1.06–1.44) and a 30% higher hazard in patients with HFpEF (HR=1.33; 95% CI: 1.09–1.63), with no significant interaction by HF type (P-interaction = 0.5).
Conclusion
Patients hospitalized with ADHF and coexisting PVD have an increased risk of death, irrespective of HF type. Clinical attention should be directed toward PVD, with secondary prevention strategies enacted to improve the prognosis of this vulnerable population.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institutes of Health Distributions of arterial diseaseTrends in 1-year mortality outcomes
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Affiliation(s)
- Z Chunawala
- Mayo Clinic, Rochester, United States of America
| | - A Qamar
- NorthShore University Health System, Chicago, United States of America
| | - S Arora
- University of North Carolina, Chapel Hill, United States of America
| | - A Pandey
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | - M Fudim
- Duke University School of Medicine, Durham, United States of America
| | - M Vaduganathan
- Brigham and Women's Hospital, Boston, United States of America
| | - R Mentz
- Duke University School of Medicine, Durham, United States of America
| | - M Caughey
- University of North Carolina, Chapel Hill, United States of America
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Burner E, Chang A, Hazime D, Gonzalez J, Garcia V, Mercado J, Berumen A, Menchine M, Arora S. 211 Long Term Effects of Mobile Health and Augmented Social Support on Emergency Department Patients With Diabetes. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Patra A, Asghar A, Ravi KS, Duparc F, Arora S. The morphological and morphometric analysis of the variant patterns of the tricipital aponeurosis: a new anatomical classification with possible clinical implications. Folia Morphol (Warsz) 2021; 81:1022-1030. [PMID: 34590297 DOI: 10.5603/fm.a2021.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tricipital aponeurosis (TA) has gained attraction as a constant and reliable landmark to identify the location of radial nerve in the setting of fracture distal humeri. The aponeurosis itself shows variant anatomical patterns. In this study, we intend to provide a comprehensive description and functional classification of observed anatomical variations with possible clinical implications. MATERIALS AND METHODS Sixty arms belonging to 30 adult cadavers were studied. TA was examined grossly to document variations in its shape and classified accordingly. Subsequently, length and breadth of TA were measured. The distance of the radial nerve (RN) from the point of confluence and from the lateral border of TA was also measured (tricepso-radial distance [TRD]). These distances were correlated with the different patterns of TA obtained. RESULTS Based on the shape of the proximal apex of TA or point of confluence and frequency of their occurrence, we propose a new classification of 4 patterns for the TA anatomy. Pattern I: classically seen as the triangular proximal apex (76.67%); pattern II: tongue shaped or blunt proximal apex (18.33%); pattern III: bifurcated or dual proximal apex (3.33%); pattern IV: as the absence of TA (1.67%). The mean of length and breadth of TA was 16.58 ± 2.05 cm and 3.61 ± 0.61 cm, respectively. The mean distance of RN from point of confluence and lateral border of TA was 3.57 ± 0.19 cm and 2.04 ± 0.56 cm, respectively. The length, breadth of TA and TRD differs amongst the different patterns of TA. CONCLUSIONS Anatomical variations in the shape and size of TA are frequently encountered. The proposed, hitherto undescribed, classification may make operating surgeon aware of these morphological variations and help prevent iatrogenic injury to RN. Such classification is simple and unique; however, its success relies upon universal acceptance.
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Affiliation(s)
- A Patra
- All India Institute of Medical Sciences, Bathinda, Department of Anatomy, AIIMS, Bathinda, India
| | - A Asghar
- All India Institute of Medical Sciences, Bathinda, Department of Anatomy, AIIMS, Bathinda, India.,All India Institute of Medical Sciences, Patna, India
| | - K S Ravi
- All India Institute of Medical Sciences, Rishikesh, India.
| | | | - S Arora
- Maulana Azad Medical College, Department of Anatomy, Bahadur Shah Zafar Marg, New Delhi, India
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Arora S, Sharma A, Pramanik R, Raina V, Deo S, Kumar S, Shukla N, Pal S, Dash N, Pathy S, Mohanty B. 1395P Impact of delay in adjuvant chemotherapy on survival in resected gastric cancer: Real world data from India. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1504] [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] Open
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Bono P, Minchom A, Shetty S, Ma Y, Cruz R, de Jonge M, Yap C, Pasanen A, Skytta T, Iivanainen S, Verlingue L, Jaakkola P, de Miguel M, Arora S, Graham D, Jalkanen S, Hollmen M, Mandelin J, Karvonen M, Kauko T, Koivunen J. LBA38 Bexmarilimab, a novel macrophage re-programmer shows promising anti-tumour activity in phase I/II trial in several last line solid tumour types. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Joshi S, Rao V, Shetty UC, Rai S, Arora S, Kumar SR. Functional Outcome of Open Latarjet Procedure in Non-Athletic Middle-Aged Patients. Malays Orthop J 2021; 15:151-158. [PMID: 34429836 PMCID: PMC8381674 DOI: 10.5704/moj.2107.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/19/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: The movement and steadiness of the shoulder joint is due to both the dynamic and static stabilisers. Recurrent anterior shoulder instability is common due to the Bankart lesion or the Hill Sachs lesion. The bone loss and soft tissue failure due to these lesions causing instability is well compensated by Latarjet procedure which acts by triple blocking effect of the bone graft, the sling effect of the conjoint tendon of subscapularis and the ligament of the coracoacromial ligament stump. Materials and methods: Middle-aged patients with recurrent anterior shoulder dislocation and a mid-range instability on clinical assessment with an isolated glenoid bone loss of 20% or Bankart lesion with engaging Hill Sachs lesion were selected for the study. The surgical procedure included a subscapularis split to expose the glenoid. The coracoid graft harvested was prefixed with Kirschner wires and placed flush over the glenoid ensuring no medial or lateral overhang and fixed with 4.0mm cancellous screws with the washer. The functional outcome was measured with the ROWE score and ASES score and the movements were evaluated. Results: A total of 24 patients fulfilled the inclusion criteria. Post-operatively at final follow-up, the mean ROWE score was 97.08 ±8.45 and the mean ASES score was 94.4±9.10. One patient had screw breakage as a complication and another had restriction of movement which was managed with physiotherapy. Conclusion: Open Latarjet is an effective procedure for recurrent anterior shoulder instability in non-athletic middle-aged patients as a excellent functional outcome was achieved with this technique. We therefore recommend open Latarjet as an alternative to arthroscopic treatment in developing countries where patient affordability and the availability of the resources are the issues.
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Affiliation(s)
- S Joshi
- Department of Orthopaedics, Government Medical College Kota, Kota, India
| | - Vkv Rao
- Department of Orthopaedics, Government Medical College Kota, Kota, India
| | - U C Shetty
- Department of Orthopaedics, Kundapur Hospital, Kundapur, India
| | - S Rai
- Department of Orthopaedics, Orthocity Hospital, Varanasi, India
| | - S Arora
- Department of Orthopaedics, Government Medical College Kota, Kota, India
| | - S R Kumar
- Department of Orthopaedics, Government Medical College Kota, Kota, India
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Liu L, Lam C, Dworkis D, Axeen S, Menchine M, Arora S, Terp S, Burner E. 74 Trends Of Diabetic Ketoacidosis During COVID-19 Pandemic In Large Urban Public Emergency Department. Ann Emerg Med 2021. [PMCID: PMC8335490 DOI: 10.1016/j.annemergmed.2021.07.076] [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: 11/22/2022]
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Elsadany M, Godoy Rivas C, Arora S, Jaiswal A, Weissler-Snir A, Duvall WL. The use of SPECT/CT quantification of 99mTc-PYP uptake to assess tafamidis treatment response in ATTR cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab111.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
Nuclear scintigraphy with bone-avid radiotracers such as Tc-99m-PYP, Tc99m-DPC and Tc-99m-HMDP are used to diagnose transthyretin (ATTR) cardiac amyloidosis with limited quantification employing a semi-quantitative visual score and a heart to contralateral lung ratio. Therapy for ATTR cardiac amyloid currently is limited to a single FDA approved agent, tafamidis, however, there is no data regarding the longitudinal assessment of imaging findings in patients undergoing therapy. SPECT/CT acquisition and analysis with dedicated software can provide volumetric assessment and quantification of cardiac tracer uptake.
Purpose
The purpose of this study was to perform longitudinal assessment of cardiac ATTR amyloid 99mTc-PYP imaging findings to determine if treatment with tafamidis results in any change in quantitative measures of tracer uptake. There is no data on if treatment results in a decrease in cardiac amyloid burden as assessed by 99mTc-PYP imaging.
Methods
A prospective, single center, study of patients with ATTR cardiac amyloid being treated with tafamidis (either 80mg or 61mg dose) who have baseline and follow-up 99mTc-PYP studies. SPECT/CT quantification software was used to quantify heart, lung, and bone tracer uptake and generate standardized uptake values (SUVs). Comparison of baseline (before treatment) total SUVs, mean SUV value, percentage of the injected dose, mean SUV of heart to mean SUV of bone ratio and to mean SUV of right lung ratio was made to the values obtained at follow-up after tafamidis treatment. Measurements were obtained from the whole heart and the isolated left ventricle. Data was obtained by two physicians and the results averaged.
Results
5 patients were analyzed with a mean age 73.8 ± 7.7, 80% were males, and a mean length of tafamidis therapy at repeat imaging of 12.5 ± 3.8 months. At follow-up there was an average decrease in whole heart total SUV counts by -25.9 ± 10.3%, in the mean SUV value by -18.2 ± 18.2% and in the percentage of injected dose by -23.7 ± 14.0%. Similar decreases were seen in the isolated left ventricle measures. Heart to bone and heart to lung ratios showed a mixed response to therapy. Detailed results are provided in the table.
Conclusion
The measurements of total SUV counts, mean SUV value, and percentage of the injected dose showed improvement with tafamidis treatment. The ratios did not uniformly show improvement and the reason for this finding is unclear. This new technique offers a potential method for following tafamidis therapy and assessing the cardiac amyloid burden.
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Affiliation(s)
- M Elsadany
- Hartford Hospital, Department of Cardiology, Hartford, United States of America
| | - C Godoy Rivas
- Hartford Hospital, Department of Cardiology, Hartford, United States of America
| | - S Arora
- Hartford Hospital, Department of Cardiology, Hartford, United States of America
| | - A Jaiswal
- Hartford Hospital, Department of Cardiology, Hartford, United States of America
| | - A Weissler-Snir
- Hartford Hospital, Department of Cardiology, Hartford, United States of America
| | - WL Duvall
- Hartford Hospital, Department of Cardiology, Hartford, United States of America
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Sood A, Keeley J, Palma-Zamora I, Chien M, Dalela D, Arora S, Jamil M, Kovacevic N, Corsi N, Jeong W, Rogers C, Trinh QD, Peabody J, Menon M, Abdollah F. Anti-androgen therapy overcomes the time-delay in initiation of salvage radiation therapy and rescues the oncological outcomes in men with recurrent prostate cancer after radical prostatectomy: A post-hoc analysis of the RTOG 9601 trial data. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01553-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bronkema C, Arora S, Keeley J, Rakic N, Sood A, Dalela D, Stricker M, Olson P, Rogers C, Menon M, Abdollah F. National Cancer Database analysis assessing the impact of treatment modalities on survival outcomes in localized neuroendocrine prostate adenocarcinoma. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01461-5] [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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Bhandoria G, Gadgil A, Khajanchi M, Sarang B, Kizhakke Veetil D, Wadhawan R, Bhandarkar P, Mohan M, Shah P, Bains L, Mishra A, Arora S, Rattan A, Kant R, Sharma N, Bhavishi D, Satoskar RR, Prajapati R, Srivastava KS, Kamble P, Mayadeo NM, Gokhale A, Jaydeep H, Belekar D, Roy N. Effects of the COVID-19 pandemic on delivery of emergency surgical care in India. Br J Surg 2021; 108:e154-e155. [PMID: 33793717 PMCID: PMC7929169 DOI: 10.1093/bjs/znab004] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022]
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Arora S, Cooper PR, Friedlander LT, Rizwan S, Seo B, Rich AM, Hussaini HM. Potential application of immunotherapy for modulation of pulp inflammation: opportunities for vital pulp treatment. Int Endod J 2021; 54:1263-1274. [PMID: 33797765 DOI: 10.1111/iej.13524] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022]
Abstract
Caries results in the demineralization and destruction of enamel and dentine, and as the disease progresses, irreversible pulpitis can occur. Vital pulp therapy (VPT) is directed towards pulp preservation and the prevention of the progression of inflammation. The outcomes of VPT are not always predictable, and there is often a poor correlation between clinical signs and symptoms, and the events occurring at a molecular level. The inflamed pulp expresses increased levels of cytokines, including tumour necrosis factor (TNF)-α, interleukin (IL)-1α, IL-1β, IL-4, IL-6, IL-8, IL-17 and IL-23, which recruit and drive a complex cellular immune response. Chronic inflammation and sustained cytokine release can result in irreversible pulp damage and a decreased capacity for tissue healing. Other chronic inflammatory diseases, such as psoriasis, inflammatory bowel diseases and rheumatoid arthritis, are also characterized by an dysregulated immune response composed of relatively high cytokine levels and increased numbers of immune cells along with microbial and hard-soft tissue destructive pathologies. Whilst anti-cytokine therapies have been successfully applied in the treatment of these diseases, this approach is yet to be attempted in cases of pulp inflammation. This review therefore focuses on the similarities in the aetiology between chronic inflammatory diseases and pulpitis, and explores how anti-cytokine therapies could be applied to manage an inflamed pulp and facilitate healing. Further proof-of-concept studies and clinical trials are justified to determine the effectiveness of these treatments to enable more predictable outcomes in VPT.
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Affiliation(s)
- S Arora
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - P R Cooper
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - L T Friedlander
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - S Rizwan
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - B Seo
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - A M Rich
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - H M Hussaini
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
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