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Ranjan R, Nath S, Jha S, Narasimha VL. Single parent adoption in India: Mental health and legal perspectives and the way forward. J Postgrad Med 2023; 69:215-220. [PMID: 37357486 PMCID: PMC10846805 DOI: 10.4103/jpgm.jpgm_718_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/08/2023] [Accepted: 02/01/2023] [Indexed: 06/27/2023] Open
Abstract
Single parent adoption (SPA) is a relatively new construct worldwide and in India. The Ministry of Women and Child Development, Government of India, has laid down criteria for adoption in general and SPA in particular, in conjunction with the Juvenile Justice Act (Care and Protection of Children), 2015. There is scant literature on this topic of SPA, more so in India, that looks into the various psychological nuances of SPA from a mental health professional's (MHP) perspective. This review paper aims to assess SPA from the perspective of a MHP that will focus on its various legal nuances as well as the psychological connotations attached to it. For this, a search strategy was employed that included a thorough literature search from two databases (PubMed and Google Scholar) with relevant keywords related to the topic. The various legal issues pertaining to SPA in the current scenario, the psychological issues and challenges faced by single parents, the behavioral outcomes of adoptees who are adopted by single parents, and ways to deal with the various obstacles of SPA are discussed.
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Affiliation(s)
- R Ranjan
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - S Nath
- Department of Psychiatry, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - S Jha
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - VL Narasimha
- Department of Psychiatry, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
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2
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Dantzer B, Mabry KE, Bernhardt JR, Cox RM, Francis CD, Ghalambor CK, Hoke KL, Jha S, Ketterson E, Levis NA, McCain KM, Patricelli GL, Paull SH, Pinter-Wollman N, Safran RJ, Schwartz TS, Throop HL, Zaman L, Martin LB. Understanding Organisms Using Ecological Observatory Networks. Integr Org Biol 2023; 5:obad036. [PMID: 37867910 PMCID: PMC10586040 DOI: 10.1093/iob/obad036] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 06/07/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Human activities are rapidly changing ecosystems around the world. These changes have widespread implications for the preservation of biodiversity, agricultural productivity, prevalence of zoonotic diseases, and sociopolitical conflict. To understand and improve the predictive capacity for these and other biological phenomena, some scientists are now relying on observatory networks, which are often composed of systems of sensors, teams of field researchers, and databases of abiotic and biotic measurements across multiple temporal and spatial scales. One well-known example is NEON, the US-based National Ecological Observatory Network. Although NEON and similar networks have informed studies of population, community, and ecosystem ecology for years, they have been minimally used by organismal biologists. NEON provides organismal biologists, in particular those interested in NEON's focal taxa, with an unprecedented opportunity to study phenomena such as range expansions, disease epidemics, invasive species colonization, macrophysiology, and other biological processes that fundamentally involve organismal variation. Here, we use NEON as an exemplar of the promise of observatory networks for understanding the causes and consequences of morphological, behavioral, molecular, and physiological variation among individual organisms.
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Affiliation(s)
- B Dantzer
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109,USA
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109,USA
| | - K E Mabry
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109,USA
- Department of Biology, New Mexico State University, Las Cruces, NM 88003,USA
| | - J R Bernhardt
- Department of Biology, New Mexico State University, Las Cruces, NM 88003,USA
- Department of Integrative Biology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - R M Cox
- Department of Biology, University of Virginia, Charlottesville, VA 22940,USA
- Department of Biological Sciences, California Polytechnic State University, San Luis Obispo, CA 93407,USA
| | - C D Francis
- Department of Biological Sciences, California Polytechnic State University, San Luis Obispo, CA 93407,USA
- Department of Biology, Centre for Biodiversity Dynamics (CBD), Norwegian University of Science and Technology (NTNU), N‐7491 Trondheim, Norway
| | - C K Ghalambor
- Department of Biology, Centre for Biodiversity Dynamics (CBD), Norwegian University of Science and Technology (NTNU), N‐7491 Trondheim, Norway
- Department of Biology, Colorado State University, Fort Collins, CO 80523, USA
| | - K L Hoke
- Department of Biology, Colorado State University, Fort Collins, CO 80523, USA
| | - S Jha
- Department of Integrative Biology, University of Texas at Austin, Austin, TX 78712,USA
| | - E Ketterson
- Department of Biology, Indiana University, 1001 E. Third Street, Bloomington, IN 47405,USA
| | - N A Levis
- Department of Biology, Indiana University, 1001 E. Third Street, Bloomington, IN 47405,USA
| | - K M McCain
- Global Health and Infectious Disease Research Center, College of Public Health, University of South Florida, Tampa, FL 33612,USA
| | - G L Patricelli
- Department of Evolution and Ecology, University of California, Davis, CA 95616,USA
| | - S H Paull
- Battelle, National Ecological Observatory Network, 1685 38th Street, Boulder, CO 80301, USA
| | - N Pinter-Wollman
- Department of Ecology and Evolutionary Biology, University of California Los Angeles, 621 Charles E. Young Drive South, Los Angeles, CA 90095, USA
| | - R J Safran
- Department of Ecology and Evolutionary Biology, University of Colorado, Boulder 80309,USA
| | - T S Schwartz
- Department of Biological Sciences, Auburn University, Auburn, AL 36849, USA
| | - H L Throop
- School of Earth and Space Exploration and School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA
| | - L Zaman
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109,USA
- Center for the Study of Complex Systems, University of Michigan, Ann Arbor, MI 48109, USA
| | - L B Martin
- Global Health and Infectious Disease Research Center and Center for Genomics, College of Public Health, University of South Florida, Tampa, FL 33612,USA
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3
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Angelopoulos V, Zhang XJ, Artemyev AV, Mourenas D, Tsai E, Wilkins C, Runov A, Liu J, Turner DL, Li W, Khurana K, Wirz RE, Sergeev VA, Meng X, Wu J, Hartinger MD, Raita T, Shen Y, An X, Shi X, Bashir MF, Shen X, Gan L, Qin M, Capannolo L, Ma Q, Russell CL, Masongsong EV, Caron R, He I, Iglesias L, Jha S, King J, Kumar S, Le K, Mao J, McDermott A, Nguyen K, Norris A, Palla A, Roosnovo A, Tam J, Xie E, Yap RC, Ye S, Young C, Adair LA, Shaffer C, Chung M, Cruce P, Lawson M, Leneman D, Allen M, Anderson M, Arreola-Zamora M, Artinger J, Asher J, Branchevsky D, Cliffe M, Colton K, Costello C, Depe D, Domae BW, Eldin S, Fitzgibbon L, Flemming A, Frederick DM, Gilbert A, Hesford B, Krieger R, Lian K, McKinney E, Miller JP, Pedersen C, Qu Z, Rozario R, Rubly M, Seaton R, Subramanian A, Sundin SR, Tan A, Thomlinson D, Turner W, Wing G, Wong C, Zarifian A. Energetic Electron Precipitation Driven by Electromagnetic Ion Cyclotron Waves from ELFIN's Low Altitude Perspective. Space Sci Rev 2023; 219:37. [PMID: 37448777 PMCID: PMC10335998 DOI: 10.1007/s11214-023-00984-w] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
We review comprehensive observations of electromagnetic ion cyclotron (EMIC) wave-driven energetic electron precipitation using data collected by the energetic electron detector on the Electron Losses and Fields InvestigatioN (ELFIN) mission, two polar-orbiting low-altitude spinning CubeSats, measuring 50-5000 keV electrons with good pitch-angle and energy resolution. EMIC wave-driven precipitation exhibits a distinct signature in energy-spectrograms of the precipitating-to-trapped flux ratio: peaks at >0.5 MeV which are abrupt (bursty) (lasting ∼17 s, or Δ L ∼ 0.56 ) with significant substructure (occasionally down to sub-second timescale). We attribute the bursty nature of the precipitation to the spatial extent and structuredness of the wave field at the equator. Multiple ELFIN passes over the same MLT sector allow us to study the spatial and temporal evolution of the EMIC wave - electron interaction region. Case studies employing conjugate ground-based or equatorial observations of the EMIC waves reveal that the energy of moderate and strong precipitation at ELFIN approximately agrees with theoretical expectations for cyclotron resonant interactions in a cold plasma. Using multiple years of ELFIN data uniformly distributed in local time, we assemble a statistical database of ∼50 events of strong EMIC wave-driven precipitation. Most reside at L ∼ 5 - 7 at dusk, while a smaller subset exists at L ∼ 8 - 12 at post-midnight. The energies of the peak-precipitation ratio and of the half-peak precipitation ratio (our proxy for the minimum resonance energy) exhibit an L -shell dependence in good agreement with theoretical estimates based on prior statistical observations of EMIC wave power spectra. The precipitation ratio's spectral shape for the most intense events has an exponential falloff away from the peak (i.e., on either side of ∼ 1.45 MeV). It too agrees well with quasi-linear diffusion theory based on prior statistics of wave spectra. It should be noted though that this diffusive treatment likely includes effects from nonlinear resonant interactions (especially at high energies) and nonresonant effects from sharp wave packet edges (at low energies). Sub-MeV electron precipitation observed concurrently with strong EMIC wave-driven >1 MeV precipitation has a spectral shape that is consistent with efficient pitch-angle scattering down to ∼ 200-300 keV by much less intense higher frequency EMIC waves at dusk (where such waves are most frequent). At ∼100 keV, whistler-mode chorus may be implicated in concurrent precipitation. These results confirm the critical role of EMIC waves in driving relativistic electron losses. Nonlinear effects may abound and require further investigation.
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Affiliation(s)
- V. Angelopoulos
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - X.-J. Zhang
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Present Address: University of Texas at Dallas, Richardson, TX 75080 USA
| | - A. V. Artemyev
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | | | - E. Tsai
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - C. Wilkins
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - A. Runov
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - J. Liu
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Atmospheric and Oceanic Sciences Departments, University of California, Los Angeles, CA USA
| | - D. L. Turner
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Present Address: Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland USA
| | - W. Li
- Atmospheric and Oceanic Sciences Departments, University of California, Los Angeles, CA USA
| | - K. Khurana
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - R. E. Wirz
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: School of Mechanical, Industrial, and Manufacturing Engineering, Oregon State University, Corvallis, OR 97331 USA
| | - V. A. Sergeev
- University of St. Petersburg, St. Petersburg, Russia
| | - X. Meng
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
| | - J. Wu
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - M. D. Hartinger
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Space Science Institute, Boulder, CO 80301 USA
| | - T. Raita
- Sodankylä Geophysical Observatory, University of Oulu, Sodankylä, Finland
| | - Y. Shen
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - X. An
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - X. Shi
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - M. F. Bashir
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - X. Shen
- Department of Astronomy and Center for Space Physics, Boston University, Boston, MA USA
| | - L. Gan
- Department of Astronomy and Center for Space Physics, Boston University, Boston, MA USA
| | - M. Qin
- Department of Astronomy and Center for Space Physics, Boston University, Boston, MA USA
| | - L. Capannolo
- Department of Astronomy and Center for Space Physics, Boston University, Boston, MA USA
| | - Q. Ma
- Department of Astronomy and Center for Space Physics, Boston University, Boston, MA USA
| | - C. L. Russell
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - E. V. Masongsong
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - R. Caron
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - I. He
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Materials Science and Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - L. Iglesias
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Present Address: Deloitte Consulting, New York, NY 10112 USA
| | - S. Jha
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Microsoft, Redmond, WA 98052 USA
| | - J. King
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - S. Kumar
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Department of Astronomy and Astrophysics, The University of Chicago, Chicago, IL 60637 USA
| | - K. Le
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Materials Science and Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - J. Mao
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Raybeam, Inc., Mountain View, CA 94041 USA
| | - A. McDermott
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - K. Nguyen
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: SpaceX, Hawthorne, CA 90250 USA
| | - A. Norris
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - A. Palla
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Reliable Robotics Corporation, Mountain View, CA 94043 USA
| | - A. Roosnovo
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Los Alamos National Laboratory, Los Alamos, NM 87545 USA
| | - J. Tam
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - E. Xie
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Present Address: Deloitte Consulting, New York, NY 10112 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - R. C. Yap
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mathematics Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Planet Labs, PBC, San Francisco, CA 94107 USA
| | - S. Ye
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - C. Young
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Microsoft, Redmond, WA 98052 USA
| | - L. A. Adair
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
- Present Address: KSAT, Inc., Denver, CO 80231 USA
| | - C. Shaffer
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Tyvak Nano-Satellite Systems, Inc., Irvine, CA 92618 USA
| | - M. Chung
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - P. Cruce
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Present Address: Apple, Cupertino, CA 95014 USA
| | - M. Lawson
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - D. Leneman
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - M. Allen
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Zipline International, South San Francisco, CA 94080 USA
| | - M. Anderson
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mathematics Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Lucid Motors, Newark, CA 94560 USA
| | - M. Arreola-Zamora
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - J. Artinger
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
- Present Address: College of Engineering and Computer Science, California State University, Fullerton, Fullerton, CA 92831 USA
| | - J. Asher
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: The Aerospace Corporation, El Segundo, CA 90245 USA
| | - D. Branchevsky
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Present Address: The Aerospace Corporation, El Segundo, CA 90245 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - M. Cliffe
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Present Address: SpaceX, Hawthorne, CA 90250 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - K. Colton
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mathematics Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Planet Labs, PBC, San Francisco, CA 94107 USA
| | - C. Costello
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Heliogen, Pasadena, CA 91103 USA
| | - D. Depe
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Argo AI, LLC, Pittsburgh, PA 15222 USA
| | - B. W. Domae
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - S. Eldin
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Present Address: Microsoft, Redmond, WA 98052 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - L. Fitzgibbon
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Terran Orbital, Irvine, CA 92618 USA
| | - A. Flemming
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - D. M. Frederick
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Millenium Space Systems, El Segundo, CA 90245 USA
| | - A. Gilbert
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Department of Electrical Engineering, Stanford University, Stanford, CA 94305 USA
| | - B. Hesford
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - R. Krieger
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Materials Science and Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Mercedes-Benz Research and Development North America, Long Beach, CA 90810 USA
| | - K. Lian
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: The Aerospace Corporation, El Segundo, CA 90245 USA
| | - E. McKinney
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Present Address: Geosyntec Consultants, Inc., Costa Mesa, CA 92626 USA
| | - J. P. Miller
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Juniper Networks Sunnyvale, California, 94089 USA
| | - C. Pedersen
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - Z. Qu
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Niantic Inc., San Francisco, CA 94111 USA
| | - R. Rozario
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: SpaceX, Hawthorne, CA 90250 USA
| | - M. Rubly
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Teledyne Scientific and Imaging, Thousand Oaks, CA 91360 USA
| | - R. Seaton
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - A. Subramanian
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - S. R. Sundin
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Naval Surface Warfare Center Corona Division, Norco, CA 92860 USA
| | - A. Tan
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Epirus Inc., Torrance, CA 90501 USA
| | - D. Thomlinson
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: The Aerospace Corporation, El Segundo, CA 90245 USA
| | - W. Turner
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Department of Astronomy, Ohio State University, Columbus, OH 43210 USA
| | - G. Wing
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Present Address: Amazon, Seattle, WA 98109 USA
| | - C. Wong
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Department of Radiology, University of California, San Francisco, San Francisco, CA 94143 USA
| | - A. Zarifian
- Earth, Planetary, and Space Sciences Department, and Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 USA
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4
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Poller A, Jha S, Espinosa AS, Zeijlon R, Thorleifsson SJ, Andersson EA, Bobbio E, Pirazzi C, Gudmundsson T, Mellberg T, Martinsson A, Bech-Hanssen O, Redfors B. Inter- and intra-observer variability in the echocardiographic evaluation of wall motion abnormality in patients with ST-elevation myocardial infarction or takotsubo syndrome - A novel approach. Echocardiography 2023. [PMID: 37363868 DOI: 10.1111/echo.15638] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Using existing transthoracic echocardiographic indices to quantify left ventricular wall motion abnormalities (WMAs) can be difficult due to the variations in the location of the abnormalities within the left ventricle, the quality of examinations, and the inter-/intra-observer variability of available indices. This study aimed to evaluate a new approach for measuring the extent of WMA by calculating the percentage of abnormal wall motion and comparing it to the wall motion score index (WMSI). The study also sought to assess inter- and intra-observer variability. METHODS The study included 140 echocardiograms from 54 patients presenting with ST-elevation myocardial infarction or Takotsubo syndrome. All patients underwent an echocardiographic examination according to a standard protocol and the images were used to measure the extent of akinesia (proportion akinesia, PrA), akinesia and hypokinesia (proportion akinesia/hypokinesia, PrAH), and WMSI. The inter-observer variability between the two operators was analyzed. The intra-observer analysis was performed by one observer using the same images at least 1 month after the first measurement. The agreement was analyzed using the Pearson correlation coefficient and Bland-Altman plots. RESULTS Inter- and intra-observer variability for PrA and PrAH were low and comparable to those for WMSI. CONCLUSION PrA and PrAH are reliable and reproducible echocardiographic methods for the evaluation of left ventricular wall motion.
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Affiliation(s)
- Angela Poller
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sandeep Jha
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Aaron Shekka Espinosa
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Rickard Zeijlon
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Internal Medicine, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Sigurdur James Thorleifsson
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Erik Axel Andersson
- Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Emanuele Bobbio
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Carlo Pirazzi
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | | | - Tomas Mellberg
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Andreas Martinsson
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Clinical Trial Centre, Cardiovascular Research Foundation, New York, USA
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5
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Espinosa AS, Hussain S, Al-Awar A, Jha S, Elmahdy A, Kalani M, Kakei Y, Zulfaj E, Aune E, Poller A, Bobbio E, Thoirleifsson S, Zeijlon R, Gudmundursson T, Wernbom M, Lindahl B, Polte CL, Omerovic E, Hammarsten O, Redfors B. Differences between cardiac Troponin I versus T according to the duration of myocardial ischemia. Eur Heart J Acute Cardiovasc Care 2023:7059134. [PMID: 36848390 DOI: 10.1093/ehjacc/zuad017] [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: 11/14/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Cardiac troponin T (cTnT) and troponin I (cTnI) are expressed as an obligate 1:1 complex in the myocardium. However, blood levels of cTnI often rise much higher than cTnT in myocardial infarction (MI), whereas cTnT is often higher in patients with stable conditions such as atrial fibrillation. Here we examine hs-cTnI and hs-cTnT after different durations of experimental cardiac ischemia. METHODS hs-cTnI, hs-cTnT, and the hs-cTnT/hs-cTnI ratio were measured in plasma samples from rats before and at 30 and 120 minutes after 5, 10, 15, and 30 minutes of myocardial ischemia. The animals were killed after 120 minutes of reperfusion, and the infarct volume and volume at risk were measured. hs-cTnI, hs-cTnT, and the hs-cTnT/hs-cTnI ratio were also measured in plasma samples collected from patients with ST-elevation myocardial infarction. RESULTS hs-cTnT and hs-cTnI increased over ten-fold in all rats subjected to ischemia. The increase of hs-cTnI and hs-cTnT after 30 minutes was similar, resulting in a hs-cTnI/hs-cTnT ratio around 1. The hs-cTnI/hs-cTnT ratio was also around 1 in blood samples collected at 120 minutes in rats subjected to 5 or 10 minutes of ischemia where no localized necrosis was observed. In contrast, the hs-cTnI/hs-cTnT ratio at 2 hours was 3.6-5.5 after longer ischemia that induced cardiac necrosis. The large hs-cTnI/hs-cTnT ratio was confirmed in patients with anterior STEMI. CONCLUSION Both hs-cTnI and hs-cTnT increased similarly after brief periods of ischemia that did not cause overt necrosis, whereas the hs-cTnI/hs-cTnT ratio tended to increase following longer ischemia that induced substantial necrosis. A low hs-cTnI/hs-cTnT ratio around 1 may signify non-necrotic cTn release.
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Affiliation(s)
- Aaron Shekka Espinosa
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Shafaat Hussain
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Amin Al-Awar
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Center for Cancer Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Sandeep Jha
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ahmed Elmahdy
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mana Kalani
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Yalda Kakei
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ermir Zulfaj
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Emma Aune
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Angela Poller
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Emanuele Bobbio
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sigurdur Thoirleifsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Rickard Zeijlon
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Thorstein Gudmundursson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mathias Wernbom
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, Sweden
| | - Christian L Polte
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ola Hammarsten
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Björn Redfors
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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6
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Zeijlon R, Jha S, Le V, Chamat J, Shekka Espinosa A, Poller A, Thorleifsson S, Bobbio E, Mellberg T, Pirazzi C, Gudmundsson T, Martinsson A, Angerås O, Råmunddal T, Omerovic E, Redfors B. Temporal electrocardiographic changes in anterior ST elevation myocardial infarction versus the Takotsubo syndrome. Int J Cardiol Heart Vasc 2023; 45:101187. [PMID: 36861065 PMCID: PMC9969279 DOI: 10.1016/j.ijcha.2023.101187] [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: 11/25/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 02/22/2023]
Abstract
Background Electrocardiography (ECG) on admission is similar in ST elevation myocardial infarction (STEMI) and Takotsubo syndrome (TTS). ECG on admission has been extensively investigated and compared between STEMI and TTS, however, only a few studies have compared temporal ECG. Our aim was to compare ECG in anterior STEMI versus female TTS from admission to day 30. Methods Adult patients with anterior STEMI or TTS treated at Sahlgrenska University Hospital (Gothenburg, Sweden) from December 2019 to June 2022 were prospectively enrolled. Baseline characteristics, clinical variables and ECGs from admission to day 30 were analyzed. Using a mixed effects model, we compared temporal ECG between female patients with anterior STEMI or TTS, as well as between female and male patients with anterior STEMI. Results A total of 101 anterior STEMI patients (31 female, 70 male) and 34 TTS patients (29 female, 5 male) were included. The temporal pattern of T wave inversion was similar between female anterior STEMI and female TTS, as well as between female and male anterior STEMI. ST elevation was more common, whereas QT prolongation was less common, in anterior STEMI compared with TTS. Q wave pathology was more similar between female anterior STEMI and female TTS than between female and male anterior STEMI. Conclusions The pattern of T wave inversion and Q wave pathology from admission to day 30 was similar in female patients with anterior STEMI and female patients with TTS. Temporal ECG in female patients with TTS may be interpreted as following a "transient ischemic" pattern.
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Affiliation(s)
- Rickard Zeijlon
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Internal Medicine, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden,Corresponding author at: Department of Internal Medicine, Sahlgrenska University Hospital/S, 413 45 Gothenburg, Sweden.
| | - Sandeep Jha
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Vina Le
- Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Jasmina Chamat
- Department of Cardiology, Sahlgrenska University Hospital/Ö, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Aaron Shekka Espinosa
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Angela Poller
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Sigurdur Thorleifsson
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Emanuele Bobbio
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Tomas Mellberg
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Carlo Pirazzi
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | | | - Andreas Martinsson
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden,Clinical Trial Center, Cardiovascular Research Foundation, NY, USA,Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, USA
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7
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Ifedili I, Heckle M, Kabra R, Jha S, Levine Y. Correlation of long term recurrence of atrial fibrillation with early occurrence during the blanking period post ablation and factors that influence this. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00629-8] [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: 01/28/2023]
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8
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Jha S, Poller A, Shekka Espinosa A, Thorleifsson S, Zeijlon R, Hussain S, Bobbio E, Martinsson A, Pirazzi C, Rydenstam Mellberg T, Elmahdy A, Kakaei Y, Kalani M, Omerovic E, Redfors B. Early changes in myocardial stunning and biomarkers after ST-elevation myocardial infarction compared to the takotsubo syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1430] [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: 11/14/2022] Open
Abstract
Abstract
Background
Takotsubo syndrome (TS) and ST-elevation myocardial infarction (STEMI) are both characterized by sudden cessation of myocardial contractions (myocardial stunning) as well as elevation of cardiac troponins and B-type natriuretic peptides (BNP). Whereas STEMI results in variable degrees of necrosis and persistent cardiac dysfunction, TS results in little to any necrosis and full recovery of cardiac function. No “head-to-head” comparison of the temporal resolution of myocardial stunning and serum biomarkers in STEMI versus takotsubo has been done.
Purpose
To compare the time course of the recovery of cardiac function and serum biomarkers over the acute and subacute phases of takotsubo and STEMI, with patients with STEMI further subdivided into anterior and non-anterior STEMI.
Method
The Stunning In Takotsubo and Acute Myocardial Infarction (STAMI) study is a prospective, multi-center study that enrolls patients with TS or STEMI without known pre-existing cardiac dysfunction. Echocardiography, laboratory testing (including troponins and NT-proBNP), and ECG are acquired within 4 hours after acute coronary angiography and at 24±6, 48±12, 72±12 hours and 7±1, 14±2, and 30±2 days. The primary endpoint is the proportion of reversible myocardial akinesia resolved after 72 hours (Figure 1), as determined by echocardiography. Secondary endpoints include troponin-I, troponin-T, and NT-proBNP.
Results
Preliminary results from 155 patients with STEMI (78 anterior STEMI and 77 non-anterior STEMI) and 32 patients with TS are presented in Figure 1. Mean (SD) age was similar for patients with takotsubo (67±14), anterior STEMI (68±11), and non-anterior STEMI (68±10). All 3 groups showed substantial recovery of cardiac function over the course of the study, with the most pronounced recovery of cardiac function in TS. Compared to both STEMI groups, the TS group also had lower troponin-I to troponin-T ratio, and higher NT-proBNP (Figure 2). The proportion of reversible akinesia that had recovered at 72 hours was similar in patients with TS, anterior STEMI and non-anterior STEMI (p=0.8414).
Conclusion
The STAMI study will provide the comprehensive assessment of cardiac function and serum biomarker profile of patients with takotsubo and STEMI over the early course of the disease. Preliminary data from the study suggest that early myocardial functional recovery is more substantial but follows a similar time-course in takotsubo and STEMI. The differences in the magnitude of troponin elevation after takotsubo versus STEMI were more pronounced for troponin-I than T.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ERC - European Research Council
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Affiliation(s)
- S Jha
- Sahlgrenska University Hospital , Gothenburg , Sweden
| | - A Poller
- Sahlgrenska University Hospital , Gothenburg , Sweden
| | | | | | - R Zeijlon
- Sahlgrenska University Hospital , Gothenburg , Sweden
| | - S Hussain
- Sahlgrenska Academy , Gothenburg , Sweden
| | - E Bobbio
- Sahlgrenska University Hospital , Gothenburg , Sweden
| | - A Martinsson
- Sahlgrenska University Hospital , Gothenburg , Sweden
| | - C Pirazzi
- Sahlgrenska University Hospital , Gothenburg , Sweden
| | | | - A Elmahdy
- Sahlgrenska Academy , Gothenburg , Sweden
| | - Y Kakaei
- Sahlgrenska Academy , Gothenburg , Sweden
| | - M Kalani
- Sahlgrenska Academy , Gothenburg , Sweden
| | - E Omerovic
- Sahlgrenska University Hospital , Gothenburg , Sweden
| | - B Redfors
- Sahlgrenska University Hospital , Gothenburg , Sweden
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9
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Clark L, Fitzgerald B, Noble S, MacNeill S, Paramasivan S, Cotterill N, Hashim H, Jha S, Toozs-Hobson P, Greenwell T, Thiruchelvam N, Agur W, White A, Garner V, Cobos-Arrivabene M, Clement C, Cochrane M, Liu Y, Lewis AL, Taylor J, Lane JA, Drake MJ, Pope C. Proper understanding of recurrent stress urinary incontinence treatment in women (PURSUIT): a randomised controlled trial of endoscopic and surgical treatment. Trials 2022; 23:628. [PMID: 35922823 PMCID: PMC9347071 DOI: 10.1186/s13063-022-06546-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/09/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with stress urinary incontinence (SUI) experience urine leakage with physical activity. Currently, the interventional treatments for SUI are surgical, or endoscopic bulking injection(s). However, these procedures are not always successful, and symptoms can persist or come back after treatment, categorised as recurrent SUI. There are longstanding symptoms and distress associated with a failed primary treatment, and currently, there is no consensus on how best to treat women with recurrent, or persistent, SUI. METHODS A two-arm trial, set in at least 20 National Health Service (NHS) urology and urogynaecology referral units in the UK, randomising 250 adult women with recurrent or persistent SUI 1:1 to receive either an endoscopic intervention (endoscopic bulking injections) or a standard NHS surgical intervention, currently colposuspension, autologous fascial sling or artificial urinary sphincter. The aim of the trial is to determine whether surgical treatment is superior to endoscopic bulking injections in terms of symptom severity at 1 year after randomisation. This primary outcome will be measured using the patient-reported International Consultation on Incontinence Questionnaire - Urinary Incontinence - Short Form (ICIQ-UI-SF). Secondary outcomes include assessment of longer-term clinical impact, improvement of symptoms, safety, operative assessments, sexual function, cost-effectiveness and an evaluation of patients' and clinicians' views and experiences of the interventions. DISCUSSION There is a lack of high-quality, randomised, scientific evidence for which treatment is best for women presenting with recurrent SUI. The PURSUIT study will benefit healthcare professionals and patients and provide robust evidence to guide further treatment and improve symptoms and quality of life for women with this condition. TRIAL REGISTRATION International Standard Randomised Controlled Trials Number (ISRCTN) registry ISRCTN12201059. Registered on 09 January 2020.
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Affiliation(s)
- L Clark
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - B Fitzgerald
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - S Noble
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - S MacNeill
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - S Paramasivan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - N Cotterill
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - H Hashim
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - S Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield, UK
| | - P Toozs-Hobson
- Department of Urogynaecology, Birmingham Women's & Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - T Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - N Thiruchelvam
- Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - W Agur
- Department of Obstetrics and Gynaecology, NHS Ayrshire and Arran, University Hospital Crosshouse, Kilmarnock, UK
| | - A White
- Patient and Public Involvement (PPI) Representative, Bristol, UK
| | - V Garner
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - M Cobos-Arrivabene
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - C Clement
- Bristol Trials Centre (BTC), University of Bristol, Bristol, UK
| | - M Cochrane
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Y Liu
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A L Lewis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Trials Centre (BTC), University of Bristol, Bristol, UK
| | - J Taylor
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Trials Centre (BTC), University of Bristol, Bristol, UK
| | - J A Lane
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Trials Centre (BTC), University of Bristol, Bristol, UK
| | - M J Drake
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK. .,Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - C Pope
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Trials Centre (BTC), University of Bristol, Bristol, UK
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10
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Zeijlon R, Chamat J, Le V, Wågerman J, Enabtawi I, Jha S, Mohammed MM, Shekka Espinosa A, Angerås O, Råmunddal T, Omerovic E, Redfors B. ECG differences and ECG predictors in patients presenting with ST segment elevation due to myocardial infarction versus takotsubo syndrome. IJC Heart & Vasculature 2022; 40:101047. [PMID: 35573653 PMCID: PMC9096129 DOI: 10.1016/j.ijcha.2022.101047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
Takotsubo syndrome and myocardial infarction can present with ST segment elevation. ECG in Takotsubo resembles left anterior descending artery myocardial infarction. Ventricular arrhythmia or death occur in both Takotsubo and myocardial infarction. ST segment changes predict ventricular arrhythmia or death in myocardial infarction. ST segment changes do not predict ventricular arrhythmia in Takotsubo syndrome.
Background Previous studies comparing electrocardiogram (ECG) in Takotsubo syndrome (TS) versus ST elevation myocardial infarction (STEMI) included TS patients without ST elevation, did not consider the culprit lesion in STEMI or had groups that were unbalanced regarding sex and age. Accounting for these factors, we sought to conduct a more reliable comparison of ECG in TS with ST-elevation (STE-TS) versus STEMI. The secondary aim was to investigate if ST segment changes, T wave inversion or prolonged QT interval predicted ventricular arrhythmia or death in STE-TS and STEMI. Methods All STE-TS patients who presented at Sahlgrenska University Hospital between 2008 and 2019 were matched by sex and age to STEMI patients. STEMI patients were subcategorized according to whether or not the culprit lesion was located in the left anterior descending artery (LAD). Baseline characteristics, in‐hospital outcomes and admission ECGs were analyzed. Results 104 STE-TS patients were sex- and age-matched with 274 STEMI patients (113 LAD-STEMI, 161 non-LAD STEMI). Admission ECG in STE-TS was more similar to LAD STEMI than non-LAD STEMI. Reciprocal ST depression was less common in STE-TS (7/104, 6.7%) compared with STEMI (112/274, 41%; p= < 0.001). The sum of all ST elevations and the sum of all ST-deviations predicted life-threatening ventricular arrhythmia (LTVA) or death in LAD STEMI but not in STE-TS. Conclusions In conclusion, admission ECG in STE-TS was similar to LAD STEMI but reciprocal ST depression was less common in STE-TS compared with STEMI overall. ST segment changes predicted LTVA or death in STEMI but not in STE-TS.
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11
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Hammarsten O, Ljungqvist P, Redfors B, Wernbom M, Widing H, Lindahl B, Salahuddin S, Sammantar R, Jha S, Ravn-Fischer A, Brink M, Gisslen M. The ratio of cardiac troponin T to troponin I may indicate non-necrotic troponin release among COVID-19 patients. Clin Chim Acta 2022; 527:33-37. [PMID: 34998858 PMCID: PMC8744390 DOI: 10.1016/j.cca.2021.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although cardiac troponin T (cTnT) and troponin I(cTnI) are expressed to similar amount in cardiac tissue, cTnI often reach ten-times higher peak levels compared to cTnT in patients with myocardial necrosis such as in acute myocardial infarction (MI). In contrast, similar levels of cTnT and cTnI are observed in other situations such as stable atrial fibrillation and after strenuous exercise. OBJECTIVE Examine cTnT and cTnI levels in relation to COVID-19 disease and MI. METHODS Clinical and laboratory data from the local hospital from an observational cohort study of 27 patients admitted with COVID-19 and 15 patients with myocardial infarction (MI) that were analyzed with paired cTnT and cTnI measurement during hospital care. RESULTS Levels of cTnI were lower than cTnT in COVID-19 patients (TnI/TnT ratio 0.3, IQR: 0.1-0.6). In contrast, levels of cTnI were 11 times higher compared to cTnT in 15 patients with MI (TnI/TnT ratio 11, IQR: 7-14). The peak cTnI/cTnT ratio among the patients with MI following successful percutaneous intervention were 14 (TnI/TnT ratio 14, IQR: 12-23). The 5 COVID-19 patient samples collected under possible necrotic events had a cTnI/cTnT ratio of 5,5 (IQR: 1,9-8,3). CONCLUSIONS In patients with COVID-19, cTnT is often elevated to higher levels than cTnI in sharp contrast to patients with MI, indicating that the release of cardiac troponin has a different cause in COVID-19 patients.
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Affiliation(s)
- Ola Hammarsten
- Department of Laboratory Medicine Institute of Biomedicine, University of Gothenburg, Sweden,Corresponding author at: Department of Clinical Chemistry and Transfusion Medicine, Bruna straket 16, Sahlgrenska Academy at the University of Gothenburg, SE-41345 Gothenburg, Sweden
| | - Pontus Ljungqvist
- Department of Laboratory Medicine Institute of Biomedicine, University of Gothenburg, Sweden
| | - Björn Redfors
- Department of emergency medicine, Sahlgrenska Academy at Sahlgrenska University hospital, Gothenburg, Sweden,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg Sweden
| | - Mathias Wernbom
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Hannes Widing
- Region Västra Götaland, Sahlgrenska University Hospital/Östra, Department of Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, Sweden
| | - Sabin Salahuddin
- Department of Laboratory Medicine Institute of Biomedicine, University of Gothenburg, Sweden
| | - Ruwayda Sammantar
- Department of Laboratory Medicine Institute of Biomedicine, University of Gothenburg, Sweden
| | - Sandeep Jha
- Department of emergency medicine, Sahlgrenska Academy at Sahlgrenska University hospital, Gothenburg, Sweden,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg Sweden
| | - Annica Ravn-Fischer
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg Sweden
| | - Magnus Brink
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Magnus Gisslen
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Zeijlon R, Hällgren P, Le V, Chamat J, Wågerman J, Enabtawi I, Rawshani A, Unenge S, Jha S, Omerovic E, Redfors B. The role of admission electrocardiogram in predicting outcome in patients hospitalized for COVID-19. J Electrocardiol 2022; 75:10-18. [PMID: 36272351 PMCID: PMC9575310 DOI: 10.1016/j.jelectrocard.2022.10.005] [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: 09/03/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Abnormal electrocardiogram (ECG) has been associated with poor outcome in patients hospitalized for COVID-19. However, the independent association between admission ECG and the risk of a poor outcome remains to be established. Our aim was to determine if abnormal admission ECG predicts treatment at intensive care unit or in-hospital death within 30 days in patients hospitalized for COVID-19. METHODS We analyzed the propensity weighted association between abnormal admission ECG and outcome in patients hospitalized for COVID-19 (March to May 2020). All adult patients hospitalized for COVID-19 at the three centers of Sahlgrenska University Hospital (Gothenburg, Sweden) were eligible for inclusion (N = 439). Patients with available admission ECG within six hours from admission were included. RESULTS 238 patients (age 62 ± 16 years, 74% male) were included. 103 patients had normal ECG and 135 patients had abnormal ECG. 99 patients were admitted to intensive care unit or died in-hospital within 30 days. Abnormal ECG was associated with increased risk of the outcome (odds ratio 2.11 [95% confidence interval 1.21-3.66]). CONCLUSIONS Abnormal admission ECG was associated with increased risk of treatment at intensive care unit or in-hospital death within 30 days; and could be considered a high-risk criterion in patients hospitalized for COVID-19.
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Affiliation(s)
- Rickard Zeijlon
- Department of Internal Medicine, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden,Corresponding author at: Department of Internal Medicine, Sahlgrenska University Hospital/S, 413 45 Gothenburg, Sweden
| | - Peter Hällgren
- Department of Internal Medicine, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Vina Le
- Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden
| | - Jasmina Chamat
- Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden,Department of Cardiology, Sahlgrenska University Hospital/Ö, Gothenburg, Sweden
| | - Johan Wågerman
- Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden
| | - Israa Enabtawi
- Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden
| | - Araz Rawshani
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Sten Unenge
- Department of Internal Medicine, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Sandeep Jha
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden,Department of Internal Medicine, Kungälvs Hospital, Kungälv, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden,Clinical Trial Center, Cardiovascular Research Foundation, New York, USA,Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, USA
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Pant V, Mathema S, Jha S, Paudel SD, Baral S. The Detection of Postprandial Hypoglycemia with 5-Hour Oral Glucose Tolerance Test. EJIFCC 2021; 32:451-457. [PMID: 35046763 PMCID: PMC8751404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Postprandial hypoglycemia (PH) is a poorly understood phenomenon. Five-hour oral glucose tolerance test (5-OGTT) is often a useful laboratory investigation to understand and establish a diagnosis of PH. The aim of this study is to present the patterns observed during 5-OGTT performed in cases with PH in a tertiary hospital in Nepal. METHODS 5-OGTTs were performed on 52 patients who complained symptomatic postprandial neuroglycopenic symptoms, at the Nepal Medicity hospital during the period of 2 years from 2017 to 2019. The anthropometry, medical history, serum glucose; insulin and cortisol were obtained. The homeostatic model assessment score for insulin resistance (HOMA-IR) based on fasting glucose and insulin levels were calculated. Data was analyzed using SPSS (Version 20.0). RESULTS 21 (40.4%) patients out of 52 developed hypoglycemia [blood glucose < 55mg/dl (3.1mmol/L)], among them nine patients developed hypoglycemia at 3 hours, 11 at 4 hours and one at 5 hours post glucose load. The fasting insulin level in patients who developed hypoglycemia was 12.1 ± 5.8 μU/ml compared to the insulin level analyzed at the point of hypoglycemic episode which was 6.4 ± 1.8 μU/ml, P<0.005. CONCLUSION The level of insulin is disproportionately high in the setting of hypoglycemia where it was expected to be nearly absent. The disturbance in physiological mechanism between insulin sensitivity and insulin secretion may be the possible cause of PH.
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Affiliation(s)
- Vivek Pant
- Department of Clinical Biochemistry, Samyak Diagnostic Pvt. Ltd, Kathmandu, Nepal,Corresponding author: Dr. Vivek Pant Department of Clinical Biochemistry Samyak Diagnostic Pvt. Ltd Kathmandu Nepal e-mail:
| | - Safala Mathema
- Department of Internal Medicine, Mediciti Hospital, Kathmandu, Nepal
| | - Sandeep Jha
- Department of Internal Medicine, Mediciti Hospital, Kathmandu, Nepal
| | | | - Suman Baral
- Department of Internal Medicine, Mediciti Hospital, Kathmandu, Nepal
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14
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Thyagaturu H, Bolton A, Jha S, Li S, Shah K, Kumar A. Associations of weekend versus weekday admission on transesophageal echocardiogram utilization and outcomes in infective endocarditis hospitalizations. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1712] [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: 11/14/2022] Open
Abstract
Abstract
Background
Infective endocarditis (IE) occurs worldwide and is associated with high mortality. Diagnosis and management of IE requires timely transesophageal echocardiography (TEE), which may not be consistently available in many institutions, especially on weekends. Hence, we wanted to evaluate the effect of weekend admission on IE in-hospital outcomes.
Purpose
To evaluate the differences in mortality and TEE utilization between weekend and weekday admissions in IE hospitalizations.
Methods
In this retrospective cohort study, we queried the 2017 and 2018 National Inpatient Sample (NIS) database to identify primary diagnosis of IE using appropriate ICD-10 CM codes. The variable for weekend admission which is available in the dataset was used to categorize hospitalizations into weekend and weekday admission groups. TEE procedures were identified using appropriate ICD-10 PCS codes. We used the Chi-square test to evaluate the difference between binary variables, and Student's t- test for differences between continuous variables. Multivariate logistic regression analysis was used to adjust for potential hospital and patient level confounders (age, sex, race, diabetes, hypertension, obesity, acute renal failure, diabetes, and Elixhauser comorbidity index score). Stata SE 16.1 was used to perform all statistical analyses.
Results
Among the identified 27,735 weighted adult IE hospitalizations, 6,145 (22.1%) were admitted on weekends. Weekend IE admissions were similar to weekday in all measured aspects except for elective admissions (Table 1). There were more elective admissions on the weekday compared to the weekend (11.3% for weekday vs. 4.9% for weekend; p<0.01). The mean age was 51 years for both hospitalizations. There were more TEEs in the first 24 hrs in weekday compared to weekend hospitalizations (7.8% vs. 3.4%; p<0.01). After adjusting for potential patient and hospital level confounders, there was no difference in mortality [Adjusted Odds ratio (aOR): 0.91 (0.62–1.33); p=0.63)], valve replacement procedures [aOR: 0.91 (0.62–1.33); p=0.63)] or incidence of atrioventricular (AV) blocks [aOR: 0.91 (0.62–1.33); p=0.63)] comparing weekend versus weekday IE hospitalizations. Additionally, we did not observe any mean difference in length of stay and total hospitalization charges between weekend and weekday hospitalizations.
Conclusion
In patients with IE, weekend admissions did not have a clinically significant difference in mortality, length of stay, incidence of AV blocks or valve replacements compared to weekday admissions. TEEs were performed equally in IE hospitalizations regardless of day of admission; however, early TEEs (within 24 hours of admission) were more commonly associated with weekday admission. Despite this, there was no clinically significant difference in the mortality between early TEEs and TEEs done after 24 hours of admission.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Thyagaturu
- Bassett Healthcare, Cooperstown, United States of America
| | - A Bolton
- University of Iowa College of Public Health, Iowa, United States of America
| | - S Jha
- Bassett Healthcare, Cooperstown, United States of America
| | - S Li
- The Wright Center for Graduate Medical Education, Internal Medicine, Scranton, United States of America
| | - K Shah
- St. Lukes University Hospital, Internal Medicine, Bethlehem, United States of America
| | - A Kumar
- University of Arkansas for Medical Sciences, Little Rock, United States of America
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15
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Jha S. Final nail in the coffin. BJOG 2021; 128:2199. [PMID: 34536978 DOI: 10.1111/1471-0528.16930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- S Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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16
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Muller P, Gurol-Urganci I, Thakar R, Ehrenstein MR, Van Der Meulen J, Jha S. Impact of a mid-urethral synthetic mesh sling on long-term risk of systemic conditions in women with stress urinary incontinence: a national cohort study. BJOG 2021; 129:664-670. [PMID: 34524725 PMCID: PMC9292923 DOI: 10.1111/1471-0528.16917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
Objective To compare the incidence of systemic conditions between women who had surgical treatment for stress incontinence with mesh and without mesh. Design National cohort study. Setting English National Health Service. Population Women with no previous record of systemic disease who had first‐time urinary incontinence surgery between 1 January 2006 and 31 December 2013, followed up to the earliest of 10 years or 31 March 2019. Methods Competing‐risks regression was used to estimate hazard ratios (HR), adjusted for patient characteristics, with HR > 1 indicating increased incidence following mesh surgery. Main outcome measures First postoperative admission with a record of autoimmune disease, fibromyalgia or myalgic encephalomyelitis up to 10 years following the first incontinence procedure. Results The cohort included 88 947 women who had mesh surgery and 3389 women who had non‐mesh surgery. Both treatment groups were similar with respect to age, socio‐economic deprivation, comorbidity and ethnicity. The 10‐year cumulative incidence of autoimmune disease, fibromyalgia or myalgic encephalomyelitis was 8.1% (95% CI 7.9–8.3%) in the mesh group and 9.0% (95% CI 8.0–10.1%) in the non‐mesh group (adjusted HR 0.89, 95% CI 0.79–1.01; P = 0.07). A sensitivity analysis including only autoimmune diseases as an outcome returned a similar result. Conclusions These findings do not support claims that synthetic mesh slings cause systemic disease. Tweetable abstract No evidence of increased risk of systemic conditions after stress incontinence treatment with a mesh sling. No evidence of increased risk of systemic conditions after stress incontinence treatment with a mesh sling.
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Affiliation(s)
- P Muller
- London School of Hygiene & Tropical Medicine, London, UK.,Royal College of Obstetricians and Gynaecologists, London, UK
| | - I Gurol-Urganci
- London School of Hygiene & Tropical Medicine, London, UK.,Royal College of Obstetricians and Gynaecologists, London, UK
| | - R Thakar
- Royal College of Obstetricians and Gynaecologists, London, UK.,Croydon University Hospital, Croydon, UK
| | | | - J Van Der Meulen
- London School of Hygiene & Tropical Medicine, London, UK.,Royal College of Obstetricians and Gynaecologists, London, UK
| | - S Jha
- British Society of Urogynaecology, London, UK.,Sheffield Teaching Hospitals, Sheffield, UK
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17
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Redfors B, Jha S, Thorleifsson S, Jernberg T, Angerås O, Frobert O, Petursson P, Tornvall P, Sarno G, Ekenbäck C, Ravn-Fisher A, Y-Hassan S, Lyon AR, James S, Erlinge D, Omerovic E. Short- and Long-Term Clinical Outcomes for Patients With Takotsubo Syndrome and Patients With Myocardial Infarction: A Report From the Swedish Coronary Angiography and Angioplasty Registry. J Am Heart Assoc 2021; 10:e017290. [PMID: 34465127 PMCID: PMC8649294 DOI: 10.1161/jaha.119.017290] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Takotsubo syndrome (TS) is a potentially life‐threatening acute cardiac syndrome with a clinical presentation similar to myocardial infarction and for which the natural history, management, and outcome remain incompletely understood. Our aim was to assess the relative short‐term mortality risk of TS, ST‐segment–elevation myocardial infarction (STEMI), and non‐STEMI (NSTEMI) and to identify predictors of in‐hospital complications and poor prognosis in patients with TS. Methods and Results This is an observational cohort study based on the data from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). We included all patients (n=117 720) who underwent coronary angiography in Sweden attributed to TS (N=2898 [2.5%]), STEMI (N=48 493 [41.2%]), or NSTEMI (N=66 329 [56.3%]) between January 2009 and February 2018. We compared patients with TS to those with NSTEMI or STEMI. The primary end point was all‐cause mortality at 30 days. Secondary outcomes were acute heart failure (Killip Class ≥2) and cardiogenic shock (Killip Class 4) at the time of angiography. Patients with TS were more often women compared with patients with STEMI or NSTEMI. TS was associated with unadjusted and adjusted 30‐day mortality risks lower than STEMI (adjusted hazard ratio [adjHR], 0.60; 95% CI, 0.48–0.76; P<0.001), but higher than NSTEMI (adjHR, 2.70; 95% CI, 2.14–3.41; P<0.001). Compared with STEMI, TS was associated with a similar risk of acute heart failure (adjHR, 1.26; 95% CI, 0.91–1.76; P=0.16) but a lower risk of cardiogenic shock (adjHR, 0.55; 95% CI, 0.34–0.89; P=0.02). The relative 30‐day mortality risk for TS versus STEMI and NSTEMI was higher for smokers than nonsmokers (adjusted P interaction STEMI=0.01 and P interaction NSTEMI=0.01). Conclusions The 30‐day mortality rate in TS was higher than in NSTEMI but lower than STEMI despite a similar risk of acute heart failure in TS and STEMI. Among patients with TS, smoking was an independent predictor of mortality.
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Affiliation(s)
- Björn Redfors
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Sandeep Jha
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | | | - Tomas Jernberg
- Department of Clinical Sciences Danderyd University HospitalKarolinska Institutet Stockholm Sweden
| | - Oskar Angerås
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Ole Frobert
- The Department of Cardiology Faculty of Health Örebro University Örebro Sweden
| | - Petur Petursson
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset Karolinska Institute Stockholm Sweden
| | - Giovanna Sarno
- The Department of Medical Sciences, Cardiology Uppsala University Uppsala Sweden
| | - Christina Ekenbäck
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine Karolinska Institutet Stockholm Sweden
| | - Annika Ravn-Fisher
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Shams Y-Hassan
- The Department of Medicine Karolinska University Hospital Huddinge Stockholm Sweden
| | - Alexander R Lyon
- NIHR Cardiovascular Biomedical Research Unit Royal Brompton Hospital London United Kingdom.,National Heart and Lung InstituteImperial College London United Kingdom
| | - Stefan James
- The Department of Medical Sciences, Cardiology Uppsala University Uppsala Sweden
| | - David Erlinge
- The Department of Cardiology Skåne University Hospital Lund Sweden
| | - Elmir Omerovic
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
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18
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Jha S. Understanding risk: scrutinising PROSPECT. BJOG 2021; 128:2190. [PMID: 34473907 DOI: 10.1111/1471-0528.16898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Affiliation(s)
- S Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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19
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Patel S, Parekh V, Patel K, Jha S. Plant Growth-promoting Activities of Penicillium sp. NAUSF2 Ameliorate Vigna radiata Salinity Stress in Phosphate-deficient Saline Soil. APPL BIOCHEM MICRO+ 2021. [DOI: 10.1134/s000368382104013x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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20
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Zeijlon R, Chamat J, Enabtawi I, Jha S, Mohammed MM, Wågerman J, Le V, Shekka Espinosa A, Nyman E, Omerovic E, Redfors B. Risk of in-hospital life-threatening ventricular arrhythmia or death after ST-elevation myocardial infarction vs. the Takotsubo syndrome. ESC Heart Fail 2021; 8:1314-1323. [PMID: 33511788 PMCID: PMC8006718 DOI: 10.1002/ehf2.13208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/23/2020] [Accepted: 12/28/2020] [Indexed: 01/14/2023] Open
Abstract
Aims The risk of life‐threatening ventricular arrhythmias (LTVA) has been reported to be lower in Takotsubo syndrome (TS) compared with ST‐elevation myocardial infarction (STEMI). However, the extent to which these differences relate to the fact that most patients with TS are women (who have a lower risk of LTVA) and a relatively larger proportion of patients with STEMI are men is incompletely understood. We aimed to investigate the risk of LTVA or death in sex‐matched and age‐matched patients with TS, anterior STEMI, and non‐anterior STEMI. Methods and results We systematically reviewed the charts of all patients with TS who were treated at Sahlgrenska University Hospital (Gothenburg, Sweden) between 2008 and 2019. A total of 155 patients with confirmed TS (according to the European Society of Cardiology diagnostic criteria for TS) were sex‐matched and age‐matched 1:1:1 to patients with anterior and non‐anterior STEMI. Baseline characteristics and in‐hospital outcomes were recorded directly from the patient charts for all patients, and all admission electrocardiographs were analysed. The primary outcome was the composite of death or LTVA [defined as sustained ventricular tachycardia (>30 s) or ventricular fibrillation] within 72 h. The risk of LTVA or death within 72 h after admission was considerably lower in TS (2.6%) vs. anterior STEMI (14%; P = 0.002) and non‐anterior STEMI (9.0%; P = 0.02), despite similar or greater risks of acute heart failure, and similar risks of cardiogenic shock. Compared with STEMI, TS was associated with a lower risk of sustained and non‐sustained ventricular tachycardia and ventricular fibrillation. Conclusions In a predominantly female age‐matched and sex‐matched cohort of patients with TS, anterior STEMI, and non‐anterior STEMI, the adjusted risk of in‐hospital LTVA or death was considerably lower in TS compared with STEMI, despite similar or greater risk of acute heart failure and similar risk of cardiogenic shock.
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Affiliation(s)
- Rickard Zeijlon
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden.,Department of Internal Medicine, Sahlgrenska University Hospital/S, Gothenburg, Sweden.,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jasmina Chamat
- Department of Cardiology, Sahlgrenska University Hospital/Ö, Gothenburg, Sweden.,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Israa Enabtawi
- Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sandeep Jha
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden.,Department of Internal Medicine, Kungälvs Hospital, Kungälv, Sweden.,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mohammed Munir Mohammed
- Department of Internal Medicine, Norra Älvsborgs Länssjukhus, Trollhättan, Sweden.,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Johan Wågerman
- Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Vina Le
- Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Aaron Shekka Espinosa
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden.,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Erik Nyman
- Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden.,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden.,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Clinical Trial Center, Cardiovascular Research Foundation, New York, NY, USA.,Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
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Angelopoulos V, Tsai E, Bingley L, Shaffer C, Turner DL, Runov A, Li W, Liu J, Artemyev AV, Zhang XJ, Strangeway RJ, Wirz RE, Shprits YY, Sergeev VA, Caron RP, Chung M, Cruce P, Greer W, Grimes E, Hector K, Lawson MJ, Leneman D, Masongsong EV, Russell CL, Wilkins C, Hinkley D, Blake JB, Adair N, Allen M, Anderson M, Arreola-Zamora M, Artinger J, Asher J, Branchevsky D, Capitelli MR, Castro R, Chao G, Chung N, Cliffe M, Colton K, Costello C, Depe D, Domae BW, Eldin S, Fitzgibbon L, Flemming A, Fox I, Frederick DM, Gilbert A, Gildemeister A, Gonzalez A, Hesford B, Jha S, Kang N, King J, Krieger R, Lian K, Mao J, McKinney E, Miller JP, Norris A, Nuesca M, Palla A, Park ESY, Pedersen CE, Qu Z, Rozario R, Rye E, Seaton R, Subramanian A, Sundin SR, Tan A, Turner W, Villegas AJ, Wasden M, Wing G, Wong C, Xie E, Yamamoto S, Yap R, Zarifian A, Zhang GY. The ELFIN Mission. Space Sci Rev 2020; 216:103. [PMID: 32831412 PMCID: PMC7413588 DOI: 10.1007/s11214-020-00721-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
The Electron Loss and Fields Investigation with a Spatio-Temporal Ambiguity-Resolving option (ELFIN-STAR, or heretoforth simply: ELFIN) mission comprises two identical 3-Unit (3U) CubeSats on a polar (∼93∘ inclination), nearly circular, low-Earth (∼450 km altitude) orbit. Launched on September 15, 2018, ELFIN is expected to have a >2.5 year lifetime. Its primary science objective is to resolve the mechanism of storm-time relativistic electron precipitation, for which electromagnetic ion cyclotron (EMIC) waves are a prime candidate. From its ionospheric vantage point, ELFIN uses its unique pitch-angle-resolving capability to determine whether measured relativistic electron pitch-angle and energy spectra within the loss cone bear the characteristic signatures of scattering by EMIC waves or whether such scattering may be due to other processes. Pairing identical ELFIN satellites with slowly-variable along-track separation allows disambiguation of spatial and temporal evolution of the precipitation over minutes-to-tens-of-minutes timescales, faster than the orbit period of a single low-altitude satellite (Torbit ∼ 90 min). Each satellite carries an energetic particle detector for electrons (EPDE) that measures 50 keV to 5 MeV electrons with Δ E/E < 40% and a fluxgate magnetometer (FGM) on a ∼72 cm boom that measures magnetic field waves (e.g., EMIC waves) in the range from DC to 5 Hz Nyquist (nominally) with <0.3 nT/sqrt(Hz) noise at 1 Hz. The spinning satellites (Tspin ∼ 3 s) are equipped with magnetorquers (air coils) that permit spin-up or -down and reorientation maneuvers. Using those, the spin axis is placed normal to the orbit plane (nominally), allowing full pitch-angle resolution twice per spin. An energetic particle detector for ions (EPDI) measures 250 keV - 5 MeV ions, addressing secondary science. Funded initially by CalSpace and the University Nanosat Program, ELFIN was selected for flight with joint support from NSF and NASA between 2014 and 2018 and launched by the ELaNa XVIII program on a Delta II rocket (with IceSatII as the primary). Mission operations are currently funded by NASA. Working under experienced UCLA mentors, with advice from The Aerospace Corporation and NASA personnel, more than 250 undergraduates have matured the ELFIN implementation strategy; developed the instruments, satellite, and ground systems and operate the two satellites. ELFIN's already high potential for cutting-edge science return is compounded by concurrent equatorial Heliophysics missions (THEMIS, Arase, Van Allen Probes, MMS) and ground stations. ELFIN's integrated data analysis approach, rapid dissemination strategies via the SPace Environment Data Analysis System (SPEDAS), and data coordination with the Heliophysics/Geospace System Observatory (H/GSO) optimize science yield, enabling the widest community benefits. Several storm-time events have already been captured and are presented herein to demonstrate ELFIN's data analysis methods and potential. These form the basis of on-going studies to resolve the primary mission science objective. Broad energy precipitation events, precipitation bands, and microbursts, clearly seen both at dawn and dusk, extend from tens of keV to >1 MeV. This broad energy range of precipitation indicates that multiple waves are providing scattering concurrently. Many observed events show significant backscattered fluxes, which in the past were hard to resolve by equatorial spacecraft or non-pitch-angle-resolving ionospheric missions. These observations suggest that the ionosphere plays a significant role in modifying magnetospheric electron fluxes and wave-particle interactions. Routine data captures starting in February 2020 and lasting for at least another year, approximately the remainder of the mission lifetime, are expected to provide a very rich dataset to address questions even beyond the primary mission science objective.
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Affiliation(s)
- V Angelopoulos
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - E Tsai
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - L Bingley
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - C Shaffer
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Tyvak Nano-Satellite Systems, Inc., Irvine, CA 92618 USA
| | - D L Turner
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723 USA
| | - A Runov
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - W Li
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Department of Astronomy and Center for Space Physics, Boston University, Boston, MA 02215 USA
| | - J Liu
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - A V Artemyev
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - X-J Zhang
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - R J Strangeway
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - R E Wirz
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - Y Y Shprits
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- GFZ German Research Centre for Geosciences, Potsdam, 14473 Germany
| | - V A Sergeev
- Saint Petersburg State University, St. Petersburg, 199034 Russia
| | - R P Caron
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - M Chung
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723 USA
| | - P Cruce
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - W Greer
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - E Grimes
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - K Hector
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Raytheon Space and Airborne Systems, El Segundo, CA 90245 USA
| | - M J Lawson
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - D Leneman
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - E V Masongsong
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - C L Russell
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - C Wilkins
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - D Hinkley
- The Aerospace Corporation, El Segundo, CA 90245 USA
| | - J B Blake
- The Aerospace Corporation, El Segundo, CA 90245 USA
| | - N Adair
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Millenium Space Systems, El Segundo, CA 90245 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - M Allen
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - M Anderson
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Aptiv, Agoura Hills, CA 91301 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - M Arreola-Zamora
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - J Artinger
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
| | - J Asher
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723 USA
| | - D Branchevsky
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- The Aerospace Corporation, El Segundo, CA 90245 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - M R Capitelli
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Millenium Space Systems, El Segundo, CA 90245 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - R Castro
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Raytheon Space and Airborne Systems, El Segundo, CA 90245 USA
| | - G Chao
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: The Boeing Company, Long Beach, CA 90808 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - N Chung
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: SF Motors, Santa Clara, CA 95054 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - M Cliffe
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: SpaceX, Hawthorne, CA 90250 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - K Colton
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Planet Labs, Inc., San Francisco, CA 94107 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - C Costello
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - D Depe
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - B W Domae
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - S Eldin
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - L Fitzgibbon
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Tyvak Nano-Satellite Systems, Inc., Irvine, CA 92618 USA
| | - A Flemming
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - I Fox
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - D M Frederick
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Millenium Space Systems, El Segundo, CA 90245 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - A Gilbert
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - A Gildemeister
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - A Gonzalez
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: SpaceX, Hawthorne, CA 90250 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - B Hesford
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Jet Propulsion Laboratory, Pasadena, CA 91109 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - S Jha
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - N Kang
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Millenium Space Systems, El Segundo, CA 90245 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - J King
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - R Krieger
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Mercedes-Benz Research and Development North America, Long Beach, CA 90810 USA
| | - K Lian
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - J Mao
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Verona, WI 53593 USA
| | - E McKinney
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: California State Polytechnic University, Pomona, CA 91768 USA
| | - J P Miller
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - A Norris
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
| | - M Nuesca
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - A Palla
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - E S Y Park
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Economics Department, University of California, Los Angeles, CA 90095 USA
| | - C E Pedersen
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - Z Qu
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - R Rozario
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: SpaceX, Hawthorne, CA 90250 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - E Rye
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - R Seaton
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - A Subramanian
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Northrop Grumman Aerospace Systems, Redondo Beach, CA 90278 USA
| | - S R Sundin
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Tyvak Nano-Satellite Systems, Inc., Irvine, CA 92618 USA
| | - A Tan
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Experior Laboratories, Oxnard, CA 93033 USA
| | - W Turner
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
| | - A J Villegas
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
| | - M Wasden
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - G Wing
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Computer Science Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - C Wong
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Physics and Astronomy Department, University of California, Los Angeles, CA 90095 USA
| | - E Xie
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Electrical and Computer Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - S Yamamoto
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering, University of California, Los Angeles, CA 90095 USA
| | - R Yap
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Mathematics Department, University of California, Los Angeles, CA 90095 USA
| | - A Zarifian
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Present Address: Jet Propulsion Laboratory, Pasadena, CA 91109 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
| | - G Y Zhang
- Earth, Planetary, and Space Sciences Department, University of California, Los Angeles, CA 90095 USA
- Institute of Geophysics and Planetary Physics, University of California, San Diego, CA USA
- Present Address: Qualcomm, San Diego, CA 92121 USA
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Acharya N, Jha S, Mishra D, Chattopadhyay A, Jain S, Sharma SK, Sharma A, Jain S, Dhir V. AB0395 SYSTEMIC LUPUS ASSOCIATED MACROPHAGE ACTIVATION SYNDROME – A SINGLE CENTRE EXPERIENCE FROM INDIA. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Macrophage activation syndrome (MAS) is a potentially fatal complication of systemic lupus erythematosus (SLE).(1) Overlapping clinical features of SLE activity with MA makes it a clinical diagnosis. There is limited data from developing countries like India.Objectives:To study the clinical features, treatment, and outcomes in SLE-MAS.Methods:This single-centre, retrospective study included patients fulfilling SLICC 2011 criteria for SLE, admitted from January 2017 to November 2019, and diagnosed as MAS by a team of attending physicians. Their demographic and clinical data, treatment, and outcomes were recorded. H score and SLEDAI were calculated. Patients were assessed for HLH classification criteria (2004) and preliminary diagnostic criteria for MAS in childhood SLE (cSLE).Results:Sixteen patients (median age – 26 years, 15 females) were included. Twelve patients (75%) had MAS as the initial presentation of SLE. The common clinical features were fever (100%) and cytopenias (100%). The mean duration of symptoms was 60 days. The most frequent biochemical abnormalities were high ferritin (>500 ng/ml, 100%) and elevated transaminases (100%, aspartate transaminase > alanine transaminase). Common complications were renal (43.8%), neurological (43.8%), and coagulopathy (43.8%). Seven and 16 patients fulfilled the HLH 2004 and cSLE – MAS preliminary criteria, respectively. The median H score was 222, giving a cumulative probability of 96%. All the patients received high-dose steroids. Cyclophosphamide pulse and cyclosporine were administered to 8 (50%) and 6 (37.5%) patients respectively. There were four (25%) in-hospital mortalities.CharacteristicN=16Age (years)26 (19.5 – 30)Duration of symptoms (days)60 (18.7 – 90)Fever16 (100)Pancreatitis1 (6.3)Renal7 (43.8)Neurological7 (43.8)Myocarditis6 (37.5)Hepatomegaly7 (43.8)Splenomegaly3 (18.8)Lymphadenopathy12 (75)Anaemia16 (100)Leukopenia13 (82)Thrombocytopenia14 (88.2)Coagulopathy7 (43.8)Concomitant infection3 (18.8)H score222 (193 – 254)cSLE-MAS diagnostic criteria16 (100%)HLH 2004 (≥5)7 (43.8)Corticosteroids16 (100%)Cyclophosphamide8 (50%)Intravenous immunoglobulin2 (12.5%)Cyclosporine6 (37.5%)Death4 (25%)All data presented as n (%) and median (IQR)cSLE-MAS – Childhood systemic lupus erythematosus – Macrophage activation syndrome, HLH – Hemophagocytic lymphohistiocytosisParameterN = 16Haemoglobin (g/dL)6.9 (5.7 – 7.8)Total leucocyte count (cells/mm3)1400 (1025 -3175)<10003 (18.8)1000 – 25009 (56.3)2500 - 40001 (6.3)Platelet (cells/mm3)57500 (23500 – 95250)<200003 (18.8)20000 – 500003 (18.8)50000 – 1 lac8 (50)Serum ferritin > 500 ng/ml16 (100%)Fibrinogen2.48 (1.6 – 4)Triglycerides (mg/dL)375 (294 -470)AST/ALT (U/L)153 (113 – 234) / 90 (68 – 170)Procalcitonin (pg/mL)0.8 (0.3 – 1.4)Lactate dehydrogenase (U/L)1674 (1081 – 2184)Erythrocyte sedimentation rate (mm in 1sthour)61 (44 – 69)C- reactive protein (mg/L)36 (6.3 – 52)Bone marrow examination14 (87.5)Increased histiocytes with hemophagocytosis5 (32.5)All data presented as n (%) and median (IQR)ALT – Alanine transaminase, AST – Aspartate transaminaseConclusion:Fever, cytopenia, high ferritin, and elevation of transaminases were the commonest features in this series of SLE-MAS. SLE-MAS carried a high mortality (25%) despite aggressive treatment.References:[1]Gavand P-E, Serio I, Arnaud L, Costedoat-Chalumeau N, Carvelli J, Dossier A, et al. Clinical spectrum and therapeutic management of systemic lupus erythematosus-associated macrophage activation syndrome: A study of 103 episodes in 89 adult patients. Autoimmun Rev. 2017;16(7):743–9.Acknowledgments:NONEDisclosure of Interests:None declared
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Dhir V, Jha S, Sharma A, Jain S, Sharma SK, Naidu G. AB0570 MIXED CONNECTIVE TISSUE DISEASE: NOT THAT UNCOMMON, A SINGLE-CENTER EXPERIENCE FROM INDIA. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Mixed connective tissue disease (MCTD) is considered to be uncommon; specifically there is sparse data on MCTD from developing countries like India.Objectives:This study examines the clinical and serological features of these patients in a single center in North-India.Methods:This was a retrospective single-center study of patients diagnosed as MCTD in last 20 years. The patients included fulfilled at least one of the diagnostic criteria namely Alarcón-Segovia, Kasukawa, and Kahns. Demographic details, clinical signs and symptoms, laboratory parameters, treatment and outcome were extracted from medical records and clinic files in a pre-designed proforma.Results:This study included 41 MCTD patients. There was a marked female preponderance (F: M=40:1), and mean age of disease onset and diagnosis was 33.8 ± 10.7 and 39.3 ± 10.2 years. 39 (92%) of the patients fulfilled both Kahn and Kasukawa criteria, while 31 (76%) fulfilled Alarcon-Segovia criteria. Initially patients had been (mis)diagnosed as rheumatoid arthritis, systemic lupus erythematosus (or UCTD) (in five patients each), overlap syndromes or myositis (in 4 patients). ANA was commonly high-titer and specked, U1RNP was positive in all. (Table 1) Other autoantibodies on immunoblot included SSA and Ro52 in half the patients. Raynaud’s was seen in three-fourth at presentation and all the patients over time. Digital gangrene and puffy fingers were seen in 8 (20%) and 18 (46%) patients. Other clinical features included arthritis in 33 (81%), sclerodactyly in 23 (56%) and proximal weakness in 20 patients (49%). Interstitial lung disease and pulmonary arterial hypertension were seen in 20 (57%) and 15 (44%) patients. All patients (except one) received prednisolone, and it was currently used in almost 90%. Intravenous cyclophosphamide was used in one-third, commonly for ILD.Table 1.Laboratory features of patients with MCTDLabs n (%)Leucopenia9 (22)Thrombocytopenia10 (24)Raised globulinsb22 (69)Mean globulins, mean (SD)a5±3.4Elevated CPKb10 (31)CPK Levels U/L, median (IQR)256 (57.5-1036)ANA Speckled Pattern N (%)31d(82)U1RNP N (%)b32 (100%)U1RNP Blot Intensity1+8 (25%)2+1 (3.2%)3+7 (21.8%)4+16 (50%)U1RNP EIA, mean(SD), n=19141.3 ± 82.4Raised RF Titersh10 (35.7%)Low C3 mg/dlf8 (40%)Low C4 mg/dlf3 (15%)FVC, mean (SD) n=2082.4 ± 18.9 ILD on HRCTg20 (57) Dilated PA on CTf10 (50)PAHeon ECHO15 (44.1%)RA/RV Dilated5 (18)SD-standard deviation, IQR- Interquartile range, CPK- Creatinine phosphokinase,, ILD- Interstitial lung disease, PAH- Pulmonary arterial hypertension, ANA- Anti nuclear antibody, IIF- Indirect Immunofluorescence, PA- pulmonary artery, RA/RV- Right atrium/Right Ventricle,a34b32d38e34f20g34h28Conclusion:MCTD was not uncommon in the single-center in North India. Kahn and Kasukawa criteria were found to be the most sensitive for its diagnosis. Digital gangrene was relatively common and sometimes the presenting feature; whereas puffy fingers was present in only half the patients.Disclosure of Interests:None declared
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Affiliation(s)
- S Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Abstract
Coronavirus disease 2019 has spread to every inhabited continent in the world. So far, plain radiography and computed tomography have been the mainstay of imaging methods used. The present analytical paper on the role of point-of-care lung ultrasound in this pandemic examines its diagnostic accuracy, clinical utility, and physical practicality in the intensive care unit. POCUS has a high sensitivity for pulmonary manifestations of COVID-19. POCUS minimises nosocomial spread. POCUS can prognosticate and assess response to therapy. Healthcare providers with skills in POCUS are encouraged to help provide this service.
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Affiliation(s)
- S Kulkarni
- Oxford University Clinical Academic Graduate School (OUCAGS), Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Headley Way, Headington, Oxfordshire OX3 9DU, UK; Department of Critical Care, Milton Keynes University Hospital, Milton Keynes University Hospital NHS Foundation Trust, Standing Way, Milton Keynes, Buckinghamshire MK6 5LD, UK.
| | - B Down
- Department of Critical Care, Milton Keynes University Hospital, Milton Keynes University Hospital NHS Foundation Trust, Standing Way, Milton Keynes, Buckinghamshire MK6 5LD, UK
| | - S Jha
- Department of Radiology, Hospital of the University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Jha S, Zeijlon R, Enabtawi I, Espinosa AS, Chamat J, Omerovic E, Redfors B. RE: Do electrocardiogram low amplitude QRS complexes predict adverse in-hospital outcomes in patients with takotsubo syndrome? Int J Cardiol 2019; 297:18. [DOI: 10.1016/j.ijcard.2019.07.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 11/30/2022]
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Affiliation(s)
- R R Kumar
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - S Jha
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - A Dhooria
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - V Dhir
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Jha S. P759Electrocardiographic predictors of adverse in-hospital outcomes in the Takotsubo syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0359] [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: 11/14/2022] Open
Abstract
Abstract
Background
The takotsubo syndrome is a life-threatening acute cardiac condition. However, little is known about risk factors associated with worse outcomes in TS, and no high-risk electrocardiographic criteria have been defined for patients with TS. We sought to identify high-risk admission ECG findings among patients with TS.
Methods
Using the Swedish Angiography and Angioplasty Registry (SCAAR) we identified all cases of TS who were treated at our university hospital between 2008 and 2017. We reviewed all cases and included patients who met the revised Gothenburg diagnostic criteria. We conducted an in-depth review of all presenting electrocardiograms, using a pre-defined case report form (CRF), including the following variables: heart rate; rhythm; PR-interval; QRS axis; QTc-interval; T-wave inversion.; presence of Q-wave; T-wave axis; and the magnitude of ST-segment deviation in each individual lead. The primary endpoint was the occurrence of in-hospital major adverse cardiac event (MACE), defined as the composite of death, ventricular tachycardia or fibrillation (VT/VF), atrioventricular block ≥2 or asystole >10 seconds.
Results
We identified 161 patients with TS, of whom 151 (93.8%) were women. The mean age was 69±13 years. MACE occurred in 19 patients (11.8%), and VT/VF occurred in 14 patients (8.7%). No clinical variables were significantly different between patients with and without MACE. Patients with MACE were less likely than those without MACE to have sinus rhythm (79.0% versus 95.8%, p=0.02) or T-wave inversion (15.8% versus 52.8%, p=0.02). T-wave inversion was less common among patients with than without VT/VF (14.3% versus 51.7%, p=0.01). After adjustment for age and sex T-wave inversion was independently associated with lower risk of MACE (Odds ratio 0.13, 95% confidence interval 0.04 to 0.48, p>0.001).
Conclusions
T-wave inversion is common in TS and is associated with lower risk of adverse events, driven by a lower risk of VT/VF.
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Affiliation(s)
- S Jha
- Sahlgrenska University Hospital, Goteborg, Sweden
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Jha S, Zeijlon R, Enabtawi I, Espinosa AS, Chamat J, Omerovic E, Redfors B. Electrocardiographic predictors of adverse in-hospital outcomes in the Takotsubo syndrome. Int J Cardiol 2019; 299:43-48. [PMID: 31279663 DOI: 10.1016/j.ijcard.2019.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Takotsubo syndrome (TS) is a life-threatening acute heart failure syndrome. However, little is known about risk factors for worse outcomes in TS and no high-risk ECG criteria have been defined. We sought to identify ECG predictors of life-threatening in-hospital complications in TS. METHOD AND RESULT Using the nationwide Swedish Angiography and Angioplasty Registry (SCAAR) we obtained data on all consecutive patients undergoing coronary angiography at Sahlgrenska University Hospital between June 2008 and February 2019. For all patients with TS we conducted in-depth chart reviews to confirm the TS diagnosis. For those with confirmed TS we then evaluated all ECGs obtained during the index hospitalization. The primary endpoint was the occurrence of in-hospital major adverse cardiac event (MACE), defined as the composite of death, ventricular tachycardia or fibrillation (VT/VF), or atrioventricular block ≥2 or asystole ≫10 s. We identified 215 patients with TS (mean age 69 ± 13 years; 93% women). MACE occurred in 34 patients (16%), of whom 20 had VT/VF (9,3%). Patients with MACE were less likely than those without MACE to have sinus rhythm (85% versus 96%, p = 0.025) or T-wave inversion (29% versus 51%, p = 0.025). After propensity score adjustment T-wave inversion was independently associated with lower MACE risk (adjusted odds ratio [AdjOR] 0.28, 95% confidence interval [CI] 0.10-0.76, p = 0.012) and VT/VF (AdjOR 0.24, 95% CI 0.06-0.94, p = 0.041). CONCLUSION T-wave inversion is common in TS and is associated with lower risk of MACE, driven by a lower risk of VT/VF.
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Affiliation(s)
- Sandeep Jha
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory, Gothenburg University, Gothenburg, Sweden; Department of Internal medicine, Kungälv Hospital, Kungälv, Sweden.
| | - Rickard Zeijlon
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory, Gothenburg University, Gothenburg, Sweden; Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Israa Enabtawi
- Wallenberg Laboratory, Gothenburg University, Gothenburg, Sweden
| | | | - Jasmina Chamat
- Wallenberg Laboratory, Gothenburg University, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory, Gothenburg University, Gothenburg, Sweden
| | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory, Gothenburg University, Gothenburg, Sweden
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Udintsev V, Danani S, Taylor G, Giacomin T, Guirao J, Pak S, Hughes S, Worth L, Vayakis G, Walsh M, Schneider M, Pandya H, Kumar R, Kumar V, Jha S, Thomas S, Padasalagi SB, Kumar S, Phillips PE, Rowan WL, Austin M, Khodak A, Feder R, Neilson H, Basile A, Hubbard AE, Saxena A, Nazare C, Maquet P, Gimbert N. Progress in ITER ECE Diagnostic Design and Integration. EPJ Web Conf 2019. [DOI: 10.1051/epjconf/201920303003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The ITER Electron Cyclotron Emission (ECE) diagnostic is progressing towards its Preliminary Design Review (PDR). In parallel, the diagnostic integration in the Equatorial Port is ongoing. Port Integration has to address the structural integrity to withstand various loads, maintenance and the safety aspects of ECE diagnostic. The ITER ECE system includes radial and oblique lines-of-sight. Recently, a successful peer-review of the in-port plug Hot Calibration Source has taken place and its performance and integration feasibility has been demonstrated. Four 45-meter long low-loss transmission lines are designed to transmit mm-wave power in the frequency range of 70- 1000 GHz in both X- and O-mode polarization from the port plug to the ECE instrumentation room in the diagnostic building. Prototype transmission lines are being tested [1]. A prototype polarizing Martin-Puplett type Fourier Transform Spectrometer (FTS) operating in the frequency range 70-1000 GHz, has a fast scanning mechanism and a cryo-cooled dual-channel THz detector system. Its performance has been tested as per ITER requirements. Assessment of the instrumentation and control requirements, functional and non-functional requirements, operation procedures, plant automation are ongoing for the PDR. The current status of the diagnostic, together with integration activities, is presented.
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Abstract
Sexual dysfunction in women with prolapse and incontinence is well documented in the literature, but the impact of treatment, particularly surgical correction, remains very limited and confusing. Age, on the other hand, has been shown to be an independent risk factor for deteriorating sexual function, with all aspects of the sexual function (i.e. desire, arousal, penetration, and orgasm) being affected. When combined with surgical correction of prolapse or incontinence there is potential for further worsening of sexual function, and hence this should be assessed before any pelvic floor surgery and patient expectations established. In this article the current evidence will be reviewed looking at the impact of pelvic floor dysfunction on sexual function and the effect of commonly performed surgery for these problems. Ways and means of preserving sexual function in women undergoing corrective surgery will also be investigated.
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Affiliation(s)
- S Jha
- a Department of Urogynaecology , Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield , UK
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Affiliation(s)
- R R Kumar
- Clinical Immunology and Rheumatology Wing, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, India
| | - S Jha
- Clinical Immunology and Rheumatology Wing, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, India
| | - A Sharma
- Clinical Immunology and Rheumatology Wing, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, India
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Affiliation(s)
- Sandeep Jha
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Internal Medicine, Kungälv Hospital, Kungälv, Sweden
| | - Rickard Zeijlon
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aaron Shekka Espinosa
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jessica Alkhoury
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jonatan Oras
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY, USA
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Kaur A, Kapil A, Elangovan R, Jha S, Kalyanasundaram D. Correction: Highly-sensitive detection of Salmonella typhi in clinical blood samples by magnetic nanoparticle-based enrichment and in-situ measurement of isothermal amplification of nucleic acids. PLoS One 2018; 13:e0203982. [PMID: 30204792 PMCID: PMC6133372 DOI: 10.1371/journal.pone.0203982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Díaz Candamio MJ, Jha S, Martel Villagrán J. Overdiagnosis in imaging. Radiologia (Engl Ed) 2018; 60:362-367. [PMID: 29685554 DOI: 10.1016/j.rx.2018.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/24/2017] [Revised: 03/11/2018] [Accepted: 03/15/2018] [Indexed: 01/22/2023]
Abstract
Overdiagnosis, more than an error regarding the diagnosis, is an error regarding the prognosis. We cannot know what consequences some lesions that we detect by imaging would have on our patients' lives if they were left untreated. As long as it is not possible for imaging techniques to differentiate between lesions that will have an indolent course from those that will have an aggressive course, there will be overdiagnosis. Advanced imaging techniques, radiomics, and radiogenomics, together with artificial intelligence, promise advances in this sense. In the meantime, it is important that radiologists be careful to ensure that only strictly necessary imaging tests are done. Moreover, we need to participate, together with patients, in making multidisciplinary decisions about diagnosis and clinical management. Finally, of course, we need to continue to contribute to the technological and scientific advance of our profession, so that we can continue to improve the diagnosis and early detection of abnormalities, especially those that require treatment.
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Affiliation(s)
| | - S Jha
- Hospital of The University of Pennsylvania, Silverstein, Filadelfia, Estados Unidos
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Offen S, Jha S, Connellan M, Dhital K, Granger E, Harkness M, Hayward C, Jabbour A, Jansz P, Kotlyar E, Montgomery E, Muthiah K, Newton P, Smith A, Spratt P, Macdonald. P. Frailty Predicts Mortality After Heart Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.102] [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: 10/17/2022] Open
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Montgomery E, Macdonald P, Newton P, Jha S, Hannu M, Thomson C, Glanville A, Havryk A, Plit M, Pearson R, Benzimra M, Harkess M, Malouf M. Frailty as a Predictor of Prognostic Outcomes in Patients with Interstitial Lung Disease Referred for Lung Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1299] [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] Open
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Kaur A, Kapil A, Elangovan R, Jha S, Kalyanasundaram D. Highly-sensitive detection of Salmonella typhi in clinical blood samples by magnetic nanoparticle-based enrichment and in-situ measurement of isothermal amplification of nucleic acids. PLoS One 2018; 13:e0194817. [PMID: 29590194 PMCID: PMC5874042 DOI: 10.1371/journal.pone.0194817] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/10/2018] [Indexed: 12/31/2022] Open
Abstract
Enteric fever continues to be a major cause of mortality and morbidity globally, particularly in poor resource settings. Lack of rapid diagnostic assays is a major driving factor for the empirical treatment of enteric fever. In this work, a rapid and sensitive method ‘Miod’ ‘has been developed. Miod includes a magnetic nanoparticle-based enrichment of target bacterial cells, followed by cell lysis and loop-mediated isothermal amplification (LAMP) of nucleic acids for signal augmentation along with concurrent measurement of signal via an in–situ optical detection system. To identify positive/negative enteric fever infections in clinical blood samples, the samples were processed using Miod at time = 0 hours and time = 4 hours post-incubation in blood culture media. Primers specific for the STY2879 gene were used to amplify the nucleic acids isolated from S. typhi cells. A limit of detection of 5 CFU/mL was achieved. No cross-reactivity of the primers were observed against 106 CFU/mL of common pathogenic bacterial species found in blood such as E. coli, P. aeruginosa, S. aureus, A. baumanni, E. faecalis, S. Paratyphi A and K. pneumonia. Miod was tested on 28 human clinical blood samples. The detection of both pre-and post-four-hours incubation confirmed the presence of viable S. typhi cells and allowed clinical correlation of infection. The positive and negative samples were successfully detected in less than 6 hours with 100% sensitivity and specificity.
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Affiliation(s)
- Avinash Kaur
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravikrishnan Elangovan
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, New Delhi, India
| | - Sandeep Jha
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
| | - Dinesh Kalyanasundaram
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
- * E-mail: ,
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Kumari N, Saei A, Lalith C, Serra V, Jha S, Eichhorn P. Identifying the oncogenic role of USP10 as the regulator of PTEN function in breast cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy047.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mugwagwa A, Santoso A, Jha S, Chia V, Mahadevan G, Huynh L. ‘Simplifying’ Diastology: Have the Updated Guidelines Increased Ambiguity? Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.365] [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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McDonagh J, Prichard R, Jha S, Ferguson C, MacDonald P, Newton P. Frailty Prevalence in Heart Failure According to Three Frailty Assessment Instruments. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.133] [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: 11/26/2022]
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Offen S, Jha S, Connellan M, Dhital K, Granger E, Harkness M, Hayward C, Jabbour A, Jansz P, Kotlyar E, Montgomery E, Muthiah K, Spratt P, MacDonald P. Frailty Predicts Mortality After Heart Transplantation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.132] [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: 11/29/2022]
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Khadka Shrestha S, Karmacharya K, Giri M, Bajracharya MR, Jha S. Relationship of thyroid peroxidase antibody test with abnormal thyroid function tests. J Pathol Nep 2017. [DOI: 10.3126/jpn.v7i2.18001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Autoimmune thyroid disease results from a complex interaction between genetic and enviromental factors. The aim of this study was to find association of anti-thyroid peroxidase antibody with abnormal thyroid function tests. Materials and Methods: This is a retrospective study, conducted in 160 patients who showed abnormal thyroid function tests in grande city clinic and hospital services and Kantipur dental college for duration of 18 months since Baisakh 2072.Results: Among 160 individuals , 126(78.8%) were female and 34(21.2%) were male. Subclinical hypothyroidism (56.3%) were most common than overthyperthyroidism (18.0%), overthypothyroidism (16.9%) and subclinical hyperthyroidism (8.8%). Anti thyroid peroxidase antibodies test was shown positive in 102/160 (63.8% ) cases.Conclusion: According to the present study, anti- thyroid peroxidase antibody has been significantly associated with thyroid dysfunction, it can be used as diagnostic marker for thyroid autoimmune diathesis.
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Rashid M, Toh T, Abdullah N, Silva A, Zhang Y, Tan P, Teh A, Karnani N, Jha S, Ho CM, Chng W, Dean H, Chow EH. Globally optimizing therapeutic combinations against bortezomib-resistant multiple myeloma using a quantitative parabolic optimization platform (QPOP). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx390.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hosoe K, Nakagawa K, Ueda T, Hosoda M, Panda SK, Morikawa H, Jha S. Efficacy of a novel herbal composition licorice flavonoid oil in subject with metabolic syndrome: a randomized double-blind placebo-controlled clinical study. FFHD 2017. [DOI: 10.31989/ffhd.v7i3.327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: In order to evaluate the effects of licorice flavonoid oil (LFO) on waist circumference, blood pressure, lipid profile, body fat composition, body weight, body mass index (BMI), and fasting blood glucose in patients with metabolic syndrome, a 12 week randomized double-blind placebo-controlled study was conducted. Methods: Fifty patients with metabolic syndrome aged between 18-75 years were assigned to either the LFO or placebo group. Abdominal waist circumference, blood pressure, body weight, and BMI were assessed at baseline, week 4, week 8, and week 12. Clinical laboratory examinations, fat composition, and fasting blood glucose level were assessed at baseline (week 0) and final visit (week 12).Results: A total of 50 subjects (25 subjects in each group) completed the 12 week study. Significant changes from baseline were observed in body weight, waist circumference, and BMI in the LFO group compared to the placebo group from week 4 or week 8 onwards. No adverse events were noted throughout the study. Conclusion: The present study suggests that LFO is a promising dietary nutrient for improving metabolic syndrome, particularly through its beneficial effect of reducing body weight, BMI, and possibly the amount of visceral fat. Keywords: licorice flavonoid oil; Glycyrrhiza glabra L.; metabolic syndrome; body mass index
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Jha S, Singh S, Bansal R, Chauhan P, Shah MP, Shah A. Nonmetric analysis of caroticoclinoid foramen in foothills of Himalayas: Its clinicoanatomic perspective. Morphologie 2017; 101:47-51. [PMID: 27839870 DOI: 10.1016/j.morpho.2016.07.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/19/2015] [Revised: 03/29/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE OF THE STUDY Study was conducted to evaluate the incidence of caroticoclinoid foramen in north Indian population. Authors have also endeavoured to discuss its clinical and embryological implications. MATERIALS AND METHODS Study was conducted on 108 dry human skulls in department of anatomy SGRR medical college, Dehradun. Incidence of caroticoclinoid foramen was evaluated in accordance with side. RESULTS A percentage of 22.22 skulls presented with the caroticoclinoid foramen with maximum incidence of unilateral and incomplete type. Incidence revealed no bias towards side. CONCLUSION Anatomical knowledge about CCF may be helpful to radiologists and neurosurgeons in providing an additional insight into the diagnosis and management of various pathologies around sellar region.
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Affiliation(s)
- S Jha
- Shri Guru Ram Rai, institute of medical and health sciences, Dehradun, India
| | - S Singh
- Vardhman Mahavir medical college, Safdarjung hospital, Ring Road, Opposite AIIMS Hospital, Safdarjung West, Safdarjung Campus, Ansari Nagar East, New Delhi, 110029 Delhi, India
| | - R Bansal
- Vardhman Mahavir medical college, Safdarjung hospital, Ring Road, Opposite AIIMS Hospital, Safdarjung West, Safdarjung Campus, Ansari Nagar East, New Delhi, 110029 Delhi, India
| | - P Chauhan
- Vardhman Mahavir medical college, Safdarjung hospital, Ring Road, Opposite AIIMS Hospital, Safdarjung West, Safdarjung Campus, Ansari Nagar East, New Delhi, 110029 Delhi, India.
| | - M-P Shah
- Shri Guru Ram Rai, institute of medical and health sciences, Dehradun, India
| | - A Shah
- Shri Guru Ram Rai, institute of medical and health sciences, Dehradun, India
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Sah B, Ayer A, Yadav BN, Jha S, Yadav SK. Development of a Valid and Reliable Questionnaire to Identify Professional Opinion Regarding Organ Transplantation System. Int J Organ Transplant Med 2017; 8:146-156. [PMID: 28924463 PMCID: PMC5592102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Currently, the Nepalese law permits organ donation by an individual who falls into the category of a "close relative" of the recipient. There is a need for expansion of the live organ donor pool beside close relatives. Different systems of organ transplantation are followed by several countries and the professional opinions that underpin these systems need to be studied. OBJECTIVE To generate a questionnaire related to different organ transplant systems and validate it so that it can be used to collect mass professional opinions. METHODS Item generation, item reduction, item scaling, and pretesting were used to develop a questionnaire. The final version of the questionnaire was reviewed by experts for its content validity and then was used twice for participants at a 20-day interval to calculate Cronbach's alpha for testing its internal consistency and Intra-class correlation for testing its test and retest reliability. RESULTS The questionnaire was found to be valid and reliable with an overall Cronbach's alpha of 0.701. Intra-class correlation scores for each question in both test and retest were correlated. CONCLUSION A valid and reliable questionnaire was developed that can be used to collect mass professional opinions to assist policy makers to establish a better organ transplant system.
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Affiliation(s)
- B. Sah
- Department of Forensic Medicine and Toxicology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal,Correspondence: Bikash Sah, Assistant Professor, Department of Forensic Medicine and Toxicology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal, E-mail:
| | - A. Ayer
- Department of Conservative Dentistry & Endodontics, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - B. N. Yadav
- Department of Forensic Medicine and Toxicology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S. Jha
- Department of Forensic Medicine and Toxicology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S. K. Yadav
- Institute of Liver Transplant and Regenerative Medicine. Medanta, The Medicity, New Delhi (NCR), India
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Abstract
The incidence of any fracture in the US is estimated to be 2 704 fractures per 100,000 person-years. Approximately 10 percent of these fractures develop complications of healing. The processes that occur during fracture healing mimic the processes that take place in the growth plate during development. The study of fracture healing represents a window to enhance our understanding of the processes of growth and development of bones and its reparative biology. This review is aimed for clinicians evaluating non-unions as an overview of different factors that inhibit fracture healing.
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Affiliation(s)
- S Jha
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - J E Blau
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda MD, USA
| | - T Bhattacharyya
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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Maini L, Sharma A, Jha S, Sharma A, Tiwari A. Three-dimensional printing and patient-specific pre-contoured plate: future of acetabulum fracture fixation? Eur J Trauma Emerg Surg 2016. [PMID: 27785534 DOI: 10.1007/s00068-016-0738-6.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Due to the complexity of acetabulum, achieving anatomical contouring intra-operatively is difficult for surgeon. A 3D (dimensional) real model can facilitate us both in contouring the plate pre-operatively and in better pre-operative planning. Patient-specific pre-contoured plate in acetabular fracture has been studied by few researchers but randomized case-control study was lacking. Hence, we conducted a case-control study to evaluate the accuracy of patient-specific pre-contoured plate. MATERIALS AND METHODS Prospective randomized case control study was conducted. 21 patients were included. 10 patients were distributed in "case" group and remaining 11 in "control" group. INCLUSION CRITERIA Displaced acetabulum fractures with displacement of ≥3 mm in adults who reported within 3 weeks of injury. Exclusion criteria were: Open fractures, associated Morel-Lavallée lesion and patients with >3 weeks old fracture. In case group, patient-specific real 3D model of fractured acetabulum was generated using rapid prototyping technology and plates were contoured pre-operatively. Control group was treated using intra-operative contoured plates. Both the groups were compared using parameters: Blood loss, Surgery time, post-operative reduction on X-ray, post-surgical residual displacement and reduction achieved as evaluated by CT scan. RESULTS Reduced blood loss (100 ml less in case group) and surgical time (12 min less in case group) and better post-operative reduction were observed in case than control. In control group, 4 patients even had step of 2-3 mm, which was not seen in case group. All the pre-contoured plates fitted well to the pelvis intra-operatively. Reduction achieved as evaluated by CT was more in "case" group with statistically significant outcomes (p < 0.05). CONCLUSION Patient-specific pre-contoured plate made using 3D model is a better implant than intra-operatively contoured plate. Real-time 3D pelvis model is an accurate technique for pre-operative planning in acetabular fractures.
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Affiliation(s)
- L Maini
- Maulana Azad Medical College, Delhi, India
| | - A Sharma
- Maulana Azad Medical College, Delhi, India. .,, E-31, Radha Kunj, Brij Vihar, Ghaziabad, Uttar Pradesh, 201011, India.
| | - S Jha
- Indian Institute of Technology, Delhi, India
| | - A Sharma
- Maulana Azad Medical College, Delhi, India
| | - A Tiwari
- Maulana Azad Medical College, Delhi, India
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