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Rawal S, Tackett R, Osae S, Young H. COVID-19 vaccine hesitancy among underserved populations. Res Social Adm Pharm 2023. [DOI: 10.1016/j.sapharm.2022.07.039] [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: 01/23/2023]
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2
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Sharma G, Shah M, Ahluwalia P, Gautam G, Dasgupta P, Challacombe B, Bhandari M, Ahlawat R, Rawal S, Buffi N, Sivaraman A, Porter J, Rogers C, Mottire, Abaza R, Rha K, Moon D, Yuvaraja T, Parekh D, Capitanio U, Maes K, Porpiglia F, Turkeri L. Off-clamp versus on-clamp robot-assisted partial nephrectomy: A propensity-matched analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Jain V, Debnath S, Sharma A, Kamboj M, Mohanty A, Rawal S. Isolated lymph node recurrence in epithelial ovarian cancer - management and outcome. J Visc Surg 2022:S1878-7886(22)00173-4. [PMID: 36564260 DOI: 10.1016/j.jviscsurg.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The aim of our study was to assess the clinical outcome of isolated lymph node recurrence in patients with epithelial ovarian cancer treated by surgery and to analyze the impact of various clinico-pathological factors on prognosis. MATERIAL AND METHODS We conducted a retrospective analysis of all the epithelial ovarian cancer patients who underwent secondary lymphadenectomy surgery for isolated lymph node recurrence at our institute from 2013 to 2020. Univariate analysis of various factors influencing the post-recurrence disease free survival and post-recurrence survival was done using Kaplan-Meier for categorical variables and cox-proportional hazard progression for continuous variables. RESULTS A total of 21 patients of isolated lymph node recurrence were treated surgically during the study period. The median disease free interval to develop lymph nodal recurrence was 13 months. All the patients achieved complete resection to no gross residual disease without any significant morbidity associated with the procedure. The median post-recurrence disease free survival after treatment of lymph node recurrence was 25 months with 3-year post-recurrence survival of 72% and 3-year overall survival of 85%. Amongst the factors influencing post-recurrence disease free survival, young age (< 50 years), para-aortic lymph node dissection at initial surgery and single site of lymph node recurrence were significantly associated with better prognosis. A single site of lymph node recurrence was associated with significantly better post-recurrence survival. CONCLUSIONS Complete resection is feasible for epithelial ovarian cancer patients presenting with isolated lymph node recurrence, without any significant perioperative morbidity. When combined with postoperative adjuvant chemotherapy, complete resection is associated with favourable survival outcomes. Young age, para-aortic lymph node dissection during primary surgery and single site of lymph node recurrence are associated with better prognosis.
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Affiliation(s)
- V Jain
- Department of Gynecologic Oncology, Rajiv-Gandhi Cancer Institute and research Centre, Delhi, India.
| | - S Debnath
- Department of Gynecologic Oncology, Rajiv-Gandhi Cancer Institute and research Centre, Delhi, India
| | - A Sharma
- Department of Histopathology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - M Kamboj
- Department of Histopathology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - A Mohanty
- Department of Research, Rajiv-Gandhi Cancer Institute and Research Centre, Delhi, India
| | - S Rawal
- Department of Gynecologic Oncology, Rajiv-Gandhi Cancer Institute and research Centre, Delhi, India
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Olszewska DA, Rawal S, Fearon C, Alcaide‐Leon P, Stell R, Paramanandan V, Lynch T, Jawad T, Vittal P, Barton B, Miyajima H, Kono S, Kandadai RM, Borgohain R, Lang AE. Neuroimaging Pearls from the MDS Congress Video Challenge. Part 1: Genetic Disorders. Mov Disord Clin Pract 2022; 9:297-310. [PMID: 35402643 PMCID: PMC8974871 DOI: 10.1002/mdc3.13412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023] Open
Abstract
We selected several "imaging pearls" presented during the Movement Disorder Society (MDS) Video Challenge for this review. While the event, as implicated by its name, was video-centered, we would like to emphasize the important role of imaging in making the correct diagnosis. We divided this anthology into two parts: genetic and acquired disorders. Genetic cases described herein were organized by the inheritance pattern and the focus was put on the imaging findings and differential diagnoses. Despite the overlapping phenotypes, certain described disorders have pathognomonic MRI brain findings that would provide either the "spot" diagnosis or result in further investigations leading to the diagnosis. Despite this, the diagnosis is often challenging with a broad differential diagnosis, and hallmark findings may be present for only a limited time.
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Affiliation(s)
- Diana A. Olszewska
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital—UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Sapna Rawal
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Conor Fearon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital—UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Paula Alcaide‐Leon
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Rick Stell
- Movement Disorders Unit, Perron Institute of Neurological Translational ScienceSir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | | | - Tim Lynch
- Centre for Brain HealthDublin Neurological Institute at the Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical ScienceUniversity College DublinDublinIreland
| | - Tania Jawad
- Department of NeurologyThe Royal Free HospitalLondonUnited Kingdom
| | - Padmaja Vittal
- Northwestern Medicine Central Dupage HospitalNeurodegenerative Diseases CenterWinfieldIllinoisUSA
| | - Brandon Barton
- Rush University Medical CenterChicagoIllinoisUSA
- Parkinson's Disease Research, Education, and Clinical Care ConsortiumJesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Hiroaki Miyajima
- First Department of MedicineHamamatsu University School of MedicineHamamatsuJapan
| | | | | | - Rupam Borgohain
- Department of NeurologyNizam's Institute of Medical SciencesHyderabadIndia
| | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital—UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
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Fearon C, Rawal S, Olszewska D, Alcaide‐Leon P, Kern DS, Sharma S, Jaiswal SK, Murthy JM, Ha AD, Schwartz RS, Fung VS, Spears C, Tholanikunnel T, Almeida L, Hatano T, Oji Y, Hattori N, Shubham S, Kumar H, Bhidayasiri R, Laohathai C, Lang AE. Neuroimaging Pearls from the MDS Congress Video Challenge. Part 2: Acquired Disorders. Mov Disord Clin Pract 2022; 9:311-325. [PMID: 35402651 PMCID: PMC8974867 DOI: 10.1002/mdc3.13415] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023] Open
Abstract
The MDS Video Challenge continues to be the one of most widely attended sessions at the International Congress. Although the primary focus of this event is the presentation of complex and challenging cases through videos, a number of cases over the years have also presented an unusual or important neuroimaging finding related to the case. We reviewed the previous Video Challenge cases and present here a selection of those cases which incorporated such imaging findings. We have compiled these "imaging pearls" into two anthologies. The first focuses on pearls where the underlying diagnosis was a genetic condition. This second anthology focuses on imaging pearls in cases where the underlying condition was acquired. For each case we present brief clinical details along with neuroimaging findings, the characteristic imaging findings of that disorder and, finally, the differential diagnosis for the imaging findings seen.
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Affiliation(s)
- Conor Fearon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital–UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Sapna Rawal
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Diana Olszewska
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital–UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Paula Alcaide‐Leon
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Drew S. Kern
- Department of Neurology and NeurosurgeryUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Soumya Sharma
- Department of Clinical Neurological Sciences, London Health Sciences CentreWestern UniversityLondonOntarioCanada
| | | | | | - Ainhi D. Ha
- Movement Disorders UnitWestmead HospitalWestmeadNew South WalesAustralia
| | - Raymond S. Schwartz
- Southern NeurologyKoharahNew South WalesAustralia,Sydney Medical SchoolThe University of SydneyCamperdownNew South WalesAustralia
| | - Victor S.C. Fung
- Movement Disorders UnitWestmead HospitalWestmeadNew South WalesAustralia,Sydney Medical SchoolThe University of SydneyCamperdownNew South WalesAustralia
| | - Chauncey Spears
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
| | - Tracy Tholanikunnel
- Department of Neurology, Normal Fixel Institute for Neurological DiseasesUniversity of FloridaGainesvilleFloridaUSA
| | - Leonardo Almeida
- Department of Neurology, Normal Fixel Institute for Neurological DiseasesUniversity of FloridaGainesvilleFloridaUSA
| | - Taku Hatano
- Department of Neurology, Faculty of Medicine, Juntendo UniversityTokyoJapan
| | - Yutaka Oji
- Department of Neurology, Faculty of Medicine, Juntendo UniversityTokyoJapan
| | - Nobutaka Hattori
- Department of Neurology, Faculty of Medicine, Juntendo UniversityTokyoJapan
| | | | | | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand,The Academy of Science, The Royal Society of ThailandBangkokThailand
| | | | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital–UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
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Rawal S, Rinkel GJE, Fang J, Washington CW, Macdonald RL, Victor JC, Krings T, Kapral MK, Laupacis A. External Validation and Modification of Nationwide Inpatient Sample Subarachnoid Hemorrhage Severity Score. Neurosurgery 2021; 89:591-596. [PMID: 34271587 DOI: 10.1093/neuros/nyab237] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Nationwide Inpatient Sample Subarachnoid Hemorrhage (SAH) Severity Score (NIS-SSS) was developed as a measure of SAH severity for use in administrative databases. The NIS-SSS consists of International Classification of Diseases Ninth Revision (ICD-9) diagnostic and procedure codes derived from the SAH inpatient course and has been validated against the Hunt-Hess score (HH). OBJECTIVE To externally validate both the NIS-SSS and a modified version of the NIS-SSS (m-NIS-SSS) consisting of codes present only on admission, against the HH in a Canadian province-wide registry and administrative database of SAH patients. METHODS A total of 1467 SAH patients admitted to Ontario stroke centers between 2003 and 2013 with recorded HH were included. The NIS-SSS and m-NIS-SSS were validated against the HH by testing correlation between the NIS-SSS/m-NIS-SSS and HH, comparing discriminative ability of the NIS-SSS/m-NIS-SSS vs HH for poor outcome by calculating area under the curve (AUC), and comparing calibration of the NIS-SSS, m-NIS-SSS, and HH by plotting predicted vs observed outcome. RESULTS Correlation with HH was 0.417 (P ≤ .001) for NIS-SSS, and 0.403 (P ≤ .001) for m-NIS-SSS. AUC for prediction of poor outcome was 0.786 (0.764-0.808) for HH, 0.771 (0.748-0.793) for NIS-SSS, and 0.744 (0.721-0.767) for m-NIS-SSS. Calibration plots demonstrated that HH had the most accurate prediction of outcome, whereas the NIS-SSS and m-NIS-SSS did not accurately predict low risk of poor outcome. CONCLUSION The NIS-SSS and m-NIS-SSS have good external validity, and therefore, may be suitable to approximate traditional clinical scores of disease severity in SAH research using administrative data.
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Affiliation(s)
- Sapna Rawal
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center, Utrecht, the Netherlands
| | | | - Chad W Washington
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - R Loch Macdonald
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre for Biomedical Research, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - J Charles Victor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Moira K Kapral
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Division of General Internal Medicine and Toronto General Research Institute, University Health Network, Toronto, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Andreas Laupacis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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Shahi A, Gautam N, Rawal S, Sharma U, Jayan A. Lipid Profile and Ultrasonographic Grading in Alcoholic and Non Alcoholic Fatty Liver Patients. Kathmandu Univ Med J (KUMJ) 2021; 19:334-338. [PMID: 36254420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Fatty liver disease (FLD) is a common and major chronic liver disease. It has been implicated that patients have disorders of lipid metabolism and are involved in the pathogenesis of fatty liver. Hence, it was designed to observe the association between lipid profile and fatty liver disease. Objective This study was undertaken to evaluate the association of lipid profile status, hemoglobin and albumin levels with fatty liver disease patients diagnosed based on ultrasonography (USG). Method This Cross-sectional study was undertaken in the Department of Internal Medicine with the collaboration of the Department of Radiology and Department of Biochemistry, Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), Bhairahawa, Nepal from March 2019 to February 2020 in a total of 100 patients diagnosed with fatty liver disease by ultrasonography. The fasting blood was collected for lipid profile and carried out in the automated analyzer following standard protocol. Result In 100 cases, the male to female ratio was 1.8:1. Fifty six percent of the total cases presented with alcoholic fatty liver disease (AFLD) while the remaining 44% with nonalcoholic fatty liver disease (NAFLD). The spectrum of lipid abnormality was observed with increased total cholesterol (TC), Low Density Lipoprotein (LDL), increased triglycerides (TG), Very Low Density Lipoprotein (VLDL) in alcoholic fatty liver disease cases as compared to nonalcoholic fatty liver disease cases. However, it has been observed that TG/HDL and Non-HDL/HDL were higher in nonalcoholic fatty liver disease as compared to alcoholic fatty liver disease. Moreover, a statistically significant difference was observed in HDL between AFLG2 and NAFLG2 (p-value: 0.012). Conclusion Dyslipidemia and decreased HDL have been implicated in fatty liver diseases. USG in conjunction with Non-HDL/HDL, TG/HDL, hemoglobin, and albumin can be useful in early screening and monitoring of dyslipidemia in fatty liver patients.
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Affiliation(s)
- A Shahi
- Department of Internal Medicine, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - N Gautam
- Department of Biochemistry, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - S Rawal
- Department of Radiology, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - U Sharma
- B.Sc. MLT Student, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - A Jayan
- Department of Biochemistry, Universal College of Medical Sciences, Bhairahawa, Nepal
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Khanna A, Singh A, Jaipuria J, Gupta S, Kasaraneni P, Rawal S. Robot assisted video endoscopic inguinal lymph node dissection in carcinoma penis with palpable inguinal lymphadenopathy: Our technique and long term functional and oncological outcomes. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01617-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gupta M, Choudhury P, Singh A, Rawal S. 1P Is 177Lu-PSMA an effective treatment modality for mCRPC patients with visceral metastasis? Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.01.011] [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: 11/24/2022] Open
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Goshen S, Tortolani D, Byham-Gray L, Rawal S. Differences in Chemosensory Perception among Those with and without Chronic Kidney Disease: A Narrative Review. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Dalton J, Rawal S, Rothpletz -Puglia P, Epstein J, Byham-Gray L, Brody R, Ganzer H, Touger-Decker R. Exploring the Transition of Identity in the Eating Experience in Individuals Post-Treatment for Head and Neck Cancer. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Tabarestani S, Varriano B, Rawal S, France Morel C, Carmela Tartaglia M, Andrade DM. Seizures and early onset dementia: D2HGA1 inborn error of metabolism in adults. Ann Clin Transl Neurol 2020; 7:2052-2056. [PMID: 32857435 PMCID: PMC7545601 DOI: 10.1002/acn3.51162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 11/24/2022] Open
Abstract
D‐2‐hydroxyglutaric aciduria type 1 (D2HGA1) is a rare inherited metabolic disorder usually manifesting in infancy/early childhood with seizures and significant central nervous system involvement. We report two siblings with D2HGA1 presenting with mild intellectual disability, and the onset of seizures in adulthood. One of them was misdiagnosed as tuberous sclerosis due to her presentation and the presence of subependymal nodules on brain imaging. Both further developed early onset dementia. This report expands the phenotype of D2HGA1 to include late‐onset seizures and early onset dementia in adults.
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Affiliation(s)
- Sepideh Tabarestani
- Epilepsy Genetics Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brenda Varriano
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Sapna Rawal
- Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Chantal France Morel
- Department of Medicine, Fred A. Litwin Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Toronto Western Hospital, Krembil Neuroscience Centre, University of Toronto, Toronto, Ontario, Canada
| | - Danielle M Andrade
- Epilepsy Genetics Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Toronto Western Hospital, Krembil Neuroscience Centre, University of Toronto, Toronto, Ontario, Canada
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Dasgupta A, Moraes FY, Rawal S, Diamandis P, Shultz DB. Focal Leptomeningeal Disease with Perivascular Invasion in EGFR-Mutant Non-Small-Cell Lung Cancer. AJNR Am J Neuroradiol 2020; 41:1430-1433. [PMID: 32616581 DOI: 10.3174/ajnr.a6640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/07/2020] [Indexed: 11/07/2022]
Abstract
We report a previously undescribed pattern of brain metastases in patients with epidermal growth factor receptor-mutated non-small-cell lung cancer treated with tyrosine kinase inhibitors and radiation therapy. These highly distinct lesions appear to spread focally within the leptomeninges, with invasion along the perivascular spaces (FLIP). The survival of patients with FLIP was significantly better compared with patients with classic leptomeningeal disease (median survival, 21 versus 3 months; P = .003). It is unclear whether this pattern of growth is unique to epidermal growth factor receptor-mutated non-small-cell lung cancer.
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Affiliation(s)
- A Dasgupta
- From the Department of Radiation Oncology (A.D., F.Y.M., D.B.S.), Division of Neuroimaging, Joint Department of Medical Imaging (S.R.), and Department of Neuropathology (P.D.), Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada
| | - F Y Moraes
- From the Department of Radiation Oncology (A.D., F.Y.M., D.B.S.), Division of Neuroimaging, Joint Department of Medical Imaging (S.R.), and Department of Neuropathology (P.D.), Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada
| | - S Rawal
- From the Department of Radiation Oncology (A.D., F.Y.M., D.B.S.), Division of Neuroimaging, Joint Department of Medical Imaging (S.R.), and Department of Neuropathology (P.D.), Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada
| | - P Diamandis
- From the Department of Radiation Oncology (A.D., F.Y.M., D.B.S.), Division of Neuroimaging, Joint Department of Medical Imaging (S.R.), and Department of Neuropathology (P.D.), Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada
| | - D B Shultz
- From the Department of Radiation Oncology (A.D., F.Y.M., D.B.S.), Division of Neuroimaging, Joint Department of Medical Imaging (S.R.), and Department of Neuropathology (P.D.), Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.
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Jaipuria J, Rawal S, Singh A, Gupta S. Robotic salvage cystectomy post radiotherapy: It’s feasible. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Schaafsma JD, Rawal S, Coutinho JM, Rasheedi J, Mikulis DJ, Jaigobin C, Silver FL, Mandell DM. Diagnostic Impact of Intracranial Vessel Wall MRI in 205 Patients with Ischemic Stroke or TIA. AJNR Am J Neuroradiol 2019; 40:1701-1706. [PMID: 31488500 DOI: 10.3174/ajnr.a6202] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/24/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Secondary prevention of ischemic stroke depends on determining the cause of the initial ischemic event, but standard investigations often fail to identify a cause or identify multiple potential causes. The purpose of this study was to characterize the impact of intracranial vessel wall MR imaging on the etiologic classification of ischemic stroke. MATERIALS AND METHODS This was a single-center, retrospective study of 205 consecutive patients who were referred for vessel wall MR imaging to clarify the etiology of an ischemic stroke or TIA. An expert panel classified stroke etiology before and after incorporating vessel wall MR imaging results using a modified Trial of Org 10172 in Acute Stroke Treatment system. We measured the proportion of patients with an altered etiologic classification after vessel wall MR imaging. RESULTS The median age was 56 years (interquartile range = 44-67 years), and 51% (106/205) of patients were men. Vessel wall MR imaging altered the etiologic classification in 55% (112/205) of patients. The proportion of patients classified as having intracranial arteriopathy not otherwise specified decreased from 31% to 4% (64/205 versus 9/205; P < .001) and the proportion classified as having intracranial atherosclerotic disease increased from 23% to 57% (48/205 versus 116/205; P < .001). Conventional work-up classification as intracranial arteriopathy not otherwise specified was an independent predictor of vessel wall MR imaging impact (OR = 8.9; 95% CI, 3.0-27.2). The time between symptom onset and vessel wall MR imaging was not a predictor of impact. CONCLUSIONS When vessel wall MR imaging is performed to clarify the etiology of a stroke or TIA, it frequently alters the etiologic classification. This is important because the etiologic classification is the basis for therapeutic decision-making.
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Affiliation(s)
- J D Schaafsma
- From the Division of Neurology, Department of Medicine (J.D.S., J.R., C.J., F.L.S.)
| | - S Rawal
- Division of Neuroradiology, Department of Medical Imaging (S.R., J.M.C., D.J.M., D.M.M.), University Health Network, Toronto, Ontario, Canada
| | - J M Coutinho
- Division of Neuroradiology, Department of Medical Imaging (S.R., J.M.C., D.J.M., D.M.M.), University Health Network, Toronto, Ontario, Canada.,Department of Neurology (J.M.C.), Academic Medical Center, Amsterdam, the Netherlands
| | - J Rasheedi
- From the Division of Neurology, Department of Medicine (J.D.S., J.R., C.J., F.L.S.)
| | - D J Mikulis
- Division of Neuroradiology, Department of Medical Imaging (S.R., J.M.C., D.J.M., D.M.M.), University Health Network, Toronto, Ontario, Canada
| | - C Jaigobin
- From the Division of Neurology, Department of Medicine (J.D.S., J.R., C.J., F.L.S.)
| | - F L Silver
- From the Division of Neurology, Department of Medicine (J.D.S., J.R., C.J., F.L.S.)
| | - D M Mandell
- Division of Neuroradiology, Department of Medical Imaging (S.R., J.M.C., D.J.M., D.M.M.), University Health Network, Toronto, Ontario, Canada
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Gupta M, Choudhury P, Rawal S, Goel H, Talwar V, Dutta K, Singh A. Safety profile and therapeutic efficacy of one cycle of [177Lu]prostate-specific membrane antigen (PSMA) in end stage metastatic castration-resistant prostate cancer patients with low performance status. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz029.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Gottesman K, Rawal S, Parrott J, Radler D, Byham-Gray L, Touger-Decker R. Changes in Cardiometabolic Risk Factors and in Physical Activity in Worksite Wellness Participants. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.069] [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: 11/24/2022]
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18
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Roberts S, Byham-Gray L, Brody R, Rawal S. VBEN vs RBEN in the ICU: Impact on Nutrition Delivery and Glycemic Control. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bajracharya Shakya A, Jain V, Sekhon R, Rawal S, Mehta A. Diagnostic Accuracy of Intraoperative Frozen Section in Ovarian Neoplasms: Experience in a Tertiary Oncology Centre. Kathmandu Univ Med J (KUMJ) 2018; 16:259-262. [PMID: 31719317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Ovarian cancer is the second most common type of female genital tract malignancy. Treatment planning differs for benign, borderline and malignant subtypes of surface epithelial tumours and depends on accurate histopathological diagnosis. A pre-operative diagnosis of the nature of ovarian tumors is not always reliable. Frozen section is a valuable diagnostic tool in rapid intraoperative categorization of ovarian masses and thereby helps in planning the surgical management. Adequate management and treatment of ovarian carcinoma requires a complete surgical staging supported by frozen-section examination. To achieve this goal it is necessary to have a high level of accuracy. Objective To assess the accuracy of intra-operative frozen section in the diagnosis of various categories of ovarian neoplasm conducted in Rajiv Gandhi Cancer Institute and Research Centre. Method Intra-operative frozen sections for suspected ovarian neoplasm that underwent surgery as primary line of therapy at this institution were analyzed retrospectively from Jan. 2014 - Dec. 2015. The results of frozen section were compared with the final histopathology diagnosis on paraffin sections and the overall accuracy, sensitivity, specificity, positive and negative predictive values were determined. Result The study included 159 cases and the mean age of patients was 44.72±14.28 years (Range 19-75 years). The mean size of tumor was 12.5±5.9 cm. Sensitivity of frozen section for benign, borderline and malignant tumors was 98.53%, 73.33% and 94.74% respectively and the related specificities were 95.60%, 96.53% and 100% respectively. There were 150 concordant cases and 9 discordant cases. Overall diagnostic accuracy of frozen section was 94.33%. Conclusion Intra-operative frozen section diagnosis appeared to be an accurate and comparable technique for the histopathology diagnosis of ovarian tumors.
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Affiliation(s)
- A Bajracharya Shakya
- Department of Gynae-Oncology, Nepal Cancer Hospital and Research Centre, Harisidhhi, Lalitpur
| | - V Jain
- Department of Gynae-Oncology, Rajiv Cancer Hospital and Research Centre, Delhi
| | - R Sekhon
- Department of Gynae-Oncology, Rajiv Cancer Hospital and Research Centre, Delhi
| | - S Rawal
- Department of Uro-gyneoncology, Rajiv Cancer Hospital and Research Centre, Delhi
| | - A Mehta
- Department of Patholgy, Rajiv Cancer Hospital and Research Centre, Delhi
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Breen DP, Rawal S, Slow EJ, Lang AE. CLIPPERS: A Treatable Cause of Spastic Ataxia. Mov Disord Clin Pract 2018; 5:212-214. [PMID: 33999979 DOI: 10.1002/mdc3.12602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/25/2018] [Accepted: 02/06/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- David P Breen
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital Toronto Canada
| | - Sapna Rawal
- Division of Neuroradiology, Department of Medical Imaging University Health Network, Toronto Western Hospital Toronto Canada
| | - Elizabeth J Slow
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital Toronto Canada
| | - Anthony E Lang
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital Toronto Canada
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Abstract
Abstract
Optimal diagnosis and characterization of cerebrovascular disease requires selection of the appropriate imaging exam for each clinical situation. In this review, we focus on intracranial arterial disease and discuss the techniques in current clinical use for imaging the blood vessel lumen and blood vessel wall, and for mapping cerebral hemodynamic impairment at the tissue level. We then discuss specific strategies for imaging intracranial aneurysms, arteriovenous malformations, dural arterial venous fistulas, and arterial steno-occlusive disease.
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Affiliation(s)
- Amy Lin
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Sapna Rawal
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Ronit Agid
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Daniel M Mandell
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
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Rawal S, Alcaide-Leon P, Macdonald RL, Rinkel GJE, Victor JC, Krings T, Kapral MK, Laupacis A. Meta-analysis of timing of endovascular aneurysm treatment in subarachnoid haemorrhage: inconsistent results of early treatment within 1 day. J Neurol Neurosurg Psychiatry 2017; 88:241-248. [PMID: 28100721 DOI: 10.1136/jnnp-2016-314596] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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] [Received: 08/02/2016] [Revised: 12/06/2016] [Accepted: 12/19/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE To systematically review and meta-analyse the data on impact of timing of endovascular treatment in aneurysmal subarachnoid haemorrhage (SAH) to determine if earlier treatment is associated with improved clinical outcomes and reduced case fatality. METHODS We searched MEDLINE, Cochrane database, EMBASE and Web of Science to identify studies for inclusion. The measures of effect utilised were unadjusted/adjusted ORs. Effect estimates were combined using random effects models for each outcome (poor outcome, case fatality); heterogeneity was assessed using the I2 index. Subgroup and sensitivity analyses were performed to account for heterogeneity and risk of bias. RESULTS 16 studies met the inclusion criteria. Treatment <1 day was associated with a reduced odds of poor outcome compared with treatment >1 day (OR=0.40 (95% CI 0.28 to 0.56; I2=0%)) but not when compared with treatment at 1-3 days (OR=1.16 (95% CI 0.47 to 2.90; I2=81%)). Treatment at <2 days and at <3 days were associated with similar odds of poor outcome compared with later treatment (OR=1.20 (95% CI 0.70 to 2.05; I2=73%; OR=0.71 (95% CI 0.36 to 1.37; I2=71%)). Early treatment was associated with similar odds of case fatality compared with later treatment, regardless of how early/late treatment were defined (OR=1.80 (95% CI 0.88 to 3.67; I2=34%) for treatment <1 day vs days 1-3; OR=1.71 (95% CI 0.72 to 4.03; I2=54%) for treatment <2 days vs later; OR=0.90 (95% CI 0.31 to 2.68; I2=48%) for treatment <3 days vs later). CONCLUSIONS In only 1 of the analyses was there a statistically significant result, which favoured treatment <1 day. The inconsistent results and heterogeneity within most analyses highlight the lack of evidence for best timing of endovascular treatment in SAH patients.
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Affiliation(s)
- Sapna Rawal
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paula Alcaide-Leon
- Division of Neuroradiology, Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
| | - R Loch Macdonald
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre for Biomedical Research and Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands
| | - J Charles Victor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Moira K Kapral
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of General Internal Medicine, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Andreas Laupacis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Medicine, St Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
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Alcaide-Leon P, Pauranik A, Alshafai L, Rawal S, Oh J, Montanera W, Leung G, Bharatha A. Comparison of Sagittal FSE T2, STIR, and T1-Weighted Phase-Sensitive Inversion Recovery in the Detection of Spinal Cord Lesions in MS at 3T. AJNR Am J Neuroradiol 2016; 37:970-5. [PMID: 26797141 DOI: 10.3174/ajnr.a4656] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/09/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Determining the diagnostic accuracy of different MR sequences is essential to design MR imaging protocols. The purpose of the study was to compare 3T sagittal FSE T2, STIR, and T1-weighted phase-sensitive inversion recovery in the detection of spinal cord lesions in patients with suspected or definite MS. MATERIALS AND METHODS We performed a retrospective analysis of 38 patients with suspected or definite MS. Involvement of the cervical and thoracic cord segments was recorded on sagittal FSE T2, STIR, and T1-weighted phase-sensitive inversion recovery sequences independently by 2 readers. A consensus criterion standard read was performed with all sequences available. Sensitivity, specificity, and interobserver agreement were calculated for each sequence. RESULTS In the cervical cord, the sensitivity of T1-weighted phase-sensitive inversion recovery (96.2%) and STIR (89.6%) was significantly higher (P < .05) than that of FSE T2 (50.9%), but no significant difference was found between T1-weighted phase-sensitive inversion recovery and STIR. In the thoracic cord, sensitivity values were 93.8% for STIR, 71.9% for FSE T2, and 50.8% for T1-weighted phase-sensitive inversion recovery. Significant differences were found for all comparisons (P < .05). No differences were detected in specificity. Poor image quality and lower sensitivity of thoracic T1-weighted phase-sensitive inversion recovery compared with the other 2 sequences were associated with a thicker back fat pad. CONCLUSIONS The use of an additional sagittal sequence other than FSE T2 significantly increases the detection of cervical and thoracic spinal cord lesions in patients with MS at 3T. In the cervical segment, both STIR and T1-weighted phase-sensitive inversion recovery offer high sensitivity and specificity, whereas in the thoracic spine, STIR performs better than T1-weighted phase-sensitive inversion recovery, particularly in patients with a thick dorsal fat pad.
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Affiliation(s)
- P Alcaide-Leon
- From the Departments of Medical Imaging (P.A.-L., A.P., W.M., G.L., A.B.)
| | - A Pauranik
- From the Departments of Medical Imaging (P.A.-L., A.P., W.M., G.L., A.B.)
| | - L Alshafai
- Department of Medical Imaging (L.A.), University Health Network, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - S Rawal
- Department of Medical Imaging (S.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - J Oh
- Movement Disorders (J.O.), St Michael's Hospital, Toronto, Ontario, Canada
| | - W Montanera
- From the Departments of Medical Imaging (P.A.-L., A.P., W.M., G.L., A.B.)
| | - G Leung
- From the Departments of Medical Imaging (P.A.-L., A.P., W.M., G.L., A.B.)
| | - A Bharatha
- From the Departments of Medical Imaging (P.A.-L., A.P., W.M., G.L., A.B.)
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Uemura H, Ye D, Wu TL, Lee JY, Chong Y, Razack A, Pripatnanont C, Chiong E, Lau W, Kanesvaran R, Li C, Rawal S, Tongaonkar H, Pu YS, Santingamkun A, Lojanapiwat B, Liang H, Mah K, van Kooten Losio M, Liu Y. 266TiP A multicenter, prospective, longitudinal registry of prostate cancer in Asia. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv524.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Singh S, Mishra A, Goel V, Talwar V, Raina S, Dodagaudar C, Mitra S, Saxena U, Shekhon R, Rawal S. 2727 Neo-adjuvant chemotherapy followed by surgery vs definitive chemo radiation as treatment for localized carcinoma cervix. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31494-0] [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: 11/27/2022]
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Abstract
Aims: This was performed to study the characteristics of Pregnancy Related Acute Kidney Injury (PRAKI), its management and outcome in patients at a tertiary level referral centre. Methods: A hospital based prospective observational study was conducted in Tribhuvan University Teaching Hospital (TUTH) over a period of 18 months. All patients diagnosed with PRAKI were included in the study. Patient profiles in terms of age, parity, gestational age were studied along with time of occurrence of PRAKI, preceding event, etiology, management and maternal outcome. Descriptive and univariate analyses were conducted and qualitative variables were expressed as percentages while quantitative variables as means. Results: There were fifteen cases of PRAKI during the study period with incidence of 2.1 per 1000 deliveries. The average age was 25.23± 3.8 years and 9(60%) were primipara. Fourteen (93.3%) developed PRAKI in the postpartum period with 10(66.6%) cases following Lower Segment Caesarian Section (LSCS). The commonest etiology of PRAKI was severe preeclampsia/ Hemolysis, Elevated Liver enzymes, Low Platelet (HELLP) syndrome and pregnancy hemorrhages each consisting 4(26.6%) cases. The stage of Acute Kidney Injury (AKI) according to RIFLE (Risk, Injury, Failure, Loss, ESRD-End Stage Renal Disease) criteria was as follows: risk in 1(6.6%), injury in 3(20%) and failure in 11(73.3%) cases. Hemodialysis was necessary in 12(80%) cases while 3 cases (20%) improved with medical management only. The average duration of hospital stay was 25.2±14.7 days and 7(46.6%) needed ICU admission. Twelve (80%) cases recovered completely while two patients were dialysis dependent at the time of evaluation. There was one death. Conclusions: PRAKI occurred mainly in the postpartum period with severe preeclampsia/HELLP syndrome and hemorrhages as the most common causes. It is associated with high maternal morbidity, prolonged hospital stay and even mortality. Multidisciplinary team management is essential.
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27
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Joshi R, Rawal S. Targeted Therapy for Renal Cell Carcinoma. JNMA J Nepal Med Assoc 2015; 53:83-88. [PMID: 26994026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Our study aims to evaluate the use of targeted therapy in metastatic renal cell carcinoma Methods: This is a prospective study done over three years from December 2010 to December, 2013.Out of Forty seven patients of metastatic renal cell carcinoma 8(neo-adjuvant cases) were excluded and 39 were included in this study. All patients received Tyrosine kinase inhibitor, sunitinib therapy (50 mg OD, 4/2 scheme). All 39 patients underwent radical nephrectomy prior to sunitinib therapy. Patients were followed up every cycle for their clinical symptoms following sunitinib therapy and every 3 months with chest X-ray, ultra-sonography and bone scan. CT scan was done if needed. A RECIST criterion was used to evaluate the complete, partial and no tumor response. RESULTS The median survival was 28.5 months (CI 9.253-47.7) and progression free survival (PFS) was 9.16 months(CI 6.08-12.23).According to RECIST, stable disease was found in 6 patients till date and a complete response in two patients. Clear cell histology was found in 30(76.9%) patients, papillary variety in 6(15.39%) patients, chromophobe type was seen in one patient and rest had mixed sarcomatoid papillary and rhabdoid clear cell variety. Twenty four patients (61.5%) had multiple metastases. Most frequent metastasis was seen in lungs in 14 patients (36%) and bone in 12 patients (31%).Metastases were also seen in draining lymph nodes, adrenals, omentum,skin, liver, and brain. CONCLUSIONS In our cohort, use of sunitinib showed similar outcome to previously published articles. Our study supports the use of sunitinib in metastatic renal cell carcinoma.
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Affiliation(s)
- R Joshi
- Kathmandu Medical College, Kathmandu, Nepal
| | - S Rawal
- Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
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Saliou G, Sacho RH, Power S, Kostynskyy A, Willinsky RA, Tymianski M, terBrugge KG, Rawal S, Krings T. Natural history and management of basilar trunk artery aneurysms. Stroke 2015; 46:948-53. [PMID: 25712945 DOI: 10.1161/strokeaha.114.006909] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Basilar trunk aneurysms (BTAs), defined as aneurysms distal to the basilar origin and proximal to the origin of the superior cerebellar artery, are rare and challenging to manage. We describe the natural history and management in a consecutive series of BTAs. METHODS Between 2000 and 2013, 2522 patients with 3238 aneurysms were referred to our institution for aneurysm management. A retrospective review of this database was conducted to identify all patients with BTAs. RESULTS In total, 52 patients had a BTA. Mean age was 56 (SD±18) years. Median clinical follow-up was 33 (interquartile range, 8-86) months, and imaging follow-up was 26 (interquartile range, 2-80.5) months. BTAs were classified into 4 causal subtypes: acute dissecting aneurysms, segmental fusiform ectasia, mural bleeding ectasia, and saccular aneurysms. Multiple aneurysms were more frequently noticed among the 13 saccular aneurysms when compared with overall population (P=0.021). There was preponderance of segmental ectasia or mural bleeding ectasia (P=0.045) in patients presenting with transit ischemic attack/stroke or mass effect. Six patients with segmental and 4 with mural bleeding ectasia demonstrated increasing size of their aneurysm, with 2 having subarachnoid hemorrhage caused by aneurysm rupture. None of the fusiform aneurysms that remained stable bled. CONCLUSIONS BTAs natural histories may differ depending on subtype of aneurysm. Saccular aneurysms likely represent an underlying predisposition to aneurysm development because more than half of these cases were associated with multiple intracranial aneurysms. Intervention should be considered in segmental ectasia and chronic dissecting aneurysms, which demonstrate increase in size over time as there is an increased risk of subarachnoid hemorrhage.
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Affiliation(s)
- Guillaume Saliou
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada.
| | - Raphael H Sacho
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Sarah Power
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Alex Kostynskyy
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert A Willinsky
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Michael Tymianski
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Karel G terBrugge
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Sapna Rawal
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- From the Department of Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicetre, France (G.S.); and Division of Neuroradiology, Department of Medical Imaging (G.S., R.H.S., S.P., A.K., R.A.W., K.G.t., S.R., T.K.) and Division of Neurosurgery (M.T.), Toronto Western Hospital, Toronto, Ontario, Canada
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Abstract
Background and Purpose—
Delayed cerebral ischemia (DCI) is a serious complication after aneurysmal subarachnoid hemorrhage. If DCI is suspected clinically, imaging methods designed to detect angiographic vasospasm or regional hypoperfusion are often used before instituting therapy. Uncertainty in the strength of the relationship between imaged vasospasm or perfusion deficits and DCI-related outcomes raises the question of whether imaging to select patients for therapy improves outcomes in clinical DCI.
Methods—
Decision analysis was performed using Markov models. Strategies were either to treat all patients immediately or to first undergo diagnostic testing by digital subtraction angiography or computed tomography angiography to assess for angiographic vasospasm, or computed tomography perfusion to assess for perfusion deficits. According to current practice guidelines, treatment consisted of induced hypertension. Outcomes were survival in terms of life-years and quality-adjusted life-years.
Results—
When treatment was assumed to be ineffective in nonvasospasm patients, Treat All and digital subtraction angiography were equivalent strategies; when a moderate treatment effect was assumed in nonvasospasm patients, Treat All became the superior strategy. Treating all patients was also superior to selecting patients for treatment via computed tomography perfusion. One-way sensitivity analyses demonstrated that the models were robust; 2- and 3-way sensitivity analyses with variation of disease and treatment parameters reinforced dominance of the Treat All strategy.
Conclusions—
Imaging studies to test for the presence of angiographic vasospasm or perfusion deficits in patients with clinical DCI do not seem helpful in selecting which patients should undergo treatment and may not improve outcomes. Future directions include validating these results in prospective cohort studies.
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Affiliation(s)
- Sapna Rawal
- From the Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (S.R., T.K.); Division of Neurology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada (C.B.); Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada (A.J.-B.); Women’s College Research Institute, Women’s College Hospital,
| | - Carolina Barnett
- From the Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (S.R., T.K.); Division of Neurology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada (C.B.); Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada (A.J.-B.); Women’s College Research Institute, Women’s College Hospital,
| | - Ava John-Baptiste
- From the Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (S.R., T.K.); Division of Neurology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada (C.B.); Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada (A.J.-B.); Women’s College Research Institute, Women’s College Hospital,
| | - Hla-Hla Thein
- From the Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (S.R., T.K.); Division of Neurology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada (C.B.); Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada (A.J.-B.); Women’s College Research Institute, Women’s College Hospital,
| | - Timo Krings
- From the Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (S.R., T.K.); Division of Neurology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada (C.B.); Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada (A.J.-B.); Women’s College Research Institute, Women’s College Hospital,
| | - Gabriel J.E. Rinkel
- From the Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada (S.R., T.K.); Division of Neurology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada (C.B.); Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada (A.J.-B.); Women’s College Research Institute, Women’s College Hospital,
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Rawal S, Munasinghe E, Shindikar A, Manning P, Katare R. Orchestrated role of cardiovascular microRNAs in diabetic cardiomyopathy. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.246] [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: 11/27/2022]
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Hashemi Sadraei N, Williams A, Du L, Pennell N, Ma P, Jacobs B, Ao Z, Rawal S, McConnell M, Haddad A, Spiro T, Jia X, Elson P, Datar R, Cote R, Borden E. Circulating Tumor Cells (CTCs) in Advanced Lung Cancer: Prognostic Impact of Quantification and Morphology by 2 Separate Techniques. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.08.319] [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: 10/24/2022]
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Rawal S, Croul SE, Willinsky RA, Tymianski M, Krings T. Subcortical cystic lesions within the anterior superior temporal gyrus: a newly recognized characteristic location for dilated perivascular spaces. AJNR Am J Neuroradiol 2013; 35:317-22. [PMID: 23945225 DOI: 10.3174/ajnr.a3669] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Cystic parenchymal lesions may pose an important diagnostic challenge, particularly when encountered in unexpected locations. Dilated perivascular spaces, which may mimic cystic neoplasms, are known to occur in the inferior basal ganglia and mesencephalothalamic regions; a focal preference within the subcortical white matter has not been reported. This series describes 15 cases of patients with cystic lesions within the subcortical white matter of the anterior superior temporal lobe, which followed a CSF signal; were located adjacent to a subarachnoid space; demonstrated variable surrounding signal change; and, in those that were followed up, showed stability. Pathology study results obtained in 1 patient demonstrated chronic gliosis surrounding innumerable dilated perivascular spaces. These findings suggest that dilated perivascular spaces may exhibit a regional preference for the subcortical white matter of the anterior superior temporal lobe. Other features-lack of clinical symptoms, proximity to the subarachnoid space, identification of an adjacent vessel, and stability with time-may help in confidently making the prospective diagnosis of a dilated perivascular space, thereby preventing unnecessary invasive management.
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Affiliation(s)
- S Rawal
- From the Division of Neuroradiology (S.R., R.A.W., T.K.)
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Su IC, Krishnan P, Rawal S, Krings T. Magnetic Resonance Evolution of De Novo Formation of a Cavernoma in a Thrombosed Developmental Venous Anomaly. Neurosurgery 2013; 73:E739-44; discussion E745. [DOI: 10.1227/neu.0000000000000002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
Mechanisms that lead to de novo formations of nonfamilial-type cavernomas are not well understood. One of the interesting hypotheses is the causative relationship between developmental venous anomaly (DVA) and cavernoma formation. We report a unique case in which serial imaging demonstrated the evolution of de novo formation of a cavernoma in association with a thrombosed DVA. A detailed review of the causal hypothesis between a DVA and cavernoma is also provided.
CLINICAL PRESENTATION:
We report a 37-year-old female patient in whom a cavernoma-like lesion arose 1 year after the progressive thrombosis of a medullary (or caput medusa) vein of a DVA. The presence of an acute angulation in the draining vein may have prompted an intrinsic outflow restriction. Possible worsening of venous disequilibrium led to subsequent thrombus progression, venous congestion, and occlusion of the vein with venous dilation and signs of stasis on follow-up magnetic resonance imaging. Finally, this developed into a lobulated lesion with salt-and-pepper appearance at the converging region of medullary tributaries, which typified the classic features of a cavernoma.
CONCLUSION:
Compared with other published cases of de novo cavernoma formation in relation to a DVA, our case, for the first time, allows us to witness the temporal evolution from a thrombosed DVA to the birth of a cavernoma around it. This supports the hypothesis that the cavernoma can be an acquired disease that arises from a DVA.
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Affiliation(s)
- I-Chang Su
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan
| | - Pradeep Krishnan
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sapna Rawal
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Mahaseth BK, Singh M, Rawal S. A Randomized Trial to Determine the Efficacy of Dry Versus Wet Misoprostol for Termination of First Trimester Pregnancy. Nepal j obstet gynaecol 2012. [DOI: 10.3126/njog.v6i2.6751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
NJOG 2011 Nov-Dec; 6 (2): 20-23 DOI: http://dx.doi.org/10.3126/njog.v6i2.6751
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Francis ST, Rawal S, Roberts H, Riley P, Planche T, Kennea NL. Detection of meticillin-resistant staphylococcus aureus (MRSA) colonization in newborn infants using real-time polymerase chain reaction (PCR). Acta Paediatr 2010; 99:1691-4. [PMID: 20528798 DOI: 10.1111/j.1651-2227.2010.01899.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Meticillin-resistant staphylococcus aureus (MRSA) colonization on neonatal units is a common and important clinical problem. Effectiveness of polymerase chain reaction (PCR) for detecting MRSA nasal colonization of infants was evaluated and compared to culture-based methods. The effect of skin decolonization in affected infants was studied. METHODS Paired nasal swabs were collected from infants in our neonatal unit over a 12-month period (September 2007-2008). Colonization with MRSA was determined with a commercially available PCR method and compared to culture. RESULTS A total of 696 paired nasal swabs were taken. Three infants were colonized at the beginning and were included. There were positive PCRs in 12 infants. Five infants cultured MRSA from a nasal swab at the same time. No infants were culture-positive when PCR was negative (sensitivity 100%, specificity 99% compared to culture). PCR results were available within 24 h. Five infants were PCR+ and isolated meticillin-sensitive Staphylococcus aureus. This organism gave a false-positive PCR result. Two infants transferred in on broad-spectrum antibiotics were PCR+ and negative by culture. Decolonization led to negative nasal PCR and culture in 4/5 infants to discharge. CONCLUSIONS PCR methods are sensitive and specific for detection of MRSA colonization in newborn infants of all gestations with results 1-2 days before culture.
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Affiliation(s)
- S T Francis
- Regional Neonatal Unit, St George's Hospital, London, UK
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Abstract
Primary ovarian pregnancy is a rare entity, the incidence being 1 in 25,000 to 40,000 pregnancies. The diagnosis is difficult and still continues to challenge the clinicians. A case of ovarian pregnancy is reported here. The patient underwent laparotomy with right sided oophorectomy. Histopathological examination confirmed it to be an ovarian pregnancy.
Keywords: ectopia pregnancy, oophorectomy, ovarian pregnancy.
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Thapa M, Rawal S, Jha R, Singh M. Ovarian pregnancy: a rare ectopic pregnancy. JNMA J Nepal Med Assoc 2010; 49:52-55. [PMID: 21180222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Primary ovarian pregnancy is a rare entity, the incidence being 1 in 25,000 to 40,000 pregnancies. The diagnosis is difficult and still continues to challenge the clinicians. A case of ovarian pregnancy is reported here. The patient underwent laparotomy with right sided oophorectomy. Histopathological examination confirmed it to be an ovarian pregnancy.
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Affiliation(s)
- M Thapa
- Department of Obstetrics and Gynaecology, TUTH, Kathmandu, Nepal.
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Khan R, Rawal S, Eisenberg MJ. Transitioning from 16-slice to 64-slice multidetector computed tomography for the assessment of coronary artery disease: are we really making progress? Can J Cardiol 2009; 25:533-42. [PMID: 19746244 DOI: 10.1016/s0828-282x(09)70144-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multidetector computed tomography (MDCT) has demonstrated promise in the noninvasive evaluation of coronary artery disease. OBJECTIVE To systematically review the literature regarding the improved diagnostic accuracy of 64-slice MDCT. METHODS An EMBASE, OVID, PubMed and Cochrane Library database search was performed using the key words 'computed tomography' matched with the terms 'coronary artery' or 'coronary angiography' to identify English-language articles examining MDCT cardiac imaging. Studies that compared 16-slice or 64-slice MDCT with catheter-based coronary angiography for the detection of coronary artery disease in nonrevascularized, poststent and post-coronary artery bypass graft patients were included. Data were pooled to obtain a weighted sensitivity, specificity and diagnostic accuracy for MDCT. Negative and positive predictive values, and likelihood ratios were calculated based on sensitivity and specificity. RESULTS Currently, 15 studies involving 1008 patients have examined the efficacy of 64-slice MDCT in the assessment of coronary artery stenosis (more than 50% luminal narrowing). In these studies, 64-slice MDCT has demonstrated a sensitivity (89%), specificity (96%) and diagnostic accuracy (95%) similar to that of 16-slice MDCT. However, 64-slice MDCT was able to assess 5% more coronary artery segments than 16-slice MDCT. In revascularized patients, MDCT can accurately assess both bypass graft occlusion and stenosis. The 64-slice MDCT is also capable of adequately detecting in-stent restenosis. Improvements in spatial and temporal resolution with 64-slice technology have decreased the occurrence of high attenuation and motion artefacts that plagued the previous generation of MDCT scanners. CONCLUSION MDCT offers an accurate assessment of the coronary arteries, stented arteries and bypass grafts. The improved accuracy and safety of MDCT may reduce the need for catheter-based coronary angiography.
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Affiliation(s)
- Razi Khan
- Division of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada.
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Rawal S, Mendoza KM, Reed KM, Coulombe RA. Structure, genetic mapping, and function of the cytochrome P450 3A37 gene in the turkey (Meleagris gallopavo). Cytogenet Genome Res 2009; 125:67-73. [PMID: 19617698 DOI: 10.1159/000218748] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2008] [Indexed: 11/19/2022] Open
Abstract
Cytochromes P450 (P450 for protein; CYP for gene) are a superfamily of membrane-bound hemoproteins that oxidize a large number of endogenous and exogenous compounds. Through oxidation reactions, these enzymes are often responsible for the toxic and carcinogenic effects of natural food-borne toxicants, such as the mycotoxin aflatoxin B1 (AFB1). Previous studies in our laboratory have shown that the extreme sensitivity of turkeys to AFB1 is in part explained by efficient hepatic P450-mediated epoxidation to the toxic and reactive metabolite the exo-AFB1-8,9-epoxide (AFBO). Using 3'-5'-rapid amplification of cDNA ends (RACE), we amplified CYP3A37 from turkey liver RNA, the E. coli-expressed protein which efficiently epoxidates AFB(1). Turkey CYP3A37 has an ORF of 1512 bp, and the protein is predicted to be 504 amino acids with 97% homology to chicken CYP3A37. The turkey gene is organized into 13 exons and 12 introns. A single nucleotide polymorphism in the 11th intron was used to assign CYP3A37 to turkey linkage group 10 (corresponding to chicken chromosome 14, GGA14). Because of the important role of P450s in the extreme sensitivity of turkeys to the toxic effects of AFB(1), this study will contribute to the identifying allelic variants of this important gene in poultry.
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Affiliation(s)
- S Rawal
- Graduate Toxicology Program and Department of Veterinary Sciences, Utah State University, Logan, Utah 84322, USA
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Bitton A, Dobkin PL, Edwardes MD, Sewitch MJ, Meddings JB, Rawal S, Cohen A, Vermeire S, Dufresne L, Franchimont D, Wild GE. Predicting relapse in Crohn's disease: a biopsychosocial model. Gut 2008; 57:1386-92. [PMID: 18390994 DOI: 10.1136/gut.2007.134817] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [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: 12/13/2022]
Abstract
BACKGROUND Crohn's disease (CD) is a chronic relapsing inflammatory bowel disorder. Both biological and psychosocial factors may modulate the illness experience. AIM The aim of this study was to identify clinical, biological and psychosocial parameters as predictors of clinical relapse in quiescent CD. METHODS Patients in medically induced remission were followed prospectively for 1 year, or less if they relapsed. Disease characteristics were determined at baseline. Serum cytokines, anti-Saccharomyces cerevisiae antibodies, C-reactive protein (CRP), erythrocyte sedimentation rate and intestinal permeability were measured every 3 months. Psychological distress, perceived stress, minor life stressors and coping strategies were measured monthly. A time-dependent multivariate Cox regression model determined predictors of time to relapse. RESULTS 101 patients (60 females, 41 males) were recruited. Fourteen withdrew and 37 relapsed. CRP (HR = 1.5 per 10 mg/l, 95% CI 1.1 to 1.9, p = 0.007), fistulising disease (HR = 3.2, 95% CI, 1.1 to 9.4, p = 0.04), colitis (HR = 3.5 95% CI 1.2 to 9.9, p = 0.02) and the interaction between perceived stress and avoidance coping (HR = 7.0 per 5 unit increase for both scales, 95% CI 2.3 to 21.8, p = 0.003) were predictors of earlier relapse. CONCLUSIONS In quiescent CD, a higher CRP, fistulising disease behaviour and disease confined to the colon were independent predictors of relapse. Moreover, patients under conditions of low stress and who scored low on avoidance coping (ie, did not engage in social diversion or distraction) were least likely to relapse. This study supports a biopsychosocial model of CD exacerbation.
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Affiliation(s)
- A Bitton
- McGill University Health Centre, 687 Pine Avenue West, Montreal, Quebec, Canada, H3A 1A1.
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Kellow ZS, MacInnes M, Kurzencwyg D, Rawal S, Jaffer R, Kovacina B, Stein LA. The Role of Abdominal Radiography in the Evaluation of the Nontrauma Emergency Patient. Radiology 2008; 248:887-93. [DOI: 10.1148/radiol.2483071772] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rawal S, Koirala P, Singh M, Rana A. Heterotopic pregnancy with spontaneous intrauterine conception: a rare clinical entity with diagnostic dilemma. Kathmandu Univ Med J (KUMJ) 2008; 6:105-108. [PMID: 18604125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Twenty-one years old primigravida presented to emergency with amenorrhoea for 2 months and complaints of severe abdominal pain for few hours. The pain was associated with 2 episodes of fainting attacks in emergency during the period of observation. Viable intrauterine pregnancy of 8-9 weeks along with collection of fluid in the Pouch of Douglas was detected by ultrasound examination and on laparotomy ectopic pregnancy was confirmed with haemoperitoneum of 2 litres with 500gms of clots. Histopathology report confirmed the tubal ectopic pregnancy and postlaparotomy, transvaginal sonography confirmed the salvage of the intrauterine pregnancy. Despite massive haemoperitoneum, the pregnancy continued till 40+6 weeks with uneventful antenatal period. She underwent emergency caesarean section for meconium stained liquor with foetal distress and delivered of an alive healthy female of 2.5 kg with good Apgar score.
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Affiliation(s)
- S Rawal
- Department of Obstetrics and Gynaecology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
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Bhatia K, Vaid AK, Rawal S, Patole KD. Pure choriocarcinoma of testis with rare gingival and skin metastases. Singapore Med J 2007; 48:e77-80. [PMID: 17342276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
A 22-year-old man presented with complaints of gingival and skin lesions. Physical examination revealed the presence of two nodular lesions, one over the sternum, 3 cm in size, and another, on the right side of chin, 1 cm in size. There was another fleshy soft tissue deposit over the left lower gingiva, in the oral cavity. He had noticed these lesions ten days prior to his visit to the hospital. In addition, there was left testicular non-tender swelling which had been present for two months, but was not investigated. Fine-needle aspiration cytology from skin and gingival lesions was suggestive of metastatic deposits. Patient underwent left high orchidectomy, and histopathological examination was consistent with the diagnosis of pure choriocarcinoma. Although rare, cases of testicular neoplasms and especially choriocarcinoma of the testis leading to skin metastases have been reported, but case reports of choriocarcinoma of testis metastatic to gingiva have been reported exceptionally in the English literature. We report this unique case of a young man with pure choricarcinoma of testis with unusual gingival and skin metastases.
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Affiliation(s)
- K Bhatia
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini Sector 5, Delhi 110085, India
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Rawal S, Giri N, Thapa D, Lama D. Early Experience with Pancreatic, Periampullary malignancies: Case Reviews, Management Guidelines and Discussion. Med J Shree Birendra Hosp 2006. [DOI: 10.3126/mjsbh.v8i0.21047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Early Experience with Pancreatic, Periampullary malignancies: Case Reviews, Management Guidelines and Discussion
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Shah R, Rawal S, Hamal BK, Giri NK, Lama D. A Rare Abdominal Mass, A Case Presentation. Med J Shree Birendra Hosp 2006. [DOI: 10.3126/mjsbh.v8i0.21054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A Rare Abdominal Mass, A Case Presentation
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Abstract
The aim of the study was to determine the correlation between MRI measured tumour volume and parametrial invasion on histology in the evaluation of carcinoma of the cervix showing full thickness stromal invasion (FTSI). Original MR images of 159 surgical cases of carcinoma of the cervix retrieved from the MR image bank of the department were analysed retrospectively. Tumour volume from the maximum tumour diameters in each case was computed using the standard formula for an ellipse and correlated with parametrial invasion on histology. Of 105 cases showing FTSI on axial T(2) weighted MRI, tumour volume between the two groups of cases, with parametrial invasion (n=27) and without parametrial invasion (n=78), shows a statistically significant difference (p=0.006). Best accuracy of 60.95%, sensitivity 59.26% and specificity 61.54% was found for tumour volume of 36.39 cm(3). The study concludes that MRI measured tumour volume is associated with low accuracy in the evaluation of parametrial invasion in carcinoma of cervix showing FTSI in axial T(2) weighted MR images and may not help as an additional diagnostic criterion to predict parametrial invasion pre-operatively.
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Affiliation(s)
- A Jena
- Department of MRI, Rajiv Gandhi Cancer Institute & Research Centre, Rohini, New Delhi, India
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Rawal S. Damage Control Surgery: Management of Critically Injured Patients. Med J Shree Birendra Hosp 2005. [DOI: 10.3126/mjsbh.v7i0.21093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Damage Control Surgery: Management of Critically Injured Patients
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Abstract
Among the variety of virulence factors of Entamoeba histolytica, an adherence lectin (Gal/GalNAc, 260 kDa) is known to mediate colonization and subsequent host responses. Gal/GalNAc lectin is universally recognized by the immune sera of patients with amoebic liver abscess. It plays a crucial role in cytolysis and phagocytosis of human and rat colonic mucin glycoproteins. The objective of the present study was to elucidate the role of antioxidants in E. histolytica Gal/GalNAc lectin-induced signals in the target epithelial cells. We have attempted to define a pathway in target cells, Henle-407 cells (human intestinal epithelial cell line), that could link this immunodominant antigen to a known biological pathway for target cell activation and triggering of subsequent disease pathology/parasite survival. Since several workers have demonstrated that cAMP and cGMP may act as important cellular signals for altering ion transport, so in the present study, cAMP and cGMP levels were measured in Henle-407 cells which showed significant increase at 15 min after stimulation. Elevated cAMP and cGMP levels are implicated in altered electrolyte transport and conductance. Results showed that there were increased levels of ROS and RNI which led to reduced activities of antioxidant enzymes--catalase, superoxide dismutase and glutathione peroxidase. Despite the increased glutathione (reduced) levels, the enzymes were not able to combat the damage caused by ROS and RNI. Thus, there was an increased local concentration of the free radicals and reduced activities of all the three enzymes which could damage the target cell in terms of cytoskeleton and permeability changes.
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Affiliation(s)
- S Rawal
- Department of Experimental Medicine and Biotechnology, Post-graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012, India
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Affiliation(s)
- A Mitra
- Division of Plant Tissue Culture, National Chemical Laboratory, Pune, India.
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Abstract
An analysis of the seasonal outbreak of diarrhoea in children in Kathmandu, Nepal, is reported. Vibrio cholera, 01 biotype El Tor Ogawa was the major cause of this epidemic. The pattern of spread suggested a waterborne infection related to contaminated river water and this was confirmed by a field survey. Although the mortality rate was low, younger children were more susceptible. Enteropathogenic E. coli seems to be a major cause for diarrhoea after cholera amongst children in this study.
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Affiliation(s)
- T Ise
- Medical Education Project, Tribhuvan University Teaching Hospital (TUTH), Maharajgung, Kathmandu, Nepal
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