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Rishi P, Sharma P, Jain S, Jain A, Kumar P, Shetty D. Correlation of palatal anatomic characteristics with dermatoglyphic heterogeneity in different growth patterns. Morphologie 2024; 108:100775. [PMID: 38518579 DOI: 10.1016/j.morpho.2024.100775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/24/2024]
Abstract
AIM AND OBJECTIVE The study aimed to explore the correlation between dermatoglyphic patterns and quantitative palatal anatomic variables in individuals with different growth patterns. MATERIALS AND METHOD A cross-sectional study was conducted involving 126 healthy patients aged 17-25 years. Participants were divided into three groups based on growth patterns: average, vertical, and horizontal. Dermatoglyphic patterns were recorded using an optical fingerprint sensor, and palatal characteristics were measured using digital software. Palatal characteristics, including intercanine width, intermolar width, and palatal depth, were measured using digital software. The results were statistically analyzed. RESULTS Significant differences were observed in ridge counts among the three growth patterns. The average growth pattern showed lower ridge counts compared to the vertical and horizontal growth patterns. Dermatoglyphic patterns, such as double loops and tented arches, were significantly higher in the horizontal growth pattern. Weak correlations were found between certain dermatoglyphic patterns and palatal characteristics, with simple arch patterns showing a negative correlation with inter-canine width and symmetrical whorl patterns showing a positive correlation with palatal depth. Loop patterns, spiral patterns, double loop patterns, symmetrical whorl, and simple arch patterns were significant predictors of growth patterns. CONCLUSION This study revealed distinct dermatoglyphic patterns and ridge counts among individuals with different growth patterns. Weak correlations were observed between dermatoglyphic patterns and palatal characteristics. However, the predictive value of dermatoglyphics for skeletal malocclusion requires further investigation. Understanding the relationships between dermatoglyphic patterns and craniofacial growth can provide valuable insights into genetic and developmental factors affecting dental and orthodontic conditions.
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Affiliation(s)
- P Rishi
- Department of Orthodontics & Dentofacial Orthopaedics, I.T.S. Center for Dental Studies and Research, Muradnagar, 201206 Ghaziabad, UP, India
| | - P Sharma
- Department of Orthodontics & Dentofacial Orthopaedics, I.T.S. Center for Dental Studies and Research, Muradnagar, 201206 Ghaziabad, UP, India
| | - S Jain
- Department of Orthodontics & Dentofacial Orthopaedics, I.T.S. Center for Dental Studies and Research, Muradnagar, 201206 Ghaziabad, UP, India.
| | - A Jain
- Independent consultant, Delhi, India
| | - P Kumar
- Department of Orthodontics & Dentofacial Orthopaedics, I.T.S. Center for Dental Studies and Research, Muradnagar, 201206 Ghaziabad, UP, India
| | - D Shetty
- Department of Orthodontics & Dentofacial Orthopaedics, I.T.S. Center for Dental Studies and Research, Muradnagar, 201206 Ghaziabad, UP, India
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Goel V, Kaizer AM, Jain S, Darrow D, Shankar H. Intraoperative neurophysiological monitoring and spinal cord stimulator implantation. Reg Anesth Pain Med 2024; 49:192-199. [PMID: 37407277 DOI: 10.1136/rapm-2023-104325] [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: 01/05/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Spinal cord injury (SCI) is one of the most dreaded complications after spinal cord stimulation (SCS) implantation surgery. As a result, intraoperative neurophysiological monitoring (IONM) has been proposed to avoid accidental damage to nervous structures under anesthesia and confirm positioning for optimal stimulation. Our study uses a large administrative claims database to determine the 30-day risk of SCI after SCS implantation. METHODS This retrospective cohort study used the IBM MarketScan Commercial and Medicare Supplemental Databases from 2016 to 2019. Adult patients undergoing SCS surgical procedures with at least 90 days of follow-up, IONM use, the type of sedation used during the procedure, and subsequent SCI were identified using administrative codes. In addition, logistic regression was used to examine the relationship between various risk factors and subsequent SCI. RESULTS A total of 9676 patients underwent SCS surgery (64.7% percutaneous implants) during the study period. Nine hundred and forty-four (9.75%) patients underwent SCS implantation with IONM. Conscious sedation, Monitored Anesthesia Care anesthesia, and general anesthesia were used in patients with 0.9%, 60.2%, and 28.6%, respectively. Eighty-one (0.8%) patients developed SCI within 30 days after SCS implant surgery. The SCI rate was higher in the group that underwent IONM (2% vs 0.7%, p value <0.001) during the implantation procedure, reflecting the underlying risk. After adjustment for other factors, the OR of SCI is 2.39 (95% CI: 1.33 to 4.14, p value=0.002) times higher for those with IONM than those without IONM. CONCLUSIONS Increased SCI risk among patients with IONM likely reflects higher baseline risk, and further research is needed for risk mitigation.
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Affiliation(s)
- Vasudha Goel
- Department of Anesthesia and Pain Medicine, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Alexander M Kaizer
- Department of Biostatistics and Infomatics, University of Colorado School of Public Health, Aurora, Colorado, USA
| | - Sejal Jain
- Department of Anesthesia and Pain medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, Texas, USA
| | - David Darrow
- Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Hariharan Shankar
- Anesthesiology, Clement Zablocki VA Medical Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Jain S, Chatterjee D, Vinay K. Symmetrical plaques on the dorsum of hands - a clinicopathological challenge. Int J Dermatol 2024. [PMID: 38426359 DOI: 10.1111/ijd.17121] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
A 60-year-old female with diabetes and hypothyroidism presented with a 2-year history of asymptomatic elevated lesions on the dorsum of her hands.
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Affiliation(s)
- Sejal Jain
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jain S, Shah S, Narayanan B, Agarwal Y, Goyal P, Jindal A, Vinay K, Narang T. Varicella gangrenosum-a gruesome complication of a benign infection. Int J Dermatol 2024; 63:345-347. [PMID: 38095301 DOI: 10.1111/ijd.16955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/21/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Sejal Jain
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Shikha Shah
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Baskaran Narayanan
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Yash Agarwal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Priyanka Goyal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Ankur Jindal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Walls GM, O'Connor J, Harbinson M, Duane F, McCann C, McKavanagh P, Johnston DI, Giacometti V, McAleese J, Hounsell AR, Cole AJ, Butterworth KT, McGarry CK, Hanna GG, Jain S. The Association of Incidental Radiation Dose to the Heart Base with Overall Survival and Cardiac Events after Curative-intent Radiotherapy for Non-small Cell Lung Cancer: Results from the NI-HEART Study. Clin Oncol (R Coll Radiol) 2024; 36:119-127. [PMID: 38042669 DOI: 10.1016/j.clon.2023.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/10/2023] [Accepted: 11/06/2023] [Indexed: 12/04/2023]
Abstract
AIMS Cardiac disease is a dose-limiting toxicity in non-small cell lung cancer radiotherapy. The dose to the heart base has been associated with poor survival in multiple institutional and clinical trial datasets using unsupervised, voxel-based analysis. Validation has not been undertaken in a cohort with individual patient delineations of the cardiac base or for the endpoint of cardiac events. The purpose of this study was to assess the association of heart base radiation dose with overall survival and the risk of cardiac events with individual heart base contours. MATERIALS AND METHODS Patients treated between 2015 and 2020 were reviewed for baseline patient, tumour and cardiac details and both cancer and cardiac outcomes as part of the NI-HEART study. Three cardiologists verified cardiac events including atrial fibrillation, heart failure and acute coronary syndrome. Cardiac substructure delineations were completed using a validated deep learning-based autosegmentation tool and a composite cardiac base structure was generated. Cox and Fine-Gray regressions were undertaken for the risk of death and cardiac events. RESULTS Of 478 eligible patients, most received 55 Gy/20 fractions (96%) without chemotherapy (58%), planned with intensity-modulated radiotherapy (71%). Pre-existing cardiovascular morbidity was common (78% two or more risk factors, 46% one or more established disease). The median follow-up was 21.1 months. Dichotomised at the median, a higher heart base Dmax was associated with poorer survival on Kaplan-Meier analysis (20.2 months versus 28.3 months; hazard ratio 1.40, 95% confidence interval 1.14-1.75, P = 0.0017) and statistical significance was retained in multivariate analyses. Furthermore, heart base Dmax was associated with pooled cardiac events in a multivariate analysis (hazard ratio 1.75, 95% confidence interval 1.03-2.97, P = 0.04). CONCLUSIONS Heart base Dmax was associated with the rate of death and cardiac events after adjusting for patient, tumour and cardiovascular factors in the NI-HEART study. This validates the findings from previous unsupervised analytical approaches. The heart base could be considered as a potential sub-organ at risk towards reducing radiation cardiotoxicity.
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Affiliation(s)
- G M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK.
| | - J O'Connor
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - M Harbinson
- Department of Cardiology, Belfast Health & Social Care Trust, Belfast, UK; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - F Duane
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland; Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland
| | - C McCann
- Department of Cardiology, Belfast Health & Social Care Trust, Belfast, UK
| | - P McKavanagh
- Department of Cardiology, Ulster Hospital, South Eastern Health & Social Care Trust, Dundonald, UK
| | - D I Johnston
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - V Giacometti
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - J McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - A R Hounsell
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - A J Cole
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - K T Butterworth
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - C K McGarry
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - G G Hanna
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - S Jain
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
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Redmond KM, Turner PG, Cole A, Jain S, Prise KM, O'Sullivan JM. A potential biomarker of radiosensitivity in metastatic hormone sensitive prostate cancer patients treated with combination external beam radiotherapy and radium-223. Radiother Oncol 2024; 191:110063. [PMID: 38135185 DOI: 10.1016/j.radonc.2023.110063] [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: 07/28/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE The ADRRAD trial reported the safety and feasibility of the combination of external beam radiotherapy and radium-223 in the treatment of de novo bone metastatic prostate. This study aimed to determine if any biomarkers predictive of response to these treatments could be identified. EXPERIMENTAL DESIGN 30 patients with newly diagnosed bone metastatic hormone sensitive prostate cancer were recruited to the ADRRAD trial. Blood samples were taken pre-treatment, before cycles 2 to 6 of radium-223, and 8 weeks and 6 months after treatment. Mononuclear cells were isolated and DNA damage was assessed at all timepoints. RESULTS DNA damage was increased in all patients during treatment, with bigger increases in foci observed in patients who relapsed late compared to those who relapsed early. Increases in DNA damage during the radium-223 only cycles of treatment were specifically related to response in these patients. Analysis of hematology counts also showed bigger decreases in red blood cell and hemoglobin counts in patients who experienced later biochemical relapse. CONCLUSIONS While some patients responded to this combination treatment, others relapsed within one year of treatment initiation. This study identifies a biomarker based approach that may be useful in predicting which patients will respond to treatment, by monitoring both increases in DNA damage above baseline levels in circulating lymphocytes and decreases in red blood cell and hemoglobin counts during treatment.
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Affiliation(s)
- K M Redmond
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom.
| | - P G Turner
- Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - A Cole
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom; Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - S Jain
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom; Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - K M Prise
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom
| | - J M O'Sullivan
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom; Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
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Jain S, Mohindra R, Chatterjee D, Rudramurthy S, Vyas S, Dogra S, Narang T. Leprosy, steroids, and diabetes: a recipe for mucormycosis? Int J Dermatol 2024; 63:e16-e18. [PMID: 37950519 DOI: 10.1111/ijd.16904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/15/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Sejal Jain
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritin Mohindra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaprakash Rudramurthy
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Vyas
- Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Chhabra S, Narang T, Sahu S, Sharma K, Shilpa S, Sharma A, Jain S, Singh I, Yadav R, Kaur M, Sharma R, Nadeem M, Pandey P, Minz RW, Dogra S. High frequency of ofloxacin resistance patterns of Mycobacterium leprae from India: An indication to revisit second line anti-leprosy treatment regimen. J Glob Antimicrob Resist 2023; 35:262-267. [PMID: 37852372 DOI: 10.1016/j.jgar.2023.10.006] [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: 06/27/2023] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVES Drug resistance in leprosy is an emerging concern, leading to treatment failures, recurrences, and potential spread of resistant Mycobacterium leprae in the community. In this study, we aimed to assess drug resistance prevalence and patterns amongst leprosy patients at a tertiary care referral hospital in India. METHODS Mutations in drug resistance determining regions for dapsone, rifampicin, and ofloxacin of the M. leprae genome in DNA extracted from skin biopsies of 136 leprosy patients (treatment-naive = 67, with persistent skin lesions = 35, with recurrence = 34) were analysed by polymerase chain reaction followed by Sanger sequencing. Wild-type strain (Thai-53) was used as a reference strain. RESULTS Resistance mutations were identified in a total of 23 patients, constituting 16.9% of the cohort. Within this subset of 23 cases, resistance to ofloxacin was observed in 17 individuals (12.5%), while resistance to both dapsone and rifampicin was detected in three patients each (2.2% for both). The occurrence of ofloxacin resistance showed minimal disparity between recurrent and treatment-naive cases, at 17.6% and 16.4%, respectively. Dapsone resistance emerged in two treatment-naive cases and one case with persistent skin lesions. Notably, none of the treatment-naive cases or those with recurrence/relapse exhibited rifampicin resistance. Subsequently, no statistically significant correlation was identified between other clinical variables and the presence of antimicrobial resistance. CONCLUSIONS The occurrence of resistance to the current multidrug therapy regimen (specifically dapsone and rifampicin) and to ofloxacin, a secondary antileprosy medication in M. leprae, represents a concerning scenario. This calls for an expansion towards bactericidal drug options and the establishment of robust surveillance for drug resistance in countries burdened with high leprosy rates. Moreover, the introduction of stringent antimicrobial stewardship initiatives is imperative. As a single centre study, it represents a limited, cross-sectional view of the real situation in the field.
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Affiliation(s)
- Seema Chhabra
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India.
| | - Tarun Narang
- Department of Dermatology, Venereology & Leprology, PGIMER, Sector-12, Chandigarh, India.
| | - Smrity Sahu
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Keshav Sharma
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Shilpa Shilpa
- Department of Dermatology, Venereology & Leprology, PGIMER, Sector-12, Chandigarh, India
| | - Ayush Sharma
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Sejal Jain
- Department of Dermatology, Venereology & Leprology, PGIMER, Sector-12, Chandigarh, India
| | - Itu Singh
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, Nand Nagari, New Delhi
| | - Rakesh Yadav
- Department of Medical Microbiology, PGIMER, Sector-12, Chandigarh, India
| | - Manjot Kaur
- Department of Medical Microbiology, PGIMER, Sector-12, Chandigarh, India
| | - Rahul Sharma
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, Nand Nagari, New Delhi
| | - Mohd Nadeem
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, Nand Nagari, New Delhi
| | - Pragati Pandey
- Department of Dermatology, Venereology & Leprology, PGIMER, Sector-12, Chandigarh, India
| | - Ranjana W Minz
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology & Leprology, PGIMER, Sector-12, Chandigarh, India.
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Abstract
The relationship between sleep and epilepsy is both intimate and bidirectional. The molecular mechanisms which control circadian rhythm and the sleep/wake cycle are dysregulated in epileptogenic tissue and are themselves effected by molecular pathways for epilepsy. Sleep affects the frequency of interictal epileptiform discharges and recent research has raised new questions regarding the impact of discharges on sleep function and cognition. Epileptiform discharges themselves affect sleep architecture and increase the risk of sleep disorders. Several sleep-related epilepsy syndromes have undergone changes in their classification which highlights their intimate relationship to sleep and novel screening tools have been developed to help clinicians better differentiate epileptic seizures from sleep-related paroxysmal events. Improving sleep and addressing sleep disorders has been associated with improved seizure control and increased well-being in people with epilepsy. These interactions are discussed in detail in this review.
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Affiliation(s)
- Wei K Liu
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital, Cincinnati, OH.
| | - Sanjeev Kothare
- Division of Pediatric Neurology, Department of Pediatrics, Cohen Children's Medical Center, New York, NY
| | - Sejal Jain
- Department of Anesthesiology and Pain Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
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Singh I, Pathak VK, Lavania M, Ahuja M, Sharma R, Narang T, Jain S, Turankar RP, Dogra S, Sengupta U. Genomic characterization of Mycobacterium lepromatosis from ENL patients from India. Infect Genet Evol 2023; 116:105537. [PMID: 38056703 DOI: 10.1016/j.meegid.2023.105537] [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] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/08/2023] [Accepted: 12/02/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Leprosy is caused by Mycobacterium leprae and Mycobacterium lepromatosis. Both organisms cannot be cultured in vitro. M. lepromatosis was found to be associated mainly with diffuse lepromatous leprosy and with Lucio's phenomena initially. Later, M. lepromatosis was observed in borderline leprosy cases (BL), lepromatous leprosy cases (LL) and leprosy reactional cases (T1R and ENL). Although many cases are being reported with similar clinical features like Lucio phenomenon in India but M. lepromatosis was not isolated from these cases. The aim of this study was to screen MB patients and patients with type 2 reaction for the presence of M. lepromatosis. METHODOLOGY We recruited a total of 75 multibacillary leprosy cases (45 MB cases without reaction and 30 type 2 reaction (ENL) cases) from TLM hospitals Purulia (West Bengal), Barabanki (Uttar Pradesh), Shahdara (Delhi) and PGIMER (Chandigarh), India. Punch biopsies of 5 mm were collected in 70% ethanol from all the study subjects. DNA was extracted followed by Hemi-nested PCR targeting 16S rRNA gene specific for M. lepromatosis. Further, PCR products were processed for Sanger sequencing for an absolute confirmation of M. lepromatosis. Whole genome sequencing was done to confirm the presence of M. lepromatosis. RESULT We observed presence of M. lepromatosis in 4 necrotic ENL patients by heminested PCR. There was 100% 16S rRNA sequence similarity with M. lepromatosis FJ924 in one case, 98.96% in two cases and in one case it was 90.9% similarity by nucleotide BLAST (BLASTn) by using the NCBI website. On the basis of Sanger sequencing, we noted presence of M. lepromatosis in 3 necrotic ENL patients as one sample only gave 90.9% similarity by BLASTn. On the basis of de novo assembly and genome obtained, only one sample S4 with a 2.9 mb genome size was qualified for downstream analysis. Sixteen M. lepromatosis- specific proteins were identified in this case and the closest species was M. lepromatosis strain FJ924 based on whole genome level phylogeny. CONCLUSION These results provide valuable insights into the prevalence of M. lepromatosis in ENL patients in different regions of India and contribute to our understanding of the genetic characteristics of this pathogen in the context of leprosy.
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Affiliation(s)
- Itu Singh
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India.
| | - Vinay Kumar Pathak
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India
| | - Mallika Lavania
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India; Enteric Viruses Group, ICMR-National Institute of Virology, 20-A Ambedkar Road, Agarkar Nagar, Pune 411001, Maharashtra, India
| | - Madhvi Ahuja
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India
| | - Rahul Sharma
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh 160012, India.
| | - Sejal Jain
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh 160012, India
| | - Ravindra P Turankar
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh 160012, India
| | - U Sengupta
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India
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Sud R, Banerjee A, Viswanath B, Purushottam M, Jain S. Non-synaptic mechanisms of antipsychotics may be key to their actions. Schizophr Res 2023; 261:128-129. [PMID: 37717511 DOI: 10.1016/j.schres.2023.09.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/09/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Affiliation(s)
- R Sud
- Molecular Genetics Lab, Department of Psychiatry, NIMHANS, Bangalore, India
| | - A Banerjee
- Molecular Genetics Lab, Department of Psychiatry, NIMHANS, Bangalore, India
| | - B Viswanath
- Molecular Genetics Lab, Department of Psychiatry, NIMHANS, Bangalore, India.
| | - M Purushottam
- Molecular Genetics Lab, Department of Psychiatry, NIMHANS, Bangalore, India
| | - S Jain
- Molecular Genetics Lab, Department of Psychiatry, NIMHANS, Bangalore, India.
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12
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Jain S, Bhandari A, Vinay K, Chatterjee D. Ponatinib Induced Pityriasis Rubra Pilaris: Case Report and Review of Literature. Indian Dermatol Online J 2023; 14:887-889. [PMID: 38099031 PMCID: PMC10718092 DOI: 10.4103/idoj.idoj_683_22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 12/17/2023] Open
Affiliation(s)
- Sejal Jain
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Adhyatm Bhandari
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Debajyoti Chatterjee
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
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13
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Dogra S, Jain S, Sharma A, Chhabra S, Narang T. Mycobacterium Indicus Pranii (MIP) Vaccine: Pharmacology, Indication, Dosing Schedules, Administration, and Side Effects in Clinical Practice. Indian Dermatol Online J 2023; 14:753-761. [PMID: 38099011 PMCID: PMC10718117 DOI: 10.4103/idoj.idoj_360_23] [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: 05/09/2023] [Revised: 08/07/2023] [Accepted: 08/19/2023] [Indexed: 12/17/2023] Open
Abstract
Mycobacterium indicus pranii (MIP), previously called Mw vaccine, is a one-of-a-kind immunomodulatory vaccine. It was indigenously developed in India for use in leprosy. MIP is heat-killed Mycobacterium w, which is a non-pathogenic atypical mycobacterium belonging to Class IV of Runyon classification. It shares epitopes with Mycobacterium leprae and Mycobacterium tuberculosis, which forms the rationale behind its use in leprosy and tuberculosis. MIP activates both innate and acquired immunity. It induces a Th1 and Th17 immune response along with downregulation of Th2 pathway and activates macrophages and dendritic cells. MIP vaccine is safe with adverse effects such as local site erythema, swelling, and rarely fever and other systemic reactions. Apart from leprosy, MIP has been used in dermatological diseases such as warts and psoriasis. Clinical trials have evaluated the efficacy of MIP in a plenitude of non-dermatological conditions such as category II tuberculosis, Gram-negative sepsis, non-small cell lung cancer, human immunodeficiency virus (HIV), muscle-invasive bladder cancer, and very recently, coronavirus 2019 (COVID-19). In vitro and animal studies have also demonstrated its utility in leishmaniasis, melanoma, and as a vaccine for the prevention of pregnancy. The PubMed database was searched using "Mycobacterium indicus pranii, MIP, Mycobacterium w" as the keyword in title. This comprehensive review provides useful information for healthcare professionals about immunotherapeutic potential of MIP vaccine, its composition, dosing schedule, administration, and side effects besides its efficacy in various indications other than leprosy.
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Affiliation(s)
- Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sejal Jain
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ayush Sharma
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Seema Chhabra
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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14
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Sankar J, Prasad CB, Mathew J, Dhir V, Jain S. Erosive hand osteoarthritis. QJM 2023; 116:871-872. [PMID: 37267217 DOI: 10.1093/qjmed/hcad114] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Indexed: 06/04/2023] Open
Affiliation(s)
- J Sankar
- Department of Internal Medicine, Clinical Immunology and Rheumatology Unit, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - C B Prasad
- Department of Internal Medicine, Clinical Immunology and Rheumatology Unit, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - J Mathew
- Department of Internal Medicine, Clinical Immunology and Rheumatology Unit, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - V Dhir
- Department of Internal Medicine, Clinical Immunology and Rheumatology Unit, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - S Jain
- Department of Internal Medicine, Clinical Immunology and Rheumatology Unit, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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15
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Gohil B, Tan N, Jolly R, Yadav N, Jain S. 25 The efficacy of pre-operative multidisciplinary meetings for surgical management of strabismus. BMJ Open Ophthalmol 2023; 8:A9. [PMID: 37798004 DOI: 10.1136/bmjophth-2023-biposa.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Informal discussion regarding surgical management plans between strabismus surgeons is common but this limits potentially valuable multi-disciplinary input and learning opportunities. We evaluate the effectiveness of virtual multidisciplinary meetings to provide a platform for discussion of pre-operative strabismus surgical cases.Weekly virtual MS Teams meetings are held on Monday mornings for one hour, attended by the three paediatric consultants, paediatric fellow, all trainees on the paediatric firm and orthoptists. The meetings are recorded and available for reference to the content and for those not present.Presentations for upcoming surgery cases are prepared and presented by the fellow, with discussion from participants regarding examination findings and surgical options. Cases are anonymised to allow multicentre collaboration. The agreed management plan is documented in the patient's medical notes, and outcomes of challenging cases are discussed.The management plan is formalised during the MDT. Where required, additional tests are arranged. There are opportunities for all participants to constructively challenge decisions. Trainees of all levels are actively engaged by presenting, listening to the rationale behind surgical plans, with the opportunity to ask and respond to questions.Patients are informed that their case has been presented in the MDT to obtain multiple opinions, which gives them additional confidence. Orthoptists can see the impact of the measurements they provide, and how differing tests can change management plans.This MDT has been a positive change to our surgical strabismus patient pathway. Knowledge and teamwork have been strengthened using this innovative virtual discussion method.
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Affiliation(s)
- B Gohil
- Royal Free London NHS Foundation Trust
| | - N Tan
- Royal Free London NHS Foundation Trust
| | - R Jolly
- Royal Free London NHS Foundation Trust
| | - N Yadav
- Royal Free London NHS Foundation Trust
| | - S Jain
- Royal Free London NHS Foundation Trust
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16
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Walls G, Johnston D, Harbsinson M, McCann C, McKavanagh P, Giacometti V, McAleese J, Cole A, Butterworth K, McGarry C, Jain S, Hanna GG. Simulation CT Features and Radiation Cardiotoxicity in Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e69. [PMID: 37786027 DOI: 10.1016/j.ijrobp.2023.06.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation cardiotoxicity is a significant clinical dilemma in non-small cell lung cancer (NSCLC) radiation therapy (RT). Baseline cardiovascular (CV) status may influence the risk of cardiotoxicity, and may be ascertainable from the appearance of the heart on simulation computed tomography (CT). We examined the association of CT features with incidental heart dose and risk of cardiac events in NSCLC. MATERIALS/METHODS Patients treated with curative-intent RT between 2015 and 2020 at a regional center were identified. Clinical notes were interrogated for baseline patient and CV health details, and follow-up CV events. Cardiac events were verified by a cardiologist. A deep learning-based auto-segmentation tool was applied, allowing extraction of a pre-specified list of volume parameters in a programming environment. CAC was graded as none, mild, moderate and severe in patients with a non-contrast scan. The craniocaudal relationship of the PTV and heart (Feng atlas) were annotated. RESULTS A total of 478 patients were included, with a median age of 70 and Charlson Index of 5. The median mean heart dose was 6.3 Gy (IQR 2.7-11.4). The median lung V20 was 20.0% (IQR 14.8-27.1). Cardiovascular risk factors were common, with most patients having 2 (39%) or 3 (31%). A history of previous cardiac events was common, including myocardial infarction (14%), arrhythmia (11%) or heart failure (9%). A total of 6.9% and 7.1% patients developed a new atrial arrhythmia (AA) or heart failure (HF) after completing RT. The volume metrics with the highest AUC for AA and HF events were the left atrium (LA) (AUC 0.67, p = 0.0002) and left ventricle:right ventricle (LV:RV) ratio (AUC 0.66, p = 0.0021). Kaplan-Meier analysis for cardiac events dichotomizing at the optimal cut-point for maximum sensitivity and specificity demonstrated significantly different rates for both AA (LA 109cc, HR 3.35, 95% CI 1.64-6.83, p = 0.0009) and HF (LV:RV ratio 1.61, HR 2.37, 95% CI 1.19-4.74, p = 0.0143). Only 2 patients with non-contrast scans developed a myocardial infarction, both had mild CAC. The incidence of pooled cardiac events was not significantly different between patients with no (n = 2/21, 9.5%), mild (n = 10/38, 26.3%), moderate (n = 8/53, 15.1%) and severe (n = 7/24, 29.2%) CAC (p = 0.3916). Where the inferior border of the PTV was above the superior border of the heart, mean heart dose was significantly lower than compared with overlap of levels (1.9 Gy v 9.7 Gy, p<0.0001), and this was true for 3DCRT (n = 139, p<0.001), IMRT (n = 94, p<0.001) and VMAT (n = 145, p<0.001) patients. CONCLUSION LA volume and LV:RV volume ratio are predictive for the development of AA and HF respectively. CAC grade did not differentiate patients by risk of cardiac events. Where the craniocaudal level of the PTV doesn't overlap with the level of the heart, the cardiac dose is likely to be very low. Several simulation CT features are associated with cardiac events following treatment for NSCLC and prospective evidence of cardiac risk could enable medical optimization prior to RT.
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Affiliation(s)
- G Walls
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - D Johnston
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - M Harbsinson
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - C McCann
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - P McKavanagh
- South Eastern Health & Social Care Trust, Belfast, United Kingdom
| | - V Giacometti
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - J McAleese
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - A Cole
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - K Butterworth
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - C McGarry
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - S Jain
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - G G Hanna
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
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17
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Jain S, Padhi S, Patel M G, Malathi H, Kumar B, Madaan S. AN INCREASED RISK OF HORMONAL DISORDERS, PRIMARILY DIABETES, IN INDIVIDUALS WITH Β -THALASSEMIA MAJOR: A RETROSPECTIVE ANALYSIS. Georgian Med News 2023:179-185. [PMID: 38096537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
β-Thalassemia major is an inherited blood condition marked by a serious anemia and a lifetime need for blood transfusions. The effects of β-thalassemia major on endocrine health, notably the risk of diabetes, remain largely unstudied, despite the fact that its haematological components are established. The purpose of this systematic analysis was to examine the incidence of reduced metabolism of glucose in β--thalassemia major. The articles were under the inclusion requirements, after which the data was retrieved. The main outcome was determined to be every prevalence (P) of DM (diabetes mellitus) in β-thalassemia major. In order to examine the percentage of aberrant glucose metabolism (GM) with individuals among β-thalassemia major, the P with the 95% CI (Confidence Interval) was utilized. In this retrospective investigation, we looked at a cohort of people with β-thalassemia major diagnoses to determine the incidence and risk of hormonal diseases, particularly diabetes. A specialist thalassemia facility treated 315 individuals with β-thalassemia major, and their medical records were examined. Age, gender, age at which a main diagnosis of β-thalassemia was made, the length of transfusion treatment, and concomitant diseases were gathered as part of the demographic and clinical data. Our research, which included 17 studies and 1500 cases altogether, showed that with β -thalassemia major had a considerably greater frequency of diabetes than people in general. With a mean beginning age of 30 years, diabetes was identified in 28% of the research cohort's participants. The combined meta-analysis showed that each year had a rather stable level of DM P in β-thalassemia major. In people with major β-thalassemia, the P of impaired fasting glucose (IFG), DM, and impaired glucose tolerance (IGT) was 17.22% (95% CI: 8.44%-26.02%), (6.57 (95% CI: 5.31%- 7.79%) and 12.47 % (95% CI: 5.97%-18.95%), respectively. Our research suggests that people with β-thalassemia major have a high chance of acquiring diabetes, particularly if they get extended transfusion treatment. For prompt diagnosis and care, early detection of diabetes and other hormonal problems in this group is crucial. In β-thalassemia major, there is a high frequency of endocrine problems, including improper GM. To stop growth and endocrine issues, treatment and preventative measures can be required.
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Affiliation(s)
- S Jain
- 1Department of Anatomy, TMMC&RC, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
| | - S Padhi
- 2Department of Pharmacy, Noida Institute of Engineering and Technology (Pharmacy Institute), Uttar Pradesh, India
| | - G Patel M
- 3Department of Community Medicine, Parul University, PO Limda, Tal. Waghodia, District Vadodara, Gujarat, India
| | - H Malathi
- 4Department of Life Sciences, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
| | - B Kumar
- 5School of Pharmacy & Research, Dev Bhoomi Uttarakhand University, Dehradun, India
| | - Sh Madaan
- 6Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, India
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18
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Hogg G, Joshi S, Mason H, O'Byrne C, Jain S. 17 Development of a questionnaire to study fear and anxiety factors affecting patients and their families undergoing strabismus surgery. BMJ Open Ophthalmol 2023; 8:A6. [PMID: 37798008 DOI: 10.1136/bmjophth-2023-biposa.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Patients and their Families undergoing Strabismus Surgery. The aim of this study was to develop a questionnaire to identify perioperative fear and anxiety factors affecting pediatric strabismus surgery patients.First, we reviewed the literature to determine precipitants of fears and anxieties experienced by pediatric patients. Subsequently, we developed a questionnaire for pediatric patients undergoing strabismus surgery. This was a two part questionnaire, consisting of a 16-piece section for patients and a 22-piece section for parents. Finally, we piloted this questionnaire to validate its clinical use.Common anxiety factors for children include pain, minor clinical procedures requiring needles, separation from parents and engaging with medical professionals. We used this information to develop a two part questionnaire for patients and parents. The questionnaire elicited positive and negative aspects of the patient journey, corroborated fears reported in the literature, and identified anxiety inducing factors specific to strabismus patients.There is a lack of evidence regarding fear and anxiety specific to pediatric ophthalmology surgeries. Strabismus surgery carries unique fear inducing factors. Interventions which may alleviate the stress of pediatric surgery, therefore greatly benefit patient experience and surgical outcomes, and should be considered in the care of pediatric patients. Patient educational material is known to provide a sense of control to patients, helping to alleviate such fear.Evidenced by the literature and the pilot questionnaire, there still exists anxiety inducing factors in pediatric surgery. Investigation into patient fears regarding pediatric strabismus surgery is needed to better understand how clinical staff can support patients perioperatively.
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Affiliation(s)
- G Hogg
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - S Joshi
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - H Mason
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - C O'Byrne
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - S Jain
- Royal Free Hospital NHS Foundation Trust, London, UK
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19
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Walls G, O'Connor J, Harbsinson M, Duane FK, McCann C, McKavanagh P, Johnston D, Giacometti V, McAleese J, Hounsell A, Cole A, Butterworth K, McGarry C, Hanna GG, Jain S. Patient-Level and Endpoint-Specific Clinico-Dosimetric Analysis of the Cardiac Base as a Mediator of Radiation Cardiotoxicity in Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e69-e70. [PMID: 37786026 DOI: 10.1016/j.ijrobp.2023.06.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Cardiac disease is a dose-limiting toxicity in non-small cell lung cancer (NSCLC) radiation therapy. Radiation dose to the cardiac base is associated with poor overall survival in several clinical studies, but has not been validated in a non-dose escalated cohort, or with individual patient delineations. In this study we examined the impact of cardiac base dose on overall survival (OS) and cardiac events (CEs), and interrogated the relationships of the substructures comprising the heart base with OS and CEs. MATERIALS/METHODS Patients with stage I-III NSCLC treated with curative-intent radiation therapy between 2015 and 2020 at a regional cancer center were identified. Clinical notes were examined for baseline patient, tumor and cardiac details, and both cancer and cardiac outcomes. Three cardiologists verified CEs. Cardiac delineations were completed using a validated deep learning-based autosegmentation tool. Cox and Fine and Gray regressions were undertaken for the risk of death and CEs respectively, accounting for pre-specified evidence-based dose metrics and clinically relevant cardiac covariates. RESULTS Most patients received 55 Gy/20# (n = 461/478, 96%) without chemotherapy (58%), planned with VMAT (51%) or IMRT (20%). Pre-existing cardiovascular morbidity was common, with 78% having ≥2 risk factors, and 46% having >1 established cardiac disease. The median follow-up was 21.1 months. Dichotomized at the median, higher heart base Dmax was associated with poorer survival on Kaplan-Meier analysis (21.6 months (95% CI 19.3-24.9) versus 29.4 months (95% CI 21.6-36.6), p = 0.021), and remained significant when statistically compared in published multivariate models. In a multivariate analysis for pooled acute CEs, heart base Dmax was associated with CEs (HR 1.75, 95% CI 1.01-1.06, p = 0.04), but this was not the case for individual CEs. Using Fine and Gray models to account for the competing risk of death, left main coronary maximum dose was associated with atrial fibrillation (p = 0.024), proximal right coronary artery V15 (p = 0.023) and mean dose (p = 0.032), and the right atrium mean dose (p = 0.029) were associated with heart failure. No dose-volume metrics were significantly associated with acute coronary syndrome. None of the constituent base substructures dose were significantly associated with death. CONCLUSION Dose to the heart base was associated with increased mortality and an increased pooled cardiac event rate. Accounting for endpoint-specific clinical covariates, only select constituent substructures of the heart base were associated with CEs and no substructures were independently associated with survival. Together, these findings are suggestive of possible interplay between the constituent base substructures in their mediation of radiation cardiotoxicity.
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Affiliation(s)
- G Walls
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - J O'Connor
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - M Harbsinson
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - F K Duane
- Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland
| | - C McCann
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - P McKavanagh
- South Eastern Health & Social Care Trust, Belfast, United Kingdom
| | - D Johnston
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - V Giacometti
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - J McAleese
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - A Hounsell
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - A Cole
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - K Butterworth
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - C McGarry
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - G G Hanna
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - S Jain
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
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20
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Jain S, Mahajan A, Patil PM, Bhandarkar P, Khajanchi M. Trends of surgical-care delivery during the COVID-19 pandemic: A multi-centre study in India (IndSurg Collaboration). J Postgrad Med 2023; 69:198-204. [PMID: 37449588 PMCID: PMC10846812 DOI: 10.4103/jpgm.jpgm_485_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: 06/14/2022] [Revised: 10/18/2022] [Accepted: 11/24/2022] [Indexed: 07/18/2023] Open
Abstract
Context The COVID-19 pandemic and subsequent lockdowns adversely affected global healthcare services to varying extents. To accommodate its added burden, emergency services were affected along-with elective surgeries. Aims To quantify and analyze the trends of essential surgeries and bellwether procedures during the waxing and waning of the pandemic, across various hospitals in India. Settings and Design Multi-centric retrospective study. Methods and Material A research consortium led by World Health Organization (WHO) Collaboration Center (WHOCC) for Research in Surgical Care Delivery in Low-and Middle-Income countries, India, conducted this study with 5 centers. All surgeries performed during April 2020 (Wave I), November 2020 (Recovery I), and April 2021 (Wave II) were compared with those performed in April 2019 (pre-pandemic period). Statistical Analysis Used Microsoft Excel 2019 and SPSS Version 20. Results The total number of surgeries reduced by 77% during Wave I, which improved to a 52% reduction in Recovery I compared to the pre-pandemic period. However, surgeries were reduced again during Wave II to 68%, but the reduction was less compared to Wave I. Emergency and essential surgeries were affected along with the elective ones but to a lesser extent. Conclusions The present study has quantified the effects of the pandemic on surgical-care delivery across a timeline and documented a reduction in overall surgical volumes during the peaks of the pandemic (Wave I and II) with minimal improvement as the surge of COVID-19 cases declined (Recovery II). The surgical volumes improved during the second wave compared to the first one which may be attributable to better preparedness. Cesarean sections were affected the least.
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Affiliation(s)
- S Jain
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - A Mahajan
- Government Medical College, Amritsar, Punjab, India
| | - PM Patil
- Department of Biostatistics, BARC Hospital, Mumbai, Maharashtra, India
| | - P Bhandarkar
- Department of Biostatistics, BARC Hospital, Mumbai, Maharashtra, India
| | - M Khajanchi
- Department of Surgery, Seth G.S. Medical College and K.E.M Hospital, Mumbai, Maharashtra, India
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21
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Jain S, Cetnar A, Woollard J, Gupta N, Blakaj D, Chakravarti A, Ayan AS. Pulse parameter optimizer: an efficient tool for achieving prescribed dose and dose rate with electron FLASH platforms. Phys Med Biol 2023; 68:19NT01. [PMID: 37735967 DOI: 10.1088/1361-6560/acf63e] [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: 04/24/2023] [Accepted: 09/01/2023] [Indexed: 09/23/2023]
Abstract
Purpose. Commercial electron FLASH platforms deliver ultra-high dose rate doses at discrete combinations of pulse parameters including pulse width (PW), pulse repetition frequency (PRF) and number of pulses (N), which dictate unique combinations of dose and dose rates. Additionally, collimation, source to surface distance, and airgaps also vary the dose per pulse (DPP). Currently, obtaining pulse parameters for the desired dose and dose rate is a cumbersome manual process involving creating, updating, and looking up values in large spreadsheets for every treatment configuration. This work presents a pulse parameter optimizer application to match intended dose and dose rate precisely and efficiently.Methods. Dose and dose rate calculation methods have been described for a commercial electron FLASH platform. A constrained optimization for the dose and dose rate cost function was modelled as a mixed integer problem in MATLAB (The MathWorks Inc., Version9.13.0 R2022b, Natick, Massachusetts). The beam and machine data required for the application were acquired using GafChromic film and alternating current current transformers (ACCTs). Variables for optimization included DPP for every collimator, PW and PRF measured using ACCT and airgap factors.Results. Using PW, PRF,Nand airgap factors as parameters, a software was created to optimize dose and dose rate, reaching the closest match if exact dose and dose rates are not achievable. Optimization took 20 s or less to converge to results. This software was validated for accuracy of dose calculation and precision in matching prescribed dose and dose rate.Conclusion. A pulse parameter optimization application was built for a commercial electron FLASH platform to increase efficiency in dose, dose rate, and pulse parameter prescription process. Automating this process reduces safety concerns associated with manual look up and calculation of these parameters, especially when many subjects at different doses and dose rates are to be safely managed.
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Affiliation(s)
- S Jain
- The Department of Radiation Oncology, The Ohio State University Wexner Medical Center, United States of America
| | - A Cetnar
- The Department of Radiation Oncology, The Ohio State University Wexner Medical Center, United States of America
| | - J Woollard
- The Department of Radiation Oncology, The Ohio State University Wexner Medical Center, United States of America
| | - N Gupta
- The Department of Radiation Oncology, The Ohio State University Wexner Medical Center, United States of America
| | - D Blakaj
- The Department of Radiation Oncology, The Ohio State University Wexner Medical Center, United States of America
| | - A Chakravarti
- The Department of Radiation Oncology, The Ohio State University Wexner Medical Center, United States of America
| | - A S Ayan
- The Department of Radiation Oncology, The Ohio State University Wexner Medical Center, United States of America
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22
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Jain S, Mohanachandran J, Mohan R. Outcomes and complications of Titanium elastic nailing for forearm bones fracture in children: our experience in a district general hospital in the United Kingdom. Acta Orthop Belg 2023; 89:539-546. [PMID: 37935240 DOI: 10.52628/89.3.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Intramedullary Titanium elastic nailing (TENS) is successfully used for irreducible and displaced forearm bone fractures in children. The purpose of this study was to report the potential complications and functional outcomes associated with paediatric forearm fractures treated with TENS nails. We retrospectively reviewed 65 children with displaced forearm bone fractures treated by TENS nailing with a mean follow-up of 5.84 months (4-12). Data detailing patient demographics, fracture characteristics, associated fractures, injury surgery interval, grade of the operating surgeon, methods of fixation, time to union, the timing of removal of the nail, and complications were collected and analysed. The mean age in our study was 9.13 years. 92% had fractures of both radius and ulna, 83.3% had fixation of both bones, and 16.7% had single bone fixation only. Open reduction was required in 38.5% of cases. The average time to fracture union was 10.34 weeks (6-20). The average time of implant removal was 20.12 weeks (9-32). We observed an overall complication rate of 41.5%. We noted a higher (56% vs 32.5%, p=0.059) complication rate in open reduction cases. According to the Price criteria, we had excellent to good results in over 98% of patients despite a slightly higher complication rate. Titanium elastic nailing is a safe, reliable method of internal fixation for irreducible or unstable fractures of both bones of the forearm in children. Open reduction of fracture was associated with higher complications. Despite higher overall complications, we noted excellent functional results in most cases.
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Jain S, Patel K, Ganapathy K, Khan F, Sahu S, Singh A. LAPAROSCOPIC APPROACH TO A GIANT RUPTURED SPLENIC CYST: A CHALLENGING CASE REPORT. Georgian Med News 2023:280-283. [PMID: 37805912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Splenic cysts are rare; their absence of an epithelial wall determines whether they're real cysts or pseudocysts. Spontaneous nonparasitic actual tumors are those that develop early in life at the anterior pole of the splenic and are typically epidermoid, dermoid, or endodermal. Surgical therapy is suggested for symptomatic, large (more than 5 cm) cysts or complicated. Inhaling splenic excision is a substitute for surgery, depending on the quantity, location, connection to the hilus, and dimension of the tumors. With an emphasis on less invasive treatments that preserve the spleen, laparoscopic methods have already established themselves as the accepted method for treating numerous disorders, including splenic cysts. They describe the effective decapsulation of a massive epidermoid spleen tumor under a prolonged, partially endoscopic technique. Laparoscopy, an operation commonly referred to as surgery with minimally invasive or keyhole surgery, is a technique that makes many tiny incisions in the belly to carry out different surgical procedures.
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Affiliation(s)
- S Jain
- 1Department of General Surgery, Jaipur National University, Jaipur, India
| | - K Patel
- 2Department of Gynecology, Parul University, PO Limda, Tal. Waghodia, District Vadodara, Gujarat, India
| | - K Ganapathy
- 3Department of Biotechnology, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
| | - F Khan
- 4Department of Nursing, IIMT University, Meerut, Uttar Pradesh, India
| | - S Sahu
- 5Department of Ayurveda, Sanskriti University, Mathura, Uttar Pradesh, India
| | - A Singh
- 6Department of General Surgery, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
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Bayetti C, Bakhshi P, Davar B, Khemka GC, Kothari P, Kumar M, Kwon W, Mathias K, Mills C, Montenegro CR, Trani JF, Jain S. Critical reflections on the concept and impact of "scaling up" in Global Mental Health. Transcult Psychiatry 2023; 60:602-609. [PMID: 37491885 PMCID: PMC7615199 DOI: 10.1177/13634615231183928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
The field of Global Mental Health (GMH) aims to address the global burden of mental illness by focusing on closing the "treatment gap" faced by many low- and middle-income countries (LMICs). To increase access to services, GMH prioritizes "scaling up" mental health services, primarily advocating for the export of Western centred and developed biomedical and psychosocial "evidence-based" approaches to the Global South. While this emphasis on scalability has resulted in the increased availability of mental health services in some LMICs, there have been few critical discussions of this strategy. This commentary critically appraises the scalability of GMH by questioning the validity and sustainability of its approach. We argue that the current approach emphasizes the development of mental health services and interventions in "silos," focusing on the treatment of mental illnesses at the exclusion of a holistic and contextualized approach to people's needs. We also question the opportunities that the current approach to GMH offers for the growth of mental health programmes of local NGOs and investigate the potential pitfalls that scalability may have on NGOs' impact and ability to innovate. This commentary argues that any "scaling up" of mental health services must place sustainability at the core of its mission by favouring the growth and development of local solutions and wider forms of support that prioritize social inclusion and long-lasting mental health recovery.
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Affiliation(s)
- C Bayetti
- Brown School, Washington University in St Louis, St Louis, MO, USA
| | - P Bakhshi
- School of Occupational Therapy, Washington University in St Louis, MO, USA
| | - B Davar
- Executive Director, Transforming Communities for Inclusion (TCI) Managing Trustee, Bapu Trust for Research on Mind & Discourse, Pune, Maharashtra, India
| | - G C Khemka
- Brown School, Washington University in St Louis, St Louis, MO, USA
| | - P Kothari
- Iswar Sankalpa (NGO), Kolkata, West Bengal, India
| | - M Kumar
- Founder & Clinical Director, MHAT, India
| | - W Kwon
- University of Edinburgh Business School, Edinburgh, Scotland
| | - K Mathias
- Burans, Herbertpur Christian Hospital, Dehradun, India
- Faculty of Health, University of Canterbury, Christchurch, New Zealand
| | - C Mills
- School of Health and Psychological Sciences, City, University of London
| | - C R Montenegro
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, UK
- School of Nursing, Pontificia Universidad Católica de Chile, Chile
| | - J F Trani
- Brown School, Washington University in St Louis, St Louis, MO, USA
| | - S Jain
- School of Social and Political Science, The University of Edinburgh, UK
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Adejuyigbe EA, Agyeman I, Anand P, Anyabolu HC, Arya S, Assenga EN, Badhal S, Brobby NW, Chellani HK, Chopra N, Debata PK, Dube Q, Dua T, Gadama L, Gera R, Hammond CK, Jain S, Kantumbiza F, Kawaza K, Kija EN, Lal P, Mallewa M, Manu MK, Mehta A, Mhango T, Naburi HE, Newton S, Nyanor I, Nyako PA, Oke OJ, Patel A, Phlange-Rhule G, Sehgal R, Singhal R, Wadhwa N, Yiadom AB. Evaluation of the impact of continuous Kangaroo Mother Care (KMC) initiated immediately after birth compared to KMC initiated after stabilization in newborns with birth weight 1.0 to < 1.8 kg on neurodevelopmental outcomes: Protocol for a follow-up study. Trials 2023; 24:265. [PMID: 37038239 PMCID: PMC10088121 DOI: 10.1186/s13063-023-07192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/20/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Preterm birth or low birth weight is the single largest cause of death in newborns, however this mortality can be reduced through newborn care interventions, including Kangaroo Mother Care (KMC). Previously, a multi-country randomized controlled trial, coordinated by the World Health Organization (WHO), reported a significant survival advantage with initiation of continuous KMC immediately after birth compared with initiation of continuous KMC a few days after birth when the baby is considered clinically stable. Whether the survival advantage would lead to higher rates of neurodevelopmental morbidities, or the immediate KMC will also have a beneficial effect on cognitive development also, has not been investigated. We therefore propose to test the hypothesis that low-birth-weight infants exposed to immediate KMC will have lower rates of neurodevelopmental impairment in comparison to traditional KMC-treated infants, by prospectively following up infants already enrolled in the immediate KMC trial for the first 2 years of life, and assessing their growth and neurodevelopment. METHODS This prospective cohort study will enroll surviving neonates from the main WHO immediate KMC trial. The main trial as well as this follow-up study are being conducted in five low- and middle-income countries in South Asia and sub-Saharan Africa. The estimated sample size for comparison of the risk of neurodevelopmental impairment is a total of 2200 children. The primary outcome will include rates of cerebral palsy, hearing impairment, vision impairment, mental and motor development, and epilepsy and will be assessed by the age of 3 years. The analysis will be by intention to treat. DISCUSSION Immediate KMC can potentially reduce low-birth-weight-associated complications such as respiratory disease, hypothermia, hypoglycemia, and infection that can result in impaired neurocognitive development. Neuroprotection may also be mediated by improved physiological stabilization that may lead to better maturation of neural pathways, reduced risk of hypoxia, positive parental impact, improved sleep cycles, and improved stress responses. The present study will help in evaluating the overall impact of KMC by investigating the long-term effect on neurodevelopmental impairment in the survivors. TRIAL REGISTRATION Clinical Trials Registry-India CTRI/2019/11/021899. Registered on 06 November 2019. Trials registration of parent trial: ACTRN12618001880235; Clinical Trials Registry-India: CTRI/2018/08/015369.
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Affiliation(s)
- E A Adejuyigbe
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - I Agyeman
- Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - P Anand
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - H C Anyabolu
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - S Arya
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - E N Assenga
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - S Badhal
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - N W Brobby
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - H K Chellani
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India.
| | - N Chopra
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - P K Debata
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - Q Dube
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - T Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - L Gadama
- Department of Obstetrics and Gynaecology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - R Gera
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - C K Hammond
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - S Jain
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - F Kantumbiza
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - K Kawaza
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - E N Kija
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - P Lal
- Atal Bihari Vajpayee Institute of Medical Sciences &, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - M Mallewa
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - M K Manu
- Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - A Mehta
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - T Mhango
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - H E Naburi
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - S Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - I Nyanor
- Research and Development, Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - P A Nyako
- Department of Psychiatry, Child And Adolescent Mental Health, Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - O J Oke
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - A Patel
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
- Division of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - G Phlange-Rhule
- Clinical Development Services Agency (CDSA), Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, PO Box #04, Faridabad, 121001, India
| | - R Sehgal
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - R Singhal
- Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, PO Box #04, 121001, Faridabad, India
| | - N Wadhwa
- Faridabad-Gurgaon Expressway, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3Rd MilestonePost Box #04, Faridabad, Haryana, 121001, India.
| | - A B Yiadom
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Jain S, Yao AG, Allen-Gipson D, Momen-Heravi F, Taylor AM. Abstract 1947: Clinical and genomic correlates with genetic ancestry in lung squamous cell carcinoma. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-1947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Many translational studies suggest racial and ethnic survival disparities in lung squamous cell carcinoma (LSCC), with self-identified African-Americans showing significantly lower overall survival and progression-free survival than self-identified Caucasians. However, potential clinical and genomic factors contributing to this disparity have yet to be elucidated. Using clinically annotated genomic data from 501 LSCC tumor samples in the Cancer Genome Atlas (TCGA), we compared clinical data, gene expression profiles, mutations, and focal and arm-level copy number changes from tumors across ancestral groups to identify significantly differential events. Within this dataset, patients of AFR ancestry had worse survival and progression-free survival then patients of EUR ancestry. We applied the Cox Proportional Hazards model to predict overall and progression-free survival as functions of genetic ancestry alongside other genetic, molecular, and clinical variables. We found a significant difference in metastatic stage between tumors from patients of African (AFR) and European (EUR) ancestry, which was significant in predicting survival. Compared to tumors from EUR patients, tumors from AFR patients featured increased chromosome arm 8q gain and more frequent amplification of genetic locus chr8q24, which contains proto-oncogene MYC. Expression of MYC target genes was also significantly increased in AFR samples relative to EUR samples. These findings may suggest a role for the MYC pathway in differential cancer progression. We found more frequent amplification of genetic loci chr22q11 and chr16p11 in AFR samples compared to EUR samples. We identified top differentially mutated genes between groups, of which SPRR3, PDGFA, FRS3, and C21orf62 correlate with survival. We also found immune signaling gene sets enriched in the EUR group by gene set expression analysis (GSEA). These results suggest potential genetic and clinical factors implicated in racial survival disparities. Further studies and more diverse sampling of cancer patient populations are required to validate these differences and elucidate patient-specific treatment modalities.
Citation Format: Sejal Jain, Alexandria G. Yao, Diane Allen-Gipson, Fatemeh Momen-Heravi, Alison M. Taylor. Clinical and genomic correlates with genetic ancestry in lung squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1947.
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Affiliation(s)
- Sejal Jain
- 1USF Health Morsani College of Medicine, Tampa, FL
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Bangaru S, Uppalapati S, Palluri S, Ram K, Sudheendra K, Jain S, Johnson K, Hynes D, Madhushankar A, Grinstein J, Pinney S, Onsager D, Rodgers D, Jeevanandam V. A Less Restrictive Approach to Procuring Organs is Not an Indicator of Prognostic Survival in Heart Transplantation: A Retrospective Analysis of 118 Adult Heart Transplant Centers from 2020 to 2022. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Ochoa E, Jain S, Rodgers D, de Matos SN, Uppalapati S, Bangaru S, Johnson K, Sudheendra K, Ram K, Hynes D, Sorensen K, Paluri S, Madhushankar A, Jeevanandam V. As Comfortable as a Pillow: The Superiority of the Sternasafe® Device Over the Standard of Care. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Paluri S, Siddiqi U, Rodgers D, Uppalapati S, Bangaru S, Ram K, Sorensen K, Sudheendra K, Madhushankar A, Johnson K, Hynes D, Jain S, Jeevanandam V. A Probable Winner in the Race for the Best Cardiac Preservation Solution: A Single-Center's Experience. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Uppalapati S, Rodgers D, Paluri S, Ram K, Jain S, Sorensen K, Bangaru S, Madhushankar A, Sudheendra K, Johnson K, Hynes D, Grinstein J, Kalathiya R, Jeevanandam V. Changes in Echocardiographic Parameters after Transcatheter Aortic Valve Replacement in Patients with a Left Ventricular Assist Device: A Case Series. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Sorensen K, Rodgers D, Uppalapati SC, Siddiqi U, Jain S, Paluri S, Madhushanka A, Sudheendra K, Johnson K, Bangaru S, Ram K, Hynes D, Ozcan C, Lee L, Kim G, Jeevanandam V. A Retrospective Study on Gender, LAA Morphology and Stroke Risk. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Bangaru S, Uppalapati S, Palluri S, Ram K, Madhushankar A, Johnson K, Hynes D, Jain S, Sudheendra K, Rodgers D, Jeevanandam V, Onsager D. Continuous Temperature Measurements in Donor Hearts During Cold Organ Procurement. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Prasad CB, Sankar J, Dhir V, Jain S. Trolley-track sign in ankylosing spondylitis. QJM 2023; 116:231-232. [PMID: 36308443 DOI: 10.1093/qjmed/hcac247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- C B Prasad
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - J Sankar
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - V Dhir
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - S Jain
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Jain S, Menon D, Mitchell T, Kerr J, Bassi V, West R, Pandit H. A cost analysis of treating postoperative periprosthetic femoral fractures following hip replacement surgery in a UK tertiary referral centre. Injury 2023; 54:698-705. [PMID: 36470768 DOI: 10.1016/j.injury.2022.11.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/14/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
AIM This study aims to evaluate costs associated with periprosthetic femoral fracture (PFF) treatment at a UK tertiary referral centre. METHODS This study included 128 consecutive PFFs admitted from 02/04/2014-19/05/2020. Financial data were provided by Patient Level Information and Costing Systems. Primary outcomes were median cost and margin. Secondary outcomes were length of stay, blood transfusion, critical care, 30-day readmission, 2-year local complication, 2-year systemic complication, 2-year reoperation and 30-day mortality rates. Statistical comparisons were made between treatment type. Statistical significance was set at p<0.05. RESULTS Across the cohort, median cost was £15,644.00 (IQR £11,031.00-£22,255.00) and median loss was £3757.50 (£599.20-£8296.20). The highest costs were ward stay (£3994.00, IQR £1,765.00-£7,013.00), theatre utilisation (£2962.00, IQR £0.00-£4,286.00) and overheads (£1705.10, IQR £896.70-£2432.20). Cost (£17,455.00 [IQR, £13,194.00-£23,308.00] versus £7697.00 [IQR £3871.00-£10,847.00], p<0.001) and loss (£4890.00 [IQR £1308.00-£10,009.00] versus £1882.00 [IQR £313.00-£3851.00], p = 0.02) were greater in the operative versus the nonoperative group. There was no difference in cost (£17,634.00 [IQR £12,965.00-£22,958.00] versus £17,399.00 [IQR £13,394.00-£23,404.00], p = 0.98) or loss (£5374.00 [IQR £1950.00-£10,143.00] versus £3860.00 [IQR -£95.50-£7601.00], p = 0.21) between the open reduction and internal fixation (ORIF) and revision groups. More patients required blood transfusion in the operative versus the nonoperative group (17 [17.9%] versus 0 [0.0%], p = 0.009). There was no difference in any clinical outcome between the ORIF and revision groups (p>0.05). CONCLUSION PFF treatment costs are high with inadequate reimbursement from NHS tariff. Work is needed to address this disparity and reduce hospital costs. Cost should not be used to decide between ORIF and revision surgery.
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Affiliation(s)
- S Jain
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapeltown Road, Leeds LS7 4SA, United Kingdom; Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Chapeltown Road, Leeds LS7 4SA, United Kingdom.
| | - D Menon
- Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Chapeltown Road, Leeds LS7 4SA, United Kingdom
| | - T Mitchell
- Patient Level Information and Costing Systems (PLICS) department, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, United Kingdom
| | - J Kerr
- Patient Level Information and Costing Systems (PLICS) department, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, United Kingdom
| | - V Bassi
- Patient Level Information and Costing Systems (PLICS) department, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, United Kingdom
| | - R West
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9TJ, United Kingdom
| | - H Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapeltown Road, Leeds LS7 4SA, United Kingdom; Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Chapeltown Road, Leeds LS7 4SA, United Kingdom
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Al-Omari L, Williams M, Fuenmayor MEF, Jain S. Case report – identical twins in the neonatal intensive care unit with hiatal hernias. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00047-2] [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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Roy A, Sharma S, Sharma B, Nag TC, Katyal J, Gupta YK, Jain S. 1147 MORPHO-FUNCTIONAL EVALUATION OF 3MG/KG ICV-STZ RAT SHOWED SPORADIC ALZHEIMER'S LIKE PATHOLOGY WITH PROGRESSIVE DEMENTIA. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Background
Intracerebroventricular streptozotocin (ICV-STZ) injection is among the best animal models to simulate sporadic Alzheimer’s disease (sAD). Abnormality in brain insulin signalling, neurodegeneration, neuroinflammation, cholinergic damage, mitochondrial dysfunction, genetic abnormality, respiratory problem, oxidative stress, gliosis, sleep disturbances are associated with cognitive abnormalities seen in ICV-STZ injected rats. Available experimental evidence has used varying doses of STZ (<1 to 3mg/kg) and studied its effect for different study durations, ranging from 14-21 (short), 30-42 (mild), 90-105 (moderate) and 250-270 (long) days. These studies indicated that 3mg/kg of body-weight is the optimum dose for inducing sAD in the rodents. However, studies on the pathological process with related the morphological and functional abnormalities reported were illusive.
Objective/Method
Hence in the present study, we have investigated the morpho-functional changes after 3mg/kg ICV-STZ treatment with a follow-up of two months in 54 male Wistar rats (ethical no. 937/IAEC/PhD-2016).
Results
Exhibited a spatial, episodic and avoidance memory decline and increase in anxiety (p<0.05) in ICV-STZ group progressively with time from 15th day to 60th day post-injection. Morphometry showed hippocampal atrophy with CA1, CA3 layer thinning (p ≤0.01) and loss of neurons (p<0.0001) associated with third ventricular enlargement (p= 0.007) in ICV-STZ rats versus sham, along-with extracellular amyloid plaque in AD rats with Congored staining. In addition, spine morphometry with Golgi-Cox impregnation of mossy fibre showed a reduction of spine density in AD group versus control and sham group (p<0.0001). Finally, immunohistochemistry of GSK3ß, PI3K and mtCOX-1 antigen in coronal sections revealed an increase in mean intensity of GSK3ß and decrease in PI3K and mtCox-1 in brain areas associated with limbic system in ICV-STZ group on 60th day.
Conclusion
These findings suggest progressive dementia and anxiety in 3mg/kg STZ treated rats, which may be due to hippocampal atrophy, amyloidopathy, ventricular enlargement, synaptic dysfunction and deficits in energy homeostasis of brain.
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Affiliation(s)
- A Roy
- All India Institute of Medical Sciences , New Delhi
| | - S Sharma
- Indian Institute of Technology , Delhi
| | - B Sharma
- All India Institute of Medical Sciences , New Delhi
| | - T C Nag
- All India Institute of Medical Sciences , New Delhi
| | - J Katyal
- All India Institute of Medical Sciences , New Delhi
| | - Y K Gupta
- Translational Health Sciences and Technology Institute , Delhi
| | - S Jain
- All India Institute of Medical Sciences , New Delhi
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Roy A, Kumar A, Kakkadi V, Nag TC, Katyal J, Gupta YK, Jain S. 1145 RTMS TREATMENT IMPROVED COGNITIVE DYSFUNCTION THROUGH ADULT NEUROGENESIS IN ICV-STZ RAT MODEL OF SPORADIC ALZHEIMER'S DISEASE. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Background
Intracerebroventricular streptozotocin injection at 3mg/kg of b/w causes phenotypes similar to that of sporadic Alzheimer’s disease (sAD) from 14th day post-injection. On the other hand, the body of evidence indicated that impairment in the sAD is the major contributor for cognitive decline. Taken together, we tested the adult neurogenesis hypothesis in streptozotocin model of sAD in female Wistar rats after extremely low magnetic stimulation (MF: 17.96, 50Hz, 2hr/day, 21days).
Method
33 rats were randomly divided into three groups viz. Sham+MF, AD and AD+MF. Consequently, animals were first induced AD with stereotaxic manipulation and then they were exposed to low frequency magnetic field stimulation, followed by terminal cognitive behavioural tasks brain tissue being isolated for both biochemical and subcellular expression experiments (ethical no. 12/IAEC-1/2017).
Results
Showed reduction in latency to the goal quadrant (p= 0.002) and transfer latency (p= 0.045) in AD+MF group versus AD. Even, Dirichlet distribution of time spent in 4 quadrants indicated un-uniform in all the groups except AD group (p= 0.067, LRS= 7.35). Further, cell count in CA3 and DG exhibited increase in cell density in AD+MF group (p<0.05). However, we found significant reduction in SOD1 activity after MF treatment (p= 0.035) but no change in GSH level in hippocampus and frontal cortex. Interestingly, these changes in AD+MF animals are associated with increase in density of BrdU+/Nestin+ cells in granular layer (p= 0.002) and hilus region (p= 0.0005) of DG along with increase in expression of L-type Ca2+ channels as compared to AD group.
Conclusion
This experimental evidence suggests that non-invasive brain stimulation can promote adult neurogenesis by activating L-type ca2+ channels in the hilus, which intern helps in retention of long-term memory even after sAD.
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Affiliation(s)
- A Roy
- All India Institute of Medical Sciences , New Delhi
| | - A Kumar
- All India Institute of Medical Sciences , New Delhi
| | - V Kakkadi
- All India Institute of Medical Sciences , New Delhi
| | - T C Nag
- All India Institute of Medical Sciences , New Delhi
| | - J Katyal
- All India Institute of Medical Sciences , New Delhi
| | - Y K Gupta
- Translational Health Sciences and Technology Institute , Delhi
| | - S Jain
- All India Institute of Medical Sciences , New Delhi
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Jeancolas C, Singh A, Jain S, Krishna S, Nghe P. An interdisciplinary effort to understand chemical organizations at the origin of life. iScience 2022; 26:105834. [PMID: 36619971 PMCID: PMC9813777 DOI: 10.1016/j.isci.2022.105834] [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] [Indexed: 12/28/2022] Open
Abstract
This backstory features the perspectives of three group leaders of a Franco-Indian collaboration on the origin of life, involving efforts to engineer evolvable chemical systems. The researchers explain how they overcame the difficulties to bring empiricist and theorist cultures together and the importance of such synergy for the future of origin of life research.
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Affiliation(s)
- C. Jeancolas
- Laboratoire Biophysique et Évolution, UMR Chimie Biologie Innovation 8231, ESPCI Paris, Université PSL, CNRS, Paris, France,Department of Philosophy, Durham University, Durham, UK
| | - A.Y. Singh
- Department of Physics and Astrophysics, University of Delhi, Delhi, India
| | - S. Jain
- Department of Physics and Astrophysics, University of Delhi, Delhi, India,Corresponding author
| | - S. Krishna
- Simons Centre for the Study of Living Machines, National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, India,Corresponding author
| | - P. Nghe
- Simons Centre for the Study of Living Machines, National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, India,Corresponding author
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Hunter B, Chen M, Ratnakumar P, Alemu E, Logan A, Linton-Reid K, Tong D, Senthivel N, Bhamani A, Bloch S, Kemp SV, Boddy L, Jain S, Gareeboo S, Rawal B, Doran S, Navani N, Nair A, Bunce C, Kaye S, Blackledge M, Aboagye EO, Devaraj A, Lee RW. A radiomics-based decision support tool improves lung cancer diagnosis in combination with the Herder score in large lung nodules. EBioMedicine 2022; 86:104344. [PMID: 36370635 PMCID: PMC9664396 DOI: 10.1016/j.ebiom.2022.104344] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Large lung nodules (≥15 mm) have the highest risk of malignancy, and may exhibit important differences in phenotypic or clinical characteristics to their smaller counterparts. Existing risk models do not stratify large nodules well. We aimed to develop and validate an integrated segmentation and classification pipeline, incorporating deep-learning and traditional radiomics, to classify large lung nodules according to cancer risk. METHODS 502 patients from five U.K. centres were recruited to the large-nodule arm of the retrospective LIBRA study between July 2020 and April 2022. 838 CT scans were used for model development, split into training and test sets (70% and 30% respectively). An nnUNet model was trained to automate lung nodule segmentation. A radiomics signature was developed to classify nodules according to malignancy risk. Performance of the radiomics model, termed the large-nodule radiomics predictive vector (LN-RPV), was compared to three radiologists and the Brock and Herder scores. FINDINGS 499 patients had technically evaluable scans (mean age 69 ± 11, 257 men, 242 women). In the test set of 252 scans, the nnUNet achieved a DICE score of 0.86, and the LN-RPV achieved an AUC of 0.83 (95% CI 0.77-0.88) for malignancy classification. Performance was higher than the median radiologist (AUC 0.75 [95% CI 0.70-0.81], DeLong p = 0.03). LN-RPV was robust to auto-segmentation (ICC 0.94). For baseline solid nodules in the test set (117 patients), LN-RPV had an AUC of 0.87 (95% CI 0.80-0.93) compared to 0.67 (95% CI 0.55-0.76, DeLong p = 0.002) for the Brock score and 0.83 (95% CI 0.75-0.90, DeLong p = 0.4) for the Herder score. In the international external test set (n = 151), LN-RPV maintained an AUC of 0.75 (95% CI 0.63-0.85). 18 out of 22 (82%) malignant nodules in the Herder 10-70% category in the test set were identified as high risk by the decision-support tool, and may have been referred for earlier intervention. INTERPRETATION The model accurately segments and classifies large lung nodules, and may improve upon existing clinical models. FUNDING This project represents independent research funded by: 1) Royal Marsden Partners Cancer Alliance, 2) the Royal Marsden Cancer Charity, 3) the National Institute for Health Research (NIHR) Biomedical Research Centre at the Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, 4) the National Institute for Health Research (NIHR) Biomedical Research Centre at Imperial College London, 5) Cancer Research UK (C309/A31316).
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Affiliation(s)
- Benjamin Hunter
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK; Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Mitchell Chen
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Prashanthi Ratnakumar
- Department of Respiratory Medicine, Charing Cross Hospital, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Esubalew Alemu
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Andrew Logan
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Kristofer Linton-Reid
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Daniel Tong
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Nishanthi Senthivel
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Amyn Bhamani
- Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, Euston Road, London, NW1 2BU, UK
| | - Susannah Bloch
- Department of Respiratory Medicine, Charing Cross Hospital, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Samuel V Kemp
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Foundation Trust, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Laura Boddy
- Early Diagnosis and Detection Centre, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Sejal Jain
- Early Diagnosis and Detection Centre, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Shafick Gareeboo
- Department of Respiratory Medicine, Queen Elizabeth Hospital, Stadium Road, Woolwich, London, SE18 4QH, UK
| | - Bhavin Rawal
- Department of Radiology, The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
| | - Simon Doran
- CRUK Cancer Imaging Centre, The Institute of Cancer Research, Cotswold Road, Sutton, SM2 5NG, UK
| | - Neal Navani
- Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, Euston Road, London, NW1 2BU, UK
| | - Arjun Nair
- Department of Radiology, University College London Hospitals NHS Foundation Trust, Euston Road, London, NW1 2BU, UK
| | - Catey Bunce
- Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Stan Kaye
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Matthew Blackledge
- Computational Imaging Group, The Institute of Cancer Research, Cotswold Road, Sutton, SM2 5NG, UK
| | - Eric O Aboagye
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Anand Devaraj
- Department of Radiology, The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK; National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse Street, London, SW3 6LY, UK
| | - Richard W Lee
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK; Early Diagnosis and Detection Centre, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK; National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse Street, London, SW3 6LY, UK.
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Jain S, Singla C, Toor S, Bhatti DJ, Gupta P. Management of dog bite wounds: Our protocol and experience with early surgical intervention. Ambulatornaya khirurgiya 2022. [DOI: 10.21518/1995-1477-2022-19-2-128-133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dog bites injuries are a significant cause of morbidity and mortality. Conventionally, it was suggested to leave the wounds open due to probable increased risk of infections and occurrence of rabies with suturing.Recent publications indicate that primary closure does not necessarily affect the chances of infection but definitely helps in improving the quality of scar. We are presenting our experience and protocol for primary closure of all dog bite wounds. From March 2020 to February 2021, 10 consecutive patients of all ages coming to the emergency of our hospital with category 3 dog bite that penetrated the epidermis and dermis and presenting within 48 hours of injury were included. Every patient was administered first dose of anti rabies vaccine (ARV) (zero dose) for active immunisation and was also given injection tetanus intramuscularly. Mean age of patients in our study was 20.9 with range from 2 years to 90 years. Only 2/10 patients developed infections which were managed conservatively with drainage of abscess and antibiotics. Rest all patients recovered without complications. Primary closure of dog bite wounds when associated with debridement, sufficient irrigation, povidine iodine cleansing and antibiotic administration resulted in improved cosmetic appearance without increase in the rate of infection.
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Affiliation(s)
- S. Jain
- Guru Gobind Singh Medical College and Hospital
| | - C. Singla
- Guru Gobind Singh Medical College and Hospital
| | - S. Toor
- Guru Gobind Singh Medical College and Hospital
| | | | - P. Gupta
- Guru Gobind Singh Medical College and Hospital
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41
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Jain S, Kumar L, Babu S, Sadhoo A, Ravindran G, Rajan S. Correlation of arterial PaCO 2 to end tidal CO 2 in children undergoing laparoscopic abdominal surgery: An observational study. J Anaesthesiol Clin Pharmacol 2022; 38:640-645. [PMID: 36778836 PMCID: PMC9912885 DOI: 10.4103/joacp.joacp_581_20] [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: 10/03/2020] [Revised: 03/23/2021] [Accepted: 04/14/2021] [Indexed: 12/31/2022] Open
Abstract
Background and Aims The reliability of end tidal carbon dioxide (ETCO2) as a measure of arterial carbon dioxide (PaCO2) in pediatric laparoscopy is unclear. We evaluated the correlation of arterial to end tidal P(a-ET) CO2 during pediatric laparoscopy at two hours of pneumoperitoneum as the primary objective. We also compared P(a-ET) CO2 and alveolar to arterial oxygen gradient P(A-a) O2 and haemodynamics at fixed time points during surgery. Material and Methods A cross-sectional study was conducted in 25 children undergoing laparoscopic abdominal surgery. Arterial blood gases were drawn at T0, baseline, T10: ten minutes, T1h: 1 hour, T2h: 2 hours of pnuemoperitoneum and T 10d: 10 mins after deflation. The P(a-ET) CO2, P(A-a) O2, were measured from the blood gas and ETCO2 and FiO2 values on the monitor. The Pearson's correlation coefficient, the Wilcoxon rank test and Chi square test were used for statistical analysis. Results At T2h moderate correlation of P(a-ET) CO2 (r = 0.605, P = 0.001) with 40% children documenting accurate P(a-ET) CO2, -1 to +1 mm Hg was seen. Moderate correlation was also seen at T0, T10, T 10d but poor correlation at T 1h. The P(A-a) O2 increased progressively with surgery and did not correlate with P(a-ET) CO2. Heart rate was stable, but systolic blood pressures at T 10 and diastolic at T10, T 1h, T 2h were higher than baseline. Conclusion Moderate correlation was seen between PaCO2 and ETCO2 at 2 h of pnuemoperitoneum and at T0, T 10, and T 10d. P(A-a) O2 increased with surgery but did not correlate with P(a-ET) CO2.
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Affiliation(s)
- S. Jain
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - L. Kumar
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - S.C. Babu
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - A. Sadhoo
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - G.C. Ravindran
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - S. Rajan
- Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Samanta J, Naidu GSRSNK, Sood R, Nada R, Sharma A, Jain S. Calcinosis cutis with amyopathic dermatomyositis. QJM 2022; 115:613-614. [PMID: 35731215 DOI: 10.1093/qjmed/hcac148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Samanta
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - G S R S N K Naidu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - R Sood
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - R Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - A Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - S Jain
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Simakajornboon N, Mignot E, Maski K, Owens J, Rosen C, Ibrahim S, Hassan F, Chervin RD, Perry G, Brooks L, Kheirandish-Gozal L, Gozal D, Mason T, Robinson A, Malow B, Naqvi K, Chen ML, Jambhekar S, Halbower A, Graw-Panzer K, Dayyat E, Lew J, Melendres C, Kotagal S, Jain S, Super E, Dye T, Hossain MM, Tadesse D. Increased incidence of pediatric narcolepsy following the 2009 H1N1 pandemic: a report from the pediatric working group of the sleep research network. Sleep 2022; 45:6607480. [DOI: 10.1093/sleep/zsac137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
This study was aimed to evaluate the yearly incidence of pediatric narcolepsy prior to and following the 2009 H1N1 pandemic and to evaluate seasonal patterns of narcolepsy onset and associations with H1N1 influenza infection in the United States. This was a multicenter retrospective study with prospective follow-up. Participants were recruited from members of the Pediatric Working Group of the Sleep Research Network including 22 sites across the United States. The main outcomes were monthly and yearly incident cases of childhood narcolepsy in the United States, and its relationship to historical H1N1 influenza data. A total of 950 participants were included in the analysis; 487 participants were male (51.3%). The mean age at onset of excessive daytime sleepiness (EDS) was 9.6 ± 3.9 years. Significant trend changes in pediatric narcolepsy incidence based on EDS onset (p < .0001) occurred over the 1998–2016 period, peaking in 2010, reflecting a 1.6-fold increase in narcolepsy incidence. In addition, there was significant seasonal variation in narcolepsy incident cases, with increased cases in spring (p < .05). Cross-correlation analysis demonstrated a significant correlation between monthly H1N1 infection and monthly narcolepsy incident cases (p = .397, p < .0001) with a lag time of 8 months. We conclude that there is a significant increase in pediatric narcolepsy incidence after the 2009 H1N1 pandemic in the United States. However, the magnitude of increase is lower than reported in European countries and in China. The temporal correlation between monthly H1N1 infection and monthly narcolepsy incidence, suggests that H1N1 infection may be a contributing factor to the increased pediatric narcolepsy incidence after the 2009 H1N1 pandemics.
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Affiliation(s)
- Narong Simakajornboon
- Division of Pulmonary and Sleep Medicine, Cincinnati Children’s Hospital Medical Center , Cincinnati, OH , USA
- Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH , USA
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Science, Stanford University , Palo Alto, CA , USA
| | - Kiran Maski
- Department of Neurology, Boston Children’s Hospital , Boston, MA , USA
| | - Judith Owens
- Department of Neurology, Boston Children’s Hospital , Boston, MA , USA
| | - Carol Rosen
- Department of Pediatric Pulmonary and Sleep Medicine, Rainbow Babies and Children’s of University Hospitals, Case Western Reserve University , Cleveland, OH , USA
| | - Sally Ibrahim
- Department of Pediatric Pulmonary and Sleep Medicine, Rainbow Babies and Children’s of University Hospitals, Case Western Reserve University , Cleveland, OH , USA
| | - Fauziya Hassan
- Sleep Disorders Center, University of Michigan , Ann Arbor, MI , USA
| | - Ronald D Chervin
- Sleep Disorders Center, University of Michigan , Ann Arbor, MI , USA
| | - Gayln Perry
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics , Kansas City, MO , USA
| | - Lee Brooks
- Department of Pediatrics, Children’s Hospital of Philadelphia , Philadelphia, PA , USA
| | - Leila Kheirandish-Gozal
- Department of Child health and Child Health Research Institute, University of Missouri Health Center , Columbia, MO , USA
| | - David Gozal
- Department of Child health and Child Health Research Institute, University of Missouri Health Center , Columbia, MO , USA
| | - Thornton Mason
- Department of Pediatrics, Children’s Hospital of Philadelphia , Philadelphia, PA , USA
| | - Althea Robinson
- Sleep Disorders Center, Vanderbilt University , Nashville, TN , USA
| | - Beth Malow
- Sleep Disorders Center, Vanderbilt University , Nashville, TN , USA
| | - Kamal Naqvi
- Department of Pediatrics, University of Texas Southwestern , Dallas, TX , USA
| | - Maida L Chen
- Department of Pediatrics, Seattle Children’s Hospital , Seattle, WA , USA
| | - Supriya Jambhekar
- Division of Pediatric Pulmonary and Sleep Medicine , University of Arkansas Medical Sciences, Little Rock, AR , USA
| | - Ann Halbower
- Department of Pediatrics, Children hospital Colorado, University of Colorado , Denver, CO , USA
| | | | - Ehab Dayyat
- Division of Pediatric Neurology, Department of Pediatrics, Baylor Scott and White McLane Children’s Specialty Clinics , Temple, TX , USA
| | - Jenny Lew
- Division of Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University , Washington, DC , USA
| | - Cecilia Melendres
- Department of Pediatrics, John Hopkins University , Baltimore, MD , USA
| | - Suresh Kotagal
- Department of Neurology, Mayo Clinic , Rochester, MN , USA
| | - Sejal Jain
- Department of Pediatrics, University of Arizona , Tucson, AZ , USA
| | - Elizabeth Super
- Department of Pediatrics, Oregon Health and Sciences University , Portland, OR , USA
| | - Thomas Dye
- Division of Pulmonary and Sleep Medicine, Cincinnati Children’s Hospital Medical Center , Cincinnati, OH , USA
- Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH , USA
| | - Md Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center , Cincinnati, OH , USA
| | - Dawit Tadesse
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center , Cincinnati, OH , USA
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Walls G, Giacometti V, Apte A, Thor M, McCann C, Hanna G, O'Connor J, Deasy J, Hounsell A, Butterworth K, Cole A, Jain S, McGarry C. P1.10-03 A Deep Learning Auto-Segmentation Tool for Cardiac Substructures in 4D Radiotherapy Planning for Locally Advanced Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.181] [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: 10/14/2022]
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Joshi R, Sekar A, Nada R, Nahar U, Bal A, Mitra S, Singh M, Rathi M, Kohli H, Aggarwal A, Singh I, Jain S, Radotra B. POS-031 Renal histomorphology in COVID autopsies - An institutional experience. Kidney Int Rep 2022. [PMCID: PMC9475104 DOI: 10.1016/j.ekir.2022.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Jain S, Dhir V, Leishangthem B, Kalyan M, Verma I, Naidu G, Sharma SK, Sharma A, Jain S. AB0417 SHORT-TERM EFFECT OF METHOTREXATE ON APOLIPOPROTEINS AND LIPID PROFILE IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4367] [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
BackgroundMethotrexate (MTX) forms the first line therapy for rheumatoid arthritis (RA). The cardioprotective effect of MTX is well established, but whether this is just due to control of inflammation, or is also via an effect on serum lipoproteins, is unclear. Although a few studies have studied the effect of the MTX on the traditional lipid profile in RA1, there is no data on the effect of MTX on apolipoproteins (Apo A1, Apo B, ApoB/ApoA1), which are considered better cardiovascular risk predictors than the traditional lipid profile.ObjectivesTo determine the short-term effect of MTX on apolipoproteins and traditional lipid profile in patients with active RA.MethodsDMARD-naïve patients with active RA (SJC≥2 and TJC≥4) who had been enrolled in the multicentre, RCT comparing two different MTX escalation strategies in RA (MEIRA)2 and for whom paired serum samples were available before and after MTX treatment were included. All these patients received MTX monotherapy started at 15 mg/week and escalated to 25 mg/week by 4-8 weeks. Serum levels of apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TG) were measured before starting MTX and after 16 weeks of MTX monotherapy. Proatherosclerotic indices (TC/HDL and ApoB/ApoA1) were also calculated.ResultsA total of 103 patients [mean age 40 (8) years, 93 (90%) females, mean BMI 25.1 (4.8) kg/m2, all non-smokers and non-alcoholics] were included. No study participant had comorbid diabetes mellitus or coronary artery disease; none of them were taking glucocorticoids or hypolipidemic drugs. An increase in Apo A1 levels [by a mean of 5.6 mg/dL (p=0.02)], and HDL levels [by a mean of 1.6 mg/dL (p=0.04)] was seen after 16 weeks of MTX monotherapy. Although a numerical increase in levels of TC (mean 4.6 mg/dL, p=0.07), LDL (mean 2 mg/dL, p=0.34) and TG (mean 6.6 mg/dL, p=0.35) was also noted, none of these were statistically significant. No obvious change in Apo B levels and TC/HDL ratio occurred due to MTX therapy. However, the ApoB/ApoA1 ratio decreased significantly from 0.8 to 0.7 (p=0.002) with 16 weeks of MTX therapy (Table 1).Table 1.Baseline and end of treatment values of apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and proatherosclerotic indices (TC/HDL and ApoB/ApoA1).Parameter (mg/dL)BaselineAfter 16 weeks of MTX therapyp-valueApo A1126.0 (25.1)131.6 (23.4)0.02Apo B92.3 (18.9)92.0 (20.9)0.84ApoB/ApoA10.8 (0.2)0.7 (0.2)0.002TC164.5 (32.4)169.1 (36.8)0.07HDL40.9 (9.8)42.5 (9.7)0.04TC/HDL4.2 (1.1)4.1 (1.1)0.34LDL88.8 (25.2)90.8 (29.8)0.34TG139.8 (69.6)146.4 (91.3)0.35All values represented as mean (SD).Apo A1=apolipoprotein A1, ApoB=apolipoprotein B, TC=total cholesterol, LDL=low-density lipoprotein, HDL=high-density lipoprotein, TG=triglyceridesConclusionMTX therapy led to a mild but significant increase in HDL, ApoA1 and a reduction in ApoB/ApoA1 over short-term. This could potentially represent one of the mechanisms by which MTX exerts its cardioprotective effect; however, these changes need to be carefully interpreted over longer term and in context of the lipid paradox operating in RA.References[1]Navarro-Millán I, Charles-Schoeman C, Yang S, et al. Changes in lipoproteins associated with methotrexate or combination therapy in early rheumatoid arthritis: results from the treatment of early rheumatoid arthritis trial. Arthritis Rheum. 2013;65(6):1430-1438.[2]Jain S, Dhir V, Aggarwal A, et al. Comparison of two dose escalation strategies of methotrexate in active rheumatoid arthritis: a multicentre, parallel group, randomised controlled trial. Ann Rheum Dis. 2021;80(11):1376-1384.Disclosure of InterestsNone declared
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Jain S, Thirunavukarasu M. Utilitarian Concept of Mind and Mental Health. Eur Psychiatry 2022. [PMCID: PMC9566857 DOI: 10.1192/j.eurpsy.2022.1787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Many classification system and mental health act in many country attempted to define mental illness but mental health perse has not been defined.Some unaddressed question like ” what is diseased in mental illness, what do you treat or set right by treatment, how the psychiatrist say that a pateint is improved and describe or define mental health” are addressed. Objectives Working concept for professionals of all allied clinical disciplines. Enable them to understand mental illness and mental health in a uniform and consistent way. Enable all MHP to speak the same language, without room for personal bias. Avoid misconceptions and reduce the stigma with mental illness Methods We divided spectrum of mental health into Mentally Healthy, Not Healthy, Unhealthy and ill . Based on two dimension: 1. impact on self and 2. Impact on other. Awareness of ones own self, ability to relate well with other and ones own actions are useful to self as well as others are the three arms of mental health. Results A presentation was given to psychiatrist & allied sciences professional & members from judicairy, technolocrats, industrialist and educationist. Interaction was recorded and analysed, people even gave their responses comments and suggestions by mail and writing. Conclusions Mind is defined as a functional concept consists of Mood Thought and Intellect which is nicely amalgamated in a synchronised manner which always function in unison and the constituents cannot function in isolation. The three arms of the mental health are used to develop a tool to measure the same. All details will be discussed during the presentation. Disclosure No significant relationships.
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Vadukapuram R, Trivedi C, Mansuri Z, Shah K, Reddy A, Jain S. Bullying victimization in children and adolescents and its impact on academic outcomes. Eur Psychiatry 2022. [PMCID: PMC9567400 DOI: 10.1192/j.eurpsy.2022.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Bullying is a serious problem in schools because of the negative impact on a child’s educational outcomes, especially academic achievement. However, the underlying mechanisms and causes are unknown. Objectives To evaluate the educational outcomes, and psychiatric comorbidities in children and adolescents who are victims of bullying Methods We used 2018–2019 Nationwide Survey of Children’s Health (NSCH) dataset for the study. The participants were children and adolescents (age: 6-17 years, n = 42,790). Data was stratified into two groups: 1) never bullied 2) bullied more than once. Prevalence of different educational outcomes were compared between the groups. Results In the never bullied group 21,015 participants were included, and in the bullied more than once group 21,775 participants were included. More females were in the bullied group compared to never bullied group (50.4% vs 47.5%, p=0.006). More White non- Hispanic individuals were in bullied group in contrast to never bullied group (56.7% vs 43.9%, p< 0.001). Individuals whose health status was fair, or poor were bullied more (2.4% vs 1.4%, p=<0.001). Individuals in bullied group were more likely to be repeating the grades compared to the never bullied group (7.1% vs 5.9%, p:0.039). Individuals who were missing >=11 school days, and sometimes or never engaged in school were observed more in bullied group compared to never bullied group (5.9% vs 3.2% and 20.3% vs 10.6% p < 0.001). Conclusions Our findings suggest that bullying victimization could be a risk factor and associated with decreased academic outcomes. Disclosure No significant relationships.
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Jain S, Dhir V, Aggarwal A, Gupta R, Leishangthem B, Naidu G, Khullar A, Dhawan V, Sharma SK, Sharma A, Jain S. POS0566 PREDICTORS OF RESPONSE TO METHOTREXATE MONOTHERAPY IN ACTIVE RHEUMATOID ARTHRITIS: RESULTS FROM A MULTICENTRE, RANDOMIZED CONTROLLED TRIAL (MEIRA). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4257] [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
BackgroundMethotrexate (MTX) is the gold standard, first-line therapy for rheumatoid arthritis (RA). However, not all patients respond to MTX, and the predictors of its response or non-response have not yet been reliably identified. Identification of these predictors will facilitate personalized therapeutic choices, and improve patient outcomes.ObjectivesTo identify the clinico-laboratory predictors of response to MTX monotherapy in active RA.MethodsThis study included patients with active RA (SJC≥2 and TJC≥4) aged 18-55 years, with disease duration <5 years, who were not receiving DMARDs (except HCQ and low-dose prednisolone) and had been enrolled in the multicentre, parallel group RCT comparing two different MTX escalation strategies in RA (MEIRA)1. All these patients received MTX monotherapy which was started at 15 mg/week, escalated to 25 mg/week by 4-8 weeks, and continued till 16 weeks. MTX response was defined as EULAR good or moderate response (based on DAS28-CRP-3v) at 16 weeks. Stepwise, multivariable logistic regression was done using key demographic (age, gender, BMI, comorbidities), clinical (disease duration, DAS28, HAQ), and laboratory parameters (RF, anti-CCP, ESR, CRP, RBC MTX-polyglutamates 1-4, IL-6, MMP-3) as independent variables to identify predictors of MTX response. A two-tailed p-value <0.05 was used for defining statistical significance. (Trial Reg: CTRI/2018/12/016549)ResultsOut of a total of 178 included patients [84% females, mean age 40 (9) years, mean DAS28-CRP=5.4 (1.1)], 113 (63.5%) were classified as MTX responders at 16 weeks. Age (OR=0.95, p=0.01), BMI (OR=1.12, p=0.006), and RF (OR=0.34, p=0.045) were found to be independent predictors of MTX response on multivariable analysis (Table 1). On sensitivity analysis with DAS28-ESR-based EULAR response, age (OR=0.94, p=0.003) and RF (OR=0.42, p=0.059) were replicated as independent predictors of MTX response, in addition to pre-treatment swollen joint count (OR=0.94, p=0.05).Table 1.Results of multivariable logistic regression analysis for prediction of response (as defined by DAS28-CRP-based EULAR good or moderate response) to methotrexate monotherapy in RAVariableOR (unadjusted)Unadjusted p-valueOR (adjusted)Adjusted p-valueAge0.97 (0.93-1.002)0.060.95 (0.91-0.99)0.01Male sex0.78 (0.35-1.76)0.55-BMI1.1 (1.02-1.19)0.011.12 (1.03-1.22)0.006Presence of comorbidities0.67 (0.31-1.44)0.31-Disease duration0.98 (0.79-1.22)0.87-Baseline DAS281.1 (0.81-1.49)0.54-Baseline HAQ1.04 (0.66-1.64)0.86-Baseline TJC1.01 (0.96-1.05)0.72-Baseline SJC0.97 (0.91-1.02)0.24-Baseline ESR1.01 (1.00-1.02)0.27-Baseline CRP1.00 (0.99-1.01)0.85-RF positive0.31 (0.11-0.85)0.020.34 (0.12-0.98)0.045Anti-CCP positive0.73 (0.27-1.99)0.54-MTX PG1 (16 weeks)0.99 (0.94-1.04)0.69-MTX PG2 (16 weeks)0.98 (0.95-1.02)0.37-MTX PG3 (16 weeks)0.99 (0.96-1.02)0.43-MTX PG4 (16 weeks)0.99 (0.95-1.03)0.62-Serum IL-6 (baseline)0.98 (0.95-1.02)0.33-Serum MMP-3 (baseline)1.00 (1.00-1.00)0.48-BMI= Body Mass Index, CCP= Cyclic Citrullinated Peptides, CRP= C-reactive protein, DAS= Disease Activity Score, ESR= Erythrocyte Sedimentation Rate, HAQ= Health Assessment Questionnaire, MTX= Methotrexate, PG= polyglutamate, OR=Odds Ratio, RF=Rheumatoid Factor, SJC= Swollen Joint Count, TJC= Tender Joint CountNote: Only variables with p-value <0.2 on univariable analysis were included in the multivariable analysis.ConclusionYounger age, RF negativity, higher BMI, and lower pre-treatment swollen joint count are potential predictors of response to MTX monotherapy in RA.References[1]Jain S, Dhir V, Aggarwal A, et al. Comparison of two dose escalation strategies of methotrexate in active rheumatoid arthritis: a multicentre, parallel group, randomised controlled trial. Ann Rheum Dis. 2021;80(11):1376-1384.Disclosure of InterestsNone declared.
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Diez P, Hanna GG, Aitken KL, van As N, Carver A, Colaco RJ, Conibear J, Dunne EM, Eaton DJ, Franks KN, Good JS, Harrow S, Hatfield P, Hawkins MA, Jain S, McDonald F, Patel R, Rackley T, Sanghera P, Tree A, Murray L. UK 2022 Consensus on Normal Tissue Dose-Volume Constraints for Oligometastatic, Primary Lung and Hepatocellular Carcinoma Stereotactic Ablative Radiotherapy. Clin Oncol (R Coll Radiol) 2022; 34:288-300. [PMID: 35272913 DOI: 10.1016/j.clon.2022.02.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 12/25/2022]
Abstract
The use of stereotactic ablative radiotherapy (SABR) in the UK has expanded over the past decade, in part as the result of several UK clinical trials and a recent NHS England Commissioning through Evaluation programme. A UK SABR Consortium consensus for normal tissue constraints for SABR was published in 2017, based on the existing literature at the time. The published literature regarding SABR has increased in volume over the past 5 years and multiple UK centres are currently working to develop new SABR services. A review and update of the previous consensus is therefore appropriate and timely. It is hoped that this document will provide a useful resource to facilitate safe and consistent SABR practice.
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Affiliation(s)
- P Diez
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK
| | - G G Hanna
- Belfast Health and Social Care Trust, Belfast, UK; Queen's University Belfast, Belfast, UK
| | - K L Aitken
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK
| | - N van As
- Institute of Cancer Research, London, UK; Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - A Carver
- Department of Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, UK
| | - R J Colaco
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - J Conibear
- Radiotherapy Department, Barts Cancer Centre, London, UK
| | - E M Dunne
- Department of Clinical Oncology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - D J Eaton
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK; Department of Medical Physics, Guys and St Thomas' NHS Foundation Trust, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - K N Franks
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, Leeds, UK
| | - J S Good
- Department of Clinical Oncology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - S Harrow
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - P Hatfield
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, Leeds, UK
| | - M A Hawkins
- Department of Medical Physics and Biomechanical Engineering, University College London, London, UK; Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Jain
- Belfast Health and Social Care Trust, Belfast, UK; Queen's University Belfast, Belfast, UK
| | - F McDonald
- Institute of Cancer Research, London, UK; Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - R Patel
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK
| | - T Rackley
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - P Sanghera
- Department of Clinical Oncology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - A Tree
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK
| | - L Murray
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
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