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Ing C, Silber JH, Lackraj D, Olfson M, Miles C, Reiter JG, Jain S, Chihuri S, Guo L, Gyamfi-Bannerman C, Wall M, Li G. Behavioural disorders after prenatal exposure to anaesthesia for maternal surgery. Br J Anaesth 2024; 132:899-910. [PMID: 38423824 DOI: 10.1016/j.bja.2024.01.025] [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: 11/14/2023] [Revised: 12/27/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The association between prenatal exposure to general anaesthesia for maternal surgery during pregnancy and subsequent risk of disruptive or internalising behavioural disorder diagnosis in the child has not been well-defined. METHODS A nationwide sample of pregnant women linked to their liveborn infants was evaluated using the Medicaid Analytic eXtract (MAX, 1999-2013). Multivariate matching was used to match each child prenatally exposed to general anaesthesia owing to maternal appendectomy or cholecystectomy during pregnancy with five unexposed children. The primary outcome was diagnosis of a disruptive or internalising behavioural disorder in children. Secondary outcomes included diagnoses for a range of other neuropsychiatric disorders. RESULTS We matched 34,271 prenatally exposed children with 171,355 unexposed children in the database. Prenatally exposed children were more likely than unexposed children to receive a diagnosis of a disruptive or internalising behavioural disorder (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.23-1.40). For secondary outcomes, increased hazards of disruptive (HR, 1.32; 95% CI, 1.24-1.41) and internalising (HR, 1.36; 95% CI, 1.20-1.53) behavioural disorders were identified, and also increased hazards of attention-deficit/hyperactivity disorder (HR, 1.32; 95% CI, 1.22-1.43), behavioural disorders (HR, 1.28; 95% CI, 1.14-1.42), developmental speech or language disorders (HR, 1.16; 95% CI, 1.05-1.28), and autism (HR, 1.31; 95% CI, 1.05-1.64). CONCLUSIONS Prenatal exposure to general anaesthesia is associated with a 31% increased risk for a subsequent diagnosis of a disruptive or internalising behavioural disorder in children. Caution is advised when making any clinical decisions regarding care of pregnant women, as avoidance of necessary surgery during pregnancy can have detrimental effects on mothers and their children.
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Affiliation(s)
- Caleb Ing
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, New York, NY, USA.
| | - Jeffrey H Silber
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Deven Lackraj
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Mark Olfson
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Caleb Miles
- Department of Biostatistics, Mailman School of Public Health, New York, NY, USA
| | - Joseph G Reiter
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Siddharth Jain
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stanford Chihuri
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ling Guo
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Melanie Wall
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Department of Biostatistics, Mailman School of Public Health, New York, NY, USA
| | - Guohua Li
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
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Choudhary S, Chattopadhyay A, Gupta P, Mehta A, Jain S, Machhua S, Minz RW, Bansal R, Sehgal S, Pandav SS, Sharma SK. Ophthalmologic profile of patients with systemic sclerosis. Indian J Ophthalmol 2024:02223307-990000000-00167. [PMID: 38622854 DOI: 10.4103/ijo.ijo_2980_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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/06/2024] [Indexed: 04/17/2024] Open
Abstract
PURPOSE To study the ophthalmologic manifestations of systemic sclerosis (SSc) and its correlation with autoantibody profile. METHODS A cross-sectional study on 200 eyes of 100 consecutive adult patients diagnosed with SSc was performed at a tertiary care center in Northern India. The examination of ocular adnexa, anterior segment, and posterior segment with slit-lamp biomicroscopy, tear film break-up time (TBUT), Schirmer's II test, and choroidal thickness measurement by swept-source ocular coherence tomography was done. Autoantibody profile was available for 85 patients, and its statistical association with the ocular examination findings was analyzed. RESULTS In total, 100 patients (93 females and 7 males) were included. The mean age was 45.11 ± 11.68 years, and the mean disease duration was 6.93 ± 3.68 years. Meibomian gland disease was more commonly found in patients with the diffuse subtype of SSc (P = 0.037). Choroidal thickness was increased in 34% and decreased in 7% (reference range = 307 ± 79 mm) patients. Reduced TBUT, meibomian gland dysfunction, and eyelid stiffness had a statistically significant association with the presence of anti-Scl-70 antibody (P = 0.003, <0.0001, and 0.004, respectively). These patients had ocular fatigue, foreign body sensation, and burning sensation. No significant association was noted with the presence of SS-A/Ro and SS-B/La antibodies. CONCLUSION This study highlights the need for an active comprehensive ophthalmic evaluation. Approximately 75% of the patients in our cohort had ocular involvement to varying extent. An isolated presence of anti-Scl70 antibody was also found to have a positive association with dry eye disease.
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Affiliation(s)
- Sandeep Choudhary
- Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arghya Chattopadhyay
- Department of Internal Medicine, Rheumatology Services, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditi Mehta
- Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddharth Jain
- Department of Internal Medicine, Rheumatology Services, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanghamitra Machhua
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjana W Minz
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reema Bansal
- Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shobha Sehgal
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder S Pandav
- Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shefali K Sharma
- Department of Internal Medicine, Rheumatology Services, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ramadan OI, Rosenbaum PR, Reiter JG, Jain S, Hill AS, Hashemi S, Kelz RR, Fleisher LA, Silber JH. Impact of Hospital Affiliation With a Flagship Hospital System on Surgical Outcomes. Ann Surg 2024; 279:631-639. [PMID: 38456279 PMCID: PMC10926994 DOI: 10.1097/sla.0000000000006132] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To compare general surgery outcomes at flagship systems, flagship hospitals, and flagship hospital affiliates versus matched controls. SUMMARY BACKGROUND DATA It is unknown whether flagship hospitals perform better than flagship hospital affiliates for surgical patients. METHODS Using Medicare claims for 2018 to 2019, we matched patients undergoing inpatient general surgery in flagship system hospitals to controls who underwent the same procedure at hospitals outside the system but within the same region. We defined a "flagship hospital" within each region as the major teaching hospital with the highest patient volume that is also part of a hospital system; its system was labeled a "flagship system." We performed 4 main comparisons: patients treated at any flagship system hospital versus hospitals outside the flagship system; flagship hospitals versus hospitals outside the flagship system; flagship hospital affiliates versus hospitals outside the flagship system; and flagship hospitals versus affiliate hospitals. Our primary outcome was 30-day mortality. RESULTS We formed 32,228 closely matched pairs across 35 regions. Patients at flagship system hospitals (32,228 pairs) had lower 30-day mortality than matched control patients [3.79% vs. 4.36%, difference=-0.57% (-0.86%, -0.28%), P<0.001]. Similarly, patients at flagship hospitals (15,571/32,228 pairs) had lower mortality than control patients. However, patients at flagship hospital affiliates (16,657/32,228 pairs) had similar mortality to matched controls. Flagship hospitals had lower mortality than affiliate hospitals [difference-in-differences=-1.05% (-1.62%, -0.47%), P<0.001]. CONCLUSIONS Patients treated at flagship hospitals had significantly lower mortality rates than those treated at flagship hospital affiliates. Hence, flagship system affiliation does not alone imply better surgical outcomes.
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Affiliation(s)
- Omar I. Ramadan
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Paul R. Rosenbaum
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Department of Statistics and Data Science, The Wharton School, University of Pennsylvania, Philadelphia, PA
| | - Joseph G. Reiter
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Siddharth Jain
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Alexander S. Hill
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sean Hashemi
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Rachel R. Kelz
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Lee A. Fleisher
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania, Philadelphia, PA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jeffrey H. Silber
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA
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Jain S, Rosenbaum PR, Reiter JG, Ramadan OI, Hill AS, Silber JH, Fleisher LA. Assessing the Ambulatory Surgery Center Volume-Outcome Association. JAMA Surg 2024; 159:397-403. [PMID: 38265816 PMCID: PMC10809135 DOI: 10.1001/jamasurg.2023.7161] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/01/2023] [Indexed: 01/25/2024]
Abstract
Importance In surgical patients, it is well known that higher hospital procedure volume is associated with better outcomes. To our knowledge, this volume-outcome association has not been studied in ambulatory surgery centers (ASCs) in the US. Objective To determine if low-volume ASCs have a higher rate of revisits after surgery, particularly among patients with multimorbidity. Design, Setting, and Participants This matched case-control study used Medicare claims data and analyzed surgeries performed during 2018 and 2019 at ASCs. The study examined 2328 ASCs performing common ambulatory procedures and analyzed 4751 patients with a revisit within 7 days of surgery (defined to be either 1 of 4735 revisits or 1 of 16 deaths without a revisit). These cases were each closely matched to 5 control patients without revisits (23 755 controls). Data were analyzed from January 1, 2018, through December 31, 2019. Main Outcomes and Measures Seven-day revisit in patients (cases) compared with the matched patients without the outcome (controls) in ASCs with low volume (less than 50 procedures over 2 years) vs higher volume (50 or more procedures). Results Patients at a low-volume ASC had a higher odds of a 7-day revisit vs patients who had their surgery at a higher-volume ASC (odds ratio [OR], 1.21; 95% CI, 1.09-1.36; P = .001). The odds of revisit for patients with multimorbidity were higher at low-volume ASCs when compared with higher-volume ASCs (OR, 1.57; 95% CI, 1.27-1.94; P < .001). Among patients with multimorbidity in low-volume ASCs, for those who underwent orthopedic procedures, the odds of revisit were 84% higher (OR, 1.84; 95% CI, 1.36-2.50; P < .001) vs higher-volume centers, and for those who underwent general surgery or other procedures, the odds of revisit were 36% higher (OR, 1.36; 95% CI, 1.01-1.83; P = .05) vs a higher-volume center. The findings were not statistically significant for patients without multimorbidity. Conclusions and Relevance In this observational study, the surgical volume of an ASC was an important indicator of patient outcomes. Older patients with multimorbidity should discuss with their surgeon the optimal location of their care.
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Affiliation(s)
- Siddharth Jain
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia
| | - Paul R. Rosenbaum
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia
- Department of Statistics and Data Science, The Wharton School, The University of Pennsylvania, Philadelphia
| | - Joseph G. Reiter
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia
| | - Omar I. Ramadan
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia
- Department of Surgery, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia
| | - Alexander S. Hill
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia
| | - Jeffrey H. Silber
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia
- The Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia
| | - Lee A. Fleisher
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia
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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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Agnihotri M, Chamola R, Bhan U, Jain S. Analyzing the performance of synthesized nano-catalysts for transesterification of waste cooking oil as environment friendly drilling fluid. Environ Res 2024; 244:117948. [PMID: 38104914 DOI: 10.1016/j.envres.2023.117948] [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: 10/12/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
Ester-based drilling fluids (EBDF) are preferred over oil-based drilling fluids (OBDF) and water-based drilling fluids (WBDF) because of their great biodegradability, low toxicity, and improved performance. In this work, waste cooking oil methyl ester (WCOME) was used to prepare an environmentally friendly EBDF. Through a transesterification process utilizing a modified calcium oxide based heterogenous catalyst, the waste cooking oil is transformed into waste cooking oil methyl ester. Response surface approach was used to strengthen the transesterification. The optimize conditions for CaO/Al2O3 resulted in the highest yield of 96.56% at a molar ratio of 11.9:1, 3.19 wt % of CaO/Al2O3, 53.79 °C, and 76.86 min. In contrast, CaO/TiO2 yielded 98.15% at a molar ratio of 11.99:1, with a CaO/TiO2 of 2.53 wt % at 59.79 in 68.14 min. Additionally, two separate densities of 9 ppg and 12 ppg EBDF are formulated with two distinct oil-to-water ratios (70:30 and 80:20) using synthesized WCOME. To assess the effectiveness of formulated EBDF thorough rheological investigation is conducted at 150°. Additionally, the filtration loss at HPHT conditions, emulsion stability, and Barite sag analysis of the drilling fluid are all analyzed at before ageing and after dynamic ageing. With better rheological features, less fluid loss, good emulsion stability, and minimal barite sagging, the designed EBDF performs efficiently. The drilling fluid met the API requirement and demonstrated stability even after ageing at 250 °F for 72 h, suggesting that it may be used for extended periods of time in drilling.
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Affiliation(s)
- Mayank Agnihotri
- Department of Petroleum Engineering and Earth Science, UPES, Dehradun, 248007, India
| | - Rahul Chamola
- Department of Mechanical Engineering, UPES, Dehradun, India
| | - Uday Bhan
- Department of Petroleum Engineering and Earth Science, UPES, Dehradun, 248007, India
| | - Siddharth Jain
- Department of Mechanical Engineering, UPES, Dehradun, India.
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Khullar A, Dhir V, Saikia B, Yadav AK, Leishangthem B, Prasad CB, Jayaprakash S, Jain S, Naidu GSRSNK, Sharma SK, Sharma A, Jain S. Rheumatoid arthritis synovial fluid shows enrichment of T-cells producing GMCSF which are polyfunctional for TNFα and IFNγ. Clin Exp Rheumatol 2024:20310. [PMID: 38372731 DOI: 10.55563/clinexprheumatol/dyjbvf] [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: 09/02/2023] [Accepted: 01/04/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES GMCSF+T-cells may be involved in pathogenesis of rheumatoid arthritis (RA), and polyfunctionality may be a marker of pathogenicity. Although, higher frequencies of CD4+GMCSF+ T-cells have been reported, there are no data on CD8+GMCSF+ T-cells or polyfunctionality.Our objective was to enumerate frequencies of CD8+GMCSF+ T cells in RA blood and synovial fluid (SF), and assess their polyfunctionality, memory phenotype and cytotoxic ability. METHODS This study included RA patients (blood samples,in some with paired synovial fluid (SF)), healthy controls (HC) (blood) and SpA patients (SF). In some RA patients' blood was sampled twice, before and 16-24 weeks after methotrexate (MTX) treatment. After mononuclear cell isolation from blood and SF, ex-vivo stimulation using PMA/Ionomycin was done, and cells were stained (surface and intracellular after permeabilisation/fixation). Subsequently, frequencies of GMCSF+CD8+ and CD4+ T-cells, polyfunctionality (TNFα, IFNγ, IL-17), phenotype (memory) and perforin/granzyme expression were assessed by flowcytometry. RESULTS There was no significant difference in frequencies of GMCSF+CD8+ (3.7, 4.1%, p=0.540) or GMCSF+CD4+ T-cells (4.5, 5.2%, p=0.450) inblood of RA and HC. However, there was significant enrichment of both CD8+GMCSF+ (5.8, 3.9%, p=0.0045) and CD4+GMCSF+ (8.5, 4.5%, p=0.0008) T-cells inSF compared to blood in RA patients. Polyfunctional triple cytokine positive TNFα+IFNγ+GMCSF+CD8+T-cells (81, 36%, p=0.049) and CD4+T-cells (48, 32%, p=0.010) was also higher in SF compared to blood in RA. CD8+ T cells showed higher frequency of effector-memory phenotype and granzyme-B expression in RA-SF. On longitudinal follow-up, blood CD4+GMCSF+ T-cells significantly declined (4.6, 2.9%, p=0.0014) post-MTX. CONCLUSIONS We report a novel finding of enrichment of CD8+GMCSF+ in addition to CD4+GMCSF+ T-cells in RA-SF. These cells showed higher polyfunctionality for TNFα and IFNγ, and effector memory phenotype suggesting their involvement in RA pathogenesis.
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Affiliation(s)
- Aastha Khullar
- Division of Rheumatology, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Varun Dhir
- Division of Rheumatology, Department of Internal Medicine, PGIMER, Chandigarh, India.
| | - Biman Saikia
- Department of Immunopathology, PGIMER, Chandigarh, India
| | - Ashok Kumar Yadav
- Department of Experimental Medicine and Biotechnology, PGIMER, Chandigarh, India
| | | | | | - Sankar Jayaprakash
- Division of Rheumatology, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Siddharth Jain
- Division of Rheumatology, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - G S R S N K Naidu
- Division of Rheumatology, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Shefali K Sharma
- Division of Rheumatology, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Aman Sharma
- Division of Rheumatology, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Sanjay Jain
- Division of Rheumatology, Department of Internal Medicine, PGIMER, 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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Suryawanshi SJ, Jain S, Sharma RK, Chawla R, Arora S, Shukla VK, Sharma N. Current veterinary regulations and way ahead. Res Vet Sci 2024; 166:105101. [PMID: 38016218 DOI: 10.1016/j.rvsc.2023.105101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
This article aims to perform a comparative systematic review of regulations in veterinary medicine between the years 2016 to 2023. It explores the complex web of veterinary medicine regulations in various agencies and the nations, including USA (United States of America), EU (European Union), UK (United Kingdom), Japan, Australia, and India. Current article provides the comparative study on the veterinary regulations of different countries, including acts, directives, and drug approval processes. Such as, the specific legislation is needed to address zoonotic diseases. The strategic and regulated stockpiling of the veterinary drugs especially in chronic veterinary disease outbreak. It is essential to develop the dedicated Veterinary Pharmacopoeia for the regulated standardization of the raw materials as well as the formulations. Veterinary medical device is a field which is highly unregulated. There is a need to have regulations for the same. It is important to have dedicated veterinary pharmacovigilance centers which help in improving quality of medications to the livestock farms. After comparing the regulations of different countries. We observed that there is the absence of the zoonotic diseases and pharma stockpiling in every country. There is also an absence of the dedicated veterinary pharmacopoeia in every country. USA and Australia have the veterinary medical device regulation which is not there in other countries. Around the globe only Australia has the dedicated pharmacovigilance center. Including these recommendations into regulatory framework enhances the quality and safety of veterinary medicine. The current article adds a valuable resource for policymakers, veterinarians, and stakeholders in the field of animal health care.
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Affiliation(s)
| | - Siddharth Jain
- Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh 201303, India
| | - Rakesh K Sharma
- Instituite of Nuclear Medicine and Allied Sciences (INMAS), Timarpur, New Delhi, Delhi 110054, India
| | - Raman Chawla
- Instituite of Nuclear Medicine and Allied Sciences (INMAS), Timarpur, New Delhi, Delhi 110054, India
| | - Sandeep Arora
- Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh 201303, India
| | - Vikesh K Shukla
- Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh 201303, India
| | - Navneet Sharma
- Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh 201303, India.
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Jain S, Rosenbaum PR, Reiter JG, Ramadan OI, Hill AS, Hashemi S, Brown RT, Kelz RR, Fleisher LA, Silber JH. Mortality Among Older Medical Patients at Flagship Hospitals and Their Affiliates. J Gen Intern Med 2023:10.1007/s11606-023-08415-w. [PMID: 38087179 DOI: 10.1007/s11606-023-08415-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/05/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND We define a "flagship hospital" as the largest academic hospital within a hospital referral region and a "flagship system" as a system that contains a flagship hospital and its affiliates. It is not known if patients admitted to an affiliate hospital, and not to its main flagship hospital, have better outcomes than those admitted to a hospital outside the flagship system but within the same hospital referral region. OBJECTIVE To compare mortality at flagship hospitals and their affiliates to matched control patients not in the flagship system but within the same hospital referral region. DESIGN A matched cohort study PARTICIPANTS: The study used hospitalizations for common medical conditions between 2018-2019 among older patients age ≥ 66 years. We analyzed 118,321 matched pairs of Medicare patients admitted with pneumonia (N=57,775), heart failure (N=42,531), or acute myocardial infarction (N=18,015) in 35 flagship hospitals, 124 affiliates, and 793 control hospitals. MAIN MEASURES 30-day (primary) and 90-day (secondary) all-cause mortality. KEY RESULTS 30-day mortality was lower among patients in flagship systems versus control hospitals that are not part of the flagship system but within the same hospital referral region (difference= -0.62%, 95% CI [-0.88%, -0.37%], P<0.001). This difference was smaller in affiliates versus controls (-0.43%, [-0.75%, -0.11%], P=0.008) than in flagship hospitals versus controls (-1.02%, [-1.46%, -0.58%], P<0.001; difference-in-difference -0.59%, [-1.13%, -0.05%], P=0.033). Similar results were found for 90-day mortality. LIMITATIONS The study used claims-based data. CONCLUSIONS In aggregate, within a hospital referral region, patients treated at the flagship hospital, at affiliates of the flagship hospital, and in the flagship system as a whole, all had lower mortality rates than matched controls outside the flagship system. However, the mortality advantage was larger for flagship hospitals than for their affiliates.
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Affiliation(s)
- Siddharth Jain
- Center for Outcomes Research, Children's Hospital of Philadelphia, 2716 South Street, Suite 5140, Philadelphia, PA, 19146-2305, USA.
| | - Paul R Rosenbaum
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- Department of Statistics and Data Science, The Wharton School of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph G Reiter
- Center for Outcomes Research, Children's Hospital of Philadelphia, 2716 South Street, Suite 5140, Philadelphia, PA, 19146-2305, USA
| | - Omar I Ramadan
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander S Hill
- Center for Outcomes Research, Children's Hospital of Philadelphia, 2716 South Street, Suite 5140, Philadelphia, PA, 19146-2305, USA
| | - Sean Hashemi
- Center for Outcomes Research, Children's Hospital of Philadelphia, 2716 South Street, Suite 5140, Philadelphia, PA, 19146-2305, USA
| | - Rebecca T Brown
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- Division of Geriatric Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Rachel R Kelz
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Lee A Fleisher
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Center for Perioperative Outcomes Research and Transformation, The University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey H Silber
- Center for Outcomes Research, Children's Hospital of Philadelphia, 2716 South Street, Suite 5140, Philadelphia, PA, 19146-2305, USA
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- The Departments of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Health Care Management, The Wharton School of the University of Pennsylvania, Philadelphia, PA, USA
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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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13
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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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Nagar G, Jain S, Rajurkar M, Lothe R, Rao H, Majumdar S, Gautam M, Rodriguez-Aponte SA, Crowell LE, Love JC, Dandekar P, Puranik A, Gairola S, Shaligram U, Jain R. Large-Scale Purification and Characterization of Recombinant Receptor-Binding Domain (RBD) of SARS-CoV-2 Spike Protein Expressed in Yeast. Vaccines (Basel) 2023; 11:1602. [PMID: 37897004 PMCID: PMC10610970 DOI: 10.3390/vaccines11101602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
SARS-CoV-2 spike protein is an essential component of numerous protein-based vaccines for COVID-19. The receptor-binding domain of this spike protein is a promising antigen with ease of expression in microbial hosts and scalability at comparatively low production costs. This study describes the production, purification, and characterization of RBD of SARS-CoV-2 protein, which is currently in clinical trials, from a commercialization perspective. The protein was expressed in Pichia pastoris in a large-scale bioreactor of 1200 L capacity. Protein capture and purification are conducted through mixed-mode chromatography followed by hydrophobic interaction chromatography. This two-step purification process produced RBD with an overall productivity of ~21 mg/L at >99% purity. The protein's primary, secondary, and tertiary structures were also verified using LCMS-based peptide mapping, circular dichroism, and fluorescence spectroscopy, respectively. The glycoprotein was further characterized for quality attributes such as glycosylation, molecular weight, purity, di-sulfide bonding, etc. Through structural analysis, it was confirmed that the product maintained a consistent quality across different batches during the large-scale production process. The binding capacity of RBD of spike protein was also assessed using human angiotensin-converting enzyme 2 receptor. A low binding constant range of KD values, ranging between 3.63 × 10-8 to 6.67 × 10-8, demonstrated a high affinity for the ACE2 receptor, revealing this protein as a promising candidate to prevent the entry of COVID-19 virus.
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Affiliation(s)
- Gaurav Nagar
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (G.N.); (S.G.)
| | - Siddharth Jain
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (G.N.); (S.G.)
| | - Meghraj Rajurkar
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (G.N.); (S.G.)
| | - Rakesh Lothe
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (G.N.); (S.G.)
| | - Harish Rao
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (G.N.); (S.G.)
| | - Sourav Majumdar
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (G.N.); (S.G.)
| | - Manish Gautam
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (G.N.); (S.G.)
| | - Sergio A. Rodriguez-Aponte
- Department of Biological Engineering, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA;
| | - Laura E. Crowell
- Department of Chemical Engineering, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (L.E.C.); (J.C.L.)
| | - J. Christopher Love
- Department of Chemical Engineering, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (L.E.C.); (J.C.L.)
| | - Prajakta Dandekar
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Matunga, Mumbai 400019, India;
| | - Amita Puranik
- Department of Biological Sciences and Biotechnology, Institute of Chemical Technology, Matunga, Mumbai 400019, India
| | - Sunil Gairola
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (G.N.); (S.G.)
| | - Umesh Shaligram
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (G.N.); (S.G.)
| | - Ratnesh Jain
- Department of Biological Sciences and Biotechnology, Institute of Chemical Technology, Matunga, Mumbai 400019, India
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15
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Sekar A, Jain S, Bakshi J, Rachagiri S, Bhujade H, Kumar R, Bal A. Disseminated Nasal subtype Extranodal NK/T-cell lymphoma and its diagnostic difficulties in antemortem biopsies. Autops Case Rep 2023; 13:e2023445. [PMID: 38034525 PMCID: PMC10688205 DOI: 10.4322/acr.2023.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/11/2023] [Indexed: 12/02/2023]
Abstract
Extranodal NK/T- cell lymphoma (ENKTCL) is an aggressive lymphoma driven by Epstein-Barr virus (EBV) infection in genetically susceptible individuals. It was historically called a lethal midline granuloma. Due to the angio-destructive nature of ENKTCL, lymphoma cells are often accompanied and masked by necrosis and dense inflammation in the biopsy. Further, the biopsy may show vasculitis, which can mimic granulomatosis with polyangiitis. Due to these masquerades, ENKTCL is often misdiagnosed in the biopsy. Several biopsies may be required to establish the diagnosis. We describe the clinical course and autopsy findings of a young female who presented with a hard-palate ulcer. Antemortem biopsies failed to establish the diagnosis. The autopsy revealed an advanced nasal subtype of Extranodal NK/T-cell lymphoma with dissemination to the kidneys, adrenals, liver, spleen, and small intestine.
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Affiliation(s)
- Aravind Sekar
- Post Graduate Institute of Medical Education and Research, Department of Histopathology, Chandigarh, India
| | - Siddharth Jain
- All India Institute of Medical Sciences, Department of Medicine, New Delhi, India
| | - Jaimanti Bakshi
- Post Graduate Institute of Medical Education and Research, Department of Otolaryngology, Chandigarh, India
| | - Suneel Rachagiri
- Post Graduate Institute of Medical Education and Research, Department of Histopathology, Chandigarh, India
| | - Harish Bhujade
- Post Graduate Institute of Medical Education and Research, Department of Radiodiagnosis, Chandigarh, India
| | - Rajender Kumar
- Post Graduate Institute of Medical Education and Research, Department of Nuclear Medicine, Chandigarh, India
| | - Amanjit Bal
- Post Graduate Institute of Medical Education and Research, Department of Histopathology, Chandigarh, India
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16
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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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17
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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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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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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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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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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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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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Jain S, Rankavat S. Analysing driving factors of India's transportation sector CO 2 emissions: Based on LMDI decomposition method. Heliyon 2023; 9:e19871. [PMID: 37809627 PMCID: PMC10559243 DOI: 10.1016/j.heliyon.2023.e19871] [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: 04/14/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
India is the world's third-largest carbon dioxide (CO2) emitter, with the transportation sector accounting for most of this emission. Using the logarithmic-mean Divisia index (LMDI) decomposition method and Tapio decoupling, this study examines the driving factors and their relationship with economic growth for the Indian transportation sector. Transportation-related energy consumption is decomposed into six factors. From 2001 to 2020, CO2 emissions from the Indian transportation sector increased from 155.9 Mt to 368.2 Mt. Roadways produce 88% of all CO2 emissions. Energy systems, economic advancement, and population scale increase CO2 emissions, whereas energy performance and transportation form decrease. Transport advancement demonstrates both tendencies intermittently. CO2 emissions from Indian transportation exhibit a weak decoupling. The increasing demand for vehicles, reliance on conventional fuel, and increase in energy consumption indicate a positive correlation with the increase in the nation's CO2 emissions, while the transition from coal to electric locomotives and the increased use of electric vehicles offset the increase in emissions. In short, the government should update strategic sustainable transport policy measures and emphasize renewable energy. This study will assist policymakers in formulating robust sustainable transportation policies.
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Affiliation(s)
- Siddharth Jain
- Department of Civil Engineering, Shiv Nadar University, Delhi NCR, Greater Noida, Uttar Pradesh 201314, India
| | - Shalini Rankavat
- Department of Civil Engineering, Shiv Nadar University, Delhi NCR, Greater Noida, Uttar Pradesh 201314, India
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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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Mishra S, Jain S, Purohit S, Lal G, Sharma N. Analgesic Effects of Magnesium Sulphate as an Adjuvant to Fentanyl for Monitored Anaesthesia Care During Hysteroscopy. Cureus 2023; 15:e43458. [PMID: 37711929 PMCID: PMC10498801 DOI: 10.7759/cureus.43458] [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] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Magnesium sulphate (MgSO4) is conventionally used in the treatment of eclampsia, refractive arrhythmias, asthma, etc. In our study, we aimed to study the analgesic effects of MgSO4 as an adjuvant to fentanyl and reduce the intraoperative opioid requirement to decrease their adverse effects. METHODS A total of 122 patients scheduled for hysteroscopy were randomly divided into two groups. Patients in the magnesium group (group A) received intravenous MgSO4 50 mg/kg in 100 ml of isotonic saline over 15 minutes before anaesthesia induction and then 15 mg/kg per hour by continuous intravenous infusion. Patients in the control group (group B) received an equal volume of isotonic saline as a placebo. All the patients were induced with fentanyl and propofol. Perioperative haemodynamic monitoring and postoperative assessment of pain were done. RESULTS Only 18% of the patients in group A required rescue analgesics as compared to 39.3% of patients in group B. The patients receiving MgSO4 displayed lower verbal numeric rating scale scores in the postoperative period. In addition, the intraoperative requirement of fentanyl (101 (21.33) vs. 144 (28.4) µg, mean (SD)) and propofol (121 (13.3) vs. 140 (16.5) mg, mean (SD)) was significantly lower in group A as compared to that in group B. CONCLUSION MgSO4, when administered as an adjuvant to opioids, provided effective postoperative analgesia thereby reducing the need for rescue analgesics. It also decreases intraoperative fentanyl consumption and its dose-related side effects.
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Affiliation(s)
- Sonal Mishra
- Anesthesiology, Sawai Man Singh (SMS) Medical College, Jaipur, IND
| | - Siddharth Jain
- Orthopedics, All India Institute of Medical Sciences, Bhopal, IND
| | - Shobha Purohit
- Anesthesiology, Sawai Man Singh (SMS) Medical College, Jaipur, IND
| | - Girdhari Lal
- Anesthesiology, Sawai Man Singh (SMS) Medical College, Jaipur, IND
| | - Neelu Sharma
- Anesthesiology, Sawai Man Singh (SMS) Medical College, Jaipur, IND
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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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Jain S, Dhir V. Correspondence on 'Five-year treat-to-target outcomes after methotrexate induction therapy with or without other csDMARDs and temporary glucocorticoids for rheumatoid arthritis in the CareRA trial'. Ann Rheum Dis 2023; 82:e162. [PMID: 34193404 DOI: 10.1136/annrheumdis-2021-220816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Siddharth Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dhir
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 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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Mishra PK, Jain S, Nadeem M. Three-Year Experience and Outcomes of Near-Early Internal Fixation for Femoral Neck Fractures in Pediatric Trauma Patients: A Retrospective Study. Cureus 2023; 15:e40049. [PMID: 37425594 PMCID: PMC10324986 DOI: 10.7759/cureus.40049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 07/11/2023] Open
Abstract
Background The fractured neck of the femur in children is commonly caused by high-energy trauma, and despite its low incidence, complications are more frequent. Delayed presentation is not unusual in developing countries. The interval between injury and surgery is thought to be a critical factor in determining outcomes. This study aims to evaluate the effectiveness of "near early" internal fixation (24-72 hours) for fractured neck of the femur in children. Methods This is a retrospective observational study that analyzed complete case records from a period of seven years. Cases were classified according to the Delbet classification and outcomes were assessed using the Ratliff criteria with a minimum follow-up of three years. Results The study included 24 male and 11 female patients, with an average age of 11.28 years. The most common cause of injury was road traffic accidents. The fracture distribution in the study population was as follows: Delbet type II in 18 patients, Delbet type III in 10 patients, and Delbet type IV in seven patients. In our study, all patients underwent near-early fixation, meaning their fractures were fixed within 24-72 hours of injury. The average time for the clinical-radiological union was 8 weeks, and the most common complication was premature physeal fusion, followed by osteonecrosis. Conclusion In developing countries, where patients often experience delayed referrals and lack of awareness, near-early fixation (24-72 hours) of a fractured neck of the femur in children is a crucial option that holds significant value.
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Affiliation(s)
- Pankaj K Mishra
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
| | - Siddharth Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
| | - Mohammed Nadeem
- Department of Orthopaedics, Gandhi Medical College, Bhopal, IND
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Bhargava M, Kopp CR, Naidu S, Dhibar DP, Saroch A, Khadwal A, Narang T, Jain S, Khullar A, Leishangthem B, Sharma A, Kumar S, Sharma S, Jain S, Dhir V. Comparison of two doses of leucovorin in severe low-dose methotrexate toxicity - a randomized controlled trial. Arthritis Res Ther 2023; 25:82. [PMID: 37208770 DOI: 10.1186/s13075-023-03054-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/20/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Leucovorin (folinic acid) is a commonly used antidote for severe toxicity with low-dose methotrexate, but its optimum dose is unclear, varying from 15 to 25 mg every 6-h. METHODS Open-label RCT included patients with severe low-dose (≤ 50 mg/week) methotrexate toxicity defined as WBC ≤ 2 × 10^9/L or platelet ≤ 50 × 10^9/L and randomized them to receive either usual (15 mg) or high-dose (25 mg) intravenous leucovorin given every 6-h. Primary outcome was mortality at 30-days and secondary outcomes were hematological recovery and mucositis recovery. TRIAL REGISTRATION NUMBER CTRI/2019/09/021152. RESULTS Thirty-eight patients were included, most with underlying RA who had inadvertently overdosed MTX (taken daily instead of weekly). At randomization, the median white blood and platelet count were 0.8 × 10^9/L and 23.5 × 10^9/L. 19 patients each were randomized to receive either usual or high-dose leucovorin. Number (%) of deaths over 30-days was 8 (42) and 9 (47) in usual and high-dose leucovorin groups (Odds ratio 1.2, 95% CI 0.3 to 4.5, p = 0.74). On Kaplan-Meier, there was no significant difference in survival between the groups (hazard ratio 1.1, 95% CI 0.4 to 2.9, p = 0.84). On multivariable cox-regression, serum albumin was the only predictor of survival (hazard ratio 0.3, 95% CI 0.1 to 0.9, p = 0.02). There was no significant difference in hematological or mucositis recovery between the two groups. CONCLUSION There was no significant difference in survival or time-to hematological recovery between the two doses of leucovorin. Severe low-dose methotrexate toxicity carried a significant mortality.
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Affiliation(s)
- Mudit Bhargava
- Division of Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Chirag Rajkumar Kopp
- Division of Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shankar Naidu
- Division of Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Deba Prasad Dhibar
- Division of Emergency Medicine, Department of Internal Medicine Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Atul Saroch
- Division of Emergency Medicine, Department of Internal Medicine Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Alka Khadwal
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Tarun Narang
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Siddharth Jain
- Division of Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aastha Khullar
- Division of Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Bidya Leishangthem
- Division of Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aman Sharma
- Division of Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Susheel Kumar
- Division of Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shefali Sharma
- Division of Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sanjay Jain
- Division of Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Varun Dhir
- Division of Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Shrivastava A, Jain S, Damaraju V, Naidu GSRSNK, Dhir V, Rathi M, Grover S, Jain S, Sharma A. Severity and determinants of psychosocial comorbidities in granulomatosis with polyangiitis and their impact on quality of life. Rheumatol Int 2023:10.1007/s00296-023-05341-2. [PMID: 37160468 DOI: 10.1007/s00296-023-05341-2] [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: 03/25/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
Depression, anxiety, sleep disturbances, and fatigue are inadequately addressed comorbidities in granulomatosis with polyangiitis (GPA). We determined the prevalence, severity, determinants, and the impact of these comorbidities on quality-of-life (QoL) in GPA. This observational study included adult GPA patients; patients with RA and lupus were included as comparators. Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder 7-item scale for anxiety, Epworth Sleepiness Scale for sleep disturbances, and Fatigue Severity Scale for fatigue were administered prospectively to estimate prevalence and severity. QoL and disability were estimated using PROMIS-HAQ, HAQ-health and HAQ-pain. Correlations among these parameters were assessed. Stepwise regression analyses were performed to identify determinants of depression, anxiety, excessive sleepiness, and fatigue. One hundred eighty-one patients-62 GPA [mean age 43 (13) years], 57 RA and 62 SLE- were included. The prevalence of depression (47%), excessive sleepiness (21%), and fatigue (39%) in GPA were comparable to RA and lupus; anxiety was less prevalent (29% versus 46% and 53%, p = 0.02). Severity was mostly mild-moderate. Younger age [OR = 0.93 (0.89-0.98)], higher BMI [OR = 1.2 (1.0-1.4)], and greater disease damage [OR = 2.0 (1.3-3.3)] independently predicted presence of depression. Higher BMI [OR = 1.3 (1.1-1.5)] and concomitant FMS [OR = 80.9 (5.1-1289.2)] were independently associated with excessive sleepiness. No association with disease activity, duration, or gender was seen. GPA patients with depression, anxiety, excessive sleepiness, and fatigue had worse PROMIS-HAQ, HAQ-pain, and HAQ-health. In conclusion, depression, anxiety, sleep disturbances, and fatigue are common in GPA. Although their severity is mostly mild-moderate, they impair QoL significantly. Potentially modifiable determinants that can form targets for future interventions have been identified.
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Affiliation(s)
- Abhinav Shrivastava
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddharth Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikram Damaraju
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - G S R S N K Naidu
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dhir
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rathi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Kataria A, Jain S, Arora M, Mishra S. Sudden Sensorineural Hearing Loss Associated with Oral Consumption of Hand Sanitizer: A Case Report. Iran J Otorhinolaryngol 2023; 35:173-178. [PMID: 37251297 PMCID: PMC10209813 DOI: 10.22038/ijorl.2023.70374.3390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/03/2023] [Indexed: 05/31/2023]
Abstract
Introduction Pediatric sudden sensorineural hearing loss (SSNHL) is a rare otological emergency. With the emergence of the Coronavirus 19 pandemic, alcohol-based hand sanitizers are among the essential household items. Many hand sanitizers are frequently coupled with scents that young children may find pleasant. Case Report A 5-year-old girl presented to our clinic with hearing loss after the consumption of alcohol-based hand sanitizer. A pure tone audiogram showed bilateral SSNHL. The child was prescribed systemic corticosteroids resulted in a slight improvement in hearing thresholds. The child was followed up at 6 and 18 months showing no further improvement in hearing thresholds. Conclusion Although various infective, vascular, and immune responses have been proposed, alcohol-based hand sanitizer consumption has not been reported to present with SSNHL to the best of our knowledge. In the current scenario of the Coronavirus pandemic, otorhinolaryngologists must keep in mind that SSNHL may occur as a result of hazardous alcohol-based hand disinfectant consumption.
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Affiliation(s)
- Arshit Kataria
- Department of ENT and Head & Neck Surgery, All India Institute of Medical Sciences, Bathinda, Punjab, India.
| | - Siddharth Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
| | - Manika Arora
- Department of Head and Neck Surgery, Government Medical College, Patiala,Punjab, India.
| | - Sonal Mishra
- Department of Anaesthesiology, S.M.S. Medical College, Jaipur, Rajasthan, India.
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Ramadan OI, Rosenbaum PR, Reiter JG, Jain S, Hill AS, Hashemi S, Kelz RR, Fleisher LA, Silber JH. Redefining Multimorbidity in Older Surgical Patients. J Am Coll Surg 2023; 236:1011-1022. [PMID: 36919934 DOI: 10.1097/xcs.0000000000000659] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Multimorbidity in surgery is common and associated with worse postoperative outcomes. However, conventional multimorbidity definitions (≥2 comorbidities) label the vast majority of older patients as multimorbid, limiting clinical usefulness. We sought to develop and validate better surgical specialty-specific multimorbidity definitions based on distinct comorbidity combinations. STUDY DESIGN We used Medicare claims for patients aged 66 to 90 years undergoing inpatient general, orthopaedic, or vascular surgery. Using 2016 to 2017 data, we identified all comorbidity combinations associated with at least 2-fold (general/orthopaedic) or 1.5-fold (vascular) greater risk of 30-day mortality compared with the overall population undergoing the same procedure; we called these combinations qualifying comorbidity sets. We applied them to 2018 to 2019 data (general = 230,410 patients, orthopaedic = 778,131 patients, vascular = 146,570 patients) to obtain 30-day mortality estimates. For further validation, we tested whether multimorbidity status was associated with differential outcomes for patients at better-resourced (based on nursing skill-mix, surgical volume, teaching status) hospitals vs all other hospitals using multivariate matching. RESULTS Compared with conventional multimorbidity definitions, the new definitions labeled far fewer patients as multimorbid: general = 85.0% (conventional) vs 55.9% (new) (p < 0.0001); orthopaedic = 66.6% vs 40.2% (p < 0.0001); and vascular = 96.2% vs 52.7% (p < 0.0001). Thirty-day mortality was higher by the new definitions: general = 3.96% (conventional) vs 5.64% (new) (p < 0.0001); orthopaedic = 0.13% vs 1.68% (p < 0.0001); and vascular = 4.43% vs 7.00% (p < 0.0001). Better-resourced hospitals offered significantly larger mortality benefits than all other hospitals for multimorbid vs nonmultimorbid general and orthopaedic, but not vascular, patients (general surgery difference-in-difference = -0.94% [-1.36%, -0.52%], p < 0.0001; orthopaedic = -0.20% [-0.34%, -0.05%], p = 0.0087; and vascular = -0.12% [-0.69%, 0.45%], p = 0.6795). CONCLUSIONS Our new multimorbidity definitions identified far more specific, higher-risk pools of patients than conventional definitions, potentially aiding clinical decision-making.
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Affiliation(s)
- Omar I Ramadan
- From the Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (Ramadan, Kelz)
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (Ramadan, Rosenbaum, Jain, Kelz, Fleisher, Silber)
| | - Paul R Rosenbaum
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (Ramadan, Rosenbaum, Jain, Kelz, Fleisher, Silber)
- Department of Statistics and Data Science, The Wharton School, University of Pennsylvania, Philadelphia, PA (Rosenbaum)
| | - Joseph G Reiter
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA (Reiter, Jain, Hill, Silber)
| | - Siddharth Jain
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (Ramadan, Rosenbaum, Jain, Kelz, Fleisher, Silber)
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA (Reiter, Jain, Hill, Silber)
| | - Alexander S Hill
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA (Reiter, Jain, Hill, Silber)
| | - Sean Hashemi
- From the Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (Ramadan, Kelz)
| | - Rachel R Kelz
- From the Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (Ramadan, Kelz)
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (Ramadan, Rosenbaum, Jain, Kelz, Fleisher, Silber)
| | - Lee A Fleisher
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (Ramadan, Rosenbaum, Jain, Kelz, Fleisher, Silber)
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (Fleisher)
- Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania, Philadelphia, PA (Fleisher)
| | - Jeffrey H Silber
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (Ramadan, Rosenbaum, Jain, Kelz, Fleisher, Silber)
- Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA (Reiter, Jain, Hill, Silber)
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (Silber)
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA (Silber)
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Silber JH, Rosenbaum PR, Reiter JG, Jain S, Ramadan OI, Hill AS, Hashemi S, Kelz RR, Fleisher LA. The Safety of Performing Surgery at Ambulatory Surgery Centers Versus Hospital Outpatient Departments in Older Patients With or Without Multimorbidity. Med Care 2023; 61:328-337. [PMID: 36929758 PMCID: PMC10079624 DOI: 10.1097/mlr.0000000000001836] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Surgery for older Americans is increasingly being performed at ambulatory surgery centers (ASCs) rather than hospital outpatient departments (HOPDs), while rates of multimorbidity have increased. OBJECTIVE To determine whether there are differential outcomes in older patients undergoing surgical procedures at ASCs versus HOPDs. RESEARCH DESIGN Matched cohort study. SUBJECTS Of Medicare patients, 30,958 were treated in 2018 and 2019 at an ASC undergoing herniorrhaphy, cholecystectomy, or open breast procedures, matched to similar HOPD patients, and another 32,702 matched pairs undergoing higher-risk procedures. MEASURES Seven and 30-day revisit and complication rates. RESULTS For the same procedures, HOPD patients displayed a higher baseline predicted risk of 30-day revisits than ASC patients (13.09% vs 8.47%, P < 0.0001), suggesting the presence of considerable selection on the part of surgeons. In matched Medicare patients with or without multimorbidity, we observed worse outcomes in HOPD patients: 30-day revisit rates were 8.1% in HOPD patients versus 6.2% in ASC patients ( P < 0.0001), and complication rates were 41.3% versus 28.8%, P < 0.0001. Similar patterns were also found for 7-day outcomes and in higher-risk procedures examined in a secondary analysis. Similar patterns were also observed when analyzing patients with and without multimorbidity separately. CONCLUSIONS The rates of revisits and complications for ASC patients were far lower than for closely matched HOPD patients. The observed initial baseline risk in HOPD patients was much higher than the baseline risk for the same procedures performed at the ASC, suggesting that surgeons are appropriately selecting their riskier patients to be treated at the HOPD rather than the ASC.
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Affiliation(s)
- Jeffrey H. Silber
- Center for Outcomes Research, Children’s Hospital of
Philadelphia, Philadelphia, PA
- The Leonard Davis Institute of Health Economics, The
University of Pennsylvania, Philadelphia, PA
- The Department of Pediatrics, The University of
Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Health Care Management, The Wharton School,
The University of Pennsylvania, Philadelphia, PA
| | - Paul R. Rosenbaum
- The Leonard Davis Institute of Health Economics, The
University of Pennsylvania, Philadelphia, PA
- Department of Statistics and Data Science, The Wharton
School, The University of Pennsylvania, Philadelphia, PA
| | - Joseph G. Reiter
- Center for Outcomes Research, Children’s Hospital of
Philadelphia, Philadelphia, PA
| | - Siddharth Jain
- Center for Outcomes Research, Children’s Hospital of
Philadelphia, Philadelphia, PA
- The Leonard Davis Institute of Health Economics, The
University of Pennsylvania, Philadelphia, PA
| | - Omar I. Ramadan
- The Leonard Davis Institute of Health Economics, The
University of Pennsylvania, Philadelphia, PA
- Department of Surgery, The Perelman School of Medicine, The
University of Pennsylvania
| | - Alexander S. Hill
- Center for Outcomes Research, Children’s Hospital of
Philadelphia, Philadelphia, PA
| | - Sean Hashemi
- Center for Outcomes Research, Children’s Hospital of
Philadelphia, Philadelphia, PA
| | - Rachel R. Kelz
- The Leonard Davis Institute of Health Economics, The
University of Pennsylvania, Philadelphia, PA
- Department of Surgery, The Perelman School of Medicine, The
University of Pennsylvania
| | - Lee A. Fleisher
- The Leonard Davis Institute of Health Economics, The
University of Pennsylvania, Philadelphia, PA
- Department of Anesthesiology and Critical Care, The
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Perioperative Outcomes Research and
Transformation, The University of Pennsylvania, Philadelphia, PA
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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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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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Modak S, Katiyar P, Yadav S, Jain S, Gole B, Talukdar D. Generation and characterization of bio-oil obtained from the slow pyrolysis of cooked food waste at various temperatures. Waste Manag 2023; 158:23-36. [PMID: 36628813 DOI: 10.1016/j.wasman.2023.01.002] [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] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/12/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
Bio-oil was generated from slow pyrolysis of cooked food waste (CFW) at various temperatures (300-500 °C). Then NMR analysis was used as a qualitative means to characterize the bio-oil for its nature (aliphatic or aromatic), and then the compounds were confirmed and quantified using the GC-MS. This analysis indicated that the pyrolysis at low temperature (300 °C) mainly generated carbonyl compounds (Aldehydes, Ketones, Esters, and Oxo groups), Levoglucosans, and Furans (17%, 24%, and 38%, respectively) considered as typical pyrolysis chemicals. Similarly, the pyrolysis at medium temperature (400 °C) generated other compounds that were present in significant quantity, including sugars, aliphatic compounds, nitrogen compounds, acids, phenolic compounds, and alcohols. However, their fraction decreased with an increase in pyrolysis temperature to 500 °C and the fraction of aromatics increased significantly (>60%). This aromatics fraction was much more than that in a bio-oil from typical biomass which can be attributed to distinctively different chemical characteristics of CFW due to presence of additional compounds such as starch, proteins, waxes and oils in CFW. Moreover, the composition of aromatic fraction was better because a very high percentage of aromatic ethers (>58%) e.g. Benzene, 1,3-bis (3-phenoxyphenoxy), was found at 500 °C which can be converted into aliphatic alkanes, aliphatic alcohols, aromatic derivatives and platform chemicals by means of catalyst addition.
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Affiliation(s)
- Sourodipto Modak
- Department of Chemical Engineering, Shiv Nadar Institution of Eminence (Deemed to be University), Gr. Noida 201314, Uttar Pradesh, India
| | - Priyanka Katiyar
- Department of Chemical Engineering, Shiv Nadar Institution of Eminence (Deemed to be University), Gr. Noida 201314, Uttar Pradesh, India.
| | - Sanjeev Yadav
- Department of Chemical Engineering, Shiv Nadar Institution of Eminence (Deemed to be University), Gr. Noida 201314, Uttar Pradesh, India
| | - Siddharth Jain
- Department of Chemical Engineering, Shiv Nadar Institution of Eminence (Deemed to be University), Gr. Noida 201314, Uttar Pradesh, India
| | - Bappaditya Gole
- Department of Chemistry, Shiv Nadar Institution of Eminence (Deemed to be University), Gr. Noida 201314, Uttar Pradesh, India
| | - Dhrubajyoti Talukdar
- Department of Chemistry, Shiv Nadar Institution of Eminence (Deemed to be University), Gr. Noida 201314, Uttar Pradesh, India
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Jain S, Boyer D, Pal A, Dagdug L. Fick-Jacobs description and first passage dynamics for diffusion in a channel under stochastic resetting. J Chem Phys 2023; 158:054113. [PMID: 36754825 DOI: 10.1063/5.0135249] [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: 02/09/2023] Open
Abstract
The transport of particles through channels is of paramount importance in physics, chemistry, and surface science due to its broad real world applications. Much insight can be gained by observing the transition paths of a particle through a channel and collecting statistics on the lifetimes in the channel or the escape probabilities from the channel. In this paper, we consider the diffusive transport through a narrow conical channel of a Brownian particle subject to intermittent dynamics, namely, stochastic resetting. As such, resetting brings the particle back to a desired location from where it resumes its diffusive phase. To this end, we extend the Fick-Jacobs theory of channel-facilitated diffusive transport to resetting-induced transport. Exact expressions for the conditional mean first passage times, escape probabilities, and the total average lifetime in the channel are obtained, and their behavior as a function of the resetting rate is highlighted. It is shown that resetting can expedite the transport through the channel-rigorous constraints for such conditions are then illustrated. Furthermore, we observe that a carefully chosen resetting rate can render the average lifetime of the particle inside the channel minimal. Interestingly, the optimal rate undergoes continuous and discontinuous transitions as some relevant system parameters are varied. The validity of our one-dimensional analysis and the corresponding theoretical predictions is supported by three-dimensional Brownian dynamics simulations. We thus believe that resetting can be useful to facilitate particle transport across biological membranes-a phenomenon that can spearhead further theoretical and experimental studies.
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Affiliation(s)
- Siddharth Jain
- Harish-Chandra Research Institute, HBNI, Chhatnag Road, Jhunsi, Allahabad (Prayagraj), UP, 211019, India
| | - Denis Boyer
- Instituto de Física, Universidad Nacional Autónoma de México, Ciudad de México C.P. 04510, Mexico
| | - Arnab Pal
- The Institute of Mathematical Sciences, CIT Campus, Taramani, Chennai 600113, India
| | - Leonardo Dagdug
- Physics Department, Universidad Autónoma Metropolitana-Iztapalapa, San Rafael Atlixco 186, Ciudad de México 09340, Mexico
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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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Mathew J, Jain S, Susngi T, Naidu S, Dhir V, Sharma A, Jain S, Sharma SK. Predictors of COVID-19 severity and outcomes in Indian patients with rheumatic diseases: a prospective cohort study. Rheumatol Adv Pract 2023; 7:rkad025. [PMID: 36908302 PMCID: PMC9995091 DOI: 10.1093/rap/rkad025] [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: 07/19/2022] [Accepted: 11/17/2022] [Indexed: 03/06/2023] Open
Abstract
Objective There is dearth of data regarding the outcomes of coronavirus disease 2019 (COVID-19) among rheumatic and musculoskeletal disease (RMD) patients from Southeast Asia. We report the clinicodemographic profile and identify predictors of COVID-19 outcomes in a large cohort of Indian RMD patients. Methods This prospective cohort study, carried out at the Postgraduate Institute of Medical Education and Research, Chandigarh (a tertiary care centre in India), included RMD patients affected with COVID-19 between April 2020 and October 2021. Demographic and clinical and laboratory details of COVID-19 and underlying RMD were noted. Predictors of mortality, hospitalization and severe COVID-19 were identified using stepwise multivariable logistic regression. Results A total of 64 severe acute respiratory syndrome coronavirus-2-infected RMD patients [age 41.5 (19-85) years; 46 (72%) females] were included. Eighteen (28%) patients had severe COVID-19. Twenty-three (36%) required respiratory support [11 (17%) required mechanical ventilation]. Thirty-six (56%) patients required hospitalization [median duration of stay 10 (1-42) days]; 17 (27%) required intensive care unit admission. Presence of co-morbidities [odds ratio (OR) = 4.5 (95% CI: 1.4, 14.7)] was found to be an independent predictor of COVID-19 severity. Co-morbidities [OR = 10.7 (95% CI: 2.5, 45.4)] and underlying lupus [OR = 7.0 (95% CI: 1.2, 40.8)] were independently associated with COVID-19 hospitalization. Ongoing rheumatic disease activity [OR = 6.8 (95% CI: 1.3, 35.4)] and underlying diagnosis of lupus [OR = 7.1 (95% CI: 1.2, 42.4)] and SSc [OR = 9.5 (95% CI: 1.5, 61.8)] were found to be strong independent predictors of mortality. Age, sex, underlying RMD-associated interstitial lung disease and choice of immunosuppressive therapy were not associated with COVID-19 severity or adverse outcomes. Conclusion The presence of co-morbidities was independently associated with COVID-19 severity and hospitalization. Ongoing rheumatic disease activity and the presence of lupus or SSc independently predicted mortality. Age, sex, type of immunosuppressive therapy and presence of RMD-associated interstitial lung disease did not affect COVID-19 severity or outcomes in Indian RMD patients.
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Affiliation(s)
- Jithin Mathew
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddharth Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Terence Susngi
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research,Chandigarh, India
| | - Shankar Naidu
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dhir
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shefali Khanna Sharma
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jain S, Modi P, Dayma RL, Mishra S. Clinical outcome of arthroscopic suture versus screw fixation in tibial avulsion of the anterior cruciate ligament in skeletally mature patients. J Orthop 2023; 35:7-12. [PMID: 36325248 PMCID: PMC9619313 DOI: 10.1016/j.jor.2022.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/29/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tibial eminence fracture is an intra-articular fracture of bony attachment of ACL. The displaced fragment could hinder the mobility of the knee and may lead joint instabilty; therefore, requires fixation. Arthroscopic suture and screw fixation are the widely used surgical modalities for eminence fractures of the tibia. Past studies have not yet depicted the superiority of one method over the other. Through this cohort study, comparison of the clinical and functional outcomes of these two surgical methods was done. METHODS A prospective, randomized, interventional study was conducted from December 2019 to January 2022 for comparing the clinical outcome of arthroscopic pull through suture fixation and arthroscopic antegrade cancellous screw fixation in skeletally mature individuals. Ninety patients (45 in each group) were randomly assigned and treated with the above two methods. A comprehensive clinical analysis was done after nine months of surgery for assessment of functional outcome, ligament laxity, range of motion, and complications if any. RESULTS 65.55% of anterior tibial eminence fractures were caused by road traffic accidents followed by sports injuries (28.88%). The postoperative mean subjective IKDC score in the suture group was 91.36 and for the screw fixation group was 85.71 (p = 0.001). After nine months of surgery, the mean LKS was 91.96 in patients treated with suture fixation and 86.00 in patients treated with screw fixation (p = 0.001). Pivot shift grading was grade 3 in one patient of the suture group and in three patients of the screw group (p = 0.319). Seven patients who had screw fixation required re-surgery for removal of the implant; however, no such complication was seen in the suture fixation group. CONCLUSION Arthroscopic pull-through suture fixation of tibial avulsion of ACL in skeletally mature patients seems to be a superior intervention over arthroscopic screw fixation with the benefits of better clinical and functional outcomes and decreased chances of re-surgery.
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Affiliation(s)
- Siddharth Jain
- Department of Orthopaedics, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Prashant Modi
- Department of Orthopaedics, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Ratan Lal Dayma
- Department of Orthopaedics, S.M.S. Medical College, Jaipur, Rajasthan, India
| | - Sonal Mishra
- Department of Anaesthesiology, S.M.S. Medical College, Jaipur, Rajasthan, India
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