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Horta F, Salih M, Austin C, Warty R, Smith V, Rolnik DL, Reddy S, Rezatofighi H, Vollenhoven B. Reply: Artificial intelligence as a door opener for a new era of human reproduction. Hum Reprod Open 2023; 2023:hoad045. [PMID: 38033328 PMCID: PMC10686939 DOI: 10.1093/hropen/hoad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Affiliation(s)
- F Horta
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Monash Data Future Institute, Monash University, Clayton, VIC, Australia
- City Fertility, Melbourne, VIC, Australia
| | - M Salih
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - C Austin
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - R Warty
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - V Smith
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - D L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Women’s and Newborn Program, Monash Health, Melbourne, VIC, Australia
| | - S Reddy
- School of Medicine, Deakin University, Geelong, VIC, Australia
| | - H Rezatofighi
- Monash Data Future Institute, Monash University, Clayton, VIC, Australia
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - B Vollenhoven
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Women’s and Newborn Program, Monash Health, Melbourne, VIC, Australia
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Berman AT, Schmidt C, Truong D, Reddy S, Avalos-Reyes E, Yeon H, Brito R, Verbrugge D, Johnson K. Differences in Radiotherapy-Treated Members with Cancer during COVID-19 Pandemic Using Nationwide Claim Data. Int J Radiat Oncol Biol Phys 2023; 117:e567. [PMID: 37785733 DOI: 10.1016/j.ijrobp.2023.06.1892] [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) This study aimed to identify the impact of the pandemic on radiotherapy activity among members with cancer. MATERIALS/METHODS This retrospective study included fully-insured commercial members of a large national payor with cancer aged ≥18 years undergoing radiotherapy from March 1, 2018 to February 28, 2022. Radiotherapy activity was defined as the mean weekly number of treatment courses and attendances (fractions) per month pre-COVID (March 2018 to February 2020); during COVID (March 2020 to February 2021); and post-COVID (March 2021 to February 2022). T-tests assessed differences between pre-COVID and post-COVID on radiotherapy activity by age, gender, and cancer type. Interrupted time series analysis (ITS) assessed change in activity overtime, controlling for pre-COVID trends and other potential confounders. A p-value of <0.05 was considered significant. RESULTS The study included 9,275 members, 10,121 courses, and 169,257 fractions; most members were female (57%), the mean age was 57 years (SD = 12). Overall, there was a decline in mean weekly number of courses from the pre-COVID to post-COVID (-18%, p<0.05) timeframe. Females < 70 years experienced the largest decline in mean weekly number of courses (-23%, p<0.05) followed by males aged 70+ (-16%, p<0.05) and males < 70 years (-16%, p<0.05). All cancer types saw a significant decline (p<0.05); breast cancer reported the largest decline (-21%, p<0.05). Fraction numbers significantly declined overall by 27% (p<0.05) from the pre-COVID to post-COVID timeframe. The largest decline in fraction numbers was observed in females < 70 (-28%, p<0.05) followed by males < 70 years (-24%, p<0.05) and males aged 70+ (-22%, p<0.05). No difference between COVID and pre-COVID weeks for courses was observed once pre-COVID trends were accounted for using ITS. Females aged 70+ received 25% (p<0.05) fewer fractions during COVID compared to pre-COVID; a decline which continued to grow even as the pandemic eased (March 2021 to February 2022). Males aged 70+ also experienced a decreased level of fractions during the pandemic (-30%, p<0.05), but increased in the recovery period (+24%, p<0.05). Males < 70 years had an increased level of fractions during the pandemic (+14%, p<0.05). CONCLUSION Radiation mean weekly number of courses and fractions between pre-COVID and post-COVID declined with the effect more pronounced in females < 70 years. A decrease in fraction number was observed in all cancer types; specifically, breast cancer had the largest decline. ITS analysis revealed no difference between COVID and pre-COVID weeks for courses as the downward trend was already present prior to the pandemic. These findings suggest while radiotherapy courses and fractions were significantly impacted, fractionation was decreased to a greater extent, indicating an increased adoption of hypofractionation during the pandemic.
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Salih M, Austin C, Warty RR, Tiktin C, Rolnik DL, Momeni M, Rezatofighi H, Reddy S, Smith V, Vollenhoven B, Horta F. Embryo selection through artificial intelligence versus embryologists: a systematic review. Hum Reprod Open 2023; 2023:hoad031. [PMID: 37588797 PMCID: PMC10426717 DOI: 10.1093/hropen/hoad031] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/17/2023] [Indexed: 08/18/2023] Open
Abstract
STUDY QUESTION What is the present performance of artificial intelligence (AI) decision support during embryo selection compared to the standard embryo selection by embryologists? SUMMARY ANSWER AI consistently outperformed the clinical teams in all the studies focused on embryo morphology and clinical outcome prediction during embryo selection assessment. WHAT IS KNOWN ALREADY The ART success rate is ∼30%, with a worrying trend of increasing female age correlating with considerably worse results. As such, there have been ongoing efforts to address this low success rate through the development of new technologies. With the advent of AI, there is potential for machine learning to be applied in such a manner that areas limited by human subjectivity, such as embryo selection, can be enhanced through increased objectivity. Given the potential of AI to improve IVF success rates, it remains crucial to review the performance between AI and embryologists during embryo selection. STUDY DESIGN SIZE DURATION The search was done across PubMed, EMBASE, Ovid Medline, and IEEE Xplore from 1 June 2005 up to and including 7 January 2022. Included articles were also restricted to those written in English. Search terms utilized across all databases for the study were: ('Artificial intelligence' OR 'Machine Learning' OR 'Deep learning' OR 'Neural network') AND ('IVF' OR 'in vitro fertili*' OR 'assisted reproductive techn*' OR 'embryo'), where the character '*' refers the search engine to include any auto completion of the search term. PARTICIPANTS/MATERIALS SETTING METHODS A literature search was conducted for literature relating to AI applications to IVF. Primary outcomes of interest were accuracy, sensitivity, and specificity of the embryo morphology grade assessments and the likelihood of clinical outcomes, such as clinical pregnancy after IVF treatments. Risk of bias was assessed using the Modified Down and Black Checklist. MAIN RESULTS AND THE ROLE OF CHANCE Twenty articles were included in this review. There was no specific embryo assessment day across the studies-Day 1 until Day 5/6 of embryo development was investigated. The types of input for training AI algorithms were images and time-lapse (10/20), clinical information (6/20), and both images and clinical information (4/20). Each AI model demonstrated promise when compared to an embryologist's visual assessment. On average, the models predicted the likelihood of successful clinical pregnancy with greater accuracy than clinical embryologists, signifying greater reliability when compared to human prediction. The AI models performed at a median accuracy of 75.5% (range 59-94%) on predicting embryo morphology grade. The correct prediction (Ground Truth) was defined through the use of embryo images according to post embryologists' assessment following local respective guidelines. Using blind test datasets, the embryologists' accuracy prediction was 65.4% (range 47-75%) with the same ground truth provided by the original local respective assessment. Similarly, AI models had a median accuracy of 77.8% (range 68-90%) in predicting clinical pregnancy through the use of patient clinical treatment information compared to 64% (range 58-76%) when performed by embryologists. When both images/time-lapse and clinical information inputs were combined, the median accuracy by the AI models was higher at 81.5% (range 67-98%), while clinical embryologists had a median accuracy of 51% (range 43-59%). LIMITATIONS REASONS FOR CAUTION The findings of this review are based on studies that have not been prospectively evaluated in a clinical setting. Additionally, a fair comparison of all the studies were deemed unfeasible owing to the heterogeneity of the studies, development of the AI models, database employed and the study design and quality. WIDER IMPLICATIONS OF THE FINDINGS AI provides considerable promise to the IVF field and embryo selection. However, there needs to be a shift in developers' perception of the clinical outcome from successful implantation towards ongoing pregnancy or live birth. Additionally, existing models focus on locally generated databases and many lack external validation. STUDY FUNDING/COMPETING INTERESTS This study was funded by Monash Data Future Institute. All authors have no conflicts of interest to declare. REGISTRATION NUMBER CRD42021256333.
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Affiliation(s)
- M Salih
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - C Austin
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - R R Warty
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - C Tiktin
- School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - D L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Women’s and Newborn Program, Monash Health, Melbourne, Victoria, Australia
| | - M Momeni
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - H Rezatofighi
- Department of Data Science and Artificial Intelligence, Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
- Monash Data Future Institute, Monash University, Clayton, Victoria, Australia
| | - S Reddy
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - V Smith
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - B Vollenhoven
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Women’s and Newborn Program, Monash Health, Melbourne, Victoria, Australia
- Monash IVF, Melbourne, Victoria, Australia
| | - F Horta
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Monash Data Future Institute, Monash University, Clayton, Victoria, Australia
- City Fertility, Melbourne, Victoria, Australia
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Kaur J, Bhardwaj N, Reddy S, D'Cruz S. Acute Kidney Injury in Acute Myocardial Infarction and Its Outcome at 3 and 6 Months. Saudi J Kidney Dis Transpl 2023; 34:297-304. [PMID: 38345584 DOI: 10.4103/1319-2442.395445] [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: 02/15/2024] Open
Abstract
Epidemiological data on the prevalence of acute kidney injury (AKI) in acute coronary syndrome are sparse, with most studies having been conducted retrospectively. This study prospectively analyzed the incidence of AKI in patients with acute myocardial infarction (AMI) and to identify the risk factors for AKI and their renal outcome at 3 and 6 months. This was a prospective and observational study, which enrolled 120 patients presenting with their first episode of AMI to our hospital and consented to the study. Renal function tests were performed at admission, at 48 h, and at follow-up at 3 and 6 months. The majority of the patients underwent a percutaneous coronary intervention (59.2%), 21.7% received thrombolytic therapy, and 19.2% were managed conservatively. At 48 h, 11 patients had AKI. At 3 months, 8 patients had died, and renal dysfunctions were seen in 9 out of 112 patients. At 6 months, 12 patients out of 112 had renal dysfunction. There was no difference in the incidence of AKI in patients with an estimated glomerular filtration rate above and below 60 mL/min/1.73 m2. Killip Class 4 and diabetes mellitus were associated with an increased incidence of renal dysfunction in AMI patients. The type of treatment and the use of a contrast agent in the coronary intervention did not affect the development of AKI. According to this study, if indicated, a percutaneous coronary intervention should not be denied to patients for fear of developing AKI. This needs to be examined in larger randomized trials.
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Affiliation(s)
- Jaspreet Kaur
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Nidhi Bhardwaj
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Sreenivas Reddy
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Sanjay D'Cruz
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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Bhasin D, Kashyap JR, Reddy S. A woman with inferior wall myocardial infarction. Heart 2023; 109:904-966. [PMID: 37236646 DOI: 10.1136/heartjnl-2022-322191] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- Dinkar Bhasin
- Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jeet Ram Kashyap
- Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Sreenivas Reddy
- Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Cardiology, Government Medical College and Hospital, Chandigarh, India
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Hassanein W, Kane L, Lezberg P, Hassanein A, Dang N, LaFrancesca S, Kaw A, Brann S, Omara M, Reddy S, Ihnken K, Salihi MA, Zafar F, Khayal T. First Report on the Performance of the National OCS Program (NOP) in U.S. Heart and Lung Transplants. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.636] [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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Matsumoto M, DePietro D, Shamimi-Noori S, Hoffmann J, Gade T, Reddy S, Nadolski G. Abstract No. 103 Changes in the Match: Results of an IR Applicant and Program Director Survey Regarding Virtual Interviews and Step 1 Pass/Fail. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Matsumoto M, DePietro D, Shamimi-Noori S, Hoffmann J, Gade T, Reddy S, Nadolski G. Abstract No. 109 Integrated IR Residency: Perspectives of Applicants and Program Directors from the 2022 Match. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Babore Y, Vance A, Cohean R, Mantell M, Troiano M, Peacock A, Reddy S, Clark T. Abstract No. 33 End-Stage Renal Disease and Risk of Major Adverse Limb Events Following Peripheral Vascular Intervention. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Berman A, Warde P, Avalos-Reyes E, Yeon H, Cavers W, Reddy S, Brito R, Johnson K. Predicting Total Hospitalizations and Emergency Visits in Radiotherapy Patients: A Claims-Based Model. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yeon H, Warde P, Avalos-Reyes E, Cavers W, Reddy S, Johnson K, Brito R, Berman A. Defining the Cost Variation by Site-of-Care for Radiotherapy: A Claims-Based Analysis. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Patel P, Reddy S, Marshall G. A CASE OF AN UNRECOGNIZED AUTOINFLAMMATORY DISEASE. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Venkata D, Reddy S, Sinha V, Sriharsha A. To Assess the Factors Affecting Employee Engagement in Organizations during a COVID-19 Crisis. CM 2022. [DOI: 10.18137/cardiometry.2022.23.292309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: To identify the steps taken by organizations during the time of crisis concerning Human Capital and understand the impact each of these steps has on the employee engagement for the employees within the organization. Proposed Design/Methodology/Approach: Post the literature review, qualitative research is conducted through indepth interviews with the Managers, who were part of the decision-making, in the organizations that went through crisis period (Sample size: 20-30) and a quantitative study is conducted to capture the perspectives of the employees from those organizations (Sample size: 70-100). Practical/Theoretical Implication: The study results enable organizations to stay cognizant of the pros and cons of the decisions they make in terms of employee engagement, which helps in successfully overcoming the crisis with minimal traction. Originality/Value: While there are standalone papers on each topic, this paper converges them coherently to study the overall effect from both employee’s and the organization’s perspectives.
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Harikrishnan S, Bahl A, Roy A, Mishra A, Prajapati J, Manjunath C, Sethi R, Guha S, Satheesh S, Dhaliwal R, Sarma M, Ganapathy S, Jeemon P, Joseph S, Narayanan S, G R, Varghese AC, Damodara R, Joseph J, Davidson D, Thomas JK, George T, Mattummal S, Naik N, Singh S, Sharma G, Seth S, Palleda G, Gupta MD, Kumar P, Kumar N, Susheel M, Vohra MV, Negi PC, Asotra S, Mahajan K, Sharma R, D B, Raj S, Katageri A, Nanjappa V, Shetty R, Katheria R, Rai M, Musthafa M M, DKS S, Selvaraj R, M V, RJ V, Rajasekhar D, V V, Naik KS, Gnanaraj JP, Hussain F, N S, Menon S, TR H, G S, S B, SR V, Alex AG, G S, Yerram S, Bhyravavajhala S, Maddury J, Oruganti SS, Mehrotra S, Dahiya N, Sharma V, Sood A, Mohan B, Tandon R, Singh CN, Monga I, Kashyap JR, Reddy S, Kumar M, Guleria D, Sharma A, Singhal R, Joshi H, Iby M, Roy B, Thakkar P, Choudhary D, Agarwal DK, Swamy A, IC M, Bohora S, Pradhan A, Vishwakarma P, Kapoor A, Kumar S, Jain D, Pande U, Tripathi S, Verma B, Ghosh S, Prajapati R, Vemuri KS, Kaushley A, Chaturvedi S, Jha N, Kumar S, Agrawal AK, Kumar N, Chowdhary S, Shrivastava S, Yadav B, Gupta R, Singh R, Singh G, Bagchi PC, Kumari T, Agrawal MK, Mondal M, Mandal SC, Mitra KK, Routray S, Das DR, Mishra TK, Malviya A, Laitthma A, Dorjee R, Kalita HC, Chaliha MS, Dutta DJ, Tramboo NA, Rashid A, Singh Rao R, Chaturvedi H, Naik GD, Nevrekar R. Clinical profile and 90 day outcomes of 10 851 heart failure patients across India: National Heart Failure Registry. ESC Heart Fail 2022; 9:3898-3908. [PMID: 36214477 PMCID: PMC9773752 DOI: 10.1002/ehf2.14096] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 02/08/2022] [Revised: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Limited data on the uptake of guideline-directed medical therapies (GDMTs) and the mortality of acute decompensated HF (ADHF) patients are available from India. The National Heart Failure Registry (NHFR) aimed to assess clinical presentation, practice patterns, and the mortality of ADHF patients in India. METHODS AND RESULTS The NHFR is a facility-based, multi-centre clinical registry of consecutive ADHF patients with prospective follow-up. Fifty three tertiary care hospitals in 21 states in India participated in the NHFR. All consecutive ADHF patients who satisfied the European Society of Cardiology criteria were enrolled in the registry. All-cause mortality at 90 days was the main outcome measure. In total, 10 851 consecutive patients were recruited (mean age: 59.9 years, 31% women). Ischaemic heart disease was the predominant aetiology for HF (72%), followed by dilated cardiomyopathy (18%). Isolated right HF was noted in 62 (0.6%) participants. In eligible HF patients, 47.5% received GDMT. The 90 day mortality was 14.2% (14.9% and 13.9% in women and men, respectively) with a re-admission rate of 8.4%. An inverse relationship between educational class based on years of education and 90 day mortality (high mortality in the lowest educational class) was observed in the study population. Patients with HF with reduced ejection fraction and HF with mildly reduced ejection fraction who did not receive GDMT experienced higher mortality (log-rank P < 0.001) than those who received GDMT. Baseline educational class, body mass index, New York Heart Association functional class, ejection fraction, dependent oedema, serum creatinine, QRS > 120 ms, atrial fibrillation, mitral regurgitation, haemoglobin levels, serum sodium, and GDMT independently predicted 90 day mortality. CONCLUSION One of seven ADHF patients in the NHFR died during the first 90 days of follow-up. One of two patients received GDMT. Adherence to GDMT improved survival in HF patients with reduced and mildly reduced ejection fractions. Our findings call for innovative quality improvement initiatives to improve the uptake of GDMT among HF patients in India.
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Affiliation(s)
| | - Ajay Bahl
- CardiologyPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
| | - Ambuj Roy
- CardiologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Animesh Mishra
- CardiologyNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS)ShillongIndia
| | - Jayesh Prajapati
- CardiologyUN Mehta Institute of Cardiology and Research Centre (UNMICRC)AhmedabadIndia
| | - C.N. Manjunath
- CardiologySri Jayadeva Institute of Cardiovascular Sciences and Research (SJICR)BangaloreIndia
| | - Rishi Sethi
- CardiologyKing George's Medical University (KGMU)LucknowIndia
| | - Santanu Guha
- CardiologyMedical College Hospital (MCH)KolkataIndia
| | - Santhosh Satheesh
- CardiologyJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PondicherryIndia
| | - R.S. Dhaliwal
- Division of Non‐Communicable DiseasesIndian Council of Medical Research (ICMR)New DelhiIndia
| | - Meenakshi Sarma
- Division of Non‐Communicable DiseasesIndian Council of Medical Research (ICMR)New DelhiIndia
| | - Sanjay Ganapathy
- CardiologySree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)TrivandrumIndia
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science StudiesSree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)Trivandrum695011KeralaIndia
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Xue Y, Lyu C, Taylor A, van Ee A, Kiemen A, Choi Y, Lee C, Wirtz D, Garza L, Reddy S. 759 Mechanical tension mobilizes Lgr6+ epidermal stem cells to drive skin growth. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vamsee R, Reddy S, Hernandez J, Arar Y, Pontiki A, Hussain T. 457 Single Vs Biplane 3d Augmented Overlay Guidance To Assist Congenital Cardiac Catheterisation Interventions. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.062] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Yuvaraj S, GopalaKrishnan M, Reddy S, Vembu R, Namboori Srinivasan S, Raja N, Pandurangi M, Nagireddy S, Raman G, Rajmohan L, Ramamoorthy S, Kumar V. O-261 In-vitro supplementation of vitamin B12 to improve post-thaw viability and DNA integrity. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does the supplementation of vitamin B12 protect the spermatozoa against damage caused by the freeze-thaw process further improving the overall post-thaw survival and DNA integrity?
Summary answer
The antioxidant property of vitamin B12 protects the spermatozoa and improves the post thaw motility, vitality, and reduces DNA damage caused by freeze-thaw process.
What is known already
Cryopreservation of spermatozoa is an effective way of fertility preservation in humans, often used in Assisted Reproductive Technology(ART). Despite the refinement in cryopreservation, the salvage of post-thaw sperms remains poor. The reactive oxygen species(ROS), that is formed as a result of freeze-thaw process is known to decrease the motility, plasma membrane integrity and increase the DNA fragmentation. Most vitamins have antioxidant properties, that protect the mammalian cells from oxidative stress one such vitamin is cyanocobalamin(vitamin B12). Vitamin B12 modulates oxidative stress through methionine synthase activity and also acts as a scavenger of ROS. Thus protecting the DNA against free radicals.
Study design, size, duration
This prospective observational study was performed for a period of 6 months in 111 men, who attended the fertility clinic. The study population included all semen samples except men with azoospermia, surgically retrieved samples and men on vitamin supplements. The study population contained men ageing between 21-40 years.
Participants/materials, setting, methods
Semen samples were analysed according to WHO 5th edition and were assessed for DNA fragmentation index (DFI) using sperm chromatin dispersion assay (SCD). The ejaculates were split into two as group A: semen samples with equal amount of cryoprotectant and group B: semen samples with equal amount of cryoprotectant supplemented with Vitamin B12 (2mg/ml). They were frozen for a minimum of 24 hrs. Post-thaw motility, vitality and DFI were assessed and compared.
Main results and the role of chance
The mean age of patients in our study was 34.26±4.7yrs. 58.5% of the study population had primary infertility. 37.8% of the study population had male factor infertility, 32.4% had oligoasthenoteratozoospermia(OAT), 31.1% had normozoospermia 16.2% had asthenoteratozoospermia, 13.5% had teratozoospermia, 3.6% had oligozoospermia and rest 2.7% had asthenozoospermia.
There was an overall increase in post thaw motility (41.59±18.09 vs 32.3±18.8,p=0.0005), progressive motility (21.54±13.02 vs 15.91±11.80,p=0.0005), vitality (57.14±15.09 vs 46.76±16.45,p=0.0005) and a significant decrease in DFI (26.69±10.03 vs 32.09±10.00,p=0.0005) in group B compared to group A.
Our study also demonstrated that, Normozoospermia patients had a significant increase in vitality (67.17±13.8 vs 58.51±12.0, p = 0.007) and lower DFI (22.68±9.3 vs 27.6±8.9, p = 0.02) in group B than in group A.
OAT patients had a significant increase in total motility (26.25±12.15 vs 15.7±11.4,p=0.0003), progressive motility (11.69±8.8 vs 6.14±5.8,p=0.0028), vitality (46.06±11.34 vs 34.31±12.99,p=0.0001) and significantly lower DFI (30.22±9.87 vs 36.08±9.7,p=0.012) in group B.
Teratozoospermia patients showed significant increase in progressive motility in group B (27.87±8.81 vs 19.33±10.69,p=0.02) and
Asthenoteratozoospermia patients showed significant increase in total motility (40.72± 13.14 vs 30.89±13.06,p=0.02) and vitality (54.39±12.28 vs 43.78±14.14,p=0.02) in group B.
However, in asthenozoospermic patients the parameters were comparable in both the groups.
Limitations, reasons for caution
Due to ethical reasons the samples were not used for in vitro procedures such as intrauterine insemination(IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection(ICSI). Hence, no inference was obtained regarding the fertilization rates/ pregnancy rates.
Wider implications of the findings
Our study demonstrated that with supplementation of vitamin B12 the recovery rate significantly increased and also preserved the DNA content. Among the various categories, supplementation of vitamin B12 to OAT samples was more beneficial as it improved the overall viability of the sperms.
Trial registration number
CSP/21/JUL/96/389
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Affiliation(s)
- S Yuvaraj
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - M GopalaKrishnan
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - S Reddy
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - R Vembu
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - S Namboori Srinivasan
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - N Raja
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - M Pandurangi
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - S Nagireddy
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - G Raman
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - L Rajmohan
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - S Ramamoorthy
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
| | - V Kumar
- Sri Ramachandra Institute of Higher Education and Research, Reproductive Medicine and Surgery , Chennai, India
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18
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Vasudevan A, Reddy S, Ghante A, Vankalakunti M. POS-022 CLINICO-PATHOLOGICAL PROFILE AND OUTCOMES OF CHILDREN WITH C3G IN RESOURCE LIMITED SETTING. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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19
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Parikh R, Shamimi-Noori S, Reddy S, Gade T, Nadolski G, Hunt S. Abstract No. 284 Demographic trends in female interventional radiology trainees with the advent of the integrated interventional radiology residency: a 12-month update. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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20
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Kashyap JR, Kumar S, Reddy S, Rao K R, Uppal L. Isolated Unilateral Agenesis of Pulmonary Artery and Reappraisal of Embryological Evolution. Anatol J Cardiol 2022; 26:226-228. [PMID: 35346909 PMCID: PMC9366439 DOI: 10.5152/anatoljcardiol.2021.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jeet Ram Kashyap
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Suraj Kumar
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Sreenivas Reddy
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Raghavendra Rao K
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Lipi Uppal
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
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21
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Spooner E, Reddy S, Ntoyanto S, Sakadavan Y, Reddy T, Mahomed S, Mlisana K, Dlamini M, Daniels B, Luthuli N, Ngomane N, Kiepiela P, Coutsoudis A. TB testing in HIV-positive patients prior to antiretroviral treatment. Int J Tuberc Lung Dis 2022; 26:224-231. [PMID: 35197162 PMCID: PMC8886959 DOI: 10.5588/ijtld.21.0195] [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] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: TB diagnosis in patients with HIV is challenging due to the lower sensitivities across tests. Molecular tests are preferred and the Xpert® MTB/RIF assay has limitations in lower-income settings. We evaluated the performance of loop-mediated isothermal amplification (LAMP) and the lipoarabinomannan (LAM) test in HIV-positive, ART-naïve clinic patients.METHODS: A total of 783 eligible patients were enrolled; three spot sputum samples of 646 patients were tested using TB-LAMP, Xpert, smear microscopy and culture, while 649 patients had TB-LAM testing. Sensitivity, specificity, and negative and positive predictive values were estimated with 95% confidence intervals.RESULTS: Sensitivities for smear microscopy, TB-LAMP and Xpert were respectively 50%, 63% and 74% compared to culture, with specificities of respectively 99.2%, 98.5% and 97.5%. An additional eight were positive on TB-LAM alone. Seventy TB patients (9%) were detected using standard-of-care testing, an additional 27 (3%) were detected using study testing. Treatment was initiated in 57/70 (81%) clinic patients, but only in 56% (57/97) of all those with positive TB tests; 4/8 multidrug-resistant samples were detected using Xpert.CONCLUSION: TB diagnostics continue to miss cases in this high-burden setting. TB-LAMP was more sensitive than smear microscopy, and if followed by culture and drug susceptibility testing as required, can diagnose TB in HIV-positive patients. TB-LAM is a useful add-in test and both tests at the point-of-care would maximise yield.
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Affiliation(s)
- E Spooner
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa, HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - S Reddy
- South African Medical Research Council, Durban, South Africa
| | - S Ntoyanto
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Y Sakadavan
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - T Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - S Mahomed
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa, Medical Microbiology Department, National Health Laboratory Services, Durban, South Africa, Centre for AIDS Programme Research in South Africa, Durban, South Africa
| | - K Mlisana
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa, Medical Microbiology Department, National Health Laboratory Services, Durban, South Africa
| | - M Dlamini
- Medical Microbiology Department, National Health Laboratory Services, Durban, South Africa
| | - B Daniels
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - N Luthuli
- EThekwini Health Unit, EThekwini Municipality, Durban, South Africa
| | - N Ngomane
- Occupational Health, Durban, South Africa
| | - P Kiepiela
- South African Medical Research Council, Durban, South Africa
| | - A Coutsoudis
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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22
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Chiramel S, Padmanabhan D, Krishnappa D, Banavalikar B, Reddy S, Shenthar J. Electrocardiographic optimization of PR interval in Left Bundle Area Pacing. Indian Pacing Electrophysiol J 2022. [DOI: 10.1016/j.ipej.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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Chiramel S, Padmanabhan D, Krishnappa D, Banavalikar B, Reddy S, Shenthar J. Feasibility and Short-term Outcomes of Left Bundle Pacing in Pediatric Patients: A Case Series. Indian Pacing Electrophysiol J 2022. [DOI: 10.1016/j.ipej.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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24
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STAUSS M, So B, White L, Reddy S. POS-594 CEFUROXIME AS AN OUTPATIENT HAEMODIALYSIS-BASED ANTIBIOTIC REGIME FOR THE TREATMENT OF MSSA BACTERAEMIA. RETROSPECTIVE ANALYSIS OF A NOVEL THERAPEUTIC APPROACH USING CEFUROXIME OVER VANCOMYCIN. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.626] [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: 12/01/2022] Open
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25
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G N P, Ekambaram S, Raman V, Ganesan K, Reddy S, Kr A, Bollam Rengaswamy N. POS-979 EFFICACY AND SAFETY OF RITUXIMAB IN COMPLICATED STEROID DEPENDENT AND REFRACTORY STEROID RESISTANT CHILDHOOD NEPHROTIC SYNDROME. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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26
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Reddy S, Hanna B, Ferguson R, Jackson S, Rose H, Chia D, Azzi M, Ko R, Winter M, Arianayagam M, Canagasingham B, Goolam A, Jeffery N, Mehan N, Varol C. Real-world cost for first-line treatment for prostate cancer: A comparative cost analysis in the public sector. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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Reddy S, Deshpande T, Pais P. POS-742 HEALTH RELATED QUALITY OF LIFE (HRQOL) IN PAEDIATRIC CHRONIC KIDNEY DISEASE (CKD) AND CAREGIVER BURDEN (CB) – A PROSPECTIVE MIXED-METHODS STUDY. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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28
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Singh B, Gupta R, Reddy S. Superdominant Right Coronary Artery with Absent Left Coronary Artery and Left Circumflex Artery with Anomalous Left Anterior Descending Artery. Indian J Radiol Imaging 2022; 31:1008-1011. [PMID: 35136517 PMCID: PMC8817807 DOI: 10.1055/s-0041-1739381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
AbstractThe occurrence of super-dominant “single coronary artery” is an extremely rare and seldom reported phenomenon. The heart is dependent on a single vessel which makes its occlusion, if present, catastrophic. Here, the authors present an extremely rare combination of superdominant right coronary artery coexisting with absent left coronary artery and left circumflex artery with abnormal origin of left anterior descending artery from right coronary sinus. Precise morphological and physiological knowledge and evaluation of these anomalies is a must for opting the best available therapeutic modality and better prognosis.
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Affiliation(s)
- Bhavneet Singh
- Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Rekha Gupta
- Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Sreenivas Reddy
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
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29
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Kadiyala V, Reddy S, Kashyap JR, Rao K R, Ramalingam V, Kumar S, Kaur J, Reddy H, Malhotra S, Kaur N. Effect of smoking on culprit lesion plaque burden and composition in acute coronary syndrome: An intravascular ultrasound-virtual histology study. Indian Heart J 2021; 73:687-692. [PMID: 34861980 PMCID: PMC8642658 DOI: 10.1016/j.ihj.2021.09.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/31/2021] [Accepted: 09/08/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vikas Kadiyala
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Sreenivas Reddy
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India.
| | - Jeet Ram Kashyap
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Raghavendra Rao K
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Vadivelu Ramalingam
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, India
| | - Suraj Kumar
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Jaspreet Kaur
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Hithesh Reddy
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Samir Malhotra
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naindeep Kaur
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
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30
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Bhat S, Covas Moschovas M, Sandri M, Noel J, Rogers T, Pereira R, Reddy S, Roof S, Patel V. Outcomes of Salvage Robot-Assisted Radical Prostatectomy (S-RARP) post focal ablation for prostate cancer in comparison with primary Robot-assisted Radical Prostatectomy (RARP); A matched analysis. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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31
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Kadesh AD, Baban S, Chaudhary R, Shi J, Ahluwalia J, Lui A, Daly G, Reddy S, Giles DL, White MP, Grimes CL. Variation of Chargemaster Price Listings for Hysterectomy Procedures across Five States. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Gopalakrishnan A, Dhulipala V, Grillo M, Ayala-Rodriguez C, Garyali S, Reddy S. Burden of arrhythmias in patients with obstructive sleep apnea and its impact on mortality: a descriptive study from the National Inpatient Sample. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Obstructive sleep apnea (OSA) accounts for significant mortality and morbidity worldwide. A limited but emerging literature has revealed increased risk of sudden cardiac death in patients with OSA. There is paucity of data on arrhythmia burden in patients with OSA, particularly in hospitalized patients.
Purpose
Therefore, we sought to study the prevalence of atrial and ventricular arrhythmias among hospitalized patients with OSA and examine its impact on sudden cardiac death and in-hospital mortality.
Methods
All patients over 18 years of age with OSA were extracted from the National Inpatient Sample (NIS) from 2009–10 using 9th revision of International Classification of Diseases (ICD-9) code 327.23. Demographic data, hospital characteristics, comorbid conditions, and arrhythmia burden including different types of arrhythmia were identified. Clinical outcomes were in-hospital mortality, length of stay and sudden cardiac death. Logistic regression analysis was performed to determine the impact of arrhythmia on in-hospital mortality in patients with OSA. Hospital level discharge weights provided by NIS were used to obtain national estimates of OSA hospitalizations.
Results
OSA was prevalent in 2.8% (n=1,114,297) of all hospitalizations among which 20.1% had any arrhythmia (n=223,974). Patients with arrhythmia were older, more likely to be males, and had higher prevalence of risk factors and comorbid conditions except for chronic liver disease, and smoking (p<0.0001 for all). Arrhythmia burden analysis revealed increase prevalence of both atrial and ventricular arrhythmia in patients with OSA compared to general population. In-hospital mortality (3.48% vs 1.27%; p<0.0001), length of hospital stay (6.4±0.1 vs 5±0.1; p<0.001) and sudden cardiac death (1.34% vs 0.4%; p<0.0001) were higher in OSA patients with arrhythmia compared to OSA patients without arrhythmia. Presence of arrhythmia in OSA patients was associated with increased in-hospital mortality in both unadjusted [OR 2.79 (2.62–2.98); p<0.001] and multivariable model adjusted for all risk factors and comorbid conditions [OR 1.83 (1.69–1.98); p<0.001].
Conclusion
Arrhythmia burden was higher in patients with OSA compared to the general population. Presence of arrhythmia among OSA patients was independently associated with increased in-hospital mortality and longer hospital stays. Routine evaluation to assess arrhythmia burden in patients in OSA could be a potential target to decrease sudden cardiac death in this high risk population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Gopalakrishnan
- The Brooklyn Hospital Center, Internal Medicine, Brooklyn, United States of America
| | - V Dhulipala
- The Brooklyn Hospital Center, Internal Medicine, Brooklyn, United States of America
| | - M Grillo
- The Brooklyn Hospital Center, Internal Medicine, Brooklyn, United States of America
| | - C Ayala-Rodriguez
- The Brooklyn Hospital Center, Internal Medicine, Brooklyn, United States of America
| | - S Garyali
- The Brooklyn Hospital Center, Internal Medicine, Brooklyn, United States of America
| | - S Reddy
- The Brooklyn Hospital Center, Internal Medicine, Brooklyn, United States of America
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Kasturiraj A, Reddy S, Daniel M, Namboor. Srinivasan S, Raja N, Reddy E. P–077 Performance of the postwash total motile sperm count as a predictor of pregnancy at the time of intrauterine insemination. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is the performance of the postwash total motile sperm count a predictor of pregnancy at the time of intrauterine insemination?
Summary answer
The number of motile spermatozoa inseminated (NMSI) in IUI can be used to define clear range of pre /postwash sperm parameters.
What is known already
There is no consensus about the optimal number of motile spermatozoa inseminated (NMSI) required for a reasonable chance of pregnancy after IUI. A meta-analysis of 16 studies assessing NMSI and IUI outcomes, concluded that at cut-off levels between 0.8 and 5 million, defined as the ability to predict failure to become pregnant. The purpose of this study is to determine the range of NMSI as a predictor of success in IUI.
Study design, size, duration
This prospective study includes 60 patients who underwent semen analysis at an academic infertility centre (SRIHER) during the month of December 2020 and January 2021.
Participants/materials, setting, methods
A total of 60 infertile couples who underwent IUI at our academic centre were enrolled in our study. A detailed history and infertility work up was done before proceeding for IUI, as per the department protocol. The semen was prepared by discontinuous 2 layered density gradient method. The results were analyzed by patient factors including age, BMI, semen parameters, NMSI. The NMSI were divided into 4 groups: A (<1), B (1–4), C (5–9), D (>10).
Main results and the role of chance
The mean age of the infertile couples who underwent IUI was (28.2 ± 3.8) in females and (31.8 ± 3.8) in males respectively. The sperm parameters such as concentration (21.8 ± 14.8), motility (53.15 ± 13.22), morphology (2.43 ± 1.33) respectively. When the NMSI was group C (5–9 x 10 6) the pregnancy rate was 38.5% whereas the pregnancy rate was 37.5% in group D ( >10 x 10 6). In the other sub groups such as group A(<1 x 10 6) and group C (1–4 x 10 6) the pregnancy rate was 14.2% and 12.5% respectively.
Limitations, reasons for caution
Infertile men with Azoospermia, Men with Retrograde ejaculation, Testicular samples, Epididymal samples, Infected samples. All of the above samples were avoided. It cannot be used for counselling during the initial infertility workup, but only during/after the IUI procedure.
Wider implications of the findings: The results suggest that NMSI can be a predictor of success in IUI in patients who are < 30 years of age & ≥35 years, NMSI does not appear to be a useful. The effect of NMSI on pregnancy rate needs to evaluated on a larger scale .
Trial registration number
Not applicable
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Affiliation(s)
- A Kasturiraj
- Sri Ramachandra institute of higher education and research, reproductive medicine and surgery, Chennai, India
| | - S Reddy
- Sri Ramachandra institute of higher education and research, reproductive medicine and surgery, Chennai, India
| | - M Daniel
- Sri Ramachandra institute of higher education and research, reproductive medicine and surgery, Chennai, India
| | - S Namboor. Srinivasan
- Sri Ramachandra institute of higher education and research, reproductive medicine and surgery, Chennai, India
| | - N Raja
- Sri Ramachandra institute of higher education and research, reproductive medicine and surgery, Chennai, India
| | - E Reddy
- Sri Ramachandra institute of higher education and research, reproductive medicine and surgery, Chennai, India
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34
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Gupte A, Sasidharan A, Kunheri B, Kumar A, Reddy S, Nair H, K U P, R A, Dutta D. PO-1645 Dosimetric comparison of radiotherapy techniques for left breast, axilla and supraclavicular fossa. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08096-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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35
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Reddy S, Rao K R, Kashyap JR, Kadiyala V, Reddy H, Malhotra S, Daggubati R, Kumar S, Soni H, Kaur N, Kaur J, Ramalingam V. Impact of plaque burden and composition on coronary slow flow in ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: intravascular ultrasound and virtual histology analysis. Acta Cardiol 2021; 76:650-660. [PMID: 32452718 DOI: 10.1080/00015385.2020.1767842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Coronary slow flow (SF) is an important complication of percutaneous coronary intervention (PCI) associated with poor prognosis. The aim was to assess grey-scale intravascular ultrasound (IVUS) and virtual histology (VH-IVUS) characteristics of culprit lesion in ST-elevation myocardial infarction (STEMI). METHODS A total of 295 consecutive patients with STEMI underwent coronary angiogram and IVUS. Following PCI, patients divided into two groups; SF (thrombolysis in myocardial infarction [TIMI] flow ≤ 2, n = 74) and normal flow (NF) (TIMI flow >2, n = 221). Coronary plaque burden and its composition in relation to SF were evaluated. RESULTS On grey-scale IVUS, the plaque area (12.3 mm2 vs. 11.5 mm2, p = .01), plaque volume (110.7 mm3 vs. 99.8 mm3, p < .001), lesion external elastic membrane (EEM) cross-sectional area (14.9 mm2 vs. 14.0 mm2, p = .011) and remodelling index (1.3 vs. 1.2, p = .043) were significantly higher in SF group. On VH-IVUS, absolute fibrous volume (48.1 mm3 vs. 41.5 mm3, p ≤ .001), fibrofatty volume (23.8 mm3 vs. 18.6 mm3, p = .015), necrotic core volume (8.3 mm3 vs. 5.5 mm3, p < .001), dense calcium volume (1.2 mm3 vs. 0.6 mm3, p = .003) and thin cap fibroatheroma either single (30.1% vs. 16.1%, p < .001) or multiple (9.6% vs. 1.8%, p < .001) were higher in SF arm. In multivariable analysis, absolute necrotic core volume (odds ratio = 1.159; 95% CI 1.030-1.305, p = .015) was the only independent predictor of SF. CONCLUSIONS Higher necrotic core volume as detected by VH-IVUS may be a potential risk factor for the development of coronary SF phenomenon in patients with STEMI after PCI.
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Affiliation(s)
- Sreenivas Reddy
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Raghavendra Rao K
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Jeet Ram Kashyap
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Vikas Kadiyala
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Hithesh Reddy
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Samir Malhotra
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Suraj Kumar
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Hariom Soni
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naindeep Kaur
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Jaspreet Kaur
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Vadivelu Ramalingam
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, India
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Vamsee R, Reddy S, Dimas V, Arar Y, Pontiki A, Hussain M. Biplane 3D Overlay Guidance For Congenital Heart Disease To Assist Cardiac Catheterization Interventions - A Pilot Study. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Covas Moschovas M, Chew C, Bhat S, Sandri M, Rogers T, Dell’oglio P, Roof S, Reddy S, Chiara Sighinolfi M, Rocco B, Patel V. Association between Oncotype DX Genomic Prostate Score (GPS) and adverse tumor pathology after radical prostatectomy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01393-2] [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: 11/25/2022]
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Zeeshan Hameed B, Somani B, Naik N, Talasila A, Shah M, Reddy S, Sachdev G, Hussein Beary R, Hegde P. Application of deep learning convolutional neural network in prediction of stone location, skin to stone distance and composition in renal lithiasis: A single center pilot study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00624-2] [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: 10/20/2022]
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Noël J, Helman T, Moschovas M, Helman R, Bhat S, Reddy S, Rogers T, Patel V. Patient surgical satisfaction following da vinci single port and multi port robotic-assisted radical prostatectomy: A propensity score matched analysis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zeeshan Hameed B, Somani B, T P R, Raza S, Paul R, Naik N, Singh H, Shah M, Reddy S. Application of Artificial Intelligence-based classifiers to predict the outcome measures and stone-free status following percutaneous nephrolithotomy for staghorn calculi: Cross-validation of data and estimation of accuracy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01348-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Covas Moschovas M, Bhat S, Rogers T, Reddy S, Noel J, Chew C, Mazzone E, Mottrie A, Patel V. Technical details comparing the da Vinci SP and da Vinci Xi approach to radical prostatectomy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kashyap JR, Kumar S, Reddy S, Rao K R, Sehrawat O, Kashyap R, Kansal M, Reddy H, Kadiyala V, Uppal L. Prevalence and Pattern of Congenital Coronary Artery Anomalies in Patients Undergoing Coronary Angiography at a Tertiary Care Hospital of Northern India. Cureus 2021; 13:e14399. [PMID: 33981512 PMCID: PMC8108404 DOI: 10.7759/cureus.14399] [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] [Indexed: 11/22/2022] Open
Abstract
Objectives: To evaluate the prevalence and pattern of congenital coronary artery anomalies (CAAs) in the adult population undergoing catheter coronary angiography. Methods: The coronary angiograms done between October 2015 and September 2020 were reviewed for the presence of coronary anomalies based upon Angelini's classification. The medical record of patients with anomalies was reviewed for symptomatology and indication of angiography. Results: CAAs were found in 129 (87 males and 42 females) of 6,258 patients giving a prevalence of 2.06%. The mean age was 57.8 ± 11.8 (range 32-81) years. Among these, the anomalous origin and course of the coronaries were the most common anomaly seen in 81 (1.29%) patients, followed by intrinsic anomalies of the coronary arterial system in 44 (0.7%) patients and anomalies of coronary termination and anomalous anastomotic vessels in 2 (0.03%) patients each. Overall, the absence of the left main trunk with a separate origin of the left anterior descending (LAD) and the circumflex artery was the commonest anomaly seen in 46 (0.74%) patients, followed by dual LAD in 35 (0.56%) patients. The anomalous origin of the right coronary artery (RCA) from the left sinus was seen in 14 patients (0.22%) and that of the circumflex artery from the right sinus or right coronary artery was seen in 11 patients (0.17%). The origin of the left main and RCA from ascending aorta was found in eight (0.13%) patients. One (0.02%) patient had a single coronary artery, and another one (0.02%) had all the three coronary arteries arising from the right sinus; however, with separate ostia. The split RCA was seen in nine (0.14%) patients and there were two (0.03%) patients each of coronary artery fistulae, and of anomalous anastomotic vessels. Conclusions: The prevalence of congenital coronary anomalies in this study was 2.06%. The commonest anomaly was that of origin and courses of the vessels, however, the pattern of anomalies is different from previous studies.
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Affiliation(s)
- Jeet Ram Kashyap
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Suraj Kumar
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Sreenivas Reddy
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Raghavendra Rao K
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Ojasav Sehrawat
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Rashmi Kashyap
- Community Medicine, Dr Yashwant Singh Parmar Government Medical College, Nahan, IND
| | - Maninder Kansal
- General Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Hithesh Reddy
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Vikas Kadiyala
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Lipi Uppal
- Cardiology, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
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Ohri N, Gill A, Vankar G, Tyagi P, Reddy S. Relationship between online cognition and personality traits: A questionnaire based study of medical college students. Eur Psychiatry 2021. [PMCID: PMC9480402 DOI: 10.1192/j.eurpsy.2021.1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Current classification systems are not sure where to place the internet use disorder. Is it an addiction, an impulse control disorder, a consequence of another psychiatric morbidity or a consequence of personality trait/personality disorder? Objectives We intended to study which personality traits associated with online cognition may contribute towards Problematic internet use(PIU). We also analysed the relationship between number of hours of use/week of internet and PIU along with its relation with two ‘screening’ questions. Methods Online cognition scale and Abbreviated Eysenck Personality questionnaires were our measurements of choice in addition to demographic measures and some questions pertaining to online behaviour patterns. Results Total 163 responses were analysed. The demographic pools consisted mostly of young adults who had, on average, used the internet for 5.2 years at present rate of 21.81hours/week. We observed significantly higher mean OCS scores in men, in people who thought that the internet interfered with their lives and in those who felt the need to ‘cut-down’. A moderate positive and significant correlation was observed between hpurs/week of internet use and OCS scores. Also, significant positive correlation was observed between Neuroticism and OCS, impulsivity, and loneliness/depression scores. Significant negative correlations were observed between the Lie trait and impulse control. Neuroticism and Lie together contributed to 21.8% of variance in OCS scores. Conclusions Neuroticism and Lie traits (representing need for social acceptance) were found to the causing significamn varience in the OCS scores of the subjects. High number of hours/week use of internet was related to the feeling of ‘need to cut down use’.
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Reddy S, Rao K R, Mahant TS, Goel S, Cheluvashetty SB. Unusual Presentation of a Rapidly Progressive Coronary Artery Pseudoaneurysm after Drug Eluting Stent Placement. Cureus 2021; 13:e13305. [PMID: 33738156 PMCID: PMC7957844 DOI: 10.7759/cureus.13305] [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] [Indexed: 11/18/2022] Open
Abstract
Infected coronary artery aneurysm (CAA) is a rare complication of percutaneous coronary intervention (PCI) and is associated with high morbidity and mortality. The management of infected CAA is unclear and is based on the clinical and imaging features. We report an interesting case of a giant infected right CAA secondary to Pseudomonas aeruginosa within four weeks of a drug eluting stent (DES) implantation. Chronological analysis of the coronary angiograms and computed tomography coronary angiography revealed rapid progression in the size of the aneurysm from small to a giant CAA over a period of four weeks. Patient remained afebrile throughout the hospital stay without any signs of septicaemia. In view of the rapid progression in size, surgical aneurysmal ligation with distal revascularisation was done with good post-operative recovery. Afebrile presentation of an infected CAA is very rarely reported in the literature as in our case. Early diagnosis using multimodality imaging and immediate surgical intervention are the cornerstone in the management of giant infected CAAs.
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Affiliation(s)
- Sreenivas Reddy
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, IND
| | - Raghavendra Rao K
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, IND
| | - Tek Singh Mahant
- Department of Cardiovascular and Thoracic Surgery, Fortis Hospital Mohali, Mohali, IND
| | - Sandeep Goel
- Department of Cardiology, Chandigarh Heart Centre, Sangrur, IND
| | - Sreedhara B Cheluvashetty
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
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Moslim M, Deng M, Handorf E, Greco S, Reddy S, Farma J. Standard of Care and Survival for Signet-ring Cell and Non-Signet-ring Cell Gastric Cancer are More Achievable at Academic Cancer Centers. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2020.11.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Rao K R, Reddy S, Kashyap JR, Ramalingam V, Dash D, Kadiyala V, Kumar S, Reddy H, Kaur J, Kumar A, Kaur N, Gupta A. Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study. Egypt Heart J 2020; 72:86. [PMID: 33296051 PMCID: PMC7726087 DOI: 10.1186/s43044-020-00121-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/27/2020] [Indexed: 12/19/2022] Open
Abstract
Background Not every patient achieves normal coronary flow following fibrinolysis in STEMI (ST-segment elevation myocardial infarction). The culprit lesion plaque characteristics play a prominent role in the coronary flow before and during percutaneous coronary intervention. The main purpose was to determine the culprit lesion plaque features by virtual histology-intravascular ultrasound (VH-IVUS) in patients with STEMI following fibrinolysis in relation to baseline coronary angiogram TIMI (thrombolysis in myocardial infarction) flow. Pre-intervention IVUS was undertaken in 61 patients with STEMI after successful fibrinolysis. After the coronary angiogram, they were separated into the TIMI1–2 flow group (n = 31) and TIMI 3 flow group (n = 30). Culprit lesion plaque composition was evaluated by VH-IVUS. Results On gray-scale IVUS, the lesion external elastic membrane cross-sectional area (EEM CSA) was significantly higher in the TIMI 1–2 groups as compared to the TIMI 3 group (15.71 ± 3.73 mm2 vs 13.91 ± 2.94 mm2, p = 0.041) with no significant difference in plaque burden (82.42% vs. 81.65%, p = 0.306) and plaque volume (108.3 mm3 vs. 94.3 mm3, p = 0.194). On VH-IVUS, at the minimal luminal area site (MLS), the fibrous area (5.83 mm2 vs. 4.37 mm2, p = 0.024), necrotic core (NC) area (0.95 mm2 vs. 0.59 mm2, p < 0.001), and NC percentage (11% vs. 7.1%, p = 0.024) were higher in the TIMI 1–2 groups in contrast to the TIMI 3 group. The absolute necrotic core (NC) volume (8.3 mm3 vs. 3.65 mm3, p < 0.001) and NC percentage (9.3% vs. 6.0%, p = 0.007) were significantly higher in the TIMI 1–2 groups as compared to the TIMI 3 group. Absolute dense calcium (DC) volume was higher in TIMI 1–2 groups with a trend towards significance (1.0 mm3 vs.0.75 mm3, p = 0.051). In multivariate analysis, absolute NC volume was the only independent predictor of TIMI 1–2 flow (odds ratio = 1.561; 95% CI 1.202–2.026, p = 0.001). Receiver operating characteristic curves showed absolute NC volume has best diagnostic accuracy (AUC = 0.816, p < 0.001) to predict TIMI 1–2 flow with an optimal cutoff value of 4.5 mm3 with sensitivity and specificity of 79% and 61%, respectively. Conclusions This study exemplifies that the necrotic core component of the culprit lesion plaque in STEMI is associated with the coronary flow after fibrinolysis. The absolute necrotic core volume is a key determinant of flow restoration post-fibrinolysis and aids in prognostication of less than TIMI 3 flow.
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Affiliation(s)
- Raghavendra Rao K
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Sreenivas Reddy
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India.
| | - Jeet Ram Kashyap
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Vadivelu Ramalingam
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Debabrata Dash
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Vikas Kadiyala
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Suraj Kumar
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Hithesh Reddy
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Jaspreet Kaur
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Ashok Kumar
- Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Naindeep Kaur
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Anish Gupta
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
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Praharaj I, Benny B, Soumya R, Hemavathi G, Giri S, Reddy S, Zondervenni Z, Manohar B, Lopman B, Kang G. Enteric virus detection from acute gastroenteritis cases in a tertiary care hospital before and after rotavirus vaccine introduction, India: 2012–2019. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Antonowicz S, Reddy S, Sgromo B. Gastrointestinal side effects of upper gastrointestinal cancer surgery. Best Pract Res Clin Gastroenterol 2020; 48-49:101706. [PMID: 33317793 DOI: 10.1016/j.bpg.2020.101706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/21/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023]
Abstract
In this chapter, we describe the gastrointestinal side effects of oesophagectomy, gastrectomy and pancreaticoduodenectomy for cancer, with a focus on long-term functional impairments and their management. Improvements in upper gastrointestinal cancer surgery have led to a growing group of long-term survivors. The invasive nature of these surgeries profoundly alters the upper gastrointestinal anatomy, with lasting implications for long-term function, and how these impairments may be treated. Successfully maintaining a high quality of survivorship requires multidisciplinary approach, with survivorship care plans focused on function as much as the detection of recurrence.
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Affiliation(s)
- S Antonowicz
- Oxford Oesophago Gastric Centre, Oxford University Hospitals NHS Trust, UK
| | - S Reddy
- Hepatobiliary and Pancreatic Unit, Oxford University Hospitals NHS Trust, UK
| | - B Sgromo
- Oxford Oesophago Gastric Centre, Oxford University Hospitals NHS Trust, UK.
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Box EW, Deng L, Morgan DE, Xie R, Kirklin JK, Wang TN, Heslin MJ, Reddy S, Vickers S, Dudeia V, Rose JB. Preoperative anthropomorphic radiographic measurements can predict postoperative pancreatic fistula formation following pancreatoduodenectomy. Am J Surg 2020; 222:133-138. [PMID: 33390246 DOI: 10.1016/j.amjsurg.2020.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/06/2020] [Accepted: 10/19/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Postoperative pancreatic fistulae (POPF) are a major contributing factor to pancreatoduodenectomy-associated morbidity. Established risk calculators mostly rely on subjective or intraoperative assessments. We hypothesized that various objective preoperatively determined computed tomography (CT) measurements could predict POPF as well as validated models and allow for more informed operative consent in high-risk patients. METHODS Patients undergoing elective pancreatoduodenectomies between January 2013 and April 2018 were identified in a prospective database. Comparative statistical analyses and multivariable logistic regression models were generated to predict POPF development. Model performance was tested with receiver operating characteristics (ROC) curves. Pancreatic neck attenuation (Hounsfield units) was measured in triplicate by pancreatic protocol CT (venous phase, coronal plane) anterior to the portal vein. A pancreatic density index (PDI) was created to adjust for differences in contrast timing by dividing the mean of these measurements by the portal vein attenuation. Total areas of subcutaneous fat and skeletal muscle were calculated at the L3 vertebral level on axial CT. Pancreatic duct (PD) diameter was determined by CT. RESULTS In the study period 220 patients had elective pancreatoduodenectomies with 35 (16%) developing a POPF of any grade. Multivariable regression analysis revealed that demographics (age, sex, and race) were not associated with POPF, yet patients resected for pancreatic adenocarcinoma or chronic pancreatitis were less likely to develop a POPF (10 vs. 24%; p = 0.004). ROC curves were created using various combinations of gland texture, body mass index, skeletal muscle index, sarcopenia, PDI, PD diameter, and subcutaneous fat area indexed for height (SFI). A model replacing gland texture with SFI and PDI (AUC 0.844) had similar predictive performance as the established model (p = 0.169). CONCLUSION A combination of preoperative objective CT measurements can adequately predict POPF and is comparable to established models relying on subjective intraoperative variables. Validation in a larger dataset would allow for better preoperative stratification of high-risk patients and improve informed consent among this patient population.
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Affiliation(s)
- E W Box
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - L Deng
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - D E Morgan
- Department of Radiology, University of Alabama at Birmingham, 500 22nd Street South, Birmingham, AL, 35233, USA
| | - R Xie
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - J K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - T N Wang
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - M J Heslin
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - S Reddy
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - S Vickers
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - V Dudeia
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA
| | - J B Rose
- Department of Surgery, University of Alabama at Birmingham, Boshell Diabetes Building #618, 1808 7th Ave. S, Birmingham, AL, 35233, USA.
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Reddy S, Kadiyala V, Kashyap JR, Rao R, Reddy H, Kaur J, Kaur N, Ramalingam V. Comparison of Intravascular Ultrasound Virtual Histology Parameters in Diabetes versus Non-Diabetes with Acute Coronary Syndrome. Cardiology 2020; 145:570-577. [PMID: 32726774 DOI: 10.1159/000508886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 05/19/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The progression and pattern of coronary atherosclerosis in diabetes mellitus (DM) is different from non-DM, leading to a higher rate of vascular complications in DM. OBJECTIVE This study aims to assess and compare the high-risk plaque characteristics in the culprit artery of DM and non-DM patients with acute coronary syndrome (ACS) using virtual histology intravascular ultrasound (VH-IVUS). METHODS A total of 158 ACS patients were included, 63 of whom were known to have DM. IVUS analysis was done in the de novo target vessel and culprit lesion for which percutaneous coronary intervention was planned. Culprit lesions with a visual-estimate angiographic stenosis of <70% were excluded. RESULTS The mean age of patients was 52.4 ± 11.6 years. The study group comprised 82% men, 31% with hypertension, and 39.87% with DM. No significant difference was observed between the DM and non-DM groups in relation to quantitative IVUS parameters like lesion length, minimal lumen area, and plaque area. However, there was a significant difference in VH-IVUS parameters like higher necrotic core and dense calcium in the DM patients than in the non-DM patients (p < 0.01). The occurrence of VH-derived thin-cap fibroatheroma (VH-TCFA) in the culprit vessel was significantly higher in the DM group than in the non-DM group (25.3 vs. 5.2%; p < 0.01). Positive vessel-wall remodeling was noted in both groups without any significant difference (p = 0.74). CONCLUSION The DM patients had high-risk plaque composition features like a higher necrotic core, which is a marker of plaque vulnerability. Thus, aggressive medical therapy targeting vascular inflammation using high-dose statins would help in the stabilization of unstable plaque morphology and the reduction of major cardiovascular events.
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Affiliation(s)
- Sreenivas Reddy
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India,
| | - Vikas Kadiyala
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Jeet Ram Kashyap
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Raghavendra Rao
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Hithesh Reddy
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Jaspreet Kaur
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Naindeep Kaur
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, India
| | - Vadivelu Ramalingam
- Department of Cardiology, Velammaal Medical College Hospital and Research Institute, Madurai, India
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