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Pabbati S, Thomson P, Sharma D, Bhandari S. The aetiology of maxillofacial trauma in Australia: A scoping review. Aust Dent J 2024; 69:146-156. [PMID: 38348522 DOI: 10.1111/adj.13009] [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] [Accepted: 01/28/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND The oral and maxillofacial complex is subject to a range of traumas. Injuries to the region are devastating and have a great impact on social health outcomes. This review intends to investigate the aetiologies of maxillofacial trauma across Australia. METHODS This review was written in accordance with the PRISMA-ScR. Comprehensive searches of CINAHL, MEDLINE, Ovid, Scopus, and Web of Science databases were conducted to identify potentially relevant literature. Quantitative observational epidemiological studies were sought and were required to include at least one aetiology to the maxillofacial region in their data set. A total of 31 eligible studies were included. RESULTS The greatest recorded causes of maxillofacial injuries included inter-personal violence (34.98%) falls (20.87%), sports (15.62%), and motor-vehicle accidents (14.31%). These four aetiologies cumulatively accounted for more than 85% of maxillofacial injuries. From all sustained injuries (n = 7661), the orbit was the most prevalent site of fracture (31.85%), followed by the zygoma (22.01%), mandible (21%), nasal bone (12.45%), maxilla (10.04%), dentoalveolus (1.84%), antrum (<1%), and frontal bone (<1%). CONCLUSION Violence was an unprecedented cause of trauma-additional research is recommended to further characterize the correlation between the two variables. Research is also recommended specifically in regional/rural communities, where data was particularly limited. © 2024 Australian Dental Association.
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Affiliation(s)
- Ssr Pabbati
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - P Thomson
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - D Sharma
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Ourimbah, New South Wales, Australia
| | - S Bhandari
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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Abbasciano RG, Layton GR, Torre S, Abbaker N, Copperwheat A, Lucarelli C, Bhandari S, Nijjer S, Mikhail G, Casula R, Zakkar M, Viviano A. Fractional flow reserve and instantaneous wave-free ratio in coronary artery bypass grafting: a meta-analysis and practice review. Front Cardiovasc Med 2024; 11:1348341. [PMID: 38516003 PMCID: PMC10955066 DOI: 10.3389/fcvm.2024.1348341] [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: 12/02/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Objective Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are invasive methods to assess the functional significance of intermediate severity coronary lesions. Both indexes have been extensively validated in clinical trials in guiding revascularisation in patients with stable ischaemic heart disease undergoing percutaneous coronary intervention (PCI) with improved clinical outcomes. However, the role of these tools in coronary artery bypass grafting (CABG) is less clear. Methods A meta-analysis of randomised trials and observational studies was carried out to help in determining the optimal strategy for assessing lesion severity and selecting graft targets in patients undergoing CABG. Electronic searches were carried out on Embase, MEDLINE, and Web of Science. A group of four authors independently screened and then assessed the retrieved records. Cochrane's Risk of Bias and Robins-I tools were used for bias assessment. A survey was conducted among surgeons and cardiologists to describe current attitudes towards the preoperative use of functional coronary investigations in practice. Results Clinical outcomes including mortality at 30 days, perioperative myocardial infarction, number of grafts, incidence of stroke, rate of further need for revascularisation, and patient-reported quality of life did not differ in CABG guided by functional testing from those guided by traditional angiography.The survey revealed that in half of the surgical and cardiology units functional assessment is performed in CABG patients; there is a general perception that functional testing has improved patient care and its use would clarify the role of moderate coronary lesions that often need multidisciplinary rediscussions; moderate stenosis are felt to be clinically relevant; and anatomical considerations need to be taken into account together with functional assessment. Conclusions At present, the evidence to support the routine use of functional testing in intermediate lesions for planning CABG is currently insufficient. The pooled data currently available do not show an increased risk in mortality, myocardial injury, and stroke in the FFR/iFR-guided group. Further trials with highly selected populations are needed to clarify the best strategy. Systematic Review Registration ClinicalTrials.gov, identifier (CRD42023414604).
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Affiliation(s)
- R. G. Abbasciano
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - G. R. Layton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - S. Torre
- Cardiac Surgery Unit, Giaccone Hospital, Palermo, Italy
| | - N. Abbaker
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - A. Copperwheat
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - C. Lucarelli
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - S. Bhandari
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - S. Nijjer
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - G. Mikhail
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - R. Casula
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M. Zakkar
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - A. Viviano
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Ryder SD, Bannister KW, Bhandari S, Deller AT, Ekers RD, Glowacki M, Gordon AC, Gourdji K, James CW, Kilpatrick CD, Lu W, Marnoch L, Moss VA, Prochaska JX, Qiu H, Sadler EM, Simha S, Sammons MW, Scott DR, Tejos N, Shannon RM. A luminous fast radio burst that probes the Universe at redshift 1. Science 2023; 382:294-299. [PMID: 37856596 DOI: 10.1126/science.adf2678] [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: 10/12/2022] [Accepted: 09/04/2023] [Indexed: 10/21/2023]
Abstract
Fast radio bursts (FRBs) are millisecond-duration pulses of radio emission originating from extragalactic distances. Radio dispersion is imparted on each burst by intervening plasma, mostly located in the intergalactic medium. In this work, we observe the burst FRB 20220610A and localize it to a morphologically complex host galaxy system at redshift 1.016 ± 0.002. The burst redshift and dispersion measure are consistent with passage through a substantial column of plasma in the intergalactic medium and extend the relationship between those quantities measured at lower redshift. The burst shows evidence for passage through additional turbulent magnetized plasma, potentially associated with the host galaxy. We use the burst energy of 2 × 1042 erg to revise the empirical maximum energy of an FRB.
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Affiliation(s)
- S D Ryder
- School of Mathematical and Physical Sciences, Macquarie University, Sydney, NSW 2109, Australia
- Astrophysics and Space Technologies Research Centre, Macquarie University, Sydney, NSW 2109, Australia
| | - K W Bannister
- Australia Telescope National Facility, Commonwealth Science and Industrial Research Organisation, Space and Astronomy, Epping, NSW 1710, Australia
| | - S Bhandari
- Netherlands Institute for Radio Astronomy (ASTRON), 7991 PD Dwingeloo, Netherlands
- Joint institute for Very Long Baseline Interferometry in Europe, 7991 PD Dwingeloo, Netherlands
| | - A T Deller
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - R D Ekers
- Australia Telescope National Facility, Commonwealth Science and Industrial Research Organisation, Space and Astronomy, Epping, NSW 1710, Australia
- International Centre for Radio Astronomy Research, Curtin Institute of Radio Astronomy, Curtin University, Perth, WA 6102, Australia
| | - M Glowacki
- International Centre for Radio Astronomy Research, Curtin Institute of Radio Astronomy, Curtin University, Perth, WA 6102, Australia
| | - A C Gordon
- Center for Interdisciplinary Exploration and Research in Astrophysics, Northwestern University, Evanston, IL 60208, USA
| | - K Gourdji
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - C W James
- International Centre for Radio Astronomy Research, Curtin Institute of Radio Astronomy, Curtin University, Perth, WA 6102, Australia
| | - C D Kilpatrick
- Center for Interdisciplinary Exploration and Research in Astrophysics, Northwestern University, Evanston, IL 60208, USA
- Department of Physics and Astronomy, Northwestern University, Evanston, IL 60208, USA
| | - W Lu
- Department of Astronomy University of California, Berkeley, CA 94720, USA
- Theoretical Astrophysics Center, University of California, Berkeley, CA 94720, USA
| | - L Marnoch
- School of Mathematical and Physical Sciences, Macquarie University, Sydney, NSW 2109, Australia
- Astrophysics and Space Technologies Research Centre, Macquarie University, Sydney, NSW 2109, Australia
- Australia Telescope National Facility, Commonwealth Science and Industrial Research Organisation, Space and Astronomy, Epping, NSW 1710, Australia
- Australian Research Council Centre of Excellence for All Sky Astrophysics in 3 Dimensions (ASTRO 3D), Macquarie University, Sydney, NSW 2109, Australia
| | - V A Moss
- Australia Telescope National Facility, Commonwealth Science and Industrial Research Organisation, Space and Astronomy, Epping, NSW 1710, Australia
| | - J X Prochaska
- Department of Astronomy and Astrophysics, University of California, Santa Cruz, CA 95064, USA
- Kavli Institute for the Physics and Mathematics of the Universe, Kashiwa, 277-8583, Japan
| | - H Qiu
- Square Kilometre Array Observatory, Jodrell Bank, Lower Withington, Macclesfield SK11 9FT, UK
| | - E M Sadler
- Australia Telescope National Facility, Commonwealth Science and Industrial Research Organisation, Space and Astronomy, Epping, NSW 1710, Australia
- Sydney Institute for Astronomy, School of Physics, University of Sydney, Sydney, NSW 2006, Australia
| | - S Simha
- Department of Astronomy and Astrophysics, University of California, Santa Cruz, CA 95064, USA
| | - M W Sammons
- International Centre for Radio Astronomy Research, Curtin Institute of Radio Astronomy, Curtin University, Perth, WA 6102, Australia
| | - D R Scott
- International Centre for Radio Astronomy Research, Curtin Institute of Radio Astronomy, Curtin University, Perth, WA 6102, Australia
| | - N Tejos
- Instituto de Física, Pontificia Universidad Católica de Valparaíso, Casilla 4059, Valparaíso, Chile
| | - R M Shannon
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
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Walklin CG, Young HML, Asghari E, Bhandari S, Billany RE, Bishop N, Bramham K, Briggs J, Burton JO, Campbell J, Castle EM, Chilcot J, Cooper N, Deelchand V, Graham-Brown MPM, Hamilton A, Jesky M, Kalra PA, Koufaki P, McCafferty K, Nixon AC, Noble H, Saynor ZL, Sothinathan C, Taal MW, Tollitt J, Wheeler DC, Wilkinson TJ, Macdonald JH, Greenwood SA. The effect of a novel, digital physical activity and emotional well-being intervention on health-related quality of life in people with chronic kidney disease: trial design and baseline data from a multicentre prospective, wait-list randomised controlled trial (kidney BEAM). BMC Nephrol 2023; 24:122. [PMID: 37131125 PMCID: PMC10152439 DOI: 10.1186/s12882-023-03173-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Physical activity and emotional self-management has the potential to enhance health-related quality of life (HRQoL), but few people with chronic kidney disease (CKD) have access to resources and support. The Kidney BEAM trial aims to evaluate whether an evidence-based physical activity and emotional wellbeing self-management programme (Kidney BEAM) leads to improvements in HRQoL in people with CKD. METHODS This was a prospective, multicentre, randomised waitlist-controlled trial, with health economic analysis and nested qualitative studies. In total, three hundred and four adults with established CKD were recruited from 11 UK kidney units. Participants were randomly assigned to the intervention (Kidney BEAM) or a wait list control group (1:1). The primary outcome was the between-group difference in Kidney Disease Quality of Life (KDQoL) mental component summary score (MCS) at 12 weeks. Secondary outcomes included the KDQoL physical component summary score, kidney-specific scores, fatigue, life participation, depression and anxiety, physical function, clinical chemistry, healthcare utilisation and harms. All outcomes were measured at baseline and 12 weeks, with long-term HRQoL and adherence also collected at six months follow-up. A nested qualitative study explored experience and impact of using Kidney BEAM. RESULTS 340 participants were randomised to Kidney BEAM (n = 173) and waiting list (n = 167) groups. There were 96 (55%) and 89 (53%) males in the intervention and waiting list groups respectively, and the mean (SD) age was 53 (14) years in both groups. Ethnicity, body mass, CKD stage, and history of diabetes and hypertension were comparable across groups. The mean (SD) of the MCS was similar in both groups, 44.7 (10.8) and 45.9 (10.6) in the intervention and waiting list groups respectively. CONCLUSION Results from this trial will establish whether the Kidney BEAM self management programme is a cost-effective method of enhancing mental and physical wellbeing of people with CKD. TRIAL REGISTRATION NCT04872933. Registered 5th May 2021.
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Affiliation(s)
- C G Walklin
- Renal Therapies, King's College Hospital NHS Trust, London, UK
| | - Hannah M L Young
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.
| | - E Asghari
- Department of Nephrology, Guy's and St Thomas' NHS Trust, London, UK
| | - S Bhandari
- Department of Nephrology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - R E Billany
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - N Bishop
- School of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, UK
| | - K Bramham
- Department of Women's Health, King's College London, London, UK
| | - J Briggs
- Renal Therapies, King's College Hospital NHS Trust, London, UK
| | - J O Burton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - J Campbell
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - E M Castle
- School of Physiotherapy, Department of Health Sciences, Brunel University, London, UK
| | - J Chilcot
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - V Deelchand
- Department of Nephrology, Royal Free Hospital, London, UK
| | | | - A Hamilton
- Department of Nephrology, Royal Exeter Hospital, Devon, UK
| | - M Jesky
- Department of Nephrology, Nottingham NHS Trust, Nottingham, UK
| | - P A Kalra
- Department of Nephrology, Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - P Koufaki
- Dietetics, Nutrition and Biological Sciences, Queen Margaret University, Edinburgh, UK
| | - K McCafferty
- Department of Nephrology, Barts Health NHS Trust, London, UK
| | - A C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - H Noble
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Z L Saynor
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - C Sothinathan
- Department of Physiotherapy, Chelsea and Westminster NHS Trust, London, UK
| | - M W Taal
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - J Tollitt
- Department of Renal Medicine, University College London, London, UK
| | - D C Wheeler
- National Institute of Health Research Leicester Biomedical Research Centre , Leicester, UK
| | - T J Wilkinson
- Institute for Applied Human Physiology, Bangor University, Bangor, Gwynedd, UK
| | - J H Macdonald
- Faculty of life sciences and medicine, King's College London, London, UK
| | - S A Greenwood
- Renal Therapies, King's College Hospital NHS Trust, London, UK
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Gurung RB, Jaisy D, Sapkota P, Bhandari S. Bedside Index of Severity in Acute Pancreatitis (BISAP) Score on Outcome of Patients Presenting with Acute Pancreatitis in a Tertiary Care Hospital. Kathmandu Univ Med J (KUMJ) 2023; 21:74-78. [PMID: 37800430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Background Acute pancreatitis is a life-threatening condition characterized by inflammation of the pancreas causing intense abdominal pain and potential harm to multiple organs. The mortality rate is 1-5% and thus requires specialized and interdisciplinary care to inhibit it. Objective To describe the bedside index of severity in acute pancreatitis score on the outcome of acute pancreatitis patients in a tertiary care hospital. Method This is a hospital based observational cross-sectional study conducted in the internal medicine inpatient department of Dhulikhel Hospital from April 2018 and March 2019. This study reviewed the medical records of the department. Result The study included 70 participants with 44 (±14) years of average age and stating common cause as gallstone (45.7%). The study showed that those with bedside index of severity in acute pancreatitis score ≥ 3 during hospital admission had significantly higher rate of organ failure (p-value < 0.05), as well as had a prolonged hospital stay (mean: 20 [±7.9] days). The mean hospital stay was 12.9 days. Conclusion Patients with bedside index of severity in acute pancreatitis score greater than three at admission were found to have an increased risk of organ failure, significantly higher chances of requiring mechanical ventilation, and a longer duration of hospital stay.
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Affiliation(s)
- R B Gurung
- Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - D Jaisy
- Department of Internal Medicine, College of Medical Science, Bharatpur, Chitwan, Nepal
| | - P Sapkota
- Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Bhandari
- Department of Internal Medicine, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Bhandari S, Frimpong SO, Bhirgoo PD. Halting COVID-19 Requires Collective, Decentralized, and Community-Led Responses. Int Journal of Com WB 2022; 5:679-683. [PMID: 35698567 PMCID: PMC9178932 DOI: 10.1007/s42413-022-00171-9] [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] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/30/2022] [Indexed: 10/31/2022]
Abstract
Abstract
Many global health organizations are reliant on the funding provided by a few dozen high-income countries, making them fiscally insecure and fragile, especially during times of global crises. The COVID-19 pandemic could be an opportunity to move away from this status quo to a more decentralized, multipolar, and community-led approach. The global health community can take four immediate steps in response to the pandemic to start that paradigm shift now: support more regional and country-specific responses, convince national and regional business houses and philanthropies to make up for response funding shortfalls, leverage public health advocacy to improve investments in public health infrastructure, and put community leaders and members at the frontlines of mitigation efforts.
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Bhandari S, Mann J, Chawla J, Jain P, Knight M, Lagor C, Mueller J, Raska P, Southwick S, Whyte W. Evaluating the impact of performance status criteria on minority eligibility for oncology clinical trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18701] [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: 11/20/2022] Open
Abstract
e18701 Background: Restrictive criteria contribute to low enrollment in clinical trials. These criteria can also amplify health disparities by reducing the racial and ethnic diversity of the cohort. Many studies show that minority patients exhibit worse Eastern Cooperative Oncology Group (ECOG) performance status than white patients. Based on clinical trial data, some researchers have hypothesized that relaxing the ECOG criterion in clinical trial criteria could improve the diversity of the cohort. However, little research exists to measure ECOG’s impact on minority eligibility. Using Real-World Data (RWD), we evaluate whether relaxing the ECOG criterion monotonically increases the racial diversity of the cohort in oncology clinical trials. Methods: We used ConcertAI’s database of US oncology Electronic Medical Record (EMR) data, which includes clinical data from CancerLinQ Discovery™. We conducted sensitivity analyses for the inclusion criteria of 16 different clinical trials across multiple cancer indications. For each trial, we created five cohorts based on five different ECOG score upper limits. For example, the first cohort only included patients who had an ECOG of 0, the second cohort included patients with an ECOG of 0 or 1, etc. We then recorded the percentage of non-white patients for the resulting cohorts. We ran simple linear regressions to measure whether the change in the percentage of non-white patients was statistically significant. Results: Relaxation in ECOG status led to no uniform change in the racial diversity of patients across the 16 trials. The limited changes we did observe were not statistically significant. Conclusions: Our findings suggest that improving diversity will require more than just relaxing ECOG restrictions, and a multi-faceted approach may be needed. Future research exploring the relationship between ECOG and diversity should control for potential confounders like age, gender, and comorbidities using multivariable models. Such research needs to also account for patients with unknown race and ECOG, which represented large parts of our study population. Such research could elucidate whether the phenomenon observed in the general population—that minority patients tend to have worse performance status than whites—holds true in the sub-population of oncology patients.[Table: see text]
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Lagor C, Bhandari S, Chawla J, Knight M, Mann J, Mueller J, Raska P, Southwick S, Whyte W. Impact of trial site selection on minority patient recruitment in prostate cancer trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1558] [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: 11/20/2022] Open
Abstract
1558 Background: Historically, minority patients have been underrepresented in clinical cancer trials. Despite recognition of this problem, trials in the early 2000’s showed a decrease from 10.5% to 6.2% in African American trial participation when compared to trials from the early 1990’s. The drop in trial participation is also reflected in prostate cancer trials, although Black men have a 1.76 higher prostate cancer incidence rate than White men. Using prostate cancer as an example, we investigated the impact of trial site selection on potential minority patient recruitment; thus, overcoming a major system-level barrier to trial access. Methods: We created a prostate cancer cohort by filtering our real-world data sources (CancerLinQ, Electronic Medical Office Logistics) for adult male patients with ICD10 CM code C61* or ICD9 CM code 185 on 1/1/2015 or later (cohort #1). As a pre-requisite for computing site level prostate cancer patient counts, we used claims data to attribute missing site information. Finally, to identify the most promising sites for minority trial recruitment, we ranked sites by the proportion of Black patients and the overall cohort patient count. We repeated the above steps for a subset of cohort #1, which was based on the criteria for trial NCT00887198 investigating the prostate cancer drug abiraterone (cohort #2). Results: The prostate cancer cohort (#1) had 151,261 patients, of which 99,152 (65.6%) were attributed to sites. The percentage of Black patients being treated at the top ten sites ranged from 33.0% to 66.4%, with a median of 45.2% (see table). All ten sites had participated in an interventional cancer trial, and eight had participated in prostate cancer trials. Half of them were community, and half were academic sites. The abiraterone cohort (#2) had 1,267 patients, of which 1,174 (92.7%) were attributed to sites. Among the top ten sites the Black patient percentages ranged from 23.8% to 85.7%, with a median of 39.3%. Conclusions: In an analysis of 17 recent FDA drug registration trials for prostate cancer, Black trial participation ranged from only 1.4% to 6.2%, with a median of 3.0%. In contrast, Black patients being treated at the top sites in our data ranged from 33.0% to 66.4%, with a median of 45.2% (cohort #1). The percentages for the abiraterone cohort (#2) were similar, suggesting that even after applying trial criteria the Black patient percentages remain in the double-digits at top sites. Our results demonstrate that informed trial site selection could have a substantial positive impact on minority patient recruitment. [Table: see text]
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Dhakal N, Adhikari A, Bhandari S, Gautam B, Shrestha S. W210 Biochemical and physiological derangement in subjects with metabolic syndrome and the effect of reduction in central adiposity. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.969] [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: 11/03/2022]
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KASSIANIDES X, Bhandari S. POS-252 THE DIFFERENTIAL IMPACT OF TWO NOVEL INTRAVENOUS IRON AGENTS ON FIBROBLAST GROWTH FACTOR 23, PHOSPHATE AND OTHER CLINICAL AND FUNCTIONAL MARKERS: METHODOLOGY AND BASELINE DATA. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.271] [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] Open
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Singh SK, Goyal A, Gauba K, Bhandari S, Kaur S. Full coverage crowns for rehabilitation of MIH affected molars: 24 month randomized clinical trial. Eur Arch Paediatr Dent 2022; 23:147-158. [PMID: 34398412 DOI: 10.1007/s40368-021-00657-8] [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: 02/03/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Teeth affected with severe molar incisor hypomineralization (MIH) require extensive restorations, which do not last for a long time and often require treatment in the form of onlays or full coverage restorations. AIM To evaluate and compare the clinical performance of zirconia, lithium disilicate, and cast metal crowns as full-coverage restorations on MIH-affected first permanent molars (FPMs). METHODS 60 MIH affected FPMs requiring full-coverage crowns were identified in children aged 8-15 years and were randomly allocated to the three treatment groups according to the type of full coverage restoration received using block randomization technique. After an adequate removal of the MIH defect and restoration with composite resin, the tooth preparation was done followed by fabrication of crown and its cementation using resin cement. The intergroup comparison was done on the basis of USPHS criteria, gingival, plaque scores, patient and parents acceptance through a visual analog scale to decipher their clinical performance at 6, 12, 24 months. RESULTS After 24 months, the crowns showed similar clinical success in terms of the criterias used to compare their clinical performance. The retention, marginal adaptation, relief from hypersensitivity, proximal contact, gingival health with no statistically significant difference among the three groups. CONCLUSION Based on the observations, Lithium disilicate, Zirconia and full cast metal crowns showed similar clinical success in rehabilitation of First permanent molars with severe MIH over 24 months of evaluation. The clinical success is not influenced by the material of the restoration. However, prospective studies with a longer follow-up are required to reach a more definitive conclusion.
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Affiliation(s)
- S K Singh
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - A Goyal
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gauba
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Bhandari
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Kaur
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Grafton-Clarke C, Bhandari S, Abdelaty A, Mashicharan M, Gulsin G, Budgeon CA, Hetherington S, Kanagala P, Ladwiniec A, McCann GP, Arnold JR. Cardiac magnetic resonance strain and mechanical dispersion assessment in patients with chronic total coronary artery occlusion. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Chronic total occlusions (CTO) are a frequent angiographic finding. Viability of CTO-subtended myocardium is dependent on the presence of an adequate collateral circulation. At rest, collateral supply may be sufficient to avert ischaemia and maintain normal systolic function. However, it remains unclear whether CTO-subtended myocardium may be considered truly normal, or whether subtle functional abnormalities may be present at rest.
Purpose
To determine whether, in the absence of infarction and hibernation, CTO-subtended myocardium remains functionally normal or whether abnormalities of strain and/or mechanical dispersion may be present at rest.
Methods
In a retrospective, single centre, observational study, we studied patients with ≥1 angiographically-diagnosed CTO referred for clinical stress perfusion cardiovascular magnetic resonance (CMR), and compared healthy volunteers (HVs) with a normal stress CMR scan. CMR imaging comprised functional and scar assessment with qualitative [visual] evaluation of infarction and segmental wall motion. Patients with infarction and/or wall motion score index (WMSI) ≥1 were excluded from further analysis. In remaining CTO subjects and HVs, segmental peak systolic longitudinal strain and circumferential strain were analysed (in 3 long-axis planes and 3 short-axis planes, respectively) and mechanical dispersion for both orientations was computed. Image analysis was performed using Medis (QStrain) software blinded to all clinical information.
Results
From a total of 389 patients with ≥1 angiographically-diagnosed CTO, 68 had normal WMSI and no infarction (63.0±11.7 years, 79.4% male, LVEF 62.6±4.5%). Fifty HVs (61.1±7.0 years, 74.0% males, LVEF 61.1±5.3%) were also studied. The majority of CTO patients had concomitant coronary artery disease in at least one non-CTO vessel (n=37, 54.4%). GLS was lower in CTO patients than HVs (−21.8%±1.5% versus −24.0±1.1%; p<0.0001; Figure 1). By contrast, GCS was greater in CTO patients (−32.7±2.5% versus −28.8±2.1%; p<0.0001). Mechanical dispersion was increased in CTO patients (Figure 2), both longitudinally (90.3±14.6 ms in CTO patients versus 68.6±11.1 ms in HVs; p<0.0001) and circumferentially (66.7±9.1 ms versus 55.3±6.6 ms, respectively; p=0.02).
Conclusion
Subclinical changes in left ventricular dynamics are present at rest in CTO patients with fully viable myocardium and no evidence of resting regional wall abnormality. Further study is warranted to evaluate the potential association between mechanical dispersion and arrhythmic events in CTO.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): NIHR Clinician Scientist Award (CS-2018-18-ST2-007 to J.R.A.) and Research Professorship award (RP-2017-08-ST2-007 to G.P.M.). Figure 1. Strain analysis. CTO vs HVFigure 2. Mechanical dispersion. CTO vs HV
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Affiliation(s)
- C Grafton-Clarke
- Cardiovascular Research Unit of Leicester, Department of Cardiovascular Sciences, University of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - S Bhandari
- Cardiovascular Research Unit of Leicester, Department of Cardiovascular Sciences, University of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - A Abdelaty
- Cardiovascular Research Unit of Leicester, Department of Cardiovascular Sciences, University of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - M Mashicharan
- Cardiovascular Research Unit of Leicester, Department of Cardiovascular Sciences, University of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - G Gulsin
- Cardiovascular Research Unit of Leicester, Department of Cardiovascular Sciences, University of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - C A Budgeon
- Cardiovascular Research Unit of Leicester, Department of Cardiovascular Sciences, University of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - S Hetherington
- Cardiovascular Research Unit of Leicester, Department of Cardiovascular Sciences, University of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - P Kanagala
- Cardiovascular Research Unit of Leicester, Department of Cardiovascular Sciences, University of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - A Ladwiniec
- Cardiovascular Research Unit of Leicester, Department of Cardiovascular Sciences, University of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - G P McCann
- Cardiovascular Research Unit of Leicester, Department of Cardiovascular Sciences, University of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - J R Arnold
- Cardiovascular Research Unit of Leicester, Department of Cardiovascular Sciences, University of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
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Madhup SK, Shrestha R, Katuwal N, Magar SR, Shrestha S, Bhandari S, Tamrakar D. Seroprevalence of Scrub Typhus in Patients Attending Dhulikhel Hospital, Kavre. Kathmandu Univ Med J (KUMJ) 2021; 19:494-498. [PMID: 36259194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Scrub typhus is a largely ignored tropical disease and a leading cause of undifferentiated febrile illness. It is caused by Orientia tsutsugamushi. Scrub Typhus is frequently observed in South Asian countries. However, clear epidemiological information of this disease is lacking in case of Nepal. Nepal has shown steady increase in cases of Scrub Typhus since 2015. The epidemiological data related to this disease would support the decision making and surveillance design for early outbreak detection and immediate responses including prevention and treatment of scrub typhus in Nepal. Objective To understand prevalence of Scrub Typhus in subjects who had visited outpatient department at Dhulikhel Hospital. Method In this study, we have studied antibody test data (n=784) for Scrub Typhus from 2019 to 2021. The tests were performed on serum samples of patients who had visited OPD at Dhulikhel Hospital with fever lasting more than 5 days. The kit used in analysis was Scrub Typhus Detect™ IgM ELISA Kit from InBios International. Result Out of the total subjects (n=784), 133 were positive (16.9%) for IgM antibody of Scrub Typhus. The positivity in female (18.6%) was higher than the male subjects (15.3%). The positivity rate was variable among the different age groups, with highest positivity for age group 0-14 years (25%). The seasonal variation was also observed among the seropositive cases. Conclusion Scrub Typhus being a neglected tropical disease has high prevalence. It can be postulated that female subjects and subjects of age group 0-14 years are vulnerable to the infection with Scrub Typhus. There is need to increase the surveillance of Scrub Typhus to add the knowledge for diagnosis and treatment.
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Affiliation(s)
- S K Madhup
- Department of Microbiology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Shrestha
- Department of Pharmacology, Research and Development Division, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - N Katuwal
- Research and Development Division, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S R Magar
- Department of Microbiology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Shrestha
- Department of Microbiology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Bhandari
- Department of Microbiology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - D Tamrakar
- Research and Development Division, Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Shresta S, Bhandari S, Aryal B, Marasini BP, Khanal S, Poudel P, Rayamajhee B, Adhikari B, Bhattarai BR, Parajuli N. Evaluation of Phytochemical, Antioxidant and Antibacterial Activities of Selected Medicinal Plants. Nepal J Biotechnol 2021. [DOI: 10.3126/njb.v9i1.38667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Medicinal plants are important reservoirs of bioactive compounds that need to be explored systematically. Because of their chemical diversity, natural products provide limitless possibilities for new drug discovery. This study aimed to investigate the biochemical properties of crude extracts from fifteen Nepalese medicinal plants. The total phenolic contents (TPC), total flavonoid contents (TFC), and antioxidant activity were evaluated through a colorimetric approach while the antibacterial activities were studied through the measurement of the zone of inhibition (ZoI) by agar well diffusion method along with minimum inhibitory concentrations (MIC) by broth dilution method. The methanolic extracts of Acacia catechu and Eupoterium adenophorum showed the highest TPC (55.21 ± 11.09 mg GAE/gm) and TFC (10.23 ± 1.07 mg QE/gm) among the studied plant extracts. Acacia catechu showed effective antioxidant properties with an IC50 value of 1.3 μg/mL, followed by extracts of Myrica esculenta, Syzygium cumini, and Mangifera indica. Morus australis exhibited antibacterial activity against Klebsiella pneumoniae (ZoI: 25mm, MIC: 0.012 mg/mL), Staphylococcus aureus ATCC 25923 (ZoI: 22 mm, MIC: 0.012 mg/mL), Pseudomonas aeruginosa (ZoI; 20 mm, MIC: 0.05 mg/mL), and methicillin-resistant Staphylococcus aureus (MRSA) (ZoI: 19 mm, MIC: 0.19 mg/mL). Morus australis extract showed a broad-spectrum antibacterial activity, followed by Eclipta prostrata, and Hypericum cordifolium. Future study is recommended to explore secondary metabolites of those medicinal plants to uncover further clinical efficacy.
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Bhandari S, Mueller J, Whyte W, Heilbroner SP. Assessment of differences in demographic characteristics and clinical diagnoses among black and white oncology patients with COVID. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18711] [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: 11/20/2022] Open
Abstract
e18711 Background: Health disparities between black and white COVID-positive patients are well documented. To help address these disparities, clinicians need to understand the specific health challenges faced by black COVID patients compared to their white counterparts. These challenges are understudied in the oncologic setting. Hence, we present the demographic and clinical features of black COVID-positive cancer patients compared to whites. Methods: We used ConcertAI’s database of oncology EMR data, which includes clinical data from CancerLinQ Discovery. We conducted two-sample t-tests and chi-squared tests to measure the differences in black and white COVID-positive cancer patients across age, gender, ethnicity, state, region, ECOG, BMI, all cancer indications, stage, and Charlson comorbidities. COVID positivity was defined using claims data. Only relevant significant results are reported to save space. Results: Table summarizes the differences in 429 black and 980 white cancer patients with COVID. Black patients were younger, more likely to have an elevated BMI, and have a higher prevalence of breast cancer, congestive heart failure, diabetes, multiple myeloma, peptic ulcer disease, and renal disease. They also had less melanoma. Results were statistically significant at 0.05 level. Analyzing only black patients by COVID status shows very similar results. Conclusions: Black cancer patients suffer from multiple comorbid conditions that increase their risk of adverse outcomes when infected with COVID-19. The CDC lists eight comorbidities that put patients at a higher risk of severe COVID infection. Black patients in our cohort have a higher prevalence of four out of eight of these conditions—elevated BMI, renal disease, congestive heart failure, and diabetes. Clinicians should inspect for these comorbidities while treating this at-risk population. [Table: see text]
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Bhandari S, Khadayat K, Poudel S, Shrestha S, Shrestha R, Devkota P, Khanal S, Marasini BP. Phytochemical analysis of medicinal plants of Nepal and their antibacterial and antibiofilm activities against uropathogenic Escherichia coli. BMC Complement Med Ther 2021; 21:116. [PMID: 33836728 PMCID: PMC8033659 DOI: 10.1186/s12906-021-03293-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 08/27/2020] [Accepted: 03/30/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A biofilm is an extracellular polymeric substance (EPS) composed of polysaccharides, proteins, nucleic acids, and lipids that impede antibiotics and immune cells, thus providing a shielded environment for bacterial growth. Due to biofilm formation, some microbes can show up to 1000 fold increased resistance towards the antibiotics than the normal planktonic forms. The study was conducted to screen the crude extracts of medicinal plants used in Nepal for their in vitro antibiofilm activities. METHODS Total phenolic and total flavonoid contents were determined by using a Folin-Ciocalteau reagent and aluminium trichloride method, respectively. Resazurin assay was used to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). The initial antibiofilm activities and their inhibitory concentration (IC50) values were determined by the microtiter based modified crystal violet staining method. RESULTS Out of 25 different plant extracts were used for the study, methanolic extracts of 20 plants showed a biofilm inhibition activity against five different strong biofilm producing Escherichia coli strains. Calotropis gigantea exhibited inhibition against all five different E. coli strains with IC50 values ranging from 299.7 ± 20.5 to 427.4 ± 2.7 μg/mL. Apart from that, Eclipta prostrata also showed biofilm formation inhibition, followed by Eupatorium adenophorum, Moringa oleifera, Ocimum tenuifolium, Oxalis lantifolia, Prunus persica, and Urtica parviflora. The extracts of C. gigantea, E. prostrata, Mangifera indica, O. tenuifolium, P. persica, and U. parviflora exhibited a moderate to poor MIC value ranging from 625 to 2500 μg/mL. The highest amount of phenolic content (TPC) was found in Acacia catechu followed by Morus alba, which was 38.9 and 25.1 mg gallic acid equivalents, respectively. The highest amount of flavonoid content was found in A. catechu followed by M. indica, which was 27.1 and 20.8 mg quercetin equivalents, respectively. CONCLUSION Extracts of C. gigantea, E. prostrata, P. persica, U. parviflora, and O. tenuifolium showed antibacterial as well as antibiofilm activity against pathogenic and strong biofilm producing E. coli. Thus, extracts or the pure compound from these medicinal plants could be used as antibiotics in the future.
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Affiliation(s)
- Sudip Bhandari
- Department of Biotechnology, National College, Tribhuvan University, Naya Bazar, Kathmandu, Nepal
| | - Karan Khadayat
- Department of Biotechnology, National College, Tribhuvan University, Naya Bazar, Kathmandu, Nepal
| | - Sami Poudel
- Department of Biotechnology, National College, Tribhuvan University, Naya Bazar, Kathmandu, Nepal
| | - Sunil Shrestha
- Department of Biotechnology, National College, Tribhuvan University, Naya Bazar, Kathmandu, Nepal
| | - Raju Shrestha
- Department of Microbiology, National College, Tribhuvan University, Naya Bazar, Kathmandu, Nepal
| | - Poonam Devkota
- Department of Biotechnology, National College, Tribhuvan University, Naya Bazar, Kathmandu, Nepal
| | - Santosh Khanal
- Department of Biotechnology, National College, Tribhuvan University, Naya Bazar, Kathmandu, Nepal
| | - Bishnu P Marasini
- Department of Biotechnology, National College, Tribhuvan University, Naya Bazar, Kathmandu, Nepal.
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Bhandari S, Allgar V, Lamplugh A, Macdougall I, Kalra PA. A multicentre prospective double blinded randomised controlled trial of intravenous iron (ferric Derisomaltose (FDI)) in Iron deficient but not anaemic patients with chronic kidney disease on functional status. BMC Nephrol 2021; 22:115. [PMID: 33784968 PMCID: PMC8010943 DOI: 10.1186/s12882-021-02308-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/15/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) is common in patients with chronic kidney disease (CKD). Intravenous (IV) iron in heart failure leads to improvement in exercise capacity and improvement in quality-of-life measurements; however, data in patients with CKD are lacking. METHODS The Iron and the Heart Study was a prospective double blinded randomised study in non-anaemic CKD stages 3b-5 patients with ID which investigated whether 1000 mg of IV iron (ferric derisomaltose (FDI)) could improve exercise capacity in comparison to placebo measured at 1 and 3 months post infusion. Secondary objectives included effects on haematinic profiles and haemoglobin, safety analysis and quality of life questionnaires (QoL). RESULTS We randomly assigned 54 patients mean (SD) age for FDI (n = 26) 61.6 (10.1) years vs placebo (n = 28; 57.8 (12.9) years) and mean eGFR (33.2 (9.3) vs. 29.1 (9.6) ml/min/1.73m2) at baseline, respectively. Adjusting for baseline measurements, six-minute walk test (6MWT) showed no statistically significant difference between arms at 1 month (p = 0.736), or 3 months (p = 0.741). There were non-significant increases in 6MWT from baseline to 1 and 3 months in the FDI arm. Haemoglobin (Hb) at 1 and 3 months remained stable. There were statistically significant increases in ferritin (SF) and transferrin saturation (TSAT) at 1 and 3 months (p < 0.001). There was a modest numerical improvement in QoL parameters. There were no adverse events attributable to IV iron. CONCLUSION This study demonstrated a short-term beneficial effect of FDI on exercise capacity, but it was not significant despite improvements in parameters of iron status, maintenance of Hb concentration, and numerical increases in functional capacity and quality of life scores. A larger study will be required to confirm if intravenous iron is beneficial in iron deficient non-anaemic non-dialysis CKD patients without heart failure to improve the 6MWT. TRIAL REGISTRATION European Clinical Trials Database (EudraCT) No: 2014-004133-16 REC no: 14/YH/1209 Date First Registered: 2015-02-17 and date of end of trail 2015-05-23 Sponsor ref R1766 and Protocol No: IHI 141.
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Affiliation(s)
- S. Bhandari
- Hull University Teaching Hospitals NHS Trust and Hull York Medical School, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - V. Allgar
- Hull University Teaching Hospitals NHS Trust and Hull York Medical School, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - A. Lamplugh
- Hull University Teaching Hospitals NHS Trust and Hull York Medical School, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - I. Macdougall
- Hull University Teaching Hospitals NHS Trust and Hull York Medical School, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
| | - P. A. Kalra
- Hull University Teaching Hospitals NHS Trust and Hull York Medical School, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ UK
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Bhandari S, Wahl B, Bennett S, Engineer CY, Pandey P, Peters DH. Identifying core competencies for practicing public health professionals: results from a Delphi exercise in Uttar Pradesh, India. BMC Public Health 2020; 20:1737. [PMID: 33203407 PMCID: PMC7670983 DOI: 10.1186/s12889-020-09711-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/15/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Ensuring the current public health workforce has appropriate competencies to fulfill essential public health functions is challenging in many low- and middle-income countries. The absence of an agreed set of core competencies to provide a basis for developing and assessing knowledge, skills, abilities, and attitudes contributes to this challenge. This study aims to identify the requisite core competencies for practicing health professionals in mid-level supervisory and program management roles to effectively perform their public health responsibilities in the resource-poor setting of Uttar Pradesh (UP), India. METHODS We used a multi-step, interactive Delphi technique to develop an agreed set of public health competencies. A narrative review of core competency frameworks and key informant interviews with human resources for health experts in India were conducted to prepare an initial list of 40 competency statements in eight domains. We then organized a day-long workshop with 22 Indian public health experts and government officials, who added to and modified the initial list. A revised list of 54 competency statements was rated on a 5-point Likert scale. Aggregate statement scores were shared with the participants, who discussed the findings. Finally, the revised list was returned to participants for an additional round of ratings. The Wilcoxon matched-pairs signed-rank test was used to identify stability between steps, and consensus was defined using the percent agreement criterion. RESULTS Stability between the first and second Delphi scoring steps was reached in 46 of the 54 statements. By the end of the second Delphi scoring step, consensus was reached on 48 competency statements across eight domains: public health sciences, assessment and analysis, policy and program management, financial management and budgeting, partnerships and collaboration, social and cultural determinants, communication, and leadership. CONCLUSIONS This study produced a consensus set of core competencies and domains in public health that can be used to assess competencies of public health professionals and revise or develop new training programs to address desired competencies. Findings can also be used to support workforce development by informing competency-based job descriptions for recruitment and performance management in the Indian context, and potentially can be adapted for use in resource-poor settings globally.
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Affiliation(s)
- Sudip Bhandari
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Brian Wahl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cyrus Y Engineer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pooja Pandey
- Indian Administrative Service, Lucknow, Uttar Pradesh, India
| | - David H Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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21
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Bhandari S, Alonge O. Measuring the resilience of health systems in low- and middle-income countries: a focus on community resilience. Health Res Policy Syst 2020; 18:81. [PMID: 32680527 PMCID: PMC7368738 DOI: 10.1186/s12961-020-00594-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/25/2020] [Indexed: 11/13/2022] Open
Abstract
The concept of community resilience has gained considerable attention in the global health discussions since the Ebola outbreak of West Africa in 2014–2015. However, there are no measurement models to quantify community resilience. Without measurement models, it is unclear how to test strategies for building community resilience or to describe their likely intended and unintended results and their impact on health outcomes. We propose a measurement model for community resilience with relevant constructs and indicators to measure these constructs. We conducted a scoping review, systematically searching, screening and selecting relevant articles from two bibliographic databases (PUBMED and Google Scholar) for literature using search terms such as “resilience”, “community resilience” and “health systems resilience”. We screened 500 papers, then completed a full text review of 112 identified as relevant based on their title and abstract. A total of 27 papers and reports were retained for analysis. We then aggregated and synthesised the various definitions of community resilience and the frameworks for understanding these definitions. We identified key constructs from these frameworks and organised these constructs into domains and sub-domains. We proposed indicators to capture aspects of these domains and sub-domains and operationalised these indicators as a measurement model for quantifying community resilience in health systems. We propose a model with 20 indicators to assess community resilience. These indicators tap into various constructs from different theoretical frameworks of community resilience and are useful for assessing the level of knowledge, financial resources, and human, social and physical capital that are needed (or lacking) to respond to any types of shock, including health shock at the community level. This is an initial attempt to describe a multilevel measurement model for quantifying community resilience. This model will help to guide the development and testing of strategies for strengthening community resilience and will require further work to assess its relevance, reliability and validity in different LMIC settings.
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Affiliation(s)
- Sudip Bhandari
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, United States of America
| | - Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, United States of America.
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22
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Gupta M, Wahl B, Adhikari B, Bar-Zeev N, Bhandari S, Coria A, Erchick DJ, Gupta N, Hariyani S, Kagucia EW, Killewo J, Limaye RJ, McCollum ED, Pandey R, Pomat WS, Rao KD, Santosham M, Sauer M, Wanyenze RK, Peters DH. The need for COVID-19 research in low- and middle-income countries. Glob Health Res Policy 2020; 5:33. [PMID: 32617414 PMCID: PMC7326528 DOI: 10.1186/s41256-020-00159-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/11/2020] [Indexed: 12/21/2022] Open
Abstract
In the early months of the pandemic, most reported cases and deaths due to COVID-19 occurred in high-income countries. However, insufficient testing could have led to an underestimation of true infections in many low- and middle-income countries. As confirmed cases increase, the ultimate impact of the pandemic on individuals and communities in low- and middle-income countries is uncertain. We therefore propose research in three broad areas as urgently needed to inform responses in low- and middle-income countries: transmission patterns of SARS-CoV-2, the clinical characteristics of the disease, and the impact of pandemic prevention and response measures. Answering these questions will require a multidisciplinary approach led by local investigators and in some cases additional resources. Targeted research activities should be done to help mitigate the potential burden of COVID-19 in low- and middle-income countries without diverting the limited human resources, funding, or medical supplies from response activities.
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Affiliation(s)
- Madhu Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Madhya Marg, Sector 12, Chandigarh, 160012 India
| | - Brian Wahl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Binita Adhikari
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Health Foundation Nepal, Kathmandu, Nepal
| | - Naor Bar-Zeev
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Sudip Bhandari
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Daniel J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nidhi Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shreya Hariyani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - E Wangeci Kagucia
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Japhet Killewo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rupali Jayant Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Eric D McCollum
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, USA
| | - Raghukul Pandey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Krishna D Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Mathuram Santosham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Molly Sauer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - David H Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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23
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Affiliation(s)
- F. Nouh
- Department of Renal Medicine Statewide Renal Services Sydney 2050, Australia
| | - S. Bhandari
- Department of Renal Medicine Statewide Renal Services Sydney 2050, Australia
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24
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Sliva MG, Sanders JK, Arendsen M, Baars A, Bhandari S, Boerma B, Broge J, Bueno M, Cherix G, Gates G, Hollembaek J, Kaufman M, Kraft C, Oerl L, Santos A, Schuep W, Wehrmann J. Vitamin D in Infant Formula and Enteral Products by Liquid Chromatography: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/79.1.73] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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]
Abstract
Abstract
Results from a collaborative study of a new liquid chromatographic (LC) method for determination ofvitamin D in infant formulas and enteral products are presented. Each of 15 laboratories was provided with 11 blind duplicate samples covering a range ofapproximately 200-500 International Units/quart (normal dilution), a system suitability sample, and the U.S. Pharmacopeia ergo- and cholecalciferol standards. Product types included liquid and powder forms of milk (whey and casein), soy, and hydrolyzed protein-based infant formulas and enteral products. The method includes a single liquid-liquid extraction following saponification, solid-phase extraction,and then concentration by evaporation. An isocratic, nonaqueous, chromatographic system with reversed-phase, zero end- capped C18 column, and UV detector set at 265 nm are used. Statistical evaluation ofdata from participating laboratories showthe average reproducibility and repeatability of the method across all samples to be excellent, with RSDR and RSDr values of 13.48 and 9.44, respectively, after elimination of out liers. The LC method for determination of vitamin D in infant formulas and enteral products has been adopted by AOAC INTERNATIONAL.
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Affiliation(s)
- Matthew G Sliva
- Bristol-Myers Squibb, 2400 W Lloyd Expressway, Evansville, IN 47721
| | - James K Sanders
- Bristol-Myers Squibb, 2400 W Lloyd Expressway, Evansville, IN 47721
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25
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Schreier CJ, Greene RJ, Bhandari S, Britton N, Greene B, Grimm D, Hannah K, Hwang Y, Jeffress D, Kegley M, Mawhinney T, McGill B, Oehrl L, Schulze C, Smallidge R, Vincent D, Wallace M, Willis D. Determination of Ethoxyquin in Feeds by Liquid Chromatography: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.4.725] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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]
Abstract
Abstract
Ethoxyquin is a chemical antioxidant used in feeds, ingredients, fats, and oils. A liquid chromatographic (LC) method for determination of ethoxyquin was developed. The method involves acetonitrile extraction of the sample and isocratic Cis reversed-phase chromatography with ammonium acetate buffer-acetonitrile as mobile phase and fluorescence detection. A collaborative study of the determination of ethoxyquin in various meals and extruded pet foods was conducted by The lams Company Research Laboratory. Eleven laboratories analyzed 16 samples (including 2 blind duplicates) consisting of 7 meat meals and 9 extruded pet foods. Sample means ranged from 0.25 to 289 ppm. Repeatability standard deviations ranged from 0.08 to 3.2 ppm, and repeatability relative standard deviations ranged from 4.5 to 32%. Reproducibility standard deviations ranged from 0.12 to 13 ppm, and reproducibility relative standard deviations ranged from 4.5 to 55%. The LC method for determination of ethoxyquin in feeds has been adopted first action by AOAC INTERNATIONAL.
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26
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Bhandari S, Rayamajhee B, Dhungel L, Poudel S, Gaire B, Shrestha S, Parajuli N. Infectious sources of Histoplasmosis and molecular techniques for its identification. Nepal J Biotechnol 2019. [DOI: 10.3126/njb.v7i1.26949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Histoplasmosis, a fungal infection caused by Histoplasma capsulatum (H. capsulatum), acquired from contaminated soil with droppings of chicken or birds and found to be distributed in many parts of the world. The prevalence of histoplasmosis has not well studied in Nepal. The common symptoms of acute and epidemic histoplasmosis include high fever, cough, and asthenia and weight loss. Most of the infections associated with histoplasmosis are asymptomatic. People with compromised immune systems such as HIV/AIDS (PLWHA), cancer, and organ transplant recipients are at risk of developing this disease. In this review, we have summarised the current status of histoplasmosis in Nepal and molecular techniques available for its identification. To date, the significant outbreak is not reported in Nepal, but the risk of infection for the vulnerable population cannot be undermined. Appropriate preventive measures and treatment on time can reduce the burden of this fungal disease. Further, this review is also focused on molecular identification of H. capsulatum. Hence, careful considerations by concerned stakeholders for national surveillance programs and the treatment of patients on time after proper diagnosis is highly recommended.
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27
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Bhandari S, Mawhinney BA, Johnson D, Bhusal DR, Youlatos D. Coexistence of Humans and Leopards in Shivapuri Nagarjun National Park, Nepal. RUSS J ECOL+ 2019. [DOI: 10.1134/s1067413619060031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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McCleary BV, De Vries JW, Rader JI, Cohen G, Prosky L, Mugford DC, Champ M, Okuma K, Abercrombie L, Ames N, Bajoras T, Bhandari S, Burkhardt G, Camire M, Cohen G, Cui S, Dougherty MP, Erhardt S, Evans A, Grutters M, Hutton-Okpalaeke M, Illaens S, Kanaya K, Kohn A, Konings E, Lai G, Lee T, Marshak M, Neese U, Nishibata T, Santi A, Saylor D, Steegmans M, Themeier H, Thomsen A, Tervila-Wilo A, Walker R, Wang C. Determination of Total Dietary Fiber (CODEX Definition) by Enzymatic-Gravimetric Method and Liquid Chromatography: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/93.1.221] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [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]
Abstract
Abstract
A method for the determination of total dietary fiber (TDF), as defined by the CODEX Alimentarius, was validated in foods. Based upon the principles of AOAC Official MethodsSM 985.29, 991.43, 2001.03, and 2002.02, the method quantitates high- and low-molecular-weight dietary fiber (HMWDF and LMWDF, respectively). In 2007, McCleary described a method of extended enzymatic digestion at 37C to simulate human intestinal digestion followed by gravimetric isolation and quantitation of HMWDF and the use of LC to quantitate low-molecular-weight soluble dietary fiber (LMWSDF). The method thus quantitates the complete range of dietary fiber components from resistant starch (by utilizing the digestion conditions of AOAC Method 2002.02) to digestion resistant oligosaccharides (by incorporating the deionization and LC procedures of AOAC Method 2001.03). The method was evaluated through an AOAC collaborative study. Eighteen laboratories participated with 16 laboratories returning valid assay data for 16 test portions (eight blind duplicates) consisting of samples with a range of traditional dietary fiber, resistant starch, and nondigestible oligosaccharides. The dietary fiber content of the eight test pairs ranged from 11.57 to 47.83. Digestion of samples under the conditions of AOAC Method 2002.02 followed by the isolation and gravimetric procedures of AOAC Methods 985.29 and 991.43 results in quantitation of HMWDF. The filtrate from the quantitation of HMWDF is concentrated, deionized, concentrated again, and analyzed by LC to determine the LMWSDF, i.e., all nondigestible oligosaccharides of degree of polymerization 3. TDF is calculated as the sum of HMWDF and LMWSDF. Repeatability standard deviations (sr) ranged from 0.41 to 1.43, and reproducibility standard deviations (sR) ranged from 1.18 to 5.44. These results are comparable to other official dietary fiber methods, and the method is recommended for adoption as Official First Action.
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Affiliation(s)
- Barry V McCleary
- Megazyme International, Bray Business Park, Bray, Co. Wicklow, Ireland
| | - Jonathan W De Vries
- Medallion Laboratories/General Mills, 9000 Plymouth Ave N, Golden Valley, MN 55427
| | - Jeanne I Rader
- U.S. Food and Drug Administration, 5100 Paint Branch Pkwy, College Park, MD 20740
| | - Gerald Cohen
- Kraft Foods, 555 S. Broadway, Tarrytown, NY 10956
| | - Leon Prosky
- U.S. Food and Drug Administration, retired, 10265 Nolan Dr, Rockville, MD 20850-3507
| | - David C Mugford
- BRI Research Pty. Ltd, PO Box 7, North Ryde, NSW, Australia 1670
| | - Martine Champ
- University of Nantes, Htel Dieu Place Alexis Ricordeau, 44093 Nantes Cedex 1, France
| | - Kazuhiro Okuma
- Matsutani Chemical, Research Laboratory, Itami City, Hyogo 664-8508, Japan
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29
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Szpylka J, DeVries JW, Bhandari S, Bui MH, Ji D, Konings E, Lewis R, Maas P, Parish H, Post B, Schierle J, Sullivan; D, Taylor A, Wang J, Ware G, Woollard D, Wu T. Determination of β-Carotene in Supplements and Raw Materials by Reversed-Phase High Pressure Liquid Chromatography: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/88.5.1279] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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]
Abstract
Abstract
Twelve laboratories representing 4 countries participated in an interlaboratory study conducted to determine all-trans-β-carotene and total β-carotene in dietary supplements and raw materials. Thirteen samples were sent as blind duplicates to the collaborators. Results obtained from 11 laboratories are reported. For products composed as softgels and tablets that were analyzed for total β-carotene, the reproducibility relative standard deviation (RSDR) ranged from 3.35 to 23.09% and the HorRat values ranged from 1.06 to 3.72. For these products analyzed for trans β-carotene, the reproducibility relative standard deviation (RSDR) ranged from 4.28 to 22.76% and the HorRat values ranged from 0.92 to 3.37. The RSDr and HorRat values in the analysis of a beadlet raw material were substantial and it is believed that the variability within the material itself introduced significant variation in subsampling. The method uses high pressure liquid chromatography (LC) in the reversed-phase mode with visible light absorbance for detection and quantitation. If high levels of α-carotenes are present, a second LC system is used for additional separation and quantitation of the carotene species. It is recommended that the method be adopted as an AOAC Official Method.
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Affiliation(s)
- John Szpylka
- Medallion Laboratories Division of General Mills, 9000 Plymouth Ave N, Minneapolis, MN 55427-3870
| | - Jonathan W DeVries
- Medallion Laboratories Division of General Mills, 9000 Plymouth Ave N, Minneapolis, MN 55427-3870
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30
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Hite DA, Angelo L, Bhandari S, Bhattacharyya S, Bonnin E, Brousseau R, Ellis C, Faulkner H, Foran M, Goins D, Hill K, Jesse C, Kreuger D, McGuire J, Mioc B, O’Neal D, Patel P, Porter E, Wagner C. Determination of Retinyl Palmitate (Vitamin A) in Fortified Fluid Milk by Liquid Chromatography: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.2.375] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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]
Abstract
Abstract
A liquid chromatographic (LC) method was developed for fast and simple measurement of retinyl palmitate (vitamin A) in fortified milk. Retinyl acetate internal standard was added to a test portion of milk followed by extraction into hexane. The hexane extract was analyzed by LC using a normal-phase silica gel column equilibrated with mobile phase (conditioned hexane–isopropanol, 99.85 + 0.15, v/v) about 1 h before injections. The retinyl palmitate concentration was calculated by using a relative response factor determined with calibration standards. In the collaborative study, 11 laboratories analyzed 13 pairs of fluid milk materials in blind duplicate. Twelve of the materials were composed of skim milk (<0.5% fat), 1% fat milk, 2% fat milk, and 1% fat chocolate milk. Each material was fortified at 3 concentrations of retinyl palmitate of approximately 581 μg/L (1000 IU/qt), 1163 μg/L (2000 IU/qt), and 2236 μg/L (4000 IU/qt). The 13th material, unfortified skim milk, served as a matrix blank. Repeatability standard deviations (RSDr) without outliers ranged from 1.5 to 5.7% and reproducibility standard deviations (RSDR) without outliers ranged from 5.0 to 22.7%. cis-Isomers co-eluted with the predominant trans-retinyl palmitate isomer and were included in the results reported by all the collaborative laboratories. Endogenous long-chain esters from milk fat were also measured with the retinyl palmitate additive. The Study Director recommends that this method for determination of retinyl palmitate in fluid milk by LC be adopted First Action.
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Affiliation(s)
- Douglas A Hite
- Tennessee Department of Agriculture, Technical Services, PO Box 40627, Melrose Station, Nashville, TN 37204
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31
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Marla V, Makaju R, Bhandari S, Shrestha S, Shrestha S, Shrestha KS, Srii R. Oral Cysticercosis Presenting as an Innocuous Lesion. Kathmandu Univ Med J (KUMJ) 2019; 17:352-355. [PMID: 33311050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cysticercosis is a parasitic infection with potential of causing significant morbidity especially in developing countries. The larval form of the parasite Taenia Solium, 'Cysticercus Cellulosae' primarily colonizes in the small intestine and has the potential to disseminate to different sites of the body. Oral presentation is rare and difficult to detect owing to its innocuous presentation. This report describes the presentation of cysticercosis involving the tongue and presenting as a submucosal mass. An incisional biopsy was performed and evaluation of the histopathological features lead to the diagnosis of oral cysticercosis. This article highlights the importance of inter-departmental collaboration for the accurate diagnosis and effective management of oral cysticercosis in order to avoid potential systemic complications.
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Affiliation(s)
- V Marla
- Department of Oral Pathology, Penang International Dental College, Malaysia
| | - R Makaju
- Department of Pathology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Bhandari
- Department of Pathology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Shrestha
- Department of Pathology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S Shrestha
- Department of Internal Medicine Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - K S Shrestha
- Department of Otorhinolaryngology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Srii
- Department of Oral Pathology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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32
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Bannister KW, Deller AT, Phillips C, Macquart JP, Prochaska JX, Tejos N, Ryder SD, Sadler EM, Shannon RM, Simha S, Day CK, McQuinn M, North-Hickey FO, Bhandari S, Arcus WR, Bennert VN, Burchett J, Bouwhuis M, Dodson R, Ekers RD, Farah W, Flynn C, James CW, Kerr M, Lenc E, Mahony EK, O'Meara J, Osłowski S, Qiu H, Treu T, U V, Bateman TJ, Bock DCJ, Bolton RJ, Brown A, Bunton JD, Chippendale AP, Cooray FR, Cornwell T, Gupta N, Hayman DB, Kesteven M, Koribalski BS, MacLeod A, McClure-Griffiths NM, Neuhold S, Norris RP, Pilawa MA, Qiao RY, Reynolds J, Roxby DN, Shimwell TW, Voronkov MA, Wilson CD. A single fast radio burst localized to a massive galaxy at cosmological distance. Science 2019; 365:565-570. [PMID: 31249136 DOI: 10.1126/science.aaw5903] [Citation(s) in RCA: 220] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/19/2019] [Indexed: 11/03/2022]
Abstract
Fast radio bursts (FRBs) are brief radio emissions from distant astronomical sources. Some are known to repeat, but most are single bursts. Nonrepeating FRB observations have had insufficient positional accuracy to localize them to an individual host galaxy. We report the interferometric localization of the single-pulse FRB 180924 to a position 4 kiloparsecs from the center of a luminous galaxy at redshift 0.3214. The burst has not been observed to repeat. The properties of the burst and its host are markedly different from those of the only other accurately localized FRB source. The integrated electron column density along the line of sight closely matches models of the intergalactic medium, indicating that some FRBs are clean probes of the baryonic component of the cosmic web.
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Affiliation(s)
- K W Bannister
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia.
| | - A T Deller
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - C Phillips
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - J-P Macquart
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
| | - J X Prochaska
- University of California Observatories-Lick Observatory, University of California, Santa Cruz, CA 95064, USA.,Kavli Institute for the Physics and Mathematics of the Universe, 5-1-5 Kashiwanoha, Kashiwa 277-8583, Japan
| | - N Tejos
- Instituto de Física, Pontificia Universidad Católica de Valparaíso, Casilla 4059, Valparaíso, Chile
| | - S D Ryder
- Department of Physics and Astronomy, Macquarie University, North Ryde, NSW 2109, Australia
| | - E M Sadler
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia.,Sydney Institute for Astronomy, School of Physics, University of Sydney, Sydney, NSW 2006, Australia
| | - R M Shannon
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Hawthorn, VIC 3122, Australia.
| | - S Simha
- University of California Observatories-Lick Observatory, University of California, Santa Cruz, CA 95064, USA
| | - C K Day
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - M McQuinn
- Astronomy Department, University of Washington, Seattle, WA 98195, USA
| | - F O North-Hickey
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
| | - S Bhandari
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - W R Arcus
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
| | - V N Bennert
- Physics Department, California Polytechnic State University, San Luis Obispo, CA 93407, USA
| | - J Burchett
- Instituto de Física, Pontificia Universidad Católica de Valparaíso, Casilla 4059, Valparaíso, Chile
| | - M Bouwhuis
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia.,Nikhef, Science Park, Amsterdam, Netherlands
| | - R Dodson
- International Centre for Radio Astronomy Research, University of Western Australia, Crawley, Perth, WA 6009, Australia
| | - R D Ekers
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia.,International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
| | - W Farah
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - C Flynn
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - C W James
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
| | - M Kerr
- Space Science Division, Naval Research Laboratory, Washington, DC 20375, USA
| | - E Lenc
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - E K Mahony
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - J O'Meara
- W. M. Keck Observatory, Waimea, HI 96743, USA
| | - S Osłowski
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - H Qiu
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia.,Sydney Institute for Astronomy, School of Physics, University of Sydney, Sydney, NSW 2006, Australia
| | - T Treu
- Department of Physics and Astronomy, University of California, Los Angeles, CA 90095, USA
| | - V U
- Department of Physics and Astronomy, University of California, Irvine, CA 92697, USA
| | - T J Bateman
- Sydney Institute for Astronomy, School of Physics, University of Sydney, Sydney, NSW 2006, Australia
| | - D C-J Bock
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - R J Bolton
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - A Brown
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - J D Bunton
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - A P Chippendale
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - F R Cooray
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - T Cornwell
- Tim Cornwell Consulting, 17 Elgan Crescent, Sandbach CW11 1LD, UK
| | - N Gupta
- Inter-University Centre for Astronomy and Astrophysics, Post Bag 4, Ganeshkhind, Pune 411 007, India
| | - D B Hayman
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - M Kesteven
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - B S Koribalski
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - A MacLeod
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - N M McClure-Griffiths
- Research School of Astronomy and Astrophysics, Australian National University, Canberra, ACT 2611, Australia
| | - S Neuhold
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - R P Norris
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia.,Western Sydney University, Locked Bag 1797, Penrith South, NSW 2751, Australia
| | - M A Pilawa
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - R-Y Qiao
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - J Reynolds
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - D N Roxby
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - T W Shimwell
- ASTRON, Netherlands Institute for Radio Astronomy, Postbus 2, 7990 AA Dwingeloo, Netherlands
| | - M A Voronkov
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
| | - C D Wilson
- Commonwealth Science and Industrial Research Organisation, Australia Telescope National Facility, P.O. Box 76, Epping, NSW 1710, Australia
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Adams AL, Li BH, Bhandari S, Kamat S, Sundar S, Krasa H, Rhee CM, Kalantar-Zadeh K, Jacobsen SJ, Sim JJ. Chronic hyponatremia and association with osteoporosis among a large racially/ethnically diverse population. Osteoporos Int 2019; 30:853-861. [PMID: 30635697 DOI: 10.1007/s00198-018-04832-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 12/26/2018] [Indexed: 10/27/2022]
Abstract
UNLABELLED Chronic hyponatremia may contribute to decreased bone density. We studied 341,003 men and women who underwent DXA testing and observed that individuals with chronic hyponatremia (sodium < 135 mEq/L) had an 11% greater likelihood of having osteoporosis. There was a dose-dependent effect with lower sodium and stronger association with osteoporosis. INTRODUCTION Chronic hyponatremia has been associated with both neurologic deficits and increased risk of gait abnormalities leading to falls and resultant bone fractures. Whether chronic hyponatremia contributes to decreased bone density is uncertain. We evaluated whether chronic, mild hyponatremia based on serial sodium measurements was associated with increased risk of osteoporosis within a large, ethnically diverse population. METHODS This is a retrospective cohort study between January 1, 1998 and December 31, 2014 within Kaiser Permanente Southern California, an integrated healthcare delivery system. Men and women were aged ≥ 55 years with ≥ 2 serum sodium measurements prior to dual-energy X-ray absorptiometry (DXA) testing. Time-weighted (TW) mean sodium values were calculated by using the proportion of time (weight) elapsed between sodium measurements and defined as < 135 mEq/L. Osteoporosis defined as any T-score value ≤ - 2.5 of lumbar spine, femoral neck, or hip. RESULTS Among 341,003 individuals with 3,330,903 sodium measurements, 11,539 (3.4%) had chronic hyponatremia and 151,505 (44.4%) had osteoporosis. Chronic hyponatremic individuals had an osteoporosis RR (95% CI) of 1.11 (1.09, 1.13) compared to those with normonatremia. A TW mean sodium increase of 3 mEq/L was associated with a lower risk of osteoporosis [adjusted RR (95% CI) 0.95 (0.93, 0.96)]. A similar association was observed when the arithmetic mean sodium value was used for comparison. CONCLUSIONS We observed a modest increase in risk for osteoporosis in people with chronic hyponatremia. There was also a graded association between higher TW mean sodium values and lower risk of osteoporosis. Our findings underscore the premise that chronic hyponatremia may lead to adverse physiological effects and responses which deserves better understanding.
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Affiliation(s)
- A L Adams
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA.
| | - B H Li
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - S Bhandari
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - S Kamat
- Otsuka Pharmaceuticals Development and Commercialization, Inc., San Francisco, CA, USA
| | - S Sundar
- Otsuka Pharmaceuticals Development and Commercialization, Inc., San Francisco, CA, USA
| | - H Krasa
- Otsuka Pharmaceuticals Development and Commercialization, Inc., San Francisco, CA, USA
| | - C M Rhee
- Division of Nephrology and Hypertension, UC Irvine Medical Center, Irvine, CA, USA
| | - K Kalantar-Zadeh
- Division of Nephrology and Hypertension, UC Irvine Medical Center, Irvine, CA, USA
| | - S J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA
| | - J J Sim
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
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Dhareula A, Goyal A, Gauba K, Bhatia SK, Kapur A, Bhandari S. A clinical and radiographic investigation comparing the efficacy of cast metal and indirect resin onlays in rehabilitation of permanent first molars affected with severe molar incisor hypomineralisation (MIH): a 36-month randomised controlled clinical trial. Eur Arch Paediatr Dent 2019; 20:489-500. [DOI: 10.1007/s40368-019-00430-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/05/2019] [Indexed: 11/29/2022]
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Bhandari S, Ngo PT, Mandadi M, Wu X, Brown C, Rai S, Riley EC. Abstract P1-12-12: Bubble packaging of adjuvant endocrine therapy:updated analysis of compliance and survival. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-12-12] [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: 11/16/2022]
Abstract
Abstract
Introduction: Adherence to endocrine therapy is a long recognized problem despite efficacy of these drugs with reported compliance rates of 89% in first year and 50% in fourth year. Most of our knowledge of noncompliance is observational and retrospective. This final analysis of the Bubble Study reports the compliance rate of adjuvant endocrine therapy among women with early stage breast cancer using “bubble” packaging. We previously reported adherence rates of 97% with bubble packaging. This updated analysis includes disease free survival (DFS) and overall survival (OS) at 5 years.
Methods: The Bubble study is a non-blinded, prospective observational cohort study, which enrolled 86 patients between August 2012 and April 2014. Demographic and clinical data were collected prospectively including age, race, insurance, duration of therapy, stage, treatment, comorbidities, recurrence and survival. Duration of therapy was divided into 3 cohorts: <12 months, 12-36 months, and 37-60 months. All patients received routine prescriptions in a “bubble” pack or daily blister pack. Patients returned all used bubble packs at follow up appointments for review and kept a diary of missed doses for analysis. DFS and OS data were obtained at 78 months. Compliance was defined as >90% adherence. We calculated institutional DFS and OS for breast cancer patients treated within a similar time frame from the tumor registry.
Results: 53 patients were included in the analysis. The remaining patients withdrew from the study prior to data collection or were deemed ineligible. The overall compliance rate was 97%; however, only 72% of enrolled patients were continued in the analysis. None of the variables examined (race, age, insurance status and stage) had an impact on compliance. Only duration of endocrine therapy had a marginal effect on compliance (p value = 0.06). The latest cohort (duration of therapy 37-60 months) was least likely to be compliant at 89.53%. Our 5-year DFS is 92% and 5-year OS is 96%. There is no statistically significant difference in DFS and OS between patients with compliance>90% and <90%. For ER+ breast cancer patients treated during similar timeframe at our institution outside the trial, 5-year DFS is 94% and 5-year OS is 90%.
Conclusion: There was no difference in OS or DFS based on compliance to oral anti-estrogens. Given the high overall compliance rate in this small patient population, the lack of OS and DFS difference is not surprising. However, the compliance rate of bubble packaging (>90%) is higher than expected based on current literature. Although this may suggest improved compliance with bubble packaging, more studies are necessary to confirm this given small sample size and high trial dropout rate. Trial withdrawal likely altered analysis of adherence rates as it selects for a largely compliant group of patients.This bias may also explain the lack of difference in compliance rate among race, insurance status and/ or age, which contradicts our current knowledge of high-risk groups.There was a trend towards lower DFS in the bubble cohort, but overall better survival when comparing to institutional rate. Studies are ongoing to confirm bubble packaging adherence rates and compare this to established strategies to improve adherence.
Citation Format: Bhandari S, Ngo PT, Mandadi M, Wu X, Brown C, Rai S, Riley EC. Bubble packaging of adjuvant endocrine therapy:updated analysis of compliance and survival [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-12.
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Affiliation(s)
- S Bhandari
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Cancer Registry, University of Louisville Medical Center, Louisville, KY
| | - PT Ngo
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Cancer Registry, University of Louisville Medical Center, Louisville, KY
| | - M Mandadi
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Cancer Registry, University of Louisville Medical Center, Louisville, KY
| | - X Wu
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Cancer Registry, University of Louisville Medical Center, Louisville, KY
| | - C Brown
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Cancer Registry, University of Louisville Medical Center, Louisville, KY
| | - S Rai
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Cancer Registry, University of Louisville Medical Center, Louisville, KY
| | - EC Riley
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Cancer Registry, University of Louisville Medical Center, Louisville, KY
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Dhakal KB, Dhakal S, Shrestha S, Bhandari S. Induction of labor in Mid-Western Hospital in Nepal: Practice and Solution. Nepal j obstet gynaecol 2018. [DOI: 10.3126/njog.v12i2.19961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IntroductionInduction of labour has been common intervention in modern obstetrics. This study is aimed to determine the distribution of practice and outcomes related to induction of labour in Mid-Western Regional Hospital in Nepal. MethodsThis is a retrospective cross-sectional study conducted at Mid-Western Regional Hospital in Surkhet, Nepal. Secondary data were collected from patients’ records of the hospital dating from 16 July 2016 to 15 July 2017. All women who underwent induction of labour with oral misoprostol were included in this study. For induction of labour, maximum five doses of 50 microgram oral misoprostol was administered in every four hours. Descriptive summary statistics such as frequency and percentages were calculated.ResultsOut of total 3,694 pregnant women who delivered in MWRH, 10.5% (n = 387) were induced by oral misoprostol. Majority of labour induced women were in the age group of 20 – 24 years (52.9%), 37 – 42 weeks of gestation (69.5%), and multi-gravida (49.9%). Majority (77.0%) who underwent induction of labour had vaginal delivery. Among total induction of labour, 88.9% had healthy babies. Majority of new borns had APGAR score of six or more in both one minute (87.9%) and five minutes (93.6%). More than half of the new borns (54.5%) had birth weight of 3000 – 3500 grams. Most of the induced cases (97.4%) were free of complications. Only 1.3% of cases had post-partum haemorrhage. ConclusionsInduction of labour using oral misoprostol is a common practice in Mid-Western Regional hospital in Nepal and majority (77.0%) who underwent induction of labour had vaginal delivery.
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Bhandari S, Wang K, Watanabe K, Taniguchi T, Kim P, Westervelt RM. Imaging quantum dot formation in MoS 2 nanostructures. Nanotechnology 2018; 29:42LT03. [PMID: 30070655 DOI: 10.1088/1361-6528/aad79f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Among two-dimensional materials, semiconducting ultrathin sheets of MoS2 are promising for nanoelectronics. We show how a scanning probe microscope (SPM) can be used to image the flow of electrons in a MoS2 Hall bar sample at 4.2 K allowing us to understand device physics at the nanoscale. The SPM tip acts as a movable gate and capacitively couples the SPM tip to the device below. By measuring the change in device conductance as the tip is raster scanned across the sample, spatial maps of the device conductance can be obtained. We present images showing the characteristic 'bullseye' pattern of Coulomb blockade conductance rings around a quantum dot formed in a narrow contact as the carrier density is depleted with a backgate. These images show that multiple dots are created by the disorder potential in MoS2. From these SPM images, we estimate the size and position of these quantum dots using a capacitive model.
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Affiliation(s)
- S Bhandari
- School of Engineering and Applied Sciences and Department of Physics, Harvard University, MA 02138, United States of America
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Bhandari S, Pham D, Pinkston C, Oechsli M, Kloecker G. P1.15-02 Migration Differences in Small Cell vs Non-Small Cell Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.934] [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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Bhandari S, Pham D, Pinkston C, Oechsli M, Kloecker G. Timing of treatment in small cell lung cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy298.006] [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: 11/14/2022] Open
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Kalra P, Bhandari S, Spyridon M, Davinson R, McCafferty K, Mikhail A, Reaich D, Lawman S, Moore J. SaO001THE NIMO UK STUDY: IS 1000 MG OF INTRAVENOUS IRON ENOUGH TO ACHIEVE HB TARGETS IN PRE-DIALYSIS ANAEMIC PATIENTS? Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sao001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Kalra
- Renal, Salford Royal Hospital, Salford, United Kingdom
| | - S Bhandari
- Renal, Hull Royal Infirmary, Hull, United Kingdom
| | - M Spyridon
- Medical Department, Pharmacosmos UK Ltd, Reading, United Kingdom
| | - R Davinson
- Renal, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - K McCafferty
- Renal, Royal London Hospital, London, United Kingdom
| | - A Mikhail
- Renal, Morriston Hospital, Swansea, United Kingdom
| | - D Reaich
- Renal, James Cook Hospital, Middlesbrough, United Kingdom
| | - S Lawman
- Renal, Royal Sussex County Hospital, Brighton, United Kingdom
| | - J Moore
- Renal, Royal Devon & Exeter Hospital, Exeter, United Kingdom
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Bargehr J, Ong L, Hofsteen P, Bhandari S, Gambardella L, Iyer D, Weinberger F, Bennett MR, Murry CE, Sinha S. P109Human ESC-derived epicardial cells promote cardiomyocyte graft incorporation and function. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.072] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Bargehr
- Addenbrooke's Hospital, Department of Medicine, Division of Cardiovascular Medicine, Cambridge, United Kingdom
| | - L Ong
- Addenbrooke's Hospital, Department of Medicine, Division of Cardiovascular Medicine, Cambridge, United Kingdom
| | - P Hofsteen
- University of Washington, Department of Pathology, Seattle, United States of America
| | - S Bhandari
- University of Washington, Department of Pathology, Seattle, United States of America
| | - L Gambardella
- Addenbrooke's Hospital, Department of Medicine, Division of Cardiovascular Medicine, Cambridge, United Kingdom
| | - D Iyer
- Addenbrooke's Hospital, Department of Medicine, Division of Cardiovascular Medicine, Cambridge, United Kingdom
| | - F Weinberger
- University of Washington, Department of Pathology, Seattle, United States of America
| | - M R Bennett
- Addenbrooke's Hospital, Department of Medicine, Division of Cardiovascular Medicine, Cambridge, United Kingdom
| | - C E Murry
- University of Washington, Department of Pathology, Seattle, United States of America
| | - S Sinha
- Addenbrooke's Hospital, Department of Medicine, Division of Cardiovascular Medicine, Cambridge, United Kingdom
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Malhotra PS, Jorna T, Bhandari S. Treatment of Immunoglobulin A Nephropathy Recurrence Post-Renal Transplant. Transplant Proc 2018; 50:165-167. [PMID: 29407303 DOI: 10.1016/j.transproceed.2017.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/09/2017] [Indexed: 11/16/2022]
Abstract
Immunoglobulin A nephropathy (IgAN) is the most commonly occurring glomerulonephritis. Recurrence of disease in the transplanted kidney can significantly reduce allograft survival rates. Currently, there is no definitive management plan for IgAN recurrence in a transplant that reduces the rate of decline of allograft function and prolongs time to dialysis or re-transplantation. Herein we present a 48-year-old man who had received a renal transplantation in 2006 following his diagnosis of IgAN. In 2015, the patient was noted to have an elevated blood pressure and proteinuria (urinary protein:creatinine ratio [uPCR] 170 mg/mmol). A transplant biopsy confirmed recurrent IgAN. A year later, he presented with dipstick hematuria, nephrotic-range proteinuria (uPCR 820 mg/mmol), and a serum creatinine of 90 to 140 μmol/L. A second biopsy revealed mesangioproliferative glomerulopathy consistent with crescentic IgAN. An optimal management plan is currently unknown for recurrent crescentic IgAN in the transplanted kidney. We decided to treat this patient with oral cyclophosphamide daily and high-dose prednisolone. The treatment has so far yielded a positive response and managed to preserve allograft function without significant adverse effects for our patient. Our case illustrates the importance of timely biopsies to identify recurrence of disease and highlights an effective therapeutic option for recurrent IgAN with crescent formation in a transplant.
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Affiliation(s)
- P S Malhotra
- Department of Renal Medicine, Hull and East Yorkshire Hospitals NHS Trust and York Medical School, Hull, United Kingdom
| | - T Jorna
- Department of Renal Medicine, Hull and East Yorkshire Hospitals NHS Trust and York Medical School, Hull, United Kingdom
| | - S Bhandari
- Department of Renal Medicine, Hull and East Yorkshire Hospitals NHS Trust and York Medical School, Hull, United Kingdom.
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Cameron AD, Champion DJ, Kramer M, Bailes M, Barr ED, Bassa CG, Bhandari S, Bhat NDR, Burgay M, Burke-Spolaor S, Eatough RP, Flynn CML, Freire PCC, Jameson A, Johnston S, Karuppusamy R, Keith MJ, Levin L, Lorimer DR, Lyne AG, McLaughlin MA, Ng C, Petroff E, Possenti A, Ridolfi A, Stappers BW, van Straten W, Tauris TM, Tiburzi C, Wex N. The High Time Resolution Universe Pulsar Survey – XIII. PSR J1757−1854, the most accelerated binary pulsar. ACTA ACUST UNITED AC 2018. [DOI: 10.1093/mnrasl/sly003] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A D Cameron
- Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn, Germany
| | - D J Champion
- Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn, Germany
| | - M Kramer
- Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn, Germany
- Jodrell Bank Center for Astrophysics, University of Manchester, Alan Turing Building, Oxford Road, Manchester M13 9PL, UK
| | - M Bailes
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Mail H39, PO Box 218, VIC 3122, Australia
- ARC Center of Excellence for All-Sky Astronomy (CAASTRO), Swinburne University of Technology, Mail H30, PO Box 218, VIC 3122, Australia
- ARC Center of Excellence for Gravitational Wave Discovery (OzGrav), Swinburne University of Technology, Mail H11, PO Box 218, VIC 3122, Australia
| | - E D Barr
- Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn, Germany
| | - C G Bassa
- ASTRON, the Netherlands Institute for Radio Astronomy, Postbus 2, NL-7990 AA Dwingeloo, the Netherlands
| | - S Bhandari
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Mail H39, PO Box 218, VIC 3122, Australia
- ARC Center of Excellence for All-Sky Astronomy (CAASTRO), Swinburne University of Technology, Mail H30, PO Box 218, VIC 3122, Australia
| | - N D R Bhat
- ARC Center of Excellence for All-Sky Astronomy (CAASTRO), Swinburne University of Technology, Mail H30, PO Box 218, VIC 3122, Australia
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
| | - M Burgay
- INAF - Osservatorio Astronomico di Cagliari, Via della Scienza 5, I-09047 Selargius (CA), Italy
| | - S Burke-Spolaor
- Department of Physics and Astronomy, West Virginia University, PO Box 6315, Morgantown, WV 26506, USA
- Center for Gravitational Waves and Cosmology, West Virginia University, Chestnut Ridge Research Building, Morgantown, WV 26505, USA
| | - R P Eatough
- Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn, Germany
| | - C M L Flynn
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Mail H39, PO Box 218, VIC 3122, Australia
| | - P C C Freire
- Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn, Germany
| | - A Jameson
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Mail H39, PO Box 218, VIC 3122, Australia
- ARC Center of Excellence for All-Sky Astronomy (CAASTRO), Swinburne University of Technology, Mail H30, PO Box 218, VIC 3122, Australia
| | - S Johnston
- CSIRO Astronomy and Space Science, Australia Telescope National Facility, PO Box 76, Epping, NSW 1710, Australia
| | - R Karuppusamy
- Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn, Germany
| | - M J Keith
- Jodrell Bank Center for Astrophysics, University of Manchester, Alan Turing Building, Oxford Road, Manchester M13 9PL, UK
| | - L Levin
- Jodrell Bank Center for Astrophysics, University of Manchester, Alan Turing Building, Oxford Road, Manchester M13 9PL, UK
| | - D R Lorimer
- Department of Physics and Astronomy, West Virginia University, PO Box 6315, Morgantown, WV 26506, USA
| | - A G Lyne
- Jodrell Bank Center for Astrophysics, University of Manchester, Alan Turing Building, Oxford Road, Manchester M13 9PL, UK
| | - M A McLaughlin
- Department of Physics and Astronomy, West Virginia University, PO Box 6315, Morgantown, WV 26506, USA
| | - C Ng
- Department of Physics and Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, BC V6T 1Z1, Canada
| | - E Petroff
- ASTRON, the Netherlands Institute for Radio Astronomy, Postbus 2, NL-7990 AA Dwingeloo, the Netherlands
| | - A Possenti
- INAF - Osservatorio Astronomico di Cagliari, Via della Scienza 5, I-09047 Selargius (CA), Italy
| | - A Ridolfi
- Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn, Germany
| | - B W Stappers
- Jodrell Bank Center for Astrophysics, University of Manchester, Alan Turing Building, Oxford Road, Manchester M13 9PL, UK
| | - W van Straten
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Mail H39, PO Box 218, VIC 3122, Australia
- ARC Center of Excellence for All-Sky Astronomy (CAASTRO), Swinburne University of Technology, Mail H30, PO Box 218, VIC 3122, Australia
- Institute for Radio Astronomy & Space Research, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - T M Tauris
- Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn, Germany
- Argelander-Insitut für Astronomie, Universität Bonn, Auf dem Hügel 71, D-53121 Bonn, Germany
| | - C Tiburzi
- Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn, Germany
- Fakultät für Physik, Universität Bielefeld, Postfach 100131, D-33501 Bielefeld, Germany
| | - N Wex
- Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn, Germany
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44
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Kumar S, De D, Handa S, Ratho RK, Bhandari S, Pal A, Kamboj P, Sarkar S. Identification of factors associated with treatment refractoriness of oral lesions in pemphigus vulgaris. Br J Dermatol 2017; 177:1583-1589. [PMID: 28498563 DOI: 10.1111/bjd.15658] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The oral mucosal lesions of patients with pemphigus vulgaris are known to show more treatment refractoriness than skin lesions. OBJECTIVES To identify which clinical and laboratory parameters may indicate treatment refractoriness of oral lesions in pemphigus vulgaris. METHODS This was a prospective study of 50 adults with pemphigus vulgaris and oral lesions; patients were given treatment appropriate for overall disease severity. Treatment refractoriness was defined arbitrarily as less than 75% reduction in oral objective Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) after treatment for 6 months. RESULTS Of 46 patients who completed the study, 17 (37%) were treatment refractory whereas 29 (63%) were treatment responsive. At baseline, the treatment refractory group had a significantly longer mean duration of disease (P = 0·02) and mean duration of oral lesions (P = 0·01), a higher percentage of lesions in the retromolar trigone (P = 0·05) and on the occlusion line along the buccal mucosa (P = 0·04), a higher percentage of deep/crateriform ulcers (P < 0·001) and erosions with a lichenoid hue (P < 0·001). Herpes simplex virus (HSV) DNA positivity, assessed by polymerase chain reaction in oral tissue scrapings (P = 0·02), was also significantly higher in the treatment refractory group. No other factors we tested for were statistically significant. CONCLUSIONS Treatment refractoriness of oral lesions was significantly associated with duration of disease/oral lesions; specific morphology and location of oral lesions; and the presence of HSV DNA in the oral cavity. These factors may forewarn the treating physician about a refractory course of oral lesions that may help with counselling patients.
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Affiliation(s)
- S Kumar
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R K Ratho
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Bhandari
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Pal
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P Kamboj
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Sarkar
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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45
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Bargehr J, Hofsteen P, Bhandari S, Gambardella L, Ong L, Iyer D, Sampaziotis F, Weinberger F, Martinson M, Bernard W, Figg N, Bennett M, Murry C, Sinha S. 5728Human embryonic stem cell derived epicardial cells advance cardiomyocyte-based heart regeneration. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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46
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Valtis YK, Rosenberg J, Bhandari S, Wachter K, Teichman M, Beauvais S, Weintraub R. Evidence-based medicine for all: what we can learn from a programme providing free access to an online clinical resource to health workers in resource-limited settings. BMJ Glob Health 2017; 1:e000041. [PMID: 28588926 PMCID: PMC5321332 DOI: 10.1136/bmjgh-2016-000041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 04/03/2016] [Accepted: 04/21/2016] [Indexed: 11/04/2022] Open
Abstract
The rapidly changing landscape of medical knowledge and guidelines requires health professionals to have immediate access to current, reliable clinical resources. Access to evidence is instrumental in reducing diagnostic errors and generating better health outcomes. UpToDate, a leading evidence-based clinical resource is used extensively in the USA and other regions of the world and has been linked to lower mortality and length of stay in US hospitals. In 2009, the Global Health Delivery Project collaborated with UpToDate to provide free subscriptions to qualifying health workers in resource-limited settings. We evaluated the provision of UpToDate access to health workers by analysing their usage patterns. Since 2009, ∼2000 individual physicians and healthcare institutions from 116 countries have received free access to UpToDate through our programme. During 2013-2014, users logged into UpToDate ∼150 000 times; 61% of users logged in at least weekly; users in Africa were responsible for 54% of the total usage. Search patterns reflected local epidemiology with 'clinical manifestations of malaria' as the top search in Africa, and 'management of hepatitis B' as the top search in Asia. Our programme demonstrates that there are barriers to evidence-based clinical knowledge in resource-limited settings we can help remove. Some assumed barriers to its expansion (poor internet connectivity, lack of training and infrastructure) might pose less of a burden than subscription fees.
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Affiliation(s)
- Yannis K Valtis
- Harvard Medical School, Boston, Massachusetts, USA.,Global Health Delivery Project at Harvard University, Cambridge, Massachusetts, USA
| | - Julie Rosenberg
- Global Health Delivery Project at Harvard University, Cambridge, Massachusetts, USA
| | - Sudip Bhandari
- Global Health Delivery Project at Harvard University, Cambridge, Massachusetts, USA
| | - Keri Wachter
- Harvard Medical School, Boston, Massachusetts, USA.,Global Health Delivery Project at Harvard University, Cambridge, Massachusetts, USA
| | - Marie Teichman
- Global Health Delivery Project at Harvard University, Cambridge, Massachusetts, USA
| | - Sophie Beauvais
- Global Health Delivery Project at Harvard University, Cambridge, Massachusetts, USA
| | - Rebecca Weintraub
- Harvard Medical School, Boston, Massachusetts, USA.,Global Health Delivery Project at Harvard University, Cambridge, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
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47
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Bhandari S. Health Service Delivery and State Legitimacy in Nepal’s Madhesh: A Study
of Health Governance and Identity-Based Conflict in a Fragile State. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.026] [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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48
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Makaju R, Amatya M, Sharma S, Dhakal R, Bhandari S, Gurung R, Malla BR. Clinico-Pathological Correlation of Colorectal Diseases by Colonoscopy and Biopsy. Kathmandu Univ Med J (KUMJ) 2017; 17:173-178. [PMID: 34547852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Colonoscopy is a simple, safe and well tolerated procedure, the visualization of the mucosa of the entire colon and terminal ileum to detect intestinal abnormalities and obtain biopsy leads to the early detection of the pathologic process and institution of appropriate therapy. Objective To find out the correlation between clinical and histopathological diagnosis of colorectal diseases. Method A cross-sectional study was conducted at Department of Pathology, Dhulikhel Hospital, Kathmandu University Hospital from Jan. 2015 - Jan. 2016. Altogether, 95 colonoscopic biopsies were examined and recorded clinical data using pre-designed pro forma. The specimens were grossed, processed and embedded using standard procedures, stained with Hematoxylin and Eosin stain and were analyzed using light microscope. Special stains Ziehl Neelsen, and Periodic Acid-Schiff were used whenever necessary. Result Analyses of 95 cases of colonoscopic biopsies were done. The most common clinical diagnosis was polyp in 49 cases (51.57%) and the common histopathological diagnosis was non-neoplastic polyps 31(32.63%). There was no correlation in cases for suspected infectious colitis, microscopic colitis and hemorrhoids. Conclusion Colonoscopy is incomplete without biopsy and histopathology is the gold standard for the diagnosis of colorectal lesions. The clinico-pathological correlation for neoplastic lesions was excellent. However, correlation was poor in non-neoplastic lesion.
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Affiliation(s)
- R Makaju
- Department of Pathology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| | - M Amatya
- Department of Pathology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| | - S Sharma
- Department of Pathology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| | - R Dhakal
- Department of Pathology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| | - S Bhandari
- Department of Pathology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| | - R Gurung
- Department of Gastroscopy, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| | - B R Malla
- Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
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49
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Ravi V, Shannon RM, Bailes M, Bannister K, Bhandari S, Bhat NDR, Burke-Spolaor S, Caleb M, Flynn C, Jameson A, Johnston S, Keane EF, Kerr M, Tiburzi C, Tuntsov AV, Vedantham HK. The magnetic field and turbulence of the cosmic web measured using a brilliant fast radio burst. Science 2016; 354:1249-1252. [PMID: 27856844 DOI: 10.1126/science.aaf6807] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 10/27/2016] [Indexed: 11/02/2022]
Abstract
Fast radio bursts (FRBs) are millisecond-duration events thought to originate beyond the Milky Way galaxy. Uncertainty surrounding the burst sources, and their propagation through intervening plasma, has limited their use as cosmological probes. We report on a mildly dispersed (dispersion measure 266.5 ± 0.1 parsecs per cubic centimeter), exceptionally intense (120 ± 30 janskys), linearly polarized, scintillating burst (FRB 150807) that we directly localize to 9 square arc minutes. On the basis of a low Faraday rotation (12.0 ± 0.7 radians per square meter), we infer negligible magnetization in the circum-burst plasma and constrain the net magnetization of the cosmic web along this sightline to <21 nanogauss, parallel to the line-of-sight. The burst scintillation suggests weak turbulence in the ionized intergalactic medium.
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Affiliation(s)
- V Ravi
- Cahill Center for Astronomy and Astrophysics, MC249-17, California Institute of Technology, Pasadena, CA 91125, USA.
| | - R M Shannon
- Commonwealth Scientific and Industrial Research Organization (CSIRO) Astronomy and Space Science, Australia Telescope National Facility, Post Office Box 76, Epping, NSW 1710, Australia. .,International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia
| | - M Bailes
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Post Office Box 218, Hawthorn, VIC 3122, Australia.,ARC Centre of Excellence for All-sky Astrophysics (CAASTRO), Australia
| | - K Bannister
- Commonwealth Scientific and Industrial Research Organization (CSIRO) Astronomy and Space Science, Australia Telescope National Facility, Post Office Box 76, Epping, NSW 1710, Australia
| | - S Bhandari
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Post Office Box 218, Hawthorn, VIC 3122, Australia.,ARC Centre of Excellence for All-sky Astrophysics (CAASTRO), Australia
| | - N D R Bhat
- International Centre for Radio Astronomy Research, Curtin University, Bentley, WA 6102, Australia.,ARC Centre of Excellence for All-sky Astrophysics (CAASTRO), Australia
| | - S Burke-Spolaor
- National Radio Astronomy Observatory, Array Operations Center, Post Office Box 0, Socorro, NM 87801-0387, USA
| | - M Caleb
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Post Office Box 218, Hawthorn, VIC 3122, Australia.,ARC Centre of Excellence for All-sky Astrophysics (CAASTRO), Australia.,Research School of Astronomy and Astrophysics, Australian National University, ACT 2611, Australia
| | - C Flynn
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Post Office Box 218, Hawthorn, VIC 3122, Australia.,ARC Centre of Excellence for All-sky Astrophysics (CAASTRO), Australia
| | - A Jameson
- Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Post Office Box 218, Hawthorn, VIC 3122, Australia.,ARC Centre of Excellence for All-sky Astrophysics (CAASTRO), Australia
| | - S Johnston
- Commonwealth Scientific and Industrial Research Organization (CSIRO) Astronomy and Space Science, Australia Telescope National Facility, Post Office Box 76, Epping, NSW 1710, Australia
| | - E F Keane
- Square Kilometer Array (SKA) Organisation, Jodrell Bank Observatory, SK11 9DL, UK
| | - M Kerr
- Commonwealth Scientific and Industrial Research Organization (CSIRO) Astronomy and Space Science, Australia Telescope National Facility, Post Office Box 76, Epping, NSW 1710, Australia
| | - C Tiburzi
- Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, 53121 Bonn, Germany
| | - A V Tuntsov
- Manly Astrophysics, 3/22 Cliff Street, Manly NSW 2095, Australia
| | - H K Vedantham
- Cahill Center for Astronomy and Astrophysics, MC249-17, California Institute of Technology, Pasadena, CA 91125, USA
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50
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Rebollo‐Mesa I, Nova‐Lamperti E, Mobillo P, Runglall M, Christakoudi S, Norris S, Smallcombe N, Kamra Y, Hilton R, Bhandari S, Baker R, Berglund D, Carr S, Game D, Griffin S, Kalra PA, Lewis R, Mark PB, Marks S, Macphee I, McKane W, Mohaupt MG, Pararajasingam R, Kon SP, Serón D, Sinha MD, Tucker B, Viklický O, Lechler RI, Lord GM, Hernandez‐Fuentes MP. Biomarkers of Tolerance in Kidney Transplantation: Are We Predicting Tolerance or Response to Immunosuppressive Treatment? Am J Transplant 2016; 16:3443-3457. [PMID: 27328267 PMCID: PMC5132071 DOI: 10.1111/ajt.13932] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 05/12/2016] [Accepted: 06/08/2016] [Indexed: 01/25/2023]
Abstract
We and others have previously described signatures of tolerance in kidney transplantation showing the differential expression of B cell-related genes and the relative expansions of B cell subsets. However, in all of these studies, the index group-namely, the tolerant recipients-were not receiving immunosuppression (IS) treatment, unlike the rest of the comparator groups. We aimed to assess the confounding effect of these regimens and develop a novel IS-independent signature of tolerance. Analyzing gene expression in three independent kidney transplant patient cohorts (232 recipients and 14 tolerant patients), we have established that the expression of the previously reported signature was biased by IS regimens, which also influenced transitional B cells. We have defined and validated a new gene expression signature that is independent of drug effects and also differentiates tolerant patients from healthy controls (cross-validated area under the receiver operating characteristic curve [AUC] = 0.81). In a prospective cohort, we have demonstrated that the new signature remained stable before and after steroid withdrawal. In addition, we report on a validated and highly accurate gene expression signature that can be reliably used to identify patients suitable for IS reduction (approximately 12% of stable patients), irrespective of the IS drugs they are receiving. Only a similar approach will make the conduct of pilot clinical trials for IS minimization safe and hence allow critical improvements in kidney posttransplant management.
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Affiliation(s)
- I. Rebollo‐Mesa
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,BiostatisticsInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom,UCB CelltechUCB Pharma S.A.SloughUnited Kingdom
| | - E. Nova‐Lamperti
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom
| | - P. Mobillo
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom
| | - M. Runglall
- National Institute for Health Research Biomedical Research CentreGuy's and St. Thomas’ National Health Service Foundation TrustKing's College LondonLondonUnited Kingdom
| | - S. Christakoudi
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,BiostatisticsInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUnited Kingdom
| | - S. Norris
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,University College LondonLondonUnited Kingdom
| | - N. Smallcombe
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom
| | - Y. Kamra
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,Peter Gorer Department of ImmunobiologyKing's College LondonLondonUnited Kingdom
| | - R. Hilton
- Guy's and St. Thomas’ NHS Foundation TrustLondonUnited Kingdom
| | - Indices of Tolerance EU Consortium
- King's College LondonLondonUnited Kingdom,Oxford UniversityOxfordUnited Kingdom,Imperial College LondonLondonUnited Kingdom,Institute for Medical Immunology, Université Libre de BruxellesBruxellesBelgium,Miltenyi BiotecBergisch GladbachGermany,University of NantesNantesFrance,Charité, Universitaatsmedizin BerlinBerlinGermany
| | - S. Bhandari
- Hull and East Yorkshire Hospitals NHS TrustHullUnited Kingdom
| | - R. Baker
- St. James's University HospitalLeedsUnited Kingdom
| | | | - S. Carr
- Leicester General HospitalLeicesterUnited Kingdom
| | - D. Game
- Guy's and St. Thomas’ NHS Foundation TrustLondonUnited Kingdom
| | - S. Griffin
- Cardiff and Vale University Health BoardCardiffUnited Kingdom
| | | | - R. Lewis
- Queen Alexandra HospitalPortsmouthUnited Kingdom
| | - P. B. Mark
- University of GlasgowGlasgowUnited Kingdom
| | - S. Marks
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUnited Kingdom
| | - I. Macphee
- St. George's HospitalLondonUnited Kingdom
| | - W. McKane
- Northern General HospitalSheffieldUnited Kingdom
| | - M. G. Mohaupt
- INSELSPITALUniversitätsspital BernKlinik für Nephrologie/Hypertonie Abteilung für HypertonieBernSwitzerland
| | | | - S. P. Kon
- King's College Hospital NHS Foundation TrustLondonUnited Kingdom
| | - D. Serón
- Hospital Universitari Vall d'Hebr_onBarcelonaSpain
| | - M. D. Sinha
- Evelina London Children's HospitalLondonUnited Kingdom
| | - B. Tucker
- King's College Hospital NHS Foundation TrustLondonUnited Kingdom
| | - O. Viklický
- Transplantační laboratoř IKEMPragueCzech Republic
| | - R. I. Lechler
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,King's Health PartnersLondonUnited Kingdom
| | - G. M. Lord
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,National Institute for Health Research Biomedical Research CentreGuy's and St. Thomas’ National Health Service Foundation TrustKing's College LondonLondonUnited Kingdom,Guy's and St. Thomas’ NHS Foundation TrustLondonUnited Kingdom
| | - M. P. Hernandez‐Fuentes
- Medical Research Council Centre for TransplantationKing's College LondonLondonUnited Kingdom,National Institute for Health Research Biomedical Research CentreGuy's and St. Thomas’ National Health Service Foundation TrustKing's College LondonLondonUnited Kingdom
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