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Gaur V, Kumar N, Vyas A, Chowdhury D, Singh J, Bera S. Identification of potential inhibitors against Escherichia coli Mur D enzyme to combat rising drug resistance: an in-silico approach. J Biomol Struct Dyn 2023:1-11. [PMID: 38149858 DOI: 10.1080/07391102.2023.2297007] [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: 05/02/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
Indiscriminate use of anti-microbial agents has resulted in the inception, frequency, and spread of antibiotic resistance among targeted bacterial pathogens and the commensal flora. Mur enzymes, playing a crucial role in cell-wall synthesis, are one of the most appropriate targets for developing novel inhibitors against antibiotic-resistant bacterial pathogens. In the present study, in-silico high-throughput virtual (HTVS) and Standard-Precision (SP) screening was carried out with 0.3 million compounds from several small-molecule libraries against the E. coli Mur D enzyme (PDB ID 2UUP). The docked complexes were further subjected to extra-precision (XP) docking calculations, and highest Glide-score compound was further subjected to molecular simulation studies. The top six virtual hits (S1-S6) displayed a glide score (G-score) within the range of -9.013 to -7.126 kcal/mol and compound S1 was found to have the highest stable interactions with the Mur D enzyme (2UUP) of E. coli. The stability of compound S1 with the Mur D (2UUP) complex was validated by a 100-ns molecular dynamics simulation. Binding free energy calculation by the MM-GBSA strategy of the S1-2UUP (Mur D) complex established van der Waals, hydrogen bonding, lipophilic, and Coulomb energy terms as significant favorable contributors for ligand binding. The final lead molecules were subjected to ADMET predictions to study their pharmacokinetic properties and displayed promising results, except for certain modifications required to improve QPlogHERG values. So, the compounds screened against the Mur D enzyme can be further studied as preparatory points for in-vivo studies to develop potential drugs. HIGHLIGHTSE.coli is a common cause of urinary tract infections.E.coli MurD enzyme is a suitable target for drug development.Novel inhibitors against E.coli MurD enzyme were identified.Molecular dynamics studies identified in-silico potential of identified compound.ADMET predictions and Lipinski's rule of five studies showed promising results.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Vinita Gaur
- Department of Microbiology, School of Bioengineering and Biosciences, Lovely Professional University, Punjab, India
| | - Neeraj Kumar
- Department of Pharmaceutical Chemistry, Bhupal Nobles' University, Udaipur, Rajasthan, India
| | - Ashish Vyas
- Department of Microbiology, School of Bioengineering and Biosciences, Lovely Professional University, Punjab, India
| | - Debabrata Chowdhury
- School of Medicine - Infectious Diseases, Stanford University, Stanford, CA, USA
| | - Joginder Singh
- Department of Microbiology, School of Bioengineering and Biosciences, Lovely Professional University, Punjab, India
| | - Surojit Bera
- Department of Microbiology, School of Bioengineering and Biosciences, Lovely Professional University, Punjab, India
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Dravid P, Murthy S, Attia Z, Cassady C, Chandra R, Trivedi S, Vyas A, Gridley J, Holland B, Kumari A, Grakoui A, Cullen JM, Walker CM, Sharma H, Kapoor A. Phenotype and fate of liver-resident CD8 T cells during acute and chronic hepacivirus infection. PLoS Pathog 2023; 19:e1011697. [PMID: 37812637 PMCID: PMC10602381 DOI: 10.1371/journal.ppat.1011697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/26/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023] Open
Abstract
Immune correlates of hepatitis C virus (HCV) clearance and control remain poorly defined due to the lack of an informative animal model. We recently described acute and chronic rodent HCV-like virus (RHV) infections in lab mice. Here, we developed MHC class I and class II tetramers to characterize the serial changes in RHV-specific CD8 and CD4 T cells during acute and chronic infection in C57BL/6J mice. RHV infection induced rapid expansion of T cells targeting viral structural and nonstructural proteins. After virus clearance, the virus-specific T cells transitioned from effectors to long-lived liver-resident memory T cells (TRM). The effector and memory CD8 and CD4 T cells primarily produced Th1 cytokines, IFN-γ, TNF-α, and IL-2, upon ex vivo antigen stimulation, and their phenotype and transcriptome differed significantly between the liver and spleen. Rapid clearance of RHV reinfection coincided with the proliferation of virus-specific CD8 TRM cells in the liver. Chronic RHV infection was associated with the exhaustion of CD8 T cells (Tex) and the development of severe liver diseases. Interestingly, the virus-specific CD8 Tex cells continued proliferation in the liver despite the persistent high-titer viremia and retained partial antiviral functions, as evident from their ability to degranulate and produce IFN-γ upon ex vivo antigen stimulation. Thus, RHV infection in mice provides a unique model to study the function and fate of liver-resident T cells during acute and chronic hepatotropic infection.
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Affiliation(s)
- Piyush Dravid
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Satyapramod Murthy
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Zayed Attia
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Cole Cassady
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Rahul Chandra
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Sheetal Trivedi
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Ashish Vyas
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - John Gridley
- Emory National Primate Research Center, Division of Microbiology and Immunology, Emory Vaccine Center, Emory University School of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States of America
| | - Brantley Holland
- Emory National Primate Research Center, Division of Microbiology and Immunology, Emory Vaccine Center, Emory University School of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States of America
| | - Anuradha Kumari
- Emory National Primate Research Center, Division of Microbiology and Immunology, Emory Vaccine Center, Emory University School of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States of America
| | - Arash Grakoui
- Emory National Primate Research Center, Division of Microbiology and Immunology, Emory Vaccine Center, Emory University School of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States of America
| | - John M. Cullen
- North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, United States of America
| | - Christopher M. Walker
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Department of Pediatrics, College of Medicine and Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Himanshu Sharma
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Amit Kapoor
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Department of Pediatrics, College of Medicine and Public Health, The Ohio State University, Columbus, Ohio, United States of America
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Garg SS, Dubey R, Sharma S, Vyas A, Gupta J. Biological macromolecules-based nanoformulation in improving wound healing and bacterial biofilm-associated infection: A review. Int J Biol Macromol 2023; 247:125636. [PMID: 37392924 DOI: 10.1016/j.ijbiomac.2023.125636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023]
Abstract
A chronic wound is a serious complication associated with diabetes mellitus and is difficult to heal due to high glucose levels, oxidative stress, and biofilm-associated microbial infection. The structural complexity of microbial biofilm makes it impossible for antibiotics to penetrate the matrix, hence conventional antibiotic therapies became ineffective in clinical settings. This demonstrates an urgent need to find safer alternatives to reduce the prevalence of chronic wound infection associated with microbial biofilm. A novel approach to address these concerns is to inhibit biofilm formation using biological-macromolecule based nano-delivery system. Higher drug loading efficiency, sustained drug release, enhanced drug stability, and improved bioavailability are advantages of employing nano-drug delivery systems to prevent microbial colonization and biofilm formation in chronic wounds. This review covers the pathogenesis, microbial biofilm formation, and immune response to chronic wounds. Furthermore, we also focus on macromolecule-based nanoparticles as wound healing therapies to reduce the increased mortality associated with chronic wound infections.
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Affiliation(s)
- Sourbh Suren Garg
- Department of Biochemistry, School of Bioengineering and Biosciences, Lovely Professional University, Punjab, India
| | - Rupal Dubey
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Lovely Professional University, Punjab, India
| | - Sandeep Sharma
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Lovely Professional University, Punjab, India
| | - Ashish Vyas
- Department of Microbiology, School of Bioengineering and Biosciences, Lovely Professional University, Punjab, India
| | - Jeena Gupta
- Department of Biochemistry, School of Bioengineering and Biosciences, Lovely Professional University, Punjab, India.
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Anjum S, Vyas A, Sofi T. Fungi-mediated synthesis of nanoparticles: characterization process and agricultural applications. J Sci Food Agric 2023; 103:4727-4741. [PMID: 36781932 DOI: 10.1002/jsfa.12496] [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] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/31/2022] [Accepted: 02/13/2023] [Indexed: 06/08/2023]
Abstract
In the field of nanotechnology, the use of biologically active products from fungi for the reduction and synthesis of nanoparticles as an alternative to toxic chemicals has received extensive attention, due to their production of large quantities of proteins, high yields, easy handling, and the low toxicity of the residues. Fungi have become valuable tools for the manufacture of nanoparticles in comparison with other biological systems because of their enhanced growth control and diversity of metabolites, including enzymes, proteins, peptides, polysaccharides, and other macro-molecules. The ability to use different species of fungi and to perform the synthesis under different conditions enables the production of nanoparticles with different physicochemical characteristics. Fungal nanotechnology has been used to develop and offer products and services in the agricultural, medicinal, and industrial sectors. Agriculturally, it has found applications in plant disease management, crop improvement, biosensing, and the production of environmentally friendly, non-toxic pesticides and fertilizers to enhance agricultural production in general. The subject of this review is the application of fungi in the synthesis of inorganic nanoparticles, characterization, and possible applications of fungal nanoparticles in the diverse agricultural sector. The literature shows potential uses of fungi in biogenic synthesis, enabling the production of nanoparticles with different physiognomies. © 2023 Society of Chemical Industry.
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Affiliation(s)
- Shahnaz Anjum
- Department of Botany, Lovely Professional University, Phagwara, India
- Division of Plant Pathology, FoH, Sher-e-Kashmir University of Agricultural Sciences and Technology, Kashmir, India
| | - Ashish Vyas
- Department of Microbiology and Biochemistry, Lovely Professional University, Phagwara, India
| | - Tariq Sofi
- Division of Plant Pathology, FoH, Sher-e-Kashmir University of Agricultural Sciences and Technology, Kashmir, India
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LaJoie AL, Chu F, Langendorf S, Cassibry J, Vyas A, Gilmore M. Multi-camera imaging to characterize jet and liner uniformity on the Plasma Liner Experiment (PLX). Rev Sci Instrum 2023; 94:063503. [PMID: 37862493 DOI: 10.1063/5.0101674] [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] [Received: 06/02/2022] [Accepted: 09/09/2022] [Indexed: 10/22/2023]
Abstract
At Plasma Liner Experiment, a set of 36 coaxial plasma guns are deployed quasi-uniformly over a 9 ft diameter spherical chamber and are used to form a high-Z spherically compressive plasma liner. Simulations indicate that for the concept to ultimately achieve optimal target density and temperature, a high degree of timing uniformity is required between all guns. To aid in quantifying and correcting gun-to-gun nonuniformities, a key diagnostic will consist of up to six fisheye-view CCD cameras positioned inside the main chamber such that each has all plasma guns within its view. The individual cameras can be triggered at different times to determine each plasma jet's muzzle velocity and structure for different operating conditions. This camera array is currently under development, and the implementation needs and challenges for this camera array are discussed here. Additionally, we detail the analysis methodology for determining jet-to-jet uniformity deviations and how we can correct them, thereby improving overall liner uniformity.
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Affiliation(s)
- A L LaJoie
- Department of Electrical Computer Engineering, University of New Mexico, Albuquerque, New Mexico 87131, USA
- Thermonuclear Plasma Physics Group, Los Alamos National Laboratory, Los Alamos, New Mexico 87544, USA
| | - F Chu
- Thermonuclear Plasma Physics Group, Los Alamos National Laboratory, Los Alamos, New Mexico 87544, USA
| | - S Langendorf
- Thermonuclear Plasma Physics Group, Los Alamos National Laboratory, Los Alamos, New Mexico 87544, USA
| | - J Cassibry
- Department of Mechanical and Aerospace Engineering, University of Alabama in Huntsville, Huntsville, Alabama 35899, USA
| | - A Vyas
- Department of Mechanical and Aerospace Engineering, University of Alabama in Huntsville, Huntsville, Alabama 35899, USA
| | - M Gilmore
- Department of Electrical Computer Engineering, University of New Mexico, Albuquerque, New Mexico 87131, USA
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Desai R, Singh S, Dyutima DR, Verma J, Raina J, Itare V, Rizvi B, Gandhi Z, Vyas A, Jain A. Predictors of acute pulmonary embolism-related hospitalizations – an artificial neural network analysis using a nationwide cohort in the United States. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1905] [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: 11/13/2022] Open
Abstract
Abstract
Background
Considering a paucity of large-scale data on predictors of pulmonary embolism (PE) and its higher association with complications and worse outcomes, we aimed to determine the predictors of PE in this United States population-based analysis using Artificial Neural Network (ANN) Model in a nationally representative cohort.
Methods
We identified PE-related hospitalizations using 2018's National Inpatient Sample database. The relevant predictive factors for ANN were selected for this cohort. Of all admissions (unweighted n=7,105,498, weighted n=35,527,481), PE cohort (weighted n=387805) consisted of 1.1% of all admissions in 2018. The 2018 cohort was randomly split into training data (unweighted n=4716132, 70.0%) which were used to calibrate ANN and testing data (unweighted n=2019290, 30%) which were used to assess the accurateness of the algorithm. We equated the rate of incorrect prediction between training and testing data and measured the Area under Receiver Operator Curve (AUC) to determine ANN's efficacy in predicting PE hospitalizations.
Results
Patients hospitalized with PE often consisted of older (mean age 62.5±17.1 years), female (51.3%), white (70.5%) patients, and patients from lower-income quartile (0–25% income quartile: 28.8%%), often admitted non-electively (93.7%) with higher rates of cardiovascular disease risk factors. PE admissions revealed significantly higher (6.5% vs. 1.9%, p<0.001) in-hospital mortality, less frequent routine discharges (51.4% vs. 68.1%) and more frequent other facility transfers and requirement of home health care. Normalized Predictors of PE admissions are displayed in Fig. 1. Our ANN model had AUC 0.873 which correlates with an excellent prediction model. Our data demonstrated low levels (0.8%) error in both testing and training models.
Conclusion
Our ANN model showed high performance to predict risk factors for PE admissions in the US population. It will enable clinicians to screen patients at high-risk for PE admissions, curtail complication rate, improve survival and lower the healthcare cost.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Desai
- Independent Researcher , Atlanta , United States of America
| | - S Singh
- Royal Free Hospital, Neurology and Stroke , London , United Kingdom
| | - D R Dyutima
- James Cook University Hospital, Internal Medicine , Middlesbrough , United Kingdom
| | - J Verma
- District Hospital Sangrur, Pulmonology, Sangrur , Punjab , India
| | - J Raina
- Brookdale University Hospital & Medical Center, Internal Medicine , Brooklyn , United States of America
| | - V Itare
- Bronxcare Health System, Internal Medicine , Bronx , United States of America
| | - B Rizvi
- Saint Agnes Medical Center, Internal Medicine , Fresno , United States of America
| | - Z Gandhi
- Geisinger Wyoming Valley Medical Center, Internal Medicine , Wilkes-Barre , United States of America
| | - A Vyas
- Baptist Hospitals of Southeast Texas, Internal Medicine , Beaumont , United States of America
| | - A Jain
- Mercy Catholic Medical Center, Internal Medicine , Darby , United States of America
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Vyas A, Cruz-Rangel S, Khan N, Ferris R, Bruno T, Schmitt N, Kiselyov K, Duvvuri U. Hydroxychloroquine synergizes with anti-PD-1 immune checkpoint blockade in squamous carcinoma of the head and neck. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01138-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jindal A, Vyas A, Dubey G. Ponder of concern and long-term safety of infants from mothers with chronic hepatitis B treated with tenofovir disoproxil. Gut 2022; 71:840-841. [PMID: 33952603 DOI: 10.1136/gutjnl-2021-324967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/08/2022]
Affiliation(s)
- Ankur Jindal
- Hepatology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Ashish Vyas
- Microbiology, All India Institute of Medical Science-Bhopal, Bhopal, Madhya Pradesh, India
| | - Garima Dubey
- Department of Microbiology, All India Institute of Medical Science-Bhopal, Bhopal, Madhya Pradesh, India
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Kumar D, Maheshwari D, Nautiyal N, Shubham S, Rooge S, Anand L, Vyas A, Kumari R, Sharma S, Bihari C, Mohanty S, Maiwall R, Kumar A, Sarin SK. Defects in energy metabolism are associated with functional exhaustion of bone marrow mesenchymal stem cells in cirrhosis. Am J Stem Cells 2022; 11:12-27. [PMID: 35295591 PMCID: PMC8918418] [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] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Cellular and functional exhaustion of bone marrow mesenchymal stem cells (BM-MSC) is significantly associated with the loss of HSCs and hepatic osteodystrophy in cirrhosis. The molecular mechanisms underlying the dysfunction of BM-MSCs are not well understood. We investigated the underlying mechanisms of cellular and functional exhaustion of BM-MSCs in cirrhosis. METHODS The MSCs were isolated retrospectively from bone marrow of decompensated alcoholic cirrhosis patients {(Trial registration: ClinicalTrials.gov NCT01902511) (n=10; MELD=16.2±2.3; CTP=8.7±2.3)} and age and gender-matched healthy controls (n=8). Global gene expression profile of healthy bone marrow MSCs (hBM-MSCs) and cirrhosis patients BM-MSCs (cBM-MSCs) were done by mRNA sequencing. XFe24-bioanalyzer analyzed the bioenergetic potential of cells. Level of different cytokines and growth factors in BM-plasma and MSCs secretome were analyzed by Luminex-based bead array. RESULTS Analysis of differentially expressed genes showed significant (P<0.01) up-regulation of genes associated with ubiquitination and catabolism of proteins; TNF signaling, insulin resistance, and down-regulation of genes associated with DNA repair, protein processing, cell cycle, and mitochondrial respiration in cBM-MSCs in comparison to hBM-MSCs. Compared to hBM-MSCs, cBM-MSCs showed a significant defect in glycolysis due to insulin resistance and poor glucose uptake (P=0.002). This led to compromised self-renewal capacity and cellular loss of MSCs in cirrhosis. cBM-MSCs also showed a significant impairment in Oxidative phosphorylation (OXPHOS) due to mitochondrial dysfunction leading to defects in the osteogenic differentiation with early aging and senescence. CONCLUSION Compromised energy metabolism due to inflammatory and metabolic stress-induced insulin resistance underlies the cellular and functional exhaustion of BM-MSCs in cirrhosis.
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Affiliation(s)
- Dhananjay Kumar
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary SciencesNew Delhi, India
| | - Deepanshu Maheshwari
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary SciencesNew Delhi, India
| | - Nidhi Nautiyal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary SciencesNew Delhi, India
| | - Smriti Shubham
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary SciencesNew Delhi, India
| | - Sheetalnath Rooge
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary SciencesNew Delhi, India
| | - Lovkesh Anand
- Department of Hepatology, Institute of Liver and Biliary SciencesNew Delhi, India
| | - Ashish Vyas
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary SciencesNew Delhi, India
| | - Rekha Kumari
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary SciencesNew Delhi, India
| | - Shvetank Sharma
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary SciencesNew Delhi, India
| | - Chhagan Bihari
- Department of Pathology, Institute of Liver and Biliary SciencesNew Delhi, India
| | - Sujata Mohanty
- Stem Cell Facility, All India Institute of Medical SciencesNew Delhi, India
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary SciencesNew Delhi, India
| | - Anupam Kumar
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary SciencesNew Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary SciencesNew Delhi, India
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Pal R, Banerjee M, Bhadada SK, Shetty AJ, Singh B, Vyas A. Vitamin D supplementation and clinical outcomes in COVID-19: a systematic review and meta-analysis. J Endocrinol Invest 2022; 45:53-68. [PMID: 34165766 PMCID: PMC8223190 DOI: 10.1007/s40618-021-01614-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/12/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To provide a precise summary and collate the hitherto available clinical evidence on the effect of vitamin D supplementation on clinical outcomes in COVID-19 patients. METHODS PubMed/MEDLINE, Scopus, and Web of Science databases were systematically searched using appropriate keywords till June 8, 2021, to identify observational studies and randomized controlled trials (RCTs) reporting adverse clinical outcomes (ICU admission and/or mortality) in COVID-19 patients receiving vitamin D supplementation vs. those not receiving the same. Both prior use and use of vitamin D after COVID-19 diagnosis were considered. Unadjusted/adjusted pooled odds ratio (OR) with 95% confidence intervals (CI) were calculated (PROSPERO registration number CRD42021248488). RESULTS We identified 13 studies (10 observational, 3 RCTs) pooling data retrieved from 2933 COVID-19 patients. Pooled analysis of unadjusted data showed that vitamin D use in COVID-19 was significantly associated with reduced ICU admission/mortality (OR 0.41, 95% CI: 0.20, 0.81, p = 0.01, I2 = 66%, random-effects model). Similarly, on pooling adjusted risk estimates, vitamin D was also found to reduce the risk of adverse outcomes (pooled OR 0.27, 95% CI: 0.08, 0.91, p = 0.03, I2 = 80%, random-effects model). Subgroup analysis showed that vitamin D supplementation was associated with improved clinical outcomes only in patients receiving the drug post-COVID-19 diagnosis and not in those who had received vitamin D before diagnosis. CONCLUSIONS Vitamin D supplementation might be associated with improved clinical outcomes, especially when administered after the diagnosis of COVID-19. However, issues regarding the appropriate dose, duration, and mode of administration of vitamin D remain unanswered and need further research.
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Affiliation(s)
- R Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - M Banerjee
- Department of Endocrinology, Institute of Postgraduate Medical Education and Research, Kolkata, 700020, India
| | - S K Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - A J Shetty
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - B Singh
- Government Medical College, Patiala, 147001, India
| | - A Vyas
- Department of Medicine, Rabindranath Tagore Medical College, Udaipur, 313001, India
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Gupta R, Malik A, Vadhar S, Briasoulis A, Vyas A, Patel N. Comparing loading strategies of P2Y12 inhibitors in patients undergoing elective PCI: a network meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Effective platelet inhibition prior to elective percutaneous coronary intervention (PCI) reduces the risk of ischemic complications. Newer P2Y12 inhibitors are preferred agents over clopidogrel for patients presenting with acute coronary syndrome. However, the comparative efficacy and safety of them over clopidogrel in elective PCI is unclear. Our objective was to perform a network meta-analysis and assess that from randomized controlled trials (RCT).
Methods
We conducted a systematic review of RCTs up to and including November 2020. The endpoints of interest were overall mortality, rates of myocardial infarction (MI), stroke, revascularization and major bleeding. Random effects model using frequentist approach was used to perform a network meta-analysis using R software.
Results
5 trials with total of 5,194 patients were included in our analysis. For ischemic outcomes including MI, Stroke and revascularization, prasugrel had the most favorable trend. However, clopidogrel had the highest probability of being most effective for major bleeding and all-cause mortality. None of these trends were statistically significant due to lack of power for each individual outcome (Figure 1).
Conclusion
Prasugrel and ticagrelor seem to show better efficacy in preventing MI and stroke. However, their effects are marginal and do not translate into improved overall mortality and bleeding. Therefore, in this lower risk population presenting for elective PCI, clopidogrel remains a reasonable P2Y12 inhibitor choice in lower risk population.
Funding Acknowledgement
Type of funding sources: None. Results
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Affiliation(s)
- R Gupta
- Lehigh Valley Health Network, Allentown, United States of America
| | - A Malik
- New York Medical College, Cardiology, Valhalla, United States of America
| | - S Vadhar
- Lehigh Valley Health Network, Allentown, United States of America
| | - A Briasoulis
- University of Iowa Hospitals and Clinics, Iowa, United States of America
| | - A Vyas
- Lehigh Valley Health Network, Allentown, United States of America
| | - N Patel
- Lehigh Valley Health Network, Allentown, United States of America
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Lokhandwala Y, Vyas A. Bridge that disconnects? J Postgrad Med 2021; 67:132-133. [PMID: 34427278 PMCID: PMC8445117 DOI: 10.4103/jpgm.jpgm_333_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Y Lokhandwala
- Department of Cardiology, LTMM College and General Hospital, Mumbai, India
| | - A Vyas
- Department of Cardiology, Vishesh Neptune Hospital, Indore, Madhya Pradesh, India
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Pandit BR, Vyas A. Clinical Symptoms, Pathogen Spectrum, Risk Factors and Antibiogram of Suspected Neonatal Sepsis Cases in Tertiary Care Hospital of Southern Part of Nepal: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2020; 58:976-982. [PMID: 34506398 PMCID: PMC8028542 DOI: 10.31729/jnma.5094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Neonatal mortality rate is highest in sub-Saharan Africa and Southern Asia region. The present study is undertaken to find out prevalence of neonatal sepsis, recognize bacterial pathogens, neonatal risk factors, major symptoms, and their antibiotic sensitivity pattern in neonates in tertiary care hospital in southern Nepal. METHODS A descriptive cross-sectional study was carried out in a tertiary care hospital from 2nd January 2017 to 20th February 2018 after approval (Ref: 125/2016-17). The sample size was calculated and convenience sampling was done. Data were collected from hospital records and microbiology laboratory and analyzed by Statistical Package for Social Sciences. RESULTS Out of 1200 clinically suspected cases, early-onset neonatal sepsis was seen in 290 (79.89%). A positive culture was seen in 363 (30.25%) where maximum bacterial growth was found in 254 (69.98%) males. Preterm gestational age was seen in 265 (73%), low birth weight 284 (78.23%), a vaginal delivery mode in 279 (76.90%), and delivery in hospital in 232 (63.91%). Likewise, Staphylococcus aureus in 229 (63.08%) was found maximum followed by Klebsiella pneumoniae in 48(13.22%). The major symptom observed was Respiratory distress in 245 (20.41%) while culture positive was seen in poor cry in 94 (53.10%). Mainly effective antibiotics against Gram-positive and gram-negative organisms were Linezolid in 250 (94%) and Imipenem in 46 (90.19%), whereas Penicillin-G in 254 (99.21%) and Ampicillin in 38 (94.74%) found resistance towards organisms respectively. CONCLUSIONS The high prevalence of neonatal sepsis in our study reflects a huge challenge to reduce the neonatal mortality rate to 12 by 2030 of Sustainable Development Goals. Bacterial isolates exhibited higher resistance towards commonly used antibiotics.
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Affiliation(s)
- Bijay Raj Pandit
- Department of Microbiology and Biochemistry,Lovely Professional University, Phagwara, Punjab 144411, India
| | - Ashish Vyas
- Department of Microbiology and Biochemistry,Lovely Professional University, Phagwara, Punjab 144411, India
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14
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Barwad P, Lokhandwala Y, Kumar B, Vyas A, Shah V, Vichare S, Bachani N. Surgical cardiac sympathetic denervation in patients with VT storm: long term follow-up data. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0751] [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
Surgical Cardiac Sympathetic Denervation (CSD) is a procedure which involves surgical removal of terminal cervical and thoracic sympathetic ganglion for reducing sympathetic discharge to the heart. CSD is usually performed as a last desperate measure in treatment of ventricular tachycardia (VT). We report here the clinical profile and long-term follow-up of all our patients who underwent CSD (unilateral or bilateral) predominantly upfront prior to considering catheter ablation of VT for VT storm.
Material and methods
We retrospectively collected data of all patients who underwent CSD for VT storm between year 2010 till 2019. Success of CSD was defined as successful discharge of patient from the hospital after the procedure more than 75% decrease in the frequency of VT after two weeks of surgical procedure.
Results
A total of 65 patients underwent CSD in the above-mentioned period and the average duration of follow-up was 28 months. The clinical parameters, demographic data and outcome analysis is provided in details in table 1. Only 14 (21.5%) patients underwent attempt of catheter ablation of VT prior to considering CSD. CSD was successful in 53 (81.5%) of patients. There was a significant decline in the incidence of number of ICD or external shocks before and after CSD (25.2±39.4 vs 1.09±2.9) respectively. There was no significant effect of CSD on ejection fraction. None of the available clinical parameters predicted the success of CSD.
Discussion and conclusion
The current retrospective analysis reemphasize the role of surgical CSD in treatment of patients with VT storm. As in predominant patient's CSD was performed even before the attempting catheter-based ablation, it brings in a new dimension in the treatment of VT. Efficacy of CSD (81.5%) in experienced hand is equivalent or even better than catheter-based ablation in patients with VT storm.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Barwad
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - B Kumar
- holy family Heart Institute, Cardiology, Mumbai, India
| | - A Vyas
- holy family Heart Institute, Cardiology, Mumbai, India
| | - V Shah
- holy family Heart Institute, Cardiology, Mumbai, India
| | - S Vichare
- holy family Heart Institute, Cardiology, Mumbai, India
| | - N Bachani
- holy family Heart Institute, Cardiology, Mumbai, India
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Kaur T, Putatunda C, Vyas A, Kumar G. Zinc oxide nanoparticles inhibit bacterial biofilm formation via altering cell membrane permeability. Prep Biochem Biotechnol 2020; 51:309-319. [PMID: 32921268 DOI: 10.1080/10826068.2020.1815057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In the current scenario nanoparticles (NPs) have gained a breathtaking impetus due to their multidimensional applications in varied fields. In the present effort, biogenic synthesis of Zinc Oxide nanoparticles (ZnO NPs) was carried out using aqueous extract of dried powder of Emblica officinalis (Amla). Physicochemical characterization of nanoparticles was carried out via UV-Visible (UV-Vis) spectroscopy, Fourier transform infrared spectroscopy (FTIR), X-ray diffractometer (XRD), Scanning electron microscopy (SEM) and Transmission electron microscopy (TEM) wherein the particles were found to be quasi spherical and with a size ranging between 3 and 11 nm. The ZnO nanoparticles exhibited significant antibacterial activity against bacteria as Streptococcus pyogenes MTCC 442, Bacillus cereus MTCC 1272, Escherichia coli MTCC 1687 and Pseudomonas aeruginosa MTCC 4673. The nanoparticles displayed high anti-biofilm activity toward all the bacterial strains, when tested against three different base materials viz. glass, plastic and metal (Aluminum). Further, the nanoparticle treatment of bacterial cells caused changes in their cell membrane permeability, leading to leakage of nucleic acid from the bacterial cells, thereby defining it as the most probable mechanism for their anti-biofilm potential.
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Affiliation(s)
- Tanvir Kaur
- Department of Microbiology, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, Punjab, India
| | - Chayanika Putatunda
- Department of Microbiology, Om Sterling Global University, Hisar, Haryana, India
| | - Ashish Vyas
- Department of Microbiology, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, Punjab, India
| | - Gaurav Kumar
- Department of Microbiology, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, Punjab, India
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Hadjiyiannakis D, Dimitroyannis D, Eastlake L, Peedell C, Tripathi L, Simcock R, Vyas A, Deutsch E, Chalmers AJ. Personal View: Low-Dose Lung Radiotherapy Should be Evaluated as a Treatment for Severe COVID-19 Lung Disease. Clin Oncol (R Coll Radiol) 2020; 33:e64-e68. [PMID: 32829986 PMCID: PMC7427522 DOI: 10.1016/j.clon.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 02/08/2023]
Affiliation(s)
- D Hadjiyiannakis
- Lancashire Teaching Hospitals, NHS Foundation Trust, Preston, UK; NIHR Lancashire Clinical Research Facility, Preston, UK
| | | | - L Eastlake
- University Hospitals Plymouth NHS Trust, Plymouth, UK.
| | - C Peedell
- James Cook University Hospital, Middlesbrough, UK
| | - L Tripathi
- Lancashire Teaching Hospitals, NHS Foundation Trust, Preston, UK; NIHR Lancashire Clinical Research Facility, Preston, UK
| | - R Simcock
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Vyas
- Lancashire Teaching Hospitals, NHS Foundation Trust, Preston, UK
| | - E Deutsch
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris, Villejuif, France
| | - A J Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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Vyas A, Creswell J, Codlin AJ, Stevens R, Rao VG, Kumar B, Khaparde S, Sahu S. Community-based active case-finding to reach the most vulnerable: tuberculosis in tribal areas of India. Int J Tuberc Lung Dis 2020; 23:750-755. [PMID: 31315709 DOI: 10.5588/ijtld.18.0741] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
<sec> <title>BACKGROUND</title> India has the world's largest indigenous/tribal population. Many areas with large tribal populations suffer from weak infrastructure and services. Surveys have shown a high prevalence of TB among Saharia communities, who rarely access public services. We evaluated a community-based active TB case-finding intervention. </sec> <sec> <title>METHODS</title> Community health workers screened people for TB symptoms in Saharia communities, made referrals, collected sputum for transport to laboratories, and initiated and supported anti-tuberculosis treatment. Microscopy testing was performed at government laboratories. The intervention tracked the people screened, referrals, the people tested, laboratory results, treatment initiation and outcomes. </sec> <sec> <title>RESULTS</title> Community health workers verbally screened 65 230 people, 8723 (13%) of whom had symptoms. Of these, 5600 were tested, 964 (17%) of whom were smear-positive. During the intervention, we observed a +52% increase in people tested at laboratories and an +84% increase in TB case notifications. Pre-treatment loss to follow-up decreased and treatment success increased slightly. </sec> <sec> <title>CONCLUSIONS</title> In India, particularly among tribal populations, many people with TB are missed by current approaches due to poor access. Community-based active case-finding can help identify more people with TB in tribal and remote rural areas by addressing barriers to health seeking as well as help reach ambitious country and global notification targets. </sec>.
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Affiliation(s)
- A Vyas
- Asha Kalp, Gwalior, India
| | - J Creswell
- Stop TB Partnership, Geneva, Switzerland
| | - A J Codlin
- Stop TB Partnership, Geneva, Switzerland
| | - R Stevens
- Independent Consultant, Manchester, UK
| | - V G Rao
- National Institute for Research in Tribal Health, Jabalpur
| | - B Kumar
- Global Coalition of TB Activists, New Delhi
| | - S Khaparde
- Central TB Division, Government of India, New Delhi, India
| | - S Sahu
- Stop TB Partnership, Geneva, Switzerland
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18
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Bhat A, Das S, Yadav G, Chaudhary S, Vyas A, Islam M, Gupta AC, Bajpai M, Maiwall R, Maras JS, Sarin SK. Hyperoxidized Albumin Modulates Platelets and Promotes Inflammation Through CD36 Receptor in Severe Alcoholic Hepatitis. Hepatol Commun 2019; 4:50-65. [PMID: 31909355 PMCID: PMC6939543 DOI: 10.1002/hep4.1440] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/17/2019] [Indexed: 12/14/2022] Open
Abstract
Hyperoxidized albumin promotes inflammation and modulates several immune cells in severe alcoholic hepatitis (SAH). Platelets mediate inflammation by interacting with immune cells, endothelium, and other cells. The role of hyperoxidized albumin in platelet activation and alteration of platelet phenotype/functions is not known. Quantitative platelet proteomics performed in 10 patients with SAH was compared with 10 patients with alcoholic cirrhosis and 10 healthy controls, respectively. Dysregulated pathways were identified and validated in a separate cohort (n = 40). Healthy platelets were exposed to patient plasma or purified albumin or ex vivo modified albumin (human‐mercaptalbumin, humannonmercaptalbumin‐1, and human nonmercaptalbumin 2) in the presence or absence of CD36 blockade, and platelet secretome was analyzed. Two hundred and two up‐regulated proteins linked to platelet activation, complement regulation, lipid transportation, and 321 down‐regulated proteins related to platelet hemostasis and coagulation (fold change ± 1.5, P < 0.01) were identified. Blood transcription module enrichment showed an inflammatory phenotype of SAH platelet. Increased level of platelet factor‐4, P‐selectin, and soluble cluster of differentiation‐40 ligand correlated with severity (Model for End‐Stage Liver Disease score, r > 0.3, P < 0.05) in SAH. Transcripts linked to platelet activation (increased) and granular secretions (decreased in SAH) correlated with disease severity. SNARE (soluble‐N‐ethylmaleimide‐sensitive‐factor‐activating‐protein‐receptor) complex proteins (SNAP‐23 [synaptosomal‐associated protein 23] and VAMP‐8 [vesicle‐associated membrane protein 3]) were down‐regulated in SAH platelets (P < 0.05). In vitro stimulation of healthy platelets showed enhanced activation with patient plasma, or purified albumin‐treatment blocking of CD36 blunted this effect (P < 0.05). Ex vivo modified albumin (primarily nonmercaptalbumin–human nonmercaptalbumin 2 [HNA2; 1 mg/mL]) showed high activation and aggregation and intracellular reactive oxygen species production in healthy platelets (P < 0.05), which significantly reduced after CD36 neutralization. Platelet secretome showed reduced inflammatory mediators and increased repair proteins. Conclusion: Hyperoxidized albumin triggers platelet activation (possibly through the CD36 receptor), promotes inflammation and oxidative stress, and contributes to disease severity in patients with SAH.
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Affiliation(s)
- Adil Bhat
- Department of Molecular and Cellular Medicine Institute of Liver and Biliary Sciences New Delhi India
| | - Sukanta Das
- Department of Molecular and Cellular Medicine Institute of Liver and Biliary Sciences New Delhi India
| | - Gaurav Yadav
- Department of Molecular and Cellular Medicine Institute of Liver and Biliary Sciences New Delhi India
| | - Sudrishti Chaudhary
- Department of Molecular and Cellular Medicine Institute of Liver and Biliary Sciences New Delhi India
| | - Ashish Vyas
- Department of Molecular and Cellular Medicine Institute of Liver and Biliary Sciences New Delhi India
| | - Mojahidul Islam
- Department of Molecular and Cellular Medicine Institute of Liver and Biliary Sciences New Delhi India
| | - Abhishak C Gupta
- Department of Molecular and Cellular Medicine Institute of Liver and Biliary Sciences New Delhi India
| | - Meenu Bajpai
- Department of Transfusion Medicine Institute of Liver and Biliary Sciences New Delhi India
| | - Rakhi Maiwall
- Department of Hepatology Institute of Liver and Biliary Sciences New Delhi India
| | - Jaswinder Singh Maras
- Department of Molecular and Cellular Medicine Institute of Liver and Biliary Sciences New Delhi India
| | - Shiv K Sarin
- Department of Molecular and Cellular Medicine Institute of Liver and Biliary Sciences New Delhi India.,Department of Hepatology Institute of Liver and Biliary Sciences New Delhi India
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Jindal A, Vyas A, Sharma M, Kumar G, Sarin SK. A randomized open label trial of tenofovir monotherapy versus tenofovir plus telbivudine in spontaneous reactivation of hepatitis B. Saudi J Gastroenterol 2019; 25:319-326. [PMID: 31044748 PMCID: PMC6784432 DOI: 10.4103/sjg.sjg_537_18] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIM Acute-on-chronic liver failure (ACLF-B) in spontaneous reactivation of chronic hepatitis B (SR-CHB) has high mortality. Tenofovir disoproxil fumarate (TDF) improves survival by ~40% in ACLF-B but is potentially nephrotoxic. Combining telbivudine (LDT) with TDF may negate this risk and could boost rapid viral clearance and improve clinical outcomes. PATIENTS AND METHODS Seventy consecutive patients with SR-CHB were randomized to TDF (300 mg/day, n = 35) or TDF plus LDT (600 mg/day; n = 35). In all, 25 had ACLF-B and none had option for liver transplantation. Primary endpoint was survival at 3 months. Secondary endpoints were survival at 3 months in ACLF-B, serial reduction in hepatitis B virus (HBV) DNA, hepatitis B surface antigen (HBsAg) loss and liver-related complications. RESULTS Overall baseline clinical and laboratory parameters in the two groups were comparable. Reduction in HBV DNA at weeks 2, 4 and 12 was independent of treatment groups and presence of ACLF-B (P < 0.01). All six patients with HBsAg loss at 12 weeks had lower HBV DNA at baseline and none had ACLF-B. Patients with no ACLF-B had more rapid decline in bilirubin and alanine aminotraminase at week 2 compared with ACLF-B. Patients on TDF plus LDT showed significant improvement in AKI on follow-up (five of six patients) compared with TDF monotherapy (none of six patients) and had less reduction in estimated glomerular filtration rate at week 12. Eight of 10 patients with liver-related deaths received TDF monotherapy (P = 0.02). New-onset septic shock, TDF monotherapy, e-antibody positivity, and higher baseline model for end-stage liver disease score were predictors of mortality in ACLF-B. None had treatment-related severe adverse effects. CONCLUSION Addition of LDT to tenofovir is safe and may be renoprotective in spontaneous reactivation of hepatitis B. Combination therapy improves survival in ACLF-B despite comparable HBV DNA suppression to tenofovir monotherapy.
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Affiliation(s)
- Ankur Jindal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India,Address for correspondence: Dr. Ankur Jindal, Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi - 110 070, India. E-mail:
| | - Ashish Vyas
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Manoj Sharma
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Guresh Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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20
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Sohn H, Vyas A, Puri L, Gupta S, Qin ZZ, Codlin A, Creswell J. Costs and operation management of community outreach program for tuberculosis in tribal populations in India. Public Health Action 2019; 9:58-62. [PMID: 31417854 DOI: 10.5588/pha.18.0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/27/2019] [Indexed: 11/10/2022] Open
Abstract
Objective To evaluate costs of an active case finding (ACF) program with tuberculosis (TB) treatment delivery and monitoring, which targeted a rural tribal population in India. Method A time and motion study was conducted to evaluate operations and workload. Costs from the program perspective were assessed using both the bottom-up and top-down costing methods, exclusive of routine TB care costs. The impact of ACF on routine TB laboratory workloads was measured based on the changes in available staff time per smear at nine designated microscopy centers before and after program implementation. Results A majority (53.2%) of the community health-care worker's time was spent in traveling to communities, with an average of 22 TB patients (95% CI 19.14-24.94) seen per day per person. Costs (at 2015 $US rates) were US$1.85-US$2.42 per patient screened and submitting sputum, US$2.51-US$4.74 per person diagnosed with TB, and US$22.52-US$34.13 per TB patient completing treatment. Total smear volumes increased significantly after the ACF program, with more than a 15% reduction in available staff time per sputum smear test in most laboratories. Conclusion This low-cost, ACF program has the potential to be highly cost-effective in addressing gaps in TB care problems in rural India.
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Affiliation(s)
- H Sohn
- Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland, USA
| | - A Vyas
- Asha Kalp, New Delhi, India
| | - L Puri
- McGill University, Toronto, Ontario, Canada
| | | | - Z Z Qin
- Stop TB Partnership, Geneva, Switzerland
| | - A Codlin
- Stop TB Partnership, Geneva, Switzerland
| | - J Creswell
- Stop TB Partnership, Geneva, Switzerland
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21
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Kohn J, Connors T, Vyas A. 003 Vulvar Lichen Sclerosus in Multidisciplinary Clinics: Treatment Compliance and Sexual Function. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.460] [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: 10/26/2022]
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Moses R, Vyas A, Wood S. I’m ready to die now a 12 month review of ventilation withdrawal for MND patients within a regional ventilation service. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.228] [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: 10/27/2022]
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23
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Moses R, Vyas A, Wood S. Reducing the carbon footprint in a regional long term ventilation service with the use of remote monitoring. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Tripathi A, Kumar R, Sahoo G, Vyas A, Kumar H, Kumar M, Das P. In vitro and in vivo antileishmanial activity of parthenin a sesquiterpene lactone obtained from Parthenium hysterophorous. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.4103] [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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Ferrieres J, Lautsch D, Velkovski-Rouyer M, Ambegaonkar B, De Ferrari G, Vyas A, Baxter C, Horack M, Bash L, Al Mahmeed W, Chiang F, Keong Poh K, Brudi P, Gitt A. Use of guideline-recommended treatments in 10,661 patients with coronary heart disease: Observational multinational DYSIS II study. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goodwin M, Patel DK, Vyas A, Khan AJ, McGrady MG, Boothman N, Pretty IA. Sugar before bed: a simple dietary risk factor for caries experience. Community Dent Health 2017; 34:8-13. [PMID: 28561551 DOI: 10.1922/cdh_3926goodwin06] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/30/2016] [Indexed: 11/11/2022]
Abstract
Clinical care pathways have placed renewed emphasis on caries risk assessment and the ability to predict and prevent further disease. With diet considered a key factor in the development of caries, the level of caries risk posed by dietary habits, such as the frequency of intake and timing of free sugars is questioned. OBJECTIVE To identify reliable and simple dietary risk factors for caries experience. RESEARCH DESIGN A cross-sectional observational study of a convenience sample with data gained from clinical examinations, questionnaire and a 24 hour dietary-recall interview. PARTICIPANTS 128 subjects aged 11-12 from comprehensive schools in Greater Manchester and Newcastle upon-Tyne, UK. OUTCOME MEASURES free sugars consumed between meals, before bed and total % of total free sugars consumed were assessed from dietary assessments led by a dietitian. D4-6MFT was generated with a caries threshold of ICDAS stage 4 from clinical examinations. RESULTS Analysis revealed no significant differences in caries experience when looking specifically at caries into dentine, referred to as the cavity group (split at D4-6MFT), between high and low deprivation, consumption of free sugars between meals and free sugars (%). The consumption of free sugars within the hour before bed revealed a statistically significant difference between the cavity/no cavity groups (p=0.002). Logistic regression analysis on the cavity/no cavity groups revealed an odds ratio of 2.4 (95%CI 1.3,4.4) for free sugars consumption before bedtime. CONCLUSIONS The study suggests that the consumption of free sugars before bedtime may be an important risk factor for adolescent caries into dentine experience.
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Affiliation(s)
- M Goodwin
- School of Dentistry Dental Health Unit, University of Manchester, M15 6SE, UK
| | - D K Patel
- School of Dentistry Dental Health Unit, University of Manchester, M15 6SE, UK
| | - A Vyas
- Manchester Academic Health Science Centre, Paediatric Endocrinology, Manchester Children's Hospital, UK
| | - A J Khan
- Manchester Academic Health Science Centre, Paediatric Endocrinology, Manchester Children's Hospital, UK
| | - M G McGrady
- School of Dentistry Dental Health Unit, University of Manchester, M15 6SE, UK
| | - N Boothman
- School of Dentistry Dental Health Unit, University of Manchester, M15 6SE, UK
| | - I A Pretty
- School of Dentistry Dental Health Unit, University of Manchester, M15 6SE, UK
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Barwad P, Devidutta S, Shah M, Vyas A, Lokhandwala Y. P1485Long term outcome of cardiac sympathetic denervation in patients with structural heart disease and refractory ventricular tachycardia storms. Europace 2017. [DOI: 10.1093/ehjci/eux158.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Shah V, Barwad P, Vyas A, Dedhia A, Shah R, Bachani N, Lokhandwala Y. P1616Clinical profile and intermediate term outcome of 50 consecutive patient of ventricular tachycardia storm managed at a tertiary care center in india. Europace 2017. [DOI: 10.1093/ehjci/eux158.242] [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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29
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Trehanpati N, Sehgal R, Patra S, Vyas A, Vasudevan M, Khosla R, Khanam A, Kumar G, Maiwall R, Ramakrishna G, Kottilil S, Sarin SK. miRNA signatures can predict acute liver failure in hepatitis E infected pregnant females. Heliyon 2017; 3:e00287. [PMID: 28413835 PMCID: PMC5384411 DOI: 10.1016/j.heliyon.2017.e00287] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 12/12/2016] [Revised: 03/07/2017] [Accepted: 03/28/2017] [Indexed: 02/07/2023] Open
Abstract
Background Acute viral hepatitis E (AVH-E) can often result in acute liver failure (ALF) during pregnancy. microRNAs serve as mediators in drug induced liver failure. We investigated their role as a biomarker in predicting ALF due to HEV (ALF-E). Methods We performed next generation sequencing and subsequent validation studies in PBMCs of pregnant (P) self limiting AVH-E, ALF due to HEV (ALF-E) and compared with AVH-E in non-pregnant (NP) females and healthy controls. Findings Eleven microRNAs were significantly expressed in response to HEV infection; importantly, miR- 431, 654, 1468 and 4435, were distinctly expressed in pregnant self-limiting AVH-E and healthy females (p = 0.0005), but not in ALF-E. Sixteen exclusive microRNAs differentiated ALF-E from self limiting AVH-E in pregnant females. miR-450b which affects cellular proliferation and metabolic processes through RNF20 and SECB was predominanlty upregulated and correlated with poor outcome (ROC 0.958, p = 0.001). Interpretation Our results reveal that a specific microRNA profile can predict fatality in ALF-E in pregnancy. These microRNAs could be exploited as prognostic biomarkers and help in the development of new therapeutic interventions.
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Affiliation(s)
- Nirupma Trehanpati
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | - Rashi Sehgal
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | - Sharda Patra
- Departrment of Gynaecology and Obstetrics, Lady Harding Medical College, New Delhi, India
| | - Ashish Vyas
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | | | - Ritu Khosla
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | - Arshi Khanam
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | - Guresh Kumar
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gayatri Ramakrishna
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | - Shyam Kottilil
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland, Baltimore, MD 21201, USA
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Vyas A, Rodrigues VC, Ayres R, Myles PR, Hothersall EJ, Thomas H. Public health matters: Innovative approaches for engaging medical students. Med Teach 2017; 39:402-408. [PMID: 28379091 DOI: 10.1080/0142159x.2017.1294753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Public health faces the paradox of being increasingly emphasized by the key health and social care regulators and stakeholders, while remaining a largely under-represented discipline in the context of medical curricula. Enhancing medical student engagement in public health teaching is one way to address this concern. METHODS We discuss four key solutions to the challenges faced by public health educators in medical schools, and present five case studies which demonstrate innovative approaches to engaging medical students in our discipline. RESULTS Four different approaches have been piloted by members of the Public Health Educators in Medical Schools (PHEMS) network: (i) ensuring social accountability, (ii) demonstrating clinical relevance, (iii) mapping the core curriculum, and (iv) using technology enhanced learning. Preliminary student feedback suggests that these approaches can be used to position public health as an enabler of modern medical practice, and promote a more holistic understanding of medicine by linking patient-centred care to the population level. CONCLUSIONS The zeitgeist in both academia and the healthcare system supports the teaching of public health within the medical curriculum; there is also consensus at the political and pedagogical level. The challenge of ensuring engagement now needs to be met at the student-teacher interface.
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Affiliation(s)
- A Vyas
- a Public Health , Norwich Medical School, University of East Anglia , Norwich , UK
| | - V C Rodrigues
- b Public Health and Medical Education , Norwich Medical School, University of East Anglia , Norwich , UK
| | - R Ayres
- c Population Health , Plymouth Peninsula Schools of Medicine and Dentistry , Plymouth , UK
| | - P R Myles
- d Health Protection and Epidemiology, Epidemiology and Public Health , University of Nottingham , Nottingham , UK
| | - E J Hothersall
- e Public Health Medicine, Systems in Practice Convenor , Dundee Medical School and NHS Tayside , Dundee , UK
| | - H Thomas
- f Public Health and Primary Care , St George's, University of London , London , UK
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Stacey RM, Vyas A, Fowler SJ. P231 Breathing pattern disorders in a complex breathlessness service; classification and clinical characteristics. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.374] [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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Ryan D, Niven R, Burhan H, Corless J, Diver S, Fowler S, Menzies D, O’Driscoll R, Scott S, Sehgal N, Vyas A, Allen D, Blakey J, Kane B. S3 The uk’s largest severe asthma multidisciplinary team meeting; experience from the first 18 months. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Haines J, Slinger C, Vyas A, Chua S, Fowler SJ. M11 The impact of respiratory speech and language therapy on patients’ cough related symptoms. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moses R, Taylor C, Wood S, Vyas A. P191 Reducing the carbon footprint in a regional long term ventilation service with the use of remote monitoring. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gn YM, Moses R, Vyas A. S58 The use of remote monitoring to assess ventilator adherence and outcomes within a regional home mechanical ventilation service. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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36
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Moses R, Morgan N, Mcdonald T, Jennifer W, Bonney H, Shakespeare D, Vyas A. A severe case of Bickerstaff's Encephalitis: the importance of specialist neuro-respiratory rehabilitation to optimise recovery and outcome. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moses R, Vyas A, Shakespeare D, Degoode C. The development of a specialist model of care for transitional paediatric neuromuscular patients: collaboration between respiratory, neurological and neuro-rehabilitation specialties. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fowler SJ, Thurston A, Chesworth B, Cheng V, Constantinou P, Vyas A, Lillie S, Haines J. The VCDQ--a Questionnaire for symptom monitoring in vocal cord dysfunction. Clin Exp Allergy 2016; 45:1406-11. [PMID: 25867098 DOI: 10.1111/cea.12550] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/13/2015] [Accepted: 04/17/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vocal cord dysfunction (VCD) typically involves abnormal adduction of the vocal cords during inspiration, mimics the symptoms of asthma and leads to the prescription of ineffective medications. OBJECTIVE We aimed to develop a clinical tool to monitor symptoms and response to treatment in confirmed VCD. METHODS We collated symptoms of VCD from focus groups comprising patients and healthcare professionals; phrases describing these symptoms were assessed for face validity and internal correlation and rated for importance. The resultant 12-item questionnaire (VCDQ) rated the impact of each on a 5-point Likert scale (total score range 12-60) and was tested for reliability, concurrent validity and performance in 31 patients with endoscopically confirmed VCD (± asthma), 29 asthmatics with no history of VCD and 14 healthy controls. We assessed response to speech and language therapy and the minimal important difference by measuring the VCDQ pre- and post- therapy in a 20 new patients. RESULTS The VCDQ had excellent test-retest reliability and differentiated VCD vs. healthy (Mann-Whitney U-test: z = -5.390, P < 0.001) and asthma (z = -5.730, P < 0.001). All patients improved post-therapy, assessed both by a global rating of change score (GRCS) and by the VCDQ [median (IQR) score pre-therapy 50.5 (48.0 - 54.8), post-therapy 35.0 (29.3 - 41.8), P < 0.001]. The minimal important difference in the VCDQ associated with a rating of 'minimally better' on the GRCS was 4 points. CONCLUSIONS AND CLINICAL RELEVANCE The VCDQ is a valid and responsive tool suitable for measuring changes in symptoms in patients with VCD. It also gives insight into which symptoms are important to patients and could guide future therapy refinements. Future assessments of novel therapies for this condition should use an appropriately validated tool such as the VCDQ to measure response.
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Affiliation(s)
- S J Fowler
- Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.,Manchester Academic Health Science Centre, NIHR South Manchester Respiratory and Allergy Clinical Research Facility, University Hospital of South Manchester, The University of Manchester, Manchester, UK
| | - A Thurston
- Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - B Chesworth
- Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - V Cheng
- Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - P Constantinou
- Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - A Vyas
- Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - S Lillie
- Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - J Haines
- Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Lopez E, Vyas A, Thabet A, Arellano R, Balesh E. Percutaneous nephrostomy tube placement via trocar technique in the pediatric patient: a single-center experience. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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40
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Raval AD, Thakker D, Negi H, Vyas A, Kaur H, Salkini MW. Association between statins and clinical outcomes among men with prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2016; 19:151-62. [PMID: 26782711 DOI: 10.1038/pcan.2015.58] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/11/2015] [Accepted: 11/08/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mixed evidence exists regarding the effects of statins among men with prostate cancer. We aimed to determine the association between statin use and clinical outcomes in prostate cancer using systematic review and meta-analysis. METHODS Original articles published until second week of August 2015 were searched in electronic databases (Medline-Ovid, Pubmed, Scopus, The Cochrane Library, Web of Science, ProQuest) for studies on statin use in prostate cancer. The main clinical outcomes for the review were: biochemical recurrence (BCR), metastases, and all-cause and prostate cancer-specific mortality. Meta-analysis was performed to calculate the pooled hazard ratio (pHR) and their 95% confidence interval (95% CI). Heterogeneity between the studies was examined using I(2) statistics. Meta-regression was performed, wherever significant heterogeneity was found in the meta-analyses, to find factors associated with poor outcomes, and sensitivity analyses were conducted to assess the robustness of findings. The analyses were conducted using RevMan v5.3, STATA v14, and R v3.1.1. RESULTS Out of the 1002 retrieved citations, 34 observational cohort studies met the inclusion criteria. Statin use was associated with a 21% reduction in the risk of BCR among those treated with radiation therapy (pHR: 0.79, 95% CI: 0.65, 0.95, P-value=0.01, 10 studies, I(2)=54%), whereas it was not associated with the BCR among those treated with radical prostatectomy (pHR: 0.94, 95% CI: 0.81, 1.09, P-value=0.43, 15 studies, I(2)=65%). Statin use was associated with a 22% reduction in the risk of metastases (pHR: 0.78, 95% CI: 0.68, 0.87, P-value<0.001, 6 studies, I(2)=0%), and a 24% reduction in risk of both all-cause mortality (pHR: 0.76, 95% CI: 0.63, 0.91, P-value=0.004, 6 studies, I(2)=71%), and prostate cancer-specific mortality (pHR: 0.76, 95% CI: 0.64, 0.89, P-value=0.0007, 5 studies, I(2)=40%). CONCLUSIONS Our systematic review found that statin significantly reduced the all-cause and prostate cancer-specific mortality and improved the BCR in certain subgroup of men with prostate cancer. In future, randomized controlled trials should be conducted to establish efficacy of statins among men with prostate cancer.
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Affiliation(s)
- A D Raval
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.,Healthcore, Inc., Wilmington, DE, USA
| | - D Thakker
- Health Outcomes Research, Capita India, Mumbai, India
| | - H Negi
- Department of Pharmacology, Post-Graduate Medical Education and Research Institute (PGIMER), Chandigarh, India
| | - A Vyas
- Department of Epidemiology, School of Public Health, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - H Kaur
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - M W Salkini
- Department of Urology, School of Medicine, West Virginia University, Morgantown, WV, USA
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Haines J, Vyas A, Slinger C, Cheyne N, Fowler SJ. M13 Clinical characteristics and management of patients presenting to the “Airways Clinic”; a specialised tertiary multi-disciplinary respiratory service. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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42
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Haines J, Vyas A, Slinger C, Fowler SJ. M12 The utilisation of Heliox21 in a tertiary vocal cord dysfunction service. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sehgal R, Patra S, David P, Vyas A, Khanam A, Hissar S, Gupta E, Kumar G, Kottilil S, Maiwall R, Sarin SK, Trehanpati N. Impaired monocyte-macrophage functions and defective Toll-like receptor signaling in hepatitis E virus-infected pregnant women with acute liver failure. Hepatology 2015; 62:1683-96. [PMID: 26331854 DOI: 10.1002/hep.28143] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/28/2015] [Indexed: 12/20/2022]
Abstract
UNLABELLED Acute viral hepatitis resulting due to hepatitis E viral infection (AVH-E) is often serious in pregnancy and could result in acute liver failure (ALF). The role of monocytes and macrophages (mono-macs) in the pathogenesis of AVH-E and development of ALF-E in pregnancy is unclear. We investigated the functions of mono-macs in pregnant (P), AVH-E (n = 44), ALF-E (n = 12), healthy controls (HC; n = 20) and compared with nonpregnant (NP) AVH-E (n = 10), ALF-E (n = 5), and HC (n = 10). We also recruited non-hepatitis E virus-related pregnant (P), ALF-NE (n = 5) and non-pregnant (NP), ALF-NE (n = 12) patients with ALF. Mono-macs, dendritic cell (DC) phenotypes, and Toll-like receptor (TLR) expressions were studied by flow cytometry and reverse-transcriptase polymerase chain reaction. Mono-macs functionality was determined by analyzing their phagocytic activity and reactive oxygen species (ROS) generation by using flow cytometry. Frequency of mono-macs and DCs was increased during HEV infection compared to HC (P < 0.001). Macrophages were increased (P < 0.002) in ALF-E(P) compared to ALF-NE(P). The macrophage phagocytic activity and Escherichia coli-induced ROS production was significantly impaired in ALF-E(P) compared to AVH-E(P) (P < 0.001), ALF-E(NP), and ALF-NE(P) patients (P < 0.02). TLR3 and TLR9 expression and downstream MYD88 signalling molecules IRF3 and IRF7 were significantly down-regulated in ALF-E(P) (P < 0.00) compared to AVH-E(P) and ALF-NE(P). CONCLUSION Functionality of mono-macs is impaired in pregnant ALF-E patients compared to AVH-E(P). Reduced TLR3 and TLR7 expression and TLR downstream-signaling molecules in pregnant ALF-E patients suggests inadequate triggers for the innate immune responses contributing to development and severity of ALF-E. Studies using TLR agonists to activate mono-macs may be of use and in vitro studies should be undertaken using patient samples.
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Affiliation(s)
- Rashi Sehgal
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Sharda Patra
- Gynecology and Obstetrics, Lady Harding Medical College, New Delhi, India
| | - Paul David
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ashish Vyas
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Arshi Khanam
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Syed Hissar
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ekta Gupta
- Department of Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Guresh Kumar
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shyam Kottilil
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India.,Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nirupama Trehanpati
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
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Haines J, Vyas A, Slinger C, Howell L, Fowler SJ. M10 The development of a Vocal Cord Dysfunction Laryngoscopic Appearance Scale: Abstract M10 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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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Sharma S, Khosla R, David P, Rastogi A, Vyas A, Singh D, Bhardwaj A, Sahney A, Maiwall R, Sarin SK, Trehanpati N. CD4+CD25+CD127(low) Regulatory T Cells Play Predominant Anti-Tumor Suppressive Role in Hepatitis B Virus-Associated Hepatocellular Carcinoma. Front Immunol 2015; 6:49. [PMID: 25767469 PMCID: PMC4341117 DOI: 10.3389/fimmu.2015.00049] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/26/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the second leading cause of cancer death worldwide and hepatitis B is one of the commonest causes. T regulatory cells (Tregs) are strong immunomodulators and are likely to play a major role in HCC development. HBV infection is reported to induce expansion of Tregs. We investigated the CD4+CD25+CD127(-ve)FoxP3+ Tregs in HBV-related HCC as compared to non-HBV-HCC. PATIENTS AND METHODS Whole blood immunophenotyping was analyzed by multicolor flow cytometry in patients with HBV-related HCC (HBV-HCC, n = 17), non-HBV-HCC (n = 22; NASH = 16, alcohol-related = 6), and chronic hepatitis B infection (CHBV; n = 10). Tregs functionality was checked by in vitro suppression assays using CD4+ CD25+ CD127(low) Tregs. Levels of serum alpha-fetoprotein (AFP), expression of FoxP3, IL-10, PD1, TGF-β, and Notch in Tregs, and liver explants were analyzed by flow cytometry, immunohistochemistry, and quantitative RT-PCR. RESULTS CD4+CD25+(hi) and Foxp3 expression in CD4+CD25+(hi)CD127(low) was significantly increased (P = 0.04, P = 0.007) in HBVHCC compared to non-HBVHCC and CHBV patients. HBVHCC also showed high IL-10 and TGF-β secreting CD4 + CD25 + (hi)Tregs. The PD1 expression in CD4 + CD25+(hi) was significantly decreased in the HBVHCC than non-HBVHCC. In HBVHCC, AFP levels were significantly high (median 941, range 2-727940) than non-HBVHCC (median 13.5, range 2-18,900). In HBVHCC, patients with high AFP (range; 3982-727940 ng/ml) showed positive correlation with Foxp3 expression in CD4+CD25+(hi) CD127(low) (r = 0.857, P = 0.014). Reduced PD1 expression in HBVHCC also had negative correlation with FOXP3 in CD4+CD25+(hi) CD127(low) (r = -0.78, P = 0.04). However, AFP levels in non-HBVHCC showed negative correlation with (R = -0.67, P = 0.005) with CD4+CD25+(hi) Tregs. CONCLUSION Our results demonstrate that CD4+ CD25+(hi) Tregs from HBVHCC patients have decreased expression of PD1, resulting in higher IL-10 and TGF-β secretion. Increased suppressive ability of Tregs in HBV-related HCC confers increased anti-tumor suppressive response than in non-HBV-HCC. Modulation of Tregs and PD1 may serve as useful therapeutic targets.
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Affiliation(s)
- Shreya Sharma
- Department of Research, Institute of Liver and Biliary Sciences , New Delhi , India
| | - Ritu Khosla
- Department of Research, Institute of Liver and Biliary Sciences , New Delhi , India
| | - Paul David
- Department of Research, Institute of Liver and Biliary Sciences , New Delhi , India
| | - Archana Rastogi
- Department of Pathology, Institute of Liver and Biliary Sciences , New Delhi , India
| | - Ashish Vyas
- Department of Research, Institute of Liver and Biliary Sciences , New Delhi , India
| | - Dileep Singh
- Department of Research, Institute of Liver and Biliary Sciences , New Delhi , India
| | - Ankit Bhardwaj
- Department of Hepatology, Institute of Liver and Biliary Sciences , New Delhi , India
| | - Amrish Sahney
- Department of Hepatology, Institute of Liver and Biliary Sciences , New Delhi , India
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences , New Delhi , India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences , New Delhi , India
| | - Nirupma Trehanpati
- Department of Research, Institute of Liver and Biliary Sciences , New Delhi , India
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Raval AD, Thakker D, Vyas A, Salkini M, Madhavan S, Sambamoorthi U. Impact of metformin on clinical outcomes among men with prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2015; 18:110-21. [PMID: 25667109 DOI: 10.1038/pcan.2014.52] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/18/2014] [Accepted: 11/19/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Conflicting evidence exists regarding the beneficial effects of metformin in prostate cancer. To determine the association between metformin and clinical outcomes in prostate cancer using systematic review and meta-analysis. METHODS Original articles published in English until third week of July, 2014 were searched in electronic databases (Medline-Ovid, Scopus, The Cochrane Library, Web of Science, ProQuest) for studies on metformin use in prostate cancer. The clinical outcomes assessed were: development of biochemical recurrence, metastases or castration-resistant metastatic cancer, all-cause and prostate cancer-specific mortality. Meta-analysis was performed to calculate the pooled hazard ratio (pHR) and their 95% confidence interval (95% CI). Heterogeneity between the studies was examined using I2 statistics. Sensitivity analysis was conducted to assess the robustness of findings and publication bias was assessed by the Egger's regression asymmetry test and contour plot. RESULTS Out of 230 retrieved citations, eight retrospective cohort studies and one nested-case-control study met the inclusion criteria. Metformin use was marginally associated with reduction in the risk of biochemical recurrence (pHR: 0.82, 95% CI: 0.67, 1.01, P-value=0.06, I2=25%, five studies). Metformin use was not significantly associated with metastases (pHR: 0.59, 95% 0.30-1.18, P-value=0.14, I2=74%, three studies), all-cause mortality (pHR: 0.86; 95% CI, 0.67, 1.10, P-value=0.23, I2: 73%, six studies) and prostate cancer-specific mortality (pHR: 0.76, 95% CI: 0.43, 1.33, P-value = 0.33, I2=60%, four studies). Pooled estimates for all outcomes varied in sensitivity analysis by diabetes status and primary treatment of prostate cancer. Systematic review revealed mixed findings on metformin use and the risk of CRPC. CONCLUSIONS Metformin may reduce the risk of biochemical recurrence in prostate cancer. Given the potential of selection bias in the observational studies, randomized trials should be designed to assess the efficacy of metformin use in prostate cancer.
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Affiliation(s)
- A D Raval
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - D Thakker
- Shrimati Kaumudiniben Health Outcomes Research Group (SKHORG), Dhrangadhra, Gujarat, India
| | - A Vyas
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - M Salkini
- Department of Surgery/Urology, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - S Madhavan
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - U Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
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Lillie S, Haines J, Vyas A, Fowler S. P121 Speech And Language Therapy In Pulmonary Rehabilitation: The Implication Of Education Sessions On Dysphagia Management. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Objective: This study aims to evaluate and compare with the existing literature on the etiology, pattern, gender, and anatomical distribution of mandibular fractures. Materials and Methods: The data of 225 cases were analyzed over a period of 5 years between March 2009 and November 2013. Of this 110 were unilateral, 23 bilateral, 18 symphysis and 74 multiple fractures. Results: Males are more affected than females. The peak incidence rate is occurring in 30-35 years of age group. The most common fracture site is parasymphysis and least common site is ramus of mandible. The most common etiological factor is road traffic accident (RTA) (45.3%) followed by falls (42.6%), assaults (8.9%), sport injuries (2.2%), and gunshot wounds (0.89%). Conclusion: Thus, we conclude that RTA is the leading cause of mandibular fractures and males are more affected. The most common site is parasymphysis fracture in association with angle fracture. We observed that gender was significantly associated with body and angle fracture (P = 0.04) and significant relationship between etiology with multiple site fracture such as (parasymphysis-angle), (body-condyle), (body-angle), and (symphysis-condyle) was observed (P ≤ 0.05).
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Affiliation(s)
- Ashish Vyas
- Department of Oral Surgery, Jodhpur Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Utpal Mazumdar
- Department of Oral Surgery, Jodhpur Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Firoz Khan
- Department of Oral Surgery, Jodhpur Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Madhura Mehra
- Department of Oral Surgery, Jodhpur Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Laveena Parihar
- Department of Oral Surgery, Jodhpur Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Chandni Purohit
- Department of Oral Surgery, Jodhpur Dental College and Hospital, Jodhpur, Rajasthan, India
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