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Shephard R, Uy J, Otterman V, Betker C, Sandhu HS, Tjaden L, Apatu E, Di Ruggiero E, Musto R, Pawa J, Steinberg M, Payne E, Fang L. The Core Competencies for Public Health in Canada: Opportunities and Recommendations for Modernization. J Public Health Manag Pract 2024; 30:432-441. [PMID: 38603751 DOI: 10.1097/phh.0000000000001884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
CONTEXT The 2008 Public Health Agency of Canada's (PHAC's) "Core Competencies for Public Health in Canada" (the "Canadian core competencies") outline the skills, attitudes, and knowledge essential for the practice of public health. The core competencies represent an important part of public health practice, workforce development, and education in Canada and internationally. However, the core competencies are considered outdated and are facing calls for review, expansion, and revision. OBJECTIVE To examine the literature on public health competencies to identify opportunities and recommendations for consideration when reviewing and updating the Canadian core competencies. METHODS This narrative literature review included 4 components: 3 literature searches conducted between 2021 and 2022 using similar search strategies, as well as an analysis of competency frameworks from comparable jurisdictions. The 3 searches were conducted in collaboration with the Health Library to identify core competency-relevant scholarly and gray literature published in English since 2007. Reference lists of sources identified were also reviewed. During the data extraction process, one researcher screened each source, extracted competency-relevant information, and categorized these data into key findings. RESULTS After identifying 2392 scholarly and gray literature sources, 166 competency-relevant sources were included in the review. Findings from these sources were synthesized into 3 main areas: (1) competency framework methodology and structure; (2) competencies to add; and (3) competencies to modify. DISCUSSION These findings demonstrate that updates to Canada's core competencies are needed and overdue. Recommendations to support this process include establishing a formal governance structure for the competencies' regular review, revision, and implementation, as well as ensuring that priority topics applicable across all competency categories are integrated as overarching themes. Limitations of the evidence include the potential lack of applicability and generalizability to the Canadian context, as well as biases associated with the narrative literature review methodology.
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Affiliation(s)
- Rosemarie Shephard
- Author Affiliations: Public Health Agency of Canada, Ottawa, Ontario, Canada (Mss Shephard, Uy, Otterman, Payne, and Fang); National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, Nova Scotia, Canada (Dr Betker, Mr Sandhu, and Ms Tjaden); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Mr Sandhu and Drs Di Ruggiero and Pawa); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (Dr Apatu); Canadian Public Health Association, Ottawa, Ontario, Canada (Dr Musto); Division of Clinical Sciences, NOSM University, Sudbury, Ontario, Canada (Dr Pawa); and Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (Dr Steinberg)
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Elsharkawy M, Sharafeldeen A, Khalifa F, Soliman A, Elnakib A, Ghazal M, Sewelam A, Thanos A, Sandhu HS, El-Baz A. A Clinically Explainable AI-Based Grading System for Age-Related Macular Degeneration Using Optical Coherence Tomography. IEEE J Biomed Health Inform 2024; PP:1-12. [PMID: 38231804 DOI: 10.1109/jbhi.2024.3355329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
We propose an automated, explainable artificial intelligence (xAI) system for age-related macular degeneration (AMD) diagnosis. Mimicking the physician's perceptions, the proposed xAI system is capable of deriving clinically meaningful features from optical coherence tomography (OCT) B-scan images to differentiate between a normal retina, different grades of AMD (early, intermediate, geographic atrophy (GA), inactive wet or active neovascular disease [exudative or wet AMD]), and non-AMD diseases. Particularly, we extract retinal OCT-based clinical imaging markers that are correlated with the progression of AMD, which include: (i) subretinal tissue, sub-retinal pigment epithelial tissue, intraretinal fluid, subretinal fluid, and choroidal hypertransmission detection using a DeepLabV3+ network; (ii) detection of merged retina layers using a novel convolutional neural network model; (iii) drusen detection based on 2D curvature analysis; (iv) estimation of retinal layers' thickness, and first-order and higher-order reflectivity features. Those clinical features are used to grade a retinal OCT in a hierarchical decision tree process. The first step looks for severe disruption of retinal layers' indicative of advanced AMD. These cases are analyzed further to diagnose GA, inactive wet AMD, active wet AMD, and non-AMD diseases. Less severe cases are analyzed using a different pipeline to identify OCT with AMD-specific pathology, which is graded as intermediate-stage or early-stage AMD. The remainder is classified as either being a normal retina or having other non-AMD pathology. The proposed system in the multi-way classification task, evaluated on 1285 OCT images, achieved 90.82% accuracy. These promising results demonstrated the capability to automatically distinguish between normal eyes and all AMD grades in addition to non-AMD diseases.
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Ashoorion V, Sadeghirad B, Sandhu HS, Busse JW. Factors Associated with Initiating Cannabis Use After Legalization in Canada: A Cross-Sectional Study. Cannabis Cannabinoid Res 2023; 8:1126-1132. [PMID: 35787021 DOI: 10.1089/can.2022.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Cannabis use has increased since the Government of Canada legalized nonmedical use in October 2018. We investigated demographic factors associated with initiating cannabis use after legalization. Materials and Methods: We used data from the 2018 and 2019 National Cannabis Survey and constructed multivariable regression models. Respondents' data were weighted and bootstrapped. We report relative measures of association as adjusted odds ratios (ORs) and absolute measures of association as adjusted risk increases (RIs). Results: Among the 58,195 households surveyed, 28,566 provided complete data (49%) and our weighted analysis represented 27,904,258 Canadians aged ≥ 15 years. Approximately one in five Canadians endorsed use of cannabis (19.8%), predominantly for nonmedical (9.5%) or combined medical and nonmedical (5.8%) reasons. Those who initiated cannabis use in the past 3 months (1.9%) were more likely to be younger (25-34 years vs. ≥ 65 years; adjusted OR 1.7, 95% confidence interval [CI] 1.1-2.8; adjusted RI 1.1%, 95% CI 0.1-2.0%), endorse poor to fair versus good to excellent physical health (adjusted OR 2.0, 95% CI 1.3-3.1; adjusted RI 1.7%, 95% CI 0.3-3.1%), and reside outside of Quebec (adjusted OR 1.4, 95% CI 1.1-2.0; adjusted RI 0.1%, 95% CI 0.6-1.1%). The 1% of Canadians who endorsed initiating use of cannabis due to legalization were more likely to reside outside of Quebec (adjusted OR 1.9, 95% CI 1.1-3.2; adjusted RI 0.5%, 95% CI 0.2-0.9%). Conclusion: Canadians initiating cannabis use after nonmedical legalization were likely to be younger and endorse worse physical health, and half of those using cannabis reported therapeutic use. Stricter policies, lower social acceptance, and less availability of cannabis in Quebec appear to have curtailed initiation of use after legalization.
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Affiliation(s)
- Vahid Ashoorion
- The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Canada
| | - Behnam Sadeghirad
- The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Harman S Sandhu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Jason W Busse
- The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Canada
- The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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Sandhu HS, Smith RW, Jarvis T, O'Neill M, Di Ruggiero E, Schwartz R, Rosella LC, Allin S, Pinto AD. Early Impacts of the COVID-19 Pandemic on Public Health Systems and Practice in 3 Canadian Provinces From the Perspective of Public Health Leaders: A Qualitative Study. J Public Health Manag Pract 2022; 28:702-711. [PMID: 36027605 PMCID: PMC9528938 DOI: 10.1097/phh.0000000000001596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT The COVID-19 pandemic has impacted health systems worldwide. Studies to date have largely focused on the health care system with less attention to the impact on public health systems and practice. OBJECTIVE To describe the early impacts of COVID-19 on public health systems and practice in 3 Canadian provinces from the perspective of public health system leaders and synthesize lessons learned. DESIGN A qualitative study using semistructured virtual interviews with public health leaders between October 2020 and April 2021. The World Health Organization's essential public health operations framework guided data collection and analysis. SETTING This study involved the Canadian provinces of Alberta, Ontario, and Québec. These provinces were chosen for their large populations, relatively high COVID-19 burden, and variation in public health systems. PARTICIPANTS Public health leaders from Alberta (n = 21), Ontario (n = 18), and Québec (n = 19) in organizations with a primary mandate of stewardship and/or administration of essential public health operations (total n = 58). RESULTS We found that the COVID-19 pandemic led to intensified collaboration in public health systems and a change in workforce capacity to respond to the pandemic. This came with opportunities but also challenges of burnout and disruption of non-COVID-19 services. Information systems and digital technologies were increasingly used and there was greater proximity between public health leaders and other health system leaders. A renewed recognition for public health work was also highlighted. CONCLUSIONS The COVID-19 pandemic impacted several aspects of public health systems in the provinces studied. Our findings can help public health leaders and policy makers identify areas for further investment (eg, intersectoral collaboration, information systems) and develop plans to address challenges (eg, disrupted services, workforce burnout) that have surfaced.
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Affiliation(s)
- Harman S. Sandhu
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Robert W. Smith
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Tamika Jarvis
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Meghan O'Neill
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Robert Schwartz
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Laura C. Rosella
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Sara Allin
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
| | - Andrew D. Pinto
- Dalla Lana School of Public Health (Mr Sandhu, Drs Smith, Di Ruggiero, Schwartz, Rosella, Allin, and Pinto, and Ms O'Neill), North American Observatory on Health Systems and Policies (Mr Sandhu and Dr Allin), Population Health Analytics Lab (Ms O'Neill and Dr Rosella), and Department of Family and Community Medicine, Faculty of Medicine (Dr Pinto), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Ms Jarvis); Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada (Dr Pinto); and Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada (Dr Pinto)
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Sandhu HS, Safari S, Bonsell L. 1026 Good Prescribing Laxatives Practice for Trauma Admissions in Orthopaedic Wards at Altnagelvin Hospital. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Aim
The aim of this QIP is to firstly increase percentage of T&O admissions to Orthopaedic Wards 23+25 prescribed laxatives by 25% by 1st of December over 1 month and to increase awareness among healthcare staff.
Background
Constipation in elderly during inpatient stay is common, 50% of pts>65years will develop this due to multifactorial reasons. Correct laxatives are very important to curb this predicament.
Method
These data were assessed over the following criteria, laxatives prescribed on admission, administered following prescription, monitoring bowel output, suppositories prescribed after admission. Following each week QI cycles, appropriate interventions were made to improve the adherence and data was re-measured again.
Results
From Baseline data, only 45% of patient were prescribed laxatives and only 20% patients received the medication initially. Of this group, only 20% pts had suppositories prescribed following admission. Lastly, 40% of patients had Bowel Opened (BO)>3days ago. First intervention was educating all SHOs to ensure patients received prescription on admission. Following this, mainly laxative prescription increased by 40%, and patient received their laxatives by 2% respectively in PDSA 1.
In PDSA 2, we actively ensured educating nursing staff to encourage laxative prescriptions and to inform doctors for patients with Last BO>3days ago for suppositories prescribing. Following this, laxative prescription increased to 80% while 65% pts received their prescription. Only 15% pts had BO>3days too.
Conclusion
Regular laxatives are superior to PRN & Recommended regime is Senna+Lactulose for patient adherence. Additionally, suppositories should be given as STAT rather than Prn as well.
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Affiliation(s)
- HS Sandhu
- Altnagelvin Hospital , Londonderry , United Kingdom
| | - S Safari
- Altnagelvin Hospital , Londonderry , United Kingdom
| | - L Bonsell
- Altnagelvin Hospital , Londonderry , United Kingdom
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Sandhu HS, Arora A, Brasch J. Correlates of explicit and implicit stigmatizing attitudes of Canadian undergraduate university students toward mental illness: A cross-sectional study. J Am Coll Health 2021; 69:567-571. [PMID: 31702960 DOI: 10.1080/07448481.2019.1682002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/09/2019] [Accepted: 10/12/2019] [Indexed: 06/10/2023]
Abstract
To assess explicit and implicit attitudes toward mental illness of undergraduate students and explore associated variables. Participants: Year 1-4 undergraduate students from a large Canadian university (n = 382). Methods: Participants completed demographics, the Opening Minds Scale for Healthcare Providers, and an Implicit Association Test. Two-tailed independent and paired-samples t-tests, and ANOVA were performed with significance level at p < .05. Results: About 67.5% self-reported having experienced a mental illness and 31.2% had been diagnosed. Lower explicit stigma was associated with females, those with a history of mental illness diagnosis, and those who have had a close relationship with someone experiencing a mental illness. Faculty of Social Sciences students had significantly lower explicit stigma scores than Faculty of Engineering students. Implicit stigma did not show significant associations with any factors. Conclusions: A high proportion of undergraduate students experience mental illness. Increased exposure and experience were associated with reduced explicit stigma.
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Affiliation(s)
- Harman S Sandhu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Anish Arora
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Jennifer Brasch
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Sandhu HS, Arora A, Sarker SI, Shah B, Sivendra A, Winsor ES, Luthra A. Pandemic prevention and unsustainable animal-based consumption. Bull World Health Organ 2021; 99:603-605. [PMID: 34354315 PMCID: PMC8319869 DOI: 10.2471/blt.20.276238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 04/02/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Harman S Sandhu
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada
| | - Anish Arora
- Faculty of Medicine, McGill University, Montréal, Canada
| | - Saadia I Sarker
- Toronto General Hospital, University Health Network, Toronto, Canada
| | - Bindra Shah
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - Anusha Sivendra
- Milken Institute School of Public Health, The George Washington University, Washington DC, United States of America
| | - Emily S Winsor
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Canada
| | - Anahat Luthra
- Schulich School of Medicine & Dentistry, Western University, London, Canada
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Kaul R, Sandhu HS, Talwar BS, Chengappa D, Bali A, Koul R. Oral pain and infection control strategies for treating children and adolescents in India. J Family Med Prim Care 2021; 10:1987-1993. [PMID: 34195136 PMCID: PMC8208180 DOI: 10.4103/jfmpc.jfmpc_2419_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/21/2021] [Accepted: 03/12/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Oral and dental health form an integral part of complete well being of an individual and society at large. Promoting oral health and societal progression go hand in hand. Aim: To investigate dentists' attitudes about pain and infection control while treating children and adolescents by assessing their recommendations of pre- and postoperative analgesics and antibiotics, and use of local anesthesia (LA) for definitive treatment in different clinical scenarios. Materials and Method: A total of 400 dentists, both general dental practitioners (GDPS) as well as specialist dentists, were surveyed over a period of 2 months by using a pre-tested close-ended questionnaire. The data was statistically analyzed using Pearson's Chi-square test and backward logistic regression analysis for analysis of categorical variables and independent variables, respectively. Level of significance was set at 5%. Results: It was found that there was a gross overuse of antibiotics and analgesics and under use of LA by GDPs compared to specialist dentists. Postoperative antibiotics and analgesics were used more commonly than preoperative antibiotics and analgesics. These strategies were used more often in permanent teeth than primary teeth except the use of LA, which was used with equal frequency in both primary as well as permanent dentition. Conclusion: Dependence on antibiotics and analgesics for achieving pain and infection control in children has to be minimized and focus has to be shifted on judicious definitive treatment involving use of LA, aseptic techniques, and behavior management techniques.
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Affiliation(s)
- Rahul Kaul
- Dental Officer (Peadodontics and Preventive Dentistry), Field Hospital, Manipur, Punjab, India
| | - H S Sandhu
- Classified Specialist (Prosthodontics) CMDC, Chandigarh, Punjab, India
| | | | - Dmm Chengappa
- Graded Specialist (Peadodontics and Preventive Dentistry) INHS Sanjivani,Kerala, India
| | - Atul Bali
- Classified Specialist (Orthodontics) Army Dental Centre Research and Referral, New Delhi, India
| | - Rishu Koul
- Dental Officer, MDC Gopalpur, Odisha, India
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Arora A, Sandhu HS, Brasch J. Authors' Response to Comment on "The Potential Effect of the Psychiatric Clerkship and Contact-Based Hypothesis on Explicit and Implicit Stigmatizing Attitudes of Canadian Medical Students Towards Mental Illness". Acad Psychiatry 2020; 44:244-245. [PMID: 31933115 DOI: 10.1007/s40596-020-01181-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/08/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Anish Arora
- McGill University, Montreal, Quebec, Canada.
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Beuzelin JM, VanWeelden MT, Soto-Adames FN, Sandhu HS, Davidson RW, Baucum L, Swanson S. Effect of Sugarcane Cultivar and Foliar Insecticide Treatment on Infestations of the Invasive Sugarcane Thrips, Fulmekiola serrata (Thysanoptera: Thripidae), in Florida. J Econ Entomol 2019; 112:2703-2712. [PMID: 31265727 DOI: 10.1093/jee/toz188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Indexed: 06/09/2023]
Abstract
Fulmekiola serrata (Kobus) was observed infesting sugarcane, Saccharum spp. hybrids, in the United States for the first time in January 2017 in Florida. Field studies were conducted to determine F. serrata infestation levels on popular sugarcane cultivars and to determine the efficacy of foliar insecticide treatments that could be used for management. Cultivar evaluations comparing six and five commercial cultivars representing >46% of the sugarcane production area in Florida were conducted in 2017 and 2018, respectively. Fulmekiola serrata infestation levels did not differ among cultivars in 2017. However, infestation levels on CP 00-1101 were greater than on CP 96-1252 grown on organic soils, and infestation levels on CP 96-1252 were greater than on CPCL 97-2730 grown on mineral soils in 2018. Three insecticide evaluations, two in 2017 and one in 2018, were conducted. The pyrethroid lambda-cyhalothrin, which is registered for use on sugarcane, was consistently associated with the greatest decreases in F. serrata infestation levels. The neonicotinoids imidacloprid and thiamethoxam, as well as the butenolide flupyradifurone, decreased infestation levels but to a lesser extent than did lambda-cyhalothrin. The spinosyn spinetoram was associated with the lowest decreases in F. serrata infestation levels. Our results supported short-term F. serrata management recommendations: Popular Florida sugarcane cultivars should be considered equally susceptible to F. serrata until additional evaluations are conducted and F. serrata outbreaks can be treated with lambda-cyhalothrin when infestations stress the crop beyond acceptable levels.
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Affiliation(s)
- J M Beuzelin
- Everglades Research and Education Center, University of Florida Institute of Food and Agricultural Sciences, Belle Glade, FL
| | - M T VanWeelden
- Extension Service, University of Florida Institute of Food and Agricultural Sciences, Belle Glade, FL
| | - F N Soto-Adames
- Florida Department of Agriculture and Consumer Services-Division of Plant Industry, Gainesville, FL
| | - H S Sandhu
- Everglades Research and Education Center, University of Florida Institute of Food and Agricultural Sciences, Belle Glade, FL
| | | | - L Baucum
- United States Sugar Corporation,Clewiston, FL
| | - S Swanson
- Extension Service, University of Florida Institute of Food and Agricultural Sciences, LaBelle, FL
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Arora A, Sandhu HS, Brasch J. The Potential Effect of the Psychiatric Clerkship and Contact-Based Hypothesis on Explicit and Implicit Stigmatizing Attitudes of Canadian Medical Students Towards Mental Illness. Acad Psychiatry 2019; 43:605-609. [PMID: 31407227 DOI: 10.1007/s40596-019-01090-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to assess if having completed a psychiatric clerkship or having increased exposure to mental illness in general was associated with reduced explicit and implicit stigmatizing attitudes towards mental illness in undergraduate medical students. METHODS A secondary analysis of data specific to medical students from McMaster University was completed. Data were obtained through a cross-sectional survey administered electronically. It consisted of a demographic questionnaire, the Opening Minds Scale for Healthcare Providers (OMS-HC) 12-item survey, and an Implicit Association Test (IAT). The OMS-HC was used as a measure of explicit stigmatizing attitudes, whereas the IAT was used as a measure of implicit bias. All analyses were completed using Stata/IC 15 and were two-tailed with significance defined as p < 0.05. RESULTS Individuals that self-reported either having had a mental illness or diagnosis by a health care professional had significantly lower levels of explicit stigma. Final-year medical students had significantly lower levels of implicit stigmatizing attitudes than first-year medical students. Neither having completed a psychiatric clerkship nor having a close relationship with someone experiencing a mental illness was significantly associated with the explicit or implicit stigmatizing attitudes of medical students. CONCLUSION More years in medical school and self-identifying or receiving a diagnosis of mental illness are associated with reduced stigmatizing attitudes, whereas having completed the psychiatric clerkship and having a close relationship with an individual experiencing mental illness were not. This study suggests that the psychiatric clerkship may have limited impact on the stigmatizing attitudes of medical students.
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Affiliation(s)
- Anish Arora
- McGill University, Montreal, Quebec, Canada.
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Arora A, Sandhu HS, Brasch J. Correction to: The Potential Effect of the Psychiatric Clerkship and Contact-Based Hypothesis on Explicit and Implicit Stigmatizing Attitudes of Canadian Medical Students Towards Mental Illness. Acad Psychiatry 2019; 43:610. [PMID: 31512158 DOI: 10.1007/s40596-019-01105-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The authors would like to correct the footnote of Table 2.
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Affiliation(s)
- Anish Arora
- McGill University, Montreal, Quebec, Canada.
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Sandhu HS, Anderson LN, Busse JW. Characteristics of Canadians likely to try or increase cannabis use following legalization for nonmedical purposes: a cross-sectional study. CMAJ Open 2019; 7:E399-E404. [PMID: 31201176 PMCID: PMC6579652 DOI: 10.9778/cmajo.20190008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/21/2022] Open
Abstract
BACKGROUND The Government of Canada legalized nonmedical use of cannabis in October 2018. Our objectives were to determine the percentage of Canadians intending to try or increase their cannabis use following legalization and to explore characteristics associated with this intent. METHODS We used data from the 2018 National Cannabis Survey and constructed multivariable regression models. Respondents' data were weighted and bootstrapped. We report relative measures of association as adjusted odds ratios (ORs) and absolute measures of association as adjusted risk increases (RIs). RESULTS Among the 39 000 households selected for recruitment for the survey, 17 089 respondents provided complete data (43.8%) and our weighted analysis represented 27 808 081 Canadians aged 15 years and older. An estimated 18.5% of respondents (95% confidence interval [CI] 17.6%-19.5%) indicated they intended to try or increase cannabis use following legalization. Being more likely to try or increase cannabis use was associated with younger age (15-24 yr v. ≥ 65 yr; adjusted OR 3.8, 95% CI 2.6-5.6; adjusted RI 20.1%, 95% CI 13.9%-26.2%), cannabis use in the past 3 months versus no use (adjusted OR 3.3, 95% CI 2.8-3.9; adjusted RI 20.4%, 95% CI 17.1%-23.6%), higher income (≥ $80 000 v. < $40 000; adjusted OR 1.5, 95% CI 1.3-1.9; adjusted RI 6.1%, 95% CI 3.2%-9.0%) and poor or fair mental health versus good to excellent mental health (adjusted OR 2.0, 95% CI 1.6-2.6; adjusted RI 11.5%, 95% CI 6.7%-16.2%). INTERPRETATION Nearly 1 in 5 respondents reported that they intended to try or increase cannabis use after legalization; however, intention may not translate into behaviour. Continued monitoring should help to establish rates and patterns of cannabis use among Canadians following legalization.
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Affiliation(s)
- Harman S Sandhu
- Department of Health Research Methods, Evidence, and Impact (Sandhu, Anderson), and Centre for Health Economics and Policy Analysis (Anderson), McMaster University; Department of Anesthesia (Busse), Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ont
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact (Sandhu, Anderson), and Centre for Health Economics and Policy Analysis (Anderson), McMaster University; Department of Anesthesia (Busse), Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ont
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact (Sandhu, Anderson), and Centre for Health Economics and Policy Analysis (Anderson), McMaster University; Department of Anesthesia (Busse), Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ont.
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Sandhu HS, Arora A, Brasch J, Streiner DL. Mental Health Stigma: Explicit and Implicit Attitudes of Canadian Undergraduate Students, Medical School Students, and Psychiatrists. Can J Psychiatry 2019; 64:209-217. [PMID: 30058372 PMCID: PMC6405810 DOI: 10.1177/0706743718792193] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare explicit and implicit stigmatizing attitudes towards mental illness among undergraduate students, medical school students, and psychiatrists, and to assess whether attitudes are associated with education level, exposure to, and personal experience with mental illness. METHODS Participants from McMaster University were recruited through email. Participants completed a web-based survey consisting of demographics; the Opening Minds Scale for Healthcare Providers (OMS-HC) 12-item survey, which measures explicit stigma; and an Implicit Association Test (IAT), measuring implicit bias toward physical illness (diabetes mellitus) or mental illness (schizophrenia). RESULTS A total of 538 people participated: undergraduate students ( n = 382), medical school students ( n = 118), and psychiatrists ( n = 38). Psychiatrists had significantly lower explicit and implicit stigma than undergraduate students and medical school students. Having been diagnosed with mental illness or having had a relationship with someone experiencing one was significantly associated with lower explicit stigma. Mean scores on the OMS-HC "disclosure/help-seeking" subscale were higher compared with the "attitudes towards people with mental illness" subscale. There was no correlation between the OMS-HC and IAT. CONCLUSIONS These findings support the theory that increased education and experience with mental illness are associated with reduced stigma. Attitudes regarding disclosure/help-seeking were more stigmatizing than attitudes towards people with mental illness. The groups identified in this study can potentially benefit from anti-stigma campaigns that focus on reducing specific components of explicit, implicit, public and self-stigma.
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Affiliation(s)
- Harman S Sandhu
- 1 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Anish Arora
- 2 Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Jennifer Brasch
- 3 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - David L Streiner
- 3 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,4 Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Bhalwar R, Deshpande VR, Sandhu HS, Gokarn AG. RANDOMISED, CONTROLLED, BLINDED FIELD TRIAL ON THE EFFICACY OF BIOCIDE FORMULATION (BACILLUS SPP.) IN THE CONTROL OF MOSQUITO VECTORS. Med J Armed Forces India 2017; 51:4-8. [PMID: 28769231 DOI: 10.1016/s0377-1237(17)30909-7] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A randomised, controlled, blinded field trial was conducted in a large cantonment area, to study the efficacy of the biocide formulation (Bacillus spp.) indigenously produced by Central Drug Research Institute, Lucknow, India, as a mosquito larvicide, in comparison with Fenthion and Temephos. The study revealed that the biocide formulation in dosage of 5 grams per square metre brought about a very high level of control of culicine larvae from third day of application and the effect persisted till at least 28 days (median values of percentage reduction achieved being 93% to 100%). This effect was statistically significant from 7th to 28th day, as compared to Fenthion, Temephos or the biocide in dosage of 2 grams per square metre. Fenthion, on the other hand was statistically more efficacious in bringing about a quick reduction, with a 100% reduction being obtained within a day, but the effect declined to a low level by 7th day.
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Mittal M, Anil Kumar S, Sandhu HS, Iyer SR, Ahuja RS. Comparative evaluation of the tensile bond strength of two silicone based denture liners with denture base resins. Med J Armed Forces India 2016; 72:258-64. [PMID: 27546966 DOI: 10.1016/j.mjafi.2015.03.004] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 03/18/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To evaluate and compare tensile bond strength of two silicone based liners with heat cure and heat cure high impact denture base resin at baseline and after storage in artificial saliva for 30 and 60 days. METHOD Heat cure conventional and high impact acrylic blocks (120 blocks each) prepared with final test specimen of two blocks of each resin with a liner. The baseline samples and those tested after 30 and 60 days interval stored in artificial saliva in thermal incubator, all were pulled apart in UTM at 20 mm/min. The tensile bond strength and mode of failure (adhesive/cohesive) were assessed. Mean, SD determined and analysis using one way ANOVA and paired 't' test. RESULTS The highest mean tensile bond strength (1.028 MPa) and the least i.e. 0.289 MPa was observed with Permaflex silicone liner against heat cure PMMA after storage in artificial saliva at 37 ± 1 °C. CONCLUSION The study rejected the null hypothesis because storage time in artificial saliva affected the bond strength of the resilient liners examined. The results revealed a statistically significant difference (p < 0.05) of artificial saliva storage on the bond strength of both the liners. After storage in artificial saliva for 30 days and 60 days at 37 ± 1 °C, all the specimens showed a significant reduction in the tensile bond strength.
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Affiliation(s)
- Manish Mittal
- Graded Specialist (Prosthodontics), Command Military Dental Centre (Central Command), Lucknow, India
| | - S Anil Kumar
- Graded Specialist (Prosthodontics), Command Military Dental Centre (Central Command), Lucknow, India
| | - H S Sandhu
- Professor & Senior Specialist (Prosthodontics), O/O DGDS, IHQ Min of Def, New Delhi, India
| | - Satish R Iyer
- Professor & Senior Specialist (Prosthodontics), Command Military Dental Centre (Southern Command), Pune, India
| | - Ratandeep S Ahuja
- Graded Specialist (Prosthodontics), Command Military Dental Centre (Northern Command), Udhampur, India
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Arun Kumar KV, Gupta SH, Sandhu HS. Determination of mesiodistal width of maxillary anterior teeth using inner canthal distance. Med J Armed Forces India 2016; 71:S376-81. [PMID: 26843753 DOI: 10.1016/j.mjafi.2014.08.002] [Citation(s) in RCA: 6] [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: 04/30/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Selection of appropriately sized maxillary anterior teeth is one of the important aspects of complete denture prosthodontics. In the past several methods have been proposed, but little consensus on an effective method for anterior teeth selection has been reached. Inner canthal distance is one of the reliable anatomic dimension that may provide a valid approach to anterior teeth selection. This study was aimed to ascertain the co-relation between inner canthal distance (ICD) and combined mesiodistal width of maxillary anterior teeth. METHOD This study was conducted in Army Dental Centre (R & R) Delhi Cantonment between Aug 2006 to Mar 2008. Eight hundred dentate Indian subjects of four different ethnic group; Such as Rajputs, Marathas, Sikh and Tamilian. 100 males and 100 females from each race under the age group of 18-30 years formed the subjects of study. The ICD and mesio-distal width of maxillary anteriors were measured using Digital Vernier Caliper. The Data obtained was statistically analyzed. RESULTS A consistent ratio of 1.61 was found between ICD and combined mesiodistal width of maxillary anteriors in all four ethnic group. The mean value showed no statistically significant difference between sex. The variation in the ratio between the ethnic groups was negligible. CONCLUSION The findings of the study indicated that, to select the combined mesiodistal width of maxillary anterior teeth, ICD of the required patient should be multiplied by 1.61. This ratio was consistent with all the four ethnic groups irrespective of sex.
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Affiliation(s)
- K V Arun Kumar
- Assistant Professor (Prosthodontics), Dept of Dental Surgery, Armed Forces Medical College, Pune 411040, India
| | - S H Gupta
- Commandant, Army Dental Centre (R&R), Delhi Cant, New Delhi 110010, India
| | - H S Sandhu
- DDGDS (P) O/o DGDS, Adjutant General's Branch, IHQ, MoD, L Block, New Delhi 110001, India
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Gill KK, Sandhu HS, Kaur R. Haematological alterations induced by oral subacute exposure to fenvalerate, nitrate and their combination in domestic buffalo, Bubalus bubalis. Bull Environ Contam Toxicol 2014; 92:703-707. [PMID: 24687223 DOI: 10.1007/s00128-014-1261-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 03/18/2014] [Indexed: 06/03/2023]
Abstract
The present study investigated haematological alterations induced by oral subacute exposure to fenvalerate, nitrate and their combination in the domestic buffalo, Bubalus bubalis. Fenvalerate exposure produced significant declines in haemoglobin (Hb), total leukocyte count (TLC), total erythrocyte count (TEC) and mean corpuscular haemoglobin concentration (MCHC), and a corresponding elevation in mean corpuscular volume (MCV). Following oral exposure to sodium nitrate, significant declines in blood Hb, TLC, TEC, MCH and MCHC, and a significant elevation in MCV occurred. Combined exposure to fenvalerate and sodium nitrate produced severe effects with an appreciably more prominent decline in Hb, TLC, TEC and MCHC and a significant elevation in MCV. The percentage of methaemoglobin was observed to follow an elevating trend in animals exposed to sodium nitrate alone (0.69 %-13.8 %) and in combination with fenvalerate (0.75 %-13.7 %).
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Affiliation(s)
- Kamalpreet Kaur Gill
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, 141004, India,
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Goswami MM, Gupta SH, Sandhu HS. Evaluation of shear bond strength of composite resin bonded to alloy treated with sandblasting and electrolytic etching. J Indian Prosthodont Soc 2014; 14:98-103. [PMID: 24605005 DOI: 10.1007/s13191-013-0280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 03/18/2013] [Indexed: 11/25/2022] Open
Abstract
Conservation of natural tooth structure precipitated the emergence of resin-retained fixed partial dentures. The weakest link in this modality is the bond between resin cement and alloy of the retainer. Various alloy surface treatment have been recommended to improve alloy-resin bond. This in vitro study was carried out to observe changes in the Nickel-Chromium alloy (Wiron 99, Bego) surface following sandblasting or electrolytic etching treatment by scanning electron microscope (SEM) and to evaluate the shear bond strength of a resin luting cement bonded to the surface treated alloy. 80 alloy blocks were cast and divided into four groups of 20 each. In groups-A & B, the test surfaces were treated by sandblasting with 50 and 250 μm sized aluminium oxide particles respectively. In groups-C & D, the test surfaces were first treated by sandblasting with 50 and 250 μm sized aluminium oxide particles respectively followed by electrolytic etching. Test surfaces were observed under SEM at 1,000× magnification. Two alloy blocks of each group were luted together by a resin luting cement (Rely X, 3M) and their shear bond strength was tested. The mean shear bond strength in MPa of groups-A to D were 6.44 (±0.74), 8.18 (±0.51), 14.45 (±0.59) and 17.43 (±1.20) respectively. Group-D showed bond strength that is more than clinically acceptable bond strength. It is recommended that before luting resin-retained fixed partial dentures, the fitting surface of the retainer should be electrolytically etched to achieve adequate micromechanical retention.
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Affiliation(s)
- M M Goswami
- 202 Military Dental Centre, C/O 56 APO, Jammu, India
| | - S H Gupta
- Command Military Dental Centre (WC), C/O 56 APO, Chandimandir.z, India
| | - H S Sandhu
- Command Military Dental Centre (NC), C/O 56 APO, Udhampur, India
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Dua P, Gupta SH, Ramachandran S, Sandhu HS. Evaluation of Four Elastomeric Interocclusal Recording Materials. Med J Armed Forces India 2011; 63:237-40. [PMID: 27408006 DOI: 10.1016/s0377-1237(07)80143-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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: 06/28/2005] [Accepted: 12/19/2005] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The fabrication of dental prosthesis requires the transfer of interocclusal records from patient's mouth to semi-adjustable articulators using different kinds of recording media. Any inaccuracy in these interocclusal records leads to occlusal errors in the final prosthesis. This study was conducted to evaluate the dimensional changes occurring in the interocclusal recording material over a given period of time and the material's resistance to compression during the cast mounting on the articulator. METHODS In this in vitro study, the linear dimensional change and compressive resistance of four commercially available elastomeric interocclusal recording media was tested. Three were addition silicones and the fourth was a polyether material. Cylindrical samples of 10mm diameter of each material were prepared in three different thicknesses of 2, 4 and 6mm. Ten samples each of thickness of 2, 4 and 6mm for all four materials were prepared (total of 120 samples). The linear dimensional changes of the samples were evaluated after 24 hours of fabrication. The compressive resistance was measured when each of these was subjected to a constant compressive load of 25 Newtons. RESULTS The mean linear dimensional change in a horizontal plane was minimum for Kanibite Hard, an addition silicone. Ramitec showed the maximum linear dimensional change. The mean compression distance was least for Futar D Occlusion (an addition silicone) and maximum for Ramitec (a polyether). It was observed that the samples of thickness 2mm for all the materials underwent least compression. CONCLUSION The compressive resistance of each elastomer was inversely proportional to the thickness of the sample. This implies that minimum thickness of the recording materials should be used for recording maxillomandibular relations without sacrificing the strength of the interocclusal record.
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Affiliation(s)
- P Dua
- Graded Specialist (Prosthodontics) OC, Military Dental Centre, Amritsar-143001
| | - S H Gupta
- Classified Specialist (Prosthodontics), Air Force Institute of Dental Sciences, Agram Post, Bangalore - 560007
| | - S Ramachandran
- Associate Professor (Prosthodontics), Dept of Dental Surgery, AFMC, Pune
| | - H S Sandhu
- Classified Specialist (Prosthodontics), 33 Corps Dental Unit, C/o 99 APO
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Abstract
In the present investigation, the behavioral, morphological, and histopathological effects of cypermethrin, a widely used synthetic pyrethroid insecticide, was ascertained in male and female albino rats (Rattus norvegicus). Cypermethrin administered at repeated oral doses of 5 and 20 mg/kg/day for 30 days produced varying degree of mild to moderate toxic symptoms and behavioral changes in both male and female rats. The lower dose produced very mild toxicosis characterized by intermittent diarrhea, decreased feed intake, and thick eye discharge, whereas higher dose displayed mild to moderate toxicosis with diarrhea, decreased feed intake, loss of body weight, dyspnoea, ataxia, eye discharge, and salivation. Two female and one male albino rats died between 23 to 28 days after displaying signs of incoordination and tremors. Repeated oral doses of cypermethrin for 30 days enhanced the relative weight of liver and heart, but significantly decreased that of brain, kidneys, and testes. Microscopically, cypermethrin produced neuronal degeneration and increase in glial cells in brain, and disorganization of hepatic laminae, increase in sinusoid, and necrosis of hepatocytes in liver. Section of kidney displayed hemorrhage and sloughing off renal epithelial cell in the convoluted tubules, shrinkage of glomeruli, and necrosis of renal tubules. Repeated administration of cypermethrin also produced hemorrhages within myocardium, disruption of branching structure, and loss of striation of cardiac tissue; thickening of alveolar septa in lungs, partial to extensive loss of various stages of spermatogenesis in testes, and loss of follicular cells and oocytes in ovaries. The study suggested that repeated oral exposure of cypermethrin has considerable harmful effects on body organs in R. norvegicus.
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Affiliation(s)
- K K Grewal
- Department of Zoology, S.G.N. Khalsa College, Sri Ganganagar, Rajasthan, India
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Chavhan SG, Brar RS, Banga HS, Sandhu HS, Sodhi S, Gadhave PD, Kothule VR, Kammon AM. Clinicopathological Studies on Vitamin D(3) Toxicity and Therapeutic Evaluation of Aloe vera in Rats. Toxicol Int 2011; 18:35-43. [PMID: 21430919 PMCID: PMC3052582 DOI: 10.4103/0971-6580.75851] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A study was conducted to examine the clinical signs, hematological, biochemical and histopathological changes in vitamin D3 toxicity at a dose rate 2 mg/kg b.wt. of vitamin D3 and to assess the protective effect of Aloe vera in vitamin D3 toxicity. The clinical signs observed were anorexia, progressive weight loss, difficulty in movement and respiration, diarrhea, epistaxis, subnormal body temperature and nervous signs before death. Mortality was observed in treated rats between day 10 and day 19 of treatment. The gross postmortem changes observed were severe emaciation, white chalky deposits on epicardial surface of heart, pin point white deposits on cortical surface of kidneys with pale yellow discoloration and diffused white deposits on serosal surface of stomach and intestine with bloody ingesta in lumen. The hematological changes included non-significant increase in hemoglobin and total leukocyte count and significant increase in relative neutrophil count. The biochemical changes observed were significant increase in plasma concentration of calcium, phosphorus and blood urea nitrogen, whereas a significant decrease in the concentration of albumin and total plasma protein was observed. The histopathological lesions included calcification of various organs, viz., tongue, stomach, intestines, kidney, heart, aorta, larynx, trachea, lungs, spleen, choroid plexus arteries of brain and vas deferens. The Aloe vera juice (2.5% in drinking water) has no protective effect on vitamin D3 toxicity (2 mg/kg b.wt.).
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Banga HS, Deshmukh S, Brar RS, Gadhave PD, Chavhan SG, Sandhu HS. A Case of Intranasal Hemangioma and Concurrent Tetracycline-induced Ulcerative Gastritis in Dogs. Toxicol Int 2010; 17:33-6. [PMID: 21042472 PMCID: PMC2964738 DOI: 10.4103/0971-6580.68348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Incidence of drug-induced gastritis and ulceration in human medicine is well established. Besides, unilateral hemangioma, a unique concurrent case of tetracycline induced gastric toxicity in a dog, characterized by gastritis and ulceration is being reported here. Grossly, the appearance of gastric ulcers mimicked the appearance of Italian pizza. Histological examination further supported drug-induced etiology in this case. This is probably the one of the few cases in the annals of veterinary medicine to be documented as drug-induced gastric toxicity in dog.
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Affiliation(s)
- H S Banga
- Department of Veterinary Pathology, College of Veterinary Science, GADVASU, Ludhiana - 141 004, Punjab, India
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Kaur R, Sandhu HS. In vivo changes in antioxidant system and protective role of selenium in chlorpyrifos-induced subchronic toxicity in bubalus bubalis. Environ Toxicol Pharmacol 2008; 26:45-8. [PMID: 21783886 DOI: 10.1016/j.etap.2008.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 01/09/2008] [Accepted: 01/10/2008] [Indexed: 05/04/2023]
Abstract
Chlorpyrifos, an organophosphate, is one of the widely used insecticides for control of pests in various agricultural and animal husbandry operations. The objective of the present investigation was to assess the effect of subchronic exposure of chlorpyrifos on the antioxidant status of buffalo calves and to perceive the role of selenium in cases of chlorpyrifos toxicity. Chlorpyrifos at a dose rate of 0.05mg/kg per day for 20 consecutive weeks, significantly elevated the enzymic activity of glutathione peroxidase (GPx) (54.8%), glutathione reductase (GR) (79.4%), glutathione-S-transferase (GST) (34.2%), glucose-6-phosphate dehydrogenase (G6PD) (33.2%), superoxide dismutase (SOD) (19.3%) and catalase (CAT) (63.8%). The altered antioxidant status was well evident from the depleting glutathione levels and a two-fold rise in the extent of lipid peroxidation. Supplementation of selenium in the form of sodium selenite @ 0.05mg/kg per day for 20 weeks in chlorpyrifos intoxicated calves had a marked beneficial effect on the overall antioxidant potential of the animals as evident by no significant alteration in the extent of lipid peroxidation, levels of blood glutathione and activities of various antioxidant enzymes viz. GST, GR, SOD, CAT and G6PD. There was only a significant increase in the activity of GPx to the tune of 27.4%. Therefore, on the basis of the present investigation it can be suggested that oxidative stress is one of the main mechanism involved in chlorpyrifos toxicity and supplementation with sodium selenite in such cases can have significant beneficial and therapeutic effects.
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Affiliation(s)
- Rajdeep Kaur
- Department of Veterinary Pharmacology & Toxicology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana 141004, India
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Raipuria M, Dumka VK, Sandhu HS. Plasma Concentrations, Pharmacokinetics and Urinary Excretion of Gatifloxacin after Single Intravenous Injection in Buffalo Calves. Vet Res Commun 2007; 31:1013-20. [PMID: 17273911 DOI: 10.1007/s11259-007-3343-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2005] [Indexed: 11/30/2022]
Abstract
The pharmacokinetics and urinary excretion of gatifloxacin were investigated after a single intravenous injection of 4 mg/kg body weight in buffalo calves. The therapeutic plasma drug concentration was maintained for up to 12 h. Gatifloxacin rapidly distributed from blood to tissue compartments, which was evident from the high values of the distribution rate constant, alpha1 (11.1 +/- 1.06 h(-1)) and the rate constant of transfer of drug from central to peripheral compartment, k12 (6.29 +/- 0.46 h(-1)). The area under the plasma drug concentration-time curve and apparent volume of distribution were 17.1 +/- 0.63 (microg.h)/ml and 3.56 +/- 0.95 L/kg, respectively. The elimination half-life (t (1/2 beta)), total body clearance (ClB) and the ratio of drug present in tissues and plasma (T/P) were 10.4 +/- 2.47 h, 235.1 +/- 8.47 ml/(kg.h) and 10.1 +/- 2.25, respectively. About 19.7% of the administered drug was excreted in urine within 24 h. A satisfactory intravenous dosage regimen for gatifloxacin in buffalo calves would be 5.3 mg/kg at 24 h intervals.
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Affiliation(s)
- M Raipuria
- Department of Pharmacology and Toxicology, College of Veterinary Science, Punjab Agricultural University, Ludhiana, 141004, India
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Arnold LM, Goldenberg DL, Stanford SB, Lalonde JK, Sandhu HS, Keck PE, Welge JA, Bishop F, Stanford KE, Hess EV, Hudson JI. Gabapentin in the treatment of fibromyalgia: A randomized, double-blind, placebo-controlled, multicenter trial. ACTA ACUST UNITED AC 2007; 56:1336-44. [PMID: 17393438 DOI: 10.1002/art.22457] [Citation(s) in RCA: 244] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of gabapentin in patients with fibromyalgia. METHODS A 12-week, randomized, double-blind study was designed to compare gabapentin (1,200-2,400 mg/day) (n=75 patients) with placebo (n=75 patients) for efficacy and safety in treating pain associated with fibromyalgia. The primary outcome measure was the Brief Pain Inventory (BPI) average pain severity score (range 0-10, where 0=no pain and 10=pain as bad as you can imagine). Response to treatment was defined as a reduction of >or=30% in this score. The primary analysis of efficacy for continuous variables was a longitudinal analysis of the intent-to-treat sample, with treatment-by-time interaction as the measure of effect. RESULTS Gabapentin-treated patients displayed a significantly greater improvement in the BPI average pain severity score (P=0.015; estimated difference between groups at week 12=-0.92 [95% confidence interval -1.75, -0.71]). A significantly greater proportion of gabapentin-treated patients compared with placebo-treated patients achieved response at end point (51% versus 31%; P=0.014). Gabapentin compared with placebo also significantly improved the BPI average pain interference score, the Fibromyalgia Impact Questionnaire total score, the Clinical Global Impression of Severity, the Patient Global Impression of Improvement, the Medical Outcomes Study (MOS) Sleep Problems Index, and the MOS Short Form 36 vitality score, but not the mean tender point pain threshold or the Montgomery Asberg Depression Rating Scale. Gabapentin was generally well tolerated. CONCLUSION Gabapentin (1,200-2,400 mg/day) is safe and efficacious for the treatment of pain and other symptoms associated with fibromyalgia.
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Affiliation(s)
- Lesley M Arnold
- University of Cincinnati College of Medicine, Cincinnati, Ohio 45219, and Newton-Wellesley Hospital, Newton, MA, USA.
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Donaldson D, Gelskey SC, Landry RG, Matthews DC, Sandhu HS. A placebo-controlled multi-centred evaluation of an anaesthetic gel (Oraqix) for periodontal therapy. J Clin Periodontol 2003; 30:171-5. [PMID: 12631173 DOI: 10.1034/j.1600-051x.2003.00017.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Six Canadian dental schools investigated the ability of a thermosetting gel containing 25 mg/g prilocaine and 25 mg/g lidocaine as active agents to produce analgesia in periodontal pockets utilizing a randomized, double-blind, placebo-controlled study. MATERIALS AND METHODS The study consisted of 130 patients, each of whom received the active or placebo gel in periodontal pockets in one quadrant of the mouth for 30 s prior to periodontal debridement (scaling and root planing). Pain was measured using both a 100-mm Visual Analogue Scale (VAS) and a Verbal Rating Scale (VRS). RESULTS The median VAS pain score for the patients treated with the anaesthetic gel was 5 mm (range 0-85 mm) as opposed to 13 mm (range 0-79 mm) in the placebo-treated patients (P=0.015). There was no significant difference in the percentage of patients reporting no or mild pain (78% and 76% for the anaesthetic gel and placebo, respectively). No significant differences were seen in patient demographics, or mandible versus maxilla. CONCLUSIONS The VAS pain scores showed that the anaesthetic gel 5% was statistically more effective than the placebo in reducing pain during periodontal debridement.
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Affiliation(s)
- D Donaldson
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, Canada.
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Zheng F, Sandhu HS, Cammisa FP, Girardi FP, Khan SN. Predictors of functional outcome in elderly patients undergoing posterior lumbar spine surgery. J Spinal Disord 2001; 14:518-21. [PMID: 11723404 DOI: 10.1097/00002517-200112000-00011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To ascertain the predictors of functional outcome in elderly patients undergoing posterior lumbar spinal decompression and fusion, a modified low back outcome score questionnaire survey in 83 elderly patients (49 men, 34 women) was carried out at our hospital. The average follow-up was 35.8 months (range: 22-57 months). The outcomes were as follows: excellent to good, 83%; fair, 7%; and poor, 10%. Multiple regression analysis revealed that significant predictors of unfavorable outcome included coexistence of other bone and joint degenerative disorders (p < 0.001) and history of heart disease (p < 0.01). Patients who had undergone previous lumbar surgery had significantly lower modified low back outcome score than those without previous lumbar spine surgery (p < 0.05). The modified low back outcome score questionnaire system is a reliable method in elderly patients.
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Affiliation(s)
- F Zheng
- Spine Service, Hospital for Special Surgery, New York, New York 10021, USA
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30
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Sandhu HS, Khan SN, Suh DY, Boden SD. Demineralized bone matrix, bone morphogenetic proteins, and animal models of spine fusion: an overview. Eur Spine J 2001; 10 Suppl 2:S122-31. [PMID: 11716009 PMCID: PMC3611543 DOI: 10.1007/s005860100303] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Preclinical investigations on the use of bone morphogenetic proteins (BMP) in the spine have yielded promising results. This has led to the preliminary introduction of these growth factors in controlled clinical trials. Initial data made available suggest that these differentiating factors will play a major role in the treatment of spinal disorders in the future. This article reviews key preclinical studies and their results that formed the basis for introduction into clinical trials. Non-primate and non-human primate models of spine fusion with BMP are reviewed objectively, and important issues regarding carrier, dose, and site of implantation are discussed. Finally, exciting new gene therapy research is discussed, with comments made on its applicability for the future.
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Affiliation(s)
- H S Sandhu
- Spinal Surgical Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, USA.
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31
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Girardi FP, Cammisa FP, Sangani PK, Parvataneni HK, Khan SN, Grewal H, Sandhu HS. Sudden sensorineural hearing loss after spinal surgery under general anesthesia. J Spinal Disord 2001; 14:180-3. [PMID: 11285432 DOI: 10.1097/00002517-200104000-00014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Two patients, ages 72 and 71, who underwent lumbar decompressive surgery for spinal stenosis, were evaluated for postoperative sudden sensorineural hearing loss (SSHL). After two uncomplicated spinal procedures, both patients developed SSHL immediately after surgery. Hearing loss was moderate to profound in these two patients. None of the patients had a significant otologic history. Nitrous oxide administration, Valsalva maneuvers during general anesthesia, and transient drops in cerebrospinal fluid pressure stemming from spinal decompression may, in some combination, lead to an implosive force on the inner ear, causing SSHL. Further causes of postlumbar surgery SSHL may include microemboli or viral infections. SSHL is a rare but possible complication after nonotologic, noncardiac bypass surgery; only 26 cases of SSHL after this surgery have been reported. We encourage the continued reporting of sudden sensorineural hearing loss after spinal surgery.
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Affiliation(s)
- F P Girardi
- SpineCare Institute, Hospital for Special Surgery, New York, New York 10021, USA
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32
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Sandhu HS. A practical guide to tobacco cessation in dental offices. J Can Dent Assoc 2001; 67:153-7. [PMID: 11315394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Tobacco use is an important risk factor for advanced periodontitis, poor response to periodontal therapy, oral neoplasms, and dental implant failure. Given the effect of tobacco use on oral health, the dental office may be an ideal place for tobacco cessation intervention, especially since a large proportion of smokers visit their dentist on a regular basis. This paper reviews various tobacco cessation strategies for the dental office and provides practical information on assessing patients' readiness to quit and choosing appropriate tobacco cessation interventions.
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Affiliation(s)
- H S Sandhu
- Division of Periodontology, School of Dentistry, University of Western Ontario, London, ON N6A 5C1.
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Cammisa FP, Girardi FP, Antonacci A, Sandhu HS, Parvataneni HK. Laparoscopic transperitoneal anterior lumbar interbody fusion with cylindrical threaded cortical allograft bone dowels. Orthopedics 2001; 24:235-9. [PMID: 11300287 DOI: 10.3928/0147-7447-20010301-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- F P Cammisa
- SpineCare Institute, Hospital for Special Surgery, New York, NY 10021, USA
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34
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Angle RP, Sandhu HS. Proactive management of air quality. Environ Manage 2001; 27:225-233. [PMID: 11116381 DOI: 10.1007/s002670010145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Traditional air resource management systems have difficulty in addressing global issues, sustainable development, direct citizen participation, and integration with broad economic interests. As reactive management systems, they tend to be compliance-driven, static, and rigid. In contrast, proactive management systems are principle-driven, innovative, and flexible. Bridge scientists play a key role in supporting the transformation of raw data into wise action. Decision-makers need to integrate social values with knowledge about emissions, atmospheric processes, and potential environmental effects using the primary tools of measurements, monitoring, and modeling. The Alberta Clean Air Strategic Alliance, a unique partnership of governments, industry, and public interest groups formed in 1994, operates a comprehensive air management system that is capable of addressing air issues of greater complexity and uncertainty. Its success is measured by the satisfaction of its diverse stakeholders and by the number and scope of its initiatives.
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Affiliation(s)
- R P Angle
- Alberta Department of Environment, 9820-106 Street, Edmonton, Alberta T5K 2J6, Canada
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35
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Girardi FP, Parvataneni HK, Sandhu HS, Cammisa FP, Grewal H, Schneider R, Lane JM. Correlation between vertebral body rotation and two-dimensional vertebral bone density measurement. Osteoporos Int 2001; 12:738-40. [PMID: 11605739 DOI: 10.1007/s001980170049] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to determine the effect of vertebral rotation, as seen in idiopathic scoliosis, on bone mineral density determination for the lumbar spine. Bone mineral content, biplanar vertebral segment area and calculated bone mineral density of each vertebra from L1 to L4 were obtained for a human cadaveric specimen. The average density for the entire L1-L4 segment was also recorded. This was done with the spine in the midline position as well as in rotation up to a maximum of 60 degrees either side of the midline. The spine was rotated in each direction using 10 degrees increments and two bone density readings were done at each rotation interval. The measured biplanar vertebral segment area increased with increasing rotation from 0 degrees to 50 degrees but decreased after 50 degrees of rotation (r = 0.73, p<0.001). The bone mineral density was significantly negatively correlated with the degree of rotation (r = -0.92, p<0.001). The decrease in measured bone mineral density was nearly 20% when the lumbar spine was rotated from neutral to 60 . This study demonstrates that degree of spinal rotation influences apparent bone mineral density by increasing the apparent vertebral segment area. The measurement change may be as high as 20%. This fact should be considered when investigating scoliotic patients with vertebral segment rotation.
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Affiliation(s)
- F P Girardi
- SpineCare Institute, Hospital for Special Surgery, New York, NY 10021, USA.
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36
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Abstract
Hydroxyurea is a cytotoxic agent indicated in the treatment of a variety of malignant and nonmalignant conditions. Apart from dose-related bone marrow suppression, this antineoplastic agent is generally well tolerated. This report describes a patient with chronic myeloid leukemia who developed severe pneumonitis within four weeks of beginning therapy with hydroxyurea. Pathological examination of a lung specimen obtained by video-assisted thoracoscopic lung biopsy revealed extensive active alveolar and interstitial inflammation, and poorly formed granulomas. After the cessation of hydroxyurea and treatment with systemic corticosteroids, both clinical and radiological resolution of pneumonitis occurred. Physicians using hydroxyurea must be aware of its potentially life-threatening pulmonary toxicity.
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Affiliation(s)
- H S Sandhu
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Canada
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Abstract
STUDY DESIGN Retrospective review of a large series of patients who underwent spinal surgery at a single institution during a 10-year period. OBJECTIVES To further clarify the frequency of incidental durotomy during spine surgery, its treatment, associated complications, and results of long-term clinical follow-up. SUMMARY OF BACKGROUND DATA Incidental durotomy is a relatively common occurrence during spinal surgery. There remains significant concern about it despite reports of good associated clinical outcomes. There have been few large clinical series on the subject. METHODS A retrospective review was conducted of clinical and surgical records and radiographic data for consecutive patients who underwent spinal surgery performed by the two senior surgeons from January 1989 through December 1998. RESULTS A total of 2144 patients were reviewed, and 74 were found to have dural tears occurring during or before surgery. Incidental durotomy occurred at the time of surgery in 66 patients (3.1% overall incidence). Incidence varied according to the specific procedure performed but was highest in the group that underwent revision surgery. The incidence of clinically significant durotomies occurring during surgery but not identified at the time was 0.28%. All dural tears that occurred during surgery and were recognized (60 of 66) were repaired primarily. Pseudomeningoceles developed in five of the remaining six patients. All six patients had subsequent surgical repair of dural defects because of failure of conservative therapy. A mean follow-up of 22.4 months was available and showed good long-term clinical results for all patients. CONCLUSIONS Incidental durotomy, if recognized and treated appropriately, does not lead to long-term sequelae.
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Affiliation(s)
- F P Cammisa
- SpineCare Institute, Hospital for Special Surgery, New York, New York 10021, USA.
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38
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Sandhu HS, Sanchez-Caso LP, Parvataneni HK, Cammisa FP, Girardi FP, Ghelman B. Association between findings of provocative discography and vertebral endplate signal changes as seen on MRI. J Spinal Disord 2000; 13:438-43. [PMID: 11052355 DOI: 10.1097/00002517-200010000-00012] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Provocative discography is a controversial diagnostic tool for pathologic discs. Modic has identified vertebral endplate signal changes on magnetic resonance imaging (MRI) that are thought to signify advanced discogenic degeneration. These two distinct diagnostic tools are examined to determine if there is association between them. Fifty-three consecutive patients who underwent both investigations were retrospectively reviewed. In discs that had negative T1 MRI findings, 28.2% of patients had concordant pain and 17.3% had discordant pain. In discs with positive T1 MRI findings, 34.8% of patients had concordant pain and 17.4% had discordant pain. 79.5% and 74.4% of levels with patient concordant pain on discography had no endplate changes on T1- and T2 weighted MR images, respectively (compared with 84.5% and 81.7%, respectively, for levels with no patient pain on discography). Our data showed no significant relationship between these distinct diagnostic tools. Further investigation of their relative roles in this application is recommended.
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Affiliation(s)
- H S Sandhu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA.
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Cammisa FP, Parvataneni HK, Girardi FP, Khan SN, Sandhu HS. Computerized frameless stereotactic image-guided spinal surgery. Bull Hosp Jt Dis 2000; 59:17-26. [PMID: 10789034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- F P Cammisa
- Spine Care Institute, Hospital for Special Surgery, New York, New York 10021, USA
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Khan SN, Sandhu HS, Parvataneni HK, Girardi FP, Cammisa FP. Bone graft substitutes in spine surgery. Bull Hosp Jt Dis 2000; 59:5-10. [PMID: 10789032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- S N Khan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York 10021, USA
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Abstract
Gene therapy is a novel therapeutic modality for repair and regeneration of musculoskeletal tissues, including the spine. Various methods for therapeutic gene transfer are presented in this article. Several studies in which gene transfer has been used specifically to enhance spine fusion in animal models are reviewed.
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Affiliation(s)
- S N Khan
- SpineCare Institute, Hospital for Special Surgery, New York, New York 10021, USA
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Abstract
A current focus of treatment for degenerative disk disease is the restoration of the intervertebral disk. This article summarizes the structure and function of the intervertebral disk, the pathogenesis of its degeneration, and the clinical relevance of degenerative disk disease. Current literature relating to intervertebral disk replacement and regeneration is reviewed.
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Affiliation(s)
- A D Diwan
- Spine Service, Hospital for Special Surgery, New York, New York 10021, USA
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43
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Dhillon MS, Sandhu HS. Surgical options in the management of residual foot problems in poliomyelitis. Foot Ankle Clin 2000; 5:327-47. [PMID: 11232234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although poliomyelitis is not encountered in the Western countries, it is still endemic in the underdeveloped world. Because the foot commonly is involved, an understanding of the causative factors and the available options of treatment is essential before surgical intervention. It is important to note that inadequate or improper surgical procedures potentially can lead to more disability; a well-planned approach to the foot problem, after considering the patient as a whole and understanding the principles involved, is the best option.
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Affiliation(s)
- M S Dhillon
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
STUDY DESIGN A prospective randomized controlled human clinical pilot trial. OBJECTIVES To determine the feasibility of using rhBMP-2/collagen as a substitute for autogenous bone graft inside interbody fusion cages to achieve arthrodesis in humans. SUMMARY OF BACKGROUND DATA Preclinical studies have shown rhBMP-2 to be an effective substitute for autogenous bone graft, but there are no studies to date documenting such efficacy for human spine fusion. METHODS Fourteen patients with single-level lumbar degenerative disc disease refractory to nonoperative management were randomized to receive lumbar interbody arthrodesis with a tapered cylindrical threaded fusion cage filled with rhBMP-2/collagen sponge or autogenous iliac crest bone. Patients were evaluated with radiographs, sagittally reformatted computed tomography scans, and Short Form-36 and Oswestry outcome questionnaires. RESULTS All 11 patients who received rhBMP-2 were judged by three independent radiologists to have solid fusions (at 6, 12, and 24 months postimplantation), whereas only 2 of the 3 control patients, who received the standard treatment of autogenous iliac crest bone, were deemed to be fused. The Oswestry Disability Questionnaire scores of the rhBMP-2 group improved sooner (after 3 months) than those of the autograft group, with both groups demonstrating similar improvement at 6 months. Short Form 36 scores continued to improve up to 24 months. CONCLUSION The arthrodesis was found to occur more reliably in patients treated with rhBMP-2-filled fusion cages than in controls treated with autogenous bone graft, although the sample size was limited. There were no adverse events related to the rhBMP-2 treatment. This study is one of the first to show consistent and unequivocal osteoinduction by a recombinant growth factor in-humans.
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Affiliation(s)
- S D Boden
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
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Abstract
Anterior intervertebral fusion increasingly is used as a treatment for discogenic or intersegmental pathologic diseases of the lumbar spine. This is in part attributable to the evolution and refinement of laparoscopic and minimally invasive surgical techniques that now can be used to access the anterior spinal column. It also is attributable to the availability of newer generation intervertebral fixation devices such as the threaded titanium cages or threaded allograft bone dowels, both of which are technically simpler to implant. Recently, limited clinical studies of intervertebral lumbar fusion have examined the use of these devices combined with osteoinductive growth factors as substitutes for autogenous bone graft. Early clinical results of lumbar fusion using threaded intervertebral implants filled with recombinant human bone morphogenetic protein-2 have been favorable. Higher fusion rates, shorter operative times, and shorter hospital stays have been reported in the initial series. Clinical trials involving larger cohorts with various spinal applications for osteoinductive molecules currently are in progress.
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Affiliation(s)
- H S Sandhu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA
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Abstract
At least 250,000 spinal fusions are performed in the United States each year, nearly all requiring implantation of bone graft material. The preferred technique for most of these operations is the transplantation of structured or morcellized autologous corticocancellous bone from the iliac crest. Further, because of the increasing frequency of spinal fusion surgery during the 1990s, arthrodesis of the spine has become the most common reason for autologous bone graft harvest. This article reviews the current clinical status of autogenous bone grafts and alternative materials in spinal fusion surgery.
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Affiliation(s)
- H S Sandhu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Cornell University Medical College, New York, New York, USA
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Girardi FP, Cammisa FP, Sandhu HS, Alvarez L. The placement of lumbar pedicle screws using computerised stereotactic guidance. J Bone Joint Surg Br 1999; 81:825-9. [PMID: 10530844 DOI: 10.1302/0301-620x.81b5.9244] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Computer-assisted frameless stereotactic image guidance allows precise preoperative planning and intraoperative localisation of the image. It has been developed and tested in the laboratory. We evaluated the efficacy, clinical results and complications of placement of a pedicle screw in the lumbar spine using this technique. A total of 62 patients (28 men, 34 women) had lumbar decompression and spinal fusion with segmental pedicle screws. Postoperative CT scans were taken of 35 patients to investigate the placement of 330 screws. None showed penetration of the medial or inferior wall of a pedicle. Registration was carried out 66 times. The number of fiducial points used on each registration averaged 5.8 (4 to 7) The mean registration error was 0.75 mm (0.32 to 1.72). This technique provides a safe and reliable guide for placement of transpedicular screws in the lumbar spine.
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Affiliation(s)
- F P Girardi
- Hospital for Special Surgery, New York, NY 10021, USA
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Abstract
Flexion and extension lateral radiographs of the cervical spine may suggest signs of ligamentous and soft tissue injuries in a potentially unstable spine. However, patients with acute injuries and severe pain and muscle spasms may not be able to move their necks effectively, severely compromising the diagnostic yield of the radiographs. In addition, there are reports of serious neurologic injuries occurring with the use of these radiographs in acutely injured patients. The purpose of this study was to determine the effectiveness and yield of obtaining cervical spine flexion and extension radiographs in the emergency department on acutely injured patients. Review of all patients with cervical flexion and extension radiographs presenting to a Level 1 trauma center was performed. All radiographs were judged based on the adequacy of flexion and extension movement and positive findings indicative of instability by the radiologist in the emergency room. The radiographs of one patient (0.34%) revealed positive findings of instability. Of the 290 flexion and extension radiographs, 97 (33.5%) of them showed such little or inadequate flexion or extension movement that cervical stability could not be assessed. Flexion and extension cervical radiographs should not be obtained routinely in the emergency department because 1/3 of these studies will be inadequate because of pain and muscle spasms experienced by patients. Patients with cervical injuries may not be able to fully flex and extend their necks; this may lead to false reassurance to patients who actually have had an inadequate study to diagnose potential instability.
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Affiliation(s)
- J C Wang
- Department of Orthopaedic Surgery, University of California at Los Angeles 90095-6902, USA
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49
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Abstract
STUDY DESIGN A prospective study of tissue surrounding spinal instrumentation was performed using histologic and chemical analysis. OBJECTIVES To identify and quantify the amount of metal debris generated by titanium pedicle screw instrumentation and to evaluate the histologic response in the spinal tissues. SUMMARY OF BACKGROUND DATA Microscopic metal particles from the soft tissue surrounding joint arthroplasties have been shown to activate a macrophage response that leads to bone resorption and increased inflammation. The use of titanium spinal implants for spine surgery projects the possibility of generating wear debris in the spine. METHODS Nine patients with titanium instrumentation from a prior lumbar decompression and fusion procedure who were undergoing reoperation were entered into this study. Tissue samples were collected from areas near the pedicle screw-rod junction, the scar tissue overlying the dura, and the pedicle screw holes. Metal levels for titanium were determined by electrothermal atomic absorption spectroscopy, and histologic analysis was performed by light and electron microscopy. RESULTS Tissue concentrations of titanium were highest in patients with a pseudarthrosis (30.36 micrograms/g of dry tissue). Patients with a solid fusion had low concentrations of titanium (0.586 microgram/g of dry tissue). Standard light microscopy identified metal particles in the soft tissues. Transmission electron microscopy demonstrated macrophages with numerous secondary lysosomes containing electron-dense bodies and collagenous stroma with electron-dense rod-like profiles consistent with metal debris. CONCLUSIONS Wear debris is generated by the use of titanium spinal instrumentation in patients with a pseudarthrosis. These particles activate a macrophage cellular response in the spinal tissues similar to that seen in surrounding joint prostheses. Patients with a solid spinal fusion have negligible levels of particulate matter.
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Affiliation(s)
- J C Wang
- Department of Orthopaedic Surgery, School of Medicine, University of California, Los Angeles, USA.
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Abstract
The HASTE (half-Fourier acquisition single-shot turbo spin-echo) technique delivers images with T2-weighting in about half a second and could be ideal for fast dynamic studies when T2-weighting is needed. We evaluated cardiac-triggered HASTE to study cervical spine flexion/extension. The cervical spines of ten asymptomatic volunteers were studied during flexion/extension motion on a 1.5 Tesla imager using a cardiac triggered version of the HASTE technique. Midline sagittal images were acquired every 2 to 3 s during neck flexion and extension. Image quality was compared to traditional T2-weighted Turbo spin-echo. The study duration per flexion/ extension was typically less than 20 seconds and well tolerated. The cardiac-gated T2-weighted HASTE images compared favorably to the traditional T2-weighted TSE images in quality and overall anatomic detail. Range of motion averaged: flexion 30 degrees (range 8 degrees -48 degrees) and extension 23 degrees (range 0 degrees -57 degrees ). Greatest motion occurred in the lower cervical spine (C4-C7). At the intervertebral discs the canal diameter, anterior and posterior CSF spaces were widest in neutral position and decreased with flexion and extension. Therefore, Cardiac-gated T2 HASTE sequences provide diagnostic and time-efficient dynamic MR images of cervical spine motion.
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Affiliation(s)
- A J Duerinckx
- Radiology Service, VA Medical Center, West Los Angeles, CA 90073, USA.
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