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Haight PJ, Piver RN, Barrington DA, Baek J, Graves SM, Ardizzone M, Akinduro JA, Busho AC, Fadoju D, Pandit R, Stephens R, Strowder LM, Tadepalli S, VanNoy B, Sriram B, McLaughlin EM, DS Lightfoot M, Chambers LM, Bixel KL, Cohn DE, Cosgrove CM, O'Malley D, Salani R, Backes FJ, I Nagel C. Assessment of the feasibility of same-day discharge following minimally invasive hysterectomy in the elderly population. Gynecol Oncol Rep 2023; 48:101227. [PMID: 37415961 PMCID: PMC10320489 DOI: 10.1016/j.gore.2023.101227] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
Objective To determine the safety and feasibility of same-day discharge (SDD) following minimally invasive hysterectomy (MIH) for elderly patients and to evaluate associations between age, frailty, and postoperative outcomes. Methods Retrospective review was conducted of patients aged ≥ 70 who underwent MIH within a single gynecologic oncology institution from 2018 to 2020. Demographics, peri-operative factors, postoperative complications, and 30-day readmission rates were collected. Frailty was determined by an 11-point modified frailty index ≥ 2. Outcomes were compared between SDD and observation groups using Fisher's exact and Wilcoxon rank-sum tests. Results Of 169 patients included in the analysis, 8.9% (n = 15) underwent SDD, and 91.1% (n = 154) were admitted for OBS following MIH. Demographics, peri-operative factors, and frailty rates (33% SDD vs 43.5% observation; p = 0.59) were similar between groups. 86.7% (n = 13) of SDD cases were completed before 12PM, and none were completed after 6PM. No SDD patients had early post-operative complications or hospital readmissions. Early postoperative complications were diagnosed in 9 (5.8%) patients admitted for OBS, and the 30-day hospital readmission rate for patients who underwent OBS was 8.4% (n = 13). While elderly patients who met objective frailty criteria (n = 72) did not have a higher likelihood of early post-operative complications (44.4% vs 55.6%; p = 0.909), they did have a higher likelihood of ED visit within 30 days of discharge (15.3 vs 3.1%; p = 0.009), and a trend was noted toward a higher rate of 30-day hospital readmission (12.5% vs 4.1%; p = 0.080). Conclusions Elderly patients undergoing SDD following MIH did not have increased morbidity or mortality. Elderly patients who meet objective criteria for frailty, however, represent a more vulnerable population.
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Affiliation(s)
- Paulina J Haight
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Rachael N Piver
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David A Barrington
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Jae Baek
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Stephen M Graves
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Audrey C Busho
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Deborah Fadoju
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Radhika Pandit
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | | | | | - Brianna VanNoy
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Bhargavi Sriram
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Eric M McLaughlin
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Michelle DS Lightfoot
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Laura M Chambers
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Kristin L Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Casey M Cosgrove
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - David O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Ritu Salani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Floor J Backes
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Christa I Nagel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
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Haight PJ, Barrington DA, Graves SM, Piver RN, Baek J, Ardizzone M, Akinduro JA, Busho AC, Fadoju D, Pandit R, Stephens R, Strowder LM, Tadepalli S, VanNoy B, Sriram B, McLaughlin EM, Lightfoot MDS, Bixel KL, Cohn DE, Cosgrove CM, O'Malley D, Salani R, Nagel CI, Backes FJ. Safety and feasibility of same-day discharge following minimally invasive hysterectomy in the morbidly obese patient population. Gynecol Oncol 2023; 170:203-209. [PMID: 36709661 DOI: 10.1016/j.ygyno.2023.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/01/2023] [Accepted: 01/12/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To determine whether morbid obesity should serve as an independent factor in the decision for same day discharge following minimally invasive hysterectomy. METHODS Retrospective review was performed of patients with BMI ≥ 40 who underwent minimally invasive hysterectomy within a single comprehensive cancer center between January 2018 - August 2020. Demographics, perioperative factors, post-operative monitoring, complications, and readmissions were compared between patients who underwent same day discharge and overnight observation using Fisher's exact tests and Wilcoxon rank-sum tests. RESULTS 374 patients with BMI ≥ 40 were included. Eighty-three (22.2%) patients underwent same day discharge, and 291 (77.8%) patients underwent overnight observation. Factors associated with increased likelihood of same day discharge included younger age (median age 53 vs 58; p = 0.001), lower BMI (median BMI 45 vs 47; p = 0.005), and fewer medical co-morbidities (Charlson Co-Morbidity Index 2 vs 3; p < 0.001). On multivariate regression analysis, frailty (OR 2.16 [1.14-4.11], p = 0.019) and surgical completion time after 12 PM (OR 3.67 [2.16-6.24], p < 0.001) were associated with increased risk of overnight observation. Few patients admitted for routine overnight observation required medical intervention (n = 14, 4.8%); most of these patients were frail (64.3%). The overall hospital readmission rate within 30 days of discharge was 3.2% (n = 12), with no patients discharged on the day of surgery being readmitted. CONCLUSIONS Morbid obesity alone should not serve as a contraindication to same day discharge following minimally invasive hysterectomy. Admission for observation was associated with low rates of clinically meaningful intervention, and patients who underwent same day discharge were not at increased risk of adverse outcome.
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Affiliation(s)
- Paulina J Haight
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America.
| | - David A Barrington
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Stephen M Graves
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Rachael N Piver
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Jae Baek
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Melissa Ardizzone
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Jenifer A Akinduro
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Audrey C Busho
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Deborah Fadoju
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Radhika Pandit
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Raeshawn Stephens
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Lauren M Strowder
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Shreekari Tadepalli
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Brianna VanNoy
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Bhargavi Sriram
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Eric M McLaughlin
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Michelle D S Lightfoot
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Kristin L Bixel
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Casey M Cosgrove
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - David O'Malley
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Ritu Salani
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Christa I Nagel
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Floor J Backes
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
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Al Sad S, Pandit R, Alhashim N, Abdel-Rasoul M. Primary care Providers' approaches to cervical cancer screening in Muslim females. Prev Med Rep 2023; 32:102126. [PMID: 36852309 PMCID: PMC9958399 DOI: 10.1016/j.pmedr.2023.102126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/07/2023] Open
Abstract
The utilization of the Papanicolaou (Pap) test and the human papillomavirus (HPV) vaccine has significantly decreased rates of cervical cancer and related mortality. Disparities in receiving these preventive screenings are scarcely studied in Muslim females. Our study explores primary care providers' (PCP) approaches to cervical cancer screening in Muslim females. We created a cross-sectional Qualtrics survey using convenience sampling of PCPs who perform Pap tests in central Ohio. Recruitment emails were disseminated via departmental email listservs. We had 200 analyzable responses and 78% of respondents reported having Muslim patients. Bivariate analysis was used to identify predictors of providers' approaches. Providers younger than 35 years obtained a sexual history from Muslim females less frequently, family medicine providers were more likely to obtain a sexual history from Muslim females, and gynecologists were more likely to offer the HPV vaccine to Muslim females. Providers who counseled patients about Pap tests (P<0.001) and HPV modes of transmission (P<0.004) were more likely to offer cervical cancer screening for Muslim females. Our findings suggested that providers' age and specialty may be predictors of proactive cervical cancer screening and prevention in Muslim females and that there is a gap between current guidelines and preventive clinical practices regarding the HPV vaccine and transmission counseling.
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Affiliation(s)
- Sondos Al Sad
- Women Health Primary Care Center, Family and Community Medicine Department, University of California San Francisco, 2356 Sutter St, San Francisco, CA 94115, USA,Corresponding author.
| | - Radhika Pandit
- The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, USA
| | | | - Mahmoud Abdel-Rasoul
- The Ohio State University College of Medicine, Center for Biostatistics, 1800 Cannon Drive Columbus, OH 43210, USA
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Biswas S, Saha D, Pandit R. A State-of-the-art Association Rule Mining Survey and It's Rare Application, Challenges, Progress. INT J ARTIF INTELL T 2022. [DOI: 10.1142/s0218213023500215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Chaudhary R, Bhatta S, Singh A, Pradhan M, Moktan B, Duwal S, Pandit R. A Comparative Study of Rapid SARS-Cov-2 Antigen Detection Assay against RT-PCR Assay for Diagnosis of COVID-19 in a Tertiary Hospital of Kathmandu. Kathmandu Univ Med J (KUMJ) 2022; 20:337-341. [PMID: 37042376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Background The Coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has spread worldwide since its first recorded case in the city of Wuhan, China, in December 2019. SARS-CoV-2 infection causes asymptomatic to sever pneumonia. Severe cases may develop acute respiratory disease symdrome (ARDS), with an average mortality rate of 6.9%. Real Time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) assay is the current reference standard laboratory method for the diagnosis of SARS-CoV-2 infection. However, it takes around 6-8 hours to get the result and is time consuming. Therefore, rapid and accurate tests for SARS-CoV-2 screening are essential to expedite disease prevention and control. Lateral flow immunoassay using monoclonal anti SARS-CoV-2 antibodies which target for SARS-CoV-2 antigen can be complimentary screening test if their accuracy were comparable to that of the real time reverse transcriptionpolymerase chain reaction (RT-PCR) assay. Objective To find the sensitivity and specificity of a rapid antigentest kit in comparison to reverse transcription-polymerase chain reaction (RT-PCR). Method A cross-sectional hospital based study was carried out at Shree Birendra Army Hospital, Kathmandu for a period of four months. Result Our finding shows sensitivity and specificity of rapid diagnostic tests (RDT) Ag kit as 60.6% and 96.4% respectively. Positive and negative predictive value was 83.7% and 89.0%. Likewise, positive and negative likelihood ratio was 17.0 and 0.4. The overall accuracy of the antigen kit was 88.1% in comparison to reverse transcriptionpolymerase chain reaction (RT-PCR) as the gold standard. Conclusion Our study concluded the use of rapid antigen kit is mainly useful for screening purposes.
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Affiliation(s)
- R Chaudhary
- Department of Microbiology, Nepalese Army Institute of Health Sciences(NAIHS), Bhandharkhal, Kathmandu, Nepal
| | - S Bhatta
- Department of Microbiology, Nepalese Army Institute of Health Sciences(NAIHS), Bhandharkhal, Kathmandu, Nepal
| | - A Singh
- Department of Microbiology, Nepalese Army Institute of Health Sciences(NAIHS), Bhandharkhal, Kathmandu, Nepal
| | - M Pradhan
- Department of Microbiology, Nepalese Army Institute of Health Sciences(NAIHS), Bhandharkhal, Kathmandu, Nepal
| | - B Moktan
- Department of Laboratory Medicine, Shree Birendra Army Hospital, Kathmandu, Nepal
| | - S Duwal
- Department of Hygiene and Sanitation, Shree Birendra Army Hospital, Kathmandu, Nepal
| | - R Pandit
- National Public Health Laboratory, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal. and Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Germann K, Kiefer MK, Rood KM, Mehl R, Wu J, Pandit R, Lynch CD, Landon MB, Grobman WA, Costantine MM, Venkatesh KK. Association of initial COVID-19 vaccine hesitancy with subsequent vaccination among pregnant and postpartum individuals. BJOG 2022; 129:1352-1360. [PMID: 35429081 PMCID: PMC9111102 DOI: 10.1111/1471-0528.17189] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/29/2022] [Accepted: 04/12/2022] [Indexed: 12/24/2022]
Abstract
Objective To examine the association between initial COVID‐19 vaccine hesitancy and subsequent vaccination among pregnant and postpartum individuals. Design Prospective cohort. Setting A Midwestern tertiary‐care academic medical center. Individuals completed a baseline vaccine hesitancy assessment from 22 March 2021 to 2 April 2021, with subsequent ascertainment of vaccination status at 3–6 months follow‐up. Methods We used multivariable Poisson regression to estimate the relative risk of vaccination by baseline vaccine hesitancy status, and then characteristics associated with vaccination. Main outcome measures Self‐report of COVID‐19 vaccination, and secondarily, consideration of COVID‐19 vaccination among those not vaccinated. Results Of 456 individuals (93% pregnant, 7% postpartum) initially surveyed, 290 individuals (64%; 23% pregnant, 77% postpartum) provided subsequent vaccination status (median = 17 weeks). Of these 290 individuals, 40% (116/290) reported COVID‐19 vaccine hesitancy upon enrolment, of whom 52% reported subsequent vaccination at follow‐up. Few individuals transitioned during the study period from vaccine hesitant to vaccinated (10%); in comparison, 80% of those who were not vaccine hesitant were vaccinated at follow‐up (aRR 0.19, 95% CI 0.11–0.33). Among those who remained unvaccinated at follow‐up, 38% who were vaccine hesitant at baseline were considering vaccination, compared with 71% who were not vaccine hesitant (aRR 0.48, 95% CI 0.33–0.67). Individuals who were older, parous, employed and of higher educational attainment were more likely to be vaccinated, and those who identified as non‐Hispanic black, were Medicaid beneficiaries, and were still pregnant at follow‐up were less likely to be vaccinated. Conclusions COVID‐19 vaccine hesitancy persisted over time in the peripartum period, and few individuals who reported hesitancy at baseline were later vaccinated. Interventions that address vaccine hesitancy in pregnancy are needed. COVID‐19 vaccination hesitancy among pregnant and postpartum individuals persists over time, and few of the individuals who reported hesitancy were later vaccinated.
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Affiliation(s)
- Katherine Germann
- College of Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Miranda K Kiefer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kara M Rood
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Rebecca Mehl
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jiqiang Wu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Radhika Pandit
- College of Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Courtney D Lynch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Mark B Landon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Maged M Costantine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Boyles GP, Baek J, Pandit R, Cosgrove CM, Bixel KL. An investigation into human papillomavirus (HPV) vaccination for patients undergoing surgery for high-grade cervical or vulvar dysplasia. Gynecol Oncol Rep 2022; 41:101001. [PMID: 35603128 PMCID: PMC9120215 DOI: 10.1016/j.gore.2022.101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 11/29/2022] Open
Abstract
HPV vaccination is not consistently offered (31.3%) to patients being treated for high-grade cervical or vulvar dysplasia. Patients undergoing surgery for HPV-related dysplasia are likely to accept HPV vaccination (65.6%). The rate at which adjuvant HPV vaccination is offered may improve over time.
Introduction Eligibility for the human papillomavirus (HPV) vaccine now includes adults 27 through 45 years. It has not been reported how providers are addressing HPV vaccination in patients with existing preinvasive disease. Our objectives were to determine the rates at which vaccination is offered to and received by patients undergoing surgery for high-grade cervical or vulvar dysplasia. Materials and Methods This was a single-institution retrospective cohort study including patients ages 18 through 45 years undergoing surgery for high-grade cervical or vulvar dysplasia from 10/2018 to 2/2020. Our primary outcome was the rate at which HPV vaccination was discussed at the pre- and/or post-operative visits. The secondary outcome was the rate of vaccine uptake in these individuals. Characteristics of those offered HPV vaccination were compared to those not offered vaccination. Results Of the 115 patients included, 36 (31.3%) had HPV vaccination addressed in the perioperative setting. Thirty-two of these patients had never been vaccinated, and 21 of these (65.6%) went on to receive partial or complete HPV vaccination. Those in whom HPV vaccination was addressed were more likely to be under 27 years (RR 3.2; 95% CI 2.1–4.8) and less likely to be smokers (RR 0.5; 95% CI 0.2–0.9) or have prior excisional procedures (RR 0.3; 95% CI 0.1–0.9). The absolute rate of discussing HPV vaccination with patients improved from 26.0% within six months of vaccine age eligibility expansion, to 35.4% after six months (P = 0.32). Conclusions Providers did not consistently address HPV vaccination among patients being treated for high-grade cervical or vulvar dysplasia despite the potential benefits. However, a high proportion of these patients are amenable to vaccination. Quality improvement initiatives are warranted to increase the rate of HPV vaccine counseling in this context.
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Affiliation(s)
- Glenn P. Boyles
- The Ohio State University Wexner Medical Center, Department of Obstetrics and Gynecology, Columbus, OH, USA
- Corresponding author at: The Ohio State University Wexner Medical Center, Department of Obstetrics and Gynecology, 410 West 10 Avenue, Columbus, OH 43210, USA.
| | - Jae Baek
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Radhika Pandit
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Casey M. Cosgrove
- The Ohio State University and Arthur G. James Cancer Hospital and Solove Research Institute, Division of Gynecologic Oncology, Columbus, OH, USA
| | - Kristin L. Bixel
- The Ohio State University and Arthur G. James Cancer Hospital and Solove Research Institute, Division of Gynecologic Oncology, Columbus, OH, USA
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Pradhan PM, Bhatt RD, Pandit R, Shrestha A, Maharjan R, Jha N, Bajracharya S, Shrestha S, Koju RP, Karmacharya BM. Needs Assessment of Leadership and Governance in Cardiovascular Health in Nepal. Kathmandu Univ Med J (KUMJ) 2022; 19:30-39. [PMID: 35526134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Good governance and leadership are essential to improve healthy life expectancy particularly in low and middle-income countries (LMICs). This study aimed to epitomize the challenges and opportunities for leadership and good governance for the health system to address non-communicable diseases particularly cardiovascular diseases (CVD) in Nepal. Objective The objective of this study was to understand and document CVD programs and policy formulation processes and to identify the government capacity to engage stakeholders for planning and implementation purposes. Method A national-level task force was formed to coordinate and steer the overall need assessment process. A qualitative study design was adopted using "The Health System Assessment Approach". Eighteen indicators under six topical areas in leadership and governance in cardiovascular health were assessed using desk review and key informant interviews. Result Voice and accountability exist in planning for health from the local level. The government has shown a strong willingness and has a strategy to work together with the private and non-government sectors in health however, the coordination has not been effective. There are strong rules in place for regulatory quality, control of corruption, and maintaining financial transparency. The government frequently relies on evidence generated from large-scale surveys for health policy formulation and planning but research in cardiovascular health has been minimum. There is a scarcity of cardiovascular disease-specific protocols. Conclusion Despite plenty of opportunities, much homework is needed to improve leadership and governance in cardiovascular health in Nepal. The government needs to designate a workforce for specific programs to help monitor the enforcement of health sector regulations, allocate enough funding to encourage CVD research, and work towards developing CVD-specific guidelines, protocols, and capacity building. KEY WORDS Cardiovascular diseases, Governance, Leadership, Needs assessment, Nepal.
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Affiliation(s)
- P Ms Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal. Nepalese Society of Community Medicine. and Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R D Bhatt
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. Wuhan University, Faculty of Medical Sciences, School of Health Sciences, Wuhan, China. and Department of Biochemistry, Kathmandu University School of Medical Sciences, Nepal
| | - R Pandit
- Fellow, CVD Translational Research Program, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. and Department of Physiology, Nepal Medical College and Teaching Hospital, Nepal
| | - A Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. and Institute for Implementation Science and Health, Kathmandu, Nepal
| | - R Maharjan
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal. and Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - N Jha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Kavrepalanchowk, Nepal
| | - S Bajracharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
| | - S Shrestha
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal
| | - R P Koju
- Dean, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre. and Department of Internal Medicine, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Kavre
| | - B M Karmacharya
- Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. and Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
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Pandit R, Yadav B. M210 Hematological and biochemical differences in school going children with sickling disorder in steady state. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cartes C, Tirapegui E, Pandit R, Brachet M. The Galerkin-truncated Burgers equation: crossover from inviscid-thermalized to Kardar-Parisi-Zhang scaling. Philos Trans A Math Phys Eng Sci 2022; 380:20210090. [PMID: 35094560 DOI: 10.1098/rsta.2021.0090] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/22/2021] [Indexed: 06/14/2023]
Abstract
The one-dimensional Galerkin-truncated Burgers equation, with both dissipation and noise terms included, is studied using spectral methods. When the truncation-scale Reynolds number [Formula: see text] is varied, from very small values to order 1 values, the scale-dependent correlation time [Formula: see text] is shown to follow the expected crossover from the short-distance [Formula: see text] Edwards-Wilkinson scaling to the universal long-distance Kardar-Parisi-Zhang scaling [Formula: see text]. In the inviscid limit, [Formula: see text], we show that the system displays another crossover to the Galerkin-truncated inviscid-Burgers regime that admits thermalized solutions with [Formula: see text]. The scaling forms of the time-correlation functions are shown to follow the known analytical laws and the skewness and excess kurtosis of the interface increments distributions are characterized. This article is part of the theme issue 'Scaling the turbulence edifice (part 2)'.
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Affiliation(s)
- C Cartes
- Complex Systems Group, Facultad de Ingeniería y Ciencias Aplicadas, Universidad de los Andes, Santiago, Chile
| | - E Tirapegui
- Departamento de Física, Universidad de Chile, Santiago, Chile
| | - R Pandit
- Department of Physics, Centre for Condensed Matter Theory, Indian Institute of Science, Bangalore 560012, India
| | - M Brachet
- Laboratoire de Physique de l'École Normale Supérieure, ENS, Université PSL, CNRS, Sorbonne Université, Université de Paris, Paris 75005, France
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11
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McKiever M, Akers A, Pandit R, Hall OT, Dixon-Shambley K, Backes C, Rood KM. 517 Racial differences in modified finnegan neonatal abstinence scoring for neonatal opioid withdrawal syndrome. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Pandit R, Cianci D, ter Hark SE, Winter‐van Rossum I, Ebdrup BH, Broberg BV, Garcia‐Portilla MP, Bobes J, Vinkers CH, Kahn RS, Guloksuz S, Huitema ADR, Luykx JJ. Phenotypic factors associated with amisulpride-induced weight gain in first-episode psychosis patients (from the OPTiMiSE cohort). Acta Psychiatr Scand 2019; 140:283-290. [PMID: 31323113 PMCID: PMC6771865 DOI: 10.1111/acps.13074] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Antipsychotic-induced weight gain (AiWG) is a debilitating adverse effect of most antipsychotics. First-episode psychosis patients are particularly vulnerable to the detrimental consequences of AiWG. Amisulpride has good efficacy and tolerability. We here aimed to identify the phenotypic factors associated with amisulpride-induced weight gain in first-episode psychosis patients. METHOD Data were collected from the Optimization of Treatment and Management of Schizophrenia in Europe trial. Multivariable regression models with various phenotypic variables (N = 305) were performed with absolute AiWG and clinically relevant AiWG (≥7% AiWG) as outcomes. RESULTS Four weeks of amisulpride treatment increased body weight from 69.7 to 72.4 kg (P < 0.001). In the regression model of absolute AiWG, unemployment (β = 0.94, P = 0.016), younger age (β = -0.07, P = 0.031) and absence of current comorbid major depression disorder (β = -1.61, P = 0.034) were positively associated with absolute AiWG. In the regression model of clinically relevant AiWG, unemployment (OR = 2.83, P = 0.001), schizophreniform disorder (OR = 2.00, P = 0.025) and low baseline weight (OR = 0.97, P = 0.032) increased the likelihood of clinically relevant AiWG. CONCLUSIONS Clinicians prescribing amisulpride should consider the relatively high susceptibility to AiWG in unemployed first-episode patients with psychosis, in particular young subjects with a diagnosis of schizophreniform disorder. We advise to carefully monitor these patients and, when needed, implement weight-reducing strategies.
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Affiliation(s)
- R. Pandit
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - D. Cianci
- Department of Biostatistics and Research SupportJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUniversity of UtrechtUtrechtthe Netherlands
| | - S. E. ter Hark
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - I. Winter‐van Rossum
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - B. H. Ebdrup
- Centre for Neuropsychiatric Schizophrenia ResearchCNSR & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINSMental Health Centre GlostrupCopenhagen University HospitalGlostrupDenmark,Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - B. V. Broberg
- Centre for Neuropsychiatric Schizophrenia ResearchCNSR & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINSMental Health Centre GlostrupCopenhagen University HospitalGlostrupDenmark
| | - M. P. Garcia‐Portilla
- Department of Psychiatry and CIBERSAMUniversity of OviedoOviedoSpain,Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA)OviedoSpain
| | - J. Bobes
- Department of Psychiatry and CIBERSAMUniversity of OviedoOviedoSpain,Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA)OviedoSpain
| | - C. H. Vinkers
- Department of PsychiatryAmsterdam UMC (location VUmc)Amsterdamthe Netherlands,Department of Anatomy and NeurosciencesAmsterdam UMC (location VUmc)Amsterdamthe Netherlands
| | - R. S. Kahn
- Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryIcahn School of MedicineMount SinaiNew YorkUSA
| | - S. Guloksuz
- Department of Psychiatry and NeuropsychologySchool for Mental HealthNeuroscience Maastricht University Medical CenterMaastrichtthe Netherlands,Department of PsychiatryYale School of MedicineNew HavenCTUSA
| | - A. D. R. Huitema
- Department of Pharmacy PharmacologyThe Netherlands Cancer InstituteAmsterdamthe Netherlands,Department of Clinical PharmacyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - J. J. Luykx
- Department of Translational NeuroscienceBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PsychiatryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,GGNet Mental HealthApeldoornthe Netherlands
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13
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Nalos M, Huang SJ, Pandit R, McLean AS. Endotoxin Stimulated Interleukin-10 Production is Enhanced by Adenosine. Possible Key to Septic Shock Associated Immune Deficiency? Anaesth Intensive Care 2019; 34:719-23. [PMID: 17183888 DOI: 10.1177/0310057x0603400608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/21/2022]
Abstract
The aim of this bench study was to investigate whether adenosine influences secretion of interleukin-10 (IL-10) in human whole blood culture stimulated with lipopolysaccharide. Whole blood from healthy human volunteers was mixed ex vivo in 1:1 ratio with RPMI 1640 culture medium and subsequently cultured at 37°C with or without adenosine (total of 120 μM added in four aliquots over two hours) in the presence or absence of 100 ng/ml lipopolysaccharide for four and eight hours, respectively. There was only a minimal IL-10 production after four hours of culture regardless of the experimental conditions. However, lipopolysaccharide stimulated whole blood cultures with added adenosine released large amounts of IL-10 after eight hours. The response was similar whether adenosine was added before (5.99 pg/ml/106 leucocytes) or after (10.35 pg/ml/106 leucocytes) stimulation with lipopolysaccharide and inter-individual variation was present. In conclusion adenosine enhances lipopolysaccharide stimulated IL-10 production in whole human blood and may contribute to the IL-10 mediated immune dysfunction in sepsis.
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Affiliation(s)
- M Nalos
- Department of Intensive Care Medicine, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
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14
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Widdrington J, Ashfaq I, Puvaneswaran B, Ong EL, Schwab U, Price DA, Schmid ML, Pandit R. Missed opportunities to diagnose syphilis prior to the development of sight-losing uveitis. J R Coll Physicians Edinb 2018; 47:129-134. [PMID: 28675181 DOI: 10.4997/jrcpe.2017.204] [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: 11/19/2022] Open
Abstract
The incidence of syphilis in the UK is rapidly rising. Uveitis (intraocular inflammation) usually occurs in the secondary or later stages of syphilis infection and is sight-threatening. Methods A retrospective analysis of the demographics, presentation, diagnosis, treatment and outcomes of patients with syphilitic uveitis managed in Newcastle from 2005-2016 was carried out. Results Ten males (19 eyes) with syphilitic uveitis had a generally good visual and serological response to penicillin treatment. In eight of the patients there had been a failure to test for syphilis during assessments by various medical practitioners for unexplained symptoms that were attributable to syphilis prior to the eye involvement. Conclusion Uveitis associated with syphilis can be sight-threatening but responds well to treatment. In our case series there were multiple missed opportunities to diagnose syphilis prior to presentation with eye disease, with a general failure of healthcare professionals to take an adequate sexual history.
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Affiliation(s)
- J Widdrington
- J Widdrington, Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
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15
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Shrestha R, Gupta HK, Hamal RR, Pandit R. Radiographic Anatomy of the Neck-Shaft Angle of Femur in Nepalese People: Correlation with its Clinical Implication. Kathmandu Univ Med J (KUMJ) 2018; 16:124-128. [PMID: 30636752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background Neck-shaft angle (NSA) is one of the prominent features in the proximal femur which is an important determinant of fracture of femoral neck. Present study evaluating the value of neck-shaft angle has relied heavily on radiographs. As knowledge of neck-shaft angle is important to orthopaedic surgeons, there is need to elucidate whether there is significant variation of this angle among the two different genders and various age groups of both right and left femora of Nepalese population. Objective To ascertain the value of neck-shaft angle in the Nepalese population by means of a radiographic study and to correlate the values with regard to right neck-shaft angle/ left neck-shaft angle side (RNSA/LNSA), gender and three different age group. Method Normal pelvic radiographs of 148 patients seen at department of orthopedic and radiology, College of Medical Sciences- Teaching Hospital (COMS-TH), Bharatpur, Chitwan from the month of February 2017 to June 2017 were divided into two different gender and three different age groups (21-40 years, 41-60 years and Above 60 years) and their neck-shaft angle of both right and left sides were recorded. Result The average of RNSA and LNSA were found to be 132.96±6.05° and 131.54±13.66° respectively for male and 134±6.57° and 132.98±6.23° respectively for female. In total the average RNSA and LNSA were 133.51±6.32° and 132.26±10.61° respectively. Similarly, the average RNSA and LNSA for three different age groups (21-40 years, 41-60 years and Above 60 years) were found to be 133.76±6.44°, 133.69±6.36° and 132.50±6.06° and the 133.35±6.29°, 132.47±5.85° and 128.84±21.98° respectively. Conclusion The average neck-shaft angle recorded here shows no significant difference in both RNSA and LNSA in males except for a small and significant difference in LNSA in female of three different age groups.
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Affiliation(s)
- R Shrestha
- Department of Anatomy, Kantipur Dental College, Basundhara, Kathmandu, Nepal
| | - H K Gupta
- Department of Orthopedics, College of Medical Sciences, Bharatpur, Chitwan, Nepal
| | - R R Hamal
- Department of Orthopedics, College of Medical Sciences, Bharatpur, Chitwan, Nepal
| | - R Pandit
- Department of Anatomy, College of Medical Sciences, Bharatpur, Chitwan, Nepal
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16
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Voros GM, Pandit R, Snow M, Griffiths PG. Unilateral Recurrent Acute Retinal Necrosis Syndrome Caused by Cytomegalovirus in an Immune-Competent Adult. Eur J Ophthalmol 2018; 16:484-6. [PMID: 16761257 DOI: 10.1177/112067210601600323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 11/15/2022]
Abstract
PURPOSE To report an immune-competent patient with unilateral recurrent acute retinal necrosis syndrome caused by cytomegalovirus, and to highlight the importance of diagnostic vitreous biopsy and specific antiviral therapy in this condition. METHODS Case report. RESULTS A 75-year-old man with good general health had two episodes of acute retinal necrosis syndrome affecting his left eye. Vitreous biopsy was performed in each episode, and polymerase chain reaction analysis on the vitreous specimen was positive for cytomegalovirus and negative for varicella zoster virus and herpes simplex virus 1 and 2. On each occasion, investigations indicated past cytomegalovirus infection but no evidence of a systemic re-activation. No indication of immunodeficiency was found over a 2-year follow-up period. His management, which included systemic and intravitreal antiviral therapy, is discussed. CONCLUSIONS To the authors' knowledge, only two other cases of acute retinal necrosis syndrome caused by cytomegalovirus have been reported previously in immune-competent patients. This case illustrates the importance of vitreous biopsy for viral polymerase chain re-action studies in cases of acute retinal necrosis syndrome, in order to direct appropriate antiviral treatment. It also illustrates the role of an intravitreal antiviral drug that is effective against all three herpetic viruses.
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Affiliation(s)
- G M Voros
- Dept. of Ophthalmology, Royal Victoria Infirmary, Univ. of Newcastle upon Tyne, Newcastle upon Tyne, UK.
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17
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Kanaan MZ, Pandit R, Dayan M. Response to Dr. Pellegrini Regarding Comments on “Bilateral Non-arteritic Anterior Ischaemic Optic Neuropathy as the Presentation of Systemic Amyloidosis”. Neuroophthalmology 2017; 41:341. [DOI: 10.1080/01658107.2017.1376339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- M. Z. Kanaan
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - R. Pandit
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Margaret Dayan
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
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18
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Kanaan MZ, Lorenzi AR, Thampy N, Pandit R, Dayan M. Bilateral Non-arteritic Anterior Ischaemic Optic Neuropathy as the Presentation of Systemic Amyloidosis. Neuroophthalmology 2017; 41:330-334. [PMID: 29344073 DOI: 10.1080/01658107.2017.1328604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 05/05/2017] [Accepted: 05/06/2017] [Indexed: 10/19/2022] Open
Abstract
A 75-year-old hypertensive female with stable idiopathic intermediate uveitis presented with bilateral sequential optic neuropathy with optic disc swelling. The optic neuropathy in the first affected eye (right) was thought to be due to non-arteritic anterior ischaemic optic neuropathy (NAION). Asymptomatic left optic disc swelling was found at routine review 2 months later, and a diagnosis of giant cell arteritis (GCA) was sought. Temporal artery duplex ultrasound showed the "halo sign," but a subsequent temporal artery biopsy showed light-chain (AL) amyloidosis with no signs of giant cell arteritis. In this case, bilateral sequential ischaemic optic neuropathy mimicking non-arteritic anterior ischaemic optic neuropathy was the presenting sign of systemic amyloidosis involving the temporal arteries.
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Affiliation(s)
- M Z Kanaan
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - A R Lorenzi
- Musculoskeletal Department, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - N Thampy
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - R Pandit
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Margaret Dayan
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
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19
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Pandit R, Beerens S, Adan RAH. Role of leptin in energy expenditure: the hypothalamic perspective. Am J Physiol Regul Integr Comp Physiol 2017; 312:R938-R947. [PMID: 28356295 DOI: 10.1152/ajpregu.00045.2016] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 01/08/2023]
Abstract
The adipocyte-derived hormone leptin is a peripheral signal that informs the brain about the metabolic status of an organism. Although traditionally viewed as an appetite-suppressing hormone, studies in the past decade have highlighted the role of leptin in energy expenditure. Leptin has been shown to increase energy expenditure in particular through its effects on the cardiovascular system and brown adipose tissue (BAT) thermogenesis via the hypothalamus. The current review summarizes the role of leptin signaling in various hypothalamic nuclei and its effects on the sympathetic nervous system to influence blood pressure, heart rate, and BAT thermogenesis. Specifically, the role of leptin signaling on three different hypothalamic nuclei, the dorsomedial hypothalamus, the ventromedial hypothalamus, and the arcuate nucleus, is reviewed. It is known that all of these brain regions influence the sympathetic nervous system activity and thereby regulate BAT thermogenesis and the cardiovascular system. Thus the current work focuses on how leptin signaling in specific neuronal populations within these hypothalamic nuclei influences certain aspects of energy expenditure.
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Affiliation(s)
- R Pandit
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Beerens
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R A H Adan
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
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20
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Thelen C, Sens J, Mauch J, Pandit R, Pitychoutis PM. Repeated ketamine treatment induces sex-specific behavioral and neurochemical effects in mice. Behav Brain Res 2016; 312:305-12. [PMID: 27343934 DOI: 10.1016/j.bbr.2016.06.041] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [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: 04/01/2016] [Revised: 05/24/2016] [Accepted: 06/21/2016] [Indexed: 11/26/2022]
Abstract
One of the most striking discoveries in the treatment of major depression was the finding that infusion of a single sub-anesthetic dose of ketamine induces rapid and sustained antidepressant effects in treatment-resistant depressed patients. However, ketamine's antidepressant-like actions are transient and can only be sustained by repeated drug treatment. Despite the fact that women experience major depression at roughly twice the rate of men, research regarding the neurobiological antidepressant-relevant effects of ketamine has focused almost exclusively on the male sex. Importantly, knowledge regarding the sex-differentiated effects, the frequency and the dose on which repeated ketamine administration stops being beneficial, is limited. In the current study, we investigated the behavioral, neurochemical and synaptic molecular effects of repeated ketamine treatment (10mg/kg; 21days) in male and female C57BL/6J mice. We report that ketamine induced beneficial antidepressant-like effects in male mice, but induced both anxiety-like (i.e., decreased time spent in the center of the open field arena) and depressive-like effects (i.e., enhanced immobility duration in the forced swim test; FST) in their female counterparts. Moreover, repeated ketamine treatment induced sustained sex-differentiated neurochemical and molecular effects, as it enhanced hippocampal synapsin protein levels and serotonin turnover in males, but attenuated glutamate and aspartate levels in female mice. Taken together, our findings indicate that repeated ketamine treatment induces opposite behavioral effects in male and female mice, and thus, present data have far-reaching implications for the sex-oriented use of ketamine in both experimental and clinical research settings.
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Affiliation(s)
- Connor Thelen
- Department of Biology & Center for Tissue Regeneration and Engineering at Dayton (TREND), University of Dayton, 300 College Park, Dayton, 45469-2320 OH, USA
| | - Jonathon Sens
- Department of Biology & Center for Tissue Regeneration and Engineering at Dayton (TREND), University of Dayton, 300 College Park, Dayton, 45469-2320 OH, USA
| | - Joseph Mauch
- Department of Biology & Center for Tissue Regeneration and Engineering at Dayton (TREND), University of Dayton, 300 College Park, Dayton, 45469-2320 OH, USA
| | - Radhika Pandit
- Department of Biology & Center for Tissue Regeneration and Engineering at Dayton (TREND), University of Dayton, 300 College Park, Dayton, 45469-2320 OH, USA
| | - Pothitos M Pitychoutis
- Department of Biology & Center for Tissue Regeneration and Engineering at Dayton (TREND), University of Dayton, 300 College Park, Dayton, 45469-2320 OH, USA.
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21
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Gibbon JD, Gupta A, Krstulovic G, Pandit R, Politano H, Ponty Y, Pouquet A, Sahoo G, Stawarz J. Depletion of nonlinearity in magnetohydrodynamic turbulence: Insights from analysis and simulations. Phys Rev E 2016; 93:043104. [PMID: 27176387 DOI: 10.1103/physreve.93.043104] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Indexed: 11/07/2022]
Abstract
It is shown how suitably scaled, order-m moments, D_{m}^{±}, of the Elsässer vorticity fields in three-dimensional magnetohydrodynamics (MHD) can be used to identify three possible regimes for solutions of the MHD equations with magnetic Prandtl number P_{M}=1. These vorticity fields are defined by ω^{±}=curlz^{±}=ω±j, where z^{±} are Elsässer variables, and where ω and j are, respectively, the fluid vorticity and current density. This study follows recent developments in the study of three-dimensional Navier-Stokes fluid turbulence [Gibbon et al., Nonlinearity 27, 2605 (2014)NONLE50951-771510.1088/0951-7715/27/10/2605]. Our mathematical results are then compared with those from a variety of direct numerical simulations, which demonstrate that all solutions that have been investigated remain in only one of these regimes which has depleted nonlinearity. The exponents q^{±} that characterize the inertial range power-law dependencies of the z^{±} energy spectra, E^{±}(k), are then examined, and bounds are obtained. Comments are also made on (a) the generalization of our results to the case P_{M}≠1 and (b) the relation between D_{m}^{±} and the order-m moments of gradients of magnetohydrodynamic fields, which are used to characterize intermittency in turbulent flows.
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Affiliation(s)
- J D Gibbon
- Department of Mathematics, Imperial College London, London SW7 2AZ, United Kingdom
| | - A Gupta
- Department of Physics, University of Rome "Tor Vergata," 00133 Rome, Italy
| | - G Krstulovic
- Laboratoire Lagrange, Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Blvd de l'Observatoire, CS 34229, 06304 Nice cedex 4, France
| | - R Pandit
- Centre for Condensed Matter Theory, Indian Institute of Science, Bangalore, 560 012, India
| | - H Politano
- Laboratoire Dieudonné, Université de Nice Sophia-Antipolis, France
| | - Y Ponty
- Laboratoire Lagrange, Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Blvd de l'Observatoire, CS 34229, 06304 Nice cedex 4, France
| | - A Pouquet
- National Center for Atmospheric Research, P.O. Box 3000, Boulder, Colorado 80307, USA.,Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, Colorado 80303, USA
| | - G Sahoo
- Department of Physics, University of Rome "Tor Vergata," 00133 Rome, Italy
| | - J Stawarz
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, Colorado 80303, USA
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Abstract
The anorexigenic hormone leptin plays an important role in the control of food intake and feeding-related behavior, for an important part through its action in the hypothalamus. The adipose-derived hormone modulates a complex network of several intercommunicating orexigenic and anorexigenic neuropeptides in the hypothalamus to reduce food intake and increase energy expenditure. In this review we present an updated overview of the functional role of leptin in respect to feeding and feeding-related behavior per distinct hypothalamic nuclei. In addition to the arcuate nucleus, which is a major leptin sensitive hub, leptin-responsive neurons in other hypothalamic nuclei, including the, dorsomedial-, ventromedial- and paraventricular nucleus and the lateral hypothalamic area, are direct targets of leptin. However, leptin also modulates hypothalamic neurons in an indirect manner, such as via the melanocortin system. The dissection of the complexity of leptin's action on the networks involved in energy balance is subject of recent and future studies. A full understanding of the role of hypothalamic leptin in the regulation of energy balance requires cell-specific manipulation using of conditional deletion and expression of leptin receptors. In addition, optogenetic and pharmacogenetic tools in combination with other pharmacological (such as the recent discovery of a leptin receptor antagonist) and neuronal tracing techniques to map the circuit, will be helpful to understand the role of leptin receptor expressing neurons. Better understanding of these circuits and the involvement of leptin could provide potential sites for therapeutic interventions in obesity and metabolic diseases characterized by dysregulation of energy balance.
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Affiliation(s)
- M M H van Swieten
- Department of Translational Neuroscience, Division of Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Master's Program Neuroscience and Cognition, Utrecht University, The Netherlands
| | - R Pandit
- Department of Translational Neuroscience, Division of Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R A H Adan
- Department of Translational Neuroscience, Division of Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G van der Plasse
- Department of Translational Neuroscience, Division of Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
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Manousaridis K, Ong E, Stenton C, Gupta R, Browning AC, Pandit R. Reply to Wakefield and Kumar. Eye (Lond) 2014; 28:111-2. [DOI: 10.1038/eye.2013.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pandit R, la Fleur SE, Adan RAH. The role of melanocortins and Neuropeptide Y in food reward. Eur J Pharmacol 2013; 719:208-214. [PMID: 23872406 DOI: 10.1016/j.ejphar.2013.04.059] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 02/15/2013] [Revised: 04/03/2013] [Accepted: 04/04/2013] [Indexed: 12/11/2022]
Abstract
The Neuropeptide Y and the melanocortin peptides are two well-described hypothalamic feeding peptides regulating energy balance. Predominantly expressed within the arcuate nucleus, these neurons project to different brain areas and modulate various aspects of feeding. Hedonic feeding, where one overindulges in palatable food consumption beyond one's nutritional necessities, is one such aspect regulated by NPY/melanocortin signaling. Research suggests that NPY/melanocortin regulate hedonic aspects of feeding through its projections to the brain reward circuitry (ventral tegmental area, lateral hypothalamus, nucleus accumbens etc.), however, exact target areas have not yet been identified. The current work explores literature to provide a mechanistic explanation for the effects of these peptides on food reward.
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Affiliation(s)
- R Pandit
- Rudolf Magnus Institute of Neuroscience, Department of Neuroscience and Pharmacology, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands.
| | - S E la Fleur
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - R A H Adan
- Rudolf Magnus Institute of Neuroscience, Department of Neuroscience and Pharmacology, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
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Karrar S, Shiwen X, Nikotorowicz-Buniak J, Abraham DJ, Denton C, Stratton R, Bayley R, Kite KA, Clay E, Smith JP, Kitas GD, Buckley C, Young SP, Ye L, Zhang L, Goodall J, Gaston H, Xu H, Lutalo PM, Zhao Y, Meng Choong L, Sangle S, Spencer J, D'Cruz D, Rysnik OJ, McHugh K, Bowness P, Rump-Goodrich L, Mattey D, Kehoe O, Middleton J, Cartwright A, Schmutz C, Askari A, Middleton J, Gardner DH, Jeffery LE, Raza K, Sansom DM, Clay E, Bayley R, Fitzpatrick M, Wallace G, Young S, Shaw J, Hatano H, Cauli A, Giles JL, McHugh K, Mathieu A, Bowness P, Kollnberger S, Webster S, Ellis L, O'Brien LM, Fitzmaurice TJ, Gaston H, Goodall J, Nazeer Moideen A, Evans L, Osgood L, Williams A, Jones S, Thomas C, O'Donnell V, Nowell M, Ouboussad L, Savic S, Dickie LJ, Hintze J, Wong CH, Cook GP, Buch M, Emery P, McDermott MF, Hardcastle SA, Gregson CL, Deere K, Davey Smith G, Dieppe P, Tobias JH, Dennison E, Edwards M, Bennett J, Coggon D, Palmer K, Cooper C, McWilliams D, Young A, Kiely PD, Walsh D, Taylor HJ, Harding I, Hutchinson J, Nelson I, Blom A, Tobias J, Clark E, Parker J, Bukhari M, McWilliams D, Jayakumar K, Young A, Kiely P, Walsh D, Diffin J, Lunt M, Marshall T, Chipping J, Symmons D, Verstappen S, Taylor HJ, Harding I, Hutchinson J, Nelson I, Tobias J, Clark E, Bluett J, Bowes J, Ho P, McHugh N, Buden D, Fitzgerald O, Barton A, Glossop JR, Nixon NB, Emes RD, Dawes PT, Farrell WE, Mattey DL, Scott IC, Steer S, Seegobin S, Hinks AM, Eyre S, Morgan A, Wilson AG, Hocking L, Wordsworth P, Barton A, Worthington J, Cope A, Lewis CM, Guerra S, Ahmed BA, Denton C, Abraham D, Fonseca C, Robinson J, Taylor J, Haroon Rashid L, Flynn E, Eyre S, Worthington J, Barton A, Isaacs J, Bowes J, Wilson AG, Barrett JH, Morgan A, Kingston B, Ahmed M, Kirwan JR, Marshall R, Chapman K, Pearson R, Heycock C, Kelly C, Rynne M, Saravanan V, Hamilton J, Saeed A, Coughlan R, Carey JJ, Farah Z, Matthews W, Bell C, Petford S, Tibbetts LM, Douglas KMJ, Holden W, Ledingham J, Fletcher M, Winfield R, Price Z, Mackay K, Dixon C, Oppong R, Jowett S, Nicholls E, Whitehurst D, Hill S, Hammond A, Hay E, Dziedzic K, Righetti C, Lebmeier M, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Nikiphorou E, Morris S, James D, Kiely P, Walsh D, Young A, Wong EC, Long J, Fletcher A, Fletcher M, Holmes S, Hockey P, Abbas M, Chattopadhyay C, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, Robson J, Kiran A, Maskell J, Arden N, Hutchings A, Emin A, Culliford D, Dasgupta B, Hamilton W, Luqmani R, Jethwa H, Rowczenio D, Trojer H, Russell T, Loeffler J, Hawkins P, Lachmann H, Verma I, Syngle A, Krishan P, Garg N, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, McGowan SP, Gerrard DT, Chinoy H, Ollier WE, Cooper RG, Lamb JA, Taborda L, Correia Azevedo P, Isenberg D, Leyland KM, Kiran A, Judge A, Hunter D, Hart D, Javaid MK, Arden N, Cooper C, Edwards MH, Litwic AE, Jameson KA, Deeg D, Cooper C, Dennison E, Edwards MH, Jameson KA, Cushnaghan J, Aihie Sayer A, Deeg D, Cooper C, Dennison E, Jagannath D, Parsons C, Cushnaghan J, Cooper C, Edwards MH, Dennison E, Stoppiello L, Mapp P, Ashraf S, Wilson D, Hill R, Scammell B, Walsh D, Wenham C, Shore P, Hodgson R, Grainger A, Aaron J, Hordon L, Conaghan P, Bar-Ziv Y, Beer Y, Ran Y, Benedict S, Halperin N, Drexler M, Mor A, Segal G, Lahad A, Haim A, Rath U, Morgensteren DM, Salai M, Elbaz A, Vasishta VG, Derrett-Smith E, Hoyles R, Khan K, Abraham DJ, Denton C, Ezeonyeji A, Takhar G, Denton C, Ong V, Loughrey L, Bissell LA, Hensor E, Abignano G, Redmond A, Buch M, Del Galdo F, Hall FC, Malaviya A, Nisar M, Baker S, Furlong A, Mitchell A, Godfrey AL, Ruddlesden M, Hadjinicolaou A, Hughes M, Moore T, O'Leary N, Tracey A, Ennis H, Dinsdale G, Roberts C, Herrick A, Denton CP, Guillevin L, Hunsche E, Rosenberg D, Schwierin B, Scott M, Krieg T, Anderson M, Hall FC, Herrick A, McHugh N, Matucci-Cerinic M, Alade R, Khan K, Xu S, Denton C, Ong V, Nihtyanova S, Ong V, Denton CP, Clark KE, Tam FWK, Unwin R, Khan K, Abraham DJ, Denton C, Stratton RJ, Nihtyanova S, Schreiber B, Ong V, Denton CP, Seng Edwin Lim C, Dasgupta B, Corsiero E, Sutcliffe N, Wardemann H, Pitzalis C, Bombardieri M, Tahir H, Donnelly S, Greenwood M, Smith TO, Easton V, Bacon H, Jerman E, Armon K, Poland F, Macgregor A, van der Heijde D, Sieper J, Elewaut D, Pangan AL, Nguyen D, Badenhorst C, Kirby S, White D, Harrison A, Garcia JA, Stebbings S, MacKay JW, Aboelmagd S, Gaffney K, van der Heijde D, Deodhar A, Braun J, Mack M, Hsu B, Gathany T, Han C, Inman RD, Cooper-Moss N, Packham J, Strauss V, Freeston JE, Coates L, Nam J, Moverley AR, Helliwell P, Hensor E, Wakefield R, Emery P, Conaghan P, Mease P, Fleischmann R, Wollenhaupt J, Deodhar A, Kielar D, Woltering F, Stach C, Hoepken B, Arledge T, van der Heijde D, Gladman D, Fleischmann R, Coteur G, Woltering F, Mease P, Kavanaugh A, Gladman D, van der Heijde D, Purcaru O, Mease P, McInnes I, Kavanaugh A, Gottlieb AB, Puig L, Rahman P, Ritchlin C, Li S, Wang Y, Mendelsohn A, Doyle M, Tillett W, Jadon D, Shaddick G, Cavill C, Robinson G, Sengupta R, Korendowych E, de Vries C, McHugh N, Thomas RC, Shuto T, Busquets-Perez N, Marzo-Ortega H, McGonagle D, Tillett W, Richards G, Cavill C, Sengupta R, Shuto T, Marzo-Ortega H, Thomas RC, Bingham S, Coates L, Emery P, John Hamlin P, Adshead R, Cambridge S, Donnelly S, Tahir H, Suppiah P, Cullinan M, Nolan A, Thompson WM, Stebbings S, Mathieson HR, Mackie SL, Bryer D, Buch M, Emery P, Marzo-Ortega H, Krutikov M, Gray L, Bruce E, Ho P, Marzo-Ortega H, Busquets-Perez N, Thomas RC, Gaffney K, Keat A, Innes W, Pandit R, Kay L, Lapshina S, Myasoutova L, Erdes S, Wallis D, Waldron N, McHugh N, Korendowych E, Thorne I, Harris C, Keat A, Garg N, Syngle A, Vohra K, Khinchi D, Verma I, Kaur L, Jones A, Harrison N, Harris D, Jones T, Rees J, Bennett A, Fazal S, Tugnet N, Barkham N, Basu N, McClean A, Harper L, Amft EN, Dhaun N, Luqmani RA, Little MA, Jayne DR, Flossmann O, McLaren J, Kumar V, Reid DM, Macfarlane GJ, Jones G, Yates M, Watts RA, Igali L, Mukhtyar C, Macgregor A, Robson J, Doll H, Yew S, Flossmann O, Suppiah R, Harper L, Hoglund P, Jayne D, Mukhtyar C, Westman K, Luqmani R, Win Maw W, Patil P, Williams M, Adizie T, Christidis D, Borg F, Dasgupta B, Robertson A, Croft AP, Smith S, Carr S, Youssouf S, Salama A, Pusey C, Harper L, Morgan M. Basic Science * 208. Stem Cell Factor Expression is Increased in the Skin of Patients with Systemic Sclerosis and Promotes Proliferation and Migration of Fibroblasts in vitro. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Pandit R, Chowdhury PR, Pramanik T, Singh S. Efficacy of isometric exercise full knee extension horizontally (FKEH)--a new and simple maneuver to predict early onset of hypertension. Nepal Med Coll J 2013; 15:68-70. [PMID: 24592799] [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: 06/03/2023]
Abstract
Hypertension is recognized as one of the risk factors for cardiovascular mortality and morbidity. Early identification of persons at increased risk for developing hypertension is a priority, which help them, to live a healthy life by altering lifestyle. Persons having predisposing factors of hypertension (e.g., family history of hypertension) show blood pressure hyper-responsiveness to stress. Elevated blood pressure due to sympathetic stimulation prevailed longer time in susceptible persons. In previous studies some instruments (e.g., hand immersion in cold (4 degrees C) water or isometric exercise by handgrip dynamometer) were required to elicit sympathetic stimulation. In the present study a simple maneuver Full Knee Extension Horizontally (FKEH) has been introduced--a stressor that caused full isometric contraction of quadriceps femoris muscles of both sides. The test was conducted in normotensive, non-smoker males (n = 150) of age group 18-25 years. Among them some (n = 100) were from families having no history of familial hypertension and others (n = 50) were from the families with history of hypertension. The causal blood pressure and heart rate of the participants were recorded. Then the volunteers were requested to perform FKEH maneuver for one minute. Both blood pressure and heart rate were recorded immediately after and 3 minutes following FKEH. The data analyzed using t-test showed that, diastolic blood pressure didn't return and stabilized to pre-exercise level even after 3 minutes following FKEH in volunteers who were mostly from hypertensive family (P< 0.05) i.e., having predisposing factors of hypertension. This indicated those people are prone to early onset of hypertension as their Autonomic Nervous System (ANS) is not competent enough to stabilize their blood pressure to pre-exercise level. Hence, stress in the form of FKEH for one minute may be used as a bedside test to assess the competence of ANS and the proneness of developing early hypertension.
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Affiliation(s)
- R Pandit
- Department of Physiology, Nepal Medical College, Jorpati, Kathmandu, Nepal.
| | - P Roy Chowdhury
- Department of Physiology, Nepal Medical College, Jorpati, Kathmandu, Nepal
| | - T Pramanik
- Department of Physiology, Nepal Medical College, Jorpati, Kathmandu, Nepal
| | - S Singh
- Department of Physiology, Nepal Medical College, Jorpati, Kathmandu, Nepal
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Manousaridis K, Ong E, Stenton C, Gupta R, Browning AC, Pandit R. Clinical presentation, treatment, and outcomes in presumed intraocular tuberculosis: experience from Newcastle upon Tyne, UK. Eye (Lond) 2013; 27:480-6. [PMID: 23429412 DOI: 10.1038/eye.2013.11] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To report the clinical manifestations and treatment outcomes of patients with presumed intraocular tuberculosis (TB) seen at the Newcastle Uveitis Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK over a 10-year period. METHODS Retrospective review of case notes. RESULTS A total of 21 patients were identified. Occlusive retinal vasculitis was the commonest ophthalmological presentation (12 patients). Eight patients (38%) were found to have underlying active systemic TB (four with mediastinal lymphadenopathy, three with pulmonary TB, one with cutaneous TB). Constitutional or respiratory symptoms, elevated inflammatory markers, and an abnormal chest radiograph were poor indicators of active TB. Two patients had inactive intrathoracic TB. Eleven patients had latent TB. Eighteen patients received anti-tuberculous treatment. Final visual acuity was better than or equal to initial visual acuity in 14 out of 16 patients who completed at least 6 months of standard anti-tuberculous treatment. CONCLUSIONS Most patients with presumed intraocular TB have latent TB, but a significant minority has hitherto undetected active TB. Our series suggests that either proven or presumed intraocular TB occurs frequently in the absence of constitutional or respiratory symptoms, elevated inflammatory markers, or an abnormal chest radiograph. A minimum of 6 months standard anti-tuberculous treatment provides good visual outcomes in the majority of patients.
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Affiliation(s)
- K Manousaridis
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Pramanik T, Khatiwada B, Pandit R. Color vision deficiency among a group of students of health sciences. Nepal Med Coll J 2012; 14:334-336. [PMID: 24579547] [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: 06/03/2023]
Abstract
Color vision deficiency, most of the time remains an unnoticed problem; even many doctors/health professionals do not know the severity of their color vision deficiency and their disability. Some common difficulties reported by medical practitioners and students of health sciences were in recognizing- widespread body color changes (pallor, cyanosis, icterus, rashes, erythema of skin), colorful charts, slides, test-strips of blood and urine, body products: blood or bile in urine, faeces, sputum, vomitus, microscopy, oral and throat lesions, titration end-points, tissue identification (surgery) etc. The present study was undertaken to evaluate the presence of congenital color vision deficiency among the students of health sciences. The study was carried out among the medical and dental male students of Nepal Medical College and Teaching Hospital (n = 215) from November 2, 2012 to December 4, 2012 with the help of Ishihara chart which was shown to all male participants and were asked to read the impressions in the color chart. The impressions perceived by a person with normal color vision were different from the impressions perceived by a person with color vision deficiency. After careful screening, it was noted that among the study population (n = 215), 12 were color deficient (5.58% of our study population). Among them, one could not appreciate color (total color blindness according to the chart used), protanomaly was detected in 1, deuteranomaly in 3 and deuteranopia in 7 volunteers. Students of health sciences must be made aware of their congenital color vision deficiency and its effects on their work. Screening enables the students and later the health professionals to become aware of limitations in their powers of observation and devise ways of overcoming them. The patient is protected from harm and legal action may be avoided when the health professional have adapted their practice to their deficiency. Medical/ dental students and health professionals must be screened for color vision deficiency and advised about it, so that they can take special care in clinical practice.
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Affiliation(s)
- T Pramanik
- Department of Physiology, Nepal Medical College, Jorpati, Katmandu, Nepal.
| | - B Khatiwada
- Department of Physiology, Nepal Medical College, Jorpati, Katmandu, Nepal
| | - R Pandit
- Department of Physiology, Nepal Medical College, Jorpati, Katmandu, Nepal
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Roychowdhury P, Pramanik T, Prajapati R, Pandit R, Singh S. In health--vital capacity is maximum in supine position. Nepal Med Coll J 2011; 13:131-132. [PMID: 22364099] [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: 05/31/2023]
Abstract
Vital capacity, frequently measured clinically as an index of pulmonary function, gives useful information about the strength of respiratory muscles and other aspects of lung functions. It is generally noted in sitting position. As in the supine position, respiratory excursions of diaphragm is highest in normal breathing, this study was planned to note whether there occurred any alteration in vital capacity in supine position in comparison to that noted in sitting position. Young sedentary non smoker healthy medial students (n = 100, age 19-22 years) of Nepal Medical College participated as volunteers in this study. Body mass index (BMI) of each of them was calculated. Vital capacity was noted in sitting position and in supine position with the help of a spirometer, following the standard procedure. Result exhibited greater vital capacity in supine posture than in sitting position in the same individual. Diaphragm is the major muscle of inspiration, responsible for some two-thirds of the vital capacity. Naturally, in supine posture the scope of diaphragmatic movements increased and as a result, vital capacity exhibited greater value in comparison to that recorded in sitting posture.
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Affiliation(s)
- P Roychowdhury
- Department of Physiology, Nepal Medical College, Jorpati, Kathmandu, Nepal
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Al-Bermani A, Figueiredo F, Speight EL, Jackson GH, Pandit R. Necrobiotic xanthogranuloma masquerading as posterior scleritis. Eye (Lond) 2008; 23:239-40. [DOI: 10.1038/eye.2008.37] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Aryal M, Pandeya A, Gautam N, Baral N, Lamsal M, Majhi S, Chandra L, Pandit R, Das BKL. Oxidative stress in benign prostate hyperplasia. Nepal Med Coll J 2007; 9:222-224. [PMID: 18298008] [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: 05/26/2023]
Abstract
Benign Prostate Hyperplasia (BPH) is the common health problem in ageing male. Free radicals and reactive oxygen species (ROS) are produced more with advancement of age leads to oxidative stress. This study aims to assess Malondialdehyde (MDA), the marker of lipid peroxidation and vitaminic antioxidants e.g. alpha-Tocopherol (Toc) and Ascorbate (Asc) status in plasma of BPH patients. This is a case control study conducted in Department of Biochemistry in collaboration with Dept of Surgery, BPKIHS. Forty eight (n = 48) confirmed patients of BPH and forty six (n = 46) healthy age matched controls were enrolled. Plasma MDA, Asc and alpha-Toc were estimated. Plasma MDA level showed 4.81 +/- 1.87 nmol/ml in BPH patients compared to 3.69 +/- 1.56 nmol/ml in healthy controls (p < 0.001). There were significant decrease in plasma alpha-Toc and Asc level which were 0.85 +/- 0.12 mg/dl and 0.93 +/- 0.13 mg/dl in BPH patients compared to 1.37 +/- 0.31 mg/dl and 1.44 +/- 0.38 mg/dl in healthy controls respectively. Inverse correlation of plasma MDA with a- Toc (r = -0.09) and Asc (r = -0.51) was found in BPH patients. There was mild elevation of PSA in BPH patients compared with control but was not statistically significant. Thus, our study showed the evidence of association of oxidative stress in BPH patients.
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Affiliation(s)
- M Aryal
- Department of Biochemistry, B.P. Koirala Institute of Health Science, Dharan, Nepal.
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Aryal M, Pandeya A, Bas BK, Lamsal M, Majhi S, Pandit R, Agrawal CS, Gautam N, Baral N. Oxidative stress in patients with benign prostate hyperplasia. JNMA J Nepal Med Assoc 2007; 46:103-106. [PMID: 18274564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Benign Prostate Hyperplasia (BPH) is a common health problem in aging male. Free radicals and Reactive Oxygen Species (ROS) are produced in overwhelming quantity with advancement of age. When in oxidative stress, these reactive species cause extensive damage to various organ in the body, may be associated with pathogenesis of BPH also. This study aimed at assessing Malondialdehyde (MDA), the marker of lipid peroxidation and anti-oxidants e.g. alpha-Tocopherol and Ascorbate status in plasma in BPH patients. Forty eight (n=48) cases of BPH and forty six (n = 46) healthy age matched controls were enrolled. Plasma MDA level showed 4.81+/-1.87 nmol/ml in cases compared to 3.69+/-1.56 nmol/ml in healthy controls (p<0.001). There were significant decrease in plasma alpha-Tocopherol and ascorbate level which were 0.85+/-0.12 mg/dl and 0.93 +/- 0.13 mg/dl in cases compared to 1.37+/-0.31 mg/dl and 1.44+/-0.38 mg/dl in healthy controls respectively. Inverse correlation of plasma MDA with alpha-Tocopherol (r = -0.09, p>0.05) and Ascorbate (r =-0.51, p=0.008) was found in BPH patients. There was mild elevation of PSA in BPH patients compared with control but was not statistically significant. Thus, our study showed the evidence of association of oxidative stress in BPH patients.
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Affiliation(s)
- M Aryal
- Department of Biochemistry, B P Koirala Institute of Health Sciences, Dharan, Nepal
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Arun CS, Pandit R, Taylor R. Long-term progression of retinopathy after initiation of insulin therapy in Type 2 diabetes: an observational study. Diabetologia 2004; 47:1380-4. [PMID: 15309288 DOI: 10.1007/s00125-004-1473-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [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] [Received: 11/17/2003] [Accepted: 04/19/2004] [Indexed: 10/26/2022]
Abstract
AIMS/HYPOTHESIS Universal worsening of retinopathy after starting insulin therapy in Type 2 diabetes has been suggested in previous work. METHODS We studied 294 such patients for up to 5 years to evaluate retinal changes and define the factors affecting progression of retinopathy. Yearly retinal photographs were graded using the EURODIAB system. RESULTS Prior to insulin therapy, 26.2% (77/294) of the patients had minimal non-proliferative diabetic retinopathy (NPDR), 3.7% (n=11) had moderate NPDR and 1% (n=3) had severe NPDR. Over the first 3 years of insulin therapy, significant progression occurred in 36 subjects (12.6%). This comprised 5/193 (2.6%) without any retinopathy at baseline, 22/77 (28.5%) with minimal NPDR and 6/11 with moderate NPDR (54.5%) (chi2=56.1, p<0.001). In a control group of 70 patients who remained on oral hypoglycaemic agents, nine patients had significant worsening of retinopathy over 3 years. Over 5 years, 22/127 (17.3%) of patients (9/95 without and 13/32 with retinopathy at baseline [chi2=16.2, p<0.001]) had significant progression of retinopathy. Higher baseline HbA1c (p=0.002) and lower initial decrease in HbA1c (p=0.007) were each independent predictors of greater retinopathy progression over this period. There was no significant worsening of visual acuity in patients whose retinopathy progressed. CONCLUSIONS/INTERPRETATION After initiation of insulin treatment in Type 2 diabetes, clinically significant worsening of retinopathy over a 3-year period was uncommon in those with no retinopathy (2.6%) but occurred in 31.8% of patients with any retinopathy at baseline. The risk of serious worsening of retinopathy after insulin therapy is started in all patients with Type 2 diabetes may have been previously overestimated.
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Affiliation(s)
- C S Arun
- Department of Medicine, The Medical School, University of Newcastle, Newcastle Upon Tyne, UK.
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Abstract
PURPOSE We report a new method of describing and recording chondral lesions of the knee at arthroscopy in order to permit a more accurate and meaningful analysis of patterns of articular cartilage damage. TYPE OF STUDY Case series study. METHODS Data were collected prospectively at 1,000 consecutive arthroscopies by the senior author and chondral lesions were recorded on anatomic articular maps divided into different functional zones. Ten zones on the femur were determined by tibiofemoral weight-bearing and flexion horizons (namely the 0 degrees, 45 degrees, 90 degrees, and 120 degrees horizons as they pass the anterior meniscosynovial junction). Ten zones were determined on the tibia, principally by meniscal relations, and 6 zones on the patella. This allowed the size, Outerbridge grade, and location to be analyzed in relation to mechanism, chronicity, and associated intra-articular pathologies. The recording methods were tested for interobserver reproducibility in 50 subsequent cases at the same arthroscopy by 2 independent observers. The results were analyzed by a third person, and showed a relatively small interobserver error of 7.2% for size for a set of grade 3 and 4 lesions and only a 3% error for site. The Fisher exact test was used. The data sheets were entered onto a computer spreadsheet database using standard software (Excel; Microsoft, Redmond, WA) to permit analysis of the data. RESULTS There were 1,553 chondral lesions in 853 patients correlated with associated lesions, including 356 meniscal lesions, 230 ligamentous injuries, 440 synovial lesions, and other pathologies. High degrees of correlation have been found between specific lesions and their opposing surfaces and the progression of these with time. CONCLUSIONS The problem of precision of localization of articular lesions in the knee has been recently acknowledged by the International Cartilage Research Society (ICRS). However, such recording ought to take into account both function and contact with other structures. This would appear essential in the assessment of prognosis and comparisons between different treatment regimes.
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Affiliation(s)
- N Hunt
- Imperial College School of Medicine, Division of Trauma and Orthopaedics, Charing Cross Hospital, London, England
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Sinha S, Pande A, Pandit R. Defibrillation via the elimination of spiral turbulence in a model for ventricular fibrillation. Phys Rev Lett 2001; 86:3678-3681. [PMID: 11328052 DOI: 10.1103/physrevlett.86.3678] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2000] [Indexed: 05/23/2023]
Abstract
Ventricular fibrillation, the major reason behind sudden cardiac death, is turbulent cardiac electrical activity in which rapid, irregular disturbances in the spatiotemporal electrical activation of the heart make it incapable of any concerted pumping action. Methods of controlling ventricular fibrillation include electrical defibrillation as well as injected medication. Electrical defibrillation, though widely used, involves subjecting the whole heart to massive, and often counterproductive, electrical shocks. We propose a defibrillation method that uses a very low-amplitude shock (of order mV) applied for a brief duration (of order 100 ms) and over a coarse mesh of lines on our model ventricle.
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Affiliation(s)
- S Sinha
- Centre for Condensed Matter Theory, Department of Physics, Indian Institute of Science, Bangalore 560 012, India
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Pandit R, Lathers DM, Beal NM, Garrity T, Young MR. CD34+ immune suppressive cells in the peripheral blood of patients with head and neck cancer. Ann Otol Rhinol Laryngol 2000; 109:749-54. [PMID: 10961808 DOI: 10.1177/000348940010900809] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [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: 11/15/2022]
Abstract
Patients with head and neck squamous cell carcinoma (HNSCC) have profound defects in their immune defenses. Using immunofluorescent staining and flow cytometric analysis, we found that most patients with HNSCC have increased levels of CD34+ cells within their peripheral blood. These circulating CD34+ cells contribute to the depressed functional competence of the peripheral blood T-lymphocytes. This was demonstrated by the increased level of proliferative responsiveness to interleukin-2 by the patients' peripheral blood T-cells after depletion of CD34+ cells. These results show the importance of CD34+ cells in contributing to the depression of T-lymphocyte function in patients with HNSCC and suggest that strategies designed to reduce the levels of circulating CD34+ cells may enhance the immune reactivity of the patients' circulating T-lymphocytes against the HNSCC.
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Affiliation(s)
- R Pandit
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
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Pande A, Pandit R. Spatiotemporal chaos and nonequilibrium transitions in a model excitable medium. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 2000; 61:6448-6460. [PMID: 11088323 DOI: 10.1103/physreve.61.6448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/1999] [Indexed: 05/23/2023]
Abstract
We present a detailed study of the statistical steady states of a model for CO oxidation on Pt(110) proposed by Bar and co-workers. We show that the stability diagram of this model depends sensitively on the boundary conditions. We elucidate several novel properties of a state with meandering spirals (M) briefly mentioned by Bar and co-workers. (1) We show that, with periodic boundary conditions, M is the state MP, a binary mixture displaying a coexistence of quasiperiodically rotating spirals and chaotically moving pointlike defects. We show that the transition from MP to the turbulent state T1 is continuous; the transition line marks the locus where the two phases cease to be distinct. (2) With Neumann boundary conditions M is the state MN, a single quasiperiodically rotating spiral. We show that the MN-T1 transition is discontinuous or first order. We also characterize the transitions from MP and MN to the state S, which has quasiperiodically rotating spirals. We also propose qualitative mechanisms for these transitions.
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Affiliation(s)
- A Pande
- Centre for Condensed Matter Theory, Department of Physics, Indian Institute of Science, Bangalore 560 012, India
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Acharyya M, Basu A, Pandit R, Ramaswamy S. Inequivalence of dynamical ensembles in a generalized driven diffusive lattice gas. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 2000; 61:1139-43. [PMID: 11046385 DOI: 10.1103/physreve.61.1139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/1999] [Indexed: 11/07/2022]
Abstract
We generalize the driven diffusive lattice gas model by using a combination of Kawasaki and Glauber dynamics. We find via Monte Carlo simulations and perturbation studies that the simplest possible generalization of the equivalence of the canonical and grand-canonical ensembles, which holds in equilibrium, does not apply for this class of nonequilibrium systems.
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Affiliation(s)
- M Acharyya
- Jawaharlal Nehru Centre for Advanced Scientific Research, Jakkur, Bangalore 560064, India
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Pandit R. Proximal and palmar dislocation of the lunate and proximal scaphoid as a unit in a case of scaphocapitate syndrome. A 32-month follow-up. J Hand Surg Br 1998; 23:266-8. [PMID: 9607679 DOI: 10.1016/s0266-7681(98)80194-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Various patterns of transscaphoid, transcapitate fracture-dislocations have been described in the literature. There is little information on the method of management and the long-term results of such severe and rare injuries. The case described here involved a transscaphoid, transcapitate, palmar perilunate fracture-dislocation with ejection of the proximal pole of the scaphoid and lunate into the palmar aspect of the forearm. The functional result 32 months after delayed open reduction and internal fixation is reported.
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Affiliation(s)
- R Pandit
- Orthopaedic Department, Queen Elizabeth II Hospital, Welwyn Garden City, Hertfordshire, UK
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Garrity T, Pandit R, Wright MA, Benefield J, Keni S, Young MR. Increased presence of CD34+ cells in the peripheral blood of head and neck cancer patients and their differentiation into dendritic cells. Int J Cancer 1997; 73:663-9. [PMID: 9398043 DOI: 10.1002/(sici)1097-0215(19971127)73:5<663::aid-ijc9>3.0.co;2-v] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.3] [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: 02/05/2023]
Abstract
Patients with head and neck squamous cell carcinoma (HNSCC) have profound immune deficiencies. In 65% of these patients, there is an increased intra-tumoral presence of immune-suppressive CD34+ progenitor cells. The goal of the present study was to determine whether CD34+ cell levels were also increased in the peripheral blood of HNSCC patients and if these immune-suppressive cells could be differentiated into dendritic cells. Our results showed that CD34+ cell levels are increased in the peripheral blood of HNSCC patients. To assess if these CD34+ cells could differentiate into dendritic cells, they were isolated from the blood of HNSCC patients and cultured for 12 days with various cytokine combinations. Culturing CD34+ cells with stem cell factor (c-kit ligand) plus granulocyte-macrophage colony-stimulating factor resulted in the appearance of a significant proportion of cells expressing phenotypic markers characteristic of dendritic cells. Also, including tumor necrosis factor-alpha yielded a significant proportion of cells resembling the bipotential precursor cells for dendritic cells and monocytes (CD14+CD1a+), in addition to the dendritic-like cells. When the differentiation inducer 1alpha,25-dihydroxyvitamin D3 [1,25(OH)2D3] was added along with the cytokine combinations, the yield of cells having characteristics of dendritic cells was further increased. Cells that were derived from CD34+ cell cultures containing 1,25(OH)2D3 had a more potent capacity to present the recall antigen tetanus toxoid to autologous peripheral blood leukocytes and to stimulate a mixed leukocyte response compared to cultures to which 1,25(OH)2D3 had not been added. Our results show that CD34+ cells, whose frequency is increased in HNSCC patients, can be differentiated into cells that phenotypically and functionally resemble dendritic cells and that 1,25(OH)2D3 accentuates this differentiation.
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Affiliation(s)
- T Garrity
- Department of Otolaryngology, Loyola University Stritch School of Medicine, Maywood, IL, USA
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Young MR, Wright MA, Pandit R. Myeloid differentiation treatment to diminish the presence of immune-suppressive CD34+ cells within human head and neck squamous cell carcinomas. The Journal of Immunology 1997. [DOI: 10.4049/jimmunol.159.2.990] [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: 01/04/2023]
Abstract
Abstract
Within human head and neck squamous cell carcinomas (HNSCC) that produce granulocyte-macrophage CSF are CD34+ cells that exhibit natural suppressive (NS) activity. The present study aimed to identify how these NS cells mediate suppression and how to diminish their presence. CD34+ cells that were immunomagnetically isolated from fresh surgical HNSCC specimens produced a soluble product that blocked normal T cell stimulation through the TCR/CD3 complex. This inhibitory activity could be neutralized with Abs to TGF-beta1. Since prior studies showed that the CD34+ NS cells within HNSCC cancers are myelomonocytic progenitor cells, the feasibility of using cytokines that can induce myeloid cell differentiation to diminish the presence of CD34+ NS cells was tested. Adding low doses of 100 U/ml IFN-gamma plus 10 U/ml TNF-alpha to bulk cultures of dissociated HNSCC cancers diminished the frequency of CD34+ cells. Studies with CD34+ cells that were isolated from the HNSCC cancers showed that this cytokine treatment induced differentiation of the CD34+ cells predominantly into monocytic cells. The consequence of treating CD34+ NS cells with the myeloid differentiation treatment was the loss of suppressive activity, a decline in TGF-beta production, and the production of TNF-alpha by the resulting monocytic cells. In HNSCC bulk cultures containing high levels of CD34+ NS activity, IFN-gamma/TNF-alpha not only reduced CD34+ cell levels, but also increased the capacity of the intratumoral T cells to express the p55 IL-2R. These studies show that IFN-gamma/TNF-alpha can induce differentiation of TGF-beta-secreting CD34+ NS cells into nonsuppressive monocytic cells that secrete TNF-alpha.
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Affiliation(s)
- M R Young
- Research Service, Hines Veterans Affairs Hospital, IL 60141, USA
| | - M A Wright
- Research Service, Hines Veterans Affairs Hospital, IL 60141, USA
| | - R Pandit
- Research Service, Hines Veterans Affairs Hospital, IL 60141, USA
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Young MR, Wright MA, Pandit R. Myeloid differentiation treatment to diminish the presence of immune-suppressive CD34+ cells within human head and neck squamous cell carcinomas. J Immunol 1997; 159:990-6. [PMID: 9218621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Within human head and neck squamous cell carcinomas (HNSCC) that produce granulocyte-macrophage CSF are CD34+ cells that exhibit natural suppressive (NS) activity. The present study aimed to identify how these NS cells mediate suppression and how to diminish their presence. CD34+ cells that were immunomagnetically isolated from fresh surgical HNSCC specimens produced a soluble product that blocked normal T cell stimulation through the TCR/CD3 complex. This inhibitory activity could be neutralized with Abs to TGF-beta1. Since prior studies showed that the CD34+ NS cells within HNSCC cancers are myelomonocytic progenitor cells, the feasibility of using cytokines that can induce myeloid cell differentiation to diminish the presence of CD34+ NS cells was tested. Adding low doses of 100 U/ml IFN-gamma plus 10 U/ml TNF-alpha to bulk cultures of dissociated HNSCC cancers diminished the frequency of CD34+ cells. Studies with CD34+ cells that were isolated from the HNSCC cancers showed that this cytokine treatment induced differentiation of the CD34+ cells predominantly into monocytic cells. The consequence of treating CD34+ NS cells with the myeloid differentiation treatment was the loss of suppressive activity, a decline in TGF-beta production, and the production of TNF-alpha by the resulting monocytic cells. In HNSCC bulk cultures containing high levels of CD34+ NS activity, IFN-gamma/TNF-alpha not only reduced CD34+ cell levels, but also increased the capacity of the intratumoral T cells to express the p55 IL-2R. These studies show that IFN-gamma/TNF-alpha can induce differentiation of TGF-beta-secreting CD34+ NS cells into nonsuppressive monocytic cells that secrete TNF-alpha.
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Affiliation(s)
- M R Young
- Research Service, Hines Veterans Affairs Hospital, IL 60141, USA
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Abstract
Primary bipolar femoral head arthroplasties performed on 100 osteoarthritic hips were studied to a minimum of 5 years after surgery. All arthroplasties were performed on physically active patients. At a mean follow-up period of 5.5 years, The Hospital for Special Surgery hip scores were good to excellent in 96 hips. Transient startup soreness constituted the most frequent complaint, occurring in 34 hips. Three hips had more persistent pain localized to the acetabulum, necessitating revision to fixed sockets, which alleviated the symptoms. Four additional hips, in heavy, active men, developed polyethylene fatigue fracture and component disassembly. Acetabular migration of more than 5 mm developed in one hip. Motion, as determined radiologically, occurred primarily at the inner bearing. There were no dislocations or infections in the series. The Bateman bipolar prosthesis provides generally good results in osteoarthritic hips. The shorter operating time and the case of revision are special advantages of bipolar devices. Start-up soreness and stiffness is a shortcoming in approximately one third of cases. Component disassembly in heavy, active men is a problem and the bipolar arthroplasty should be avoided in these patients. Start-up soreness was a significant problem in particular.
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Affiliation(s)
- R Pandit
- Orthopaedic Research Laboratory, St. Joseph's Health Center, London, Ontario, Canada
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Abstract
Few studies have investigated the effects of endoscopic sinus surgery (ESS) on olfaction. In particular, the effect of surgical manipulation of the middle turbinate on olfaction has not been established. Using the University of Pennsylvania Smell Identification Test (UPSIT) and patient questionnaires, the authors performed a prospective study of olfaction in 64 patients undergoing ESS. Thirty-eight patients (59%) underwent partial middle turbinate resection; in the remaining 26 patients (41%), the middle turbinate was preserved. All patients were reevaluated approximately 8 weeks after surgery by endoscopic examination, questionnaire, and the UPSIT. Patients who underwent no resection had a median decrease in UPSIT score of 1.4, and those who underwent resection had a median decrease of 0.5; this difference was not statistically significant. Further, no correlation was found between changes in UPSIT score and follow-up time, sex of the patient, or the patient's subjective assessment of postoperative olfaction. It is concluded that middle turbinate resection has no effect on olfaction.
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Affiliation(s)
- M Friedman
- Department of Otolaryngology and Bronchoesophagology, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center; Chicago, IL 60612, USA
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Pai RV, Pandit R, Krishnamurthy HR, Ramasesha S. One-dimensional disordered bosonic Hubbard model: A density-matrix renormalization group study. Phys Rev Lett 1996; 76:2937-2940. [PMID: 10060829 DOI: 10.1103/physrevlett.76.2937] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Ramaswamy S, Pandit R, Lahiri R. Comment on "Noise-induced nonequilibrium phase transition". Phys Rev Lett 1995; 75:4786. [PMID: 10059998 DOI: 10.1103/physrevlett.75.4786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Menon GI, Pandit R. Glass formation in a lattice model for living polymers. Phys Rev Lett 1995; 75:4638-4641. [PMID: 10059960 DOI: 10.1103/physrevlett.75.4638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Sheshadri K, Krishnamurthy HR, Pandit R, Ramakrishnan TV. Percolation-enhanced localization in the disordered bosonic Hubbard model. Phys Rev Lett 1995; 75:4075-4078. [PMID: 10059808 DOI: 10.1103/physrevlett.75.4075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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