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Baser B, Patel DK, Mishra A. The Role of Extracorporeal Septoplasty in Severely Deviated Nasal Septum. Indian J Otolaryngol Head Neck Surg 2017; 71:271-277. [PMID: 31275843 DOI: 10.1007/s12070-017-1237-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/15/2017] [Indexed: 11/26/2022] Open
Abstract
Extracorporeal septoplasty is a valuable tool in the armamentarium of the nasal surgeon for the reconstruction of the severely deviated septum. Extracorporeal septoplasty offers the surgeon the opportunity to correct the septum under direct visualization, shape the nasal vault and address the nasal dorsum with the ultimate goal of providing both form and function for the patient with a complex septal deviation. The study was conducted with the aim to measure the outcomes of extracorporeal septoplasty in severely deviated nasal septum, relief of symptoms (nasal obstruction), surgical complications, if any, revision, if any with objective to evaluate the functional outcome and aesthetic aspects of extracorporeal septoplasty. This was a prospective observational study of 35 patients with severe deviated nasal septum with or without external deformity of nose attending the ENT OPD between Jan 2015 and Jan 2016 at Sri Aurobindo Medical College and Post Graduate Institute, Indore (M.P.). In this study, 17 patients (48.57%) shows excellent improvement on VAS scale, out of which 13 patients shows excellent improvement and 4 patients shows good improvement on photographic assessment. 11 patients (31.43%) show good improvement on VAS as well as photographic assessment and 7 patients (20%) show moderate improvement on VAS scale and fair improvement on photographic assessment. Extracorporeal septal reconstruction is an important surgical option for the correction of the markedly deviated nasal septum. Fixation of the straightened and replanted septum at the nasal spine and dorsal septum border with the upper lateral cartilages is essential. Spreader grafts for stabilization of the internal nasal valve and dorsal onlay grafts to prevent dorsal irregularity are strongly encouraged.
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Roy P, Jaisree S, Balakrishnan S, Senthilkumar K, Mahaprabhu R, Mishra A, Maity B, Ghosh TK, Karmakar AP. Molecular epidemiology of goat pox viruses. Transbound Emerg Dis 2017; 65:32-36. [PMID: 29150913 DOI: 10.1111/tbed.12763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Indexed: 11/27/2022]
Abstract
Goat pox disease outbreaks were observed in different places affecting Black Bengal Goats in West Bengal (WB) and Tellicherry, Vembur and non-descriptive breeds in Tamil Nadu (TN) causing severe lesions and mortality up to 30%. Clinical specimens from all the outbreaks were screened by polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) and confirmed the diseases as Goat Pox. Virus isolation in Vero cell line was done with randomly selected ten samples, cytopathic effects (CPE) characterized by syncytia and intracytoplasmic inclusion bodies were observed after several blind passages. Nucleotide sequence of complete p32 gene using randomly selected two isolates and three clinical specimens revealed presence of Goat pox virus (GTPV)-specific signature residues in all the sequences. Phylogenetic analysis using the present five sequences along with GenBank data of GTPV complete p32 gene sequences showed all the GTPV sequences cluster together except Pellor strain (NC004003) and FZ Chinese strain (KC951854). The five sequences either from WB or TN cluster more closely with GTPV isolates of Maharashtra state that were responsible for cross species outbreak of pox disease in both sheep (KF468759) and goats (KF468762) in India during the year 2010. All the Indian goat pox viruses, including the Mukteswar strain, isolated in 1946 and sequence reported in 2004 clustered together with the GTPVs causing the recent outbreaks. It was observed that GTPVs caused similar clinical manifestation irrespective of their geographical locations and breed characteristics, no variation observed among the Indian isolates based on p32 gene over the period of seventy years and disease outbreaks could not be observed or reported in vaccinated goats.
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Mishra A, Gill J, Mishra Y, Medhashri S. Role of Humanized EGFR Monoclonal Antibody as Induction Chemotherapy in Advanced Head and Neck Cancer along with Chemo-Radiation. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx511.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mishra A, Gill J, Mishra Y, Medhashri S. Relationship between tumor microenviroment and development and progression of cancer: A Review. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx510.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gill J, Mishra A, Medhashri S, Kaur P, Mishra Y. Role of Intensity Modulated Radiotherapy with Concurrent and Adjuvant Chemotherapy With Temozolamide in Glioblastoma Multiforme. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx512.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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106
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Gill J, Mishra A, Kaur P, Medhashri S, Mishra Y. A Qualitative Study on Views and Perspectives of Non-Governmental Organisations on Implementation of Personalised Medicine in Cancer Patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx508.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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107
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Maiti R, Mishra B, Sanyal S, Mohapatra D, Mishra A. Effect of carbamazepine and oxcarbazepine on serum neuron-specific enolase in focal seizures: A randomized controlled trial. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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108
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Patra J, Basu A, Mishra A, Dhal NK. Bioconversion of Municipal Solid Wastes for Bioethanol Production. ACTA ACUST UNITED AC 2017. [DOI: 10.13005/bbra/2554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ABSTRACT: The use of dilute acid (H2SO4, 3%) and alkali (NaOH, 3%) pretreatment methods has some potential how ever to date, these methods effectively increase ethanol production of municipal solid waste (MSW). Enzymatic hydrolysis was carried out with Aspergillus niger, Aspergillus fumigatus and Trichoderma reesei. Finally, the fermentation was done by sugar three ethanologenic yeasts, Saccharomyces cerevisiae, pichia stipitis, canida shehatae for bioethanol production.The highest ethanol yield (22.32%) v/v. was obtained with a pre-hydrolysis treatment consisting of NaOH at 3% concentration, followed by Pichia stipitis and enzymatic hydrolysis with Aspergillus niger. Pre-hydrolysis treatment consisted Enzymatic hydrolysis was carried out with Alkali pretreated wastes yield more sugar as compared to acid treatment using produced more ethanol than others at each time point. The experimental results observed that 80% of the cellulose converted to glucose from the waste which can be easily fermented to production. of ethanol. The ability focus on related environmental issues, such as sustainable waste management, climate change, land use and biodiversity, are discussed.
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Taskesen E, Mishra A, van der Sluis S, Ferrari R, Veldink JH, van Es MA, Smit AB, Posthuma D, Pijnenburg Y. Susceptible genes and disease mechanisms identified in frontotemporal dementia and frontotemporal dementia with Amyotrophic Lateral Sclerosis by DNA-methylation and GWAS. Sci Rep 2017; 7:8899. [PMID: 28827549 PMCID: PMC5567187 DOI: 10.1038/s41598-017-09320-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 07/26/2017] [Indexed: 12/13/2022] Open
Abstract
Frontotemporal dementia (FTD) is a neurodegenerative disorder predominantly affecting the frontal and temporal lobes. Genome-wide association studies (GWAS) on FTD identified only a few risk loci. One of the possible explanations is that FTD is clinically, pathologically, and genetically heterogeneous. An important open question is to what extent epigenetic factors contribute to FTD and whether these factors vary between FTD clinical subgroup. We compared the DNA-methylation levels of FTD cases (n = 128), and of FTD cases with Amyotrophic Lateral Sclerosis (FTD-ALS; n = 7) to those of unaffected controls (n = 193), which resulted in 14 and 224 candidate genes, respectively. Cluster analysis revealed significant class separation of FTD-ALS from controls. We could further specify genes with increased susceptibility for abnormal gene-transcript behavior by jointly analyzing DNA-methylation levels with the presence of mutations in a GWAS FTD-cohort. For FTD-ALS, this resulted in 9 potential candidate genes, whereas for FTD we detected 1 candidate gene (ELP2). Independent validation-sets confirmed the genes DLG1, METTL7A, KIAA1147, IGHMBP2, PCNX, UBTD2, WDR35, and ELP2/SLC39A6 among others. We could furthermore demonstrate that genes harboring mutations and/or displaying differential DNA-methylation, are involved in common pathways, and may therefore be critical for neurodegeneration in both FTD and FTD-ALS.
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Chennakesavulu S, Mishra A, Sudheer A, Sowmya C, Suryaprakash Reddy C, Bhargav E. Pulmonary delivery of liposomal dry powder inhaler formulation for effective treatment of idiopathic pulmonary fibrosis. Asian J Pharm Sci 2017; 13:91-100. [PMID: 32104382 PMCID: PMC7032187 DOI: 10.1016/j.ajps.2017.08.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/14/2017] [Accepted: 08/10/2017] [Indexed: 11/30/2022] Open
Abstract
Dry powder inhaler Liposomes were prepared to investigate the effectiveness of pulmonary delivery of Colchicine and Budesonide for Idiopathic Pulmonary fibrosis. Budesonide (BUD) and Colchicine (COL) liposomes were prepared by thin layer film hydration method (TFH) using 1,2-Dipalmitoyl-sn-glycero-3- phosphoglycerol sodium (DPPG), Hydrogenated Soyaphosphotidylcholine (HSPC), Soyaphosphatidylcholine (SPC), cholesterol (CHOL) and drug in different weight ratios. The optimum lipid composition for BUD (74.22 ± 0.97%) was DPPG: HSPC: CHOL (4:5:1) and for COL (50.94 ± 2.04%) was DPPG: SPC: CHOL (3:6:1). These compositions retained drug for a longer period of time so selected for further study. Liposomes were found to be spherical in shape with mean size below 100 nm. Liposomes lyophilized using Mannitol as carrier and cryoprotectant showed high entrapment efficiency (97.89 - 98.6%). The powder was dispersed through an Andersen cascade impactor to evaluate the performance of the aerosolized powder. It was found that prepared liposomal dry powder inhaler (DPIs) sustained the drug release up to 24 hours. Optimized Budesonide DPI Formulation B2 (86.53 ± 1.9%), Colchicine DPI Formulation C2 (90.54 ± 2.3 %) and BUD and COL DPI Combination M2 (89.91 ± 1.8%, 91.23 ± 1.9%). Histopathological results, measurements of lung hydroxyproline content, Myeloperoxidase activity indicated that liposomal dry powder inhaler administration attenuates lung fibrosis induced by bleomycin. Long term stability studies indicated that lyophilised BUD and COL liposomes were stable for 6 months at (25 °C ± 2 °C, 60% ± 5% RH) and refrigerated conditions (2 - 8 °C). These results supported that combination of budesonide and colchicine liposomal dry powder inhaler pulmonary drug delivery for treatment of idiopathic Pulmonary Fibrosis exhibits prolonged drug retention at targeted site and reduces the systemic exposure.
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Key Words
- BLM, Bleomycin
- Budesonide
- Colchicine
- DE, Drug entrapment
- DPI, Dry Powder Inhaler
- EPC, Egg phosphatidyl choline
- FPF, Fine particle fraction
- HDPE, High density polyethylene
- Idiopathic Pulmonary fibrosis
- Liposomal dry powder inhaler
- M2, Mixture of BUD & COL (Optimized formulation)
- MDI's, Metered Dose Inhalers
- MMAD, Mean Median Aerodynamic diameter
- PBS, Saline Phosphate buffer
- PVC, Poly vinyl chloride
- Pulmonary drug delivery
- SLS, Sodium lauryl sulphate
- UV, Ultraviolet
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Mishra A, Datta S, Malik A, Garg A, Nair D, Nair S, Mair M, Bal M, Agarwal J, Chaturvedi P. Role of microscopic spread beyond gross disease as an adverse prognostic factor in oral squamous cell carcinoma. Eur J Surg Oncol 2017; 43:1503-1508. [DOI: 10.1016/j.ejso.2017.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/10/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022] Open
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Kumar A, Vijayakumar P, Gandhale PN, Ranaware PB, Kumar H, Kulkarni DD, Raut AA, Mishra A. Genome-wide gene expression pattern underlying differential host response to high or low pathogenic H5N1 avian influenza virus in ducks. Acta Virol 2017; 61:66-76. [PMID: 28161961 DOI: 10.4149/av_2017_01_66] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The differences in the influenza viral pathogenesis observed between different pathogenic strains are associated with distinct properties of virus strains and the host immune responses. In order to determine the differences in the duck immune response against two different pathogenic strains, we studied genome-wide host immune gene response of ducks infected with A/duck/India/02CA10/2011 and A/duck/Tripura/103597/2008 H5N1 viruses using custom-designed microarray. A/duck/India/02CA10/2011 is highly pathogenic virus (HP) to ducks, whereas A/duck/Tripura/103597/2008 is a low pathogenic (LP) virus strain. Comparative lung tissue transcriptome analysis of differentially expressed genes revealed that 686 genes were commonly expressed, 880 and 1556 genes are expressed uniquely to infection with HP and LP virus, respectively. The up-regulation of chemokines (CCL4 and CXCR4) and IFN-stimulated genes (IFITM2, STAT3, TGFB1 and TGFB3) was observed in the lung tissues of ducks infected with HP virus. The up-regulation of other immune genes (IL17, OAS, SOCS3, MHC I and MHC II) was observed in both infection conditions. The expression of important antiviral immune genes MX, IFIT5, IFITM5, ISG12, β-defensins, RSAD2, EIF2AK2, TRIM23 and SLC16A3 was observed in LP virus infection, but not in HP virus infection. Several immune-related gene ontology terms and pathways activated by both the viruses were qualitatively similar but quantitatively different. Based on these findings, the differences in the host immune response might explain a part of the difference observed in the viral pathogenesis of high and low pathogenic influenza strains in ducks.
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Mishra A, Kumar J, Singh T, Varde PV, Bhattacharya S. Production of radioisotopes Sm153 and Lu177 in Dhruva. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s41872-017-0015-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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114
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Taneja N, Sethuraman N, Mishra A, Mohan B. The 2002 Chandigarh cholera outbreak revisited: utility of MALDI-TOF as a molecular epidemiology tool. Lett Appl Microbiol 2017; 62:452-8. [PMID: 27198622 DOI: 10.1111/lam.12574] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 04/09/2016] [Accepted: 04/14/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED In July 2002, an outbreak of cholera occurred in north India with two separate geographical foci. Pulsed field gel electrophoresis (PFGE) was previously used in typing a representative sample of these isolates. This study evaluates the usefulness of MALDI-TOF as an epidemiological tool for typing Vibrio cholerae isolates in comparison with PFGE and Amplified fragment length polymorphisms (AFLP). Forty-six isolates of V. cholerae isolated from stool of patients affected in the July 2002 outbreak were typed using MALDI-TOF. To validate its utility, clinical and environmental isolates previously characterized by PFGE and AFLP were included for dendrogram analysis. All 46 isolates were correctly identified by MALDI-TOF to species level. Two distinct clades appeared on dendrogram using MALDI-TOF corresponding to the two geographical foci of the outbreak. For the study of evolution of organisms from environment, AFLP was superior as it clearly demarcated clinical and environmental isolates. The outbreak was not due to a single clone but due to multiple clones circulating simultaneously, as was seen with PFGE also. SIGNIFICANCE AND IMPACT OF THE STUDY MALDI-TOF appears to be a highly discriminatory, cost-effective and rapid epidemiological typing technique that can be used in the investigation of cholera outbreaks.
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Sabaretnam M, Mishra A, Agarwal G, Agarwal A, Verma AK, Mishra SK. Adrenocortical carcinoma in children and adults: Two decades experience in a single institution. Indian J Cancer 2017; 53:317-321. [PMID: 28071637 DOI: 10.4103/0019-509x.197737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT Adrenocortical carcinoma (ACC) occurring in children and adults show distinct characteristics. However, due to rarity of the disease no large series addressing this issue has been published. AIMS The aim of this study was to study clinico-pathologic profile and outcome of ACC in children and adults. SETTINGS AND DESIGN Tertiary referral center. Retrospective study (January 1990-June 2011). SUBJECTS AND METHODS Forty-five patients with ACC were included; 16children (aged < 18 years) and 29 adults. Clinical details, hormonal profile, operation records, pathology reports and follow-up findings were noted and compared. Survival analysis was performed using Kaplan-Meier method. Log rank test and Cox regressionan alysis were performed. RESULTS Mean age was 8 ± 5.7 (M: F = 1:2.1) in children and 44.4 ± 15 years (M: F = 1:1.1) in adult groups. Prevalence of functioning tumors was significantly high in children (87.5 vs. 31% P = 0.001), while prevalence of incidentalomas was high in adults (6.3 vs. 51.7% P = 0.05). Tumor stage distribution at presentation, mean diameter (10.9 vs. 13.7 cm), and weight (392.9 vs. 892.9 g) didn't differ significantly in two groups. Adults had better albeit non-significant 5 year overall survival (OS) than children (0 vs. 13%). On univariate analysis stage of disease (P = 0.008), surgical intervention (P = 0.004), Weiss score (P = 0.04) and hormonal secretion (P = 0.04) were significantly associated with OS in adults but not in children. No factor was found significant on multivariate analysis. CONCLUSIONS Except for high prevalence of functioning tumors in children, clinico-pathologic attributes and outcome of ACC in the two groups didn't differ significantly.
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Agarwal G, Sonthineni C, Sabaretnam M, Chand G, Mishra A, Agarwal A, Verma A, Mishra S, Agrawal V, Lal P. Frozen section histology of margins facilitates one-step safe & cost-effective breast conservation surgery. Breast 2017. [DOI: 10.1016/s0960-9776(17)30348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Agarwal G, Sonthineni C, Maylivahanan S, Chand G, Mishra A, Agarwal A, Verma AK, Mishra SK, Agrawal V, Krishnani N, Lal P. Abstract P1-11-07: Frozen section histology evaluation of surgical margins helps perform single step oncologically safe and cost-effective breast conservation surgery. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-11-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Mishra A, Rout M, Singh DR, Jana S. Influence of Density of Emulsion Explosives on its Velocity of Detonation and Fragmentation of Blasted Muckpile. CURR SCI INDIA 2017. [DOI: 10.18520/cs/v112/i03/602-608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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119
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Baker BG, Joseph L, Mishra A. An adnexal tumour masquerading as a distal interphalangeal joint ganglion. J Hand Surg Eur Vol 2017; 42:204-205. [PMID: 26642849 DOI: 10.1177/1753193415620179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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120
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Alashek W, Ehtuish E, Elhabashi A, Emberish W, Mishra A. Reasons for Unwillingness of Libyans to Donate Organs after Death. Libyan J Med 2016. [DOI: 10.3402/ljm.v4i3.4827] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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121
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Mishra A, Abuhajar R, Alsawidi K, AlAoud M, Ehtuish E. Congenital Orbital Lymphangioma in a 20-Years Old Girl A Case Report and Review of Literature. Libyan J Med 2016. [DOI: 10.3402/ljm.v4i4.4843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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122
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Mishra A, Purvar R, Malik S, Agarwal K, Gera R, Sridhar S. McCune Albright Syndrome from Gynaecological Perspective. J Obstet Gynaecol India 2016; 66:672-674. [DOI: 10.1007/s13224-016-0864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022] Open
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123
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Baker B, Murphy R, Mishra A. Giant cell tumours of tendon sheath; a 10-year experience from Manchester. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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124
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Mishra A, Tiwari S, Tyagi S. Effect of Urbanization Pollution on Atmospheric Visibility in the National Capital of India: A Case Study of Republic Day. ACTA ACUST UNITED AC 2016. [DOI: 10.17485/ijst/2016/v9i39/97109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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125
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Agrawal S, Agarwal G, Mishra A, Agarwal V, Lal P, Mishra S. Locoregional Recurrence Rates (LRR) After Neoadjuvant Chemotherapy (NACT) and Locoregional Radiation Therapy (RT) According to Pathologic Response and Intrinsic Subtype in Locally Advanced Breast Cancers. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jotwani A, Ravi S, Vallinayagam S, Ayyalusamy A, Reddy R, Mishra A, Lahiri D, Jain A, Reddy K, J N, Rawat S. Application of Lean Principles to Improve High-Precision Radiation Treatment Process and Patient Experience in a High-Volume Cancer Center. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mishra A, Reddy IJ, Gupta PSP, Mondal S. Developmental regulation and modulation of apoptotic genes expression in sheep oocytes and embryos cultured in vitro with L-carnitine. Reprod Domest Anim 2016; 51:1020-1029. [DOI: 10.1111/rda.12789] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/07/2016] [Indexed: 11/30/2022]
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128
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Agarwal A, Pradhan R, Kumari N, Krishnani N, Shukla P, Gupta SK, Chand G, Mishra A, Agarwal G, Verma AK, Mishra SK. Molecular Characteristics of Large Parathyroid Adenomas. World J Surg 2016; 40:607-14. [PMID: 26669787 DOI: 10.1007/s00268-015-3380-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The clinical entity of large parathyroid adenomas (LPTAs) has not been well defined. It is speculated that LPTAs would have biochemical, histological, and molecular characteristics different from small adenomas. Our study aimed to find out occurrence of atypia and carcinomas in large parathyroid lesions and the presence of distinct molecular abnormalities in LPTAs. MATERIALS AND METHODS We divided the parathyroid lesions into large (>7 g, i.e., LPTAs) and small (<7 g) adenomas. We performed parafibromin, APC (adenomatous polyposis coli), galectin 3, and PGP9.5 (protein gene product 9.5) analysis by immunohistochemistry in adenomas without atypia, atypical adenomas, and carcinomas. RESULTS Mean serum calcium, alkaline phosphatase, and intact PTH were significantly higher in large parathyroid tumor group. The presence of both atypical adenoma and carcinoma was higher in large parathyroid tumor group. There was higher percentage of atypia in patients with LPTAs >10 g (33%), and 68% of tumors showed at least one marker suggestive of malignancy in this group. Detailed analysis of immunohistochemical features of LPTA >10 g revealed that six patients showed complete loss of parafibromin immunoreactivity (out of these four showed atypia), while seven showed partial loss. In histopathologically proven malignancy (n = 9), six patients showed complete loss of parafibromin staining, 5 (55%) APC negativity, and 45% showed both galectin 3 and PGP9.5 positivity. Three out of these showed all IHC markers s/o malignancy, and all of them had evidence of metastases or recurrence. 32% of atypical adenoma and 13% of atypical adenoma showed complete loss of parafibromin staining, however none developed metastases or recurrence in follow-up (median follow-up 40 months). Loss of parafibromin staining (complete or partial) was higher in LPTA group (56%) than that in small adenoma (39%); however, it was not statistically significant. APC, galectin 3, and PGP9.5 markers suggestive were higher in LPTA group but were not significant. CONCLUSION LPTAs may show some morphological and immunohistochemical features suggestive of malignancy and can be considered a separate entity. However, the immunohistochemical markers are unable to clearly segregate those LPTAs that may show premalignant potential. Further, we would like to recommend that LPTAs showing complete parafibromin loss together with atypia should be kept under close follow-up.
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Babra R, Singh J, Mishra A. 528. Comparison of patients who underwent laparoscopic versus open surgery for colorectal cancer: Tertiary care centre experience. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Paiker M, Bezbaruah N, Hussain F, Mishra P, Perna G, Mishra A. Morphometric analysis of length and diameter in umbilical cord in normal vs diabetic pregnancies. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.08.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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131
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Singh D, Bezbaruah N, Hussain F, Mishra P, Mishra A, Gupta P. Morphometric study of placenta in normal vs diabetic pregnancies among hospital deliveries in Lucknow. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.08.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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132
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Mishra PP, Manvikar P, Arole V, Swami V, Mishra A. Morphometric measurements of tricuspid valve in cadaveric heart from Maharashtra population. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.08.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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133
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Hanna J, Kyranis S, Alghamry A, Bell B, Mishra A, Raffel C. Coronary Artery Disease Distribution in Patients Presenting with Symptomatic Atrial Fibrillation. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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134
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Bhatia S, Khandia R, Sood R, Bhat S, Siddiqui A, Jahagirdhar G, Mishra S, Mishra A, Pateriya A, Kulkarni D. Reverse genetics based rgH5N2 vaccine provides protection against high dose challenge of H5N1 avian influenza virus in chicken. Microb Pathog 2016; 97:172-7. [DOI: 10.1016/j.micpath.2016.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/05/2016] [Accepted: 06/06/2016] [Indexed: 11/25/2022]
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135
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Mishra A, Malik S, Agarwal K, Yadav A, Gautam A. Benign Cystic Mesothelioma of Uterus: An Unusual Cause of Pelvic Pain. J Obstet Gynaecol India 2016; 66:720-722. [PMID: 27803554 DOI: 10.1007/s13224-016-0917-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/30/2016] [Indexed: 11/25/2022] Open
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Raheja JL, Mishra A, Chaudhary A. Indian sign language recognition using SVM. PATTERN RECOGNITION AND IMAGE ANALYSIS 2016. [DOI: 10.1134/s1054661816020164] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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137
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Mishra A, Mishra S. P-229 An Evaluation Based on a Systematic Review of Epidemiologic Evidence of Colorectal Cancer Risk among the Alcohol Consuming Indian Population. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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138
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Todorovich S, Poonai C, Wright B, Ali S, Bhatt C, Todorovich S, Canton K, Mishra A, Speechley K, Stang A, Thompson G, Poonai N. Family Perceptions and Provision of Analgesia for Acutely Painful Conditions in Children: A Multi-Centred Prospective Survey. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: More than two-thirds of children who present to the emergency department (ED) complain of pain. It is well known that children’s pain is poorly managed in the ED compared to their adult counterparts. With respect to analgesic administration in the ED, discrepancies exist between physician self-report and institutional audit. Patient refusal of analgesia is a likely explanation. There is good evidence that misconceptions and fears about analgesia in children are common among caregivers and may contribute to withholding pain medication. To date, no study has surveyed caregivers presenting the the ED to assess frequency of analgesic administration and reasons for withholding analgesia. We hypothesize that there will be a significant proportion of care-givers and patients that refuse pain medication in the ED. We also hypothesize that there will be a wide range of reasons for refusal. The insight we gain from this study will help nurses, clinical educators, and physicians provide the appropriate information to parents in an effort to target misconceptions and allay fears.
OBJECTIVES: Our objectives were to characterize the degree of care-giver and patient provision of analgesia prior to arrival, refusal of analgesia in the ED, and reasons behind their decision-making process. We hope to identify specific misconceptions, attitudes, or beliefs that impair the optimal provision of analgesia to children in the ED.
DESIGN/METHODS: A novel survey was designed by a focus group using an iterative approach and implemented over a 16-week period across two Canadian tertiary care paediatric EDs. We included a consecutive sample of caregivers of children aged 4-17 years with an acutely painful condition (headache, abdominal pain, injury, otitis, pharyngitis). Caregivers were asked to answer questions covering five domains: (i) demographics, (ii) analgesia prior to arrival (iii) analgesia offered in the ED and reasons for refusal, (iv) perceptions of analgesia, and (v) caregiver satisfaction at discharge. Children were asked to rate their pain on arrival and at discharge. The primary outcome was the frequency of caregiver provision of analgesia prior to arrival and the proportion of caregivers who accept the offer of analgesia offered in the ED.
RESULTS: Three hundred forty-four caregivers completed the survey. The majority were female (269/339, 79%), aged 36 years or older (256/340, 75%) with a post-secondary education (237/336, 71%). Most (309/339, 91%) reported being able to “tell when their child was in pain”. All respondents rated their child’s maximal pain related to the presenting condition as at least a 6/10. With regards to the primary outcome, 229/338 (68%) of caregivers reported that they did not treat their child’s pain prior to arrival in the ED. Of those who did treat their child’s pain, ibuprofen was the most commonly used analgesic (77/112, 69%). The most common reasons for withholding analgesia was a lack of time (80/210, 38%), fear of masking seriousness of child’s condition (49/210, 23%), fear of masking signs and symptoms (48/210, 23%), and a lack of analgesia at home (47/210, 22%). Analgesia was offered to 186/344 (45%) of children in the ED and the majority of caregivers 157/186 (84%) accepted the offer. The most common reason for not accepting analgesia in the ED was child refusal (15/20, 75%). Most, 231/338 (68%) of caregivers felt that their child’s pain was managed well in the ED.
CONCLUSION: This survey of caregiver perceptions surrounding analgesia for children with acutely painful conditions presenting to the pae-diatric ED suggests that most do not treat their child’s pain prior to arrival, despite high levels of pain. Misconceptions surrounding analgesia prior to arrival are common. Despite this, most caregivers accepted analgesia in the ED. Our results suggest that educational strategies should be directed at caregiver awareness of the impact of pain on children and the need for prompt analgesic therapy, even when an ED visit is planned.
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Jain D, Mishra A, Sinha S, Gupta P, Srivastava R, Deshpande S, Prabhakaran D, Unnikrishnan A, Bhalla S. PT014 Quality Improvement and Assurance of a Cardio-Diabetes Education Programme: A Pan India Initiative for Primary Care Physicians. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Sathe KP, Ohri A, Mishra A, Ali U. Digital gangrene in a child with atypical hemolytic uremic syndrome associated with anti-factor H antibodies. Indian J Nephrol 2016; 26:231-2. [PMID: 27194846 PMCID: PMC4862277 DOI: 10.4103/0971-4065.169557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Reazaul Karim HM, Yunus M, Mishra A. Medical education technology workshop for residents: A step towards development of new faculty. THE NATIONAL MEDICAL JOURNAL OF INDIA 2016; 29:180-181. [PMID: 27808076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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142
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Ranaware P, Mishra A, vijayakumar P, Gandhale P, Sudhakar S, Kumar H, Kulkarni D, Raut A. Genome wide host gene expression analysis in chicken lungs infected with avian influenza viruses. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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143
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Mishra A, Maltais TR, Walter TM, Wei A, Williams SJ, Wereley ST. Trapping and viability of swimming bacteria in an optoelectric trap. LAB ON A CHIP 2016; 16:1039-1046. [PMID: 26891971 PMCID: PMC5562368 DOI: 10.1039/c5lc01559f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Non-contact manipulation methods capable of trapping and transporting swimming bacteria can significantly aid in chemotaxis studies. However, high swimming speed makes the trapping of these organisms an inherently challenging task. We demonstrate that an optoelectric technique, rapid electrokinetic patterning (REP), can effectively trap and manipulate Enterobacter aerogenes bacteria swimming at velocities greater than 20 μm s(-1). REP uses electro-orientation, laser-induced AC electrothermal flow, and particle-electrode interactions for capturing these cells. In contrast to trapping non-swimming bacteria and inert microspheres, we observe that electro-orientation is critical to the trapping of the swimming cells, since unaligned bacteria can swim faster than the radially inward electrothermal flow and escape the trap. By assessing the cell membrane integrity, we study the effect of REP trapping conditions, including optical radiation, laser-induced heating, and the electric field on cell viability. When applied individually, the optical radiation and laser-induced heating have negligible effect on cells. At the standard REP trapping conditions fewer than 2% of cells have a compromised membrane after four minutes. To our knowledge this is the first study detailing the effect of REP trapping on cell viability. The presented results provide a clear guideline on selecting suitable REP parameters for trapping living bacteria.
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Chugh A, Agarwal P, Singh R, Mishra A. Snapshot Quiz 15/11. Br J Surg 2016; 103:617. [DOI: 10.1002/bjs.10177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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145
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Koppolu P, Mishra A, Swapna LA, Butchibabu K, Bagalkokar A, Baroudi K. Comparison of efficacy among various topical anesthetics: An approach towards painless injections in periodontal surgery. Saudi J Anaesth 2016; 10:55-7. [PMID: 26955311 PMCID: PMC4760043 DOI: 10.4103/1658-354x.169476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background and Aims: Local anesthetics (LAs) are most commonly used agents in dentistry. They are used to prevent the pain and nociception generated during dental procedures. Since pain associated at the time of injection of LA is uncomfortable, most of the dentists are on pursuit of painless administration of LA injection and use of topical anesthetics prior to the injection has proven effective in reducing anxiety and pain to the patient. The aim of this study is to compare pain responses after application of three types of topical anesthetics with control in the patients referred for periodontal full mouth flap surgery. Materials and Methods: A total of 83 patients (42 males and 41 females) participated in the study with age group ranging from 30 to 50 years. The present study is to evaluate the efficacy of three topical anesthetics (Precaine gel, Benzocaine topical paste and Lignocaine spray) before infiltration in altering visual analog scale (VAS) scores of pain during LA injection. The statistical analysis was performed using SPSS version 15.0 software. Repeated analysis of variance was performed to know the effect of each variable and reveal statistical significance. Results: Results revealed that Precaine gel had least VAS score compared with other topical anesthetics. Conclusion: From the present study, it can be concluded that procaine gel is a better than other topical LA agents, as the number of studies on this subject is rare and clinical results are mixed, further studies are required with a larger sample before its routine application in our field.
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Mishra A, Reddy IJ, Gupta PSP, Mondal S. l-carnitine Mediated Reduction in Oxidative Stress and Alteration in Transcript Level of Antioxidant Enzymes in Sheep Embryos ProducedIn Vitro. Reprod Domest Anim 2016; 51:311-21. [DOI: 10.1111/rda.12682] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 02/04/2016] [Indexed: 01/25/2023]
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147
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Mishra A, Prapasrivorakul S, Gosselink MP, Gorissen KJ, Hompes R, Jones O, Cunningham C, Matzel KE, Lindsey I. Sacral neuromodulation for persistent faecal incontinence after laparoscopic ventral rectopexy for high-grade internal rectal prolapse. Colorectal Dis 2016; 18:273-8. [PMID: 26391837 DOI: 10.1111/codi.13125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/05/2015] [Indexed: 02/08/2023]
Abstract
AIM Internal rectal prolapse is recognized as an aetiological factor in faecal incontinence. Patients found to have a high-grade internal rectal prolapse on routine proctography are offered a laparoscopic ventral rectopexy after failed maximum medical therapy. Despite adequate anatomical repair, faecal incontinence persists in a number of patients. The aim of this study was to evaluate the outcome of sacral neuromodulation in this group of patients. METHOD Between August 2009 and January 2012, 52 patients who underwent a laparoscopic ventral rectopexy for faecal incontinence associated with high-grade internal rectal prolapse had persistent symptoms of faecal incontinence and were offered sacral neuromodulation. Symptoms were evaluated before and after the procedure using the Fecal Incontinence Severity Index (FISI) and the Gastrointestinal Quality of Life Index (GIQLI). RESULTS Temporary test stimulation was successful in 47 (94%) of the patients who then underwent implantation of a permanent pulse generator. The median FISI score 1 year after sacral neuromodulation was lower than the median score before [34 (28-59) vs. 19 (0-49); P < 0.01], indicating a significant improvement in faecal continence. Quality of life (GIQLI) was significantly better after starting sacral neuromodulation [78 (31-107) vs. 96 (55-129); P < 0.01]. CONCLUSION Patients may benefit from sacral neuromodulation for persisting faecal incontinence after laparoscopic ventral rectopexy.
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Nizamuddin S, Govindaraj P, Saxena S, Kashyap M, Mishra A, Singh S, Rotti H, Raval R, Nayak J, Bhat BK, Prasanna BV, Dhumal VR, Bhale S, Joshi KS, Dedge AP, Bharadwaj R, Gangadharan GG, Nair S, Gopinath PM, Patwardhan B, Kondaiah P, Satyamoorthy K, Valiathan MS, Thangaraj K. Reply to 'Lack of replication of association of THSD7A with obesity'. Int J Obes (Lond) 2016; 40:727-8. [PMID: 26902698 DOI: 10.1038/ijo.2016.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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149
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Agarwal G, Gambhir S, Lal P, Rajan S, Krishnani N, Mishra A, SabaRetnam M, Agarwal A, Chand G, Verma AK, Mishra SK, Kumari N, Agrawal V, Kheruka SC. Abstract P3-01-06: Sentinel lymph node biopsy after NACT: Results of a validation study in large/locally advanced breast cancer patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-01-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Sentinel lymph node biopsy (SLNB) is the current standard of care for surgical staging of clinically node negative axilla (N0) early breast cancer patients undergoing primary surgery. SLN- identification rate (IR) of 90% and SLN- false negative rate (FNR) of 10% are considered minimum acceptable indices for SLNB. Its role in staging axillae in patients undergoing post-NACT surgery is somewhat unclear. In India, and most low-and-middle income countries, large operable breast cancers (LOBC) and locally advanced breast cancers (LABC) constitute a large proportion of breast cancer patients treated. These patients are usually are treated with NACT, followed by surgery and radiation therapy. In a prospective validation SLNB study, we investigated the accuracy of SLNB in staging post-NACT N0 axilla in a patient cohort that were LOBC or LABC at the time of initial presentation.
Methods:
Hundred consenting non-inflammatory LOBC/LABC patients (mean age 49.3+8.6; index stage T3,N0-1=21; T4b,N0-1=33; T1-3,N2a=24; T4b,N2a=22) who were N0 after NACT at time of surgery (Breast conservation surgery in 19, Mastectomy in 81) were included. Majority had Infiltrating ductal carcinoma (n=87), and grade II/III tumors (n=93); 45 were hormone receptor positive (+), 29 had HR negative (-) HER2(+); and 26 had triple negative breast cancer on IHC sub-typing. Commonest NACT regimen used was Anthracycline followed by taxanes in 83. SLNB was performed using low-cost methylene-blue and 99mTc-Antimony-colloid, which were produced in-house using well standardized protocols, with clearance of the institutional ethics committee. Irrespective of the SLN histology, a complete axillary dissection (ALND) was carried out in all. SLN-IR and SLN-FNR were calculated, comparing the histological status of the SLN and the ALND specimen. Factors predicting non-identified SLN and false negative SLN were evaluated in uni-variate and multi-variate analysis.
Results:
With a combination of methylene blue dye and radiopharmaceutical, the SLN-IR was 81%. Mean number of SLN removed was 2.4+/-1.02. Mean number of nodes removed at ALND was 13.3+/-2.2. SLN-IR varied significantly (p<0.05) per index stage, and were- 90.4% in T3,N0-1; 84.4% in T4b,N0-1; 83.3% in T1-3,N2a; and 63.6% in T4bN2a. The FNR was 17.3% for the whole cohort. FNR varied significantly (p<0.05) per index stage, and were- 8.3% in T3,N0-1; 14.9% in T4b,N0-1; 22.2% in T1-3,N2a; and 30% in T4bN2a. Factors found predictive of non-identified SLN were tumor stage T4b, nodal stage N2a, extra-nodal spread, and LVI. Factors found predictive of FNR SLN were tumor stage T4b, nodal stage N2a, and extra-nodal spread.
Conclusions:
Considering SLN-IR of 90% and SLN-FNR of 10% as acceptable standards, SLNB in post-NACT N0 patients undergoing surgery was not found robust in staging the axilla, with the exception of patients with index stage T3,N0-1 who had SLN-IR of 90.4% and SLN-FNR of 8.3%. Patients with (pre-NACT) skin involvement(T4b), matted axillary nodes(N2a) and LVI are fraught with high-risk of non-identification and false-negative SLNB.
Citation Format: Agarwal G, Gambhir S, Lal P, Rajan S, Krishnani N, Mishra A, SabaRetnam M, Agarwal A, Chand G, Verma AK, Mishra SK, Kumari N, Agrawal V, Kheruka SC. Sentinel lymph node biopsy after NACT: Results of a validation study in large/locally advanced breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-06.
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Sabaretnam M, Mishra A. Utility of ultrasonic scalpel for axillary dissection in a patient with permanent cardiac pacemakers. Indian J Cancer 2016; 52:209. [PMID: 26853407 DOI: 10.4103/0019-509x.175822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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