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Pal S, Chughtai M, Sultan AA, Khlopas A, Sodhi N, George NE, Etcheson JI, Gwam CU, Newman JM, Samuel LT, Bhave A, DaVanzo JE, Mont MA. Impact of Neuromuscular Electrical Stimulation (NMES) on 90-Day Episode Costs and Post-Acute Care Utilization in Total Knee Replacement Patients with Disuse Atrophy. Surg Technol Int 2017; 31:384-388. [PMID: 29316600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION This study evaluated differences in: 1) total episode payments, 2) probability of hospital readmission, 3) probability of inpatient rehab facility (IRF) and utilization, and 4) probability of skilled nursing care facility (SNF) utilization in patients who had disuse atrophy and underwent a total knee arthroplasty (TKA) and either did, or did not, receive preoperative home-based neuromuscular electrical stimulation (NMES) therapy. MATERIALS AND METHODS We used the Medicare limited dataset for a 5% sample of beneficiaries from 2014 and 2015 to construct episodes-of-care for TKA (DRG-470) patients with disuse atrophy who underwent a TKA during the 30 days prior to hospital admission and 90 days post-discharge. Patients were stratified into those who either did or did not receive pre- and postoperative NMES therapy. An ordinary least square (OLS) model was used to estimate the impact of NMES on total episode. Linear probability models were used to estimate the impact of NMES on SNF or IRF utilization and readmission. RESULTS A $3,274 reduction in episode payments for patients who used preoperative NMES versus those who did not (p<0.001) was demonstrated. The probability of readmission was 12.7% lower for those who used preoperative NMES therapy versus those who did not (p=0.609). The probability of utilizing IRF and SNF was 56.7% (p=0.061) and 46.4% (p=<0.001) lower for those who used pre- and postoperative NMES versus those who did not, respectively. CONCLUSION Significant reduction in total episode payments and SNF utilization for TKA patients with disuse atrophy who had NMES therapy was demonstrated.
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Kilambi R, Singh AN, Madhusudhan KS, Das P, Pal S. Choledochal cyst of the proximal cystic duct: a taxonomical and therapeutic conundrum. Ann R Coll Surg Engl 2017; 100:e34-e37. [PMID: 29181996 DOI: 10.1308/rcsann.2017.0201] [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] [Indexed: 11/22/2022] Open
Abstract
Isolated choledochal cysts involving the cystic duct are rare. We present a case of a choledochal cyst involving only the proximal cystic duct, and discuss the taxonomic and therapeutic challenges. There is a need for a clearly defined classification system for these cysts as they may be categorised as either type II or type VI cysts. The optimal treatment remains debatable, with some authors recommending a bilioenteric reconstruction owing to the wide cystic duct-bile duct junction. However, we suggest that a cholecystectomy should be performed with examination of the specimen and frozen section in case of any abnormality rather than upfront bile duct excision. In addition, given the rarity of this condition and the paucity of long-term data, we recommend meticulous follow-up for development of any malignancy.
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Uthappa CK, Allam RR, Pant R, Pal S, Dinaker M, Oruganti G, Yeldandi VV. Pre-exposure prophylaxis: awareness, acceptability and risk compensation behaviour among men who have sex with men and the transgender population. HIV Med 2017; 19:243-251. [PMID: 29178158 DOI: 10.1111/hiv.12572] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This exploratory study examined the facilitators of and barriers to acceptance of pre-exposure prophylaxis (PrEP) and potential risk compensation behaviour emerging from its use among men who have sex with men (MSM) and transgender individuals (TGs) in India. METHODS A questionnaire was administered to 400 individuals registered with a targeted intervention programme. Logistic regression models were used to identify facilitators of and barriers to PrEP acceptance. RESULTS The respondents consisted of 68% MSM and 32% TGs. Risk behaviour categorization identified 40% as low risk, 41% as medium risk and, 19% as high risk for HIV infection. About 93% of the respondents were unaware of PrEP, but once informed about it, 99% were willing to use PrEP. The facilitators of PrEP acceptance were some schooling [odds ratio (OR) 2.16; P = 0.51], being married or in a live-in relationship (OR 2.08; P = 0.46), having a high calculated risk (OR 3.12; P = 0.33), and having a high self-perceived risk (OR 1.8; P = 0.35). Increasing age (OR 2.12; P = 0.04) was a significant barrier. TGs had higher odds of acceptance of PrEP under conditions of additional cost (OR 2.12; P = 0.02) and once-daily pill (OR 2.85; P = 0.04). Individuals identified as low risk for HIV infection showed lower odds of potential risk compensation, defined as more sexual partners (OR 0.8; P = 0.35), unsafe sex with new partners (OR 0.71; P = 0.16), and decreased condom use with regular partners (OR 0.95; P = 0.84), as compared with medium-risk individuals. The associations, although not statistically significant, are nevertheless important for public health action given the limited scientific evidence on PrEP use among MSM and TGs in India. CONCLUSIONS With high acceptability and a low likelihood of risk compensation behaviour, PrEP can be considered as an effective prevention strategy for HIV infection among MSM and TGs in India.
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Powles T, Motzer R, George D, Jonasch E, Pal S, Tannir N, Signoretti S, Mai T, Scheffold C, Wang E, Aftab D, Escudier B, Choueiri T. Outcomes based on plasma biomarkers in METEOR, a randomized phase 3 trial of cabozantinib (c) vs everolimus (e) in advanced renal cell carcinoma (rcc). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.026] [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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Juyal D, Rathaur VK, Pal S, Sharma N. Salmonella Enterica Serotype Paratyphi B - An Unusual Pathogen in Sepsis Neonatorum. Kathmandu Univ Med J (KUMJ) 2017; 17:182-184. [PMID: 34547854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Sepsis remains a significant cause of morbidity and mortality in newborns especially in the developing countries. Salmonellosis, a global public health problem is common in tropical countries. However Salmonella enterica serotype Paratyphi B causing neonatal sepsis is rare and the survival depends on high index of suspicion and appropriate empiric therapy. We here report a case of sepsis neonatorum due to Salmonella enterica serotype Paratyphi B in a four day old baby girl. Salmonella infections should be considered in the differential diagnosis of neonatal sepsis, especially in endemic areas.
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Fernandes PM, Macleod MR, Bateman A, Abrahams S, Pal S. Conjugal amyotrophic lateral sclerosis: a case report from Scotland. BMC Neurol 2017; 17:64. [PMID: 28356084 PMCID: PMC5372255 DOI: 10.1186/s12883-017-0847-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Conjugal amyotrophic lateral sclerosis is rare, with significant effects on psychological and care needs. We report a case of conjugal amyotrophic lateral sclerosis disease from central Scotland. This case is particularly unusual as both patients were diagnosed within an 18-month period and experienced the disease simultaneously, with similar symptomatology and progression. Case presentation Patient A was a 71-year-old man who presented with unilateral arm weakness and wasting. Patient B was a 68-year-old woman who presented with unilateral shoulder and elbow weakness. Diagnosis of amyotrophic lateral sclerosis was made within a few months of presentation in both cases, based on typical clinical symptomatology together with supportive neurophysiological testing. Interventions included enteral feeding and non-invasive ventilation. The time period between symptom onset and death was 5 years for Patient A and 3.5 years for Patient B. Conclusion This case illustrates two main points: the care issues surrounding cases of conjugal neurological disease, and the psychological issues in these patients. There are significant care issues arising when co-habiting couples both develop severe functionally limiting neurological diseases at the same time. The more slowly progressive nature of Patient A’s disease may be at least partially explained by the support he was able to receive from Patient B before she developed symptoms. Secondly, there are important psychological effects of living with someone with the same – but more advanced – progressive and incurable neurological disease. Thus, Patient B was reluctant to have certain interventions that she had observed being given to her husband. Lastly, no plausible shared environmental risk factors were identified, implying that the co-occurrence of ALS in this couple was a random association.
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Seisen T, Sonpavde G, Kachroo N, Lipsitz S, Leow J, Menon M, Gild P, Von Landenberg N, Rouprêt M, Kibel A, Sun M, Pal S, Bellmunt J, Choueiri T, Trinh QD. Comparative effectiveness of selective adjuvant versus systematic neoadjuvant chemotherapy-based strategy for muscle-invasive urothelial carcinoma of the bladder. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/s1569-9056(17)30239-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Irshad K, Jyotsna V, Chosdol K, Agarwal S, Pal S. Mutational status of Yin Yang 1 gene in rare sporadic insulinomas: the Indian scenario with a review. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30568-3] [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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Grande E, Choueiri T, Motzer R, Escudier B, Pal S, Kollmannsberger C, Pikiel J, Gurney H, Rha S, Park S, Geertsen P, Gross Goupil M, Suarez C, Arroyo A, Dean M, George D, Powles T. Effect of prior systemic therapy on clinical outcomes with cabozantinib vs everolimus in advanced renal cell carcinoma: Results from the phase 3 METEOR study. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sadeghi S, Groshen S, Parikh R, Mortazavi A, Dorff T, Hoimes C, Pal S, Levine E, Doyle L, Quinn D, Newman E, Lara P. Phase II California Cancer Consortium trial of gemcitabine–eribulin combination (GE) in cisplatin ineligible patients (pts) with metastatic urothelial carcinoma (mUC): tolerability and toxicity report (NCI-9653; 1UM1CA186717-01, NO1-CM-2011-00038). Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30706-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dhal A, Mukherjee G, Bhattacharjee M, Naik V, Mukhopadhyay S, Pandit D, Pal S, Mondal D, Karmakar P, Roy T, Asgar M, Bhattacharya S, Bhattacharyya S, Bhattacharya C, Banerjee S, Chakrabarti A. Decay measurements of 43K( β−) 43Ca by HRS and TAS. EPJ WEB OF CONFERENCES 2017. [DOI: 10.1051/epjconf/201714610013] [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] Open
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Khan S, Miah RA, Pal S, Khatun S, Fatema N, Roy RR, Naheen CR. Comparison of Molecular Detection Method (Nested Polymerase Chain Reaction) with Blood Culture and Paired Widal test for the Rapid Diagnosis of Typhoid Fever. Mymensingh Med J 2017; 26:117-123. [PMID: 28260765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Typhoid fever is a major health problem in developing countries in spite of the use of antibiotics and the development of newer antibacterial drugs. Blood culture & serological tests (specially Widal test) which are invariably done in Bangladesh for typhoid fever diagnosis give unacceptable levels of false negative & false positive results respectively. This cross sectional study was done at Bangabandhu Sheikh Mujib Medical University from March 2013 to February 2014. In this study, a polymerase chain reaction-based technique (which has 100% specificity for Salmonella Typhi) was compared with blood culture and widal test among 80 clinically suspected cases of typhoid fever. PCR showed maximum positivity rate (70%) followed by widal test (43.75%) and blood culture (16.25%). PCR showed positive results for 17(48.6%) of 35 typhoid patients with negative results with blood culture and widal test. The results of the study revealed that PCR is rapid and reliable diagnostic technique for detection of S. Typhi in clinically suspected typhoid fever cases, as compared to most commonly done methods such as conventional blood culture, widal test applied.
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Pal S, Juyal D, Sharma M, Kotian S, Negi V, Sharma N. An outbreak of hepatitis A virus among children in a flood rescue camp: A post-disaster catastrophe. Indian J Med Microbiol 2016; 34:233-6. [PMID: 27080781 DOI: 10.4103/0255-0857.180354] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We report an outbreak of acute viral hepatitis among children in a flood rescue camp at Rudraprayag district of Uttarakhand State, India. In May 2013, there was a disastrous natural calamity, The Himalayan Tsunami in Himalayan and Sub-Himalayan region of Uttarakhand. More than 5700 people were feared dead, and thousands were sheltered in different rescue camps. A linkage was hypothesised between the infected individuals and the common water sources feared of being contaminated faecally. Aetiological agent of the present outbreak was HAV that is emerging in an outbreak form in India, emphasizing a definite need for formulating mandatory vaccination and proper control strategies. The report exemplifies the basic problems encountered after a natural calamity.
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Pal S, Karagiannis G, Dubrey SW. Cardiac sarcoidosis: a diagnostic puzzle. Br J Hosp Med (Lond) 2016; 77:656-657. [PMID: 27828751 DOI: 10.12968/hmed.2016.77.11.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cella D, Escudier B, Tannir N, Powles T, Donskov F, Peltola K, Schmidinger M, Heng D, Mainwaring P, Hammers H, Lee JL, Rini B, Roth B, Baer J, Mangeshkar M, Scheffold C, Hutson T, Pal S, Motzer R, Choueiri T. Quality of life (QoL) in the phase 3 METEOR trial of cabozantinib vs everolimus for advanced renal cell carcinoma (RCC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Thandar L, Chattopadhyay J, Mandal S, Sukul B, Pal S, Gupta A. Study of palatal sutures in adult human skulls of eastern Indian population. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.08.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Prasad TV, Gupta AK, Garg P, Pal S, Gamanagatti S. Minimally invasive image-guided interventional management of Haemobilia. ACTA ACUST UNITED AC 2016; 36:179-84. [PMID: 27522737 DOI: 10.7869/tg.280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hemobilia is a well known cause for upper gastrointestinal (UGI) bleed seen commonly in setting of iatrogenic or accidental trauma and various inflammatory and neoplastic conditions. Patients present with UGI bleed and symptoms of associated biliary obstruction. Management options in intractable cases are surgery and endovascular embolisation. We report a series of eighteen patients presented with severe hemobilia from January 2010 to October 2014, who were managed by endovascular approach in our department. Etiology in these patients were trauma (n = 3), liver biopsy (n = 3), surgery (n = 3), percutaneous procedures (n = 2), inflammatory (n-3), neoplasm (n = 1) and the rest were idiopathic. Angiography revealed pseudoaneurysms of hepatic artery (n = 5), splenic artery (n = 1) and gastroduodenal artery (n = 1) and arterio-biliary fistula (n = 1). Embolising agents used were detachable coils (n = 10) and glue (n = 8). All patients had technical and clinical success with minor non-consequential complications. Our findings show that endovascular embolisation is a simple, safe, accurate and effective treatment in patients with severe hemobilia. It is a viable alternative to major and potentially morbid surgeries.
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Pal S, Egger G, Wright G. Dealing with Obesity: An Australian Perspective. Asia Pac J Public Health 2016; 15 Suppl:S33-6. [PMID: 18924539 DOI: 10.1177/101053950301500s09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over half of all Australians are classified as overweight or obese and this is increasing by 1% of the population per year. Obesity is linked with a range of health ailments including type 2 diabetes, heart diseases and some cancers. At a population level it is well accepted that obesity is a result of the increasing use of modern technology, resulting in decreased energy expenditure, in combination with easily available high energy density foods, the “obesogenic environment”. In the modern environment, there are two major areas of management to assist the overweight and obese. Both include a change in lifestyle. Future strategies in weight management should include reduction in energy density and increase in daily physical activity.
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Bandyopadhyay A, Dalui R, Pal S, Bhattacharjee I, Goswami B, Roy AS. Pulmonary function in young females of Kolkata, India - Revisited. Physiol Int 2016. [PMID: 28639867 DOI: 10.1556/036.103.2016.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Rapid economic and industrial growths imposed significant impact on human health including the pulmonary health. Questions were raised regarding the validity of the existing prediction norms of pulmonary function tests (PFTs) in a particular population. The present study was conducted to investigate the applicability of the existing norms for PFTs in young healthy non-smoking female university students of Kolkata, India. Significant difference was noted in vital capacity (VC), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1) when the present data were compared with the earlier study in similar population. Correlation statistic revealed significant relationship of age and body height with all the PFT parameters. Body mass had significant correlation with VC, FVC, FEV1 as a percentage of FVC (FEV1%), and peak expiratory flow rate (PEFR). Regression equations have been computed for predicting PFTs from age and body height. There has been a change of PFTs in the studied population for the last couple of decades due to increased environmental pollution in the course of economical and industrial developments. Regression equations computed in this study are not only recommended to predict PFT parameters in the studied population, but they are also considered more reliable owing to their substantially smaller standard error of estimate than those proposed in the previous study.
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Ghosh S, Nandi M, Pal S, Mukhopadhyay D, Chakraborty BC, Khatun M, Bhowmick D, Mondal RK, Das S, Das K, Ghosh R, Banerjee S, Santra A, Chatterjee M, Chowdhury A, Datta S. Natural killer cells contribute to hepatic injury and help in viral persistence during progression of hepatitis B e-antigen-negative chronic hepatitis B virus infection. Clin Microbiol Infect 2016; 22:733.e9-733.e19. [PMID: 27208430 DOI: 10.1016/j.cmi.2016.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/05/2016] [Accepted: 05/09/2016] [Indexed: 12/13/2022]
Abstract
Hepatitis B e-antigen negative (e(-)) chronic HBV infection (CHI) encompasses a heterogeneous clinical spectrum ranging from inactive carrier (IC) state to e(-) chronic hepatitis B (CHB), cirrhosis and hepatic decompensation. In the backdrop of dysfunctional virus-specific T cells, natural killer (NK) cells are emerging as innate effectors in CHI. We characterized CD3(-) CD56(+) NK cells in clinically well-defined, treatment-naive e(-) patients in IC, e(-)CHB or decompensated liver cirrhosis (LC) phase to appraise their role in disease progression. The NK cell frequencies increased progressively with disease severity (IC 8.2%, e(-)CHB 13.2% and LC 14.4%). Higher proportion of NK cells from LC/e(-)CHB expressed CD69, NKp46, NKp44, TRAIL and perforin, the last two being prominent features of CD56(bright) and CD56(dim) NK subsets, respectively. The frequencies of CD3(-) CD56(+) NK cells together with TRAIL(+) CD56(bright) and Perforin(+) CD56(dim) NK cells correlated positively with serum alanine transaminase levels in e(-)CHB/LC. K562 cell-stimulated NK cells from e(-)CHB/LC exhibited significantly greater degranulation but diminished interferon-γ production than IC. Further, Perforin(+) NK cell frequency inversely correlated with autologous CD4(+) T-cell count in e(-) patients and ligands of NK receptors were over-expressed in CD4(+) T cells from e(-)CHB/LC relative to IC. Co-culture of sorted CD56(dim) NK cells and CD4(+) T cells from e(-)CHB showed enhanced CD4(+) T-cell apoptosis, which was reduced by perforin inhibitor, concanamycin A, suggesting a possible perforin-dependent NK cell-mediated CD4(+) T-cell depletion. Moreover, greater incidence of perforin-expressing NK cells and decline in CD4(+) T cells were noticed intrahepatically in e(-)CHB than IC. Collectively, NK cells contribute to the progression of e(-)CHI by enhanced TRAIL- and perforin-dependent cytolytic activity and by restraining anti-viral immunity through reduced interferon-γ secretion and perforin-mediated CD4(+) T-cell lysis.
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Uthappa C, Pal S, Panth R, Allam R, Yeldandi V. Pre-exposure Prophylaxis (PrEP): Attitudes, preferences and risk compensation behavior among men who have sex with other men (MSM) in India. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Metha R, Gahlot GPS, Das P, Jindal G, Mouli VP, Madhusudhan KS, Sharma R, Pal S, Ahuja V, DattaGupta S. Sclerosing mesenteric panniculitis in a young patient : common cause of diagnostic dilemma and treatment refractoriness. Acta Gastroenterol Belg 2016; 79:254-256. [PMID: 27382948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Sclerosing mesenteric panniculitis (SMP) is an idiopathic chronic fibroinflammatory disorder of the intra-abdominal fat. CASE PRESENTATION Herin, we report a case of SMP, involving the omentum, mesentery and peri-colic fat in a 18 year old male, who presented with significant and recurrent abdominal distension for 4.5 years. Computed tomogram revealed ascites, with nodular and irregular omental thickening and foci of calcification. Non-specific radiological and histological features made an accurate diagnosis extremely difficult. After a thorough work up and exclusion of other differentials, diagnosis of a nodular SMP (Weber Christian disease) was given. After showing resistance to chemotherapeutic agents, slow response was noted with cyclophosphamide, followed by rapid symptomatic improvement with mesenterectomy. CONCLUSION SMP is an uncommon benign mesenteric/ omental inflammation, and is a diagnosis of exclusion. As treatment refractoriness is common, management should be individualized and continued for along period. Surgical omentectomy may be helpful.
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Chen CA, Strain A, Mickelsen JL, Larson DA, Jesinger RA, Botelho D, Fromholz S, Obi CN, Crawley A, Lipson JA, Ikeda DM, Cooper C, Pal S. Abstract P4-01-05: Improving the quality of mammographic positioning. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-01-05] [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
Purpose:
Optimal breast positioning is a key component to high quality screening mammograms to allow the radiologist to make the best interpretation for the patient and referring physician. In addition, the success of newer imaging techniques also depends on breast positioning. The American College of Radiology (ACR) sets the standard of what images should include by outlining 13 criteria of breast positioning. An initial audit of over 100 mammograms at our institution in 2013 found that only a mean of 33% were achieving the ACR criteria. The goal of our project was to increase the percentage of screening mammograms achieving ACR criteria to 90% by June 2015.
Methods:
Our breast imaging center partnered with a quality improvement (QI) team driving a radiology department-wide program on quality improvement. Team members identified 5 key causes that barred achieving the ACR criteria: disagreement on what meets criteria, not having a standard work for acquiring and reading mammograms, lack of communication between the technologist and radiologist, not having a measurement system to track performance, and lack of coaching on technologist techniques for acquiring images. Developments to address these causes included: teaching modules on what meets ACR criteria, standard work for radiologists to recall mammograms that did not meet ACR criteria, system for the technologist to document why criteria were missed, auditing system to track performance, and feedback sessions between technologists and radiologists. Over 1,700 mammograms were audited from the time period of July 2014 to March 2015.
Results:
By October 2014, the percentage of mammograms achieving all 13 of the ACR criteria was 71%, with 4 criteria that prevented reaching the 90% goal. By March 2015, 10 of the 13 ACR criteria were being sustainably met by the target goal of 90% of mammograms, better in all criteria compared to our 2013 data, and better in all but one criterion compared to published 1993 data. Table 1 demonstrates that we have been able to sustain a composite percentage of 12 of the 13 ACR criteria greater than 90% for the last 2 consecutive months.
Table 1 shows the composite percentage of mammograms achieving 12 of the 13 ACR criteria over time.2013 Baseline8/20149/201410/201411/20141/20152/20153/201564%67%77%82%83%81%95%96%The excluded, most difficult criterion (visualization of the opposite breast cleavage) has been achieved at 32% per 1993 published data; we currently achieve it at 40%. 12/2014 audits were not performed due to holidays and changes in staffing.
Conclusion:
Few institutions have published positioning data, with the most recent QI publication on breast positioning dating to 1993. We have conducted a structured process to improve quality of mammographic positioning, including revision of processes that led to poor positioning outcomes and creation of an environment to sustain our improved outcomes. Three ACR criteria continue to be problematic in reaching the 90% goal, with future investigation into whether it is actually feasible to achieve the most difficult criterion at our goal of 90%. Future work also includes assessing how the recent hire of a mammography coach to spread best practices and real-time feedback is able to further improve results and maintain the infrastructure of ongoing QI.
Citation Format: Chen CA, Strain A, Mickelsen JL, Larson DA, Jesinger RA, Botelho D, Fromholz S, Obi CN, Crawley A, Lipson JA, Ikeda DM, Cooper C, Pal S. Improving the quality of mammographic positioning. [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 P4-01-05.
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Moin Shaikh M, Roy S, Rajbanshi S, Mukherjee A, Pradhan MK, Basu P, Pal S, Nanal V, Shrivastava A, Saha S, Pillay RG. Measurement of fusion excitation function for 7Li+ 64Ni near the barrier. EPJ WEB OF CONFERENCES 2016. [DOI: 10.1051/epjconf/201611708020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pal S, Nelson R, Vogelzang N. 2613 Conditional survival in de novo metastatic urothelial carcinoma: Assessment of 3,410 patients in the SEER database. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31431-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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