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Aggarwal R, Mansfield A, Beltran H, Farago A, Hann C, Kaye F, Lewis K, Niu J, Richey S, Smith D, Soares H, Spira A, Taylor M, Waqar S, Lally S, Rossi M, Saunders L, Dylla S, Kavalerchik E, Anthony L. Preliminary safety and efficacy of rovalpituzumab tesirine in patients with delta-like protein 3-expressing advanced solid tumors. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx368.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Soni KD, Garg N, Aggarwal R, Ambuj A. Percutaneous dilatational tracheostomy through paramedian technique and lateral approach in a patient with cervical esophagostomy-a case report. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2017; 7:47-49. [PMID: 28804685 PMCID: PMC5545430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/17/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Percutaneous dilatational tracheostomy (PDT) is a common surgical procedure and established as first choice for securing the airway in critically ill patients needing prolonged mechanical ventilation. There are case reports of open tracheostomy through paramedian approach without complications. This case report presents a case of PDT through paramedian approach. CASE REPORT An 18 year old female, case of firearm injury underwent cervical esophagostomy on the left side of neck approaching midline. So we perform PDT through paramedian technique and lateral approach safely with use of real time ultrasound and fiberoptic bronchoscope. DISCUSSION PDT can be done through paramedian technique and lateral approach to trachea safely with help of ultrasound and fiberoptic bronchoscope in the conditions where midline approach is not feasible and unsafe.
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Maertens H, Aggarwal R, Moreels N, Vermassen F, Van Herzeele I. A Proficiency Based Stepwise Endovascular Curricular Training (PROSPECT) Program Enhances Operative Performance in Real Life: A Randomised Controlled Trial. Eur J Vasc Endovasc Surg 2017; 54:387-396. [PMID: 28734705 DOI: 10.1016/j.ejvs.2017.06.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 06/13/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Healthcare evolution requires optimisation of surgical training to provide safe patient care. Operating room performance after completion of proficiency based training in vascular surgery has not been investigated. DESIGN A randomised controlled trial evaluated the impact of a Proficiency based Stepwise Endovascular Curricular Training program (PROSPECT) on the acquisition of endovascular skills and the transferability of these skills to real life interventions. MATERIALS All subjects performed two endovascular interventions treating patients with symptomatic iliac and/or superficial femoral artery stenosis under supervision. Primary outcomes were technical performances (Global Rating Scale [GRS]; Examiner Checklist), operative metrics, and patient outcomes, adjusted for case difficulty and trainee experience. Secondary outcomes included knowledge and technical performance after 6 weeks and 3 months. METHODS Thirty-two general surgical trainees were randomised into three groups. Besides traditional training, the first group (n = 11) received e-learning and simulation training (PROSPECT), the second group (n = 10) only had access to e-learning, while controls (n = 11) did not receive supplementary training. RESULTS Twenty-nine trainees (3 dropouts) performed 58 procedures. Trainees who completed PROSPECT showed superior technical performance (GRS 39.36 ± 2.05; Checklist 63.51 ± 3.18) in real life with significantly fewer supervisor takeovers compared with trainees receiving e-learning alone (GRS 28.42 ± 2.15; p = .001; Checklist 53.63 ± 3.34; p = .027) or traditional education (GRS 23.09 ± 2.18; p = .001; Checklist 38.72 ± 3.38; p = .001). Supervisors felt more confident in allowing PROSPECT trained physicians to perform basic (p = .006) and complex (p = .003) procedures. No differences were detected in procedural parameters (such as fluoroscopy time, DAP, procedure time, etc.) or complications. Proficiency levels were maintained up to 3 months. CONCLUSIONS A structured, stepwise, proficiency based endovascular curriculum including e-learning and simulation based training should be integrated early into training programs to enhance trainee performance.
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Aggarwal R, Saxena A, Soni K. Posterior Reversible Encephalopathy Syndrome during Recovery from Hypovolemic Acute Kidney Injury after Trauma; Case Report and Literature Review. Bull Emerg Trauma 2017; 5:215-218. [PMID: 28795068 PMCID: PMC5547211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 05/08/2017] [Accepted: 05/17/2017] [Indexed: 06/07/2023] Open
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Daniel LC, Aggarwal R, Schwartz LA. Sleep in Adolescents and Young Adults in the Year After Cancer Treatment. J Adolesc Young Adult Oncol 2017. [PMID: 28628351 DOI: 10.1089/jayao.2017.0006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Adolescents and young adults (AYA) with cancer are a vulnerable group facing more intense treatments, higher symptom burden, and poorer treatment outcomes relative to younger children. Sleep disruption is common during cancer treatment and sleep problems persist into adulthood for some survivors of AYA cancer. The developmental period of adolescence/emerging adulthood confers greater biological and behavioral risk for insufficient sleep relative to older or younger ages. Thus, understanding AYA sleep disturbances shortly after completing treatment can inform interventions to manage cancer-related symptoms and improve quality of life. METHODS Sixty-one AYA (ages 12-25) within 1 year of finishing cancer treatment completed the Pittsburgh Sleep Quality Index (PSQI) and the Minneapolis-Manchester Quality of Life Instrument-Adolescent Form. Treatment variables were extracted from electronic medical records. RESULTS Forty-seven percent of participants were classified as "poor sleepers," 41% reported prolonged sleep onset latency (>30 minutes), 31% reported sleep efficiency suggestive of insomnia, and 33% slept <8 hours nightly. Age moderated the relationship between time off treatment and PSQI total score: for younger AYA the relationship was positive and for older AYA the relationship was negative. Better sleep and higher quality of life were strongly related (r = -0.57, p < 0.001). CONCLUSIONS For almost half of AYA cancer survivors studied, sleep is disrupted as indicated by long sleep-onset latencies, sleep efficiency suggestive of insomnia, and inadequate total sleep time. Screening for sleep disturbances after AYA complete cancer therapy may reduce the impact of sleep on quality of life and identify those at risk for insomnia.
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Sinha P, Suneja A, Guleria K, Aggarwal R, Vaid NB. Comparison of Mifepristone Followed by Misoprostol with Misoprostol Alone for Treatment of Early Pregnancy Failure: A Randomized Double-Blind Placebo-Controlled Trial. J Obstet Gynaecol India 2017; 68:39-44. [PMID: 29391674 DOI: 10.1007/s13224-017-0992-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/07/2017] [Indexed: 12/01/2022] Open
Abstract
Objective To compare the efficacy and safety of mifepristone followed by misoprostol with misoprostol alone in the management of early pregnancy failure (EPF). Study Design A randomized double-blind placebo-controlled clinical trial. Methods Ninety-two women with EPF ≤12 weeks were recruited and randomly allocated to receive either mifepristone 200 mg (n = 46) or placebo (n = 46). Forty-eight hours later, patients in both the groups were given 800 µg misoprostol per-vaginum. If no expulsion occurred within 4 h, repeat doses of 400 µg misoprostol were given orally at 3-hourly interval to a maximum of 2 doses in women ≤9 weeks by scan and 4 doses in women >9 weeks by scan. Results Pre-treatment of misoprostol with mifepristone significantly increased the complete abortion rate (86.7 vs. 57.8%, p = 0.009) and, hence, reduced the need for surgical evacuation (13.3 vs. 42.2%, p = 0.002), induction to expulsion interval (4.74 ± 2.24 vs. 8.03 ± 2.77 h, p = 0.000), mean number of additional doses of misoprostol required (0.68 vs. 1.91, p = 0.000), and side effects. Conclusion Use of mifepristone prior to misoprostol in EPF significantly improves the efficacy and reduces the side effects of misoprostol alone.
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Soni KD, Jindal M, Aggarwal R, Deganwa M, Prasad J. Ultrasound and fibreoptic-guided percutaneous tracheostomy in patient with deviated trachea. Anaesthesiol Intensive Ther 2017; 48:148-9. [PMID: 27248287 DOI: 10.5603/ait.2016.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Indexed: 11/25/2022] Open
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Aggarwal A, Sarangi AN, Gaur P, Shukla A, Aggarwal R. Gut microbiome in children with enthesitis-related arthritis in a developing country and the effect of probiotic administration. Clin Exp Immunol 2016; 187:480-489. [PMID: 27861762 DOI: 10.1111/cei.12900] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 12/18/2022] Open
Abstract
In Asia, enthesitis-related arthritis (ERA) is the most frequent category of juvenile idiopathic arthritis. ERA has a strong association with human leucocyte antigen (HLA)-B27 and subclinical gut inflammation. In an HLA-B27 transgenic rat model, the presence of Bacteroides bacteria in the gut appears to cause spondyloarthropathy (SpA). Thus, we studied gut microbiota in children with ERA. Stool specimens from 33 patients with ERA and 14 age-matched healthy controls were studied; none had any gastrointestinal symptom, or had received a drug known to affect gut motility or microbiota in the preceding 6 weeks. From each specimen, a cDNA library for the V3 region of bacterial 16S rRNA was subjected to high-throughput, massively parallel sequencing. Relationship of the specimens was studied using principal co-ordinate analysis (PCoA), and abundances of various bacterial taxa and alpha diversity were compared between groups. In eight patients, a repeat faecal specimen was studied after 12 weeks of probiotic therapy. The 55 specimens yielded a median (range) of 397 315 (102 093-1 502 380) high-quality reads each. In PCoA, gut microbiota from ERA showed a wider dispersion than those from controls. In patients, families Bacteroidaceae and Enterobacteriaceae were more abundant and Prevotellaceae were less abundant than in controls. Also, genera Bacteroides, Entercoccus and Klebsiella were over-represented and genus Prevotella was under-represented in ERA patients. Probiotic therapy led to a non-significant increase in Prevotellaceae. Patients with ERA have a dysbiosis in the gut, with increased abundance of Bacteroides and reduction of Prevotella. Probiotic supplementation in a subset of patients did not reverse these changes significantly.
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Luckett T, Phillips J, Lintzeris N, Allsop D, Lee J, Solowij N, Martin J, Lam L, Aggarwal R, McCaffrey N, Currow D, Chye R, Lovell M, McGregor I, Agar M. Clinical trials of medicinal cannabis for appetite-related symptoms from advanced cancer: a survey of preferences, attitudes and beliefs among patients willing to consider participation. Intern Med J 2016; 46:1269-1275. [DOI: 10.1111/imj.13224] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/02/2016] [Accepted: 08/06/2016] [Indexed: 11/27/2022]
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Mishra VV, Nanda S, Agarwal R, Aggarwal R. Large hemorrhagic ovarian cyst in postmenopausal patient with autosomal dominant polycystic kidney disease. Indian J Nephrol 2016; 26:387-388. [PMID: 27795640 PMCID: PMC5015524 DOI: 10.4103/0971-4065.181476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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136
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Hansen A, Massard C, Ott P, Haas N, Lopez J, Ejadi S, Wallmark J, Keam B, Delord JP, Aggarwal R, Gould M, Qiu P, Saraf S, Keefe S, Piha-Paul S. Pembrolizumab for patients with advanced prostate adenocarcinoma: Preliminary results from the KEYNOTE-028 study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.09] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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137
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Crochet P, Aggarwal R, Knight S, Boubli L, Berdah S, Agostini A. Development of an Evidence-Based Virtual Reality Training Curriculum for Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2016; 22:S17. [PMID: 27678933 DOI: 10.1016/j.jmig.2015.08.056] [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]
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138
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Rath G, Aggarwal R, Jain A, Mittal P. Immunomodulatory role of toll-like receptor signaling in preeclampsia. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.08.152] [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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139
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Maertens H, Madani A, Landry T, Vermassen F, Van Herzeele I, Aggarwal R. Systematic review of e-learning for surgical training. Br J Surg 2016; 103:1428-37. [PMID: 27537708 DOI: 10.1002/bjs.10236] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/25/2016] [Accepted: 05/18/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Internet and software-based platforms (e-learning) have gained popularity as teaching tools in medical education. Despite widespread use, there is limited evidence to support their effectiveness for surgical training. This study sought to evaluate the effectiveness of e-learning as a teaching tool compared with no intervention and other methods of surgical training. METHODS A systematic literature search of bibliographical databases was performed up to August 2015. Studies were included if they were RCTs assessing the effectiveness of an e-learning platform for teaching any surgical skill, compared with no intervention or another method of training. RESULTS From 4704 studies screened, 87 were included with 7871 participants enrolled, comprising medical students (52 studies), trainees (51 studies), qualified surgeons (2 studies) and nurses (6 studies). E-learning tools were used for teaching cognitive (71 studies), psychomotor (36 studies) and non-technical (8 studies) skills. Tool features included multimedia (84 studies), interactive learning (60 studies), feedback (27 studies), assessment (26 studies), virtual patients (22 studies), virtual reality environment (11 studies), spaced education (7 studies), community discussions (2 studies) and gaming (2 studies). Overall, e-learning showed either greater or similar effectiveness compared with both no intervention (29 and 4 studies respectively) and non-e-learning interventions (29 and 22 studies respectively). CONCLUSION Despite significant heterogeneity amongst platforms, e-learning is at least as effective as other methods of training.
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Samanta S, Samanta S, Aggarwal R, Soni KD. Airway compromise during central venous cannulation in an undiagnosed tubercular retropharyngeal abscess: a case report. Ann Card Anaesth 2016; 18:596-8. [PMID: 26440253 PMCID: PMC4881684 DOI: 10.4103/0971-9784.166483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Central venous cannulation is often associated with complications during insertion even by expert's hand and with the aid of ultrasound. We encountered a patient for central line insertion through the right internal jugular vein having a retropharyngeal abscess of tubercular origin. We accidentally punctured the abscess cavity leading to increased respiratory distress and subsequent need of intubation to the patient. This kind of complication during central line insertion has never been reported before. We intend to report such a case to alert everyone about the grave complications it can lead to and the methods to minimize them in the times ahead.
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Aggarwal R, Soni KD, Gupta A, Kumar S. Outcome of patients of chest trauma suffering from chronic obstructive pulmonary disease - experience at level 1 trauma centre. Anaesthesiol Intensive Ther 2016; 48:162-5. [PMID: 27248144 DOI: 10.5603/ait.a2016.0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/30/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The outcome of chest trauma depends on many factors, one of which includes comorbidities. Nowadays, as the elderly population is on the rise, more and more trauma victims are being admitted with chronic obstructive pulmonary disease as a comorbidity in trauma centre intensive care units. However, there are hardly any studies describing the outcome of such patients with chest trauma and chronic obstructive pulmonary disease, both being respiratory problems. The aim was to study the outcomes and various complications in patients of chest trauma with COPD admitted to our ICU over a given time period. METHODS A detailed review of charts of patients with chest trauma and chronic obstructive pulmonary disease admitted over one and a half years was performed and various parameters noted, including as follows: demographic data; various scores; the number of days on a ventilator and in the ICU. Moreover, complications, such as ventilator associated pneumonia, catheter related bloodstream infections, as well as outcomes, were noted. RESULT During the study period, 19 patients were admitted, out of which 4 died. The APACHE scores were higher for those who died and all had ventilator-associated pneumonia as a complication. All those who had undergone the placement of an epidural and were managed with non-invasive ventilation initially did not require invasive ventilation. CONCLUSIONS Chest trauma patients with chronic obstructive pulmonary disease are prone to develop ventilator-associated pneumonia which may be the source of increased mortality among such patients. Epidural placement reduces the risk of invasive ventilation if a patient can be managed with non-invasive ventilation.
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Moghadam-Kia S, Oddis C, Sato S, Kuwana M, Aggarwal R. FRI0251 Anti-MDA5 Auto-Antibody: Expanding The Clinical Spectrum in Patients with Dermatomyositis in North america: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Garg N, Soni KD, Aggarwal R. Unstable cardiac injury complicated with septic shock-a challenge. BURNS & TRAUMA 2016; 4:11. [PMID: 27574681 PMCID: PMC4963929 DOI: 10.1186/s41038-016-0035-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 03/25/2016] [Indexed: 11/16/2022]
Abstract
Background Road traffic accident accounts for 70 % to 80 % of the blunt cardiac injury. The true incidence varies in the literature due to non-uniform criteria for diagnosis. Case Presentation Here, we describe the case of a young male presenting after blunt chest injury and hemodynamic instability. Initially, the patient had frequent episodes of arrhythmias and hypotension due to cardiac injury per se. However, he was stabilized by day 2. Subsequently, patient developed cellulitis followed by septic shock and succumbed to cellulitis on day 5 of injury. Conclusion Sepsis is difficult to be diagnosed and treated in the presence of cardiac injury. Myocardial depression has been found in sepsis, which contributes as an added comorbidity in an already compromised heart function. Sepsis also interferes with the diagnosis and follow-up of progress of blunt cardiac injury.
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Gupta S, Singh P, Soni KD, Aggarwal R, Yadav D. Percutaneous tracheostomy in post-cervical spine fixation patients: challenging the dogma. Am J Emerg Med 2016; 34:910-1. [PMID: 26944106 DOI: 10.1016/j.ajem.2016.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 02/01/2016] [Indexed: 11/19/2022] Open
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Mishra VV, Tanvir T, Aggarwal R, Nawal R. Adnexal torsion in an adolescent renal transplant recipient. Indian J Nephrol 2016; 26:66-7. [PMID: 26937088 PMCID: PMC4753751 DOI: 10.4103/0971-4065.167774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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146
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Thomas S, Aggarwal R, Jahan T, Ryan C, Troung T, Cripps AM, Raha P, Thurn KT, Chen S, Grabowsky JA, Park J, Hwang J, Daud A, Munster PN. A phase I trial of panobinostat and epirubicin in solid tumors with a dose expansion in patients with sarcoma. Ann Oncol 2016; 27:947-52. [PMID: 26903311 DOI: 10.1093/annonc/mdw044] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/27/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Treatment options for sarcoma are limited. Histone deacetylase inhibitors increase the efficacy of topoisomerase II inhibitors by promoting access to chromatin and by down-regulating DNA repair. Thus, combined panobinostat and epirubicin therapy was evaluated to treat refractory sarcoma. PATIENTS AND METHODS Patients with advanced solid tumors were enrolled in a 3 + 3 dose-escalation phase I trial of panobinostat given on days 1, 3, and 5 followed by 75 mg/m(2) of epirubicin on day 5 in 21-day cycles, with a dose expansion at maximum tolerated dose (MTD) in 20 sarcoma patients. Peripheral blood mononucleocyte histone acetylation was also evaluated. RESULTS Forty patients received 20-60 mg panobinostat. Dose-limiting toxicities included thrombocytopenia, febrile neutropenia, and fatigue at 60 mg, defining a panobinostat MTD at 50 mg. Four responses were seen in 37 assessable patients, all after progression on prior topoisomerase II inhibitors. For those with sarcoma, 12 of 20 derived clinical benefit (1 partial response and 11 stable disease, median overall survival 8.3 months), including 8 of 14 previously progressed on topoisomerase II therapy. Treatment benefits correlated with increased histone acetylation and decreased neutrophil count on day 5. CONCLUSIONS Panobinostat and epirubicin treatment is well tolerated and may reverse anthracycline resistance. Changes in histone acetylation and associated decrease in neutrophil count correlated with clinical benefit and warrant investigation as predictive biomarkers. CLINICAL TRIAL This trial is registered at www.Clinicaltrials.gov, Identifier: NCT00878904.
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Aggarwal R, Gogtay NJ, Kumar R, Sahni P. The revised guidelines of the Medical Council of India for academic promotions: Need for a rethink. J Postgrad Med 2016; 62:69-72. [PMID: 26821564 PMCID: PMC4944353 DOI: 10.4103/0022-3859.175001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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148
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Aggarwal R, Pal S, Soni KD, Gamangatti S. Massive cerebral fat embolism leading to brain death: A rare presentation. Indian J Crit Care Med 2016; 19:687-9. [PMID: 26730124 PMCID: PMC4687182 DOI: 10.4103/0972-5229.169358] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Fat embolism syndrome (FES) typically consists of a triad of neurological, pulmonary, and cutaneous symptoms. There exist few case reports of FES involving central nervous system (CNS) only without pulmonary involvement. In most of such cases, CNS involvement is partial, and patients recover fully neurologically within days. We report a rare and unusual case of massive cerebral fat embolism that led to brain death in trauma patient.
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Srivastava R, Agnihotry S, Aggarwal R, Bajpai P, Aggarwal A. HLA-B27 subtypes in enthesitis-related arthritis category of juvenile idiopathic arthritis and ankylosing spondylitis in northern India. Clin Exp Rheumatol 2015; 33:931-935. [PMID: 26314893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/21/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Enthesitis-related arthritis (ERA) is the most common form of juvenile idiopathic arthritis (JIA) in the Asian and Indian populations. The presence of HLA-B27 has a strong association with JIA-ERA similar to that with adult ankylosing spondylitis (AS). The HLA-B27gene is highly polymorphic. Susceptibility to AS varies between different HLA-B27 subtypes; data on the relationship of susceptibility to JIA-ERA with HLA-B27 types are scant. In this study, we determined HLA-B27 subtypes in patients with JIA-ERA and AS to find out whether there is any difference in the HLA-B27 subtypes prevalent in these two diseases. METHODS Genomic DNA from 135 patients with JIA-ERA and 121 with AS was tested for the presence of HLA-B27. In patients testing positive, HLA-B27subtyping was done by sequencing a genomic region that contained second and third exons and the intervening intron of this gene; this method permitted identification of common HLA-B27 subtypes (HLA-B*27:01 to HLA-B*27:09). RESULTS One hundred and seven (79%) patients with JIA-ERA and 102 (84%) patients with AS tested positive for HLA-B27. In both groups, HLA-B*27:05 and HLA-B*27:04 were the common subtypes; some patients had HLA-B*27:07(7.4%) and HLA-B*27:18. Patients with JIA-ERA had a higher frequency of HLA-B*27:05 than those with AS (70% vs. 57%, p=0.047), and a lower frequency of HLA-B*27:04 (21% vs. 36%, p=0.018). CONCLUSIONS HLA-B*27:05 and HLA-B*27:04 were the most common HLA-27 subtypes in both JIA-ERA and AS. However, HLA-B*27:05 was more frequent and HLA-B*27:04 was less frequent in JIA-ERA. It is possible that HLA-B*27:05 being the ancestral HLA-27 subtype leads to expression of disease early in life.
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Aggarwal R, Griffin Y. Value of PET-CT in plasma cell dyscrasias: a literature and pictorial review. Cancer Imaging 2015. [PMCID: PMC4601117 DOI: 10.1186/1470-7330-15-s1-p11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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