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Pandey A, Bohm S, Carls A, Cordes C, Endler M, Fellinger J, Freundt S, Gallowski K, Hammond K, Hathiramani D, Isberner G, Kallmeyer JP, Krause M, Kügler J, Otte M, Pedersen TS, Rondeshagen D, Ruhnau J, Schröder T, Sieber T, Wendorf J. Pop-up Langmuir probe diagnostic in the water cooled divertor of Wendelstein 7-X. Rev Sci Instrum 2024; 95:043503. [PMID: 38563720 DOI: 10.1063/5.0188738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
The design, development, and successful implementation of pop-up Langmuir probes installed in the water-cooled divertor of W7-X are described. The probes are controlled by drive coils (actuators) installed behind the divertor plates. These drive coils make use of the magnetic field in W7-X to move the probe tips into and out of the plasma. The drive coils were installed in the vacuum vessel after extensively testing the durability of the coils and analyzing the criteria for safe operation. The probe design is carefully tailored for each of the 36 probe tips in order to be suitable for the different magnetic field configurations used in W7-X and ensure that the probes do not present leading edges to the magnetic flux tubes. An electronic bridge circuit is used for measurement to compensate for the effects of signal propagation time on the long cable lengths used. The diagnostic is integrated with the segment control of W7-X for automated operation and control of the diagnostic. The evaluation of the results from the plasma operation is presented after accounting for appropriate sheath expansion for negative bias voltage on the probes.
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Affiliation(s)
- A Pandey
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - S Bohm
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - A Carls
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - C Cordes
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - M Endler
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - J Fellinger
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - S Freundt
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - K Gallowski
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - K Hammond
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540, USA
| | - D Hathiramani
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - G Isberner
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - J P Kallmeyer
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - M Krause
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - J Kügler
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - M Otte
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | | | - D Rondeshagen
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - J Ruhnau
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - T Schröder
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - T Sieber
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
| | - J Wendorf
- Max-Planck Institut für Plasmaphysik, Greifswald 17491, Germany
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Hoogendoorn BW, Karlsson O, Xiao X, Pandey A, Mattsson SE, Ström V, Andersson RL, Li Y, Olsson RT. Cellulose nanofibers (CNFs) in the recycling of nickel and cadmium battery metals using electrodeposition. Nanoscale Adv 2023; 5:5263-5275. [PMID: 37767029 PMCID: PMC10521207 DOI: 10.1039/d3na00401e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/11/2023] [Indexed: 09/29/2023]
Abstract
Cellulose nanofibers (CNFs) were employed in the aqueous electrodeposition of nickel and cadmium for battery metal recycling. The electrowinning of mixed Ni-Cd metal ion recycling solutions demonstrated that cadmium with a purity of over 99% could be selectively extracted while leaving the nickel in the solution. Two types of CNFs were evaluated: negatively charged CNFs (a-CNF) obtained through acid hydrolysis (-75 μeq. g-1) and positively charged CNFs (q-CNF) functionalized with quaternary ammonium groups (+85 μeq. g-1). The inclusion of CNFs in the Ni-Cd electrolytes induced growth of cm-sized dendrites in conditions where dendrites were otherwise not observed, or increased the degree of dendritic growth when it was already present to a lesser extent. The augmented dendritic growth correlated with an increase in deposition yields of up to 30%. Additionally, it facilitated the formation of easily detachable dendritic structures, enabling more efficient processing on a large scale and enhancing the recovery of the toxic cadmium metal. Regardless of the charged nature of the CNFs, both negatively and positively charged CNFs led to a significant formation of protruding cadmium dendrites. When deposited separately, dendritic growth and increased deposition yields remained consistent for the cadmium metal. However, dendrites were not observed during the deposition of nickel; instead, uniformly deposited layers were formed, albeit at lower yields (20%), when positively charged CNFs were present. This paper explores the potential of utilizing cellulose and its derivatives as the world's largest biomass resource to enhance battery metal recycling processes.
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Affiliation(s)
- B W Hoogendoorn
- Department of Fibre and Polymer Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology Teknikringen 56 114 28 Stockholm Sweden
| | - O Karlsson
- Department of Fibre and Polymer Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology Teknikringen 56 114 28 Stockholm Sweden
| | - X Xiao
- Department of Fibre and Polymer Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology Teknikringen 56 114 28 Stockholm Sweden
| | - A Pandey
- Department of Fibre and Polymer Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology Teknikringen 56 114 28 Stockholm Sweden
| | - S E Mattsson
- SAFT AB Jungnergatan 25 572 32 Oskarshamn Sweden
| | - V Ström
- Department of Material Science and Engineering, School of Industrial Engineering and Management, KTH Royal Institute of Technology Brinellvägen 23 SE-100 24 Stockholm Sweden
| | - R L Andersson
- Department of Fibre and Polymer Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology Teknikringen 56 114 28 Stockholm Sweden
| | - Y Li
- Department of Fibre and Polymer Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology Teknikringen 56 114 28 Stockholm Sweden
| | - R T Olsson
- Department of Fibre and Polymer Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology Teknikringen 56 114 28 Stockholm Sweden
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Pandey A, Liu E, Graham J, Chen W, Keten S. B-factor prediction in proteins using a sequence-based deep learning model. Patterns (N Y) 2023; 4:100805. [PMID: 37720331 PMCID: PMC10499862 DOI: 10.1016/j.patter.2023.100805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/23/2023] [Accepted: 07/07/2023] [Indexed: 09/19/2023]
Abstract
B factors provide critical insight into protein dynamics. Predicting B factors of an atom in new proteins remains challenging as it is impacted by their neighbors in Euclidean space. Previous learning methods developed have resulted in low Pearson correlation coefficients beyond the training set due to their limited ability to capture the effect of neighboring atoms. With the advances in deep learning methods, we develop a sequence-based model that is tested on 2,442 proteins and outperforms the state-of-the-art models by 30%. We find that the model learns that the B factor of a site is prominently affected by atoms within a 12-15 Å radius, which is in excellent agreement with cutoffs from protein network models. The ablation study revealed that the B factor can largely be predicted from the primary sequence alone. Based on the abovementioned points, our model lays a foundation for predicting other properties that are correlated with the B factor.
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Affiliation(s)
- Akash Pandey
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Elaine Liu
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Jacob Graham
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Wei Chen
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Sinan Keten
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL, USA
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Chaudhari P, Gupta S, Srivastav S, Sanker V, Medarametla GD, Pandey A, Agarwal Y. Digital Versus Conventional Teaching of Surgical Pathology: A Comparative Study. Cureus 2023; 15:e45747. [PMID: 37872909 PMCID: PMC10590475 DOI: 10.7759/cureus.45747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE To compare the digital method and the conventional method of teaching surgical pathology to medical students. METHODS A prospective case-control study was conducted on second-year students during the period of August 20, 2022, through January 15, 2023. Students, divided into two groups of 45 each, were taught surgical pathology via both conventional and digital methods. Four specimens and four slides were taught in total to the same set of students. A pre-test and a post-test were used to evaluate students' performance and the impact of the teaching method. The answers were analyzed using a paired t-test. In the end, students' responses were obtained regarding their views on a better method of teaching on a Likert scale. RESULTS To study gross pathology, 50.7% of students were in favor of the digital method, and 21% were not in favor. For the microscopic examination of tissues, 56.92% of students were in favor of the digital method, and 15% were not in favor. There was a significant increase in post-test scores (12.54-9.79 = 2.75, p=0.007) when digital methods for teaching surgical pathology were applied. CONCLUSION The Likert scale demonstrated that the digital method of teaching surgical pathology not only improved student performance but also resulted in a better understanding of the subject.
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Affiliation(s)
| | | | | | - Vivek Sanker
- General Surgery, Noorul Islam Institute of Medical Science (NIMS), Trivandrum, IND
| | | | - Akash Pandey
- Internal Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, IND
| | - Yash Agarwal
- Medicine, West Bengal University of Health Sciences, Kolkata, IND
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Upadhyaya VD, Pandey A, Gangopadhyay AN. Sparing the Perineal Body in the Vestibular Fistula. Eur J Pediatr Surg 2023; 33:328. [PMID: 37406662 DOI: 10.1055/s-0043-1770997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Affiliation(s)
- V D Upadhyaya
- Department of Pediatric Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Pandey
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - A N Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Balakrishnan B, Altassan R, Budhraja R, Liou W, Lupo A, Bryant S, Mankouski A, Radenkovic S, Preston G, Pandey A, Boudina S, Kozicz T, Morava E, Lai K. AAV-based gene therapy prevents and halts the progression of dilated cardiomyopathy in a mouse model of phosphoglucomutase 1 deficiency (PGM1-CDG). Transl Res 2023; 257:1-14. [PMID: 36709920 PMCID: PMC10192047 DOI: 10.1016/j.trsl.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
Phosphoglucomutase 1 (PGM1) deficiency is recognized as the third most common N-linked congenital disorders of glycosylation (CDG) in humans. Affected individuals present with liver, musculoskeletal, endocrine, and coagulation symptoms; however, the most life-threatening complication is the early onset of dilated cardiomyopathy (DCM). Recently, we discovered that oral D-galactose supplementation improved liver disease, endocrine, and coagulation abnormalities, but does not alleviate the fatal cardiomyopathy and the associated myopathy. Here we report on left ventricular ejection fraction (LVEF) in 6 individuals with PGM1-CDG. LVEF was pathologically low in most of these individuals and varied between 10% and 65%. To study the pathobiology of the cardiac disease observed in PGM1-CDG, we constructed a novel cardiomyocyte-specific conditional Pgm2 gene (mouse ortholog of human PGM1) knockout (Pgm2 cKO) mouse model. Echocardiography studies corroborated a DCM phenotype with significantly reduced ejection fraction and left ventricular dilation similar to those seen in individuals with PGM1-CDG. Histological studies demonstrated excess glycogen accumulation and fibrosis, while ultrastructural analysis revealed Z-disk disarray and swollen/fragmented mitochondria, which was similar to the ultrastructural pathology in the cardiac explant of an individual with PGM1-CDG. In addition, we found decreased mitochondrial function in the heart of KO mice. Transcriptomic analysis of hearts from mutant mice demonstrated a gene signature of DCM. Although proteomics revealed only mild changes in global protein expression in left ventricular tissue of mutant mice, a glycoproteomic analysis unveiled broad glycosylation changes with significant alterations in sarcolemmal proteins including different subunits of laminin-211, which was confirmed by immunoblot analyses. Finally, augmentation of PGM1 in KO mice via AAV9-PGM1 gene replacement therapy prevented and halted the progression of the DCM phenotype.
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Affiliation(s)
- B Balakrishnan
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - R Altassan
- Department of Medical Genomics, Centre for Genomic Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - R Budhraja
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - W Liou
- Electron Microscopy Core Facility, University of Utah, Salt Lake City, USA
| | - A Lupo
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - S Bryant
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - A Mankouski
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - S Radenkovic
- Department of Clinical Genomics, Center of Individualized Medicine, Mayo Clinic, Rochester, USA
| | - G Preston
- Department of Clinical Genomics, Center of Individualized Medicine, Mayo Clinic, Rochester, USA
| | - A Pandey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
- Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India
| | - S Boudina
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, USA
| | - T Kozicz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Clinical Genomics, Center of Individualized Medicine, Mayo Clinic, Rochester, USA
- Department of Anatomy, University of Pecs School of Medicine, Pecs, Hungary
| | - E Morava
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Clinical Genomics, Center of Individualized Medicine, Mayo Clinic, Rochester, USA
- Department of Medical Genetics, University of Pecs, School of Medicine, Pecs, Hungary
| | - K Lai
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, USA
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, USA
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Flapper MM, Pandey A, Essink MH, van Brummelen EH, Karpitschka S, Snoeijer JH. Reversal of Solvent Migration in Poroelastic Folds. Phys Rev Lett 2023; 130:228201. [PMID: 37327417 DOI: 10.1103/physrevlett.130.228201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 04/04/2023] [Indexed: 06/18/2023]
Abstract
Polymer networks and biological tissues are often swollen by a solvent such that their properties emerge from a coupling between swelling and elastic stress. This poroelastic coupling becomes particularly intricate in wetting, adhesion, and creasing, for which sharp folds appear that can even lead to phase separation. Here, we resolve the singular nature of poroelastic surface folds and determine the solvent distribution in the vicinity of the fold tip. Surprisingly, two opposite scenarios emerge depending on the angle of the fold. In obtuse folds such as creases, it is found that the solvent is completely expelled near the crease tip, according to a nontrivial spatial distribution. For wetting ridges with acute fold angles, the solvent migration is reversed as compared to creasing, and the degree of swelling is maximal at the fold tip. We discuss how our poroelastic fold analysis offers an explanation for phase separation, fracture, and contact angle hysteresis.
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Affiliation(s)
- M M Flapper
- Physics of Fluids Group, Faculty of Science and Technology, Mesa+ Institute, University of Twente, 7500 AE Enschede, The Netherlands
| | - A Pandey
- Department of Mechanical and Aerospace Engineering and BioInspired Syracuse, Syracuse University, Syracuse, New York 13244, USA
| | - M H Essink
- Physics of Fluids Group, Faculty of Science and Technology, Mesa+ Institute, University of Twente, 7500 AE Enschede, The Netherlands
| | - E H van Brummelen
- Multiscale Engineering Fluid Dynamics Group, Department of Mechanical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - S Karpitschka
- Max Planck Institute for Dynamics and Self-Organization, 37077 Göttingen, Germany
| | - J H Snoeijer
- Physics of Fluids Group, Faculty of Science and Technology, Mesa+ Institute, University of Twente, 7500 AE Enschede, The Netherlands
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Ray R, Das K, Adhikary A, Pandey A, Ananthakrishnan V, Gnana Swathika O. Smart Robotic Arm. Integrated Green Energy Solutions Volume 1 2023:141-156. [DOI: 10.1002/9781119847564.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
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Upadhyaya VD, Pandey A, Gangopadhyay AN. Saving the perineal body in the vestibular fistula. Pediatr Surg Int 2023; 39:193. [PMID: 37155020 DOI: 10.1007/s00383-023-05481-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Affiliation(s)
- V D Upadhyaya
- Department of Pediatric Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - A Pandey
- Department of Pediatric Surgery, King George's Medical University, Lucknow, UP, 226010, India.
| | - A N Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
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Fernandez J, Hopson P, Patel SB, Horvath K, Pandey A. Prevalence of Exocrine Pancreatic Dysfunction Based on Direct Function Testing in Pediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2023; 76:475-479. [PMID: 36720112 DOI: 10.1097/mpg.0000000000003725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Patients with inflammatory bowel disease (IBD) frequently have extraintestinal manifestations. The goal of this pilot study was to assess exocrine pancreatic function in cases with suspicion for or an established diagnosis of IBD. METHODS Direct stimulated endoscopic pancreatic function test (ePFT) was performed in 74 children with IBD, in both newly diagnosed and established cases. Demographic, clinical, and laboratory parameters were entered into a database and analyzed. RESULTS Among the 74 children, 49 were newly diagnosed and 25 had an established diagnosis of IBD. A majority had the diagnosis of Crohn disease (CD) (n = 48; 32 new and 16 established cases) with male predominance (64.6%). Altogether, 42 (56.7%) children had either generalized or partial exocrine pancreatic insufficiency (EPI). Twenty-four of the 48 CD children (50%) had abnormal ePFT. In those with ulcerative colitis (UC), 18 of the 26 (62.9%) had abnormal ePFT. The highest abnormality rate was in lipase enzyme activity. Weight z scores were significantly lower in those with abnormal ePFT (Crohn cases: P = 0.008; UC cases: P = 0.046). Peak protein concentration in collected pancreatic fluid was significantly lower in children with CD who had abnormal ePFT ( P = 0.013). CONCLUSIONS This pilot study revealed a relatively high prevalence of EPI in children with IBD through use of ePFT. EPI can result in maldigestion, with decreased capacity to digest fat. Further prospective studies are needed to assess need and efficacy of pancreatic enzyme replacement therapy in children with IBD and abnormal ePFT.
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Affiliation(s)
- Jenelle Fernandez
- From the Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL
- the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of South Florida, Morsani College of Medicine, Tampa, FL
| | - Puanani Hopson
- From the Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL
- the Department of Pediatric and Adolescent Medicine, Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Samit B Patel
- From the Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL
- Pediatric Gastroenterology and Nutrition of Tampa Bay, Tampa, FL
| | - Karoly Horvath
- From the Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL
| | - Akash Pandey
- From the Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL
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Hamid A, Yimer W, Oshunbade A, Khan MS, Kamimura D, Kipchumba RK, Pandey A, Clark D, Mentz R, Fox ER, Berry J, Stacey B, Shah A, Correa A, Virani SS, Butler J, Hall ME. Trajectory of high sensitivity c-reactive protein and incident heart failure in black adults: the jackson heart study. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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14
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Borisenkov M, Agabekian A, Beier J, Keller HJ, Pandey A. Long-term outcomes of ventral onlay buccal mucosa graft urethroplasty. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00500-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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15
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Shetty NS, Parcha V, Pampana A, Kalra R, Pandey A, Morris A, Prabhu S, Arora G, Arora P. Incident heart failure risk reclassification with race-$$$independent estimated glomerular filtration rate: an NHLBI pooled cohorts analysis. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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16
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Krychowiak M, König R, Barbui T, Brezinsek S, Brunner J, Effenberg F, Endler M, Feng Y, Flom E, Gao Y, Gradic D, Hacker P, Harris J, Hirsch M, Höfel U, Jakubowski M, Kornejew P, Otte M, Pandey A, Pedersen T, Puig A, Reimold F, Schmitz O, Schröder T, Winters V, Zhang D. First feedback-controlled divertor detachment in W7-X: Experience from TDU operation and prospects for operation with actively cooled divertor. Nuclear Materials and Energy 2023. [DOI: 10.1016/j.nme.2023.101363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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17
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Chakraborty P, Pandey A, Natarajan S, Dahal S. Awareness and perception of an Indian dental professional in context to the process and their role in disaster victim identification as a taskmaster. J Forensic Odontostomatol 2022; 40:34-44. [PMID: 36623296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Forensic odontology is a young area in India. However, it has been used as an integral component in a various medicolegal cases in India. However, the involvement of a dentist in mass disasters still needs to be well recognized. The role of the dentists in any unforeseen circumstances is to contribute as an adjunct hand in Disaster Victim Identification (DVI) which is in an emergent stage in India. This study aimed to assess an Indian dental professional's knowledge and awareness of their role in DVI. A pre-tested, self-administered anonymous questionnaire consisting of 6 open-ended and 14 close-ended questions was mailed to the participants. A total of 441 responses were recorded. The study indicated adequate knowledge and awareness among dental practitioners. Conversely, only a handful of people had first-hand autopsy experience. Thus, to supplement the skills needed to work at ground zero, it is recommended to develop hands-on training programs for dentists in each state of India. Also, creating a pool of experts in each state of India can strengthen the task force.
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Affiliation(s)
- P Chakraborty
- School of Forensic Science, National Forensic Science University, Gujarat, India
| | - A Pandey
- School of Forensic Science, National Forensic Science University, Gujarat, India
| | - S Natarajan
- Department of Oral Pathology & Microbiology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, India
| | - S Dahal
- Department of Oral Pathology & Forensic Dentistry, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
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18
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Wall KC, Elphingstone J, Paul KD, Arguello A, Pandey A, Qureshi H, McGwin G, MacBeth L, Feinstein J, Momaya A, Ponce B, Brabston E. Nerve block with liposomal bupivacaine yields fewer complications and similar pain relief when compared to an interscalene catheter for arthroscopic shoulder surgery: a randomized controlled trial. J Shoulder Elbow Surg 2022; 31:2438-2448. [PMID: 36115616 DOI: 10.1016/j.jse.2022.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/13/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Following orthopedic surgery, patients frequently experience pain and discomfort. Multiple methods of regional anesthesia are available; however, the optimal technique to adequately manage pain while minimizing complications remains under investigation. This study aims to compare the complication rates and pain relief of single-injection, liposomal bupivacaine brachial plexus nerve block to a conventional, indwelling ropivacaine interscalene catheter (ISC) in patients undergoing arthroscopic shoulder surgery. We hypothesize that liposomal bupivacaine will have fewer patient complications with similar pain relief than an indwelling catheter. METHODS Patients undergoing arthroscopic shoulder surgery were prospectively assessed after randomization into either ropivacaine ISC or single-injection liposomal bupivacaine brachial plexus nerve block (LB) arms. All patients were discharged with 5 analgesics (acetaminophen, methocarbamol, gabapentin, acetylsalicylic acid, and oxycodone) for as-needed pain relief. Preoperatively, patient demographics and baseline Visual Analog Scale, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and Penn Shoulder Scores were obtained. For the first four days postoperatively, complication rates (nausea, dyspnea, anesthetic site discomfort and/or irritation and/or leakage, and self-reported concerns and complications), pain, medication usage, and sleep data were assessed by phone survey every 12 hours. The primary outcome was overall complication rate. At 12 weeks postoperatively, Visual Analog Scale, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and Penn scores were reassessed. Outcome scores were compared with Mann-Whitney U tests, and demographics were compared with chi-squared tests. Significance was set at P < .05. RESULTS A total of 63 individuals were allocated into ISC (N = 35) and in the LB arms (N = 28) for analysis. Demographics and preoperative patient-reported outcomes were not different between the arms. Patients in the LB arm experienced fewer (13.1%) overall complications than those in the ISC arm (29.8%) (P < .001), with patients in the ISC arm specifically reporting more anesthetic site discomfort (36.4% vs. 7.1%, P = .007), leakage (30.3% vs. 7.1%, P = .023), and 'other,' free-response complications (ISC: 21.2%; LB: 3.6%; P = .042). No differences were noted in pain, sleep, opioid use, or satisfaction between arms during the perioperative period. More nonopioid medications were consumed on average in the ISC (1.8 ± 1.4) than in the LB arm (1.4 ± 1.3) (P = .001), with greater reported use of acetylsalicylic acid (40.9% vs. 23.4% P < .001) and acetaminophen (69.5% vs. 59.6% P = .013). Patient-reported outcome scores did not differ between groups preoperatively or at 12 weeks. DISCUSSION Patients receiving liposomal bupivacaine experienced fewer complications than traditional ISCs after arthroscopic shoulder surgery. Analgesia, sleep, satisfaction, and functional scores were similar between the 2 groups.
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Affiliation(s)
- Kevin C Wall
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Joseph Elphingstone
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Kyle D Paul
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | | | - Akash Pandey
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hamza Qureshi
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerald McGwin
- University of Alabama at Birmingham Department of Epidemiology, Birmingham, AL, USA
| | - Lisa MacBeth
- University of Alabama at Birmingham Department of Anesthesiology, Birmingham, AL, USA
| | - Joel Feinstein
- University of Alabama at Birmingham Department of Anesthesiology, Birmingham, AL, USA
| | - Amit Momaya
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Brent Ponce
- Hughston Clinic Foundation, Columbus, GA, USA
| | - Eugene Brabston
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA.
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19
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Chauhan V, Dhiman VK, Mahajan G, Pandey A, Kanwar SS. Synthesis and characterization of silver nanoparticles developed using a novel lipopeptide(s) biosurfactant and evaluating its antimicrobial and cytotoxic efficacy. Process Biochem 2022. [DOI: 10.1016/j.procbio.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Pandey A, Pandey AS, Mir H. Sustained usage of an app-based clinical-decision making aid for the management of atherosclerotic cardiovascular disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Complexity of therapies for atherosclerotic cardiovascular disease (ASCVD) risk reduction represents a challenge for clinicians and may lead to poor uptake of these therapies.
Purpose
The goal of this project was to design an easy-to-use, point-of-care tool to risk stratify ASCVD patients and provide individualized guidance for clinicians to incorporate these agents.
Methods
Based on the REACH registry trial and predictive modeling (including 49,689 patients with ASCVD in 44 countries), we designed and implemented an app for secondary risk assessment. Using demographic and comorbidity profiles, this tool was used to calculate an individual's 20-month risk of cardiovascular events and mortality. It also provided graphical comparison to an age-matched control with optimized cardiovascular risk profile to illustrate the modifiable residual risk. The app then utilized the patient's risk profile to provide specific guidance for possible therapeutic interventions SGLT2-inhibitors, GLP1-agonists, PCSK9-inhibitors, Vascular-dose Rivaroxaban, and Icosapent Ethyl. Additionally, it identified individuals who qualified for cardiac rehabilitation or may benefit from smoking cessation interventions, including counselling or pharmacological therapies.
We launched a pilot test of the “Residual Cardiovascular Risk: Assessment and Management Guide” app at a regional cardiac center. 240 referring physicians (including family doctors, emergency physicians, internists, and cardiologists) were invited by email or fax to utilize the app. Feedback was solicited from all users three months into the test period. Following this, no further marketing of the app was performed for all users. Usage data was recorded using Google Analytics over a 12-month period and analyzed in 4-month increments.
Results
From January to December 2021, our app was used to risk stratify 1576 patients. A total of 47 individual users utilized the app over this period. From January to April, the app was used on average 160 times monthly. From May to August, it was used 115 times monthly. From September to December, it was used 118 times monthly. Twenty-four physicians provided feedback; 100% affirmed the functionality, ease of use, and utility of the tool. The app was described as “useful for discussions with patients”, “helpful to optimize patients” and “similar to a mini-cardiology consult”. User suggestions resulted in further improvements to the app, including integration of reports into Electronic Medical Records.
Conclusions
The early success of this app demonstrates a need for simple, accessible, and individualized guidance for management of ASCVD patients to improve uptake of guideline-based medical therapies. This tool demonstrates sustained usage among clinicians, as well as subjective utility in aiding therapeutic decision making. Future clinical research will focus on the ability of this tool to impact physician prescribing patterns and clinical outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Pandey
- University of Ottawa , Ottawa , Canada
| | - A S Pandey
- Cambridge Cardiac Care Centre , Cambridge , Canada
| | - H Mir
- University of Ottawa Heart Institute , Ottawa , Canada
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21
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Pandey A, Bonsignore A, Pandey A, Bonvanie I, Verma S. A novel algorithm for rapid sequence optimization of guideline directed medical therapy for heart failure with reduced ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Current guidelines for management of Heart Failure with Reduced Ejection Fraction (HFrEF) recommend Beta-blockers, Angiotensin Receptor Neprilysin Inhibitors (ARNI), Mineralocorticoid Receptor Antagonists (MRA) and SGLT2 inhibitors. However, guideline-directed medical therapies (GDMT) remain underutilized. The 2018 CHAMP-HF registry of HFrEF patients demonstrated that only 1% of patients were treated with target doses of Beta-blockers, MRA and ACE-inhibitors (ACE-I) and Angiotensin Receptor Blocker (ARB) or ARNI. Historically, HFrEF therapies were initiated and up-titrated sequentially. Recent expert commentary has suggested a more aggressive approach of initiating all 4 classes of therapy at low doses after which patients should be up-titrated to target dose
Purpose
This study tested a novel, virtual HFrEF optimization program with the goal of achieving GDMT using a novel “rapid sequence” algorithm.
Methods
We conducted a single center study at a regional cardiovascular centre using a prospective pre-post design. NYHA class II/III HFrEF patients referred from both inpatient and outpatient settings were enrolled in a virtual 3-month HFrEF optimization program. All participants underwent an initial consult with a program nurse and cardiologist. After this, all patients were seen remotely by a nurse every two weeks for adjustment of HFrEF medications. At week 1, patients started on ARNI and SGLT2i. After week 3, Beta-Blocker was initiated. After week 5, MRA was initiated. Following this, medications were up-titrated every two weeks, based on clinical judgement of the overseeing cardiologist. Vital signs and bloodwork were obtained after all medication adjustments. In addition, all patients were seen once weekly by a kinesiologist for lifestyle optimization and counselling.
Results
From April 2020 to January 2021, 297 NYHA class II/III HFrEF patients enrolled in the virtual HFrEF optimization program. Mean age was 69 and 63% were male. Mean ejection fraction was 28% and 54% had ischemic cardiomyopathy. At intake, the proportion of patients prescribed maximally-tolerated dosage was 64% for Beta-Blockers, 7% for MRA, 1% for ARNI and 1% for SGLT2i. At 3-month follow-up, maximally-tolerated dose was prescribed in 84% of patients for beta-blockers (p<0.01), 58% for MRA (p<0.01), 77% for SGLT2i (p<0.01) and 96% for ARNI (p<0.01). 39% of patients achieved maximal doses of all 4 classes of medications at follow-up. No medication-related adverse events were reported and 18 patients were hospitalized for HF exacerbation during study follow-up.
Conclusions
This study demonstrates that a program using aggressive GDMT initiation can safely and effectively improve uptake of therapy in HFrEF patients. Future research should examine HFrEF “rapid sequence” optimization on patient outcomes in a randomized setting.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Pandey
- University of Ottawa , Ottawa , Canada
| | - A Bonsignore
- Cambridge Cardiac Care Centre , Cambridge , Canada
| | - A Pandey
- University of Guelph , Guelph , Canada
| | - I Bonvanie
- Cambridge Cardiac Care Centre , Cambridge , Canada
| | - S Verma
- St. Michael's Hospital , Toronto , Canada
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22
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Pandey A, Hibino M, Ha A, Quan A, Verma A, Bisleri A, Mazer CD, Verma S. Impact of diabetes and glucose-lowering therapy on post-operative atrial fibrillation after cardiac surgery: secondary analysis of the SEARCH-AF CardioLink-1 randomized clinical trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes mellitus is an important risk factor for atrial fibrillation (AF) and is associated with an increased risk of complications for patients with AF. The impact of diabetes on post-operative AF after cardiac surgery is not well-defined.
Purpose
We sought to characterize the effect of diabetes, insulin, and oral hypoglycemic agents on the incidence of post-operative atrial fibrillation (POAF) after cardiac surgery. Accordingly, we conducted a secondary analysis of the Post-Surgical Enhanced Monitoring for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF) CardioLink-1 randomized trial.
Methods
In the SEARCH-AF trial, 336 patients with risk factors for stroke (CHA2DS2-VASc score ≥2) and no history of preoperative AF were randomized to usual care or continuous cardiac rhythm monitoring for 30 days after discharge from cardiac surgery with a wearable, patched-based device. The primary outcome was occurrence of cumulative atrial fibrillation/flutter (AF/AFL) lasting for ≥6 minutes detected by continuous monitoring or AF/AFL documented by a 12-lead electrocardiogram within 30 days of randomization. We assessed the association between diabetes and occurrence of post-operative AF. In addition, we examined the association between POAF and glucose-lowering therapy among patients with diabetes.
Results
Among the 176 (52%) patients with diabetes in the study cohort, 80 (45%) patients were treated with at least 1 oral hypoglycemic agent and 44 (25%) patients were treated with insulin. The incidence of POAF occurring within 30 days after discharge from surgery was similar between patients with or without diabetes (cumulative incidence: 10.8% vs. 10.0%, log-rank p=0.77). Among patients with diabetes, the incidence of POAF was highest in those who were not treated with glucose-lowering therapy (17.3%) when compared with those treated with oral hypoglycemic agents (10.0%) or insulin (4.5%) (log-rank ptrend=0.045 among the 3 groups). In an exploratory analysis, we observed a trend suggesting a lower incidence of POAF among cardiac surgical patients who were treated with SGLT-2 inhibitors (log-rank ptrend=0.084).
Conclusion
The incidence of POAF occurring after discharge from cardiac surgery is equally high among patients with or without diabetes. Our results suggest a potential association between specific glucose-lowering therapies and risk of POAF after cardiac surgery, meriting further investigations.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Heart and Stroke Foundation of Canada
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Affiliation(s)
- A Pandey
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - M Hibino
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - A Ha
- UHN - University of Toronto , Toronto , Canada
| | - A Quan
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - A Verma
- Southlake Regional Health Centre , Newmarket , Canada
| | - A Bisleri
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - C D Mazer
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - S Verma
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
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23
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Hibino M, Verma S, Pandey A, Quan A, Verma A, Bisleri G, Mazer CD, Ha A. Valvular surgery is associated with an increased risk of post-operative atrial fibrillation: secondary analysis of the SEARCH-AF CardioLink-1 randomized trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients undergoing valve surgery have a higher risk of developing post-operative atrial fibrillation (POAF) relative to those undergoing isolated coronary artery bypass grafting (CABG). Whether this risk extends beyond hospital discharge is unknown.
Purpose
We examined the association between surgery type (isolated CABG vs. valve repair/replacement) on the incidence of post-operative atrial fibrillation (POAF) by conducting a secondary analysis of the Post-Surgical Enhanced Monitoring for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF) CardioLink-1 randomized trial.
Methods
In the SEARCH-AF trial, 336 patients with risk factors for stroke (CHA2DS2-VASc score ≥2) and no history of preoperative AF were randomized to usual care or continuous cardiac rhythm monitoring for 30 days after discharge from cardiac surgery with a wearable, patched-based device. The primary outcome was occurrence of cumulative atrial fibrillation/flutter (AF/AFL) lasting for ≥6 minutes detected by continuous monitoring or AF/AFL documented by a 12-lead ECG within 30 days of randomization. We compared the risk of POAF between patients who underwent CABG vs. valve repair/replacement. Patients who experienced post-operative AF during hospitalization were excluded from this analysis.
Results
The overall cohort consisted of 255, 39, and 42 patients who underwent isolated CABG, isolated valve replacement/repair, and CABG + valve repair/replacement, respectively. Baseline characteristics were similar among the groups except for younger age (p=0.0014), higher prevalence of preoperative myocardial infarction (p=0.002) and lower ejection fraction (p=0.025) in the isolated CABG group. Eighteen patients experienced post-operative AF during hospitalization. Patients who underwent CABG + valve surgery or isolated valve surgery were more likely to experience post-operative AF compared with those who underwent isolated CABG (Log-Rank ptrend=0.0096). Among patients who were randomized to continuous cardiac rhythm monitoring, the probability of post-operative AF among patients who underwent isolated CABG, valve surgery, and CABG + valve surgery was 15.8%, 29.4%, and 35.0%, respectively (Log-Rank ptrend=0.017). After multivariable adjustment, the risk of developing post-operative AF within 30 days after discharge remained higher among patients who underwent valve surgery compared with those who underwent isolated CABG (hazard ratio (HR) 2.22, 95% CI 1.01–4.87. Patients who underwent CABG + repair/replacement had the highest risk of experiencing post-operative AF when compared to patients who underwent isolated CABG (HR 2.78, 95% CI 1.12–6.86).
Conclusion
Patients undergoing valve repair or bioprosthetic valve replacement have a substantial risk of post-operative AF within 30 days after discharge from surgery. An aggressive cardiac rhythm monitoring strategy during this vulnerable period should be considered for this high-risk patient population.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Heart and Stroke Foundation of Canada
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Affiliation(s)
- M Hibino
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - S Verma
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - A Pandey
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - A Quan
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - A Verma
- Southlake Regional Health Centre , Newmarket , Canada
| | - G Bisleri
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - C D Mazer
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - A Ha
- UHN - University of Toronto , Toronto , Canada
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24
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Hibibo M, Verma S, Pandey A, Quan A, Verma A, Bisleri G, Ha A, Mazer CD. The impact of statin on post-operative atrial fibrillation after discharge from cardiac surgery: secondary analysis of the SEARCH-AF CardioLink-1 randomized trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is conflicting evidence regarding the use of statins to reduce the risk of post-operative atrial fibrillation (POAF) in patients undergoing cardiac surgery.
Purpose
We sought to determine the effects of statin use on the burden of new-onset post-discharge POAF in the Post-Surgical Enhanced Monitoring for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF) CardioLink-1 randomized controlled trial.
Methods
In the SEARCH-AF trial, 336 patients with risk factors for stroke (CHA2DS2-VASc score ≥2) and no history of preoperative AF were randomized to usual care or continuous cardiac rhythm monitoring for 30 days after discharge from cardiac surgery with a wearable, patched-based device. The primary endpoint was the occurrence of cumulative atrial fibrillation/flutter (AF/AFL) lasting for ≥6 minutes detected by continuous monitoring or AF/AFL documented by a 12-lead electrocardiogram within 30 days of randomization. Using time-to-event analysis and Cox regression, we evaluated the association between the risk of post-operative AF in relation to statin use and dosing intensity (low, moderate, high) at the time of discharge. We excluded patients who experienced post-operative AF during hospitalization in this analysis.
Results
In the overall cohort (n=336), 260 (77.4%) patients were treated with statins at the time of hospital discharge. There were 18 (5.4%) patients who experienced post-operative AF during hospitalization. Patients prescribed with statins were more likely to be male (p=0.018), had lower CHA2DS2-VASc scores (p=0.011), and were more likely to undergo isolated coronary artery bypass grafting (CABG) (p=0.083). Baseline characteristics were otherwise similar between the 2 groups. Patients treated with statins at discharge had a 2-fold lower rate of post-operative AF than those who were not treated with statins in the overall cohort (17.6% vs. 8.2%, Log-Rank p=0.017) and among those who were randomized to continuous cardiac rhythm monitoring (31.6% vs. 16.0%, Log-Rank p=0.027) (Figure). After adjusting for surgery type (CABG vs. valve surgery) and the CHA2DS2-VASc score, statin use at discharge was associated with a lower risk of post-operative AF within 30 days after surgery (hazard ratio 0.48, 95% CI 0.24–0.97). Furthermore, increasing intensity of statin therapy was associated with lower risk of POAF (ptrend=0.0012) (Figure 1)
Conclusion
Among cardiac surgery patients with risk factors for stroke and no history of pre-operative AF, the use of statins was associated with a reduction in post-operative AF risk within 30 days of discharge. The routine use of high-intensity statin to prevent post-operative AF after cardiac surgery deserves further study.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Heart and Stroke Foundation of Canada
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Affiliation(s)
- M Hibibo
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - S Verma
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - A Pandey
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - A Quan
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - A Verma
- Southlake Regional Health Centre , Newmarket , Canada
| | - G Bisleri
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
| | - A Ha
- UHN - University of Toronto , Toronto , Canada
| | - C D Mazer
- St. Michael's Hospital, Cardiac surgery , Toronto , Canada
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Wang E, König R, Krychowiak M, Brezinsek S, Drews P, Gradic D, Jakubowski M, Kornejew P, Kremeyer T, Killer C, Liang Y, Neubauer O, Pandey A, Rudischhauser L, Sereda S, Schlisio G, Xu S. Radiation characteristics of detached divertor plasmas in W7-X. Nuclear Materials and Energy 2022. [DOI: 10.1016/j.nme.2022.101283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kumar G, Pandey A. Selfish Genetic Drive of B Chromosomes in Diploid and Autotetraploid Coriander (Coriandrum sativum L.). CYTOL GENET+ 2022. [DOI: 10.3103/s0095452722050073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hibino M, Verma S, Pandey A, Quan A, Puar P, Verma R, Pandey A, Bisleri G, Verma A, Mazer C, Ha A. VALVULAR SURGERY IS ASSOCIATED WITH AN INCREASED RISK OF POST-OPERATIVE ATRIAL FIBRILLATION: SECONDARY ANALYSIS OF THE SEARCH-AF CARDIOLINK-1 RANDOMIZED TRIAL. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pandey A, Hibino M, Ha A, Quan A, Puar P, Pandey A, Verma R, Bisleri G, Verma A, Mazer C, Verma S. IMPACT OF DIABETES AND GLUCOSE-LOWERING THERAPY ON POST-OPERATIVE ATRIAL FIBRILLATION AFTER CARDIAC SURGERY: SECONDARY ANALYSIS OF THE SEARCH-AF CARDIOLINK-1 RANDOMIZED CLINICAL TRIAL. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hibino M, Verma S, Quan A, Puar P, Verma R, Pandey A, Bisleri G, Verma A, Ha A, Mazer C. THE IMPACT OF STATIN ON POST-OPERATIVE ATRIAL FIBRILLATION AFTER DISCHARGE FROM CARDIAC SURGERY: SECONDARY ANALYSIS OF THE SEARCH-AF CARDIOLINK-1 RANDOMIZED TRIAL. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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30
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Pandey A. P21-27 Use of non-animal approaches for pesticide safety assessment. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Jha N, Thapa B, Pathak SB, Pandey A, Pokhrel S, Shankar PR, Bhandary S, Mudvari A, Dangal G. A Point Prevalence Study of the Use of Antibiotics in Six Tertiary Care Hospitals in the Kathmandu Valley, Nepal. Kathmandu Univ Med J (KUMJ) 2022; 20:351-358. [PMID: 37042379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Background Point prevalence survey (PPS) on antibiotic use developed by the WHO has already been used in many hospitals globally. Objective To obtain information on antibiotic prescribtion using point prevalence survey methodology in six private hospitals in the Kathmandu valley. Method This descriptive cross-sectional study was completed during 20th July to 28th July 2021 using point prevalence survey methodology. The study was conducted among inpatients admitted at or before 8:00 AM on the day of survey in various wards. Data was presented as frequencies and percentages. Result Maximum number of patients were above 60 years [34 (18.7%)]. Number of male and female participants were equal [91 (50%)]. Only one antibiotic was used in 81 patients (44.5%) followed by two antibiotics in 71 (39%) patients. Duration of prophylactic antibiotic use was one day in 66 (63.7%) patients. Blood, urine, sputum, and wound swabs were the common samples for culture. Cultures were positive for 17 (24.7%) samples. The common organisms isolated were E. Coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Ceftriaxone was the most used antibiotic. Drug and therapeutics, infection control committee and pharmacovigilance activities were present in 3/6 (50%) study sites. Antimicrobial stewardship was present in 3/6 (50%) and microbiological services was present in all hospitals. Antibiotic formulary and antibiotic guideline were present in 4/6 sites and facilities to audit or review surgical antibiotic prophylaxis choice in 2/6 (33.3%) sites, facility to monitor antibiotic use in 4/6 (66.6%) and cumulative antibiotic susceptibility reports in 2/6 (33.3%) study sites. Conclusion Ceftriaxone was the most used antibiotic. E. Coli, Pseudomonas aeruginosa and Klebsiella pneumonia were the commonly isolated organisms. Not all parameters for infrastructure, policy and practice and monitoring and feedback were present at the study sites. KEY WORDS.
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Affiliation(s)
- N Jha
- Department of Clinical Pharmacology and Therapeutics, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - B Thapa
- Department of Emergency Medicine, Kirtipur Hospital, Kirtipur, Nepal
| | - S B Pathak
- Department of Intensive Care Unit and Critical care, Nepal Mediciti Hospital, Sainbu, Bhaisepati, Nepal
| | - A Pandey
- Department of General Surgery, Madhyapur Hospital, Bhaktapur, Nepal
| | - S Pokhrel
- Department of Emergency Medicine, Nidan Hospital, Lalitpur, Pulchowk, Nepal
| | - P R Shankar
- IMU Centre for Education, International Medical University, Kuala Lumpur, Malaysia
| | - S Bhandary
- Department of Community Health Sciences and School of Public Health, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
| | - A Mudvari
- Department of Clinical Pharmacology, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
| | - G Dangal
- Kathmandu Model Hospital, Kathmandu, Nepal
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Nattudurai R, Arous D, F N, Edin J, Pandey A, Malinen E. PO-1573 Investigation of BaSO4:Eu nanophosphors for thermoluminescence dosimetry of X-ray and proton beams. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03537-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Seppälä J, Palmgren J, Pandey A. PO-1675 Feasibility of robotic stereotactic body radiation therapy for palliative bile duct obstruction. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03639-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pandey A, Nayak S, Khare A, Sharma R, Reddy BVV, Risheen GD. Perspectives in the use of tannins in animal production & health: a review. Journal of Livestock Science 2022. [DOI: 10.33259/jlivestsci.2022.112-119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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35
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Singh S, Shahi U, Aggarwal L, Choudhury S, Pal S, Pandey A. Feasibility of Interdigitation of Intracavitary High Dose Rate Brachytherapy for Locally Advanced Carcinoma Cervix in the Era of Concurrent Chemoradiation. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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Chunawala Z, Qamar A, Arora S, Pandey A, Fudim M, Vaduganathan M, Mentz R, Caughey M. Prognostic significance of polyvascular disease in patients admitted with acute decompensated heart failure: the ARIC Study Community Surveillance. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The prevalence and outcomes of polyvascular disease (PVD) in patients admitted with acute decompensated heart failure (ADHF) have not been previously reported, nor is it known whether associations differ for heart failure (HF) with reduced vs. preserved ejection fraction (HFrEF vs HFpEF, respectively).
Purpose
To investigate the relationship between atherosclerotic involvement of multiple arterial territories and mortality in patients hospitalized with ADHF.
Methods
The Atherosclerosis Risk in Communities (ARIC) study conducted hospital surveillance of adjudicated heart failure in 4 US areas from 2005–2014, with events verified by physician review. Medical histories were abstracted from the hospital record. PVD was defined by coexisting disease in ≥2 arterial beds, identified by prevalent coronary artery disease, peripheral arterial disease, and cerebrovascular disease. Mortality hazards of PVD vs. no PVD were analyzed separately for HFpEF and HFrEF, with adjustment for age, race, sex, year of admission and geographic region. All analyses were weighted by the inverse of the sampling probability.
Results
Of 24,936 ADHF hospitalizations (52% female, 32% Black, mean age 75 years), 19% had PVD (22% among HFrEF hospitalizations, 17% among HFpEF hospitalizations), Figure 1. There was an increasing trend in 1-year mortality with 0, 1 and ≥2 arterial bed involvement, both for patients with HFrEF (29% to 32% to 38%; P-trend=0.0006) and HFpEF (26% to 32% to 37%; P-trend <0.0001). After adjustments, PVD was associated with a 20% higher hazard of 1-year mortality in patients with HFrEF (HR=1.23; 95% CI: 1.06–1.44) and a 30% higher hazard in patients with HFpEF (HR=1.33; 95% CI: 1.09–1.63), with no significant interaction by HF type (P-interaction = 0.5).
Conclusion
Patients hospitalized with ADHF and coexisting PVD have an increased risk of death, irrespective of HF type. Clinical attention should be directed toward PVD, with secondary prevention strategies enacted to improve the prognosis of this vulnerable population.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institutes of Health Distributions of arterial diseaseTrends in 1-year mortality outcomes
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Affiliation(s)
- Z Chunawala
- Mayo Clinic, Rochester, United States of America
| | - A Qamar
- NorthShore University Health System, Chicago, United States of America
| | - S Arora
- University of North Carolina, Chapel Hill, United States of America
| | - A Pandey
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | - M Fudim
- Duke University School of Medicine, Durham, United States of America
| | - M Vaduganathan
- Brigham and Women's Hospital, Boston, United States of America
| | - R Mentz
- Duke University School of Medicine, Durham, United States of America
| | - M Caughey
- University of North Carolina, Chapel Hill, United States of America
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Cherney DZI, Segar M, Pandey A, Cannon CP, Cosentino F, Dagogo-Jack S, Pratley RE, Frederich R, Cater NB, Maldonado M, Liu J, Liu CC, Pong A, McGuire DK. Mediators of the effect of ertugliflozin on a composite kidney outcome in patients with type 2 diabetes and atherosclerotic cardiovascular disease: analyses from VERTIS CV. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Sodium–glucose cotransporter 2 (SGLT2) inhibitors have been shown to slow the decline of kidney function in outcome trials, but the biological mediator(s) underlying the therapeutic benefit are not well established.
Purpose
We performed a post-hoc analysis exploring potential mediators of the effects of the SGLT2 inhibitor ertugliflozin on the VERTIS CV exploratory kidney composite outcome (sustained 40% decrease from baseline in estimated glomerular filtration rate [eGFR], chronic kidney replacement therapy or kidney death).
Methods
In VERTIS CV, 8246 participants with type 2 diabetes mellitus and established atherosclerotic cardiovascular disease were randomised to placebo, ertugliflozin 5 mg or 15 mg (pooled for analyses, as prospectively planned), and were followed for a mean of 3.5 years. The hazard ratio (HR; 95% confidence interval) for the pre-specified exploratory kidney composite outcome was 0.66 (0.50, 0.88). Cox regression models were used to evaluate covariates that were significantly differentially changed from baseline with ertugliflozin treatment as candidate mediators, with a mediator identified as a covariate when added to an unadjusted model of randomised treatment assignment a) yielded a larger hazard ratio; and b) the mediator retained P<0.05 in the model (eGFR was excluded as a covariate). The percentage of mediation was determined by the proportional increase in the HR between the unadjusted and adjusted models for each post-randomisation period: early (first change from baseline measurement) and average (weighted average of change from baseline from all post-baseline measurements). Each potential mediator was tested individually, so across analyses, mediation % sums to >100%.
Results
Of 22 covariates significantly changed by ertugliflozin, nine were identified as potential mediators (Table). The covariates with a high percentage of mediation were those related to changes in blood erythrocytes (haemoglobin, haematocrit and red blood cell mass), with average changes in haemoglobin having the highest percentage of mediation (61.8%). Serum uric acid was associated with a mediation of 29.4% and 50.0% for the early and average post-randomisation effect periods, respectively. Early changes in glycated haemoglobin had a large mediation (50%), but the average change during the trial was not significant. Average change in serum albumin had a large mediation (29.4%). Average changes in body weight and systolic blood pressure had percentages of mediation of 41.2% and 14.7%, respectively.
Conclusion
Multiple factors may be involved in the reduction of the kidney composite outcome observed with ertugliflozin. In the short-term, changes in glycaemia had a high mediation effect. Over the long-term, changes suggestive of haemoconcentration and/or haematopoiesis (natriuresis-related effects), showed the highest percentage of mediation, followed by changes in serum uric acid and body weight (glucosuria-related effects).
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Sponsored by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA in collaboration with Pfizer Inc., New York, NY, USA
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Affiliation(s)
- D Z I Cherney
- University of Toronto, Division of Nephrology, Toronto, Canada
| | - M Segar
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | - A Pandey
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | - C P Cannon
- Brigham and Women's Hospital, Harvard Medical School, Cardiovascular Divison, Boston, United States of America
| | - F Cosentino
- Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden
| | - S Dagogo-Jack
- University of Tennessee Health Science Center, Memphis, United States of America
| | - R E Pratley
- AdventHealth Translational Research Institute, Memphis, United States of America
| | - R Frederich
- Pfizer Inc., Collegeville, United States of America
| | - N B Cater
- Pfizer Inc., New York, United States of America
| | - M Maldonado
- Merck Sharp & Dohme Limited, London, United Kingdom
| | - J Liu
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - C.-C Liu
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - A Pong
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - D K McGuire
- University of Texas Southwestern Medical Center; Parkland Hospital and Health System, Dallas, United States of America
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Segar MW, Pandey A, Cherney DZI, Cannon CP, Cosentino F, Dagogo-Jack S, Pratley RE, Shih WJ, Frederich R, Cater NB, Maldonado M, Liu J, Liu C, Pong A, McGuire DK. Mediation analyses of the effect of ertugliflozin on hospitalisation for heart failure in patients with type 2 diabetes and atherosclerotic cardiovascular disease from the VERTIS CV trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce risk of hospitalisation for heart failure (HHF) in outcome trials, but the biological mediators underlying the therapeutic benefit are not well established.
Purpose
To identify potential biological mediators through which ertugliflozin reduces risk of HHF.
Methods
In VERTIS CV, 8246 patients with type 2 diabetes and atherosclerotic cardiovascular disease were randomised to ertugliflozin 5 or 15 mg (observations pooled as prospectively planned) or placebo. Cox regression models were used to evaluate the associations between changes in 26 potential mediators with outcomes. Potential mediators were selected based on proposed mechanisms and/or differential change from baseline with SGLT2 inhibitors. Mediation criteria required 1) significant (P<0.05 for change from baseline) effects of ertugliflozin vs placebo on each potential mediator; and 2) significant (P<0.05) association of change in post-randomisation levels of the potential mediator with risk of HHF when added to an unadjusted model of randomised treatment assignment. Percent mediation was determined by comparing the unadjusted hazard ratio and hazard ratio adjusted for change in the potential mediator of interest. Each covariate was tested individually, such that percent mediation across the analyses summed to >100%. Time-dependent models were used to evaluate associations between early (change from baseline for the first post-baseline measurement) and average (weighted average of change from baseline using all post-baseline measurements) changes in covariates with clinical outcomes.
Results
Over a mean of 3.5 years, the incidence rate of HHF was 0.7 and 1.1 per 100 patient-years with ertugliflozin and placebo, respectively. Among 26 candidate mediators, 9 and 13 met the mediation criteria based on early and average changes, respectively. The 3 covariates with the largest mediating effects of early changes included haematocrit (40%), haemoglobin (27%) and HDL-C (23%) (Table); other significant biomarkers included urine albumin/creatinine ratio, and serum albumin, uric acid, chloride, protein and sodium. The 3 biomarkers with the largest mediating effects in average changes included haemoglobin (63%), albumin (50%) and uric acid (47%) (Table); other significant biomarkers included haematocrit, urine albumin/creatinine ratio, body weight, serum protein and chloride, systolic blood pressure, ALT, BUN, eGFR and heart rate.
Conclusions
In these analyses from the VERTIS CV trial, potential markers of volume status and haemoconcentration and/or haematopoiesis were the strongest mediators of the effect of ertugliflozin on reducing risk of HHF in the early and average change periods. Other potential mediators included uric acid, lipid markers and kidney parameters. These findings provide insights into potential mechanisms through which ertugliflozin, and potentially the SGLT2 inhibitor class, may prevent HHF.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Sponsored by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, and Pfizer Inc., New York, NY, USA.
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Affiliation(s)
- M W Segar
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | - A Pandey
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | | | - C P Cannon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America
| | - F Cosentino
- Unit of Cardiology, Karolinska Institute & Karolinska University Hospital, Stockholm, Sweden
| | - S Dagogo-Jack
- University of Tennessee Health Science Center, Memphis, United States of America
| | - R E Pratley
- AdventHealth Translational Research Institute, Orlando, United States of America
| | - W J Shih
- Rutgers School of Public Health and Rutgers Cancer Institute of New Jersey, Piscataway, United States of America
| | - R Frederich
- Pfizer Inc., Collegeville, United States of America
| | - N B Cater
- Pfizer Inc., New York, United States of America
| | | | - J Liu
- Merck & Co., Inc., Kenilworth, United States of America
| | - C Liu
- Merck & Co., Inc., Kenilworth, United States of America
| | - A Pong
- Merck & Co., Inc., Kenilworth, United States of America
| | - D K McGuire
- University of Texas Southwestern Medical Center & Parkland Health and Hospital System, Dallas, United States of America
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Patel T, Arora P, Jakhetiya A, Pandey A. Left lower lobectomy for uncommon endobronchial mucoepidermoid carcinoma in a 15-year-old male. J Postgrad Med 2021; 67:241-242. [PMID: 34643548 PMCID: PMC8706539 DOI: 10.4103/jpgm.jpgm_1070_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- T Patel
- Department of Pathology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - P Arora
- Department of Pathology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - A Jakhetiya
- Department of Surgical Oncology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - A Pandey
- Department of Surgical Oncology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
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Chapgain RH, Adhikari S, Pandey A, Sharma S, Pokhrel S, Devkota N, Shrestha NJ, Upadhaya D, Acharay J, Dharel M. Knowledge and Practices of Child Protection among the School Health Nurses of Nepal. Kathmandu Univ Med J (KUMJ) 2021; 19:460-466. [PMID: 36259189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Child protection is burning issues in developing countries including Nepal. Child protection is one of the key works of the school health nurses. Objective To find out about the existing knowledge and practices of child protection among the school health nurses. Method This descriptive cross-sectional study was conducted among 130 school health nurses working in different schools throughout Nepal. The participants were selected using purposive sampling technique and were invited to participate via various online networks. Self-administered questionnaire was used to collect data. Duration of data collection was 20 December 2020 to 10 February 2021. Descriptive statistics was used to analyze and interpret the data. Result Among the 130 Participants, 88.5% belonged to less than 29 years age group and 67.7% had Proficiency Certificate Level in Nursing education. None of them has received training related to child protection recognition and response and 90.8% had work experience of less than 5 years. Eighty percent and 96.9% participants had knowledge regarding the meaning of child right and child abuse respectively. But 45.4% had knowledge on meaning of child neglect; 53.1% and 72.3% had the knowledge of physical abuse and noncontact sexual abuse respectively. Majority (86.9%) of the participants reported as relatives were the abuser and 63.8% replied as home is the common place for abuse. Similarly, 85.4% had received the information regarding child protection via television radio and newspaper. Only 36.1% has already been involved in child protection. The participants who went to local government (Palika), police and Non-government Organizations for coordination for child right issues were 9(19.1%), 7(14.8%) and 8(17.0%) respectively. Conclusion Most of the school health nurses are young without having experience of childhood abuse and received any child protection training before joining the job. They have good knowledge of child right, physical, sexual abuse except child neglect and existing legal arrangements. There is gap in knowledge and practice.
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Affiliation(s)
- R H Chapgain
- Kanti Children's Hospital, Kathmandu, Nepal. National Academy of Medical Sciences (NAMS), Kathmandu, Nepal
| | - S Adhikari
- KantiChildren's Hospital, Kathmandu, Nepal
| | - A Pandey
- Birgunj Nursing Campus, Institute of Medicine, Tribhuvan University, Birgunj, Parsa, Nepal
| | - S Sharma
- Scheer Memorial Hospital, Banepa, Nepal
| | - S Pokhrel
- KantiChildren's Hospital, Kathmandu, Nepal
| | - N Devkota
- KantiChildren's Hospital, Kathmandu, Nepal
| | - N J Shrestha
- KantiChildren's Hospital, Kathmandu, Nepal. National Academy of Medical Sciences (NAMS), Kathmandu, Nepal
| | - D Upadhaya
- Cumbria Partnership NHS Foundation Trust, UK
| | - J Acharay
- Alder Hey Children's Hospital, NHS Foundation Trust, UK
| | - M Dharel
- National Child Right Council, Kathmandu, Nepal
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Pandey A, Seam R, Pandey L, Malik D, Mahajan R, Srinivasavittal Rao Sumithra B, Inampudi P, Acharya M, Chaparala S, Patel F. 879P Adaptive radiotherapy in head and neck cancer: A prospective dosimetric and volumetric study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pandey A, Shambhavi , Shukla A, Lal P, Kumar N, Srivastava AK, Dubey PK. Effect of the Coronavirus Disease-19 Pandemic on Mental Health of Positive Patients and Suspects: A Cross-sectional Study. JMSH 2021. [DOI: 10.46347/jmsh.2021.v07i02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Develtere D, Rosiello G, Piazza P, Pandey A, Berquin C, Sinatti C, Van Puyvelde H, Puliatti S, Amato M, Farinha R, De Groote R, Schatteman P, De Naeyer G, D’Hondt F, Mottrie A. Very early catheter removal on postoperative day 2 after robot-assisted radical prostatectomy: reporting on early complications and functional results. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01481-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Inampudi P, Seam R, Pandey L, Malik D, Pandey A, Anjali A, Hakim A, Mahajan R, Sharma S. 84P Prospective comparative study of dosimetric parameters and acute radiation toxicity of 3-dimensional conformal radiotherapy (3DCRT) and volumetric modulated arc therapy (VMAT) in post mastectomy carcinoma breast patients. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Pandey A, Shahi U, Aggarwal L, Choudhary S, Singh S. Role of hypofractionated tumor bed boost in the era of short course radiotherapy in early stage breast cancer. Breast 2021. [DOI: 10.1016/s0960-9776(21)00156-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Baokar S, Mane K, Bhujbal A, Pharande S, Patil G, Patil R, Jain P, Pandey A. A Current Review on Analytical Tools for Determination of New Oral Antidiabetic Drugs, Empagliflozin, Linagliptin and Biguanides in Bulk Materials, Pharmaceuticals & Biological Samples. JPRI 2020. [DOI: 10.9734/jpri/2020/v32i3430966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Worldwide the R & D divisions of Pharma industry are actively involved in the development of new therapeutic agents. These agents may be either new entities or partial structural modification of the existing one. The recent FDA statistics represent that the average number of drug filings are increasing every year in the thrust areas like anti-cancer agents, anti-diabetic, antibiotics, cardio-vascular drugs, respiratory drugs etc. Sodium glucose co-transporter-2(SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors and biguanides are effective oral anti-diabetic agents used in treatment of type 2 Diabetes Mellitus. Therefore, the necessity to explore and compare the existing analytical and bioanalytical assays used for determination of such drugs either single or in combination is crucial. Many methods were reported in the literature for the bio-analysis and analysis of four novel gliptins combinations, empagliflozin-linagliptin, empagliflozin-metformin HCl, linagliptin-metformin HCl, empagliflozin-linagliptin-metformin HCl combination with application on Glyxambi®, Synjardy®, Jentadueto®, Trijardy® XR tablets respectively. Furthermore, this review offered an overview of different methods used for determination of every drug alone as empagliflozin from SGLT-2 inhibitors, linagliptin from DPP-4 inhibitors and metformin from biguanides in a tabulated comparative way. Moreover, the current review emphasizes the most common stability indicating assays to be of interest to the analysts in the area of drug control. This review helps in understanding the further need for the development of analytical methods for the estimation of such drugs.
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Gupta N, Liu C, King E, Sylvester F, Lee D, Boyle B, Trauernicht A, Chen S, Colletti R, Ali SA, Al-Nimr A, Ayers TD, Baron HI, Beasley GL, Benkov KJ, Cabrera JM, Cho-Dorado ME, Dancel LD, Di Palma JS, Dorsey JM, Gulati AS, Hellmann JA, Higuchi LM, Hoffenberg E, Israel EJ, Jester TW, Kiparissi F, Konikoff MR, Leibowitz I, Maheshwari A, Moulton DE, Moses J, Ogunmola NA, Palmadottir JG, Pandey A, Pappa HM, Pashankar DS, Pasternak BA, Patel AS, Quiros JA, Rountree CB, Samson CM, Sandberg KC, Schoen B, Steiner SJ, Stephens MC, Sudel B, Sullivan JS, Suskind DL, Tomer G, Tung J, Verstraete SG. Continued Statural Growth in Older Adolescents and Young Adults With Crohn's Disease and Ulcerative Colitis Beyond the Time of Expected Growth Plate Closure. Inflamm Bowel Dis 2020; 26:1880-1889. [PMID: 31968095 DOI: 10.1093/ibd/izz334] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cessation of statural growth occurs with radiographic closure of the growth plates, radiographically defined as bone age (BA) 15 years in females and 17 in males. METHODS We determined the frequency of continued growth and compared the total height gain beyond the time of expected growth plate closure and the chronological age at achievement of final adult height in Crohn's disease (CD) vs ulcerative colitis (UC) and described height velocity curves in inflammatory bowel disease (IBD) compared with children in the National Health and Nutrition Examination Survey (NHANES). We identified all females older than chronological age (CA) 15 years and males older than CA 17 years with CD or UC in the ImproveCareNow registry who had height documented at ≥3 visits ≥6 months apart. RESULTS Three thousand seven patients (48% female; 76% CD) qualified. Of these patients, 80% manifested continued growth, more commonly in CD (81%) than UC (75%; P = 0.0002) and in females with CD (83%) than males with CD (79%; P = 0.012). Median height gain was greater in males with CD (1.6 cm) than in males with UC (1.3 cm; P = 0.0004), and in females with CD (1.8 cm) than in females with UC (1.5 cm; P = 0.025). Height velocity curves were shifted to the right in patients with IBD vs NHANES. CONCLUSIONS Pediatric patients with IBD frequently continue to grow beyond the time of expected growth plate closure. Unexpectedly, a high proportion of patients with UC exhibited continued growth, indicating delayed BA is also common in UC. Growth, a dynamic marker of disease status, requires continued monitoring even after patients transition from pediatric to adult care.
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Affiliation(s)
- Neera Gupta
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eileen King
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Francisco Sylvester
- Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dale Lee
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Brendan Boyle
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anna Trauernicht
- Division of Pediatric Gastroenterology, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Shiran Chen
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Richard Colletti
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT, USA
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Snoeijer JH, Pandey A, Herrada MA, Eggers J. The relationship between viscoelasticity and elasticity. Proc Math Phys Eng Sci 2020; 476:20200419. [PMID: 33363441 PMCID: PMC7735292 DOI: 10.1098/rspa.2020.0419] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022] Open
Abstract
Soft materials that are subjected to large deformations exhibit an extremely rich phenomenology, with properties lying in between those of simple fluids and those of elastic solids. In the continuum description of these systems, one typically follows either the route of solid mechanics (Lagrangian description) or the route of fluid mechanics (Eulerian description). The purpose of this review is to highlight the relationship between the theories of viscoelasticity and of elasticity, and to leverage this connection in contemporary soft matter problems. We review the principles governing models for viscoelastic liquids, for example solutions of flexible polymers. Such materials are characterized by a relaxation time λ, over which stresses relax. We recall the kinematics and elastic response of large deformations, and show which polymer models do (and which do not) correspond to a nonlinear elastic solid in the limit λ → ∞. With this insight, we split the work done by elastic stresses into reversible and dissipative parts, and establish the general form of the conservation law for the total energy. The elastic correspondence can offer an insightful tool for a broad class of problems; as an illustration, we show how the presence or absence of an elastic limit determines the fate of an elastic thread during capillary instability.
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Affiliation(s)
- J H Snoeijer
- Physics of Fluids Group, Faculty of Science and Technology, Mesa+ Institute, University of Twente, 7500 AE Enschede, The Netherlands
| | - A Pandey
- Physics of Fluids Group, Faculty of Science and Technology, Mesa+ Institute, University of Twente, 7500 AE Enschede, The Netherlands
| | - M A Herrada
- Depto. de Mecánica de Fluidos e Ingeniería Aeroespacial, Universidad de Sevilla, 41092 Sevilla, Spain
| | - J Eggers
- School of Mathematics, University of Bristol, Fry Building, Woodland Road, Bristol BS8 1UG, UK
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Srivastava S, Rastogi M, Gandhi A, Rath S, Pandey A, Masood S, Agarwal A, Singhal A, Khurana R, Hadi R, Sapru S, Srivastva A, Bharati A, Mishra S. Complete Pathological Response Rates and Outcome of Two Cycles Neoadjuvant Chemotherapy Followed by Long Course Concurrent Chemoradiotherapy in Patients of Locally Advanced Carcinoma Rectum. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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DiSilvestro J, DiSilvestro P, Pandey A, Gordon J, Ball J, Moxley K. Analysis of advanced quantitative computed tomography imaging features in predicting progression free survival of advanced epithelial ovarian cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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