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Misra A, Porras MP, Rajendran A, Contreras J, Scott NS. Cardio-Obstetrics: A Focused Review. Curr Cardiol Rep 2023; 25:1065-1073. [PMID: 37540401 DOI: 10.1007/s11886-023-01928-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease is the leading cause of maternal mortality in the USA. All cardiovascular care providers should have a foundational knowledge on the management of pregnant individuals with heart disease. This focused review touches on several key cardio-obstetric themes. RECENT FINDINGS Many individuals with cardiovascular disease can safely undergo pregnancy, but should have counseling preconception to optimize cardiac status. There are several cardiovascular conditions that are high risk for maternal mortality and morbidity. These individuals should be adequately counseled preconception and offered reliable birth control. The approach to a high-risk pregnant patient with cardiac disease is best managed by a multidisciplinary team to address potential maternal and fetal complications. Identification of at risk individuals can be estimated preconception with several risk scores. The development of risk scores to stratify and identify those at elevated risk during pregnancy is an area of continued research and development.
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Affiliation(s)
- Amrit Misra
- Department of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Aardra Rajendran
- Department of Internal Medicine, John Hopkins University, Baltimore, MD, USA
| | - Johanna Contreras
- Department of Cardiology, Division of Advanced Heart Failure and Transplant, Icahn School of Medicine, Mount Sinai, New York City, NY, USA
| | - Nandita S Scott
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA.
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Misra A, Desai AS, Valente AM. Valvular Regurgitation in Adults with Congenital Heart Disease and Heart Failure: Current Status and Potential Interventions. Heart Fail Clin 2023; 19:345-356. [PMID: 37230649 DOI: 10.1016/j.hfc.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The great majority of patients born with congenital heart disease (CHD) are living well into adulthood, yet they often have residual hemodynamic lesions, including valvar regurgitation. As these complex patients grow older, they are at risk of developing heart failure, which can be exacerbated by the underlying valvular regurgitation. In this review, we describe the etiologies of heart failure related to valvular regurgitation in the CHD population and discuss potential interventions.
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Affiliation(s)
- Amrit Misra
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood, Boston, MA 02115, USA; Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Akshay S Desai
- Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood, Boston, MA 02115, USA; Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Mylavarapu RV, Kanumuri VV, de Rivero Vaccari JP, Misra A, McMillan DW, Ganzer PD. Importance of timing optimization for closed-loop applications of vagus nerve stimulation. Bioelectron Med 2023; 9:8. [PMID: 37101239 PMCID: PMC10134677 DOI: 10.1186/s42234-023-00110-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023] Open
Abstract
In recent decades, vagus nerve stimulation (VNS) therapy has become widely used for clinical applications including epilepsy, depression, and enhancing the effects of rehabilitation. However, several questions remain regarding optimization of this therapy to maximize clinical outcomes. Although stimulation parameters such as pulse width, amplitude, and frequency are well studied, the timing of stimulation delivery both acutely (with respect to disease events) and chronically (over the timeline of a disease's progression) has generally received less attention. Leveraging such information would provide a framework for the implementation of next generation closed-loop VNS therapies. In this mini-review, we summarize a number of VNS therapies and discuss (1) general timing considerations for these applications and (2) open questions that could lead to further therapy optimization.
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Affiliation(s)
| | - Vivek V Kanumuri
- Department of Otolaryngology, University of Miami, Miami, FL, USA
| | - Juan Pablo de Rivero Vaccari
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Amrit Misra
- Newton Wellesley Neurology Associates, Newton, MA, USA
| | - David W McMillan
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Patrick D Ganzer
- Department of Biomedical Engineering, University of Miami, Miami, FL, USA.
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA.
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Dawdy J, Datta I, Misra A, Kottam A. Non-invasive ischemic evaluation in an aging population of transposition of great arteries patients with atrial switch procedure. J Nucl Cardiol 2023; 30:854-857. [PMID: 35013910 DOI: 10.1007/s12350-021-02900-7] [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] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 12/11/2021] [Indexed: 11/27/2022]
Affiliation(s)
- John Dawdy
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, MI, USA.
| | - Ishita Datta
- Department of Internal Medicine/Pediatrics, Detroit Medical Center/Wayne State University, Detroit, MI, USA
| | - Amrit Misra
- Division of Pediatric Cardiology, Children's Hospital of Michigan/Central Michigan University, Detroit, MI, USA
| | - Anupama Kottam
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, MI, USA
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Sheikh I, Nascimento F, Misra A, Lang‐Orsini M, Cole AJ, Richardson RM, Cash SS. Focal cortical dysplasia IIb: near‐continuous rhythmic fast spike burst pattern on intracranial EEG with atypical electroclinical‐clinical semiology. Epileptic Disord 2023. [PMID: 37358919 DOI: 10.1002/epd2.20018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
- Irfan Sheikh
- Department of Neurology Massachusetts General Hospital
| | | | - Amrit Misra
- Department of Neurology Massachusetts General Hospital
| | | | | | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital Boston Massachusetts USA
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Sureka S, Misra A, Raj H, Singh U. Evaluation of different pneumoperitoneal pressures with respect to technical feasibility and physiological parameters in laparoscopic renal surgery: A prospective and randomized study to determine the safe pressure. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00371-8] [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: 02/12/2023]
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Henneberg J, Grohmann-Izay B, Huang C, Schulze C, Llinas N, Giorgi D, Misra A, Pominchuk D, Prokhorof A, Rapoport B, Semiglazov V, Tseng L, Yanez Ruiz E, Loibl S. A Phase III, Randomized, Multicenter, Double-blind Study to Compare Efficacy and Safety of EG12014 (EirGenix Trastuzumab) with Herceptin® as Neoadjuvant Treatment in Combination with Anthracycline/Paclitaxel-based Systemic Therapy in Patients with HER2-positive Early Breast Cancer. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01510-6] [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: 11/19/2022]
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Pasqualin G, Misra A, Gauvreau K, Desai AS, Prakash A, Sanders S, Givertz MM, Valente AM. Ventricular-arterial coupling predicts outcomes in adults with a systemic right ventricle. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1539] [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
Patients with a systemic right ventricle (SRV) and biventricular circulation experience high incidence of cardiovascular morbidities and decreased survival [1]. Non-invasive measures of subclinical ventricular dysfunction are needed to appropriately identify patients at increased risk for adverse outcomes. Ventricular-arterial coupling (VAC), the ratio between the effective arterial elastance (Ea) and ventricular end-systolic elastance (Ees), may predict clinical outcomes in patients with SRV [2].
Objectives
To assess VAC in adults with SRV and evaluate its correlation with clinical outcomes.
Methods
Consecutive cardiovascular magnetic resonance (CMR) examinations of adults with D-loop transposition of great arteries (TGA) after atrial switch operation and L-loop TGA performed at Boston Children's Hospital between 2005 and 2019 were analyzed. VAC was calculated as Ea/Ees (Ea = mean arterial blood pressure (MBP)/ventricular stroke volume; Ees = MBP/end-systolic volume). Global myocardial strain was measured by feature tracking analysis on cine steady-state free precession sequences. Cox proportional hazards regression analysis was performed to assess the association of SRV functional parameters with clinical outcomes. The analysis was adjusted for age, sex, and body mass index. The primary outcome was defined as a composite of death, cardiovascular arrest, hospitalizations for heart failure (HF); the secondary outcome as atrial arrhythmias; the tertiary outcome included other causes of cardiovascular hospitalizations (percutaneous or surgical interventions, device implantation, other cardiovascular disease). Cumulative incidence of the study outcomes was estimated using Kaplan-Meier method.
Results
One hundred sixty-seven adults (mean age 32±10 years, 59% men) with SRV were analyzed. Patients with HF (n=48, 29%) had higher VAC values as compared to those without HF (1.4±0.8 vs. 1.1±0.5, p=0.01). Over a mean follow-up of 6.5±4.2 years, 15 over 139 patients (11%) experienced the primary outcome with an incidence rate of 1.7 per 100 patient-years (95% confidence interval (CI), 1.04–2.85). Higher VAC values were significantly associated with an increased risk of the primary outcome (p for trend = 0.01, Figure 1). VAC was the only functional parameter associated with the primary outcome (hazard ratio (HR) 1.99, 95% CI: 1.06–3.73, p=0.031), secondary outcome (HR 2.33, 95% CI: 1.12–4.82, p=0.023) and tertiary outcome (HR 1.63, 95% CI: 1.09–2.44, p=0.018) in the adjusted analysis (Table 1). Ejection fraction (EF) was not associated with the study outcomes in the adjusted analysis (p>0.05, Table 1) whereas global circumferential and radial strain showed an association limited to the tertiary endpoint (p=0.004, Table 1).
Conclusions
CMR-derived VAC is associated with adverse outcomes in SRV patients and may improve risk stratification of this unique population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Pasqualin
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - A Misra
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - K Gauvreau
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - A S Desai
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine , Boston , United States of America
| | - A Prakash
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - S Sanders
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - M M Givertz
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine , Boston , United States of America
| | - A M Valente
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
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Misra A, Halas R, Kobayashi D, Walters HL, Bondarenko I, Thomas R, Vener DF, Aggarwal S, Safa R. Outcomes of Patients with Sickle Cell Disease and Trait Following Congenital Heart Disease Surgery. Ann Thorac Surg 2022; 115:1494-1502. [PMID: 35483424 DOI: 10.1016/j.athoracsur.2022.04.021] [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] [Received: 11/13/2021] [Revised: 03/12/2022] [Accepted: 04/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a hemoglobinopathy which can cause multi-organ dysfunction. The objective of our paper was to assess the perioperative outcomes of patients undergoing surgery for congenital heart disease who had either SCD or sickle cell trait (SCT). METHODS We performed a retrospective review of patients with SCD and SCT who had records in the Society of Thoracic Surgeons Congenital Heart Surgery Database between 2014 and 2019. The primary outcome was operative mortality; secondary outcomes included post-operative complications. One-to-one propensity score matching was performed between the SCD and SCT groups and the control group for further analysis. RESULTS Our study population consisted of 73, 411, and 36501 patients in the SCD, SCT, and control groups respectively. Median age at surgery in years (25-75% interquartile range) was 2.8(0.4, 9.7), 0.60(0.2, 3.1), and 0.70(0.2, 6.4) years in the SCD, SCT, and control cohort respectively. Operative mortality, surgery duration, cardiopulmonary bypass time, and cross clamp time were not significantly different among the three groups. The SCD group had a higher rate of post-surgical cardiac arrest than its propensity score matched control group (5.5% vs 0%, p<0.05); otherwise there were no statistically significant differences in the outcomes between the SCD and SCT groups and their respective matched control groups. CONCLUSIONS Operative mortality following cardiothoracic procedures in patients with SCD and SCT appeared similar to our control patients. While these patients may require unique peri-operative management, they can undergo cardiac surgery without an observed increase in mortality.
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Affiliation(s)
- Amrit Misra
- Department of Cardiology, Boston Children's Hospital, Boston, MA.
| | - Ryan Halas
- Division of Cardiology, Children's Hospital of Michigan, Department of Pediatrics, Central Michigan University College of Medicine, Detroit, MI
| | - Daisuke Kobayashi
- Division of Cardiology, Children's Hospital of Michigan, Department of Pediatrics, Central Michigan University College of Medicine, Detroit, MI
| | - Henry L Walters
- Department of Cardiovascular Surgery, Children's Hospital of Michigan, Department of Surgery, Wayne State University School of Medicine, MI
| | - Igor Bondarenko
- Department of Cardiovascular Surgery, Children's Hospital of Michigan, Department of Surgery, Wayne State University School of Medicine, MI
| | - Ronald Thomas
- Division of Cardiology, Children's Hospital of Michigan, Department of Pediatrics, Central Michigan University College of Medicine, Detroit, MI
| | - David F Vener
- Department of Anesthesiology, Baylor College of Medicine; Pediatric and Congenital Cardiac Anesthesia, Texas Children's Hospital, Texas
| | - Sanjeev Aggarwal
- Division of Cardiology, Children's Hospital of Michigan, Department of Pediatrics, Central Michigan University College of Medicine, Detroit, MI
| | - Raya Safa
- Division of Cardiology, Children's Hospital of Michigan, Department of Pediatrics, Central Michigan University College of Medicine, Detroit, MI; Division of Critical Care, Children's Hospital of Michigan, Central Michigan College of Medicine, Detroit, MI
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Misra A, Balakrishnan PL, Mewada A, Singla M, Singh G, Aggarwal S. Longitudinal Trends in Body Mass Index for Adults with Congenital Heart Disease. Pediatr Cardiol 2022; 43:547-553. [PMID: 34665285 DOI: 10.1007/s00246-021-02753-4] [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: 06/17/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Abstract
Obesity is a modifiable, independent risk factor for adverse long-term outcomes in children and adults. Our objective was to determine the prevalence of overweight and obese status in a cohort of adults with congenital heart disease (CHD) as well as to assess longitudinal trends over a 20-year period. The study group consisted of patients 18 years of age and older followed at our adult CHD clinic. Body mass index (BMI) data were collected from our index period, consisting of patient encounters from 2009 to 2012 (Period 2), as well as during 2000-2003 (Period 1) and 2017-2020 (Period 3) when available. The study cohort was subdivided into three groups per published guidelines: simple, moderate, and greater CHD complexity. The prevalence of obesity and overweight status was compared among the different groups as well as with published data (NHANES). Our cohort in Period 2 consisted of 261 subjects. The median age (25-75% interquartile range) for Period 2 was 27.6 (21.1-35.9) years and BMI was 25.2 (21.7-30.0) kg/m2 with 8.0% underweight, 40.0% with normal weight, 27.0% overweight, and 25% obese. 95 patients had follow-up data from each time period, with 96% of patients having moderate or greater complexity of CHD. The combined percentage of overweight and obese patients for the moderate and greater complex CHD groups increased from 42 and 37% in period 1 to 60% and 65% in period 3, respectively. The percentage of obese patients with moderate and greater CHD complexity increased by 250% and 55%, respectively, from Period 1 to 3. Our study cohort had a high prevalence of overweight and obese weight status. Given adults with CHD have high baseline cardiovascular morbidity, the presence of obesity can increase their risk for poor outcomes, highlighting the need for prevention of this modifiable risk factor.
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Affiliation(s)
- Amrit Misra
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan, Central Michigan University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI, 48201, USA.
| | - Preetha L Balakrishnan
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan, Central Michigan University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI, 48201, USA
| | - Abhishek Mewada
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan, Central Michigan University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI, 48201, USA
| | - Manit Singla
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan, Central Michigan University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI, 48201, USA
| | - Gautam Singh
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan, Central Michigan University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI, 48201, USA
| | - Sanjeev Aggarwal
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan, Central Michigan University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI, 48201, USA
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Torpoco-Rivera D, Misra A, Sanil Y, Sabzghabaei N, Safa R, Garcia RU. Vitamin D and morbidity in children with multisystem inflammatory syndrome related to Covid-19. Progress in Pediatric Cardiology 2022; 66:101507. [PMID: 35250251 PMCID: PMC8885084 DOI: 10.1016/j.ppedcard.2022.101507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/24/2022]
Abstract
Background Multisystem inflammatory syndrome (MIS-C) is a clinical presentation reported in children related to Coronavirus-19 infection who present with a toxic shock like syndrome. Vitamin D deficiency has been postulated to play a role with severity of coronavirus infection in adult patients and other viral respiratory infections. Objective This study aims to investigate if severe vitamin D deficiency was associated with increased disease severity and cardiac involvement in MIS-C. Methods This is a retrospective and single center study. We included hospitalized patients less than 18 years of age with diagnosis of MIS-C between March and July 2020. Severe vitamin D deficiency was defined as 25-OH vitamin D level < 10 ng/ml within 48 h of admission. The composite outcome severe disease included patients requiring inotropes, mechanical ventilation, and extracorporeal membrane oxygenation. Results Of the 31 patients with MIS-C, 45% were male and 58% were African American. The median age was 8 (1–13) years. Ten patients had severe vitamin D deficiency with a mean level of 7.2 ng/ml. Ninety percent of patients with severe vitamin D deficiency had severe disease (P < 0.001). Patients with severe vitamin D deficiency had an increased risk of cardiac involvement (P < 0.001). Conclusions We describe a potential association between severe vitamin D deficiency and severe disease in children presenting with MIS-C. Severe vitamin D deficiency predisposes patients for cardiovascular involvement and may play a critical role in the host immune response to COVID-19 infection. Future prospective studies at the basic science and clinical level should be pursued to better delineate this association.
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Shaw S, Patra A, Misra A, Nayak MK, Chamkha AJ. A Numerical Approach to the Modeling of Thomson and Troian Slip on Nonlinear Radiative Microrotation of Casson Carreau Nanomaterials in Magnetohydrodynamics. j nanofluids 2021. [DOI: 10.1166/jon.2021.1790] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The goal of the current work is to explore the influence of Thompson and Troian slip on the hydromagnetic microrotations of Carreau nanomaterials over a linearly stretched surface subject to NLTR, viscous dissipation, Newtonian heating, homogenous and heterogeneous reactions. Effect
of non linear slip (Thompson and Troian slip) on non Newtonian nanofluid (Carreau nanofluid) subject to microrotation is the novelty of the investigation. Shooting technique is the instrumental to get appropriate numerical solution. The significant outcomes of the current study are that Casson
parameter and Weissenberg number exhibit opposite results for velocity and heat transfer rate due to flow of micropolar Carreau nanofluid. Further, more and more Thompson and Troian slip yields diminution of flow velocity as well as microrotations. Amplifying Casson parameter intensifies the
HTR from the stretched surface.
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Affiliation(s)
- S. Shaw
- Department of Mathematics and Statistical Sciences, Botswana International University of Science and Technology, Private Bag 16, Palapye, Botswana
| | - A. Patra
- Department of Mathematics, Govt. Autonomous College, Rourkela, Odisha 769004, India
| | - A. Misra
- Department of Mathematics, Centurion University of Technology and Management, Paralakhemundi, Gajapati 761211, Odisha, India
| | - M. K. Nayak
- Department of Mechanical Engineering, FET, ITER, Siksha ‘O’ Anusandhan University, Bhubaneswar 751030, India
| | - Ali J. Chamkha
- Faculty of Engineering, Kuwait College of Science and Technology, Doha District, 35004, Kuwait
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Kurup R, Misra A, Patel S. Colchicine suppresses atherosclerotic plaque development and modulates atherogenic vascular smooth muscle cell and monocyte behaviour. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.080] [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: 11/30/2022]
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Sanil Y, Misra A, Safa R, Blake JM, Eddine AC, Balakrishnan P, Garcia RU, Taylor R, Dentel JN, Ang J, Cashen K, Heidemann SM, Bauerfield C, Sethuraman U, Farooqi A, Aggarwal S, Singh G. Echocardiographic Indicators Associated with Adverse Clinical Course and Cardiac Sequelae in Multisystem Inflammatory Syndrome in Children with Coronavirus Disease 2019. J Am Soc Echocardiogr 2021; 34:862-876. [PMID: 33957250 PMCID: PMC8089028 DOI: 10.1016/j.echo.2021.04.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 02/08/2023]
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 causes significant cardiovascular involvement, which can be a determinant of clinical course and outcome. The aim of this study was to investigate whether echocardiographic measures of ventricular function were independently associated with adverse clinical course and cardiac sequelae in patients with MIS-C. Methods In a longitudinal observational study of 54 patients with MIS-C (mean age, 6.8 ± 4.4 years; 46% male; 56% African American), measures of ventricular function and morphometry at initial presentation, predischarge, and at a median of 3- and 10-week follow-up were retrospectively analyzed and were compared with those in 108 age- and gender-matched normal control subjects. The magnitude of strain is expressed as an absolute value. Risk stratification for adverse clinical course and outcomes were analyzed among the tertiles of clinical and echocardiographic data using analysis of variance and univariate and multivariate regression. Results Median left ventricular apical four-chamber peak longitudinal strain (LVA4LS) and left ventricular global longitudinal strain (LVGLS) at initial presentation were significantly decreased in patients with MIS-C compared with the normal cohort (16.2% and 15.1% vs 22.3% and 22.0%, respectively, P < .01). Patients in the lowest LVA4LS tertile (<13%) had significantly higher C-reactive protein and high-sensitivity troponin, need for intensive care, and need for mechanical life support as well as longer hospital length of stay compared with those in the highest tertile (>18.5%; P < .01). Initial LVA4LS and LVGLS were normal in 13 of 54 and 10 of 39 patients, respectively. There was no mortality. In multivariate regression, only LVA4LS was associated with both the need for intensive care and length of stay. At median 10-week follow-up to date, seven of 36 patients (19%) and six of 25 patients (24%) had abnormal LVA4LS and LVGLS, respectively. Initial LVA4LS < 16.2% indicated abnormal LVA4LS at follow-up with 100% sensitivity. Conclusion Impaired LVGLS and LVA4LS at initial presentation independently indicate a higher risk for adverse acute clinical course and persistent subclinical left ventricular dysfunction at 10-week follow-up, suggesting that they could be applied to identify higher risk children with MIS-C.
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Affiliation(s)
- Yamuna Sanil
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Amrit Misra
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Raya Safa
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Division of Pediatric Cardiology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Jennifer M Blake
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Ahmad Charaf Eddine
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Preetha Balakrishnan
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Richard U Garcia
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Division of Pediatric Cardiology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Rachel Taylor
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - John N Dentel
- Department of Pediatrics, Division of Pediatric Cardiothoracic Surgery, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Jocelyn Ang
- Department of Pediatrics, Division of Pediatric Infectious Disease, Wayne State University, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Division of Pediatric Infectious Disease, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Katherine Cashen
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Sabrina M Heidemann
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Christian Bauerfield
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Usha Sethuraman
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Ahmad Farooqi
- Children's Research Center of Michigan, Central Michigan University College of Medicine, Detroit, Michigan
| | - Sanjeev Aggarwal
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan; Department of Pediatrics, Division of Pediatric Cardiology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Gautam Singh
- Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan.
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15
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Tamim I, Chung DY, de Morais AL, Loonen ICM, Qin T, Misra A, Schlunk F, Endres M, Schiff SJ, Ayata C. Spreading depression as an innate antiseizure mechanism. Nat Commun 2021; 12:2206. [PMID: 33850125 PMCID: PMC8044138 DOI: 10.1038/s41467-021-22464-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 03/15/2021] [Indexed: 12/16/2022] Open
Abstract
Spreading depression (SD) is an intense and prolonged depolarization in the central nervous systems from insect to man. It is implicated in neurological disorders such as migraine and brain injury. Here, using an in vivo mouse model of focal neocortical seizures, we show that SD may be a fundamental defense against seizures. Seizures induced by topical 4-aminopyridine, penicillin or bicuculline, or systemic kainic acid, culminated in SDs at a variable rate. Greater seizure power and area of recruitment predicted SD. Once triggered, SD immediately suppressed the seizure. Optogenetic or KCl-induced SDs had similar antiseizure effect sustained for more than 30 min. Conversely, pharmacologically inhibiting SD occurrence during a focal seizure facilitated seizure generalization. Altogether, our data indicate that seizures trigger SD, which then terminates the seizure and prevents its generalization.
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Affiliation(s)
- Isra Tamim
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Charité-Universitätsmedizin Berlin, Klinik und Hochschulambulanz für Neurologie und Centrum für Schlaganfallforschung Berlin (CSB), Berlin, Germany
| | - David Y Chung
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreia Lopes de Morais
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Inge C M Loonen
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tao Qin
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amrit Misra
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Frieder Schlunk
- Charité-Universitätsmedizin Berlin, Klinik und Hochschulambulanz für Neurologie und Centrum für Schlaganfallforschung Berlin (CSB), Berlin, Germany
| | - Matthias Endres
- Charité-Universitätsmedizin Berlin, Klinik und Hochschulambulanz für Neurologie und Centrum für Schlaganfallforschung Berlin (CSB), Berlin, Germany
| | - Steven J Schiff
- Center for Neural Engineering, Departments of Engineering Science and Mechanics and Physics, The Pennsylvania State University, State College, PA, USA
| | - Cenk Ayata
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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16
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Abstract
Femoral artery thrombosis (FAT) is an adverse event post-catheterization. We decided to study the incidence and risk factors of FAT before and after initiation of a pulse loss monitoring program. All cardiac catheterization cases performed using femoral arterial vascular access were retrospectively reviewed. The study period was divided into two eras: before (era 1), and after the initiation of the protocol (era 2). The primary outcome was FAT requiring therapy. Univariable and multivariable logistic regression models were used to identify factors associated with FAT. Receiver operating characteristic curve were generated to predict FAT. Our cohort consisted of 2,388 cases including 467 (19.6%) infants weighing < 10 kg. The overall incidence of FAT was 1.7% (n = 41). The incidence of FAT was 3.5 times higher in era 2 (p < 0.001). Multivariable model showed that era, weight, sheath exchange, and coarctation intervention were significantly associated with FAT. Infants younger than 7.7 months and less than 6.7 kg were found to be at highest risk for FAT. Our study shows that the incidence of FAT may be underestimated without a monitoring program. Small infants and coarctation interventions requiring larger sheaths or sheath exchanges are at highest risk for FAT.
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Affiliation(s)
- Neha Bansal
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Montefiore Medical Center, 3415 Bainbridge Ave- R1, Bronx, NY, 10467, USA.
| | - Amrit Misra
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Thomas J Forbes
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Daisuke Kobayashi
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
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17
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Nilavarasan T, Joshi GN, Misra A, Manisankar C, Verma SB. Topological modifications due to ramped vanes in a flare-induced shock–boundary layer interaction flowfield. J Vis (Tokyo) 2021. [DOI: 10.1007/s12650-020-00735-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Lyons TP, Gillard D, Molina-Sánchez A, Misra A, Withers F, Keatley PS, Kozikov A, Taniguchi T, Watanabe K, Novoselov KS, Fernández-Rossier J, Tartakovskii AI. Interplay between spin proximity effect and charge-dependent exciton dynamics in MoSe 2/CrBr 3 van der Waals heterostructures. Nat Commun 2020; 11:6021. [PMID: 33244001 PMCID: PMC7691354 DOI: 10.1038/s41467-020-19816-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 03/23/2020] [Accepted: 10/30/2020] [Indexed: 11/18/2022] Open
Abstract
Semiconducting ferromagnet-nonmagnet interfaces in van der Waals heterostructures present a unique opportunity to investigate magnetic proximity interactions dependent upon a multitude of phenomena including valley and layer pseudospins, moiré periodicity, or exceptionally strong Coulomb binding. Here, we report a charge-state dependency of the magnetic proximity effects between MoSe2 and CrBr3 in photoluminescence, whereby the valley polarization of the MoSe2 trion state conforms closely to the local CrBr3 magnetization, while the neutral exciton state remains insensitive to the ferromagnet. We attribute this to spin-dependent interlayer charge transfer occurring on timescales between the exciton and trion radiative lifetimes. Going further, we uncover by both the magneto-optical Kerr effect and photoluminescence a domain-like spatial topography of contrasting valley polarization, which we infer to be labyrinthine or otherwise highly intricate, with features smaller than 400 nm corresponding to our optical resolution. Our findings offer a unique insight into the interplay between short-lived valley excitons and spin-dependent interlayer tunneling, while also highlighting MoSe2 as a promising candidate to optically interface with exotic spin textures in van der Waals structures.
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Affiliation(s)
- T P Lyons
- Department of Physics and Astronomy, The University of Sheffield, Sheffield, S3 7RH, UK.
| | - D Gillard
- Department of Physics and Astronomy, The University of Sheffield, Sheffield, S3 7RH, UK
| | - A Molina-Sánchez
- QuantaLab, International Iberian Nanotechnology Laboratory, Braga, 4715-330, Portugal
| | - A Misra
- School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK
- Department of Physics, Indian Institute of Technology Madras (IIT Madras), Chennai, India
| | - F Withers
- Department of Physics and Astronomy, University of Exeter, Exeter, EX4 4QL, UK
| | - P S Keatley
- Department of Physics and Astronomy, University of Exeter, Exeter, EX4 4QL, UK
| | - A Kozikov
- School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK
| | - T Taniguchi
- National Institute for Materials Science, Tsukuba, Ibaraki, 305-0044, Japan
| | - K Watanabe
- National Institute for Materials Science, Tsukuba, Ibaraki, 305-0044, Japan
| | - K S Novoselov
- School of Physics and Astronomy, The University of Manchester, Manchester, M13 9PL, UK
- Centre for Advanced 2D Materials, National University of Singapore, Singapore, 117546, Singapore
- Chongqing 2D Materials Institute, Liangjiang New Area, Chongqing, 400714, China
| | - J Fernández-Rossier
- QuantaLab, International Iberian Nanotechnology Laboratory, Braga, 4715-330, Portugal
| | - A I Tartakovskii
- Department of Physics and Astronomy, The University of Sheffield, Sheffield, S3 7RH, UK.
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19
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Caballero AE, Ceriello A, Misra A, Aschner P, McDonnell ME, Hassanein M, Ji L, Mbanya JC, Fonseca VA. COVID-19 in people living with diabetes: An international consensus. J Diabetes Complications 2020; 34:107671. [PMID: 32651031 PMCID: PMC7336933 DOI: 10.1016/j.jdiacomp.2020.107671] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 02/08/2023]
Abstract
The COVID-19 pandemic has added an enormous toll to the existing challenge of diabetes care world-wide. A large proportion of patients with COVID-19 requiring hospitalization and/or succumbing to the disease have had diabetes and other chronic conditions as underlying risk factors. In particular, individuals belonging to racial/ethnic minorities in the U.S. and other countries have been significantly and disproportionately impacted. Multiple and complex socioeconomic factors have long played a role in increasing the risk for diabetes and now for COVID-19. Since the pandemic began, the global healthcare community has accumulated invaluable clinical experience on providing diabetes care in the setting of COVID-19. In addition, understanding of the pathophysiological mechanisms that link these two diseases is being developed. The current clinical management of diabetes is a work in progress, requiring a shift in patient-provider interaction beyond the walls of clinics and hospitals: the use of tele-medicine when feasible, innovative patient education programs, strategies to ensure medication and glucose testing availability and affordability, as well as numerous ideas on how to improve meal plans and physical activity. Notably, this worldwide experience offers us the possibility to not only prepare better for future disasters but also transform diabetes care beyond the COVID-19 era.
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Affiliation(s)
- A E Caballero
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | | | - A Misra
- Fortis-C-DOC Center of Excellence for Diabetes, Metabolic Disease and Endocrinology, National Diabetes, Obesity and Cholesterol Foundation, New Dheli, India
| | - P Aschner
- San Ignacio University Hospital, Javeriana University School of Medicine, Bogota, Colombia
| | - M E McDonnell
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - M Hassanein
- Dubai Hospital, Endocrine Department, Dubai Health Authority, Dubai, United Arab Emirates
| | - L Ji
- Peking University People's Hospital, Peking University, Beijing, China
| | - J C Mbanya
- Central Hospital, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - V A Fonseca
- Tulane University Medical Center, Tulane University Medical School, New Orleans, USA
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20
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Vega C, Misra A, Schubert G, Arora R. Gradual onset of psychotic symptoms in an adolescent. J Paediatr Child Health 2020; 56:332-333. [PMID: 31482641 DOI: 10.1111/jpc.14610] [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] [Received: 06/16/2019] [Revised: 08/08/2019] [Accepted: 08/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Carolina Vega
- Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan, United States
| | - Amrit Misra
- Department of Pediatric Cardiology, Children's Hospital of Michigan, Detroit, Michigan, United States
| | - Gena Schubert
- Pediatric Emergency Medicine, Phoenix Children's Hospital, Phoenix, Arizona, United States
| | - Rajan Arora
- Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan, United States
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21
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Tucker B, Vaidya K, Kurup R, Khandkar C, Pandzic E, Barraclough J, Misra A, Kavurma M, Martinez G, Rye K, Cochran B, Patel S. 461 Colchicine Inhibits Neutrophil Extracellular Trap Formation in Acute Coronary Syndrome Patients Post Percutaneous Coronary Intervention. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.468] [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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22
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23
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Abstract
PURPOSE OF REVIEW This article attempts to review some of the commonly seen repaired congenital heart defects in the adult population (ACHD), with a focus on important echocardiographic findings that may assist a practitioner in recognizing and managing this group of patients. RECENT FINDINGS The prevalence of ACHD population is increasing, and currently, there are over 1 million adults with congenital heart disease. At the current time, the total number of ACHD patients exceeds the total number of pediatric patients with CHD. The recently released 2018 American College of Cardiology/American Heart Association guidelines for the management of adults with congenital heart disease (ACHD) recommends transthoracic echocardiography for all ACHD patients for initial assessment and serial assessment as needed (class of recommendation: I) and echocardiography remains the mainstay for diagnosing and managing these patients in adjunct with other available imaging modalities. It is imperative for all cardiologists to be familiar with the echocardiographic features of the commonly seen repaired CHD in adult population.
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Affiliation(s)
- Amrit Misra
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA
| | - Chenni Sriram
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA.
| | - Pooja Gupta
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA
| | - Richard Humes
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201-2119, USA
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24
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Misra A, Wiens D, Kassam H, Gill R, Borgia SM. A191 HCV SCREENING VIA RAPID POINT OF CARE TESTING IN PATIENTS ON OPIATE SUBSTITUTION THERAPY IN PEEL REGION, CANADA. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.190] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Misra
- McMaster University, Hamilton, ON, Canada
| | - D Wiens
- New Direction Addiction Clinic, Brampton, ON, Canada
| | - H Kassam
- Vector Health Clinics, Mississauga, ON, Canada
| | - R Gill
- Bloom Clinic, Bramalea Community Health Centre, Brampton, ON, Canada
| | - S M Borgia
- William Osler Health System, Brampton Civic Hospital, Brampton, ON, Canada
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25
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Misra A, Soares MJ, Mohan V, Anoop S, Abhishek V, Vaidya R, Pradeepa R. Body fat, metabolic syndrome and hyperglycemia in South Asians. J Diabetes Complications 2018; 32:1068-1075. [PMID: 30115487 DOI: 10.1016/j.jdiacomp.2018.08.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 12/26/2022]
Abstract
The prevalence of overweight and obesity is escalating in South Asian countries. South Asians display higher total and abdominal obesity at a lower BMI when compared to Whites. Consequently, metabolic dysfunction leading to metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) will account for a majority of the health burden of these countries. In this review, we discuss those factors that contribute to MetS and T2DM in South Asians when compared to whites, focusing on adiposity. Abdominal obesity is the single-most important risk factor for MetS and its predisposition to T2DM. Excessive ectopic fat deposition in the liver (non-alcoholic fatty liver disease) has been linked to insulin resistance in Asian Indians, while the effects of ectopic fat accumulation in pancreas and skeletal muscle need more investigation. South Asians also have lower skeletal muscle mass than Whites, and this may contribute to their higher risk T2DM. Lifestyle factors contributing to MetS and T2DM in South Asians include inadequate physical activity and high intakes of refined carbohydrates and saturated fats. These are reflective of the recent but rapid economic transition and urbanization of the South Asian region. There is need to further the research into genetic determinants of dysmetabolism as well as gene x environment interactions. Collectively, MetS and T2DM have multi-factorial antecedents in South Asians and efforts to combat it through low-cost and socio-culturally appropriate lifestyle interventions need to be supported.
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Affiliation(s)
- A Misra
- Centre of Nutrition & Metabolic Research (C-NET), National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India; Diabetes Foundation (India), SDA, New Delhi, India; Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, Nehru Place, New Delhi, India.
| | - Mario J Soares
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Viswanathan Mohan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - Shajith Anoop
- Centre of Nutrition & Metabolic Research (C-NET), National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India; Diabetes Foundation (India), SDA, New Delhi, India
| | - Vishnu Abhishek
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - Ruchi Vaidya
- Genetics of Obesity and Related Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rajendra Pradeepa
- Department of Foods Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
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26
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Elahian B, Lado NE, Mankin E, Vangala S, Misra A, Moxon K, Fried I, Sharan A, Yeasin M, Staba R, Bragin A, Avoli M, Sperling MR, Engel J, Weiss SA. Low-voltage fast seizures in humans begin with increased interneuron firing. Ann Neurol 2018; 84:588-600. [PMID: 30179277 DOI: 10.1002/ana.25325] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Intracellular recordings from cells in entorhinal cortex tissue slices show that low-voltage fast (LVF) onset seizures are generated by inhibitory events. Here, we determined whether increased firing of interneurons occurs at the onset of spontaneous mesial-temporal LVF seizures recorded in patients. METHODS The seizure onset zone (SOZ) was identified using visual inspection of the intracranial electroencephalogram. We used wavelet clustering and temporal autocorrelations to characterize changes in single-unit activity during the onset of LVF seizures recorded from microelectrodes in mesial-temporal structures. Action potentials generated by principal neurons and interneurons (ie, putative excitatory and inhibitory neurons) were distinguished using waveform morphology and K-means clustering. RESULTS From a total of 200 implanted microelectrodes in 9 patients during 13 seizures, we isolated 202 single units; 140 (69.3%) of these units were located in the SOZ, and 40 (28.57%) of them were classified as inhibitory. The waveforms of both excitatory and inhibitory units remained stable during the LVF epoch (p > > 0.05). In the mesial-temporal SOZ, inhibitory interneurons increased their firing rate during LVF seizure onset (p < 0.01). Excitatory neuron firing rates peaked 10 seconds after the inhibitory neurons (p < 0.01). During LVF spread to the contralateral mesial temporal lobe, an increase in inhibitory neuron firing rate was also observed (p < 0.01). INTERPRETATION Our results suggest that seizure generation and spread during spontaneous mesial-temporal LVF onset events in humans may result from increased inhibitory neuron firing that spawns a subsequent increase in excitatory neuron firing and seizure evolution. Ann Neurol 2018;84:588-600.
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Affiliation(s)
- Bahareh Elahian
- Department of Neuroscience, Thomas Jefferson University, Philadelphia, PA.,Department of Neurology, Thomas Jefferson University, Philadelphia, PA.,Department of Electrical and Computer Engineering, University of Memphis, Memphis, TN
| | - Nathan E Lado
- Department of Neuroscience, Thomas Jefferson University, Philadelphia, PA.,Department of Neurology, Thomas Jefferson University, Philadelphia, PA
| | - Emily Mankin
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sitaram Vangala
- Department of Medicine, Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Amrit Misra
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Karen Moxon
- Department of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA
| | - Itzhak Fried
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA
| | - Mohammed Yeasin
- Department of Electrical and Computer Engineering, University of Memphis, Memphis, TN
| | - Richard Staba
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Anatol Bragin
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Massimo Avoli
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.,Department of Physiology, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | | | - Jerome Engel
- Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA.,Department of Psychiatry and Biobehavioral Sciences, Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Shennan A Weiss
- Department of Neuroscience, Thomas Jefferson University, Philadelphia, PA.,Department of Neurology, Thomas Jefferson University, Philadelphia, PA
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27
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Hinds WA, Misra A, Sperling MR, Sharan A, Tracy JI, Moxon KA. Enhanced co-registration methods to improve intracranial electrode contact localization. Neuroimage Clin 2018; 20:398-406. [PMID: 30128278 PMCID: PMC6095944 DOI: 10.1016/j.nicl.2018.07.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/20/2018] [Accepted: 07/26/2018] [Indexed: 11/26/2022]
Abstract
Background Electrode contact locations are important when planning tailored brain surgeries to identify pathological tissue targeted for resection and conversely avoid eloquent tissue. Current methods employ trained experts to use neuroimaging scans that are manually co-registered and localize contacts within ~2 mm. Yet, the state of the art is limited by either the expertise needed for each type of intracranial electrode or the inter-modality co-registration which increases error, reducing accuracy. Patients often have a variety of strips, grids and depths implanted; therefore, it is cumbersome and time-consuming to apply separate localization methods for each type of electrode, requiring expertise across different approaches. New method To overcome these limitations, a computational method was developed by separately registering an implant magnetic resonance image (MRI) and implant computed tomography image (CT) to the pre-implant MRI, then calculating an iterative closest point transformation using the contact locations extracted from the signal voids as ground truth. Results The implant MRI is robustly co-registered to the pre-implant MRI with a boundary-based registration algorithm. By extracting and utilizing ‘signal voids’ (the metal induced artifacts from the implant MRI) as electrode fiducials, the novel method is an all-in-one approach for all types of intracranial electrodes while eliminating inter-modality co-registration errors. Comparison with existing methods The distance between each electrode centroid and the brain's surface was measured, for the proposed method as well as the state of the art method using two available software packages, SPM 12 and FSL 4.1. The method presented here achieves the smallest distances to the brain's surface for all strip and grid type electrodes, i.e. contacts designed to rest directly on the brain surface. Conclusion We use one of the largest reported sample sizes in localization studies to validate this novel method for localizing different kinds of intracranial electrodes including grids, strips and depth electrodes. Co-registration between intramodal pre- and implant images allows for accurate localization of all subdural electrode types. Iterative closest point (ICP) assisted grid electrode localization is comparable to existing implant MRI based methods. ICP is a novel, semi-automated method to localize grid, strip and depth electrodes with state-of-the-art accuracy
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Affiliation(s)
- Walter A Hinds
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA
| | - Amrit Misra
- Dept. of Neurology, Partners Healthcare, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA 02114, USA
| | - Michael R Sperling
- Dept. of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ashwini Sharan
- Dept. of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Joseph I Tracy
- Cognitive Neuroscience and Brain Imaging Laboratory, Department of Neurology, Thomas Jefferson University, Jefferson Medical College, Philadelphia, PA 19107, USA
| | - Karen A Moxon
- University of California Davis, Department of Biomedical Engineering, Davis, CA 95616, USA.
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28
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Walsh S, Bhopal R, Bhardwaj S, Misra A. 5.10-P20Urbanised South Asians' susceptibility to coronary heart disease: the high-heat food preparation hypothesis. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Walsh
- Edinburgh University, United Kingdom
| | - R Bhopal
- Edinburgh University, United Kingdom
| | - S Bhardwaj
- National Diabetes, Obesity and Cholesterol Diseases Foundation, (N-DOC), SDA, India
- Diabetes Foundation (India), SDA, India
- Center of Nutrition and Metabolic Research (C-NET), India
| | - A Misra
- National Diabetes, Obesity and Cholesterol Diseases Foundation, (N-DOC), SDA, India
- Diabetes Foundation (India), SDA, India
- Center of Nutrition and Metabolic Research (C-NET), India
- Fortis C-DOC Center for Excellence for Diabetes, Metabolic Diseases and Endocrinology, India
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Patel S, Huang J, Wright K, Albihani S, Misra A, Zhou P, Jones B, Kimata J, Bollard C, Cruz R. HIV-specific T cells expressing an X5-GPI artificial receptor can suppress HIV replication in vitro—implications for a cure strategy for HIV+ individuals with hematologic malignancies. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.296] [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: 10/17/2022]
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Rai S, Bhardwaj U, Misra A, Singh S, Gupta R. Comparison between photostability of Alexa Fluor 448 and Alexa Fluor 647 with conventional dyes FITC and APC by flow cytometry. Int J Lab Hematol 2018; 40:e52-e54. [PMID: 29575796 DOI: 10.1111/ijlh.12809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- S Rai
- Department of Laboratory Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - U Bhardwaj
- Maharaj Vinayak Global University, Jaipur, Rajasthan
| | - A Misra
- Department of Laboratory Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S Singh
- Department of Laboratory Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - R Gupta
- Department of Laboratory Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Misra A, Long X, Sperling MR, Sharan AD, Moxon KA. Increased neuronal synchrony prepares mesial temporal networks for seizures of neocortical origin. Epilepsia 2018; 59:636-649. [PMID: 29442363 DOI: 10.1111/epi.14007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To gain understanding of the neuronal mechanisms underlying regional seizure spread, the impact of regional synchrony between seizure focus and downstream networks on neuronal activity during the transition to seizure in those downstream networks was assessed. METHODS Seven patients undergoing diagnostic intracranial electroencephalographic studies for surgical resection of epileptogenic regions were implanted with subdural clinical electrodes into the cortex (site of seizure initiation) and mesial temporal lobe (MTL) structures (downstream) as well as microwires into MTL. Neural activity was recorded (24/7) in parallel with the clinical intracranial electroencephalogram recordings for the duration of the patient's diagnostic stay. Changes in (1) regional synchrony (ie, coherence) between the presumptive neocortical seizure focus and MTL, (2) local synchrony between MTL neurons and their local field potential, and (3) neuronal firing rates within MTL in the time leading up to seizure were examined to study the mechanisms underlying seizure spread. RESULTS In seizures of neocortical origin, an increase in regional synchrony preceded the spread of seizures into MTL (predominantly hippocampal). Within frequencies similar to those of regional synchrony, MTL networks showed an increase in unit-field coherence and a decrease in neuronal firing rate, specifically for inhibitory interneuron populations but not pyramidal cell populations. SIGNIFICANCE These results suggest a mechanism of spreading seizures whereby the seizure focus first synchronizes local field potentials in downstream networks to the seizure activity. This change in local field coherence modifies the activity of interneuron populations in these downstream networks, which leads to the attenuation of interneuronal firing rate, effectively shutting down local interneuron populations prior to the spread of seizure. Therefore, regional synchrony may influence the failure of downstream interneurons to prevent the spread of the seizures during generalization.
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Affiliation(s)
- Amrit Misra
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Xianda Long
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ashwini D Sharan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Karen A Moxon
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA.,Department of Biomedical Engineering, University of California, Davis, Davis, CA, USA
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Misra A, de Souza L, Illner M, Hohl L, Kraume M, Repke JU, Thévenin D. Simulating separation of a multiphase liquid-liquid system in a horizontal settler by CFD. Chem Eng Sci 2017. [DOI: 10.1016/j.ces.2017.03.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The prevalence of obesity in India is increasing and ranges from 8% to 38% in rural and 13% to 50% in urban areas. Obesity is a risk factor for development of type 2 diabetes mellitus (T2DM), hypertension, dyslipidemia, coronary heart disease and many cancers. In Asian Indians excess abdominal and hepatic fat is associated with increased risk for T2DM and cardiovascular disease. There is higher risk for development of obesity related non-communicable diseases at lower body mass index levels, compared to white Caucasians. Despite being a commonly encountered medical problem, obesity poses challenges in treatment. Many Indian physicians find themselves to be lacking time and expertise to prepare an appropriate obesity management plan and patients experience continuous weight gain over time despite being under regular medical supervision. In this article, we outline approaches to obesity management in ‘real life mode’ and in context to Asian Indian patients.
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Affiliation(s)
- S Behl
- Fortis-C-DOC Hospital for Diabetes, Metabolic Diseases and Allied Specialties, New Delhi, India.
| | - A Misra
- Fortis-C-DOC Hospital for Diabetes, Metabolic Diseases and Allied Specialties, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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Patel S, Wright K, Misra A, Zhou P, Kimata J, Bollard C, Cruz R. HIV specific t cells expressing an X5–GPI artificial receptor can suppress hiv replication in vitro— implications for a cure strategy for HIV+ individuals with hematologic malignancies. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.005] [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: 10/19/2022]
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Misra A. Initiating Kangaroo Mother Care in Facilities in Limited Resource
Settings. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.260] [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: 10/19/2022] Open
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Misra A, Chopra A, Kumar R, Bakhshi S. Diagnostic considerations in juvenile myelomonocytic leukemia in tropical settings. Int J Lab Hematol 2017; 39:e77-e79. [PMID: 28263030 DOI: 10.1111/ijlh.12626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Misra
- DR BRAIRCH, Laboratory Oncology, AIIMS New Delhi, New Delhi, India
| | - A Chopra
- DR BRAIRCH, Laboratory Oncology, AIIMS New Delhi, New Delhi, India
| | - R Kumar
- DR BRAIRCH, Laboratory Oncology, AIIMS New Delhi, New Delhi, India
| | - S Bakhshi
- IRCH, Medical Oncology, AIIMS, New Delhi, India
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Pacheco AG, Salgado-Morán G, Gerli-Candia L, Ramírez-Tagle R, Glossman-Mitnik D, Misra A, de Carvalho Alcântara AF. Theoretical investigation of the molecular structure and spectroscopic properties of oxicams. J STRUCT CHEM+ 2017. [DOI: 10.1134/s0022476617020068] [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: 11/23/2022]
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Ranasinghe P, Mathangasinghe Y, Jayawardena R, Hills AP, Misra A. Prevalence and trends of metabolic syndrome among adults in the asia-pacific region: a systematic review. BMC Public Health 2017; 17:101. [PMID: 28109251 PMCID: PMC5251315 DOI: 10.1186/s12889-017-4041-1] [Citation(s) in RCA: 378] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/14/2017] [Indexed: 01/08/2023] Open
Abstract
Background The Asia-Pacific region is home to nearly half of the world’s population. The region has seen a recent rapid increase in the prevalence of obesity, type-2 diabetes and cardiovascular disease. The present systematic review summarizes the recent prevalence and trends of Metabolic Syndrome (MetS) among adults in countries of the Asia-Pacific Region. Methods Data on MetS in Asia-Pacific countries were obtained using a stepwise process by searching the online Medline database using MeSH terms ‘Metabolic Syndrome X’ and ‘Epidemiology/EP’. For the purpose of describing prevalence data for the individual countries, studies that were most recent, nationally representative or with the largest sample size were included. When evaluating secular trends in prevalence in a country we only considered studies that evaluated the temporal change in prevalence between similar populations, prospective studies based on the same population or National surveys conducted during different time periods. Results This literature search yielded a total of 757 articles, and five additional article were identified by screening of reference lists. From this total, 18 studies were eligible to be included in the final analysis. Of the 51 Asia-Pacific countries (WHO) we only located data for 15. There was wide between country variation in prevalence of MetS. A national survey from Philippines conducted in 2003 revealed the lowest reported prevalence of 11.9% according to NCEP ATP III criteria. In contrast, the highest recorded prevalence in the region (49.0%) came from a study conducted in urban Pakistan (Karachchi, 2004). Most studies reported a higher prevalence of MetS in females and urban residents. Data on secular trends were available for China, South Korea and Taiwan. An increase in the prevalence of MetS was observed in all three countries. Conclusion Despite differences in methodology, diagnostic criteria and age of subjects studied, the Asia-Pacific region is facing a significant epidemic of MetS. In most countries nearly 1/5th of the adult population or more were affected by MetS with a secular increase in prevalence. Strategies aimed at primary prevention are required to ameliorate a further increase in the epidemic and for the reduction of the morbidity and mortality associated with MetS. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4041-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Y Mathangasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - R Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - A P Hills
- School of Health Sciences, Faculty of Health, University of Tasmania, Tasmania, Australia
| | - A Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, New Delhi, India
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Shrivastava U, Misra A, Mohan V, Unnikrishnan R, Bachani D. Obesity, Diabetes and Cardiovascular Diseases in India: Public Health Challenges. Curr Diabetes Rev 2017; 13:65-80. [PMID: 27515855 DOI: 10.2174/1573399812666160805153328] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/26/2016] [Accepted: 07/25/2016] [Indexed: 11/22/2022]
Abstract
Non-communicable diseases (NCDs; including coronary heart disease and type 2 diabetes) are rapidly increasing in India causing nearly 5.8 million deaths per year. Primary reasons for rise in NCDs in India are nutrition and lifestyle transitions. Further, presence of higher body fat, abdominal fat, liver and pancreatic fat and lower lean mass than whites, contribute to heightened metabolic and cardiovascular risk in Asian Indians. Importantly, conversion from pre-diabetes to diabetes occurs more rapidly, and reversion to normal glucose regulation with appropriate lifestyle measures is more difficult in Asian Indians than white population. Huge number of patients with diabetes and with complications increase morbidity, mortality and pose substantial economic burden. It is difficult, though not impossible, to decrease pace of rapidly expanding juggernaut of NCDs in India. Only concerted efforts from multiple stakeholders, consistently sincere efforts and intensely focused attention from health officialdom and clear political will may help counter this increasingly difficult challenge. Finally, all prevention and management approaches should be cost-effective, pragmatic, and focused on children and underprivileged populations.
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Affiliation(s)
| | - A Misra
- Fortis-C-DOC Hospital for Diabetes, Metabolic Diseases and Endocrinology, B-16, Chirag Enclave, New Delhi, India
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Abstract
The vessel wall is composed of distinct cellular layers, yet communication among individual cells within and between layers results in a dynamic and versatile structure. The morphogenesis of the normal vascular wall involves a highly regulated process of cell proliferation, migration, and differentiation. The use of modern developmental biological and genetic approaches has markedly enriched our understanding of the molecular and cellular mechanisms underlying these developmental events. Additionally, the application of similar approaches to study diverse vascular diseases has resulted in paradigm-shifting insights into pathogenesis. Further investigations into the biology of vascular cells in development and disease promise to have major ramifications on therapeutic strategies to combat pathologies of the vasculature.
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Affiliation(s)
- R Mazurek
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - J M Dave
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - R R Chandran
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - A Misra
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - A Q Sheikh
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - D M Greif
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States.
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Wagner LM, De Souza L, Misra A, Janiga G, Thévenin D. CFD-Simulation der Trennung eines mehrphasigen Flüssig/Flüssig-Systems in einem Dekanter. CHEM-ING-TECH 2016. [DOI: 10.1002/cite.201650350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Alsaleem M, Saadeh L, Misra A, Madani S. Neonatal isolated ACTH deficiency (IAD): a potentially life-threatening but treatable cause of neonatal cholestasis. BMJ Case Rep 2016; 2016:bcr-2016-215032. [PMID: 27535729 PMCID: PMC5015154 DOI: 10.1136/bcr-2016-215032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Isolated ACTH deficiency (IAD) is a rare cause of neonatal cholestasis and hypoglycaemia. This diagnosis has a 20% mortality potential if unrecognised. We describe a case of an infant presenting with cholestatic jaundice and hypoglycaemia. The patient had laboratory findings suggestive of IAD, which was later confirmed with molecular genetic testing. One of the mutations this patient had is a new finding. The patient was started on glucocorticoid replacement therapy after which his bilirubin and glucose levels normalised.
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Affiliation(s)
- Mahdi Alsaleem
- Detroit Medical Center, Detroit, Michigan, USA Wayne State University, Detroit, Michigan, USA
| | - Lina Saadeh
- Detroit Medical Center, Detroit, Michigan, USA Wayne State University, Detroit, Michigan, USA
| | - Amrit Misra
- Wayne State University, Detroit, Michigan, USA
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Wallbank JR, Ghazaryan D, Misra A, Cao Y, Tu JS, Piot BA, Potemski M, Pezzini S, Wiedmann S, Zeitler U, Lane TLM, Morozov SV, Greenaway MT, Eaves L, Geim AK, Fal'ko VI, Novoselov KS, Mishchenko A. Tuning the valley and chiral quantum state of Dirac electrons in van der Waals heterostructures. Science 2016; 353:575-9. [DOI: 10.1126/science.aaf4621] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/13/2016] [Indexed: 11/02/2022]
Affiliation(s)
- J. R. Wallbank
- National Graphene Institute, University of Manchester, Manchester M13 9PL, UK
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, UK
| | - D. Ghazaryan
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, UK
| | - A. Misra
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, UK
| | - Y. Cao
- Centre for Mesoscience and Nanotechnology, University of Manchester, Manchester M13 9PL, UK
| | - J. S. Tu
- Centre for Mesoscience and Nanotechnology, University of Manchester, Manchester M13 9PL, UK
| | - B. A. Piot
- Laboratoire National des Champs Magnétiques Intenses, LNCMI-CNRS-UGA-UPS-INSA-EMFL, 25 avenue des Martyrs, 38042 Grenoble, France
| | - M. Potemski
- Laboratoire National des Champs Magnétiques Intenses, LNCMI-CNRS-UGA-UPS-INSA-EMFL, 25 avenue des Martyrs, 38042 Grenoble, France
| | - S. Pezzini
- High Field Magnet Laboratory (HFML-EMFL) and Institute of Molecules and Materials, Radboud University, Nijmegen, 6525 ED, Netherlands
| | - S. Wiedmann
- High Field Magnet Laboratory (HFML-EMFL) and Institute of Molecules and Materials, Radboud University, Nijmegen, 6525 ED, Netherlands
| | - U. Zeitler
- High Field Magnet Laboratory (HFML-EMFL) and Institute of Molecules and Materials, Radboud University, Nijmegen, 6525 ED, Netherlands
| | - T. L. M. Lane
- National Graphene Institute, University of Manchester, Manchester M13 9PL, UK
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, UK
| | - S. V. Morozov
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, UK
- Institute of Microelectronics Technology and High Purity Materials, RAS, Chernogolovka 142432, Russia
- National University of Science and Technology “MISiS”, 119049, Leninsky pr. 4, Moscow, Russia
| | - M. T. Greenaway
- School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2RD, UK
| | - L. Eaves
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, UK
- School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2RD, UK
| | - A. K. Geim
- Centre for Mesoscience and Nanotechnology, University of Manchester, Manchester M13 9PL, UK
| | - V. I. Fal'ko
- National Graphene Institute, University of Manchester, Manchester M13 9PL, UK
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, UK
| | - K. S. Novoselov
- National Graphene Institute, University of Manchester, Manchester M13 9PL, UK
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, UK
| | - A. Mishchenko
- National Graphene Institute, University of Manchester, Manchester M13 9PL, UK
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, UK
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Vdovin EE, Mishchenko A, Greenaway MT, Zhu MJ, Ghazaryan D, Misra A, Cao Y, Morozov SV, Makarovsky O, Fromhold TM, Patanè A, Slotman GJ, Katsnelson MI, Geim AK, Novoselov KS, Eaves L. Phonon-Assisted Resonant Tunneling of Electrons in Graphene-Boron Nitride Transistors. Phys Rev Lett 2016; 116:186603. [PMID: 27203338 DOI: 10.1103/physrevlett.116.186603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Indexed: 05/07/2023]
Abstract
We observe a series of sharp resonant features in the differential conductance of graphene-hexagonal boron nitride-graphene tunnel transistors over a wide range of bias voltages between 10 and 200 mV. We attribute them to electron tunneling assisted by the emission of phonons of well-defined energy. The bias voltages at which they occur are insensitive to the applied gate voltage and hence independent of the carrier densities in the graphene electrodes, so plasmonic effects can be ruled out. The phonon energies corresponding to the resonances are compared with the lattice dispersion curves of graphene-boron nitride heterostructures and are close to peaks in the single phonon density of states.
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Affiliation(s)
- E E Vdovin
- School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2RD, United Kingdom
- Institute of Microelectronics Technology and High Purity Materials, RAS, Chernogolovka 142432, Russia
- National University of Science and Technology "MISiS," 119049 Leninsky Prospect 4, Moscow, Russia
| | - A Mishchenko
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, United Kingdom
| | - M T Greenaway
- School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2RD, United Kingdom
| | - M J Zhu
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, United Kingdom
| | - D Ghazaryan
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, United Kingdom
| | - A Misra
- National Graphene Institute, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Y Cao
- Centre for Mesoscience and Nanotechnology, University of Manchester, Manchester M13 9PL, United Kingdom
| | - S V Morozov
- Institute of Microelectronics Technology and High Purity Materials, RAS, Chernogolovka 142432, Russia
- National University of Science and Technology "MISiS," 119049 Leninsky Prospect 4, Moscow, Russia
| | - O Makarovsky
- School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2RD, United Kingdom
| | - T M Fromhold
- School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2RD, United Kingdom
| | - A Patanè
- School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2RD, United Kingdom
| | - G J Slotman
- Radboud University, Institute for Molecules and Materials, Heyendaalseweg 135, 6525 AJ Nijmegen, The Netherlands
| | - M I Katsnelson
- Radboud University, Institute for Molecules and Materials, Heyendaalseweg 135, 6525 AJ Nijmegen, The Netherlands
| | - A K Geim
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, United Kingdom
- Centre for Mesoscience and Nanotechnology, University of Manchester, Manchester M13 9PL, United Kingdom
| | - K S Novoselov
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, United Kingdom
- National Graphene Institute, University of Manchester, Manchester M13 9PL, United Kingdom
| | - L Eaves
- School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2RD, United Kingdom
- School of Physics and Astronomy, University of Manchester, Manchester M13 9PL, United Kingdom
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Bala A, Rawat KS, Misra A, Srivastava A. Vegetation indices mapping for Bhiwani district of Haryana (India) through LANDSAT-7ETM+ and remote sensing techniques. ACTA ACUST UNITED AC 2015. [DOI: 10.31018/jans.v7i2.699] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study describes the VIs Vegetation Condition Index in term of vegetation health of wheat crop; with help of LANDSAT-7ETM+ data based NDVI and LAI for Bhiwani District of Haryana states (India) and gave the spatial development pattern of wheat crop in year 2005 over the study area of India. NDVI is found to vary from 0.3 to 0.8. In northern and southern parts of study area NDVI varied from 0.6 to 0.7 but in western part of Bhiwani showed NDVI 0.2 to 0.4 due to fertility of soil and well canal destitution. LAI showed variation from 1 to 6 accordingto the health of crop as the same manner of NDVI because LAI VI is NDVI dependent only change the manner of representation of vegetation health, due to this fact relation curve (r2=) between NDVI and LAI of four different growing date of sates are in successively increasing order 0.509, 0.563, 0.577 and 0.719. The study reveals that VIs can be mapped with LANDSAT-7ETM+ through remote sensing, which can be further used for many studies like crop yield or estimating evaptranspiration on regional basis for water management because satellite observations provide better spatial and temporal coverage, the VIs based system will provide efficient tools for monitoring health of crop for improvement of agricultural planning. VIs based monitoring will serve as a prototype in the other parts of the world where ground observations are limited or not available.
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Li N, Yadav SK, Liu XY, Wang J, Hoagland RG, Mara N, Misra A. Quantification of dislocation nucleation stress in TiN through high-resolution in situ indentation experiments and first principles calculations. Sci Rep 2015; 5:15813. [PMID: 26537338 PMCID: PMC4633591 DOI: 10.1038/srep15813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/09/2015] [Indexed: 11/09/2022] Open
Abstract
Through in situ indentation of TiN in a high-resolution transmission electron microscope, the nucleation of full as well as partial dislocations has been observed from {001} and {111} surfaces, respectively. The critical elastic strains associated with the nucleation of the dislocations were analyzed from the recorded atomic displacements, and the nucleation stresses corresponding to the measured critical strains were computed using density functional theory. The resolved shear stress was estimated to be 13.8 GPa for the partial dislocation 1/6 <110> {111} and 6.7 GPa for the full dislocation ½ <110> {110}. Such an approach of quantifying nucleation stresses for defects via in situ high-resolution experiment coupled with density functional theory calculation may be applied to other unit processes.
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Affiliation(s)
- N Li
- Materials Physics and Applications Division, MPA-CINT, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S K Yadav
- Materials Science and Technology Division, MST-8, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - X-Y Liu
- Materials Science and Technology Division, MST-8, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J Wang
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE 68583, USA
| | - R G Hoagland
- Materials Science and Technology Division, MST-8, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - N Mara
- Materials Physics and Applications Division, MPA-CINT, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A Misra
- Department of Materials Science and Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA
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Charnay B, Meadows V, Misra A, Leconte J, Arney G. 3D MODELING OF GJ1214b's ATMOSPHERE: FORMATION OF INHOMOGENEOUS HIGH CLOUDS AND OBSERVATIONAL IMPLICATIONS. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/2041-8205/813/1/l1] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Li N, Misra A, Shao S, Wang J. Experimental Quantification of Resolved Shear Stresses for Dislocation Motion in TiN. Nano Lett 2015; 15:4434-4439. [PMID: 26065576 DOI: 10.1021/acs.nanolett.5b00791] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Experimental quantification of the critical resolved shear stress (CRSS) at the level of unit dislocation glide is still a challenge. By using in situ nanoindentation in a high-resolution transmission electron microscope and strain analysis of the acquired structural images, the CRSS for the motion of individual dislocations on {110}⟨011⟩ slip system and glide dislocation re-emission from a tilt grain boundary in TiN are quantified. This work offers an approach to measure the local stresses associated with dislocation motion in high-strength materials.
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Affiliation(s)
| | - A Misra
- §Department of Materials Science and Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
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Misra A, Balaji R. Decadal changes in the land use/land cover and shoreline along the coastal districts of southern Gujarat, India. Environ Monit Assess 2015; 187:461. [PMID: 26108747 DOI: 10.1007/s10661-015-4684-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/09/2015] [Indexed: 06/04/2023]
Abstract
The coastal zone along the districts of Surat, Navsari, and Valsad in southern Gujarat, India, is reported to be facing serious environmental challenges in the form of shoreline erosion, wetland loss, and man-made encroachments. This study assesses the decadal land use/ land cover (LULC) changes in these three districts for the years 1990, 2001, and 2014 using satellite datasets of Landsat TM, ETM, and OLI. The LULC changes are identified by using band ratios as a pre-classification step, followed by implementation of hybrid classification (a combination of supervised and unsupervised classification). An accuracy assessment is carried out for each dataset, and the overall accuracy ranges from 90 to 95%. It is observed that the spatial extents of aquaculture, urban built-up, and barren classes have appreciated over time, whereas the coverage of mudflats has depreciated due to rapid urbanization. The changes in the shoreline of these districts have also been analyzed for the same years, and significant changes are found in the form of shoreline erosion. The LULC maps prepared as well as the shoreline change analysis done for this study area will enable the local decision makers to adopt better land-use planning and shoreline protection measures, which will further aid in sustainable future developments in this region.
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Affiliation(s)
- A Misra
- Department of Civil Engineering, Indian Institute of Technology Bombay, Mumbai, India
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Abstract
The 2-fold objectives of this study were 1) to understand whether model hydrophobic- and hydrophilic-rich phase mimics of dentin adhesive polymerize similarly and 2) to determine which factor, the dimethacrylate component, bisphenol A glycerolate dimethacrylate (BisGMA) or photoinitiator concentration, has greater influence on the polymerization of the hydrophilic-rich phase mimic. Current dentin adhesives are sensitive to moisture, as evidenced by nanoleakage in the hybrid layer and phase separation into hydrophobic- and hydrophilic-rich phases. Phase separation leads to limited availability of the cross-linkable dimethacrylate monomer and hydrophobic photoinitiators within the hydrophilic-rich phase. Model hydrophobic-rich phase was prepared as a single-phase solution by adding maximum wt% deuterium oxide (D2O) to HEMA/BisGMA neat resins containing 45 wt% 2-hydroxyethyl methacrylate (HEMA). Mimics of the hydrophilic-rich phase were prepared similarly but using HEMA/BisGMA neat resins containing 95, 99, 99.5, and 100 wt% HEMA. The hydrophilic-rich mimics were prepared with standard or reduced photoinitiator content. The photoinitiator systems were camphorquinone (CQ)/ethyl 4-(dimethylamino)benzoate (EDMAB) with or without [3-(3, 4-dimethyl-9-oxo-9H-thioxanthen-2-yloxy)-2-hydroxypropyl]trimethylammonium chloride (QTX). The polymerization kinetics was monitored using a Fourier transform infrared spectrophotometer with a time-resolved collection mode. The hydrophobic-rich phase exhibited a significantly higher polymerization rate compared with the hydrophilic-rich phase. Postpolymerization resulting in the secondary rate maxima was observed for the hydrophilic-rich mimic. The hydrophilic-rich mimics with standard photoinitiator concentration but varying cross-linker (BisGMA) content showed postpolymerization and a substantial degree of conversion. In contrast, the corresponding formulations with reduced photoinitiator concentrations exhibited lower polymerization and inhibition/delay of postpolymerization within 2 h. Under conditions relevant to the wet, oral environment, photoinitiator content plays an important role in the polymerization of the hydrophilic-rich phase mimic. Since the hydrophilic-rich phase is primarily water and monomethacrylate monomer (e.g., HEMA as determined previously), substantial polymerization is important to limit the potential toxic response from HEMA leaching into the surrounding tissues.
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Affiliation(s)
- F Abedin
- Bioengineering Research Center, University of Kansas, Lawrence, KS, USA Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA
| | - Q Ye
- Bioengineering Research Center, University of Kansas, Lawrence, KS, USA
| | - R Parthasarathy
- Bioengineering Research Center, University of Kansas, Lawrence, KS, USA
| | - A Misra
- Bioengineering Research Center, University of Kansas, Lawrence, KS, USA Department of Civil Engineering, University of Kansas, Lawrence, KS, USA
| | - P Spencer
- Bioengineering Research Center, University of Kansas, Lawrence, KS, USA Department of Mechanical Engineering, University of Kansas, Lawrence, KS, USA
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