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Burgod C, Mazlan M, Pant S, Krishnan V, Garegrat R, Montaldo P, Muraleedharan P, Bandiya P, Kamalaratnam CN, Chandramohan R, Manerkar S, Jahan I, Moni SC, Shahidullah M, Rodrigo R, Sumanasena S, Sujatha R, Sathyanathan BP, Joshi AR, Pressler RR, Bassett P, Shankaran S, Thayyil S. Duration of birth depression and neurodevelopmental outcomes after whole-body hypothermia for hypoxic ischemic encephalopathy in India, Sri Lanka and Bangladesh - an exploratory analysis of the HELIX trial. Lancet Reg Health Southeast Asia 2024; 20:100284. [PMID: 38234698 PMCID: PMC10794099 DOI: 10.1016/j.lansea.2023.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 01/19/2024]
Abstract
Background Effect of duration of birth depression on neurodevelopmental outcomes in low- and middle-income countries (LMICs) is not known. We examined the association of birth depression with brain injury, neurodevelopmental outcomes, and hypothermia after hypoxic ischemic encephalopathy (HIE) in south Asia. Methods We compared cerebral magnetic resonance (MR) at 2 weeks, and adverse outcomes (death or moderate or severe disability) at 18 months in 408 babies with moderate or severe HIE who had long birth depression (positive pressure ventilation (PPV) >10 min or Apgar score<6 at 10 min or cord pH < 7.0) and short birth depression (PPV for 5-10 min or Apgar score<6 at 5 min, but ≥6 at 10 min). Findings Long depression group (n = 201) had more severe HIE (32.8% versus 6.8%), mortality (47.5% versus 26.4%), death or disability at 18 months (62.2% versus 35.4%) (all p < 0.001), MR injury (Odds ratio; 95% CI) to basal ganglia (2.4 (1.3, 4.1); p = 0.003), posterior limb of internal capsule (2.3 (1.3, 4.3); p < 0.001) and white matter (1.7 (1.1, 2.7); p = 0.021), and lower thalamic N-acetylaspartate levels (7.69 ± 1.84 versus 8.29 ± 1.60); p = 0.031) than short depression group (n = 207). Three babies had no heartbeat at 5 min, of which 1 died and 2 survived with severe disability. No significant interaction between the duration of birth depression and whole-body hypothermia was seen for any of the MR biomarker or clinical outcomes. Interpretation Long birth depression was associated with more brain injury and adverse outcomes than short depression. Effect of hypothermia was not modified by duration of birth depression. Funding National Institute for Health Research.
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Affiliation(s)
- Constance Burgod
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
| | - Munirah Mazlan
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
| | - Stuti Pant
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
| | - Vaisakh Krishnan
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
| | - Reema Garegrat
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
| | - Paolo Montaldo
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
| | | | - Prathik Bandiya
- Neonatal Unit, Indira Gandhi Institute of Child Health, Bangalore, India
| | | | | | - Swati Manerkar
- Neonatal Unit and Radiology, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Ismat Jahan
- Neonatal Unit, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | - Sadeka C. Moni
- Neonatal Unit, Bangabandhu Sheikh Mujib Medical University, Bangladesh
| | | | | | | | - Radhika Sujatha
- Neonatal Unit, Sree Avittom Thirunal Hospital and Government Medical College, Thiruvananthapuram, India
| | | | - Anagha R. Joshi
- Neonatal Unit and Radiology, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Ronit R. Pressler
- Department of Neurophysiology, Great Ormond Street Hospital, United Kingdom
| | | | - Seetha Shankaran
- Department of Neonatal-Perinatal Medicine, Wayne State University, Detroit, MI, USA
- University of Texas at Austin, Dell Children's Hospital, Austin, USA
| | - Sudhin Thayyil
- Centre for Perinatal Neuroscience, Imperial College, London, United Kingdom
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Sundar U, Mukhopadhyay A, Raghavan S, Debata I, Menon RN, Kesavadas C, Shah N, Adsul BB, Joshi AR, Tejas J. Evaluation of 'Normal' Cognitive Functions and Correlation With MRI Volumetry: Towards a Definition of Vascular Cognitive Impairment. Cureus 2023; 15:e49461. [PMID: 38152804 PMCID: PMC10751464 DOI: 10.7759/cureus.49461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/29/2023] Open
Abstract
Introduction It is important to establish criteria to define vascular cognitive impairment (VCI) in India as VCI is an image-based diagnosis and magnetic resonance imaging (MRI) changes resulting from age with prevalent vascular risk factors may confound MRI interpretation. The objective of this study was to establish normative community data for MRI volumetry including white matter hyperintensity volume (WMHV), correlated with age-stratified cognitive scores and vascular risk factors (VRFs), in adults aged 40 years and above. Methods We screened 2651 individuals without known neurological morbidity, living in Mumbai and nearby rural areas, using validated Marathi translations of Kolkata Cognitive Battery (KCB) and geriatric depression score (GDS). We stratified 1961 persons with GDS ≤9 by age and cognitive score, and randomly selected 10% from each subgroup for MRI brain volumetry. Crude volumes were standardized to reflect percentage of intracranial volume. Results MRI volumetry studies were done in 199 individuals (F/M = 90/109; 73 with body mass index (BMI) ≥25; 44 hypertensives; 29 diabetics; mean cognitive score 76.3). Both grey and white matter volumes decreased with increasing age. WMHV increased with age and hypertension. Grey matter volume (GMV) decreased with increasing WMHV. Positive predictors of cognition included standardized hippocampal volume (HCV), urban living, education, and BMI, while WMHV and age were negative predictors. Urban dwellers had higher cognitive scores than rural, and, paradoxically, smaller HCV. Conclusion In this study of MRI volumetry correlated with age, cognitive scores and VRFs, increasing age and WMHV predicted lower cognitive scores, whereas urban living and hippocampal volume predicted higher scores. Age and WMHV also correlated with decreasing GMV. Further study is warranted into sociodemographic and biological factors that mutually influence cognition and brain volumes, including nutritional and endocrine factors, especially at lower cognitive score bands. In this study, at the lower KCB score bins, the lack of laboratory data pertaining to nutritional and endocrine deficiencies is a drawback that reflects the logistical limitations of screening large populations at the community level. Our volumetric data which is age and cognition stratified, and takes into account the vascular risk factors associated, nevertheless constitutes important baseline data for the Indian population. Our findings could possibly contribute to the formulation of baseline criteria for defining VCI in India and could help in early diagnosis and control of cognitive decline and its key risk factors.
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Affiliation(s)
- Uma Sundar
- Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
| | - Amita Mukhopadhyay
- Department of Hospital and Health Management, Institute of Health Management Research Bangalore, Bengaluru, IND
| | - Sheelakumari Raghavan
- Department of Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, IND
| | - Ipsita Debata
- Department of Community and Family Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Ramshekhar N Menon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, IND
| | - Chandrasekharan Kesavadas
- Department of Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, IND
| | - Nilesh Shah
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
| | - Balkrishna B Adsul
- Department of Community Medicine, Hinduhrudaysamrat Balasaheb Thackarey Medical College and Dr RN Cooper Municipal General Hospital, Mumbai, IND
| | - Anagha R Joshi
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
| | - Janardhan Tejas
- Department of Forensic Medicine and Toxicology, Karpaga Vinayaga Institute of Medical Sciences and Research Center, Chengalpattu, IND
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Joshi AR, Muthe MM, Gonapati S, Agarwal MR, Rai PR. Ipsilateral renal dysgenesis or agenesis with tubulocystic anomalies of the mesonephric duct. SA J Radiol 2023; 27:2700. [PMID: 37794947 PMCID: PMC10546241 DOI: 10.4102/sajr.v27i1.2700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/08/2023] [Indexed: 10/06/2023] Open
Abstract
Tubulocystic anomalies of the mesonephric duct (MND) are a rare group of related entities with a perplexing clinical presentation. Ultrasound is a useful screening investigation, which can help identify a dysplastic kidney or point to renal agenesis and identify cystic or tubulocystic changes in the structures derived from the ureteric bud or MND. Further evaluation with MRI can help in characterisation and direct management. The presence of a dysplastic kidney or absence of a kidney should prompt further evaluation for associated ureteric abnormalities such as ectopic insertion or ureterocoele, which could lead to a diagnosis of tubulocystic anomaly of the MND. Contribution The authors describe two cases, briefly outline the diagnostic approach and summarise the literature on management. Reporting radiologists should be aware of these entities.
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Affiliation(s)
- Anagha R Joshi
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Mridula M Muthe
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Sheethal Gonapati
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Mehak R Agarwal
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Pareekshith R Rai
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
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Thayyil S, Montaldo P, Krishnan V, Ivain P, Pant S, Lally PJ, Bandiya P, Benkappa N, Kamalaratnam CN, Chandramohan R, Manerkar S, Mondkar J, Jahan I, Moni SC, Shahidullah M, Rodrigo R, Sumanasena S, Sujatha R, Burgod C, Garegrat R, Mazlan M, Chettri I, Babu Peter S, Joshi AR, Swamy R, Chong K, Pressler RR, Bassett P, Shankaran S. Whole-Body Hypothermia, Cerebral Magnetic Resonance Biomarkers, and Outcomes in Neonates With Moderate or Severe Hypoxic-Ischemic Encephalopathy Born at Tertiary Care Centers vs Other Facilities: A Nested Study Within a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2312152. [PMID: 37155168 PMCID: PMC10167567 DOI: 10.1001/jamanetworkopen.2023.12152] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 05/10/2023] Open
Abstract
Importance The association between place of birth and hypothermic neuroprotection after hypoxic-ischemic encephalopathy (HIE) in low- and middle-income countries (LMICs) is unknown. Objective To ascertain the association between place of birth and the efficacy of whole-body hypothermia for protection against brain injury measured by magnetic resonance (MR) biomarkers among neonates born at a tertiary care center (inborn) or other facilities (outborn). Design, Setting, and Participants This nested cohort study within a randomized clinical trial involved neonates at 7 tertiary neonatal intensive care units in India, Sri Lanka, and Bangladesh between August 15, 2015, and February 15, 2019. A total of 408 neonates born at or after 36 weeks' gestation with moderate or severe HIE were randomized to receive whole-body hypothermia (reduction of rectal temperatures to between 33.0 °C and 34.0 °C; hypothermia group) for 72 hours or no whole-body hypothermia (rectal temperatures maintained between 36.0 °C and 37.0 °C; control group) within 6 hours of birth, with follow-up until September 27, 2020. Exposure 3T MR imaging, MR spectroscopy, and diffusion tensor imaging. Main Outcomes and Measures Thalamic N-acetyl aspartate (NAA) mmol/kg wet weight, thalamic lactate to NAA peak area ratios, brain injury scores, and white matter fractional anisotropy at 1 to 2 weeks and death or moderate or severe disability at 18 to 22 months. Results Among 408 neonates, the mean (SD) gestational age was 38.7 (1.3) weeks; 267 (65.4%) were male. A total of 123 neonates were inborn and 285 were outborn. Inborn neonates were smaller (mean [SD], 2.8 [0.5] kg vs 2.9 [0.4] kg; P = .02), more likely to have instrumental or cesarean deliveries (43.1% vs 24.7%; P = .01), and more likely to be intubated at birth (78.9% vs 29.1%; P = .001) than outborn neonates, although the rate of severe HIE was not different (23.6% vs 17.9%; P = .22). Magnetic resonance data from 267 neonates (80 inborn and 187 outborn) were analyzed. In the hypothermia vs control groups, the mean (SD) thalamic NAA levels were 8.04 (1.98) vs 8.31 (1.13) among inborn neonates (odds ratio [OR], -0.28; 95% CI, -1.62 to 1.07; P = .68) and 8.03 (1.89) vs 7.99 (1.72) among outborn neonates (OR, 0.05; 95% CI, -0.62 to 0.71; P = .89); the median (IQR) thalamic lactate to NAA peak area ratios were 0.13 (0.10-0.20) vs 0.12 (0.09-0.18) among inborn neonates (OR, 1.02; 95% CI, 0.96-1.08; P = .59) and 0.14 (0.11-0.20) vs 0.14 (0.10-0.17) among outborn neonates (OR, 1.03; 95% CI, 0.98-1.09; P = .18). There was no difference in brain injury scores or white matter fractional anisotropy between the hypothermia and control groups among inborn or outborn neonates. Whole-body hypothermia was not associated with reductions in death or disability, either among 123 inborn neonates (hypothermia vs control group: 34 neonates [58.6%] vs 34 [56.7%]; risk ratio, 1.03; 95% CI, 0.76-1.41), or 285 outborn neonates (hypothermia vs control group: 64 neonates [46.7%] vs 60 [43.2%]; risk ratio, 1.08; 95% CI, 0.83-1.41). Conclusions and Relevance In this nested cohort study, whole-body hypothermia was not associated with reductions in brain injury after HIE among neonates in South Asia, irrespective of place of birth. These findings do not support the use of whole-body hypothermia for HIE among neonates in LMICs. Trial Registration ClinicalTrials.gov Identifier: NCT02387385.
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Affiliation(s)
- Sudhin Thayyil
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Paolo Montaldo
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
- Neonatal Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vaisakh Krishnan
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Phoebe Ivain
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Stuti Pant
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Peter J Lally
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Prathik Bandiya
- Neonatal Unit, Indira Gandhi Institute of Child Health, Bengaluru, India
| | - Naveen Benkappa
- Neonatal Unit, Indira Gandhi Institute of Child Health, Bengaluru, India
| | | | | | - Swati Manerkar
- Neonatal Unit, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Jayshree Mondkar
- Neonatal Unit, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Ismat Jahan
- Neonatal Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sadeka C Moni
- Neonatal Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Ranmali Rodrigo
- Department of Pediatrics, University of Kelaniya, Kelaniya, Sri Lanka
| | | | - Radhika Sujatha
- Neonatal Unit, Sree Avittom Thirunal Hospital, Government Medical College, Thiruvananthapuram, India
| | - Constance Burgod
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Reema Garegrat
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Munirah Mazlan
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Ismita Chettri
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Anagha R Joshi
- Department of Radiology, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Ravi Swamy
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Kling Chong
- Department of Neuroradiology, Great Ormond Street Hospital, London, United Kingdom
| | - Ronit R Pressler
- Department of Neurophysiology, Great Ormond Street Hospital, London, United Kingdom
| | | | - Seetha Shankaran
- Division of Neonatal-Perinatal Medicine, Wayne State University, Detroit, Michigan
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Shah AU, Joshi AR, Rai PR, Kapse P. Hyperplastic Anterior Choroidal Artery—A Rare Variant Detected on MR Angiography. Indian J Radiol Imaging 2022; 32:266-269. [PMID: 35924131 PMCID: PMC9340196 DOI: 10.1055/s-0042-1744231] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction
The anterior choroidal artery is a branch of the terminal internal carotid artery (ICA) that is often an incidentally detected anomaly. The hyperplastic variant has been linked with an increased risk of aneurysms. We explore the role of magnetic resonance (MR) angiography in the detection of this variant and its impact of presentation of patients.
Patient Presentation
A 62-year-old diabetic and hypertensive male came to the casualty with complaints of giddiness, left-sided weakness, and loss of coordination for the last 2 to 3 days. He was provisionally diagnosed with a posterior circulation stroke.
Management and Outcome
Magnetic resonance imaging of brain revealed an acute infarct in the right thalamus and the midbrain. Time-of-flight angiography sequences were done that showed hypoplasia of the A1 segment of the left anterior cerebral artery, fetal origin of the right posterior cerebral artery, narrowing of the left ICA, and a hyperplastic left anterior choroidal artery. He was managed conservatively with antiplatelets. He later underwent a digital subtraction angiography that revealed significant narrowing of the left ICA for which he was advised carotid stenting. However, the patient was unwilling for the procedure and was discharged on oral medication with stable vitals.
Conclusion
Anatomical variations in the intracranial vasculature impact ischemia territory and the approach to intracranial pathology. Hyperplastic anterior choroidal artery results from the abnormal persistence of fetal pattern of vascular supply. It is important to recognize the presence of a hyperplastic anterior choroidal artery as it impacts both disease presentation and management of these patients. MR angiography allows for noninvasive and reliable detection of these anomalies in patients without the risks associated with radiation or contrast exposure in conventional/computed tomography angiography.
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Affiliation(s)
- Ankita U. Shah
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Anagha R. Joshi
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Pareekshith R. Rai
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Pratik Kapse
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Pillai KS, Thakre M, Asole D, Venkitachalam A, Sundar U, Sankhe AP, Joshi AR, Firke VP. Teaching Video NeuroImage: Congenital Hemidystonia–Hemi-midbrain Atrophy Syndrome. Neurology 2022; 98:860-861. [DOI: 10.1212/wnl.0000000000200513] [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] [Received: 10/05/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
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Joshi AR, Kulkarni K, Shah AU. Labrune Syndrome: A Very Rare Association of Leukoencephalopathy, Cerebral Calcifications, and Cysts. Indian J Radiol Imaging 2021; 31:772-775. [PMID: 34790336 PMCID: PMC8590554 DOI: 10.1055/s-0041-1736398] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Leukoencephalopathy, cerebral calcifications, and cysts (LCC) form a very rare association which is named as “Labrune syndrome” after Labrune who reported the first case in 1996. To the best of our knowledge only eight to 10 cases have been reported in literature to date. We report a case of a 26-year-old male with onset of neurological symptoms in late adolescence (at 19 years of age) and presented with complains of continued seizures for 7 years, giddiness with imbalance, and slowly progressive motor symptoms. MRI brain revealed multiple calcifications in bilateral basal ganglia, cerebral white matter, multiple cystic lesions in the supratentorial white matter, and abnormal diffused bilateral white matter T2 hyperintensity suggesting leukoencephalopathy. Histopathological evaluation revealed prominent congested blood vessels suggestive of angiomatous changes and cystic areas suggestive of secondary gliosis.
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Affiliation(s)
- Anagha R Joshi
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Kiran Kulkarni
- Department of Radiology, NMR Scan Centre, Hubli, Karnataka, India
| | - Ankita U Shah
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Joshi AR, Talreja AO, Rahatgaonkar MM, Badgujar HA. Imaging in a Rare Case of Unilateral External and Middle Ear Anomalies Associated with Inner Ear Malformation. Indian J Radiol Imaging 2021; 31:495-498. [PMID: 34556939 PMCID: PMC8448219 DOI: 10.1055/s-0041-1734355] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
External ear malformations are commonly associated with middle ear malformations due to their closely related embryogenesis. Inner ear anomalies are less consistently seen due to their independent development. Cross-sectional imaging has come to play a critical role in the workup of congenital deafness in the pediatric age group. To optimize speech and language development, early diagnosis and treatment are very crucial. Identification of these anomalies is additionally important when operative intervention is being planned because they may complicate or perhaps preclude the surgery.
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Affiliation(s)
- Anagha R Joshi
- Department of Radiology, Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai, Maharashtra, India
| | - Anisha O Talreja
- Department of Radiology, Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai, Maharashtra, India
| | - Mrinalini M Rahatgaonkar
- Department of Radiology, Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai, Maharashtra, India
| | - Harshal A Badgujar
- Department of Radiology, Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai, Maharashtra, India
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Thayyil S, Pant S, Montaldo P, Shukla D, Oliveira V, Ivain P, Bassett P, Swamy R, Mendoza J, Moreno-Morales M, Lally PJ, Benakappa N, Bandiya P, Shivarudhrappa I, Somanna J, Kantharajanna UB, Rajvanshi A, Krishnappa S, Joby PK, Jayaraman K, Chandramohan R, Kamalarathnam CN, Sebastian M, Tamilselvam IA, Rajendran UD, Soundrarajan R, Kumar V, Sudarsanan H, Vadakepat P, Gopalan K, Sundaram M, Seeralar A, Vinayagam P, Sajjid M, Baburaj M, Murugan KD, Sathyanathan BP, Kumaran ES, Mondkar J, Manerkar S, Joshi AR, Dewang K, Bhisikar SM, Kalamdani P, Bichkar V, Patra S, Jiwnani K, Shahidullah M, Moni SC, Jahan I, Mannan MA, Dey SK, Nahar MN, Islam MN, Shabuj KH, Rodrigo R, Sumanasena S, Abayabandara-Herath T, Chathurangika GK, Wanigasinghe J, Sujatha R, Saraswathy S, Rahul A, Radha SJ, Sarojam MK, Krishnan V, Nair MK, Devadas S, Chandriah S, Venkateswaran H, Burgod C, Chandrasekaran M, Atreja G, Muraleedharan P, Herberg JA, Kling Chong WK, Sebire NJ, Pressler R, Ramji S, Shankaran S. Hypothermia for moderate or severe neonatal encephalopathy in low-income and middle-income countries (HELIX): a randomised controlled trial in India, Sri Lanka, and Bangladesh. Lancet Glob Health 2021; 9:e1273-e1285. [PMID: 34358491 PMCID: PMC8371331 DOI: 10.1016/s2214-109x(21)00264-3] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although therapeutic hypothermia reduces death or disability after neonatal encephalopathy in high-income countries, its safety and efficacy in low-income and middle-income countries is unclear. We aimed to examine whether therapeutic hypothermia alongside optimal supportive intensive care reduces death or moderate or severe disability after neonatal encephalopathy in south Asia. METHODS We did a multicountry open-label, randomised controlled trial in seven tertiary neonatal intensive care units in India, Sri Lanka, and Bangladesh. We enrolled infants born at or after 36 weeks of gestation with moderate or severe neonatal encephalopathy and a need for continued resuscitation at 5 min of age or an Apgar score of less than 6 at 5 min of age (for babies born in a hospital), or both, or an absence of crying by 5 min of age (for babies born at home). Using a web-based randomisation system, we allocated infants into a group receiving whole body hypothermia (33·5°C) for 72 h using a servo-controlled cooling device, or to usual care (control group), within 6 h of birth. All recruiting sites had facilities for invasive ventilation, cardiovascular support, and access to 3 Tesla MRI scanners and spectroscopy. Masking of the intervention was not possible, but those involved in the magnetic resonance biomarker analysis and neurodevelopmental outcome assessments were masked to the allocation. The primary outcome was a combined endpoint of death or moderate or severe disability at 18-22 months, assessed by the Bayley Scales of Infant and Toddler Development (third edition) and a detailed neurological examination. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02387385. FINDINGS We screened 2296 infants between Aug 15, 2015, and Feb 15, 2019, of whom 576 infants were eligible for inclusion. After exclusions, we recruited 408 eligible infants and we assigned 202 to the hypothermia group and 206 to the control group. Primary outcome data were available for 195 (97%) of the 202 infants in the hypothermia group and 199 (97%) of the 206 control group infants. 98 (50%) infants in the hypothermia group and 94 (47%) infants in the control group died or had a moderate or severe disability (risk ratio 1·06; 95% CI 0·87-1·30; p=0·55). 84 infants (42%) in the hypothermia group and 63 (31%; p=0·022) infants in the control group died, of whom 72 (36%) and 49 (24%; p=0·0087) died during neonatal hospitalisation. Five serious adverse events were reported: three in the hypothermia group (one hospital readmission relating to pneumonia, one septic arthritis, and one suspected venous thrombosis), and two in the control group (one related to desaturations during MRI and other because of endotracheal tube displacement during transport for MRI). No adverse events were considered causally related to the study intervention. INTERPRETATION Therapeutic hypothermia did not reduce the combined outcome of death or disability at 18 months after neonatal encephalopathy in low-income and middle-income countries, but significantly increased death alone. Therapeutic hypothermia should not be offered as treatment for neonatal encephalopathy in low-income and middle-income countries, even when tertiary neonatal intensive care facilities are available. FUNDING National Institute for Health Research, Garfield Weston Foundation, and Bill & Melinda Gates Foundation. TRANSLATIONS For the Hindi, Malayalam, Telugu, Kannada, Singhalese, Tamil, Marathi and Bangla translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Sudhin Thayyil
- Centre for Perinatal Neuroscience, Imperial College London, London, UK.
| | - Stuti Pant
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Paolo Montaldo
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Deepika Shukla
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Vania Oliveira
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Phoebe Ivain
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | | | - Ravi Swamy
- Perinatal Epidemiology Unit, Bengaluru, Karnataka, India
| | - Josephine Mendoza
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | | | - Peter J Lally
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Naveen Benakappa
- Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Prathik Bandiya
- Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Indramma Shivarudhrappa
- Perinatal Epidemiology Unit, Bengaluru, Karnataka, India; Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India; Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Jagadish Somanna
- Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | | | - Ankur Rajvanshi
- Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Sowmya Krishnappa
- Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | | | | | | | | | - Monica Sebastian
- Perinatal Epidemiology Unit, Bengaluru, Karnataka, India; Institute of Child Health, Madras Medical College, Chennai, India
| | | | - Usha D Rajendran
- Institute of Child Health, Madras Medical College, Chennai, India
| | | | - Vignesh Kumar
- Institute of Child Health, Madras Medical College, Chennai, India
| | | | - Padmesh Vadakepat
- Institute of Child Health, Madras Medical College, Chennai, India; Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Kavitha Gopalan
- Institute of Child Health, Madras Medical College, Chennai, India
| | - Mangalabharathi Sundaram
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Arasar Seeralar
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Prakash Vinayagam
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Mohamed Sajjid
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Mythili Baburaj
- Perinatal Epidemiology Unit, Bengaluru, Karnataka, India; Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Kanchana D Murugan
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | | | | | - Jayashree Mondkar
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Swati Manerkar
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Anagha R Joshi
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Kapil Dewang
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | | | - Pavan Kalamdani
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Vrushali Bichkar
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Saikat Patra
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Kapil Jiwnani
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | | | - Sadeka C Moni
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Ismat Jahan
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Sanjoy K Dey
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Mst N Nahar
- National Institute of Neurosciences, Dhaka, Bangladesh
| | | | - Kamrul H Shabuj
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | | | | | | | | | - Radhika Sujatha
- Sree Avittom Thirunal Hospital and Government Medical College, Thiruvananthapuram, Kerala, India
| | - Sobhakumar Saraswathy
- Sree Avittom Thirunal Hospital and Government Medical College, Thiruvananthapuram, Kerala, India
| | - Aswathy Rahul
- Sree Avittom Thirunal Hospital and Government Medical College, Thiruvananthapuram, Kerala, India
| | - Saritha J Radha
- Sree Avittom Thirunal Hospital and Government Medical College, Thiruvananthapuram, Kerala, India
| | - Manoj K Sarojam
- Sree Avittom Thirunal Hospital and Government Medical College, Thiruvananthapuram, Kerala, India
| | - Vaisakh Krishnan
- Institute of Maternal and Child Health, Government Medical College, Kozhikode, Kerala, India
| | - Mohandas K Nair
- Institute of Maternal and Child Health, Government Medical College, Kozhikode, Kerala, India
| | - Sahana Devadas
- Vanivilas Hospital, Bangalore Medical College and Research Institute, Karnataka, India
| | - Savitha Chandriah
- Vanivilas Hospital, Bangalore Medical College and Research Institute, Karnataka, India
| | | | - Constance Burgod
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | | | - Gaurav Atreja
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | | | - Jethro A Herberg
- Section of Paediatric Infectious Disease, Imperial College London, London, UK
| | - W K Kling Chong
- Centre for Perinatal Neuroscience, Imperial College London, London, UK; Department of Neuroradiology, Great Ormond Street Hospital, London, UK
| | - Neil J Sebire
- Perinatal Pathology, National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital for Children, University College London, London, UK
| | - Ronit Pressler
- Department of Neurophysiology, Great Ormond Street Hospital, London, UK
| | | | - Seetha Shankaran
- Neonatal-Perinatal Medicine, Wayne State University, Detroit, MI, USA
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Joshi AR, Firke VP, Ukirde VK. Challenges for extending radiology services during COVID-19 pandemic. Indian J Radiol Imaging 2021; 31:S213-S215. [PMID: 33814788 PMCID: PMC7996685 DOI: 10.4103/ijri.ijri_749_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/21/2020] [Accepted: 01/02/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Anagha R Joshi
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India. E-mail:
| | - Vikrant P Firke
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India. E-mail:
| | - Vivek K Ukirde
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India. E-mail:
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Ramanan RV, Joshi AR, Venkataramanan A, Nambi SP, Badhe R. Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective. Indian J Radiol Imaging 2021; 31:S45-S52. [PMID: 33814761 PMCID: PMC7996682 DOI: 10.4103/ijri.ijri_479_20] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/18/2020] [Accepted: 07/06/2020] [Indexed: 12/23/2022] Open
Abstract
In December 2019, an unprecedented outbreak of pneumonia of unknown etiology emerged called COVID-19. A vast number of people affected by this disease are asymptomatic and yet contagious with up to 79% of COVID-19 infections reportedly caused by undocumented infections. Surprisingly, these asymptomatic subjects are also known to quietly harbor pneumonia changes on CT scans. RT-PCR, the definitive test for COVID-19, maybe false negative in patients with COVID-19 pneumonia on CT. Incidental findings highly suspicious of COVID-19 pneumonia on CT chest of asymptomatic patients may increase as the community transmission of the virus rises and isolation restrictions are released. It is advisable to be aware of its appearances and the challenges associated with it.
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Affiliation(s)
| | - Anagha R Joshi
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, India
| | | | - Senthur P Nambi
- Department of Infectious Diseases, Apollo Hospitals, Chennai, India
| | - Rashmi Badhe
- Department of Radiology, Global Hospitals, Mumbai, Maharashtra, India
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Dinerstein E, Joshi AR, Vynne C, Lee ATL, Pharand-Deschênes F, França M, Fernando S, Birch T, Burkart K, Asner GP, Olson D. A "Global Safety Net" to reverse biodiversity loss and stabilize Earth's climate. Sci Adv 2020; 6:6/36/eabb2824. [PMID: 32917614 PMCID: PMC7473742 DOI: 10.1126/sciadv.abb2824] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 07/22/2020] [Indexed: 05/06/2023]
Abstract
Global strategies to halt the dual crises of biodiversity loss and climate change are often formulated separately, even though they are interdependent and risk failure if pursued in isolation. The Global Safety Net maps how expanded nature conservation addresses both overarching threats. We identify 50% of the terrestrial realm that, if conserved, would reverse further biodiversity loss, prevent CO2 emissions from land conversion, and enhance natural carbon removal. This framework shows that, beyond the 15.1% land area currently protected, 35.3% of land area is needed to conserve additional sites of particular importance for biodiversity and stabilize the climate. Fifty ecoregions and 20 countries contribute disproportionately to proposed targets. Indigenous lands overlap extensively with the Global Safety Net. Conserving the Global Safety Net could support public health by reducing the potential for zoonotic diseases like COVID-19 from emerging in the future.
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Affiliation(s)
| | - A R Joshi
- University of Minnesota, Minneapolis, MN, USA
| | - C Vynne
- RESOLVE, Washington, DC, USA
| | | | | | | | | | - T Birch
- Google, Mountain View, CA, USA
| | - K Burkart
- One Earth, Rockefeller Philanthropy, Los Angeles, CA, USA
| | - G P Asner
- Arizona State University, Tempe, AZ, USA
| | - D Olson
- World Wildlife Fund, Hong Kong SAR
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Sundar U, Manwatkar AA, Joshi AR, Bhandarkar P. The Effect of Hypertension and Diabetes Mellitus on White Matter Changes in MRI Brain: A Comparative Study between Patients with Alzheimer's Disease and an Age-matched Control Group. J Assoc Physicians India 2019; 67:14-17. [PMID: 31299831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND White matter hyperintensities (WMH) on MRI brain in the periventricular and deep white matter regions are commonly seen in older persons with normal cognition and in patients with AD. AIMS To compare presence and severity of WMHs in patients with AD with that in a cognitively normal control group, and to evaluate effect of presence of Hypertension and Diabetes on WMHs in both groups. MATERIAL AND METHODS Thirty four patients with AD were serially recruited from Neurology and Psychiatry OPDs. An age and gender matched cohort of 24 persons with MMSE over 27/30 from the community acted as controls. Vascular risk factors, MMSE and MRI brain were assessed in all. Fezeka's and Pasquier grading of WMH and atrophy were done. Periventricular WMHs (PVWMH) and Deep WMH (DWMH) were assessed separately. RESULTS AND CONCLUSIONS Overall, Periventricular WMHs of grade 2 and over were seen in 19/34 patients, and in 7/24 controls (P value 0.044). Significantly higher grades of PVWMHs were seen in hypertensives as compared to nonhypertensives in the case group, and in women compared to men. In the control group, hypertension had no effect on severity of PVWMHs. Among both Diabetics and non-diabetics, no difference in PVWMHs was found between the case and control groups. DWMHs were, conversely, seen only in the control group. Overall, over a quarter of cognitively normal older persons had WM hyperintensities of grade 2 and over on MRI brain; 55% of AD patients had PVWMH of Gd 2 or over, and no DWMHs.
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Affiliation(s)
- Uma Sundar
- Professor of Medicine Department, LTM Medical College and LTMG Hospital, Mumbai, Maharashtra; Corresponding Author
| | | | - Anagha R Joshi
- Professor of Radiology Department, LTM Medical College and LTMG Hospital, Mumbai, Maharashtra
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Bhavsar PN, Padwal NJ, Bhide M, Ghagare SP, Joshi AR, Karnik ND. Life-threatening Medical Complications Due to Ovarian Hyperstimulation Syndrome: A Hidden Etiology. J Assoc Physicians India 2017; 65:87-91. [PMID: 29322719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ovarian hyperstimulation syndrome is usually an iatrogenic complication in women taking ovulation induction medications during assisted reproduction. We hereby report the case of a 25 years old female who presented with hypertension, polyserositis with tense ascites and large cystic ovaries. She developed sigmoid and transverse sinus thrombosis. She had undergone a clandestine ovulation induction therapy as a commercial ovum donor. She fitted in severe category of ovarian hyperstimulation syndrome.
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Affiliation(s)
| | | | | | | | - Anagha R Joshi
- Professor, Department of Radiology, LTM Medical College and LTMG Hospital, Mumbai, Maharashtra
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Abstract
Introduction: Female sex hormones, estrogen and progesterone regulate various phases of the menstrual cycle. Hormonal changes tend to affect various parameters of physical fitness. Maximum oxygen uptake (VO2 max) is a measure of aerobic power. This study was planned to assess effect of different phases of menstrual cycle on cardiorespiratory parameters like pulse rate, respiratory rate and VO2 max. Methods: 100 female medical students in the age group of 17-22 years were studied for three consecutive menstrual cycles. Weight, resting pulse rate, respiratory rate and VO2 max were measured during premenstrual phase (20th-25th day) and postmenstrual phase (5th to 10th day). Results: It was observed that there was a significant increase in body weight, pulse rate, and respiratory rate during premenstrual phase. There was a decrease in VO2 max during the premenstrual phase. Conclusion: This study indicates that there is decreased cardio-respiratory efficiency during premenstrual phase.
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Affiliation(s)
- Gayatri Godbole
- Department of Physiology, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India
| | - A R Joshi
- Department of Physiology, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India
| | - Savita M Vaidya
- Department of Physiology, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India
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Haridas A, Trivedi TH, Moulick ND, Joshi AR. Metronidazole-Induced Encephalopathy in Chronic Diarrhoea. J Assoc Physicians India 2015; 63:77-79. [PMID: 26710409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Metronidazole-induced encephalopathy (MIE) is a rare cause of drug-induced toxic encephalopathy. We report the clinical and neuroimaging findings of a patient with chronic diarrhoea who developed metronidazole-induced encephalopathy. After the drug was discontinued there was complete reversal of the condition.
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Upadhyaya Baskota S, Joshi AR, Singh SK. Bone marrow touch imprint smears as an adjunct to bone marrow aspiration smears in hematological disorders. J Pathol Nep 2015. [DOI: 10.3126/jpn.v5i9.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Morphological examination of the marrow requires a combination of a properly prepared bone marrow aspirate smear, a trephine biopsy section and an imprint of core biopsy. Some conditions often result in a dry tap and are best studied by marrow biopsy.The major drawbacks of biopsy sections are their thickness, precludingfine morphologic detail.The objective of this study was to compare the diagnostic accuracy, cellularity and cytomorphology from bone marrow biopsy core imprint smears with bone marrow aspiration smears.Materials and Methods: Imprint smears were prepared from 138 cases subjected to bone marrow examination. The bone marrow aspiration, imprint smears andbone marrow biopsy sections were examined and were categorized into five different groups on cytomorphological basis: Non-malignant alterations and normal marrow, Myeloid neoplasms, Plasma cell myeloma, myelo-infiltrative disease and absence of residual disease and further delineated into specific entities wherever necessary.Results: Out of 138 cases, non-malignant alterations and normal marrow was the largest subgroup (N=87, 63%), followed by myeloid neoplasms (N=26, 18.5%), Plasma cell myeloma (N=13, 9.4%), myelo-infiltrative disease (N=9, 6.5%) and absence of residual disease (N=3, 2.2%). The diagnostic accuracy of imprint smears was highest (92%) followed by biopsy sections (89.9%) and aspiration smears (87%). Kappa analysis showed strong agreement (>0.8) and p-value was statistically significant (<0.001) while correlating the final diagnosis.Conclusion: Imprint smear technique is a simple, rapid, inexpensive and reliable procedure. The routine use of imprint smear in the bone marrow examination will serve as an invaluable adjunct to bone marrow aspiration and biopsy.Journal of Pathology of Nepal (2015) Vol. 5, 739-746
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Abstract
Actinomycosis is a gram positive commensal bacteria. In predisposed individuals like immunocompromised patients, it can cause myriad lesions involving virtually any organ of the body. Involvement of spinal cord with its compression is rare though. We are reporting here a case of 30-year-old immunocompetent male who presented with weakness of left lower limb. Radiologically differential diagnosis was tuberculosis or lymphoma of spinal cord. Histopathology showed actinomycotic colonies that were periodic Schiff (PAS) positive and revealed gram positive filamentous bacteria.
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Affiliation(s)
- V R Patil
- Department of Pathology, Shrimati Kashibai Navale Medical College, Pune, Maharashtra, India
| | - A R Joshi
- Department of Pathology, Shrimati Kashibai Navale Medical College, Pune, Maharashtra, India
| | - S S Joshi
- Department of Pathology, Shrimati Kashibai Navale Medical College, Pune, Maharashtra, India
| | - D Patel
- Department of Pathology, Shrimati Kashibai Navale Medical College, Pune, Maharashtra, India
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Abstract
We report the clinical details and imaging findings of a case of transient angioedema of the small bowel following intravenous administration of non-ionic iodinated contrast material in a 17 year old female with no predisposing risk factors. Findings included long segment, symmetric, circumferential, low-density, bowel wall thickening involving the duodenum, jejunum, and most of the ileum on computed tomography scan obtained at 7 min following intravenous contrast material injection. This entity is self-limiting with a favourable clinical outcome and requires no specific treatment but only aggressive clinical monitoring.
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Affiliation(s)
- Kirankumar N Kulkarni
- Department of Radiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Rahul G Hegde
- Department of Radiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Ankit Balani
- Department of Radiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Anagha R Joshi
- Department of Radiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
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Gaopande VL, Joshi AR, Khandeparkar SGS, Dwiwedi S. Unusual finding of cellular glomeruli infiltrated with lymphocytes in end stage renal disease due to obstructive nephropathy. Indian J Nephrol 2014; 24:266-7. [PMID: 25097349 PMCID: PMC4119349 DOI: 10.4103/0971-4065.133056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V L Gaopande
- Department of Pathology, Smt. Kashibai Navale Medical College, Narhe, Ambegaon, Pune, Maharashtra, India
| | - A R Joshi
- Department of Pathology, Smt. Kashibai Navale Medical College, Narhe, Ambegaon, Pune, Maharashtra, India
| | - S G S Khandeparkar
- Department of Pathology, Smt. Kashibai Navale Medical College, Narhe, Ambegaon, Pune, Maharashtra, India
| | - S Dwiwedi
- Department of Pathology, Smt. Kashibai Navale Medical College, Narhe, Ambegaon, Pune, Maharashtra, India
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Pranita A, Balsubramaniyan B, Phadke AV, Tambe DB, Apte GM, Kharche JS, Godbole G, Joshi AR. Association of Occupational & Prediabetes Statuses with Obesity in middle aged Women. J Clin Diagn Res 2013; 7:1311-3. [PMID: 23998053 DOI: 10.7860/jcdr/2013/5466.3134] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/17/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND The association between Type 2 Diabetes Mellitus and Obesity is very close. The prediabetes status i.e Impaired Fasting Glucose (IFG) reflects an intermediate condition between normality and diabetes. The socioeconomic position (SEP) is one of the non traditional determinants of type 2 DM. The occupational status, which is a good indicator of the socioeconomic status, also indicates the level and the type of stress that they are exposed to, as well as the individual lifestyle choices. The present work was planned to study the relationship of the prediabetic status with obesity and the occupational status by estimating the Fasting Blood Glucose (FBG) levels. OBJECTIVES To study the association of the occupational status with the fasting blood glucose levels and obesity in middle aged women. METHOD The Fasting Blood Glucose levels and the BMI were estimated in 300 asymptomatic middle aged women who had no family history of Type 2 Diabetes Mellitus (D.M.), who had been divided into the Control (I), the Pre - obese (IIa) and the Obese groups (IIb). The occupational status was broadly divided into the categories of housewives and service women. The results was analysed statistically by using the correlation coefficient and the 'z' test. RESULT The mean FBG levels in the pre - obese and the obese groups were higher than those in the control group. We found significant differences in the FBG levels in the normal weight, the pre - obese as well as in the obese groups among the service women, but no significant correlation was found in the pre - obese and the obese groups. Among the housewives, we found significant differences in the FBG levels of the normal weight and the obese groups, but not in the pre - obese group. Also, no significant correlation was found in the pre - obese and obese groups among the service women. CONCLUSION The BMI may be good risk predictor for Type 2 D.M. irrespective of the occupational status, especially in middle aged women.
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Affiliation(s)
- A Pranita
- Assistant Professor, Department of Physiology, Bharati Vidyapeeth Deemed University Medical College , Dhanakawadi
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Pranita A, Phadke AV, Singh R, Joshi AR. Correlation of BMI with fasting blood glucose in perimenopausal women. Indian J Physiol Pharmacol 2011; 55:390-391. [PMID: 23362736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Sabnis GR, Gokhale YA, Kulkarni UP, Joshi AR. Young male with syncope, absent lower limb pulses, hypertension and systolic murmur. J Assoc Physicians India 2011; 59:374. [PMID: 21751592] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Girish R Sabnis
- Department of Medicine, LTM Medical College and LTMG Hospital, Sion, Mumbai-400022
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Joshi AR, Singh R, Joshi AR. Correlation of pulmonary function tests with body fat percentage in young individuals. Indian J Physiol Pharmacol 2008; 52:383-388. [PMID: 19585755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The present study was planned to assess the correlation of pulmonary functions with body fat percentage in young individuals. A total of 132 (males--68, females--64) young students (18 to 21 years) with moderately sedentary lifestyle were recruited in this study. Their height, weight, body mass index (BMI) and waist to hip ratio (WHR) were measured. Pulmonary function tests (static and dynamic) were recorded on a computerized portable Schiller lung function unit SP-1. The percentage of body fat was estimated by measuring skin fold thickness at four sites (4SFT-biceps, triceps, subscapular and suprailiac) with the help of Harpenden's caliper. In males body fat % showed negative correlation with expiratory reserve volume (ERV), forced vital capacity (FVC), maximum ventilatory volume (MVV), peak expiratory flow rate (PEFR) and forced expiratory volume at the end of first second (FEV1). It was observed that in females body fat % had negative correlation with ERV, FVC, and MVV. These results indicate that increase in percentage of body fat and central pattern of fat distribution may affect the pulmonary function tests.
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Affiliation(s)
- Anuradha R Joshi
- Department of Physiology, Bharati Vidyapeeth University Medical College, Pune.
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Bhople KS, Joshi AR, Patil SP, Nalamwar PP. Cervical thymic cyst: a case report. INDIAN J PATHOL MICR 2007; 50:585-7. [PMID: 17883146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Cervical thymic cysts are rare benign lesions. It should be considered in the differential diagnosis of cervical cysts in paediatric age group. This paper presents a case of a 6 years male child who presented with gradually increasing painless mass on right side of neck. Surgical excision was done. Histopathological study revealed features diagnostic of thymic cyst. It was clinically diagnosed as branchial cleft cyst. Though rare, thymic cysts should be included in the differential diagnosis of neck masses, especially in children.
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Affiliation(s)
- K S Bhople
- Department of Pathology, G.M.C.H., Aurangabad.
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Bhople KS, Joshi AR, Patil SP, Tembhare PR. Microcystic adenoma of pancreas: a case report. INDIAN J PATHOL MICR 2007; 50:334-6. [PMID: 17883062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Microcystic adenomas of the pancreas are rare benign neoplasms that occur most frequently in elderly females. Characteristically, the tumors have a spongy gross appearance and are composed of innumerable cysts lined by flat, and cuboidal cells which are rich in glycogen. They commonly present with abdominal discomfort or pain. In this case report, we present a cystic neoplasm of pancreas in a 65-year-old lady who clinically presented with discomfort in the abdomen and hyperglycaemia. Proximal pancreatectomy was done. Histopathological examination of surgical specimen confirmed the diagnosis of "Microcystic Adenoma ofPancreas". Despite of the rarity, microcystic adenoma should kept in the mind as the differential diagnosis of cystic lesions of pancreas.
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Affiliation(s)
- K S Bhople
- Department of Pathology, GMCH, Aurangabad.
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Joshi AR, Garg A, Vhanmane B, Merchant S, Nerurkar N. A vascular ring variant: an unusual case of vocal cord palsy due to an anomalous left carotid artery arising from a retrotracheal arch of the aorta. Br J Radiol 2006; 79:e81-3. [PMID: 16940366 DOI: 10.1259/bjr/25504514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present the case of an unusual vascular ring in a 23-year-old male patient who presented for CT examination of the chest for diagnostic work up for unilateral vocal cord palsy. Contrast-enhanced CT revealed the left common carotid artery to be arising from the ascending part of a retrotracheal arch of aorta and traversing anterior to the trachea in the retromanubrial space.
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Affiliation(s)
- A R Joshi
- Department of Radiology, Lokmanya Tilak Medical College and Municipal General Hospital, Mumbai, India
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Joshi AR. Variations in serum glucose, urea, creatinine and sodium and potassium as a consequence of delayed transport/processing of samples and delay in assays. JNMA J Nepal Med Assoc 2006; 45:186-9. [PMID: 17160095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Fifty blood samples were drawn in replicates and brought to the laboratory. One batch of the samples was processed immediately and the glucose, urea, creatinine and the electrolytes, sodium and potassium were assayed. The batch of replicate samples were processed after three hours and the assays performed. The assays for the above analytes were again performed from the replicate samples after twenty-four hours of serum-clot contact. The variations of the values of the above analytes were scrutinized. Glucose values showed significant variation with time. There was significant decrease in the glucose values after three hours and after further twenty-four hours of serum-clot contact the values reduced significantly. The variations in the values of urea and creatinine and also sodium after processing the samples after three hours and also further twenty-four of serum-clot contact were insignificant. The values of potassium after processing after three hours were insignificant but the values however increased significantly after further twenty-four hours of serum-clot contact.
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Affiliation(s)
- A R Joshi
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
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Khanna PC, Karnik ND, Jankharia BG, Merchant SA, Joshi AR, Kukreja KU. Magnetic resonance urography (MRU) versus intravenous urography (IVU) in obstructive uropathy: a prospective study of 30 cases. J Assoc Physicians India 2005; 53:527-34. [PMID: 16121807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
AIM Intravenous Urography (IVU) as a diagnostic modality has limitations in patients of obstructive uropathy with impaired renal function. Our aim was to study the technique and diagnostic accuracy of Magnetic Resonance Urography (MRU) in obstructive uropathy and to correlate the findings with IVU. METHODOLOGY Forty-eight patients, selected over a six-month period, based on mild to severe pelvicalyceal dilatation on screening ultrasonography, underwent an IVU; those having non-obstructive dilatation were excluded (18 patients). Thirty patients (age range 10 to 75 years) with definite obstructive dilatation underwent MRU. These were obtained using an open MRI unit (Siemens Magnetom Open Viva) with low-dose gadolinium-DTPA (0.01 mmol/kg body weight) using various MRI sequences. MRU studies were classified as 'excellent' or 'diagnostic' and data generated was compared with that of IVU. RESULTS MRU studies were 'excellent' in twelve and 'diagnostic' in eighteen patients. Of the sixty pelvicalyceal systems (PCS) evaluated in thirty patients, there were thirty-seven calculi, nine pelvi-ureteric junction (PUJ) obstructions, six with impaired renal function, four malrotated kidneys and one each of horseshoe kidney, pancake kidney, pelvic mass (endometriomas), duplex moieties, ureterocele and vesico-ureteric reflux. MRU better depicted moderate-severe PCS dilatation, staghorn and urethral calculi, impaired renal function, extrinsic ureteric and PUJ obstruction. IVU better depicted small calculi and mild PCS dilatation. CONCLUSIONS In these thirty patients of obstructive uropathy, low magnetic field, open MRI units and low-dose Gd-DTPA provided cost-effective MRU studies with excellent diagnostic utility. MRU scored over IVU in patients with moderate-severe dilatation, staghorn and urethral calculi, impaired renal function, extrinsic ureteric and PUJ obstruction.
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Affiliation(s)
- P C Khanna
- Department of Radiology, LTMG Hospital, Sion, Mumbai 400 022
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Goray VB, Joshi AR, Garg A, Merchant S, Yadav B, Maheshwari P. Aortic arch variation: a unique case with anomalous origin of both vertebral arteries as additional branches of the aortic arch distal to left subclavian artery. AJNR Am J Neuroradiol 2005; 26:93-5. [PMID: 15661708 PMCID: PMC7975054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
We present the case of bilateral anomalous origin of both vertebral arteries (VAs) in a 20-year-old male patient who presented for routine contrast-enhanced CT follow-up examination of the chest. Contrast-enhanced CT revealed abnormal origins of both the VAs from the aortic arch distal to the origin of the left subclavian artery. Following this, CT angiography was performed, which confirmed the findings. To our knowledge, this is the first report of anomalous origins of both VAs beyond the origin of the left subclavian artery. The possible embryonic mechanism and the clinical importance of this variant is also reviewed.
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Affiliation(s)
- Vaishali B Goray
- Department of Radiology, Lokmanya Tilak Medical College and Municipal General Hospital, Mumbai, India
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Gore MA, Joshi AR, Nagarajan G, Iyer SP, Kulkarni T, Khandelwal A. Virtual bronchoscopy for diagnosis of inhalation injury in burnt patients. Burns 2004; 30:165-8. [PMID: 15019127 DOI: 10.1016/j.burns.2003.09.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2003] [Indexed: 11/16/2022]
Abstract
Virtual bronchoscopy using a multislice CT scanner, is a new non-invasive imaging technique and its utility in the diagnosis of inhalation injury in burnt patients has not been reported in literature yet. Initial experience of technique is encouraging and it merits more interest. It overcomes many of the limitations of the presently established procedure of fibreoptic bronchoscopy. Ten burned patients with clinical suspicion of inhalation injury underwent this investigation and in eight of these the diagnosis was confirmed.
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Affiliation(s)
- Madhuri A Gore
- Department of General Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai 400022, India.
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Joshi AR, Khanna PC, Merchant SA, Khandelwal A, Agrawal N, Karnik ND. Role of multidetector CT virtual bronchoscopy in the evaluation of post-tracheostomy tracheal stenosis--a preliminary study. J Assoc Physicians India 2003; 51:871-6. [PMID: 14710971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
AIM To study the technique and utility of virtual bronchoscopy (virtual reality endobronchial simulation, VRES) as a tool to evaluate post-tracheostomy tracheal stenoses and to correlate the findings of virtual and invasive bronchoscopy and to follow-up treated lesions or those currently under treatment that were initially diagnosed with VRES. METHODOLOGY This prospective study comprised nine patients in the age group 13 to 65 years presenting with breathlessness and stridor following one or multiple tracheostomies. They underwent plain CT using a multidetector CT (MDCT) scanner (Siemens Volume Zoom) using narrow (1 mm) collimation. These thin slice images were post-processed using an Irix-based workstation with a 'Fly-Through' endoscopy application. These patients also underwent a rigid (three patients) or fiberoptic (six patients) bronchoscopy. RESULTS Of the nine patients that underwent VRES, five were found to have stenoses, three had obstructing granulation tissue, one had an obstructing membrane and one had synechiae. The invasive bronchoscopic findings supported the VRES diagnosis in all but one case of stenosis, one of granulation tissue and the case with synechiae. Membranes and synechiae were relatively difficult to diagnose without the corresponding axial and multiplanar images. VRES achieved a higher sensitivity, while invasive bronchoscopy a higher specificity. CONCLUSIONS VRES proved to be comparable to invasive bronchoscopy in the depiction of post-tracheostomy tracheal stenoses, with a notable advantage in critical stenoses in that the airway distal to the stenosis could be assessed with VRES but not with invasive bronchoscopy. A preliminary VRES was found to be of assistance in the selection of patients for the more invasive therapeutic procedures such as laser ablation of granulation tissue and its follow-up.
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Affiliation(s)
- Anagha R Joshi
- Department of Radiology, LTMG Hospital, Sion, Mumbai 400 022
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Abstract
A 14 month old child with intractable painless otorrhoea resistant to conventional treatment with sadden onset facial palsy was referred to us for HRCT of temporal bone. A rare diagnosis of tuberculous mastoiditis was made which was confirmed by histopathological reports. In this case the use of a Multislice CT scanner (Siemens Volume Zoom) in demonstrating the intricate involvement of the middle and inner ear structures by the disease is accentuated.
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Affiliation(s)
- A R Joshi
- Radiology Department of Lokmanya Tilak Municipal General Hospital & Medical College, Mumbai
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Abstract
A field survey was conducted in the villages of Ramdi, Malunga, Balam, Beltari, Mirmi, Burgha and Ridi in the Kali Gandaki watershed, Nepal; 48 medicinal plants belonging to 31 families were reported, each with local names, traditional uses, methods of preparation and route of administration. Traditional medicine remains an integral part of the health system in these areas. Local people have remarkable knowledge of species identity and their uses as crude drugs.
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Affiliation(s)
- A R Joshi
- South Asia Cooperative Environment Programme, 10 Anderson Road, 5, Colombo, Sri Lanka.
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Abstract
OBJECTIVE To retrospectively analyze our experience using nasal turbinate and hard palate mucosal grafts as shared buttress grafts between the upper and lower eyelid for reconstruction in severe cicatricial entropion. SURGICAL TECHNIQUES A horizontal tarsectomy is performed in the upper and lower eyelid approximately 2 mm posterior to the gray line. The distal tarsal segments are then dissected and rotated 180 degrees. A graft of nasal turbinate mucosa or hard palate mucosa measuring 1.5 x 3 cm is harvested. The graft is sutured to the cut edge of tarsus in the upper and lower eyelid. The rotated distal tarsal segment is stabilized against the graft using 5 mattress sutures. After 3 weeks, the graft is split by sharp dissection between the upper and lower eyelids. METHODS The medical records of 12 consecutive patients, representing 15 shared buttress grafts, were reviewed. There were 5 hard palate and 10 nasal turbinate mucosal grafts placed. Follow-up ranged from 2 months to 7 years. RESULTS The amount of corneal stipple, as well as subjective patient comfort, improved after eyelid margin reconstruction in 12 of the 15 eyes. One patient's visual acuity improved by more than 2 lines after surgery. There were no cases of failure of graft survival and no complications directly related to the shared graft technique. Recurrent entropion and trichiasis were noted in 3 eyelids more than a year after graft placement, reflecting ongoing cicatrization in these eyelids. Hard palate mucosal grafts were irritating to the corneal surface, requiring removal of the epithelium using a diamond burr and bandage contact lens wear. Nasal turbinate mucosal grafts were better tolerated by the corneal surface and had the added benefit of mucous production. CONCLUSIONS Eyelid reconstruction using nasal turbinate and hard palate mucosal tissues as a shared buttress graft is a viable treatment option for patients with severe cicatricial entropion. Resolution of trichiasis and mechanical corneal abrasion was noted in 13 (86%) of 15 patients with no specific complications related to the technique. The shared buttress technique successfully autostents the healing eyelid margins, makes good use of the large turbinate mucosal graft, and minimizes trips to the operating room. When the mechanical requirements of eyelid margin reconstruction do not require the sturdiness of hard palate mucosa, nasal turbinate mucosa is a preferable graft tissue because it is better tolerated by the corneal surface and produces mucous.
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Affiliation(s)
- R A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, School of Medicine, USA
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Speno HS, Luthi-Carter R, Macias WL, Valentine SL, Joshi AR, Coyle JT. Site-directed mutagenesis of predicted active site residues in glutamate carboxypeptidase II. Mol Pharmacol 1999; 55:179-85. [PMID: 9882712 DOI: 10.1124/mol.55.1.179] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Glutamate carboxypeptidase II (GCP II) catalyzes the extracellular hydrolysis of the neuromodulator N-acetyl-aspartylglutamate to N-acetyl-aspartate and glutamate. GCP II also hydrolyzes gamma-glutamyl bonds in folylpolyglutamate. The predicted amino acid sequence of GCP II displays similarities to aminopeptidases from Streptomyces griseus and Vibrio proteolyticus, whose crystal structures have been determined. These aminopeptidases are cocatalytic zinc metallopeptidases belonging to the peptidase family M28. Specific zinc and substrate ligands have been proposed in GCP II based on the amino acid sequence alignment to these M28 family members. In the present study, site-directed mutagenesis has been used to test the assignment of these putative ligands in human GCP II. Substitutions to the five putative zinc ligands resulted in severely reduced enzyme activity, although mutant protein was expressed as demonstrated by immunoblot analysis. In addition, substitutions of amino acids near the putative zinc ligands have identified other specific residues important for enzyme structure and/or function. Substitutions to putative substrate ligands were less perturbing, and increases in Km were observed for substitutions that introduced a large charge perturbation (e.g., Lys to Glu). The results from substitutions at the proposed zinc and substrate ligands are consistent with the assignment of these residues and suggest that GCP II has a three-dimensional structure similar to other members of the peptidase family M28.
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Affiliation(s)
- H S Speno
- Laboratory of Molecular and Developmental Neuroscience, Massachusetts General Hospital-East, Charlestown, Massachusetts, USA
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Affiliation(s)
- P T Joshi
- Division of Child and Adolescent Psychiatry, John Hopkins Medical Institutions, Baltimore, MD 21287-3325, USA
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Joshi AR, Mullen L, Small KW. The retina: genetic studies of several retinopathies located on the short arm of chromosome 17. Curr Opin Neurol 1997; 10:31-5. [PMID: 9099524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The short arm of chromosome 17 has emerged as a hot spot where several phenotypically distinct retinal disorders have been mapped in the past year. An autosomal dominant retinitis pigmentosa, Leber's congenital amaurosis, autosomal dominant cone degeneration, central areolar choroidal dystrophy and Sjogren-Larsson syndrome were all recently mapped to chromosome 17p. These disorders, their genetic linkage, possible candidate genes and the possibility that several of these disorders may share candidate genes are discussed.
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Affiliation(s)
- A R Joshi
- Jules Stein Eye Institute, UCLA School of Medicine 90095, USA
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Joshi AR. The optimism of modern medicine. Med Health R I 1996; 79:415-6. [PMID: 8993053] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Joshi AR, Sinha S, Sulaiman IM, Banerji AK, Hasnain SE. Alterations in brain tumor DNA detected by a fingerprinting probe. Indian J Biochem Biophys 1996; 33:455-7. [PMID: 9219429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We used a novel DNA fingerprinting probe O-chi-1 (ref. 1) to detect differences in the hybridization pattern of brain tumor DNA and paired normal tissue of a given individual. Representatives of meningiomas (two), glioblastoma multeforme (three) and astrocytoma (one) were studied. Alterations, which included amplification as well as the loss of a normal band in tumor DNA, were observed in four of the six tumours. While the increased intensity of a band can be taken to imply increased copy number, the disappearance of bands could either be due to loss of DNA sequence or rearrangement resulting in different sized bands.
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Affiliation(s)
- A R Joshi
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
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Joshi AR, Ahamed RN, Pathan KM, Manivannan B. Effect of Azadirachta indica leaves on testis and its recovery in albino rats. Indian J Exp Biol 1996; 34:1091-4. [PMID: 9055629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Histological and biochemical changes in the testis of rats treated with the leaf powder of A. indica are reported. The pattern of recovery is also studied at 8, 16 and 24 day after withdrawal of the treatment. In the treated rats, a general reduction in the diameters of seminiferous tubule, nuclei of the germinal elements and a mass atrophy of the spermatogenic elements has been observed. The Leydig cells are found to be atrophic. Biochemically, a decrease in the protein content and the activity of acid phosphatase and an increase in the total free sugar, glycogen, cholesterol contents and the activities of alkaline phosphatase and lactate dehydrogenase have been observed. A gradual recovery is observed in both the histological and biochemical parameters after 8.16 and 24 day of cessation of the treatment. The result suggest a possible reversible antiandrogenic property of the leaves of A. indica in male albino rats.
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Affiliation(s)
- A R Joshi
- Department of Zoology, Karnatak University, Dharwad, India
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LeVine RA, Dexter E, Velasco P, LeVine S, Joshi AR, Stuebing KW, Tapia-Uribe FM. Maternal literacy and health care in three countries: a preliminary report. Health Transit Rev 1994; 4:186-91. [PMID: 10150517] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- R A LeVine
- Harvard Graduate School of Education, Cambridge MA, USA
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Joshi AR. Maternal schooling and child health: preliminary analysis of the intervening mechanisms in rural Nepal. Health Transit Rev 1994; 4:1-28. [PMID: 10147162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This article provides evidence from a community-level study in rural Nepal of the mechanisms by which schooling affects maternal behaviour and infant and child health. Two hypotheses concerning the mechanisms are identified and tested. It was found that schooling equips women with specific skills and dispositions or identity which significantly predict two principal domains of health-care behaviour: use of medical services; and changes in household health behaviour. It was also found that women with schooling had healthier children using height-for-age as an indicator of health.
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Affiliation(s)
- A R Joshi
- The World Bank, Washington, DC 20433
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Joshi AR, Daga SR, Daga AS. Perinatal audit through Wigglesworth's classification. Indian Pediatr 1988; 25:525-9. [PMID: 3235190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Sekar V, Atmar VJ, Joshi AR, Krim M, Kuehn GD. Inhibition of ornithine decarboxylase in human fibroblast cells by type I and type II interferons. Biochem Biophys Res Commun 1983; 114:950-4. [PMID: 6412711 DOI: 10.1016/0006-291x(83)90652-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Dilution of human fibroblast GM2767 cell cultures into fresh serum-containing growth medium induces ornithine decarboxylase activity 45-fold over a six-hour interval. When the fibroblast cultures are supplemented with human fibroblast alpha-, beta-, or gamma-interferon at the time of dilution into fresh growth medium, the induction of ornithine decarboxylase is inhibited 61%, 90%, and 65%, respectively. beta-Interferon is the most effective type of interferon to inhibit induction of ornithine decarboxylase.
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Joshi AR, Sarkar FH, Gupta SL. Interferon receptors. Cross-linking of human leukocyte interferon alpha-2 to its receptor on human cells. J Biol Chem 1982; 257:13884-7. [PMID: 6292213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Joshi AR, Sarkar FH, Gupta SL. Interferon receptors. Cross-linking of human leukocyte interferon alpha-2 to its receptor on human cells. J Biol Chem 1982. [DOI: 10.1016/s0021-9258(19)45311-8] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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