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Haregu T, Chen Q, Arafat SMY, Cherian A, Armstrong G. Prevalence, correlates and common methods of non-suicidal self-injury in South Asia: a systematic review. BMJ Open 2023; 13:e074776. [PMID: 37993150 PMCID: PMC10668266 DOI: 10.1136/bmjopen-2023-074776] [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] [Received: 04/18/2023] [Accepted: 10/27/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION The dynamics of self-harm vary substantially around the world, yet it is severely under-researched outside of a small number of high-income 'Western' countries. South Asia is disproportionately impacted by suicide, yet we know less about non-suicidal self-injury (NSSI) in the region. OBJECTIVE To review and summarise evidence on the prevalence, correlates and common methods of NSSI in South Asia. METHODS We searched Medline, Embase and PsycINFO for the period 1 January 2000 to 31 August 2023, for peer-reviewed observational studies. A total of 11 studies from eight South Asian countries that reported prevalence and/or correlates of NSSI were included in this review. We assessed the quality of the studies using the Study Quality Assessment Tools for Observational Cohort and Cross-Sectional Studies. We used meta-regression to describe the sources of heterogeneity. Abstracted data were summarised using thematic synthesis. RESULTS For non-clinical populations, the 12-month prevalence of NSSI ranged from 3.2% to 44.8%, and the lifetime prevalence ranged from 21% to 33%. For clinical populations, the 12-month prevalence of NSSI ranged from 5% to 16.4%, while the lifetime prevalence ranged from 2% to 27%. Male sex, unemployment, financial stress, history of suicidal behaviour and depression were associated with a higher risk of NSSI. Better access to counselling services, higher self-esteem and self-knowledge were associated with a lower risk of NSSI. CONCLUSION The burden of NSSI in South Asia appears to be high in both clinical and non-clinical populations. Further research, especially with general population samples, is needed to build evidence on the epidemiology, context and meaning of NSSI in South Asia to inform the design of context-specific interventions. PROSPERO REGISTRATION NUMBER CRD42022342536.
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Affiliation(s)
- Tilahun Haregu
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Quan Chen
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - S M Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Savar, Bangladesh
| | - Anish Cherian
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Gregory Armstrong
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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2
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Sen S, Thomas SS, Cherian A, Abraham D, Hepzhibah J, John R, Therese M, Reka K, Paul MJ. Thyroglossal Duct Cyst Carcinoma: Lessons from a 20-Case Series. Indian J Surg Oncol 2023; 14:609-618. [PMID: 37900628 PMCID: PMC10611691 DOI: 10.1007/s13193-023-01720-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Aims and Objectives Thyroglossal duct cyst (TDC) is a common congenital cyst with an incidence of about 7%. Thyroglossal duct cyst carcinoma (TDCC) is a rare sequel which arises from TDC and has an incidence of about 1%. As these are rare, they do not have well-defined management guidelines. The aim of this study was to analyse the clinical profile and pathological characteristics of patients with thyroglossal duct cyst carcinoma and to propose a protocol for their treatment and follow-up. Materials and Methods A retrospective study was done from January 2000 to December 2019. All the clinical details, imaging characteristics, treatment and histopathology were analysed. Results The mean age group in our study was 37.9 years with a female preponderance. The clinical features like rapid increase in size, fixity of the lump and lymph node metastasis were not very common. Seventy-five percent of our patients who underwent imaging had suspicious characteristics. Fifty-six percent of our patients had FNAC suggestive of TDCC. Fifty percent of our patients had concomitant thyroid carcinoma. None of our patients had distant metastasis at follow-up. Conclusions TDCC is rare and a disease of young adulthood and usually has good prognosis. It may be a clinical surprise or a small lesion which can be detected with ultrasound and targeted FNAC. There is high rate of concomitant thyroid carcinoma and hence needs careful assessment. Sistrunk's procedure with total thyroidectomy either staged or simultaneously has good outcome and permits adjuvant treatment.
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Affiliation(s)
- Supriya Sen
- Department of Endocrine Surgery, CMC Hospital Vellore, Vellore, 632004 Tamil Nadu India
| | - Shawn Sam Thomas
- Department of Endocrine Surgery, CMC Hospital Vellore, Vellore, 632004 Tamil Nadu India
| | - Anish Cherian
- Department of Endocrine Surgery, CMC Hospital Vellore, Vellore, 632004 Tamil Nadu India
| | - Deepak Abraham
- Department of Endocrine Surgery, CMC Hospital Vellore, Vellore, 632004 Tamil Nadu India
| | - Julie Hepzhibah
- Department of Nuclear Medicine, CMC Hospital Vellore, Vellore, 632004 Tamil Nadu India
| | - Reetu John
- Department of Radiology, CMC Hospital Vellore, Vellore, 632004 Tamil Nadu India
| | - Marie Therese
- Department of Pathology, CMC Hospital Vellore, Vellore, 632004 Tamil Nadu India
| | - K. Reka
- Department of Biostatistics, CMC Hospital Vellore, Vellore, 632004 Tamil Nadu India
| | - M. J. Paul
- Department of Endocrine Surgery, CMC Hospital Vellore, Vellore, 632004 Tamil Nadu India
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Henderson C, Ouali U, Bakolis I, Berbeche N, Bhattarai K, Brohan E, Cherian A, Girma E, Gronholm PC, Gurung D, Hanlon C, Kallakuri S, Kaur A, Ketema B, Lempp H, Li J, Loganathan S, Maulik PK, Mendon G, Mulatu T, Ma N, Romeo R, Venkatesh RK, Zgueb Y, Zhang W, Thornicroft G. Training for mental health professionals in responding to experienced and anticipated mental health-related discrimination (READ-MH): protocol for an international multisite feasibility study. Pilot Feasibility Stud 2022; 8:257. [PMID: 36514144 PMCID: PMC9745687 DOI: 10.1186/s40814-022-01208-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mental health and other health professionals working in mental health care may contribute to the experiences of stigma and discrimination among mental health service users but can also help reduce the impact of stigma on service users. However, few studies of interventions to equip such professionals to be anti-stigma agents took place in high-income countries. This study assesses the feasibility, potential effectiveness and costs of Responding to Experienced and Anticipated Discrimination training for health professionals working in mental health care (READ-MH) across low- and middle-income countries (LMICs). METHODS This is an uncontrolled pre-post mixed methods feasibility study of READ-MH training at seven sites across five LMICs (China, Ethiopia, India, Nepal and Tunisia). OUTCOME MEASURES knowledge based on course content, attitudes to working to address the impact of stigma on service users and skills in responding constructively to service users' reports of discrimination. The training draws upon the evidence bases for stigma reduction, health advocacy and medical education and is tailored to sites through situational analyses. Its content, delivery methods and intensity were agreed upon through a consensus exercise with site research teams. READ-MH will be delivered to health professionals working in mental health care immediately after baseline data collection; outcome measures will be collected post-training and 3 months post-baseline, followed by qualitative data collection analysed using a combined deductive and inductive approach. Fidelity will be rated during the delivery of READ-MH, and data on training costs will be collected. Quantitative data will be assessed using generalised linear mixed models. Qualitative data will be evaluated by thematic analysis to identify feedback about the training methods and content, including the implementability of the knowledge and skills learned. Pooled and site-specific training costs per trainee and per session will be reported. CONCLUSIONS The training development used a participatory and contextualised approach. Evaluation design strengths include the diversity of settings, the use of mixed methods, the use of a skills-based measure and the knowledge and attitude measures aligned to the target population and training. Limitations are the uncertain generalisability of skills performance to routine care and the impact of COVID-19 restrictions at several sites limiting qualitative data collection for situational analyses.
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Affiliation(s)
- Claire Henderson
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park Box, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
| | - Uta Ouali
- Department Psychiatry A, Razi University Hospital, Cité des Orangers, 2010, La Manouba, Tunisia
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nada Berbeche
- Department of Psychology, Laboratory of Clinical Psychology: Intersubjectivity and Culture, University of Tunis, Tunis, Tunisia
| | | | - Elaine Brohan
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Anish Cherian
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Petra C Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park Box, London, SE5 8AF, UK
| | - Dristy Gurung
- Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sudha Kallakuri
- George Institute for Global Health, 308 Elegance Tower, New Delhi, 110025, India
| | - Amanpreet Kaur
- George Institute for Global Health, 308 Elegance Tower, New Delhi, 110025, India
| | - Bezawit Ketema
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, Weston Education Centre, 10, Cutcombe Rd, London, SE5 9RJ, UK
| | - Jie Li
- The Affiliated Brain Hospital of Guangzhou Medical University, No. 36 Mingxin Road, Liwan District, Guangzhou, 510370, China
| | - Santosh Loganathan
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Pallab K Maulik
- George Institute for Global Health, 308 Elegance Tower, New Delhi, 110025, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Gurucharan Mendon
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Tesfahun Mulatu
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ning Ma
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University, No 51, Huayuanbei Road, Haidian District, Beijing, 100191, China
| | - Renee Romeo
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park Box, London, SE5 8AF, UK
| | | | - Yosra Zgueb
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Wufang Zhang
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University, No 51, Huayuanbei Road, Haidian District, Beijing, 100191, China
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park Box, London, SE5 8AF, UK
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4
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Krishnamurthy S, Meena KS, Chaturvedi SK, Kapanee ARM, Krishnamurthy L, Cherian A. Media reporting of suicide in the bengaluru E-edition of three major indian dailies: An archival study. Indian J Public Health 2022; 66:348-351. [PMID: 36149120 DOI: 10.4103/ijph.ijph_372_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
India has the world's largest newspaper market, with over 100 million copies sold daily. The media scapegoat, simplify, speculate, and sensationalize suicide-related news instead of signposting people to seek help. Suicide affects individuals, families, and communities and is worthy of responsible reporting. This study examined the quality of newspaper coverage of suicides from January to December 2017 in three popular English dailies in Bengaluru, South India. Three hundred and ninety-five online suicide reports were evaluated for compliance with the 2017 WHO recommendations for responsible suicide reporting by media professionals. The secondary data were obtained from digital newspaper archives and analyzed. A handful of the sampled articles met key recommendations. While reporting on suicide in the Indian media, three critical areas that require the most attention are reducing sensationalism, providing help-seeking information, and educating the public on suicide prevention without perpetuating myths.
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Affiliation(s)
| | - Kolar S Meena
- Additional Professor and Head, NIMHANS, Bengaluru, Karnataka, India
| | | | - Aruna Rose Mary Kapanee
- Additional Professor, Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
| | - Latha Krishnamurthy
- Assistant Professor, Department of Mental Health Education, NIMHANS, Bengaluru, Karnataka, India
| | - Anish Cherian
- Associate Professor, Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
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5
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Henderson C, Ouali U, Bakolis I, Berbeche N, Bhattarai K, Brohan E, Cherian A, Girma E, Gronholm PC, Gurung D, Hanlon C, Kallakuri S, Kaur A, Ketema B, Lempp H, Li J, Loganathan S, Maulik PK, Mendon G, Mulatu T, Ma N, Romeo R, Venkatesh RK, Zgueb Y, Zhang W, Thornicroft G. Training for mental health professionals in responding to experienced and anticipated mental health related discrimination (READ-MH): protocol for an international multisite feasibility study. Res Sq 2022:rs.3.rs-1466318. [PMID: 35378758 PMCID: PMC8978942 DOI: 10.21203/rs.3.rs-1466318/v1] [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] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Mental health and other health professionals working in mental health care may contribute to the experiences of stigma and discrimination among mental health service users, but can also help reduce the impact of stigma on service users. However the few studies of interventions to equip such professionals to be anti-stigma agents those took place in High-Income Countries. This study assesses the feasibility, potential effectiveness and costs of Responding to Experienced and Anticipated Discrimination training for health professionals working in mental health care (READ-MH) across Low- and Middle-Income Countries (LMICs). Methods: This is an uncontrolled pre-post mixed methods feasibility study of READ-MH training at seven sites across five LMICs (China, Ethiopia, India, Nepal, and Tunisia). Outcome measures: knowledge based on course content; attitudes to working to address the impact of stigma on service users; and skills in responding constructively to service users' reports of discrimination. The training draws upon the evidence bases for stigma reduction, health advocacy and medical education and is tailored to sites through situational analyses. Its content, delivery methods and intensity were agreed through a consensus exercise with site research teams. READ-MH will be delivered to health professionals working in mental health care immediately after baseline data collection; outcome measures will be collected post-training and three months post-baseline, followed by qualitative data collection. Fidelity will be rated during delivery of READ-MH, and data on training costs will be collected. Quantitative data will be assessed using generalised linear mixed models. Qualitative data will be evaluated by thematic analysis to identify feedback about the training methods and content, including the implementability of the knowledge and skills learned. Pooled and site-specific training costs per trainee and per session will be reported. Conclusions: The training development used a participatory and contextualized approach. Evaluation design strengths include the diversity of settings; the use of mixed methods; the use of a skills-based measure; and knowledge and attitude measures aligned to the target population and training. Limitations are the uncertain generalisability of skills performance to routine care, and the impact of COVID-19 restrictions at several sites limiting qualitative data collection for situational analyses.
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Affiliation(s)
- Claire Henderson
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | | | - Ioannis Bakolis
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | | | | | - Elaine Brohan
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | - Anish Cherian
- NIMHANS: National Institute of Mental Health and Neuro Sciences
| | | | - Petra C Gronholm
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | - Dristy Gurung
- TPO Nepal: Transcultural Psychosocial Organization Nepal
| | - Charlotte Hanlon
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | | | | | | | | | - Jie Li
- Affiliated Brain Hospital of Guangzhou Medical University: Guangzhou Huiai Hospital
| | | | | | | | - Tesfahun Mulatu
- Addis Ababa University Department of Community Health: Addis Ababa University School of Public Health
| | - Ning Ma
- Peking University Institute of Mental Health: Peking University Sixth Hospital
| | - Renee Romeo
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | | | | | - Wufang Zhang
- Peking University Institute of Mental Health: Peking University Sixth Hospital
| | - Graham Thornicroft
- King’s College London Institute of Psychiatry Psychology and Neuroscience
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Armstrong G, Vijayakumar L, Cherian A, Krishnaswamy K, Pathare S. Indian media professionals' perspectives regarding the role of media in suicide prevention and receptiveness to media guidelines: a qualitative study. BMJ Open 2021; 11:e047166. [PMID: 34011600 PMCID: PMC8137173 DOI: 10.1136/bmjopen-2020-047166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Crime reports of suicide incidents routinely feature in the Indian mass media, with minimal coverage of suicide as a broader public health issue. To supplement our recently published content analysis study, we undertook qualitative interviews to examine media professionals' perspectives and experiences in relation to media reporting of suicide-related news in India. DESIGN AND SETTING In 2017-2018, we undertook semistructured qualitative interviews with media professionals with experience reporting on suicide-related news. A semistructured interview guide was designed to initiate discussions around their perspectives and experiences in relation to reporting on suicide. Interviews were digitally audio-recorded and transcribed, and a deductive and inductive approach to thematic analysis was used. PARTICIPANTS Twenty-eight interviews were undertaken with media professionals in Delhi, Chandigarh and Chennai. RESULTS A clear role for media in suicide prevention framed around educating and informing the public was articulated by several participants and a majority of participants also reported concerns and anecdotal accounts that their reporting may negatively influence vulnerable people in the population. Nonetheless, a fatalistic attitude towards suicide was evident among several participants including dismissing or minimising concerns around imitation suicides. Several participants also expressed doubts around the quality of suicide helplines in India and were hesitant to add such contact details to their reports. Participants were largely very receptive to the idea of developing voluntary media guidelines for the Indian context, although doubts were raised around compliance unless additional initiatives were taken to engage media professionals at the highest levels. CONCLUSIONS Our findings reveal the perspectives of media professionals operating in the Indian context and can be used to support constructive partnerships between media professionals and suicide prevention experts. There is a clear need for a genuine and sustained partnership between suicide prevention experts and media professionals at all levels.
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Affiliation(s)
- Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Lakshmi Vijayakumar
- Department of Psychiatry, Voluntary Heath Services, Chennai, Tamil Nadu, India
- SNEHA Suicide Prevention Centre, Chennai, Tamil Nadu, India
| | - Anish Cherian
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | | | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, Maharashtra, India
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7
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Shetty S, Cherian KE, Shetty S, Kapoor N, Jebasingh FK, Cherian A, Hephzibah J, Chandramohan A, John RA, Asha HS, Paul MJ, Manipadam MT, Abraham DT, Thomas N, Paul TV. Does Baseline PTH Influence Recovery of Bone Mineral Density, Trabecular Bone Score and Bone Turnover Markers? A Prospective Study Following Curative PArathyroidectomy in Primary Hyperparathyroidism. Endocr Pract 2021; 26:1442-1450. [PMID: 33471736 DOI: 10.4158/ep-2020-0148] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/15/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This prospective study was carried out to assess trabecular bone score, bone mineral density (BMD), and bone biochemistry in Indian subjects with symptomatic primary hyperparathyroidism (PHPT), and to study the influence of baseline parathyroid hormone (PTH) on recovery of these parameters following curative surgery. METHODS This was a 2-year prospective study conducted at a tertiary care centre in southern India. Baseline assessment included demographic details, mode of presentation, bone mineral biochemistry, BMD, trabecular bone score (TBS), and bone turnover markers (BTMs). These parameters were reassessed at the end of the first and second years following curative parathyroid surgery. RESULTS Fifty-one subjects (32 men and 19 women) with PHPT who had undergone curative parathyroidectomy were included in this study. The mean (SD) age was 44.6 (13.7) years. The TBS, BTMs, and BMD at lumbar spine and forearm were significantly worse at baseline in subjects with higher baseline PTH (≥250 pg/mL) when compared to the group with lower baseline PTH (<250 pg/mL). At the end of 2 years, the difference between high versus low PTH groups (mean ± SD) persisted only for forearm BMD (0.638±0.093 versus 0.698±0.041 g/cm2; P =.01). However, on follow-up visits in the first and second year after curative parathyroidectomy, there was no significant difference in BTMs, BMD at the femoral neck, lumbar spine, and TBS between the 2 groups stratified by baseline PTH. CONCLUSION The BMD at the forearm remained significantly worse in individuals with high baseline PTH even at 2 years after surgery, while other parameters including TBS improved significantly from baseline. ABBREVIATIONS 25(OH)D = 25-hydroxyvitamin D; BMD = bone mineral density; BMI = body mass index; BTMs = Bone turnover markers; CTX = C-terminal telopeptide of type 1 collagen; DXA = dual energy X-ray absorptiometry; P1NP = N-terminal propeptide of type 1 procollagen; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone; TBS = trabecular bone score.
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8
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Simpson HB, van den Heuvel OA, Miguel EC, Reddy YCJ, Stein DJ, Lewis-Fernández R, Shavitt RG, Lochner C, Pouwels PJW, Narayanawamy JC, Venkatasubramanian G, Hezel DM, Vriend C, Batistuzzo MC, Hoexter MQ, de Joode NT, Costa DL, de Mathis MA, Sheshachala K, Narayan M, van Balkom AJLM, Batelaan NM, Venkataram S, Cherian A, Marincowitz C, Pannekoek N, Stovezky YR, Mare K, Liu F, Otaduy MCG, Pastorello B, Rao R, Katechis M, Van Meter P, Wall M. Toward identifying reproducible brain signatures of obsessive-compulsive profiles: rationale and methods for a new global initiative. BMC Psychiatry 2020; 20:68. [PMID: 32059696 PMCID: PMC7023814 DOI: 10.1186/s12888-020-2439-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/10/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 2-3% and is a leading cause of global disability. Brain circuit abnormalities in individuals with OCD have been identified, but important knowledge gaps remain. The goal of the new global initiative described in this paper is to identify robust and reproducible brain signatures of measurable behaviors and clinical symptoms that are common in individuals with OCD. A global approach was chosen to accelerate discovery, to increase rigor and transparency, and to ensure generalizability of results. METHODS We will study 250 medication-free adults with OCD, 100 unaffected adult siblings of individuals with OCD, and 250 healthy control subjects at five expert research sites across five countries (Brazil, India, Netherlands, South Africa, and the U.S.). All participants will receive clinical evaluation, neurocognitive assessment, and magnetic resonance imaging (MRI). The imaging will examine multiple brain circuits hypothesized to underlie OCD behaviors, focusing on morphometry (T1-weighted MRI), structural connectivity (Diffusion Tensor Imaging), and functional connectivity (resting-state fMRI). In addition to analyzing each imaging modality separately, we will also use multi-modal fusion with machine learning statistical methods in an attempt to derive imaging signatures that distinguish individuals with OCD from unaffected siblings and healthy controls (Aim #1). Then we will examine how these imaging signatures link to behavioral performance on neurocognitive tasks that probe these same circuits as well as to clinical profiles (Aim #2). Finally, we will explore how specific environmental features (childhood trauma, socioeconomic status, and religiosity) moderate these brain-behavior associations. DISCUSSION Using harmonized methods for data collection and analysis, we will conduct the largest neurocognitive and multimodal-imaging study in medication-free subjects with OCD to date. By recruiting a large, ethno-culturally diverse sample, we will test whether there are robust biosignatures of core OCD features that transcend countries and cultures. If so, future studies can use these brain signatures to reveal trans-diagnostic disease dimensions, chart when these signatures arise during development, and identify treatments that target these circuit abnormalities directly. The long-term goal of this research is to change not only how we conceptualize OCD but also how we diagnose and treat it.
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Affiliation(s)
- Helen Blair Simpson
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Odile A. van den Heuvel
- grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands ,grid.12380.380000 0004 1754 9227Department of Anatomy and Neuroscience, Amsterdam UMC, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Euripedes C. Miguel
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Y. C. Janardhan Reddy
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Dan J. Stein
- grid.7836.a0000 0004 1937 1151SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Roberto Lewis-Fernández
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Roseli Gedanke Shavitt
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Christine Lochner
- grid.11956.3a0000 0001 2214 904XSAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Petra J. W. Pouwels
- grid.12380.380000 0004 1754 9227Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Janardhanan C. Narayanawamy
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Ganesan Venkatasubramanian
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Dianne M. Hezel
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Chris Vriend
- grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands ,grid.12380.380000 0004 1754 9227Department of Anatomy and Neuroscience, Amsterdam UMC, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Marcelo C. Batistuzzo
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Marcelo Q. Hoexter
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Niels T. de Joode
- grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands ,grid.12380.380000 0004 1754 9227Department of Anatomy and Neuroscience, Amsterdam UMC, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Daniel Lucas Costa
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Maria Alice de Mathis
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Karthik Sheshachala
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Madhuri Narayan
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Anton J. L. M. van Balkom
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest, Specialised Mental Health Care, Amsterdam, The Netherlands
| | - Neeltje M. Batelaan
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest, Specialised Mental Health Care, Amsterdam, The Netherlands
| | - Shivakumar Venkataram
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Anish Cherian
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Clara Marincowitz
- grid.11956.3a0000 0001 2214 904XSAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Nienke Pannekoek
- grid.11956.3a0000 0001 2214 904XSAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Yael R. Stovezky
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Karen Mare
- grid.7836.a0000 0004 1937 1151SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Feng Liu
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Maria Concepcion Garcia Otaduy
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Bruno Pastorello
- grid.11899.380000 0004 1937 0722Institute of Radiology, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Rashmi Rao
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Martha Katechis
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Page Van Meter
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Melanie Wall
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
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9
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Abstract
INTRODUCTION Urinary tract anomalies in children at times pose challenges in which immediate urinary diversion is required before definitive reconstruction. Open cutaneous ureterostomy technique is a well-established approach for this scenario. We describe the laparoscopy-assisted alternative. MATERIAL AND METHODS Transperitoneal laparoscopy is performed with three ports. One trans-umbilical 5mm port for vision and two 3mm working instruments, one of which is through the proposed ureterostomy site minimising scarring. The position of the third port is carefully checked both externally and internally. Laparoscopic identification of the dilated ureter is quick and easy. The redundant ureter is mobilised and excess excised if needed. The ureteric loop is then exteriorised and the ureterostomy fashioned externally. Proximal and distal patency is checked both externally and laparoscopically. RESULTS Nineteen patients underwent the procedure for primary VUR (n=6), neuropathic bladder 7, posterior urethral valve 4, and vesico-ureteric obstruction 2. The mean operative time was 40 minutes. the patients received three doses of perioperative antibiotics and were discharged in 72 hours (mean). At three months, clinical and ultrasound review have shown satisfactory and stable upper tracts and no episodes of UTI. DISCUSSION The laparoscopic view gives the benefit of direct visualisation and identification with adequate dissection in order to bring the ureter to the surface in a tensionless manner. A redundant ureter can be easily addressed to correct tortuosity or redundancy appropriately. Bladder drainage can be ensured with careful dissection of the distal ureter and inspection at the end of the procedure. CONCLUSION Laparoscopy-Assisted ureterostomy formation is easy and quick to perform. It is feasible even in the smallest of babies, assures the shortest segment of ureter to the bladder providing prompt drainage in a refluxing ureterostomy setting. Our early experience is promising with potential benefits.
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Affiliation(s)
- M Asimakidou
- Dept of Paediatric Urology, Great Ormond Street Hospital for Children, UK
| | - G De Win
- Dept of Urology, Antwerp University Hospital, Antwerp, Belgium
| | - A Cherian
- Dept of Paediatric Urology, Great Ormond Street Hospital for Children, UK.
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10
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Papageorgiou E, Cherian A. Laparoscopic posterior appendix Mitrofanoff using the modified Shanfield anastomosis. J Pediatr Urol 2019; 15:419-420. [PMID: 30940431 DOI: 10.1016/j.jpurol.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/07/2018] [Revised: 01/08/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
Laparoscopic transperitoneal technique for appendicovesicostomy was performed in a 5-year-old boy with a non-neurogenic neuropathic bladder using a transumbilical 5-mm port, two 3-mm working ports and a modified Shanfield anastomosis. Posterior extramucosal detrusorotomy and submucosal dissection was performed. The proximal appendix was spatulated and advanced into the bladder through a mucosal window using a U-stitch and fixed. The detrusor was then approximated creating an antirefluxing extramucosal tunnel. VQ plasty was fashioned for stoma formation. The procedure and postoperative period were uneventful. Clean intermittent catheterisation (CIC) was established subsequently and continued for the last 6 months. Our experience shows that appendix Mitrofanoff can be performed with minimal number and size of ports, resulting in a good cosmetic outcome. A simplified anastomosis makes it less cumbersome, and catheterisation is reliable as there is no mucosa-mucosa junction to negotiate.
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Affiliation(s)
- E Papageorgiou
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Cherian
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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11
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Armstrong G, Vijayakumar L, Pirkis J, Jayaseelan M, Cherian A, Soerensen JB, Arya V, Niederkrotenthaler T. Mass media representation of suicide in a high suicide state in India: an epidemiological comparison with suicide deaths in the population. BMJ Open 2019; 9:e030836. [PMID: 31324688 PMCID: PMC6661630 DOI: 10.1136/bmjopen-2019-030836] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Suicide rates in India are among the highest in the world, equating to over 200 000 suicides annually. Reports of suicides are a routine feature in major newspapers in India, and reporters may selectively present 'newsworthy' suicide stories. The aim of this paper was to systematically investigate whether mass media reports of suicides reflect the epidemiological data on suicide in a high suicide state in India. DESIGN We undertook a content analysis study to extract sociodemographic data on suicides reported among nine of the most highly read daily newspapers in the high suicide southern state of Tamil Nadu between June and December 2016. A total of 1258 newspaper articles were retrieved containing reports on 1631 suicides. Two-tailed binomial tests on aggregate frequencies assessed whether the sociodemographic characteristics of suicides in the newspaper articles were different to the population suicide statistics for Tamil Nadu. RESULTS We identified some statistically significant discrepancies between suicide characteristics in the population and the media. Suicides involving females (p<0.001), those aged under 30 years (p<0.001), separated or widowed males (p<0.001), unmarried females (p<0.001), those using methods with a higher case fatality rate (ie, hanging (p<0.001), jumping off high structures (p<0.001) and coming under vehicles (p<0.001) and those who were students (p<0.001) or working in the agricultural sector (p<0.001) were significantly over-reported relative to their occurrence in the broader population. Suicides involving men (p<0.001), those aged over 30 years and above (p<0.001), those who were married and suicides by poisoning (p<0.001) were significantly under-reported relative to their occurrence in the broader population. CONCLUSIONS The suicide characteristics in the print media were not entirely representative of suicides in the broader Tamil Nadu population, which may lead the general public to develop misunderstandings about suicide in their state. The discrepancies we identified will inform tailored suicide prevention education for media professionals.
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Affiliation(s)
- Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lakshmi Vijayakumar
- Department of Psychiatry, Voluntary Health Services Hospital, Chennai, Tamil Nadu, India
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population Health, University of Melbourne, Melbourne, Australia
| | - Mala Jayaseelan
- Department of Psychiatry, Voluntary Health Services Hospital, Chennai, Tamil Nadu, India
| | - Anish Cherian
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | | | - Vikas Arya
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
| | - Thomas Niederkrotenthaler
- Center for Public Health, Department of General Practice and Family Medicine, Medical University of Vienna, Vienna, Austria
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12
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Cherian A. Response to letter to the editor regarding 'Externalised stenting in laparoscopic pyeloplasty: The K-wire technique'. J Pediatr Urol 2019; 15:232. [PMID: 30962009 DOI: 10.1016/j.jpurol.2019.01.016] [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: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Affiliation(s)
- A Cherian
- Great Ormond Street Hospital NHS Foundation Trust London, London, UK.
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13
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Affiliation(s)
- S Ramanathan
- Department of Radiology, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Radiology, Weil Cornell Medical College, Doha, Qatar
| | - E Soaly
- Department of Cardiology, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - A Cherian
- Department of Cardiology, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - M A Heidous
- Department of Radiology, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
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14
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Lasso Betancor CE, Cherian A, Smeulders N, Mushtaq I, Cuckow P. Mid- to long-term outcomes of the 'anatomical approach' to congenital megaprepuce repair. J Pediatr Urol 2019; 15:243.e1-243.e6. [PMID: 30878211 DOI: 10.1016/j.jpurol.2019.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/28/2018] [Revised: 01/12/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The understanding of the aetiopathogenesis and the long-term outcomes of correctional repair of congenital megaprepuce (CMP) remains unestablished. Different techniques have been described; however, optimum results have been difficult to achieve. OBJECTIVE The aim of our study was to review our experience of the 'anatomical approach' to the correction of CMP. MATERIAL AND METHODS This is a retrospective review of boys who underwent CMP repair between 2003 and 2014. All of them had the anatomical approach: A curved incision is made between the scrotal and penile skin. Circumferential dissection superficial to Buck's fascia frees the penis and allows the scrotum to assume a more caudal position. The dissection distally lifts the preputial sac that is opened ventrally. The redundant inner preputial skin is excised. After full degloving, the dorsal flap of skin is thinned. The base of the flap is anchored, and the rectangle of skin is wrapped around the shaft. The remaining diamond-shaped incision is closed in a vertical line. Postoperatively, foam dressings and urethral catheter are left in place. Symptomatology, hospital stay, postoperative complications, redosurgery, voiding and cosmesis were evaluated. RESULTS Sixty-one patients had surgery at 5-151 months (median 17 months). Median hospital stay was 24 h (12-168 h). Foam dressings and urethral catheter were used in 47 boys and removed in outpatient clinic after 3-7 days. There were two immediate postoperative complications requiring surgery. One due to severe oedema and constriction ring, and the other had wound infection with wound breakdown, both in patients with no dressings (P < 0.05). Follow-up was available for 58 patients, with a median of 22 months (3-79 months). Two required redosurgery (3.5%), one with poor cosmetic result and one recurrence. In all patients, a normal circumcised appearance had been achieved and in 47, cosmetic result was excellent (81%). Five patients have residual suprapubic fat, and four, excess ventral skin. One with residual suprapubic fat has reached puberty and it has resolved. All declared good stream. The same technique was used for six patients with poor cosmetic result after surgery elsewhere. The outcome is excellent for all, with median follow-up of 20.5 months (5-31 months). CONCLUSION The 'anatomical' repair provides the ability to create the appearance of a standard circumcision, which is generally accepted as normality. Apart from the penis itself, this technique facilitates correction of the penoscrotal transposition, giving the external genitalia the best appearance. It seems to provide good functional and cosmetic outcomes, and it holds true at mid- to long-term follow-up. Dressings and catheter can potentially prevent postoperative complications. However, a prospective study with standardised parameters is required to confirm these findings.
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Affiliation(s)
- C E Lasso Betancor
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, United Kingdom
| | - A Cherian
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, United Kingdom.
| | - N Smeulders
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, United Kingdom
| | - I Mushtaq
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, United Kingdom
| | - P Cuckow
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, United Kingdom
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15
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Iyengar NM, Siegel B, Malik M, Giri DD, Tsai J, Hughes M, Adam A, Williams S, Zhou XK, Rodgers W, Ginter P, Patel A, Yong F, Cherian A, August P, Dannenberg AJ. Abstract P5-07-05: Obesity, adipose inflammation, and race in patients with early stage breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-07-05] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Elevated body mass index (BMI) is associated with increased risk of estrogen receptor-positive postmenopausal breast cancer. Mechanistically, most individuals with elevated BMI have breast white adipose tissue inflammation (WATi) which confers increased breast cancer risk, particularly in those with existing benign breast disease. Individuals with WATi have elevated in-breast expression of aromatase and several systemic changes that increase breast cancer risk, including hyperinsulinemia and higher levels of C-reactive protein. However, women with normal BMI but high levels of body fat are also likely to harbor WATi and are at increased risk of postmenopausal breast cancer. The accuracy of BMI for assessing adiposity and predicting obesity-related disorders, including cancer, varies across race and ethnicity. Whether the association between BMI and WATi varies by race is unknown. Here we aimed to characterize relationships among breast WATi and clinicopathologic features in a racially diverse cohort undergoing mastectomy for breast cancer treatment.
Methods: Non-tumorous breast tissue and fasting blood were collected from women undergoing mastectomy for breast cancer treatment or prevention at a single center serving a racially diverse patient population. Breast WATi was detected by the presence of crown-like structures in the breast (CLS-B), which are composed of a dead/dying adipocyte surrounded by CD68+ macrophages. Clinicopathologic data were abstracted from electronic medical records. Associations among categorical variables were examined using Fisher's exact test. Relationships between continuous variables were examined using the Spearman correlation.
Results: As of May 18, 2018 62 patients have been accrued; median age 55 (range 32 to 84). Self-reported race distribution was: 36 (58%) Asian, 5 African American (8%), 20 (32%) Caucasian, and 1 (2%) unknown. Breast tissue has been analyzed for WATi in 60 cases thus far. Clinicopathologic features stratified by the presence or absence of breast WATi are presented in. Breast WAT inflammation was associated with obesity (P=0.02) and a trend to association was observed with dyslipidemia (P<0.09).
VariableBreast WATi Absent (n=25)Breast WATi Present (n=35)Age, years Median (range)51 (32 to 71)59 (36 to 80)BMI, kg/m2 Median (range)22.5 (18.1 to 35.3)28.0 (19.2 to 38.9)BMI Category Underweight1 (4%)0 (0%)Normal16 (64%)10 (29%)Overweight5 (20%)18 (51%)Obese3 (12%)7 (20%)Race, n (%) Asian15 (60%)19 (54%)African American2 (8%)3 (9%)Caucasian8 (32%)12 (34%)Unknown0 (0%)1 (3%)Menopausal Status, n (%) Pre10 (40%)12 (34%)Post15 (60%)23 (66%)Hypertension, n (%)7 (28%)16 (46%)Diabetes mellitus, n (%)0 (0%)5 (14%)Dyslipidemia, n (%)1 (4%)11 (31%)
Conclusions: Breast adipose inflammation is associated with elevated BMI and possibly metabolic syndrome disorders in a racially diverse population. These findings are consistent with observations from predominantly Caucasian cohorts. Race-specific characteristics will also be examined. Study accrual is ongoing and updated results will be presented.
Citation Format: Iyengar NM, Siegel B, Malik M, Giri DD, Tsai J, Hughes M, Adam A, Williams S, Zhou XK, Rodgers W, Ginter P, Patel A, Yong F, Cherian A, August P, Dannenberg AJ. Obesity, adipose inflammation, and race in patients with early stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-07-05.
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Affiliation(s)
- NM Iyengar
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - B Siegel
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - M Malik
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - DD Giri
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - J Tsai
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - M Hughes
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - A Adam
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - S Williams
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - XK Zhou
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - W Rodgers
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - P Ginter
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - A Patel
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - F Yong
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - A Cherian
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - P August
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
| | - AJ Dannenberg
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital Queens, New York, NY; Weill Cornell Medicine, New York, NY
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17
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Abstract
The majority of surgeons leave internal stents following laparoscopic pyeloplasty, which necessitates a second anaesthetic for removal. A novel technique of placing external nephro-ureteric stents, thus obviating a second procedure for retrieval, is shown in this video bank. As demonstrated in the video, a Kirschner wire (K-wire) is used to thread the stent in place. Although, there are few reports of using externalised stents in laparoscopic pyeloplasty, it is believed that this technique has not been previously described. So far this technique has been used in 22 patients without any stent-related complications. The technique is feasible, safe and reproducible. It obviates the need for a further anaesthetic and avoids potential risks of another procedure. Secondary benefits include avoiding another hospital admission.
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Affiliation(s)
- A Upasani
- Department of Paediatric Urology, Great Ormond Street Hospital, London, UK
| | - A Paul
- Department of Paediatric Urology, Great Ormond Street Hospital, London, UK
| | - A Cherian
- Department of Paediatric Urology, Great Ormond Street Hospital, London, UK.
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18
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Abstract
Extra-renal calyces are a rare anomaly of the renal collecting system, characterised by the presence of calyces and pelvis outside the renal parenchyma. It may also be associated with other anomalies, such as renal ectopia, fusion and malrotation. We describe an unusual case of extra-renal calyces with six long calyces arising from a suspected multicystic dysplastic kidney that was successfully managed laparoscopically.
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Affiliation(s)
- S Rajendran
- Urology, Great Ormond Street Hospital , London UK
| | - A Cho
- Urology, Great Ormond Street Hospital , London UK
| | - P Mishra
- Urology, Great Ormond Street Hospital , London UK
| | - A Cherian
- Urology, Great Ormond Street Hospital , London UK
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19
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Silay MS, Spinoit AF, Undre S, Fiala V, Tandogdu Z, Garmanova T, Guttilla A, Sancaktutar AA, Haid B, Waldert M, Goyal A, Serefoglu EC, Baldassarre E, Manzoni G, Radford A, Subramaniam R, Cherian A, Hoebeke P, Jacobs M, Rocco B, Yuriy R, Zattoni F, Kocvara R, Koh CJ. Global minimally invasive pyeloplasty study in children: Results from the Pediatric Urology Expert Group of the European Association of Urology Young Academic Urologists working party. J Pediatr Urol 2016; 12:229.e1-7. [PMID: 27346071 DOI: 10.1016/j.jpurol.2016.04.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 01/05/2016] [Accepted: 04/24/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Minimally invasive pyeloplasty (MIP) for ureteropelvic junction (UPJ) obstruction in children has gained popularity over the past decade as an alternative to open surgery. The present study aimed to identify the factors affecting complication rates of MIP in children, and to compare the outcomes of laparoscopic (LP) and robotic-assisted laparoscopic pyeloplasty (RALP). MATERIALS AND METHODS The perioperative data of 783 pediatric patients (<18 years old) from 15 academic centers who underwent either LP or RALP with an Anderson Hynes dismembered pyeloplasty technique were retrospectively evaluated. Redo cases and patients with anatomic renal abnormalities were excluded. Demographics and operative data, including procedural factors, were collected. Complications were classified according to the Satava and modified Clavien systems. Failure was defined as any of the following: obstructive parameters on diuretic renal scintigraphy, decline in renal function, progressive hydronephrosis, or symptom relapse. Univariate and multivariate analysis were applied to identify factors affecting the complication rates. All parameters were compared between LP and RALP. RESULTS A total of 575 children met the inclusion criteria. Laparoscopy, increased operative time, prolonged hospital stay, ureteral stenting technique, and time required for stenting were factors influencing complication rates on univariate analysis. None of those factors remained significant on multivariate analysis. Mean follow-up was 12.8 ± 9.8 months for RALP and 45.2 ± 33.8 months for LP (P = 0.001). Hospital stay and time for stenting were shorter for robotic pyeloplasty (P < 0.05 for both). Success rates were similar between RALP and LP (99.5% vs 97.3%, P = 0.11). The intraoperative complication rate was comparable between RALP and LP (3.8% vs 7.4%, P = 0.06). However, the postoperative complication rate was significantly higher in the LP group (3.2% for RALP and 7.7% for LP, P = 0.02). All complications were of no greater severity than Satava Grade IIa and Clavien Grade IIIb. DISCUSSION This was the largest multicenter series of LP and RALP in the pediatric population. Limitations of the study included the retrospective design and lack of surgical experience as a confounder. CONCLUSIONS Both minimally invasive approaches that were studied were safe and highly effective in treating UPJ obstruction in children in many centers globally. However, shorter hospitalization time and lower postoperative complication rates with RALP were noted. The aims of the study were met.
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Affiliation(s)
- M S Silay
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey; Department of Urology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - S Undre
- Department of Pediatric Urology, Great Ormond Street Hospital, London, UK
| | - V Fiala
- Department of Urology, General Teaching Hospital in Prague and Charles University, 1st Faculty of Medicine, Prague, Czech Republic
| | - Z Tandogdu
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - T Garmanova
- Department of Urology, Institute of Moscow, Moscow, Russia
| | - A Guttilla
- Department of Urology, University of Padua, Padua, Italy
| | | | - B Haid
- Department of Pediatric Urology, Sisters of the Charity Hospital, Linz, Austria
| | - M Waldert
- Department of Urology, University of Vienna, Vienna, Austria
| | - A Goyal
- Department of Pediatric Urology, University of Manchester, Manchester, UK
| | - E C Serefoglu
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - E Baldassarre
- Department of Urology, Umberto Parini Hospital, Aosta, Italy
| | - G Manzoni
- Department of Urology, Policlinico, Milan, Italy
| | - A Radford
- Department of Pediatric Urology, Leeds Children's Hospital, Leeds, UK
| | - R Subramaniam
- Department of Pediatric Urology, Leeds Children's Hospital, Leeds, UK
| | - A Cherian
- Department of Pediatric Urology, Great Ormond Street Hospital, London, UK
| | - P Hoebeke
- Department of Urology, General Teaching Hospital in Prague and Charles University, 1st Faculty of Medicine, Prague, Czech Republic
| | - M Jacobs
- Department of Pediatric Urology, Children's Medical Center, Dallas, USA
| | - B Rocco
- Department of Urology, Policlinico, Milan, Italy
| | - R Yuriy
- Department of Urology, Institute of Moscow, Moscow, Russia
| | - Fabio Zattoni
- Department of Urology, University of Padua, Padua, Italy
| | - R Kocvara
- Department of Urology, General Teaching Hospital in Prague and Charles University, 1st Faculty of Medicine, Prague, Czech Republic
| | - C J Koh
- Department of Urology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
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Rao NP, Venkatasubramanian G, Ravi V, Kalmady S, Cherian A, Yc JR. Plasma cytokine abnormalities in drug-naïve, comorbidity-free obsessive-compulsive disorder. Psychiatry Res 2015; 229:949-52. [PMID: 26187339 DOI: 10.1016/j.psychres.2015.07.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [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: 10/08/2014] [Revised: 06/03/2015] [Accepted: 07/05/2015] [Indexed: 02/06/2023]
Abstract
Growing evidence in the last decade suggest significant role of immune alterations in the pathogenesis of obsessive-compulsive disorder (OCD). Cytokines, mediators of inflammation, alter the neurotransmitter concentration and result in a hyposerotonergic and hyperglutamatergic state implicated in pathogenesis of OCD. However, only few studies have examined cytokine abnormalities in OCD with inconsistent results possibly due to confounding effects of medications and comorbid anxiety-depression. We examined 20 comorbidity free, drug free OCD patients and 20 age and sex matched healthy controls. Clinical severity was assessed using Yale Brown Obsessive Compulsive Scale, Hamilton anxiety rating scale, Hamilton depression rating scale and Clinical Global Impression. Levels of different cytokines, Interleukin (IL)-2, IL-4, IL-6, IL-10, Tumor necrosis factor (TNF)-α and Interferon (IFN)-γ were assessed using Cytometric Bead Array. OCD patients had significantly greater plasma levels of IL-2, IL-4, IL-6, IL-10 and TNF-α levels than controls but not IFN-γ. Reanalysis of data with only drug naïve patients (excluding 4 drug free patients) did not alter the results. Presence of these abnormalities in drug-naïve patients suggests the possible role of cytokines in the pathogenesis of OCD. Study findings have potential clinical utility in development of novel therapeutic options targeting cytokine aberrations in OCD.
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Affiliation(s)
- Naren P Rao
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India.
| | | | - Vasanthapuram Ravi
- Department of Neurovirology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Sunil Kalmady
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Anish Cherian
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Janardhan Reddy Yc
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
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Vujovic O, Yu E, Cherian A, Dar A, Stitt L, Perera F. Comparison of 2 Radiation Schedules in the Adjuvant Treatment of Early-Stage Breast Carcinoma With Long-Term Follow-Up. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.810] [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: 11/28/2022]
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22
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Abstract
Single incision, single port, or single site surgery for retro-peritoneoscopic nephrectomy and nephro-ureterectomy in paediatric practice using an advanced access platform (GelPOINT Mini) is described in two patients. One patient had bilateral synchronous nephrectomy. The technique, advantages, and challenges are reported. Beyond the initial hurdles and learning curve, this technique is promising and has the potential to be extended to other procedures in paediatric urology.
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Affiliation(s)
- A Cherian
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK.
| | - G De Win
- Urology Department, Antwerp University Hospital, Antwerp, Belgium
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Valiveru RC, Maroju NK, Srinivasan K, Cherian A. Clinical audit system in implementing Surviving Sepsis Campaign guidelines in patients with peritonitis. Crit Care 2014. [PMCID: PMC4273802 DOI: 10.1186/cc14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Ramakant P, Cherian A, Abraham D, Paul M. Cancer in Toxic Goitres: A Significant Association. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Mushtaq I, Garriboli M, Smeulders N, Cherian A, Desai D, Eaton S, Duffy P, Cuckow P. Primary bladder exstrophy closure in neonates: challenging the traditions. J Urol 2013; 191:193-7. [PMID: 23871929 DOI: 10.1016/j.juro.2013.07.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE We describe a novel approach to neonatal bladder exstrophy closure that challenges the role of postoperative immobilization and pelvic osteotomy. MATERIALS AND METHODS We reviewed the primary management of bladder exstrophy at our institutions between 2007 and 2011. In particular we compared postoperative management in the surgical ward using epidural analgesia to muscle paralysis and ventilation in the intensive care unit. Clinical outcome measures were time to full feed, length of stay, postoperative complications and redo closure. Cost-effectiveness was also evaluated using hospital financial data. Data are expressed as median (range). Significance was explored by Fisher exact test and unpaired t-test. RESULTS A total of 74 patients underwent primary closure without osteotomy. Successful closure was achieved in 70 patients (95%). A total of 48 cases (65%) were managed on the ward (group A) and 26 (35%) were transferred to the intensive care unit (group B). The 2 groups were homogeneous for gestational age (median 39 weeks, range 27 to 41) and age at closure (3 days, 1 to 152). Complications requiring surgical treatment were noted in 4 patients (8.3%) in group A and 3 (11.5%) in group B (p = 0.609). Length of stay was significantly shorter for the group managed on the ward (11 vs 18 days, p <0.0001). Median costs were $42,732 for patients admitted to the intensive care unit and $16,214 for those admitted directly to the surgical ward (p <0.0001). CONCLUSIONS Primary closure of bladder exstrophy without lower limb immobilization and osteotomy is feasible. Postoperative care on the surgical ward using epidural analgesia results in shorter hospitalization.
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Affiliation(s)
- I Mushtaq
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - M Garriboli
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom; Department of Pediatric Surgery, UCL Institute of Child Health, London, United Kingdom
| | - N Smeulders
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - A Cherian
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - D Desai
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - S Eaton
- Department of Pediatric Surgery, UCL Institute of Child Health, London, United Kingdom
| | - P Duffy
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - P Cuckow
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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Abstract
We present a case of a 27-year-old Royal Marine with a massive pericardial effusion, presenting with minimal clinical findings, suggesting that high levels of physical fitness may effectively mask the normal symptoms of this potentially life-threatening condition.
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27
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Sinha CK, Barnacle A, Mushtaq I, Cherian A. Combined laparoscopic and cystoscopic injection sclerotherapy for bladder venous malformation: a novel technique. J Pediatr Urol 2013; 9:e22-4. [PMID: 22841403 DOI: 10.1016/j.jpurol.2012.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 04/16/2012] [Accepted: 06/12/2012] [Indexed: 11/26/2022]
Abstract
Treatment of vascular malformations of the urinary bladder can be challenging. We report a case of bladder venous malformation treated with sodium tetradecyl sulphate (STS 3%) sclerotherapy, using a combined cystoscopic and percutaneous transperitoneal laparoscopy guided approach. When cystoscopic views are poor, the laparoscopic approach is a useful adjunct to aid sclerotherapy of bladder venous malformation. This technique has not been previously described.
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Affiliation(s)
- C K Sinha
- Department of Paediatric Urology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
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28
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Vujovic O, Yu E, Cherian A, Perera F, Dar AR, Stitt L, Hammond A. The Significance of Time Interval From Clinical Presentation to Definitive Breast Surgery in Node Negative Breast Carcinoma With Long-term Follow-up: Clinical Implications. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Sandeep P, Cherian A, Iype T, Ayyappan K. A sac in a shaking uncus. J Postgrad Med 2012; 58:165-6. [PMID: 22718071 DOI: 10.4103/0022-3859.97188] [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: 11/04/2022] Open
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30
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Blackburn SC, Parkar S, Prime M, Healiss L, Desai D, Mustaq I, Cuckow P, Duffy P, Cherian A. Ileal bladder augmentation and vitamin B12: levels decrease with time after surgery. J Pediatr Urol 2012; 8:47-50. [PMID: 21183408 DOI: 10.1016/j.jpurol.2010.11.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [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: 08/30/2010] [Accepted: 11/15/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We investigated vitamin B12 deficiency following ileocystoplasty in children. METHODS Patients who underwent ileocystoplasty between December 1993 and September 2006 were included and B12 levels were retrospectively analysed. Patients with a serum B12 of less than 150 pg/ml were considered deficient. The distance of the ileal segment from the ileocaecal valve was recorded. RESULTS There were 105 patients in the series; 61 were male. Mean age at surgery was 7.7 years (SD = 3.9). The mean interval from surgery to most recent B12 level was 50 months (SD = 30). None of the patients were on B12 supplementation. Two patients were B12 deficient, both more than 7 years after surgery; 44% of patients with levels available 7 years after surgery had a B12 below 300 pg/ml. There was a significant negative correlation between B12 level and length of follow up (Spearman's rank, P < 0.01). Twenty patients with an ileal segment sparing 60 cm from the ileocaecal valve had a higher mean B12 (524 vs 419, SEM 60 vs 28). This was not statistically significant. CONCLUSION We demonstrate a reduction in serum B12 level with time following ileocystoplasty. These patients should have their B12 levels measured in the long term.
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Affiliation(s)
- S C Blackburn
- Department of Urology, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
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31
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Abstract
Poor post-natal growth of preterm neonates is common and fortification is recommended. However, this is not always practical in low-resource areas. Hypothesizing that increasing the volume of feeds would be safe and lead to better post-natal weight gain, we randomized 64 babies with birth weight <1500 g, once they reached full feeds, to continue feeds at 200 ml/kg/day (standard volume) or increase to 300 ml/kg/day (high volume) of expressed breast milk. There was a significantly higher daily weight gain in the high-volume group as compared to the standard volume group (24.9 vs. 18.7 g/kg/day, p < 0.0001). There were no differences in complications like feed intolerance, tachypnoea, sepsis, patent ductus arteriosus or necrotizing enterocolitis. High-volume feeds at 300 ml/kg/day was safe and resulted in better weight gain than standard volume feeds in very low birth weight babies.
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Affiliation(s)
- Niranjan Thomas
- Neonatology Unit, Christian Medical College Hospital, Vellore 632004, India.
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32
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Mathew M, Cherian A. Intracranial hypertension with delayed puberty: a rare presentation of juvenile onset systemic lupus erythematosus. Singapore Med J 2012; 53:e15-e17. [PMID: 22252192] [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: 05/31/2023]
Abstract
An adolescent boy presented with headache, bilateral papilloedema, growth retardation and absent secondary sexual characteristics. The diagnosis of intracranial hypertension was confirmed by increased intracranial pressure and normal neuroimaging of the brain except for partial empty sella and prominent perioptic cerebrospinal fluid (CSF) spaces. Evaluation showed an erythrocyte sedimentation rate of 150 mm/hr, positive antinuclear antibody, anti-dsDNA and antiribosomal P protein. Renal biopsy revealed diffuse segmental proliferative lupus nephritis (LN) class IV-S (A), which confirmed the diagnosis of systemic lupus erythematosus (SLE). Treatment of LN with intravenous pulse methylprednisolone and cyclophosphamide normalised the patient's CSF pressure and symptoms. In cases of intracranial hypertension, SLE must be considered. Growth retardation and absence of secondary sexual characteristics could coexist and may be presenting features of SLE. These manifestations point to advanced grades of LN, which could be asymptomatic and may be missed without a renal biopsy.
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Affiliation(s)
- M Mathew
- Department of Neurology, Government Medical College Hospital, Medical College, Trivandrum, Kerala, India
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Menon R, Baheti NN, Cherian A, Radhakrishnan A. Teaching Video NeuroImages: Epilepsy with myoclonic absences: A distinct electroclinical syndrome. Neurology 2011; 76:e113. [DOI: 10.1212/wnl.0b013e31821e54c9] [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: 11/15/2022] Open
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Cherian A, Krucoff MO, Miller LE. Motor cortical prediction of EMG: evidence that a kinetic brain-machine interface may be robust across altered movement dynamics. J Neurophysiol 2011; 106:564-75. [PMID: 21562185 DOI: 10.1152/jn.00553.2010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
During typical movements, signals related to both the kinematics and kinetics of movement are mutually correlated, and each is correlated to some extent with the discharge of neurons in the primary motor cortex (M1). However, it is well known, if not always appreciated, that causality cannot be inferred from correlations. Although these mutual correlations persist, their nature changes with changing postural or dynamical conditions. Under changing conditions, only signals directly controlled by M1 can be expected to maintain a stable relationship with its discharge. If one were to rely on noncausal correlations for a brain-machine interface, its generalization across conditions would likely suffer. We examined this effect, using multielectrode recordings in M1 as input to linear decoders of both end point kinematics (position and velocity) and proximal limb myoelectric signals (EMG) during reaching. We tested these decoders across tasks that altered either the posture of the limb or the end point forces encountered during movement. Within any given task, the accuracy of the kinematic predictions tended to be somewhat better than the EMG predictions. However, when we used the decoders developed under one task condition to predict the signals recorded under different postural or dynamical conditions, only the EMG decoders consistently generalized well. Our results support the view that M1 discharge is more closely related to kinetic variables like EMG than it is to limb kinematics. These results suggest that brain-machine interface applications using M1 to control kinetic variables may prove to be more successful than the more standard kinematic approach.
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Affiliation(s)
- A Cherian
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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35
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Menon R, Cherian A, Suma A, Maicykutty, Mathew P, Nair S, Aipe K. DEVELOPING RESISTANT BANANA AND PLANTAIN CULTIVARS THROUGH CONVENTIONAL BREEDING TECHNIQUES. ACTA ACUST UNITED AC 2011. [DOI: 10.17660/actahortic.2011.897.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cherian A, Thomas SV. Central nervous system tuberculosis. Afr Health Sci 2011; 11:116-127. [PMID: 21572867 PMCID: PMC3092316] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Central nervous system (CNS) involvement, one of the most devastating clinical manifestations of tuberculosis (TB) is noted in 5 to 10% of extrapulmonary TB cases, and accounts for approximately 1% of all TB cases. Definitive diagnosis of tuberculous meningitis (TBM) depends upon the detection of the tubercle bacilli in the CSF. Every patient with TBM should preferably be evaluated by imaging with contrast enhanced CT either before or within the first 48 hours of treatment. An extra-neural focus of tuberculosis should be sought clinically and radiologically in all patients with CNS TB as it may indicate safer and more accessible sites for diagnostic samplings. A minimum of 10 months treatment is warranted, prompted by the uncertain influences of disease severity, CNS drug penetration, undetected drug resistance and patient compliance. All patients with TB meningitis may receive adjunctive corticosteroids at presentation regardless of disease severity even for those with HIV infection. Drug resistance is strongly associated with previous treatment. The key principle of managing drug-resistant TB is never to add a single drug to a failing regimen. Early ventriculo-peritoneal shunting should be considered in those with hydrocephalus failing medical management. The single most important determinant of outcome is the stage of tuberculous meningitis at which treatment has been started.
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Affiliation(s)
- A Cherian
- Department of Neurology, Government Medical College, Trivandrum, Kerala, India, PIN-695011.
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37
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Pabari PA, Kyriacou A, Moraldo M, Unsworth B, Baruah R, Sutaria N, Hughes A, Mayet J, Francis DP, Uejima T, Loboz K, Antonini-Canterin F, Polombo C, Carerj S, Hughes A, Vinereanu D, Evangelista A, Leftheriotis G, Fraser AG, Kiotsekoglou A, Govindan M, Govind SC, Saha SK, Camm AJ, Azcarate PM, Castano S, Rodriguez-Manero M, Arraiza M, Levy B, Barba J, Rabago G, Bastarrika G, Nemes A, Takacs R, Varkonyi T, Gavaller H, Baczko I, Forster T, Wittmann T, Papp JG, Lengyel C, Varro A, Tumasyan LR, Adamyan KG, Savu O, Mieghem T, Dekoninck P, Gucciardo L, Jurcut R, Giusca S, Popescu BA, Ginghina C, Deprest J, Voigt JU, Versiero M, Galderisi M, Esposito R, Rapacciuolo A, Esposito G, Raia R, Morgillo T, Piscione F, De Simone G, Oraby MA, Maklady FA, Mohamed EM, Eraki AZ, Zaliaduonyte-Peksiene D, Tamuleviciute E, Janenaite J, Marcinkeviciene J, Mizariene V, Bucyte S, Vaskelyte J, Trifunovic D, Nedeljkovic I, Popovic D, Ostojic M, Vujisic-Tesic B, Petrovic M, Stankovic S, Sobic-Saranovic D, Banovic M, Dikic-Djordjevic A, Savino K, Lilli A, Grikstaite E, Giglio V, Bordoni E, Maragoni G, Cavallini C, Ambrosio G, Nedeljkovic I, Ostojic M, Vujisic-Tesic B, Jakovljevic B, Petrovic M, Trifunovic D, Beleslin B, Nedeljkovic M, Banovic M, Petrovic O, Moral S, Rodriguez-Palomares J, Descalzo M, Marti G, Pineda V, Mahia P, Gutierrez L, Gonzalez-Alujas T, Evangelista A, Garcia-Dorado D, Schnell F, Donal E, Thebault C, Bernard A, Corbineau H, Le Breton H, Kochanowski J, Scislo P, Piatkowski R, Roik M, Marchel M, Kosior D, Opolski G, Lesniak-Sobelga AM, Wicher-Muniak E, Kostkiewicz M, Olszowska M, Suchon E, Klimeczek P, Banys P, Pasowicz M, Tracz W, Podolec P, Moral S, Rodriguez-Palomares J, Descalzo M, Pineda V, Mahia P, Gutierrez L, Gonzalez-Alujas T, Laynez A, Evangelista A, Garcia-Dorado D, Hoefsten DE, Loegstrup BB, Norager B, Moller JE, Flyvbjerg A, Egstrup K, Streb W, Szulik M, Nowak J, Markowicz-Pawlus E, Duszanska A, Sedkowska A, Kalarus Z, Kukulski T, Spinelli L, Morisco C, Assante Di Panzillo E, Buono F, Crispo S, Trimarco B, Oraby MA, Hawary AA, Nasr GM, Fawzy MM, Faber L, Scholtz W, Boergermann J, Wiemer M, Kleikamp G, Bogunovic N, Dimitriadis Z, Gummert J, Hering D, Horstkotte D, Luca' F, Gelsomino S, Lorusso R, Caciolli S, Carella R, Bille' G, De Cicco G, Pazzagli V, Gensini GF, Borowiec A, Dabrowski R, Janas J, Kraska A, Firek B, Kowalik I, Szwed H, Marcus KA, De Korte CL, Feuth T, Thijssen JM, Kapusta L, Dahl J, Videbaek L, Poulsen MK, Pellikka PA, Veien K, Andersen LI, Haghfelt T, Moller JE, Haberka M, Mizia - Stec K, Adamczyk T, Mizia M, Chmiel A, Pysz P, Sosnowski M, Gasior Z, Trusz - Gluza M, Tendera M, Niklewski T, Wilczek K, Chodor P, Podolecki T, Frycz-Kurek A, Kukulski T, Kalarus Z, Zembala M, Yurdakul S, Yildirimturk O, Tayyareci Y, Memic K, Demiroglu ICC, Aytekin S, Garcia Alonso CJ, Ferrer Sistach E, Delgado L, Lopez Ayerbe J, Vallejo Camazon N, Gual Capllonch F, Espriu Simon M, Ruyra X, Caballero Parrilla A, Bayes Genis A, Lecuyer L, Berrebi A, Florens E, Noghin M, Huerre C, Achouh P, Zegdi R, Fabiani JN, De Chiara B, Moreo A, Musca F, De Marco F, Lobiati E, Belli O, Mauri F, Klugmann S, Caballero A, Vallejo N, Gonzalez Guardia A, Nunez Aragon R, Bosch C, Lopez Ayerbe J, Ferrer E, Pedro Botet ML, Gual F, Bayes Genis A, Cusma-Piccione M, Zito C, Oreto G, Giuffre R, Todaro MC, Barbaro CM, Lanteri S, Longordo C, Salvia J, Carerj S, Bensaid A, Gallet R, Fougeres E, Lim P, Nahum J, Deux JF, Gueret P, Teiger E, Dubois-Rande JL, Monin JL, Yurdakul S, Tayyareci Y, Yildirimturk O, Behramoglu F, Colakoglu Z, Aytekin V, Demiroglu C, Aytekin S, Gargani L, Poggianti E, Bucalo R, Rizzo M, Agrusta F, Landi P, Sicari R, Picano E, Sutandar A, Siswanto BB, Irmalita I, Harimurti G, Hayashi SY, Nascimento MM, Lindholm B, Lind B, Seeberger A, Nowak J, Pachaly MA, Riella MC, Bjallmark A, Brodin LA, Poanta L, Porojan M, Dumitrascu DL, Ikonomidis I, Tzortzis S, Lekakis J, Kremastinos DT, Paraskevaidis I, Andreadou I, Nikolaou M, Katsibri P, Anastasiou-Nana M, Maceira Gonzalez AM, Ripoll C, Cosin-Sales J, Igual B, Salazar J, Belloch V, Cosin-Aguilar J, Pennell DJ, Masaki M, Pulido JN, Yuasa T, Gillespie S, Afessa B, Brown DR, Mankad SV, Oh JK, Gurghean AL, Mihailescu AM, Tudor I, Homentcovschi C, Muraru M, Bruckner IV, Correia CE, Rodrigues B, Moreira D, Santos LF, Gama P, Dionisio O, Cabral C, Santos O, Bombardini T, Gherardi S, Arpesella G, Valente S, Calamai I, Pasanisi E, Sansoni S, Picano E, Szymanski P, Dobrowolski P, Lipczynska M, Klisiewicz A, Hoffman P, Stepowski D, Kurtz B, Grezis-Soulie G, Savoure A, Anselme F, Bauer F, Castillo J, Herszkowicz N, Ferreira C, Goscinska A, Mizia-Stec K, Gasior Z, Mizia M, Haberka M, Chmiel A, Poborski W, Azevedo O, Quelhas I, Guardado J, Fernandes M, Miranda CS, Gaspar P, Lourenco A, Medeiros R, Almeida J, L Bennani S, Algalarrondo V, Dinanian S, Guiader J, Juin C, Adams D, Slama MS, Onaindia JJ, Quintana O, Velasco S, Astigarraga E, Cacicedo A, Gonzalez J, Rodriguez I, Sadaba M, Eneriz M, Laraudogoitia Zaldumbide E, Nunez-Gil I, Luaces M, Zamorano J, Garcia Rubira JC, Vivas D, Ibanez B, Marcos Alberca P, Fernandez Golfin C, Alonso J, Macaya C, Silva Marques J, Almeida AG, Carvalho V, Jorge C, Silva D, Gato Varela M, Martins S, Brito D, Lopes MG, Tripodi E, Miserrafiti B, Montemurro V, Scali R, Tripodi P, Marchel M, Kochanowski J, Piatkowski R, Scislo P, Winkler A, Madej A, Hausmanowa-Petrusewicz I, Opolski G, Fijalkowski M, Koprowski A, Jaguszewski M, Galaska R, Taszner M, Rynkiewicz A, Citro R, Rigo F, Provenza G, Ciampi Q, Patella MM, D'andrea A, Antonini-Canterin F, Vriz O, Astarita C, Bossone E, Heggemann F, Walter TH, Kaelsch TH, Sueselbeck T, Papavassiliu TH, Borggrefe M, Haghi D, Monk-Hansen T, Have Dall C, Bisgaard Christensen S, Snoer M, Gustafsson F, Rasmusen H, Prescott E, Finocchiaro G, Pinamonti B, Merlo M, Barbati G, Di Lenarda A, Bussani R, Sinagra G, Butz T, Faber L, Lang CN, Meissner A, Plehn G, Yeni H, Langer C, Horstkotte D, Trappe HJ, Gu X, Gu XY, He YH, Li ZA, Han JC, Chen J, Gaudron P, Niemann M, Herrmann S, Hu K, Bijnens B, Hillenbrand H, Beer M, Ertl G, Weidemann F, Mazzone A, Mariani M, Foffa I, Vianello A, Del Ry S, Bevilacqua S, Andreassi MG, Glauber M, Berti S, Kochanowski J, Scislo P, Piatkowski R, Grabowski M, Roik M, Postula M, Marchel M, Kosior D, Opolski G, Dragulescu A, Van Arsdell G, Al-Radi O, Caldarone C, Mertens L, Lee KJ, Unsworth B, Casula RP, Yadav H, Baruah R, Cherian A, Sutaria N, Hughes AD, Mayet J, Francis DP, Vitarelli A, D'orazio S, Nguyen BL, Iorio G, Battaglia D, Caranci F, Padella V, Capotosto L, Alessandroni L, Barilla F, Cardin C, Hascoet S, Saudron M, Caudron G, Arnaudis B, Acar P, Sun MM, Shu XH, Pan CZ, Fang XY, Kong DH, Fang F, Zhang Q, Chan YS, Xie JM, Yip WK, Lam YY, Sanderson JE, Yu CM, Rosca M, O' Connor K, Romano G, Magne J, Calin A, Popescu BA, Muraru D, Pierard L, Ginghina C, Lancellotti P, Roushdy A, Elfiky I, El Shahid G, Elfiky A, El Sayed M, Wierzbowska-Drabik K, Chrzanowski L, Kapusta A, Plonska-Goscinak E, Krzeminska-Pakula M, Kurpesa M, Rechcinski T, Trzos E, Kasprzak JD, Ersboll MK, Valeur N, Mogensen UM, Andersen M, Moller JE, Hassager C, Sogaard P, Kober LV, Kloeckner M, Hayat D, Nahum J, Dussault C, Lellouche N, Elbaz N, Dubois-Rande JL, Gueret P, Lim P, Demopoulos A, Hatzigeorgiou G, Leontiades E, Motsi A, Karatasakis G, Athanassopoulos G, Zycinski P, Chrzanowski L, Wierzbowska-Drabik K, Kasprzak J, Vazquez Alvarez MC, Medrano Lopez C, Camino Lopez M, Granja S, Zunzunegui Martinez JL, Maroto Alvaro E, Tsai WC, Chen JY, Liu YW, Lin CC, Tsai LM, Silva Marques J, Gomes DC, Robalo Martins S, Gois MR, Ribeiro S, Nunes Diogo A, Almeida AG, Lopes MG, Zito C, Sengupta P, Di Bella G, Cusma-Piccione M, Oreto G, Caracciolo G, Longordo C, Lentini S, Carerj S, Kinova E, Zlatareva N, Goudev A, Papagiannis N, Mpouki M, Papagianni A, Vorria M, Mpenetos G, Lytra D, Papadopoulou E, Sgourakis P, Malakos J, Kyriazis J, Saha SK, Kodali V, Toole R, Govind SC, Kiotsekoglou A, Gopal AS, Celutkiene J, Rudys A, Grabauskiene V, Glaveckaite S, Sadauskiene E, Lileikiene Z, Bickauskaite N, Ciburiene E, Skorniakov V, Laucevicius A, Attenhofer Jost CH, Pfyffer M, Lindquist R, Santos JLF, Coelho ORC, Mady CM, Picard MHP, Salemi VMC, Funk L, Butz T, Lang CN, Prull MW, Plehn G, Yeni H, Meissner A, Trappe HJ, Tsai WC, Liu YW, Shih JY, Lin CC, Huang YY, Tsai LM, Lancellotti P, Donal E, Magne J, O'connor K, Moonen M, Pierard LA, Cozma DC, Mornos C, Ionac A, Petrescu L, Dragulescu D, Dan R, Popescu I, Dragulescu SI, Von Lueder TG, Hodt A, Gjerdalen GF, Andersen TE, Solberg EE, Steine K, Savu O, Van Mieghem T, Dekoninck P, Gucciardo L, Jurcut R, Giusca S, Popescu BA, Ginghina C, Deprest J, Voigt JU, Rostek M, Pikto-Pietkiewicz W, Dluzniewski M, Antoniewicz A, Poletajew S, Borowka A, Pasierski T, Malyutina SK, Ryabikov M, Ragino J, Ryabikov A, Sitia S, Tomasoni L, Atzeni F, Gianturco L, Sarzi-Puttini P, De Gennaro Colonna V, Turiel M, Uejima T, Loboz K, Vriz O, Polombo C, Carerj S, Hughes A, Vinereanu D, Gutierrez FR, Lefhtheriotis G, Fraser AG, Hurst RT, Nelson MR, Mookadam F, Thota V, Emani U, Al Harthi M, Stepanek J, Cha S, Lester SJ, Ho EMM, Hemeryck L, Hall M, Scott K, Bennett K, Mahmud A, Daly C, King G, Murphy RT, Brown AS, Teske AJ, D'Hooge J, Claus P, Rademakers F, Voigt JU, Santos L, Cortez-Dias N, Silva D, Silva Marques J, Ribeiro S, Goncalves S, Almeida Ribeiro M, Robalo Martins S, Bordalo E Sa A, Lopes MG, Teske AJ, D'Hooge J, Claus P, Rademakers F, Voigt JU, Magnino C, Marcos-Alberca P, Milan A, Nunez-Gil I, Almeria C, Caniadas V, Rodrigo JL, Perez De Isla L, Macaya C, Zamorano JL, Gustafsson U, Larsson M, Bjallmark A, Lindqvist P, Brodin L, Waldenstrom A, Roosens B, Hernot S, Droogmans S, Van Camp G, Lahoutte T, Lancellotti P, Cosyns B, Ho EMM, Scott K, Hemeryck L, Hall M, Bennett K, Mahmud A, Daly C, King G, Murphy RT, Brown AS, Rao CM, Aguglia D, Casciola G, Imbesi C, Marvelli A, Sgro M, Benedetto D, Tripepi R, Zoccali C, Benedetto FA, Muraru D, Badano LP, Cardillo M, Del Mestre L, Gianfagna P, Proclemer A, Tschernich HD, Mora B, Base E, Weber U, Dumfarth J, Mukherjee C, Skaltsiotis HS, Kaladaridis AK, Bramos DB, Kottis GK, Antoniou AA, Agrios IA, Takos DT, Vasiladiotis NV, Pamboucas KP, Toumanidis STT, Shim A, Kasprzak JD, Lipec P, Michalski B, Wozniakowski B, Stefanczyk L, Rotkiewicz A, Cameli M, Lisi M, Padeletti M, Bigio E, Bernazzali S, Tsoulpas C, Maccherini M, Henein M, Mondillo S, Garcia Lunar I, Mingo Santos S, Monivas Palomero V, Mitroi C, Beltran Correas P, Ruiz Bautista L, Muniz Lozano A, Gonzalez Gonzalez M, Pabari PA, Stegemann B, Willson K, Kyriacou A, Moraldo M, Mayet J, Hughes A, Francis DP, Zeppellini R, Iavernaro A, Zadro M, Carasi M, De Domenico R, Rigo T, Artuso E, Erente G, Ramondo A, Le TT, Huang FQ, Gu Y, Tan RS. Poster session II * Thursday 9 December 2010, 14:00-18:00. European Journal of Echocardiography 2010. [DOI: 10.1093/ejechocard/jeq138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kang JSL, Cherian A, Gan SH, Lee TH, Lee KC, Chee CBE, Doherty TM, Wang YT, Seah GT. Strong purified protein derivative responses are associated with poor mycobacterium inhibition in latent TB. Eur Respir J 2009; 36:348-54. [PMID: 19996195 DOI: 10.1183/09031936.00063209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The tuberculin skin test (TST) using purified protein derivative (PPD) of Mycobacterium tuberculosis is traditionally used to diagnose latent tuberculosis (TB) infection (LTBI). However, LTBI diagnosis by peripheral blood mononuclear cell (PBMC) interferon (IFN)-gamma responses to M. tuberculosis-specific antigens, early secreted antigenic target 6 kDa (ESAT-6) and culture filtrate protein (CFP)-10 has greater specificity. We investigated the difference in antimycobacterium cellular immunity in TB contacts who were strong TST reactors but nonresponsive to the ESAT-6/CFP-10 assay compared with those with concordant results. Healthy TB contacts were tested using the above two assays and mycobacterium survival was measured after co-culture of infected macrophages with their PBMCs. Whether PPD reactivity was tested by TST or by PBMC-specific IFN-gamma responses, strongly PPD-reactive TB contacts without ESAT-6/CFP-10 responsiveness showed significantly better mycobacterium inhibition activity than ESAT-6/CFP-10-responsive TB contacts with the same PPD reactivity. In the former group, stronger PPD reactivity was associated with improved mycobacterium killing, whereas ESAT-6/CFP-10 responders showed the opposite result. PPD-reactive ESAT-6/CFP-10-nonresponsive TB contacts in our population may have had protective immunity related to prior mycobacterium exposure. ESAT-6/CFP10-responsive TB contacts are more likely to have LTBI and, in this group, strong PPD reactivity may paradoxically be associated with poor mycobactericidal activity.
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Affiliation(s)
- J S L Kang
- Dept of Microbiology and Immunology Programme, Yong Loo Lin School of Medicine, National University of Singapore, MD4, 5 Science Drive 2, Singapore 117597, Singapore
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Abstract
AIMS AND OBJECTIVES This study attempts to assess the safety of low-flow anaesthesia (LFA) at fixed flow rates with particular reference to the incidence of a decline in FiO(2) below safe levels of 0.3 and to determine whether LFA can be used safely in the absence of an FiO(2) monitor. METHODS A total of 100 patients undergoing procedures under general anaesthesia at fresh gas flows of 300 ml/min of O(2) and 300 ml/min of N(2)O were monitored while maintaining the dial setting of isoflurane at 1.5% for 2 h. The changes in gas composition were analysed and even a single recording of FiO(2) of <0.3 was considered sufficient to render the technique unsafe in the absence of gas monitors. RESULTS The lowest recorded value of FiO(2) was 31% (v/v%). There was no incidence of adverse events necessitating the conversion from low flows to conventional flows. CONCLUSIONS We conclude that low flows of 300 ml/min of N(2)O and 300 ml/min of oxygen can be used safely for a period of 2 h without the use of monitors for gas analysis of oxygen and agent in adult patients weighing between 40 and 75 kgs.
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Affiliation(s)
- A Cherian
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, India.
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Vujovic O, Yu E, Cherian A, Perera F, Dar R, Stitt L, Hammond A. Is Survival in Early Stage Invasive Breast Cancer Determined by Clinical Presentation and Time Interval to Definitive Breast Surgery? Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1221] [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: 10/22/2022]
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Abstract
Splenogonadal fusion is a rare congenital abnormality found in boys and girls. There is fusion of the developing splenic anlage and the gonadal mesoderm at approximately week 5 of intrauterine life. It commonly presents as a testicular mass treated with an unnecessary orchidectomy. We report two cases of the discontinuous type presenting with testicular swelling and review the literature.
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Affiliation(s)
- I Milliken
- Department of Paediatric Surgery, Leeds Teaching Hospitals, Leeds, UK.
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Vujovic O, Yu E, Cherian A, Dar A, Stitt L, Perera F. 2011. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.413] [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: 10/24/2022]
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Vujovic O, Yu E, Cherian A, Dar R, Stitt L, Perera F. 241 The number of axillary nodes removed as a predictor of regional recurrence in node negative breast cancer. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80982-5] [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: 11/28/2022]
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Vujovic O, Cherian A, Yu E, Perera F, Dar R, Stitt L, Hammond A. 229 The effect of time interval from clinical presentation to definitive breast surgery on local recurrence and survival in early stage breast cancer. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80970-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
We report a 6-month-old child who presented with recurrent chest infections associated with a right diaphragmatic eventration. Failure in conservative management lead to thoracoscopic plication at 17 months of age and discharge on the third postoperative day. At one year followup he is completely free from all symptoms, and his chest x-ray demonstrates a marked improvement in the position of the diaphragm. We recommend thoracoscopy as a viable approach in treating this condition in children.
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Affiliation(s)
- A Cherian
- Department of Paediatric Surgery, University Hospital Nottingham, Nottingham NG7 2UH, UK
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Abstract
We report on a 14-year-old girl with acute intestinal obstruction due to volvulus of the small bowel caused by a giant mesenteric lipoma. To the best of our knowledge, this presentation of a mesenteric lipoma is unknown in the previous paediatric literature.
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Affiliation(s)
- A Cherian
- Department of Paediatric Surgery, University Hospital Nottingham, Nottingham NG7 2UH, UK
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Vujovic O, Cherian A, Yu E, Dar A, Stitt L, Perera F. Pattern of local recurrence with delay in breast irradiation in patients with positive or close resection margins and young age and node negative disease. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.069] [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: 10/26/2022]
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Anoop S, Saravanan B, Joseph A, Cherian A, Jacob KS. Maternal depression and low maternal intelligence as risk factors for malnutrition in children: a community based case-control study from South India. Arch Dis Child 2004; 89:325-9. [PMID: 15033840 PMCID: PMC1719856 DOI: 10.1136/adc.2002.009738] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To determine whether current and postpartum maternal depression and low maternal intelligence are risk factors for malnutrition in children. METHODS In rural South India 72 children with malnutrition were identified from a central register; 72 controls were matched for age, gender, and residence. RESULTS Major depression in the postpartum period (OR 5.0, 95% CI 1.0 to 24.0), current major depression (OR 3.2, 95% CI 1.1 to 9.5), and low maternal intelligence (OR 3.8, 95% CI 1.3 to 11.1) were associated with malnutrition in the child. Low birth weight (OR 2.9, 95% CI 1.2 to 6.8) was also significantly associated with infant malnutrition. Conditional logistic regression adjusting for all other determinants yielded the following results: major depression during the postpartum period (OR 7.8; 95% CI 1.6 to 38.51), current major depression (OR 3.1; 95% CI 0.9 to 9.7), low maternal intelligence (OR 4.6; 95% CI 1.5 to 14.1), and low birth weight (OR 2.7; 95% CI 2.5 to 6.8). The interactions between current maternal depression and low birth weight and between postpartum depression and low maternal intelligence were statistically significant. The level of maternal intelligence was associated with nutritional status. The severity of malnutrition was also significantly associated with major depression during the postpartum period and low maternal intelligence. CONCLUSION There is evidence for an association between postpartum maternal depression, low maternal intelligence, and low birth weight with malnutrition in children aged 6-12 months.
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Affiliation(s)
- S Anoop
- Department of Psychiatry, Christian Medical College, Vellore 632002, India
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