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Sahay SC, Kesarwani P, Sharma G, Tiwari A. Sahay's modification of Winter's shunt technique for priapism. Indian J Urol 2024; 40:72-73. [PMID: 38314082 PMCID: PMC10836460 DOI: 10.4103/iju.iju_407_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/23/2023] [Accepted: 12/08/2023] [Indexed: 02/06/2024] Open
Affiliation(s)
| | - P. Kesarwani
- Department of Urology, Max Superspeciality Hospital, Delhi, India
| | - G. Sharma
- Department of Urology, Max Superspeciality Hospital, Delhi, India
| | - A. Tiwari
- Department of Urology, Max Superspeciality Hospital, Delhi, India
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2
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Sinha A, Savargaonkar D, De A, Tiwari A, Yadav CP, Anvikar AR. Joint Involvement Can Predict Chikungunya in a Dengue Syndemic Setting in India. J Epidemiol Glob Health 2023; 13:895-901. [PMID: 37962782 PMCID: PMC10686949 DOI: 10.1007/s44197-023-00163-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023] Open
Abstract
Dengue and chikungunya have been endemic in India but have the tendency to cause periodic epidemics, often together, wherein they are termed 'syndemic'. Such a syndemic was observed in 2016 in India which resulted in a further scarcity of already resource-poor specific diagnostic infrastructure even in many urban conglomerates. A cross-sectional study was thus conducted, on 978 fever patients that consulted the ICMR-NIMR fever clinic, New Delhi, in September 2016, with an objective to identify symptom/s that could predict chikungunya with certainty. The overall aim was to rationally channelize the most clinically suitable patients for the required specific diagnosis of chikungunya. Based on their clinical profile, febrile patients attending NIMR's clinic, appropriate laboratory tests and their association analyses were performed. Bivariate analysis on 34 clinical parameters revealed that joint pain, joint swelling, rashes, red spots, weakness, itching, loss of taste, red eyes, and bleeding gums were found to be statistically significantly associated predictors of chikungunya as compared to dengue. While, in multivariate analysis, only four symptoms (joint pain in elbows, joint swelling, itching and bleeding gums) were found in statistically significant association with chikungunya. Hence, based on the results, a clinician may preferably channelize febrile patients with one or more of these four symptoms for chikungunya-specific diagnosis and divert the rest for dengue lab diagnosis in a dengue-chikungunya syndemic setting.
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Affiliation(s)
- Abhinav Sinha
- ICMR-National Institute of Malaria Research, New Delhi, India.
| | | | - Auley De
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Aparna Tiwari
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - C P Yadav
- ICMR-National Institute of Malaria Research, New Delhi, India
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Tiwari A, De A, Sinha A. Increasing blood pressure: could malaria have a role? Lancet Glob Health 2023; 11:e1697. [PMID: 37858581 DOI: 10.1016/s2214-109x(23)00419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/29/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Aparna Tiwari
- ICMR-National Institute of Malaria Research, New Delhi, India; Department of Atomic Energy, Centre for Excellence in Basic Sciences, University of Mumbai, Mumbai, India
| | - Auley De
- ICMR-National Institute of Malaria Research, New Delhi, India; Nirnayan Healthcare, Kolkata, India
| | - Abhinav Sinha
- ICMR-National Institute of Malaria Research, New Delhi, India.
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Tiwari A, Patel M G, Borah N, Singh A, Shah S, Prabhakar A. COVID-19 SAFETY MEASURES AND THEIR EFFECTS ON GAMBLING HABITS: AN INVESTIGATIVE STUDY. Georgian Med News 2023:144-152. [PMID: 38096532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
This study looked at the way COVID-19 was starting to affect gambling during first six weeks of emergency actions. The following factors were evaluated: the economic effect of COVID-19 on internet gambling, according to COVID-19, psychological issues, addiction to drugs, and risky gambling habits and intentions. Online survey with cross-sectional data of 2015 gamblers was conducted, with a subsample of 1048 people who gambled online (age 18 and older). Numerous metrics of correlation and probability ratio analyses were performed. The Issue of Gambling Intensity Index's extremely dangerous gamblers and those who have gambled online are more likely to engage in gambling online, according to the outcomes, even though there was an obvious transition toward physical gaming. The most predicted indicators for high-risk gamblers on the internet were moderate to severe depression and anxiety, reduced work weeks, convincing themselves to gamble by COVID-19, gambling under the effects of alcohol or cannabis, and dangerous gambling motivations related to psychological disorders, such as gambling to relieve anxiety and depressive disorders, chasing gambling damages, and trying to make money from gambling. This research has validated numerous risk connections associated with gambling risk, psychological issues, and substance use reported in previous studies on the worldwide recession and upcoming COVID-19-related investigations. In contrast to many other inquiries, the current research considers each component comprehensively. It offers more information on the risk factors associated with online gambling throughout the epidemic.
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Affiliation(s)
- A Tiwari
- 1Department of CSE (Artificial Intelligence and Machine Learning), Noida Institute of Engineering and Technology, Greater Noida, Uttar Pradesh, India
| | - G Patel M
- 2Department of Community Medicine, Parul University, PO Limda, Tal. Waghodia, District Vadodara, Gujarat, India
| | - N Borah
- 3Department of Life Sciences, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
| | - A Singh
- 4School of Pharmacy & Research, Dev Bhoomi Uttarakhand University, Dehradun, India
| | - Sh Shah
- 5Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, India
| | - A Prabhakar
- 5Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, India
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Tiwari A, Mehrotra M, Hasan A, Agarwal J, Singh GK. "HBV liver decompensation: Antiviral therapy for all". J Gastroenterol Hepatol 2023; 38:833-834. [PMID: 36999212 DOI: 10.1111/jgh.16187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/01/2023]
Affiliation(s)
- A Tiwari
- Department of Gastroenterology Regency Hospital Ltd, Kanpur, Uttar Pradesh, India, 208005
| | - M Mehrotra
- Department of Gastroenterology Regency Hospital Ltd, Kanpur, Uttar Pradesh, India, 208005
| | - A Hasan
- Department of Gastroenterology Regency Hospital Ltd, Kanpur, Uttar Pradesh, India, 208005
| | - J Agarwal
- Regency Hospital Ltd, Kanpur, Uttar Pradesh, India, 208005
| | - G K Singh
- Regency Hospital Ltd, Kanpur, Uttar Pradesh, India, 208005
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Sinha A, Kar S, Deora N, Dash M, Tiwari A, Kori L, Schneider K, Ranford-Cartwright L. India-EMBO Lecture Course: understanding malaria from molecular epidemiology, population genetics, and evolutionary perspectives. Trends Parasitol 2023; 39:307-313. [PMID: 36933966 DOI: 10.1016/j.pt.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Abhinav Sinha
- ICMR-National Institute of Malaria Research, New Delhi, India.
| | - Sonalika Kar
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Nimita Deora
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Manoswini Dash
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Aparna Tiwari
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Lokesh Kori
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Kristan Schneider
- Hochschule Mittweida University of Applied Sciences, Mittweida, Germany
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Tiwari A, Thapa A, Choudhury N, Khatri R, Sapkota S, Wu WJ, Halliday S, Citrin D, Schwarz R, Maru D, Rayamazi HJ, Paudel R, Bhatt LD, Bhandari V, Marasini N, Khadka S, Bogati B, Saud S, Kshetri YKB, Bhatta A, Magar KR, Shrestha R, Kafle R, Poudel R, Gautam S, Basnett I, Shrestha GN, Nirola I, Adhikari S, Thapa P, Kunwar L, Maru S. A Type II hybrid effectiveness-implementation study of an integrated CHW intervention to address maternal healthcare in rural Nepal. PLOS Glob Public Health 2023; 3:e0001512. [PMID: 36963046 PMCID: PMC10021605 DOI: 10.1371/journal.pgph.0001512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 12/26/2022] [Indexed: 01/25/2023]
Abstract
Skilled care during pregnancy, childbirth, and postpartum is essential to prevent adverse maternal health outcomes, yet utilization of care remains low in many resource-limited countries, including Nepal. Community health workers (CHWs) can mitigate health system challenges and geographical barriers to achieving universal health coverage. Gaps remain, however, in understanding whether evidence-based interventions delivered by CHWs, closely aligned with WHO recommendations, are effective in Nepal's context. We conducted a type II hybrid effectiveness-implementation, mixed-methods study in two rural districts in Nepal to evaluate the effectiveness and the implementation of an evidence-based integrated maternal and child health intervention delivered by CHWs, using a mobile application. The intervention was implemented stepwise over four years (2014-2018), with 65 CHWs enrolling 30,785 families. We performed a mixed-effects Poisson regression to assess institutional birth rate (IBR) pre-and post-intervention. We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to evaluate the implementation during and after the study completion. There was an average 30% increase in IBR post-intervention, adjusting for confounding variables (p<0.0001). Study enrollment showed 35% of families identified as dalit, janjati, or other castes. About 78-89% of postpartum women received at least one CHW-counseled home visit within 60 days of childbirth. Ten (53% of planned) municipalities adopted the intervention during the study period. Implementation fidelity, measured by median counseled home visits, improved with intervention time. The intervention was institutionalized beyond the study period and expanded to four additional hubs, albeit with adjustments in management and supervision. Mechanisms of intervention impact include increased knowledge, timely referrals, and longitudinal CHW interaction. Full-time, supervised, and trained CHWs delivering evidence-based integrated care appears to be effective in improving maternal healthcare in rural Nepal. This study contributes to the growing body of evidence on the role of community health workers in achieving universal health coverage.
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Affiliation(s)
| | | | - Nandini Choudhury
- Possible, New York, NY, United States of America
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, United States of America
| | | | - Sabitri Sapkota
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, United States of America
- Possible, Kathmandu, Nepal
| | - Wan-Ju Wu
- Possible, New York, NY, United States of America
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA, United States of America
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States of America
| | - Scott Halliday
- Possible, New York, NY, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - David Citrin
- Possible, New York, NY, United States of America
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Anthropology, University of Washington, Seattle, WA, United States of America
| | - Ryan Schwarz
- Possible, New York, NY, United States of America
- Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Duncan Maru
- Possible, New York, NY, United States of America
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, United States of America
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, United States of America
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | | | | | | | | | - Sonu Khadka
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | | | - Sita Saud
- Civil Service Hospital, Kathmandu, Nepal
| | | | | | - Kshitiz Rana Magar
- Department of Public Health and Community Program, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Ramesh Shrestha
- Department of Public Health and Community Program, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | | | | | | | | | - Goma Niroula Shrestha
- Department of Health Services, Nursing and Social Security Division (NSSD), Ministry of Health and Population, Nepal
| | - Isha Nirola
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Samrachana Adhikari
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | - Poshan Thapa
- University of New South Wales, School of Population Health, Sydney, Australia
| | | | - Sheela Maru
- Possible, New York, NY, United States of America
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, United States of America
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, United States of America
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Amara AAAF, Amin P, Ammashi S, Arfin S, Cruz JN, El-Baky NA, Enibukun JS, Fatoki TH, Garg N, Gurav N, Gurav S, Jain D, Jaiswal PK, Jena GK, Jha AN, Kesharwani R, Khan F, Khataniar A, Kumar D, Kumar P, Kumar V, Mali SN, Manjunatha VC, Moharana M, Nadaf S, Nagella P, Ogunyemi IO, Patel DK, Pattanayak SK, Prakash SE, Rajak N, Rangaraj S, Rathinavel T, Redwan EM, Saha D, Sasikanth V, Singh AK, Tambe S, Tiwari A, Veerappa Lakshmaiah V, Verma P. Contributors. Nutraceuticals 2023:xiii-xvi. [DOI: 10.1016/b978-0-443-19193-0.09992-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Sharma S, Tripathi A, Baran C, Awasthi A, Tiwari A, Sharma S, Jaiswal A, Uttam KN. Monitoring Pigment Dynamics Involved in the Ripening of Sweet Cherries Non-Destructively Using Confocal Micro Raman Spectroscopy. ANAL LETT 2022. [DOI: 10.1080/00032719.2022.2147536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Sweta Sharma
- Saha’s Spectroscopy Laboratory, Department of Physics, University of Allahabad, Prayagraj
- Department of Applied Science and Humanities, Faculty of Engineering and Technology, Khwaja Moinuddin Chishti Language University, Lucknow
| | - Aradhana Tripathi
- Saha’s Spectroscopy Laboratory, Department of Physics, University of Allahabad, Prayagraj
| | - Chhavi Baran
- Centre for Environmental Science, IIDS, University of Allahabad, Prayagraj
| | - Aishwary Awasthi
- Saha’s Spectroscopy Laboratory, Department of Physics, University of Allahabad, Prayagraj
| | - Aparna Tiwari
- Saha’s Spectroscopy Laboratory, Department of Physics, University of Allahabad, Prayagraj
| | - Shristi Sharma
- Saha’s Spectroscopy Laboratory, Department of Physics, University of Allahabad, Prayagraj
| | - Aarti Jaiswal
- Centre for Material Sciences, IIDS, University of Allahabad, Prayagraj
| | - K. N. Uttam
- Saha’s Spectroscopy Laboratory, Department of Physics, University of Allahabad, Prayagraj
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Tang TY, Tiwari A, Yap CJQ, Soon SXY, Wong CLJ. Re: “Modification of protocol with one extra drop of endovascular cyanoacrylate improved closure rates in incompetent great saphenous veins”—time to rethink the instructions for use for VenaSeal™? Phlebology 2022; 37:616-617. [DOI: 10.1177/02683555221108880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- TY Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore
- Duke NUS Graduate Medical School, Singapore
| | - A Tiwari
- Department of Vascular Surgery, University Hospital Birmingham, Birmingham, UK
| | - CJQ Yap
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - SXY Soon
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - CLJ Wong
- The Vascular & Endovascular Clinic, Gleneagles Medical Centre, Singapore
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Choudhury N, Tiwari A, Wu WJ, Bhandari V, Bhatta L, Bogati B, Citrin D, Halliday S, Khadka S, Marasini N, Pandey S, Ballard M, Rayamazi HJ, Sapkota S, Schwarz R, Sullivan L, Maru D, Thapa A, Maru S. Comparing two data collection methods to track vital events in maternal and child health via community health workers in rural Nepal. Popul Health Metr 2022; 20:16. [PMID: 35897038 PMCID: PMC9327361 DOI: 10.1186/s12963-022-00293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/03/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Timely tracking of health outcomes is difficult in low- and middle-income countries without comprehensive vital registration systems. Community health workers (CHWs) are increasingly collecting vital events data while delivering routine care in low-resource settings. It is necessary, however, to assess whether routine programmatic data collected by CHWs are sufficiently reliable for timely monitoring and evaluation of health interventions. To study this, we assessed the consistency of vital events data recorded by CHWs using two methodologies-routine data collected while delivering an integrated maternal and child health intervention, and data from a birth history census approach at the same site in rural Nepal. METHODS We linked individual records from routine programmatic data from June 2017 to May 2018 with those from census data, both collected by CHWs at the same site using a mobile platform. We categorized each vital event over a one-year period as 'recorded by both methods,' 'census alone,' or 'programmatic alone.' We further assessed whether vital events data recorded by both methods were classified consistently. RESULTS From June 2017 to May 2018, we identified a total of 713 unique births collectively from the census (birth history) and programmatic maternal 'post-delivery' data. Three-fourths of these births (n = 526) were identified by both. There was high consistency in birth location classification among the 526 births identified by both methods. Upon including additional programmatic 'child registry' data, we identified 746 total births, of which 572 births were identified by both census and programmatic methods. Programmatic data (maternal 'post-delivery' and 'child registry' combined) captured more births than census data (723 vs. 595). Both methods consistently classified most infants as 'living,' while infant deaths and stillbirths were largely classified inconsistently or recorded by only one method. Programmatic data identified five infant deaths and five stillbirths not recorded in census data. CONCLUSIONS Our findings suggest that data collected by CHWs from routinely tracking pregnancies, births, and deaths are promising for timely program monitoring and evaluation. Despite some limitations, programmatic data may be more sensitive in detecting vital events than cross-sectional census surveys asking women to recall these events.
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Affiliation(s)
- Nandini Choudhury
- grid.429937.2Possible, New York, USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA
| | | | - Wan-Ju Wu
- grid.429937.2Possible, New York, USA ,grid.239424.a0000 0001 2183 6745Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA USA
| | | | | | | | - David Citrin
- grid.429937.2Possible, New York, USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA ,grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Anthropology, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
| | - Scott Halliday
- grid.429937.2Possible, New York, USA ,grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | | | | | | | - Madeleine Ballard
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA ,Community Health Impact Coalition, New York, NY USA
| | | | | | - Ryan Schwarz
- grid.429937.2Possible, New York, USA ,grid.62560.370000 0004 0378 8294Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine, Harvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Lisa Sullivan
- grid.189504.10000 0004 1936 7558Boston University School of Public Health, Boston, MA USA
| | - Duncan Maru
- grid.429937.2Possible, New York, USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA ,grid.59734.3c0000 0001 0670 2351Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | | | - Sheela Maru
- grid.429937.2Possible, New York, USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA ,grid.59734.3c0000 0001 0670 2351Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY USA
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Acharya S, Meador R, Plocharczyk E, Tiwari A, Gupta SS. Isolated interstitial lung disease associated with anti-synthetase syndrome. QJM 2022; 115:408-409. [PMID: 35166846 DOI: 10.1093/qjmed/hcac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Acharya
- Department of Internal Medicine, Cayuga Medical Center, 101 Dates Drive, Ithaca, New York, NY 14850, USA
| | - R Meador
- Department of Rheumatology, Cayuga Medical Center, 101 Dates Drive, Ithaca, New York, NY 14850, USA
| | - E Plocharczyk
- Department of Pathology, Cayuga Medical Center, 101 Dates Drive, Ithaca, New York, NY 14850, USA
| | - A Tiwari
- Department of Internal Medicine, Cayuga Medical Center, 101 Dates Drive, Ithaca, New York, NY 14850, USA
| | - S S Gupta
- Department of Pulmonary and Critical Care Medicine, Cayuga Medical Center, 101 Dates Drive, Ithaca, New York, NY 14850, USA
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Sharma S, Jaiswal A, Tiwari A, Uttam KN. Rapid Detection of Metal Ions in the Aqueous Medium by Colorimetry and Surface Enhanced Raman Scattering Using Vanillic Acid-Coated Silver Nanoparticles. ANAL LETT 2022. [DOI: 10.1080/00032719.2022.2069796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Sweta Sharma
- Saha’s Spectroscopy Laboratory, Department of Physics, University of Allahabad, Allahabad, India
- Department of Applied Science and Humanities, Faculty of Engineering and Technology, Khwaja Moinuddin Chishti Language University, Lucknow, India
| | - Aarti Jaiswal
- Centre for Material Science, IIDS, University of Allahabad, Allahabad, India
| | - Aparna Tiwari
- Saha’s Spectroscopy Laboratory, Department of Physics, University of Allahabad, Allahabad, India
| | - K. N. Uttam
- Saha’s Spectroscopy Laboratory, Department of Physics, University of Allahabad, Allahabad, India
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De A, Tiwari A, Pande V, Sinha A. Evolutionary trilogy of malaria, angiotensin II and hypertension: deeper insights and the way forward. J Hum Hypertens 2022; 36:344-351. [PMID: 34480100 DOI: 10.1038/s41371-021-00599-0] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 08/06/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
Despite clinical and pathological distinctions between malaria and hypertension, accumulated epidemiological and evolutionary evidence indicate the need of deeper understanding how severe malaria contributes to elevated hypertension risk. Malaria is said to exert strong selection pressure on the host genome, thus selecting certain genetic polymorphisms. Few candidate polymorphisms have also been reported in the RAS (ACE I/D and ACE2 rs2106809) that are shown to increase angiotensin II (ang II) levels in a combinatorial manner. The raised ang II has some antiplasmodial actions in addition to protecting against severe/cerebral malaria. It is hypothesized that RAS polymorphisms may have been naturally selected over time in the malaria-endemic areas in such a way that hypertension, or the risk thereof, is higher in such areas as compared to non-malaria endemic areas. The purpose of this review is to gain deeper insights into various sparse evidence linking malaria and hypertension and suggesting a way forward.
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Affiliation(s)
- Auley De
- Parasite-Host Biology, ICMR-National Institute of Malaria Research, New Delhi, India
| | - Aparna Tiwari
- Parasite-Host Biology, ICMR-National Institute of Malaria Research, New Delhi, India.,Department of Biotechnology, Bhimtal, Kumaun University, Nainital, Uttarakhand, India
| | - Veena Pande
- Department of Biotechnology, Bhimtal, Kumaun University, Nainital, Uttarakhand, India
| | - Abhinav Sinha
- Parasite-Host Biology, ICMR-National Institute of Malaria Research, New Delhi, India.
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15
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Datta B, Tiwari A. Adding to her woes: child bride's higher risk of hypertension at young adulthood. J Public Health (Oxf) 2022:6543034. [PMID: 35257178 DOI: 10.1093/pubmed/fdac026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 11/10/2021] [Accepted: 02/01/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Child marriage is associated with various adverse socio-economic and pregnancy outcomes. However, there remains a dearth of research on the long-term health implications of child marriage. As such, this study sought to expand upon the growing literature on child marriage, specifically examining the associations between child marriage and hypertension during young adult age. METHODS We obtained data of 5369 women aged 20-34 from the Tajikistan Demographic and Health Survey 2017. Using multivariable logistic regression framework, we estimated the adjusted odds in favor of being hypertensive for women who were married before the age of 18. We also explored the presence of several stressors to understand the role of probable medication factors. RESULTS We found that the odds of being hypertensive for young adult women married before the age of 18 were 1.6 (95% confidence interval: 1.1-2.4) times that of those who were not. Likelihood of having stressors, such as pregnancy loss or child death, marital control and spousal violence, was found higher among child brides compared to their peers. CONCLUSIONS Findings suggest that child marriage may increase the risk of hypertension among young adult women. This work reinforces recommendations by the United Nations to the end child marriage.
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Affiliation(s)
- B Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA.,Department of Population Health Sciences, Medical College of Georgia, Augusta University, GA 30912, USA
| | - A Tiwari
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA
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16
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Chan KL, Leung WC, Tiwari A, Or KL, Ip P. Effectiveness of the iParent app for postnatal depression: a randomised controlled trial (abridged secondary publication). Hong Kong Med J 2022; 28 Suppl 1:17-18. [PMID: 35260510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- K L Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University
| | - W C Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital
| | - A Tiwari
- School of Nursing, Hong Kong Sanatorium and Hospital
| | - K L Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong
| | - P Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong
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17
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Tiwari A, Swamy M, Mishra P, Verma Y, Dubey A, Srivastav N. Molecular detection of Salmonella isolated from commercial chicken. Iran J Vet Res 2022; 23:39-45. [PMID: 35782360 PMCID: PMC9238933 DOI: 10.22099/ijvr.2021.41301.5996] [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] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/30/2021] [Accepted: 11/07/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Salmonella in chicken, specially, the motile salmonellae, causes the food chain unsafe from farm to table and is considered a significant global threat to public health. AIMS The present study was carried out for molecular detection of Salmonellae in commercial poultry using PCR. METHODS The study was conducted for eight months, from July 2019 to February 2020, and a total of 26 poultry farms, including 15 broiler and 11-layer farms, were visited individually. Pooled faecal samples were obtained from the sheds. A total of 189 necropsy cases were examined for gastrointestinal lesions. Isolation and identification of the organism were done using microbe culture method, and the molecular characterization was performed via PCR targeting invA and ent genes. RESULTS The prevalence of salmonellosis in the broiler and layer farms was recorded at 20.0% and 45.4%, respectively, through the traditional gold standard culture method. From 189 necropsy birds, salmonellosis was recorded at 1.58% dead cases. Molecular detection of Salmonella isolates by PCR targeting invA gene was confirmed in 13.33% of the broiler farms and 36.3% of the layer farms. Further detection of Salmonella enteritidis was performed by PCR targeting ent gene by which 11.11% positivity was determined. CONCLUSION This study, focused on the Salmonella prevalence, highlighted the zoonotic importance of the bacterium in the commercial poultry farms, which can subsequently be dispersed into the human food chain causing harmful health effects.
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Affiliation(s)
- A. Tiwari
- Ph.D. Student in Veterinary Pathology, Department of Veterinary Pathology, College of Veterinary Science and Animal Husbandry, Nanaji Deshmukh Veterinary Science University, Jabalpur, Madhya Pradesh, 482001, India
| | - M. Swamy
- Department of Veterinary Pathology, College of Veterinary Science and Animal Husbandry, Nanaji Deshmukh Veterinary Science University, Jabalpur, Madhya Pradesh, 482001, India
| | - P. Mishra
- Ph.D. Student in Veterinary Pharmacology & Toxicology, Department of Veterinary Pharmacology & Toxicology, College of Veterinary Science and Animal Husbandry, Nanaji Deshmukh Veterinary Science University, Jabalpur, Madhya Pradesh, 482001, India
| | - Y. Verma
- Department of Veterinary Pathology, College of Veterinary Science and Animal Husbandry, Nanaji Deshmukh Veterinary Science University, Jabalpur, Madhya Pradesh, 482001, India
| | - A. Dubey
- Department of Veterinary Pathology, College of Veterinary Science and Animal Husbandry, Nanaji Deshmukh Veterinary Science University, Jabalpur, Madhya Pradesh, 482001, India
| | - N. Srivastav
- Department of Veterinary Microbiology, College of Veterinary Science and Animal Husbandry Rewa, Nanaji Deshmukh Veterinary Science University, Jabalpur, Madhya Pradesh, 482001, India
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18
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Tiwari A, Wu WJ, Citrin D, Bhatta A, Bogati B, Halliday S, Goldberg A, Khadka S, Khatri R, Kshetri Y, Rayamazi HJ, Sapkota S, Saud S, Thapa A, Vreeman R, Maru S. “Our mothers do not tell us”: a qualitative study of adolescent girls’ perspectives on sexual and reproductive health in rural Nepal. Sex Reprod Health Matters 2022; 29:2068211. [PMID: 35695251 PMCID: PMC9225746 DOI: 10.1080/26410397.2022.2068211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Adolescent girls in low- and middle-income countries continue to face poor sexual and reproductive health (SRH). In Nepal, early marriage and motherhood, gender-based violence, and unmet need for contraception remain pervasive. Adolescent girls in rural areas bear a disproportionate burden of poor reproductive health outcomes, but there are limited context-specific data. This is a qualitative study to identify factors that impact adolescent girls’ utilisation of and access to SRH services in a rural district of Nepal. We conducted 21 individual interviews with adolescent girls aged 15–19 years, and three focus group discussions with community health workers. We used an inductive analytic approach to identify emergent and recurrent themes and present the themes using the social ecological model. Individual-level factors that contribute to low uptake of services among adolescent girls include lack of knowledge, self-perceived lack of need, low decision-making autonomy, and shyness. Interpersonal factors that impact access include unsupportive family norms, absence of open communication, and need for permission from family members to access care. At the community level, disparate gender norms, son preference, and judgment by community members affect adolescent SRH. Inadequate sex education, far travel distance to facilities, lack of female healthcare providers and teachers, and inability to access abortion services were identified as organisational and systems barriers. Stigma was a factor cross-cutting several levels. Our findings suggest the need for multi-level strategies to address these factors to improve adolescent girls’ SRH.
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Affiliation(s)
| | - Wan-Ju Wu
- Assistant Professor, Boston Medical Center, Department of Obstetrics and Gynecology, Boston, MA, USA; Boston University School of Medicine, Department of Obstetrics and Gynecology, Boston, MA, USA; Possible, New York, USA
| | - David Citrin
- Adviser, Possible, New York, USA; University of Washington, Department of Global Health, Seattle, WA, USA; University of Washington, Department of Anthropology, Seattle, WA, USA; Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | - Aasha Bhatta
- Community Health Program Associate, Nyaya Health Nepal, Kathmandu, Nepal
| | - Bhawana Bogati
- Community Health Program Associate, Nyaya Health Nepal, Kathmandu, Nepal
| | - Scott Halliday
- Adviser, Possible, New York, USA; University of Washington, Department of Global Health, Seattle, WA, USA
| | - Alisa Goldberg
- Associate Professor, Brigham and Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Biology, Boston, MA, Harvard Medical School, Boston MA, USA
| | - Sonu Khadka
- Community Health Program Associate, Nyaya Health Nepal, Kathmandu, Nepal
| | - Rekha Khatri
- Qualitative Research Manager, Possible, Kathmandu, Nepal
| | - Yashoda Kshetri
- Community Health Program Associate, Nyaya Health Nepal, Kathmandu, Nepal
| | | | - Sabitri Sapkota
- Director of Research, Possible, Kathmandu, Nepal; Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | - Sita Saud
- Community Health Program Associate, Nyaya Health Nepal, Kathmandu, Nepal
| | | | - Rachel Vreeman
- Chair, Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai New York, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai; Arnhold Institute for Global Health, New York, NY, USA
| | - Sheela Maru
- Assistant Professor, Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Department of Health Systems Design and Global Health, New York, USA; Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology and Reproductive Science, New York, NY, USA; Possible, New York, USA
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19
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Gulati A, Tiwari A, Shetty V, Nwosu I, Khurana S. Tirofiban: A Rare Cause of Thrombocytopenia in a Patient Undergoing Percutaneous Coronary Intervention. Cureus 2021; 13:e18217. [PMID: 34722029 PMCID: PMC8544618 DOI: 10.7759/cureus.18217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
Patients admitted to the hospital can develop thrombocytopenia due to multifactorial causes. It can be pseudo-thrombocytopenia or true thrombocytopenia. Among patients admitted for chest pain, coronary angiography (CAG) is a common diagnostic test to evaluate patients for coronary artery disease (CAD). Normally, patients undergoing angiogram receive antiplatelets and anticoagulants pre-catheterization, and platelet aggregation inhibitor agents are sometimes used during and after CAG like in patients with high thrombus burden. Glycoprotein IIb/IIIa receptor inhibitors are a type of platelet antiaggregant agents that can cause severe thrombocytopenia in few cases. We present a case of a 68-year-old patient who came to the emergency department with inferior wall ST-segment elevation myocardial infarction and underwent angiography and had percutaneous coronary intervention (PCI) done. He was administered tirofiban during the angiogram that caused acute severe thrombocytopenia decreasing platelets count to 4000/microliter within one day. Patients' platelets gradually recovered after platelets transfusion.
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Affiliation(s)
- Amit Gulati
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Aparna Tiwari
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Vijay Shetty
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Ifeanyi Nwosu
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Sakshi Khurana
- Radiology, New York Presbyterian-Columbia University Irving Medical Center, New York City, USA
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20
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Tiwari A, De A, Pande V, Sinha A. Interlinking Antecedent Malaria and Hypertension Through Angiotensin II in India. Front Cardiovasc Med 2021; 8:729525. [PMID: 34708085 PMCID: PMC8542721 DOI: 10.3389/fcvm.2021.729525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/17/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Aparna Tiwari
- Parasite Host Biology, Indian Council of Medical Research - National Institute of Malaria Research, New Delhi, India.,Department of Biotechnology, Kumaun University, Nainital, India
| | - Auley De
- Parasite Host Biology, Indian Council of Medical Research - National Institute of Malaria Research, New Delhi, India
| | - Veena Pande
- Department of Biotechnology, Kumaun University, Nainital, India
| | - Abhinav Sinha
- Parasite Host Biology, Indian Council of Medical Research - National Institute of Malaria Research, New Delhi, India
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21
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Abstract
The etiopathogenesis of COVID-19 and its differential geographic spread suggest some populations are apparently 'less affected' through many host-related factors that involve angiotensin-converting enzyme 2 (ACE2) protein, which is also the entry receptor for SARS-CoV-2. The role of ACE2 has been well studied in COVID-19 but not in the context of malaria and COVID-19. We have previously suggested how malaria might intersect with COVID-19 through ACE2 mutation and here we evaluate the currently available data that could provide a link between the two diseases. Based on the existing global and Indian data on malaria, COVID-19 and the suggested ACE2 mutation, the association could not be examined robustly, neither accepting nor refuting the suggested hypothesis. We strongly recommend targeted evaluation of this hypothesis through carefully designed robust molecular epidemiological studies.
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Affiliation(s)
- A. De
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - M. Dash
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - A. Tiwari
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - A. Sinha
- ICMR-National Institute of Malaria Research, New Delhi, India
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22
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Chickermane PR, Kuriakose M, Tiwari A, Shahul A, Balan S. POS1331 LONG-TERM OUTCOME IN CHILDREN WITH JUVENILE DERMATOMYOSITIS FROM SOUTHERN INDIA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:There is paucity of data regarding long-term outcome and cumulative damage in children with juvenile dermatomyositis (JDM) from the Indian subcontinent.Objectives:To assess the long-term outcome and cumulative damage in children with JDM receiving treatment at a tertiary hospital in southern India.Methods:Retrospective review of records and cross-sectional assessment of outcome and damage in 29 patients with JDM at a tertiary hospital in Kochi, India. The disease course was categorized as monocyclic, polycyclic and chronic progressive. Cumulative damage was assessed using the IMACS myositis damage index (MDI).Results:Twenty-nine patients (male-16) diagnosed with definite or probable juvenile dermatomyositis based on the Bohan and Peter criteria and having a minimum follow-up period of 3 years each were enrolled. Of these, 20 children were diagnosed and initiated on treatment at our institute (inceptional) and 9 were diagnosed elsewhere and referred to our centre for further management (non-inceptional). The mean age at disease onset was 7.01 ± 3.34 years (range 1.0 to 13.5 years). The median interval from onset to diagnosis was 3 months (range- 3 weeks to 8.75 years). Delayed diagnosis defined as interval from onset to diagnosis exceeding 6 months was noted in case of 8 children. Among patients in the non-inceptional group, six were considered to have not received standard of care treatment prior to referral to our centre. Standard of care treatment was defined as initiation of a treatment regimen comprising of a combination of glucocorticoids with an immunosuppressive agent within 4 weeks of diagnosis. A total of 11 children had a delayed diagnosis and/or had not received standard of care treatment prior to referral.At our centre, all patients received oral steroids and subcutaneous methotrexate as standard therapy. Pulse steroids were used to induce remission in 12 patients and as a rescue for relapses in 2 patients. Intravenous immunoglobulin was used in 10 children with severe myositis, oropharyngeal weakness, refractory cutaneous disease including calcinosis and concomitant infection, where affordable with good results. Hydroxychloroquine was added in 15 patients with dominant cutaneous manifestations. Mycophenolate mofetil, azathioprine and tacrolimus were used in patients refractory or intolerant to methotrexate. Cyclophosphamide and rituximab were used in 4 patients each with refractory disease and extra-muscular manifestations such as interstitial lung disease. Seven patients with refractory calcinosis received pamidronate infusions.The total follow-up duration was 121.06 patient-years. A monocyclic course was observed in 11/29 (37.9%), chronic progressive course in 16/29 (55.2%) and polycyclic course in 2/29(6.9 %). Nearly half of the patients (14/29) had damage in at least one organ using the MDI (MDI ≥1). 38% of the patients (11/29) had at least one sign of cutaneous damage, the most common being calcinosis (n=11) and lipodystrophy (n=4). This was followed by skeletal damage (n=6, joint contractures-5, osteoporosis with fracture-1), muscle and pulmonary (pulmonary fibrosis) damage in 3 patients each, endocrine damage in 2 patients (diabetes mellitus-1, growth failure and delayed development of secondary sexual characteristics-1) and chronic infection in one patient. All patients with damage in at least one organ had a chronic progressive course, indicating damage accrual. Delayed diagnosis and lack of standard of care treatment prior to referral (i.e., longer duration of untreated/ sub-optimally treated disease) were associated with an increased risk of cumulative damage (p< 0.05).Conclusion:Nearly half of the patients had damage in at least one organ using the MDI. Cutaneous damage was the most common, followed by skeletal, muscle, pulmonary and endocrine damage. Longer duration of untreated/ sub-optimally treated disease significantly increases the risk of cumulative damage, highlighting the need for an early diagnosis and referral to pediatric rheumatology services.Disclosure of Interests:None declared
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23
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Manchanda R, Dhar N, Kumar M, Kumar N, Tiwari A. Thickened sural nerve in Hansen's disease. QJM 2021; 114:202-203. [PMID: 32614397 DOI: 10.1093/qjmed/hcaa216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Manchanda
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - N Dhar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - M Kumar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - N Kumar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - A Tiwari
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
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24
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Raheja H, Chukwuka N, Agarwal C, Sharma D, Munoz-Martinez A, Fogel J, Khalid M, Hashmi AT, Ehrlich S, Waheed MA, Siddiqui S, de Brito Gomes BA, Aslam A, Merino Gualan CJ, Aftab I, Tiwari A, Singh S, Pouching K, Somal N, Shani J, Rojas-Marte G. Should COVID-19 patients >75 years be Ventilated? An Outcome Study. QJM 2021; 114:182-189. [PMID: 33580251 PMCID: PMC7928642 DOI: 10.1093/qjmed/hcab029] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/02/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Elderly patients with COVID-19 disease are at increased risk for adverse outcomes. Current data regarding disease characteristics and outcomes in this population are limited. AIM To delineate the adverse factors associated with outcomes of COVID-19 patients ≥75 years of age. DESIGN Retrospective cohort study. METHODS Patients were classified into mild/moderate, severe/very severe and critical disease (intubated) based on oxygen requirements. The primary outcome was in-hospital mortality. RESULTS A total of 355 patients aged ≥75 years hospitalized with COVID-19 between 19 March and 25 April 2020 were included.Mean age was 84.3 years. One-third of the patients developed critical disease. Mean length of stay was 7.10 days. Vasopressors were required in 27%, with the highest frequency in the critical disease group (74.1%). Overall mortality was 57.2%, with a significant difference between severity groups (mild/moderate disease: 17.4%, severe/very severe disease: 71.3%, critical disease: 94.9%, P < 0.001).Increased age, dementia, and severe/very severe and critical disease groups were independently associated with increased odds for mortality while diarrhea was associated with decreased odds for mortality (OR: 0.12, 95% CI: 0.02-0.60, P < 0.05). None of the cardiovascular comorbidities were significantly associated with mortality. CONCLUSION Age and dementia are associated with increased odds for mortality in patients ≥75 years of age hospitalized with COVID-19. Those who require intubation have the greatest odds for mortality. Diarrhea as a presenting symptom was associated with lower odds for mortality.
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Affiliation(s)
- H Raheja
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - N Chukwuka
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - C Agarwal
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - D Sharma
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - A Munoz-Martinez
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - J Fogel
- Department of Business Management, Brooklyn College, Brooklyn, NY, USA
| | - M Khalid
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - A T Hashmi
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - S Ehrlich
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - M A Waheed
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - S Siddiqui
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - B A de Brito Gomes
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - A Aslam
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - C J Merino Gualan
- Department of Volunteer and Student Services, Maimonides Medical Center, Brooklyn, NY, USA
| | - I Aftab
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - A Tiwari
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - S Singh
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - K Pouching
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - N Somal
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - J Shani
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - G Rojas-Marte
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Staten Island, NY, USA
- Address correspondence to Geurys R Rojas-Marte, M.D., Department of Cardiology, Maimonides Medical Center, Assistant Professor of Cardiology, Zucker School of Medicine at Hosftra/Northwell, 4802 10th Ave, Brooklyn, NY, USA.
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25
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Tiwari A, Rauf A, Kesavan S, Kappanayil M, Sivadas S, Balan S, Chickermane P. POS1262 A COHORT STUDY OF COVID-19 RELATED MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN AND ADOLESCENTS FROM MULTIPLE TERTIARY CARE CENTRES IN SOUTH INDIA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:After the peak of COVID 19 pandemic, a surge of cases with multi-system involvement and hyperinflammatory state was reported in children, at multiple tertiary care centers across the world. (1) This COVID-19 associated multisystem inflammatory syndrome in children and adolescents is also known as multisystem inflammatory syndrome in children (MIS-C). There is a paucity of literature of clinical profile of MIS-C patients from India.Objectives:To study the clinical manifestations and treatment outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C) and adolescents.Methods:It was a cohort study including cases defnied as per the case definitions of MIS-C by World Health Organisation (WHO) or Centre for Disease Control and Prevention(CDC).(2)The clinical parameters, laboratory parameters (including inflammatory markers, D dimer and NT ProBNP), electrocardiogram, 2D echocardiogram, course in hospital, and immediate outcomes were noted.Results:Twenty five patients (male-14) with a mean age of 6.22 ±4.25 years and a mean body mass index of 16.21 ±3.36 kg/m2 were enrolled on the study. Average length of hospital stay was 8.12±5.76 days. Associated comorbidities were present in 4 of our patients (16%). Figure 1 shows the frequency of clinical features in our study patients. Table 1 shows the clinical, laboratory, imaging findings, disease course and outcomes.Figure 1.Frequency of clinical features in our MIS-C cohort patientsTable 1.Clinical characteristics of MIS-C patients (n)=25Clinical Phenotypes:Incomplete/ Atypical Kawasaki Disease (KD)18 (72%)Macrophage activation syndrome (MAS)11 (44%)Unexplained Shock13 (52%)Fever with gastrointestinal symptoms17 (68%)Fever with neurological symptoms9 (36%)Fever with respiratory symptoms5 (20%)COVID chronology:MISC with acute COVID 19 with MAS1 (4%)MISC with acute COVID 19 with incomplete/atypical KD1 (4%)COVID 19 tests:COVID 19 RTPCR positive2 (8%)COVID 19 RTPCR negative23 (92%)COVID 19 IgG positive20 (80%)COVID 19 IgM positive6 (24%)COVID 19 IgG and IgM both positive2 (8%)COVID 19 IgG and IgM not done4 (16%)Other laboratory investigations(Peak/ trough values):Anaemia20 (80%)Leukopenia2 (8%)Thrombocytopenia6 (24%)Pancytopenia2 (8%)Positive CRP23 (92%)High Procalcitonin9 (36%)High ferritin10 (40%)High D- dimer17 (68%)High NT ProBNP23 (92%)Hypoalbuminemia14 (56%)Sterile pyuria7 (28%)Proteinuria4 (16%)Cardiac assessment:Abnormal Electrocardiogram (ECG)5 (20%)Abnormal Echocardiography15 (60%)Coronary dilation/prominence/non-tapering9 (36%)Coronary aneurysm1 (4%)LAD Z score (Mean±SD)2.12 ± 1.11Decreased Ejection fraction (EF)5 (20%)Systolic Dysfunction5 (20%)Pericardial effusion9 (36%)Global/septal hypokinesia4 (16%)Mitral Valve regurgitation3 (12%)Complete heart block1 (4%)Twenty patients (80%) had severe illness requiring intensive care. Fourteen patients (56%) required inotropic support, 8 patients (32%) required supplemental oxygen, 5 patients (20%) required mechanical ventilation and 2 patients (8%) expired. A total of 23 patients (92%) received pulse steroids followed by oral/iv steroids, 22 patients (88%) received IVIG (2g/kg) and 3 patients (12%) required anticoagulation.Conclusion:Our MIS-C cohort had varied clinical manifestations ranging from the mild cutaneous and gastrointestinal symptoms to fatal multiorgan dysfunctions. In contrast to western cohorts, our study cohort had higher number of patients from younger age group and lower BMI.References:[1]Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine. 2020;26:100527.[2]Jiang L, Tang K, Levin M, Irfan O, Morris S, Wilson K et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. The Lancet Infectious Diseases. 2020;20(11):e276-e288.Disclosure of Interests:None declared
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Al-Mufti F, Amuluru K, Sahni R, Bekelis K, Karimi R, Ogulnick J, Cooper J, Overby P, Nuoman R, Tiwari A, Berekashvili K, Dangayach N, Liang J, Gupta G, Khandelwal P, Dominguez JF, Sursal T, Kamal H, Dakay K, Taylor B, Gulko E, El-Ghanem M, Mayer SA, Gandhi C. Cerebral Venous Thrombosis in COVID-19: A New York Metropolitan Cohort Study. AJNR Am J Neuroradiol 2021; 42:1196-1200. [PMID: 33888450 DOI: 10.3174/ajnr.a7134] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/23/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is associated with hypercoagulability. We sought to evaluate the demographic and clinical characteristics of cerebral venous thrombosis among patients hospitalized for coronavirus disease 2019 (COVID-19) at 6 tertiary care centers in the New York City metropolitan area. MATERIALS AND METHODS We conducted a retrospective multicenter cohort study of 13,500 consecutive patients with COVID-19 who were hospitalized between March 1 and May 30, 2020. RESULTS Of 13,500 patients with COVID-19, twelve had imaging-proved cerebral venous thrombosis with an incidence of 8.8 per 10,000 during 3 months, which is considerably higher than the reported incidence of cerebral venous thrombosis in the general population of 5 per million annually. There was a male preponderance (8 men, 4 women) and an average age of 49 years (95% CI, 36-62 years; range, 17-95 years). Only 1 patient (8%) had a history of thromboembolic disease. Neurologic symptoms secondary to cerebral venous thrombosis occurred within 24 hours of the onset of the respiratory and constitutional symptoms in 58% of cases, and 75% had venous infarction, hemorrhage, or both on brain imaging. Management consisted of anticoagulation, endovascular thrombectomy, and surgical hematoma evacuation. The mortality rate was 25%. CONCLUSIONS Early evidence suggests a higher-than-expected frequency of cerebral venous thrombosis among patients hospitalized for COVID-19. Cerebral venous thrombosis should be included in the differential diagnosis of neurologic syndromes associated with SARS-CoV-2 infection.
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Affiliation(s)
- F Al-Mufti
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.) .,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - K Amuluru
- Department of Radiology (K.A.), Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - R Sahni
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.).,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - K Bekelis
- Department of Neurosurgery (K. Bekelis), Catholic Health Services and Good Samaritan Hospital, West Islip, New York
| | - R Karimi
- Department of Neurosurgery (R.K.), Hackensack University Medical Center, Hackensack, New Jersey
| | - J Ogulnick
- Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - J Cooper
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - P Overby
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - R Nuoman
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - A Tiwari
- Department of Neurosurgery (A.T., K. Berekashvili), New York University, New York, New York
| | - K Berekashvili
- Department of Neurosurgery (A.T., K. Berekashvili), New York University, New York, New York
| | - N Dangayach
- Department of Neurosurgery (N.D., J.L.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - J Liang
- Department of Neurosurgery (N.D., J.L.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - G Gupta
- Department of Neurological Surgery (G.G., P.K., B.T.), Rutgers University, New Brunswick, New Jersey
| | - P Khandelwal
- Department of Neurological Surgery (G.G., P.K., B.T.), Rutgers University, New Brunswick, New Jersey
| | - J F Dominguez
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - T Sursal
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - H Kamal
- Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - K Dakay
- Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - B Taylor
- Department of Neurological Surgery (G.G., P.K., B.T.), Rutgers University, New Brunswick, New Jersey
| | - E Gulko
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.).,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - M El-Ghanem
- Department of Neurology (M.E.-G.), University of Arizona-Tuscon, Tuscon, Arizona
| | - S A Mayer
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.).,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - C Gandhi
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.).,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
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Xu Y, Das L, Ma JZ, Yi CJ, Nie SM, Shi YG, Tiwari A, Tsirkin SS, Neupert T, Medarde M, Shi M, Chang J, Shang T. Unconventional Transverse Transport above and below the Magnetic Transition Temperature in Weyl Semimetal EuCd_{2}As_{2}. Phys Rev Lett 2021; 126:076602. [PMID: 33666464 DOI: 10.1103/physrevlett.126.076602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/13/2020] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
As exemplified by the growing interest in the quantum anomalous Hall effect, the research on topology as an organizing principle of quantum matter is greatly enriched from the interplay with magnetism. In this vein, we present a combined electrical and thermoelectrical transport study on the magnetic Weyl semimetal EuCd_{2}As_{2}. Unconventional contribution to the anomalous Hall and anomalous Nernst effects were observed both above and below the magnetic transition temperature of EuCd_{2}As_{2}, indicating the existence of significant Berry curvature. EuCd_{2}As_{2} represents a rare case in which this unconventional transverse transport emerges both above and below the magnetic transition temperature in the same material. The transport properties evolve with temperature and field in the antiferromagnetic phase in a different manner than in the paramagnetic phase, suggesting different mechanisms to their origin. Our results indicate EuCd_{2}As_{2} is a fertile playground for investigating the interplay between magnetism and topology, and potentially a plethora of topologically nontrivial phases rooted in this interplay.
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Affiliation(s)
- Y Xu
- Physik-Institut, Universität Zürich, Winterthurerstrasse 190, CH-8057 Zürich, Switzerland
| | - L Das
- Physik-Institut, Universität Zürich, Winterthurerstrasse 190, CH-8057 Zürich, Switzerland
| | - J Z Ma
- Department of Physics, City University of Hong Kong, Kowloon, Hong Kong
- Swiss Light Source, Paul Scherrer Institut, Villigen CH-5232, Switzerland
| | - C J Yi
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, China
| | - S M Nie
- Department of Materials Science and Engineering, Stanford University, Stanford, California 94035, USA
| | - Y G Shi
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - A Tiwari
- Physik-Institut, Universität Zürich, Winterthurerstrasse 190, CH-8057 Zürich, Switzerland
- Condensed Matter Theory Group, Paul Scherrer Institute, CH-5232 Villigen PSI, Switzerland
| | - S S Tsirkin
- Physik-Institut, Universität Zürich, Winterthurerstrasse 190, CH-8057 Zürich, Switzerland
| | - T Neupert
- Physik-Institut, Universität Zürich, Winterthurerstrasse 190, CH-8057 Zürich, Switzerland
| | - M Medarde
- Laboratory for Multiscale Materials Experiments, Paul Scherrer Institut, CH-5232 Villigen PSI, Switzerland
| | - M Shi
- Swiss Light Source, Paul Scherrer Institut, Villigen CH-5232, Switzerland
| | - J Chang
- Physik-Institut, Universität Zürich, Winterthurerstrasse 190, CH-8057 Zürich, Switzerland
| | - T Shang
- Physik-Institut, Universität Zürich, Winterthurerstrasse 190, CH-8057 Zürich, Switzerland
- Laboratory for Multiscale Materials Experiments, Paul Scherrer Institut, CH-5232 Villigen PSI, Switzerland
- Key Laboratory of Polar Materials and Devices (MOE), School of Physics and Electronic Science, East China Normal University, Shanghai 200241, China
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Affiliation(s)
- Auley De
- ICMR-National Institute of Malaria Research, New Delhi, 110077, India
| | - Aparna Tiwari
- ICMR-National Institute of Malaria Research, New Delhi, 110077, India.,Kumaun University, Nainital, 263001, Uttarakhand, India
| | - Manoswini Dash
- ICMR-National Institute of Malaria Research, New Delhi, 110077, India.,Kumaun University, Nainital, 263001, Uttarakhand, India
| | - Abhinav Sinha
- ICMR-National Institute of Malaria Research, New Delhi, 110077, India.
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Tiwari A, Fong DYT, Yuen FKH, Fung HYK, Pang POY, Wong JYH. Purpose-built intervention for mental health of Mainland Chinese immigrant women survivors of intimate partner violence: a randomised controlled trial (abridged secondary publication). Hong Kong Med J 2020; 26 Suppl 8:7-9. [PMID: 33504670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Affiliation(s)
- A Tiwari
- School of Nursing, The University of Hong Kong
| | - D Y T Fong
- School of Nursing, The University of Hong Kong
| | - F K H Yuen
- School of Nursing, The University of Hong Kong
| | | | | | - J Y H Wong
- School of Nursing, The University of Hong Kong
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Wang J, Tiwari A, Persson BNJ, Sivebaek IM. Cylinder-flat-surface contact mechanics during sliding. Phys Rev E 2020; 102:043002. [PMID: 33212665 DOI: 10.1103/physreve.102.043002] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/16/2020] [Indexed: 11/07/2022]
Abstract
Using molecular dynamics we study the dependency of the contact mechanics on the sliding speed when an elastic block (cylinder) with a cos(q_{0}x) surface height profile is sliding in adhesive contact on a rigid flat substrate. The atoms on the block interact with the substrate atoms by Lennard-Jones potentials, and we consider both commensurate and (nearly) incommensurate contacts. For the incommensurate system the friction force fluctuates between positive and negative values, with an amplitude proportional to the sliding speed, but with the average close to zero. For the commensurate system the (time-averaged) friction force is much larger and nearly velocity independent. For both types of systems the width of the contact region is velocity independent even when, for the commensurate case, the frictional shear stress increases from zero (before sliding) to ≈0.1MPa during sliding. This frictional shear stress, and the elastic modulus used, are typical for polydimethylsiloxane rubber sliding on a glass surface, and we conclude that the reduction in the contact area observed in some experiments when increasing the tangential force must be due to effects not included in our model study, such as viscoelasticity or elastic nonlinearity.
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Affiliation(s)
- J Wang
- PGI-1, FZ Jülich, Germany, European Union and College of Science, Zhongyuan University of Technology, Zhengzhou 450007, China
| | - A Tiwari
- PGI-1, FZ Jülich, Germany, European Union
| | | | - I M Sivebaek
- PGI-1, FZ Jülich, Germany, European Union; Department of Mechanical Engineering, Technical University of Denmark, Kongens Lyngby 2800, Denmark, European Union; and Novo Nordisk Device R & D, DK-3400 Hillerød, Denmark, European Union
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Tiwari A, Wang J, Persson BNJ. Adhesion paradox: Why adhesion is usually not observed for macroscopic solids. Phys Rev E 2020; 102:042803. [PMID: 33212630 DOI: 10.1103/physreve.102.042803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/30/2020] [Indexed: 11/07/2022]
Abstract
The adhesion paradox refers to the observation that for most solid objects no adhesion can be detected when they are separated from a state of molecular contact. The adhesion paradox results from surface roughness, and we present experimental and theoretical results that show that adhesion in most cases is "killed" by the longest-wavelength roughness. In addition, adhesion experiments between a human finger and a clean glass plate were carried out, and for a dry finger no macroscopic adhesion occurred. We suggest that the observed decrease in the contact area with increasing shear force results from nonadhesive finger-glass contact mechanics, involving large deformations of complex layered material.
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Affiliation(s)
- A Tiwari
- PGI-1, FZ Jülich, Germany, Jülich 52428, European Union
| | - J Wang
- PGI-1, FZ Jülich, Germany, Jülich 52428, European Union.,College of Science, Zhongyuan University of Technology, Zhengzhou 450007, China
| | - B N J Persson
- PGI-1, FZ Jülich, Germany, Jülich 52428, European Union
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Nevrekar V, Choudhary P, Tiwari A, Suryaprakash V, Upadhyay A. 908P Impact of serum galactomannan assay on diagnosis and outcome of invasive fungal infections in high risk febrile neutropenia: A prospective cohort study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nepal P, Schwarz R, Citrin D, Thapa A, Acharya B, Acharya Y, Aryal A, Baum A, Bhandari V, Bhatt L, Bhattarai D, Choudhury N, Dangal B, Dhimal M, Dhungana SK, Gauchan B, Halliday S, Kalaunee SP, Kunwar LB, Maru D, Nirola I, Paudel R, Raut A, Rayamazi HJ, Sapkota S, Schwarz D, Thapa P, Thapa P, Tiwari A, Tuitui R, Walter E, Maru S. Costing Analysis of a Pilot Community Health Worker Program in Rural Nepal. Glob Health Sci Pract 2020; 8:239-255. [PMID: 32606093 PMCID: PMC7326517 DOI: 10.9745/ghsp-d-19-00393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 05/19/2020] [Indexed: 01/01/2023]
Abstract
Data from a retrospective costing analysis offers insights and practical considerations for policy makers and locally elected officials for designing and implementing a new community health work cadre as a mechanism to achieve SDG targets in Nepal. Community health workers (CHWs) are essential to primary health care systems and are a cost-effective strategy to achieve the Sustainable Development Goals (SDGs). Nepal is strongly committed to universal health coverage and the SDGs. In 2017, the Nepal Ministry of Health and Population partnered with the nongovernmental organization Nyaya Health Nepal to pilot a program aligned with the 2018 World Health Organization guidelines for CHWs. The program includes CHWs who: (1) receive regular financial compensation; (2) meet a minimum education level; (3) are well supervised; (4) are continuously trained; (5) are integrated into local primary health care systems; (6) use mobile health tools; (7) have consistent supply chain; (8) live in the communities they serve; and (9) provide service without point-of-care user fees. The pilot model has previously demonstrated improved institutional birth rate, antenatal care completion, and postpartum contraception utilization. Here, we performed a retrospective costing analysis from July 16, 2017 to July 15, 2018, in a catchment area population of 60,000. The average per capita annual cost is US$3.05 (range: US$1.94 to US$4.70 across 24 villages) of which 74% is personnel cost. Service delivery and administrative costs and per beneficiary costs for all services are also described. To address the current discourse among Nepali policy makers at the local and federal levels, we also present 3 alternative implementation scenarios that policy makers may consider. Given the Government of Nepal’s commitment to increase health care spending (US$51.00 per capita) to 7.0% of the 2030 gross domestic product, paired with recent health care systems decentralization leading to expanded fiscal space in municipalities, this CHW program provides a feasible opportunity to make progress toward achieving universal health coverage and the health-related SDGs. This costing analysis offers insights and practical considerations for policy makers and locally elected officials for deploying a CHW cadre as a mechanism to achieve the SDG targets.
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Affiliation(s)
| | - Ryan Schwarz
- Possible, New York, NY, USA. .,Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA.,Massachusetts General Hospital, Department of Medicine, Division of General Internal Medicine, Boston, MA, USA
| | - David Citrin
- Possible, New York, NY, USA.,University of Washington, Department of Global Health, Seattle, WA, USA.,University of Washington, Department of Anthropology, Seattle, WA, USA.,University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | | | - Bibhav Acharya
- Possible, New York, NY, USA.,University of California, San Francisco, Department of Psychiatry, San Francisco, CA, USA
| | - Yubraj Acharya
- Pennsylvania State University, College of Health and Human Development, Department of Health Policy and Administration, University Park, PA, USA
| | - Anu Aryal
- Nyaya Health Nepal, Kathmandu, Nepal
| | - Aaron Baum
- Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | | | | | | | - Nandini Choudhury
- Possible, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | | | | | | | - Bikash Gauchan
- Nyaya Health Nepal, Kathmandu, Nepal.,University of California, San Francisco, Health Equity Action Leadership Initiative, San Francisco, CA, USA
| | - Scott Halliday
- Possible, New York, NY, USA.,University of Washington, Department of Global Health, Seattle, WA, USA.,University of Washington, Department of Anthropology, Seattle, WA, USA.,University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA
| | - S P Kalaunee
- Nyaya Health Nepal, Kathmandu, Nepal.,Eastern University, College of Leadership and Development, St. Davids, PA, USA
| | | | - Duncan Maru
- Possible, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Health Systems Design and Global Health, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Internal Medicine, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Pediatrics, New York, NY, USA
| | - Isha Nirola
- Possible, New York, NY, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | | | - Dan Schwarz
- Possible, New York, NY, USA.,Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA, USA.,Ariadne Labs, Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, MA, USA
| | - Poshan Thapa
- University of New South Wales, School of Public Health and Community Medicine, Sydney, NSW, Australia
| | | | | | - Roshani Tuitui
- Nursing and Social Security Division, Dept of Health Services, Kathmandu, Nepal
| | - Eric Walter
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.,University of Pennsylvania, The Wharton School, Healthcare Management Department, Philadelphia, PA, USA
| | - Sheela Maru
- Possible, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Health Systems Design and Global Health, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology and Reproductive Science, New York, NY, USA
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Wu WJ, Tiwari A, Choudhury N, Basnett I, Bhatt R, Citrin D, Halliday S, Kunwar L, Maru D, Nirola I, Pandey S, Rayamazi HJ, Sapkota S, Saud S, Thapa A, Goldberg A, Maru S. Community-based postpartum contraceptive counselling in rural Nepal: a mixed-methods evaluation. Sex Reprod Health Matters 2020; 28:1765646. [PMID: 32546070 PMCID: PMC7887993 DOI: 10.1080/26410397.2020.1765646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Unmet need for postpartum contraception in rural Nepal remains high and expanding access to sexual and reproductive healthcare is essential to achieving universal healthcare. We evaluated the impact of an integrated intervention that employed community health workers aided by mobile technology to deliver patient-centred, home-based antenatal and postnatal counselling on postpartum modern contraceptive use. This was a pre–post-intervention study in seven village wards in a single municipality in rural Nepal. The primary outcome was modern contraceptive use among recently postpartum women. We performed a multivariable logistic regression to examine contraceptive use among postpartum women pre- and one-year post-intervention. We conducted qualitative interviews to explore the implementation process. There were 445 postpartum women in the pre-intervention group and 508 in the post-intervention group. Modern contraceptive use increased from 29% pre-intervention to 46% post-intervention (p < 0.0001). Adjusting for age, caste, and household expenditure, time since delivery and sex of child in the index pregnancy, postpartum women one-year post-intervention had twice the odds (OR 2.3; CI 1.7, 3.1; p < 0.0001) of using a modern contraceptive method as compared to pre-intervention. Factors at the individual, family, and systems level influenced women’s contraceptive decisions. The intervention contributed to increasing contraceptive use through knowledge transfer, demand generation, referrals to healthcare facilities, and follow-up. A community-based, patient-centred contraceptive counselling intervention supported by mobile technology and integrated into longitudinal care delivered by community health workers appears to be an effective strategy for improving uptake of modern contraception among postpartum women in rural Nepal.
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Affiliation(s)
- Wan-Ju Wu
- Assistant Professor, Possible, New York, NY, USA; Boston Medical Center, Department of Obstetrics and Gynecology, Boston, MA, USA; Boston University School of Medicine, Department of Obstetrics and Gynecology, Boston, MA, USA
| | - Aparna Tiwari
- Research Analyst, Nyaya Health Nepal, Kathmandu, Nepal
| | - Nandini Choudhury
- Delivery Science Analyst, Possible, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | - Indira Basnett
- Health Advisor, Ministry of Health and Population, Nepal Health Sector Support Programme, Kathmandu, Nepal
| | - Rita Bhatt
- Community Health Nurse, Nyaya Health Nepal, Kathmandu, Nepal
| | - David Citrin
- Director of Evidence to Policy, Possible, New York, NY, USA; Departments of Global Health and Anthropology, Henry M Jackson School of International Studies, University of Washington, Seattle, WA, USA
| | - Scott Halliday
- Senior Implementation Research Manager, Possible, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, US; Department of Global Health, Henry M Jackson School of International Studies, University of Washington, Seattle, WA, USA
| | - Lal Kunwar
- Independent Consultant, Nyaya Health Nepal, Kathmandu, Nepal
| | - Duncan Maru
- Senior Advisor, Possible, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Departments of Internal Medicine and Pediatrics, Arnhold Institute for Global Health, New York, NY, USA
| | - Isha Nirola
- Doctoral Candidate, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sachit Pandey
- Mobile Systems Engineer, Nyaya Health Nepal, Kathmandu, Nepal
| | | | - Sabitri Sapkota
- Director of Implementation Research, Nyaya Health Nepal, Kathmandu, Nepal
| | - Sita Saud
- Community Health Programme Associate , Nyaya Health Nepal, Kathmandu, Nepal
| | - Aradhana Thapa
- Director of Healthcare Design, Nyaya Health Nepal, Kathmandu, Nepal
| | - Alisa Goldberg
- Associate Professor, Brigham and Women's Hospital, Department of Obstetrics, Gynecology and Reproductive Biology, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Planned Parenthood League of Massachusetts, Boston, MA, USA
| | - Sheela Maru
- Assistant Professor, Possible, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Arnhold Institute for Global Health, New York, NY, USA
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Singh M, Pawar M, Bothra A, Maheshwari A, Dubey V, Tiwari A, Kelati A. Personal protective equipment induced facial dermatoses in healthcare workers managing Coronavirus disease 2019. J Eur Acad Dermatol Venereol 2020; 34:e378-e380. [PMID: 32396675 PMCID: PMC7272982 DOI: 10.1111/jdv.16628] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- M Singh
- Department of Dermatology, JK Medical College & LN Hospital, Bhopal, India
| | - M Pawar
- Department of Dermatology, MVP's Dr. V.P Medical College& Hospital & Research Center, Nashik, India
| | - A Bothra
- Department of Dermatology, Gauhati Medical College & Hospital, Guwahati, India
| | - A Maheshwari
- Consultant Dermatologist, Private Practice, New Delhi, India
| | - V Dubey
- Department of Orthopaedic surgery, JK Medical College & LN Hospital, Bhopal, India
| | - A Tiwari
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - A Kelati
- Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
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Pathak Y, Shukla PK, Tiwari A, Stalin S, Singh S, Shukla PK. Deep Transfer Learning Based Classification Model for COVID-19 Disease. Ing Rech Biomed 2020; 43:87-92. [PMID: 32837678 PMCID: PMC7238986 DOI: 10.1016/j.irbm.2020.05.003] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022]
Abstract
The COVID-19 infection is increasing at a rapid rate, with the availability of limited number of testing kits. Therefore, the development of COVID-19 testing kits is still an open area of research. Recently, many studies have shown that chest Computed Tomography (CT) images can be used for COVID-19 testing, as chest CT images show a bilateral change in COVID-19 infected patients. However, the classification of COVID-19 patients from chest CT images is not an easy task as predicting the bilateral change is defined as an ill-posed problem. Therefore, in this paper, a deep transfer learning technique is used to classify COVID-19 infected patients. Additionally, a top-2 smooth loss function with cost-sensitive attributes is also utilized to handle noisy and imbalanced COVID-19 dataset kind of problems. Experimental results reveal that the proposed deep transfer learning-based COVID-19 classification model provides efficient results as compared to the other supervised learning models.
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Affiliation(s)
- Y Pathak
- Department of Information Technology, Indian Institute of Information Technology (IIIT-Bhopal), Bhopal (MP), 462003, India
| | - P K Shukla
- Department of Computer Science & Engineering, School of Engineering & Technology, Jagran Lake City University (JLU), Bhopal-462044 (MP), India
| | - A Tiwari
- Department of CSE & IT, Madhav Institute of Technology and Science, Gwalior-474005 (MP), India
| | - S Stalin
- Department of CSE, Maulana Azad National Institute of Technology (MANIT), Bhopal, MP, 462003, India
| | - S Singh
- Department of Computer Science & Engineering, Jabalpur Engineering College, Jabalpur-482001 (MP), India
| | - P K Shukla
- Department of Computer Science & Engineering, University Institute of Technology, RGPV, Bhopal (MP), 462033, India
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Tiwari A, Barwad PARAG, Dabi UMA. P268 Anomalies of pulmonary arteries in Tetralogy of Fallot in developing countries: study of 100 cases in indian population. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Right ventricular outflow tract (RVOT) obstruction in some or other form is one of the major components of Tetralogy of Fallot. It can occur at any level, isolated or in combination, from Infundibulum (most common), Pulmonary valve, Main pulmonary artery, Right and Left pulmonary arteries and up to their segmental branches. Incidence of pulmonary artery anomalies are reported between 15-20%, though some reported as high as 40%.
Purpose
The objective of this retrospective observational study is to determine the presence and degree of pulmonary artery abnormalities and associated cardiac defects in patients with Tetralogy of Fallot and to define the pulmonary arterial anatomy to guide the further surgical management.
Method
A total of 100 newly diagnosed or follow up cases of TOF irrespective of age (range 5 days- 32 years) and gender (32 female, 68 male) who were planned for surgical management and referred for evaluation of pulmonary artery anatomy. All patient underwent non-ECG gated CT pulmonary Angiography in Toshiba 64 slice CT scanner. CT data was analyzed retrospectively to look for cardiac and pulmonary artery anatomy by one independent observer having experience in cardiac radiology.
Results
92 patient had infundibular and valvular stenosis and 8 patients has atretic pulmonary valve with additional supravalvar pulmonary stenosis in 17% patient. Out of total 100 patients, 35% had pulmonary artery abnormalities. This included 19 patient (19%) with isolated main pulmonary artery (MPA) abnormality, 6 % had isolated left pulmonary artery (LPA) abnormality, 2 had isolated right pulmonary artery abnormality, 4% had combined MPA and LPA abnormality, 2% had combined MPA and RPA abnormalities and 1% patient had all 3 (MPA,LPA,RPA) involvement in form of stenosis or hypoplasia. As TOF is commonly associated with other cardiac structural anomalies, we encountered following associations in our study – aortopulmonary collaterals (37%), Patent ductus arteriosus (29%), right sided aortic arch (19%), bilateral superior vena cava (10%), bovine arch (3%), double aortic arch (2%), d malposition of great vessels (2%), l malposition of great vessels (1%), situs inversus (1%), dextrocardia (1%), annuloaortic ectasia (1%) aortopulmonary window (1%) and cardiac totally anomalous pulmonary venous connection (1%).
Conclusions
Anomalies of pulmonary arteries are important determinant of surgical outcome of TOF patients. CT angiography is now established modality to delineate pulmonary artery and other anatomical details in TOF patient. Pulmonary artery anomaly can range from isolated branch pulmonary stenosis to diffuse hypoplasia of pulmonary vasculature, based on which management can differ from complete correction to palliative or medical management only. Our study emphasize the importance of pulmonary artery evaluation and its variation among patients of TOF.
Abstract P268 Figure.
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Affiliation(s)
- A Tiwari
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - PARAG Barwad
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - U M A Dabi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Tiwari A, Honingh C, Ensing B. Accurate calculation of zero point energy from molecular dynamics simulations of liquids and their mixtures. J Chem Phys 2019; 151:244124. [PMID: 31893925 DOI: 10.1063/1.5131145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The two-phase thermodynamic (2PT) method is used to compute the zero point energy (ZPE) of several liquids and their mixtures. The 2PT method uses the density of states (DoS), which is computed from the velocity autocorrelation (VAC) function obtained from a short classical molecular dynamics trajectory. By partitioning the VAC and the DoS of a fluid into solid and gaslike components, quantum mechanical corrections to thermodynamical properties can be computed. The ZPE is obtained by combining the partition function of the quantum harmonic oscillator with the vibrational part of the solidlike DoS. The resulting ZPE is found to be in excellent agreement with both experimental and ab initio results. Solvent effects such as hydrogen bonding and polarization can be included by the utilization of ab initio density functional theory based molecular dynamics simulations. It is found that these effects significantly influence the DoS of water molecules. The obtained results demonstrate that the 2PT model is a powerful method for efficient ZPE calculations, in particular, to account for solvent effects and polarization.
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Affiliation(s)
- A Tiwari
- Van't Hoff Institute for Molecular Sciences, Universiteit van Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - C Honingh
- Van't Hoff Institute for Molecular Sciences, Universiteit van Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - B Ensing
- Van't Hoff Institute for Molecular Sciences, Universiteit van Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
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Gupta PK, Lal P, Tiwari A. A case report of carcinoma of uterine cervix throwing heterochronous metastasis to the skin, spleen, and pancreas: the role of multimodality treatment approach. J Egypt Natl Canc Inst 2019; 31:8. [PMID: 32372163 DOI: 10.1186/s43046-019-0009-9] [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: 07/31/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer of cervix often fails locally and/or within the pelvis. One to two percent of cervical squamous cell carcinoma patients have lung metastases at presentation, and 5-35% develop pulmonary metastases later on. Common sites of metastases are the liver, bone, and bowel. We report a rare case presentation of cervical squamous cell cancer where heterochronous metastasis occurred in the skin, spleen, and pancreas without loco-regional recurrence and skipping of visceral organs such as the lung, liver, and brain. CASE PRESENTATION A 55-year-old, postmenopausal lady presented with a complaint of bleeding of the vagina for 2 months duration. Cervical biopsy revealed squamous cell carcinoma of the cervix, and she was staged as a case of FIGO stage IIIB. She received external beam-beam radiotherapy of 50 Gy in 25 fractions along with concurrent weekly cisplatin at 35 mg/m2 followed by 3 fractions of intracavitary brachytherapy of 6 Gy each. After 30 months of follow-up, she presented with a skin lesion of 6 × 5 cm2 in the infrascapular region for 2 months duration. Biopsy revealed metastatic squamous cell carcinoma. Her metastatic work-up revealed no other lesions. Palliative radiotherapy to local site of 8 Gy in single fraction was delivered. The lesion disappeared within 4 weeks. She was given 6 cycles of cisplatin and paclitaxel salvage chemotherapy. After 30 months of follow-up, she presented with a skin lesion of 6 × 5 cm2 in the infrascapular region. Biopsy revealed metastatic squamous cell carcinoma. Her metastatic work-up revealed no other lesions. Palliative radiotherapy to the local site was planned, and a dose of 8 Gy in a single fraction was delivered. The lesion disappeared within 4 weeks. She was given 6 cycles of cisplatin and paclitaxel salvage chemotherapy. Six months after the completion of salvage therapy, she reported with the complaints of recurrent bouts of hematemesis and melena. Her CECT scan revealed 2 × 1.5 cm2 growth in the body of the pancreas and a subcentric splenic hilum node. She underwent open splenectomy with distal pancreatectomy. Histopathology report showed metastatic infiltration in pancreatic tissue by squamous cell carcinoma and one metastatic node in the splenic hilum. Post-treatment, 6 months, the patient was asymptomatic with no recurrence. CONCLUSIONS This is a rare heterochronous metastatic presentation of cervical cancer without loco-regional recurrence and visceral organs such as the lung, liver, and brain. The optimal treatment remains undefined for these patients. Multimodality treatment is necessary to manage the patients.
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Affiliation(s)
- P K Gupta
- Department of Radiation Oncology, Super Speciality Cancer Institute and Hospital, C.G. City, Lucknow, Uttar Pradesh, 226002, India.
| | - P Lal
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - A Tiwari
- Royal Cancer Institute and Research Centre, Kanpur, Uttar Pradesh, India
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Abstract
We have developed a theory of air leakage at interfaces between two elastic solids with application to suction cups in contact with randomly rough surfaces. We present an equation for the airflow in narrow constrictions which interpolates between the diffusive and ballistic (Knudsen) air-flow limits. To test the theory, we performed experiments using two different suction cups, made from soft polyvinylchloride (PVC), in contact with sandblasted polymethylmethacrylate (PMMA) plates. We found that the measured time to detach (lifetime) of the suction cups was in good agreement with theory, except for surfaces with a root-mean-square (rms) roughness below ≈1 μm, where diffusion of plasticizer from the PVC to the PMMA surface caused blockage of critical constrictions. The suction cup volume, stiffness, and elastic modulus have a huge influence on the air leakage and hence the failure time of the cups. Based on our research we propose an improved biomimetic design of suction cups that could show improved failure times with varying degrees of roughness under dry and wet environments.
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Abstract
We study the temperature and velocity dependency of rolling friction. Steel and PMMA cylinders are rolled on sheets of nitrile butadiene rubber (NBR), with and without filler, and fluoroelastomer (FKM) with filler. Measurements of the rolling friction are performed for temperatures between -40 °C and 20 °C, and for velocities between 5 μm s-1 and 0.5 cm s-1. For the unfilled NBR, a smooth rolling friction master curve is obtained using the bulk viscoelastic frequency-temperature shift factor aT. For the filled rubber compounds, a small deviation from the bulk viscoelastic shift factor is observed at low temperatures. The experimental data are analyzed using an analytical theory of rolling friction. For the filled compounds, good agreement with theory is obtained when strain softening is included, which increases the rolling friction by a factor ∼2 for the filled FKM and ∼3 for the filled NBR compounds. For the unfilled NBR, the maximum of the rolling friction occurs at higher sliding speeds than predicted by the theory. We discuss the role of the adhesive (crack-opening) contribution to the rolling friction, and the role of frozen-in elastic deformations as the rubber is cooled down below the rubber glass transition temperature.
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Affiliation(s)
| | - N Miyashita
- The Yokohama Rubber Company, 2-1 Oiwake, Hiratsuka, Kanagawa 254-8601, Japan
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Tiwari A, Dwivedi S, Chandra S, Chaudhary G, Sharma A, Pradhan A, Vishwakarma P, Bhandari M, Narain V. Early Discharge after Acute ST-Segment Elevation Myocardial Infarction: Early Experience from a High Volume Tertiary Care Center in India. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.075] [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: 10/25/2022] Open
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Tiwari A, Chaudhary G, Chandra S, Dwivedi S. IVC web angioplasty in a asymptomatic adult with primary budd-chiari syndrome. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Khanukaeva D, Filippov A, Yadav P, Tiwari A. Creeping flow of micropolar fluid through a swarm of cylindrical cells with porous layer (membrane). J Mol Liq 2019. [DOI: 10.1016/j.molliq.2019.111558] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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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Tiwari A, Dwivedi S, Chandra S, Chaudhary G, Sharma A, Sethi R, Pradhan A, Vishwakarma P, Bhandari M, Narain V. Prevalence of single and double vessel disease in aVR ST-segment elevation (aVR-STE) and acute coronary syndrome (ACS) by coronary angiography. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.030] [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: 11/27/2022] Open
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Abstract
Chondroblastoma is a benign bone tumor, represents 1%–2% of all primary bone tumors, typically seen in patients 10–25-year-old and more common in males. It occurs most frequently in the distal femur, proximal tibia, and proximal humerus. Soft tissue extension is extremely rare. Adjacent joints may develop effusions, but the tumor mass protruding into the joint has never been seen in case of chondroblastoma. We report a rare case of intra-articular chondroblastoma arising from proximal tibia in a 16-year-old boy and growing into the knee joint mimicking an intra-articular osteochondroma.
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Affiliation(s)
- Y Karkhur
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - A Tiwari
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - T Verma
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - L Maini
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Jain A, Tiwari A, Verma A, Jain SK. Vitamins for Cancer Prevention and Treatment: An Insight. Curr Mol Med 2019; 17:321-340. [PMID: 29210648 DOI: 10.2174/1566524018666171205113329] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 06/22/2017] [Revised: 10/29/2017] [Accepted: 11/28/2017] [Indexed: 12/29/2022]
Abstract
Over a few decades a strong interlink between oxidative damage and cancer has been investigated by various scientists across the world on the basis of epidemiological observations of the effects of fruits and vegetables used in the diet for cancer patients. Primarily, Vitamin C, Vitamin D and Vitamin E are reported to be involved in the amelioration of side effects which occur in chemotherapy and radiation therapy of lungs, stomach, prostate, colorectal, gastric head and neck cancers. The vitamins acting as antioxidant adjuvants are found to have apoptotic and antiangiogenesis potential as well as inhibitory effects against metastasis in cancer cells. This chapter explicitly discusses the key aspects concerned with the vitamins in relation to cancer prevention and treatment. It describes vitamins and their natural resources, role of vitamins in the body, and vitamins as prime ingredients in the diet and their effects on cancer biology with reference to recent research reports. Moreover, this paper also includes the emerging potential of pharmaceutical advances to enhance bioavailability of the vitamins to cancer patients with improved safety and efficacy. Clinicians and researchers must mull over the nutritional requirements of individual cancer patient so as to treat cancer and increase life expectancy.
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Affiliation(s)
- A Jain
- Institute of Pharmaceutical Research, GLA University, NH-2, Mathura-Delhi Road, Mathura (U.P.), 281 406. India
| | - A Tiwari
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Hari Singh Gour Central University, Sagar (M.P.), 470 003. India
| | - A Verma
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Hari Singh Gour Central University, Sagar (M.P.), 470 003. India
| | - S K Jain
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Hari Singh Gour Central University, Sagar (M.P.), 470 003. India
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Tiwari A. PO-137 Psycho-Social Issues in Ca Head and Neck survivors with respect to physical wellbeing- A retrospective study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mehanni S, Wong L, Acharya B, Agrawal P, Aryal A, Basnet M, Citrin D, Dangal B, Deukmedjian G, Dhungana SK, Gauchan B, Gupta TK, Halliday S, Kalaunee SP, Kshatriya U, Kumar A, Maru D, Maru S, Nguyen V, Paudel JS, Rimal P, Saleh M, Schwarz R, Swar SB, Thapa A, Tiwari A, White R, Wu WJ, Schwarz D. Transition to active learning in rural Nepal: an adaptable and scalable curriculum development model. BMC Med Educ 2019; 19:61. [PMID: 30786884 PMCID: PMC6383231 DOI: 10.1186/s12909-019-1492-3] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/12/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND Traditional medical education in much of the world has historically relied on passive learning. Although active learning has been in the medical education literature for decades, its incorporation into practice has been inconsistent. We describe and analyze the implementation of a multidisciplinary continuing medical education curriculum in a rural Nepali district hospital, for which a core objective was an organizational shift towards active learning. METHODS The intervention occurred in a district hospital in remote Nepal, staffed primarily by mid-level providers. Before the intervention, education sessions included traditional didactics. We conducted a mixed-methods needs assessment to determine the content and educational strategies for a revised curriculum. Our goal was to develop an effective, relevant, and acceptable curriculum, which could facilitate active learning. As part of the intervention, physicians acted as both learners and teachers by creating and delivering lectures. Presenters used lecture templates to prioritize clarity, relevance, and audience engagement, including discussion questions and clinical cases. Two 6-month curricular cycles were completed during the study period. Daily lecture evaluations assessed ease of understanding, relevance, clinical practice change, and participation. Periodic lecture audits recorded learner talk-time, the proportion of lecture time during which learners were talking, as a surrogate for active learning. Feedback from evaluation and audit results was provided to presenters, and pre- and post-curriculum knowledge assessment exams were conducted. RESULTS Lecture audits showed a significant increase in learner talk-time, from 14% at baseline to 30% between months 3-6, maintained at 31% through months 6-12. Lecture evaluations demonstrated satisfaction with the curriculum. Pre- and post-curriculum knowledge assessment scores improved from 50 to 64% (difference 13.3% ± 4.5%, p = 0.006). As an outcome for the measure of organizational change, the curriculum was replicated at an additional clinical site. CONCLUSION We demonstrate that active learning can be facilitated by implementing a new educational strategy. Lecture audits proved useful for internal program improvement. The components of the intervention which are transferable to other rural settings include the use of learners as teachers, lecture templates, and provision of immediate feedback. This curricular model could be adapted to similar settings in Nepal, and globally.
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Affiliation(s)
- Stephen Mehanni
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
- Gallup Indian Medical Center, Gallup, NM USA
| | - Lena Wong
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
- Tuba City Regional Health Care, Tuba City, AZ USA
| | - Bibhav Acharya
- Possible, Kathmandu, Nepal
- Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
| | | | | | - Madhur Basnet
- Possible, Kathmandu, Nepal
- Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - David Citrin
- Possible, Kathmandu, Nepal
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Anthropology, University of Washington, Seattle, WA USA
| | | | - Grace Deukmedjian
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
- Department of Pediatrics, Natividad Medical Center, Salinas, CA USA
| | | | - Bikash Gauchan
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | | | - Scott Halliday
- Possible, Kathmandu, Nepal
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
| | - S. P. Kalaunee
- Possible, Kathmandu, Nepal
- College of Business and Leadership, Eastern University, St. Davids, PA USA
| | | | - Anirudh Kumar
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Duncan Maru
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Sheela Maru
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Viet Nguyen
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Jhalak Sharma Paudel
- National Health Training Center, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Pragya Rimal
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Marwa Saleh
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Ryan Schwarz
- Possible, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Sikhar Bahadur Swar
- Possible, Kathmandu, Nepal
- Department of Psychiatry, Kathmandu Medical College, Kathmandu, Nepal
| | | | | | - Rebecca White
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Wan-Ju Wu
- Possible, Kathmandu, Nepal
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA USA
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA USA
| | - Dan Schwarz
- Possible, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
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