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Sinha A, Mattson A, Njere I, Sinha CK. Comparison of laparoscopic cholecystectomy in children at paediatric centres and adult centres: a systematic review and meta-analysis. Ann R Coll Surg Engl 2024. [PMID: 38445605 DOI: 10.1308/rcsann.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Paediatric laparoscopic cholecystectomy (LC) is performed by both paediatric and adult surgeons. The aim of this review was to compare outcomes at paediatric centres (PCs) and adult centres (ACs). METHODS A literature search was conducted, in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, for papers published between January 2000 and December 2020. Statistical analysis was performed using Stata® version 16 (StataCorp, College Station, TX, US). RESULTS A total of 92 studies involving 74,852 paediatric LCs met the inclusion criteria. Over half (59%) of the LCs were performed at ACs. No significant differences were noted in the male-to-female ratio, mean age or mean body mass index between PCs and ACs. The main indications were cholelithiasis (34.1% vs 34.4% respectively, p=0.83) and biliary dyskinesia (17.0% vs 23.5% respectively, p<0.01). There was no significant difference in the median inpatient stay (2.52 vs 2.44 days respectively, p=0.89). Bile duct injury was a major complication (0.80% vs 0.37% respectively, p<0.01). Reoperation rates (2.37% vs 0.74% respectively, p<0.01) and conversion to open surgery (1.97% vs 4.74% respectively, p<0.01) were also significantly different. Meta-analysis showed no significant difference in overall complications (p=0.92). CONCLUSIONS The number of LCs performed, intraoperative cholangiography use and conversion rates were higher at ACs whereas bile duct injury and reoperation rates were higher at PCs. Despite a higher incidence of bile duct injury at PCs, the incidence at both PCs and ACs was <1%. In complex cases, a joint operation by both paediatric and adult surgeons might be a better approach to further improve outcomes. Overall, LC was found to be a safe operation with comparable outcomes at PCs and ACs.
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Affiliation(s)
- A Sinha
- East and North Hertfordshire NHS Trust, UK
| | - A Mattson
- St George's University Hospitals NHS Foundation Trust, UK
| | - I Njere
- Royal Devon University Healthcare NHS Foundation Trust, UK
| | - C K Sinha
- St George's University Hospitals NHS Foundation Trust, UK
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Chauhan A, Parmar M, Rajesham JD, Shukla S, Sahoo KC, Chauhan S, Chitiboyina S, Sinha A, Srigana G, Gorla M, Pati S. Landscaping tuberculosis multimorbidity: findings from a cross-sectional study in India. BMC Public Health 2024; 24:453. [PMID: 38350875 PMCID: PMC10863254 DOI: 10.1186/s12889-024-17828-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Multimorbidity, the concurrent presence of two or more chronic conditions is an emerging public health challenge. Till date, most of the research have focused on the presence and interaction of selected co-morbidities in tuberculosis (TB). There exist a critical knowledge gap on the magnitude of multimorbidity among TB patients and its impact on health outcomes. METHODS We undertook a cross-sectional study to assess the prevalence and patterns of multimorbidity among newly diagnosed TB patients in two states of India. A total of 323 patients were interviewed using a structured multimorbidity assessment questionnaire for primary care (MAQ-PC). MAQ-PC is already validated for Indian population and elicits 22 chronic conditions. We defined TB multimorbidity as the co-existence of TB with one or more chronic conditions and identified commonly occurring dyads (TB + single condition) and triads (TB + two conditions). RESULTS More than half (52%) of TB patients reported multimorbidity. Among dyads, depression, diabetes mellitus (DM), acid peptic disease (APD), hypertension, chronic alcoholism, arthritis and chronic back ache (CBA) were the most common co-occurring conditions while 'DM + arthritis', 'depression + APD', 'depression + DM' were the most commonly occurring triads among TB patients. Factors such as increasing age, low levels of education, alcohol abusers, drug-resistant TB and having health insurance were significantly associated with multimorbidity among TB patients. CONCLUSIONS Our findings suggest high prevalence of multimorbidity among newly diagnosed TB patients in India. The presence of concordant and discordant conditions with TB may increase the health complexity, thus necessitating appropriate care protocols. Given, the current situation, wherein TB and non-communicable diseases (NCD) services are delivered through collaborative framework between programmes, there is a need for addressing multimorbidity at the healthcare delivery level.
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Affiliation(s)
- A Chauhan
- Public Health Foundation of India, New Delhi, India
| | - M Parmar
- World Health Organization, Country Office for India, New Delhi, India
| | - J D Rajesham
- State Tuberculosis Cell, Hyderabad, Telangana, India
| | - S Shukla
- World Health Organization, National Tuberculosis Elimination Programme - Technical Support Network, New Delhi, India
| | - K C Sahoo
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - S Chauhan
- World Health Organization, National Tuberculosis Elimination Programme - Technical Support Network, New Delhi, India
| | - S Chitiboyina
- State TB Training and Demonstration Centre, Hyderabad, Telangana, India
| | - A Sinha
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - G Srigana
- World Health Organization, National Tuberculosis Elimination Programme - Technical Support Network, New Delhi, India
| | - M Gorla
- World Health Organization, National Tuberculosis Elimination Programme - Technical Support Network, New Delhi, India
| | - Sanghamitra Pati
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, Odisha, India.
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Milinis K, Thiagarajan J, Leong S, De S, Sinha A, Sharma R, Sharma S. Review of management practices of sinogenic intracranial abscesses in children. J Laryngol Otol 2023; 137:1135-1140. [PMID: 36751894 DOI: 10.1017/s0022215123000166] [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] [Indexed: 02/09/2023]
Abstract
OBJECTIVE This study aimed to evaluate the management practices and outcomes in children with sinogenic intracranial suppuration. METHOD This was a retrospective cohort study in a single paediatric tertiary unit that included patients younger than 18 years with radiologically confirmed intracranial abscess, including subdural empyema and epidural or intraparenchymal abscess secondary to sinusitis. Main outcomes studied were rate of return to the operating theatre, length of hospital stay, death in less than 90 days and neurological disability at 6 months. RESULTS A cohort of 39 consecutive patients presenting between 2000 and 2020 were eligible for inclusion. Subdural empyema was the most common intracranial complication followed by extradural abscess and intraparenchymal abscess. Mean length of hospital stay was 42 days. Sixteen patients were managed with combined ENT and neurosurgical interventions, 15 patients underwent ENT procedures alone and 4 patients had only neurosurgical drainage. Four patients initially underwent non-operative management. The rates of return to the operating theatre, neurological deficits and 90-day mortality were 19, 9 and 3, respectively, and were comparable across the 4 treatment arms. In the univariate logistic regression, only the size of an intracranial abscess was found be associated with an increased likelihood of return to the operating theatre, whereas combined ENT and neurosurgical intervention did not result in improved outcomes. CONCLUSION Sinogenic intracranial abscesses are associated with significant morbidity and mortality. The size of an intracranial abscess has a strong association with a need for a revision surgery.
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Affiliation(s)
- K Milinis
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - J Thiagarajan
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
- School of Medicine, University of Liverpool, Liverpool, UK
| | - S Leong
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S De
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - A Sinha
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - R Sharma
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - S Sharma
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
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Rekart ML, Aung A, Cullip T, Mulanda W, Mun L, Pirmahmadzoda B, Kliescokova J, Achar J, Alvarez JL, Sitali N, Sinha A. Household drug-resistant TB contact tracing in Tajikistan. Int J Tuberc Lung Dis 2023; 27:748-753. [PMID: 37749832 PMCID: PMC10519379 DOI: 10.5588/ijtld.23.0066] [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: 02/14/2023] [Accepted: 04/13/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND: Tajikistan has a high burden of rifampicin-resistant TB (RR-TB), with 2,700 new cases estimated for 2021 (28/100,000 population). TB is spread among household members through close interaction and children exposed through household contact progress to disease rapidly and frequently.METHODS: We retrospectively analysed programmatic data from household contact tracing in Dushanbe over 50 months. We calculated person-years of follow-up, contact tracing yield, number needed to screen (NNS) and number needed to test (NNT) to find one new case, and time to diagnosis.RESULTS: We screened 6,654 household contacts of 830 RR-TB index cases; 47 new RR-TB cases were detected, 43 in Year 1 and 4 in Years 2 or 3. Ten were aged <5 years; 46/47 had TB symptoms, 34/45 had chest radiographs consistent with TB, 11/35 were Xpert Ultra-positive, 29/32 were tuberculin skin test-positive and 28/47 had positive TB culture and phenotypic drug susceptibility results. The NNS to find one RR-TB case was 141.57 and the NNT was 34.49. The yields for different types of contacts were as follows: 0.7% for screened contacts, 2.9% for tested contacts, 17.0% for symptomatic contacts and 12.1% for symptomatic contacts aged below 5 years.CONCLUSION: RR-TB household contact tracing was feasible and productive in Tajikistan, a low middle-income country with an inefficient healthcare delivery system.
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Affiliation(s)
- M L Rekart
- Médecins Sans Frontières (MSF), Dushanbe, Tajikistan
| | - A Aung
- Médecins Sans Frontières (MSF), Dushanbe, Tajikistan
| | | | - W Mulanda
- Médecins Sans Frontières (MSF), Dushanbe, Tajikistan
| | - L Mun
- Médecins Sans Frontières (MSF), Dushanbe, Tajikistan
| | | | - J Kliescokova
- Médecins Sans Frontières (MSF), Dushanbe, Tajikistan
| | - J Achar
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Dahmer KJ, Palma-Cuero M, Ciuoderis K, Patiño C, Roitman S, Li Z, Sinha A, Hite JL, Bellido Cuellar O, Hernandez-Ortiz JP, Osorio JE, Christensen BM, Carlow CKS, Zamanian M. Molecular surveillance detects high prevalence of the neglected parasite Mansonella ozzardi in the Colombian Amazon. medRxiv 2023:2023.05.10.23289806. [PMID: 37215049 PMCID: PMC10197819 DOI: 10.1101/2023.05.10.23289806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Mansonellosis is an undermapped insect-transmitted disease caused by filarial nematodes that are estimated to infect hundreds of millions of people globally. Despite their prevalence, there are many outstanding questions regarding the general biology and health impacts of the responsible parasites. Historical reports suggest that the Colombian Amazon is endemic for mansonellosis and may serve as an ideal location to pursue these questions in the backdrop of other endemic and emerging pathogens. We deployed molecular and classical diagnostic approaches to survey Mansonella prevalence among adults belonging to indigenous communities along the Amazon River and its tributaries near Leticia, Colombia. Deployment of a loop-mediated isothermal amplification (LAMP) assay on blood samples revealed an infection prevalence of ∼40% for Mansonella ozzardi . This assay identified significantly more infections than blood smear microscopy or LAMP assays performed using plasma, likely reflecting greater sensitivity and the ability to detect low microfilaremias or occult infections. Mansonella infection rates increased with age and were higher among males compared to females. Genomic analysis confirmed the presence of M. ozzardi that clusters closely with strains sequenced in neighboring countries. We successfully cryopreserved and revitalized M. ozzardi microfilariae, advancing the prospects of rearing infective larvae in controlled settings. These data suggest an underestimation of true mansonellosis prevalence, and we expect that these methods will help facilitate the study of mansonellosis in endemic and laboratory settings.
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Affiliation(s)
- KJ Dahmer
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI USA
| | - M Palma-Cuero
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI USA
- University of Wisconsin Global Health Institute One Health Colombia, Madison, WI USA
| | - K Ciuoderis
- University of Wisconsin Global Health Institute One Health Colombia, Madison, WI USA
- Universidad Nacional de Colombia - UW-GHI One Health Colombia, Medellín, Colombia
| | - C Patiño
- Universidad Nacional de Colombia - UW-GHI One Health Colombia, Medellín, Colombia
| | - S Roitman
- New England Biolabs, 240 County Road, Ipswich, MA USA
| | - Z Li
- New England Biolabs, 240 County Road, Ipswich, MA USA
| | - A Sinha
- New England Biolabs, 240 County Road, Ipswich, MA USA
| | - JL Hite
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI USA
| | | | - JP Hernandez-Ortiz
- University of Wisconsin Global Health Institute One Health Colombia, Madison, WI USA
- Universidad Nacional de Colombia - UW-GHI One Health Colombia, Medellín, Colombia
| | - JE Osorio
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI USA
- University of Wisconsin Global Health Institute One Health Colombia, Madison, WI USA
| | - BM Christensen
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI USA
- University of Wisconsin Global Health Institute One Health Colombia, Madison, WI USA
| | - CKS Carlow
- New England Biolabs, 240 County Road, Ipswich, MA USA
| | - M Zamanian
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI USA
- University of Wisconsin Global Health Institute One Health Colombia, Madison, WI USA
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Moe S, Rekart ML, Hernandez D, Sholpan A, Ismailov A, Oluya M, Bayniyazova A, Zinaida T, Nargiza P, Gomez-Restrepo C, Sitali N, Sinha A. Primary bedaquiline resistance in Karakalpakstan, Uzbekistan. Int J Tuberc Lung Dis 2023; 27:381-386. [PMID: 37143220 PMCID: PMC10171487 DOI: 10.5588/ijtld.22.0536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND: Bedaquiline (BDQ) is widely used in the treatment of rifampicin-resistant TB (RR-TB). However, resistance to BDQ is now emerging. There are no standardised regimens for BDQ-resistant TB. This study aims to share experience in managing primary BDQ-resistant TB.METHODS: We performed a retrospective study of patients treated for RR-TB in Karakalpakstan, Uzbekistan, from January 2017 to March 2022. We identified patients with resistance to BDQ with no history of BDQ exposure. We describe baseline characteristics, treatment and follow-up of these patients.RESULTS: Twelve of the 1,930 patients (0.6%) had baseline samples resistant to BDQ with no history of BDQ exposure, 75% (9/12) of whom had been previously treated for TB. Ten (83.3%) were resistant to fluoroquinolones; respectively 66% and 50% had culture conversion by Month 3 and Month 6. The interim treatment outcomes were as follows: unfavourable treatment outcomes (3/12, 25%), favourable outcomes (2/12, 17%); the remaining seven (58%) were continuing treatment.CONCLUSIONS: A large proportion of the cases had previously been treated for TB and had TB resistant to quinolone. Both patients who had not experienced culture conversion by Month 3 had an unfavourable treatment outcome. Therefore, we recommend monthly monitoring of culture status for patients on treatment regimens for BDQ resistance.
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Affiliation(s)
- S Moe
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - M L Rekart
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - D Hernandez
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - A Sholpan
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - A Ismailov
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - M Oluya
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - A Bayniyazova
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - T Zinaida
- Republican Center of Tuberculosis and Pulmonology, Nukus, Uzbekistan
| | - P Nargiza
- Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent, Uzbekistan
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Rammohan R, Joy MV, Saggar T, Magam SG, Sinha A, Natt D, Gomez S, Sheikh S, Anand P, Mustacchia P. Healthcare Disparities and Upper Gastrointestinal Bleeding: Exploring the Linkages. Cureus 2023; 15:e37977. [PMID: 37101799 PMCID: PMC10123219 DOI: 10.7759/cureus.37977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 04/28/2023] Open
Abstract
Introduction Upper gastrointestinal bleeding (UGIB) refers to blood loss from a gastrointestinal (GI) source proximal or above the ligament of Treitz. Health equity means giving everyone an equal chance to achieve optimal health by addressing injustices, overcoming barriers, and eliminating health disparities. Healthcare providers must analyze racial and ethnic disparities in UGIB management to ensure all patients receive equal care. Identifying risk factors in specific populations leads to tailored interventions that improve outcomes. Our study aims to examine trends and identify disparities in upper gastrointestinal bleeding across races and ethnicities to promote health equity. Methods Retrospective data on upper gastrointestinal bleeding from June 2009 to June 2022 were collected and categorized into five groups based on race. The baseline characteristics of each group were matched to ensure equitable comparison. A joinpoint regression model was used to compare incidence trends, identifying potential healthcare disparities for different racial/ethnic groups over time. Patients aged 18-75 who suffered from upper gastrointestinal bleeding at Nassau University Medical Center in New York from 2010 to 2021 were selected, excluding those with incomplete baseline comorbidity information. Results This study examined 5103 cases of upper gastrointestinal bleeding, with 41.9% female. The cohort was diverse, with 29.4% African American, 15.6% Hispanic, 45.3% White, 6.8% Asian, and 2.9% of other races. Data were split into two groups; 49.9% occurred between 2009 and 2015 and 50.1% between 2016 and 2022. Findings showed increased UGIB among Hispanics and decreased bleeding among Asians during 2016-2021 compared to 2009-2015. However, no significant difference was found for African Americans, Whites, and other races. In addition, Hispanics had a rise in the annual percentage change (APC) rate, whereas Asians had a decrease. Conclusion Our study examined trends in upper gastrointestinal bleeding and potential healthcare disparities across races and ethnicities. Our findings highlight an increased incidence of UGIB in Hispanics and a decreased incidence in Asians. Additionally, we identified a significant increase in the annual percentage change rate in Hispanics and a decrease in Asians over time. Our study underscores the importance of identifying and addressing disparities in UGIB management to promote health equity. Future research can build on these findings to develop tailored interventions that improve patient outcomes.
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Affiliation(s)
- Rajmohan Rammohan
- Gastroenterology, Nassau University Medical Center, East Meadow, USA
| | - Melvin V Joy
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Tulika Saggar
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | | | - Atul Sinha
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
| | - Dilman Natt
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Sandra Gomez
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
| | - Saher Sheikh
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
| | - Prachi Anand
- Rheumatology, Nassau University Medical Center, East Meadow, USA
| | - Paul Mustacchia
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr K, Garrod R, Makia F, Eldeeb F, Abdekader R, Gomaa A, Kandasamy S, Maruthanayagam R, Nadar SK, Nakad G, Nair R, Mota P, Prior P, Mcdonald S, Rand J, Schumacher N, Abraheem A, Clark M, Coulding M, Qamar N, Turner V, Negahban AQ, Crew A, Hope S, Howson J, Jones S, Lancaster N, Nicholson A, Wray G, Donnelly P, Gierlotka M, Hammond L, Hammond S, Regan S, Watkin R, Papadopoulos C, Ludman P, Hutton K, Macdonald S, Nilsson A, Roberts S, Monteiro S, Garg S, Balachandran K, Mcdonald J, Singh R, Marsden K, Davies K, Desai H, Goddard W, Iqbal N, Chalil S, Dan GA, Galasko G, Assaf O, Benham L, Brown J, Collins S, Fleming C, Glen J, Mitchell M, Preston S, Uttley A, Radovanovic M, Lindsay S, Akhtar N, Atkinson C, Vinod M, Wilson A, Clifford P, Firoozan S, Yashoman M, Bowers N, Chaplin J, Reznik EV, Harvey S, Kononen M, Lopesdesousa G, Saraiva F, Sharma S, Cruddas E, Law J, Young E, Hoye A, Harper P, Balghith M, Rowe K, Been M, Cummins H, French E, Gibson C, Abraham JA, Hobson S, Kay A, Kent M, 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Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Orlando M, Sinha A, Yao M, Shippey E, Kho R. Perioperative Venous Thromboembolism in Patients Undergoing Hysterectomy for Fibroids: A Nationwide Sample. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rekart ML, Morshed T, Mulanda WK, Klieascikova J, Sitali N, Rajabzoda A, Avzamova S, Pirmahmadzoda B, Aung A, Sayfulloev M, Sleit R, Sinha A. Family directly observed therapy for children with drug-resistant TB. Int J Tuberc Lung Dis 2022; 26:792-794. [PMID: 35898123 DOI: 10.5588/ijtld.22.0168] [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: 11/10/2022] Open
Affiliation(s)
- M L Rekart
- Medecins Sans Frontieres (MSF), Dushanbe, Tajikistan, MSF, Uzbekistan
| | - T Morshed
- Medecins Sans Frontieres (MSF), Dushanbe, Tajikistan
| | - W K Mulanda
- Medecins Sans Frontieres (MSF), Dushanbe, Tajikistan
| | | | - N Sitali
- MSF Holland, Amsterdam, The Netherlands
| | - A Rajabzoda
- National Tuberculosis Programme, Dushanbe, Tajikistan
| | - S Avzamova
- National Tuberculosis Programme, Dushanbe, Tajikistan
| | - B Pirmahmadzoda
- Dushanbe City Tuberculosis Programme, Dushanbe City, Tajikistan
| | - A Aung
- Medecins Sans Frontieres (MSF), Dushanbe, Tajikistan
| | - M Sayfulloev
- Medecins Sans Frontieres (MSF), Dushanbe, Tajikistan
| | - R Sleit
- MSF Holland, Amsterdam, The Netherlands
| | - A Sinha
- Manson Unit, MSF, London, UK
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Devanabanda B, Louis MA, Schlussel Y, Mashchenko I, Charles M, Sinha A, Louis JA, Chen A, Maloof M. The patient behind the wound assessment and plan. J Wound Care 2022; 31:S30-S40. [PMID: 35797248 DOI: 10.12968/jowc.2022.31.sup7.s30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Hard-to-heal wounds are a common problem, worsened by ageing, and the increased prevalence of diabetes and morbid obesity. The provider-patient relationship has undergone a transformation, from a paternalistic to a mutual participation model, in which 'the physician tries to enter the patient's world to see the illness through the patient's eyes'. The indepth assessment of the impact of psychosocial, physical issues and provider-patient dynamics is crucial to wound healing and patient wellbeing. It can customise future treatment including physical therapy, psychological and social interventions to improve outcomes. METHOD A new health-related quality of life instrument (HRQOL) proposal based on a survey consisting of 20 questions was completed by patients as a pilot project. The psychosocial, physical and provider-patient dynamics were evaluated. A total wound impact score (WIs) was tabulated, ranging from 20-80 points. A wound assessment and plan (PBW-AP) was created. RESULTS In our sample of 25 patients, 75% experienced a moderate WIs (50-69) and 5% experienced a severe WIs (31-49). Feeling angry about having a wound was reported by 40% of patients. A majority of patients (60%) thought about their wounds >1 hour per day. Importantly, 24% answered that their primary care physicians never mentioned their wounds. CONCLUSION It is important for all physicians taking care of patients with hard-to-heal wounds to see 'the patient behind the wound'. The PBW-AP algorithm is an individualised, multidisciplinary assessment and intervention based on a WIs. It is designed not only to identify but also to tackle psychosocial, physical, and provider-patient issues, to improve overall quality of life, patient satisfaction and clinical outcomes. Based on the results, the PBW-AP algorithm was designed to be used at initial and subsequent visits as a roadmap for problem identification and intervention.
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Affiliation(s)
| | - Martine A Louis
- Department of Surgery, Flushing Hospital Medical Center, New York, US
| | | | - Igor Mashchenko
- Department of Surgery, Flushing Hospital Medical Center, New York, US
| | - Mike Charles
- St. George's University School of Medicine, Grenada
| | - Atul Sinha
- St. George's University School of Medicine, Grenada
| | - Joseph A Louis
- Comprehensive primary family medical care, Far Rockaway, NY, USA
| | - Ashley Chen
- Department of Surgery, Flushing Hospital Medical Center, New York, US
| | - Mark Maloof
- Department of Surgery, Flushing Hospital Medical Center, New York, US
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al Bahri T, Bhoombla N, Rao BM, Titu L, Chatha S, Field C, Gandhi T, Gulati R, Jha R, Jones Sam MT, Karim S, Patel R, Saunders M, Sharma K, Abid S, Heath E, Kurup D, Patel A, Ali M, Cresswell B, Felstead D, Jennings K, Kaluarachchi T, Lazzereschi L, Mayson H, Miah JE, Reinders B, Rosser A, Thomas C, Williams H, Al-Hamid Z, Alsadoun L, Chlubek M, Fernando P, Gaunt E, Gercek Y, Maniar R, Ma R, Matson M, Moore S, Morris A, Nagappan PG, Ratnayake M, Rockall L, Shallcross O, Sinha A, Tan KE, Virdee S, Wenlock R, Donnelly HA, Ghazal R, Hughes I, Liu X, McFadden M, Misbert E, Mogey P, O'Hara A, Peace C, Rainey C, Raja P, Salem M, Salmon J, Tan CH, Alves D, Bahl S, Baker C, Coulthurst J, Koysombat K, Linn T, Rai P, Sharma A, Shergill A, Ahmed M, Ahmed S, Belk LH, Choudhry H, Cummings D, Dixon Y, Dobinson C, Edwards J, Flint J, Franco Da Silva C, Gallie R, Gardener M, Glover T, Greasley M, Hatab A, Howells R, Hussey T, Khan A, Mann A, Morrison H, Ng A, Osmond R, Padmakumar N, Pervaiz F, Prince R, Qureshi A, Sawhney R, Sigurdson B, Stephenson L, Vora K, Zacken A, Cope P, Di Traglia R, Ferarrio I, Hackett N, Healicon R, Horseman L, Lam LI, Meerdink M, Menham D, Murphy R, Nimmo I, Ramaesh A, Rees J, Soame R, Dilaver N, Adebambo D, Brown E, Burt J, Foster K, Kaliyappan L, Knight P, Politis A, Richardson E, Townsend J, Abdi M, Ball M, Easby S, Gill N, Ho E, Iqbal H, Matthews M, Nubi S, Nwokocha JO, Okafor I, Perry G, Sinartio B, Vanukuru N, Walkley D, Welch T, Yates J, Yeshitila N, Bryans K, Campbell B, Gray C, Keys R, Macartney M, Chamberlain G, Khatri A, Kucheria A, Lee STP, Reese G, Roy choudhury J, Tan WYR, Teh JJ, Ting A, Kazi S, Kontovounisios C, Vutipongsatorn K, Amarnath T, Balasubramanian N, Bassett E, Gurung P, Lim J, Panjikkaran A, Sanalla A, Alkoot M, Bacigalupo V, Eardley N, Horton M, Hurry A, Isti C, Maskell P, Nursiah K, Punn G, Salih H, Epanomeritakis E, Foulkes A, Henderson R, Johnston E, McCullough H, McLarnon M, Morrison E, Cheung A, Cho SH, Eriksson F, Hedges J, 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H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Nair P, Hasan T, Zaw KK, Allamuratova S, Ismailov A, Mendonca P, Bekbaev Z, Parpieva N, Singh J, Sitali N, Bermudez-Aza E, Sinha A. Acquired bedaquiline resistance in Karakalpakstan, Uzbekistan. Int J Tuberc Lung Dis 2022; 26:658-663. [PMID: 35768925 PMCID: PMC9272738 DOI: 10.5588/ijtld.21.0631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: The WHO recommends the use of bedaquiline (BDQ) in longer, as well as shorter, multidrug-resistant TB (MDR-TB) treatment regimens. However, resistance to this new drug is now emerging. We aimed to describe the characteristics of patients in Karakalpakstan, Uzbekistan, who were treated for MDR-TB and acquired BDQ resistance during treatment.METHODS: We performed a retrospective study of routinely collected data for patients treated for MDR-TB in Karakalpakstan between January 2015 and December 2020. We included patients on BDQ-containing regimens with baseline susceptibility to BDQ who developed BDQ resistance at any point after treatment initiation. Patients resistant to BDQ at baseline or with no confirmed susceptibility to BDQ at baseline were excluded.RESULTS: Of the 523 patients who received BDQ-containing regimens during the study period, BDQ resistance was detected in 31 patients (5.9%); 20 patients were excluded-16 with no prior confirmation of BDQ susceptibility and 4 who were resistant at baseline. Eleven patients with acquired BDQ resistance were identified. We discuss demographic variables, resistance profiles, treatment-related variables and risk factors for unfavourable outcomes for these patients.CONCLUSION: Our programmatic data demonstrated the acquisition of BDQ resistance during or subsequent to receiving a BDQ-containing regimen in a patient cohort from Uzbekistan. We highlight the need for individualised treatment regimens with optimised clinical and laboratory follow up to prevent resistance acquisition.
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Affiliation(s)
- P Nair
- Médecins Sans Frontières (MSF) Holland, Amsterdam
| | - T Hasan
- Médecins Sans Frontières (MSF) Holland, Amsterdam
| | - K K Zaw
- Médecins Sans Frontières (MSF) Holland, Amsterdam
| | | | - A Ismailov
- Médecins Sans Frontières (MSF) Holland, Amsterdam
| | - P Mendonca
- Médecins Sans Frontières (MSF) Holland, Amsterdam
| | - Z Bekbaev
- Republican Center of Tuberculosis and Pulmonology, Nukus, Uzbekistan
| | - N Parpieva
- Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent, Uzbekistan
| | - J Singh
- Médecins Sans Frontières (MSF) Holland, Amsterdam
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Stubbs M, Hey J, Fung A, Maynard J, Parnell B, Sinha A. P.21 A multidisciplinary safety checklist to facilitate continuous fetal heart monitoring during labour epidural analgesia insertion. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Aharonian F, Ait Benkhali F, Angüner EO, Ashkar H, Backes M, Baghmanyan V, Barbosa Martins V, Batzofin R, Becherini Y, Berge D, Bernlöhr K, Bi B, Böttcher M, Boisson C, Bolmont J, de Bony de Lavergne M, Breuhaus M, Brose R, Brun F, Caroff S, Casanova S, Cerruti M, Chand T, Chen A, Cotter G, Damascene Mbarubucyeye J, Djannati-Ataï A, Dmytriiev A, Doroshenko V, Duffy C, Egberts K, Ernenwein JP, Fegan S, Feijen K, Fiasson A, Fichet de Clairfontaine G, Fontaine G, Füßling M, Funk S, Gabici S, Gallant YA, Ghafourizadeh S, Giavitto G, Giunti L, Glawion D, Glicenstein JF, Grondin MH, Hermann G, Hinton JA, Hörbe M, Hofmann W, Hoischen C, Holch TL, Holler M, Horns D, Huang Z, Jamrozy M, Jankowsky F, Jung-Richardt I, Kasai E, Katarzyński K, Katz U, Khangulyan D, Khélifi B, Klepser S, Kluźniak W, Komin N, Konno R, Kosack K, Kostunin D, Le Stum S, Lemière A, Lemoine-Goumard M, Lenain JP, Leuschner F, Lohse T, Luashvili A, Lypova I, Mackey J, Malyshev D, Malyshev D, Marandon V, Marchegiani P, Marcowith A, Martí-Devesa G, Marx R, Maurin G, Meyer M, Mitchell A, Moderski R, Mohrmann L, Montanari A, Moulin E, Muller J, Murach T, Nakashima K, de Naurois M, Nayerhoda A, Niemiec J, Priyana Noel A, O'Brien P, Ohm S, Olivera-Nieto L, de Ona Wilhelmi E, Ostrowski M, Panny S, Panter M, Parsons RD, Peron G, Pita S, Poireau V, Prokhorov DA, Prokoph H, Pühlhofer G, Punch M, Quirrenbach A, Reichherzer P, Reimer A, Reimer O, Renaud M, Reville B, Rieger F, Rowell G, Rudak B, Rueda Ricarte H, Ruiz-Velasco E, Sahakian V, Sailer S, Salzmann H, Sanchez DA, Santangelo A, Sasaki M, Schäfer J, Schüssler F, Schutte HM, Schwanke U, Senniappan M, Shapopi JNS, Simoni R, Sinha A, Sol H, Specovius A, Spencer S, Stawarz Ł, Steinmassl S, Steppa C, Takahashi T, Tanaka T, Taylor AM, Terrier R, Thorpe-Morgan C, Tsirou M, Tsuji N, Tuffs R, Uchiyama Y, Unbehaun T, van Eldik C, van Soelen B, Veh J, Venter C, Vink J, Wagner SJ, Werner F, White R, Wierzcholska A, Wong YW, Yusafzai A, Zacharias M, Zargaryan D, Zdziarski AA, Zech A, Zhu SJ, Zouari S, Żywucka N. Time-resolved hadronic particle acceleration in the recurrent nova RS Ophiuchi. Science 2022; 376:77-80. [PMID: 35271303 DOI: 10.1126/science.abn0567] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Recurrent novae are repeating thermonuclear explosions in the outer layers of white dwarfs, due to the accretion of fresh material from a binary companion. The shock generated when ejected material slams into the companion star's wind can accelerate particles. We report very-high-energy (VHE, [Formula: see text]) gamma rays from the recurrent nova RS Ophiuchi, up to a month after its 2021 outburst, observed using the High Energy Stereoscopic System. The VHE emission has a similar temporal profile to lower-energy GeV emission, indicating a common origin, with a two-day delay in peak flux. These observations constrain models of time-dependent particle energization, favoring a hadronic emission scenario over the leptonic alternative. Shocks in dense winds provide favorable environments for efficient acceleration of cosmic-rays to very high energies.
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Affiliation(s)
- F Aharonian
- Dublin Institute for Advanced Studies, 31 Fitzwilliam Place, Dublin 2, Ireland
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
- High Energy Astrophysics Laboratory, Russian-Armenian University (RAU), 123 Hovsep Emin St Yerevan 0051, Armenia
| | - F Ait Benkhali
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - E O Angüner
- Aix Marseille Université, Centre national de la recherche scientifique (CNRS)/Institut National de Physique Nucléaire et Physique des Particules (IN2P3), Centre de Physique des Particules de Marseille (CPPM), Marseille, France
| | - H Ashkar
- Laboratoire Leprince-Ringuet, École Polytechnique, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - M Backes
- University of Namibia, Department of Physics, Private Bag 13301, Windhoek 10005, Namibia
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - V Baghmanyan
- Instytut Fizyki J[Formula: see text]drowej Polskiej Akademii Nauk (PAN), ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - V Barbosa Martins
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - R Batzofin
- School of Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2050 South Africa
| | - Y Becherini
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - D Berge
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - K Bernlöhr
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - B Bi
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - M Böttcher
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - C Boisson
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - J Bolmont
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), 4 Place Jussieu, F-75252 Paris, France
| | - M de Bony de Lavergne
- Université Savoie Mont Blanc, CNRS, Laboratoire d'Annecy de Physique des Particules - IN2P3, 74000 Annecy, France
| | - M Breuhaus
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - R Brose
- Dublin Institute for Advanced Studies, 31 Fitzwilliam Place, Dublin 2, Ireland
| | - F Brun
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - S Caroff
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), 4 Place Jussieu, F-75252 Paris, France
| | - S Casanova
- Instytut Fizyki J[Formula: see text]drowej Polskiej Akademii Nauk (PAN), ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - M Cerruti
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - T Chand
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - A Chen
- School of Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2050 South Africa
| | - G Cotter
- University of Oxford, Department of Physics, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, UK
| | | | - A Djannati-Ataï
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - A Dmytriiev
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - V Doroshenko
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - C Duffy
- University of Oxford, Department of Physics, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, UK
| | - K Egberts
- Institut für Physik und Astronomie, Universität Potsdam, Karl-Liebknecht-Strasse 24/25, D 14476 Potsdam, Germany
| | - J-P Ernenwein
- Aix Marseille Université, Centre national de la recherche scientifique (CNRS)/Institut National de Physique Nucléaire et Physique des Particules (IN2P3), Centre de Physique des Particules de Marseille (CPPM), Marseille, France
| | - S Fegan
- Laboratoire Leprince-Ringuet, École Polytechnique, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - K Feijen
- School of Physical Sciences, University of Adelaide, Adelaide 5005, Australia
| | - A Fiasson
- Université Savoie Mont Blanc, CNRS, Laboratoire d'Annecy de Physique des Particules - IN2P3, 74000 Annecy, France
| | - G Fichet de Clairfontaine
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - G Fontaine
- Laboratoire Leprince-Ringuet, École Polytechnique, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - M Füßling
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - S Funk
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - S Gabici
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - Y A Gallant
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - S Ghafourizadeh
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - G Giavitto
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - L Giunti
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - D Glawion
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - J F Glicenstein
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - M-H Grondin
- Université Bordeaux, CNRS, Laboratoire de Physique des Deux Infinis (LP2i), Bordeaux, Joint Research Unit (UMR 5797), F-33170 Gradignan, France
| | - G Hermann
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - J A Hinton
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - M Hörbe
- University of Oxford, Department of Physics, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, UK
| | - W Hofmann
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - C Hoischen
- Institut für Physik und Astronomie, Universität Potsdam, Karl-Liebknecht-Strasse 24/25, D 14476 Potsdam, Germany
| | - T L Holch
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - M Holler
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - D Horns
- Universität Hamburg, Institut für Experimentalphysik, Luruper Chaussee 149, D 22761 Hamburg, Germany
| | - Zhiqiu Huang
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - M Jamrozy
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ul. Orla 171, 30-244 Kraków, Poland
| | - F Jankowsky
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - I Jung-Richardt
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - E Kasai
- University of Namibia, Department of Physics, Private Bag 13301, Windhoek 10005, Namibia
| | - K Katarzyński
- Institute of Astronomy, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University, Grudziadzka 5, 87-100 Torun, Poland
| | - U Katz
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - D Khangulyan
- Department of Physics, Rikkyo University, 3-34-1 Nishi-Ikebukuro, Toshima-ku, Tokyo 171-8501, Japan
| | - B Khélifi
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - S Klepser
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - W Kluźniak
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - Nu Komin
- School of Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2050 South Africa
| | - R Konno
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - K Kosack
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - D Kostunin
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - S Le Stum
- Aix Marseille Université, Centre national de la recherche scientifique (CNRS)/Institut National de Physique Nucléaire et Physique des Particules (IN2P3), Centre de Physique des Particules de Marseille (CPPM), Marseille, France
| | - A Lemière
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - M Lemoine-Goumard
- Université Bordeaux, CNRS, Laboratoire de Physique des Deux Infinis (LP2i), Bordeaux, Joint Research Unit (UMR 5797), F-33170 Gradignan, France
| | - J-P Lenain
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), 4 Place Jussieu, F-75252 Paris, France
| | - F Leuschner
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - T Lohse
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstr. 15, D 12489 Berlin, Germany
| | - A Luashvili
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - I Lypova
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - J Mackey
- Dublin Institute for Advanced Studies, 31 Fitzwilliam Place, Dublin 2, Ireland
| | - D Malyshev
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - D Malyshev
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - V Marandon
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - P Marchegiani
- School of Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2050 South Africa
| | - A Marcowith
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - G Martí-Devesa
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - R Marx
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - G Maurin
- Université Savoie Mont Blanc, CNRS, Laboratoire d'Annecy de Physique des Particules - IN2P3, 74000 Annecy, France
| | - M Meyer
- Universität Hamburg, Institut für Experimentalphysik, Luruper Chaussee 149, D 22761 Hamburg, Germany
| | - A Mitchell
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - R Moderski
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - L Mohrmann
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - A Montanari
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - E Moulin
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - J Muller
- Laboratoire Leprince-Ringuet, École Polytechnique, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - T Murach
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - K Nakashima
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - M de Naurois
- Laboratoire Leprince-Ringuet, École Polytechnique, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - A Nayerhoda
- Instytut Fizyki J[Formula: see text]drowej Polskiej Akademii Nauk (PAN), ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - J Niemiec
- Instytut Fizyki J[Formula: see text]drowej Polskiej Akademii Nauk (PAN), ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - A Priyana Noel
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ul. Orla 171, 30-244 Kraków, Poland
| | - P O'Brien
- Department of Physics and Astronomy, The University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - S Ohm
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - L Olivera-Nieto
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - E de Ona Wilhelmi
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - M Ostrowski
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ul. Orla 171, 30-244 Kraków, Poland
| | - S Panny
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - M Panter
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - R D Parsons
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstr. 15, D 12489 Berlin, Germany
| | - G Peron
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - S Pita
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - V Poireau
- Université Savoie Mont Blanc, CNRS, Laboratoire d'Annecy de Physique des Particules - IN2P3, 74000 Annecy, France
| | - D A Prokhorov
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, Netherlands
| | - H Prokoph
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - G Pühlhofer
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - M Punch
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - A Quirrenbach
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - P Reichherzer
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - A Reimer
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - O Reimer
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - M Renaud
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - B Reville
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - F Rieger
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - G Rowell
- School of Physical Sciences, University of Adelaide, Adelaide 5005, Australia
| | - B Rudak
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - H Rueda Ricarte
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - E Ruiz-Velasco
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - V Sahakian
- Yerevan Physics Institute, 2 Alikhanian Brothers St., 375036 Yerevan, Armenia
| | - S Sailer
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - H Salzmann
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - D A Sanchez
- Université Savoie Mont Blanc, CNRS, Laboratoire d'Annecy de Physique des Particules - IN2P3, 74000 Annecy, France
| | - A Santangelo
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - M Sasaki
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - J Schäfer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - F Schüssler
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - H M Schutte
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - U Schwanke
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstr. 15, D 12489 Berlin, Germany
| | - M Senniappan
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - J N S Shapopi
- University of Namibia, Department of Physics, Private Bag 13301, Windhoek 10005, Namibia
| | - R Simoni
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, Netherlands
| | - A Sinha
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - H Sol
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - A Specovius
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - S Spencer
- University of Oxford, Department of Physics, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, UK
| | - Ł Stawarz
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ul. Orla 171, 30-244 Kraków, Poland
| | - S Steinmassl
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - C Steppa
- Institut für Physik und Astronomie, Universität Potsdam, Karl-Liebknecht-Strasse 24/25, D 14476 Potsdam, Germany
| | - T Takahashi
- Kavli Institute for the Physics and Mathematics of the Universe (World Premier International Research Center Initiative (WPI)), The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba, 277-8583, Japan
| | - T Tanaka
- Department of Physics, Konan University, 8-9-1 Okamoto, Higashinada, Kobe, Hyogo 658-8501, Japan
| | - A M Taylor
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - R Terrier
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - C Thorpe-Morgan
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - M Tsirou
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - N Tsuji
- Institute of Physical and Chemical Research (RIKEN), 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - R Tuffs
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - Y Uchiyama
- Department of Physics, Rikkyo University, 3-34-1 Nishi-Ikebukuro, Toshima-ku, Tokyo 171-8501, Japan
| | - T Unbehaun
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - C van Eldik
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - B van Soelen
- Department of Physics, University of the Free State, PO Box 339, Bloemfontein 9300, South Africa
| | - J Veh
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - C Venter
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - J Vink
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, Netherlands
| | - S J Wagner
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - F Werner
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - R White
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - A Wierzcholska
- Instytut Fizyki J[Formula: see text]drowej Polskiej Akademii Nauk (PAN), ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - Yu Wun Wong
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - A Yusafzai
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - M Zacharias
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - D Zargaryan
- Dublin Institute for Advanced Studies, 31 Fitzwilliam Place, Dublin 2, Ireland
- High Energy Astrophysics Laboratory, Russian-Armenian University (RAU), 123 Hovsep Emin St Yerevan 0051, Armenia
| | - A A Zdziarski
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - A Zech
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - S J Zhu
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - S Zouari
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - N Żywucka
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
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Sinha A, McKenna M, Kollikonda S, Yao M, Mei L, Valentine L, Russo ML, Hornacek D, Kho R. The risk of venous thromboembolism in patients with and without leiomyomas undergoing hysterectomy. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.113] [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: 11/01/2022]
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17
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Upadhyaya Kafle S, Singh M, Kafle N, Sinha A, Guragain P, Rimal HS. Introducing Clinical Pathology Course to Fourth Year Medical Students as a Bridge between Pre-clinical and Clinical Medical Sciences. Kathmandu Univ Med J (KUMJ) 2022; 20:97-101. [PMID: 36273300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
There isn't any vertical integration of pre-clinical and clinical sciences subjects in the existing Kathmandu University MBBS curriculum. Many of the graduates are not able to correlate the clinico-pathological aspects of various diseases as a result the rational use of investigations for diagnosing various diseases is compromised. There are few published examples of implementation of pathology instruction courses during the clinical years of medical training but it is not universally practiced. This lack of exposure to pathology may lead to poor understanding of laboratory testing and the role of pathologists in patient care. To set and implement an exemplary vertical integration of pre-clinical science with clinical science. A 12 credit hours clinical pathology education course comprising clinical hematology, cytopathology and histopathology was developed. Students belonging from the ongoing fourth year MBBS course of Birat Medical College were enrolled in the course. All of the interactive lecture sessions were delivered via an e-learning interface, using the Zoom platform as the main teaching methods. Evaluation of students' achievement of learning objectives was conducted through distributing pre and post-test online multiple-choice questionnaires. Chi-square tests were used to compare the variables between pre-test and post-test questionnaire responses. Results suggested that the designed clinical pathology course is valuable. The pretest and post-test questionnaire responses revealed the positive impact regarding the importance of introducing clinical pathology courses within the clinical year of MBBS undergraduate curriculum. Response rate to the online session was 100%. The point of agreement between the pre-test and post-test questionnaire responses were highly achieved after intervention of the clinical pathology course. A statistically significant result (p < 0.05) between all of the pre-test and post-test questionnaire responses was noted. There was a strong positive recommendation for incorporating clinical laboratory medicine courses within the MBBS clinical science curriculum. The improvement observed among fourth-year MBBS students on learning the importance of clinical pathology courses was encouraging. This experience thus contributed to set and implement an exemplary vertical integration of pre-clinical science with clinical science.
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Affiliation(s)
- S Upadhyaya Kafle
- Department of Pathology, Birat Medical College Teaching Hospital, Morang, Nepal
| | - M Singh
- Department of Pathology, Birat Medical College Teaching Hospital, Morang, Nepal
| | - N Kafle
- Department of Pathology, Birat Medical College Teaching Hospital, Morang, Nepal
| | - A Sinha
- Department of Pathology, Birat Medical College Teaching Hospital, Morang, Nepal
| | - P Guragain
- Department of Community Medicine, Birat Medical College Teaching Hospital, Morang, Nepal
| | - H S Rimal
- Department of Pediatrics, Birat Medical College Teaching Hospital, Morang, Nepal
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18
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Agrawal S, Chakraborty P, Sinha A, Maiti A, Chakraborty M. ADRENAL HISTOPLASMOSIS: AN EASTERN INDIAN PERSPECTIVE. Acta Endocrinol (Buchar) 2022; 18:106-114. [PMID: 35975261 PMCID: PMC9365407 DOI: 10.4183/aeb.2022.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CONTEXT The clinical presentation of histoplasmosis is varied. Due to its propensity for adrenal involvement, histoplasmosis is an important differential diagnosis in any patient presenting with adrenal mass, bilateral in particular. OBJECTIVE Data on clinical presentation, pattern of adrenal involvement, radiological appearance and long-term follow-up of adrenal histoplasmosis are relatively sparse; hence we looked at it. DESIGN This record based single-centre retrospective study was conducted in one of the tertiary care hospitals, situated in eastern India catering the Gangetic delta. SUBJECTS AND METHODS Data on demographic characters, presenting manifestations, biochemical & hormonal parameters and radiological appearance of confirmed adrenal histoplasmosis cases (n=9), admitted between 2015-2019 have been retrieved. The treatment outcome and condition of patients after 1-4 years of follow-up has also been discussed. RESULTS Four out of the nine (44.4%) patients had predisposing immunocompromised conditions in the form of diabetes and/or chronic alcoholism while rest were immunocompetent. Seven out of nine patients (77.8 %) had signs and symptoms suggestive of adrenal insufficiency, while two (22.2%) presented with only pyrexia of unknown origin. All of them had bilateral adrenal mass, though the radiologically appearances were different. All patients received anti-fungal agents with/without hydrocortisone and/or fludrocortisone. One patient died (11.1%), while majority responded favourably to treatment. Adrenocortical function did not recover completely. CONCLUSIONS The possibility of adrenal histoplasmosis should always be considered in patients presenting with bilateral adrenal mass, irrespective of adrenal morphology. Treatment is effective, but many of them require supplemental hydrocortisone for quite a long period, if not lifelong. Mineralocorticoid deficiency, however, is not permanent.
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Affiliation(s)
- S.S. Agrawal
- Endocrinology & Metabolism Medical College and Hospital Kolkata, West Bengal, India
| | - P.P. Chakraborty
- Endocrinology & Metabolism Medical College and Hospital Kolkata, West Bengal, India
| | - A. Sinha
- Endocrinology & Metabolism Medical College and Hospital Kolkata, West Bengal, India
| | - A. Maiti
- Endocrinology & Metabolism Medical College and Hospital Kolkata, West Bengal, India
| | - M. Chakraborty
- Microbiology, Medical College and Hospital Kolkata, Kolkata,West Bengal, India
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Harris E, Eng D, Ang Q, Clarke E, Sinha A. Goals of care discussions in acute hospital admissions - Qualitative description of perspectives from patients, family and their doctors. Patient Educ Couns 2021; 104:2877-2887. [PMID: 34598803 DOI: 10.1016/j.pec.2021.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/03/2021] [Accepted: 09/06/2021] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Goals of care discussions guide care for hospital inpatients at risk of deterioration. We aimed to explore patient and family experience of goals of care during the first 72 h of admission along with their doctor's perspective. METHODS A qualitative descriptive study. Patients, family and doctors who participated in a goals of care discussion during an acute hospital admission at an Australian tertiary teaching hospital were interviewed in 2019. RESULTS Many participants found goals of care discussions appropriate and reported understanding. However, communication was commonly procedure-focused, with questioning about preferences for cardiopulmonary resuscitation and intubation. Some considered the discussion as inapplicable to their state of health, and occasionally surprising. Participants commonly related goals of care with death, and without context, this led to fear of abandonment. Previous experience with end of life care influenced decision-making. Preference for family presence was clear. CONCLUSIONS This study identifies deficiencies in goals of care communication in the acute hospital setting. Discussions are life-saving-procedure focused, leading to poor understanding and potentially distress, and jeopardising patient-centred care. PRACTICE IMPLICATIONS Assessment of patient values and clear communication on the aims of goals of care discussions is essential to optimise patient and institutional outcomes. Clinicians should consider environment and invite family participation.
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Affiliation(s)
| | - Derek Eng
- Royal Perth Hospital, Perth, Australia; School of Medicine, Division of Internal Medicine, University of Western Australia, Crawley, Australia; St John of God Subiaco Hospital, Subiaco, Australia; School of Medicine, University of Notre Dame, Fremantle, Australia.
| | - QiKai Ang
- Royal Perth Hospital, Perth, Australia.
| | | | - Atul Sinha
- Royal Perth Hospital, Perth, Australia; School of Medicine, Division of Internal Medicine, University of Western Australia, Crawley, Australia; Fiona Stanley Hospital, Murdoch, Australia.
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20
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Ali S, Khan SU, Gupta SK, Sinha A, Gupta MK, Abbasnia A, Mohammadi AA. Health risk assessment due to fluoride exposure from groundwater in rural areas of Agra, India: Monte Carlo simulation. Int J Environ Sci Technol 2021; 18:3665-3676. [DOI: 10.1007/s13762-020-03084-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/03/2020] [Accepted: 12/14/2020] [Indexed: 10/24/2023]
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21
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Nathan A, Rashid A, Shukla S, Sinha A, Sivathasan S, Rassam J, Smart S, Patel K, Shah N, Lamb B. 198 Immediate Post-Operative PDE5i Therapy Improves Early Erectile Function Outcomes after Robot-Assisted Radical Prostatectomy (RARP). Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1071] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
To assess whether the timing of post-operative Phosphodiesterase Inhibitor (PDE5i) therapy after Robot Assisted Radical Prostatectomy (RARP) is associated with a change in early erectile function, continence, or safety outcomes.
Method
Data was prospectively collected from a single surgeon in one tertiary centre and retrospectively evaluated. 158 patients were treated with PDE5i therapy post RARP over a two-year period.
Results
There were no significant differences in pre-operative characteristics between the therapy groups. Patients that had bilateral nerve sparing had a mean drop in Erectile Function (EF) score by 5.4 compared to 8.8 in the unilateral group. Additionally, 34.9% of bilateral nerve sparing patients returned to baseline compared to 12.1% of unilateral. Drop in EF scores and percentage return to baseline for unilateral nerve sparing was respectively 9 and 11.1% of immediate (day 1-2), 7 and 14.8% of early (day 3-14) and 9.7 and 9.5% of late (day >14) therapy (p = 0.9 and p = 0.6). For bilateral nerve sparing this was respectively 3.5 and 42.9% immediate therapy, 5.5 and 35.5% early therapy and 7.3 and 25% late therapy (p = 0.017 and p = 0.045). Pad free and social continence was achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early therapy and 26% and 54% for late therapy. There were no differences in compliance, complication, or readmission outcomes.
Conclusions
Immediate PDE5i therapy should be considered in patients following nerve sparing RARP in order to maximise functional outcomes, especially in those undergoing bilateral nerve spare.
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Affiliation(s)
- A Nathan
- Addenbrooke's Hospital, Cambridge, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
| | - A Rashid
- University of Cambridge, Cambridge, United Kingdom
| | - S Shukla
- University of Cambridge, Cambridge, United Kingdom
| | - A Sinha
- University of Cambridge, Cambridge, United Kingdom
| | - S Sivathasan
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J Rassam
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S Smart
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - K Patel
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - N Shah
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - B Lamb
- Addenbrooke's Hospital, Cambridge, United Kingdom
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22
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Fricker M, Nathan A, Hanna N, Asif A, Patel S, Georgi M, Hang K, Sinha A, Mullins W, Shea J, Lamb B, Sridhar A, Kelly J, Collins J. 81 VIRTUAL: Virtual Interactive Surgical Skills Classroom – An Ongoing Randomized Controlled Trial. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.
Method
72 medical students will be randomly assigned to three equal intervention groups based on year group and surgical skill confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots pre- and post-intervention, and Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts. Change in confidence, time to completion and a granular performance score will also be measured. Each intervention’s feasibility and accessibility will be assessed.
Results
Data collection will be completed in January 2021. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions.
Conclusions
To our knowledge, this will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the virtual classroom’s suitability as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and in the future.
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Affiliation(s)
- M Fricker
- Newcastle University, Newcastle, United Kingdom
| | - A Nathan
- University College London, London, United Kingdom
| | - N Hanna
- University of Cambridge, Cambridge, United Kingdom
| | - A Asif
- University of Leicester, Leicester, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - M Georgi
- University College London, London, United Kingdom
| | - K Hang
- University College London, London, United Kingdom
| | - A Sinha
- University of Cambridge, Cambridge, United Kingdom
| | - W Mullins
- University of Cambridge, Cambridge, United Kingdom
| | - Jessie Shea
- University of Cambridge, Cambridge, United Kingdom
| | - Benjamin Lamb
- Cambridge University Hospitals, Cambridge, United Kingdom
| | | | - John Kelly
- University College London, London, United Kingdom
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23
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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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24
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Farraj K, Sinha A, Kaliounji A, Kagolanu D, Rizvon K, Subramani K. Abdominal Pain: A Silent and Unlikely Cause. J Investig Med High Impact Case Rep 2021; 9:23247096211045254. [PMID: 34538107 PMCID: PMC8450547 DOI: 10.1177/23247096211045254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
While diverticulosis is a common phenomenon in the large intestine, it is a rare disease found in the small intestine accounting for only 0.06% to 1.3% of cases. Although most cases are asymptomatic, roughly 30% to 40%, it is crucial that it is on the differential of acute abdominal pain as it can be life-threatening and potentially require surgical management. Here, we describe a case of a 61-year-old Hispanic man who was found to have a perforated jejunal diverticula after initially presenting with left upper quadrant abdominal pain.
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Affiliation(s)
| | - Atul Sinha
- Nassau University Medical Center, East Meadow, NY, USA
| | | | | | - Kaleem Rizvon
- Nassau University Medical Center, East Meadow, NY, USA
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25
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Nathan A, Fricker M, Hanna N, Asif A, Patel S, Georgi M, Hang K, Sinha A, Mullins W, Shea J, Lamb B, Sridhar A, Kelly J, Collins J. O43 Virtual: virtual interactive surgical skills classroom: a randomized controlled trial (protocol). Br J Surg 2021. [DOI: 10.1093/bjs/znab282.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.
Method
72 medical students will be randomly assigned to three equal intervention groups based on surgical skills experience and confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots pre- and post-intervention. Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts.
Result
Change in confidence, time to completion and a novel granular performance score will also be measured. Each intervention’s feasibility and accessibility will be assessed. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions.
Conclusion
This will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the suitability of virtual classrooms as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and beyond.
Take-home Message
This is the first RCT assessing virtual basic surgical skill classroom training and serves as a comprehensive appraisal of the suitability of virtual classrooms as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and in the future.
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Affiliation(s)
- A Nathan
- University College London, London, UK
| | | | - N Hanna
- University of Cambridge, Cambridge, UK
| | - A Asif
- University of Leicester, Leicester, UK
| | - S Patel
- University College London, London, UK
| | - M Georgi
- University College London, London, UK
| | - K Hang
- University College London, London, UK
| | - A Sinha
- University of Cambridge, Cambridge, UK
| | - W Mullins
- University of Cambridge, Cambridge, UK
| | - J Shea
- University of Cambridge, Cambridge, UK
| | - B Lamb
- Cambridge University Hospitals, Cambridge, UK
| | - A Sridhar
- University College London, London, UK
| | - J Kelly
- University College London, London, UK
| | - J Collins
- University College London, London, UK
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Abdalla H, Aharonian F, Ait Benkhali F, Angüner EO, Arcaro C, Armand C, Armstrong T, Ashkar H, Backes M, Baghmanyan V, Barbosa Martins V, Barnacka A, Barnard M, Becherini Y, Berge D, Bernlöhr K, Bi B, Bissaldi E, Böttcher M, Boisson C, Bolmont J, de Bony de Lavergne M, Breuhaus M, Brun F, Brun P, Bryan M, Büchele M, Bulik T, Bylund T, Caroff S, Carosi A, Casanova S, Chand T, Chandra S, Chen A, Cotter G, Curyło M, Damascene Mbarubucyeye J, Davids ID, Davies J, Deil C, Devin J, Dirson L, Djannati-Ataï A, Dmytriiev A, Donath A, Doroshenko V, Dreyer L, Duffy C, Dyks J, Egberts K, Eichhorn F, Einecke S, Emery G, Ernenwein JP, Feijen K, Fegan S, Fiasson A, Fichet de Clairfontaine G, Fontaine G, Funk S, Füßling M, Gabici S, Gallant YA, Giavitto G, Giunti L, Glawion D, Glicenstein JF, Grondin MH, Hahn J, Haupt M, Hermann G, Hinton JA, Hofmann W, Hoischen C, Holch TL, Holler M, Hörbe M, Horns D, Huber D, Jamrozy M, Jankowsky D, Jankowsky F, Jardin-Blicq A, Joshi V, Jung-Richardt I, Kasai E, Kastendieck MA, Katarzyński K, Katz U, Khangulyan D, Khélifi B, Klepser S, Kluźniak W, Komin N, Konno R, Kosack K, Kostunin D, Kreter M, Lamanna G, Lemière A, Lemoine-Goumard M, Lenain JP, Leuschner F, Levy C, Lohse T, Lypova I, Mackey J, Majumdar J, Malyshev D, Malyshev D, Marandon V, Marchegiani P, Marcowith A, Mares A, Martí-Devesa G, Marx R, Maurin G, Meintjes PJ, Meyer M, Mitchell A, Moderski R, Mohrmann L, Montanari A, Moore C, Morris P, Moulin E, Muller J, Murach T, Nakashima K, Nayerhoda A, de Naurois M, Ndiyavala H, Niemiec J, Oakes L, O'Brien P, Odaka H, Ohm S, Olivera-Nieto L, de Ona Wilhelmi E, Ostrowski M, Panny S, Panter M, Parsons RD, Peron G, Peyaud B, Piel Q, Pita S, Poireau V, Priyana Noel A, Prokhorov DA, Prokoph H, Pühlhofer G, Punch M, Quirrenbach A, Raab S, Rauth R, Reichherzer P, Reimer A, Reimer O, Remy Q, Renaud M, Rieger F, Rinchiuso L, Romoli C, Rowell G, Rudak B, Ruiz-Velasco E, Sahakian V, Sailer S, Salzmann H, Sanchez DA, Santangelo A, Sasaki M, Scalici M, Schäfer J, Schüssler F, Schutte HM, Schwanke U, Seglar-Arroyo M, Senniappan M, Seyffert AS, Shafi N, Shapopi JNS, Shiningayamwe K, Simoni R, Sinha A, Sol H, Specovius A, Spencer S, Spir-Jacob M, Stawarz Ł, Sun L, Steenkamp R, Stegmann C, Steinmassl S, Steppa C, Takahashi T, Tam T, Tavernier T, Taylor AM, Terrier R, Thiersen JHE, Tiziani D, Tluczykont M, Tomankova L, Tsirou M, Tuffs R, Uchiyama Y, van der Walt DJ, van Eldik C, van Rensburg C, van Soelen B, Vasileiadis G, Veh J, Venter C, Vincent P, Vink J, Völk HJ, Wadiasingh Z, Wagner SJ, Watson J, Werner F, White R, Wierzcholska A, Wong YW, Yusafzai A, Zacharias M, Zanin R, Zargaryan D, Zdziarski AA, Zech A, Zhu SJ, Zorn J, Zouari S, Żywucka N, Evans P, Page K. Revealing x-ray and gamma ray temporal and spectral similarities in the GRB 190829A afterglow. Science 2021; 372:1081-1085. [PMID: 34083487 DOI: 10.1126/science.abe8560] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/07/2021] [Indexed: 11/02/2022]
Abstract
Gamma-ray bursts (GRBs), which are bright flashes of gamma rays from extragalactic sources followed by fading afterglow emission, are associated with stellar core collapse events. We report the detection of very-high-energy (VHE) gamma rays from the afterglow of GRB 190829A, between 4 and 56 hours after the trigger, using the High Energy Stereoscopic System (H.E.S.S.). The low luminosity and redshift of GRB 190829A reduce both internal and external absorption, allowing determination of its intrinsic energy spectrum. Between energies of 0.18 and 3.3 tera-electron volts, this spectrum is described by a power law with photon index of 2.07 ± 0.09, similar to the x-ray spectrum. The x-ray and VHE gamma-ray light curves also show similar decay profiles. These similar characteristics in the x-ray and gamma-ray bands challenge GRB afterglow emission scenarios.
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Affiliation(s)
| | - H Abdalla
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - F Aharonian
- Dublin Institute for Advanced Studies, Dublin 2, Ireland. .,Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany.,High Energy Astrophysics Laboratory, Russian-Armenian University (RAU), Yerevan 0051, Armenia
| | - F Ait Benkhali
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - E O Angüner
- Aix Marseille Université, Centre national de la recherche scientifique (CNRS)/Institut National de Physique Nucléaire et Physique des Particules (IN2P3), Centre de Physique des Particules de Marseille (CPPM), Marseille, France
| | - C Arcaro
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - C Armand
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - T Armstrong
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - H Ashkar
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - M Backes
- University of Namibia, Department of Physics, Windhoek 10005, Namibia.,Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - V Baghmanyan
- Instytut Fizyki Jądrowej Polskiej Akademii Nauk (PAN), 31-342 Kraków, Poland
| | | | - A Barnacka
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, 30-244 Kraków, Poland
| | - M Barnard
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - Y Becherini
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - D Berge
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - K Bernlöhr
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - B Bi
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - E Bissaldi
- Dipartimento Interateneo di Fisica, Politecnico di Bari, 70125 Bari, Italy.,Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70125 Bari, Italy
| | - M Böttcher
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - C Boisson
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - J Bolmont
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), F-75252 Paris, France
| | - M de Bony de Lavergne
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - M Breuhaus
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - F Brun
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - P Brun
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - M Bryan
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, 1098 XH Amsterdam, Netherlands
| | - M Büchele
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - T Bulik
- Astronomical Observatory, The University of Warsaw, 00-478 Warsaw, Poland
| | - T Bylund
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - S Caroff
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - A Carosi
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - S Casanova
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany.,Instytut Fizyki Jądrowej Polskiej Akademii Nauk (PAN), 31-342 Kraków, Poland
| | - T Chand
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - S Chandra
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - A Chen
- School of Physics, University of the Witwatersrand, Braamfontein, Johannesburg 2050, South Africa
| | - G Cotter
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - M Curyło
- Astronomical Observatory, The University of Warsaw, 00-478 Warsaw, Poland
| | | | - I D Davids
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - J Davies
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - C Deil
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - J Devin
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - L Dirson
- Universität Hamburg, Institut für Experimentalphysik, D 22761 Hamburg, Germany
| | - A Djannati-Ataï
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - A Dmytriiev
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - A Donath
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - V Doroshenko
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - L Dreyer
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - C Duffy
- School of Physics and Astronomy, The University of Leicester, Leicester LE1 7RH, UK
| | - J Dyks
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, 00-716 Warsaw, Poland
| | - K Egberts
- Institut für Physik und Astronomie, Universität Potsdam, D 14476 Potsdam, Germany
| | - F Eichhorn
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - S Einecke
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - G Emery
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), F-75252 Paris, France
| | - J-P Ernenwein
- Aix Marseille Université, Centre national de la recherche scientifique (CNRS)/Institut National de Physique Nucléaire et Physique des Particules (IN2P3), Centre de Physique des Particules de Marseille (CPPM), Marseille, France
| | - K Feijen
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - S Fegan
- Laboratoire Leprince-Ringuet, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - A Fiasson
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - G Fichet de Clairfontaine
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - G Fontaine
- Laboratoire Leprince-Ringuet, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - S Funk
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - M Füßling
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - S Gabici
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - Y A Gallant
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, F-34095 Montpellier Cedex 5, France
| | - G Giavitto
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - L Giunti
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France.,Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - D Glawion
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - J F Glicenstein
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - M-H Grondin
- Université Bordeaux, CNRS/IN2P3, Centre d'Études Nucléaires de Bordeaux Gradignan, 33175 Gradignan, France
| | - J Hahn
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - M Haupt
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - G Hermann
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - J A Hinton
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - W Hofmann
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - C Hoischen
- Institut für Physik und Astronomie, Universität Potsdam, D 14476 Potsdam, Germany
| | - T L Holch
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - M Holler
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - M Hörbe
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - D Horns
- Universität Hamburg, Institut für Experimentalphysik, D 22761 Hamburg, Germany
| | - D Huber
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - M Jamrozy
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, 30-244 Kraków, Poland
| | - D Jankowsky
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - F Jankowsky
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - A Jardin-Blicq
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - V Joshi
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - I Jung-Richardt
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - E Kasai
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - M A Kastendieck
- Universität Hamburg, Institut für Experimentalphysik, D 22761 Hamburg, Germany
| | - K Katarzyński
- Institute of Astronomy, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University, 87-100 Torun, Poland
| | - U Katz
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - D Khangulyan
- Department of Physics, Rikkyo University, Toshima-ku, Tokyo 171-8501, Japan.
| | - B Khélifi
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - S Klepser
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - W Kluźniak
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, 00-716 Warsaw, Poland
| | - Nu Komin
- School of Physics, University of the Witwatersrand, Braamfontein, Johannesburg 2050, South Africa
| | - R Konno
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - K Kosack
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - D Kostunin
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - M Kreter
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - G Lamanna
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - A Lemière
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - M Lemoine-Goumard
- Université Bordeaux, CNRS/IN2P3, Centre d'Études Nucléaires de Bordeaux Gradignan, 33175 Gradignan, France
| | - J-P Lenain
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), F-75252 Paris, France
| | - F Leuschner
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - C Levy
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), F-75252 Paris, France
| | - T Lohse
- Institut für Physik, Humboldt-Universität zu Berlin, D 12489 Berlin, Germany
| | - I Lypova
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - J Mackey
- Dublin Institute for Advanced Studies, Dublin 2, Ireland
| | - J Majumdar
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - D Malyshev
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - D Malyshev
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - V Marandon
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - P Marchegiani
- School of Physics, University of the Witwatersrand, Braamfontein, Johannesburg 2050, South Africa
| | - A Marcowith
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, F-34095 Montpellier Cedex 5, France
| | - A Mares
- Université Bordeaux, CNRS/IN2P3, Centre d'Études Nucléaires de Bordeaux Gradignan, 33175 Gradignan, France
| | - G Martí-Devesa
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - R Marx
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany.,Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - G Maurin
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - P J Meintjes
- Department of Physics, University of the Free State, Bloemfontein 9300, South Africa
| | - M Meyer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - A Mitchell
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - R Moderski
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, 00-716 Warsaw, Poland
| | - L Mohrmann
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - A Montanari
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - C Moore
- School of Physics and Astronomy, The University of Leicester, Leicester LE1 7RH, UK
| | - P Morris
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - E Moulin
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - J Muller
- Laboratoire Leprince-Ringuet, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - T Murach
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - K Nakashima
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - A Nayerhoda
- Instytut Fizyki Jądrowej Polskiej Akademii Nauk (PAN), 31-342 Kraków, Poland
| | - M de Naurois
- Laboratoire Leprince-Ringuet, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - H Ndiyavala
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - J Niemiec
- Instytut Fizyki Jądrowej Polskiej Akademii Nauk (PAN), 31-342 Kraków, Poland
| | - L Oakes
- Institut für Physik, Humboldt-Universität zu Berlin, D 12489 Berlin, Germany
| | - P O'Brien
- School of Physics and Astronomy, The University of Leicester, Leicester LE1 7RH, UK
| | - H Odaka
- Department of Physics, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - S Ohm
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - L Olivera-Nieto
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | | | - M Ostrowski
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, 30-244 Kraków, Poland
| | - S Panny
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - M Panter
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - R D Parsons
- Institut für Physik, Humboldt-Universität zu Berlin, D 12489 Berlin, Germany
| | - G Peron
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - B Peyaud
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - Q Piel
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - S Pita
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - V Poireau
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - A Priyana Noel
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, 30-244 Kraków, Poland
| | - D A Prokhorov
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, 1098 XH Amsterdam, Netherlands
| | - H Prokoph
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - G Pühlhofer
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - M Punch
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden.,Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - A Quirrenbach
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - S Raab
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - R Rauth
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - P Reichherzer
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - A Reimer
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - O Reimer
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - Q Remy
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - M Renaud
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, F-34095 Montpellier Cedex 5, France
| | - F Rieger
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - L Rinchiuso
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - C Romoli
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany.
| | - G Rowell
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - B Rudak
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, 00-716 Warsaw, Poland
| | - E Ruiz-Velasco
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany.
| | - V Sahakian
- Yerevan Physics Institute, 375036 Yerevan, Armenia
| | - S Sailer
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - H Salzmann
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - D A Sanchez
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - A Santangelo
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - M Sasaki
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - M Scalici
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - J Schäfer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - F Schüssler
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France.
| | - H M Schutte
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - U Schwanke
- Institut für Physik, Humboldt-Universität zu Berlin, D 12489 Berlin, Germany
| | - M Seglar-Arroyo
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - M Senniappan
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - A S Seyffert
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - N Shafi
- School of Physics, University of the Witwatersrand, Braamfontein, Johannesburg 2050, South Africa
| | - J N S Shapopi
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - K Shiningayamwe
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - R Simoni
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, 1098 XH Amsterdam, Netherlands
| | - A Sinha
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - H Sol
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - A Specovius
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - S Spencer
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - M Spir-Jacob
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - Ł Stawarz
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, 30-244 Kraków, Poland
| | - L Sun
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, 1098 XH Amsterdam, Netherlands
| | - R Steenkamp
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - C Stegmann
- Institut für Physik und Astronomie, Universität Potsdam, D 14476 Potsdam, Germany.,Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - S Steinmassl
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - C Steppa
- Institut für Physik und Astronomie, Universität Potsdam, D 14476 Potsdam, Germany
| | - T Takahashi
- Kavli Institute for the Physics and Mathematics of the Universe (World Premier International Research Center Initiative (WPI)), The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Kashiwa, Chiba, 277-8583, Japan
| | - T Tam
- School of Physics and Astronomy, Sun Yat Sen University, Guangzhou 510275, People's Republic of China
| | - T Tavernier
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - A M Taylor
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany.
| | - R Terrier
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - J H E Thiersen
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - D Tiziani
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - M Tluczykont
- Universität Hamburg, Institut für Experimentalphysik, D 22761 Hamburg, Germany
| | - L Tomankova
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - M Tsirou
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - R Tuffs
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - Y Uchiyama
- Department of Physics, Rikkyo University, Toshima-ku, Tokyo 171-8501, Japan
| | - D J van der Walt
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - C van Eldik
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - C van Rensburg
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - B van Soelen
- Department of Physics, University of the Free State, Bloemfontein 9300, South Africa
| | - G Vasileiadis
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, F-34095 Montpellier Cedex 5, France
| | - J Veh
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - C Venter
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - P Vincent
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), F-75252 Paris, France
| | - J Vink
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, 1098 XH Amsterdam, Netherlands
| | - H J Völk
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - Z Wadiasingh
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - S J Wagner
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - J Watson
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - F Werner
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - R White
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - A Wierzcholska
- Instytut Fizyki Jądrowej Polskiej Akademii Nauk (PAN), 31-342 Kraków, Poland.,Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - Yu Wun Wong
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - A Yusafzai
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - M Zacharias
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa.,Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - R Zanin
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - D Zargaryan
- Dublin Institute for Advanced Studies, Dublin 2, Ireland.,High Energy Astrophysics Laboratory, Russian-Armenian University (RAU), Yerevan 0051, Armenia
| | - A A Zdziarski
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, 00-716 Warsaw, Poland
| | - A Zech
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - S J Zhu
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany.
| | - J Zorn
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - S Zouari
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - N Żywucka
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - P Evans
- School of Physics and Astronomy, The University of Leicester, Leicester LE1 7RH, UK
| | - K Page
- School of Physics and Astronomy, The University of Leicester, Leicester LE1 7RH, UK
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Zhou R, Prasad G, Robinson S, Shahane S, Sinha A. The significance of urgent ultrasound scan for shoulder dislocation in patients above the age of 40: A prospective British Elbow and Shoulder Society pathway implementation study. Shoulder Elbow 2021; 13:303-310. [PMID: 34659471 PMCID: PMC8512999 DOI: 10.1177/1758573220913285] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The highlight of the British Elbow and Shoulder Society pathway for the management of traumatic anterior shoulder instability is early imaging in patients aged over 40 years to assess rotator cuff integrity and early repair, if indicated to optimise function. The senior author set up a protocol in our institute to streamline the diagnostic process for this cohort of patients. This was a retrospective analysis from a prospectively collected database to highlight the importance of early specialist imaging. METHODS Our protocol is to perform urgent ultrasound scans for all suitable patients above 40 years after first-time traumatic shoulder dislocation. Demographics, associated injuries, ultrasound scan results, operations and functional outcomes were collated. RESULTS One year following the introduction of our protocol, 40 patients with a mean age of 67 (range, 42-89; SD = 13.1) had ultrasound. The incidence of full-thickness rotator cuff tears was 57.5% (n = 23). Eleven patients with confirmed full-thickness rotator cuff tears underwent surgery. The mean age of surgical patients was significantly younger than the non-surgical group (p = 0.004). DISCUSSION The use of early diagnostic imaging demonstrated a high incidence of full-thickness rotator cuff tears in this cohort of patients. This allowed early surgical repair to optimise function.
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Affiliation(s)
- R Zhou
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - G Prasad
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - S Robinson
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - S Shahane
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - A Sinha
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
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Tripathi T, Singh AR, Kapoor R, Sinha A, Ghosh S, Kaur K, Pokhariya D, Maity S, Tapadar A, Chandra A. Dapsone-induced methaemoglobinaemia in leprosy: a close mimic of 'happy hypoxia' in the COVID-19 pandemic. J Eur Acad Dermatol Venereol 2021; 35:e568-e571. [PMID: 34037283 PMCID: PMC8242520 DOI: 10.1111/jdv.17394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T Tripathi
- Department of Dermatology, Base Hospital Barrackpore, Kolkata, India
| | - A R Singh
- Department of Medicine, Base Hospital Barrackpore, Kolkata, India
| | - R Kapoor
- Departments of Medicine and Haematology, Command Hospital Eastern Command, Kolkata, India
| | - A Sinha
- Department of Dermatology, Military Hospital Kirkee, Pune, India
| | - S Ghosh
- Department of Medicine, Base Hospital Barrackpore, Kolkata, India
| | - K Kaur
- Department of Pathology, Base Hospital Barrackpore, Kolkata, India
| | - D Pokhariya
- Department of Radiology, Base Hospital Barrackpore, Kolkata, India
| | - S Maity
- Department of Anaesthesiology and Critical Care, Base Hospital Barrackpore, Kolkata, India
| | - A Tapadar
- Department of Medicine, Base Hospital Barrackpore, Kolkata, India
| | - A Chandra
- Department of Medicine, Base Hospital Barrackpore, Kolkata, India
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Sinha A, Kumari S, Ganguly M. Development, validation, and feasibility of a school-based short duration integrated classroom yoga module: A pilot study design. J Educ Health Promot 2021; 10:148. [PMID: 34222523 PMCID: PMC8224480 DOI: 10.4103/jehp.jehp_674_20] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/02/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND The practice of yoga is proven to have physical, cognitive and emotional benefits for school children. Despite this many schools do not include yoga in their daily schedule. The reasons cited are lack of time and resources. To overcome these problems the present study aimed to develop and validate a short duration Integrated classroom yoga module. The design guidelines were that it should be possible to practice in the classroom environment and that it could be led by the class teacher. In this way the module would overcome the problem of both time and resource. MATERIALS AND METHODS The study had two main phases. In the first phase, selected ICYM practices based on the literature review were validated by 21 subject matter experts using Lawhse's content validity ratio (CVR) formula. In the second phase, a pilot study using a paired sample prepost measurement design was carried out on 49 high school children. The study was conducted in June 2019. The intervention period was 1 month, and the test variables were physical fitness, cognitive performance, self-esteem, emotional well-being, and personality characteristic. Paired sample t-test was the analysis tool and the software used was the Statistical Package for the Social Science version 26. RESULTS In the Lawshe's CVR analysis, 17 out of the 24 practices tested were rated by experts as essential as was the overall module (CVR score ≥0.429). In the pilot study, there were significant differences in the postmean scores compared to premean scores, for all the 4 EUROFIT physical fitness testing battery tests (P < 0.02), all the three scores of the Stroop color-word naming task (P < 0.001) and the Rosenberg self-esteem scale (P < 0.008). CONCLUSION ICYM was validated and found feasible by the present study. It was found to have a statistically significant impact on physical fitness, cognitive performance, and self-esteem variables. However, a randomized control trial with a longer intervention period is needed to strengthen the present study.
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Affiliation(s)
- Atul Sinha
- Department of Yoga and Humanities, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
| | - Sony Kumari
- Department of Yoga and Humanities, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
| | - Mollika Ganguly
- Department of Yoga and Humanities, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
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Nathan A, Shukla S, Sinha A, Sivathasan S, Rashid A, Rassam J, Smart S, Patel K, Shah N, Lamb B. 31 Immediate Post-Operative Phosphodiesterase-5 Inhibitors (PDE5i) Therapy Improves Early Erectile Function Outcomes After Robot Assisted Radical Prostatectomy (RARP). Br J Surg 2021. [DOI: 10.1093/bjs/znab134.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
To assess whether the timing of post-RARP PDE5i therapy affects early erectile function, continence, or safety outcomes.
Method
Data from 158 patients treated with PDE5is post-RARP was prospectively collected over two years from a single surgeon at one tertiary centre and retrospectively evaluated. Therapy was started: immediately (day 1-2) in 29%, early (day 3-14) in 37% and late (after day 14) post-op in 34%. EPIC-26 Erectile Function (EF) scores were collected pre-op and post-op after a median 43-day follow-up interval.
Results
Drop in EF scores and percentage return to baseline post unilateral nerve sparing (UNS) compared to bilateral nerve sparing (BNS) RARP was respectively 9 and 11.1% versus 3.5 and 42.9% of immediate therapy, 7 and 14.8% versus 5.5 and 35.5% of early and 9.7 and 9.5% versus 7.3 and 25% of late. Pad free and social continence was achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early and 26% and 54% for late.
Conclusions
Immediate post RARP PDE5i therapy may protect EF and should be considered clinically, with more benefits for BNS than UNS patients. Immediate or early, rather than late, PDE5i therapy improved early continence in BNS patients.
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Affiliation(s)
- A Nathan
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - S Shukla
- University of Cambridge, Cambridge, United Kingdom
| | - A Sinha
- University of Cambridge, Cambridge, United Kingdom
| | - S Sivathasan
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - A Rashid
- University of Cambridge, Cambridge, United Kingdom
| | - J Rassam
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - S Smart
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - K Patel
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - N Shah
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - B Lamb
- Addenbrooke’s Hospital, Cambridge, United Kingdom
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Sinha A. A study of the intranuclear cascade evaporation model and its application in estimating helium and transmutation product cross-sections in spallation neutron sources / Untersuchung und Anwendung eines intranuklearen Verdampfungsmodells zur Abschätzung von Querschnitten für die Erzeugung von Helium und Transmutationsprodukten in Spallationsneutronenquellen. KERNTECHNIK 2021. [DOI: 10.1515/kern-1988-520116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mathew G, Sinha A, Grewal N, Ahmad A, Hari P, Bagga A. POS-457 EFFICACY AND SAFETY OF RITUXIMAB VERSUS TACROLIMUS IN FREQUENTLY RELAPSING NEPHROTIC SYNDROME: AN OPEN LABEL RANDOMIZED CONTROLLED TRIAL. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Sinha A, Ghanapriya K, Hari P, Bagga A. POS-462 EFFICACY AND SAFETY OF PREDNISOLONE ON ALTERNATE DAYS MADE DAILY WITH INFECTIONS VERSUS LEVAMISOLE IN FREQUENTLY RELAPSING NEPHROTIC SYNDROME: AN OPEN LABEL RANDOMIZED CONTROLLED TRIAL. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Patel A, Kong R, Sato T, Yoo S, Sinha A, Powell C, Zhu J, Watanabe H. FP12.11 Single-Cell RNA Sequencing Analyses Distinguishes Transcriptional Activity of c-Myc and L-Myc in Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.137] [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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Das PP, Mondal P, Anweshan, Sinha A, Biswas P, Sarkar S, Purkait MK. Treatment of steel plant generated biological oxidation treated (BOT) wastewater by hybrid process. Sep Purif Technol 2021. [DOI: 10.1016/j.seppur.2020.118013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Iaccarino C, Kolias A, Adelson PD, Rubiano AM, Viaroli E, Buki A, Cinalli G, Fountas K, Khan T, Signoretti S, Waran V, Adeleye AO, Amorim R, Bertuccio A, Cama A, Chesnut RM, De Bonis P, Estraneo A, Figaji A, Florian SI, Formisano R, Frassanito P, Gatos C, Germanò A, Giussani C, Hossain I, Kasprzak P, La Porta F, Lindner D, Maas AIR, Paiva W, Palma P, Park KB, Peretta P, Pompucci A, Posti J, Sengupta SK, Sinha A, Sinha V, Stefini R, Talamonti G, Tasiou A, Zona G, Zucchelli M, Hutchinson PJ, Servadei F. Consensus statement from the international consensus meeting on post-traumatic cranioplasty. Acta Neurochir (Wien) 2021; 163:423-440. [PMID: 33354733 PMCID: PMC7815592 DOI: 10.1007/s00701-020-04663-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/28/2020] [Indexed: 12/26/2022]
Abstract
Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.
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Das PP, Mondal P, Sinha A, Biswas P, Sarkar S, Purkait MK. Integrated ozonation assisted electrocoagulation process for the removal of cyanide from steel industry wastewater. Chemosphere 2021; 263:128370. [PMID: 33297281 DOI: 10.1016/j.chemosphere.2020.128370] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 08/15/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 05/22/2023]
Abstract
This work focuses on the removal of cyanide, chemical oxygen demand (COD), biological oxygen demand (BOD), and chloride from biological oxidation treated (BOT) effluent of the steel industry by integrated ozonation assisted electrocoagulation method. The removal efficiency of the pollutants was found to be inefficient when the electrocoagulation or ozonation process was performed separately. However, a combination of ozonation and electrocoagulation gives a highly satisfactory result. Such an integrated approach for the treatment of BOT effluent has not been previously investigated. The effects of operating variables viz. ozone generation rate, current density, and analysis time on pollutant removal were primarily analyzed for the hybrid process. The experimental operating condition was optimized and was seen that ozone generation rate of 1.33 mg s-1, ozonation time of 40 min, a current density of 100 A m-2, and electrolysis time of 30 min were sufficient for reducing the pollutant concentration below its permissible limits. The removal efficiencies of the combined process at optimum conditions were 99.8%, 94.7%, 95%, and 46.5% for cyanide, COD, BOD, and chloride ions, respectively. A kinetic study was performed for the degradation of the pollutants during ozonation. The pseudo-first-order kinetic model was found to be best suited for the analysis with the highest R2 value of 0.99 for cyanide, COD, BOD, and chloride, respectively. The mass transfer study conducted further showed that the volumetric mass transfer coefficient, Kla, was increased with that of the ozone generation rate. Cost estimation of the hybrid process was done and compared with that of the other reported integrated process.
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Affiliation(s)
- Pranjal P Das
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India
| | - Piyal Mondal
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India
| | - A Sinha
- Environmental Research Group, Tata Steel Limited, Jamshedpur, 831007, India
| | - P Biswas
- Environmental Research Group, Tata Steel Limited, Jamshedpur, 831007, India
| | - S Sarkar
- Environmental Research Group, Tata Steel Limited, Jamshedpur, 831007, India
| | - M K Purkait
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India.
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Seenarain V, Idrees M, Mogridge J, Sinha A, Thompson A. Random colonic biopsies in macroscopically normal colonoscopies: is there any benefit? A two-centre audit of current practice. ANZ J Surg 2020; 90:E163-E167. [PMID: 32856361 DOI: 10.1111/ans.16248] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recent guidelines from the British Society of Gastroenterology published in April 2018, recommended performing random colonic biopsies (RCB) in endoscopically normal colonic mucosa when investigating chronic diarrhoea in adults to rule out microscopic colitis; however, cost effectiveness was not accounted for due to poor evidence base. There is now more evidence that RCBs are of low yield and of significant cost. METHODS A two-centre audit of current practice was conducted at Rockingham General Hospital and Fremantle Hospital in Western Australia, aiming to determine the yield of RCB in macroscopically normal mucosa for microscopic colitis, from 1 January 2009 to 30 June 2018, with comparisons of practice and results between gastroenterologists and general surgeons. Variability in the indications (diarrhoea and non-diarrhoea indications) for RCBs was determined and the cost of consumables, additional endoscopy time and histopathology analysis were calculated. RESULTS A total of 872 normal colonoscopies with RCBs were included; 48.7% of colonoscopies with RCB were for diarrhoea. Only 1.5% of RCBs were positive for microscopic colitis; 3.1% of patients with diarrhoea had microscopic colitis. Only one patient received pharmacologial treatment as a result of the test. The calculated cost per positive diagnosis of microscopic colitis was $10 862.42. CONCLUSION RCBs from normal colonic mucosa have poor yield and are costly. Local guidelines should be updated, so RCBs are performed only in patients with a high degree of suspicion of an organic cause of chronic diarrhoea.
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Affiliation(s)
- Vidya Seenarain
- Department of General Surgery, Rockingham General Hospital, Perth, Western Australia, Australia
| | - Marwan Idrees
- Department of General Surgery, Fremantle Hospital Health Services, Fremantle, Western Australia, Australia
| | - Jessie Mogridge
- General Surgery, Rockingham General Hospital, Perth, Western Australia, Australia
| | - Atul Sinha
- Gastroenterology, Rockingham General Hospital, Perth, Western Australia, Australia
| | - Andrew Thompson
- Surgical and Specialist Care Division, Rockingham Peel Group, Perth, Western Australia, Australia
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Nathan A, Shukla S, Sinha A, Sivathasan S, Rashid A, Rassam J, Smart S, Patel K, Shah N, Lamb B. Immediate post-operative PDE5i therapy improves early Erectile Function Outcomes after Robot Assisted Radical Prostatectomy (RARP). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rustagi N, Raghav P, Dutt N, Sinha A, Rodha MS. Assessing continuum of trauma care for road accident victim in Jodhpur, Rajasthan. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Road traffic injuries (RTIs) are a major public health problem, requiring concerted efforts both for their prevention and a reduction of their consequences. The present study was designed to assess the existing process of pre-hospital trauma care administered to road accident victims in a fast urbanizing city of Jodhpur, Rajasthan
Methods
A cross-sectional study was designed from 1st November 2018 to 30th June 2019. All cases who were admitted to tertiary level trauma care facility in the study period were reviewed and were analyzed for type of injuries suffered, prehospital care services availed and the time duration that elapsed before patient arrived at tertiary health facility. Geographic information system was used to identify clustering of accident hot spots in the Jodhpur district.
Results
A total of 137 patients or their caregivers were interviewed during the study period. A large proportion of patients 57(41.6%) were unconscious in post-crash phase. Private taxis contributed to maximum patient transfer (75.9%) and only 12.4% were transported through ambulance. Almost three fourth (78.1%) of patients received some form of pre-hospital care within 30 minutes of accident. About one third patients (35.7%) reached the trauma facility directly after the accident while majority (64.9%) were referred from other health facilities
Conclusions
Pre-hospital trauma care for road traffic accident victims is available in golden hour for majority of victims in Jodhpur district. Victims from rural area and tourists form a sizeable proportion of accident victims brought to trauma care facility. The primary health care facilities play a pivotal role in managing victims as first point of care. Future research is thus warranted to explicitly examine the role of health professionals at primary health care facilities in administering pre-hospital trauma care.
Key messages
The primary health care facilities play a pivotal role in managing victims as first point of care. In areas with evolving trauma systems, pre-hospital trauma care strengthening requires capacity building of all level of health professionals.
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Affiliation(s)
- N Rustagi
- Community Medicine & Family Medicine, AIIMS Jodhpur, Jodhpur, India
| | - P Raghav
- Community Medicine & Family Medicine, AIIMS Jodhpur, Jodhpur, India
| | - N Dutt
- Community Medicine & Family Medicine, AIIMS Jodhpur, Jodhpur, India
| | - A Sinha
- Community Medicine & Family Medicine, AIIMS Jodhpur, Jodhpur, India
| | - M S Rodha
- Community Medicine & Family Medicine, AIIMS Jodhpur, Jodhpur, India
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Kamal N, Tarafdar A, Sinha A, Kumar V. Effect of Glucose Cometabolism on Biodegradation of Gabapentin (an Anticonvulsant Drug) by Gram-Positive Bacteria Micrococcus luteus N.ISM.1. APPL BIOCHEM MICRO+ 2020. [DOI: 10.1134/s0003683820040067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Anele CC, Nachiappan S, Sinha A, Cuthill V, Jenkins JT, Clark SK, Latchford A, Faiz OD. Safety and efficacy of laparoscopic near-total colectomy and ileo-distal sigmoid anastomosis as a modification of total colectomy and ileorectal anastomosis for prophylactic surgery in patients with adenomatous polyposis syndromes: a comparative study. Colorectal Dis 2020; 22:799-805. [PMID: 31943692 DOI: 10.1111/codi.14964] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/15/2019] [Indexed: 02/08/2023]
Abstract
AIM Colectomy in patients with adenomatous polyposis (AP) syndromes demands good oncological and surgical outcome. Total colectomy with ileorectal anastomosis (TC-IRA) is one surgical option for these patients. Anastomotic leakage rates of 11% have been reported following TC-IRA. Ileo-distal sigmoid anastomosis (IDSA) is a recent modification of our practice. Our aim was to compare postoperative outcome in patients with AP following near-total colectomy with IDSA (NT-IDSA) and TC-IRA at a single institution. METHOD A prospectively maintained database was reviewed to identify patients with AP who underwent laparoscopic NT-IDSA and TC-IRA. Patient demographics, early morbidity and mortality and outcome of endoscopic surveillance were evaluated. RESULTS A total of 191 patients with AP underwent laparoscopic colectomy between 2006 and 2017, of whom 139 (72.8%) underwent TC-IRA and 52 (27.2%) NT-IDSA. The median age at surgery in the TC-IRA and NT-IDSA groups was 20 years (IQR 17-45) and 27 years (IQR 19-50), respectively. Grade II complications were comparable between the two groups. There were no anastomotic leakages in the NT-IDSA group compared with 15 (10.8%) in the TC-IRA group (P = 0.0125) and no reoperation in the NT-IDSA group compared with 17 (12.2%) in the TC-IRA group (P = 0.008). The frequency of polypectomies per flexible sigmoidoscopy was comparable between the two groups. CONCLUSION This study demonstrates that laparoscopic NT-IDSA for polyposis is associated with a significant improvement in anastomotic leakage rates and surgical outcome. It is too soon to tell whether NT-IDSA alters the need for further intervention, either endoscopic polypectomy or further surgery.
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Affiliation(s)
- C C Anele
- The Polyposis Registry, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK.,Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - S Nachiappan
- Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Sinha
- The Polyposis Registry, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - V Cuthill
- The Polyposis Registry, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - J T Jenkins
- The Polyposis Registry, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - S K Clark
- The Polyposis Registry, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Latchford
- The Polyposis Registry, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - O D Faiz
- The Polyposis Registry, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK.,Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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Sinha A, Biswas P, Sarkar S, Bora U, Purkait MK. Utilization of LD slag from steel industry for the preparation of MF membrane. J Environ Manage 2020; 259:110060. [PMID: 31929036 DOI: 10.1016/j.jenvman.2019.110060] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/06/2019] [Accepted: 12/31/2019] [Indexed: 06/10/2023]
Abstract
This work is focused on utilizing the solid waste generated from steel industry for the fabrication of porous ceramic membrane from Linz Donawitz (LD) slag. Membranes were fabricated using uniaxial method sintered at three different temperatures like 650 °C, 850 °C and 950 °C. Membranes fabricated with raw LD slag gave a highly basic filtrate. In contrast with this issue, LD slag was modified using acetic acid and CO2 purging to convert calcium oxide which is present in the slag to calcium carbonate. The membranes fabricated from modified LD slag showed a filtrate pH of 8.4 and 8.5. Porosity, pore size distribution, flexural strength, chemical stability was determined and pure water flux experiments were conducted to evaluate the efficiency of the prepared membranes. Considering the raw materials cost, the cost of the fabricated membranes was estimated in the range of 32.55-55.7 USD/m2. This work gives a potential path to develop microfiltration ceramic membrane with, high porosity and great quality in terms of strength and chemical stability. The fabricated membranes were utilized in a hybrid technique (flocculation followed by microfiltration) for the treatment of cold roll mill (CRM) wastewater generated from steel industry. Use of LD slag for the fabrication of ceramic membrane is not only an appealing option towards the commercialization of membrane, yet also great option to reduce the solid waste which is dumped to the environment.
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Affiliation(s)
- A Sinha
- Environmental Research Group, Tata Steel Limited, Jamshedpur, 831007, India
| | - P Biswas
- Environmental Research Group, Tata Steel Limited, Jamshedpur, 831007, India
| | - S Sarkar
- Environmental Research Group, Tata Steel Limited, Jamshedpur, 831007, India
| | - U Bora
- Centre for the Environment, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India
| | - M K Purkait
- Centre for the Environment, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India.
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KHANDELWAL P, Faruq M, Puraswani M, Sinha A, Hari P, Bagga A. SAT-462 COEXISTING VARIATIONS IN COMPLEMENT REGULATORY GENES INCREASE SUSCEPTIBILITY TO RELAPSE IN ANTI-FACTOR H ASSOCIATED ATYPICAL HEMOLYTIC UREMIC SYNDROME. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Parker R, Kim SJ, Im GY, Nahas J, Dhesi B, Vergis N, Sinha A, Ghezzi A, Rink MR, McCune A, Aithal GP, Newsome PN, Weston CJ, Holt A, Gao B. Obesity in acute alcoholic hepatitis increases morbidity and mortality. EBioMedicine 2019; 45:511-518. [PMID: 31278069 PMCID: PMC6642069 DOI: 10.1016/j.ebiom.2019.03.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 02/12/2019] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Alcohol and obesity synergise to increase the risk of liver-related mortality. We examined the influence of adiposity on clinical outcomes in alcoholic hepatitis (AH) and the underlying inflammatory crosstalk between adipose tissue (AT) and the liver. METHODS A cohort of 233 patients with AH from the UK and USA provided data to analyse the effects of obesity in AH. Body mass index was corrected for the severity of ascites, termed cBMI. Inflammatory and metabolic profiling was undertaken by proteome analysis of human serum samples. The effect of alcohol on adipose tissue and CXCL11 expression was studied in 3 T3-derived adipocytes and in mice using the high-fat diet-plus-binge ethanol model. FINDINGS Obesity was common amongst patients with AH, seen in 19% of individuals. Obesity (HR 2.22, 95%CI 1.1-4.3, p = .022) and underweight (HR 2.38, 1.00-5.6, p = .049) were independently associated with mortality at 3 months. Proteome analysis demonstrated multiple metabolic and inflammatory factors differentially expressed in obese AH verse lean AH, with CXCL11 being the most elevated factor in obese AH. In vitro analysis of cultured adipocytes and in vivo analysis of mouse models showed that alcohol induced CXCL11 expression in AT, but not in liver. INTERPRETATION Obesity is common in AH and associated with a greater than two-fold increase in short-term mortality. Obese AH is associated with a different inflammatory phenotype, with the greatest elevation in CXCL11. These data confirm that adiposity is clinically important in acute alcohol-related liver disease and illustrate the adipose-liver inflammatory axis in AH. FUND: This work was supported in part by an EASL Sheila Sherlock Physician Scientist Fellowship. The funder played no role in gathering or analysing data or writing the manuscript. This paper presents independent research supported by the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
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Affiliation(s)
- Richard Parker
- Liver and Hepatobiliary Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Centre for Liver Research, University of Birmingham, Birmingham, UK; National Institute for Alcoholism and Alcohol Abuse, National Institutes of Health, Rockville, MD, USA.
| | - S J Kim
- National Institute for Alcoholism and Alcohol Abuse, National Institutes of Health, Rockville, MD, USA
| | - G Y Im
- Mount Sinai Medical Centre, New York, NY, USA
| | - J Nahas
- Mount Sinai Medical Centre, New York, NY, USA
| | - B Dhesi
- Liver and Hepatobiliary Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - N Vergis
- Imperial College Healthcare NHS Foundation Trust, UK
| | - A Sinha
- Department of Liver Medicine, University Hospitals Bristol NHS Foundation Trust, UK
| | - A Ghezzi
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University Of Nottingham, Nottingham, UK
| | - M R Rink
- Centre for Liver Research, University of Birmingham, Birmingham, UK
| | - A McCune
- Department of Liver Medicine, University Hospitals Bristol NHS Foundation Trust, UK
| | - G P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University Of Nottingham, Nottingham, UK
| | - P N Newsome
- Liver and Hepatobiliary Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Centre for Liver Research, University of Birmingham, Birmingham, UK
| | - C J Weston
- Centre for Liver Research, University of Birmingham, Birmingham, UK
| | - A Holt
- Liver and Hepatobiliary Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - B Gao
- National Institute for Alcoholism and Alcohol Abuse, National Institutes of Health, Rockville, MD, USA
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Morschhauser F, Flinn I, Gasiorowski R, Illés Á, Feugier P, Greil R, Johnson N, Larouche J, Lugtenburg P, Patti C, Salles G, Trněný M, de Vos S, Mir F, Kornacker M, Punnoose E, Samineni D, Szafer-Glusman E, Petrich A, Sinha A, Spielewoy N, Humphrey K, Bazeos A, Zelenetz A. IMPROVED OUTCOMES IN PATIENTS (PTS) WITH BCL2-POSITIVE DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) TREATED WITH VENETOCLAX (VEN) PLUS R-CHOP: RESULTS FROM THE PHASE 2 CAVALLI STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.95_2629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- F. Morschhauser
- Institute of Hematology-Transfusion; Université de Lille, Centre Hospitalier Universitaire [CHU] Lille, Groupe de Recherche sur les Formes Injectables et les Technologies Associées; Lille France
| | - I.W. Flinn
- Center for Blood Cancers; Sarah Cannon Research Institute-Tennessee Oncology; Nashville TN United States
| | - R. Gasiorowski
- Department of Haematology; Concord Hospital, University of Sydney; Sydney Australia
| | - Á. Illés
- Faculty of Medicine; Department of Hematology, University of Debrecen; Debrecen Hungary
| | - P. Feugier
- Service d'Hématologie; CHU Régional de Nancy; Vandoeuvre lès Nancy France
| | - R. Greil
- 3rd Medical Department, Paracelsus Medical University Salzburg; Salzburg Cancer Research Institute, Cancer Cluster Salzburg; Salzburg Austria
| | - N.A. Johnson
- Department of Medicine, Lady Davis Institute for Medical Research; Jewish General Hospital; Montreal Quebec Canada
| | - J. Larouche
- Hematology-Oncology, CHU de Québec; Hôpital de l'Enfant-Jésus; Quebec Canada
| | - P.J. Lugtenburg
- HOVON Lunenburg Lymphoma Phase I-II Consortium, Department of Hematology; Erasmus MC Cancer Institute; Rotterdam Netherlands
| | - C. Patti
- Department of Hematology; Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello; Palermo Italy
| | - G. Salles
- Clinical Hematology; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, University of Lyon; Pierre-Benite France
| | - M. Trněný
- 1st Department of Medicine; Charles University General Hospital; Prague Czech Republic
| | - S. de Vos
- Division Hematology/Oncology; David Geffen School of Medicine at UCLA; Los Angeles CA United States
| | - F. Mir
- On assignment to PD Clinical Oncology, Roche Products Ltd; Welwyn Garden City, United Kingdom, and Royal Marsden Hospital; Sutton United Kingdom
| | - M. Kornacker
- Pharma Research and Early Development; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - E.A. Punnoose
- Oncology Biomarker Development; Genentech, Inc.; South San Francisco CA United States
| | - D. Samineni
- Genentech Research and Early Development; Genentech, Inc.; South San Francisco CA United States
| | - E. Szafer-Glusman
- Oncology Biomarker Development; Genentech, Inc.; South San Francisco CA United States
| | - A. Petrich
- Oncology Early Development; AbbVie; North Chicago IL United States
| | - A. Sinha
- Product Development; Roche Products Ltd; Welwyn Garden City United Kingdom
| | - N. Spielewoy
- Pharmaceutical Development Clinical Science Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - K. Humphrey
- Clinical Development Oncology; Roche Products Ltd.; Welwyn Garden City United Kingdom
| | - A. Bazeos
- PD Clinical Science; Oncology, Roche Products Ltd.; Welwyn Garden City United Kingdom
| | - A.D. Zelenetz
- Lymphoma Service; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College; New York City NY United States
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Sinha A, Singh N, Dixit B, Painuly N, Patni H, Yadav A. Evaluation of Electron Specific Absorbed Fractions in Organs of Digimouse Voxel Phantom Using Monte Carlo Simulation Code FLUKA. J Biomed Phys Eng 2019; 9:161-166. [PMID: 31214521 PMCID: PMC6538914] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 05/21/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND For preclinical evaluations of radiopharmaceuticals, most studies are carried out on mice. Electron specific absorbed fractions (SAF) values have had vital role in the assessment of absorbed dose. In past studies, electron SAFs were given for limited source target pairs using older reports of human organ compositions. OBJECTIVE Electron specific absorbed fraction values for monoenergetic electrons of energies 15, 50, 100, 500, 1000 & 4000 keV were evaluated for the Digimouse voxel phantom incorporated in Monte Carlo code FLUKA. From the latest report (International Commission on Radiological Protection ICRP) 110, organ compositions and densities were adopted. MATERIAL AND METHODS We have used the Digimouse voxel phantom which was incorporated in Monte Carlo code FLUKA. Simulation studies were performed using FLUKA. The organ sources considered in this study were lungs, skeleton, heart, bladder, testis, stomach, spleen, pancreas, liver, kidney, adrenal, eye and brain. The considered target organs were lungs, skeleton, heart, bladder, testis, stomach, spleen, pancreas, liver, kidney, adrenal and brain. Eye and brain were considered as target organs only for eye and brain as source organs. RESULTS The electron SAF values for self-irradiation decreases with increasing electron energy. The electron SAF values for cross-irradiation are also found to be dependent on the electron energy and the geometries of source and target. Organ masses and electron SAF values are presented in tabular form. CONCLUSION The results of this study will be useful in evaluating the absorbed dose to various organs of mice similar in size to the present study.
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Affiliation(s)
- A. Sinha
- Faculty of Physical Sciences, Shri Ramswaroop Memorial University, Lucknow, India
| | - N. Singh
- Department of Radiotherapy, King George Medical University, Lucknow, India
| | - B.M. Dixit
- Faculty of Physical Sciences, Shri Ramswaroop Memorial University, Lucknow, India
| | - N.K. Painuly
- Department of Radiotherapy, King George Medical University, Lucknow, India
| | - H.K. Patni
- Bhabha Atomic Research Center, Mumbai, India
| | - A. Yadav
- Department of Radiodiagnosis, Uttar Pradesh Rural Institute of Medical Sciences & Research, Saifai- Etawah, India
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Foster MT, Grayston R, Hennigan D, Harishchandra LS, Tonder LV, Millward CP, Pettorini B, Sinha A, Parks C, Burn S, Pizer B, Mallucci C. FP2-3 Ten years of paediatric neuro-oncology surgery: quantifying and predicting complications after surgery for intracranial tumour excision. J Neurol Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.81] [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
ObjectivesTo measure complications of paediatric neurooncology surgery using the Clavien Dindo grading scale, and identify predictors of surgical morbidity.DesignRetrospective review of prospectively collected data.SubjectsAll paediatric patients treated with craniotomy for excision of intracranial tumour between 2008 and 2017 in a single tertiary paediatric neurosurgery centre.MethodsDemographics, surgical details and perioperative complications were prospectively recorded between 0 and 30 days post operatively. These were retrospectively graded using the CD scale. Data analysis was done in R using logistic regression. Significance was defined as p<0.05ResultsBetween 3/1/2008 and 21/12/2017 there were 322 operations, on 254 patients (142 Male). Median age at surgery was 9 years (IQR 4–13 years). 48% were without complication on the CD scale. Maximum CD grade complication for each procedure was 1 in 11%, 2 in 19%, 3A in 2%, 3B in 14%, and 4 in 0.6% of operations. 30 day mortality was 0.9%. CD grade of 3B or over was associated with infratentorial tumours (OR 2.24; CI 1.10–4.68; p=0.004) and WHO grade III tumours (OR 4.12; CI 1.56–10.86; p=0.028).ConclusionsComplications in paediatric neurooncology surgery are common overall, but our results are favourable in comparison to the literature. The CD scale has limitations in neurosurgery but gives insight into the health economic impact of complications. Infratentorial tumours, and WHO grade III tumours were associated with increased morbidity.
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Millward CP, Tonder LV, Foster M, Williams D, Griffiths M, Kneen R, Sinha A, Mallucci C. P96 Screening for cerebrovascular pathology on the basis of positive family history in the paediatric population. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.153] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesNeurovascular disorders are uncommon, complex conditions in children. We reviewed the screening practice and outcome of children referred to the neurovascular service on the basis of positive family history.DesignRetrospective review of prospectively maintained database.SubjectsChildren referred to the neurovascular service on the basis of family history, for screening at our hospital.MethodsWe retrospectively examined our database between July 2008 and April 2018 for the reasons for referral, family history, investigations performed, and the outcome of the screening process.Results44 children were reviewed (23 male, median age 10). Thirty-one children had an MRI/MRA brain. One child subsequently had uncomplicated digital subtraction angiography. Thirty children were referred due to a family history of subarachnoid haemorrhage, of which 17 had a single first-degree relative, and two had two first-degree relatives. Nine children were referred with a family history of arteriovenous malformation, (2 were associated with hereditary haemorrhagic telangiectasia). Five children were discussed due to a family history of non-specific haemorrhagic stroke. Seven children had a history of headache, (4 were prescribed Pizotifen for migraine). No neurovascular pathology was detected following screening within our cohort.ConclusionsA consensus screening policy does not exist but is required both to guide clinical practice and to assuage parental or patient concerns. We will survey UK paediatric centres to commence this process.
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Clarke D, Sinha A, Ion L, Weston S, Jones L, Kham M, Harries S. Abstract P3-03-11: Intraoperative assessment of the sentinel node in breast cancer by one step nucleic acid assay: Experience of over 1100 patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-03-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
The intraoperative assessment of the sentinel node in women with breast cancer enables an immediate axillary node clearance to be done as part of the same operative procedure if the sentinel node is positive. This has significant benefits for the Patient, the Surgeon and the Health Care Provider. There are a variety of methods for the intra-operative assessment of the sentinel node which include: Touch Imprint Cytology, Frozen Section Analysis and Polymerase Chain Reaction (PCR) based molecular assays. OSNA is an automated molecular assay using a Polymerase Chain Reaction (PCR), which detects the presence of cytokeratin 19 in the sentinel node. We report our experience of OSNA for the intraoperative assessment of the sentinel node in our institution with 1148 patients.
Methods
All patients with operable breast cancer who were found to be node negative on clinical and radiological assessment of the axilla, and who had their axilla staged by a sentinel node biopsy at the Breast Unit at Warwick Hospital, UK over a 7 year period were included in this study. Data was collected from a prospective database maintained at the Breast Unit. The axillary node positivity rate and the number of patients with macrometastatic and micrometastatic disease as detected by OSNA was collected and compared with a group of 411 patients who had the intraoperative assessment by Touch Imprint Cytology and final histology by conventional Haematoxylin & Eosin (H&E) assessment, prior to the introduction of OSNA. The Chi-square test were used for statistical significance.
Results
1148 patients had their sentinel node assessed intraoperatively using OSNA in this 7 year study period. The sentinel node was positive in 376 patients (32.8%). Of those who had a positive node, 183 (15.9%) had macro-metastatic disease and 193 (16.8%) had micro-metastatic disease. When compared to 411 patients in the pre-OSNA period, that were assessed by Touch Imprint Cytology and H&E sections, the node positivity rate increased from 23.8% to 32.8% (p<0.05) with the introduction of OSNA. Whilst there was no significant increase in the rate of macrometastatic disease – 20.4% versus 15.9 % ( p0.038), there was a significant increase in the patients who had micrometastases detected on OSNA - 3.4% versus 16.8 % ( p<0.05) as shown in the table.
Conclusion
Our results demonstrate that OSNA is a more sensitive test for picking up metastatic disease, especially micrometastatic disease, in the sentinel node. Whilst this did cause some anxiety initially, the results of recent trials like ACSOG Z-11 and IBCSG 23-01 have shown that small volume disease or micrometastases in the sentinel node do not require an axillary node clearance. Intraoperative assessment of the sentinel node with OSNA significantly upstages the axillary nodal status, especially with regard to micrometastatic disease, but the ability to proceed to an axillary node clearance at the same operation as the sentinel node biopsy, still has significant advantages for the Patient, Surgeon and Health Care Providers.
Citation Format: Clarke D, Sinha A, Ion L, Weston S, Jones L, Kham M, Harries S. Intraoperative assessment of the sentinel node in breast cancer by one step nucleic acid assay: Experience of over 1100 patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-11.
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Affiliation(s)
- D Clarke
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
| | - A Sinha
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
| | - L Ion
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
| | - S Weston
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
| | - L Jones
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
| | - M Kham
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
| | - S Harries
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
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