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Thakar S, Raj V, Neelakantan S, Vasoya P, Aryan S, Mohan D, Hegde AS. Spinal Morphometry As A Novel Predictor For Recurrent Lumbar Disc Herniation Requiring Revision Surgery: Results of A Case Control Study. Neurol India 2022; 70:S211-S217. [PMID: 36412371 DOI: 10.4103/0028-3886.360932] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction There is conflicting data on the risk factors for recurrent lumbar disc herniation (rLDH). Most of the predictors for rLDH identified so far are acquired risk factors or radiological factors at the level of the herniation. Whole lumbar spine (WLS) morphometry has not been evaluated as a possible predictor of rLDH. Objectives We aimed to evaluate if preoperative spinal morphometry can predict the occurrence of rLDH requiring revision surgery. Methods This retrospective case-control study on 250 patients included 45 patients operated for rLDH, 180 controls without rLDH who had previously undergone microdiscectomy for a single level lumbar disc prolapse, and a holdout validation set of 25 patients. Morphometric variables related to the WLS were recorded in addition to previously identified predictors of rLDH. Logistic regression (LR) analysis was performed to identify independent predictors of rLDH. Results LR yielded four predictors of which two were WLS morphometric variables. While increasing age and smoking positively predicted rLDH, increasing WLS interfacet distance and WLS dural-sac circumference negatively predicted rLDH. The LR model was statistically significant, χ2 (4) =15.98, P = 0.003, and correctly classified 80.3% of cases. On validation, the model demonstrated a fair accuracy in predicting rLDH (accuracy: 0.80, AUC: 0.70). Conclusions Larger mean lumbar bony canals and dural sacs protect from the occurrence of symptomatic rLDH. These WLS morphometric variables should be included in future risk stratification algorithms for lumbar disc disease. In addition to the previously recognized risk factors, our study points to an underlying developmental predisposition for rLDH.
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Affiliation(s)
- Sumit Thakar
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Vivek Raj
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Sankar Neelakantan
- Department of Radiodiagnosis, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Pavan Vasoya
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Saritha Aryan
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Dilip Mohan
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Alangar S Hegde
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
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Lukobo-Durrell M, Aladesanmi L, Suraratdecha C, Laube C, Grund J, Mohan D, Kabila M, Kaira F, Habel M, Hines JZ, Mtonga H, Chituwo O, Conkling M, Chipimo PJ, Kachimba J, Toledo C. Maximizing the Impact of Voluntary Medical Male Circumcision for HIV Prevention in Zambia by Targeting High-Risk Men: A Pre/Post Program Evaluation. AIDS Behav 2022; 26:3597-3606. [PMID: 35900708 PMCID: PMC9550704 DOI: 10.1007/s10461-022-03767-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 01/26/2023]
Abstract
A well-documented barrier to voluntary medical male circumcision (VMMC) is financial loss due to the missed opportunity to work while undergoing and recovering from VMMC. We implemented a 2-phased outcome evaluation to explore how enhanced demand creation and financial compensation equivalent to 3 days of missed work influence uptake of VMMC among men at high risk of HIV exposure in Zambia. In Phase 1, we implemented human-centered design-informed interpersonal communication. In Phase 2, financial compensation of ZMW 200 (~ US$17) was added. The proportion of men undergoing circumcision was significantly higher in Phase 2 compared to Phase 1 (38% vs 3%). The cost of demand creation and compensation per client circumcised was $151.54 in Phase 1 and $34.93 in Phase 2. Financial compensation is a cost-effective strategy for increasing VMMC uptake among high-risk men in Zambia, and VMMC programs may consider similar interventions suited to their context.
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Affiliation(s)
- M Lukobo-Durrell
- Jhpiego, Baltimore, MD, USA. .,Jhpiego, 1615 Thames Street, MD, 21231, Baltimore, USA.
| | | | - C Suraratdecha
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - J Grund
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - D Mohan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - M Habel
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Z Hines
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - O Chituwo
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - M Conkling
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - P J Chipimo
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - C Toledo
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Sai Kiran NA, Vidyasagar K, Srinivasa R, Sivaraju L, Raj V, Furtado SV, Thakar S, Aryan S, Mohan D, Hegde AS. Occipital Interhemispheric Transtentorial Approach for Tumors of Posterior Third Ventricular Region: Review of Surgical Results. Neurol India 2022; 70:1417-1426. [PMID: 36076638 DOI: 10.4103/0028-3886.355141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Controversies exist regarding the ideal surgical approach for tumors in posterior third ventricular region (PTV). Objective To evaluate the results of occipital interhemispheric transtentorial (OITT) approach for tumors in PTV. Materials And Methods Thirty-three patients underwent surgery via OITT approach for PTV tumors at Sri Sathya Sai Institute of Higher Medical Sciences during the study period of 5 years (June 2011-May 2016). Ideal trajectory for OITT approach was determined by neuronavigation. Endoscope was used for removing any residual lesion at the blind spots. Results Postoperative magnetic resonance imaging (MRI) performed in all the patients revealed gross total or near-total (>95%) excision of tumor in 31 patients (93.9%). Preoperative neurological deficits improved either completely or significantly following excision of the tumor in 73.3% (11/15) of the patients. Outcome was good (modified Rankin scale ≤2) at discharge in 93.9% (31/33) and at a final follow-up of 3 months or more in 96.8% (30/31) of the patients. None of the patients died during the postoperative period. Complications included upgaze palsy (transient- 6.1% [2/33], persisting- 3% [1/33]), visual field defects (transient- 3% [1/33], persisting- 3% [1/33]), transient third nerve paresis (1/33-3%), transient hemiparesis (1/33-3%), operative site hematoma (1/33-3%), small posterior cerebral artery (PCA) territory infarct (1/33-3%), and small venous infarct (1/33-3%). At least one follow-up MRI could be performed in 23 patients. Final follow-up MRI revealed no recurrence or increase in the size of the residual lesion compared to postoperative images in 20 patients (20/23-87%) and large recurrence in 3 patients (3/23-13%) with high-grade lesions. Conclusion Gross total/near-total excision can be performed in majority of the PTV tumors through OITT approach with minimal morbidity and mortality.
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Affiliation(s)
- Narayanam A Sai Kiran
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, Karnataka, India
| | - Kanneganti Vidyasagar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, Karnataka, India
| | - Rakshith Srinivasa
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, MS Ramaiah Nagar, Mathikere, Bengaluru, Karnataka, India
| | - Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, Karnataka, India
| | - Vivek Raj
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, Karnataka, India
| | - Sunil V Furtado
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, MS Ramaiah Nagar, Mathikere, Bengaluru, Karnataka, India
| | - Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, Karnataka, India
| | - Saritha Aryan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, Karnataka, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, Karnataka, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, Karnataka, India
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Krsihna BV, Gangadhar A, Ravi S, Mohan D, Panigrahy AK, Rajeswari VR, Prakash MD. A Highly Sensitive Graphene-based Field Effect Transistor for the Detection of Myoglobin. Silicon 2022; 14:11741-11748. [PMCID: PMC9043500 DOI: 10.1007/s12633-022-01790-9] [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] [Received: 02/06/2022] [Accepted: 02/24/2022] [Indexed: 08/27/2023]
Abstract
Biomedical applications adapt Nano technology-based transistors as a key component in the biosensors for diagnosing life threatening diseases like Covid-19, Acute myocardial infarction (AMI), etc. The proposed work introduces a new biosensor, based on Graphene Field Effect Transistor (GFET), which is used in the diagnosis of Myoglobin (Mb) in human blood. Graphene-based biosensors are faster, more precise, stronger, and more trustworthy. A GFET is created in this study for the detection of myoglobin biomarker at various low concentrations. Because graphene is sensitive to a variety of biomarker materials, it can be employed as a gate material. When constructed Graphene FET is applied to myoglobin antigens, it has a significant response. The detection level for myoglobin is roughly 30 fg/ml, which is quite high. The electrical behavior of the GFET-based biosensor in detecting myoglobin marker is ideal for Lab-on-Chip platforms and Cardiac Point-of-Care Diagnosis.
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Affiliation(s)
- B. Vamsi Krsihna
- Department of ECE, Koneru Lakshmaih Education Foundation, Guntur, 522502 Andhra Pradesh India
| | - A. Gangadhar
- Department of ECE, University College of Engineering Narasaropet, Narasaropet, 522601 India
| | - S. Ravi
- Department of ECE, Gudlavalleru Engineering College, 521356 Gudlavalleru, Andhra Pradesh India
| | - D. Mohan
- Department of ECE, Sreenidhi Institute of Science and Technology, 501301 Hyderabad, Telangana India
| | - Asisa Kumar Panigrahy
- Department of ECE, Gokaraju Rangaraju Institute of Engineering & Technology, 500090 Hyderabad, Telangana India
| | - V. Raja Rajeswari
- Department of ECE, VR Siddhartha Engineering College, 520007 Vijayawada, Andhra Pradesh India
| | - M. Durga Prakash
- Department of ECE, SRM University-AP, 522240 Mangalagiri, Andhra Pradesh India
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Arora M, Nazar GP, Sharma N, Jain N, Davidson F, Mohan S, Mohan D, Ali MK, Mohan V, Tandon N, Narayan KMV, Prabhakaran D, Bauld L, Srinath Reddy K. COVID-19 and tobacco cessation: lessons from India. Public Health 2022; 202:93-99. [PMID: 34933205 PMCID: PMC8633921 DOI: 10.1016/j.puhe.2021.11.010] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/20/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The Government of India prohibited the sale of tobacco products during the COVID-19 lockdown to prevent the spread of the SARS-CoV-2 virus. This study assessed the tobacco cessation behaviour and its predictors among adult tobacco users during the initial COVID-19 lockdown period in India. METHODS A cross-sectional study was conducted with 801 adult tobacco users (both smoking and smokeless tobacco) in two urban metropolitan cities of India over a 2-month period (July to August 2020). The study assessed complete tobacco cessation and quit attempts during the lockdown period. Logistic and negative binomial regression models were used to study the correlates of tobacco cessation and quit attempts, respectively. RESULTS In total, 90 (11.3%) tobacco users reported that they had quit using tobacco after the COVID-19 lockdown period. Overall, a median of two quit attempts (interquartile range 0-6) was made by tobacco users. Participants with good knowledge on the harmful effects of tobacco use and COVID-19 were significantly more likely to quit tobacco use (odds ratio [OR] 2.2; 95% confidence interval [CI] 1.2-4.0) and reported more quit attempts (incidence risk ratio 5.7; 95% CI 2.8-11.8) compared to those with poor knowledge. Participants who had access to tobacco products were less likely to quit tobacco use compared to those who had no access (OR 0.3; 95% CI 0.2-0.5]. CONCLUSIONS Access restrictions and correct knowledge on the harmful effects of tobacco use and COVID-19 can play an important role in creating a conducive environment for tobacco cessation among users.
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Affiliation(s)
- M Arora
- HRIDAY, New Delhi, India; Public Health Foundation of India, Haryana, New Delhi, India.
| | - G P Nazar
- HRIDAY, New Delhi, India; Public Health Foundation of India, Haryana, New Delhi, India
| | | | - N Jain
- Public Health Foundation of India, Haryana, New Delhi, India
| | - F Davidson
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, United Kingdom
| | - S Mohan
- Public Health Foundation of India, Haryana, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - D Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - M K Ali
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - V Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - N Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | - D Prabhakaran
- Public Health Foundation of India, Haryana, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - L Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, United Kingdom
| | - K Srinath Reddy
- Public Health Foundation of India, Haryana, New Delhi, India
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Abstract
Objective Indirect bypass surgeries for moyamoya disease have included modifications of procedures involving placement of the superficial temporal artery on the brain pial surface. We evaluate the functional and angiographic outcomes of patients treated with encephaloduroarteriomyosynangiosis (indirect) revascularization and examine the outcome in relation to demographic and radiological factors. Materials and Methods Patients treated surgically for moyamoya disease over a 14-year period were identified. Demographics, clinical presentation, and radiology were analyzed to assign a stage for the disease (Suzuki staging) and the extent of revascularization (Matsushima grade) at the last follow-up. A modified Rankin score was used to assess the clinical status at presentation and the functional outcome at follow-up. Results There were 46 patients operated on by a single surgeon over a 14-year period. A higher incidence of motor deficits, seizures, and speech deficits was seen in the pediatric population. Age, sex, preoperative Suzuki disease stage, and hemispheric involvement had no bearing on angiographic outcome at last follow-up. Three of 46 patients (6.5%) developed immediate postoperative complications. Among 43 patients on follow-up, 39 had stable disease or showed improvement in clinical symptoms with 90% event-free status at last follow-up. Conclusions Indirect revascularization procedures are an effective alternative to direct cerebral revascularizations in the early or advanced stages of moyamoya disease. This is effective in a predominant ischemic presentation as noted in our series.
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Affiliation(s)
- Sunil V Furtado
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Eilene Basu
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Anish Mehta
- Department of Neurology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Kuldeep Vala
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Insitute of Higher Medical Sciences, Bengaluru, Karnataka, India
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Furtado SV, Jayakumar D, Perikal PJ, Mohan D. Contemporary Management of Distal Anterior Cerebral Artery Aneurysms: A Dual-Trained Neurosurgeon's Perspective. J Neurosci Rural Pract 2021; 12:711-717. [PMID: 34737505 PMCID: PMC8559076 DOI: 10.1055/s-0041-1735823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objectives Distal anterior cerebral artery (DACA) aneurysms are a subset of aneurysms located in the anterior circulation but away from the circle of Willis. We analyze the clinical presentation and outcomes of two treatment groups-surgical and endovascular-for DACA aneurysms managed by a dual-trained neurosurgeon. Material and Methods A retrospective evaluation of radiological and operative/interventional data of 34 patients with 35 DACA aneurysms over a 12-year period was analyzed. Twenty-seven patients underwent surgery, whereas seven underwent endovascular coiling of the aneurysms. Modified Fisher grade and World Federation of Neurosurgical Societies scale (WFNS) were used to note the subarachnoid hemorrhage (SAH) severity. Statistical Analysis Categorical data were presented as frequency and percentage, while noncategorical data were represented as mean ± SD. Statistical significance for difference in outcome between the two groups was analyzed using Chi-square test, and p < 0.05 was considered statistically significant. Results Of 34 patients, 33 presented with a bleed and 23.5% patients were noted to have another aneurysm in addition to the DACA aneurysm. Patients who underwent clipping for another aneurysm along with the DACA aneurysm in a single surgical exercise had a poor outcome compared with those who underwent surgery for the lone DACA aneurysm (7 vs. 20, p = 0.015). Most patients in both surgical (70.37%) and endovascular (85.71%) groups had good outcome (mRS ≤ 2). Conclusions A good outcome can be achieved with either surgery or endovascular coiling in the management of DACA aneurysms. In patients with multiple aneurysms, SAH with aneurysmal rupture of DACA should be managed first; the other unruptured aneurysm may be operated after an interval to avoid morbidity.
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Affiliation(s)
- Sunil V Furtado
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Dravya Jayakumar
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Parichay J Perikal
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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Thakar S, Arun AA, Rajagopal N, Aryan S, Mohan D, Vijayan JE, Hegde AS. Outcomes after Cervical Duraplasty for Monomelic Amyotrophy (Hirayama Disease): Results of a Case-Control Study of 60 Patients. J Neurosci Rural Pract 2021; 12:642-651. [PMID: 34737497 PMCID: PMC8559061 DOI: 10.1055/s-0041-1735248] [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] [Indexed: 11/15/2022] Open
Abstract
Background The optimal management and the role of surgery in monomelic amyotrophy, also known as Hirayama disease (HD), remain controversial. In the largest series of patients with HD managed by cervical duraplasty (CD), this study compares the outcomes between conservative and surgical management. Methods A retrospective case-control study was performed on 60 patients with HD. The cases consisted of 30 patients who underwent CD, and 30 age- and sex-matched controls who managed with long-term collar wear. Clinical improvement was recorded using two patient-reported outcome measures-the Odom's scale and a self-rated hand grip strength score. Median and ulnar compound muscle action potential (CMAP) amplitudes and various magnetic resonance imaging parameters were recorded. Results None of the controls experienced clinical improvement at follow-up; 90% remained status quo at 24.33 ± 9.38 months. Seventy-six percent of the operated patients demonstrated clinical improvement at 29.61 ± 12.78 months, and a majority of them reported moderately better grip strength. The preoperative anteroposterior diameter (APD) of the surgical group improved from 0.74 ± 0.13 to 0.86 ± 0.21 ( p = 0.01), and the cord demonstrated a significant decrease in forward migration on flexion (0.20 ± 0.11 and 0.03 ± 0.07 preoperatively and at follow-up, respectively, p < 0.0001). Patients with clinical improvement demonstrated significantly better mean APD and median and ulnar CMAP values than those who did not improve ( p < 0.0001). The mean cervical alignment did not change significantly at follow-up ( p = 0.13). Conclusions This study shows that CD can significantly alter the clinical course of patients with progressive symptoms of HD. This approach successfully arrests the forward migration of the cervical cord on flexion and promotes morphological recovery of the cord. A majority of the patients undergoing CD demonstrate clinical and electrophysiological improvement at mid-term follow-up.
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Affiliation(s)
- Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Aditya Atal Arun
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Niranjana Rajagopal
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Saritha Aryan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Joshy E. Vijayan
- Department of Neurology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Alangar S. Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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Kennedy HG, Mohan D, Davoren M. Forensic psychiatry and Covid-19: accelerating transformation in forensic psychiatry. Ir J Psychol Med 2021; 38:145-153. [PMID: 32434610 PMCID: PMC7556898 DOI: 10.1017/ipm.2020.58] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 02/07/2023]
Abstract
Swift medically led scientifically informed responses to the Covid-19 epidemic nationally have been demonstrably superior to other, non-scientific approaches. In forensic psychiatry and across all psychiatric services, urgent and clinically led responses have underlined redundancies and confusions in the governance of mental health services and a vacuum in policy makers. For the future, a greater emphasis on services for patients with schizophrenia and other severe, enduring mental disorders must aim at reducing standardised mortality ratios, managing risk of violence and improving hard outcomes such as symptomatic remission, functional recovery and forensic recovery of autonomy. This will require more use of information technology at service level and at national level where Scandinavian-style population-based data linkage research must now become legally sanctioned and necessary. A national research and development centre for medical excellence in forensic psychiatry is urgently required and is complimentary to and different from quality management.
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Affiliation(s)
- H. G. Kennedy
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - D. Mohan
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - M. Davoren
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
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Mohan D, O'Malley AJ, Chelen J, MacMartin M, Murphy M, Rudolph M, Barnato A. Videogame intervention to increase advance care planning conversations by hospitalists with older adults: study protocol for a stepped-wedge clinical trial. BMJ Open 2021; 11:e045084. [PMID: 33753443 PMCID: PMC7986882 DOI: 10.1136/bmjopen-2020-045084] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/28/2020] [Accepted: 03/05/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Fewer than half of all people in the USA have a documented advance care plan (ACP). Hospitalisation offers an opportunity for physicians to initiate ACP conversations. Despite expert recommendations, hospital-based physicians (hospitalists) do not routinely engage in these conversations, reserving them for the critically ill.The objective of this study is to test the effect of a novel behavioural intervention on the incidence of ACP conversations by hospitalists practicing at a stratified random sample of hospitals drawn from 220 US acute care hospitals staffed by a large, nationwide acute care physician practice with an ongoing ACP quality improvement initiative. METHODS AND ANALYSIS We developed Hopewell Hospitalist, a theory-based adventure video game, to modify physicians' attitudes towards ACP conversations and to increase their motivation for engaging in them. The planned study is a pragmatic stepped-wedge crossover phase III trial, testing the efficacy of Hopewell Hospitalist for increasing ACP conversations. We will randomise 40 hospitals to the month (step) in which they receive the intervention. We aim to recruit 30 hospitalists from up to eight hospitals each step to complete the intervention, playing Hopewell Hospitalist for at least 2 hours. The primary outcome is ACP billing for patients aged 65 and older managed by participating hospitalists. We hypothesise that the intervention will increase ACP billing in the quarter after dissemination, and have 80% power to detect a 1% absolute increase and 99% power to detect a 3.5% absolute increase. ETHICS AND DISSEMINATION Dartmouth's Committee for the Protection of Human Subjects has approved the study protocol, which is registered on clinicaltrials.gov. We will disseminate the results through manuscripts and the trials website. Hopewell Hospitalist will be made available on the iOS Application Store for download, free of cost, at the conclusion of the trial. TRIAL REGISTRATION NUMBER NCT04557930.
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Affiliation(s)
- D Mohan
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - A James O'Malley
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Julia Chelen
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Meredith MacMartin
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Section of Palliative Care, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Megan Murphy
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | | | - Amber Barnato
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Section of Palliative Care, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Kanneganti V, Thakar S, Aryan S, Kini P, Mohan D, Hegde AS. Clinical and Laboratory Markers of Brain Abscess in Tetralogy of Fallot ('BA-TOF' Score): Results of a Case-Control Study and Implications for Community Surveillance. J Neurosci Rural Pract 2021; 12:302-307. [PMID: 33935447 PMCID: PMC8079174 DOI: 10.1055/s-0041-1722819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background
Cardiogenic brain abscess (CBA) is the commonest noncardiac cause of morbidity and mortality in cyanotic heart disease (CHD). The clinical diagnosis of a CBA is often delayed due to its nonspecific presentations and the scarce availability of computed tomography (CT) imaging in resource-restricted settings. We attempted to identify parameters that reliably point to the diagnosis of a CBA in patients with Tetralogy of Fallot (TOF).
Methods
From among 150 children with TOF treated at a tertiary care institute over a 15-year period from 2001 to 2016, 30 consecutive patients with CBAs and 85 age- and sex-matched controls without CBAs were included in this retrospective case–control study. Demographic and clinical features, laboratory investigations, and baseline echocardiographic findings were analyzed for possible correlations with the presence of a CBA.
Statistical Analysis
Variables demonstrating significant bivariate correlations with the presence of a CBA were further analyzed using multivariate logistic regression (LR) analysis. Various LR models were tested for their predictive value, and the best model was then validated on a hold-out dataset of 25 patients.
Results
Among the 26 variables tested for bivariate associations with the presence of a CBA, some of the clinical, echocardiographic, and laboratory variables demonstrated significant correlations (
p
< 0.05). LR analysis revealed elevated neutrophil–lymphocyte ratio and erythrocyte sedimentation rate values and a lower age-adjusted resting heart rate percentile to be the strongest independent biomarkers of a CBA. The LR model was statistically significant, (χ
2
= 23.72,
p =
<0.001), and it fitted the data well. It explained 53% (Nagelkerke
R2
) of the variance in occurrence of a CBA, and correctly classified 83.93% of cases. The model demonstrated a good predictive value (area under the curve: 0.80) on validation analysis.
Conclusions
This study has identified simple clinical and laboratory parameters that can serve as reliable pointers of a CBA in patients with TOF. A scoring model—the ‘BA-TOF’ score—that predicts the occurrence of a CBA has been proposed. Patients with higher scores on the proposed model should be referred urgently for a CT confirmation of the diagnosis. Usage of such a diagnostic aid in resource-limited settings can optimize the pickup rates of a CBA and potentially improve outcomes.
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Affiliation(s)
- Vidyasagar Kanneganti
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Sumit Thakar
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Saritha Aryan
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Prayaag Kini
- Department of Cardiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Dilip Mohan
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Alangar S Hegde
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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Furtado SV, Srinivasa R, Vala K, Mohan D. Contemporary management of scalp cirsoid aneurysm: A dual-trained neurosurgeon's perspective. Clin Neurol Neurosurg 2020; 201:106437. [PMID: 33373833 DOI: 10.1016/j.clineuro.2020.106437] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Scalp cirsoid aneurysms are subcutaneous arteriovenous fistulae fed by branches of the external carotid artery. They present with progressive scalp swelling and cosmetic deformities in addition to neuro-vascular symptoms. We evaluate the treatment and outcome of this rare vascular lesion with surgery and adjunctive endovascular embolisation performed by a dual-trained neurosurgeon. METHODS A retrospective analysis of 6 cases operated over a 16 year-period was performed which comprised of clinical data, radiology including angiography and pre-operative embolisation, surgical approaches, outcomes and complications. RESULTS 6 patients with ages ranging between 26 and 51 years were operated in the study period. All the patients underwent surgical excision of the lesion, of which 2 had undergone pre-operative embolisation of the feeders. There was no recurrence in the follow-up period (Mean 4.7 years) following total excision of the lesions. One patient had post-operative wound dehiscence and another had migration of embolic material to lungs. CONCLUSION Surgery is the predominant treatment method for scalp cirsoid aneurysms. Various adjunctive endovascular procedures can be performed pre-operatively to minimise operative blood loss.Though lower recurrence is seen with surgery for the scalp AV fistula, embolisation performed in select cases can achieve curative results with appropriate techniques.
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Affiliation(s)
- Sunil V Furtado
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bangalore, 560054, Karnataka, India
| | - Rakshith Srinivasa
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bangalore, 560054, Karnataka, India.
| | - Kuldeep Vala
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bangalore, 560054, Karnataka, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Insitute of Higher Medical Sciences, Bangalore, 560066, Karnataka, India
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Sai Kiran NA, Vidyasagar K, Sivaraju L, Raj V, Aryan S, Thakar S, Mohan D, Hegde AS. Outcome of Surgery for Congenital Craniovertebral Junction Anomalies with Atlantoaxial Dislocation/Basilar Invagination: A Retrospective Study of 94 Patients. World Neurosurg 2020; 146:e313-e322. [PMID: 33096283 DOI: 10.1016/j.wneu.2020.10.082] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the results of surgery for congenital craniovertebral junction (CVJ) anomalies with atlantoaxial dislocation (AAD)/basilar invagination (BI) and compare the results of transoral odontoidectomy and posterior fusion (TOO+PF) with only posterior fusion (PF) in patients with irreducible AAD/BI. METHODS AND RESULTS All 94 patients with congenital CVJ anomalies with AAD/BI operated on during the 3-year study period (June 2013-May 2016) were included. Of these patients, 55 had irreducible AAD/BI and the remaining 39 had reducible AAD/BI. TOO+PF was restricted to patients (34/94; 36.2%) with irreducible AAD/BI when reduction and realignment by intraoperative C1-C2 facet joint manipulation were considered technically difficult and risky. The remaining patients with irreducible AAD/BI and all the patients with reducible AAD/BI (60/94; 63.8%) were managed with only posterior fusion. Poor preoperative Nurick grade, preoperative dyspnea/lower cranial nerve deficits, and syringomyelia were associated with significantly higher incidence of postoperative pulmonary complications. Follow-up ≥3 months (final follow-up) was available for 87 patients. Good outcome (Nurick grade 0-3) at final follow-up was noted in 90% (45/50) of the patients with irreducible AAD/BI and 91.9% (34/37) of the patients with reducible AAD/BI. Preoperative poor Nurick grade (4-5) was the only factor associated with poor outcome. No significant difference in perioperative complications, outcome, and fusion was noted between patients who underwent TOO+PF or only PF for irreducible AAD/BI. CONCLUSIONS Many of the patients with congenital AAD/BI showed remarkable recovery after surgery. Preoperative poor Nurick grade (4-5) is associated with poor outcome. TOO+PF is a safe alternative treatment option for irreducible AAD/BI when only PF techniques are technically difficult/risky.
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Affiliation(s)
- Narayanam Anantha Sai Kiran
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Kanneganti Vidyasagar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India.
| | - Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Vivek Raj
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Saritha Aryan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
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Sai Kiran NA, Vidyasagar K, Raj V, Sivaraju L, Srinivasa R, Mohan D, Hegde AS. Microsurgery for Spetzler-Martin Grade I-III Arteriovenous Malformations: Analysis of Surgical Results and Correlation of Lawton-Young Supplementary Grade and Supplemented Spetzler-Martin Score with Functional Outcome. World Neurosurg 2020; 144:e227-e236. [PMID: 32827741 DOI: 10.1016/j.wneu.2020.08.101] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the results of microsurgery for Spetzler-Martin (SM) grade I-III AVMs and evaluate the correlation of the Lawton-Young (LY) supplementary grade, supplemented Spetzler-Martin (SM-Supp/combined) score with the functional outcome. METHODS A total of 42 patients with SM grade I-III AVMs who had undergone surgery at our institute during a 3-year period (June 2013 to May 2016) were included in the present study. RESULTS All 42 patients had undergone primary surgery without previous embolization. Three patients (7.1%) had died due to surgical site hematoma in the postoperative period. One patient was lost to follow-up. The mean follow-up period for the remaining patients was 27 ± 14 months (range, 12-62 months). At the final follow-up examination of ≥12 months (FFU), 92.7% of the patients had a good outcome (modified Rankin scale [mRS] score ≤1), with an improved or unchanged mRS score in 87.8%. An AVM size >3 cm, diffuse AVM, SM grade III, and SM-Supp score >5 were associated with worsened mRS score at discharge and FFU. Higher LY grade (IV and V), eloquent AVM location, deep venous drainage, age >40 years, and unruptured presentation were not associated with worsened mRS score at both discharge and FFU. Of the 20 ARUBA-eligible patients, 19 (95%) had good outcomes. Postoperative angiograms for 39 patients revealed complete excision of the AVM in 37 (94.9%) and a residual AVM in 2 (5.1%). CONCLUSIONS High cure rates and excellent clinical outcomes can be expected with microsurgery for most patients with SM grade I-III AVMs. An AVM size >3 cm, diffuse AVM nidus, SM grade III, and SM-Supp score >5 are associated with postoperative worsening of functional scores in patients with SM grade I-III AVMs.
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Affiliation(s)
| | - Kanneganti Vidyasagar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India.
| | - Vivek Raj
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Rakshith Srinivasa
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
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Sai Kiran NA, Sivaraju L, Furtado SV, Vidyasagar K, Raj V, Aryan S, Thakar S, Mohan D, Hegde AS. Far lateral approach without occipital condylar resection for intradural ventral/ventrolateral foramen magnum tumors and aneurysms of V4 segment of vertebral artery: Review of surgical results. Clin Neurol Neurosurg 2020; 197:106163. [PMID: 32916393 DOI: 10.1016/j.clineuro.2020.106163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Controversies exist regarding the need and extent of condylar resection for safe surgical management of intradural ventral/ventrolateral foramen magnum (VFM) tumors and aneurysms of V4 segment of vertebral artery (VA) by far lateral approach. This retrospective study was conducted to evaluate the results of basic far lateral approach(retrocondylar approach) without upfront occipital condylar resection. METHODS AND RESULTS Twenty one patients underwent surgery via far lateral approach for intradural VFM tumors and aneurysms of V4 segment of VA at Sri Sathya Sai Institute of Higher Medical Sciences during 9 years(2008-2016) study period. Eight patients had VA aneurysms and 13 patients had intradural VFM tumors. After basic far lateral approach(retrocondylar approach), dura was opened and checked if the exposure was adequate for safe surgery. Retrocondylar approach provided adequate exposure for all these lesions and resection of occipital condyle/jugular tubercle was not required in any of these cases. Skeletonization or transposition of VA was not done in any of these cases. Gross total resection of the tumor could be done in 9 patients(9/13-69.2 %) and near total excision (>95 %) in 4 patients (4/13-30.8 %). Seven of the 8 VA aneurysms were successfully clipped. Outcome at a final follow up of 3 months or more was good(mRS<2) in 19 patients(19/21-90.5 %) and poor in 2 patients. Complications included lower cranial nerve deficits [transient-2/21(9.5 %), persisting-2/21(9.5 %)], motor deficits(2/21-9.5%), seventh nerve paresis(1/21-4.8%), sixth nerve paresis(2/21-9.5%) and pseudomeningocele(1/21-4.8%). CONCLUSION Basic far lateral (retrocondylar) approach provides excellent exposure for majority of VFM tumors and aneurysms of V4 segment of VA. Condylar resection(transcondylar approach), drilling of jugular tubercle (transtubercular approach), skeletonization/transposition of VA might not be required for safe surgical management of majority of these lesions.
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Affiliation(s)
- Narayanam Anantha Sai Kiran
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
| | - Laxminadh Sivaraju
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India.
| | - Sunil Valentine Furtado
- Department and Institution, Department of Neurosurgery, MS Ramaiah Medical College and Hospital, M S Ramaiah Nagar, Mathikere, Bangalore, 560054, India
| | - Kanneganti Vidyasagar
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
| | - Vivek Raj
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
| | - Saritha Aryan
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
| | - Sumit Thakar
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
| | - Dilip Mohan
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
| | - Alangar S Hegde
- Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India
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Sai Kiran NA, Mohan D, Sivaraju L, Raj V, Vidyasagar K, Hegde AS. Adenosine-Induced transient asystole during surgical treatment of basilar artery aneurysms. Neurol India 2020; 68:419-426. [PMID: 32415018 DOI: 10.4103/0028-3886.284353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim To evaluate the safety and efficacy of adenosine-induced transient asystole (AITA) during surgery for basilar artery aneurysms. Materials and Methods All the patients with basilar artery aneurysms operated using AITA at our institute during two years period (August 2013-July 2015) were included in this study. Results Adenosine was used in 11 patients with 13 basilar artery aneurysms. Seven of these aneurysms were basilar bifurcation aneurysms, four were basilar-superior cerebellar artery junction aneurysms, and two were distal basilar trunk aneurysms. The indications for AITA were narrow corridor for placement of temporary clip in 11 aneurysms, intraop rupture in 1 aneurysm, and circumferential dissection of a large aneurysm in 1. The mean dose of adenosine used for inducing asystole was 19.4 mg (range: 15-30 mg) and the mean total dose of adenosine used was 40.6 mg (range: 18-90 mg). A mean of 2 (range: 1-5) AITAs were required during surgical treatment of these aneurysms. The mean duration of a systole was 27 s (range: 9-76 s). There were no complications related to AITA in these patients except for transient rebound hypertension in one patient. Check angiogram revealed complete obliteration of 11 aneurysms and small residual neck in 2 aneurysms. Modified Rankin Scale at three months of follow-up was 0 in seven patients, 1 in two patients, 4 in one patient, and 6 in one patient. Conclusion AITA during surgical management of basilar artery aneurysms is a safe and effective technique and has an important role during surgery for these aneurysms.
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Affiliation(s)
- Narayanam A Sai Kiran
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Vivek Raj
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Kanneganti Vidyasagar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
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Mohan D, Siddika A, Al Alawi F, Najad S, Railey M, Alhadari A. SAT-416 Pattern of Biopsy Proven Renal Disease in Adults: Single-Centre Experience from a Tertiary Care Hospital in Dubai, UAE. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.440] [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: 11/28/2022] Open
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Thakar S, Rajagopal N, Mani S, Shyam M, Aryan S, Rao AS, Srinivasa R, Mohan D, Hegde AS. Comparison of telemedicine with in-person care for follow-up after elective neurosurgery: results of a cost-effectiveness analysis of 1200 patients using patient-perceived utility scores. Neurosurg Focus 2019; 44:E17. [PMID: 29712532 DOI: 10.3171/2018.2.focus17543] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 11/06/2022]
Abstract
OBJECTIVE The utility of telemedicine (TM) in neurosurgery is underexplored, with most of the studies relating to teletrauma or telestroke programs. In this study, the authors evaluate the cost-effectiveness of TM consultations for follow-up care of a large population of patients who underwent neurosurgical procedures. METHODS A decision-analytical model was used to assess the cost-effectiveness of TM for elective post-neurosurgical care patients from a predominantly nonurban cohort in West Bengal, India. The model compared TM care via a nodal center in West Bengal to routine, in-person, per-episode care at the provider site in Bangalore, India. Cost and effectiveness data relating to 1200 patients were collected for a 52-month period. The effectiveness of TM care was calculated using efficiency in terms of the percentage of successful TM consultations, as well as patient-perceived utility values for overall experience of the type of health care access that they received. Incremental cost-effectiveness ratio (ICER) analysis was done using the 4-quadrant charting of the cost-effectiveness plane. One-way sensitivity and tornado analyses were performed to identify thresholds where the care strategy would change. RESULTS The overall utility for the 3 TM scenarios was found to be higher (89%) than for the utility of routine care (80%). TM was found to be more cost-effective (Indian rupee [INR] 2630 per patient) compared to routine care (INR 6848 per patient). The TM strategy "dominates" that of routine care by being more effective and less expensive (ICER value of -39,400 INR/unit of effectiveness). Sensitivity analysis revealed that cost-effectiveness of TM was most sensitive to changes in the number of TM patients, utility and success rate of TM, and travel distance to the TM center. CONCLUSIONS TM care dominates the in-person care strategy by providing more effective and less expensive follow-up care for a remote post-neurosurgical care population in India. In the authors' setting, this benefit of TM is sustainable even if half the TM consultations turn out to be unsuccessful. The viability of TM as a cost-effective care protocol is attributed to a combination of factors, like an adequate patient volume utilizing TM, patient utility, success rate of TM, and the patient travel distance.
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Affiliation(s)
| | | | | | - Maya Shyam
- Finance and Accounts, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
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19
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Thakar S, Arun AA, Aryan S, Mohan D, Hegde AS. Deep flexor sarcopenia as a predictor of poor functional outcome after anterior cervical discectomy in patients with myelopathy. Acta Neurochir (Wien) 2019; 161:2201-2209. [PMID: 31177335 DOI: 10.1007/s00701-019-03972-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/08/2019] [Accepted: 05/29/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Paraspinal muscle morphometry has been recognized to be a prognostic factor across various surgical conditions, but its utility in predicting disease-specific outcomes in spine surgery remains under-explored. METHODS A prospective cohort study was performed on 45 consecutive patients undergoing anterior cervical discectomy (ACD) for single-level, symptomatic cervical degenerative disc disease causing radiculomyelopathy or myelopathy. Previously described predictors of outcome such as age, gender, smoking, comorbidities, duration of symptoms, preoperative Nurick grade, extent of cord compression, and signal intensity change in the cord were recorded. Additionally, MRI-based morphometrics of the superficial and deep paraspinal muscles were recorded. Logistic regression (LR) analysis was performed using a purposeful variable selection process to identify variables that independently predicted Nurick grade improvement (NGI). RESULTS At a mean follow-up of 20.02 ± 8.63 months after ACD, 37 (82.22%) patients demonstrated NGI. LR analysis yielded three predictors of NGI of which two were related to the deep flexor muscles. While a worse preoperative Nurick grade negatively predicted NGI, a deep flexor area and deep flexor/deep extensor area ratio positively predicted NGI. The regression model demonstrated a good fit and was statistically significant (χ2(3) = 22.18, p < 0.0001). The model explained 64% of the variance in NGI and correctly classified 89% of cases. CONCLUSIONS This study has for the first time identified the utility of paraspinal morphometrics in predicting disease-specific functional outcome after cervical spine surgery. Our results indicate that in addition to preoperative Nurick grade, an already accepted outcome predictor, the deep flexor cross-sectional area, and the deep flexor/deep extensor ratio are strong predictors of NGI following ACD for single-level, symptomatic cervical degenerative disc disease with myelopathy. Deep muscle morphometrics could be included in future risk stratification algorithms for patients with cervical disc disease.
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Affiliation(s)
- Sumit Thakar
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India.
| | - Aditya Atal Arun
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Saritha Aryan
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Dilip Mohan
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Alangar S Hegde
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
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Neelakantan S, Samant R, Prasad J, Reddy B, Reddy P, Das B, Viswamitra S, Mohan D. Digital Subtraction Neuroangiography: What a Resident Should Know. J Clin Interv Radiol ISVIR 2019. [DOI: 10.1055/s-0039-1681979] [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: 10/26/2022] Open
Abstract
AbstractNeuroangiography (NA) is an integral investigation in the management of patients with neurovascular diseases. NA is basically used for diagnosis, but in many instances, it may be followed up with treatment in the same sitting. Indications for diagnostic NA range from extracranial diseases (vertebra-basilar insufficiency from subclavian steal, extracranial carotid stenosis, cavernous-carotid fistula, neck trauma, epistaxis, etc.) to intracranial diseases (nontraumatic subarachnoid hemorrhage, cerebral aneurysms, cerebral arteriovenous malformations, cerebral vasospasm, acute stroke, etc.). A sound understanding of the principles of appropriate periprocedural care and anatomy, catheter technique, and basic disease pathology are vital for the test to be diagnostic. This pictorial review illustrates normal neurovascular anatomy along with an approach to analyze a spectrum of neurovascular pathologies and also explains a step-wise checklist for appropriate preprocedural assessment, technique of procedure, and postprocedural care of the patient. Basic knowledge on how to interpret these images and principles on how to perform it is important.
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Affiliation(s)
- Sankar Neelakantan
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Rohan Samant
- Department of Radiology, UAMS, Arkansas, Texas, United States
| | - Jagadish Prasad
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Bhavana Reddy
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Prashanth Reddy
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Bharath Das
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Sanjaya Viswamitra
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - Dilip Mohan
- Department of Neruosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
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Don Xavier ND, Bijoy Nandan S, Jayachandran PR, Anu PR, Midhun AM, Mohan D. Chronic effects of copper and zinc on the fish, Etroplus suratensis (Bloch, 1790) by continuous flow through (CFT) bioassay. Mar Environ Res 2019; 143:141-157. [PMID: 30497666 DOI: 10.1016/j.marenvres.2018.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 06/09/2023]
Abstract
Copper (Cu) and zinc (Zn) play a vital role in the growth and development, however increased uptake causes deleterious effects in normal functioning of organisms. We have demonstrated in this contribution the tolerance limit of Cu and Zn on Etroplus suratensis (pearl spot) by Continuous Flow Through (CFT) bioassay and the biomarker responses. The accumulation for Cu, Zn and selected trace metals (Cr, Cd, Ni and Pb) from field conditions, as well Geo-accumulation index (I geo) and Contamination factor (C.F) suggested moderate to heavy pollution in the Cochin estuarine system. The 96 h LC50 values for Cu was 1.74 ± 0.04 mg L-1and that for Zn was 24.36 ± 0.58 mg L-1 at 95% confidence interval. No observed effect concentration (NOEC) and low observed effect concentration (LOEC) for Cu and Zn were derived based on the survival rates. Chronic toxicity values for Cu and Zn were 0.23 mg L-1 and 2.005 mg L-1 respectively for 30 days period. The histological, biochemical, hematological and behavioral parameters showed significant variations at sublethal concentrations. Lamellar hyperplasia in gills, vacuolation combined with necrosis in liver, increased occurrence of melanomacrophage centres in spleen were noticed at chronic levels for both Cu and Zn. Tissue specific bioconcentration was observed for zinc and copper in gill and liver respectively, with least rate of bioconcentration observed in muscle tissues. Malaonate Dehydrogenase (MDH), Super oxide dismutase (SOD), Nonspecific esterase (EST) activity significantly varied compared to control at NOEC and LOEC values in both the metals. The hematological and genotoxic alterations as decrease in erythrocyte count, lymphocytes, hemoglobin concentration and hematocrit percentage were significantly reduced (p < 0.05) and increased thrombocytes and neutrophils, increased frequency of micronuclei, lobed, blebbed and notched nuclei and binucleate cells were characteristic for the metals at the sublethal concentrations. The frequency of behavioral changes remained significantly higher at chronic level than the control group. Thus such CFT based studies are important for precisely mapping the toxicity changes in organisms and also to develop suitable water quality guidelines.
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Affiliation(s)
- N D Don Xavier
- Department of Marine Biology, Microbiology and Biochemistry School of Marine Sciences, Cochin University of Science and Technology Fine Arts Avenue, Kochi, 682 016, Kerala, India
| | - S Bijoy Nandan
- Department of Marine Biology, Microbiology and Biochemistry School of Marine Sciences, Cochin University of Science and Technology Fine Arts Avenue, Kochi, 682 016, Kerala, India.
| | - P R Jayachandran
- Department of Marine Biology, Microbiology and Biochemistry School of Marine Sciences, Cochin University of Science and Technology Fine Arts Avenue, Kochi, 682 016, Kerala, India
| | - P R Anu
- Department of Marine Biology, Microbiology and Biochemistry School of Marine Sciences, Cochin University of Science and Technology Fine Arts Avenue, Kochi, 682 016, Kerala, India
| | - A M Midhun
- Department of Marine Biology, Microbiology and Biochemistry School of Marine Sciences, Cochin University of Science and Technology Fine Arts Avenue, Kochi, 682 016, Kerala, India
| | - D Mohan
- Integrated Coastal and Marine Area Management-PD Government of India, Ministry of Earth Sciences, Chennai, 600 100, Tamil Nadu, India
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Garg A, Shivashankar R, Vora K, Ali M, Mohan V, Mohan D, Kadir M, Tandon N, Venkat Narayan K, Prabhakaran D. PO206 Family History of Cardiometabolic Diseases (CMDS) as a Determinant of CMD Risk Behaviours: A Secondary Analysis of CARRS Study. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.176] [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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23
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Sai Kiran NA, Sivaraju L, Vidyasagar K, Raj V, Rao AS, Mohan D, Thakar S, Aryan S, Hegde AS. Intradural “limited drill” technique of anterior clinoidectomy and optic canal unroofing for microneurosurgical management of ophthalmic segment and PCOM aneurysms—review of surgical results. Neurosurg Rev 2018; 43:555-564. [DOI: 10.1007/s10143-018-1054-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/17/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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Marigoudar SR, Nagarjuna A, Karthikeyan P, Mohan D, Sharma KV. Comparative toxicity of chlorpyrifos: Sublethal effects on enzyme activities and histopathology of Mugil cephalus and Chanos chanos. Chemosphere 2018; 211:89-101. [PMID: 30071440 DOI: 10.1016/j.chemosphere.2018.07.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/03/2018] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 06/08/2023]
Abstract
Ecotoxicological data and potential impact of chlorpyrifos (CPF) in the region are scarce for prescribing safety limits. Therefore, toxicity and sublethal impact of CPF on fish fingerlings of Mugil cephalus (3.0 ± 1.2 cm) and Chanos chanos (3.0 ± 1.5 cm) were studied. Acute and chronic toxicity tests were conducted by continuous flow through method and derived 96 h median lethal concentration (LC50). Mean LC50 value of 1.13 μg/L for M. cephalus, and 3.20 μg/L for C. chanos were derived by Probit. Chronic toxicity tests were conducted for 30 days and determined no observed effect concentration values of 0.09 μg/L 0.17 μg/L and lowest observed effect concentration values of 0.16 μg/L 0.32 μg/L and chronic values of 0.13 μg/L 0.25 μg/L for M. cephalus and C. chanos respectively. Key biomarker enzyme activities viz., EST, SOD and MDH were studied at sublethal concentrations of CPF. Native gel electrophoresis revealed gradual decrease in isoforms of EST and SOD activities, whereas MDH activity increased in fingerlings. These responses indicate inhibition of cholinesterase, antioxidants and synthesis of ATPs in the cells due to CPF stress. Pathological lesions were evaluated in gill and eye tissues of fingerlings. Epithelial fusion and degenerative changes were prominent in primary lamellae. Hyperplasia, lifting epithelium, fusion of lamellae and necrosis were evidenced in the secondary lamellae. Cellular anomalies in the retina of the eye of C. chanos include vacuoles in nerve fiber layer, shrinkage of outer plexiform layer and detachment of pigment epithelium layer. These changes indicate physiological disturbance in the gill and eye.
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Affiliation(s)
- S R Marigoudar
- National Centre for Coastal Research, NIOT Campus, Ministry of Earth Sciences, Govt. of India, Pallikaranai, Chennai 600 100, India.
| | - A Nagarjuna
- National Centre for Coastal Research, NIOT Campus, Ministry of Earth Sciences, Govt. of India, Pallikaranai, Chennai 600 100, India
| | - P Karthikeyan
- National Centre for Coastal Research, NIOT Campus, Ministry of Earth Sciences, Govt. of India, Pallikaranai, Chennai 600 100, India
| | - D Mohan
- National Centre for Coastal Research, NIOT Campus, Ministry of Earth Sciences, Govt. of India, Pallikaranai, Chennai 600 100, India
| | - K V Sharma
- National Centre for Coastal Research, NIOT Campus, Ministry of Earth Sciences, Govt. of India, Pallikaranai, Chennai 600 100, India
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Anu PR, Bijoy Nandan S, Jayachandran PR, Don Xavier ND, Midhun AM, Mohan D. Toxicity effects of zinc on two marine diatoms, under varying macronutrient environment. Mar Environ Res 2018; 142:275-285. [PMID: 30389236 DOI: 10.1016/j.marenvres.2018.10.013] [Citation(s) in RCA: 3] [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: 03/27/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 06/08/2023]
Abstract
Diatoms constitute one of the fundaments in the trophic food chains and are responsible for much of the bioaccumulation of heavy metals, in particular zinc, throughout the web of food chains. Chaetoceros calcitrans and Thalassiosira weissflogii are widely present as a dominant marine diatom in estuarine and coastal waters. The zinc uptake, its fractionation in subcellular structures and macromolecular compartments in two marine diatoms, C. calcitrans and T. weissflogii and trophic transfer under different macronutrient concentrations were investigated. The study reveals a significant interaction between macronutrients and metal uptake by the two diatom species. Increased cellular accumulation of zinc and N, P-limited condition were found to affect N, P and Si assimilation by diatoms negatively. Conversely, nitrogen (N) limitation inhibited the intracellular uptake of zinc. However, at higher concentration of zinc, the difference in zinc uptake between nutrient enriched condition (+NP) and nutrient limited (N or P) condition become smaller, indicating that the zinc uptake by diatoms is less dependent on N containing protein ligands at high Zn concentration. Nitrogen concentration in the medium was also found to affect the relative distribution of zinc in subcellular structures and macromolecular components. However, major portion of zinc was distributed in soluble substance and in the protein of the algal cells. The N limited condition facilitates the accumulation of zinc in cell organelles (insoluble substance) leading to increased toxicity. Trophic transfer of zinc was also measured by calculating percentage of metal retained in mussel, Perna viridis over the experiment period. Regardless of the algal species, the percentage of accumulation of zinc was found to be high in mussels fed with algal cells acclimated to nutrient enriched condition (31 and 38%). Our study therefore suggests that N enrichment may lead to an increase in Zn uptake and transfer in marine plankton.
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Affiliation(s)
- P R Anu
- Department of Marine Biology, Microbiology & Biochemistry, School of Marine Sciences, Cochin University of Science and Technology, Kochi, 682016, Kerala, India
| | - S Bijoy Nandan
- Department of Marine Biology, Microbiology & Biochemistry, School of Marine Sciences, Cochin University of Science and Technology, Kochi, 682016, Kerala, India.
| | - P R Jayachandran
- Department of Marine Biology, Microbiology & Biochemistry, School of Marine Sciences, Cochin University of Science and Technology, Kochi, 682016, Kerala, India
| | - N D Don Xavier
- Department of Marine Biology, Microbiology & Biochemistry, School of Marine Sciences, Cochin University of Science and Technology, Kochi, 682016, Kerala, India
| | - A M Midhun
- Department of Marine Biology, Microbiology & Biochemistry, School of Marine Sciences, Cochin University of Science and Technology, Kochi, 682016, Kerala, India
| | - D Mohan
- Integrated Coastal and Marine Area Management, Government of India, Ministry of Earth Sciences, NIOT Campus, Pallikkaranai, Chennai, 600 100, Tamil Nadu, India
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Gillespie T, Dhillon P, Ward K, Aggarwal A, Bumb D, Kondal D, Kaushik N, Mohan D, Mohan V, Swaminathan R, Rama R, Manoharan N, Malhotra R, Rath G, Tandon N, Goodman M, Prabhakaran D. Feasibility and Results of Cancer Registry and Noncommunicable Disease Cohort Data Linkages in India. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.53600] [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: 11/20/2022] Open
Abstract
Background: Cancer registries worldwide are vital to determine cancer burden, plan cancer control measures, and facilitate research. Population-based cancer registries are a priority for LMICs by the UICC; the National Cancer Registry Program (NCRP) of India oversees 28 such registries. A primary function of registries is to combine data for the same individual from multiple sources. For other disease cohorts where cancer is an outcome of interest, registries can potentially connect information by linking datasets together. Barriers to successful registration and linkages include systems in which cancer is not a notifiable disease, no universal unique individual identifier exists, and lack of trained personnel. This study utilizes technology and infrastructure to develop better linkages, surveillance, and outcomes. Aim: To assess the feasibility of linking large cohorts designed for cardio-metabolic disease research with cancer registries in New Delhi and Chennai; determine additional steps required for linkage accuracy and completeness; and develop detailed protocols for future applications. Methods: A pilot protocol for linkage between a large diabetes cohort and cancer registries in Delhi and Chennai was developed using MatchPro, a probabilistic record linkage program developed for cancer registries. Probabilistic software links datasets together in the presence of uncertainty (eg misspelled or abbreviated names) to identify record pairs with high probability of representing the same individual. For this study, algorithms were developed to address unique aspects of names and demographics in India. The software and algorithms focused on: detecting duplicates in cancer registries; and linking registries with external files from diabetes cohorts. In Delhi, 3 1-year datasets covering 3 years (2010, 2011, 2012) were linked with the diabetes cohort; in Chennai, the linkage included 3 5-year datasets covering 15 years (2000-04, '05-'09, '10-'14). The unique ID (Aadhaar) is not collected or linked systematically between different systems at this point in time. Results: Linkage attempts yielded potential matches ranked according to probabilistic scores; highest scores were reviewed to determine true matches. In Chennai, this process yielded: (2010-2014) 21% self-reported (SR) cases matching perfectly, 36% requiring follow-up, 13 nonreported (NR) cases found; 2005-2009: 33% SR cases matched perfectly, 1 NR case found; 2000-2004: 1 NR case. Also, 2 training workshops on data linkages and software were held. Conclusion: Linkages between cancer registries and other data sources are feasible in LMICs using probabilistic record linkage software augmented by manual matching. Future efforts to use existing epidemiologic resources (cohorts) and cancer research infrastructure (registries and clinical centers) can enhance research including understanding shared risk factors and pathophysiologic mechanisms e.g., between cancer and other NCD.
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Affiliation(s)
| | | | - K. Ward
- Emory University, Surgery, Atlanta, GA
| | | | - D. Bumb
- Emory University, Surgery, Atlanta, GA
| | - D. Kondal
- Emory University, Surgery, Atlanta, GA
| | | | - D. Mohan
- Emory University, Surgery, Atlanta, GA
| | - V. Mohan
- Emory University, Surgery, Atlanta, GA
| | | | - R. Rama
- Emory University, Surgery, Atlanta, GA
| | | | | | - G. Rath
- Emory University, Surgery, Atlanta, GA
| | - N. Tandon
- Emory University, Surgery, Atlanta, GA
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Sai Kiran NA, Sivaraju L, Vidyasagar K, Aryan S, Raj V, Rajagopal N, Mohan D, Thakar S, Rao AS, Hegde AS. Safety and Accuracy of Anatomic and Lateral Fluoroscopic-Guided Placement of C2 Pars/Pedicle Screws and C1 Lateral Mass Screws, and Freehand Placement of C2 Laminar Screws. World Neurosurg 2018; 118:e304-e315. [DOI: 10.1016/j.wneu.2018.06.184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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Marigoudar SR, Mohan D, Nagarjuna A, Karthikeyan P. Biomarker and histopathological responses of Lates calcarifer on exposure to sub lethal concentrations of chlorpyrifos. Ecotoxicol Environ Saf 2018; 148:327-335. [PMID: 29091835 DOI: 10.1016/j.ecoenv.2017.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 06/19/2017] [Revised: 10/07/2017] [Accepted: 10/10/2017] [Indexed: 05/20/2023]
Abstract
Bioassay tests on fingerlings (3.0 ± 0.5cm) of euryhyaline fish Lates calcarifer were conducted using customized continuous flow through system and derived 96h acute toxicity value for chlorpyrifos (CPF). Based on the measured concentration of CPF mean median lethal concentration (LC50) of 1.07µg/l with lower and upper 95% confidence limits (0.95 and 1.19µg/l). No observed Effect Concentration (NOEC), Lowest Observed Effect Concentration (LOEC) and chronic values were found to be 0.4, 0.09 and 0.07µg/l respectively. Key biomarker enzyme activities such as esterase, superoxide dismutase and malate dehydrogenase were measured in whole body tissues of the fish fingerlings on exposure to sublethal toxicity of CPF resulting in inhibition of enzyme activities. Native gel electrophoresis revealed single isoform of SOD and MDH enzyme activities exhibiting time and concentration dependent inhibition. Interestingly, three isoforms of esterase activity were witnessed, two isoforms didn't show changes and one isoform was completely inhibited. The observed changes indicated continuous production of reactive oxygen species (ROS) in cells, affecting the integrity and function of cell membrane. Decreased MDH activity indicates reduction of ATP production in the mitochondria leading to susceptibility of fish fingerlings due to the imposed CPF toxicity. Histopathological changes are evident as physiological signatures of chemical interactions in the cell and are prominently used for the evaluation of toxic effects. Gills and eye tissues were selected considering the possible effects on respiratory surfaces and vision impairment. Their tissue sections were observed for changes in primary & secondary lamellae, and retina of the eye respectively. Prominent pathological lesions of gills and retina of the eye include degeneration of cells, fusion, lifting of epithelium and increased cellular space, detachment of pigment epithelium, fusion of photoreceptor cells, respectively on exposure to 30 days of sub lethal concentrations. CPF was found to be highly toxic, affecting the vital functions of respiration, vision and cellular activities leading to susceptibility of fish fingerlings.
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Affiliation(s)
- S R Marigoudar
- Integrated Coastal and Marine Area Management-Project Directorate, NIOT Campus, Ministry of Earth Sciences, Govt. of India, Pallikaranai, Chennai 600100, India.
| | - D Mohan
- Integrated Coastal and Marine Area Management-Project Directorate, NIOT Campus, Ministry of Earth Sciences, Govt. of India, Pallikaranai, Chennai 600100, India
| | - A Nagarjuna
- Integrated Coastal and Marine Area Management-Project Directorate, NIOT Campus, Ministry of Earth Sciences, Govt. of India, Pallikaranai, Chennai 600100, India
| | - P Karthikeyan
- Integrated Coastal and Marine Area Management-Project Directorate, NIOT Campus, Ministry of Earth Sciences, Govt. of India, Pallikaranai, Chennai 600100, India
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Thakar S, Sivaraju L, Jacob KS, Arun AA, Aryan S, Mohan D, Sai Kiran NA, Hegde AS. A points-based algorithm for prognosticating clinical outcome of Chiari malformation Type I with syringomyelia: results from a predictive model analysis of 82 surgically managed adult patients. J Neurosurg Spine 2017; 28:23-32. [PMID: 29125433 DOI: 10.3171/2017.5.spine17264] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although various predictors of postoperative outcome have been previously identified in patients with Chiari malformation Type I (CMI) with syringomyelia, there is no known algorithm for predicting a multifactorial outcome measure in this widely studied disorder. Using one of the largest preoperative variable arrays used so far in CMI research, the authors attempted to generate a formula for predicting postoperative outcome. METHODS Data from the clinical records of 82 symptomatic adult patients with CMI and altered hindbrain CSF flow who were managed with foramen magnum decompression, C-1 laminectomy, and duraplasty over an 8-year period were collected and analyzed. Various preoperative clinical and radiological variables in the 57 patients who formed the study cohort were assessed in a bivariate analysis to determine their ability to predict clinical outcome (as measured on the Chicago Chiari Outcome Scale [CCOS]) and the resolution of syrinx at the last follow-up. The variables that were significant in the bivariate analysis were further analyzed in a multiple linear regression analysis. Different regression models were tested, and the model with the best prediction of CCOS was identified and internally validated in a subcohort of 25 patients. RESULTS There was no correlation between CCOS score and syrinx resolution (p = 0.24) at a mean ± SD follow-up of 40.29 ± 10.36 months. Multiple linear regression analysis revealed that the presence of gait instability, obex position, and the M-line-fourth ventricle vertex (FVV) distance correlated with CCOS score, while the presence of motor deficits was associated with poor syrinx resolution (p ≤ 0.05). The algorithm generated from the regression model demonstrated good diagnostic accuracy (area under curve 0.81), with a score of more than 128 points demonstrating 100% specificity for clinical improvement (CCOS score of 11 or greater). The model had excellent reliability (κ = 0.85) and was validated with fair accuracy in the validation cohort (area under the curve 0.75). CONCLUSIONS The presence of gait imbalance and motor deficits independently predict worse clinical and radiological outcomes, respectively, after decompressive surgery for CMI with altered hindbrain CSF flow. Caudal displacement of the obex and a shorter M-line-FVV distance correlated with good CCOS scores, indicating that patients with a greater degree of hindbrain pathology respond better to surgery. The proposed points-based algorithm has good predictive value for postoperative multifactorial outcome in these patients.
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Affiliation(s)
- Sumit Thakar
- 1Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore; and
| | - Laxminadh Sivaraju
- 1Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore; and
| | | | - Aditya Atal Arun
- 1Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore; and
| | - Saritha Aryan
- 1Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore; and
| | - Dilip Mohan
- 1Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore; and
| | | | - Alangar S Hegde
- 1Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore; and
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Rao AS, Thakar S, Sai Kiran NA, Aryan S, Mohan D, Hegde AS. Analogous Three-Dimensional Constructive Interference in Steady State Sequences Enhance the Utility of Three-Dimensional Time of Flight Magnetic Resonance Angiography in Delineating Lenticulostriate Arteries in Insular Gliomas: Evidence from a Prospective Clinicoradiologic Analysis of 48 Patients. World Neurosurg 2017; 109:e426-e433. [PMID: 29017985 DOI: 10.1016/j.wneu.2017.09.199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/28/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Three-dimensional (3D) time of flight (TOF) imaging is the current gold standard for noninvasive, preoperative localization of lenticulostriate arteries (LSAs) in insular gliomas; however, the utility of this modality depends on tumor intensity. METHODS Over a 3-year period, 48 consecutive patients with insular gliomas were prospectively evaluated. Location of LSAs and their relationship with the tumor were determined using a combination of contrast-enhanced coronal 3D TOF magnetic resonance angiography and coronal 3D constructive interference in steady state (CISS) sequences. These findings were analyzed with respect to extent of tumor resection and early postoperative motor outcome. RESULTS Tumor was clearly visualized in 29 (60.4%) patients with T1-hypointense tumors using 3D TOF and in all patients using CISS sequences. Using combined 3D TOF and CISS, LSA-tumor interface was well seen in 47 patients, including all patients with T1-heterointense or T1-isointense tumors. Extent of resection was higher in the LSA-pushed group compared with the LSA-encased group. In the LSA-encased group, 6 (12.5%) patients developed postoperative hemiparesis; 2 (4.2%) cases were attributed to LSA injury. CONCLUSIONS Contrast-enhanced 3D TOF can delineate LSAs in almost all insular gliomas but is limited in identifying the LSA-tumor interface. This limitation can be overcome by addition of analogous CISS sequences that delineate the LSA-tumor interface regardless of tumor intensity. Combined 3D TOF and 3D CISS is a useful tool for surgical planning and safer resections of insular tumors and may have added surgical relevance when included as an intraoperative adjunct.
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Affiliation(s)
- Arun S Rao
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Sumit Thakar
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India.
| | | | - Saritha Aryan
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Dilip Mohan
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Alangar S Hegde
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
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Thakar S, Kurudi Siddappa A, Aryan S, Mohan D, Sai Kiran NA, Hegde AS. Does the mesodermal derangement in Chiari Type I malformation extend to the cervical spine? Evidence from an analytical morphometric study on cervical paraspinal muscles. J Neurosurg Spine 2017; 27:421-427. [DOI: 10.3171/2016.12.spine16914] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe mesodermal derangement in Chiari Type I malformation (CMI) has been postulated to encompass the cervical spine. The objectives of this study were to assess the cross-sectional areas (CSAs) of cervical paraspinal muscles (PSMs) in patients with CMI without syringomyelia, compare them with those in non-CMI subjects, and evaluate their correlations with various factors.METHODSIn this retrospective study, the CSAs of cervical PSMs in 25 patients were calculated on T2-weighted axial MR images and computed as ratios with respect to the corresponding vertebral body areas. These values and the cervical taper ratios were then compared with those of age- and sex-matched non-CMI subjects and analyzed with respect to demographic data and clinicoradiological factors.RESULTSCompared with the non-CMI group, the mean CSA values for the rectus capitis minor and all of the subaxial PSMs were lower in the study group, and those of the deep extensors were significantly lower (p = 0.004). The cervical taper ratio was found to be significantly higher in the study cohort (p = 0.0003). A longer duration of symptoms and a steeper cervical taper ratio were independently associated with lower CSA values for the deep extensors (p = 0.04 and p = 0.03, respectively). The presence of neck pain was associated with a lower CSA value for the deep flexors (p = 0.03).CONCLUSIONSPatients with CMI demonstrate alterations in their cervical paraspinal musculature even in the absence of coexistent syringomyelia. Their deep extensor muscles undergo significant atrophic changes that worsen with the duration of their symptoms. This could be related to a significantly steeper cervical taper ratio that their cervical cords are exposed to. Neck pain in these patients is related to atrophy of their deep flexor muscles. A steeper cervical taper ratio and alterations in the PSMs could be additional indicators for surgery in patients with CMI without syringomyelia.
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Karthikeyan M, Rose R, Shridevi V, Anandan B, Shanmugasundaram S, Mohan D, Ramesh A, Jayaraman G. Core Promoter Variants (A-20C, T-18C and G-6A) of the Angiotensinogen (AGT) Gene are not Significantly Associated with Hypertension in Patients of Tamilnadu, India. INT J HUM GENET 2017. [DOI: 10.1080/09723757.2009.11886056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M. Karthikeyan
- Department of Genetics, Dr. ALMPGIBMS, University of Madras, Taramani Campus, Chennai 600 113, Tamilnadu, India
- Department of Bioinformatics, Alagappa University, Karaikudi 630 003, Tamilnadu, India
| | - Rajiv Rose
- Department of Genetics, Dr. ALMPGIBMS, University of Madras, Taramani Campus, Chennai 600 113, Tamilnadu, India
| | - V. Shridevi
- Department of Genetics, Dr. ALMPGIBMS, University of Madras, Taramani Campus, Chennai 600 113, Tamilnadu, India
| | - B. Anandan
- Department of Genetics, Dr. ALMPGIBMS, University of Madras, Taramani Campus, Chennai 600 113, Tamilnadu, India
| | | | - D. Mohan
- Govt. Hospital, Head quarters, Dindigul 624001, Tamilnadu, India
| | - A. Ramesh
- Department of Genetics, Dr. ALMPGIBMS, University of Madras, Taramani Campus, Chennai 600 113, Tamilnadu, India
| | - G. Jayaraman
- Department of Genetics, Dr. ALMPGIBMS, University of Madras, Taramani Campus, Chennai 600 113, Tamilnadu, India
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Karthikeyan M, Shridevi V, Rose R, Anandan B, Singh KD, Shanmugasundaram S, Mohan D, Ramesh A, Jayaraman G. Angiotensin Gene Polymorphisms (T174M and M235T) are Significantly Associated with the Hypertensive Patients of Tamil Nadu, South India. INT J HUM GENET 2017. [DOI: 10.1080/09723757.2013.11886218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M. Karthikeyan
- Department of Bioinformatics, Alagappa University, Karaikudi 630 004, Tamil Nadu, India
- Department of Genetics, Dr. ALMPGIBMS, University of Madras, Taramani Campus, Chennai 600 113, Tamil Nadu, India
| | - V. Shridevi
- Department of Genetics, Dr. ALMPGIBMS, University of Madras, Taramani Campus, Chennai 600 113, Tamil Nadu, India
| | - Rajiv Rose
- Department of Genetics, Dr. ALMPGIBMS, University of Madras, Taramani Campus, Chennai 600 113, Tamil Nadu, India
| | - B. Anandan
- Department of Bioinformatics, Alagappa University, Karaikudi 630 004, Tamil Nadu, India
| | | | | | - D. Mohan
- Govt. Hospital, Head quarters, Dindigul 624001, Tamil Nadu, India
| | - A. Ramesh
- Department of Genetics, Dr. ALMPGIBMS, University of Madras, Taramani Campus, Chennai 600 113, Tamil Nadu, India
| | - G. Jayaraman
- Department of Genetics, Dr. ALMPGIBMS, University of Madras, Taramani Campus, Chennai 600 113, Tamil Nadu, India
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35
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Padmakumari TV, Jacob Kaleekkal N, Mohan D, Velmurugan S. Removal of nitrogen containing reducing agents from water coolant systems using ion exchange resin and membranes. J Appl Polym Sci 2017. [DOI: 10.1002/app.44588] [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: 11/11/2022]
Affiliation(s)
- T. V. Padmakumari
- Water and Steam Chemistry Division; BARC Facilities; Kalpakkam Tamil Nadu India
| | - Noel Jacob Kaleekkal
- Membrane Laboratory, Department of Chemical Engineering; Anna University; Chennai Tamil Nadu India
| | - D. Mohan
- Membrane Laboratory, Department of Chemical Engineering; Anna University; Chennai Tamil Nadu India
| | - S. Velmurugan
- Water and Steam Chemistry Division; BARC Facilities; Kalpakkam Tamil Nadu India
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36
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Melbiah JB, Nithya D, Mohan D. Surface modification of polyacrylonitrile ultrafiltration membranes using amphiphilic Pluronic F127/CaCO3 nanoparticles for oil/water emulsion separation. Colloids Surf A Physicochem Eng Asp 2017. [DOI: 10.1016/j.colsurfa.2016.12.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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37
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Nagarjuna A, Mohan D. Biochemical and Histopathological Changes Induced by Nickel in the Striped Mullet, Mugil cephalus (Linnaeus 1758). Bull Environ Contam Toxicol 2017; 98:33-40. [PMID: 27837204 DOI: 10.1007/s00128-016-1961-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 05/21/2016] [Accepted: 10/20/2016] [Indexed: 06/06/2023]
Abstract
The present study is focused on determining the acute and chronic toxicity of nickel (Ni) to fish fingerlings, Mugil cephalus. The 96-h median lethal concentration (LC50) for Ni was found to be 42.2 ± 3.9 mg L-1. Based on the chronic toxicity test for 30 days, "No Observed Effect Concentration", "Lowest Observed Effect Concentration" and "Chronic value" were found to be 2.9 ± 0.14, 4.7 ± 0.14 and 3.7 ± 0.14 mg Ni L-1, respectively. The activities of biomarker enzymes including esterase, superoxide dismutase and malate dehydrogenase showed differential expression and cellular anomalies like hyperplasia and detachment of bipolar cells from photoreceptor cells in the retina of eye of mullet. Cellular anomalies in the retina of fish eye affect the primary function of retina, which is to convert light energy into nerve impulses transferred to the brain via the optic nerve, leading to loss or poor vision.
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Affiliation(s)
- A Nagarjuna
- Integrated Coastal and Marine Area Management, Government of India, Ministry of Earth Sciences, NIOT Campus, Chennai, Tamil Nadu, India
| | - D Mohan
- Integrated Coastal and Marine Area Management, Government of India, Ministry of Earth Sciences, NIOT Campus, Chennai, Tamil Nadu, India.
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38
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Al-Ani SA, Mohan D, Platt AJ. Hand Surgery on Patients Who Are “High Risk” For Blood-Borne Viruses. ACTA ACUST UNITED AC 2016; 31:426-31. [PMID: 16725242 DOI: 10.1016/j.jhsb.2006.03.172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2005] [Revised: 11/08/2005] [Accepted: 03/29/2006] [Indexed: 11/28/2022]
Abstract
There is a risk of transmission of blood-borne viruses (BBV) to health-care workers when performing hand surgery on intravenous drug abusers and other patients known to have BBV. This review summarises methods and procedures that may be employed to help reduce this risk to a minimum. High-risk patients should be identified early and a non-invasive procedure considered. Only experienced staff should scrub and appropriate clothing should be worn. Sharp instrument use should be kept to a minimum and only instrument retraction and suturing should be employed. When possible, wounds should be closed with staples, glue or absorbable sutures. Appropriate steps must be taken to reduce the risk of injuries from sharp bone ends, K-wires and splash exposure during irrigation.
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Affiliation(s)
- S A Al-Ani
- Department of Plastic Surgery, Castle Hill Hospital, Cottingham, UK.
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Gupta S, Basant N, Mohan D, Singh KP. Room-temperature and temperature-dependent QSRR modelling for predicting the nitrate radical reaction rate constants of organic chemicals using ensemble learning methods. SAR QSAR Environ Res 2016; 27:539-558. [PMID: 27385532 DOI: 10.1080/1062936x.2016.1199592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/11/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Abstract
Experimental determinations of the rate constants of the reaction of NO3 with a large number of organic chemicals are tedious, and time and resource intensive; and the development of computational methods has widely been advocated. In this study, we have developed room-temperature (298 K) and temperature-dependent quantitative structure-reactivity relationship (QSRR) models based on the ensemble learning approaches (decision tree forest (DTF) and decision treeboost (DTB)) for predicting the rate constant of the reaction of NO3 radicals with diverse organic chemicals, under OECD guidelines. Predictive powers of the developed models were established in terms of statistical coefficients. In the test phase, the QSRR models yielded a correlation (r(2)) of >0.94 between experimental and predicted rate constants. The applicability domains of the constructed models were determined. An attempt has been made to provide the mechanistic interpretation of the selected features for QSRR development. The proposed QSRR models outperformed the previous reports, and the temperature-dependent models offered a much wider applicability domain. This is the first report presenting a temperature-dependent QSRR model for predicting the nitrate radical reaction rate constant at different temperatures. The proposed models can be useful tools in predicting the reactivities of chemicals towards NO3 radicals in the atmosphere, hence, their persistence and exposure risk assessment.
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Affiliation(s)
- S Gupta
- a Environmental Chemistry Division , CSIR-Indian Institute of Toxicology Research , Lucknow , India
| | | | - D Mohan
- c School of Environmental Sciences, Jawaharlal Nehru University , New Delhi , India
| | - K P Singh
- a Environmental Chemistry Division , CSIR-Indian Institute of Toxicology Research , Lucknow , India
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Saranya R, Beril JS, Mohan D. Effects of polymer blend composition on membrane properties and separation performance of PEES/PEI blend membrane. HIGH PERFORM POLYM 2016. [DOI: 10.1177/0954008316650271] [Citation(s) in RCA: 2] [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: 11/16/2022]
Abstract
In this work, an attempt has been made for protein rejection from aqueous solution using ultrafiltration blend membrane based on poly(phenylene ether ether sulfone) (PEES) and polyetherimide (PEI) was prepared in various blend compositions. Prepared membranes were characterized in terms of pure water flux, water content, membrane hydraulic resistance, porosity, contact angle, scanning electron microscopy, thermogravimetric analysis, and attenuated total reflectance-Fourier transform infrared spectroscopy. Studies were carried out to find out the rejection of proteins such as trypsin, pepsin, egg albumin, and bovine serum albumin. The extent of protein separation is directly proportional to molecular weight of protein. Pristine PEES membrane exhibited high-percentage protein rejection of BSA (92.7%), EA (88.2%), pepsin (85.8%), and trypsin (82.2%) compared to PEES/PEI blend membranes. PEES/PEI blend membranes have better hydrophilic property compared to pristine PEES membrane. Pristine PEES has a contact angle of 97.8°, embedded with PEI and reduced to 67.9°. The thermal stability of the membrane was slightly decreased when the percentage of PEI composition into the PEES/PEI blend increased and observed that the pure PEES membrane has superior thermal stability than PEES/PEI blend membranes
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Affiliation(s)
- R Saranya
- Department of Chemical Engineering, Anna University, Chennai, Tamil Nadu, India
| | - JS Beril
- Department of Chemical Engineering, Anna University, Chennai, Tamil Nadu, India
| | - D Mohan
- Membrane Lab, Department of Chemistry, Anna University, Chennai, Tamil Nadu, India
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Abstract
Intracranial occurrence of myeloid sarcoma without any evidence of systemic hematological disorder is uncommon. We report the case of a 17-year-old girl who presented with features of raised intracranial pressure and paraparesis of short duration. Magnetic resonance imaging showed a 6 cm bilateral middle 1/3rd para sagittal contrast enhancing extra-axial mass with mass effect. The tumor was subtotally excised. Histology and immunohistochemistry proved to be a myelosarcoma. Further evaluation done with peripheral blood smear and bone marrow biopsy ruled out the possibility of leukemia or myeloproliferative disorder. She was referred for chemotherapy and clinically showed improvement after 6 months of follow-up. Authors report a case of intracranial myelosarcoma which closely resembled meningioma both radiologically and in intraoperative morphological appearance. Authors discuss in detail the radiological and histological features of myelosarcoma along with differential diagnoses and treatment options.
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Affiliation(s)
- Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Nandita Ghosal
- Department of Pathology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Bevinahalli N Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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Thakar S, Mohan D, Srinivasa R, Ghosal N, Hegde AS. Intracranial high grade glioma masquerading as a skull base lesion: Report of two unusual cases. J Cancer Res Ther 2016; 11:1044. [PMID: 26881678 DOI: 10.4103/0973-1482.158199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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Supriya K, Rowe M, Laskemoen T, Mohan D, Price TD, Lifjeld JT. Early diversification of sperm size in the evolutionary history of the old world leaf warblers (Phylloscopidae). J Evol Biol 2016; 29:777-89. [PMID: 26781541 DOI: 10.1111/jeb.12826] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 01/06/2023]
Abstract
Sperm morphological traits are highly variable among species and are commonly thought to evolve by post-copulatory sexual selection. However, little is known about the evolutionary dynamics of sperm morphology, and whether rates of evolutionary change are variable over time and among taxonomic groups. Here, we examine sperm morphology from 21 species of Old World leaf warblers (Phylloscopidae), a group of generally dull, sexually monochromatic birds, which are known to have high levels of extra-pair paternity. We found that sperm length differs markedly across species, spanning about 40% of the range observed across a larger selection of passerine birds. Furthermore, we found strong support for an 'early-burst' model of trait evolution, implying that the majority of divergence in sperm length has occurred early in the evolutionary history of this clade with subsequent evolutionary stasis. This large early divergence matches the early divergence reported in ecological traits (i.e. body size and feeding behaviour). Our findings demonstrate that rates of evolution in sperm morphology can change over time in passerine taxa, and that evolutionary stasis in sperm traits can occur even in species exhibiting characteristics consistent with moderate-to-high levels of sperm competition. It remains a major challenge to identify the selection mechanisms and possible constraints responsible for these variable rates of sperm evolution.
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Affiliation(s)
- K Supriya
- Committee on Evolutionary Biology, University of Chicago, Chicago, IL, USA
| | - M Rowe
- Natural History Museum, University of Oslo, Oslo, Norway.,Centre for Ecological and Evolutionary Synthesis, Department of Biosciences, University of Oslo, Oslo, Norway
| | - T Laskemoen
- Natural History Museum, University of Oslo, Oslo, Norway
| | - D Mohan
- Wildlife Institute of India, Dehradun, India
| | - T D Price
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA
| | - J T Lifjeld
- Natural History Museum, University of Oslo, Oslo, Norway
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Thakar S, Sai Kiran NA, Mohan D, Pushpa BT, Hegde V, Hegde AS. Aggressive thoracic vertebral lesion with intraosseous and epidural components. Spine J 2016; 16:e35-6. [PMID: 26386169 DOI: 10.1016/j.spinee.2015.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/10/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore 560066, Karnataka State, India
| | - Narayanam Anantha Sai Kiran
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore 560066, Karnataka State, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore 560066, Karnataka State, India
| | - B T Pushpa
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore 560066, Karnataka State, India
| | - Vinay Hegde
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore 560066, Karnataka State, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore 560066, Karnataka State, India
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Thakar S, Sivaraju L, Aryan S, Mohan D, Sai Kiran NA, Hegde AS. Lumbar paraspinal muscle morphometry and its correlations with demographic and radiological factors in adult isthmic spondylolisthesis: a retrospective review of 120 surgically managed cases. J Neurosurg Spine 2016; 24:679-85. [PMID: 26771373 DOI: 10.3171/2015.9.spine15705] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to assess the cross-sectional areas (CSAs) of lumbar paraspinal muscles in adults with isthmic spondylolisthesis (IS), to compare them with those in the normative population, and to evaluate their correlations with demographic factors and MRI changes in various spinal elements. METHODS The authors conducted a retrospective study of patients who had undergone posterior lumbar interbody fusion for IS, and 2 of the authors acting as independent observers calculated the CSAs of various lumbar paraspinal muscles (psoas, erector spinae [ES], multifidus [MF]) on preoperative axial T2-weighted MR images from the L-3 to L-5 vertebral levels and computed the CSAs as ratios with respect to the corresponding vertebral body areas. These values were then compared with those in an age- and sex-matched normative population and were analyzed with respect to age, sex, duration of symptoms, grade of listhesis, and various MRI changes at the level of the listhesis (pedicle signal change, disc degeneration, and facetal arthropathy). RESULTS Compared with values in normative controls, the mean CSA value for the ES muscle was significantly higher in the study cohort of 120 patients (p = 0.002), whereas that for the MF muscle was significantly lower (p = 0.009), and more so in the patients with PSC (p = 0.002). Magnetic resonance imaging signal change in the pedicle was seen in half of the patients, all of whom demonstrated a Type 2 change. Of the variables tested in a multivariate analysis, age independently predicted lower area values for all 3 muscles (p ≤ 0.001), whereas female sex predicted a lower mean psoas area value (p < 0.001). None of the other variables significantly predicted any of the muscle area values. A decrease in the mean MF muscle area value alone was associated with a significantly increased likelihood of a PSC (p = 0.039). CONCLUSIONS Compared with normative controls, patients with IS suffer selective atrophy of their MF muscle, whereas their ES muscle undergoes a compensatory hypertrophy. Advancing age has a detrimental effect on the areas of the lumbar PSMs, whereas female sex predisposes to a decreased psoas muscle area. Multifidus muscle atrophy correlates with PSC, indicating the role of this deep stabilizer in the biomechanical stability of spondylolisthetic spines. This may be of clinical significance in targeted physiotherapy programs during the conservative management of IS.
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Affiliation(s)
- Sumit Thakar
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Laxminadh Sivaraju
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Saritha Aryan
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Dilip Mohan
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | | | - Alangar S Hegde
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
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Abstract
Functionalized multi-walled carbon nanotube incorporated polyetherimide mixed matrix membranes for blood purification application.
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Affiliation(s)
- Noel Jacob Kaleekkal
- Membrane Laboratory
- Department of Chemical Engineering
- Anna University
- Chennai-600025
- India
| | - Dipak Rana
- Department of Chemical and Biological Engineering
- University of Ottawa
- Ottawa
- Canada
| | - D. Mohan
- Membrane Laboratory
- Department of Chemical Engineering
- Anna University
- Chennai-600025
- India
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47
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Sivaraju L, Mohan D, Rao AS, Hegde AS. Osteolytic vascular lesion of upper cervical spine. Spine J 2015; 15:e39-40. [PMID: 26239764 DOI: 10.1016/j.spinee.2015.07.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 07/07/2015] [Accepted: 07/17/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore 560066, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore 560066, India
| | - Arun S Rao
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore 560066, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore 560066, India
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Fisk M, Gale NS, Mohan D, McEniery CM, Forman JR, Bolton CE, MacNee W, Cockcroft JR, Fuld J, Calverley PMA, Cheriyan J, Tal-Singer R, Polkey MI, Wilkinson IB. S124 The BODE Index is an independent determinant of arterial stiffness in Chronic Obstructive Pulmonary Disease (COPD): Abstract S124 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Thakar S, Dadlani R, Sivaraju L, Aryan S, Mohan D, Sai Kiran NA, Rajarathnam R, Shyam M, Sadanand V, Hegde AS. A value-based, no-cost-to-patient health model in the developing world: Critical appraisal of a unique patient-centric neurosurgery unit. Surg Neurol Int 2015; 6:131. [PMID: 26322241 PMCID: PMC4538577 DOI: 10.4103/2152-7806.162484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/24/2015] [Indexed: 12/04/2022] Open
Abstract
Background: It is well-accepted that the current healthcare scenario worldwide is due for a radical change, given that it is fraught with mounting costs and varying quality. Various modifications in health policies have been instituted toward this end. An alternative model, the low-cost, value-based health model, focuses on maximizing value for patients by moving away from a physician-centered, supply-driven system to a patient-centered system. Methods: The authors discuss the successful inception, functioning, sustainability, and replicability of a novel health model in neurosurgery built and sustained by inspired humanitarianism and that provides all treatment at no cost to the patients irrespective of their socioeconomic strata, color or creed. Results: The Sri Sathya Sai Institute of Higher Medical Sciences (SSSIHMS) at Whitefield, Bengaluru, India, a private charitable hospital established in 2001, functions on the ideals of providing free state-of-the-art healthcare to all in a compassionate and holistic manner. With modern equipment and respectable outcome benchmarks, its neurosurgery unit has operated on around 18,000 patients since its inception, and as such, has contributed INR 5310 million (USD 88.5 million) to society from an economic standpoint. Conclusions: The inception and sustainability of the SSSIHMS model are based on self-perpetuating philanthropy, a cost-conscious culture and the dissemination of human values. Replicated worldwide, at least in the developing nations, this unique healthcare model may well change the face of healthcare economics.
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Affiliation(s)
- Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | - Ravi Dadlani
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | - Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | - Saritha Aryan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | - Narayanam Anantha Sai Kiran
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | - Ravikiran Rajarathnam
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | - Maya Shyam
- Department of Finance and Accounts, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
| | - Venkatraman Sadanand
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India ; Department of Neurosurgery, Loma Linda University, Loma Linda, California, USA
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India
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Kaleekkal NJ, Thanigaivelan A, Durga M, Girish R, Rana D, Soundararajan P, Mohan D. Graphene Oxide Nanocomposite Incorporated Poly(ether imide) Mixed Matrix Membranes for in Vitro Evaluation of Its Efficacy in Blood Purification Applications. Ind Eng Chem Res 2015. [DOI: 10.1021/acs.iecr.5b01655] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Noel Jacob Kaleekkal
- Membrane
Laboratory, Department of Chemical Engineering, Alagappa College of
Technology, Anna University, Chennai 600025, India
| | - A. Thanigaivelan
- Membrane
Laboratory, Department of Chemical Engineering, Alagappa College of
Technology, Anna University, Chennai 600025, India
| | - M. Durga
- Membrane
Laboratory, Department of Chemical Engineering, Alagappa College of
Technology, Anna University, Chennai 600025, India
| | - R. Girish
- Department
of Nephrology, Sri Ramachandra University, Porur, Chennai 600116, India
| | - Dipak Rana
- Department
of Chemical and Biological Engineering, University of Ottawa, 161 Louis Pasteur Private, Ottawa, Ontario K1N 6N5, Canada
| | - P. Soundararajan
- Department
of Nephrology, Sri Ramachandra University, Porur, Chennai 600116, India
| | - D. Mohan
- Membrane
Laboratory, Department of Chemical Engineering, Alagappa College of
Technology, Anna University, Chennai 600025, India
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