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Iqbal H, Arora GS, Singh I, Kohli I, Chaudhry H, Sohal A, Prajapati D. The impact of aspirin use on outcomes in patients with inflammatory bowel disease: Insights from a national database. Int J Colorectal Dis 2023; 39:6. [PMID: 38117356 PMCID: PMC10733222 DOI: 10.1007/s00384-023-04575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is an inflammatory disorder that can increase the risk of mortality. Aspirin is an anti-inflammatory drug used for primary prevention of cardiovascular events. A single center analysis previously reported that aspirin use did not impact major outcomes in IBD. In this study, we aim to assess the impact of aspirin use on mortality and other outcomes in patients with IBD using national data. METHODS National inpatient sample (NIS) 2016-2020 was used to identify adult patients with IBD. Data were collected on patient demographics, hospital characteristics, and comorbidities. The outcomes studied were in-hospital mortality, sepsis, shock, Intensive Care Unit (ICU) admission, and need for surgery. Multivariate logistic regression analysis was performed. RESULTS A total of 1,524,820 IBD hospitalizations were included. Of these, 137,430 (9%) were long-term aspirin users. The majority of the patients in the aspirin group were aged > 65 years (34.11%), female (56.37%), White (78.83%) and had Medicare insurance (36.77%). Aspirin users had a lower incidence of in-hospital mortality (1.6% vs 1.4%, P = 0.06), sepsis (2.5% vs 2.9%, P < 0.001), shock (2.9% vs 3.4%, P < 0.001), ICU admission (2.6% vs 2.9%, P < 0.001), need for surgery (2.1% vs 4.2%, P < 0.001). After adjusting for confounders, aspirin was associated with a reduction in mortality (adjusted odds ratio: 0.49, 95%CI 0.45-0.55, P < 0.001). CONCLUSION Our study reports that aspirin use among patients with IBD was associated with a lower risk of death, sepsis, and shock. Aspirin use may have a protective effect in patients with IBD. Further studies are needed to confirm these results.
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Affiliation(s)
- Humzah Iqbal
- Department of Internal Medicine, University of California San Francisco, Fresno, USA.
| | | | | | - Isha Kohli
- Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California San Francisco, Fresno, USA
| | | | - Devang Prajapati
- Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, USA
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Patel A, Arora GS, Roknsharifi M, Javed H, Kaur P. Relamorelin in Gastroparesis and Diabetic Gastroparesis: A Meta-Analysis on Its Efficacy and Safety. Cureus 2023; 15:e48303. [PMID: 38058346 PMCID: PMC10696281 DOI: 10.7759/cureus.48303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2023] [Indexed: 12/08/2023] Open
Abstract
This meta-analysis aimed to evaluate the efficacy and safety of relamorelin, a synthetic ghrelin receptor agonist, for the treatment of gastroparesis and diabetic gastroparesis. A total of 1,033 participants from five randomized controlled trials were included. The primary outcome was the mean change in gastric emptying time from baseline. Relamorelin demonstrated a statistically significant improvement in gastric emptying time with a mean difference of -11.40 minutes compared to the placebo group. Furthermore, a significant improvement was observed specifically in diabetic gastroparesis patients, with a mean difference of -8.43 minutes. However, adverse effects, such as headaches, dizziness, and gastrointestinal symptoms, were more prevalent in the relamorelin group. Despite these adverse effects, the study concludes that relamorelin offers a promising avenue for gastroparesis treatment, especially given the limited existing therapeutic options. This comprehensive meta-analysis synthesizes existing evidence to inform clinical practice and guides future research in this domain.
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Affiliation(s)
- Akash Patel
- Internal Medicine, Eisenhower Health, Rancho Mirage, USA
| | - Gagandeep Singh Arora
- Hepatobiliary Pancreatic Surgery and Liver Transplant, BLK-Max Super Speciality Hospital, New Delhi, IND
- Internal Medicine, University of California, Riverside, San Bernardino, USA
| | - Mona Roknsharifi
- Internal Medicine, University of California, Riverside, San Bernardino, USA
| | - Hamna Javed
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
| | - Parneet Kaur
- Emergency, Civil Hospital Mukerian, Mukerian, IND
- Internal Medicine, Suburban Community Hospital, Philadelphia, USA
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Ramphul K, Dhaliwal JS, Verma R, Sakthivel H, Arora GS. An Update on the Outcomes of Solid Organ Transplant Patients undergoing Transcatheter Aortic Valve Replacement Compared to Surgical Aortic Valve Replacement in the United States. Curr Probl Cardiol 2023; 48:101994. [PMID: 37487851 DOI: 10.1016/j.cpcardiol.2023.101994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Affiliation(s)
| | | | - Renuka Verma
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV
| | - Hemamalini Sakthivel
- Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Ctr Program, Brooklyn, NY
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Patel A, Arora GS, Roknsharifi M, Kaur P, Javed H. Artificial Intelligence in the Detection of Barrett's Esophagus: A Systematic Review. Cureus 2023; 15:e47755. [PMID: 38021699 PMCID: PMC10676286 DOI: 10.7759/cureus.47755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Barrett's esophagus (BE) remains a significant precursor to esophageal adenocarcinoma, requiring accurate and efficient diagnosis and management. The increasing application of machine learning (ML) technologies presents a transformative opportunity for diagnosing and treating BE. This systematic review evaluates the effectiveness and accuracy of machine learning technologies in BE diagnosis and management by conducting a comprehensive search across PubMed, Scopus, and Web of Science databases up to the year 2023. The studies were organized into five categories: computer-aided systems, natural language processing and text-based systems, deep learning on histology and biopsy images, real-time and video analysis, and miscellaneous studies. Results indicate high sensitivity and specificity across machine learning applications. Specifically, computer-aided systems showed sensitivities ranging from 84% to 100% and specificities from 64% to 90.7%. Natural language processing and text-based systems achieved an accuracy as high as 98.7%. Deep learning techniques applied to histology and biopsy images displayed sensitivities up to greater than 90% and a specificity of 100%. Furthermore, real-time and video analysis technologies demonstrated high performance with assessment speeds of up to 48 frames per second (fps) and a mean average precision of 75.3%. Overall, the reviewed literature underscores the growing capability and efficiency of machine learning technologies in diagnosing and managing Barrett's esophagus, often outperforming traditional diagnostic methods. These findings highlight the promising future role of machine learning in enhancing clinical practice and improving patient care for Barrett's esophagus.
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Affiliation(s)
- Akash Patel
- Internal Medicine, Eisenhower Health, Rancho Mirage, USA
| | - Gagandeep Singh Arora
- Hepatobiliary Pancreatic Surgery and Liver Transplant, BLK-Max Super Speciality Hospital, New Delhi, IND
- Internal Medicine, University of California, Riverside, San Bernardino, USA
| | - Mona Roknsharifi
- Internal Medicine, University of California, Riverside, San Bernardino, USA
| | - Parneet Kaur
- Emergency, Civil Hospital, Mukerian, IND
- Internal Medicine, Suburban Community Hospital, Philadelphia, USA
| | - Hamna Javed
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
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Ramphul K, Dhaliwal JS, Arora GS, Verma R, Aggarwal S, Sombans S, Memon RA, Aisha F, Mejias SG, Sakthivel H. Differences in Outcomes of Transcatheter Aortic Valve Replacement Compared With Surgical Aortic Valve Replacement in 100,995 Patients With Obesity across the United States. Am J Cardiol 2023; 203:528-529. [PMID: 37517900 DOI: 10.1016/j.amjcard.2023.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Affiliation(s)
| | | | | | - Renuka Verma
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas
| | | | - Shaheen Sombans
- Bharati Vidyapeeth University Medical College and Hospital, Hyderabad, India
| | | | - Fnu Aisha
- Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
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Arora GS, Javed H, Kaur P, Singh S. Hepatopulmonary Syndrome in a Patient With Autoimmune Hepatitis and Chronic Hepatitis C: A Case Report Highlighting Typical Echo Findings. Cureus 2023; 15:e41491. [PMID: 37484786 PMCID: PMC10359196 DOI: 10.7759/cureus.41491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 07/25/2023] Open
Abstract
Hepatopulmonary syndrome (HPS) is a rare complication of liver disease characterized by intrapulmonary vascular dilatations leading to arterial hypoxemia. We present the case of a 59-year-old female with a past medical history of bilateral breast cancer status post mastectomy who presented with progressive dyspnea on exertion and fatigue. A comprehensive diagnostic workup was conducted to exclude other cardiac, pulmonary, and systemic etiologies. She was diagnosed with autoimmune hepatitis along with chronic hepatitis C. Echocardiography revealed characteristic findings of intrapulmonary shunting characteristic of HPS. The patient showed improvement in pulmonary symptoms and oxygenation status following the initiation of steroid therapy. Although corticosteroids are not the definitive treatment for HPS, they were considered a supportive measure in this case. However, it is important to note that liver transplantation remains the definitive treatment for HPS. This case underscores the importance of echocardiography and the potential role of supportive measures, like corticosteroids, in managing HPS-related symptoms, particularly in patients with autoimmune hepatitis, as a bridging therapy while awaiting liver transplantation.
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Affiliation(s)
| | - Hamna Javed
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
| | - Parneet Kaur
- Internal Medicine, Suburban Community Hospital, Philadelphia, USA
| | - Simran Singh
- Internal Medicine, Jinnah Sindh Medical University (SMC), Karachi, PAK
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Arora GS, Kalra S. Ectopic Liver Tissue Encountered Incidentally During a Laparoscopic Cholecystectomy: A Case Report. Cureus 2023; 15:e42220. [PMID: 37484795 PMCID: PMC10359195 DOI: 10.7759/cureus.42220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 07/25/2023] Open
Abstract
A 60-year-old male patient who presented with right upper quadrant (RUQ) pain was diagnosed with acute cholecystitis after an ultrasound of the abdomen revealed multiple gallstones, gallbladder wall thickening, pericholecystic fluid, and a positive sonographic Murphy sign. The patient was admitted, administered IV fluids, antibiotics, and pain relief, and scheduled for laparoscopic cholecystectomy. During surgery, an incidental finding of ectopic liver tissue attached to the gallbladder was noted. Histopathology confirmed the presence of chronic cholecystitis and multifaceted cholesterol stones. Normal liver tissue was noted in the ectopic mass. Ectopic liver tissue is defined as liver tissue located outside the main liver parenchyma and is usually asymptomatic. They are usually detected at the time of autopsies, incidentally during surgeries, or during imaging done for other etiologies. They can occur at various sites in the body. Ectopic liver tissue can cause potential complications such as hepatocellular carcinoma and torsion, and in the event that they are incidentally detected, it is advised to remove them. The case report highlights the importance of dealing with incidental findings during laparoscopic cholecystectomy and creating awareness about it.
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Affiliation(s)
| | - Shivam Kalra
- Department of Internal Medicine, Trident Medical Center, North Charleston, USA
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
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Arora GS, Ghosh S, Singh J. Pericardial Cyst in Birt-Hogg-Dubé Syndrome: An Unexpected Discovery. Cureus 2023; 15:e41728. [PMID: 37484785 PMCID: PMC10359194 DOI: 10.7759/cureus.41728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
Birt-Hogg-Dubé syndrome (BHD) is a genetic disorder typically characterized by pulmonary cysts, cutaneous fibrofolliculomas, and renal tumors. We report a case of an 87-year-old male patient with a known diagnosis of BHD and a large pericardial cyst who presented to the emergency room with chest pain. BHD is classically associated with pulmonary cysts and not pericardial cysts. In this report, we highlight the potential of pericardial cysts to independently cause retrosternal pain resembling angina, while also mentioning that BHD too can cause chest pain through the rupture of a pulmonary cyst leading to spontaneous pneumothorax. In our case, coronary angiography revealed non-obstructive coronary arteries, so the cause of chest pain was attributed to myocardial infarction with non-obstructive coronary arteries (MINOCA). Atypical causes of chest pain should be considered, especially in patients with diagnosed genetic syndromes.
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Affiliation(s)
- Gagandeep Singh Arora
- Internal Medicine, University of California, Riverside, School of Medicine, Riverside, USA
| | - Sudeshna Ghosh
- Internal Medicine, University of California, Riverside, School of Medicine, Riverside, USA
| | - Jarmanjeet Singh
- Cardiology, University of California, Riverside, School of Medicine, Riverside, USA
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Arora GS, Kaur P. Acute Delirium Post-inguinal Hernia Mesh Repair in a 40-Year-Old Male: An Unusual Case of Cystocerebral Syndrome. Cureus 2023; 15:e42260. [PMID: 37605679 PMCID: PMC10440094 DOI: 10.7759/cureus.42260] [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] [Accepted: 07/21/2023] [Indexed: 08/23/2023] Open
Abstract
Acute urinary retention is a known complication of inguinal hernia repair. However, the development of severe agitation and delirium as a result of acute urinary retention following inguinal hernia repair is less commonly reported. Here, we present the case of a 40-year-old male with no relevant medical history who underwent open mesh hernia repair for an uncomplicated left-sided indirect inguinal hernia. Postoperatively, the patient became hypertensive, delirious, and violent. He was found to have urinary retention on a bladder scan. Urgent intervention with catheterization and bladder decompression resulted in the prompt resolution of the patient's symptoms. The patient regained his senses and did not remember the events that led to it. This case highlights the importance of recognizing and managing acute urinary retention to prevent the development of severe agitation and delirium following spinal anesthesia. Further research and awareness are necessary to better understand the underlying neurovisceral mechanisms and optimize preventive strategies.
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Affiliation(s)
- Gagandeep Singh Arora
- Internal Medicine, University of California Riverside, San Bernardino, USA
- General Surgery, Government Medical College, Patiala, Patiala, IND
| | - Parneet Kaur
- Emergency Department, Civil Hospital Mukerian, Mukerian, IND
- Internal Medicine, Suburban Community Hospital, Philadelphia, USA
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Arora GS, Madisetty DBS. Right Atrial Thrombus and Submassive Pulmonary Embolism in a COVID-19-Infected Patient: A Case Report. Cureus 2023; 15:e42221. [PMID: 37605708 PMCID: PMC10439843 DOI: 10.7759/cureus.42221] [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] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is primarily a respiratory infection, but it undoubtedly results in systemic illness that affects multiple systems. The high incidence of thromboembolic events is one distinctive clinical characteristic of COVID-19. This case report is about a unique clinical presentation of a 40-year-old homeless female with polysubstance abuse, who was diagnosed with a right atrial thrombus, sub-massive pulmonary embolism, and COVID-19 infection. The patient presented with shortness of breath, subjective fevers, generalized swelling, and chest and upper abdominal pain. Initially, she was treated with tissue plasminogen activator (TPA) and heparin drip for her thrombi, and she was managed conservatively when hemoptysis ensued post-TPA. She was later sent to a higher level of care for surgical embolectomy. In most cases, severe pulmonary parenchymal disease secondary to COVID-19 correlates with the severity of thromboembolic complications, however, in our case report, there was a right atrial thrombus and pulmonary embolism in the absence of COVID pneumonia. This highlights how notorious COVID-19 infections can be.
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Affiliation(s)
- Gagandeep Singh Arora
- Internal Medicine, UC (University of California) Riverside, San Bernardino, USA
- General Surgery, Government Medical College Patiala, Patiala, IND
- Hepatobiliary Pancreatic Surgery and Liver Transplant, BLK-Max Super Speciality Hospital, New Delhi, IND
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Arora GS, Phung D, Kaur P. Herpes Simplex Virus Meningoencephalitis Masquerading as Acute Stroke With Broca's Aphasia: A Case Report. Cureus 2023; 15:e40618. [PMID: 37476130 PMCID: PMC10354683 DOI: 10.7759/cureus.40618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 07/22/2023] Open
Abstract
This case report presents a rare and unique instance of a 70-year-old morbidly obese female with type 2 diabetes mellitus and bilateral lymphedema, who presented with fever and expressive aphasia, initially suspected to be a stroke. A negative CT scan prompted the performance of an MRI, which revealed suggestive imaging findings of herpes encephalitis. Following the MRI, the patient experienced seizures and required intubation in the intensive care unit. Subsequently, a lumbar puncture was performed, confirming the diagnosis of herpes simplex virus (HSV) meningoencephalitis. Prompt initiation of acyclovir therapy led to an improvement in aphasia, ultimately allowing for extubation and transfer to the general ward. The rarity of this case lies in the unusual manifestation of Broca's aphasia caused by HSV, which is not typically associated with this neurological deficit. This report highlights the importance of considering herpes encephalitis as a potential etiology in patients presenting with atypical neurological symptoms, even in the absence of typical radiological findings. Early diagnosis and appropriate management with acyclovir are crucial in improving outcomes in such cases.
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Affiliation(s)
- Gagandeep Singh Arora
- Internal Medicine, University of California, Riverside, School of Medicine, Riverside, USA
| | - Don Phung
- Internal Medicine, University of California, Riverside, School of Medicine, Riverside, USA
| | - Parneet Kaur
- Internal Medicine, Suburban Community Hospital, Norristown, USA
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Som NC, Ghosh BB, Arora GS, Majumdar MK. Isolation & identification of Pseudomonas aeruginosa pathogenic to insect larvae. Indian J Exp Biol 1980; 18:590-3. [PMID: 6777292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Chauhan PP, Bhatia BB, Arora GS, Agrawal RD. Viability of Neoascaris vitulorum (Goeze, 1782) eggs under different physical and chemical conditions. Indian Vet J 1978; 55:1011-3. [PMID: 751964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Chauhan PP, Arora GS, Ahluwalia SS. A note on the occurrence of an immature parafilariid worm in the anterior chamber of eye of a buffalo (Bubalus bubalis). J Helminthol 1974; 48:289-91. [PMID: 4448892 DOI: 10.1017/s0022149x00022975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AbstractAn immature parafilarial worm recovered from the anterior chamber of the eye of a buffalo (Bubalus bubalis) is described. On the basis of characteristic cuticular ornamentation at the anterior extremity, an undivided short oesophagus and unequal spicules, the specimen has been identified tentatively as a male juvenile of Parafilaria bovicola. This is the first record for P. bovicola as an accidental infection of the eye of a buffalo.
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