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Chandramohan D, Rajasekaran R, Konda R, Pujari A, Avula S, Bell M, Palleti SK, Deotare A, Naik R, Bali A, Simhadri P, Arora H, Jena N. Cardiac Magnetic Resonance Imaging Findings in Patients With Chronic Kidney Disease and End-Stage Kidney Disease: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e51672. [PMID: 38313918 PMCID: PMC10838180 DOI: 10.7759/cureus.51672] [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: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
In this systematic review and meta-analysis, we explored the utilization of cardiac magnetic resonance imaging (CMR) to detect fibrotic changes secondary to uremic cardiomyopathy during the early stages of chronic kidney disease (CKD) and in patients with end-stage kidney disease (ESKD). Uremic myocardial fibrosis can lead to arrhythmia and heart failure, and it is important to detect these changes. CMR offers a noninvasive way to characterize the severity of cardiac remodeling. A comprehensive search of multiple electronic databases was conducted. Studies were divided according to scanner field strength (1.5 or 3 Tesla). The random effects model was used to calculate the pooled mean, 95% confidence interval (CI), standard error, and standardized mean difference (SMD). The I2 statistic was used to assess the heterogeneity between study-specific estimates. The search retrieved 779 studies. From these, 20 studies met the inclusion criteria and had 642 CKD patients (mean age of 56.8 years; 65.2% males; mean estimated glomerular filtration rate (eGFR) of 33 mL/min/1.73 m2) and 658 ESKD patients on dialysis (mean age of 55.6 years; 63.3% males; mean dialysis duration of 3.47 years). CKD patients had an increased left ventricular mass index (LVMi) compared to controls, with an SMD of 0.37 (95% CI: 0.20-0.54; I2 0%; p-value <0.05). ESKD patients also had increased LVMi compared to controls, SMD 0.88 (95% CI: 0.35-1.41; I2 79.1%; p-value 0.001). Myocardial fibrosis assessment using T1 mapping showed elevated values; the SMD of native septal T1 values between CKD and controls was 1.099 (95% CI: 0.73-1.46; I2 33.6%; p-value <0.05), and the SMD of native septal T1 values between ESKD patients and controls was 1.12 (95% CI: 0.85-1.38; I2 33.69%; p-value <0.05). In conclusion, patients with CKD and ESKD with preserved left ventricular ejection fraction (LVEF) have higher LVMi and T1 values, indicating increased mass and fibrosis. T1 mapping can be used for the early detection of cardiomyopathy and as a risk stratification tool. Large, randomized trials are needed to confirm these findings and determine the effect of long-term dialysis on cardiac fibrosis.
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Affiliation(s)
| | - Rhoshini Rajasekaran
- General Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, IND
| | | | - Ashwini Pujari
- Nephrology, University of Alabama at Birmingham, Birmingham, USA
| | - Sreekant Avula
- Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, USA
| | - Megan Bell
- Libraries, University of Alabama at Birmingham, Birmingham, USA
| | - Sujith K Palleti
- Nephrology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Apoorv Deotare
- Nephrology, Montgomery Kidney Specialists, Montgomery, USA
| | - Roopa Naik
- Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
- Internal Medicine/Hospital Medicine, Geisinger Health System, Wilkes-Barre, USA
| | - Atul Bali
- Internal Medicine/Nephrology, Geisinger Medical Center, Danville, USA
- Internal Medicine/Nephrology, Geisinger Health System, Wilkes-Barre, USA
- Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Prathap Simhadri
- Internal Medicine/Nephrology, AdventHealth, Florida State University College of Medicine, Daytona Beach, USA
| | - Harkesh Arora
- Hospital Medicine, Lovelace Medical Center, Albuquerque, USA
| | - Nihar Jena
- Cardiovascular Medicine, Wayne State University, Pontiac, USA
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Arora H, Mammadova A, Nebigil C. Crosstalk between PKR1 and miR-124 is crucial for EMT regulation of tc21+epicardial mesothelial cells during cardiac development and repair process. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The epicardial-mesothelial cells (EMCs) are essential regulators of cardiac growth and repairment process. The epicardial-to-mesenchymal transition (EMT) of epicardial fate determination are controlled by both cell autonomous and cardiomyocyte-originated mechanisms. Here, by using an in vitro and in vivo model of epicardial EMT, we investigated the role of miRNAs as regulators of these process and their potential targets.
Methods
EMT was induced in mice embryonic tcf21+EMCs through an angiogenic cytokine, prokineticin treatments. Cre-dependent tracing of TCF21-tm-iCRE-EMCs was utilized to abrogate prokineticin receptor-1 (PKR1) in mice epicardium. Human tcf21+ cardiac fibroblast (mainly originated from epicardial origin also utilized to study for their repairment signaling.
Results
Upon EMC-specific abrogation of PKR1 in early stages of cardiac development the TCF21-tm-iCREPKR1−/− mice exhibited 13±4% embryonic lethality due to a disconnection of epicardial cells from compact layer, failed expansion of the sub-epicardial space, and disruption of heterotypic cell interaction between epicardium and myocardium. EMT-RT profiler and enrichment analysis revealed an impaired EMT in TCF21-tm-iCREPKR1−/− hearts. Ingenuity Pathway Analysis on the EMT molecular network (e.g., Snai1, Snai2, B-catenin, N-cadherin, vimentin), specific to cardiac development and defects revealed MiR-124 as a part of this network that was inversely associated and down-stream of PKR1 in cultured Tcf21+ cells. Furthermore, protein expression of SNAIL2 was significantly downregulated in TCF21-tm-iCREPKR1−/− hearts and cultured Tcf21+ cells upon treatment with mir124 mimic. The luciferase reporter assay showed that miR124 directly targeted the 3'-untranslated region of SNAIL2 in EMCs. In a counter experiment, PKR1 gene replacement or mir124 inhibitor was able to rescue the impaired EMT-genes, and an increase in apoptosis and impaired proliferation in epicardium of embryonic TCF21-tm-iCREPKR1−/− hearts. Importantly, miRNA mimic in cultured tcf21 cells maintained epithelial features in EMCs, and increased EMT-associated transcripts and traits, such as apoptosis. In contrast, MiR124 is involved in wound healing process in tcf21+human CFs and EMCs.
Conclusion
This study shows the importance of a crosstalk between PKR1 and miR-124 with respect to EMT regulation during cardiac development and repair. Controlling fibroblast-committed EMT and pathological fibrotic remodeling is of increasing interest within the field of regenerative tissue engineering and development of interventional strategies after cardiac injury.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fondation de France
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Affiliation(s)
- H Arora
- University of Miami Leonard M. Miller School of Medicine, University of Miami, Florida, Deprtment of Urology , Miami , United States of America
| | - A Mammadova
- INSERM, University of Strasbourg, CRBS , Strasbourg , France
| | - C Nebigil
- INSERM, University of Strasbourg, CRBS , Strasbourg , France
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Chin V, Arora H, Senabouth A, Hernandez JA, McCloy R, Simes J, Boyer M, Hogg P, Young J, Joshua A, Brown B, Watkins N, Powell J. EP16.03-041 Single Cell RNA Sequencing Reveals Phenotypic Predispositions to Developing Lung Cancer in Never-Smokers. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Khodamoradi K, Dullea A, Golan R, Molina Leyba M, Masterson T, Arora H, Ramasamy R. Growth Factor Concentration Can Vary in Platelet-Rich Plasma from Men with Erectile Dysfunction. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Seetharam D, Khodamoradi K, Catherine II, Farber N, Parmar M, Ramasamy R, Arora H. Leptin-LEPR-Desert Hedgehog Signaling Induced Leydig Stem Cells Differentiation in Testis is Modulated by EMT Inducing Transcription Factors which Binds to LEPR. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Seetharam D, Qureshi R, Khodamoradi K, Parmar M, Van Booven D, Vedenko A, Farber N, Arora H, Ramasamy R. Endogenous Effects of Leptin on Leydig Stem Cell Differentiation through Desert Hedgehog Signaling Pathway. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ramalingam S, Arora H, Lewis S, Gunasekaran K, Muruganandam M, Nagaraju S, Padmanabhan P. COVID-19 vaccine-induced cellulitis and myositis. Cleve Clin J Med 2021; 88:648-650. [PMID: 34857596 DOI: 10.3949/ccjm.88a.21038] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kaur M, Khatri K, Kankaria A, Dhir T, Arora H. Efficacy and safety of combined administration of erythropoietin and iron in comparison to iron therapy alone in orthopaedic surgery: systematic review and metanalysis. Acta Ortop Mex 2021; 35:547-556. [PMID: 35793256] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Iron deficiency anaemia in orthopaedic surgery is common and there is increased risk of blood transfusion and associated adverse reactions. The management involves administration of iron (oral or intravenous) and erythropoietin stimulating agents. MATERIAL AND METHODS We searched for PubMed, Embase, Google Scholar and Cochrane database to identify the studies from inception to April 2021. Randomized controlled trials with adult patients undergoing orthopedic surgery were included. The metanalysis compared patients who were administered combination of erythropoietin stimulating agents and iron in one group and iron alone. The primary outcome was the rate of blood transfusion and the secondary outcome studied were postoperative hemoglobin concentration, after treatment hemoglobin levels, and complications like mortality, stroke, myocardial infarction, deep vein thrombosis, pulmonary embolism and renal dysfunction. RESULTS Eleven studies were included. The combination of ESA and iron decreased number of patients who required blood transfusion in comparison to patients treated with iron therapy alone (RR, 0.73; 95% CI, 0.59 to 0.91, I. CONCLUSION <ref id="2">2</ref> = 65%; p = 0.005). In subgroup analysis with oral and intravenous iron, the difference was not statistically significant (p = 0.24). Administration of erythropoietin either in high ( 80,000 IU) or low dose ( 80,000 IU) resulted in lower blood transfusion rates (p = 0.0007) with no significant difference between groups. The risk of mortality, myocardial infarction, stroke, deep vein thrombosis or pulmonary embolism did not significantly increase. Combined administration of ESA and iron versus iron only reduces the number of red blood cell transfusions in the postoperative period in orthopedic procedures with minimal risk of complications.
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Affiliation(s)
- M Kaur
- Department of Pathology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - K Khatri
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - A Kankaria
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - T Dhir
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - H Arora
- Community and Family Medicine, GGS Medical College and Hospital, Faridkot, Punjab, India
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Ramalingam S, Gunasekaran K, Arora H, Muruganandam M, Nagaraju S, Padmanabhan P. Disseminated BCG Infection after intravesical BCG Immunotherapy of Bladder Cancer. QJM 2021; 114:410-411. [PMID: 33585923 DOI: 10.1093/qjmed/hcab033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - K Gunasekaran
- Department of Pulmonary and Critical Care, Pulmonary and Critical Care, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610-5000, USA
| | | | - M Muruganandam
- Department of Rheumatology, University of New Mexico, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA
| | | | - P Padmanabhan
- Department of Cardiology, Unity Point Cardiology, 1301 Pennsylvania Ave Ste 100, Des Moines, IA 50316, USA
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Best J, Kuchakulla M, Khodamoradi K, Lima T, Frech F, Achua J, Rosete O, Mora B, Arora H, Ibrahim E, Ramasamy R. P–070 Evaluation of SARS-CoV–2 in human semen and effect on total sperm number: A prospective observational study. Hum Reprod 2021. [PMCID: PMC8385871 DOI: 10.1093/humrep/deab130.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Study question Is the SARS-CoV–2 virus present in human semen and what is the impact on semen parameters following an infection? Summary answer SARS-CoV–2 infection, though not detected in semen of recovered men, can affect TSN in ejaculate in the acute setting. What is known already Early epidemiological data has suggested that the primary mode of transmission is through respiratory droplets, but the presence of SARS-CoV–2 has been identified in other bodily fluids such as feces, urine, and semen. Study design, size, duration We prospectively recruited thirty men diagnosed with acute SARS-CoV–2 infection using real-time reverse transcriptase-polymerase chain reaction (RT-PCR) of pharyngeal swab specimens. Thirty semen samples from recovered men were obtained 11–64 days after testing positive for SAR-CoV–2 infection. The median duration between positive SAR-CoV–2 test and semen collection was 37 days (IQR=23). Participants/materials, setting, methods Semen samples were collected from each individual using mailed kits. Follow-up semen samples were done with mailed kits or in-person in office setting. Semen analysis and PCR was performed after samples were received. Main results and the role of chance The median total sperm number (TSN) in ejaculate was 12.5 million (IQR=53.1). When compared with age-matched SARS-CoV–2(-) men, TSN was lower among SARS-CoV–2(+) men (p = 0.0024). Five men completed a follow-up sperm analysis (median 3 months) and had a median TSN of 18 million (IQR=21.6). No RNA was detected by means of RT-PCR in the semen in 16 samples tested. Limitations, reasons for caution First, most of the semen samples came from non-severe men of whom were in the recovery stage and lacked symptoms. Additionally, our sample size was relatively small and overnight mail-in semen analysis kits were used during the acute phase of infection to minimize contact with positive subjects. Wider implications of the findings: Our findings suggest extremely low risk of viral transmission during sexual contact and assisted reproductive techniques, although further data need to be obtained. The impact on TSC in recovered men from SARS-CoV–2 infection is concerning, nevertheless long-term follow-up of these men is critical to determine the nadir of TSC. Trial registration number 20200401
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Affiliation(s)
- J Best
- University of MIami, Urology, MIAMI, USA
| | | | | | - T Lima
- University of MIami, Urology, MIAMI, USA
| | - F Frech
- University of MIami, Urology, MIAMI, USA
| | - J Achua
- University of MIami, Urology, MIAMI, USA
| | - O Rosete
- University of MIami, Urology, MIAMI, USA
| | - B Mora
- University of MIami, Urology, MIAMI, USA
| | - H Arora
- University of MIami, Urology, MIAMI, USA
| | - E Ibrahim
- University of MIami, Urology, MIAMI, USA
| | - R Ramasamy
- University of MIami, Urology, MIAMI, USA
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Arora H, Ramalingam S, Sanghavi R, Balogun A, Muruganandam M. Disseminated Nocardia infection-A rare presentation. Clin Case Rep 2021; 9:e04673. [PMID: 34457292 PMCID: PMC8380077 DOI: 10.1002/ccr3.4673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/02/2021] [Accepted: 07/11/2021] [Indexed: 11/22/2022] Open
Abstract
Nocardia infection is rare and requires early diagnosis, extended use of sulfonamides for good prognosis, and prevention of recurrence. It is crucial to suspect nocardiosis in cases of atypical pneumonias or unexplained visceral organ dysfunction.
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Ramalingam S, Arora H, Gunasekaran K, Muruganandam M, Nagaraju S. A Unique Case of Spontaneous Pneumomediastinum in a Patient With COVID-19 and Influenza Coinfection. J Investig Med High Impact Case Rep 2021; 9:23247096211016228. [PMID: 33978499 PMCID: PMC8120538 DOI: 10.1177/23247096211016228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Spontaneous pneumomediastinum is reported in patients with coronavirus disease-2019 (COVID-19) and influenza infection independently, usually associated with noninvasive and mechanical ventilation. We report a case of spontaneous pneumomediastinum in a patient with COVID-19 and influenza coinfection. A 58-year-old male admitted with shortness of breath, diagnosed with COVID-19 and influenza infection. A computed tomography angiogram showed pneumomediastinum. He was treated conservatively with 15 L of oxygen, remdesivir, convalescent plasma, and oseltamivir. The case is being reported for its uniqueness since this is the first documented case of spontaneous pneumomediastinum in COVID-19 and influenza coinfection.
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Ramalingam S, Gunasekaran K, Arora H, Muruganandam M, Padmanabhan P. Clostridium Difficile and Noncirrhotic Hyperammonnemia in a Patient With COVID-19 Infection. Cureus 2021; 13:e14533. [PMID: 33880318 PMCID: PMC8052988 DOI: 10.7759/cureus.14533] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Clostridium difficile is a bacterial infection that usually presents with diarrhea and is mostly associated with previous antibiotics use. Patients with coronavirus disease 2019 (COVID-19) generally have respiratory symptoms but can also present with diarrhea. Noncirrhotic hyperammonemia is an infrequent presentation and is treated with lactulose. We report the case of a 40-year-old male who was admitted to our hospital with abdominal pain, diarrhea, shortness of breath, and confusion. During hospitalization, the patient tested positive for COVID-19 and C. difficile, and oral vancomycin was administered. His kidney functions improved, but he remained confused. His ammonia levels were elevated, and he was not treated with lactulose due to ongoing diarrhea secondary to C. difficile infection.
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Affiliation(s)
| | | | - Harkesh Arora
- Hospital Medicine, Lovelace Medical Center, Albuquerque, USA
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Ramalingam S, Arora H, Gunasekaran K, Muruganandam M, Nagaraju S. Isolated Radial Vein Thrombosis: Upper Extremity Deep Vein Thrombosis in a Patient With COVID-19 Infection. Cureus 2021; 13:e12856. [PMID: 33520558 PMCID: PMC7834546 DOI: 10.7759/cureus.12856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In general, upper extremity deep vein thrombosis (DVT) is less common than lower extremity DVT. Among upper extremity DVT cases, most of them are due to secondary causes like indwelling catheters, cancer, surgery, trauma or immobilization by plaster casts, pregnancy, oral contraceptives, and estrogen. Patients with coronavirus disease 2019 (COVID-19) infection are known to have coagulation dysfunction and a high incidence of DVT, mostly in the lower extremities; however, upper extremity DVT has been rarely reported. We present a rare case of upper extremity DVT in COVID-19 infection. A 56-year-old male with no significant past medical history was admitted with acute respiratory failure due to COVID-19 pneumonia. During hospitalization, he developed right upper extremity swelling, and an ultrasonogram showed right radial vein thrombosis. He was initially started on low molecular weight heparin (LMWH) and was discharged on apixaban. Patients with COVID-19 infection who develop DVT are recommended treatment with a direct oral anticoagulant (DOAC) for three months.
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Affiliation(s)
| | - Harkesh Arora
- Hospital Medicine, Lovelace Medical Center, Albuquerque, USA
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Arora H, Ramasamy R, Hare J. 170 Evaluation of Paracrine Factors Critical for Human Leydig Stem Cell Function. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.116] [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]
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Chu K, Kulandavelu S, Masterson T, Ibrahim E, Arora H, Ramasamy R. 044 Short-acting Exogenous Testosterone Appears to have a Lesser Effect on Gonadotropins Compared to Long-acting Testosterone: A Pilot Study Using Mouse Models. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.046] [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: 11/17/2022]
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Kulkarni S, Thambar S, Arora H. Evaluating the effectiveness of non-steroidal anti-inflammatory drugs (nsaids) for relief of pain associated with temporomandibular joint disorders: a systematic review. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.870] [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]
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Arora H, Hare J, Ramasamy R. 078 Evaluation of Paracrine Factors Critical for Human Leydig Stem Cell Function. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee J, Kuchakulla M, Arora H, Kulandavelu S, Masterson T, Hare J, Ramasamy R. 173 Nitroso-Redox Imbalance Affects Age-Related Decline in Male Androgen Production and Can Be Reversed With Ascorbate. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arora H, Willcocks R, Forbes S, Triplett W, Rooney W, Wang D, Daniels M, Finanger E, Tennekoon G, Brandsema J, Sweeney H, Walter G, Vandenborne K. DUCHENNE MUSCULAR DYSTROPHY - PHYSIOTHERAPY. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Arora H, Hare J, Ramasamy R. Evaluation of paracrine factors critical for human leydig stem cell function. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nguyen A, Arora H, Reese J, Kaouk J, Rhee A. Robot-assisted laparoscopic excision of prostatic utricle in a 3-year old. J Pediatr Urol 2018; 14:343-344. [PMID: 30396603 DOI: 10.1016/j.jpurol.2018.07.015] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 07/22/2018] [Indexed: 11/25/2022]
Abstract
Prostatic utricles have traditionally been excised via the open approach or laparoscopically. Recently, the robot-assisted laparoscopic approach has been described in a 19-year-old male. the case of a 3-year-old male with a disorder of sex development (mosaic 45X/46 XY), with multiple associated anomalies, who presented with recurrent UTI is presented. Renal/bladder ultrasound revealed normal bilateral kidneys, and a 4.3 × 2.8 × 3.3 cm cystic mass in the midline posterior to the bladder. Voiding cystourethrogram demonstrated a large cystic mass behind the bladder, concerning for large prostatic utricle. The patient was brought to the operating room and placed in lithotomy. The urethra was examined cystoscopically. The os of the utricle was identified, an open-ended catheter was advanced, the cystoscope was removed, and a Foley was placed. The camera port was introduced supraumbilically, and robotic ports were introduced inferolaterally. Irrigation of the catheter and distension of the utricle allowed manipulation of the utricle to facilitate identification of a plane of dissection. The neck of the utricle was identified and incised. The catheter was removed, transection was completed, and the stump was oversewn. CONCLUSION: Combined cystoscopic and robotic approach to prostatic utricle excision is feasible, safe, and effective in this patient population.
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Affiliation(s)
- A Nguyen
- Cleveland Clinic Glickman Urological and Kidney Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - H Arora
- Cleveland Clinic Glickman Urological and Kidney Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - J Reese
- Foothills Urology, 400 Indiana Street, Suite 300, Golden, CO, 80401, USA.
| | - J Kaouk
- Cleveland Clinic Glickman Urological and Kidney Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - A Rhee
- Cleveland Clinic Glickman Urological and Kidney Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Arora H, Ramasamy R, Nahar B, Hare J, Zuttion M. 168 Subcutaneous Leydig Stem Cell Autograft in Mice: An Approach to Increase Serum Testosterone. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2017.11.127] [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]
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Lopategui DM, Griswold AJ, Arora H, Clavijo RI, Tekin M, Ramasamy R. A rare ANOS1
variant in siblings with Kallmann syndrome identified by whole exome sequencing. Andrology 2017; 6:53-57. [DOI: 10.1111/andr.12432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 12/30/2022]
Affiliation(s)
- D. M. Lopategui
- Clinical and Translational Science Institute; University of Miami; Miami FL USA
| | - A. J. Griswold
- John P Hussman Institute for Human Genomics; University of Miami; Miami FL USA
| | - H. Arora
- Department of Urology; University of Miami; Miami FL USA
| | - R. I. Clavijo
- Department of Urology; University of Miami; Miami FL USA
| | - M. Tekin
- John P Hussman Institute for Human Genomics; University of Miami; Miami FL USA
| | - R. Ramasamy
- Department of Urology; University of Miami; Miami FL USA
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Arora H, Sawhney J, Mehta A, Mohanty A, Passey R, Jain R. A hospital based observational study of iron, B12 and folate deficiency in heart failure patients with or without anemia. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Willcocks R, Forbes S, Lott D, Senesac C, Arora H, Barnard A, Harrington A, Daniels M, Finanger E, Tennekoon G, Finkel R, Wang D, Rooney W, Walter G, Sweeney H, Vandenborne K. Magnetic resonance biomarkers in the proximal and distal upper extremity in a large cohort of boys with Duchenne muscular dystrophy. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.122] [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: 11/24/2022]
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Arora H, Hare J, Ramasamy R. Subcutaneous leydig stem cell autograft in human: a novel approach to increase serum testosterone. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.926] [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]
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Arora H, Hare J, Ramasamy R. Subcutaneous leydig stem cell autograft in mice: a novel approach to increase serum testosterone. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Masterson T, Arora H, Hare J, Ramasamy R. S-nitrosoglutathione reductase (GSNOR) deficiency impairs spermatogenesis due to secondary hypogonadism. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.633] [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: 11/15/2022]
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Lopategui D, Griswold A, Arora H, Ramasamy R. Whole exome sequencing identifies novel mutation in ANOS1 in siblings with Kallmann's syndrome. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gorris MA, Arora H, Lieb DC, Aloi JA. A Word of Caution When Prescribing High-Dose Vitamin D. Am J Med 2017; 130:e129-e130. [PMID: 27894737 DOI: 10.1016/j.amjmed.2016.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/05/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Matthew A Gorris
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC
| | | | - David C Lieb
- Division of Endocrinology, Eastern Virginia Medical School, Norfolk, Va
| | - Joseph A Aloi
- Division of Endocrinology, Wake Forest Baptist Medical Center, Winston Salem, NC
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Arora H, Ivanovski S. Melatonin as a pro-osteogenic agent in oral implantology: a systematic review of histomorphometric outcomes in animals and quality evaluation using ARRIVE guidelines. J Periodontal Res 2016; 52:151-161. [DOI: 10.1111/jre.12386] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2016] [Indexed: 12/26/2022]
Affiliation(s)
- H. Arora
- School of Dentistry and Oral Health; Griffith University; Gold Coast Qld Australia
| | - S. Ivanovski
- School of Dentistry and Oral Health; Griffith University; Gold Coast Qld Australia
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Arora H, Kelly M, Worley A, Del Linz P, Fergusson A, Hooper PA, Dear JP. Compressive strength after blast of sandwich composite materials. Philos Trans A Math Phys Eng Sci 2014; 372:20130212. [PMID: 24711494 PMCID: PMC3982654 DOI: 10.1098/rsta.2013.0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Composite sandwich materials have yet to be widely adopted in the construction of naval vessels despite their excellent strength-to-weight ratio and low radar return. One barrier to their wider use is our limited understanding of their performance when subjected to air blast. This paper focuses on this problem and specifically the strength remaining after damage caused during an explosion. Carbon-fibre-reinforced polymer (CFRP) composite skins on a styrene-acrylonitrile (SAN) polymer closed-cell foam core are the primary composite system evaluated. Glass-fibre-reinforced polymer (GFRP) composite skins were also included for comparison in a comparable sandwich configuration. Full-scale blast experiments were conducted, where 1.6×1.3 m sized panels were subjected to blast of a Hopkinson-Cranz scaled distance of 3.02 m kg(-1/3), 100 kg TNT equivalent at a stand-off distance of 14 m. This explosive blast represents a surface blast threat, where the shockwave propagates in air towards the naval vessel. Hopkinson was the first to investigate the characteristics of this explosive air-blast pulse (Hopkinson 1948 Proc. R. Soc. Lond. A 89, 411-413 (doi:10.1098/rspa.1914.0008)). Further analysis is provided on the performance of the CFRP sandwich panel relative to the GFRP sandwich panel when subjected to blast loading through use of high-speed speckle strain mapping. After the blast events, the residual compressive load-bearing capacity is investigated experimentally, using appropriate loading conditions that an in-service vessel may have to sustain. Residual strength testing is well established for post-impact ballistic assessment, but there has been less research performed on the residual strength of sandwich composites after blast.
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Affiliation(s)
- H. Arora
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - M. Kelly
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - A. Worley
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - P. Del Linz
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - A. Fergusson
- FAC Technology, Canterbury Court, 1–3 Brixton Road, London SW9 6DE, UK
| | - P. A. Hooper
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - J. P. Dear
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
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Trilok-Kumar G, Arora H, Rajput M, Chellani H, Singh V, Raynes J, Arya S, Aggarwal S, Srivastava N, Sachdev HPS, Filteau S. Effect of vitamin D supplementation of low birth weight term Indian infants from birth on cytokine production at 6 months. Eur J Clin Nutr 2012; 66:746-50. [PMID: 22510791 DOI: 10.1038/ejcn.2012.33] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND/OBJECTIVES Vitamin D deficiency has been associated with impaired resistance to infection, which may be mediated by alterations in cytokine responses. We investigated the effect of vitamin D supplementation to infants on whole blood in-vitro cytokine production and on the inflammatory marker, plasma C-reactive protein (CRP). SUBJECTS/METHODS Blood samples were taken at 6 months of age from infants participating in the DIVIDS (Delhi Infant Vitamin D Supplementation) randomized controlled trial of weekly vitamin D supplements (1400 IU = recommended intake) from birth to 6 months with the aim of decreasing mortality and severe morbidity. We measured plasma CRP and whole blood in-vitro production of tumour necrosis factor-α (TNFα), interferon-γ (INFγ), interleukin (IL)-10 and IL-13 following no stimulation or stimulation with lipopolysaccharide or phytohemagglutinin. RESULTS Although the intervention improved vitamin D status in a severely deficient population, there were no differences between treatment groups in plasma CRP or in the production of any of the cytokines in either unstimulated or stimulated cultures. Recent illness had limited association with immunological markers. Plasma 25-hydroxyvitamin D levels were not associated with CRP or production of any cytokines. CONCLUSIONS Vitamin D supplementation did not affect plasma CRP or whole blood cytokine production of vitamin D-deficient low birth weight infants. This is consistent with the lack of effect of vitamin D on mortality and severe morbidity among infants in the DIVIDS trial.
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Affiliation(s)
- G Trilok-Kumar
- Department of Biochemistry, Institute of Home Economics, Delhi University, New Delhi, India.
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Sahai S, Rajan S, Singh N, Arora H. Congenital infiltrating lipomatosis of the face with exophytic temporomandibular joint ankylosis: a case report and review of the literature. Dentomaxillofac Radiol 2012; 42:16128745. [PMID: 22241871 DOI: 10.1259/dmfr/16128745] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Congenital infiltrating lipomatosis of the face (CIL-F) is a rare lipomatous lesion with diffuse fatty infiltration of tissues and hyperplasia of underlying bone. We report clinical and CT findings in an unusual case of CIL-F presenting with progressive hemifacial asymmetry, manifesting as severely restricted mouth opening owing to exophytic temporomandibular joint ankylosis. The role of imaging in diagnosis is presented with a review of the literature. Differential diagnosis of CIL-F and its exclusion as a cause of hemifacial hyperplasia are also discussed.
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Affiliation(s)
- S Sahai
- DCA Imaging Research Centre, 10-B Kasturba Gandhi Marg, New Delhi 110 001, India. E-mail:
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Virani SS, Alam M, Mendoza CE, Arora H, Ferreira AC, de Marchena E. Clinical significance, angiographic characteristics, and short-term outcomes in 30 patients with early coronary artery graft failure. Neth Heart J 2011; 17:13-7. [PMID: 19148333 DOI: 10.1007/bf03086209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/28/2022] Open
Abstract
BACKGROUND Despite technical advances in coronary artery bypass grafting (CABG), early postoperative myocardial ischaemia still remains a challenging problem. The aim of this study was to determine the incidence, clinical features, angiographic characteristics, and management of early graft failure in the present CABG era. METHODS Between January 1997 and December 2002, 1731 patients underwent CABG at our institution. Coronary angiography was performed in patients with clinical evidence of early postoperative ischaemia (</=3 months). Thirty of these patients with graft failure constituted the population of this study. RESULTS Off-pump and on-pump CABG were almost evenly performed in these patients [n=16 (53%) and n=14 (47%) respectively]. Acute myocardial infarction and unstable angina were the leading indications for coronary angiography in the majority of patients [n=28 (93%)]. The most common cause of graft failure was occlusion / thrombosis [n=20 (67%)]. Percutaneous coronary intervention (PCI) was offered to the majority of patients [n=22 (73%)]. Of these patients, 14 underwent PCI to native coronary arteries, whereas eight underwent PCI to the culprit vessel. Three patients underwent reoperation, and five received medical management. Four patients (13%) died in hospital (two after redo CABG, one after unsuccessful PCI, and one patient managed medically). Two patients (7%) had nonfatal major complications (one non-ST-elevation myocardial infarction and one stroke). CONCLUSION Early graft failure generally presents as acute coronary syndrome. Graft occlusion/ thrombosis is the leading cause of ischaemia. Patients with graft failure can undergo PCI with a relatively low risk, but the need for redo CABG in associated with a high mortality. (Neth Heart J 2009;17:13-7.).
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Affiliation(s)
- S S Virani
- Division of Cardiology, Texas Heart Institute, St Lukes Episcopal Hospital, Houston, Texas, USA
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Arora H, Wu A, Raha S, Boyle J, Paunesku T, Woloschak G. Conjugation to Fe3O4@TiO2 Nanoparticles Increases Uptake and Nuclear Localization of Doxorubicin in a Drug-Resistant Ovarian Carcinoma Model. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1518] [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: 10/19/2022]
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Arora H, Wu A, Boyle J, Paunesku T, Woloschak G. Conjugation to Fe3O4@TiO2 Nanoparticles Increases Uptake and Nuclear Localization of Doxorubicin in a Drug-resistant Ovarian Carcinoma Model. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boyle J, Wu A, Arora H, Paunesku T, Woloschak G. The Radiosensitizing Effects of Titanium-dioxide Nanoparticles In Vitro. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fried MP, Satava R, Weghorst S, Gallagher AG, Sasaki C, Ross D, Sinanan M, Uribe JI, Zeltsan M, Arora H, Cuellar H. Identifying and reducing errors with surgical simulation. Qual Saf Health Care 2004. [PMID: 15465950 DOI: 10.1136/qshc.2004.009969] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The major determinant of a patient's safety and outcome is the skill and judgment of the surgeon. While knowledge base and decision processing are evaluated during residency, technical skills-which are at the core of the profession-are not evaluated. Innovative state of the art simulation devices that train both surgical tasks and skills, without risk to patients, should allow for the detection and analysis of errors and "near misses". Studies have validated the use of a sophisticated endoscopic sinus surgery simulator (ES3) for training residents on a procedural basis. Assessments are proceeding as to whether the integration of a comprehensive ES3 training programme into the residency curriculum will have long term effects on surgical performance and patient outcomes. Using various otolaryngology residencies, subjects are exposed to mentored training on the ES3 as well as to minimally invasive trainers such as the MIST-VR. Technical errors are identified and quantified on the simulator and intraoperatively. Through a web based database, individual performance can be compared against a national standard. An upgraded version of the ES3 will be developed which will support patient specific anatomical models. This advance will allow study of the effects of simulated rehearsal of patient specific procedures (mission rehearsal) on patient outcomes and surgical errors during the actual procedure. The information gained from these studies will help usher in the next generation of surgical simulators that are anticipated to have significant impact on patient safety.
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Affiliation(s)
- M P Fried
- Department of Otolaryngology, Albert Einstein College of Medicine, Montefiore Medical Center, 3400 Bainbridge Ave 3rd Floor, Bronx, NY, USA.
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Fried MP, Satava R, Weghorst S, Gallagher AG, Sasaki C, Ross D, Sinanan M, Uribe JI, Zeltsan M, Arora H, Cuellar H. Identifying and reducing errors with surgical simulation. Qual Saf Health Care 2004; 13 Suppl 1:i19-26. [PMID: 15465950 PMCID: PMC1765795 DOI: 10.1136/qhc.13.suppl_1.i19] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The major determinant of a patient's safety and outcome is the skill and judgment of the surgeon. While knowledge base and decision processing are evaluated during residency, technical skills-which are at the core of the profession-are not evaluated. Innovative state of the art simulation devices that train both surgical tasks and skills, without risk to patients, should allow for the detection and analysis of errors and "near misses". Studies have validated the use of a sophisticated endoscopic sinus surgery simulator (ES3) for training residents on a procedural basis. Assessments are proceeding as to whether the integration of a comprehensive ES3 training programme into the residency curriculum will have long term effects on surgical performance and patient outcomes. Using various otolaryngology residencies, subjects are exposed to mentored training on the ES3 as well as to minimally invasive trainers such as the MIST-VR. Technical errors are identified and quantified on the simulator and intraoperatively. Through a web based database, individual performance can be compared against a national standard. An upgraded version of the ES3 will be developed which will support patient specific anatomical models. This advance will allow study of the effects of simulated rehearsal of patient specific procedures (mission rehearsal) on patient outcomes and surgical errors during the actual procedure. The information gained from these studies will help usher in the next generation of surgical simulators that are anticipated to have significant impact on patient safety.
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Affiliation(s)
- M P Fried
- Department of Otolaryngology, Albert Einstein College of Medicine, Montefiore Medical Center, 3400 Bainbridge Ave 3rd Floor, Bronx, NY, USA.
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Verma SM, Arora H, Dubey R. Anti - inflammatory and sedative - hypnotic activity of the methanolic extract of the leaves of mentha arvensis. Anc Sci Life 2003; 23:95-9. [PMID: 22557118 PMCID: PMC3330963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2003] [Accepted: 07/16/2003] [Indexed: 11/05/2022] Open
Abstract
Mentha arvensis Linn, a plant used as traditional medicine and in perfumery, has now been explored for its pharmacological activities as an anti-inflammatory and also as sedativehypnotic plant drug. The methanolic extract of the leaves after being processed, was taken for the pharmacological study. Anti-inflammatory activity was carried out on albino rats. Further, the activity was compared to that of a standard anti-inflammatory drug - nimesulide and the percent inhibition of oedema determined. The sedative hypnotic activity, when carried out on mice, showed the potentiation of pentobarbitone induced sleeping time. The data of average recovery time was analyzed to show the standard deviation from the mean.
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Affiliation(s)
- S. M. Verma
- Department of Pharmaceutical Sciences, Birla Institute of Technology, Mesra, Ranchi – 835 215, India
| | - H. Arora
- Department of Pharmaceutical Sciences, Birla Institute of Technology, Mesra, Ranchi – 835 215, India
| | - R. Dubey
- Department of Pharmaceutical Sciences, Birla Institute of Technology, Mesra, Ranchi – 835 215, India
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Abstract
Hemodynamic and temperature dose-response relationships were characterized in freely moving rats following i.v. (+)-methamphetamine administration to mimic the rapid onset of effects experienced by many human users. Rats received saline and (+)-methamphetamine in a repeated-measures, mixed-sequence design at 22+/-1 degrees C. Significantly greater blood pressure and heart rate elevations were observed after 1.0 and 3.0 mg/kg (+)-methamphetamine vs. 0.1 and 0.3 mg/kg. The time to peak hemodynamic values and the duration of effects were significantly greater after 3.0 mg/kg vs. the lower doses. The time to peak temperatures was significantly longer after 1.0 mg/kg vs. the lower doses. Following 3.0 mg/kg, all rats experienced temperature decreases before having elevated temperatures. The duration and magnitude of the delayed temperature elevations were significantly greater after 3.0 mg/kg vs. the lower doses. In conclusion, the (+)-methamphetamine-induced hemodynamic and temperature effects were not temporally synchronized, and the complex responses were not linearly related to dose.
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Affiliation(s)
- H Arora
- Department of Anesthesiology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Abstract
Thirty-one cases of untreated 'mild hypertension' and equal number of age and sex matched controls with 'normal' blood pressure were evaluated by echocardiography. Patients with mild hypertension had significantly increased left ventricular mass index, concentric remodeling, and diastolic dysfunction. Thickness of right ventricular anterior wall, flow velocities across tricuspid and pulmonary valves were also significantly higher in hypertensives. Pulmonary flow acceleration time was significantly less in hypertensives. On multiple regression analysis, mitral valve 'A' wave velocity alone correlated with systolic blood pressure. Other echocardiographic variables did not have any relation with blood pressure readings. Height, weight, body surface area and body mass index could also explain only around 50% of variability in echocardiographic parameters. Cardiac structure and functions in hypertensives are affected by factors other than blood pressure reading, body surface area or body mass index. Routine echocardiography can be useful in identifying those patients of mild hypertension who have disproportionate increase in left ventricular mass or disproportionate impairment of diastolic functions.
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Affiliation(s)
- S R Mittal
- Department of Cardiology, JLN Medical College, Ajmer, Rajasthan, India
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Mittal SR, Arora H. Pulmonary embolism with isolated right ventricular infarction. Indian Heart J 2001; 53:218-20. [PMID: 11428483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
Concomitant occurrence of pulmonary embolism and right ventricular infarction is rare. It poses important diagnostic and therapeutic implications. A case of pulmonary embolism with isolated right ventricular anterior wall infarction presented with ventricular tachycardia. One pathology could have led to the other. Two-dimensional echocardiography was useful in documenting pulmonary artery hypertension as well as regional wall motion abnormality of the right ventricle. Thrombolytic therapy and dobutamine infusion were useful. Nitrates, fluid infusion and diuretics should be used cautiously.
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Affiliation(s)
- S R Mittal
- Department of Cardiology, JLN Medical College, Ajmer
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Purswani M, Eckert S, Arora H, Johann-Liang R, Noel GJ. The effect of three broad-spectrum antimicrobials on mononuclear cell responses to encapsulated bacteria: evidence for down-regulation of cytokine mRNA transcription by trovafloxacin. J Antimicrob Chemother 2000; 46:921-9. [PMID: 11102411 DOI: 10.1093/jac/46.6.921] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The effect of trovafloxacin, ciprofloxacin and ceftriaxone on cytokine production of human peripheral blood mononuclear cells (PBMCs) was examined. PBMC responses were measured after stimulation with lipopolysaccharide (LPS), lipoteichoic acid (LTA) or killed or viable Streptococcus pneumoniae and Haemophilus influenzae. Trovafloxacin inhibited the production of tumour necrosis factor alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-6 and IL-8 by PBMCs after stimulation with either LPS or LTA by 83%. Similar inhibition occurred in PBMCs incubated with killed or live bacteria and trovafloxacin, but not with ciprofloxacin or ceftriaxone. The relevance of this in vitro observation was explored by examining TNF-alpha and IL-6 responses in trovafloxacin-treated mice. Serum concentrations of both cytokines 1 h after LPS challenge were 95% less than serum concentrations in mice that were not given trovafloxacin. Reverse transcription- polymerase chain reaction studies of the mechanisms determining cytokine down-regulation demonstrated that trovafloxacin reduced TNF-alpha, IL-1beta and IL-6 mRNA to levels similar to those of unstimulated cells. These observations indicate that trovafloxacin can consistently and significantly reduce production of cytokines that play an important role in sepsis. In vitro, this effect can occur in the presence of bacteriolysis and is associated with inhibition of transcription of cytokine genes.
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Affiliation(s)
- M Purswani
- Division of Pediatric Infectious Diseases and Immunology, Weill Medical College of Cornell University, New York Presbyterian-Cornell Medical Center, 525 East 68th Street, Box 296, New York, NY 10021, USA
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Jonah B, Yuen L, Au-Yeung E, Paterson D, Dawson N, Thiessen R, Arora H. Front-line police officers' practices, perceptions and attitudes about the enforcement of impaired driving laws in Canada. Accid Anal Prev 1999; 31:421-443. [PMID: 10440540 DOI: 10.1016/s0001-4575(98)00081-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A survey of front line police officers' practices, perceptions and attitudes regarding detection of impaired driving, processing of driving while impaired (DWI) charges, criminal court proceedings and DWI sanctions was conducted across Canada. A sample of 1545 officers of all jurisdictions across the country, representative of different types of police services (i.e. national, provincial, municipal) and types of policing (i.e. traffic, general duty) were surveyed by mail. The results, based on a 71% response rate, indicate that: an average of 7.5 charges/year are laid by officers resulting mainly from erratic driving; videotaping and mobile breath testing could improve efficiency of DWI enforcement; it takes an average of 2 h 48 min to process each DWI charge; about 2/3 of officers say plea bargaining occurs at least sometimes; the average length of DWI trial is over 4 h; less than half of officers think Crown Attorneys are adequately prepared for DWI cases; about 3/4 of officers think the accused escapes conviction on a legal technicality at least sometimes; about 30% of officers say short-term licence suspensions and other forms of discretion are used at least sometimes; DWI places fifth in priority among 15 offences, up from eighth in a 1981 survey; DWI is a priority for most police management but human resources are not adequate; and there is greater support for administrative than for Criminal Code changes. Multiple regressions indicated that the number of DWI charges laid by officers depended mainly on the officers' personal priority regarding DWI enforcement. The results suggest that many officers want to enforce DWI laws but that the numerous procedural and legal barriers that they confront often force them to exercise discretion in the laying of DWI charges.
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Affiliation(s)
- B Jonah
- Road Safety Directorate, Transport Canada, Place de Ville, Ottawa, Ont., Canada.
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Choudhary HR, Jain R, Arora H. Adrenaline precipitated intracerebral hemorrhage. J Assoc Physicians India 1999; 47:562. [PMID: 10778580] [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: 02/16/2023]
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