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Patel P, Suthar V, Suthar B, Joshi M, Patil D, Joshi C. 166 Intracytoplasmic morphological evaluation of. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab166] [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: 12/07/2022] Open
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Singh P, Efstathiou J, Plets M, Jhavar S, Delacroix S, Tripathi A, Gupta A, Sachdev S, Jani A, Kirschner A, Tangen C, Bangs R, Joshi M, Costello B, Thompson I, Feng F, Lerner S. INTACT (S/N1806): Phase III Randomized Trial of Concurrent Chemoradiotherapy with or without Atezolizumab in Localized Muscle Invasive Bladder Cancer—Toxicity Update on First 213 Patients. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.475] [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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Joshi M, R N, Gupta R, Agarwal V, Aggarwal R, Gupta L. POS1565-PARE ASSESSMENT OF QUALITY AND RELIABILITY OF YOUTUBE VIDEOS FOR PATIENT AND PHYSICIAN EDUCATION ON INFLAMMATORY MYOSITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundNowadays 80% of internet users access health information online, with YouTube being the second most popular search website worldwide. This study was undertaken to assess the reliability and quality of videos pertaining to myositis on YouTube and identify lacunae in information material on the platform.ObjectivesThis study aims to assess the quality and profile of myositis information videos on YouTube, and to compare and delineate attributes of useful and not useful videos using standard metrics.MethodsA thorough search was carried out on YouTube using 9 search terms related to myositis. The inclusion criteria were primary English content related to myositis, acceptable audio-video quality, and multi-part videos to be considered as one, while duplicates and advertisements were excluded. The videos were classified as useful, not useful or misleading, and patient experiences (Figure 1).Figure 1.Flowchart of selection of YouTube videos for the studyReliability of the videos was determined using the 5-point modified DISCERN (mDISCERN) criteria and quality by the 5-point Global Quality Scale (GQS) and 4-point JAMA scoring system. Score-based usefulness was defined as mDISCERN >4 or GQS >4 or JAMA >3. All values are in median and IQR.ResultsOf 453 analyzed videos 74% and 2% provided useful and not useful information respectively. 24% were patient experiences, and 324 (71%) were intended specifically for patients while 313 (69%) were for healthcare providers and students. Nearly one-thirds (n=143) reported information related to treatment of myositis.Noteworthily, useful and not useful videos had similar views count. However, number of likes and daily viewership were higher for useful videos (p=0.024, p=0.046). Nearly half (47%) of useful videos were by professional medical societies/patient support groups while not useful ones were often by nonmedical media (38%).Useful videos had higher mDISCERN reliability scores [4(3-4) vs 2(1-3), p<0.001] and better quality on GQS [4.5 (3.5-5) vs 1 (1-2.8), p<0.001] and JAMA [3 (3-4) vs 2.25 (2-3), p=0.004]. Physician predicted usefulness was discordant with score-based usefulness(κ=0.129). However, GQS score emerged significant (p=0.008) for predicting video usefulness in multivariate analysis (Table 1).Table 1.Factors predicting usefulness of video in binary logistic regression.VariableB coefficientS.E.Exp (B) and 95% CIp valueIntended audience Anyone/General public-5.452.5860.004 (0.0-0.68)0.035Average GQS-2.861.0760.05 (0.007-0.47)0.008GQS Global Quality Scale. Exp (B) is odd’s ratio, p<0.05 is significantConclusionMajority of English YouTube videos on myositis provide useful information for patients, largely related to treatment of myositis. However, the dynamic nature of YouTube could potentially change this equation in the future and physicians should correct any misinformation identified in face-to-face meetings or teleconsultations. High quality useful videos, often predicted by validated scores and produced by professional medical societies should be promoted as the first line of content consumed.Disclosure of InterestsNone declared
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Liu YF, Powrie J, Arif S, Yang JH, Williams E, Khatri L, Joshi M, Lhuillier L, Fountoulakis N, Smith E, Beam C, Lorenc A, Peakman M, Tree T. Immune and Metabolic Effects of Antigen-Specific Immunotherapy Using Multiple β-Cell Peptides in Type 1 Diabetes. Diabetes 2022; 71:722-732. [PMID: 35073398 PMCID: PMC8965665 DOI: 10.2337/db21-0728] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/15/2022] [Indexed: 01/11/2023]
Abstract
Type 1 diabetes is characterized by a loss of tolerance to pancreatic β-cell autoantigens and defects in regulatory T-cell (Treg) function. In preclinical models, immunotherapy with MHC-selective, autoantigenic peptides restores immune tolerance, prevents diabetes, and shows greater potency when multiple peptides are used. To translate this strategy into the clinical setting, we administered a mixture of six HLA-DRB1*0401-selective, β-cell peptides intradermally to patients with recent-onset type 1 diabetes possessing this genotype in a randomized placebo-controlled study at monthly doses of 10, 100, and 500 μg for 24 weeks. Stimulated C-peptide (measuring insulin functional reserve) had declined in all placebo subjects at 24 weeks but was maintained at ≥100% baseline levels in one-half of the treated group. Treatment was accompanied by significant changes in islet-specific immune responses and a dose-dependent increase in Treg expression of the canonical transcription factor FOXP3 and changes in Treg gene expression. In this first-in-human study, multiple-peptide immunotherapy shows promise as a strategy to correct immune regulatory defects fundamental to the pathobiology of autoimmune diabetes.
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Affiliation(s)
- Yuk-Fun Liu
- Department of Diabetes, School of Life Course Sciences, King’s College London, London, U.K
- Department of Diabetes and Endocrinology, Guy’s and St. Thomas’ NHS Foundation Trust, London, U.K
- Institute of Diabetes, Endocrinology and Obesity, King’s Health Partners, London, U.K
| | - Jake Powrie
- Department of Diabetes and Endocrinology, Guy’s and St. Thomas’ NHS Foundation Trust, London, U.K
| | - Sefina Arif
- Department of Immunobiology, School of Immunology and Microbial Sciences, King’s College London, London, U.K
| | - Jennie H.M. Yang
- Department of Immunobiology, School of Immunology and Microbial Sciences, King’s College London, London, U.K
- National Institute for Health Research Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust and Kings College London, London, U.K
| | - Evangelia Williams
- Department of Immunobiology, School of Immunology and Microbial Sciences, King’s College London, London, U.K
- National Institute for Health Research Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust and Kings College London, London, U.K
| | - Leena Khatri
- Department of Immunobiology, School of Immunology and Microbial Sciences, King’s College London, London, U.K
- National Institute for Health Research Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust and Kings College London, London, U.K
| | - Mamta Joshi
- Department of Diabetes and Endocrinology, Guy’s and St. Thomas’ NHS Foundation Trust, London, U.K
| | - Loic Lhuillier
- Department of Immunobiology, School of Immunology and Microbial Sciences, King’s College London, London, U.K
| | - Nikolaos Fountoulakis
- Department of Diabetes and Endocrinology, Guy’s and St. Thomas’ NHS Foundation Trust, London, U.K
| | | | - Craig Beam
- Department of Biomedical Sciences, Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, MI
| | - Anna Lorenc
- Department of Immunobiology, School of Immunology and Microbial Sciences, King’s College London, London, U.K
| | - Mark Peakman
- Department of Diabetes, School of Life Course Sciences, King’s College London, London, U.K
- Department of Diabetes and Endocrinology, Guy’s and St. Thomas’ NHS Foundation Trust, London, U.K
- Institute of Diabetes, Endocrinology and Obesity, King’s Health Partners, London, U.K
- Department of Immunobiology, School of Immunology and Microbial Sciences, King’s College London, London, U.K
- Corresponding authors: Mark Peakman, , and Timothy Tree,
| | - Timothy Tree
- Department of Immunobiology, School of Immunology and Microbial Sciences, King’s College London, London, U.K
- National Institute for Health Research Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust and Kings College London, London, U.K
- Corresponding authors: Mark Peakman, , and Timothy Tree,
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White G, Velusamy A, Anandappa S, Masucci M, Breen LA, Joshi M, McGowan B, Hubbard JGH, Obholzer R, Christodoulou D, Jacques A, Touska P, Hassan FU, Izatt L, Carroll PV. Tumour detection and outcomes of surveillance screening in SDHB and SDHD pathogenic variant carriers. Endocr Connect 2022; 11:EC-21-0602.R1. [PMID: 35060925 PMCID: PMC8859962 DOI: 10.1530/ec-21-0602] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Succinate dehydrogenase subunit (SDHx) pathogenic variants predispose to phaeochromocytoma and paraganglioma (PPGL). Lifelong surveillance is recommended for all patients to enable prompt detection and treatment. There is currently limited evidence for optimal surveillance strategies in hereditary PPGL. We aim to detail the clinical presentation of PPGL in our cohort of non-index SDHB and SDHD pathogenic variant carriers. METHODS Retrospective analysis of medical and genetic records from a single tertiary referral centre identified SDHB or SDHD pathogenic variants in 74 non-index cases (56 SDHB and 18 SDHD). Surveillance screening for asymptomatic relatives consisted of annual plasma metanephrine measurement and whole-body MRI with contrast at 3-5 yearly intervals. RESULTS Twenty-three out of 74 non-index patients (10 SDHB and 13 SDHD) were diagnosed with PPGL, 17 patients through surveillance screening (24 tumours in total) and 6 diagnosed prior to commencement of cascade screening with symptomatic presentation. MRI with contrast identified PPGL in 22/24 screen-detected tumours and 5/24 tumours had elevated plasma metanephrine levels. Penetrance in non-index family members was 15.2 and 47.2% for SDHB carriers and 71.6 and 78.7% for SDHD carriers at age of 50 and 70 years, respectively. CONCLUSION Surveillance screening with combined biochemical testing and imaging enables early detection of PPGL in asymptomatic relatives with SDHx pathogenic variants. The presence of disease at first screen was significant in our cohort and hence further multi-centre long-term data are needed to inform counselling of family members undergoing lifelong surveillance.
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Affiliation(s)
- Gemma White
- Department of Diabetes and Endocrinology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Anand Velusamy
- Department of Diabetes and Endocrinology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Correspondence should be addressed to A Velusamy:
| | - Samantha Anandappa
- Department of Diabetes and Endocrinology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Michael Masucci
- Department of Diabetes and Endocrinology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Louise A Breen
- Department of Diabetes and Endocrinology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Mamta Joshi
- Department of Diabetes and Endocrinology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Barbara McGowan
- Department of Diabetes and Endocrinology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Johnathan G H Hubbard
- Department of Endocrine Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Rupert Obholzer
- Department of Ear, Nose and Throat Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Audrey Jacques
- Department of Radiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Philip Touska
- Department of Radiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Fahim-Ul Hassan
- Department of Nuclear Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Louise Izatt
- Department of Clinical Genetics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Paul V Carroll
- Department of Diabetes and Endocrinology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Amereller F, Deutschbein T, Joshi M, Schopohl J, Schilbach K, Detomas M, Duffy L, Carroll P, Papa S, Störmann S. Differences between immunotherapy-induced and primary hypophysitis-a multicenter retrospective study. Pituitary 2022; 25:152-158. [PMID: 34518996 PMCID: PMC8821509 DOI: 10.1007/s11102-021-01182-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Immune checkpoint inhibitors can cause various immune-related adverse events including secondary hypophysitis. We compared clinical characteristics of immunotherapy-induced hypophysitis (IIH) and primary hypophysitis (PH) DESIGN: Retrospective multicenter cohort study including 56 patients with IIH and 60 patients with PH. METHODS All patients underwent extensive endocrine testing. Data on age, gender, symptoms, endocrine dysfunction, MRI, immunotherapeutic agents and autoimmune diseases were collected. RESULTS Median time of follow-up was 18 months in IIH and 69 months in PH. The median time from initiation of immunotherapy to IIH diagnosis was 3 months. IIH affected males more frequently than PH (p < 0.001) and led to more impaired pituitary axes in males (p < 0.001). The distribution of deficient adenohypophysial axes was comparable between both entities, however, central hypocortisolism was more frequent (p < 0.001) and diabetes insipidus considerably less frequent in IIH (p < 0.001). Symptoms were similar except that visual impairment occurred more rarely in IIH (p < 0.001). 20 % of IIH patients reported no symptoms at all. Regarding MRI, pituitary stalk thickening was less frequent in IIH (p = 0.009). Concomitant autoimmune diseases were more prevalent in PH patients before the diagnosis of hypophysitis (p = 0.003) and more frequent in IIH during follow-up (p = 0.002). CONCLUSIONS Clinically, IIH and PH present with similar symptoms. Diabetes insipidus very rarely occurs in IIH. Central hypocortisolism, in contrast, is a typical feature of IIH. Preexisting autoimmunity seems not to be indicative of developing IIH.
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Affiliation(s)
- Felix Amereller
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ziemssenstr. 1, 80336, München, Germany.
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
- Medicover Oldenburg MVZ, Oldenburg, Germany
| | - Mamta Joshi
- Department of Endocrinology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Jochen Schopohl
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ziemssenstr. 1, 80336, München, Germany
| | - Katharina Schilbach
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ziemssenstr. 1, 80336, München, Germany
| | - Mario Detomas
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Leo Duffy
- Department of Endocrinology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Paul Carroll
- Department of Endocrinology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Sophie Papa
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Sylvère Störmann
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ziemssenstr. 1, 80336, München, Germany
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Gopalakrishnan S, Chaurasia S, Sankar MJ, Paul VK, Deorari AK, Joshi M, Agarwal R. Stepwise interventions for improving hand hygiene compliance in a level 3 academic neonatal intensive care unit in north India. J Perinatol 2021; 41:2834-2839. [PMID: 34321595 DOI: 10.1038/s41372-021-01141-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 06/20/2021] [Accepted: 06/30/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We evaluated effect of sequentially introducing four WHO-recommended interventions to promote hand-hygiene compliance in tertiary-care NICU. STUDY DESIGN Four dedicated research nurses directly observed doctors and nurses to record success in hand-hygiene opportunities at randomly selected NICU beds and randomly sampled time-slots in four phases (of 4-weeks each): I-Baseline, II-Self-directed learning; III-Participatory learning; IV-Closed-Circuit Television (CCTV); and V-CCTV-plus (with feedback). FINDINGS Hand-hygiene compliance changed from 61.8% (baseline) to 77% (end) with overall relative change: 24.6% (95% CI 18, 32; p value= 0.003); compared with preceding phase, relative changes of 21% (15, 28; <0.001), 4% (0, 8; 0.008), -10% (-13, -6; <0.001), and 10% (5, 15; <0.001) during phases II, III, IV, and V, respectively were observed. Rise in hand-hygiene compliance was higher for after-WHO-moments (12.7%; upto 2.5-folds for moment 5, <0.001) compared to before-WHO-moments (5.2%). Educational interventions, feedback and monitoring WHO moments can improve hand-hygiene compliance significantly among health-care providers in NICU.
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Affiliation(s)
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Dehradun, 249203, Uttarakhand, India.
| | - M J Sankar
- Newborn Health Knowledge Centre (NHKC) and WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - V K Paul
- Department of Pediatrics, AIIMS, New Delhi, India
| | - A K Deorari
- WHO Collaborating Centre for Training & Research in Newborn Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - M Joshi
- WHO Collaborating Centre for Training & Research in Newborn Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R Agarwal
- Newborn Health Knowledge Centre (NHKC) and WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Gopalakrishnan S, Chaurasia S, Sankar MJ, Paul VK, Deorari AK, Joshi M, Agarwal R. Correction: Stepwise interventions for improving hand hygiene compliance in a level 3 academic neonatal intensive care unit in north India. J Perinatol 2021; 41:2847. [PMID: 34645955 DOI: 10.1038/s41372-021-01224-1] [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] [Indexed: 11/09/2022]
Affiliation(s)
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Dehradun, 249203, Uttarakhand, India.
| | - M J Sankar
- Newborn Health Knowledge Centre (NHKC) and WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - V K Paul
- Department of Pediatrics, AIIMS, New Delhi, India
| | - A K Deorari
- WHO Collaborating Centre for Training & Research in Newborn Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - M Joshi
- WHO Collaborating Centre for Training & Research in Newborn Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R Agarwal
- Newborn Health Knowledge Centre (NHKC) and WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Affiliation(s)
- M Joshi
- Department of Radiology, B.J. Medical College, Ahmedabad-380016, India
| | - S Yadav
- Department of Radiology, B.J. Medical College, Ahmedabad-380016, India
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Ospel JM, Hill MD, Menon BK, Demchuk A, McTaggart R, Nogueira R, Poppe A, Haussen D, Qiu W, Mayank A, Almekhlafi M, Zerna C, Joshi M, Jayaraman M, Roy D, Rempel J, Buck B, Tymianski M, Goyal M. Strength of Association between Infarct Volume and Clinical Outcome Depends on the Magnitude of Infarct Size: Results from the ESCAPE-NA1 Trial. AJNR Am J Neuroradiol 2021; 42:1375-1379. [PMID: 34167959 DOI: 10.3174/ajnr.a7183] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/17/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Infarct volume is an important predictor of clinical outcome in acute stroke. We hypothesized that the association of infarct volume and clinical outcome changes with the magnitude of infarct size. MATERIALS AND METHODS Data were derived from the Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial, in which patients with acute stroke with large-vessel occlusion were randomized to endovascular treatment plus either nerinetide or a placebo. Infarct volume was manually segmented on 24-hour noncontrast CT or DWI. The relationship between infarct volume and good outcome, defined as mRS 0-2 at 90 days, was plotted. Patients were categorized on the basis of visual grouping at the curve shoulders of the infarct volume/outcome plot. The relationship between infarct volume and adjusted probability of good outcome was fitted with linear or polynomial functions as appropriate in each group. RESULTS We included 1099 individuals in the study. Median infarct volume at 24 hours was 24.9 mL (interquartile range [IQR] = 6.6-92.2 mL). On the basis of the infarct volume/outcome plot, 4 infarct volume groups were defined (IQR = 0-15 mL, 15.1-70 mL, 70.1-200 mL, >200 mL). Proportions of good outcome in the 4 groups were 359/431 (83.3%), 219/337 (65.0%), 71/201 (35.3%), and 16/130 (12.3%), respectively. In small infarcts (IQR = 0-15 mL), no relationship with outcome was appreciated. In patients with intermediate infarct volume (IQR = 15-200 mL), there was progressive importance of volume as an outcome predictor. In infarcts of > 200 mL, outcomes were overall poor. CONCLUSIONS The relationship between infarct volume and clinical outcome varies nonlinearly with the magnitude of infarct size. Infarct volume was linearly associated with decreased chances of achieving good outcome in patients with moderate-to-large infarcts, but not in those with small infarcts. In very large infarcts, a near-deterministic association with poor outcome was seen.
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Affiliation(s)
- J M Ospel
- Department of Clinical Neurosciences (J.M.O., M.D.H., B.K.M., A.D., W.Q., A.M., M.A., C.Z., M.G.), University of Calgary, Calgary, Alberta, Canada.,Department of Radiology (J.M.O.), University Hospital of Basel, Basel, Switzerland
| | - M D Hill
- Department of Clinical Neurosciences (J.M.O., M.D.H., B.K.M., A.D., W.Q., A.M., M.A., C.Z., M.G.), University of Calgary, Calgary, Alberta, Canada.,Department of Radiology (M.D.H., B.K.M., A.D., M.A., M. Joshi, M.G.), University of Calgary, Calgary, Alberta, Canada
| | - B K Menon
- Department of Clinical Neurosciences (J.M.O., M.D.H., B.K.M., A.D., W.Q., A.M., M.A., C.Z., M.G.), University of Calgary, Calgary, Alberta, Canada.,Department of Radiology (M.D.H., B.K.M., A.D., M.A., M. Joshi, M.G.), University of Calgary, Calgary, Alberta, Canada
| | - A Demchuk
- Department of Clinical Neurosciences (J.M.O., M.D.H., B.K.M., A.D., W.Q., A.M., M.A., C.Z., M.G.), University of Calgary, Calgary, Alberta, Canada.,Department of Radiology (M.D.H., B.K.M., A.D., M.A., M. Joshi, M.G.), University of Calgary, Calgary, Alberta, Canada
| | - R McTaggart
- Department of Interventional Radiology (R.M., M. Jayaraman), Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - R Nogueira
- Department of Neurology (R.N., D.H.), Emory University School of Medicine, Atlanta, Georgia
| | - A Poppe
- Centre Hospitalier de l'Université de Montréal (A.P., D.R.), Montreal, Quebec, Canada
| | - D Haussen
- Department of Neurology (R.N., D.H.), Emory University School of Medicine, Atlanta, Georgia
| | - W Qiu
- Department of Clinical Neurosciences (J.M.O., M.D.H., B.K.M., A.D., W.Q., A.M., M.A., C.Z., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - A Mayank
- Department of Clinical Neurosciences (J.M.O., M.D.H., B.K.M., A.D., W.Q., A.M., M.A., C.Z., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - M Almekhlafi
- Department of Clinical Neurosciences (J.M.O., M.D.H., B.K.M., A.D., W.Q., A.M., M.A., C.Z., M.G.), University of Calgary, Calgary, Alberta, Canada.,Department of Radiology (M.D.H., B.K.M., A.D., M.A., M. Joshi, M.G.), University of Calgary, Calgary, Alberta, Canada
| | - C Zerna
- Department of Clinical Neurosciences (J.M.O., M.D.H., B.K.M., A.D., W.Q., A.M., M.A., C.Z., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - M Joshi
- Department of Radiology (M.D.H., B.K.M., A.D., M.A., M. Joshi, M.G.), University of Calgary, Calgary, Alberta, Canada
| | - M Jayaraman
- Department of Interventional Radiology (R.M., M. Jayaraman), Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - D Roy
- Centre Hospitalier de l'Université de Montréal (A.P., D.R.), Montreal, Quebec, Canada
| | - J Rempel
- University of Alberta Hospital (J.R., B.B.), Edmonton, Alberta, Canada
| | - B Buck
- University of Alberta Hospital (J.R., B.B.), Edmonton, Alberta, Canada
| | | | - M Goyal
- Department of Clinical Neurosciences (J.M.O., M.D.H., B.K.M., A.D., W.Q., A.M., M.A., C.Z., M.G.), University of Calgary, Calgary, Alberta, Canada .,Department of Radiology (M.D.H., B.K.M., A.D., M.A., M. Joshi, M.G.), University of Calgary, Calgary, Alberta, Canada
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White G, Anandappa S, Masucci M, Hassan FU, Breen L, Joshi M, McGowan B, Hubbard J, Obholzer R, Touska P, Izatt L, Velusamy A, Carroll P. Using Multimodal Functional Imaging in the Management of SDHx-Related Pheochromocytoma and Paraganglioma. J Endocr Soc 2021. [PMCID: PMC8091470 DOI: 10.1210/jendso/bvab048.2117] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: Succinate Dehydrogenase (SDH) subunit pathogenic variants predispose to Pheochromocytoma and Paraganglioma (PPGL). Functional imaging harnesses the innate receptor expression and the aberrant cellular pathways in PPGLs to improve diagnostic accuracy & guide treatments, including nuclear medicine therapies. Currently commonly available functional imaging modalities include 18F-FDG PET, 123I-MIBG and 68Ga-DOTATATE. Aims: To analyze the use of 123I-MIBG, 18F-FDG PET and 68Ga-DOTATATE in patients harboring SDHB & SDHD pathogenic variants and determine the detection rates for both primary tumors and metastatic sites of disease. Methods: Retrospective review of patient records and imaging reports allowed tumor characteristics and imaging features of 21 patients with SDH-related PPGL to be recorded. Contrast enhanced CT/MRI were used as control to calculate the sensitivity of each functional imaging modality. Avidity of the primary lesion and metastatic deposits were used to calculate detection rates. 123I-MIBG imaging was available for 22 primary tumors (8 SDHB, 14 SDHD), 18FDG-PET for 24 (9 SDHB, 15 SDHD) and 68Ga-DOTATATE for 6 (2 SDHB, 4 SDHD) respectively. Results: 29 PPGLs (primary and metastases, 13 SDHB, 16 SDHD) were identified in 21 patients. 123I-MIBG detected 14/22 (64%) primary tumors; 5/8 (63%) SDHB and 9/14 (64%) SDHD-related PPGL. According to tumor location, 3/3 PCCs, 6/8 HNPGLs and 4/11 non-HNPGLs demonstrated 123I-MIBG avidity. Both18F-FDG PET and 68Ga-DOTATATE detected all PPGLs imaged; 24 (9 SDHB, 15 SDHD) and 6 (2 SDHB, 4 SDHD) respectively, demonstrating 100% sensitivity in the detection of the primary PPGL in all the above locations. 6 metastatic deposits (located in bone, lungs, liver and local lymph nodes) in 4 patients were imaged using all 3 modalities (3 SDHB, 1 SDHD), all of which were avid on 18F-FDG PET and 68Ga-DOTATATE whereas only 50% demonstrated avidity on 123I-MIBG imaging. Discussion: Recent guidelines promote preferential use of 68Ga-DOTATATE and 18F-FDG PET as initial functional imaging modalities in SDHx-related disease over 123I-MIBG. The results from our patient cohort indicate superior sensitivity (100%) for detection of SDHx-related disease with FDG and Dotatate compared with MIBG. In contrast to the current literature, a high proportion (75%) of HNPGLs in our series demonstrated MIBG avidity. Further prospective studies are needed to further evaluate these and various other novel tracers to inform diagnostic and therapeutic strategy in PPGLs arising from SDHx and various other germline and somatic pathogenic variants.
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Affiliation(s)
- Gemma White
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | | | | | | | - Louise Breen
- Guys and St Thomas’ NHS Trust, London, United Kingdom
| | - Mamta Joshi
- Guys and St Thomas’ NHS Trust, London, United Kingdom
| | | | | | | | - Philip Touska
- Guys and St Thomas’ NHS Trust, London, United Kingdom
| | - Louise Izatt
- Guys and St Thomas’ NHS Trust, London, United Kingdom
| | | | - Paul Carroll
- Guys and St Thomas’ NHS Trust, London, United Kingdom
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12
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Punekar YS, Parks D, Joshi M, Kaur S, Evitt L, Chounta V, Radford M, Jha D, Ferrante S, Sharma S, Van Wyk J, de Ruiter A. Effectiveness and safety of dolutegravir two-drug regimens in virologically suppressed people living with HIV: a systematic literature review and meta-analysis of real-world evidence. HIV Med 2021; 22:423-433. [PMID: 33529489 PMCID: PMC8248313 DOI: 10.1111/hiv.13050] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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] [Accepted: 12/01/2020] [Indexed: 01/21/2023]
Abstract
Objectives Dolutegravir (DTG) is widely recommended within three‐drug regimens. However, similar efficacy and tolerability have also been achieved with DTG within two‐drug regimens in clinical trials. This study evaluated the real‐world effectiveness and discontinuations in people living with HIV‐1 (PLHIV) switching to DTG with lamivudine (3TC) or rilpivirine (RPV). Methods This was a one‐arm meta‐analysis utilizing data from a systematic literature review. Data from real‐world evidence studies of DTG + RPV and DTG + 3TC were extracted, pooled and analysed. The primary outcome was the proportion of patients with viral failure (VF; ≥ 50 copies/mL in two consecutive measurements and/or ≥ 1000 copies/mL in a single measurement) at week 48 (W48) and week 96 (W96). Other outcomes included virological suppression (VS; < 50 copies/mL) and discontinuations (W48 and W96). Estimates were calculated for VF, VS as per snapshot (VSS) and on treatment analysis (VSOT), and discontinuations. Results Pooled mean estimates of VF for DTG + 3TC and DTG + RPV were 0.8% [95% confidence interval (CI): 0.4–1.3] and 0.6% (95% CI: 0.0–1.6), respectively, at W48. VSS rate at W48 was 85.0% (95% CI: 82.3–87.5) for DTG + 3TC regimen and 92.4% (95% CI: 85.0–97.7) in the DTG + RPV regimen. The DTG + 3TC and DTG + RPV regimens led to discontinuations in 13.6% (95% CI: 11.1–16.2) and 7.2% (95% CI: 2.1–14.4) of patients, respectively, at W48. Similar results were observed at W96. Conclusions Treatment with DTG + 3TC or DTG + RPV in clinical practice provides a low rate of VF and a high rate of VS when initiated in virologically suppressed PLHIV with diverse backgrounds.
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Affiliation(s)
| | - D Parks
- GlaxoSmithKline, Collegeville, PA, USA
| | - M Joshi
- GlaxoSmithKline Knowledge Centre, Gurgaon, India
| | - S Kaur
- Parexel India, Chandigarh, India
| | - L Evitt
- ViiV Healthcare, Brentford, UK
| | | | | | - D Jha
- GlaxoSmithKline Knowledge Centre, Gurgaon, India
| | | | - S Sharma
- Parexel India, Chandigarh, India
| | | | - A de Ruiter
- ViiV Healthcare, Brentford, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
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13
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Doultani S, Mootapally C, Nathani N, Suthar V, Highland H, Patil D, Joshi M, Joshi C. 130 Expression of selected biomarker candidate genes to confer invitro maturation in Indian buffaloes. Reprod Fertil Dev 2021. [DOI: 10.1071/rdv33n2ab130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Invitro maturation (IVM) of oocytes is a crucial step and is directly related to better embryo production in buffaloes. Therefore, we planned to study gene expression of GDF9, HAS2, SPRY1, ARHGAP22, COL18A1, and GPC4 genes in IVM and immature cumulus–oocyte complexes (COCs). The COCs were recovered from follicles of slaughter origin ovaries of native buffaloes. COCs were observed under stereo zoom microscope and categorized in four grades according to morphology. Of the four grades, the first three grade COCs were considered and randomly allotted in two groups: immature treatment group (n=263) and IVM treatment group (n=272). IVM of COCs was carried out in 100-μL drops of BO-IVM medium overlaying embryo tested oil in a 35-mm petri dish under 5% CO2 in a 39.0°C incubator for 24h. Cumulus of COCs of both groups were removed by treating with 0.25% trypsin, and oocytes were stored in RNALater for future use. The expression of genes was evaluated using quantitative PCR, and the relative expression of each gene was calculated using the ΔΔCt method with efficiency correction. The logarithmic transformation of fold change (log2FC) of each candidate gene in the IVM oocyte group was computed against the immature oocyte group based on the observed cycle threshold values. Appropriate standard deviations were determined based on the observed deviations among the triplicates. The expression in the IVM treatment group of previously reported upregulated genes (GDF9, HAS2, SPRY1) was higher (up to 10-fold) compared with the immature treatment group (reference group). In the present study, relatively lower expression was observed for the other candidate genes (ARHGAP22, COL18A1, GPC4) in the bovine transcripts of oocyte, which were previously also reported as being downregulated.
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14
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Gadkari R, Ali SW, Joshi M, Rajendran S, Das A, Alagirusamy R. Leveraging antibacterial efficacy of silver loaded chitosan nanoparticles on layer-by-layer self-assembled coated cotton fabric. Int J Biol Macromol 2020; 162:548-560. [DOI: 10.1016/j.ijbiomac.2020.06.137] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/29/2020] [Accepted: 06/14/2020] [Indexed: 12/28/2022]
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15
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Joshi M, Zakharia Y, Kaag M, Kilari D, Holder S, Emamekhoo H, Sankin A, Liao J, Merrill S, DeGraff D, Zheng H, Warrick J, Hauke R, Gartrell B, Stein M, Drabick J, Tuanquin L. Concurrent Durvalumab And Radiation Therapy (DUART) followed by Adjuvant Durvalumab in Patients with Localized Urothelial Cancer of Bladder: BTCRC-GU15-023. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2124] [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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Anandappa S, Joshi M, Polanski L, Carroll PV. Thyroid disorders in subfertility and early pregnancy. Ther Adv Endocrinol Metab 2020; 11:2042018820945855. [PMID: 33133491 PMCID: PMC7576916 DOI: 10.1177/2042018820945855] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/08/2020] [Indexed: 01/04/2023] Open
Abstract
Disorders of thyroid function are common in pregnancy and have implications for foetal and maternal health. Thyroid autoimmunity, as evidenced by the presence of elevated levels of anti-thyroid antibodies (anti-TPO and anti-Tg antibodies) is associated with an increased risk of miscarriage, though the mechanism remains poorly understood. There has been considerable focus on the implications and optimal management of pregnant women with thyroid disease, especially those undergoing assisted reproduction. Pregnancy results in significant changes in thyroid physiology and these need to be understood by clinicians involved in the care of pregnant women. Guidelines for the use of thyroxine and target thyroid function tests have been produced by international bodies but it is recognised that these predominantly reflect expert opinion rather than established evidence-based practice. Importantly a number of key clinical trials have been performed to aid understanding, particularly of the consequences of hypothyroidism for mother and baby, and the effectiveness of thyroid hormone use in autoimmune and subclinical hypothyroidism. This review summarises the current knowledge base and guidance for practice relating to thyroid disorders in pregnancy and subfertility.
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Affiliation(s)
- Samantha Anandappa
- Department of Endocrinology, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
| | - Mamta Joshi
- Department of Endocrinology, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
| | - Lukasz Polanski
- Assisted Conception, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
| | - Paul V. Carroll
- Department of Endocrinology, Guy’s & St. Thomas’ NHS Foundation Trust, DEDC 3rd Floor Lambeth Wing, St. Thomas’ Hospital, London, SE1 7EH, UK
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Mariathasan S, Andrews KA, Thompson E, Challis BG, Wilcox S, Pierce H, Hale J, Spiden S, Fuller G, Simpson HL, Fish B, Jani P, Seetho I, Armstrong R, Izatt L, Joshi M, Velusamy A, Park SM, Casey RT. Genetic testing for hereditary hyperparathyroidism and familial hypocalciuric hypercalcaemia in a large UK cohort. Clin Endocrinol (Oxf) 2020; 93:409-418. [PMID: 32430905 DOI: 10.1111/cen.14254] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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] [Received: 02/06/2020] [Revised: 04/29/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPTH) is a common endocrine disorder and an estimated 10% of cases are hereditary, related to syndromes including; multiple endocrine neoplasia (MEN) type 1, MEN type 4, MEN2A and hereditary hyperparathyroidism-jaw tumour syndrome. Establishing the underlying genetic cause for PHPTH allows for personalized and cost-effective management. Familial hypocalicuric hypercalcaemia (FHH) is a benign disorder of hypercalcaemia associated with an inappropriately low urinary calcium excretion, which is quantified by the calcium creatinine clearance ratio (CCCR). Recent NHS England National Genomic Test Directory testing criteria for familial hyperparathyroidism state testing patients presenting with PHPTH and CCCR > 0.02 presenting (i) <35 years of age, or (ii) <45y with one of (a) multiglandular disease, or (b) hyperplasia on histology, or (c) ossifying fibroma(s) of the maxilla and/ or mandible, or (d) a family history of unexplained PHPTH. The testing criterion for FHH is a CCCR < 0.02. AIMS AND METHODS A retrospective review of patients referred for genetic testing over a 4 year period for suspected hereditary HPTH was performed. Genetic analysis was performed by next-generation sequencing of the following genes; MEN1, CDC73, CASR, CDKN1A, CDKN1B, CDKN2B, CDKN2C, RET, GCM2, GNA11, and AP2S1 in NHS-accredited Regional Genetic laboratories. Aims of this study were to better define testing criteria for suspected hereditary PHPTH in a UK cohort. RESULTS A total of 121 patients were included in this study (92 female) with a mean age of 41 years (SD 17). A pathogenic germline variant was identified in 16% (n = 19). A pathogenic variant was identified in the PHPTH genes CDC73 in a single patient and MEN1 in six patients (6% of total), in the FHH genes, CASR in 11 patients and AP2S1 in a single paediatric case (10% of total). A variant of uncertain significance (VUS) was identified in eight patients (6%) but over the course of this study familial segregation studies and computational analysis enabled re-classification of four of the variants, with two VUS's in the CASR gene being upgraded to likely pathogenic variants. Age at diagnosis and multiglandular disease as sole risk factors were not predictive of a pathogenic germline variant in this cohort but a positive family history was strongly predictive (P = .0002). A significant difference in the mean calcium creatinine clearance ratio (CCCR) in those patients with an identified CASR pathogenic variant versus those without (P = .0001) was demonstrated in this study. Thirty-three patients were aged over 50 years and the diagnostic rate of a pathogenic variant was 15.1% in those patients >50 years of age compared to 15.9% in those <50 years. Five patients >50 years and with a CCCR of <0.01, were diagnosed with a pathogenic variant in CASR. CONCLUSION Family history was the strongest predictor of hereditary PHPTH in this cohort. This study has highlighted the importance of re-evaluating VUS's in order to inform patient management and enable appropriate genetic counselling. Finally, this study has demonstrated the need to consider genetic testing for PHPTH in patients of any age, particularly those with additional risk factors.
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Affiliation(s)
- Sashi Mariathasan
- Department of Endocrinology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Katrina A Andrews
- Department of Clinical Genetics, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Edward Thompson
- East Midlands and East of England NHS Genomic Laboratory Hub, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Ben G Challis
- Department of Endocrinology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
- Translational Science & Experimental Medicine, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Sarah Wilcox
- Department of Clinical Genetics, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Heather Pierce
- Department of Clinical Genetics, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Julia Hale
- Department of Endocrinology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Sarah Spiden
- East Midlands and East of England NHS Genomic Laboratory Hub, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Gavin Fuller
- East Midlands and East of England NHS Genomic Laboratory Hub, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Helen L Simpson
- Department of Endocrinology, University College Hospital, London, UK
| | - Brian Fish
- Department of Head and Neck Surgery, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Piyush Jani
- Department of Head and Neck Surgery, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Ian Seetho
- Department of Endocrinology, Northwick Park Hospital, London North West University Hospital NHS Trust, London, UK
| | - Ruth Armstrong
- Department of Clinical Genetics, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Louise Izatt
- Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mamta Joshi
- Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anand Velusamy
- Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Soo-Mi Park
- Department of Clinical Genetics, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Ruth T Casey
- Department of Endocrinology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
- Department of Medical Genetics, Cambridge University, Cambridge, UK
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18
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Suwa Y, Joshi M, Poynter L, Endo I, Ashrafian H, Darzi A. Obese patients and robotic colorectal surgery: systematic review and meta-analysis. BJS Open 2020; 4:1042-1053. [PMID: 32955800 PMCID: PMC7709366 DOI: 10.1002/bjs5.50335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/05/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Obesity is a major health problem, demonstrated to double the risk of colorectal cancer. The benefits of robotic colorectal surgery in obese patients remain largely unknown. This meta-analysis evaluated the clinical and pathological outcomes of robotic colorectal surgery in obese and non-obese patients. METHODS MEDLINE, Embase, Global Health, Healthcare Management Information Consortium (HMIC) and Midwives Information and Resources Service (MIDIRS) databases were searched on 1 August 2018 with no language restriction. Meta-analysis was performed according to PRISMA guidelines. Obese patients (BMI 30 kg/m2 or above) undergoing robotic colorectal cancer resections were compared with non-obese patients. Included outcome measures were: operative outcomes (duration of surgery, conversion to laparotomy, blood loss), postoperative complications, hospital length of stay and pathological outcomes (number of retrieved lymph nodes, positive circumferential resection margins and length of distal margin in rectal surgery). RESULTS A total of 131 full-text articles were reviewed, of which 12 met the inclusion criteria and were included in the final analysis. There were 3166 non-obese and 1420 obese patients. A longer duration of surgery was documented in obese compared with non-obese patients (weighted mean difference -21·99 (95 per cent c.i. -31·52 to -12·46) min; P < 0·001). Obese patients had a higher rate of conversion to laparotomy than non-obese patients (odds ratio 1·99, 95 per cent c.i. 1·54 to 2·56; P < 0·001). Blood loss, postoperative complications, length of hospital stay and pathological outcomes were not significantly different in obese and non-obese patients. CONCLUSION Robotic surgery in obese patients results in a significantly longer duration of surgery and higher conversion rates than in non-obese patients. Further studies should focus on better stratification of the obese population with colorectal disease as candidates for robotic procedures.
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Affiliation(s)
- Y. Suwa
- Department of Surgery and CancerImperial College LondonLondonUK
- Department of Gastroenterological SurgeryYokohama City UniversityYokohamaJapan
| | - M. Joshi
- Department of Surgery and CancerImperial College LondonLondonUK
| | - L. Poynter
- Department of Surgery and CancerImperial College LondonLondonUK
| | - I. Endo
- Department of Gastroenterological SurgeryYokohama City UniversityYokohamaJapan
| | - H. Ashrafian
- Department of Surgery and CancerImperial College LondonLondonUK
| | - A. Darzi
- Department of Surgery and CancerImperial College LondonLondonUK
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Necchi A, Siefker-Radtke A, Loriot Y, Park S, Garcia-Donas J, Huddart R, Burgess E, Fleming M, Rezazadeh A, Mellado B, Varlamov S, Joshi M, Duran I, Zakharia Y, Fu M, Santiago-Walker A, O'Hagan A, Monga M, Tagawa S. 750P Erdafitinib (ERDA) in patients (pts) with locally advanced or metastatic urothelial carcinoma (mUC): Subgroup analyses of long-term efficacy outcomes of a pivotal phase II trial (BLC2001). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.822] [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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Joshi M, Kumar R, Jha D, Punekar Y. PIN3 Is Dolutegravir Cost Effective in Treating Patients Living with HIV? Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.250] [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: 10/23/2022]
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21
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Joshi M, Karat I, Leff DR. COVID 19 and breast surgery - silver linings? Br J Surg 2020; 107:e359. [PMID: 32687599 PMCID: PMC7404887 DOI: 10.1002/bjs.11784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/08/2022]
Affiliation(s)
- M Joshi
- Imperial College London, Department of Surgery & Cancer, UK.,Frimley Health NHS Foundation Trust, UK
| | - I Karat
- Frimley Health NHS Foundation Trust, UK
| | - D R Leff
- Imperial College London, Department of Surgery & Cancer, UK
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22
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Anandappa S, Joshi M, Breen LA, Thurairaja R, Christodoulou D, Jacques A, McGowan BMC, Izatt L, Velusamy A, Carroll PV. MON-924 Susceptibility Genetic Testing and Functional Imaging Modalities in the Management of Bladder Paragangliomas. J Endocr Soc 2020. [PMCID: PMC7209050 DOI: 10.1210/jendso/bvaa046.809] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Bladder Paragangliomas (PGLs) are rare neuroendocrine tumors derived from sympathetic paraganglionic tissue within the bladder wall, accounting for <1% of all Pheochromocytomas and Paragangliomas (PPGLs). >40% of PPGLs are associated with inherited syndromes through mutations affecting citric acid cycle enzymes (commonly SDH). Susceptibility gene identification has important implications for long-term care and facilitates targeted cascade genetic screening. Functional imaging using MIBG, Gallium DOTATATE and FDG-PET have become important tools in both diagnosis and treatment (Peptide Receptor Radionuclide Therapy). Clinical Cases: We report the demographics, clinical characteristics and novel features of 7 patients with bladder PGLs. The series includes 2 females and 5 males, median age 38 years (range 14-68). 5 presented with hematuria and 2 were detected incidentally (1 found on radiological imaging and the other during cystoscopy surveillance). Other symptoms reported were headaches, sweating and palpitations which were relieved by urination. Only 1/7 had a known family history of PGLs. 5/7 patients had elevated plasma normetadrenaline levels and 2 had non-elevated catecholamine metabolites (these 2 patients were asymptomatic). 6/7 patients had genetic testing performed and pathogenic variants were identified in 4 (Fumarate hydratase (FH), SDHA, SDHB*2 genes) and no pathogenic variant identified in 2 patients in our genetic panel of 10 PPGL genes. All primary tumors demonstrated MIBG avidity and in 2 patients assessed there was PGL FDG-PET avidity. Metastatic disease was present in 2 patients (2 SDHB mutations; with 1 MIBG avid bone and 1 FDG-PET avid nodal metastasis). SDHB immunostaining on resected histology was available for 3 cases - absent SDHB immunostaining in the patient with SDHA mutation and strongly positivity in 2 patients (1 with no genetic mutation and in 1 with FH mutation). Conclusions: The majority (>65%) of patients with bladder PGL have a germ line mutation in a susceptibility gene involving the citric acid cycle. An extended gene panel should be performed in all patients diagnosed with bladder PGLs including SDHA and FH gene mutations. SDH immunostaining of tumour can indicate SDHx gene defects but can be normal in FH mutations. SDHB is associated with increased risk of malignant/metastatic behavior. All 3 modalities of functional imaging (Ga DOTATATE, FDG PET, & MIBG) have a role in the assessment and treatment decision making in the management of bladder PGLs.
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Affiliation(s)
- Samantha Anandappa
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mamta Joshi
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Louise A Breen
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ramesh Thurairaja
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Audrey Jacques
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Louise Izatt
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Anand Velusamy
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Paul V Carroll
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
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Soliman M, Rosenblatt R, Joshi M, Chung C, Mitry M, Oh K, Talenfeld A, Samstein B, Brown R, Halazun K, Fortune B, Charalel R. 3:27 PM Abstract No. 130 Hospitalization and complication rates following radiation segmentectomy versus microwave ablation for small hepatocellular carcinoma. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.162] [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: 11/16/2022] Open
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Joshi M, Rosenblatt R, Chung C, Mitry M, Soliman M, Oh K, Askin G, Talenfeld A, Samstein B, Brown R, Halazun K, Fortune B, Charalel R. Abstract No. 532 Comparative efficacy of transarterial embolization versus transarterial embolization plus microwave ablation for hepatocellular carcinoma 3 to 5 cm in size. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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25
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Jain AK, Thakur VC, Joshi M, Mukherjee PK, Patel RC, Bhattacharyya K, Singhal S, Agarwal KK, Dixit R, Deshmukh G, Mohan M. Tectonics of the Western, Sikkim and Arunachal Himalaya. PINSA 2020. [DOI: 10.16943/ptinsa/2020/49781] [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: 11/13/2022]
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Posthuma LM, Downey C, Visscher MJ, Ghazali DA, Joshi M, Ashrafian H, Khan S, Darzi A, Goldstone J, Preckel B. Remote wireless vital signs monitoring on the ward for early detection of deteriorating patients: A case series. Int J Nurs Stud 2020; 104:103515. [PMID: 32105974 DOI: 10.1016/j.ijnurstu.2019.103515] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 09/17/2019] [Revised: 12/24/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Remote wireless monitoring is a new technology that allows the continuous recording of ward patients' vital signs, supporting nurses by measuring vital signs frequently and accurately. A case series is presented to illustrate how these systems might contribute to improved patient surveillance. METHODS AND RESULTS Five hospitals in three European countries installed a remote wireless vital signs monitoring system on medical or surgical wards. Heart rate, respiratory rate and temperature were measured by the system every 2 min. Four cases of (paroxysmal) atrial fibrillation are presented, two cases of sepsis and one case each of pyrexia, cardiogenic pulmonary edema and pulmonary embolisms. All cases show that the remote monitoring system revealed the first signs of ventilatory and circulatory deterioration before a change in the trends of the respective values became obvious by manual vital signs measurement. DISCUSSION This case series illustrates that a wireless remote vital signs monitoring system on medical and surgical wards has the potential to reduce time to detect deteriorating patients.
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Affiliation(s)
- L M Posthuma
- Department of Anaesthesiology, Amsterdam UMC, location AMC, H1-148, Amsterdam UMC, location AMC, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - C Downey
- Leeds Institute of Medical Research at St. James's, University of Leeds, United Kingdom
| | - M J Visscher
- Department of Anaesthesiology, Amsterdam UMC, location AMC, H1-148, Amsterdam UMC, location AMC, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - D A Ghazali
- Emergency Department, University Hospital of Bichat, Paris, France
| | - M Joshi
- Department of Surgery & Cancer, Academic Surgical Unit, St Mary's Hospital, Imperial College London, London, United Kingdom; Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, London, United Kingdom
| | - H Ashrafian
- Department of Surgery & Cancer, Academic Surgical Unit, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - S Khan
- Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, London, United Kingdom
| | - A Darzi
- Department of Surgery & Cancer, Academic Surgical Unit, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - J Goldstone
- Chief Intensivist, King Edward VII Hospital, The London Clinic and University College London Hospitals NHS Trust, London, United Kingdom
| | - B Preckel
- Department of Anaesthesiology, Amsterdam UMC, location AMC, H1-148, Amsterdam UMC, location AMC, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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Shrestha AK, Joshi M, DeBono L, Naeem K, Basu S. Laparoscopic repair of type III/IV giant para-oesophageal herniae with biological prosthesis: a single centre experience. Hernia 2019; 23:387-396. [PMID: 30661178 DOI: 10.1007/s10029-019-01888-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/27/2018] [Accepted: 01/09/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Repair of giant paraoesophageal herniae (GPEH) is technically challenging and requires significant experience in advanced foregut surgery. Controversy continues on suture versus mesh cruroplasty with the most recent systematic review and meta-analysis putting the onus on the operating surgeon. Study aim was to review whether the biological prosthesis (non-cross-linked bovine pericardium and porcine dermis) and the technique adopted for patients with GPEH had an influence on clinical and radiological recurrences. METHOD A retrospective analysis of a prospectively collected data of 60 consecutive patients with confirmed 5 cm hiatus hernia and ≥ 30% stomach displacement in the thorax that were operated in the upper gastrointestinal unit of a large district general hospital between September 2010 and August 2017. Pre and post-surgery Gastro-Oesophageal Reflux Disease Questionnaire [(GORD-HRQOL)] and a follow up contrast study were completed. RESULTS 60 included 2 (3%) and 58 (97%) emergency and elective procedures respectively with a male: female ratio of 1:3, age 71* (Median) (42-89) years, BMI 29* (19-42) and 26 (43%) with ASA III/IV. Investigations confirmed 46* (37-88) mm and 42* (34-77) mm transverse and antero-posterior hiatal defect respectively with 60* (30-100)% displacement of stomach into chest. Operative time and length of stay was 180* (120-510) minutes and 2* (1-30) days respectively. One (2%) converted for bleeding and 2 (3%) peri-operative deaths. Five (8%), 5 (8%) and 4 (7%) have dysphagia, symptomatic and radiological recurrences respectively. GORD-HRQOL recorded preoperatively was 27* (10-39) dropping significantly postoperatively to 0* (0-21) (P < 0.005) with 95% patient satisfaction at a follow up of 60* (36-84) months. CONCLUSIONS Our technique of laparoscopic GPEH repair with biological prosthesis is safe with a reduced symptomatic and radiological recurrence and an acceptable morbidity and mortality.
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Affiliation(s)
- A K Shrestha
- Department of General Surgery, East Kent Hospitals University NHS Foundation Trust (EKHUFT), Ashford, Kent, UK
| | - M Joshi
- Department of General Surgery, East Kent Hospitals University NHS Foundation Trust (EKHUFT), Ashford, Kent, UK
| | - L DeBono
- Department of Surgery, One Ashford Hospital, Willesborough, Ashford, Kent, UK
| | - K Naeem
- Department of Radiology, EKHUFT, Ashford, Kent, UK
| | - S Basu
- Department of Surgery, EKHUFT, Ashford, Kent, UK. .,Department of Surgery, William Harvey Hospital, Ashford, Kent, TN24 0LZ, UK.
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Malbari K, Gonsalves H, Chintakrindi A, Gohil D, Joshi M, Kothari S, Srivastava S, Chowdhary A, Kanyalkar M. In search of effective H1N1 neuraminidase inhibitor by molecular docking, antiviral evaluation and membrane interaction studies using NMR. Acta Virol 2018; 62:179-190. [PMID: 29895159 DOI: 10.4149/av_2018_209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Considering the need for discovery of new antiviral drugs, in view to combat the issue of resistance particularly to anti-influenza drugs, a series of 2'-amino, 3'-amino and 2', 4'-dihydroxy chalcone derivatives were designed. Structure-based drug design was used to design inhibitors of influenza virus - H1N1 neuraminidase enzyme. These were further optimized by a combination of iterative medicinal chemistry principles and molecular docking. Based on the best docking scores, some chalcone derivatives were synthesized and characterized by infrared spectroscopy (IR) and proton nuclear magnetic resonance (NMR). The molecules were evaluated for their anti-influenza action against influenza A/Pune isolate/2009 (H1N1) virus by in vitro enzyme-based assay (neuraminidase inhibition assay). We have then selected few of them for multinuclear NMR studies, 31P NMR, in order to probe the molecular mechanism of their antiviral action. Reasonably good correlation between docking scores; anti-influenza activity; and 31P NMR results were observed. The computational predictions were in consensus with the experimental results. It was observed that among tested compounds, derivative 1A, viz. 2', 4'-dihydroxy-4-methoxy chalcone, showed highest activity (IC50 = 2.23 μmol/l) against the virus under study. This derivative 1A can be explored further to provide a future therapeutic option for the treatment and prophylaxis of H1N1 viral infections.
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Gupta P, Sinha S, Joshi M, Kumar P, Bhalla S. PO520 A Unique Education Program On Diabetes and Cardiovascular Disease For Primary Care Physicians In India: A Support to WHO Global Action Plan. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.397] [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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30
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Yu H, Chen Z, Ballman K, Watson M, Govindan R, Beer D, Bueno R, Herman M, Franklin W, Gandara D, Joshi M, Merrick D, Richards W, Rivard C, Shepherd F, Tsao M, Bokhoven A, Harpole D, Hirsch F. P1.04-23 Expression of Emerging Immunotherapy Targets in Early-Stage Squamous Lung Carcinoma. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.738] [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: 11/16/2022]
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Maharjan BR, Bhandary S, Upadhyay S, Ghimire S, Shrestha I, Joshi M, Vaidya S, Pradhan P. Developing tool and Measuring Integration Characteristics of Basic Science Curriculum to Improve Curriculum Integration. Kathmandu Univ Med J (KUMJ) 2018; 16:338-344. [PMID: 31729350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Integrated curriculum enhances students' learning and the retention of knowledge. At Patan Academy of Health Sciences, integrated organ system based curriculum is used with Problem Based Learning as the principle teaching learning method to foster students' learning. In addition, other approaches of integration were under taken such as integrated assessment; logical arrangement teaching learning methods (lectures and practicals); joint effort of faculty in curriculum planning and delivery; conducive environment to foster hidden curriculum. This study describes the perception of faculty and students on integration characteristics of Basic Science curriculum. Objective To measure the integration characteristics of Basic Science Curriculum. Method Tool was developed to measure integration characteristics of Basic Science Curriculum and ensure whether such planned integration has been achieved. Mixed method was used to measure the perception of the integration characteristics i) quantitatively by questionnaire survey to faculty and students ii) qualitatively by in-depth interview of students. Result Both faculty and students perceived that all the blocks in Basic Science was well integrated in the quantitative questionnaire survey. But, in the in-depth interview, students perceived integration of curriculum in organ system blocks were better integrated compared to Principle of Human Biology blocks where fundamentals of basic science disciplines were delivered. Students reflected that Problem Based Learning not only integrated Basic Science disciplines but also with clinical sciences and the social context. But, students perceived that Community Health Sciences curriculum was not so well integrated with Basic Science subjects. Conclusion Overall, this study showed that planned integration in Basic Science curriculum was successfully executed during curriculum implementation.
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Affiliation(s)
- B R Maharjan
- Department of Biochemistry, School of Medicine, Patan Academy of Health Sciences, Lagankhel-5, Lalitpur, Nepal
| | - S Bhandary
- Department of Community Health Sciences, School of Medicine, Patan Academy of Health Sciences, Lagankhel-5, Lalitpur, Nepal
| | - S Upadhyay
- Department of Community Health Sciences, School of Medicine, Patan Academy of Health Sciences, Lagankhel-5, Lalitpur, Nepal
| | - S Ghimire
- Department of Anatomy, School of Medicine, Patan Academy of Health Sciences, Lagankhel-5, Lalitpur, Nepal
| | - I Shrestha
- Department of Physiology, School of Medicine, Patan Academy of Health Sciences, Lagankhel-5, Lalitpur, Nepal
| | - M Joshi
- Department of Pharmacology, School of Medicine, Patan Academy of Health Sciences, Lagankhel-5, Lalitpur, Nepal
| | - S Vaidya
- Department of Pathology, School of Medicine, Patan Academy of Health Sciences, Lagankhel-5, Lalitpur, Nepal
| | - P Pradhan
- Department of Microbiology, School of Medicine, Patan Academy of Health Sciences, Lagankhel-5, Lalitpur, Nepal
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Joshi M, Szatmary P, Howes N. Survival comparison from upper GI cancers based on intention-to-treat and definitive staging, following surgery with or without neo-adjuvant therapy. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Raiteri CM, Villata M, Acosta-Pulido JA, Agudo I, Arkharov AA, Bachev R, Baida GV, Benítez E, Borman GA, Boschin W, Bozhilov V, Butuzova MS, Calcidese P, Carnerero MI, Carosati D, Casadio C, Castro-Segura N, Chen WP, Damljanovic G, D'Ammando F, Di Paola A, Echevarría J, Efimova NV, Ehgamberdiev SA, Espinosa C, Fuentes A, Giunta A, Gómez JL, Grishina TS, Gurwell MA, Hiriart D, Jermak H, Jordan B, Jorstad SG, Joshi M, Kopatskaya EN, Kuratov K, Kurtanidze OM, Kurtanidze SO, Lähteenmäki A, Larionov VM, Larionova EG, Larionova LV, Lázaro C, Lin CS, Malmrose MP, Marscher AP, Matsumoto K, McBreen B, Michel R, Mihov B, Minev M, Mirzaqulov DO, Mokrushina AA, Molina SN, Moody JW, Morozova DA, Nazarov SV, Nikolashvili MG, Ohlert JM, Okhmat DN, Ovcharov E, Pinna F, Polakis TA, Protasio C, Pursimo T, Redondo-Lorenzo FJ, Rizzi N, Rodriguez-Coira G, Sadakane K, Sadun AC, Samal MR, Savchenko SS, Semkov E, Skiff BA, Slavcheva-Mihova L, Smith PS, Steele IA, Strigachev A, Tammi J, Thum C, Tornikoski M, Troitskaya YV, Troitsky IS, Vasilyev AA, Vince O. Blazar spectral variability as explained by a twisted inhomogeneous jet. Nature 2017; 552:374-377. [PMID: 29211720 DOI: 10.1038/nature24623] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/06/2017] [Indexed: 11/09/2022]
Abstract
Blazars are active galactic nuclei, which are powerful sources of radiation whose central engine is located in the core of the host galaxy. Blazar emission is dominated by non-thermal radiation from a jet that moves relativistically towards us, and therefore undergoes Doppler beaming. This beaming causes flux enhancement and contraction of the variability timescales, so that most blazars appear as luminous sources characterized by noticeable and fast changes in brightness at all frequencies. The mechanism that produces this unpredictable variability is under debate, but proposed mechanisms include injection, acceleration and cooling of particles, with possible intervention of shock waves or turbulence. Changes in the viewing angle of the observed emitting knots or jet regions have also been suggested as an explanation of flaring events and can also explain specific properties of blazar emission, such as intra-day variability, quasi-periodicity and the delay of radio flux variations relative to optical changes. Such a geometric interpretation, however, is not universally accepted because alternative explanations based on changes in physical conditions-such as the size and speed of the emitting zone, the magnetic field, the number of emitting particles and their energy distribution-can explain snapshots of the spectral behaviour of blazars in many cases. Here we report the results of optical-to-radio-wavelength monitoring of the blazar CTA 102 and show that the observed long-term trends of the flux and spectral variability are best explained by an inhomogeneous, curved jet that undergoes changes in orientation over time. We propose that magnetohydrodynamic instabilities or rotation of the twisted jet cause different jet regions to change their orientation and hence their relative Doppler factors. In particular, the extreme optical outburst of 2016-2017 (brightness increase of six magnitudes) occurred when the corresponding emitting region had a small viewing angle. The agreement between observations and theoretical predictions can be seen as further validation of the relativistic beaming theory.
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Affiliation(s)
- C M Raiteri
- INAF, Osservatorio Astrofisico di Torino, I-10025 Pino Torinese, Italy
| | - M Villata
- INAF, Osservatorio Astrofisico di Torino, I-10025 Pino Torinese, Italy
| | - J A Acosta-Pulido
- Instituto de Astrofisica de Canarias (IAC), La Laguna, E-38200 Tenerife, Spain.,Departamento de Astrofisica, Universidad de La Laguna, La Laguna, E-38205 Tenerife, Spain
| | - I Agudo
- Instituto de Astrofísica de Andalucía (CSIC), E-18080 Granada, Spain
| | - A A Arkharov
- Pulkovo Observatory, 196140 St Petersburg, Russia
| | - R Bachev
- Institute of Astronomy and NAO, Bulgarian Academy of Sciences, 1784 Sofia, Bulgaria
| | - G V Baida
- Crimean Astrophysical Observatory RAS, Nauchny 298409, Russia
| | - E Benítez
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Mexico
| | - G A Borman
- Crimean Astrophysical Observatory RAS, Nauchny 298409, Russia
| | - W Boschin
- Instituto de Astrofisica de Canarias (IAC), La Laguna, E-38200 Tenerife, Spain.,Departamento de Astrofisica, Universidad de La Laguna, La Laguna, E-38205 Tenerife, Spain.,INAF, TNG Fundación Galileo Galilei, E-38712 La Palma, Spain
| | - V Bozhilov
- Department of Astronomy, Faculty of Physics, University of Sofia, BG-1164 Sofia, Bulgaria
| | - M S Butuzova
- Crimean Astrophysical Observatory RAS, Nauchny 298409, Russia
| | - P Calcidese
- Osservatorio Astronomico della Regione Autonoma Valle d'Aosta, I-11020 Nus, Italy
| | - M I Carnerero
- INAF, Osservatorio Astrofisico di Torino, I-10025 Pino Torinese, Italy
| | - D Carosati
- INAF, TNG Fundación Galileo Galilei, E-38712 La Palma, Spain.,EPT Observatories, Tijarafe, E-38780 La Palma, Spain
| | - C Casadio
- Instituto de Astrofísica de Andalucía (CSIC), E-18080 Granada, Spain.,Max-Planck-Institut für Radioastronomie, D-53121 Bonn, Germany
| | - N Castro-Segura
- Departamento de Astrofisica, Universidad de La Laguna, La Laguna, E-38205 Tenerife, Spain.,School of Physics and Astronomy, University of Southampton, Southampton SO17 1BJ, UK
| | - W-P Chen
- Graduate Institute of Astronomy, National Central University, Jhongli City, Taoyuan County 32001, Taiwan
| | | | - F D'Ammando
- Dipartimento di Fisica e Astronomia, Università di Bologna, I-40129 Bologna, Italy.,INAF, Istituto di Radioastronomia, I-40129 Bologna, Italy
| | - A Di Paola
- INAF, Osservatorio Astronomico di Roma, I-00040 Monte Porzio Catone, Italy
| | - J Echevarría
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Mexico
| | - N V Efimova
- Pulkovo Observatory, 196140 St Petersburg, Russia
| | - Sh A Ehgamberdiev
- Ulugh Beg Astronomical Institute, Maidanak Observatory, Tashkent 100052, Uzbekistan
| | - C Espinosa
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Mexico
| | - A Fuentes
- Instituto de Astrofísica de Andalucía (CSIC), E-18080 Granada, Spain
| | - A Giunta
- INAF, Osservatorio Astronomico di Roma, I-00040 Monte Porzio Catone, Italy
| | - J L Gómez
- Instituto de Astrofísica de Andalucía (CSIC), E-18080 Granada, Spain
| | - T S Grishina
- Astronomical Institute, St Petersburg State University, 198504 St Petersburg, Russia
| | - M A Gurwell
- Harvard-Smithsonian Center for Astrophysics, Cambridge, Massachusetts 02138, USA
| | - D Hiriart
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Mexico
| | - H Jermak
- Astrophysics Research Institute, Liverpool John Moores University, Liverpool L3 5RF, UK
| | - B Jordan
- School of Cosmic Physics, Dublin Institute For Advanced Studies, Dublin, Ireland
| | - S G Jorstad
- Astronomical Institute, St Petersburg State University, 198504 St Petersburg, Russia.,Institute for Astrophysical Research, Boston University, Boston, Massachusetts 02215, USA
| | - M Joshi
- Institute for Astrophysical Research, Boston University, Boston, Massachusetts 02215, USA
| | - E N Kopatskaya
- Astronomical Institute, St Petersburg State University, 198504 St Petersburg, Russia
| | - K Kuratov
- NNLOT, Al-Farabi Kazakh National University, Almaty, Kazakhstan.,Fesenkov Astrophysical Institute, Almaty, Kazakhstan
| | - O M Kurtanidze
- Abastumani Observatory, Mt Kanobili, 0301 Abastumani, Georgia.,Engelhardt Astronomical Observatory, Kazan Federal University, Tatarstan, Russia.,Landessternwarte, Zentrum für Astronomie der Universität Heidelberg, 69117 Heidelberg, Germany.,Center for Astrophysics, Guangzhou University, Guangzhou 510006, China
| | - S O Kurtanidze
- Abastumani Observatory, Mt Kanobili, 0301 Abastumani, Georgia
| | - A Lähteenmäki
- Aalto University Metsähovi Radio Observatory, FI-02540 Kylmälä, Finland.,Aalto University Department of Electronics and Nanoengineering, FI-00076 Aalto, Finland.,Tartu Observatory, 61602 Tõravere, Estonia
| | - V M Larionov
- Pulkovo Observatory, 196140 St Petersburg, Russia.,Astronomical Institute, St Petersburg State University, 198504 St Petersburg, Russia
| | - E G Larionova
- Astronomical Institute, St Petersburg State University, 198504 St Petersburg, Russia
| | - L V Larionova
- Astronomical Institute, St Petersburg State University, 198504 St Petersburg, Russia
| | - C Lázaro
- Instituto de Astrofisica de Canarias (IAC), La Laguna, E-38200 Tenerife, Spain.,Departamento de Astrofisica, Universidad de La Laguna, La Laguna, E-38205 Tenerife, Spain
| | - C S Lin
- Graduate Institute of Astronomy, National Central University, Jhongli City, Taoyuan County 32001, Taiwan
| | - M P Malmrose
- Institute for Astrophysical Research, Boston University, Boston, Massachusetts 02215, USA
| | - A P Marscher
- Institute for Astrophysical Research, Boston University, Boston, Massachusetts 02215, USA
| | - K Matsumoto
- Astronomical Institute, Osaka Kyoiku University, Osaka 582-8582, Japan
| | - B McBreen
- School of Physics, University College Dublin, Dublin 4, Ireland
| | - R Michel
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Mexico
| | - B Mihov
- Institute of Astronomy and NAO, Bulgarian Academy of Sciences, 1784 Sofia, Bulgaria
| | - M Minev
- Department of Astronomy, Faculty of Physics, University of Sofia, BG-1164 Sofia, Bulgaria
| | - D O Mirzaqulov
- Ulugh Beg Astronomical Institute, Maidanak Observatory, Tashkent 100052, Uzbekistan
| | - A A Mokrushina
- Pulkovo Observatory, 196140 St Petersburg, Russia.,Astronomical Institute, St Petersburg State University, 198504 St Petersburg, Russia
| | - S N Molina
- Instituto de Astrofísica de Andalucía (CSIC), E-18080 Granada, Spain
| | - J W Moody
- Department of Physics and Astronomy, Brigham Young University, Provo, Utah 84602, USA
| | - D A Morozova
- Astronomical Institute, St Petersburg State University, 198504 St Petersburg, Russia
| | - S V Nazarov
- Crimean Astrophysical Observatory RAS, Nauchny 298409, Russia
| | | | - J M Ohlert
- Michael Adrian Observatorium, Astronomie Stiftung Trebur, 65468 Trebur, Germany.,University of Applied Sciences, Technische Hochschule Mittelhessen, 61169 Friedberg, Germany
| | - D N Okhmat
- Crimean Astrophysical Observatory RAS, Nauchny 298409, Russia
| | - E Ovcharov
- Department of Astronomy, Faculty of Physics, University of Sofia, BG-1164 Sofia, Bulgaria
| | - F Pinna
- Instituto de Astrofisica de Canarias (IAC), La Laguna, E-38200 Tenerife, Spain.,Departamento de Astrofisica, Universidad de La Laguna, La Laguna, E-38205 Tenerife, Spain
| | - T A Polakis
- Command Module Observatory, Tempe, Arizona, USA
| | - C Protasio
- Instituto de Astrofisica de Canarias (IAC), La Laguna, E-38200 Tenerife, Spain.,Departamento de Astrofisica, Universidad de La Laguna, La Laguna, E-38205 Tenerife, Spain
| | - T Pursimo
- Nordic Optical Telescope, E-38700 Santa Cruz de La Palma, Spain
| | - F J Redondo-Lorenzo
- Instituto de Astrofisica de Canarias (IAC), La Laguna, E-38200 Tenerife, Spain.,Departamento de Astrofisica, Universidad de La Laguna, La Laguna, E-38205 Tenerife, Spain
| | - N Rizzi
- Osservatorio Astronomico Sirio, I-70013 Castellana Grotte, Italy
| | - G Rodriguez-Coira
- Instituto de Astrofisica de Canarias (IAC), La Laguna, E-38200 Tenerife, Spain.,Departamento de Astrofisica, Universidad de La Laguna, La Laguna, E-38205 Tenerife, Spain
| | - K Sadakane
- Astronomical Institute, Osaka Kyoiku University, Osaka 582-8582, Japan
| | - A C Sadun
- Department of Physics, University of Colorado Denver, Denver, Colorado 80217-3364 USA
| | - M R Samal
- Graduate Institute of Astronomy, National Central University, Jhongli City, Taoyuan County 32001, Taiwan
| | - S S Savchenko
- Astronomical Institute, St Petersburg State University, 198504 St Petersburg, Russia
| | - E Semkov
- Institute of Astronomy and NAO, Bulgarian Academy of Sciences, 1784 Sofia, Bulgaria
| | - B A Skiff
- Lowell Observatory, Flagstaff, Arizona, USA
| | - L Slavcheva-Mihova
- Institute of Astronomy and NAO, Bulgarian Academy of Sciences, 1784 Sofia, Bulgaria
| | - P S Smith
- Steward Observatory, University of Arizona, Tucson, Arizona, USA
| | - I A Steele
- Astrophysics Research Institute, Liverpool John Moores University, Liverpool L3 5RF, UK
| | - A Strigachev
- Institute of Astronomy and NAO, Bulgarian Academy of Sciences, 1784 Sofia, Bulgaria
| | - J Tammi
- Aalto University Metsähovi Radio Observatory, FI-02540 Kylmälä, Finland
| | - C Thum
- Instituto de Radio Astronomía Milimétrica, E-18012 Granada, Spain
| | - M Tornikoski
- Aalto University Metsähovi Radio Observatory, FI-02540 Kylmälä, Finland
| | - Yu V Troitskaya
- Astronomical Institute, St Petersburg State University, 198504 St Petersburg, Russia
| | - I S Troitsky
- Astronomical Institute, St Petersburg State University, 198504 St Petersburg, Russia
| | - A A Vasilyev
- Astronomical Institute, St Petersburg State University, 198504 St Petersburg, Russia
| | - O Vince
- Astronomical Observatory, 11060 Belgrade, Serbia
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Sokwalla S, Joshi M, Amayo E, Mecha J, Acharya K, Mutai K. Quality of sleep and risk for obstructive sleep apnoea in ambulant individuals with type 2 diabetes mellitus at a tertiary referral hospital in Kenya: a cross-sectional, comparative study. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Voigt S, Joshi M, Speicher P, Tong B, Onaitis M, Crawford J, D'Amico T, Harpole D. MA 19.09 The Role of Neoadjuvant Chemotherapy in Patients with Malignant Pleural Mesothelioma. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.640] [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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Mishra R, Joshi M, Meisenberg O, Gierl S, Prajith R, Kanse SD, Rout R, Sapra BK, Mayya YS, Tschiersch J. Deposition and spatial variation of thoron decay products in a thoron experimental house using the Direct Thoron Progeny Sensors. J Radiol Prot 2017; 37:379-389. [PMID: 28418936 DOI: 10.1088/1361-6498/aa6408] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Experiments have been carried out using the deposition-based Direct Thoron Progeny Sensors (DTPS) in a thoron experimental house. The objective was to study the thoron decay product characteristics such as the deposition velocities, spatial variability and dependence on aerosol particle concentrations. Since the deposition velocity is an important characteristic in the calibration of the DTPS, it is very important to study its dependence on aerosol concentration in a controlled environment. At low aerosol concentration (1500 particles/cm3) the mean effective deposition velocity was measured to be 0.159 ± 0.045 m h-1; at high aerosol concentration (30 000 particles/cm3) it decreased to 0.079 ± 0.009 m h-1. The deposition velocity for the attached fraction of the thoron decay products did not change with increasing aerosol concentration, showing measurement results of 0.048 ± 0.005 m h-1 and 0.043 ± 0.014 m h-1, respectively. At low particle concentration, the effective deposition velocity showed large scattering within the room at different distances from center. The attached fraction deposition velocity remained uniform at different distances from the wall. The measurements in the thoron experimental house can be used as a sensitivity test of the DTPS in an indoor environment with changing aerosol concentration. The uniform spatial distribution of thoron decay products was confirmed within the experimental house. This indicates that direct measurement of thoron decay product concentration should be carried out instead of inferring it from thoron gas concentration, which is very inhomogeneous within the experimental house.
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Affiliation(s)
- R Mishra
- Bhabha Atomic Research Centre, Radiological Physics and Advisory Division, Mumbai 400 085, India
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Hendra L, Shrestha A, Joshi M, Basu S. Open intraperitoneal onlay mesh repair for medium-large lateral abdominal wall herniae. Ann R Coll Surg Engl 2016; 98:595-596. [PMID: 27412806 DOI: 10.1308/rcsann.2016.0206] [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: 11/22/2022] Open
Affiliation(s)
- L Hendra
- Isle of Wight Healthcare NHS Trust , UK
| | - A Shrestha
- East Kent Hospitals University NHS Foundation Trust
| | - M Joshi
- East Kent Hospitals University NHS Foundation Trust
| | - S Basu
- East Kent Hospitals University NHS Foundation Trust
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Tuanquin L, McDermott D, Mackley H, Holder S, Wagner H, Rosenberg J, Drabick J, Kaag M, Joshi M, Raman J, Merrill S. The Outcomes of Adjuvant Radiation Therapy in Postcystectomy Muscle-Invasive Bladder Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1329] [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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Agarwal N, Joshi M. Effectiveness of amitriptyline and lamotrigine in traumatic spinal cord injury-induced neuropathic pain: a randomized longitudinal comparative study. Spinal Cord 2016; 55:126-130. [PMID: 27527240 DOI: 10.1038/sc.2016.123] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Randomized longitudinal comparative study. OBJECTIVES To compare the efficacy of lamotrigine and amitriptyline in the management of traumatic spinal cord injury (SCI)-induced neuropathic pain (NP). SETTING Sawai Man Singh Medical College and Hospital, Jaipur, India. METHODS A total of 147 individuals with NP were randomized for a 3-week trial of either amitriptyline or lamotrigine. Amitriptyline was administered orally at doses of 25, 50 and 100 mg once daily at night time, and lamotrigine was administered orally at doses of 25, 50 and 100 mg twice daily, both for 1 week by means of optional titration. Assessment of NP was done at baseline and thereafter at 1, 2 and 3 weeks using Short-form MC Gill Pain Questionnaire-2 (SFMPQ2) scores. RESULTS There was a significant difference between the mean values of the SFMPQ2 score at baseline and those at each follow-up for amitriptyline. Similar results were seen in the lamotrigine group. When the differences in mean SFMPQ2 scores at different time frames from baseline were compared with those of the other group, values were found to be nonsignificant as seen on the Mann-Whitney U-test. CONCLUSIONS These findings support the use of both amitriptyline and lamotrigine in the management of NP after traumatic SCI.
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Affiliation(s)
- N Agarwal
- Physical Medicine and Rehabilitation, Sawai Man Singh Medical College and Hospital, Jaipur, India
| | - M Joshi
- Department of PMR, SMS Medical College & Associate Hospital Jaipur, Jaipur, India
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Gupta P, Sinha S, Joshi M, Vats S, Sharma M, Srivastava R, Bhalla S, Mohan V, Tandon N, Unnikrishnan A, Reddy K, Prabhakaran D. PS218 Education Programs for Primary Care Physicians: An Experience From Various Capacity Building Initiatives on Chronic Conditions in India. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Skittrall JP, Eid-Arimoku L, Joshi M, Newport MJ, Moore EM. Rigid sigmoidoscopy: no contamination of the sigmoidoscopist's face with faecal flora in a small study. J Hosp Infect 2016; 93:112-3. [PMID: 26996086 DOI: 10.1016/j.jhin.2016.01.017] [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: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Affiliation(s)
- J P Skittrall
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
| | - L Eid-Arimoku
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK
| | - M Joshi
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK
| | - M J Newport
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK
| | - E M Moore
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK
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Affiliation(s)
- U. Chatterjee
- Department of Textile Technology; I.I.T; Delhi 110 016 India
| | - B. S. Butola
- Department of Textile Technology; I.I.T; Delhi 110 016 India
| | - M. Joshi
- Department of Textile Technology; I.I.T; Delhi 110 016 India
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Agarwal TK, Joshi M, Sahoo BK, Kanse SD, Sapra BK. Effect of 220Rn gas concentration distribution on its transmission from a delay chamber: evolving a CFD-based uniformity index. Radiat Prot Dosimetry 2016; 168:546-552. [PMID: 26152566 DOI: 10.1093/rpd/ncv361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/05/2015] [Indexed: 06/04/2023]
Abstract
(220)Rn mitigation can be achieved by delay chamber technique, which relies on the advantage of its short half-life. However, flow rate as well as inlet-outlet position for the delay chamber can have a significant impact on (220)Rn concentration distribution patterns and hence transmission factor. In the present study, computational fluid dynamics simulations to estimate the concentration distribution has been carried out in a chamber of 0.5 m(3) for the combination of six different inlet-outlet positions and five different flow rates. Subsequently, the transmission factor (TF) for the chamber was evaluated and found to be highly dependent on the flow rate and inlet-outlet positions. For ease of scale up, the dependency of TF on the flow rate and the inlet-outlet positions is best summarised by relative transmission factor (RTF), which is the ratio of the TFs for the case of inlet and outlet on different faces to that on the same face.
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Affiliation(s)
- T K Agarwal
- Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India
| | - M Joshi
- Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India
| | - B K Sahoo
- Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India
| | - S D Kanse
- Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India
| | - B K Sapra
- Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India
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Subramani E, Jothiramajayam M, Dutta M, Chakravorty D, Joshi M, Srivastava S, Mukherjee A, Datta Ray C, Chakravarty BN, Chaudhury K. NMR-based metabonomics for understanding the influence of dormant female genital tuberculosis on metabolism of the human endometrium. Hum Reprod 2016; 31:854-65. [PMID: 26851602 DOI: 10.1093/humrep/dew003] [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] [Received: 10/27/2015] [Accepted: 01/05/2016] [Indexed: 01/13/2023] Open
Abstract
STUDY QUESTION Does investigation of metabolic perturbations in endometrial tissue of women with dormant genital tuberculosis (GTB) during the window of implantation (WOI) assist in improving the understanding of endometrial receptivity? SUMMARY ANSWER In dormant GTB cases significant alterations in endometrial tissue metabolites occur, largely related to energy metabolism and amino acid biosynthesis in dormant GTB cases. WHAT IS KNOWN ALREADY As an intracellular pathogen, Mycobacterium tuberculosis strongly influences the metabolism of host cells causing metabolic dysregulation. It is also accepted that dormant GTB impairs the receptive status of the endometrium. Global metabolic profiling is useful for an understanding of disease progression and distinguishing between diseased and non-diseased groups. STUDY DESIGN, SIZE, DURATION Endometrial tissue samples were collected from patients reporting at the tertiary infertility care center during the period September 2011-March 2013. Women having tested positive for GTB were considered as the study group (n = 24). Normal healthy women undergoing sterilization (n = 26) and unexplained infertile women with repeated IVF failure (n = 21) volunteered to participate as controls. PARTICIPANTS/MATERIALS, SETTING, METHODS Endometrial tissue samples were collected 6-10 days after confirmation of ovulation. PCR and BACTEC-460 culture were used for diagnosing GTB. Proton nuclear magnetic resonance (1H NMR) spectra of tissue were recorded using a 700 MHz Bruker Avance AV III spectrometer. Following phase and baseline correction of all NMR spectra by Bruker Topspin 2.1 software, spectral peak alignment of the data was performed. Multivariate analysis was applied to all spectra and individual metabolites identified and multiple correlation analysis was performed. MAIN RESULTS AND THE ROLE OF CHANCE Leucine, isoleucine, acetate, lactate, glutamate, glutamine, methionine, lysine, creatine, glycogen, glycine, proline and choline were found to be significantly increased (P < 0.05) in endometrial tissue of women with dormant GTB compared with unexplained infertile women with repeated implantation failure. Valine, citrate, succinate and aspartate were also observed to be significantly up-regulated (P < 0.01). Furthermore, a significant decrease in glucose (P < 0.05), threonine (P < 0.05), tyrosine (P < 0.01) and phenylalanine (P < 0.0001) was observed in women with dormant GTB. Pearson's correlation analysis between the expression of various endometrial receptivity markers and metabolites showed a significant negative correlation (-0.236 to -0.545, P < 0.05). Also, the metabolites were positively correlated with endometrial receptivity markers (0.207 to 0.618, P < 0.05). LIMITATIONS, REASONS FOR CAUTION It is often difficult to diagnose dormant GTB because it tends to exist without any clinical signs or symptoms. In addition, the diagnosis of GTB by culture remains a challenge due to low detection rates and its paucibacillary nature. Testing for prostate-specific antigen or the Y chromosome in order to account for the possible influences of recent exposure to semen on endometrial metabolism would be important. WIDER IMPLICATIONS OF THE FINDINGS The metabolic changes associated with the dormant tubercle infection are of potential relevance to clinicians for the treatment of dormant GTB-related infertility. STUDY FUNDING/COMPETING INTERESTS Government of India, Indian Council of Medical Research. There are no conflicts of interest.
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Affiliation(s)
- E Subramani
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - M Jothiramajayam
- Cell Biology and Genetic Toxicology Laboratory, Centre of Advanced study, Department of Botany, University of Calcutta, Kolkata 700019, India
| | - M Dutta
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - D Chakravorty
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - M Joshi
- National Facility for High-field NMR, Tata Institute of Fundamental Research, Mumbai 400005, India
| | - S Srivastava
- National Facility for High-field NMR, Tata Institute of Fundamental Research, Mumbai 400005, India
| | - A Mukherjee
- Cell Biology and Genetic Toxicology Laboratory, Centre of Advanced study, Department of Botany, University of Calcutta, Kolkata 700019, India
| | - C Datta Ray
- Department of Obstetrics and Gynaecology, Institute of Post-Graduate Medical Education and Research (IPGME&R) and SSKM Hospital, Kolkata 700020, India
| | | | - K Chaudhury
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
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Holder SL, Drabick J, Zhu J, Joshi M. Dexamethasone may be the most efficacious corticosteroid for use as monotherapy in castration-resistant prostate cancer. Cancer Biol Ther 2015; 16:207-9. [PMID: 25756508 PMCID: PMC4622618 DOI: 10.1080/15384047.2014.1002687] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Corticosteroids have been used in the therapy for castration-resistant prostate cancer (CRPC) for decades, both as monotherapy and in combination with additional agents. In this article the authors report the results of a phase II trial of dexamethasone versus prednisolone as monotherapy for CRPC. The study suggests improved PSA and radiographic response rates as well as improved time to PSA progression for dexamethasone over prednisolone therapy; however the differences only trend toward statistical significance. Nonetheless, in light of these data, when treating patients with corticosteroid monotherapy for CRPC it may be prudent to consider using daily dexamethasone over prednisone/prednisolone.
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Affiliation(s)
- S L Holder
- a Division of Hematology/Oncology; Department of Internal Medicine ; Penn State Milton S. Hershey Cancer Institute ; Hershey , PA USA
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Haq Z, Joshi M, Ghatahora S, Okorie M. Glucose infusion-induced liver dysfunction following treatment of prolonged hypoglycaemia after a massive insulin overdose. Br J Diabetes 2015. [DOI: 10.15277/bjdvd.2015.048] [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: 11/10/2022]
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Sillo T, Joshi M. Surgeons' perceptions on the impact of language barriers in the delivery of healthcare. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.162] [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: 10/22/2022]
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Constandinou T, Ogunsanya L, Joshi M, Hathaway C, Davies H. A local audit on the content and quality of operation notes using the royal college of surgeons' guidelines. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.317] [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: 10/22/2022]
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Abstract
Achieving optimal glucose control with minimal hypoglycemia and minimizing the impact of diabetes on quality of life are the aims of management of type 1 diabetes. The main therapeutic options for patients include multiple daily injections (MDI) and continuous subcutaneous insulin therapy (CSII). It is important to differentiate fixed dose MDI with more flexible use, based on carbohydrate counting and structured education programmes, often termed functional insulin therapy (FIT), shown to deliver better outcomes. A significant proportion of patients can achieve optimal glucose control with either therapy, and for those who are unable to achieve desired glucose control with MDI, there is a large body of observational data showing CSII enables them to reduce HbA1c and hypoglycemia, with associated improvements in diabetes-related quality of life. However, in many healthcare systems, guidelines restrict the use of CSII on the basis of cost, with only 20-35 % of patients with type 1 diabetes across Europe using CSII. Although data support improved glucose control and quality of life with CSII, we must recognize that insulin pump therapy is not for everyone and has some downsides such as being attached to a device or issues with cannulas. When we sit down with our patients, we have a responsibility to support those patients with the therapeutic strategy that is best suited to them. In this paper, we review some of the literature that informs this decision-making, highlighting areas where CSII offers clear benefits and also some areas where it may not be appropriate.
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Affiliation(s)
- Mamta Joshi
- Specialist Registrar in Diabetes and Endocrinology, King's College Hospital, Denmark Hill, SE5 9RS, London, UK,
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Dadu T, Sehgal K, Joshi M, Khodaiji S. Evaluation of the immature platelet fraction as an indicator of platelet recovery in dengue patients. Int J Lab Hematol 2015; 36:499-504. [PMID: 25356498 DOI: 10.1111/ijlh.12177] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Thrombocytopenia is a common complication in many disorders (such as aplastic anemia, ITP, dengue fever,), the etiology being multifactorial. Immature platelet fraction (IPF) is a new parameter which is a measure of reticulated platelets that reflects the rate of thrombopoiesis. We tried to evaluate IPF as an indicator to predict the recovery of platelets in patients with dengue. METHODS A total of 32 patients suffering from dengue fever (as confirmed by NS1 antigen or IgM antibody positivity for dengue) were taken for the study. The platelet count and IPF value of all these patients were evaluated on a daily basis. RESULTS It was found out that IPF has a strong correlation with the recovery of platelet counts in patients with dengue. 84.3% patients showed recovery within 24 h after attaining the peak IPF, 93.75% of the patients showed recovery within 24-48 h of the rise of the IPF compared with the previous day's value, and 100% patients showed a recovery within 24 h of the fall of the IPF compared with the previous days. It was also observed that 93.75% of the patients show platelet recovery within 24-48 h if the IPF was more than 10%. CONCLUSION Based on our study, we concluded that IPF can be used to evaluate the recovery of platelets in patients with dengue. It holds a great promise of becoming a reliable future guide for decisions concerning platelet transfusions.
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