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Chopra HK, Wander GS, Ponde CK, Nanda NC, Khullar D, Venugopal K, Ray S, Nair T, Rana DS, Kher V, S Sawhney JP, Kasliwa RR, Jabir A, Chakraborty R, Chandra P, Bansal S, Kumar V, Pancholia AK, Kapoor A, Prakash S, Saxena A, Rastogi V, Sharma V, Arora YK, Dasbiswas A, Bhargava M, Jaswal A, Bhargava K, Bhatia M, Omar AK, Khanna NN, Passey R, Bhalla D, Vijayalakshmi IB, Bhalla AK, Moorthy A, Isser HS, Mishra SS, Routray SN, Tandon V, Sinha A, Bansal M, Jain P, Hotchandani R, Jain D, Katyal VK, Gulati S, Tandon R, Jaggi S, Sehgal B, Gupta V, Mehrotra R, Krishnamani NC, Pathak SN, Yadav MS, Chawla R, Pal J, Chatterjee N, Samajdar SS, Shastry NR. The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement. J Assoc Physicians India 2023; 71:11-12. [PMID: 37354473 DOI: 10.5005/japi-11001-0209] [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] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
;Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril-Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril-Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril-Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril-Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40-50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.
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Affiliation(s)
- H K Chopra
- Senior Consultant Cardiologist, Medanta Moolchand Heart Institute, Delhi
| | - G S Wander
- Professor & Head of Cardiology, Hero DMC Heart Institute, Dayanand Medical College & Hospital (DMCH), Ludhiana, Punjab
| | - C K Ponde
- Consultant Cardiologist and Head of Department, Department of Cardiology, P. D. Hinduja Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Navin C Nanda
- Professor of Medicine and Cardiovascular Disease, Heersink School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, United Kingdom
| | - Dinesh Khullar
- Chairman, Department of Nephrology; Department of Kidney Transplant, Max Super Speciality Hospital, Delhi
| | - K Venugopal
- Professor Emeritus, Department of Cardiology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala
| | - Saumitra Ray
- Director, Department of Invasive Cardiology, AMRI Hospitals, Kolkata, West Bengal
| | - Tiny Nair
- Head, Department of Cardiology & Interventional Cardiology, PRS Hospital, Trivandrum, Kerala
| | - D S Rana
- Emeritus Consultant Nephrologist, Department of Nephrology, Sir Ganga Ram Hospital
| | - Vijay Kher
- Chairman; Department of Nephrology; Department of Kidney Transplant, Epitome Kidney Urology Institute & Lions Hospital
| | - J P S Sawhney
- Chairman, Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, Delhi
| | - R R Kasliwa
- Adjunct Professor, Department of Cardiology; Chairman, Department of Clinical and Preventive Cardiology, Medanta Moolchand Heart Institute, Gurugram, Haryana
| | - A Jabir
- Senior Consultant Cardiologist, Lisie Hospital, Kochi, Kerala
| | - Rabin Chakraborty
- Senior Vice Chairman and Head of Cardiology, Medica Superspecialty Hospital (MSH), Kolkata, West Bengal
| | - Praveen Chandra
- Chairman, Department of Interventional Cardiology, Medanta Moolchand Heart Institute
| | - Sandeep Bansal
- Professor and HOD, Department of Cardiology, Safdarjung Hospital
| | - Viveka Kumar
- Principal Director and Chief of Cath Lab, Department of Cardiac Sciences, Max Super Speciality Hospital, Delhi
| | - A K Pancholia
- HOD, Department of Medicine and Preventive Cardiology, Arihant Hospital & Research Centre, Indore, Madhya Pradesh
| | - Aditya Kapoor
- Professor and Head of the Department, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences
| | - Sunil Prakash
- Director and Head, Department of Nephrology; Department of Transplant service BLK, Max Super Speciality Hospital
| | - Anil Saxena
- Executive Director, Department of Cardiac Pacing and Electrophysiology, Fortis Escorts Heart Institute
| | - Vishal Rastogi
- Director of Cardiology, Department of Cardiology, Fortis Escorts Heart Institute
| | - Vinod Sharma
- Vice CEO and Head, Department of Cardiology, National Heart Institute
| | - Y K Arora
- Cardiologist, National Heart Institute, Delhi
| | - Arup Dasbiswas
- Ex-Director, ICVS, Institute of Post Graduate Medical Education and Research (IPGME&R); Chief Cardiologist, Das Biswas Clinic, Kolkata, West Bengal
| | - Mohan Bhargava
- Director, Department of Interventional Cardiology, Max Super Speciality Hospital, Delhi, India
| | - Aparna Jaswal
- Member, Board of Directors, International Board of Heart Rhythm Examiners, Columbia, Washington, United States of America; Director, Department of Cardiac Pacing and Electrophysiology, Fortis Escorts Heart Institute
| | - K Bhargava
- Senior Director, Department of Cardiac Electrophysiology and Pacing, Medanta Moolchand Heart Institute
| | - Mona Bhatia
- Principal, Director, Head, Department of Imaging, Fortis Escorts Heart Institute
| | - A K Omar
- Director, Head, Department of Non-Invasive Cardiology, Fortis Escorts Heart Institute
| | - N N Khanna
- Advisor, Senior Consultant, Department of Cardiology, Indraprastha Apollo Hospitals
| | | | - Dilip Bhalla
- Senior Director, Department of Nephrology and Renal Transplant, Max Super Speciality Hospital, Delhi
| | - I B Vijayalakshmi
- Professor Emeritus, Former HOD, Department of Paediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka
| | - A K Bhalla
- Chairman, Department of Nephrology, Sir Ganga Ram Hospital, Delhi
| | - Asha Moorthy
- Senior Consultant Cardiologist, SIMS Hospital, Chennai, Tamil Nadu
| | - H S Isser
- Department of Cardiology, VMMC & Safdarjung Hospital
| | | | - S N Routray
- Professor, Department of Cardiology, Srirama Chandra Bhanj Medical College & Hospital (S.C.B Medical College), Cuttack, Odisha
| | - Vivek Tandon
- Associate Director, In charge, Non-Invasive Cardiac Laboratory, Max Smart Super Speciality Hospital, Delhi
| | - Ajay Sinha
- Senior Consultant, Cardiologist, Jay Prabha Medanta Super Specialty Hospital, Patna, Bihar
| | - Manish Bansal
- Senior Director, Department Clinical and Preventive Cardiology, Medanta - The Medicity Multi-Speciality Hospital, Gurugram, Haryana
| | - Praveen Jain
- Executive Director, Chief Cardiologist, Lifeline Superspeciality Hospital and Heart Center, Jhansi, Uttar Pradesh
| | - Ramesh Hotchandani
- Consultant, Head, Department of Nephrology, Moolchand Centre for Renal Care and Dialysis, Moolchand Hospital, Delhi
| | - Dharmendra Jain
- Professor, Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
| | - V K Katyal
- HOD, Department of General Medicine, Positron Hospital; Formerly Senior Professor, HOD, Department of Medicine, Pt. B.D.Sharma, Post Graduate Institute of Medical Sciences, Rohtak, Haryana
| | - Sanjiv Gulati
- Principal Director, Department of Nephrology, Fortis Hospital, Delhi
| | - Rohit Tandon
- Senior Consultant Physician, Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College & Hospital (DMCH), Ludhiana, Punjab
| | - Shalini Jaggi
- Director, Consultant Diabetologist, Lifecare Diabetes Centre
| | - Blessy Sehgal
- Consultant Nephrologist, Department of Nephrology, Sri Balaji Action Medical Institute, Delhi
| | - Vitull Gupta
- Honorary Teaching Faculty, All India Institute of Medical Sciences; Consultant Physician, Kishori Ram Hospital, Bathinda, Punjab
| | - Rahul Mehrotra
- Director and Head, Department of Non-Invasive Cardiology, Max Super Speciality Hospital
| | | | - S N Pathak
- Senior Consultant Interventional Cardiologist, Indraprastha Apollo Hospital
| | - M S Yadav
- Senior Consultant, Department of Interventional Cardiology, Max Super Speciality Hospital
| | - Rajeev Chawla
- Senior Consultant Diabetologist, Director, North Delhi Diabetes Centre, Delhi
| | - Jyotirmoy Pal
- Professor, Department of General Medicine, R.G. Kar Medical College & Hospital
| | - Nandini Chatterjee
- Clinical Pharmacologist, Diabetes & Allergy-Asthma Therapeutics Specialty Clinic
| | - Shambo S Samajdar
- Professor, Department of Medicine, Institute of Post Graduate Medical Education and Research (IPGME&R) - SSKM Hospital
| | - N R Shastry
- Cardiologist, Department of Clinical Cardiology, Medanta-Moolchand Heart Centre, Delhi, India
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Puri R, Mehta V, Duell P, Iyengar S, Yusuf J, Dalal J, Narasingan S, Kalra D, Kapoor A, Pradhan A, Mukhopadhyay S, Vijayaraghavan K, Aggarwal R, Muruganathan A, Prabhakar D, Misra S, Shetty S, Kasliwal RR, Bansal M, Khanna NN, Khan A, Melinkeri RP, Kumar S, Chakraborty RN, Bardoloi N, Sahoo P, Vinayagam P, Modi R, Nanda R, Wong ND. Evidence for Intensive LDL-C Lowering for Acute Coronary Syndrome: Recommendations from the Lipid Association of India. J Clin Lipidol 2022; 16:261-271. [PMID: 35508456 DOI: 10.1016/j.jacl.2022.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 02/08/2023]
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Khanna NN. Innovations in cardiovascular sciences – A roadmap toward new standardization in cardiovascular treatment. Apollo Med 2022. [DOI: 10.4103/am.am_107_22] [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: 11/04/2022] Open
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4
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Gupta R, Das MK, Mohanan PP, Deb PK, Parashar SK, Chopra HK, Shrivastava S, Guha S, Goswami KC, Yadav R, Alagesan R, Amuthan V, Bansal M, Chakraborty RN, Chakraborti N, Chandra S, Chatterjee A, Chatterjee D, Chatterjee SS, Dutta AL, De A, Garg A, Garg VK, Goyal A, Goyal NK, Govind SC, Gupta VK, Hasija PK, Jabir A, Jain P, Jain V, Jayagopal PB, Kasliwal RR, Katyal VK, Kerkar PG, Khan AK, Khanna NN, Mandal M, Majumder B, Mishra SS, Meena CB, Naik N, Narain VS, Pancholia AK, Pathak LA, Ponde CK, Raghu K, Ray S, Roy D, Sarma D, Shanmugasundarum S, Singh BP, Tyagi S, Vijayaraghavan G, Wander GS, Wardhan H, Nanda NC. Cardiological society of India document on safety measure during echo evaluation of cardiovascular disease in the time of COVID-19. Indian Heart J 2020; 72:145-150. [PMID: 32768012 PMCID: PMC7250084 DOI: 10.1016/j.ihj.2020.05.016] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 01/08/2023] Open
Abstract
An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.
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Affiliation(s)
- Rakesh Gupta
- JROP Institute of Echocardiography, Ultrasound & Vascular Doppler, JROP Healthcare Pvt. Ltd., C-1/16, Ashok Vihar-II, Delhi, 110052, India; JROP Charak Heart City, MD City Hospital, Model Town Northex, Delhi, 110009, India.
| | - Mrinal Kanti Das
- C K Birla Group of Hospitals (BMB and CMRI), Kolkata, West Bengal, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | | | - S K Parashar
- Metro Heart Hospital, Lajpat Nagar, New Delhi, India
| | | | | | - Santanu Guha
- Calcutta Medical College Hospital, Kolkata, West Bengal, India
| | | | - Rakesh Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | | | - V Amuthan
- Jeyalakshmi Heart Center, Madurai, Tamilnadu, India
| | - M Bansal
- Medanta, The Medicity, New Delhi, India
| | - R N Chakraborty
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - N Chakraborti
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - S Chandra
- King George's Medical University, Lucknow, India
| | | | - D Chatterjee
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | | | | | - A De
- Apollo Gleneagles Hospital, Kolkata, India
| | - A Garg
- Jaipur Heart Institute, Jaipur, India
| | - V K Garg
- R D Gardi Medical College, Ujjain, India
| | - A Goyal
- Bani Park Hospital, Jaipur, India
| | - N K Goyal
- BLK Superspeciality Hospital, New Delhi, India
| | | | - V K Gupta
- Kishori Ram Hospital & Diabetes Care Centre, Bhatinda, India
| | | | - A Jabir
- Lisie Hospital Kochi, Kerala, India
| | - P Jain
- Lifeline Superspeciality Hospital, Jhansi, India
| | - V Jain
- Choithram Hospital &R.C., Indore, India
| | | | | | | | | | | | | | - M Mandal
- NRS Medical College, Kolkata, India
| | - B Majumder
- R.G. Kar Medical College & Hospital, Kolkata, India
| | - S S Mishra
- Hi-Tech Medical College and Hospital, Bhubaneshwar, India
| | - C B Meena
- SMS Medical College, Jaipur, Rajasthan
| | | | - V S Narain
- King George's Medical University, Lucknow, India
| | | | - L A Pathak
- Nanavati Heart Institute, Nanavati Superspeciality Hospital, Mumbai, India
| | - C K Ponde
- PD Hinduja National Hospital & RC, Mumbai, India
| | - K Raghu
- Care Hospital, Hyderabad, India
| | - S Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | - D Roy
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - D Sarma
- Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | | | | | - S Tyagi
- GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | | | - G S Wander
- Hero DMC Heart Institute, Ludhiana, India
| | - Harsh Wardhan
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - N C Nanda
- University of Alabama at Birmingham, Birmingham, AL, USA
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5
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Kerkar PG, Naik N, Alexander T, Bahl VK, Chakraborty RN, Chatterjee SS, Chopra HK, Dani SI, Deb PK, Goswami KC, Guha S, Gupta R, Gupta V, Hasija PK, Jayagopal PB, Justin Paul G, Kahali D, Katyal VK, Khanna NN, Mandal M, Mishra SS, Mohanan PP, Mullasari A, Mehta S, Pancholia AK, Ray S, Roy D, Shanmugasundarm S, Sharma S, Singh BP, Tewari S, Tyagi SK, Venugopal KN, Wander GS, Yadav R, Das MK. Cardiological Society of India: Document on acute MI care during COVID-19. Indian Heart J 2020; 72:70-74. [PMID: 32534693 PMCID: PMC7201231 DOI: 10.1016/j.ihj.2020.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022] Open
Abstract
The unprecedented and rapidly spreading Coronavirus Disease-19 (COVID-19) pandemic has challenged public health care systems globally. Based on worldwide experience, India has initiated a nationwide lockdown to prevent the exponential surge of cases. During COVID-19, management of cardiovascular emergencies like acute Myocardial Infarction (MI) may be compromised. Cardiological Society of India (CSI) has ventured in this moment of crisis to evolve a consensus document for care of acute MI. However, this care should be individualized, based on local expertise and governmental advisories.
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Affiliation(s)
- P G Kerkar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Naik
- All India Institute of Medical Sciences, New Delhi, India
| | - T Alexander
- Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - V K Bahl
- All India Institute of Medical Sciences, New Delhi, India
| | - R N Chakraborty
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - S S Chatterjee
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | | | - S I Dani
- Apollo Hospital, Ahmedabad, Gujarat, India
| | - P K Deb
- Daffodil Hospital, Kolkata, West Bengal, India
| | - K C Goswami
- All India Institute of Medical Sciences, New Delhi, India
| | - S Guha
- Calcutta Medical College Hospital, Kolkata, West Bengal, India
| | - R Gupta
- JROP Healthcare, New Delhi, India
| | - V Gupta
- Kishori Ram Hospital & Diabetes Care Centre, India
| | - P K Hasija
- Armed Forces Medical College, Pune, Maharashtra, India
| | | | | | - D Kahali
- BM Birla Heart Research Center, Kolkata, West Bengal, India
| | - V K Katyal
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - N N Khanna
- Indraprastha Apollo Hospital, New Delhi, India
| | - M Mandal
- NRS Medical College and Hospital, Kolkata, West Bengal, India
| | - S S Mishra
- Hi-Tech Medical College and Hospital, Bhubaneshwar, Odisha, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | - A Mullasari
- Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
| | - S Mehta
- University of Miami, Florida, USA
| | | | - S Ray
- Vivekanand Institute of Medical Sciences, Kolkata, West Bengal, India
| | - D Roy
- Rabindranath Tagore International Institute of Medical Sciences, Kolkata, West Bengal, India
| | | | | | - B P Singh
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - S Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - K N Venugopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - G S Wander
- Dayanand Medical College, Ludhiana, Punjab, India
| | - R Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | - M K Das
- C K Birla Group of Hospitals (BMB and CMRI), Kolkata, West Bengal, India.
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Harikrishnan S, Mohanan PP, Chopra VK, Ambuj R, Sanjay G, Bansal M, Chakraborty RN, Chandra S, Chattarjee SS, Chopra HK, Mathew C, Deb PK, Goyal A, Goswami KC, Gupta R, Guha S, Gupta V, Hasija PK, Wardhan H, Jabir A, Jayagopal PB, Kahali D, Katyal VK, Kerkar PG, Khanna NN, Majumder B, Mandal M, Meena CB, Naik N, Narain VK, Pathak LA, Ray S, Roy D, Routray SN, Sarma D, Shanmugasundaram S, Singh BP, Tyagi SK, Venugopal K, Wander GS, Yadav R, Das MK. Cardiological society of India position statement on COVID-19 and heart failure. Indian Heart J 2020; 72:75-81. [PMID: 32405088 PMCID: PMC7219407 DOI: 10.1016/j.ihj.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- S Harikrishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
| | | | | | | | - G Sanjay
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | | | | | | | | | - P K Deb
- Daffodil Hospitals, Kolkata, India
| | - A Goyal
- Bani Park Hospital, D-9, Kabir Marg, Bani Park, JAIPUR, 302016, Rajasthan, India
| | | | - R Gupta
- JROP Institute of Echocardiography, New Delhi, India
| | - S Guha
- Medical College, Kolkata, India
| | - V Gupta
- Kishori Ram Hospital & Diabetes Care Centre, Bhatinda, Punjab, India
| | - P K Hasija
- MH Chennai, Armed Forces Medical Services, India
| | - Harsh Wardhan
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | | | | | - D Kahali
- C.K.Birla Group of Hospitals (BMB), Kolkata, India
| | | | | | - N N Khanna
- Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - B Majumder
- R.G. Kar Medical College, Kolkata, India
| | - M Mandal
- NRS Medical College, Kolkata, India
| | - C B Meena
- SMS Medical College, Jaipur, Rajasthan, India
| | | | - V K Narain
- King George's Medical University, Lucknow, India
| | - L A Pathak
- Nanavati Superspeciality Hospital, Mumbai, India
| | - S Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | - D Roy
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | | | - D Sarma
- Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | | | | | - S K Tyagi
- GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | | | | | | | - M K Das
- C.K. Birla Group of Hospitals (BMB/CMRI), Kolkata, India
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7
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Saba L, Biswas M, Suri HS, Viskovic K, Laird JR, Cuadrado-Godia E, Nicolaides A, Khanna NN, Viswanathan V, Suri JS. Ultrasound-based carotid stenosis measurement and risk stratification in diabetic cohort: a deep learning paradigm. Cardiovasc Diagn Ther 2019; 9:439-461. [PMID: 31737516 PMCID: PMC6837906 DOI: 10.21037/cdt.2019.09.01] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/20/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Stroke is in the top three leading causes of death worldwide. Non-invasive monitoring of stroke can be accomplished via stenosis measurements. The current conventional image-based methods for these measurements are not accurate and reliable. They do not incorporate shape and intelligent learning component in their design. METHODS In this study, we propose a deep learning (DL)-based methodology for accurate measurement of stenosis in common carotid artery (CCA) ultrasound (US) scans using a class of AtheroEdge system from AtheroPoint, USA. Three radiologists manually traced the lumen-intima (LI) for the near and the far walls, respectively, which served as a gold standard (GS) for training the DL-based model. Three DL-based systems were developed based on three types of GS. RESULTS IRB approved (Toho University, Japan) 407 US scans from 204 patients were collected. The risk was characterized into three classes: low, moderate, and high-risk. The area-under-curve (AUC) corresponding to three DL systems using receiver operating characteristic (ROC) analysis computed were: 0.90, 0.94 and 0.86, respectively. CONCLUSIONS Novel DL-based strategy showed reliable, accurate and stable stenosis severity index (SSI) measurements.
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Affiliation(s)
- Luca Saba
- Department of Radiology, A.O.U., Cagliari, Italy
| | - Mainak Biswas
- Department of Computer Science and Engineering, JIS University, Agarpara, Kolkata, India
| | | | - Klaudija Viskovic
- Department of Radiology and Ultrasound University Hospital for Infectious Diseases, Zagreb, Croatia
| | - John R. Laird
- Heart and Vascular Institute, Adventist, St. Helena Hospital, Napa Valley, CA, USA
| | | | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, London, UK
- Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - N. N. Khanna
- Cardiology Department, Indraprastha Apollo Hospitals, New Delhi, India
| | - Vijay Viswanathan
- MV Hospital for Diabetes and Professor M Viswanathan Diabetes Research Centre, Chennai, India
| | - Jasjit S. Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
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Guha S, Sethi R, Ray S, Bahl VK, Shanmugasundaram S, Kerkar P, Ramakrishnan S, Yadav R, Chaudhary G, Kapoor A, Mahajan A, Sinha AK, Mullasari A, Pradhan A, Banerjee AK, Singh BP, Balachander J, Pinto B, Manjunath CN, Makhale C, Roy D, Kahali D, Zachariah G, Wander GS, Kalita HC, Chopra HK, Jabir A, Tharakan J, Paul J, Venogopal K, Baksi KB, Ganguly K, Goswami KC, Somasundaram M, Chhetri MK, Hiremath MS, Ravi MS, Das MK, Khanna NN, Jayagopal PB, Asokan PK, Deb PK, Mohanan PP, Chandra P, Girish CR, Rabindra Nath O, Gupta R, Raghu C, Dani S, Bansal S, Tyagi S, Routray S, Tewari S, Chandra S, Mishra SS, Datta S, Chaterjee SS, Kumar S, Mookerjee S, Victor SM, Mishra S, Alexander T, Samal UC, Trehan V. Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India. Indian Heart J 2017; 69 Suppl 1:S63-S97. [PMID: 28400042 PMCID: PMC5388060 DOI: 10.1016/j.ihj.2017.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Rishi Sethi
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saumitra Ray
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Vinay K Bahl
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Prafula Kerkar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Rakesh Yadav
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Aditya Kapoor
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajay Mahajan
- Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | | | | | | | - Amal Kumar Banerjee
- Institute of Post Graduate Medical Education & Research and Memorial Hospital, Kolkata, West Bengal, India
| | - B P Singh
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - J Balachander
- Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Brian Pinto
- Holy family Hospital, Mumbai, Maharashtra, India
| | - C N Manjunath
- Sri Jaydeva Institute of Cardiovascular Sciences & Research, Bangaluru, Karnataka, India
| | | | | | - Dhiman Kahali
- BM Birla Heart Research Center, Kolkata, West Bengal, India
| | | | - G S Wander
- Hero DMC Heart Institute, Ludhiana, Punjab, India
| | - H C Kalita
- Assam Medical College, Dibrugarh, Assam, India
| | | | - A Jabir
- Lisie Hospital, Kochi, Kerala, India
| | - JagMohan Tharakan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Justin Paul
- Madras Medical College, Chennai, Tamil Nadu, India
| | - K Venogopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - K B Baksi
- Belle Vue Clinic, Kolkata, West Bengal, India
| | | | - Kewal C Goswami
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - M K Chhetri
- IPGMER & SSKM Hospital, Kolkata, West Bengal, India
| | | | - M S Ravi
- Madras Medical College, Chennai, Tamil Nadu, India
| | | | | | | | - P K Asokan
- The Fatima Hospital, Calicut, Kerala, India
| | - P K Deb
- ESI Hospital, Manicktala, Kolkata, West Bengal, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | | | - Col R Girish
- Command Hospital, Central Command, Lucknow, India
| | - O Rabindra Nath
- Apollo Gleneagles Heart Institute, Kolkata, West Bengal, India
| | | | - C Raghu
- Prime Hospitals, Hyderabad, India
| | | | | | - Sanjay Tyagi
- GB Pant Institute of Post Graduate Medical Education & Research, New Delhi, India
| | | | - Satyendra Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | | | | | - S S Chaterjee
- Indra Gandhi Institute of Cardiology, Patna, Bihar, India
| | - Soumitra Kumar
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | | | | | - Sundeep Mishra
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Vijay Trehan
- Indo-US Super Speciality Hospital, Hyderabad, India
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Rajput R, Gupta S, Khanna NN. A rare case of ruptured subclavian artery aneurysm treated successfully with covered stent. Indian Heart J 2009; 61:308-309. [PMID: 20503846] [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: 05/29/2023] Open
Abstract
Subclavian artery aneurysms are uncommon. Presentation with complication of rupture is extremely rare. We report a patient presenting as hemothorax and shock because of ruptured right subclavian artery aneurysm. This was successfully treated with placement of a covered stent with good clinical outcome.
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Affiliation(s)
- Rajeeve Rajput
- Department of Cardiology, Indraprastha Apollo Hospitals, New Delhi 110076, India.
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Seth A, Khanna NN. Immediate interventions in acute myocardial infarction. J Assoc Physicians India 2001; Suppl 2:47-52. [PMID: 11235618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- A Seth
- Escorts Heart Institute and Research Centre, New Delhi, 110025
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Pathak KA, Khanna R, Khanna HD, Khanna S, Gupta S, Khanna NN. Carcinoembryonic antigen: an invaluable marker for advanced breast cancer. J Postgrad Med 1996; 42:68-71. [PMID: 9715319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Serial serum Carcinoembryonic antigen (CEA) levels were measured in 150 individuals (50 patients with breast cancer, 50 benign breast diseases and 50 other controls). These levels were correlated with clinicopathological parameters and follow-up information. Serum CEA levels were independent of the primary tumor status, their histology, lymphoreticular response and the patients' characteristics as well as the age, sex and the menstrual status. However, the nodal status, number of involved nodes and the grade of the tumors had significant influence on the level of serum CEA. Breast cancer patients especially those with metastasis had significantly higher serum CEA levels as compared to the controls and those with localised disease, irrespective of the site of metastasis. These levels were lowered appreciably by the disease regression and were raised or stable during the disease progression. Receiver operating characteristic (ROC) curve showed metastasis to be more frequent in patients with pretreatment serum CEA levels above 25 ng/ml and persistent post treatment CEA levels above 15 ng/ml. Serum CEA level was found to be a valuable prognostic indicator for advanced breast cancer and serial serum CEA levels provided an average lead time of about 3.9 months before the clinical appearance of metastasis.
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Affiliation(s)
- K A Pathak
- Department of Surgery, Biophysics and Pathology, Banaras Hindu University, Varanasi
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Khanna NN, Singhal SS. Coronary reperfusion injury. J Assoc Physicians India 1996; 44:267-8. [PMID: 9251400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- N N Khanna
- Deptt. of Cardiology L.P.S. Institute of Cardiology GSVM Medical College, Kanpur
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Abstract
Oral cholecystography is the basic radiodiagnostic procedure required to assess chemical composition of gallstones as well as functional status of gall bladder prior to non-surgical management of gallstones. However, the value of ultrasound in non-surgical management of gallstones is yet to be proved. In this study we attempt to establish sonographic criteria which will predict the composition of gallstones prior to their non-surgical treatment. For this purpose the ultrasonographic characteristics of 233 patients with gallstone disease and functioning gall bladders were studied and an effort was made to correlate cholesterol and calcium content of different types of stones (as estimated by X-Ray powder diffraction study and atomic absorption spectrophotometry) with their ultrasonographic characteristics. Sonographic criteria for the presence of cholesterol stones were those which were floating and gallstones producing acoustic shadowing without internal echoes from within the stone. In detecting findings which would predict the presence of cholesterol stones on ultrasound, ultrasound had a sensitivity of 72.90% and a specificity of 100%. The predictive values of positive findings and negative findings were 100% and 93.4%, respectively. The demonstration of typical features of cholesterol stones on ultrasound obviates the need for oral cholecystography.
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Affiliation(s)
- B S Kapoor
- Department of Surgery, University Hospital, Banaras Hindu University, Varanasi, India
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Pathak KA, Khanna R, Khanna NN. Situs inversus with cholelithiasis. J Postgrad Med 1995; 41:45-6. [PMID: 10707709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Situs inversus totalis is a form of heterotaxia which is usually detected accidentally while investigating for any associated condition. If undetected, this condition can create a diagnostic puzzle. We report one such case in which situs inversus was associated with cholelithiasis.
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Affiliation(s)
- K A Pathak
- Department of Surgery, Banaras Hindu University, Varanasi, India
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Abstract
A case of unilateral giant hydronephrosis containing about 20 litres of old haemorrhagic fluid, clinically simulating massive ascites, is reported. The role of preceding abdominal trauma in the pathogenesis and the rapidity of the disease process is discussed.
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Affiliation(s)
- N K Singh
- Department of Medicine, Institute of Medical Sciences, Varanasi, India
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Kuhn MJ, Couch SM, Binstadt DH, Rightmire DA, Morales A, Khanna NN, Long SD. Prenatal recognition of central nervous system complications of alloimmune thrombocytopenia. Comput Med Imaging Graph 1992; 16:137-42. [PMID: 1568201 DOI: 10.1016/0895-6111(92)90128-v] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The radiological findings associated with alloimmune thrombocytopenia have not been well described. We present two such cases diagnosed in utero by ultrasound and discuss the radiographic findings of intracranial hemorrhage and hydrocephalus secondary to alloimmune thrombocytopenia. An awareness of this entity and its early diagnosis and intervention may greatly reduce the morbidity and mortality associated with alloimmune thrombocytopenia.
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Affiliation(s)
- M J Kuhn
- Department of Radiology, Southern Illinois University, School of Medicine, Springfield 62769
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Khanna AK, Singh MR, Khanna S, Khanna NN. Fine needle aspiration cytology, imprint cytology and tru-cut needle biopsy in breast lumps: a comparative evaluation. J Indian Med Assoc 1991; 89:192-5. [PMID: 1940411] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Fine needle aspiration cytology, imprint cytology and tru-cut needle biopsy were performed in 86 patients with breast lump and the results of these techniques were finally compared with the incisional or excisional biopsy in all the patients. Fine needle aspiration cytology had the sensitivity of 96.8% and specificity of 100%, the imprint cytology had the sensitivity of 98.4% and specificity of 100%. While the tru-cut needle biopsy had the sensitivity and specificity of 100% though in this technique 15 of 86 (17.4%) specimens were rejected as insufficient for any diagnosis.
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Affiliation(s)
- A K Khanna
- Institute of Medical Sciences, Banaras Hindu University, Varanasi
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Jain P, Khanna NN, Chatarjee S, Das SN. Total peripheral lymphocyte count and T-cell percentage in patients with breast cancer. J Indian Med Assoc 1988; 86:143-5. [PMID: 3266498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Jain P, Khanna NN. Delayed cutaneous hypersensitivity reaction in breast cancer patients. J Indian Med Assoc 1988; 86:5-7. [PMID: 3288701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
Thirty cases of fungating breast cancer (stages III and IV) were treated preoperatively by combination chemotherapy using cyclophosphamide (Endoxan), methotrexate, 5-fluorouracil, and prednisone. Mastectomy was performed after 2 cycles of preoperative chemotherapy followed by 6 more cycles postoperatively. Of 30 patients, 25 (83.3%) were made operable and had better disease-free survival. Preoperative chemotherapy has an advantage as regards improvement in quality and longevity without much toxicity, and provides a better palliation.
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Affiliation(s)
- A Kumar
- Department of Surgery and Pathology, Banaras Hindu University, Varanasi, India
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Jain P, Khanna S, Khanna NN. Aspiration and imprint cytology as rapid diagnostic methods in breast cancer. J Indian Med Assoc 1987; 85:355-7. [PMID: 3450729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
The ABH isoantigen was investigated in 80 patients with squamous cell carcinoma of the oral cavity and in their 46 affected lymph nodes. Isoantigen deletion shows a characteristic pattern of benign to malignant transformation of oral cancer. Total loss of isoantigen was found in anaplastic tumours, in metastatic lymph nodes and in the majority of advanced stage tumours. Total loss of isoantigen in metastatic lymph nodes indicates a frequent discharge of isoantigen-negative metastatic cells from the primary tumours to the lymph nodes and the regional organs. It seems that with the recent techniques a prospective observation of ABH isoantigen added to other pathological and clinical findings could be of prognostic significance in patients with squamous cell carcinoma of the oral cavity.
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Das SN, Khanna NN, Khanna S. In vivo and in vitro observation of cellular immune parameters in squamous cell carcinoma of the oral cavity and its correlation with tumor load and prognosis. Cancer Invest 1986; 4:207-16. [PMID: 3719410 DOI: 10.3109/07357908609018450] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In vivo and in vitro observations of cellular immune response in 70 patients with squamous cell cancer of the oral cavity and in 40 age-matched normal controls, were made using delayed hypersensitivity responses to DNCB, PPD, and Candida albicans extract (Dermatophytin 'O'), absolute lymphocyte counts, absolute T-cell numbers, and PHA-induced lymphocyte blastogenesis reactions as parameters. The results were correlated with clinical stage, tumor size, lymph node involvement, tumor differentiation, lymphoreticular responses, and outcome during a one-year follow-up period. A significant degree of impairment of both in vivo and in vitro parameters was found in oral cancer patients compared to normal control. The impairment was more prominent in advanced stages. Lymph node involvement was associated with impaired dermal hypersensitivity to recall antigens as well as a reduced T-cell population and blastogenic response. Only delayed hypersensitivity response to DNCB, PPD, and Candida showed a correlation with histologic features such as tumor differentiation and lymphoreticular response. Although absolute lymphocyte counts and T-cell population were reduced in the primary stage of the disease, the functional capacity of isolated lymphocytes to undergo blast formation was retained. PHA-induced lymphocyte blastogenesis showed a significant impairment only when the tumor was well established and disseminated beyond its local confines. Delayed hypersensitivity responses to DNCB, higher T-cell counts, and blastogenic indices were associated with recurrence-free survival. Immunologic parameters provide prognostic information beyond the clinical stage of the disease. Therefore, it seems that a multiparametric in vivo and in vitro observation of cellular immune response may be useful as an indicator of clinical course and prognosis of patients with squamous cell cancer of the oral cavity.
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Abstract
Fifty-four patients with advanced upper gastrointestinal cancer were assessed for their nutritional status prior to any form of therapy. Anthropometric parameters--weight loss, arm muscle circumference, skin-fold thickness--and biochemical parameters--serum albumin and delayed cutaneous hypersensitivity reactions to purified protein derivative (PPD) and phytohemagglutinin (PHA)--were used for nutritional assessment. Using standard values for comparison, about 80% of all patients were found to be nutritionally depleted. Immunocompetence did not show significant correlation with other nutritional parameters.
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Abstract
Thirty-eight cases of advanced upper gastrointestinal cancer were assessed for their immune status prior to any form of therapy. Cell-mediated immunity, as tested by absolute lymphocyte count, T-cell count and delayed cutaneous hypersensitivity reactions to purified protein derivative and phytohemagglutinin showed severe depression. Immunoglobulins A and M were elevated, while immunoglobulin G reduced. No correlation could be established between the immune status and the site of cancer or its extent, the performance status of the patients, or their response to chemotherapy.
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Gupta YN, Gupta S, Singh IJ, Khanna NN, Agarwal MK. Epithelial isoantigens A, B and H in oral carcinomas. Ear Nose Throat J 1985; 64:239-42. [PMID: 3996275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Das SN, Khanna NN, Khanna S. A multiparametric observation of immune competence in breast cancer and its correlation with tumour load and prognosis. Ann Acad Med Singap 1985; 14:374-81. [PMID: 3876055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A multiparametric observation of cellular immune status by delayed hypersensitivity response to primary and recall antigens, absolute lymphocyte counts, T-cells counts, lymphocyte stimulation to PHA and serum immunoglobulin levels (IgG, IgM, IgA) was done in 60 patients of breast cancer and 40 age-matched normal controls. The findings were correlated with clinical stage, tumour size, lymphnode involvement, distant metastases, tumour differentiation, lymphoreticular response and tumour recurrence within one year of follow-up period. Delayed hypersensitivity response to DNCB, PPD and Candida was significantly impaired (P = less than .001) in breast cancer patients as compared to normal controls. DNCB and candida response showed a gradual decrease with increasing clinical stage and PPD response was impaired in the advanced stage (Stage III and IV). Patients with well-differentiated tumour were more anergic than those with poorly differentiated tumour. Delayed hypersensitivity response to both primary and recall antigen showed a good correlation with tumour recurrence. Patients who had early recurrence or progressive disease were more anergic to all the three antigens. Absolute lymphocyte counts, absolute T-cells and E-rosette were significantly reduced in breast cancer patients as compared to normal controls and further correlated with clinical stage. Absolute T-cells and E-rosettes were lower in patients with lymphnode involvement, and distant metastases as compared to those with localized tumour. Absence of lymphoreticular response was related with impaired T-cell population. Absolute T-cell counts and E-rosettes further correlated with prognosis of the patients being significantly impaired in patients with early recurrence or with progressive disease (P = less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Khanna AK, Khanna NN. Some observations on oral cancer. Indian J Med Sci 1985; 39:23-6. [PMID: 3997214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
In a kindred of 46 individuals of an Indian Sikh family with no history of consanguinity, 8 suffered from site specific colon (caecum) cancer (not associated with polyposis). The clinical features in the affected kindred were indicative of a "cancer family syndrome". The study of the family depicted an autosomal dominant transmission pattern of site specific colon cancer, with probably 100% penetrance in the affected individuals. A low percentage of mitotic index (MI) was observed in the two probands who were available for the study. No structural or numerical chromosomal aberrations were observed in either case. It is probable that the gene responsible in this family could have begun by mutation at the germ cell level in the 1st generation and remained in a heterozygous condition in the affected individuals.
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Kumar A, Khanna NN, Pant GC, Khanna S. High-dose versus low-dose CMFP regimen in advanced breast cancer. J Surg Oncol 1984; 25:300-2. [PMID: 6371385 DOI: 10.1002/jso.2930250417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Fifty cases of advanced breast cancer (stages III and IV) were treated by combination chemotherapy. The study compares the two different dose schedules and toxicities of a combination of cyclophosphamide, methotrexate, 5-flurouracil, and prednisone. Results are better with high-dose regimen, though the incidence of toxicity is much as compared to low-dose schedules, but, considering the beneficial response, the high-dose schedule is recommended.
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Abstract
A case of qualitative platelet dysfunction following cancer chemotherapy is documented. Besides the numerical reduction defect, there appear to be functional changes in the platelets leading to bleeding diathesis. The present case was thoroughly evaluated, and it was observed that there is suppression of the platelet functions in a patient receiving cancer chemotherapy, a combination of cyclophosphamide, methotrexate, and 5-fluorouracil.
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Abstract
The authors report a case of a premature infant with unusually high concentrations of transplacentally acquired caffeine. The mother drank 24 cups of coffee per day during pregnancy. The infant developed apnea, and not having known the above maternal history, was started on caffeine therapy. Serum caffeine concentration was found to be 40.3 micrograms/ml prior to caffeine administration on the fifth day of age. Caffeine concentration at birth was probably much higher based on the pharmacokinetic extrapolation (caffeine half-life of 100 hours). It is suggested that manifestation of apnea in this infant may have been related to caffeine withdrawal.
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Abstract
Thirty advanced cases of cancer of the oral cavity were treated by intensive combination chemotherapy using bleomycin, methotrexate, 5-fluorouracil, cyclophosphamide, and Oncovin administered over a period of 48 hours. Bleomycin was given as a continuous infusion and Oncovin was administered six hours prior to the administration of other drugs. A clinical response was obtained in 73.3% of the cases, a complete response in 33.3%, and a partial response in 40%. The toxicity was within acceptable limits.
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Das SN, Khanna NN, Khanna S. Delayed hypersensitivity in squamous cell carcinoma of the oral cavity. Ann Acad Med Singap 1983; 12:416-9. [PMID: 6354055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Delayed hypersensitivity response to Dinitrochlorobenzine (DNCB), Purified Protein Derivative (PPD) and Candida albicans abstract (Dermatophytin 'O') was observed in 60 patients of squamous cell carcinoma of the oral cavity and 40 normal controls. The response to all these three antigens were significantly impaired in cancer patients as compared to normal controls. PPD and Dermatophytin 'O' response showed progressive decline with increasing tumour burden. Patients with well differentiated tumours responded well to all these three antigens as compared to those with poorly differentiated tumours.
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Menke JA, Bashiru M, Bada HS, Menten TG, Khanna NN, Chua C. Microcomputer evaluation of cerebral blood flow velocity studies in the neonate. Comput Biol Med 1983; 13:257-64. [PMID: 6661907 DOI: 10.1016/0010-4825(83)90001-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A semi-automated system for evaluation of Doppler cerebral blood flow studies obtained from newborn infants is described. A low cost digitizer is used to convert the graphic data from the flow tracing to digital data. A small business computer is used to analyze the data and produce a chartable report. The reliability of the digitizer is also evaluated.
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Khanna S, Khanna NN. Congenital absence of vagina: an analysis of 18 cases corrected by the McIndoe operation using a condom mould. Int Surg 1982; 67:345-6. [PMID: 7160995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Bashiru M, Mongkolsmai C, Von Behren PA, Menke JA, Chua C, Khanna NN. Microcomputer-assisted evaluation of pediatric echocardiograms. Appl Radiol 1982; 11:55-8. [PMID: 10260615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Menke JA, Miles R, McIlhany M, Bashiru M, Chua C, Schwied E, Menten TG, Khanna NN. The fontanelle tonometer: a noninvasive method for measurement of intracranial pressure. J Pediatr 1982; 100:960-3. [PMID: 7086600 DOI: 10.1016/s0022-3476(82)80528-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The use of a modified pneumotonometer as a noninvasive method to measure intracranial pressure through the fontanel was evaluated in the animal laboratory and in the clinical setting. Pressure measured with the tonometer from a surgically created fontanel in an adult mongrel dog demonstrated good correlation with pressure measured from an epidural balloon catheter. Pressure recorded with the tonometer was compared with direct measurements in a single infant. There were 20 paired measurements with a correlation coefficient of 0.91. Fontanel pressure was measured in 72 healthy infants. The mean pressure was 7.0 mm Hg with a standard deviation of 1.75. This result compares favorably with previous reports utilizing other methods. The machine is safe and simple to use.
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Abstract
Serum immunoglobulins (IgG, IgA, and IgM) have been studied in 70 patients with squamous cell carcinoma of oral cavity and in 40 age-matched normal controls. The results were correlated with clinical stage, tumor size, lymph node status, tumor differentiation, and treatment modalities. There was a significant rise in serum IgM and IgA in oral cancer patients as compared to controls. It was further raised in advanced clinical stage, but tumor size and histological differentiation and treatment modalities (surgery and chemotherapy) do not seem to affect serum immunoglobulin levels. The observations implies that the extension and dissemination of tumor mass is the important factor for the change in serum immunoglobulin level in squamous cell carcinoma of the oral cavity.
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Bada HS, Miller JE, Menke JA, Menten TG, Bashiru M, Binstadt D, Sumner DS, Khanna NN. Intracranial pressure and cerebral arterial pulsatile flow measurement in neonatal intraventricular hemorrhage. J Pediatr 1982; 100:291-6. [PMID: 6977024 DOI: 10.1016/s0022-3476(82)80657-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We examined the clinical significance of noninvasive intracranial pressure measurements and pulsatility indices in 74 infants with confirmed IC-IVh. The intracranial pressure measurements were obtained using the applanation principle, and the pulsatility indices were calculated from the Doppler flow velocity tracings of the anterior cerebral artery. Fifty-three infants (71.6%) who died had a significantly lower birth weight and gestational age than those who survived. Survival rate decreased significantly with increased intracranial pressure (P less than 0.0002) and increased pulsatility indices (P less than 0.0001). We found no significant relationship between outcome and the size of IC-IVH demonstrated by CT scan. Birth weight, intracranial pressure measurements, and cerebral arterial pulsatile flow changes appear to be major prognostic indicators in neonatal IC-IVH.
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Khanna NN, Somani SM, Boyer A, Miller J, Chua C, Menke JA. Cross validation of serum to saliva relationships of caffeine, theophylline and total methylxanthines in neonates. Dev Pharmacol Ther 1982; 4:18-27. [PMID: 7117087 DOI: 10.1159/000457387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We have previously described the relationships of serum and saliva concentrations of caffeine, theophylline and total methylxanthines in premature infants. We have now extended the previous studies in order to validate the previously derived relationships with new data. The new serum to saliva relationships, derived using regression and ratio models, are cross validated against the relationships from the previous data, and vice versa. A good cross validation was observed for caffeine and total methylxanthine concentrations in infants treated with caffeine. In the theophylline treatment group, theophylline concentrations did not cross validate well, whereas the total methylxanthine concentrations did. Since in vivo conversion of theophylline to caffeine and vice versa may affect the individual methylxanthine relationships, the total methylxanthine equations are recommended for predicting serum concentrations from salivary concentrations.
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Somani SM, Khanna NN. Methylxanthines in serum, saliva, and spinal fluid of premature infants. Semin Perinatol 1981; 5:346-50. [PMID: 7302610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Khanna NN, Sinha JK, Tripathi FM, Srivastava AB, Khanna S. Temporomandibular ankylosis. Ann Acad Med Singap 1981; 10:175-9. [PMID: 7332278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Temporomandibular ankylosis is commonly seen in children and young adults. Trauma in childhood is the commonest cause. Treatment of choice is by surgical intervention. Depending upon the local findings a gap arthroplasty or interposition arthroplasty is the procedure carried out. Early mobilisation is recommended.
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Khanna NN, Kumar A, Khanna S, Pant GC, Sanyal B. Chemotherapy for advanced breast cancer. Indian J Cancer 1981; 18:59-62. [PMID: 7262908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
Eighteen cases of sarcomas of the breast are reported. Cases could be divided into two groups histogenetically. Group A, malignant cystosarcoma phylloides (14 cases); and Group B, pure sarcomas (4 cases). The malignant cystosarcoma phylloides occurred in the forth decade, had linger duration of illness invariably followed by sudden increase in the size of the tumor, had a striking mucoid and slimy look grossly, and showed discernible epithelial elements histologically. In the event of their recurrence the ductal elements were not seen microscopically. Contrarily, Group B cases presented in the sixth decade were rapidly growing from the beginning, and grossly were fleshy and haemorrhagic. Microscopically these did not reveal any epithelial component. There was poor correlation between cytologic malignancy and the biologic behavior in Group A. Mode of treatment seems more important in determining the subsequent course of the disease. Simple mastectomy with follow-up appears to be adequate in the majority of cases.
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Abstract
Reports on comprehensive mandibular tumours are very rare. The present article describes a total of 81 primary tumour and tumour-like lesions of the mandible seen at the University Hospital, Banaras Hindu University, during last 16 years. In the mandible the ratio of odontogenic to nonodontogenic tumors is 1.6:1. Ameloblastomas constitute 56% of the odontogenic tumors. Among the benign mesenchymal tumours of the jaw 58% are neoplastic and 42% are nonneoplastic in which cementoostoid tissue is laid down secondary to inflammatory process. Over all 40 cases are benign 28 potentially malignant (ameloblastoma) and 13 are malignant lesions. Among the malignant mandibular tumours, bone tumours are more common than the soft tissue sarcomas. Microscopically mandibular osteosarcomas are better differentiated than similar tumours in the long bones. Local, segmental, or radical surgery seems to be the treatment of choice in the mandibular tumours.
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Abstract
Out of 840 cases of breast carcinoma seen over a period of ten years, 18 were found to be associated with pregnancy and lactation. According to the mode of onset and presentation of the disease, these patients were divided into four groups. The average age of these patients was 31.9 years old. Thirteen out of 18 patients presented in a very advanced stage of the disease. In a short period, involvement of liver was noticed in 8, brain in 3, and bones and lung in 2 each. The disease was bilaterally simultaneous in two patients. The acceleration of growth was noticed during second and third trimesters of pregnancy as well as during lactation. The termination of pregnancy in three patients did not alter the clinical course of the disease.
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