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Bansal RK, Cassim R, Sun R, Mallick R, Finelli A, Tanguay S, Drachenberg DE, Pouliot F, Lavallee L, So AI, Rendon RA, Wood L, Kapoor A, Lalani AKA, Basappa NS, Bhindi B, Dean LW, Bjarnason GA, Breau RH. Outcomes of partial nephrectomy for non-metastatic cT2 renal tumors: Results from a Canadian multi-institutional collaborative. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
690 Background: The role of partial nephrectomy (PN) is not well defined for cT2 renal cell carcinoma (RCC) as compared to radical nephrectomy (RN). The aim of this study was to examine oncological outcomes of PN as compared to RN for non-metastatic cT2 RCC. Methods: The Canadian Kidney Cancer information system was used to define patients who underwent surgery for non-metastatic cT2 RCC from January 2011 to October 2022. Patients with clear-cell, papillary, and chromophobe RCC were included. Other histology, multiple tumours, and hereditary RCC syndrome patients were excluded. Each PN patient was individually matched to RN up to 1:4 depending on availability of patients based on tumor size (+/- 1cm), histology, grade (clear cell and papillary), and necrosis (clear cell). Matched patients were analyzed as clusters. Results: A total of 1523 patients were identified, and 50 PN patients met study criteria who were then matched to 185 RN patients. Both groups had similar age, gender, smoking status, BMI, Charlson comorbidity index score, symptoms at presentation, baseline eGFR, hemoglobin and pathological characteristics. PN patients had smaller tumors (7.6 cm [IQR 2] vs 8.4 [IQR 2.4], p=0.05), had higher likelihood of undergoing open surgery (72.9% vs 31.8%, p<0.0001) and less likely received adrenalectomy (2% vs 24.3%, p=0.0004). Positive surgical margin rates were similar in both groups (8.2% in PN vs 3.4% in RN, p=0.2). Median follow up was not significantly different in either group (3.6 yrs [IQR 4.7] in PN vs 3.3 [4.7] yrs in RN, p=0.9). During the follow up period, PN patients had higher risk of local recurrence (HR 3.0, 95%CI 1.08-8.37), lower risk of distant metastasis (HR 0.36, 95%CI 0.15-0.88), better cancer specific survival (HR 0.56, 95%CI 0.18-1.78) and overall survival (HR 0.36, 95%CI 0.11-1.19) and as compared to RN. At 6 months and beyond after surgery, PN patients had less decline in eGFR than RN patients (-16.6 [SD 21.1] vs -24.4[SD 16.2], p=0.0002). Complications rates between PN and RN were (18% vs 9%, p=0.057). Conclusions: In this multi-institutional Canadian cohort of patients with non-metastatic cT2 RCC undergoing surgery, PN compared to RN was associated with slightly higher risk of peri-operative complications, better preservation of renal function, and higher risk of local recurrence. The lower risk of distant metastasis and death was likely from residual confounding unaccounted for in the individual patient match. [Table: see text]
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Affiliation(s)
| | | | - Ryan Sun
- University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Simon Tanguay
- McGill University Health Center, Montreal, QC, Canada
| | | | | | - Luke Lavallee
- Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Alan I. So
- Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | | | - Lori Wood
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Anil Kapoor
- St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | | | | | - Bimal Bhindi
- Southern Alberta Institute of Urology, Calgary, AB, Canada
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Sharma AK, Agarwal A, Sinha SK, Razi MM, Pandey U, Shukla P, Thakur R, Verma CM, Bansal RK, Krishna V. An echocardiographic evaluation to determine the immediate and short-term changes in biventricular systolic and diastolic functions after PDA device closure-an observational analytical prospective study (echo- PDA study). Indian Heart J 2021; 73:617-621. [PMID: 34627579 PMCID: PMC8551535 DOI: 10.1016/j.ihj.2021.06.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 06/03/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives –This prospective study with a sizable cohort was undertaken to assess changes in left and right ventricle systolic and diastolic functions after percutaneous patent ductus arteriosus device closure with appropriate follow up evaluation. Methods – It is an observational analytical prospective study. Ninety-eight patients were recruited out of which sixty-eight patients underwent percutaneous PDA device closure and were taken for final analysis. The primary objective was to study the left and right ventricular systolic and diastolic functions pre- and post-procedure at 48 h with follow up analysis at six months. Results – The mean age of the patients was 7.88 ± 5.05 years with the female to male ratio was 3.85:1. Thirty-three (48.52%) of the patients had immediate post PDA device closure LV systolic dysfunction. It was more common in those having pre-procedure mean low LVEF and those having a significant reduction in mitral A velocity. It became normal at six months follow up. The study reported immediate decrease in mea/n LVEF from 63.55 ± 8.11% to 48.19 ± 7.9%. The changes in LVEDD, LVEF, LVFS and LVEDV were statistically significant (p < 0.0001). In diastolic functions, there were significant reductions in peak early and late diastolic velocities. There was no statistically significant difference in right chamber functional assessment. Conclusion Asymptomatic LV systolic and diastolic dysfunction in immediate post PDA closure period is a common complication and reported in around 48.5% cases. It was more common in those having pre-procedure mean low LVEF and those having a significant reduction in mitral A velocity.
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Affiliation(s)
- Awadhesh Kumar Sharma
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India.
| | - Abhishek Agarwal
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - M M Razi
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Praveen Shukla
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - C M Verma
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - R K Bansal
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Vinay Krishna
- Department of Cardiothoracic Surgury, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
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Shiff B, Breau RH, Mallick R, Pouliot F, So A, Tanguay S, Kapoor A, Lattouf JB, Lavallée L, Fairey A, Finelli A, Bhindi B, Kawakami J, Rendon R, Bansal RK. Prognostic significance of extent of venous tumor thrombus in patients with non-metastatic renal cell carcinoma: Results from a Canadian multi-institutional collaborative. Urol Oncol 2021; 39:836.e19-836.e27. [PMID: 34556430 DOI: 10.1016/j.urolonc.2021.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/01/2020] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The prognostic significance of level of venous tumor thrombus (VTT) extension in patients with non-metastatic renal cell carcinoma (RCC) has been controversial. The aim of this study was to examine the prognostic significance of VTT extent in patients who underwent surgery for non-metastatic RCC. MATERIALS AND METHODS The Canadian Kidney Cancer information system database was used to identify patients who underwent surgery for non-metastatic RCC and VTT from January 2011 to December 2019. Association between VTT level and recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) was examined. Univariable and multivariable analyses were performed to estimate predictors of survival. RESULTS Out of 6,340 patients during the study period, 228 patients (3.6%) had VTT. VTT was level 0 in 84 (37%), level I to II in 112 (49%), and level III to IV in 33 (14%) patients as per the Mayo Clinic classification. Median age was 65.4 years (interquartile range [IQR] 57.6-72.2) and 169 (74.1%) were male. After a median follow-up of 21.2 months, VTT level did not significantly impact the RFS, CSS, or OS. For VTT level 0, I to II, and III to IV, there was no significant difference in estimated 5-year RFS (31%, 23%, and 30.5%; P > 0.05), CSS (70%, 69%, and 55%; P > 0.05) and OS (64%, 66%, and 50%; P > 0.05). Adjusting for known prognostic factors, thrombus level was not associated with risk of recurrence or death. CONCLUSION In a large, multi-institutional cohort of patients undergoing surgery for non-metastatic RCC with tumor thrombus, thrombus extent was not independently associated with recurrence or death.
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Affiliation(s)
- Benjamin Shiff
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Frédéric Pouliot
- Division of Urology, Université Laval, Quebec City, Quebec, Canada
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, British Columbia, Canada, Vancouver
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, Quebec, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | | | - Luke Lavallée
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | - Adrian Fairey
- Division of Urology, University of Alberta, Edmonton, Alberta, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Bimal Bhindi
- Section of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Jun Kawakami
- Section of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rahul K Bansal
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada.
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Sharma AK, Kumar H, Razi MM, Sinha SK, Pandey U, Shukla P, Thakur R, Verma CM, Bansal RK, Krishna V. To determine the correlation between echocardiographic diastolic parameters and invasively measured left ventricular end diastolic pressure in patients with heart failure with preserved ejection fraction- an observational, descriptive study. (CEAL-HFpEF study). Indian Heart J 2021; 73:470-475. [PMID: 34474760 PMCID: PMC8424284 DOI: 10.1016/j.ihj.2021.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/18/2021] [Accepted: 06/27/2021] [Indexed: 12/28/2022] Open
Abstract
Objectives Though invasive monitoring is the most accurate to estimate diastolic dysfunction but it has its own risk. The purpose of this study was to find out any standardized correlation between invasive and non -invasive parameters. Methods It is an observational, descriptive study comprising of a total of 500 patients. The primary objective of the study was to determine the correlation between echocardiographic diastolic parameters and invasively measured left ventricular end diastolic pressure (LVEDP). Results On studying correlation of different invasive and non-invasive data it was reported that there was a weak correlation between peak E velocity (r = 0.14, p = 0.631), Peak A velocity (r = 0.67, p = 0.59), IVRT (r = −0.35, p = 0.178), Mitral deceleration time (DT) (r = −0.06, p = 0.842), pulmonary venous peak systolic (r = −0.02, p = 0.966) and diastolic flows (r = 0.47, p = 0.201) to LVEDP. There was a good positive correlation between elevated LVEDP and difference in duration of pulmonary venous and mitral flow at atrial contraction (A-Ard) and E/Ea at all four longitudinal segments of the left ventricle. The sensitivity and specificity for detecting an elevated LVEDP of more than 12 mm Hg, using a cut off value of E/Ea< 8, were 89% and 90%.Lateral E/Ea ≥ 12, LAVI ≥34 mL/m2, and Ard–Ad > 30 msec have the greatest diagnostic value for diagnosing diastolic dysfunction in HFpEF patients. Conclusion Lateral E/Ea ≥ 12, LAVI ≥34 mL/m2, and Ard–Ad > 30 msec have the greatest diagnostic value for diagnosing diastolic dysfunction in HFpEF patients and have good correlation with invasively measured LVEDP.
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Affiliation(s)
- Awadhesh Kumar Sharma
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India.
| | - Hitender Kumar
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - M M Razi
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Praveen Shukla
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - C M Verma
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - R K Bansal
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
| | - Vinay Krishna
- Department of Cardiothoracic Surgury, LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, 208019, India
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Desai KT, Patel F, Patel PB, Bansal RK. Role of demographic and clinical factors in survival of HIV patients on antiretroviral therapy. Trop Doct 2021; 51:403-408. [PMID: 33550938 DOI: 10.1177/0049475520981257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our retrospective cohort study assesses the survival probability and identifies the demographic and clinical predictors of mortality in HIV patients taking antiretroviral therapy using an antiretroviral therapy centre data in Western India. Secondary data on 7532 registered HIV-infected individuals between September 2006 and January 2013 were analysed. The probability of survival at 75 months was 84.9%. Significant indicators of poor chances of survival were greater age, lower occupation class, lower CD4 count, poor functional status; higher stage of disease, lower weight, the presence and type of opportunistic infections, co-trimoxazole therapy and poor adherence to antiretroviral therapy. We thus find that, in addition to pre-ART, antiretroviral therapy clinical status and treatment adherence, socioeconomic status plays an important influence on ultimate survival of HIV patients on antiretroviral therapy.
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Affiliation(s)
- Kanan T Desai
- Postgraduate Resident, Department of Community Medicine, 29033Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, India
| | - Fenil Patel
- Postgraduate Resident, Department of Community Medicine, 29033Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, India
| | - Prakash B Patel
- Assistant Professor, Department of Community Medicine, 29033Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, India
| | - R K Bansal
- Professor & Head, Department of Community Medicine, 29033Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, India
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Sun R, Breau RH, Mallick R, Tanguay S, Pouliot F, Kapoor A, Lavallée LT, Finelli A, So AI, Rendon RA, Fairey AS, Lattouf JB, Kawakami J, Bhindi B, Basappa NS, Wood LA, Bjarnason GA, Heng DYC, Bansal RK. Prognostic impact of paraneoplastic syndromes on patients with non-metastatic renal cell carcinoma undergoing surgery: Results from Canadian Kidney Cancer information system. Can Urol Assoc J 2020; 15:132-137. [PMID: 33007184 DOI: 10.5489/cuaj.6833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The impact of paraneoplastic syndromes (PNS) on survival in patients with renal cell carcinoma (RCC) is uncertain. This study was conducted to analyze the association of PNS with recurrence and survival of patients with non-metastatic RCC undergoing nephrectomy. METHODS The Canadian Kidney Cancer information system is a multi-institutional cohort of patients started in January 2011. Patients with nephrectomy for non-metastatic RCC were identified. PNS included anemia, polycythemia, hypercalcemia, and weight loss. Associations between PNS and recurrence or death were assessed using Kaplan-Meier curves and multivariable analysis. RESULTS Of 4337 patients, 1314 (30.3%) had evidence of one or more PNS. Patients with PNS were older, had higher comorbidity, and had more advanced clinical and pathological tumor characteristics as compared to patients without PNS (all p<0.05). Kaplan-Meier five-year estimated recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were significantly worse in patients with PNS (63.7%, 84.3%, and 79.6%, respectively, for patients with PNS vs. 73.9%, 90.8%, and 90.1%, respectively, for patients without PNS, all p<0.005). On univariable analysis, presence of PNS increased risk of recurrence (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.48-1.90, p<0.0001) and cancer-related death (HR 1.85, 95% CI 1.34-2.54, p=0.0002). Adjusting for known prognostic factors, PNS was not associated with recurrence or survival. CONCLUSIONS In non-metastatic RCC patients undergoing surgery, presence of PNS is associated with older age, higher Charlson comorbidity index score, advanced tumor stage, and aggressive tumor histology. Following surgery, baseline PNS is not strongly independently associated with recurrence or death.
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Affiliation(s)
- Ryan Sun
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | | | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC, Canada
| | - Frederic Pouliot
- Division of Urology, Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Anil Kapoor
- Division of Urology, McMaster Institute of Urology, Hamilton, ON, Canada
| | - Luke T Lavallée
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ricardo A Rendon
- Department of Medicine and Urology, Dalhousie University, Halifax, NS, Canada
| | - Adrian S Fairey
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | | | - Jun Kawakami
- Southern Alberta Institute of Urology, Calgary, AB, Canada
| | - Bimal Bhindi
- Southern Alberta Institute of Urology, Calgary, AB, Canada
| | - Naveen S Basappa
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Lori A Wood
- Department of Medicine and Urology, Dalhousie University, Halifax, NS, Canada
| | - Georg A Bjarnason
- Division of Medical Oncology/Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Rahul K Bansal
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
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Sindhu M, Bansal RK, Goyal P. Ultrasound findings in optic nerve avulsion. QJM 2020; 113:363-364. [PMID: 31504980 DOI: 10.1093/qjmed/hcz210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Desai KT, Patel PB, Verma A, Bansal RK. Environment and psychosocial factors are more important than clinical factors in determining quality of life of HIV-positive patients on antiretroviral therapy. Trop Doct 2020; 50:180-186. [PMID: 32138621 DOI: 10.1177/0049475520908180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Assessing quality of life (QOL) outcome helps to show the effect of antiretroviral therapy (ART) on the subjective perception of its benefits among patients with HIV. A cross-sectional assessment of QOL, using the World Health Organization WHOQOL-HIV, on 204 HIV patients taking ART in western India showed patients with HIV on ART as having the best QOL score in the spiritual domain and the worst in the environment domain. Patients who are single, highly educated, of higher occupational status, with no HIV-positive children, not undergoing frequent hospital admissions, with access to a counsellor for support, who are not stigmatised or discriminated against due to HIV status, who do not have guilt or suicidal ideas, and who are theist, tend to have a better QOL, irrespective of their clinical condition or ART regimen. Patients' personal perceptions and feelings, societal support or stigma, and sociodemographic status have a more significant influence on QOL than clinical variables.
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Affiliation(s)
- Kanan T Desai
- Postgraduate Resident, Department of Community Medicine, Surat Municipal Institute of Medical Education & Research (SMIMER), Surat, Gujarat, India
| | - Prakash B Patel
- Assistant Professor, Department of Community Medicine, Surat Municipal Institute of Medical Education & Research (SMIMER), Surat, Gujarat, India
| | - Anupam Verma
- Associate Professor, Department of Community Medicine, Surat Municipal Institute of Medical Education & Research (SMIMER), Surat, Gujarat, India
| | - R K Bansal
- Professor & Head, Department of Community Medicine, Surat Municipal Institute of Medical Education & Research (SMIMER), Surat, Gujarat, India
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Oake J, Harasemiw O, Tangri N, Ferguson T, Saranchuk JW, Bansal RK, Drachenberg D, Nayak JG. The relationship between socioeconomic status and treatment for prostate cancer in a universal healthcare system: A population-based analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
361 Background: A large body of research has shown that there are strong socioeconomic disparities in access to cancer treatment. However, whether these inequalities persist among men with prostate cancer has not been previously explored in the equal-access, universal Canadian health care system. The aim of this study is to compare whether socioeconomic status is associated with the type of treatment received (radical prostatectomy (RP) versus radiation therapy (RT)) for men diagnosed with nonmetastatic prostate cancer in Manitoba, Canada. Methods: Men who were diagnosed with non-metastatic prostate cancer between 2004 and 2016 and subsequently treated with RP or RT were identified using the CancerCare Manitoba Registry and linked to provincial databases. SES was defined as neighbourhood income by postal code and divided into income quintiles (Q1-Q5, with Q1 the lowest quintile and Q5 the highest). Multivariable logistic regression nested models were used to compare whether socioeconomic status was associated with treatment type received. Results: We identified 4,560 individuals between 2004-2016 who were diagnosed with non-metastatic prostate cancer. 2,554 men were treated with RP and 2,006 with RT.As income quintile increased, men were more likely to undergo RP than RT (Q3 vs Q1: aOR 1.45 (1.09-1.92); Q5 vs. Q1: aOR 2.17, 95% CI 1.52-2.86). Conclusions: Despite a universal health care system, socioeconomic inequities are present for men seeking primary treatment for prostate cancer. Further investigation into the decision making process among patients diagnosed with prostate cancer may inform decision making to ameliorate these disparities.
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Affiliation(s)
- Justin Oake
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Oksana Harasemiw
- Chronic Disease Innovation Centre, Seven Oaks General Hospital; Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Department of Internal Medicine, University of Manitoba, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas Ferguson
- Chronic Disease Innovation Centre, Seven Oaks General Hospital; Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Rahul K. Bansal
- McMaster Institute of Urology, St. Joseph's Hospital, Hamilton, ON, Canada
| | | | - Jasmir G. Nayak
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
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Lavallée LT, McAlpine K, Kapoor A, Pouliot F, Mason R, Violette PD, Bansal RK, Richard PO, Karakiewicz PI, Bhindi B, Maloni R, Pautler S, Lattouf JB, Kassouf W, Tanguay S, So A, Rendon RA, Breau RH. Kidney Cancer Research Network of Canada (KCRNC) consensus statement on the role of renal mass biopsy in the management of kidney cancer. Can Urol Assoc J 2019; 13:377-383. [PMID: 31799919 DOI: 10.5489/cuaj.6176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Luke T Lavallée
- Division of Urology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Anil Kapoor
- Departments of Surgery (Urology) and Oncology, McMaster University, Hamilton, ON, Canada
| | - Frédéric Pouliot
- Department of Surgery, Division of Urology, Université Laval, Quebec City, QC, Canada
| | - Ross Mason
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Philippe D Violette
- Departments of Health Research Methods Evidence and Impact and Surgery, McMaster University, Hamilton, ON, Canada
| | - Rahul K Bansal
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Bimal Bhindi
- Department of Surgery, Section of Urology, University of Calgary, Calgary, AB, Canada
| | | | - Stephen Pautler
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | | | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada
| | - Simon Tanguay
- Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Singh J, Wong R, Bansal RK. Images - pT3a clear-cell renal cell carcinoma in a renal allograft managed effectively with open partial nephrectomy. Can Urol Assoc J 2019; 13:E385-E386. [PMID: 30817283 DOI: 10.5489/cuaj.5789] [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: 11/19/2022]
Affiliation(s)
- Jas Singh
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Rachel Wong
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Rahul K Bansal
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
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Abstract
Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmune disorder which significantly impacts patients' lives and can lead to permanent disability. Inflammation in RA not only affects joints; but can affect organs including the heart and lungs. Early diagnosis, initiation of intensive drug therapy, and a multidisciplinary care approach have vastly improved the long-term prognosis for those living with the condition. However, RA patients often present with co-morbidities which add to the complexity of clinical management. Orofacial conditions associated with RA which dental professionals need to be aware of include periodontal disease, temporomandibular dysfunction and salivary gland dysfunction. In this article, we provide information on RA, oral health in RA and guidance on how best to manage patients with RA in general dental practice.
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Affiliation(s)
- S de Souza
- Academic Rheumatology, King's College London, London
| | - R K Bansal
- Springfield Dental Practice, Chelmsford and MSc Student, Dental Institute, King's College London, London
| | - J Galloway
- Academic Rheumatology, King's College London, London and Honorary Consultant Rheumatologist, Rheumatology, King's College Hospital NHS Foundation Trust, London
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Bansal RK, Tanguay S, Finelli A, Rendon R, Moore RB, Breau RH, Lacombe L, Black PC, Kawakami J, Drachenberg D, Pautler S, Saarela O, Liu Z, Jewett MAS, Kapoor A. Positive surgical margins during partial nephrectomy for renal cell carcinoma: Results from Canadian Kidney Cancer information system (CKCis) collaborative. Can Urol Assoc J 2017; 11:182-187. [PMID: 28652876 DOI: 10.5489/cuaj.4264] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to determine the incidence, risk factors, and prognosis for patients with positive surgical margin (PSM) during partial nephrectomy (PN) for renal cell carcinoma (RCC). METHODS From the Canadian Kidney Cancer information system (CKCis) database, a historical cohort of PN patients with PSM were identified and compared to negative surgical margin (NSM). Risk factors for PSM were examined through multivariable logistic regression. Kaplan-Meier curves were used to compare progression-free survival. RESULTS Of 1103 patients, 972 (88.1%), 71 (6.4%), and 60 (5.4%) had NSM, PSM, and unknown status, respectively. Median patient age and tumour size were 61 years and 3.0 cm for both groups. From multivariable analysis, pathological stage ≥T3 (odds ratio [OR] 2.51; 95% confidence interval [CI] 1.13-5.60) and Fuhrman grade 4 (OR 5.35; 95% CI 1.11-25.72) were associated with PSM, whereas age, operative technique, and tumour size were not. Forty-nine (5.0%) patients from the NSM cohort and seven (9.9%) from the PSM cohort had a local/systemic progression of disease (adjusted hazard ratio [HR] 1.4; 95% CI 0.6-3.6). There were three (0.3%) cancer-related deaths in the NSM group and none in the PSM group. After median followup of 19 (interquartile range [IQR] 5-42) and 15 (IQR 7-30) months, 855 (91.4%) and 61 (89.7%) patients were alive in the NSM and PSM groups, respectively. CONCLUSIONS PSM occurred in 6.4% of PNs performed for RCC in this pan-Canadian cohort. Higher stage and grade are associated with a higher risk of positive margin. The small association between a PSM and progression suggests that complete nephrectomy is not necessary in patients with a PSM. The main study limitations are lack of nephrometry score and possible reporting bias.
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Affiliation(s)
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON
| | - Ricardo Rendon
- Department of Urology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - Ronald B Moore
- Division of Urology, University of Alberta, Edmonton, AB
| | | | | | - Peter C Black
- Department of Urology, University of British Columbia, Vancouver, BC
| | - Jun Kawakami
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB
| | - Darrel Drachenberg
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB
| | - Stephen Pautler
- Divisions of Urology and Surgical Oncology, Departments of Surgery and Oncology, Western University, London, ON
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON; Canada
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Kumar V, Sinha S, Kumar P, Razi M, Verma CM, Thakur R, Pandey U, Bhardwaj RS, Ahmad M, Bansal RK, Gupta S. Short-term outcome of acute inferior wall myocardial infarction with emphasis on conduction blocks: a prospective observational study in Indian population. Anatol J Cardiol 2017; 17:229-234. [PMID: 27752031 PMCID: PMC5864984 DOI: 10.14744/anatoljcardiol.2016.6782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The primary aim of the present study was to evaluate the complications, particularly conduction blocks, subsequent morbidity and mortality, and effect of thrombolytic therapy in Indian patients with inferior wall myocardial infarction (IWMI). METHODS This was a prospective, observational, single-center study conducted at LPS Institute of Cardiology, Kanpur, from December 2011 to May 2014. Patients who presented with typical chest pain and were subsequently diagnosed by standardized diagnostic criteria as having IWMI were enrolled. Patients were grouped on basis of conduction abnormalities, right ventricular (RV) infarction and thrombolytic treatment. Each group was analyzed for comparison of complication profile and mortality. RESULTS Of 573 patients with IWMI enrolled in the study (mean age: 58.90±12.3 years), 81.2% were male, 225 (39.3%) had conduction blocks, and 189 (32.9%) had RV infarction. In patients with conduction blocks, mortality occurred in 27 patients (12.0%) in contrast to 3.4% of patients without conduction block (p<0.03). Also, there were 27 cases of in-hospital mortality in patients with RV infarction compared with 9 cases in patients without RV infarction (p<0.01). Thrombolytic therapy significantly reduced mortality in patients with IWMI (p<0.001). A significant reduction was observed in cardiogenic shock (p=0.002), severe mitral regurgitation (p=0.007), and left ventricular failure (p<0.001) in patients undergoing thrombolytic therapy. CONCLUSION In Indian patients with IWMI, incidence of conduction blocks was higher than previously reported studies. Major complications such as atrioventricular block and RV infarction are associated with increased mortality and poor clinical outcomes. Thrombolytic therapy has a beneficial role in reduction of mortality rate and other complications.
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Affiliation(s)
- Varun Kumar
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College; Rawatpur, Kanpur-India.
| | - Santosh Sinha
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College; Rawatpur, Kanpur-India
| | - Prakash Kumar
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College; Rawatpur, Kanpur-India
| | - Mohammed Razi
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College; Rawatpur, Kanpur-India
| | - Chandra Mohan Verma
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College; Rawatpur, Kanpur-India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College; Rawatpur, Kanpur-India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College; Rawatpur, Kanpur-India
| | - Rajpal Singh Bhardwaj
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College; Rawatpur, Kanpur-India
| | - Mohammed Ahmad
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College; Rawatpur, Kanpur-India
| | - R K Bansal
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College; Rawatpur, Kanpur-India
| | - Shalini Gupta
- Institute of Medical Sciences, Banaras Hindu University; Varanasi-India
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Wong NC, Dason S, Bansal RK, Davies TO, Braga LH. Can it wait? A systematic review of immediate vs. delayed surgical repair of penile fractures. Can Urol Assoc J 2017; 11:53-60. [PMID: 28443146 DOI: 10.5489/cuaj.4032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Penile fractures have classically been thought to require immediate surgical intervention; however, recent series have described acceptable outcomes with delayed repair. In this systematic review, we compared complication rates between immediate and delayed repair of penile fractures. METHODS A systematic search of MEDLINE, Embase, CENTRAL, and Web of Science was performed with predefined search terms between 1974 and 2015. Titles and abstracts were screened prior to full-text review and quality appraisal by two independent investigators. Abstracted outcomes included postoperative erectile dysfunction (ED), tunical scar formation, and penile curvature. Only studies reporting a direct comparison of complications following immediate (<24 hours from injury to presentation/surgery) and delayed (>24 hours) repair of penile fractures were included. RESULTS A total of 12 studies met inclusion criteria. All were retrospective, observational studies of low or moderate methodological quality. Of the reported 502 patients, 391 underwent immediate repair and 111 delayed repair. In the immediate repair group, the percent of patients with postoperative ED, tunical scars, and curvature were 6.6%, 5.4%, and 1.8%, respectively, while in the delayed group, the rates of ED, tunical scars, and curvature were 4.5% across the board. Rates of ED and tunical scar formation following immediate compared to delayed repair trended towards favouring immediate repair, but did not differ significantly, while rates of curvature significantly favoured immediate repair. However, cases of curvature were typically reported as mild and none affected sexual functioning. CONCLUSIONS In this systematic review, we demonstrated that ED and tunical scar formation rates between immediate and delayed repair of penile fractures were statistically similar, while immediate repair had a lower rate of penile curvature. Although this suggests that a brief delay in repair may be acceptable in select patients, the results should be interpreted with caution, as the included studies were of low or moderate methodological quality. Most importantly, this review highlights the deficiencies in the current penile fracture literature, setting the stage to improve the quality of future studies.
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Affiliation(s)
| | - Shawn Dason
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Rahul K Bansal
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | | | - Luis H Braga
- Division of Urology, McMaster University, Hamilton, ON, Canada
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Desai KT, Patel F, Patel PB, Nayak S, Patel NB, Bansal RK. A case-control study of epidemiological factors associated with leptospirosis in South Gujarat region. J Postgrad Med 2017; 62:223-227. [PMID: 27763478 PMCID: PMC5105206 DOI: 10.4103/0022-3859.188551] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The current study was planned to identify the epidemiological factors associated with leptospirosis in South Gujarat region using neighborhood controls. METHODS A total of 100 cases of leptospirosis occurred in South Gujarat region during the year 2012 were selected using simple random sampling. Three neighbors of the selected cases formed the controls (n = 300). A pretested structured questionnaire was used for data collection and data were analyzed using Epi Info 2007. RESULTS There was significant association of illiteracy (odds ratio [OR] =1.82, 95% confidence interval [CI] =1.14-2.89), working in waterlogged fields during the reference season (OR = 4.6, 95% CI = 1.6-17.9), swimming/bathing in canals, open air defecation practices, storage of cow dung in or surrounding house, residence in the house made up of cow dung walls, households with access of food to rodents, injuries over hands/foot during the endemic season (OR = 3, 95% CI = 1.8-4.8), and history of skin disease during the endemic season (OR = 4.2, 95% CI = 2-8.5), with leptospirosis. Only 10% of individuals had gumboots for protection. A total of 83 (83%) cases and 240 (80%) controls had taken oral doxycycline chemoprophylaxis (P > 0.05). Cases had taken chemoprophylaxis for a median 4 weeks (range: 1-8) while controls had taken the same for median 8 weeks (range = 1-8) (P < 0.002). CONCLUSIONS Although the commonly established factors appear to be associated with leptospirosis, the role of host factors seems to play a more important role in determining susceptibility to leptospirosis in exposed individuals.
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Affiliation(s)
- K T Desai
- Department of Community Medicine, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India
| | - F Patel
- Department of Community Medicine, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India
| | - P B Patel
- Department of Community Medicine, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India
| | - S Nayak
- Department of Community Medicine, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India
| | - N B Patel
- Department of Community Medicine, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India
| | - R K Bansal
- Department of Community Medicine, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India
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Wong NC, Bansal RK, Lorenzo AJ, DeMaria J, Braga LH. Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study. Can Urol Assoc J 2015; 9:387-90. [PMID: 26788226 DOI: 10.5489/cuaj.3242] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Although previous evidence has shown that ultrasound is unreliable to diagnose undescended testis, many primary care providers (PCP) continue to misuse it. We assessed the performance of ultrasound as a diagnostic tool for palpable undescended testis, as well as the diagnostic agreement between PCP and pediatric urologists. METHODS We performed a prospective observational cohort study between 2011 and 2013 for consecutive boys referred with a diagnosis of undescended testis to our tertiary pediatric hospital. Patients referred without an ultrasound and those with non-palpable testes were excluded. Data on referring diagnosis, pediatric urology examination and ultrasound reports were analyzed. RESULTS Our study consisted of 339 boys. Of these, patients without an ultrasound (n = 132) and those with non-palpable testes (n = 38) were excluded. In the end, there were 169 pateints in this study. Ultrasound was performed in 50% of referred boys showing 256 undescended testis. The mean age at time of referral was 45 months. When ultrasound was compared to physical examination by the pediatric urologist, agreement was only 34%. The performance of ultrasound for palpable undescended testis was: sensitivity = 100%; specificity = 16%; positive predictive value = 34%; negative predictive value = 100%; positive likelihood ratio = 1.2; and negative likelihood ratio = 0. Diagnosis of undescended testis by PCP was confirmed by physical examination in 30% of cases, with 70% re-diagnosed with normal or retractile testes. CONCLUSION Ultrasound performed poorly to assess for palpable undescended testis in boys and should not be used. Although the study has important limitations, there is an increasing need for education and evidence-based guidelines for PCP in the management of undescended testis.
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Affiliation(s)
- Nathan C Wong
- Department of Surgery (Urology), McMaster Children's Hospital, McMaster University, Hamilton, ON
| | - Rahul K Bansal
- Department of Surgery (Urology), McMaster Children's Hospital, McMaster University, Hamilton, ON
| | - Armando J Lorenzo
- Department of Surgery (Urology), Hospital for Sick Children, University of Toronto, ON
| | - Jorge DeMaria
- Department of Surgery (Urology), Hospital for Sick Children, University of Toronto, ON
| | - Luis H Braga
- Department of Surgery (Urology), McMaster Children's Hospital, McMaster University, Hamilton, ON
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Bansal RK, Kapoor A, Finelli A, Rendon RA, Moore RB, Breau RH, Lacombe L, Kawakami J, Drachenberg DE, Black PC, Pautler SE, Liu Z, Tanguay S. Positive surgical margins after partial nephrectomy for renal cell carcinoma: Results from Canadian Kidney Cancer Information System database. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.420] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
420 Background: Partial nephrectomy (PN) is the standard of care for small renal masses (SRMs) whenever feasible. The occurrence of a positive surgical margin (PSM) on a pathological specimen is not uncommon and an ideal management is unknown. We conducted this study to examine the rate of PSM, predictors of PSM and their oncological outcomes after PN for renal cell carcinoma (RCC), using the Canadian Kidney Cancer information system (CKCis) database. Methods: We accessed the prospectively maintained CKCis database for 1066 patients who underwent PN for RCC in major academic centers all across Canada. Demographics, clinical, pathological and follow-up data were noted for patients with PSM and negative surgical margins (NSM). Multivariate logistic regression analysis was performed to assess predictors of PSM. Results: Out of 1066 patients, 59 (5.5%) had PSM, 928 (87%) had NSM and records of 79 (7.4%) patients were not available. Mean patient age was 61 years and 59 years in the PSM and NSM group respectively, and in each group 63% of the patients were males. Mean tumor size was 3.6cm (range 1.1 – 9.5) and 3.3cm (range 0.5 – 16.2) in PSM and NSM group respectively. PSM group had 5 (8%) grade 1, 28 (47%) grade 2, 16 (27%) grade 3 and 5 (8%) grade 4 tumors as compared to 127 (14%), 458 (50%), 207 (23%) and 27 (3%) respectively in NSM group. Four (6.7%) patients from the PSM group and 49 (5.3%) patients from the NSM group had local and/or systemic progression of disease. There were two cancer specific deaths in NSM group and none in PSM group. Fifty two (88%) and 861 (93%) patients were alive at mean follow-up of 18.5 (range 0 – 91.7) and 28.9 months (range 0 – 315.5) in PSM and NSM group respectively. For the multivariate logistic regression analysis; Fuhrman grade 4 predicted presence of PSM whereas age, operative technique, tumor size, tumor stage did not. Conclusions: Results from the CKCis database suggest that PSM after PN are common but does not result in adverse oncological outcomes. Presence of Fuhrman grade 4 may be associated with PSM on final pathological specimen.
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Affiliation(s)
- Rahul K. Bansal
- McMaster Institute of Urology, St. Joseph's Hospital, Hamilton, ON, Canada
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Abstract
Objectives: Cosmetics are a multi-billion dollar industry today. The present study was designed with an objective to know the extent, purpose, type and awareness for cosmetic in people's daily life in Surat city. Materials & Methods: The study was conducted among 500 randomly selected people from the Surat city through convenience sampling. All the participants were interviewed personally, using structured questionnaire. The whole study was conducted from December, to March, 2008. Results; Around 73% of the population used cosmetics for protection purpose, while only 37% used it for attraction and 19% for fashion. Only 31% checked whether cosmetic they used were tested on animals or not. 89% of the people are concerned about the brands of the cosmetic and advertisement is an important source in the selection of the cosmetics. People still prefer ayurvedic products which comprise of 44% of the total population. Only 9% of the people use the expired products suggesting that people are aware that expired products cannot be used. 77% of the people are aware about the side effects of the cosmetics. Conclusion: Overall prevalence of cosmetic product use is increasing among both males and females. Though, associated increase in awareness regarding safe use of the same was not present widely. The use of other cosmetic services like skin specialist visits, contact lenses usage is also increasing slowly. DOI: http://dx.doi.org/10.3329/bjms.v12i4.13330 Bangladesh Journal of Medical Science Vol. 12 No. 04 October 13 Page 392-397
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Jariwala RA, Kanpurwala DB, Desai KT, Bansal RK. Issues and dilemmas in career planning of medical students in Surat, India. Bangladesh J Med Sci 2013. [DOI: 10.3329/bjms.v12i4.13336] [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: 11/05/2022] Open
Abstract
Background: In recent time issues of career choices in medical student has been gaining mounting attention. Aim: The current study was planned with an aim to understand issues and dilemmas in career planning of medical students in Surat city, India Methods: This is a cross-sectional study comprising of personal interviews using a self -designed structured questionnaire among 400 simple randomly selected medical students, interns and junior residents of Surat Municipal Institute of Medical Education and Research covering issues associated with their career concerns and future life. Data analysis was done with help of Epi Info 7. The study sample comprised of students 46.5%, intern doctors 36%, junior resident doctors 17.5%. Results:Females were more content with either a graduate or a post graduate degree, whereas males were more inclined towards pursuing super specialty degrees (P<0.001). Majority 62% of the respondent stated that given another chance, they would again like to choose for medical studies only. The percentages of females interested in a non clinical career abroad as compared to clinical career in India were lower. Majority 89% of respondents agree that there is more struggle for the students who enter M.B.B.S. from a non medical background. Percentages of males in favor of increasing the postgraduate/super specialty seats far exceeded females (P<0.0001). The vast majority of the respondents wanted the specialty and super specialty seats to increase as they wanted an equal ratio of Undergraduate: Postgraduate seats (70%). Those who did not favor the increase in the seats perceived that the quality of treatment may actually worsen rather than improve if the number of seats increased (60%). Conclusion: Freshly graduating doctors do face a severe dilemma regarding their future career after graduation, which is a very perplexing situation for them and their parents, as there is absence of any career guidance cell; absence of the culture and avenues of campus placement; and there is human need to be materialistically comparable to their counterparts who are already in a job as an engineer. DOI: http://dx.doi.org/10.3329/bjms.v12i4.13336 Bangladesh Journal of Medical Science Vol. 12 No. 04 October 13 Page 385-391
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Sinha N, Kumar S, Rai H, Singh N, Kapoor A, Tewari S, Saran RK, Narain VS, Bharadwaj RPS, Bansal RK, Saxena PC, Sinha PR, Gupta PR, Mishra M, Jain P, Pandey CM, Singh U, Agarwal SS. Patterns and determinants of dyslipidaemia in 'Young' versus 'Not so Young' patients of coronary artery disease: a multicentric, randomised observational study in northern India. Indian Heart J 2013; 64:229-35. [PMID: 22664802 DOI: 10.1016/s0019-4832(12)60078-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIMS The aims of the study were to ascertain difference in lipid levels of 'Young' onset of coronary artery disease (CAD) (≤ 45 years) vs. 'Not so Young' onset of CAD (≥ 55 years) among north Indians and also to investigate determinants of 'dyslipidaemia' in CAD patients. METHODS This was a prospective, multicentric, randomised, observational study carried in eight centres of UP, India. All blood investigations were performed employing a central laboratory. RESULTS Out of a total 435 patients studied, 218 were in the 'young group' (YG) and 235 were in the 'Not so Young Group' (NSYG). Dyslipidaemia was more common in YG as evident by significantly higher levels of total cholesterol, triglycerides, low- and very low-density lipoprotein cholesterol as compared to NSYG. Diabetes, hypertension, urban lifestyle, and family history of CAD were found to be important determinants of dyslipidaemia in YG. CONCLUSION We conclude that lipid levels among north Indians are significantly higher in younger patients with CAD when compared with elderly.
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Affiliation(s)
- Nakul Sinha
- Sahara India Medical Institute, Lucknow, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Paul BS, Singh G, Bansal RK, Paul G. Author reply: To PMID 23793316. J Postgrad Med 2013; 59:248-249. [PMID: 24156125] [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: 06/02/2023] Open
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Bansal RK, Mathur R, Jain V, Ram ARMR, Bhagoliwal A. Revisiting Interheart Study in Indian context. Indian Heart J 2011; 63:269-272. [PMID: 22734348] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- R K Bansal
- Department of Cardiology, L P S Institute of Cardiology, Kanpur, Uttar Pradesh, lndia.
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Pawar AB, Bansal RK, Kumar M, Jain NC, Vaishnav KG. A rapid assessment of mosquito breeding, vector control measures and treatment seeking behaviour in selected slums of Surat, Gujarat, India, during post-flood period. J Vector Borne Dis 2008; 45:325-327. [PMID: 19248661] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- A B Pawar
- Department of Community Medicine, Surat Municipal Institute of Medical Education & Research, Umarwada, India.
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Bansal RK, Mistry N, Kargathra V, Kosambi A, Lathiya P, Raval B. Unsupervised weight losing patterns by anorexic subjects: a cause for concern. J Assoc Physicians India 2008; 56:731-732. [PMID: 19086367] [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: 05/27/2023]
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Bansal RK, Verma A, Bansal M. Judgement safeguarding the interests of children and pregnant women convicts in Indian jails. Indian J Community Med 2008; 33:133. [PMID: 19967045 PMCID: PMC2784626 DOI: 10.4103/0970-0218.40889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Accepted: 09/10/2007] [Indexed: 11/10/2022] Open
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Abstract
PURPOSE To report the magnitude and causes of unilateral absolute blindness (no light perception) and barriers faced by persons with unilateral blindness in the South Batinah region of Oman. METHODS Between January and June 2002, 12,000 patients were evaluated for visual acuity, ocular pressure, anterior ocular biomicroscopic examination, and posterior segment indirect ophthalmoscopy examination by ophthalmologists at Al Rustaq hospital in Oman. Patients having no perception of light in at least one eye were included in the cohort. A closed-ended questionnaire was used to collect data on the personal profile, history of blindness, barriers perceived as the cause of blindness, and participants' attitude towards eye care and quality of life following visual disability. RESULTS In the 12,000 patients studied, absolute unilateral blindness (no perception of light) was present in 122 persons, a rate of 1.0% in our series. The onset of blindness was gradual in 78 (63.9%) persons and 64 (54.9%) persons had unilateral blindness for more than 10 years. The main causes of blindness e phthisis/absent/disorganized blind eye, which was present in 64 (52.5%) persons; glaucoma, seen in 49 (40.2%) participants; and corneal opacity, seen in 8 (6.5%) persons. Eighty 4.8%) persons had <3/60 vision in the fellow eye. Thirty (24.6%) persons had cataract and 19 (15.6%) persons glaucoma in the fellow eye. Forty-eight (39.3%) persons had undergone cataract surgeries while 2 (1.6%) persons were operated for glaucoma in the fellow eye. Lack of access to ophthalmic services and use of traditional medicines during the onset of blindness were reported by nearly half of the cohort. The attitude towards blindness was negative in two thirds of subjects. CONCLUSIONS Cataract and glaucoma were important determinants of visual impairment in the fellow eyes of this cohort. These patients are at higher risk of developing bilateral impairment and need special care to prevent/treat visual disabilities in the fellow eyes. Using appropriate services, one can attempt attitudinal changes, rehabilitate them, and create a positive attitude towards life.
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Affiliation(s)
- R K Bansal
- Ophthalmology Department, Rustaq Hospital, Ministry of Health, Rustaq, Oman
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Tripathi VS, Bansal RK. Creating panic during disasters. Indian J Med Ethics 2007; 4:97. [PMID: 18630364 DOI: 10.20529/ijme.2007.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Ali SS, Chandrashekar SR, Singh M, Bansal RK, Sharma DR, Arora D. A multicenter, prospective, open-label, non-comparative study to evaluate the immunogenicity and tolerance of a new, fully liquid pentavalent vaccine (DTwP-HepB-Hib vaccine). Hum Vaccin 2007; 3:116-20. [PMID: 17617743 DOI: 10.4161/hv.3.4.4061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The current study was planned to assess the immunogenicity and reactogenicity of a fully liquid pentavalent combination vaccine containing diphtheria, tetanus, pertussis, Haemophilus influenzae type B and hepatitis B vaccines. Infants six to eight weeks of age were enrolled and administered the study vaccine at 0, 4 and 8 weeks of enrollment. The children were kept under observation for 30 minutes after each vaccination for local and systemic reactions. A record was maintained of suspected adverse drug reactions (ADRs) for the subsequent three days. Blood was collected for antibody titer estimations prior to the first dose and four to six weeks after the third dose. 100% of children developed protective antibody titres to D, T and HepB. 97% and 81% of vaccinees responded (2-4 fold rise in antibody titres) to the anti-fimbrial and anti-pertactin components of the pertussis antigen respectively. 100% infants developed short-term protective antibody titres to Hib (> 0.15 microg/ml) and 90% developed titres indicative of long-term protection (> 1.00 mg/ml). Fever was most commonly reported adverse event but none of the children had fever more than 102 degrees F. A few infants had mild, expected local and systemic side effects such as tenderness, erythema, induration, excessive fussiness and a change in feeding pattern. Except for one child who was withdrawn from the study for persistent crying, there were no other severe or unexpected adverse reactions reported.
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Affiliation(s)
- S Suhail Ali
- Clinical Research Dept., Panacea Biotec Ltd., New Delhi, India.
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Bansal RK, Verma A. Government should enforce restrictions on medical practice by non-qualified persons as well as cross practice in India. Indian J Community Med 2007. [DOI: 10.4103/0970-0218.35673] [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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Verma A, Bansal RK. Universal right to safe water. Indian J Community Med 2007. [DOI: 10.4103/0970-0218.53385] [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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Bansal RK, Tripathi VS, Desai VK, Singh A. Concerted health efforts prevent and contain diseases after floods disaster in Varachha zone of Surat. Indian J Community Med 2007. [DOI: 10.4103/0970-0218.36844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bansal RK. Court directs state of Rajasthan to clean up Jaipur City and improve environment. Indian J Community Med 2007. [DOI: 10.4103/0970-0218.36848] [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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Bansal RK. Court directs doctors in India to write legibly. Med Leg J 2005; 73:111. [PMID: 16235754 DOI: 10.1258/rsmmlj.73.3.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- R K Bansal
- Department of Community Medicine, Surat Municipal, Institute of Medical Education and Research Umarwada, Gujarat, India
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Abstract
INTRODUCTION Internship is a problematic phase in the training of doctors in India. At the end of their one-year Internship, students are not formally examined for proficiency, rarely a student is not given a satisfactory completion certificate and training is sometimes not supervised. Students are required to spend three months of this Internship in Primary Health Centres at rural postings. During this period the students often prepare for the written exams that would allow them to pursue post-graduate studies. METHOD In a personal reflection, this situation is described in the current article. The author suggests several approaches to improve this unwanted situation, so that the rural postings could be taken more seriously by the students. OUTCOMES Suggestions range from a post-internship examination, via the introduction of compulsory rural postings after graduation to an increase of the avenues for post-graduate training to include a course in family medicine and general practice. CONCLUSIONS The objective of providing excellent training during internship periods cannot be achieved unless interns actively participate. If the current situation does not change, for example according to the suggested solutions, this valuable component of medical training will remain problematic, thereby hindering the optimal preparation of doctors for the entire spectrum of necessary health care in India.
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Affiliation(s)
- R K Bansal
- Surat Municipal Institute of Medical Education & Research, India.
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Verma AK, Bansal RK, Pawar AB. Facilitating behavioral change for acceptance of oral polio vaccine. Indian Pediatr 2004; 41:951-2. [PMID: 15475641] [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: 04/30/2023]
Abstract
A child aged 26 months could not be vaccinated initially during pulse polio immunisation due to parental fear of untoward side effects. Owning responsibility of child's welfare, in-depth counseling and involvement of community leaders are crucial in this regard.
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Affiliation(s)
- A K Verma
- Community Medicine, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India.
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Bansal RK. Making India a rabies-free country. J Assoc Physicians India 2004; 52:79. [PMID: 15633729] [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: 05/01/2023]
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Bansal RK. Does the right of a doctor to prescribe a branded drug without informed consent of the patient constitute a violation of patient's rights? Indian J Med Sci 2003; 57:458-60. [PMID: 14573967] [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: 04/27/2023]
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Bansal RK. Donors do die in kidney transplantation in India. Indian J Med Sci 2003; 57:320-2. [PMID: 12928561] [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: 03/04/2023]
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Bansal RK, Srivastava RK, Sharma V. Efforts to improve nutritional status in rural areas of Gujarat, India. Indian J Med Sci 2003; 57:319-20. [PMID: 12928560] [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: 03/04/2023]
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Bansal RK, Saxena DM. Overcrowding and health. Indian J Med Sci 2002; 56:177-9. [PMID: 12710336] [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: 03/02/2023]
Abstract
The present study correlates the disease profile of 2536 persons belonging to 542 families with the available per capita floor area (PCFA). It was observed that 91.9 percent individuals were living in overcrowded conditions. As the PCFA decreased, the communicable diseases, infective and parasitic diseases and respiratory disease episodes exhibited a significant increase.
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Affiliation(s)
- R K Bansal
- Department of Community Medicine, Surat Municipal Institute of Medical Education and Research, P.O. Box 1030, Bombay Market P.O., Surat 395010
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Affiliation(s)
- R K Bansal
- Department of Chemistry, University of Rajasthan, Jaipur 302004, India
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Bansal RK. Critical issues in determining citizen's right to health care in India. Indian J Med Sci 2000; 54:177-81. [PMID: 11216326] [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)
- R K Bansal
- Deptt of Community Medicine, P.S. Medical College, Karamsad, Pin-388 325, Gujarat, India
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Bansal RK. Adolescent's sexual and reproductive health, behavioural change and the application of psychosocial theories. Indian J Med Sci 2000; 54:8-13. [PMID: 11214520] [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)
- R K Bansal
- Dept of Community Medicine, Pramukhswami Medical College, Karamsad, Pin-388 325, Gujarat
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Abstract
DPC4/SMAD4 is a candidate tumor suppressor gene with a strikingly high frequency of gene alterations in pancreatic cancer that suggests a discrete role for DPC4 in these tumors. DPC4 tumor-suppressive function has been implicated to mediate the transforming growth factor-beta (TGFbeta)-suppressive pathway; however, in a DPC4-null pancreatic cancer cell line, TGFbeta growth-inhibitory and transcriptional responses were found to be DPC4-independent. This was observed within native cells having a natural homozygous deletion and in clones engineered for stable expression of wild-type DPC4 integrated into the genome. This observation contrasted with the absolute DPC4 dependence of TGFbeta responses in a breast cancer cell line studied in parallel. This growth-inhibitory response to TGFbeta in DPC4-null cells relied on an intact ras effector pathway. These data further suggest a major categorization of TGFbeta responses into DPC4-dependent and -independent signaling pathways and specifically suggest that disruption of the TGFbeta-independent signal might be a basis of selection for the emergence of DPC4 alterations during tumorigenesis in the pancreas and other sites.
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Affiliation(s)
- J L Dai
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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