1
|
Srivastava R, Bansal R, Dubey PK, Singh D. A comparative evaluation of masticatory load distribution in different types of prosthesis with varying number of implants: A FEM analysis. J Oral Biol Craniofac Res 2024; 14:284-289. [PMID: 38577263 PMCID: PMC10993183 DOI: 10.1016/j.jobcr.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/06/2024] Open
Abstract
Aim To identify the optimal number and position of implants to reduce stress concentration on the implant, denture, and attachment system for sustaining an overdenture prosthesis. Materials and methods By incorporating one to eight indigenous implants with bar-type attachments, eight 3D finite element models of mandibular overdentures were created. All models received a 200 N vertical load, and the biomechanical characteristics of peri-implant bone were assessed. Result The study observed that with a vertical load of 200 N, the maximum equivalent stress around peri-implant tissue in all models was within the physiological tolerance threshold of bone. The von Mises stress values ranged from 116.18 MPa to 536.7 MPa. Conclusion The three-implant-supported overdenture model revealed superior peri-implant stress, stability, cost-effectiveness, and hygiene maintenance outcomes. Placing a third implant in the mid-symphysis region may offer a practical solution to reduce rotations in two-implant-supported overdentures.
Collapse
Affiliation(s)
- Roopal Srivastava
- Prosthodontics, Faculty of Dental Sciences, IMS BHU, Varanasi, India
| | - Rajesh Bansal
- Prosthodontics, Faculty of Dental Sciences, IMS BHU, Varanasi, India
| | - Pavan Kumar Dubey
- Prosthodontics, Faculty of Dental Sciences, IMS BHU, Varanasi, India
| | - Deepak Singh
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| |
Collapse
|
2
|
Bhattacharjee B, Srivastava R, Bansal R, Sharma NK. Fabrication of orbital prosthesis by two different methods in patients with post-COVID-19 rhino-orbital maxillary mucormycosis: A case series. Natl J Maxillofac Surg 2024; 15:164-167. [PMID: 38690241 PMCID: PMC11057580 DOI: 10.4103/njms.njms_183_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 05/02/2024] Open
Abstract
Neoplasms, congenital disorders, fungal infections, and traumatic injuries are the predominant causes of orbital defects. Various retentive mechanisms such as application of adhesive, utilization of mechanical undercuts, and implant-supported attachments are generally used in the maxillofacial prosthesis. In the orbital region, the result of magnet-retained attachments is favorable compared with other mechanisms. Different advantages of the magnet-retained prosthesis are less manual dexterity needed during insertion or removal and better maintenance of hygiene. The skin-implant interface and thick tissues in the maxillofacial region are the critically important points that should be given importance during the planning and placement of implants. Ideally, implant sites for orbital prosthesis are the lateral, infra-, and supraorbital rims of the orbital region. The following case series describes two different methods to rehabilitate patients with an exenterated eye due to mucormycosis by individually designed implant with magnetic attachment and mechanical undercut-retained orbital prosthesis.
Collapse
Affiliation(s)
- Bappaditya Bhattacharjee
- Department of Prosthodontics, Faculty of Dental Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Roopal Srivastava
- Department of Prosthodontics, Faculty of Dental Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rajesh Bansal
- Unit of Prosthodontics, Faculty of Dental Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Naresh K. Sharma
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| |
Collapse
|
3
|
Sabrie N, Seleq S, Homsi H, Khan R, Gimpaya N, Bansal R, Scaffidi M, Lightfoot D, Grover S. A128 GLOBAL TRENDS IN TRAINING AND CREDENTIALING GUIDELINES FOR GASTROINTESTINAL (GI) ENDOSCOPY: A SYSTEMATIC REVIEW. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991236 DOI: 10.1093/jcag/gwac036.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Credentialing in GI endoscopy is not a universally standardized process. National guidelines may provide a framework for local training, however in certain settings, training committees set minimal competency requirements that must be met before a clinician can be accredited to practice independently. There is a paucity of literature assessing the inter-societal and geographic variability in guidelines and training requirements in endoscopy. Purpose To systematically review the available credentialing guidelines proposed by different GI endoscopy societies and affiliated training committees internationally. Method We conducted a systematic review according to the PRISMA guidelines. A comprehensive literature search was performed for credentialing guidelines for GI endoscopy from inception until January 2022. Two reviewers screened and one reviewer abstracted data using a pre-defined data collection form. Result(s) From the 653 records obtained from our search, 20 credentialing guidelines from 12 different GI societies were ultimately included in the review. These guidelines encompassed the following procedures and outlined the following key-performance indicators; a) Colonoscopy: the recommended minimum number of procedures performed ranged from 150-275 with a minimum cecal intubation and adenoma detection rate of 85-90% and 20-30% respectively; b) EGD: the minimum number of procedures prior to credentialing ranged from 130-1000, the minimum duodenal intubation rate ranged from 95-100%, and the range for minimum number of upper GI bleeds managed was 20-45 (in addition to other procedural KPIs); c) ERCP: the recommended minimum number of procedures prior to credentialing ranged from 100-300 cases with a minimum selective duct cannulation rate of 80-90%. Guidelines for flexible sigmoidoscopy, EUS and capsule endoscopy were also obtained. Image ![]()
Conclusion(s) There is a general concordance amongst the various international GI societies with regards to minimum procedural volume and performance in key procedural tasks prior to credentialing, however the use of validated education assessment tools was lacking in the majority of guidelines. Additional KPI’s need to be explored for less routinely performed procedures such as EUS and capsule endoscopy. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
Collapse
Affiliation(s)
| | | | | | - R Khan
- University of Toronto,Gastroenterology
| | | | | | | | | | - S Grover
- Gastroenterology,Gastroenterology, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
Zhao AY, Gimpaya N, Lisondra J, Fujiyoshi R, Fujiyoshi Y, Khan R, Tham D, Scaffidi MA, Bansal R, Walsh C, Grover SC. A119 DEVELOPMENT AND EVALUATION OF LOW-COST GEL POLYPS FOR POLYPECTOMY SKILLS TRAINING IN NOVICE ENDOSCOPISTS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991154 DOI: 10.1093/jcag/gwac036.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Polypectomy is an essential skill for endoscopists to acquire. As polyps are encountered ad hoc during colonoscopies, exposure to polypectomy in clinical training may vary. There is a need to deliver a curriculum that standardizes exposure to polypectomy while remaining cost-effective for endoscopy programs worldwide. Purpose To develop low-cost simulated polyps that can be incorporated into endoscopic training programs, and to evaluate their perceived realism and useability for polypectomy training. Method We designed 3D molds based on the Paris classification, a validated rubric for polyp morphology. The polyps are depicted in Figure 1. Using low-cost materials, we created gel-based polyps compatible with physical colonic simulators. Current versions of the polyps were finalized based on visual realism and durability. Expert (performed >1000 procedures) and novice (<25 procedures) endoscopists were invited to perform simulated polypectomies and evaluate the realism of the polyps. Using a 7-point Likert scale (“strongly disagree” to “strongly agree”), we administered a survey adapted from the Direct Observed Polypectomy Skills (DOPyS) checklist to evaluate the polyps on practicality of design and useability for training. Additionally, the simulator’s resemblance to human polypectomy was assessed through a scale with 1 indicating “low resemblance” and 7 indicating “high resemblance”. The ease of identifying morphology was also evaluated, with 1 indicating “difficult” and 7 indicating “easy”. Result(s) The survey was completed by 11 expert endoscopists and 10 novices. The median score submitted by experts on the polyps’ useability in training the technique for mobilization of the polyp was 7 (IQR 6-7). Experts rated the simulator’s practicality in teaching cold snare or electrocautery techniques with a median score of 6 (IQR 6-7). Lastly, the ability of the simulator to develop skills in identifying and treating the residual polyp was assessed by expert endoscopists, giving it a median score of 6 (IQR 6-7). The simulators were tested on similarity to human polypectomy, with the median score of expert groups being 5 (IQR 5-6), and novice groups being 6 (IQR 6-6). Both groups were asked to rate if morphology could be identified using the simulator; the median score of expert groups being 6 (IQR 6-7), and 6.5 for novice endoscopists (IQR 5-7). Image ![]()
Conclusion(s) The development of simulated polyps with differing morphologies using low-cost and common materials with high realism is feasible. These polyps may potentially be integrated into different endoscopic training programs. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest A. Zhao: None Declared, N. Gimpaya: None Declared, J. Lisondra: None Declared, R. Fujiyoshi: None Declared, Y. Fujiyoshi: None Declared, R. Khan Grant / Research support from: Rishad Khan has received research grants from AbbVie (2018) and Ferring Pharmaceuticals (2019) and research funding from Pendopharm (2019). , D. Tham: None Declared, M. Scaffidi: None Declared, R. Bansal: None Declared, C. Walsh: None Declared, S. Grover Shareholder of: Samir C. Grover has equity in Volo Healthcare., Grant / Research support from: Samir C. Grover has received research grants and personal fees from AbbVie and Ferring Pharmaceuticals, personal fees from Takeda, education grants from Janssen.
Collapse
Affiliation(s)
- A Y Zhao
- Division of Gastroenterology, St. Michael's Hospital
| | - N Gimpaya
- Division of Gastroenterology, St. Michael's Hospital
| | - J Lisondra
- Division of Gastroenterology, St. Michael's Hospital
| | - R Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital
| | - Y Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital
| | - R Khan
- Division of Gastroenterology, St. Michael's Hospital,Department of Medicine, University of Toronto
| | - D Tham
- Division of Gastroenterology, St. Michael's Hospital
| | - M A Scaffidi
- Division of Gastroenterology, St. Michael's Hospital
| | - R Bansal
- Division of Gastroenterology, St. Michael's Hospital
| | - C Walsh
- Division of Gastroenterology, Hepatology, and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children,Department of Pediatrics, University of Toronto Faculty of medicine,The Wilson Centre, University of Toronto, Toronto, Canada
| | - S C Grover
- Division of Gastroenterology, St. Michael's Hospital,Department of Medicine, University of Toronto
| |
Collapse
|
5
|
Khan R, Homsi H, Gimpaya N, Sabrie N, Gholami R, Bansal R, Scaffidi M, Lightfoot D, James P, Siau K, Forbes N, Wani S, Keswani R, Walsh C, Grover S. A117 VALIDITY EVIDENCE FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY COMPETENCY ASSESSMENT TOOLS: A SYSTEMATIC REVIEW. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991253 DOI: 10.1093/jcag/gwac036.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Assessment of competence in endoscopic retrograde cholangiopancreatography (ERCP) is essential to ensure trainees possess the skills needed for independent practice. Traditionally, ERCP training has used the apprenticeship model, whereby novices learn skills under the supervision of an expert. A growing focus on procedural quality, however, has supported the implementation of competency-based medical education models which require documentation of a trainee’s competence for independent practice. Observational assessment tools with strong evidence of validity are critical to this process. Validity evidence supporting ERCP observational assessment tools has not been systematically evaluated. Purpose To conduct a systematic review of ERCP assessment tools and identify tools with strong evidence of validity using a unified validity evidence framework Method We conducted a systematic search using electronic databases and hand-searching from inception until August 2021 for studies evaluating observational assessment tools of ERCP performance. We used a unified validity framework to characterize validity evidence from five sources: content, response process, internal structure, relations to other variables, and consequences. Each domain was assigned a score of 0-3 (maximum score 15). We assessed educational utility and methodological quality using the Accreditation Council for Graduate Medical Education framework and the Medical Education Research Quality Instrument, respectively. Result(s) From 2769 records, we included 17 studies evaluating 7 assessment tools. Five tools were studied for clinical ERCP, one on simulated ERCP, and one on simulated and clinical ERCP. Validity evidence scores ranged from 2-12. The Bethesda ERCP Skills Assessment Tool (BESAT), ERCP Direct Observation of Procedural Skills Tool (ERCP DOPS), and The Endoscopic Ultrasound (EUS) and ERCP Skills Assessment Tool (TEESAT) had the strongest validity evidence with scores of 10, 12, and 11, respectively. Regarding educational utility, most tools were easy to use and interpret, and required minimal additional resources. Overall methodological quality was strong, with scores ranging from 10-12.5 (maximum 13.5). Conclusion(s) The BESAT, ERCP DOPS, and TEESAT have strong validity evidence compared to other assessments. Integrating tools into training may help drive learners’ development and support competency decision-making. Please acknowledge all funding agencies by checking the applicable boxes below CAG Disclosure of Interest None Declared
Collapse
Affiliation(s)
- R Khan
- Western University, London
| | | | | | | | | | | | | | | | - P James
- University Health Network, Toronto, Canada
| | - K Siau
- University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - N Forbes
- University of Calgary, Calgary, Canada
| | - S Wani
- University of Colorado Anschutz Medical Campus, Aurora
| | - R Keswani
- Northwestern University, Chicago, United States
| | - C Walsh
- The Hospital for Sick Children, Toronto, Canada
| | | |
Collapse
|
6
|
Sarin A, Agarwal A, Dodagoudar C, Baghmar S, Qureshi S, Raj A, Kailey N, Hasthavaram N, Kumar R, Potsangbam L, Bansal R, Bhardwaj S, Rajpurohit S, Vaibhav V, Handoo A, Dadu T, Mittal A, Gupta N, Aggarwal S. 285P Reticulocyte hemoglobin equivalent as an early predictor of iron deficiency anemia in cancer patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
|
7
|
Gupta N, Bansal R, Shukla NK. The effect of ball versus locator attachment system on the performance of implant supported overdenture: A systematic review. J Oral Biol Craniofac Res 2022; 13:44-55. [PMID: 36406295 PMCID: PMC9673099 DOI: 10.1016/j.jobcr.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/07/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Objective This systematic review was aimed to compare ball and locator attachment system on the basis of clinical and biomechanical performance of implant supported overdenture as well as biological and patient related outcomes. Material and methods Open and free electronic and manual searches were performed in digital databases including MEDLINE via PubMed, the Cochrane Database of Clinical Trials, and Scopus along with some other reliable sources. From the 667 retrieved records, 11 full-text controlled trials were included in this study. Risk of bias was assessed according to RoB 2.0 except for one RCT (economic evaluation), only assessed by CASP checklist. Results From the 11 retrieved studies, total 183 locator and 219 ball attachments were identified in 452 subjects of 30 yrs–95 yrs of age. Studies provided data about prosthodontic complications or maintenance (replacement or the activation of matrix and patrix part, loss of retention, fracture and relining of the prosthesis, fracture of the attachment and the survival probability), oral health impact profile, soft tissue parameters and periodontal complications, marginal bone loss, patient related outcome and cost of the attachment systems. Only 5 studies were assessed at low risk bias, while other 6 at moderate to high risk of bias. Conclusion Locator attachment system show lesser complications including loss of retention and lower maintenance appointments, lesser soft tissue, and periodontal complications than the ball attachment. Ball is better in terms of cost effectiveness. In other related outcomes, no significant differences were noted between ball and locator attachment.
Collapse
Affiliation(s)
- Nimmi Gupta
- Dpt. of Prosthodontics, Faculty of Dental Sciences, IMS, Banaras Hindu University, India
- Corresponding author. Dpt. of Prosthodontics, Faculty of Dental Sciences, IMS, BHU, Varanasi, UP, 221005, India.
| | - Rajesh Bansal
- Dpt. of Prosthodontics, Faculty of Dental Sciences, IMS, Banaras Hindu University, India
| | - Neeteesh K. Shukla
- Dpt. of Orthodontics, Faculty of Dental Sciences, IMS, Banaras Hindu University, India
| |
Collapse
|
8
|
Cruz Torres R, Bansal R, Palicherla A, Thandra A, Sharma A, Narmi A, Smer A. Outcomes of infective endocarditis in patients with and without pericardial effusion: a National Inpatient Sample study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Pericardial effusion (PE) in patients with infective endocarditis (IE) has been shown to be an independent risk factor for severe complications, however no significant association with mortality has been established. Our study aims to study the significance of pericardial effusion in patients with IE.
Methods
We performed a retrospective analysis using the United States National Inpatient Sample (NIS) database to identify all the hospital admissions with IE using ICD 10 codes and divided them into two groups based on the presence of PE. The outcomes of interest were in-hospital mortality, in-hospital complications, need for cardiac surgery, and length of stay (LOS).
Results
A total of 381,300 patients were hospitalized from 2016 to 2019 with IE, of whom 10,370 developed PE. Mean age of patients in the PE group was 51 years and in non-PE group was 61 years with males and Caucasian race being predominant in both groups. PE group had higher rates of in-hospital death (12.7% vs 9%, P≤0.001) and longer in-hospital stay (12 days vs 7 days, P≤0.001) compared to non-PE group. The rates of cardiac surgery were higher in PE group (26.1% vs 8.4%, P≤0.001). The rates of heart failure, heart block, renal failure, cardiogenic shock, and embolic stroke were higher in PE group [Table 1].
Conclusion
Our study shows that presence of PE in patients with IE is a predictor for in-hospital mortality, length of stay, and need for cardiac surgery. Also, these patients are at higher risk for heart failure, heart block, cardiogenic shock and embolic stroke.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- R Cruz Torres
- Chi Health Creighton University Medical Center - Bergan Mercy , Omaha , United States of America
| | - R Bansal
- Chi Health Creighton University Medical Center - Bergan Mercy , Omaha , United States of America
| | - A Palicherla
- Chi Health Creighton University Medical Center - Bergan Mercy , Omaha , United States of America
| | - A Thandra
- Chi Health Creighton University Medical Center - Bergan Mercy , Omaha , United States of America
| | - A Sharma
- Mayo Clinic, Endocrinology , Rochester , United States of America
| | - A Narmi
- University of Nebraska Medical Center, Cardiovascular Medicine , Omaha , United States of America
| | - A Smer
- Chi Health Creighton University Medical Center - Bergan Mercy , Omaha , United States of America
| |
Collapse
|
9
|
Rakshit S, Bansal R, Potter A, Manochakian R, Lou Y, Zhao Y, Ernani V, Savvides P, Schwecke A, Moffett N, Hocum C, Leventakos K, Adjei A, Marks R, Molina J, Mansfield A, Dimou A. MA13.09 Time from Immune Checkpoint Inhibitor to Sotorasib Use Correlates with Risk of Hepatotoxicity in Non-small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
10
|
Varma M, Singh S, Bansal H, Tuli H, Bansal R, Kaur T. P-381 A novel natural cycle proliferative phase/progesterone replacement(NC/PR) protocol for endometrial preparation for frozen-thawed embryo transfer(FET) Can it improve pregnancy outcomes : a prospective comparative study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.359] [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: 11/13/2022] Open
Abstract
Abstract
Study question
Can a novel protocol for endometrial preparation- NC/PR-FET, lead to better pregnancy outcomes than artificial cycle (AC)-FET, with similar ease of cycle monitoring and scheduling?
Summary answer
NC/PR-FET protocol gave comparable clinical pregnancy rates (CPR), significantly less early miscarriage rates (MR) and significantly more live birth rates (LBR) compared to AC-FET protocol.
What is known already
AC-FET is the most common protocol for endometrial preparation due to flexibility, easy monitoring, and high pregnancy rates albeit with evidence of higher obstetrical risks e.g., miscarriage, pre-eclampsia versus NC-FET. This risk could be due to suboptimal hormonal administration in AC-FET leading to impaired endometrial maturation, predecidualization, and altered endometrial function. Studies indicate, estradiol may have a stronger negative effect(versus progesterone) on the endometrial transcriptome. Hence, we studied a novel protocol with NC-estrogen (but with progesterone similar to AC-FET), for better endometrial maturation, predecidualization along with simple monitoring and flexible ET scheduling. Previously, a proof-of-concept case-series has been reported.
Study design, size, duration
The prospective comparative study was conducted at a tertiary center (Jan2019-Dec2021) with 126 patients (both autologous [AO] and donor oocytes [DO]):79 (AC-FET) and 47 (NC/PR-FET) with similar ICSI, vitrification, ET protocols. 2 or 3 Grade A cleavage stage embryos were transferred. CPR, implantation rates(IR), early MR (≤13 weeks, miscarriages/clinical pregnancies) and LBR (≥28 weeks, LBs/ETs) were compared. Serum progesterone was studied on day 5 post-ET. Antenatal care and most deliveries were at the same institute.
Participants/materials, setting, methods
Patients were non-smokers with normal hysteroscopy. In AC-FET, oral estradiol (6-8mg) was initiated from day 1-2 (for 10-17 days). In both groups, when endometrium ≥7mm and S.progesterone<1ng/ml, intramuscular progesterone was initiated(daily till day 4 post-ET, then every 3rd day till week 8). ET was scheduled on day 4 of intramuscular progesterone, and concurrently, vaginal progesterone was added (till week 10). Chi-square, t-tests, and multiple regression was used for statistical analysis and 2-tailed P <.05 indicated statistical significance.
Main results and the role of chance
Mean age and BMI were comparable in NC/PR-FET and AC-FET groups: 34.48±4.69 years vs. 33.58 ± 5.62 years (P =.35) and 26.27 ± 3.62 kg/m2 vs. 27.34 ± 4.61kg/m2 (P =.18) respectively. Similarly, the source of oocytes (%AO) and % singletons were also comparable in NC/PR-FET and AC-FET groups: 57.4% vs. 46.8% (P = .25), and 78.1% vs. 75% (P= .75) respectively. There were 3 ectopic pregnancies overall. The CPRs and IRs were comparable: 68.09% (NC/PR-FET) vs. 60.76% (AC-FET) (P=.41) and 32.30% (NC/PR-FET) vs. 28.96% (AC-FET) (P=.45) respectively.
The early MR was significantly more in AC-FET vs. NC/PR-FET: 29.17% vs. 6.25% (P =.012). Consequently, LBRs were significantly more in NC/PR-FET vs. AC-FET: 59.57% vs. 39.24% (P =.028). After adjusting for age, BMI, AO/DO, this difference remained significant (AOR 2.66; 95% CI 1.21-5.81; P =.014)
Mean serum progesterone was comparable in all patients in both groups: 38.50 ± 13.6ng/ml (NC/PR-FET) vs. 40.98 ± 28.64 ng/ml (AC-FET) (P =.57). Serum progesterone levels were also comparable in patients who were pregnant in both groups: 38.51 ± 14.79 (NC/PR-FET) vs. 42.25 ± 32.63 (AC-FET) (P =.53).Also, in the AC-FET group serum progesterone was comparable in patients who aborted,44.23 ± 31.60 vs. those who didn’t, 41.48 ± 33.44 (P =.79).
Limitations, reasons for caution
This was a single center study. Due to limited sample size, we could not control for many potential confounders (e.g., multiple pregnancies). For the same reason, we could not compare obstetrical risks as a study outcome.
Wider implications of the findings
This study shows significantly better pregnancy outcomes with a novel NC/PR-FET protocol vs. AC-FET. This needs to be validated in larger studies. Since suboptimal hormone administration in AC-FET could be causal factor for pre-eclampsia, larger studies can test if the NC/PR-FET protocol can lead to better obstetrical outcomes.
Trial registration number
not applicable
Collapse
Affiliation(s)
- M Varma
- Sadbhavna Medical & Heart Institute , Obgy, Patiala, India
| | - S Singh
- Artemis Health Institute, Reproductive Medicine , Gurgaon, India
| | - H Bansal
- Modern Laboratory & Scan Centre , Pathalogy, Patiala, India
| | - H Tuli
- Sadbhavna Medical & Heart Institute , Neonatology, Patiala, India
| | - R Bansal
- Sadbhavna Medical & Heart Institute , Neonatology, Patiala, India
| | - T Kaur
- Sadbhavna Medical & Heart Institute , Anesthesia, Patiala, India
| |
Collapse
|
11
|
Kumble Y, Bachani N, Shah H, Bansal R, Lokhandwala Y. Study of arrythmias and electrophysiological characteristics in relation to echocardiographic severity in ebsteins anomaly. Indian Pacing Electrophysiol J 2022. [DOI: 10.1016/j.ipej.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
12
|
Scaffidi M, Gimpaya N, Pattni C, Genis S, Khan R, Li J, Bansal R, Grover S. A89 PERCEPTIONS OF NON-TECHNICAL SKILLS IN GASTROINTESTINAL ENDOSCOPY: A THEMATIC ANALYSIS OF FOUR FOCUS GROUPS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859238 DOI: 10.1093/jcag/gwab049.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Nontechnical skills (NTS), which involve an individual’s cognitive, attitudinal, and social skills that supplement task expertise, are an essential component in the practice of gastrointestinal endoscopy. There is a growing body of literature that highlights the association between these skills and patient outcomes. To date, however, these skills have not been adequately defined within the context of gastrointestinal endoscopy. Aims To define the domain and corresponding characteristics of NTS in GI endoscopy. Methods We conducted a qualitative study at a tertiary-care academic center in Toronto, Ontario. Specifically, we held four focus groups with physician endoscopists, nurses who work in an endoscopy unit, and patients who have had previous endoscopies, in order to ascertain their input on the role of NTS in gastrointestinal endoscopy. The three groups were interviewed independently and there was one focus group of both physicians and nurses that was used for validation of our initial thematic framework. Data from the focus groups was collected using a combination of field notes and discussion transcriptions. Three authors independently generated codes from these data. Using these codes, a thematic network analysis was used to identify emerging themes. The primary outcome of this study was the development of a cohesive thematic network of NTS in endoscopy, including their characteristics and examples. Results The four focus groups included a total of 34 participants, including 15 physician endoscopists, 15 nurses, and 4 patients. Using thematic network analysis, we identified six dimensions of NTS using the first three focus groups: communication; professionalism; teamwork; leadership; decision-making; and situational awareness. Additional topics related to the practice and evaluation of NTS were identified. In particular, there is a degree of subjectivity in the appraisal of NTS due to the nuances among individual practice, aside from egregious errors of NTS (e.g. unprofessional behaviours). The use of video recordings was suggested as a way to capture signs of good NTS, such as appropriate levels of calmness during procedures and attention to patient comfort. Finally, patient involvement can be useful for evaluating communication and professionalism based on patient comprehension and the nature of the therapeutic relationship. Conclusions Our findings provide the first cohesive framework of NTS in gastrointestinal endoscopy that is anchored in real world experiences with relevant stakeholders – physicians, nurses, and patients. Future research should consolidate these findings into an assessment tool for NTS in order to evaluate and provide feedback to endoscopists who are both in training and in practice. Funding Agencies CAG
Collapse
Affiliation(s)
- M Scaffidi
- St. Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- St. Michael’s Hospital, Toronto, ON, Canada
| | - C Pattni
- St. Michael’s Hospital, Toronto, ON, Canada
| | - S Genis
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- St. Michael’s Hospital, Toronto, ON, Canada
| | - J Li
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Bansal
- St. Michael’s Hospital, Toronto, ON, Canada
| | - S Grover
- St. Michael’s Hospital, Toronto, ON, Canada
| |
Collapse
|
13
|
Tham D, Gimpaya N, Gholami R, Pattni C, Seleq S, Bansal R, Fujiyoshi MA, Ramkissoon A, Lisondra J, Ariaratnam J, Scaffidi M, Khan R, Grover S. A25 CRITICAL APPRAISAL OF GI ENDOSCOPY CLINICAL PRACTICE GUIDELINES DURING THE COVID-19 PANDEMIC. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859207 DOI: 10.1093/jcag/gwab049.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Clinical Practice Guidelines (CPGs) are integral during a pandemic, offering guidance to clinicians through uncertainty. Existing literature has established that the need for rapid publication of CPGs during previous infectious disease outbreaks resulted in less rigorous guidelines. CPGs were rapidly developed since the onset of the pandemic in December 2019, providing guidance in gastrointestinal (GI) endoscopy, an area where COVID-19 may pose risk of transmission.
Aims
To evaluate the quality of GI endoscopy guidelines developed during the COVID-19 pandemic and to compare these with (a) endoscopy CPGs developed prior to the pandemic; (b) CPGs for other endoscopic topics unrelated to COVID-19; and, (c) non-endoscopic CPGs published during the pandemic.
Methods
We systematically searched Medline, Embase and Scopus for CPGs published by GI societies from January 1, 2018 to December 31, 2020. A grey literature search was conducted. Two authors screened full-texts. In this interim analysis, CPGs were grouped based on publication year: before 2020, or 2020. Endoscopy CPGs published in 2020 were categorized as COVID or non-COVID related. Two authors independently assessed the CPGs using the AGREE II tool, consisting of six domains for evaluating guidelines. A domain score of 60 was set as a threshold to indicate good quality.
Results
There were 70 endoscopy guidelines and 27 CPGs focused on other GI topics. The mean overall scores were 69% (±12%) for endoscopy CPGs published before 2020 (n=28), and 51% (±23%) for CPGs published in 2020 (n=42). For individual AGREE II domains, mean scores for pre-2020 CPGs ranged from 33.11 (±17.39) in Applicability to 81.55 (±10.37) in Clarity of Presentation. For CPGs published during COVID-19, mean domain scores ranged from 34.18 (±10.52) in Applicability to 75.26 (±13.85) in Clarity of Presentation. 21 of 42 CPGs published in 2020 were related to COVID. Mean overall scores were 35% (±20%) for COVID-related CPGs and 67% (±13%) for non-COVID-19 CPGs. For COVID-19 CPGs, scores ranged from 27.88 (±20.31) in Rigour of Development to 69.58 (±10.81) in Scope and Purpose. For non-COVID CPGs, the scores ranged from 37.30 (±8.93) in Applicability to 84.52 (±5.93) in Clarity of Presentation.
Conclusions
The difference in overall scores between COVID-19 endoscopy CPGs and non-COVID endoscopy CPGs may suggest that the urgency to disseminate COVID-19 information decreased CPG quality or completeness of reporting. This interim analysis is limited by the lack of distinction between peer-reviewed CPGs and non-peer reviewed recommendations. Given the importance of CPGs in clinical decision making, it is important to ensure that the rapid development of guidelines does not compromise quality and rigour.
Funding Agencies
None
Collapse
Affiliation(s)
- D Tham
- St. Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Gholami
- St. Michael’s Hospital, Toronto, ON, Canada
| | - C Pattni
- St. Michael’s Hospital, Toronto, ON, Canada
| | - S Seleq
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Bansal
- St. Michael’s Hospital, Toronto, ON, Canada
| | | | | | - J Lisondra
- St. Michael’s Hospital, Toronto, ON, Canada
| | | | - M Scaffidi
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- St. Michael’s Hospital, Toronto, ON, Canada
| | - S Grover
- St. Michael’s Hospital, Toronto, ON, Canada
| |
Collapse
|
14
|
Verma Y, Bansal R, Gimpaya N, Scaffidi M, Khan R, Grover S. A99 PHARMACEUTICAL INDUSTRY FUNDING TO GASTROINTESTINAL PATIENT ADVOCACY ORGANIZATIONS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859379 DOI: 10.1093/jcag/gwab049.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Patient advocacy organizations (PAOs) are not-for-profit organizations that aim to support families and individuals afflicted by illnesses. PAOs play a significant role in guiding health policy, providing education to patients, lobbying, and supporting research. Previous studies have demonstrated that PAOs may receive financial payments from pharmaceutical and medical device manufacturers. This may create a risk of conflict of interest. Aims To assess the prevalence and transparency of financial donations from industry to gastrointestinal patient advocacy groups based in the United States (US). Methods We conducted a cross-sectional study to determine the prevalence of industry donations to PAOs. Data was extracted from the Kaiser Health News (KHN) Database, a database that tracked payments from pharmaceutical companies to PAOs in 2015. After an initial list of 1215 PAOs was obtained from the database, authors extracted the annual revenues, websites and mission statements for each PAO. Authors individually screened each organization’s mission statement and website to determine whether their primary scope of focus included gastroenterology. A final list of 11 PAOs with annual revenues surpassing $500,000 USD was included for descriptive analysis. From this list, the annual reports and websites of each group were reviewed to determine the extent of transparency of PAOs disclosing financial relationships with industry sponsors. The primary outcome of our study was the total amount of funding that each PAO received from pharmaceutical companies. The secondary outcome was the self-reported amount of funding stated on each PAO’s website and annual report. Results From our analysis of 11 PAOs, 9 (81%) organizations received payments from pharmaceutical companies. The median dollar value of donations received was $31,052 USD (IQR=$25 to $302,550). The total dollar value of donations received was $4,059,433 USD. Across the 9 PAOs that received donations, 5 (56%) organizations disclosed a financial relationship with a pharmaceutical company on their website and 2 (22%) disclosed the value of industry donations within a range. No group specified an exact amount of funding received. Conclusions Our results demonstrate that a majority of US based gastrointestinal PAOs receive funding from pharmaceutical companies. Furthermore, our results show that many PAOs that receive industry funding do not disclose this amount on their website or annual reports. Given their role in providing patient centered support, it is important for PAOs to disclose financial relationships with industry so as to not produce a conflict of interest. Funding Agencies None
Collapse
Affiliation(s)
- Y Verma
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - R Bansal
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - M Scaffidi
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S Grover
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| |
Collapse
|
15
|
Sirot L, Bansal R, Esquivel CJ, Arteaga-Vázquez M, Herrera-Cruz M, Pavinato VAC, Abraham S, Medina-Jiménez K, Reyes-Hernández M, Dorantes-Acosta A, Pérez-Staples D. Post-mating gene expression of Mexican fruit fly females: disentangling the effects of the male accessory glands. Insect Mol Biol 2021; 30:480-496. [PMID: 34028117 DOI: 10.1111/imb.12719] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/26/2021] [Accepted: 05/16/2021] [Indexed: 06/12/2023]
Abstract
Mating has profound physiological and behavioural consequences for female insects. During copulation, female insects typically receive not only sperm, but a complex ejaculate containing hundreds of proteins and other molecules from male reproductive tissues, primarily the reproductive accessory glands. The post-mating phenotypes affected by male accessory gland (MAG) proteins include egg development, attraction to oviposition hosts, mating, attractiveness, sperm storage, feeding and lifespan. In the Mexican fruit fly, Anastrepha ludens, mating increases egg production and the latency to remating. However, previous studies have not found a clear relationship between injection of MAG products and oviposition or remating inhibition in this species. We used RNA-seq to study gene expression in mated, unmated and MAG-injected females to understand the potential mating- and MAG-regulated genes and pathways in A. ludens. Both mating and MAG-injection regulated transcripts and pathways related to egg development. Other transcripts regulated by mating included those with orthologs predicted to be involved in immune response, musculature and chemosensory perception, whereas those regulated by MAG-injection were predicted to be involved in translational control, sugar regulation, diet detoxification and lifespan determination. These results suggest new phenotypes that may be influenced by seminal fluid molecules in A. ludens. Understanding these influences is critical for developing novel tools to manage A. ludens.
Collapse
Affiliation(s)
- L Sirot
- The College of Wooster, Wooster, OH, USA
| | - R Bansal
- USDA-ARS, San Joaquin Valley Agricultural Sciences Center, Parlier, CA, USA
| | - C J Esquivel
- Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH, USA
| | - M Arteaga-Vázquez
- INBIOTECA, Universidad Veracruzana, Av de las Culturas Veracruzanas 101, Col. Emiliano Zapata, Xalapa, Veracruz, Mexico
| | - M Herrera-Cruz
- CONACyT- Facultad de Medicina y Cirugía, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca, Mexico
| | - V A C Pavinato
- Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH, USA
| | - S Abraham
- Laboratorio de Investigaciones Ecoetológicas de Moscas de la Fruta y sus Enemigos Naturales (LIEMEN), PROIMI, Tucumán, Argentina, CONICET, Argentina
| | - K Medina-Jiménez
- INBIOTECA, Universidad Veracruzana, Av de las Culturas Veracruzanas 101, Col. Emiliano Zapata, Xalapa, Veracruz, Mexico
| | - M Reyes-Hernández
- INBIOTECA, Universidad Veracruzana, Av de las Culturas Veracruzanas 101, Col. Emiliano Zapata, Xalapa, Veracruz, Mexico
| | - A Dorantes-Acosta
- INBIOTECA, Universidad Veracruzana, Av de las Culturas Veracruzanas 101, Col. Emiliano Zapata, Xalapa, Veracruz, Mexico
| | - D Pérez-Staples
- INBIOTECA, Universidad Veracruzana, Av de las Culturas Veracruzanas 101, Col. Emiliano Zapata, Xalapa, Veracruz, Mexico
| |
Collapse
|
16
|
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT), a rare inheritable fatal arrhythmogenic disorder, is difficult to diagnose and is a challenge to manage. A 21-years-old man presented with recurrent exertional syncope and complex multifocal ventricular ectopy. CPVT was diagnosed based on the clinical criteria, despite the absence of some classical findings. The patient underwent cardiac sympathetic denervation (CSD) after lifestyle modification and pharmacological management were ineffective. CSD proved to be effective. The patient did not have any exertional symptoms or recurrence of syncope at follow-up period of 1 year. The present case report adds to the growing evidence in favour of CSD for CPVT.
Collapse
Affiliation(s)
- R Bansal
- Holy Family Hospital, Mumbai, Maharashtra, India
| | - A Mahajan
- Holy Family Hospital, Mumbai, Maharashtra, India
| | - S Vichare
- Holy Family Hospital, Mumbai, Maharashtra, India
| | | |
Collapse
|
17
|
Rakshit S, Bansal R, Desai A, Leventakos K. 38P Brain metastases in non-small cell lung cancer in era of molecularly driven therapy. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01880-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
18
|
Li J, Hu M, Scaffidi MA, Gimpaya N, Bansal R, Verma Y, Elsolh K, Khan R, Grover SC. A104 PREVALENCE OF GHOST-AUTHORSHIP IN INDUSTRY-SPONSORED CLINICAL TRIALS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Ghost-authorship involves the exclusion of individuals who have made substantial contributions to the article from the author byline. Previous studies have found that ghost-authorship is highly prevalent in industry-sponsored clinical trials. Its prevalence, however, has yet to be investigated in trials of biologics in the management of inflammatory bowel disease (IBD).
Aims
To determine the prevalence of ghost-authorship in IBD biologic industry-sponsored clinical randomized controlled trials (RCTs).
Methods
Biologic medications indicated for ulcerative colitis (UC) or for Crohn’s disease (CD) were identified using the Food and Drug Agency (FDA) database. We identified the clinical trials on clinicaltrials.gov corresponding to the data presented at the time of FDA approval. Specifically, we included the first publication for each trial to report study results for our analysis. Two authors independently identified the presence of ghost-authorship, which we defined as the exclusion on the author byline of the included RCT publication of any individuals who assisted in the writing of the trial manuscript and/or performed the data analyses.
Results
We identified a total of 28 relevant RCTs on biologic medications (10 for UC and 18 for CD), which were matched to 20 publications. We found ghost-authorship in 70% of publications (n=14); 40% (n=8) involved manuscript and protocol writing assistance from sponsor staff; 35% (n=7) involved medical writers from external companies; 15% (n=3) involved both sponsor staff and medical writers assisting in manuscript writing; and 20% (n=4) involved individuals performing data analysis or interpretation.
Conclusions
We found that ghost-authorship in industry-sponsored IBD biologic clinical trials has a moderately high prevalence, with the most common being manuscript or protocol writing assistance. A lack of transparency regarding sponsor-affiliated and/or external contributors may negatively affect the trust placed in medical research. One limitation is that data was only extracted from publications. Further evidence on ghost-authorship may be found in study protocols and registrations, which will be investigated in the future.
Funding Agencies
None
Collapse
Affiliation(s)
- J Li
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - M Hu
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - M A Scaffidi
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - R Bansal
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - Y Verma
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - K Elsolh
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S C Grover
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| |
Collapse
|
19
|
Bansal R, Khan R, Gimpaya N, Scaffidi MA, Elsolh K, Verma Y, Li J, Grover SC. A160 PREVALENCE OF OUTCOME SWITCHING AMONG PUBLISHED PHASE 3 INTERVENTIONAL TRIALS FOR INFLAMMATORY BOWEL DISEASE THERAPEUTICS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Outcome switching is a well-described form of inconsistent reporting in randomized clinical trials (RCTs), wherein pre-specified primary and/or secondary outcomes are changed between trial registration and the publication of results without explanation. This is of particular concern, as the selective publication of results that are favorable will insert bias into the trial’s results and may cast doubt on the veracity of its findings. While it has been investigated in other disciplines, the prevalence of outcome switching has yet to be described among RCTs for inflammatory bowel disease (IBD).
Aims
To determine the prevalence of correctly reported pre-specified primary and secondary outcomes in published phase 3 interventional RCTs for IBD.
Methods
We identified all phase 3 interventional trials for IBD with published results using clinicaltrials.gov. We included all results with an associated publication that detailed the results of the trial. We excluded registrations if: only an abstract of the results was available; trial results were only published as a pooled analysis; multiple trial segments were reported collectively; or a publication of the results could not be identified through clinicaltrials.gov or a custom search.
Two reviewers extracted all pre-specified primary and secondary outcomes for each trial using the clinical trial registration page that was dated before the commencement of the trial. These outcomes were compared to the outcomes reported in the corresponding journal articles. Any discrepancies were noted, and additional outcomes were extracted.
Results
We identified a total of 88 phase 3 interventional RCTs for IBD, of which 57 were matched to independent publications of their results. All trials pre-specified a primary outcome, and 50 (87.7%) pre-specified secondary outcomes. 10 (17.5%) of trials did not report some or all primary outcomes, and 19 (33.3%) trials had a change or alteration to the primary outcome. Of the trials that pre-specified secondary outcomes, 16 (28.1%) did not report all pre-specified secondary outcomes. 49 (86.0%) trials added 6 (IQR: 2–8) unspecified secondary outcomes on average.
Conclusions
Many phase 3 interventional RCTs in IBD either did not report some or all primary outcomes, or altered the primary outcome. Trials routinely reported additional outcomes that were not pre-specified and failed to note that they were added post hoc. Based on these results, we recommend improvements in the reporting of pre-specified outcomes and higher fidelity in order to maintain confidence in trial results.
Funding Agencies
None
Collapse
Affiliation(s)
- R Bansal
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - N Gimpaya
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - M A Scaffidi
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - K Elsolh
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - Y Verma
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - J Li
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - S C Grover
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| |
Collapse
|
20
|
Verma Y, Scaffidi MA, Gimpaya N, Panjwani A, Bansal R, Li J, Elsolh K, Khan R, Grover SC. A70 PREVALENCE OF SELF-PUBLICATION AMONG EDITORIAL BOARD MEMBERS OF GASTROENTEROLOGY JOURNALS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Editorial self-publication refers to the practice wherein editors publish research in journals to which they serve as editorial board members. The International Committee of Medical Journal Editors (ICMJE) has detailed recommendations against the practice of self-publication. There is evidence to suggest that editorial board membership may influence the decision to publish academic papers, which may contribute to publication bias. Despite this, there have been few attempts to characterize this practice in gastroenterology journals.
Aims
To determine the prevalence of original gastroenterology research articles published by editorial board members in their own journal.
Methods
We conducted a cross-sectional study to determine the prevalence of editorial board members publishing within their own journals. A list of the top 25 highest impact factor gastroenterology journals was created through InCites Journal reports. Journals were screened to determine eligibility based on whether their primary focus included gastroenterology research and whether archives with the names and affiliations of editorial board members were available. 10 journals were selected based on these criteria. For each journal, we extracted all original research articles published in 2019 using Web of Science (Clarivate Analytics ©). Articles classified as editorial material, meeting abstracts, reviews, and clinical practice guidelines were excluded. We cross-referenced the affiliations of all authors found in each publication with affiliations of editors disclosed on the journal website. For each editorial board member, we determined the number of publications within their own journal.
Results
We identified 844 editorial board members in the 10 journals included. Overall, 337 (39.9%) of the editors had a publication in their own journal, of which, 152 (18.0%) had more than one publication. Across all journals, the median number of editors with self-publication is 27 (IQR=20.3–49.8). The median number of editors with more than one self-publication is 16 (IQR=10.0–25.3). In total, 507 (60.1%) of all editors had no publications within their respective journals.
Conclusions
Despite recommendations against this practice, our results show a high number of research publications authored by editorial board members. These results demonstrate a potential risk for publication bias. However, this study was limited by the inability to investigate beyond the prevalence of self-publication. Furthermore, the explicit implications of our results remain unclear. Further research is required to evaluate factors such as disclosures and the review process associated with increased rates of self-publication as well as its impact on publication bias.
Funding Agencies
None
Collapse
Affiliation(s)
- Y Verma
- St. Michael’s Hospital, Toronto, ON, Canada
| | | | - N Gimpaya
- St. Michael’s Hospital, Toronto, ON, Canada
| | - A Panjwani
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Bansal
- St. Michael’s Hospital, Toronto, ON, Canada
| | - J Li
- St. Michael’s Hospital, Toronto, ON, Canada
| | - K Elsolh
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S C Grover
- St. Michael’s Hospital, Toronto, ON, Canada
| |
Collapse
|
21
|
Khan R, Elsolh K, Gimpaya N, Scaffidi MA, Bansal R, Grover SC. A89 CHARACTERISTICS AND CONFLICTS OF INTEREST AT FOOD AND DRUG ADMINISTRATION GASTROINTESTINAL DRUG ADVISORY COMMITTEE MEETINGS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The United States Food and Drug Administration (FDA) Gastrointestinal Drug Advisory Committee (GIDAC) is involved in gastrointestinal drug application reviews. Characteristics and conflicts of interest (COI) in GIDAC meetings are not well described.
Aims
To analyze FDA GIDAC meetings and characteristics that predict recommendations.
Methods
This was a cross-sectional study of all publicly available GIDAC meetings where proposed medications were voted on from 1998–2018. Data were collected on individual meetings and individual voting members at meetings. Predefined predictor variables included type of medication, medication sponsor, primary efficacy studies, and voting member characteristics (e.g. committee membership, COI). Univariate analyses were conducted at per-meeting and per-vote levels to assess for predictors of committee recommendation and individual votes respectively.
Results
Thirty-four meetings with 476 individual votes from 1998–2018 were included. Twenty-three (68%) proposals were recommended for approval and 25 (74%) received FDA approval. Most proposals involved >1 primary study (n=27, 79%). At least one voting member had a COI in 24 (71%) of 34 meetings. Twelve (35%) meetings had at least one sponsor COI. Among 476 individual votes, 74 (15.5%) involved a COI, with 33 (6.9%) sponsor COI. COI decreased significantly over time, with more COI in 1996–2000 and 2001–2005 compared to 2006–2010, 2011–2015, and 2016–2020 (p<0.01). There were no significant associations between pre-defined predictors, including COI, and committee level recommendations or individual votes (p>0.05 for all univariate analyses).
Conclusions
The GIDAC reviewed 34 proposals from 1998–2018. The majority were recommended for approval and later approved by the FDA, highlighting the GIDAC’s prominence in the regulatory process. COI are present among GIDAC panelists but decreasing over time and not associated with recommendations.
Funding Agencies
None
Collapse
Affiliation(s)
- R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - K Elsolh
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - N Gimpaya
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - M A Scaffidi
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Bansal
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S C Grover
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
22
|
Gimpaya N, Khan R, Gallinger ZR, Scaffidi MA, Al Abdulqader AK, Ahmed M, Gholami R, Ramkissoon A, James PD, Mosko J, Griller N, Bansal R, Grover SC. A77 A REUSABLE POLYCARBONATE BOX TO DECREASE DROPLET CONTAMINATION DURING UPPER ENDOSCOPY: A SIMULATION-BASED STUDY FOR THE COVID-19 PANDEMIC. J Can Assoc Gastroenterol 2021. [PMCID: PMC7989228 DOI: 10.1093/jcag/gwab002.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Upper gastrointestinal (GI) endoscopic procedures are aerosol-generating, increasing the risk of healthcare workers (HCW) contracting Coronavirus disease 2019 (COVID-19). Aims To present a polycarbonate box (EndoBox) designed for use in upper GI endoscopy and evaluate its impact on the contamination of endoscopy staff during simulated procedures. Methods Simulated gastroscopies were performed using an upper body simulator placed in left lateral decubitus (LLD) and supine positions. The endoscopist and assistant wore personal protective equipment. Droplet exposure was measured using fluorescent abiotic surrogate particles. Two blinded observers independently viewed images from each scenario to qualitatively evaluate contamination levels. The primary outcome was the level of HCW contamination by droplets generated from a simulated cough with and without the EndoBox on the upper body simulator. The endoscopist’s ergonomic behaviour was also assessed using the Rapid Upper Limb Assessment (RULA) tool. Results Without the EndoBox, there was a higher level of contamination on the endoscopist when the upper body simulator is in the LLD position. A higher level of contamination was observed on the assistant when the simulator is in supine position. With the EndoBox, the contamination levels on the endoscopy staff were lower in both LLD and supine scenarios. The endoscopist’s ergonomics were rated 2 to 3 on the RULA tool when using the EndoBox. Conclusions The EndoBox reduces macroscopic droplet contamination during simulated gastroscopy. The endoscopist’s risk of musculoskeletal injury remained in the low risk categories as assessed by the RULA tool. Another advantage of the EndoBox design is the arch extending from the bottom that allows for removal of the box without withdrawing the endoscope. This enables rapid access to the patient’s airway if they experience respiratory distress. This study was limited by an inability to assess microscopic contamination and contamination at the level of the port or buttons when suction is applied. Within these limitations, the EndoBox may be a useful adjunct to traditional personal protective equipment. Funding Agencies SMHA AFP COVID-Related Innovation Funds
Collapse
Affiliation(s)
- N Gimpaya
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Z R Gallinger
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - M A Scaffidi
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | | | - M Ahmed
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
| | - R Gholami
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - A Ramkissoon
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - P D James
- University Health Network, Toronto, ON, Canada
| | - J Mosko
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - N Griller
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - R Bansal
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - S C Grover
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| |
Collapse
|
23
|
Elsolh K, Tham D, Scaffidi MA, Bansal R, Li J, Verma Y, Gimpaya N, Khan R, Grover SC. A161 PREVALENCE OF FINANCIAL CONFLICTS OF INTEREST (FCOI) AMONG PROPENSITY-SCORE MATCHED RETROSPECTIVE STUDIES EVALUATING BIOLOGIC THERAPEUTICS FOR IBD. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Inflammatory Bowel Disease (IBD) studies have commonly relied on real-world evidence to evaluate different therapies. An emerging idea has been the use of propensity score matching as a statistical method to account for baseline characteristics in IBD patients. In retrospective studies, propensity score matching of patients helps reduce treatment assignment bias and mimic the effects of randomization. Recently, propensity-score matching has become an important tool in IBD studies comparing biologic therapeutics. Biologic medications are among the highest-grossing drugs worldwide, and their pharmaceutical producers make considerable payments to physicians to market them. In spite of this, there is a lack of evidence examining the role of undue industry influence among propensity-score matched comparative studies evaluating biologic therapeutics for IBD.
Aims
Given the documented association between IBD biologics and FCOI, we hypothesize a high burden of FCOI in propensity-score matched studies. The aim of this study was to evaluate the prevalence of disclosed & undisclosed financial conflicts of Interest (FCOI) in propensity-score matched comparison studies evaluating biologics for IBD.
Methods
We developed & ran a librarian-reviewed systematic search on EMBASE, MEDLINE, and Cochrane Library databases for all propensity-score matched retrospective studies comparing biologics for the treatment of IBD. Full-text retrieval & screening was performed on all studies in duplicate. 16 articles were identified. Industry payments to authors were only considered FCOI if they were made by a company producing a biologic that was included in the comparison study. Disclosed FCOI were identified by authors’ interests disclosures in full-texts. Any undisclosed FCOI among US authors were identified using the Centre for Medicare and Medicaid Services (CMS) Open Payments Database, which collects industry payments to physicians.
Results
Based on a preliminary analysis of 16 studies, there was at least one author with a relevant FCOI in 14 (88%) of the 16 studies. 14 studies (88%) had at least one disclosed FCOI, while 6 studies (37.5%) had at least one undisclosed FCOI. Among studies with disclosed FCOI, a mean of 40.2% (SD = 23.4%) of authors/study reported FCOI. Among studies with undisclosed FCOI, a mean of 18.8% (SD = 7.0%) of authors/study reported FCOI. The total dollar value of FCOIs was $1,974,328.3. The median conflict dollar value was $5,576.6 (IQR: $321.6 to $36,394.9).
Conclusions
We found a high burden of undisclosed FCOI (37.5%) among authors of propensity-score matched studies evaluating IBD biologics. Given the potential for undue industry influence stemming from such payments, authors should ensure better transparency with industry relationships.
Funding Agencies
None
Collapse
Affiliation(s)
- K Elsolh
- St Michael’s Hospital, Toronto, ON, Canada
| | - D Tham
- St Michael’s Hospital, Toronto, ON, Canada
| | | | - R Bansal
- St Michael’s Hospital, Toronto, ON, Canada
| | - J Li
- St Michael’s Hospital, Toronto, ON, Canada
| | - Y Verma
- St Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- St Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- University of Toronto, Hamilton, ON, Canada
| | - S C Grover
- St Michael’s Hospital, Toronto, ON, Canada
| |
Collapse
|
24
|
Gholami R, Gimpaya N, Khan R, Scaffidi MA, Bansal R, Ramkissoon A, Alabdulqader A, Grover SC. A71 RECOMMENDATION REVERSALS IN GASTROENTEROLOGY CLINICAL PRACTICE GUIDELINES. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Clinical practice guidelines are evidence-based resources designed to inform clinical decision making. Often, superior evidence will support the inclusion of novel procedures and practices to replace older recommendations. Recommendation reversals occur when (a) superior quality evidence emerges to suggest the harm or non-beneficence of prior recommendations, and (b) that recommendation is not supplanted by a newer one.
Aims
The primary objective of this study was to describe the content, frequency and rationale for recommendation reversals in CPGs published by gastroenterological societies.
Methods
For this meta-epidemiologic study, we considered two criteria to define a recommendation reversal: (a) the more recent CPG makes a recommendation that contradicts a previously accepted practice; and (b) the prior recommendation is not replaced by any novel intervention. We searched CPGs published by 20 major GI societies from 1991- 2019. Guidelines were included if had at least two iterations with the same title and used a valid evidence rating system (such as GRADE). Explicit recommendations which reported definite levels of evidence and strength of recommendation were extracted.
Results
We identified 1022 clinical guidelines from GI societies over 28 years. 292 CPGs were included for data synthesis. 5985 explicit statements were extracted. 12 reversals were confirmed and are summarized in the Table. Six reversals (50.0%) occurred due to studies reporting non-beneficence and 3 (25.0%) occrred due to studies reporting harm. Three recommendations (25.0%) were reversed due to new clinical trials; 3 (25.0%) due to systematic reviews or meta-analyses; and 2 to conform with CPGs of other societies (16.7%).
Conclusions
We describe recommendation reversals made in gastroenterology CPGs, and the reasons thereof. Investigation of recommendation reversals allows for the identification of low-value medical practices. This reinforces the need for GI CPG committees to (1) iteratively review guidelines to re-evaluate recommendations made on low-quality evidence and; (2) refrain from making recommendations when evidence for the same is weak.
Funding Agencies
None
Collapse
Affiliation(s)
- R Gholami
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - M A Scaffidi
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - R Bansal
- McMaster University Faculty of Health Sciences, Richmond Hill, ON, Canada
| | - A Ramkissoon
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - A Alabdulqader
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - S C Grover
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| |
Collapse
|
25
|
Bachani N, Bagchi A, Sinkar K, Jadwani JP, Panicker GK, Bansal R, Mahajan A, Lokhandwala Y. Is the right ventricular function affected by permanent pacemaker? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The effect of right ventricular (RV) pacing on left ventricular (LV) function has been extensively evaluated, and so has the effect of the RV pacing lead on tricuspid valve function. However, the effects on RV function per se have not been evaluated systematically.
Purpose
We aimed to assess the RV dimensions and RV function six months after dual chamber pacemaker implantation
performed for atrioventricular (AV) block by detailed echocardiography, including three-dimensional (3D) echocardiography.
Method
All adult patients undergoing dual chamber pacemaker from January 2018 to March 2019 for symptomatic AV block with a structurally normal heart were included in the study. They underwent pre-procedure detailed echocardiography specifically directed at measuring RV dimensions and function [including 3D RV ejection fraction (EF)] and a repeat detailed echocardiogram at six-month follow-up, by the same echocardiographer. The echocardiographic parameters at baseline and after six-month follow-up were compared.
Results
All patients had more than 75% ventricular pacing in these six months. At six-month follow-up, there was no significant change in LVEF, while there was a mild decrease in RVEF as outlined in the Table 1. While there was some overlap between RVEF range of values at baseline and after six months, 23 (38.3%) patients showed a drop in RVEF by >5%.
Conclusion
Our study shows a change in several RV function parameters in a majority of patients six months after
pacemaker implantation for AV block.
RV Function at six month follow-up Parameters Pre-procedure Six-Month Follow-up p value (Paired t-test) PASP (mm Hg) 20.2 ± 1.3 26.1 ± 12.2 <0.001 FAC (%) 42.6 ± 3.4 39.4 ± 6 <0.001 TAPSE (mm) 18.4 ±3.8 15.6 ± 4.7 <0.001 RIMP 0.66 ± 0.09 0.61 ± 0.11 0.003 RV E/E’ 9.4 ± 2.1 7.7 ± 2.1 <0.001 RV S’ 13.6 ± 2.4 10.7 ± 2.4 <0.001 RVEF % [By 3D Echocardiography] 47.7± 5.1 44.9 ± 7.4 <0.001 TR Jet Area (cm2) 0.03 ± 0.26 0.55 ± 0.96 <0.001 RV= Right Ventricle; RA= Right Atrium; RVOT = Right Ventricular Outflow Tract; PASP = Pulmonary Artery Systolic Pressure; FAC= Fractional Area Change; TAPSE= Tricuspid Annular Plane Systolic Excursion; RIMP = Right Ventricular Index of Myocardial Performance; TR = Tricuspid Regurgitation S’ = Peak Systolic Annular Velocity; RVEF = Right Ventricular Ejection Fraction; 3D = Three Dimensional Abstract Figure. Change in RVEF in 6 months
Collapse
Affiliation(s)
| | - A Bagchi
- Holy Family Hospital, Mumbai, India
| | - K Sinkar
- Holy Family Hospital, Mumbai, India
| | | | - GK Panicker
- Indian Institute of Management, Ahmedabad, India
| | - R Bansal
- Holy Family Hospital, Mumbai, India
| | | | | |
Collapse
|
26
|
Shah H, Bansal R, Bachani N, Panicker G, Dhirawani B, Lokhandwala Y. CHARACTERISATION OF SUBSETS OF TACHYCARDIOMYOPATHY. Indian Pacing Electrophysiol J 2021. [DOI: 10.1016/j.ipej.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
27
|
Jhand A, Bansal R, Dhawan R, Abbott J, Porter T, Tcheng J, Chatzizisis Y, Goldsweig A. Coronary artery bypass grafting versus percutaneous coronary intervention for left main disease in chronic kidney disease patients: a meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Limited data exist on the optimal revascularization strategy for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD). We conducted a meta-analysis to compare the outcomes of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in this population.
Methods
Multiple electronic databases were queried for studies comparing CABG and PCI in CKD patients undergoing LMCAD (>50% diameter stenosis) revascularization. CKD was defined as estimated glomerular filtration rate of <60 ml/min/1.73 m2. The primary outcome was long-term major adverse cardiac and cerebrovascular events (MACCE), which was a composite of cardiovascular death, myocardial infarction (MI), stroke and repeat revascularization. Secondary outcomes included all-cause mortality, MI, stroke and repeat revascularization. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. The analysis was performed using the DerSimonian and Laird random effect model.
Results
Six studies (4 observational, 2 randomized controlled trials) met inclusion criteria with a total of 2051 patients (CABG: 977, PCI: 1074). Patients undergoing CABG had a higher incidence of multi-vessel disease (74.7% vs 65.7%, p=0.01). At a mean follow-up of 3.4±1.1 years, MACCE was significantly lower in the CABG group (OR = 0.70, 95% CI 0.57–0.87; p=0.001) (Figure 1). The odds of MI or repeat revascularization were lower with CABG, whereas the odds of stroke were higher; no statistically-significant difference was seen in all-cause mortality.
Conclusion
This meta-analysis shows that CABG is associated with lower rates of MACCE and MI but with a higher rate of stroke compared to PCI in LMCAD patients with CKD.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- A Jhand
- University of Nebraska Medical Center, Omaha, United States of America
| | - R Bansal
- Creighton University School of Medicine, Internal Medicine, Omaha, United States of America
| | - R Dhawan
- University of Nebraska Medical Center, Omaha, United States of America
| | - J.D Abbott
- Brown University, Providence, United States of America
| | - T Porter
- University of Nebraska Medical Center, Omaha, United States of America
| | - J Tcheng
- Duke University School of Medicine, Durham, United States of America
| | - Y Chatzizisis
- University of Nebraska Medical Center, Omaha, United States of America
| | - A Goldsweig
- University of Nebraska Medical Center, Omaha, United States of America
| |
Collapse
|
28
|
Singh R, Bansal R. Synthesis and pharmacological evaluation of 16-imidazolyl substituted heterosteroids in LPS induced neuroinflammation model of rat for antiparkinsonian and antioxidant effects. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
29
|
Abstract
Background: Xanthogranulomatous pyelonephritis (XGP) is a rare chronic bacterial inflammation of the renal parenchyma and is often a diagnostic dilemma.Case Presentation: We present a challenging case of a patient with XGP. Initially thought to have had renal cell cancer she was treated accordingly with a partial nephrectomy. However, on the final pathology, she was found to have XGP and required further antibiotic therapy and referral to the infectious disease service.Discussion: Management of XGP and diagnostic pitfalls are discussed.Conclusion: XGP is a diagnostic and therapeutic dilemma. Partial Nephrectomy may be appropriate in management of XGP in select cases.
Collapse
Affiliation(s)
- S M Mohaghegh P
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - R S Wong
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - M Rahimi
- Department of Pathology, University of Manitoba, Winnipeg, MB, Canada
| | - F Shih
- Department of Pathology, University of Manitoba, Winnipeg, MB, Canada
| | - R Bansal
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|
30
|
Menacho Medina KD, Ramirez S, Katekaru D, Dragonetti L, Perez D, Illatopa V, Rodriguez B, Bansal R, Rodriguez I, Jacob R, Ntusi N, Herrey A, Westwood M, Walker M, Mooon J. 28Impact of non-invasive rapid cardiac magnetic resonance for the assessment of cardiomyopathies in developing countries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular mortality is higher in developing countries. Part of that is suboptimal testing. Cardiac magnetic resonance (CMR) is the gold standard for measuring structure, function of the heart and adds incremental value by imaging scarring and to assess iron level. Despite the existence of MRI units, CMR is identified as a complex test, with poor training and availability in developing countries.
Purpose
To assess the potential impact of a faster CMR protocol at a multicentre level in developing countries; implementing it with an education program, for the assessment cardiomyopathies.
Methods
An international partnership. A rapid CMR protocol for the evaluation of cardiac volumes, function and tissue characterization (Cardiac Iron T2* and LGE for scar) Figure 1a. We deployed the protocol as a multicentre study: Argentina, Peru, India and South Africa accompanied by a program of education. Pre-scan clinical information, scanning data: complications, image quality and post-scan follow-up of participants for the assessment on impact, between 3 to 24 months.
Results
510 scans (4 countries, 6 cities, 12 centres) were performed with the rapid CMR protocol. Contrast studies in 378 (74%). There were no scan-related complications. Quality of the studies was maintained in a high level as an average of 89%. 97% of studies responded referral's question. All patients with contrast CMR scan have had at least one 2D echocardiogram before CMR. Average scan duration was 21±6 mins for contrast studies and 12±3 for non-contrast T2* protocol. The most common underlying diagnoses were non-ischaemic cardiomyopathy in 73% of participants (including cardiac iron level assessment in 26%, HCM in 17%, DCM in 15%), 27% for ischaemic cardiomyopathy and 15% for other pathologies. 4 of the 12 participant centres started to incorporate CMR for the first time. Findings impacted management in 60% of patients, including new diagnosis in 21% of participants. See table 1, figure 1b. For just cardiac iron assessment: 1/3 of participants had iron deposited in the heart with 14% of patients in severe levels.
Conclusions
CMR can be delivered faster and easier. When this abbreviated protocol is enabled with education, it can be implemented in developing countries with existing technology. This protocol shows high quality exam, with an important impact on patient's management.
Characteristics and impact on management Contrast studies Non-contrast studies All patients (%) 378 (74) 132 (36) Age, mean (range) years 54 (16–93) 24 (13–41) Male (%) 151 (39) 64 (48) Pre-echocardiography exam (%) 370 (98) 42 (32) Scanning duration mean (SD) 21 (6) 12 (3) Good quality exam (%) 329 (87) 120 (91) Impact on management Total All patients (%) 510 (100) Completely new diagnosis (%) 105 (21) Change/Addition of Medication (%) 128 (25) Intervention/ Surgery (%) 31 (6) Invasive angiography/biopsy (%) 25 (5) Hospital discharge/admission (%) 15 (3) TOTAL 306 (60%) SD: Standard Deviation.
Acknowledgement/Funding
Global Engagement UCL, UK Foreign & Commonwealth Office and The Peruvian Scientific, Technological Development and Technological Innovation (FONDECYT)
Collapse
Affiliation(s)
| | - S Ramirez
- International Clinic, Lima – Peru, Cardiac Imaging Department, Lima, Peru
| | - D Katekaru
- Military Hospital, Cardiac Imaging Department, Lima, Peru
| | - L Dragonetti
- High Technology Medical Institute - IMAT, Radiology Department, Buenos Aires, Argentina
| | - D Perez
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - V Illatopa
- National Cardiovascular Institute - INCOR, Lima, Peru
| | - B Rodriguez
- Edgardo Rebagliati Hospital, MRI and CT Department, Lima, Peru
| | - R Bansal
- Bhawani Singh Marg Hospital and OK Diagnostic Centre, Jaipur, India
| | | | - R Jacob
- Lancaster General Health Hospital, Lancaster, United States of America
| | - N Ntusi
- University of Cape Town, Cape Town, South Africa
| | - A Herrey
- St Bartholomew's Hospital, Barts Hear Centre, London, United Kingdom
| | - M Westwood
- St Bartholomew's Hospital, Barts Hear Centre, London, United Kingdom
| | - M Walker
- University College London, London, United Kingdom
| | - J Mooon
- St Bartholomew's Hospital, Barts Hear Centre, London, United Kingdom
| |
Collapse
|
31
|
N Ray, Vyas S, Khandelwal N, Bansal R, Lal V. Papilloedema: diffusion-weighted imaging of optic nerve head. Clin Radiol 2019; 74:652.e11-652.e19. [PMID: 31202568 DOI: 10.1016/j.crad.2019.05.005] [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] [Received: 11/12/2018] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
AIM To establish the correlation between clinical grading of papilloedema and diffusion abnormalities of optic nerve head (ONH) on diffusion-weighted imaging (DWI). MATERIALS AND METHODS Brain magnetic resonance imaging (MRI), including readout segmented echo planar imaging-based DWI, was performed in 32 patients with papilloedema and the same number of age- and sex-matched controls. Clinical grading of papilloedema was done according to the modified Frisén scale. Two neuroradiologists independently evaluated the MRI for ONH hyperintensity and apparent diffusion coefficient (ADC) value of ONH. The comparison between papilloedema clinical grade and qualitative grade of ONH hyperintensity and its presence between cases and control groups were done using the Chi-square test and Fisher's exact test, respectively. The comparison between mean ADC value of ONH among different grades and between cases and controls were done using analysis of variance (ANOVA)-F-test and Student's t-test, respectively. Receiver operating characteristic (ROC) analysis was done to calculate a cut-off ADC value between the case and control groups. RESULTS Significant correlation between ONH hyperintensity and mean ADC value of ONH with clinical grades of papilloedema and between cases and control groups were found. ONH hyperintensity was found to be a highly sensitive (87.5% for both) and specific (specificity 97.1% and 98.6% for two observers) sign of papilloedema. A mean cut-off ONH ADC value was found to have high sensitivity (96.83%) and specificity (95.31%) to distinguish between the cases and controls. CONCLUSIONS Diffusion parameters of ONH have significant correlation with clinical grading of papilloedema and can serve as a surrogate marker for intracranial pressure.
Collapse
Affiliation(s)
- N Ray
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - S Vyas
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - N Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - R Bansal
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - V Lal
- Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
32
|
Rumman A, Bansal R, Scaffidi MA, Bukhari A, Khan R, Dhillon J, Genis S, Grover SC. A207 UNDISCLOSED PAYMENTS BY PHARMACEUTICAL AND MEDICAL DEVICE MANUFACTURERS TO AUTHORS OF ENDOSCOPY GUIDELINES IN THE UNITED STATES. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Rumman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Bansal
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - M A Scaffidi
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - A Bukhari
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - J Dhillon
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S Genis
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S C Grover
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
33
|
Sasson AN, Scaffidi MA, Bansal R, Dhillon J, Khan R, Grover SC. A180 PREVALENCE AND RELEVANCE OF FINANCIAL CONFLICTS OF INTEREST AMONG CLINICAL PRACTICE GUIDELINES IN NUTRITION. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A N Sasson
- Division of Gastroenterology. St. Michael’s Hospital. University of Toronto, Toronto, ON, Canada
| | - M A Scaffidi
- Division of Gastroenterology. St. Michael’s Hospital. University of Toronto, Toronto, ON, Canada
| | - R Bansal
- Division of Gastroenterology. St. Michael’s Hospital. University of Toronto, Toronto, ON, Canada
| | - J Dhillon
- Division of Gastroenterology. St. Michael’s Hospital. University of Toronto, Toronto, ON, Canada
| | - R Khan
- Division of Gastroenterology. St. Michael’s Hospital. University of Toronto, Toronto, ON, Canada
| | - S C Grover
- Division of Gastroenterology. St. Michael’s Hospital. University of Toronto, Toronto, ON, Canada
| |
Collapse
|
34
|
Kuninty P, Bansal R, Satav T, Bijlsma M, Laarhoven H, Östman A, Prakash J. PO-009 A novel integrin alpha 5 binding peptide potentiates effects of chemotherapy in pancreatic cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.544] [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
|
35
|
Abstract
AbstractEpilepsy is the commonest serious neurological problem faced by obstetricians and gynaecologists. Epidemiological studies estimate epilepsy to complicate 0.3–0.7% of all pregnancies.1 2 The importance of epilepsy in pregnancy lies in the fact that many women with epilepsy (WWE) have to go through their pregnancy while taking antiepileptic (AED) drugs. Both the seizures and AEDs can have harmful effects on the mother as well the foetus. Thus, during pregnancy, the clinician faces dual challenge of controlling seizures as well as preventing teratogenicity of AEDs.1 In this review we discuss the possible impact of seizures as well as AEDs on mother as well as the child. We try to answer some of the commonest questions which are relevant to successful management of pregnancy and ensuring birth of a healthy baby.
Collapse
Affiliation(s)
- R. Bansal
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - G. Jain
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - P. Kharbanda
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - M. Goyal
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - V. Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| |
Collapse
|
36
|
Kour M, Gupta R, Saini R, Bansal R. Diastereoselectivity in the Aza-Michael Reaction of Chiral α-Methylbenzylamines with α,β-Unsaturated Carbonyl Compounds. SynOpen 2018. [DOI: 10.1055/s-0036-1591999] [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: 10/17/2022] Open
Abstract
The aza-Michael reaction of (S)-(–)- and (R)-(+)-α-methylbenzylamines with trans-cinnamaldehyde and other α,β-unsaturated carbonyl compounds occurs with 52–98% diastereoselectivity (de); however, in the reaction with crotonaldehyde, the de is lower (20–38%). In the products obtained from the reaction with α,β-unsaturated aldehydes, the de could be determined on the basis of the relative intensities of the aldehydic protons of the two diastereomers. Theoretical investigations of the reaction of (S)-(–)-α-methylbenzylamine with trans-cinnamaldehyde at the DFT (B3LYP/6-31+G*) level reveal that the diastereomer formed from the attack of the amine on the Re face is thermodynamically more stable. The calculations also show that the aldehydic proton of this diastereomer is expected to be more deshielded, which on the basis of the 1H NMR spectrum is the major product.
Collapse
Affiliation(s)
- M. Kour
- Department of chemistry, The IIS University
| | - R. Gupta
- Department of chemistry, The IIS University
| | | | - R. Bansal
- Department of chemistry, The IIS University
| |
Collapse
|
37
|
Sharma K, Gupta A, Sharma M, Sharma A, Singh R, Aggarwal K, Bansal R, Thakur A, Prakash S, Gupta V. MTBDRplus for the rapid diagnosis of ocular tuberculosis and screening of drug resistance. Eye (Lond) 2017; 32:451-456. [PMID: 29052602 DOI: 10.1038/eye.2017.214] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/21/2017] [Indexed: 12/20/2022] Open
Abstract
PurposeTimely diagnosis of intraocular tuberculosis (IOTB) along with detection of drug resistance can save many eyes from visual impairment. With the growing incidence of IOTB and rising drug resistance, a reliable diagnostic platform for simultaneous detection of the agent and mutated gene is urgently needed. The MTBDRplus assay was evaluated directly on vitreous fluid samples for the same.Patients and methodsIn a prospective study, The MTBDRplus assay was performed on 127 vitreous fluid samples (77 'study group' comprising cases of presumed ocular tuberculosis and 50 'control group' cases of disease controls (n=25) and non-uveitic controls (n=25)). All samples positive by MTBDRplus assay were subjected to gene sequencing to confirm the mutations for rifampicin and isoniazid resistance.ResultsThe MTBDRplus assay produced a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 36.36%, 100%, 100%, and 50.50%, respectively, for the detection of IOTB. Among the 28 cases from study group that were positive by MTBDRplus assay, rifampicin resistance was reported in six and isoniazid resistance in two cases. On sequencing of rpoB and katG gene, one case of false rifampicin-resistant by MTBDRplus was found. The other resistant isolates showed concordant mutations between MTBDRplus assay and sequencing.ConclusionThe MTBDRplus assay is an effective tool for the rapid diagnosis of IOTB along with detection of drug resistance, thereby improving the outcome in IOTB.
Collapse
Affiliation(s)
- K Sharma
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M Sharma
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Singh
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Aggarwal
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Bansal
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Thakur
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Prakash
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
38
|
Szachniewicz M, Bartneck M, Tacke F, Bansal R. OR4-3TARGETING LIVER INFLAMMATION USING MINCLE-TARGETED LIPOSOMES AS A NOVEL DRUG DELIVERY SYSTEM. Alcohol Alcohol 2017. [DOI: 10.1093/alcalc/agx074.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
39
|
Bansal R, Duddempudi S, Thelmo W, Rajnish L. A unique case of upper GI bleed. Acta Gastroenterol Belg 2017; 80:553-554. [PMID: 29560659] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- R Bansal
- Division of Gastroenterology, Wyckoff Heights Medical Center, Brooklyn, NY
| | - S Duddempudi
- Division of Gastroenterology, Wyckoff Heights Medical Center, Brooklyn, NY
| | - W Thelmo
- Division of Pathology, Wyckoff Heights Medical Center, Brooklyn, NY
| | - L Rajnish
- Department of Medicine, Elmhurst Hospital Center, NY, USA
| |
Collapse
|
40
|
Sarkar T, Bansal R, Das P. A novel G to A transition at initiation codon and exon-intron boundary of PAX9 identified in association with familial isolated oligodontia. Gene 2017; 635:69-76. [PMID: 28847717 DOI: 10.1016/j.gene.2017.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/23/2017] [Indexed: 11/18/2022]
Abstract
Several studies on experimental animals indicate that the process of organogenesis crucially depends upon the spatiotemporal dose of certain critical bio-molecules. Tooth development is also not an exception. While most of the knowledge regarding the molecular mechanism of tooth development comes from the studies on mouse model, pathogenic variations identified in human tooth agenesis also provide valuable information on mammalian tooth development. Until now five major candidate genes have been identified for tooth agenesis in human. Among them, PAX9 plays the crucial role in tooth development and in non-syndromic congenital tooth agenesis. In this study, microsatellite and SNP based genotyping identifies a disease specific haplotype block, which includes PAX9 gene, segregates with autosomal dominant tooth agenesis phenotype. Direct sequencing of PAX9 identifies a novel heterozygous G to A transition at the third base (c.3G>A) of initiation codon leading to ATG to ATA shift in all affected individuals which is absent in all unaffected relatives and 200 control chromosomes. Further, in vitro functional analysis creating PAX9 minigene construct did apparently show no effect on the splice-site migration. It is therefore proposed that haploinsufficiency of PAX9 is the causal factor for tooth agenesis in this family.
Collapse
Affiliation(s)
- Tanmoy Sarkar
- Centre for Genetic Disorders, Institute of Science, Banaras Hindu University, India
| | - Rajesh Bansal
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India
| | - Parimal Das
- Centre for Genetic Disorders, Institute of Science, Banaras Hindu University, India.
| |
Collapse
|
41
|
Jaiswal M, Bansal R, Agarwal A. Role of Mid-Upper Arm Circumference for Determining Overweight and Obesity in Children and Adolescents. J Clin Diagn Res 2017; 11:SC05-SC08. [PMID: 28969228 DOI: 10.7860/jcdr/2017/27442.10422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 02/10/2017] [Accepted: 03/22/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The prevalence of obesity in adolescents and children has risen to alarming levels globally and this has led to serious public health consequences. AIM To assess the use of Mid-Upper Arm Circumference (MUAC) in the identification of overweight and obesity in North Indian children and adolescents. MATERIALS AND METHODS The study was conducted in Bareilly district of Uttar Pradesh, India, from October 2014 to November 2015. Anthropometric data (weight, height and MUAC) was collected from a cross-sectional sample of 875 children aged 5-14 year old. Receiver Operating Characteristic (ROC) curve analysis determined the validity of MUAC as a proxy for determining overweight and obesity. RESULTS Area Under the Curve (AUC) results were generally high (0.92 - 0.98). The accuracy level of MUAC for identifying obesity was high in both sexes and across age groups (overall AUC of 0.95, sensitivity of 95% and specificity of 90%). The MUAC cut-off to identify BMI defined obesity was 18.8 cm and 19.4 cm for boys and girls of 5-9 age group; 23 cm and 23.3 cm for boys and girls of 10-14 age group. CONCLUSION MUAC may have potential for clinical and surveillance applications as an accurate yet simple and widely available indicator of overweight and obesity in children and adolescents in resourcepoor settings.
Collapse
Affiliation(s)
- Madhur Jaiswal
- Junior Resident, Department of Paediatrics, Rohilkhand Medical College, Bareilly, Uttar Pradesh, India
| | - Rajesh Bansal
- Professor, Department of Paediatrics, Rohilkhand Medical College, Bareilly, Uttar Pradesh, India
| | - Ashok Agarwal
- Professor, Department of Paediatrics, Rohilkhand Medical College, Bareilly, Uttar Pradesh, India
| |
Collapse
|
42
|
Affiliation(s)
- H. Indani
- Geriatric Medicine, All India Institute of Medical Sciences, Delhi, Delhi, India
| | - R. Bansal
- Geriatric Medicine, All India Institute of Medical Sciences, Delhi, Delhi, India
| | - P. Chatterjee
- Geriatric Medicine, All India Institute of Medical Sciences, Delhi, Delhi, India
| | - A. Chakrawarty
- Geriatric Medicine, All India Institute of Medical Sciences, Delhi, Delhi, India
| | - S. Dwivedi
- Geriatric Medicine, All India Institute of Medical Sciences, Delhi, Delhi, India
| | - A.B. Dey
- Geriatric Medicine, All India Institute of Medical Sciences, Delhi, Delhi, India
| |
Collapse
|
43
|
Bansal R, Indani H, Chatterjee P, Chakrawarty A, Dwivedi S, Dey A. ASSOCIATION OF DIABETES AND ITS COMPLICATIONS WITH DEPRESSION IN OLDER PEOPLE OF INDIA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1932] [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: 11/13/2022] Open
|
44
|
Thairu MW, Skidmore IH, Bansal R, Nováková E, Hansen TE, Li-Byarlay H, Wickline SA, Hansen AK. Efficacy of RNA interference knockdown using aerosolized short interfering RNAs bound to nanoparticles in three diverse aphid species. Insect Mol Biol 2017; 26:356-368. [PMID: 28314050 DOI: 10.1111/imb.12301] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
RNA interference (RNAi) has emerged as a promising method for validating gene function; however, its utility in nonmodel insects has proven problematic, with delivery methods being one of the main obstacles. This study investigates a novel method of RNAi delivery in aphids, the aerosolization of short interfering RNA (siRNA)-nanoparticle complexes. By using nanoparticles as a siRNA carrier, the likelihood of cellular uptake is increased, when compared to methods previously used in insects. To determine the efficacy of this RNAi delivery system, siRNAs were aerosolized with and without nanoparticles in three aphid species: Acyrthosiphon pisum, Aphis glycines and Schizaphis graminum. The genes targeted for knockdown were carotene dehydrogenase (tor), which is important for pigmentation in Ac. pisum, and branched chain-amino acid transaminase (bcat), which is essential in the metabolism of branched-chain amino acids in all three aphid species. Overall, we observed modest gene knockdown of tor in Ac. pisum and moderate gene knockdown of bcat in Ap. glycines along with its associated phenotype. We also determined that the nanoparticle emulsion significantly increased the efficacy of gene knockdown. Overall, these results suggest that the aerosolized siRNA-nanoparticle delivery method is a promising new high-throughput and non-invasive RNAi delivery method in some aphid species.
Collapse
Affiliation(s)
- M W Thairu
- Department of Entomology, University of Illinois, Urbana-Champaign, IL, USA
| | - I H Skidmore
- Department of Entomology, University of Illinois, Urbana-Champaign, IL, USA
| | - R Bansal
- Department of Entomology, The Ohio State University, Wooster, OH, USA
| | - E Nováková
- Department of Entomology, University of Illinois, Urbana-Champaign, IL, USA
| | - T E Hansen
- Department of Entomology, University of Illinois, Urbana-Champaign, IL, USA
| | - H Li-Byarlay
- Department of Entomology, North Carolina State University, Raleigh, NC, USA
| | - S A Wickline
- School of Medicine, Washington University in St. Louis, MO, USA
| | - A K Hansen
- Department of Entomology, University of Illinois, Urbana-Champaign, IL, USA
| |
Collapse
|
45
|
Arora N, Passey JC, Agarwal AK, Bansal R. Type 1 Tympanoplasty by Cartilage Palisade and Temporalis Fascia Technique: A Comparison. Indian J Otolaryngol Head Neck Surg 2017; 69:380-384. [PMID: 28929072 DOI: 10.1007/s12070-017-1137-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 03/16/2016] [Accepted: 04/22/2017] [Indexed: 11/24/2022] Open
Abstract
(1) To compare graft take up of type-1 tympanoplasty with cartilage palisade technique with those of type-1 tympanoplasty using autotemporalis fascia. (2) To compare hearing results of type 1 tympanoplasty with cartilage palisade technique with those of type-1 tympanoplasty using autotemporalis fascia. A prospective clinical study. It consisted of 60 patients divided into two groups of 30 patients each. After randomization 30 patients underwent type 1 tympanoplasty using cartilage palisade technique and 30 underwent type 1 tympanoplasty using autotemporalis fascia. In follow up, pure tone audiogram were carried out at 2nd, 4th and 6th month. Clinical assessment was done at 2nd 4th and 6th month. The graft uptake rate between the group 1 and group 2 are 93.33 and 90% respectively. As p value was greater than 0.05 so statistically there is no significant difference between the two group. The post operative air bone gap of the two groups were compared using student t test. The pre op mean of group 1 was 32.5 db and pre op mean of group 2 was 30.66 db. The post op mean of group 1 was 21.33, with standard deviation of 3.6984 and standard error of 0.67523. The post op mean of group 2 was 21.09 with standard deviation of 3.29 and standard error of 0.58261. t value was 0.1357. Analysis was done using student t test and p value was found to be greater than 0.05. p value is greater than 0.05 which shows that there is no statistical difference between the two groups. This study establishes the fact that hearing results after performing type 1 tympanoplasty by autotemporalis fascia when compared with type 1 tympanoplasty performed by cartilage palisade technique showed similar hearing gain and post operatively graft take up rate was also similar in two groups. The disadvantage of reducing the mechanical vibration of the tympanic membrane was overcome by the palisade reconstruction of the tympanic membrane. This study definitely emphasizes upon usage of new grafting materials in reconstruction of tympanic membrane, with similar, if not better functional results, without compromising the acoustic transfer characteristics.
Collapse
Affiliation(s)
- Nikhil Arora
- Department of Otorhinolaryngology and Head and Neck Surgery, Maulana Azad Medical College, D-55 Arya Nagar Apartment, I.P Extension, Patparganj, New Delhi, 110092 India
| | - J C Passey
- Department of Otorhinolaryngology and Head and Neck Surgery, Maulana Azad Medical College, D-55 Arya Nagar Apartment, I.P Extension, Patparganj, New Delhi, 110092 India
| | - A K Agarwal
- Department of Otorhinolaryngology and Head and Neck Surgery, Maulana Azad Medical College, D-55 Arya Nagar Apartment, I.P Extension, Patparganj, New Delhi, 110092 India
| | - R Bansal
- Department of Otorhinolaryngology and Head and Neck Surgery, Maulana Azad Medical College, D-55 Arya Nagar Apartment, I.P Extension, Patparganj, New Delhi, 110092 India
| |
Collapse
|
46
|
Abstract
Sheehan's syndrome (SS) develops as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and is characterized by various degrees of hypopituitarism. Although the occurrence of SS is now rare, it should still be considered in any woman with a history of peripartum hemorrhage who develops manifestations of pituitary hormone deficiency any time following the event. Appropriate hormone replacement therapy results in marked clinical improvement. We present an unusual case of SS in a young lady who continued to have normal menstruation after the index event, had two spontaneous pregnancies, and was diagnosed only 11 years later when she presented to us with acute heart failure.
Collapse
Affiliation(s)
- S Giri
- Department of Medicine, University College of Medical Sciences, GTB Hospital, New Delhi, India
| | - P Bansal
- Department of Medicine, University College of Medical Sciences, GTB Hospital, New Delhi, India
| | - S Malik
- Department of Medicine, University College of Medical Sciences, GTB Hospital, New Delhi, India
| | - R Bansal
- Department of Medicine, University College of Medical Sciences, GTB Hospital, New Delhi, India
| |
Collapse
|
47
|
Jha S, Singh S, Bansal R, Chauhan P, Shah MP, Shah A. Nonmetric analysis of caroticoclinoid foramen in foothills of Himalayas: Its clinicoanatomic perspective. Morphologie 2017; 101:47-51. [PMID: 27839870 DOI: 10.1016/j.morpho.2016.07.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/29/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE OF THE STUDY Study was conducted to evaluate the incidence of caroticoclinoid foramen in north Indian population. Authors have also endeavoured to discuss its clinical and embryological implications. MATERIALS AND METHODS Study was conducted on 108 dry human skulls in department of anatomy SGRR medical college, Dehradun. Incidence of caroticoclinoid foramen was evaluated in accordance with side. RESULTS A percentage of 22.22 skulls presented with the caroticoclinoid foramen with maximum incidence of unilateral and incomplete type. Incidence revealed no bias towards side. CONCLUSION Anatomical knowledge about CCF may be helpful to radiologists and neurosurgeons in providing an additional insight into the diagnosis and management of various pathologies around sellar region.
Collapse
Affiliation(s)
- S Jha
- Shri Guru Ram Rai, institute of medical and health sciences, Dehradun, India
| | - S Singh
- Vardhman Mahavir medical college, Safdarjung hospital, Ring Road, Opposite AIIMS Hospital, Safdarjung West, Safdarjung Campus, Ansari Nagar East, New Delhi, 110029 Delhi, India
| | - R Bansal
- Vardhman Mahavir medical college, Safdarjung hospital, Ring Road, Opposite AIIMS Hospital, Safdarjung West, Safdarjung Campus, Ansari Nagar East, New Delhi, 110029 Delhi, India
| | - P Chauhan
- Vardhman Mahavir medical college, Safdarjung hospital, Ring Road, Opposite AIIMS Hospital, Safdarjung West, Safdarjung Campus, Ansari Nagar East, New Delhi, 110029 Delhi, India.
| | - M-P Shah
- Shri Guru Ram Rai, institute of medical and health sciences, Dehradun, India
| | - A Shah
- Shri Guru Ram Rai, institute of medical and health sciences, Dehradun, India
| |
Collapse
|
48
|
|
49
|
|
50
|
Dutta D, Dharmshaktu P, Aggarwal A, Gaurav K, Bansal R, Devru N, Garga UC, Kulshreshtha B. Severity and pattern of bone mineral loss in endocrine causes of osteoporosis as compared to age-related bone mineral loss. J Postgrad Med 2016; 62:162-9. [PMID: 27241810 PMCID: PMC4970342 DOI: 10.4103/0022-3859.183170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Data are scant on bone health in endocrinopathies from India. This study evaluated bone mineral density (BMD) loss in endocrinopathies [Graves’ disease (GD), type 1 diabetes mellitus (T1DM), hypogonadotrophic hypogonadism (HypoH), hypergonadotropic hypogonadism (HyperH), hypopituitarism, primary hyperparathyroidism (PHPT)] as compared to age-related BMD loss [postmenopausal osteoporosis (PMO), andropause]. Materials and Methods: Retrospective audit of records of patients >30 years age attending a bone clinic from August 2014 to January 2016 was done. Results: Five-hundred and seven records were screened, out of which 420 (females:male = 294:126) were analyzed. A significantly higher occurrence of vitamin D deficiency and insufficiency was noted in T1DM (89.09%), HyperH (85%), and HypoH (79.59%) compared to age-related BMD loss (60.02%; P < 0.001). The occurrence of osteoporosis among females and males was 55.41% and 53.97%, respectively, and of osteopenia among females and males was 28.91% and 32.54%, respectively. In females, osteoporosis was significantly higher in T1DM (92%), HyperH (85%), and HypoH (59.26%) compared to PMO (49.34%; P < 0.001). Z score at LS, TF, NOF, and greater trochanter (GT) was consistently lowest in T1DM women. Among men, osteoporosis was significantly higher in T1DM (76.67%) and HypoH (54.55%) compared to andropause (45.45%; P = 0.001). Z score at LS, TF, NOF, GT, and TR was consistently lowest in T1DM men. In GD, the burden of osteoporosis was similar to PMO and andropause. BMD difference among the study groups was not significantly different after adjusting for body mass index (BMI) and vitamin D. Conclusion: Low bone mass is extremely common in endocrinopathies, warranting routine screening and intervention. Concomitant vitamin D deficiency compounds the problem. Calcium and vitamin D supplementations may improve bone health in this setting.
Collapse
Affiliation(s)
- D Dutta
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - P Dharmshaktu
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - A Aggarwal
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - K Gaurav
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - R Bansal
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - N Devru
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - U C Garga
- Department of Radiology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - B Kulshreshtha
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| |
Collapse
|