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Chipako I, Singhal S, Hollingsworth B. Impact of sexual and reproductive health interventions among young people in sub-Saharan Africa: a scoping review. Front Glob Womens Health 2024; 5:1344135. [PMID: 38699461 PMCID: PMC11063325 DOI: 10.3389/fgwh.2024.1344135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/29/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives The aim of this scoping review was to identify and provide an overview of the impact of sexual and reproductive health (SRH) interventions on reproductive health outcomes among young people in sub-Saharan Africa. Methods Searches were carried out in five data bases. The databases were searched using variations and combinations of the following keywords: contraception, family planning, birth control, young people and adolescents. The Cochrane risk-of-bias 2 and Risk of Bias in Non-Randomized Studies-of-Interventions tools were used to assess risk of bias for articles included. Results Community-based programs, mHealth, SRH education, counselling, community health workers, youth friendly health services, economic support and mass media interventions generally had a positive effect on childbirth spacing, modern contraceptive knowledge, modern contraceptive use/uptake, adolescent sexual abstinence, pregnancy and myths and misperceptions about modern contraception. Conclusion Sexual and reproductive health interventions have a positive impact on sexual and reproductive health outcomes. With the increasing popularity of mHealth coupled with the effectiveness of youth friendly health services, future youth SRH interventions could integrate both strategies to improve SRH services access and utilization.
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Affiliation(s)
- Isaac Chipako
- Health Economics and Policy Department, Division of Health Research Graduate College, Lancaster University, Lancaster, United Kingdom
| | - Saurabh Singhal
- Economics Department, Lancaster University, Lancaster, United Kingdom
| | - Bruce Hollingsworth
- Health Economics and Policy Department, Division of Health Research Graduate College, Lancaster University, Lancaster, United Kingdom
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Santos L, Zheng H, Singhal S, Wong M. Remifentanil for tracheal intubation without neuromuscular blocking drugs in adult patients: a systematic review and meta-analysis. Anaesthesia 2024. [PMID: 38403817 DOI: 10.1111/anae.16255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/27/2024]
Abstract
There is increasing interest in the use of short-acting opioids such as remifentanil to facilitate tracheal intubation. The aim of this systematic review was to determine the efficacy and safety of remifentanil for tracheal intubation compared with neuromuscular blocking drugs in adult patients. We conducted a systematic search for randomised controlled trials evaluating remifentanil for tracheal intubation. Primary outcomes included tracheal intubation conditions and adverse events. Twenty-one studies evaluating 1945 participants were included in the analysis. Use of remifentanil (1.5-4.0 μg.kg-1 ) showed no evidence of a difference in tracheal intubation success rate compared with neuromuscular blocking drugs (risk ratio (95%CI) 0.97 (0.94-1.01); six studies; 1232 participants; I2 28%; p = 0.16; moderate-certainty evidence). Compared with neuromuscular blocking drugs, the use of remifentanil (2.0-4.0 μg.kg-1 ) makes little to no difference in terms of producing excellent tracheal intubation conditions (risk ratio (95%CI) 1.16 (0.72-1.87); two studies; 121 participants; I2 31%, p = 0.54; moderate-certainty of evidence). There was no evidence of an effect between remifentanil (2.0-4.0 μg.kg-1 ) and neuromuscular blocking drugs for bradycardia (risk ratio (95%CI) 0.44 (0.01-13.90); two studies; 997 participants; I2 81%; p = 0.64) and hypotension (risk ratio (95%CI) 1.05 (0.44-2.49); three studies; 1071 participants; I2 92%; p = 0.92). However, the evidence for these two outcomes was judged to be of very low-certainty. We conclude that remifentanil may be used as an alternative drug for tracheal intubation in cases where neuromuscular blocking drugs are best avoided, but more studies are required to evaluate the haemodynamic adverse events of remifentanil at different doses.
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Affiliation(s)
- L Santos
- Dental Anaesthesia, University of Toronto, Toronto, ON, Canada
| | - H Zheng
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - S Singhal
- Dental Public Health, University of Toronto, Toronto, ON, Canada
| | - M Wong
- Dental Anaesthesia, University of Toronto, Toronto, ON, Canada
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Singhal S, Verma M, Bhatia G. Is scolding analogous to positive end-expiratory pressure (PEEP)? South Afr J Crit Care 2023; 39:10.7196/SAJCC.2023.v39i2.563. [PMID: 37547771 PMCID: PMC10399544 DOI: 10.7196/sajcc.2023.v39i2.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- S Singhal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, India
| | - M Verma
- Department of Radiation Oncology, King George’s Medical University, Lucknow, India
| | - G Bhatia
- Department of Psychiatry, All India Institute of Medical Sciences, Rajkot, India
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Bala R, Budhwar D, Kumar V, Singhal S, Kaushik P, Sharma J. Clinical and ultrasonographic assessment of airway indices among non-pregnant, normotensive pregnant and pre-eclamptic patients: a prospective observational study. Int J Obstet Anesth 2023; 54:103637. [PMID: 36827944 DOI: 10.1016/j.ijoa.2023.103637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/05/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prediction of a difficult airway is of paramount importance for an anaesthesiologist. Various anatomical and physiological factors contribute to a difficult airway in pregnant females, especially those with pre-eclampsia. The aim of the study was to assess airway indices using both routinely used clinical methods and ultrasound. METHODS Fifty-five non-pregnant females, 55 normotensive pregnant females and 55 females with pre-eclampsia were included in this prospective study. Clinical airway assessment was the modified Mallampati score, thyromental distance, hyomental distance, hyomental distance ratio, chest circumference, neck circumference and chest-to-neck circumference ratio. Sonographic assessment included tongue width, tongue volume, anterior neck soft tissue thickness at the level of hyoid, epiglottis and vocal cords, subglottic diameter, ratio of pre-epiglottic space to anterior, posterior and midpoint of anterior and posterior vocal folds. RESULTS Several significant differences were observed between pregnant and non-pregnant females, with additional changes in pre-eclamptic females. These included clinical parameters such as the modified Mallampati score and sonographic measurements of tongue width, tongue volume, subglottic diameter, anterior neck soft tissue thickness at the level of hyoid, epiglottis and vocal cords, and the ratio of pre-epiglottic space to anterior, posterior and midpoint of anterior and posterior vocal folds. CONCLUSION Routinely used clinical methods of airway assessment lack sensitivity and specificity. Ultrasound can visualise anatomical structures in the supraglottic and subglottic views and is encouraging as an airway assessment tool.
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Affiliation(s)
- R Bala
- Department of Anesthesia, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India
| | - D Budhwar
- Department of Anesthesia, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India
| | - V Kumar
- Department of Anesthesia, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India.
| | - S Singhal
- Department of Obstetrics and Gynaecology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India
| | - P Kaushik
- Department of Radiology, PT. B.D. Sharma PGIMS, Rohtak, Haryana 124001, India
| | - J Sharma
- Department of Anesthesia, AIIMS Bhatinda, Punjab 151001, India
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Singhal S, Athithan S, Alomar MA, Kumar R, Sharma B, Srivastava G, Lin JCW. Energy Aware Load Balancing Framework for Smart Grid Using Cloud and Fog Computing. Sensors (Basel) 2023; 23:3488. [PMID: 37050548 PMCID: PMC10098693 DOI: 10.3390/s23073488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/09/2023] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
Data centers are producing a lot of data as cloud-based smart grids replace traditional grids. The number of automated systems has increased rapidly, which in turn necessitates the rise of cloud computing. Cloud computing helps enterprises offer services cheaply and efficiently. Despite the challenges of managing resources, longer response plus processing time, and higher energy consumption, more people are using cloud computing. Fog computing extends cloud computing. It adds cloud services that minimize traffic, increase security, and speed up processes. Cloud and fog computing help smart grids save energy by aggregating and distributing the submitted requests. The paper discusses a load-balancing approach in Smart Grid using Rock Hyrax Optimization (RHO) to optimize response time and energy consumption. The proposed algorithm assigns tasks to virtual machines for execution and shuts off unused virtual machines, reducing the energy consumed by virtual machines. The proposed model is implemented on the CloudAnalyst simulator, and the results demonstrate that the proposed method has a better and quicker response time with lower energy requirements as compared with both static and dynamic algorithms. The suggested algorithm reduces processing time by 26%, response time by 15%, energy consumption by 29%, cost by 6%, and delay by 14%.
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Affiliation(s)
- Saurabh Singhal
- Department of Computer Engineering and Applications, GLA University, Mathura 281406, Uttar Pradesh, India
| | - Senthil Athithan
- Department of Computer Science and Engineering, Koneru Lakshmaiah Education Foundation, Vaddeswaram 522302, Andhra Pradesh, India
| | - Madani Abdu Alomar
- Department of Industrial Engineering, Faculty of Engineering-Rabigh, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Rakesh Kumar
- Department of Computer Engineering and Applications, GLA University, Mathura 281406, Uttar Pradesh, India
| | - Bhisham Sharma
- Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura 140401, Punjab, India
| | - Gautam Srivastava
- Department of Mathematics and Computer Science, Brandon University, Brandon, MB R7A 6A9, Canada
- Department of Computer Science and Mathematics, Lebanese American University, Beirut 1102, Lebanon
- Research Centre for Interneural Computing, China Medical University, Taichung 40402, Taiwan
| | - Jerry Chun-Wei Lin
- Department of Computer Science, Electrical Engineering and Mathematical Sciences, Western Norway University of Applied Sciences, 5063 Bergen, Norway
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Singhal S, Verma M, Kukreja D. A simple way of doing the complex but utmost important things: cancer pain management. Ann Oncol 2023; 34:496. [PMID: 36796539 DOI: 10.1016/j.annonc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Affiliation(s)
- S Singhal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, India
| | - M Verma
- Department of Radiation Oncology, KGMU, Lucknow, India.
| | - D Kukreja
- Department of Radiotherapy, RMLIMS, Lucknow, India
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Venuthurimilli AK, Gupta R, Singhal S, Madaan V, Kumar P, Singh A, Sah R, Rastogi H, Vohra S, Sahni R, Bharadwaj R, Kumar K, Malhotra S, Jerat N, Sibal A, Goyal N. Intraoperative portal vein stenting through umbilical vein approach: An innovative salvage procedure for portal vein thrombosis in pediatric liver transplant. Pediatr Transplant 2023; 27:e14427. [PMID: 36324265 DOI: 10.1111/petr.14427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND IPVS is considered a last resort or a salvage procedure in the event of recurrent PV thrombosis despite multiple attempts at redo PV anastomosis. We employed the opened umbilical vein approach to place the stent in the PV and deliver anticoagulation through a catheter. MATERIALS AND METHODS From Jan 2017 to Feb 2022, 150 patients underwent pediatric transplantation at department of liver transplant and hepatobiliary surgery unit, Indraprastha Apollo hospitals, New Delhi. Age, weight, PELD Score, diagnosis, portal vein diameter on preoperative CT, Portal flow after stenting, decrease in spleen size after stenting in follow-up CT were collected from a prospectively maintained data base and reviewed. RESULTS Eight patients underwent IPVS following LDLT (mean age-10.6 ± 2.2 months, mean weight 8.1 ± 1.6, mean PELD score 32.7 ± 7.3). The mean PV diameter on preoperative CT scan was 3.6 mm (range 2.7-5.6 mm). The mean portal flow following stenting was 718.75 cc/min. Percentage reduction in size of the spleen was 26.35% beyond 2nd post-operative week. No patient had recurrent PV thrombosis following IPVS and all maintained an adequate portal flow throughout the immediate postoperative period. Two patients had in-hospital mortality secondary to septic complications. CONCLUSION Umbilical vein approach is technically feasible, easy to manipulate the stent and catheter placement after stenting helps to deliver anticoagulants locally.
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Affiliation(s)
- Arun Kumar Venuthurimilli
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Rigved Gupta
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Saurabh Singhal
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Varun Madaan
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Pradeep Kumar
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Akanand Singh
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Rambabu Sah
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Harsh Rastogi
- Department of Interventional Radiology, Indraprastha Apollo Hospital, New Delhi
| | - Sandeep Vohra
- Department of Radio-diagnosis, Indraprastha Apollo Hospitals, New Delhi, India
| | - Reeti Sahni
- Department of Radio-diagnosis, Indraprastha Apollo Hospitals, New Delhi, India
| | - Ravi Bharadwaj
- Department of Pediatric Hepatology and Gastroenterology, New Delhi, India
| | - Karunesh Kumar
- Department of Pediatric Hepatology and Gastroenterology, New Delhi, India
| | - Smita Malhotra
- Department of Pediatric Hepatology and Gastroenterology, New Delhi, India
| | - Namit Jerat
- Department of Pediatric Intensive Care, New Delhi, India
| | - Anupam Sibal
- Department of Pediatric Hepatology and Gastroenterology, New Delhi, India
| | - Neerav Goyal
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
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Kumar P, Verma R, Kundu K, Anant G, Johar S, Singhal S. Soft palate adhesion to the posterior pharyngeal wall preventing passage of a flexible bronchoscope. Anaesth Rep 2023; 11:e12215. [PMID: 36910908 PMCID: PMC9996103 DOI: 10.1002/anr3.12215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 03/14/2023] Open
Affiliation(s)
- P. Kumar
- Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical SciencesRohtakIndia
| | - R. Verma
- Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical SciencesRohtakIndia
| | - K. Kundu
- Vardhman Mahavir Medical College and Safdarjung HospitalNew DelhiIndia
| | - G. Anant
- Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical SciencesRohtakIndia
| | - S. Johar
- Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical SciencesRohtakIndia
| | - S. Singhal
- Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical SciencesRohtakIndia
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Verma M, Singhal S, Deokar K. Is this the Start of a New Era in Medicine? Media Influences Practice and Research. Clin Oncol (R Coll Radiol) 2022; 34:819-820. [PMID: 36184468 DOI: 10.1016/j.clon.2022.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/25/2022] [Accepted: 09/15/2022] [Indexed: 11/22/2022]
Affiliation(s)
- M Verma
- Department of Radiation Oncology, KGMU, Lucknow, India.
| | - S Singhal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, India
| | - K Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, India
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Shetmahajan M, Singhal S, Ranganathan P, Parab S. A SINGLE ARM PILOT STUDY TO DETERMINE WHETHER AN EARLY CREATION OF PNEUMOTHORAX IN THE NON-VENTILATED LUNG IMPROVES THE QUALITY OF LUNG COLLAPSE DURING ONE LUNG VENTILATION. J Cardiothorac Vasc Anesth 2022. [DOI: 10.1053/j.jvca.2022.09.048] [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: 12/07/2022]
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Mahmudiono T, Singhal S, Mohammad AA, Failoc-Rojas VE, Catalan Opulencia MJ, Haro AS, Salam Karim Y, Qurbonov N, Kamal Abdelbasset W, Mahdi AB, Fakri Mustafa Y. The impact of aerosol box on tracheal intubation during the COVID‐19 pandemic: a systematic review. Expert Rev Med Devices 2022; 19:779-789. [DOI: 10.1080/17434440.2022.2132149] [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: 11/09/2022]
Affiliation(s)
- Trias Mahmudiono
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Kota Surabaya, Indonesia
| | - Saurabh Singhal
- Department of Computer Engineering and Applications, GLA University, Mathura, Uttar Pradesh, India
| | | | | | | | | | | | - Nizom Qurbonov
- Department of DKTF Surgery, Endoscopy and Anesthesiology and Intensive Care, Samarkand State Medical Institute, Amir Temur Street 18, Samarkand, Uzbekistan
- Department of Scientific Affairs, Tashkent State Dental Institute, Makhtumkuli Street 103, Tashkent, 100047, Uzbekistan
| | - Walid Kamal Abdelbasset
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Ahmed B. Mahdi
- Anesthesia Techniques Department, Al-Mustaqbal University College, Babylon, Iraq
| | - Yasser Fakri Mustafa
- Department of Pharmaceutical Chemistry, College of Pharmacy, University of Mosul, Mosul-41001, Iraq
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Martinino A, Aloulou M, Chatterjee S, Scarano Pereira JP, Singhal S, Patel T, Kirchgesner TPE, Agnes S, Annunziata S, Treglia G, Giovinazzo F. Artificial Intelligence in the Diagnosis of Hepatocellular Carcinoma: A Systematic Review. J Clin Med 2022; 11:6368. [PMID: 36362596 PMCID: PMC9655417 DOI: 10.3390/jcm11216368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 09/21/2023] Open
Abstract
Hepatocellular carcinoma ranks fifth amongst the most common malignancies and is the third most common cause of cancer-related death globally. Artificial Intelligence is a rapidly growing field of interest. Following the PRISMA reporting guidelines, we conducted a systematic review to retrieve articles reporting the application of AI in HCC detection and characterization. A total of 27 articles were included and analyzed with our composite score for the evaluation of the quality of the publications. The contingency table reported a statistically significant constant improvement over the years of the total quality score (p = 0.004). Different AI methods have been adopted in the included articles correlated with 19 articles studying CT (41.30%), 20 studying US (43.47%), and 7 studying MRI (15.21%). No article has discussed the use of artificial intelligence in PET and X-ray technology. Our systematic approach has shown that previous works in HCC detection and characterization have assessed the comparability of conventional interpretation with machine learning using US, CT, and MRI. The distribution of the imaging techniques in our analysis reflects the usefulness and evolution of medical imaging for the diagnosis of HCC. Moreover, our results highlight an imminent need for data sharing in collaborative data repositories to minimize unnecessary repetition and wastage of resources.
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Affiliation(s)
| | | | - Surobhi Chatterjee
- Department of Internal Medicine, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
| | | | - Saurabh Singhal
- Department of HPB Surgery and Liver Transplantation, BLK-MAX Superspeciality Hospital, New Delhi 110005, Delhi, India
| | - Tapan Patel
- Department of Surgery, Baroda Medical College and SSG Hospital, Vadodara 390001, Gujarat, India
| | - Thomas Paul-Emile Kirchgesner
- Département of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1348 Brussels, Belgium
| | - Salvatore Agnes
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Salvatore Annunziata
- Unit of Nuclear Medicine, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giorgio Treglia
- Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
| | - Francesco Giovinazzo
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Azari F, Meijer R, Kennedy G, Chang A, Nadeem B, Din A, Marfatia I, CAILLER F, Pèlegrin A, Vahrmeijer A, Singhal S. OA14.05 Intraoperative Molecular Imaging Guided Resection of CEACAM5+ Lung Tumors: First In-Human SGM-101 Lung Cancer Surgical Trial. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Morand E, Pike M, Merrill JT, Van Vollenhoven R, Werth VP, Hobar C, Delev N, Shah V, Sharkey B, Wegman T, Catlett I, Banerjee S, Singhal S. LB0004 EFFICACY AND SAFETY OF DEUCRAVACITINIB, AN ORAL, SELECTIVE, ALLOSTERIC TYK2 INHIBITOR, IN PATIENTS WITH ACTIVE SYSTEMIC LUPUS ERYTHEMATOSUS: A PHASE 2, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5020a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundTyrosine kinase 2 (TYK2) mediates signaling of Type I interferons, IL-23, and IL-12, key cytokines involved in lupus pathogenesis. Deucravacitinib (DEUC) is an oral, selective, allosteric TYK2 inhibitor with a unique mechanism of action, distinct from Janus kinase (JAK) 1/2/3 inhibitors, and has shown efficacy in psoriasis and psoriatic arthritis.ObjectivesAssess efficacy and safety of DEUC in patients with active systemic lupus erythematosus (SLE).MethodsThis was a 48-week (wk), randomized, double-blind, placebo (PBO)-controlled, phase 2 trial (NCT03252587). Eligible patients met SLICC criteria, were seropositive (ANA/anti-dsDNA/anti-Sm), and had a SLEDAI-2K score ≥6 and ≥1 BILAG index A or >2 BILAG B manifestations from the musculoskeletal or mucocutaneous domain. Patients on standard background medications were randomized 1:1:1:1 to PBO or DEUC (3 mg BID, 6 mg BID, 12 mg QD). Oral corticosteroid tapering to 7.5 mg/day was required from wks 8-20; further tapering was optional from wks 32-40. The primary endpoint was the proportion of patients achieving SRI(4) at wk 32. Key secondary endpoints at wk 48 included SRI(4), BICLA, LLDAS, CLASI-50, and change from baseline in active (tender and swollen) joint count.ResultsA total of 363 patients were randomized, with baseline demographic and disease characteristics similar across treatment groups. Of randomized patients, 275 (76%) completed 48 wks of treatment. The primary endpoint at wk 32 was met, with significantly greater proportion of patients in DEUC 3 mg BID and 6 mg BID groups vs PBO achieving SRI(4) responses (PBO: 34.4%; DEUC 3 mg BID: 58.2%, P=0.0006; DEUC 6 mg BID: 49.5%, P=0.021; DEUC 12 mg QD: 44.9%, P=0.078). SRI(4) response was sustained across all DEUC groups up to 48 wks (Figure 1). At wk 48, the DEUC 3 mg BID group demonstrated statistical significance in BICLA, LLDAS, CLASI-50, and active joint count, and the two other DEUC groups demonstrated clinically meaningful differences vs PBO (Figure 1). Rates of adverse events (AEs), serious AEs, and AEs of interest were similar between DEUC and PBO groups (Table 1). Most common AEs (≥10%) with DEUC were upper respiratory tract infection, nasopharyngitis, headache, and urinary tract infection. No deaths, major cardiac events, thrombotic events, systemic opportunistic infections, or active tuberculosis occurred. Malignancies were rare with similar rates across all groups. No meaningful abnormalities in mean levels of hematology and chemistry laboratory parameters were observed.Table 1.Summary of Adverse Events Through Week 48AE, na(%)Placebo n = 90DEUC 3 mg BID n = 91DEUC 6 mg BID n = 93DEUC 12 mg QD n = 89AE79 (87.8)85 (93.4)81 (87.1)75 (84.3)SAE11 (12.2)7 (7.7)8 (8.6)7 (7.9)AEs leading to treatment discontinuation3 (3.3)8 (8.8)6 (6.5)11 (12.4)Skin-related AEsb12 (13.3)15 (16.5)32 (34.4)30 (33.7)Overall infections/infestations48 (53.3)60 (65.9)60 (64.5)45 (50.6)Serious infections/infestations1 (1.1)1 (1.1)2 (2.2)1 (1.1)Infections of interest Tuberculosis0000 Herpes zosterc4 (4.4)3 (3.3)3 (3.2)2 (2.2) Influenza1 (1.1)3 (3.3)1 (1.1)3 (3.4) COVID-193 (3.3)3 (3.3)5 (5.4)3 (3.4)Malignancy events1 (1.1)d1 (1.1)e01 (1.1)fMACE0000Thrombotic events0000an is the number of patients who experienced an event. bIncludes (≤8.6% in any arm) acne, rash, dermatitis acneiform, pruritus, skin lesion, urticaria. cIncludes herpes zoster, herpes ophthalmic, genital herpes zoster. dBasal cell carcinoma. eBreast carcinoma. fVaginal squamous cell carcinoma.AE, adverse event; COVID-19, coronavirus disease 2019; DEUC, deucravacitinib; MACE, major adverse cardiac events; SAE, serious adverse event.ConclusionIn patients with active SLE, DEUC showed statistically significant and sustained clinical efficacy in SRI(4), improvement across multiple composite and organ-specific measures up to 48 wks, and was well tolerated. DEUC shows promise as a novel therapy for SLE and warrants further investigation in phase 3 trials.AcknowledgementsThis study was sponsored by Bristol Myers Squibb. Professional medical writing assistance was provided by Julianne Hatfield, PhD at Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, USA, and funded by Bristol Myers Squibb. The authors acknowledge Christina Crater, MD, who was employed by Bristol Myers Squibb at the time the study was conducted, for contributions to study conduct.Disclosure of InterestsEric Morand Consultant of: AstraZeneca, Bristol Myers Squibb, Biogen, Eli Lilly, EMD Serono, Genentech, Servier, and Novartis , Grant/research support from: AbbVie, Amgen, AstraZeneca, Bristol Myers Squibb, Biogen, Eli Lilly, EMD Serono, Genentech, Janssen, and UCB , Marilyn Pike Consultant of: AstraZeneca, Bristol Myers Squibb, and Pfizer, Joan T. Merrill Consultant of: UCB, GlaxoSmithKline, AbbVie, EMD Serono, Remegen, Celgene/Bristol Myers Squibb, AstraZeneca, Amgen, Janssen, Lilly, Genentech, Aurinia, Astellas, Alexion, Sanofi, Zenas, and Provention , Grant/research support from: GlaxoSmithKline and AstraZeneca , Ronald van Vollenhoven Consultant of: UCB, Pfizer, AbbVie, AstraZeneca, Biogen, Biotest, Celgene, Galapagos, Gilead, Janssen, Servier, Paid instructor for: Roche, Pfizer, Speakers bureau: UCB, Pfizer, AbbVie, Galapagos, Janssen, Grant/research support from: Bristol Myers Squibb, GlaxoSmithKline, Eli Lilly, UCB, , Victoria P. Werth Consultant of: Celgene, Medimmune, Resolve, Genentech, Idera, Janssen, Lilly, Biogen, Bristol Myers Squibb, Gilead, Amgen, Medscape, Nektar, Incyte, EMD Serono, CSL Behring, Principia, Crisalis, Viela Bio, Argenx, Kirin, AstraZeneca, AbbVie, GSK, AstraZeneca, Cugene, UCB, Corcept, Beacon Bioscience , Grant/research support from: Celgene, Janssen, Biogen, Gilead, AstraZeneca, Viela, Amgen, Lupus Research Alliance/BMS , Coburn Hobar Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Nikolay Delev Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Vaishali Shah Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Brian Sharkey Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Thomas Wegman Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Ian Catlett Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Subhashis Banerjee Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Shalabh Singhal Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb
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Singh A, Singhal S, Venuthurimilli A, Pareek S, Maung PM, Aung TH, Garg HK, Vohra S, Sahni R, Goyal N. HPi: A Novel Parameter to Predict Graft-related Outcome in Adult Living Donor Liver Transplant. Transplantation 2022; 106:767-780. [PMID: 34260473 DOI: 10.1097/tp.0000000000003890] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Portal hyperperfusion is frequently associated with early allograft dysfunction (EAD). It is imperative to identify patients who would require portal inflow modulation. We aimed to identify factors associated with hyperperfusion-related graft injury and develop a predictive index for the same. METHODS Prospectively maintained database was queried to identify 135 adult living donor liver transplant recipients between September 2016 and July 2020. According to the calculated sample size, 96 patients were randomly selected for "test cohort". The remaining 39 patients made the "validation cohort." EAD was defined according to the A2ALL study. "Hyperperfusion index (HPi)," defined as posttransplant portal pressure gradient (ΔPpost)/graft-to-recipient splenic volume ratio (GRSVR), was devised on the basis of laws of flow dynamics and regression analysis. RESULTS Overall, 40 patients (29.6%) had EAD, six 90-d mortalities (4.4%) were attributable to EAD. In the test cohort, EAD patients (n = 29, 30.2%) had lower GRSVR (1.00 versus 2.22, P < 0.001), higher ΔPpost (14.8 versus 11.9, P = 0.004), and HPi (20.89 versus 8.67, P < 0.001). Multivariate analysis revealed GRSVR, ΔPpost, and HPi as significant factors to predict EAD. Receiver operating characteristic determined cutoff of HPi ≥9.97 could predict EAD with sensitivity of 90% and specificity of 73% (F-score = 0.712). HPi ≥16.25 predicted 90-d mortality with sensitivity of 100% and specificity of 78.9%. Patients with higher HPi had delayed graft-related recovery. Non-EAD patients had a higher 1-y (96% versus 79%) and 2-y (88% versus 79%) survival. The cutoff of HPi was validated well in the validation cohort (F-score = 0.645) (Hosmer-Lemeshow test, P = 0.89). CONCLUSIONS While predicted GRSVR may help identify at-risk patients preoperatively, intraoperatively calculated HPi is more accurate in identifying patients who would require portal inflow modulation. Achieving an HPi below target cutoff significantly decreases the risk of EAD even in low-GRSVR patients.
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Affiliation(s)
- Akanand Singh
- Liver Transplant and Hepato-Pancreatico-Biliary Surgery (LTHPS) Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Saurabh Singhal
- Liver Transplant and Hepato-Pancreatico-Biliary Surgery (LTHPS) Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Arun Venuthurimilli
- Liver Transplant and Hepato-Pancreatico-Biliary Surgery (LTHPS) Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Shishir Pareek
- Liver Transplant and Hepato-Pancreatico-Biliary Surgery (LTHPS) Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Pyone Maung Maung
- Liver Transplant and Hepato-Pancreatico-Biliary Surgery (LTHPS) Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Thet Htoo Aung
- Liver Transplant and Hepato-Pancreatico-Biliary Surgery (LTHPS) Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Hitendra Kumar Garg
- Liver Transplant and Hepato-Pancreatico-Biliary Surgery (LTHPS) Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Sandeep Vohra
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Reeti Sahni
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Neerav Goyal
- Liver Transplant and Hepato-Pancreatico-Biliary Surgery (LTHPS) Unit, Indraprastha Apollo Hospital, New Delhi, India
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Singhal S, Veeratterapillay J, Locks S, Morgan D, Patil R. Magnetic Resonance Imaging-Guided Adaptive Brachytherapy for the Treatment of Cervical Cancer and its Impact on Clinical Outcome. Clin Oncol (R Coll Radiol) 2022; 34:442-451. [DOI: 10.1016/j.clon.2022.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/22/2021] [Accepted: 01/19/2022] [Indexed: 12/24/2022]
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Singhal S, Deokar K, Verma M. Commercial screening tests: Beneficial or a hypnosis to advertisements? J Postgrad Med 2022; 68:231-232. [PMID: 36255016 PMCID: PMC9841549 DOI: 10.4103/jpgm.jpgm_300_22] [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: 11/07/2022] Open
Affiliation(s)
- S Singhal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, Gujarat, India,Address for correspondence: Dr. Singhal S, E-mail:
| | - K Deokar
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | - M Verma
- Department of Radiation Oncology, KGMU, Lucknow, Uttar Pradesh, India
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Smith J, Kim J, Spilchuk V, Tran V, Singhal S. Letter to the Editor, "Sources of SARS-CoV-2 and Other Microorganisms in Dental Aerosols". J Dent Res 2021; 101:237. [PMID: 34928740 DOI: 10.1177/00220345211037659] [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: 11/17/2022] Open
Affiliation(s)
- J Smith
- Research Coordinator, Infection Prevention and Control, Public Health Ontario, Santé Publique Ontario, Ottawa, ON, Canada
| | - J Kim
- Public Health Physician, Environmental and Occupational Health, Public Health Ontario, Santé publique Ontario, Toronto, ON, Canada
| | - V Spilchuk
- Occupational Medicine Physician, Environmental and Occupational Health, Public Health Ontario, Santé publique Ontario, Toronto, ON, Canada
| | - V Tran
- Clinical Microbiologist, Public Health Laboratories, Public Health Ontario, Santé publique Ontario, Toronto, ON, Canada
| | - S Singhal
- Public Health Dentist, Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Santé publique Ontario, Toronto, ON, Canada
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Raj A, Shankar V, Singhal S, Goyal N, Arunkumar V, Garg HK, Pal A. Recurrent Hepatic Artery Thrombosis Following Living Donor Liver Transplant as Sequelae of SARS-CoV-2 Infection-a Case Report. SN Compr Clin Med 2021; 3:2629-2634. [PMID: 34642651 PMCID: PMC8497065 DOI: 10.1007/s42399-021-01076-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 12/30/2022]
Abstract
As the second wave of COVID-19 disease is gripping the globe, liver transplant centers are increasingly receiving patients recovered from SARS-CoV-2 infection in recent few weeks. Unexpected complications in these patients are increasingly being recognized. We performed liver transplantation on a 51-year-old gentleman with decompensated liver disease 23 days after recovering from a mild SARS-CoV-2 infection. Surprisingly, despite massive blood loss and a prolonged anhepatic phase, his thromboelastographic (TEG) parameters persistently revealed hypercoagulability. After a brief uneventful early post-operative period, he developed hepatic arterial thrombosis on the 14th post-operative day, and again after 4 days, both of which required surgical intervention. Following discharge, the artery was thrombosed again which was only picked up when he developed a cholangiolar abscess, leading to graft loss necessitating re-transplantation. There is a lot of evidence suggesting that patients with SARS-CoV-2 infection tend to be hypercoagulable. We believe that this hypercoagulability might have played a significant role in the development of hepatic arterial thrombosis and eventual graft loss in this patient. This highlights the importance of revisiting anticoagulation protocols in liver transplant recipients recovered from COVID-19 and base them on TEG rather than routine parameters such as INR and APTT, which are routinely deranged in such patients.
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Affiliation(s)
- Anupam Raj
- Department of Anaesthesiology and Critical Care, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India 110076
| | - Vijay Shankar
- Department of Anaesthesiology and Critical Care, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India 110076
| | - Saurabh Singhal
- Liver Transplant and Hepato-Pancreatobiliary Surgery (LTHPS) Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Neerav Goyal
- Liver Transplant and Hepato-Pancreatobiliary Surgery (LTHPS) Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Venuthurimilli Arunkumar
- Liver Transplant and Hepato-Pancreatobiliary Surgery (LTHPS) Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Hitendra Kumar Garg
- Department of Transplant Hepatology, Indraprastha Apollo Hospital, New Delhi, India
| | - Atish Pal
- Department of Anaesthesiology and Critical Care, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India 110076
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Agnihotri V, Gupta A, Bajpai S, Singhal S, Dey AB, Dey S. Serum Proteomic Approach for Differentiation of Frail and Non-Frail Elderly. Adv Gerontol 2021. [DOI: 10.1134/s2079057021020028] [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: 11/23/2022]
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Mease PJ, Deodhar A, Van der Heijde D, Behrens F, Kivitz A, Kim J, Singhal S, Nowak M, Banerjee S. POS0198 EFFICACY AND SAFETY OF DEUCRAVACITINIB, AN ORAL, SELECTIVE TYROSINE KINASE 2 INHIBITOR, IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS: RESULTS FROM A PHASE 2, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Tyrosine kinase 2 (TYK2) is an intracellular kinase that mediates signaling by key cytokines involved in psoriatic arthritis (PsA) and plaque psoriasis (PsO) pathogenesis. Deucravacitinib is a novel oral agent that selectively inhibits TYK2 via an allosteric mechanism by binding to the nonconserved regulatory domain of the kinase. A previous Phase 2 trial in PsO had demonstrated that deucravacitinib was efficacious and well tolerated, with no laboratory abnormalities observed.Objectives:To evaluate the efficacy and safety of deucravacitinib in active PsA.Methods:This is an ongoing, 1-year, randomized, double-blind, placebo (PBO)-controlled (initial 16 weeks), multiregional, Phase 2 trial (NCT03881059). Eligible patients had a PsA diagnosis for ≥6 months, met CASPAR criteria, and had active disease with ≥3 tender and ≥3 swollen joints, C-reactive protein ≥3 mg/L (ULN, 5 mg/L), and ≥1 psoriatic lesion (≥2 cm). Patients had failed or were intolerant to ≥1 nonsteroidal anti-inflammatory drug, corticosteroid, conventional synthetic disease-modifying antirheumatic drug (csDMARD), and/or 1 TNF inhibitor (TNFi; ≤30%). Patients were randomized 1:1:1 to deucravacitinib 6 mg once daily (QD) or 12 mg QD, or PBO. The primary endpoint was achievement of ACR 20 response at Week 16. Additional endpoints included the proportion of patients achieving ACR 50/70 response, Health Assessment Questionnaire-Disability Index (HAQ-DI) response (≥0.35 improvement from baseline), enthesitis resolution (Leeds Index score of 0), minimal disease activity, change from baseline in SF-36 physical component score (SF-36 PCS) and mental component score (SF-36 MCS), Psoriasis Area and Severity Index (PASI) 75 response, adverse events (AEs), and laboratory parameters.Results:Of 203 patients randomized, 180 (89%) completed 16 weeks of treatment (deucravacitinib 6 mg QD, 63/70 [90%]; deucravacitinib 12 mg QD, 59/67 [88%]; PBO, 58/66 [88%]). Demographic and baseline disease characteristics were similar across groups. Mean age was 49.8 years, 51% of patients were female, median PsA duration was 4.5 years, 66% of patients used csDMARDs at baseline and throughout the study, and 15% had used a TNFi. This study met its primary endpoint, with deucravacitinib 6 mg and 12 mg QD demonstrating significantly higher ACR 20 responses versus PBO at Week 16 (Figure 1). Additional endpoints were also met with deucravacitinib versus PBO (Figure 1). Adjusted mean changes from baseline in SF-36 PCS and SF-36 MCS at Week 16, respectively, were significantly higher in the deucravacitinib 6 mg QD group (5.6 vs 2.3, P=0.0062; 3.6 vs 0.7, P=0.0211) and 12 mg QD group (5.8 vs 2.3, P=0.0042; 3.5 vs 0.7, P=0.0263) compared with PBO. PASI 75 responses were also significantly higher in the deucravacitinib groups (P≤0.0136 vs PBO). The most common AEs in the deucravacitinib 6 mg/12 mg/PBO groups, respectively, during the 16-week treatment period were nasopharyngitis (5.7%/17.9%/7.6%), sinusitis (0%/7.5%/0%), headache (7.1%/1.5%/4.5%), and rash (4.3%/6.0%/0%). No serious AEs, herpes zoster infections, opportunistic infections, or thrombotic events were reported in deucravacitinib-treated patients during this period. Additionally, no significant changes from baseline in hematologic parameters (lymphocytes, neutrophils, platelets, and hemoglobin) or serum lipids were observed with deucravacitinib treatment.Conclusion:Deucravacitinib was efficacious versus PBO over 16 weeks in patients with active PsA. Treatment was generally well tolerated and the safety and laboratory parameter profile of deucravacitinib was consistent with that observed in an earlier Phase 2 PsO trial.Acknowledgements:This study was sponsored by Bristol Myers Squibb. Professional medical writing assistance was provided by Peloton Advantage, LLC, an OPEN Health company, and funded by Bristol Myers Squibb.Disclosure of Interests:Philip J Mease Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, UCB, Atul Deodhar Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, Glaxo Smith & Kline, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly, Glaxo Smith & Kline, Novartis, Pfizer, UCB, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma, Frank Behrens Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, MSD, Celgene, Roche, Chugai, Bristol Myers Squibb, UCB Pharma, Grant/research support from: Pfizer, Janssen, Chugai, Celgene, Roche, Alan Kivitz Shareholder of: Pfizer, Sanofi, GlaxoSmithKline, Gilead Sciences, Inc., Novartis, Paid Consultant: AbbVie, Boehringer Ingelheim, Flexion, Janssen, Pfizer, Sanofi, Regeneron, SUN Pharma Advanced Research, Gilead Sciences, Inc., Speakers bureau: Celgene, Merck, Lilly, Novartis, Pfizer, Sanofi, Genzyme, Flexion, AbbVie, Jonghyeon Kim Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Shalabh Singhal Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Miroslawa Nowak Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Subhashis Banerjee Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb
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Gupta A, Jha A, Singhal S. Optimisation of modification parameters for amaranth starch for the development of pudding and study of the quality traits of developed pudding. AAlim 2021. [DOI: 10.1556/066.2020.00110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AbstractAmaranth is considered to be a part of “superfood”, however, due to multiple restricting properties, its functionality in the food industry is still not explored to its fullest. The present study investigated the effect of almond gum concentration (3–10 g), temperature (50–90 °C), and quantity of water (30–70 mL) on the functional properties of amaranth starch. A central composite rotatable design (CCRD) showed that the 6.9 g of almond gum, 64.43 mL of water, and temperature maintained at 90 °C, were the optimised conditions to attain 16.77 g g−1 of swelling power, 12.97% of solubility index, and 20.13% freeze-thaw stability. Moreover, the modified amaranth starch was further employed to develop pudding as a value-added product. The findings concluded that the developed pudding using modified amaranth starch exhibited enhanced sensorial attributes due to an increase in cohesiveness, chewiness, and resilience of starch gel.
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Affiliation(s)
- A.K. Gupta
- Department of Food Engineering and Technology, Tezpur University, Assam, 784028, India
| | - A.K. Jha
- Department of Food Engineering and Technology, Tezpur University, Assam, 784028, India
| | - S. Singhal
- Department of Food Engineering and Technology, Tezpur University, Assam, 784028, India
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Shankar V, Raj A, Singhal S, Sahni R, Goyal N, Venuthurimilli A, Olson MT, Chatterji C. Doppler-derived renal resistive index helps predict acute kidney injury in patients undergoing living-related liver transplantation. Clin Transplant 2021; 35:e14263. [PMID: 33608962 DOI: 10.1111/ctr.14263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/24/2021] [Accepted: 02/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is commonly associated with increased postoperative morbidity in liver transplant (LT) recipients. The aim of this study was to identify the role of renal resistive index (RRI) in predicting AKI and to study the factors associated with AKI in LT recipients. PATIENTS AND METHODS We performed a single-center, prospective study, including adult living donor LT recipients at our center between January 2018 and September 2019 with no preoperative renal dysfunction. RRI was calculated on ultrasound doppler once preoperatively, and once daily in the postoperative period through postoperative day (POD) six. Patients were grouped into AKI and non-AKI groups for comparison. RESULTS Fifty patients were included in the study (mean age, 44 years; 20% females). AKI developed in 25 patients (50%). Both groups were similar in baseline characteristics. RRI of ≥ 0.69 on POD 2 predicted AKI (sensitivity 88%; specificity 92%). RRI on the day before AKI diagnosis (0.71 vs. 0.65) and on the day of diagnosis (0.72 vs. 0.65) were significantly increased relative to preoperative baseline. CONCLUSIONS Doppler-derived RRI is a rapid, non-invasive, and bedside procedure capable of predicting the occurrence of postoperative AKI in LT recipients.
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Affiliation(s)
- Vijay Shankar
- Department of Anesthesiology and Critical Care, Indraprastha Apollo Hospital, New Delhi, India
| | - Anupam Raj
- Department of Anesthesiology and Critical Care, Indraprastha Apollo Hospital, New Delhi, India
| | - Saurabh Singhal
- Liver Transplant and Hepatopancreaticobiliary Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Reeti Sahni
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Neerav Goyal
- Liver Transplant and Hepatopancreaticobiliary Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Arun Venuthurimilli
- Liver Transplant and Hepatopancreaticobiliary Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Michael T Olson
- Department of Surgery, University of Arizona College of Medicine -Phoenix Campus, Phoenix, AZ, USA
| | - Chitra Chatterji
- Department of Anesthesiology and Critical Care, Indraprastha Apollo Hospital, New Delhi, India
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Singhal S, Singh S, Singh D. Variation in the analytical figure of merit for in situ Hf isotopic measurements by LA-MC-ICPMS in zircon standards at variable spatial resolutions. J Mass Spectrom 2021; 56:e4715. [PMID: 33764638 DOI: 10.1002/jms.4715] [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] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
Lu-Hf isotopic systematics is a powerful tool and gained importance as a geochemical tracer in geosciences. A multi-collector inductively coupled plasma mass spectrometer coupled with a laser ablation system has been used to perform zircon hafnium (Hf) isotopic analysis, and protocol is established for measurement of Hf isotopes. Toward this, two zircon standards, Z91500 and Plesovice, have been used for Hf isotopic measurements at four different spot sizes (50, 40, 25, and 20 μm). The isotopic data for ≥25 μm have an excellent agreement with published data, but for 20 μm, the results are erroneous and irrelevant to geological application. It has been observed that Hf beam intensity has a linear relation to the volume of the target (RM) ablated. 178 Hf/177 Hf ratio and ɛHf for both standards are comparable with the published recommended values. The present study indicates that 176 Lu/177 Hf ratio for Z91500 is more homogeneous than Plesovice zircon. The 176 Hf/177 Hf isotopic ratio for 50 and 25 μm shows an excellent agreement with the previously reported data. However, for 40-μm spot size, a slightly higher but negative offset of -123 and -105 ppm in 176 Hf/177 Hf ratio have been observed for Plesovice and 91500, respectively.
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Affiliation(s)
- Saurabh Singhal
- Department of Petrology and Geochemistry, Wadia Institute of Himalayan Geology, 33 GMS Road, Dehradun, 248001, India
- Department of Electronics and Communication Engineering, Indian Institute of Technology Roorkee, Roorkee, 247667, India
| | - Sandeep Singh
- Department of Earth Sciences, Indian Institute of Technology Roorkee, Roorkee, 247667, India
| | - Dharmendra Singh
- Department of Electronics and Communication Engineering, Indian Institute of Technology Roorkee, Roorkee, 247667, India
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Singhal S, Mittal SK. Readmission after esophageal resection for esophageal cancer: incidence and risk factors. J Thorac Dis 2020; 12:4608-4611. [PMID: 33145033 PMCID: PMC7578455 DOI: 10.21037/jtd-20-1670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Saurabh Singhal
- Department of GI-HPB Surgery and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India
| | - Sumeet K Mittal
- Department of Esophageal Surgery, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Barsky A, Maxwell R, Marmarelis M, Singhal S, Li Y, Alley E, Haas A, Busch T, Langer C, Simone C, Cengel K. Prospective Assessment of Proton Therapy for Malignant Pleural Mesothelioma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Triantafyllou T, Olson MT, Theodorou D, Zografos G, Singhal S. Esophageal cancer: challenges, concerns, and recommendations for management amidst the COVID-19 pandemic. Ann Gastroenterol 2020; 33:453-458. [PMID: 32879590 PMCID: PMC7406811 DOI: 10.20524/aog.2020.0519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/17/2020] [Indexed: 12/21/2022] Open
Abstract
Since December 2019, the outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, raising great concern, particularly in immunosuppressed cancer patients. The pandemic situation remains extremely dynamic, which necessitates proactive management decisions from oncologists and oncologic surgeons in effort to mitigate the risk of both SARS-CoV-2 infection and cancer metastasis. Esophageal cancer, in particular, is one of the deadliest types of malignancy worldwide, reflecting both aggressive biology and a lack of adequate treatment. Several challenges and concerns regarding the management of esophageal cancer have been raised in light of the ongoing viral pandemic. The primary aim of this review is to summarize the salient evidence for recommendations and optimal treatment strategies for patients with esophageal cancer amidst the COVID-19 pandemic.
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Affiliation(s)
- Tania Triantafyllou
- Department of Surgery, Hippocration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece (Tania Triantafyllou, Dimitrios Theodorou, Georgios Zografos)
| | - Michael T Olson
- Department of Surgery, University of Arizona College of Medicine - Phoenix Campus, Phoenix, AZ, USA (Michael T. Olson)
| | - Dimitrios Theodorou
- Department of Surgery, Hippocration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece (Tania Triantafyllou, Dimitrios Theodorou, Georgios Zografos)
| | - Georgios Zografos
- Department of Surgery, Hippocration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece (Tania Triantafyllou, Dimitrios Theodorou, Georgios Zografos)
| | - Saurabh Singhal
- Department of GI Surgery and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India (Saurabh Singhal)
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Olson MT, Triantafyllou T, Singhal S. Resumption of elective surgery during the COVID-19 pandemic: what lessons can we apply? Eur Surg 2020; 52:190-192. [PMID: 32837512 PMCID: PMC7274057 DOI: 10.1007/s10353-020-00645-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Michael T Olson
- University of Arizona College of Medicine-Phoenix Campus, Phoenix, AZ USA
| | - Tania Triantafyllou
- Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Saurabh Singhal
- Department of GI Surgery and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India
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Gupta Y, Goyal A, Kalaivani M, Singhal S, Bhatla N, Gupta N, Tandon N. High burden of cardiometabolic risk factors in spouses of Indian women with hyperglycaemia in pregnancy. Diabet Med 2020; 37:1058-1065. [PMID: 32112453 DOI: 10.1111/dme.14283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2020] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the burden and association of cardiometabolic risk factors in the spouses of women with and without hyperglycaemia in pregnancy. METHODS Women with (n = 204) and without (n = 197) hyperglycaemia in pregnancy, along with their spouses, participated in this cross-sectional study. The hyperglycaemia in pregnancy group included women with gestational diabetes and diabetes in pregnancy. A detailed questionnaire was completed for all participants (men and women), documenting relevant personal and medical history, along with biochemical investigations (men). RESULTS A total of 401 couples were evaluated at the time point during the pregnancy of 24.7 ± 5.2 gestational weeks (mean ± sd). Dysglycaemia (prediabetes or diabetes), overweight/obesity (BMI ≥25 kg/m2 ) and metabolic syndrome were detected in 120 (58.9%), 123 (60.3%) and 98 spouses (48.3%) of women with hyperglycaemia in pregnancy, respectively. In the fully adjusted model, an increased risk of dysglycaemia [odds ratio 1.43 (95% CI 0.95-2.17); P = 0.088], overweight/obesity [odds ratio 1.49 (95% CI 0.98-2.27); P = 0.064] and metabolic syndrome [odds ratio 2.00 (95% CI 1.30-3.07); P = 0.001] was seen in the spouses of women with hyperglycaemia in pregnancy. The prevalence of these metabolic conditions was higher in spouses of women with diabetes in pregnancy compared to spouses of women with gestational diabetes mellitus. CONCLUSIONS A high burden of cardiometabolic risk factors was observed in the spouses of women with hyperglycaemia in pregnancy. The opportunity provided by pregnancy could be used by the healthcare system not only to improve the health of the woman and her offspring, but also her spouse.
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Affiliation(s)
- Y Gupta
- Departments of, Department of, Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - A Goyal
- Departments of, Department of, Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - M Kalaivani
- Department of, Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - S Singhal
- Department of, Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - N Bhatla
- Department of, Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - N Gupta
- Departments of, Department of, Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - N Tandon
- Departments of, Department of, Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Adewusi J, Burness C, Ellawela S, Emsley H, Hughes R, Lawthom C, Maguire M, McLean B, Mohanraj R, Oto M, Singhal S, Reuber M. Brivaracetam efficacy and tolerability in clinical practice: A UK-based retrospective multicenter service evaluation. Epilepsy Behav 2020; 106:106967. [PMID: 32179501 DOI: 10.1016/j.yebeh.2020.106967] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/14/2020] [Accepted: 02/01/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE This multicenter service evaluation explores the efficacy and tolerability of brivaracetam (BRV) in an unselected, consecutive population in 'real-life' clinical settings. METHOD We retrospectively collected data from patient records at 11 UK hospitals and epilepsy centers. Consecutive patients prescribed BRV with at least 3 months of follow-up (FU) were included. Apart from reporting effectiveness and tolerability of BRV across the whole cohort, we compared treatment outcomes depending on previous levetiracetam use (LEV+ versus LEV-), comorbid learning disability (LD+ versus LD-), and epilepsy syndrome (focal versus generalized epilepsy). RESULTS Two hundred and ninety patients (46% male, median age: 38 years, range: 15 to 77) with ≥3 months of FU were included. The median duration of BRV exposure was 12 months (range: 1 day to 72 months). Overall BRV retention was 71.1%. While 56.1% of patients improved in terms of seizure frequency category (daily, weekly, monthly, yearly seizures), 23.1% did not improve on this measure and 20.8% deteriorated. In terms of seizure frequency, 21% of patients experienced a ≥50% reduction, with 7.0% of all patients becoming seizure-free. Treatment-emergent adverse events (AEs) were reported by 107 (36.9%) patients, but there were no serious AEs. The commonest AEs were sedation/fatigue (18.3%), mood changes (9.0%), and irritability/aggression (4.8%). There were no significant differences in drug retention, seizure frequency outcomes, or AEs between the LEV+ and LEV- subgroups, or between patients with generalized or focal epilepsies. Although 15.5% of patients in the LD+ group achieved a ≥50% reduction, this rate was lower than in the LD- group. CONCLUSIONS This 'real-life' evaluation suggests that reductions in seizure frequency can be achieved with BRV in patients with highly refractory epilepsy. Brivaracetam may be a useful treatment option in patients who have previously failed to respond to or tolerate LEV, those with LD, or (off-label) those with generalized epilepsies.
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Affiliation(s)
- J Adewusi
- Academic Neurology Unit, University of Sheffield, UK.
| | - C Burness
- The Walton Centre, NHS Foundation Trust, Liverpool, UK.
| | - S Ellawela
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
| | - H Emsley
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
| | - R Hughes
- Manchester University NHS Foundation Trust, UK.
| | | | - M Maguire
- Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK.
| | - B McLean
- Royal Cornwall Hospital NHS Trust, Truro, UK.
| | - R Mohanraj
- Salford Royal NHS Foundation Trust, Manchester, UK.
| | - M Oto
- William Quarriers Epilepsy Centre, Glasgow, UK
| | - S Singhal
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - M Reuber
- Academic Neurology Unit, University of Sheffield, UK.
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Rosenthal VD, Bat-Erdene I, Gupta D, Belkebir S, Rajhans P, Zand F, Myatra SN, Afeef M, Tanzi VL, Muralidharan S, Gurskis V, Al-Abdely HM, El-Kholy A, AlKhawaja SAA, Sen S, Mehta Y, Rai V, Hung NV, Sayed AF, Guerrero-Toapanta FM, Elahi N, Morfin-Otero MDR, Somabutr S, De-Carvalho BM, Magdarao MS, Velinova VA, Quesada-Mora AM, Anguseva T, Ikram A, Aguilar-de-Moros D, Duszynska W, Mejia N, Horhat FG, Belskiy V, Mioljevic V, Di-Silvestre G, Furova K, Gamar-Elanbya MO, Gupta U, Abidi K, Raka L, Guo X, Luque-Torres MT, Jayatilleke K, Ben-Jaballah N, Gikas A, Sandoval-Castillo HR, Trotter A, Valderrama-Beltrán SL, Leblebicioglu H, Riera F, López M, Maurizi D, Desse J, Pérez I, Silva G, Chaparro G, Golschmid D, Cabrera R, Montanini A, Bianchi A, Vimercati J, Rodríguez-del-Valle M, Domínguez C, Saul P, Chediack V, Piastrelini M, Cardena L, Ramasco L, Olivieri M, Gallardo P, Juarez P, Brito M, Botta P, Alvarez G, Benchetrit G, Caridi M, Stagnaro J, Bourlot I, García M, Arregui N, Saeed N, Abdul-Aziz S, ALSayegh S, Humood M, Mohamed-Ali K, Swar S, Magray T, Aguiar-Portela T, Sugette-de-Aguiar T, Serpa-Maia F, Fernandes-Alves-de-Lima L, Teixeira-Josino L, Sampaio-Bezerra M, Furtado-Maia R, Romário-Mendes A, Alves-De-Oliveira A, Vasconcelos-Carneiro A, Anjos-Lima JD, Pinto-Coelho K, Maciel-Canuto M, Rocha-Batista M, Moreira T, Rodrigues-Amarilo N, Lima-de-Barros T, Guimarães KA, Batista C, Santos C, de-Lima-Silva F, Santos-Mota E, Karla L, Ferreira-de-Souza M, Luzia N, de-Oliveira S, Takeda C, Azevedo-Ferreira-Lima D, Faheina J, Coelho-Oliveira L, do-Nascimento S, Machado-Silva V, Bento-Ferreira, Olszewski J, Tenorio M, Silva-Lemos A, Ramos-Feijó C, Cardoso D, Correa-Barbosa M, Assunção-Ponte G, Faheina J, da-Silva-Escudero D, Servolo-Medeiros E, Andrade-Oliveira-Reis M, Kostadinov E, Dicheva V, Petrov M, Guo C, Yu H, Liu T, Song G, Wang C, Cañas-Giraldo L, Marin-Tobar D, Trujillo-Ramirez E, Andrea-Rios P, Álvarez-Moreno C, Linares C, González-Rubio P, Ariza-Ayala B, Gamba-Moreno L, Gualtero-Trujill S, Segura-Sarmiento S, Rodriguez-Pena J, Ortega R, Olarte N, Pardo-Lopez Y, Luis Marino Otela-Baicue A, Vargas-Garcia A, Roncancio E, Gomez-Nieto K, Espinosa-Valencia M, Barahona-Guzman N, Avila-Acosta C, Raigoza-Martinez W, Villamil-Gomez W, Chapeta-Parada E, Mindiola-Rochel A, Corchuelo-Martinez A, Martinez A, Lagares-Guzman A, Rodriguez-Ferrer M, Yepes-Gomez D, Muñoz-Gutierrez G, Arguello-Ruiz A, Zuniga-Chavarria M, Maroto-Vargas L, Valverde-Hernández M, Solano-Chinchilla A, Calvo-Hernandez I, Chavarria-Ugalde O, Tolari G, Rojas-Fermin R, Diaz-Rodriguez C, Huascar S, Ortiz M, Bovera M, Alquinga N, Santacruz G, Jara E, Delgado V, Salgado-Yepez E, Valencia F, Pelaez C, Gonzalez-Flores H, Coello-Gordon E, Picoita F, Arboleda M, Garcia M, Velez J, Valle M, Unigarro L, Figueroa V, Marin K, Caballero-Narvaez H, Bayani V, Ahmed S, Alansary A, Hassan A, Abdel-Halim M, El-Fattah M, Abdelaziz-Yousef R, Hala A, Abdelhady K, Ahmed-Fouad H, Mounir-Agha H, Hamza H, Salah Z, Abdel-Aziz D, Ibrahim S, Helal A, AbdelMassih A, Mahmoud AR, Elawady B, El-sherif R, Fattah-Radwan Y, Abdel-Mawla T, Kamal-Elden N, Kartsonaki M, Rivera D, Mandal S, Mukherjee S, Navaneet P, Padmini B, Sorabjee J, Sakle A, Potdar M, Mane D, Sale H, Abdul-Gaffar M, Kazi M, Chabukswar S, Anju M, Gaikwad D, Harshe A, Blessymole S, Nair P, Khanna D, Chacko F, Rajalakshmi A, Mubarak A, Kharbanda M, Kumar S, Mathur P, Saranya S, Abubakar F, Sampat S, Raut V, Biswas S, Kelkar R, Divatia J, Chakravarthy M, Gokul B, Sukanya R, Pushparaj L, Thejasvini A, Rangaswamy S, Saini N, Bhattacharya C, Das S, Sanyal S, Chaudhury B, Rodrigues C, Khanna G, Dwivedy A, Binu S, Shetty S, Eappen J, Valsa T, Sriram A, Todi S, Bhattacharyya M, Bhakta A, Ramachandran B, Krupanandan R, Sahoo P, Mohanty N, Sahu S, Misra S, Ray B, Pattnaik S, Pillai H, Warrier A, Ranganathan L, Mani A, Rajagopal S, Abraham B, Venkatraman R, Ramakrishnan N, Devaprasad D, Siva K, Divekar D, Satish Kavathekar M, Suryawanshi M, Poojary A, Sheeba J, Patil P, Kukreja S, Varma K, Narayanan S, Sohanlal T, Agarwal A, Agarwal M, Nadimpalli G, Bhamare S, Thorat S, Sarda O, Nadimpalli P, Nirkhiwale S, Gehlot G, Bhattacharya S, Pandya N, Raphel A, Zala D, Mishra S, Patel M, Aggarwal D, Jawadwal B, Pawar N, Kardekar S, Manked A, Tamboli A, Manked A, Khety Z, Singhal T, Shah S, Kothari V, Naik R, Narain R, Sengupta S, Karmakar A, Mishra S, Pati B, Kantroo V, Kansal S, Modi N, Chawla R, Chawla A, Roy I, Mukherjee S, Bej M, Mukherjee P, Baidya S, Durell A, Vadi S, Saseedharan S, Anant P, Edwin J, Sen N, Sandhu K, Pandya N, Sharma S, Sengupta S, Palaniswamy V, Sharma P, Selvaraj M, Saurabh L, Agarwal M, Punia D, Soni D, Misra R, Harsvardhan R, Azim A, Kambam C, Garg A, Ekta S, Lakhe M, Sharma C, Singh G, Kaur A, Singhal S, Chhabra K, Ramakrishnan G, Kamboj H, Pillai S, Rani P, Singla D, Sanaei A, Maghsudi B, Sabetian G, Masjedi M, Shafiee E, Nikandish R, Paydar S, Khalili H, Moradi A, Sadeghi P, Bolandparvaz S, Mubarak S, Makhlouf M, Awwad M, Ayyad O, Shaweesh A, Khader M, Alghazawi A, Hussien N, Alruzzieh M, Mohamed Y, ALazhary M, Abdul Aziz O, Alazmi M, Mendoza J, De Vera P, Rillorta A, de Guzman M, Girvan M, Torres M, Alzahrani N, Alfaraj S, Gopal U, Manuel M, Alshehri R, Lessing L, Alzoman H, Abdrahiem J, Adballah H, Thankachan J, Gomaa H, Asad T, AL-Alawi M, Al-Abdullah N, Demaisip N, Laungayan-Cortez E, Cabato A, Gonzales J, Al Raey M, Al-Darani S, Aziz M, Al-Manea B, Samy E, AlDalaton M, Alaliany M, Alabdely H, Helali N, Sindayen G, Malificio A, Al-Dossari H, Kelany A, Algethami A, Mohamed D, Yanne L, Tan A, Babu S, Abduljabbar S, Al-Zaydani M, Ahmed H, Al Jarie A, Al-Qathani A, Al-Alkami H, AlDalaton M, Alih S, Alaliany M, Gasmin-Aromin R, Balon-Ubalde E, Diab H, Kader N, Hassan-Assiry I, Kelany A, Albeladi E, Aboushoushah S, Qushmaq N, Fernandez J, Hussain W, Rajavel R, Bukhari S, Rushdi H, Turkistani A, Mushtaq J, Bohlega E, Simon S, Damlig E, Elsherbini S, Abraham S, Kaid E, Al-Attas A, Hawsawi G, Hussein B, Esam B, Caminade Y, Santos A, Abdulwahab M, Aldossary A, Al-Suliman S, AlTalib A, Albaghly N, HaqlreMia M, Kaid E, Altowerqi R, Ghalilah K, Alradady M, Al-Qatri A, Chaouali M, Shyrine E, Philipose J, Raees M, AbdulKhalik N, Madco M, Acostan C, Safwat R, Halwani M, Abdul-Aal N, Thomas A, Abdulatif S, Ali-Karrar M, Al-Gosn N, Al-Hindi A, Jaha R, AlQahtani S, Ayugat E, Al-Hussain M, Aldossary A, Al-Suliman S, Al-Talib A, Albaghly N, Haqlre-Mia M, Briones S, Krishnan R, Tabassum K, Alharbi L, Madani A, Al-Hindi A, Al-Gethamy M, Alamri D, Spahija G, Gashi A, Kurian A, George S, Mohamed A, Ramapurath R, Varghese S, Abdo N, Foda-Salama M, Al-Mousa H, Omar A, Salama M, Toleb M, Khamis S, Kanj S, Zahreddine N, Kanafani Z, Kardas T, Ahmadieh R, Hammoud Z, Zeid I, Al-Souheil A, Ayash H, Mahfouz T, Kondratas T, Grinkeviciute D, Kevalas R, Dagys A, Mitrev Z, Bogoevska-Miteva Z, Jankovska K, Guroska S, Petrovska M, Popovska K, Ng C, Hoon Y, Hasan YM, Othman-Jailani M, Hadi-Jamaluddin M, Othman A, Zainol H, Wan-Yusoff W, Gan C, Lum L, Ling C, Aziz F, Zhazali R, Abud-Wahab M, Cheng T, Elghuwael I, Wan-Mat W, Abd-Rahman R, Perez-Gomez H, Kasten-Monges M, Esparza-Ahumada S, Rodriguez-Noriega E, Gonzalez-Diaz E, Mayoral-Pardo D, Cerero-Gudino A, Altuzar-Figueroa M, Perez-Cruz J, Escobar-Vazquez M, Aragon D, Coronado-Magana H, Mijangos-Mendez J, Corona-Jimenez F, Aguirre-Avalos G, Lopez-Mateos A, Martinez-Marroquin M, Montell-Garcia M, Martinez-Martinez A, Leon-Sanchez E, Gomez-Flores G, Ramirez M, Gomez M, Lozano M, Mercado V, Zamudio-Lugo I, Gomez-Gonzalez C, Miranda-Novales M, Villegas-Mota I, Reyes-Garcia C, Ramirez-Morales M, Sanchez-Rivas M, Cureno-Diaz M, Matias-Tellez B, Gonzalez-Martinez J, Juarez-Vargas R, Pastor-Salinas O, Gutierrez-Munoz V, Conde-Mercado J, Bruno-Carrasco G, Manrique M, Monroy-Colin V, Cruz-Rivera Z, Rodriguez-Pacheco J, Cruz N, Hernandez-Chena B, Guido-Ramirez O, Arteaga-Troncoso G, Guerra-Infante F, Lopez-Hurtado M, Caleco JD, Leyva-Medellin E, Salamanca-Meneses A, Cosio-Moran C, Ruiz-Rendon R, Aguilar-Angel L, Sanchez-Vargas M, Mares-Morales R, Fernandez-Alvarez L, Castillo-Cruz B, Gonzalez-Ma M, Zavala-Ramír M, Rivera-Reyna L, del-Moral-Rossete L, Lopez-Rubio C, Valadez-de-Alba M, Bat-Erdene A, Chuluunchimeg K, Baatar O, Batkhuu B, Ariyasuren Z, Bayasgalan G, Baigalmaa S, Uyanga T, Suvderdene P, Enkhtsetseg D, Suvd-Erdene D, Chimedtseye E, Bilguun G, Tuvshinbayar M, Dorj M, Khajidmaa T, Batjargal G, Naranpurev M, Bat-Erdene A, Bolormaa T, Battsetseg T, Batsuren C, Batsaikhan N, Tsolmon B, Saranbaatar A, Natsagnyam P, Nyamdawa O, Madani N, Abouqal R, Zeggwagh A, Berechid K, Dendane T, Koirala A, Giri R, Sainju S, Acharya S, Paul N, Parveen A, Raza A, Nizamuddin S, Sultan F, Imran X, Sajjad R, Khan M, Sana F, Tayyab N, Ahmed A, Zaman G, Khan I, Khurram F, Hussain A, Zahra F, Imtiaz A, Daud N, Sarwar M, Roop Z, Yusuf S, Hanif F, Shumaila X, Zeb J, Ali S, Demas S, Ariff S, Riaz A, Hussain A, Kanaan A, Jeetawi R, Castaño E, Moreno-Castillo L, García-Mayorca E, Prudencio-Leon W, Vivas-Pardo A, Changano-Rodriguez M, Castillo-Bravo L, Aibar-Yaranga K, Marquez-Mondalgo V, Mueras-Quevedo J, Meza-Borja C, Flor J, Fernandez-Camacho Y, Banda-Flores C, Pichilingue-Chagray J, Castaneda-Sabogal A, Caoili J, Mariano M, Maglente R, Santos S, de-Guzman G, Mendoza M, Javellana O, Tajanlangit A, Tapang A, Sg-Buenaflor M, Labro E, Carma R, Dy A, Fortin J, Navoa-Ng J, Cesar J, Bonifacio B, Llames M, Gata H, Tamayo A, Calupit H, Catcho V, Bergosa L, Abuy M, Barteczko-Grajek B, Rojek S, Szczesny A, Domanska M, Lipinska G, Jaroslaw J, Wieczoreka A, Szczykutowicza A, Gawor M, Piwoda M, Rydz-Lutrzykowska J, Grudzinska M, Kolat-Brodecka P, Smiechowicz K, Tamowicz B, Mikstacki A, Grams A, Sobczynski P, Nowicka M, Kretov V, Shalapuda V, Molkov A, Puzanov S, Utkin I, Tchekulaev A, Tulupova V, Vasiljevic S, Nikolic L, Ristic G, Eremija J, Kojovic J, Lekic D, Simic A, Hlinkova S, Lesnakova A, Kadankunnel S, Abdo-Ali M, Pimathai R, Wanitanukool S, Supa N, Prasan P, Luxsuwong M, Khuenkaew Y, Lamngamsupha J, Siriyakorn N, Prasanthai V, Apisarnthanarak A, Borgi A, Bouziri A, Cabadak H, Tuncer G, Bulut C, Hatipoglu C, Sebnem F, Demiroz A, Kaya A, Ersoz G, Kuyucu N, Karacorlu S, Oncul O, Gorenek L, Erdem H, Yildizdas D, Horoz O, Guclu E, Kaya G, Karabay O, Altindis M, Oztoprak N, Sahip Y, Uzun C, Erben N, Usluer G, Ozgunes I, Ozcelik M, Ceyda B, Oral M, Unal N, Cigdem Y, Bayar M, Bermede O, Saygili S, Yesiler I, Memikoglu O, Tekin R, Oncul A, Gunduz A, Ozdemir D, Geyik M, Erdogan S, Aygun C, Dilek A, Esen S, Turgut H, Sungurtekin H, Ugurcan D, Yarar V, Bilir Y, Bayram N, Devrim I, Agin H, Ceylan G, Yasar N, Oruc Y, Ramazanoglu A, Turhan O, Cengiz M, Yalcin A, Dursun O, Gunasan P, Kaya S, Senol G, Kocagoz A, Al-Rahma H, Annamma P, El-Houfi A, Vidal H, Perez F, D-Empaire G, Ruiz Y, Hernandez D, Aponte D, Salinas E, Vidal H, Navarrete N, Vargas R, Sanchez E, Ngo Quy C, Thu T, Nguyet L, Hang P, Hang T, Hanh T, Anh D. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module. Am J Infect Control 2020; 48:423-432. [PMID: 31676155 DOI: 10.1016/j.ajic.2019.08.023] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. METHODS During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied. RESULTS Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher. CONCLUSIONS Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.
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Triantafyllou T, Olson MT, Theodorou D, Schizas D, Singhal S. Enhanced recovery pathways vs standard care pathways in esophageal cancer surgery: systematic review and meta-analysis. Esophagus 2020; 17:100-112. [PMID: 31974853 DOI: 10.1007/s10388-020-00718-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/12/2020] [Indexed: 02/03/2023]
Abstract
Enhanced recovery after surgery (ERAS) protocols vs standard care pathways after esophagectomy for malignancy have gained wide popularity among surgeons. However, the current literature is still lacking level-I evidence to show a clear superiority of one approach. The present study is a detailed systematic review and meta-analysis of the published trials. A systematic review of literature databases was conducted for randomized controlled trials (RCTs) and non-randomized, prospective, comparative studies between January 1990 and September 2019, comparing ERAS pathway group with standard care for esophageal resection for esophageal cancer. Mean difference (MD) for continuous variables and odds ratio (OR) or risk difference (RD) for dichotomous variables with 95% confidence interval (CI) were used. Between-study heterogeneity was evaluated. Eight studies with a total of 1133 patients were included. Hospital stay [Standard mean difference (Std. MD) = - 1.92, 95% CI - 2.78, - 1.06, P < 0.0001], overall morbidity (OR 0.68, CI 0.49, 0.96, P = 0.03), pulmonary complications (OR 0.45, CI 0.31, 0.65, P < 0.0001), anastomotic leak rate (OR 0.37, CI 0.18, 0.74, P = 0.005), time to first flatus and defecation (Std. MD = -5.01, CI - 9.53, - 0.49, P = 0.03), (Std. MD = - 1.36, CI - 1.78, - 0.94, P < 0.00001) and total hospital cost (Std. MD = - 1.62, CI - 2.24, - 1.01, P < 0.00001) favored the ERAS group. Patients who undergo ERAS have a clear benefit over the standard care protocol. However, existing protocols in different centers are followed by great variability, while the evaluated parameters suffer from significant heterogeneity. A well-formulated, standardized protocol should be standard-of-care at all centers.
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Affiliation(s)
- Tania Triantafyllou
- 1st Propaedeutic Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Michael T Olson
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Dimitrios Theodorou
- 1st Propaedeutic Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital of Athens, Athens, Greece
| | - Saurabh Singhal
- Department of GI Surgery and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India.
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Faraz A, Ashraf H, Singhal S, Hussain F, Jaiswal J. P47 Correlation of Neurophysiological parameters with HRV in patients of Diabetic peripheral neuropathy. A cross sectional study. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Faraz A, Singhal S, Hossain M, Siddiqui S. P4 Neurophysiological changes in newly diagnosed thyroid disorder: A Case-Control Study. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Singh S, Kumar S, Gupta P, Singhal S, Sahu A. Himalayan Magmatic Events. PINSA 2020. [DOI: 10.16943/ptinsa/2020/49813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rao YJB, Chopra S, Kumar P, Mukherjee PK, Singhal S, Adlakha V, Vijaya Kumar T, Sreenivas B, Babu E. New initiatives to bolster analytical facilities in India for in situ U-Th-Pb Geochronology, Hf and O isotope systematics in zircon: a focus on laboratories at the IUAC, WIHG and CSIR-NGRI. PINSA 2020. [DOI: 10.16943/ptinsa/2020/49823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jain AK, Thakur VC, Joshi M, Mukherjee PK, Patel RC, Bhattacharyya K, Singhal S, Agarwal KK, Dixit R, Deshmukh G, Mohan M. Tectonics of the Western, Sikkim and Arunachal Himalaya. PINSA 2020. [DOI: 10.16943/ptinsa/2020/49781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Saran S, Bansal P, Singhal S, Malik A. Coexisting Cerebral Venous Sinus Thrombosis and Posterior Reversible Encephalopathy Syndrome in a Pre-Eclamptic Female. J Assoc Physicians India 2019; 67:77-78. [PMID: 31571460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | | | | | - Ankita Malik
- Junior Resident, Dept. of Radiology, Subharti Medical College, Meerut, Uttar Pradesh
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Olson MT, Triantafyllou T, Singhal S. A Decade of Investigation: Peroral Endoscopic Myotomy Versus Laparoscopic Heller Myotomy for Achalasia. J Laparoendosc Adv Surg Tech A 2019; 29:1093-1104. [PMID: 31313957 DOI: 10.1089/lap.2019.0242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Although laparoscopic Heller myotomy (LHM) with partial fundoplication has long been considered the gold standard for treatment of patients with achalasia, peroral endoscopic myotomy (POEM) has emerged in the last decade as a viable alternative. Methods: A collective review of literature concerning investigations that have reported patient outcomes and treatment success of LHM and POEM for all achalasia subtypes. Results: While POEM has shown excellent short-term safety and efficacy in the relief of symptoms, the long-term symptomatic outcomes after the intervention are yet to be concluded. Further evaluation of patients' interpretations and answers on subjective questionnaires is warranted before determining treatment success for POEM. Use of more reliable and disease-specific health-related quality-of-life questionnaires are better justified when comparing a new endoscopic procedure to an established gold standard. The need for objective parameters to measure reflux, longer follow-up studies, and randomized trials comparing POEM to LHM is particularly important when assessing the outcome of this new technique. High incidence of post-POEM pathologic reflux and indication for daily proton pump inhibitor use is of concern, and the lack of more long-term, objective evidence leaves the clinical value of the procedure in a state of uncertainty. Conclusions: The LHM combined with partial fundoplication is still considered to be the gold standard treatment modality for achalasia, but as the POEM procedure rapidly becomes common practice, this treatment may be performed in the majority of achalasia cases. Given the number of flaws overlooked in seminal investigations, careful consideration should be given to the patients being selected for this therapy.
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Affiliation(s)
- Michael T Olson
- University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Tania Triantafyllou
- Hippocration General Hospital of Athens, University of Athens, Athens, Greece
| | - Saurabh Singhal
- Department of GI Surgery and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India
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Affiliation(s)
- Saurabh Singhal
- Department of GI Surgery and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India
| | - Soumen Roy
- Department of GI Surgery and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India
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Singhal S, Kumar P, Sykes R. Dexmedetomidine supplementing scalp block for cerebral abscess drainage in a patient with severe pulmonary hypertension. South Afr J Anaesth Analg 2019. [DOI: 10.36303/sajaa.2019.25.2.2198] [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: 11/05/2022]
Affiliation(s)
| | - P Kumar
- Post Graduate Institute of Medical Sciences
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Roy K, Maddirala H, Kumar S, Singhal S, Meena J. Evaluation of Laparoscopic Ovarian Drilling by Harmonic Scalpel versus Monopolar Drilling Needle in Cases of Clomiphene Citrate Resistant Polycystic Ovarian Response. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Katz S, Mcnulty S, Cengel K, Alley E, Singhal S. P2.06-17 Real-World Accuracy of Malignant Pleural Mesothelioma (MPM) Preoperative Magnetic Resonance Imaging (MRI) for Staging the Diaphragm. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
BACKGROUND Physicians' offices and emergency departments (EDs) are not suited for addressing nontraumatic dental conditions (NTDCs); however, significant numbers of people in Canada, including Ontario, visit such settings for their dental complaints. Also, people sometimes visit hospitals for day surgery to get their complicated dental conditions treated. This reflects the inefficient usage of the health care system and gaps in accessing timely dental care. METHODS We assessed trends in the burden of NTDCs in Ontario by estimating the visits made for such conditions to physicians, EDs, and hospitals for day surgery. Aggregate data for years 2001 to 2015 were retrieved from Intellihealth Ontario. Descriptive analysis was conducted to calculate rates of visits as stratified by sex, age groups (0 to 6, 7 to 18, 19 to 64, and ≥65 y), and jurisdictions (public health unit level). RESULTS On average, 70,274 visits to physicians, 51,861 to EDs, and 13,889 to hospital day surgery are made each year in Ontario for NTDCs, which costs approximately CAN$29 million. Children aged 0 to 6 y visit more than their counterparts. Statistically significant increasing trends for physician and ED visits were observed over the years. Analyses show large variations in rates of visits across public health units, with higher rates in rural communities. CONCLUSION A large number of visits for NTDCs, with jurisdictional variations, were consistently made to nondental health care settings in Ontario over the last 15 y. Central- and local-level policy options for optimizing resources and health care system use are required. KNOWLEDGE TRANSFER STATEMENT The findings of this study will provide oral and general health professionals a comprehensive understanding about the ineffective usage of a health care system for nontraumatic dental conditions. Quantifying the burden and associated dollars spent will promote crucial policy discussions to explore the possible options for providing emergency and essential dental services for all Canadians and possible equitable options to enhance access to dental care for vulnerable populations in Canadian society.
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Affiliation(s)
- S Singhal
- 1 Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada.,2 Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - C Quiñonez
- 2 Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,3 Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - H Manson
- 1 Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada.,3 Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,4 School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Singhal S, Kapoor H, Subramanian S, Agrawal DK, Mittal SK. Polymorphisms of Genes Related to Function and Metabolism of Vitamin D in Esophageal Adenocarcinoma. J Gastrointest Cancer 2018; 50:867-878. [PMID: 30187205 DOI: 10.1007/s12029-018-0164-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 02/07/2023]
Abstract
PURPOSE The vitamin D receptor (VDR) endocrine system has emerged as an endogenous pleiotropic biological cell regulator with anti-neoplastic effects on breast, colorectal, and prostatic adenocarcinomas. We studied the association of gene expression, polymorphisms of VDR, CYP27B1, and CYP24A1 genes and serum vitamin D levels as surrogate markers of disease progression in patients with acid reflux, Barrett's esophagus (BE), or esophageal adenocarcinoma (EAC). METHODS We analyzed blood and tissue samples from patients with biopsy-confirmed BE or EAC for vitamin D levels, gene expressions, and polymorphisms in VDR (FokI [F/f], BsmI [B/b], ApaI [A/a], and TaqI [T/t]), CYP27B1 (HinfI [H/h]), and CYP24A1 (Hpy1881 [Y/y]). Percentages of homozygous dominant/recessive or heterozygous traits were assessed for each polymorphism in all patient subgroups. RESULTS Genomic Bb and FF polymorphisms were highly prevalent in EAC patients, whereas BE patients had a high prevalence of wild-type Hpy1881 (YY polymorphism). Some polymorphisms (Yy for CYP24A1, bb for VDR) were noted only in EAC patients. Yy and bb forms were both uniquely present in some EAC patients without associated Barrett's lesions, but not in patients with concomitant BE. AA and bb polymorphisms were associated with decreased response to neoadjuvant therapy. A high level of VDR and CYP24A1 mRNA expression was observed in EAC tissue of non-responders. Serum vitamin D deficiency was common in EAC patients. CONCLUSIONS Specific polymorphisms in vitamin D metabolism-related genes are associated with the likelihood of reflux-BE-EAC progression. Identifying such polymorphisms may aid in development of better surveillance and diagnostic and therapeutic protocols.
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Affiliation(s)
- Saurabh Singhal
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Suite 500, Phoenix, AZ, USA
- Clinical and Translational Sciences, Creighton University, 2500 California Plaza, Omaha, NE, USA
| | - Harit Kapoor
- Clinical and Translational Sciences, Creighton University, 2500 California Plaza, Omaha, NE, USA
| | - Saravanan Subramanian
- Clinical and Translational Sciences, Creighton University, 2500 California Plaza, Omaha, NE, USA
| | - Devendra K Agrawal
- Clinical and Translational Sciences, Creighton University, 2500 California Plaza, Omaha, NE, USA
| | - Sumeet K Mittal
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Suite 500, Phoenix, AZ, USA.
- Clinical and Translational Sciences, Creighton University, 2500 California Plaza, Omaha, NE, USA.
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Nkhoma E, Kessler P, Friend K, Wang R, Burns L, Borentain M, Singhal S, Desouza M. P4713Evaluation of the risk and determinants of 30-day outcomes following acute heart failure hospitalization using electronic health records. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4713] [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)
- E Nkhoma
- Bristol-Myers Squibb, Global Pharmacovigilance and Epidemiology, Pennington, United States of America
| | - P Kessler
- Bristol-Myers Squibb, Innovative Medicines Development, Lawrence Township, United States of America
| | - K Friend
- Bristol-Myers Squibb, Innovative Medicines Development, Lawrence Township, United States of America
| | - R Wang
- Bristol-Myers Squibb, Center for Observational Research and Data Sciences, Princeton, United States of America
| | - L Burns
- Bristol-Myers Squibb, Center for Observational Research and Data Sciences, Princeton, United States of America
| | - M Borentain
- Bristol-Myers Squibb, Innovative Medicines Development, Lawrence Township, United States of America
| | - S Singhal
- Bristol-Myers Squibb, Innovative Medicines Development, Lawrence Township, United States of America
| | - M Desouza
- Bristol-Myers Squibb, Innovative Medicines Development, Lawrence Township, United States of America
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Saran S, Bansal P, Singhal S, Malik A. Coexisting cerebral venous sinus thrombosis and posterior reversible encephalopathy syndrome in a preeclamptic female. Ann Afr Med 2018. [PMID: 29536965 PMCID: PMC5875127 DOI: 10.4103/aam.aam_41_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Sonal Saran
- Department of Radiology, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Pradeep Bansal
- Department of Radiology, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Saurabh Singhal
- Department of Medicine, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Ankita Malik
- Department of Radiology, Subharti Medical College, Meerut, Uttar Pradesh, India
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Sen K, Adlakha V, Singhal S, Chaudhury R. Migmatization and intrusion of “S-type” granites in the trans-Himalayan Ladakh Magmatic Arc of north India and their bearing on Indo-Eurasian collisional tectonics. Geological Journal 2018; 53:1543-1556. [DOI: 10.1002/gj.2973] [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] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Affiliation(s)
- Koushik Sen
- Wadia Institute of Himalayan Geology; Dehradun India
| | - Vikas Adlakha
- Wadia Institute of Himalayan Geology; Dehradun India
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Klampatsa A, O’Brien S, Eruslanov E, Rao A, Thompson J, Kim S, Cengel K, Moon E, Singhal S, Albelda S. PO-387 Phenotypic and functional analysis of malignant mesothelioma tumor-infiltrating lymphocytes (TILs). ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Olson MT, Singhal S, Panchanathan R, Roy SB, Kang P, Ipsen T, Mittal SK, Huang JL, Smith MA, Bremner RM. Primary paraesophageal hernia repair with Gore® Bio-A® tissue reinforcement: long-term outcomes and association of BMI and recurrence. Surg Endosc 2018; 32:4506-4516. [PMID: 29761272 DOI: 10.1007/s00464-018-6200-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/21/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic repair remains the gold-standard treatment for paraesophageal hernia (PEH). We analyzed long-term symptomatic outcomes and surgical reintervention rates after primary PEH repair with onlay synthetic bioabsorbable mesh (W. L. Gore & Associates, Inc., Flagstaff, AZ) and examined body mass index (BMI) as a possible risk factor for poor outcomes and for recurrence. METHODS We queried a prospectively maintained database to identify patients who underwent laparoscopic primary PEH repair with onlay patch of a bioprosthetic absorbable mesh (Bio-A® Gore®) between 05/28/2009 and 12/31/2013. Electronic health records were accessed to record demographic and operative data and were reviewed up to the present to identify any repeat procedures. Patients were grouped according to preoperative BMI (A: BMI < 25; B: BMI = 25-29.9; C: BMI = 30-34.9; D: BMI ≥ 35). Patients completed standardized satisfaction and symptom surveys. RESULTS In total, 399 patients were included. Most patients (n = 261; 65.4%) were women. Mean age was 59.6 ± 13.4 years; mean BMI was 29.9 ± 5.0 kg/m2. The patients were grouped as follows: A, 53 patients (13.3%); B, 166 (41.6%); C, 115 (28.8%); D: 65 (16.3%). Four procedures (1.0%) were converted from laparoscopy to open procedures. All patients underwent an antireflux procedure (225 Nissen, 170 Toupet, 4 Dor). A mean follow-up of 44.7 ± 22.8 months was available for 305 patients (76.4%). 24/305 patients (7.9%) underwent reoperation, and the number of reoperations did not differ among groups (P = 0.64). Long-term symptomatic outcomes were available for 217/305 patients (71.1%) at a mean follow-up of 54.0 ± 13.1 months; no significant difference was observed among groups. 194/217 patients (89.4%) reported good to excellent satisfaction, with no significant differences among the groups. CONCLUSIONS Laparoscopic primary PEH repair with onlay Bio-A® mesh is a safe and feasible procedure with excellent long-term patient-centered outcomes and acceptable symptomatic recurrence rate. BMI does not appear to be related to the need for surgical reintervention.
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Affiliation(s)
- Michael T Olson
- Grand Canyon University College of Science, Engineering, and Technology, Phoenix, AZ, USA.,Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA
| | - Saurabh Singhal
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA
| | - Roshan Panchanathan
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA.,University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Sreeja Biswas Roy
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA
| | - Paul Kang
- University of Arizona College of Public Health, Phoenix, AZ, USA
| | - Taylor Ipsen
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA.,Midwestern University College of Osteopathic Medicine, Glendale, AZ, USA
| | - Sumeet K Mittal
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA
| | - Jasmine L Huang
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA
| | - Michael A Smith
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA
| | - Ross M Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA.
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