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Christopher S, Dutta S, Gopal TVS. Bilateral pericapsular end nerve blocks for steroid-induced avascular necrosis following COVID-19 infection requiring bilateral total hip replacement. World J Anesthesiol 2024; 13:90514. [DOI: 10.5313/wja.v13.i1.90514] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/05/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Osteonecrosis or avascular necrosis (AVN) of the hip was one of the dreaded complications of coronavirus disease 2019 (COVID-19), which emerged in patients who received steroid therapy. Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients. Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous (IV) or oral dexamethasone, methylprednisolone or hydrocortisone. The use of such high doses of corticosteroids has shown very positive results and has been lifesaving in many cases. Still, long-term consequences were drug-induced diabetes, osteoporosis, Cushing syndrome, muscle wasting, peripheral fat mobilization, AVN, hirsutism, sleep disturbances and poor wound healing. A significant number of young patients were admitted for bilateral total hip replacements (THR) secondary to AVN following steroid use for COVID-19 treatment.
AIM To assess the efficacy of bilateral pericapsular end nerve group (PENG) blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery.
METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals, Hyderabad, India. Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months. All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia.
RESULTS The duration of surgery was 2.5 h on average. Seventeen out of twenty patients (85%) had a Visual Analog Score (VAS) of less than 2 and did not require any supplementation. One patient was removed from the study, as he required re-exploration. The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug. Fifteen out of seventeen patients (88.2%) could be mobilized 12 h after the procedure.
CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19, which surfaced in patients who received steroid therapy requiring surgical intervention. Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.
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Affiliation(s)
| | - Sweety Dutta
- Department of Anaesthesiology, Care Hospitals, Hyderabad 500025, India
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Christopher S, Tadlock BA, Veroneau BJ, Harnish C, Perera NKP, Knab AM, Vallabhajosula S, Bullock GS. Epidemiological profile of pain and non-steroid anti-inflammatory drug use in collegiate athletes in the United States. BMC Musculoskelet Disord 2020; 21:561. [PMID: 32814544 PMCID: PMC7437034 DOI: 10.1186/s12891-020-03581-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although athletic endeavours are associated with a high amount of physical stress and injury, the prevalence of pain is underreported in the sports medicine literature with only a few studies reporting pain on collegiate athletes or exploring sex difference of pain. Impact of pain on athlete availability, training and performance can be mitigated when key epidemiological information is used to inform adequate pain management strategies. This study aims to 1) provide an epidemiological profile of self-reported pain experienced by the National Collegiate Athletic Association (NCAA) athletes by sex during the first half of the 2019 season, 2) describe their self-reported non-steroidal anti-inflammatory drug (NSAID) use. METHODS Online survey was completed by athletes at three NCAA institutions from 1 August to 30 September 2019. Descriptive statistics were used to describe player demographic data, self-reported pain and self-reported NSAID use. Pain incidence proportion were calculated. RESULTS Two hundred thirty female athletes and 83 male athletes completed the survey. Self-reported pain incidence proportion for female athletes was 45.0 (95% CI 41.5-48.5) vs 34.9 (95% CI 29.4-40.4) for male athletes. Majority of the athletes did not report pain (55% female vs 62% male) during the first half of the 2019 season. Female athletes reported pain in their back (35%), knee (26%), and ankle/foot (23%) whilst male athletes reported pain in their knee (35%), back (28%), and shoulder (24%). Of all athletes, 28% female vs 20% male athletes reported currently taking NSAIDs. Of athletes that reported pain, 46% female vs 38% male athletes currently took NSAIDs. 70% female vs 61% male athletes self-purchased NSAIDs, and 40% female vs 55% male athletes consumed alcohol. CONCLUSIONS Half of female athletes and one in three male athletes reported pain. Most commonly back, knee and foot/ankle pain and knee, back and shoulder pain was reported in female and male athletes respectively. One in four female athletes and one in five male athletes use NSAIDs for pain or prophylactic purpose. Majority self-purchase these medications indicating need for health literacy interventions to mitigate potential adverse effects.
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Affiliation(s)
- S Christopher
- Department of Physical Therapy Education, Elon University, Elon, NC, USA
| | - B A Tadlock
- Department of Physical Therapy Education, Elon University, Elon, NC, USA
| | - B J Veroneau
- Department of Physical Therapy Education, Elon University, Elon, NC, USA
| | - C Harnish
- Department of Exercise Science, Mary Baldwin College, Staunton, VA, USA
| | - N K P Perera
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, UK.,Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, B4495, Oxford, OX3 7LD, UK.,Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden.,School of Allied Health, Human Services and Sport, Latrobe University, Melbourne, Victoria, Australia
| | - A M Knab
- Kinesiology Department, Queens University of Charlotte, Charlotte, NC, USA
| | - S Vallabhajosula
- Department of Physical Therapy Education, Elon University, Elon, NC, USA
| | - G S Bullock
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, UK. .,Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, B4495, Oxford, OX3 7LD, UK. .,Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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Christopher S, Gopal TVS, Vardhan V. Thoracolumbar interfascial plane block, way forward for awake endoscopic laminectomies. Indian J Anaesth 2020; 64:436-437. [PMID: 32724256 PMCID: PMC7286402 DOI: 10.4103/ija.ija_915_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/14/2020] [Accepted: 02/09/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - T V S Gopal
- Department of Anesthesia, Care Hospital, Hyderabad, Telangana, India
| | - Vishnu Vardhan
- Department of Neurosurgery, Care Hospital, Hyderabad, Telangana, India
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Van Tassell B, Trankle CR, Kadariya D, Canada JM, Carbone S, Buckley LF, Wohlford GF, Dixon DL, Christopher S, Vo C, Mankad P, Dell M, Shah KB, Kontos MC, Abbate A. 5947Predictive role of C-reactive protein levels in patients with ST-segment elevation acute myocardial infarction for heart failure related events. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
ST-segment elevation myocardial infarction (STEMI) is associated with an intense acute inflammatory response and an increased risk of death and heart failure (HF). C-reactive protein (CRP) is the inflammatory biomarker most commonly used for risk stratification in patients with cardiovascular diseases. CRP levels are known to rise and fall during STEMI in response to myocardial injury. In this study, we analyzed whether admission CRP or delayed CRP (measured at 72 hours after admission) held a greater predictive value for adverse HF events in patients with STEMI.
Methods
We analyzed data from the VCUART3 clinical trial enrolling 99 patients with STEMI within 12 hours of presentation at 3 sites in the United States of America treated with anakinra or placebo. CRP levels were measured with a high-sensitivity assay at time of admission and again at 72 hours later. A dedicated committee composed of individuals not involved in the conduct of the trial adjudicated HF events including a composite endpoint of death from any reason or incidence of HF defined as new-onset HF requiring hospital admission or a new prescription for a loop diuretic (D+HF) and a composite endpoint of death and HF hospitalization (D+HHF) at 1 year. We used a time-dependent Cox-regression analysis to determine the association of CRP at admission or at 72 hours with the outcomes of interest in univariate and multivariate analysis. Data are presented as median and interquartile range. (ClinicalTrials NCT01950299)
Results
CRP levels from admission and 72 hours were available in 90 and 87 subjects respectively and they increased from 4.6 [2.8–8.5] mg/L to 11.6 [4.6–24.5] mg/L (P<0.001). Both admission CRP (CRP0) and CRP at 72 hours (CRP72) were associated with the risk of D+HF (P=0.011 and <0.001, respectively) and of D+HHF (P=0.010 and P<0.001, respectively); however at multivariate analysis, only CRP72 remained significantly associated with the risk of D+HF (P=0.001) and D+HHF (P=0.004) while CRP0 was not. CRP72 significantly correlated with NTproBNP levels at 72 hours (NTproBNP72, Spearman rho R=+0.37, P=0.001). NTproBNP72 predicted D+HF (P=0.030) but not independently of CRP72 (P=0.096 for NTproBNP72 and P=0.007 for CRP72 at multivariate analysis including the 2 variables). NTproBNP72 did not predict D-HHF.
Conclusions
Among contemporary patients with STEMI, the levels of CRP at 72 hours after admission was superior to admission CRP levels for predicting the incidence of HF events, and independent of NTproBNP levels. Our results indicate the importance of the inflammatory response during STEMI, supporting the concept of inhibiting the inflammatory response as a therapeutic strategy.
Acknowledgement/Funding
Funded by NHLBI 1R34HL121402; Drug supply from Swedish Orphan Biovitrum
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Affiliation(s)
- B Van Tassell
- Virginia Commonwealth University, Richmond, United States of America
| | - C R Trankle
- Virginia Commonwealth University, Richmond, United States of America
| | - D Kadariya
- Virginia Commonwealth University, Richmond, United States of America
| | - J M Canada
- Virginia Commonwealth University, Richmond, United States of America
| | - S Carbone
- Virginia Commonwealth University, Richmond, United States of America
| | - L F Buckley
- Brigham and Womens Hospital, Boston, United States of America
| | - G F Wohlford
- Virginia Commonwealth University, Richmond, United States of America
| | - D L Dixon
- Virginia Commonwealth University, Richmond, United States of America
| | - S Christopher
- Virginia Commonwealth University, Richmond, United States of America
| | - C Vo
- Virginia Commonwealth University, Richmond, United States of America
| | - P Mankad
- Virginia Commonwealth University, Richmond, United States of America
| | - M Dell
- Virginia Commonwealth University, Richmond, United States of America
| | - K B Shah
- Virginia Commonwealth University, Richmond, United States of America
| | - M C Kontos
- Virginia Commonwealth University, Richmond, United States of America
| | - A Abbate
- Virginia Commonwealth University, Richmond, United States of America
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Showen R, Dunson C, Woodman GH, Christopher S, Lim T, Wilson SC. Locating fish bomb blasts in real-time using a networked acoustic system. Mar Pollut Bull 2018; 128:496-507. [PMID: 29571401 DOI: 10.1016/j.marpolbul.2018.01.029] [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] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
Results are presented of a demonstration of real-time fish blast location in Sabah, Malaysia using a networked hydroacoustic array based on the ShotSpotter gunshot location system. A total of six acoustic sensors - some fixed and others mobile - were deployed at ranges from 1 to 9 km to detect signals from controlled test blasts. This allowed the blast locations to be determined to within 60 m accuracy, and for the calculated locations to be displayed on a map on designated internet-connected computers within 10 s. A smaller three-sensor system was then installed near Semporna in Eastern Sabah that determined the locations of uncontrolled blasts set off by local fishermen. The success of these demonstrations shows that existing technology can be used to protect reefs and permit more effective management of blast fishing activity through improved detection and enforcement measures and enhanced community engagement.
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Affiliation(s)
- R Showen
- ShotSpotter Inc., Suite 210, 7979 Gateway Blvd, Newark, CA 94560, USA.
| | - C Dunson
- ShotSpotter Inc., Suite 210, 7979 Gateway Blvd, Newark, CA 94560, USA
| | - G H Woodman
- Teng Hoi Conservation Organization, Room 1906, 19/F, China Insurance Group Building, 141 Des Voeux Road, Central, Hong Kong
| | - S Christopher
- Scubazoo Images Sdn. Bhd., 3, Jalan Nosoob Hungab, 88300 Kota Kinabalu, Sabah, Malaysia
| | - T Lim
- Scubazoo Images Sdn. Bhd., 3, Jalan Nosoob Hungab, 88300 Kota Kinabalu, Sabah, Malaysia
| | - S C Wilson
- Five Oceans Environmental Services LLC, P.O. Box 660, Postal Code 131, Hamriyah, Oman
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Christopher S, S Gopal TV. Pectoral nerves-II block for chronic resynchronization therapy device placement: A novel approach. Indian Anaesth Forum 2018. [DOI: 10.4103/theiaforum.theiaforum_39_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chatterjee S, Bain J, Christopher S, Gopal TVS, Raju KP, Mathur P. Role of regional anesthesia for placement of peritoneal dialysis catheter under ultrasound guidance: Our experience with 52 end-stage renal disease patients. Saudi J Anaesth 2015; 9:132-5. [PMID: 25829899 PMCID: PMC4374216 DOI: 10.4103/1658-354x.152838] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: The number of patients with end-stage renal disease (ESRD) has shown a consistent rise in India in recent years. Continuous ambulatory peritoneal dialysis (CAPD) remains one of the safe and effective forms of treatment. In this study, we have tried to assess the effectiveness of field block technique for analgesia during catheter placement surgery until 24 h postoperatively, also, if it can obviate the need for general anesthesia in these high-risk patients. Materials and Methods: We studied 52 ESRD patients from 2010 to 2012 who were posted for CAPD catheterization in the Department of Urology, Care Hospital, Hyderabad, India. Under ultrasound guidance, “unilateral posterior” and “unilateral subcostal” transversus abdominis plane block anesthesia were given for the placement of CAPD catheter. Patient's intra-operative pain and post-operative pain were recorded with visual analog scores (VAS) and analyzed. Results: All patients in our study belonged to American Society of Anesthesiologists category 2 or 3 with multiple co-morbidities. 41 out of 52 patients required no supplemental analgesia during the procedure; 8 patients needed additional infiltration of local anesthetic during skin incisions. Three patients required supplemental analgesia and were considered as failure. A VAS of two was noted in 30 patients and 1 in 19 Patients. No Patient had significant pain 24 h post operatively. No local complication was noted in any patient. Conclusion: CAPD Catheterization under regional field block remains safe and effective options for ESRD patients.
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Affiliation(s)
| | - Jayanta Bain
- Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Somita Christopher
- Department of Anaesthesiology, Care Hospitals, Hyderabad, Telangana, India
| | | | | | - Piyush Mathur
- Department of Nephrology, Care Hospitals, Hyderabad, Telangana, India
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Korhonen P, Kuoppamäki M, Prami T, Hoti F, Christopher S, Ellmén J, Aho V, Vahteristo M, Pukkala E, Haukka J. Entacapone did not Increase Prostate Cancer Risk or Mortality in Patients with Parkinson's Disease. Value Health 2014; 17:A393. [PMID: 27200912 DOI: 10.1016/j.jval.2014.08.870] [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: 06/05/2023]
Affiliation(s)
| | | | - T Prami
- EPID Research, Espoo, Finland
| | - F Hoti
- EPID Research, Espoo, Finland
| | | | - J Ellmén
- Orion Corporation, Espoo, Finland
| | - V Aho
- Orion Corporation, Espoo, Finland
| | | | - E Pukkala
- Finnish Cancer Registry, Helsinki, Finland
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Christopher S, Hassanein M, Flattery M, Smallfield M, Cooke R, Shah K. Novel Lipoprotein Markers Remain Elevated Despite Statin Therapy After Heart Transplant. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Christopher S. Microwaves in Airborne Surveillance. DEFENCE SCI J 2013. [DOI: 10.14429/dsj.63.4255] [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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Chordia P, Christopher S, Abraham OC, Muliyil J, Kang G, Ajjampur SSR. Risk factors for acquiring Strongyloides stercoralis infection among patients attending a tertiary hospital in south India. Indian J Med Microbiol 2011; 29:147-51. [DOI: 10.4103/0255-0857.81797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Marshall L, Mundy J, Garrahy P, Hukins C, Christopher S, Wood A, Griffin R, Shah P. Institutional Experience with Surgical Pulmonary Embolectomy: A 10 Case Series. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2010.11.061] [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: 11/27/2022]
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Vasan SK, Thomas N, Christopher S, Geethanjali FS, Paul TV, Sanjeevi CB. Anthropometric measurements for the prediction of the metabolic syndrome: a cross-sectional study on adolescents and young adults from southern india. Heart Asia 2011; 3:2-7. [PMID: 27325971 DOI: 10.1136/ha.2009.001735] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine which anthropometric measurement correlates best with the metabolic abnormalities associated with the metabolic syndrome in adolescents and young adults. DESIGN Cross-sectional study. SETTING Schools, high schools and universities. PARTICIPANTS 1359 adolescents and young adults aged 14-25 years. MAIN OUTCOME MEASURES Anthropometric predictors of metabolic abnormalities as classified by International Diabetes Federation definition. RESULTS The waist circumference (OR 1.56, 95% CI 1.0 to 2.43: p≤0.01) and the abdominal skin fold thickness (OR 1.44, 95% CI 1.02 to 2.04, p≤0.01) above the third quintile cut-offs were found to be significantly associated with metabolic abnormalities. The sensitivity of either one of these measurements in predicting metabolic abnormalities was 66.1% with a negative predictive value of 82.8%. Hyperglycaemia was significantly associated with an abdominal skin fold thickness over the fourth quintile alone (OR 1.63, 95% CI 1.24 to 2.1). All the anthropometric measurements correlated well with elevated triglycerides and hypertension. CONCLUSIONS In a large community-based cross-sectional survey of subjects aged 14-25 years, the waist circumference and the abdominal skin fold thickness are important predictors of the metabolic abnormalities associated with metabolic syndrome. This simple clinical tool may help in a primary care setting to identify subjects who require a further biochemical evaluation and would considerably reduce the cost of unwarranted testing.
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Affiliation(s)
- S K Vasan
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India; Department of Molecular Medicine & Surgery, Karolinska INSTITUTET, Stockholm, Sweden
| | - N Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - S Christopher
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - F S Geethanjali
- Department of Clinical Biochemistry, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - T V Paul
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - C B Sanjeevi
- Department of Molecular Medicine & Surgery, Karolinska INSTITUTET, Stockholm, Sweden
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Christopher S. Active Electronically-steered Array Surveillance Radar: Indian Value Addition. DEFENCE SCI J 2010. [DOI: 10.14429/dsj.60.338] [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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Haywood JM, Pelon J, Formenti P, Bharmal N, Brooks M, Capes G, Chazette P, Chou C, Christopher S, Coe H, Cuesta J, Derimian Y, Desboeufs K, Greed G, Harrison M, Heese B, Highwood EJ, Johnson B, Mallet M, Marticorena B, Marsham J, Milton S, Myhre G, Osborne SR, Parker DJ, Rajot JL, Schulz M, Slingo A, Tanré D, Tulet P. Overview of the Dust and Biomass-burning Experiment and African Monsoon Multidisciplinary Analysis Special Observing Period-0. ACTA ACUST UNITED AC 2008. [DOI: 10.1029/2008jd010077] [Citation(s) in RCA: 166] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Venkatesan T, Sen N, Korula PJ, Surendrababu NRS, Raj JP, John P, Christopher S. Blind placements of peripherally inserted antecubital central catheters: initial catheter tip position in relation to carina. Br J Anaesth 2007; 98:83-8. [PMID: 17124185 DOI: 10.1093/bja/ael316] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [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: 11/12/2022] Open
Abstract
BACKGROUND We investigated how often blind placement of peripherally inserted central catheters (PICCs) through the antecubital veins results in a correct tip location in relation to carina and evaluated the inter-observer agreement in locating the tip of PICCs in plain radiography with digital imaging. METHODS In this study, 202 suitable chest radiographs with PICCs out of 803 patients were identified. An initial audit on the tip of these catheters in relation to carina was done by a consultant anaesthetist and was recorded as the first observer. The same sets of CXRs were examined by a consultant radiologist and the tips were identified and recorded as the second observer. Inter-observer agreement was assessed. RESULTS In 75 of 202 (37%), PICCs had a central tip location in relation to the carina. Fifty-five of 131 (42%) right-sided catheters had a central location compared with 20 of 71 (28%) of the left-sided catheters. The tip position for right-sided catheters was most frequently centrally located whereas the tip for left-sided catheters was most commonly positioned in the ipsilateral innominate vein. There was excellent agreement between the observers in reporting the tip of PICCs at all positions (kappa=0.87) including central locations (kappa=0.83). CONCLUSIONS Right antecubital PICCs are more likely to be placed in the central location in relation to the carina. PICCs inserted through the left antecubital veins need to be pushed further down to aim for a central location. Inter-observer variability in identifying the tip of PICCs is least with the introduction of digital imaging.
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Affiliation(s)
- T Venkatesan
- Department of Anaesthesia, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
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Chan CY, Chan LY, Zheng YG, Harris JM, Oltmans SJ, Christopher S. Effects of 1997 Indonesian forest fires on tropospheric ozone enhancement, radiative forcing, and temperature change over the Hong Kong region. ACTA ACUST UNITED AC 2001. [DOI: 10.1029/2001jd900092] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Christopher S, Devi SA. Myosin ATPase in young and old mammalian myocardium: responses to exercise in cold and thermo neutral environment. Indian J Exp Biol 2001; 39:29-34. [PMID: 11349522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Resting levels of blood lactate (La) were significantly lower at 35 degrees C than at 25 degrees C in the trained (Tr) rats while untrained (UTr) rats maintained higher levels. Extent of decrease in blood glucose (Glu) in Tr rats was lower in cold (C) than in thermo neutral (N) water in young but not in old. Training in C had no impact on young right and left ventricles (RV and LV). UTr old rats showed loss in LV Glu at both the temperatures. Old trainees had reduced RV Glu in C while no change was observed at N. Substrate changes were concomitant with altered myosin ATPase activity. Young ventricles showed higher ATPase activity in LV than in RV, and training in C evoked elevations in RV enzyme. The results suggest that training may enhance the functional and biochemical activity in terms of higher myosin ATPase activity in N, as against a C environment, and the effect is better pronounced in LV. Anaerobic condition is felt more in C as seen through elevated blood La.
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Affiliation(s)
- S Christopher
- Department of Zoology, Bangalore University, Bangalore 560 056, India
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Abstract
The evaluation of the protein binding partner(s) of biologically important proteins is currently an area of intense research, especially since the development of the yeast two-hybrid assay. However, not all protein-protein interactions uncovered by this assay are biologically relevant and another confirmatory assay must be performed. Ideally, this assay should be rapid, versatile and performed under conditions which mimic the 'normal' physiological state as closely as possible. Towards this goal, we have constructed two eukaryotic expression vectors that facilitate the purification of a protein of interest, along with any associated proteins, from mammalian cells. These vectors incorporate the following features: (i) a tetracycline-responsive promoter so that the level of protein production can be regulated; (ii) an N-terminal glutathione S-transferase tag or a triple repeat of the HA1 epitope, to facilitate purification of the protein either by glutathione affinity chromatography or immunoprecipitation, respectively, followed by a multiple cloning site; (iii) the gene for the enhanced green fluorescent protein (for detection of the presence of the fusion protein and subcellular localization); (iv) a puromycin marker for the selection of stable transformants; (v) a truncated EBNA protein and oriP sequence for episomal replication of the vector. These latter two features permit expansion of small cultures of transfected cells under puromycin selection, thereby increasing the amount of tagged protein that can be purified. We show that these vectors can be used to direct the doxycycline-inducible expression of tagged proteins and to recover tagged CIP1-p21 protein complexes from HeLa cells. Furthermore, we show that these tagged p21-purified complexes contain both cyclin A and Cdk2, which are known to interact with p21, but not beta-actin.
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Affiliation(s)
- D Medina
- Department of Medicine, RWJU Medical School, UMDNJ, Member CINJ, 195 Little Albany Street, New Brunswick, NJ 08901, USA
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Abstract
This issue of the Journal of Neuro-Oncology is devoted to recent investigations of low-grade gliomas. The purpose of this issue is not to debate the relative merits and liabilities of different management strategies for low-grade gliomas, but to present new data concerning novel and innovative approaches to evaluating these lesions. The common theme of many of these reports represents a departure from grading systems that primarily depend on a morphology-based analysis from light microscopy to classify these tumors. The purpose of this review is to present the reasoning behind the selection of authors for this issue of the Journal of Neuro-Oncology and to provide a format for presentation of new ideas concerning these interesting tumors. It is clear that standard classification systems that address only the morphological characteristics of tumor cells can not adequately represent the wide variation in biological activity that is found with these lesions. It is hoped that these articles will stimulate further interest and research into low-grade gliomas that will one day lead to more effective therapy.
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Affiliation(s)
- J M Piepmeier
- Yale University School of Medicine, Section of Neurosurgery, New Haven, CT 06520-8039, USA
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Bartolomei JC, Christopher S, Vives K, Spencer DD, Piepmeier JM. Low-grade gliomas of chronic epilepsy: a distinct clinical and pathological entity. J Neurooncol 1997; 34:79-84. [PMID: 9210054 DOI: 10.1023/a:1005711321343] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [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: 02/04/2023]
Abstract
The authors present a summary of their recent experience regarding the management of patients with a variety of low-grade gliomas found during the evaluation for chronic epilepsy. These tumors are notable because the long-term patient outcome in this population is significantly better than the anticipated results of patients with the same tumors who do not have chronic epilepsy. Based on the long history of preoperative seizures (median 14 years), the frequent cortical location, and the absence of tumor recurrence or anaplastic transformation and the lack of mortality in this population, low-grade gliomas of chronic epilepsy appear to define a specific pathological entity that separates them from other histologically similar low-grade gliomas. Low-grade gliomas of chronic epilepsy also are notable for the absence of morphological features that characterize with dysembryoplastic neuroepithelial tumors (DNTs). Our evidence suggests that low-grade gliomas of chronic epilepsy should be recognized as a distinct pathological entity.
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Affiliation(s)
- J C Bartolomei
- Yale University School of Medicine, Section of Neurosurgery, New Haven, CT 06520-8039, USA
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Piepmeier J, Christopher S, Spencer D, Byrne T, Kim J, Knisel JP, Lacy J, Tsukerman L, Makuch R. Variations in the natural history and survival of patients with supratentorial low-grade astrocytomas. Neurosurgery 1996; 38:872-8; discussion 878-9. [PMID: 8727811 DOI: 10.1097/00006123-199605000-00002] [Citation(s) in RCA: 199] [Impact Index Per Article: 7.1] [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: 02/01/2023] Open
Abstract
Data from 55 consecutive patients with low-grade astrocytomas treated between 1982 and 1990 were analyzed to determine specific outcome factors, including time to recurrence, incidence of anaplastic transformation, and survival. Gender, type of symptoms, contrast enhancement, and timing of radiation therapy were not significant in determining outcome. Patients who had symptoms for > 2 years and underwent gross-total resection of the tumor, with age as a continuous variable, were associated with significantly longer time to recurrence and survival. Within the population of patients with low-grade astrocytomas, patients with chronic epilepsy clearly had the best prognoses. There were no tumor recurrences or deaths in 27 patients with chronic epilepsy, regardless of the extent of surgery and without the use of radiotherapy. Ten-year survival was 100% for 31 patients who underwent gross-total tumor resection, regardless of the length of preoperative symptoms. Immediate postoperative radiotherapy did not prolong the time to recurrence, reduce the incidence of transition to more malignant tumors at recurrence, or increase the length of survival when compared with delayed radiotherapy. Because recurrence with a high-grade lesion caused 92% of the mortality in our series, the benefit in patients who underwent aggressive surgery seems to result from a significant decrease in the risk of recurrence when compared with patients who underwent anything less than gross-total resection. Our data also suggest that variability in the natural history of low-grade astrocytomas has a strong influence in determining survival and that tumors associated with chronic epilepsy are much less likely to become more malignant over time.
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Affiliation(s)
- J Piepmeier
- Department of Surgery/Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Issar SK, Ramakrishna BS, Ramakrishna B, Christopher S, Samuel BU, John TJ. Prevalence and presentation of hepatitis C related chronic liver disease in southern India. J Trop Med Hyg 1995; 98:161-5. [PMID: 7783272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To determine the importance of hepatitis C virus (HCV) infection in the aetiology of chronic liver disease in southern India, the prevalence of HCV antibodies and HBV markers was estimated in 100 patients with chronic liver disease and in 56 patients with a variety of other gastrointestinal and liver diseases who served as controls. HCV antibody was measured by a second-generation ELISA. HBsAg, anti-HBc, anti-HBs and anti-D were also estimated. HCV antibodies were detected in 26/100 patients with chronic liver disease compared to 0/56 controls. HBV markers were present in 72 of 100 patients with chronic liver disease compared to 21/56 (37.5%) controls. Anti-D was noted in 4/100 patients with chronic liver disease and in none of the controls. Many patients had serological evidence of both B and C infection; 73% of those with anti-HCV also tested positive for HBV markers. HCV related disease presented at a median age of 60 years compared to HBV related disease which presented at a median age of 40. There was no significant difference between HCV and HBV positive patients in symptomatology, but encephalopathy was uncommon and cirrhosis the usual finding at histology in HCV positive individuals, while chronic active hepatitis was found in 30% of biopsied HBV related disease. HCV is a significant cause of chronic liver disease in this geographic region, although HBV infection continues to account for the largest proportion of cases.
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Affiliation(s)
- S K Issar
- Department of Gastrointestinal Sciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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Bhave AA, Chandy M, John TJ, Sudarsanam A, Christopher S, Dennison D. Cytomegalovirus (CMV) mononucleosis syndrome. Indian J Pediatr 1994; 61:584-5. [PMID: 7744461 DOI: 10.1007/bf02751725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A A Bhave
- Department of Haematology, Christian Medical College Hospital, Vellore
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Babu G, Christopher S, Newmark R. Corrections: Poly(dimethylsiloxane-co-diphenylsiloxanes): Synthesis, Characterization and Sequence Analysis. Macromolecules 1988. [DOI: 10.1021/ma00184a600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Katiyar BC, Misra S, Singh RB, Singh AK, Gupta S, Gulati AK, Christopher S, John TJ. Adult polio-like syndrome following Enterovirus 70 conjunctivitis (natural history of the disease). Acta Neurol Scand 1983; 67:263-74. [PMID: 6880605 DOI: 10.1111/j.1600-0404.1983.tb04575.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
During the Indian EV 70 conjunctivitis epidemic in 1981, 79 patients with neurological complications were evaluated by clinical, electrophysiological, histopathological and virological studies. The disease was heralded by an attack of conjunctivitis and was followed, after a variable latent period, by a pre-paralytic, paralytic, and post-paralytic stage of slow recovery. The above events occurred in an orderly sequence. The paralysis affected the cranial nerves, limbs or both. The clinical course closely simulated poliomyelitis, without any evidence of radiculopathy or myelopathy. Cranial nerve palsies were seen in approximately half of the patients. The electrophysiological and histologicl studies pointed towards the affection of anterior horn cells. The raised neutralizing antibody titres to Enterovirus 70, confirmed the aetiology of the disease. On the available data, we believe that this nosological entity should be considered under the general title of "polio-like syndrome" following EV 70 conjunctivitis. On account of two epidemics in 1971 and 1981 with unfavourable prognosis and high resultant disability, and because of lack of specific therapy, it has become imperative to develop, as a top priority, a vaccine for immunization.
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Abstract
An epidemic of acute hemorrhagic conjunctivitis in 416 (10.8%) of 3,830 staff and students of the Christian Medical College and Hospital in Vellore, India, during September-December 1979 was studied. Virus was isolated in cultures of HeLa cells from 171 of the 249 persons cultured. Most of the viral isolates were identified as an antigenic variant of coxsackievirus A24. Success in isolating the virus from conjunctival swabs was inversely proportional to the time elapsed between the onset of illness and the time the specimens were collected. In general, titers of antibody to coxsackievirus A24 were low or undetectable. Three persons had subconjunctival hemorrhage with no other symptoms, and virologic evidence of infection with coxsackievirus A24 was obtained in two of them.
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John TJ, Maiya PP, Jadhav M, Christopher S, Mukundan P. Mumps virus meningitis and encephalitis without parotitis. Indian J Med Res 1978; 68:883-6. [PMID: 750438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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John TJ, Patoria NK, Christopher S, George S. Epidemiology of enterovirus infections in children in Nagpur. Indian J Med Res 1978; 68:549-54. [PMID: 730226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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34
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Christopher S, Mukundan P, John TJ. Mumps virus cytopathic effect in bonnet monkey kidney cell cultures. Indian J Med Res 1977; 65:753-5. [PMID: 414999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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35
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Christopher S, John TJ, Charles V, Ray S. Coxsackievirus A24 variant EH 24/70 and enterovirus type 70 in an epidemic of acute haemorrhagic conjunctivitis--a preliminary report. Indian J Med Res 1977; 65:593-5. [PMID: 200553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Abstract
Antibodies titres against Coxsackie-B (CB) and mumps virus (MV) were determined in 180 normal subjects and two groups of diabetics, 236 with diabetes of recent onset (DRO) and 108 with diabetes of long duration (DLD). Positive antibody titres to these viruses were found more frequently in controls than in diabetics. In fact, the percentage of positive titres was significantly less than in controls in several instances particularly in juvenile onset diabetes of long duration. These data suggest that CB and MV are not causally related to human diabetes mellitus.
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John TJ, Christopher S. Oral polio vaccination of children in the tropics. III. Intercurrent enterovirus infections, vaccine virus take and antibody response. Am J Epidemiol 1975; 102:422-8. [PMID: 1200026 DOI: 10.1093/oxfordjournals.aje.a112181] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The effect of intercurrent enterovirus infections on host responses to oral polio vaccine (OPV) was studied in groups of infants and children who were without antibodies to one, two or three serotypes of poliovirus. The prevalence of enterovirus infections as detected in fecal specimens collected at weekly intervals and inoculated in primary monkey kidney cell culture, HEp 2 cells and newborn mice ranged between 60 and 70 per cent. The presence of such infections at the time of, 1 week prior to, or during the 3 weeks prior to the administration of OPV did not appear to inhibit either vaccine virus take or antibody response. However, in both the infected and uninfected children the rates of vaccine virus take and seroconversion were found to be considerably lower than those reported from several temperate climate countries.
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John TJ, Christopher S, Fernandez E. Improved cell yield from monkey kidneys by using versene and trypsin. Indian J Med Res 1974; 62:699-703. [PMID: 4215752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Christopher S. A dental laboratory technology program at the high-school level. CAL 1974; 37:18-21. [PMID: 4523338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Feldman RA, Christopher S, George S, Kamath KR, John TJ. Infection and disease in a group of South Indian families. 3. Virological methods and a report of the frequency of enteroviral infection in preschool children. Am J Epidemiol 1970; 92:357-66. [PMID: 4322315 DOI: 10.1093/oxfordjournals.aje.a121218] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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John TJ, Kamath KR, Feldman RA, Christopher S. Infection and disease in a group of South Indian Families. IX. Poliovirus infection among pre-school children. Indian J Med Res 1970; 58:551-5. [PMID: 4319667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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43
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Feldman RA, Kamath DK, Christopher S. Oral poliovaccine and paralysis. Indian Pediatr 1968; 5:475-8. [PMID: 5715225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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44
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Christopher S. Plant crises in health management. Hosp Prog 1968; 49:80,84 passim. [PMID: 5643384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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