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Lennon JT, Abramoff RZ, Allison SD, Burckhardt RM, DeAngelis KM, Dunne JP, Frey SD, Friedlingstein P, Hawkes CV, Hungate BA, Khurana S, Kivlin SN, Levine NM, Manzoni S, Martiny AC, Martiny JBH, Nguyen NK, Rawat M, Talmy D, Todd-Brown K, Vogt M, Wieder WR, Zakem EJ. Priorities, opportunities, and challenges for integrating microorganisms into Earth system models for climate change prediction. mBio 2024; 15:e0045524. [PMID: 38526088 PMCID: PMC11078004 DOI: 10.1128/mbio.00455-24] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Climate change jeopardizes human health, global biodiversity, and sustainability of the biosphere. To make reliable predictions about climate change, scientists use Earth system models (ESMs) that integrate physical, chemical, and biological processes occurring on land, the oceans, and the atmosphere. Although critical for catalyzing coupled biogeochemical processes, microorganisms have traditionally been left out of ESMs. Here, we generate a "top 10" list of priorities, opportunities, and challenges for the explicit integration of microorganisms into ESMs. We discuss the need for coarse-graining microbial information into functionally relevant categories, as well as the capacity for microorganisms to rapidly evolve in response to climate-change drivers. Microbiologists are uniquely positioned to collect novel and valuable information necessary for next-generation ESMs, but this requires data harmonization and transdisciplinary collaboration to effectively guide adaptation strategies and mitigation policy.
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Affiliation(s)
- J. T. Lennon
- Department of Biology, Indiana University, Bloomington, Indiana, USA
| | - R. Z. Abramoff
- Lawrence Berkeley National Laboratory, Berkeley, California, USA
- Ronin Institute, Montclair, New Jersey, USA
| | - S. D. Allison
- Department of Ecology and Evolutionary Biology, University of California Irvine, Irvine, California, USA
- Department of Earth System Science, University of California Irvine, Irvine, California, USA
| | | | - K. M. DeAngelis
- Department of Microbiology, University of Massachusetts, Amherst, Massachusetts, USA
| | - J. P. Dunne
- NOAA/OAR Geophysical Fluid Dynamics Laboratory, Princeton, New Jersey, USA
| | - S. D. Frey
- Department of Natural Resources and the Environment, University of New Hampshire, Durham, New Hampshire, USA
| | - P. Friedlingstein
- College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter, United Kingdom
| | - C. V. Hawkes
- Department of Plant and Microbial Biology, North Carolina State University, Raleigh, North Carolina, USA
| | - B. A. Hungate
- Department of Biological Sciences, Center for Ecosystem Science, Northern Arizona University, Flagstaff, Arizona, USA
| | - S. Khurana
- Department of Physical Geography, Bolin Centre for Climate Research, Stockholm University, Stockholm, Sweden
| | - S. N. Kivlin
- Department of Ecology and Evolutionary Biology, University of Tennessee, Knoxville, Tennessee, USA
| | - N. M. Levine
- Department of Biological Sciences, University of Southern California, Los Angeles, California, USA
| | - S. Manzoni
- Department of Physical Geography, Bolin Centre for Climate Research, Stockholm University, Stockholm, Sweden
| | - A. C. Martiny
- Department of Ecology and Evolutionary Biology, University of California Irvine, Irvine, California, USA
| | - J. B. H. Martiny
- Department of Ecology and Evolutionary Biology, University of California Irvine, Irvine, California, USA
| | - N. K. Nguyen
- American Society for Microbiology, Washington, DC, USA
| | - M. Rawat
- National Science Foundation, Washington, DC, USA
| | - D. Talmy
- Department of Microbiology, University of Tennessee, Knoxville, Tennessee, USA
| | - K. Todd-Brown
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
| | - M. Vogt
- Institute for Biogeochemistry and Pollutant Dynamics, ETH Zürich, Zürich, Switzerland
| | - W. R. Wieder
- National Center for Atmospheric Research, Boulder, Colorado, USA
- Institute of Arctic and Alpine Research, University of Colorado, Boulder, Colorado, USA
| | - E. J. Zakem
- Department of Global Ecology, Carnegie Institution for Science, Stanford, California, USA
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Garg K, Bhandari RK, Shafiq N, Jain S, Jaswal S, Chawla D, Mallayasamy S, Khurana S, Batcha JSD. Population pharmacokinetics of ciprofloxacin in newborns with early onset neonatal sepsis and suspected meningitis. Pediatr Res 2024; 95:1273-1278. [PMID: 38062257 DOI: 10.1038/s41390-023-02941-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 10/20/2023] [Accepted: 11/14/2023] [Indexed: 04/24/2024]
Abstract
BACKGROUND Neonatal Sepsis accounts for significant proportion of neonatal mortality globally. Ciprofloxacin can be used as an effective antimicrobial against common causative agents of neonatal sepsis. However, there is only limited information about its pharmacokinetic distribution in plasma and Cerebrospinal fluid (CSF) of neonates. METHODS Plasma and CSF samples were taken using a sparse sampling technique from neonates who received at least one dose of intravenous ciprofloxacin. Ciprofloxacin levels were analysed using high-performance liquid chromatography (HPLC). Population pharmacokinetic analysis was conducted using a non-linear mixed-effects modelling using Pumas® (Pharmaceutical Modelling and Simulation) package (Version 2.0). RESULTS 53 neonates were enroled in the study of whom; 9 (17%) had meningitis. The median concentration of ciprofloxacin in CSF was 1.4 (0.94-2.06) ug/ml and plasma was 2.94 (1.8-5.0) ug/ml. A one-compartment model with first-order elimination fitted the data. Body weight was found to be a significant covariate on volume of distribution (Vd). Simulations based on the final model suggest that dose of 10 mg/kg, intravenous b.d may not be able to achieve the desirable indices. CONCLUSIONS One compartment model with weight as a covariate explained the available data. Further studies with modified sampling strategy, larger sample size and variable dose levels are needed.
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Affiliation(s)
- Kunal Garg
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Ritika Kondel Bhandari
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suksham Jain
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Shivani Jaswal
- Department of Biochemistry, Government Medical College and Hospital, Chandigarh, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Surulivelrajan Mallayasamy
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Supreet Khurana
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India.
| | - Jaya Shree Dilli Batcha
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Jain S, Bansal A, Khurana S, Chawla D. Quality improvement initiative for a sustained increase in human milk donation during the hospital stay. BMJ Open Qual 2023; 12:e002133. [PMID: 37863506 PMCID: PMC10603414 DOI: 10.1136/bmjoq-2022-002133] [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] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/05/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The demand for donors' human milk is much more than the availability of the same due to the myriad challenges faced during the collection process. METHODS Baseline milk volume donation done in a human milk bank facility located in tertiary care government institute in a low-middle income country was assessed. It was initially aimed to increase the absolute quantity of milk volume donation by 30% over a period of 6 months, which was subsequently continued following COVID-19 emergence (over another 12 months) along with a particular emphasis on the sustenance of milk donation activities. INTERVENTIONS Counselling of both the healthcare workers and stakeholders, standardising the timing of milk donation and other policies, equipment in proportion to demand and supply and addition of human resource were done as a multiprong approach to have sustained increase in human milk donation. RESULTS The median control line (MCL) showed a shift of 27.8%; from a baseline of 5032 mL to 6971 mL during intervention phase I comprising of five plan do study act cycles spread over a period of 6 months. During the sustenance phase I even though the monthly collection was non-uniform, there was a further 16% upward shift in MCL to 8122 mL. During the second intervention phase, each component of the Ishikawa diagram was worked on (people, policy, place, procedure) resulting in a more than 100% increase from sustenance phase I taking the MCL to 17 181 mL with an overall increase of 3.41 times from the baseline. CONCLUSION Dedicated counselling and constant motivation have been conventionally considered as the utmost measure to increase milk volume donation in milk bank. Our study highlights the need to introduce scheduled timings along with sufficient equipment and manpower to overcome the shortage of milk donation in human milk bank facilities.
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Singh K, Chawla D, Jain S, Khurana S, Takkar N. Immediate skin-to-skin contact versus care under radiant warmer at birth in moderate to late preterm neonates - A randomized controlled trial. Resuscitation 2023; 189:109840. [PMID: 37196802 DOI: 10.1016/j.resuscitation.2023.109840] [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] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To compare the effect of immediate care at birth in skin-to-skin contact (SSC) or under a radiant warmer on cardiorespiratory stability at 60 minutes of age in moderate-to-late preterm neonates. METHODS In this open-label, parallel-group, randomized controlled trial, neonates born at 330/7 to 366/7 weeks of gestation by vaginal delivery and breathing or crying were randomized to receive care at birth in SSC (n = 50) or under a radiant warmer (n = 50). In the SSC group, immediate care at birth including drying and clearing of the airway was provided in SSC over the mother's abdomen. SSC was maintained for an observational period of 60 minutes after birth. In the radiant warmer group, care at birth and post-birth observation was performed under an overhead radiant warmer. The primary outcome of the study was the stability of the cardio-respiratory system in late preterm infants (SCRIP) score at 60 minutes of age. RESULTS Baseline variables were similar in the two study groups. The SCRIP score at 60 minutes of age was similar in the two study groups (median: 5.0, IQR: 5-6 vs. 5.0, 5-6). The mean axillary temperature at 60 minutes of age was significantly lower in the SSC group (°C; 36.4 ± 0.4 vs. 36.6 ± 0.4, P = 0.004). CONCLUSION It was feasible to provide immediate care at birth in moderate and late preterm neonates while being positioned in SSC with the mother. However, in comparison to care under a radiant warmer, this did not lead to better cardiorespiratory stability at 60 minutes of age. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI/2021/09/036730).
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Affiliation(s)
- Kuldeep Singh
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India.
| | - Suksham Jain
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Supreet Khurana
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Navneet Takkar
- Department of Obstetrics & Gynecology, Government Medical College Hospital, Chandigarh, India
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Verma S, Chitikela S, Singh V, Khurana S, Pushpam D, Jain D, Kumar S, Gupta Y, Malik PS. A phase II study of metformin plus pemetrexed and carboplatin in patients with non-squamous non-small cell lung cancer (METALUNG). Med Oncol 2023; 40:192. [PMID: 37261532 DOI: 10.1007/s12032-023-02057-y] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
Immune checkpoint inhibitors (ICIs) ± chemotherapy is the standard treatment for driver mutation-negative non-small cell lung cancer (NSCLC). However, accessibility to ICIs in LMICs is limited due to high cost, and platinum-based chemotherapy remains the mainstay of treatment. Metformin has anticancer properties, and studies suggest synergism between metformin and pemetrexed. Based on preclinical evidence, this combination may be more beneficial for STK11-mutated NSCLC, a subgroup, inherently resistant to ICIs. In this Simon two-stage, single-arm phase 2 trial, we investigated metformin with pemetrexed-carboplatin (PC) in patients with treatment-naive stage IV non-squamous NSCLC. The primary outcome was 6-month progression-free survival (PFS) rate. Secondary outcomes were safety, overall survival (OS), overall response rate (ORR), proportion of STK11 mutation, and effect of STK11 mutation on 6-month PFS rate. The study was terminated for futility after interim analysis. The median follow-up was 34.1 months. The 6-month PFS rate was 28% (95% CI 12.4-0.46). The median PFS and OS were 4.5 (95% CI 2.2-6.1) and 7.4 months (95% CI 5.3-15.3), respectively. The ORR was 72%. Gastrointestinal toxicities were the most common. No grade 4/5 toxicities were reported. Targeted sequencing was possible in nine cases. Two patients had STK11 mutation and a poor outcome (PFS < 12 weeks). We could not demonstrate the benefit of metformin with CP in terms of improvement in 6-month PFS rate; however, the combination was safe (CTRI/2019/02/017815).
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Affiliation(s)
- S Verma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S Chitikela
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - V Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S Khurana
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - D Pushpam
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - D Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Y Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - P S Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India.
- Department of Medical Oncology, Dr.B.R.A.I.R.C.H., All India Institute of Medical Sciences, Room 245, New Delhi, India.
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Khurana S. Surfactant administration during endotracheal CPAP- Is DD-Surf comparable to LISA? Acta Paediatr 2023. [PMID: 37163241 DOI: 10.1111/apa.16834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 05/11/2023]
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Tansir G, Khurana S, Malik P, Pramanik R, Kumar L, Bhatla N. 20P A single-center retrospective analysis of clinical patterns, management and survival outcomes of malignant ovarian germ cell tumors. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101041] [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: 04/05/2023] Open
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Gahan AK, Jain S, Khurana S, Chawla D. Closed versus open endotracheal tube suction in mechanically ventilated neonates: a randomized controlled trial. Eur J Pediatr 2023; 182:785-793. [PMID: 36477637 DOI: 10.1007/s00431-022-04726-y] [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: 07/15/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Abstract
UNLABELLED This study aimed to evaluate the effect of closed versus open endotracheal tube suction in reducing ventilator-associated pneumonia in mechanically ventilated neonates. In this open-label, parallel-group, randomized controlled trial with allocation concealment, ventilated neonates (≥ 28 weeks and ≥ 800 g) were either allocated to the closed-suction group (n = 41) or open-suction group (n = 39). The ventilator circuit of the babies enrolled in the closed-suction group was attached to the closed-suction catheter on the requirement of their first suction, and it was changed after every 48 h or earlier if visibly soiled whereas babies enrolled in the open-suction group were suctioned with a new suction catheter each time they require suction. The primary outcome was the incidence of VAP per 1000 days. Baseline maternal and neonatal characteristics were comparable between the two groups. The proportion of neonates with VAP in the closed-suction group was 3 (7.3%) and 1 (2.6%) in the open-suction group with an RR of 2.8 (95% CI: 0.30-26.28) and a p-value of 0.35. The incidence of VAP in the closed-suction group was 3.9 per 1000 ventilator days and 1.3 per 1000 ventilator days in the open-suction group. The incidence of clinical VAP/1000 ventilator days was 33.63 ± 22.96 in the closed-suction group and 28.67 ± 12.32 in the open-suction group with a mean difference of 5 (95% CI: - 3.26 to 13.26) and p-value of 0.24. CONCLUSION In a unit with a low incidence of VAP, the effect of the endotracheal suction method alone did not impact the occurrence of VAP in the study population. CLINICAL TRIAL REGISTRATION CTRI/2020/03/023679; Date: 17.02.2020. WHAT IS KNOWN • Better physiological stability of the closed-suctioning method on short-term measures including noticeably fewer episodes of hypoxia, a smaller drop in TcPO2 levels, and less variability in heart rate and bradycardia episodes. WHAT IS NEW • In a unit with a low incidence of VAP in the neonates, randomized control trial studying the effect of the endotracheal suction method alone did not impact the occurrence of VAP amongst the study population.
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Affiliation(s)
- Ajaya Kumar Gahan
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Suksham Jain
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India.
| | - Supreet Khurana
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
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Soni V, Jain S, Chawla D, Khurana S, Rani S. Supplementation of mother's own milk with term versus preterm donor human milk: a randomized controlled trial. Eur J Pediatr 2023; 182:709-718. [PMID: 36446888 PMCID: PMC9708515 DOI: 10.1007/s00431-022-04711-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022]
Abstract
The purpose of this is to evaluate the effect of supplementation of enteral feed volume with preterm versus term donor human milk (DHM) on short-term physical growth in very low birth weight (VLBW) neonates. In this open-label, variable block-sized, superiority, randomized controlled trial with allocation concealment, VLBW neonates with insufficient volume of mother's own milk (MOM) were assigned to receive either preterm (n = 48) or term (n = 54) DHM till discharge. Preterm DHM was defined as the breast milk expressed within 28 days of delivery at ≤ 34 weeks of gestation. The primary outcome was days to regain birth weight. Maternal and neonatal demographic variables were comparable in the two study groups. Days to regain birth weight were significantly more in the preterm DHM group, 17.4 (7.7) vs 13.6 (7.2) days, mean difference (95% CI) being 3.74 (0.48-7.0) days, P = 0.02). The proportion of MOM use was 82% in preterm vs 91.1%, P = 0.03 in the term milk group. Duration of skin-to-skin contact was also significantly lower in the preterm vs term milk group, the median (IQR) was 4 (0, 6) vs 4 (2, 6) hours/day, P < 0.01. However, bronchopulmonary dysplasia was higher in the preterm milk group (13% vs. 4%, P = 0.17). The velocity of gain in weight was similar in the two groups from week 1-3 but higher in the term DHM supplementation group during the 4th week. Conclusion: Supplementing MOM with preterm DHM did not result in a faster regaining of birth weight. Trial registration: CTRI/2020/02/023569; Date: 17.02.2020.
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Affiliation(s)
- Vimlesh Soni
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Suksham Jain
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India.
| | - Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Supreet Khurana
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Shikha Rani
- Department of Obstetrics and Gynecology, Government Medical College Hospital, Chandigarh, India
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Singh H, Sikarwar P, Khurana S, Sharma J. Assessing the Incidence of New-onset Diabetes Mellitus with Statin Use: A Systematic Review of the Systematic Reviews and Meta-analyses. touchREV Endocrinol 2022; 18:96-101. [PMID: 36694884 PMCID: PMC9835812 DOI: 10.17925/ee.2022.18.2.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
Statin use has been linked with new-onset diabetes mellitus (NODM). In the present systematic review, we aimed to determine the incidence of NODM with statin use by assessing and summarizing the data generated by different systematic reviews and metaanalyses published on this topic. We conducted a systematic review of systematic reviews and meta-analyses using a pre-defined study protocol. Two authors independently performed a literature search using PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies reporting data on statin use and NODM incidence and screened and extracted data for the outcomes of interest. The Assessing the Methodological Auality of Systematic Reviews 2 (AMSTAR 2) checklist was used to evaluate the quality of the included systematic reviews and meta-analyses. The initial search yielded 621 potential records, and 16 relevant systematic reviews and meta-analyses were included in the present systematic review. The included studies showed an increase in the risk of NODM with statin use. In particular, rosuvastatin and atorvastatin were associated with NODM in many systematic reviews or meta-analyses; however, pravastatin and pitavastatin were found to be associated with lower or no risk. We observed a positive trend of development of NODM with statin use became more evident with advancing years as more number of studies were added. Intensive doses of statins and use in older subjects were found to be important risk factors for NODM. Finally, the quality assessment revealed that the included systematic reviews and metaanalyses were of critically low or low quality. We concluded that statin use carries a risk of causing NODM. Statins should not be discouraged in anticipation of NODM. However, glycaemic monitoring should be encouraged with the on-going statin therapy. Furthermore, clinical studies addressing the use of statins and the incidence of NODM as their primary objective should be planned.
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Affiliation(s)
- Harmanjit Singh
- These authors have contributed equally to this work and share first authorship.,Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
| | - Pallavi Sikarwar
- These authors have contributed equally to this work and share first authorship.,MBBS Student, Government Medical College and Hospital, Chandigarh, India
| | - Supreet Khurana
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Jatin Sharma
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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Nambirajan A, Jangra K, Khurana S, Malik P, Mohan A, Jain D. EP03.01-005 Clinicopathological Features of ROS1-rearranged Adenocarcinomas: A Single Institutional Experience Spanning Four Years From India. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.400] [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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Rathor A, Malik P, Tanwar P, Khurana S, Kumar S, Mohan A, Nambirajan A, Jain D. EP11.01-011 Clinical Application of Liquid Biopsy for Assessing Early EGFR Mutation Detection in Non-Small Cell Lung Carcinoma. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.908] [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: 10/14/2022]
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Verma S, Malik P, Kalra K, Singh V, Kumar S, Khurana S, Pushpam D, Jain D, Gupta Y. P2.02-03 A Phase II Study of Metformin with Pemetrexed/Carboplatin in Patients with Metastatic Non-Squamous Non-Small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.218] [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: 10/14/2022]
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Raju R, Khurana S, Mahadevan A, John DV. Central nervous system infections caused by pathogenic free-living amoebae: An Indian perspective. Trop Biomed 2022; 39:265-280. [PMID: 35838101 DOI: 10.47665/tb.39.2.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pathogenic free-living amoebae (FLA), namely Acanthamoeba sp., Naegleria fowleri and Balamuthia mandrillaris are distributed worldwide. These neurotropic amoebae can cause fatal central nervous system (CNS) infections in humans. This review deals with the demographic characteristics, symptoms, diagnosis, and treatment outcomes of patients with CNS infections caused by FLA documented in India. There have been 42, 25, and 4 case reports of Acanthamoeba granulomatous amoebic encephalitis (GAE), N. fowleri primary amoebic meningoencephalitis (PAM), and B. mandrillaris meningoencephalitis (BAE), respectively. Overall, 17% of Acanthamoeba GAE patients and one of the four BAE patients had some form of immunosuppression, and more than half of the N. fowleri PAM cases had history of exposure to freshwater. Acanthamoeba GAE, PAM, and BAE were most commonly seen in males. Fever, headache, vomiting, seizures, and altered sensorium appear to be common symptoms in these patients. Some patients showed multiple lesions with edema, exudates or hydrocephalus in their brain CT/MRI. The cerebrospinal fluid (CSF) of these patients showed elevated protein and WBC levels. Direct microscopy of CSF was positive for amoebic trophozoites in 69% of Acanthamoeba GAE and 96% of PAM patients. One-fourth of the Acanthamoeba GAE and all the BAE patients were diagnosed only by histopathology following autopsy/biopsy samples. Twenty-one Acanthamoeba GAE survivors were treated with cotrimoxazole, rifampicin, and ketoconazole/amphotericin B, and all eleven PAM survivors were treated with amphotericin B alongside other drugs. A thorough search for these organisms in CNS samples is necessary to develop optimum treatment strategies.
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Affiliation(s)
- R Raju
- KIDWAI Memorial Institute of Oncology Research & Training Centre, Bangalore, India
| | - S Khurana
- Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - D V John
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Abstract
BACKGROUND Neonatal sepsis is a major contributor to neonatal mortality in India. Blood culture, the gold standard for the diagnosis of sepsis takes 48-72 h while the serological markers have suboptimal diagnostic test characteristics. Perfusion index (PI) is a real time, non-invasive marker that can detect microcirculatory changes before other clinical manifestation of sepsis. OBJECTIVE To determine the diagnostic accuracy of PI in detecting hospital-acquired sepsis before overt clinical manifestations. STUDY DESIGN A prospective observational study conducted in the Neonatal Intensive Care Unit (NICU) of a tertiary care hospital. PARTICIPANTS Preterm neonates admitted to NICU. METHODS PI was continuously monitored in all enrolled neonates. Clinical sepsis was defined using the NeonatalKrankenhaus-Infektions-Surveillance-System (NeoKISS). The time of fall of PI below 0.88 and time of clinical sepsis as per NeoKISS were noted and the difference was calculated. RESULTS Among 65 preterm neonates (gestational age: 31.5 ± 2.6 weeks, birth weight: 1350, IQR 1100-1700 g), a total of 86 events of suspected sepsis were noted, of which 69 were sepsis screen positive. Fifteen events were associated with culture positive sepsis. PI yielded a sensitivity of 89.47% (95% CI 78.48-96.04%), specificity of 56% (95% CI 34.93-75.60%), positive predictive value of 82.26% (95% CI 74.70-87.92%) and negative predictive value of 70% (95% CI 50.36-84.29%) in detection of hospital-acquired sepsis. CONCLUSION PI might serve as an early, non-invasive marker of hospital-acquired sepsis in preterm neonates.
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Affiliation(s)
- Jasmine Singh
- Department of Pediatrics, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Suksham Jain
- Department of Neonatology, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Shivani Randev
- Department of Pediatrics, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Supreet Khurana
- Department of Neonatology, Government Medical College and Hospital, Sector 32, Chandigarh, India
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Khurana S. Obituary: Dr. Ramesh Chander Mahajan. Trop Parasitol 2022. [DOI: 10.4103/tp.tp_10_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Khurana S, Chawla D, Jain S. Questions about the HELIX trial. The Lancet Global Health 2021; 9:e1650. [DOI: 10.1016/s2214-109x(21)00495-2] [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] [Received: 08/24/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
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18
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Sharma VK, Khurana S, Kaur S, Ram J. Arcus lipoides juvenilis: a presenting sign of dyslipidaemia. QJM 2021; 114:333-334. [PMID: 32770245 DOI: 10.1093/qjmed/hcaa236] [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] [Received: 07/24/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- V K Sharma
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - S Khurana
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - S Kaur
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - J Ram
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Mittal A, Malik PS, Kumar S, Saikia J, Chitikela S, Khurana S, Bharti S, Jain D, Pathy S, Thulkar S, Kumar R, Madan K, Mohan A. Dose-dense Paclitaxel and Carboplatin as Neoadjuvant Chemotherapy for Stage IIB/IIIA Non-small Cell Lung Cancer - A Phase II trial. Clin Oncol (R Coll Radiol) 2021; 33:e553-e560. [PMID: 34340919 DOI: 10.1016/j.clon.2021.07.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/02/2021] [Accepted: 07/14/2021] [Indexed: 12/25/2022]
Abstract
AIMS The approach to potentially resectable non-small cell lung cancer (NSCLC) remains controversial. There is a benefit of neoadjuvant chemotherapy (NACT), but the ideal regimen is unknown. We evaluated the efficacy and safety of dose-dense NACT in potentially resectable NSCLC in this phase II trial. MATERIALS AND METHODS Paclitaxel at 80 mg/m2 on days 1, 8 and 15 with AUC-6 carboplatin on day 1, 3 weekly for four cycles was evaluated as NACT. Patients with Eastern Cooperative Oncology Group performance status 0-2, stage IIB and IIIA (with only non-bulky N2 nodes) were included. The primary end point was the objective response rate. Secondary end points included toxicity, progression-free survival, recurrence-free survival, complete resection rate and overall survival. The relative dose intensity (RDI) was calculated to define tolerability (CTRI/2016/05/006916). RESULTS In total, 37 patients were enrolled (median age 55 years). Most (78.8%) were smokers. Most patients had adenocarcinoma (57.6%) and stage IIIA disease (81.0%) according to the seventh American Joint Committee on Cancer staging system. Seventy-eight per cent of patients completed four cycles. The objective response rate was 75.6% with a complete response in 10.8%. The mean RDI of paclitaxel was 88.61%, with 68.0% of patients able to maintain an RDI ≥85.0%. In total, 187 toxicity events were recorded (120 grade 1, 64 grade 2 and three grade 3 events). Common toxicities were peripheral neuropathy (20.3%), myalgia (19.8%), nausea (15.7%) and neutropenia (10.2%). There were no treatment-related deaths. Seventeen patients underwent surgery (lobectomy 82.4%). After a median follow-up of 47 months (95% confidence interval 27-50.7 months), the median progression-free survival was 9.6 months (7.4-17.4) and overall survival was 29.2 months (16.0-37.2). CONCLUSION Dose-dense paclitaxel-carboplatin is feasible, safe and efficacious and should be evaluated further in potentially resectable NSCLC.
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Affiliation(s)
- A Mittal
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - P S Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - S Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - J Saikia
- Department of Surgical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Chitikela
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Khurana
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Bharti
- Department of Oncoanaesthesia and Palliative Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - D Jain
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Pathy
- Department of Radiation Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Thulkar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - R Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - K Madan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A Mohan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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20
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Bampton TJ, Holmes-Walker DJ, Drogemuller CJ, Radford T, Anderson P, Etherton C, Russell CH, Khurana S, Torpy DJ, Couper JJ, Couper RLT, Macintyre P, Neo EL, Benitez-Aguirre P, Thomas G, Loudovaris T, Thomas HE, Palmer LJ, Wu D, Rogers NM, Williams L, Hawthorne WJ, O'Connell PJ, Kay TW, Pleass H, Chen JW, Coates PT. Australian experience with total pancreatectomy with islet autotransplantation to treat chronic pancreatitis. ANZ J Surg 2021; 91:2663-2668. [PMID: 33956377 DOI: 10.1111/ans.16853] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND This study aimed to describe the clinical outcomes of total pancreatectomy with islet autotransplantation (TP-IAT) in Australia. METHODS Individuals selected for TP-IAT surgery according to the Minnesota Criteria (Appendix) without evidence of diabetes were evaluated including time to transplantation from pancreatectomy, islet numbers infused and post-transplantation HbA1c, C-peptide, total daily insulin and analgesic requirement. RESULTS Sixteen individuals underwent TP-IAT from Australia and New Zealand between 2010 and 2020. Two recipients are deceased. The median islet equivalents/kg infused was 4244 (interquartile range (IQR) 2290-7300). The median C-peptide 1 month post-TP-IAT was 384 (IQR 210-579) pmol/L and at median 29.5 (IQR 14.5-46.5) months from transplant was 395 (IQR 139-862) pmol/L. Insulin independence was achieved in eight of 15 (53.3%) surviving recipients. A higher islet equivalents transplanted was most strongly associated with the likelihood of insulin independence (P < 0.05). Of the 15 surviving recipients, 14 demonstrated substantial reduction in analgesic requirement. CONCLUSION The TP-IAT programme in Australia has been a successful new therapy for the management of individuals with chronic pancreatitis including hereditary forms refractory to medical treatment to improve pain management with 50% insulin independence rates.
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Affiliation(s)
- Tristan J Bampton
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - D Jane Holmes-Walker
- Department of Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Chris J Drogemuller
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Toni Radford
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Patricia Anderson
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - C Etherton
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - C H Russell
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - S Khurana
- Department of Gastroenterology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - David J Torpy
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - J J Couper
- Department of Gastroenterology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - R L T Couper
- Department of Gastroenterology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Pamela Macintyre
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - E L Neo
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Paul Benitez-Aguirre
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - G Thomas
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Children's Hospital, Sydney, New South Wales, Australia
| | - T Loudovaris
- Islet biology, St Vincent's Institute, Melbourne, Victoria, Australia
| | - H E Thomas
- Islet biology, St Vincent's Institute, Melbourne, Victoria, Australia
| | - Lyle J Palmer
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Denghao Wu
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Natasha M Rogers
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - L Williams
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - W J Hawthorne
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - P J O'Connell
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Tom W Kay
- Islet biology, St Vincent's Institute, Melbourne, Victoria, Australia
| | - Henry Pleass
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - John W Chen
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Gastroenterology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - P Toby Coates
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Khurana S, Roy S, Gupta M. Who manages health workforce in the States of India: Profile, knowledge and perceptions of the team. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Problem
Human resources in the public health sector is of prime importance in a limited resource setting country, who at times work in a high-pressure, limited resource environment and where skilled staff continue to remain in short supply. The role of Human Resource for Health (HRH) team responsible for managing this health workforce is crucial. They play an important role in improving the human resource practices and creating an enabling organizational culture for optimal resource utilization. The paper explores the profile of the HRH teams of the states of India, their knowledge levels, and perceptions of their role.
Methods
The participants were HR Managers from 29 states of India who look after HRH in National Health Mission and State Health Departments. Cross-sectional survey tool was used for data collection. Quantitative data analysis included univariate and bivariate analysis. One Way ANOVA test of significance and post-hoc tests using Tukey's method was used to ascertain the groups with significant difference.
Results
Most of the HRH team members are postgraduates or have management background. Their experience varies from <1year to > 25 years. Mostly of them perceive their role to be limited to implementing bare essential HRM practices, mostly administrative. The educational qualification of the members did not have any significant bearing on their technical knowledge related to HRM practices; but their experience in public health sector showed a significant association.
Lessons
This study lends evidence to the principle that professionals who have been in the system for long, know about HRH and the associated policies better, and hence may be better equipped to handle HRH and establish good HR Management (HRM) systems. Better role clarity among the HRH teams, expansion of their current scope of work to include advanced practices of HRM and continuous capacity building mechanisms are needed to help strengthen the development and management of HRH.
Key messages
This study, a first of its kind in the country, lend evidence related to the principle for deciding the profile of team who should be entrusted with managing and development of HRH. The Study gives evidence to focus on the role clarity of HRH to zero down their knowledge and skills gaps and enhance their competencies through better capacity building.
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Affiliation(s)
- S Khurana
- Human Resource for Health Division, National Health Systems Resource Centre, New Delhi, India
| | - S Roy
- Human Resource for Health Division, National Health Systems Resource Centre, New Delhi, India
| | - M Gupta
- Human Resource for Health Division, National Health Systems Resource Centre, New Delhi, India
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22
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Purkayastha S, Cheng J, Chang M, Wang R, Soulen M, Stavropoulos S, Khurana S, Silva A, McGirr A, Bai H. 3:18 PM Abstract No. 266 Differentiation of low- and high-grade renal cell carcinoma using magnetic resonance–based radiomics. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.314] [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] Open
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23
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Rauschert L, Purkayastha S, Zhao Y, Xi I, Wang R, Khurana S, McGirr A, Soulen M, Zhang Z, Silva A, Stavropoulos S, Ahn S, Bai H. 3:18 PM Abstract No. 292 Differentiation of malignant and benign renal tumors using magnetic resonance–based radiomics. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.343] [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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24
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Khurana S, Dadwal R, Sharma N, Mewara A, Singh S, Bagga R, Yadav R, Sethi S. Loop mediated isothermal amplification assay for detection of Trichomonas vaginalis in vaginal swabs among symptomatic women from North India. Lett Appl Microbiol 2020; 70:196-202. [PMID: 31808556 DOI: 10.1111/lam.13260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 11/30/2022]
Abstract
Trichomonas vaginalis is one of the most common curable sexually transmitted pathogens infecting both men and women worldwide. Unlike traditional methods such as microscopy and culture, nucleic acid amplification tests rapidly detect this agent, assisting in treatment. Conventional polymerase chain reaction (PCR), the loop-mediated isothermal amplification (LAMP), and the Xpert TV assay were evaluated using 28 microscopy positive T. vaginalis samples and 125 microscopy negative samples from symptomatic females of reproductive age. The sensitivity of all tests was 100% and the specificity was 100%, 100%, and 99·2% for PCR, Xpert TV, and LAMP, respectively. The inter-rater reliability was excellent for PCR: Xpert TV (kappa-coefficient = 1) and good for LAMP assay: Xpert TV/PCR (kappa-coefficient = 0·98) and conventional PCR: LAMP (kappa-coefficient = 0·98). The study highlights the importance of PCR for screening T. vaginalis in women, particularly in laboratories where the Xpert-TV assay is not available or not affordable. The LAMP assay showed a lower positive predictive value which merits further evaluation. SIGNIFICANCE AND IMPACT OF THE STUDY: Trichomonas vaginalis is a common sexually transmitted pathogen associated with considerable morbidity and risk of complications. Due to the limitations of traditional diagnostic modalities, three molecular assays were compared: conventional polymerase chain reaction (PCR), Xpert TV assay, and loop mediated isothermal amplification (LAMP) assay for detecting T. vaginalis in symptomatic females. All tests had a sensitivity of 100% and the inter-rater reliability was excellent for PCR: Xpert TV, and good for LAMP assay: Xpert TV/PCR. The translational impact of this study lies in the possible use of conventional PCR and LAMP in laboratories where the Xpert TV assay is not available or not affordable.
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Affiliation(s)
- S Khurana
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Dadwal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - N Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Mewara
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Singh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Bagga
- Department of Gynecology and Obstetrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Yadav
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Sethi
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Khurana S, Gupta PC, Balamurugan R, Sharma VK, Ram J. Crystalline cataract in diabetes. QJM 2020; 113:57. [PMID: 31086962 DOI: 10.1093/qjmed/hcz111] [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: 11/15/2022] Open
Affiliation(s)
- S Khurana
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P C Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Balamurugan
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V K Sharma
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - J Ram
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Khurana S, Waidha K, Guleria R, Sharda S, Bose S. Regulation of circulating micro-RNAs and their targets in obstructive sleep apnea. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.534] [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: 10/25/2022]
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Varshney A, Vanidassane I, Ramavth D, Malik P, Khurana S, Garg V, Vadlamani S, Kalra K, Gunasekar S, Kumar S, Sethi S, Yadav M, Pathy S, Jain D. Chemotherapy in advanced thymic malignancies. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz436.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Khurana S, Bansal A, Saini SS, Mishra A, Kumar P. Severe Pulmonary Arteriopathy in a Neonate with Congenital Rubella Syndrome and Patent Ductus Arteriosus. Indian Pediatr 2019; 56:868-872. [PMID: 31724543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Neonates with congenital rubella syndrome (CRS) are known to have associated congenital cardiac malformations. Patent ductus arteriosus (PDA) is one the most common cardiac anomalies associated with CRS. PDA refractory to medical management and associated with ventilatory dependence is considered for surgical ligation. However, the management of PDA can be challenging in the presence of underlying lung disease or pulmonary vascular disease. Outcomes after closure in neonates are dependent upon age, weight, nutritional status, pre-operative pulmonary arterial hypertension and presence of chronic lung disease. We present a neonate with CRS who required surgical PDA closure. The neonate developed severe pulmonary arterial hypertension which led to fatal outcome. The clinical course is corroborated with histo-pathological changes observed on the autopsy of this neonate.
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MESH Headings
- Cardiac Catheterization/methods
- Disease Progression
- Ductus Arteriosus, Patent/complications
- Ductus Arteriosus, Patent/diagnostic imaging
- Ductus Arteriosus, Patent/surgery
- Echocardiography/methods
- Erythrocyte Transfusion/methods
- Fatal Outcome
- Female
- Gestational Age
- Humans
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/diagnosis
- India
- Infant, Newborn
- Infant, Premature
- Ligation/methods
- Male
- Oxygen Inhalation Therapy/methods
- Persistent Fetal Circulation Syndrome/complications
- Persistent Fetal Circulation Syndrome/diagnosis
- Persistent Fetal Circulation Syndrome/therapy
- Pregnancy
- Radiography, Thoracic/methods
- Rubella Syndrome, Congenital/complications
- Rubella Syndrome, Congenital/diagnosis
- Rubella Syndrome, Congenital/therapy
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Affiliation(s)
- Supreet Khurana
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akriti Bansal
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shiv Sajan Saini
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Correspondence to: Dr Shiv Sajan Saini, Assistant Professor, Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Anand Mishra
- Department of Cardiothoracic Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Malik P, Yadav A, Jain D, Pathy S, Mohan A, Khurana S, Kumar S. P1.01-02 Pemetrexed-Carboplatin Versus Paclitaxel (Weekly)-Carboplatin as First Line Chemotherapy in Advanced Non-Squamous NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.717] [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]
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Singendonk M, Kritas S, Omari T, Feinle-Bisset C, Page AJ, Frisby CL, Kentish SJ, Ferris L, McCall L, Kow L, Chisholm J, Khurana S. Upper Gastrointestinal Function in Morbidly Obese Adolescents Before and 6 Months After Gastric Banding. Obes Surg 2019; 28:1277-1288. [PMID: 29103072 DOI: 10.1007/s11695-017-3000-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/14/2022]
Abstract
BACKGROUND The effects of laparoscopic adjustable gastric band (LAGB) placement on upper gastrointestinal tract function in obese adolescents are unknown. Therefore, our aim was to determine the short-term effects of LAGB on esophageal motility, gastroesophageal reflux, gastric emptying, appetite-regulatory hormones, and perceptions of post-prandial hunger and fullness. METHODS This study was part of a prospective cohort study (March 2009-December 2015) in one tertiary referral hospital. The study included obese adolescents (14-18 years) with a body mass index (BMI) > 40 (or ≥ 35 with comorbidities). Gastric emptying was assessed by 13C-octanoic acid breath test, pharyngeal, and esophageal motor function by high-resolution manometry with impedance (HRIM), and appetite and other perceptions using 100-mm visual analogue scales. Dysphagia symptoms were scored using a Dakkak questionnaire. Data were compared pre- and post-LAGB placement and at a 6-month follow-up. RESULTS Based upon analysis of 15 adolescents, at the 6-month follow-up, LAGB placement: (i) led to a significant reduction in weight and BMI; (ii) increased fullness and decreased hunger post-meal; (iii) increased symptoms of dysphagia after solid food; and, despite these effects, (iv) caused little or no changes to appetite hormones, while (v) effects on gastric emptying, esophageal motility, esophageal bolus transport, and esophageal emptying were not significant. CONCLUSION In adolescents, LAGB improved BMI and altered the sensitivity to nutrients without significant effects on upper gastrointestinal tract physiology at the 6-month follow-up.
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Affiliation(s)
- M Singendonk
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/AMC, Amsterdam, The Netherlands
| | - S Kritas
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
| | - T Omari
- Human Physiology, Medical Science and Technology, School of Medicine, Flinders University, Adelaide, South Australia, Australia.
| | - C Feinle-Bisset
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - A J Page
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - C L Frisby
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - S J Kentish
- Centre for Nutrition and Gastrointestinal Diseases, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - L Ferris
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia.,Human Physiology, Medical Science and Technology, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - L McCall
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
| | - L Kow
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - J Chisholm
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - S Khurana
- Paediatric Surgery & Urology, Women's & Children's Hospital, Adelaide, Australia.,Department of Surgery, Flinders Medical Centre, Adelaide, Australia
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Kancharla H, Malik P, Khurana S, Jain D, Kumar S, Pathy S. EP1.01-91 Outcomes with Systemic Chemotherapy with Weekly Regimen in Advanced NSCLC Patients with PS 2 and Above and Without Driver Mutation. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2064] [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]
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Gundu N, Malik P, Khurana S, Pathy S, Yadav M, Jain D, Kancharla H. Non-small cell lung carcinoma (NSCLC) patients with baseline brain imaging: A prospective observational study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz066.002] [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: 11/14/2022] Open
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Kancharla H, Malik P, Khurana S, Gundu N, Yadav A, Jain D, Pathy S, Kumar S. P3.01-51 Outcomes with Systemic Chemotherapy in Advanced NSCLC Patients with Performance Status 2 and Above and without Driver Mutation. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1611] [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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Khurana S, Saini SS, Sundaram V, Dutta S, Kumar P. Reducing Healthcare-associated Infections in Neonates by Standardizing and Improving Compliance to Aseptic Non-touch Techniques: A Quality Improvement Approach. Indian Pediatr 2018; 55:748-752. [PMID: 30345977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To standardize and improve compliance to Aseptic non-touch techniques (ANTT) for commonly performed procedures in Neonatal intensive care unit (NICU) through application of Model for improvement, and study its impact on Healthcare-associated infection (HCAI) rates. DESIGN Quality improvement project utilizing multiple Plan-Do-Study-Act (PDSA) cycles. SETTING Tertiary-care neonatal unit. PARTICIPANTS All resident doctors and nurses working in neonatal unit were subjects for assessment of compliance to ANTT. All admitted neonates staying in hospital for more than 48 hours were subjects for HCAI data collection. PROCEDURE Most frequently performed procedures in NICU were identified and pictorial Standard Operating Procedures (SOP) were developed. Implementation and uptake was reinforced by means of PDSA cycles. Compliance to ANTT was assessed as proportion of components to which adherence was documented. Trend of HCAI rates in unit were analyzed using process control charts. MAIN OUTCOME MEASURE Change in compliance to ANTT for most frequently performed procedures. RESULTS Significant improvement in compliance to ANTT practices was observed, specifically in use of procedure tray/trolley (16% to 49%, P=0.001), iv hub scrubbing (0% to 60%, P=0.001), local skin cleaning (33% to 67%, P=0.004), personal protective equipment use (55% to 80%, P=0.02) and disposal (27% to 51%, P=0.03), use of non-touch technique (50% to 70%, P=0.001) and reduction in key part contamination (45% to 31%, P=0.03). A modest decrease in HCAI rates was seen in the short period of observation after implementation. CONCLUSIONS Substantial improvements in compliance to aseptic non-touch techniques can be ensured by adopting a combination of initial intensive teaching and sustaining through multiple PDSA cycles, targeting specific areas revealed by audits.
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Affiliation(s)
- Supreet Khurana
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shiv Sajan Saini
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Venkataseshan Sundaram
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabh Dutta
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India Correspondence to: Dr Praveen Kumar, Professor, Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Khurana S, Shivakumar M, Sujith Kumar Reddy GV, Jayashree P, Ramesh Bhat Y, Lewis LES. Long-term neurodevelopment outcome of caffeine versus aminophylline therapy for apnea of prematurity. J Neonatal Perinatal Med 2018; 10:355-362. [PMID: 29286928 DOI: 10.3233/npm-16147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Methylxanthines are the most commonly prescribed drug in neonatal setups. However, Clinicians show indecision in choosing the right agent for Apnea of Prematurity in most of the developing countries. Present study aimed to compare rate of mortality and survival with normal neurodevelopment outcome at 18 to 24 months of corrected age, between Caffeine- and Aminophylline-treated infants for apnea of prematurity. METHODS 240 infants were randomly allocated to caffeine and aminophylline for apnea of prematurity during February 2012 to January 2015. Long-term neurodevelopmental assessment was done only from children who had attained corrected age of 18 to 24 months during April 2014 to February 2016. Cognitive, language and motor deficits were assessed by Bayley Scale of infant and toddler development (BSID - III). Postnatal characteristics such as hearing and visual impairments during NICU stay were noted and same were followed up. RESULTS Infants allocated to caffeine group showed 83% less risk of getting cognitive impairment (RR 0.16; CI 95% range 0.02 to 1.36), 50% less risk of developing motor deficits (RR 0.50; CI 95% range 0.12 to 1.95) and 24% less risk of developing language problems (RR 0.76; CI 95% range 0.36 to 1.58). However in all the neurodevelopment domains the difference between groups was not statistically significant. Risk of mortality in caffeine group was 9% less over aminophylline group which was statistically non-significant (RR - 0.92; CI 95% range - 0.45 to 1.84; p = 0.81). Physical growth parameters were found to be similar in both the groups. Risk of developing visual abnormality and hearing impairments was also statistically non-significant between the groups. CONCLUSION Caffeine and aminophylline showed similar effects in reducing the rate of mortality and improving the survival without neurodevelopment delays; though the clinical significance of caffeine over aminophylline cannot be undermined.
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Affiliation(s)
- S Khurana
- Department of Physiotherapy, School of Allied Health Sciences, Madhav Nagar, Manipal University, Manipal, Karnataka, India
| | - M Shivakumar
- Department of Pediatrics, Neonatology Unit, Kasturba Medical College, Madhav Nagar, Manipal University, Manipal, Karnataka, India
| | - G V Sujith Kumar Reddy
- Department of Pediatrics, Neonatology Unit, Kasturba Medical College, Madhav Nagar, Manipal University, Manipal, Karnataka, India
| | - P Jayashree
- Department of Physiotherapy, School of Allied Health Sciences, Madhav Nagar, Manipal University, Manipal, Karnataka, India
| | - Y Ramesh Bhat
- Department of Physiotherapy, School of Allied Health Sciences, Madhav Nagar, Manipal University, Manipal, Karnataka, India
| | - L E S Lewis
- Department of Pediatrics, Neonatology Unit, Kasturba Medical College, Madhav Nagar, Manipal University, Manipal, Karnataka, India
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Madsen PL, Joerg L, Khurana S, Wong W, De Pasquale C, Selvanayagam J. P1791The decreasing limb of frank and starlings law of the heart is associated with an increase in left ventricular end-diastolic volume. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P L Madsen
- Herlev Hospital - Copenhagen University Hospital, Dept. of Cardiology, Copenhagen, Denmark
| | - L Joerg
- Cantonal Hospital St. Gallen, Dept of Cardiology, St. Gallen, Switzerland
| | - S Khurana
- Flinders Medical Centre and Flinders University, Dept of Cardiology, Adelaide, Australia
| | - W Wong
- Flinders Medical Centre and Flinders University, Dept of Cardiology, Adelaide, Australia
| | - C De Pasquale
- Flinders Medical Centre and Flinders University, Dept of Cardiology, Adelaide, Australia
| | - J Selvanayagam
- Flinders Medical Centre and Flinders University, Dept of Cardiology, Adelaide, Australia
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Khurana S, Singh R. Workflow scheduling and reliability improvement by hybrid intelligence optimization approach with task ranking. ICST Transactions on Scalable Information Systems 2018. [DOI: 10.4108/eai.13-7-2018.161408] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Omari T, Connor F, McCall L, Ferris L, Ellison S, Hanson B, Abu-Assi R, Khurana S, Moore D. A study of dysphagia symptoms and esophageal body function in children undergoing anti-reflux surgery. United European Gastroenterol J 2018; 6:819-829. [PMID: 30023059 PMCID: PMC6047286 DOI: 10.1177/2050640618764936] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 11/27/2017] [Accepted: 02/22/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of high-resolution esophageal impedance manometry (HRIM) for establishing risk for dysphagia after anti-reflux surgery is unclear. We conducted a prospective study of children with primary gastroesophageal reflux (GER) disease, for whom symptoms of dysphagia were determined pre-operatively and then post-operatively and we examined for features that may predict post-operative dysphagia. METHODS Thirteen children (aged 6.8-15.5 years) undergoing work-up prior to 360o Nissen fundoplication were included in the study. A dysphagia score assessed symptoms at pre-operative study and post-operatively (mean 1.4 years). A HRIM procedure recorded 5-ml liquid, 5-ml viscous and 2-cm solid boluses. We assessed esophageal motility, esophago-gastric junction (EGJ) morphology, EGJ contractility and pressure-flow variables indicative of bolus distension pressures and bolus clearance pressures. A composite pressure-flow index score was also derived. RESULTS Pre-operative pressure-flow index was positively correlated with post-operative dysphagia score (viscous bolus r = 0.771, p < 0.005). Of three variables that comprise the pressure-flow index, the ramp pressure measured during bolus clearance was the main driver of the effect seen (viscous bolus r = 0.819, p < 0.005). CONCLUSIONS In order to mitigate symptoms in relation to anti-reflux surgery, dysphagia symptoms and esophageal function need to be pre-operatively assessed. In patients with normal motility, an elevated pressure-flow index may predict post-operative dysphagia.
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Affiliation(s)
- T Omari
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Centre for Neuroscience, Flinders University, Adelaide, Australia
| | - F Connor
- Department of Gastroenterology, Royal Children's Hospital, Brisbane, Australia
| | - L McCall
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
| | - L Ferris
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Centre for Neuroscience, Flinders University, Adelaide, Australia
| | - S Ellison
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
| | - B Hanson
- UCL Mechanical Engineering, University College London, London, UK
| | - R Abu-Assi
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
| | - S Khurana
- Paediatric Surgery & Urology, Women's & Children's Hospital, Adelaide, Australia
| | - D Moore
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
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Boukhvalova MS, Mbaye A, Kovtun S, Yim KC, Konstantinova T, Getachew T, Khurana S, Falsey AR, Blanco JCG. Improving ability of RSV microneutralization assay to detect G-specific and cross-reactive neutralizing antibodies through immortalized cell line selection. Vaccine 2018; 36:4657-4662. [PMID: 29960801 DOI: 10.1016/j.vaccine.2018.06.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/08/2018] [Accepted: 06/16/2018] [Indexed: 11/29/2022]
Abstract
Respiratory syncytial virus (RSV) is a significant cause of bronchiolitis and pneumonia. Protection against RSV is associated with neutralizing antibodies against the fusion (F) and attachment (G) glycoproteins. Several RSV vaccine candidates are in development, but their immunogenicity is hard to compare due to the little-understood differences between multiple RSV neutralizing antibody assays used. Existing assays utilize primarily Vero or HEp-2 cells, but their ability to detect G-neutralizing antibodies or antibodies against specific RSV strains is unclear. In this work, we developed an RSV microneutralization assay (MNA) using unmodified RSV and immortalized cell line derived from human airway epithelial cells (A549). Performance of A549-, HEp-2- and Vero-based MNA was compared under the same assay conditions (fixed amount of virus and cells) with regards to detection of neutralizing antibodies against RSV A or B viruses, G-reactive neutralizing antibodies, and effect of complement. Our results indicate that A549 cells yield the highest MNA titers, particularly in the RSV A/A2 MNA, are least susceptible to complement-enhancing effect of neutralizing titer readout and are superior to Vero or HEp-2 MNA at recognizing G-reactive neutralizing antibodies when no complement is used. Vero cells, however, can be more consistent at recognizing neutralizing antibodies against multiple RSV strains. The choice of substrate cells thus affects the outcome of MNA, as some immortalized cells better support detection of broader range of neutralizing antibodies, while others facilitate detection of G-targeting neutralizing antibodies, a long-thought prerogative of primary airway epithelial cells.
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Affiliation(s)
- M S Boukhvalova
- Sigmovir Biosystems, Inc, 9610 Medical Center Drive, Suite 100, Rockville, MD 20850, USA.
| | - A Mbaye
- Sigmovir Biosystems, Inc, 9610 Medical Center Drive, Suite 100, Rockville, MD 20850, USA
| | - S Kovtun
- Sigmovir Biosystems, Inc, 9610 Medical Center Drive, Suite 100, Rockville, MD 20850, USA
| | - K C Yim
- Sigmovir Biosystems, Inc, 9610 Medical Center Drive, Suite 100, Rockville, MD 20850, USA
| | - T Konstantinova
- Sigmovir Biosystems, Inc, 9610 Medical Center Drive, Suite 100, Rockville, MD 20850, USA
| | - T Getachew
- Sigmovir Biosystems, Inc, 9610 Medical Center Drive, Suite 100, Rockville, MD 20850, USA
| | - S Khurana
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), Food and Drug Administration (FDA), 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - A R Falsey
- University of Rochester Medical Center, Rochester General Hospital, 1425 Portland Avenue, Infectious Diseases Unit, Rochester, NY 14621, USA
| | - J C G Blanco
- Sigmovir Biosystems, Inc, 9610 Medical Center Drive, Suite 100, Rockville, MD 20850, USA
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Abstract
The primary objective of this narrative review was to evaluate the current literature and to provide further insight into the role of concurrent training on various components of physical health or performance. Literature was obtained by electronic searches of databases using specific keywords. Combined effect of training sessions proved to be as beneficial as drug interactions. Results from cross-sectional, longitudinal, and intervention studies are reviewed and discussed with main focus on physical parameters, such as body composition, physiological parameters, molecular adaptation, athlete’s perspective, order of execution, interference phenomena and recovery. In conclusion, concurrent resistance and endurance training is an effective method for enhancing overall fitness as well as improving quality of life.
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Affiliation(s)
- P. Jha
- Human Performance Lab, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi 110070, India
| | - S. Khurana
- Department of Rehabilitation, Indian Spinal Injuries Centre, Sector-C, Vasant Kunj, New Delhi 110070, India
| | - K. Ali
- Human Performance Lab, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi 110070, India
| | - I. Ahmad
- Exercise Physiology Lab, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi 110070, India
| | - S. Verma
- Exercise Physiology Lab, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi 110070, India
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Abstract
Management of cervical cancer has undergone refinement in the past two decades; concurrent chemo-radiation (CCRT) (with cisplatin alone or in combination) is currently the standard treatment approach for patients with locally advanced disease (FIGO stage IIB-IVA). About 30%-40% of such patients fail to achieve complete response; alternative approaches are needed to improve outcome for them. Treatment with bevacizumab (an inhibitor of vascular endothelial growth factor) along with chemotherapy is associated with improved survival in patients with recurrent or metastatic cervical cancer. Weekly paclitaxel and carboplatin for 4-6 weeks as dose dense chemotherapy prior to CCRT is currently under study in a phase III, multicentric trial. Role of adjuvant chemotherapy after CCRT in patients with positive lymph nodes, larger tumor volume and those with stage III-IVA disease needs further exploration. Novel agents targeting molecular pathways are currently being studied. Recent development of immune check point inhibitors is exciting, results of ongoing studies are awaited with interest.
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Affiliation(s)
- Lalit Kumar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
| | - P Harish
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat S Malik
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - S Khurana
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Mangla A, Kim GJ, Agarwal N, Khurana S, Catchatourian R, Jiang JJ. Localized insulin amyloidosis with use of concentrated insulin: a potential complication. Diabet Med 2016; 33:e32-e35. [PMID: 27087031 DOI: 10.1111/dme.13137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Insulin-derived amyloidosis is a rare form of amyloidosis composed of insulin fibrils. The pH and concentration of insulin are known to influence the conformational state of the insulin hormone, with an increasing concentration favouring a more complex conformation. Concentrated insulin delivers a large amount of insulin to a localized area, raising the possibility of inducing conformational changes, forming insulin fibrils and leading to localized insulin amyloidosis. CASE REPORT A middle-aged woman with long history of Type 2 diabetes mellitus, treated with concentrated human insulin (U-500 insulin) presented with nodular lesions at the site of her daily insulin injections. A punch biopsy of the nodules showed skin with dermal amyloidosis staining favourably with Congo Red stain. The amyloid tumours were resected and areas positive for Congo Red stain were sent for liquid chromatography tandem mass spectrometry, which showed a peptide profile consistent with amyloid insulin. CONCLUSION Concentrated insulin was first introduced in 1952, however, it is only over the last two decades that it has been used increasingly, in congruence with the increasing incidence of obesity and diabetes mellitus seen in the USA. Only a few cases of insulin amyloidosis at the site of injection have been described in literature. With the increase in the use of insulin, this complication seems to be occurring more frequently. This is the first case report of a person with diabetes mellitus who developed localized insulin amyloidosis with the use of concentrated insulin, and points towards a potential complication of developing insulin amyloidosis with the use of concentrated insulin.
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Affiliation(s)
- A Mangla
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, USA
| | - G J Kim
- Department of Pathology, John H. Stroger Jr. Hospital of Cook County, Chicago, USA
| | - N Agarwal
- Division of Hematology/Oncology, John H. Stroger Jr. Hospital of Cook County, Chicago, USA
| | - S Khurana
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, USA
| | - R Catchatourian
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, USA
- Division of Hematology/Oncology, John H. Stroger Jr. Hospital of Cook County, Chicago, USA
| | - J J Jiang
- Department of Pathology, John H. Stroger Jr. Hospital of Cook County, Chicago, USA
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Hua L, Linke RJ, Boucaut HAP, Khurana S. Micturating cystourethrogram as a tool for investigating UTI in children - An institutional audit. J Pediatr Urol 2016; 12:292.e1-292.e5. [PMID: 27230383 DOI: 10.1016/j.jpurol.2016.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 03/04/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Micturating cystourethrograms (MCUG) are the gold standard for evaluating vesicoureteric reflux (VUR). There is a growing consensus for increasing the threshold for performing MCUGs following urinary tract infections (UTI) in children. There are several varying guidelines. It is important to detect high-grade reflux in the setting of an UTI because of potential long-term complications. OBJECTIVE This audit aimed to retrospectively: (1) identify the conformance rate of local guidelines at the Women's and Children's Hospital (WCH); (2) assess predictors for an abnormal MCUG; and (3) compare local guidelines against the Royal Children's Hospital, Melbourne (RCH), National Institute for Healthcare and Excellence (NICE), and American Academy of Pediatrics (AAP) guidelines for selectively detecting high-grade reflux. METHOD The number of MCUGs performed from 2008 to 2012 at the WCH radiology department was collected. Patients undergoing MCUG during the 2012 calendar year were identified. Only children having an initial MCUG as part of an UTI investigation with prerequisite imaging as per guidelines were included. Each child's age, sex, referral source, reason, renal ultrasound (RUS) prior to the MCUG, MCUG result and VUR grade were recorded. The WCH guidelines were applied to determine conformance, to evaluate predictors for an abnormal MCUG, and compared against other retrospectively applied guidelines (RCH, NICE, AAP). RESULTS/DISCUSSION There was complete data for 168 children who underwent MCUG as part of an UTI investigation (median age 0.79 years, range 0.12-8.74, male:female 67:101). There were 67/168 abnormal MCUGs (62 children with VUR, five bladder diverticulum), and 97 refluxing renal units (43 high-grade VUR units). No posterior urethral valves (PUV) were identified as part of the UTI investigation. A total of 143/168 patients had prior RUS (normal:abnormal 67:76). The WCH guidelines had 82% conformance. There was no statistically significant association between an abnormal MCUG and age, sex, referral source, reason, or prior RUS result. The WCH guidelines may have missed five children with high-grade VUR (four children had surgery), compared with RCH, APP and NICE, with 8, 15, and 17 children, respectively, having high-grade VUR (two, five, and five children had surgery, respectively) show in the Summary Table. The retrospective study had limitations and possible selection bias (children with UTI without a MCUG). There were no standard treatment approaches for VUR; hence establishing a MCUG guideline is difficult. An alternative is the top-down approach. CONCLUSION Current institutional guidelines for considering MCUG following UTI in children vary considerably. The MCUG guidelines at any institution must take into account the local management guidelines for high-grade VUR.
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Affiliation(s)
- L Hua
- Department of Surgery, Central Adelaide Local Health Network, Adelaide, Australia.
| | - R J Linke
- Department of Medical Imaging, Women's and Children's Hospital, Adelaide, Australia
| | - H A P Boucaut
- Department of Paediatric Surgery and Urology, Women's and Children's Hospital, Adelaide, Australia
| | - S Khurana
- Department of Paediatric Surgery and Urology, Women's and Children's Hospital, Adelaide, Australia
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Megha K, Khurana S, Sehgal R. Genotyping of acanthamoeba spp causing granulomatous amoebic encephalitis. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.788] [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: 11/29/2022] Open
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Khurana S, Biswal M, Kaur H, Malhotra P, Arora P, Megha K, Taneja N, Sehgal R. Free living amoebae in water sources of critical units in a tertiary care hospital in India. Indian J Med Microbiol 2016; 33:343-8. [PMID: 26068332 DOI: 10.4103/0255-0857.158543] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Isolation of free-living amoebae (FLA) is reported sparsely from water taps, ventilators, air conditioners, haemodialysis units and dental irrigation systems of hospitals worldwide. Their prevalence in hospital environment especially in wards having immunocompromised patients may pose a risk to this group of susceptible population as they may cause disease themselves or may carry pathogens inside them. No study from India has performed such surveillance. OBJECTIVE To evaluate extent of FLA contamination in water sources of bone marrow transplant (BMT) intensive care unit (ICU), transplant ICU, haemodialysis unit and high dependency unit in a tertiary care hospital in India. MATERIALS AND METHODS A total of hundred samples including fifty each of tap water samples and swabs from mouth of taps used for drinking, bathing and hand washing purposes in these units were collected according to standard procedure. Samples were inoculated onto non-nutrient agar plates at room temperature followed by morphological confirmation. Molecular identification including polymerase chain reaction (PCR) and sequencing was performed in culture positive samples. RESULTS Four tap water samples and ten swab samples showed growth of trophozoites and cyst formation. Morphologically, four amoebae resembled Acanthamoeba spp. which was further confirmed by PCR and sequencing showed them to be of T3 and T4 genotypes. CONCLUSION The presence of these FLA in hospital water sources emphasises the urgent need of implementing effective preventive measures. Further studies are required to estimate the true prevalence of FLA in Indian hospitals by taking larger number of samples.
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Affiliation(s)
- S Khurana
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kim K, Kim D, Juh H, Khurana S, Rhyu K. Robot‐assisted total knee arthroplasty in haemophilic arthropathy. Haemophilia 2016; 22:446-52. [DOI: 10.1111/hae.12875] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/28/2022]
Affiliation(s)
- K.‐I. Kim
- Department of Orthopaedic Surgery Center for Joint Diseases and Rheumatism Kyung Hee University Hospital at Gangdong Seoul Korea
| | - D.‐K. Kim
- Department of Orthopaedic Surgery Center for Joint Diseases and Rheumatism Kyung Hee University Hospital at Gangdong Seoul Korea
| | - H.‐S. Juh
- Department of Orthopaedic Surgery Center for Joint Diseases and Rheumatism Kyung Hee University Hospital at Gangdong Seoul Korea
| | - S. Khurana
- Department of Orthopaedic Surgery Center for Joint Diseases and Rheumatism Kyung Hee University Hospital at Gangdong Seoul Korea
| | - K.‐H. Rhyu
- Department of Orthopaedic Surgery Center for Joint Diseases and Rheumatism Kyung Hee University Hospital at Gangdong Seoul Korea
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Mehdi S, Jeyarajah C, Storrar J, Craig C, Orekoya O, Obot I, Shah D, Halkyard E, Webster I, Sheikh H, Bayman N, Blackhall F, Khurana S, Sundar R, Taggart S. 158 Management of small cell lung cancer in Manchester's Northwest Sector. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30175-1] [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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Abstract
PURPOSE The diagnosis of toxoplasmosis is challenging since conventional methods like culture and immunofluorescence are not universally available. Serology, which is used regularly might be negative during early phase of infection and in immunosuppressed patients or may remain positive for a long time. Several molecular tests have been used for the diagnosis of toxoplasmosis, but none of them have an internal control which would inform us regarding the presence of polymerase chain reaction (PCR) inhibitors thus, undermining the confidence of a laboratory physician. MATERIALS AND METHODS We designed a multiplex PCR containing primers targeting human beta globin gene which would act as internal control and two primers against the B1 gene and 5s gene which aid in sensitive detection of T. gondii. RESULTS Multiplex PCR had a sensitivity of 83.3% and specificity of 100%. CONCLUSION Multiplex PCR may provide a sensitive and specific tool for diagnosis of human toxoplasmosis.
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Affiliation(s)
| | | | - S Khurana
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
We report two cases of fatal chronic meningoencephalitis caused by Balamuthia mandrillaris in immunocompetent men. Diagnosis of amoebic meningoencephalitis was made ante-mortem in one case and postmortem in another by histopathological examination and confirmed by demonstration of B. mandrillaris deoxyribonucleic acid (DNA) by polymerase chain reaction (PCR).
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Affiliation(s)
| | | | | | | | - B D Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Nguyen P, Khurana S, Peltsch H, Grandbois J, Eibl J, Crispo J, Ansell D, Tai TC. Prenatal glucocorticoid exposure programs adrenal PNMT expression and adult hypertension. J Endocrinol 2015; 227:117-27. [PMID: 26475702 DOI: 10.1530/joe-15-0244] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Prenatal exposure to glucocorticoids (GCs) programs for hypertension later in life. The aim of the current study was to examine the impact of prenatal GC exposure on the postnatal regulation of the gene encoding for phenylethanolamine N-methyltransferase (PNMT), the enzyme involved in the biosynthesis of the catecholamine, epinephrine. PNMT has been linked to hypertension and is elevated in animal models of hypertension. Male offspring of Wistar-Kyoto dams treated with dexamethasone (DEX) developed elevated systolic, diastolic and mean arterial blood pressure compared to saline-treated controls. Plasma epinephrine levels were also elevated in adult rats exposed to DEX in utero. RT-PCR analysis revealed adrenal PNMT mRNA was higher in DEX exposed adult rats. This was associated with increased mRNA levels of transcriptional regulators of the PNMT gene: Egr-1, AP-2, and GR. Western blot analyses showed increased expression of PNMT protein, along with increased Egr-1 and GR in adult rats exposed to DEX in utero. Furthermore, gel mobility shift assays showed increased binding of Egr-1 and GR to DNA. These results suggest that increased PNMT gene expression via altered transcriptional activity is a possible mechanism by which prenatal exposure to elevated levels of GCs may program for hypertension later in life.
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Affiliation(s)
- P Nguyen
- Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada
| | - S Khurana
- Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada
| | - H Peltsch
- Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada
| | - J Grandbois
- Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada
| | - J Eibl
- Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada
| | - J Crispo
- Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada
| | - D Ansell
- Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada
| | - T C Tai
- Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada Medical Sciences DivisionNorthern Ontario School of Medicine, Sudbury, Ontario, CanadaDepartments of BiologyChemistry and BiochemistryBiomolecular Sciences ProgramLaurentian University, Sudbury, Ontario, Canada
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