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Mahesh M, Bali A, Gupta T. Analytical method development, identification, and characterization of stress degradation products of idelalisib by ultrahigh-performance liquid chromatography with photodiode array and ultrahigh-performance liquid chromatography with electrospray ionization quadrupole time-of-flight mass spectrometry studies. Rapid Commun Mass Spectrom 2024; 38:e9745. [PMID: 38591150 DOI: 10.1002/rcm.9745] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/02/2024] [Accepted: 03/10/2024] [Indexed: 04/10/2024]
Abstract
RATIONALE As per International Council for Harmonization (ICH) drug stability test guideline Q1A(R2), inherent stability characteristics of a drug should be studied. This work was designed to investigate inherent degradation characteristics of the drug idelalisib under ICH prescribed stress conditions, identify its degradation products, and postulate their corresponding degradation pathways. METHODS Idelalisib was subjected to the ICH prescribed conditions of hydrolytic (neutral, acidic, and alkaline), photolytic, oxidative, and thermal stress according to ICH guideline Q1A(R2). An ultrahigh-performance liquid chromatography with photodiode array (UHPLC-PDA) method was developed to adequately resolve the drug from its degradation products, validated as per the ICH guidelines, and subsequently extended to UHPLC with electrospray ionization quadrupole time-of-flight mass spectrometry (ESI-QTOFMS) studies to identify the degradation products. RESULTS Significant degradation was noted under conditions of acidic/alkaline hydrolysis, acid photolysis, and oxidative stress. The UHPLC/ESI-QTOFMS studies revealed the generation of four degradation products (I-IV), which were satisfactorily resolved from the drug by UHPLC on a Kinetex® C18 (100 × 4.6 mm; 2.6 μm) column by the developed isocratic elution method. Detection wavelength was selected as 270 nm. All the degradation products (I-IV) could be identified and characterized from their mass spectral data. The degradation pathways for the generation of various products from the drug were postulated. CONCLUSIONS A UHPLC-PDA method was developed and validated for idelalisib. Four degradation products of idelalisib were revealed through UHPLC/ESI-QTOFMS studies, and corresponding degradation pathways were postulated for the same.
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Affiliation(s)
- Marella Mahesh
- University Institute of Pharmaceutical Sciences, UGC Center of Advanced Study, Panjab University, Chandigarh, India
| | - Alka Bali
- University Institute of Pharmaceutical Sciences, UGC Center of Advanced Study, Panjab University, Chandigarh, India
| | - Tanvi Gupta
- University Institute of Pharmaceutical Sciences, UGC Center of Advanced Study, Panjab University, Chandigarh, India
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Swain M, Budrukkar A, Murthy V, Pai P, Kanoja A, Ghosh-Laskar S, Deshmukh A, Pantvaidya G, Kannan S, Patil VM, Naronha V, Prabhash K, Sinha S, Kumar A, Gupta T, Agarwal J. Contralateral Nodal Relapse in Well-lateralised Oral Cavity Cancers Treated Uniformly with Ipsilateral Surgery and Adjuvant Radiotherapy With or Without Concurrent Chemotherapy: a Retrospective Study. Clin Oncol (R Coll Radiol) 2024; 36:278-286. [PMID: 38365518 DOI: 10.1016/j.clon.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
AIMS To evaluate the incidence and pattern of contralateral nodal relapse (CLNR), contralateral nodal relapse-free survival (CLNRFS) and risk factors predicting CLNR in well-lateralised oral cavity cancers (OCC) treated with unilateral surgery and adjuvant ipsilateral radiotherapy with or without concurrent chemotherapy. MATERIALS AND METHODS Consecutive patients of well-lateralised OCC treated between 2012 and 2017 were included. The primary endpoint was incidence of CLNR and CLNRFS. Univariable and multivariable analyses were carried out to identify potential factors predicting CLNR. RESULTS Of the 208 eligible patients, 21 (10%) developed isolated CLNR at a median follow-up of 45 months. The incidence of CLNR was 21.3% in node-positive patients. CLNR was most common at level IB (61.9%) followed by level II. The 5-year CLNRFS and overall survival were 82.5% and 57.7%, respectively. Any positive ipsilateral lymph node (P = 0.001), two or more positive lymph nodes (P < 0.001), involvement of ipsilateral level IB (P = 0.002) or level II lymph node (P < 0.001), presence of extranodal extension (P < 0.001), lymphatic invasion (P = 0.015) and perineural invasion (P = 0.021) were significant factors for CLNR on univariable analysis. The presence of two or more positive lymph nodes (P < 0.001) was an independent prognostic factor for CLNR on multivariable analysis. CLNR increased significantly with each increasing lymph node number beyond two compared with node-negative patients. CONCLUSION The overall incidence of isolated CLNR is low in well-lateralised OCC. Patients with two or more positive lymph nodes have a higher risk of CLNR and may be considered for elective treatment of contralateral neck.
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Affiliation(s)
- M Swain
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Kanoja
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Deshmukh
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Pantvaidya
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Kannan
- Clinical Research Secretariat Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi, Mumbai, India
| | - V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Naronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Sinha
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Kumar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - T Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Moreci R, Gates RS, Luckoski J, Marcotte K, Mullens CL, Yee CC, Gupta T, Kendrick D, Thelen A, Krumm AE, George BC. Characteristics and Practice Patterns of Non-certified Surgeons Treating Medicare Patients. Ann Surg 2024:00000658-990000000-00841. [PMID: 38606552 DOI: 10.1097/sla.0000000000006298] [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: 04/13/2024]
Abstract
OBJECTIVE The objective of this study is to explore the patient characteristics and practice patterns of non-certified surgeons who treat Medicare patients in the United States. SUMMARY BACKGROUND DATA While most surgeons in the United States are board-certified, non-certified surgeons are permitted to practice in many locations. At the same time, surgical workforce shortages threaten access to surgical care for many patients. It is possible that non-certified surgeons may be able to help fill these access gaps. However, little is known about the practice patterns of non-certified surgeons. METHODS A 100% sample of Medicare claims data from 2014-2019 were used to identify practicing general surgeons. Surgeons were categorized as certified or non-certified in general surgery based on data from the American Board of Surgery. Surgeon practice patterns and patient characteristics were analyzed. RESULTS A total of 2,097,206 patient cases were included in the study. These patients were treated by 16,076 surgeons, of which 6% were identified as non-certified surgeons. Compared to certified surgeons, non-certified surgeons were less frequently fellowship-trained (20.5% vs. 24.2%, P=0.008) and more likely to be a foreign medical graduate (14.5% vs. 9.2%, P<0.001). Non-certified surgeons were more frequently practicing in for-profit hospitals (21.2% vs. 14.2%, P<0.001) and critical access hospitals (2.2% vs. 1.3%, P<0.001), and were less likely to practice in a teaching hospital (63.2% vs. 72.4%, P<0.001). Compared to certified surgeons, non-certified surgeons treated more non-White patients (19.6% vs. 14%, P<0.001) as well as a higher percentage of patients in the two lowest socioeconomic status (SES) quintiles (36.2% vs. 29.2%, P<0.001). Operations related to emergency admissions were more common amongst non-certified surgeons (68.8% vs. 55.7%, P<0.001). There were no differences in gender or age of the patients treated by certified and non-certified surgeons. CONCLUSION For Medicare patients, non-certified surgeons treated more patients who are non-White, of lower SES, and in more rural, critical-access hospitals.
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Affiliation(s)
- Rebecca Moreci
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Rebecca S Gates
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - John Luckoski
- Department of Surgery, University of Toledo, Toledo, OH
| | - Kayla Marcotte
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI
| | - Cody L Mullens
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Chia Chye Yee
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Tanvi Gupta
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Daniel Kendrick
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Angela Thelen
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Andrew E Krumm
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
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Howard RA, Thelen AE, Chen X, Gates R, Krumm AE, Millis MA, Gupta T, Brown CS, Bandeh-Ahmadi H, Wnuk GM, Yee CC, Ryan AM, Mukherjee B, Dimick JB, George BC. Mortality and Severe Complications Among Newly Graduated Surgeons in the United States. Ann Surg 2024; 279:555-560. [PMID: 37830271 PMCID: PMC10939969 DOI: 10.1097/sla.0000000000006128] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To evaluate severe complications and mortality over years of independent practice among general surgeons. BACKGROUND Despite concerns that newly graduated general surgeons may be unprepared for independent practice, it is unclear whether patient outcomes differ between early and later career surgeons. METHODS We used Medicare claims for patients discharged between July 1, 2007 and December 31, 2019 to evaluate 30-day severe complications and mortality for 26 operations defined as core procedures by the American Board of Surgery. Generalized additive mixed models were used to assess the association between surgeon years in practice and 30-day outcomes while adjusting for differences in patient, hospital, and surgeon characteristics. RESULTS The cohort included 1,329,358 operations performed by 14,399 surgeons. In generalized mixed models, the relative risk (RR) of mortality was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [5.5% (95% CI: 4.1%-7.3%) vs 4.7% (95% CI: 3.5%-6.3%), RR: 1.17 (95% CI: 1.11-1.22)]. Similarly, the RR of severe complications was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [7.5% (95% CI: 6.6%-8.5%) versus 6.9% (95% CI: 6.1%-7.9%), RR: 1.08 (95% CI: 1.03-1.14)]. When stratified by individual operation, 21 operations had a significantly higher RR of mortality and all 26 operations had a significantly higher RR of severe complications in the first compared with the 15th year of practice. CONCLUSIONS Among general surgeons performing common operations, rates of mortality and severe complications were higher among newly graduated surgeons compared with later career surgeons.
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Affiliation(s)
- Ryan A Howard
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Angela E Thelen
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Xilin Chen
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Rebecca Gates
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Andrew E Krumm
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan American Board of Surgery, Philadelphia, PA
| | - Michael Andrew Millis
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Tanvi Gupta
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Craig S Brown
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Hoda Bandeh-Ahmadi
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Greg M Wnuk
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Chia Chye Yee
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
| | - Andrew M Ryan
- Department of Biostatistics and Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
- Center for Evaluating Health Reform, University of Michigan, Ann Arbor, MI
| | - Bhramar Mukherjee
- Department of Biostatistics and Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, MI
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan American Board of Surgery, Philadelphia, PA
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Gupta T, Eckstrand KL, Lenniger CJ, Haas GL, Silk JS, Ryan ND, Phillips ML, Flores LE, Pizzagalli DA, Forbes EE. Anhedonia in adolescents at transdiagnostic familial risk for severe mental illness: Clustering by symptoms and mechanisms of association with behavior. J Affect Disord 2024; 347:249-261. [PMID: 37995926 PMCID: PMC10843785 DOI: 10.1016/j.jad.2023.11.062] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Anhedonia is a transdiagnostic symptom of severe mental illness (SMI) and emerges during adolescence. Possible subphenotypes and neural mechanisms of anhedonia in adolescents at risk for SMI are understudied. METHODS Adolescents at familial risk for SMI (N = 81) completed anhedonia (e.g., consummatory, anticipatory, social), demographic, and clinical measures and one year prior, a subsample (N = 46) completed fMRI scanning during a monetary reward task. Profiles were identified using k-means clustering of anhedonia type and differences in demographics, suicidal ideation, impulsivity, and emotional processes were examined. Moderation analyses were conducted to investigate whether levels of brain activation of reward regions moderated the relationships between anhedonia type and behaviors. RESULTS Two-clusters emerged: a high anhedonia profile (high-anhedonia), characterized by high levels of all types of anhedonia, (N = 32) and a low anhedonia profile (low-anhedonia), characterized by low levels of anhedonia types (N = 49). Adolescents in the high-anhedonia profile reported more suicidal ideation and negative affect, and less positive affect and desire for emotional closeness than low-anhedonia profile. Furthermore, more suicidal ideation, less positive affect, and less desire for emotional closeness differentiated the familial high-risk, high-anhedonia profile adolescents from the familial high-risk, low-anhedonia profile adolescents. Across anhedonia profiles, moderation analyses revealed that adolescents with high dmPFC neural activation in response to reward had positive relationships between social, anticipatory, and consummatory anhedonia and suicidal ideation. LIMITATIONS Small subsample with fMRI data. CONCLUSION Profiles of anhedonia emerge transdiagnostically and vary on clinical features. Anhedonia severity and activation in frontostriatal reward areas have value for clinically important outcomes such as suicidal ideation.
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Affiliation(s)
- T Gupta
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA.
| | - K L Eckstrand
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - C J Lenniger
- University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA
| | - G L Haas
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA; University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA; VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - J S Silk
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA; University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA
| | - N D Ryan
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - M L Phillips
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - L E Flores
- Queens University, Department of Psychology, Kingston, Ontario, CA, USA
| | - D A Pizzagalli
- Harvard Medical School and McLean Hospital, Department of Psychiatry, Boston, MA, USA
| | - E E Forbes
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA; University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA; University of Pittsburgh, Department of Pediatrics, Pittsburgh, PA, USA; University of Pittsburgh, Department of Clinical and Translational Science, Pittsburgh, PA, USA
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Gupta T, Cash BD. In primary care, second-line IBS therapy with amitriptyline vs. placebo reduced symptoms at 6 mo. Ann Intern Med 2024; 177:JC15. [PMID: 38315998 DOI: 10.7326/j23-0122] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
SOURCE CITATION Ford AC, Wright-Hughes A, Alderson SL, et al; ATLANTIS trialists. Amitriptyline at low-dose and titrated for irritable bowel syndrome as second-line treatment in primary care (ATLANTIS): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2023;402:1773-1785. 37858323.
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Affiliation(s)
- Tanvi Gupta
- University of Texas Health Science Center at Houston, Houston, Texas, USA (T.G., B.D.C.)
| | - Brooks D Cash
- University of Texas Health Science Center at Houston, Houston, Texas, USA (T.G., B.D.C.)
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Gupta T, Bowles P, Bhutta MF. Effectiveness, perceptions and environmental benefits of remote consultation for adults referred with recurrent tonsillitis. Ann R Coll Surg Engl 2024; 106:173-177. [PMID: 36779457 PMCID: PMC10830344 DOI: 10.1308/rcsann.2022.0098] [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] [Accepted: 06/27/2022] [Indexed: 02/14/2023] Open
Abstract
INTRODUCTION We evaluate remote consultation for adult patients referred with recurrent sore throat, measuring the effectiveness of the consultation, satisfaction and environmental impact. METHODS Eligible patients were invited to telephone clinics, undertaking a satisfaction survey after consultation, focusing on perceived convenience, satisfaction, cost and travel arrangements (used to calculate potential environmental benefit). Provider opinion was also captured. RESULTS Forty-eight of 60 patients attended, with 38 (63%) eligible for inclusion. Thirty-six of these 38 patients (95%) had a definitive outcome of tonsillectomy (27/38) or discharge (9/38). Thirty-three of the 38 patients (87%) responded to the survey and reported high satisfaction in all arms of questioning (mean Likert ranking = 4.7/5). A mean of 3.76 hours of missed work and 5.17kg carbon dioxide emission equivalents were saved per patient. Provider responses were positive towards ongoing remote consultation use. CONCLUSIONS Telephone consultation for adult patients considered for tonsillectomy is convenient to patients in terms of cost and time, reduces environmental harm and is associated with high patient and provider satisfaction.
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Affiliation(s)
- T Gupta
- University Hospitals Sussex NHS Foundation Trust, UK
| | - P Bowles
- University Hospitals Sussex NHS Foundation Trust, UK
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Gulati S, Tripathy S, Gupta T, Gaba S. Facial nerve communication with ansa cervicalis - An unusual anatomical variation. J Postgrad Med 2024; 70:60-63. [PMID: 38037772 PMCID: PMC10947731 DOI: 10.4103/jpgm.jpgm_454_23] [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: 06/11/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 12/02/2023] Open
Abstract
Neural connections of the seventh cranial nerve with its neighboring nerves are common and well documented; however, communication with ansa cervicalis is as yet unknown. We present a case with such a connection found during cadaveric dissection, with hitherto unknown consequences. In this specimen, after giving the marginal mandibular and cervical branches, the cervicofacial division continued distally to communicate with the distal loop of ansa cervicalis. Presence of such connection may result in facial muscle paralysis on injury to the ansa or strap muscle paralysis on injury to the facial nerve, depending on the direction of nerve fibers. Such unusual connections bring to light the need for extreme care during surgeries in the neck to safeguard any such connections and when using the ansa as donor.
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Affiliation(s)
- S Gulati
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Tripathy
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - T Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Gaba
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Gupta T, Ali Y, Sudan S, Bowles PFD. Injection medialisation laryngoplasty: an alternative approach for challenging cases. J Laryngol Otol 2023; 137:1406-1408. [PMID: 36683388 DOI: 10.1017/s0022215123000038] [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] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Conventional injection medialisation laryngoplasty techniques may be compromised by patient-specific factors such as marked kyphosis, an anteriorly positioned larynx or intolerance to nasendoscopy. This paper describes a technique for successful injection medialisation laryngoplasty where conventional methods are precluded, in an 88-year-old man with presbyphonia on a background of Parkinson's disease. METHODS After induction of general anaesthesia, a transoral introducing needle, shaped by tactile manipulation to match the curvature of a 'C-MAC' intubating video-laryngoscope 'D-blade' attachment, was introduced until visible above the glottis. The implant material was then injected into the paraglottic space as normal until satisfactory medialisation of the vocal fold was achieved. RESULTS When reviewed in the out-patient clinic four weeks later, the patient's post-operative Voice Handicap Index score fell to 6, from a pre-operative score of 21. CONCLUSION By utilising commonly available equipment and anaesthetic support to recreate the views and access conventional nasendoscopy and laryngoscopy facilitate, this novel procedure provides a viable and proven alternative in uncommon but challenging cases.
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Affiliation(s)
- T Gupta
- ENT, Royal Sussex County Hospital, Brighton, UK
| | - Y Ali
- Anaesthetics, Royal Sussex County Hospital, Brighton, UK
| | - S Sudan
- Anaesthetics, Royal Sussex County Hospital, Brighton, UK
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George BC, Thelen AE, Howard RA, Kendrick DE, Chen X, Clark MJ, Gupta T, Brown CS, Bandeh-Ahmadi H, Luckoski JL, Wnuk GM, Fan Z, Krumm AE, Ryan AM, Buyske J, Mukherjee B, Dimick JB. Evaluating Educational Outcomes Using Patient Outcomes of New Surgeons Performing Partial Colectomy Compared to Cholecystectomy. Acad Med 2023; 98:S143-S148. [PMID: 37983406 DOI: 10.1097/acm.0000000000005368] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE Despite ongoing efforts to improve surgical education, surgical residents face gaps in their training. However, it is unknown if differences in the training of surgeons are reflected in the patient outcomes of those surgeons once they enter practice. This study aimed to compare the patient outcomes among new surgeons performing partial colectomy-a common procedure for which training is limited-and cholecystectomy-a common procedure for which training is robust. METHOD The authors retrospectively analyzed all adult Medicare claims data for patients undergoing inpatient partial colectomy and inpatient cholecystectomy between 2007 and 2018. Generalized additive mixed models were used to investigate the associations between surgeon years in practice and risk-adjusted rates of 30-day serious complications and death for patients undergoing partial colectomy and cholecystectomy. RESULTS A total of 14,449 surgeons at 4,011 hospitals performed 340,114 partial colectomy and 355,923 cholecystectomy inpatient operations during the study period. Patients undergoing a partial colectomy by a surgeon in their 1st vs 15th year of practice had higher rates of serious complications (5.22% [95% CI, 4.85%-5.60%] vs 4.37% [95% CI, 4.22%-4.52%]; P < .01) and death (3.05% [95% CI, 2.92%-3.17%] vs 2.83% [95% CI, 2.75%-2.91%]; P < .01). Patients undergoing a cholecystectomy by a surgeon in their 1st vs 15th year of practice had similar rates of 30-day serious complications (4.11% vs 3.89%; P = .11) and death (1.71% vs 1.70%; P = .93). CONCLUSIONS Patients undergoing partial colectomy faced a higher risk of serious complications and death when the operation was performed by a new surgeon compared to an experienced surgeon. Conversely, patient outcomes following cholecystectomy were similar for new and experienced surgeons. More attention to partial colectomy during residency training may benefit patients.
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Affiliation(s)
- Brian C George
- B.C. George is associate professor of surgery and director, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Angela E Thelen
- A.E. Thelen is a surgical education research fellow, Center for Surgical Training and Research, University of Michigan, Ann Arbor, Michigan
| | - Ryan A Howard
- R.A. Howard is a research fellow, Center for Health Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Daniel E Kendrick
- D.E. Kendrick was a surgical education research fellow, Center for Surgical Training and Research, University of Michigan, Ann Arbor, Michigan, and is currently assistant professor, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Xilin Chen
- X. Chen is a data analyst, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael J Clark
- M.J. Clark is a statistician lead, Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan
| | - Tanvi Gupta
- T. Gupta is a data analyst, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Craig S Brown
- C.S. Brown is a general surgery resident and research fellow, Center for Health Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Hoda Bandeh-Ahmadi
- H. Bandeh-Ahmadi is director of social research, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - John L Luckoski
- J.L. Luckoski is a surgical education research fellow, Center for Surgical Training and Research, University of Michigan, Ann Arbor, Michigan
| | - Greg M Wnuk
- G.M. Wnuk is program manager, Center for Surgical Training and Research, University of Michigan, Ann Arbor, Michigan
| | - Zhaohui Fan
- Z. Fan is a data analyst, Center for Health Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew E Krumm
- A.E. Krumm is assistant professor of learning health sciences, University of Michigan, Ann Arbor, Michigan
| | - Andrew M Ryan
- A.M. Ryan is professor of health services, policy, and practice, Brown University School of Public Health, Providence, Rhode Island
| | - Jo Buyske
- J. Buyske is president and chief executive officer, American Board of Surgery, Philadelphia, Pennsylvania
| | - Bhramar Mukherjee
- B. Mukherjee is professor of epidemiology and chair of biostatistics, Department of Biostatistics and Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Justin B Dimick
- J.B. Dimick is professor and chair, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Baviskar Y, Likonda B, Pant S, Mokal S, Pawar A, Dasgupta A, Chatterjee A, Gupta T. Short-course Palliative Hypofractionated Radiotherapy in Patients with Poor-prognosis High-grade Glioma: Survival and Quality of Life Outcomes from a Prospective Phase II Study. Clin Oncol (R Coll Radiol) 2023; 35:e573-e581. [PMID: 37455146 DOI: 10.1016/j.clon.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/11/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
AIMS To report longitudinal quality of life (QoL) outcomes and survival in patients with poor-prognosis high-grade glioma (HGG) treated with palliative hypofractionated radiotherapy. MATERIALS AND METHODS Patients with poor-prognosis HGG were accrued on a prospective study of short-course palliative hypofractionated radiotherapy (35 Gy/10 fractions/2 weeks). The European Organization for Research and Treatment of Cancer QoL core questionnaire (QLQ-C30) and brain cancer module (BN20) were used in English or validated Indian vernacular languages (Hindi and Marathi) for QoL assessment at baseline (before radiotherapy), the conclusion of radiotherapy, 1 month post-radiotherapy and subsequently at 3-monthly intervals until disease progression/death. Baseline QoL scores were compared with corresponding scores from a historical HGG cohort. Summary QoL scores were compared longitudinally over time by related samples Friedman's two-way test. Progression-free survival and overall survival were calculated using the Kaplan-Meier method and reported as 1-year estimates with 95% confidence intervals. RESULTS Forty-nine (89%) of 55 patients completed the planned course of hypofractionated radiotherapy. Longitudinal QoL data were available in 42 (86%) of 49 patients completing radiotherapy, comprising the present cohort. The median age of included patients, comprised mainly of glioblastoma patients (81%), was 57 years, with an interquartile range (IQR) of 50-66 years and a median baseline Karnofsky score of 60 (IQR = 50-60). Baseline QoL scores were significantly worse for several domains compared with a historical institutional cohort of HGG patients treated previously with conventionally fractionated radiotherapy, indicating negative selection bias. QoL scores remained stable for most domains after palliative hypofractionated radiotherapy, with statistically significant improvements in fatigue (P = 0.032), dyspnoea (P = 0.042) and motor dysfunction (P = 0.036) over time. At a median follow-up of 8 months, Kaplan-Meier estimates of 1-year progression-free survival and overall survival were 33.3% (95% confidence interval 21.7-51.1%) and 38.1% (95% confidence interval 25.9-56%), respectively. CONCLUSION Short-course palliative hypofractionated radiotherapy in patients with poor-prognosis HGG is associated with stable and/or improved QoL scores in several domains, making it a viable resource-sparing regimen.
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Affiliation(s)
- Y Baviskar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - B Likonda
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - S Pant
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - S Mokal
- Department of Clinical Research Secretariat, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - A Pawar
- Department of Clinical Research Secretariat, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - A Dasgupta
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - A Chatterjee
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - T Gupta
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.
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Sushant S, Sharma DN, Pandey R, Saini SK, Sanyal S, Pattanaik J, Samala SK, Praveen DVS, Tanwar MS, Pandey S, Mandal S, Solanky AP, Sisodiya R, Ghosh A, Dagar A, Shukla BD, Gupta T, Gupta S, Rana P, Mounika G. Multiple Sessions vs. Single Session Image-Based Intracavitary Brachytherapy for Locally Advanced Cervical Cancer: A Randomized Control Trial. Int J Radiat Oncol Biol Phys 2023; 117:S41-S42. [PMID: 37784495 DOI: 10.1016/j.ijrobp.2023.06.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The objectives of this study are: 1) To compare the acute toxicity caused in the treatment of locally advanced cervical cancer (LACC) treated with weekly multiple applications vs. a single application for image-guided intracavitary High Dose Rate (HDR) brachytherapy (BT) after External Beam Radiation Therapy (EBRT) 2) To compare the loco-regional control of cancer at six months in the two arms MATERIALS/METHODS: In a prospective study, 40 patients with biopsy-proven LACC with FIGO-2018 stage IIB-IIIC1 disease, underwent EBRT to the pelvis at a dose of 50.4 Gy/ 28 fractions over 5.5 weeks with weekly concurrent cisplatin. After completion of EBRT, they were randomized into two arms with 20 patients each. In the Control arm (Arm-A), BT sessions were given with weekly 3 applications whereas, in the experimental arm (Arm-B), all the sessions were given with a single application at 6-12 hours intervals with aim of the high-risk clinical target volume receiving >80 Gy EQD2 and 2 cm3 of the bladder and rectum/sigmoid receiving <85 Gy and <75 Gy, respectively. The OAR contouring was done on CT RESULTS: All 40 patients were treated as per protocol. The mean duration of treatment including EBRT and BT was 73.15 days [95% CI 68.63-77.66] in Arm A and 55.85 days [95% CI 52.11-59.58] in Arm B which was significant. After 6 months, 37 patients came for follow-up, all 19 patients in Arm A had Grade 1 or Grade 2 rectal toxicity. In Arm B as well all 18 patients had Grade 1 or Grade 2 rectal toxicity. Bladder toxicity was Grade 1 or Grade 2 in 18 patients and Grade 3 severity in 1 patient among Arm A. Among 18 patients of Arm B, bladder toxicity of Grade 1 or Grade 2 was seen in 16 patients, and 2 patients had grade 3 toxicity. 2 patients in Arm A and 3 in Arm B complained of Grade 1 urinary incontinence. Moreover, Abdominal pain at 6 months was of Grade 1 in around 6 patients in Arm A but 14 patients had abdominal pain in Arm B which was of Grade 1 in 8, 4 had grade 2 and 2 patients had grade 3 severity abdominal pain. In the monthly analysis of acute toxicity, none of the patients showed Grade 3 or 4 toxicity at the 1st, 2nd, or 3rd month of completion of treatment. When comparing local control in both arms at 6 months, 2 patients had treatment failure in the Experimental Arm compared to only 1 patient in the Control Arm CONCLUSION: Single Application Multiple Fraction Intracavitary Brachytherapy post concurrent CTRT is a safe option for the treatment of locally advanced cervical cancer. When compared to the weekly application arm, single-application ICRT showed a comparable acute toxicity profile and comparable local control rates as well. Some patients in Single Application Arm showed abdominal pain which needs to be investigated with further trials. The overall treatment time in the single application arm is significantly lower than the standard weekly application arm.
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Affiliation(s)
- S Sushant
- All India Institute of Medical Sciences, New Delhi, India
| | - D N Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - R Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | - S K Saini
- All India Institute of Medical Sciences, New Delhi, India
| | - S Sanyal
- All India Institute of Medical Sciences, New Delhi, India
| | - J Pattanaik
- All India Institute of Medical Sciences, New Delhi, India
| | - S K Samala
- All India Institute of Medical Sciences, New Delhi, India
| | - D V S Praveen
- All India Institute of Medical Sciences, New Delhi, India
| | - M S Tanwar
- All India Institute of Medical Sciences, New Delhi, India
| | - S Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | - S Mandal
- All India Institute of Medical Sciences, New Delhi, India
| | - A P Solanky
- All India Institute of Medical Sciences, New Delhi, India
| | - R Sisodiya
- All India Institute of Medical Sciences, New Delhi, India
| | - A Ghosh
- National Cancer Institute, AIIMS, Jhajjar, India
| | - A Dagar
- National Cancer Institute, AIIMS, Jhajjar, India
| | - B D Shukla
- All India Institute of Medical Sciences, New Delhi, India
| | - T Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - P Rana
- All India Institute of Medical Sciences, New Delhi, India
| | - G Mounika
- All India Institute of Medical Sciences, New Delhi, India
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Kendrick DE, Thelen AE, Chen X, Gupta T, Yamazaki K, Krumm AE, Bandeh-Ahmadi H, Clark M, Luckoscki J, Fan Z, Wnuk GM, Ryan AM, Mukherjee B, Hamstra SJ, Dimick JB, Holmboe ES, George BC. Association of Surgical Resident Competency Ratings With Patient Outcomes. Acad Med 2023; 98:813-820. [PMID: 36724304 DOI: 10.1097/acm.0000000000005157] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE Accurate assessment of clinical performance is essential to ensure graduating residents are competent for unsupervised practice. The Accreditation Council for Graduate Medical Education milestones framework is the most widely used competency-based framework in the United States. However, the relationship between residents' milestones competency ratings and their subsequent early career clinical outcomes has not been established. It is important to examine the association between milestones competency ratings of U.S. general surgical residents and those surgeons' patient outcomes in early career practice. METHOD A retrospective, cross-sectional study was conducted using a sample of national Medicare claims for 23 common, high-risk inpatient general surgical procedures performed between July 1, 2015, and November 30, 2018 (n = 12,400 cases) by nonfellowship-trained U.S. general surgeons. Milestone ratings collected during those surgeons' last year of residency (n = 701 residents) were compared with their risk-adjusted rates of mortality, any complication, or severe complication within 30 days of index operation during their first 2 years of practice. RESULTS There were no associations between mean milestone competency ratings of graduating general surgery residents and their subsequent early career patient outcomes, including any complication (23% proficient vs 22% not yet proficient; relative risk [RR], 0.97, [95% CI, 0.88-1.08]); severe complication (9% vs 9%, respectively; RR, 1.01, [95% CI, 0.86-1.19]); and mortality (5% vs 5%; RR, 1.07, [95% CI, 0.88-1.30]). Secondary analyses yielded no associations between patient outcomes and milestone ratings specific to technical performance, or between patient outcomes and composites of operative performance, professionalism, or leadership milestones ratings ( P ranged .32-.97). CONCLUSIONS Milestone ratings of graduating general surgery residents were not associated with the patient outcomes of those surgeons when they performed common, higher-risk procedures in a Medicare population. Efforts to improve how milestones ratings are generated might strengthen their association with early career outcomes.
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Affiliation(s)
- Daniel E Kendrick
- D.E. Kendrick is assistant professor, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Angela E Thelen
- A.E. Thelen is research fellow, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Xilin Chen
- X. Chen is research analyst, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Tanvi Gupta
- T. Gupta is research analyst, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kenji Yamazaki
- K. Yamazaki is senior data analyst, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Andrew E Krumm
- A.E. Krumm is assistant professor, Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Hoda Bandeh-Ahmadi
- H. Bandeh-Ahmadi is project manager, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael Clark
- M. Clark is a biostatistician, Consulting for Statistics, Computing, and Analytics Research, University of Michigan, Ann Arbor, Michigan
| | - John Luckoscki
- J. Luckoscki is research fellow, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Zhaohui Fan
- Z. Fan is research analyst, Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Greg M Wnuk
- G.M. Wnuk is program manager, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew M Ryan
- A.M. Ryan is professor, Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Bhramar Mukherjee
- B. Mukherjee is professor and chair, Division of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Stanley J Hamstra
- S.J. Hamstra is professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin B Dimick
- J.B. Dimick is professor and chair, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Eric S Holmboe
- E.S. Holmboe is chief research, Milestone Development, and evaluation officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Brian C George
- B.C. George is director, Center for Surgical Training and Research, and assistant professor, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Labrada L, Mazurek J, Haeffele C, Weingarten A, Gupta T, Menachem J. Shone's Complex: Not So ‘Simple’ after All. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.482] [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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Gupta T, Bhutta MF. Outcomes of remote versus face-to-face ear, nose and throat outpatient consultation on patient pathways. Ann R Coll Surg Engl 2023:rcsann20220144. [PMID: 36688846 DOI: 10.1308/rcsann.2022.0144] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Remote consultation has potential benefits in increasing patient pathway efficiency and has been found to reduce costs and carbon emissions. Previous studies of remote consultation in ear, nose and throat (ENT) practice have reported mixed results and used relatively small sample sizes. The aim of this article is to study the impact of remote telephone consultation on ENT clinic outcomes and pathway efficiency, compared with in-person review, within new and follow-up patient cohorts and subspeciality, where previous studies demonstrate mixed and inconclusive results. METHODS This was a comparison of remote clinic appointment outcomes over a 2-month period from a single ENT referral centre (426) with an equivalent data set of face-to-face clinic appointments over a similar time frame (1,533). Statistical analysis included chi-squared test for clinic outcomes and two-sample t-squared test for mean hand-off between both cohorts (p < 0.05). RESULTS For new referrals, remote consultation was associated with statistically significantly greater rates of follow-up (p < 0.00001), investigation (p = 0.00251) and hand-off (p < 0.00013) than patients seen face-to-face - particularly where presenting with head and neck symptoms. For follow-up patients, remote consultation had similar rates of investigation (p = 0.11071) or further follow-up (p = 0.08) and mean hand-off (p < 0.11764) to those seen face-to-face. CONCLUSIONS Remote consultation in ENT could become the norm for follow-up patients, but should be used with caution in the initial consultation of new patients.
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Affiliation(s)
- T Gupta
- Brighton and Sussex University Hospital NHS Foundation Trust, UK
| | - M F Bhutta
- Brighton and Sussex University Hospital NHS Foundation Trust, UK.,Brighton and Sussex Medical School, UK
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Berberian S, Patock-Peckham JA, Guarino K, Gupta T, Sanabria F, Infurna F. Does loneliness before the age of twelve indirectly affect impaired control over drinking, alcohol use, and problems through perceived stress? Addict Behav Rep 2022; 16:100448. [PMID: 35875348 PMCID: PMC9301507 DOI: 10.1016/j.abrep.2022.100448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/21/2022] [Accepted: 07/10/2022] [Indexed: 11/03/2022] Open
Abstract
Loneliness is the pain of feeling socially isolated from others (Russell et al., 1980). The Stress-Dampening Hypothesis (Marlatt, 1987; Sayette, 1993; Sher, 1987) posits that individuals drink to alleviate negative affect. To date, it has not been determined whether loneliness experienced as a child can indirectly influence at-risk patterns of alcohol use through the mediating mechanism of stress and impaired control. Impaired control over alcohol use (IC) is the difficulty adhering to one's own self-proscribed limits on drinking behaviors (Heather et al., 1993). Impaired control is an at-risk pattern of use that is particularly relevant to emerging adults. Methods: We examined the direct and indirect relationships between childhood loneliness, stress, IC, and alcohol-related problems with a structural equation model. In a college student sample, we utilized a (k = 20,000) bootstrap technique and a model indirect command in Mplus to examine potential mediational pathways. Cisgender sex was included as a covariate. Results: Loneliness was directly linked to stress as well as to alcohol-related problems. Higher levels of loneliness were indirectly linked to both more alcohol use and alcohol-related problems through more stress and in turn, more impaired control over drinking. Conclusions: The current study is consistent with the Stress Dampening Hypothesis (Marlatt, 1987; Sayette, 1993; Sher, 1987). Our findings suggest that therapeutic interventions combating loneliness in childhood may disrupt the stress-dampening pathway to dysregulated alcohol use in emerging adulthood.
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Affiliation(s)
- S Berberian
- Arizona State University, Department of Psychology, Tempe, AZ 85287-1104, USA
| | - J A Patock-Peckham
- Arizona State University, Department of Psychology, Tempe, AZ 85287-1104, USA
| | - K Guarino
- Arizona State University, Department of Psychology, Tempe, AZ 85287-1104, USA
| | - T Gupta
- Arizona State University, Department of Psychology, Tempe, AZ 85287-1104, USA
| | - F Sanabria
- Arizona State University, Department of Psychology, Tempe, AZ 85287-1104, USA
| | - F Infurna
- Arizona State University, Department of Psychology, Tempe, AZ 85287-1104, USA
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Bagal B, Goda Shastri J, Nayak L, Chatterjee A, Dasgupta A, Jain H, Thorat J, Sahay A, Epari S, Khanna N, Laskar S, Gupta T, Sengar M. 216P Lenalidomide maintenance after whole brain radiotherapy in relapsed/refractory primary CNS lymphoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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Filipov N, Mote R, Sakamoto K, Gupta T, Wallon O, Carpenter J. P16-02 Mycobacterium tuberculosis challenge enhances dopaminergic toxicity and neuroinflammation caused by intrapallidal manganese administration. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.592] [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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Dale J, Mclean E, Gupta T, Healy C. 788 Caecal Duplication Cyst: An Unexpected Cause of Bowel Obstruction in a 12-Year-Old. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.296] [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: 11/05/2022]
Abstract
Abstract
We report the case of a rare cause of bowel obstruction in a 12-year-old girl who presented with a short history of abdominal distension and vomiting after a month of unexplained urinary frequency and weight loss. Abdominal radiographs demonstrated small bowel obstruction with an unknown pelvic mass. A raised CA125 suggested a possible ovarian lesion and a magnetic resonance scan was interpreted as supportive of this pathology. Intra-operatively a 120x90x70mm cystic mass was found attached to the caecal serosa, immediately adjacent to the ileocaecal valve. There was an associated 180-degree twist of the terminal ileum and ascending colon. A limited right hemicolectomy was performed, and histopathology confirmed the diagnosis of a caecal intestinal duplication cyst. Post-operatively she has recovered well, with resolution of her obstructive and urinary symptoms. Given the unusual age of presentation, uncommon location of the cyst and the diagnostic challenges incurred, the authors wish to share their experience of managing an atypical duplication cyst.
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Affiliation(s)
- J Dale
- Royal Alexandra Children's Hospital , Brighton , United Kingdom
| | - E Mclean
- Royal Alexandra Children's Hospital , Brighton , United Kingdom
| | - T Gupta
- Royal Alexandra Children's Hospital , Brighton , United Kingdom
| | - C Healy
- Royal Alexandra Children's Hospital , Brighton , United Kingdom
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Gauthier DT, Doss JH, LaGatta M, Gupta T, Karls RK, Quinn FD. Genomic Degeneration and Reduction in the Fish Pathogen Mycobacterium shottsii. Microbiol Spectr 2022; 10:e0115821. [PMID: 35579461 PMCID: PMC9241763 DOI: 10.1128/spectrum.01158-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/26/2022] [Indexed: 01/17/2023] Open
Abstract
Mycobacterium shottsii is a dysgonic, nonpigmented mycobacterium originally isolated from diseased striped bass (Morone saxatilis) in the Chesapeake Bay, USA. Genomic analysis reveals that M. shottsii is a Mycobacterium ulcerans/Mycobacterium marinum clade (MuMC) member, but unlike the superficially similar M. pseudoshottsii, also isolated from striped bass, it is not an M. ulcerans ecovar, instead belonging to a transitional group of strains basal to proposed "Aronson" and "M" lineages. Although phylogenetically distinct from the human pathogen M. ulcerans, the M. shottsii genome shows parallel but nonhomologous genomic degeneration, including massive accumulation of pseudogenes accompanied by proliferation of unique insertion sequences (ISMysh01, ISMysh03), large-scale deletions, and genomic reorganization relative to typical M. marinum strains. Coupled with its observed ecological characteristics and loss of chromogenicity, the genomic structure of M. shottsii is suggestive of evolution toward a state of obligate pathogenicity, as observed for other Mycobacterium spp., including M. ulcerans, M. tuberculosis, and M. leprae. IMPORTANCE Morone saxatilis (striped bass) is an ecologically and economically important finfish species on the United States east coast. Mycobacterium shottsii and Mycobacterium pseudoshottsii were originally described in the early 2000s as novel species from outbreaks of visceral and dermal mycobacteriosis in this species. Biochemical and genetic characterization place these species within the Mycobacterium ulcerans/M. marinum clade (MuMC), and M. pseudoshottsii has been proposed as an ecovar of M. ulcerans. Here, we describe the complete genome of M. shottsii, demonstrating that it is clearly not an M. ulcerans ecovar; however, it has undergone parallel genomic modification suggestive of a transition to obligate pathogenicity. As in M. ulcerans, the M. shottsii genome demonstrates widespread pseudogene formation driven by proliferation of insertion sequences, as well as genomic reorganization. This work clarifies the phylogenetic position of M. shottsii relative to other MuMC members and provides insight into processes shaping its genomic structure.
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Affiliation(s)
- D. T. Gauthier
- Department of Biological Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - J. H. Doss
- Department of Biological Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - M. LaGatta
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Pathens Incorporated, Athens, Georgia, USA
| | - T. Gupta
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | - R. K. Karls
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Pathens Incorporated, Athens, Georgia, USA
| | - F. D. Quinn
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Pathens Incorporated, Athens, Georgia, USA
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Dasgupta A, Thomas Alex A, Sahu A, Agarwal U, Chatterjee A, Goswami S, Gaikwad U, Bano N, Singh V, Shetty P, Moiyadi A, Sahay A, Sridhar E, Choudhari A, Bhattacharya K, Kinhikar R, Jalali R, Gupta T, Goda J. OC-0927 Impact of radiation doses to parahippocampal gyrus and amygdala on memory in pituitary adenomas. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02707-4] [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: 10/18/2022]
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Budrukkar A, Murthy V, Kashid S, Swain M, Rangarajan V, Ghosh Laskar S, Kannan S, Kale S, Upereti R, Gawli S, Pai P, Pantvaidya G, Gupta T, Agarwal J. OC-0100 IMRT vs IMRT and brachytherapy for early oropharyngeal cancers (Brachytrial) : A randomized trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02476-8] [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: 10/18/2022]
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Agarwal J, Sinha S, Lewis Salins S, Pandey S, Deodhar J, Salins N, Ghosh Laskar S, Budrukkar A, Gupta T, Murthy V, Swain M, Nair S, Chaturvedi P. OC-0592 Impact of palliative care referral on distress in patients undergoing RT for HNSCC: Randomized Trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02614-7] [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: 10/18/2022]
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Gupta T, Debele TA, Wei YF, Gupta A, Murtaza M, Su WP. Synergistic Action of Immunotherapy and Nanotherapy against Cancer Patients Infected with SARS-CoV-2 and the Use of Artificial Intelligence. Cancers (Basel) 2022; 14:213. [PMID: 35008377 PMCID: PMC8750412 DOI: 10.3390/cancers14010213] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 01/08/2023] Open
Abstract
Since 2019, the SARS-CoV-2 pandemic has caused a huge chaos throughout the world and the major threat has been possessed by the immune-compromised individuals involving the cancer patients; their weakened immune response makes them vulnerable and susceptible to the virus. The oncologists as well as their patients are facing many problems for their treatment sessions as they need to postpone their surgery, chemotherapy, or radiotherapy. The approach that could be adopted especially for the cancer patients is the amalgamation of immunotherapy and nanotherapy which can reduce the burden on the healthcare at this peak time of the infection. There is also a need to predict or analyze the data of cancer patients who are at a severe risk of being exposed to an infection in order to reduce the mortality rate. The use of artificial intelligence (AI) could be incorporated where the real time data will be available to the physicians according to the different patient's clinical characteristics and their past treatments. With this data, it will become easier for them to modify or replace the treatment to increase the efficacy against the infection. The combination of an immunotherapy and nanotherapy will be targeted to treat the cancer patients diagnosed with SARS-CoV-2 and the AI will act as icing on the cake to monitor, predict and analyze the data of the patients to improve the treatment regime for the most vulnerable patients.
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Affiliation(s)
- Tanvi Gupta
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Tilahun Ayane Debele
- Department of Biomedical, Chemical & Environmental Engineering, College of Engineering and Applied Science (CEAS), University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Yu-Feng Wei
- Department of Internal Medicine, School of Medicine for International Students, College of Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung 824, Taiwan;
| | - Anish Gupta
- Devscope IT, First Floor, 40A/B Gandhi Nagar, Jammu 180001, India;
| | - Mohd Murtaza
- Microbial Biotechnology Division, CSIR-Indian Institute of Integrative Medicine, Jammu 180012, India;
| | - Wen-Pin Su
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Departments of Oncology and Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Center of Applied Nanomedicine, National Cheng Kung University, Tainan 704, Taiwan
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Laskar SG, Sinha S, Singh M, Mummudi N, Mittal R, Gavarraju A, Budrukkar A, Swain M, Agarwal JP, Gupta T, Murthy V, Mokal S, Patil V, Noronha V, Joshi A, Menon N, Prabhash K. Post-cricoid and Upper Oesophagus Cancers Treated with Organ Preservation Using Intensity-modulated Image-guided Radiotherapy: a Phase II Prospective Study of Outcomes, Toxicity and Quality of Life. Clin Oncol (R Coll Radiol) 2021; 34:220-229. [PMID: 34872822 DOI: 10.1016/j.clon.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/12/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
AIMS To prospectively examine the outcomes, toxicity and quality of life (QoL) of patients with post-cricoid and upper oesophagus (PCUE) cancers treated with an organ-preservation approach of (chemo)-radiotherapy using intensity-modulated image-guided radiotherapy (IM-IGRT). MATERIALS AND METHODS This phase II prospective study was conducted at a tertiary cancer centre from February 2017 to January 2020. Forty patients with squamous cell carcinoma of PCUE of stage T1-3, N0-2, M0 were accrued. Gross exolaryngeal extension/dysfunctional larynx were major exclusion criteria. Patients received 63-66 Gy in once-daily fractions using volumetric modulated arc therapy with daily IGRT. Outcome measures included disease-related outcomes, patterns of failure, Radiation Therapy Oncology Group toxicities, feeding tube dependency and QoL. RESULTS The median follow-up was 22 months. Twenty-six (87.5%) patients had locoregionally advanced disease and 34 (85%) patients received (chemo)-radiotherapy. A complete response was observed in 26 (65%) patients. The 2-year locoregional control, event-free survival and cause-specific survival were 59.6%, 40.2% and 44.8%, respectively. The volume of primary tumour (GTVPvol) exceeding 28 cm3 had inferior overall survival (P = 0.005) on univariate analysis. Multivariable analysis showed GTVPvol and positron emission tomography-computed tomography maximum standardised uptake value to be independently predictive for event-free and overall survival. A feeding tube requirement at presentation was seen in 11 (27.5%) patients, whereas long-term feeding tube dependency at 6 months was seen in 10 (37%) patients. For QoL, a statistical improvement in pain, appetite loss and swallowing was observed over time. CONCLUSION Although the outcomes of PCUE cancers remain dismal, the use of state of the art diagnostic modalities, careful case selection and modern radiotherapy techniques improved outcomes as compared with before in this exclusive analysis of PCUE cancers.
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Affiliation(s)
- S G Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - S Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Singh
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - N Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - R Mittal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Gavarraju
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - T Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Mokal
- Clinical Research Secretariat, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - N Menon
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Lamiman K, Mavratsas V, Gupta T, Cooney E, Lee TG, Cummins C, Gorman B, Gerber J, Radhakrishnan R. Novel abdomino-pelvic anomalies in Kagami-Ogata syndrome. Journal of Pediatric Surgery Case Reports 2021. [DOI: 10.1016/j.epsc.2021.102045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gupta T, Pant S, Likonda B, Dasgupta A, Chatterjee A, Kannan S, Sastri G, Trivedi S, Dutta D, Jalali R. Comparison of Two Palliative Hypofractionated Radiotherapy Regimens in Poor-Prognosis High-Grade Glioma: A Propensity-Matched Analysis. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abbott KL, Kwakye G, Kim GJ, Luckoski JL, Krumm AE, Clark M, Chen X, Gupta T, Weiser TG, George BC. US general surgical trainee performance for representative global surgery procedures. Am J Surg 2021; 223:224-228. [PMID: 34119330 DOI: 10.1016/j.amjsurg.2021.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Many US general surgery residents are interested in global surgery, but their competence with key procedures is unknown. METHODS Using a registry managed by the Society for Improving Medical Professional Learning (SIMPL), we extracted longitudinal operative performance ratings data for a national cohort of US general surgery residents. Operative performance at the time of graduation was estimated via a Bayesian generalized linear mixed model. RESULTS Operative performance ratings for 12,976 procedures performed by 1584 residents in 52 general surgery programs were analyzed. These spanned 17 of 31 (55%) procedures deemed important for global surgical practice. For these procedures, the probability of a graduating resident being deemed competent to perform a procedure was 0.95 (95% confidence interval 0.86-1.00) but was less than 0.9 for 3 observed procedures. CONCLUSION Our results highlight gaps in the preparedness of US general surgery trainees to perform procedures deemed most important for global surgery settings.
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Affiliation(s)
- Kenneth L Abbott
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA
| | - Gifty Kwakye
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Grace J Kim
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - John L Luckoski
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrew E Krumm
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Michael Clark
- Consulting for Statistics, Computing, and Analytics Research, University of Michigan, Ann Arbor, MI, USA
| | - Xilin Chen
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tanvi Gupta
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Thomas G Weiser
- Stanford University School of Medicine, Department of Surgery, Division of General Surgery, Section of Trauma & Critical Care, Stanford, CA, USA; Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
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Gupta T, Kaur H, Kapila S, Kapila R. Lactobacillus fermentum (MTCC-5898) alleviates Escherichia coli-induced inflammatory responses in intestinal epithelial cells by modulating immune genes and NF-κB signalling. J Appl Microbiol 2021; 131:3008-3017. [PMID: 33999475 DOI: 10.1111/jam.15153] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 02/06/2023]
Abstract
AIM Dietary intervention using probiotic bacteria has emerged as a promising preventive strategy in addressing foodborne infections or gastrointestinal disorders. This study investigated the immunomodulatory effects of Lactobacillus fermentum (MTCC-5898) on Escherichia coli-induced inflammatory responses in intestinal epithelial cells. METHODS AND RESULTS The immune response of intestinal cells (Caco-2) in the presence of probiotic Lact. fermentum was determined during exclusion, competition and displacement of E. coli as the inflammatory agent. To achieve this objective, transcriptional modulation of key immune-related genes (cytokines, pattern recognition receptors and NF-κB), release of cytokines and nuclear translocation of the NF-κB subunit p-65 were studied. Expression of pro-inflammatory cytokines IL-8, TNF-α, IFN-ϒ and IL-23 was high in E. coli-exposed intestinal cells. However, overexpression of these E. coli-induced pro-inflammatory cytokines was prevented by Lact. fermentum during exclusion and competition assays. It also modulated the transcriptional expression of regulatory cytokines (IL-10 and TGF-β), pattern recognition receptors (TLR-2 and TLR-4) and genes associated with master inflammatory regulators (NF-κB and SIGIRR) to reduce E. coli-induced inflammation. The protective effect of Lact. fermentum was further confirmed by suppression of nuclear translocation of cytoplasmic NF-κB subunit (p-65). CONCLUSION Lactobacillus fermentum alleviated E. coli-induced inflammatory responses by modulating the NF-κB signalling besides pro-inflammatory and regulatory cytokines expression. SIGNIFICANCE AND IMPACT OF THE STUDY Lactobacillus fermentum holds significant promise as a potent nutraceutical that prevents and manages inflammatory gut-associated dysfunctions.
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Affiliation(s)
- T Gupta
- Animal Biochemistry Division, ICAR-National Dairy Research Institute, Karnal, India
| | - H Kaur
- Animal Biochemistry Division, ICAR-National Dairy Research Institute, Karnal, India
| | - S Kapila
- Animal Biochemistry Division, ICAR-National Dairy Research Institute, Karnal, India
| | - R Kapila
- Animal Biochemistry Division, ICAR-National Dairy Research Institute, Karnal, India
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Gupta T, Maitre M, Maitre P, Goda JS, Krishnatry R, Chatterjee A, Moiyadi A, Shetty P, Epari S, Sahay A, Patil V, Jalali R. High-dose salvage re-irradiation for recurrent/progressive adult diffuse glioma: healing or hurting? Clin Transl Oncol 2021; 23:1358-1367. [PMID: 33528810 DOI: 10.1007/s12094-020-02526-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To report survival outcomes and identify prognostic factors of salvage re-irradiation (re-RT) in recurrent/progressive glioma. METHODS Medical records of patients treated with high-dose re-RT as part of multi-modality salvage therapy for recurrence/progression of adult diffuse glioma from 2010 to 2019 were analyzed retrospectively. RESULTS A total of 111 patients developing recurrent/progressive high-grade glioma after adequate upfront treatment at initial diagnosis were included. The first course of radiotherapy (RT) had been delivered to a median dose of 59.4 Gy with an inter-quartile range (IQR) of 54-60 Gy. Median time to recurrence/progression was 4.3 years (IQR = 2.3-7.4 years) while the median time to re-RT was 4.8 years (IQR = 3.6-7.9 years). Re-RT was delivered with intensity-modulated radiation therapy (IMRT) using 1.8 Gy/fraction to a median dose of 54 Gy (IQR = 50.4-55.8 Gy) for a cumulative median equivalent dose in 2-Gy fractions (EQD2) of 104.3 Gy (IQR = 102.6-109.4 Gy). At a median follow-up of 14 months after re-RT, the 1-year Kaplan-Meier estimates of post-re-RT progression-free survival (PFS) and overall survival (OS) were 42.8 and 61.8%, respectively. Univariate analysis identified histological grade at recurrence/progression; histological subtype; disease-free interval (DFI) and time interval between both courses of RT; performance status at re-RT; dose at re-RT and cumulative EQD2; isocitrate dehydrogenase (IDH) mutation; and O6-methyl-guanine DNA methyl transferase (MGMT) gene promoter methylation as significant prognostic factors. Preserved performance status, longer DFI, prolonged time interval between both courses of RT, and presence of IDH mutation were associated with significantly improved PFS on multi-variate analysis. However, only performance status retained independent prognostic significance for OS on multi-variate analysis. Post-treatment changes were seen in 33 (30%) patients on follow-up imaging, with higher cumulative dose (EQD2 ≥ 104.3 Gy) being associated with increased risk of post-re-RT pseudo-progression. CONCLUSION This clinical audit reports encouraging survival outcomes and identifies key prognostic factors associated with high-dose salvage re-RT in recurrent/progressive glioma.
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Affiliation(s)
- T Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India.
| | - M Maitre
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - P Maitre
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - J S Goda
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - R Krishnatry
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - A Chatterjee
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - A Moiyadi
- Department of Neuro-Surgical Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - P Shetty
- Department of Neuro-Surgical Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - S Epari
- Department of Pathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - A Sahay
- Department of Pathology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - V Patil
- Department of Medical Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
| | - R Jalali
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India
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Kumari C, Virk AK, Kumari S, Gupta T, Rolta R, Li X, Kulshrestha S. Identification of potential targets for Thymidylate Synthase and Amp-C βlactamase from of non-alkaloidal fractions of Moringa oleifera leaves. Curr Pharm Biotechnol 2021; 22:2085-2093. [PMID: 33430724 DOI: 10.2174/1389201022666210111120208] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
AIM The aim of present investigation is to identify the potential targets for Thymidylate Synthase and Amp-C βlactamase from of non-alkaloidal fractions of Moringa oleifera leaves. BACKGROUND Bioactive constituents from medicinal plants, either as pure compounds or as crude form, provide vast opportunities for new drug discoveries. Due to an increasing demand for chemical diversity in screening programs, seeking therapeutic drugs from natural products, mainly from edible plants, has grown throughout the world. Moringa oleifera has an impressive range of medicinal uses with high nutritional value. Therefore, this medicinal plant has been used widely in traditional Indian medicine for anti-inflammation, anticancer, and antibacterial infections. OBJECTIVES The primary objective is to identify the phytoconstituents present in the maximum proportion in the nonalkaloidal fractions of ethanolic leaf extract of Moringa oleifera. Then, the identified phytoconstituents were used to ensure the potential target molecules for the binding affinity towards the target proteins viz. Thymidylate Synthase (1HVY) and Amp-C beta-lactamase (1FSY) by docking analysis. METHODS In the present investigation, ethanolic extract of Moringa leaves was prepared and then fractionated on the presence/absence of alkaloids. The antimicrobial activity of different fractions of ethanolic leaf extract was evaluated against various pathogens. After this, bioactive molecules present in the non-alkaloidal fractions of ethanolic leaf extract were accomplished through GC-MS analysis and finally the identified phytocompounds were analyzed through docking studies to evaluate their affinity for target proteins viz. Thymidylate Synthase (1HVY) and Amp-C β-lactamase (1FSY). RESULTS The antimicrobial activity of non-alkaloidal fractions of ethanolic leaf extract was evaluated against various pathogens which exhibited significant antimicrobial activity. Twenty phytocompounds were identified as gas chromatogram of the non-alkaloidal fractions (chloroform and ethyl acetate) of leaf extract of M. oleifera, Four most prominent compounds having highest peak area percentage were identified as Ethane, 1,1,2,2-tetrachloro, (46.45%) 2-Propanone, 1,1,3-trichloro, (13.77%) Heptasiloxane, 1,1,3,3,5,5,7,7,9,9,11,11,13,13-tetradecamethyl (17.87%) and 2,4-Dichlorodiphenylsulfone (17.64%). Other notable compounds were 9,12-Octadecadienoic acid (Z,Z) (14.06%), Oleic acid, 3-(octadecyloxy)propyl ester (12.41%), Fluoranthene (6.98%), Phenol, 2,4-bis( 1,1-dimethylethyl) (4.16%) and Phthalic acid, butyl nonyl ester (3.47%). Only, five compounds viz. 2,6-Bis(1,1-dimethylethyl)phenol(C1), Dodecamethylcyclohexasiloxane(C2), Chlorodimethylethylsilane(C3), Fluoranthene(C4) and Hexadecanoic acid, methyl ester(C5) showed the maximum interaction with 1HVY with highest docking score of -178.51Kcal/mol, - 231.65Kcal/mol, -129.18Kcal/mol, - 173.10Kcal/mol and -220.78Kcal/mol, respectively. Also, three compounds viz. Dodecamethylcyclohexasiloxane(C2), Fluoranthene(C4) and Hexadecanoic acid, methyl ester(C5) showed the maximum interaction with 1FSY with highest docking score of -137.23Kcal/mol, -54.34Kcal/mol and -153.84Kcal/mol, respectively. CONCLUSION Moringa plant may provide incredible capabilities to develop pharmacological products. The present finding demonstrated that Moringa oleifera is an excellent plant candidate to be used for improving the health of communities.
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Affiliation(s)
- Chandresh Kumari
- Faculty of Applied Science and Biotechnology, Shoolini University of Biotechnology & Management Sciences, BajholSolan (HP)-173212. India
| | - Amanpreet Kaur Virk
- Faculty of Applied Science and Biotechnology, Shoolini University of Biotechnology & Management Sciences, BajholSolan (HP)-173212. India
| | - Swati Kumari
- Faculty of Applied Science and Biotechnology, Shoolini University of Biotechnology & Management Sciences, BajholSolan (HP)-173212. India
| | - Tanvi Gupta
- Faculty of Applied Science and Biotechnology, Shoolini University of Biotechnology & Management Sciences, BajholSolan (HP)-173212. India
| | - Rajan Rolta
- Faculty of Applied Science and Biotechnology, Shoolini University of Biotechnology & Management Sciences, BajholSolan (HP)-173212. India
| | - Xiangkai Li
- Ministry of Education Key Laboratory of Cell Activities and Stress Adaptations, School of Life Science, Lanzhou University, Tianshuinanlu #222, Lanzhou 730000, Gansu Province. China
| | - Saurabh Kulshrestha
- Faculty of Applied Science and Biotechnology, Shoolini University of Biotechnology & Management Sciences, BajholSolan (HP)-173212. India
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Sardana K, Mathachan SR, Gupta T. Antibiotic resistance in acne an emergent need to recognize resistance to azithromycin and restrict its unapproved use in acne vulgaris. J Eur Acad Dermatol Venereol 2021; 35:e347-e348. [PMID: 33351973 DOI: 10.1111/jdv.17099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/26/2020] [Accepted: 12/16/2020] [Indexed: 12/26/2022]
Affiliation(s)
- K Sardana
- Department of Dermatology, Venereology and Leprosy, ABVIMS & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - S R Mathachan
- Department of Dermatology, Venereology and Leprosy, ABVIMS & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - T Gupta
- Department of Dermatology, Venereology and Leprosy, Maulana Azad Medical College, New Delhi, India
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Gupta R, Rahman K, Gupta T, Singh L, Chandra D, Sarkar M, Singh M, Kumar S, Nityanand S. Hepatosplenic T-cell lymphoma diagnosed using flow cytometry. A single-center study of 12 cases from North India. J Cancer Res Ther 2021; 18:1093-1097. [DOI: 10.4103/jcrt.jcrt_877_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Das D, Kuri G, Soibam R, Bhattacharjee H, Tayab S, Deka H, Das B, Das Mohapatra S, Gupta T, Deka A. Ocular crystals in chronic uveitic eye. J Clin Ophthalmol Res 2021. [DOI: 10.4103/jcor.jcor_37_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gupta T, Sachdeva SN. Recurrent neural network-based prediction of compressive and flexural strength of steel slag mixed concrete. Neural Comput Appl 2020. [DOI: 10.1007/s00521-020-05470-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gupta T, Singh J, Kaur S, Sandhu S, Singh G, Kaur IP. Enhancing Bioavailability and Stability of Curcumin Using Solid Lipid Nanoparticles (CLEN): A Covenant for Its Effectiveness. Front Bioeng Biotechnol 2020; 8:879. [PMID: 33178666 PMCID: PMC7593682 DOI: 10.3389/fbioe.2020.00879] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/09/2020] [Indexed: 12/17/2022] Open
Abstract
Curcumin, very rightly referred to as "a wonder drug" is proven to be efficacious in a variety of inflammatory disorders including cancers. Antiaging, anti-inflammatory, antioxidant, antitumor, chemosensitizing, P-gp efflux inhibiting, and antiproliferative activity are some of the striking features of curcumin, highlighting its importance in chemotherapy. Curcumin inhibits Bcl-2, Bcl-XL, VEGF, c-Myc, ICAM-1, EGFR, STAT3 phosphorylation, and cyclin D1 genes involved in the various stages of breast, prostate, and gastric cancer proliferation, angiogenesis, invasion, and metastasis. The full therapeutic potential of curcumin however remains under explored mainly due to poor absorption, rapid metabolism and systemic elimination culminating in its poor bioavailability. Furthermore, curcumin is insoluble, unstable at various pH and is also prone to undergo photodegradation. Nanotechnology can help improve the therapeutic potential of drug molecules with compromised biopharmaceutical profiles. Solid lipid nanoparticles (SLNs) are the latest offshoot of nanomedicine with proven advantages of high drug payload, longer shelf life, biocompatibility and biodegradability, and industrial amenability of the production process. We successfully developed CLEN (Curcumin encapsulated lipidic nanoconstructs) containing 15 mg curcumin per ml of the SLN dispersion with highest (till date, to our knowledge) increase in solubility of curcumin in an aqueous system by 1.4 × 106 times as compared to its intrinsic solubility of 11 ng/ml and high drug loading (15% w/v with respect to lipid matrix). Zero-order release kinetics observed for CLEN versus first order release for free curcumin establish controlled release nature of the developed CLEN. It showed 69.78 times higher oral bioavailability with respect to free curcumin; 9.00 times higher than a bioavailable marketed formulation (CurcuWIN®). The formulation showed 104, 13.3, and 10-times enhanced stability at pH 6.8, 1.2, and 7.4, respectively. All these factors ensure the efficacy of CLEN in treating cancer and other inflammatory diseases.
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Affiliation(s)
| | | | | | | | | | - Indu Pal Kaur
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
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Rahman K, Harankhedkar S, Gupta R, Gupta T, Sharma S, Nityanand S. Microfilariae in bone marrow aspirate of a case of myelofibrosis: A cause or coincidence? J Cancer Res Ther 2020; 16:164-166. [PMID: 32362629 DOI: 10.4103/jcrt.jcrt_1413_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Filariasis is among the common parasitic infestations found in India, with Wuchereria bancrofti being the most common causative organism. Presentation ranges from clinically asymptomatic to profound elephantiasis. It is also detected incidentally in diagnostic samples such as body fluids, fine needle aspirates, peripheral blood smears, and other cytological smears. Its detection in bone marrow aspirates with an associated hematolymphoid neoplasm is rare, with only a few case reports. We report one such case of young male who presented with leukocytosis of 253 × 109/L with basophilia and massive splenomegaly. Bone marrow aspirate smears showed the presence of microfilariae along with other features of a myeloproliferative neoplasm (MPN). The present case is probably the first case of finding a microfilaria in a case of MPN.
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Affiliation(s)
- Khaliqur Rahman
- Department of Hematology, SGPGI, Lucknow, Uttar Pradesh, India
| | | | - Ruchi Gupta
- Department of Hematology, SGPGI, Lucknow, Uttar Pradesh, India
| | - Tanvi Gupta
- Department of Hematology, SGPGI, Lucknow, Uttar Pradesh, India
| | - Seema Sharma
- Department of Pathology, SGPGI, Lucknow, Uttar Pradesh, India
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Wu PH, Gupta T, Chang H, Petrenko D, Schafer A, Kazakia G. Soft tissue variations influence HR-pQCT density measurements in a spatially dependent manner. Bone 2020; 138:115505. [PMID: 32599223 PMCID: PMC7428203 DOI: 10.1016/j.bone.2020.115505] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Significant weight loss following treatments for obesity undermines bone metabolism and increases bone turnover and fracture incidence. High resolution peripheral quantitative computed tomography (HR-pQCT) is widely used in skeletal heath assessment research to provide noninvasive bone parameter measurement (e.g. volumetric bone mineral density (vBMD)) with minimal radiation exposure. However, variation in body composition among study groups or longitudinal variations within individuals undergoing significant weight change will generate artifacts and errors in HR-pQCT data. The purpose of this study is to determine the influence of these artifacts on the measurement of vBMD. METHODS We designed a custom-made hydroxyapatite (HA)-polymer phantom surrounded by layers of reusable gel pack and hydrogenated fat to mimic the distal tibia and the surrounding lean and fat tissue. Four different thicknesses of fat were used to mimic the soft tissue of increasingly overweight individuals. We then evaluated how a change in soft tissue thickness influenced image quality and vBMD quantification within total, trabecular, and cortical bone compartments. Based on these data, we applied a data correction to previously acquired clinical data in a cohort of gastric bypass patients. RESULTS In the phantom measurements, total, trabecular, and cortical vBMD increased as soft tissue thickness decreased. The impact of soft tissue thickness on vBMD varied by anatomic quadrant. When applying the soft tissue data correction to a set of clinical data, we found that soft tissue reduction following bariatric surgery can lead to a clinically significant underestimation of bone loss in longitudinal data, and that the effect is most severe in the cortical compartment. CONCLUSION HR-pQCT-based vBMD measurement accuracy is influenced by soft tissue thickness and is spatially inhomogeneous. Our results suggest that variations in soft tissue thickness must be considered in HR-pQCT studies, particularly in studies enrolling cohorts with differing body composition or in studies of longitudinal weight change.
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Affiliation(s)
- Po-Hung Wu
- Department of Radiology and Biomedical Imaging at China Basin, University of California - San Francisco, 185 Berry Street, Suite 190, Lobby 6, San Francisco, CA 94107, USA.
| | - Tanvi Gupta
- Department of Radiology and Biomedical Imaging at China Basin, University of California - San Francisco, 185 Berry Street, Suite 190, Lobby 6, San Francisco, CA 94107, USA.
| | - Hanling Chang
- Department of Medicine, University of California - San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, USA
| | - Dimitry Petrenko
- Department of Medicine, University of California - San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, USA
| | - Anne Schafer
- Department of Medicine, University of California - San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; Department of Epidemiology and Biostatistics, University of California -San Francisco, 550 16th St 2nd floor, San Francisco, CA 94158, USA.
| | - Galateia Kazakia
- Department of Radiology and Biomedical Imaging at China Basin, University of California - San Francisco, 185 Berry Street, Suite 190, Lobby 6, San Francisco, CA 94107, USA.
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Sasson SC, Zaunders JJ, Nahar K, Munier CML, Fairfax BP, Olsson-Brown A, Jolly C, Read SA, Ahlenstiel G, Palendira U, Scolyer RA, Carlino MS, Payne MJ, Cheung VTF, Gupta T, Klenerman P, Long GV, Brain O, Menzies AM, Kelleher AD. Mucosal-associated invariant T (MAIT) cells are activated in the gastrointestinal tissue of patients with combination ipilimumab and nivolumab therapy-related colitis in a pathology distinct from ulcerative colitis. Clin Exp Immunol 2020; 202:335-352. [PMID: 32734627 PMCID: PMC7670140 DOI: 10.1111/cei.13502] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/09/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to investigate the pathogenesis of combination ipilimumab and nivolumab-associated colitis (IN-COL) by measuring gut-derived and peripheral blood mononuclear cell (GMNC; PBMC) profiles. We studied GMNC and PBMC from patients with IN-COL, IN-treated with no adverse-events (IN-NAE), ulcerative colitis (UC) and healthy volunteers using flow cytometry. In the gastrointestinal-derived cells we found high levels of activated CD8+ T cells and mucosal-associated invariant T (MAIT) cells in IN-COL, changes that were not evident in IN-NAE or UC. UC, but not IN-C, was associated with a high proportion of regulatory T cells (Treg ). We sought to determine if local tissue responses could be measured in peripheral blood. Peripherally, checkpoint inhibition instigated a rise in activated memory CD4+ and CD8+ T cells, regardless of colitis. Low circulating MAIT cells at baseline was associated with IN-COL patients compared with IN-NAE in one of two cohorts. UC, but not IN-COL, was associated with high levels of circulating plasmablasts. In summary, the alterations in T cell subsets measured in IN-COL-affected tissue, characterized by high levels of activated CD8+ T cells and MAIT cells and a low proportion of Treg , reflected a pathology distinct from UC. These tissue changes differed from the periphery, where T cell activation was a widespread on-treatment effect, and circulating MAIT cell count was low but not reliably predictive of colitis.
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Affiliation(s)
- S C Sasson
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - J J Zaunders
- Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia
| | - K Nahar
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia
| | - C M L Munier
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - B P Fairfax
- Department of Oncology, Churchill Hospital, Oxford, UK.,Department of Oncology, University of Oxford, Oxford, UK.,MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - A Olsson-Brown
- The Clatterbridge Cancer Centre NHS Foundation Trust and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - C Jolly
- The Clatterbridge Cancer Centre NHS Foundation Trust and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - S A Read
- Westmead Institute of Medical Research, Sydney, Australia.,Western Sydney University, Sydney, Australia
| | - G Ahlenstiel
- Westmead Institute of Medical Research, Sydney, Australia.,Department of Gastroenterology, Blacktown Hospital, Sydney, Australia
| | - U Palendira
- Discipline of Infectious Diseases and Immunology, The University of Sydney, Sydney, Australia
| | - R A Scolyer
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - M S Carlino
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Westmead and Blacktown Hospitals, Sydney, Australia
| | - M J Payne
- Department of Oncology, Churchill Hospital, Oxford, UK
| | - V T F Cheung
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - T Gupta
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - P Klenerman
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Peter Medawar Building of Pathogen Research, University of Oxford, Oxford, UK
| | - G V Long
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore Hospital and Mater Hospitals, Sydney, Australia
| | - O Brain
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Gastroenterology, John Radcliffe Hospital, Oxford, UK
| | - A M Menzies
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore Hospital and Mater Hospitals, Sydney, Australia
| | - A D Kelleher
- Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia.,The Kirby Institute, University of New South Wales, Sydney, Australia
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Gupta T, Vanshika, Kumari C, Kulshrestha S. First Report of Mycovirus Infected Sclerotinia sclerotiorum in Cauliflower from Sirmaur District of Himachal Pradesh. Recent Pat Biotechnol 2020; 14:283-294. [PMID: 32767933 DOI: 10.2174/1872208314666200806112116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/13/2020] [Accepted: 06/10/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sclerotinia sclerotiorum is a ubiquitous fungal pathogen infecting more than 400 plant species. Sclerotinia stem rot is known to cause as high as 100% crop loss in many cases. Currently, chemical fungicides are the only known solution to this problem. Thus, there is an urgent need for developing environment-friendly alternatives for controlling this pathogen. The review of published articles revealed that a number of mycoviruses with the potential of a biocontrol agent against Sclerotinia had been identified from different parts of the world. OBJECTIVE The present investigation describes the isolation and characterization of isolates of S. sclerotiorum infecting cauliflower, peas, and mustard for the presence of a potent mycovirus from lower Himachal region of India. METHODS Various infected fields were visited and samples in the form of sclerotia were collected. Various isolates of S. sclerotiorum were obtained, and putative hypovirulent isolates were screened. Thereafter, hypovirulent strains were chosen and mycovirus isolation was performed. Finally, isolates showing an extra nucleic acid band were used for mycovirus isolation and further characterization. Curing of mycovirus was used to confirm if altered phenotype was due to the presence of this virus. RESULTS A ssDNA mycovirus was identified and confirmed from the growth defective isolate. CONCLUSION This mycovirus can in turn act as a biocontrol agent, thus reducing dependency on chemical fungicides and can also be developed in the form of a patent once completely characterized and formulated. To our knowledge, this is the first report on mycovirus isolation from any Sclerotinia sclerotiorumisolate from India.
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Affiliation(s)
- Tanvi Gupta
- Center for Omics and Biodiversity Research, Shoolini University, Solan 9817707071, India,Faculty of Applied Sciences and Biotechnology, Shoolini University, Solan 9625033405, India
| | - Vanshika
- Center for Omics and Biodiversity Research, Shoolini University, Solan 9817707071, India,Faculty of Applied Sciences and Biotechnology, Shoolini University, Solan 9625033405, India
| | - Chandresh Kumari
- Center for Omics and Biodiversity Research, Shoolini University, Solan 9817707071, India,Faculty of Applied Sciences and Biotechnology, Shoolini University, Solan 9625033405, India
| | - Saurabh Kulshrestha
- Center for Omics and Biodiversity Research, Shoolini University, Solan 9817707071, India,Faculty of Applied Sciences and Biotechnology, Shoolini University, Solan 9625033405, India
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Niggas A, Schwestka J, Creutzburg S, Gupta T, Eder D, Bayer BC, Aumayr F, Wilhelm RA. The role of contaminations in ion beam spectroscopy with freestanding 2D materials: A study on thermal treatment. J Chem Phys 2020; 153:014702. [PMID: 32640815 DOI: 10.1063/5.0011255] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
As surface-only materials, freestanding 2D materials are known to have a high level of contamination-mostly in the form of hydrocarbons, water, and residuals from production and exfoliation. For well-designed experiments, it is of particular importance to develop effective cleaning procedures, especially since standard surface science techniques are typically not applicable. We perform ion spectroscopy with highly charged ions transmitted through freestanding atomically thin materials and present two techniques to achieve clean samples, both based on thermal treatment. Ion charge exchange and energy loss are used to analyze the degree of sample contamination. We find that even after cleaning, heavily contaminated spots remain on single layer graphene. The contamination coverage, however, clusters in strand-like structures leaving large clean areas. We present a way to discriminate clean from contaminated areas with our ion beam spectroscopy if the heterogeneity of the surface is increased sufficiently enough. We expect a similar discrimination to be necessary in most other experimental techniques.
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Affiliation(s)
- A Niggas
- Institute of Applied Physics, TU Wien, 1040 Vienna, Austria
| | - J Schwestka
- Institute of Applied Physics, TU Wien, 1040 Vienna, Austria
| | - S Creutzburg
- Institute of Ion Beams and Materials Research, Helmholtz-Zentrum Dresden-Rossendorf, 01328 Dresden, Germany
| | - T Gupta
- Institute of Materials Chemistry, TU Wien, 1060 Vienna, Austria
| | - D Eder
- Institute of Materials Chemistry, TU Wien, 1060 Vienna, Austria
| | - B C Bayer
- Institute of Materials Chemistry, TU Wien, 1060 Vienna, Austria
| | - F Aumayr
- Institute of Applied Physics, TU Wien, 1040 Vienna, Austria
| | - R A Wilhelm
- Institute of Applied Physics, TU Wien, 1040 Vienna, Austria
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Bansal A, Gupta T. Angiokeratoma Circumscriptum on the Breast: A Case with Unusual Features. Indian Dermatol Online J 2020; 11:655-657. [PMID: 32832469 PMCID: PMC7413429 DOI: 10.4103/idoj.idoj_472_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/10/2019] [Accepted: 12/15/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Anuva Bansal
- Department of Dermatology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, Delhi, India
| | - Tanvi Gupta
- Department of Dermatology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, Delhi, India
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Dennis B, Highet A, Kendrick D, Mazer L, Loiselle S, Bandeh-Ahmadi H, Gupta T, Abbott K, Lea J, Dang T, Ramey M, George B, Terhune K. Knowing Your Team: Rapid Assessment of Residents and Fellows for Effective Horizontal Care Delivery in Emergency Events. J Grad Med Educ 2020; 12:272-279. [PMID: 32595843 PMCID: PMC7301919 DOI: 10.4300/jgme-d-20-00290.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Horizontal care, in which clinicians assume roles outside of their usual responsibilities, is an important health care systems response to emergency situations. Allocating residents and fellows into skill-concordant clinical roles, however, is challenging. The most efficient method to accomplish graduate medical education (GME) assessment and deployment for horizontal care is not known. OBJECTIVE We designed a categorization schema that can efficiently facilitate clinical and educational horizontal care delivery for trainees within a given institution. METHODS In September 2019, as part of a general emergency response preparation, a 4-tiered system of trainee categorization was developed at one academic medical center. All residents and fellows were mapped to this system. This single institution model was disseminated to other institutions in 2020 as the COVID-19 pandemic began to affect hospitals nationally. In March 2020, a multi-institution collaborative launched the Trainee Pandemic Role Allocation Tool (TPRAT), which allows institutions to map institutional programs to COVID-19 roles within minutes. This was disseminated to other GME programs for use and refinement. RESULTS The emergency response preparation plan was disseminated and selectively implemented with a positive response from the emergency preparedness team, program directors, and trainees. The TPRAT website was visited more than 100 times in the 2 weeks after its launch. Institutions suggested rapid refinements via webinars and e-mails, and we developed an online user's manual. CONCLUSIONS This tool to assess and deploy trainees horizontally during emergency situations appears feasible and scalable to other GME institutions.
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Gupta T, Bhattacharjee H, Tayab S, Sarma P, Sangma CA, Paul S, Borgohain M. Re: Kwon et al.: Baseline systolic versus diastolic blood pressure dip and subsequent visual field progression in normal-tension glaucoma (Ophthalmology. 2019;126:967-979). Ophthalmology 2020; 127:e37. [PMID: 32444023 DOI: 10.1016/j.ophtha.2019.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/20/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Shahinur Tayab
- Department of Glaucoma, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Prafulla Sarma
- Department of Glaucoma, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | | | - Susmita Paul
- Department of Glaucoma, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Mayuri Borgohain
- Department of Glaucoma, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
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Singal A, Gupta T, Sahni D, Aggarwal A. Anatomy of scalenovertebral triangle: A vade mecum for clinicians. Morphologie 2020; 104:174-181. [PMID: 31982324 DOI: 10.1016/j.morpho.2019.12.004] [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: 03/04/2019] [Revised: 12/27/2019] [Accepted: 12/31/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE OF THE STUDY The thorough anatomical knowledge of scalenovertebral triangle or Triangle of the vertebral artery and its contents is crucial in various neurosurgical procedures such as scalenotomy, stellate ganglion block, direct isolation of proximal vertebral artery and proximal brachial plexus repair. MATERIAL AND METHOD Thirty scalenovertebral triangles of known age and sex were dissected. The morphometry of the triangle and stellate ganglion was done. Various relevant distances were measured for topographical location of neurovascular structures especially stellate ganglion and vertebral artery within the triangle. RESULTS The mean height and width of the scalenovertebral triangle was 21.7+5.1mm and 19.4+4.4mm respectively. Vertebral artery originated from subclavian artery within the triangle except in one case (left side) where it originated from aortic arch. The mean minimum distance of stellate ganglion from phrenic nerve, scalenus anterior and vertebral origin was 12.6+4.5mm, 12.26+4mm and 2.3+1.3mm respectively. CONCLUSIONS The origin and proximal part of vertebral artery may not be present within the scalenovertebral triangle, thus topographic anatomy of the stellate ganglion is also affected and may cause complications during stellate ganglion block. Stellate ganglion is never located in the lateral or upper third of triangle. Occasionally, the phrenic nerve may cross the triangle, making it unsafe during stellate ganglion block.
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Affiliation(s)
- A Singal
- Department of Anatomy, All India institute of Medical Sciences, 151001 Bathinda (Punjab), India
| | - T Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education & Research (PGIMER), 160012 Chandigarh, India.
| | - D Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education & Research (PGIMER), 160012 Chandigarh, India
| | - A Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education & Research (PGIMER), 160012 Chandigarh, India
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krishnatry R, Maitre M, Goda J, Jalali R, Moiyadi A, Gupta T. PO-139: Cushing’s disease outcomes with conventional fractionated modern stereotactic conformal or IM-IGRT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(20)30481-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Menon N, Simha V, Abhyankar A, Kalra D, Krishnatry R, Gupta T, Jalali R, Patil V. Pattern of care in high-grade gliomas after recurrence. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz419.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Krishnatry R, Gudi S, Sawant S, Sastri J, Gupta T. Optimizing Immobilization and IGRT schedule for decreasing PTV margins for supine Cranio-spinal irradiation. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.07.033] [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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Noronha V, Patil V, Joshi A, Menon N, Agarwal J, Laskar S, Budrukkar A, Murthy V, Gupta T, Prabhash K. DOES AGE MATTER FOR RADICAL CHEMORADIATION IN HEAD AND NECK CANCER: A POST-HOC ANALYSIS OF A RANDOMIZED STUDY. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31203-2] [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] [Indexed: 11/29/2022]
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