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Tsang S, Mittal T. Satisfaction of orthodontic Post-CCST training: A survey of trainee perceptions. J Orthod 2024; 51:7-18. [PMID: 37081826 DOI: 10.1177/14653125231170020] [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: 04/22/2023]
Abstract
INTRODUCTION This survey was undertaken as a second part to 'Barriers to Post-CCST training in orthodontics: A survey of trainee perceptions'. Recruitment of Post-CCST trainees in certain areas of the country has attracted concerns as it has become increasingly difficult. This survey was undertaken to assess trainee satisfaction with Post-CCST training and to look at possible ways to improve trainee satisfaction and make Post-CCST training more desirable. METHODS The Training Grades Group (TGG) committee of the British Orthodontic Society (BOS) produced an online survey that was sent to all TGG members and newly qualified consultants in May 2021. All Post-CCSTs who entered training between February 2017 and October 2020, were asked to complete the survey. RESULTS There were 37 respondents, which gave a response rate of 62%. While 61% of respondents were satisfied with their Post-CCST training, 17% were 'neither satisfied or dissatisfied' and 6% were either 'dissatisfied' or 'very dissatisfied'. Of the 37 respondents, 25 (67%) would apply for Post-CCST training again, 6 (16%) would not and 6 (16%) did not answer this question. When asked for possible suggestions for improvements to Post-CCST training to encourage greater satisfaction, the responses could be grouped into the following themes: Part-time training; Teaching; Time commitment; Salary; and Experience. CONCLUSION In general, respondents were satisfied with Post-CCST training. There was a significant range of positive and negative responses to various aspects of training including multidisciplinary team clinic preparation, support, supervision and management experience. Suggestions for improvements echo the barriers to Post-CCST training survey.
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Affiliation(s)
- Stacey Tsang
- Orthodontic Department, Milton Keynes University Hospital, Milton Keynes, UK
| | - Tarun Mittal
- Orthodontic Department, The James Cook University Hospital, Middlesbrough, UK
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Mittal T, Ahuja A, Dey A, Malik VK. Surgical Importance of Belseys Fat in Sleeve Gastrectomy-a Less Visited Topic. Obes Surg 2023; 33:4174-4175. [PMID: 37907676 DOI: 10.1007/s11695-023-06892-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/06/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Affiliation(s)
- Tarun Mittal
- Department of Laparoscopic, Laser & General Surgery, Sir Ganga Ram Hospital, New Delhi, 110060, India.
| | - Anmol Ahuja
- Department of Laparoscopic, Laser & General Surgery, Sir Ganga Ram Hospital, New Delhi, 110060, India
| | - Ashish Dey
- Department of Laparoscopic, Laser & General Surgery, Sir Ganga Ram Hospital, New Delhi, 110060, India
| | - Vinod K Malik
- Department of Laparoscopic, Laser & General Surgery, Sir Ganga Ram Hospital, New Delhi, 110060, India
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Osama MA, Rao S, Mittal T, Kumar S. Gastric Metastasis of Primary Neuroendocrine Tumor of Skin: Rare Tumor with Rare Presentation. J Lab Physicians 2023; 15:466-469. [PMID: 37564238 PMCID: PMC10411111 DOI: 10.1055/s-0042-1760670] [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: 01/20/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a rare primary neuroendocrine tumor of the skin. It has an aggressive biological behavior and shows early local and distant metastasis. Diagnosis of MCC is a challenge and requires confirmation by immunohistochemistry (IHC). However, metastasis of MCC to the stomach is extremely uncommon and is rarely reported in the literature. We hereby describe a patient with gastric metastasis of MCC, who presented with black tarry stool and was finally diagnosed on the basis of clinical history, histology, and IHC.
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Affiliation(s)
- Md Ali Osama
- Department of Pathology, Lady Hardinge Medical College, New Delhi, India
| | - Seema Rao
- Department of Histopathology, Sir Gangaram Hospital, New Delhi, India
| | - Tarun Mittal
- Department of General and Laparoscopic Surgery, Sir Gangaram Hospital, New Delhi, India
| | - Sandeep Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Bhopal, India
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Lota AS, Hazebroek MR, Theotokis P, Wassall R, Salmi S, Halliday BP, Tayal U, Verdonschot J, Meena D, Owen R, de Marvao A, Iacob A, Yazdani M, Hammersley DJ, Jones RE, Wage R, Buchan R, Vivian F, Hafouda Y, Noseda M, Gregson J, Mittal T, Wong J, Robertus JL, Baksi AJ, Vassiliou V, Tzoulaki I, Pantazis A, Cleland JG, Barton PJ, Cook SA, Pennell DJ, Garcia-Pavia P, Cooper LT, Heymans S, Ware JS, Prasad SK. Genetic Architecture of Acute Myocarditis and the Overlap With Inherited Cardiomyopathy. Circulation 2022; 146:1123-1134. [PMID: 36154167 PMCID: PMC9555763 DOI: 10.1161/circulationaha.121.058457] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 07/15/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Acute myocarditis is an inflammatory condition that may herald the onset of dilated cardiomyopathy (DCM) or arrhythmogenic cardiomyopathy (ACM). We investigated the frequency and clinical consequences of DCM and ACM genetic variants in a population-based cohort of patients with acute myocarditis. METHODS This was a population-based cohort of 336 consecutive patients with acute myocarditis enrolled in London and Maastricht. All participants underwent targeted DNA sequencing for well-characterized cardiomyopathy-associated genes with comparison to healthy controls (n=1053) sequenced on the same platform. Case ascertainment in England was assessed against national hospital admission data. The primary outcome was all-cause mortality. RESULTS Variants that would be considered pathogenic if found in a patient with DCM or ACM were identified in 8% of myocarditis cases compared with <1% of healthy controls (P=0.0097). In the London cohort (n=230; median age, 33 years; 84% men), patients were representative of national myocarditis admissions (median age, 32 years; 71% men; 66% case ascertainment), and there was enrichment of rare truncating variants (tv) in ACM-associated genes (3.1% of cases versus 0.4% of controls; odds ratio, 8.2; P=0.001). This was driven predominantly by DSP-tv in patients with normal LV ejection fraction and ventricular arrhythmia. In Maastricht (n=106; median age, 54 years; 61% men), there was enrichment of rare truncating variants in DCM-associated genes, particularly TTN-tv, found in 7% (all with left ventricular ejection fraction <50%) compared with 1% in controls (odds ratio, 3.6; P=0.0116). Across both cohorts over a median of 5.0 years (interquartile range, 3.9-7.8 years), all-cause mortality was 5.4%. Two-thirds of deaths were cardiovascular, attributable to worsening heart failure (92%) or sudden cardiac death (8%). The 5-year mortality risk was 3.3% in genotype-negative patients versus 11.1% for genotype-positive patients (Padjusted=0.08). CONCLUSIONS We identified DCM- or ACM-associated genetic variants in 8% of patients with acute myocarditis. This was dominated by the identification of DSP-tv in those with normal left ventricular ejection fraction and TTN-tv in those with reduced left ventricular ejection fraction. Despite differences between cohorts, these variants have clinical implications for treatment, risk stratification, and family screening. Genetic counseling and testing should be considered in patients with acute myocarditis to help reassure the majority while improving the management of those with an underlying genetic variant.
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Affiliation(s)
- Amrit S. Lota
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Mark R. Hazebroek
- Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (M.R.H., J.V., S.H.)
| | - Pantazis Theotokis
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Rebecca Wassall
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Sara Salmi
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Brian P. Halliday
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Upasana Tayal
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Job Verdonschot
- Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (M.R.H., J.V., S.H.)
| | - Devendra Meena
- Epidemiology and Biostatistics, School of Public Health (D.M., I.T.), Imperial College London, UK
| | - Ruth Owen
- London School of Hygiene and Tropical Medicine, UK (R.O., J.G.)
| | - Antonio de Marvao
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Alma Iacob
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Momina Yazdani
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Daniel J. Hammersley
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Richard E. Jones
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Riccardo Wage
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Rachel Buchan
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Fredrik Vivian
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Yakeen Hafouda
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Michela Noseda
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
| | - John Gregson
- London School of Hygiene and Tropical Medicine, UK (R.O., J.G.)
| | - Tarun Mittal
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Joyce Wong
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Jan Lukas Robertus
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - A. John Baksi
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Vassilios Vassiliou
- Norfolk and Norwich University Hospital and University of East Anglia, Norwich, UK (V.V.)
| | - Ioanna Tzoulaki
- Epidemiology and Biostatistics, School of Public Health (D.M., I.T.), Imperial College London, UK
| | - Antonis Pantazis
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - John G.F. Cleland
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Robertson Centre for Biostatistics, University of Glasgow, UK (J.G.F.C.)
| | - Paul J.R. Barton
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- MRC London Institute of Medical Sciences (P.J.R.B., S.A.C., J.S.W.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Stuart A. Cook
- MRC London Institute of Medical Sciences (P.J.R.B., S.A.C., J.S.W.), Imperial College London, UK
- National Heart Centre Singapore and Duke-National University of Singapore (S.A.C.)
| | - Dudley J. Pennell
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain (P.G.-P.)
- Universidad Francisco de Vitoria, Pozuelo de Alarcon, Spain (P.G.-P.)
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (P.G.-P.)
| | - Leslie T. Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (L.T.C.)
| | - Stephane Heymans
- Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (M.R.H., J.V., S.H.)
| | - James S. Ware
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- MRC London Institute of Medical Sciences (P.J.R.B., S.A.C., J.S.W.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
| | - Sanjay K. Prasad
- National Heart & Lung Institute (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., M.N., J.L.R., A.P., J.G.F.C., P.J.R.B., D.J.P., J.S.W., S.K.P.), Imperial College London, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (A.S.L., P.T., R.W., S.S., B.P.H., U.T., A.d.M., A.I., M.Y., M.J.H., R.E.J., R.W., R.B., F.V., Y.H., T.M., J.W., J.L.R., A.J.B., A.P., P.J.R.B., D.J.P., J.S.W., S.K.P.)
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Tyagi V, Pahwa M, Chadha S, Mittal T, Ahuja A. Robot-assisted radical cystectomy with intracorporeal urinary diversion - An experience with hybrid sandwich technique. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02186-3] [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: 11/06/2022] Open
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6
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Hothi S, Mittal T, Duarte A, Venugopal V, Taleyratne D, O’Brien D, Adnan K, Sehmi J, Daskalopoulos G, Deshpande A, Elfawal S, Sharma V, Shahin R, Yuan M, Schlosshan D, Walker A, Rahman SED, Sunderji I, Wagh S, Beattie A, Chow J, Masood M, Sharma S, Agrawal S, Duraikannu C, McAlindon E, Mirsadraee S, Nicol E, Kelion A. 136 The use and efficacy of ffr-ct – a real-world multi-centre audit of clinical data and cost-analysis. IMAGING 2022. [DOI: 10.1136/heartjnl-2022-bcs.136] [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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7
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Mittal T, Ahuja A, Dey A, Malik VK, Sheikh MTM, Bansal NK, Kanuri H. Safety and efficacy of laparoscopic sleeve gastrectomy in patients with portal hypertension with liver function of Childs A. Surg Endosc 2022; 36:2942-2948. [PMID: 34129090 DOI: 10.1007/s00464-021-08587-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/02/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Advanced liver disease and portal hypertension (PH) are seen as a relative contraindication for bariatric and metabolic surgery. Several studies have shown significant improvement in liver function and liver histology after bariatric surgery. There are very few studies describing bariatric surgery in patients with PH. The purpose of this retrospective study is to evaluate the feasibility and results of laparoscopic sleeve gastrectomy (SG) in patients with PH. MATERIAL AND METHODS We present our experience of performing laparoscopic SG in 15 patients with evidence of PH. All the patients were Childs Pugh Criteria A. PH was confirmed by the presence of dilated esophageal varices on endoscopy. RESULTS The mean operative time was 77.33 ± 15.22 min and mean blood loss was 80.67 ± 37.12 ml. The mean length of stay was 2.73 ± 0.59 days. There were no intraoperative or immediate postoperative complications. None of the patients required blood transfusion in the postoperative period. The weight, BMI, Excess body weight loss% (EBWL%), Total weight loss (TWL) and TWL% at 1 year were 86.05 ± 14.40 kg, 31.16 kg/m2 ± 3.82, 63.84% ± 15.24, 31.49 ± 9.54 kg and 26.50 ± 5.42%, respectively. Diabetes and hypertension resolution at 1 year was 80% and 72.72%, respectively. All the patients were followed up for mean 3 ± 1.5 years. There were no immediate or long-term morbidity and mortality noted. CONCLUSION SG is a feasible and safe option for the treatment of obesity in carefully selected patients with PH with good weight loss and comorbidity resolution.
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Affiliation(s)
- Tarun Mittal
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India.
| | - Anmol Ahuja
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India
| | - Ashish Dey
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India
| | - Vinod K Malik
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India
| | - Mohammad Taha Mustafa Sheikh
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India
| | - Naresh Kumar Bansal
- Institute of Liver Gastroenterology and Hepatobiliary Sciences, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India
| | - Harish Kanuri
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India
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8
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Singhal R, Ludwig C, Rudge G, Gkoutos GV, Tahrani A, Mahawar K, Pędziwiatr M, Major P, Zarzycki P, Pantelis A, Lapatsanis DP, Stravodimos G, Matthys C, Focquet M, Vleeschouwers W, Spaventa AG, Zerrweck C, Vitiello A, Berardi G, Musella M, Sanchez-Meza A, Cantu FJ, Mora F, Cantu MA, Katakwar A, Reddy DN, Elmaleh H, Hassan M, Elghandour A, Elbanna M, Osman A, Khan A, Layani L, Kiran N, Velikorechin A, Solovyeva M, Melali H, Shahabi S, Agrawal A, Shrivastava A, Sharma A, Narwaria B, Narwaria M, Raziel A, Sakran N, Susmallian S, Karagöz L, Akbaba M, Pişkin SZ, Balta AZ, Senol Z, Manno E, Iovino MG, Osman A, Qassem M, Arana-Garza S, Povoas HP, Vilas-Boas ML, Naumann D, Super J, Li A, Ammori BJ, Balamoun H, Salman M, Nasta AM, Goel R, Sánchez-Aguilar H, Herrera MF, Abou-Mrad A, Cloix L, Mazzini GS, Kristem L, Lazaro A, Campos J, Bernardo J, González J, Trindade C, Viveiros O, Ribeiro R, Goitein D, Hazzan D, Segev L, Beck T, Reyes H, Monterrubio J, García P, Benois M, Kassir R, Contine A, Elshafei M, Aktas S, Weiner S, Heidsieck T, Level L, Pinango S, Ortega PM, Moncada R, Valenti V, Vlahović I, Boras Z, Liagre A, Martini F, Juglard G, Motwani M, Saggu SS, Al Moman H, López LAA, Cortez MAC, Zavala RA, D'Haese C, Kempeneers I, Himpens J, Lazzati A, Paolino L, Bathaei S, Bedirli A, Yavuz A, Büyükkasap Ç, Özaydın S, Kwiatkowski A, Bartosiak K, Walędziak M, Santonicola A, Angrisani L, Iovino P, Palma R, Iossa A, Boru CE, De Angelis F, Silecchia G, Hussain A, Balchandra S, Coltell IB, Pérez JL, Bohra A, Awan AK, Madhok B, Leeder PC, Awad S, Al-Khyatt W, Shoma A, Elghadban H, Ghareeb S, Mathews B, Kurian M, Larentzakis A, Vrakopoulou GZ, Albanopoulos K, Bozdag A, Lale A, Kirkil C, Dincer M, Bashir A, Haddad A, Hijleh LA, Zilberstein B, de Marchi DD, Souza WP, Brodén CM, Gislason H, Shah K, Ambrosi A, Pavone G, Tartaglia N, Kona SLK, Kalyan K, Perez CEG, Botero MAF, Covic A, Timofte D, Maxim M, Faraj D, Tseng L, Liem R, Ören G, Dilektasli E, Yalcin I, AlMukhtar H, Al Hadad M, Mohan R, Arora N, Bedi D, Rives-Lange C, Chevallier JM, Poghosyan T, Sebbag H, Zinaï L, Khaldi S, Mauchien C, Mazza D, Dinescu G, Rea B, Pérez-Galaz F, Zavala L, Besa A, Curell A, Balibrea JM, Vaz C, Galindo L, Silva N, Caballero JLE, Sebastian SO, Marchesini JCD, da Fonseca Pereira RA, Sobottka WH, Fiolo FE, Turchi M, Coelho ACJ, Zacaron AL, Barbosa A, Quinino R, Menaldi G, Paleari N, Martinez-Duartez P, de Aragon Ramírez de Esparza GM, Esteban VS, Torres A, Garcia-Galocha JL, Josa M, Pacheco-Garcia JM, Mayo-Ossorio MA, Chowbey P, Soni V, de Vasconcelos Cunha HA, Castilho MV, Ferreira RMA, Barreiro TA, Charalabopoulos A, Sdralis E, Davakis S, Bomans B, Dapri G, Van Belle K, Takieddine M, Vaneukem P, Karaca ESA, Karaca FC, Sumer A, Peksen C, Savas OA, Chousleb E, Elmokayed F, Fakhereldin I, Aboshanab HM, Swelium T, Gudal A, Gamloo L, Ugale A, Ugale S, Boeker C, Reetz C, Hakami IA, Mall J, Alexandrou A, Baili E, Bodnar Z, Maleckas A, Gudaityte R, Guldogan CE, Gundogdu E, Ozmen MM, Thakkar D, Dukkipati N, Shah PS, Shah SS, Shah SS, Adil MT, Jambulingam P, Mamidanna R, Whitelaw D, Adil MT, Jain V, Veetil DK, Wadhawan R, Torres A, Torres M, Tinoco T, Leclercq W, Romeijn M, van de Pas K, Alkhazraji AK, Taha SA, Ustun M, Yigit T, Inam A, Burhanulhaq M, Pazouki A, Eghbali F, Kermansaravi M, Jazi AHD, Mahmoudieh M, Mogharehabed N, Tsiotos G, Stamou K, Barrera Rodriguez FJ, Rojas Navarro MA, Torres OMO, Martinez SL, Tamez ERM, Millan Cornejo GA, Flores JEG, Mohammed DA, Elfawal MH, Shabbir A, Guowei K, So JB, Kaplan ET, Kaplan M, Kaplan T, Pham D, Rana G, Kappus M, Gadani R, Kahitan M, Pokharel K, Osborne A, Pournaras D, Hewes J, Napolitano E, Chiappetta S, Bottino V, Dorado E, Schoettler A, Gaertner D, Fedtke K, Aguilar-Espinosa F, Aceves-Lozano S, Balani A, Nagliati C, Pennisi D, Rizzi A, Frattini F, Foschi D, Benuzzi L, Parikh C, Shah H, Pinotti E, Montuori M, Borrelli V, Dargent J, Copaescu CA, Hutopila I, Smeu B, Witteman B, Hazebroek E, Deden L, Heusschen L, Okkema S, Aufenacker T, den Hengst W, Vening W, van der Burgh Y, Ghazal A, Ibrahim H, Niazi M, Alkhaffaf B, Altarawni M, Cesana GC, Anselmino M, Uccelli M, Olmi S, Stier C, Akmanlar T, Sonnenberg T, Schieferbein U, Marcolini A, Awruch D, Vicentin M, de Souza Bastos EL, Gregorio SA, Ahuja A, Mittal T, Bolckmans R, Wiggins T, Baratte C, Wisnewsky JA, Genser L, Chong L, Taylor L, Ward S, Chong L, Taylor L, Hi MW, Heneghan H, Fearon N, Plamper A, Rheinwalt K, Heneghan H, Geoghegan J, Ng KC, Fearon N, Kaseja K, Kotowski M, Samarkandy TA, Leyva-Alvizo A, Corzo-Culebro L, Wang C, Yang W, Dong Z, Riera M, Jain R, Hamed H, Said M, Zarzar K, Garcia M, Türkçapar AG, Şen O, Baldini E, Conti L, Wietzycoski C, Lopes E, Pintar T, Salobir J, Aydin C, Atici SD, Ergin A, Ciyiltepe H, Bozkurt MA, Kizilkaya MC, Onalan NBD, Zuber MNBA, Wong WJ, Garcia A, Vidal L, Beisani M, Pasquier J, Vilallonga R, Sharma S, Parmar C, Lee L, Sufi P, Sinan H, Saydam M. 30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries. Obes Surg 2021; 31:4272-4288. [PMID: 34328624 PMCID: PMC8323543 DOI: 10.1007/s11695-021-05493-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.
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Affiliation(s)
- Rishi Singhal
- Upper GI unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Christian Ludwig
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gavin Rudge
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, B15 2TT, UK
- MRC Health Data Research UK (HDR), Midlands Site, UK
| | - Abd Tahrani
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kamal Mahawar
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
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Rajani P, ElMorsy ElMaghawry M, Mittal T, Mattar W. Anomalous Left Coronary Artery Arising From Right Coronary Sinus in the Setting of Anterior STEMI. JACC Case Rep 2021; 3:1182-1186. [PMID: 34401755 PMCID: PMC8353565 DOI: 10.1016/j.jaccas.2021.04.003] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 06/13/2023]
Abstract
We present the case of a 55-year-old man who had a diagnosis of an acute anterior ST-segment elevation myocardial infarction. Emergency angiography demonstrated that both coronary systems originated from the right coronary sinus with a culprit proximal left anterior descending artery lesion, which was stented. This is a rare presentation, with only 1 similar case found in published reports. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Prina Rajani
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Uxbridge, United Kingdom
| | | | - Tarun Mittal
- Department of Imaging, Royal Brompton and Harefield NHS Foundation Trust, Uxbridge, United Kingdom
| | - Wala Mattar
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Uxbridge, United Kingdom
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10
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Singhal R, Ludwig C, Rudge G, Gkoutos GV, Tahrani A, Mahawar K, Pędziwiatr M, Major P, Zarzycki P, Pantelis A, Lapatsanis DP, Stravodimos G, Matthys C, Focquet M, Vleeschouwers W, Spaventa AG, Zerrweck C, Vitiello A, Berardi G, Musella M, Sanchez-Meza A, Cantu FJ, Mora F, Cantu MA, Katakwar A, Reddy DN, Elmaleh H, Hassan M, Elghandour A, Elbanna M, Osman A, Khan A, Layani L, Kiran N, Velikorechin A, Solovyeva M, Melali H, Shahabi S, Agrawal A, Shrivastava A, Sharma A, Narwaria B, Narwaria M, Raziel A, Sakran N, Susmallian S, Karagöz L, Akbaba M, Pişkin SZ, Balta AZ, Senol Z, Manno E, Iovino MG, Osman A, Qassem M, Arana-Garza S, Povoas HP, Vilas-Boas ML, Naumann D, Super J, Li A, Ammori BJ, Balamoun H, Salman M, Nasta AM, Goel R, Sánchez-Aguilar H, Herrera MF, Abou-Mrad A, Cloix L, Mazzini GS, Kristem L, Lazaro A, Campos J, Bernardo J, González J, Trindade C, Viveiros O, Ribeiro R, Goitein D, Hazzan D, Segev L, Beck T, Reyes H, Monterrubio J, García P, Benois M, Kassir R, Contine A, Elshafei M, Aktas S, Weiner S, Heidsieck T, Level L, Pinango S, Ortega PM, Moncada R, Valenti V, Vlahović I, Boras Z, Liagre A, Martini F, Juglard G, Motwani M, Saggu SS, Al Moman H, López LAA, Cortez MAC, Zavala RA, D'Haese C, Kempeneers I, Himpens J, Lazzati A, Paolino L, Bathaei S, Bedirli A, Yavuz A, Büyükkasap Ç, Özaydın S, Kwiatkowski A, Bartosiak K, Walędziak M, Santonicola A, Angrisani L, Iovino P, Palma R, Iossa A, Boru CE, De Angelis F, Silecchia G, Hussain A, Balchandra S, Coltell IB, Pérez JL, Bohra A, Awan AK, Madhok B, Leeder PC, Awad S, Al-Khyatt W, Shoma A, Elghadban H, Ghareeb S, Mathews B, Kurian M, Larentzakis A, Vrakopoulou GZ, Albanopoulos K, Bozdag A, Lale A, Kirkil C, Dincer M, Bashir A, Haddad A, Hijleh LA, Zilberstein B, de Marchi DD, Souza WP, Brodén CM, Gislason H, Shah K, Ambrosi A, Pavone G, Tartaglia N, Kona SLK, Kalyan K, Perez CEG, Botero MAF, Covic A, Timofte D, Maxim M, Faraj D, Tseng L, Liem R, Ören G, Dilektasli E, Yalcin I, AlMukhtar H, Al Hadad M, Mohan R, Arora N, Bedi D, Rives-Lange C, Chevallier JM, Poghosyan T, Sebbag H, Zinaï L, Khaldi S, Mauchien C, Mazza D, Dinescu G, Rea B, Pérez-Galaz F, Zavala L, Besa A, Curell A, Balibrea JM, Vaz C, Galindo L, Silva N, Caballero JLE, Sebastian SO, Marchesini JCD, da Fonseca Pereira RA, Sobottka WH, Fiolo FE, Turchi M, Coelho ACJ, Zacaron AL, Barbosa A, Quinino R, Menaldi G, Paleari N, Martinez-Duartez P, de Aragon Ramírez de Esparza GM, Esteban VS, Torres A, Garcia-Galocha JL, Josa M, Pacheco-Garcia JM, Mayo-Ossorio MA, Chowbey P, Soni V, de Vasconcelos Cunha HA, Castilho MV, Ferreira RMA, Barreiro TA, Charalabopoulos A, Sdralis E, Davakis S, Bomans B, Dapri G, Van Belle K, Takieddine M, Vaneukem P, Karaca ESA, Karaca FC, Sumer A, Peksen C, Savas OA, Chousleb E, Elmokayed F, Fakhereldin I, Aboshanab HM, Swelium T, Gudal A, Gamloo L, Ugale A, Ugale S, Boeker C, Reetz C, Hakami IA, Mall J, Alexandrou A, Baili E, Bodnar Z, Maleckas A, Gudaityte R, Guldogan CE, Gundogdu E, Ozmen MM, Thakkar D, Dukkipati N, Shah PS, Shah SS, Shah SS, Adil MT, Jambulingam P, Mamidanna R, Whitelaw D, Adil MT, Jain V, Veetil DK, Wadhawan R, Torres A, Torres M, Tinoco T, Leclercq W, Romeijn M, van de Pas K, Alkhazraji AK, Taha SA, Ustun M, Yigit T, Inam A, Burhanulhaq M, Pazouki A, Eghbali F, Kermansaravi M, Jazi AHD, Mahmoudieh M, Mogharehabed N, Tsiotos G, Stamou K, Barrera Rodriguez FJ, Rojas Navarro MA, Torres OMO, Martinez SL, Tamez ERM, Millan Cornejo GA, Flores JEG, Mohammed DA, Elfawal MH, Shabbir A, Guowei K, So JB, Kaplan ET, Kaplan M, Kaplan T, Pham D, Rana G, Kappus M, Gadani R, Kahitan M, Pokharel K, Osborne A, Pournaras D, Hewes J, Napolitano E, Chiappetta S, Bottino V, Dorado E, Schoettler A, Gaertner D, Fedtke K, Aguilar-Espinosa F, Aceves-Lozano S, Balani A, Nagliati C, Pennisi D, Rizzi A, Frattini F, Foschi D, Benuzzi L, Parikh C, Shah H, Pinotti E, Montuori M, Borrelli V, Dargent J, Copaescu CA, Hutopila I, Smeu B, Witteman B, Hazebroek E, Deden L, Heusschen L, Okkema S, Aufenacker T, den Hengst W, Vening W, van der Burgh Y, Ghazal A, Ibrahim H, Niazi M, Alkhaffaf B, Altarawni M, Cesana GC, Anselmino M, Uccelli M, Olmi S, Stier C, Akmanlar T, Sonnenberg T, Schieferbein U, Marcolini A, Awruch D, Vicentin M, de Souza Bastos EL, Gregorio SA, Ahuja A, Mittal T, Bolckmans R, Wiggins T, Baratte C, Wisnewsky JA, Genser L, Chong L, Taylor L, Ward S, Chong L, Taylor L, Hi MW, Heneghan H, Fearon N, Plamper A, Rheinwalt K, Heneghan H, Geoghegan J, Ng KC, Fearon N, Kaseja K, Kotowski M, Samarkandy TA, Leyva-Alvizo A, Corzo-Culebro L, Wang C, Yang W, Dong Z, Riera M, Jain R, Hamed H, Said M, Zarzar K, Garcia M, Türkçapar AG, Şen O, Baldini E, Conti L, Wietzycoski C, Lopes E, Pintar T, Salobir J, Aydin C, Atici SD, Ergin A, Ciyiltepe H, Bozkurt MA, Kizilkaya MC, Onalan NBD, Zuber MNBA, Wong WJ, Garcia A, Vidal L, Beisani M, Pasquier J, Vilallonga R, Sharma S, Parmar C, Lee L, Sufi P, Sinan H, Saydam M. 30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries. Obes Surg 2021. [PMID: 34328624 DOI: 10.1007/s11695-021-05493-9.] [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: 01/08/2023]
Abstract
BACKGROUND There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.
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Affiliation(s)
- Rishi Singhal
- Upper GI unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Christian Ludwig
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gavin Rudge
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,NIHR Biomedical Research Centre, Birmingham, B15 2TT, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, B15 2TT, UK.,MRC Health Data Research UK (HDR), Midlands Site, UK
| | - Abd Tahrani
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK.,Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kamal Mahawar
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
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Pottle A, Deane S, Dent N, Mackay N, Marshall G, Mittal T. Same day CT angiography in a nurse-led Rapid Access Chest Pain Clinic. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
None
Background
Rapid Access Chest Pain clinics (RACPCs) were established in the UK in 2000 following the publication of the National Service Framework for Coronary Heart Disease. Patients underwent an exercise test (ETT) in the clinic as part of a ‘one-stop’ protocol with follow-up only if further investigation was required. In 2010, the National Institute for Health and Care Excellence (NICE) produced guidelines for the assessment and diagnosis of chest pain of recent onset (CG95), replacing the recommendation for ETT with non-invasive functional testing for patients with an intermediate pre-test probability of coronary artery disease (CAD), necessitating multiple appointments to evaluate the patient’s symptoms. The guidelines were updated in 2016, with a new recommendation that patients with atypical or typical chest pain should undergo CT coronary angiography (CTCA) as the first diagnostic test.
Purpose
The aim of this study was to investigate the feasibility and potential benefit of performing same -day CTCA in the RACPC.
Method
From November 2016 all patients with atypical or typical chest pain attending the RACPC at this tertiary cardiac centre were referred for CTCA unless alternative investigation was clinically indicated. From February 2018, same day CTCA was offered to some patients. Up to two scans could be performed in each clinic, which was increased to up to three in June 2018.
Results
A total of 985 patients were seen in the nurse-led clinic between 12/02/2018 and 30/11/2019. 473 patients were referred for CTCA (48.0%) and 314 scans were carried out in the clinic (66.4%). Of those scans carried out in clinic, 128 patients had a CTCA which showed no evidence of CAD (40.8%) and 34.4% of scans showed non-obstructive CAD. In 18.2% of patients, the CTCA showed significant CAD and in 21 patients (6.7%) the scan was inconclusive. Patient with inconclusive scans underwent further testing which was negative in all cases. The outcome for patients with significant CAD (57 patients) is shown in the table.
Conclusion
CTCA on the same day as the RACPC appointment is feasible and facilitates rapid further investigation and treatment of patients with potentially significant CAD. It also enables patients with non-significant or no CAD to be reassured that their symptoms are unlikely to be cardiac which will reduce anxiety and allow timely investigation of other causes of the chest pain. Nurses need training in the risks of radiation in order to be able to request the scans and enable the clinic to be nurse-led.
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Affiliation(s)
- A Pottle
- Royal Brompton and Harefield NHS, Harefield, United Kingdom of Great Britain & Northern Ireland
| | - S Deane
- Royal Brompton and Harefield NHS, Harefield, United Kingdom of Great Britain & Northern Ireland
| | - N Dent
- Royal Brompton and Harefield NHS, Harefield, United Kingdom of Great Britain & Northern Ireland
| | - N Mackay
- Royal Brompton and Harefield NHS, Harefield, United Kingdom of Great Britain & Northern Ireland
| | - G Marshall
- Royal Brompton and Harefield NHS, Harefield, United Kingdom of Great Britain & Northern Ireland
| | - T Mittal
- Royal Brompton and Harefield NHS, Harefield, United Kingdom of Great Britain & Northern Ireland
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Dey A, Ahuja A, Mittal T, Sheikh MTM, Dhawan S, Malik VK. Proliferative fasciitis arising from the abdominal wall: A rare tumour excised by laparoscopy. J Minim Access Surg 2021; 18:136-138. [PMID: 34259207 PMCID: PMC8830567 DOI: 10.4103/jmas.jmas_317_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Proliferative fasciitis (PF) is a rare pseudosarcomatous lesion arising from the subcutaneous fascia and the fibrous septa. Only few hundred cases have been reported in the literature. In the largest series of 53 patients, only two patients had PF lesion arising from the flank. The most common site of origin is extremities followed by abdomen and head and neck. Its origin from the abdominal wall layer and presentation as the fever has been rarely reported in the literature. A PF lesion larger than 5 cm dimension has been sparsely noted. We report the presence of this rare entity in a 68-year-old gentleman who presented to us with low-grade fever and the presence of large lump arising from the abdominal wall. In our patient, the lesion was arising from transervsalis fascia and was excised in toto laparoscopically without damaging the abdominal muscles. It is imperative to differentiate both these lesions from sarcoma on histopathological examination as the follow-up treatment protocols for both vary.
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Affiliation(s)
- Ashish Dey
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Anmol Ahuja
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Tarun Mittal
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Shashi Dhawan
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Vinod K Malik
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Dey A, Ahuja A, Mittal T, Malik VK. Webinars and Online Surgical Conferences: Is Fatigue Settling in? Indian J Surg 2021; 84:334-335. [PMID: 34025050 PMCID: PMC8121634 DOI: 10.1007/s12262-021-02861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/19/2021] [Indexed: 10/26/2022] Open
Affiliation(s)
- Ashish Dey
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Anmol Ahuja
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Tarun Mittal
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Vinod Kumar Malik
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
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Khetan M, Dey A, Bindal V, Suviraj J, Mittal T, Kalhan S, Malik VK, Ramana B. Correction to: e-TEP repair for midline primary and incisional hernia: technical considerations and initial experience. Hernia 2021; 25:1739. [PMID: 33871744 DOI: 10.1007/s10029-021-02414-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Khetan
- Department of Minimal Access and Bariatric Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India. .,Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, Room no 400, SWB block, 4th floor Rajinder Nagar, New Delhi, 110060, India.
| | - A Dey
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - V Bindal
- Department of Minimal Access and Bariatric Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - J Suviraj
- Department of Minimal Access and Bariatric Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - T Mittal
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - S Kalhan
- Department of Minimal Access and Bariatric Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - V K Malik
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - B Ramana
- Calcutta Medical Research Institute, Kolkata, India
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Khetan M, Dey A, Bindal V, Suviraj J, Mittal T, Kalhan S, Malik VK, Ramana B. e-TEP repair for midline primary and incisional hernia: technical considerations and initial experience. Hernia 2021; 25:1635-1646. [PMID: 33826031 DOI: 10.1007/s10029-021-02397-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/11/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Enhanced-View Totally Extra Peritoneal Rives-Stoppa (e-TEP-RS) Technique for the repair of large, complex, ventral abdominal hernias has gained popularity especially in overcoming the disadvantages with Intra Peritoneal Onlay Mesh (IPOM) repairs and to enable siting of a large prosthetic mesh in an anatomical plane distinct from the abdominal cavity and its contents. Evolving variations of the original technique have allowed the definitive repair of such defects in a reproducible manner. We present our initial experience of this approach and detailed steps of our native technical modifications in overcoming the challenges in performing this complex and potentially challenging procedure. MATERIALS AND METHODS This is a retrospective review of the clinical data of midline, large, complex, ventral abdominal hernia patients who underwent e-TEP-RS with and without Transversus Abdominis Release (TAR). Patients, with or without Diastasis of Rectus Abdominis Muscle (DRAM) were included. Key outcomes measured were post-operative pain, operative morbidity, readmission, Quality of Life (QoL), hernia recurrence. RESULTS A total of 58 midline, ventral abdominal hernia patients who underwent e-TEP-RS with and without Transversus Abdominis Release (TAR), between March 2018 and December 2019 were studied. Mean defect area was 41.0 ± 28 cm2 and the mean mesh surface area was 473.5 ± 165 cm2. e-TEP-RS was done in 35 cases, e-TEP RS TAR in 15 cases and e-TEP-RS with e-TEP inguinal in 08 cases. There was no intraoperative morbidity. Mean duration of surgery was 156.2 ± 40 min and mean blood loss was 40.5 ± 26 cc. The CCS QoL scores improved from 34.6 (± 2) pre-operatively to 27.2 (± 4) at the end of 6 months. One patient had a supra-umbilical recurrence following bilateral TAR over the superior edge of the mesh. Follow-up ranged from 6 to 22 months, with a mean of 14 months. Major complications (n = 12; 20.7%) were seroma formation and prolonged ileus. CONCLUSION The e-TEP-RS technique for large, complex, midline, ventral abdominal hernias can be used with excellent results and acceptable morbidity. This technique is technically challenging and should be mastered in relatively smaller ventral hernias to achieve good results before attempting it in larger, complex ones.
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Affiliation(s)
- M Khetan
- Department of Minimal Access and Bariatric Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India.
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, Room no 400, SWB block, 4th floor Rajinder Nagar, New Delhi, 110060, India.
| | - A Dey
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - V Bindal
- Department of Minimal Access and Bariatric Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - J Suviraj
- Department of Minimal Access and Bariatric Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - T Mittal
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - S Kalhan
- Department of Minimal Access and Bariatric Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - V K Malik
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - B Ramana
- Calcutta Medical Research Institute, Kolkata, India
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Mittal T, Ahuja A, Dey A, Malik VK, Sheikh MTM. Comment on: Relevance of Posterior Gastric Vessel in Bariatric Surgery. Obes Surg 2021; 31:2773. [PMID: 33474676 DOI: 10.1007/s11695-021-05229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 12/15/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Tarun Mittal
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India.
| | - Anmol Ahuja
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India
| | - Ashish Dey
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India
| | - Vinod K Malik
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India
| | - Mohammad Taha Mustafa Sheikh
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India
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Abstract
INTRODUCTION In order to be eligible for consultant appointments within the NHS, orthodontists can undertake higher specialty training after their Certificate of Completion of Specialist Training (CCST). These training posts are known as Post-CCST positions and orthodontists must be eligible for inclusion on the General Dental Council's (GDC) specialist list for orthodontics before applying. There has been a decline in the number of applicants and the number of filled Post-CCST positions in recent years, leading to concerns over a potential shortage of appropriately trained consultant orthodontists to provide a secondary care service in the near future. This survey was undertaken to identify barriers to applying for Post-CCST training and assess potential options for increasing trainee numbers. METHODS An online survey was distributed, by email, to current orthodontic trainees and those that had recently completed training in the last six months via the British Orthodontic Society Training Grades Group. Reminder emails were sent at two and four weeks. A total of 201 trainees were invited to complete the survey. RESULTS Eighty-nine trainees completed the survey (response rate of 44.3%). Regarding applying to Post-CCST training, 32.6% and 47.7% of respondents, respectively, either wanted to or were considering applying for Post-CCST training. The South East was the most preferred region for Post-CCST training (38.0%). Reasons for not wishing to complete Post-CCST training included salary (71.9%), lack of consultant posts in desired regions (64.1%) and inability/unwillingness to relocate (63.5%). Part-time training (91.0%) and a higher salary during training (86.0%) were most likely to incentivise application for Post-CCST training. CONCLUSION Financial, family and geographical concerns appear to be the main reasons why trainees might not consider Post-CCST training. Part-time and run-through training options may encourage trainees to apply for Post-CCST training.
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Affiliation(s)
- Stacey Quach
- Orthodontic Department, Guy's Hospital, London, UK
| | - Tarun Mittal
- Orthodontic Department, Leeds Dental Institute, Leeds, UK
| | - Gavin Bell
- Orthodontic Department, Rotherham General Hospital, Rotherham, UK
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18
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Dey A, Mittal T, Ahuja A, Malik VK, Bambrule P. Biliopancreatic Limb Lengths Affects Weight Loss in Roux-en-Y Gastric Bypass: Are We Close to the Truth? Obes Surg 2020; 31:1349-1350. [PMID: 33089385 DOI: 10.1007/s11695-020-05033-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Ashish Dey
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India.
| | - Tarun Mittal
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - Anmol Ahuja
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - Vinod K Malik
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - Parmeshwar Bambrule
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
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19
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Smail H, Stock UA, De Robertis F, Bhudia SK, Mittal T, Mattison S, Petrou M, Hill J, Gaer J. Cardiac surgery during the COVID-19 pandemic: from vita minima to recovery. Br J Surg 2020; 107:e481-e483. [PMID: 32846001 PMCID: PMC7461194 DOI: 10.1002/bjs.11941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Hassiba Smail
- Department of Cardiothoracic Surgery and Transplantation, Harefield Hospital, Harefield, Middlesex, UK
| | - Ulrich A Stock
- Department of Cardiothoracic Surgery and Transplantation, Harefield Hospital, Harefield, Middlesex, UK
| | - Fabio De Robertis
- Department of Cardiothoracic Surgery and Transplantation, Harefield Hospital, Harefield, Middlesex, UK
| | - Sunil K Bhudia
- Department of Cardiothoracic Surgery and Transplantation, Harefield Hospital, Harefield, Middlesex, UK
| | - Tarun Mittal
- Department of Radiology, Harefield Hospital, Harefield, Middlesex, UK
| | - Simon Mattison
- Department of Anaesthesia and Intensive Care, Harefield Hospital, Harefield, Middlesex, UK
| | - Mario Petrou
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, UK
| | - Jonathan Hill
- Department of Cardiology, Harefield Hospital, Harefield, Middlesex, UK
| | - Jullien Gaer
- Department of Cardiothoracic Surgery and Transplantation, Harefield Hospital, Harefield, Middlesex, UK
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20
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Sabry H, Baltabaeva A, Gkikas A, Valencia O, Sarri G, Mirsadraee S, Mittal T, Bahrami T. Rapid deployment aortic valve replacement through anterior right thoracotomy: Clinical outcomes and haemodynamic performance. J Card Surg 2020; 35:1420-1424. [PMID: 32340065 DOI: 10.1111/jocs.14585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The ease of implantation of the rapid deployment (RD) and sutureless valves has contributed to the adoption of anterior right thoracotomy (ART) approach for aortic valve replacement (AVR). AIM OF THE STUDY This study evaluates the safety and haemodynamic performance of minimally invasive AVR through ART using the RD valves. METHODS This is a retrospective, single-center review of a total of 50 consecutive patients who received RD-AVR through ART. RESULTS The median age of patients was 75 years (interquartile range [IQR]: 69-80), and median Euroscore II was 5.1 (IQR: 2.4-7.5). ART RD-AVR was successfully performed in all cases with no conversion to sternotomy, paravalvular leaks or need for valve explantation. The mean size of the implanted valve was 23.2 ± 2.3 mm. In-hospital mortality was 2%. The mean and maximum pressure gradients across the aortic prosthesis were 10 mm Hg (IQR: 9-12) and 19 mm Hg (IQR: 16-23). CONCLUSIONS Rapid deployment aortic valve replacement can be safely performed through anterior right thoracotomy wit excellent haemodynamic performance and low postoperative complications rate.
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Affiliation(s)
- Haytham Sabry
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield Trust, Harefield Hospital, London, UK
| | - Aigul Baltabaeva
- Department of Cardiology, Royal Brompton and Harefield Trust, Harefield Hospital, London, UK
| | - Andreas Gkikas
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield Trust, Harefield Hospital, London, UK
| | - Oswaldo Valencia
- Department of Cardiothoracic Surgery, St George's University Hospital, London, UK
| | - Georgia Sarri
- Department of Cardiology, Royal Brompton and Harefield Trust, Harefield Hospital, London, UK
| | - Saeed Mirsadraee
- Department of Radiology, Royal Brompton and Harefield Trust, Harefield Hospital, London, UK
| | - Tarun Mittal
- Department of Radiology, Royal Brompton and Harefield Trust, Harefield Hospital, London, UK
| | - Toufan Bahrami
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield Trust, Harefield Hospital, London, UK
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21
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Sharma A, Rajan R, Modi M, Pinto B, Dhooria A, Rathi M, Mittal T, Kumar S, Sharma K, Dhir V, Nada R, Minz RW, Singh S. Neurological Manifestations Do not Affect Cumulative Survival in Indian Patients with Antineutrophil Cytoplasmic Antibody Associated Vasculitis. Neurol India 2019; 67:1043-1047. [PMID: 31512630 DOI: 10.4103/0028-3886.266234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Neurological manifestations are an important cause of morbidity in antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). It is not clear whether or not they are indicative of a severe disease course with multiple organ involvement and shortened survival. Aims and Objectives To characterize the neurological manifestations of AAV and analyze their relationship with other organ system and cumulative survival. Methods This was a retrospective single-center cohort study of AAV patients at a tertiary care hospital in North India. Data was collected from medical records regarding clinical history, neurological examination, Birmingham Vasculitis Activity Score (BVAS), serology, electrophysiology, imaging, and histopathological examination findings of patients. Results Ninety-two patients of systemic vasculitis were identified, 67 with granulomatosis with polyangiitis (GPA), 14 with microscopic polyangiitis, 8 with Churg-Strauss syndrome (CSS), and 3 with undifferentiated AAV. The median BVAS at presentation was 18.0 (interquartile range (IQR): 12.0). The median duration of follow-up was 31.3 months (IQR: 40.5). A total of 45.7% patients had neurological manifestations among which 23.8% presented with neurological complaints. Peripheral neuropathy was the most common manifestation noted in 23.9% of the patients. Among patients with GPA, 40.3% had neurological involvement (seen in 33.3% patients at presentation). Patients with nervous system disease were more likely to have associated musculoskeletal manifestations (P = 0.046) and less likely to have renal involvement (P = 0.017). The estimated cumulative survival of the subgroup with neurological involvement was 95.1 months from the time of diagnosis, which was not significantly different from the cohort without neurological involvement (113.8 months, P = 0.631). Conclusion Neurological morbidity commonly accompanies systemic vasculitis. Nervous system disease does not affect the survival significantly in these patients.
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Affiliation(s)
- Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Roopa Rajan
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Modi
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Benzeeta Pinto
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aadhaar Dhooria
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rathi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Mittal
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Susheel Kumar
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kusum Sharma
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dhir
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjana W Minz
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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22
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Pulle MV, Mittal T, Dey A, Malik VK. Emphysematous Cholecystitis: Rare Scenario Revisited. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1847-8] [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: 10/27/2022] Open
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23
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Rogers P, Al-Aidrous S, Banya W, Haley SR, Mittal T, Kabir T, Panoulas V, Raja S, Bhudia S, Probert H, Prendergast C, Spence MS, Davies S, Moat N, Taylor RS, Dalby M. Cardiac rehabilitation to improve health-related quality of life following trans-catheter aortic valve implantation: a randomised controlled feasibility study: RECOVER-TAVI Pilot, ORCA 4, For the Optimal Restoration of Cardiac Activity Group. Pilot Feasibility Stud 2018; 4:185. [PMID: 30564436 PMCID: PMC6293531 DOI: 10.1186/s40814-018-0363-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/24/2018] [Indexed: 01/13/2023] Open
Abstract
Objectives Transcatheter aortic valve implantation (TAVI) is often undertaken in the oldest frailest cohort of patients undergoing cardiac interventions. We plan to investigate the potential benefit of cardiac rehabilitation (CR) in this vulnerable population. Design We undertook a pilot randomised trial of CR following TAVI to inform the feasibility and design of a future randomised clinical trial (RCT). Participants We screened patients undergoing TAVI at a single institution between June 2016 and February 2017. Interventions Participants were randomised post-TAVI to standard of care (control group) or standard of care plus exercise-based CR (intervention group). Outcomes We assessed recruitment and attrition rates, uptake of CR, and explored changes in 6-min walk test, Nottingham Activities of Daily Living, Fried and Edmonton Frailty scores and Hospital Anxiety and Depression Score, from baseline (30 days post TAVI) to 3 and 6 months post randomisation. We also undertook a parallel study to assess the use of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in the post-TAVI population. Results Of 82 patients screened, 52 met the inclusion criteria and 27 were recruited (3 patients/month). In the intervention group, 10/13 (77%) completed the prescribed course of 6 sessions of CR (mean number of sessions attended 7.5, SD 4.25) over 6 weeks. At 6 months, all participants were retained for follow-up. There was apparent improvement in outcome scores at 3 and 6 months in control and CR groups. There were no recorded adverse events associated with the intervention of CR. The KCCQ was well accepted in 38 post-TAVI patients: mean summary score 72.6 (SD 22.6). Conclusions We have demonstrated the feasibility of recruiting post-TAVI patients into a randomised trial of CR. We will use the findings of this pilot trial to design a fully powered multicentre RCT to inform the provision of CR and support guideline development to optimise health-related quality of life outcomes in this vulnerable population. Retrospectively registered 3rd October 2016 clinicaltrials.gov NCT02921880. Trial registration Clinicaltrials.Gov identifier NCT02921880.
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Affiliation(s)
- Paula Rogers
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
| | - Sayed Al-Aidrous
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
| | - Winston Banya
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
| | - Shelley Rahman Haley
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
| | - Tarun Mittal
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
| | - Tito Kabir
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
| | - Vasileois Panoulas
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
| | - Shahzad Raja
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
| | - Sunil Bhudia
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
| | - Heather Probert
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
| | - Claire Prendergast
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
| | | | - Simon Davies
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
| | - Neil Moat
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
| | - Rod S Taylor
- 3Institute of Health Research, University of Exeter Medical School, Exeter & The School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Miles Dalby
- 1Royal Brompton & Harefield NHS Foundation Trust London, Imperial College, London, UK.,2Royal Victoria Hospital, Belfast, UK
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24
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Hosni S, Mittal T, Harrison J. Relevant research from orthodontic journals. J Orthod 2018. [DOI: 10.1080/14653125.2018.1545178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sara Hosni
- Orthodontic Department, Liverpool University Dental Hospital, Liverpool, UK
| | - Tarun Mittal
- Orthodontic Department, Leeds Dental Institute, Leeds, UK
| | - Jayne Harrison
- Orthodontic Department, Liverpool University Dental Hospital, Liverpool, UK
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25
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Mittal T, Dey A, Siddhartha R, Nali A, Sharma B, Malik V. Efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in laparoscopic gastric sleeve resection: a randomized single blinded case control study. Surg Endosc 2018; 32:4985-4989. [PMID: 29869078 DOI: 10.1007/s00464-018-6261-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 04/03/2018] [Accepted: 05/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pain following bariatric surgery can be quite troublesome and prolongs recovery. Transversus abdominis plane (TAP) block is a new regional anesthetic technique to reduce postoperative pain and is an important part of current analgesic regimen for many abdominal surgeries. The primary objective of our study was to assess the efficacy of the TAP block in controlling postoperative pain in laparoscopic sleeve gastrectomy. Secondary outcomes assessed in this study were postoperative nausea and vomiting (PONV), time to ambulate, readiness for discharge, and whether it leads to improved patient satisfaction. METHODS This is a prospective single blind randomized controlled study. A total of 60 patients were included in the study. Patients were allocated in two groups, using a computer generated randomization sequence using http://www.randomization.com . Test group included 30 patients who received Ultrasound-guided transversus abdominis plane (USG-TAP) block along with systemic analgesia and the Control group included 30 patients who received only systemic analgesia. Postoperatively patients were evaluated for pain and satisfaction using VAS scores and 'Capuzzo' satisfaction score, respectively. RESULTS Sixty patients were enrolled in the study after fulfilling the eligibility criteria. No patient was lost to follow-up. The difference of VAS scores between test (TAP) and control (Non-TAP) was statistically significant both at rest and on movement. The patient satisfaction score in TAP group was higher than the control group (p value < 0.001). The patients who received TAP block showed earlier readiness for discharge, early ambulation, early resumption of bowel activity, and decreased incidence of PONV as compared to the non-TAP group. CONCLUSION USG-guided TAP block is a feasible, minimally invasive technique and can be a part of an effective multimodal analgesia in morbidly obese patients undergoing bariatric surgery. Limitations of this study would be the small sample size and the study being Single-blinded.
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Affiliation(s)
- Tarun Mittal
- Department of Laparoscopic and General Surgery, Sir Ganga Ram Hospital, New Delhi, India. .,Department of Laparoscopic and General Surgery, Sir Ganga Ram Hospital, Room No. 1316, Old Building, New Delhi, India.
| | - Ashish Dey
- Department of Laparoscopic and General Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Rahul Siddhartha
- Department of Laparoscopic and General Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Abhilash Nali
- Department of Laparoscopic and General Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Bimla Sharma
- Department of Anaesthesiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Vinod Malik
- Department of Laparoscopic and General Surgery, Sir Ganga Ram Hospital, New Delhi, India
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26
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Zambon E, Karagiannis G, Kourkoveli P, Salterain Gonzalez N, Simon A, Banner N, Mittal T. CT Coronary Angiography Predicts Cardiovascular Outcomes after Heart Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.478] [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: 11/24/2022] Open
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27
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Mittal T, Nicol E, Reichmuth L, Jain M, Baltabaeva A, Rahman-Haley S, Kabir T, Panoulas V, Mirsadraee S, Dalby M, Long Q. INFLUENCE OF FLOW AND VELOCITY PROFILE ON INCONSISTENCY IN ECHOCARDIOGRAPHIC AORTIC VALVE STENOSIS ASSESSMENT: A COMPUTED TOMOGRAPHY AND COMPUTATIONAL FLOW DYNAMICS STUDY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32124-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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28
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Puryer J, Mittal T, McNamara C, Ireland T, Sandy J. Bilateral Transverse Mandibular Second Molars: A Case Report. Dent J (Basel) 2016; 4:dj4040043. [PMID: 29563485 PMCID: PMC5806949 DOI: 10.3390/dj4040043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/05/2016] [Accepted: 11/17/2016] [Indexed: 12/05/2022] Open
Abstract
Impaction of mandibular second permanent molars is a rare occurrence, with prevalence rates reported to be between 0.65% and 2.0%. In the absence of systemic conditions, impactions are usually unilateral. There appears to be no consensus as to the optimal treatment for impacted mandibular second molars and treatment plans will be based upon the individual case. Treatment may involve orthodontics and/or various surgical techniques, and early diagnosis is important. This paper presents an unusual case of bilateral transverse impaction of both mandibular second and third molars that was diagnosed at 18 years of age. All impacted molars were extracted.
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Affiliation(s)
- James Puryer
- School of Oral and Dental Sciences, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK.
| | - Tarun Mittal
- School of Oral and Dental Sciences, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK.
| | - Catherine McNamara
- HSE Regional Orthodontic Department, St James's Hospital, Dublin 8, Ireland.
| | - Tony Ireland
- School of Oral and Dental Sciences, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK.
| | - Jonathan Sandy
- School of Oral and Dental Sciences, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK.
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Abstract
Congenital absence of the common bile duct (CBD) is an extremely rare developmental anomaly with right and left hepatic ducts draining directly into the gallbladder (GB). Other synonyms for this clinical condition are "cholecystohepatic ducts", "transverse lie of the GB" or "interposition of the GB". The potential for iatrogenic injury is high, because of either inadvertent division or ligation of the ducts. Diagnosis is mostly made intraoperatively, and needs some form of biliary reconstruction. Herein, we are reporting a case of congenital absence of the CBD in a 36-year-old lady that was detected intraoperatively.
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Affiliation(s)
- Tarun Mittal
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Mohan V Pulle
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Dey
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Vinod K Malik
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India
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30
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Rathi M, Pinto B, Dhooria A, Sagar V, Mittal T, Rajan R, Dhir V, Kumar S, Sharma K, Nada R, Singh S, Minz RW, Sharma A. Impact of renal involvement on survival in ANCA-associated vasculitis. Int Urol Nephrol 2016; 48:1477-82. [PMID: 27272254 DOI: 10.1007/s11255-016-1330-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/23/2016] [Indexed: 11/25/2022]
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31
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Abstract
Sarcoidosis is a multi-system disease with a wide range of phenotypes. Pulmonary involvement is the most frequently identified target for sarcoidosis and is responsible for the majority of deaths. Cardiac sarcoid is less commonly identified, may be occult, is significantly influenced by race, and can portend an unpredictable and sometimes fatal outcome. Sarcoidosis remains an enigmatic disease spectrum of unknown aetiology, frequently difficult to diagnose and with a variable disease course. This article summarises current views on the diagnosis and management of cardiopulmonary involvement.
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Affiliation(s)
- Simon Dubrey
- Department of Cardiology, Hillingdon Hospital, Uxbridge, UK
| | - Rakesh Sharma
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Richard Underwood
- Imperial College London, Royal Brompton and Harefield Hospitals, London, UK
| | - Tarun Mittal
- Department of Radiology, Harefield Hospital, Harefield, UK
| | - Athol Wells
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
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32
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Abstract
RATIONALE Understanding the changing incidence and impact of acute kidney injury requiring dialysis in patients with severe sepsis will allow better risk stratification, design of clinical trials, and guide resource allocation. OBJECTIVES To assess the longitudinal incidence of acute kidney injury requiring dialysis and its impact on mortality in patients with severe sepsis. METHODS Retrospective cohort study of adults (≥20 yr) hospitalized with severe sepsis from 2000 to 2009 in the United States using a nationally representative database. MEASUREMENTS AND MAIN RESULTS We calculated the incidences of acute kidney injury requiring dialysis and mortality over time. We used linear regression to assess temporal trends. We used logistic regression to estimate the odds of acute kidney injury requiring dialysis and mortality. Of the estimated 5,257,907 hospitalizations with severe sepsis, 6.1% had acute kidney injury requiring dialysis. The odds of acquiring acute kidney injury requiring dialysis increased by 14% in 2009 compared with 2000. Mortality in patients with acute kidney injury requiring dialysis was higher (43.6% vs. 24.9%; P < 0.001). After multivariable adjustment, odds of mortality declined 61% by the year 2009. Acute kidney injury requiring dialysis remained an independent predictor of mortality in patients with severe sepsis, although its influence on mortality declined with time. CONCLUSIONS Incidence of acute kidney injury requiring dialysis in patients with severe sepsis has increased over time; conversely, associated mortality has declined. The likelihood of demise from acute kidney injury requiring dialysis in patients with severe sepsis has also declined.
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Affiliation(s)
- Ankit Sakhuja
- 1 Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Gagan Kumar
- 2 Department of Critical Care, Phoebe Putney Memorial Hospital, Albany, Georgia
| | - Shipra Gupta
- 3 Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Tarun Mittal
- 4 Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio; and
| | - Amit Taneja
- 5 Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rahul S Nanchal
- 5 Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Rahman MS, Mittal T, Chandrasekaran V, Chua TP. The role of multi-modality imaging to investigate and manage anomalous right coronary artery originating from the pulmonary artery (ARCAPA) anomaly with associated coronary aneurysms presenting as acute left ventricular failure. Eur Heart J 2015; 36:3031. [PMID: 26040809 DOI: 10.1093/eurheartj/ehv212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mohammed Shamim Rahman
- Faculty of Medicine and National Heart & Lung Institute, Imperial College London, Room 5N1 Commonwealth Building, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK Department of Cardiology, Royal Surrey County Hospital, Guildford, UK
| | - Tarun Mittal
- Faculty of Medicine and National Heart & Lung Institute, Imperial College London, Room 5N1 Commonwealth Building, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK Department of Radiology, Harefield Hospital, Royal Brompton & Harefield NHS Trust, UK
| | | | - Tuan Peng Chua
- Department of Cardiology, Royal Surrey County Hospital, Guildford, UK Department of Cardiac Surgery, St George's Hospital NHS Trust, London, UK
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34
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Bhattacharyya S, Mittal T, Abayalingam M, Kabir T, Dalby M, Cleland JG, Baltabaeva A, Rahman Haley S. Classification of Aortic Stenosis by Flow and Gradient Patterns Provides Insights into the Pathophysiology of Disease. Angiology 2015; 67:664-9. [PMID: 26475710 DOI: 10.1177/0003319715611804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/17/2022]
Abstract
Different patterns of flow and valve gradients can lead to diagnostic uncertainty about the severity of aortic stenosis (AS). Consecutive patients with severe AS (valve area <1 cm(2)) underwent echocardiography and computed tomography. Patients were classified into 4 groups (high-gradient/normal flow [HGNF], high-gradient/low flow [HGLF], low-gradient/normal flow [LGNF], and low-gradient/low flow [LGLF]). Low flow was defined as stroke volume index <35 mL/m(2) and low gradient as a mean aortic gradient <40 mm Hg. Aortic valve calcification (AVC) was calculated using the Agatston score. Of 181 patients, 56, 30, 46, and 49 had HGNF, HGLF, LGNF and LGLF with median AVC of 2048, 2015, 1366, and 1178 AU/m(2) (P < .0001) and valvuloarterial impedance of 4.5, 6.4, 4.2, and 5.9, respectively (P < .0001). Among those with LGLF, AVC was lower in patients with preserved compared to reduced left ventricular ejection fraction (1018 vs 2550 AU/m(2); P < .0001), but valvuloarterial impedance was similar (P = .33). The LGLF AS with preserved ejection fraction is associated with lower AVC and may identify patients with less severe AS in association with an adaptive ventricular response to high afterload.
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Affiliation(s)
- Sanjeev Bhattacharyya
- Department of Cardiology, Harefield Hospital, London, United Kingdom Echocardiography Laboratory, Harefield Hospital, London, United Kingdom
| | - Tarun Mittal
- Department of Imaging, Harefield Hospital, London, United Kingdom
| | | | - Tito Kabir
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Miles Dalby
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - John G Cleland
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Aigul Baltabaeva
- Department of Cardiology, Harefield Hospital, London, United Kingdom Echocardiography Laboratory, Harefield Hospital, London, United Kingdom
| | - Shelley Rahman Haley
- Department of Cardiology, Harefield Hospital, London, United Kingdom Echocardiography Laboratory, Harefield Hospital, London, United Kingdom
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Macintosh B, Graham JR, Barman T, De Rosa RJ, Konopacky Q, Marley MS, Marois C, Nielsen EL, Pueyo L, Rajan A, Rameau J, Saumon D, Wang JJ, Patience J, Ammons M, Arriaga P, Artigau E, Beckwith S, Brewster J, Bruzzone S, Bulger J, Burningham B, Burrows AS, Chen C, Chiang E, Chilcote JK, Dawson RI, Dong R, Doyon R, Draper ZH, Duchêne G, Esposito TM, Fabrycky D, Fitzgerald MP, Follette KB, Fortney JJ, Gerard B, Goodsell S, Greenbaum AZ, Hibon P, Hinkley S, Cotten TH, Hung LW, Ingraham P, Johnson-Groh M, Kalas P, Lafreniere D, Larkin JE, Lee J, Line M, Long D, Maire J, Marchis F, Matthews BC, Max CE, Metchev S, Millar-Blanchaer MA, Mittal T, Morley CV, Morzinski KM, Murray-Clay R, Oppenheimer R, Palmer DW, Patel R, Perrin MD, Poyneer LA, Rafikov RR, Rantakyrö FT, Rice EL, Rojo P, Rudy AR, Ruffio JB, Ruiz MT, Sadakuni N, Saddlemyer L, Salama M, Savransky D, Schneider AC, Sivaramakrishnan A, Song I, Soummer R, Thomas S, Vasisht G, Wallace JK, Ward-Duong K, Wiktorowicz SJ, Wolff SG, Zuckerman B. Discovery and spectroscopy of the young jovian planet 51 Eri b with the Gemini Planet Imager. Science 2015; 350:64-7. [DOI: 10.1126/science.aac5891] [Citation(s) in RCA: 391] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 08/03/2015] [Indexed: 11/02/2022]
Affiliation(s)
- B. Macintosh
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, CA 94305, USA
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, CA 94040, USA
| | - J. R. Graham
- Department of Astronomy, University of California–Berkeley, Berkeley, CA 94720, USA
| | - T. Barman
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ 85721, USA
| | - R. J. De Rosa
- Department of Astronomy, University of California–Berkeley, Berkeley, CA 94720, USA
| | - Q. Konopacky
- Center for Astrophysics and Space Sciences, University of California–San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - M. S. Marley
- NASA Ames Research Center, MS 245-3, Moffett Field, CA 94035, USA
| | - C. Marois
- National Research Council of Canada, Herzberg Institute of Astrophysics, 5071 West Saanich Road, Victoria, British Columbia V9E 2E7, Canada
- Department of Physics and Astronomy, University of Victoria, 3800 Finnerty Road, Victoria, British Columbia V8P 5C2, Canada
| | - E. L. Nielsen
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, CA 94305, USA
- Search for Extraterrestrial Intelligence Institute, Carl Sagan Center, 189 Bernardo Avenue, Mountain View, CA 94043, USA
| | - L. Pueyo
- Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218, USA
| | - A. Rajan
- School of Earth and Space Exploration, Arizona State University, Post Office Box 871404, Tempe, AZ 85287, USA
| | - J. Rameau
- Institut de Recherche sur les Exoplanètes, Départment de Physique, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - D. Saumon
- Los Alamos National Laboratory, Post Office Box 1663, MS F663, Los Alamos, NM 87545, USA
| | - J. J. Wang
- Department of Astronomy, University of California–Berkeley, Berkeley, CA 94720, USA
| | - J. Patience
- School of Earth and Space Exploration, Arizona State University, Post Office Box 871404, Tempe, AZ 85287, USA
| | - M. Ammons
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, CA 94040, USA
| | - P. Arriaga
- Department of Physics and Astronomy, University of California–Los Angeles, 430 Portola Plaza, Los Angeles, CA 90095, USA
| | - E. Artigau
- Institut de Recherche sur les Exoplanètes, Départment de Physique, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - S. Beckwith
- Department of Astronomy, University of California–Berkeley, Berkeley, CA 94720, USA
| | - J. Brewster
- Search for Extraterrestrial Intelligence Institute, Carl Sagan Center, 189 Bernardo Avenue, Mountain View, CA 94043, USA
| | - S. Bruzzone
- Department of Physics and Astronomy, Centre for Planetary Science and Exploration, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - J. Bulger
- School of Earth and Space Exploration, Arizona State University, Post Office Box 871404, Tempe, AZ 85287, USA
- Subaru Telescope, 650 North A'ohoku Place, Hilo, HI 96720, USA
| | - B. Burningham
- NASA Ames Research Center, MS 245-3, Moffett Field, CA 94035, USA
- Science and Technology Research Institute, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - A. S. Burrows
- Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544, USA
| | - C. Chen
- Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218, USA
| | - E. Chiang
- Department of Astronomy, University of California–Berkeley, Berkeley, CA 94720, USA
| | - J. K. Chilcote
- Dunlap Institute for Astronomy and Astrophysics, University of Toronto, 50 St. George Street, Toronto, Ontario M5S 3H4, Canada
| | - R. I. Dawson
- Department of Astronomy, University of California–Berkeley, Berkeley, CA 94720, USA
| | - R. Dong
- Department of Astronomy, University of California–Berkeley, Berkeley, CA 94720, USA
| | - R. Doyon
- Institut de Recherche sur les Exoplanètes, Départment de Physique, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - Z. H. Draper
- National Research Council of Canada, Herzberg Institute of Astrophysics, 5071 West Saanich Road, Victoria, British Columbia V9E 2E7, Canada
- Department of Physics and Astronomy, University of Victoria, 3800 Finnerty Road, Victoria, British Columbia V8P 5C2, Canada
| | - G. Duchêne
- Department of Astronomy, University of California–Berkeley, Berkeley, CA 94720, USA
- Institut de Planétologie et d’Astrophysique de Grenoble, Université Grenoble Alpes, Centre National de la Recherche Scientifique, 38000 Grenoble, France
| | - T. M. Esposito
- Department of Physics and Astronomy, University of California–Los Angeles, 430 Portola Plaza, Los Angeles, CA 90095, USA
| | - D. Fabrycky
- Department of Astronomy and Astrophysics, University of Chicago, 5640 South Ellis Avenue, Chicago, IL 60637, USA
| | - M. P. Fitzgerald
- Department of Physics and Astronomy, University of California–Los Angeles, 430 Portola Plaza, Los Angeles, CA 90095, USA
| | - K. B. Follette
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, CA 94305, USA
| | - J. J. Fortney
- Department of Astronomy and Astrophysics, University of California–Santa Cruz, Santa Cruz, CA 95064, USA
| | - B. Gerard
- National Research Council of Canada, Herzberg Institute of Astrophysics, 5071 West Saanich Road, Victoria, British Columbia V9E 2E7, Canada
- Department of Physics and Astronomy, University of Victoria, 3800 Finnerty Road, Victoria, British Columbia V8P 5C2, Canada
| | - S. Goodsell
- Department of Physics, Durham University, Stockton Road, Durham DH1, UK
- Gemini Observatory, Casilla 603, La Serena, Chile
| | - A. Z. Greenbaum
- Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218, USA
- Department of Physics and Astronomy, Johns Hopkins University, 3600 North Charles Street, Baltimore, MD 21218, USA
| | - P. Hibon
- Gemini Observatory, Casilla 603, La Serena, Chile
| | - S. Hinkley
- University of Exeter, Astrophysics Group, Physics Building, Stocker Road, Exeter EX4 4QL, UK
| | - T. H. Cotten
- Department of Physics and Astronomy, University of Georgia, Athens, GA 30602, USA
| | - L.-W. Hung
- Department of Physics and Astronomy, University of California–Los Angeles, 430 Portola Plaza, Los Angeles, CA 90095, USA
| | - P. Ingraham
- Large Synoptic Survey Telescope, 950 North Cherry Avenue, Tucson, AZ 85719, USA
| | - M. Johnson-Groh
- National Research Council of Canada, Herzberg Institute of Astrophysics, 5071 West Saanich Road, Victoria, British Columbia V9E 2E7, Canada
- Department of Physics and Astronomy, University of Victoria, 3800 Finnerty Road, Victoria, British Columbia V8P 5C2, Canada
| | - P. Kalas
- Department of Astronomy, University of California–Berkeley, Berkeley, CA 94720, USA
- Search for Extraterrestrial Intelligence Institute, Carl Sagan Center, 189 Bernardo Avenue, Mountain View, CA 94043, USA
| | - D. Lafreniere
- Institut de Recherche sur les Exoplanètes, Départment de Physique, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - J. E. Larkin
- Department of Physics and Astronomy, University of California–Los Angeles, 430 Portola Plaza, Los Angeles, CA 90095, USA
| | - J. Lee
- Department of Physics and Astronomy, University of Georgia, Athens, GA 30602, USA
| | - M. Line
- Department of Astronomy and Astrophysics, University of California–Santa Cruz, Santa Cruz, CA 95064, USA
| | - D. Long
- Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218, USA
| | - J. Maire
- Dunlap Institute for Astronomy and Astrophysics, University of Toronto, 50 St. George Street, Toronto, Ontario M5S 3H4, Canada
| | - F. Marchis
- Search for Extraterrestrial Intelligence Institute, Carl Sagan Center, 189 Bernardo Avenue, Mountain View, CA 94043, USA
| | - B. C. Matthews
- National Research Council of Canada, Herzberg Institute of Astrophysics, 5071 West Saanich Road, Victoria, British Columbia V9E 2E7, Canada
- Department of Physics and Astronomy, University of Victoria, 3800 Finnerty Road, Victoria, British Columbia V8P 5C2, Canada
| | - C. E. Max
- Department of Astronomy and Astrophysics, University of California–Santa Cruz, Santa Cruz, CA 95064, USA
| | - S. Metchev
- Department of Physics and Astronomy, Centre for Planetary Science and Exploration, The University of Western Ontario, London, Ontario N6A 3K7, Canada
- Department of Physics and Astronomy, Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794-3800, USA
| | - M. A. Millar-Blanchaer
- Department of Astronomy and Astrophysics, University of Toronto, Toronto, Ontario M5S 3H4, Canada
| | - T. Mittal
- Department of Astronomy, University of California–Berkeley, Berkeley, CA 94720, USA
| | - C. V. Morley
- Department of Astronomy and Astrophysics, University of California–Santa Cruz, Santa Cruz, CA 95064, USA
| | - K. M. Morzinski
- Steward Observatory, 933 North Cherry Avenue, University of Arizona, Tucson, AZ 85721, USA
| | - R. Murray-Clay
- Department of Physics, University of California–Santa Barbara, Broida Hall, Santa Barbara, CA 93106-9530, USA
| | - R. Oppenheimer
- Department of Astrophysics, American Museum of Natural History, New York, NY 10024, USA
| | - D. W. Palmer
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, CA 94040, USA
| | - R. Patel
- Department of Physics and Astronomy, Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794-3800, USA
| | - M. D. Perrin
- Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218, USA
| | - L. A. Poyneer
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, CA 94040, USA
| | - R. R. Rafikov
- Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544, USA
| | | | - E. L. Rice
- Department of Astrophysics, American Museum of Natural History, New York, NY 10024, USA
- Department of Engineering Science and Physics, College of Staten Island, City University of New York, Staten Island, NY 10314, USA
| | - P. Rojo
- Departamento de Astronomía, Universidad de Chile, Camino El Observatorio 1515, Casilla 36-D, Las Condes, Santiago, Chile
| | - A. R. Rudy
- Department of Astronomy and Astrophysics, University of California–Santa Cruz, Santa Cruz, CA 95064, USA
| | - J.-B. Ruffio
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, CA 94305, USA
- Search for Extraterrestrial Intelligence Institute, Carl Sagan Center, 189 Bernardo Avenue, Mountain View, CA 94043, USA
| | - M. T. Ruiz
- Departamento de Astronomía, Universidad de Chile, Camino El Observatorio 1515, Casilla 36-D, Las Condes, Santiago, Chile
| | - N. Sadakuni
- Gemini Observatory, Casilla 603, La Serena, Chile
- Stratospheric Observatory for Infrared Astronomy, Universities Space Research Association, NASA Armstrong Flight Research Center, 2825 East Avenue P, Palmdale, CA 93550, USA
| | - L. Saddlemyer
- National Research Council of Canada, Herzberg Institute of Astrophysics, 5071 West Saanich Road, Victoria, British Columbia V9E 2E7, Canada
| | - M. Salama
- Department of Astronomy, University of California–Berkeley, Berkeley, CA 94720, USA
| | - D. Savransky
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853, USA
| | - A. C. Schneider
- Physics and Astronomy, University of Toledo, 2801 West Bancroft Street, Toledo, OH 43606, USA
| | - A. Sivaramakrishnan
- Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218, USA
| | - I. Song
- Department of Physics and Astronomy, University of Georgia, Athens, GA 30602, USA
| | - R. Soummer
- Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218, USA
| | - S. Thomas
- Large Synoptic Survey Telescope, 950 North Cherry Avenue, Tucson, AZ 85719, USA
| | - G. Vasisht
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, CA 91109, USA
| | - J. K. Wallace
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, CA 91109, USA
| | - K. Ward-Duong
- School of Earth and Space Exploration, Arizona State University, Post Office Box 871404, Tempe, AZ 85287, USA
| | - S. J. Wiktorowicz
- Department of Astronomy and Astrophysics, University of California–Santa Cruz, Santa Cruz, CA 95064, USA
| | - S. G. Wolff
- Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218, USA
- Department of Physics and Astronomy, Johns Hopkins University, 3600 North Charles Street, Baltimore, MD 21218, USA
| | - B. Zuckerman
- Department of Physics and Astronomy, University of California–Los Angeles, 430 Portola Plaza, Los Angeles, CA 90095, USA
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Mittal T, Dedhia P, Roy-Chaudhury P, Abu Jawdeh B, Mogilishetty G, Cuffy M, Alloway R, Woodle E, Govil A. Complete Remission of Post-transplantation Recurrence of Focal Segmental Glomerulosclerosis With the Use of Adrenocorticotrophic Hormone Gel: Case Report. Transplant Proc 2015; 47:2219-22. [DOI: 10.1016/j.transproceed.2015.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
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Abstract
Cardiac sarcoidosis is one of the most serious and unpredictable aspects of this disease state. Heart involvement frequently presents with arrhythmias or conduction disease, although myocardial infiltration resulting in congestive heart failure may also occur. The prognosis in cardiac sarcoidosis is highly variable, which relates to the heterogeneous nature of heart involvement and marked differences between racial groups. Electrocardiography and echocardiography often provide the first clue to the diagnosis, but advanced imaging studies using positron emission tomography and MRI, in combination with nuclear isotope perfusion scanning are now essential to the diagnosis and management of this condition. The identification of clinically occult cardiac sarcoidosis and the management of isolated and/or asymptomatic heart involvement remain both challenging and contentious. Corticosteroids remain the first treatment choice with the later substitution of immunosuppressive and steroid-sparing therapies. Heart transplantation is an unusual outcome, but when performed, the results are comparable or better than heart transplantation for other disease states. We review the epidemiology, developments in diagnostic techniques and the management of cardiac sarcoidosis.
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Affiliation(s)
- S W Dubrey
- Department of Cardiology, Hillingdon Hospital, Uxbridge, UK
| | - R Sharma
- Department of Cardiology, The Royal Brompton Hospital, London, UK
| | - R Underwood
- Department of Radiology, Harefield Hospital, Harefield, UK
| | - T Mittal
- Department of Radiology, Harefield Hospital, Harefield, UK
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Dubrey SW, Grocott-Mason R, Ghonim S, Mittal T. Takayasu's arteritis in an active man: burnt out or quiescent? Br J Hosp Med (Lond) 2015; 76:364-5. [PMID: 26053909 DOI: 10.12968/hmed.2015.76.6.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Simon W Dubrey
- Consultant Cardiologist, Hillingdon Hospital, Uxbridge, Middlesex UB8 3NN
| | | | - Sarah Ghonim
- Cardiology Specialist Registrar in the Department of Cardiology, Hillingdon Hospital, Uxbridge, Middlesex UB8 3NN
| | - Tarun Mittal
- Consultant Radiologist in the Department of Radiology, Royal Brompton and Harefield Hospitals, Harefield Hospital, Harefield, Middlesex
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Pulle MV, Siddhartha R, Dey A, Mittal T, Malik VK. Port site hernia in laparoscopic surgery: Mechanism, prevention and management. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.cmrp.2015.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Hasson F, Ganesan K, Fernandes G, Mittal T, Travill C. Posture related symptoms in left ventricular outflow tract obstruction. ICFJ 2015. [DOI: 10.17987/icfj.v1i4.53] [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: 11/20/2022] Open
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Mittal T, Pulle M, Dey A, Malik V. Porto mesenteric thrombosis: An uncommon complication after laparoscopic sleeve gastrectomy. ACTA ACUST UNITED AC 2015. [DOI: 10.4103/2347-9906.148613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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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Ali O, Schultz C, Jabbour A, Rubens M, Mittal T, Mohiaddin R, Davies S, Di Mario C, Van der Boon R, Ahmad A, Amrani M, Moat N, De Jaegere P, Dalby M. Predictors of paravalvular aortic regurgitation following self-expanding Medtronic CoreValve implantation: The role of annulus size, degree of calcification, and balloon size during pre-implantation valvuloplasty and implant depth. Int J Cardiol 2015; 179:539-45. [DOI: 10.1016/j.ijcard.2014.10.117] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/21/2014] [Indexed: 11/24/2022]
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Costopoulos C, Wong J, Mittal T, Srinivasan M. Multi-modality imaging aids the diagnosis of bilateral coronary-cameral fistulae with involvement of the left ventricle. Int J Cardiol 2014; 182:166-7. [PMID: 25577754 DOI: 10.1016/j.ijcard.2014.12.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/29/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Charis Costopoulos
- Hertfordshire Cardiology Centre, East and North Hertfordshire NHS Trust, UK
| | - Joyce Wong
- Department of Imaging, Royal Brompton & Harefield NHS Foundation Trust, UK
| | - Tarun Mittal
- Department of Imaging, Royal Brompton & Harefield NHS Foundation Trust, UK
| | - Manivannan Srinivasan
- Hertfordshire Cardiology Centre, East and North Hertfordshire NHS Trust, UK; Department of Imaging, Royal Brompton & Harefield NHS Foundation Trust, UK.
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Kumar S, Ramachandran R, Mete U, Mittal T, Dutta P, Kumar V, Rathi M, Jha V, Gupta KL, Sakhuja V, Kohli HS. Acute pyelonephritis in diabetes mellitus: Single center experience. Indian J Nephrol 2014; 24:367-71. [PMID: 25484530 PMCID: PMC4244716 DOI: 10.4103/0971-4065.135347] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Diabetes mellitus is a common cause of pyelonephritis. Both emphysematous pyelonephritis (EPN) and non-EPN (NEPN) are associated with poor outcome. This study was aimed at analyzing the clinical features, microbiological profile, prognostic factors, and treatment outcome of pyelonephritis in diabetic patients. A total of 105 diabetic patients with pyelonephritis were admitted from July 2010 to June 2012. Patients were treated with appropriate antibiotics and percutaneous drainage (PCD) as indicated. Nephrectomy was carried out in patients of EPN who were refractory to conservative measures. NEPN and EPN were seen in 79 (75.2%) and 26 (24.7%) patients, respectively. Escherichia coli was the most common organism. Pyelonephritis was associated with renal abscess and papillary necrosis in 13 (12.4%) and 4 (3.8%) patients with EPN and NEPN, respectively. Worsening of renal functions were seen in 92 and 93% of patients with EPN and NEPN, respectively. Class 1 EPN was seen in 2 (7.7%), Class II in 8 (30.7%), IIIa in 7 (27%), IIIb in 5 (19.3), and IV in 4 (15.4%) patients. Antibiotics alone were sufficient in 38.5% of EPN versus 62% in NEPN; additional PCD was required in 42.3% in EPN and 21.4% in NEPN. Nephrectomy was required in 5 (19.2%) EPN patients with Class IIIB or IV. A total of 13 patients (12.4%) expired, 4 (15.4%) in EPN, and 9 (11.4%) in NEPN group. Patients with EPN had a higher incidence of shock (6% vs. 0; P < 0.05) and poorly controlled blood sugar (26% vs. 50%; P < 0.05) compared with NEPN. Presence of shock and altered sensorium were associated with poor outcome in patients with EPN. Diabetics with pyelonephritis have severe disease. Patients of EPN have poorer treatment outcome compared with those with NEPN. However, there is no difference in the mortality, but a greater need of nephrectomy in EPN compared with NEPN patients. Presence of shock and altered sensorium at presentation were poor prognostic factors in EPN.
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Affiliation(s)
- S Kumar
- Department of Nephrology, PGIMER, Chandigarh, India
| | | | - U Mete
- Department of Urology, PGIMER, Chandigarh, India
| | - T Mittal
- Department of Nephrology, PGIMER, Chandigarh, India
| | - P Dutta
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - V Kumar
- Department of Nephrology, PGIMER, Chandigarh, India
| | - M Rathi
- Department of Nephrology, PGIMER, Chandigarh, India
| | - V Jha
- Department of Nephrology, PGIMER, Chandigarh, India
| | - K L Gupta
- Department of Nephrology, PGIMER, Chandigarh, India
| | - V Sakhuja
- Department of Nephrology, PGIMER, Chandigarh, India
| | - H S Kohli
- Department of Nephrology, PGIMER, Chandigarh, India
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Kanaganayagam GS, Ngo AT, Alsafi A, Kamanahalli R, Sutaria N, Mittal T, Ariff B. CT coronary angiography in the investigation of chest pain — Beyond coronary artery atherosclerosis; A pictorial review. Int J Cardiol 2014; 176:618-29. [DOI: 10.1016/j.ijcard.2014.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 07/13/2014] [Accepted: 08/05/2014] [Indexed: 12/26/2022]
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Torii R, Ibrahim M, Mittal T, Lee SL, Yacoub MH. The wide spectrum of aortic root dilatation after the Ross operation. Glob Cardiol Sci Pract 2014; 2014:49-50. [PMID: 25054120 PMCID: PMC4104378 DOI: 10.5339/gcsp.2014.9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 02/28/2014] [Accepted: 04/11/2014] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Michael Ibrahim
- Harefield Heart Science Centre, Harefield Hospital and Imperial College London, UK
| | | | - Su-Lin Lee
- Department of Computing, Imperial College London, UK
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Abstract
Renal involvement is a common occurrence in subjects with rheumatological diseases and can develop either due to the disease itself or secondary to drugs used in the treatment. The prevalence of renal involvement and its severity depends on the underlying disease as well as aggressiveness of the therapy. For most rheumatological diseases, renal involvement heralds a poor prognosis and warrants aggressive immunosuppressive treatment. Thus, it is important to diagnose and manage them at an early stage. On the other hand, patients with primary kidney disease can also develop rheumatological manifestations which need to be differentiated from the former. This article provides the nephrologist's perspective upon various rheumatological disorders and associated renal involvement with the aim of sensitizing the rheumatological community about them, resulting in better management of these subjects.
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Affiliation(s)
- Tarun Mittal
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Parashari A, Singh V, Mittal T, Ahmed S, Grewal H, Gupta S, Sehgal A. Low cost technology for screening early cancerous lesions of oral cavity in rural settings. Ann Med Health Sci Res 2014; 4:146-8. [PMID: 24669350 PMCID: PMC3952289 DOI: 10.4103/2141-9248.126628] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Low cost technologies are needed in resource poor rural settings for detection of pre-cancer and cancer lesions of the oral cavity. AIM The study was undertaken to investigate the feasibility of a low cost technology (Magnivisualizer) for the early detection any lesions of the oral cavity among tobacco users in a resource poor rural field setting. SUBJECTS AND METHODS A total of 1329 tobacco users were motivated to come forward for oral examination in the camp organized for this purpose. Their oral cavities were screened with a torch and Magnivisualizer by a Dentist. RESULTS With torch light, 104/1329 (7.8%) lesions were identified, though only 62/104 (59.6%) positive lesions could be differentiated into various categories. However, through Magnivisualizer 156/1329 (11.7%) lesions were detected and 153/156 (98.1%) positive lesions were differentiated into different categories. CONCLUSION Magnivisualizer offers an alternative instrument for detecting most of the early cancerous and high-grade precancerous lesions and it can be used in the rural field settings.
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Affiliation(s)
- A Parashari
- Division of Clinical Research, Institute of Cytology and Preventive Oncology, Noida, Uttar Pradesh, India
| | - V Singh
- Division of Clinical Research, Institute of Cytology and Preventive Oncology, Noida, Uttar Pradesh, India
| | - T Mittal
- Division of Clinical Research, Institute of Cytology and Preventive Oncology, Noida, Uttar Pradesh, India
| | - S Ahmed
- Division of Clinical Research, Institute of Cytology and Preventive Oncology, Noida, Uttar Pradesh, India
| | - H Grewal
- Department of Orthodontics, Guru Teg Bahadur Hospital, New Delhi, India
| | - S Gupta
- Division of Clinical Research, Institute of Cytology and Preventive Oncology, Noida, Uttar Pradesh, India
| | - A Sehgal
- Division of Clinical Research, Institute of Cytology and Preventive Oncology, Noida, Uttar Pradesh, India
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