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Sharma Y, Horwood C, Hakendorf P, Thompson C. Response to: Outcomes of admission for heart failure under general and cardiological medicine services. QJM 2023; 116:816-817. [PMID: 37267212 DOI: 10.1093/qjmed/hcad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Indexed: 06/04/2023] Open
Affiliation(s)
- Y Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5042, Australia
- Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Adelaide, South Australia 5042, Australia
| | - C Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia 5042, Australia
| | - P Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia 5042, Australia
| | - C Thompson
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia
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2
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Neha, Sardana HK, Dahiya N, Dogra N, Kanawade R, Sharma YP, Kumar S. Automated myocardial infarction and angina detection using second derivative of photoplethysmography. Phys Eng Sci Med 2023; 46:1259-1269. [PMID: 37395927 DOI: 10.1007/s13246-023-01293-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
Photoplethysmography (PPG) based healthcare devices have gained enormous interest in the detection of cardiac abnormalities. Limited research has been implemented for myocardial infarction (MI) detection. Moreover, PPG-based detection of angina is still a research gap. PPG signals are not always informative. Therefore, this research work presents the use of PPG signals and their second derivative to evaluate myocardial infarction and angina using a novel set of morphological features. The obtained morphological features are fed onto the feed-forward artificial neural network for the identification of the type of MI and unstable angina (UA). The initial experiments have been carried out on non-ambulatory (public) subjects for feature extraction and later evaluated on ambulatory (self-generated) databases. The intended method attains accuracy, sensitivity, and specificity of 98%, 97%, 98% on the public database and 94%, 94%, 94% on the self-generated database. The result shows that the proposed set of features can detect MI and UA with significant accuracy.
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Affiliation(s)
- Neha
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- Central Scientific Instruments Organisation, Chandigarh, India
| | - H K Sardana
- Indian Institute of Information Technology, Raichur, India.
| | - N Dahiya
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - N Dogra
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Kanawade
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- National Chemical Laboratory, Pune, India
| | - Y P Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Kumar
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- Central Scientific Instruments Organisation, Chandigarh, India
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3
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Sharma Y, Horwood C, Hakendorf P, Thompson C. Characteristics and outcomes of patients with heart failure discharged from different speciality units in Australia: an observational study. QJM 2022; 115:727-734. [PMID: 35176164 DOI: 10.1093/qjmed/hcac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous studies have reported differing clinical outcomes among hospitalized heart failure (HF) patients admitted under cardiology and general medicine (GM) without consideration of patients' frailty. AIMS To explore outcomes in patients admitted under the two specialities after taking into account their frailty and other characteristics. METHODS This retrospective study included all HF patients ≥18 years admitted between 1 January 2013 and 31 December 2019 at two Australian tertiary hospitals. Frailty was determined by use of the Hospital Frailty Risk Score (HFRS) and patients with HFRS ≥ 5 were classified as frail. Propensity score matching (PSM) was used to match 11 variables between the two specialities. The primary outcomes included the days-alive-and-out-of-hospital (DAOH90) at 90 days of discharge, 30-day mortality and readmissions. RESULTS Of 4913 HF patients, mean age 76.2 (14.1) years, 51% males, 2653 (54%) were admitted under cardiology compared to 2260 (46%) under GM. Patients admitted under GM were more likely to be older females, with a higher Charlson index and poor renal function than those admitted under cardiology. Overall, 23.8% patients were frail and frail patients were more likely to be admitted under GM than cardiology (33.6% vs. 15.3%, P < 0.001). PSM created 1532 well-matched patients in each group. After PSM, the DAOH90 was not significantly different among patients admitted in GM when compared to cardiology (coefficient -5.36, 95% confidence interval -11.73 to 1.01, P = 0.099). Other clinical outcomes were also similar between the two specialities. CONCLUSIONS Clinical characteristics of HF patients differ between GM and cardiology; however, clinical outcomes were not significantly different after taking into account frailty and other variables.
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Affiliation(s)
- Y Sharma
- From the College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia
- Division of Medicine, Cardiac and Critical Care, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia
| | - C Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA 5042, Australia
| | - P Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA 5042, Australia
| | - C Thompson
- Discipline of Medicine, The University of Adelaide, Adelaide, SA 5005, Australia
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Batta A, Sharma YP, Makkar K, Hatwal J, Malhi T, Panda P. Accuracy of global longitudinal and territorial longitudinal strain in determining myocardial viability in out of window period Anterior wall myocardial infarction patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.007] [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] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Primary percutaneous intervention remains the principal treatment modality for anterior wall myocardial infarction (AWMI). However, a large fraction of patients especially in the developing countries present outside the window period (OWP) with no chest pain and akinetic left anterior descending (LAD) territory on echocardiography. Revascularization in these patients is primarily guided by viability status.
Purpose
This study was conducted to determine the accuracy of strain echocardiographic parameters compared to single-photon emission computed tomography (SPECT) in predicting myocardial viability in patients of AWMI presenting OWP.
Methods
All patients presenting with AWMI-OWP without ongoing chest pain and akinetic LAD territory on echocardiography from December 2020 to June 2021 were recruited. All patients underwent determination of both Global longitudinal strain (GLS) and territorial longitudinal strain (TLS) within 24-72 hours on AWMI. In addition, all underwent SPECT to determine the percentage of non-viable myocardium. On SPECT, a defect >5% myocardial territory showing severe reperfusion defect was considered as a marker of non-viability.
Results
A total of 27 patients were recruited. The mean age of the population was 61.66 + 12.6 years. Acute left ventricular failure (LVF) and cardiogenic shock (CS) was present in 6 (22.2%) and 5 (18.5%) patients respectively. Out of 22 patients who underwent angiography, majority of the patients 19 (86%) had single vessel disease involving the LAD.
The mean left ventricular ejection fraction (LVEF) of the study group was 29.6 + 6.5%. The mean GLS and LAD territory TLS of the study group was -11.13 + 3.14% and -7.2 + 2.75% respectively. On SPECT, 8 (29.6%) patients had non-viable underlying myocardium.
Parameters that very significantly associated with non-viability on SPECT included past history of CAD (p = 0.004), smoking (p = 0.05) and presentation with LVF (p = 0.0008) and CS (p = 0.001).
The mean LVEF was significantly lower in the group with non-viability on SPECT (32.3 + 5.1% vs 23.1 + 4.5%; p < 0.001). Both GLS (-12.8 + 1.4% vs -7.1+ 2.3%; p < 0.001) and TLS (-8.7 + 1.4% vs -3.8 + 1.8%; p < 0.001) were significantly lower in group showing non-viability on SPECT.
On receiver operating curves, a GLS of > -10.45% and TLS of > -6.65%, both had a sensitivity of 87.5% and specificity of 89.5% in predicting non-viability on SPECT. Both showed good accuracy in predicting non-viability on overall quality model. (Figures 1 and 2)
Conclusion
Modalities like cardiac magnetic resonance, SPECT or positron emission tomography are resource dependent and take time to be performed. Hence, performing these investigations is challenging in unstable patients. Strain echocardiography provides GLS of the myocardium which has good sensitivity and specificity in predicting viability and can be performed safely and quickly in this high-risk group. Abstract Figure. Abstract Figure. Overall quality model
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Affiliation(s)
- A Batta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Y P Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Makkar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - J Hatwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - T Malhi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Panda
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Batta A, Sharma YP, Makkar K, Panda P, Barwad P. Angiographic Profiles in Persistent Non-Valvular Atrial Fibrillation Patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Cardiology dept. PGIMER, Chandigarh
Background
The relationship of atrial fibrillation (AF) with coronary artery disease (CAD) is well established. Atrial ischemia due to obstructive CAD has been identified as one of the key risk factors, leading to AF. However, sufficient evidence exists as to the presence of myocardial ischemia on stress imaging, even without the presence of obstructive CAD in AF patients. Slow flow and coronary tortuosity on angiogram can lead to downstream myocardial ischemia independent of CAD.
Purpose
We aimed to delineate the angiographic profiles in AF patients with attention to slow flow and tortuosity leading to ischemia in those without obstructive CAD.
Methods
The study was a nonrandomised, prospective, single-centre observational study of consecutive patients of persistent non valvular AF. Symptomatic patients despite optimal medical therapy (OMT) for 3 months were recruited and all underwent coronary angiograms (CAG). Patients with known CAD or prior history of myocardial infarction were excluded. Further angiographic analysis was done in those without obstructive CAD to determine incidence of slow flow (>27 corrected TIMI frame count) and tortuosity (presence of ≥3 fixed bends in an epicardial artery).
Results
A total of 70 patients were recruited and followed for a mean duration of 12 ± 1.4 months. The mean age of the study group was 66.07 (±11.49). Hypertension (74%) was the commonest comorbidity followed by obesity (35%) and diabetes (30%). At CAG, 32/70 (46%) had obstructive CAD, 17/70 (24%) had non obstructive (<50-70% stenosis) CAD and 21/70 (30%) had normal coronaries without atherosclerosis. Amongst patients without obstructive CAD (n = 38) slow flow was seen in 16/38 (42%) and coronary tortuosity in 11/38 (29%) patients. There ware no differences in terms of death, HF and FVR hospitalisations or stroke at follow up between the obstructive CAD vs no obstructive CAD. However in patients without obstructive CAD, hospitalisations for FVR was significantly increased in those having slow flow on CAG, 9/12 (75%) vs 7/26 (27%) in those without slow flow (p value = 0.005). The mean TIMI frame count was also significantly higher in those with FVR hospitalisations 35.3 ± 11 vs 25.8 ± 8.9 (p value = 0.005). TIMI frame count >31 had a sensitivity of 83% and a specificity of 69% for predicting hospitalisations for FVR on ROC curve(AUC = 0.71).
Conclusions
CAD is closely related to AF and majority (70%) of our patients had evidence of atherosclerotic CAD on CAG in our study. A large proportion of patients with no evidence of obstructive CAD on CAG had slow flow or coronary tortuosity. Significantly increased hospitalisation for FVR seen in the slow flow group shows its significance and may lead to newer treatment modalities in future. Further larger studies looking at these aspects on CAG may give further insight as to the nature and prognosis of these entities. Abstract Figure 1: Flow diagram showing the patie
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Affiliation(s)
- A Batta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Y P Sharma
- Post Graduate Institute of Medical Education and Research, Cardiology, Chandigarh, India
| | - K Makkar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Panda
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Barwad
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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6
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Gal-Yam A, Bruch R, Schulze S, Yang Y, Perley DA, Irani I, Sollerman J, Kool EC, Soumagnac MT, Yaron O, Strotjohann NL, Zimmerman E, Barbarino C, Kulkarni SR, Kasliwal MM, De K, Yao Y, Fremling C, Yan L, Ofek EO, Fransson C, Filippenko AV, Zheng W, Brink TG, Copperwheat CM, Foley RJ, Brown J, Siebert M, Leloudas G, Cabrera-Lavers AL, Garcia-Alvarez D, Marante-Barreto A, Frederick S, Hung T, Wheeler JC, Vinkó J, Thomas BP, Graham MJ, Duev DA, Drake AJ, Dekany R, Bellm EC, Rusholme B, Shupe DL, Andreoni I, Sharma Y, Riddle R, van Roestel J, Knezevic N. A WC/WO star exploding within an expanding carbon-oxygen-neon nebula. Nature 2022; 601:201-204. [PMID: 35022591 DOI: 10.1038/s41586-021-04155-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/15/2021] [Indexed: 11/09/2022]
Abstract
The final fate of massive stars, and the nature of the compact remnants they leave behind (black holes and neutron stars), are open questions in astrophysics. Many massive stars are stripped of their outer hydrogen envelopes as they evolve. Such Wolf-Rayet stars1 emit strong and rapidly expanding winds with speeds greater than 1,000 kilometres per second. A fraction of this population is also helium-depleted, with spectra dominated by highly ionized emission lines of carbon and oxygen (types WC/WO). Evidence indicates that the most commonly observed supernova explosions that lack hydrogen and helium (types Ib/Ic) cannot result from massive WC/WO stars2,3, leading some to suggest that most such stars collapse directly into black holes without a visible supernova explosion4. Here we report observations of SN 2019hgp, beginning about a day after the explosion. Its short rise time and rapid decline place it among an emerging population of rapidly evolving transients5-8. Spectroscopy reveals a rich set of emission lines indicating that the explosion occurred within a nebula composed of carbon, oxygen and neon. Narrow absorption features show that this material is expanding at high velocities (greater than 1,500 kilometres per second), requiring a compact progenitor. Our observations are consistent with an explosion of a massive WC/WO star, and suggest that massive Wolf-Rayet stars may be the progenitors of some rapidly evolving transients.
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Affiliation(s)
- A Gal-Yam
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel.
| | - R Bruch
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel
| | - S Schulze
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel.,The Oskar Klein Centre, Department of Astronomy and Department of Physics, AlbaNova, Stockholm University, Stockholm, Sweden
| | - Y Yang
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel.,Department of Astronomy, University of California, Berkeley, Berkeley, CA, USA
| | - D A Perley
- Astrophysics Research Institute, Liverpool John Moores University, Liverpool, UK
| | - I Irani
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel
| | - J Sollerman
- The Oskar Klein Centre, Department of Astronomy and Department of Physics, AlbaNova, Stockholm University, Stockholm, Sweden
| | - E C Kool
- The Oskar Klein Centre, Department of Astronomy and Department of Physics, AlbaNova, Stockholm University, Stockholm, Sweden
| | - M T Soumagnac
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel.,Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - O Yaron
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel
| | - N L Strotjohann
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel
| | - E Zimmerman
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel
| | - C Barbarino
- The Oskar Klein Centre, Department of Astronomy and Department of Physics, AlbaNova, Stockholm University, Stockholm, Sweden
| | - S R Kulkarni
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - M M Kasliwal
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - K De
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - Y Yao
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - C Fremling
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - L Yan
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - E O Ofek
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot, Israel
| | - C Fransson
- The Oskar Klein Centre, Department of Astronomy and Department of Physics, AlbaNova, Stockholm University, Stockholm, Sweden
| | - A V Filippenko
- Department of Astronomy, University of California, Berkeley, Berkeley, CA, USA.,Miller Institute for Basic Research in Science, University of California, Berkeley, Berkeley, CA, USA
| | - W Zheng
- Department of Astronomy, University of California, Berkeley, Berkeley, CA, USA
| | - T G Brink
- Department of Astronomy, University of California, Berkeley, Berkeley, CA, USA
| | - C M Copperwheat
- Astrophysics Research Institute, Liverpool John Moores University, Liverpool, UK
| | - R J Foley
- Department of Astronomy and Astrophysics, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - J Brown
- Department of Astronomy and Astrophysics, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - M Siebert
- Department of Astronomy and Astrophysics, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - G Leloudas
- DTU Space, National Space Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | | | | | - S Frederick
- Department of Astronomy, University of Maryland, College Park, MD, USA
| | - T Hung
- Department of Astronomy and Astrophysics, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - J C Wheeler
- Department of Astronomy, University of Texas at Austin, Austin, TX, USA
| | - J Vinkó
- Department of Astronomy, University of Texas at Austin, Austin, TX, USA.,Konkoly Observatory, ELKH CSFK, Budapest, Hungary.,Department of Optics and Quantum Electronics, University of Szeged, Szeged, Hungary.,ELTE Institute of Physics, Eötvös Loránd University, Budapest, Hungary
| | - B P Thomas
- Department of Astronomy, University of Texas at Austin, Austin, TX, USA
| | - M J Graham
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - D A Duev
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - A J Drake
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - R Dekany
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - E C Bellm
- DIRAC Institute, Department of Astronomy, University of Washington, Seattle, WA, USA
| | - B Rusholme
- IPAC, California Institute of Technology, Pasadena, CA, USA
| | - D L Shupe
- IPAC, California Institute of Technology, Pasadena, CA, USA
| | - I Andreoni
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - Y Sharma
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - R Riddle
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - J van Roestel
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, CA, USA
| | - N Knezevic
- Department of Astronomy, Faculty of Mathematics, University of Belgrade, Belgrade, Serbia
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Sharma Y, Horwood C, Hakendorf P, Thompson C. Benefits of Heart Failure Specific Pharmacotherapy in Frail Hospitalised Heart Failure Patients: An Observational Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Makkar K, Malhi TS, Batta A, Panda P, Sharma YP. Observational study of Covid-19 patients presenting with acute coronary syndrome at a tertiary care center in India. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aim
Patients with Covid-19 are theoretically at a higher risk of ACS, as respiratory infections can often lead to coronary endothelial damage and plaque rupture. Initial reports during start of pandemic suggested decrease in STEMI patients, however this has been explained by iatrophobia rather than actual decrease. Data on pathophysiology and outcome of patients presenting with ACS is scarce. We did a prospective observational study to study epidemiology and outcomes of Covid-19 patients with ACS.
Methods
A total of 654 patients were admitted with Covid-19 at PGIMER, Chandigarh from August 2020 to February 2021, 35 (5.3%) consecutive patients of ACS were enrolled into the study. Acute myocardial infarction was defined as per fourth universal definition of myocardial infarction. Diagnosis of Covid-19 was established using RT-PCR from nasopharyngeal swab. Angiographic assessment was done by two interventional cardiologists.
Results
Mean age of patients was 59.5±11.8 years, males comprised majority (80%) of study group. Most common risk factor was hypertension seen in around 70% followed by DM in 57% patients. Most common symptom at presentation was rest angina seen >90% while history of fever was present in only 31.4%. STEMI was most common ACS seen in 45.7% followed by USA in 23% patients. CS was present in 15% patients at presentation while another 5% developed shock in hospital. Oxygen requirement was required in over half the patients while 25% patients succumbed to illness in hospital.Thrombolysis was done in half the patients of STEMI. In view of Covid-19 disease 71.4% required dexamethasone and remdesivir. Coronary angiography was done in around 20% patients, which revealed obstructive CAD in 83% patients with 60% patients having 100% occlusion of IRA. Percutaneous intervention was done in 66% patients. Hypoalbuminemia was commonly seen patients with mean albumin of 3.3 gm/dL. Low T3 syndrome was most common thyroid function abnormality seen in 37.1%.On univariate analysis age, BNP levels and albumin were able to predict 30-day mortality.
Conclusion
ACS can be first presentation of patients with Covid-19 as shown by our study only 30% patients had prior history of fever. Our data reaffirms that patients with Covid-19 and ACS have worse prognosis. Interestingly mortality in our study was comparable to western study, despite low rate of angiography and intervention thus underscoring individualization of therapy. We believe Type-2 myocardial infarction is common in pathophysiology of patients who benefit most from medical therapy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Makkar
- Postgraduate Institute of Medical Education and Research (PGIMER), Cardiology, Chandigarh, India
| | - T S Malhi
- Postgraduate Institute of Medical Education and Research (PGIMER), Cardiology, Chandigarh, India
| | - A Batta
- Postgraduate Institute of Medical Education and Research (PGIMER), Cardiology, Chandigarh, India
| | - P Panda
- Postgraduate Institute of Medical Education and Research (PGIMER), Cardiology, Chandigarh, India
| | - Y P Sharma
- Postgraduate Institute of Medical Education and Research (PGIMER), Cardiology, Chandigarh, India
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Sharma S, Parasher K, Mukherjee P, Sharma YP. Cryopreservation of a threatened medicinal plant, Valeriana jatamansi Jones, using vitrification and assessment of biosynthetic stability of regenerants. Cryo Letters 2021; 42:300-308. [PMID: 35363851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Valeriana jatamansi Jones is a medicinal plant of the Himalayan region with high trade value. Since overexploitation of this wild species led it to be listed as threatened, a comprehensive conservation strategy is needed. Cryopreservation would be a useful complementary method to conventional conservation methods. OBJECTIVE To develop a cryopreservation protocol for V. jatamansi with maintenance of biosynthetic stability of regenerants. MATERIALS AND METHODS In vitro shoot tips were cryopreserved using vitrification with either PVS2 or PVS3 and the efficacy of the two cryoprotectant mixtures compared. Regenerated plantlets were evaluated by HPLC analysis for contents of four valepotriates viz. valtrate, acevaltrate, didrovaltrate and IVHD valtrate. RESULTS The highest shoot recovery (91.6%) after transfer to liquid nitrogen was obtained when shoot tips were treated with PVS2 at 0°C for 110 min, which was significantly higher than the highest recovery (73.3%) obtained using PVS3 for any duration tested. Evaluation of biosynthetic stability showed no variation in valepotriate contents between in vitro maintained and cryopreserved derived plantlets. CONCLUSION This protocol will be useful for the long-term conservation of this species as high frequency recovery and biosynthetic stability after cryopreservation were obtained.
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Affiliation(s)
- S Sharma
- Department of Botany, Panjab University, Chandigarh, 160 014, India
| | - K Parasher
- Department of Botany, Panjab University, Chandigarh, 160 014, India
| | - P Mukherjee
- Department of Botany, Panjab University, Chandigarh, 160 014, India.
| | - Y P Sharma
- Department of Forest Products, Dr. YS Parmar University of Horticulture and Forestry, Solan, Himachal Pradesh, 173 230, India
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Batta A, Sharma YP, Makkar K, Panda P, Gawalkar A. Angiographic profiles in patients of persistent non-valvular atrial fibrillation from a tertiary care center in north india. Europace 2021. [DOI: 10.1093/europace/euab116.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The relationship of atrial fibrillation (AF) with coronary artery disease (CAD) is well established. Atrial ischemia due to obstructive CAD has been identified as one of the key risk factors, leading to AF. However, sufficient evidence exists as to the presence of myocardial ischemia on stress imaging, even without the presence of obstructive CAD in AF patients. Slow flow and coronary tortuosity on angiogram can lead to downstream myocardial ischemia independent of CAD.
Purpose
We aimed to delineate the angiographic profiles in AF patients with attention to slow flow and tortuosity leading to ischemia in those without obstructive CAD.
Methods
The study was a nonrandomised, prospective, single-centre observational study of consecutive patients of persistent non valvular AF. Symptomatic patients despite optimal medical therapy (OMT) for 3 months were recruited and all underwent coronary angiograms (CAG). Patients with known CAD or prior history of myocardial infarction were excluded. Further angiographic analysis was done in those without obstructive CAD to determine incidence of slow flow (>27 corrected TIMI frame count) and tortuosity (presence of ≥3 fixed bends in an epicardial artery).
Results
A total of 70 patients were recruited and followed for a mean duration of 12 ± 1.4 months. The mean age of the study group was 66.07 (±11.49). Hypertension (74%) was the commonest comorbidity followed by obesity (35%) and diabetes (30%). At CAG, 32/70 (45%) had obstructive CAD, 17/70 (24%) had non obstructive (<50-70% stenosis) CAD and 21/70 (30%) had normal coronaries without atherosclerosis. Amongst patients without obstructive CAD (n = 38) slow flow was seen in 16/38 (42%) and coronary tortuosity in 11/38 (29%) patients. There ware no differences in terms of death, HF and FVR hospitalisations or stroke at follow up between the obstructive CAD vs no obstructive CAD. However in patients without obstructive CAD, hospitalisations for FVR was significantly increased in those having slow flow on CAG, 9/12 (75%) vs 7/26 (27%) in those without slow flow (p value = 0.005). The mean TIMI frame count was also significantly higher in those with FVR hospitalisations 35.3 ± 11 vs 25.8 ± 8.9 (p value = 0.005). TIMI frame count >31 had a sensitivity of 83% and a specificity of 69% for predicting hospitalisations for FVR on ROC curve(AUC = 0.71).
Conclusions
CAD is closely related to AF and majority (70%) of our patients had evidence of atherosclerotic CAD on CAG in our study. A large proportion of patients with no evidence of obstructive CAD on CAG had slow flow or coronary tortuosity. Significantly increased hospitalisation for FVR seen in the slow flow group shows its significance and may lead to newer treatment modalities in future. Further larger studies looking at these aspects on CAG may give further insight as to the nature and prognosis of these entities.
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Affiliation(s)
- A Batta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - YP Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Makkar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Panda
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Gawalkar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Han CY, Sharma Y, Yaxley A, Baldwin C, Miller M. Use of the Patient-Generated Subjective Global Assessment to Identify Pre-Frailty and Frailty in Hospitalized Older Adults. J Nutr Health Aging 2021; 25:1229-1234. [PMID: 34866150 DOI: 10.1007/s12603-021-1704-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and Edmonton Frail Scale (EFS) are widely used in acute care settings to assess nutritional and frailty status, respectively. We aimed to determine whether the scored PG-SGA can identify pre-frailty and frailty status, to simultaneously evaluate malnutrition and frailty in clinical practice. DESIGN Cross-sectional study. SETTINGS AND PARTICIPANTS A convenience sample of 329 consecutive patients admitted to an acute medical unit in South Australia. MEASUREMENTS Nutritional and frailty status were ascertained with scored PG-SGA and EFS, respectively. Optimal cut-off scores to identify pre-frailty and frailty were determined by calculating the Scored PG-SGA's sensitivity, specificity, positive and negative predictive values, Youden Index (YI), Liu index, Receiver Operator Curves (ROC) and Area Under Curve (AUC). Nutritional status and patient characteristics were analysed according to frailty categories. RESULTS The optimal cut-off PG-SGA score as determined by the highest YI, to identify both pre-frailty and frailty was >3, with a sensitivity of 0.711 and specificity of 0.746. The AUC was 0.782 (95% CI 0.731-0.833). In this cohort, 64% of the patients were well-nourished, 26% were moderately malnourished and 10% were severely malnourished. Forty-three percent, 24% and 33% of the patients were classified as robust, pre-frail and frail, respectively. Bivariate analysis showed that those robust were significantly younger than those who were pre-frail (-2.8, 95% CI -5.5 to -0.1, p=0.036) or frail (-3.4, 95% CI -5.9 to -1.0, p=0.002). Robust patients had significantly lower Scored PG-SGA than those who were pre-frail (-2.5, 95%CI -3.8 to -1.1, p<0.001) or frail (-4.9, 95% CI -6.1 to -3.7, p<0.001). CONCLUSION The Scored PG-SGA is moderately sensitive in identifying pre-frailty/frailty in older hospitalized adults and can be useful in identifying both conditions concurrently.
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Affiliation(s)
- C Y Han
- Chad Yixian Han, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, SA5042, Australia, E-mail address:
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Pyngrope A, Khardewsaw A, Sharma Y, Maibam D, Saxena A, Sahoo BK. STUDY OF INDOOR RADON, THORON AND THEIR PROGENY IN SOUTH WEST KHASI HILLS DISTRICT OF MEGHALAYA, INDIA. Radiat Prot Dosimetry 2020; 189:347-353. [PMID: 32342102 DOI: 10.1093/rpd/ncaa048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 06/11/2023]
Abstract
A survey of indoor radon/thoron and their progeny concentrations was carried out in dwellings in the South West Khasi Hills district of Meghalaya, India. The survey was carried out using solid-state nuclear track detectors based on single-entry pinhole dosimeter and direct radon/thoron progeny sensors. The results are subjected to statistical analysis and discussed in the manuscript. The mean value of annual effective dose of the study region is estimated at 1.8 mSv.y -1. Seasonal variability and role of different indoor parameters are also discussed.
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Affiliation(s)
- A Pyngrope
- Department of Physics, North-Eastern Hill University, Shillong 793022, India
| | - A Khardewsaw
- Department of Physics, North-Eastern Hill University, Shillong 793022, India
| | - Y Sharma
- Department of Physics, Don Bosco College, Tura 794001, India
| | - D Maibam
- Don Bosco College of Teacher Education, Tura 794001, India
| | - A Saxena
- Department of Physics, North-Eastern Hill University, Shillong 793022, India
| | - B K Sahoo
- Radiological Physics and Advisory Division, BARC, Mumbai 400085, India
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Bhargava D, Neelakandan R, Sharma Y, Dalsingh V, Beena S, Gurjar P. Predictability and Feasibility of Total Alloplastic Temporomandibular Joint Reconstruction using DARSN TM Joint Prosthesis for patients in Indian subcontinent–A prospective clinical study. Journal of Stomatology, Oral and Maxillofacial Surgery 2020; 121:2-8. [DOI: 10.1016/j.jormas.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
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Khatoon N, Sharma Y, Sardar M, Manzoor N. Mode of action and anti-Candida activity of Artemisia annua mediated-synthesized silver nanoparticles. J Mycol Med 2019; 29:201-209. [DOI: 10.1016/j.mycmed.2019.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
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Babu BV, Sharma Y, Kusuma YS, Sivakami M, Lal DK, Marimuthu P, Geddam JB, Khanna A, Agarwal M, Sudhakar G, Sengupta P, Borhade A, Khan Z, Kerketta AS, Brogen A. Patient experiences and health system responsiveness among internal migrants: A nationwide study in 13 Indian cities. J Healthc Qual Res 2019; 34:167-175. [PMID: 31713527 DOI: 10.1016/j.jhqr.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/06/2018] [Revised: 04/02/2019] [Accepted: 04/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To report various components of health system responsiveness among poor internal migrants who availed the government health facilities in 13 Indian cities. MATERIALS AND METHODS Cluster random sampling was used to select 50,806 migrant households, of which 14,263 households avail the government health facility in last six months. In addition, 5072 women, who sought antenatal care and 3946 women who had delivery in government health facility during last six months were also included. Data on different domains of health system responsiveness were collected using an interviewer-administered questionnaire, developed based on the World Health Survey of WHO. RESULTS Of the eight domains of responsiveness, namely, autonomy, communication, confidentiality, dignity, choice, quality of basic facilities, prompt attention and access to family and community, seven domains, except the 'choice', are assessed, and they are moderate. Only about 30% of participants said that doctor discussed on treatment options (autonomy). And 50-60% of participants said positively for questions of clarity of communication. About 59% of participants acknowledged the confidentiality. Not more than 40% of participants said they were treated with dignity, and privacy is respected (dignity). The responses to quality basic amenities, prompt attention and access to family and community domains are fairly satisfactory. CONCLUSIONS This study has implications as many urban poor, including migrants do not utilize the services of public healthcare facilities. Hence, a responsive health system is required. There should be a policy in place to train and orient healthcare workers on some of the domains of health system responsiveness.
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Affiliation(s)
- B V Babu
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India.
| | - Y Sharma
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India
| | - Y S Kusuma
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - M Sivakami
- Centre for Health and Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - D K Lal
- International Institute of Health Management Research, New Delhi, India
| | - P Marimuthu
- Department of Biostatistics, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - J B Geddam
- National Institute of Nutrition of Indian Council of Medical Research, Hyderabad, India
| | - A Khanna
- Indian Institute of Health Management Research, Jaipur, India
| | - M Agarwal
- Department of Community Medicine & Public Health, KG Medical University, Lucknow, India
| | - G Sudhakar
- Department of Human Genetics, Andhra University, Visakhapatnam, India
| | - P Sengupta
- Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - A Borhade
- Indian Institute of Public Health, Public Health Foundation of India, Gurgaon, India
| | - Z Khan
- Department of Community Medicine, JN Medical College, Aligarh Muslim University, Aligarh, India
| | - A S Kerketta
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
| | - A Brogen
- Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, India
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Bhargava D, Neelakandan RS, Dalsingh V, Sharma Y, Pandey A, Pandey A, Beena S, Koneru G. A three dimensional (3D) musculoskeletal finite element analysis of DARSN temporomandibular joint (TMJ) prosthesis for total unilateral alloplastic joint replacement. J Stomatol Oral Maxillofac Surg 2019; 120:517-522. [PMID: 30965154 DOI: 10.1016/j.jormas.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the strain and stress distribution for DARSN alloplastic unilateral temporomandibular joint (TMJ) prosthesis and the effects on contralateral natural joint using a finite element analysis (FEA). METHODS The replacement of the TMJ may have complications like infection, failure of hardware, facial paralysis and perforation. The understanding of the mechanical forces exerted by muscles of mastication and jaw movement on the joint helps in identifying the regions on alloplastic TMJ with various maximum forces, which makes that area more prone for failure of hardware. A three dimensional structural FEA was applied using a validated finite element model (FEM) where the areas of stress and strain were evaluated in the alloplastic joint and the contralateral natural joint. As the pattern of stress and strain can be influenced by the materials used for alloplastic joint and geometry of the design, mechanical property of bone and the attached musculature were also considered while construction the FEM analysis. RESULTS The forces of the muscles of mastication has a vital role on the amount of stress and strain present across the alloplastic joint. Masseter and temporalis exhibited the greatest resultant force on the alloplastic as well as the natural condyle with a magnitude of 272 N and 329 N. This study assessed the maximum stress and strain on the condyle-ramus unit and fossa. CONCLUSION FEA shows that alloplastic DARSN TMJ prosthesis distributes stress and strain equally between the alloplastic joint site and the contralateral natural joint causing minimal adverse effects to the natural joint. FEA also evaluated the stress and strain on alloplastic component and resulted in drawing clinical implications for operating surgical team.
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Affiliation(s)
- D Bhargava
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Center, People's University, Bhanpur, Bhopal, 462037 Madhya Pradesh, India.
| | - R S Neelakandan
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, 600095 Tamil Nadu, India
| | - V Dalsingh
- Department of Oral and Maxillofacial Surgery, Lenora Institute of Dental Sciences, Rajahmundry, 533294 Andhra Pradesh, India
| | - Y Sharma
- Department of Oral and Maxillofacial Surgery, People's Dental Academy, People's University, Bhanpur, Bhopal, 462037 Madhya Pradesh, India
| | - A Pandey
- TMJ Consultancy, Bhopal, 462001 Madhya Pradesh, India
| | - A Pandey
- Department of Oral and Maxillofacial Surgery, RKDF Dental College and Research Centre, Bhopal, 462026 Madhya Pradesh, India
| | - S Beena
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Center, People's University, Bhanpur, Bhopal, 462037 Madhya Pradesh, India
| | - G Koneru
- Department of Oral and Maxillofacial Surgery, Sibar Institute of Dental Sciences and Research Center, Vijayawada, 522509 Andhra Pradesh, India
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Bhargava D, Neelakandan RS, Sharma Y, Beena S, Gurjar P. Partial thickness temporalis rotation for alloplastic temporomandibular joint - how I do it. J Stomatol Oral Maxillofac Surg 2019; 120:355-357. [PMID: 30641280 DOI: 10.1016/j.jormas.2019.01.001] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022]
Abstract
With increasing clinical evidence, the replacement of the temporomandibular joint with alloplastic joints is being increasingly accepted in severe degenerative diseases. There remains a risk of infection and a possibility of a failure of not just these prostheses but any alloplastic joint prosthesis post-operatively. Therefore, an extra precaution and additional coverage to the joint using partial thickness myo-temporalis rotation flap could be a useful option to minimize post-operative joint failure.
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Affiliation(s)
- D Bhargava
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Centre, People's University, 462037, Bhanpur, Bhopal, Madhya Pradesh, India.
| | - R S Neelakandan
- Meenakshi Academy of Higher Education and Research Centre, Chennai, Tamil Nadu, India
| | - Y Sharma
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Centre, People's University, 462037, Bhanpur, Bhopal, Madhya Pradesh, India; Department of Oral and Maxillofacial Surgery, People's Dental Academy, People's University, 462037, Bhanpur, Bhopal, Madhya Pradesh, India
| | - S Beena
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Centre, People's University, 462037, Bhanpur, Bhopal, Madhya Pradesh, India
| | - P Gurjar
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Centre, People's University, 462037, Bhanpur, Bhopal, Madhya Pradesh, India
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Wu CH, Chen CH, Chen PH, Yang JJ, Chang PC, Huang TC, Bagga S, Sharma Y, Lin RM, Chan DC. Identifying characteristics of an effective fracture liaison service: systematic literature review. Osteoporos Int 2018. [PMID: 29525971 DOI: 10.1007/s00198-017-4370-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fracture liaison services (FLS) have been demonstrated to improve outcomes following osteoporotic fracture. The aim of this systematic literature review (SLR) was to determine the characteristics of an FLS that lead to improved patient outcomes. We conducted a SLR, including articles published between 2000 and February 2017, using global (Medline, EMBASE, PubMed and Cochrane Library) and local databases. Studies including patients aged ≥ 50 years with osteoporotic fractures enrolled in an FLS were assessed. Information extracted from each article included key person coordinating the FLS (physician, nurse or other healthcare professional), setting (hospital vs community), intensity (single vs multiple), duration (long vs short term), fracture type and gender. A meta-analysis of randomised controlled trials was conducted based on the key person coordinating the FLS. Out of 7236 articles, 57 were considered to be high quality and identified for further analysis. The SLR identified several components which contributed to FLS success, including multidisciplinary involvement, driven by a dedicated case manager, regular assessment and follow-up, multifaceted interventions and patient education. Meta-analytic data confirm the effectiveness of an FLS following an osteoporotic fracture: approximate 27% increase in the likelihood of BMD testing and up to 21% increase in the likelihood of treatment initiation compared with usual care. The balance of evidence indicates that the multifaceted FLS and dedicated coordination are important success factors that contribute to effective FLS interventions which reduce fracture-related morbidity and mortality.
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Affiliation(s)
- C-H Wu
- Department of Family Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
- Institute of Gerontology, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - C-H Chen
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Adult Reconstruction Surgery, Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - P-H Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - J-J Yang
- Department of Internal Medicine, Po Jen General Hospital, Taipei City, Taiwan
| | - P-C Chang
- Department of Orthopedics, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - T-C Huang
- National Taiwan University Hospital Chu-Tung Branch, Hsinchu, Taiwan
| | - S Bagga
- Complete HEOR Solutions LLC, 1046 Knapp Road, North Wales, PA, 19454, USA
| | - Y Sharma
- Complete HEOR Solutions LLC, 1046 Knapp Road, North Wales, PA, 19454, USA
| | - R-M Lin
- Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan
| | - D-C Chan
- National Taiwan University Hospital Chu-Tung Branch, Hsinchu, Taiwan.
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Sharma Y, Thompson CH, Kaambwa B, Shahi R, Hakendorf P, Miller M. Investigation of the benefits of early malnutrition screening with telehealth follow up in elderly acute medical admissions. QJM 2017; 110:639-647. [PMID: 28472530 DOI: 10.1093/qjmed/hcx095] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The benefit of providing early nutrition intervention and its continuation post-discharge in older hospitalized patients is unclear. This study examined efficacy of such an intervention in older patients discharged from acute care. METHODS In this randomized controlled trial, 148 malnourished patients were randomized to receive either a nutrition intervention for 3 months or usual care. Intervention included an individualized nutrition care plan plus monthly post-discharge telehealth follow-up whereas control patients received intervention only upon referral by their treating clinicians. Nutrition status was determined by the Patient Generated Subjective Global Assessment (PG-SGA) tool. Clinical outcomes included changes in length of hospital stay, complications during hospitalization, Quality of life (QoL), mortality and re-admission rate. RESULTS Fifty-four males and 94 females (mean age, 81.8 years) were included. Both groups significantly improved PG-SGA scores from baseline. There was no between-group differences in the change in PG-SGA scores and final PG-SGA scores were similar at 3 months 6.9 (95% CI 5.6-8.3) vs. 5.8 (95% CI 4.8-6.9) (P = 0.09), in control and intervention groups, respectively. Median total length of hospital stay was 6 days shorter in the intervention group (11.4 (IQR 16.6) vs. 5.4 (IQR 8.1) (P = 0.01). There was no significant difference in complication rate during hospitalization, QoL and mortality at 3-months or readmission rate at 1, 3 or 6 months following hospital discharge. CONCLUSION In older malnourished inpatients, an early and extended nutrition intervention showed a trend towards improved nutrition status and significantly reduced length of hospital stay.
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Affiliation(s)
- Y Sharma
- Department of General Medicine, Flinders Medical Centre, South Australia, School of Medicine, Flinders University, Adelaide, South Australia 5042
| | - C H Thompson
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia 5005
| | - B Kaambwa
- Department of Health Economics, Flinders University, Adelaide, South Australia 5042
| | - R Shahi
- Faculty of Medicine, Health and Nursing, Monash University, Melbourne, Australia 3800
| | - P Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia 5042
| | - M Miller
- Department of Nutrition & Dietetics, Flinders University, Adelaide, South Australia 5042
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Kumari N, Ranac RC, Sharma YP, Kumar S. Extraction, Purification and Analysis of Sweet Compounds in Stevia rebaudiana Bertoni using Chromatographic Techniques. Indian J Pharm Sci 2017. [DOI: 10.4172/pharmaceutical-sciences.1000270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Sharma Y, Thompson C, Shari R, Hakendorf P, Miller M. Malnutrition in Acutely Unwell Hospitalized Elderly - "The Skeletons Are Still Rattling in the Hospital Closet". J Nutr Health Aging 2017; 21:1210-1215. [PMID: 29188881 DOI: 10.1007/s12603-017-0903-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/16/2022]
Abstract
INTRODUCTION Malnutrition is common in hospitalized patients with prevalence rates of up to 30% in Australian hospitals with adverse consequences for both the patients and health care services. Despite formulation of nutritional screening protocols, not all hospitalized patients get nutritional screening. Real life screening rates of hospitalized elderly patients are unknown. AIM The present study explored nutrition screening rate in acutely unwell elderly patients admitted in a large tertiary hospital and how these patients fared depending upon their nutrition status. METHODS A prospective cross-sectional study involving 205 general medical patients ≥60years recruited between November 2014 and November 2015. The number of patients who missed nutrition screening were noted and all patients underwent nutritional assessment by a qualified dietitian using PG-SGA and quality of life was measured using EQ-5D 5L. A survival curve was plotted and multivariate cox proportional hazard model was used to adjust for confounders. RESULTS Only 99 (49.7%) patients underwent nutritional screening. One hundred and six (53.5%) patients were confirmed as malnourished by PG-SGA. Malnourished patients had significantly longer length of hospital stay and had worse quality of life. Mortality was significantly higher in malnourished patients at one year (23 (21.7%) vs 4 (4.3%); p<0.001) and cox proportional hazard model suggests that malnutrition significantly affects survival even after adjustment for confounders like age, sex, Charlson index and polypharmacy. CONCLUSION This study confirms that nutrition screening is still suboptimal in elderly hospitalized patients with adverse consequences and suggests need for review of policies to improve screening practices.
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Affiliation(s)
- Y Sharma
- Michelle Miller, Flinders University, Australia,
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Abstract
A 3-step continuous flow oxidation of alcohols is demonstrated with continuous generation of chlorine as the first step followed by its use for the flow synthesis of high strength sodium hypochlorite.
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Affiliation(s)
- Y. Sharma
- Academy of Scientific and Innovative Research (AcSIR)
- CSIR-National Chemical Laboratory (NCL) Campus
- Pune - 411008
- India
- Chem. Eng. & Proc. Dev
| | - S. Moolya
- Chem. Eng. & Proc. Dev
- CSIR-National Chemical Laboratory
- Pune - 411008
- India
| | - R. A. Joshi
- Org. Chem. Div
- CSIR-National Chemical Laboratory
- Pune - 411008
- India
| | - A. A. Kulkarni
- Academy of Scientific and Innovative Research (AcSIR)
- CSIR-National Chemical Laboratory (NCL) Campus
- Pune - 411008
- India
- Chem. Eng. & Proc. Dev
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Sharma Y, Khan L, Manzoor N. Anti-Candida activity of geraniol involves disruption of cell membrane integrity and function. J Mycol Med 2016; 26:244-54. [DOI: 10.1016/j.mycmed.2016.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/07/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
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Rivas MA, Graham D, Sulem P, Stevens C, Desch AN, Goyette P, Gudbjartsson D, Jonsdottir I, Thorsteinsdottir U, Degenhardt F, Mucha S, Kurki MI, Li D, D'Amato M, Annese V, Vermeire S, Weersma RK, Halfvarson J, Paavola-Sakki P, Lappalainen M, Lek M, Cummings B, Tukiainen T, Haritunians T, Halme L, Koskinen LLE, Ananthakrishnan AN, Luo Y, Heap GA, Visschedijk MC, MacArthur DG, Neale BM, Ahmad T, Anderson CA, Brant SR, Duerr RH, Silverberg MS, Cho JH, Palotie A, Saavalainen P, Kontula K, Färkkilä M, McGovern DPB, Franke A, Stefansson K, Rioux JD, Xavier RJ, Daly MJ, Barrett J, de Lane K, Edwards C, Hart A, Hawkey C, Jostins L, Kennedy N, Lamb C, Lee J, Lees C, Mansfield J, Mathew C, Mowatt C, Newman B, Nimmo E, Parkes M, Pollard M, Prescott N, Randall J, Rice D, Satsangi J, Simmons A, Tremelling M, Uhlig H, Wilson D, Abraham C, Achkar JP, Bitton A, Boucher G, Croitoru K, Fleshner P, Glas J, Kugathasan S, Limbergen JV, Milgrom R, Proctor D, Regueiro M, Schumm PL, Sharma Y, Stempak JM, Targan SR, Wang MH. A protein-truncating R179X variant in RNF186 confers protection against ulcerative colitis. Nat Commun 2016; 7:12342. [PMID: 27503255 PMCID: PMC4980482 DOI: 10.1038/ncomms12342] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/24/2016] [Indexed: 01/05/2023] Open
Abstract
Protein-truncating variants protective against human disease provide in vivo validation of therapeutic targets. Here we used targeted sequencing to conduct a search for protein-truncating variants conferring protection against inflammatory bowel disease exploiting knowledge of common variants associated with the same disease. Through replication genotyping and imputation we found that a predicted protein-truncating variant (rs36095412, p.R179X, genotyped in 11,148 ulcerative colitis patients and 295,446 controls, MAF=up to 0.78%) in RNF186, a single-exon ring finger E3 ligase with strong colonic expression, protects against ulcerative colitis (overall P=6.89 × 10(-7), odds ratio=0.30). We further demonstrate that the truncated protein exhibits reduced expression and altered subcellular localization, suggesting the protective mechanism may reside in the loss of an interaction or function via mislocalization and/or loss of an essential transmembrane domain.
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Affiliation(s)
- Manuel A. Rivas
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Daniel Graham
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
| | | | - Christine Stevens
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
| | - A. Nicole Desch
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
| | - Philippe Goyette
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada H1T1C8
| | - Daniel Gudbjartsson
- deCODE Genetics, Amgen Inc., 101 Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, 101 Reykjavik, Iceland
| | - Ingileif Jonsdottir
- deCODE Genetics, Amgen Inc., 101 Reykjavik, Iceland
- Department of Immunology, Landspitali, the National University Hospital of Iceland, 101 Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | - Unnur Thorsteinsdottir
- deCODE Genetics, Amgen Inc., 101 Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | - Frauke Degenhardt
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany
| | - Sören Mucha
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany
| | - Mitja I. Kurki
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Dalin Li
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California 90048 USA
| | - Mauro D'Amato
- Department of Biosciences and Nutrition, Karolinska Institutet, 14183 Stockholm, Sweden
- BioCruces Health Research Institute and IKERBASQUE, Basque Foundation for Science, 48903 Bilbao, Spain
| | - Vito Annese
- Unit of Gastroenterology, Istituto di Ricovero e Cura a Carattere Scientifico-Casa Sollievo della Sofferenza (IRCCS-CSS) Hospital, 71013 San Giovanni Rotondo, Italy
- Strutture Organizzative Dipartimentali (SOD) Gastroenterologia 2, Azienda Ospedaliero Universitaria (AOU) Careggi, 50134 Florence, Italy
| | - Severine Vermeire
- Department of Clinical and Experimental Medicine, Translational Research in GastroIntestinal Disorders (TARGID), Katholieke Universiteit (KU) Leuven, Leuven 3000, Belgium
- Division of Gastroenterology, University Hospital Gasthuisberg, BE-3000 Leuven, Belgium
| | - Rinse K. Weersma
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, SE 701 82 Örebro, Sweden
| | - Paulina Paavola-Sakki
- Department of Medicine, University of Helsinki, 00100 Helsinki, Finland
- Helsinki University Hospital, 00100 Helsinki, Finland
- Clinic of Gastroenterology, Helsinki University Hospital, 00100 Helsinki, Finland
| | - Maarit Lappalainen
- Department of Medicine, University of Helsinki, 00100 Helsinki, Finland
- Helsinki University Hospital, 00100 Helsinki, Finland
- Research Programs Unit, Immunobiology, and Department of Medical and Clinical Genetics, University of Helsinki, 00014 Helsinki, Finland
| | - Monkol Lek
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Beryl Cummings
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Taru Tukiainen
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Talin Haritunians
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California 90048 USA
| | - Leena Halme
- Department of Transplantation and Liver Surgery, University of Helsinki, 00100 Helsinki, Finland
| | - Lotta L. E. Koskinen
- Research Programs Unit, Immunobiology, and Department of Medical and Clinical Genetics, University of Helsinki, 00014 Helsinki, Finland
- Department of Medical Genetics, Biomedicum Helsinki, University of Helsinki, 00100 Helsinki, Finland
| | - Ashwin N. Ananthakrishnan
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
- Division of Medical Sciences, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Yang Luo
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, UK
| | - Graham A. Heap
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
| | - Marijn C. Visschedijk
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Daniel G. MacArthur
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Benjamin M. Neale
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Tariq Ahmad
- Peninsula College of Medicine and Dentistry, Exeter PL6 8BU, UK
| | - Carl A. Anderson
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, UK
| | - Steven R. Brant
- Meyerhoff Inflammatory Bowel Disease Center, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, 21205, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205, USA
| | - Richard H. Duerr
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261, USA
| | - Mark S. Silverberg
- Department of Medicine, Inflammatory Bowel Disease Centre, Mount Sinai Hospital, Toronto, Ontario, Canada M5G 1X5
| | - Judy H Cho
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | - Aarno Palotie
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
- Institute for Molecular Medicine Finland, University of Helsinki, 00100 Helsinki, Finland
- Massachusetts General Hospital, Center for Human Genetic Research, Psychiatric and Neurodevelopmental Genetics Unit, Boston, Massachusetts 02114, USA
| | - Päivi Saavalainen
- Research Programs Unit, Immunobiology, University of Helsinki, 00100 Helsinki, Finland
| | - Kimmo Kontula
- Department of Medicine, University of Helsinki, 00100 Helsinki, Finland
- Helsinki University Hospital, 00100 Helsinki, Finland
| | - Martti Färkkilä
- Department of Medicine, University of Helsinki, 00100 Helsinki, Finland
- Helsinki University Hospital, 00100 Helsinki, Finland
- Clinic of Gastroenterology, Helsinki University Hospital, 00100 Helsinki, Finland
| | - Dermot P. B. McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California 90048 USA
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany
| | - Kari Stefansson
- deCODE Genetics, Amgen Inc., 101 Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | - John D. Rioux
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada H1T1C8
- Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada H3T 1J4
| | - Ramnik J. Xavier
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Mark J. Daly
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - J. Barrett
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
| | - K. de Lane
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
| | - C. Edwards
- Department of Gastroenterology, Torbay Hospital, Devon, UK
| | - A. Hart
- Department of Medicine, St. Mark's Hospital, Middlesex, UK
| | - C. Hawkey
- Nottingham Digestive Disease Centre, Queens Medical Centre, Nottingham, UK
| | - L. Jostins
- Wellcome Trust Centre for Human Genetics, University of Oxford, Headington, UK
- Christ Church, University of Oxford, Oxford, UK
| | - N. Kennedy
- Gastrointestinal Unit, Wester General Hospital, University of Edinburgh, Edinburgh, UK
| | - C. Lamb
- Newcastle University, Newcastle upon Tyne, UK
| | - J. Lee
- Inflammatory Bowel Disease Research Group, Addenbrooke's Hospital, Cambridge, UK
| | - C. Lees
- Gastrointestinal Unit, Wester General Hospital, University of Edinburgh, Edinburgh, UK
| | | | - C. Mathew
- Department of Medical and Molecular Genetics, Guy's Hospital, London, UK
- Department of Medical and Molecular Genetics, King's College London School of Medicine, Guy's Hospital, London, UK
| | - C. Mowatt
- Department of Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - B. Newman
- Genetic Medicine, Manchester Academic Health Science Centre, Manchester, UK
- The Manchester Centre for Genomic Medicine, University of Manchester, Manchester, UK
| | - E. Nimmo
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - M. Parkes
- Inflammatory Bowel Disease Research Group, Addenbrooke's Hospital, Cambridge, UK
| | - M. Pollard
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
| | - N. Prescott
- Department of Medical and Molecular Genetics, Guy's Hospital, London, UK
- Department of Medical and Molecular Genetics, King's College London School of Medicine, Guy's Hospital, London, UK
| | - J. Randall
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
| | - D. Rice
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
| | - J. Satsangi
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - A. Simmons
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - M. Tremelling
- Gastroenterology & General Medicine, Norfolk and Norwich University Hospital, Norwich, UK
| | - H. Uhlig
- Translational Gastroenterology Unit and the Department of Pediatrics, University of Oxford, Oxford, UK
| | - D. Wilson
- Pediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh, UK
- Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - C. Abraham
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - J. P. Achkar
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - A. Bitton
- Division of Gastroenterology, Royal Victoria Hospital, Montréal, Québec, Canada
| | - G. Boucher
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada H1T1C8
| | - K. Croitoru
- Inflammatory Bowel Disease Group, Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - P. Fleshner
- Department of Transplantation and Liver Surgery, University of Helsinki, 00100 Helsinki, Finland
| | - J. Glas
- Division of Gastroenterology, Royal Victoria Hospital, Montréal, Québec, Canada
| | - S. Kugathasan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J. V. Limbergen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada
| | - R. Milgrom
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | - D. Proctor
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - M. Regueiro
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261, USA
| | - P. L. Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Y. Sharma
- Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J. M. Stempak
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | - S. R. Targan
- Department of Transplantation and Liver Surgery, University of Helsinki, 00100 Helsinki, Finland
| | - M. H. Wang
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA
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Bala P, Gupta D, Sharma YP. Mycoflora and natural aflatoxin contamination in dried quince seeds from Jammu, India. J Environ Biol 2016; 37:101-106. [PMID: 26930866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Eighty two samples of dried quince seeds, obtained from the markets of Jammu province, were examined for mycoflora by different isolation techniques. A total of 27 fungal species belonging to 11 genera were recovered and identified from these samples. The predominant fungal genera encountered were Aspergillus, Penicillium and Fusarium. In view of the predominance of Aspergillus flavus, a known producer of aflatoxins, screening of the fungal contaminated samples was carried out for total aflatoxin levels using high performance liquid chromatography (HPLC). Twenty one aflatoxin positive samples contained 8.07-33.45 μg g(-1) and 0.05-3946.97 μg g(-1) AFB1 and AFB2 respectively. These results suggest that biochemical composition of dried quince seeds, along with climatic conditions of the region seem to be very favourable for aflatoxin production by toxigenic strains of A. flavus. Therefore, monitoring of aflatoxins in dried quince seeds is recommended for this region.
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Sharma Y, Phillion AB, Martinez DM. Automated segmentation of wood fibres in micro-CT images of paper. J Microsc 2015; 260:400-10. [PMID: 26301453 DOI: 10.1111/jmi.12308] [Citation(s) in RCA: 7] [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] [Received: 02/13/2015] [Accepted: 07/26/2015] [Indexed: 11/28/2022]
Abstract
A novel algorithm has been developed and validated to isolate individual papermaking fibres in micro-computed tomographic images of paper handsheets as a first step to characterize the structure of the paper. The three-step fibre segmentation algorithm segments the papermaking fibres by (i) tracking the hollow inside the fibres via a modified connected component methodology, (ii) extracting the fibre walls using a distance transform and (iii) labelling the fibres through collapsed sections by a final refinement step. Furthermore, postprocessing algorithms have been developed to calculate the length and coarseness of the segmented fibres. The fibre segmentation algorithm is the first ever reported method for the automated segmentation of the tortuous three-dimensional morphology of papermaking fibres within microstructural images of paper handsheets. The method is not limited to papermaking fibres, but can be applied to any material consisting of tortuous and hollow fibres.
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Affiliation(s)
- Y Sharma
- Department of Mechanical Engineering, The University of British Columbia, Vancouver, Canada.,School of Engineering, Okanagan Campus, The University of British Columbia, Kelowna, Canada
| | - A B Phillion
- School of Engineering, Okanagan Campus, The University of British Columbia, Kelowna, Canada
| | - D M Martinez
- Department of Mechanical Engineering, The University of British Columbia, Vancouver, Canada.,Department of Chemical and Biological Engineering, The University of British Columbia, Vancouver, Canada
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Sharma Y, Joshi RA, Kulkarni AA. Continuous-Flow Nitration of o-Xylene: Effect of Nitrating Agent and Feasibility of Tubular Reactors for Scale-Up. Org Process Res Dev 2015. [DOI: 10.1021/acs.oprd.5b00064] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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)
- Y. Sharma
- Chemical Engineering & Process Development Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pashan, Pune-411 008, India
| | - R. A. Joshi
- Chemical Engineering & Process Development Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pashan, Pune-411 008, India
| | - A. A. Kulkarni
- Chemical Engineering & Process Development Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pashan, Pune-411 008, India
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Bhatnagar R, Sharma Y, Mohan M, Vajpayee RB, Azad RV, Mukesh K. Does milk have a cataractogenic effect. A weighing of clinical evidence. Dev Ophthalmol 2015; 17:93-6. [PMID: 2507368 DOI: 10.1159/000417008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- R Bhatnagar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, India
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Pramanick KK, Kashyap P, Kishore DK, Sharma YP. Effect of summer pruning and CPPU on yield and quality of kiwi fruit (Actinidia deliciosa). J Environ Biol 2015; 36:351-356. [PMID: 25895255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A field experiment was conducted on bearing vines of kiwifruit cv. Abbott to find the effect of CPPU (N-(2- chloro-4-pyridyl)-N-phenylurea) and summer pruning on fruit yield, fruit size and quality. CPPU greatly stimulated fruit growth indicating that it can be a powerful tool for improving kiwifruit cropping. Application of CPPU at 10 ppm concentration was done by dipping the fruits for 10 sec in the aqueous solution of compound at petal fall and 30 days after petal fall. CPPU applied fruits increased size by 20-70 g over control. Summer pruning along with CPPU application proved to be more effective in obtaining fruits of high grades with increased fruit weight (95.37 g fruit(-1)) and high quality. Summer pruning, when done by pinching 1/5th at Petal Fall stage + CPPU dipping (10 ml(-1)) and pinching 1/5th continued till harvest, at one month interval resulted in increased fruit yield (54.80 kg vine(-1)), high TSS (17.60 Brix), high total sugar (9.85%), advanced ripening by one week and reduced flesh firmness.
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Odaya S, Phillips R, Sharma Y, Bellerive J, Phillion A, Hoorfar M. X-ray Tomographic Analysis of Porosity Distributions in Gas Diffusion Layers of Proton Exchange Membrane Fuel Cells. Electrochim Acta 2015. [DOI: 10.1016/j.electacta.2014.11.143] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Misra P, Sharma Y, Katiyar RS. Effect of Current Compliance on Resistive Switching Characteristics of Amorphous Ternary Rare Earth Oxide SmGdO3 Thin Films Grown by Pulsed Laser Deposition. ACTA ACUST UNITED AC 2014. [DOI: 10.1149/06106.0133ecst] [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: 11/16/2022]
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Jadhav MP, Jadhav PM, Shelke P, Sharma Y, Nadkar M. Assessment of use of complementary alternative medicine and its impact on quality of life in the patients attending rheumatology clinic, in a tertiary care centre in India. ACTA ACUST UNITED AC 2013. [PMID: 23196313 DOI: 10.4103/0019-5359.103961] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Complementary and alternative medicine (CAM) has witnessed an increase in use in recent times in rheumatological conditions and is expected to have impact on the quality of life (QOL). We had planned to conduct this study to investigate the extent of use of CAM and its effect on QOL of patients at a tertiary care center. MATERIALS AND METHODS Ethics committee approval was obtained. Sixty patients suffering from osteoarthritis (OA) and rheumatoid arthritis (RA) were enrolled as per the selection criteria, after obtaining their informed consent. Each patient was interviewed for CAM use/non-use, and Western Ontario and McMaster Universities (WOMAC) (modified) index for QOL was recorded by the study personnel. STATISTICAL ANALYSIS The normality was checked by using Kolmogorov-Smirnov test. Descriptive statistics was performed and Mann-Whitney U-test was used to compare the QOL of CAM users and non-users. RESULTS Of the 60 patients enrolled with OA (10) and RA (50), 58% (35/60) used CAM. Ayurveda and massage therapy were the commonest [80% (28/35)], followed by yoga asana [34% (12/35)] and homoeopathy [20% (7/35)]. It was observed that combinations of therapies were used too. Nearly half [49% (17/35)] of the CAM users were on self-prescribed medication and 71% (25/35) of them did not inform the physician of CAM use. The QOL of CAM users (WOMAC score: 56.31 ± 6.82) was better than that of CAM non-users (WOMAC score: 60.16 ± 4.02) (P value 0.01). CONCLUSION Patients with RA frequently used CAM and QOL improvised with CAM use. We observed that self-administration of CAM was common and this was not informed to the treating physician.
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Affiliation(s)
- M P Jadhav
- Department of Infectious Diseases, Maharashtra University of Health Sciences, Seth G. S. Medical College and KEM Hospital, Parel, Mumbai, India
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Pathak VM, Swati R, Sharma YP, Jain P, Thoke S. AN APPROACH TO ENHANCE THE SOLUBILITY OF RIFAPENTINE BY SOLID DISPERSION TECHNIQUE USING HYDROPHILIC CARRIERS. ACTA ACUST UNITED AC 2013. [DOI: 10.22270/jddt.v3i4.559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kumar R, Chakraborti A, Aggarwal AK, Vohra H, Sagar V, Dhanda V, Sharma YP, Majumdar S, Hoe N, Krause RM. Streptococcus pyogenes pharyngitis & impetigo in a rural area of Panchkula district in Haryana, India. Indian J Med Res 2012; 135:133-6. [PMID: 22382196 PMCID: PMC3307175 DOI: 10.4103/0971-5916.93437] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- N S Chauhan
- Department of Radiodiagnosis, Dr Rajendra Prasad Government Medical College, Himachal Pradesh, India.
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Li JYZ, Yong TY, Hakendorf P, Roberts S, O'Brien L, Sharma Y, Ben-Tovim D, Thompson CH. Simple clinical score is associated with mortality and length of stay of acute general medical admissions to an Australian hospital. Intern Med J 2012; 42:160-5. [DOI: 10.1111/j.1445-5994.2011.02498.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kumar R, Vohra H, Chakraborty A, Sharma YP, Bandhopadhya S, Dhanda V, Sagar V, Sharma M, Shah B, Ganguly NK. Epidemiology of group A streptococcal pharyngitis & impetigo: a cross-sectional & follow up study in a rural community of northern India. Indian J Med Res 2009; 130:765-771. [PMID: 20090140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND & OBJECTIVE Group A streptococcus (GAS) causes a wide array of human diseases. Epidemiological picture of streptococcal infection in India is not complete. Hence, disease burden due to GAS in 5-15 yr old school children in northern India was studied and emm typing of GAS isolates was carried out to help in designing prevention strategies. METHODS A cross-sectional survey was carried out among 4249 school children (5-15 yr) from Raipur Rani Block of Panchkula district in Haryana during 2000-2002; 334 children were followed up fortnightly for one year. Standard clinical and microbiological procedures were used for collection of swabs from throat and skin and confirmation of GAS and its emm types. RESULTS Of the 4249 children studied, 658 (15.5%) had pharyngitis; 579 of them could be swabbed, of which 2.8 per cent had GAS. From 3591 children without pharyngitis, 3385 who could be swabbed, GAS was found in 1.3 per cent of them. Impetigo was rare (0.7%), but 7.1 per cent (2/28) children had GAS. In the followup study, 17.4 per cent (776/4447 child-contacts) had pharyngitis, 761 could be swabbed and 2.4 per cent had GAS; among those without pharyngitis, 2016 swabs could be taken and GAS was found in 1.3 per cent; whereas only 2.6 per cent (2/75) of skin sores had GAS. Three children had GAS pharyngitis twice during follow up. Fourteen different GAS emm types were found. emm 71, 77 and 81 constituted 69 per cent of the pharyngeal isolates. GAS pharyngitis and impetigo were more common in winters and summers respectively. INTERPRETATION & CONCLUSION In north India, pharyngitis was more common than impetigo. Most prevalent emm types of GAS in this region differ from those included in M protein-based vaccines.
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Affiliation(s)
- R Kumar
- School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India.
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Jain SK, Prashar M, Bhardwaj SC, Singh SB, Sharma YP. Emergence of Virulence to Sr25 of Puccinia graminis f. sp. tritici on Wheat in India. Plant Dis 2009; 93:840. [PMID: 30764335 DOI: 10.1094/pdis-93-8-0840b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Stem (black) rust, caused by Puccinia graminis Pers. f. sp. tritici Eriks. & Henn., is one of the most destructive diseases of wheat. It could be controlled through introgression of race-specific resistance genes. However, such kind of resistance is mostly short lived due to emergence of new virulences. For example, resistance genes Sr11, Sr24, Sr30, and Sr31 are no longer effective (2,4). Detection of new virulences has remained vital in the evaluation and identification of new sources of resistance. We report here the detection of virulence to Sr25, a gene from Thinopyrum elongatum (4), which had been effective or partially effective against stem rust worldwide, including race Ug99 (TTKSK) (4). A stem rust isolate collected in 2006 from Karnataka (southern India) produced susceptible reactions (infection type [IT] 3+ to 4) on the primary leaves of differential genotype 'Agatha' carrying Sr25 and susceptible check 'Agra Local' at 22 ± 2°C. To verify virulence to Sr25, single-pustule isolates from this sample were inoculated onto seedlings of 'Agrus', 'Agatha', 'RL6040' ('Thatcher' + Sr25), 'Superseri#1', 'Wheatear', and 'Morocco' + Sr25 (obtained from CIMMYT), which all carry Sr25. All these accessions were found susceptible (IT 3+ to 4) to this isolate, except Wheatear which expressed resistance (IT ;1), indicating the presence of additional gene(s). These genotypes are resistant (ITs ;1 to 2+) to Sr25-avirulent pathotypes. The new pathotype is avirulent to Sr11, 13, 14, 21, 22, 23, 24, 26, 27, 29, 31, 32, 33, 35, 37, 38, 39, 40, 43, and Tmp and virulent to Sr5, 6, 7a, 7b, 8a, 9a, 9b, 9d, 9e, 9f, 9g, 10, 12, 15, 16, 17, 18, 19, 20, 25, 28, 30, 34, 36, 42, Wld-1, and Gt at 22 ± 2°C. This pathotype has been designated as 58G13-3 and PKTSC according to the Indian nomenclature (1) and the North American system (3), respectively. It represents race 40 based on Stakman's differentials. It may have arisen from race 40 through mutation. The type culture of the pathotype has been added to the culture collection at Flowerdale, Shimla. Interestingly, 'Festiguay' (Sr30) was found resistant to this pathotype, indicating the presence of additional gene(s), whereas 'Webster' (Sr30) was susceptible. Adult plants of Agrus, Agatha, RL6040, Superseri#1, and Morocco+Sr25 also were susceptible, producing 20S to 60S responses. Sr25-avirulent pathotype 62G29 produced a TR (flecking in traces) response on these lines except Morocco + Sr25 that showed 20 to 40MR (moderately resistant) responses. In the same study however, adult plants of Thatcher showed a resistant reaction (10R to MR) at low (16 ± 2°C) and susceptible (20S) at high (22 ± 2°C) temperatures. Agatha and RL6040, having Thatcher as one of the parents, had similar responses. The detection of Sr25 virulence is significant since Sr25 is an important gene to be targeted for breeding wheat cultivars resistant to Ug99. We should use either adult plant resistance and/or pyramiding two or more genes for seedling resistance to enhance the field life of wheat cultivars. References: (1) P. Bahadur et al. Proc. Indian Acad. Sci. 95:29, 1985. (2) S. C. Bhardwaj et al. J. Wheat Res. 1:51, 2007. (3) Y. Jin et al. Plant Dis. 92:923, 2008. (4) R. P. Singh et al. CAB Rev. No. 054:1, 2006.
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Affiliation(s)
- S K Jain
- Regional Station, Directorate of Wheat Research (ICAR), Flowerdale, Shimla-171 002, Himachal Pradesh, India
| | - M Prashar
- Regional Station, Directorate of Wheat Research (ICAR), Flowerdale, Shimla-171 002, Himachal Pradesh, India
| | - S C Bhardwaj
- Regional Station, Directorate of Wheat Research (ICAR), Flowerdale, Shimla-171 002, Himachal Pradesh, India
| | - S B Singh
- Regional Station, Directorate of Wheat Research (ICAR), Flowerdale, Shimla-171 002, Himachal Pradesh, India
| | - Y P Sharma
- Regional Station, Directorate of Wheat Research (ICAR), Flowerdale, Shimla-171 002, Himachal Pradesh, India
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Ahmed G, Sharma Y, Ahuja B. Electronic properties of PbCl2 and PbBr2 using Compton scattering technique. Appl Radiat Isot 2009; 67:1050-6. [DOI: 10.1016/j.apradiso.2009.01.083] [Citation(s) in RCA: 6] [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] [Received: 12/30/2008] [Accepted: 01/27/2009] [Indexed: 11/25/2022]
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Mukhopadhyay C, Chawla K, Sharma Y, Bairy I. Emerging extra-intestinal infections with Aeromonas hydrophila in coastal region of southern Karnataka. J Postgrad Med 2009; 54:199-202. [PMID: 18626167 DOI: 10.4103/0022-3859.41801] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Aeromonas species are gram-negative rods usually isolated from the gastrointestinal tract. They have been occasionally reported as a cause of extra-intestinal infections such as cellulitis, cholangitis, necrotizing fascitis, meningitis, bacteremia, or peritonitis in both immunocompetent and immunocompromised patients. AIM To determine the role and possible pathogenesis of Aeromonas in extra-intestinal infections. SETTINGS AND DESIGN Retrospective analysis carried out at Kasturba Hospital Manipal, Karnataka in the months of January and February 2007. MATERIALS AND METHODS Clinical manifestations and management of eight cases of extra-intestinal infections caused by A. hydrophila , from the south Karnataka coastal region were reviewed. The isolates were identified with the help of biochemical tests using standard guidelines. RESULTS All patients acquired Aeromonas infections in the community. Five (62.5%) had underlying illnesses, such as liver disease, diabetes mellitus or malignancy. Five (62.5%) had polymicrobial infections, and three (37.5%) were complicated with bacteremia. These included three patients with ulcers or abscess over the lower leg, two with cellulitis due to snake bite and one each with pelvic inflammatory disease, spontaneous bacterial peritonitis and pneumonia. A. hydrophila was found to be a causative agent of pelvic inflammatory disease or cellulitis following sea snake bite, and such a clinical scenario has not been previously described. Seven patients survived the illness. CONCLUSIONS Isolation of A. hydrophila from extra-intestinal specimens demands utmost clinical and microbiological vigilance in diagnosis, since the organism can cause serious infections among immunocompromised as well as immunocompetent individuals.
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Affiliation(s)
- C Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal - 576 104, Karnataka, India.
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Sharma A, Paliwal P, Dadhwal V, Sharma Y, Deka D. Rare finding of 2n/4n mixoploidy in mother and fetus with severe immune hydrops. Cytogenet Genome Res 2009; 124:90-3. [DOI: 10.1159/000200092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2008] [Indexed: 11/19/2022] Open
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Bhansali S, Shafiq N, Malhotra S, Pandhi P, Singh I, Venkateshan SP, Siddhu S, Sharma YP, Talwar KK. Evaluation of the ability of clinical research participants to comprehend informed consent form. Contemp Clin Trials 2009; 30:427-30. [PMID: 19341820 DOI: 10.1016/j.cct.2009.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 03/18/2009] [Accepted: 03/22/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The comprehension of informed consent is an integral part of clinical trials. Though India is rapidly becoming a hub of clinical trials very few studies have dealt with the issue of comprehension of informed consent by the patients participating in these trials. METHODS Patients who were invited to participate in a phase 3 multicentric trial of a novel lipid lowering agent were evaluated for comprehension score. The participants were explained about the structured consent form which included the question on background details for the study, design of the study, rights of the patients and miscellaneous aspects pertinent to the clinical trial. The questionnaire comprised of 24 items and each correct answer was assigned a score of 1. Total comprehension score (CS) was obtained by summing all the scores. RESULTS Participants were from diverse socio economic and educational backgrounds. The mean +/- SD CS achieved by the participants was 13.4 +/- 2.9; median 14(6 to 20). The highest correct responses were obtained for questions on background details (38%). For most of the categories the mean CS was more than 50%. Aspects related to design were mostly difficult to comprehend. No significant difference in the CS was noted between participants from different educational and socioeconomic groups. 8 patients refused to give consent, fear of adverse drug reactions (n = 3) and inability to follow up (n = 5) were the reasons cited by the patients. CONCLUSION In conclusion, CS of patients in trials conducted in developing countries can be reasonably good if the investigators explain the consent form in simple language to the participants and CS is not related to the educational status of the participants. Moreover, though a larger majority of patients agree to participate after knowing study details, some patients exercise their right to refuse.
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Affiliation(s)
- S Bhansali
- Department of Pharmacology, Postgraduate Institute of Medical & Research, Chandigarh 160012, India
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Sharma S, Malhotra A, Sharma YP, Pandhi P, Malhotra S, Nageswari KS, Shafiq N, Venkateshan SP, Kaur R. Association of anticardiolipin antibodies levels with instent restenosis in patients with coronary artery disease. Indian J Physiol Pharmacol 2008; 52:288-292. [PMID: 19552061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Present study was conducted to evaluate the association of IgG anticardiolipin antibodies with instent restenosis in patients having undergone percutaneous intervention with bare metal or drug eluting stents. Coronary artery disease patients with stent placement at least 6 months prior were screened for eligibility. 26 satisfied the inclusion/exclusion criteria. 10 patients with symptoms of restenosis, confirmed on check angiography served as cases and 16 without symptoms of restenosis served as control. Unpaired t- test was applied to ascertain the significance of any difference between control and study groups. Antibody levels were estimated on ELISA reader. The mean (+/- SD) anticardiolipin antibodies levels in cases and controls were 11.8 +/- 5.1 GPL/U/ml and 14.3 +/- 10.2 GPL/U/ml, respectively. The difference was not statistically significant (P > 0.05). In conclusion, we did not observe any significant correlation between the level of IgG aCL and instent restenosis.
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Affiliation(s)
- Sumali Sharma
- Department of Physiology, Govt. Medical College, Chandigarh 160 012
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Rathor A, Sharma V, Heda N, Sharma Y, Ahuja B. Compton profiles and band structure calculations of IV–VI layered compounds GeS and GeSe. Radiat Phys Chem Oxf Engl 1993 2008. [DOI: 10.1016/j.radphyschem.2007.12.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sharma A, Bambery P, Wanchu A, Sharma YP, Panda NK, Gupta A, Singh S. Relapsing polychondritis in North India: a report of 10 patients. Scand J Rheumatol 2008; 36:462-5. [PMID: 18092269 DOI: 10.1080/03009740701406502] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Relapsing polychondritis (RP) is a rare autoimmune disorder characterized by recurrent episodes of inflammation and destruction of cartilaginous tissues. We describe the outcome of 10 patients followed up at the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, over the past 10 years. METHODS All the patients fulfilling the diagnostic criteria suggested by McAdam et al (Medicine (Baltimore) 1976;55:193-215) and modified by Damiani and Levine (Laryngoscope 1979;89;929-46) were included in the study. Detailed clinical features, investigations, treatment given, and outcome were recorded on file. RESULTS Six women and four men, mean age 48.1 years (range 26-65 years), met the criteria for diagnosis. The mean duration of symptoms, before diagnosis, was 27 months (range 1-72 months). Clinical features included auricular chondritis (100%), arthritis (80%), fever (50%), constitutional symptoms (50%), eye involvement (50%), hearing loss (40%), collapsed bridge of nose (30%), laryngotracheal involvement (20%), aortic dilatation (10%), and nephrotic syndrome (10%). Two patients had the MAGIC (mouth and genital ulcers with inflamed cartilage) syndrome. The number of episodes of cartilaginous inflammation varied from one to eight. Treatment included oral prednisolone (n = 9), intermittent 'pulse' cyclophosphamide (n = 2), and azathioprine (n = 2). One patient required tracheostomy and died later. The others are doing well. Mean duration of follow-up was 35.5 months (range 1-79 months). CONCLUSIONS The diagnosis of this potentially lethal condition is frequently delayed. Our series suggests that clinical manifestations of RP are similar in Caucasian, Oriental, and Asian populations. Laryngotracheal involvement was seen less frequently in our patients.
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Affiliation(s)
- A Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
The present review gives an updated overview of transfusion transmitted virus (TTV), a novel agent, in relation to its molecular characteristics, epidemiological features, modes of transmission, tissue tropism, pathogenesis, role in various diseases and its eradication from the body. TTV, a DNA virus, is a single stranded, non-enveloped, 3.8 kb long DNA virus with a small and covalently closed circular genome comprising 3852 bases. It was tentatively designated Circinoviridae virus. TTV genome sequence is heterogeneous and reveals the existence of six different genotypes and several subtypes. TTV has been reported to transmit not only via parenteral routes, but also via alternate routes. This virus has been detected in different non-human primates as well. At present, TTV is detected by polymerase chain reaction (PCR) with no other available diagnostic assays. It shows its presence globally and was detected in high percent populations of healthy persons as well as in various disease groups. Initially it was supposed to have strong association with liver disease; however, there is little evidence to show its liver tropism and contribution in causing liver diseases. It shows high prevalence in hemodialysis patients, pointing towards its significance in renal diseases. In addition, TTV is associated with several infectious and non-infectious diseases. Although its exact pathogenesis is not yet clear, TTV virus possibly resides and multiplies in bone marrow cells and peripheral blood mononuclear cells (PBMCs). Recently, attempts have been made to eradicate this virus with interferon treatment. More information is still needed to extricate various mysteries related to TTV.
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Affiliation(s)
- M Irshad
- Clinical Biochemistry Division, Department of Laboratory Medicine, PO Box -4938, A I I M S, New Delhi-110029, India.
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Irshad M, Sharma Y, Dhar I, Singh J, Joshi YK. Transfusion-transmitted virus in association with hepatitis A-E viral infections in various forms of liver diseases in India. World J Gastroenterol 2006; 12:2432-6. [PMID: 16688839 PMCID: PMC4088084 DOI: 10.3748/wjg.v12.i15.2432] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe the prevalence of transfusion-transmitted virus (TTV) infection in association with hepatitis A-E viral infections in different forms of liver diseases in North India.
METHODS: Sera from a total number of 137 patients, including 37 patients with acute viral hepatitis (AVH), 37 patients with chronic viral hepatitis (CVH), 31 patients with cirrhosis of liver and 32 patients with fulminant hepatic failure (FHF), were analyzed both for TTV-DNA and hepatitis A-E viral markers. Presence of hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis E virus (HEV) infections was detected in different proportions in different groups. Moreover, TTV-DNA was simultaneously tested in 100 healthy blood donors also.
RESULTS: None of the patients had hepatitis A virus (HAV) and hepatitis D virus (HDV) infections. Overall prevalence of TTV-DNA was detected in 27.1% cases with AVH, 18.9% cases with CVH, 48.4% cases with cirrhosis and 9.4% cases with FHF. TTV-DNA simultaneously tested in 100 healthy blood donors showed 27% positivity. On establishing a relation between TTV infection with other hepatitis viral infections, TTV demonstrated co-infection with HBV, HCV and HEV in these disease groups. Correlation of TTV with ALT level in sera did not demonstrate high ALT level in TTV-infected patients, suggesting that TTV does not cause severe liver damage.
CONCLUSION: TTV infection is prevalent both in patients and healthy individuals in India. However, it does not have any significant correlation with other hepatitis viral infections, nor does it produce an evidence of severe liver damage in patients with liver diseases.
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Affiliation(s)
- M Irshad
- Clinical Biochemistry Division, Department of Laboratory Medicine, PO Box-4938, A.I.I.M.S., Ansari Nagar, New Delhi 110029, India.
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Makaju RK, Tamang MD, Sharma Y, Sharma N, Koju R, Ashraf M. Prevalence of Helicobacter pylori in Dhulikhel Hospital, Kathmandu University Teaching Hospital: a retrospective histopathologic study. Kathmandu Univ Med J (KUMJ) 2005; 3:355-9. [PMID: 16449835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The main objective of this study was to determine prevalence of Helicobacter pylori infection in Dhulikhel Hospital, Kathmandu University Teaching Hospital. METHODOLOGY Endoscopic antral biopsies from January 1, 2004 to August 31, 2005 were studied retrospectively. Hematoxylin and eosin and Giemsa stained histological sections were examined. RESULTS Out of 224 patients (Male 125 and female 99) who underwent endoscopic biopsy and included in the study, a total of 76 (33.9%) patients (Male 50 and female 26) were infected by H. pylori. The mean age of the H. pylori infected patients was 40.2 years (SD 16.0). The infection by H. pylori was significantly higher in males than females (p<0.05) with male to female ratio of 1.9:1. The most common (31.3%) histopathologic finding was chronic superficial gastritis followed by normal histology (30.8%). A total of 10 cases (4.5%) of adenocarcinoma and 16 cases (7.1%) of intestinal metaplasia were detected and neither of them showed presence of H. pylori. Two cases (0.9%) were diagnosed as suspected malignancy and both were negative for H. pylori infection. Among gastritis, H. pylori was most frequently observed in chronic active gastritis (86.1%). Two of 69 cases (2.9%) of normal gastric mucosa showed H. pylori.
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Affiliation(s)
- R K Makaju
- Department of Pathology, Kathmandu University Medical School.
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