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Schubert PJ, Saxena R, Kornfeld J. DeepFocus: fast focus and astigmatism correction for electron microscopy. Nat Commun 2024; 15:948. [PMID: 38296974 PMCID: PMC10830472 DOI: 10.1038/s41467-024-45042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
High-throughput 2D and 3D scanning electron microscopy, which relies on automation and dependable control algorithms, requires high image quality with minimal human intervention. Classical focus and astigmatism correction algorithms attempt to explicitly model image formation and subsequently aberration correction. Such models often require parameter adjustments by experts when deployed to new microscopes, challenging samples, or imaging conditions to prevent unstable convergence, making them hard to use in practice or unreliable. Here, we introduce DeepFocus, a purely data-driven method for aberration correction in scanning electron microscopy. DeepFocus works under very low signal-to-noise ratio conditions, reduces processing times by more than an order of magnitude compared to the state-of-the-art method, rapidly converges within a large aberration range, and is easily recalibrated to different microscopes or challenging samples.
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Affiliation(s)
- P J Schubert
- Max Planck Institute for Biological Intelligence, Martinsried, 82152, Germany
| | - R Saxena
- Max Planck Institute for Biological Intelligence, Martinsried, 82152, Germany
| | - J Kornfeld
- Max Planck Institute for Biological Intelligence, Martinsried, 82152, Germany.
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Khot MS, Chakraborti A, Saini JK, Sethi P, Mullick S, Saxena R, Wani AR. Comparison of the diagnostic yield of transbronchial lung biopsies by forceps and cryoprobe in diffuse parenchymal lung disease. Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i3.799. [PMID: 37970571 PMCID: PMC10642398 DOI: 10.7196/ajtccm.2023.v29i3.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/28/2023] [Indexed: 11/17/2023] Open
Abstract
Background Transbronchial lung cryobiopsy (TBLC) in the diagnosis of diffuse parenchymal lung disease (DPLD) has shown a promising yield in recent times, with low post-procedural mortality and morbidity. Objectives To compare the yield of TBLC and conventional transbronchial forceps lung biopsy (TBLB). Methods A prospective study was carried out in patients with DPLD over a period of 1 year in a tertiary respiratory care institute in New Delhi, India. All 87 patients enrolled underwent both TBLB and TBLC. The procedures were performed in the bronchoscopy suite under conscious sedation and local anaesthesia, with an attempt to take a minimum of three biopsy specimens by conventional TBLB followed by TBLC. A 1.9 mm cryoprobe with a freezing time of 4 - 5 seconds was used. An Arndt endobronchial blocker was used to control bleeding along with locally administered medications. Results TBLB and TBLC led to a definitive diagnosis in 27 (31.0%) and 69 (79.3%) cases, respectively. The commonest diagnoses were hypersensitivity pneumonitis, sarcoidosis and pulmonary tuberculosis. TBLC led to additional diagnoses in 42 cases (48.3%). Pneumothorax was observed in 12 cases (13.8%), and moderate bleeding occurred in 63 (72.4%). There were no procedure-related deaths. Conclusion TBLC had a better diagnostic yield than conventional TBLB in DPLD. It has the potential to become a safe day-care procedure in a resource-limited setting, if certain precautions are taken. Study synopsis What the study adds. Compared with transbronchial forceps lung biopsy, transbronchial lung cryobiopsy (TBLC) led to additional diagnoses in 42 (48.3%) of 87 patients with clinicoradiological features of diffuse parenchymal lung disease. Pneumothorax was observed in 12 cases (13.8%) and moderate bleeding in 63 (72.4%). TBLC without rigid bronchoscopy or advanced airway devices under conscious sedation had a good diagnostic yield with an acceptable adverse events profile.Implications of the findings. TBLC under conscious sedation is not resource intensive and can be carried out in settings with limited resources.
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Affiliation(s)
- M S Khot
- Department of Pulmonary Medicine, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - A Chakraborti
- Department of Pulmonary Medicine, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - J K Saini
- Department of Pulmonary Medicine, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - P Sethi
- Department of Pulmonary Medicine, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - S Mullick
- Department of Pathology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - R Saxena
- Department of Thoracic Surgery, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - A R Wani
- Department of Pulmonary Medicine, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
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Scammell BH, Tchio C, Song Y, Nishiyama T, Louie TL, Dashti HS, Nakatochi M, Zee PC, Daghlas I, Momozawa Y, Cai J, Ollila HM, Redline S, Wakai K, Sofer T, Suzuki S, Lane JM, Saxena R. Multi-ancestry genome-wide analysis identifies shared genetic effects and common genetic variants for self-reported sleep duration. Hum Mol Genet 2023; 32:2797-2807. [PMID: 37384397 PMCID: PMC10656946 DOI: 10.1093/hmg/ddad101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023] Open
Abstract
Both short (≤6 h per night) and long sleep duration (≥9 h per night) are associated with increased risk of chronic diseases. Despite evidence linking habitual sleep duration and risk of disease, the genetic determinants of sleep duration in the general population are poorly understood, especially outside of European (EUR) populations. Here, we report that a polygenic score of 78 European ancestry sleep duration single-nucleotide polymorphisms (SNPs) is associated with sleep duration in an African (n = 7288; P = 0.003), an East Asian (n = 13 618; P = 6 × 10-4) and a South Asian (n = 7485; P = 0.025) genetic ancestry cohort, but not in a Hispanic/Latino cohort (n = 8726; P = 0.71). Furthermore, in a pan-ancestry (N = 483 235) meta-analysis of genome-wide association studies (GWAS) for habitual sleep duration, 73 loci are associated with genome-wide statistical significance. Follow-up of five loci (near HACD2, COG5, PRR12, SH3RF1 and KCNQ5) identified expression-quantitative trait loci for PRR12 and COG5 in brain tissues and pleiotropic associations with cardiovascular and neuropsychiatric traits. Overall, our results suggest that the genetic basis of sleep duration is at least partially shared across diverse ancestry groups.
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Affiliation(s)
- B H Scammell
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02215, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - C Tchio
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02215, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Y Song
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02215, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - T Nishiyama
- Department of Public Health, Nagoya City University Graduate School of Medicine, Nagoya 467-8701, Japan
| | - T L Louie
- Department of Biostatistics, University of Washington, Seattle, WA 98105, USA
| | - H S Dashti
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02215, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - M Nakatochi
- Public Health Informatics Unit, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya 467-8701, Japan
| | - P C Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - I Daghlas
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02215, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Y Momozawa
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - J Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - H M Ollila
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02215, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Helsinki 00014, Finland
| | - S Redline
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - K Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya 467-8701, Japan
| | - T Sofer
- Department of Biostatistics, University of Washington, Seattle, WA 98105, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - S Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medicine, Nagoya 467-8701, Japan
| | - J M Lane
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02215, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - R Saxena
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02215, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
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Prasad P, Lata S, Gupta SK, Kumar P, Saxena R, Arya DK, Singh H. Aedes aegypti container preference for oviposition and its possible implications for dengue vector surveillance in Delhi, India. Epidemiol Health 2023; 45:e2023073. [PMID: 37641822 PMCID: PMC10728616 DOI: 10.4178/epih.e2023073] [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: 12/08/2022] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Dengue is a mosquito-borne viral disease globally transmitted by Aedes aegypti. The most effective method to prevent the transmission of the disease is proficient vector control. Understanding the breeding behaviour of the responsible vectors is very pertinent in this regard; therefore, the present study was conducted to understand Ae. aegypti behaviour regarding the selection of containers for oviposition in the megacity of Delhi. METHODS A household survey in different localities within Delhi was carried out during 2018-2019. All available containers were inspected for the presence of immature Ae. aegypti. In entomological surveillance, the ovipositional preference of Aedes was computed using the breeding preference ratio, container index in the field, and laboratory settings, and associations of dengue cases with monthly variation in environmental factors and container type were also calculated. RESULTS The household larval survey in 40 localities showed that 40% of 27,776 water-holding containers in 3,400 houses were plastic, followed by overhead tanks (26.2%), and coolers (12.1%). The most preferred breeding habitat was clay pots (9.3%), followed by metallic containers (8.5%) and solid waste (7.1%). A laboratory-based study showed that Aedes preferred clay containers (81.8%) over 4 other types of containers (plastic, paper, metal, and glass). CONCLUSIONS The present study provides a rationale for using clay containers as a possible surveillance tool (ovitraps) or as a vector control tool. This information might aid researchers in developing novel traps and targeting preferred containers for larval control activities during transmission and non-transmission seasons.
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Affiliation(s)
- Pooja Prasad
- ICMR-National Institute of Malaria Research, New Delhi, India
- Department of Zoology, D.S.B Campus, Kumaun University, Nainital, India
| | - Suman Lata
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), New Delhi, India
| | | | - Pawan Kumar
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Rekha Saxena
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Deepak Kumar Arya
- Department of Zoology, D.S.B Campus, Kumaun University, Nainital, India
| | - Himmat Singh
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), New Delhi, India
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Prasad P, Lata S, Kumar D, Gupta SK, Saxena R, Arya DK, Singh H. Susceptibility status of Aedes aegypti (Diptera: Culicidae) against insecticides of public health use in Delhi and NCR region, India. J Vector Borne Dis 2023; 60:300-306. [PMID: 37843241 DOI: 10.4103/0972-9062.374044] [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: 10/17/2023] Open
Abstract
BACKGROUND & OBJECTIVES Aedes (Stegomyia) aegypti is a primary vector responsible for the transmission of various arboviral diseases in India. Without an effective drug or vaccine against these diseases, chemical insecticide-based vector control supplemented with source reduction remains the best option for their effective management. The development of insecticide resistance due to the continuous use of insecticides might affect the control operations. METHODS Adults and larvae of Aedes aegypti were collected from different localities in Delhi. Larvae were exposed to discriminating (0.02mg/l) and application (1mg/l) doses of temephos. WHO tube assay was conducted for F1 adults using impregnated insecticide papers of dichlorodiphenyltrichloroethane (DDT), malathion, deltamethrin, permethrin, cyfluthrin, and lambda-cyhalothrin. RESULTS Larvae of Ae. aegypti were found resistant (76.0%) to the discriminating dose of temephos, whereas suscep-tible (100.0%) to the application dose of the temephos. Adult Aedes (Fl) mosquitoes were resistant to DDT (23.7%), malathion (90.5%), deltamethrin (76.0%), permethrin (96.2 %) cyfluthrin (85.5%), and lambda-cyhalothrin (94.0%). INTERPRETATION & CONCLUSION Indoor residual spray is not used in Delhi for vector control. Resistance in Aedes might be due to pesticide usage for agricultural activities in peripheral regions of Delhi. There is a need to investigate more on the insecticide resistance mechanisms for indirect resistance development. Understanding the insecticide susceptibility status of urban vectors is critical for planning effective control strategies.
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Affiliation(s)
- Pooja Prasad
- ICMR-National Institute of Malaria Research, New Delhi; Department of Zoology, DSB Campus, Kumaun University, Nainital, Uttarakhand, India
| | - Suman Lata
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Dinesh Kumar
- ICMR-National Institute of Malaria Research, New Delhi, India
| | | | - Rekha Saxena
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Deepak Kumar Arya
- Department of Zoology, DSB Campus, Kumaun University, Nainital, Uttarakhand, India
| | - Himmat Singh
- ICMR-National Institute of Malaria Research, New Delhi, India
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Sharma G, Sharma R, Saxena R, Rajni E, Prakash Mamoria V. [Pharmacological importance of novel spiro derivatives against human pathogenic fungi]. Biomed Khim 2023; 69:55-61. [PMID: 36857427 DOI: 10.18097/pbmc20236901055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Human mycoses have become a threat to health world-wide. Unfortunately there are only a limited number of antimycotic drugs in use. In the present study, antifungal activity of earlier synthesized spiro-1,4-dihydropyridines (1,4-DHPs) was investigated. The antifungal activity of spiro-1,4-DHPs compounds were screened against Aspergillus flavus, A. fumigatus, and Candida albicans by using Disc Diffusion and Modified Microdilution method. Among six spiro-1,4-DHPs compounds tested all of them showed stronger antifungal activity possibly through inhibiting the synthesis of chitin in cell wall against A. flavus, A. fumigatus, and C. albicans as compared to fluconazole, a standard antifungal drug. The combination of compounds showed that the synthesized compounds had synergistic, additive effects as compared to currently used drugs as an antifungal agent. These results indicated that these designed compounds were potential chitin synthase inhibitors and had excellent antimycotic activity for the treatment of fungal infections.
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Affiliation(s)
- G Sharma
- Department of Chemistry, MPS International, Jaipur, Rajasthan, India
| | - R Sharma
- Department of Microbiology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - R Saxena
- Department of Biotechnology, Invertis University, Bareilly, Uttar Pradesh, India
| | - E Rajni
- Department of Microbiology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - V Prakash Mamoria
- Department of Microbiology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
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Dabas A, Mishra D, Swarnim, Saxena R. Faculty-or senior resident-led SNAPPS for postgraduate teaching in pediatrics. J Postgrad Med 2023; 69:43-45. [PMID: 35708397 PMCID: PMC9997607 DOI: 10.4103/jpgm.jpgm_144_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This was an educational intervention on postgraduates using SNAPPS (Summarize narrow, analyze, probe, plan, self-directed learning) showing comparable median (interquartile range) satisfaction scores with faculty or senior residents as 4 (3,5) and 4 (4, 4.25); respectively, P = 0.79. Further training of senior residents in medical education will enable them to participate efficiently and actively in postgraduate teaching.
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Affiliation(s)
- A Dabas
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - D Mishra
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Swarnim
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - R Saxena
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
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Saxena R, Moore N, Johnson J. Digital Pathology, A Cognitively Efficient Teaching Strategy: Current Application and a Glimpse into Future. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
If pathology education is to be efficacious, it must embrace the ramifications of cognitive load of the learners, to optimize the capacity of the working memory. When undergraduate students commence their learning of pathology, they encounter a heap of new data and classifications. Simplifying these intricate systems into assimilable subschemas and items is key for effective transfer of knowledge. The minimization of the profundity of intrinsic cognitive load is essential, considering that its impact on pathology beginners is often left unaccounted, both in active learning as well as in traditional methods of instruction. In today’s digital generation, digital pathology plays a key role by intertwining disease morphology with clinical presentation and fortifying its pathophysiologic basis. We designed a teaching methodology utilizing digital pathology to evaluate its effect on cognitive load.
Methods/Case Report
Active learning was implemented online using digital pathology, molecular pathology, and laboratory data in case-based setting with question-answer sessions. In small groups, students were encouraged to analyze digital pathology slides with the help of annotations and identify areas of histopathological significance. They utilized this information further to make an accurate diagnosis and answer corresponding questions, with access to answers available later, complemented with algorithms and concept maps. A 14-item structured questionnaire was delivered afterwards to evaluate the efficacy and popularity of the exercise.
Results (if a Case Study enter NA)
End-of-term examination results showed that learners developed higher-order comprehension skills along with a greater potential in interpreting histopathological data towards solving case studies. Feedback revealed a higher degree of overall satisfaction and increased ability to retain information.
Conclusion
Digital transformation of pathology education provides the kind of framework where learning happens naturally - developing in small boosts of progress until expertise is achieved, and students appreciate the value of the ‘learned thing’ along with the real utility of that knowledge. The innovative approach utilizing digitization and integration offers the opportunity of decrement in intrinsic cognitive load by invoking students to build better, reliable, long-lasting, supportable and inclusive schemata while correlating the relevant incoming information with previously stabilized knowledge and consolidating the entirety of understanding.
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Affiliation(s)
- R Saxena
- Pathology, Medical University of the Americas , Charlestown , Saint Kitts and Nevis
| | - N Moore
- Pathology, Medical University of the Americas , Charlestown , Saint Kitts and Nevis
| | - J Johnson
- Pathology, Medical University of the Americas , Charlestown , Saint Kitts and Nevis
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Sharma G, Sharma R, Rajni E, Saxena R. Synergistic, Antidermatophytic Activity and Chemical Composition of Essential Oils against Zoonotic Dermatophytosis. Russ J Bioorg Chem 2022. [DOI: 10.1134/s1068162022060218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Prick JCM, van Schaik SM, Deijle IA, Dahmen R, Brouwers PJAM, Hilkens PHE, Garvelink MM, Engels N, Ankersmid JW, Keus SHJ, The R, Takahashi A, van Uden-Kraan CF, van der Wees PJ, Van den Berg-Vos RM, van Schaik S, Brouwers P, Hilkens P, van Dijk G, Gons R, Saxena R, Schut E. Development of a patient decision aid for discharge planning of hospitalized patients with stroke. BMC Neurol 2022; 22:245. [PMID: 35790912 PMCID: PMC9254531 DOI: 10.1186/s12883-022-02679-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/11/2022] [Indexed: 10/13/2023] Open
Abstract
Abstract
Background
Patient involvement in discharge planning of patients with stroke can be accomplished by providing personalized outcome information and promoting shared decision-making. The aim of this study was to develop a patient decision aid (PtDA) for discharge planning of hospitalized patients with stroke.
Methods
A convergent mixed methods design was used, starting with needs assessments among patients with stroke and health care professionals (HCPs). Results of these assessments were used to develop the PtDA with integrated outcome information in several co-creation sessions. Subsequently, acceptability and usability were tested to optimize the PtDA. Development was guided by the International Patient Decision Aids Standards (IPDAS) criteria.
Results
In total, 74 patients and 111 HCPs participated in this study. A three-component PtDA was developed, consisting of:
1) a printed consultation sheet to introduce the options for discharge destinations, containing information that can be specified for each individual patient;
2) an online information and deliberation tool to support patient education and clarification of patient values, containing an integrated “patients-like-me” model with outcome information about discharge destinations;
3) a summary sheet to support actual decision-making during consultation, containing the patient’s values and preferences concerning discharge planning.
In the acceptability test, all qualifying and certifying IPDAS criteria were fulfilled. The usability test showed that patients and HCPs highly appreciated the PtDA with integrated outcome information.
Conclusions
The developed PtDA was found acceptable and usable by patients and HCPs and is currently under investigation in a clinical trial to determine its effectiveness.
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Prick JCM, Zonjee VJ, van Schaik SM, Dahmen R, Garvelink MM, Brouwers PJAM, Saxena R, Keus SHJ, Deijle IA, van Uden-Kraan CF, van der Wees PJ, Van den Berg-Vos RM. Experiences with information provision and preferences for decision making of patients with acute stroke. Patient Educ Couns 2022; 105:1123-1129. [PMID: 34462248 DOI: 10.1016/j.pec.2021.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/23/2021] [Accepted: 08/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this study was to gain insight into experiences of patients with acute stroke regarding information provision and their preferred involvement in decision-making processes during the initial period of hospitalisation. METHODS A sequential explanatory design was used in two independent cohorts of patients with stroke, starting with a survey after discharge from hospital (cohort 1) followed by observations and structured interviews during hospitalisation (cohort 2). Quantitative data were analysed descriptively. RESULTS In total, 72 patients participated in this study (52 in cohort 1 and 20 in cohort 2). During hospitalisation, the majority of the patients were educated about acute stroke and their treatment. Approximately half of the patients preferred to have an active role in the decision-making process, whereas only 21% reported to be actively involved. In cohort 2, 60% of the patients considered themselves capable to carefully consider treatment options. CONCLUSIONS Active involvement in the acute decision-making process is preferred by approximately half of the patients with acute stroke and most of them consider themselves capable of doing so. However, they experience a limited degree of actual involvement. PRACTICE IMPLICATIONS Physicians can facilitate patient engagement by explicitly emphasising when a decision has to be made in which the patient's opinion is important.
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Affiliation(s)
- J C M Prick
- Department of Neurology, OLVG, Amsterdam, The Netherlands; Santeon, Utrecht, The Netherlands.
| | - V J Zonjee
- Department of Neurology, OLVG, Amsterdam, The Netherlands
| | - S M van Schaik
- Department of Neurology, OLVG, Amsterdam, The Netherlands
| | - R Dahmen
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
| | - M M Garvelink
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - P J A M Brouwers
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R Saxena
- Department of Neurology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - S H J Keus
- Department of Quality and Improvement, OLVG, Amsterdam, The Netherlands
| | - I A Deijle
- Department of Quality and Improvement, OLVG, Amsterdam, The Netherlands
| | | | - P J van der Wees
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R M Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, The Netherlands; Department of Neurology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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Gupta SK, Saroha P, Singh K, Saxena R, Barman K, Kumar A, Sharma A. Malaria Epidemiology Along the Indian Districts Bordering Bhutan and Implications for Malaria Elimination in the Region. Am J Trop Med Hyg 2022; 106:655-660. [PMID: 34749312 PMCID: PMC8832941 DOI: 10.4269/ajtmh.21-0513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/02/2021] [Indexed: 02/03/2023] Open
Abstract
It is important for malaria-endemic countries to address malaria control across international borders, and in particular to prioritize appropriate rapid diagnosis, treatment and surveillance. Bhutan and India aim to achieve malaria elimination by 2023 and 2030 respectively. Malaria elimination along the Indo-Bhutan border is of common concern. We delineated malaria epidemiology along the border to provide a blueprint for focusing malaria control efforts in key foci within this region. Epidemiological data from 2015 to 2019 were analyzed, as the most drastic reductions in malaria burden across most parts of India were witnessed in this time frame. Several areas of concern include low surveillance in most border districts, favorable climatic conditions for perennial malaria transmission, and movement of potential parasite carriers because of the porous borders. India and Bhutan need to control the importation/exportation of malaria cases. We highlight the foci of concern for which implementing tailor-made malaria control strategies may benefit both countries.
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Affiliation(s)
| | - Poonam Saroha
- National Institute of Malaria Research, New Delhi, India
| | - Kuldeep Singh
- National Institute of Malaria Research, New Delhi, India
| | - Rekha Saxena
- National Institute of Malaria Research, New Delhi, India
| | - Keshab Barman
- National Vector Borne Diseases Control Programme, Guwahati, India
| | - Avdhesh Kumar
- National Vector Borne Diseases Control Programme, Delhi, India
| | - Amit Sharma
- National Institute of Malaria Research, New Delhi, India;,Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India,Address correspondence to Amit Sharma, ICMR-National Institute of Malaria Research, Sector 8, Dwarka, New Delhi, 110 077, India. E-mail:
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Singh H, Gupta SK, Vikram K, Saxena R, Srivastava A, Nagpal BN. Sustainable control of malaria employing Gambusia fishes as biological control in Jalore and Barmer districts of Western Rajasthan. J Vector Borne Dis 2022; 59:91-97. [PMID: 35708410] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Sardar Sarovar Irrigation Canal system was constructed by Narmada Valley Development Authority (NVDA) to cater to drinking water as well as for irrigation purposes in Jalore and Barmer districts of Western Rajasthan. To cater to the needs of water for the villagers in the command areas, 'Diggies' (surface water tanks) with 'Sumpwells' (water supply surface tanks) were installed. In a health impact assessment study of the irrigation canals from December 2010 to February 2016, the breeding of two major malaria vectors. An. culicifacies and An. stephensi were observed in diggies and sumpwells. As a biological control, Gambusia affanis fishes were employed for larval control in such stagnated water sites during the intervention phase viz. February 2012 in 251 diggies and 251 sumpwells. A significant reduction of breeding in diggies (99.54%) and sumpwells (97.81%) was observed. The positivity and larval density (dip index) were monitored in the control from up to February 2016 for their sustainability.
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Affiliation(s)
- Himmat Singh
- ICMR-National Institute of Malaria Research, New Delhi, India
| | | | - Kumar Vikram
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Rekha Saxena
- ICMR-National Institute of Malaria Research, New Delhi, India
| | | | - B N Nagpal
- ICMR-National Institute of Malaria Research, New Delhi, India
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Nagpal BN, Singh H, Gupta S, Vikram K, Saxena R, Srivastava A. Sustainable control of malaria employing Gambusia fishes as biological control in Jalore and Barmer districts of Western Rajasthan. J Vector Borne Dis 2022. [DOI: 10.4103/0972-9062.346869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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15
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Agarwal M, Shukla R, Dwivedi S, Saxena R, Luthra K, Kabra M, Seth R. Gene copy number alterations in Indian children with B-acute Lymphoblastic Leukemia: Correlation with survival outcome. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Alkashash AM, Rush N, Saxena R, Rokop Z, Mangus R, Kubal C. Utility of colon allograft biopsies in surveillance of patients with small intestinal transplantation – A systematic study of 129 biopsies. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.120] [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: 11/15/2022] Open
Abstract
Abstract
Introduction/Objective
A segment of right colon is sometimes included with small intestinal allografts to preserve the ileocecal valve and maintain water reabsorption. We correlated pathological findings of colon allograft biopsies obtained during surveillance colonoscopies with clinical, endoscopic, and microbiologic findings.
Methods/Case Report
All colon allograft biopsies from surveillance colonoscopies over a 3-year period were reviewed for crypt apoptotic activity, cryptitis, lamina propria inflammation, ulceration, and crypt architectural distortion. Clinical and endoscopic findings, and positive cultures a week before and after the biopsies were recorded.
Results (if a Case Study enter NA)
There were 129 colon biopsies from 29 patients; 98 were histologically normal, whereas 28 showed rare apoptoses (n=14), focal cryptitis (n=8), increased intraepithelial lymphocytes (n=2), moderate acute rejection (n=1), and crypt architectural distortion (n=2). Of these 29 patients, 8 had abnormal endoscopic findings, 21 were normal. Out of 8 patients with abnormal endoscopic exams, 50% had normal histology on biopsy. Twenty-one biopsies were associated with positive cultures in the blood (n=5), urine (n=16) or wound, peritoneal, stool (n=6); 3 had abnormal endoscopies, and 4, abnormal histology. One patient with C.difficle toxin had normal endoscopy and focal cryptitis, whereas another with CMV DNA in blood showed endoscopically congested mucosa and rare apoptoses on biopsy. Of 12 biopsies (7 patients) with abnormal endoscopic findings, (erythema, congestion, ulceration), 4 biopsies had no pathologic findings, 8 had rare apoptosis, and one each had focal cryptitis and chronic colitis. Paired small intestinal biopsies were present with 59 biopsies; 10 showed rare apoptosis and 2, focal cryptitis. Of 70 without paired small intestinal biopsies, there were 5 with rare apoptotic bodies, 5 with focal cryptitis, and 2 with crypt architectural distortion.
Conclusion
The correlation of histologic, endoscopic, and microbiologic findings in colonic allograft surveillance biopsies is inconsistent. Colon allograft biopsies have limited utility in the follow-up of patients, particularly in absence of paired small intestinal biopsies.
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Affiliation(s)
- A M Alkashash
- Pathology Department, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - N Rush
- Pathology Department, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - R Saxena
- Pathology Department, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - Z Rokop
- Department of Surgery, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - R Mangus
- Department of Surgery, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - C Kubal
- Department of Surgery, Indiana University, Indianapolis, Indiana, UNITED STATES
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Saxena R, Ejutse T, Salzle M, Carnevale K. Using digital pathology in competency based case scenarios as an efficient pathology learning platform. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.227] [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
Introduction/Objective
Case-based learning has been utilized for implementation in learning pathological and clinical features of diseases in an integrated, facile manner for some time now. We applied certain novel technological advances to improve case-based learning - short clinical vignettes describing all pertinent pathologic features with the help of digital pathology images - including both negative and positive findings. The clinical cases combined with digital pathological and radiological images and labs were uploaded on Moodle platform for student access, to be followed later by an online interactive discussion via Zoom.
Methods/Case Report
Clinical cases meticulously woven with digital pathological and radiological images and labs were centralized on 3 fundamental competencies – disease processes, systemic pathology and diagnostic & therapeutic pathology. This was followed by corresponding Q-A session using the “breakout room” feature of Zoom to form a differential diagnosis, reach a final diagnosis and discuss appropriate management options. Students exited the breakout rooms after individual groupwork to return to the main Zoom session for final discussion. Novel web- based tools, social media assistance, and other online resources were utilized to enhance the online learning experience.
Results (if a Case Study enter NA)
Student feedback confirmed that our online instructional methodology was incredibly stimulatory, particularly in topics that were difficult to grasp using traditional pedagogical methods. Summative and formative assessments indicated performance gain, enhanced motivation, improved critical thinking and evolved ability to solve clinical cases. Drawbacks included irregular student participation, lack of face-to-face interaction, network issues and time differences.
Conclusion
Our pathology pedagogy provides flexibility and self-directed learning skills, while simultaneously covering the geographical limitations. This not only helps students in developing critical clinical reasoning, but also enables them to acquire life-long learning and problem-solving skills. The technique proved to be a powerful educational tool that facilitated an interactive learning experience beyond the classroom setting, with integration of multidisciplinary aspects in learning Pathology. Additionally, the communication competency was also covered during case discussion among students, promoting literary, verbal and team-working capabilities.
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Affiliation(s)
- R Saxena
- Pathology, Medical University of the Americas, Charlestown, SAINT KITTS AND NEVIS
| | - T Ejutse
- Pathology, Medical University of the Americas, Charlestown, SAINT KITTS AND NEVIS
| | - M Salzle
- Pathology, Medical University of the Americas, Charlestown, SAINT KITTS AND NEVIS
| | - K Carnevale
- Pathology, Des Moines University College of Osteopathic Medicine, Des Moines, Iowa, UNITED STATES
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Alkashash AM, Khan S, Saxena R, Nephew L, Kubal C. Porto-Sinusoidal Vascular Disease and Focal Nodular Hyperplasia-like Nodules in a Patient with Neurofibromatosis and Non-Cirrhotic Portal Hypertension. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.265] [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
Introduction/Objective
Non-cirrhotic portal hypertension (NCPH) is uncommon. The underlying pathophysiology appears to lie at the level of intrahepatic portal veins and sinusoids, hence the term “porto-sinusoidal vascular disease” (PSVD). We report a rare case of PSVD with focal nodular hyperplasia (FNH)-like nodules in a patient with neurofibromatosis type 2 (NF2).
Methods/Case Report
A 57-year-old male with NF2 and type 2 diabetes, presented with a large variceal bleed requiring blood transfusion and subsequent transjugular intrahepatic portosystemic shunt (TIPS). Imaging showed a nodular liver, presumed to be cirrhosis due to non-alcoholic liver disease. Liver biopsy was not done. Thereafter, he had several episodes of hepatic encephalopathy and TIPS was downsized to prevent recurrences. The patient required liver transplantation for intractable portal hypertension and severe hepatic encephalopathy; his liver synthetic function was near normal and MELD was 11. Portal vein was patent. The explanted liver was micronodular, soft and weighed 946 grams. Unencapsulated nodules, a few mm to 1 cm in size, were present. Microscopically, there was diffuse nodularity in the absence of bridging fibrosis. Thin, incomplete curvilinear fibrous septa were present. There were aberrant veins, hypervascular portal tracts, herniated portal veins and rare occluded portal veins. Trichrome and reticulin stains confirmed architectural abnormalities including nodularity, lack of bridging fibrosis and approximation of portal tracts. Immunohistochemistry for glutamine synthetase accentuated architectural distortion and revealed nodules with FNH-like geographic areas of staining.
Results (if a Case Study enter NA)
NA
Conclusion
This is a rare case of NCPH due to PSVD in a patient with NF2. Microscopy suggested incomplete septal cirrhosis (ISC), a pattern associated with both PSVD and regression of fibrosis in a cirrhotic liver. Isolated portal hypertension without loss of synthetic function favors primary PSVD over regression of fibrosis. FNH-like nodules are consistent with regenerative changes caused by localized abnormalities of blood flow.
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Affiliation(s)
- A M Alkashash
- Pathology Department, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - S Khan
- Pathology Department, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - R Saxena
- Pathology Department, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - L Nephew
- Gastroenterology, Indiana Univerity, Indianapolis, Indiana, UNITED STATES
| | - C Kubal
- Gastroenterology, Indiana Univerity, Indianapolis, Indiana, UNITED STATES
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Alkashash AM, Saxena R, Poulos C, Phillips CL, Nassiri M, Hains D. Rare presentation of primary hepatic marginal zone B-cell lymphoma and membranous glomerulopathy in a 3-year-old boy. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.262] [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
Introduction/Objective
Primary hepatic marginal zone B-cell lymphoma (MZL) is a rare entity that has been described with chronic inflammatory disorders such as chronic viral hepatitides B and C and primary biliary cholangitis. We report MZL in a 3-year-old African-American boy that was discovered incidentally at autopsy.
Methods/Case Report
The patient first came to medical attention at 9-months of age with bilateral periorbital edema that progressed to generalized edema of the[PL1] face, extremities, and abdomen. Laboratory testing showed nephrotic syndrome with massive proteinuria (50-60 g/day). A percutaneous renal biopsy specimen showed membranous glomerulopathy with PLA2R detected by immunofluorescence, and granular IgG deposition along tubular basement membranes. Serum was negative for anti-PLA2R antibodies. The patient suffered recurrent upper respiratory tract infections requiring several intensive care hospitalizations. At 3 years of age, he was transported unresponsive and pulseless to the emergency department where he was pronounced dead. A brother with the infantile nephrotic syndrome had died from sepsis at 2 years of age. Suspicion of abuse led to an autopsy by the medical examiner, who discovered nodular masses in the right and left liver lobes, which histologically showed a serpiginous infiltrate of small B-lymphocytes positive for CD20, CD43 admixed with plasmacytoid cells with kappa light chain restriction. There were no extrahepatic tumors. Transmission electron microscopy of glomeruli showed membranous glomerulopathy. Kidneys showed dense reactive interstitial lymphocytic infiltrate with germinal centers
Results (if a Case Study enter NA)
NA
Conclusion
To our knowledge, this is the first reported case of MZL presenting in a pediatric patient with membranous glomerulopathy. Both diagnoses are associated with autoimmune diseases and persistent, chronic inflammation. Recurrent infections in this patient suggest an immunoregulatory disorder, setting the stage for chronic inflammation, as seen in the kidney, with progression to MZL in the liver.
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Affiliation(s)
- A M Alkashash
- Pathology, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - R Saxena
- Pathology, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - C Poulos
- Pathology, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - C L Phillips
- Pathology, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - M Nassiri
- Pathology, Indiana University, Indianapolis, Indiana, UNITED STATES
| | - D Hains
- Ped-Nephrology, Indiana University, Indianapolis, Indiana, UNITED STATES
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Singh H, Gupta SK, Vikram K, Saxena R, Sharma A. The impact of mosquito proof lids of underground tanks "tanka" on the breeding of Anopheles stephensi in a village in western Rajasthan, India. Malar J 2021; 20:412. [PMID: 34666794 PMCID: PMC8527675 DOI: 10.1186/s12936-021-03939-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background Western Rajasthan in India has a typical desert climate. Until the introduction of the canal water irrigation system, malaria was an unstable and seasonal occurrence. Due to the scarcity of water, the community practised having one large underground tank (locally known as the tanka) in their house to collect rainwater for long-term household use. Anopheles stephensi, one of the major malaria vectors, breeds in improperly covered "tankas” if not properly covered and harbours a vector population throughout the year. Methods Two villages, Ajasar (intervention) and Tota (control), with similar ecological features, were selected for the study. A pre-intervention survey was carried out in both villages to assess the presence and quality of lids of tankas, and mosquito breeding and adult mosquito density. Awareness of the community about malaria and mosquitoes was also assessed during the pre-intervention period. In the intervention village, damaged or improper lids were replaced with improved mosquito proof polyvinyl chloride plastic (PVC) lids and lasted longer than the conventional lids. The fitness of the lids was assessed one year after the pre-intervention survey. The entomological assessment was carried out in both intervention and non-intervention villages. The level of community awareness about malaria, mosquitoes, their breeding places, and the role of tankas in malaria transmission was assessed both during pre- and post-intervention. Results During the pre-intervention survey,Anopheles breeding was found in 22.1% (58/262) of tankas in the intervention village and 27.1% (19/70) in tankas in the control village. Mosquito breeding was observed in the tankas with iron lids in the intervention village (48.3%) and the control village (42.1%). In the intervention village, out of 262 tankas in the village, 200 lids were replaced, resulting in the complete absence of mosquito breeding. In the pre-intervention survey conducted in May 2018, Anopheles stephensi consisted of 46% of adult mosquitoes in the intervention village and 55% in the control village. Its density was significantly reduced to 0.55 per man-hour (94.95%) and 0.22 per man-hour (97.8%) in the post-intervention survey in June 2018 and a follow-up survey in May 2019, respectively, in the intervention village. Discussion The density of Anopheles stephensi adults was reduced significantly (97.8%) in the intervention village due to complete prevention of breeding in the underground tankas in the intervention village as compared to the control with no density reduction. The awareness level of the community was also improved due to their involvement in the study. Conclusion Provision of proper metal lids or replacement of damaged lids on underground water storage tanks as an environmental management approach prevented the breeding of the malaria vector, Anopheles stephensi, in a desert village in western Rajasthan.
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Affiliation(s)
- Himmat Singh
- ICMR-National Institute of Malaria Research, Sector 8 Dwarka, Delhi, 110077, India.
| | - Sanjeev Kumar Gupta
- ICMR-National Institute of Malaria Research, Sector 8 Dwarka, Delhi, 110077, India
| | - Kumar Vikram
- Indian Council of Medical Research, V. Ramalingaswami Bhawan, Ansari Nagar, P.O. Box No. 4911, New Delhi, 110029, India
| | - Rekha Saxena
- ICMR-National Institute of Malaria Research, Sector 8 Dwarka, Delhi, 110077, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, Sector 8 Dwarka, Delhi, 110077, India
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21
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Kumar NP, Kumar A, Panneer D, Abidha S, Muthukumaravel S, Sankari T, Ajithlal PM, Mathew J, Koothradan S, Paramasivan R, Muniyaraj M, Singh H, Saxena R, Vijayachari P, Sunish IP, Shriram AN, Dutta P, Patgiri SJ, Bhattacharyya DR, Hoti SL, Chattopadhyay D, Roy S, Mahapatra N, Pati S, Chand G, Mishra AK, Barde P, Jambulingam P. Nation-wide vector surveillance on Zika and Dengue did not indicate transmission of the American lineage-pandemic Zika virus in India. Int J Infect Dis 2021; 113:119-124. [PMID: 34601144 DOI: 10.1016/j.ijid.2021.09.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Following the Public Health Emergency of International Concern declared on Zika by the World Health Organization during 2016, the Indian Council of Medical Research carried out nationwide vector surveillance for Zika and Dengue viruses (ZIKV and DENV) in India as a preparedness measure in 2016-19. METHODS High-risk zones distributed to 49 Districts in 14 states/union territories were included in the study. Seven ICMR institutions participated, following a standard operating protocol. Aedes specimens sampled weekly were processed by multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) for ZIKV/DENV and random samples crosschecked with real-time RT-PCR for ZIKV. RESULTS Altogether, 79 492 Aedes specimens in 6492 pools were processed; 3 (0.05%) and 63 (0.97%) pools, respectively, were found positive for ZIKV and DENV. ZIKV infections were recorded in Aedes aegypti sampled during the 2018 sporadic Zika outbreak in Jaipur, Rajasthan. However, these belonged to the Asian lineage of the virus, already circulating in the country. Both Ae. aegypti and Aedes albopictus distributed to 8 states/union territories were found to be infected with DENV. Both sexes of Ae. albopictus were infected, indicating transovarial transmission. CONCLUSION This investigation evinced no active transmission of the American lineage-pandemic Zika virus in India during the pandemic period.
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Affiliation(s)
- N Pradeep Kumar
- ICMR-Vector Control Research Centre Field Station, Kottayam, Kerala, India.
| | - Ashwani Kumar
- ICMR-Vector Control Research Centre, Puducherry, India
| | - D Panneer
- ICMR-Vector Control Research Centre, Puducherry, India
| | - S Abidha
- ICMR-Vector Control Research Centre Field Station, Kottayam, Kerala, India
| | | | - T Sankari
- ICMR-Vector Control Research Centre, Puducherry, India
| | - P M Ajithlal
- ICMR-Vector Control Research Centre Field Station, Kottayam, Kerala, India
| | - Jessu Mathew
- ICMR-Vector Control Research Centre Field Station, Kottayam, Kerala, India
| | - Suhana Koothradan
- ICMR-Vector Control Research Centre Field Station, Kottayam, Kerala, India
| | - R Paramasivan
- ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
| | - M Muniyaraj
- ICMR-Vector Control Research Centre Field Station, Madurai, Tamil Nadu, India
| | - Himmat Singh
- ICMR- National Institute for Malaria Research, New Delhi, India
| | - Rekha Saxena
- ICMR- National Institute for Malaria Research, New Delhi, India
| | - P Vijayachari
- ICMR- Regional Medical Research Centre, Port Blair, Andaman Nicobar Islands, India
| | - I P Sunish
- ICMR- Regional Medical Research Centre, Port Blair, Andaman Nicobar Islands, India
| | - A N Shriram
- ICMR-Vector Control Research Centre, Puducherry, India
| | - Prafulla Dutta
- ICMR-Regional Medical Research Centre (NE), Dibrugarh, Assam, India
| | | | | | - S L Hoti
- ICMR-National Institute of Medicinal Plants Research, Belagavi, Karnataka, India
| | - D Chattopadhyay
- ICMR-National Institute of Medicinal Plants Research, Belagavi, Karnataka, India
| | - Subarna Roy
- ICMR-National Institute of Medicinal Plants Research, Belagavi, Karnataka, India
| | - Namita Mahapatra
- ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Gyan Chand
- ICMR- National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - A K Mishra
- ICMR- National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Pradip Barde
- ICMR- National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - P Jambulingam
- ICMR-Vector Control Research Centre, Puducherry, India
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22
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Vikram K, Nagpal BN, Gupta SK, Tuli NR, Singh H, Srivastava A, Saxena R. Co-distribution of dengue and Chikungunya viruses in Aedes mosquitoes of Delhi, India. J Vector Borne Dis 2021; 58:386-390. [PMID: 35381830 DOI: 10.4103/0972-9062.325638] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND & OBJECTIVES In India, vector-borne diseases, dengue and chikungunya are major public health concerns. In recent decades, dengue outbreaks have been reported in almost every part of India. In 2016, India recorded 101388 dengue cases and 210 deaths, including 4337 cases and six deaths in Delhi, whereas Chikungunya outbreaks were reported from several states in 2006, with 1.3 million cases. The Dengue virus (DENV) and Chikungunya virus (CHIKV) are both transmitted by the same Aedes mosquito species. DENV and CHIKV co-infections have been reported in 13 of 98 countries, with both viruses being transmitted locally. The reasons for the sudden upsurge in cases of these diseases are undetermined. METHODS From March to December 2016, a study was carried out in 66 localities of Delhi in collaboration with the Municipal Corporation of Delhi. Localities were selected on the basis of confirmed dengue cases reported during the last five years and the study area was visited once a month. A door-to-door entomological survey was conducted to identify Aedes breeding in all water-filled containers in and around houses. Both immature and mature stages of Aedes mosquitoes were collected. Mosquitoes were pooled (n≤10 each for male and female) breeding site-wise and stored in Trizol at -80°C. The Chikungunya and dengue viruses were detected using a multiplex RT-PCR. RESULTS A total of 981 Aedes mosquitos were distributed among 146 Pools, and DENV and CHIKV were detected using Multiplex Reverse Transcriptase-PCR. Chikungunya virus was identified in 19 pools of females captured adults, whereas dengue virus was found in 8 pools of females captured adults. There was no evidence of coinfection in any of the pools. INTERPRETATION & CONCLUSION In endemic areas, continuous surveillance for both dengue and Chikungunya viruses is required to identify and characterize these viral pathogens. This information will also help implement effective strategies to combat outbreaks produced by these emerging viral pathogens.
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Affiliation(s)
- Kumar Vikram
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - B N Nagpal
- ICMR-National Institute of Malaria Research, New Delhi, India
| | | | - N R Tuli
- South Delhi Municipal Corporation, Delhi, India
| | - Himmat Singh
- ICMR-National Institute of Malaria Research, New Delhi, India
| | | | - Rekha Saxena
- ICMR-National Institute of Malaria Research, New Delhi, India
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Gupta SK, Nagpal BN, Singh H, Vikram K, Nayak A, Chalga MS, Srivastava A, Joshi MC, Saxena R. Mobile app based pictorial identification key for Indian anophelines. J Vector Borne Dis 2021; 58:306-310. [PMID: 35381818 DOI: 10.4103/0972-9062.325634] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND & OBJECTIVES Malaria control strategies for a particular area largely depends on the correct identification of the mosquito species prevalent in that area. This study aimed to develop an android mobile app named 'Pictorial Indian anophelines key', which can be used to identify the 58 species of Indian female adult anophelines based on morphological characteristics. METHODS The pre-requisite to use this app requires a minimum basic knowledge of mosquito morphological characteristics and features. The user needs to view the collected mosquito under a dissecting binocular microscope and has to select the observations on the app presented in the form of labelled picture format. The app uses a divide and conquer algorithm which narrows the selection from genus level to final identification of species. RESULTS The app is user-friendly, quick and it accurately identifies the mosquito species in a maximum of six consecutive clicks. The result displays a complete image of identified mosquito along with its quick identification features. It can be used for both subgenus Cellia and Anopheles. INTERPRETATION & CONCLUSION This pictorial key-based mobile app could be helpful for entomologists, malariologists, researchers, public health workers as well as students in the quick and correct identification of anopheline mosquitoes prevalent in India which in turn could be helpful in devising appropriate approaches towards malaria control and prevention. The app can be modified as per future requirements.
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Affiliation(s)
| | - B N Nagpal
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Himmat Singh
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Kumar Vikram
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Ajay Nayak
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - M S Chalga
- ICMR-National Institute of Malaria Research, New Delhi, India
| | | | - M C Joshi
- Kumaun University, Nainital, Uttarakhand, India
| | - Rekha Saxena
- ICMR-National Institute of Malaria Research, New Delhi, India
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Saxena R, Crum R, Moore N, Warha S. Innovating With the Times: Pathology Education in Context of Physician Burnout. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.268] [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: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Learning a boundless volume of information, preparing for multiple exams, and getting involved in several other academic activities are just a few things that the current medical students need to tackle in a finite duration. While these challenges encourage learners to be their best, and prepare them for their careers as future physicians, they can also result in a largely unnoticed issue — burnout. Curricular reform targeted at developing skills to mitigate burnout is the need of the hour. To combat this issue in the pathology classroom, we used our tried and tested strategy of algorithms in combination with fun activities, particularly keyword mnemonics, to evaluate the impact on reducing burnout in medical students.
Methods
Lectures were delivered and recorded for students of semester 4 and 5, and sample algorithms and mnemonics were included. We also used pathophysiology case sessions comprising clinical vignettes and questions. Students were divided into small groups to solve questions and had to frame their own algorithms and mnemonics to help them. The method’s effectiveness was assessed using performance in past and current exams. Feedback was performed to gauge students’ perceptions
Results
Feedback evaluation showed that 86% of students indicated that algorithms and mnemonics not only strengthened the rote memory but also helped lessen the stress during exam preparation. 59% of students expressed that teamwork made it easier and fun to work. Almost 11% felt that mnemonics should be included as part of new lectures but they found it difficult and ineffective to make their own. Further assessment will be performed to analyze the strategy’s impact on burnout.
Conclusion
Classroom traditions that encourage shared problem-solving and decision-making leads to reduced burnout rates among medical students, with the added benefit of enhanced retention of complicated material and improved clinical correlation capabilities. The relationship between stress and memory is well-documented, and feedback revealed that this technique helped alleviate negative stress on the students. Our project underlines the essence of research studies to minimize burnout in medical students, for design and development of future interventions to prevent burnout at the outset in the training of future physicians.
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Affiliation(s)
- R Saxena
- Pathology, Medical University of the Americas, Charlestown, SAINT KITTS AND NEVIS
| | - R Crum
- Medical University of the Americas, Potworks, Nevis, SAINT KITTS AND NEVIS
| | - N Moore
- Medical University of the Americas, Potworks, Nevis, SAINT KITTS AND NEVIS
| | - S Warha
- Medical University of the Americas, Potworks, Nevis, SAINT KITTS AND NEVIS
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Gray KJ, Kovacheva VP, Mirzakhani H, Bjonnes AC, Almoguera B, Wilson ML, Ingles SA, Lockwood CJ, Hakonarson H, McElrath TF, Murray JC, Norwitz ER, Karumanchi SA, Bateman BT, Keating BJ, Saxena R. Risk of pre-eclampsia in patients with a maternal genetic predisposition to common medical conditions: a case-control study. BJOG 2020; 128:55-65. [PMID: 32741103 DOI: 10.1111/1471-0528.16441] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess whether women with a genetic predisposition to medical conditions known to increase pre-eclampsia risk have an increased risk of pre-eclampsia in pregnancy. DESIGN Case-control study. SETTING AND POPULATION Pre-eclampsia cases (n = 498) and controls (n = 1864) in women of European ancestry from five US sites genotyped on a cardiovascular gene-centric array. METHODS Significant single-nucleotide polymorphisms (SNPs) from 21 traits in seven disease categories (cardiovascular, inflammatory/autoimmune, insulin resistance, liver, obesity, renal and thrombophilia) with published genome-wide association studies (GWAS) were used to create a genetic instrument for each trait. Multivariable logistic regression was used to test the association of each continuous scaled genetic instrument with pre-eclampsia. Odds of pre-eclampsia were compared across quartiles of the genetic instrument and evaluated for significance. MAIN OUTCOME MEASURES Genetic predisposition to medical conditions and relationship with pre-eclampsia. RESULTS An increasing burden of risk alleles for elevated diastolic blood pressure (DBP) and increased body mass index (BMI) were associated with an increased risk of pre-eclampsia (DBP, overall OR 1.11, 95% CI 1.01-1.21, P = 0.025; BMI, OR 1.10, 95% CI 1.00-1.20, P = 0.042), whereas alleles associated with elevated alkaline phosphatase (ALP) were protective (OR 0.89, 95% CI 0.82-0.97, P = 0.008), driven primarily by pleiotropic effects of variants in the FADS gene region. The effect of DBP genetic loci was even greater in early-onset pre-eclampsia cases (at <34 weeks of gestation, OR 1.30, 95% CI 1.08-1.56, P = 0.005). For other traits, there was no evidence of an association. CONCLUSIONS These results suggest that the underlying genetic architecture of pre-eclampsia may be shared with other disorders, specifically hypertension and obesity. TWEETABLE ABSTRACT A genetic predisposition to increased diastolic blood pressure and obesity increases the risk of pre-eclampsia.
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Affiliation(s)
- K J Gray
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - V P Kovacheva
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - H Mirzakhani
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A C Bjonnes
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - B Almoguera
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - M L Wilson
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - S A Ingles
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - C J Lockwood
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - H Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Divisions of Human Genetics and Pulmonary Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - T F McElrath
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J C Murray
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - E R Norwitz
- Department of Obstetrics & Gynecology, Tufts Medical Center, Boston, Massachusetts, USA
| | - S A Karumanchi
- Center for Vascular Biology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - B T Bateman
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - B J Keating
- Department of Surgery and Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - R Saxena
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Dashti HS, Cade B, Stutaite G, Saxena R, Redline S, Karlson E. 1164 Prospective Associations Between Sleep Duration, Variability and Timing and Diseases from an Electronic Health Record Biobank in 24,065 Individuals. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1158] [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
Introduction
Implementation of electronic health records (EHR) across healthcare systems linking clinical to survey data has enabled systematic assessments of longitudinal relationships between sleep traits and diseases classified by PheWAS codes where ICD-9/10 codes are collapsed to categories based on clinical similarity. In the Partners Biobank, a hospital-based virtual cohort from Mass General Brigham in greater Boston, MA, we aimed to assess associations between sleep traits and incident diseases.
Methods
Self-reported weekday/weekend bed and wake times from a survey at consent were used to derive sleep traits. Incident diseases were defined as two incident PheWAS codes on separate dates ≥1y after consent. Cox proportional hazards models compared short (<7h) and long (≥9h) sleep duration, with 7-8h (referent group), adjusted for age, gender, race/ethnicity, and employment status, then further adjusted for BMI. Similarly, sleep midpoint (midpoint between weekend wake/bed times), sleep debt (difference in weekend/weekday sleep duration), and social jetlag (difference in weekend/weekday sleep midpoint) were assessed.
Results
The analytical sample consisted of 24,065 adults (mean sleep duration =8.12h) seeking regular care with sleep data. Participants had a total of 7,513,649 ICD codes of which incident 323,946 ICD codes mapped to 137,137 PheWAS codes. Over a median follow-up of 2.73 years (interquartile range: 1.82-3.98), participants sleeping <7h had a significantly higher risk of incident Acute pain [hazard ratio(95% confidence interval)=1.46(1.2-1.78)], Tobacco use disorder [1.42(1.18-1.71)], Sciatica [1.72(1.3-2.27)], and Edema [1.69(1.25-2.28)]. Each additional hour of later sleep midpoint and increased sleep debt and social jetlag associated with higher risk of incident Major depressive disorder [midpoint:1.30(1.14-1.49); debt:1.23(1.09-1.38); jetlag:1.54(1.27-1.84)]. Associations retained significance upon further adjustment for BMI, except for Edema, and no other associations were observed at the Bonferroni threshold (P=0.0125).
Conclusion
Our findings in a large hospital-based virtual cohort support unique inter-relationships between sleep duration/timing on somatic, behavioral, and mental health outcomes.
Support
H.S.D. and R.S. are supported by NIDDK grant R01DK107859. B.C. is supported by K01-HL135405-01. S.R. and R.S. are partially supported by R35 NHLBI HL 135816.
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Affiliation(s)
- H S Dashti
- Massachusetts General Hospital, Boston, MA
| | - B Cade
- Brigham and Women’s Hospital, Boston, MA
| | - G Stutaite
- Massachusetts General Hospital, Boston, MA
| | - R Saxena
- Massachusetts General Hospital, Boston, MA
| | - S Redline
- Brigham and Women’s Hospital, Boston, MA
| | - E Karlson
- Brigham and Women’s Hospital, Boston, MA
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Gao L, Li P, Cui L, Luo Y, Vetter C, Saxena R, Scheer FA, Johnson-Akeju O, Hu K. 0259 Shiftworkers are at Increased Risk of Developing Chronic Pain and Opioid Use Disorders: A Study of 116,000 UK Biobank Participants Over a Decade. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.257] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
In the current epidemic of opioid-related deaths, and widespread use of opioids to treat chronic pain, there is a pressing need to understand the underlying risk factors that contribute to such devastating conditions. Shiftwork has been associated with adverse health outcomes. We tested whether shiftwork during middle age is linked to the development of chronic pain and opioid misuse.
Methods
We studied 116,474 participants in active employment between 2006–2010 (mean age 57±8; range 37–71) from the UK Biobank, who have been followed for up to 10 years until 2017. We included participants who were free from all forms of self-reported pain, and were not taking opioid medications at baseline. Chronic pain and opioid use disorder diagnoses were determined using hospitalization records and diagnostic coding from ICD-10. Multivariate logistic regression models were performed to examine the associations of shiftwork status (yes/no) and nightshift frequency (none/occasional/permanent) and with incident chronic pain and/or opioid use disorder during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, major confounders (BMI, diabetes, bone fractures/injuries, operations, peripheral vascular disease, joint/inflammatory diseases, cancer, standing/manual labor at work) and covariates (smoking, alcohol, high cholesterol, depression/anxiety, and cardiovascular diseases).
Results
In total, 190 (1.6/1,000) developed chronic pain or opioid use disorders. Shiftworkers (n=17,673) saw a 1.5-fold increased risk (OR 1.56, 95% CI: 1.08–2.24, p=0.01) relative to day workers. Within shiftworkers, those who reported occasional nightshift work (n=3,966) were most vulnerable (OR 1.57, 95% CI: 1.06–2.34, p=0.02). Results remained similar after adjusting for baseline sleep duration, chronotype and insomnia.
Conclusion
Shiftwork, and in particular rotating nightshift work is associated with increased risk for developing chronic pain and opioid use disorders. Replication is required to confirm the findings and to examine underlying mechanisms.
Support
This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.
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Affiliation(s)
- L Gao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
| | - P Li
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - L Cui
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
| | - Y Luo
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Center for Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - C Vetter
- Department of Integrative Physiology, University of Colorado, Boulder, CO
| | - R Saxena
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - F A Scheer
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - O Johnson-Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - K Hu
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
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Wang H, Lane J, Jones S, Dashti H, Ollila H, Wood A, van Hees V, Brumpton B, Winsvold B, Kantojärvi K, Palviainen T, Cade B, Sofer T, Song Y, Patel K, Anderson S, Bechtold D, Bowden J, Emsley R, Kyle S, Little M, Loudon A, Scheer F, Purcell S, Richmond R, Spiegelhalder K, Tyrrell J, Zhu X, Hublin C, Kaprio J, Kristiansson K, Sulkava S, Paunio T, Hveem K, Nielsen J, Willer C, Zwart JA, Strand L, Frayling T, Ray D, Lawlor D, Rutter M, Weedon M, Redline S, Saxena R. Genome-wide association analysis of self-reported daytime sleepiness identifies 42 loci that suggest biological subtypes. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mori V, Sawhney J, Mehta A, Sharma M, Saxena R, Verma I. Incidence of genetic mutations in patients with familial dilated cardiomyopathy. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.046] [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: 11/28/2022] Open
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Sisodia P, Bhatia R, Bali P, Singh N, Chauhan A, Hooda R, Saxena R, Srivastava M, Prasad K, Vishnubhatla S, Sharma G, Singh M. Aspirin resistance with mortality in patients with ischemic stroke. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Galodha S, Saxena R, Singh R, Aggrawal J, Kapoor V, Behari A. Incidental gallbladder cancer: can we improve survival? Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Martins J, Saxena R, Neppl S, Alhazmi A, Reiner M, Belka C, Parodi K. PO-0906 Perturbation techniques for optimizing IAEA phase spaces for different medical linacs. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dhakan DB, Maji A, Sharma AK, Saxena R, Pulikkan J, Grace T, Gomez A, Scaria J, Amato KR, Sharma VK. The unique composition of Indian gut microbiome, gene catalogue, and associated fecal metabolome deciphered using multi-omics approaches. Gigascience 2019; 8:giz004. [PMID: 30698687 PMCID: PMC6394208 DOI: 10.1093/gigascience/giz004] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/02/2018] [Accepted: 01/10/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Metagenomic studies carried out in the past decade have led to an enhanced understanding of the gut microbiome in human health; however, the Indian gut microbiome has not been well explored. We analyzed the gut microbiome of 110 healthy individuals from two distinct locations (North-Central and Southern) in India using multi-omics approaches, including 16S rRNA gene amplicon sequencing, whole-genome shotgun metagenomic sequencing, and metabolomic profiling of fecal and serum samples. RESULTS The gene catalogue established in this study emphasizes the uniqueness of the Indian gut microbiome in comparison to other populations. The gut microbiome of the cohort from North-Central India, which was primarily consuming a plant-based diet, was found to be associated with Prevotella and also showed an enrichment of branched chain amino acid (BCAA) and lipopolysaccharide biosynthesis pathways. In contrast, the gut microbiome of the cohort from Southern India, which was consuming an omnivorous diet, showed associations with Bacteroides, Ruminococcus, and Faecalibacterium and had an enrichment of short chain fatty acid biosynthesis pathway and BCAA transporters. This corroborated well with the metabolomics results, which showed higher concentration of BCAAs in the serum metabolome of the North-Central cohort and an association with Prevotella. In contrast, the concentration of BCAAs was found to be higher in the fecal metabolome of the Southern-India cohort and showed a positive correlation with the higher abundance of BCAA transporters. CONCLUSIONS The study reveals the unique composition of the Indian gut microbiome, establishes the Indian gut microbial gene catalogue, and compares it with the gut microbiome of other populations. The functional associations revealed using metagenomic and metabolomic approaches provide novel insights on the gut-microbe-metabolic axis, which will be useful for future epidemiological and translational researches.
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Affiliation(s)
- D B Dhakan
- Metagenomics and Systems Biology Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhauri, Madhya Pradesh, 462066, India
| | - A Maji
- Metagenomics and Systems Biology Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhauri, Madhya Pradesh, 462066, India
| | - A K Sharma
- Metagenomics and Systems Biology Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhauri, Madhya Pradesh, 462066, India
| | - R Saxena
- Metagenomics and Systems Biology Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhauri, Madhya Pradesh, 462066, India
| | - J Pulikkan
- Department of Genomic Science, Central University of Kerala, Periye Post, Kasargod, Kerala, 671316, India
| | - T Grace
- Department of Genomic Science, Central University of Kerala, Periye Post, Kasargod, Kerala, 671316, India
- Division of Biology, Kansas State University, 116 Ackert Hall, Manhattan, Kansas, KS 66506, USA
| | - A Gomez
- Microbiomics Laboratory, Department of Animal Science, University of Minnesota, 1988 Fitch Avenue, Minnesota, MN 55108, USA
| | - J Scaria
- Animal Disease Research & Diagnostic Laboratory, Veterinary and Biomedical Sciences Department, South Dakota State University, Brookings, South Dakota, SD 57007, USA
| | - K R Amato
- Department of Anthropology, Northwestern University, 1810 Hinman Avenue, Evanston, Illinois, IL 60208, USA
| | - V K Sharma
- Metagenomics and Systems Biology Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research Bhopal, Bhauri, Madhya Pradesh, 462066, India
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van Dijk AC, Donkel SJ, Zadi T, Sonneveld MAH, Schreuder FHBM, Chohan MF, Koudstaal PJ, Leebeek FWG, Saxena R, Hendrikse J, Kooi ME, van der Lugt A, de Maat MPM. Association between fibrinogen and fibrinogen γ' and atherosclerotic plaque morphology and composition in symptomatic carotid artery stenosis: Plaque-At-RISK study. Thromb Res 2019; 177:130-135. [PMID: 30897531 DOI: 10.1016/j.thromres.2019.02.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/16/2019] [Accepted: 02/23/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Von Willebrand Factor (VWF), ADAMTS13, fibrinogen and fibrinogen γ' are associated with an increased risk of ischemic stroke. Carotid atherosclerosis is an important risk factor for ischemic stroke. Characteristics of the vulnerable plaque; intraplaque hemorrhage (IPH), plaque ulceration and lipid-rich necrotic core (LRNC) can be visualized with imaging techniques. Since atherosclerosis might attribute to the association between coagulation factors and ischemic stroke risk, the aim of this study is to investigate the association between coagulation factors and atherosclerotic plaque characteristics in more detail. MATERIALS AND METHODS In 182 patients of the Plaque-At-RISK study (prospective multicenter cohort study) with a recent transient ischemic attack (TIA) or ischemic stroke and a symptomatic mild-to-moderate carotid artery stenosis, we measured VWF antigen (VWF:Ag), ADAMTS13 activity, fibrinogen (Clauss), and fibrinogen γ'. Presence of plaque ulceration, IPH volume and LRNC volume were determined by Multidetector-Row Computed Tomography (MDCTA, n = 160) and Magnetic Resonance Imaging (MRI, n = 172). Linear regression analysis was used to assess the association between imaging biomarkers and coagulation factors. RESULTS VWF:Ag or ADAMTS13 levels were not significantly associated with plaque ulceration, IPH and LRNC. We found an inverse association between fibrinogen and fibrinogen γ' and IPH volume (B = -23.40 mm3/g/L, p = 0.01 and B = -161.73 mm3/g/L, p = 0.01) and between fibrinogen and fibrinogen γ' and LRNC volume (B = -38.89 mm3 g/L, p < 0.01 and B = -227.06 mm3 g/L, p = 0.01). Additional adjustments for C-reactive protein (CRP) did not change the results. CONCLUSIONS Fibrinogen and fibrinogen γ' are inversely associated with IPH volume and LRNC volume, independent of inflammation. CLINICAL TRIAL REGISTRATION clinicaltrials.govNCT01208025.
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Affiliation(s)
- A C van Dijk
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - S J Donkel
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - T Zadi
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - M A H Sonneveld
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - F H B M Schreuder
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - M F Chohan
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - P J Koudstaal
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - F W G Leebeek
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - R Saxena
- Department of Neurology, Maasstad hospital, Rotterdam, the Netherlands
| | - J Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M E Kooi
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A van der Lugt
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - M P M de Maat
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
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Abstract
Autosomal dominant polycystic kidney disease is characterized by multiple cysts in both kidneys manifesting in adult life. In general, the disorder is caused by a pathogenic variant in one allele of PKD1 or PKD2 genes, while the other allele is normal. Pathogenic variants in both the alleles are rare and have variable phenotypes, from lethal or perinatal presentation to a mild form in later adulthood, depending on the type of variant. Here, we describe a proband with two variants (p.Thr1773Ile and p.Ala1871Thr in trans) in PKD1 gene, who presented with disease at age 24 years. Both the parents and one brother had a variant in one allele, the other being wild type only and had normal ultrasound findings. Segregation studies suggest that both the variants may act as “hypomorphic” or “incompletely penetrant” alleles and acting together resulted in haploinsufficiency of protein PC1 in renal cells, leading to cystogenesis in the proband. The consequences of the presence of two hypomorphic variants have been poorly documented in literature. We reviewed the few published cases having two hypomorphic variants and the data conform to the conclusions that we reached by study of the family described. It is emphasized that to resolve the significance of suspected hypomorphic variants, segregation studies in the parents and siblings are essential.
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Affiliation(s)
- S Pandita
- Molecular Genetics Laboratory, Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - D Khullar
- Department of Nephrology and Renal Transplant Medicine, Max Super Speciality Hospital, New Delhi, India
| | - R Saxena
- Molecular Genetics Laboratory, Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - I C Verma
- Molecular Genetics Laboratory, Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
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Dashti HS, Jones S, Lane JM, Wang H, Song Y, Patel K, Gill S, Gottlieb D, Tiemeier H, Ray DW, Frayling TM, Rutter MK, Weedon MN, Saxena R. 0013 Genome-wide Association Analysis Identifies >75 Genetic Loci Associated With Sleep Duration In UK Biobank Participants. Sleep 2018. [DOI: 10.1093/sleep/zsy061.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- H S Dashti
- Massachusetts General Hospital, Boston, MA
| | - S Jones
- University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - J M Lane
- Massachusetts General Hospital, Boston, MA
| | - H Wang
- Brigham and Women’s Hospital, Boston, MA
| | - Y Song
- Massachusetts General Hospital, Boston, MA
| | - K Patel
- Massachusetts General Hospital, Boston, MA
| | - S Gill
- Massachusetts General Hospital, Boston, MA
| | - D Gottlieb
- Brigham and Women’s Hospital, Boston, MA
| | - H Tiemeier
- Harvard Chan School of Public Health, Boston, MA
| | - D W Ray
- The University of Manchester, Manchester, UNITED KINGDOM
| | - T M Frayling
- University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - M K Rutter
- The University of Manchester, Manchester, UNITED KINGDOM
| | - M N Weedon
- University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - R Saxena
- Massachusetts General Hospital, Boston, MA
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Lane JM, Jones S, Dashti HS, Wood A, Van Hees V, Spiegelhalder K, Wang H, Bowden J, Kyle SD, Ray D, Frayling TM, Lawlor DA, Rutter MK, Weedon M, Saxena R. 0015 Biological And Clinical Insights from Genetics of Insomnia Symptoms. Sleep 2018. [DOI: 10.1093/sleep/zsy061.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J M Lane
- Massachusetts General Hospital, Boston, MA
| | - S Jones
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - H S Dashti
- Massachusetts General Hospital, Boston, MA
| | - A Wood
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - V Van Hees
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | | | - H Wang
- Brigham and Women’s Hospital, Boston, MA
| | - J Bowden
- University of Bristol, Bristol, UNITED KINGDOM
| | - S D Kyle
- University of Oxford, Oxford, UNITED KINGDOM
| | - D Ray
- University of Manchester, Manchester, UNITED KINGDOM
| | - T M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - D A Lawlor
- University of Bristol, Bristol, UNITED KINGDOM
| | - M K Rutter
- University of Manchester, Manchester, UNITED KINGDOM
| | - M Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - R Saxena
- Massachusetts General Hospital, Boston, MA
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Cade BE, Lee J, Sofer T, Wang H, Chen H, Gharib SA, Mei H, Ochs-Balcom HM, Patel SR, Saxena R, Shah NA, Zhu X, Gottlieb DJ, Lin X, Redline S. 0018 Whole Genomic Associations of Transcription Factor Networks With Sleep Disordered Breathing Traits in Trans-Omics for Precision Medicine (TOPMed). Sleep 2018. [DOI: 10.1093/sleep/zsy061.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B E Cade
- Brigham and Women’s Hospital / Harvard Medical School, Boston, MA
| | - J Lee
- Brigham and Women’s Hospital, Boston, MA
| | - T Sofer
- Brigham and Women’s Hospital / Harvard Medical School, Boston, MA
| | - H Wang
- Brigham and Women’s Hospital / Harvard Medical School, Boston, MA
| | - H Chen
- University of Texas Health Science Center, Houston, TX
| | | | - H Mei
- University of Mississippi Medical Center, Jackson, MS
| | | | - S R Patel
- University of Pittsburgh, Pittsburgh, PA
| | - R Saxena
- Brigham and Women’s Hospital / Harvard Medical School, Boston, MA
| | - N A Shah
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - X Zhu
- Case Western Reserve University, Cleveland, OH
| | - D J Gottlieb
- Brigham and Women’s Hospital / Harvard Medical School, Boston, MA
| | - X Lin
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - S Redline
- Brigham and Women’s Hospital / Harvard Medical School, Boston, MA
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Wang H, Lane JM, Dashti HS, Jones S, Cade BE, Song Y, Patel K, Frayling TM, Weedon MN, Lawlor DA, Rutter MK, Redline S, Saxena R. 0014 Genome-wide Association Analysis Of Excessive Daytime Sleepiness In The Uk Biobank Identifies 42 Novel Loci. Sleep 2018. [DOI: 10.1093/sleep/zsy061.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Wang
- Division of Sleep and Circadian Disorder, Brigham and Women’s Hospital, Boston, MA
| | - J M Lane
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - H S Dashti
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - S Jones
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - B E Cade
- Division of Sleep and Circadian Disorder, Brigham and Women’s Hospital, Boston, MA
| | - Y Song
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - K Patel
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - T M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - M N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - D A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UNITED KINGDOM
| | - M K Rutter
- Division of Endocrinology, Diabetes and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UNITED KINGDOM
| | - S Redline
- Division of Sleep and Circadian Disorder, Brigham and Women’s Hospital, Boston, MA
| | - R Saxena
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
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Gupta A, Mishra P, Pati HP, Tyagi S, Mahapatra M, Seth T, Saxena R. Spectrum of hemostatic disorders in Indian females presenting with bleeding manifestations. Int J Lab Hematol 2018; 40:437-441. [PMID: 29575615 DOI: 10.1111/ijlh.12806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/16/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Hemostatic disorders are often missed in women with bleeding particularly menorrhagia. Preexisting hemostatic disorders are now known as common risk factor for postpartum hemorrhage and prolonged bleeding in puerperium. Females with bleeding complaints constitute an important population referred to hematology clinic. Hence, we aim to evaluate the type and frequency of hemostatic disorders among females presenting with bleeding in a tertiary care hospital and a basic hemostatic laboratory. METHODS Three-year data were retrospectively analyzed for 200 females with various bleeding complaints. Due to resource constraints, a hemostatic workup was done with prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen assay, clot solubility test, mixing studies, specific factor assays, platelet function test, and von Willebrand factor antigen level. RESULTS A total of 200 females were investigated to identify the cause of their bleeding. Thirty-five of 200 (17.5%) females were found with an underlying bleeding disorder. Of these 35 females, 65.7% presented with bleeding from more than 1 site. Most common bleeding manifestation was spontaneous bruising in 18 of 35 (51.4%) patients followed by petechiae (48.6%). Inherited bleeding disorders were noted in majority. The most common inherited bleeding disorder identified was von Willebrand disease (VWD) in 34.3% females. Second most common disorder was Glanzmann's thrombasthenia accounting for 22.8%. Rare coagulation factor deficiency, such as factors VII, X, and XIII deficiencies, was noted. Three cases revealed acquired causes of coagulation defects. CONCLUSION Underlying hemostatic defects should be searched for in women with unexplained bleeding complaints. This will not only help in diagnosis but also in proper management for future hemostatic challenges.
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Affiliation(s)
- A Gupta
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - P Mishra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - H P Pati
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - S Tyagi
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - M Mahapatra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - T Seth
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - R Saxena
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Much controversy surrounds the establishment of proper planning, placement and management (the best practice pattern) of dialysis access. These include the dialysis type and modality selection, timing of access placement and who places the access. The lack of and the difficulty of performing randomized studies with multiple confounding factors, in an extremely heterogeneous and rapidly changing ESRD population demographics, only partly explains the dialysis access conundrum. Add to this the rapidly developing and competing technologies, the wide spectrum of the professional experience, bias and socio-economic forces to make the ESRD problems as multivariate and complex as life itself. This overview describes a dialysis access algorithm approach to the patient needing renal replacement therapy, considering long-term improved patient outcome as the ultimate objective.
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Affiliation(s)
- I. Davidson
- Division of Transplant, Department of Surgery, Parkland Memorial Hospital, University of Texas Southwestern Medical Center, Dallas - USA
| | - M. Gallieni
- Renal Unit San Paolo Hospital, University of Milan - Italy
| | - R. Saxena
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas - USA
| | - B. Dolmatch
- Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas - USA
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Davidson I, Chan D, Dolmatch B, Hasan M, Nichols D, Saxena R, Shenoy S, Vazquez M, Gallieni M. Duplex Ultrasound Evaluation for Dialysis access Selection and Maintenance: A Practical Guide. J Vasc Access 2018. [DOI: 10.1177/112972980800900101] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Detailed case directed history and examination is the mainstay of dialysis access modality selection, ie site and type of access, as well as for maintenance of dialysis access for longevity. As a logical step following history and physical examination, duplex ultrasound evaluation (DUE) is the most cost effective and non-invasive screening tool for evaluation for access placement and for assessment of an established access. Pre-operative vascular mapping allows selection of the optimal dialysis access modality and site. In established accesses, duplex ultrasound testing will diagnose the majority of vascular access complications and direct proper surgical or interventional radiology management. This review outlines a practical decision-making algorithm using DUE for choosing and managing the dialysis access.
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Affiliation(s)
- I. Davidson
- Division of Transplant, Department of Surgery, Parkland Memorial Hospital University of Texas Southwestern Medical Center, Dallas - USA
| | - D. Chan
- Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas - USA
| | - B. Dolmatch
- Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas - USA
| | - M. Hasan
- Baptist Cardiac & Vascular Institute, Miami, Florida - USA
| | - D. Nichols
- Vascular Center, Medical City Hospital Dallas - USA
| | - R. Saxena
- Division of Nephrology, Department of internal medicine, University of Texas Southwestern Medical Center, Dallas - USA
| | - S. Shenoy
- Section of Transplantation, Department of Surgery, Washington University School of Medicine, St Louis - USA
| | - M. Vazquez
- Division of Nephrology, Department of internal medicine, University of Texas Southwestern Medical Center, Dallas - USA
| | - M. Gallieni
- Renal Unit San, Paolo Hospital, University of Milano, Milano - Italy
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43
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Abstract
PURPOSE An easily recognized clinical marker for early changes of primary angle closure glaucoma (PACG) or eyes predisposed to angle closure is important so that timely laser iridotomy can prevent morbidity. Pupillary ruff changes, specifically appearance of entropion uveae (EU), are frequent in eyes with PACG. METHODS Pupillary ruff was examined under magnification and EU, if present, was graded and correlated with gonioscopic grading and presence of peripheral anterior synechiae (PAS) in consecutive patients with primary open angle glaucoma (POAG), non-glaucomatous controls, and PACG of the subacute, acute, chronic symptomatic, and creeping angle closure glaucoma subgroups. RESULTS No POAG eye had an abnormal pupillary ruff. A total of 86.7% of subacute PACG eyes and all eyes with acute and chronic PACG showed some grade of EU. Iridocorneal synechiae were more significantly correlated with EU than goniosynechiae (p<0.001). Meridian of iridocorneal but not iridotrabecular synechiae could be correlated with the meridian of EU. In age-matched patients EU was only present in eyes with steep iris configuration, with significant correlation with narrow angles and goniosynechiae. In the detection of PACG the presence of EU Grade I was 94.9% sensitive and 98.2% specific for PACG eyes compared to the gonioscopic picture of angle closure in occludable angles. Its positive predictive value was 91.4%. CONCLUSIONS EU shows significant correlation with narrow angles, steep iris configuration, and PAS. Kinking of radial iris arteries during angle closure probably causes temporary ischemia, especially of end arteries supplying area of the pupil and sphincter pupillae. EU emerges as an easily observed, objective marker for PACG.
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Affiliation(s)
- R Sihota
- Glaucoma Service, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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44
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Affiliation(s)
- I.J.A. Davidson
- The University of Texas Southwestern Medical Center, Dallas, TX - USA
| | - M. Gallieni
- Renal Unit, San Paolo Hospital, University of Milano - Italy
| | - R. Saxena
- The University of Texas Southwestern Medical Center, Dallas, TX - USA
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45
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Kumar A, Jain M, Saxena R, Yadav A, Kumari N, Krishnani N. Pattern of mismatch repair protein loss and its clinicopathological correlation in colorectal cancer in North India. S AFR J SURG 2018. [DOI: 10.17159/2078-5151/2018/v56n1a2285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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46
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Agarwal M, Chaudhary M, Bakhshi S, Saxena R, Dwivedi S, Kabra M, Lall M, Shukla R, Seth R. Gene copy number alterations in Indian children with acute lymphoblastic leukemia. Pediatric Hematology Oncology Journal 2018. [DOI: 10.1016/j.phoj.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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47
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Cade B, Wang H, Chen H, Ekunwe L, Gharib S, Guo X, Hale L, Hsiung A, McGarvey S, Mei H, Mitchell B, Min N, Ochs-Balcom H, Patel S, Purcell S, Rotter J, Saxena R, Shah N, Sofer T, Sul JH, Sunyaev S, Wilson J, Zhu X, Gottlieb D, Lin X, Redline S. Whole genome sequence association analysis of sleep-disordered breathing traits in trans-omics for precision medicine (topmed). Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Saxena R, Mittal P, Hegde P, Veeranagaiah M, Roy N, Breton L, Misra N, Clavaud C, Gueniche A, Sharma V. 157 The microbial and functional diversity of the microflora present on the scalps of Indian subjects with and without dandruff. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.467] [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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49
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Tyagi S, Kabra M, Tandon N, Saxena R, Pati H, Choudhry V. Clinico-Haematological Profile of Thalassemia Intermedia Patients. INT J HUM GENET 2017. [DOI: 10.1080/09723757.2003.11885860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Seema Tyagi
- Department of Hematology, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - M. Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - N. Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - R. Saxena
- Department of Hematology, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - H.P. Pati
- Department of Hematology, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - V.P. Choudhry
- Department of Hematology, All India Institute of Medical Sciences, New Delhi 110 029, India
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Chhikara S, Sazawal S, Seth T, Chaubey R, Singh K, Sharma R, Mishra P, Mahapatra M, Saxena R. Molecular Response to Imatinib and Its Correlation with mRNA Expression Levels of Imatinib Influx Transporter (OCT1) in Indian Chronic Myeloid Leukemia Patients. Asian Pac J Cancer Prev 2017; 18:2043-2048. [PMID: 28843219 PMCID: PMC5697457 DOI: 10.22034/apjcp.2017.18.8.2043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background and objectives: Imatinib mesylate is approved for the treatment of Chronic Myeloid Leukemia (CML). About 20% of patients with CML do not respond to treatment with Imatinib either initially or because of acquired resistance. In addition to mutated BCR-ABL1 kinase, the organic cation transporter1 (OCT1, encoded by SLC22A1) has been considered to contribute to Imatinib resistance in patients with chronic myeloid leukemia (CML). OCT1 has been reported to be the main influx transporter involved in Imatinib uptake into CML cells. To date, only a few studies have been reported on involvement of influx transporters in development of Imatinib resistance. Therefore this study was aimed to determine the expression level of Imatinib uptake transporter (OCT1) in CML patients and to correlate this level with molecular response. Methods: One hundred fifty eight patients on Imatinib were considered for gene expression analysis study for OCT1 gene. Total RNA was extracted from peripheral blood mononuclear cells. Complementary DNAs (cDNAs) were synthesized and Real Time Polymerase Chain Reaction (RQ-PCR) was performed. Results: High OCT1 expression was present in 81 (51.8%) patients and low OCT1 expression was in 77 (48.7%) patients. Low Sokal risk score group have a significantly high OCT1 expression (p=0.048). The rate of molecular response was higher in those with high OCT1 expression than in those with low OCT1 expression (p=0.05). Both event-free survival and median overall survival were significantly shorter in patients with low OCT1 expressions when compared to the patients with high OCT1 expression (p=0.03 and p=0.05). Conclusions: Our findings demonstrated that the mRNA expression level of OCT1 was significantly correlated with molecular response in CML patients. Based on these findings, present study believes that the pre-therapeutic higher expression of OCT1 may help to predict response to imatinib therapy in CML patients.
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Affiliation(s)
- S Chhikara
- Department of Hematology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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