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Wiala A, Ranjan R, Schnidar H, Rappersberger K, Posch C. Automated classification of hidradenitis suppurativa disease severity by convolutional neural network analyses using calibrated clinical images. J Eur Acad Dermatol Venereol 2024; 38:576-582. [PMID: 38013510 DOI: 10.1111/jdv.19639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/29/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The assessment of hidradenitis suppurativa (HS) severity requires detailed, and error-prone lesion counts. This proof-of-concept study aimed to automatically classify HS disease severity using machine learning of clinical smartphone images. METHODS 777 ambient-light and size-controlled images were used to build a class-balanced synthetic dataset (n = 7675). Convolutional neural networks (CNN) were used for automated severity classification (scale 0-3), and to assess disease-dynamics. International Hidradenitis Suppurativa Severity Score System (IHS4) served as reference. A U-NET algorithm was implemented for automated localization of diseased skin. RESULTS CNNs were able to distinguish no/mild from moderate/severe disease with an overall prediction accuracy of 78% [receiver operating curve (AUC) 0.85]. Correct IHS4 classification was achieved with an overall accuracy of 72% (AUC 0.84-0.89). In addition, disease dynamics using IHS4 numerical values aligned with CNN outputs (NRMSE 0.262). The UNET algorithm localized lesions with a pixel accuracy of 88.1% and test loss of 0.42. LIMITATIONS Limitations in assessing tattooed and hairy skin. Limited number of patients with dark skin colour and Hurley I. CONCLUSION CNNs were able to distinguish no/mild from moderate/severe disease, classify disease severity over time, and automatically identify diseased skin areas and the skin phototype. This study breaks new grounds for fast, reliable, reproducible and easy-to-use HS severity assessments using clinical images.
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Affiliation(s)
- A Wiala
- Department of Dermatology, Clinic Landstrasse, Vienna, Austria
| | - R Ranjan
- SCARLETRED Holding GmbH, Vienna, Austria
| | - H Schnidar
- SCARLETRED Holding GmbH, Vienna, Austria
| | - K Rappersberger
- Department of Dermatology, Clinic Landstrasse, Vienna, Austria
- School of Medicine, Sigmund Freud University, Vienna, Austria
| | - C Posch
- School of Medicine, Sigmund Freud University, Vienna, Austria
- Department of Dermatology, Clinic Hietzing, Vienna, Austria
- Department of Dermatology and Allergy, School of Medicine, German Cancer Consortium (DKTK), Technical University of Munich, Munich, Germany
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Deopujari CE, Ambekar S, Yetukuri BR, Diyora B, Ghosh A, Krishnan P, Panigrahi M, Ranjan R, Raman C, Tyagi S, Vaishya S, Venkataramana N, Sinha VD, Paniker D, Das S. Expert panel recommendations for topical hemostatic agent use in varied bleeding sites and situations during neuro-spine surgeries. J Clin Neurosci 2024; 120:30-35. [PMID: 38176112 DOI: 10.1016/j.jocn.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
Intraoperative bleeding poses a substantial challenge, particularly in neuro-spine surgeries leading to complications such as hematomas, infections, and hemodynamic instability. Despite their proven efficacy, use of topical hemostatic agents (THAs) lacks comprehensive published literature and guidelines particularly in the Indian setting. The present study provides the first-ever Indian expert panel recommendations for effective adjunct THA use in different intraoperative bleeding sites and situations in neuro-spine surgeries. A comprehensive approach, encompassing a literature review, followed by experience sharing in a meeting using a survey helped integrate expert opinions in the form of practical algorithms to guide THA selection. Our survey results revealed a strong inclination towards specific THAs, flowable gelatin + thrombin being choice of THA for difficult to access and problematic bleeding situations during tumor removal/resection, transsphenoidal hypophysectomy and skull-based procedures. Both oxidized regenerated cellulose (ORC)/Fibrillar and flowable gelatin + thrombin were recommended for continuous oozing. ORC/Fibrillar was preferred for arteriovenous and cavernous malformations. This expert-panel guidance on THA use aims to optimize hemostat use practices and improve surgical outcomes in neuro-spine surgery.
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Affiliation(s)
- C E Deopujari
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - S Ambekar
- Department of Neurosurgery, Jaslok Hospital, Mumbai, India
| | - B R Yetukuri
- Department of Neurosurgery and Spine Surgery, Yashoda Hospitals, Hyderabad, India
| | - B Diyora
- Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - A Ghosh
- Department of Neurosurgery, Institute of Neurosciences Kolkata, Kolkata, India
| | - P Krishnan
- Department of Neurosurgery, National Neurosciences Centre Calcutta, Kolkata, India
| | - M Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Hyderabad, India
| | - R Ranjan
- Department of Neurosurgery, Aditya Birla Memorial Hospital, Pune, India
| | - C Raman
- Department of Neurosurgery, Nobel Hospital, Pune, India
| | - S Tyagi
- Department of Neurosurgery, Indraprastha Apollo Hospital, New Delhi, India
| | - S Vaishya
- Department of Neurosurgery, Fortis Memorial Research Institute, Gurugram, India
| | - N Venkataramana
- Department of Neurosurgery, Brains Hospital, Bengaluru, India
| | - V D Sinha
- Department of Neurosurgery, Santokba Durlabhji Memorial Hospital, Jaipur, India
| | - D Paniker
- Department of Neurosurgery, Aster Medcity, Kochi, India
| | - S Das
- Johnson and Johnson Private Limited, Mumbai, India.
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Kachapila M, Oppong R, Ademuyiwa AO, Bhangu A, Dauda R, Ghosh DN, Kamarajah SK, Lawani I, Medina ARDL, Monahan M, Morton DG, Omar O, Picciochi M, Tabiri S, Roberts TE, Brocklehurst P, Chakrabortee S, Glasbey J, Hardy P, Harrison E, Lillywhite R, Magill L, Nepogodiev D, Simoes J, Smith D, Kadir B, Pinkney T, Brant F, Li E, Runigamugabo E, Bahrami-Hessari M, Bywater E, Martinez L, Habumuremyi S, Ntirenganya F, Williams E, Fourtounas M, Melic BKC, Ghosh DN, Suroy A, Ahogni D, Ahounou A, Boukari KA, Gbehade O, Hessou TK, Nindopa S, Nontonwanou MB, Guessou NO, Sambo A, Tchati SV, Tchogo A, Tobome SR, Yanto P, Gandaho I, Hadonou A, Hinvo S, Hodonou MA, Tamou SB, Lawani S, Dossou FM, Gaou A, Goudou R, Kouroumta MC, Lawani I, Malade E, Dikao ASM, Nsilu JN, Ogouyemi P, Akpla M, Mitima NB, Kovohouande B, Loupeda SL, Agbangla MV, Hedefoun SE, Mavoha T, Ngaguene J, Rugendabanga J, Soton RR, Totin M, Agbadebo M, Dewamon H, Akpo I, Djeto M, Hada A, Hollo M, Houndji A, Houndote A, Hounsa S, Kpatchassou E, Yome H, Alidou MM, Bara EJ, Yovo BBD, Guinnou R, Hamadou S, Kola H, Moussa N, Cakpo B, Etchisse L, Hatangimana E, Muhindo M, Sanni K, Yevide AB, Agossou H, Musengo FB, Behanzin H, Seto DM, Alia BA, Alitonou A, Mehounou Y, Agbanda L, Attinon J, Hounsou NR, Gbassi M, Adagrah A, Alhassan BBA, Amoako-Boateng MP, Appiah AB, Asante-Asamani A, Boakye B, Debrah SA, Ganiyu RA, Enti D, Koggoh P, Kpankpari R, Opandoh INM, Manu MA, Manu MPO, Mensah S, Morna MT, Nortey M, Nkrumah J, Ofori EO, Quartson EM, Acquah AO, Adam-Zakariah LI, Asabre E, Boateng RA, Koomson B, Kusiwaa A, Twerefour EY, Ankomah J, Assah-Adjei F, Boakye AA, Fosu G, Serbeh G, Gyan KY, Nyarko IO, Robertson Z, Acheampong DO, Acquaye J, Adinku M, Agbedinu K, Agbeko AE, Amankwa EG, Amoah M, Amoah G, Appiah J, Arthur J, Ayim A, Ayodeji EK, Boakye-Yiadom J, Boateng EA, Dally C, Davor A, Gyasi-Sarpong CK, Hamidu NNN, Haruna I, Kwarley N, Lovi AK, Nimako B, Nyadu BB, Opoku D, Osabutey A, Sagoe R, Tuffour S, Tufour Y, Yamoah FA, Yefieye AC, Yorke J, Addo KG, Akosa EA, Boakye P, Coompson CL, Gyamfi B, Kontor BE, Kyeremeh C, Manu R, Mensah E, Solae FI, Toffah GK, Adu-Brobbey R, Coompson CL, Labaran AH, Owusu JA, Adobea V, Bennin A, Dankwah F, Doe S, Kantanka RS, Kobby E, Larnyor H, Owusu PY, Sie-Broni CA, Zume M, Abantanga FA, Abdulai DR, Acquah DK, Ayingayure E, Osman I, Kunfah S, Limann G, Mohammed SA, Mohammed S, Musah Y, Ofori B, Owusu EA, Saba AH, Seidu AS, Yakubu M, Yenli EMTA, Bhatti K, Dhiman J, Dhir K, Hans M, Haque PD, Jesudason EDM, Madankumar L, Mittal R, Nagomy I, Prasad S, Dasari A, Jacob P, Kurien E, Mathew A, Prakash D, Susan A, Varghese R, Ortiz RC, Gonzalez GH, Krauss RH, Miguelena LH, Romero MH, Gomez IB, Aguirre CC, Avendaño AC, Sansores LD, Mejia HO, Campo LUGD, Sánchez ID, Vazquez DG, Lara MM, Maldonado LMP, Fuente ANSDL, Medina ARDL, Adeleye V, Adeniyi O, Akinajo O, Akinboyewa D, Alasi I, Alakaloko F, Atoyebi O, Balogun O, Belie O, Bode C, Ekwesianya A, Elebute O, Ezenwankwo F, Fatuga A, Ihediwa G, Jimoh A, Kuku J, Ladipo-Ajayi O, Makanjuola A, Mokwenyei O, Nwokocha S, Ogein O, Ojewola R, Oladimeji A, Olajide T, Oluseye O, Seyi-Olajide J, Soibi-Harry A, Ugwu A, Williams E, Abdur-Rahman L, Adeleke N, Adesola M, Afolabi R, Agodirin S, Aremu I, Bello J, Lawal S, Lawal A, Raji H, Sayomi O, Shittu A, Acquah R, Banka C, Esssien D, Hussey R, Mustapha Y, Nunoo-Ghartey K, Yeboah G, Aniakwo LA, Adjei MNM, Adofo-Asamoah Y, Agyapong MM, Agyen T, Alhassan BAB, Amoako-Boateng MP, Appiah AB, Ashong J, Awindaogo JK, Brimpong BB, Dayie MSCJK, Enti D, Ghansah WW, Gyamfi JE, Koggoh P, Kpankpari R, Kudoh V, Mensah P, Opandoh INM, Morna MT, Nortey M, Odame E, Ofori EO, Quaicoo S, Quartson EM, Teye-Topey C, Yigah M, Yussif S, Adjei-Acquah E, Agyekum-Gyimah VO, Agyemang E, AkotoAmpaw A, Amponsah-Manu F, Arkorful TE, Dokurugu MA, Essel N, Ijeoma A, Obiri EL, Ofosu-Akromah R, Quarchey KND, Adam-Zakariah L, Andoh AB, Asabre E, Boateng RA, Koomson B, Kusiwaa A, Naah A, Oppon-Acquah A, Oppong BA, Agbowada EA, Akosua A, Armah R, Asare C, Awere-Kyere LKB, Bruce-Adjei A, Christian NA, Gakpetor DA, Kennedy KK, Mends-Odro J, Obbeng A, Ofosuhene D, Osei-Poku D, Robertson Z, Ciociano MCJMC, Valle CJZFD, Aziz HIAG, Calvillo MDCG, Iriarte DGIM, Namur LDCM, Medina ARDL, Mustapha BKLA, Utumatwishima AMJN, Abdul-Aziz IIA, Anasara GAG, Ogudi DKD, Quansah JIK, Kumar NAU, Mehraj IMA, Nayak SMP, Díaz KVA, Herrera VJA, Camacho FJB, Pérez IVB, Llamas MAC, Cardona GAC, Andrade LRC, Flores AOC, Torres EJC, Valadez TAC, Valadez AEC, Cardoza JAF, González LAG, Bojorquez JLG, Ponce FYG, Ramírez CSG, Barba JAG, Ramírez BGG, Ruvalcaba MJG, Alva DAH, Camargo SAI, Peña JCI, Pérez ZML, Tellez MPM, Ackerman RCM, Vallejo LRP, Bocanegra VHP, Navarro JVP, Posada FJP, Hernández MAQ, Gonzalez LRR, Elizalde EAR, Ascencio EVR, Velasco CBR, Martínez JAS, Pulido JIS, García AGS, Carreón LOS, Ávila JJT, Gastelum JOV, Ramirez MLV, Casas MFZ, Mata JAA, Vanegas MAC, Arias RGC, Barajas BVE, Angeles LOM, Lomeli AFM, Navarro JEO, Baolboa LGP, Dominguez ACG, Morales JFM, Pesquera JAA, Maldonado LMP, Fonseca RKC, Hernandez EEL, Ramirez JAR, Moscoso MRB, Duniya SAN, Adeleye GTC, Bakare TIB, Ohemu AA, Habumuremyi DUS, Seneza GNC, Haragirimana JDD, Ingabire AJC, Ekwunife OH, Acheampong DO, Agbeko AE, Gyamfi FE, Nyadu BB, Adu-Aryee NA, Amoako JK, Aperkor NT, Asman WK, Attepor GS, Bediako-Bowan AA, Brown GD, Etwire VK, Fenu BS, Kumassah PK, Larbi-Siaw LA, Olatola DO, Tsatsu SE, Barimah CG, Boateng GC, Kwabena PW, Kwarteng SM, Luri PT, Kantanka RS, Owusu PY, Acquah DK, Adams SM, Alhassan MS, Asirifi SA, Dery MK, Ofori BA, Sam NB, Seidu AS, Acquah EK, Coompson CL, Gyambibi AK, Kontor BE, Poonia DR, Rathod KK, Rodha MS, Soni SC, Varsheney VK, Vishnoi JR, Garnaik DK, Lokavarapu MJ, Seenivasagam RK, Kalyanapu JA, Gautham AK, Singh DS, Abraham ES, Gold CS, Joseph JN, Kurien EN, Mathew AJ, Mathew AE, Prakash DD, Hans MA, Haque PD, Sam VD, Thind RS, Veetil SK, Daniel ER, Jacob SE, Jesudason MR, Samuel VM, Sivakumar MV, Saluja SS, Attri AK, Pai MV, Prabhu PS, T SP, Alexander PV, Ismavel VA, Solomi CV, Alpheus RA, Choudhrie AV, Gunny RJ, Malik MA, Peters NJ, Chowdri NA, Dar RA, Parray FQ, Shah ZA, Wani RA, Villaseñor SA, Hernández AB, Ahumada EB, Cardiel GC, Guevara GC, Perez EC, Martinez EC, Barradas PD, Estrada IE, Becerril PF, Orozco CF, Reyna BG, Sánchez EG, Espinoza EG, Ojeda AG, Torres MI, Tornero JJ, País RM, Santana DM, Villela GM, Hinojosa RN, Escobar CN, Rodríguez IO, Flores OO, Barreiro AO, Rubio JO, Bravo CR, Villaseñor GS, Tinajero CC, Samano FD, Banuelos GG, Ortiz FI, Ramirez ML, Arroyo GL, Perez JO, Ramirez DO, Lozano JP, Reyes GY, Castillo MN, Mellado DH, Bozada-Gutierrez K, Casado-Zarate AF, Delano-Alonso R, Herrera-Esquivel J, Moreno-Portillo M, Trejo-Avila M, Quiros BC, Ambriz-González G, Cabrera-Lozano I, Calderón-Alvarado AB, León-Frutos FJ, Villanueva-Martínez EE, Aliyu MS, Balogun AO, Francis AA, Duromola KM, Gana SG, George MD, Iji LO, Jimoh AO, Koledade AK, Lawal AT, Nwabuoku SE, Ogunsua OO, Okafor IF, Okorie EI, Saidu IA, Sholadoye TT, Abdulkarim AA, Abdullahi LB, Tolani MA, Tukur AM, Umar AS, Umar AM, Yusuf SA, Ado KA, Aliyu NU, Anyanwu LJC, Daneji SM, Magashi MK, Mohammad MA, Muhammad AB, Muhammad SS, Muideen BA, Nwachukwu CU, Sallau SB, Sheshe AA, Takai IU, Umar GI, Adze JA, Airede LR, Bature SB, Galadima MC, Hamza BK, Kache SA, Kagomi WY, Kene IA, Makama JG, Mohammed-Durosinlorun AA, Taingson MC, Odunafolabi TA, Okereke CE, Oladele OO, Olaleye OH, Olubayo OO, Abiola OP, Abiyere HO, Adebara IO, Adeniyi AA, Adewara OE, Adeyemo OT, Adeyeye AA, Ariyibi AL, Awoyinka BS, Ayankunle OM, Babalola OF, Banjo OO, Egharevba PA, Fatudimu OS, Obateru JA, Odesanya OJ, Ojo OD, Okunlola AI, Okunlola CK, Olajide AT, Orewole TO, Salawu AI, Abdulsalam MA, Adelaja AT, Ajai OT, Atobatele KM, Bakare OO, Faboya OM, Imam ZO, Nwaenyi FC, Ogunyemi AA, Oludara MA, Omisanjo OA, Onyeka CU, Oshodi OA, Oshodi YA, Salami OS, Williams OM, Adeyeye VI, Agbulu MV, Akinajo OR, Akinboyewa DO, Alakaloko FM, Alasi IO, Atoyebi OA, Balogun OS, Bode CO, Busari MO, Duru NJ, Edet GB, Elebute OA, Ezenwankwo FC, Fatuga AL, Ihediwa GC, Inyang ES, Jimoh AI, Kuku JO, Ladipo-Ajayi OA, Lawal AO, Makwe CC, Mgbemena CV, Nwokocha SU, Ogunjimi MA, Ohazurike EO, Ojewola RW, Badedale ME, Okeke CJ, Okunowo AA, Oladimeji AT, Olajide TO, Oluseye OO, Orowale AA, Osinowo AO, Oyegbola CB, Seyi-Olajide JO, Soibi-Harry AP, Timo MT, Ugwu AO, Williams EO, Duruewuru IO, Egwuonwu OA, Emeka JJ, Modekwe VI, Nwosu CD, Obiechina SO, Obiesie AE, Okafor CI, Okonoboh TO, Okoye OA, Onu OA, Onyejiaka CC, Uche CF, Ugboajah JO, Ugwu JO, Adeleke AA, Adepiti AC, Aderounmu AA, Adesunkanmi AO, Adisa AO, Ajekwu SC, Ajenifuja OK, Alatise OI, Badmus TA, Mohammed TO, Salako AA, Sowande OA, Talabi AO, Wuraola FO, Adegoke PA, Eseile IS, Ogundoyin OO, Olulana DI, Adumah CC, Ajagbe AO, Akintunde OP, Asafa OQ, Eziyi AK, Fasanu AO, Ojewuyi OO, Ojewuyi AR, Oyedele AE, Taiwo OA, Abdullahi HI, Adewole ND, Agida TE, Ailunia EE, Akaba GO, Bawa KG, Chinda JY, Daluk EB, Eniola SB, Ezenwa AO, Garba SE, Mshelbwala PM, Ndukwe NO, Ogolekwu IP, Osagie OO, Sani SA, Tabuanu NO, Umar AM, Agbonrofo PI, Arekhandia AI, Edena ME, Eghonghon RA, Enaholo JE, Ideh SN, Iribhogbe OI, Irowa OO, Isikhuemen ME, Odutola OR, Okoduwa KO, Omorogbe SO, Osagie OT, Abdus-Salam RA, Adebayo SA, Ajagbe OA, Ajao AE, Ayandipo OO, Egbuchulem KI, Ekwuazi HO, Idowu OC, Irabor DO, Lawal TA, Lawal OO, Ogundoyin OO, Sanusi AT, Takure AO, Abdur-Rahman LO, Adebisi MO, Adeleke NA, Afolabi RT, Aremu II, Bello JO, Lawal SA, Raji HO, Igwe PO, Iweha IE, John RE, Okoro PE, Oriji VK, Oweredaba IT, Majyabere JP, Habiyakare JA, Nabada MG, Masengesho JP, Niyomuremyi JP, Uwimana JC, Maniraguha HL, Urimubabo CJ, Shyirakera JY, Adams MA, Ede CJ, Mathe MN, Nhlabathi NA, Nxumalo HS, Sethoana ME, Acquaye J, Appiah J, Arthur J, Boakye-Yiadom J, Abdulai S, Agboadoh N, Akoto E, Boakye-Yiadom K, Dedey F, Nsaful J, Wordui T, Abubakari F, Akunyam J, Ballu C, Ngaaso K, Adobea V, Bennin A, Doe S, Kobby E, Kyeremeh C, Osei E, Owusu F, Sie-Broni C, Zume M, Abdul-Hafiz S, Amadu M, Awe M, Azanlerigu M, Edwin Y, Limann G, Maalekuu A, Malechi H, Mohammed S, Mohammed I, Mumuni K, Yahaya S, Alhassan J, Boakye P, Jeffery-Felix A, Manu R, Mensah E, Naah G, Noufuentes C, Sakyi A, Chaudhary R, Misra S, Pareek P, Pathak M, Sharma N, Sharma N, Huda F, Mishra N, Ranjan R, Singh S, Solanki P, Verma R, Yhoshu E, John S, Kutma A, Philips S, Hepzibah A, Mary G, Chetana C, Dasari A, Dummala P, Jacob J, Mary P, Samuel O, Sukumar A, Syam N, Varghese R, Bhatt A, Bhatti W, Dhar T, Goyal A, Goyal S, Jain D, Jain R, Kaur S, Kumar K, Luther A, Mahajan A, Mandrelle K, Michael V, Mukherjee P, Rajappa R, Singh P, Suroy A, Williams R, D S, Kumari P, Mittal R, Prasad S, Shankar B, Sharma S, Surendran S, Thomas A, Trinity P, Kanchodu S, Leshiini K, Bansal I, Gupta S, Gureh M, Kapoor S, Aggarwal M, Kanna V, Kaur H, Kumar A, Singh S, Singh G, John V, Adnan M, Kumar P, S A, Sehrawat V, Singla D, Thami G, Kumar V, Mathew S, Akhtar N, Chaturvedi A, Gupta S, Kumar V, Prakash P, Rajan S, Singh M, Tripathi A, Thomas J, Zechariah P, Kichu M, Joseph S, Pundir N, Samujh R, Kour R, Saqib N, Raul S, Rautela K, Sharma R, Singh N, Vakil R, Chowdhury P, Chowdhury S, Roy B, Abdullahi A, Abubakar M, Awaisu M, Bakari F, Bashir M, Bello A, Daniyan M, Gimba J, Gundu I, Oyelowo N, Sufyan I, Umaru-Sule H, Usman M, Yahya A, Yakubu A, Abdullahi M, Soladoye A, Yahaya A, Abdulrasheed L, Aminu B, Bello-Tukur F, Chinyio D, Joshua S, Lawal J, Mohammed C, Nuwam D, Sale D, Sani A, Tabara S, Usam E, Yakubu J, Adegoke F, Ige O, Bakare A, Akande O, Anyanwu N, Eke G, Oyewole Y, Abunimye E, Adeoluwa A, Adesiyakan A, Amao M, Ashley-Osuzoka C, Gbenga-Oke C, Makanjuola A, Olanrewaju O, Olayioye O, Olutola S, Onyekachi K, Osariemen E, Osunwusi B, Owie E, Okoro C, Ugwuanyi K, Ugwunne C, Olasehinde O, Akinloye A, Akinniyi A, Ejimogu J, Okedare A, Omotola O, Sanwo F, Awodele K, Aisuodionoe-Shadrach O, Alfred J, Atim T, Mbajiekwe N, Olori A, Suleiman S, Sunday H, Ida G, Oruade D, Osemwegie O, Ajibola G, Elemile P, Fakoya A, Ojediran O, Olagunju N, Bello R, Lawal A, Ojajuni A, Oyewale S, Sayomi O, Shittu A, Abhulimen V, Okoi N, Mizero J, Mutimamwiza I, Nirere F, Niyongombwa I, Byaruhanga A, Dukuzimana R, Uwizeye M, Ruhosha M, Igiraneza J, Ingabire F, Karekezi A, Mpirimbanyi C, Mukamazera L, Mukangabo C, Imanishimwe A, Kanyarukiko S, Mukaneza F, Mukantibaziyaremye D, Munyaneza A, Ndegamiye G, Nyirangeri P, Tubasiime R, Dusabe M, Izabiriza E, Mpirimbanyi C, Mutuyimana J, Mwenedata O, Rwagahirima E, Zirikana J, Sibomana I, Rubanguka D, Umuhoza J, Uwayezu R, Uzikwambara L, Dieudonne A, Kabanda E, Mbonimpaye S, Mukakomite C, Muroruhirwe P, Butana H, Dusabeyezu M, Batangana M, Bucyibaruta G, Habumuremyi S, Imanishimwe A, Mukanyange V, Munyaneza E, Mutabazi E, Mwungura E, Ncogoza I, Ntirenganya F, Nyirahabimana J, Nyirasebura D, Dusabimana A, Kanyesigye S, Munyaneza R, Fourtounas M, Hyman G, Moore R, Sentholang N, Wondoh P, Ally Z, Domingo A, Munda P, Nyatsambo C, Ojo V, Pswarayi R, Cook J, Jayne D, Laurberg S, Brown J, Smart N, Cousens S. Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a model-based cost-effectiveness analysis of a pragmatic, cluster-randomised trial in seven low-income and middle-income countries. Lancet Glob Health 2024; 12:e235-e242. [PMID: 38245114 DOI: 10.1016/s2214-109x(23)00538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 10/17/2023] [Accepted: 11/07/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Surgical site infection (SSI) is a major burden on patients and health systems. This study assessed the cost-effectiveness of routine change of sterile gloves and instruments before abdominal wall closure to prevent SSI. METHODS A decision-analytic model was built to estimate average costs and outcomes of changing gloves and instruments before abdominal wall closure compared with current practice. Clinical data were obtained from the ChEETAh trial, a multicentre, cluster-randomised trial in seven low-income and middle-income countries (LMICs), and costs were obtained from a study (KIWI) that assessed costs associated with SSIs in LMICs. Outcomes were measured as the percentage of surgeries resulting in SSIs. Costs were measured from a health-care provider perspective and were reported in 2021 US$. The economic analysis used a partially split single-country costing approach, with pooled outcomes data from all seven countries in the ChEETAh trial, and data for resource use and unit costs from India (KIWI); secondary analyses used resource use and costs from Mexico and Ghana (KIWI). FINDINGS In the base case, the average cost of the intervention was $259∙92 compared with $261∙10 for current practice (cost difference -$1∙18, 95% CI -4∙08 to 1∙33). In the intervention group, an estimated 17∙6% of patients had an SSI compared with 19∙7% of patients in the current practice group (absolute risk reduction 2∙10%, 95% CI 2∙07-2∙84). At all cost-effectiveness thresholds assumed ($0 to $14 000), the intervention had a higher likelihood of being cost-effective compared with current practice, indicating that the intervention was cost-effective. Similar results were obtained when the analysis using data from India was repeated using resource use and unit cost data from Mexico and Ghana. INTERPRETATION Routine sterile glove and instrument change before abdominal wall closure is effective and the costs are similar to those for current practice. Routine change of gloves and instruments before abdominal wall closure should be rolled out in LMICs. FUNDING National Institute for Health and Care Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, and Mölnlycke Healthcare.
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Ranjan R, Sharma K, Kumar M, Swain DK, Singh SP, Kharche SD, Singh MK, Chauhan MS. IGF-1 stabilizes goat sperm mitochondrial transmembrane potential and reduces dna fragmentation. Cryo Letters 2023; 44:327-332. [PMID: 38311926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
BACKGROUND Antioxidant present in sperm cells protects them from oxidative damage. However, sperm are more susceptible to peroxidative damages due to the loss of these enzymes during cryopreservation and their survival and fertility may be compromised. Insulin like growth factor-1 (IGF-1) has an antioxidant effect and could maintain sperm motility. OBJECTIVE To improve seminal parameters, mitochondrial membrane potential (MMP), oxidative status and DNA integrity of buck semen after freeze-thawing by fortification of goat semen diluent with various concentrations of IGF-1. MATERIALS AND METHODS Fifty ejaculates were collected and were extended with tris- citric acid- fructose diluent with 10% egg yolk and 6% glycerol with sperm concentrations of 1×108 mL-1. Post-cryopreserved sperm were assessed for motility and a range of other functional parameters. RESULTS In post-thaw semen sperm motility, live sperm count, acrosome integrity, hypo-osmotic swelling positive spermatozoa, malondialdehyde (MDA), protein carbonyl content (PCC), TUNEL positive sperm differed significantly (P<0.05) with the various concentrations of IGF-1 used. Sperm functional parameters post-thawing were significantly (P<0.05) better in 250 ng/mL IGF-1. IGF-1 protects against lipid peroxidation by lowering MDA and PCC production, thus reducing the harmful effect of reactive oxygen species. The kidding percentage using the artificial insemination technique was significantly higher ( i.e., 40%) in the group supplemented with 250 ng/mL of IGF-1 than in the non-supplemented group (i.e., 30%). CONCLUSION IGF-1 may be used to improve post-thaw semen quality and fertility as measured by actual kidding rate. Doi.org/10.54680/fr23610110312.
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Affiliation(s)
- R Ranjan
- Indian Council of Agricultural Research (ICAR), Central Institute for Research on Goats, Makhdoom, Farah, Mathura, Uttar Pradesh (U.P.), India.
| | - K Sharma
- Indian Council of Agricultural Research (ICAR), Central Institute for Research on Goats, Makhdoom, Farah, Mathura, Uttar Pradesh (U.P.), India
| | - M Kumar
- Indian Council of Agricultural Research (ICAR), Central Institute for Research on Goats, Makhdoom, Farah, Mathura, Uttar Pradesh (U.P.), India
| | - D K Swain
- Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidyalaya Evam Go-Anusandhan Sansthan (DUVASU), Mathura, U.P. India
| | - S P Singh
- Indian Council of Agricultural Research (ICAR), Central Institute for Research on Goats, Makhdoom, Farah, Mathura, Uttar Pradesh (U.P.), India
| | - S D Kharche
- Indian Council of Agricultural Research (ICAR), Central Institute for Research on Goats, Makhdoom, Farah, Mathura, Uttar Pradesh (U.P.), India
| | - M K Singh
- Indian Council of Agricultural Research (ICAR), Central Institute for Research on Goats, Makhdoom, Farah, Mathura, Uttar Pradesh (U.P.), India
| | - M S Chauhan
- ICAR-National Dairy Research Institute, Karnal, Haryana, India
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Ranjan R, Nath S, Jha S, Narasimha VL. Single parent adoption in India: Mental health and legal perspectives and the way forward. J Postgrad Med 2023; 69:215-220. [PMID: 37357486 PMCID: PMC10846805 DOI: 10.4103/jpgm.jpgm_718_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/08/2023] [Accepted: 02/01/2023] [Indexed: 06/27/2023] Open
Abstract
Single parent adoption (SPA) is a relatively new construct worldwide and in India. The Ministry of Women and Child Development, Government of India, has laid down criteria for adoption in general and SPA in particular, in conjunction with the Juvenile Justice Act (Care and Protection of Children), 2015. There is scant literature on this topic of SPA, more so in India, that looks into the various psychological nuances of SPA from a mental health professional's (MHP) perspective. This review paper aims to assess SPA from the perspective of a MHP that will focus on its various legal nuances as well as the psychological connotations attached to it. For this, a search strategy was employed that included a thorough literature search from two databases (PubMed and Google Scholar) with relevant keywords related to the topic. The various legal issues pertaining to SPA in the current scenario, the psychological issues and challenges faced by single parents, the behavioral outcomes of adoptees who are adopted by single parents, and ways to deal with the various obstacles of SPA are discussed.
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Affiliation(s)
- R Ranjan
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - S Nath
- Department of Psychiatry, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - S Jha
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - VL Narasimha
- Department of Psychiatry, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
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Goyal S, Verma S, Ranjan R, Goyal R. 16 Horner Syndrome: Can it be Familial? Case series in a family and review of literature. BMJ Open Ophthalmol 2023; 8:A6. [PMID: 37797987 DOI: 10.1136/bmjophth-2023-biposa.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Ophthalmic literature reveals vague and rare references to Horner syndrome on a hereditary basis. We present a case series of mother and son with Horner syndrome, which was confirmed pharmacologically. They noticed symptoms on the same side at a similar age and no serious pathology was found.Retrospective case review of notes:Case 1: An 11-year-old male presented with 6 week history of anisocoria, mild right ptosis, no heterochromia and no history of trauma or previous surgeries. The anisocoria was more noticeable in the dark, Horner syndrome was confirmed with apraclonidine test.Case 2: Mother of case 1, 50-year-old female diagnosed with right Horner syndrome at the age of 14 in Austria. The presenting features were anisocoria, a lack of sweating on the right side of her face. Diagnosis was reconfirmed pharmacologically.Case 1 was referred to paediatrics for a systemic examination which was normal. He was investigated with urinary catecholamines, MRI head and CT neck and thorax which were all normal. Case 2 was investigated in the past with a normal CT head.Horner syndrome results in the interruption of the oculo-sympathetic pathway and can indicate serious pathology in the head, chest or neck. Our cases demonstrate that familial presentation could indicate an idiopathic aetiology as it is unlikely to have pathological Horner syndrome in two first degree relatives.Our case series highlights the importance of eliciting a family history of Horner syndrome and examining the family members. Positive family history can reassure patients while awaiting results of investigations.
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Affiliation(s)
- S Goyal
- Royal Glamorgan Hospital, UK
| | - S Verma
- Royal Glamorgan Hospital, UK
| | | | - R Goyal
- Royal Glamorgan Hospital, UK
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Kumar R, Chatterjee M, Ranjan R. Black Grain Mycetoma by a Hyaline Fungus: It is Possible? Indian J Dermatol 2023; 68:464-467. [PMID: 37822405 PMCID: PMC10564221 DOI: 10.4103/ijd.ijd_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Affiliation(s)
- Richa Kumar
- From the Department of Dermatology, Command Hospital, Eastern Command, Kolkata, West Bengal, India
| | | | - R Ranjan
- Department of Pathology, Command Hospital, Eastern Command, Kolkata, West Bengal, India
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Ahogni D, Ahounou A, Boukari KA, Gbehade O, Hessou TK, Nindopa S, Nontonwanou MJB, Guessou NO, Sambo A, Tchati SV, Tchogo A, Tobome SR, Yanto P, Gandaho I, Hadonou A, Hinvo S, Hodonou MA, Tamou SB, Lawani S, Kandokponou CMB, Dossou FM, Gaou A, Goudou R, Kouroumta MC, Lawani I, Malade E, Dikao ASM, Nsilu JN, Ogouyemi P, Akpla M, Mitima NB, Kovohouande B, Kpangon C, Loupeda SL, Agbangla MV, Hedefoun SE, Mavoha T, Ngaguene J, Rugendabanga J, Soton RR, Totin M, Agbadebo M, Akpo I, Dewamon H, Djeto M, Hada A, Hollo M, Houndji A, Houndote A, Hounsa S, Kpatchassou E, Yome H, Alidou MM, Bara EJ, Yovo BTBD, Guinnou R, Hamadou S, Kola HP, Moussa N, Cakpo B, Etchisse L, Hatangimana E, Muhindo M, Sanni K, Yevide AB, Agossou H, Musengo FB, Behanzin H, Seto DM, Alia BA, Alitonou A, Mehounou YE, Agbanda L, Attinon J, Gbassi M, Hounsou NR, Acquah R, Banka C, Esssien D, Hussey R, Mustapha Y, Nunoo-Ghartey K, Yeboah G, Aniakwo LA, Adjei MNM, Adofo-Asamoah Y, Agyapong MM, Agyen T, Alhassan BAB, Amoako-Boateng MP, Appiah AB, Ashong J, Awindaogo JK, Brimpong BB, Dayie MSCJK, Enti D, Ghansah WW, Gyamfi JE, Koggoh P, Kpankpari R, Kudoh V, Mensah S, Mensah P, Morkor Opandoh IN, Morna MT, Nortey M, Odame E, Ofori EO, Quaicoo S, Quartson EM, Teye-Topey C, Yigah M, Yussif S, Adjei-Acquah E, Agyekum-Gyimah VO, Agyemang E, Akoto-Ampaw A, Amponsah-Manu F, Arkorful TE, Dokurugu MA, Essel N, Ijeoma A, Obiri EL, Ofosu-Akromah R, Quarchey KND, Adam-Zakariah L, Andoh AB, Asabre E, Boateng RA, Koomson B, Kusiwaa A, Naah A, Oppon-Acquah A, Oppong BA, Agbowada EA, Akosua A, Armah R, Asare C, Awere-Kyere LKB, Bruce-Adjei A, Christian NA, Gakpetor DA, Kennedy KK, Mends-Odro J, Obbeng A, Ofosuhene D, Osei-Poku D, Robertson Z, Acheampong DO, Acquaye J, Appiah J, Arthur J, Boakye-Yiadom J, Agbeko AE, Gyamfi FE, Nyadu BB, Abdulai S, Adu-Aryee NA, Agboadoh N, Akoto E, Amoako JK, Aperkor NT, Asman WK, Attepor GS, Bediako-Bowan AA, Boakye-Yiadom K, Brown GD, Dedey F, Etwire VK, Fenu BS, Kumassah PK, Larbi-Siaw LA, Nsaful J, Olatola DO, Tsatsu SE, Wordui T, Abdul-Aziz IIA, Abubakari F, Akunyam J, Anasara GAG, Ballu C, Barimah CG, Boateng GC, Kwabena PW, Kwarteng SM, Luri PT, Ngaaso K, Ogudi DKD, Adobea V, Bennin A, Doe S, Kantanka RS, Kobby E, Kyeremeh C, Osei E, Owusu PY, Owusu F, Sie-Broni C, Zume M, Abdul-Hafiz S, Acquah DK, Adams SM, Alhassan MS, Amadu M, Asirifi SA, Awe M, Azanlerigu M, Dery MK, Edwin Y, Francis AA, Limann G, Maalekuu A, Malechi H, Mohammed S, Mohammed I, Mumuni K, Ofori BA, Quansah JIK, Seidu AS, Tabiri S, Yahaya S, Acquah EK, Alhassan J, Boakye P, Coompson CL, Gyambibi AK, Jeffery-Felix A, Kontor BE, Manu R, Mensah E, Naah G, Noufuentes C, Sakyi A, Chaudhary R, Misra S, Pareek P, Pathak M, Poonia DR, Rathod KK, Rodha MS, Sharma N, Sharma N, Soni SC, Varsheney VK, Vishnoi JR, Garnaik DK, Huda F, Lokavarapu MJ, Mishra N, Ranjan R, Seenivasagam RK, Singh S, Solanki P, Verma R, Yhoshu E, John S, Kalyanapu JA, Kutma A, Philips S, Gautham AK, Hepzibah A, Mary G, Singh DS, Abraham ES, Chetana C, Dasari A, Dummala P, Gold CS, Jacob J, Joseph JN, Kurien EN, Mary P, Mathew AJ, Mathew AE, Prakash DD, Samuel O, Sukumar A, Syam N, Varghese R, Bhatt A, Bhatti W, Dhar T, Ghosh DN, Goyal A, Goyal S, Hans MA, Haque PD, Jain D, Jain R, Jyoti J, Kaur S, Kumar K, Luther A, Mahajan A, Mandrelle K, Michael V, Mukherjee P, Rajappa R, Sam VD, Singh P, Suroy A, Thind RS, Veetil SK, Williams R, Sreekar D, Daniel ER, Jacob SE, Jesudason MR, Kumari P, Mittal R, Prasad S, Samuel VM, Shankar B, Sharma S, Sivakumar MV, Surendran S, Thomas A, Trinity P, Kanchodu S, Leshiini K, Saluja SS, Attri AK, Bansal I, Gupta S, Gureh M, Kapoor S, Aggarwal M, Kanna V, Kaur H, Kumar A, Singh S, Singh G, John V, Adnan M, Agrawal N, Kumar U, Kumar P, Abhishek S, Sehrawat V, Singla D, Thami G, Kumar V, Mathew S, Pai MV, Prabhu PS, Sundeep PT, Akhtar N, Chaturvedi A, Gupta S, Kumar V, Prakash P, Rajan S, Singh M, Tripathi A, Alexander PV, Thomas J, Zechariah P, Ismavel VA, Kichu M, Solomi CV, Alpheus RA, Choudhrie AV, Gunny RJ, Joseph S, Malik MA, Peters NJ, Pundir N, Samujh R, Ahmed HI, Aziz G, Chowdri NA, Dar RA, Kour R, Mantoo I, Mehraj A, Parray FQ, Saqib N, Shah ZA, Wani RA, Raul S, Rautela K, Sharma R, Singh N, Vakil R, Chowdhury P, Chowdhury S, Mathai S, Nayak P, Roy B, Alvarez Villaseñor AS, Ascencio Díaz KV, Avalos Herrera VJ, Barbosa Camacho FJ, Hernández AB, Ahumada EB, Brancaccio Pérez IV, Calderón Llamas MA, Cardiel GC, Cervantes Cardona GA, Guevara GC, Perez EC, Chávez M, Chejfec Ciociano JM, Cifuentes Andrade LR, Cortés Flores AO, Cortes Torres EJ, Cueto Valadez TA, Cueto Valadez AE, Martinez EC, Barradas PD, Estrada IE, Becerril PF, Flores Cardoza JA, Orozco CF, García González LA, Reyna BG, Sánchez EG, González Bojorquez JL, Espinoza EG, Ojeda AG, González Ponce FY, Guerrero Ramírez CS, Guzmán Barba JA, Guzmán Ramírez BG, Guzmán Ruvalcaba MJ, Hérnandez Alva DA, Ibarra Camargo SA, Ibarrola Peña JC, Torres MI, Tornero JJ, Lara Pérez ZM, País RM, Mellado Tellez MP, Miranda Ackerman RC, Santana DM, Villela GM, Hinojosa RN, Escobar CN, Rodríguez IO, Flores OO, Barreiro AO, Rubio JO, Pacheco Vallejo LR, Pérez Bocanegra VH, Pérez Navarro JV, Plascencia Posada FJ, Quirarte Hernández MA, Ramirez Gonzalez LR, Reyes Elizalde EA, Romo Ascencio EV, Bravo CR, Ruiz Velasco CB, Sánchez Martínez JA, Villaseñor GS, Sandoval Pulido JI, Serrano García AG, Suárez Carreón LO, Tijerina Ávila JJ, Vega Gastelum JO, Vicencio Ramirez ML, Zarate Casas MF, Zuloaga Fernández del Valle CJ, Mata JAA, Vanegas MAC, Arias RGC, Tinajero CC, Samano FD, Zepeda FD, Barajas BVE, Banuelos GG, Calvillo MDCG, Ortiz FI, Ramirez ML, Arroyo GL, Angeles LOM, Morales Iriarte DGI, Lomeli AFM, Navarro JEO, Perez JO, Ramirez DO, Baolboa LGP, Lozano JP, Reyes GY, Castillo MN, Dominguez ACG, Mellado DH, Morales JFM, del Carmen H Namur L, Pesquera JAA, Maldonado LMP, De la Medina AR, Bozada-Gutierrez K, Casado-Zarate AF, Delano-Alonso R, Herrera-Esquivel J, Moreno-Portillo M, Trejo-Avila M, Fonseca RKC, Hernandez EEL, Quiros BC, Ramirez JAR, Ambriz-González G, Becerra Moscoso MR, Cabrera-Lozano I, Calderón-Alvarado AB, León-Frutos FJ, Villanueva-Martínez EE, Abdullahi A, Abubakar M, Aliyu MS, Awaisu M, Bakari F, Balogun AO, Bashir M, Bello A, Daniyan M, Duromola KM, Gana SG, George MD, Gimba J, Gundu I, Iji LO, Jimoh AO, Koledade AK, Lawal AT, Lawal BK, Mustapha A, Nwabuoku SE, Ogunsua OO, Okafor IF, Okorie EI, Oyelowo N, Saidu IA, Sholadoye TT, Sufyan I, Tolani MA, Tukur AM, Umar AS, Umar AM, Umaru-Sule H, Usman M, Yahya A, Yakubu A, Yusuf SA, Abdulkarim AA, Abdullahi LB, Abdullahi M, Ado KA, Aliyu NU, Anyanwu LJC, Daneji SM, Magashi MK, Mohammad MA, Muhammad AB, Muhammad SS, Muideen BA, Nwachukwu CU, Sallau SB, Sheshe AA, Soladoye A, Takai IU, Umar GI, Yahaya A, Abdulrasheed L, Adze JA, Airede LR, Aminu B, Bature SB, Bello-Tukur F, Chinyio D, Duniya SAN, Galadima MC, Hamza BK, Joshua S, Kache SA, Kagomi WY, Kene IA, Lawal J, Makama JG, Mohammed C, Mohammed-Durosinlorun AA, Nuwam D, Sale D, Sani A, Tabara S, Taingson MC, Usam E, Yakubu J, Adegoke F, Ige O, Odunafolabi TA, Okereke CE, Oladele OO, Olaleye OH, Olubayo OO, Abiola OP, Abiyere HO, Adebara IO, Adeleye GTC, Adeniyi AA, Adewara OE, Adeyemo OT, Adeyeye AA, Ariyibi AL, Awoyinka BS, Ayankunle OM, Babalola OF, Bakare A, Bakare TIB, Banjo OO, Egharevba PA, Fatudimu OS, Obateru JA, Odesanya OJ, Ojo OD, Okunlola AI, Okunlola CK, Olajide AT, Orewole TO, Salawu AI, Abdulsalam MA, Adelaja AT, Ajai OT, Akande O, Anyanwu N, Atobatele KM, Bakare OO, Eke G, Faboya OM, Imam ZO, Nwaenyi FC, Ogunyemi AA, Oludara MA, Omisanjo OA, Onyeka CU, Oshodi OA, Oshodi YA, Oyewole Y, Salami OS, Williams OM, Abunimye E, Ademuyiwa AO, Adeoluwa A, Adesiyakan A, Adeyeye VI, Agbulu MV, Akinajo OR, Akinboyewa DO, Alakaloko FM, Alasi IO, Amao M, Ashley-Osuzoka C, Atoyebi OA, Balogun OS, Bode CO, Busari MO, Duru NJ, Edet GB, Elebute OA, Ezenwankwo FC, Fatuga AL, Gbenga-Oke C, Ihediwa GC, Inyang ES, Jimoh AI, Kuku JO, Ladipo-Ajayi OA, Lawal AO, Makanjuola A, Makwe CC, Mgbemena CV, Nwokocha SU, Ogunjimi MA, Ohazurike EO, Ojewola RW, Badedale ME, Okeke CJ, Okunowo AA, Oladimeji AT, Olajide TO, Olanrewaju O, Olayioye O, Oluseye OO, Olutola S, Onyekachi K, Orowale AA, Osariemen E, Osinowo AO, Osunwusi B, Owie E, Oyegbola CB, Seyi-Olajide JO, Soibi-Harry AP, Timo MT, Ugwu AO, Williams EO, Duruewuru IO, Egwuonwu OA, Ekwunife OH, Emeka JJ, Modekwe VI, Nwosu CD, Obiechina SO, Obiesie AE, Okafor CI, Okonoboh TO, Okoro C, Okoye OA, Onu OA, Onyejiaka CC, Uche CF, Ugboajah JO, Ugwu JO, Ugwuanyi K, Ugwunne C, Adeleke AA, Adepiti AC, Aderounmu AA, Adesunkanmi AO, Adisa AO, Ajekwu SC, Ajenifuja OK, Alatise OI, Badmus TA, Mohammed TO, Olasehinde O, Salako AA, Sowande OA, Talabi AO, Wuraola FO, Adegoke PA, Akinloye A, Akinniyi A, Ejimogu J, Eseile IS, Ogundoyin OO, Okedare A, Olulana DI, Omotola O, Sanwo F, Adumah CC, Ajagbe AO, Akintunde OP, Asafa OQ, Awodele K, Eziyi AK, Fasanu AO, Ojewuyi OO, Ojewuyi AR, Oyedele AE, Taiwo OA, Abdullahi HI, Adewole ND, Agida TE, Ailunia EE, Aisuodionoe-Shadrach O, Akaba GO, Alfred J, Atim T, Bawa KG, Chinda JY, Daluk EB, Eniola SB, Ezenwa AO, Garba SE, Mbajiekwe N, Mshelbwala PM, Ndukwe NO, Ogolekwu IP, Ohemu AA, Olori S, Osagie OO, Sani SA, Suleiman S, Sunday H, Tabuanu NO, Umar AM, Agbonrofo PI, Arekhandia AI, Edena ME, Eghonghon RA, Enaholo JE, Ida G, Ideh SN, Iribhogbe OI, Irowa OO, Isikhuemen ME, Odutola OR, Okoduwa KO, Omorogbe SO, Oruade D, Osagie OT, Osemwegie O, Abdus-Salam RA, Adebayo SA, Ajagbe OA, Ajao AE, Ajibola G, Ayandipo OO, Egbuchulem KI, Ekwuazi HO, Elemile P, Fakoya A, Idowu OC, Irabor DO, Lawal TA, Lawal OO, Ogundoyin OO, Ojediran O, Olagunju N, Sanusi AT, Takure AO, Abdur-Rahman LO, Adebisi MO, Adeleke NA, Afolabi RT, Aremu II, Bello JO, Bello R, Lawal A, Lawal SA, Ojajuni A, Oyewale S, Raji HO, Sayomi O, Shittu A, Abhulimen V, Igwe PO, Iweha IE, John RE, Okoi N, Okoro PE, Oriji VK, Oweredaba IT, Mizero J, Mutimamwiza I, Nirere F, Niyongombwa I, Majyabere JP, Byaruhanga A, Dukuzimana R, Habiyakare JA, Nabada MG, Uwizeye M, Ruhosha M, Igiraneza J, Ingabire F, Karekezi A, Masengesho JP, Mpirimbanyi C, Mukamazera L, Mukangabo C, Niyomuremyi JP, Ntwari G, Seneza C, Umuhoza D, Habumuremyi S, Imanishimwe A, Kanyarukiko S, Mukaneza F, Mukantibaziyaremye D, Munyaneza A, Ndegamiye G, Nyirangeri P, Tubasiime R, Uwimana JC, Dusabe M, Izabiriza E, Maniraguha HL, Mpirimbanyi C, Mutuyimana J, Mwenedata O, Rwagahirima E, Zirikana J, Sibomana I, Rubanguka D, Umuhoza J, Uwayezu R, Uzikwambara L, Hirwa AD, Kabanda E, Mbonimpaye S, Mukakomite C, Muroruhirwe P, Butana H, Dusabeyezu M, Mukasine A, Utumatwishima JN, Batangana M, Bucyibaruta G, Habumuremyi S, de Dieu Haragirimana J, Imanishimwe A, Ingabire AJC, Mukanyange V, Munyaneza E, Mutabazi E, Mwungura E, Ncogoza I, Ntirenganya F, Nyirahabimana J, Nyirasebura D, Urimubabo CJ, Dusabimana A, Kanyesigye S, Munyaneza R, Shyirakera JY, Fourtounas M, Adams MA, Ede CJ, Hyman G, Mathe MN, Moore R, Nhlabathi NA, Nxumalo HS, Sentholang N, Sethoana ME, Wondoh P, Ally Z, Domingo A, Munda P, Nyatsambo C, Ojo V, Pswarayi R. Strategies to minimise and monitor biases and imbalances by arm in surgical cluster randomised trials: evidence from ChEETAh, a trial in seven low- and middle-income countries. Trials 2023; 24:259. [PMID: 37020311 PMCID: PMC10077601 DOI: 10.1186/s13063-022-06852-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/19/2022] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Cluster randomised controlled trials (cRCT) present challenges regarding risks of bias and chance imbalances by arm. This paper reports strategies to minimise and monitor biases and imbalances in the ChEETAh cRCT. METHODS ChEETAh was an international cRCT (hospitals as clusters) evaluating whether changing sterile gloves and instruments prior to abdominal wound closure reduces surgical site infection at 30 days postoperative. ChEETAh planned to recruit 12,800 consecutive patients from 64 hospitals in seven low-middle income countries. Eight strategies to minimise and monitor bias were pre-specified: (1) minimum of 4 hospitals per country; (2) pre-randomisation identification of units of exposure (operating theatres, lists, teams or sessions) within clusters; (3) minimisation of randomisation by country and hospital type; (4) site training delivered after randomisation; (5) dedicated 'warm-up week' to train teams; (6) trial specific sticker and patient register to monitor consecutive patient identification; (7) monitoring characteristics of patients and units of exposure; and (8) low-burden outcome-assessment. RESULTS This analysis includes 10,686 patients from 70 clusters. The results aligned to the eight strategies were (1) 6 out of 7 countries included ≥ 4 hospitals; (2) 87.1% (61/70) of hospitals maintained their planned operating theatres (82% [27/33] and 92% [34/37] in the intervention and control arms); (3) minimisation maintained balance of key factors in both arms; (4) post-randomisation training was conducted for all hospitals; (5) the 'warm-up week' was conducted at all sites, and feedback used to refine processes; (6) the sticker and trial register were maintained, with an overall inclusion of 98.1% (10,686/10,894) of eligible patients; (7) monitoring allowed swift identification of problems in patient inclusion and key patient characteristics were reported: malignancy (20.3% intervention vs 12.6% control), midline incisions (68.4% vs 58.9%) and elective surgery (52.4% vs 42.6%); and (8) 0.4% (41/9187) of patients refused consent for outcome assessment. CONCLUSION cRCTs in surgery have several potential sources of bias that include varying units of exposure and the need for consecutive inclusion of all eligible patients across complex settings. We report a system that monitored and minimised the risks of bias and imbalances by arm, with important lessons for future cRCTs within hospitals.
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Islam MM, Faruque SM, Das D, Ranjan R, Ahmed SM, Adhikary AB. Diagnostic Dilemma of Frozen Shoulder in Post CABG Patient: A Case Report. Mymensingh Med J 2023; 32:593-598. [PMID: 37002777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Frozen shoulder, also known as adhesive capsulitis, is a condition featured by stiffness and pain in shoulder joint. In this report, we present a case of 58 years old diabetic male patient with the history of coronary artery bypass grafting (CABG) 06 months back. He presented with persistent right shoulder pain for 05 months. Clinical examinations reveal restriction of the right shoulder joint movement in all directions and wasting of the right supraspinatus, infraspinatus and trapezius muscles. Both active and passive range of motions was restricted with painful right shoulder joint. Pain free abduction range was about 40 degrees in right shoulder. Plain X-ray of right shoulder joint and other relevant investigations show normal findings. Considering the clinical and laboratory findings decision was taken to treat the patient with exercise, pain killer and ultrasound therapy which were found to be optimistic.
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Affiliation(s)
- M M Islam
- Dr Md Mahbubul Islam, MD (Physical Medicine) Phase B Student, Department of Physical Medicine & Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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Stumpf A, Xu D, Ranjan R, Angelaud R, Gosselin F. A Convergent Synthesis of HPK1 Inhibitor GNE-6893 via Palladium-Catalyzed Functionalization of a Tetrasubstituted Isoquinoline. Org Process Res Dev 2023. [DOI: 10.1021/acs.oprd.2c00384] [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: 03/03/2023]
Affiliation(s)
- Andreas Stumpf
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Di Xu
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Rohit Ranjan
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Remy Angelaud
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Francis Gosselin
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
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Wiala A, Ranjan R, Schnidar H, Rappersberger K, Posch C. 091 Automated classification of hidradenitis suppurativa severity by convolutional neural network analyses using clinical images. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.101] [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: 11/19/2022]
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Andoh AB, Atindaana Francis A, Abdulkarim AA, Adesunkanmi AO, Salako AA, Soladoye A, Sheshe AA, Sani A, Lawal AO, Lawal A, Tripathi A, S A, Akinloye A, Olajumoke Balogun A, Ariyibi AL, Okunlola AI, Ojewuyi AR, Oyedele AE, Sakyi A, Oladimeji AT, Bala Muhammad A, Yahaya A, Soibi-Harry AP, Gyambibi AK, Adeniyi AA, Adeoluwa A, Olumide Osinowo A, Salawu AI, Fatuga AL, Adesiyakan A, Fakoya A, Naah A, Adeyeye AA, Talabi AO, Fasanu AO, Ayoola Orowale A, Ojajuni A, Adelaja AT, Ademuyiwa AO, Jimoh AI, Aderounmu AA, Adisa AO, Ajagbe AO, Olajide AT, Bakare A, Okunowo AA, Tchogo A, Koledade AK, Barthelemy Yevide A, Bello A, Shehu Umar A, Lawal AT, Obiesie AE, Dieudonne Hirwa A, Domingo A, Mustapha A, Abdullahi A, Hada A, Ijeoma A, Adeleke AA, Adepiti AC, Ajao AE, Sanusi AT, Houndji A, Bernal Hernández A, González Ojeda A, Serrano García AG, Ohemu AA, Arekhandia AI, Yakubu A, Hepzibah A, Bhatt A, Muhammad Tukur A, Ingabire AJC, Okechukwu Ugwu A, Karekezi A, Maalekuu A, Imanishimwe A, Bruce-Adjei A, Obbeng A, Akosua A, Jeffery-Felix A, Mohammed-Durosinlorun AA, Jimoh AO, Umar AM, Umar AM, Mahajan A, Eziyi AK, Bennin A, Dasari A, Okedare A, Mathew AE, Florencia Casado-Zarate A, Calderón-Alvarado AB, Dominguez ACG, Cortés Flores AO, Dusabimana A, Kutma A, Byaruhanga A, Houndote A, Cueto Valadez AE, Alvarez Villaseñor AS, Bhangu A, Ortega Barreiro A, Mortola Lomeli AF, Luther A, Yahya A, Eseenam Agbeko A, Thomas A, Goyal A, Mkoh Dikao AS, Appiah AB, Gaou A, Bediako-Bowan AA, Ramos De la Medina A, Seidu AS, Munyaneza A, Ahounou A, Akoto-Ampaw A, Hadonou A, Alitonou A, Sambo A, Mathew AJ, Chaturvedi A, Gautham AK, Choudhrie AV, Attri AK, Kumar A, Sukumar A, Mehraj A, Shittu A, Mukasine A, Oppon-Acquah A, Kusiwaa A, Suroy A, Ezenwa AO, Takure AO, Akinniyi A, Ogunyemi AA, Makanjuola A, Dossou Yovo BB, Alhassan BAB, Hamza BK, Awoyinka BS, Koomson B, Aminu B, Abodunde Muideen B, Osunwusi B, García Reyna B, Oppong BA, Brimpong BB, Fenu BS, Ofori BA, Guzmán Ramírez BG, Nyadu BB, Shankar B, Lawal BK, Armstrong Alia B, Roy B, Kontor BE, Kovohouande B, Cakpo B, Enriquez Barajas BV, Crocco Quiros B, Kadir B, Mohammed C, Nwachukwu CU, Colunga Tinajero C, Ruiz Velasco CB, Zuloaga Fernández del Valle CJ, Noufuentes C, Solomi CV, Okunlola CK, Seneza C, Okafor CI, Nuño Escobar C, Banka C, Barimah CG, Chetana C, Nyatsambo C, Okeke CJ, Jeffrey Ede C, Nwosu CD, Victoria Mgbemena C, Onyeka CU, Gold CS, Faith Uche C, Chigoze Makwe C, Urimubabo CJ, Coompson CL, Ashley-Osuzoka C, Gbenga-Oke C, Bidemi Oyegbola C, Mukakomite C, Mpirimbanyi C, Asare C, Bode CO, Ugwunne C, Onyejiaka CC, Okoro C, Okereke CE, Mukangabo C, Sie-Broni C, Ballu C, Fuentes Orozco C, Kyeremeh C, Adumah CC, Ruelas Bravo C, Bokossa Kandokponou CM, Guerrero Ramírez CS, Teye-Topey C, Kpangon C, Chinyio D, Orozco Ramirez D, Mora Santana D, Nyirasebura D, Hérnandez Alva DA, Acquah DK, Prakash DD, Sale D, Olulana DI, Oruade D, Jayne D, Morales Iriarte DGI, Ogudi DKD, Olatola DO, Akinboyewa DO, Irabor DO, Nuwam D, Mukantibaziyaremye D, Jain D, Singla D, Garnaik DK, Singh DS, Gakpetor DA, Esssien D, Rubanguka D, Poonia DR, Ghosh D, Ahogni D, Morton D, Umuhoza D, Morel Seto D, Nepogodiev D, Enti D, Smith D, Osei-Poku D, Acheampong DO, Mellado DH, Ofosuhene D, Cortes Torres EJ, Efren Lozada E, Gómez Sánchez E, González Espinoza E, Osei E, Mensah E, Rwagahirima E, Quartson EM, Li E, Kurien EN, Bonilla Ahumada E, Kabanda E, Odame E, Izabiriza E, Hatangimana E, Osariemen E, Reyes Elizalde EA, Agbowada EA, Usam E, Sylvester Inyang E, Owie E, Ojo Williams E, Munyaneza E, Mutabazi E, Kojo Acquah E, Obiri EL, Ofori EO, Runigamugabo E, Yhoshu E, Malade E, Cervantes Perez E, Kobby E, Okwudiri Ohazurike E, Jerry Bara E, Agyemang E, Akoto E, Villanueva-Martínez EE, Mwungura E, Cueva Martinez E, Asabre E, Adjei-Acquah E, Abunimye E, Daluk EB, Daniel ER, Ike Okorie E, Ailunia EE, Abraham ES, Romo Ascencio EV, Harrison E, Kpatchassou E, Bakari F, González Ponce FY, Huda F, Abubakari F, Ntirenganya F, Ingabire F, Parray FQ, Brant F, Alakaloko FM, Diaz Samano F, Duque Zepeda F, Bello-Tukur F, Basirwa Musengo F, Dedey F, Adegoke F, Amponsah-Manu F, Mukaneza F, Chinonso Ezenwankwo F, Sanwo F, Dossou FM, Nwaenyi FC, Ibanez Ortiz F, Barbosa Camacho FJ, León-Frutos FJ, Plascencia Posada FJ, Nirere F, Owusu F, Gyamfi FE, Wuraola FO, Cervantes Guevara G, Ntwari G, Ambriz-González G, Hyman G, Umar GI, Thami G, Adeleye GTC, Limann G, Ajibola G, Ida G, Ihediwa GC, Brown GD, Bucyibaruta G, Gallardo Banuelos G, Lopez Arroyo G, Ndegamiye G, Naah G, Morgan Villela G, Edet G, Attepor GS, Akaba GO, Aziz G, Yeboah G, Mary G, Eke G, Castillo Cardiel G, Yanowsky Reyes G, Sanchez Villaseñor G, Cervantes Cardona GA, Singh G, Boateng GC, Kola H, Abdullahi HI, Olaide Raji H, Ahmed HI, Umaru-Sule H, Kaur H, Malechi H, Sunday H, Abiyere HO, Butana H, Agossou H, Samkelisiwe Nxumalo H, Maniraguha HL, Dewamon H, Yome H, Behanzin H, Ekwuazi HO, Oweredaba IT, Mohammed I, Sufyan I, Saidu IA, Abdul-Aziz IIA, Eseile IS, Ogolekwu IP, Adebara IO, Usman Takai I, Fidelis Okafor I, Kene IA, Enyinnaya Iweha I, Mutimamwiza I, Mantoo I, Duruewuru IO, Akpo I, Niyongombwa I, Brancaccio Pérez IV, Esparza Estrada I, Gundu I, Morkor Opandoh IN, Ncogoza I, Sibomana I, Bansal I, Cabrera-Lozano I, Ishola Aremu I, Gandaho I, Lawani I, Ochoa Rodríguez I, Alasi IO, Alhassan J, Mends-Odro J, Osuna Rubio J, Orozco Perez J, González Bojorquez JL, Rodriguez Ramirez JA, Glasbey J, Emeka JJ, Lawal J, Acquaye J, Alfred J, Rugendabanga J, Mizero J, Ingabire JCA, Aimable Habiyakare J, Claude Uwimana J, de Dieu Haragirimana J, Yves Shyirakera J, Utumatwishima JN, Niyomuremyi JP, Majyabere JP, Masengesho JP, Nyirahabimana J, Vishnoi JR, Kalyanapu JA, Joseph JN, Makama JG, Pizarro Lozano J, Aguilar Mata JA, Morales JFM, Vega Gastelum JO, Oyekunle Bello J, Okechukwu Ugwu J, Amoako JK, Simoes J, Zirikana J, Nzuwa Nsilu J, Adze JA, Enaholo JE, Obateru JA, Chinda JY, Akunyam J, Boakye-Yiadom J, Cook J, Quansah JIK, Chejfec Ciociano JM, Jiménez Tornero J, Herrera-Esquivel J, Flores Cardoza JA, Sánchez Martínez JA, Guzmán Barba JA, Pesquera JAA, Orozco Navarro JE, Sandoval Pulido JI, Pérez Navarro JV, Igiraneza J, Ejimogu J, Awindaogo JK, Ugboajah JO, Ashong J, Nsaful J, Arthur J, Yakubu J, Mutuyimana J, Umuhoza J, Thomas J, Ibarrola Peña JC, Tijerina Ávila JJ, Oladayo Kuku J, Gyamfi JE, Brown J, Appiah J, Attinon J, Jacob J, Gimba J, Seyi-Olajide JO, Ngaguene J, Jyoti J, Leshiini K, Boukari KA, Kumar K, Mumuni K, Quarchey KND, Sanni K, Bozada-Gutierrez K, Mandrelle K, Atobatele KM, Awodele K, Bawa KG, Duromola KM, Egbuchulem KI, Ngaaso K, Onyekachi K, Ugwuanyi K, Okoduwa KO, Ado KA, Rathod KK, Nunoo-Ghartey K, Rautela K, Kennedy KK, Ascencio Díaz KV, Boakye-Yiadom K, Onahi Iji L, Magill L, Martinez Perez Maldonado L, Pena Baolboa LG, Montano Angeles LO, Barau Abdullahi L, Ismail L, Awere-Kyere LKB, Uzikwambara L, Adam-Zakariah L, Larbi-Siaw LA, Chukwuemeka Anyanwu LJ, Etchisse L, Abdulrasheed L, Agbanda L, García González LA, Suárez Carreón LO, Cifuentes Andrade LR, Pacheco Vallejo LR, Ramirez Gonzalez LR, Aniakwo LA, Olajide Abdur-Rahman L, Abdur-Rahman LO, Namur LDCM, Mukamazera L, Airede LR, Nontonwanou MB, Amoako-Boateng MP, Rodha MS, Kawu Magashi M, Abubakar M, Yigah M, Dayie MSCJK, Victorin Agbangla M, Pathak M, Aggarwal M, Lokavarapu MJ, Talla Timo M, Isikhuemen ME, Gbassi M, Uwizeye M, Akpla M, Adjei MNM, Picciochi M, Chávez M, Fourtounas M, Quirarte Hernández MA, Zarate Casas MF, Gloriose Nabada M, Kouroumta MC, De Cristo Gonzalez Calvillo M, Trejo-Avila M, Guzmán Ruvalcaba MJ, Monahan M, Jesudason MR, Zume M, Totin M, Djeto M, Awe M, Islas Torres M, Morna MT, Oluwadamilola Adebisi M, Adams MA, Oluwatobi Busari M, Lazo Ramirez M, Taingson MC, Ruhosha M, Dery MK, Batangana M, Mellado Tellez MP, Vicencio Ramirez ML, Agyapong MM, Nortey M, Amao M, Bahrami-Hessari M, Calderón Llamas MA, Calderon Vanegas MA, Azanlerigu M, Becerra Moscoso MR, Sethoana ME, Oludara MA, Moussa Alidou M, Mohammad MA, Bashir M, Usman M, Adnan M, Alhassan MS, Aliyu MS, Singh M, Muhindo M, Dusabeyezu M, Kichu M, Castillo MN, Gureh M, Hans MA, Hollo M, Hodonou MA, Sivakumar MV, Edena ME, Abdulsalam MA, Adebisi Ogunjimi M, Dusabe M, Dokurugu MA, Galadima MC, Agbulu MV, Agbadebo M, Eunice ME, Nosipho Mathe M, Moreno-Portillo M, Awaisu M, Daniyan M, Duke George M, Malik MA, Amadu M, Pai MV, Adetola Tolani M, Abdullahi M, Moussa N, Guessou NO, Saqib N, Christian NA, Essel N, Tabuanu NO, Olagunju N, Sam NB, Akhtar N, Oyelowo N, Bisimwa Mitima N, Adewole ND, Sharma N, Anthea Nhlabathi N, Mbajiekwe N, Mishra N, Pundir N, Winkles N, Smart N, Agboadoh N, Ndukwe NO, Aperkor NT, Adu-Aryee NA, Chowdri NA, Singh N, Peters NJ, Sharma N, Agrawal N, Syam N, Duru NJ, Sentholang N, Okoi N, Anyanwu N, Rene Hounsou N, Aliyu NU, Abiola Adeleke N, Egwuonwu OA, Okoye OA, Hyginus Ekwunife O, Olanrewaju O, Osagie OO, Adeyemo OT, Oshodi OA, Olaolu Ogundoyin O, Ogundoyin OO, Babalola OF, Olasehinde O, Ajai OT, Balogun OS, Lawal OO, Olayioye O, Sayomi O, Samuel O, Mwenedata O, Oluwaseyi Bakare O, Sowande OA, Ojewuyi OO, Omisanjo OA, Akintunde OP, Abiola OP, Abiola OP, Akande O, Elebute OA, Adewara OE, Ayankunle OM, Odesanya OJ, Alatise OI, Ajenifuja OK, Ogunsua OO, Banjo OO, Ojediran O, Oladele OO, Fatudimu OS, Ajagbe OA, Idowu OC, Ladipo-Ajayi OA, Taiwo OA, Olaleye OH, Oluseye OO, Ige O, Odutola OR, Atoyebi OA, Omar O, Ayandipo OO, Omotola O, Faboya OM, Williams OM, Irowa OO, Salami OS, Onu OA, Asafa OQ, Akinajo OR, Osemwegie O, Osagie OT, Olvera Flores O, Iribhogbe OI, Aisuodionoe-Shadrach O, Gbehade O, Ojo OD, Olubayo OO, Prabhu PS, Flores Becerril P, Kumar P, Yanto P, Mukherjee P, Haque PD, Koggoh P, Igwe PO, Trinity P, Aderemi Adegoke P, Wondoh P, Domínguez Barradas P, Ogouyemi P, Boakye P, Brocklehurst P, Elemile P, Egharevba PA, Agbonrofo PI, Okoro PE, Kumassah PK, Mensah P, Munda P, Mshelbwala PM, Alexander PV, Nyirangeri P, Muroruhirwe P, Hardy P, Kwabena PW, Zechariah P, Nayak P, Dummala P, Singh P, Solanki P, Yeboah Owusu P, Mary P, Chowdhury P, Luri PT, Pareek P, Prakash P, Kumari P, Lillywhite R, Moore R, Tinuola Afolabi R, Williams R, Alpheus RA, Sharma R, Seenivasagam RK, Vakil R, Armah R, Samujh R, Chaudhary R, John RE, Gunny RJ, Wani RA, Verma R, Thind RS, Dar RA, Eghonghon RA, Acquah R, Rajappa R, Kpankpari R, Ofosu-Akromah R, Romaric Soton R, Jain R, Guinnou R, Munyaneza R, Mares País R, Delano-Alonso R, Miranda Ackerman RC, Bello R, Kour R, Guadalupe Cano Arias RG, Uwayezu R, Nájar Hinojosa R, Mittal R, Ranjan R, Goudou R, Cethorth Fonseca RK, Hussey R, Tubasiime R, Dukuzimana R, Varghese R, Boateng RA, Pswarayi R, Ojewola RW, Abdus-Salam RA, Abdus-Salam RA, Sarfo Kantanka R, Manu R, Abdul-Hafiz S, Oyewale S, Yussif S, Abolade Lawal S, Kanyarukiko S, Abeku Yusuf S, Suleiman S, Tabara S, Mbonimpaye S, Kanyesigye S, Joshua S, Tamou SB, Gupta S, Muhammad SS, Abdulai S, Olori S, Mensah S, Asirifi SA, Sani SA, Ajekwu SC, Nwokocha SU, Quaicoo S, Tsatsu SE, Philips S, Gupta S, Misra S, Kaur S, Omorogbe SO, Eniola SB, Kwarteng SM, Tobome SR, Emmanuel Hedefoun S, Adams SM, Singh S, Duniya SAN, Yahaya S, Mohammed S, Rajan S, Adekola Adebayo S, Ibarra Camargo SA, Cousens S, Hinvo S, Kapoor S, Singh S, Nindopa S, Jacob SE, Laurberg S, Chakrabortee S, Chowdhury S, Mathai S, Prasad S, Tchati SV, Habumuremyi S, Habumuremyi S, Hamadou S, Lawani S, Veetil SK, D S, D S, Sharma S, Doe S, Mathew S, Emeka Nwabuoku S, Ideh SN, Laurent Loupeda S, Tabiri S, Olutola S, Kache SA, Bature SB, Garba SE, Gana SG, Soni SC, Raul S, Kanchodu S, Daneji SM, Sallau SB, P T S, Saluja SS, Goyal S, Surendran S, Joseph S, John S, Obiechina SO, Hounsa S, Lawal TA, Badmus TA, Bakare TIB, Mohammed TO, Cueto Valadez TA, Dhar T, Agida TE, Arkorful TE, Atim T, Orewole TO, Wordui T, Okonoboh TO, Mavoha T, Hessou TK, Agyen T, Pinkney T, Olajide TO, Odunafolabi TA, Sholadoye TT, Kumar U, Kingsley Oriji V, Varsheney VK, Samuel VM, Agyekum-Gyimah VO, Ifeanyichukwu Modekwe V, Ojo V, Abhulimen V, Pérez Bocanegra VH, Avalos Herrera VJ, Etwire VK, Ibukunoluwa Adeyeye V, Kumar V, Ismavel VA, John V, Sehrawat V, Kudoh V, Kanna V, Mukanyange V, Michael V, Adobea V, Sam VD, Ghansah WW, Asman WK, Bhatti W, Kagomi WY, Mehounou Y, Mustapha Y, Oyewole Y, Edwin Y, Oshodi YA, Adofo-Asamoah Y, Ally Z, Imam ZO, Shah ZA, Lara Pérez ZM, Robertson Z. Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a pragmatic, cluster-randomised trial in seven low-income and middle-income countries. Lancet 2022; 400:1767-1776. [PMID: 36328045 DOI: 10.1016/s0140-6736(22)01884-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/06/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Surgical site infection (SSI) remains the most common complication of surgery around the world. WHO does not make recommendations for changing gloves and instruments before wound closure owing to a lack of evidence. This study aimed to test whether a routine change of gloves and instruments before wound closure reduced abdominal SSI. METHODS ChEETAh was a multicentre, cluster randomised trial in seven low-income and middle-income countries (Benin, Ghana, India, Mexico, Nigeria, Rwanda, South Africa). Any hospitals (clusters) doing abdominal surgery in participating countries were eligible. Clusters were randomly assigned to current practice (42) versus intervention (39; routine change of gloves and instruments before wound closure for the whole scrub team). Consecutive adults and children undergoing emergency or elective abdominal surgery (excluding caesarean section) for a clean-contaminated, contaminated, or dirty operation within each cluster were identified and included. It was not possible to mask the site investigators, nor the outcome assessors, but patients were masked to the treatment allocation. The primary outcome was SSI within 30 days after surgery (participant-level), assessed by US Centers for Disease Control and Prevention criteria and on the basis of the intention-to-treat principle. The trial has 90% power to detect a minimum reduction in the primary outcome from 16% to 12%, requiring 12 800 participants from at least 64 clusters. The trial was registered with ClinicalTrials.gov, NCT03700749. FINDINGS Between June 24, 2020 and March 31, 2022, 81 clusters were randomly assigned, which included a total of 13 301 consecutive patients (7157 to current practice and 6144 to intervention group). Overall, 11 825 (88·9%) of 13 301 patients were adults, 6125 (46·0%) of 13 301 underwent elective surgery, and 8086 (60·8%) of 13 301 underwent surgery that was clean-contaminated or 5215 (39·2%) of 13 301 underwent surgery that was contaminated-dirty. Glove and instrument change took place in 58 (0·8%) of 7157 patients in the current practice group and 6044 (98·3%) of 6144 patients in the intervention group. The SSI rate was 1280 (18·9%) of 6768 in the current practice group versus 931 (16·0%) of 5789 in the intervention group (adjusted risk ratio: 0·87, 95% CI 0·79-0·95; p=0·0032). There was no evidence to suggest heterogeneity of effect across any of the prespecified subgroup analyses. We did not anticipate or collect any specific data on serious adverse events. INTERPRETATION This trial showed a robust benefit to routinely changing gloves and instruments before abdominal wound closure. We suggest that it should be widely implemented into surgical practice around the world. FUNDING National Institute for Health Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, Mölnlycke Healthcare.
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Raj R, Mahey R, Bhatla N, Manchanda S, Kumari A, Ranjan R. Laparoscopic Inguinal Gonadectomy in a Case of Partial Androgen Insensitivity Syndrome and Bilateral Gonads in Inguinal Canal. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pradhan S, Ranjan R, Verma A, Singh T, Aggarwal L, Singh R, Shahi U. PD-0906 Functional MRI as an Assessment Tool in Carcinoma Cervix Patients Undergoing Chemoradiation. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02985-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Talwar H, Panwar V, Mittal A, Tosh J, Singh G, Ranjan R, Ghorai R, Kumar S, Navriya S, Mandal A. Efficacy and safety of percutaneous nephrolithotomy in patients with chronic kidney disease: Outcomes from a tertiary care center. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01091-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Talwar HS, Mittal A, Panwar VK, Tosh JM, Singh G, Ranjan R, Ghorai RP, Kumar S, Navriya S, Mandal À. Efficacy and safety of percutaneous nephrolithotomy in patients with chronic kidney disease: Outcomes from a tertiary care center. J Endourol 2021; 36:600-609. [PMID: 34861766 DOI: 10.1089/end.2021.0514] [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
BACKGROUND The management of renal stone disease in the presence of chronic kidney disease is a challenging scenario, both in terms of surgical safety as well as perioperative outcomes. The aim of the present study is to study the efficacy, safety, and outcomes of percutaneous nephrolithotomy in patients with chronic kidney disease. MATERIALS AND METHODS A prospective study was conducted including adult patients with renal stone disease and a creatinine clearance of <90ml/min (Stage 2 CKD or more) who underwent percutaneous nephrolithotomy. Pre-operative and post-operative serum creatinine and glomerular filtration rates were compared. Patients were divided into CKD stages 1-5 having creatinine clearance >90ml/min, 60-90ml/min, 30-60ml/min, 15-30ml/min and <15ml/min respectively. Based on up migration or down migration of CKD stages, patients were classified as improved, deteriorated or stable. Peri-operative complications and outcomes were also compared. RESULTS A total of 185 patients with CKD stage less than or equal to 2 underwent PCNL. The mean age of the patients was 43.24+/-14.32 years. The mean preoperative estimated glomerular filtration rate was 62.88±23.42mL/min/1.73m2. Pre-operative CKD stage distribution was as follows: stage 2-121(65.4%), stage 3-34(18.4%), stage 4-24(13%) and stage 5-6(3.2%). On last follow-up of patients, the mean creatinine was 1.07±0.65 mg/dL and the mean eGFR was 82.75±31.22 mL/min/1.73m2. The median change in creatinine and mean change in GFR was 0.23 (0.16-0.27) g/dL and 19.87 ± 19.77 mL/min/1.73 m2 respectively. Improvement in kidney function with a stage down migration was seen in 115 cases(62.2%), slight improvement with no change in stage in 69 cases(37.3%) and deterioration of CKD stage was present in one case(0.5%). CONCLUSION Percutaneous nephrolithotomy is associated with favourable functional outcomes in chronic kidney disease patients including severe CKD(stage IV and V). Improvement or stabilization of CKD stage was seen in 99.5% patients post PCNL.
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Affiliation(s)
- Harkirat Singh Talwar
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Ankur Mittal
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Vikas Kumar Panwar
- All India Institute of Medical Sciences - Rishikesh, 442339, Virbhadra, Rishikesh, Rishikesh, India, 249203;
| | - Jyoti Mohan Tosh
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Gurpremjit Singh
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Rohit Ranjan
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Rudra Prasad Ghorai
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Sunil Kumar
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Shivcharan Navriya
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Àrup Mandal
- All India Institute of Medical Sciences - Rishikesh, 442339, Urology, Rishikesh, Uttarakhand, India;
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Stumpf A, Burkhard J, Xu D, Marx A, Lao D, Ochsenbein M, Ranjan R, Angelaud R, Gosselin F. Efficient, Protecting Group Free Kilogram-Scale Synthesis of the JAK1 Inhibitor GDC-4379. Org Process Res Dev 2021. [DOI: 10.1021/acs.oprd.1c00302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Andreas Stumpf
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Johannes Burkhard
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Di Xu
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Andreas Marx
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - David Lao
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Miriam Ochsenbein
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Rohit Ranjan
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Remy Angelaud
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Francis Gosselin
- Department of Small Molecule Process Chemistry, Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
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Ranjan R, Mittal A, Panwar V, Navriya S, Singh S, Mandal A. Novel scoring system and advanced management algorithm for emphysematous pyelonephritis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00554-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ranjan R, Navriya S, Kumar S, Mittal A, Singh S, Panwar V, Mandal A. Emerging role of Telemedicine in urology: COVID brought the opportunity for the future! Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Kimura Y, Ranjan R, Raghuraman N, Srimathveeravalli G. Abstract No. 85 Electric pulse assisted transcriptomic and proteomic profiling of tumors. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.509] [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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21
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Ranjan R, Singh P, Singh SP, Gururaj K, Kharche SD, Singh MK. Status of Beta Defensin-1 and its Effect on Post-thaw Semen Fertility Gene Expression in Indian Goat Breed. Cryo Letters 2021; 42:137-145. [PMID: 33970991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Defensins are antimicrobial peptides and uniformly spans the entire sperm surface and is not exclusive to a specific domain. Goat β-defensin-1 helps in initiation of motility and capacitation of sperm. OBJECTIVE To know the status of β-defensin-1 in blood, semen and its effect on post thaw fertility gene expression in Indian goat breeds. MATERIALS AND METHODS Semen was extended and divided for estimation of β-defensin-1 and cryopreserved having different concentrations of β-defensin-1. RESULTS Bet defensin-1 concentration (pg/mL) in neat semen, sperm pellet and seminal plasma was significantly higher (P< 0.05) in goat breed Barbari followed by Jamunapari and Jakhrana. β-defensing-1 was also high in Jakhrana blood followed by Barbari and Jamunapari. The post thaw motility, live sperm, acrosome intactness and hypo osmotic swelled sperms were significantly higher (P< 0.05) with 10 ng/mL β-defensin in the semen dilutor. CONCLUSION Beta defensin (10 ng/mL) in semen dilutor may be used as immuno-modulator to get better post thaw quality suitable for artificial insemination.
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Affiliation(s)
- R Ranjan
- ICAR-Central Institute for Research on Goats, Makhdoom, Farah, Mathura, India. or
| | - P Singh
- ICAR-Central Institute for Research on Goats, Makhdoom, Farah, Mathura, India
| | - S P Singh
- ICAR-Central Institute for Research on Goats, Makhdoom, Farah, Mathura, India
| | - K Gururaj
- ICAR-Central Institute for Research on Goats, Makhdoom, Farah, Mathura, India
| | - S D Kharche
- ICAR-Central Institute for Research on Goats, Makhdoom, Farah, Mathura, India
| | - M K Singh
- ICAR-Central Institute for Research on Goats, Makhdoom, Farah, Mathura, India
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Talwar HS, Mittal A, Kumar S, Panwar VK, Narain TA, Ranjan R, Ranjan SK. Robot-Assisted Laparoscopic Approach in a Patient of Zinner Syndrome with Hematuria: A Rare Presentation. J Midlife Health 2021; 12:79-81. [PMID: 34188430 PMCID: PMC8189340 DOI: 10.4103/jmh.jmh_49_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/17/2020] [Accepted: 10/01/2020] [Indexed: 11/12/2022] Open
Abstract
Congenital malformations of the seminal vesicles (SVs) are rare and are often associated with abnormalities of the ipsilateral upper tracts as embryologically both the ureteral buds and SVs arise from the mesonephric ducts. The triad of SV cysts, ipsilateral renal agenesis, and ejaculatory duct obstruction is known as the Zinner syndrome. We herein present the case of Zinner syndrome with hematuria as the mode of presentation. A 52-year-old gentleman presented with complaints of gross and painless hematuria for 3 months. An initial ultrasound revealed absent right kidney with a cystic structure abutting the urinary bladder. Cystoscopic examination revealed a high bladder neck. Magnetic resonance imaging of the abdomen revealed an absent right kidney and a large tubular structure in the region of the right ureter extending up to right SV with blood content and stones within. It was distally seen communicating with one of the cysts of the right SV. The cystic structure was removed with a robot-assisted laparoscopic approach. The console time was 110 min with minimal blood loss. Postoperative course was uneventful. Histopathology of the cyst wall revealed chronic inflammation. The patient is doing well on 6 months follow-up. This case was unique in terms of it presenting with a large intra-abdominal cyst with sharp stones within, probably first of its kind to be ever reported. Surgery is mandated for such symptomatic cysts and the daVinci robot with its minimally invasive approach offers the perfect platform for treating such challenging cases.
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Affiliation(s)
- Harkirat Singh Talwar
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ankur Mittal
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sunil Kumar
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vikas Kumar Panwar
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Tushar Aditya Narain
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rohit Ranjan
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Satish Kumar Ranjan
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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23
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Ranjan R, Mittal A, Ranjan SK, Panwar V, Talwar HS. Ganglioneuroma presenting as an adrenal incidentaloma: Feasibility of adrenal-sparing surgery. J Minim Access Surg 2021; 17:389-391. [PMID: 34045401 PMCID: PMC8270040 DOI: 10.4103/jmas.jmas_147_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adrenal ganglioneuromas (GNs) are very rare tumours that originate from neural crest cells. Most of the time, they are diagnosed incidentally as they are usually non-functional and remain asymptomatic. Nowadays, they are being detected more often due to better availability of imaging facilities such as computed tomography (CT)/magnetic resonance imaging (MRI). Minimally invasive adrenalectomy (laparoscopic or robotic) remains the standard of care for such lesions. Hereby, we report a case of a 15-year-old young girl with right adrenal incidentaloma which was diagnosed on CT with the features suggestive of GN. She underwent robot-assisted excision of the mass with adrenal-sparing surgery. Histopathology revealed benign GN and no adjuvant treatment was required. As GN is not known for recurrence or metastasis, minimal invasive adrenal-sparing surgery should be a preferred modality of choice.
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Affiliation(s)
- Rohit Ranjan
- Department of Urology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Ankur Mittal
- Department of Urology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Satish Kumar Ranjan
- Department of Urology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Vikas Panwar
- Department of Urology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Harkirat Singh Talwar
- Department of Urology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
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24
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Ranjan R, Mittal A, Panwar V, Narain TA, Talwar HS, Mammen KJ. Extending Horizon of Robotic Surgery to Bladder-Preserving Approach for Vesical Paraganglioma: Rare Case with Unusual Presentation. J Endourol Case Rep 2020; 6:319-321. [PMID: 33457663 DOI: 10.1089/cren.2020.0077] [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: 10/23/2022] Open
Abstract
Background: Vesical paraganglioma is rare and accounts for <0.1% of all urinary bladder tumors. They are mostly functional because of secretion of catecholamines and clinical presentation may mimic like a hyperfunctioning adrenal pheochromocytoma. They are easily misdiagnosed as urothelial malignancy and adequate perioperative attention is not provided. Case presentation: We hereby report a case of 55-year-old Indian lady with silent vesical paraganglioma at anatomically difficult location of bladder neck managed with robot-assisted excision of mass and bladder preservation. Conclusion: Surgery is the mainstay of the treatment that requires total excision of mass. However, minimally invasive bladder-preserving approach should be always kept as an option, if feasible. Robot assistance can help in bladder preservation even in difficult anatomic locations.
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Affiliation(s)
- R Ranjan
- Department of Urology, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - A Mittal
- Department of Urology, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - V Panwar
- Department of Urology, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - T A Narain
- Department of Urology, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - H S Talwar
- Department of Urology, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - K J Mammen
- Department of Urology, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
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25
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Susan S, Ranjan R, Taluja U, Rai S, Agarwal P. Global-best optimization of ANN trained by PSO using the non-extensive cross-entropy with Gaussian gain. Soft comput 2020. [DOI: 10.1007/s00500-020-05080-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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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26
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Ranjan R, Singh P, Kharche S, Gangwar C, Ramachandran N, Singh S, Singh M. Effect of temperature humidity index on sexual behavior and semen quality in Barbari buck under Indian climatic condition. Small Rumin Res 2020. [DOI: 10.1016/j.smallrumres.2020.106263] [Citation(s) in RCA: 1] [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: 12/27/2022]
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Pal S, Pradhan S, Narayan G, Ghosh A, Singh T, Prasad C, Ranjan R. Change in Expression of Biomarkers Bcl-2 and Survivin in Patients of Cancer Cervix Undergoing Chemo-radiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2566] [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: 10/23/2022]
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28
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Talwar HS, Panwar VK, Narain TA, Mittal A, Ranjan R. Subcapsular Renal Hematoma Following Ureteroscopic Lithotripsy: An Uncommon Complication of a Common Procedure-A Report of Two Cases. J Endourol Case Rep 2020; 6:244-247. [PMID: 33102738 DOI: 10.1089/cren.2020.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To highlight the unusual complication of subcapsular renal hematoma (SRH) after a seemingly simple ureteroscopic lithotripsy (URSL), to try and identify the predisposing factors that lead to this complication, and steps that can be taken to further decrease the incidence of this rare but potential life-threatening complication. Methods: We highlight two cases of obstructed ureteral stones with upstream hydronephrosis who presented with colicky pain. Both underwent URSL with 8F/9.8F semirigid ureteroscope and were found to have postprocedure SRH. Results: Both our patients were managed conservatively with culture-directed intravenous antibiotics. One patient needed intervention in the form of aspiration of the hematoma. Follow-up ultrasound revealed complete resolution of the hematoma in both the cases and are doing fine on follow-up. Conclusion: Various risk factors have been identified, which predispose an individual to this complication and all endourologists must take certain precautionary measures such as decreased operative time and perfusion pressures, treating urinary tract infections and preoperative optimization of hypertension, diabetes, and chronic kidney disease (CKD) to further decrease the incidence of SRH. Management is conservative in majority of cases with percutaneous drainage and antibiotics, with surgery being reserved for hemodynamically unstable patients.
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Affiliation(s)
- Harkirat S Talwar
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vikas K Panwar
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Tushar A Narain
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ankur Mittal
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rohit Ranjan
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Murari V, Singh N, Ranjan R, Singh RS, Banerjee T. Source apportionment and health risk assessment of airborne particulates over central Indo-Gangetic Plain. Chemosphere 2020; 257:127145. [PMID: 32497836 DOI: 10.1016/j.chemosphere.2020.127145] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 05/15/2023]
Abstract
Sources of airborne particulates (PM10) were investigated in two contrasting sites over central Indo-Gangetic Plain (IGP), one representing a rural background (Mirzapur) and another as an urban pollution hotspot (Varanasi). Very high PM10 concentration was noted both in Varanasi (178 ± 105 μgm-3; N:435) and Mirzapur (131 ± 56 μgm-3; N:169) with 72% and 62% of monitoring days exceeded the national air quality standard, respectively. Particulate-bound elements contribute significant proportion of PM10 mass (15%-18%), with highest contribution from Ca (7%-10%) and Fe (2%-3%). Besides, presence of Zn (1%-3%), K (1%-2%) and Na (1%-2%) was also noted. Water-soluble ionic species contributed 15%-19% of particulate mass, primarily by the secondary inorganic aerosols (SIA). Among the SIA, sulphate (5%-7%) and nitrate (4%) were prominent, contributing 59%-62% of the total ionic load, especially in winter. Particulate-bound metallic species and ions were selectively used as signatory molecules and source apportionment of PM10 was done by multivariate factor analysis. UNMIX was able to extract particulate sources in both the locations and crustal resuspensions (dust/-soil) were identified as the dominant source contributing 57%-63% of PM10 mass. Secondary aerosols were the second important source (17%-23%), followed by emissions from biomass/-refuse burning (10-19%). Transport of airborne particulates from upper IGP by prevailing westerly were identified as the important contributor of particulates, especially during high particulate loading days. Health risks associated to particulate-bound toxic metal exposure were also assessed. Non-carcinogenic health risk was within the permissible limit while there is possibility of elevated risk for PM10-bound Cr and Cd, if adequate control measures are not in place.
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Affiliation(s)
- Vishnu Murari
- Institute of Environment and Sustainable Development, Banaras Hindu University, Varanasi, India
| | - Nandita Singh
- Institute of Environment and Sustainable Development, Banaras Hindu University, Varanasi, India
| | - Rohit Ranjan
- DST-Mahamana Centre of Excellence in Climate Change Research, Banaras Hindu University, Varanasi, India
| | - R S Singh
- Department of Chemical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi, India
| | - Tirthankar Banerjee
- Institute of Environment and Sustainable Development, Banaras Hindu University, Varanasi, India; DST-Mahamana Centre of Excellence in Climate Change Research, Banaras Hindu University, Varanasi, India.
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Krishnan A, Kohli R, Degulmadi D, Mayi S, Ranjan R, Dave B. Cauda Equina Syndrome: A Review of 15 Patients Who Underwent Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD) Under Local Anaesthesia. Malays Orthop J 2020; 14:101-110. [PMID: 32983384 PMCID: PMC7513651 DOI: 10.5704/moj.2007.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/19/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION To analyse the results of Cauda Equina Syndrome (CES) operated by Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD). MATERIAL AND METHODS The study is a retrospective series of 15 patients operated by PTELD. Bladder dysfunction was classified as incomplete CES (CESI) and complete CES retention (CESR). Bladder / motor recovery rate and its timing, Oswestry Disability Index (ODI), Visual Analogue Score (VAS), patient satisfaction index, and sexual dysfunction were used to measure the outcome objectively. Additionally, in CESR patients, post-void residual (PVR) urine was measured by sonography. Complications and technical problems were noted. RESULTS There were ten patients of CESI and five patients of CESR. The average follow-up was 20.33(12.05) months. Bladder symptoms recovery was 100%, and motor recovery was 80%. VAS for back pain recovered to 0.53(0.52) from 8(2.39). VAS for leg pain recovered to 0.13(0.35) from 9.20(1.32). ODI improved to 6.07(2.85) from 77.52(13.20). The time to the recovery of bladder function was 1.47(1.55) days. All CESR patient's abnormal PVR urine was normalised at five weeks post-operative. No complications were reported. However, five technical executional problems occurred. CONCLUSION PTELD can be considered for CES treatment due to its substantial and quick recovery advantages. However, more evidence support is needed to make it a practice recommendation.
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Affiliation(s)
- A Krishnan
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - R Kohli
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - D Degulmadi
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - S Mayi
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - R Ranjan
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - B Dave
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, India
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Ranjan R, Adhikary D, Mandal S, Saha H, Saha SK, Adhikary AB. A 15 Year's Experience with Minimally Invasive Mitral Valve Replacement in Bangladesh. Mymensingh Med J 2020; 29:97-103. [PMID: 31915343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study was aimed to compare the long-term outcomes and survival rate among mitral valve replacement using thoracotomy and standard median sternotomy in a single surgeon's practice. Total 250 patients were evaluated; Group I (n=65) patients had anterolateral thoracotomy and Group II (n=185) had standard median sternotomy for valve replacement. Mean age was 25.1±5 years in Group I and 41.8±10.5 years in Group II. Female was predominant in Group I. Total operative time and bypass time was statistically significant in Group I (235.5±25.8 minutes; 84.2±12.75 minutes) in contrast to Group II (203.8±15.5 minutes; 71.5±10.5 minutes). Incision scar was not visible in females in Group I but full incision scar was visible in Group II. Post-operative ICU stay duration was significant high in Group II. Though, wound infection incidence was 0% in Group I; however, 9.73% patient had wound infection in Group II. Only 1.62% patient developed unstable sternum in Group II. Most of the patients from both study group were in regular follow up and 1-year mortality rate was 4.62% and 5.94% in Group I and Group II respectively. Mitral valve replacement through a right anterolateral thoracotomy is easy and safe to perform; while getting maximum benefits for the patients. Besides satisfactory cosmetic outcome especially in female, this approach provides better exposure to mitral apparatus even in patients with small left atrium, cost effectiveness, less duration of hospital stays and absence of the risk for unstable sternum.
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Affiliation(s)
- R Ranjan
- Dr Redoy Ranjan, Assistant Professor, Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh; E-mail:
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Ranjan R, Adhikary D, Rahman M, Mandal S, Saha SK, Adhikary AB. Fast Tract Anesthesia Using Isoflurane and Propofol During Off-pump Coronary Artery Bypass Graft Surgery. Mymensingh Med J 2019; 28:811-818. [PMID: 31599245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study aimed to evaluate myocardial protective effect of isoflurane and propofol as a fast tract anesthesia in off pump coronary artery bypass graft surgery by measuring postoperative cardiac enzyme Troponin-I, and liver enzyme. The study was conducted on 260 patients scheduled to undergo elective off pump coronary artery bypass graft surgery. Patients were randomly allocated to receive either isoflurane or propofol anesthesia and was aimed to extubated within 6 hours. Troponin-I levels were measured preoperatively, at arrival in postoperative intensive care unit, at 12, 24, 48, 72 hours and 4 weeks following surgery. Liver function was also assessed and compared between preoperative and postoperative values. There is no difference in Troponin-I levels between the two studies groups at observed pre and post-operative time intervals. Fast tract anesthesia using isoflurane and propofol provides same myocardial protection during and after OPCABG and overall outcome was excellent.
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Affiliation(s)
- R Ranjan
- Dr Redoy Ranjan, Assistant Professor, Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh; E-mail:
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Verma R, Ranjan R. Scintigraphic spectrum of fronto temporal lobar degeneration on FDG PET CT. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Verma R, Ranjan R, Agrawal C, Batra A. Complementary role of 99m-Tc-TRODAT-1 and FDG PET-CT in evaluating patients of Parkinson's disease and other movement disorders: 7 years experience from a tertiary care center. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1182] [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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Verma R, Ranjan R. Lew body dementia and posterior cortical variant Alzheimer’s disease: Similarities and differences on FDG pet and TRODAT scan. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.241] [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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Verma R, Ranjan R, Agrawal C, Batra A. Comprehensive functional evaluation of the spectrum of multi-system atrophy with 18F-FDG PET/CT and 99MTC TRODAT-1 SPECT: 5 years experience from a tertiary care centre. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.264] [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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Swenson D, Blauer J, Taepke R, Kwan E, Ghafoori E, Barton M, Tate J, Coles J, MacLeod R, Degroot P, Ranjan R. P6555A self-adaptive approach to antitachycardia pacing - a head to head comparison using advanced computational modeling. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Antitachycardia pacing (ATP) for monomorphic VT (MVT) reduces painful defibrillation shocks. Most ICD-treated ventricular arrhythmias are MVT, suggesting an opportunity for improved ATP to decrease shocks. We report on a new algorithm (Yee, Circ AE 2017) that uses electrophysiologic (EP) first-principles to design ATP sequences in real-time. Heart-rate history is used to design the first ATP sequence, and failed ATP post-pacing interval is used to design later sequences.
Purpose
The purpose of this modeling study was to understand how this new ATP algorithm would perform in a head-to-head comparison with traditional burst ATP. Modeling allows direct comparison of the two algorithms in identical, realistic, patient-derived cardiac arrythmias.
Methods
Patient-specific late gadolinium enhanced MRI and EP data were used to build an adjudicated cohort of realistic numerical heart models with varied EP, infarct, border zone. Publicly available EP modeling software CARPentry was used to calculate sustained reentrant VT initiated with the programmed electrical stimulation used to induce VT clinically. The VTs were physician-adjudicated to validate models. Burst ATP was 3 sequences of 8 pulses at 88% of VT cycle length, each decremented by 10ms. The new ATP was limited to 3 automatically designed sequences.
Results
Three hundred unique VT scenarios were generated from 6 human hearts with multiple VT circuits, 5 electrophysiologic states, and 10 pacing locations. Burst ATP terminated 168/300 VTs (56%) and accelerated 2.7%. The new ATP terminated 234/300 VTs (78%) with the same acceleration. The two dominant ATP failure mechanisms were identified as 1) insufficient prematurity to close the excitable gap, and 2) failure to reach the critical isthmus of the VT circuit. For these mechanisms, the new ATP algorithm reduce failures from 64 to 28 (44% reduction) without increasing acceleration.
Conclusion
The new automated ATP algorithm successfully adapted ATP sequences for VT episodes that burst ATP failed to terminate. The new ATP was successful even with complex scar geometries and electrophysiology heterogeneity as seen in the real world.
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Affiliation(s)
- D Swenson
- Medtronic, Minneapolis, United States of America
| | - J Blauer
- Medtronic, Minneapolis, United States of America
| | - R Taepke
- Medtronic, Minneapolis, United States of America
| | - E Kwan
- University of Utah, Div of Cardiovascular Medicine, Salt Lake City, United States of America
| | - E Ghafoori
- University of Utah, Div of Cardiovascular Medicine, Salt Lake City, United States of America
| | - M Barton
- Medtronic, Minneapolis, United States of America
| | - J Tate
- University of Utah, Salt Lake City, United States of America
| | - J Coles
- Medtronic, Minneapolis, United States of America
| | - R MacLeod
- University of Utah, Salt Lake City, United States of America
| | - P Degroot
- University of Utah, Salt Lake City, United States of America
| | - R Ranjan
- University of Utah, Div of Cardiovascular Medicine, Salt Lake City, United States of America
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Ranjan R, Adhikary D, Adhikary AB. Pregnancy Outcome with Prosthetic Heart Valve in Bangladesh: A Retrospective Cohort Study. Mymensingh Med J 2019; 28:620-626. [PMID: 31391435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The aim of this retrospective cohort study was to evaluate the occurrence of the maternal and fetal outcome during pregnancy and immediately after delivery in women with prosthetic heart valve, especially with oral anticoagulants therapy that must be weighed against the risk of intracardiac thrombosis. This study was undertaken at Department of Cardiac surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2012 to December 2017. A total of 82 pregnancies with heart valve prosthesis were evaluated in two groups: Group I (n=58) includes pregnancy with mechanical heart valve, while Group II (n=24) includes pregnancy with bioprosthetic valve. The mean age of patients was 25.7±2.5 years and 24.9±5.5 years in Group I and Group II respectively. Approximately 70% pregnancies ended in healthy live births, however about 75% of study population developed maternal complications in Group I, which is significantly higher than Group II. First trimester spontaneous miscarriage was statistically significant between two groups (p value <0.005). Mean birth weight and mean APGAR score was found normal in both study group. Majority of the patients were found in good health status during and after pregnancy. Proper antenatal care and early risk stratification are the fundamental measures to improve the maternal and fetal outcome in a patient with prosthetic heart valve.
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Affiliation(s)
- R Ranjan
- Dr Redoy Ranjan, Assistant Professor, Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail: redoy_ranjan@ yahoo.com
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Agarwal A, Dhiraaj S, Raza M, Singhal V, Gupta D, Ranjan R, Singh PK, Singh U. Pain during Injection of Propofol: The Effect of Prior Administration of Ephedrine. Anaesth Intensive Care 2019; 32:657-60. [PMID: 15535489 DOI: 10.1177/0310057x0403200508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Propofol causes pain on intravenous injection in 28 to 90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. In a randomized, double-blind, placebo-controlled trial, we compared the efficacy of ephedrine 30 μg/kg pretreatment to lignocaine 40 mg for prevention of propofol-induced pain. Ninety-three adult patients, ASA 1 and 2, undergoing elective laparoscopic cholecystectomy were randomly assigned to three groups of 31 each. Group 1 received normal saline, group 2 received lignocaine 2% (40 mg) and group 3 received 30 μg/kg ephedrine. All pretreatment drugs were made up to 2 ml. Pain at the time of propofol injection was assessed on a four-point scale: 0=no pain, 1=mild pain, 2=moderate pain, and 3=severe pain. Twenty-seven patients (87%) of ephedrine pretreatment patients had pain during intravenous injection of propofol as compared to 24 (77%) in the normal saline group. In the lignocaine group, propofol-induced pain was observed in only 13 (42%) when compared with other study groups (P<0.05). Pretreatment with ephedrine 30 μg/kg did not attenuate pain associated with intravenous injection of propofol, nor did it improve haemodynamic stability during induction. However, pretreatment with 2% lignocaine (40 mg) was effective in attenuating propofol-associated pain.
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Affiliation(s)
- A Agarwal
- Department of Anesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Abstract
Syphilis is notorious and a great imitator of all diseases. It is a chronic bacterial infection, caused by the sexually transmitted spirochete, Treponema pallidum. Though it has drastically reduced in prevalence, its recent resurgence (especially with HIV disease) is worrying. Without treatment, the disease can progress over years through a series of clinical stages and lead to irreversible neurological or cardiovascular complications. The disease may occur in any organ, including the testis, and is commonly mistaken for malignancy. We report a case of scrotal abscess consequent on epididymo-orchitis, confirmed by histopathological examination to be syphilitic in origin, in an immunocompromised HIV-positive patient.
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Affiliation(s)
- Vivek Agrawal
- 1 Director Professor, Department of Surgery, UCMS and GTB Hospital, New Delhi, India
| | - Rohit Ranjan
- 2 Junior Resident, Department of Surgery, UCMS and GTB Hospital, New Delhi, India
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Rajappa S, Bhakuni Y, Ram D, Shukla H, Ranjan R, Dewan A, Dabas S, Dewan A. A gland of diverse pathology and unpredictable behaviour: our experience of primary submandibular gland malignancies. Int J Oral Maxillofac Surg 2018; 47:1243-1249. [DOI: 10.1016/j.ijom.2018.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/22/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022]
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Mishra S, Sahu SK, Panigrahi S, Biswal SS, Mishra SR, Ranjan R, Mohanty DN, Pattnaik B, Das S. Comparative therapeutic efficacy of levofloxacin, ornidazole and alpha tocopherol combination with prostaglandin F2α on IL-6 and IL-10 transcript level in longstanding cases of endometritis in crossbreed Jersey cows. Iran J Vet Res 2018; 19:217-224. [PMID: 30349569 PMCID: PMC6184032] [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] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/12/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
This study compared the therapeutic efficacy of levofloxacin, ornidazole and alpha tocopherol combination and prostaglandin F2α (PGF2α) in longstanding cases of endometritis and evaluated their impact on Interleukin-6 (IL-6) and Interleukin-10 (IL-10) transcript level in peripheral blood leukocytes. Eighteen endometritic crossbred Jersey cows were randomly allotted to three groups (six in each) viz. Group I (levofloxacin combo treatment I/U), group II (PGF2α treatment I/M), group III (no treatment, control), and group IV (six non-endometritic healthy cyclic) was taken for comparison study. The clinical efficacy was assessed by haematological study (TLC: Total leukocyte count; DC: Differential count), polymorphonuclear leukocytes (PMN) count in uterine cytology and relative mRNA expression of IL-6 and IL-10 in peripheral blood leukocytes before and after treatment with respect to conception rate following single and second inseminations. Group I and II registered significant increase in TLC and neutrophil count. PMN cytology was increased two and three fold in group I and II, respectively. The IL-6 transcript level was increased by 2.5 and 4.6 fold while that of IL-10 increased by 3.7 and 5.2 fold in group I and II, respectively. Conception rate across group I to IV following single insemination was found to be 66.67%, 50%, 16.67%, and 83.33% and their corresponding values following second insemination were 66.67%, 83.33%, 16.67%, and 83.33%, respectively. Thus, the administration of levofloxacin combo and PGF2α might have better conception rate following first and second insemination, respectively. Our study also reveals that PGF2α could register better clearance of bacteria through stronger PMN cell and cytokine activity in post-treatment period.
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Affiliation(s)
- S. Mishra
- MVSc in Animal Reproduction, Gynaecology and Obstetrics, Department of Animal Reproduction, Gynaecology and Obstetrics, College of Veterinary Science & Animal Husbandry, Orissa University of Agriculture and Technology, Bhubaneswar, 751003, India
| | - S. K. Sahu
- Ph.D. Scholar in Veterinary Gynaecology and Obstetrics, Department of Veterinary Gynaecology and Obstetrics, ICAR-National Dairy Research Institute, Karnal, Haryana, 132001, India
| | - S. Panigrahi
- Ph.D. Scholar in Animal Genetics and Breeding, Department of Animal Genetics & Breeding, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati-781022, India
| | - S. S. Biswal
- Department of Teaching Veterinary Clinical Complex, College of Veterinary Science & Animal Husbandry, Orissa University of Agriculture and Technology, Bhubaneswar, 751003, India
| | - S. R. Mishra
- Department of Veterinary Physiology, College of Veterinary Science & Animal Husbandry, Orissa University of Agriculture and Technology, Bhubaneswar, 751003, India
| | - R. Ranjan
- ICAR-Project Directorate on Foot-and-Mouth Disease, Mukteshwar, Nainital, Uttarakhand, 263138, India
| | - D. N. Mohanty
- Department of Animal Reproduction, Gynaecology and Obstetrics, College of Veterinary Science & Animal Husbandry, Orissa University of Agriculture and Technology, Bhubaneswar, 751003, India
| | - B. Pattnaik
- ICAR-Project Directorate on Foot-and-Mouth Disease, Mukteshwar, Nainital, Uttarakhand, 263138, India
| | - S. Das
- Department of Animal Reproduction, Gynaecology and Obstetrics, College of Veterinary Science & Animal Husbandry, Orissa University of Agriculture and Technology, Bhubaneswar, 751003, India
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Hayer SS, VanderWaal K, Ranjan R, Biswal JK, Subramaniam S, Mohapatra JK, Sharma GK, Rout M, Dash BB, Das B, Prusty BR, Sharma AK, Stenfeldt C, Perez A, Delgado AH, Sharma MK, Rodriguez LL, Pattnaik B, Arzt J. Foot-and-mouth disease virus transmission dynamics and persistence in a herd of vaccinated dairy cattle in India. Transbound Emerg Dis 2017; 65:e404-e415. [PMID: 29205858 DOI: 10.1111/tbed.12774] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Indexed: 11/28/2022]
Abstract
Foot-and-mouth disease (FMD) is an important transboundary disease with substantial economic impacts. Although between-herd transmission of the disease has been well studied, studies focusing on within-herd transmission using farm-level outbreak data are rare. The aim of this study was to estimate parameters associated with within-herd transmission, host physiological factors and FMD virus (FMDV) persistence using data collected from an outbreak that occurred at a large, organized dairy farm in India. Of 1,836 regularly vaccinated, adult dairy cattle, 222 had clinical signs of FMD over a 39-day period. Assuming homogenous mixing, a frequency-dependent compartmental model of disease transmission was built. The transmission coefficient and basic reproductive number were estimated to be between 16.2-18.4 and 67-88, respectively. Non-pregnant animals were more likely to manifest clinical signs of FMD as compared to pregnant cattle. Based on oropharyngeal fluid (probang) sampling and FMDV-specific RT-PCR, four of 36 longitudinally sampled animals (14%) were persistently infected carriers 10.5 months post-outbreak. There was no statistical difference between subclinical and clinically infected animals in the duration of the carrier state. However, prevalence of NSP-ELISA antibodies differed significantly between subclinical and clinically infected animals 12 months after the outbreak with 83% seroprevalence amongst clinically infected cattle compared to 69% of subclinical animals. This study further elucidates within-herd FMD transmission dynamics during the acute-phase and characterizes duration of FMDV persistence and seroprevalence of FMD under natural conditions in an endemic setting.
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Affiliation(s)
- S S Hayer
- UMN, STEMMA Laboratory, Veterinary Population Medicine, University of Minnesota, St Paul, MN, USA
| | - K VanderWaal
- UMN, STEMMA Laboratory, Veterinary Population Medicine, University of Minnesota, St Paul, MN, USA
| | - R Ranjan
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - J K Biswal
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - S Subramaniam
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - J K Mohapatra
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - G K Sharma
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - M Rout
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - B B Dash
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - B Das
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - B R Prusty
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - A K Sharma
- ICAR-Indian Veterinary Research Institute, Mukteshwar, Nainital, Uttarakhand, India
| | - C Stenfeldt
- UMN, STEMMA Laboratory, Veterinary Population Medicine, University of Minnesota, St Paul, MN, USA.,Foreign Animal Disease Research Unit, USDA-ARS, Plum Island Animal Disease Center, Greenport, NY, USA
| | - A Perez
- UMN, STEMMA Laboratory, Veterinary Population Medicine, University of Minnesota, St Paul, MN, USA
| | - A H Delgado
- Center for Epidemiology and Animal Health, APHIS, USDA, Fort Collins, CO, USA
| | - M K Sharma
- ABIS Dairy, Rajnandgaon, Chhattisgarh, India
| | - L L Rodriguez
- Foreign Animal Disease Research Unit, USDA-ARS, Plum Island Animal Disease Center, Greenport, NY, USA
| | - B Pattnaik
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - J Arzt
- Foreign Animal Disease Research Unit, USDA-ARS, Plum Island Animal Disease Center, Greenport, NY, USA
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Abstract
Background: Oral health is an integral part of general health. Poor oral health can have adverse effect on general health hence a good oral health is very essential, which in turn is achieved by good oral hygiene. Even though, the concept of good oral hygiene evolved 5000 years back, it is only in the beginning of 19th century it gained more importance. (1) Dental caries and periodontal disease are the most commonly occurring diseases affecting mankind. Dental plaque is a very important factor in the causation of both the diseases. (2) Aims & Objectives: To evaluate efficacy of four different types of toothbrushes, with difference in duration of brushing along with different bristle hardness in removal of microbial plaque. Material & Methods: In a randomized controlled trial, four groups with 40 subjects used manual toothbrushes with either hard, medium, soft and ultra-soft bristles. On baseline examination, clinical parameter plaque index (Sillness & Loe, 1964) was recorded. Selected subjects were refrained from all kinds of oral hygiene measures for 24 hrs before clinical appointment. On the day of clinical appointment scores of pre and post brushing were recorded in each patient when brushing time was set for 1 minute and same procedure was repeated after a wash off period of 3 days and similar recordings were made with brushing time of 11/2minute. Primary outcome was measured with differences in the plaque index (Sillness & Loe, 1964) compared to baseline. Results: Significant reduction in mean value of plaque score was observed on comparing pre-brushing and post-brushing data in all the subjects irrespective of bristle hardness in both 1 minute and 11/2 minute groups. On increasing time duration from 1 minute to 11/2 minute intergroup comparison revealed that significant correlation exist in mean plaque score reduction in subjects using medium bristle brush, soft bristle brush, ultra-soft bristle brush. However, no significant reduction in plaque score was observed on increasing duration from 1 minute to 11/2 minute in subjects using hard bristle brush. Conclusion: Manual toothbrushes with hard bristles better remove plaque, but may also cause more soft tissue trauma compared to brushes with softer bristles.
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Hayer SS, Ranjan R, Biswal JK, Subramaniam S, Mohapatra JK, Sharma GK, Rout M, Dash BB, Das B, Prusty BR, Sharma AK, Stenfeldt C, Perez A, Rodriguez LL, Pattnaik B, VanderWaal K, Arzt J. Quantitative characteristics of the foot-and-mouth disease carrier state under natural conditions in India. Transbound Emerg Dis 2017; 65:253-260. [PMID: 28251837 DOI: 10.1111/tbed.12627] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 09/14/2016] [Indexed: 11/28/2022]
Abstract
The goal of this study was to characterize the properties and duration of the foot-and-mouth disease (FMD) carrier state and associated serological responses subsequent to vaccination and naturally occurring infection at two farms in northern India. Despite previous vaccination of cattle in these herds, clinical signs of FMD occurred in October 2013 within a subset of animals at the farms containing juvenile-yearling heifers and steers (Farm A) and adult dairy cattle (Farm B). Subsequent to the outbreak, FMD virus (FMDV) asymptomatic carriers were identified in both herds by seroreactivity to FMDV non-structural proteins and detection of FMDV genomic RNA in oropharyngeal fluid. Carriers' seroreactivity and FMDV genome detection status were subsequently monitored monthly for 23 months. The mean extinction time of the carrier state was 13.1 ± 0.2 months, with extinction having occurred significantly faster amongst adult dairy cattle at Farm B compared to younger animals at Farm A. The rate of decrease in the proportion of carrier animals was calculated to be 0.07 per month. Seroprevalence against FMDV non-structural proteins decreased over the course of the study period, but was found to increase transiently following repeated vaccinations. These data provide novel insights into viral and host factors associated with the FMDV carrier state under natural conditions. The findings reported herein may be relevant to field veterinarians and governmental regulatory entities engaged in FMD response and control measures.
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Affiliation(s)
- S S Hayer
- UMN, STEMMA Laboratory, Veterinary Population Medicine, University of Minnesota, St Paul, MN, USA
| | - R Ranjan
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - J K Biswal
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - S Subramaniam
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - J K Mohapatra
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - G K Sharma
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - M Rout
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - B B Dash
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - B Das
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - B R Prusty
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - A K Sharma
- ICAR-Indian Veterinary Research Institute, Mukteshwar, Nainital, Uttarakhand, India
| | - C Stenfeldt
- Foreign Animal Disease Research Unit, USDA-ARS, Plum Island Animal Disease Center, Greenport, NY, USA.,PIADC Research Participation Program, Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - A Perez
- UMN, STEMMA Laboratory, Veterinary Population Medicine, University of Minnesota, St Paul, MN, USA
| | - L L Rodriguez
- Foreign Animal Disease Research Unit, USDA-ARS, Plum Island Animal Disease Center, Greenport, NY, USA
| | - B Pattnaik
- ICAR-Directorate of Foot and Mouth Disease, Mukteshwar, Nainital, Uttarakhand, India
| | - K VanderWaal
- UMN, STEMMA Laboratory, Veterinary Population Medicine, University of Minnesota, St Paul, MN, USA
| | - J Arzt
- Foreign Animal Disease Research Unit, USDA-ARS, Plum Island Animal Disease Center, Greenport, NY, USA
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Ranjan R, Singh RK, Kumar N, Dutta V. Pediatric subcutaneous panniculitis-like T-cell lymphoma presenting as paraparesis: An unreported manifestation. Neurol India 2016; 64:1035-6. [PMID: 27625250 DOI: 10.4103/0028-3886.190275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R Ranjan
- Department of Pathology, Command Hospital (CC) Lucknow, Uttar Pradesh, India
| | - Rajesh K Singh
- Department of Pathology, Command Hospital (CC) Lucknow, Uttar Pradesh, India
| | - Nidhish Kumar
- Department of Pathology, Command Hospital (CC) Lucknow, Uttar Pradesh, India
| | - Vibha Dutta
- Department of Pathology, Command Hospital (CC) Lucknow, Uttar Pradesh, India
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Jaywant SV, Singh AK, Prabhu MS, Ranjan R. Statin therapy/lipid lowering therapy among Indian adults with first acute coronary event: The dyslipidemia Residual and Mixed Abnormalities IN spite of Statin therapy (REMAINS) study. Indian Heart J 2016; 68:646-654. [PMID: 27773403 PMCID: PMC5079128 DOI: 10.1016/j.ihj.2015.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/30/2015] [Accepted: 12/22/2015] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The primary objective was to evaluate the effect of statin therapy/lipid lowering therapy (LLT) on lipid profile, in adults presenting with first acute coronary event. METHODS AND MATERIAL A multicentre, observational, prospective cohort study of lipid profiles pre- and post-statin therapy/LLT, among adult patients with confirmed diagnosis of first acute coronary event. The primary outcome measures were low-density lipoprotein cholesterol (LDL-C) in mg/dl, high-density lipoprotein cholesterol (HDL-C) in mg/dl and triglycerides (TG) in mg/dl at baseline and end of study (EOS, 12 weeks [mean: 13.5 weeks]). RESULTS Totally 474 patients completed the study. Number of patients with any LDL-C abnormality (LDL-C [all; LDL was abnormal, either alone or along with other lipid parameter(s)]) decreased from 118 (24.9%) to 27 (5.7%), and for LDL-C (only; only the LDL was abnormal), from 46 (9.7%) to 13 (2.7%), both from baseline to EOS. Of 118 patients with high LDL-C (all) at baseline, 91 (77.1%) had reduction in LDL-C to <100mg/dl, of which 54 (45.8%) had LDL-C <70mg/dl at EOS. The patients with LDL-C fraction abnormalities decreased, while HDL-C abnormalities increased at EOS from baseline. No major difference was observed at baseline and EOS in levels of TG (all [TG was abnormal, either alone or along with other lipid parameter(s)]) and TG (only [only the TG was abnormal]). Six (1.3%) had seven serious adverse events. CONCLUSIONS Though statin therapy is effective in lowering LDL-C, there still remains residual dyslipidemia, which probably should be tackled with therapeutic and non-therapeutic options.
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Affiliation(s)
| | | | | | - R Ranjan
- Associate Manager, Medical Affairs, MSD, India
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Ranjan A, Dumka VK, Ranjan R, Randhawa CS. Flubendiamide and Lead Exposure Alters Glial Fibrillary Acidic Protein and Aspartic Acid Concentrations in Cerebrospinal Fluid in Buffalo Calves. Toxicol Int 2016. [DOI: 10.22506/ti/2016/v23/i1/146666] [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: 11/27/2022] Open
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Rahman MM, Ranjan R, Khan OS, Aftabuddin M, Hoque MR. Left Atrial Myxoma in a Late Case of Lung Carcinoma. Mymensingh Med J 2016; 25:370-373. [PMID: 27277375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Concomitant occurrence of lung carcinoma and an atrial myxoma is rare. We are reporting such a case, a 55 year old male, farmer, smoker for 30 years was under evaluation for his recent episode of stroke with hemiparesis during which an echocardiography showed presence of a left atrial myxoma and chest x-ray showed a lesion in the midzone of right lung. Fine needle aspiration cytology (FNAC) from enlarged right supraclavicular lymphnode revealed metastatic adenocarcinoma. Patient was referred to a tertiary cancer care hospital thereafter.
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Affiliation(s)
- M M Rahman
- Dr Md Mushfiqur Rahman, MS Resident (Phase-B), Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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Sood M, Ranjan R, Chadda R, Khandelwal S. Changing Pattern of Clinical Profile of First Contact Patients Attending Outpatient Services At the General Hospital Psychiatric Units In India Over the Last 50 Years. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IntroductionOver the last eight decades, general hospital psychiatric units (GHPUs) have become important mental health service set-ups in India. This period has seen a large number of radical changes in the Indian society. In this background, it is important to know if it had any effects on the patients attending the GHPUs.MethodologyA total of five hundred subjects, attending a GHPU were recruited prospectively for the study. The subjects were assessed using a semi-structured proforma. A comparison was made with similar studies conducted in GHPU settings over the last 5 decades.ResultsNeurotic, stress related and somatoform disorders was the commonest diagnostic group (33%) followed by psychotic disorders (17%) and mood disorders (15%). The finding is broadly similar to the studies done at different times in the last 5 decades. However, there were lesser number of patients with mental retardation, organic brain syndrome and seizure disorder.ConclusionThe study highlights the strengths of GHPU set-ups like inter-speciality referrals, fewer stigmas, patients travelling from far off places to seek treatment and involvement of family in the care of mentally ill.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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