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1. Repair by Primary Closure of Traumatic Blunt Duodenal Injuries: Simple is Not Always Safe

Author

Dinesh Bagaria, Harshit Agarwal, Abhishek Jaiswal, Anand Katiyar, Shivam Pandey, Narendra Choudhary, Junaid Alam, Biplab Mishra, Sushma Sagar, Subodh Kumar, and Amit Gupta

Subjects
Duodenum, Humans, Surgery, Abdominal Injuries, Vascular System Injuries, Hypotension, Wounds, Nonpenetrating
Abstract

Recent literature on managing traumatic duodenal injuries suggests the superiority of primary repair. We hypothesized that duodenal trauma repair by primary closure might not be a safe strategy in an environment dealing predominantly blunt injuries with limited resources.Data analysis was done from the prospectively maintained trauma registry. The study period chosen was from January 1, 2014 to December 31, 2018. Data of 63 patients were analyzed for demographics, injuries, management, and outcome. Logistic regression was used to identify mortality predictors.The most common mechanism of injury was blunt (56/63, 88.9%). Forty (63.5%) patients had associated intraabdominal injuries. The most common American Association for the Surgery of Trauma grade of injury to the duodenum was three in 21 patients. Univariate analysis showed that mortality was associated with hypotension on presentation, higher duodenal grade, associated abdominal vascular injuries, primary closure, and duodenal leak. Logistic regression showed associated associated abdominal vascular injuries, primary closure, and leak remained significant predictors of mortality.Primary repair was found to be an independent predictor of mortality. A patient's physiology is a critical determinant of the outcome. Liberal use of tube duodenostomy over primary repair seems reasonable for blunt duodenal injury management.

Published
2022
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2. Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study

Author

Purva Mathur, Paul Malpiedi, Kamini Walia, Padmini Srikantiah, Sunil Gupta, Ayush Lohiya, Arunaloke Chakrabarti, Pallab Ray, Manisha Biswal, Neelam Taneja, Priscilla Rupali, Veeraraghavan Balaji, Camilla Rodrigues, Vijaya Lakshmi Nag, Vibhor Tak, Vimala Venkatesh, Chiranjay Mukhopadhyay, Vijayshri Deotale, Kanne Padmaja, Chand Wattal, Sanjay Bhattacharya, Tadepalli Karuna, Bijayini Behera, Sanjeev Singh, Reema Nath, Raja Ray, Sujata Baveja, Bashir A Fomda, Khumanthem Sulochana Devi, Padma Das, Neeta Khandelwal, Prachi Verma, Prithwis Bhattacharyya, Rajni Gaind, Lata Kapoor, Neil Gupta, Aditya Sharma, Daniel VanderEnde, Valan Siromany, Kayla Laserson, Randeep Guleria, Rajesh Malhotra, Omika Katoch, Sonal Katyal, Surbhi Khurana, Subodh Kumar, Richa Agrawal, Kapil Dev Soni, Sushma Sagar, Naveet Wig, Pramod Garg, Arti Kapil, Rakesh Lodha, Manoj Sahu, M.C. Misra, Mamta Lamba, Shristi Jain, Hema Paul, Joy Sarojini Michael, Pradeep Kumar Bhatia, Kuldeep Singh, Neeraj Gupta, Daisy Khera, D Himanshu, Sheetal Verma, Prashant Gupta, Mala Kumar, Mohammed Pervez Khan, Sarika Gupta, Vandana Kalwaje Eshwara, Muralidhar Varma, Ruchita Attal, Sukanya Sudhaharan, Neeraj Goel, Saurabh Saigal, Sagar Khadanga, Ayush Gupta, M.A. Thirunarayan, Nandini Sethuraman, Ujjaini Roy, Hirak Jyoti Raj, Desma D'Souza, Mammen Chandy, Sudipta Mukherjee, Manas Kumar Roy, Gaurav Goel, Swagata Tripathy, Satyajeet Misra, Anupam Dey, Tushar Misra, Rashmi Ranjan Das, Gulnaz Bashir, Shaista Nazir, Khuraijam Ranjana Devi, Langpoklakpam Chaoba Singh, Anudita Bhargava, Ujjwala Gaikwad, Geeta Vaghela, Tanvi Sukharamwala, Anil Ch. Phukan, Clarissa Lyngdoh, Rushika Saksena, Rajeev Sharma, and Anoop Velayudhan

Subjects
Tertiary Care Centers, Cross Infection, Anti-Infective Agents, Klebsiella, Sepsis, Urinary Tract Infections, Infant, Newborn, Humans, Pneumonia, Ventilator-Associated, Prospective Studies, General Medicine, Child
Abstract

Health-care-associated infections (HAIs) cause significant morbidity and mortality globally, including in low-income and middle-income countries (LMICs). Networks of hospitals implementing standardised HAI surveillance can provide valuable data on HAI burden, and identify and monitor HAI prevention gaps. Hospitals in many LMICs use HAI case definitions developed for higher-resourced settings, which require human resources and laboratory and imaging tests that are often not available.A network of 26 tertiary-level hospitals in India was created to implement HAI surveillance and prevention activities. Existing HAI case definitions were modified to facilitate standardised, resource-appropriate surveillance across hospitals. Hospitals identified health-care-associated bloodstream infections and urinary tract infections (UTIs) and reported clinical and microbiological data to the network for analysis.26 network hospitals reported 2622 health-care-associated bloodstream infections and 737 health-care-associated UTIs from 89 intensive care units (ICUs) between May 1, 2017, and Oct 31, 2018. Central line-associated bloodstream infection rates were highest in neonatal ICUs (20 per 1000 central line days). Catheter-associated UTI rates were highest in paediatric medical ICUs (4·5 per 1000 urinary catheter days). Klebsiella spp (24·8%) were the most frequent organism in bloodstream infections and Candida spp (29·4%) in UTIs. Carbapenem resistance was common in Gram-negative infections, occurring in 72% of bloodstream infections and 76% of UTIs caused by Klebsiella spp, 77% of bloodstream infections and 76% of UTIs caused by Acinetobacter spp, and 64% of bloodstream infections and 72% of UTIs caused by Pseudomonas spp.The first standardised HAI surveillance network in India has succeeded in implementing locally adapted and context-appropriate protocols consistently across hospitals and has been able to identify a large number of HAIs. Network data show high HAI and antimicrobial resistance rates in tertiary hospitals, showing the importance of implementing multimodal HAI prevention and antimicrobial resistance containment strategies.US Centers for Disease Control and Prevention cooperative agreement with All India Institute of Medical Sciences, New Delhi.For the Hindi translation of the abstract see Supplementary Materials section.

Published
2022
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6. Complicated Facial Lacerations: Challenges in the Repair and Management of Complications by a Facial Trauma Team

Author

Moumita De, Sushma Sagar, Aniket Dave, Ruchi Pathak Kaul, and Maneesh Singhal

Subjects
integumentary system, Otorhinolaryngology, Surgery, Oral Surgery
Abstract

Study Design: This is a descriptive study where we present our experience in managing complicated facial wounds over a period of 1 year at a level 1 trauma centre by a dedicated facial trauma team consisting of a plastic surgeon, a trauma surgeon and a Maxillofacial surgeon. Objective: Facial deformities have profound impact on the social and psychological aspect of a person’s life. Hence, management of facial wounds is very crucial. Most of the facial injuries are usually managed by emergency care physician and emergency surgeon. But certain wounds require specialised knowledge and care due to their complicated nature. The objective of this paper is to highlight those special types of wounds and the challenges they pose. It also aims to enumerate the best possible management according to each situation in a protocol-based manner, which will help in decision making by the attending emergency physician/surgeon. Methods: Facial lacerations were designated as “complicated” according to some pre-defined features and pre, intra and post operative data and photographs were collected by interviewing the concerned surgical team. The data were analysed and presented as different clinical scenarios. Results: The cases were broadly grouped under 6 scenarios according to the unique combination of difficulties faced and their specific management. The challenges faced were enumerated and the steps undertaken were also mentioned against them. Lastly, the scenarios were compared with available literature to find out the best possible management in each situation and to present them in a protocol-based manner. Conclusion: Protocol-based management of injuries to the different parts and specialised structures of the face is extremely helpful. Role of a specialised facial trauma team also should be emphasised in complicated facial injuries.

Published
2022
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7. Revisiting Role of Bilateral Ligation of Internal Iliac Arteries and Preperitoneal Pelvic Packing for Hemorrhage Control in Patients with Pelvic Injuries in Resource Constraint Settings

Author

Pratyusha Priyadarshini, Narendra Choudhary, Junaid Alam, Sushma Sagar, Niladri Banerjee, Amit Gupta, Dinesh Bagaria, Biplab Mishra, Majid Anwer, Subodh Kumar, and Abhinav Kumar

Subjects
Resuscitation, medicine.medical_specialty, business.industry, medicine.disease, Surgery, Blood pressure, Damage control surgery, Blunt trauma, Shock (circulatory), Pelvic fracture, Medicine, Hybrid operating room, medicine.symptom, Ligation, business
Abstract

BackgroundSince the description of bilateral ligation of internal iliac arteries (BLIIA) and preperitoneal pelvic packing (PPP) for haemorrhage control in pelvic injury patients, multiple reports have been published advocating its use with acceptable outcomes. We analyzed our experience with this technique in a setting where the facility of hybrid Operating room for simultaneous angioembolisation is not available.Material and MethodsWe prospectively analysed data of sixty-six patients who presented in a state of unresponsive shock with pelvic fracture between January 2014 and September 2019. After initial resuscitation, they all underwent BLIIA with PPP as part of damage control surgery.ResultsOut of 66 patients, 55 were male. The mean age was 36.12 years. All patients sustained blunt trauma, with road traffic injuries being the most common mechanism involving 65 % of the patients followed by fall from height. The mean systolic blood pressure at the time of surgery was 77 ±34.46mm Hg. Median packed red blood cell transfusion in the first 24 hours was 8.5 units with IQR of 6-12. The hemorrhage related mortality was 48%.ConclusionBLIIA with PPP may be considered as a viable treatment option in hemodynamically unstable patients with pelvic injuries in resource constraint facilities.

Published
2022
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12. Validation of the adapted clavien dindo in trauma (ACDiT) scale to grade management related complications at a level I trauma center

Author

Niladri Banerjee, Dinesh Bagaria, Harshit Agarwal, Anand Kumar Katiyar, Subodh Kumar, Sushma Sagar, Biplab Mishra, and Amit Gupta

Subjects
General Earth and Planetary Sciences, Original Article, General Environmental Science
Abstract

Objective: Complications during trauma management are the main factor responsible for the overall increase in treatment cost. There are very few grading systems to measure the burden of complications in trauma patients. A prospective study was conducted using the Adapted Clavien Dindo in Trauma (ACDiT) scale, with the primary aim of validating it at our center. As a secondary aim, it was also wanted to measure the mortality burden among our admitted patients. Material and Methods: The study was conducted at a dedicated trauma center. All patients with acute injuries, who were admitted, were included. An initial treatment plan was made within 24 hours of admission. Any deviation from this was recorded and graded according to the ACDiT. The grading was correlated with hospital-free days and ICU-free days within 30 days. Results: A total of 505 patients were included in this study, with a mean age of 31 years. The most common mechanism of injury was road traffic injury, with a median ISS and NISS of 13 and 14, respectively. Two hundred and forty-eight out of 505 patients had some grade of complication as determined by the ACDiT scale. Hospital-free days (13.5 vs. 25; p< 0.001) were significantly lower in patients with complications than those without complications, and so were ICU-free days (29 vs. 30; p< 0.001). Significant differences were also observed when comparing mean hospital free and ICU free days across various ACDiT grades. Overall mortality of the population was 8.3 %, the majority of whom were hypotensive on arrival and required ICU care. Conclusion: We successfully validated the ACDiT scale at our center. We recommend using this scale to objectively measure in-hospital complications and improve trauma management quality. ACDiT scale should be one of the data points in any trauma database/registry.

Published
2022

14. DIFFERENTIAL REACTION OF RICE CULTIVARS IN SEED GERMINATION AND SEEDLING VIGOUR IN Trichoderma harzianum TREATED SEEDS

Author

Lakshman Prasad, Someshree Mane, Aditi Singh, Sushma Sagar, Gyanendra Singh1 And A.K. Singh1 Division Of Plant Pathology, 1Division Of Genetics, ICAR-Indian Agricultural Research Institute, New Delhi-110012, India Laxmanprasad25@Yahoo.Com

Abstract

Rice is one of the most important food crop drastically affected by several biotic and abiotic factors. The present study aimed to examine differential response of rice cultivars treated with Trichoderma harzianum to improve seed germination and seedling vigour. To obtain higher quality seedlings T. harzianum can be employed. Trichoderma stimulates seedlings growth through accelerating nutrient absorption and inhibiting harmful root microorganisms. The seeds of rice cultivars were treated in T. harzianum suspension @107 conidia/ml and kept overnight and then next day arranged in germination paper containing 200 seeds each. Seeds were soaked in sterilised water only serve as control. The results showed that among the treated paddy cultivars the maximum per cent increase in seed vigour index was observed in PB-1886 followed by PB-1885, PB-1718 and PB-1509. Similarly, the maximum per cent increase in shoot length and root length was recorded in PB-1886 and PB-1885, respectively. Two cultivars namely PB-1886 and PB-1885 were found highly responsive to T. harzianum. Hence, it can be concluded that T. harzianum increased rice seedling growth, germination rate, seedling biomass and vigour. Keywords: Rice, Seed germination, Seedling vigour, Seedling biomass, Trichoderma.

Published
2022
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16. Does ATLS Training Work? 10-Year Follow-Up of ATLS India Program

Author

Amulya Rattan, Parli R. Ravi, Sushma Sagar, Mahesh C. Misra, Radhesh Nambiar, Suresh Sangi, Vinod Jain, Neerja Bannerjee, Amit Gupta, and Subodh Kumar

Subjects
medicine.medical_specialty, Delphi Technique, Delphi method, India, 03 medical and health sciences, 0302 clinical medicine, Trauma management, Physicians, Humans, Medicine, Psychomotor learning, Trauma Severity Indices, business.industry, 10 year follow up, Indian scenario, Advanced Trauma Life Support Care, 030220 oncology & carcinogenesis, Family medicine, Organizational skills, Wounds and Injuries, Education, Medical, Continuing, 030211 gastroenterology & hepatology, Surgery, Clinical Competence, Curriculum, Survey instrument, business, Follow-Up Studies, Program Evaluation
Abstract

Background Studies evaluating the efficacy of ATLS in low- and middle-income countries are limited. We followed up ATLS providers certified by the ATLS India program over a decade (2009 to 2019), aiming to measure the benefits in knowledge, skills, attitude and their attrition over time. Methods The survey instrument was developed taking a cue from published literature on ATLS and improvised using the Delphi method. Randomly selected ATLS providers were sent the survey instrument via email as a Google form, along with a statement of purpose. Results are presented descriptively. Results ATLS India trained 7,847 providers over the study period. 2500 providers were selected for the survery using computer-generated random number table. One thousand and thirty doctors (41.2%) responded. Improvement in knowledge (n = 1,013 [98.3%]), psychomotor skills (n = 986 [95.7%]), organizational skills (n = 998 [96.9%]), overall trauma management (n = 1,013 [98.7%]) and self-confidence (n = 939 [91%]) were reported. Majority (904 [87.8%]) started ATLS promulgation at workplace in personal capacity. These benefits lasted beyond 2 years in majority (>60%) of respondents. More than 40% reported cognitive (n = 492 [47.8%]), psychomotor (n = 433 [42%]), and organizational benefits (n = 499 [48.4%]) lasting beyond 3 years. Improvement in self-confidence, ATLS promulgation at the workplace, and retention of organizational skills were more pronounced in ATLS faculties than providers. All other benefits were found to be comparable in both sub-groups. Lack of trained staff (n = 660 [64.1%]) and attitude issues (n = 495 [48.1%]) were the major impediments in implementing ATLS at the workplace. More than a third of respondents (n = 373 [36.2%]) could enumerate one or more incidents where ATLS principles were life- or limb- saving. Conclusions Cognitive, psychomotor, organizational, and affective impact of ATLS is overwhelmingly positive in the Indian scenario. Until formal trauma systems are established, ATLS remains the best hope for critically injured patients in resource-contrained settings.

Published
2021
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17. The impact of minor injury cases at a level I trauma center: a retrospective observational study

Author

Vivek Kumar, Junaid Alam, R Theepan, Nitish Kumar, Subodh Kumar, Amit Gupta, and Sushma Sagar

Subjects
Male, Medical–Surgical Nursing, Trauma Centers, Humans, Surgery, Accidental Falls, Female, Retrospective Studies
Abstract

Introduction. Few studies have been done on the burden of minor injuries on trauma centers. Patients with minor injuries require care in the ED, which diverts staff time and resources from patients with more serious injuries and which can sometimes overwhelm the functioning of even the best trauma facility. Objective. This study was conducted to assess the burden of minor trauma and thus emphasize the need to develop further management protocols. Methods. A retrospective observational study was conducted at a level I trauma center for a period of 1 month (February 14, 2020 through March 14, 2020) to assess the burden of minor injuries at that facility. The study population included all patients who required ED care for minor injuries. Data collected included age, sex, time of presentation, anatomical region involved, and interventions done. Results. Of the 3293 patients, 1255 were triaged as green. Seven hundred ninety-one patients with 849 injuries required ED intervention in the minor operation theater. Of the 791 patients, most were male (84.32%), and 61.4% were aged 21 to 40 years. In decreasing order, the most common modes of injury were road traffic injuries (68.4%), fall (15%), and interpersonal violence (13.8%). Maxillofacial injuries were present in 26.15% of patients, 25.8% of patients presented with injuries to the head and neck, 24% with lower extremity injury, and 21.9% with upper extremity injury. Conclusions. The burden of minor trauma should be recognized. Knowledge of local trauma epidemiology and injury patterns is essential for trauma centers to function well. It is important that all trauma centers should have dedicated protocols in place and trained personnel to address these minor trauma cases.

Published
2022

18. Emerging role of phospholipase C mediated lipid signaling in abiotic stress tolerance and development in plants

Author

Sushma Sagar and Amarjeet Singh

Subjects
0106 biological sciences, 0301 basic medicine, Phospholipid, Plant Development, Plant Science, Biology, 01 natural sciences, Phosphates, Diglycerides, 03 medical and health sciences, chemistry.chemical_compound, Stress, Physiological, Inositol, Plant Proteins, Diacylglycerol kinase, Phospholipase C, Abiotic stress, General Medicine, Lipid signaling, Phosphatidic acid, Plants, Lipid Metabolism, Cell biology, 030104 developmental biology, chemistry, Type C Phospholipases, Phosphorylation, Agronomy and Crop Science, Aluminum, 010606 plant biology & botany
Abstract

Environmental stimuli are primarily perceived at the plasma membrane. Stimuli perception leads to membrane disintegration and generation of molecules which trigger lipid signaling. In plants, lipid signaling regulates important biological functions however, the molecular mechanism involved is unclear. Phospholipases C (PLCs) are important lipid-modifying enzymes in eukaryotes. In animals, PLCs by hydrolyzing phospholipids, such as phosphatidylinositol-4,5-bisphosphate [PI(4,5)P2] generate diacylglycerol (DAG) and inositol- 1,4,5-trisphosphate (IP3). However, in plants their phosphorylated variants i.e., phosphatidic acid (PA) and inositol hexakisphosphate (IP6) are proposed to mediate lipid signaling. Specific substrate preferences divide PLCs into phosphatidylinositol-PLC (PI-PLC) and non-specific PLCs (NPC). PLC activity is regulated by various cellular factors including, calcium (Ca2+) concentration, phospholipid substrate, and post-translational modifications. Both PI-PLCs and NPCs are implicated in plants' response to stresses and development. Emerging evidences show that PLCs regulate structural and developmental features, like stomata movement, microtubule organization, membrane remodelling and root development under abiotic stresses. Thus, crucial insights are provided into PLC mediated regulatory mechanism of abiotic stress responses in plants. In this review, we describe the structure and regulation of plant PLCs. In addition, cellular and physiological roles of PLCs in abiotic stresses, phosphorus deficiency, aluminium toxicity, pollen tube growth, and root development are discussed.

Published
2021
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19. Management of Blunt Solid Organ Injuries: the Indian Society for Trauma and Acute Care (ISTAC) Consensus Guidelines

Author

Pratyusha Priyadarshini, Kapil Dev Soni, Ajay Kumar, Niladri Banerjee, Sushma Sagar, Narendra Choudhary, Naveen Sharma, Shivanand Gammangatti, Peeyush Dhagat, Pawan Sharma, Gyan Saurabh, Mohit Kumar Joshi, Amita Jain, Dinesh Bagaria, Sunil Kumar, Rajesh Gupta, Satish Dharap, Samir Misra, Sandeep Kumar, Biplab Mishra, Shamita Chatterjee, Girish D. Bakhshi, Winston Noronha, Mallikarjun Gunjaganvi, Harshit Agarwal, Vikas Singh, Soumya Ghoshal, Sanjay Shah, Yogesh Meena, Rajashekar Mohan, Maneesh Singhal, Brijesh Sharma, Amulya Rattan, Vinod Jain, Megha Tandon, Richa Agarwal, Pramod Kumar Garg, Amit Kalangutkar, Abhinav Kumar, Subodh Kumar, Mahesh C Misra, Atin Kumar, Amit Gupta, L. N. Mohan, Sandeep Jain, Junaid Alam, and Vivek Kumar

Subjects
medicine.medical_specialty, business.industry, 030230 surgery, medicine.disease, Trauma care, 03 medical and health sciences, 0302 clinical medicine, Blunt, Abdominal trauma, 030220 oncology & carcinogenesis, Acute care, Pediatric surgery, Health care, Medicine, Surgery, Solid organ, Neurosurgery, business, Intensive care medicine
Abstract

Abdominal trauma management has seen a paradigm shift over the last few decades. There is wide variation in the treatment depending on the level of healthcare facilities available. With an aim to standardise the treatment of solid organ injuries in blunt abdominal trauma, Indian Society for Trauma and Acute Care (ISTAC®) formulated consensus guidelines to benefit doctors engaged in trauma care in the country.

Published
2021
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20. Buccal Fat Pad Injury—Delayed Presentation

Author

Sushma Sagar, Archana Sinha, Saravanan Lakshmanan, and Maneesh Singhal

Subjects
Plastic surgery, Buccal fat pad, medicine.medical_specialty, COVID-19, Oral injury, business.industry, Buccal fat pad injury, Incidence (epidemiology), Pediatric trauma, Images in Surgery, Emergency department, medicine.disease, Trauma surgery, humanities, Oral surgery, Pediatric surgery, Emergency medicine, Health care, medicine, Surgery, Presentation (obstetrics), business
Abstract

COVID-19 pandemic has been a major challenge for health care services all around the world. With increasing COVID-19 cases and lockdown enforcement, there has been a significant delay in the presentation of patients in the emergency department; also the fear in people of contracting COVID-19 from the hospital is an additional factor. The following case report describes such an incidence of delay in presentation of buccal fat pad injury patient to the emergency department.

Published
2021

21. Early hospital discharge following non-operative management of blunt liver and splenic trauma: A pilot randomized controlled trial

Author

Narendra Choudhary, Richa Aggarwal, Kapil Dev Soni, Pratyusha Priyadarshini, Biplab Mishra, Mohit Kumar Joshi, Harshit Agarwal, Vijayan Purushothaman, Majid Anwer, Sushma Sagar, Abhinav Kumar, Vignesh Kumar, Subodh Kumar, Amit Gupta, and Dinesh Bagaria

Subjects
Adult, Male, medicine.medical_specialty, Splenic trauma, Pilot Projects, Wounds, Nonpenetrating, Asymptomatic, Group B, law.invention, 03 medical and health sciences, Injury Severity Score, 0302 clinical medicine, Blunt, Randomized controlled trial, law, Hospital discharge, medicine, Humans, Child, Early discharge, Retrospective Studies, General Environmental Science, Liver injury, 030222 orthopedics, business.industry, 030208 emergency & critical care medicine, medicine.disease, Hospitals, Patient Discharge, Surgery, Treatment Outcome, Liver, General Earth and Planetary Sciences, Female, medicine.symptom, business, Spleen
Abstract

Background Despite the acceptance of non-operative management (NOM), there is no consensus on the optimal length of hospital stay in patients with blunt liver and splenic injury (BLSI). Recent studies on pediatric patients have demonstrated the safety of early discharge following NOM for BLSI. We aimed at evaluating the feasibility and safety of early discharge in adult patients with BLSI following NOM in a randomized controlled trial. Materials and methods After initial assessment and management, patients aged 18–60 years with BLSI planned for NOM were randomized into 2 groups: Group A (test group; discharge day 3), and Group B (control group; discharge day 5). Standard NOM protocol was followed. These patients were discharged on the proposed day if they met the pre-defined discharge criteria. All patients were followed at days 7, 15, and 30 of discharge. Results Sixty patients were recruited, 30 randomized to each arm. Most patients were males and aged less than 30 years. Road traffic injury was the most common mode of injury. Both groups were comparable in demography and injury-related parameters. 27 patients (90%) from group A and 28 patients (93%) from group B were discharged on the proposed day. Three patients had unplanned hospital visits for reasons unrelated to BLSI. All patients were asymptomatic and had a normal examination during their scheduled follow-up visits. Conclusion Adult patients undergoing NOM for BLSI can be safely discharged after 48 h of in-hospital observation, provided other injuries precluding discharge do not exist.

Published
2021
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22. Impact and Modifications of In-Hospital Trauma Care Workflow Due to COVID 19 Pandemic: Lessons Learnt for the Future

Author

Gaurav Kaushik, Ankita Sharma, Dinesh Bagaria, Subodh Kumar, Sushma Sagar, and Amit Gupta

Subjects
Hospital, emergency department, Pandemic, injury, RC86-88.9, infectious disease, COVID-19, Medical emergencies. Critical care. Intensive care. First aid, Original Article, Trauma Care
Abstract

Objective: To describe the restructuring in-hospital systems of care at a Level -1 trauma center in India and to analyze an injury volume and patterns for future preparedness as well as to establish a specific injuries preventive measures during health emergencies like COVID-19. Methods: Data was extracted from a prospectively managed trauma registry at level-1 trauma center in India. We have compared the data in lockdown period with the same day’s number from the pre-lockdown period. Patients were categorized according to age, gender, injury cause, injury place, injury severity, and injury outcome to compare the statistical analysis between two periods. Results: Total emergency department (ED) trauma footfall decreased significantly by 73% during lockdown period. The injuries result increased significantly due to blunt forces. There was a significant decrease in the major injury of the patient’s percentage. The road traffic injuries (RTIs) in individuals were less than the reported falls number, which increased significantly during lockdown. The less number of patients significantly presented without receiving primary care. Majority of the patients had been transferred by using private cars, police vehicle, and two wheelers during lockdown; however, patients’ less number were transferred significantly by three wheelers as expected. The comparative analysis between quantitative data points shows significant differences in median Injury Severity Score (ISS) and length of stay during lockdown. Conclusion: This study highlighted that the preparedness should not focus solely on the response to treat infectious disease during health emergencies but also on ensuring access and provision of reasonable quality of care for non-infectious illnesses especially acute conditions like trauma.

Published
2021

23. Contrast-enhanced computed tomography abdomen versus diagnostic laparoscopy-based management in patients with penetrating abdominal trauma: a randomised controlled trial

Author

Supreet Kaur, Dinesh Bagaria, Abhinav Kumar, Pratyusha Priyadarshini, Narendra Choudhary, Sushma Sagar, Amit Gupta, Biplap Mishra, Mohit Joshi, Atin Kumar, Shivanand Gamanagatti, Kapil Dev Soni, Richa Aggarwal, Sreenivas Vishnubhatla, and Subodh Kumar

Subjects
Emergency Medicine, Orthopedics and Sports Medicine, Surgery, Critical Care and Intensive Care Medicine
Abstract

Penetrating abdominal trauma was traditionally managed by mandatory exploration, which led to high rates of non-therapeutic surgery and prolonged hospital stay. Diagnostic laparoscopy (DL) is a less-invasive alternative; however, it requires general anaesthesia and carries a potential risk of iatrogenic injuries. Contrast-enhanced computed tomography (CECT)-guided selective non-operative management (SNOM) may avoid surgery altogether, but there is apprehension of missed injury. Randomised trials comparing these two modalities are lacking. This study is aimed at comparing outcomes of these two management approaches.Hemodynamically stable patients with penetrating trauma to anterior abdominal wall were randomised in 1:1 ratio to DL or CECT-based management. Primary outcome was length of hospital stay (LOS). Secondary outcomes were rate of non-therapeutic surgery, complications, and length of intensive care unit (ICU) stay.There were 52 patients in DL group and 54 patients in CECT group. Mean LOS was comparable (3 vs 3.5 days; p = 0.423). Rate of non-therapeutic surgery was significantly lower in CECT group (65.4 vs 17.4%, p = 0.0001). Rate of complications and length of ICU stay were similar. Selective non-operative management based on CECT findings was successful in 93.8% of patients; 2 patients had delayed surgery.In patients with penetrating trauma to anterior abdominal wall, DL and CECT-based management led to comparable hospital stay. Significant reduction in non-therapeutic surgery could be achieved using a CECT-based approach.Clinical trials registry-India (CTRI/2019/04/018721, REF/2019/01/023400).

Published
2022

24. No role of antibiotics in patients with chest trauma requiring inter-costal drain: a pilot randomized controlled trial

Author

Takio Teyi, Joses Dany James, Vivek Kumar, Dinesh Bagaria, Abhinav Kumar, Narendra Choudhary, Pratyusha Priyadarshini, Amit Gupta, Sushma Sagar, Biplab Mishra, and Subodh Kumar

Subjects
Emergency Medicine, Orthopedics and Sports Medicine, Surgery, Critical Care and Intensive Care Medicine
Abstract

To study the role of prolonged prophylactic antibiotic therapy (PAT) in the prevention of Inter-costal drain (ICD) related infectious complications in patients with Blunt Trauma Chest (BTC).Patients of age 15 years and above with BTC requiring ICD were included. Patients with penetrating chest injuries, associated injuries/illnesses requiring antibiotic administration, need for mechanical ventilation, known pulmonary disease or immuno-compromised status and need for open thoracotomy were excluded. 120 patients were randomized equally to two groups; no prolonged PAT group (Group A) and prolonged PAT group (group B). Both group patients received one shot of injectable antibiotic prior to ICD insertion. Primary outcome measure was comparison of ICD related infectious complications (pneumonia, empyema and SSI) and secondary outcome measures included the duration of ICD, Length of Hospital stay (LOS) and in-hospital mortality in both the groups.Infectious complications (pneumonia, empyema and SSI) were seen in only one patient in antibiotic group, and none in no antibiotic group (p value = 0.500). Other complications such as post ICD pain scores, respiratory failure requiring ventilatory support, retained hemothorax or recurrent pneumothorax, did not show any statistical difference between both groups. Also, no significant difference was seen in both the groups in terms of mean duration of ICD (p value = 0.600) and LOS (p value = 0.259).m CONCLUSION: Overall prevalence of ICD related infectious complications are low in BTC patients. Definitive role of prolonged prophylactic antibiotics in reducing infectious complications and other associated co morbidities in BTC patients with ICDs could not be established.Clinical Trial Registry, India (Trial registered at ctri.nic.in/clinical trials/login.php, number REF/2019/021704 dated 18/10/2019).

Published
2022

25. Digital workflow for treating comminuted anterior mandibular fracture — A technical note

Author

Ajoy Roychoudhury, Ragavi Alagarsamy, Sushma Sagar, Rahul Yadav, and Babu Lal

Subjects
Mandibular fracture, medicine.medical_treatment, Mandible, Surgical planning, Anterior region, Workflow, 03 medical and health sciences, 0302 clinical medicine, Mandibular Fractures, medicine, Humans, 030223 otorhinolaryngology, Reference model, Reduction (orthopedic surgery), Orthodontics, business.industry, Technical note, 030206 dentistry, medicine.disease, Surgery, Computer-Assisted, Otorhinolaryngology, Surgery, Oral Surgery, business, Bone Plates
Abstract

Comminuted mandibular fracture poses a surgical challenge. Extensive comminution and absence of reference adds complexity particularly in anterior region. In this technical note, we describe a novel application of virtual surgical planning combined with 3D printing which grants precise anatomic reduction in such cases. Computed Tomography data (mandible) of another patient of same age and sex was utilized to create reference model by virtual surgical planning. Virtually created model was 3D printed and utilized for precontouring the reconstruction plate which assisted in achieving satisfactory outcome.

Published
2021
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26. Crosstalk between T Helper Cell Subsets and Their Roles in Immunopathogenesis and Outcome of Polytrauma Patients

Author

Sushma Sagar, Purva Mathur, Rajesh Malhotra, Subodh Kumar, Nidhi Bhardwaj, Rahul Pal, Richa Aggarwal, Kapil Dev Soni, and Surbhi Khurana

Subjects
Critical Care and Intensive Care Medicine, Th-22, Trauma, Tr1, 03 medical and health sciences, 0302 clinical medicine, Immune system, RAR-related orphan receptor gamma, medicine, business.industry, 030208 emergency & critical care medicine, iTregs, T helper cell, Th-17, medicine.disease, Polytrauma, nTregs, Th-9, Crosstalk (biology), medicine.anatomical_structure, 030228 respiratory system, Immunology, Th-3, Early phase, business, Homeostasis, Research Article, IRF4
Abstract

Purpose One of the leading causes of morbidity and early-age mortality across the globe is trauma. It disrupts immune system homeostasis and intensely affects the innate and adaptive immune responses, predisposing patients to posttrauma complications and poor outcomes. Most of the studies on posttrauma cellular immune response have been centered on the T helper-1-T helper-2 imbalances after trauma. This study was conducted to understand the role of circulating novel T helper cells in the acute posttraumatic period and clinical outcome of trauma patients. Materials and methods Signature cytokines and transcription factors of circulating Th (T helper)-9, Th-17, Th-22, and regulatory T helper cells were studied using flowcytometry along with serum biomarkers in 49 patients with polytraumatic injuries admitted to a tertiary care hospital. The patients were followed up until their outcome. The results were correlated with their clinical outcomes. Results In patients who died, higher nTreg, iTreg, Tr1 (early-phase), and higher IRF4+Th-9, IL17+ Th-17, and RORγT+ Th-17 (mid-phase) were seen. However, by the late phase, only RORγT+ Th-17 remained higher. Serum IL-6 and PCT were found to be consistently higher. In survivors, higher Th-3 (early phase), Th-22 (mid-phase), and IRF4+Th-9, IL17+ Th-17, nTreg, Th-3 (late phase) were observed to have played a protective role. Serum IL-2, IL-4, IL-17A and IL-22 were significantly higher in survivors. Conclusion Different T helper subsets were observed to be playing pathogenic and protective roles in different phases of trauma and could be used for early prognostication and make way for noninvasive management of critically injured trauma patients by immunomodulation. How to cite this article Khurana S, Bhardwaj N, Kumar S, Sagar S, Pal R, Soni KD, et al. Crosstalk between T Helper Cell Subsets and Their Roles in Immunopathogenesis and Outcome of Polytrauma Patients. Indian J Crit Care Med 2020;24(11):1037–1044.

Published
2020
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27. Imaging Modalities in Trauma and Emergency—a Review

Author

Sushma Sagar, Subodh Kumar, Harshit Agarwal, Abhinav Kumar, Amit Gupta, and Niladri Banerjee

Subjects
medicine.medical_specialty, Resuscitation, Modality (human–computer interaction), Trauma patient, Modalities, genetic structures, business.industry, 030230 surgery, Trauma care, Imaging modalities, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Pediatric surgery, medicine, Surgery, Neurosurgery, Intensive care medicine, business
Abstract

Radiology plays a very important role in the management of acutely injured patients. As per the Advanced Trauma Life Support (ATLS) program, it has been made an integral part of primary and secondary surveys. The primary objective of the imaging during the primary survey is to identify immediately life-threatening injuries and to assist in resuscitation of the patient. While during the secondary survey, imaging modality is aimed to assist in definitive management of the trauma patient. However, imaging modality should never hamper the resuscitation process of the patient and should be used judiciously. This review is aimed to study the indications, advantages and disadvantages of these modalities and to guide the treating trauma surgeons about the utilization of imaging modalities in different aspects of the trauma care.

Published
2020
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28. Early Surgery in Trauma Patients Is a Key Performance Indicator of Outcome—A Case Series Analysis

Author

Narendra Choudhary, Abhinav Kumar, Dinesh Bagaria, Pratyusha Priyadarshini, Santosh Mahindrakar, Biplab Mishra, Subodh Kumar, Amit Gupta, Sushma Sagar, and Ankita Sharma

Subjects
medicine.medical_specialty, business.industry, Trauma center, Cardiac surgery, 03 medical and health sciences, Plastic surgery, 0302 clinical medicine, Interquartile range, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Emergency medicine, Pediatric surgery, medicine, 030211 gastroenterology & hepatology, Surgery, Neurosurgery, Presentation (obstetrics), business
Abstract

We analyzed one feasible timeline of critical surgery within the first hour of admission as a possible intervention, which could be applied in existing trauma systems in Low and middle-income countries (LMIC), and may improve trauma care outcomes. Retrospective analysis of a prospectively maintained data registry under project named TITCO (Towards Improved Trauma Care Outcome) was done at a level one trauma center in India from October 2013 to September 2015. All admitted patients who underwent critical surgery within the first hour of admission were analyzed. These patients were divided in two groups depending upon primary presentation or referred from other facility. Statistical analysis was done between these two groups to compare outcome. Sixty-one (57.6%) patients were directly admitted, whereas forty-five (42.4%) were transferred from other hospitals. The median time from injury to presentation for primary patients was 50 min with interquartile range (IQR) of 40. In referred patient median time gap between the injury to our center (not referring center) was 230 min with IQR of 350. This difference was statistically significant. Both the groups were comparable in terms of injury severity measured by ISS. Major outcome indicators in the form of median ICU and total stay, as well as mortality, were not significantly different. We propose that critical surgery within the first hour of presentation might be a useful hospital-based key performance indicator even in the existing trauma systems in LMIC to improve the outcome of injured patients.

Published
2020
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29. Train-Associated Injuries Pose a Significant Burden on Trauma Care Systems of Emerging Economies

Author

Niladri Banerjee, Narendra Choudhary, Dinesh Bagaria, Ravindra Mohan Pandey, Sushma Sagar, Biplab Mishra, Abhinav Kumar, Pratyusha Priyadarshini, Subodh Kumar, and Amit Gupta

Subjects
Adult, Male, medicine.medical_specialty, Original Scientific Report, Young Adult, 03 medical and health sciences, Injury Severity Score, 0302 clinical medicine, Trauma Centers, medicine, Humans, Hospital Mortality, Railroads, Retrospective Studies, business.industry, Incidence (epidemiology), Head injury, Trauma center, Length of Stay, Middle Aged, Vascular surgery, medicine.disease, Trauma care, Cardiac surgery, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Emergency medicine, Wounds and Injuries, Female, 030211 gastroenterology & hepatology, Surgery, business, Abdominal surgery
Abstract

Background The Indian railway system is the fourth largest in the world and causes about 15 deaths every day, due to intentional or unintentional reasons. This study presents a 5-year retrospective analysis of patients injured due to train-associated events, managed at a level-1 trauma center in India. Materials and methods Hospital-based trauma registry data of train-associated injuries presenting between 2012 and 2016 were analyzed. Data from 726 patients were analyzed for demographics, injury events, injury regions, their management and outcomes. ISS and NISS were used to quantify the injury severity. Results Mean age was 33 years, with male-to-female ratio 86 to 14%. The majority of patients (62%) were between 20–40 years. The median ISS was 9 (IQR 4–16), median hospital stays 11 days (IQR6-23), with in-hospital mortality of 17.4%. Presence of head injury; ISS > 9 and CPR in ED were independent risk factors of mortality. Trespassers on the rail track had significantly more severe injuries compared to passengers (Median ISS 13 vs. 9, p = 0.012; Median NISS 22 vs.17, p = 0.015); however, mortality and hospital length of stay were not significantly different. Location of injury event (on platform or tracks) showed no difference between the severity of injuries, mortality and hospital length of stay. Conclusions Current study reports comprehensive injury patterns and outcomes of train-associated injuries from a low- and middle-income country (LMIC). Apart from the mortality, there is a high incidence of permanent disabilities from extremity amputations. No significant difference was noted in the severity and outcomes among patients injured on or off train platforms, emphasizing the need for comprehensive safety measures including enforcement and promoting safe behavior not only on locations like train tracks but equally at platforms.

Published
2020
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30. Multidrug-Resistant Candida auris Fungemia in Critical Care Units: Experience from a Tertiary Care Hospital in India

Author

Sushma Sagar, Purva Mathur, Subodh Kumar, Aishwarya Govindaswamy, Rajesh Malhotra, Vijeta Bajpai, Immaculata Xess, and Pramod Kumar Garg

Subjects
Microbiology (medical), Pharmacology, 0303 health sciences, medicine.medical_specialty, 030306 microbiology, business.industry, Immunology, High mortality, Outbreak, Tertiary care hospital, medicine.disease, Microbiology, Intensive care unit, law.invention, Multiple drug resistance, 03 medical and health sciences, Candida auris, law, Internal medicine, Health care, medicine, business, Fungemia, 030304 developmental biology
Abstract

Candida auris, a recently identified multiresistant Candida species, was first reported in Japan in 2009. It is different from other pathogenic yeast species because of its propensity to cause outbreaks and transmits between patients within health care settings. The invasive infections caused by C. auris are associated with high mortality rates, approaching 70% particularly in intensive care unit patients. Conventional biochemical methods are inaccurate in identifying this species of Candida. Although C. auris is frequently reported as multi-, extended-, or pan drug resistant to antifungal drugs, there is a wide variability in the susceptibility among reports worldwide. In this study we report a case series of five hospitalized patients with multidrug-resistant candidemia caused by C. auris in a tertiary hospital in India. Our finding suggests that correct identification followed by therapeutic intervention is necessary for favorable outcome in patients with C. auris fungemia.

Published
2020
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31. Screening Wild Brassica Species Against Alternaria Brassicicola (Schw.) Wiltsh for Breeding Alternaria Leaf Spot Resistance in Brassica Vegetables

Author

Shrawan Singh, Sushma Sagar, Mahesh Rao, Sandhya Saroha, Pooja Garg, and Lakshman Prasad

Subjects
fungi, food and beverages
Abstract

Alternaria leaf spot (ALS) is a major disease of Brassica crops, and it causes huge economic losses to both the cultivated oilseed-and vegetable- Brassicas . The present study was aimed to develop a non-destructive robust method for screening of wild Brassica species and to find resistant wild species against Alternaria brassicicola (Schw.) Wiltsh available in the germplasm. For this, 38 wild Brassica species were screened at adult plant stage by an in vitro detached leaf inoculation method in three consecutive years i.e. 2019-20, 2020-21 and 2021-22. The new screening protocol provides favourable environment (temperature 25±2 °C; relative humidity >90%) for the pathogen and retained the host leaves in condition (by placing sucrose 5% w/v in petiolar base) for disease development. The consistency in reactions of the species against A. brassicicola during all three years of testing indicates the robustness of the protocol. Further, the multiple parameters were recorded on leaf condition and disease response of the wild species. Complete resistance was observed in Capsella while resistance in Lepidium , Camelina and Biscutella . Both Capsella bursa pastoris (L.) Medik (early) and C. bursa pastoris (late) were symptomless resistant. Camelina sativa (L.) Crantz, Diplotaxis erucoides (L.) DC and Diplotaxis gomez-campoi Mart.-Laborde were found to be resistant against A. brassicicola . The significant correlation between disease parameters indicates the robustness and effectiveness of the screening protocol for wild Brassica species.

Published
2022
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32. Imaging in extremity vascular trauma: can MDCT angiography predict the nature of injury?

Author

Deeksha Bhalla, Atin Kumar, Shivanand Gamanagatti, Sushma Sagar, Subodh Kumar, and Amit Gupta

Subjects
Computed Tomography Angiography, Multidetector Computed Tomography, Emergency Medicine, Angiography, Humans, Radiology, Nuclear Medicine and imaging, Extremities, Vascular System Injuries, Retrospective Studies
Abstract

This study aims to evaluate the utility of computed tomography angiography (CTA) signs of vascular injury in the differentiation of vessel transection from pure thrombosis with intact vessel wall.Retrospective analysis was done on 146 consecutive patients who had undergone CTA and surgical exploration from January 2015 to September 2019. Twelve imaging parameters were assessed. Chi-square was used to test the difference between groups. In addition, a scoring system was devised where one point each was added for the presence of 5 signs and absence of 3 signs. ROC analysis was done for the variables which had shown significant difference between groups and for the composite score.On surgical exploration, 87 patients had transection of vessel, while 59 had thrombosis. Significant difference was found among the two groups in non-opacification, pseudoaneurysm, extravasation (p = 0.04 each), thrombosed cord (p 0.001), collaterals (p = 0.001) and hematoma (p = 0.002), while other signs did not show significant difference. The AUC value for each of these variables was 0.650, while for the score, AUC was .843(.773-.913). A cut-off value of ≥ 1.5 gave 83.1% sensitivity and 70% specificity for diagnosing transection.CTA is a useful tool to classify the nature of vascular injury. It is advisable to use a composite score for maximum diagnostic value.

Published
2022

33. Enhanced recovery after surgery (ERAS) in patients undergoing emergency laparotomy after trauma: a prospective, randomized controlled trial

Author

Pratyusha Priyadarshini, Sushma Sagar, Narendra Choudhary, Vijayan Purushothaman, Purva Mathur, Dinesh Bagaria, Biplab Mishra, Mohit Kumar Joshi, Subodh Kumar, Amit Gupta, and Abhinav Kumar

Subjects
medicine.medical_specialty, RD1-811, medicine.medical_treatment, recovery of function, Critical Care and Intensive Care Medicine, law.invention, Randomized controlled trial, laparotomy, law, Laparotomy, medicine, Clinical endpoint, In patient, Trial registration, Enhanced recovery after surgery, business.industry, RC86-88.9, World Trauma Congress article, Medical emergencies. Critical care. Intensive care. First aid, Evidence-based medicine, Surgery, Clinical trial, emergency treatment, business, multiple trauma
Abstract

BackgroundThe role of enhanced recovery after surgery (ERAS) has been established in elective operations. However, its role in emergency operations especially in trauma is under-recognized. The aim of this study was to explore the safety and efficacy of ERAS program in patients undergoing emergency laparotomy for trauma.MethodsIn this single-center study, patients who underwent emergency laparotomy after trauma were randomized to the ERAS protocol or conventional care. The ERAS protocol included early removal of catheters, early initiation of diet, use of postoperative prophylaxis and optimal usage of analgesia. The primary endpoint was duration of hospital stay. The secondary endpoints were recovery of bowel function, pain scores, complications and readmission rate.ResultsThirty patients were enrolled in each arm. The ERAS group had significant reduction in duration of hospital stay (3.3±1.3 vs. 5.0±1.7; pConclusionERAS protocol, when implemented in patients undergoing laparotomy for trauma, has decreased duration of hospital stay with no additional complications.Level of evidenceLevel 1, randomized controlled trial, care management.Trial registration numberClinical Trials Registry of India (CTRI/2019/06/019533).

Published
2021

34. A COMPREHENSIVE OVERVIEW ON SHEATH BLIGHT DISEASE OF RICE AND ITS MANAGEMENT

Author

SORABH CHAUDHARY, SUSHMA SAGAR, and MEHI LAL

Subjects
Agriculture (General), fungi, food and beverages, Plant culture, Agriculture, sheath blight, r. solani, chemical control, biocontrol, rice transgenic, rnai, S1-972, SB1-1110
Abstract

Rice sheath blight disease, caused by Rhizoctonia solani Kühn (teleomorph Thanatephorus cucumeris [Frank] Donk), is a serious threat in rice growing countries. R. solani is a soil borne necrotic fungus that survives in plant debris as sclerotia, and is able to infect plants belonging to more than 27 plant families including economic important monocots and dicots. Management of sheath blight requires an integrated strategy based on the population structure, correct identification of pathogen at early stage and molecular aspects of rice defence responses against R. solani. This review summarizes elaborative and updated knowledge on taxonomic classification of the pathogen, disease etiology and economics, molecular aspects of R. solani pathogenicity and strategies for detection and diagnosis of the disease. Up to date information for management of sheath blight using various strategies are discussed Specifically, the effects of popular cultural practices influencing sheath blight incidence, various chemical fungicides, biological control individually and their combined effect on sheath blight are presented. Summarized and updated information of various biotechnological approaches viz., genetic transformation, host-delivered RNAi technology, genome-editing tools and nanotechnological approaches to enhance resistance in rice against sheath blight is mentioned in this review.

Published
2019

35. Study protocol to report the effectiveness of virtual reality therapy in combination with physical therapy protocol for improving balance in traumatic lower limb amputees: A parallel, open-label, randomized controlled trial

Author

Kalaivani Kalaivani, Chhavvi Sawhne, Avinash Dargave, Sushma Sagar, Rajesh Sagar, Saravana Moorthy, and Vivek Trikha

Subjects
medicine.medical_specialty, Rehabilitation, business.industry, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, Gait, Virtual reality therapy, law.invention, Occupational Therapy, Randomized controlled trial, Quality of life, law, Statistical significance, Postural stability, Physical therapy, Medicine, business, Balance (ability)
Abstract

INTRODUCTION: Virtual reality (VR) intervention was found to be feasible in lower limb amputees (LLA). To best of our knowledge, only there is no randomized controlled trial available regarding the rehabilitation of LLA using VR. Evidence suggest that more researches for amputee rehabilitation using VR is warranted. OBJECTIVE: To compare the effectiveness of VR therapy as an additional therapeutic adjunct with physical therapy protocol on limits of stability and postural stability, pain and quality of life among LLA. METHODS: A total of 100 LLA will be recruited by the simple random sampling (random number generator) from JPN Apex Trauma Centre, AIIMS to participate in randomized controlled trial. Recruited LLA will be randomly divided into two groups, virtual reality therapy along with physical therapy protocol (VRT-PTP) group and physical therapy protocol (PTP) group. Duration of the treatment will be 30 minutes in one session/day for 4 days/week for 3 weeks. Thus, each LLA will receive 12 sessions in total. The Biodex Balance System for measuring dynamic balance, NPRS for pain and quality of life by WHO Quality of Life-BREF (WHOQOL-BREF) are the outcome measures will be recorded at baseline, end of 3-week post-intervention period. The follow-up will be taken at 6th and 9th week after enrollment. RESULTS: Normality of the collected data will be confirmed by Kolmogorov-Smirnov test. Statistical significance within and between the groups will be determined. Effect size and power analysis will be performed. CONCLUSION: This study will present data for the efficacy of the VRT in improving balance and gait in addition to PTP.

Published
2019
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36. Multiple importations and transmission of colistin-resistantKlebsiella pneumoniaein a hospital in northern India

Author

Richa Aggarwal, Padmini Srikantiah, Anoop Velayudhan, Sushma Sagar, Purva Mathur, Manigandan Venkatesan, Rajesh Malhotra, Subodh Kumar, Balaji Veeraraghavan, Surbhi Khurana, Valan Siromany, Neil Gupta, Omika Katoch, Aditya Sharma, Neha Rastogi, Kapil Dev Soni, Tom J. B. de Man, Amit Gupta, Ayyan Raj Neeravi, Kayla F. Laserson, Joseph D. Lutgring, and Paul Malpiedi

Subjects
0301 basic medicine, Microbiology (medical), medicine.medical_specialty, biology, Epidemiology, Klebsiella pneumoniae, business.industry, medicine.drug_class, 030106 microbiology, Antibiotics, Broth microdilution, Drug resistance, Tigecycline, biology.organism_classification, Microbiology, Multiple drug resistance, 03 medical and health sciences, 030104 developmental biology, Infectious Diseases, medicine, Colistin, business, medicine.drug
Abstract

Objective:Resistance to colistin, a last resort antibiotic, has emerged in India. We investigated colistin-resistantKlebsiella pneumoniae(ColR-KP) in a hospital in India to describe infections, characterize resistance of isolates, compare concordance of detection methods, and identify transmission events.Design:Retrospective observational study.Methods:Case-patients were defined as individuals from whom ColR-KP was isolated from a clinical specimen between January 2016 and October 2017. Isolates resistant to colistin by Vitek 2 were confirmed by broth microdilution (BMD). Isolates underwent colistin susceptibility testing by disk diffusion and whole-genome sequencing. Medical records were reviewed.Results:Of 846K. pneumoniaeisolates, 34 (4%) were colistin resistant. In total, 22 case-patients were identified. Most (90%) were male; their median age was 33 years. Half were transferred from another hospital; 45% died. Case-patients were admitted for a median of 14 days before detection of ColR-KP. Also, 7 case-patients (32%) received colistin before detection of ColR-KP. All isolates were resistant to carbapenems and susceptible to tigecycline. Isolates resistant to colistin by Vitek 2 were also resistant by BMD; 2 ColR-KP isolates were resistant by disk diffusion. Moreover, 8 multilocus sequence types were identified. Isolates were negative for mobile colistin resistance (mcr) genes. Based on sequencing analysis, in-hospital transmission may have occurred with 8 case-patients (38%).Conclusions:Multiple infections caused by highly resistant,mcr-negative ColR-KP with substantial mortality were identified. Disk diffusion correlated poorly with Vitek 2 and BMD for detection of ColR-KP. Sequencing indicated multiple importation and in-hospital transmission events. Enhanced detection for ColR-KP may be warranted in India.

Published
2019
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38. Management of Patients with Neurotrauma by Trauma Surgeons: Need of the Hour

Author

Sushma Sagar, Biplab Mishra, Amulya Rattan, Subodh Kumar, and Amit Gupta

Subjects
Government, business.industry, media_common.quotation_subject, education, Trauma center, Developing country, medicine.disease, Scarcity, 03 medical and health sciences, Patient safety, 0302 clinical medicine, 030220 oncology & carcinogenesis, Golden hour (medicine), medicine, Medical emergency, business, Developed country, Trauma surgery, 030217 neurology & neurosurgery, media_common
Abstract

Trauma-related deaths in excess of 1 million occur annually in India, more than half of which are attributable to head injury. There are just 1,400 certified neurosurgeons in India, and only 300 new trainees are inducted every year. More than 80% of India’s specialist doctors live in urban India. There is evidence that patients travel hundreds of kilometers to seek a neurosurgeon; needless to say, golden hour of trauma is surely lost in this time. Scarcity of neurosurgeons is a problem in the developed world too. Government of India is building a national network of trauma centers for better trauma care. However, neurosurgeon availability at these centers remains a cause of concern. In dire need of neurotrauma management and scarcity of neurosurgeons, management of neurotrauma by trauma and general surgeons is the best available option. Such management policies have already been tested successfully in both developed (Germany, Sweden) and developing world (Nepal). There is evidence on patient safety and good outcome in neurotrauma management by trauma surgeons. Refresher training of 1 week every 2 years has been recommended to prevent skill attrition after 2-week neurotrauma training led by a neurosurgeon. Uninterrupted run of 3-year trauma surgery residency program at JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India, incorporating in-house neurotrauma training is a testimony to need and utility of this approach. A “readily available neurosurgeon when needed” is a scarce resource in most parts of world. Therefore, trauma surgeon is best suited to deliver timely care in neurotrauma and tackle this “hidden epidemic.”

Published
2019
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39. Evaluation of Risk Factors for Enteric Fistula and Intra-abdominal Sepsis in Patients with Open Abdomen in Trauma—a Level 1 Trauma Centre Study

Author

Biplab Mishra, Sushma Sagar, Narendra Choudhary, Subodh Kumar, Harshit Agarwal, and Amit Gupta

Subjects
medicine.medical_specialty, Resuscitation, Abdominal compartment syndrome, business.industry, General surgery, medicine.medical_treatment, medicine.disease, Cardiac surgery, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Laparotomy, Pediatric surgery, Medicine, Abdomen, 030211 gastroenterology & hepatology, Surgery, Body region, business
Abstract

Open abdomen or laparostomy as a method of damage control in emergency surgery especially with perforated viscus has been used mainly to prevent abdominal compartment syndrome, burst abdomen and delayed ventral hernia. The authors aimed to study the associated morbidity of open abdomen with clinical and resuscitative parameters. A historical cohort of patients with open abdomen after emergency laparotomy at Trauma Centre AIIMS, New Delhi, from January 2013 to December 2017 was included in this analysis. Patients operated elsewhere came to this hospital for further care; patients with AIS (abbreviated injury score) > 3 in other body regions and patients who died within 48 h were excluded. These patients were studied for their requirement of more than usual post-operative care in the form of requirement of resuscitative measures and other vital clinical parameters. A comparative analysis of patients with and without intra-abdominal complications (enteric fistula and intra-abdominal sepsis) was performed. Of the 113 subjects studied from historical case records, 52 had intra-abdominal sepsis and 10 had entero-cutaneous fistulae. These patients in comparison with those who did not undergo laparotomy during the same period did not require extra efforts for resuscitation, ICU care, increased hospital stay, chest infection and other clinical and biochemical morbid parameters. Immediate post-operative period in this cohort of patients with open abdomen was not associated with extra effort to resuscitate or burden on clinical work. Early definitive closure of abdomen is recommended once patients are stabilised to avoid laparostomy-related complications.

Published
2019
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40. Magnitude and outcomes of complex perineal injury - A retrospective analysis of five years' data from a Level 1 trauma centre

Author

Pratyusha Priyadarshani, Sushma Sagar, Harshit Agarwal, Amit Gupta, Anand K. Katiyar, and Subodh Kumar

Subjects
Adult, medicine.medical_specialty, Soft Tissue Injuries, Adolescent, Perineum, Wounds, Nonpenetrating, Hospital records, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Injury Severity Score, Quality of life, Trauma Centers, medicine, Retrospective analysis, Trauma centre, Humans, 030212 general & internal medicine, Child, Pelvic Bones, Retrospective Studies, Retrospective review, business.industry, Public Health, Environmental and Occupational Health, Accidents, Traffic, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Infectious Diseases, Child, Preschool, Soft tissue injury, Emergency medicine, Quality of Life, Accidental Falls, business, human activities
Abstract

Complex perineal injuries pose a major diagnostic and therapeutic challenge to trauma surgeons. A retrospective review of the hospital records of 29 patients with complex perineal injury following blunt trauma was done. Demographic profile, management and outcomes were collected. Quality of life analysis was conducted for patients with complex perineal injuries who were discharged. The most predominant mode of injury was a road crash: being a pedestrian run over by a heavy motor vehicle. Pelvic fracture was seen in 20, anorectal involvement in 22 and urogenital injuries in 14. Urgent surgical debridement was done in all patients, faecal diversion in 27 and urinary diversion in 14. There were nine deaths, three from haemorrhage, and the remainder from sepsis and multi-organ dysfunction. Complex perineal injury remains a major cause of morbidity and mortality in trauma patients. There is a need to ensure adequate rehabilitation services for such patients.

Published
2021

41. Yoga-An Alternative Form of Therapy in Patients with Blunt Chest Trauma: A Randomized Controlled Trial

Author

Sushma Sagar, Mohini Meti, Rajesh Sagar, Altaf Hussain Mir, Atin Kumar, Purva Mathur, Amit Gupta, Karan Madan, Subodh Kumar, Minu Kumari, Biplab Mishra, and Mallikarjun Gunjiganvi

Subjects
Vital capacity, medicine.medical_specialty, Original Scientific Report, Thoracic Injuries, Chest injury, Chest physiotherapy, Wounds, Nonpenetrating, law.invention, Pulmonary function testing, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Randomized controlled trial, law, Forced Expiratory Volume, Respiratory muscle, medicine, Humans, business.industry, Yoga, Cardiac surgery, 030220 oncology & carcinogenesis, Physical therapy, Quality of Life, 030211 gastroenterology & hepatology, Surgery, business
Abstract

Background Yoga as alternative form of therapy has shown positive impact on pulmonary functions, exercise capacity, behavioral changes, and inflammation in non-trauma patients. However, the efficacy of Yoga has not been studied in chest trauma patients. Methods This randomized controlled trial was conducted at level-1 Trauma Centre. Isolated chest injury patients were randomized into either standard physiotherapy or Yogatherapy groups. Patients in physiotherapy group received conventional chest physiotherapy and Yogatherapy group received a set of Yogic exercises in addition to conventional chest physiotherapy. Primary outcome measure was changes in pulmonary function tests (PFT) at 4 weeks of discharge. Secondary outcomes were changes in quality of life (QoL), respiratory muscle strength and endurance, chest wall mobility, and levels of cytokines at 4 weeks. Data were analyzed using STATA v14.0. Results A total of 89 eligible patients were randomized to physiotherapy (n = 46) and Yoga therapy (n = 43) groups. Demographic characteristics were comparable in both the groups. There were statistically significant improvements in PFT in the Yogatherapy group compared with physiotherapy with an increase in Forced vital capacity (p = 0.02) and Forced expiratory volume (p = 0.01) at 4 weeks. In addition, there were significant improvement in physical component of QoL, respiratory muscle endurance (p = 0.003) and axillary cirtometry (p = 0.009) in the Yogatherapy group. However, no statistically significant difference in the trends of cytokine markers seen between the groups. Conclusion Yoga was found to be effective in improving pulmonary functions and QoL in patients with chest trauma. (Trial registered at ctri.nic.in/clinicaltrials/login.php, numberREF/2016/05/011,287).

Published
2021

42. Device associated infections at a trauma surgical center of India: Trend over eight years

Author

Richa Aggrawal, Navdeep Sokhal, Kamran Farooque, Gyanendra Pal Singh, Subodh Kumar, Ashish Bindra, Rajesh Malhotra, Amit Gupta, Kapil Dev Soni, S. M. P. Khurana, Anjan Trikha, Vivek Trikha, Keshav Goyal, Sushma Sagar, Purva Mathur, Deepak Gupta, and Vijay Sharma

Subjects
0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Surveillance data, 030106 microbiology, Immunology, India, Dais, Data entry, Microbiology, 03 medical and health sciences, 0302 clinical medicine, Immunology and Microbiology (miscellaneous), Trauma Centers, Drug Resistance, Multiple, Bacterial, medicine, Immunology and Allergy, Humans, 030212 general & internal medicine, Acinetobacter sp, Candida sp, Cross Infection, General Immunology and Microbiology, Acinetobacter, business.industry, Trauma center, Pneumonia, Ventilator-Associated, medicine.disease, Pneumonia, Intensive Care Units, Infectious Diseases, Catheter-Related Infections, Emergency medicine, Urinary Tract Infections, Equipment Contamination, business
Abstract

Background Device-associated infections (DAIs) are an important cause of excessive stay and mortality in ICUs. Trauma patients are predisposed to acquire such infections due to various factors. The prevalence of HAIs is underreported from developing nations due to a lack of systematic surveillance. This study reports the rates and outcomes of DAIs at a dedicated Trauma Center in trauma patients and compares the rates with a previous pilot observation. Methods The study reports the finding of ongoing surveillance and the use of an indigenous software at a level-1 trauma center in India. Surveillance for ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections was done based on standard definitions. The rates of HAIs and the profile of pathogens isolated from June 2010 to December 2018 were analyzed. Results A total of 7485 patients were included in the analysis, amounting to 68,715 patient days. The rates of VAP, CLABSI, and CA-UTI were respectively 12, 9.8 1st 8.5/1000 device days. There was a significant correlation between device days and the propensity to develop infections. Of the 1449 isolates recovered from cases of DAIs, Acinetobacter sp (28.2%) was the most common isolate, followed by Candida sp. A high rate of multi-resistance was observed. Conclusion Automated surveillance was easy and useful for data entry and analysis. Surveillance data should be used for implementing preventive programs.

Published
2021

43. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study

Author

Dmitri, Nepogodiev, Joana Ff Simoes, Elizabeth, Li, Maria, Picciochi, James, C Glasbey, Glauco, Baiocchi, Ruth, Blanco-Colino, Daoud, Chaudhry, Ehab, Alameer, Kariem, El-Boghdadly, Funmilola, Wuraola, Dhruva, Ghosh, Rohan, R Gujjuri, Ewen, M Harrison, Herman, Lule, Haytham, Kaafarani, Mohammad, Khosravi, Irmgard, Kronberger, Sezai, Leventoğlu, Harvinder, Mann, Kenneth, A Mclean, Mengistu Gebreyohanes Mengesha, Maria Marta Modolo, Faustin, Ntirenganya, Lisa, Norman, Oumaima, Outani, Riinu, Pius, Peter, Pockney, Ahmad Uzair Qureshi, April Camilla Roslani, Sohei, Satoi, Catherine, Shaw, Aneel, Bhangu, Omar, M Omar, Waheed-Ul-Rahman, Ahmed, Leah, Argus, Alasdair, Ball, Edward, P Bywater, Amanpreet, Brar, Brett, E Dawson, Irani, Duran, Muhammed, Elhadi, Conor, S Jones, Sivesh, K Kamarajah, James, M Keatley, Samuel, Lawday, Ella, J Marson, Riinu, Ots, Irène, Santos, Elliott, H Taylor, Isobel, M Trout, Chris, Varghese, Mary, L Venn, William, Xu, Irida, Dajti, Arben, Gjata, Salah Eddine Oussama Kacimi, Luis, Boccalatte, Daniel, Cox, Philip, Townend, Felix, Aigner, Irmgard Elisabeth Kronberger, Elgun, Samadov, Amer, Alderazi, Kamral, Hossain, Greg, Padmore, Gabrielle van Ramshorst, Ismaïl, Lawani, Anis, Cerovac, Samir, Delibegovic, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Muhammad, Gohar, Mihail, Slavchev, Chukwuemeka, Nwegbu, Arnav, Agarwal, Janet, Martin, Joshua, Ng-Kamstra, Maricarmen, Olivos, Wenhui, Lou, Dong-Lin, Ren, Jose Andres Calvache, Carlos, J Perez Rivera, Ana Danic Hadzibegovic, Tomislav, Kopjar, Jakov, Mihanovic, Pablo Mijahil Avilés Jiménez, Nikolaos, Gouvas, Jaroslav, Klat, René, Novysedlák, Nicolas, Amisi, Peter, Christensen, Alaa, El-Hussuna, Sylvia, Batista, Eddy, Lincango-Naranjo, Sameh, Emile, Danilo Alfonso Arévalo Sandoval, Hailu, Dhufera, Samuel, Hailu, Mengistu, G Mengesha, Joonas, H Kauppila, Alexis, P Arnaud, Zaza, Demetrashvili, Markus, Albertsmeier, Hans, Lederhuber, Markus, W Löffler, Daniel Kwesi Acquah, Bernard, Ofori, Stephen, Tabiri, Symeon, Metallidis, Georgios, Tsoulfas, Maria-Lorena, Aguilera-Arevalo, Gustavo, Recinos, Tamás, Mersich, Dániel, Wettstein, Gabriele, Kembuan, Peiman Brouki Milan, Mohammad Hossein Khosravi, Masoud, Mozafari, Ahmed, Hilmi, Helen, Mohan, Oded, Zmora, Gaetano, Gallo, Francesco, Pata, Gianluca, Pellino, Yuki, Fujimoto, Naoto, Kuroda, Mohamad, K Abou Chaar, Faris, Ayasra, Ildar, Fakhradiyev, Intisar Hisham Said Hamdun, Jang, Jin-Young, Mohammad, Jamal, Lina, Karout, Aiste, Gulla, Fanjandrainy, Rasoaherinomenjanahary, Luc Hervé Samison, Iran Irani Durán Sánchez, Diana Samantha Gonzalez, Laura, Martinez, María José Martínez, Alejandra, Nayen, Antonio Ramos-De la Medina, Jade, Nunez, Pueya Rashid Nashidengo, Rakesh, Shah, Ashish Lal Shrestha, Pascal, Jonker, Schelto, Kruijff, Milou, Noltes, Pieter, Steinkamp, Deborah, Wright, Lukman, Abdur-Rahman, Adesoji, Ademuyiwa, Adewale, Adisa, Babatunde, Osinaike, Justina, Seyi-Olajide, Omolara, Williams, Emmanuel, Williams, Sofija, Pejkova, 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Amanda Lira Dos Santos Leite, Laercio, Pol-Fachin, Tainá Santos Bezerra, Alcimar Lavareda Dos Santos Junior Alcimar, Robson, Amorim, Maria Eduarda Bellotti Leão, João José Corrêa Bergamasco, Cintia Cardoso Pinheiro, Rubem Alves Da Silva Neto, Elaine Francisca De Araújo, Lilian, Guimaraes, Tatiana, Liborio-Kimura, Isabelle Melo da Camara, Victor Ripardo Siqueira, Juan, Rodriguez, Jeancarllo, Silva, Rubem Alves Silva Junior, Cláudio, Cardoso, Andre, Guimaraes, Wislene Sarajane Moreira Alves, Agna Soares Da Silva Menezes, Marcelo, Araujo, Kattiucy, Brito, Josie Marcelle Lira Albuquerque, Jairo Alberto Dussan-Sarria, Andressa, Souza, Andre Ricardo Stüker, Tiago, Bresciani, Luciana Cadore Stefani, Leandro Totti Cavazzola, Tainá, Costa, Matheus, Dasqueve, Gustavo De Bacco Marangon, Otávio Ritter Silveira Martins, Josy, Rodrigues, Guilherme Roloff Cardoso, Brasil Silva Neto, Tilaê, Soares, Aline, Zanella, Lucas Torelly Filippi, Enilde Eloena Guerra, Ricardo Pedrini Cruz, Antonio Nocchi Kalil, Gustavo, Laporte, Moacyr, Salem, Murilo de Lima Brazan, Caio Antonio de Campos Prado, Elaine Christine Dantas Moises, Hilda Satie Suto, Alice Gadotti Yasuda, Ana Carolina Tagliatti Zani, Roberto Cardoso Cardoso Dos Santos, Geraldo, Duarte, Edwaldo Edner Joviliano, Carolina Lourenço Gomes Dos Santos, Silvana Maria Quintana, Edwin, Tamashiro, Fabiana Cardoso Pereira Valera, Marília Veccechi Bijos Zaccaro, Isis, Andreotti, Leonardo, Lima, Wilson Salgado Jr, Alonço da Cunha Viana Júnior, Lana, Moutinho, Cora Pichler de Oliveira, Isabela Trindade Martins, Isabela Vieira Toledo, Marco Antonio Correa Guimaraes-Filho, Rodrigo, Arrivabeno, Claudio Bovolenta Murta, Danniel Frade Said, Jose Pontes Junior, Felipe Guimarães Pugliesi, Paulo, Gregorio, Alessandro, Mariani, Fabio, Minamoto, Juliana Lourenço da Silva, Bruno, Muller, Caio, Zanon, Vladimir, C Carvalho, Ana Lucia Munhoz Lima, Priscila, R Oliveira, Jorge Dos Santos Silva, Mariana Faccini Teixeira, Marco, Kulcsar, Leandro, Matos, Kamilla 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Volpe, Arthur, Gatti, Caroline, Nardi, Ramon, Oliva, Layze Braz de Oliveira, Herica Emilia Félix de Carvalho, Ivonizete Pires Ribeiro, Gabriel Renan Soares Rodrigues, Álvaro Francisco Lopes de Sousa, Michel, Chebel, Paulo Henrique de Sousa Fernandes, Marcelo Augusto Faria Freitas, Juliano Rodrigues da Cunha, Zeenia, Ather, Dobromir, Dimitrov, Emil, Filipov, Elitsa, Gyokova, Ivelina, Ilieva, Tsvetomir, Ivanov, Martin, Karamanliev, Vasil, Neykov, Boyko, Atanasov, Nikolay, Belev, Paolina, Kamenova, Kaloyan, Tonev, Tsanko, Yotsov, Evguenia, Hristova, Kolyo, Spassov, Tsanko, Tsankov, Dragomir, Dardanov, Petar, Gribnev, Manol, Sokolov, James, Brown, John, Tanyi, Heather, Hurdle, Anthony, Maclean, Michael, Sander, Salim Al Riyami, Krittika, Bali, David, Bigam, Khaled, Dajani, Mehran, Anvari, Rafik, Bolis, David, Choi, Susan, Ellis, Michael, Gupta, Wael, Hanna, Dennis, Hong, Cynthia, Horner, Lea, Luketic, Peter, Moisiuk, Yaron, Shargall, Hilda, Alfaro, Nawar, Alkhamesi, Laura, Allen, Muriel, Brackstone, Eunice, Chan, Davy, Cheng, Jason, Chui, Nelson, Gonzalez, Brent, Lanting, S Danielle MacNeil, Robert, Mayer, Jacob, Mcgee, Mahesh, Nagappa, Nicholas, Power, Agya, Prempeh, Mehdi, Qiabi, Hassan, Razvi, Emil, Schemitsch, Herman, Sehmbi, Ushma, Shah, Yamini, Subramani, Edward, Vasarhelyi, Kelly, Vogt, Homer, Yang, Ali Ghorbani Abdehgah, Saba, Balvardi, Liane, Feldman, Julio Flavio Fiore Jr, Melissa, Hanson, Brent, Hopkins, Pepa, Kaneva, Lawrence, Lee, Julia, Leonard, Jad, Abou-Khalil, Andre, Martel, James, Stevenson, Susan, Lee, Richard, Merchant, Samuel, Avoine, Laurence, Belanger, Mathieu, Belanger, Etienne, Belzile, Anne-Sophie, Blais, Sofia, Boucher-Kovalik, Cindy, Boulanger-Gobeil, Etienne, Cardinal, Pierre-Olivier, Champagne, Jonathan, Cloutier, Simon, Corriveau-Durand, Mathieu, Cote, Maxime, Cote, Mathilde, Côté, Valérie, Courval, Suzanne, Demers, Christine, Desbiens, Mehdi El Ouazzani, Karine, Girard, Ève-Marie, Girard, Karo, Gosselin, Helene, Khuong, Nathalie, Labrecque, Eve-Lyne, Langlais, Audrey, Larouche, Andréane, Lavallée, Madeleine, Lemyre, Sarah, Maheux-Lacroix, Melissa, Marien, Patrick, Marin, Julie, Mauger, Genevieve, Milot, Sylvie, Nadeau, Sebastien, Nguyen, Mélinda, Paris, Stéphane, Pelet, Marie, Plante, Carole, Plante, Frederic, Pouliot, Marie Claude Renaud, Mathilde, Sarlabous, Isabelle, Schmit, Raphaël, St-Germain, Brian, Johnston, Nicole, Labine, Amit, Persad, Hong, Pham, Melissa, Wood, Riordan, Azam, Amit, Atrey, Andrew, Beckett, Daniel, Cohen, Sunit, Das, Julian, Daza, Cheryl, Dunkerton, Yosef, Ellenbogen, Ciara, Hanley, Sorcha, Kellett, Amir, Khoshbin, Karim, Ladha, Amanda, Mcfarlan, Spencer, Montgomery, Janneth, Pazmino-Canizares, Hrishikesh, Suresh, Ravleen, Vasdev, Maira, Ahmed, Fred, Gentili, Aristotelis, Kalyvas, Matthias, Millesi, Can, Sarica, Taariq, Shaikh, Leslie, St, Jacques, Raha, Tabasinejad, Gelareh, Zadeh, Marvin, Hsiao, Nicole, Jedrzejko, Peter, Black, Claire, Broe, Charlotte, Dandurand, Rebecca, Grey, Philemon, Leung, Andrew, Lindberg, Juan Mata Gutierrez, Kelly, Mayson, Adam, Meneghetti, Drew, Phillips, John, Street, Carolina Carvajal Calderón, Daniel Alejandro Donoso Pizarro, Esteban, Fernández, Ángela, Molero, Nastassja, Mutarello, Jorge Núñez Lucic, Katherine Ochoa Gaete, Catalina Ruiz Lopez, Rina, Sepúlveda, Camila, Ulloa, Mauricio, Barreda, Matias, Dallaserra, Matías Günther Wood, Mauricio Sandoval Tobar, Francisco, Garcia-Huidobro, Jimena, Dona, Carolina Soto Diez, Daniel, Igor, Javier, Mena, José Tomás Reyes, Catalina Arredondo Soto, Jose, Campos, Javier, Gonzalez, Barbara, Rivera, Jaime, Altamirano-Villarroel, David, Cohn, Luis Marin de Amesti, Pedro, Recabal, Camilo, Sandoval, Bruno Catoia Fonseca, Monica, Contador, Andres, Hodali, Camila, Pincheira, Andrea Ramos Mantilla, Claudio Salas Garrido, Janina, Torres, Marco, Valenzuela, Zehua, Chen, Jiankun, Hu, Jin, Tao, Kun, Yang, Yuexin, Zhang, Yuan, Chen, Wang, Cunchuan, Wah, Yang, Xueli, Bai, Tingbo, Liang, Tao, Ma, Ning, Pu, Hanlin, Yin, Camilo, Caicedo, Diego Felipe Tellez Beltran, Alejandro, Escobar, Carolina Perez Granados, Lisbeth Alexandra Urueña Pinzon, Carlos, Bonilla, Diana, Santana, Oscar, Serrano, Andrea, Garcia, Fernando Giron Luque, Nasly, G Patino-Jaramillo, Laura Giselle Contreras Baquero, Nestor Augusto Muñoz Botero, Jhoana Andrea Murillo Castellanos, Andrea Juliana Vega Calvera, Lina, M Acosta Buitrago, Maria Paz Bohórquez-Tarazona, Paulo Andrés Cabrera Rivera, J Felipe Casas, Valeria Cormane Alfaro, Julian, Corso, Bayron, Guerra, Albert Franz Guerrero-Becerra, Akram Kadamani Abiyomaa, Felix Ramon Montes, Manuel Santiago Mosquera Paz, Camilo Andrés Polanía Sandoval, Natalia, Quintana, Carlos Fernando Roman Ortega, Carlos, Santacruz, Manuela, Téllez, Camilo Alejandro Velandia Sánchez, Fernando, Arias-Amézquita, Luis Felipe Cabrera Vargas, Natalia Cortes Murgueitio, Elkin, Escorcia, Kemel Ahmed Ghotme Ghotme, Jorge Luis Gomez-Mayorga, Alvaro Felipe Guerrero Vergel, Gabriel, Herrera-Almario, Eduardo, Londono-Schimmer, Juan, A Mejia, Guillermo, Monsalve, Camilo, Rodriguez, Juan Nicolas Rodriguez Niño, Luis Martín Rodríguez Ortegón, Daniel, Sanabria, Andres, Alvarez, Arnulfo, Andrade, Javier, Ardila-Montealegre, David, Baquero, Edgar Mauricio Barrios Vidales, María Alejandra Caicedo Giraldo, María Camila Carvajal, Maria, Castillo, Maria Carolina Castillo Florez, María Angelica Cendales, Danny Conde Monroy, Henry, Cortes, Mario, Daniel, Jairo De la Peña, Elena Leonor Delgado-Nieto, Hernando, Espitia, Carlos Figueroa Avendaño, Edgar Oswaldo Hernandez Burgos, Andres, Isaza-Restrepo, German, Londono, Margarita Maria Maldonado, Andrea, Montenegro, Juan Carlos Navarro, Jorge, Navarro-Alean, Katherine Parra Abaunza, Eliana, Pulido, Erika, M Ramírez Amaya, Carlos Eduardo Rey Chaves, Natalia Andrea Rivera Rincón, William Mauricio Riveros Castillo, Lizeth Rodriguez Sanchez, Wilson, Rubiano, Maria, Russi, Juan Carlos Sabogal Olarte, Javier Mauricio Salgado Tovar, Maria Juliana Sanchez, David Mauricio Solano Varela, Paula Torres Gomez, Marcial, Trillos, Ana María Vargas Patiño, Felipe, Vargas-Barato, Juan Pablo Villate Leon, María Alejandra Wagner Useche, Jesus, Acosta, Adriana, Almeciga, Luis Becerra Mendez, Rafael Jose Beltran, Ana, Bonilla, Miguel, Buitrago, Marino, Cabrera, Pedro Hernando Calderon Quiroz, Diego, Camacho-Nieto, Carlos Andrés Carvajal Fierro, Sergio Cervera Bonilla, Sandra, Diaz, Helena, Facundo, Jorge, Forero, Mauricio Garcia Mora, Karena Victoria Garcia Tirado, German Fabian Godoy Perez, Felipe, Gonzalez, Oscar, Guevara, Jairo Alonso Hernandez, David Ricardo Herrera Mora, Juan David Lalinde, Carlos, Lehmann, Eduardo Leon Llanos, Byron Eduardo Lopez De Mesa Lopez, Ivan, Mariño, Monica, Medina, Raúl Eduardo Pinilla Morales, Angela, Puerto, Andrea, Quintero-Ortíz, Juliana Rendón Hernández, Elio Fabio Sánchez Cortés, Alvaro Eduardo Sánchez Hernández, Raul, Suarez, Oscar, Suescun, Marco, Vanegas, Rodolfo, Varela, Jorge Luis Velez Bernal, David, Viveros-Carreño, Daniela Camargo Gómez, Angelica, Fletcher, Abel, Merchan, Euler Javier Burbano Luna, Indira, Cujiño, Mauricio Velasquez Galvis, Lina Maria Vergara Galliadi, Orlando Abonia Gonzalez Abonia Gonzalez, Maria Fernanda Acuna Saravia, Roberto, Arroyave, Jose Maria Barreto Angulo, Francisco Javier Bonilla-Escobar, Uriel, Cardona, Ivan Castañeda Giacometto, José Luis Castillo, Diego Fernando Castillo-Cobaleda, Diego Jose Caycedo Garcia, Brenda Marcela Coll Tello, Juan Carlos Dueñas-Ramirez, Oscar Andres Escobar Vidarte, Luis, Figueroa, Herney, Garcia-Perdomo, Alden, Gomez, Laura, Gomez, Alejandro, Gomez, Ana María Grande-Gil, David, Guarin, Natalia, Guzman, Enrique Herrera Castañeda, Marisol, Hinaoui, Anuar Armando Idrobo Escobar, Christian Kammerer Kammerer, Sergio, Leon, Carlos Antonio Llanos Lucero, Angie, López, Alexander Maximiliano Martinez-Blanco, Antonio José Montoya Casella, Ricardo Andres Niño Corredor, Sebastian, Ordoñez, Diego Alfredo Palta Uribe, Andrea Carolina Perea Serna, July, Ríos, Gabriel, Ríos-Samper, Juan David Rivera Garcia, Juan Camilo Salcedo Moreno, John, Sandoval, Guillermo Alberto Sarmiento Ramirez, Paola Andrea Tabares Romero, Ricardo, Urzola, Iliana Maria Valdes-Duque, Miguel, Velasquez, Lina Maria Villegas, James, Zapata-Copete, José Omar Zorrilla Lara, Mauricio Zuluaga Zuluaga, Alejandra Echeverri Moreno, Juan Sebastian Figueroa, Adolfo Enrique Gómez Ortiz, Maria Fernanda Gonzalez Mosos, Alejandro, González-Orozco, Juan Jose Jaramillo Roncancio, María Camila Leyva Martínez, Monica, Mosos, Juan Sebastian Ramirez, Henry Andrés Rodríguez, Juan David Saavedra Henao, María Alejandra Torrado Varón, Leidy Natalia Idarraga Ramírez, Lorena, Ocampo, Monica Cardona Marin, Ana Maria Marin Gonzalez, David Alejandro Mejia, Luis Emiro Vanegas, Yicel Alvarez Martinez, Sandra Aruachan Vesga, Dayana Vanessa Baron Fuentes, Alejandra Caballero Salas, Gustavo Antonio Martinez Estrada, Kelly Viloria Campo, Juan Antonio Corralez Alvarez, Cesar David Galindo Regino, Angela Maria Giraldo Velasquez, Carlos Enrique Melo Moreno, Jorman, H Tejada, Jesus Hernan Tovar, German Alirio Tovar, Edison Alexander Benavides Hernández, Claudia Milena Orozco-Chamorro, Gustavo Adolfo Angel, Christian Ali Buesaquillo, Victor David Olave Montaño, Andrés, Sánchez-Gómez, Daniela Patricia Escalante Ureche, Jairo Martinez Garrido, Eben-Ezer, Genda, Fabrice, Eboma, Kristina, Bitunjac, Karlo, Grulović, Marijana, Vučković, Goran, Šantak, Emanuel, Borovic, Ana Bosak Versic, Damir, Hasandić, Natasa Poldan Grabar, Suzana Srsen Medancic, Lucija, Brkic, Sara, Cokarić, Petra Pavic Palac, Zeljka, Samac, Josipa, Tomić, Marija, Vrdoljak, Ivan, Bacic, Bernarda, Bakmaz, Nikolina Bratošević Vučičić, Domagoj, Brzic, Samir, Canovic, Emilio, Dijan, Maja Grgec Dragicevic, Robert, Karlo, Suzana, Konjevoda, Petra, Kovačević, Ivan, Kovačić, Frane, Markulić, Luka, Matak, Domagoj, Morović, Gordan, Perišić, Andrea, Simic, Neven, Skitarelić, Matea, Veršić, 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Ioanna, Pozotou, Olga, Stavrinidou, Anneza, Yiallourou, Lukáš, Burda, Michal, Dosoudil, Lubomir, Martinek, Wladyslaw, B Gawel, Milan, Lerch, Matúš, Peteja, Jan, Žatecký, Toman, Daniel, Martin, Formánek, Veronika, Javurkova, Markéta, Kepičová, Nicole, Macečková, Petr, Matousek, Ondrej, Simetka, Petr, Vavra, Karol, Zelenik, Jan, Černý, Sami, Khan, Robert, Lischke, Martin, Přibyl, Temoore, Younus, Yenuksha, Amarasena, Karel, Klíma, Setareh, Pirmorad, Zuzana, Hotová, Aleš, Mladěnka, Nulvin, Bozo, Julie Lykke Harbjerg, Louise, Hviid, Helle, Ø Kristensen, Mira, Mekhael, Mette Fugleberg Nielsen, Laerke, Paulsen, Saija, Sinimäki, Louise Zinck Mogensen, Peter, Bonde, Anders Lyng Ebbehøj, Anne-Sophie, Fenger, Aleksander Fjeld Haugstvedt, Christine Hangaard Hansen, Maria Lovisa Jönsson, Lars, N Jorgensen, Peter-Martin, Krarup, Anne-Louise, Lihn, Christian, Meyhoff, Helena, Otte, Anas Ould Si Amar, Henrik, Palm, Nis, Schlesinger, Henry, Smith, Ida, Tryggedsson, Anne Reiss Axelsen, Jens Kristian Baelum, Mark Bremholm Ellebaek, Signe Bremholm Ellebaek, Anders, Hogh, Maria, Acosta, Yancy, Acosta, Pedro, Baez, Luis Alfredo Betances, Luis Rodolfo Bonilla, Daniel, Cabreja, Wilton Cabrera Cruz, María Mabel Collado Expósito, Aldo, Crespo, Octavio, Cruz-Pineda, Claudio Samuel D'óleo García, Pedro, Díaz, Remberto, Escoto, Jatnna, Figueroa, Luis, Garcia, U Garcia-Dubus Rodriguez, Humberto, Gomez, Adrian, Grullon, Fatherin, Guerrero, Lillian, Guzman, Thelma Rocío Jiménez Mosquea, Engels, Lazala, Ariela, Lopez, Leeany Maletta Francisco, Jhomayri, Mercado, Herisardy, Munoz, Jeffrey, Paulino, Maricely Ambar Perez Fernandez, Rudeily, Reyes, Lilia Rosa Reyes Guilamo, Ruben, Rivas, Claudia Alejandra Rivas Torres, Ada, Rodríguez, Madelin Tamar Rosario Villa, Eleazar, Santana, Joel, Soto, Nassin, Tactuk, Cristina Kristel Tonos Sardiñas, Raul, Ubinas, Jose, Victoria, Aaron, Villegas, Ricardo, Acra-Tolari, Larissa, Beltran, Luis Fernand Betances, Alejandro, Blaubach, Denisse Idalia Campos Mejía, 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Maher, Hosain, Ahmed, Hossam, Hamza Hussein Aly Salama Aly, Mohamed, Ibrahim, Abdelrahman, Ibrahim, Nourhan, Ibrahim, Noha Mohamed Salah Ibrahim Moussa Hamouda, Monica, Iskander, Islam, Khalifa, Mostafa, Kotb, Nada, Mahmoud, Alaa Mahmoud Abo Shabana, Nora, Mamdouh, Maram, Metwalli, Khaled, Metwally, Mahmoud, Moghazy, Moustafa, Mohamed, Mohamed, Mourad, Esraa, Moustafa, Kamilia, Mubarek, Nour Eldin Nader, Ahmed, Nasser, Samaa, Omar, Mostafa Shehata Qatora, Mohamed, Ragab, Marawan, Ragal, Dina, Ramadan, Rana, Ramadan, Sara, Ramadan, John, Romany, Ahmed, Sabry, Yasmeen, Said, Sara, Salamah, Ahmed Mostafa Saleh, Mona Saleh Mesbah Mohamed Elkaffas, Alaa, Salem, Hashem, Salim, Ahmed, Samih, Ahmed Samir Abdelaal, Ahmed, Shaheen, Yassmeen Sharafeldin Mohammed, Abdelrahman, Shehata, Mohamed, Shemeis, Karim, Shenit, Mennatallah, Sheta, Asmaa, Soffar, Yousef, Tanas, Ahmed, Tarek, Nermin, Yehia, Omar Khaled Mohamed Eid, Ammar Yasser Abdulfattah, Ahmed, Elsaghir, Mohamed Fouad Elganainy, Omar Ibrahim Elsayed, Omar, Elmandouh, Omar, Hamam, Mostafa Ahmed Shehata, Areej, A Abdelaziz, Ahmed, M Abbas, Wael Abd El-Ghani, Hossam Aldein, S Abd Elazeem, Mustafa Abd Elsayed, Ahmed Yassien Abd-Elkariem, Shimaa, Abdalla, Mahmoud, Abdel-Aleem, Khaled, Abdelazeem, Mahmoud, Abdelfattah, Mohammed, Abdelhafez, Mohamed, M Abdelkarem, Ali, Abdelraouf, Lamess, Abdullaha, Hossam, Abubeih, Moaiad Eldin Ahmed, Nagm Eldin Abu Elnga Ahmed, Ahmed, Ahmed, Sarah Ahmed Saad, Sherif, Alaa, Ali, Alhussaini, Abdelrahman Ahmed Abdelrahman Ali, Ibrahim, Ali, Wagdi, Ali, Mohamed Ali Mohamed, Mohamed, Ashraf, Muhammad, Bassiouni, Mohamed, G El-Adawy, Mohammad, El-Sharkawi, Hussein, Elkhayat, Khaled, Elmaghraby, Shady, Elsdfy, Mohamed, Elsharkawy, Almoutaz, Eltayeb, Mohamed Esmat Mohamed, Esraa, Essam, Mahmoud, Fahd, Osama, Farouk, Rabea, Gadelkareem, Ahmed, Ghoneim, Mohammed Hamada Takrouney, Ahmed, Hamdan, Abd El-Rahman Hamed, Ahmad, Hasan, Mohamed Abdelghafor Hassanin, Islam, Hawal, Kerollos, Henes, Mohamed Omar Herdan, Helal, F Hetta, Omar, Ibrahem, Mostafa, Ibrahim, Islam, H Ibrahim, Mahmoud, Kamel, Mohamed, Khallaf, Shrouk, M Elghazaly, Abobakr, Mahfouz, Osman, Mahmoud, Wesam, Mahran, Doha, Mahrous, Abadeer, Marsis, Ayman, Mohamed, Aliae Mohamed Hussein, Amr Mohamed Sayed, Mahmoud, M Mohammed, Ahmed, Mokhtar, Fatma, A Monib, Ahmed, Nageeb, Mariam Albatoul Nageh, Mohammed, Nageh, Nehal Gamal Omar, Abdelrahman, Ragab, Abdelrahman, Ramadan, Abdallah Rashad Temerik, Aya, Sabry, Hadeer, Safwat, Omar, Salah, Ahmed Elhussiny Salah Mahmoud, Ahmed, Saleh, Mahmoud, Sallam, Ahmed, Samir, Reem, Sayad, Esraa, Sayed, Ahmed, S Sedik, Mohammed, Shahine, Antonios, Soliman, Wael, Soliman, Mohamed Gamal Taher, Randa, Wanees, Ebrahim Ahmed Yousof, Ahmed, Youssef, Omar Zein Elabedeen, Ahmed Emad Sayed Hassan, Shrouk Abdel Fattah, Ahmed, Abostate, Samar, Ali, Saad Ali Saad Salama, Mohamed, Allam, Ahmed, Alsadek, Ebrahim, Arafa, Ahmed, Barakat, Mohammed El Sherpiny, Gehad, Elbehairy, Mahmoud, Eleisawy, 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Bahi, Abdurhman, Atea, Ibrahim, Gamal, Mohamed El Kassas, Wael, Omar, Ahmed, Tawheed, Saeid, Al-Oribi, Nuran Khaled Aly, Mahmoud, Elfiky, Alaa Eldine Elmaghraby, Abdulrahman, Elrahmany, Motaz, Elsherbeeny, Youssef, Helmy, Ahmed, Nabil, Ahmed Samir Farahat, Mostafa, Soliman, Amr, Wassef, Abdelrahman, Abdelrahman, Seif, Elsaban, Galal, Ghaly, Rana, Hamdy, Hamada, Mondy, Lubna, Abdallah, Abdelrhman Kz Darwish, Mohamed, Rabea, Mohammed, A Azab, Alzhraa Salah Abbas, Marwa, El-Deeb, Mohamed, Fawzy, Maher, Ibraheem, Abdelrahman, Bakry, Sarah, Elnems, Randa, Elsheikh, Mohamed Ibrahim Gbreel, Mahmoud, Hafez, Mohamed, Jammal, Khaled, M Hamam, Abdelrahman, M Makram, Omar Mohamed Makram, Salma, Rabie, Sherine Yousery Askalany, Mokhtar Mohamed Ibrahim Abushanab, Abdulrahman, Eid, Mohammed Refaat Ibrahiem Amin El Ghalid, Ahmed Adel Abdelaty, Elsayed, A Fayad, Asmaa, Radwan, Moataz, Sallam, Ahmad, Shokry, Ahmed Mohamed Farouk, Ahmed, Elfallal, Hossam, Elfeki, Mohamed, Elsaeed, Mahmoud, Elsaid, Amany, 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Abanga Alatiiga, Munira, Amadu, Nathaniel, Annan, German Azahares Leal, Mohammed, Bukari, Alexis, Buunaaim, Ernest, Cheyuo, Latif Daboo Salifu, Michael, Damah, Malcolm, Dery, Edem Kojo Dzantor, Odoniel Guerra Garcia, Yabasin Iddrisu Baba, Adamu, Issaka, Abdul-Jalilu Mohammed Muntaka, James, Murphy, Yaa Nyarko Agyeman, Wisdom Opoku Amankwaa, Imoro, Osman, Samuel, Pie, Anwar Sadat Seidu, Mohammed, Sheriff, Ana Maria Simono Charadan, Abraham, Titigah, Mundashiru, Yahaya, Musah, Yakubu, Edwin Mwintiereh Ta-Ang Yenli, Ioannis, Grypiotis, Nikolaos, Kiriakopoulos, Georgios, Koliopoulos, Vasilis, Kyvelos, Georgia, Micha, Triada, Papadopoulou, Dimitrios, Balalis, Evangelos, Fradelos, Dimitrios, Korkolis, Nicholas, Alexakis, Kyveli, Angelou, Dimitrios, Haidopoulos, Anastasia, Prodromidou, Alexandros, Rodolakis, Nikolaos, Thomakos, Dimitris, Psychogios, Pantelis, Antonakis, Konstantinos, Bramis, Leonidas, Chardalias, Ioannis, Contis, Nikos, Dafnios, Dionysios, Dellaportas, Papalouka, Dimitra, 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Santhosh Kumar Sampengere Annayappa, Tulika, Agrawal, Premkumar, Anandan, Aditya, Baindur, Manjunath, Bd, Savitha, C, S Anitha, G, Sandeep, Harigond, K Tejeswini, K, Venkatesh, Kesarla, Mallikarjuna, Manangi, B Hareesh, P, Jyothi K, R Ranjan, Athish, Shetty, Santhosh Shivashankar Chikkanayakanahalli, Tanvi, Sunil, Shreya, Syamala, Kavya, Tharanath, Aditya, Atal, Niranjana, Rajagopal, S Srinath, B, Vinod, Nk, L Thirumanikandan, P, Nitu, Mishra, Sushruta, Shrivastava, Rekha, Wadhwani, Reyaz, Ahmad, Zainab Ahmad Haq, Prateek, Behera, Ritika, Dhurwe, Rehan, Haq, Vaibhav, Jain, Anuj, Jain, Sunaina, Karna, Kameshwarachari, Pushpalatha, Sumit, Raj, John Ashutosh Santoshi, Pooja, Singh, Virendra, Verma, Vaishali, Waindeskar, Moorat Singh Yadav, Zaheda, Aziz, Koyel, Chakraborty, Preetam, Chappity, Gurudip, Das, Debajyoti, Datta, Saubhagya Kumar Jena, Madhabananda, Kar, Susanta, Khuntia, Pankaj, Kumar, Ravi, Kumar, Aswathi, Kv, Abhijeet, Mishra, Swastik, Mishra, Yash, Mittal, Dillip, Muduly, 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Reddy Voppuru, Anushri, Soni, Gira, Soni, Junaid, Alam, Dinesh, Bagaria, Minu, Bajpai, Akshay Kumar Bisoi, Arvind, Chaturvedi, Sandeep, Chauhan, Narendra, Choudhary, Rajendra Singh Chouhan, Sunil, Chumber, Kamran, Farooque, Vasubabu, Gudala, Amit, Gupta, Mohit, Joshi, Apoorva, Kabra, Shashank Sharad Kale, Abhinav, Kumar, Subodh, Kumar, Dhruv, Mahajan, Rajesh, Malhotra, P Ramesh Menon, Biplap, Misra, Samarth, Mittal, Rajinder, Parshad, Pratyusha, Priyadarshini, Sushma, Sagar, Pradeep Brijkishor Sharma, Vijay, Sharma, Vivek, Trikha, Mayank, Tyagi, Kuldeep, Bansal, Kalyan, Varma, Anurag, Mishra, Rajdeep, Singh, Rohit, Bhardwaj, Abhishek, Mittal, Sabarirajan, Ponnusamy, Gyan Ranjan Singh, Isha, Tuli, Pramod, Bhor, Sanjay, Dhar, Sachin, Kale, Manisha, Aggarwal, Himani, Gupta, Gurleen, Kaur, Ajinkya, Deshpande, Anup, Gadekar, Tanmay, Jaysingani, Taufiq, Panjwani, Rakesh, Patil, Narendra, Vaidya, Sunil Kumar Vishwakarma, Utkarsha, Wayal, Debnarayan, Dutta, Rajnish, Arora, Mohit, Dhingra, 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Venkateshwaran, Narasiman, Meer, Chisthi, Gejoe, George, Harihara, Jothi, Dilber, Pareed, Godwin David, C Mathew, Livingston, Abel, Mansi, Agrawal, Rabindranath, B, Manish, Baldia, Ravi Kishore Barla, Manisha, Beck, Santosh, Benjamin, Jeremy, Bliss, Lisa, Cherian, Sreekar, Devarakonda, Geley, Ete, Arun Jacob Philip George, Amish, Gohil, Deeptiman, James, Mark Ranjan Jesudason, Lallu, Joseph, Treasa, Joseph, Kathir, Joyson, Gomathi, Karnan, Albert, Kota, Pushplata, Kumari, Anitha, Loganathan, Vasanth Mark Samuel, John, Mathew, Senthil, K Nathan, Joby Elizabeth Ninan, Ajay, Philip, R Priyadarshini Priyadarshini, Suganya, S, Habie, Samuel, Gilbert, Samuel, Daniel, Selvaraj, Srujan, Sharma, Suraj, Surendran, D Hariharan, T, Santhosh Kumar Thangaraj, Vinotha, Thomas, Varghese, Thomas, John, K Thomas, S Harish, Y, Manobhiram, Boggavarapu, Murali Krishna Voonna, Marilaeta Cindryani Lolobali, Christopher, Ryalino, Tjokorda Gde Agung Senapathi, Mahadewa, Tjokorda, I Made Gede Widnyana, Dita, 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Massimiliano, Gennaro, Lorenzo, Giannini, Marcello, Guaglio, Marco, Guzzo, Andrea, Leva, Alberto, Macchi, Elena, Manzo, Fabio, Martinelli, Ilaria, Mattavelli, Vincenzo Maria Mazzaferro, Francesco, Raspagliesi, Luigi, Rolli, Laura, Sala, Roberto, Salvioni, Mario, Santinami, Silvia, Segattini, Luca, Sorrentino, Carlotta, Zaborra, Alexandre, Anesi, Gianmaria Casoni Pattacini, Mattia Di Bartolomeo, Francesca, Pecchini, Arrigo, Pellacani, Micaela, Piccoli, Federico, Fusini, Andrea, Gattolin, Marco, Migliore, Roberto, Rimonda, Diego, Sasia, Elisabetta, Travaglio, Federica, Brunetti, Marco, Cereda, Marco, Ceresoli, Luca, Cigagna, Cristina, Dell'Oro, Alessandro, Fogliati, Robert, Fruscio, Tommaso, Grassi, Maini Marzia Isabella, Luca Carlo Nespoli, Massimo, Oldani, Sara, Ornaghi, Nicolò, Tamini, Carmine, Antropoli, Antonio, Castaldi, Alessio, Palumbo, Gaia, Altieri, Umberto, Bracale, Francesco, Corcione, Marcello De Luca, Giovanni Domenico De Palma, Maria Michela Di Nuzzo, Ruggero, Lionetti, Dalila Loredana Lo Bue, Gaetano, Luglio, Gianluca, Pagano, Roberto, Peltrini, Nello, Pirozzi, Francesca Paola Tropeano, Alessia, Aversano, Andrea, Belli, Maria, D'Amico, Paolo, Delrio, Francesco, Izzo, Renato, Patrone, Daniela, Rega, Pietro, Maida, Ester, Marra, Gianpaolo, Marte, Andrea, Tufo, Francesco, Bianco, Antonio, Cappiello, Simona, Gili, Paola, Incollingo, Alessandra, Novi, Giulia, Bagaglini, Claudio, Iovino, Francesco Menegon Tasselli, Maria Paola Menna, Francesco Maria Romano, Settimio, Rossi, Guido, Sciaudone, Francesco, Selvaggi, Lucio, Selvaggi, Francesca, Simonelli, Guido, Coretti, Mario, Pannullo, Adolfo, Renzi, Francesca, Ascari, Giuliano, Barugola, Giacomo, Ruffo, Paolo, Baroffio, Paolo, Bellora, Laura Enrica Benedetti, Cristina, Cerri, Giordana, D'Aloisio, Maurizio, Ferrari, Elisa, Francone, Sergio, Gentilli, Herald, Nikaj, Antonella, Chessa, Alessandro, Fiorini, Luca, Campagnaro, Franco, Chioffi, Pietro, Ciccarino, Roberto, Colasanti, Francesco de Falco, Fotios, Kalfas, Gioacchino, Mattisi, Giulia, Nezi, Matteo, Palma, Angelica, Rizzoli, Domenico, Rossi, Davide, Russo, Renato, Salvador, Francesco, Volpin, Guido, Bissolotti, Stefano, Fusetti, Francesco, Lemma, Vito, Chiantera, Mariano Catello Di Donna, Giulio, Sozzi, Emanuele, Cammarata, Sofia, Campanella, Daniela, Canzonieri, Adriana, Cordova, Federico De Michele, Ettore, Dinoto, Mara, Franza, Leo, Licari, Daniele, Matta, Domenico, Mirabella, Felice, Pecoraro, Roberto, Pirrello, Pierfrancesco, Pugliese, Fernando, Rosatti, Giuseppe, Salamone, Francesca, Toia, Massimiliano, Tripoli, Cosimo, Callari, Dario Di Miceli, Alfredo, Annicchiarico, Luca, Bellanti, Michela, Bergonzani, Roberto, Berretta, Elisa, Cabrini, Vito Andrea Capozzi, Fausto, Catena, Federico, Cozzani, Paolo Del Rio, Marco, Domenichini, Anna, Fornasari, Antonio, Freyrie, Tiziana, Frusca, Mario, Giuffrida, Gennaro, Perrone, Giulia, Rossi, Matteo, Rossini, Andrea, Varazzani, Vittorio, Arici, Antonio, Bozzani, Lorenzo, Cobianchi, Matteo, Filardo, Marika Sharmayne Milani, Franco, Ragni, Andrea de Manzoni Garberini, Edoardo, Baldini, Diana, Carpaneto, Michele, Cauteruccio, Corrado, Ciatti, Luigi, Conti, Serena, Gattoni, Pietro, Maniscalco, Gerardo, Palmieri, Calogero Puma Pagliarello, Giuseppe, Caristo, Raffaele, Galleano, Michele, Malerba, Marcello, Calabrò, Francesca, Farnesi, Elia Giuseppe Lunghi, Andrea, Muratore, Nicoletta Sveva Pipitone Federico, Joel Reuben Abel, Lorenzo, Andreani, Darienzo, Antonio, Vittorio, Aprile, Riccardo, Balestri, Giacomo, Benettini, Stefano, Berrettini, Luca, Bruschini, Massimo, Chiarugi, Federico, Coccolini, Simone, Colangeli, Camilla, Cremonini, Lodovica Cristofani Mencacci, Iacopo, Dallan, Silvia De Santi, Gregorio Di Franco, Lorena Di Girolami, Giacomo, Fiacchini, Niccolò, Furbetta, Stylianos, Korasidis, Marco, Lucchi, Andrea, Morandi, Luca, Morelli, Serena, Musetti, Carlo Maria Neri, Matteo, Palmeri, Miriana, Picariello, Francesco, Porcelli, Marco, Puccini, Nicolo, Roffi, Erica, Statuti, Dario, Tartaglia, Alberto, Tonelli, Matteo, Vianini, Gianluca, Baronio, Mauro, Montuori, Enrico, Pinotti, Stefano Maria Massimiliano Basso, Federica, Maffeis, Paolo, Ubiali, Lorenzo, Aguzzoli, Saverio, Coiro, Giuseppe, Falco, Vincenzo Dario Mandato, Valentina, Mastrofilippo, Simone, Mele, Caterina, Baldi, Carlo, Corbellini, Gianluca Matteo Sampietro, Massimo, Dugo, Mauro, Garino, Chiara, Marafante, Antonio, Masciandaro, Elisabetta, Moggia, Alessandra, Murgese, Felice Eugenio Agro, Gabriella Teresa Capolupo, Filippo, Carannante, Marco, Caricato, Vincenzo, Denaro, Erica, Mazzotta, Rocco, Papalia, Giuseppe, Pascarella, Alessandro, Strumia, Biagio, Zampogna, Matteo, Cinquepalmi, Marco, Colasanti, Celeste Del Basso, Federica, Falaschi, Nicola, Guglielmo, Roberto Luca Meniconi, Alessandra, Pecoraro, Sofia, Usai, Giacomo, Crescentini, Antonella, Larcinese, Emanuele, Picone, Giovanni, Sinibaldi, Annamaria, Agnes, Salvatore, Agnes, Sergio, Alfieri, Francesco, Belia, Valentina, Bianchi, Giuseppe, Bianco, Alberto, Biondi, Paola, Campennì, Valerio, Cozza, Sabatino, D'Archi, Domenico, D'Ugo, Veronica De Simone, Marta Di Grezia, Sofia Di Lorenzo, Federica, Ferracci, Valeria, Fico, Gianluca, Franceschini, Pietro, Fransvea, Giulio, Gasparini, Luca, Gordini, Antonio La Greca, Francesco, Litta, Celestino Pio Lombardi, Angelo Alessandro Marra, Angelo, Parello, Marco Maria Pascale, Romeo, Patini, Gilda, Pepe, Roberto, Persiani, Caterina, Puccioni, Carlo, Ratto, Fausto, Rosa, Gianmarco, Saponaro, Lorenzo, Scardina, Tedesco, Silvia, Giuseppe, Tropeano, Maria, Benevolo, Daniele, Bugada, Flaminia, Campo, Maria Gabriella Dona, Valentina, Manciocco, Paolo, Marchesi, Riccardo, Mastroianni, Francesco, Mazzola, Silvia, Moretto, Raul, Pellini, Gerardo, Petruzzi, Barbara, Pichi, Giuseppe, Simone, Gabriele, Tuderti, Jacopo, Zocchi, Luigi Marino Cosentino, Andrea, Sagnotta, Roberta, Angelico, Vittoria, Bellato, Michela, Campanelli, Marzia, Franceschilli, Michele, Grande, Giorgio, Lisi, Tommaso Maria Manzia, Lorenzo, Petagna, Bruno, Sensi, Giuseppe, Sica, Leandro, Siragusa, Giuseppe, Tisone, Marco, Assenza, Barbara, Binda, Massimo, Biondi, Gioia, Brachini, Placido, Bruzzaniti, Mauro, Casagrande, Flavia, Ciccarone, Pierfranco Maria Cicerchia, Bruno, Cirillo, Daniele, Crocetti, Giancarlo, D'Ambrosio, Vito, D'Andrea, Francesca De Felice, Giorgio De Toma, Carlo Della Rocca, Giulia, Duranti, Pietro, Familiari, Enrico, Fiori, Giovanni Battista Fonsi, Alessandro, Frati, Stefania La Rocca, Filippo La Torre, Pierfrancesco, Lapolla, Giovanni, Marruzzo, Simona, Meneghini, Andrea, Mingoli, Andrea, Picchetto, Antonella, Polimeni, Diego, Ribuffo, Maurizio, Salvati, Antonio, Santoro, Paolo, Sapienza, Luigi, Simonelli, Valentino, Valentini, Martina, Zambon, Giuseppa, Zancana, Emma, Zuppi, Simone, D'Annunzio, Cosimo De Nunzio, Silvia, Fiorelli, Mohsen, Ibrahim, Chiara, Loffredo, Domenico, Massullo, Cecilia, Menna, Rocco, Monica, Massimiliano, Pelli, Erino Angelo Rendina, Leonardo, Teodonio, Andrea, Tubaro, Giulio, Argenio, Giulio, Accarino, Accarino, Giancarlo, Antonio Nicola Giordano, Luca, Cardinali, Elisa, Sebastiani, Grazia, Travaglini, Erika, Andreatta, Emanuele Luigi Giuseppe Asti, Daniele, Bernardi, Luigi, Bonavina, Caterina, Froiio, Andrea, Lovece, Chiara, Copelli, Alfonso, Manfuso, Pasquale Di Maio, Marco, Giudice, Oreste, Iocca, Rosario, Cennamo, Tommaso, Cornali, Francesco Di Marzo, Cristian, Altana, Francesco, Bussu, Giampiero, Capobianco, Anna Giacomina Carta, Sandro, Ciccarello, Maria Laura Cossu, Pietrina, Cottu, Giacomo De Riu, Salvatore, Dessole, Francesco, Dessole, Salvatora, Dettori, Carlo, Doria, Alessandro, Fancellu, Claudio, F Feo, Giorgio Carlo Ginesu, Giuliana, Giuliani, Marco Giuseppe Iannuccelli, Massimo, Madonia, Roberto, Mancino, Olindo, Massarelli, Gianfranco, Meloni, Fabio, Milia, Andrea, Mulliri, Teresa, Perra, Marco, Petrillo, Antonio, Piras, Franco, Piredda, Francesco, Pisanu, Alberto, Porcu, Davide, Rizzo, Angelino, Sanna, Antonio Mario Scanu, Fabrizio, Scognamillo, Damiano, Soma, Anna Rita Tanca, Alessandro, Tedde, Matteo, Tedde, Luigi Angelo Vaira, Andrea Bartalini Cinughi de Pazzi, Osvaldo Carpineto Samorani, Daniele, Fusario, Luigi, Marano, Gaia, Oldrà, Anna Lisa Pesce, Stefania Angela Piccioni, Luca, Resca, Vincenzo, Ricchiuti, Franco, Roviello, Vinno, Savelli, Alberto, Abrate, Pierpaolo, Bordoni, Lorenzo, Bosio, Guglielmo, Clarizia, Francesco, Fleres, Marco, Franzini, Antonio, Fratto, Pierluigi, Giumelli, Alessandro, Grechi, Alessandro, Longhini, Fabrizio, Lorusso, Elisa, Scarnecchia, Federica, Scolari, Alessandro, Spolini, Vincenzo, Maiuri, Matteo, Papandrea, Arturo, Roncone, Lorenzo, Conti, Andrea, Rizzi, Marco, Rovagnati, Alberto, Brolese, Tommaso, Cai, Francesco Antonio Ciarleglio, Francesca, Dalprà, Gianni, Malossini, Liliana, Mereu, Irene, Tamanini, Saverio, Tateo, Giovanni, Viel, Enrico, Battistella, Paolo Boscolo Rizzo, Cristoforo, Fabbris, Marco, Massani, Giacomo, Spinato, Roberta, Tutino, Ugo, Grossi, Alessandro, Iacomino, Simone, Novello, Maurizio, Romano, Serena, Rossi, Giulio, Santoro, Giacomo, Zanus, Sokol, Trungu, Giada, Aizza, Gabriele, Bellio, Selene, Bogoni, Marina, Bortul, Biagio, Casagranda, Sara, Cortinovis, Nicolò de Manzini, Davide, Drigo, Paola, Germani, Manuela, Mastronardi, Lucia, Paiano, Silvia, Palmisano, Pier Luigi Filosso, Francesco, Guerrera, Matteo, Marro, Mauro, Rinaldi, Enrico, Ruffini, Stefano, Salizzoni, Laura, Bardelli, Mattia, Berselli, Giacomo, Borroni, Eugenio, Cocozza, Matteo, Desio, Bottazzoli, Elisa, Giuseppe, Ietto, Valentina, Iori, Domenico, Iovino, Lorenzo, Livraghi, Valentina, Marchionini, Stefano, Megna, Emma Amal Nahal, Mara, Palumbo, Valeria, Quintodei, Alessandra, Zullo, Lucrezia, D'Alimonte, Giovanni, Pirozzolo, Chiara, Vignotto, Tommaso, Campagnaro, Andrea, Caravati, Simone, Conci, Carlotta De Cristofaro, Gabriele, Gecchele, Tommaso, Giuliani, Jacopo, Graziosi, Alfredo, Guglielmi, Salvatore, Paiella, Corrado, Pedrazzani, Tommaso, Pollini, Simone, Rattizzato, Andrea, Ruzzenente, Roberto, Salvia, Giulia, Turri, Matilde, Bacchion, Giovanni, Butturini, Andrea, Casaril, Alessandro, Giardino, Harmony, Impellizzeri, Marco, Inama, Frigerio, Isabella, Gianluigi, Moretto, Marco De Zuanni, Enrica, Deiana, Mario, Guglielmo, Alessandro, Broglia, Claudia, Casarini, Caterina Costanza Zingaretti, Marta, Bonaldi, Giovanni, Cesana, Francesco, Mastriale, Stefano, Olmi, Matteo Uccelli Yasuyuki Fukami, Takuya, Saito, Tsuyoshi, Sano, Naoki, Hirai, Kazuyoshi, Hirota, Tetsuya, Kushikata, Tasuku, Oyama, Junichi, Saito, Katsuhiko, Ishibashi, Mizue, Kamiyama, Kyongsuk, Son, Kentaroh, Tarao, Takayuki, Yamada, Toshiya, Shiga, Chisaki, Aze, Yoshihiko, Deguchi, Hirotoshi, Hasegawa, Tatsuki, Hoshino, Yasushi, Innami, Hiroyuki, Inoue, Shingo, Ito, Takeshi, Nomura, Tomomi, Ogihara, Reina, Okada, Takashi, Ouchi, Yuri, Sekiya, Keikoku, Tachibana, Emi, Takano, Masae, Yamamoto, Shuko, Matsuda, Yuka, Matsuki, Kenji, Shigemi, 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Yu, Mitsuru, Ida, Masahiko, Kawaguchi, Kenji, Kawamura, Munehiro, Ogawa, Hiroshi, Okada, Shunji, Endo, Yoshinori, Fujiwara, Masaharu, Higashida, Hisako, Kubota, Toshimasa, Okada, Hironori, Tanaka, Tomio, Ueno, Kazuhiko, Yoshimatsu, Motohiro, Kikukawa, Akira, Kuriyama, Susumu, Matsushime, Hishikawa, Hidehiko, Haruaki, Hino, Yoji, Hisamatsu, Akio, Kamiya, Hidefumi, Kinoshita, Masato, Kita, Toshinori, Kobayashi, Taku, Michiura, Hirokazu, Miki, Tomohiro, Murakawa, Hidetaka, Okada, Tomohito, Saito, Ryoichi, Saito, Motohiko, Sugi, Genichiro, Sumi, Yamaki, So, Tomohisa, Yamamoto, Aya, Yoshida, Tatsuya, Kambara, Sayaka, Kanematsu, Okazaki, Satoshi, Takeshi, Hijikawa, Hiroaki, Kitade, Hidesuke, Yanagida, Tomoyuki, Fujita, Satsuki, Fukushima, Naoki, Tadokoro, Taku, Furukawa, Yusuke, Iizuka, Yuji, Otsuka, Masamitsu, Sanui, Ikumi, Sawada, Hideki, Iwahashi, Morikazu, Miyamoto, Masashi, Takano, Tsutomu, Mieda, Chihiro, Ando, Tetsuro, Isada, Taku, Ishizaki, Qaed Bani Amer, Sachi, Ishida, Yasuma, 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Rakotoarisoa, Maharo, Ramifehiarivo, Solonirina Harinarindra Ranaivoson, Hajamihamina Marina Parfaite Randriantsoa, Narindra Njarasoa Mihaja Razafimanjato, Jeannie Ba Razafindrahita, Solofoarimanana, Solofoarimanana, Guillaume Odilon Tsiambanizafy, Rakotonaivo Mamisoa Judicaël, Corinne Eulalie Solo, Tojomamy Herinjaka Ralaizafindraibe, Fanonjomahasoa Safiry Andofenohasina, Hanta, Rasataharifetra, Vanona Barijaona Razafindraibe, Angelin Sablon Herinirina, Andre, Das, Thanga, Ganapathy, Yohesuwary, Gunarasa, Kalyani, Mariapan, Maathichsudhaar, Muniandy, Mohd Firdauss Osman, Mohd Azem Fathi Mohammad Azmi, Jien Yen Soh, Wan Zainira Wan Zain, Andee Dzulkarnaen Zakaria, Zaidi, Zakaria, Kheng Hooi Chan, Firdaus, Hayati, Syamim, Johan, Jin Jiun Mah, Ratha Krishnan Sriram, Sentilnathan, Subramaniam, Nur Shahirah Binti Muhammad Shahimi, Khairul Hazim Hamdan, Mohd Razali Ibrahim, Guhan, Muthkumaran, Ju Ann Tan, Mohana Raj Thanapal, Dayang Anita Abdul Aziz, Mae-Lynn, Bastion, Mohd Hairul Nizam Harun, Farrah-Hani, Imran, Norshamsiah Md Din, Ayesha Mohd Zain, Mushawiahti, Mustapha, Syed, Nabil, Ainal Adlin Naffi, Abd Jabar Nazimi, Roszalina, Ramli, Bee Hong Soon, Pavin, Bal, Joo Qing Cheng, Mohd Rusdi Draman, Ahmad Nazran Fadzli, Sakina, Ghauth, Weipin, Hung, Suniza, Jamaris, Peng Soon Koh, Sivakumar, Krishnasamy, Yeong Sing Lee, Yew Toong Liew, Jeffery Zk Lim, Raymond Chung Siang Lim, Hiong Chin Lim, Siti Farhan Moh Pauzi, Shireen Anne Nah, Ashvin Krishna Nair, Doris Sin Wen Ng, Yuki Julius Ng We Yong, Kamarajan, Ramayah, Rahmah, Saaid, Anand, Sanmugam, Mee Hoong See, Kanesh Kumaran Seevalingam, Neha, Sethi, Srihari, Singaravel, Syeda Nureena Syed Jafer Hussain Zaidi, Chu Yik Tang, Li Ying Teoh, Kian Boon Wong, Ruben, Xavier, Ahmad Shuib Yahaya, Norhafiza, Ab, Rahman, Islah Munjih Ab, Rashid, Mohd Fahmi Abd Aziz, Mohd Norhisham Azmi Abdul Rahman, Nasser Muhammad Amjad, Shahidah Che Alhadi, Faisal, Elagili, Mohd Nazli Kamarulzaman, Azmi Md Nor, Ahmad Faidzal Othman, Mohd Yusof Sainal, Mat Salleh Sarif, Richelle, Chua, Aini Fahriza Ibrahim, Abdul Rauf Bin Ahmad, Yii Ling Lau, Ka Yee Liew, Kandasami, Palayan, Hui Yu Wong, Jasiah, Zakaria, Nor Azimah Abd Aziz, Norazila Abdul Rahim, Noorneza Abdul Rahman, Bahiyah, Abdullah, Mohamed Faizal Bin Sikkandar, Fatin, Firman, Nik Mohd Hazleigh, Intan Kartika Kamarudin, Shahril, Khalid, Mohd Fairudz Mohd Miswan, Akmal Zulayla Mohd Zahid, Norasyikin, Mustafa, Kadhim, Obaid, Mohd Yusoff Bin Yahaya Yahaya, Ahmad Ramzi Yusoff, Predrag, Andrejevic, Jeremy Borg Myatt, Svetlana, Brincat, Clifford, Caruana, Kurt Lee Chircop, Francesca, Chircop, Daniel Mario Chircop, Charles, Cini, Viktoria, Czok, Melanie, Farrugia, Gabriella, Grima, Fatimah Mj Hassan Almukhariq, Esther, Muscat, Darryl, Pisani, Mohsin Hassan Khan Roshan, Nicholas, Schembri, Mohamed, Shoukry, Neville, Spiteri, Gilbert, Tanti, Ziad Aboharp Hasan, Alberto Bazan Soto, Cedillo Rodrìguez Jonathan Rubén, Gustavo Esteban Lugo Zamudio, David Gerardo Miranda Gómez, José Alfredo Pérez Meave, Victor Pinto Angulo, Antonio Rojas Aguilar, Erik Efrain Sosa Duran, Alejandro Vàzquez Perez, Diego, Arroyo, Jose, Corona-Cruz, Hector, Martinez-Said, Heriberto, Medina-Franco, Manuel, Mendez, Teresa Moreno, Y Suárez Ma, Dolores Orta Díaz, Martha Patricia Pérez de León Vázquez, Angélica Azucena Soto Carvajal, Fidel Soto Hernández, Juan Ignacio Stenner, Adriana Valenzuela López, Mauricio Rene Hernandez, Rey Jesus Romero, Aldo Bernal Hernandez, Ana Olivia Cortes-Flores, Carlos Jose Zuloaga Fernandez Del Valle, Carlos Andres Colunga Tinajero, Jaime, Orozco-Perez, Laura Gabriela Peña Balboa, Guillermo, Yanowsky-Reyes, Víctor Hugo Alcalá Torres, Francisco José Barbosa Camacho, Irma Valeria Brancaccio Perez, Miguel Angel Calderon-Llamas, Aldo Camacho Gomez, Edgar-Joaquin, Cortes-Torres, Esteban, Cueva-Martinez, Oscar Durán Anguiano, Isaac Esparza Estrada, Roberto, Fierro-Rizo, Paola Flores Becerril, Clotilde Fuentes Orozco, Miguel García Castillo, Alejandro Gonzalez Ojeda, Ana Sofia Gonzalez Rubio, Erick Alonso González-García de Rojas, Luis Humberto Govea-Camacho, Jose Aldo Guzman Barba, Juan Carlos Ibarrola Peña, César Íñiguez Martínez, Francisco Javier Llamas-Macias, Ruben Eduardo Morán Galaviz, Cesar, Nuño-Escobar, Oscar-Everardo, Olvera-Flores, Jaqueline, Osuna-Rubio, Jose Victor Pérez-Navarro, Rodrigo, Prieto-Aldape, Luis Ricardo Ramirez Gonzalez, Marco Vinicio Ramírez Sánchez, Emilio, Reyes, Olaya Moramay Romero-Limón, Carlos Beas Ruiz-Velasco, José Antonio Sánchez Martínez, Guillermo, Sanchez-Villaseñor, Ismael, Sedano-Portillo, Gabriela Ambriz Gonzalez, Pedro Berrones Moreno Berrones Moreno, Ana Beatriz Calderon Alvarado, José de Jesús Cárdenas Barón, Araceli, Hernández, Francisco Javier León Frutos, Edgard Efren Lozada Hernandez, Eduardo Morales Valencia, Karla Daniela Pérez, Francina, Bolanos-Morales, Julio, Herrera-Zamora, Patricio, Santillan-Doherty, David Omar Arriaga Zavala, Salvador Francisco Campos Campos, Lizette, Carmona, Antonio Galindo Nava, Blanca, Santos, Juan Roberto Torres Cisneros, Katya, Bozada-Gutiérrez, Jose Jesus Herrera, Mucio Moreno Portillo, Francisco Pérez López, Mario, Trejo-Avila, Carlos Valenzuela Salazar, Maria Regina Alvarez, Fernando, Cordera, Marco Antonio de la Rosa Abaroa, Antonio, Gómez-Pedraza, Roberto, Hernandez, Antonio, Maffuz-Aziz, José Antonio Posada, Carlos Robles Vidal, Jose-Luis, Beristain-Hernandez, Blas Eduardo Quintero Sada, Nicolás Uxmal Soruco Heredia, Ernesto, Anaya, Ricardo, Arceo-Olaiz, Bernardo Gutiérrez Sougarret, Sonia Lopez Flores, Francisco, J Ochoa Carrillo, Raymundo Alfredo Pérez Uribe, Ludwigvan Adriano Bustamante Silva, Arianne, I Lupián-Angulo, Christian Enrique Soulé Martínez, Francisco César Becerra García, Ernesto Javier Guerrero Casillas, Edgar, Uribe, Nereida Esparza Arias, J Mindy Hernández-Nava, David, Isla-Ortiz, Javier, Melchor-Ruan, Esmeralda Romero Bañuelos, Rosa, Salcedo-Hernández, Diana, Vilar-Compte, Paola Zinser Peniche, Jorge, L Aguilar Frasco, Alejandro, Alfaro-Goldaracena, Gabriela Alejandra Buerba, Emma, Castro, Carlos, Chan, Ruben, Cortes, Ismael, Dominguez-Rosado, Daniel Garay Lechuga, Miguel, Herrera, Carlos, Hinojosa, Gabriel, Lopez-Pena, Edgar, Martos, Miguel Ángel Mercado, Paulina Moctezuma Velázquez, Roberto, Moguel, Mariano, Oropeza, Emmanuel Peña Gómez Portugal, Oscar Emmanuel Posadas-Trujillo, Noel, Salgado-Nesme, Oscar Santes Jasso, Catherine, Sarre, Karla Yareli Hernandez Skewes, Cristian, Jimenez, Roque Delfino Licona-Meníndez, Guillermo, Montiel, Alberto, Navarrete-Peón, Shannat, Ortega, Fernanda Romero Lechuga, Oscar, Roque, Fernando, Sevilla, Rogelio, González-López, Roberto Ángel Núñez-González, José Antonio Ortega-Jiménez, Antonio, Alvarado, Alfonso Alvarez Manilla Orendain, José Alberto Atristain Pesquera, Diego, Frutos, Felipe, Garcia, Juan Antonio González León, Marlin, Guzman, Dorihela, Herappe, Jesús Giovanni Inzunza Miranda, Miguel Angel Jimenez Botello, Ricardo, Lerma, Fabián Hilario Mendoza Pedraza, Monica Noguez Castillo, Jose Anatolio Resendiz, Oscar Alejandro Sánchez García, Laura Elena Fernandez Rios, Pamela, Frigerio, Iset, Garcia, Gloria Isela Mendoza Frías, Emmanuel, Moreno, Raquel, Quiroga, Alejandra Anzures Mendoza, Arantza Govela Hinojosa, Aldo, Izaguirre, Luis Hdez Miguelena, Jose Manuel Luna Vazquez, Indalecio Barcelata Rodriguez, Raul Ramos Mange, Carlos Reyes Utrera, David Zarate Saenz, Miguel Angel Zavala Gonzalez, Francisco Andrade González, Ludivina, Cortes, David, Roman, Aaron, Sanchez, Radu, Gurghiș, Gheorghe, Rojnoveanu, Marin, Vozian, Petru, Caraja, Gheorghe, Croitor, Roman, Mosneaga, Sarnai, Erdene, Lundeg, Ganbold, Sergelen, Orgoi, Soyombo, Orsoo, Altanchimeg, Sainbayar, Erdene, Sandag, Burmaa, Sanjaa, Rita Ait Benhamou, Abdessamad El Azhari, Bennis, Ghita, Sara, Lhassani, Sidi Mamoun Louraoui, Mounir, Rghioui, Sarra, Saaf, Taha, Gadouali, Iltimass, Gouazar, Moniba, Korch, Ahmed, Letrache, Amina, Louari, Anas, Zamame, Samia, Ousouss, Meryem, 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Alexander, Borgstein, Suzanne, Gisbertz, Sarah, Mikdad, Mark van Berge Henegouwen, Roel, Bakx, Marc, Besselink, Daniel Hl Lemmers, Anne-Jasmin, Roelofs, Paul van Amstel, Claire van Helsdingen, Ludi, Smeele, Niels, Harlaar, Frederik, Jonker, Sjirk van der Burg, Justin, Y van Oostendorp, Saranda, Ombashi, Tim van der Voort, Martijn van Geldorp, Lisanne, Posma-Bouman, Hans Donald de Boer, Annette, Olieman, Henriette, Smid-Nanninga, Jean-Paul P, M De Vries, Rianne, Hogenbirk, Tyche, Derksen, Josephine, Franken, Steven, Oosterling, Peter, Nolte, Jelle van der List, Ian, Alwayn, Okker, Bijlstra, Andries, Braat, Ruth, Bulder, Michèle de Kok, Robin, Faber, Ben, Goudsmit, Jaap, Hamming, Sven, Mieog, Alexander, Vahrmeijer, Fenna E, M van de Leemkolk, Joost van der Vorst, Jan van Schaik, Merel, Verhagen, Kim, Albers, Larsa, Gawria, Harry Van Goor, Michiel, Warle, Tessa, M van Ginhoven, Charlotte, Viëtor, Evert-Jan, Boerma, Lara, Lallitsch, Donald, Schweitzer, Wouter, Leclercq, Julie, Sijmons, 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Asensio, Luis Asensio Gomez, Diego, Carrion, Nuria, Chavarrias, Alvaro de Arriba, Jose Antonio Gazo Martínez Gazo, Alberto Gegúndez Simón, Juan Gómez Rivas, Natalia Gonzalez Alcolea, Carolina, Gonzalez-Gomez, Sara Gortázar de Las Casas, María Alexandra Heras Garceau, Alicia Hernández Gutierrez, Luis, Lassaletta, Fuad Samir Lopez Fernández, Marta, Mancheño, Blanca, Mateos-Serrano, Isabel Pascual Miguelañez, Maria Fernanda Pedrero Escalas, Julio, Peñarrocha, Yolanda, Perez, Maria Isabel Prieto-Nieto, Teresa Rivera Schmitz, Laura, Rodrigáñez, Ines, Rubio-Perez, Isabel Sanchez Cuadrado, José Ignacio Sánchez Méndez, Jorge Fernando Tone, Carlos Toribio Vazquez, Aitor, Urbieta, Diego Córdova García, Francisca Garcia-Moreno Nisa, Laura, Jiménez, Inmaculada, Lasa, Belen, Matías-García, Fernando, Mendoza-Moreno, Marina Pérez González, Ana Sánchez Gollarte, Alejandro Sanchez Pellejero, Cristina Vera Mansilla, Rafael, Barberá, Lourdes, Montes-Jovellar, Sara Fra Fernández, Nicolas Moreno Mata, Barbara, Algar-Yañez, Gutiérrez, Bérénice, Olga De La Varga-Martínez, Paula, Fernandez-Valdes-Bango, Sandra Maria Gadin-Lopez, José María Martínez-Gómiz, Elena, Nieto-Moreno, Ana, Nieto-Moreno, Montserrat Ocampos Hernandez, Maria Laura Pelegrina-Lopez, Alicia Ruiz Escobar, Elena, Sáez-Ruiz, Beatriz, Vazquez-Rivero, Antonio, Lara, Belén Vielva Del Campo, Fernando Alcaide Matas, Simbad, Costas-Ochoa, José María García Pérez, Elizabeth, Marmol, Paula Troncoso Pereira, Maria Del Pilar Concejo Cutoli, Juan Ramón Gómez López, Juan Carlos Martín Del Olmo, Paloma Guillamot Ruano, Javier Páramo Zunzunegui, Antonio Albarracín Marín Blázquez, Alfonso, Aliaga-Sanchez, Marta María Arroyo Domingo, Miriam Artés Artés, Ana Isabel Avellaneda Camarena, Aida, Blaya, Emny Rochell Bobadilla Romero, Pedro Vicente Fernández-Fernández, Lorena Galindo Iñiguez, Víctor Javier García Porcel, Clara Giménez Francés, Antonio Javier Gomez Poveda, Rebeca Gonzalez Celdran, Francisco Miguel González Valverde, Laura Guillamon Vivancos, Elena, Gurrea-Almela, Alejandra Jara Maquilón, Jose David Jimenez Parra, Abd Al Aziz Lanagrán Torres, Raquel Lax Perez, Carmen Maria Lopez Lopez, Francisco, Machado, Alfonso Marco Garrido, Florencio Manuel Marin Martinez, Victoria Martínez Muñoz, Esther, Medina, Olimpia, Molina, José Manuel Muñoz Camarena, Julian, Onate, Pedro Antonio Parra Baños, Emilio Peña Ros, Enrique, Rubio, Marina Sánchez Robles, Carlos Sanchez Rodriguez, María Valero Soriano, María Teresa Yepes García, Felipe, Alconchel, Andrés Balaguer Román, Valentín, Cayuela, Ana, Conesa, Ana Delegido García, Pedro José Gil Vázquez, Paula Gómez Valles, Francisco, Gómez-Bosch, Vicente, J León-Muñoz, Francisco, Martínez, Alvaro, Navarro-Barrios, Tatiana, Nicolás-López, Pablo Ramirez Romero, Emiliano, Cano-Trigueros, María Concepcion Alonso González, Leticia Gómez Viana, Ana Pastor Zapata, Elisa Contreras Saiz, Tamara Díaz Vico, Maria, Fernandez-Hevia, Luis Joaquín García Flórez, Raquel, Rodríguez-Uria, Sandra, Sanz, Lorena, Solar-Garcia, Aida Suárez Sánchez, Jaume, Gelonch, Dietmar, Reinaldo, Miriam Abdulkarim Polo, Asier, Aguirre, Marta Alomar Bofill, Santiago, Baena, Ashish, Bartakke, Carmen Cabeza Oliver, Marta Castro Suárez, José Andrés Cifuentes Rodenas, Olga Claramonte Bellmunt, Ant Onia Crespí Mir, Anabel De La Llave Serralvo, Mar, Escales, Isabel Rosa Fernández Burgos, Pablo Gandia Gonzalez, Juan Lliteras Jorge, María Cristina Martínez Canto, Javier, Mata, Andreu, Morell, Naila, Pagès, Sara Pérez Palao, Cristian Plaza Valiente, Catalina Ramon Barcelo, Carmen Reyero Fernández, Albert Reyes Claret, Leticia Rodriguez Vaquero, Maialen Saez de Vicuña Salinas, Pilar Santos Cidon, Concepcion, Segura, Aina, Serra, Maria Serra Guivernau, Maria Soler Pedrola, Marta, Tasende, Marta Torrent Lluch, María Inmaculada Valldeperas Hernández, Rosa-Maria, Yañez-Lpez, Andrea, Craus-Miguel, Laura Fernández Vega, Natalia Pujol Cano, Juan José Segura-Sampedro, Laura Colet Oliver, Ivan Dot Pascuet, Mireia, Duart, Isabel Tello Galindo, Eduardo Arrea Salto, Jaume Cámara Cabrera, Marta Camats Terré, Juan Gabriel Castro Ríos, Marta de la Rosa-Estadella, Anna, Fernandez-Colorado, Anna, Gasulla-Rodriguez, Antonio, Gimenez-Gaibar, Elena, Gonzalez, Yeray Maldonado Sotoca, Matilde, Molina-Corbacho, Montserrat Monfort Mira, Josep, Rodoreda, Marta Santos Espí, Arnau Verdaguer Figuerola, Elisa Angela Diego-Alonso, Jaime, López-Sánchez, Luis, Muñoz-Bellvis, Jacobo, Trebol, Borja, Aguinagalde, Cristina Gabriela Alzate Arsuaga, Ainhoa Andres Imaz, Iñigo, Arana, Coro Aranzabal Urrutia, Mikel, Armendariz, Lorena, Arrabal, Iñigo, Augusto, Adolfo, Beguiristain, Laura, Busto, Ainhoa, Cuevas, Itziar De Ariño, Alejandro, Elúa, Leticia, Fernandez, Arantza, Fernandez-Monge, Lander, Gallego, Alba, Garcia, Amaia Garcia Dominguez, Gregorio, Garmendia, Carmen, Grañén, Pelayo Hevia Rodríguez, Maria, Iraola, José Miguel Izquierdo, Aintzane, Lizarazu, Jon Ander Lizarbe, Claudia Cristina Lopes Moreira, Iker, López, Ruth Marquina González, Tania, Pastor, Adrián Recio Ayesa, Ana Paula Riverola Aso, Carballo, Rodríguez, Araceli, Rodrìguez, Maria Inmaculada Ruiz Montesinos, Patricia, Torres, Jose, Undabeitia, Ainara, Villafruela, Maria Barrionuevo Ramos, David, Blanco, Marta, Calderón, Eva Corral Rubio, Angel, Cuadrado-García, Daniela, Cubek, Ignacio, Fariña, Maria Fernandez LLorente, Natalia Flores Amador, Mariana García Virosta, Luis Garcia-Sancho Tellez, Adelina Gonzalez Martinez, María, Hernandez, Rubén Herreros Ruiz-Valdepeñas, Carmen Jimenez Sanchez, Eduardo Llamazares Cobo, María, López, Javier, López-Martin, Teresa Martínez Marivela, Luis Miguel Martinez Parra, Paloma Maté Mate, Paloma, Medrano, Manuel Moriche Carretero, Sara Núñez O'Sullivan, Manuel Ortega Oria de Rueda, María Begoña Pastor Nieto, Clara, Pérez, Antonio, L Picardo, Remedios Revilla Amores, Carmen Rodríguez Haro, Jose Alberto Rojo López, Fatima Sanchez Cabezudo Noguera, Cristina, Sanz, Daniel Serralta de Colsa, Cristina Valor Garcia, Marta Velasco Martinez, Iván Andújar Lara, Aranzazu, Calero-Lillo, Enrique, López-Ruiz, Alberto Díaz García, Alejandro Menéndez Moreno, Luis Eduardo Pérez-Sánchez, Ángela, Pascual, Miguel Adeba García, Marta Alonso Fernández, Javier Alvarez Gama, Roberto, Ballestero, Loreto Berjon De La Vega, Paola Calleja Hermosa, Mariana, Carrillo-Rivas, Alfonso, Casado, Andrea, Cerveró, Bonifacio Cimadevilla Calvo, Patricia Corriols Noval, Paloma de la Dehesa Cueto-Felgueroso, Miren Jasone Diez Zapirain, José Estevez Tesouro, José Antonio Fernández-Dívar Sánchez, Lucia Garcia Alcalde, Juan García Cardo, Tito García Moreno, Daniel, García-López, Belen Garcia-Montesinos Perea, Miren Gonzalez Benito, Rocio, Gonzalez-Aguado, Miguel Ángel Gordo Vega Gordo-Vega, Jose, Gutierrez-Banos, Jaime Jimeno Fraile, Yolanda Jubete Castañeda, Patricia Lopez Gomez, Antonia Jesús López López, David Mato Mañas, Carmelo, Morales-Angulo, Dieter, Morales-Garcia, Sara, Naranjo, Jose Luis Rabago, Jose Manuel Rabanal, Rocio Revuelta Zorrilla, Adriana Reyes Echeverría, Juan Carlos Rodríguez-Sanjuán, Juan Ramón Sanz, Isabel Simal Badiola, Guillermo, Tejón, Enrique Toledo Martínez, Raquel Varea Malo, Begoña, Fadrique, Tania, Funes, Elena González Revilla, Isaias, Alarcón, Daniel Aparicio Sánchez, Pablo Beltran Miranda, Carmen, Cepeda-Franco, María Josefa Cuevas López, Sandra, Dios-Barbeito, Virginia María Durán Muñoz-Cruzado, Carlos Gonzalez De Pedro, Rosa, M Jimenez-Rodriguez, Francisco, Manresa-Manresa, Gabriel, Marin, Cristobalina, Martin-Garcia, Sara, Martínez-Núñez, Juan Manuel Martos Martinez, Lucas, Mengíbar, Felipe Pareja Ciuro, Eduardo Perea Del Pozo, Veronica Pino Diaz, José, Pintor-Tortolero, Claudia, Quintero-Pérez, Maria Luisa Reyes Diaz, Mercedes Rubio Manzanares Dorado, Alejandro Sanchez Arteaga, Ana, Senent-Boza, Luis, Tallon-Aguilar, Jose, Tinoco-Gonzalez, Luis-Cristobal, Capitan-Morales, Juan Cintas Catena, Javier, Valdes-Hernandez, María Del Campo Lavilla, Alina López De Fernández, Miriam Abellan Lucas, Alba Diaz Padillo, Maria Gómez Romero, Linda Grace Puerto Tamayo, El Mostafa El Yaqine Er Raoudi, Melody García Domínguez, María Ángeles Gascón Domínguez, Marta González Pérez, Alba Hernáez Arzoz, Joana San Anton, Cristian, Ruminot, Hander Guillermo Acosta Diaz, Daniella, Laguado, Kristina, Aghababyan, Alba, Jr, Enrique, Artigues, Rocío, Belda, Miguel, Beltran, Jose Ignacio Blanes, Elena Campos Carot, Miriam, Cantos, Laura, Costa, Carolina Ferrer Gomez, José María Gallego Sánchez, Oscar, Gil-Albarova, Juan, Gilabert-Estellés, Emilio Lopez Alcina, Isabel López Sánchez, Severiano Marin Bertolin, Carolina, Martinez-Perez, Antonio Melero Abellán, Claudia Mulas Fernández, Beatriz, Novoa, Ruth, Nuñez, Pablo Renovell Ferrer, Guijarro-Jorge, Ricardo, Carolina Soledad Romero Garcia, Miguel Sanfeliu Giner, Silvia, M West, Enrique, Zapater, Ignacio, Miranda, Ana, Monís, Alejandro Roselló Añón, María José Sangüesa, Jorge Sanz Romera, Marcos, Adrianzén, Maria Barrios Carvajal, Mireia, Bauzá, Ana Benítez Riesco, Jose Antonio Carbonell Lopez, María-Carmen, Fernández-Moreno, Ricardo Gadea Mateo, Francisco, Garcia, Maris Luisa García-Pérez, Luisa Paola Garzon, Ana, Izquierdo, Maria Lapeña Rodríguez, Carlos, León-Espinoza, Fernando, Lopez, Rosa Martí Fernández, Sara Martínez Castro, Berta Monleón López, Isabel Mora Oliver, David, Moro-Valdezate, Ernesto Muñoz Sornosa, Sara Palomares Casasús, Leticia Pérez Santiago, Mara Albert Fort, Reyes, Balanzá, Lorena Bermell Marco, Carla Carratalá Pérez, Claudia Pilar Clemente Tomas, Marta, Córcoles, Jose Ángel Diez Ares, Carlos Domingo Del Pozo, Nuria Estellés Vidagany, Gonzalo, Garrigos, Mar Gimeno Gimeno Vicente, Blanca Alastrue Giner, Segundo, Gomez-Abril, Paloma, Gonzalez, Paula Gonzálvez Guardiola, Guillermo Sebastian Martínez Fernández, Charo Martínez García, Lucía, Martínez-Costa, Luz María Moratalla Charcos, Sergio Navarro Martínez, Carmen, Payá-Llorente, Álvaro Pérez Rubio, Nuria, Peris, Eduardo Picazo Pineda, Jordi Planelles Gómez, Francisco Ripoll Vidal, Andrea, Roca, Enrique, Salmerón-González, Raquel Segura Roselló, Ramon Trullenque Juan, Cristina Verdejo Gimeno, Jose Miguel Zaragozá García, Gema Zomeño Bravo, Marcos Bruna Esteban, Hanna, Cholewa, Milton de Jesus, Matteo, Frasson, Luis Oliver García, Héctor, J Aguado, Antonio Jose Alonso Villalba, Francisco, Ardura, Carmen Elena Badillo Bercebal, María Bedate Núnez, Alvarez-Ramos Begoña Aranzazu, Juan Beltrán de Heredia, Hugo, Bermejo, Juan Berrocal Cuadrado, Maria Bragado González, Juan, Bustamante-Munguira, Raul Calvo Gonzalez, Yolanda, Carrascal, Ana Belén Casas Marcos, María Carmen Cervera, Sergio Chávez Valladares, Ángel Cilleruelo Ramos, Susana, Cortes, Jesús, Crespo-Sanjuán, María, Cuaresma, Luis Antonio Cuellar Martin, Carlos Ferreras García, Alvaro, Fuentes-Martín, Abel, Ganso, Elena García García, Luis, Garcia-Florez, Virginia, Garcia-Virto, Juan, Gatón, Julio Alberto Gobernado Tejedor, Tania Gómez Sanz, Jose Ignacio González Martín, María Begoña Gregorio Crespo, Ana Herranz Arriero, Jose, Herreros, Marta Ibáñez Nieto, César, Infante, Carlos, Jezieniecki, Moises, Juarez, Gregorio de Jesus Labrador Hernandez, Ana Patricia Legido Morán, Ricardo León Fernández, Alejandro, Leon-Andrino, Almudena, Llorente, Maria Lopez Pais, Mauricio Loucel Bellino, Sergio, Martin, Miguel Angel Martin-Ferrero, Gonzalo Martinez Municio, Elvira Mateos Alvarez, José María Matilla, Luis María Merino Peñacoba, Mario, Montes-Manrique, Fernando Natal Álvarez, David, C Noriega, Henar Nuñez Del Barrio, Francisco Javier Ortiz de Solórzano Aurusa, Lucía, Pañeda, Victoria Pascual Escudero, Miguel Pascual Samaniego, Adela, Pereda, Marta Pérez Febles, Laura, Pesquera, Maria, Plata, Emma Puertas Ruiz, Mario, Rodriguez-Lopez, Alejandro Romero de Diego, Ana, Ruano, María Ruiz Soriano, Cristina Sánchez Torralvo, Silvia Santiago Maniega, Bárbara, Segura-Méndez, Clarisa Simon Perez, José, Soro-García, Paula Suárez Mansilla Suárez-Mansilla, Jeancarlos Trujillo Díaz, Mª Esther Valsero Herguedas, Andrea Vazquez Fernandez, Eduardo Velasco García, Ana, Zabalza, Álvaro Zamora Horcajada, Fernando Acebes García, Enrique Asensio Díaz, Martín, Bailón, Alejandro David Bueno Cañones, Alvaro Centeno Velasco, Ekta Choolani Bhojwani, Fernando Labarga Rodríguez, Sara, Mambrilla, Pablo, Marcos-Santos, Toledano, Miguel, David Pacheco Sánchez, Baltasar, Pérez-Saborido, Pilar, Pinto, Katherine, Plua, Javier Sanchez Gonzalez, Vicente, Simo, Rosalía Velasco López, Sandra Veleda Belanche, Fabiola Eugenia Michel Campos, Iciar Muñoz Lindez, Maria, Balluerca, Maite, Camuera, Pablo, Helguera, Imanol, Herrero, Patricia Paunero Vazquez, María, Sánchez-Rubio, Isami, Soeda, María Dolores Arribas Del Amo, Vicente Manuel Borrego Estella, Estefania, Casas, Néstor Castán Villanueva, Daniel Delfau Lafuente, Elena Delgado Blanco, María, Domingo, Ismael Gil Romea, Azucena, Gonzalo, Emilio Lagunas Lostao, Noelia Lete Aguirre, Yaiza Martinez Lahoz, Jesús Víctor Pérez-Tierra Ruiz, Maria Del Mar Soriano, Isabel Valero Lázaro, Esmeralda Carnicer Escusol, Guillermo Pola Bandres, Juan Luis Blas Laina, Beatriz, Cros, Patricio Andrés Freile Pazmiño, David, Garcia-Aguilera, Ana Mejía Casado, Ana, Nogués, Issa Talal El-Abur, Carlos, Yánez, Isabel Gascon Ferrer, Carlos, Gracia-Roche, Ursula María Jariod Ferrer, María Victoria Simón Sanz, Tomas, Uson, Waseem, Ahamed, Sumudu, Jayasinghe, Eranda, Karunadasa, Prathibha, Nelihela, Sujeewa Priyantha Bandara Thalgaspitiya, Dickson, Wickramarathna, Nagenthiram, Harivallavan, Pirashanthan, Nagarasa, Eranga, Perera, Kanapathipillai, Piratheep, Vithranage Srimantha Dewsiri Rodrigo, Meera, Thayalan, Rajendram, Thayaparren, Arulprashanth, Arulanantham, Kanishka De Silva, Gagana, Ganga, Anuja Nadeeshan Kumarasinghe, Mahanada, Udukala, Koculen, Vimaleswaran, Prashanthan, Yogarajah, Ravindri, Jayasinghe, Probhodana, Ranaweera, Mohamed, Rishard, Dharmabandhu, N Samarasekera, Sanjeewa, Seneviratne, Sivasuriya, Sivaganesh, Chamal, Fernando, Nishantha, Mendis, Balasingam, Balagobi, Balasupramaniam, Sathesan, Lanka, Dasanayake, Malitha, Patabendige, Wickramasooriya, Dj, Kugarajh, Ganeshapillai, Sathyamoorthy, Prasanna, Dileepa, Ediriweera, Sumudu, Kumarage, Asanka, Jayawardane, Athula, Kaluarachchi, Pituwala Liyanage Adithya Sirisena, Abubakr, Abubakr, Hozifa, Mohamed, Ismail, Mustafa, Mogahid, Sharfeldein, Samir, Ismail, Reem, Musa, Monira, Sarih, Mussab, Abaker, Eman Adam Abdalla, Mohamad, Abdelbagi, Alsafe, Adlan, Ahmed, Alnaeem, Safa, Atyah, Yasir, Awad, Rsheeda, Dawelbait, Mohamed El Hag, Ibrahim, Elbashir, Sami, Eldirdiri, Samwal, Eldirdiri, Mohammed Eltahier Abdalla Omer, Lana Abdalgadir Ahmed Mohamed, Hiba Hassan Rehmtallah Ahmed, Mohammed Balla Yousif Balla, Abdulmoiz, Aljafari, Abdulmalek, Aljafari, Elsagad, Mohamed, Abdulkader, Mohammad, Abdulkader, Shaar, Mohamed Nafea Shaar, Maab Hussein Yousif Elhafiz, Mohammed Husien Yosif Elhafiz, Abubakr Ali Mohammed Alhassan Humidan, Almigdad, Ali, Hisham, Eljack, Mohamedyasin, Elrashid, Manhal, Ahmed, Albrra, Alhag, Douaa, Ali, Mohammed Ahmed Babikir, Imad, Bakheit, Hytham K, S Hamid, Sami, Mohamed, Walid, Shaban, Nidhal, Siddig, Mohamed, Suliman, Rihab Yasir Abdelmagid, Abubaker, Yassin, Omer, Abbas, Eltahir, Abdelrahim, Muhammed, Ahmed, Mohamed, Elobaid, Adil, Hashim, Ali, Mohamed, Omer, Mohamed, Khalid, Osman, Abdallah, Yousif, Safaa, Abdulaal, Marwa, Elsadig, Mohammed, Hussain, Malaz Amir Ataalmanan, Doha Amir AtaAlmanan, Tebyan Amir AtaAlmanan, Alaa, Elgaili, Maria, Mohamed, Usra, Omara, Alkhansa, Osman, Amna, Osman, Safaa, Saad, Abdelkareem, Ahmed, Ali Adil Ali Karar, Aya, Alhassan, Mohanad, Alsidig, Mohamed, Eljack, Mohammed Ibrahim Mohammed Ali, Awad Kamal Awad Osman, Liena, Mohamed, Samah Ibrahim Omer Mohamed Osman Mohamed Osman, Altayeb, Mohammed, Ayman, Mohammed, Khadija, Muhmmed, Eltahir, Musa, Egbal Sahal Abdelmajed, Khalid Z M, Y Hamid, Omnia M, M Yousif, Mahmoud, Saleh, Osman, Bashir, Yassein, Elhussein, Omar, Madani, Eva, Angenete, Jennifer, Park, Lars, Gillberg, Monir, Jawad, Linas, Pieteris, Yousif, Saeed, Sergej, Safonov, Martin, Spångfors, Henrik, Andersson, Hans, Bahlmann, Karin Björnström Karlsson, Michelle, Chew, Lara, Daham, Lina De Geer, Helen, Didriksson, Gunilla, Gagnö, Carina, Jonsson, Anna, Oscarsson, Pamela, Buchwald, Mathilde, Delorme, Marie-Louise, Lydrup, Shahin, Mohseni, Arvid, Pourlotfi, Souheil, Reda, Kajsa, Anderin, Nina, Blomme, Josefin, Segelman, Malin, Simlund, Anders, Thorell, Fredrik, Wogensen, Daniel, Danielsson, Peter, Elbe, Rebecka, Hultgren, Boel, Hynning, Fredrik, Klevebro, Karin, Lind, Ebba, K Lindqvist, Carl, Montan, Ernesto, Sparrelid, Clara Svenberg Lind, Jeremy, Wales, Andreas, Älgå, Martin, Nordberg, Emil, Pieniowski, Ioannis, Gkekas, Niklas, Löfgren, Karolina, Niska, Robert, Zürner, Silvio, Däster, Otto, Kollmar, Savas, Soysal, Stephanie, Taha-Mehlitz, Athanasios, Tampakis, Dominik Valentin Flury, Marie, Heyne-Pietschmann, Gregor Jan Kocher, Ana, M Calinescu, Barbara, Wildhaber, Markus, Gass, Jürg, Metzger, Andreas, Scheiwiller, Lukas, Briner, Oliver, Dwidar, Steven, Grandjean, Pietro, Ricciardi, Alexandra, Calmels, Christodoulou, Michel, Morena, Antonilli, Dimitrios, Christoforidis, Alessandra, Cristaudi, Jacopo, Galafassi, Maria Luisa Gasparri, Francesco, Mongelli, Martino, Munini, Andrea, Papadia, Sotirios Georgios Popeskou, Alex, Alfieri, Thomas, Bächler, Matteo, Giardini, Christian, Gingert, Laura, Guglielmetti, Inna, Meyer, Tobias, Müller, Daniel, Schöni, Folco, Solimene, Frank, Weidner, Marco, Bueter, Daniel, Gero, Amelie, Müller, Carmen, Portenkirchner, Andreas, Thalheimer, Jeannette, Widmer, Ahmad, Hmaideh, Alaa, Kour, Saleem, Swaes, Omar, Alannaz, Ramez, Aljasem, Ezeddin, Dabbagh, M Wafa Hamoud Alhussein, Amr, Hamza, Mazen, Mohammad, Abd El-Fattah Mouhandes, Mohamad, Shareeda, Mohammad Nour Shashaa, Mousa, Sifat, Sheraa, Tahhan, Rahaf, Toutounji, Mohamed, Abdulrahman, Albaraa, Abdulsalam, Ziad Al Jarad, Hala, Alayyoubi, Dina, Alfarra, Ahmad, Alhamid, Mahmoud, Alnasser, Mulham, Gharib, Ruwaid, Gharib, Obaida, Kabel, Osama, Kherallah, Abdulqader, Klaho, Mohamed Shukri Najjar, Ahmad, Razouk, Joud, Shiekhoni, Wael, Alkhaleel, Amira, Almosa, Mohammad, Aloulou, Maen, Alzaeem, Khaled, Arnaout, Muhamad Zakaria Brimo Alsaman, Mohamad, Estanbouli, Hanadi, Hawa, Ahmad Nbrass Kabawi, Ghina, Maarawi, Yehia, Mashhadany, Sana Shaikh Torab, Waleed, Abd, Tayma Abd Alghafour, Hani, Abdalnour, Nazeeh Al Aktaa, Marwan Al Aliwy, M Maher Al Arje, Tasneem Al Najjar, Ahmad, Al-Mouakeh, Ahmad, Aldakhil, Aos, Alhamid, Hasan, Alhasan, Mohamad Shadi Alkarrash, Jumaa, Alkhamis, Sara, Alshekh, Ahmad Yamen Arnaout, Oula, Azizeh, Mohammed, Dalaleh, Aghyad, Danial, Zain, Douba, Raghad, Ghadri, Mohammad Maen Ghannam, Anas, Ghawi, Luma Haj Kassem, M Yasser Halwani, Shahed, Hamadieh, Mohammad, Hanino, Ala Aldeen Hasan, Haya, Jawish, Nasr Ullah Kabbani, Saadullah, Kabbany, Mohamad, Kadi, Lama, Kadoura, Ahmad Amir Kayali, Ammar, Kayyali, Aya, Kelzia, Amana, Kezze, Abdullah, Khalaf, Maymona, Khayata, Mohammad Nour Kitaz, Mohammad, Kour, Raghad, Makki, Ruqaya, Masri, Joseph, Masri, Noor, Masri, Muhammad, Mazketly, Shiar, Mustafa, Ezzeldin, Nashed, Yaman Qoudra Danial, Hasan, Raslan, Rima, Salem, Mohammed Asaad Salem, Thabet Sayed Bakir, Manaf, Sharabaji, Majd Sheikh Alganameh, Duaa Sheikh Kadro, Joudy, Shurbatji, Mohammad Noor Sultan, Dana, Sultan, Hala, Swied, Bakri Tarras Jarkas, Tayf, Toutounji, Fadi, Ward, Rama, Zazo, Aya, Zazo, Zainab, Zeino, Mohamed, Alaktaa, Wael, Alsado, Hala, Fares, Nouran, Hawa, Hamza, Ibrahim, Abdulmonem, Kawas, Mourad, Niazi, Bayan, Toutounji, Mohammad, Abdow, Mohamad, Ahmad, Tareq, Ahmad, Rawan Al Azhar, Hiba Al Hage Diab, Rahaf Al Mulke, Mohammad, Al-Jadaan, Ahmad, Alhussein, Zahra, Alnajem, Omar, Alneser, Bayan, Alsaid, Elias, Azar, Lubna, Bakr, Ammar, Hamza, Yara, Houdifa, Sami, Jomaa, Samer, Kefo, Hiba, Mardini, Alaa, Mohammad, Fadi, Rayya, Fatima, Razzouk, Mohannad, Saleh, Anwar, Shamandi, Ammar Youzkatli Alkhatib, Omar Abdul Salam, Dany, Ajami, Mohammad, Alhamid, Ahmad, Alkhaledi, Danny, Hadidi, Massa, Jabra, Mamdouh, Kallas, Antoine, Laktine, Joelle, Naem, Naya, Naoum, Ghena Mohammed Fawaz Ashour, Ahmad, Alhouri, Deema, Fallouh, Ahmad, N Mohammad, Ahmad, Rmman, Ali, Slitin, Christine, Tanos, Ibrahim, Wakim, Hanaa, Zahrawi, Majd, Abouassi, Layth, Abouassi, Ayham, Aboutrab, Basel, Ahmad, Ahmad Mustafa Ahmad, Aya, Ahmad, Afaf, Ahmad, Mohamad, Alabras, Mohammad, Albasheer, Ola, Alkasser, Mhd Khaled Alkasser, Ali, Alkhdor, Marah, Azkoul, Mohammad Karam Chaaban, Haya, Deeb, Basel, Jazieh, Basel, Kouz, Youssef, Kozah, Raied, Mohamad, Ammar, Mohammad, Mhd Zied Nasri, Mohammed Mouaz Shebani, Mohammed, Shwin, Alaa, Sommaq, Amal, Youssef, Tala Al Asadi, Suhad, Alkhateb, Rasha Khalil Alsayyad, Roula, Altom, Mhd Amin Alzabibi, Batoul, Bakkar, Hlma, Ismail, Salma Khadem Alsrouji, Sara, Melhem, Mohamad, Sankari, Mosa, Shibani, Noura, Shujaa, Ibrahim, 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Giuseppe Salamone, Francesca Toia, Massimiliano Tripoli, Nepogodiev, D, Rosati, R, Surgery, Medicine and Pharmacy academic/administration, Basic (bio-) Medical Sciences, Surgical clinical sciences, Faculty of Medicine and Pharmacy, Gastroenterology, Medical Oncology, Clinical sciences, Breda, João, ARD - Amsterdam Reproduction and Development, Paediatric Surgery, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, AGEM - Endocrinology, metabolism and nutrition, Graduate School, Tytgat Institute for Liver and Intestinal Research, Laura Alberici, Filippo Antonacci, Alessandro Arena, Angela Belvedere, Fabio Bernagozzi, Paolo Bernante, Pietro Bertoglio, Lorenzo Bianchi, Maria Bisulli, Barbara Bonfanti, Safia Boussedra, Jury Brandolini, Crescenzo Cacciapuoti, Stefano Cardelli, Riccardo Casadei, Matteo Cescon, Alessandro Cipolli, Riccardo Cipriani, Alfredo Conti, Luca Contu, Francesco Costa, Niccolo’ Daddi, Eugenia De Crescenzo, Pierandrea De Iaco, Alessandra De Palma, Massimo Del Gaudio, Anna Nunzia Della Gatta, Giampiero Dolci, Giulia Dondi, Matteo Droghetti, Sergio Nicola Forti Parri, Elena Garelli, Chiara Gelati, Giuliana Germinario, Federico A. Giorgini, Carlo Ingaldi, Elio Jovine, Kenji Kawamukai, Antonio Lanci Lanci, Raffaele Lombardi, Maria Elisa Lozano Miralles, Claudio Marchetti, Michele Masetti, Francesco Minni, Daniele Morezzi, Daniele Parlanti, Alice Pellegrini, Anna Myriam Perrone, Anna paola Pezzuto, Marco Pignatti, Gianluigi Pilu, Valentina Pinto, Gilberto Poggioli, Silvana Bernadetta Puglisi, Diego Raimondo, Matteo Ravaioli, Claudio Ricci, Sara Ricciardi, Francesco Ricotta, Roberta Rizzo, Angela Romano, Matteo Rottoli, Riccardo Schiavina, Renato Seracchioli, Matteo Serenari, Margherita Serra, Piergiorgio Solli, Gioia Sorbi, Mario Taffurelli, Marta Tanzanu, Achille Tarsitano, Marco Tesei, Gabriele Vago, Tommaso Violante, Simone Zanotti, Tommaso Frisoni, leonardo solaini, giorgio ercolani, Fruscio, R, Ornaghi, S, Collaborative, Covidsurg, Collaborative, Globalsurg, Palmisano, Silvia, de Manzini, Nicolo', Žundienė, Laura, Dulskas, Audrius, Kuliavas, Justas, Čekauskas, Albertas, Kielaitė-Gulla, Aistė, Poškus, Tomas, Strupas, Kęstutis, Želvys, Arūnas, COVIDSurg Collaborative, GlobalSurg Collaborative, Department of Surgery, HUS Abdominal Center, Simoes, Jff, Li, E, Picciochi, M, Glasbey, Jc, Baiocchi, G, Blanco-Colino, R, Chaudhry, D, Alameer, E, El-Boghdadly, K, Wuraola, F, Ghosh, D, Gujjuri, Rr, Harrison, Em, Lule, H, Kaafarani, H, Khosravi, M, Kronberger, I, Leventoglu, S, Mann, H, Mclean, Ka, Mengistu, Gm, Modolo, Mm, Ntirenganya, F, Norman, L, Outani, O, Pius, R, Pockney, P, Qureshi, Au, Roslani, Ac, Satoi, S, Shaw, C, Bhangu, A, Omar, Om, Ahmed, Wur, Argus, L, Ball, A, Bywater, Ep, Brar, A, Dawson, Be, Duran, I, Elhadi, M, Jones, C, Kamarajah, Sk, Keatley, Jm, Lawday, S, Marson, Ej, Ots, R, Santos, I, Taylor, Eh, Trout, Im, Varghese, C, Venn, Ml, Xu, W, Dajti, I, Gjata, A, Kacimi, Seo, Boccalatte, L, Cox, D, Townend, P, Aigner, F, Kronberger, Ie, Samadov, E, Alderazi, A, Hossain, K, Padmore, G, van Ramshorst, G, Lawani, I, Cerovac, A, Delibegovic, S, Gomes, Gma, Buarque, Il, Gohar, M, Slavchev, M, Nwegbu, C, Agarwal, A, Martin, J, Ng-Kamstra, J, Olivos, M, Lou, Wh, Ren, Dl, Calvache, Ja, Rivera, Cjp, Hadzibegovic, Ad, Kopjar, T, Mihanovic, J, Jimenez, Pma, Gouvas, N, Klat, J, Novysedlak, R, Amisi, N, Christensen, P, El-Hussuna, A, Batista, S, Lincango-Naranjo, E, Emile, S, Sandoval, Daa, Dhufera, H, Hailu, S, Mengesha, Mg, Kauppila, Jh, Arnaud, Ap, Demetrashvili, Z, Albertsmeier, M, Lederhuber, H, Loffler, Mw, Acquah, Dk, Ofori, B, Tabiri, S, Metallidis, S, Tsoulfas, G, Aguilera-Arevalo, Ml, Recinos, G, Mersich, T, Wettstein, D, Kembuan, G, Milan, Pb, Khosravi, Mh, Mozafari, M, Hilmi, A, Mohan, H, Zmora, O, Gallo, G, Pata, F, Pellino, G, Fujimoto, Y, Kuroda, N, Abou Chaar, Mk, Ayasra, F, Fakhradiyev, I, Hamdun, Ih, Jin-Young, J, Jamal, M, Karout, L, Gulla, A, Rasoaherinomenjanahary, F, Samison, Lh, Sanchez, Iid, Gonzalez, D, Martinez, L, Martinez, Mj, Nayen, A, and Ramos-De la Medina, A

Subjects
Male, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], MULTICENTER, infectious diseases, 0302 clinical medicine, 030202 anesthesiology, Anesthesiology, Cirugía, 80 and over, Prospective Studies, Young adult, Child, Lung, Aged, 80 and over, COVID-19, delay, SARS-CoV-2, surgery, timing, SARS‐CoV‐2 infection, Operative, Child, Preschool, Pneumonia & Influenza, Infection, Cohort study, Human, medicine.medical_specialty, Clinical Sciences, Sars-cov-2, GlobalSurg Collaborative, Settore MED/28 - MALATTIE ODONTOSTOMATOLOGICHE, 03 medical and health sciences, Clinical Research, Biodefense, Correspondence, Humans, PULMONARY COMPLICATIONS, CRIANÇAS EM IDADE PRÉ-ESCOLAR, Aged, Science & Technology, Cirurgia, Prevention, Infant, Odds ratio, Pneumonia, Prospective Studie, Clinical research, Surgery, Human medicine, 610 Medizin und Gesundheit, 1109 Neurosciences, Internationality, Settore MED/29 - CHIRURGIA MAXILLOFACCIALE, Settore MED/18 - CHIRURGIA GENERALE, Adolescent, Adult, Cohort Studies, Female, Middle Aged, Surgical Procedures, Operative, Time, Young Adult, Practice Guidelines as Topic, gastroenterology, Medicine and Health Sciences, 030212 general & internal medicine, Prospective cohort study, Mortality rate, Covid19, Infectious Diseases, Patient Safety, medicine.symptom, 6.4 Surgery, Life Sciences & Biomedicine, 610 Medicine & health, COVID-19, SARS-CoV-2, delay, surgery, timing, Asymptomatic, NO, COVIDSurg Collaborative, Vaccine Related, All institutes and research themes of the Radboud University Medical Center, medicine, Mortalitat, ddc:610, Mortality, Preschool, LS7_4, Surgical Procedures, business.industry, Neurosciences, Evaluation of treatments and therapeutic interventions, 1103 Clinical Sciences, 3126 Surgery, anesthesiology, intensive care, radiology, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Anesthesiology and Pain Medicine, Emerging Infectious Diseases, Good Health and Well Being, Mortalidad, Cohort Studie, business
Abstract

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay. ispartof: ANAESTHESIA vol:76 issue:6 pages:748-758 ispartof: location:England status: published

Published
2021
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44. Genome-wide identification, structure analysis and expression profiling of phospholipases D under hormone and abiotic stress treatment in chickpea (Cicer arietinum)

Author

Dipul Kumar Biswas, Deepika, Sushma Sagar, Ramsankar Chandrasekar, and Amarjeet Singh

Subjects
Gene Expression, 02 engineering and technology, Biology, Sodium Chloride, Genes, Plant, Biochemistry, Conserved sequence, 03 medical and health sciences, Structural Biology, Gene Expression Regulation, Plant, Stress, Physiological, Phospholipase D, Gene family, Molecular Biology, Gene, Phylogeny, 030304 developmental biology, Plant Proteins, Abiotic component, 0303 health sciences, Abiotic stress, Cold-Shock Response, Gene Expression Profiling, General Medicine, 021001 nanoscience & nanotechnology, Cicer, Cell biology, Droughts, Gene expression profiling, enzymes and coenzymes (carbohydrates), lipids (amino acids, peptides, and proteins), 0210 nano-technology, Function (biology)
Abstract

Phospholipases D (PLDs) are phospholipid hydrolyzing enzymes and crucial components of lipid signaling in plants. PLDs are implicated in stress responses in different plants however, characterization of PLDs in chickpea is missing. Here, we identify 13 PLD genes in the chickpea genome. PLD family could be divided into α, β, δ, e and ζ isoforms based on sequence and structure. Protein remodeling described that chickpea PLDs are composed of defined arrangements of α-helix, β-sheets and short loops. Phylogenetic analysis suggested evolutionary conservation of chickpea PLD family with dicots. In-planta subcellular localization showed the plasma membrane localization of chickpea PLDs. All PLD promoters had hormone and stress related cis-regulatory elements, which suggested overlapping function of PLDs in hormone and abiotic stress signaling. The qRT-PCR expression analysis revealed that most PLD genes are differentially expressed in multiple abiotic stresses (drought, salt and cold stress). Moreover, several PLD genes had overlapping expression in abiotic stress and ABA and JA treatment. These observations indicate the involvement of PLD gene family in cross-talk of phytohormone and abiotic stress signaling in chickpea. Thus, present study opens new avenues of utilizing PLD related information for understanding hormone-regulated abiotic stress signaling in legume crops.

Published
2020

45. Exocrine and endocrine functions and pancreatic volume in patients with pancreatic trauma

Author

Lalchhandami Colney, Nikhil Tandon, Sushma Sagar, Pramod Kumar Garg, Amit Gupta, Nandita Gupta, Atin Kumar, and Subodh Kumar

Subjects
Adult, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Aftercare, Critical Care and Intensive Care Medicine, Gastroenterology, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Pancreatectomy, Internal medicine, Diabetes mellitus, medicine, Endocrine system, Humans, Orthopedics and Sports Medicine, In patient, Pancreas, 030222 orthopedics, business.industry, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Patient Discharge, Partial Pancreatectomy, medicine.anatomical_structure, Pancreatic trauma, Emergency Medicine, Surgery, Exocrine Pancreatic Insufficiency, Endocrine functions, business
Abstract

Injury to the pancreas may lead to significant morbidity and mortality. We aim to assess pancreatic endocrine and exocrine functions and evaluated morphological regenerations of pancreas following partial pancreatectomy in patients with pancreatic trauma. The study was performed between June 2016 and December 2017. Endocrine functions were assessed at the time of admission and at 6 months follow-up with 75 g oral glucose tolerance test (OGTT), serum insulin and C-peptide levels and HbA1c estimation and exocrine functions were assessed with fecal elastase test. Pancreatic volumetry was done with imaging scan at 1 month and 6 months post discharge. Twenty patients were studied with a median age of 30 years (range18–48) at the time of injury. All the patients were normoglycemic on admission; only one patient who underwent pancreatic resection developed diabetes mellitus at follow-up. Eight patients (40%) were found to be prediabetic by American Diabetes Association (ADA) criteria. Eleven patients (55%) had pancreatic exocrine insufficiency. Pancreatic volume increment, from the mean pancreatic volume of 48.65 to 54.29 cm3, was noted in patients who underwent partial pancreatectomy. Patients with pancreatic trauma may develop biochemical endocrine and exocrine insufficiencies following pancreatic resection. Pancreatic volume increment requires further research in a larger study.

Published
2020

46. Dark-Induced Hormonal Regulation of Plant Growth and Development

Author

Deepika, Amarjeet Singh, Sushma Sagar, and Ankit

Subjects
0106 biological sciences, 0301 basic medicine, Mini Review, growth, hormone, Gene regulatory network, Plant Science, lcsh:Plant culture, Biology, 01 natural sciences, 03 medical and health sciences, Shade avoidance, Gene expression, lcsh:SB1-1110, Plastid, development, Transcription factor, Effector, fungi, food and beverages, Cell biology, 030104 developmental biology, Darkness, sense organs, Signal transduction, signaling, dark, 010606 plant biology & botany
Abstract

The sessile nature of plants has made them extremely sensitive and flexible toward the constant flux of the surrounding environment, particularly light and dark. The light is perceived as a signal by specific receptors which further transduce the information through the signaling intermediates and effector proteins to modulate gene expression. Signal transduction induces changes in hormone levels that alters developmental, physiological and morphological processes. Importance of light for plants growth is well recognized, but a holistic understanding of key molecular and physiological changes governing plants development under dark is awaited. Here, we describe how darkness acts as a signal causing alteration in hormone levels and subsequent modulation of the gene regulatory network throughout plant life. The emphasis of this review is on dark mediated changes in plant hormones, regulation of signaling complex COP/DET/FUS and the transcription factors PIFs which affects developmental events such as apical hook development, elongated hypocotyls, photoperiodic flowering, shortened roots, and plastid development. Furthermore, the role of darkness in shade avoidance and senescence is discussed.

Published
2020
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47. Changes in extracellular cytokines in predicting disease severity and final clinical outcome of patients with blunt chest trauma

Author

Subodh Kumar, Surbhi Khurana, Sushma Sagar, Vishnubhatla Sreenivas, Richa Aggarwal, Purva Mathur, Minu Kumari, Karan Madan, and Amit Gupta

Subjects
0301 basic medicine, Adult, Male, medicine.medical_specialty, Thoracic Injuries, medicine.medical_treatment, Immunology, Inflammation, Severity of Illness Index, Proinflammatory cytokine, Sepsis, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Blunt, Internal medicine, medicine, Immunology and Allergy, Humans, Prospective cohort study, medicine.diagnostic_test, business.industry, Hematology, Middle Aged, medicine.disease, Prognosis, 030104 developmental biology, Bronchoalveolar lavage, Cytokine, Case-Control Studies, Injury Severity Score, Cytokines, Female, Disease Susceptibility, medicine.symptom, business, Bronchoalveolar Lavage Fluid, Biomarkers, 030215 immunology, Follow-Up Studies
Abstract

Background Chest trauma causes substantial morbidity and mortality and its severity is assessed using clinical diagnosis or scoring systems like Injury severity score (ISS) and thoracic trauma severity score (TTSS). Association of inflammatory cytokines with severity of disease and final clinical outcome is not clearly defined in patients with chest trauma. In this study, we thought to evaluate the inflammatory response in serum and bronchoalveolar lavage fluid (BALF) in chest trauma patients and correlate the level of extracellular cytokines with diseases severity and final outcome. Methods A total of 65 patients with blunt chest trauma and 30 healthy controls were enrolled in this prospective observational study. Assessment of inflammatory cytokines such as Interleukin (s) - IL-5, IL-13, IL-2, IL-6, IL-9, IL-1β, IFN-γ, TNF-α, IL-17A, IL-17F,IL-4, IL-21 and IL-22 was performed in both serum and bronchoalveolar lavage fluid using 13-plex multiplex kit using fluorescence–encoded bead based immunoassays. Results A significantly higher level of IL-13, IL-2, IL-6, IL-9, IL-1β, IFN-γ, TNF-α, IL-17A, IL-17F, IL-21 and IL-22 cytokines were observed in patients with blunt chest trauma compared to healthy controls. Level of IL-2, IL-6, IL-1β and IL-17A was significantly raised in the patients with blunt chest trauma who had a fatal outcome during the hospital stay. An elevated cytokine response of IL-13, IL-4, and IL-21 was noted in the group of patients with high (>5) thoracic trauma severity score. Conclusion Routine monitoring of the inflammatory cytokine level in patients with chest trauma may be used routinely. Longer prospective studies should be encouraged to determine the role of cytokines in patients with chest trauma in predicting the patient final clinical outcome.

Published
2020

48. Profile of Injuries in Children: Report From a Level I Trauma Center

Author

Subodh Kumar, Mohit Kumar Joshi, Amulya Rattan, Sushma Sagar, Amit Gupta, and Biplab Mishra

Subjects
Thorax, Male, medicine.medical_specialty, Hemorrhage, Sepsis, Injury Severity Score, Trauma Centers, Pediatric surgery, medicine, Trauma centre, Humans, Registries, Child, Road traffic, Retrospective Studies, business.industry, Trauma center, Accidents, Traffic, medicine.disease, medicine.anatomical_structure, Pediatrics, Perinatology and Child Health, Emergency medicine, Abdomen, Wounds and Injuries, business
Abstract

Objective We present our experience of pediatric injuries over 5 years from a level I trauma centre. Methods De-identified data from a prospectively maintained database of pediatric patients was analyzed for demography and injury-related parameters, and management provided. Results There were 906 patients (698 male, median age 12 years). Predominant cause was road traffic injuries. The median injury severity score was 9. Abdomen and thorax were the commonest regions affected. There were 44 deaths. Sepsis and hemorrhage were the commonest causes of mortality. Conclusions The magnitude of pediatric injuries is significant, and maintenance of dedicated trauma registries is the need of the hour.

Published
2020

49. Haemorrhage control beyond Advanced Trauma Life Support (ATLS) protocol in life threatening maxillofacial trauma - experience from a level Ⅰ trauma centre

Author

Sushma Sagar, Swasthi S Kumar, Atish Kumar, Abhishek Gupta, Maneesh Singhal, Pankaj Gupta, R. Kaul, Shivanand Gamangatti, and Parvez Mohi Ud Din Dar

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Traumatic brain injury, Balloon tamponade, medicine.medical_treatment, 0211 other engineering and technologies, 02 engineering and technology, Haemorrhage control, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Trauma Centers, medicine, Trauma centre, Humans, 021102 mining & metallurgy, Aged, Retrospective Studies, medicine.diagnostic_test, Skull Fractures, business.industry, Medical record, 030206 dentistry, Middle Aged, medicine.disease, Surgery, Advanced trauma life support, Epistaxis, Otorhinolaryngology, Angiography, Advanced Trauma Life Support Care, Female, Maxillofacial Injuries, Oral Surgery, business, Airway
Abstract

Maxillofacial injuries are usually not life-threatening and do not get priority over other associated injuries. However, some maxillofacial injuries with active oral or nasal bleeding need immediate management due to threatened airway and blood loss. In the case of major active vascular bleeding, measures such as local pressure, anterior nasal packing, posterior nasal packing, and balloon tamponade are ineffective. In these cases, angiography and transcatheter arterial embolisation (TAE) are used to treat life-threatening haemorrhage caused by maxillofacial trauma. We analysed the medical records of 39 patients with severe maxillofacial trauma and life-threatening haemorrhage that was a result of intractable oral or nasal bleeding. These patients were considered for TAE from January 2010 to December 2019. A total of 1668 patients was admitted, out of which 39 (2.3%) had severe maxillofacial injuries with life-threatening oral or nasal bleeding and underwent TAE. Out of a total of 39 patients, 38 were male and one female. Ages ranged from 16 to 65 years. Road traffic injury was the most common cause of injury (79.5%), Lefort I and II were the most common facial fractures, and traumatic brain injury was the most common associated injury. Embolisation and bleeding control were done successfully in all 39 patients with no procedure-related complications. A total of 17 deaths during the study period were due to severe traumatic brain injuries or haemorrhagic shock.

Published
2020

50. Trauma care in the times of COVID

Author

Supreet, Kaur, Vivek, Kumar, Soumya, Ghoshal, Niladri, Banerjee, and Sushma, Sagar

Subjects
Infection Control, Trauma Centers, Research Letter, COVID-19, Humans, India, Wounds and Injuries, General, Developing Countries, Pandemics
Published
2020

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