444 results on '"Thind S"'
Search Results
152. DEVELOPMENT OF “FISH MINCE PAKORA” FROM A CULTURED CARP SPECIES, LABEO ROHITA (HAM.).
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SEHGAL, H. S., SEHGAL, G. K., THIND, S. S., KAUR, A., and REHAL, J.
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ROHU ,LABEO ,FISH farming ,FISH as food ,COOKING - Abstract
A convenience ready-to-cook product Fish Mince Pakora (FMP) has been developed at the Fisheries Research Complex of the Punjab Agricultural University from the deboned meat of Labeo rohita (Ham.). The sensory evaluation of the product (on a 9-point hedonic scale) scored between 7.7 and 8.5 for different sensory attributes. The overall acceptability score was 8.0. The cooking yield of FMP was 98.43% with fat retention capacity of 359.51%. The crude protein content of the fried FMP was 22.79%, total lipids 3.36%, total soluble sugars 2.60% and gross energy 188.31 kcal/g. PRACTICAL APPLICATIONS Processing of carps such as Labeo rohita into value-added ready-to cook/ready-to-eat products such as fish mince pakora (FMP) has a great potential in the present scenario of the increasing number of nuclear families and more and more women getting jobs. The development of FMP from L. rohita has a special significance in making carp culture sustainable. Carps can be cultured in semi-intensive fish farming systems, which are based on low-input technology and are most widely adopted in south and Southeast Asian countries. But as such, carps have limited consumer acceptability because of the presence of intramuscular bones. Processing of carps into value-added products such as FMP can enhance their acceptability and market value as revealed by the sensory evaluation of the product (FMP). [ABSTRACT FROM AUTHOR]
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- 2010
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153. The Effect of Diclofenac Sodium on Urinary Concentration of Calcium, Uric Acid and Glycosaminoglycans in Traumatic Paraplegics
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SHARMA, S., primary, VAIDYANATHAN, S., additional, THIND, S. K., additional, NATH, R., additional, and SANKARANARAYANAN, A., additional
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- 1991
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154. Some quality aspects of fish patties prepared from an Indian major carp, Labeo rohita (Ham.).
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Sehgal, >H. S., Shahi, Meenakshi, Sehgal, G. K., and Thind, S. S.
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FISH as food ,ROHU ,SUGARS ,POTATOES ,INDIAN cooking (South Asian) ,COOKING - Abstract
Six different types of fish patties were prepared from de-boned meat of three weight groups (250-500 g, 501-750 g, and 751-1,000 g) of an Indian major carp, Labeo rohita, using two extenders (boiled potato and corn flour). The weight of the fish and the type of the extender affected the nutritional quality of the patties. Cooking lowered the crude protein but increased the total lipid, total soluble sugars, and gross energy contents of the patties. Cooking yield increased with an increase in the weight of the fish. Similarly, the use of corn flour as the extender resulted in a higher cooking yield and higher fat retention capacity than boiled potato. The type of extender had no effect on the water-holding capacity of the patties. The weight of the fish and the extender had no significant effect on appearance, colour, flavour, taste, and the overall acceptability of the product. However, the patties prepared from 250-500 g and 501-750 g weight groups with corn flour as the extender had a significantly higher score for their texture. The total plate count suggested that the patties were safe (from microbiological point of view) up to a storage period of 80 days. [ABSTRACT FROM AUTHOR]
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- 2008
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155. Effect of Farmyard Manure and P Application to Potato on Available P and Crop Yield of Potato (Solanum tuberosum)-Sun flower (Helianthus annuus) Sequence.
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Sidhu, A. S., Thind, S. S., Sekhon, N. K., and Hira, G. S.
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PHOSPHORUS , *FARM manure , *AGRICULTURAL wastes , *SUSTAINABLE agriculture , *CROP yields , *AGRICULTURAL productivity , *POTATOES , *SUNFLOWERS , *CROPS - Abstract
A field experiment was conducted on a loamy sand soil for five years to evaluate the effect of farmyard manure (FYM) at 0 and 50 t ha-1 and P levels (0, 13, 26 and 39 kg P ha-1)on the yield of potato tuber and succeeding sunflower and build up of available P in soil. Application of FYM at 50 t ha-1 caused substantial improvement in tuber yield (29%) and, P uptake (26%) of potato, seed yield of sunflower (14.7%), sustainable yield index of potato and available P content of soil. Response toP application to potato was significant up to 13 kg P ha-1 both in the presence and absence of FYM but fertilizer P efficiency was greater in no-FYM as compared to FYM treatment. For obtaining optimum potato and sunflower yield and maintenance of available P content of soil on sustainable basis, application of 13 and 26 kg P ha-1 to potato in the presence and absence of FYM, respectively, seem to be sufficient. [ABSTRACT FROM AUTHOR]
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- 2007
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156. Thereapeutic response of Tribulus terrestris (gokhru) aqueous extract on hyperoxaluria in male adult rats.
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Sangeeta, D., Sidhu, H., Thind, S. K., Nath, R., and Vaidyanathan, S.
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- 1993
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157. Lignocaine pretreatment for suxamethonium.
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CHATTERJI, S., THIND, S. S., and DAGA, S. R.
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- 1983
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158. Rearing Practices of Rural Girls- A Situational Analysis Across Cultural Zones of Punjab
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Thind, S., Mahal, R., and Seema
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AbstractThe Punjab State is divided into three cultural zones i.e. Majha, Malwa and Doaba. A multi stage random sampling method was employed for the selection of the sample. The total sample of the study was 3600 adolescent girls. The girls were interviewed on the existing levels of schooling status, household responsibilities, upbringing practices, economic, social, health and marriage aspects. The girls in all the three cultural zones were of the view that discrimination between genders was felt in different rearing practices No matter, what amount of school work is there, the girls from all cultural zones have to give priority to their household responsibilities Girls were not allowed to go for movies /shopping, as this would bring bad name to their families. No social /religious functions are performed on birth of a baby girl.
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- 2008
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159. Biochemical Mechanism of Action of Pyridoxine in the Prevention of Glycolate Induced Hyperoxaluria in Male Albino Rats
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Rattan, V., Sidhu, H., and Thind, S. K.
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- 1995
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160. The Loss of Circadian Rhythmicity of Urinary Solute Excretion in Idiopathic Stone Formers.
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SIDHU, H., VAIDYANATHAN, S., WANGOO, D., THIND, S. K., NATH, R., MALAKONDAIAH, G. C., and KRISHAN, K.
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- Circadian rhythmicity in urinary volume and excretion of creatinine, calcium, oxalate, uric acid and phosphate was studied in 15 idiopathic stone formers and in 17 control subjects who were age-matched, related adult males, living in the same house and engaged in similar occupations to those of the stone patients, but who had no clinically obvious stone disease. Three-hourly urine samples were collected and creatinine, calcium, oxalate, uric acid and inorganic phosphate were estimated. The time series of data were analysed by cosinor rhythmometry. Circadian rhythmicity has been described in urinary volume and urinary excretion of creatinine, calcium, oxalate, uric acid and inorganic phosphate in normal subjects, but it was not detected in the stone formers. The control subjects exhibited a circadian rhythmicity only in urinary volume and creatinine excretion. Thus they occupied a position midway between healthy adults, who exhibit circadian rhythmicity in all of the above parameters, and the stone formers, who appear to have lost it altogether. [ABSTRACT FROM AUTHOR]
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- 1989
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161. Statistical comparison of lane shift sign configurations with driving simulation
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Thind, S. S., Moradpour, S., Konur, D., Suzanna Long, and Qin, R.
162. Work zone simulator analysis : driver performance and acceptance of Missouri alternate lane shift configurations.
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Missouri. Department of Transportation. Construction and Materials Division, United States. Federal Highway Administration, Long, Suzanna, Qin, Ruwen, Konur, Dincer, Leu, Ming C., Moradpour, S., Thind, S., Nadathur, H., Missouri University of Science and Technology. Dept. of Engineering Management and Systems Engineering, Missouri. Department of Transportation. Construction and Materials Division, United States. Federal Highway Administration, Long, Suzanna, Qin, Ruwen, Konur, Dincer, Leu, Ming C., Moradpour, S., Thind, S., Nadathur, H., and Missouri University of Science and Technology. Dept. of Engineering Management and Systems Engineering
- Abstract
MoDOT Project #TR201612, The objective of this project is to evaluate MoDOT’s alternate lane shift sign configuration for work zones. The single sign proposed by MoDOT provides the traveler with enough information to let them know that all lanes are available to shift around the work zone, whereas the MUTCD signs require drivers to see two signs. This research simulation project evaluates the drivers’ lane shifting performance and acceptance of the alternate lane shift sign proposed by MoDOT to be used on work zones as compared to the MUTCD lane shift signs. Based on the study results, no difference was observed between MUTCD lane shift sign and MoDOT lane shift sign lane shift patterns with respect to driving patterns. In summary, statistical data analysis clearly demonstrated that there was not a noticeable, statistical difference between lane change patterns of drivers in the MoDOT alternate signs with MUTCD signs in the work zone.
163. Lignocaine Pretreatment for Suxamethonium
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CHATTERJI, S., primary, THIND, S. S., additional, DAGA, S. R., additional, and Owens, William D., additional
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- 1984
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164. ChemInform Abstract: HETEROCYCLES IN ORGANIC SYNTHESIS. PART 42. PREPARATION OF AZIDES, PHTHALIMIDES, AND SULFONAMIDES FROM PRIMARY AMINES
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KATRITZKY, A. R., primary, LISO, G., additional, LUNT, E., additional, PATEL, R. C., additional, THIND, S. S., additional, and ZIA, A., additional
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- 1980
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165. ChemInform Abstract: IMPROVED METHODS FOR CONVERSION OF PRIMARY AMINES INTO BROMIDES
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KATRITZKY, A. R., primary, AL-OMRAN, F., additional, PATEL, R. C., additional, and THIND, S. S., additional
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- 1980
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166. ChemInform Abstract: REACTIONS OF N-SUBSTITUTED PYRIDINIUM CATIONS WITH CARBANIONS: 5,6,8,9-TETRAHYDRO-7-PHENYLBISBENZO(AH)ACRIDINE, A SUPERIOR LEAVING GROUP
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KATRITZKY, A. R., primary and THIND, S. S., additional
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- 1981
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167. ChemInform Abstract: THE CONVERSION OF AMINO INTO SULFUR FUNCTIONALITY
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KATRITZKY, A. R., primary, REZENDE, M. C., additional, and THIND, S. S., additional
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- 1980
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168. ChemInform Abstract: STERIC ACCELERATION IN THE DECOMPOSITION OF PYRIDINIUM CATIONS: A SAFE ALTERNATIVE TO THE DIAZONIUM CONVERSION OF ARYL AMINES INTO ARYL THIOCYANATES
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KATRITZKY, A. R., primary and THIND, S. S., additional
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- 1979
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169. ChemInform Abstract: KINETICS AND MECHANISMS OF NUCLEOPHILIC DISPLACEMENTS WITH HETEROCYCLES AS LEAVING GROUPS. 2. N-BENZYLPYRIDINIUM CATIONS: RATE VARIATION WITH STERIC EFFECTS IN THE LEAVING GROUP
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KATRITZKY, A. R., primary, EL-MOWAFY, A. M., additional, MUSUMARRA, G., additional, SAKIZADEH, K., additional, SANA-ULLAH, C., additional, EL-SHAFIE, S. M. M., additional, and THIND, S. S., additional
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- 1982
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170. ChemInform Abstract: THE PREPARATION OF 2,4,6‐TRIPHENYLPYRYLIUM TRIFLUOROMETHANESULFONATE, FLUOROSULFONATE, ETHOXYSULFONATE, NAPHTHALENE‐2‐SULFONATE, STANNOCHLORIDE, TRICHLOROACETATE, AND TRIFLUOROACETATE, AND THEIR REACTIONS WITH PRIMARY AMINES
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KATRITZKY, A. R., primary, EL‐MOWAFY, A. M., additional, MARZORATI, L., additional, PATEL, R. C., additional, and THIND, S. S., additional
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- 1980
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171. ChemInform Abstract: HETEROCYCLES IN ORGANIC SYNTHESIS. PART 6. NUCLEOPHILIC DISPLACEMENTS OF PRIMARY AMINO-GROUPS VIA 2,4,6-TRIPHENYLPYRIDINIUM SALTS
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KATRITZKY, A. R., primary, BAPAT, J. B., additional, BLADE, R. J., additional, LEDDY, B. P., additional, NIE, P.-L., additional, RAMSDEN, C. A., additional, and THIND, S. S., additional
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- 1979
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172. ChemInform Abstract: THE SYNTHESIS OF SOME HIGHLY STRAINED PYRYLIUM AND N‐BENZYLPYRIDINIUM SALTS AND KINETICS OF THEIR REACTIONS WITH PIPERIDINE
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KATRITZKY, A. R., primary, MARSON, C. M., additional, THIND, S. S., additional, and ELLISON, J., additional
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- 1983
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173. ChemInform Abstract: THE SYNTHESIS AND REACTIONS OF STERICALLY CONSTRAINED PYRYLIUM AND PYRIDINIUM SALTS
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KATRITZKY, A. R., primary and THIND, S. S., additional
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- 1980
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174. ChemInform Abstract: HETEROCYCLES IN ORGANIC SYNTHESIS. PART 36. AN ALTERNATIVE TO THE GATTERMANN REACTION FOR THE CONVERSION OF ANILINES INTO THIOCYANATES
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KATRITZKY, A. R., primary and THIND, S. S., additional
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- 1980
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175. The Effect of Age on the Variations in the Activities of Glucose-6-phosphatase and Fructose-1, 6-Diphosphatase in the Liver of Chicks
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Thind, S. K., primary, Singh, A., additional, and Sarkar, N. K., additional
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- 1966
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176. Fidaxomicin versus oral vancomycin for severe Clostridium difficile infection: a retrospective cohort study.
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Gentry, C.A., Nguyen, P.K., Thind, S., Kurdgelashvili, G., Skrepnek, G.H., and Williams II, R.J.
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CLOSTRIDIOIDES difficile , *VANCOMYCIN , *PROPENSITY score matching , *COHORT analysis , *THERAPEUTICS - Abstract
This study was conducted to compare clinical outcomes of fidaxomicin versus oral vancomycin in the management of severe Clostridium difficile infection (CDI). The investigation was a retrospective, multicentre, propensity score-matched analysis using a national clinical administrative database. Veterans treated for severe CDI from any Veterans Affairs Medical Center between 1 June 2011 and 30 June 2017 were included if they received fidaxomicin or an oral vancomycin regimen for treatment. The two groups were matched by the nearest-neighbour method from a propensity score derived from independent variables associated with the selection of a fidaxomicin course. Propensity score matching resulted in two well-matched cohorts consisting of 213 fidaxomicin and 639 oral vancomycin courses. No statistically-significant difference was found for the primary outcome of combined clinical failure or recurrence (68/213 (31.9%) versus 163/639 (25.5%), respectively, p 0.071). Additionally, no statistically significant differences were found for the secondary outcomes of 30-day (23/213 (10.8%) versus 75/639 (11.7%), respectively, p 0.71), 90-day (48/213 (22.5%) versus 140/639 (21.9%), respectively, p 0.85), and 180-day mortality (62/213 (29.1%) versus 186/639 (29.1%), respectively, p 1.0) between the two treatment groups. Courses of fidaxomicin or oral vancomycin for severe CDI resulted in similar treatment outcomes. Study findings are consistent with current treatment guideline recommendations for the use of either agent in the management of severe CDI. [ABSTRACT FROM AUTHOR]
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- 2019
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177. Is colon cancer survival influenced by tumor location?
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Meyers BM, Dhesy-Thind S, and Zbuk K
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- 2012
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178. Clinical practice guidelines for the care and treatment of breast cancer: follow-up after treatment for breast cancer (summary of the 2005 update)
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Grunfeld E, Dhesy-Thind S, Levine M, and Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer
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- 2005
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179. [Retracted] Intramedullary Chondrosarcoma of Proximal Humerus
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Yadav, Pratiksha, Thakkar, Dolly, and S. Thind, S.
- Abstract
Primary chondrosarcoma is the third most frequent primary malignancy of bone after myeloma and osteosarcoma. It is ranging from slow growing nonmetastasising lesions to highly aggressive lesions. We report a case of primary intramedullary chondrosarcoma of proximal humerus. A 60-year-old female presented with pain and hard swelling involving the left arm for 5 months. Radiograph showed a lucent expansile intramedullary lesion with matrix calcification and associated soft tissue mass. CT confirmed the finding. MRI showed a lobulated lesion which is hyperintense on T2WI with low signal fibrous septae. Increased tracer uptake was seen on bone scan. Histopathology confirmed the radiology diagnosis. The patient underwent wide resection and endoprosthetic reconstruction of proximal humerus.
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- 2012
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180. Functionalisations of primary amines
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Thind, S. S.
- Subjects
- 547
- Published
- 1979
181. Effect of Tribulus terrestris on oxalate metabolism in rats
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Sangeeta, D., Sidhu, H., Thind, S. K., and Nath, R.
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- 1994
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182. 21-Gene Assay to Inform Chemotherapy Benefit in Node-Positive Breast Cancer.
- Author
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Kalinsky, K., Barlow, W. E., Gralow, J. R., Meric-Bernstam, F., Albain, K. S., Hayes, D. F., Lin, N. U., Perez, E. A., Goldstein, L. J., Chia, S. K. L., Dhesy-Thind, S., Rastogi, P., Alba, E., Delaloge, S., Martin, M., Kelly, C. M., Ruiz-Borrego, M., Gil-Gil, M., Arce-Salinas, C. H., and Brain, E. G. C.
- Abstract
The recurrence score based on the 21-gene breast-cancer assay has been clinically useful in predicting a chemotherapy benefit in hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, axillary lymph-node-negative breast cancer. In women with positive lymph-node disease, the role of the recurrence score with respect to predicting a benefit of adjuvant chemotherapy is unclear. METHODS In a prospective trial, we randomly assigned women with hormone-receptor-positive, HER2-negative breast cancer, one to three positive axillary lymph nodes, and a recurrence score of 25 or lower (scores range from 0 to 100, with higher scores indicating a worse prognosis) to endocrine therapy only or to chemotherapy plus endocrine (chemoendocrine) therapy. The primary objective was to determine the effect of chemotherapy on invasive disease-free survival and whether the effect was influenced by the recurrence score. Secondary end points included distant relapse-free survival. RESULTS A total of 5083 women (33.2% premenopausal and 66.8% postmenopausal) underwent randomization, and 5018 participated in the trial. At the prespecified third interim analysis, the chemotherapy benefit with respect to increasing invasive disease-free survival differed according to menopausal status (P=0.008 for the comparison of chemotherapy benefit in premenopausal and postmenopausal participants), and separate prespecified analyses were conducted. Among postmenopausal women, invasive disease-free survival at 5 years was 91.9% in the endocrine-only group and 91.3% in the chemoendocrine group, with no chemotherapy benefit (hazard ratio for invasive disease recurrence, new primary cancer [breast cancer or another type], or death, 1.02; 95% confidence interval [CI], 0.82 to 1.26; P=0.89). Among premenopausal women, invasive disease-free survival at 5 years was 89.0% with endocrine-only therapy and 93.9% with chemoendocrine therapy (hazard ratio, 0.60; 95% CI, 0.43 to 0.83; P=0.002), with a similar increase in distant relapse-free survival (hazard ratio, 0.58; 95% CI, 0.39 to 0.87; P=0.009). The relative chemotherapy benefit did not increase as the recurrence score increased. CONCLUSIONS Among premenopausal women with one to three positive lymph nodes and a recurrence score of 25 or lower, those who received chemoendocrine therapy had longer invasive disease-free survival and distant relapse-free survival than those who received endocrine-only therapy, whereas postmenopausal women with similar characteristics did not benefit from adjuvant chemotherapy. (Funded by the National Cancer Institute and others; RxPONDER. ClinicalTrials.gov number, NCT01272037.) [ABSTRACT FROM AUTHOR]
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- 2021
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183. An evaluation of the safety of continuing trastuzumab despite overt left ventricular dysfunction.
- Author
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Barron, C. C., Alhussein, M. M., Kaur, U., Cosman, T. L., Tyagi, N. K., Brown, M., Mukherjee, S. D., Ellis, P. M., Dhesy-Thind, S., and Leong, D. P.
- Subjects
- *
VENTRICULAR ejection fraction - Abstract
Background The major limitation in the use of trastuzumab therapy is cardiotoxicity. We evaluated the safety of a strategy of continuing trastuzumab in patients with breast cancer despite mild, asymptomatic left ventricular impairment. Methods Charts of consecutive patients referred to a cardio-oncology clinic from January 2015 to March 2017 for decline in left ventricular ejection fraction (LVEF), defined as a fall of 10 percentage points or more, or a value of less than 50% during trastuzumab therapy, were reviewed. The primary outcome of interest was change in LVEF, measured before and during trastuzumab exposure and up to 3 times after initiation of cardiac medications during a median of 9 months. Results All 18 patients referred for decline in LVEF chose to remain on trastuzumab and were included. All patients were treated with angiotensin converting–enzyme inhibitors or beta-blockers, or both. After initiation of cardiac medications, LVEF increased over time by 4.6 percentage points (95% confidence interval: 1.9 percentage points to 7.4 percentage points), approaching baseline values. Of the 18 patients, 17 (94%) were asymptomatic at all future visits. No deaths occurred in the group. Conclusions Many patients with mildly reduced LVEF and minimal heart failure symptoms might be able to continue trastuzumab without further decline in LVEF, adverse cardiac events, or death when treated under the supervision of a cardiologist with close follow-up. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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184. Traditional ethnobotanical knowledge of important local plants in Sudhnoti, Azad Kashmir, Pakistan.
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Ishtiaq M, Sardar T, Hussain I, Maqbool M, Mazhar MW, Parveen A, Ajaib M, Bhatti KH, Hussain T, Gul A, Azeem M, Khanum H, Moussa IM, Ullah F, Elansary HO, Thind S, and Sridhara S
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- Pakistan ethnology, Humans, Female, Male, Adult, Middle Aged, Knowledge, Aged, Health Knowledge, Attitudes, Practice, Ethnobotany methods, Plants, Medicinal, Medicine, Traditional methods
- Abstract
This research purpose was focused to document the traditional ethnobotanical knowledge (TEK) associated with important wild plants and indigenous communities residing in mountainous zone of District Sudhnoti of Azad Jammu and Kashmir, Pakistan and to determine their conservation status with suggestions and recommendations to protect and propagate the rare and endangered wild flora of the area for sustainable use. The data regarding traditional ethnomedicines (TEMs) and phytogeography with conservation analysis of wild plants were collected via structured and semi structured interviews of 150 participants belonging to various professions and of both genders. Prior consent and permission were obtained from family heads and from all the participants, and the data were shared with all the informants through the local female translator guide. To validate the collected data, various microstatistical tools, such as the informant consensus factor (ICF), fidelity level (FL) and data matrix ranking (DMR) were used. The relative frequency of citations (RFC) and rank order of popularity (ROP) were also calculated to determine and authenticate the relative importance of TEMs which may be further studied in future research and used for drug discovery. In the present study, 150 locally important plants belonging to 69 families were documented, and the Rosaceae was the most dominant and prevalent family. The results indicated that many locally important plants have multiple uses such as food, medicine, fodder, shelter, ornamental and fuel. The TEMs obtained from these plants have been known to be useful for curing various infirmities such as flu, renal disorders, fever, malaria, cough, migraine, whooping cough, influenza, skin rashes, allergies, stomach aches, wounds and bruises, diabetes, tumours and joint pains. The ICF analysis revealed that renal calculus, malaria, fever, whooping cough, rheumatoid arthritis and arthritis were prevalent infirmities of the mountainous area. The FL analysis indicated the popularity of these plants used in various TEMs and among these Artemisia maritima and Berberis lycium were the most common. The DMR indicated that Pinus roxburghii was the most common species being used for multipurpose by the indigenous communities. The highest use value index was found for Indigofera linifolia. The relative frequency of citations was calculated to determine the importance of plants in traditional ethnomedicine, highlighting Morus nigra, Pinus wallichiana, and Rosa indica as significant species. The Jaccard index indicated a high level of novelty in the research which can be exploited for neo-drug discovery and drug development. In conclusion, this study has successfully documented the ethnobotanically and ethnomedicinally important plants in District Sudhnoti, Azad Jammu and Kashmir, Pakistan. The findings of this research contribute to the preservation and documentation of cultural heritage, as well as provide a foundation for further studies in ethnobotany, ethnopharmacology and biodiversity conservation efforts for sustainable provision of wild flora to the indigenous communities which will also assist in combating drasting climatic changes., (© 2024. The Author(s).)
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- 2024
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185. A randomised trial comparing 6-monthly adjuvant zoledronate with a single one-time dose in patients with early breast cancer.
- Author
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Awan AA, Stober C, Pond GR, Machado I, Clemons L, Conter H, Simos D, Dhesy-Thind S, Mates M, Kumar V, Hilton J, Savard MF, Fergusson D, Vandermeer L, and Clemons M
- Abstract
Purpose: While adjuvant bisphosphonate use in early breast cancer (EBC) is associated with improvements in breast cancer-specific outcomes, questions remain around optimal bisphosphonate type, dose and scheduling. We evaluated a single zoledronate infusion in a prospective randomised trial., Methods: Postmenopausal patients with EBC were randomised to receive a single infusion of zoledronate (4 mg IV) or 6-monthly treatment for 3 years. Outcomes measured were; Quality of Life (QoL; EQ-5D-5L), bisphosphonate-related toxicities, including acute phase reactions (APRs), recurrence-free survival (RFS), bone metastasis-free survival (BMFS) and overall survival (OS)., Results: 211 patients were randomized to either a single infusion (n = 107) or six-monthly treatment (n = 104). After 3 years of follow up there were no significant differences between the arms for QoL and most toxicity endpoints. APRs following zoledronate occurred in 81% (171/211) of patients (77.6% in single infusion arm and 84.6% in the 6-monthly group). While the frequency of APRs decreased over 3 years in the 6-monthly arm, they still remain common. Of 34/104 (32.7%) patients who discontinued zoledronate early in the 6-monthly treatment group, the most common reason was APRs (16/34, 47%). At the 3 year follow up, there were no differences between arms for RFS, BMFS or OS., Conclusion: A single infusion of zoledronate was associated with increased patient convenience, less toxicity, and lower rates of treatment discontinuation. Despite the common clinical impression that APRs decrease with time, this was not observed when patients were specifically questioned. While the study is not powered for non-inferiority, longer-term follow-up for confirmation of RFS and OS rates is ongoing., (© 2024. The Author(s).)
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- 2024
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186. Patient and Provider Attitudes and Preferences Regarding Early Palliative Care Delivery for Patients with Advanced Gastrointestinal Cancers: A Prospective Survey.
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Levine O, Bainbridge D, Pond GR, Slaven M, Dhesy-Thind S, Sussman J, and Meyer RM
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- Humans, Female, Male, Aged, Middle Aged, Prospective Studies, Surveys and Questionnaires, Patient Preference, Attitude of Health Personnel, Aged, 80 and over, Adult, Ontario, Palliative Care methods, Gastrointestinal Neoplasms therapy, Gastrointestinal Neoplasms psychology
- Abstract
Early integrated palliative care (EIPC) for patients with advanced cancers requires the involvement of family doctors (FDs) and oncologists. We compared attitudes between patients and their providers regarding the delivery of EIPC. Patients with newly diagnosed incurable gastrointestinal (GI) cancer at a tertiary cancer centre in Ontario, Canada, were surveyed using a study-specific instrument regarding the importance of and preferences for accessing support across eight domains of palliative care. Physicians within the circle of care completed a parallel survey for each patient. The concordance between patient and physician responses was analyzed. A total of 66 patients were surveyed (median age 69, 35% female). All had an oncologist, 12% had a specialist palliative care provider (SPC), and 97% had an FD, but only 41% listed the FD as part of the care team. In total, 95 providers responded (oncologist = 68, FD = 21, SPC = 6; response rate 92%; 1-3 physician responses per patient). Disease management and physical concerns were most important to patients. Patients preferred to access care in these domains from oncologists or SPCs. For all other domains, most patients attributed primary responsibility to self or family rather than any healthcare provider. Thus, concordance was poor between patient and physician responses. Across most domains of palliative care, we found low agreement between cancer patients and their physicians regarding responsibilities for care, with FDs appearing to have limited involvement at this stage.
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- 2024
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187. Early single-center experience with middle meningeal artery embolization using Zoom ™ 45 Catheter.
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Morsi RZ, Thind S, Baskaran A, Rana R, Carrión-Penagos J, Desai H, Kothari SA, Chahine A, Zakaria J, Polster SP, Siegler JE, Mendelson SJ, Mansour A, Hurley MC, Prabhakaran S, and Kass-Hout T
- Abstract
Background: Middle meningeal artery (MMA) embolization for subdural hematomas (SDH) and dural arteriovenous fistulas (dAVFs) has gained momentum in the neuroendovascular space. However, there is variability in the technique for safe and effective embolization. The aim of this report is to describe the technical feasibility and clinical performance of using Zoom
™ 45 catheter for MMA access to facilitate embolization., Methods: We analyzed all cases of MMA embolization in which the Zoom™ 45 catheter was used and performed in our institution from February 2021 to March 2023 for SDH and dAVFs., Results: A total of 32 patients were included. Mean age was 64.0 ± 18.0 years, 75.0% (4/32) were male, and 56.7% (17/30), were black. The technical success was achieved in 93.8% (30/32) of cases, with selective embolization utilizing microcatheter directly into frontal and parietal branches for most patients (96.9%, 31/32). Identification of dangerous collaterals, such as lacrimal and petrous branches, prior to embolization, was achieved in most patients (96.9%, 31/32). Bilateral MMA embolization was done in 50.0% (16/32) of patients. The transradial approach and transfemoral approach were used in 53.1% (17/32) and 46.9% (15/32) of patients, respectively. The most common embolization material was n-butyl cyanoacrylate (84.4%, 27/32). There were no access site complications or complications related to the MMA embolization procedures and used devices., Conclusions: The use of Zoom™ 45 Catheter seems to be technically feasible, safe, and effective for facilitating MMA access for embolization in the context of SDH and dAVFs., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.- Published
- 2024
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188. The Significance of Thyroid Hormone Receptors in Breast Cancer: A Hypothesis-Generating Narrative Review.
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Quan T, Cockburn J, Dhesy-Thind S, Bane A, Leong H, Geleff C, Devion C, Ajel N, and Jerzak KJ
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- Humans, Female, Biomarkers, Tumor metabolism, Prognosis, Breast Neoplasms metabolism, Receptors, Thyroid Hormone metabolism
- Abstract
Background: Breast cancer (BC) is frequently diagnosed among Canadian women. While targeted therapies are available for most BC patients; treatment resistance is common and novel therapeutic targets are of interest. Thyroid hormones (TH) bound to thyroid hormone receptors (THR) influence cell proliferation and differentiation; they are also involved in the growth and development of normal breast tissue. Evidence suggests that THRβ is a tumor suppressor in various solid tumors., Purpose: This narrative review discusses retrospective studies regarding the clinical relevance of THRβ as a potential prognostic biomarker and therapeutic target in BC., Methods: We consulted with an information specialist to develop a search strategy to find all literature related to THRα expression as a potential prognostic and therapeutic biomarker in breast cancer. The primary search was developed for Medline and translated to Embase. The searches were conducted on the Ovid platform on 18 August 2023., Results: Across seven retrospective studies identified, several have shown an association between higher THRβ1 expression with a lower risk of BC recurrence and with longer overall survival., Conclusions: Some evidence suggests that THRβ expression is associated with a lower risk of BC recurrence and death. Validation of THRβ as an independent prognostic biomarker and possible predictive biomarker of response to endocrine therapy and/or chemotherapy is of interest. Given that THRβ is upstream of the AKT/PI3K pathway, its potential as a predictive biomarker of response to AKT inhibitors and/or PI3K inhibitors may also be of value. Finally, the potential re-purposing of THRβ agonists as anti-cancer agents warrants investigation.
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- 2024
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189. Endovascular Embolization of Traumatic Vessel Injury Using N-butyl Cyanoacrylate: A Case Series.
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Morsi RZ, Baskaran A, Thind S, Carrión-Penagos J, Desai H, Kothari SA, Mirza M, Lazaridis C, Goldenberg F, Hurley MC, Mendelson SJ, Prabhakaran S, Zakrison T, Mansour A, and Kass-Hout T
- Abstract
There is limited evidence of N-butyl cyanoacrylate (n-BCA) use in endovascular embolization of traumatic face and neck vessel injuries. We investigated the safety and effectiveness of n-BCA for this purpose. We retrospectively analyzed consecutive patients presenting to a Level 1 trauma center between April 2021 and July 2022. We included patients aged ≥ 18 years old with any vessel injury in the face and neck circulation requiring n-BCA embolization. The primary endpoint was n-BCA effectiveness defined as immediate control of active bleeding post-embolization. In total, 13 patients met the inclusion criteria. The median decade of life was 3 (IQR 3 - 5) with a male predominance (n = 11, 84.6%). Median Glasgow Coma Scale score on presentation was 15 (IQR 3-15). Eleven patients suffered gunshot wound injuries; two patients suffered blunt injuries. Injured vessels included facial artery (n = 6, 46.2%), buccal branch artery (n = 3, 23.1%), internal maxillary (n = 5, 38.5%), cervical internal carotid artery (n = 1, 7.7%), and vertebral artery (n = 1, 7.7%). All patients were treated with 1:2 n-BCA to ethiodol mixture with immediate extravasation control. No bleeding recurrence or need for retreatment occurred. One patient died in-hospital (7.7%). Patients were discharged to home (n = 8, 61.5%), day rehabilitation (n = 1, 7.7%), or acute rehabilitation (n = 3, 23.1%). One patient developed a right posterior cerebral artery infarct with hemorrhagic transformation. To our knowledge, this is the first study demonstrating the safety and effectiveness of n-BCA liquid embolism in traumatic vessel injuries, especially penetrating gunshot wounds., Competing Interests: Conflict of interestThe authors declare no competing interests., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)
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- 2024
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190. The Zoom RDL radial access system for neurointervention: An early single-center experience.
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Morsi RZ, Kothari SA, Thind S, Desai H, Polster SP, Goldenberg F, Coleman E, Brorson JR, Mendelson S, Mansour A, Prabhakaran S, and Kass-Hout T
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- Humans, Male, Adult, Middle Aged, Aged, Female, Radial Artery diagnostic imaging, Radial Artery surgery, Thrombectomy methods, Catheters, Retrospective Studies, Treatment Outcome, Stroke diagnostic imaging, Stroke surgery, Embolization, Therapeutic
- Abstract
Background: The transradial approach (TRA) for neurointerventional procedures is increasingly being used given its technical feasibility and safety. However, catheter trackability and device deliverability are reported barriers to TRA adoption., Methods: This is the first report describing the technical feasibility and performance of using the Zoom RDL Radial Access System (Imperative Care, Inc., Campbell, CA) in 29 patients who underwent neurointerventional procedures from October 2022 to January 2023 in a single-center institution., Results: Mean age of the study population was 61.9±17.2 years, 79.3% were male (23/29), and 62.1% were black (18/29). The most common procedures were stroke thrombectomy (31.0%, 9/29) and aneurysm embolization (27.6%, 8/29). All the stroke thrombectomy procedures were successfully performed; first-pass effect rate (mTICI≥2 c in one pass) was achieved in 66.7% (6/9) of cases. We used TRA in 86.2% of cases (25/29), including distal radial/snuffbox access in 31.0% (9/29) of cases. The radial diameter was >2 mm for all cases. An intermediate/aspiration catheter was used in 89.7% (26/29) of cases. Access success was achieved in 89.7% of cases (26/29); two cases required conversion from TRA to transfemoral approach (6.9%) and one case required conversion to a different guide catheter (3.4%). There were no access site complications or other Zoom RDL-related complications. One intracerebral hemorrhage, and one procedure-related thrombus were observed., Conclusions: The use of Zoom RDL Radial Access System is technically feasible and effective for complex neurointerventional procedures with low complication rates., Competing Interests: Competing interests: TK – Brainomix: Consultant, Cerenovus: Consultant, Imperative Care: Consultant, Medtronic Inc.: Consultant, Microvention: Consultant, Stryker Neurovascular: Consultant. The remaining authors declared no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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191. High-Sensitivity Cardiac Troponin I for Long-Term Cardiovascular Risk Stratification in a Cancer Clinic Population.
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Kavsak PA, Cerasuolo JO, Kirkwood D, Perez R, Seow H, Ma J, Worster A, Ko DT, Dhesy-Thind S, and Leong D
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- 2024
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192. The use of PK Papyrus covered coronary stent for carotid reconstruction: an initial institutional experience.
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Morsi RZ, Thind S, Chahine A, Zakaria J, Desai H, Kothari SA, Shah AP, Nathan S, Coleman E, Mendelson S, Siegler JE, Prabhakaran S, Mansour A, and Kass-Hout T
- Abstract
Background: The use of covered stent grafts for the treatment of carotid rupture is increasingly being used given their ability to preserve the parent artery while simultaneously occluding the fistula or rupture point., Methods: This case series describes the technical feasibility of using, and the performance of, the PK Papyrus covered coronary stent (Biotronik, Inc., Lake Oswego, Oregon, USA) in six patients with carotid rupture, including carotid cavernous fistulas, between July 2021 and October 2023 in a single-center institution in the USA., Results: The median decade of life was 5 (IQR 3) with a 1:1 male-to-female ratio. The majority were black patients (n=5/6, 83.3%). The most common disease pathology was carotid cavernous fistula (n=4/6, 66.7%), followed by traumatic carotid rupture (n=2/6, 33.3%). All the stent embolization procedures were successfully treated with the PK Papyrus covered coronary stent. None of the patients had any recurrence or re-treatment. The number of stents required ranged from 1 to 3. A balloon guide catheter was used in 66.7% of cases (n=4/6). In-hospital mortality was 0.0% (n=0/6). No in-stent thrombosis was observed, but there was one case of cangrelor-associated hemorrhagic stroke conversion. Transfemoral access was used in all cases with one access site complication. Median follow-up time was 1.8 months (IQR 3.5)., Conclusions: To our knowledge, this is the largest case series in the USA demonstrating the feasibility and safety of using the PK Papyrus covered coronary stent for the treatment of carotid rupture, including carotid cavernous fistulas., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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193. Cytochrome c oxidase deficiency detection in human fibroblasts using scanning electrochemical microscopy.
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Thind S, Lima D, Booy E, Trinh D, McKenna SA, and Kuss S
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- Infant, Humans, Adolescent, Microscopy, Electrochemical, Scanning, Quality of Life, Electron Transport Complex IV metabolism, Fibroblasts metabolism, Cytochrome-c Oxidase Deficiency genetics
- Abstract
Cytochrome c oxidase deficiency (COXD) is an inherited disorder characterized by the absence or mutation in the genes encoding for the cytochrome c oxidase protein (COX). COX deficiency results in severe muscle weakness, heart, liver, and kidney disorders, as well as brain damage in infants and adolescents, leading to death in many cases. With no cure for this disorder, finding an efficient, inexpensive, and early means of diagnosis is essential to minimize symptoms and long-term disabilities. Furthermore, muscle biopsy, the traditional detection method, is invasive, expensive, and time-consuming. This study demonstrates the applicability of scanning electrochemical microscopy to quantify COX activity in living human fibroblast cells. Taking advantage of the interaction between the redox mediator N, N, N', N' -tetramethyl- para -phenylene-diamine, and COX, the enzymatic activity was successfully quantified by monitoring current changes using a platinum microelectrode and determining the apparent heterogeneous rate constant k
0 using numerical modeling. This study provides a foundation for developing a diagnostic method for detecting COXD in infants, which has the potential to increase treatment effectiveness and improve the quality of life of affected individuals., Competing Interests: Competing interests statement:The authors declare no competing interest.- Published
- 2024
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194. Endovascular Thrombectomy With or Without Thrombolysis for Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
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Morsi RZ, Zhang Y, Carrión-Penagos J, Desai H, Tannous E, Kothari S, Khamis A, Darzi AJ, Tarabichi A, Bastin R, Hneiny L, Thind S, Coleman E, Brorson JR, Mendelson S, Mansour A, Prabhakaran S, and Kass-Hout T
- Abstract
Background: To this date, whether to administer intravenous thrombolysis (IVT) prior to endovascular thrombectomy (EVT) for stroke patients still stirs some debate. We aimed to systematically update the evidence from randomized trials comparing EVT alone vs EVT with bridging IVT., Methods: We searched MEDLINE, EMBASE, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing EVT with or without IVT in patients presenting with stroke secondary to a large vessel occlusion. We conducted meta-analyses using random-effects models to compare functional independence, mortality, and symptomatic intracranial hemorrhage (sICH), between EVT and EVT with IVT. We assessed risk of bias using the Cochrane risk-of-bias tool and certainty of evidence for each outcome using the GRADE approach., Results: Of 11,111 citations, we included 6 studies with a total of 2336 participants. We found low-certainty evidence of possibly a small decrease in the proportion of patients with functional independence (risk difference [RD] -2.0%, 95% CI -5.9% to 2.0%), low-certainty evidence that there is possibly a small increase in mortality (RD 1.0%, 95% CI -2.2% to 4.7%), and moderate-certainty evidence that there is probably a decrease in sICH (RD -1.0%, 95% CI -1.6% to .7%) for patients with EVT alone compared to EVT plus IVT, respectively., Conclusion: Low-certainty evidence shows that there is possibly a small decrease in functional independence, low-certainty evidence shows that there is possibly a small increase in mortality, and moderate-certainty evidence that there is probably a decrease in sICH for patients with EVT alone compared to EVT plus IVT., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)
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- 2024
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195. Endovascular Thrombectomy with or without Bridging Thrombolysis in Acute Ischemic Stroke: A Cost-Effectiveness Analysis.
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Morsi RZ, Zhang Y, Zhu M, Xie S, Carrión-Penagos J, Desai H, Tannous E, Kothari SA, Khamis A, Darzi AJ, Tarabichi A, Bastin R, Hneiny L, Thind S, Siegler JE, Coleman ER, Mendelson SJ, Mansour A, Prabhakaran S, and Kass-Hout T
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- Humans, Thrombolytic Therapy, Cost-Effectiveness Analysis, Thrombectomy, Treatment Outcome, Cost-Benefit Analysis, Ischemic Stroke drug therapy, Ischemic Stroke surgery, Brain Ischemia drug therapy, Brain Ischemia surgery, Stroke drug therapy, Stroke surgery, Endovascular Procedures
- Abstract
Background: There is unclear added benefit of intravenous thrombolysis (IVT) with endovascular thrombectomy (EVT). We performed a cost-effectiveness analysis to assess the cost-effectiveness of comparing EVT with IVT versus EVT alone., Methods: We used a decision tree to examine the short-term costs and outcomes at 90 days after the occurrence of index stroke to compare the cost-effectiveness of EVT alone with EVT plus IVT for patients with stroke. Subsequently, we developed a Markov state transition model to assess the costs and outcomes over 1-year, 5-year, and 20-year time horizons. We estimated total and incremental cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio., Results: The average costs per patient were estimated to be $47,304, $49,510, $59,770, and $76,561 for EVT-only strategy and $55,482, $57,751, $68,314, and $85,611 for EVT with IVT over 90 days, 1 year, 5 years, and 20 years, respectively. The cost saving of EVT-only strategy was driven by the avoided medication costs of IVT (ranging from $8,178 to $9,050). The additional IVT led to a slight decrease in QALY estimate during the 90-day time horizon (loss of 0.002 QALY), but a small gain over 1-year and 5-year time horizons (0.011 and 0.0636 QALY). At a willingness-to-pay threshold of $50,000 per QALY gained, the probabilities of EVT only being cost-effective were 100%, 100%, and 99.3% over 90-day, 1-year, and 5-year time horizons., Conclusion: Our cost-effectiveness model suggested that EVT only may be cost-effective for patients with acute ischemic stroke secondary to large vessel occlusion., (© 2023 S. Karger AG, Basel.)
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- 2024
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196. RAPIDIRON Trial follow-up study - the RAPIDIRON-KIDS Study: protocol of a prospective observational follow-up study.
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Derman RJ, Bellad RB, Bellad MB, Bradford-Rogers J, Georgieff MK, Aghai ZH, Thind S, Auerbach M, Boelig R, Leiby BE, Short V, Yogeshkumar S, Charantimath US, Somannavar MS, Mallapur AA, Pol R, Ramadurg U, Sangavi R, Peerapur BV, Banu N, Patil PS, Patil AP, Roy S, Vastrad P, Wallace D, Shah H, and Goudar SS
- Subjects
- Female, Humans, Infant, Infant, Newborn, Pregnancy, Follow-Up Studies, Hemoglobins, Iron, Observational Studies as Topic, Prospective Studies, Randomized Controlled Trials as Topic, Child, Preschool, Anemia complications, Iron Deficiencies
- Abstract
Background: Anemia is a worldwide problem with iron deficiency being the most common cause. When anemia occurs in pregnancy, it increases the risk of adverse maternal, fetal, and postnatal outcomes. It induces preterm births and low birth weight (LBW) deliveries, long-term neurodevelopmental sequelae, and an increased risk of earlier onset of postnatal iron deficiency. Anemia rates are among the highest in South Asia, and India's National Family Health Survey (NFHS-5) for 2019-2021 indicated that over half of pregnant women, and more than 65% of children, in the country are classified as anemic (Sciences IIfP, National Family Health Survey-5, 2019-21, India Fact Sheet). In 2021, the parent RAPIDIRON Trial (Derman et al., Trials 22:649, 2021) was initiated in two states in India, with the goal of assessing whether a dose of intravenous (IV) iron given to anemic women during early pregnancy results in a greater proportion of participants with normal hemoglobin concentrations in the third trimester and a lower proportion of participants with LBW deliveries compared to oral iron. As a follow-up to the RAPIDIRON Trial, the RAPIDIRON-KIDS Study will follow the offspring of previously randomized mothers to assess, neurobehavioral, hematological, and health outcomes., Methods: This prospective observational cohort study will follow a subset of participants previously randomized as part of the RAPIDIRON Trial and their newborns. Study visits occur at birth, 6 weeks, 4 months, 12 months, 24 months, and 36 months and include blood sample collection with both maternal and infant participants and specific neurobehavioral assessments conducted with the infants (depending on the study visit). The primary outcomes of interest are (1) infant iron status as indicated by both hemoglobin and ferritin (a) at birth and (b) at 4 months of age and (2) the developmental quotient (DQ) for the cognitive domain of the Bayley Scales of Infant Development Version IV (BSID-IV) at 24 months of age., Discussion: This RAPIDIRON-KIDS Study builds upon its parent RAPIDIRON Trial by following a subset of the previously randomized participants and their offspring through the first 3 years of life to assess neurodevelopmental and neurobehavioral (infants, children), hematological, and health outcomes., Trial Registration: ClinicalTrials.gov NCT05504863 , Registered on 17 August 2022. Clinical Trials Registry - India CTRI/2022/05/042933 . Registered on 31 May 2022., (© 2023. The Author(s).)
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- 2023
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197. Intravenous cangrelor use for neuroendovascular procedures: a two-center experience and updated systematic review.
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Desai H, Al-Salihi MM, Morsi RZ, Vayani OR, Kothari SA, Thind S, Carrión-Penagos J, Baskaran A, Tarabichi A, Bonderski VA, Siegler JE, Hahn M, Coleman ER, Brorson JR, Mendelson SJ, Mansour A, Dabus G, Hurley M, Prabhakaran S, Linfante I, and Kass-Hout T
- Abstract
Background: The optimal antiplatelet therapy regimen for certain neuroendovascular procedures remains unclear. This study investigates the safety and feasibility of intravenous dose-adjusted cangrelor in patients undergoing acute neuroendovascular interventions., Methods: We conducted a retrospective chart review of all consecutive patients on intravenous cangrelor for neuroendovascular procedures between September 1, 2020, and March 13, 2022. We also conducted an updated systematic review and meta-analysis using PubMed, Scopus, Web of Science, Embase and the Cochrane Library up to February 22, 2023., Results: In our cohort, a total of 76 patients were included [mean age (years): 57.2 ± 18.2, males: 39 (51.3), Black: 49 (64.5)]. Cangrelor was most used for embolization and intracranial stent placement ( n = 24, 32%). Approximately 44% of our patients had a favorable outcome with a modified Rankin Scale (mRS) score of 0 to 2 at 90 days ( n = 25/57); within 1 year, 8% of patients had recurrent or new strokes ( n = 5/59), 6% had symptomatic intracranial hemorrhage [sICH] (4/64), 3% had major extracranial bleeding events (2/64), and 3% had a gastrointestinal bleed (2/64). In our meta-analysis, 11 studies with 298 patients were included. The pooled proportion of sICH and intraprocedural thromboembolic complication events were 0.07 [95% CI 0.04 to 1.13] and 0.08 [95% CI 0.05 to 0.15], respectively., Conclusion: Our study found that intravenous cangrelor appears to be safe and effective in neuroendovascular procedures, with low rates of bleeding and ischemic events. However, further research is needed to compare different dosing and titration protocols of cangrelor and other intravenous agents., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Desai, Al-Salihi, Morsi, Vayani, Kothari, Thind, Carrión-Penagos, Baskaran, Tarabichi, Bonderski, Siegler, Hahn, Coleman, Brorson, Mendelson, Mansour, Dabus, Hurley, Prabhakaran, Linfante and Kass-Hout.)
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- 2023
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198. An alternative reduced dose regimen of ticagrelor for neuroendovascular patients.
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Kass-Hout O, Stern J, D Tangonan R, Morsi RZ, Thind S, Kass-Hout T, and Guterman L
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- Humans, Clopidogrel pharmacology, Hemorrhage chemically induced, Retrospective Studies, Treatment Outcome, Platelet Aggregation Inhibitors adverse effects, Ticagrelor adverse effects
- Abstract
Objective: There is a growing use of ticagrelor in patients undergoing neuroendovascular procedures, especially those who demonstrate clopidogrel resistance. While multiple dosages are studied in the cardiology literature, the optimal dose for patients with neurological pathology has yet to be established. Here, we describe a single center experience involving 39 patients who underwent neuroendovascular procedures that then received an adjusted lower dose of ticagrelor., Methods: A retrospective chart review was performed between 2013 and 2017 for patients on dual anti-platelet therapy (DAPT) for either cervical or intracranial vascular pathologies, as well as stenting of the neurovasculature, including carotid arteries. Patients were placed on ticagrelor if their measured P2Y
12 reaction units (PRU) responses to clopidogrel were outside the expected range in our center using the VerifyNow™ P2Y12 test. All patients were maintained on a dose of 45 mg twice daily except for one patient who received 22.5 mg twice daily. Responsiveness to ticagrelor were measured utilizing the VerifyNow™ P2Y12 test., Results: The mean number of days for follow-up post treatment initiation was 532 days. A total of 39 patients were included in the analysis. Of these, 8 patients (21%) received implantation of intracranial stents (5 patients received pipeline embolization devices, 1 patient received stent-assisted coiling, and 2 patients received intracranial stents for atherosclerotic disease). Fourteen patients (35%) received carotid angioplasty and stenting. Seventeen patients (44%) did not receive permanent implantation of a stent. All patients on the lower dose ticagrelor of 45 mg twice daily achieved responsiveness (i.e., PRU < 194). Hemorrhagic transformation of ischemic stroke occurred in one patient (2.5%). No other hemorrhagic complications were encountered. No thromboembolic events were recorded aside from one patient (2.5%) with intracranial atherosclerotic disease who had an ischemic event., Conclusions: A lower dose of ticagrelor (45 mg twice daily) appears to be safe and effective in this small cohort of patients who are resistant to clopidogrel per P2Y12 testing and who have increased risk of ischemic or hemorrhagic strokes due to neurovascular pathologies and implants. Further randomized studies are required to confirm these findings., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.- Published
- 2023
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199. Three-Year Outcomes Following Permissive Cardiotoxicity in Patients on Trastuzumab.
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Zhou S, Cirne F, Chow J, Zereshkian A, Bordeleau L, Dhesy-Thind S, Ellis PM, Mukherjee SD, Aghel N, and Leong DP
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- Humans, Female, Trastuzumab therapeutic use, Cardiotoxicity, Stroke Volume, Retrospective Studies, Ventricular Function, Left, Receptor, ErbB-2 therapeutic use, Breast Neoplasms drug therapy, Heart Failure chemically induced, Ventricular Dysfunction, Left chemically induced
- Abstract
Introduction: Cardiotoxicity, manifest by reduced left ventricular ejection fraction (LVEF), is the most common reason for the premature discontinuation of trastuzumab. While permissive cardiotoxicity (where mild cardiotoxicity is accepted to enable ongoing trastuzumab) has been shown feasible, the longer-term outcomes are unknown. We aimed to study the intermediate-term clinical outcomes of patients who underwent permissive cardiotoxicity., Materials and Methods: We performed a retrospective cohort study of patients referred to the cardio-oncology service at McMaster University from 2016 to 2021 for LV dysfunction following trastuzumab administration., Results: Fifty-one patients underwent permissive cardiotoxicity. The median (25th-75th percentile) follow-up time from cardiotoxicity onset was 3 years (1.3-4 years). Forty-seven (92%) patients completed trastuzumab; 3 (6%) developed severe LV dysfunction or clinical heart failure (HF) while on trastuzumab and prematurely discontinued therapy. One discontinued trastuzumab by patient choice. At final follow-up after therapy completion, 7 (14%) patients still had mild cardiotoxicity, including 2 who had clinical heart failure and stopped trastuzumab early. Among those with recovered LV function, 50% had normalized LVEF or GLS by 6 and 3 months, respectively, after initial cardiotoxicity. There was no difference in characteristics between those who did or did not recover their LV function., Conclusions: Among patients exposed to permissive trastuzumab cardiotoxicity for HER2-positive breast cancer, 6% were unable to complete planned trastuzumab due to severe LV dysfunction or clinical HF. Although most patients recover their LV function after trastuzumab discontinuation or completion, 14% still have persistent cardiotoxicity by 3-year follow-up., (© The Author(s) 2023. Published by Oxford University Press.)
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- 2023
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200. Endovascular thrombectomy with or without thrombolysis bridging in patients with acute ischaemic stroke: protocol for a systematic review, meta-analysis of randomised trials and cost-effectiveness analysis.
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Morsi RZ, Zhang Y, Carrión-Penagos J, Desai H, Tannous E, Kothari S, Khamis AM, Darzi AJ, Tarabichi A, Bastin R, Hneiny L, Thind S, Coleman E, Brorson JR, Mendelson S, Mansour A, Prabhakaran S, and Kass-Hout T
- Subjects
- Adult, Humans, Adolescent, Cost-Effectiveness Analysis, Thrombectomy, Thrombolytic Therapy, Systematic Reviews as Topic, Brain Ischemia, Stroke, Ischemic Stroke
- Abstract
Introduction: Current published guidelines and meta-analyses comparing endovascular thrombectomy (EVT) alone versus EVT with bridging intravenous thrombolysis (IVT) suggest that EVT alone is non-inferior to EVT with bridging thrombolysis in achieving favourable functional outcome. Because of this controversy, we aimed to systematically update the evidence and meta-analyse data from randomised trials comparing EVT alone versus EVT with bridging thrombolysis, and performed an economic evaluation comparing both strategies., Methods and Analysis: We will conduct a systematic review of randomised controlled trials comparing EVT with or without bridging thrombolysis in patients presenting with large vessel occlusions. We will identify eligible studies by systematically searching the following databases from inception without any language restrictions: MEDLINE (through Ovid), Embase and the Cochrane Library. The following criteria will be used to assess eligibility for inclusion: (1) adult patients ≥18 years old; (2) randomised patients to EVT alone or to EVT with IVT; and (3) measured outcomes, including functional outcomes, at least 90 days after randomisation. Pairs of reviewers will independently screen the identified articles, extract information and assess the risk of bias of eligible studies. We will use the Cochrane Risk-of-Bias tool to evaluate risk of bias. We will also use the Grading of Recommendations, Assessment, Development and Evaluation approach to assess the certainty in evidence for each outcome. We will then perform an economic evaluation based on the extracted data., Ethics and Dissemination: This systematic review will not require a research ethics approval because no confidential patient data will be used. We will disseminate our findings by publishing the results in a peer-reviewed journal and via presentation at conferences., Prospero Registration Number: CRD42022315608., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
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