149 results on '"Krishna Manohar"'
Search Results
2. Role of innate T cells in necrotizing enterocolitis
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Jianyun Liu, Sharon Joseph, Krishna Manohar, Jasmine Lee, John P. Brokaw, W. Christopher Shelley, and Troy A. Markel
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immunity ,innate T cells ,NKT ,MAIT ,γδ T ,neonates ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Necrotizing enterocolitis (NEC) is a destructive gastrointestinal disease primarily affecting preterm babies. Despite advancements in neonatal care, NEC remains a significant cause of morbidity and mortality in neonatal intensive care units worldwide and the etiology of NEC is still unclear. Risk factors for NEC include prematurity, very low birth weight, feeding with formula, intestinal dysbiosis and bacterial infection. A review of the literature would suggest that supplementation of prebiotics and probiotics prevents NEC by altering the immune responses. Innate T cells, a highly conserved subpopulation of T cells that responds quickly to stimulation, develops differently from conventional T cells in neonates. This review aims to provide a succinct overview of innate T cells in neonates, encompassing their phenotypic characteristics, functional roles, likely involvement in the pathogenesis of NEC, and potential therapeutic implications.
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- 2024
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3. Case–control association study of congenital heart disease from a tertiary paediatric cardiac centre from North India
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Prachi Kukshal, Radha O Joshi, Ajay Kumar, Shadab Ahamad, Prabhatha Rashmi Murthy, Yogesh Sathe, Krishna Manohar, Soma Guhathakurta, and Subramanian Chellappan
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Congenital Heart Disease ,North India ,GWAS variants ,Case–control association ,Pediatrics ,RJ1-570 - Abstract
Abstract Background Congenital Heart diseases (CHDs) account for 1/3rd of all congenital birth defects. Etiopathogenesis of CHDs remain elusive despite extensive investigations globally. Phenotypic heterogeneity witnessed in this developmental disorder reiterate gene-environment interactions with periconceptional factors as risk conferring; and genetic analysis of both sporadic and familial forms of CHD suggest its multigenic basis. Significant association of de novo and inherited variants have been observed. Approximately 1/5th of CHDs are documented in the ethnically distinct Indian population but genetic insights have been very limited. This pilot case–control based association study was undertaken to investigate the status of Caucasian SNPs in a north Indian cohort. Method A total of 306 CHD cases sub-classified into n = 198 acyanotic and n = 108 cyanotic types were recruited from a dedicated tertiary paediatric cardiac centre in Palwal, Haryana. 23 SNPs primarily prioritized from Genome-wide association studies (GWAS) on Caucasians were genotyped using Agena MassARRAY Technology and test of association was performed with adequately numbered controls. Results Fifty percent of the studied SNPs were substantially associated in either allelic, genotypic or sub-phenotype categories validating their strong correlation with disease manifestation. Of note, strongest allelic association was observed for rs73118372 in CRELD1 (p
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- 2023
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4. Chondroitin sulfate supplementation improves clinical outcomes in a murine model of necrotizing enterocolitis
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Krishna Manohar, Brian D. Hosfield, Fikir M. Mesfin, Cameron Colgate, William Christopher Shelley, Jianyun Liu, Lifan Zeng, John P. Brokaw, and Troy A. Markel
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chondroitin sulfate ,eNOS ,intestinal dysbiosis ,necrotizing enterocolitis ,Physiology ,QP1-981 - Abstract
Abstract Necrotizing enterocolitis (NEC) continues to be a devastating disease in preterm neonates and has a paucity of medical management options. Chondroitin sulfate (CS) is a naturally occurring glycosaminoglycan (GAG) in human breast milk (HM) and has been shown to reduce inflammation. We hypothesized that supplementation with CS in an experimental NEC model would alter microbial diversity, favorably alter the cytokine profile, and (like other sulfur compounds) improve outcomes in experimental NEC via the eNOS pathway. NEC was induced in 5‐day‐old pups. Six groups were studied (n = 9–15/group): (1) WT breastfed and (2) Formula fed controls, (3) WT NEC, (4) WT NEC + CS, (5) eNOS KO (knockout) NEC, and (6) eNOS KO NEC + CS. Pups were monitored for clinical sickness score and weights. On postnatal day 9, the pups were killed. Stool was collected from rectum and microbiome analysis was done with 16 s rRNA sequencing. Intestinal segments were examined histologically using a well‐established injury scoring system and segments were homogenized and analyzed for cytokine profile. Data were analyzed using GraphPad Prism with p
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- 2023
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5. Gut-Brain cross talk: The pathogenesis of neurodevelopmental impairment in necrotizing enterocolitis
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Krishna Manohar, Fikir M. Mesfin, Jianyun Liu, W. Christopher Shelley, John P. Brokaw, and Troy A. Markel
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gut-brain axis ,necrotizing enterocolitis ,perinatal brain injury ,microbiome ,neonatal brain ,neurodevelopmental impairment ,Pediatrics ,RJ1-570 - Abstract
Necrotizing enterocolitis (NEC) is a devastating condition of multi-factorial origin that affects the intestine of premature infants and results in high morbidity and mortality. Infants that survive contend with several long-term sequelae including neurodevelopmental impairment (NDI)—which encompasses cognitive and psychosocial deficits as well as motor, vision, and hearing impairment. Alterations in the gut-brain axis (GBA) homeostasis have been implicated in the pathogenesis of NEC and the development of NDI. The crosstalk along the GBA suggests that microbial dysbiosis and subsequent bowel injury can initiate systemic inflammation which is followed by pathogenic signaling cascades with multiple pathways that ultimately lead to the brain. These signals reach the brain and activate an inflammatory cascade in the brain resulting in white matter injury, impaired myelination, delayed head growth, and eventual downstream NDI. The purpose of this review is to summarize the NDI seen in NEC, discuss what is known about the GBA, explore the relationship between the GBA and perinatal brain injury in the setting of NEC, and finally, highlight the existing research into possible therapies to help prevent these deleterious outcomes.
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- 2023
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6. Volatile Organic Compound Assessment as a Screening Tool for Early Detection of Gastrointestinal Diseases
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Costa Dalis, Fikir M. Mesfin, Krishna Manohar, Jianyun Liu, W. Christopher Shelley, John P. Brokaw, and Troy A. Markel
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electronic nose ,dysbiosis ,volatile organic compound ,gastrointestinal diseases ,Biology (General) ,QH301-705.5 - Abstract
Gastrointestinal (GI) diseases have a high prevalence throughout the United States. Screening and diagnostic modalities are often expensive and invasive, and therefore, people do not utilize them effectively. Lack of proper screening and diagnostic assessment may lead to delays in diagnosis, more advanced disease at the time of diagnosis, and higher morbidity and mortality rates. Research on the intestinal microbiome has demonstrated that dysbiosis, or unfavorable alteration of organismal composition, precedes the onset of clinical symptoms for various GI diseases. GI disease diagnostic research has led to a shift towards non-invasive methods for GI screening, including chemical-detection tests that measure changes in volatile organic compounds (VOCs), which are the byproducts of bacterial metabolism that result in the distinct smell of stool. Many of these tools are expensive, immobile benchtop instruments that require highly trained individuals to interpret the results. These attributes make them difficult to implement in clinical settings. Alternatively, electronic noses (E-noses) are relatively cheaper, handheld devices that utilize multi-sensor arrays and pattern recognition technology to analyze VOCs. The purpose of this review is to (1) highlight how dysbiosis impacts intestinal diseases and how VOC metabolites can be utilized to detect alterations in the microbiome, (2) summarize the available VOC analytical platforms that can be used to detect aberrancies in intestinal health, (3) define the current technological advancements and limitations of E-nose technology, and finally, (4) review the literature surrounding several intestinal diseases in which headspace VOCs can be used to detect or predict disease.
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- 2023
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7. Inhibition of Microglial Activation in the Amygdala Reverses Stress-Induced Abdominal Pain in the Male RatSummary
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Tian Yuan, Krishna Manohar, Rocco Latorre, Albert Orock, and Beverley Greenwood-Van Meerveld
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IBS ,Brain–Gut Axis ,Chronic Psychological Stress ,Visceral Hypersensitivity ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Psychological stress is a trigger for the development of irritable bowel syndrome and associated symptoms including abdominal pain. Although irritable bowel syndrome patients show increased activation in the limbic brain, including the amygdala, the underlying molecular and cellular mechanisms regulating visceral nociception in the central nervous system are incompletely understood. In a rodent model of chronic stress, we explored the role of microglia in the central nucleus of the amygdala (CeA) in controlling visceral sensitivity. Microglia are activated by environmental challenges such as stress, and are able to modify neuronal activity via synaptic remodeling and inflammatory cytokine release. Inflammatory gene expression and microglial activity are regulated negatively by nuclear glucocorticoid receptors (GR), which are suppressed by the stress-activated pain mediator p38 mitogen-activated protein kinases (MAPK). Methods: Fisher-344 male rats were exposed to water avoidance stress (WAS) for 1 hour per day for 7 days. Microglia morphology and the expression of phospho-p38 MAPK and GR were analyzed via immunofluorescence. Microglia-mediated synaptic remodeling was investigated by quantifying the number of postsynaptic density protein 95–positive puncta. Cytokine expression levels in the CeA were assessed via quantitative polymerase chain reaction and a Luminex assay (Bio-Rad, Hercules, CA). Stereotaxic infusion into the CeA of minocycline to inhibit, or fractalkine to activate, microglia was followed by colonic sensitivity measurement via a visceromotor behavioral response to isobaric graded pressures of tonic colorectal distension. Results: WAS induced microglial deramification in the CeA. Moreover, WAS induced a 3-fold increase in the expression of phospho-p38 and decreased the ratio of nuclear GR in the microglia. The number of microglia-engulfed postsynaptic density protein 95–positive puncta in the CeA was increased 3-fold by WAS, while cytokine levels were unchanged. WAS-induced changes in microglial morphology, microglia-mediated synaptic engulfment in the CeA, and visceral hypersensitivity were reversed by minocycline whereas in stress-naïve rats, fractalkine induced microglial deramification and visceral hypersensitivity. Conclusions: Our data show that chronic stress induces visceral hypersensitivity in male rats and is associated with microglial p38 MAPK activation, GR dysfunction, and neuronal remodeling in the CeA.
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- 2020
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8. Recent Development of the Molecular and Cellular Mechanisms of Hydrogen Sulfide Gasotransmitter
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Jianyun Liu, Fikir M. Mesfin, Chelsea E. Hunter, Kenneth R. Olson, W. Christopher Shelley, John P. Brokaw, Krishna Manohar, and Troy A. Markel
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gasotransmitter ,persulfidation ,reactive sulfur species ,reactive species interactome ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Hydrogen sulfide has been recently identified as the third biological gasotransmitter, along with the more well studied nitric oxide (NO) and carbon monoxide (CO). Intensive studies on its potential as a therapeutic agent for cardiovascular, inflammatory, infectious and neuropathological diseases have been undertaken. Here we review the possible direct targets of H2S in mammals. H2S directly interacts with reactive oxygen/nitrogen species and is involved in redox signaling. H2S also reacts with hemeproteins and modulates metal-containing complexes. Once being oxidized, H2S can persulfidate proteins by adding -SSH to the amino acid cysteine. These direct modifications by H2S have significant impact on cell structure and many cellular functions, such as tight junctions, autophagy, apoptosis, vesicle trafficking, cell signaling, epigenetics and inflammasomes. Therefore, we conclude that H2S is involved in many important cellular and physiological processes. Compounds that donate H2S to biological systems can be developed as therapeutics for different diseases.
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- 2022
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9. Guidelines for the management of common congenital heart diseases in India: A consensus statement on indications and timing of intervention
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Anita Saxena, Jay Relan, Ravi Agarwal, Neeraj Awasthy, Sushil Azad, Manisha Chakrabarty, Kulbhushan S. Dagar, Velayoudam Devagourou, Baiju S. Dharan, Saurabh K. Gupta, Krishna S. Iyer, M. Jayranganath, Raja Joshi, B.R.J. Kannan, Ashish Katewa, Vikas Kohli, Shyam S. Kothari, K.M. Krishnamoorthy, Snehal Kulkarni, Rohit Manoj Kumar, Raman Krishna Kumar, Sunita Maheshwari, Krishna Manohar, Ashutosh Marwah, Smita Mishra, Smruti R. Mohanty, Kona Samba Murthy, Nageswara Rao Koneti, P.V. Suresh, S. Radhakrishnan, Palleti Rajashekar, Sivasubramanian Ramakrishnan, Nitin Rao, Suresh G. Rao, Chinnaswamy H.M. Reddy, Rajesh Sharma, Krishnanaik Shivaprakasha, Raghavan Subramanyan, R. Suresh Kumar, Sachin Talwar, Munesh Tomar, Sudeep Verma, and Vijayakumar Raju
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Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Introduction: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. Process: Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on the 10th and 11th of August, 2018 at the All India Institute of Medical Sciences. Objectives: The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases and (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. Recommendations: Evidence-based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts, obstructive lesions, and cyanotic congenital heart diseases. In addition, protocols for follow-up of postsurgical patients are also described. Keywords: Congenital heart disease, Intervention, Surgery
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- 2019
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10. Indian guidelines for indications and timing of intervention for common congenital heart diseases: Revised and updated consensus statement of the Working group on management of congenital heart diseases
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Anita Saxena, Jay Relan, Ravi Agarwal, Neeraj Awasthy, Sushil Azad, Manisha Chakrabarty, Kulbhushan S Dagar, Velayoudam Devagourou, Baiju S Dharan, Saurabh K Gupta, Krishna S Iyer, M Jayranganath, Raja Joshi, B R J Kannan, Ashish Katewa, Vikas Kohli, Shyam S Kothari, K M Krishnamoorthy, Snehal Kulkarni, R Manoj Kumar, R Krishna Kumar, Sunita Maheshwari, Krishna Manohar, Ashutosh Marwah, Smita Mishra, Smruti R Mohanty, K Samba Murthy, K Nageswara Rao, P V Suresh, S Radhakrishnan, Palleti Rajashekar, S Ramakrishnan, Nitin Rao, Suresh G Rao, H M Chinnaswamy Reddy, Rajesh Sharma, Krishnanaik Shivaprakash, Raghavan Subramanyan, R Suresh Kumar, Sachin Talwar, Munesh Tomar, Sudeep Verma, and R Vijaykumar
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Congenital heart disease ,intervention ,surgery ,Medicine ,Pediatrics ,RJ1-570 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A number of guidelines are available for the management of congenital heart diseases (CHD) from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for CHD, as often these patients present late in the course of the disease and may have coexisting morbidities and malnutrition. Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on August 10 and 11, 2018, at the All India Institute of Medical Sciences. The meeting was supported by Children's HeartLink, a nongovernmental organization based in Minnesota, USA. The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common CHD; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for CHD; and (iii) indications for use of pacemakers in children. Evidence-based recommendations are provided for indications and timing of intervention in common CHD, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, and others), obstructive lesions (pulmonary stenosis, aortic stenosis, and coarctation of aorta), and cyanotic CHD (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein's anomaly, and others). In addition, protocols for follow-up of postsurgical patients are also described, disease wise. Guidelines are also given on indications for implantation of permanent pacemakers in children.
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- 2019
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11. Aorto-left ventricular tunnel – A case report
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Anitha Diwakar, Kolli S Chalam, Channabasavaraj S Hiremath, Krishna Manohar, and P K Dash
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aorto-left ventricular tunnel ,congenital ,morphology ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Aorto-left ventricular tunnel (ALVT) is a rare congenital anomaly with extracardiac channel connecting ascending aorta to the ventricle. It presents early in life due to congestive cardiac failure. We present a case of ALVT with unusual morphology in an 11-year-old male child with palpitations and dyspnea. We also describe the transesophageal echocardiography evaluation of ALVT.
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- 2020
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12. Myocardial ischemia following arterial switch operation: An uncommon etiology
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R Saileela, C Shanthi, Krishna Manohar, Raghavan Subramanyan, and K M Cherian
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Arterial switch operation ,coronary steal ,MAPCA ,myocardial ischemia ,Medicine ,Pediatrics ,RJ1-570 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Myocardial ischemia following arterial switch operation (ASO) usually occurs due to coronary ostial narrowing that might result from technical failure in translocation of the coronary arteries to the neoaorta. We present an unusual case report of neonatal myocardial ischemia caused by coronary steal secondary to aortopulmonary collaterals, following ASO in transposition of great arteries.
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- 2012
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13. Synergizing AI and CPU: Empowering Next-Generation Computing
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Tallapaneni, Karthikeya, primary, Bhardwaj, Harshit, additional, Kajla, Amar, additional, Reddy, Prudhvi Sai, additional, Krishna, Manohar, additional, and Kaushik, Priyanka, additional
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- 2024
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14. A hydrogen-sulfide derivative of mesalamine reduces the severity of intestinal and lung injury in necrotizing enterocolitis through endothelial nitric oxide synthase
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Brian D. Hosfield, Chelsea E. Hunter, Hongge Li, Natalie A. Drucker, Anthony R. Pecoraro, Krishna Manohar, W. Christopher Shelley, and Troy A. Markel
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Nitric Oxide Synthase Type III ,Physiology ,Interleukin-6 ,Infant, Newborn ,Lung Injury ,Sulfides ,Nitric Oxide ,Weight Gain ,Infant, Newborn, Diseases ,Toll-Like Receptor 4 ,Disease Models, Animal ,Mice ,Animals, Newborn ,Enterocolitis, Necrotizing ,Physiology (medical) ,Animals ,Eosine Yellowish-(YS) ,Humans ,Disulfides ,Hydrogen Sulfide ,Intestinal Mucosa ,Hematoxylin ,Mesalamine ,Infant, Premature ,Hydrogen - Abstract
Necrotizing enterocolitis (NEC) remains a devastating disease that affects preterm infants. Hydrogen sulfide (H2S) donors have been shown to reduce the severity of NEC, but the optimal compound has yet to be identified. We hypothesized that oral H2S-Mesalamine (ATB-429) would improve outcomes in experimental NEC, and its benefits would be dependent on endothelial nitric oxide synthase (eNOS) pathways. NEC was induced in 5-day-old wild-type (WT) and eNOS knockout (eNOSKO) pups by formula feeding and stress. Four groups were studied in both WT and eNOSKO mice: 1) breastfed controls, 2) NEC, 3) NEC + 50 mg/kg mesalamine, and 4) NEC + 130 mg/kg ATB-429. Mesalamine and ATB-429 doses were equimolar. Pups were monitored for sickness scores and perfusion to the gut was measured by Laser Doppler Imaging (LDI). After euthanasia of the pups, intestine and lung were hematoxylin and eosin-stained and scored for injury in a blind fashion. TLR4 expression was quantified by Western blot and IL-6 expression by ELISA. P < 0.05 was significant. Both WT and eNOSKO breastfed controls underwent normal development and demonstrated milder intestinal and pulmonary injury compared with NEC groups. For the WT groups, ATB-429 significantly improved weight gain, reduced clinical sickness score, and improved perfusion compared with the NEC group. In addition, WT ATB-429 pups had a significantly milder intestinal and pulmonary histologic injury when compared with NEC. ATB-429 attenuated the increase in TLR4 and IL-6 expression in the intestine. When the experiment was repeated in eNOSKO pups, ATB-429 offered no benefit in weight gain, sickness scores, perfusion, intestinal injury, pulmonary injury, or decreasing intestinal inflammatory markers. An H2S derivative of mesalamine improves outcomes in experimental NEC. Protective effects appear to be mediated through eNOS. Further research is warranted to explore whether ATB-429 may be an effective oral therapy to combat NEC.
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- 2023
15. Impact of friction stir welding (FSW) process parameters on tensile strength during dissimilar welds of AA2014 and AA6061
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Jenarthanan, M.P., Varun Varma, C., and Krishna Manohar, V.
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- 2018
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16. Age disparities in intestinal stem cell quantities: a possible explanation for preterm infant susceptibility to necrotizing enterocolitis
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Brian D. Hosfield, W. Christopher Shelley, Fikir M. Mesfin, John P. Brokaw, Krishna Manohar, Jianyun Liu, Hongge Li, Anthony R. Pecoraro, Kanhaiya Singh, and Troy A. Markel
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Pediatrics, Perinatology and Child Health ,Surgery ,General Medicine - Published
- 2022
17. Effect of Different Coloured Shade Nets with Varying Shade Intensities on Reproductive Parameters and Yield of Tomato (Solanum lycopersicum L.,) var. Arka Rakshak
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Godi, Vinod, Krishna, Manohar R., and Vasanthakumari, R.
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- 2015
18. Stem cell derived therapies to preserve and repair the developing intestine
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Fikir M. Mesfin, Krishna Manohar, Chelsea E. Hunter, W. Christopher Shelley, John P. Brokaw, Jianyun Liu, Minglin Ma, and Troy A. Markel
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Pediatrics, Perinatology and Child Health ,Obstetrics and Gynecology - Published
- 2023
19. Sildenafil attenuates intestinal injury in necrotizing enterocolitis independently of endothelial nitric oxide synthase
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Chelsea E. Hunter, Brian D. Hosfield, Fikir M. Mesfin, Anthony R. Pecoraro, Jianyun Liu, W. Christopher Shelley, Krishna Manohar, and Troy A. Markel
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Intestines ,Mice ,Disease Models, Animal ,Nitric Oxide Synthase Type III ,Animals, Newborn ,Enterocolitis, Necrotizing ,Pediatrics, Perinatology and Child Health ,Animals ,Surgery ,General Medicine ,Intestinal Mucosa ,Nitric Oxide ,Sildenafil Citrate - Abstract
Necrotizing enterocolitis (NEC) is a devastating disease that impacts the intestine of premature infants. Sildenafil has shown benefit in colitis and ischemia/reperfusion models but has not been adequately studied in NEC. Sildenafil's best studied mechanism involves augmenting nitric oxide induced vasodilation. We hypothesized that sildenafil would improve outcomes during experimental NEC in an eNOS dependent manner.NEC was induced in five-day old mouse pups with gavage formula feeds plus intermittent hypoxia and hypothermia. Using wild type (WT) mice, the route of sildenafil administration was studied in the following groups: (1) breastfed controls, (2) NEC + oral (PO) sildenafil, (3) NEC + PO vehicle, (4) NEC + intraperitoneal (IP) sildenafil, (5) NEC + IP vehicle. The eNOS KO groups studied included: (1) breastfed controls, (2) NEC + PO sildenafil, (3) NEC + PO vehicle. Data were tested for normality and compared using t-tests or Mann-Whitney with a p-value0.05 considered significant.In WT mice, oral and IP sildenafil resulted in improved clinical outcomes compared to their respective vehicle group. Only orally administered sildenafil significantly improved perfusion to the intestine and protected it from macroscopic and histologic injury. When repeated in eNOS KO mice, oral sildenafil improved clinical scores and attenuated intestinal injury scores, despite no effect on intestinal perfusion.Sildenafil, when administered orally, improves clinical outcomes and protects the intestine in a murine model of experimental necrotizing enterocolitis. While sildenafil requires eNOS to impact mesenteric perfusion, it does not appear to be dependent on eNOS to attenuate intestinal injury.
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- 2022
20. Indian Guidelines for Indications and Timing of Intervention for Common Congenital Heart Diseases: Revised and Updated Consensus Statement of the Working Group on Management of Congenital Heart Diseases. Abridged Secondary Publication
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Palleti Rajashekar, Smruti Ranjan Mohanty, Sudeep Verma, Krishna Manohar, Nitin Rao, Jay Relan, Raman Krishna Kumar, Raja Joshi, Ashish Katewa, Shyam S. Kothari, Kona Samba Murthy, Sunita Maheshwari, Ashutosh Marwah, Velayoudam Devagourou, Suresh G Rao, Rohit Manoj Kumar, B R J Kannan, Ravi Agarwal, Krishnanaik Shivaprakasha, Rajesh Sharma, C Reddy, Baiju S. Dharan, M. Jayranganath, Neeraj Awasthy, Manisha Chakrabarty, Smita Mishra, Kavassery Mahadevan Krishnamoorthy, Vikas Kohli, Anita Saxena, Kulbhushan Singh Dagar, Snehal Kulkarni, Raghavan Subramanyan, V.S. Raju ., R. Suresh Kumar, Krishna S Iyer, PV Suresh, Munesh Tomar, S. R. Radhakrishnan, Sushil Azad, Nageswara Rao Koneti, Sivasubramanian Ramakrishnan, Saurabh Gupta, and Sachin Talwar
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Heart Defects, Congenital ,Pediatrics ,medicine.medical_specialty ,Consensus ,business.industry ,Infant ,Cardiovascular Agents ,Disease ,medicine.disease ,Time-to-Treatment ,Cardiac surgery ,Stenosis ,medicine.anatomical_structure ,Great arteries ,Child, Preschool ,Ductus arteriosus ,Pediatrics, Perinatology and Child Health ,Pediatric surgery ,medicine ,Humans ,Cardiac Surgical Procedures ,Total anomalous pulmonary venous connection ,Child ,business ,Tetralogy of Fallot - Abstract
A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of Medical Sciences, New Delhi. The meeting was supported by Children’s HeartLink, a non-governmental organization based in Minnesota, USA. To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. Evidence based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heart diseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein anomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.
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- 2020
21. Inhibition of Microglial Activation in the Amygdala Reverses Stress-Induced Abdominal Pain in the Male Rat
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Beverley Greenwood-Van Meerveld, Tian Yuan, Krishna Manohar, Albert Orock, and Rocco Latorre
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Male ,0301 basic medicine ,MAPK/ERK pathway ,Minocycline ,p38 Mitogen-Activated Protein Kinases ,Irritable Bowel Syndrome ,Stereotaxic Techniques ,PCR, polymerase chain reaction ,0302 clinical medicine ,Glucocorticoid receptor ,Chronic stress ,ANOVA, analysis of variance ,Original Research ,PSD95, postsynaptic density protein 95 ,TNF, tumor necrosis factor ,Neuronal Plasticity ,Microglia ,Central nucleus of the amygdala ,CeA, central nucleus of the amygdala ,Gastroenterology ,Visceral Pain ,phospho-p38 MAPK, phosphorylated p38 mitogen-activated protein kinase ,mRNA, messenger RNA ,medicine.anatomical_structure ,Brain–Gut Axis ,030211 gastroenterology & hepatology ,Visceral Hypersensitivity ,VMR, visceromotor behavioral response ,WAS, water avoidance stress ,medicine.medical_specialty ,IBS, irritable bowel syndrome ,MAP Kinase Signaling System ,p38 mitogen-activated protein kinases ,Central nervous system ,PBS, phosphate-buffered saline ,CNS, central nervous system ,FPO, fecal pellet output ,03 medical and health sciences ,Receptors, Glucocorticoid ,CORT, corticosterone ,CRF, corticotropin-release factor ,IBS ,Internal medicine ,medicine ,Animals ,Humans ,lcsh:RC799-869 ,GR, glucocorticoid receptor ,Hepatology ,Chemokine CX3CL1 ,business.industry ,Chronic Psychological Stress ,Central Amygdaloid Nucleus ,CRD, colorectal distension ,IL, interleukin ,Rats ,Disease Models, Animal ,030104 developmental biology ,Endocrinology ,lcsh:Diseases of the digestive system. Gastroenterology ,business ,Postsynaptic density ,Stress, Psychological - Abstract
Background & Aims Psychological stress is a trigger for the development of irritable bowel syndrome and associated symptoms including abdominal pain. Although irritable bowel syndrome patients show increased activation in the limbic brain, including the amygdala, the underlying molecular and cellular mechanisms regulating visceral nociception in the central nervous system are incompletely understood. In a rodent model of chronic stress, we explored the role of microglia in the central nucleus of the amygdala (CeA) in controlling visceral sensitivity. Microglia are activated by environmental challenges such as stress, and are able to modify neuronal activity via synaptic remodeling and inflammatory cytokine release. Inflammatory gene expression and microglial activity are regulated negatively by nuclear glucocorticoid receptors (GR), which are suppressed by the stress-activated pain mediator p38 mitogen-activated protein kinases (MAPK). Methods Fisher-344 male rats were exposed to water avoidance stress (WAS) for 1 hour per day for 7 days. Microglia morphology and the expression of phospho-p38 MAPK and GR were analyzed via immunofluorescence. Microglia-mediated synaptic remodeling was investigated by quantifying the number of postsynaptic density protein 95–positive puncta. Cytokine expression levels in the CeA were assessed via quantitative polymerase chain reaction and a Luminex assay (Bio-Rad, Hercules, CA). Stereotaxic infusion into the CeA of minocycline to inhibit, or fractalkine to activate, microglia was followed by colonic sensitivity measurement via a visceromotor behavioral response to isobaric graded pressures of tonic colorectal distension. Results WAS induced microglial deramification in the CeA. Moreover, WAS induced a 3-fold increase in the expression of phospho-p38 and decreased the ratio of nuclear GR in the microglia. The number of microglia-engulfed postsynaptic density protein 95–positive puncta in the CeA was increased 3-fold by WAS, while cytokine levels were unchanged. WAS-induced changes in microglial morphology, microglia-mediated synaptic engulfment in the CeA, and visceral hypersensitivity were reversed by minocycline whereas in stress-naïve rats, fractalkine induced microglial deramification and visceral hypersensitivity. Conclusions Our data show that chronic stress induces visceral hypersensitivity in male rats and is associated with microglial p38 MAPK activation, GR dysfunction, and neuronal remodeling in the CeA., Graphical abstract
- Published
- 2020
22. Isolated left subclavian with a compensatory ductus in a child with Tetralogy of Fallot
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Radha Joshi, Naveen Hiremath, Subramanian Chellappan, Siddharth Amboli, Yogesh Sathe, and Krishna Manohar
- Subjects
Pulmonary and Respiratory Medicine ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Left subclavian ,Heart disease ,Cardiovascular Abnormalities ,Subclavian Artery ,Aorta, Thoracic ,Pulmonary Artery ,030204 cardiovascular system & hematology ,Intracardiac injection ,Arterial insufficiency ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Internal medicine ,medicine ,Humans ,Pulmonary blood flow ,cardiovascular diseases ,Common carotid artery ,Child ,Tetralogy of Fallot ,business.industry ,General Medicine ,Oxygenation ,medicine.disease ,030228 respiratory system ,Arm ,cardiovascular system ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Tetralogy of Fallot is a cyanotic heart disease wherein aortopulmonary collaterals serve as source of pulmonary blood flow to maintain oxygenation. We report an incidentally detected isolated left subclavian artery supplying a compensatory ductus in a child with Tetralogy of Fallot that effectively contributed as a de novo palliative systemic to pulmonary artery shunt. Clinically, the entity could not be suspected, as the child did not have symptoms suggestive of arterial insufficiency of the left arm or weak pulses or neurological symptoms. The child underwent successful intracardiac repair with a reimplantation of left subclavian artery to left common carotid artery.
- Published
- 2021
23. Pseudoaneurysm following a neonatal coarctation repair; a dreadful complication
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Arya James, Ameer Hamza, Krishna Manohar, Yogesh Sathe, Subramanian Chellappan, and Radha Joshi
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Aorta, Thoracic ,Anastomosis ,Aortic Coarctation ,law.invention ,Pseudoaneurysm ,law ,medicine.artery ,Cardiopulmonary bypass ,medicine ,Thoracic aorta ,Humans ,End to end anastomosis ,Surgical repair ,Pericardial patch ,business.industry ,Anastomosis, Surgical ,Infant, Newborn ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,Complication ,business ,Vascular Surgical Procedures ,Aneurysm, False - Abstract
Aneurysms of descending thoracic aorta following surgical repair of coarctation have been reported in literature. Almost always, they are seen in repairs involving prosthetic patch aortoplasty. We report a neonate who underwent resection and an extended end to end anastomosis repair of coarctation and subsequently developed a huge pseudoaneurysm at a 3-month follow-up. He underwent a repair of the same through a sternotomy approach under hypothermic low flow cardiopulmonary bypass. An autologous pericardial patch aortoplasty was done successfully.
- Published
- 2021
24. Timing of congenital cardiac surgery in children who turned COVID-19 positive
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Krishna Manohar, Subramanian Chellappan, and Anagha Tulsi
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Heart Defects, Congenital ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,General Medicine ,Perioperative ,Disease ,Sitting ,Asymptomatic ,Cardiac surgery ,Surgery ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,medicine.symptom ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,business ,Child - Abstract
We report a series of four patients with CHD who tested positive for COVID-19, got treated, and underwent cardiac surgery in the same sitting. All had an uneventful perioperative course similar to COVID-19-negative patients. We conclude that children with asymptomatic or mild COVID-19 disease may be subjected to surgery as early as within 1 week since COVID-19 negative.
- Published
- 2021
25. Guidelines for the management of common congenital heart diseases in India: A consensus statement on indications and timing of intervention⋆
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Ravi Agarwal, Raghavan Subramanyan, Sachin Talwar, Kona Samba Murthy, Raman Krishna Kumar, Smita Mishra, Nageswara Rao Koneti, Shyam S. Kothari, Jay Relan, Smruti Ranjan Mohanty, Krishna S Iyer, V.S. Raju ., Rajesh Sharma, Sivasubramanian Ramakrishnan, Kulbhushan Singh Dagar, Baiju S. Dharan, Krishna Manohar, Kavassery Mahadevan Krishnamoorthy, Ashutosh Marwah, Ashish Katewa, Snehal Kulkarni, B R J Kannan, Sudeep Verma, Sushil Azad, Neeraj Awasthy, Nitin Rao, R. Suresh Kumar, Manisha Chakrabarty, Suresh G Rao, Raja Joshi, Rohit Manoj Kumar, Krishnanaik Shivaprakasha, C Reddy, Vikas Kohli, Munesh Tomar, Saurabh Gupta, PV Suresh, Velayoudam Devagourou, Sunita Maheshwari, M. Jayranganath, Anita Saxena, S. R. Radhakrishnan, and Palleti Rajashekar
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Heart Defects, Congenital ,medicine.medical_specialty ,Post surgical ,Evidence-based practice ,Time Factors ,RD1-811 ,Psychological intervention ,India ,Intervention ,Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Intervention (counseling) ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,Humans ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Intensive care medicine ,Developing Countries ,Congenital heart disease ,business.industry ,Infant, Newborn ,medicine.disease ,Cardiac surgery ,Catheter ,Malnutrition ,RC666-701 ,Original Article ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. Process: Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on the 10th and 11th of August, 2018 at the All India Institute of Medical Sciences. Objectives: The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases and (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. Recommendations: Evidence-based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts, obstructive lesions, and cyanotic congenital heart diseases. In addition, protocols for follow-up of postsurgical patients are also described. Keywords: Congenital heart disease, Intervention, Surgery
- Published
- 2019
26. Aorto-left ventricular tunnel - A case report
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Kolli S Chalam, Krishna Manohar, Anitha Diwakar, P K Dash, and Channabasavaraj S Hiremath
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Aortico-Ventricular Tunnel ,Male ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Heart Ventricles ,Case Report ,030204 cardiovascular system & hematology ,Aorto-left ventricular tunnel ,lcsh:RD78.3-87.3 ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Internal medicine ,medicine.artery ,Ascending aorta ,morphology ,Palpitations ,Medicine ,Humans ,Child ,Aorta ,business.industry ,congenital ,General Medicine ,Magnetic Resonance Imaging ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Ventricle ,lcsh:Anesthesiology ,lcsh:RC666-701 ,Cardiology ,cardiovascular system ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
Aorto-left ventricular tunnel (ALVT) is a rare congenital anomaly with extracardiac channel connecting ascending aorta to the ventricle. It presents early in life due to congestive cardiac failure. We present a case of ALVT with unusual morphology in an 11-year-old male child with palpitations and dyspnea. We also describe the transesophageal echocardiography evaluation of ALVT.
- Published
- 2020
27. Pioneers of congenital heart surgery in India: historical perspective: Mumbai - The Gateway of Congenital Heart Surgery to India
- Author
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Krishna Manohar S R
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,education ,Gateway (computer program) ,Review Article ,030204 cardiovascular system & hematology ,Vascular surgery ,First generation ,Surgery ,Cardiac surgery ,03 medical and health sciences ,0302 clinical medicine ,surgical procedures, operative ,030228 respiratory system ,Cardiothoracic surgery ,medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Congenital heart surgery was born in the USA and then spread all over the world in the second half of the twentieth century. The speciality was brought to India by foreign-trained Indian surgeons as well as American and Canadian missionary surgeons. The first generation Indian surgeons were trained in the USA, Canada, Australia, and New Zealand. In this article, an attempt is made to explore how the pioneer surgeons established this speciality in India by reviewing the published literature, visiting institutions of historical significance, and also interviewing few surgeons who took the key role in both laying the foundation as well as training the next generation surgeons.
- Published
- 2019
28. Adult tetralogy repair: factors affecting early outcome in the current era
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Salla Sweta Ramani, Sowmya Ramanan, Navaneetha Sasikumar, Krishna Manohar, Raghavan Subramanyam, Kotturathu Mammen Cherian, Ravi Agarwal, and Raghavannair Suresh Kumar
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,Treatment outcome ,030204 cardiovascular system & hematology ,Outcome (game theory) ,Risk Assessment ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Hemofiltration ,medicine ,Humans ,Tetralogy ,Cardiac Surgical Procedures ,Tetralogy of Fallot ,Retrospective Studies ,business.industry ,Age Factors ,General Medicine ,Perioperative ,Recovery of Function ,Surgical correction ,Length of Stay ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,030228 respiratory system ,Female ,Pulmonary Valve Insufficiency ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The benefits of surgical correction of adult tetralogy of Fallot are well known. The current recommendation is for total correction regardless of age. This study analyzed perioperative factors affecting early outcome after corrective surgery in adulthood in the current era. Methods This was a retrospective chart review of 40 consecutive patients over 18 years of age who underwent total correction of tetralogy of Fallot from September 2006 to June 2013. Patients with pulmonary atresia and absent pulmonary valve were excluded. The mean age at surgery was 26.60 ± 8.69 years (range 18–49 years). Results The mean intensive care unit stay was 3.30 ± 2.29 days (range 0.75–12 days) and hospital stay was 9.97 ± 3.39 days (range 7–22 days). Mortality was 5% (2/40). Multiple parameters indicating immediate postoperative outcomes and their relationships to selected pre-, intra-, and postoperative factors were analyzed. Multivariate analysis showed that postoperative right ventricular dysfunction had a significant influence on mortality ( p Conclusions Total correction of tetralogy of Fallot is a safe option for presentations as late as adulthood. The protective effect of zero-balance ultrafiltration on postoperative morbidity needs to be reassessed in larger studies.
- Published
- 2019
29. Impact of friction stir welding (FSW) process parameters on tensile strength during dissimilar welds of AA2014 and AA6061
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C. Varun Varma, V. Krishna Manohar, and M.P. Jenarthanan
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Design–Expert ,Materials science ,Tension (physics) ,Weldability ,chemistry.chemical_element ,02 engineering and technology ,Welding ,021001 nanoscience & nanotechnology ,law.invention ,020303 mechanical engineering & transports ,0203 mechanical engineering ,chemistry ,law ,Aluminium ,Ultimate tensile strength ,Friction stir welding ,Response surface methodology ,Composite material ,0210 nano-technology - Abstract
Friction Stir Welding (FSW) is a solid state joining technique which is universally used for joining of aluminium alloys in marine, aerospace, automotive and many other applications of commercial importance. In this present study, the effect of FSW parameters on the weldability of dissimilar aluminium alloys such as AA2014 and AA6061 were investigated. The two plates were aligned perpendicular to the rolling directions and the welding was carried out. The main objective of the experiment is to find out the maximum tensile strength. The experiments were conducted on a milling machine. Three factor three levels Central-Composite matrix in Response Surface Methodology (RSM) is employed to carry out the experimental investigation. The “Design Expert 8.0”, software was used for regression and graphical analysis of data collected. ANOVA was used to check the validity of the model. A designed FSW experiments were carried out to get a high strength welding by controlling the rotational, welding speed and tool pin diameter. The tensile tests were carried under tension at room temperature in order to analyze the mechanical response.
- Published
- 2018
30. Azygos Vein to the Rescue of Warden Anastomosis in High Pulmonary Venous Drainage
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Channabasavaraj S Hiremath, Anuradha Kamath, Siddharth Amboli, Yatindra U. Ashtaputre, and Krishna Manohar
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Pulmonary Circulation ,medicine.medical_specialty ,Vena Cava, Superior ,Partial anomalous pulmonary venous return ,030204 cardiovascular system & hematology ,Anastomosis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Child ,business.industry ,Anastomosis, Surgical ,Scimitar Syndrome ,Venous drainage ,General Medicine ,medicine.anatomical_structure ,030228 respiratory system ,Pulmonary Veins ,Azygos Vein ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Cardiology ,Right atrium ,Surgery ,Azygos vein ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Abstract
Partial anomalous pulmonary venous return is a congenital anomaly in which some of the pulmonary veins drain into the right atrium or one of its venous tributaries. Although excellent long-term results have been described for the classic two-patch technique repair in older patients, The Warden procedure has an important role in smaller and younger patients and those patients in whom the superior vena cava (SVC) may be small and the right-sided pulmonary veins may connect high, at or above the azygos vein. In addition to prevention of early and late sinus node dysfunction, the Warden procedure helps to avoid systemic or pulmonary venous obstruction if care is taken to ensure a tension-free Warden anastomosis. Patch extension or interposition of prosthetic grafts with no growth potential have been used in instances of high partial anomalous pulmonary venous connection (PAPVC) to SVC. We report three cases of high PAPVC to SVC using an innovative technique of incorporating the azygos vein into the Warden anastomosis for a tension-free suture line.
- Published
- 2018
31. Region of interest based robust watermarking scheme for adaptation in small displays.
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Sapthagirivasan Vivekanandhan, Kishore Mohan K. B., and Krishna Manohar Vemula
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- 2010
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32. Accelerated calcific degeneration of homologous pericardium resulting in pulmonary venous obstruction following senning procedure
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Theodore, Sanjay, Bhuyan, Ritwick Raj, Rema, Krishna Manohar Soman, and Neelakandhan, Kurur Sankaran
- Published
- 2006
- Full Text
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33. Absent Superior Vena Cava in Tetralogy of Fallot
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Shah, Tejas R., Hiremath, Channabasavaraj S., Diwakar, Anitha, and Soman Rema, Krishna Manohar
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cardiovascular system ,Case Report ,cardiovascular diseases ,superior vena cava interruption ,tetralogy of Fallot ,Azygous continuation - Abstract
Absent superior vena cava (SVC) is an asymptomatic congenital systemic venous anomaly which is rarely detected and compatible with normal life. Undiagnosed absent SVC may cause problems during cardiac catheterization or cardiac surgery. We present our surgical experience in a patient with tetralogy of Fallot who had undiagnosed absent SVC.
- Published
- 2018
34. A Connectomic Atlas of the Human Cerebrum—Chapter 8: The Posterior Cingulate Cortex, Medial Parietal Lobe, and Parieto-Occipital Sulcus
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Daniel L. O'Donoghue, Joshua D. Burks, Krishna Manohar, Cordell M Baker, Michael E. Sughrue, Goksel Sali, Camille K Milton, Chad A. Glenn, Tressie M McCoy, Andrew K. Conner, Robert G. Briggs, and James Battiste
- Subjects
0301 basic medicine ,Cingulate cortex ,Neuroimaging ,Gyrus Cinguli ,A Connectomic Atlas of the Human Cerebrum Supplement ,03 medical and health sciences ,0302 clinical medicine ,Parietal Lobe ,Neural Pathways ,medicine ,Connectome ,Humans ,Human Connectome Project ,business.industry ,Cerebrum ,Parietal lobe ,Sulcus ,Magnetic Resonance Imaging ,030104 developmental biology ,medicine.anatomical_structure ,Diffusion Tensor Imaging ,Cerebral cortex ,Posterior cingulate ,Surgery ,Neurology (clinical) ,Occipital Lobe ,Nerve Net ,Parieto-occipital sulcus ,business ,Neuroscience ,030217 neurology & neurosurgery - Abstract
In this supplement, we build on work previously published under the Human Connectome Project. Specifically, we seek to show a comprehensive anatomic atlas of the human cerebrum demonstrating all 180 distinct regions comprising the cerebral cortex. The location, functional connectivity, and structural connectivity of these regions are outlined, and where possible a discussion is included of the functional significance of these areas. In part 8, we specifically address regions relevant to the posterior cingulate cortex, medial parietal lobe, and the parieto-occipital sulcus.
- Published
- 2018
35. Bilateral Anomalous Pulmonary Venous Connection to Bilateral Superior Caval Veins
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Sowmya Ramanan, Kootturathu Mammen Cherian, Navaneetha Sasikumar, Krishna Manohar Soman Rema, and Shanthi Chidambaram
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medicine.medical_specialty ,Vena Cava, Superior ,Heart Septal Defects, Atrial ,law.invention ,Pulmonary vein ,law ,Superior vena cava ,Left atrial ,Internal medicine ,Ductus arteriosus ,medicine ,Cardiopulmonary bypass ,Humans ,Abnormalities, Multiple ,cardiovascular diseases ,Cardiac Surgical Procedures ,Atrium (heart) ,Ductus Arteriosus, Patent ,Incidental Findings ,Cardiopulmonary Bypass ,Anomalous pulmonary venous connection ,business.industry ,General Medicine ,Left pulmonary artery ,Anatomy ,medicine.disease ,Treatment Outcome ,medicine.anatomical_structure ,Pulmonary Veins ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,Cardiology ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Abstract
A four-year-old girl presented with superior vena cava (SVC) type of sinus venosus defect, right upper pulmonary vein draining into right SVC-right atrium junction, left upper lobe pulmonary veins draining into the lower part of persistent left SVC (LSVC), and a patent ductus arteriosus. The anomalous pulmonary venous drainage to LSVC was overlooked in the preoperative evaluation and was found intraoperatively. Warden procedure was performed for right-sided veins. Lower LSVC draining the anomalous pulmonary veins was anastomosed to the left atrial appendage. The short stump of LSVC was diverted to left pulmonary artery. Anomalous pulmonary venous connections to LSVC are rare. Embryology of venous development is analyzed with respect to this rare anomaly, and options for surgical correction are discussed.
- Published
- 2014
36. Hybrid intraoperative pulmonary artery stenting in redo congenital cardiac surgeries
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Rajasekaran Premsekar, Shanthi Chidambaram, Raghavan Subramanyan, Ravi Agarwal, K.M. Cherian, Anuradha Sridhar, and Soman Rema Krishna Manohar
- Subjects
Male ,medicine.medical_treatment ,Heart Septal Defects, Atrial ,Cohort Studies ,Stent ,Hospital Mortality ,Child ,Ultrasonography ,Tetralogy of Fallot ,Pulmonary Valve Stenosis ,Survival Rate ,Treatment Outcome ,surgical procedures, operative ,Child, Preschool ,Original Article ,Female ,Stents ,Patient Safety ,Cardiology and Cardiovascular Medicine ,Pulmonary atresia ,Adult ,Heart Defects, Congenital ,Reoperation ,medicine.medical_specialty ,RD1-811 ,Adolescent ,India ,Pulmonary Artery ,Risk Assessment ,Young Adult ,Double outlet right ventricle ,Angioplasty ,medicine.artery ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,cardiovascular diseases ,Cardiac Surgical Procedures ,Retrospective Studies ,Intraoperative Care ,business.industry ,Infant ,medicine.disease ,Hybrid ,Surgery ,Stenosis ,RC666-701 ,Pulmonary valve stenosis ,Pulmonary artery ,Redo surgery ,business ,Follow-Up Studies - Abstract
Objective Reconstruction of branch pulmonary arteries (PAs) can be challenging in redo congenital heart surgeries. Treatment options like percutaneous stent implantation and surgical patch angioplasty may yield suboptimal results. We present our experience with hybrid intraoperative stenting which may be an effective alternative option. Methods We retrospectively analyzed data of all patients with PA stenosis who underwent intraoperative PA branch stenting in our institution between January 2011 and December 2012. Results Ten patients [6 females, median age 10 (1.4 to 37) years], underwent hybrid stenting of the PA. Primary cardiac diagnoses were pulmonary atresia with ventricular septal defect (VSD) in three patients, pulmonary atresia with intact ventricular septum in two, Tetralogy of Fallot (TOF) in one, Double outlet right ventricle (DORV) with pulmonary stenosis (PS) in one, complex single ventricle in two and VSD with bilateral branch PA stenosis in one patient. Concomitant surgeries were revision/reconstruction of RV-PA conduit in 4, Fontan completion in 4, repair of TOF with conduit placement in 1 and VSD closure in 1 patient. The left PA was stented in 7, the right in 2 and both in 1, with a total of 11 stents. There were no complications related to stent implantation. Two early postoperative deaths were unrelated to stent implantation. At mean follow-up period of 14.8 (12–26) months, stent position and patency were satisfactory in all survivors. None of them needed repeat dilatation or surgical reintervention. Conclusion Hybrid stenting of branch PA is a safe and effective option for PA reconstruction in redo cardiac surgeries. With meticulous planning, it can be safely performed without fluoroscopy.
- Published
- 2014
37. Prosthetic reconstruction of bicuspid pulmonary valve in tetralogy of Fallot
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Krishna Manohar Soman Rema, Navaneetha Sasikumar, Sowmya Ramanan, Kootturathu Mammen Cherian, Raghavan Subramanyan, and Raghavannair Suresh Kumar
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Adolescent ,Ventricular Outflow Obstruction ,Prosthesis Design ,Intracardiac injection ,law.invention ,Young Adult ,law ,Internal medicine ,medicine ,Humans ,Ventricular outflow tract ,Child ,Polytetrafluoroethylene ,Tetralogy of Fallot ,Heart Valve Prosthesis Implantation ,Pulmonary Valve ,business.industry ,Infant ,General Medicine ,Plastic Surgery Procedures ,medicine.disease ,Intensive care unit ,Pulmonary Valve Insufficiency ,Surgery ,Pulmonary valve function ,Treatment Outcome ,medicine.anatomical_structure ,Child, Preschool ,Heart Valve Prosthesis ,Pulmonary valve ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Bicuspid pulmonary valve - Abstract
Background Various techniques have been described for preserving pulmonary valve function in tetralogy of Fallot repair. In selected substrates, the pulmonary valve can be bicuspidized and preserved using polytetrafluoroethylene pericardial membrane. Methods This study was a retrospective review of 20 patients aged 11 months to 31 years with tetralogy of Fallot and a bicuspid pulmonary valve (with anteroposterior cusps) who underwent intracardiac repair from August 2010 to January 2013. The anterior cusp was augmented using polytetrafluoroethylene pericardial membrane to preserve the valve hinge. A transannular patch was used in all cases. Data relating to surgical outcome, intensive care unit course, pulmonary regurgitation, and right ventricular outflow tract gradient were collected. Results There was no mortality. Predischarge pulmonary regurgitation was ≤grade 2 in 18 (90%) patients. One patient had an outflow gradient >40 mm Hg. On follow-up of 3–24 months, there was no increase in outflow gradient; 18.7% had progression of pulmonary regurgitation. Conclusion In selected substrates, this technique is associated with minimization of pulmonary regurgitation and an excellent functional outcome. The utility of this technique needs to be validated over a longer time scale in a larger series.
- Published
- 2013
38. Analytics of Data Science using Big Data
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Ch. Sai Krishna Manohar Ch. Sai Krishna Manohar
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World Wide Web ,Social business ,Computer science ,Analytics ,business.industry ,Enabling ,Server ,Critical success factor ,Big data ,Key (cryptography) ,Social media ,business ,Data science - Abstract
This paper will cover the concepts of Adoption trends of Big Data, needs of BIG DATA, benefits of Big Data and finally the summary, conclusion. My analysis illustrate that the fast-growing and a key enabler for the social business. The paper also discuss about the storing of the data as a Big Data. It deals with the servers that the Big Data is going to maintain at the backend. The insights gained from the user generated online contents and collaboration with customers is critical for customers are critical success in the age of social media.
- Published
- 2013
39. Congenital Pulmonary vein stenosis - Diagnosis and treatment
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Indra Kuladhipati, Navaneetha Sasikumar, Premsekar Rajasekaran, Sowmya Ramanan, Krishna Manohar Soman Rema, and Raghavan Suramanyan
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Congenital pulmonary vein stenosis ,Disease ,business ,Pathophysiology ,Surgery - Abstract
Congenital pulmonary vein stenosis is a rare and interesting condition. This disease was classically believed to have an exceptionally bad prognosis. This article reviews the pathophysiology of the disease and advancements in diagnosis and management
- Published
- 2013
40. ECONOMICS OF PROPAGATION OF POMEGRANATE (PUNICA GRANATUM L.) UNDER PROTECTED ENVIRONMENTAL CONDITIONS
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C. Ravindran, R. Krishna Manohar, B. N. Maruthi Prasad, and S. Jaganath
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Integrated pest management ,Cutting ,Horticulture ,Geography ,biology ,Benefit–cost ratio ,Punica ,Sowing ,Greenhouse ,Cultivar ,biology.organism_classification ,Fruit tree - Abstract
Fruit crops play a vital role in Indian Horticulture because of their high economic returns. Pomegranate (Punica granatum L.) is a favorite table fruit. In India, it is grown in Maharashtra followed by Karnataka, Andhra Pradesh and Gujarat states. The total area under pomegranate is 88,500 ha with a production of 568.20 thousand metric tons. Pomegranate is generally propagated by hard wood stem cuttings which root easily. However, the percentage of rooting varies with the cultivar and vagary of climatic conditions does not permit propagation of disease free planting material throughout the year. Hence, under greenhouse conditions it is possible to protect them from unfavorable climatic conditions and also produce disease free quality planting material with remunerative profit. The present study was structured to examine the cost efficiency of propagation of pomegranate under different greenhouse structures by estimating the benefit cost ratio under different propagating structures. The results showed a maximum benefit:cost ratio of 1.51:1 with a medium cost greenhouse structure with misting followed by 1.42:1 with medium cost greenhouse structure with humidifier and fans compared to high cost greenhouse structure with misting (1.21:1). A low benefit:cost ratio of 1.14:1 was obtained in open conditions.
- Published
- 2011
41. Cantrell's syndrome: A report of two cases
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Iyer A, Nagi GS, Krishna Manohar SR, and Jayakumar K
- Published
- 2006
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42. Results of surgical correction of Ebstein's anomaly
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Malempati, Amaresh Rao, Anand, Iyer, Krishna, Manohar, Shyam KG, Krishnan, and Jayakumar K
- Published
- 2006
- Full Text
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43. Experience of surgery for sinus venousus ASD with partial anomalous pulmonary venous connection to the superior venacava
- Author
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Iyer A, Sadiq A, Haridas A, Malempatti A, Bansal N, Shvamkrishnan KG, Krishna Manohar SR, and Jayakumar K
- Published
- 2006
- Full Text
- View/download PDF
44. Technique of bi-directional cavopulmonary shunt when there is partial anomalous pulmonary venous connection to superior venacava: A Case report
- Author
-
Bansal N, Iyer AP, Krishna Manohar SR, and Jayakumar K
- Published
- 2006
- Full Text
- View/download PDF
45. Surgical outcome of simple repair for congenitally corrected transposition of great arteries at mid-term follow up
- Author
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Shyamkrishnan KG, Sadiq A, Krishna Manohar SR, and Jayakumar K
- Published
- 2006
- Full Text
- View/download PDF
46. 638 - Microglia in the Central Nucleus of the Amygdala: Role in Stress-Induced Visceral Hypersensitivity
- Author
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Krishna Manohar, Beverley Greenwood-Van Meerveld, Rocco Latorre, and Michelle Zalles
- Subjects
medicine.anatomical_structure ,Hepatology ,Microglia ,Chemistry ,Central nucleus of the amygdala ,Stress induced ,Gastroenterology ,medicine ,Neuroscience - Published
- 2018
47. Single-Stage Surgical Correction of Combination Lesions Through Thoracotomy
- Author
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Kootturathu Mammen Cherian, Sowmya Ramanan, Premsekar Rajasekaran, Kizakke K. Pradeep, Krishna Manohar Soman Rema, and Navaneetha Sasikumar
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Coarctation of the aorta ,Aortic Coarctation ,Pulmonary vein ,Lesion ,medicine.artery ,medicine ,Humans ,Thoracotomy ,Cardiac Surgical Procedures ,Single stage ,business.industry ,General Medicine ,Surgical correction ,medicine.disease ,Surgery ,Echocardiography ,Median sternotomy ,Descending aorta ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Magnetic Resonance Angiography - Abstract
Coarctation of the descending aorta is associated with significant cardiac lesions in up to 50% of the patients. Under such circumstances, surgical management requires consideration of the nature of the associated lesion which usually requires a median sternotomy for surgical correction. Coarctation of the aorta (COA) is, therefore, rarely associated with lesions that are amenable to surgical correction through a thoracotomy incision. In this case report, we report a case of COA with significant associated cardiac disease that was repaired through a left thoracotomy incision. A 13-year-old boy was found to have COA and also partial anomalous pulmonary venous drainage of the left upper pulmonary vein to the innominate vein. Both the lesions were surgically corrected simultaneously through a thoracotomy.
- Published
- 2013
48. Follow up study of sixty six cases of intracardiac repair for double chambered right ventricle
- Author
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Misra M, Sankar Kumar R, Shyamkrishnan KG, Krishna Manohar SR, Titus T, and Neelakandhan KS
- Published
- 2004
- Full Text
- View/download PDF
49. A review of chitra experience of 40 cases of aortopulmonary window
- Author
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Sai Kiran KVSS, Krishna Manohar SR, Sankar Kumar R, Shyam krishnan KG, and Neelakandhan KS
- Published
- 2004
- Full Text
- View/download PDF
50. Scimitar syndrome with anomalous left superior pulmonary vein to left innominate vein: A rare surgical experience
- Author
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Mishra M, Krishna Manohar SR, Sivasankaran S, Manikandan S, and Neelakandhan KS
- Published
- 2004
- Full Text
- View/download PDF
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