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2. 2 A Systematic Review on Clinical Efficacy and Cost-Effectiveness of Reverse Total Shoulder Arthroplasty or Hemiarthroplasty on Proximal Humeral Fractures

Author

S.N. Zallipalli, P. Harish Kumar, R.R. Bethi, V. Kaur, and N. Shejale

Subjects
Surgery
Abstract

Introduction Proximal humeral fractures (PHF) are one of the most challenging injuries to treat and recover from. Humeral fracture stems have become popular among individuals undergoing arthroplasty because of their superior ability to reduce and repair tuberosities. This study aims to determine better clinical, functional, and radiology outcomes and cost-effectiveness surgical management of PHF and Comparison of these outcomes among the surgical option. Method This systematic review includes the literature from the multi-database electronic search, i.e., Medline, PubMed, Embase, and web of science based on PRISMA guideline 2009. The data from the eligible literature meeting the study criteria were extracted and analysed. Results Reverse total shoulder arthroplasty (RTSA) provides better patients satisfaction and more improved functional outcomes when compared with shoulder hemiarthroplasty. Taking into consideration of healthcare perspective and payer perspective, RTSA was most cost-effective when compared to a hemiarthroplasty. Our work delivers significant baseline statistics about characteristics related to cost and outcomes of surgical approach for the management of PHF. RTSA can be considered as beneficial management of fracture Of PHF following the encouraging outcome of RTSA. Conclusions This systematic review provides favourable short to long-term functional outcomes of RTSA.

Published
2022
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6. Association of atrial strain ratio with invasive pulmonary hemodynamics in rheumatic mitral stenosis

Author

Aristomenis Manouras, Ashwin Venkateshvaran, and V Kaur

Subjects
Atrial strain, medicine.medical_specialty, business.industry, Internal medicine, Cardiology, medicine, Rheumatic mitral stenosis, Radiology, Nuclear Medicine and imaging, General Medicine, Cardiology and Cardiovascular Medicine, business, Pulmonary hemodynamics
Abstract

Funding Acknowledgements Type of funding sources: None. Background. Symptomatic rheumatic mitral stenosis (MS) results in elevation in left atrial (LA) pressure that is passively transmitted to derange pulmonary hemodynamics and subsequently elevate right ventricular afterload. We studied associations between LA to right atrial reservoir strain ratio (LA-RAs) and invasive pulmonary hemodynamics in addition to the ratio’s ability to identify subjects with elevated pulmonary vascular resistance (PVR). Methods. Consecutive MS subjects undergoing right heart catheterization (RHC) and percutaneous transvenous mitral commissurotomy (PTMC) were enrolled. Subjects with atrial fibrillation, >mild mitral regurgitation, concomitant aortic valve or ischemic heart disease were excluded. LA-RAs was assessed by speckle-tracking echocardiography and stratified into high or low LA-RAs subgroups based on mean value. Correlations with invasive pulmonary hemodynamics was studied. ROC analysis was performed to identify pulmonary hypertension (PH) and PVR > 3 Wood Units. Results. 110 subjects were analysed (age: 32 ± 8; 72% female). LA and RA reservoir strain was feasible in 88 (80%) and 83 (75%) subjects respectively. Patients with low LA-RAs demonstrated more severe MS (0.8 ± 0.1 vs. 1.0 ± 0.2cm2), higher mean pulmonary artery (43 ± 13 vs. 33 ± 13mmHg) and capillary wedge pressure (28 ± 6 vs.23 ± 16mmHg) as compared with high LA-RAs (p Conclusions. The novel atrial strain ratio is associated with measures of invasive pulmonary hemodynamics and demonstrates ability to identify PH and elevated PVR in MS.

Published
2021
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12. Outcome of appendicectomy in children performed in paediatric surgery units compared with general surgery units

Author

S Tiboni, A Bhangu, N J Hall, I G Panagiotopoulou, N Chatzizacharias, M Rana, K Rollins, F Ejtehadi, B Jha, Y-W Tan, N Fanous, G Markides, A Tan, C Marshal, S Akhtar, D Mullassery, A Ismail, C Hitchins, S P Sharif, L Osborne, N Sengupta, C Challand, D Pournaras, K Bevan, J King, J Massey, I Sandhu, J M Wells, D A Teichmann, A Peckham-Cooper, M Sellers, S E Folaranmi, B Davies, S P Loukogeorgakis, R Kalaiselvan, S Marzouk, E J H Turner, S Kaptanis, V Kaur, G Shingler, A Bennett, M Aly, J Coad, T Khong, Z Nouman, J Crawford, P Szatmary, H West, A L MacDonald, K A Hanks, E Griggs, L Humphreys, A Torrance, J Hardman, L Taylor, D Rex, J Bennett, N Crowther, B McAree, S Flexer, P Mistry, P Jain, M Hwang, N Oswald, A Wells, H Newsome, A Campbell, D Carradice, R Gohil, M Mount, S Iype, E Dyson, T Groot-Wassink, A R Ross, C Jones, N Baylem, J Voll, T Sian, L Creedon, P Charlesworth, J Goring, V Ng, T Palser, B Rees, P Ravindra, C Neophytou, H Dent, T Lo, L Broom, M O'Connell, R Foulkes, D Griffith, K Butcher, O Mclaren, A Tai, H D T Torrance, O Moussa, D Mittapalli, D Watt, S Basson, A Wilkins, J Yee, H Cain, M Wilson, J Pearson, E Turnbull, A Brigic, N A Yassin, J Clarke, S Mallappa, P Jackson, C E Jones, B Lakshminarayanan, K Fareed, G Yip, A Brown, N Patel, M Ghisel, N Tanner, H Jones, J Witherspoon, M Phillips, W K Mitchell, F Amawi, E Dickson, S Aggarwal, L K Satherley, F Asprou, C Keys, M Steven, J Muhlschlegel, E Hamilton, J Yin, M Dilworth, A Wright, P Spreadborough, M Singh, K Mockford, J Morgan, W Ball, J Royle, J Lacy-Colson, C Batterbsy, C A Hateley, A Penkethman, C Lambden, W Lai, S Griffiths, S Mitchell, C Parsons, A Conway, P Dent, D Yacob, C Tennuci, N Battersby, R Wilkin, C Lloyd, E Sein, K McEvoy, L Whisker, S Austin, A Colori, P Sinclair, M Loughran, A Lawrence, A Pisesky, S Mastoridis, K Solanki, I Siddiq, L Merker, P Sarmah, C Richardson, T Pinkney, C Battersby, D Beral, J Cornish, S Strong, and R Velineni

Subjects
Male, medicine.medical_specialty, Adolescent, Consultants, Preoperative care, Case mix index, Medical Staff, Hospital, medicine, Appendectomy, Humans, Prospective Studies, Child, Adverse effect, Prospective cohort study, Pediatric Surgical Procedures, Laparoscopy, Ultrasonography, medicine.diagnostic_test, business.industry, General surgery, Infant, Odds ratio, Appendicitis, medicine.disease, Surgery, Treatment Outcome, Child, Preschool, Acute Disease, Female, business, Hospital Units
Abstract

Background Appendicectomy for acute appendicitis in children may be performed in specialist centres by paediatric surgeons or in general surgery units. Service provision and outcome of appendicectomy in children may differ between such units. Methods This multicentre observational study included all children (aged less than 16 years) who had an appendicectomy at either a paediatric surgery unit or general surgery unit. The primary outcome was normal appendicectomy rate (NAR). Secondary outcomes included 30-day adverse events, use of ultrasound imaging and laparoscopy, and consultant involvement in procedures. Results Appendicectomies performed in 19 paediatric surgery units (242 children) and 54 general surgery units (461 children) were included. Children treated in paediatric surgery units were younger and more likely to have a preoperative ultrasound examination, a laparoscopic procedure, a consultant present at the procedure, and histologically advanced appendicitis than children treated in general surgery units. The unadjusted NAR was significantly lower in paediatric surgery units (odds ratio (OR) 0·37, 95 per cent confidence interval 0·23 to 0·59; P < 0·001), and the difference persisted after adjusting for age, sex and use of preoperative ultrasound imaging (OR 0·34, 0·21 to 0·57; P < 0·001). Female sex and preoperative ultrasonography, but not age, were significantly associated with normal appendicectomy in general surgery units but not in paediatric surgery units in this adjusted model. The unadjusted 30-day adverse event rate was higher in paediatric surgery units than in general surgery units (OR 1·90, 1·18 to 3·06; P = 0·011). When adjusted for case mix and consultant presence at surgery, no statistically significant relationship between centre type and 30-day adverse event rate existed (OR 1·59, 0·93 to 2·73; P = 0·091). Conclusion The NAR in general surgery units was over twice that in paediatric surgery units. Despite a more severe case mix, paediatric surgery units had a similar 30-day adverse event rate to general surgery units. Service provision differs between paediatric and general surgery units.

Published
2014
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15. Profile of blood donors and reasons for deferral in coastal South India

Author

V Kaur, B Reshmi, S Ganti, Bhaskaran Unnikrishnan, R Prasad, P Aggarwal, Prabudh Goel, M Seetha, Amit Nautiyal, Nithin Kumar, P Kesharwani, Padma G. M. Rao, and A Amarnath

Subjects
medicine.medical_specialty, lcsh:R5-920, Blood transfusion, business.industry, Research, medicine.medical_treatment, South India, General Medicine, Donor deferral, Blood donors, medicine, transfusion transmitted infections, deferral, Deferral, Intensive care medicine, business, lcsh:Medicine (General)
Abstract

BackgroundA blood transfusion is a life-saving procedure in manyinstances. An adequate supply of safe blood is ensured byexercising donor deferral criteria and screening forTransfusion Transmitted Infections (TTI). The aim of thispaper is to study the profile of blood donors and reasons fordonor deferral in coastal South India.MethodThe study was conducted at a tertiary care hospital inMangalore. All those who donated between 1 January 2008and 31 December 2008 were included in the study. Datawas collected using a pre-tested semi-structured proformaand analysed using SPSS version 11.5.ResultsMost of the donors were under the age of 25 (42.92%).Donors were predominantly male (95.20%). In terms ofoccupation, most subjects were students (28.01%) followedby businessmen (18.61%). Slightly more than three-quartersof the donors (77.20%) were replacement donors. The mainreasons for deferral were consumption of medication in thepast 72 hours (15.15%), hypertension (13.18%), a lowhaemoglobin level (12.34%) and alcohol intake in the past72 hours (12.20%). Among the TTIs identified, most sampleswere positive for Hepatitis B surface Antigen – HBsAg(0.87%) or tested positive for Anti-Hepatitis C (HCVantibodies (0.36%).ConclusionFrom the study it was concluded that the majority of thedonor population was young and educated. The reason fordonation was mainly replacement rather than voluntary.This issue needs to be addressed by exercising proactivemeasures to increase the number of voluntary, nonremunerated,low-risk donors.

Published
2011

17. Structural Effects Through Nuclear Charge Radius in Mass Asymmetric Collisions

Author

Sangeeta and V. Kaur

Subjects
Physics, 030507 speech-language pathology & audiology, 03 medical and health sciences, Classical electron radius, Ionic potential, 0202 electrical engineering, electronic engineering, information engineering, General Physics and Astronomy, 020201 artificial intelligence & image processing, 02 engineering and technology, Radius, Atomic physics, 0305 other medical science, Effective nuclear charge
Published
2017
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19. Composite endpoints in trials of type-2 diabetes

Author

Thomas R. Einarson, V. Kaur, M. E. H. Hemels, and Madhur Garg

Subjects
medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Type 2 diabetes, Saxagliptin, Pharmacology, Linagliptin, law.invention, chemistry.chemical_compound, Endocrinology, Randomized controlled trial, Sodium-Glucose Transporter 2, law, Glucagon-Like Peptide 1, Internal medicine, Internal Medicine, medicine, Humans, Hypoglycemic Agents, Dapagliflozin, Sodium-Glucose Transporter 2 Inhibitors, Randomized Controlled Trials as Topic, Dipeptidyl-Peptidase IV Inhibitors, business.industry, medicine.disease, Clinical trial, chemistry, Diabetes Mellitus, Type 2, Sitagliptin, business, Exenatide, medicine.drug
Abstract

Composite endpoints (CEPs) are being used more frequently as outcomes for trials of drugs in type-2 diabetes. We reviewed the literature to determine how CEPs have been used to date in trials of drugs for type-2 diabetes. A systematic search was undertaken on Medline, Embase and Cochrane databases and Clinicaltrials.gov for randomized controlled trials of currently marketed agents including SGLT-2 inhibitors (dapagliflozin), GLP-1 agonists (exenatide, liraglutide) and DPP-4 inhibitors (linagliptin, saxagliptin, sitagliptin and vildagliptin). CEPs used were identified as well as numbers and percentages of patients achieving each. Thirty-six studies were identified that reported results on ≥1 CEP; 15 different CEPs were reported (7 with 2 components, 8 with 3 components). All CEPs addressed goals recommended by the American Diabetes Association (ADA). All included HbA1c

Published
2013

22. CMS physics technical design report, volume II: Physics performance

Author

Bayatian, G.L. Chatrchyan, S. Hmayakyan, G. Sirunyan, A.M. Adam, W. Bergauer, T. Dragicevic, M. Erö, J. Friedl, M. Fruehwirth, R. Ghete, V. Glaser, P. Hrubec, J. Jeitler, M. Krammer, M. Magrans, I. Mikulec, I. Mitaroff, W. Noebauer, T. Pernicka, M. Porth, P. Rohringer, H. Strauss, J. Taurok, A. Waltenberger, W. Walzel, G. Widl, E. Wulz, C.-E. Fedorov, A. Korzhik, M. Missevitch, O. Zuyeuski, R. Chekhovsky, V. Dvornikov, O. Emeliantchik, I. Litomin, A. Mossolov, V. Shumeiko, N. Solin, A. Stefanovitch, R. Suarez Gonzalez, J. Tikhonov, A. Petrov, V. D'Hondt, J. De Weirdt, S. Goorens, R. Heyninck, J. Lowette, S. Tavernier, S. Van Doninck, W. Van Lancker, L. Bouhali, O. Clerbaux, B. De Lentdecker, G. Dewulf, J.P. Mahmoud, T. Marage, P.E. Neukermans, L. Sundararajan, V. Vander Velde, C. Vanlaer, P. Wickens, J. Assouak, S. Bonnet, J.L. Bruno, G. Caudron, J. De Callatay, B. De Favereau De Jeneret, J. De Visscher, S. Delaere, C. Demin, P. Favart, D. Feltrin, E. Forton, E. Grégoire, G. Kalinin, S. Kcira, D. Keutgen, T. Leibenguth, G. Lemaitre, V. Liu, Y. Michotte, D. Militaru, O. Ninane, A. Ovyn, S. Pierzchala, T. Piotrzkowski, K. Roberfroid, V. Rouby, X. Teyssier, D. Van Der Aa, O. Vander Donckt, M. Daubie, E. Herquet, P. Mollet, A. Romeyer, A. Beaumont, W. Cardaci, M. De Langhe, E. De Wolf, E.A. Rurua, L. Souza, M.H.G. Oguri, V. Santoro, A. Sznajder, A. Vaz, M. Gregores, E.M. Novaes, S.F. Anguelov, T. Antchev, G. Atanasov, I. Damgov, J. Darmenov, N. Dimitrov, L. Genchev, V. Iaydjiev, P. Panev, B. Piperov, S. Stoykova, S. Sultanov, G. Vankov, I. Dimitrov, A. Kozhuharov, V. Litov, L. Makariev, M. Marinov, A. Marinova, E. Markov, S. Mateev, M. Pavlov, B. Petkov, P. Sabev, C. Stoynev, S. Toteva, Z. Verguilov, V. Chen, G.M. Chen, H.S. He, K.L. Jiang, C.H. Li, W.G. Liu, H.M. Meng, X. Shen, X.Y. Sun, H.S. Yang, M. Zhao, W.R. Zhuang, H.L. Ban, Y. Cai, J. Liu, S. Qian, S.J. Yang, Z.C. Ye, Y.L. Ying, J. Wu, J. Zhang, Z.P. Godinovic, N. Puljak, I. Soric, I. Antunovic, Z. Dzelalija, M. Marasovic, K. Brigljevic, V. Ferencek, D. Kadija, K. Morovic, S. Planinic, M. Nicolaou, C. Papadakis, A. Razis, P.A. Tsiakkouri, D. Hektor, A. Kadastik, M. Kannike, K. Lippmaa, E. Müntel, M. Raidal, M. Aarnio, P.A. Czellar, S. Haeggstroem, E. Heikkinen, A. Härkönen, J. Karimäki, V. Kinnunen, R. Lampén, T. Lassila-Perini, K. Lehti, S. Lindén, T. Luukka, P.R. Michal, S. Mäenpää, T. Nysten, J. Stettler, M. Tuominen, E. Tuominiemi, J. Wendland, L. Tuuva, T. Guillaud, J.P. Nedelec, P. Sillou, D. Anfreville, M. Beauceron, S. Bougamont, E. Bredy, P. Chipaux, R. Dejardin, M. Denegri, D. Descamps, J. Fabbro, B. Faure, J.L. Ganjour, S. Gentit, F.X. Givernaud, A. Gras, P. Hamel De Monchenault, G. Jarry, P. Kircher, F. Lemaire, M.C. Levesy, B. Locci, E. Lottin I Mandjavidze, J.P. Mur, M. Pasquetto, E. Payn, A. Rander, J. Reymond, J.M. Rondeaux, F. Rosowsky, A. Sun, Z.H. Verrecchia, P. Baffioni, S. Beaudette, F. Bercher, M. Berthon, U. Bimbot, S. Bourotte, J. Busson, P. Cerutti, M. Chamont, D. Charlot, C. Collard, C. Decotigny, D. Delmeire, E. Dobrzynski, L. Gaillac, A.M. Geerebaert, Y. Gilly, J. Haguenauer, M. Karar, A. Mathieu, A. Milleret, G. Miné, P. Paganini, P. Romanteau, T. Semeniouk, I. Sirois, Y. Berst, J.D. Brom, J.M. Didierjean, F. Drouhin, F. Fontaine, J.C. Goerlach, U. Graehling, P. Gross, L. Houchu, L. Juillot, P. Lounis, A. Maazouzi, C. Mangeol, D. Olivetto, C. Todorov, T. Van Hove, P. Vintache, D. Ageron, M. Agram, J.L. Baulieu, G. Bedjidian, M. Blaha, J. Bonnevaux, A. Boudoul, G. Chabanat, E. Combaret, C. Contardo, D. Della Negra, R. Depasse, P. Dupasquier, T. El Mamouni, H. Estre, N. Fay, J. Gascon, S. Giraud, N. Girerd, C. Haroutunian, R. Ianigro, J.C. Ille, B. Lethuillier, M. Lumb, N. Mathez, H. Maurelli, G. Mirabito, L. Perries, S. Ravat, O. Kvatadze, R. Roinishvili, V. Adolphi, R. Brauer, R. Braunschweig, W. Esser, H. Feld, L. Heister, A. Karpinski, W. Klein, K. Kukulies, C. Olzem, J. Ostapchuk, A. Pandoulas, D. Pierschel, G. Raupach, F. Schael, S. Schwering, G. Thomas, M. Weber, M. Wittmer, B. Wlochal, M. Adolf, A. Biallass, P. Bontenackels, M. Erdmann, M. Fesefeldt, H. Hebbeker, T. Hermann, S. Hilgers, G. Hoepfner, K. Hof, C. Kappler, S. Kirsch, M. Lanske, D. Philipps, B. Reithler, H. Rommerskirchen, T. Sowa, M. Szczesny, H. Tonutti, M. Tsigenov, O. Beissel, F. Davids, M. Duda, M. Flügge, G. Franke, T. Giffels, M. Hermanns, T. Heydhausen, D. Kasselmann, S. Kaussen, G. Kress, T. Linn, A. Nowack, A. Poettgens, M. Pooth, O. Stahl, A. Tornier, D. Weber, M. Flossdorf, A. Hegner, B. Mnich, J. Rosemann, C. Flucke, G. Holm, U. Klanner, R. Pein, U. Schirm, N. Schleper, P. Steinbrück, G. Stoye, M. Van Staa, R. Wick, K. Blüm, P. Buege, V. De Boer, W. Dirkes, G. Fahrer, M. Feindt, M. Felzmann, U. Fernandez Menendez, J. Frey, M. Furgeri, A. Hartmann, F. Heier, S. Jung, C. Ledermann, B. Müller, Th. Niegel, M. Oehler, A. Ortega Gomez, T. Piasecki, C. Quast, G. Rabbertz, K. Saout, C. Scheurer, A. Schieferdecker, D. Schmidt, A. Simonis, H.J. Theel, A. Vest, A. Weiler, T. Weiser, C. Weng, J. Zhukov, V. Karapostoli, G. Katsas, P. Kreuzer, P. Panagiotou, A. Papadimitropoulos, C. Anagnostou, G. Barone, M. Geralis, T. Kalfas, C. Koimas, A. Kyriakis, A. Kyriazopoulou, S. Loukas, D. Markou, A. Markou, C. Mavrommatis, C. Theofilatos, K. Vermisoglou, G. Zachariadou, A. Aslanoglou, X. Evangelou, I. Kokkas, P. Manthos, N. Papadopoulos, I. Sidiropoulos, G. Triantis, F.A. Bencze, G. Boldizsar, L. Hajdu, C. Horvath, D. Laszlo, A. Odor, G. Sikler, F. Toth, N. Vesztergombi, G. Zalan, P. Molnar, J. Beni, N. Kapusi, A. Marian, G. Raics, P. Szabo, Z. Szillasi, Z. Zilizi, G. Bawa, H.S. Beri, S.B. Bhandari, V. Bhatnagar, V. Kaur, M. Kaur, R. Kohli, J.M. Kumar, A. Singh, J.B. Bhardwaj, A. Bhattacharya, S. Chatterji, S. Chauhan, S. Choudhary, B.C. Gupta, P. Jha, M. Ranjan, K. Shivpuri, R.K. Srivastava, A.K. Borkar, S. Dixit, M. Ghodgaonkar, M. Kataria, S.K. Lalwani, S.K. Mishra, V. Mohanty, A.K. Topkar, A. Aziz, T. Banerjee, S. Bose, S. Cheere, N. Chendvankar, S. Deshpande, P.V. Guchait, M. Gurtu, A. Maity, M. Majumder, G. Mazumdar, K. Nayak, A. Patil, M.R. Sharma, S. Sudhakar, K. Tonwar, S.C. Acharya, B.S. Banerjee, S. Bheesette, S. Dugad, S. Kalmani, S.D. Lakkireddi, V.R. Mondal, N.K. Panyam, N. Verma, P. Arabgol, M. Arfaei, H. Hashemi, M. Mohammadi, M. Mohammadi Najafabadi, M. Moshaii, A. Paktinat Mehdiabadi, S. Grunewald, M. Abbrescia, M. Barbone, L. Colaleo, A. Creanza, D. De Filippis, N. De Palma, M. Donvito, G. Fiore, L. Giordano, D. Iaselli, G. Loddo, F. Maggi, G. Maggi, M. Manna, N. Marangelli, B. Mennea, M.S. My, S. Natali, S. Nuzzo, S. Pugliese, G. Radicci, V. Ranieri, A. Romano, F. Selvaggi, G. Silvestris, L. Tempesta, P. Trentadue, R. Zito, G. Abbiendi, G. Bacchi, W. Benvenuti, A. Bonacorsi, D. Braibant-Giacomelli, S. Capiluppi, P. Cavallo, F.R. Ciocca, C. Codispoti, G. D'Antone, I. Dallavalle, G.M. Fabbri, F. Fanfani, A. Giacomelli, P. Grandi, C. Guerzoni, M. Guiducci, L. Marcellini, S. Masetti, G. Montanari, A. Navarria, F. Odorici, F. Perrotta, A. Rossi, A. Rovelli, T. Siroli, G. Travaglini, R. Albergo, S. Chiorboli, M. Costa, S. Galanti, M. Gatto Rotondo, G. Noto, F. Potenza, R. Russo, G. Tricomi, A. Tuve, C. Bocci, A. Ciraolo, G. Ciulli, V. Civinini, C. D'Alessandro, R. Focardi, E. Genta, C. Lenzi, P. Macchiolo, A. Magini, N. Manolescu, F. Marchettini, C. Masetti, L. Mersi, S. Meschini, M. Paoletti, S. Parrini, G. Ranieri, R. Sani, M. Fabbricatore, P. Farinon, S. Greco, M. Cattaneo, G. De Min, A. Dominoni, M. Farina, F.M. Ferri, F. Ghezzi, A. Govoni, P. Leporini, R. Magni, S. Malberti, M. Malvezzi, S. Marelli, S. Menasce, D. Moroni, L. Negri, P. Paganoni, M. Pedrini, D. Pullia, A. Ragazzi, S. Redaelli, N. Rovelli, C. Rovere, M. Sala, L. Sala, S. Salerno, R. Tabarelli De Fatis, T. Vigano', S. Comunale, G. Fabozzi, F. Lomidze, D. Mele, S. Paolucci, P. Piccolo, D. Polese, G. Sciacca, C. Azzi, P. Bacchetta, N. Bellato, M. Benettoni, M. Bisello, D. Borsato, E. Candelori, A. Checchia, P. Conti, E. De Mattia, M. Dorigo, T. Drollinger, V. Fanzago, F. Gasparini, F. Gasparini, U. Giarin, M. Giubilato, P. Gonella, F. Kaminskiy, A. Karaevskii, S. Khomenkov, V. Lacaprara, S. Lippi, I. Loreti, M. Lytovchenko, O. Mazzucato, M. Meneguzzo, A.T. Michelotto, M. Montecassiano, F. Nigro, M. Passaseo, M. Pegoraro, M. Rampazzo, G. Ronchese, P. Torassa, E. Ventura, S. Zanetti, M. Zotto, P. Zumerle, G. Belli, G. Berzano, U. De Vecchi, C. Guida, R. Necchi, M.M. Ratti, S.P. Riccardi, C. Sani, G. Torre, P. Vitulo, P. Ambroglini, F. Babucci, E. Benedetti, D. Biasini, M. Bilei, G.M. Caponeri, B. Checcucci, B. Fanò, L. Lariccia, P. Mantovani, G. Passeri, D. Pioppi, M. Placidi, P. Postolache, V. Ricci, D. Santocchia, A. Servoli, L. Spiga, D. Azzurri, P. Bagliesi, G. Basti, A. Benucci, L. Bernardini, J. Boccali, T. Borrello, L. Bosi, F. Calzolari, F. Castaldi, R. Cerri, C. Cucoanes, A.S. D'Alfonso, M. Dell'Orso, R. Dutta, S. Foà, L. Gennai, S. Giammanco, A. Giassi, A. 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Wang, S. Anderson, E.W. Atramentov, O. Hauptman, J.M. Lamsa, J. Barnett, B.A. Blumenfeld, B. Chien, C.Y. Kim, D.W. Maksimovic, P. Spangler, S. Swartz, M. Baringer, P. Bean, A. Coppage, D. Grachov, O. Kim, E.J. Murray, M. Bandurin, D. Bolton, T. Khanov, A. Maravin, Y. Onoprienko, D. Rizatdinova, F. Sidwell, R. Stanton, N. Von Toerne, E. Baden, D. Bard, R. Eno, S.C. Grassi, T. Hadley, N.J. Kellogg, R.G. Kunori, S. Ratnikov, F. Skuja, A. Arcidiacono, R. Ballintijn, M. Bauer, G. Harris, P. Kravchenko, I. Loizides, C. Nahn, S. Paus, C. Pavlon, S. Roland, C. Roland, G. Sumorok, K. Vaurynovich, S. Veres, G. Wyslouch, B. Bailleux, D. Corum, S. Cushman, P. De Benedetti, A. Dolgopolov, A. Egeland, R. Franzoni, G. Gilbert, W.J. Grahl, J. Haupt, J. Kubota, Y. Mans, J. Pearson, N. Rusack, R. Singovsky, A. Cremaldi, L.M. Godang, R. Kroeger, R. Sanders, D.A. Summers, D. Bloom, K. Claes, D.R. Dominguez, A. Eads, M. Lundstedt, C. Malik, S. Snow, G.R. Sobol, A. Iashvili, I. Kharchilava, A. Alverson, G. Barberis, E. Boeriu, O. Eulisse, G. Musienko, Y. Muzaffar, S. Osborne, I. Reucroft, S. Swain, J. Taylor, L. Tuura, L. Wood, D. Gobbi, B. Kubantsev, M. Schellman, H. Schmitt, M. Spencer, E. Velasco, M. Baumbaugh, B. Cason, N.M. Hildreth, M. Karmgard, D.J. Marinelli, N. Ruchti, R. Warchol, J. Wayne, M. Bylsma, B. Durkin, L.S. Gilmore, J. Gu, J. Herman, D. Killewald, P. Knobbe, K. Ling, T.Y. Elmer, P. Marlow, D. Piroué, P. Stickland, D. Tully, C. Wildish, T. Wynhoff, S. Xie, Z. Apresyan, A. Arndt, K. Banicz, K. Barnes, V.E. Bolla, G. Bortoletto, D. Bujak, A. Garfinkel, A.F. Gonzalez Lopez, O. Gutay, L. Ippolito, N. Kozhevnikov, Y. Laasanen, A.T. Liu, C. Maroussov, V. Merkel, P. Miller, D.H. Miyamoto, J. Neumeister, N. Rott, C. Roy, A. Sedov, A. Shipsey, I. Parashar, N. Eppley, G. Lee, S.J. Liu, J. Matveev, M. Nussbaum, T. Padley, B.P. Roberts, J. Tumanov, A. Yepes, P. Bodek, A. Budd, H. Chung, Y.S. De Barbaro, P. Demina, R. Eusebi, R. Ginther, G. Gotra, Y. Hocker, A. Husemann, U. Korjenevski, S. Sakumoto, W. Slattery, P. Tipton, P. Zielinski, M. Bartz, E. Doroshenko, J. Halkiadakis, E. Jacques, P.F. Kalelkar, M.S. Khits, D. Lath, A. Macpherson, A. Perera, L. Plano, R. Rose, K. Schnetzer, S. Somalwar, S. Stone, R. Thomson, G. Watts, T.L. Akchurin, N. Carrell, K.W. Gumus, K. Jeong, C. Kim, H. Papadimitriou, V. Sill, A. Spezziga, M. Washington, E. Wigmans, R. Zhang, L. Bapty, T. Engh, D. Johns, W. Keskinpala, T. Luiggi Lopez, E. Neema, S. Nordstrom, S. Pathak, S. Sheldon, P. Vaandering, E.W. Webster, M. Arenton, M.W. Conetti, S. Cox, B. Hirosky, R. Imlay, R. Ledovskoy, A. Phillips Ii, D. Powell, H. Ronquest, M. Smith, D. Baek, Y.W. Bellinger, J.N. Bradley, D. Carlsmith, D. Crotty, I. Dasu, S. Feyzi, F. Gorski, T. Grothe, M. Hogg, W. Jaworski, M. Klabbers, P. Lanaro, A. Loveless, R. De Magrans Abril, M. Reeder, D. Smith, W.H. Wenman, D. Atoyan, G.S. Dhawan, S. Issakov, V. Neal, H. Poblaguev, A. Zeller, M.E. Yuldashev, B.S.

Subjects
High Energy Physics::Phenomenology, High Energy Physics::Experiment
Abstract

CMS is a general purpose experiment, designed to study the physics of pp collisions at 14 TeV at the Large Hadron Collider (LHC). It currently involves more than 2000 physicists from more than 150 institutes and 37 countries. The LHC will provide extraordinary opportunities for particle physics based on its unprecedented collision energy and luminosity when it begins operation in 2007. The principal aim of this report is to present the strategy of CMS to explore the rich physics programme offered by the LHC. This volume demonstrates the physics capability of the CMS experiment. The prime goals of CMS are to explore physics at the TeV scale and to study the mechanism of electroweak symmetry breaking - through the discovery of the Higgs particle or otherwise. To carry out this task, CMS must be prepared to search for new particles, such as the Higgs boson or supersymmetric partners of the Standard Model particles, from the start-up of the LHC since new physics at the TeV scale may manifest itself with modest data samples of the order of a few fb-1 or less. The analysis tools that have been developed are applied to study in great detail and with all the methodology of performing an analysis on CMS data specific benchmark processes upon which to gauge the performance of CMS. These processes cover several Higgs boson decay channels, the production and decay of new particles such as Z′ and supersymmetric particles, Bs production and processes in heavy ion collisions. The simulation of these benchmark processes includes subtle effects such as possible detector miscalibration and misalignment. Besides these benchmark processes, the physics reach of CMS is studied for a large number of signatures arising in the Standard Model and also in theories beyond the Standard Model for integrated luminosities ranging from 1 fb-1 to 30 fb-1. The Standard Model processes include QCD, B-physics, diffraction, detailed studies of the top quark properties, and electroweak physics topics such as the W and Z0 boson properties. The production and decay of the Higgs particle is studied for many observable decays, and the precision with which the Higgs boson properties can be derived is determined. About ten different supersymmetry benchmark points are analysed using full simulation. The CMS discovery reach is evaluated in the SUSY parameter space covering a large variety of decay signatures. Furthermore, the discovery reach for a plethora of alternative models for new physics is explored, notably extra dimensions, new vector boson high mass states, little Higgs models, technicolour and others. Methods to discriminate between models have been investigated. This report is organized as follows. Chapter 1, the Introduction, describes the context of this document. Chapters 2-6 describe examples of full analyses, with photons, electrons, muons, jets, missing E T, B-mesons and τ's, and for quarkonia in heavy ion collisions. Chapters 7-15 describe the physics reach for Standard Model processes, Higgs discovery and searches for new physics beyond the Standard Model. © 2007 IOP Publishing Ltd.

Published
2007

23. Outpatient parenteral antibiotic therapy in Singapore

Author

Asok Kurup, Dale Fisher, David C. Lye, Zuraidah Sulaiman, Poh Lian Lim, Winnie Lee, V. Kaur, E.Y.H. Poon, and Paul A. Tambyah

Subjects
Microbiology (medical), Adult, Male, medicine.medical_specialty, Staphylococcus aureus, Adolescent, Vancomycin, Outpatients, Ambulatory Care, Medicine, Humans, Pharmacology (medical), Infusions, Parenteral, Dosing, Intensive care medicine, Home Infusion Therapy, Antibacterial agent, Aged, Aged, 80 and over, Singapore, business.industry, Parenteral antibiotic, General Medicine, Middle Aged, Staphylococcal Infections, Anti-Bacterial Agents, Outreach, Infectious Diseases, Ambulatory, Female, Methicillin Resistance, business, medicine.drug
Abstract

Outpatient parenteral antibiotic therapy (OPAT) remains in its infancy in Singapore, with the first patients enrolled 4 years ago. Singapore's three largest hospitals, with over 3000 inpatient beds, now have designated and approved OPAT services. This study reviews the demographic, clinical and cost data of all patients enrolled in 2005 to facilitate benchmarking between services in Singapore and abroad and also to identify common needs for further development. In 2005, 225 OPAT enrollments in 208 different patients resulted in 4050 days of OPAT care. Orthopaedic diagnoses constituted 40% of admissions. Vancomycin was the most frequently used antibiotic (34%). The re-admission rate was 8.9%, but complications of OPAT care were only occasionally implicated. An estimated $207,200 was saved by patients despite there being significant financial disincentives to subsidised patients. OPAT is a safe, cost-efficient system that is becoming increasingly accepted in Singapore by patients, clinicians and management. Our three services have evolved independently into very similar practices. There is potential for further innovation, including outreach and carer-delivered dosing. However, major financial disincentives require review.

Published
2006

24. 29 * ACE IMPACT: EVALUATION OF AN INTEGRATED GERIATRIC SERVICE

Author

V. Kaur, C. Lowrey, N. Hashemi, C. Bell, and F. Wieland

Subjects
Geriatrics, Service (business), Aging, medicine.medical_specialty, business.industry, Impact evaluation, General Medicine, medicine.disease, Patient room, Acute care, Hospital admission, Emergency medicine, medicine, Frail elderly, Diagnosis code, Medical emergency, Geriatrics and Gerontology, business
Published
2014
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25. Puerperal psychosis--analysis of 35 cases

Author

T, Singh and V, Kaur

Subjects
Adult, Psychotic Disorders, Risk Factors, Humans, Female, Puerperal Disorders, Stress, Psychological, Retrospective Studies
Abstract

Thirty-five patients admitted with psychosis either immediately or within six months of delivery were analysed for various risk factors. Primiparity, previous psychiatric history, antenatal complications, caesarean section, perinatal death and female baby were all associated with an increased risk of psychiatric admission, suggesting that psychological stresses do contribute to high psychiatric morbidity in puerperium. Women with history of affective disorder had a much higher risk of psychiatric admissions in the puerperium than those with history of schizophrenia or depressive neurosis.

Published
2000

26. A search for the evidence supporting community paediatric practice

Author

Mary C J Rudolf, A Kelly, S Bosson, M Garner, R Thazin, P Guest, N Lyth, A Bundle, T Bennett, D Damman, M Khan, V Cove, V Kaur, and G Rowland

Subjects
medicine.medical_specialty, Pediatrics, media_common.quotation_subject, Child Health Services, Health Promotion, Child health, law.invention, Promotion (rank), Randomized controlled trial, law, Good evidence, medicine, Humans, Medical prescription, Child, Referral and Consultation, media_common, Quality of Health Care, Randomized Controlled Trials as Topic, Evidence-Based Medicine, business.industry, Evidence-based medicine, Original Articles, United Kingdom, Health promotion, Multicenter study, Family medicine, Pediatrics, Perinatology and Child Health, business
Abstract

AIM Controversy exists regarding the evidence base of medicine. Estimates range from 20% to 80% in various specialties, but there have been no studies in paediatrics. The aim of this study was to ascertain the evidence base for community paediatrics. METHODS Twelve community paediatricians working in clinics and schools in Yorkshire, Manchester, Teesside, and Cheshire carried out a prospective review of consecutive clinical contacts. Evidence for diagnostic processes, prescribing, referrals, counselling/advice, and child health promotion was found by searching electronic databases. This information was critically appraised and a consensus was obtained regarding quality and whether it supported actions taken. RESULTS Two hundred and forty seven consultations and 1149 clinical actions were performed. Good evidence was found from a randomised controlled trial or other appropriate study for 39.9% of the 629 actions studied; convincing non-experimental evidence for 7%; inconclusive evidence for 25.4%; evidence of ineffectiveness for 0.2%; and no evidence for 27.5%. Prescribing and child health promotion activities had the highest levels of quality evidence, and counselling/advice had the lowest. CONCLUSIONS An encouraging amount of evidence was found to support much of community paediatric practice. This study improved on previous research in other specialties because actions other than medications and surgery were included.

Published
1999

27. The eSTEP™ Website: A Good Model for Online Surgical Training?

Author

EM Harrison and V Kaur

Subjects
Online discussion, Medical education, Direct debit, business.industry, Distance education, General Medicine, Minor (academic), Data science, Knowledge acquisition, Basic skills, Resource (project management), Medicine, Surgery, business, Multiple choice
Abstract

eSTEPTM: http://www.rcseng.ac.uk/education/estep/home_html BeST online: https://www.intumed.com/ Online learning is not a new concept and this is certainly true in surgery. With online textbooks, basic skills videos and interactive tutorials, the World Wide Web should be the surgical trainees’ oyster. Yet few of these resources are comprehensive enough or of sufficient quality to be the ideal surgical training tool. Perhaps recognising this deficit, The Royal College of Surgeons of England (RCSE) launched eSTEPTM in 2001 – a comprehensive online learning resource aimed at surgical trainees. eSTEPTM complements the printed modules in the Surgeons in Training Education Programme (STEPTM), a distance learning programme introduced in 1994. STEPTM is firmly aimed at the surgical trainee working towards the MRCS examinations. A wide breadth of information is presented on the eSTEPTM website including case discussions, anatomy teaching videos, GMED Limited’s ‘Multimedia Course in Minor Surgery’, self-test questions and discussion boards – much of what the surgical trainee is seeking online. The website is quick, convenient to access and easy-to-navigate, if a little bland. The study modules are divided into 12 components reflecting the STEPTM printed modules – six core modules covering areas common to all branches of surgery and six system-specific modules – with each containing a variable number of case studies and multiple choice questions. The case studies are well written and are illustrated using realistic examples from every-day practise. A large compilation of clinical cases is supplemented on a weekly basis and explores the study modules in depth. Trainees are encouraged to participate in online discussion – commenting, answering questions and clarifying areas of uncertainty – facilitated by an online moderator. Thought-provoking exchanges result, promoting self-directed learning rather than the classical ‘spoon-feeding’ mode of knowledge acquisition. Some cases are supplemented with convenient anatomical videos – useful given the limited anatomy teaching resources available to postgraduate trainees. The minor surgery course uses images, videos and animation to prepare the surgical trainee embarking on their first minor operations list. A large bank of multiple choice and extended matching questions are of good quality and are written in a format similar to the MRCS examination making them suitable for exam preparation. So far, eSTEPTM sounds like the answer to a surgical trainee’s prayer – a high-quality learning resource aimed at supporting the trainee through their early surgical training years and their MRCS examinations – what more could a trainee ask for? If so, why are all trainees not subscribing to STEPTM so they can make use of the eSTEPTM website? One potential reason is financial – £1370 (or £1420 via direct debit) for a 24-month subscription will seem pretty hefty to the average junior surgical trainee. Subscription is limited to one option (24 months) which some will find restrictive. Many may only wish to use certain aspects of the website, while some will complete the MRCS examinations in less than 24 months – more flexible subscription periods would certainly be attractive. It is important to bear in mind that subscription includes the 12 STEPTM printed modules, 24-months’ access to the eSTEPTM website, 24-months’ subscription to the Surgery journal, discounts on books and RCSE courses, access to a College Day which includes an introduction to eSTEPTM, an overview of the Intercollegiate doi 10.1308/003588408X301190

Published
2008
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28. Bayesian Network Meta-Analysis to Assess the Relative Efficacy and Safety of Canagliflozin in Patients with Type 2 Diabetes Mellitus (T2DM) Inadequately Controlled on Metformin and Sulphonylurea (MET+SU)

Author

M Pacou, S. van Sanden, V. Kaur, M. Hemels, AT Nielsen, M. Schroeder, C. Neslusan, S. Nuhoho, Madhur Garg, K.R. Abrams, Joris Diels, and Vanessa Taieb

Subjects
Canagliflozin, medicine.medical_specialty, Relative efficacy, business.industry, Health Policy, Public Health, Environmental and Occupational Health, Bayesian network, Type 2 Diabetes Mellitus, Metformin, Endocrinology, Meta-analysis, Internal medicine, medicine, In patient, business, medicine.drug
Published
2013
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29. Bayesian Network Meta-Analysis to Assess Relative Efficacy and Safety of Canagliflozin in Patients with Type 2 Diabetes Mellitus (T2DM) Inadequately Controlled with Metformin

Author

M Pacou, Vanessa Taieb, S. van Sanden, C. Neslusan, Madhur Garg, M. Hemels, M. Schroeder, K.R. Abrams, AT Nielsen, Joris Diels, V. Kaur, and S. Nuhoho

Subjects
musculoskeletal diseases, Canagliflozin, medicine.medical_specialty, Relative efficacy, business.industry, Health Policy, Public Health, Environmental and Occupational Health, Bayesian network, Type 2 Diabetes Mellitus, Metformin, Internal medicine, Meta-analysis, medicine, In patient, skin and connective tissue diseases, business, medicine.drug
Published
2013
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30. Prevalence of tuberculosis in Kishtwar Tehsil of Jammu region in Jammu and Kashmir State

Author

P, Malhotra, A, Abrol, V, Kaur, S, Dhar, A, Singh, S, Kaul, and R K, Raina

Subjects
Adult, Male, Adolescent, India, Anemia, Middle Aged, Age Distribution, Risk Factors, Population Surveillance, Prevalence, Humans, Tuberculosis, Female, Child, Aged
Abstract

A study of prevalence of tuberculosis in Kishtwar tehsil of Jammu region was conducted from June 1991 to May 1992. A total of one thousand two hundred ninety-eight rural as well as urban population suffering from various types of lung diseases was studied for prevalence of tuberculosis and a sizeable number (98) of patients were found to be positive of various types of tuberculosis, viz, pulmonary tuberculosis, tuberculous pleural effusion and miliary tuberculosis. Of the population studied 7.55% were found to be positive for tuberculosis and among them 88.76% patients were anaemic and the commonest type of anaemia was normocytic normochromic and normocytic hypochromic. The ESR was raised in almost of all the patients. Of the population, 80.61% were seen to be positive on skiagram chest and 58.16% were found to be positive on other diagnostic tests like Mantoux's tests, sputum for acid-fast bacilli, etc. Mantoux's test was positive in 27.55% cases and sputum was positive in 30.61% cases. All the cases studied were subjected to special investigations. The changes in parameters are consistent with the diagnosis of tuberculosis. Large family size, poverty, excessive smoking, illiteracy, etc, are the major contributing factors.

Published
1996

31. Probing the Effect of Different Cross Sections in Asymmetric Systems

Author

D. Kaur, V. Kaur, and S. Kumar

Subjects
Nuclear Theory, General Physics and Astronomy, Nuclear Experiment
Abstract

We present a complete systematic theoretical study of the multifragmentation for asymmetric colliding nuclei in heavy-ion reactions in the energy range between 50 and 1000 MeV/nucleon by using the isospin-dependent quantum molecular dynamics (IQMD) model. We have observed an interesting outcome for asymmetric colliding nuclei. The comparison between the symmetric and asymmetric colliding nuclei for the isospin-independent and isospin-dependent cross sections has been performed. We have found the pronounced effect of different cross sections and mass asymmetry on the nuclear reaction dynamics.

Published
2012
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32. Sexual and treatment behaviour of STD patients

Author

V, Kaur, P, Kaur, and S, Singh

Subjects
Behavior, Asia, Sexual Behavior, Sexually Transmitted Diseases, India, Disease, Therapeutics, Infections, Developing Countries
Abstract

Many individuals infected with STDs have their infections/diseases misdiagnosed and mistreated by people who are not qualified to practice medicine. This paper looks at HIV infection and treatment behavior in India. All STD patients attending the private clinic of a senior dermatologist and venereologist in Varanasi during a 6-month period were interviewed. There were 54 men and 6 women of mean age 27.5 years in the range of 18-52. 40 of the men were younger than age 30 years, while most patients had contracted infection from prostitutes. A fair number of more casual contacts were also reported. Infections among males came from known prostitutes in 22 cases, girlfriends in 13, relatives in 10, and a neighbor in 9. 69% of the men were married, with 40.6% of these men living with their wives at the time of exposure. Viral STDs such as herpes genitalis were common. 20 of the men consulted a qualified venereologist after the first exposure to infection. Indigenous "gupt rog" specialists in sexual medicine attracted the second largest number of patients after first exposure. On subsequent visit, however, none of the men returned to a gupt rog specialist. Good compliance as in the case of primary syphilis, gonorrhea, and non-gonococcal urethritis was probably due to good symptomatic response. Poor compliance in the case of herpes genitalis was probably the result of recurrence and inconvenient treatment regimens.

Published
1992

33. Should the Age of Breast Cancer Screening for Ethnic Minorities Be Reduced?

Author

N. Abbott, G. Lawrence, Soni Soumian, V. Kaur, H. Winter, O. Kearins, L. Whisker, T. Sircar, and J. Skillman

Subjects
Gerontology, Cancer Research, education.field_of_study, medicine.diagnostic_test, business.industry, Population, Ethnic group, Cancer, Disease, medicine.disease, Breast cancer screening, Breast cancer, Oncology, Relative risk, medicine, Stage (cooking), education, business, Demography
Abstract

IntroductionThe National Health Service Breast Screening Programme (NHSBSP) offers breast screening every three years for all women aged 50 and over in the United Kingdom (UK). Women aged between 50 and 70 are routinely invited. The NHSBSP will extend the age range of women invited for breast screening from ages 47 to 73 in the future. However, the ideal age for screening should take into consideration the relative risk of the population. The UK has a significant population of ethnic minority groups, mainly Asian and Afro-Caribbean, comprising of about 8% of the total population. The ethnic minority groups have remained geographically concentrated in specific regions especially London and West Midlands, where they comprise 30% and 14% of the population respectively. It has been reported that ethnic minorities present with relatively advanced breast cancer at a younger age. These groups could potentially benefit from early screening. We wanted to test this hypothesis by assessing the age and route of presentation of breast cancer across ethnic groups in the West Midlands region.MethodsThe West Midlands Cancer Intelligence Unit (WMCIU), a population based registry, collects prospective data on breast cancer diagnosed and treated in this region. Data on patients treated for breast cancer from 2001 to 2007 was obtained from the WMCIU. The age and route of presentation (screening or symptomatic) of Asian, Afro-Caribbean and Caucasian patients were analysed and compared.Results.A total of 27,444 female patients were diagnosed during this period. Data regarding ethnicity was available for 18,941 Caucasians, 528 Asians and 274 Afro-Caribbean's. Diagnosis through screening was 37%, 26% and 29% for Asian, Afro-Caribbean and the Caucasian population respectively. In the symptomatic group, 26.5% of Asians and 35% of Afro-Caribbeans presented below the age of 47 years compared to 13% of the Caucasian population. Furthermore, 13.5% of Asians, 16.5%of Afro-Caribbeans and 5.9% of Caucasians presented at or below the age of 40 years.ConclusionA significant percentage of breast cancers diagnosed within ethnic groups will still be missed despite revising the screening age to 47 years. Unless the participation of ethnic groups in screening is targeted, the benefits (detecting disease at an earlier stage and potentially reduced mortality) will be lost. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4008.

Published
2009
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38. Photosensitizing CNTs by organotin(IV) compounds: generation of reactive oxygen species and degradation of amoxicillin.

Author

Thakur S, Rohilla J, Sharma S, Singh R, Kamboj R, and Kaur V

Abstract

This work is based on probing photosensitization in carbon nanotubes (CNTs) by organotin(IV) compounds to fabricate a hybrid material with excellent photocatalytic activity and generation of reactive oxygen species. Two organotin(IV) compounds (compounds 1 and 2) were synthesized and characterized by spectroscopic and spectrometric studies, elemental analysis and single crystal X-ray diffraction followed by their impregnation inside the CNTs. The so obtained hybrid materials (1@CNT and 2@CNT) were characterized by FTIR, TGA, FE-SEM, HR-TEM, PXRD and XPS analysis, and assessed for photosensitization and generation of reactive oxygen species. The enhanced photocatalytic activity of the fabricated materials in comparison to bare CNTs is attributed to the reduction of band gap and suppression of rapid recombination rates due to the encapsulation of photogenerated electrons. The generation of reactive species in photocatalyst 1@CNT was validated by the degradation of Amoxicillin (AMX) under optimized conditions for catalytic dosage, H 2 O 2 concentration, response time and pH. The material 1@CNT could degrade ca. 83% of AMX by generating free radicals (˙OH and ˙O 2 - ) under visible light irradiation at pH 6 as investigated by UV-visible spectroscopy and supported by EPR and DFT studies. Furthermore, the structural stability and sustained photocatalytic properties of 1@CNT over four cycles highlight its potential as an eco-friendly solution for degrading environmental toxins.

Published
2024
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39. A conjugated oligoelectrolyte for the recognition of uranyl ion in aqueous and soil samples via RGB method.

Author

Thakur L, Garg L, Mohiuddin I, Singh R, Kaur V, and Thakur N

Abstract

The development of selective and practically applicable sensors for monitoring trace uranyl ions (UO 2 2+ ) in an aqueous medium is the biggest challenge. This study presents the development of a conjugated oligoelectrolyte-based probe (COE) for the selective detection of UO 2 2+ ions in water bodies. The COE is a water-soluble probe having an organic backbone with two ionic pendants at the terminal points. It changes its color to a dark yellow selectively in the presence of UO 2 2+ ions. This visible change was integrated with a smartphone RGB color quantification method. The COE displayed an RGB chemo-dosimeter to selectively monitor UO 2 2+ ions without interference from other metal ions. In the parallel experiment, COE displays a spectrofluorimetric emission signal at λ ems.  = 525 nm (with λ exc.  = 420 nm), which exhibits quenching of signal when interacted with UO 2 2+ ions. The limit of detection (LOD) is found to be 3.07 × 10 -2 µM and 4.50 µM by spectrofluorimetric and RGB color value methods, respectively. 1 H NMR and XPS analysis investigated the mode of interaction, and it suggested that the quenching of the emission signal was due to the interaction between the electron-rich azomethine site of COE and UO 2 2+ ion. The smartphone-based RGB color analysis makes COE a potential probe with reduced operation time and offers a fresh approach for the immediate, real-time detection of UO 2 2+ ions in aqueous and soil samples., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Published
2024
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40. Ectopic acromegaly with tumoral range hyperprolactinemia and apoplexy with a dramatic regression of pituitary hyperplasia.

Author

Gupta A, Kasaliwal R, Das L, Sharma SK, Kaur V, Vasiljevic A, Raverot V, Korbonits M, and Dutta P

Subjects
Humans, Female, Adult, Pituitary Gland pathology, Pituitary Gland diagnostic imaging, Pituitary Gland metabolism, Growth Hormone-Releasing Hormone metabolism, Pituitary Neoplasms complications, Pituitary Neoplasms pathology, Acromegaly complications, Hyperprolactinemia complications, Hyperprolactinemia etiology, Hyperplasia complications, Hyperplasia pathology, Pituitary Apoplexy complications
Abstract

Acromegaly due to ectopic secretion of growth hormone-releasing hormone (GHRH) is a rare disorder. The signs and symptoms of ectopic acromegaly are indistinguishable from acromegaly due to a somatotroph adenoma. A 35-year-old female presented with secondary amenorrhea for 10 years, intermittent headache, and reduced vision in both eyes for 4 years, which worsened over 4 months before presentation. Additionally, she was diagnosed with uncontrolled diabetes mellitus. On examination, she had coarse facial features, a fleshy nose, and acral enlargement. She had diminished visual acuity (left>right) and bitemporal hemianopia on perimetry. Biochemical investigations revealed elevated IGF-1 [588 ng/ml, reference range (RR) 100-242], markedly elevated basal growth hormone (>80 ng/ml; RR, 0.12-9.88), and hyperprolactinemia in the tumoral range (832 ng/ml; RR, 5-25). MRI sella demonstrated a 22×30×34mm sellar-suprasellar mass with T2 hypointensity. Chest imaging revealed a 75×87×106mm left lung mass, which was found to be a well-differentiated neuroendocrine tumor (NET) on biopsy. Plasma GHRH levels were elevated [38,088 ng/l; RR, <250-300], and a diagnosis of ectopic acromegaly secondary to lung neuroendocrine tumor was considered. During workup, the patient developed in-hospital pituitary apoplexy, which improved with medical management. After a left pneumonectomy, her clinical features of acromegaly improved, her diabetes underwent remission, and there was a marked reduction in plasma GHRH and pituitary size. Histopathology was suggestive of a neuroendocrine tumor, with immunohistochemistry positive for GHRH and negative for prolactin. Her final diagnosis was ectopic acromegaly due to GHRH secreting a lung NET with pituitary somatotroph and lactotroph pituitary hyperplasia and apoplexy in the hyperplastic pituitary., 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 © 2024 Gupta, Kasaliwal, Das, Sharma, Kaur, Vasiljevic, Raverot, Korbonits and Dutta.)

Published
2024
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41. STRN-ALK Fusion in Advanced Salivary Gland Carcinoma With Response to Anaplastic Lymphoma Kinase Inhibition: Case Report and Literature Review.

Author

Kaur V and Zadeh S

Subjects
Humans, Male, Protein Kinase Inhibitors therapeutic use, Adenocarcinoma drug therapy, Adenocarcinoma genetics, Adenocarcinoma pathology, Middle Aged, Female, Calmodulin-Binding Proteins, Membrane Proteins, Nerve Tissue Proteins, Salivary Gland Neoplasms drug therapy, Salivary Gland Neoplasms genetics, Salivary Gland Neoplasms pathology, Anaplastic Lymphoma Kinase genetics, Anaplastic Lymphoma Kinase antagonists & inhibitors
Abstract

Salivary gland carcinomas are a heterogeneous group of rare tumors. There is no established standard of care therapy for metastatic disease. We describe the case of a patient with metastatic salivary gland adenocarcinoma harboring STRN-ALK translocation, with tumor response and clinical benefit from anaplastic lymphoma kinase ( ALK ) inhibition. Our patient experienced clinical benefit from first and second generation ALK inhibition in a chemotherapy refractory tumor. Tumor mutation profiling can identify mutations that may render tumors sensitive to targeted therapy with tyrosine kinase inhibitors., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Published
2024

42. Utilization of 16Sr RNA and secA genes for molecular discernment of ' Candidatus Phytoplasma australasiaticum' strain associated with linseed germplasm in India.

Author

Yadav SK, Singh D, Prasad L, Jat B, Rao GP, Saharan MS, and Kaur V

Abstract

The growing prevalence of phytoplasma associated symptoms on linseed or flax ( Linum usitatissimum L.) germplasm at Indian Council of Agricultural Research- National Bureau of Plant Genetic Resources (ICAR-NBPGR) fields was noticed during the 2019-22 growing seasons. The characteristic phytoplasma symptoms of phyllody, stem fasciation, stunting, along with floral and capsule malformations were observed in 41 linseed accessions grown at experimental fields of ICAR-NBPGR, Delhi. During 3 years, the presence of phytoplasma in symptomatic linseed accessions was confirmed by nested-PCR assays utilizing 16S rRNA and secA gene-specific primers. The 16S rRNA and secA gene sequences of linseed phytoplasma strains from the representative symptomatic 41 linseed accessions exhibited 100% sequence identity among themselves and 99.93% and 99.82% sequence homology with reference strain, ' Candidatus Phytoplasma australasiaticum' (GenBank Accession: Y10097). Phylogenetic analysis of 16S rRNA and secA gene sequences clustered the linseed isolates with the peanut witches' broom group belonging to ' Ca . P. australasiaticum' strains. The virtual RFLP analysis of 16S rRNA F2nR2 fragment (~1.2 kb) of linseed phytoplasma strains further classified it into 16Sr group II, subgroup D. Our results suggested confirmation of the association of ' Ca . P. australasiaticum' strain (16SrII-D) in the linseed germplasm accessions from North India, which is the first report from India. The phytoplasma infection also reduced the growth and yield parameters of two linseed accessions (IC0498748 and EC0718851)., Competing Interests: Conflict of interestThe author(s) declare no conflict of interest., (© King Abdulaziz City for Science and Technology 2024. 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.)

Published
2024
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43. Leveraging genetic resource diversity and identification of trait-enriched superior genotypes for accelerated improvement in linseed (Linum usitatissimum L.).

Author

Kaur V, Gomashe SS, Yadav SK, Singh D, Sheela, Chauhan SS, Kumar V, Jat B, Tayade NR, Langyan S, Kaushik N, Singh M, Kheralia M, Wankhede DP, Aravind J, Srivastava V, Gupta K, Kumar A, and Singh GP

Subjects
Seeds genetics, Seeds growth & development, India, Phenotype, Plant Breeding methods, Fatty Acids metabolism, Fatty Acids analysis, Flax genetics, Flax growth & development, Flax metabolism, Genotype, Genetic Variation
Abstract

Linseed or flaxseed, native to the Indian subcontinent, had undergone domestication, edaphic selection and evolutionary processes that may have resulted in huge genetic variability in Indian genotypes. To understand the hitherto unexplored genetic diversity for sustainable flaxseed production amid challenges of climate fluctuation and identify trait-specific high-yielding genotypes, 2576 unique linseed accessions were comprehensively evaluated for 36 traits for up to six environments representing two major agroecological zones in India. A wide range of variability was recorded for days to initiation of flowering (42.86-114.99), plant height (43.31-122.88 cm), capsules/plant (64.62-375.87), seed size (6.06-14.44 cm 2 ), thousand seed weight (2.80-11.86 g), seed yield (2.93-17.28 g/plant), oil content (30.14-45.96%) and fatty acid profile especially the key constituent omega-3 fatty acid (25.4-65.88%). Most of the traits such as plant height, flowering time, seed yield, seed and capsule size showed a high or moderately high level of variance coupled with high broad sense heritability indicating precise capturing of less heritable quantitative traits. The infraspecific classification of the tested collection revealed the seed/oil type (2498 accessions) as the dominant morphotype over dual-purpose/fiber flax (78 accessions) in the conserved collection. Correlation analysis indicated a significant positive association between flowering time, plant height, days to maturity and oil content. Trait-specific superior genotypes for earliness (50% flowering in < 60 days, maturity in < 122 days), bold seeds with high thousand seed weight (> 11 g), capsules/plant (> 350), oil content (> 45%) and fatty acid composition (> 65% alpha-linolenic acid) were identified to aid genetic improvement of linseed and to broaden the narrow genetic base., (© 2024. The Author(s).)

Published
2024
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44. Single Institution Experience with Immune Checkpoint Inhibitors in Vulvar and Vaginal Melanomas.

Author

Ladwa A, Elghawy O, and Kaur V

Abstract

Objectives: This study aimed to report clinical outcomes of patients with vaginal melanoma (VaM) or vulvar melanoma (VuM) who were treated with immune checkpoint inhibitors (ICI) and discuss the development of immune-related adverse events (irAE)., Materials and Methods: This is a retrospective case series of patients diagnosed with VaM or VuM between July 2011 and September 2022 at the University of Virginia, Emily Couric Clinical Cancer Center. Patient demographics, disease characteristics, treatment outcomes, and adverse events were abstracted. The primary outcome was incidence of irAE., Results: Eight patients were included in this study, four with VaM and four with VuM. Most ( n  = 6) had local or regional disease at first presentation, and 25% ( n  = 2) presented with distant metastasis. All patients received a CTLA-4 inhibitor and 75% ( n  = 6) received PD-1 inhibitor alone or in combination with a CTLA-4 inhibitor. Most (75%, n  = 6) patients experienced irAE. Of those who had irAE, 83% ( n  = 5) required therapy interruption or discontinuation. Most (66%, n  = 4) underwent ICI rechallenge of which 75% ( n  = 3) experienced subsequent irAE. Of all patients in the series, 75% of patients ( n  = 6) had partial or complete response to ICI., Conclusion: This series is the first to detail incidence of irAEs and ICI rechallenges in vulvovaginal melanoma. Our findings indicate that while ICIs are effective, their use is associated with significant irAE development. Rechallenge of ICI after irAE is feasible but associated with risk of recurrent/new irAE. Further studies are needed to better quantify this risk., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Amrita Ladwa et al.)

Published
2024
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45. Comprehensive characterization of protease inhibiting gene family, cis-regulatory elements, and protein interaction network in linseed and their expression upon bud fly infestation.

Author

Singh CM, Singh BK, Purwar S, Nair B, Ruchi, Patel A, Singh S, and Kaur V

Subjects
Animals, Protein Interaction Maps, Plant Proteins genetics, Plant Proteins metabolism, Plant Diseases parasitology, Plant Diseases genetics, Promoter Regions, Genetic, Regulatory Sequences, Nucleic Acid, Multigene Family, Phylogeny, Flax genetics, Flax metabolism, Diptera genetics, Protease Inhibitors pharmacology, Protease Inhibitors metabolism, Gene Expression Regulation, Plant
Abstract

Linseed, also known as flax is an important oilseed crop with many potential uses in paint, textile, food and pharmaceutical industries. Susceptibility to bud fly (Dasyneura lini Barnes) infestation is a serious biotic concern leading to severe yield penalty in linseed. Protease inhibitors (PIs) are potential candidates that activate during the insect-pest attack and modulate the resistance. In the present study, we explored the PI candidates in the linseed genome and a total of 100 LuPI genes were identified and grouped into five distinct subgroups. The analysis of cis-acting elements revealed that almost all LuPI promoters contain several regulatory elementary related to growth and development, hormonal regulation and stress responses. Across the subfamilies of PIs, the specific domains are consistently found conserved in all protein sequences. The tissue-specific in-silico expression pattern via RNA-seq revealed that all the genes were regulated during different stress. The expression through qRT-PCR of 15 genes revealed the significant up-regulation of LuPI-24, LuPI-40, LuPI-49, LuPI-53, and LuPI-63 upon bud fly infestation in resistant genotype EC0099001 and resistant check variety Neela. This study establishes a foundation resource for comprehending the structural, functional, and evolutionary dimensions of protease inhibitors in linseed., (© 2024. The Author(s).)

Published
2024
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46. Mild Cognitive Impairment: Clinical Presentation and Short-Term Comparative Outcome of Patients With Potentially Modifiable and Nonmodifiable Risk Factors.

Author

Moria K, Sharma A, Bansal PD, Bahetra M, Saini B, Bansal P, Kaur V, Singh G, Singh J, and Kaur H

Subjects
Humans, Male, Female, Risk Factors, Aged, Middle Aged, Mental Status and Dementia Tests, Prevalence, Depression epidemiology, Cognitive Dysfunction etiology, Cognitive Dysfunction epidemiology, Quality of Life
Abstract

Objective: To estimate the prevalence and study the clinical presentation of mild cognitive impairment (MCI), assess its outcome in terms of cognition and quality of life, identify factors for reversion to baseline, and compare these factors in the modifiable and nonmodifiable risk factor groups., Methods: Individuals aged >50 years with memory/cognitive complaint(s) were screened using the Mini-Cog over 1 year (August 2018-August 2019). Those meeting the DSM-5 criteria for MCI were enrolled, and risk factors (modifiable and nonmodifiable) were noted. Assessments were done using the Hindi version of the Montreal Cognitive Assessment (H-MoCA), the Clinical Dementia Rating (CDR)-Hindi version, and the World Health Organization Quality of Life-Brief Hindi version. Treatment outcome was assessed at 6 months and compared between the risk factor groups. Factors for reversion of MCI were assessed., Results: A total of 124 patients (22.1% of 561 with cognitive complaints) had MCI, and 100 patients (50 patients from the modifiable group and 50 patients from the nonmodifiable group) completed the study. Depression (52%) and hypertension (48%) were common risk factors. End point cognition scores were similar in both groups, with quality of life better in the modifiable group ( P = .023). Age was negatively correlated with cognition in total patients and the nonmodifiable group ( r =0.283-0.420; P = .002-.004). In total patients, cognition moderately correlated with education and somewhat with quality of life; 31% and 57% reverted to normal on the MoCA and CDR scales, respectively, while 1 progressed to dementia. Reverters had higher baseline H-MoCA scores (odds ratio [OR] = 6.996; P < .001) and were treated with cholinesterase inhibitors + vitamin E (OR = 28.999; P = .007)., Conclusion: Short-term outcome for both the modifiable and nonmodifiable risk factor groups was favorable. Higher education positively correlated with cognition, which itself predicted a better quality of life. Reverters of MCI had better baseline cognition and were treated with cholinesterase inhibitors + vitamin E., Prim Care Companion CNS Disord 2024;26(4):24m03708 ., Author affiliations are listed at the end of this article., (© Copyright 2024 Physicians Postgraduate Press, Inc.)

Published
2024
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47. A case of biopsy-proven acute interstitial nephritis following atezolizumab-bevacizumab treatment of advanced unresectable hepatocellular carcinoma.

Author

Patel R, Elghawy O, Gibbs A, Gupta S, and Kaur V

Subjects
Humans, Male, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols adverse effects, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Biopsy, Immune Checkpoint Inhibitors adverse effects, Immune Checkpoint Inhibitors administration & dosage, Carcinoma, Hepatocellular drug therapy, Carcinoma, Hepatocellular pathology, Nephritis, Interstitial chemically induced, Nephritis, Interstitial diagnosis, Nephritis, Interstitial pathology, Liver Neoplasms drug therapy, Liver Neoplasms pathology, Antibodies, Monoclonal, Humanized adverse effects, Antibodies, Monoclonal, Humanized administration & dosage, Bevacizumab adverse effects, Bevacizumab administration & dosage
Abstract

Background: The advent of immune checkpoint inhibitors (ICIs) represented a significant breakthrough in cancer therapy. Recently, the combined use of atezolizumab and bevacizumab was approved as first-line treatment for unresectable hepatocellular carcinoma (HCC). Exposure to a novel and diverse spectrum of immune-related adverse events (irAEs) has increased with the growing utilization of ICIs, however, a comprehensive understanding surrounding newer agents is still lacking. The incidence of kidney toxicities is rare but rising, often underreported due to the lack of confirmatory biopsies. Here, we present a rare case of biopsy-proven acute interstitial nephritis (AIN) following atezolizumab-bevacizumab treatment of advanced unresectable HCC., Case: An 84-year-old male with T4N0M0 hepatocellular carcinoma was admitted after cycle 5 of atezolizumab due to decreased urine output and dysuria with a serum creatine of 4.7 mg/dL compared to a baseline of 1.3 mg/dL. To confirm the diagnosis of possible intrinsic renal injury, an ultrasound-guided non-focal biopsy of the left kidney was performed, revealing AIN. Potential exacerbatory medications, such as proton-pump inhibitors, were discontinued. The patient was discharged on oral steroids with improvement in serum creatinine. Before completing the steroid taper, the patient developed pneumocystis pneumonia and eventually transitioned to hospice care., Conclusion: This case highlights the valuable role renal biopsy can play in accurately capturing irAEs and guiding appropriate management in the setting of ICI-induced AKI. It also exemplifies important considerations for steroid treatment of irAEs in the setting of comorbidities, such as diabetes., (© 2024 The Author(s). Cancer Reports published by Wiley Periodicals LLC.)

Published
2024
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48. Clinical outcome analysis of patients with multiple sclerosis - Analysis from the UK Medical Cannabis Registry.

Author

Murphy M, Kaur V, Bui HL, Yang T, Erridge S, Holvey C, Coomber R, Rucker JJ, Weatherall MW, and Sodergren MH

Subjects
Humans, Male, Female, Adult, Middle Aged, United Kingdom, Registries, Quality of Life, Medical Marijuana therapeutic use, Medical Marijuana adverse effects, Multiple Sclerosis drug therapy
Abstract

Introduction: Whilst disease-modifying therapies are the cornerstone for treatment of multiple sclerosis (MS), there is a need to develop novel therapeutics for the symptomatic sequalae of the disease. Cannabis-based medicinal products (CBMPs) have been suggested as a potential therapy for the associated pain, spasticity, and mental health disorders. However, there is a paucity of clinical evidence on CBMPs in MS. The aim of this study is to assess changes in MS-specific and general health-related quality of life (HRQoL) outcomes alongside adverse event incidence in patients prescribed CBMPs for MS from the UK Medical Cannabis Registry (UKMCR)., Method: Patients prescribed CBMPs for MS symptoms for longer than one month were identified from the UKMCR. The primary outcomes were changes from baseline in MS Quality of Life-54 (MSQoL-54), Generalised Anxiety Disorder-7 (GAD-7), Single-Item Sleep Quality Scale (SQS), and EQ-5D-5L scales at one month, three months and six months. p < 0.050 was defined as statistically significant., Results: 141 patients met the inclusion criteria for the study. There was an improvement in the following subscales of the MSQoL-54 at 6 months: change in health scale, cognitive function, mental health composition, physical health, role limitations due to physical limitation and due to emotional problems, as well as social and sexual function (p < 0.050). There were also improvements in the EQ-5D-5L index value, GAD-7 and SQS (p < 0.050). 146 (103.55 %) adverse events were reported in total. Most were considered mild (n = 47; 33.33 %) and moderate (n = 72; 51.06 %)., Conclusions: This preliminary analysis demonstrates a possible association with improved general health-related quality of life in those prescribed CBMPs for MS. Moreover, the results suggest that CBMPs are well-tolerated in the first 6 months of treatment. However, this must be interpreted with caution considering the limitations of the observational study design., Competing Interests: Declaration of competing interest Coauthor: Name: Mr Matthew Murphy Disclosure: Matthew Murphy is a biomedical sciences student at Imperial College London. Matthew Murphy has no shareholdings in pharmaceutical companies. Coauthor: Name: Ms Varinder Kaur Disclosure: Varinder Kaur is a biomedical sciences student at Imperial College London. Varinder Kaur has no shareholdings in pharmaceutical companies. Coauthor: Name: Ms Hahn Lan Bui Disclosure: Hanh Lan Bui is a biomedical sciences student at Imperial College London. Hanh Lan Bui has no shareholdings in pharmaceutical companies. Coauthor: Name: Mr Toby Yang Disclosure: Toby Yang is a biomedical sciences student at Imperial College London. Toby Yang has no shareholdings in pharmaceutical companies. Coauthor: Name: Dr Simon Erridge Disclosure: Simon Erridge is a junior doctor and is the Head of Research at Curaleaf Clinic. Simon Erridge is an honorary clinical research fellow at Imperial College London. The views expressed are those of the author(s) and not necessarily those of the NHS. Simon Erridge has no shareholdings in pharmaceutical companies. … Coauthor: Name: Mr Carl Holvey Disclosure: Carl Holvey is Chief Clinical Pharmacist at Curaleaf Clinic. Carl Holvey has no shareholdings in pharmaceutical companies. Coauthor: Name: Dr Ross Coomber Disclosure: Ross Coomber is a consultant orthopaedic surgeon, Operations Director at Curaleaf Clinic and a consultant at St George's Hospital, London. The views expressed are those of the author(s) and not necessarily those of the NHS. Ross Coomber has no shareholdings in pharmaceutical companies. Coauthor: Name: Dr James J Rucker Disclosure: James Rucker is a consultant psychiatrist and a former director at Curaleaf Clinic. James Rucker is an honorary consultant psychiatrist at The South London & Maudsley NHS Foundation Trust, and an NIHR Clinician Scientist Fellow at the Centre for Affective Disorders at King's College London. James Rucker is funded by a fellowship (CS-2017-17-007) from the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. James Rucker has no shareholdings in pharmaceutical companies. James Rucker reviewed this article and made comments. Coauthor: Name: Dr Mark W Weatherall. Disclosure: Mark Weatherall is a consultant in neurology and a former director at Curaleaf Clinic. The views expressed are those of the author(s) and not necessarily those of the NHS. Mark Weatherall has no shareholdings in pharmaceutical companies. Corresponding author: Name: Mr Mikael H Sodergren Disclosure: Mikael Sodergren is a consultant hepatopancreatobiliary surgeon, the managing director at Curaleaf Clinic and a consultant at Imperial College NHS Trust, London. He is senior clinical lecturer at Imperial College London and Chief Medical Officer at Curaleaf International. The views expressed are those of the author(s) and not necessarily those of the NHS., (Copyright © 2024. Published by Elsevier B.V.)

Published
2024
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50. A New Source of Opioid and Lead Toxicity on the Block-Kamini: An Emerging Health Hazard-A Case Series.

Author

Abhilasha P, Vats K, Gautam N, Kaur V, Singla M, Pavitra Ds, Gupta M, Chaudhary V, Joyal W, and John MJ

Abstract

Introduction: Illicit drug abuse with opioids can inadvertently lead to refractory anemia and lead poisoning. 1 The absence of adequate regulations for Ayurvedic herbal products has led to the adulteration of opioid-containing drugs with lead. 2 As a result, lead toxicity has become a concern within this seldom-addressed population of opioid users. In this report, we present a collection of cases where individuals developed lead toxicity while being dependent on opioids due to their use of a little-known herbal product called Kamini, which contains Papaver somniferum . This retrospective case series aims to raise awareness about and foster broader recognition of opioid dependence linked to herbal products like Kamini, along with the associated risks associated with its usage., Methods: We retrospectively analyzed the records of three patients who were opioid abusers and presented with symptoms and signs of lead poisoning., Results: All three patients were male and presented with complaints of abdominal pain and generalized weakness. Laboratory examinations showed high lead levels and low hemoglobin as well as basophilic stippling. Urine porphyrins were falsely positive in two patients. All three patients showed symptomatic improvement with a decrease in lead levels after chelation therapy., Discussion and Conclusion: This case series highlights the need for awareness regarding opioid dependence syndrome and potential lead toxicity stemming from the use of Ayurvedic preparations over the counter, such as Kamini. A low threshold should be kept for testing for lead poisoning in patients who present with anemia and/or abdominal pain with a history of opioid dependence., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2024 The Author(s).)

Published
2024
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