Publications by authors named "A Babu"

457 Publications

Physical confinement during cancer cell migration triggers therapeutic resistance and cancer stem cell-like behavior.

Cancer Lett 2021 Feb 24. Epub 2021 Feb 24.

Neuroengineering Lab, Department of Bioengineering, University of Texas at Arlington, TX, USA; Department of Urology, UT Southwestern Medical Center, TX, USA. Electronic address:

Metastasized cancer cells have an increased resistance to therapies leading to a drastic decrease in patient survival rates. However, our understanding of the cause for this enhanced resistance is lacking. In this study, we report that physically tight confinement during cancer cell migration triggers therapeutic resistance and induces cancer stem cell-like behavior including up-regulation in efflux proteins and in cancer stem cell related markers. Moreover, the re-localization of Yes-associated protein (YAP) to the cell nucleus indicated an elevated level of cytoskeletal tension. The increased cytoskeletal tension suggested that mechanical interactions between cancer cells and tight surroundings during metastasis is one of the factors that contributes to therapeutic resistance and acquisition of cancer stem cell (CSC) like features. With this system and supporting data, we are able to study cells with therapeutic resistance and CSC-like properties for the future purpose of developing new strategies for the treatment of metastatic cancer.
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http://dx.doi.org/10.1016/j.canlet.2021.01.020DOI Listing
February 2021

SARS-CoV-2 Infection (COVID-19) and Herpes Simplex Virus-1 Conjunctivitis: Concurrent Viral Infections or a Cause-Effect Result?

Cureus 2021 Jan 9;13(1):e12592. Epub 2021 Jan 9.

Infectious Diseases, University of South Florida Morsani College of Medicine, Tampa, USA.

The pulmonary effects of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus that causes coronavirus disease (COVID-19), are well documented; however, more evidence is needed to understand its effect on multiple organ systems. We present the case of a 69-year-old male with dyspnea for two weeks and bilateral conjunctivitis who tested positive for SARS-CoV-2. He was found to be hypoxic, requiring supplemental oxygen. On hospital day two, he complained of worsening left eye pain with the development of a left lower eyelid ulcer. He underwent a CT of facial bones, which showed findings consistent with pre-septal cellulitis and abscess. Samples from bilateral conjunctival secretions and left lower eyelid ulcer tested positive for herpes simplex virus-1 (HSV-1), and negative for SARS-CoV-2. He received supportive care, antibiotics, and famciclovir with almost complete resolution of his ocular complaints. This case illustrates an atypical COVID-19 presentation and raises concern as to how this virus modulates the immune system, allowing for concurrent viral infections.
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http://dx.doi.org/10.7759/cureus.12592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870094PMC
January 2021

Effect of Particle Size of Nano-Oxides on Color Stability and Mechanical Properties of Maxillofacial Silicone Elastomers: An In Vitro Study.

Int J Prosthodont 2021 Jan-Feb;34(1):54-60

Purpose: To evaluate the physical and mechanical properties of maxillofacial silicone elastomers following the incorporation of a specific particle size and concentration of nano-titanium dioxide (TiO) and nano-zinc oxide (ZnO).

Materials And Methods: Nano-TiO and nano-ZnO of 20-nm and 40-nm particle sizes and in 1% and 2% concentrations were chosen. Silicone elastomer samples were prepared according to the manufacturer's recommendations. The nano-oxides were incorporated via hand spatulation. The samples were subsequently tested for hardness and color stability and were then subjected to aging in an aging chamber for 1,008 hours, following which they were again evaluated for hardness, color stability, and surface roughness.

Results: A significant change was noted in the physical and mechanical properties post-aging in all the groups. The samples with nano-TiO of 40-nm particle size/2% concentration had the highest hardness, while color stability and surface roughness were higher in samples with nano-TiO of 20-nm particle size/1% and 2% concentrations, respectively.

Conclusion: It can be concluded that 20-nm nano-TiO particles best maintain the ideal properties of maxillofacial silicone elastomers and can potentially be used as alternative opacifiers when mixed with A-2186 maxillofacial silicone elastomers.
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http://dx.doi.org/10.11607/ijp.6593DOI Listing
February 2021

The need for exercise sciences and an integrated response to COVID-19: A position statement from the international HL-PIVOT network.

Prog Cardiovasc Dis 2021 Feb 4. Epub 2021 Feb 4.

Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA.

COVID-19 is one of the biggest health crises that the world has seen. Whilst measures to abate transmission and infection are ongoing, there continues to be growing numbers of patients requiring chronic support, which is already putting a strain on health care systems around the world and which may do so for years to come. A legacy of COVID-19 will be a long-term requirement to support patients with dedicated rehabilitation and support services. With many clinical settings characterized by a lack of funding and resources, the need to provide these additional services could overwhelm clinical capacity. This position statement from the Healthy Living for Pandemic Event Protection (HL-PIVOT) Network provides a collaborative blueprint focused on leading research and developing clinical guidelines, bringing together professionals with expertise in clinical services and the exercise sciences to develop the evidence base needed to improve outcomes for patients infected by COVID-19.
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http://dx.doi.org/10.1016/j.pcad.2021.01.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859729PMC
February 2021

Altered patterns of abdominal muscle activation during forced exhalation following elective laparotomy: An experimental research.

Ann Med Surg (Lond) 2021 Jan 9;61:198-204. Epub 2020 Dec 9.

Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.

Background: Post-operative pulmonary complications are common after exploratory laparotomy. Good abdominal muscle functioning is essential for forced exhalation and effective coughing. However, the impact of a laparotomy on abdominal muscle activity remains uncertain. The study aimed to assess abdominal muscle activity during forced exhalation following elective laparotomy.

Materials And Methods: A was carried out on those undergoing (n = 30) their first elective laparotomy. Abdominal muscle activity, as percentage maximal voluntary contraction (%MVC), was assessed during forced exhalation using surface electromyography (EMG) for transverse abdominis (TrAb), external oblique (EO), and rectus abdominis (RA) pre-operatively and up to seven days post-operatively. Peak expiratory flow rate (PEFR) was assessed during the forced exhalation maneuver. Median %MVC was used to represent the trends and Z-scores to report the change from the baseline activity. Spearman's correlation was used for the correlation between %MVC and PEFR.

Results: Pre-operatively, we observed the %MVC of TrAb (75.58%) to be the highest followed by RA (66.28%) and EO (62.12%). Post-operatively, all the muscles demonstrated increased activity wherein EO (84.33%) was most active on post-op day1, and for the rest of the days TrAb was the most active. However, as observed from Z-scores of all the three muscles the activity of EO was raised significantly from the baseline. No correlation was observed between %MVC and PEFR.

Conclusion: TrAb is the most active muscle that contributes to forced exhalation. Following an elective laparotomy, TrAb is no longer the most active muscle, rather it is the EO that primarily contributes to forced exhalation. This should be considered while providing post-operative respiratory care. However, more research is required in this area to better understand the role of expiratory muscle training for those undergoing elective laparotomies.
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http://dx.doi.org/10.1016/j.amsu.2020.11.080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817774PMC
January 2021

Multistimuli-Responsive Polymeric Vesicles for Accelerated Drug Release in Chemo-photothermal Therapy.

ACS Biomater Sci Eng 2020 Sep 25;6(9):5012-5023. Epub 2020 Aug 25.

BK21 PLUS Center for Advanced Chemical Technology, Department of Polymer Science and Engineering, Pusan National University, Busan 609-735, Republic of Korea.

Multistimuli-responsive nanomedicines present great potential for cancer therapy, as they can be featured as simple, selective, and smart carriers that can release their payload on-demand. In this study, we prepared a multifunctional polymeric vesicular nanocarrier (PVN) based on robust and triple stimuli-responsive micelles that could encapsulate chemotherapeutic drugs (doxorubicin (DOX)) and photothermal agents (IR780 iodide) for combined chemo-photothermal therapy. The size of the PVNs was stable and uniform (∼100 nm), and its DOX and IR780 loading were high: 26.5 and 16.4 wt %, respectively. Further investigations suggested that the DOX/IR780 coloaded PVNs presented controlled drug release kinetics upon costimulation with specific endogenous stimuli. Upon laser irradiation, DOX/IR780 coloaded PVNs exhibited prominent photothermal cytotoxicity toward murine colon cancer (CT-26) cells. Intracellular uptake assays indicated that DOX/IR780 coloaded PVNs could be readily uptaken by CT-26 cells, resulting in the release of DOX within the cytoplasm of the cells in response to laser irradiation.
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http://dx.doi.org/10.1021/acsbiomaterials.0c00585DOI Listing
September 2020

Effects of chlorantraniliprole residual on Helicoverpa zea in Bt and non-Bt cotton.

Pest Manag Sci 2021 Jan 7. Epub 2021 Jan 7.

Application Technology Research Unit, USDA-Agricultural Research Service, Wooster, OH, USA.

Background: Helicoverpa zea is managed with foliar applications of chlorantraniliprole in cotton varieties that do not express the Vip3Aa19 toxin in the US Cotton Belt. Foliar insecticides and Bt could interact to influence larval susceptibility. Therefore, it has been suggested that chlorantraniliprole can be used as a tool for Bt resistance management. We designed field and laboratory studies to test the hypothesis that the interaction of Bt toxin and chlorantraniliprole application would result in lower H. zea larval survival when compared to the individual effect of Bt or chlorantraniliprole alone. We also tested for these interactions over time, since chlorantraniliprole residual has not been studied in cotton.

Results: Results from two field experiments and two laboratory experiments were similar. We found no interactions with Bt and chlorantraniliprole using data not corrected for natural mortality in untreated plots, indicating that these factors did not interact to influence survival. Moreover, we found that Bt and chlorantraniliprole did not interact to influence larval weight and instar. Chlorantraniliprole had lethal and sublethal effects on H. zea larval growth parameters feeding on cotton leaves up to 22 days after application, the final time period that we tested. Finally, concentration of chlorantraniliprole in the leaf was associated with larval survival for the duration of this study, but not larval growth or instar.

Conclusion: Our findings complement the recommendation to use chlorantraniliprole for managing H. zea in cotton, given its long-residual effects. However, the utility of chlorantraniliprole as a Bt-resistance management tool for H. zea remains unclear.
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http://dx.doi.org/10.1002/ps.6263DOI Listing
January 2021

A Fluoro Derivative of Embelin, as Potent B-RAF Inhibitor in Melanoma.

Anticancer Agents Med Chem 2020 Dec 28. Epub 2020 Dec 28.

Department of Chemistry, College of Engineering Trivandrum, Thiruvananthapuram. India.

Background: Melanoma is one of the common forms of skin cancer and B-RAF is a mutated protein found in most Melanomas. The important function of B-RAF is normal cell growth and survival. Most of known B-RAF mutations are V600E mutations. Vemurafenib is the currently used fluorine based drug used for V600E mutations but this drug has side effects, so in this scenario, more potent drugs with less side effects are required.

Objective: This study aims to develop a more effective lead compound as B-RAF inhibitor from a hydroxyquinone, by structural modification of embelin, a naturally occurring hydroxybenzoquinone, which has got a potency of detoxifying blood, hence useful in wide range of skin diseases. Thus a fluorine substituted semisynthetic derivative of embelin, 5-(3-chloro-4-trifluoromethoxy phenyl amino)-2- hydroxy-3-undecyl- [1, 4] benzoquinone to fight against skin cancer was prepared.

Method: Fluoro derivative of embelin was synthesized by the direct condensation of embelin with 3-chloro-4-trifluoromethoxy aniline. The structure of the product was characterized using various spectral data, obtained from IR, 1H NMR, 19F NMR, 13C NMR and Mass spectrum. Various in vitro studies like Antiproliferative study in A375 Cell Lines, (B-RAF Elisa), Western Blotting analysis, Gene Expression study by Reverse Transcriptase PCR, Caspase assay, Flow Cytometry analysis, Clonogenic assay and Transwell Migration assay were carried out to find its biological activity.

Results: A semisynthetic derivative of embelin 5-(3-chloro-4-trifluoromethoxy phenyl amino)-2-hydroxy-3-undecyl- [1, 4] benzoquinone (EOCF) was prepared and the structure of the derivative was confirmed by spectral analysis. The MTT assay proves that the fluoro derivative of embelin exhibited better anticancer activity in Melanoma cell lines than the parent compound, embelin. Western blot analysis showed that B-RAF expression level was reduced by the addition of derivative than the parent compound embelin. The Caspase ELISA analysis indicated that the derivative was found to be a good apoptotic marker and from the flow cytometry analysis, it was observed that the cell arrest occurs at G0/G1 phase. Its antimetastatic activity determined using Clonogenic assay indicated that the derivative, EOCF inhibits the metastatic effects in melanoma cell lines. Migratory potential of Melanoma cells were significantly reduced in presence of EOCF when Transwell migration assay was conducted.

Conclusion: This work established that the potency of the synthesized compound was more than the parent compound, embelin when it was structurally modified with 3-chloro-4-trifluoromethoxy aniline and that the derivative can be used as a lead molecule for further drug discovery.
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http://dx.doi.org/10.2174/1871520621666201229115253DOI Listing
December 2020

Rehabilitation following return of spontaneous circulation (ROSC-Rehab): A new role for rehabilitation professionals in post-resuscitation care.

Resuscitation 2021 Feb 31;159:38-39. Epub 2020 Dec 31.

Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India. Electronic address:

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http://dx.doi.org/10.1016/j.resuscitation.2020.12.011DOI Listing
February 2021

HIV Lymphadenopathy: Differential Diagnosis and Important Imaging Features.

AJR Am J Roentgenol 2021 02 16;216(2):526-533. Epub 2020 Dec 16.

Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA.

The purpose of this article is to review important imaging and clinical features to help elucidate causes of lymphadenopathy in patients with HIV infection. HIV lymphadenopathy has various causes generally categorized as inflammatory or reactive, such as immune reconstitution syndrome; infectious, such as tuberculous and nontuberculous mycobacterial infections and HIV infection itself; and neoplastic, such as lymphoma, Kaposi sarcoma, and Castleman disease. It is important to consider patients' demographic characteristics, clinical presentations, CD4 lymphocyte counts, and radiologic features to identify likely causes of lymphadenopathy.
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http://dx.doi.org/10.2214/AJR.19.22334DOI Listing
February 2021

Impact of yoga and exercises on polycystic ovarian syndrome risk among adolescent schoolgirls in South India.

Health Sci Rep 2020 Dec 4;3(4):e212. Epub 2020 Dec 4.

Rajalakshmi College of Nursing Chennai India.

Background: To identify the adolescent school girls with risk for polycystic ovarian syndrome (PCOS), assess their risk status, and evaluate the impact of lifestyle modifications on PCOS risk reduction.

Methods: An experimental research was conducted among adolescent girls belonging to two Government run schools in Tiruvallur district of Tamil Nadu state, India, from 6 June to 9 December 2016. A standard risk assessment questionnaire was adopted for risk assessment after making few modifications (Cronbach alpha 0.86). The experimental group received lifestyle modifications (yoga for two months and walking exercise for two months), with no such intervention provided for the control group. The impact of these interventions was assessed in terms of risk minimization and a value less than .05 was considered statistically significant.

Results: A total of 204 (control-102; experimental-102) girls with statistically insignificant difference in demographic features were studied. During the pretest, 85.2% (n = 87) in the experimental group and 83.3% (n = 85) the controls had "moderate risk" for PCOS. Girls with "high risk" level of PCOS were 14.8% (n = 15) and 15.7% (n = 17) in the experimental group and the control group, respectively. In posttest-1 (after yoga sessions) risk assessment, 71.6% had "moderate risk," 5.9% had "high risk" in the experimental group, whereas 87.3% had "moderate risk" and 12.7% had "high risk" in the control group. In posttest-2 (after exercise sessions) risk assessment, 48% had "moderate risk" and 0% had high risk in the experimental group, whereas 88.2% were "moderate risk" and 11.8% were "high risk" in the control group. Repeated measure ANOVA with Greenhouse-Geisser correction showed mean risk reduction score statistically significant between pretest and post-test (33.38 ± 7.28 vs 22.75 ± 12.09, respectively mean difference is 10.63: = 236.12  < .001), suggesting a positive correlation with the intervention.

Conclusions: Yoga and exercise were beneficial in minimizing PCOS risk, as reflected in the risk assessment score. More such interventions, covering different schools, could provide larger health benefits.
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http://dx.doi.org/10.1002/hsr2.212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717472PMC
December 2020

Intraoperative factors contributory to myocardial injury in high-risk patients undergoing abdominal surgery in a South Indian population.

Indian J Anaesth 2020 Sep 1;64(9):743-749. Epub 2020 Sep 1.

Department of Internal Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.

Background And Aims: Myocardial injury after non-cardiac surgery (MINS) is associated with high postoperative mortality. We sought to examine the intraoperative variables associated with MINS among high-risk patients undergoing abdominal surgery at a South Indian Centre.

Methods: A retrospective analysis of patients who underwent abdominal surgery, aged >45 years with one of five factors: hypertension, diabetes mellitus, previous coronary artery disease (CAD), stroke, or peripheral vascular disease or all patients >65 years of age was undertaken. Forty-six patients with raised troponin Group (Trop I > 0.03 ng/d) were compared with 125 troponin-negative patients Group N (Trop I < 0.012 ng/dL) as well as 51 with intermediate levels Group I (Trop I > 0.012 and < 0.03 ng/dL). We evaluated the association of pre and intraoperative factors on MINS using logistic regression to identify the explanatory variables.

Results: Demographics were similar among the three groups. In-hospital mortality was significantly higher in group ( = 0.005).The use of vasopressors (OR 2.6; 95% CI 1.2-5.5), female gender, (OR 2.3; 95%CI 1.1-4.7), associated CAD (OR 2.8;95% CI 1.1-7.4), and fresh frozen plasma (FFP) transfusion (OR 12.1;95% CI 1.3-11.7) were associated with MINS in regression analysis between group versus group N. Female gender (OR2.3; 95% CI 1.2-4.5), postoperative mechanical ventilation (OR 3.5; 95% CI 1.2-10.4), and perioperative hypothermia (OR 4.5; 95% CI 1.3-14.9) were significant between Group and Group I with Group N.

Conclusions: Female patients with CAD undergoing abdominal surgery, needing vasopressors and transfusion of plasma are at high risk for MINS with higher hospital mortality and merit vigilant monitoring postoperatively.
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http://dx.doi.org/10.4103/ija.IJA_436_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641085PMC
September 2020

mTORC1 activation in lung mesenchyme drives sex- and age-dependent pulmonary structure and function decline.

Nat Commun 2020 11 6;11(1):5640. Epub 2020 Nov 6.

Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Lymphangioleiomyomatosis (LAM) is a rare fatal cystic lung disease due to bi-allelic inactivating mutations in tuberous sclerosis complex (TSC1/TSC2) genes coding for suppressors of the mechanistic target of rapamycin complex 1 (mTORC1). The origin of LAM cells is still unknown. Here, we profile a LAM lung compared to an age- and sex-matched healthy control lung as a hypothesis-generating approach to identify cell subtypes that are specific to LAM. Our single-cell RNA sequencing (scRNA-seq) analysis reveals novel mesenchymal and transitional alveolar epithelial states unique to LAM lung. This analysis identifies a mesenchymal cell hub coordinating the LAM disease phenotype. Mesenchymal-restricted deletion of Tsc2 in the mouse lung produces a mTORC1-driven pulmonary phenotype, with a progressive disruption of alveolar structure, a decline in pulmonary function, increase of rapamycin-sensitive expression of WNT ligands, and profound female-specific changes in mesenchymal and epithelial lung cell gene expression. Genetic inactivation of WNT signaling reverses age-dependent changes of mTORC1-driven lung phenotype, but WNT activation alone in lung mesenchyme is not sufficient for the development of mouse LAM-like phenotype. The alterations in gene expression are driven by distinctive crosstalk between mesenchymal and epithelial subsets of cells observed in mesenchymal Tsc2-deficient lungs. This study identifies sex- and age-specific gene changes in the mTORC1-activated lung mesenchyme and establishes the importance of the WNT signaling pathway in the mTORC1-driven lung phenotype.
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http://dx.doi.org/10.1038/s41467-020-18979-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648630PMC
November 2020

Quest for the Ideal Nasal Pack in Post Operative Cases of Septo-Turbinoplasty: Study in a Tertiary Care Hospital.

Indian J Otolaryngol Head Neck Surg 2020 Dec 27;72(4):463-467. Epub 2020 Jun 27.

Department of ENT, JSS Academy of Higher Education and Research (JSSAHER), Ramachandra Agrahara, Mysuru, Karnataka 570004 India.

To compare the efficacies and post operative outcomes of patients with nasal packing with merocel, intranasal splints and merocel along with intra-nasal infant feeding tubes following septo-turbinoplasty, in patients with nasal obstruction secondary to septal deviation and inferior turbinate hypertrophy. A prospective study was done in 60 patients of symptomatic deviated nasal septum with inferior turbinate hypertrophy. Septoturbinoplasty was performed. Patients' nasal cavity was packed for 48 h after being randomly divided into 3 groups: (1) packing using merocel, (2) intra-intra nasal septal silicone splint, (3) packing using truncated merocel along with infant feeding tube. Patients were given a questionnaire 24 h post operatively and their reponse was analysed to compare nasal blockage, epistaxis, epiphora and headache. Pain on pack removal was recorded after 48 h. We found that merocel with infant feeding tube had better tolerance than plain merocel in almost all cases, with symptoms of nasal blockage, epiphora, headache and pain on pack removal being lesser than with plain merocel, and comparable to the results produced by nasal splints. Also the epistaxis control in merocel with infant feeding tube was better than with nasal splints. Truncated merocel with infant feeding tubes provides a suitable and cheap replacement for nasal splints which may not be affordable to a lot of patients, or may not in available in many settings. The results are superior to plain merocel and the control of post operative bleeding is better than with intra nasal splints.
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http://dx.doi.org/10.1007/s12070-020-01919-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544796PMC
December 2020

Spontaneous pancreatic pseudocyst - superior mesenteric vein fistula: A rare complication of chronic pancreatitis.

Radiol Case Rep 2020 Oct 19;15(10):1939-1942. Epub 2020 Aug 19.

Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023, USA.

Pseudocyst formation is common in chronic pancreatitis. A rare subset of these patients may develop fistulization between the pseudocyst and the portal vein system. We report a case of spontaneous pancreatic pseudocyst - superior mesenteric vein fistula in a 61-year-old male with a history of chronic recurrent calcifying pancreatitis. The fistulous connection was correctly identified on both computed tomography and magnetic resonance cholangiopancreatography (MRCP), and the patient was treated successfully with a conservative approach. Our case report aims to educate on this rare and potentially fatal vascular complication of chronic pancreatitis and to discuss the role of modern noninvasive imaging techniques, such as T2-weighted MRI/MRCP, in establishing this diagnosis and making a decision regarding its management.
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http://dx.doi.org/10.1016/j.radcr.2020.07.062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452026PMC
October 2020

Influence of Physical Activity of the Rescuer on Chest Compression Duration and its Effects on Hemodynamics and Fatigue Levels of the Rescuer: A Simulation-based Study.

Indian J Crit Care Med 2020 Jun;24(6):409-413

Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Background: Cardiopulmonary resuscitation (CPR) is a lifesaving skill performed during the cardiac arrest. Various factors of rescuer affect CPR quality, and rescuers physical fitness is one among the important factors needs to be explored for improved CPR quality. This study aimed to assess the physical activity (PA) levels of the health care providers (HCPs) who were trained in basic life support (BLS) and its relationship on chest compression duration, hemodynamic parameters, and fatigue levels of the rescuers.

Materials And Methods: A single-center, cross-sectional study was conducted on 48 HCPs who were trained in BLS within one year. Eligible participants were contacted by email, and the responders' level of PA was determined using the global physical activity questionnaire (GPAQ). The participants were recruited for chest compression-only cardiac arrest scenarios. Each subject performed continuous chest compression on the manikin until they perceived maximum fatigue. Heart rate (HR), blood pressure (BP), oxygen saturation (SpO), and fatigue level were assessed at baseline, immediately after and following two minutes of cessation of chest compressions. The total duration of chest compression was also documented.

Results: Most participants (24, 50%) reported high levels of PA while 22 (45.83%) and 2 (4.17%) reported moderate and low intensity of PA, respectively. The mean age of the 35 participants was 26.08 ± 4.60 years. The mean duration of chest compressions was 193.25 seconds with higher times reported for those with high PA when compared to those with moderate PA ( = 0.017). Similar findings were also observed for fatigue.

Conclusion: Rescuers who reported high PA had lower levels of fatigue and could perform longer duration of chest compressions.

How To Cite This Article: Nayak VR, Babu A, Unnikrishnan R, Babu AS, Krishna HM. Influence of Physical Activity of the Rescuer on Chest Compression Duration and its Effects on Hemodynamics and Fatigue Levels of the Rescuer: a Simulation-based Study. Indian J Crit Care Med 2020;24(6):409-413.
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http://dx.doi.org/10.5005/jp-journals-10071-23457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7435083PMC
June 2020

Feasibility of an exercise-based cardiac rehabilitation algorithm in patients following percutaneous coronary intervention for acute coronary syndrome.

Indian Heart J 2020 Jul - Aug;72(4):289-292. Epub 2020 Jul 17.

Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India. Electronic address:

Cardiac rehabilitation (CR) is underutilised across the world and India. The use of simple algorithms is one way to facilitate CR, however, these algorithms need to be feasible to use across low resource settings. The objectives were to assess the feasibility of a CR algorithm following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). A single group, pre-post study on 50 participants undergoing PCI for ACS found significant improvement in various feasibility metrics at discharge and 30-days, with no major adverse events. The proposed CR algorithm was safe and feasible for low and moderate risk patients with ACS undergoing PCI.
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http://dx.doi.org/10.1016/j.ihj.2020.07.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474114PMC
July 2020

Aesthetic Surgery: How Comprehensive Are Fellowship Websites?

Ann Plast Surg 2020 Jul 30. Epub 2020 Jul 30.

SR Plastic Surgery, P.C. East Brunswick, NJ.

Background: Fellowship programs heavily utilize websites in the recruitment of senior residents. Studies in subspecialty areas have demonstrated deficiencies in website content; however, no study has evaluated the websites of esthetic surgery fellowships. The recent establishment of the aesthetic fellowship match in 2018 highlights the need for accessible program information.

Objective: To assess the success in accessibility of educational and recruitment content of aesthetic surgery fellowship websites for prospective applicants.

Methods: Websites of aesthetic surgery fellowships were eligible for study inclusion. Aesthetic fellowship websites (AFWs) were evaluated for content regarding fellow education and fellow recruitment. Website content was analyzed using Fisher exact test and analysis of variance.

Results: Twenty-eight programs were compiled from the American Society of Aesthetic Plastic Surgery website. Regarding fellowship education, 35.7% of AFWs described operative experience and research requirements, and 28.6% of AFWs included information on didactics, but less than 11% outlined rotation schedules, annual meetings, or academic conferences. None listed fellow evaluation criteria. Regarding recruitment information, 85.7% of AFWs had program descriptions, but less than 33% listed affiliated hospitals, faculty, or current fellows. Of the 67.9% of AFWs that listed eligibility criteria, none listed selection criteria. When programs were stratified by the type of aesthetic training offered, fellowships that offered whole-body aesthetic training had significantly more recruitment content (P = 0.0394) on their websites than those specializing in facial aesthetics only.

Conclusions: There is a paucity of information regarding recruitment and education on AFWs. Programs should strive to create a comprehensive website to better attract and assist residents applying for fellowship.
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http://dx.doi.org/10.1097/SAP.0000000000002518DOI Listing
July 2020

Update on the diagnosis and management of autoimmune encephalitis.

Clin Med (Lond) 2020 07;20(4):389-392

The Walton Centre NHS Foundation Trust, Liverpool, UK, Institute for Infection and Global Health, Liverpool, UK and NIHR Health Protection Research Unit for Emerging and Zoonotic Infection at University of Liverpool, Liverpool, UK

In recent years, autoimmunity has been increasingly recognised as an important cause of encephalitis. Many different antibodies are now known to target antigens on the neuronal surface, and some of these are associated with characteristic clinical presentations, although seronegative cases are also recognised. Autoimmune encephalitis may mimic other conditions, including primary psychiatric disorders, particularly early in the disease. Because early immune treatment of autoimmune encephalitis improves patient outcomes, and indeed many make a good recovery, it is important to recognise these syndromes promptly.
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http://dx.doi.org/10.7861/clinmed.2020-0241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385764PMC
July 2020

Rapid detection of microbiota cell type diversity using machine-learned classification of flow cytometry data.

Commun Biol 2020 Jul 15;3(1):379. Epub 2020 Jul 15.

Department of Fundamental Microbiology, University of Lausanne, 1015, Lausanne, Switzerland.

The study of complex microbial communities typically entails high-throughput sequencing and downstream bioinformatics analyses. Here we expand and accelerate microbiota analysis by enabling cell type diversity quantification from multidimensional flow cytometry data using a supervised machine learning algorithm of standard cell type recognition (CellCognize). As a proof-of-concept, we trained neural networks with 32 microbial cell and bead standards. The resulting classifiers were extensively validated in silico on known microbiota, showing on average 80% prediction accuracy. Furthermore, the classifiers could detect shifts in microbial communities of unknown composition upon chemical amendment, comparable to results from 16S-rRNA-amplicon analysis. CellCognize was also able to quantify population growth and estimate total community biomass productivity, providing estimates similar to those from C-substrate incorporation. CellCognize complements current sequencing-based methods by enabling rapid routine cell diversity analysis. The pipeline is suitable to optimize cell recognition for recurring microbiota types, such as in human health or engineered systems.
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http://dx.doi.org/10.1038/s42003-020-1106-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363847PMC
July 2020

Ten Years' Experiences in the Treatment of Nonaneurysmal Subarachnoid Hemorrhage: A Retrospective Analysis of Outcome Parameters in a Single-Center Study.

Asian J Neurosurg 2020 Apr-Jun;15(2):315-321. Epub 2020 Apr 7.

Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar.

Objectives: Subarachnoid hemorrhage (SAH) with negative angiographic findings has a heterogeneous nature with variations in clinical course and outcome as compared to the aneurysmal SAH. It makes up to 15% of the spontaneous SAH and is characterized by milder clinical presentation. The purpose of this study was the analyses of risk factors, clinical observations, radiologic characteristics, and outcome in patients with nonaneurysmal SAH (NA-SAH).

Patients And Methods: In a retrospective design, 77 consecutive patients with NA-SAH were recruited from May 2008, to October 2018. All patients underwent conventional cerebral angiography. We stratified patients into two groups based on the distribution of blood on their CT scan into perimesencephalic (PM) and non-PM (NPM) SAH. We performed the Outcome using Glasgow Coma Scale (GCS) and modified Rankin scale (favorable mRS 0-2 vs. unfavorable mRS 3-6). Data were analyzed using IBM SPSS Statistics V22.0.

Results: The mean age at presentation was 48.5 ± 8.4 years with male predominance (71.4%). About 76.7% of the patients had headache and vomiting, most of the patients (75.3%) presented with GCS 15 at initial clinical presentation (61.03%) had NPM versus (38.96%) with PM characters in computed tomography scans. Fourteen (17.9%) patients developed hydrocephalus and 12 (15.3%) needed external ventricular drain placement, while none of the patients needed permanent shunt placement. However, all patients had a favorable clinical and functional outcome at discharge and at late follow-up (up to 3 months).

Conclusions: NA-SAH does not affect the short- and long-term prognosis. In our results, the pattern of bleeding affects the initial presentation, clinical course, and complications. The clinical and functional outcomes in the majority of our patients were comparable in both groups with good prognosis. Hypertension, smoking, and elevated venous pressure, such as a history of deep venous thrombosis and asthma might be considered as a risk factor.
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http://dx.doi.org/10.4103/ajns.AJNS_315_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335133PMC
April 2020

Protek Duo Rapid Deployment cannulation utilized to bridge to durable heartware left ventricular assist device.

J Card Surg 2020 Aug 11;35(8):2067-2069. Epub 2020 Jul 11.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.

A 43-year-old gentleman was transferred for management of acute on chronic cardiogenic shock (left ventricular ejection fraction < 10%). Upon arrival, we inserted a left axillary intra-aortic balloon pump for hemodynamic support. He underwent an emergent left and right-heart catheterization which showed patent stents and coronaries, in the setting of severely elevated pulmonary artery and pulmonary capillary wedge pressure. On hospital day 35, we escalated support to Centrimag in conjunction with a 31 French Protek Duo Rapid Deployment cannula. A centrimag cannula apical sewing cuff was sewn in continuous fashion along the left ventricular apex. Via modified seldinger technique, we tunneled the Protek Duo Rapid Deployment cannula through the silastic sewing cuff and the ventricular apex, traversing the aortic valve. On hospital day 50, he underwent left anterior thoracotomy and mini-sternotomy for implantation of durable Heartware left ventricular assist device. He was discharged home off inotropes and had resumed his normal activities. He is currently listed as status four for heart transplantation.
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http://dx.doi.org/10.1111/jocs.14775DOI Listing
August 2020

Recent advances in managing Peyronie's disease.

F1000Res 2020 20;9. Epub 2020 May 20.

Department of Urology, Leeds Teaching Hospitals, Leeds, UK.

Treating men with Peyronie's disease remains a challenging problem facing clinicians working across urology and sexual medicine fields. Patients can often be left disappointed by current treatment paradigms, and an overall lack of suitable molecular targets has limited the options for novel, effective medical therapy. Managing men with Peyronie's disease often involves careful counselling alongside multifaceted and possible combination treatments to help improve symptoms whilst ameliorating potential side effects of therapy. We review the latest medical literature and evidence in the contemporary management of Peyronie's disease.
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http://dx.doi.org/10.12688/f1000research.20557.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255896PMC
August 2020

Cardiac Rehabilitation in India: Results from the International Council of Cardiovascular Prevention and Rehabilitation's Global Audit of Cardiac Rehabilitation.

Glob Heart 2020 04 3;15(1):28. Epub 2020 Apr 3.

School of Kinesiology and Health Science, York University, Toronto, Ontario, CA.

Background: Cardiac rehabilitation (CR) is recommended in clinical practice guidelines for comprehensive secondary prevention. While India has a high burden of cardiovascular diseases (CVD), availability and nature of services delivered there is unknown. In this study, we undertook secondary analysis of the Indian data from the global CR audit and survey, conducted by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR).

Methods: In this cross-sectional study, an online survey was administered to CR programs, identified in India by CR champions and through snowball sampling. CR density was computed using Global Burden of Disease study ischemic heart disease (IHD) incidence estimates.

Results: Twenty-three centres were identified, of which 18 (78.3%) responded, from 3 southern states. There was only one spot for every 360 IHD patients/year, with 3,304,474 more CR spaces needed each year. Most programs accepted guideline-indicated patients, and most of these patients paid out-of-pocket for services. Programs were delivered by a multidisciplinary team, including physicians, physiotherapists, among others. Programs were very comprehensive. Apart from exercise training, which was offered across all centers, some centers also offered yoga therapy. Top barriers to delivery were lack of patient referral and financial resources.

Conclusions: Of all countries in ICCPR's global audit, the greatest need for CR exists in India, particularly in the North. Programs must be financially supported by government, and healthcare providers trained to deliver it to increase capacity. Where CR did exist, it was generally delivered in accordance with guideline recommendations. Tobacco cessation interventions should be universally offered.
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http://dx.doi.org/10.5334/gh.783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218762PMC
April 2020

C3d-positive donor-specific antibodies have a role in pretransplant risk stratification of cross-match-positive HLA-incompatible renal transplantation: United Kingdom multicentre study.

Transpl Int 2020 Sep 25;33(9):1128-1139. Epub 2020 Jun 25.

Warwick Medical School, University of Warwick, Coventry, UK.

Anti-HLA-antibody characteristics aid to risk-stratify patients and improve long-term renal graft outcomes. Complement activation by donor-specific antibody (DSA) is an important characteristic that may determine renal allograft outcome. There is heterogeneity in graft outcomes within the moderate to high immunological risk cases (cross-match-positive). We explored the role of C3d-positive DSAs in sub-stratification of cross-match-positive cases and relate to the graft outcomes. We investigated 139 cross-match-positive living-donor renal transplant recipients from four transplant centres in the United Kingdom. C3d assay was performed on serum samples obtained at pretreatment (predesensitization) and Day 14 post-transplant. C3d-positive DSAs were found in 52 (37%) patients at pretreatment and in 37 (27%) patients at Day 14 post-transplant. Median follow-up of patients was 48 months (IQR 20.47-77.57). In the multivariable analysis, pretreatment C3d-positive DSA was independently associated with reduced overall graft survival, the hazard ratio of 3.29 (95% CI 1.37-7.86). The relative risk of death-censored five-year graft failure was 2.83 (95% CI 1.56-5.13). Patients with both pretreatment and Day 14 C3d-positive DSAs had the worst five-year graft survival at 45.5% compared with 87.2% in both pretreatment and Day 14 C3d-negative DSA patients with the relative risk of death-censored five-year graft failure was 4.26 (95% CI 1.79, 10.09). In this multicentre study, we have demonstrated for the first time the utility of C3d analysis as a distinctive biomarker to sub-stratify the risk of poor graft outcome in cross-match-positive living-donor renal transplantation.
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http://dx.doi.org/10.1111/tri.13663DOI Listing
September 2020

Understanding the Lymphatics: Review of the N Category in the Updated TNM Staging of Cancers of the Digestive System.

AJR Am J Roentgenol 2020 07 20;215(1):58-68. Epub 2020 May 20.

Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023.

The N category has been significantly updated in the 8th edition of the American Joint Committee on Cancer's TNM classification. To ensure correct tumor staging, prognosis, and management, it is critical to be aware of these changes. This article reviews the updated N category, organ-specific regional lymph nodes, and lymphatic drainage pathways for cancers of the digestive system from the esophagus to the anal canal. Detection of lymph node involvement may be challenging, and knowledge of nodal characteristics, lymphatic drainage pathways, and imaging modalities is essential to optimize detection rate to ensure accurate staging, prognosis estimation, and streamlined management.
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http://dx.doi.org/10.2214/AJR.19.22636DOI Listing
July 2020

Telemedicine During COVID-19 for Outpatient Sports and Musculoskeletal Medicine Physicians.

PM R 2020 09 10;12(9):926-932. Epub 2020 Jul 10.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA.

Introduction: The global pandemic due to SARS-CoV-2 has resulted in an expansion of telemedicine. Measures of quality and barriers for rapid use by patients and physicians are not well described.

Objective: To describe results from a quality improvement initiative during a rapid adoptive phase of telemedicine during the pandemic.

Design: Patient and physician satisfaction with synchronous audiovisual telemedicine visits was measured during the early adoptive phase (6 April 2020-17 April 2020) within the division of sports medicine in an academic Physical Medicine and Rehabilitation (PM&R) department. Patients were invited to participate in a quality improvement initiative by completing an online survey at the end of a telemedicine visit. Physicians completed a separate survey.

Primary Outcome Measures: Patient measures included visit type, duration of encounter, quality, and satisfaction. Physicians reported on experiences performed telemedicine.

Results: Surveys were completed by 119 patients (293 telemedicine encounters, response rate 40.6%) and 14 physiatrists. Telemedicine was utilized primarily for follow-up visits (n = 74, 70.6%), and the most common duration was 15 to 29 minutes. Patients rated their telemedicine visit as "excellent" or "very good" across measures (91.6%-95.0%) including addressing concerns, communication, developing a treatment plan, convenience, and satisfaction. Value of completing a future telemedicine visit was measured at 84.9%. Most reported estimated travel time saved was in excess of 30 minutes. Rate of no-show was 2.7%. Most physicians (57.1%) had no prior experience with telemedicine visits, and most were comfortable performing these visits after completing 1 to 4 sessions (71%). Nearly all physicians (92.9%) rated their telemedicine experience as very good or excellent. The key barrier identified for telemedicine was technical issues. All physicians reported plans to perform telemedicine visits if reimbursement continues.

Conclusions: In summary, rapid expansion of telemedicine during the COVID-19 pandemic was well-received by a majority of patients and physicians. This suggests feasibility in rapid expansion of telemedicine for other outpatient sports medicine practices.
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http://dx.doi.org/10.1002/pmrj.12422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276758PMC
September 2020

COVID-19: A Time for Alternate Models in Cardiac Rehabilitation to Take Centre Stage.

Can J Cardiol 2020 06 25;36(6):792-794. Epub 2020 Apr 25.

Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana, USA.

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http://dx.doi.org/10.1016/j.cjca.2020.04.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195273PMC
June 2020

Baseline Flight Potential of Euschistus servus (Hemiptera: Pentatomidae) and Its Implications on Local Dispersal.

Environ Entomol 2020 06;49(3):699-708

Department of Entomology and Plant Pathology, North Carolina State University, 207 Research Station Road, Plymouth, NC.

The brown stink bug, Euschistus servus (Say), is a damaging pest of multiple crops in the southeastern United States. In addition to crops, both the weedy field borders and wooded areas of a typical farmscape in this region harbor E. servus host plants, many of which are temporally and spatially limiting in availability or nutritional suitability. Therefore, local dispersal is required so that individuals efficiently track and utilize host resources. This research sought to establish the baseline flight capacity of adult E. servus across the season in relation to body weight, sex, and plant host use with a flight mill system. Across this 2-yr study, among the individuals with a flight response in the flight mill, 90.1% of individuals flew in a range of >0-1 km, with an individual maximum flight distance of 15.9 km. In 2017, mean total distance flown varied across the season. Except for the individuals collected from corn in 2019, during both 2017 and 2019, the highest numerical mean flight potential occurred soon after overwintering emergence and a relatively low flight potential occurred during the cropping season. Individuals collected from wheat, corn, and early season weeds lost a higher proportion of body weight after flight than did individuals from soybean and late season weeds. The baseline dispersal potential information generated from this study can be extrapolated to the farmscape level aiming to develop, plan, and implement E. servus management programs.
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http://dx.doi.org/10.1093/ee/nvaa041DOI Listing
June 2020