Publications by authors named "Abhijit Patil"

57 Publications

Sporadic Creutzfeldt-Jakob disease: A case report.

Am J Emerg Med 2021 Jul 22. Epub 2021 Jul 22.

Orlando Regional Medical Center, Orlando, Florida, United States of America.

Being considered among the most fatal neurological conditions, Creutzfeldt-Jakob disease is a transmissible spongiform encephalopathy characterized by its unknown etiology and rapidly progressive neurodegenerative symptoms that often lead to a mean survival of 6 to 12 months. The accumulation of the prionic protein causes brain matter degeneration, which leads to a set of clinical findings that include rapidly progressive dementia, myoclonus, tremors, cerebellar ataxia, and extrapyramidal signs. This clinical presentation is non-specific, which makes CJD a very difficult condition to diagnose, due to the low level of clinical suspicion. However, combining this clinical presentation with neuroimaging, a lumbar puncture and an encephalogram will help us make the correct diagnosis. We present the case of a 57-year-old male presenting to the Emergency department with complaint of personality change and intermittent memory loss. The patient's physical exam was significant for resting pill roll tremor, bilateral cogwheel rigidity, dysmetria, and shuffling gait. Magnetic resonance imaging of his brain showed symmetric bilateral diffusion signal abnormality involving the cortex, bilateral caudate heads and putamina. Continuous electroencephalogram revealed multiple bifrontal delta discharges with triphasic morphology. Lumbar puncture was significant for presence of 14-3-3 protein in cerebrospinal fluid. The multiple examinations performed in conjunction with the previous findings supported the diagnosis of acute encephalopathy secondary to sporadic CJD.
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http://dx.doi.org/10.1016/j.ajem.2021.07.038DOI Listing
July 2021

: The New Culprit on the Block Causing Denture Stomatitis? An Study.

J Contemp Dent Pract 2021 May 1;22(5):517-521. Epub 2021 May 1.

Ahemdabad, Gujarat, India.

Aim: The present study aimed to carry out DNA extraction and polymerase chain reaction (PCR) amplification to isolate the physiological and phenotypic traits of and in denture wearer patients with and without denture-induced stomatitis.

Materials And Methods: A total sample size of 160 participants were divided into two equal groups (80 each), patients in the study group having 40 males and 40 females with Newton type II denture stomatitis, and in the control group, healthy 40 males and 40 females those who wear complete denture were selected. All the samples were collected from the hard palate with a sterile swab and inoculated on CHROM agar plate; samples that displayed dark green colored colonies were selected for DNA extraction. DNA isolation was done on agarose gel using electrophoresis. Biorad gene identification was used. Strands depicting the presence of DNA in particular samples were identified, and further standardization of the procedure was done. PCR amplification was done using species-specific primer, preset to the hyphal wall of the protein 1 gene with the CRR forward and reverse primers, under strict standard conditions with reverse transcriptase technique.

Results: Results showed that prevalence of was more in females with denture stomatitis which was 67.50% than in males, i.e., 52.50%, and prevalence of was found in one female and in one male who were having denture stomatitis and it was not isolated from patients without denture stomatitis. Statistical analyses were performed using the Chi-square test.

Conclusion: Denture stomatitis is the most common problem faced by long-term denture wearers, with as one of the causative organisms. However, recent findings show an emerging pathogenic yeast species, , which was isolated from denture-induced stomatitis candidates in the present study, which is closely related to the species. The identification of candidal strains causing denture stomatitis with DNA extraction and PCR amplification and its management by determination of its susceptibility to antifungals may improve the treatment outcome of the same.

Clinical Significance: Candidiasis is the most frequently seen mucocutaneous infection of the oral cavity especially in denture wearers. It is caused mainly by the genus is phenotypically similar but genotypically different from . This affects the treatment outcome drastically as there is enough literature suggesting resistance to the common antifungal drugs. Hence, drugs like fungus-specific calcineurin inhibitors should also be considered in resistant patients. Therefore, DNA identification of genus plays a major role in deciding the treatment outcome. How to cite this article: Patil A, Boparai NK, Shankargouda SB, : The New Culprit on the Block Causing Denture Stomatitis? An Study. J Contemp Dent Pract 2021;22(5):517-521.
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May 2021

Behavioral Biometric Data Analysis for Gender Classification Using Feature Fusion and Machine Learning.

Front Robot AI 2021 7;8:685966. Epub 2021 May 7.

Department of MCA, KLE Technological University, Hubballi, India.

Biometric security applications have been employed for providing a higher security in several access control systems during the past few years. The handwritten signature is the most widely accepted behavioral biometric trait for authenticating the documents like letters, contracts, wills, MOU's, etc. for validation in day to day life. In this paper, a novel algorithm to detect gender of individuals based on the image of their handwritten signatures is proposed. The proposed work is based on the fusion of textural and statistical features extracted from the signature images. The LBP and HOG features represent the texture. The writer's gender classification is carried out using machine learning techniques. The proposed technique is evaluated on own dataset of 4,790 signatures and realized an encouraging accuracy of 96.17, 98.72 and 100% for k-NN, decision tree and Support Vector Machine classifiers, respectively. The proposed method is expected to be useful in design of efficient computer vision tools for authentication and forensic investigation of documents with handwritten signatures.
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http://dx.doi.org/10.3389/frobt.2021.685966DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8139629PMC
May 2021

Initial experience with slimmest single-use flexible ureteroscope Uscope PU3033A (PUSEN™) in retrograde intrarenal surgery and its comparison with Uscope PU3022a: a single-center prospective study.

World J Urol 2021 Oct 10;39(10):3957-3962. Epub 2021 May 10.

Muljibhai Patel Urological Hospital, Nadiad, India.

Purpose: Single-use disposable digital flexible ureterorenoscope has become an attractive option to reusable scope with many advantages. Currently available single-use digital fURS have outer shaft diameter above 9 Fr which requires large access sheath insertion and sometimes double J stent placement. Recently, 7.5 Fr single-use digital fURS is introduced in market by Pusen. Objective of this study is to compare two Pusen single-use scopes in the clinical setting: 7.5 Fr Uscope PU3033A and 9.5 Fr Uscope PU3022A.

Methods: 30 patients, having renal stones < 2 cm, planned for RIRS were prospectively randomized to two groups: group 1 had 15 patients in which 7.5 Fr Uscope PU3033A and group 2 had 15 patients in which 9.5 Fr Uscope PU3022A was used. The various pre-operative, intra-operative, and post-operative parameters at 1 month along with complications were evaluated for both the scopes by a single surgical team.

Results: Pre-operative parameters including stone characteristics were comparable in both the groups. Three patients in group 2 needed ureteric dilatation prior to 11/13 access sheath insertion, while 10/12 Fr access sheath was placed in all patients in group 1 without manipulation (p = 0.06). Intra-operative vision was comparable in both scopes with an empty working channel and with laser. Hazy vision while lasing in two and one patient in group 1 and group 2, respectively (p = 0.54). In group 1, one had fever and UTI, while in group 2, one had fever post-operatively.

Conclusion: 7.5 Fr Uscope PU3033A could be introduced with smaller access sheath. The vision, deflection, maneuverability is comparable to 9.5 Fr Uscope PU3022a.
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http://dx.doi.org/10.1007/s00345-021-03707-4DOI Listing
October 2021

Myelolipoma of Kidney: A Rare Extra-Adrenal Tumor in an Unusual Site.

Int J Appl Basic Med Res 2021 Jan-Mar;11(1):60-62. Epub 2021 Jan 26.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.

Myelolipoma of the kidney is a very rare benign disease which is composed of mature adipose tissue admixed with mature hematopoietic elements in varying proportions. The most common location of myelolipoma is in the adrenal glands, but extra-adrenal myelolipomas in other locations such as the retroperitoneum, presacral region, pelvis, and mediastinum has also been reported. In this case report, we present a case of huge extra-adrenal myelolipoma in renal parenchyma which is rare site for its origin. We report a case of extra-adrenal myelolipoma occurring in the left kidney of a 46-year-old Indian man. We describe the radiological and clinicopathologic features of this unusual tumor with a review of the literature. This case is noteworthy because the tumor was very enlarged and its site was unusual. It is generally impossible to distinguish extra-adrenal myelolipoma from other retroperitoneal tumors by radiological imaging given the rarity of tumor more cases need to be reported to elucidate its biological behavior.
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http://dx.doi.org/10.4103/ijabmr.IJABMR_341_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8025959PMC
January 2021

Epilepsy in Ring Chromosome 20 Syndrome Might Have Variable Clinical Features.

Ann Indian Acad Neurol 2020 Sep-Oct;23(5):718-722. Epub 2020 Jun 5.

Department of Pediatric Neurology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

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http://dx.doi.org/10.4103/aian.AIAN_32_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887504PMC
June 2020

A fruit-tissue (apple) based training model for transurethral resection of prostate: face, content and construct validation.

Am J Clin Exp Urol 2020 15;8(6):177-184. Epub 2020 Dec 15.

Muljibhai Patel Urological Hospital Nadiad, Gujarat.

Aims And Objectives: To establish face, content and construct validity of an innovative fruit-tissue (apple) based transurethral resection of prostate (TURP) training model devised at our institute.

Method And Material: Six consultants, three fellows and 16 residents performed TURP on the new fruit-tissue (apple) based TURP model for ten minutes after watching a demo-video. The procedure was videographed. At the end, participants answered a set of questionnaires regarding their experience. The video and the apple both were examined by blinded separate assessors based on pre-decided parameters. Statistical analysis was done to find out the face, content and construct validity of the training model.

Results: Participants were divided into two groups, expert and novice, based TURP surgery experience. The model was positively rated (lowest median value 4) by all novice for its 'realism' and 'acceptability'. The expert group also felt that the model reproduced real TURP experience (lowest median value 4). Thus, both face and content validity were established. The expert group resected more tissue (18.3±2.5 gm vs 10.3±3.4 gm; P<0.001) with less irrigation fluid (1566.6±187.0 ml vs 2112.5±344.2 ml; P<0.001) removing more chips (39.8±6.2 vs 25.6±3.0; P<0.001) and orientated themselves faster (63.3±12.2 sec vs 90.3±12.7 sec; P<0.001). The assessors' subjective evaluation of videos and apples both favored the experts. The model can differentiate 'expert' from 'novice', thus establishing 'construct validity'.

Conclusion: The new fruit-tissue (apple) based TURP model is a realistic and acceptable TRUP training model with proven face, content and construct validity.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811922PMC
December 2020

A Single-Center Prospective Comparative Study of Two Single-Use Flexible Ureteroscopes: LithoVue (Boston Scientific, USA) and Uscope PU3022a (Zhuhai Pusen, China).

J Endourol 2021 03 21;35(3):274-278. Epub 2021 Jan 21.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.

Single-use flexible ureteroscopes have the benefit of decreasing infection transmission, avoiding sterilization need, and no maintenance cost. Primary objective was to compare performance and surgical outcomes with two single-use ureteroscopes: LithoVue (Boston Scientific, USA) and Uscope PU3022a (Zhuhai Pusen, China) with secondary objective being to compare vision by independent endourologist blinded to ureteroscope manufacturer. Fifty patients undergoing retrograde intrarenal surgery with <2 cm renal stones were prospectively allocated: Group 1 (25 patients) for LithoVue and group 2 (25 patients) for Uscope. Pre-, intra-, and postoperative parameters were evaluated. Vision of both ureteroscopes with and without accessory was evaluated by an independent endourologist, blinded to the make of the ureteroscope. Stone clearance was assessed with kidney, ureter, and bladder radiograph (KUB) and ultrasonography KUB at 1 month. Student's -test for quantitative and chi-square for categorical data was used. Pre- and intraoperative parameters such as need for ureteral dilatation ( > 0.05), ureteral access-sheath size ( = 0.78), accessibility to pelvicaliceal system ( > 0.05), and maneuverability ( > 0.05) were comparable in both groups. Lower-pole access was possible in all cases of LithoVue and slightly difficult in three cases of Uscope ( > 0.5). Intraoperative vision was hazy in four cases of LithoVue and eight cases of Uscope ( = 0.32) during lasing along with three cases of Uscope with accessory ( = 0.24). Blinded endourologist reported more cases of hazy vision with or without accessory or lasing in Uscope arm ( > 0.05). One device had malfunction in LithoVue arm. Complete stone clearance was achieved in all cases at 1 month. We conclude that performance of these two single-use ureteroscopes, LithoVue and Uscope, is comparable in clinical settings with similar clinical outcomes and complications.
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http://dx.doi.org/10.1089/end.2020.0409DOI Listing
March 2021

A clinical experience of thulium fibre laser in miniperc to dust with suction: a new horizon.

World J Urol 2021 Jul 22;39(7):2727-2732. Epub 2020 Sep 22.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.

Purpose: To report safety and efficacy of mini-PCNL with suction attached to sheath combined with high-power Thulium Fibre laser (TFL). The secondary aim was to evaluate optimal laser settings for maximum stone dusting.

Materials And Methods: Prospective, single arm study was conducted from June 2019-December 2019 using miniPCNL with suction and TFL in 54 patients with renal stones < 3 cm. Stone fragments for each laser setting were independently retrieved and segregated according to size(< 1 mm,1-3 mm, > 3 mm) and weighed. Xray/CT scan imaging was performed in all patients within 48 h and 30 days to assess stone clearance. Optimal laser settings were evaluated for maximum dusting.

Results: Mean stone size was 18.32 ± 6.37 mm, volume was 2337.75 ± 1996.84mm and stone density was 1300.55 ± 435.32 HU. Total operative time was 39.85 ± 20.52 min, laser time was 10.08 ± 7.41 min and stone fragmentation rate was 5.02 ± 3.93 mm/s. The procedure was completely tubeless in 37.04%, nephrostomy tube in 37.04% and DJ stent placed in 25.92%. Postoperatively, three patients had urinary infection (Clavien 2). Complete stone clearance at 48 h was achieved in 35 (64.8%) cases. 19 patients (35.2%) who had residual fragments at 48 h, had 100% clearance at one month on CT/Xray KUB.

Conclusions: MiniPCNL using a nephrostomy sheath with suction along with high power Thulium Fibre Laser is safe and effective modality for lithotripsy. An initial laser setting of 0.2 J and 125-200 Hz was optimal for maximum dusting and simultaneous aspiration. Randomized comparative studies with other energy sources are being considered.
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http://dx.doi.org/10.1007/s00345-020-03458-8DOI Listing
July 2021

Validity of a Novel Chicken and Porcine Model for Laparoscopic Neobladder Reconstruction.

J Endourol 2021 01 3;35(1):109-115. Epub 2020 Nov 3.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.

Simulation-based training in laparoscopic urology is essential, as these surgeries require a skill set different from routine urologic procedures. We aim to describe and validate the chicken and porcine intestine model for laparoscopic neobladder reconstruction. Prospective observational study was conducted at our institute. Twenty novice and 20 trained laparoscopic surgeons were included in the study. The relevant chicken anatomy and surgical steps were described to all the surgeons. The surgeons were asked to fill a nine-point questionnaire after completing the exercise comprising bowel organization, ability to do urethroneovesical anastomosis, suturing time, suturing similarity, quality of suturing, tissue feel, integrity of anastomosis, realism, and usefulness of model after finishing the procedure, and score it on a scale of 1-5. Time taken to perform the entire exercise was noted in addition. An independent expert observer retrospectively rated the urethroneovesical anastomosis on a scale of 1-5. All the participants in the study gave a mean score of 3.5 or more to all the questions asked in the questionnaire. Both the groups rated the usefulness of the model highly with a mean score of 4.6 and 4.45, respectively. The mean score of the questionnaire was 35.9 and 36, respectively, for both the groups. The quality of urethroneovesical anastomosis as observed by an expert was better in the expert group ( = 0.001). The chicken and porcine model for laparoscopic neobladder reconstruction is a useful and effective training tool. This model has face, content, and construct validity to be used as a teaching and training tool in laparoscopic urology.
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http://dx.doi.org/10.1089/end.2020.0313DOI Listing
January 2021

Migration of Hem-O-Lok in Pelvicaliceal System Mimicking Renal Calculus Following Robotic Nephron-Sparing Surgery: A Case Report with Review of Literature.

J Endourol Case Rep 2020 11;6(1):22-25. Epub 2020 Mar 11.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.

Migration of Hem-O-Lok clips in pelvicaliceal system after nephron-sparing surgery (NSS) is rare. We present a rare case of clip migration 8 years after robotic NSS. A 61-year-old female presented with right flank pain and fever 8 years after robotic NSS for clear cell carcinoma. She was reported to have an 11 mm right renal calculus (570 HU) on CT scan. She underwent flexible ureteroscopy that revealed three Hem-O-Lok clips with encrustations. We removed the clips after laser lithotripsy of the encrusted clips. She is now asymptomatic on follow-up. The possibility of intrarenal migration of Hem-O-Lok clips should be kept as differential diagnosis for patients presenting as renal calculus postminimal access NSS. They could act as nidus for stone formation, leading to recurrent urinary infection. Excessive tension on renorrhaphy sutures should be avoided to prevent migration of clips. The underrunning of any clip in the renal bed during reconstruction should be the standard of care.
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http://dx.doi.org/10.1089/cren.2019.0087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383411PMC
March 2020

Unique, Cost-effective and Retentive Removable Prosthesis to Rehabilitate Long Span Kennedy's Class I Edentulism with Custom Attachment System: A Case Report.

J Contemp Dent Pract 2020 Feb 1;21(2):215-218. Epub 2020 Feb 1.

Department of Prosthodontics and Crown and Bridge, KAHER'S KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India.

Aim: This case report describes about a distinctive custom-made attachment on the abutment teeth to improve the retention and stability of the removable partial denture (RPD). It also throws light on the cost-effective method for altering the abutment teeth with the aid of the crowns and custom-made attachments.

Background: Achieving retention in Kennedy's class I bilateral edentulism usually affects the abutment teeth's periodontal health and eventually the retention is compromised. Distal extension edentulism also affects patient's masticatory efficiency. The rehabilitation of a patient with the long span Kennedy's class I condition complicates the problem because of the unavailability of enough abutments to support the prosthesis. Conventional removable prosthesis with clasps and cantilever fixed partial prosthesis are not advisable in this situation for the same reason.

Case Description: A case with Kennedy's class I modification 1 partially edentulous arch with 1st and 2nd molars missing along with central incisors was rehabilitated with an inexpensive custom attachment using die pin and sleeve for giving a fixed prosthesis on abutment teeth and removable prosthesis with missing teeth.

Conclusion: This technique has advantages of retention better than conventional RPDs, protection of abutment health by restoring it with crown, easy to place and remove and very cost-effective.

Clinical Significance: The entire technique demands less skill compared to semi precision and precision attachments.
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February 2020

Five compelling UTI questions after kidney transplant.

World J Urol 2020 Nov 7;38(11):2733-2742. Epub 2020 Apr 7.

Department of Urology, Shahid Labbafinejad Medical Center, Tehran, Iran.

Purpose: Urinary tract infection (UTI) is the most common bacterial infection among infectious complications in kidney transplant recipients (KTR). After transplantation, infections can result from surgical complications, donor-derived infections, pre-existing recipient infections, and nosocomial infections. Post-transplant infection is still a major cause of morbidity, mortality, graft dysfunction and rejection. In this paper, we aimed to review a few compelling questions in kidney transplantation (KTX).

Methods: To identify relevant clinical questions regarding KTX and UTI a meeting was conducted among physicians involved in the KT program in our hospital. After discussion, several clinically relevant questions related to UTI after KTX. The 5 first rated in importance were judged generalizable to other clinical settings and selected for the purposes of this review.

Results: Nearly half of the patients present in the first three months of transplant with UTI. The most common uropathogens in post-transplant UTIs are Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. Risk factors for UTI include female sex, advanced age, recurrent UTI before transplant, prolonged urethral catheterization, delayed graft function, and cadaveric kidney transplant.

Conclusion: The incidence of post-transplant UTI is similar in both developed and developing countries. E.coli is the most common pathogen in most of studies. Cadaveric donor and post-dialysis transplantation are defined as independent risk factors for post-transplant UTI. Further studies are still required to identify risk factors after kidney transplantation and UTI's importance for graft function and patient outcome.
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http://dx.doi.org/10.1007/s00345-020-03173-4DOI Listing
November 2020

Localization of acute pyelonephritis in pyrexia of unknown origin using FDG PET/CT.

Asia Ocean J Nucl Med Biol 2020 ;8(1):79-83

SPECT Lab, Nuclear Medicine Services, Pune, Maharashtra, India.

Objectives: Acute pyelonephritis presents with high-grade fever, dysuria, flank pain, leukocytosis, and microscopic hematuria. Urine culture aids in the diagnosis of this infection. It can be complicated or uncomplicated. Complicated pyelonephritis includes uncontrolled diabetes, transplant, pregnancy, acute or chronic renal failure, structural abnormality of the urinary tract, immunocompromised state, and hospital-acquired infections. Gram-negative bacteria commonly involved are and . The FDG PET/CT helps detect occult causes of fever, such as skeletal tuberculosis, thyroiditis, and lymphoma, when other investigations are inconclusive. We present three cases of pyrexia of unknown origin (PUO) in whom FDG PET/CT helped localize the focus of infection in the kidneys.

Methods: The F-FDG PET/CT was performed on all three cases and images were acquired using the Biograph Horizon PET/CT system.

Results: A cortical-based focus of FDG uptake was localized in the kidneys. The focus of abnormality was persistent following diuretic administration at 1-hour delayed regional image. Two cases had supportive evidence of pyelonephritis on DMSA scan. One case also had frank pus drained after DJ stenting of the affected side. All of them responded to treatment.

Conclusion: Physiologic excretion of FDG in the urinary tract may interfere with the detection of the focus of infection in the kidneys on FDG PET/CT. However, occult infection in the kidneys may be detected with adequate precautions, such as the use of diuretics and delayed imaging, as illustrated in this case report. Routine investigations were noncontributory in all three cases presenting with PUO. However, FDG PET provided a diagnostic clue for pyelonephritis.
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http://dx.doi.org/10.22038/aojnmb.2019.14242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994777PMC
January 2020

A low-profile universal attachment system with housing welded to metal reinforcement framework to retain mandibular implant overdenture: A clinical report.

J Indian Prosthodont Soc 2019 Oct-Dec;19(4):374-378. Epub 2019 Oct 10.

Department of Prosthodontics and Crown and Bridge, Bharati Vidyapeeth Deemed University Dental College and Hospital, Pune, Maharashtra, India.

Literature has proved that implant-retained overdenture is one of the best prosthetic options in the rehabilitation of complete edentulism. Tissue-supported implant-retained overdentures have been an appropriate treatment modality for atrophic mandibular ridges. In this case report, the patient presented with Class I maxillomandibular relationship and Class II Prosthodontic Diagnostic Index. The patient was concerned about esthetics as well as the retention of the lower denture. Taking into consideration the above concerns, an implant-retained mandibular overdenture was the chosen treatment modality. There are numerous attachment systems that have been used to improve the retention, stability, and support of implant-retained overdenture. Every attachment system has its own set of advantages. The OT Equator is a new line of low-profile attachment which is a radically modified OT-CAP Normo. The rationale for using this attachment is that it is considered the smallest attachment system available with the least overall dimension. It is a resilient and self-aligning attachment system which can be used in limited inter-arch space situation. OT equator derives its name from the OT Dental Laboratory (Bologna, Italy) used as a brand name. Considering these advantages, this was the chosen attachment and proved beneficial in terms of both patient satisfaction and the overall success of the treatment.
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http://dx.doi.org/10.4103/jips.jips_129_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6803799PMC
October 2019

Robotic-assisted kidney transplant: a single center experience with median follow-up of 2.8 years.

World J Urol 2020 Oct 5;38(10):2651-2660. Epub 2019 Sep 5.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.

Purpose: The main aim of the paper is to report a single-centre experience with RAKT, focusing on surgical, perioperative and functional outcomes at a median follow-up of 2.8 years.

Methods: Data of 26 RAKT patients was prospectively collected from December 2014 to February 2019 with follow-up of up to 55 months. All donors were done laparoscopically. We followed Vattikuti-Medanta technique with modification of using pfannenstiel incision instead of Gelpoint and patient positioned in steep Trendelenburg position (30°) with leg split position. Hypothermia was maintained using a "modified graft hypothermia jacket". The engrafted kidney is oriented with the vessels being tagged with Prolene sutures.

Results: The mean BMI was 26.1 ± 4.7. The mean warm, cold and total ischemia times were 4.8 ± 1.1, 113.8 ± 20.9 and 118.7 ± 21.2 min, respectively. Mean rewarming time was 62.5 ± 10 min. The mean post-operative day (POD) 1, 3, 7, 30, 6 months, 1 year and most recent creatinine was 3.4, 2.4, 1.8, 1.4,1.2, 1.2 and 1.69 mg/dl. There was no case of delayed graft dysfunction (DGF) with graft survival of 1.8-55 months. The mean GFR at POD 1, 1 month and 1 year was 24, 53.16 and 64.6. We had two intraoperative complications-one topsy turvy graft placement with anastomosis of donor ureter to native ureter and other had to be converted to open technique after anastomosis to control graft surface bleeding. Three postoperative complications-one patient has graft pyelonephritis which was managed conservatively with antibiotics. Two patients had lymphocele. One patient was managed with just aspiration while the other required laparoscopic de-roofing of the lymphocele. The mean hospital stay was 13.5 ± 3 days.

Conclusions: RAKT is feasible and safe only if performed by surgeons with appropriate background in robotic surgery and kidney transplantation after proper surgical training at experienced centres in the mid-term follow-up. Further studies need to confirm the long-term safety of RAKT.
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http://dx.doi.org/10.1007/s00345-019-02934-0DOI Listing
October 2020

Two South Indian Children with KCNT1-Related Malignant Migrating Focal Seizures of Infancy - Clinical Characteristics and Outcome of Targeted Treatment with Quinidine.

Ann Indian Acad Neurol 2019 Jul-Sep;22(3):311-315

Department of Neurology, Division of Paediatric Neurology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

gene encodes a sodium-gated potassium channel subunit that plays an important role in regulating excitability in neurons. Quinidine is a partial antagonist of this channel. We report the clinical characteristics of two south Indian children with -related epileptic encephalopathy. Both of them had very high seizure burden which were resistant to antiepileptic and dietary therapy. Pharmacological response to quinidine in these children is described. Case 1 had 30% reduction in seizure burden at 20 mg/kg/day and 80% reduction at 36 mg/kg/day; case 2 had 30% reduction at 20 mg/kg/day. Serial electrocardiography was used to monitor the cardiotoxicity. Serum quinidine levels were not measured due to nonavailability. A critical review on the current status of targeted treatment of -related epileptic encephalopathies with quinidine is attempted.
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http://dx.doi.org/10.4103/aian.AIAN_229_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613401PMC
July 2019

False-positive FDG PET CT Scan in Vertebral Hemangioma.

Asia Ocean J Nucl Med Biol 2019 ;7(1):95-98

SPECT Lab, Nuclear Medicine Services, Pune, Maharashtra, India.

FDG PET CT scan is considered to be a sensitive tool to detect skeletal metastasis in known malignancies. However, it's high sensitivity and low specificity may account for false positive diagnosis in cases of trauma, infection, inflammation and other benign conditions. Skeletal hemangioma is one of the common benign conditions which are typically ametabolic on FDG PET CT with no uptake on bone scan. However, rarely they may have atypical imaging features and appear hypermetabolic. Other imaging modalities such as MRI and CT scan have typical imaging findings for hemangioma and can be used for evaluation of focal hypermetabolic skeletal lesions. There are atypical imaging characteristics in each of these modalities. Hence when used judiciously they can complement each other and avoid a false positive test result. This case report highlights the importance of bone scan and CT scan in excluding pathological involvement of skeleton with false positive FDG PET scan result.
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http://dx.doi.org/10.22038/AOJNMB.2018.12010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352053PMC
January 2019

Amyotrophic Lateral Sclerosis and its Mimics/Variants: A Comprehensive Review.

J Clin Imaging Sci 2018 6;8:53. Epub 2018 Dec 6.

Department of Radiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.

Motor neuron diseases (MNDs) are a debilitating subset of diseases, which result in progressive neuronal destruction and eventual loss of voluntary muscular function. These entities are often challenging to distinguish and accurately diagnose given overlapping clinical pictures and overall rarity. This group of diseases has a high morbidity and mortality rate overall and delineating each type of disease can help guide appropriate clinical management and improve quality of life for patients. Of all MNDs, amyotrophic lateral sclerosis (ALS) is by far the most common comprising 80%-90% of cases. However, other mimics and variants of ALS can appear similar both clinically and radiographically. In this review, we delve into the epidemiological, physiological, neuroimaging, and prognostic characteristics and management of ALS and its most common MND mimics/variants. In doing so, we hope to improve accuracy in diagnosis and potential management for this rare group of diseases.
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http://dx.doi.org/10.4103/jcis.JCIS_40_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302559PMC
December 2018

Comparison of contrast-enhanced voiding urosonography with voiding cystourethrography in pediatric vesicoureteral reflux.

Turk J Urol 2018 May 6;44(3):261-267. Epub 2018 Mar 6.

TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India.

Objective: Voiding cystourethrography (VCUG) has been considered as the gold standard technique for the diagnosis of vesicoureteral reflux (VUR). But, it requires fluoroscopic guidance which expose children to radiation. Voiding urosonography (VUS) is technically analogous to VCUG and has the major advantage of zero radiation exposure. This study aims to determine the efficacy of contrast enhanced-VUS (ce-VUS) with respect to VCUG in diagnosing VUR.

Material And Methods: This study involves 30 children over a period of 3 years. All patients underwent a VCUG followed by the ce-VUS on the same day. All VUS studies were done by the same sonologist in the sonography department. The images were recorded and reviewed by the same sonologist before reporting.

Results: The median age of the patients was 51.53 months. There were 21 males and 9 females. On VCUG, 16 patients had no reflux, and 14 patients had reflux. On ce-VUS, 14 patients had no VUR, and 16 patients had VUR. Of the total 58 kidney-ureter units (KUUs), VUR was detected in 17 KUUs on VCUG and in 21 KUUs on ce-VUS. Thus, ce-VUS detected 4 refluxing units that were not seen on VCUG. In right KUUs, ce-VUS detected VUR in 3 units where no reflux was found in VCUG. In the 28 left KUUs, 25 units on ce-VUS showed concordance with the grade of VUR as detected by VCUG; 3 were discordant. Two units on ce-VUS showed a VUR one grade higher than the corresponding grade on VCUG and in one unit it was one grade lower. Thus, in total, ce-VUS picked up 4 cases which were missed by VCUG.

Conclusion: ce-VUS is a good imaging modality when compared to voiding cystourethrography to assess pediatric vesicoureteral reflux, in view of its superior diagnostic performance, feasibility and radiation safety for children.
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http://dx.doi.org/10.5152/tud.2018.76702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937646PMC
May 2018

Evaluation of Antibacterial Effect and Dimensional Stability of Self-disinfecting Irreversible Hydrocolloid: An in vitro Study.

J Contemp Dent Pract 2017 Oct 1;18(10):887-892. Epub 2017 Oct 1.

Department of Prosthodontics, KLE VK Institute of Dental Sciences, KLE University, Belagavi, Karnataka, India.

Aim: This study evaluated the antibacterial activity and dimensional stability of irreversible hydrocolloids mixed with different concentrations of chlorhexidine gluconate instead of water.

Materials And Methods: Experimental specimens (45 specimens) were prepared and allocated into three groups of 15 each. Group I: Impression material mixed with distilled water served as control. Groups II and III were prepared with 0.12 and 0.2% chlorhexidine gluconate solution, respectively. Specimens in each group were subjected to tests for dimensional stability. For antimicrobial activity, 30 specimens were prepared and allocated into three groups of 10 each named as group I (control), group II (0.12% chlorhexidine gluconate), and group III (0.2% chlorhexidine gluconate) similar to specimens for dimensional stability. Statistical analysis was performed using a one-way analysis of variance (ANOVA) and Tukey test.

Results: Zones of inhibition were observed around test specimens, but not around control specimens; there was a significant intergroup difference in the diameters of the inhibition zones. In the test for dimensional stability, no significant differences were detected among groups, and the accuracy was clinically acceptable.

Conclusion: Irreversible hydrocolloid impression material mixed with chlorhexidine exhibits varying degrees of antibacterial activity without influencing the dimensional stability of set material.

Clinical Significance: Many contagious diseases can be prevented by practical control of infection in the dental office. Chlorhexidine gluconate, as a mixing liquid, ensures disinfection of impression, and this method of disinfection is more convenient and avoids extra effort as in other disinfection techniques.
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http://dx.doi.org/10.5005/jp-journals-10024-2144DOI Listing
October 2017

Comparison of computed tomographic angiography and noncontrast magnetic resonance angiography in preoperative evaluation of living renal donors.

Indian J Urol 2017 Jan-Mar;33(1):30-35

Department of Urology, Malabar Institute of Medical Sciences, Calicut, Kerala, India.

Introduction: The computed tomographic angiography (CTA) renal donor protocol is an established method of preoperative renal vascular pedicle evaluation in prospective renal donors. However, CTA is associated with significant radiation exposure and intravenous contrast administration. The newer noncontrast-enhanced magnetic resonance angiography (NCE-MRA) techniques, especially arterial spin labeling (ASL) with steady-state free precession (SSFP) hold promise as an effective alternative. We prospectively compared CTA with NCE MRA for accuracy in the evaluation of renal arterial anatomy in prospective renal donors.

Methods: A total of 43 subjects underwent CTA followed by NCE MRA in a prospective comparative study. The number of renal arteries and early branching of renal arteries were noted in both kidneys in all subjects. Intermodality agreement was calculated using "K" (Kappa) statistics and 95% confidence interval for both modalities.

Results: A total of 63 single, 21 double, and 2 triple arteries were detected in 43 subjects on CTA. CTA showed an early branch in 17 kidneys. NCE MRAshowed 64 single arteries, 20 double arteries, and 2 triple arteries. A total of 14 kidneys showed an early branch. Unweighted Kappa statistic of agreement between CTA and NCE MRA for number of renal arteries and for frequency of early branching was 0.9707 and 0.8822, respectively.

Conclusions: The newer NCE MRA techniques such as ASL with SSFP among others are potential alternatives for CTA, in the evaluation of prospective renal donors.
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http://dx.doi.org/10.4103/0970-1591.195726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5264189PMC
February 2017

Isolated intrasplenic vascular calcifications in a child with type 1 diabetes mellitus---A case report.

J Clin Ultrasound 2017 Sep 3;45(7):438-440. Epub 2016 Nov 3.

Department of Radiology, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, India, 411018.

We report a case of vascular calcifications in the spleen of a 7-year-old girl who was diagnosed with type 1 diabetes mellitus (DM). The possible etiology for vascular calcifications might be medial sclerosis associated with DM. To the best of our knowledge, this finding has not yet been reported in the literature. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:438-440, 2017.
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http://dx.doi.org/10.1002/jcu.22418DOI Listing
September 2017

MRNIP/C5orf45 Interacts with the MRN Complex and Contributes to the DNA Damage Response.

Cell Rep 2016 09 25;16(10):2565-2575. Epub 2016 Aug 25.

Sheffield Institute for Nucleic Acids (SInFoNiA), Department of Oncology and Metabolism, Academic Unit of Molecular Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK. Electronic address:

Through an RNAi-based screen for previously uncharacterized regulators of genome stability, we have identified the human protein C5orf45 as an important factor in preventing the accumulation of DNA damage in human cells. Here, we functionally characterize C5orf45 as a binding partner of the MRE11-RAD50-NBS1 (MRN) damage-sensing complex. Hence, we rename C5orf45 as MRNIP for MRN-interacting protein (MRNIP). We find that MRNIP is rapidly recruited to sites of DNA damage. Cells depleted of MRNIP display impaired chromatin loading of the MRN complex, resulting in reduced DNA end resection and defective ATM-mediated DNA damage signaling, a reduced ability to repair DNA breaks, and radiation sensitivity. Finally, we show that MRNIP phosphorylation on serine 115 leads to its nuclear localization, and this modification is required for MRNIP's role in promoting genome stability. Collectively, these data reveal that MRNIP is an important component of the human DNA damage response.
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http://dx.doi.org/10.1016/j.celrep.2016.07.087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014761PMC
September 2016

Human CDK18 promotes replication stress signaling and genome stability.

Nucleic Acids Res 2016 Oct 5;44(18):8772-8785. Epub 2016 Jul 5.

Genome Stability Group, Sheffield Institute for Nucleic Acids (SInFoNiA), Academic Unit of Molecular Oncology, Department of Oncology & Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK

Cyclin-dependent kinases (CDKs) coordinate cell cycle checkpoints with DNA repair mechanisms that together maintain genome stability. However, the myriad mechanisms that can give rise to genome instability are still to be fully elucidated. Here, we identify CDK18 (PCTAIRE 3) as a novel regulator of genome stability, and show that depletion of CDK18 causes an increase in endogenous DNA damage and chromosomal abnormalities. CDK18-depleted cells accumulate in early S-phase, exhibiting retarded replication fork kinetics and reduced ATR kinase signaling in response to replication stress. Mechanistically, CDK18 interacts with RAD9, RAD17 and TOPBP1, and CDK18-deficiency results in a decrease in both RAD17 and RAD9 chromatin retention in response to replication stress. Importantly, we demonstrate that these phenotypes are rescued by exogenous CDK18 in a kinase-dependent manner. Collectively, these data reveal a rate-limiting role for CDK18 in replication stress signalling and establish it as a novel regulator of genome integrity.
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http://dx.doi.org/10.1093/nar/gkw615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5062979PMC
October 2016

The leukemia-associated Rho guanine nucleotide exchange factor LARG is required for efficient replication stress signaling.

Cell Cycle 2014 ;13(21):3450-9

a Genome Stability Group ; Department of Oncology ; Academic Unit of Molecular Oncology ; University of Sheffield Medical School ; Sheffield , UK.

We previously identified and characterized TELO2 as a human protein that facilitates efficient DNA damage response (DDR) signaling. A subsequent yeast 2-hybrid screen identified LARG; Leukemia-Associated Rho Guanine Nucleotide Exchange Factor (also known as Arhgef12), as a potential novel TELO2 interactor. LARG was previously shown to interact with Pericentrin (PCNT), which, like TELO2, is required for efficient replication stress signaling. Here we confirm interactions between LARG, TELO2 and PCNT and show that a sub-set of LARG co-localizes with PCNT at the centrosome. LARG-deficient cells exhibit replication stress signaling defects as evidenced by; supernumerary centrosomes, reduced replication stress-induced γH2AX and RPA nuclear foci formation, and reduced activation of the replication stress signaling effector kinase Chk1 in response to hydroxyurea. As such, LARG-deficient cells are sensitive to replication stress-inducing agents such as hydroxyurea and mitomycin C. Conversely we also show that depletion of TELO2 and the replication stress signaling kinase ATR leads to RhoA signaling defects. These data therefore reveal a level of crosstalk between the RhoA and DDR signaling pathways. Given that mutations in both ATR and PCNT can give rise to the related primordial dwarfism disorders of Seckel Syndrome and Microcephalic osteodysplastic primordial dwarfism type II (MOPDII) respectively, which both exhibit defects in ATR-dependent checkpoint signaling, these data also raise the possibility that mutations in LARG or disruption to RhoA signaling may be contributory factors to the etiology of a sub-set of primordial dwarfism disorders.
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http://dx.doi.org/10.4161/15384101.2014.956529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4615130PMC
July 2015

Anomalous Origin of Left Vertebral Artery from Carotid Bulb Seen as "Trifurcation" of Left Common Carotid Artery with Acute Infarct in Ipsilateral Thalamus: A Case Report.

J Neuroimaging 2015 Jul-Aug;25(4):662-4. Epub 2014 Oct 7.

Bolsover Radiology, Hillcrest Hospital, Rockhampton, QLD, Australia.

Anomalous origin of vertebral arteries is not common and usually seen as an incidental finding on imaging. We report a case of anomalous origin of left vertebral artery from left carotid bulb ("trifurcation" of left common carotid artery) on magnetic resonance angiography in a 64-year old male who also had ipsilateral thalamic acute infarct.
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http://dx.doi.org/10.1111/jon.12172DOI Listing
November 2016

FANCD2 re-expression is associated with glioma grade and chemical inhibition of the Fanconi Anaemia pathway sensitises gliomas to chemotherapeutic agents.

Oncotarget 2014 Aug;5(15):6414-24

Sheffield Cancer Research Centre, Academic Unit of Molecular Oncology, Department of Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK.

Brain tumours kill more children and adults under 40 than any other cancer. Around half of primary brain tumours are glioblastoma multiforme (GBMs) where treatment remains a significant challenge, where survival rates have improved little over the last 40 years, thus highlighting an unmet need for the identification/development of novel therapeutic targets and agents to improve GBM treatment. Using archived and fresh glioma tissue, we show that in contrast to normal brain or benign schwannomas GBMs exhibit re-expression of FANCD2, a key protein of the Fanconi Anaemia (FA) DNA repair pathway, and possess an active FA pathway. Importantly, FANCD2 expression levels are strongly associated with tumour grade, revealing a potential exploitable therapeutic window to allow inhibition of the FA pathway in tumour cells, whilst sparing normal brain tissue. Using several small molecule inhibitors of the FA pathway in combination with isogenic FA-proficient/deficient glioma cell lines as well as primary GBM cultures, we demonstrate that inhibition of the FA pathway sensitises gliomas to the chemotherapeutic agents Temozolomide and Carmustine. Our findings therefore provide a strong rationale for the development of novel and potent inhibitors of the FA pathway to improve the treatment of GBMs, which may ultimately impact on patient outcome.
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http://dx.doi.org/10.18632/oncotarget.2225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171640PMC
August 2014

Comparative assessment of marginal accuracy of grade II titanium and Ni-Cr alloy before and after ceramic firing: An in vitro study.

Eur J Dent 2013 Jul;7(3):272-277

Department of Prosthodontics, Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, Uttar Pradesh, India.

Objective: The aims of the study are to assess the marginal accuracy of base metal and titanium alloy casting and to evaluate the effect of repeated ceramic firing on the marginal accuracy of base metal and titanium alloy castings.

Materials And Methods: Twenty metal copings were fabricated with each casting material. Specimens were divided into 4 groups of 10 each representing base metal alloys castings without (Group A) and with metal shoulder margin (Group B), titanium castings without (Group C) and with metal shoulder margin (Group D). The measurement of fit of the metal copings was carried out before the ceramic firing at four different points and the same was followed after porcelain build-up.

Results: Significant difference was found when Ni-Cr alloy samples were compared with Grade II titanium samples both before and after ceramic firings. The titanium castings with metal shoulder margin showed highest microgap among all the materials tested.

Conclusions: Based on the results that were found and within the limitations of the study design, it can be concluded that there is marginal discrepancy in the copings made from Ni-Cr and Grade II titanium. This marginal discrepancy increased after ceramic firing cycles for both Ni-Cr and Grade II titanium. The comparative statistical analysis for copings with metal-collar showed maximum discrepancy for Group D. The comparative statistical analysis for copings without metal-collar showed maximum discrepancy for Group C.
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http://dx.doi.org/10.4103/1305-7456.115409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4053614PMC
July 2013

Ccdc13 is a novel human centriolar satellite protein required for ciliogenesis and genome stability.

J Cell Sci 2014 Jul 9;127(Pt 13):2910-9. Epub 2014 May 9.

Genome Stability Group, CR-UK/YCR Sheffield Cancer Research Centre, Department of Oncology, Academic Unit of Molecular Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK

Here, we identify coiled-coil domain-containing protein 13 (Ccdc13) in a genome-wide RNA interference screen for regulators of genome stability. We establish that Ccdc13 is a newly identified centriolar satellite protein that interacts with PCM1, Cep290 and pericentrin and prevents the accumulation of DNA damage during mitotic transit. Depletion of Ccdc13 results in the loss of microtubule organisation in a manner similar to PCM1 and Cep290 depletion, although Ccdc13 is not required for satellite integrity. We show that microtubule regrowth is enhanced in Ccdc13-depleted cells, but slowed in cells that overexpress Ccdc13. Furthermore, in serum-starved cells, Ccdc13 localises to the basal body, is required for primary cilia formation and promotes the localisation of the ciliopathy protein BBS4 to both centriolar satellites and cilia. These data highlight the emerging link between DNA damage response factors, centriolar and peri-centriolar satellites and cilia-associated proteins and implicate Ccdc13 as a centriolar satellite protein that functions to promote both genome stability and cilia formation.
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http://dx.doi.org/10.1242/jcs.147785DOI Listing
July 2014
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