Publications by authors named "Anand Gupta"

112 Publications

S-144 lack of association between glycated hemoglobin and adverse outcomes in diabetic patients undergoing ventral hernia repair: an ACHQC study.

Surg Endosc 2022 Aug 15. Epub 2022 Aug 15.

Department of Anesthesia, University of Florida College of Medicine, Gainesville, USA.

Introduction: Elevated preoperative glycated hemoglobin (HbA1c) is believed to predict complications in diabetic patients undergoing ventral hernia repair (VHR). Our objective was to assess the association between HbA1c and outcomes of VHR in diabetic patients.

Methods: We conducted a retrospective cohort study using the Abdominal Core Health Quality Collaborative (ACHQC) database. We included adult diabetic patients who underwent elective VHR with an available HbA1c result. The patients were divided into two groups (HbA1c < 8% and HbA1c ≥ 8%). Patient demographics, comorbidities, hernia characteristics, operative details, and surgical outcomes were compared. Multivariable logistic regression analysis of complications was performed. Cox proportional hazard regression was used to assess probability of composite recurrence at different HbA1c levels.

Results: 2167 patients met the inclusion criteria (HbA1c < 8% = 1,776 and HbA1c ≥ 8% = 391). Median age was 61 years and median body mass index was 34 kg/m. 75% had an American Society of Anesthesiology class of 3. The median HbA1c was 6.5% in the HbA1c < 8% group versus 8.7% in the HbA1c ≥ 8% group. 73% were incisional hernias, 34% were recurrent, and median hernia width was 6 cm. Open approach was used in 63% and myofascial release was performed in 46%. Median follow-up was 27 days. There were no clinically significant differences in the rates of overall 30-day complications, wound complications, reoperation, readmission, mortality, length of stay and quality of life and pain scores between the two groups. Regression analyses did not identify an association between HbA1c and the rates of complications, surgical site infection or composite recurrence across the spectrum of HbA1c values.

Conclusion: Our study finds no evidence of an association between HbA1c and operative outcomes in diabetic patients undergoing elective VHR.
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http://dx.doi.org/10.1007/s00464-022-09479-1DOI Listing
August 2022

Clinical and Echocardiographic Profile of Congenital Heart Diseases in the 0-12-Year Age Group in a Tertiary Care Medical Institute in Eastern India: A Retrospective, Cross-Sectional Study.

Cureus 2022 Jun 20;14(6):e26114. Epub 2022 Jun 20.

Cardiology, Indira Gandhi Institute of Medical Sciences, Patna, IND.

Background This study aimed to determine the clinical and echocardiography profile of congenital heart diseases (CHDs) among admitted children as well as patients presenting to the outpatient department of the Indira Gandhi Institute of Medical Sciences, Patna, which is a tertiary care and apex institute located in Bihar, India. Methodology A retrospective, cross-sectional study was conducted in a tertiary care hospital from January 2019 to January 2021. In total, 200 patients aged 0-12 were enrolled in the study. The study design was exploratory, with a proforma drafted to study patients with features suggestive of CHDs. All pediatric echocardiography was performed by a trained cardiologist. Records were obtained from the departmental record-keeping register, and reports were available for analyzing the data. For data collection, cardiology and pediatric department registers were reviewed and all CHD data were collected. Data analysis was done using SPSS software version 25.0 (IBM Corp., Armonk, NY, USA). Results Of the 200 children with CHDs, 142 were diagnosed to have acyanotic heart disease (ACHD), while 58 had cyanotic congenital heart disease (CCHD). Among 200 cases of CHD, ventricular septal defect (VSD) constituted 62 cases comprising 31% of the total CHD cases and 44% of all ACHD cases. Atrial septal defect (ASD) was the second most common CHD comprising 23% of all CHD cases. Tetralogy of Fallot (TOF) constituted 23 cases accounting for 11.5% of all CHD cases. It was the most common CCHD. Based on the age at the time of presentation, 90 (45%) cases were diagnosed below one year of age. Congestive heart failure (CHF) was most common in ACHD comprising 30% compared to CCHD in which only 7% of cases had CHF. This finding was statistically significant (p < 0.05). Analyzing the symptoms of different CHDs, of both ACHDs and CCHDs, the common symptoms were fast breathing (38%). Conclusions Among ACHD patients, 31% VSD and 21% ASD were noted. In CCHD, TOF was the most common with 11.5% of cases. Respiratory tract conditions were the most common comorbidities encountered. Because this is one of the first studies conducted in Bihar in the pediatric age group, it can help know the prevalence of CHDs in this region and will be useful for developing policies by stakeholders.
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http://dx.doi.org/10.7759/cureus.26114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9208535PMC
June 2022

Round Ligament Management in Female Patients Undergoing Inguinal Hernia Repair: Should We Divide or Preserve?

J Am Coll Surg 2022 Jun 8;234(6):1193-1200. Epub 2022 Apr 8.

From the Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH.

Background: Although inguinal hernia repair in female patients is less common than in male patients, it remains a frequent procedure. The decision to divide or preserve the round ligament has largely been left to surgeon preference, but little data exists about its impact on outcomes. This study aimed to describe current practices for round ligament management and identify the impact of division on surgical and patient-reported outcomes.

Study Design: The 2013 to 2021 Abdominal Core Health Quality Collaborative database was queried for all female patients undergoing inguinal hernia repair with 30-day patient-reported outcome data available. Comparison groups were created based on round ligament management: round ligament division (RLD) or round ligament preservation (RLP).

Results: We identified 1365 female patients who underwent open (36.3%), laparoscopic (34.5%), or robotic (28.2%) repair. Most were non-recurrent (93%) and unilateral (82.6%). The round ligament was divided in 868 (63.6%) and preserved in 497 (36.4%) cases. There were no significant differences in overall complications (RLD 7.1%, RLP 5.2%, p = 0.17), reoperation (RLD 0.5%, RLP 0.2%, p = 0.4), or recurrence (RLD 0.1%, RLP 0.4%, p = 0.28). Mean European Registry for Abdominal Wall Hernias quality of life summary scores were not significantly different at 30 days (RLD 27.2, RLP 27.8) or 6 months (RLD 12.8, RLP 17.1). However, a significant difference was found in terms of mean pain-specific scores at 6 months, with lower pain scores in the RLD group (3 vs 4.7, p < 0.01), which persisted on multivariable analysis (p = 0.02).

Conclusions: RLD is a common practice and is not associated with increased complications or recurrence. Although there is some evidence that RLD may result in decreased pain at 6 months, this must be balanced with potential functional complications of division that are not fully studied in this paper.
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http://dx.doi.org/10.1097/XCS.0000000000000207DOI Listing
June 2022

Improvement of Hand Hygiene Compliance Using the Plan-Do-Study-Act Method: Quality Improvement Project From a Tertiary Care Institute in Bihar, India.

Cureus 2022 Jun 2;14(6):e25590. Epub 2022 Jun 2.

Pediatrics, Indira Gandhi Institute of Medical Sciences, Patna, IND.

Background Hospital-acquired infections (HAIs) are the most severe complications of intensive care stay, especially in pediatric patients. Proper hand hygiene (HH) is the cheapest, simplest, but often neglected method to prevent HAIs. The World Health Organization (WHO) has formulated and promoted a standardized recommendation for HH. Both the WHO and the Centers for Disease Control and Prevention (CDC) recommend the use of soap and water for handwashing whenever there is visible dirt on the hands. In all other situations, an alcohol-based hand rub is an effective alternative. The quality improvement (QI) methodology has been widely followed in many countries to improve basic and advanced healthcare systems. The QI strategy follows the plan-do-study-act (PDSA) method. Methodology This quasi-experimental (pre- and post-intervention), prospective, QI study was conducted at the neonatal intensive care unit and pediatric intensive care unit of the pediatrics department in a tertiary care hospital in Bihar, India. A QI team was formed. The study was divided into four phases. WHO charts for assessing HH compliance were used for observation and data collection. The EQUATOR Checklist (Squire Checklist) was used to accurately report the QI work. Epi Info™ (version 7.2.5) was used for statistical analysis. The chi-square test was used to measure the statistical difference between pre- and post-intervention HH compliance (proportions). Results In the pre-intervention phase, a total of 106 HH opportunities were observed. The HH compliance at this stage was 40.6%. The QI team conducted several meetings, and a root cause analysis was performed with the help of the Fishbone diagram. It was decided to target three probable causes, namely, (a) less awareness, (b) inconvenient locations of hand rub dispensers, and (c) forgetfulness. The QI team decided to run three PDSA cycles. In the last phase, 212 HH opportunities were observed with a compliance percentage of 69.8%. There was a significant improvement when data of pre- and post-intervention HH compliance were compared in all categories of healthcare workers (HCWs), except doctors, where the improvement was not statistically significant. When the cumulative data of all subtypes of HCWs were analyzed, there was a significant improvement (p < 0.0001). Run charts and box plots were used for the easy depiction of the results. Conclusions Adopting proper HH methods remains the most effective way of preventing nosocomial infections, especially in intensive care units. We used the WHO model of HH in our study. The pre-intervention HH compliance was 40.6%. QI methodology using root cause analysis and implementation of three PDSA cycles were used to increase the HH compliance percentage. Post-intervention HH compliance increased to 69.8% and the effect was sustained. The study highlights the usefulness of the QI methodology in bringing small but important changes in clinical practice for better patient care.
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http://dx.doi.org/10.7759/cureus.25590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9162031PMC
June 2022

Impact of insurance type in postoperative emergency department utilization and clinical outcomes following ventral hernia repair (VHR).

Surg Endosc 2022 May 18. Epub 2022 May 18.

Center for Abdominal Core Health, Department of Surgery, Ohio State University Wexner Medical Center, 181 Taylor Avenue, 11th Floor, Suite 1102A, Columbus, OH, 43203, USA.

Background: Access to care and barriers to achieving health equity remain persistent and prevailing issues in the USA, particularly for low socioeconomic (L-SES) populations. Previous studies have shown that public insurance (a surrogate marker for L-SES) is an independent predictor of emergent hernia repair. However, the impact of insurance type on postoperative healthcare utilization, including emergency department (ED) care, following ventral hernia repair (VHR) remains unknown.

Methods: The 2013-2020 Abdominal Core Health Quality Collaborative (ACHQC) database was used to identify patients aged 18-64 undergoing ventral hernia repair (VHR) who had private or Medicaid insurance. Patients with no health insurance were also included. Using insurance type, the cohort was divided into three groups: private, public (Medicaid), and uninsured (self-pay). Multivariate logistic regression analyses were used to assess the impact of insurance type on emergency department (ED) utilization, postoperative complications, and readmission.

Results: A total of 17,036 patients undergoing VHR were included in the study, out of which 13,980 (85.8%) had private insurance, 2,451 (8.4%) had public, and 605 (5.8%) were uninsured. Following adjustment for demographics (age, gender, race), comorbidities (hypertension, diabetes, smoking), and clinical characteristics (emergent procedure, ASA class, surgical approach), public insurance was associated with 1.7 times greater odds of returning to the emergency department (ED) within 30 days of surgery compared to private insurance (95% CI 1.4, 2.0; p = 0.01). Public insurance or being uninsured was also associated with increased odds of experiencing any postoperative complications compared to those who were privately insured (public: OR 1.3, p < 0.01; self-pay: OR 1.67, p < 0.01).

Conclusion: Our study demonstrates that public and self-pay insurance are associated with increased emergency department (ED) utilization and worse postoperative outcomes compared to those with private insurance. In an effort to promote health equity, healthcare providers need to assess how parameters beyond physical presentation may impact a patient's health.
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http://dx.doi.org/10.1007/s00464-022-09287-7DOI Listing
May 2022

The pathogenicity and virulence of Leishmania - interplay of virulence factors with host defenses.

Virulence 2022 12;13(1):903-935

Infectious Diseases and Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata, India.

Leishmaniasis is a group of disease caused by the intracellular protozoan parasite of the genus . Infection by different species of results in various host immune responses, which usually lead to parasite clearance and may also contribute to pathogenesis and, hence, increasing the complexity of the disease. Interestingly, the parasite tends to reside within the unfriendly environment of the macrophages and has evolved various survival strategies to evade or modulate host immune defense. This can be attributed to the array of virulence factors of the vicious parasite, which target important host functioning and machineries. This review encompasses a holistic overview of leishmanial virulence factors, their role in assisting parasite-mediated evasion of host defense weaponries, and modulating epigenetic landscapes of host immune regulatory genes. Furthermore, the review also discusses the diagnostic potential of various leishmanial virulence factors and the advent of immunomodulators as futuristic antileishmanial drug therapy.
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http://dx.doi.org/10.1080/21505594.2022.2074130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9154802PMC
December 2022

Bilateral Neck of Femur Fracture in a Child With Underlying Vitamin D Deficiency: A Case Report on Management and 10-Year Follow-Up.

Cureus 2022 Mar 8;14(3):e22953. Epub 2022 Mar 8.

Orthopaedics, Lady Hardinge Medical College, New Delhi, IND.

Bilateral femoral neck fracture is a rare entity in the pediatric age group. These types of fractures occur mostly due to high-velocity trauma. We report the surgical outcome with approximately 10 years of follow-up in a 10-year-old child presenting with bilateral femoral neck fracture after trivial trauma and underlying nutritional vitamin D deficiency. A 10-year-old female child with bilateral neglected fracture neck of femur was managed with a primary valgus osteotomy done on the left side and closed reduction and screw fixation with fibular grafting done on the right side. Later on, as the right side fracture progressed to non-union, it was converted to valgus osteotomy fixed with an external fixator. The patient had a good functional outcome at 10 years of follow-up with no difficulty in her day-to-day activities. Pathological bilateral fracture neck of femur is rare in children and it is often mismanaged due to a delayed diagnosis. It can have potentially dangerous complications with a grave outcome affecting the rest of the life of the child. Hence it is important to know about such rare presentations so that they can be adequately addressed early on, thereby minimizing the risk of complications like non-union and avascular necrosis.
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http://dx.doi.org/10.7759/cureus.22953DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8988905PMC
March 2022

The Impact of the COVID-19 Pandemic on Sociodemographic Disparities in Rates of Elective Hernia Surgeries.

Am Surg 2022 Jul 25;88(7):1452-1458. Epub 2022 Mar 25.

Department of Surgery, 5718Vanderbilt University Medical Center, Nashville, TN, USA.

Background: The global pandemic has shed light on the role of health care disparities; however, little data exists to determine how COVID-19 affected access to elective surgical care. We aimed to determine the impact of health care disparities and surgical care for patients undergoing hernia surgery across a national quality collaborative database.

Materials And Methods: All patients undergoing elective hernia surgery between March 2018 and April 2021 were identified within the Abdominal Core Health Quality Collaborative. Patients were divided based on date of surgery into pre-, post-, and COVID-19 spike groups. Descriptive statistics were calculated for comorbidities, demographics, surgical location, Distressed Community Index (DCI), and hernia characteristics stratified by period of surgery. Rates and chi-squared test were used for categorical variables. Median, IQR, and Wilcoxon test were used continuous variables.

Results: 35 149 patients met inclusion criteria. Pre-COVID-19, COVID-19 spike, and post-COVID-19 groups showed no significant difference in mean age or the proportion of patients in each DCI variable. Proportionately fewer females and more White non-Hispanic patients were operated on during the COVID-19 spike. Surgeons affiliated with academic hospitals saw proportionality fewer elective cases during the COVID-19 spike.

Discussion: This study suggests white males with private hospital affiliation were more likely to have elective hernia surgery during the COVID-19 spike, however these trends were not associated with health care DCI changes during the same period. Further study is necessary to determine the reasons for these differences and will be important to optimize surgical care for patients during a worldwide pandemic.
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http://dx.doi.org/10.1177/00031348221082273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8960748PMC
July 2022

Coarse-Grained Molecular Dynamics Simulations of Paclitaxel-Loaded Polymeric Micelles.

Mol Pharm 2022 04 4;19(4):1117-1134. Epub 2022 Mar 4.

Department of Pharmaceutical Sciences, School of Pharmacy, University of Connecticut, Storrs, Connecticut 06269, United States.

A continuous manufacturing technology based on coaxial turbulent jet in coflow was previously developed to produce paclitaxel-loaded polymeric micelles. Herein, coarse-grained molecular dynamics (CG-MD) simulations were implemented to better understand the effect of the material attributes (i.e., the drug-polymer ratio and the ethanol concentration) and process parameters (i.e., temperature) on the self-assembly process of polymeric micelles as well as to provide molecular details on micelle instability. An all-atom (AA) poly (ethylene glycol)-poly (lactic acid) (PEG-PLA) polymer model was developed as the reference for parameterizing a coarse-grained (CG) model, and the AA polymer model was further validated with experimental glass transition temperature (). The model transferability was verified by comparing structural properties between the AA and CG models. The CG model was further validated with experimental data, including micelle particle size measurements and drug encapsulation efficiency. Furthermore, the encapsulation of paclitaxel into the polymeric micelles was included in the simulations, taking into consideration the interactions between the paclitaxel and the polymers. The results from various points of view demonstrated a strong dependence of the shape of the micelles on the drug encapsulation, with micelles transitioning from spherical to ellipsoidal structures with an increasing paclitaxel amount. Simulation data were also used to identify the critical aggregation number (i.e., the number of polymer and drug molecules required for transition from one shape to another). Improved micellar structural stability was found with a larger micellar size and less solvent accessibility. Lastly, an evaluation was performed on the micellar dissociation free energy using a steered molecular dynamics simulation over a range of temperatures and ethanol concentrations. These simulations revealed that at higher ethanol and temperature conditions, micelles become destabilized, resulting in greater paclitaxel release. The increased drug release was determined to originate from the solvation of the hydrophobic core, which promoted micellar swelling and an associated reduction in hydrophobic interactions, leading to a loosely packed micellar structure.
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http://dx.doi.org/10.1021/acs.molpharmaceut.1c00800DOI Listing
April 2022

Expanded Transoral Microvascular Mandibular Reconstruction: A Scar-Free Approach.

J Oral Maxillofac Surg 2022 06 26;80(6):1115-1126. Epub 2022 Jan 26.

Associate Professor, Department, of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China. Electronic address:

Purpose: We present our experience with transoral segmental mandibulectomy, in conjunction with vascularized osseous mandibular reconstruction, utilizing an intraoral anastomosis and free of extraoral incisions. Virtual surgical planning and intraoperative navigation were used to help achieve this minimally invasive and scar-free approach.

Methods: A retrospective study was performed on 9 patients who underwent transoral segmental mandibulectomy followed by vascularized osseous reconstruction using an intraoral anastomosis between January 2018 and October 2018. The anastomotic recipient vessels were the facial artery and vein. The outcome variable was defined as the flap survival. Postoperative panoramic radiographs and computed tomography images were obtained for assessment of the neo-mandible. In addition, we performed a cadaver dissection to highlight relevant anatomic details of the facial artery and vein.

Results: Successful transoral segmental mandibulectomy was achieved in 9 patients, with an intraoral anastomosis successfully achieved in 8 patients. In one patient, an extraoral anastomosis was required because of challenging facial vein anatomy. Both recipient and donor sites healed uneventfully with a 100% successful rate of flap survival. In all cases, a well-positioned neo-mandible with good occlusion was demonstrated on postoperative imaging and examination. A symmetric facial appearance with no restrictions in mouth opening was also achieved in each case. In our cadaver dissection, we describe the anatomical course of the facial artery and vein. An average angle of 30° between these vessels is identified.

Conclusions: Transoral segmental mandibulectomy combined with intraoral microvascular mandibular reconstruction is a surgically achievable technique with the benefit of being scar free.
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http://dx.doi.org/10.1016/j.joms.2022.01.013DOI Listing
June 2022

Accurate reconstruction of bone defects in orbital-maxillary-zygomatic (OMZ) complex with polyetheretherketone (PEEK).

J Plast Reconstr Aesthet Surg 2022 05 3;75(5):1750-1757. Epub 2021 Dec 3.

Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Center for Oral Disease, Shanghai 200011, China. Electronic address:

Purpose: The aim of this study was to evaluate the safety and efficacy of using patient-specific polyetheretherketone (PEEK) for the reconstruction of patients with defects in orbital-maxillary-zygomatic (OMZ) complex.

Patients And Methods: This study included 12 patients who underwent primary/delayed reconstruction of defects in OMZ complex by using patient-specific PEEK implants. Postoperative appearance (facial and orbital symmetry) and function were assessed after 6 months. Ophthalmologic examinations including globe position, exophthalmos, and orbital volume measurement were also performed. A comparative analysis of the treatment outcomes between pre- and postoperation was performed, and a value of P < 0.05 was considered as significant.

Results: All patients underwent planned surgical procedure successfully. No obvious complications occurred. Facial symmetry and globe position were improved after surgery and the postoperative esthetic assessment was rated as excellent. The postoperative evaluation revealed that exophthalmos was 15.91 ± 1.80 mm, vertical position difference of eyeball 15.91 ± 1.80 mm, and orbital volume 15.91 ± 1.80 mm, respectively. There was a statistically significant difference in the mean values of exophthalmos, vertical position difference, and orbital volume among pre- and postoperation conditions, whereas there was no statistically significant difference between the reconstructed side and the unaffected side after surgery.

Conclusion: With the aid of virtual surgical planning and individual custom-made surgical guides, patient-specific PEEK implantation can successfully reconstruct the complicated 3D structure of OMZ complex and shows excellent biocompatibility and clinical outcomes.
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http://dx.doi.org/10.1016/j.bjps.2021.11.101DOI Listing
May 2022

Pancreastatin inhibitor PSTi8 prevents free fatty acid-induced oxidative stress and insulin resistance by modulating JNK pathway: In vitro and in vivo findings.

Life Sci 2022 Jan 10;289:120221. Epub 2021 Dec 10.

Pharmaceutics &Pharmacokinetics, CSIR-Central Drug Research Institute, Jankipuram Extension, Lucknow 226031, India; Pharmacology Division, CSIR-Central Drug Research Institute, Jankipuram Extension, Lucknow 226031, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India. Electronic address:

Aim: Free fatty acid-mediated obesity plays a crucial role in the pathogenesis of Type 2 Diabetes. FFA induced JNK activation acts as a central regulator in causing hepatic insulin resistance. Similarly, Pancreastatin, a chromogranin A peptide, serves as a crucial link between FFA-induced insulin resistance. Therefore, in the present work, we sought to test Pancreastatin inhibitor PSTi8 to ameliorate FFA-induced hepatic insulin resistance in in vitro and in vivo models.

Material And Methods: To verify our objective, we exposed hepatocytes (HepG2 cells) with palmitate (0.3 mM) or palmitate + PSTi8 (200 nM). Parallelly mice were fed either HFD or HFD + PSTi8 (1 mg/kg). After 21 days animals were scanned for increased fat mass, along with GTT, ITT and PTT experiment to check glucose, and insulin tolerance. Furthermore, ROS generation and hepatic glycogen content was measured in FFA exposed hepatocytes. Gene expression and protein expression studies were further conducted to delineate the action mechanism of PSTi8.

Key Findings: PSTi8 exposure decreased ROS accumulation, lipid accumulation, and reduced glycogen content in FFA-induced groups. It also enhances glucose uptake and reduces gluconeogenesis to combat the FFA effect. Furthermore, gene expression studies indicate that PSTi8 treatment reduces NADPH oxidase3 (NOX3) expression and inhibits JNK signaling, a predominant source of ROS-induced insulin resistance.

Significance: To summarize, the protective effect of PSTi8 on FFA-induced insulin resistance is mediated via inhibition of JNK signaling, which leads to decreased ROS generation and enhanced insulin sensitivity. Hence PSTi8 could be a therapeutic molecule to prevent western diet-induced insulin resistance.
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http://dx.doi.org/10.1016/j.lfs.2021.120221DOI Listing
January 2022

Intracranial hemorrhage in a patient with severe COVID-19 acute respiratory distress syndrome on Veno-venous extra corporeal membrane oxygenation: A case report.

Ann Med Surg (Lond) 2022 Jan 3;73:103033. Epub 2021 Dec 3.

Department of Critical Care Medicine, AIG Asian Institute of Gasteroenterology Hospitals, Gachibowli, Hyderabad, Telangana, India.

Introduction And Importance: COVID-19 can lead to severe acute respiratory distress syndrome (ARDS) where Veno-Venous Extra Corporeal Membrane Oxygenation (V-V ECMO) may be utilized for patients with severe respiratory failure. Our case report highlights a life threatening complication of V-V ECMO - intracranial hemorrhage (ICH), in a patient being treated for severe COVID-19 ARDS.

Case Presentation: A 41-year-old male of Indian ethnicity with no known comorbidities presented with an 8 day history of fever and dyspnoea. The patient was diagnosed with COVID-19 through a positive RT PCR test and his clinical condition progressively deteriorated requiring mechanical ventilation. Inspite of lung protective ventilation strategies and prone ventilation, there was no improvement in oxygenation. Therefore, the patient was placed on extra corporeal life support. On day three of V-V ECMO, the patient developed anisocoria and his GCS dropped to E1VTM1. A non-contrast CT brain scan revealed a large intraparenchymal hemorrhage in the right frontoparietal lobe with an extension into the right lateral and third ventricles leading to an emergency decompressive craniectomy with lax duroplasty.Post intracranial hemorrhage,ECMO support was continued without systemic anticoagulation. Despite a transient improvement in his GCS post surgery, the patient eventually succumbed to refractory septic shock with multi organ dysfunction syndrome.

Clinical Discussion And Conclusion: Balancing anticoagulation therapy is one of the biggest challenges in managing ECMO support for COVID-19 ARDS. ICH is a rare and potentially fatal complication of V-V ECMO with an apparently higher incidence among COVID-19 patients. Neurosurgical procedures may be considered in such patients when no other possible management strategies are available (and the risk of death is imminent).
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http://dx.doi.org/10.1016/j.amsu.2021.103033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8639484PMC
January 2022

Pregnane-Oximino-Alkyl-Amino-Ether Compound as a Novel Class of TGR5 Receptor Agonist Exhibiting Antidiabetic and Anti-Dyslipidemic Activities.

Pharmacology 2022 23;107(1-2):54-68. Epub 2021 Nov 23.

Division of Bio-chemistry, CSIR-Central Drug Research Institute, Lucknow, India.

Introduction: The present study deals with the synthesis of pregnane-oximino-amino-alkyl-ethers and their evaluation for antidiabetic and anti-dyslipidemic activities in validated animal and cell culture models.

Methods: The effect on glucose tolerance was measured in sucrose-loaded rats; antidiabetic activity was evaluated in streptozotocin (STZ)-induced diabetic rats and genetically diabetic db/db mice; the anti-dyslipidemic effect was characterized in high-fructose, high-fat diet (HFD)-fed dyslipidemic hamsters. The effect on glucose production and glucose utilization was analyzed in HepG2 liver and L6 skeletal muscle cells, respectively.

Results: From the synthesized molecules, pregnane-oximino-amino-alkyl-ether (compound 14b) improved glucose clearance in sucrose-loaded rats and exerted antihyperglycemic activity on STZ-induced diabetic rats. Further evaluation in genetically diabetic db/db mice showed temporal decrease in blood glucose, and improvement in glucose tolerance and lipid parameters, associated with mild improvement in the serum insulin level. Moreover, compound 14b treatment displayed an anti-dyslipidemic effect characterized by significant improvement in altered lipid parameters of the high-fructose, HFD-fed dyslipidemic hamster model. In vitro analysis in the cellular system suggested that compound 14b decreased glucose production in liver cells and stimulated glucose utilization in skeletal muscle cells. These beneficial effects of compound 14b were associated with the activation of the G-protein-coupled bile acid receptor TGR5.

Conclusion: Compound 14b exhibits antidiabetic and anti-dyslipidemic activities through activating the TGR5 receptor system and can be developed as a lead for the management of type II diabetes and related metabolic complications.
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http://dx.doi.org/10.1159/000519721DOI Listing
January 2022

Syphilitic hepatitis as a manifestation of secondary syphilis.

Proc (Bayl Univ Med Cent) 2021 6;34(6):696-697. Epub 2021 Jul 6.

Division of Gastroenterology, VA Medical Center, Syracuse, New York.

Syphilis is a multisystem disease caused by the spirochete . Among various organs affected, liver involvement is seen infrequently and can be missed. Here we present a case of hepatitis due to secondary syphilis that completely resolved with penicillin G therapy.
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http://dx.doi.org/10.1080/08998280.2021.1936362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8545153PMC
July 2021

Craniocerebral missile injuries in a combat zone: spectrum of injuries and lessons learnt.

Med J Armed Forces India 2021 Oct 16;77(4):382-389. Epub 2021 Aug 16.

Ex-Senior Consultant (Surgery), Delhi, India.

Background: High-velocity missile injuries are commonly encountered in war or war-like situations. Aggressive resuscitation, early evacuation to neurosurgical center, and application of neurosurgical principles remain tenets of success.

Methods: The spectrum of injuries and clinical profile of 14 such cases with craniocerebral missile injuries managed at our center in the northern sector were included. Site of injury, GCS at presentation, associated injuries, surgical intervention, duration of hospitalization, and recovery of the patient were analyzed.

Results: Five patients had sustained gunshot wounds, and nine patients had sustained shrapnel injuries. Thirteen patients were deeply comatose, and one patient was conscious. The entry wound was in frontal lobe in eight patients, and in four patients, it was in the faciocranial area. Ten patients had Glasgow Coma Scale (GCS) less than 8 at presentation. Surgical intervention was required in 13 patients, including 11 decompressive craniectomies and anterior skull base repair in four patients with faciocranial entry wound. One patient expired during initial resuscitation, and one patient died in the postoperative period. Location of injury was the single most important determinant of outcome.

Conclusion: An early decompressive craniectomy provides a reasonable chance of recovery. Aggressive debridement involving track explorations, lobectomies, or removal of retained shrapnels is not beneficial. Injuries to the skull base and violation of sinus spaces predispose these patients to cerebrospinal fluid leaks and infective sequelae. All these patients require aggressive postoperative intensive care and rehabilitation.
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http://dx.doi.org/10.1016/j.mjafi.2021.03.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8459072PMC
October 2021

Modified plant architecture integrated with liquid fertilizers improves fruit productivity and quality of tomato in North West Himalaya, India.

Sci Rep 2021 09 20;11(1):18664. Epub 2021 Sep 20.

ICAR-Indian Institute of Soil and Water Conservation, 218 Kaulagarh Road, Dehradun, 248195, Uttarakhand, India.

India produces around 19.0 million tonnes of tomatoes annually, which is insufficient to meet the ever-increasing demand. A big gap of tomato productivity (72.14 t ha) between India (24.66 t ha) and the USA (96.8 t ha) exist, which can be bridged by integrating trellis system of shoot training, shoot pruning, liquid fertilizers, farmyard manure, and mulching technologies. Therefore, the present experiment was conducted on tomato (cv. Himsona) during 2019-2020 at farmers' fields to improve tomato productivity and quality. There were five treatments laid in a randomized block design (RBD) with three replications; T [Farmer practice on the flatbed with RDF @ N:P:K + FYM @6.0 t ha without mulch], T [T + Polythene mulch (50 microns)], T [Tomato plants grown on the raised bed with polythene mulch + FYM @ 8.0 t ha + Single shoot trellis system + Side shoot pruning + Liquid Fertilizer (LF-N:P:K) @ 2.0 g l for vegetative growth + Liquid Fertilizer (LF-N: P: K) @ 1.5 g l for improving fruit quality], T [Tomato plants grown on the raised bed with polythene mulch + FYM @ 8.0 t ha + Single shoot trellis system + Side shoot pruning + LF @ 4.0 g l + LF @ 3.0 g l], and T [Tomato plants grown on the raised bed with polythene mulch + FYM @ 10.0 t ha + Single shoot trellis system + Side shoot pruning + LF @ 6.0 g l + LF @ 4.5 g l]. The results revealed that tomato plant grown on the raised beds with polythene mulch, shoot pruning, trellising, liquid fertilizers, and farmyard manure (i.e., T) recorded higher shoot length, dry matter content, and tomato productivity by 20.75-141.21, 18.79-169.4, and 18.89-160.87% as compared to T-T treatments, respectively. The T treatment also recorded the highest water productivity (28.39 kg m), improved fruit qualities, net return (10,751 USD ha), benefit-cost ratio (3.08), microbial population, and enzymatic activities as compared to other treatments. The ranking and hierarchical clustering of treatments confirmed the superiority of the T treatment over all other treatments.
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http://dx.doi.org/10.1038/s41598-021-98209-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452768PMC
September 2021

Greatest Quality of Life Improvement in Patients With Large Ventral Hernias: An Individual Assessment of Items in the HerQLes Survey.

J Surg Res 2021 12 13;268:337-346. Epub 2021 Aug 13.

Division of GI and General Surgery, The Ohio State University, Columbus, Ohio; Center for Minimally Invasive Surgery, Columbus, Ohio.

Background: Ventral hernia repair (VHR) has been shown to improve overall quality of life (QOL) by the validated 12-question Hernia-Related Quality-of-Life survey (HerQLes). However, which specific aspects of quality of life are most affected by VHR have not been formally investigated.

Methods: Through retrospective analysis of the Abdominal Core Health Quality Collaborative national database, we measured the change in each individual component of the HerQLes questionnaire from a pre-operative baseline assessment to one-year postoperatively in VHR patients.

Results: In total, 1,875 VHR patients had completed both pre- and post-operative questionnaires from 2014-2018. They were predominately Caucasian (92.3%), 57.9 ± 12.4 Y old, and evenly gender split (50.5% male, 49.5% female, P = 0.31). Most operations were performed open (80.5%) with fewer laparoscopic (7.5%) or robotic cases (12.1%). For each of the 12 individual categories, improvement in QOL from baseline to 1-Y was found to be statistically significant (P < 0.0001). This held true with subgroup analysis of small (<2 cm), medium (2-6 cm), and large (>6 cm) hernias (P < 0.0001), though a larger improvement was seen in 8 of 12 components in hernias >6 cm (P < 0.001). Operative approach did not carry a significant effect except in medium hernias (2-6 cm), where an open approach saw a greater improvement in the "accomplish less at work" item (P = 0.02).

Conclusions: VHR is associated with improvement in each of the 12 components of QOL measured in the HerQLes questionnaire, regardless of the size of their hernia. The amount of improvement, however, may be dependent on hernia size and approach.
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http://dx.doi.org/10.1016/j.jss.2021.06.075DOI Listing
December 2021

Continuous processing of paclitaxel polymeric micelles.

Int J Pharm 2021 Sep 30;607:120946. Epub 2021 Jul 30.

Department of Pharmaceutical Sciences, UConn, Storrs, CT 06269, United States. Electronic address:

A continuous polymeric micelle processing platform was successfully developed, which eliminated batch-to-batch variation in critical quality attributes (for example, size and polydispersity that are typically associated with batch processing). A continuous precipitation process was achieved via coaxial turbulent jet in co-flow technology allowing precise control of particle size with average particle size in the range 15 to 70 nm and low polydispersity. Critical relationships between material attributes (e.g., block copolymer design), process parameters (e.g., polymer concentration, organic to aqueous flow rate ratios, and temperature), and critical quality attributes (e.g., size and polydispersity) of the polymeric micelles were realized via multiple designs of experiments studies. Both polymer molecular weight and concentration were shown to influence the micelle polydispersity index. Notably, higher molecular weight polymer required higher processing temperatures to produce monodispersed particles and were generally of larger size. Using optimized conditions, paclitaxel polymeric micelles that are qualitatively and quantitatively equivalent to commercial Genexol PM were produced, exhibiting comparable quality attributes including particle size, size distribution, morphology, drug loading, release characteristics, and stability. Lastly, a dynamic light scattering method was adapted to determine the critical micelle concentration and aggregation number of the block copolymers, providing useful information about the raw material.
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http://dx.doi.org/10.1016/j.ijpharm.2021.120946DOI Listing
September 2021

Evaluation of Arm Length as a New Upper Limb Anthropometric Method for Preoperative Estimation of Tibial Intramedullary Nail Length.

Strategies Trauma Limb Reconstr 2021 Jan-Apr;16(1):20-26

Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India.

Aim And Objective: To assess the use of arm length (AL) for the estimation of tibial nail length preoperatively and compare its accuracy to various established upper and lower limb anthropometric parameters.

Material And Methods: This prospective study of 54 patients assessed upper limb parameters as a possible alternative for intraoperatively measured tibial nail length. The anthropometric parameters measured independently by two observers were AL, olecranon to fifth metacarpal head (OMD), tibial tuberosity to medial malleolus (TT-MM), tibial tuberosity to medial malleolus minus 20 mm (TT-MM-20 mm) and knee joint line to medial malleolus minus 40 mm (KJL-MM-40) and compared to final nail size used intraoperatively. Two observers were used. Bland-Altman plots were constructed to assess the limits of agreement to intraoperative estimates of optimum nail length. A repeatability assessment was also assessed by both observers.

Results: None of the anthropometric parameters showed limits of agreement within ±10 mm of nail length. AL showed the least average difference and best limits of agreement among all the anthropometric parameters. Among the lower limb parameters, the KJL-MM showed the least average difference but poorer limits of agreement to nail length. The OMD measurement showed a greater average difference than the AL indicating it is a poorer upper limb parameter for predicting nail length.

Conclusion: AL as measured between the angle of the acromion to the lateral epicondyle can be used as a preoperative upper limb anthropometric estimate of nail length to one nail size of the optimum length. Further studies with a larger sample size may reduce the confidence intervals and help justify its wider use.

How To Cite This Article: Sharma A, Sinha S, Gupta S, Evaluation of Arm Length as a New Upper Limb Anthropometric Method for Preoperative Estimation of Tibial Intramedullary Nail Length. Strategies Trauma Limb Reconstr 2021;16(1):20-26.
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http://dx.doi.org/10.5005/jp-journals-10080-1520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311751PMC
July 2021

Establishing the minimal clinically important difference for the Hernia-Related Quality of Life Survey (HerQLes).

Am J Surg 2022 02 2;223(2):245-249. Epub 2021 Jul 2.

Center for Abdominal Core Health, Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA.

Background: Hernia-Related Quality of Life Survey (HerQLes) assesses quality of life (QoL) after hernia repair, but the minimal clinically important difference (MCID) is unknown.

Methods: Using 2013-2019 data from the Abdominal Core Health Quality Collaborative, HerQLes summary scores were calculated for VHR patients at baseline and 1-year. MCID was calculated using distribution-based method. Multivariate regression identified factors associated with exceeding MCID at 1 year.

Results: 1817 patients met criteria. MCID was identified as a change in HerQLes of at least 15.6 points. Mean 1-year post-op score was 74.9 (SD ± 26.2), which exceeded the MCID threshold (p < 0.001). Patients with increasing hernia width had higher odds of exceeding MCID at 1 year post-op (OR 1.04, p < 0.01), as did patients with greater ASA class (OR 8.9, p < 0.01).

Conclusion: Using MCID can help identify patients who may significantly improve QoL after VHR, as well as power clinical trials with QoL as primary outcome.
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http://dx.doi.org/10.1016/j.amjsurg.2021.06.018DOI Listing
February 2022

Comparison of saliva with healthcare workers- and patient-collected swabs in the diagnosis of COVID-19 in a large cohort.

BMC Infect Dis 2021 Jul 5;21(1):648. Epub 2021 Jul 5.

Department of Medical Gastroenterology, AIG Hospitals, Survey No 136, Plot No 2/3/4/5, 1, Mindspace Road, Gachibowli, Hyderabad, Telangana, 500032, India.

Background: A considerable amount of evidence demonstrates the potential of saliva in the diagnosis of COVID-19. Our aim was to determine the sensitivity of saliva versus swabs collected by healthcare workers (HCWs) and patients themselves to assess whether saliva detection can be offered as a cost-effective, risk-free method of SARS-CoV-2 detection.

Methods: This study was conducted in a hospital involving outpatients and hospitalized patients. A total of 3018 outpatients were tested. Of these, 200 qRT-PCR-confirmed SARS-CoV-2-positive patients were recruited for further study. In addition, 101 SARS-CoV-2-positive hospitalized patients with symptoms were also enrolled in the study. From outpatients, HCWs collected nasopharyngeal swabs (NPS), saliva were obtained. From inpatients, HCWs collected swabs, patient-collected swabs, and saliva were obtained. qRT-PCR was performed to detect SARS-CoV-2 by TAQPATH assay to determine the sensitivity of saliva detection. Sensitivity, specificity and positive/negative predictive values (PPV, NPV) of detecting SARS-CoV-2 were calculated using MedCalc.

Results: Of 3018 outpatients (asymptomatic: 2683, symptomatic: 335) tested by qRT-PCR, 200 were positive (males: 140, females: 60; aged 37.9 ± 12.8 years; (81 asymptomatic, 119 symptomatic). Of these, saliva was positive in 128 (64%); 39 of 81 asymptomatic (47%),89 of 119 symptomatic patients (74.8%). Sensitivity of detection was 60.9% (55.4-66.3%, CI 95%), with a negative predictive value of 36%(32.9-39.2%, CI 95%).Among 101 hospitalized patients (males:65, females: 36; aged 53.48 ± 15.6 years), with HCW collected NPS as comparator, sensitivity of saliva was 56.1% (47.5-64.5, CI 95%), specificity 63.5%(50.4-75.3, CI95%) with PPV of 77.2% and NPV of 39.6% and that of self-swab was 52.3%(44-60.5%, CI95%), specificity 56.6% (42.3-70.2%, CI95%) with PPV 77.2% and NPV29.7%. Comparison of positivity with the onset of symptoms revealed highest detection in saliva on day 3 after onset of symptoms. Additionally, only saliva was positive in 13 (12.8%) hospitalized patients.

Conclusion: Saliva which is easier to collect than nasopharyngeal swab is a viable alternate to detect SARS-COV-2 in symptomatic patients in the early stage of onset of symptoms. Although saliva is currently not recommended for screening asymptomatic patients, optimization of collection and uniform timing of sampling might improve the sensitivity enabling its use as a screening tool at community level.
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http://dx.doi.org/10.1186/s12879-021-06343-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8256642PMC
July 2021

Preoperative exercise and outcomes after ventral hernia repair: Making the case for prehabilitation in ventral hernia patients.

Surgery 2021 08 20;170(2):516-524. Epub 2021 Apr 20.

Center for Abdominal Core Health, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: https://twitter.com/DrCoCoMD.

Background: An increasing body of information suggests that preoperative physical activity level can impact postoperative outcomes. We sought to investigate this relationship in patients undergoing ventral hernia repair (VHR).

Methods: The Abdominal Core Health Quality Collaborative registry was used to identify patients undergoing a VHR between 2013 and 2019. Patient-reported preoperative exercise level was used to stratify the study population into 4 groups: none (no reported exercise), sporadic (once a month), moderate (once per week), and intense (more than once per week). Multi-variate logistic regression analyses were used to assess the impact of preoperative exercise frequency on postoperative outcomes, including complications, hospital readmissions and length of stay. Changes in quality of life and pain from baseline to 30-days postoperatively were assessed using the Hernia-Related Quality of Life Survey and National Institutes of Health Patient-Reported Outcomes Measurement Information System 3A Pain Scale.

Results: A total of 2,994 patients were included in the study, out of which 1,519 (50.7%) patients reported no preoperative exercise, 662 (22.1%) sporadic exercise, 467 (15.6%) moderate exercise, and 346 (11.6%) intense exercise. A total of 1,253 patients (19.2%) experienced a postoperative complication, out of which 249 (3.8%) had a surgical site infection. After multi-variable analysis and adjusting for demographics, comorbidities, and hernia characteristics, increasing exercise frequency (versus no reported exercise) was associated with significantly lower odds of experiencing any postoperative complication (sporadic: odds ratio 0.70; P = .008; moderate: odds ratio 0.62, P = .006; intense: odds ratio 0.67, P = .04), as well as lower odds of readmission (sporadic: odds ratio 0.04; moderate: odds ratio 0.40; intense: odds ratio 0.03; P = .01). Exercise level was not associated with length of stay (sporadic: P = .36; moderate: P = .19; intense: P = .95). No significant differences were found in changes in quality of life or pain from baseline to 30-days after surgery (Hernia-Related Quality of Life Survey, P = .24; National Institutes of Health Patient-Reported Outcomes Measurement Information System 3A P = .14).

Conclusion: Patients reporting greater exercise frequency before surgery demonstrated decreased risk of complications and readmission after undergoing ventral hernia repair. Increasing preoperative exercise participation through targeted prehabilitation programs may be a viable way for patients to reduce complications associated with VHR and improve their postoperative recovery.
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http://dx.doi.org/10.1016/j.surg.2021.03.006DOI Listing
August 2021

Elective ventral hernia repair provides significant abdominal wall quality of life improvements in older patients.

Surg Endosc 2022 03 8;36(3):1927-1935. Epub 2021 Apr 8.

Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA.

Background: An increasing proportion of ventral hernia patients are over age 65. These patients are frequently offered watchful waiting rather than surgical intervention due to their frail state or perioperative risk. However, many in this age group suffer from significant quality of life impacts that are not well understood.

Methods: We performed a retrospective cohort study using data from the Abdominal Core Health Quality Collaborative (ACHQC), including adults undergoing elective ventral hernia repair from 2013 to 2019. Median differences in Hernia-Related Quality of Life Survey (HerQLes) summary scores at baseline, 30-days, 6-months, and 1 year post operatively were compared in four age categories (18-40, 40-64, 65-75, 76 +) using multivariable regression. Secondary outcomes included major post-operative complications and mortality.

Results: Of 6681 patients meeting inclusion criteria, 13.5% were 18-40, 55.8% were 41-64, 25.2% were 65-75, and 5% were 76 + . Patients in the 65-75 age group and those over 76 had higher mean baseline HerQLes scores (51.7 and 60.8) compared to those in the 18-40 and 41-64 groups (45 and 43.3, p < 0.01). Patients 65-75 had smaller increases in HerQLes scores at 30 days (6.7) compared to patients in the younger age groups (11.7 for 18-40; 8.3 for 41-64) and the oldest age group (8.3, p < 0.01). However, patients in the older age groups had higher overall median 1 year HerQles Scores (66.7 for 65-75; 78.3 for 76 +) compared to patients in the 18-40 and 41-64 age groups (65 and 58.3, p < 0.01). On multivariable analysis, HerQLes scores at 30 days post-surgery were decreased for patients in the 41-64 (-3.14, CE -5.89, -0.04, p = 0.03) and 65-75 (-4.53; CE -7.65, -1.41, p < 0.01) groups compared to the youngest age group, while those over 76 had no effect.

Conclusion: Older adults undergoing ventral hernia repair demonstrate equal gains in hernia-related quality of life compared to younger patients and actually report higher quality of life scores at 30 days, 6 months and, 1 year post-surgery.
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http://dx.doi.org/10.1007/s00464-021-08475-1DOI Listing
March 2022

Length of stay and surgical site complications are not increased after elective incisional hernia in patients with a history of solid organ transplantation.

Surg Endosc 2022 03 31;36(3):2159-2168. Epub 2021 Mar 31.

Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, USA.

Background: The incidence of ventral hernia development after solid organ transplantation has been reported to be up to 30%. We aim to determine the impact of previous solid organ transplant on post-operative length of stay (LOS) and surgical site complications in elective ventral hernia repairs.

Methods: A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) was conducted to include all patients age 18 years or older who underwent elective incisional hernia repair. Those with and without a history of solid organ transplantation were compared. The primary outcome was in-hospital LOS. Secondary outcomes included 30-day surgical site infection (SSI) rate, 30-day surgical site occurrence requiring procedural intervention (SSOPI) rate, 30-day overall post-operative complications and recurrence. The association between transplant and the LOS was tested with a negative binomial regression model adjusted for the demographic characteristics, comorbidities and hernia characteristics in the model.

Results: The population analyzed included 13,452 (98.79%) patients without a history of organ transplantation and 165 (1.21%) patients who had a history of organ transplantation. After adjusting for age, hernia width, BMI, gender, race, insurance type, ASA class, hypertension, dyspnea, OR time > 2 h, abdominal wall SSI history, recurrent hernia, operative approach the median LOS was not significantly different between patients with a history of solid organ transplant [2.8 (2.6, 2.9) days] and those without [2.6 days (2.2, 3.1)] (p = 0.5). The proportion of SSI (2.4% vs 4.04%; p = 0.42), SSOPI (4.2% vs 5.8%; p = 0.38) and recurrence (0.6% vs 0.4%, p = 0.51) was similar between both groups. Other remaining 30-day post-operative were negligible in our sample.

Conclusions: There were no significant differences in LOS or infection rates between patients with and without a history of solid organ transplantation despite known risks of immunosuppression and chronic steroid use. Therefore, although these patients have many classic risk factors for poor outcomes, the data suggest that their history of solid organ transplantation should not preclude them from surgery.
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http://dx.doi.org/10.1007/s00464-021-08458-2DOI Listing
March 2022

Emerging role of cannabinoids and synthetic cannabinoid receptor 1/cannabinoid receptor 2 receptor agonists in cancer treatment and chemotherapy-associated cancer management.

J Cancer Res Ther 2021 Jan-Mar;17(1):1-9

Amity Institute of Biotechnology, Amity University, Navi Mumbai, Maharashtra, India.

Cannabis was extensively utilized for its medicinal properties till the 19 century. A steep decline in its medicinal usage was observed later due to its emergence as an illegal recreational drug. Advances in technology and scientific findings led to the discovery of delta-9-tetrahydrocannabinol (THC), the primary psychoactive compound of cannabis, that further led to the discovery of endogenous cannabinoids system consisting of G-protein-coupled receptors - cannabinoid receptor 1 and cannabinoid receptor 2 along with their ligands, mainly anandamide and 2-arachidonoylglycerol. Endocannabinoid (EC) is shown to be a modulator not only for physiological functions but also for the immune system, endocrine network, and central nervous system. Medicinal research and meta-data analysis over the last few decades have shown a significant potential for both THC and cannabidiol (CBD) to exert palliative effects. People suffering from many forms of advanced stages of cancers undergo chemotherapy-induced nausea and vomiting followed by severe and chronic neuropathic pain and weight loss. THC and CBD exhibit effective analgesic, anxiolytic, and appetite-stimulating effect on patients suffering from cancer. Drugs currently available in the market to treat such chemotherapy-induced cancer-related ailments are Sativex (GW Pharmaceutical), Dronabinol (Unimed Pharmaceuticals), and Nabilone (Valeant Pharmaceuticals). Apart from exerting palliative effects, THC also shows promising role in the treatment of cancer growth, neurodegenerative diseases (multiple sclerosis and Alzheimer's disease), and alcohol addiction and hence should be exploited for potential benefits. The current review discusses the nature and role of CB receptors, specific applications of cannabinoids, and major studies that have assessed the role of cannabinoids in cancer management.
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http://dx.doi.org/10.4103/jcrt.JCRT_488_18DOI Listing
November 2021

Early liver transplantation after COVID-19 infection: The first report.

Am J Transplant 2021 06 15;21(6):2279-2284. Epub 2021 Feb 15.

Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India.

COVID-19 (coronavirus disease 2019) has impacted solid organ transplantation (SOT) in many ways. Transplant centers have initiated SOT despite the COVID-19 pandemic. Although it is suggested to wait for 4 weeks after COVID-19 infection, there are no data to support or refute the timing of liver transplant after COVID-19 infection. Here we describe the course and outcomes of COVID-19-infected candidates and healthy living liver donors who underwent transplantation. A total of 38 candidates and 33 potential living donors were evaluated from May 20, 2020 until October 30, 2020. Ten candidates and five donors were reverse transcriptase-polymerase chain reaction (RT-PCR) positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pretransplant. Four candidates succumbed preoperatively. Given the worsening of liver disease, four candidates underwent liver transplant after 2 weeks due to the worsening of liver disease and the other two candidates after 4 weeks. Only one recipient died due to sepsis posttransplant. Three donors underwent successful liver donation surgery after 4 weeks of COVID-19 infection without any postoperative complications, and the other two were delisted (as the candidates expired). This report is the first to demonstrate the feasibility of elective liver transplant early after COVID-19 infection.
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http://dx.doi.org/10.1111/ajt.16509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013377PMC
June 2021

PSTi8 with metformin ameliorates perimenopause induced steatohepatitis associated ER stress by regulating SIRT-1/SREBP-1c axis.

Heliyon 2020 Dec 29;6(12):e05826. Epub 2020 Dec 29.

Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, 226031, India.

Aims: Hepatic steatosis in women confronting menopause is the manifestation of substantial fructose consumption and forms a positive feedback loop to develop endoplasmic reticulum (ER) stress. Previously pancreastatin inhibitor peptide-8 (PSTi8) and Metformin (Met) combination effectively ameliorated hepatic lipid accumulation in high fructose diet (HFrD) fed diabetic mice models at reduced doses. Moreover, SIRT-1 plays a crucial role in the regulation of SREBP-1c. Hence we hypothesized that Met and PSTi8 in combination (at therapeutic lower doses) could mitigate hepatic steatosis linked ER stress by activating SIRT-1 and precluding SREBP-1c in HFrD fed 4-Vinylcyclohexenediepoxide (HVCD) induced perimenopausal rats.

Main Methods: HVCD rats were fed HFrD for 12 weeks, accompanied by 14 days of treatment with Met, PSTi8, and combination. We confirmed model establishment by estrus cycle study, estradiol level, and intraperitoneal glucose tolerance test. Plasma lipid profile and liver function were determined. Also, mRNA and protein expressions were examined. Moreover, distribution of SIRT-1 and SREBP-1c was detected in HepG2 cells by immunofluorescence staining.

Key Findings: HVCD group displayed augmented insulin resistance (IR), lipogenesis, and ER stress in the liver. Combination therapy improved the estrus cyclicity, estradiol, and lipid profile of HVCD rats. Met and PSTi8 combination reduced hepatic SREBP-1c and triggered SIRT-1 expression in high fructose-induced insulin-resistant HepG2 cells; consequently, combination therapy attenuated ER stress.

Significance: Succinctly, present research promotes impetus concerning the remedial impact of Met with PSTi8 at lower therapeutic doses to ameliorate hepatic IR, steatosis, and associated ER stress by revamping the SIRT-1/SREBP-1c axis in perimenopausal rats.
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http://dx.doi.org/10.1016/j.heliyon.2020.e05826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779780PMC
December 2020

Please spare my teeth! Dental procedures and trigeminal neuralgia.

Surg Neurol Int 2020 22;11:455. Epub 2020 Dec 22.

Department of Radiotherapy, Postgraduate Institute of Medical Education and Reserach, Chandigarh, India.

Background: The correct diagnosis of trigeminal neuralgia (TN) is still a far cry and the patients suffer from unnecessary dental procedures before getting the definite treatment. In this study, we evaluated, if the patients have undergone dental procedures for their misdiagnosed TN before receiving definite treatment for the same.

Methods: A total of 187 patients received GKRS for their TN (excluding secondary TN) in two institutes from 2010 to 2019. We did a retrospective analysis of these patients' primary complaints on a standard questionnaire.

Results: One hundred and seventeen of the 187 patients responded. About 55.5% of patients had a toothache and 65.8% did visit a dentist for the pain. About 41.8% of patients underwent one dental procedure; 18.8% suffered from worsening of the pain while 8.5% received some partial improvement. About 19.6% also underwent root canal treatment while 6.8% had a nerve block. Mean of 1.6 teeth was extracted per person. About 71% of patients were satisfied with their Gamma Knife radiosurgery for TN at a median follow-up of 49 months.

Conclusion: There is a need for a better understanding of the disease among the dentists and the patients for the timely and correct treatment, without losing their teeth. The onus lies on neurosurgeons/neurologists disseminate knowledge regarding proper diagnosis and treatment modalities.
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http://dx.doi.org/10.25259/SNI_729_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771490PMC
December 2020

Emergency Department "Bounce-Back" Rates as a Function of Emergency Medicine Training Year.

Cureus 2020 Sep 17;12(9):e10503. Epub 2020 Sep 17.

Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA.

Introduction: Since the 1990s, the emergency department (ED) unscheduled return visit (URV), or "bounce-back," has been used as a quality of care measurement. During that time, resident training was also scrutinized and uncovered a need for closer resident supervision, especially of second-year residents. Over the years, bounce-backs have continued to be analyzed with vigor, but research on residency training and supervision has lagged with few studies concurrently investigating residency supervision and bounce-backs. Other literature on resident supervision suggests that with adequate attending supervision, resident performance is equivalent to attending performance. With that in mind, it was hypothesized that resident bounce-back rates will be equivalent to attending bounce-back rates, and there will be no change among residency years. The primary objective of this study was to determine the rate at which patients are seen as a bounce-back visit within 72 hours of their initial visit to a community hospital ED during the study time frame. The secondary aims were to evaluate if the ED bounce-back rate is impacted by training level (residents or attending) and to describe bounce-back patient characteristics, including primary complaint/disease, age, comorbidities and issues with compliance.

Methods: A retrospective chart review of 1000 charts was conducted from September 2015 to September 2017. Charts were randomly selected by the Quality & Patient Safety (QPS) team and, after applying inclusion/exclusion criteria, 732 charts were analysed. Inclusion criteria included age ≥ 18 years, patients treated by an Emergency Medicine (EM) resident during their initial visit and patients with a "discharge" disposition. Exclusion criteria included patients seen as a scheduled return visit (e.g., two-day return for blood pregnancy recheck, wound check, etc.). Demographics, initial visit variables, comorbidities and bounce-back data were collected based on electronic record query or chart review. Data was analysed using means, standard deviations, medians and ranges for continuous variables. Logistic regression modelling techniques were used to examine factors that affect whether the patient had a bounce-back visit.

Results: The rate of URVs within 72 hours of the patient's initial visit was 4.65%. PGY1 and PGY2's bounce-back rate was 3.8% and 3.6%, respectively, and PGY3 and PGY4's bounce-back rate was 5.7% and 5.6%, respectively (p-value=.63). There was no statistically significant change among residency years. Most bounce-back characteristics analysed including primary complaint, age, and comorbidities demonstrated no statistical significance in the increased rate of bounce-back except for patients with a history of tobacco abuse, alcohol abuse and chronic pain. Current smokers were 6.5 times more likely to bounce back than former smokers (odds ratio=6.485, 95% confidence interval = 2.089 to 20.133, p-value=0.0012) and those with chronic pain were 2.5 times more likely to bounce back than those without chronic pain (odds ratio=2.518, 95% confidence interval =1.029 to 6.164, p=0.0431).

Conclusion: EM residency training year does not increase the frequency of bounce-backs in a community hospital ED. Finally, patients with substance abuse and chronic pain were more likely to bounce back.
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Source
http://dx.doi.org/10.7759/cureus.10503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571604PMC
September 2020
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