Publications by authors named "Anjali Aggarwal"

89 Publications

Improving Student Confidence With Electronic Health Record Order Entry.

PRiMER 2021 2;5:23. Epub 2021 Jul 2.

Baylor College of Medicine, Department of Family and Community Medicine, Houston, TX.

Introduction: Despite near-universal utilization of electronic health records (EHRs) by physicians in practice, medical students in most ambulatory settings gain limited experience with placing EHR orders. In this study, an individual preceptor site investigated the usefulness of a targeted curriculum in improving students' EHR confidence and clinical reasoning skills.

Methods: Family medicine clerkship students assigned to one community health center were invited to participate in this prospective, survey-based study. In their first week, students observed a preceptor performing EHR tasks. For the remainder of the 4-week clerkship, students utilized decision support tools, assigned a working diagnosis, entered unsigned orders in the EHR, proposed an assessment, and discussed a plan with a preceptor. Students completed weekly questionnaires to self-report confidence across several EHR domains while preceptors synchronously evaluated students' accuracy with entering orders correctly.

Results: From February 2017 to March 2020, all 49 eligible students completed the study. One hundred percent of students reported that placing EHR orders was beneficial to their medical education. The difference over time in learner confidence with placing EHR orders was statistically significant across every domain (eg, writing prescriptions, ordering labs and imaging). Preceptors' evaluations of students' accuracy with placing orders also showed significant improvement between each week.

Conclusion: Clerkship-wide EHR training may be limited by multiple sites with multiple EHR products. This pilot study suggests that committed faculty at an individual preceptor site can offer a targeted curriculum to help students develop EHR confidence. We propose other preceptors similarly offer students this opportunity to maximize clerkship education.
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http://dx.doi.org/10.22454/PRiMER.2021.619838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284489PMC
July 2021

Alleviation of heat stress by Chlorophytum borivilianum: impact on stress markers, antioxidant, and immune status in crossbred cows.

Trop Anim Health Prod 2021 Jun 8;53(3):351. Epub 2021 Jun 8.

Animal Physiology Division, ICAR-National Dairy Research Institute, Karnal, Haryana, 132001, India.

Eighteen crossbred Karan Fries (KF) cows in mid-lactation (av. 130 days) were selected from the livestock herd of the institute. The treatment for the experimental cows was as follows: no supplement (control), a low dose of Chlorophytum borivilianum (CB) at a dose rate of 40 mg/kg BW/day (T1, n = 6), and a high dose of CB at a dose rate of 80 mg/kg BW/day (T2, n = 6) for a period of 90 days in hot-humid season. Physiological responses like respiration rate (RR), pulse rate (PR), and rectal temperature (RT) were recorded in the morning (8.00 A.M.) and afternoon (2.30 P.M.) at weekly intervals. The expression of pro-inflammatory (IL-1β and TNF-α) and anti-inflammatory cytokine (IL-10) in PBMCs, the plasma level of antioxidants (SOD, catalase, TBARS, and TAC), hormones (cortisol, prolactin), and energy metabolites (glucose, NEFA, urea, and creatinine) were determined. Dry and wet bulb temperatures and minimum and maximum temperatures were recorded, and the THI was calculated. The values of PR and RT were decreased (p < 0.01) in the T2 group in comparison to T1. Plasma glucose level was lower, and NEFA, urea, and creatinine level were higher (p < 0.01) in the control group as compared to T2 and T1 groups, respectively. Plasma cortisol and prolactin levels were significantly higher (p < 0.01) in the control group and were lower in T1 and T2 groups. Feeding of CB in high dose decreased (p < 0.01) plasma SOD, catalase, TBARS, and improved TAC levels in T2 over the T1 group. The dietary supplementation of CB at a dose rate of 80 mg/kg BW/day was more effective in lowering the stress level and augments the immunity by downregulating pro-inflammatory and anti-inflammatory cytokine levels. Therefore, dietary CB supplementation could be used as an effective heat stress ameliorator in dairy cows.
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http://dx.doi.org/10.1007/s11250-021-02796-yDOI Listing
June 2021

Novel and known miRNAs in zebu (Tharparkar) and crossbred (Karan-Fries) cattle under heat stress.

Funct Integr Genomics 2021 Jul 11;21(3-4):405-419. Epub 2021 May 11.

Animal Biochemistry Division, ICAR-National Dairy Research Institute, Karnal, 132001, Haryana, India.

MicroRNAs (miRNAs) are small single-stranded non-coding RNAs that act as the master regulator of animal growth and development. RNA-RNA interaction is an important mechanism of gene regulation during biotic and abiotic stress. Heat stress (HS) is one of the most important abiotic factors which affect the growth, milk yield and reproductive health of the dairy animals. In the present investigation, we identified 387 known and 77 novel miRNAs from Tharparkar (TH) and Karan Fries (KF) cattle under HS condition. Family distribution analysis showed the identified miRNAs belong to more than 15 different families in which miR-2284 was the most abundant. We identified 42,350 targets for the known miRNAs reported in cattle. Pathway analysis of the identified targets showed most of the target genes were involved in cancer, mitogen-activated protein kinase (MAPK) signaling, calcium signaling, Ras signaling, and cAMP signaling pathways. Differential gene expression showed more than 344 miRNAs changed their expression significantly between control and HS condition. Heat map was generated for the top 20 most up and downregulated miRNAs. Ten miRNAs were validated using qRT-PCR to be heat responsive, based on read count value and differential gene expression. These novel miRNAs are new addition to the miRNA database of cattle. This study provides an overview of miRNA profile and their interaction with the target genes which leads to further understanding in deciphering the thermotolerance mechanism in cattle.
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http://dx.doi.org/10.1007/s10142-021-00785-wDOI Listing
July 2021

Cobalamin J disease detected on newborn screening: Novel variant and normal neurodevelopmental course.

Am J Med Genet A 2021 06 17;185(6):1870-1874. Epub 2021 Mar 17.

Division of Genetics and Metabolism, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.

Cobalamin J disease (CblJ) is an ultra-rare autosomal recessive disorder of intracellular cobalamin metabolism associated with combined methylmalonic acidemia and homocystinuria. It is caused by pathogenic variants in ABCD4, which encodes an ATP-binding cassette (ABC) transporter that affects the lysosomal release of cobalamin (Cbl) into the cytoplasm. Only six cases of CblJ have been reported in the literature. Described clinical features include feeding difficulties, failure to thrive, hypotonia, seizures, developmental delay, and hematological abnormalities. Information on clinical outcomes is extremely limited, and no cases of presymptomatic diagnosis have been reported. We describe a now 17-month-old male with CblJ detected by newborn screening and confirmed by biochemical, molecular, and complementation studies. With early detection and initiation of treatment, this patient has remained asymptomatic with normal growth parameters and neurodevelopmental function. To the best of our knowledge, this report represents the first asymptomatic and neurotypical patient with CblJ.
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http://dx.doi.org/10.1002/ajmg.a.62170DOI Listing
June 2021

Cadaveric anatomy of the lumbar triangular safe zone of Kambin's in North West Indian population.

Anat Cell Biol 2021 Mar;54(1):35-41

Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

A three dimensional triangular space 'the Kambin's triangle (KT)' present on the dorsolateral aspect of the intervertebral disc, is considered to be a safe area for transforaminal approaches. It allows access to the exiting and traversing nerve roots, the thecal sac and to the intervertebral disc spaces. Our aim was to calculate the area of the triangle by measuring the height and base at all the intervertebral spaces bilaterally in the lumbar region in North West Indian cadavers and to assess the diameter of circle inscribed within this triangle which will correspond to the size of cannula inserted for the minimally invasive transforaminal approaches in this population. Five randomly chosen adult cadavers were used for this study. After clearing the area, the exiting nerve was identified. The height and base of the bony KTs (n=40) were measured with the help of digital Vernier's calliper (accuracy 0.02 mm) to calculate the area of the KT. There is a steady increase in the area of the bony KT reaching maximum at the level of L4-5 intervertebral space. Statistically there were no differences in the calculated areas between right and left side. The mean diameter of inscribed circle within the triangle also showed gradual increase from 5.82 mm at L1-2 level, reaching maximum value of 7.26 mm at L4-5 level on the right side while on the left side the values were 5.66 mm and 8.16 mm respectively. Careful anatomical consideration is of utmost importance in transforaminal approaches during surgical or interventional procedures in this region. Cannula having external diameter ranging 6-8 mm is recommended for any interventional approach through Kambin's space.
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http://dx.doi.org/10.5115/acb.20.243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017462PMC
March 2021

"No, You Need to Explain What You Are Doing": Obstetric Care Experiences and Preferences of Adolescent Mothers With a History of Childhood Trauma.

J Pediatr Adolesc Gynecol 2021 Aug 31;34(4):538-545. Epub 2021 Jan 31.

Department of Paediatrics, Division of Endocrinology, Section of Gynecology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, Mount Sinai Health System, Toronto, Ontario, Canada.

Study Objective: To understand the pregnancy and childbirth experiences and preferences of adolescent mothers with a history of childhood trauma in order to develop trauma-informed care practice recommendations for this unique group.

Design: Mixed methods convergent parallel design involving completion of the Adverse Childhood Experiences (ACE) questionnaire, a survey of care experiences and preferences during pregnancy and delivery, and a one-on-one interview.

Setting: hHospital-based medical home program for pregnant and parenting adolescents.

Participants: Adolescent and young adult mothers aged 12-22 years, receiving care between June 2018 and June 2019.

Results: A total of 29 adolescent mothers completed the questionnaire, out of a potential 38 in the program (76.3% participation). Five went on to complete an interview. The average age was 17.9 years (standard deviation 1.8 years). The mean ACE score was 5.1 out of 10, indicating childhood exposure to an average of 5 different types of potential trauma. A total of 19 participants (65.5%) reported being triggered during pregnancy or postpartum. Trauma memories were elicited during vaginal examinations in the clinic (27.6%) and in the hospital (27.6%), abdominal examinations (13.8%), measurement of vital signs (17.2%), and labor (17.2%). Ten participants (34.5%) felt that the providers delivering their baby knew how to help them cope with trauma memories. Themes that emerged included the following: acknowledgment of trauma by provider, avoiding re-telling of story, building a relationship with provider, choice and control in care, and providing coping strategies.

Conclusion: A majority of adolescent mothers in our sample experienced trauma memories during pregnancy and postpartum medical interactions. Priorities for trauma-informed care in this population are described.
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http://dx.doi.org/10.1016/j.jpag.2021.01.006DOI Listing
August 2021

Myeloid-derived suppressor cells: Bridging the gap between inflammation and pancreatic adenocarcinoma.

Scand J Immunol 2021 May 27;93(5):e13021. Epub 2021 Jan 27.

Department of Anatomy, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Pancreatic cancer has been identified as one of the deadliest malignancies because it remains asymptomatic and usually presents in the advanced stage. Tumour immune evasion is a well-known mechanism of tumorigenesis in various forms of human malignancies. Chronic inflammation via complex networking of various inflammatory cytokines in the local tissue microenvironment dysregulates the immune system and support tumour development. Pro-inflammatory mediators present in the tumour microenvironment increase the tumour burden by causing immune suppression through the generation of myeloid-derived suppressor cells (MDSCs) and T regulatory cells. These cells, along-with myofibroblasts, create a highly immunosuppressive and resistant tumour microenvironment and are thus considered as one of the culprits for the failure of anti-cancer chemotherapies in pancreatic adenocarcinoma patients. Targeting these MDSCs using various combinatorial approaches might have the potential for abrogating the resistance and suppressive nature of the pancreatic tumour microenvironment. Therefore, there is more curiosity in studying the crosstalk of MDSCs with other immune cells during pathological conditions and the underlying mechanisms of immunosuppression in the current scenario. In this article, the possible role of MDSCs in inflammation-mediated tumour progression of pancreatic adenocarcinoma has been discussed.
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http://dx.doi.org/10.1111/sji.13021DOI Listing
May 2021

Surgical anatomy of basal turn in relation to middle cranial fossa and round window as pertaining to middle fossa cochlear implant technique.

Surg Radiol Anat 2021 Jul 5;43(7):1195-1201. Epub 2021 Jan 5.

Department of Otorhinolaryngology and Head-Neck Surgery, Fortis Hospital, Mohali, Punjab, India.

Purpose: The purpose of this investigation was to evaluate the relation of the basal turn of cochlea with middle cranial fossa and round window as pertaining to middle cranial fossa cochlear implant technique.

Methods: Fifty-four formalin preserved temporal bones were micro-dissected to expose the basal turn. The point (f) was marked on the basal turn of cochlea where there was minimum distance of basal turn of cochlea from the floor of middle cranial fossa (f). The f-f distance, the angle (∠smf) and distance of point "f" from the round window (s-f) was measured.

Results: The mean minimum distance between basal turn of cochlea and floor of middle cranial fossa (f-f) was 2.0 ± 0.7 mm.The point f was at mean distance (s-f) and angle (∠smf) of 14.7 ± 1.6 mm and 217° ± 13.7° from round window, respectively.

Conclusions: The information may be helpful for designing appropriate electrode array for middle fossa technique especially for deciding the length of electrode array towards round window, as otherwise electrode may extend into vestibule of inner ear. In the cases where bone thickness between superior part of basal turn of cochlea and middle cranial fossa is < 1.5 mm, surgeon should be extra cautious.
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http://dx.doi.org/10.1007/s00276-020-02647-9DOI Listing
July 2021

Stillbirths among Advanced Maternal Age Women in the United States: 2003-2017.

Int J MCH AIDS 2020 10;9(1):153-156. Epub 2020 Feb 10.

Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas, USA.

The aim of the study was to evaluate the association between fetal stillbirth and advanced maternal age in the United States (US). This was a population-based study using the Natality and Fetal Death datasets for the years 2003-2017. We built Cox proportional regression models to examine the likelihood of stillbirth among women aged ≥40 years. Out of a total of 57,273,305 births, stillbirth was observed in 302,522, yielding a stillbirth rate of 5 per 1000. After adjusting for confounders, women of advanced age (≥40 years) had a 40-50% greater risk of stillbirth compared to women 20-29 years of age.
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http://dx.doi.org/10.21106/ijma.346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031887PMC
February 2020

Trends in Stillbirths and Stillbirth Phenotypes in the United States: An Analysis of 131.5 Million Births.

Int J MCH AIDS 2020 10;9(1):146-148. Epub 2020 Feb 10.

Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas, USA.

We examined the trends in stillbirth across gestational age in the United States (US).We conducted a trend analysis using the U.S. Natality and Fetal Death datasets covering 1982 and 2017. We compared the incidence and rates of stillbirth for term, all preterm, moderate-to-late preterm, very preterm, and extreme preterm phenotypes. The incidence of stillbirth decreased for the entire birth cohort over the 36-year period. The rates of overall, term, all preterm, very preterm and moderate-to-late preterm stillbirth decreased from 1982 to 2017; however, the rates for extreme preterm stillbirth increased by about 7.6% over the same study period.
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http://dx.doi.org/10.21106/ijma.344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031879PMC
February 2020

Evaluation of an Evidence-based and Community-responsive Fatherhood Training Program: Providers' Perspective.

Int J MCH AIDS 2020 28;9(1):64-72. Epub 2019 Dec 28.

University of South Florida, College of Public Health, 13201 Bruce B. Downs MDC 56, Tampa, FL 33612, USA.

Background And Objectives: Studies on male involvement and pregnancy outcomes have often not incorporated the providers' perspectives, which are potentially critical to understanding program context, evolution, perceived impact, and sustainability. We sought to evaluate the 24/7 Dad® program from the viewpoint of the program providers.

Methods: We conducted purposive sampling of 24/7 Dad program facilitators and administrators who were involved in recruitment, training, and follow up of program participants within a federal Healthy Start program (REACHUP) in Tampa, Florida, USA. Using a snowballing approach, we recruited six key informants who had administered the program for at least four years. We elicited and evaluated factors impacting the performance of the father involvement program using content analysis.

Results: Under program participation and perceived impact, most providers thought that the program had created a safe space previously unavailable for men in the community. The most useful recruitment strategy was building partnerships with other organizations. The key informants noted an important evolutionary trend in the father involvement program over time as well as the nature of linkages to partner organizations within the area. Threats to program sustainability included the continued reluctance and scepticism to invest funds to address male issues, sub-optimal retention of participants who were living transient lives as well as geographical/transportation barriers.

Conclusion And Global Health Implications: The involvement of fathers during pregnancy has significant implications for healthy babies. Our study results provide a clarion call to augment capacity and infuse more resources to improve paternal involvement in order to attain the United Nations Sustainable Goal (2015-2030) of ensuring healthy lives and the promotion of well-being for all at all ages.
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http://dx.doi.org/10.21106/ijma.297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031889PMC
December 2019

Maternal Caffeine Consumption and Racial Disparities in Fetal Telomere Length.

Int J MCH AIDS 2020 30;9(1):14-21. Epub 2019 Dec 30.

Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, One Baylor Plaza, MS:411 Houston, TX 77030, USA.

Background And Objectives: The identification of risk factors for shorter telomere length, especially during fetal development, would be important towards caffeine consumption recommendations for pregnant women on a global scale. The purpose of this study was to evaluate the association between caffeine intake and fetal telomere length as well as racial/ethnic differences in telomere length regardless of maternal caffeine consumption status.

Methods: Caffeine intake was measured using a food frequency questionnaire (FFQ). Three generalized linear models (GLM) were compared based on binary categorical variables of caffeine levels using data mean value of 117.3 mg as cut-off; the World Health Organization (WHO) recommendations of 300 mg; and the American College of Obstetricians and Gynecologists (ACOG) recommendations of 200 mg. The association between caffeine consumption and telomere length (telomere to single-copy [T/S] ratio) was then assessed.

Results: Among 57 maternal-fetal dyads, 77.2% reported less than 200 mg of caffeine (ACOG) and 89.5% less than 300 mg (WHO). Both WHO and ACOG models found that caffeine intake was significantly and positively associated with longer telomere length (p<0.05); and sodium (p<0.05). Other" race (p<0.001) and "white" race (p<0.001) were also significantly and positively associated with longer telomere length in the same models. Increasing maternal age shortened telomere length significantly in all models (p<0.001).

Conclusion And Global Health Implications: Caffeine intake, maternal age, and race may be associated with alterations in fetal telomere length. This indicates that caffeine consumption during pregnancy may have long-term implications for fetal development. The racial/ethnic differences in telomere length found in this study warrant larger studies to further confirm these associations.
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http://dx.doi.org/10.21106/ijma.290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031881PMC
December 2019

Anatomic variability of oval window as pertaining to stapes surgery.

Surg Radiol Anat 2020 Mar 23;42(3):329-335. Epub 2019 Sep 23.

Department of Otorhinolaryngology and Head-Neck Surgery, Fortis Hospital, Sahibzada Ajit Singh Nagar, India.

Purpose: The purpose of the study is to study the details of dimensions and shape of oval window in different age groups, sides and genders and their clinical implications. The oval window is a key structure while performing surgeries in relation to stapes. An intricate knowledge of the shape and size of the oval window is important for the reconstruction and fitting of cartilage compatible with the native shape of the oval window.

Methods: Sixty normal wet cadaveric temporal bones of known age; gender and side were micro-dissected. The maximum height and width of the oval window was measured. The shape of the oval window was noticed.

Results: The mean value for maximum height and width of the oval window was 1.31 ± 0.28 mm and 2.67 ± 0.42 mm, respectively. The height and width of the oval window ranged between 1 mm and 1.5 mm and 2 mm and 3 mm in majority of the cases.  he oval window was found to be oval shaped in 53.3% cases, other shapes such as kidney, D shape, rectangular or trapezoidal were also observed.

Conclusions: The refined morphometric information of the oval window will help in preoperative assessment and surgical planning of various oval window-related surgical procedures. The knowledge may also help in designing and selecting proper cartilage shoe for the best outcome. Narrow oval window may cause procedural complications and surgeon discomfort in various stapes surgeries.
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http://dx.doi.org/10.1007/s00276-019-02347-zDOI Listing
March 2020

Reappraisal of the classical abdominal anatomical landmarks using in vivo computerized tomography imaging.

Surg Radiol Anat 2020 Apr 11;42(4):417-428. Epub 2019 Sep 11.

Department of Anatomy, PGIMER, #123-c Type V Flats, Sector 24 A, Chandigarh, 160023, India.

Introduction: With expanding scope of interventions it becomes mandatory to have correct and evidence-based knowledge of surface anatomy of internal abdominal structures. Information available in text books is derived from work done on cadaveric studies. Current study was designed to provide data of key abdominal surface anatomical landmarks and their variations in living subjects using CT imaging of adult population.

Materials And Methods: Cross-sectional study was conducted using 100 abdominopelvic CT scans of patients of Indian origin.

Results: Vertebral levels of origin of celiac trunk varied from T11 to L1/2 intervertebral disc, superior mesenteric artery from T12 to L2, inferior mesenteric artery from L2 to L4 and aortic bifurcation from L3 to L5. Origin of both renal arteries varied between T12 and L2 and the formation of inferior vena cava varied from L3 to L5. Vertebral levels of upper pole of both kidneys ranged from T11 to upper L3. Spleen was related to 9th to 11th ribs in 36% and 10th to 12th ribs in 34% scans. Most common vertebral levels of subcostal plane, planum supracristale and planum intertuberculare noticed were lower L2, L4 and lower L5, respectively.

Conclusions: Data derived from imaging investigations of living subjects and variations from the conventional descriptions observed in the current study might be helpful for clinicians.
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http://dx.doi.org/10.1007/s00276-019-02326-4DOI Listing
April 2020

Anatomy of the hepatic arteries and their extrahepatic branches in the human liver: A cadaveric study.

Ann Anat 2020 Jan 7;227:151409. Epub 2019 Aug 7.

Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.

Background: To describe the hepatic arterial anatomy in detail, tracing the individual hepatic arteries from their origin, extrahepatic course, branching to their segmental territorial supply as applicable to the vascular mapping for hepatic endovascular procedures.

Methods: The study was conducted on 100 formalin fixed adult cadaveric livers. The hepatic arterial anatomy was dissected from the origin of hepatic arteries up to their segmental branching.

Results: The origin of hepatic arteries was standard in 72% and aberrant in 28% livers. In livers with standard origin, extrahepatic branching of the main hepatic artery was close to the hepatic hilum in 48% and was in the lower part of the hepatoduodenal ligament in 24% livers. The pattern of extrahepatic branching in each type was three and five respectively. Aberrant arterial anatomy was broadly categorized into three groups. The mapping of segmental arterial vascularization of individual hepatic arteries in each type was also done.

Conclusions: In the present study, an attempt was made to systematically describe the complex hepatic arterial anatomy in a clinically applicable fashion. High variability was seen in the hepatic arterial anatomy at each level, a lot of which could not be included in the current classification systems. The information provided is an important prerequisite for performing accurate intra-arterial hepatic interventions.
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http://dx.doi.org/10.1016/j.aanat.2019.07.010DOI Listing
January 2020

Rare anatomic variations of the right hepatic biliary system.

Surg Radiol Anat 2019 Sep 21;41(9):1087-1092. Epub 2019 May 21.

Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Purpose: To report rare and clinically significant anatomic variations in the biliary drainage of right hepatic lobe.

Methods: Unique variations in the extra- and intrahepatic biliary drainage of right hepatic lobe were observed in 6 cadaveric livers during dissection on 100 formalin-fixed en bloc cadaveric livers.

Results: There was presence of aberrant drainage of right segmental and sectorial ducts in four cases and of accessory right posterior sectorial duct in two cases.

Conclusions: We encountered some extensively complicated biliary drainage of right hepatic lobe, unsuccessful recognition of which can lead to serious biliary complications during hepatobiliary surgeries and biliary interventions.
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http://dx.doi.org/10.1007/s00276-019-02260-5DOI Listing
September 2019

Chronic inflammation during osteoarthritis is associated with an increased expression of CD161 during advanced stage.

Scand J Immunol 2019 Jul 14;90(1):e12770. Epub 2019 May 14.

Department of Anatomy, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Increasing evidence suggests a role of inflammation during the pathogenesis of osteoarthritis (OA). The local and systemic inflammation was studied in 33 patients of different KL grades, grade2 (n = 11), grade3 (n = 6) and grade4 (n = 16). The levels of cytokines, adipokines and matrix metalloproteinases (MMPs) were measured in serum and synovial fluid (SF) by flow cytometry and ELISA, respectively. The frequency of T cells and CD161 expression was measured by flow cytometry. The levels of IL-1β, IL-6 and IL-10 were significantly higher in sera and SF of patients with OA as compared to healthy control's serum. Higher levels of MMP9 and leptin and lower levels of adiponectin were observed in SF as compared to serum. The MMP9 in SF and MMP13 levels in serum and SF decreased in KL grade 4 cases. In these patients, higher levels of leptin and lower levels of adiponectin were observed in SF versus patients of lower grades. There was increased infiltration of CD8+ T cells in SF of OA cases with decreased frequency in grade 4 cases. The expression of CD161 on T cells was significantly higher in SF than peripheral blood with significant upregulation in grade 4 patients. The CD161 expression had significant positive correlation with IL-17 in the serum of patients. The ROC curves of CD161 expression significantly distinguished grade 2 and grade 4 patients. Collectively, an elevated CD161 expression on T cells in circulation and synovial compartment clearly distinguished lower and higher grade patients warranting studies to assess its role as a contributing factor towards OA progression.
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http://dx.doi.org/10.1111/sji.12770DOI Listing
July 2019

Temporal trends and black-white disparity in mortality among hospitalized persons living with HIV in the United States.

Medicine (Baltimore) 2019 Mar;98(9):e14584

Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN.

We sought to determine whether black-white gap in mortality exists among hospitalized HIV-positive patients in the United States (US). We hypothesized that in-hospital mortality (IHM) would be similar between black and white HIV-positive patients due to the nationwide availability of HIV services.Our analysis was restricted to hospitalized HIV-positive patients (15-49 years). We used the National Inpatient Sample (NIS) that covered the period from January 1, 2002 to December 31, 2014. We employed joinpoint regression to construct temporal trends in IHM overall and within subgroups over the study period. We applied multivariable survey logistic regression to generate adjusted odds ratios (OR) and 95% confidence intervals (CI).The total number of HIV-related hospitalizations and IHM decreased over time, with 6914 (3.9%) HIV-related in-hospital deaths in 2002 versus 2070 HIV-related in-hospital deaths (1.9%) in 2014, (relative reduction: 51.2%). HIV-related IHM among blacks declined at a slightly faster rate than in the general population (by 56.8%, from 4.4% to 1.9%). Among whites, the drop was similar to that of the general population (51.2%, from 3.9% to 1.9%). Although IHM rates did not differ between blacks and whites, being black with HIV was independently associated with a 17% elevated odds for IHM (OR = 1.17; 95% CI = 1.11-1.25).In-hospital HIV-related deaths continue to decline among both blacks and whites in the US. Among hospitalized HIV-positive patients black-white disparity still persists, but to a lesser extent than in the general HIV population. Improved access to HIV care is a key to eliminating black-white disparity in HIV-related mortality.
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http://dx.doi.org/10.1097/MD.0000000000014584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831347PMC
March 2019

Description of the aortic root anatomy in relation to transcatheter aortic valve implantation.

Cardiovasc Pathol 2019 May - Jun;40:19-23. Epub 2019 Jan 21.

Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.

Introduction: Transcatheter aortic valve implantation (TAVI) has emerged as a less invasive treatment than surgical aortic valve replacement in patients with aortic stenosis. Understanding the anatomy of aortic valve complex may help in optimal positioning of prosthetic valve and circumvent complications that can arise during its implantation.

Material And Methods: The anatomy of aortic root was studied in 30 formalin-fixed cadavers. Aortic root and left ventricular cavity was opened to measure the diameter at the base of aortic root and sinotubular junction (STJ); distance of coronary ostia from base of aortic root and STJ; height and width of aortic valve leaflets; length and thickness of membranous septum (MS).

Results: The diameter of aorta at the base of aortic root and STJ was 22.4±2.1 mm and 21.8±2.4 mm, respectively. The height of aortic leaflets was smaller than the width. The right and left coronary ostia were 10.7±1.9 mm and 10.5±1.9 mm above the base of aortic root. Membranous septum was 4.7±1.23 mm (range 2.9-6.1 mm) long and formed part of the wall of aortic root in 40% (12/30) cases.

Conclusions: Low lying coronary ostia speculate the use of a small prosthesis size to avoid or reduce the degree of coronary compression. Length of MS may help in deciding the extent of devise penetration into left ventricular outflow tract to avoid conduction block. Membranous septum forming wall of aortic root increases the risk of aortic root rupture and iatrogenic membranous defect during TAVI.
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http://dx.doi.org/10.1016/j.carpath.2019.01.005DOI Listing
July 2019

No. 313-Menstrual Suppression in Special Circumstances.

J Obstet Gynaecol Can 2019 Feb;41(2):e7-e17

Calgary, AB.

Objective: To provide a Canadian consensus document for health care providers with recommendations for menstrual suppression in patients with physical and/or cognitive challenges or those who are undergoing cancer treatment in whom menstruation may have a deleterious effect on their health.

Options: This document reviews the options available for menstrual suppression, its specific indications, contraindications, and side effects, both immediate and long-term, and the investigations and monitoring necessary throughout suppression.

Outcomes: Clinicians will be better informed about the options and indications for menstrual suppression in patients with cognitive and/or physical disabilities and patients undergoing chemotherapy, radiation, or other treatments for cancer.

Evidence: Published literature was retrieved through searches of Medline, EMBASE, OVID, and the Cochrane Library using appropriate controlled vocabulary and key words (heavy menstrual bleeding, menstrual suppression, chemotherapy/radiation, cognitive disability, physical disability, learning disability). Results were restricted to systematic reviews, randomized controlled trials, observation studies, and pilot studies. There were no language or date restrictions. Searches were updated on a regular basis and new material was incorporated into the guideline until September 2013. Grey (unpublished) literature was identified through searching websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1).

Benefits, Harms, And Costs: There is a need for specific guidelines on menstrual suppression in at-risk populations for health care providers.

Recommendations:
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http://dx.doi.org/10.1016/j.jogc.2018.11.030DOI Listing
February 2019

The segmental branching of the hepatic arteries in the liver: a cadaveric study.

Anat Sci Int 2019 Mar 7;94(2):216-223. Epub 2019 Jan 7.

Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

The purpose of this work was to evaluate the sectorial and segmental arterial branching (second- and third-order branching) in the right and left hemilivers, as knowledge of this branching should lead to improved vascular mapping for various endovascular procedures in the liver. The study was conducted on 100 formalin-fixed adult cadaveric livers. The arterial anatomy of the liver was dissected from the origin of the hepatic arteries to their segmental branches. Conventional segmental branching of both the right and the left hepatic arteries was seen in only 25% of the livers. In the remaining livers, the segmental branching of one or both of the hepatic arteries was different from that given in anatomy texts. The branching of the right and left hepatic arteries was anatomically classified into seven and six patterns, respectively, mainly on the basis of their sectorial and segmental anatomy. The present study details the highly diverse segmental arterial anatomy of the liver. The information provided here has important implications for procedures that involve selective catheterization of segmental arteries.
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http://dx.doi.org/10.1007/s12565-018-00475-xDOI Listing
March 2019

Use of Audio Computer-Assisted Self-Interviews to Gather Information on Risk Behaviors in a Population of Pregnant Adolescents.

J Pediatr 2018 12 21;203:450-453. Epub 2018 Sep 21.

Section of Pediatric Gynecology, Division of Endocrinology, Hospital for Sick Children, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.

In a prospective study comparing the use of the Audio Computer-Assisted Self-Interview (ACASI) with a traditional clinical interview in 40 pregnant adolescents, there was significantly greater disclosure of violence with the ACASI method. Better identification of high-risk behaviors may help to optimize care and programing for pregnant adolescents.
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http://dx.doi.org/10.1016/j.jpeds.2018.08.018DOI Listing
December 2018

Astaxanthin inhibits cytokines production and inflammatory gene expression by suppressing IκB kinase-dependent nuclear factor κB activation in pre and postpartum Murrah buffaloes during different seasons.

Vet World 2018 Jun 10;11(6):782-788. Epub 2018 Jun 10.

Animal Physiology Division, ICAR-National Dairy Research Institute, Karnal - 132 001, Haryana, India.

Aim: We examined regulatory function of astaxanthin on mRNA expression of nuclear factor κB (NF-κB) p65, interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and interferon gamma (IFN-γ) in peripheral blood mononuclear cells in pre and postpartum Murrah buffaloes during summer (temperature-humidity index [THI]=86; relative humidity [RH]=24) and winter (THI=58.74; RH=73) seasons.

Materials And Methods: A total of 32 Murrah buffaloes apparently healthy and in their one to four parity were selected from National Dairy Research Institute herd and equally distributed randomly into four groups (control and supplemented groups of buffaloes during summer and winter season, respectively). All groups were fed according to the nutrient requirement of buffaloes (ICAR, 2013). The treatment group was supplemented with astaxanthin at 0.25 mg/kg body weight/animal/day during the period 30 days before expected date of calving and up to 30 days postpartum.

Results: There was downregulation of NF-κB p65 gene in all the groups. NF-κB p65 mRNA expression was lower (p<0.05) in treatment than control group from prepartum to postpartum during summer, while mRNA expression was low only on day 21 after calving during winter season. The mRNA expression of IL-6, TNF-α, and IFN-γ was lower (p<0.05) in treatment than a control group of buffaloes during summer and winter seasons. The mRNA expression of NFkB p65, IL-6, TNF-α, and IFN-γ was higher (p<0.05) in summer than in winter seasons.

Conclusion: The xanthophyll carotenoid astaxanthin a reddish-colored C-40 compound is a powerful broad-ranging antioxidant that naturally occurs in a wide variety of living organisms, such as microalgae, fungi, crustaceans, and complex plants. Astaxanthin blocked nuclear translocation of NF-κB p65 subunit and IκBα degradation, which correlated with its inhibitory effect on IκB kinase (IKK) activity. These results suggest that astaxanthin, probably due to its antioxidant activity, inhibits the production of inflammatory mediators by blocking NF-κB activation and as a consequent suppression of IKK activity and IκB-degradation.
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http://dx.doi.org/10.14202/vetworld.2018.782-788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048090PMC
June 2018

Predictors of student use of an electronic record.

Clin Teach 2019 04 25;16(2):131-137. Epub 2018 Mar 25.

Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA.

Background: Little is known on ambulatory clerkship students' use of an electronic medical record (EMR). We investigated students' use of recommended EMR tasks across different types of sites and studied the predictors of these recommended tasks.

Methods: Students documented how often they performed recommended EMR tasks and suggested improvements to enhance EMR use. We compared student performance of recommended tasks across different types of sites using χ tests and the Fisher's exact test. We performed regression analyses to investigate factors predicting students' performance of EMR tasks. Two faculty members read all of the suggested improvements and agreed on themes.

Results: From January 2014 to June 2015, 263 of 295 Family and Community Medicine Clerkship (FCMC) students (89.2%) were at sites that used an EMR. Of the 263 students, 68.4% typed their own note into the EMR, but only 31.2% entered orders and 27.8% entered prescriptions for their teacher to sign. Students' rating of the orientation to the EMR predicted their use of all EMR tasks. The number of years that the teaching site used an EMR predicted the students' use of some tasks. Suggested improvements included a better orientation to the EMR, more use of the EMR, and access to a computer and the EMR. Little is known on ambulatory clerkship students' use of an electronic medical record DISCUSSION: Many students did not perform recommended EMR tasks. To help more students learn EMR tasks, clinical teachers can offer students a detailed orientation to their EMR, provide them with access to a computer and the EMR, and give them the opportunity to perform recommended EMR tasks, including typing their own note and entering orders and prescriptions.
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http://dx.doi.org/10.1111/tct.12785DOI Listing
April 2019

Effect of zinc and vitamin E supplementation on hormones and blood biochemicals in peri-partum Sahiwal cows.

J Trace Elem Med Biol 2018 Dec 21;50:489-497. Epub 2018 Feb 21.

Department of Veterinary Physiology and Biochemistry, College of Veterinary Science and Animal Husbandry, NDUVAS, Jabalpur, India.

Thirty-two advanced pregnant multiparous Sahiwal cows were used to study the effect of additional zinc (Zn) and vitamin E (VE) supplementation on hormonal and biochemical changes. Cows were randomly assigned to four groups and fed a basal diet of compounded concentrate, berseem fodder, and wheat straw in a ratio of 60:20:20. The groups were: (1) the basal diet with no supplement (control treatment); (2) the basal diet supplemented with 60 mg/kg DM/cow daily of Zn (Zn treatment); (3) the basal diet supplemented with 1000 IU/cow daily of vitamin E (VE treatment); and (4) the basal diet supplemented with a combination of 60 mg Zn/kg DM/cow and 1000 IU vitamin E/cow/d (Zn + VE treatment). Blood samples were collected on -60, -45, -30, -15, -7, -3, 0, 3, 7, 15, 30, 45, 60, 90, and 120 d in relation to expected date of calving and were analyzed for endocrine variables and biochemical changes. Plasma concentrations of leptin, insulin, insulin like growth factor-1 (IGF-1), triidothyronine (T3), and tetraiodothyronine (T4) were decreased toward calving and observed lowest (P < 0.05) on 3 d post-partum. However, plasma levels of growth hormone (GH) and cortisol increased toward calving and were found highest (P < 0.05) on 3 d post-partum. Pre-partum concentrations of leptin and IGF-1 were higher (P < 0.05) than its respective concentration observed during post-partum. Post-partum concentrations of GH and cortisol were higher (P < 0.05) than its respective pre-partum concentration. Pre-partum concentrations of urea, triglycerides, Zn, and VE were higher (P < 0.05) and total cholesterol and HDL cholesterol were lower than its values observed in post-partum among all the groups. Treatments had significant (P < 0.05) effect on plasma hormonal levels and levels of Zn and VE but no effect on biochemical attributes. Cows fed on diet supplemented with Zn + VE had highest (P < 0.05) pre as well as post-calving concentrations of leptin (6.38 vs 5.01 ng/ml), insulin (1.39 vs 1.33 ng/ml), GH (9.29 vs 13.72 ng/ml), IGF-1 (14.55 vs 12.59 nmol/l), T3 (1.45 vs 1.40 ng/ml), T4 (32.44 vs 31.79 ng/ml) whereas as lowest concentration of cortisol hormone (3.05 vs 3.44 ng/ml). Cows supplemented with combination of Zn and VE showed minimum decline in plasma concentration of leptin, insulin, GH, IGF-1, T3, and T4, and minimum increase in cortisol concentration. In conclusion, dairy cows around parturition faces various endocrine and biochemical alterations and supplementation of Zn in combination with VE can ameliorate adverse effect of calving stress by maintaining circulatory concentration of hormone and biochemicals towards the basal levels.
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http://dx.doi.org/10.1016/j.jtemb.2018.02.015DOI Listing
December 2018

Diminished Capsule Exacerbates Virulence, Blood-Brain Barrier Penetration, Intracellular Persistence, and Antibiotic Evasion of Hyperhemolytic Group B Streptococci.

J Infect Dis 2018 03;217(7):1128-1138

Department of Pediatrics, University of Washington.

Group B streptococci (GBS) are encapsulated, β-hemolytic bacteria that are a common cause of infections in human newborns and certain adults. Two factors important for GBS virulence are the sialic acid capsular polysaccharide that promotes immune evasion and the hemolytic pigment that induces host cell cytotoxcity. These virulence factors are often oppositely regulated by the CovR/CovS two-component system. Clinical GBS strains exhibiting hyperhemolysis and low capsule due to pathoadaptive covR/S mutations have been isolated from patients. Given the importance of capsule to GBS virulence, we predicted that a decrease or loss of capsule would attenuate the virulence of covR/S mutants. Surprisingly, hyperhemolytic GBS with low or no capsule exhibit increased virulence, intracellular persistence, and blood-brain barrier penetration, which was independent of a Trojan horse mechanism of barrier penetration. Additionally, intracellular persistence enabled both hemolytic and hyperhemolytic GBS to evade antibiotics routinely used to treat these infections. The finding that diminished capsule expression promotes GBS virulence, intracellular persistence, and antibiotic evasion has important implications for sustained antibiotic therapy and efficacy of capsule-based vaccines.
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http://dx.doi.org/10.1093/infdis/jix684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5939829PMC
March 2018

Monogenic Hypertension in Children: A Review With Emphasis on Genetics.

Adv Chronic Kidney Dis 2017 Nov;24(6):372-379

Division of Medical Genetics, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX. Electronic address:

Hypertension (HT) is a public health problem in children particularly related to the epidemic of overweight and obesity. Monogenic forms of HT are important in the differential diagnosis in children presenting with severe or refractory HT, who have a family history of early-onset HT, unusual physical examination findings, and/or characteristic hormonal and biochemical abnormalities. Most genetic defects in these disorders ultimately result in increased sodium transport in the distal nephron resulting in volume expansion and HT. Genetic testing, which is increasingly available, has diagnostic, therapeutic, and predictive implications for families affected by these rare conditions.
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http://dx.doi.org/10.1053/j.ackd.2017.09.006DOI Listing
November 2017

Opioid Drug Use and Acute Cardiac Events Among Pregnant Women in the United States.

Am J Med 2018 Jan 12;131(1):64-71.e1. Epub 2017 Aug 12.

Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tenn.

Background: Cardiovascular disease remains a leading cause of pregnancy-associated deaths in the United States. The extent to which increasing opioid use among pregnant women contributes to fatal cardiovascular events is unknown. We examined trends in opioid use among pregnant women over the previous decade and the association between changes in temporal trends in opioid drug use and the incidence of acute cardiac events among mothers.

Methods: In this retrospective analysis of the Healthcare and Cost Utilization Project, we used a 2-stage stratified cluster sampling of all inpatient hospital discharges from nonfederal hospitals from January 1, 2002 through December 31, 2014. The study population comprised pregnant women aged 13-49 years and related hospitalizations, including delivery. The primary exposure of interest was opioid use during pregnancy. The primary outcome was the occurrence of acute myocardial infarction or cardiac arrest during pregnancy or childbirth.

Results: Among the estimated 57.4 million pregnancy-related inpatient hospitalizations, 511,469 (approximately 1%) had documented use of opioids, cocaine, and/or amphetamines. There was a 300% increase in the use of opioids during pregnancy over the study period, whereas cocaine consumption significantly decreased and that of amphetamine remained stable. Over the 13-year period, the rise in opioid use paralleled a 50% increase in the incidence of acute cardiac events among mothers.

Conclusion: Over the previous decade opioid use during pregnancy increased significantly, in parallel with the rise in the incidence of acute cardiac events in pregnancy and childbirth. An effective national policy is needed to address this emerging public health challenge.
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http://dx.doi.org/10.1016/j.amjmed.2017.07.023DOI Listing
January 2018

Histological topography of the atrioventricular node and its extensions in relation to the cardiothoracic surgical landmarks in normal human hearts.

Cardiovasc Pathol 2017 Sep - Oct;30:38-44. Epub 2017 Jun 30.

Department of Cardiothoracic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012.

Background: Atrioventricular (AV) nodal injury which results in cardiac conduction disorders is one of the potential complications of heart valve surgeries and radiofrequency catheter ablations. Understanding the topography of the AV conduction system in relation to the tricuspid and mitral valves will help in reducing these complications.

Methods: A tissue block of 3cmx4cm, which contain the AV node, bundle of His and the AV nodal extensions, was excised at the AV septal junction in 20 apparently normal human hearts. The block was divided into three equal segments through vertical incisions perpendicular to the insertion of the septal leaflet of the tricuspid valve. Each segment was processed and stained with H&E and Gomori to study the different parts of the AV conduction system.

Results: The lower pole of the AV node was located vertically above the tricuspid septal leaflet (TSL) in 100% (20/20) of cases and at the level of the muscular interventricular septum in 65% (13/20) of cases. The upper pole of the compact AV node was located at the level of the mitral valve leaflet (MVL) in 50% (10/20) of cases. The penetrating bundle of His was seen at the level of the TSL, while the branching bundle of His was situated 1.9±1.5 mm inferior to the TSL. The right and left posterior extensions of the AV node spanned from the MVL to 2.9±1.3 mm above the TSL.

Conclusions: A rectangular area (2.5 mm × 12 mm) in the Koch's triangle was devoid of AV nodal tissue and could be labeled as a safe area with no risk of conduction defects during valve surgeries. Information on the separation of AV nodal extensions from the TSL, MVL and muscular interventricular septum may play a crucial role in guiding and improving the safety of radiofrequency ablations.
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http://dx.doi.org/10.1016/j.carpath.2017.06.005DOI Listing
May 2018
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