Publications by authors named "Anubhav Garg"

28 Publications

  • Page 1 of 1

Changes in aqueous and vitreous inflammatory cytokine levels in diabetic macular oedema: a systematic review and meta-analysis.

Acta Ophthalmol 2021 May 4. Epub 2021 May 4.

Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Canada.

Diabetic macular oedema (DME) is considered a chronic inflammatory disease associated with aberrations in many intraocular cytokines. Studies assessing the role of these cytokines as biomarkers in the diagnosis and management of DME have demonstrated inconsistent findings. We quantitatively summarized data related to 116 candidate aqueous and vitreous inflammatory cytokines as biomarkers in DME. A systematic search without year limitation was performed up to 19 October 2020. Studies were included if they provided data on aqueous or vitreous cytokine concentrations in patients with DME. Effect sizes were generated as standardized mean differences (SMDs) of cytokine concentrations between patients with DME and controls. Data were extracted from 128 studies that included 4163 study eyes with DME and 1281 control eyes. Concentrations (standard mean difference, 95% confidence interval and p-value) of aqueous IL-6 (1.28, 0.57-2.00, p = 0.004), IL-8 (1.06, 0.74-1.39, p < 0.00001), MCP-1 (1.36, 0.57-2.16, p = 0.0008) and VEGF (1.31, 1.01-1.62, p < 0.00001) and vitreous VEGF (2.27, 1.55-2.99, p < 0.00001) were significantly higher in patients with DME (n = 4163) compared to healthy controls (n = 1281). No differences, failed sensitivity analyses or insufficient data were found between patients with DME and healthy controls for the concentrations of the remaining cytokines. This analysis implicates multiple cytokine biomarker candidates other than VEGF in DME and clarifies previously reported inconsistent associations. As the therapeutic options for DME expand to include multiple agents with multiple targets, it will be critical to manage the treatment burden with tailored therapy that optimizes outcomes and minimizes treatment burden. Intraocular cytokines have the promise of providing a robust individualized assessment of disease status and response to therapy. We have identified key candidate cytokines that may serve as biomarkers in individualized treatment algorithms.
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http://dx.doi.org/10.1111/aos.14891DOI Listing
May 2021

Ten Years of Papilledema From Idiopathic Intracranial Hypertension With Preserved Visual Function.

J Neuroophthalmol 2021 Apr 14. Epub 2021 Apr 14.

Faculty of Medicine (AG), University of Toronto, Toronto, Canada; Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Canada; Division of Neurology (JAM), Department of Medicine, University of Toronto, Toronto, Canada; and Kensington Vision and Research Centre (JAM), Toronto, Canada.

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http://dx.doi.org/10.1097/WNO.0000000000001225DOI Listing
April 2021

Gaze-evoked amaurosis from idiopathic orbital inflammation.

Orbit 2021 Mar 29:1-4. Epub 2021 Mar 29.

Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada.

Gaze-evoked amaurosis is a transient monocular vision loss elicited by eccentric gaze and has been reported in many orbital conditions but is most classically associated with intraconal tumors, such as cavernous hemangioma and optic nerve sheath meningioma. Here, the authors report a case of gaze-evoked amaurosis due to idiopathic orbital inflammation. The patient was a 35-year-old man who presented with vision loss only when abducting his left eye. He had a history of sclerosing idiopathic orbital inflammation with a left orbital intraconal mass diagnosed 15 months prior to the current presentation. The patient had difficulty with immunosuppressive therapy, which was stopped 5 months prior to presentation. Repeat imaging during the current presentation revealed enlargement of the mass. This case demonstrates that idiopathic orbital inflammation should be considered in the differential diagnosis for gaze-evoked amaurosis, which may be the first symptom of disease progression.
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http://dx.doi.org/10.1080/01676830.2021.1904423DOI Listing
March 2021

Diagnoses and Outcomes of Prosthetic Replacement of the Ocular Surface Ecosystem Treatment-A Canadian Experience.

Eye Contact Lens 2021 Mar 16. Epub 2021 Mar 16.

Faculty of Medicine (B.M.W. and A.G.), University of Toronto, Toronto, Canada; Department of Ophthalmology and Vision Sciences (T.T., M.M., M.C., C.C.C., and A.R.S.), University of Toronto, Toronto, Canada; Kensington Eye Institute (T.T., M.M., S.R., J.L., M.C., C.C.C., and A.R.S.), Toronto, Canada; and New England College of Optometry (J.L.), Boston, MA.

Objectives: To investigate underlying diagnoses and outcomes of patients undergoing Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment at the first Canadian PROSE center.

Methods: A retrospective chart review was conducted on patients referred for PROSE treatment and fitted with PROSE devices from 2018 to 2020. Data were collected on diagnoses, presenting symptoms, previous lens modalities attempted, best-corrected visual acuities (BCVAs) pre-PROSE and post-PROSE, daily wear time, and failure rates. Best-corrected visual acuities pre-PROSE and post-PROSE were compared to evaluate visual improvement.

Results: In total, 78 patients (126 eyes) were analyzed. The most common diagnoses were keratoconus (n=39 eyes) and postcorneal graft (n=15) in the distorted cornea group, and limbal stem cell deficiency (n=17) and graft versus host disease (n=15) in the ocular surface disease (OSD) group. Most frequent symptoms included blur, photophobia, and pain. Most common lens modalities attempted pre-PROSE were conventional scleral lenses and glasses. The overall mean BCVA improvement was 0.40 logarithm of the minimal angle of resolution (logMAR) (4-lines Snellen) (P<0.0001). Best-corrected visual acuities improvement in the distorted cornea group (0.52 logMAR, 5-lines) was significantly greater than in the OSD group (0.29 logMAR, 3-lines) (P=0.004).

Conclusions: Prosthetic replacement of the ocular surface ecosystem treatment can provide significant visual improvement for patients with distorted corneal surfaces and OSDs who failed other lens modalities.
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http://dx.doi.org/10.1097/ICL.0000000000000779DOI Listing
March 2021

Importance of the "Rule of the Pupil" in the Modern Neuroimaging Era.

J Neuroophthalmol 2021 Jan 15. Epub 2021 Jan 15.

Faculty of Medicine (AG), University of Toronto, Toronto, Canada; Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Canada; Division of Neurology (JAM), Department of Medicine, University of Toronto, Canada; and Kensington Vision and Research Centre (JAM), University of Toronto, Toronto, Canada.

Abstract: The "Rule of the Pupil" states that when aneurysms compress the oculomotor nerve, a dilated or sluggishly reactive pupil will result. In previous decades, when cerebral angiography was required to detect an intracranial aneurysm, the "Rule of the Pupil" was used to determine the relative risk of angiography and the likelihood of aneurysmal compression in patients with third nerve palsies (3NPs). Noninvasive imaging including computed tomography angiography (CTA) and magnetic resonance angiography has become readily accessible and can detect all aneurysms large enough to cause 3NPs. It is therefore recommended that all patients with 3NP undergo neuroimaging regardless of pupil status because the consequences of missing an aneurysm are high. The question therefore remains as to whether the "Rule of the Pupil" still has relevance in today's era of modern neuroimaging. We describe a 73-year-old man who developed a left complete, pupil-sparing 3NP and was found to have a paraclinoid meningioma in the left cavernous sinus. As compressive lesions are expected to impair the iris sphincter muscle, no intervention was recommended and his 3NP spontaneously improved within 3 months. We also describe a 54-year-old woman with diabetes and a complete 3NP with a dilated, nonreactive pupil. Initial CTA was reported as normal, but re-review of imaging revealed a posterior communicating artery aneurysm and immediate intervention to coil the aneurysm occurred. The "Rule of the Pupil" is still important in the modern neuroimaging era as demonstrated in cases of incidentally found lesions along the course of the oculomotor nerve and missed radiological findings.
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http://dx.doi.org/10.1097/WNO.0000000000001175DOI Listing
January 2021

Dural venous sinus thrombosis after lumbar puncture in a patient with idiopathic intracranial hypertension.

Eur J Ophthalmol 2020 Nov 11:1120672120970406. Epub 2020 Nov 11.

Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Introduction: Idiopathic intracranial hypertension (IIH) is one of the most common causes of papilloedema seen by ophthalmologists and neurologists. Patients with IIH routinely undergo lumbar puncture (LP) for diagnosis. Dural venous sinus thrombosis (DVST) is a rare complication of cerebrospinal fluid pressure (CSF)-lowering procedures such as lumbar puncture and epidural and may be an intracranial complication of IIH.

Case Description: A 29-year-old obese woman was diagnosed with severe idiopathic intracranial hypertension (IIH) after she presented with new-onset headache, pulsatile tinnitus and blurred vision. Magnetic resonance imaging (MRI) and venography (MRV) were normal apart from signs of intracranial hypertension. Lumbar puncture (LP) revealed an opening pressure of 40 cm of water. Due to the severity of the papilloedema and vision loss, she was referred for a ventriculoperitoneal shunt and found to have venous sinus thrombosis involving the superior sagittal sinus on the pre-operative computed tomography (CT) head 5 days after the LP. CT venography (CTV) one day later and MRV 3 days later showed significant worsening as the thrombosis extended into the deep venous system. She was started on therapeutic heparin and her symptoms and vision improved and she did not develop any neurological complications.

Conclusions: DVST should be considered in IIH patients who have worsening papilloedema or symptoms of intracranial hypertension. Repeat venous imaging can prevent devastating consequences such as venous infarcts of haemorrhage in these patients.
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http://dx.doi.org/10.1177/1120672120970406DOI Listing
November 2020

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis in Canada.

Can J Neurol Sci 2021 May 14;48(3):321-326. Epub 2020 Sep 14.

Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.

Objective: To describe clinical characteristics of Canadian patients with myelin-oligodendrocyte glycoprotein immunoglobulin-G optic neuritis (MOG-IgG ON).

Methods: Retrospective observational case series of MOG-IgG seropositive patients with ON referred to tertiary neuro-ophthalmology practices. Outcome measures included clinical characteristics, radiologic findings, and visual outcomes.

Results: Forty-six eyes of 30 patients were included. Twenty-three (76.7%) were women, mean onset age was 40.7 years (range 16-77), and most were Caucasian. Seventeen (56.7%) presented with their first ON episode. Sixteen (53.3%) had bilateral eye involvement. Isolated ON without associated neurological symptoms occurred in 90.0%. In 22 patients with acute ON (seen within 1 month of onset), presenting mean visual acuity (VA) was 20/258 (logMAR 1.11), mean deviation (MD) on Humphrey visual fields was -16.90 ± 10.83 dB, and peripapillary retinal nerve fiber layer (RNFL) thickness on ocular coherence tomography (OCT) was 164.23 ± 46.53 um. Orbital magnetic resonance imaging (MRI) within 1 month of symptom onset for 19 patients demonstrated orbital optic nerve enhancement in 11 (57.9%) and perineural enhancement in 11 (57.9%). Brain MRI was normal in 28 (93.3%) patients. Twenty out of 22 patients with acute presentation were treated with high-dose glucocorticoids and 5 with plasma exchange in addition to corticosteroids. Long-term immunosuppression was utilized in 9 (30%) out of all 30 patients. Final VA was 20/30 (logMAR 0.18), MD was -7.17 ± 8.85 dB, and RNFL thickness was 72.15 ± 20.16 um.

Conclusion: MOG-IgG ON in Canada has a variable presentation with most patients having substantial initial vision loss with good recovery. This is the largest characterization of the disease in Canada to date.
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http://dx.doi.org/10.1017/cjn.2020.201DOI Listing
May 2021

Guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis: An Indian perspective.

Indian J Dermatol Venereol Leprol 2016 Nov-Dec;82(6):603-625

Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Background: Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous adverse drug reactions with a high morbidity and mortality that require immediate medical care. The various immunomodulatory treatments include systemic corticosteroids, cyclosporine, intravenous immunoglobulin, cyclophosphamide, plasmapheresis and tumor necrosis factor-α inhibitors.

Aim: The ideal therapy of Stevens-Johnson syndrome/toxic epidermal necrolysis still remains a matter of debate as there are only a limited number of studies of good quality comparing the usefulness of different specific treatments. The aim of this article is to comprehensively review the published medical literature and frame management guidelines suitable in the Indian perspective.

Methods: The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these guidelines to its special interest group on cutaneous adverse drug reactions. The group performed a comprehensive English language literature search for management options in Stevens-Johnson syndrome/toxic epidermal necrolysis across multiple databases (PubMed, EMBASE, MEDLINE and Cochrane) for keywords (alone and in combination) and MeSH items such as "guidelines," "Stevens-Johnson syndrome," "toxic epidermal necrolysis," "corticosteroids," "intravenous immunoglobulin," "cyclosporine" and "management." The available evidence was evaluated using the strength of recommendation taxonomy and graded using a three-point scale. A draft of clinical recommendations was developed on the best available evidence which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, this final consensus statement was prepared.

Results: A total of 104 articles (meta-analyses, prospective and retrospective studies, reviews [including chapters in books], previous guidelines [including Indian guidelines of 2006] and case series) were critically evaluated and the evidence thus gathered was used in the preparation of these guidelines.

Recommendations: This expert group recommends prompt withdrawal of the culprit drug, meticulous supportive care, and judicious and early (preferably within 72 h) initiation of moderate to high doses of oral or parenteral corticosteroids (prednisolone 1-2 mg/kg/day or equivalent), tapered rapidly within 7-10 days. Cyclosporine (3-5 mg/kg/day) for 10-14 days may also be used either alone, or in combination with corticosteroids. Owing to the systemic nature of the disease, a multidisciplinary approach in the management of these patients is helpful.
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http://dx.doi.org/10.4103/0378-6323.191134DOI Listing
May 2017

A study of pattern of nonvenereal genital dermatoses of male attending skin OPD at a tertiary care center.

Indian J Sex Transm Dis AIDS 2014 Jul-Dec;35(2):129-34

Department of Dermatology, Venereology and Leprosy, G R College, Gwalior, Madhya Pradesh, India.

Background: Nonvenereal dermatoses tend to create confusion from venereal dermatoses. This may be responsible for considerable concern to the patient as well as may cause diagnostic dilemma to the physicians. Nonvenereal dermatoses may not be restricted to genitalia alone; it may affect skin and mucous membrane also. Most of the patients with genital lesions had apprehension of suffering from some venereal disorders.

Aim: The aim was to determine clinical and epidemiological pattern of nonvenereal dermatoses of male external genitalia.

Materials And Methods: This was a descriptive study of 100 consecutive adult male patients with nonvenereal genital dermatoses attending skin and STD OPD at J A Group of Hospitals, Gwalior. Cases having any venereal dermatoses were excluded from this study.

Results: The study included 100 male patients with nonvenereal genital lesions. A total of sixteen nonvenereal genital dermatoses were noted. The most common nonvenereal genital dermatoses were vitiligo (18%), pearly penile papule (16%), fixed drug eruptions (12%), scabies (10%), scrotal dermatitis (9%) and lichen planus (9%). Other dermatoses included sebaceous cyst, psoriasis, lichen sclerosus, plasma cell balanitis or Zoon's balanitis, granuloma annulare, lichen nitidus, lymphangioma circumscriptum, papulo-necrotic tuberculid, squamous cell carcinoma and tinea infections. The age ranged from 18 years to 65 years with majority in the age group of 21-30 years (40%).

Conclusion: This study highlights the importance of diagnosing common nonvenereal genital dermatoses. It also helps in avoiding the general misconception that all genital lesions are sexually transmitted.
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http://dx.doi.org/10.4103/0253-7184.142408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553841PMC
September 2015

Congenital and hereditary causes of sudden cardiac death in young adults: diagnosis, differential diagnosis, and risk stratification.

Radiographics 2013 Nov-Dec;33(7):1977-2001

From the Department of Radiology, Division of Cardiothoracic Radiology (J.S., S.P., D.M.M., E.A.K., G.C.M.), and Department of Internal Medicine, Division of Cardiovascular Medicine (A.G.), University of Michigan Health System, 1500 E Medical Center Dr, UH B1-132 Taubman, Box 0302, Ann Arbor, MI 48109-0302.

Sudden cardiac death is defined as death from unexpected circulatory arrest-usually a result of cardiac arrhythmia-that occurs within 1 hour of the onset of symptoms. Proper and timely identification of individuals at risk for sudden cardiac death and the diagnosis of its predisposing conditions are vital. A careful history and physical examination, in addition to electrocardiography and cardiac imaging, are essential to identify conditions associated with sudden cardiac death. Among young adults (18-35 years), sudden cardiac death most commonly results from a previously undiagnosed congenital or hereditary condition, such as coronary artery anomalies and inherited cardiomyopathies (eg, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy [ARVC], dilated cardiomyopathy, and noncompaction cardiomyopathy). Overall, the most common causes of sudden cardiac death in young adults are, in descending order of frequency, hypertrophic cardiomyopathy, coronary artery anomalies with an interarterial or intramural course, and ARVC. Often, sudden cardiac death is precipitated by ventricular tachycardia or fibrillation and may be prevented with an implantable cardioverter defibrillator (ICD). Risk stratification to determine the need for an ICD is challenging and involves imaging, particularly echocardiography and cardiac magnetic resonance (MR) imaging. Coronary artery anomalies, a diverse group of congenital disorders with a variable manifestation, may be depicted at coronary computed tomographic angiography or MR angiography. A thorough understanding of clinical risk stratification, imaging features, and complementary diagnostic tools for the evaluation of cardiac disorders that may lead to sudden cardiac death is essential to effectively use imaging to guide diagnosis and therapy.
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http://dx.doi.org/10.1148/rg.337125073DOI Listing
June 2014

A case of zosteriform Darier's disease with seasonal recurrence.

Indian Dermatol Online J 2013 Jul;4(3):219-21

Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India.

Darier's disease is an uncommon genodermatosis characterized by keratotic papules in seborrheic distribution. The disease can rarely present in unilateral zosteriform pattern, as a mosaic form following the Blaschko's line. We present a 35-year-old woman with zosteriform pattern of Darier's disease over right infra mammary region. The lesions occurred strictly during summers. Histologically, suprabasal acantholysis with abundant dyskeratotic cells were seen.
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http://dx.doi.org/10.4103/2229-5178.115523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752482PMC
July 2013

Phacomatosis cesioflammea with Klippel Trenaunay syndrome: A rare association.

Indian Dermatol Online J 2013 Jul;4(3):216-8

Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India.

A 30-year-old Indian male presented with bilateral Nevus of Ota, extensive nevus flammeus over the trunk and left lower limb with soft tissue hypertrophy and varicosities affecting the left lower limb. He was otherwise in good general health. A diagnosis of Phacomatosis cesioflammea or Phacomatosis pigmentovasularis Type II with Klippel Trenaunay syndrome was made. The case is being reported on account of its rarity.
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http://dx.doi.org/10.4103/2229-5178.115522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752481PMC
July 2013

Treatment of nodular scabies with topical tacrolimus.

Indian Dermatol Online J 2013 Jan;4(1):52-3

Department of Dermatology, RNT Medical College, Udaipur, Rajasthan, India.

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http://dx.doi.org/10.4103/2229-5178.105486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573456PMC
January 2013

Echocardiography in liver transplant candidates.

JACC Cardiovasc Imaging 2013 Jan;6(1):105-19

Department of Internal Medicine, Division of Cardiovascular Disease, University of Michigan Medical Center, Ann Arbor, Michigan 48109-5853, USA.

Involvement of the cardiovascular system in patients with end-stage liver disease (ESLD) is well recognized and may be seen in several scenarios in adult liver transplantation (LT) candidates. The hemodynamic effects of ESLD may result in apparent heart disease, or in some instances may mask cardiac disease. Alternatively, cardiac disease can occasionally be the underlying etiology of ESLD. LT imposes significant hemodynamic stresses, with cardiovascular complications accounting for considerable perioperative mortality and morbidity. Pre-operative assessment of the cardiac status of LT candidates is thus critically important for risk stratification and management. Cardiac imaging plays an integral role in the assessment of LT candidates. In this review, we discuss the role of cardiac imaging, including transthoracic echocardiography with Doppler and contrast enhancement, noninvasive functional assessment for routine pre-operative assessment of coronary artery disease, and transesophageal echocardiography in select cases to aid in intra-operative fluid management and monitoring in LT candidates.
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http://dx.doi.org/10.1016/j.jcmg.2012.11.002DOI Listing
January 2013

Prolonged QT interval diagnosis suppression by a widely used computerized ECG analysis system.

Circ Arrhythm Electrophysiol 2013 Feb 29;6(1):76-83. Epub 2012 Dec 29.

Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA.

Background: Clinicians commonly rely on automated diagnostic interpretations for initial, point-of-care identification of ECG abnormalities. Our study goal was to investigate how one widely used computerized ECG analysis system performs in labeling prolongation of heart rate-corrected QT interval (QTc), an arrhythmia risk marker.

Methods And Results: ECGs acquired in 2009-2010 from patients ≥18 years old within the University of Michigan Health System, analyzed by the Marquette 12SL ECG Analysis Program (GE Healthcare), and exhibiting sinus rhythms with heart rate <100 beats per minute and QRS duration <120 ms constituted our database. Of 97 046 study ECGs (48.2% from males), a prolonged 12SL-calculated QTc value (ie, ≥470 ms in females >60 years old, and ≥460 ms in other sex/age groups) was displayed in 16 235 (16.7%). Nonetheless, for only 7709 (47.5%) of these ECGs with prolonged QTc did the automated interpretation include an accompanying "Prolonged QT" diagnostic statement. Such prolonged QT under-reporting was manifest across all patient environments and reflected algorithmic suppression of the diagnosis, attributable to ECG waveform-based criteria, in 8526 (52.5%) ECGs with prolonged QTc. Of the latter ECGs with prolonged QT diagnosis suppression, the computer declared 3588 (42.1%) "Normal" despite QTc prolongation.

Conclusions: In evaluating an adult patient whose 12SL-interpreted ECG lacks a prolonged QT diagnostic statement (assuming sinus rhythm <100 beats per minute and QRS duration <120 ms), physicians should examine the actual QTc value displayed on the report before concluding that this parameter is normal. Assessment of the clinical impact of prolonged QT diagnosis suppression by ECG waveform-based criteria is warranted.
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http://dx.doi.org/10.1161/CIRCEP.112.976803DOI Listing
February 2013

Terminal 4q deletion syndrome.

Indian J Dermatol 2012 May;57(3):222-4

Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India.

Terminal deletion of the long arm of chromosome 4, (4q) is a rare event. It is characterized by spectral phenotypic manifestations, depending upon the site and quantity of chromatin lost. The chromosomal loss which span 4 (q31-q35) segment often manifests as craniofacial anomalies, mental retardation with ocular, cardiac, genitourinary defects and pelvic/limb dysmorphism. These abnormalities are usually unilateral. We report a female child (46, XX), aged 11 months, born to nonconsanguineous parents, bearing chromosomal deletion of 4 (q31.2-35.2) segment, which has manifested as craniofacial hypoplasia of left side of face, ipsilateral ptosis, erythroderma and bilateral thumb anomalies.
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http://dx.doi.org/10.4103/0019-5154.96203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371530PMC
May 2012

Lichen planus presenting as erythroderma.

Indian J Dermatol Venereol Leprol 2012 May-Jun;78(3):409

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http://dx.doi.org/10.4103/0378-6323.95497DOI Listing
September 2012

Multisystem Langerhans cell histiocytosis in adult.

Indian J Dermatol 2012 Jan;57(1):58-60

Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India.

Langerhans cell histiocytosis (LCH), is a rare disorder, clinically presents with heterogeneous manifestations, and has an unpredictable outcome. Commonly seen in infancy or early childhood, the disorder is characterized by proliferation of abnormal and clonal Langerhans cell in skin, bone, lymph nodes, lungs, liver, spleen, and bone marrow. Occurrence of LCH in adults is rare. Here, we report the case of an adult with acute onset of polymorphic eruptions all over the body, which on biopsy showed features of multisystem LCH, and was confirmed by immunohistochemistry. Although multisystem LCH has a poor prognosis, our patient responded well to chemotherapy.
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http://dx.doi.org/10.4103/0019-5154.92683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312662PMC
January 2012

Kaposi's sarcoma as a presenting manifestation of HIV.

Indian J Sex Transm Dis AIDS 2011 Jul;32(2):108-10

Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India.

Kaposi's sarcoma is a multi-focal vascular tumor involving skin and the other organs. HIV associated Kaposi's sarcoma is one of the AIDS defining condition. It is rarely reported from India. We report a 40-year-old heterosexual married male with widespread cutaneous lesions of Kaposi's sarcoma without any oral lesions or systemic association as a presenting manifestation of HIV.
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http://dx.doi.org/10.4103/0253-7184.85415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195171PMC
July 2011

Familial erythromelanosis follicularis faciei et colli with extensive keratosis pilaris.

Int J Dermatol 2011 Nov;50(11):1400-1

Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India.

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http://dx.doi.org/10.1111/j.1365-4632.2010.04776.xDOI Listing
November 2011

Congenital triangular alopecia: a close mimicker of alopecia areata.

Int J Trichology 2011 Jan;3(1):40-1

Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India.

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http://dx.doi.org/10.4103/0974-7753.82135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129126PMC
January 2011

Randomized comparison of topical betamethasone valerate foam, intralesional triamcinolone acetonide and tacrolimus ointment in management of localized alopecia areata.

Int J Trichology 2011 Jan;3(1):20-4

Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India.

Background: Alopecia areata (AA) is a common, non-scarring, patchy loss of hair at scalp and elsewhere. Its pathogenesis is uncertain; however, auto-immunity has been exemplified in various studies. Familial incidence of AA is 10-42%, but in monozygotic twins is 50%. Local steroids (topical / intra-lesional) are very effective in treatment of localized AA.

Aim: To compare hair regrowth and side effects of topical betamethasone valerate foam, intralesional triamcinolone acetonide and tacrolimus ointment in management of localized AA.

Materials And Methods: 105 patients of localized AA were initially registered but 27 were drop out. So, 78 patients allocated at random in group A (28), B (25) and C (25) were prescribed topical betamethasone valerate foam (0.1%) twice daily, intralesional triamcinolone acetonide (10mg/ml) every 3 weeks and tacrolimus ointment (0.1%) twice daily, respectively, for 12 weeks. They were followed for next12 weeks. Hair re-growth was calculated using "HRG Scale"; scale I- (0-25%), S II-(26-50%), S III - (51-75%) and S IV- (75-100%).

Results: Hair re-growth started by 3 weeks in group B (Scale I: P<0.03), turned satisfactory at 6 weeks in group A and B (Scale I: P<0.005, Scale IV: P<0.001)), good at 9 weeks (Scale I: P<0.0005, Scale IV: P<0.00015), and better by 12 weeks of treatment (Scale I: P<0.000021, Scale IV: P<0.000009) in both A and B groups. At the end of 12 weeks follow-up hair re-growth (>75%, HRG IV) was the best in group B (15 of 25, 60%), followed by A (15 of 28, 53.6%) and lastly group-C (Nil of 25, 0%) patients. Few patients reported mild pain and atrophy at injection sites, pruritus and burning with betamethasone valerate foam and tacrolimus.

Conclusion: Intralesional triamcinolone acetonide is the best, betamethasone valerate foam is better than tacrolimus in management of localized AA.
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http://dx.doi.org/10.4103/0974-7753.82123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129118PMC
January 2011

Use of methotrexate in recalcitrant eczema.

Indian J Dermatol 2011 Mar;56(2):232

Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India. E-mail:

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http://dx.doi.org/10.4103/0019-5154.80434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108534PMC
March 2011

Atrophoderma of pasini and pierini.

Indian Dermatol Online J 2011 Jul;2(2):126-8

Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India.

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http://dx.doi.org/10.4103/2229-5178.86012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481816PMC
July 2011

Impact of mitral isthmus anatomy on the likelihood of achieving linear block in patients undergoing catheter ablation of persistent atrial fibrillation.

Heart Rhythm 2011 Sep 4;8(9):1404-10. Epub 2011 May 4.

Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.

Background: Although prior studies have described the anatomy of the mitral isthmus in patients undergoing left atrial (LA) ablation of atrial fibrillation (AF), none has examined the impact of isthmus anatomy on the likelihood of achieving conduction block.

Objective: The purpose of this study was to identify morphologic characteristics of the mitral isthmus that may influence the acute efficacy of linear ablation at the mitral isthmus.

Methods: Fifty-five patients (age 61 ± 10 years, 41 [75%] men, LA 46 ± 6 mm, ejection fraction 0.55 ± 0.11, AF duration 4 ± 3 years) underwent linear ablation at the mitral isthmus during an ablation procedure for persistent AF. Computed tomographic scan was performed before the procedure. The morphology of the mitral isthmus and its anatomic relationship to the adjacent vasculature were analyzed.

Results: Complete block along the mitral isthmus was achieved in 35 (64%) of 55 patients, 23 (66%) of whom required radiofrequency ablation in the coronary sinus (CS). Patients with incomplete block were more likely to have a pouch at the isthmus (40% vs 9%; P = .01), a greater isthmus depth (8.1 ± 4.2 mm vs 5.7 ± 3.4 mm; P = .04), and a higher prevalence of an interposed circumflex artery between the CS and the mitral isthmus (60% vs 20%; P = .003) compared to patients with isthmus block. An interposed circumflex artery was the only independent predictor of incomplete conduction block at the mitral isthmus (odds ratio 4.9, 95% confidence interval 1.3-18.2; P = .02).

Conclusion: Preprocedural computed tomographic imaging identifies patients in whom linear ablation at the mitral isthmus is unlikely to be successful. Interposition of the circumflex artery between the mitral isthmus and the CS is associated with a lower probability of achieving complete mitral isthmus block.
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http://dx.doi.org/10.1016/j.hrthm.2011.04.030DOI Listing
September 2011

Congenital hypertrichosis lanuginosa.

Indian J Dermatol Venereol Leprol 2010 Nov-Dec;76(6):699-700

Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India.

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http://dx.doi.org/10.4103/0378-6323.72476DOI Listing
October 2011

Stress relaxation preconditioning of porcine aortic valves.

Ann Biomed Eng 2004 Apr;32(4):563-72

Department of Biomedical Engineering/ND 20, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA.

In uniaxial tensile testing, load preconditioning is used to generate repeatable load/elongation curves and set a "reference state" for subsequent tensile tests. We have observed however, that for porcine aortic valve (PAV) tissues, preconditioning does not lead to repeatable stress relaxation curves. We thus investigated possible experimental protocols that could be used to generate repeatable load/elongation and stress relaxation curves. To quantify repeatability of stress relaxation, we compared normalized loads at the same time points from repeated stress relaxation curves and computed a repeatability ratio. We found that PAV specimens can generate repeatable stress relaxation curves (repeatability ratio >0.95) if they are subjected to at least five cycles of repeated load preconditioning and stress relaxation. We also found that a single cycle of loading/unloading prior to each stress relaxation phase is sufficient to generate repeatable stress relaxation curves. Stress relaxation preconditioning is therefore required to generate repeatable load/elongation and stress relaxation curves. It is expected that such curves will generate more accurate material constants for the characterization and modeling of PAV mechanics.
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http://dx.doi.org/10.1023/b:abme.0000019176.49650.19DOI Listing
April 2004