Publications by authors named "Megha Patel"

33 Publications

An Evidence-Based Review of Elagolix for the Treatment of Pain Secondary to Endometriosis.

Psychopharmacol Bull 2020 Oct;50(4 Suppl 1):197-215

Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Berger, MD, PhD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Adamian, BS, Creighton University School of Medicine-Phoenixix Regional Campus, Phoenix, AZ. Miro, BS, Callan, BS, M. Patel, BS, Patel, BS, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE.

Purpose Of Review: This is a review of elagolix use for pain related to endometriosis. It summarizes the background and recent data available about the pathogenesis of endometriosis and pain that is secondary to this syndrome. It then reviews the evidence to support the use of elagolix and the indications for use.

Recent Findings: Endometriosis occurs in 10% of reproductive-age women and is a common source of chronic pelvic pain, infertility, and co-morbid disorders. It usually presents with some combination of dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. Treatment options may be surgical or hormonal. Traditional treatment is divided into medical and surgical. The latter, though effective, is reserved for surgical emergencies and patients failing medical management. Medical management with NSAIDs is usually limited in efficacy. It is generally based on hormonal suppression leading to atrophy of endometrial lesions. Elagolix (Orlissa) is a GnRH antagonist that suppressed the entire hypophysis-gonadal axis. Reduced levels of estrogen and progesterone lead to involution of the endometrial lesions and improvement in symptoms. Clinical trials showed that elagolix is effective in treating dysmenorrhea and non-menstrual pain that is secondary to endometriosis. It is well tolerated and has a relatively safe usage profile. Studies up to 12 months long showed continued efficacy and reduction in dysmenorrhea of up to 75%, with 50%-60% reduction in non-menstrual pain. Elagolix was found effective when compared to both placebo and alternative treatments.

Summary: Endometriosis is a common syndrome that causes significant pain, morbidity, and disability, as well as financial loss. Elagolix is an effective drug in treating the symptoms of endometriosis and is a relatively safe option. Phase 4 studies will be required to evaluate the safety and efficacy of long term chronic use.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901127PMC
October 2020

Oral Muscle Relaxants for the Treatment of Chronic Pain Associated with Cerebral Palsy.

Psychopharmacol Bull 2020 Oct;50(4 Suppl 1):142-162

Peck, MD, Noor, BS, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Crane, BS, McNally, BS, Georgetown University School of Medicine, Washington, DC. Patel, BS, University of Arizona College of Medicine-Phoenix, Phoenix, AZ. Cornett, MD, Louisiana State University Health Sciences, Department of Anesthesiology, New Orleans, LA. Kaye, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE.

Purpose Of Review: This is a comprehensive literature review of the available for treatment of oral muscle relaxants for cerebral palsy (CP) and associated chronic pain. It briefly describes the background and etiology of pain in CP and proceeds to review and weigh the available evidence for treatment for muscle relaxants.

Recent Findings: CP is a permanent, chronic, non-progressive neuromuscular and neurocognitive disorder of motor dysfunction that is diagnosed in infancy and is frequently (62% of patients) accompanied by chronic or recurrent muscular pain. Treatment of pain is crucial, and focuses mostly on treatment of spasticity through non-interventional techniques, surgery and medical treatment. Botulinum toxin injections provide temporary denervation, at the cost of repeated needle sticks. More recently, the use of oral muscle relaxants has gained ground and more evidence are available to evaluate its efficacy. Common oral muscle relaxants include baclofen, dantrolene and diazepam. Baclofen is commonly prescribed for spasticity in CP; however, despite year-long experience, there is little evidence to support its use and evidence from controlled trials are mixed. Dantrolene has been used for 30 years, and very little current evidence exists to support its use. Its efficacy is usually impacted by non-adherence due to difficult dosing and side-effects. Diazepam, a commonly prescribed benzodiazepine carries risks of CNS depression as well as addiction and abuse. Evidence supporting its use is mostly dated, but more recent findings support short-term use for pain control as well as enabling non-pharmacological interventions that achieve long term benefit but would otherwise not be tolerated. More recent options include cyclobenzaprine and tizanidine. Cyclobenzaprine carries a more significant adverse events profile, including CNS sedation; it was found to be effective, possible as effective as diazepam, however, it is not currently FDA approved for CP-related spasticity and further evidence is required to support its use. Tizanidine was shown to be very effective in a handful of small studies.

Summary: Muscle relaxants are an important adjunct in CP therapy and are crucial in treatment of pain, as well as enabling participation in other forms of treatments. Evidence exist to support their use, however, it is not without risk and further research is required to highlight proper dosing, co-treatments and patient selection.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901132PMC
October 2020

Total laparoscopic hysterectomy in combination with dilation and evacuation of an 18-week-sized uterus with gestational trophoblastic neoplasia: a novel treatment approach.

Am J Obstet Gynecol 2021 03 13;224(3):314-315. Epub 2020 Nov 13.

University of California, Riverside, Riverside, CA.

Gestational trophoblastic disease is a spectrum that includes complete and partial hydatidiform moles, invasive mole, choriocarcinoma, and placental site trophoblastic tumor. Although most cases of gestational trophoblastic neoplasia occur after a molar pregnancy, it can develop after any pregnancy. Suction curettage remains the standard first-line management in a molar pregnancy in patients desiring fertility. However, hysterectomy is a reasonable option in patients that do not desire to preserve fertility. Hysterectomy for gestational trophoblastic neoplasia can be difficult because of the enlarged uterus and prominent uterine vasculature. Traditionally, hysterectomy for gestational trophoblastic neoplasia is usually performed via laparotomy. In this article and accompanying video, we describe and illustrate a minimally invasive technique that demonstrates a safe and feasible laparoscopic removal of an enlarged uterus and illustrates alternative extraction techniques to avoid laparotomy in hysterectomy for gestational trophoblastic disease. In this case, a combination of laparoscopic transection of the vascular pedicles followed by dilation and evacuation was used before colpotomy. The addition of dilation and evacuation allowed us to reduce the overall size of the uterus and remove it intact through the vagina with minimal bleeding, avoiding unnecessary laparotomy. This allowed the patient to have an improved postsurgical recovery experience with minimal blood loss compared with standard laparotomy for gestational trophoblastic neoplasia.
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http://dx.doi.org/10.1016/j.ajog.2020.10.046DOI Listing
March 2021

Identifying the Impacts of Acne and the Use of Questionnaires to Detect These Impacts: A Systematic Literature Review.

Am J Clin Dermatol 2021 Mar;22(2):159-171

Department of Dermatology, Harrogate and District NHS Foundation Trust, Lancaster Park Road, Harrogate, HG2 7SX, UK.

Background: Acne (syn: acne vulgaris) ranks as the most common inflammatory dermatosis treated worldwide. Acne typically affects adolescents at a time when they are undergoing maximum physical and social transitions, although prevalence studies suggest it is starting earlier and lasting longer, particularly in female patients. According to global burden of disease studies, acne causes significant psychosocial impact. Hence, identifying mechanisms to accurately measure the impact of the disease is important. Adopting an approach to harmonize and standardize measurements is now recognized as an essential part of any clinical evaluation and allows for better comparison across studies and meta-analyses.

Objective: The Acne Core Outcome Research Network (ACORN) has identified relevant domains as part of a core outcome set of measures for use in clinical studies. One of these is health-related quality of life (HRQoL). The aim of this systematic review was to provide information to inform the identification of the impacts most important to people with acne.

Methods: A synthesis of available evidence on acne impacts was constructed from a systematic review of the literature, with searches conducted in the MEDLINE, EMBASE and PsychInfo databases.

Results: We identified 408 studies from 58 countries using 138 different instruments to detect the impacts of acne. Four of the five most commonly used instruments (Dermatology Life Quality Index [DLQI], Cardiff Acne Disability Index [CADI], Acne Quality of Life scale [Acne-QoL], Hospital Anxiety and Depression Scale [HADS] and Skindex-29) do not identify specific impacts but rather quantify to what extent acne affects HRQoL. Other studies identified one or more impacts using open-ended questions or tailor-made questionnaires.

Conclusion: This review serves as a rich data source for future efforts by groups such as ACORN (that include patients and health care providers) to develop a core set of outcome measurements for use in clinical trials.
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http://dx.doi.org/10.1007/s40257-020-00564-6DOI Listing
March 2021

The role of acupuncture in the treatment of chronic pain.

Best Pract Res Clin Anaesthesiol 2020 Sep 8;34(3):603-616. Epub 2020 Aug 8.

University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA; Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA.

Acupuncture is a practice based on traditional Chinese medicine, in which needles are used to restore the body's internal balance. Recently, there has been growing interest in the use of acupuncture for various pain conditions. Acupuncture's efficacy in five pain conditions-low back pain (LBP), migraines, fibromyalgia, neck pain, and abdominal pain-was evaluated in this evidence-based, comprehensive review. Based on the most recent evidence, migraine and fibromyalgia are two conditions with the most favorable outcomes after acupuncture. At the same time, abdominal pain has the least evidence for the use of acupuncture. Acupuncture is efficacious for reducing pain in patients with LBP, and for short-term pain relief for those with neck pain. Further research needs to be done to evaluate acupuncture's efficacy in these conditions, especially for abdominal pain, as many of the current studies have a risk of bias due to lack of blinding and small sample size.
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http://dx.doi.org/10.1016/j.bpa.2020.08.005DOI Listing
September 2020

Acupuncture and Its Role in the Treatment of Migraine Headaches.

Neurol Ther 2020 Dec 1;9(2):375-394. Epub 2020 Oct 1.

Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.

Acupuncture is a form of traditional Chinese medicine that is performed by placing needles or pressure in specific locations on a patient's skin to achieve a therapeutic effect. Although used to treat a variety of disorders, one of the most common applications of acupuncture is to treat chronic pain, especially headache and migraine pain. Migraines are difficult to treat, and pharmacotherapies are often the first line of treatment, although these options have many unwanted side effects, such as exacerbation of headache pain in those with chronic migraine. Many complimentary and integrative therapies are available to treat migraine (including nutraceuticals, yoga, tai chi, and biofeedback), among which acupuncture as a treatment is gaining increasing attention. In this review, we provide an overview of the current understanding of both acupuncture and migraine and of current research investigating the effectiveness of acupuncture in treating migraine and chronic migraine.
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http://dx.doi.org/10.1007/s40120-020-00216-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606388PMC
December 2020

Pearls and Pitfalls in Imaging Bone Marrow in Pediatric Patients.

Semin Ultrasound CT MR 2020 Oct 28;41(5):472-487. Epub 2020 May 28.

Department of Radiology, Hershey Children's Hospital, Penn State Milton S. Hershey Medical Center, Hershey, PA. Electronic address:

Magnetic resonance is a noninvasive, nonionizing modality used in the detection and evaluation of marrow lesions, as well as surgical planning and treatment follow-up. Since the distribution of red and yellow marrow occurs in a predictable sequence according to age, understanding this sequence is essential in establishing an accurate and timely diagnosis. This article provides an overview of the normal appearance of bone marrow in healthy children as well as focal and diffuse marrow abnormalities. Imaging pitfalls unique to children and solutions to use in difficult cases will be described.
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http://dx.doi.org/10.1053/j.sult.2020.05.012DOI Listing
October 2020

Chronic Pain Following Cosmetic Breast Surgery: A Comprehensive Review.

Pain Ther 2020 Jun 28;9(1):71-82. Epub 2020 Jan 28.

Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, USA.

Introduction: Cosmetic breast surgery is commonly performed in the United States; 520,000 procedures of the total 1.8 million cosmetic surgical procedures performed in 2018 were breast related. Postoperative chronic pain, defined as lasting 3 or more months, has been reported in a wide variety of breast surgical procedures including breast augmentation, reduction mammaplasty, mastectomy, and mastectomy with reconstruction. Patient characteristics associated with the development of postoperative chronic pain following cosmetic breast surgery include a younger age, larger BMI, smaller height, postoperative hyperesthesia, and elevated baseline depression, anxiety, and catastrophizing scores. The anatomical distribution of chronic pain following breast augmentation procedures is dependent upon incision site placement; pectoral and intercostal nerves have been implicated. The purpose of this review is to provide an update on the current literature addressing the pathophysiology, clinical presentation, and treatment of patients presenting with chronic postoperative pain following cosmetic breast surgery.

Methods: A comprehensive literature review was performed in MEDLINE, PubMed, and Cochrane databases from 1996 to 2019 using the terms "cosmetic surgery", "breast surgery", "postoperative pain", and "chronic pain".

Results: Cosmetic breast surgery can have a similar presentation as post-mastectomy pain syndrome and thus have overlapping diagnostic criteria. Seven domains are identified for a diagnosis of PBSPS: Pain after breast surgery, neuropathic in nature, at least a moderate intensity of pain, as defined as within the middle one-third of the selected pain scale, pain for at least 6 months, symptoms occurring for 12 or more hours a day for a minimum of 4 days each week, pain in at least one of the following sites: breast, chest wall, axilla, or arm on the affected side, pain exacerbated by movement. Patient risk factors and surgical risk factors may influence the development of chronic post-cosmetic surgery breast pain. Improved perioperative analgesia including preoperative regional nerve anesthesia and postoperative catheter infusion have been shown to improve chronic postoperative pain outcomes.

Conclusions: The present review provides a discussion of clinical presentation, pathophysiology, and treatment and preventative strategies for chronic breast pain following cosmetic surgery. This review provides evidence from multiple randomized controlled trials (RCTs) and systematic reviews of efficacy and effectiveness. While chronic postoperative breast pain remains challenging to treat, various preventative strategies have been described to improve postoperative pain outcomes.
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http://dx.doi.org/10.1007/s40122-020-00150-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203369PMC
June 2020

Comparison of Plaque Removal Efficacy of a Novel Flossing Agent with the Conventional Floss: A Clinical Study.

Int J Clin Pediatr Dent 2018 Nov-Dec;11(6):474-478

Department of Pedodontics and Preventive Dentistry, Karnavathi School of Dentistry, Uvarsad, Gujarat, India.

Introduction: The various methods for plaque control include mechanical plaque control methods which comprises use of toothbrushes, flosses, interdental brushes, and chemical plaque control which includes mouthwashes, dentrifices. The need for the study was to prove the efficacy of flossing in children using gumchucks.

Materials And Methods: A total sample size of 24 children age groups 6-12 years according to chronological age were selected. In 12 patients, flossing using gumchucks was done and in 12 patients flossing using unwaxed floss without handle was done. Proximal plaque index was taken at 0,2,4,6 weeks to assess the efficacy of both types of floss in removal of interproximal plaque. At the end of 6 weeks, patient's parents were asked to fill up the questionnaire.

Results: In the intragroup comparison for gumchucks, significant plaque reductions were found at 4 and 6 weeks. In the intragroup comparison for unwaxed floss, significant reduction for plaque marginal index were recorded from baseline to 2 and 4 weeks. In the intergroup comparison, significant reduction in plaque index was recorded at 4 and 6 weeks.

Conclusion: Gumchucks have the high efficacy of plaque removal as well as easy in use for children routinely. Also when surveyed majority of the patents preferred gumchucks if available in the stores.

How To Cite This Article: Kiran SDP, Ghiya K, Makwani D, Bhatt R, Patel M, Srivastava M. Comparison of Plaque Removal Efficacy of a Novel Flossing Agent with the Conventional Floss: A Clinical Study. Int J Clin Pediatr Dent, 2018;11(6):474-478.
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http://dx.doi.org/10.5005/jp-journals-10005-1560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611534PMC
July 2019

Cutaneous Metastasis from Renal Cell Carcinoma.

Skinmed 2019 19;17(1):65-66. Epub 2019 Mar 19.

From the DermDOX Center for Dermatology, Hazleton, PA.

A 73-year-old man presented with a red papule on the posterior aspect of his neck (Figure 1). The growth had first been noted approximately 1 month before his visit. The patient complained of irritation from his collar but had no other symptoms. He had hypertension controlled by medication and denied recent weight loss, malaise, or swollen glands. Examination of the lesion revealed a firm, bright red papule 4 mm in diameter on a slightly indurated flesh-color base. (. 2019;17:65-66).
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July 2019

IL-6 and ovarian cancer: inflammatory cytokines in promotion of metastasis.

Cancer Manag Res 2018 5;10:6685-6693. Epub 2018 Dec 5.

Department of Biological Sciences, Boise State University, Boise, ID 83725, USA,

Ovarian cancer is the most fatal gynecological cancer in the USA and the fifth most common cancer-related cause of death in women. Inflammation has been shown to play many roles in ovarian cancer tumor growth, with the proinflammatory cytokine interleukin-6 (IL-6) having been established as a key immunoregulatory cytokine. Ovarian cancer cells continuously secrete cytokines that promote tumorigenicity in both autocrine and paracrine fashions while also receiving signals from the tumor microenvironment (TME). The TME contains many cells including leukocytes and fibroblasts, which respond to proinflammatory cytokines and secrete their own cytokines, which can produce many effects including promotion of chemoresistance, resistance to apoptosis, invasion, angiogenesis by way of overexpression of vascular endothelial growth factor, and promotion of metastatic growth at distant sites. IL-6 and its proinflammatory family members, including oncostatin M, have been found to directly stimulate enhanced invasion of cancer cells through basement membrane degradation caused by the overexpression of matrix metalloproteinases, stimulate promotion of cell cycle, enhance resistance to chemotherapy, and cause epithelial-to-mesenchymal transition (EMT). IL-6 has been shown to activate signaling pathways that lead to tumor proliferation, the most studied of which being the Janus kinase (JAK) and STAT3 pathway. IL-6-induced JAK/STAT activation leads to constitutive activation of STAT3, which has been correlated with enhanced tumor cell growth and resistance to chemotherapy. IL-6 has also been shown to act as a trigger of the EMT, the hypothesized first step in the metastatic cascade. Understanding the important role of IL-6 and its family members' effects on the pathogenesis of ovarian cancer tumor growth and metastasis may lead to more novel treatments, detection methods, and improvement of overall clinical outcomes.
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http://dx.doi.org/10.2147/CMAR.S179189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287645PMC
December 2018

Acceptability of Health Kiosks Within African American Community Settings: A Pilot Study.

Health Serv Res Manag Epidemiol 2018 Jan-Dec;5:2333392817752211. Epub 2018 Jan 21.

Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.

Introduction: Health kiosks have been increasingly adopted to provide health-care services to those with limited access. Kiosks have the potential to reach people who may have undiagnosed health conditions or those who are not under regular physician care. Thus far, there is limited research assessing the usefulness of health kiosks in the community. This study aimed to explore the acceptability, usability, usefulness, and overall satisfaction of health kiosks in African American majority community settings.

Methods: Two health kiosks were placed in predominantly African American low-income areas in an urban city in Western Pennsylvania. After the kiosk interaction, participants 18 years and older were recruited to complete a survey on their overall kiosk use experience. The technology acceptance model was adapted to develop the survey. Survey responses were analyzed using descriptive statistics. Qualitative survey responses were analyzed using content analysis.

Results: Seventy-seven percent of the 31 survey respondents were female and 37.8% were ages 60 to 69 years old. Overall, 90% of participants were satisfied with their kiosk experience and 97% found the kiosk useful for health self-management, with 94% stating that they would use the kiosk again.

Conclusion: This study showed that health kiosks are accepted among African Americans in community settings such as churches and community centers. Participants found the kiosks easy to use and an overall useful tool to help manage their health. Future studies are needed to provide a better understanding of health kiosk acceptance among minority populations and in community settings.
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http://dx.doi.org/10.1177/2333392817752211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5784498PMC
January 2018

In vitro simulation of fretting-corrosion in hip implant modular junctions: The influence of pH.

Med Eng Phys 2018 02 29;52:1-9. Epub 2017 Dec 29.

Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA; Department of Biomedical Science, University of Illinois at Chicago, Rockford, IL, USA. Electronic address:

Background: The fretting-corrosion behavior of mixed metal contacts is affected by various mechanical and electrochemical parameters. Crevice conditions at the junction and patient-specific pathologies can affect the pH of the prosthetic environment. The main objective of this study is to understand the effect of pH variation at the stem/head junction of the hip implant under fretting corrosion exposure. We hypothesized that pH will have a significant influence on the fretting-corrosion behavior hip implant modular junctions.

Materials And Methods: A custom-made setup was used to evaluate the fretting corrosion behavior of hip implant modular junctions. A Newborn calf serum solution (30 g/L protein content) was used to simulate the synovial fluid environment. A sinusoidal fretting motion, with a displacement amplitude of +50 µm, was applied to the Ti alloy rod. The effects of pathology driven, periprosthetic pH variation were simulated at four different pH levels (3.0, 4.5, 6.0 and 7.6). Electrochemical and mechanical properties were evaluated before, during, and after the applied fretting motion.

Results: The impedance of the system was increased in response to the fretting motion. The hysteresis tangential load/displacement behavior was not affected by pH level. The worn surfaces of CoCrMo pins exhibited the presence of tribolayer or organic deposits, in the pH 4.5 group, which may explain the lower drop in potential and mass loss observed in that group. Mechanically dominated wear mechanisms, namely, adhesive wear was shown in the pH 7.6 group, which may account for a higher potential drop and metal content loss.

Conclusions: This study suggests that the fretting-corrosion mechanisms in hip implant are affected by the pH levels of the surrounding environment and patient-specific factors.
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http://dx.doi.org/10.1016/j.medengphy.2017.10.016DOI Listing
February 2018

Fretting-corrosion behavior in hip implant modular junctions: The influence of friction energy and pH variation.

J Mech Behav Biomed Mater 2016 09 3;62:570-587. Epub 2016 Jun 3.

Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States of America. Electronic address:

Background: Recently, there has been increasing concern in the orthopedic community over the use of hip implant modular devices due to an increasing number of reports of early failure, failure that has been attributed to fretting-corrosion at modular interfaces. Much is still unknown about the electrochemical and mechanical degradation mechanisms associated with the use of such devices.

Purpose: Accordingly, the purpose of our study was to develop a methodology for testing the fretting-corrosion behavior of modular junctions.

Methods: A fretting-corrosion apparatus was used to simulate the fretting-corrosion conditions of a CoCrMo hip implant head on a Ti6Al4V hip implant stem. The device features two perpendicularly-loaded CoCrMo pins that articulated against a Ti6Al4V rod. A sinusoidal fretting motion was applied to the rod at various displacement amplitudes (25, 50, 100, 150 and 200μm) at a constant load of 200N. Bovine calf serum at two different pH levels (3.0 and 7.6) was used to simulate the fluid environment around the joint. Experiments were conducted in two modes of electrochemical control - free-potential and potentiostatic. Electrochemical impedance spectroscopy tests were done before and after the fretting motion to assess changes in corrosion kinetics.

Results: In free potential mode, differences were seen in change in potential as a function of displacement amplitude. In general, VDrop (the drop in potential at the onset of fretting), VFretting, (the average potential during fretting), ΔVFretting (the change in potential from the onset of fretting to its termination) and VRecovery (the change in potential from the termination of fretting until stabilization) appeared linear at both pH levels, but showed drastic deviation from linearity at 100μm displacement amplitude. Subsequent EDS analysis revealed a large number of Ti deposits on the CoCrMo pin surfaces. Potentiostatic tests at both pH levels generally showed increasing current with increasing displacement amplitude. Electrochemical impedance spectroscopy measurements from free potential and potentiostatic tests indicated increased levels of resistance of the system after induction of the fretting motion. In free potential tests, the largest increase in impedance was found for the 100μm group.

Conclusions: We conclude that the 100µm group exhibits deviations from linearity for several parameters, and this was most likely due to adhesive wear between Ti6Al4V and CoCrMo surfaces. Overall, the degradation of the system was dominated by wear at all pH levels, and displacement amplitudes.
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http://dx.doi.org/10.1016/j.jmbbm.2016.05.024DOI Listing
September 2016

Impact of Dental Health Education on "Specific Learning Needs" Children.

Int J Clin Pediatr Dent 2016 Jan-Mar;9(1):31-4. Epub 2016 Apr 22.

Reader, Department of Pedodontics and Preventive Dentistry, Karnavati School of Dentistry, Gandhinagar, Gujarat, India.

Introduction: This article compares and evaluates the effect of dental health education through schoolteachers and dental health professionals to "specific learning needs" children attending special school.

Materials And Methods: A total of 71 "specific learning needs" children attending special school participated in the study. The baseline oral hygiene index-simplified (OHI-S) for all the participants was recorded. The training of schoolteachers was done using audiovisual and verbal methods on dental health facts and how to provide instructions on oral hygiene measures for reinforcing to the students. The students were randomly divided into three groups: Group 1 - No further dental health education by the schoolteachers or by the dental professionals was given to these students after the initial oral health education. Group 2 - In this group, the trained teachers taught students about the importance of oral health and demonstrated them brushing technique at intervals of 15 days, 1 month and 3 months. Group 3 - The dental professionals imparted dental health education and also demonstrated brushing techniques to these students at intervals of 15 days, 1 month and 3 months. Six months following the intervention a second examination was done to find out the OHI-S scores. Data analysis were done with Statistical Packages for the Social Sciences (SPSS) version 16 using one-way analysis of variance (ANOVA) statistical test.

Results: Group 2 demonstrated significant decline in OHI-S scores after intervention and all the three groups showed a statistically significant difference between the baseline OHI-S score and the scores after 6 months.

Conclusion: Schoolteachers can be utilized for reinforcing dental health education among "specific learning needs" children effectively. How to cite this article: Relwani AH, Kiran S, Bhatt R, Patel M. Impact of Dental Health Education on "Specific Learning Needs" Children. Int J Clin Pediatr Dent 2016;9(1):31-34.
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http://dx.doi.org/10.5005/jp-journals-10005-1329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890059PMC
June 2016

Deciphering the Finger Prints of Brain Cancer Glioblastoma Multiforme from Four Different Patients by Using Near Infrared Raman Spectroscopy.

J Cancer Sci Ther 2015 Feb;7(2):44-47

University De Lyon, France.

To explore the effectiveness of Raman spectra to diagnose brain cancer glioblastoma multiforme (GBM), we investigated the Raman spectra of single cell from four different GBM cell lines developed from four different patients and analyzed the spectra. The Raman spectra of brain cancer (GBM) cells were similar in all these cell lines. The results indicate that Raman spectra can offer the experimental basis for the cancer diagnosis and treatment.
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http://dx.doi.org/10.4172/1948-5956.1000323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415986PMC
February 2015

A Complicated Case of Acute Promyelocytic Leukemia in the Second Trimester of Pregnancy Successfully Treated with All-trans-Retinoic Acid.

Case Rep Hematol 2015 5;2015:634252. Epub 2015 Mar 5.

New Hope Cancer and Research Institute, 350 Vinton Avenue Suite 101, Pomona, CA 91767, USA.

A 40-year-old female at 26-week gestation was diagnosed with acute promyelocytic leukemia (APL) after an abnormal prenatal lab workup showed pancytopenia. She was treated with all-trans-retinoic acid (ATRA), idarubicin, and dexamethasone. After day one of treatment, she developed differentiation syndrome, which was treated with dexamethasone. At 30-week gestation, she had preterm premature rupture of membranes and delivered by cesarean section because of the fetus' breech presentation. Despite ATRA's potential for teratogenicity, a viable infant was born without apparent anomalies. Postpartum, she underwent consolidation treatment with ATRA and arsenic trioxide (ATO). The patient continued ATRA therapy after delivery and is currently in remission.
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http://dx.doi.org/10.1155/2015/634252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363600PMC
March 2015

A patient with diffuse hair loss.

Indian Dermatol Online J 2015 Jan-Feb;6(1):46-8

Ackerman Academy of Dermatopathology, New York, USA.

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http://dx.doi.org/10.4103/2229-5178.148942DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314890PMC
February 2015

Non-metallic foreign body embedded inside tooth.

BMJ Case Rep 2014 Oct 3;2014. Epub 2014 Oct 3.

Department of Pedodontics & Preventive Dentistry, Karnavati School of Dentistry, Gandhinagar, Gujarat, India.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187535PMC
http://dx.doi.org/10.1136/bcr-2014-206905DOI Listing
October 2014

An unusual cystic lesion on the helix.

Indian Dermatol Online J 2014 Jul;5(3):326-7

Ackerman Academy of Dermatopathology, New York, USA.

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http://dx.doi.org/10.4103/2229-5178.137792DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144225PMC
July 2014

Interrelationship between chronic periodontitis and anemia: A 6-month follow-up study.

J Indian Soc Periodontol 2014 Jan;18(1):19-25

Department of Periodontology and Oral Implantology, Padmashree Dr. D. Y. Patil Dental College and Hospital, Nerul, Navi Mumbai, Maharashtra, India.

Background: In India, anemia is a common and serious health disorder among both sexes and all age groups, with anemia of chronic disease (ACD) being the second most prevalent anemia. Periodontitis is an inflammatory disease of the supporting tissues of the tooth caused by specific microorganisms. An immune response to bacteria and their products induces a major vascular response, offering explanatory mechanisms for the interactions between periodontal infection and a variety of systemic disorders. Therefore, periodontitis results in low-grade systemic inflammation, which may cause lower number of erythrocytes and, consequently, lower hemoglobin concentration.

Materials And Methods: A total of 100 systemically healthy male patients visiting the outpatient department participated in the study. Of these, 50 patients had healthy periodontium and 50 patients had chronic periodontitis. Clinical parameters and red blood cell parameters of all the patients were assessed at baseline and 6 months after non-surgical periodontal therapy. Statistical analysis using Student's t-test was performed.

Results: Data analysis revealed that patients with chronic periodontitis showed an improvement in both clinical and red blood cell parameters from baseline to 6 months after non-surgical periodontal therapy.

Conclusion: From the present study, it can be concluded that like any other chronic condition, chronic periodontitis can lead to ACD. It also provides evidence that non-surgical periodontal therapy can improve the anemic status of patients with chronic periodontitis.
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http://dx.doi.org/10.4103/0972-124X.128194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988635PMC
January 2014

Determination of accuracy of polycythemia vera diagnoses and use of the JAK2V617F test in the diagnostic scheme.

Ann Hematol 2014 Sep 1;93(9):1467-72. Epub 2014 Apr 1.

Geisinger Health System, 100 N. Academy Ave., Danville, PA, 17822, USA.

In 2005, three independent research groups described the presence of a specific mutation in the JAK2 gene, JAK2V617F, in patients with a Philadelphia chromosome-negative myeloproliferative neoplasm (MPN). The percentage of patients with the mutation varied according to specific disease with >98 % of polycythemia vera (PV) patients having the mutation. In 2008, the World Health Organization issued new diagnostic criteria for PV including use of the JAK2V617F test as a major diagnostic criterion. The goal of the present study is to determine the accuracy of diagnosing PV in a community practice and reporting of PV to cancer registries, as well as assessing the integration of molecular testing into diagnostic paradigms. Using Geisinger Medical Center's electronic medical records (EMR), patients with a PV diagnosis being seen by a hematologist/oncologist during 2004-2009 were identified. Records were reviewed by a single hematologist/oncologist to determine accuracy of the treating physician's diagnosis and use of the molecular test for the JAK2V617F mutation. There was a diagnosis of PV from the treating physicians in 121 of the 204 evaluable patients (59 %) and another MPN in 21 (10 %). However, we confirmed a PV diagnosis in only 90 patients (44 %). Of the 90 confirmed PV patients, 64 were JAK2V617F-mutation positive while 24 were not tested. While JAK2V617F testing has made a major impact in facilitating the successful delineation of the type of polycythemia (PV versus secondary polycythemia) in patients evaluated in a large, community-based Hematology/Oncology practice, physician usage of other critical tests is inconsistent leading to errors in diagnosis. JAK2V617F mutation testing in combination with other diagnostic criteria may help reduce diagnostic errors.
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http://dx.doi.org/10.1007/s00277-014-2068-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039909PMC
September 2014

Maturational and aging effects on human brain apparent transverse relaxation.

PLoS One 2012 21;7(2):e31907. Epub 2012 Feb 21.

Department of Radiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America.

The goal of this study was to address the need for comprehensive reference data regarding maturational and aging effects on regional transverse relaxation rates (R(2)) of the brain in normal humans. Regional R(2)s were measured in twenty-five brain structures from a sample of seventy-seven normal volunteers 9 to 85 years of age. The relationships between regional R(2) and age were determined using generalized additive models, without the constraint of a specified a priori model. Data analysis demonstrated that the brain tissue R(2)-age correlations followed various time courses with both linear and non-linear characteristics depending on the particular brain structure. Most anatomical structures studied exhibited non-linear characteristics, including the amygdala, hippocampus, thalamus, globus pallidus, putamen, caudate nucleus, red nucleus, substantia nigra, orbitofrontal white matter and temporal white matter. Linear trends were detected in occipital white matter and in the genu of corpus callosum. These results indicate the complexity of age-related R(2) changes in the brain while providing normative reference data that can be utilized in clinical examinations and studies utilizing quantitative transverse relaxation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0031907PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283700PMC
June 2012

Standardized method for quantification of developing lymphedema in patients treated for breast cancer.

Int J Radiat Oncol Biol Phys 2011 Apr 3;79(5):1436-43. Epub 2010 Jun 3.

Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA.

Purpose: To develop a simple and practical formula for quantifying breast cancer-related lymphedema, accounting for both the asymmetry of upper extremities' volumes and their temporal changes.

Methods And Materials: We analyzed bilateral perometer measurements of the upper extremity in a series of 677 women who prospectively underwent lymphedema screening during treatment for unilateral breast cancer at Massachusetts General Hospital between August 2005 and November 2008. Four sources of variation were analyzed: between repeated measurements on the same arm at the same session; between both arms at baseline (preoperative) visit; in follow-up measurements; and between patients. Effects of hand dominance, time since diagnosis and surgery, age, weight, and body mass index were also analyzed.

Results: The statistical distribution of variation of measurements suggests that the ratio of volume ratios is most appropriate for quantification of both asymmetry and temporal changes. Therefore, we present the formula for relative volume change (RVC): RVC = (A(2)U(1))/(U(2)A(1)) - 1, where A(1), A(2) are arm volumes on the side of the treated breast at two different time points, and U(1), U(2) are volumes on the contralateral side. Relative volume change is not significantly associated with hand dominance, age, or time since diagnosis. Baseline weight correlates (p = 0.0074) with higher RVC; however, baseline body mass index or weight changes over time do not.

Conclusions: We propose the use of the RVC formula to assess the presence and course of breast cancer-related lymphedema in clinical practice and research.
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http://dx.doi.org/10.1016/j.ijrobp.2010.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2952286PMC
April 2011

MR cholangiopancreatography at 3.0 T.

Radiographics 2009 Oct;29(6):1689-706

Postgraduate Institute of Radiology and Imaging, Gujarat Imaging Centre, Samved Hospital, Navarangpura, Ahmedabad, India.

The rapid evolution of magnetic resonance (MR) imaging technology has produced much-needed improvements in temporal and spatial resolution that have led to greater recognition of diseases of the hepatobiliary and pancreatic ducts at MR cholangiopancreatography. This modality often substitutes for diagnostic evaluations with endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography. Recent innovations in whole-body MR imaging, including fast imaging sequences, phased-array coils, parallel imaging techniques, and 3.0-T magnets, allow the acquisition of higher-quality diagnostic images in less time. An understanding of these technical advances and their potential clinical applications, limitations, and pitfalls for cholangiopancreatographic evaluation is as essential as a familiarity with the spectrum of possible findings; both are needed to accurately identify and characterize the disease process and to provide effective guidance for treatment.
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http://dx.doi.org/10.1148/rg.296095505DOI Listing
October 2009

Noninvasive optical measures of CBV, StO(2), CBF index, and rCMRO(2) in human premature neonates' brains in the first six weeks of life.

Hum Brain Mapp 2010 Mar;31(3):341-52

Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Charlestown, 02129, USA.

With the causes of perinatal brain injuries still unclear and the probable role of hemodynamic instability in their etiology, bedside monitoring of neonatal cerebral hemodynamics with standard values as a function of age are needed. In this study, we combined quantitative frequency domain near infrared spectroscopy (FD-NIRS) measures of cerebral tissue oxygenation (StO(2)) and cerebral blood volume (CBV) with diffusion correlation spectroscopy (DCS) measures of a cerebral blood flow index (CBF(ix)) to test the validity of the CBV-CBF relationship in premature neonates and to estimate cerebral metabolic rate of oxygen (rCMRO(2)) with or without the CBF(ix) measurement. We measured 11 premature neonates (28-34 weeks gestational age) without known neurological issues, once a week from one to six weeks of age. In nine patients, cerebral blood velocities from the middle cerebral artery were collected by transcranial Doppler (TCD) and compared with DCS values. Results show a steady decrease in StO(2) during the first six weeks of life while CBV remains stable, and a steady increase in CBF(ix). rCMRO(2) estimated from FD-NIRS remains constant but shows wide interindividual variability. rCMRO(2) calculated from FD-NIRS and DCS combined increased by 40% during the first six weeks of life with reduced interindividual variability. TCD and DCS values are positively correlated. In conclusion, FD-NIRS combined with DCS offers a safe and quantitative bedside method to assess CBV, StO(2), CBF, and rCMRO(2) in the premature brain, facilitating individual follow-up and comparison among patients. A stable CBV-CBF relationship may not be valid for premature neonates.
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http://dx.doi.org/10.1002/hbm.20868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826558PMC
March 2010

Modulation of PPAR receptor subtype selectivity of the ligands: aliphatic chain vs aromatic ring as a spacer between pharmacophore and the lipophilic moiety.

Bioorg Med Chem Lett 2008 Dec 17;18(24):6471-5. Epub 2008 Oct 17.

Zydus Research Centre, Sarkhej-Bavla N.H. No. 8A, Moraiya, Ahmedabad, Gujarat 382210, India.

Oxazole containing glycine and oximinobutyric acid derivatives were synthesized as PPARalpha agonists by incorporating polymethylene spacer as a replacement of commonly used phenylene group that connects the acidic head with lipophilic tail. Compound 13a was found to be a selective and potent PPARalpha agonist. Further 1,3-dioxane-2-carboxylic acid derivative 20 was synthesized by replacing the tetramethylene spacer of NS-220, a selective PPARalpha agonist with phenylene group and found to exhibit PPARalpha/gamma dual agonism. These results suggest that compounds possessing polymethylene spacer between pharmacophore and lipophilic tail exhibit predominantly PPARalpha agonism whereas those with an aromatic phenylene spacer shows PPARalpha/gamma dual agonism.
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http://dx.doi.org/10.1016/j.bmcl.2008.10.062DOI Listing
December 2008

Discovery of a highly orally bioavailable c-5-[6-(4-Methanesulfonyloxyphenyl)hexyl]-2-methyl-1,3-dioxane-r-2-carboxylic acid as a potent hypoglycemic and hypolipidemic agent.

Bioorg Med Chem Lett 2008 Oct 3;18(20):5586-90. Epub 2008 Sep 3.

Zydus Research Centre, Sarkhej-Bavla N.H 8A Moraiya, Ahmedabad 382210, India.

A series of novel 1,3-dioxane-2-carboxylic acid derivatives containing alkyl chain tether and substituted phenyl group as a lipophilic tail have been prepared as agonists of PPARalpha and gamma. c-5-[6-(4-Methanesulfonyloxyphenyl)hexyl]-2-methyl-1,3-dioxane-r-2-carboxylic acid 13c exhibited potent hypoglycemic and lipid lowering activity with high oral bioavailability in animal models.
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http://dx.doi.org/10.1016/j.bmcl.2008.08.112DOI Listing
October 2008

Design and synthesis of novel oxazole containing 1,3-dioxane-2-carboxylic acid derivatives as PPAR alpha/gamma dual agonists.

Bioorg Med Chem 2008 Aug 28;16(15):7117-27. Epub 2008 Jun 28.

Zydus Research Centre, Sarkhej-Bavla N.H 8A Moraiya, Ahmedabad 382210, India.

A few novel 1,3-dioxane carboxylic acid derivatives were designed and synthesized to aid in the characterization of PPAR alpha/gamma dual agonists. Structural requirements for PPARalpha/gamma dual agonism of 1,3-dioxane carboxylic acid derivatives included the structural similarity with potent glitazones in fibric acid chemotype. The compounds with this pharmacophore and substituted oxazole as a lipophilic heterocyclic tail were synthesized and evaluated for their in vitro PPAR agonistic potential and in vivo hypoglycemic and hypolipidemic efficacy in animal models. Lead compound 2-methyl-c-5-[4-(5-methyl-2-(4-methylphenyl)-oxazol-4-ylmethoxy)-benzyl]-1,3-dioxane-r-2-carboxylic acid 13b exhibited potent hypoglycemic, hypolipidemic and insulin sensitizing effects in db/db mice and Zucker fa/fa rats.
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http://dx.doi.org/10.1016/j.bmc.2008.06.050DOI Listing
August 2008