Publications by authors named "Rahul Gupta"

432 Publications

Remdesivir therapy associated with Bradycardia in SARS-CoV2.

Clin Cardiol 2021 Jul 28. Epub 2021 Jul 28.

Division of Cardiology, Loma Linda University School of Medicine, Loma Linda, California, USA.

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http://dx.doi.org/10.1002/clc.23700DOI Listing
July 2021

Transperitoneal laparoscopic ureteropyeloplasty of retrocaval ureter: Single surgeon experience and review of literature.

Asian J Endosc Surg 2021 Jul 28. Epub 2021 Jul 28.

Department of Urology, GMC Jammu, Jammu, India.

Introduction: Retrocaval ureter (RCU) is a rare congenital abnormality, secondary to anomalous development of inferior vena cava (IVC) presenting as ipsilateral obstruction needing surgical intervention. The aim of this article is to present surgical techniques and outcome of transperitoneal laparoscopic ureteropyeloplasty in patients with RCU treated by a single surgeon at a tertiary care center and with review of literature.

Material And Methods: We conducted a retrospective, institutional review board approved chart review of patients who underwent transperitoneal laparoscopic ureteropyeloplasty for RCU at our unit between January 2010 and December 2020. A total of 10 patients were identified. Preoperative evaluation involved a computed tomography-intravenous urography in addition to the conventional evaluation. All the patients underwent dismembered transperitoneal laparoscopic ureteropyeloplasty over a Double J stent. Data analyzed included the demographic profile, operative time difficulty if any, postoperative, intraoperative complications and functional outcome.

Results: All cases were completed laparoscopically and no open conversion was required. Average operating time was 96.6 minutes ± 8.16. Average blood loss was 71 ± 14.49 mL with an analgesia requirement of 115 ± 33.74 mg. One patient developed postoperative urinary leak and responded to percutaneous nephrostomy drainage. Patients were followed up for 3 to 12 months with a serial ultrasound and a follow-up diethylene-triamine-penta-acetic acid renal scan at 3 months to rule out any anastomotic site obstruction.

Conclusion: Transperitoneal laparoscopic ureteropyeloplasty for RCU was associated with minimal morbidity and good outcomes.
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http://dx.doi.org/10.1111/ases.12970DOI Listing
July 2021

Correction to: Biomethanol Production from Methane by Immobilized Co-cultures of Methanotrophs.

Indian J Microbiol 2021 Sep 21;61(3):396. Epub 2021 May 21.

Department of Chemical Engineering, Konkuk University, Seoul, 05029 Republic of Korea.

[This corrects the article DOI: 10.1007/s12088-020-00883-6.].
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http://dx.doi.org/10.1007/s12088-021-00946-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263816PMC
September 2021

Spectrum of Endocrine Dysfunction and Association With Disease Severity in Patients With COVID-19: Insights From a Cross-Sectional, Observational Study.

Front Endocrinol (Lausanne) 2021 2;12:645787. Epub 2021 Jul 2.

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

Introduction: Evidence on new-onset endocrine dysfunction and identifying whether the degree of this dysfunction is associated with the severity of disease in patients with COVID-19 is scarce.

Patients And Methods: Consecutive patients enrolled at PGIMER Chandigarh were stratified on the basis of disease severity as group I (moderate-to-severe disease including oxygen saturation <94% on room air or those with comorbidities) (n= 35) and group II (mild disease, with oxygen saturation >94% and without comorbidities) (n=49). Hypothalamo-pituitary-adrenal, thyroid, gonadal axes, and lactotroph function were evaluated. Inflammatory and cell-injury markers were also analysed.

Results: Patients in group I had higher prevalence of hypocortisolism (38.5 6.8%, p=0.012), lower ACTH (16.3 32.1pg/ml, p=0.234) and DHEAS (86.29 117.8µg/dl, p= 0.086) as compared to group II. Low T3 syndrome was a universal finding, irrespective of disease severity. Sick euthyroid syndrome (apart from low T3 syndrome) (80.9 73.1%, p= 0.046) and atypical thyroiditis (low T3, high T4, low or normal TSH) (14.3 2.4%, p= 0.046) were more frequent in group I than group II. Male hypogonadism was also more prevalent in group I (75.6% 20.6%, p=0.006) than group II, with higher prevalence of both secondary (56.8 15.3%, p=0.006) and primary (18.8 5.3%, p=0.006) hypogonadism. Hyperprolactinemia was observed in 42.4% of patients without significant difference between both groups.

Conclusion: COVID-19 can involve multiple endocrine organs and axes, with a greater prevalence and degree of endocrine dysfunction in those with more severe disease.
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http://dx.doi.org/10.3389/fendo.2021.645787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283965PMC
July 2021

Safety and efficacy of oral anticoagulants in atrial fibrillation and bioprosthetic heart valves.

Eur J Intern Med 2021 Jul 13. Epub 2021 Jul 13.

Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA.

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http://dx.doi.org/10.1016/j.ejim.2021.06.027DOI Listing
July 2021

Response to Dr. Masaya Miyauchi and Dr. Teruhiko Imamura, Clinical implication of COVID-19 associated bradycardia.

Clin Cardiol 2021 Jul 9. Epub 2021 Jul 9.

Division of Cardiology, Loma Linda University School of Medicine, Loma Linda, California, USA.

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http://dx.doi.org/10.1002/clc.23675DOI Listing
July 2021

Essential Thrombocythemia Due to Janus Kinase 2 Mutation Unmasked After Splenectomy.

Cureus 2021 May 31;13(5):e15357. Epub 2021 May 31.

Surgery, Sahloul Hospital, Sousse, TUN.

Reactive thrombocytosis after splenectomy is common and often self-limiting. However, thrombocytosis can be multifactorial, especially extreme thrombocytosis (platelet count > 100 x 10/cubic mm). It can lead to thrombotic or hemorrhagic complications. Hence, in patients with rising platelet count after splenectomy, detailed evaluation may be required to rule out other causes of thrombocytosis, such as infection, iron deficiency, and myeloproliferative disorders. Timely treatment of patients with thrombocytosis can prevent the development of life-threatening complications. The index case highlights the importance of regular follow-up of the patients after splenectomy to detect thrombocytosis and suspect other causes if the spleen was diseased or the platelet count fails to resolve spontaneously.
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http://dx.doi.org/10.7759/cureus.15357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245623PMC
May 2021

Endocrown - A Paradigm Shift in Rehabilitation: A Report of Two Cases.

Contemp Clin Dent 2021 Apr-Jun;12(2):195-198. Epub 2021 Jun 14.

Department of Conservative Dentistry and Endodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India.

Along with the advent of dentistry, the ideal restoration of an endodontically treated tooth has been a widely discussed and controversial topic. Coronal rehabilitation of an endodontically treated tooth is quite a challenge for clinicians as considerations should be taken for its minimally invasive preparation and the retention and stability of the restoration. With the development of adhesive systems, the need for intraradicular anchorage and thus the post-core system is greatly reduced. Endocrown is a restorative option for an endodontically treated tooth, and it serves as a suitable alternative to the conventional post-core restoration and full-coverage restoration. This novel approach promotes the stability and retention of the indirect restoration without the need of a cast metal core or reconstruction with intracanal post, thereby reducing the treatment time. Thus, endocrown has become a promising alternative in the esthetic and functional rehabilitation of an endodontically treated tooth.
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http://dx.doi.org/10.4103/ccd.ccd_557_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237820PMC
June 2021

Paraplegia due to medullary compression caused by a large cell neuroendocrine carcinoma of the urinary bladder: A case report.

Ann Med Surg (Lond) 2021 Jul 6;67:102475. Epub 2021 Jun 6.

Department of Urology, Sahloul Hospital, Sousse, Tunisia.

Background: Neuroendocrine carcinomas of the urinary bladder are rare tumors, estimated at less than 1% of urinary bladder malignancies. They are mainly represented by small cell neuroendocrine carcinoma, while large cell neuroendocrine carcinoma (LCNEC) is rarely reported.

Case Presentation: We report a case of a 49-year-old man presenting paraplegia caused by a metastatic urinary bladder LCNEC, which was managed with palliative external beam radiotherapy (EBRT) associated with MVAC chemotherapy, including methotrexate, vinblastine sulfate, doxorubicin hydrochloride (Adriamycin), and cisplatin. At the last follow-up of one year after his admission, there was a symptomatic improvement in the pain intensity.

Conclusion: LCNEC of the bladder was first described in 1986, and, until now, less than 40 cases have been published in the literature. To the best of our knowledge, this is the first case of primary LCNEC of the urinary bladder presenting with paraplegia.
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http://dx.doi.org/10.1016/j.amsu.2021.102475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220165PMC
July 2021

Lambda-Restricted Crystal-Storing Histiocytosis of Stomach: A Case Report and Review of Literature.

Cureus 2021 May 13;13(5):e15009. Epub 2021 May 13.

Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND.

Crystal-storing histiocytosis (CSH) is a rare tissue phenomenon that is usually associated with lympho-proliferative diseases. The disease is characterized by prominent collections of macrophages with abundant eosinophilic cytoplasm and fibrillary cytoplasmic inclusions. The inclusions appear as linear crystals within the macrophages which are usually kappa restricted. The disease usually involves lungs, lymph nodes, bone marrow, thymus and spleen with rare involvement of the gastrointestinal tract. We report a rare case of lambda-restricted CSH of the stomach. The diagnosis of CSH triggered further hematological evaluation. The patient was later diagnosed to have diffuse large B-cell lymphoma involving lymph nodes and bone marrow. He received chemotherapy for the same and is on regular follow up. The index case highlights the need to identify CSH of stomach prompting evaluation for hematological malignancies and to increase its awareness among clinicians and pathologists.
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http://dx.doi.org/10.7759/cureus.15009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8197172PMC
May 2021

Streptokinase irrigation through a percutaneous catheter helps decrease the need for necrosectomy and reduces mortality in necrotizing pancreatitis as part of a step-up approach.

Surgery 2021 Jun 11. Epub 2021 Jun 11.

Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address:

Background: Percutaneous catheter drainage in pancreatic necrosis with a predominant solid component has a reduced success rate. To improve the efficacy of percutaneous catheter drainage, we used streptokinase in the irrigation fluid in the present study.

Methods: In this retrospective analysis of 4 prospective randomized studies performed at our center from 2014 to 2019, 108 patients were evaluated. We assessed the safety, feasibility, and efficacy of streptokinase irrigation compared to saline irrigation. Data were also analyzed between 50,000 IU and 150,000 IU streptokinase.

Results: There were 53 patients in the streptokinase irrigation group and 55 in the saline irrigation group, and both groups were comparable in terms of age, sex, etiology, APACHE II score, and percutaneous catheter drainage characteristics. The modified computerised tomography severity index and modified Marshall score at the onset of pain were significantly higher in the streptokinase group. Sepsis reversal was significantly higher in the streptokinase group (75% vs 36%), and the need for necrosectomy (34% vs 54%) was also lower in the streptokinase group. Mortality was lower in the streptokinase group than in the saline group (32% vs 40%). The incidence of bleeding in the streptokinase group was lower than that in the saline group (7% vs 18%). A higher dose of streptokinase (150,000 IU) resulted in lower rates of necrosectomy, bleeding, and mortality compared to those with 50,000 IU streptokinase.

Conclusion: Significant reductions in the need for surgery and sepsis reversal were noted in the streptokinase group. The results using 150,000 IU streptokinase were superior to those using 50,000 IU streptokinase.
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http://dx.doi.org/10.1016/j.surg.2021.05.028DOI Listing
June 2021

Effect of a Prescription Drug Monitoring Program on Emergency Department Opioid Prescribing.

West J Emerg Med 2021 Apr 19;22(3):756-762. Epub 2021 Apr 19.

Penn State Hershey Medical Center, Department of Emergency Medicine, Hershey, Pennsylvania.

Introduction: Our goal was to determine whether implementation of a prescription drug monitoring program (PDMP) altered emergency department (ED) opioid prescription rates overall and in patients of different pain severities.

Methods: We conducted this single-center, retrospective review at an academic ED. The study examined patients discharged from the ED who received opioid prescriptions, before and after the state's implementation of a PDMP (August 25, 2016). The monthly rate was a ratio of the patients given ≥ 1 opioid prescription to the ED patients with a numeric pain rating scale (NPRS) > 0. We performed an interrupted time series analysis on each demographic.

Results: The overall ED opioid prescription rate decreased from 51.3% (95% confidence interval [Cl], 50.4%-52.2%) to 47.9% (95% Cl, 47.0%-48.7%). For males, this decreased from 51.1% to 46.7% (P < 0.0001), while in females it did not significantly change (51.6% to 49.7% [P = 0.0529]). For those with mild pain, the rate increased from 27.5% to 34.3% (P < 0.0001), while for those with moderate pain, it did not significantly change (42.8% to 43.5% [P = 0.5924]). For those with severe pain, the rate decreased from 66.1% to 59.6% (P < 0.0001).

Conclusion: We found that PDMP implementation was associated with an overall decrease in opioid prescription rates, and that patients with mild pain were prescribed opioids more often while severe pain patients were prescribed opioids less often.
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http://dx.doi.org/10.5811/westjem.2021.1.49652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202985PMC
April 2021

Serum Sickness-Like Reaction Associated With Acute Hepatitis B in a Previously Vaccinated Adult Male.

Cureus 2021 Apr 28;13(4):e14742. Epub 2021 Apr 28.

Infectious Disease, Michigan State University/Hurley Medical Center, Flint, USA.

Serum sickness is a well-known immune complex deposition phenomenon, occurring as a reaction to proteins in antiserum from a non-human animal source. Serum sickness-like reaction (SSLR), typically associated with drugs and vaccines, sometimes occurs with acute hepatitis B infection and poses a diagnostic dilemma for clinicians, as other viral syndromes, vasculitic processes, and autoimmune conditions can have similar presentations. We present a 36-year-old intravenous drug user, with confirmed records of hepatitis B immunization, who presented with multi-joint pain, joint swelling, and a skin rash. There is a paucity of cases in the literature reporting occurrence of serum sickness-like reaction due to acute hepatitis B infection in a previously fully-immunized adult. This diagnosis should be kept in mind even in the clinical scenario of a fully-immunized patient.
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http://dx.doi.org/10.7759/cureus.14742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8163517PMC
April 2021

Colonic Gangrene: A Sequela of Coronavirus Disease 2019.

Cureus 2021 Apr 26;13(4):e14687. Epub 2021 Apr 26.

Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND.

Initially considered to be a respiratory disease, coronavirus disease 2019 (COVID-19) is now recognized as a multisystem disease known to affect all the major organs, including the gastrointestinal system. Based on recent studies, severe acute respiratory syndrome coronavirus 2 causes dysregulation of multiple biological pathways, triggers an exaggerated immune response, and affects multiple organs. The gastrointestinal symptoms in COVID-19 are common but often overlooked. We report the case of a 50-year-old female with a recent history of COVID-19 presenting with complaints of abdominal pain and constipation. Initially, the patient was treated for respiratory symptoms and discharged home. Subsequently, she was re-admitted and diagnosed with colonic obstruction on radiology. Laparotomy revealed descending and sigmoid colonic gangrene requiring left colectomy. This case highlights the uncommon but severe gastrointestinal manifestations of COVID-19.
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http://dx.doi.org/10.7759/cureus.14687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8153963PMC
April 2021

Mucinous Adenocarcinoma of Gallbladder Presenting As Acute Calculous Cholecystitis.

Cureus 2021 Apr 18;13(4):e14548. Epub 2021 Apr 18.

Surgery, Sahloul Hospital, Sousse, TUN.

Mucinous adenocarcinoma (MAC) is a rare type of gallbladder cancer accounting for less than 5% of the reported cases. It is characterized by mucin deposition involving more than 50% of the tumor volume. It is a distinct subtype of gallbladder cancer and associated with poor prognosis. Accurate preoperative diagnosis is difficult. Most of the cases are diagnosed incidentally during the histopathological examination of the resected gallbladder. We report the case of a 75-year-old man who presented with right upper abdominal pain, fever, and vomiting for 15 days. Abdominal ultrasound revealed acute calculous cholecystitis for which he underwent laparoscopic cholecystectomy. Histological examination of the gallbladder found ulcerated gallbladder mucosa lined with dysplastic epithelium. The tumor was mainly composed of dysplastic glands floating in the pools of mucin with invasion of the perivascular connective tissue suggestive of MAC. This case highlights the importance of histological examination of gallbladder after routine cholecystectomy.
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http://dx.doi.org/10.7759/cureus.14548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130641PMC
April 2021

Dual Versus Triple Therapy in Patients with Acute Coronary Syndrome and an Anticoagulation Indication - A Systematic Review with Meta-Analysis and Trial-Sequential Analysis.

Cardiol Rev 2020 May 15. Epub 2020 May 15.

Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY Department of Surgery, Adesh Medical College and Hospital, Kurukshetra, India Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV Department of Cardiology, Medical College of Wisconsin, Milwaukee, WI.

Choosing an antithrombotic regime in patients with acute coronary syndrome (ACS) and a concomitant indication for anticoagulation is a challenge commonly encountered by clinicians. Our aim in this article is to evaluate the safety and efficacy of triple antithrombotic therapy (TT, anticoagulant plus dual antiplatelet) versus dual antithrombotic therapy (DT, anticoagulant plus single antiplatelet) in patients with acute coronary syndrome. We included all randomized trials comparing the outcomes of single versus dual antiplatelet therapy in patients with acute coronary syndrome on anticoagulants. The primary outcome was major adverse cardiac events (MACE). Other outcomes studied were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stroke, stent thrombosis and major bleeding. The Mantel-Haenszel risk ratio (RR) random effects model was used to summarize data. Six studies, with a total of 11,437 patients, met our selection criteria. With a follow-up duration of 9-14 months, there was no significant difference between DT and TT in terms of MACE (RR 0.96, 95% confidence interval [CI] 0.79-1.17), all-cause mortality (RR 1.00, 95% CI 0.77-1.29), cardiovascular mortality (RR1.03, 95% CI 0.79-1.34), MI (RR 1.14, 95% CI 0.90-1.45), stroke (RR 0.83, 95% CI 0.56-1.23) and stent thrombosis (RR 1.32 95% CI 0.87-2.01). Compared with TT, DT was associated with significant reductions in major bleeding 4.1% vs 6.5% (RR 0.61, 95% CI 0.45-0.81, NNT=42), clinically significant bleeding 10.5% vs 16.4% (RR 0.62, 95% CI 0.48-0.80) and intracranial hemorrhage 0.4% vs 0.8% (RR 0.43, 95% CI 0.24-0.77). In patients on anticoagulant therapy, the strategy of single antiplatelet therapy (DT) confers a benefit of less major bleeding with no difference in MACE, all-cause mortality, cardiovascular mortality, MI, stroke and ST.
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http://dx.doi.org/10.1097/CRD.0000000000000320DOI Listing
May 2020

Firibastat: A Novel Brain Aminopeptidase Inhibitor - A New Era of Antihypertensive therapy.

Curr Probl Cardiol 2021 Apr 3:100859. Epub 2021 Apr 3.

Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA.

Global incidence and prevalence of hypertension continues to increase and remains a significant challenge. The ever-increasing number of cases are due to comorbid conditions such as obesity and diabetes, as well as lifestyle indiscretions such as excessive salt intake. Hypertension, congestive heart failure, and kidney disease are all conditions resulting from abnormal Renin-Angiotensin-Aldosterone activation and adverse remodeling. Firibastat, a novel Brain Aminopeptidase inhibitor, may be able to help achieve blood pressure control in those with resistant hypertension. In this review article, we will discuss the biochemical pathway of firibastat and various trials assessing drug efficacy in animals and humans. This drug has the potential to curb the risk of uncontrolled hypertension and help improve long term cardiovascular morbidity and mortality.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.100859DOI Listing
April 2021

A novel study on SARS-COV-2 virus associated bradycardia as a predictor of mortality-retrospective multicenter analysis.

Clin Cardiol 2021 Jun 8;44(6):857-862. Epub 2021 May 8.

Divison of Cardiology, Loma Linda University School of Medicine, Loma Linda, California, USA.

Background: SARS-CoV2 has affected more than 73.8 million individuals. While SARS-CoV2 is considered a predominantly respiratory virus, we report a trend of bradycardia among hospitalized patients, particularly in association with mortality.

Methodology: The multi-center retrospective analysis consisted of 1053 COVID-19 positive patients from March to August 2020. A trend of bradycardia was noted in the study population. Absolute bradycardia and profound bradycardia was defined as a sustained heart rate < 60 BPM and < 50 BPM, respectively, on two separate occasions, a minimum of 4 h apart during hospitalization. Each bradycardic event was confirmed by two physicians and exclusion criteria included: less than 18 years old, end of life bradycardia, left AMA, or taking AV Nodal blockers. Data was fetched using a SQL program through the EMR and data was analyzed using SPSS 27.0. A logistic regression was done to study the effect of bradycardia, age, gender, and BMI on mortality in the study group.

Results: 24.9% patients had absolute bradycardia while 13.0% had profound bradycardia. Patients with absolute bradycardia had an odds ratio of 6.59 (95% CI [2.83-15.36]) for mortality compared with individuals with a normal HR response. The logistic regression model explained 19.6% (Nagelkerke R ) of variance in the mortality, correctly classified 88.6% of cases, and was statistically significant X (5)=47.10, p < .001. For each year of age > 18, the odds of dying increased 1.048 times (95% CI [1.25-5.27]).

Conclusion: The incidence of absolute bradycardia was found in 24.9% of the study cohort and these individuals were found to have a significant increase in mortality.
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http://dx.doi.org/10.1002/clc.23622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207973PMC
June 2021

The outcome of TSHoma from a tertiary care institute in India.

Surg Neurol Int 2021 14;12:161. Epub 2021 Apr 14.

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

Background: Thyroid-stimulating hormone (TSH)-secreting pituitary adenoma (TSHoma) is the rarest functioning pituitary adenoma.

Methods: A retrospective analysis of eight patients of TSHomas to highlight the presentations, diagnostic challenges, and treatment outcomes.

Results: Median age at diagnosis was 42 years, median latency to diagnosis was 2.5 years, and thyrotoxic and compressive symptoms were the most common presenting symptoms. At presentation, three cases were plurihormonal, six cases were on medical treatment including thyroxine, and two cases were incidentally discovered. Imaging revealed macroadenoma in all cases. Seven cases underwent pituitary surgery, after which three achieved remission. Another case entered remission after adjunctive radiotherapy. Thyrotropin (TSH) immunostaining was demonstrated in six out of seven adenomas.

Conclusion: TSHoma is a rare functioning pituitary tumor with both silent and symptomatic presentations. Diagnosis can be established with biochemical and imaging features, even without dynamic tests.
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http://dx.doi.org/10.25259/SNI_877_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088499PMC
April 2021

Impact of COVID-19 on the outcomes of gastrointestinal surgery.

Clin J Gastroenterol 2021 Aug 29;14(4):932-946. Epub 2021 Apr 29.

Department of Surgery, Sousse Hospital, Sousse, Tunisia.

COVID-19 pandemic has brought a paradigm shift in the treatment of various surgical gastrointestinal disorders. Given the increasing number of patients requiring hospitalization and intensive care for SARS-CoV-2 infections, various surgical departments worldwide were forced to stop or postpone elective surgeries to save the health resources for COVID-19 patients. Since the declaration of the COVID-19 pandemic by the World Health Organization on 12th March 2020, the recommendations from the surgical societies kept evolving to help the surgeons in making informed decisions regarding patient care. Moreover, various socio-economic and epidemiological factors have come into play while deciding the optimal approach towards patients requiring gastrointestinal surgery. Surgeries for many abdominal diseases such as acute appendicitis and acute calculous cholecystitis were postponed. Elective surgeries were triaged based on the urgency of performing the surgical procedure, the hospital burden of COVID-19 patients, and the availability of healthcare resources. Various measures were adopted such as preoperative screening for SARS-CoV-2 infection, use of personal protective equipment, and the COVID-19-free surgical pathway to prevent perioperative SARS-CoV-2 transmission. In this article, we have reviewed the recent studies reporting the outcomes of various gastrointestinal surgeries in the COVID-19 pandemic era and the recommendations from various surgical societies on the safety precautions to be followed during gastrointestinal surgery.
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http://dx.doi.org/10.1007/s12328-021-01424-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083095PMC
August 2021

Correlation between Prostate Imaging Reporting and Data System Version 2, Prostate-Specific Antigen Levels, and Local Staging in Biopsy-Proven Carcinoma Prostate: A Retrospective Study.

Int J Appl Basic Med Res 2021 Jan-Mar;11(1):32-35. Epub 2021 Jan 26.

Department of Pathology, Government Medical College, Jammu, Jammu and Kashmir, India.

Background: Multi-parametric magnetic resonance imaging (mp-MRI) is a promising tool in the diagnosis of clinically significant prostate cancer. Morphologic assessment using T2-weighted (T2W) images and functional assessment with diffusion-weighted imaging is the cornerstone for the diagnosis of prostate cancer on mp-MRI.

Aim/objectives: The aim of this study is to evaluate the role of mp-MRI based prostate imaging reporting and data system version 2 (PI-RADS v2) for the assessment of prostate cancer and its correlation with serum prostate specific antigen (S.PSA) levels, local (T) staging on MRI and histopathology.

Materials And Methods: The study was carried out from June 2019 to February 2020. All patients with raised S.PSA levels and abnormal digital rectal examination who underwent mp-MRI of the prostate were included. MRI findings were characterized on the basis of PI-RADS v2 grading. All the patients underwent biopsy and histopathology. The score was correlated with S.PSA levels and the local stage of disease on MRI. Statistical analysis was performed, and results interpreted.

Results: Carcinoma prostate was reported in 32/33 cases on biopsy. A significant correlation was observed between PI-RADS v2 score and S.PSA Levels and between PI-RADS v2 score and T stage of disease in our study. MRI was highly sensitive (93.75%) and specific (100%) in the diagnosis of prostate cancer in our study.

Conclusions: Significant correlation between lesion score on PI-RADS v2 with the local stage and S.PSA levels was seen, thus signifying the importance of mp-MRI in detecting clinically significant prostate cancer. Diffusion-weighted and T2W sequences were the primary diagnostic sequence for the prostate cancer with no additional role of dynamic contrast enhanced sequences.
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http://dx.doi.org/10.4103/ijabmr.IJABMR_115_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8025949PMC
January 2021

Laparoscopic treatment of postpartum pre-sacral haematoma.

J Minim Access Surg 2021 Apr-Jun;17(2):265-267

Department of Digestive Surgery, Sahloul Hospital, University of Sousse, Sousse, Tunisia.

Postpartum retroperitoneal or pelvic haematomas are rare after vaginal delivery. The clinical presentation can vary from being an incidental finding to the development of life-threatening bleeding. Due to their rarity, there are no established guidelines for the management of these postpartum haematomas. The reported treatments vary from watchful observation to emergent laparotomy. We report a case of postpartum pre-sacral haematoma after uneventful vaginal delivery managed successfully by laparoscopic drainage after the failure of conservative treatment.
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http://dx.doi.org/10.4103/jmas.JMAS_153_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083755PMC
March 2021

Modification of Cas9, gRNA and PAM: Key to further regulate genome editing and its applications.

Prog Mol Biol Transl Sci 2021 21;178:85-98. Epub 2021 Jan 21.

Department of Natural Products, National Institute of Pharmaceutical Research and Education (NIPER), Kolkata, India. Electronic address:

The discovery of CRISPR-Cas9 system has revolutionized the genome engineering research and has been established as a gold standard genome editing platform. This system has found its application in biochemical researches as well as in medical fields including disease diagnosis, development of therapeutics, etc. The enormous versatility of the CRISPR-Cas9 as a high throughput genome engineering platform, is derailed by its off-target activity. To overcome this, researchers from all over the globe have explored the system structurally and functionally and postulated several strategies to upgrade the system components including redesigning of Cas9 Nuclease and modification of guide RNA(gRNA) structure and customization of the protospacer adjacent motif. Here in this review, we portray the comprehensive overview of the strategies that has been adopted for redesigning the CRISPR-Cas9 system to enhance the efficiency and fidelity of the technology.
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http://dx.doi.org/10.1016/bs.pmbts.2020.12.001DOI Listing
January 2021

Predictors of permanent pacemaker insertion after TAVR: A systematic review and updated meta-analysis.

J Cardiovasc Electrophysiol 2021 May 17;32(5):1411-1420. Epub 2021 Mar 17.

Department of Cardiology, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA.

Objectives: The aim of this analysis was to evaluate the predictors associated with increased risk of permanent pacemaker implantation (PPMI) following transcatheter aortic valve replacement (TAVR).

Background: While TAVR has evolved as the standard of care for patients with severe aortic stenosis, conduction abnormalities leading to the need for PPMI is one of the most common postprocedural complications.

Methods: A systematic literature search was performed to identify relevant trials from inception to May 2020. Summary effects were calculated using a DerSimonian and Laird random-effects model as odds ratio with 95% confidence intervals for all the clinical endpoints.

Results: Thirty-seven observational studies with 71 455 patients were identified. The incidence of PPMI following TAVR was 22%. Risk was greater in men and increased with age. Patients with diabetes mellitus, presence of right bundle branch block, baseline atrioventricular conduction block, and left anterior fascicular block were noted to be at higher risk. Other significant predictors include the presence of high calcium volume in the area below the left coronary cusp and noncoronary cusp, use of self-expandable valve over balloon-expandable valve, depth of implant, valve size/annulus size, predilatation balloon valvuloplasty, and postimplant balloon dilation.

Conclusion: Fourteen factors were found to be associated with increased risk of PPMI after TAVR, suggesting early identification of high-risk populations and targeting modifiable risk factors may aid in reducing the need for this post TAVR PPMI.
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http://dx.doi.org/10.1111/jce.14986DOI Listing
May 2021

Laccase Immobilization on Magnetic Nanoparticles to Improve Stability and Its Potential Application in Bisphenol A Degradation.

Indian J Microbiol 2021 Mar 19;61(1):45-54. Epub 2020 Nov 19.

Department of Chemical Engineering, Konkuk University, 1 Hwayang-Dong, Gwangjin-Gu, Seoul, 05029 Republic of Korea.

In the present study, laccase (Lac) was immobilized through covalent methods on the magnetic nanoparticles. FeO and FeO nanoparticles activated by 3-aminopropyltriethoxysilane followed with glutaraldehyde showed maximum immobilization yields and relative activity up to 81.4 and 84.3% at optimum incubation and pH of 18 h and 5.8, respectively. The maximum Lac loading of 156 mg/g of support was recorded on FeO nanoparticles. A higher optimum pH and temperature of 4.0 and 45 °C were noted for immobilized enzyme compared to values of 3.5 and 40 °C for free form, respectively. Immobilized Lac exhibited better relative activity profiles at various pH and temperature ranges. The immobilized enzyme showed up to 16-fold improvement in the thermal stability, when incubated at 60 °C, and retained up to 82.9% of residual activity after ten cycles of reuses. Immobilized Lac exhibited up to 1.9-fold higher bisphenol A degradation efficiency potential over free enzyme. Previous reports have demonstrated the immobilization of Lac on non-magnetic supports. This study has demonstrated that immobilization of Lac on magnetic nanoparticles is very efficient especially for achieving high loading, better pH and temperature profiles, and thermal- and solvents-stability, high reusability, and higher degradation of bisphenol A.
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http://dx.doi.org/10.1007/s12088-020-00912-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810807PMC
March 2021

Scrotal Migration of Two Ventriculoperitoneal Shunts Presenting as Hydrocele.

J Indian Assoc Pediatr Surg 2020 Nov-Dec;25(6):414-416. Epub 2020 Oct 27.

Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India.

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http://dx.doi.org/10.4103/jiaps.JIAPS_195_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815041PMC
October 2020

The Outcomes of Surgically Treated Distal Tibia Salter-Harris Type III and IV Fractures.

J Surg Orthop Adv 2020 ;29(4):219-224

Pennsylvania State University College of Medicine, Department of Orthopaedics, Hershey, Pennsylvania.

Current literature suggests that distal tibia Salter-Harris Type III and IV fractures with > 2 mm of displacement should be treated surgically to minimize growth arrest. The objective of the current study is to determine, in Salter-Harris Type III and IV distal tibia fractures, if gap displacements < 2 mm post-surgery are associated with fracture union, if step-offs > 2 mm post-surgery are associated with osteoarthritis, and to determine how often growth disturbances are observed in surgically-treated patients. A retrospective case series review of fourteen patients with displaced distal tibia Salter-Harris Type III and IV fractures was performed. The patients were evaluated using Kärrholm's method of clinical evaluation. The current study demonstrated that surgical reduction to < 2 mm gap displacement results in fracture union in all cases, reduction to < 2 mm does not result in osteoarthritis in any cases, and only 8% of patients demonstrated a growth disturbance with surgical intervention. (Journal of Surgical Orthopaedic Advances 29(4):219-224, 2020).
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January 2021

Myopathy Associated With Statins and SGLT2 - A Review of Literature.

Curr Probl Cardiol 2021 Apr 11;46(4):100765. Epub 2020 Dec 11.

Drug-induced myopathy is a well-described clinical entity characterized by muscle damage leading to symptoms ranging from myalgias to rhabdomyolysis and acute kidney injury. Many pharmacotherapies are known to precipitate myopathic symptoms. Recent case reports suggest a potential relationship between the use of sodium/glucose cotransport 2 (SGLT2) inhibitors and onset of myopathy. The pathogenesis of this has yet to be elucidated. The relevance of this association is augmented by the recent popularity of SGLT2 inhibitors as well as the tendency for them to be prescribed alongside statins. This study reviewed the literature on the incidence and mechanism of drug-induced myopathy in patients with type 2 diabetes mellitus who are taking SGLT2 inhibitors with and without the use of statins.
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http://dx.doi.org/10.1016/j.cpcardiol.2020.100765DOI Listing
April 2021

Management of Genitourinary Fistulas Following Benign Gynecological and Obstetric Procedures: A Single Surgeon Experience.

J Midlife Health 2020 Jul-Sep;11(3):156-160. Epub 2020 Sep 29.

Department of Urology, Government Medical College, Jammu, Jammu and Kashmir, India.

Background: Genitourinary fistula results in lot of anxiety in the suffering females. Scant literature regarding the comprehensive management of genitourinary fistula i.e. VVF and UVF is available.

Objective: The aim of the study was to review a single surgeon experience in dealing with these complex situations.

Material And Methods: We conducted a retrospective, institutional review board approved chart review of patients who underwent genitourinary fistula repair from Jan 2014 till Dec 2019. Of all the fistulas VVF accounted for 18 and UVF for 12 cases. Pre-operative diagnosis in these patients was based predominantly on the history, local examination and cystoscopy. Of the 18 VVF 12 were managed laparoscopically and 6 by open O'Connor's repair. Of the 12 UVF, 8 were managed laparoscopically and 4 by open ureteric reimplants. All were followed up for three months post operatively.

Results: A total of 30 patients were treated since 2014 till December 2019. Average age for the VVF was 54.72 ≤ 10.9 years and that for UVF repair was 59.9 ≤ 7.6 years. Hysterectomies for benign diseases accounted for 66.66% of VVF and 91.6% of UVF. Of the VVF patients one required a ureteric reimplantation, remaining were managed with O'Connors' repair. We had one failure which was successfully repaired after 6 weeks. None of our patients with UVF repairs had a failure at three months follow-up.

Conclusion: Genitourinary fistulas are a debilitating problem in females but a comprehensive approach regarding diagnosis and treatment can cure these patients.
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http://dx.doi.org/10.4103/jmh.JMH_70_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718932PMC
September 2020

Integrating anaerobic digestion of potato peels to methanol production by methanotrophs immobilized on banana leaves.

Bioresour Technol 2021 Mar 16;323:124550. Epub 2020 Dec 16.

Department of Chemical Engineering, Konkuk University, Seoul 05029, Republic of Korea. Electronic address:

In the present study, potato peels were subjected to anaerobic digestion (AD) to produce biogas (methane [CH] and carbon dioxide), which was subsequently used as a substrate for methanol production by methanotrophs. AD resulted in high yields of up to 170 L CH/kg total solids (TS) from 250 mL substrate (2% TS, w/v). Under optimized conditions, maximum methanol production of 4.97 and 3.36 mmol/L from raw biogas was observed in Methylocella tundrae and Methyloferula stellata, respectively. Immobilization of methanotrophs on banana leaves showed loading of up to 156 mg dry cell mass/g support. M. tundrae immobilized on banana leaves retained 31.6-fold higher methanol production stability, compared to non-immobilized cells. To the best of our knowledge, this is the first study on immobilization of methanotrophs on banana leaves for producing methanol from potato peels AD-derived biogas. Such integrative approaches may be improved through process up-scaling to achieve sustainable development.
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http://dx.doi.org/10.1016/j.biortech.2020.124550DOI Listing
March 2021
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