Publications by authors named "Raj V"

403 Publications

Swallowing dysfunction after minimally invasive oesophagectomy.

BMJ Support Palliat Care 2020 Oct 22. Epub 2020 Oct 22.

Department of Surgery, Levine Cancer Institute, Charlotte, North Carolina, USA

Objectives: Patients undergoing oesophagectomy frequently experience malnutrition, which in combination with the catabolic effects of surgery can result in loss of muscle mass and function. Safe swallowing requires preservation of muscle mass. Swallowing dysfunction puts postoperative patients at risk for aspiration and pneumonia. Modified Barium Swallow Study (MBSS) enables assessment of postoperative swallowing impairments. The current study assessed incidence and risk factors associated with swallowing dysfunction and restricted diet at discharge in patients after oesophagectomy in a high-volume surgical centre.

Methods: Patients with an MBSS after oesophagectomy were identified between March 2015 to April 2020 at a high-volume surgical centre. Swallowing was quantitatively evaluated on MBSS with the Rosenbek Penetration-Aspiration Scale (PAS). Muscle loss was evaluated clinically with preoperative hand grip strength (HGS). Univariable and multivariable logistic and linear regression analyses were performed.

Results: 129 patients (87% male; median age 66 years) underwent oesophagectomy with postoperative MBSS. Univariate analysis revealed older age, preoperative feeding tube, lower preoperative HGS and discharge to non-home were associated with aspiration or penetration on MBSS. Age and preoperative feeding tube remained as independent predictors in the multivariable analysis. Both univariate and multivariable analyses revealed increased age and preoperative feeding tube were associated with diet restrictions at discharge.

Conclusions: Swallowing dysfunction after oesophagectomy is correlated with increased age and need for preoperative enteral feeding tube placement. Further research is needed to understand the relationship between muscle loss and aspiration with the goal of enabling preoperative physiological optimisation and patient selection.
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http://dx.doi.org/10.1136/bmjspcare-2020-002626DOI Listing
October 2020

Development of potential proteasome inhibitors against .

J Biomol Struct Dyn 2020 Oct 19:1-15. Epub 2020 Oct 19.

Centre for Drug Design Discovery and Development (C4D), SRM University, Delhi, Haryana, India.

Tuberculosis (TB) has been recently declared as a health emergency because of sporadic increase in Multidrug-resistant Tuberculosis (MDR-TB) problem throughout the world. TB causing bacteria, has become resistant to the first line of treatment along with second line of treatment and drugs, which are accessible to us. Thus, there is an urgent need of identification of key targets and development of potential therapeutic approach(s), which can overcome the complications. In the present study, proteasome has been taken as a potential target as it is one of the key regulatory proteins in propagation. Further, a library of 400 compounds (small molecule) from Medicines for Malaria Venture (MMV) were screened against the target (proteasome) using molecular docking and simulation approach, and selected lead compounds were validated in model. In this study, we have identified two potent small molecules from the MMV Pathogen Box library, MMV019838 and MMV687146 with -9.8kcal/mol and -8.7kcal/mol binding energy respectively, which actively interact with the catalytic domain/active domain of proteasome and inhibit the growth in culture. Furthermore, the molecular docking and simulation study of MMV019838 and MMV687146 with proteasome show strong and stable interaction with compared to human proteasome and show no cytotoxicity effect. A better understanding of proteasome inhibition in in and model would eventually allow us to understand the molecular mechanism(s) and discover a novel and potent therapeutic agent against Tuberculosis. Active efflux of drugs mediated by efflux pumps that confer drug resistance is one of the mechanisms developed by bacteria to counter the adverse effects of antibiotics and chemicals. Efflux pump activity was tested for a specific compound MMV019838 which was showing good in silico results than MIC values.Communicated by Ramaswamy H. Sarma.
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http://dx.doi.org/10.1080/07391102.2020.1835722DOI Listing
October 2020

Time series and fractal analyses of wheezing: a novel approach.

Phys Eng Sci Med 2020 Dec 14;43(4):1339-1347. Epub 2020 Oct 14.

Department of Optoelectronics, University of Kerala, Trivandrum, Kerala, 695581, India.

Since the outbreak of the pandemic Coronavirus Disease 2019, the world is in search of novel non-invasive methods for safer and early detection of lung diseases. The pulmonary pathological symptoms reflected through the lung sound opens a possibility of detection through auscultation and of employing spectral, fractal, nonlinear time series and principal component analyses. Thirty-five signals of vesicular and expiratory wheezing breath sound, subjected to spectral analyses shows a clear distinction in terms of time duration, intensity, and the number of frequency components. An investigation of the dynamics of air molecules during respiration using phase portrait, Lyapunov exponent, sample entropy, fractal dimension, and Hurst exponent helps in understanding the degree of complexity arising due to the presence of mucus secretions and constrictions in the respiratory airways. The feature extraction of the power spectral density data and the application of principal component analysis helps in distinguishing vesicular and expiratory wheezing and thereby, giving a ray of hope in accomplishing an early detection of pulmonary diseases through sound signal analysis.
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http://dx.doi.org/10.1007/s13246-020-00937-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556586PMC
December 2020

Radiation Oncologist Perceptions and Utilization of Digital Patient Assessment Platforms.

Appl Radiat Oncol 2020 Sep;9(3):24-29

Department of Radiation Oncology, Fox Chase Cancer Center.

Background: Patient engagement is increasing in the presence of digital patient assessment platforms, or physician rating websites. Despite this rapid growth, data remains insufficient regarding how these evaluations impact radiation oncologists.

Objectives: The purpose of this study was to assess radiation oncologists worldwide on their awareness and noted effects of digital patient assessment platforms.

Methods: An electronic survey was delivered to 6,199 members of the American Society of Radiation Oncology. Subjects were radiation oncologists practicing throughout the world. The survey consisted of 14 questions focused on demographics, practice details, patient volume, institutional utilization of patient reviews, and perceptions of radiation oncologists on health care reviews provided by patients.

Results: There were 447 responses from practicing radiation oncologists in total, 321 (72%) of which are in the US. Most respondents (228; 51%) either agreed or strongly agreed that patients consider online reviews when deciding which physician to visit. Of all respondents, 188 (42%) reported that their institution checks their online feedback, whereas 157 (36%) and 99 (22%) respectively reported not knowing, or to their knowledge their institution does not check their online feedback. Respondents who saw more than the average number of consults per week were significantly more likely to receive negative feedback ( = 0.005). Forty-five percent of respondents agreed or strongly agreed that online virtual assessment tools contribute to physician burnout. Respondents (100; 22%) who received inappropriate or misdirected feedback were significantly more likely to report that virtual reviews contribute to burnout ( = 0.001).

Conclusions: Radiation oncologists need to be aware that self-reported patient assessments are a data point in the quality of a physician and health care establishment. To best ensure appropriate feedback of a physician's capabilities as a doctor, leadership and employee alignment for patient experience are now more important than ever.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536100PMC
September 2020

Single-pill Combination of Empagliflozin and Linagliptin in Real World Indian Type 2 Diabetes Patient (GRID).

J Assoc Physicians India 2020 Oct;68(10):53-55

Dietitian and Diabetes Educator, Dr. Kovil Diabetes Care Centre, Mumbai, Maharashtra.

Introduction: For the recently introduced single-pill combination of empagliflozin and linagliptin, real-world evidence has not been available. This observational study aims to assess real-world effectiveness of this combination, in the Indian outpatient setting of type-2 diabetes.

Methods: This was a prospective cohort study design, involving patients from 4 centres across western India. Patients with type-2 diabetes and uncontrolled HbA1c, were categorized into 4 groups, including: (1) Naïve to DPP-4i or SGLT-2i; (2) Receiving DPP-4i; (3) Receiving SGLT-2i; (4) Receiving SGLT-2i and DPP-4i as individual pills. Patients were initiated on the fixed-dose combination of empagliflozin + linagliptin, and followed-up over 12-week duration. Clinical parameters of changes in glycaemia, body-weight, and blood-pressure were observed.

Results: 251 patients were included in the analysis, with just over half of them being males (57%), or having pre-existing cardiovascular disease (54%). The group-wise patient distribution was approximately 47%, 18%,15%, and 20% respectively. The study represented patients across broad range of duration of type-2 diabetes, use of background antidiabetic therapies, and comorbid cardiovascular risk. The use of combination demonstrated significant and clinically meaningful reductions in HbA1c, fasting and postprandial glycaemia levels across all the study groups. Reductions in body-weight and blood-pressure levels were also demonstrated. Interestingly, patients in group 4, who were switched from free drug combination to the fixed-dose combination, also demonstrated significant and meaningful improvements in HbA1c, fasting as well as postprandial glycaemia levels, suggestive of possible improvement in medication-adherence.

Conclusion: This real-world evidence complements the results observed in randomized controlled trials, for meaningful effectiveness with the use of empagliflozin-linagliptin fixed dose combination in the Indian outpatient setting. More evidence may facilitate further characterization of clinical value of this promising combination.
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October 2020

Shorter telomere length, higher telomerase activity in association with tankyrase gene polymorphism contribute to high-altitude pulmonary edema.

Hum Mol Genet 2020 11;29(18):3094-3106

Department of Biotechnology, SRM University, Delhi-NCR, Sonepat, Haryana 131029, India.

High-altitude pulmonary edema (HAPE) is a noncardiogenic form of pulmonary edema, which is induced upon exposure to hypobaric hypoxia at high altitude (HA). Hypobaric hypoxia generates reactive oxygen species that may damage telomeres and disturb normal physiological processes. Telomere complex comprises of multiple proteins, of which, tankyrase (TNKS) is actively involved in DNA damage repairs. We hence investigated the association of TNKS and telomeres with HAPE to delineate their potential role at HA. The study was performed in three groups, High-altitude pulmonary edema patients (HAPE-p, n = 200), HAPE-resistant sojourners (HAPE-r, n = 200) and highland permanent healthy residents (HLs, n = 200). Variants of TNKS were genotyped using polymerase chain reaction-restriction fragment length polymorphism. Plasma TNKS level was estimated using enzyme-linked immunosorbent assay, expression of TNKS and relative telomere length were assessed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and telomerase activity was assessed by the telomere repeat amplification protocol assay. TNKS poly-ADP ribosylates the telomere-repeat factor (TRF), which is a negative regulator of telomere length. Consequently, TRF expression was also measured by RT-qPCR. The TNKS heterozygotes rs7015700GA were prevalent in HLs compared to the HAPE-p and HAPE-r. The plasma TNKS was significantly decreased in HAPE-p than HAPE-r (P = 0.006). TNKS was upregulated 9.27 folds in HAPE-p (P = 1.01E-06) and downregulated in HLs by 3.3 folds (P = 0.02). The telomere length was shorter in HAPE-p compared to HAPE-r (P = 0.03) and HLs (P = 4.25E-4). The telomerase activity was significantly higher in HAPE-p compared to both HAPE-r (P = 0.01) and HLs (P = 0.001). HAPE-p had the lowest TNKS levels (0.186 ± 0.031 ng/μl) and the highest telomerase activity (0.0268 amoles/μl). The findings of the study indicate the association of TNKS and telomeres with HA adaptation/maladaptation.
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http://dx.doi.org/10.1093/hmg/ddaa205DOI Listing
November 2020

Far lateral approach without occipital condylar resection for intradural ventral/ventrolateral foramen magnum tumors and aneurysms of V4 segment of vertebral artery: Review of surgical results.

Clin Neurol Neurosurg 2020 10 22;197:106163. Epub 2020 Aug 22.

Department and Institution, Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India.

Background: Controversies exist regarding the need and extent of condylar resection for safe surgical management of intradural ventral/ventrolateral foramen magnum (VFM) tumors and aneurysms of V4 segment of vertebral artery (VA) by far lateral approach. This retrospective study was conducted to evaluate the results of basic far lateral approach(retrocondylar approach) without upfront occipital condylar resection.

Methods And Results: Twenty one patients underwent surgery via far lateral approach for intradural VFM tumors and aneurysms of V4 segment of VA at Sri Sathya Sai Institute of Higher Medical Sciences during 9 years(2008-2016) study period. Eight patients had VA aneurysms and 13 patients had intradural VFM tumors. After basic far lateral approach(retrocondylar approach), dura was opened and checked if the exposure was adequate for safe surgery. Retrocondylar approach provided adequate exposure for all these lesions and resection of occipital condyle/jugular tubercle was not required in any of these cases. Skeletonization or transposition of VA was not done in any of these cases. Gross total resection of the tumor could be done in 9 patients(9/13-69.2 %) and near total excision (>95 %) in 4 patients (4/13-30.8 %). Seven of the 8 VA aneurysms were successfully clipped. Outcome at a final follow up of 3 months or more was good(mRS<2) in 19 patients(19/21-90.5 %) and poor in 2 patients. Complications included lower cranial nerve deficits [transient-2/21(9.5 %), persisting-2/21(9.5 %)], motor deficits(2/21-9.5%), seventh nerve paresis(1/21-4.8%), sixth nerve paresis(2/21-9.5%) and pseudomeningocele(1/21-4.8%).

Conclusion: Basic far lateral (retrocondylar) approach provides excellent exposure for majority of VFM tumors and aneurysms of V4 segment of VA. Condylar resection(transcondylar approach), drilling of jugular tubercle (transtubercular approach), skeletonization/transposition of VA might not be required for safe surgical management of majority of these lesions.
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http://dx.doi.org/10.1016/j.clineuro.2020.106163DOI Listing
October 2020

Nonlinear time series and principal component analyses: Potential diagnostic tools for COVID-19 auscultation.

Chaos Solitons Fractals 2020 Nov 24;140:110246. Epub 2020 Aug 24.

Department of Optoelectronics, University of Kerala, Trivandrum, Kerala, India- 695581.

The development of novel digital auscultation techniques has become highly significant in the context of the outburst of the pandemic COVID 19. The present work reports the spectral, nonlinear time series, fractal, and complexity analysis of vesicular (VB) and bronchial (BB) breath signals. The analysis is carried out with 37 breath sound signals. The spectral analysis brings out the signatures of VB and BB through the power spectral density plot and wavelet scalogram. The dynamics of airflow through the respiratory tract during VB and BB are investigated using the nonlinear time series and complexity analyses in terms of the phase portrait, fractal dimension, Hurst exponent, and sample entropy. The higher degree of chaoticity in BB relative to VB is unwrapped through the maximal Lyapunov exponent. The principal component analysis helps in classifying VB and BB sound signals through the feature extraction from the power spectral density data. The method proposed in the present work is simple, cost-effective, and sensitive, with a far-reaching potential of addressing and diagnosing the current issue of COVID 19 through lung auscultation.
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http://dx.doi.org/10.1016/j.chaos.2020.110246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444955PMC
November 2020

2H/4H-Chromenes-A Versatile Biologically Attractive Scaffold.

Front Chem 2020 5;8:623. Epub 2020 Aug 5.

School of Chemical Engineering, Yeungnam University, Gyeongsan-si, South Korea.

2H/4H-chromene (2H/4H-ch) is an important class of heterocyclic compounds with versatile biological profiles, a simple structure, and mild adverse effects. Researchers discovered several routes for the synthesis of a variety of 2H/4H-ch analogs that exhibited unusual activities by multiple mechanisms. The direct assessment of activities with the parent 2H/4H-ch derivative enables an orderly analysis of the structure-activity relationship (SAR) among the series. Additionally, 2H/4H-ch have numerous exciting biological activities, such as anticancer, anticonvulsant, antimicrobial, anticholinesterase, antituberculosis, and antidiabetic activities. This review is consequently an endeavor to highlight the diverse synthetic strategies, synthetic mechanism, various biological profiles, and SARs regarding the bioactive heterocycle, 2H/4H-ch. The presented scaffold work compiled in this article will be helpful to the scientific community for designing and developing potent leads of 2H/4H-ch analogs for their promising biological activities.
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http://dx.doi.org/10.3389/fchem.2020.00623DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419998PMC
August 2020

Blunt Chest Wall Trauma and Troponin Elevation: Is It a Cardiac Contusion or a Myocardial Infarction?

Am J Med 2021 02 21;134(2):e113-e114. Epub 2020 Aug 21.

Department of Cardiology, State University of New York Upstate Medical University, Syracuse.

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http://dx.doi.org/10.1016/j.amjmed.2020.06.049DOI Listing
February 2021

Microsurgery for Spetzler-Martin Grade I-III Arteriovenous Malformations: Analysis of Surgical Results and Correlation of Lawton-Young Supplementary Grade and Supplemented Spetzler-Martin Score with Functional Outcome.

World Neurosurg 2020 12 20;144:e227-e236. Epub 2020 Aug 20.

Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India.

Objective: To analyze the results of microsurgery for Spetzler-Martin (SM) grade I-III AVMs and evaluate the correlation of the Lawton-Young (LY) supplementary grade, supplemented Spetzler-Martin (SM-Supp/combined) score with the functional outcome.

Methods: A total of 42 patients with SM grade I-III AVMs who had undergone surgery at our institute during a 3-year period (June 2013 to May 2016) were included in the present study.

Results: All 42 patients had undergone primary surgery without previous embolization. Three patients (7.1%) had died due to surgical site hematoma in the postoperative period. One patient was lost to follow-up. The mean follow-up period for the remaining patients was 27 ± 14 months (range, 12-62 months). At the final follow-up examination of ≥12 months (FFU), 92.7% of the patients had a good outcome (modified Rankin scale [mRS] score ≤1), with an improved or unchanged mRS score in 87.8%. An AVM size >3 cm, diffuse AVM, SM grade III, and SM-Supp score >5 were associated with worsened mRS score at discharge and FFU. Higher LY grade (IV and V), eloquent AVM location, deep venous drainage, age >40 years, and unruptured presentation were not associated with worsened mRS score at both discharge and FFU. Of the 20 ARUBA-eligible patients, 19 (95%) had good outcomes. Postoperative angiograms for 39 patients revealed complete excision of the AVM in 37 (94.9%) and a residual AVM in 2 (5.1%).

Conclusions: High cure rates and excellent clinical outcomes can be expected with microsurgery for most patients with SM grade I-III AVMs. An AVM size >3 cm, diffuse AVM nidus, SM grade III, and SM-Supp score >5 are associated with postoperative worsening of functional scores in patients with SM grade I-III AVMs.
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http://dx.doi.org/10.1016/j.wneu.2020.08.101DOI Listing
December 2020

Refractory Vasospastic Angina and Sudden Cardiac Arrest: Is Implantable Cardioverter Defibrillator Indicated and Is It Always Protective?

Cureus 2020 Aug 8;12(8):e9613. Epub 2020 Aug 8.

Cardiovascular Medicine, State University of New York Upstate Medical University, Syrcause, USA.

Vasospastic angina (VSA) is characterized by episodic chest pain associated with transient ST-segment abnormalities on electrocardiogram, secondary to vasospasm of the epicardial coronary artery. We report the rare case of a 46-year-old female with refractory VSA secondary to multivessel coronary vasospasm causing an anterior myocardial infarction. She succumbed secondary to ventricular tachycardia (VT) storm, in spite of being on maximally tolerated medical therapy and having an implantable cardioverter defibrillator (ICD) for secondary prevention of VT. Contemporary guidelines recommend ICD implantation (class IIa) in VSA patients who survived sudden cardiac arrest (SCA), if they are already on optimal medical therapy or if medical therapy is not tolerated. Whether ICD implantation is appropriate in VSA patients with aborted SCA, even before assessing the response to medical therapy, is not well known and requires further studies.
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http://dx.doi.org/10.7759/cureus.9613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417089PMC
August 2020

Outcome of Microsurgical Clipping for Multiple Versus Single Intracranial Aneurysms: A Single-Institution Retrospective Comparative Cohort Study.

World Neurosurg 2020 11 8;143:e590-e603. Epub 2020 Aug 8.

Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India.

Objective: To evaluate the results of microsurgical clipping for single intracranial aneurysm (SIA) and multiple intracranial aneurysms (MIA) and compare the outcomes.

Methods: All patients who underwent surgery for intracranial aneurysm (IA) at our institution over a 3-year period (June 2013 to May 2016) were included in this study.

Results: A total of 157 patients with 225 IAs were included. Forty-one of these patients had MIA (109 IAs, mean, 2.7 ± 1.2; range, 2-7), and remaining 116 had SIA. In the patients with MIA, all aneurysms were secured during the same admission whenever possible. Depending on the locations of the IAs and condition of brain during surgery (tense/lax), all aneurysms were secured on same day (in a single session, single or multiple craniotomy in 28 patients) or on different days (multiple sessions in 13 patients). Postoperative control angiography (DSA) before discharge could be done for 216 aneurysms (MIA, n = 105; SIA, n = 111). Successful occlusion of the aneurysm from circulation was noted in 96.2% (101/105) of MIA and 93.7% (104/111) of SIA. Follow-up of 6 months or longer was available for 146 patients. A modified Rankin Scale score ≤2 was considered a good outcome. Univariate analysis of the entire group revealed no significant difference in clinical outcomes between patients with SIA and MIA both at discharge (good outcome: MIA, 82.9%; SIA, 93.1%; P = 0.068) and at a final follow-up of ≥6 months (good outcome: MIA, 87.2%; SIA, 94.4%; P = 0.164). Clipping for MIA was not associated with poor outcome in multivariate analysis.

Conclusions: Comparable clinical outcomes and high rates of complete aneurysm occlusion following microsurgical clipping can be expected in patients with SIA and patients with MIA.
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http://dx.doi.org/10.1016/j.wneu.2020.08.019DOI Listing
November 2020

Predicting transition from oral pre-malignancy to malignancy via Bcl-2 immuno-expression: Evidence and lacunae.

J Oral Biol Craniofac Res 2020 Oct-Dec;10(4):397-403. Epub 2020 Jul 19.

DHR-MRU, Faculty of Dental Sciences, King George's Medical University, Lucknow, UP, India.

Bcl-2 (B cell Lymphoma -2) family comprises of both anti-apoptotic and pro-apoptotic proteins whose altered expression or change in ratio inhibits apoptosis, and promotes tumor progression. The aim of this study is to assess the usefulness of Bcl-2 in distinguishing dysplastic or malignant epithelium from non-dysplastic or normal epithelium to aid in prediction of malignant transformation potential.

Material And Method: Study group comprised of 30 cases of clinically diagnosed leukoplakia (OPMD), 15 cases of Oral Squamous Cell Carcinoma (OSCC) and 5 normal tissue samples. The labeling index of Bcl-2 was analyzed in immunohistochemically stained sections. Different statistical tools were used to analyze the data and to compare Bcl-2 expression qualitatively and quantitatively among all the groups.

Results: An increasing trend of Bcl-2 immunoexpression was observed from normal epithelium to non-dysplastic and from non-dysplastic to dysplastic lesions. In OSCC, the peripheral cells in the differentiating epithelial islands (within the connective tissue) showed Bcl-2 immuno-reactivity, which gradually decreased towards the center. In contrast, intense and diffuse Bcl-2 immuno-reactivity was seen in poorly differentiated carcinoma. But the overall Bcl-2 positivity was less in OSCC as compared to dysplastic lesions.

Conclusion: Increased expression of Bcl-2 oncoprotein in sequentially progressing epithelial dysplasia and down-regulation in differentiating carcinoma (well and moderately differentiating OSCC) unveils the clinical relevance of Bcl-2 in early stages of OSCC tumorigenesis. The heterogenous expression of Bcl-2 in carcinoma with different grades of differentiation renders them unable to be used as an independent tool for predicting transition from oral pre-malignancy to malignancy.
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http://dx.doi.org/10.1016/j.jobcr.2020.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394759PMC
July 2020

Downscaling of sample entropy of nanofluids by carbon allotropes: A thermal lens study.

Chaos 2020 Jul;30(7):073116

Department of Optoelectronics, University of Kerala, Trivandrum, Kerala 695581, India.

The work reported in this paper is the first attempt to delineate the molecular or particle dynamics from the thermal lens signal of carbon allotropic nanofluids (CANs), employing time series and fractal analyses. The nanofluids of multi-walled carbon nanotubes and graphene are prepared in base fluid, coconut oil, at low volume fraction and are subjected to thermal lens study. We have studied the thermal diffusivity and refractive index variations of the medium by analyzing the thermal lens (TL) signal. By segmenting the TL signal, the complex dynamics involved during its evolution is investigated through the phase portrait, fractal dimension, Hurst exponent, and sample entropy using time series and fractal analyses. The study also explains how the increase of the photothermal energy turns a system into stochastic and anti-persistent. The sample entropy (S) and refractive index analyses of the TL signal by segmenting into five regions reveal the evolution of S with the increase of enthalpy. The lowering of S in CAN along with its thermal diffusivity (50%-57% below) as a result of heat-trapping suggests the technique of downscaling sample entropy of the base fluid using carbon allotropes and thereby opening a novel method of improving the efficiency of thermal systems.
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http://dx.doi.org/10.1063/5.0009756DOI Listing
July 2020

Grafting modification of okra mucilage: Recent findings, applications, and future directions.

Carbohydr Polym 2020 Oct 17;246:116653. Epub 2020 Jun 17.

School of Chemical Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan, 38541, Republic of Korea. Electronic address:

Okra polysaccharides are biocompatible polymers with antimicrobial, anticancer, hypoglycemic, and antioxidant characteristics and hence are used in different fields such as drug delivery, food industry, and wastewater treatment. Consequently, okra-polymer modification by different methods, such as grafting, to satisfy industrial demands is attracting much scientific attention. Although a large body of literature is available on the extraction of okra polysaccharides and their applications, little is known about their grafting modification. While crosslinking and binary grafting can help in the realization of the desired properties, these methods have not been widely used on okra polysaccharides. In this review, we highlight the different methods used for the extraction of okra polysaccharides and systematically summarize major findings on their grafting modification and applications in different industries. This information will help in designing experimental protocols for the modification of okra polysaccharides to suit future needs.
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http://dx.doi.org/10.1016/j.carbpol.2020.116653DOI Listing
October 2020

Saphenous vein graft aneurysm - Unusual cause of hemoptysis: A case report and review of literature.

J Postgrad Med 2020 Jul-Sep;66(3):165-168

Department of Radiology and Imaging Services, Narayana Health City, Bengaluru, India.

Hemoptysis due to saphenous venous graft (SVG) aneurysm is an extremely rare condition and published literature has described the role of conservative management, surgical resection, and covered stent. Here, we report a successful placement of a covered stent for SVG aneurysm in a 56-year-old male who presented with hemoptysis. He was a known diabetic and had undergone a coronary artery bypass grafting 5 years ago. Computed tomography (CT) chest and fiberoptic bronchoscopy performed in another local hospital had revealed blood in the left lingula with spillover into the left lung parenchyma. Hence, he had received empirical anti-tuberculosis medication for 2 months without any improvement. He was referred to our hospital for further management of hemoptysis. Multidetector CT (MDCT) angiography of the chest covering coronaries performed at our hospital revealed SVG aneurysm that was managed with covered stent placement.
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http://dx.doi.org/10.4103/jpgm.JPGM_187_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542063PMC
November 2020

Right Coronary Artery Pseudoaneurysm With Hemopericardium: A Rare Complication of Percutaneous Coronary Intervention.

Cureus 2020 Jun 11;12(6):e8567. Epub 2020 Jun 11.

Pulmonary and Critical Care, Stony Brook Medical University, Stony Brook, USA.

While percutaneous coronary intervention (PCI) is a commonly performed procedure, it still has many serious complications. Coronary artery pseudoaneurysms can form after PCI and can progress to cardiac tamponade. We report the case of an 80-year-old male who presented for an inferior wall ST elevation myocardial infarction, had drug-eluting stents placed to the right coronary artery (RCA), and subsequently suffered a RCA pseudoaneurysm with hemopericardium. He eventually underwent pseudoaneurysm repair with off pump coronary artery bypass graft. There is no established treatment protocol, and involvement of a multidisciplinary team improves outcomes.
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http://dx.doi.org/10.7759/cureus.8567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358945PMC
June 2020

Nerolidol Mitigates Colonic Inflammation: An Experimental Study Using both In Vivo and In Vitro Models.

Nutrients 2020 Jul 8;12(7). Epub 2020 Jul 8.

Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 17666, UAE.

Nerolidol (NED) is a naturally occurring sesquiterpene alcohol present in various plants with potent anti-inflammatory effects. In the current study, we investigated NED as a putative anti-inflammatory compound in an experimental model of colonic inflammation. C57BL/6J male black mice (C57BL/6J) were administered 3% dextran sodium sulfate (DSS) in drinking water for 7 days to induce colitis. Six groups received either vehicle alone or DSS alone or DSS with oral NED (50, 100, and 150 mg/kg body weight/day by oral gavage) or DSS with sulfasalazine. Disease activity index (DAI), colonic histology, and biochemical parameters were measured. TNF-α-treated HT-29 cells were used as in vitro model of colonic inflammation to study NED (25 µM and 50 µM). NED significantly decreased the DAI and reduced the inflammation-associated changes in colon length as well as macroscopic and microscopic architecture of the colon. Changes in tissue Myeloperoxidase (MPO) concentrations, neutrophil and macrophage mRNA expression (CXCL2 and CCL2), and proinflammatory cytokine content (IL-1β, IL-6, and TNF-α) both at the protein and mRNA level were significantly reduced by NED. The increase in content of the proinflammatory enzymes, COX-2 and iNOS induced by DSS were also significantly inhibited by NED along with tissue nitrate levels. NED promoted Nrf2 nuclear translocation dose dependently. NED significantly increased antioxidant enzymes activity (Superoxide dismutase (SOD) and Catalase (CAT)), Hemeoxygenase-1 (HO-1), and SOD3 mRNA levels. NED treatment in TNF-α-challenged HT-29 cells significantly decreased proinflammatory chemokines (CXCL1, IL-8, CCL2) and COX-2 mRNA levels. NED supplementation attenuates colon inflammation through its potent antioxidant and anti-inflammatory activity both in in vivo and in vitro models of colonic inflammation.
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http://dx.doi.org/10.3390/nu12072032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400891PMC
July 2020

Carbon monoxide poisoning and its effect on QTc prolongation.

J Cardiol Cases 2020 Jul 4;22(1):19-21. Epub 2020 May 4.

State University of New York (SUNY) Upstate Medical University, Syracuse, NY, USA.

Carbon monoxide (CO) poisoning has been associated with direct toxicity to the cardiovascular system by causing arrhythmias through prolongation of QTc. It has been reported to have arrhythmogenic potential likely due to its action on the cardiac membranes. We present a case of a 69-year-old man who presented to the emergency department for evaluation of a syncopal episode after exposure to CO. His carboxyhemoglobin level was elevated at 10.5% on admission, electrocardiogram revealed QTc interval of 622 msec. He was treated with hyperbaric oxygen and a repeat electrocardiogram 15 h after hyperbaric oxygen initiation showed improvement in QTc to 490 msec and his carboxyhemoglobin level decreased to 1.8%. There is a direct association between acute CO poisoning and QTc prolongation as reported in patient cases and evidence of it was seen by investigators who worked on rats and found that this phenomenon occurs due to the action of nitric oxide on the late Na + channels affecting repolarization. The resolution after hyperbaric oxygen could be due to decrease in the CO concentration and the absence of nitric oxide synthase activation further propagating the QT prolongation, however, further research would have to be performed to consolidate this.
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http://dx.doi.org/10.1016/j.jccase.2020.03.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326656PMC
July 2020

Choice of Prophylactic Antibiotic Post Kasai Portoenterostomy.

J Indian Assoc Pediatr Surg 2020 May-Jun;25(3):188. Epub 2020 Apr 11.

Department of Pediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.

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http://dx.doi.org/10.4103/jiaps.JIAPS_119_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302452PMC
April 2020

The Spectrum of Cardiac Anomalies Associated with Heterotaxy: A Single-Center Study of a Large Series Based on Computed Tomography.

Pediatr Cardiol 2020 Oct 18;41(7):1414-1424. Epub 2020 Jun 18.

Departments of Radiodiagnosis, Narayana Institute of Cardiovascular Sciences, Narayana Health City, 258/A, Bommasandra, Hosur Road, Bangalore, 560099, India.

The aim of the study was to identify and correlate the anatomical variants of cardiac structures among patients with heterotaxy. In this retrospective cross-sectional analysis of 13 years duration, 302 patients of congenital heart diseases associated with heterotaxy were studied. All these patients had undergone a meticulous clinical evaluation, echocardiography, and cardiac computed tomography. The mean age of the cohort was 38.4 months, with 180 males and 122 females. The cohort had 184 patients of right isomerism and 118 of left isomerism. More than half of the cohort had abnormal pulmonary veins. Over 75% of the cohort had low pulmonary blood flow. Abnormal relationship of great arteries was seen in nearly 69% of the cohort. Atrio-venticular canal defect was the commonest anatomical variant. Overall, 43% of the cohort had single ventricle physiology, predominantly associated with right isomerism. Heterotaxy forms a difficult anatomical subset to comprehend due to the plethora of possible abnormalities. However, unless the cardiac and visceral anatomy is delineated well, the surgical plan becomes suboptimal and often elusive, leaving tough choices for cardiac surgeon. It is essential to obtain all the possible anatomical information using additional imaging modalities to devise a basis for a comprehensive plan for medical and surgical management. A better understanding of the genetic and molecular factors in the etiology, coupled with the application of state-of-the-art imaging techniques, is likely to add to our knowledge of heterotaxy to bring about improved surgical outcomes and a better quality of life for patients suffering from this complex entity.
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http://dx.doi.org/10.1007/s00246-020-02402-2DOI Listing
October 2020

Balloon venoplasty as primary modality of treatment in children with Budd-Chiari syndrome.

J Pediatr Surg 2020 Oct 23;55(10):2183-2186. Epub 2020 May 23.

Department of Pediatric Surgery, Lilavati Hospital & Research Centre, Mumbai.

Introduction: Budd-Chiari syndrome (BCS) is a rare condition affecting children. It is characterized by occlusion of venous outflow from liver at the level of hepatic veins (HV) or inferior vena cava (IVC). The management of BCS in children revolves around forming new collaterals for venous outflow or by elimination of blockage in the venous outflow tracts. These can be achieved by balloon venoplasty (BV), transjugular intrahepatic portosystemic shunting (TIPSS) or open shunt surgeries.

Aim: The aim of this study is to evaluate the management of BCS in children with balloon venoplasty as primary modality of treatment.

Materials And Methods: This is a retrospective study which includes children diagnosed with BCS managed by balloon venoplasty by a single surgeon at a single institute. Once confirmed, the child was posted for balloon venoplasty and liver biopsy. When venoplasty was successful, child was subsequently heparinized and dose titrated. Routine follow up was mandated and dose adjustments were continued during follow up. In case of unsuccessful venoplasty, depending on the liver biopsy report, shunt procedure or liver transplantation is offered to patients. An algorithm was then designed for management of BCS in children.

Results: A total of 35 children who underwent evaluation of symptoms associated with Budd-Chiari syndrome were included in the study. Of all the children, 14 are alive and symptom free, 9 are deceased and 12 lost to follow up. Hepatic vein was the most common site of obstruction (85%), followed by both IVC and HV (15%). Overall, in 35 children, 26 had a successful balloon venoplasty, in 3 venoplasty was not done (2 spontaneous resolution and 1 died awaiting), in 6 it was unsuccessful (3 technical failures: 1 underwent TIPSS and 2 lost to follow up, 3 clinical failures: portocaval shunt for failed venoplasty).

Conclusion: Budd-Chiari syndrome is a rare condition affecting children. Balloon venoplasty as a primary modality of treatment for BCS is a promising option for management in children. Early and aggressive use of radiological intervention can help achieve recanalization in children.

Type Of Study: Clinical research paper.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1016/j.jpedsurg.2020.05.021DOI Listing
October 2020

Atypical Cardiac Tamponade Manifesting as Left Ventricular Diastolic Collapse: A Case Report.

Cureus 2020 May 10;12(5):e8045. Epub 2020 May 10.

Cardiology, State University of New York Upstate Medical University, Syracuse, USA.

Cardiac tamponade is a medical emergency, the diagnosis of which is predominantly clinical with supportive echocardiographic findings. Echocardiographic findings highly suggestive of cardiac tamponade include chamber collapse, inferior vena cava (IVC) plethora, and respiratory volume/flow variations. The right-sided cardiac chambers are a low-pressure system and are the first to show signs of collapse with high specificity for tamponade. We report the case of a 35-year-old woman who demonstrated left ventricular (LV) diastolic collapse on echocardiogram following a tricuspid valve replacement. Although left-sided chamber collapse with tamponade has been reported with localized pericardial effusions postoperatively, our patient had a large circumferential pericardial effusion. Selective chamber compression can be a presenting sign of postoperative tamponade after cardiac surgery. Our case highlights the importance of recognizing atypical forms of cardiac tamponade to help in early identification and emergent management in such patients.
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http://dx.doi.org/10.7759/cureus.8045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286439PMC
May 2020

Use Chou's 5-steps rule to evaluate protective efficacy induced by antigenic proteins of Mycobacterium tuberculosis encapsulated in chitosan nanoparticles.

Life Sci 2020 Sep 11;256:117961. Epub 2020 Jun 11.

Institute of Biological Sciences, Federal University of Para, Para 66075-000, Brazil. Electronic address:

The study focuses on whether antigenic proteins encapsulated in biopolymeric nanoparticles can augment protective efficacy. Chitosan nanoparticles (ChN) were prepared by ionic gelation method and Culture Filtrate Proteins (CFP) - CFP-10 and CFP-21 of Mycobacterium tuberculosis (Mtb) were encapsulated in ChN. The binding efficiency of nanoparticles with CFP-10 and CFP-21 proteins was confirmed by UV-Spectrophotometer. The efficacy of nanoparticles-encapsulated antigenic proteins administered intraperitoneal against Mtb aerosol infection was evaluated in Balb/c mice. Protection study was done by bacterial counts [CFU]. CFP-10 and CFP-21 proteins primed cells demonstrated a Th1 bias T cell response in an ex vivo assay. ChN-CFP10 and ChN-CFP21 nanoparticles have both protective and therapeutic potential against Mtb. In the group of mice immunized with CHN-CFP-10 the number of colonies reduced significantly from day 15 to day 60. ChN-CFP-21 showed maximum protection in ChN-CFP-21 immunized mice. ChN-CFP-10 and ChN-CFP-21 clearly showed enhanced protection against Mtb.
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http://dx.doi.org/10.1016/j.lfs.2020.117961DOI Listing
September 2020

Pharmacophore generation, Quantitative Structure Activity Relationship (QSAR), and Molecular Dynamic Simulation of newly substituted N-(6-Chloro-3-cyano-4-phenyl-4H-chromen-2-yl)-2-(4-chloro-phenoxy)-acetamide for anticancer activity.

Curr Comput Aided Drug Des 2020 May 25. Epub 2020 May 25.

Gyan Vihar School of Pharmacy, Suresh Gyan vihar University, Jaipur, Rajasthan. India.

Aim And Objective: The main objective of the study was to develop the Quantitative Structure Activity Relationship (QSAR) and pharmacophoric model by using data obtained from HT-29 cells study for the scientific community to develop potent lead molecule.

Materials And Methods: Common pharmacophore model, atom-based 3D-QSAR, and molecular dynamic (MD) simulation were carried out via computational techniques by using 4Hchromene derivatives.

Results: The reliable common pharmacophoric hypothesis, DHH13 was generated and 3.95 survival values were also found. Furthermore, the statistically significant of 3D-QSAR model was developed where we have found the r2=0.52 by using Partial least squares (PLS) regression method. Phase predicted activity and Log GI50 were demonstrated the mainly important atomic position in the backbone structure of ligands in order to ascertain anticolon cancer activity. In addition, MD simulation was carried out between top rank lead with IL-6 target which provided and also defined the better binding conformational and complex stability into the active pocket of target throughout the MD simulation.

Conclusion: The final outcome from this design approach shows that the pharmacophoric model and 3D-QSAR might be helpful in the medicinal chemistry field for the researcher to develop the potential anticolon cancer compounds.
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http://dx.doi.org/10.2174/1573409916666200525150410DOI Listing
May 2020

COVID-19: We All Have a Role.

Authors:
Vishwa S Raj

Arch Phys Med Rehabil 2020 08 25;101(8):1471. Epub 2020 May 25.

Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, NC.

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http://dx.doi.org/10.1016/j.apmr.2020.04.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247503PMC
August 2020

Direct Growth of Light-Emitting III-V Nanowires on Flexible Plastic Substrates.

ACS Nano 2020 Jun 27;14(6):7484-7491. Epub 2020 May 27.

Department of Electronics and Nanoengineering, Micronova, Aalto University, P.O. Box 13500, Espoo FI-00076, Finland.

Semiconductor nanowires are routinely grown on high-priced crystalline substrates as it is extremely challenging to grow directly on plastics and flexible substrates due to high-temperature requirements and substrate preparation. At the same time, plastic substrates can offer many advantages such as extremely low price, light weight, mechanical flexibility, shock and thermal resistance, and biocompatibility. We explore the direct growth of high-quality III-V nanowires on flexible plastic substrates by metal-organic vapor phase epitaxy (MOVPE). We synthesize InAs and InP nanowires on polyimide and show that the fabricated NWs are optically active with strong light emission in the mid-infrared range. We create a monolithic flexible nanowire-based p-n junction device on plastic in just two fabrication steps. Overall, we demonstrate that III-V nanowires can be synthesized directly on flexible plastic substrates inside a MOVPE reactor, and we believe that our results will further advance the development of the nanowire-based flexible electronic devices.
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http://dx.doi.org/10.1021/acsnano.0c03184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315631PMC
June 2020

Adenosine-Induced transient asystole during surgical treatment of basilar artery aneurysms.

Neurol India 2020 Mar-Apr;68(2):419-426

Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India.

Aim: To evaluate the safety and efficacy of adenosine-induced transient asystole (AITA) during surgery for basilar artery aneurysms.

Materials And Methods: All the patients with basilar artery aneurysms operated using AITA at our institute during two years period (August 2013-July 2015) were included in this study.

Results: Adenosine was used in 11 patients with 13 basilar artery aneurysms. Seven of these aneurysms were basilar bifurcation aneurysms, four were basilar-superior cerebellar artery junction aneurysms, and two were distal basilar trunk aneurysms. The indications for AITA were narrow corridor for placement of temporary clip in 11 aneurysms, intraop rupture in 1 aneurysm, and circumferential dissection of a large aneurysm in 1. The mean dose of adenosine used for inducing asystole was 19.4 mg (range: 15-30 mg) and the mean total dose of adenosine used was 40.6 mg (range: 18-90 mg). A mean of 2 (range: 1-5) AITAs were required during surgical treatment of these aneurysms. The mean duration of a systole was 27 s (range: 9-76 s). There were no complications related to AITA in these patients except for transient rebound hypertension in one patient. Check angiogram revealed complete obliteration of 11 aneurysms and small residual neck in 2 aneurysms. Modified Rankin Scale at three months of follow-up was 0 in seven patients, 1 in two patients, 4 in one patient, and 6 in one patient.

Conclusion: AITA during surgical management of basilar artery aneurysms is a safe and effective technique and has an important role during surgery for these aneurysms.
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http://dx.doi.org/10.4103/0028-3886.284353DOI Listing
March 2021

Facile one pot microwave-assisted green synthesis of FeO/Ag nanocomposites by phytoreduction: Potential application as sunlight-driven photocatalyst, antibacterial and anticancer agent.

J Photochem Photobiol B 2020 Jun 24;207:111885. Epub 2020 Apr 24.

Department of Chemistry, PGP College of Arts and science, Namakkal 637 207, Tamil Nadu, India. Electronic address:

Herein, we report a one-pot microwave assisted method to prepare an efficient FeO/Ag nanocomposites (NCs) using Aloe vera (A. vera) gel extract as a mild, safe, renewable and active stabilizer without any harmful reagent. The advanced characterization techniques including XRD, FT-IR, UV-DRS, PL, TGA, SEM-EDX, TEM, DLS, Elemental mapping, VSM and BET were applied to analyze the morphology and structure of the prepared FeO/Ag NCs. The results exhibited that the FeO/Ag NCs was successfully synthesized by greener route. Furthermore, these bio-reduced FeO/Ag NCs was tested for its catalytic degradation toward methylene blue (MB) as a model contaminant and exhibited outstanding photocatalytic degradation efficiency with 88.2% removal rate in 140 min. It was worth pointing out that the FeO/Ag nanoparticles facilitated the charge transportation and inhibit the charge recombination of an electron in the conduction band. Additionally, the prepared FeO/Ag NCs was studied for their in-vitro antibacterial activity against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) bacteria and anticancer properties against A549 cell lines (human lung cancer). The biological results of this study demonstrated that A. vera gel extract derived FeO/Ag NCs showed significant inhibition properties against bacterial strains and also capable of achieving superior action against A549 cancer cell lines.
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http://dx.doi.org/10.1016/j.jphotobiol.2020.111885DOI Listing
June 2020