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1. Glucagon-Like Peptide-1 Receptor Agonist Use is Not Associated With Increased Complications After Total Knee Arthroplasty in Patients With Type-2 Diabetes

Author

Kevin Y. Heo, BS, Rahul K. Goel, MD, Andrew Fuqua, BS, Jeffrey S. Holmes, MD, Brian T. Muffly, MD, Greg A. Erens, MD, Jacob M. Wilson, MD, and Ajay Premkumar, MD, MPH

Subjects
GLP-1 receptor agonist, Glucagon-like Peptide-1 receptor agonist, Complications, Total knee arthroplasty, Diabetes, Orthopedic surgery, RD701-811
Abstract

Background: Glucagon-like peptide-1 (GLP-1) agonists have emerged as a powerful diabetic treatment adjunct; however, its effects on outcomes following total knee arthroplasty (TKA) are not well known. The purpose of this study was to compare the risk of complications after TKA in patients with type-2 diabetes who were on GLP-1 agonists with those who were not. Methods: In total, 34,696 type 2 diabetes patients undergoing primary TKA between 2016 and 2021 were retrospectively reviewed utilizing a large national database. Propensity score matching was employed to match patients on GLP-1 agonists to controls at a 1:1 ratio (n = 2388 each). Multivariable logistic regression was utilized to examine 90-day and 1-year TKA outcomes between cohorts. Results: Controls had higher odds of extended hospital stays (≥3 days) (odds ratio 1.29, P < .001). However, surgical complication rates at 90-days including surgical site infection and prosthetic joint infection were not significantly different. Similarly, no differences were seen in medical complications. There were also no significant differences in rates of all-cause revision TKA and aseptic revision TKA at 1 year postoperatively. Conclusions: This study found that GLP-1 agonist use was not associated with increased medical or surgical complication rates in patients with diabetes undergoing TKA and was associated with lower rates of extended hospital stays after surgery. Given the potential for increased glycemic control and weight loss in patients using GLP-1 agonists, more data are needed to delineate the potential role of GLP-1 agonists in preoperative optimization of patients with diabetes prior to joint arthroplasty to minimize postoperative complications.

Published
2024
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2. Robotic Total Hip Arthroplasty for Traumatic Acetabular Fracture Using an Image-free Second-Generation System

Author

Justin Leal, BS, David N. Kugelman, MD, Rahul K. Goel, MD, Niall H. Cochrane, MD, and Thorsten M. Seyler, MD, PhD

Subjects
Robotics, Navigation, Total hip arthroplasty, Acetabular fracture, Orthopedic surgery, RD701-811
Abstract

Complex traumatic acetabular fractures with concomitant hip dislocations are an orthopaedic emergency often requiring open reduction and internal fixation; however, total hip arthroplasty (THA) for acute acetabular fractures may be indicated in certain scenarios. This study reports the case of a 65-year-old male who had a motor vehicle collision that resulted in acetabular fracture dislocation with concomitant femoral head fracture. The patient underwent acute image-free robotic THA. At 6-month follow-up, the patient had good pain management and was doing well after surgery. With the reported technique using a reamer basket, an image-free robotic system can be used in acute THA in patients to achieve appropriate cup positioning.

Published
2024
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3. Mechanical Failure of Modular Rotating Hinge Femoral Component

Author

Justin Leal, BS, Rahul K. Goel, MD, Michael P. Bolognesi, MD, Samuel S. Wellman, MD, Thorsten M. Seyler, MD, PhD, and Sean P. Ryan, MD

Subjects
Revision total knee arthroplasty, Modular rotating hinge, Femoral component, Mechanical failure, Stress radiographs, Orthopedic surgery, RD701-811
Abstract

Hinge constructs can be used in revision total knee arthroplasty in cases of major collateral ligament deficiency, global knee instability, repeated failure of constrained implants, or large bone defects. Although the success of this construct in revision total knee arthroplasty varies depending on the type of surgery and bone quality, hinged implants can solve a wide array of complex problems while preserving stable flexion-extension motion for ambulation. The most common reasons for re-revision include patellofemoral complications, aseptic loosening, and infection. Most cases of mechanical failure for these hinged constructs occur at the hinge component. Here, we report the first instance of catastrophic femoral component failure in a modular rotating hinge via a low-energy mechanism.

Published
2024
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6. Acromegaly: Cardiovascular risk factors, cardiovascular manifestations and early vascular alterations in relation to disease activity

Author

Sudeep Kumar, Satyendra Tewari, Sushil Gupta, Aditya Kapoor, Pravin K. Goel, Mullusoge Mariappa Harsha, Roopali Khanna, and Naveen Garg

Subjects
Vascular Alterations, medicine.medical_specialty, Flow mediated dilatation, RD1-811, Cardiovascular risk factors, 030204 cardiovascular system & hematology, Growth hormone, Research Brief, Carotid Intima-Media Thickness, Disease activity, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Lv dysfunction, Internal medicine, Acromegaly, Medicine, Diseases of the circulatory (Cardiovascular) system, Humans, 030212 general & internal medicine, cardiovascular diseases, Ejection fraction, business.industry, CIMT, medicine.disease, Intima-media thickness, Cardiovascular Diseases, Heart Disease Risk Factors, RC666-701, Cardiology, cardiovascular system, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract

Acromegaly is associated with increased cardiovascular morbidity and mortality. 49 acromegaly patients were evaluated for presence of cardiovascular risk factors and manifestations using 2D-Echocardiography, strain, strain-rate, carotid intima media thickness (CIMT) and flow mediated dilatation (FMD) and correlated with disease activity. 32 patients with growth hormone (GH) level >1 ng/ml were considered active. Patients with active disease have more LV dysfunction as assessed by strain(p-0.031) and strain rate(p-0.001); trend towards lower ejection fraction(p-0.11) with significant correlation to GH(cc −0.252,p-0.05). Patient with active disease have reduced FMD(p- 0.042); with no difference in prevalence of cardiovascular risk factors and CIMT inrelation to disease activity.

Published
2021

7. A pilot study on the acute conversion and maintenance of sinus rhythm in rheumatic atrial fibrillation using oral flecainide

Author

Sudeep Kumar, Pravin K. Goel, Ankit Kumar Sahu, Anindya Ghosh, Roopali Khanna, Satyendra Tewari, Naveen Garg, and Aditya Kapoor

Subjects
Adult, Male, medicine.medical_specialty, Heart disease, RD1-811, medicine.medical_treatment, Population, Administration, Oral, Pilot Projects, 030204 cardiovascular system & hematology, Cardioversion, Amiodarone, Loading dose, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, Heart Rate, Internal medicine, medicine, Diseases of the circulatory (Cardiovascular) system, Humans, Sinus rhythm, 030212 general & internal medicine, Prospective Studies, education, Flecainide, Aged, Voltage-Gated Sodium Channel Blockers, education.field_of_study, business.industry, Rheumatic Heart Disease, Atrial fibrillation, Middle Aged, medicine.disease, Treatment Outcome, RC666-701, Cardiology, Surgery, Original Article, Female, Cardiology and Cardiovascular Medicine, business, medicine.drug, Follow-Up Studies
Abstract

Background: Achievement of sinus rhythm (SR) is an important goal in rheumatic atrial fibrillation (AF). Studies in rheumatic AF have often used amiodarone for rhythm control. Flecainide has not been studied in these patients due to concerns of underlying structural heart disease. Methods: Pharmacological cardioversion by oral single loading dose (SLD) of Flecainide (4 mg/kg, ≤300 mg) was tested in 50 patients with rheumatic AF (MVA 1.51 ± 0.19 mm2, age 46.2 ± 10.28 yrs, AF duration 3.10 ± 1.7 yrs, LA size: 44.42 ± 7.48 mm). Non-converters underwent DC cardioversion (DCC) at 24 h. All patients received oral flecainide and ββ/diltiazem at discharge. Results: At 24 h, 38/50 (76%) achieved SR (2 with SLD; 36 after DCC). At 30 days (mean Flecainide dose 116.5 ± 10.5 mg) successful maintenance of SR was noted in 31/38 (89%). At 1 year, 30/38 (79%) of the initial converters and 60% of the overall population maintained SR. Those in SR had significantly better NYHA Class (1.1 ± 0.12 vs 1.3 ± 0.10, p = 0.03) and mean PCS8 score (50.11 ± 5.337 vs 46.84 ± 5.379, p = 0.02). AF duration (OR 0.594 CI 0.375–0.940, p = 0.02) and LA size (OR 0.840, CI 0.757–0.933, p = 0.001) were found to be the only significant predictors of successful outcomes. Patients with AF duration

Published
2020

8. Etiology and distribution of isolated aortic stenosis in Indian patients – A study from a large tertiary care hospital in north India

Author

Ankit Kumar Sahu, Roopali Khanna, Naveen Garg, Aditya Kapoor, Sudeep Kumar, Pravin K. Goel, Pramod Sagar, and Satyendra Tewari

Subjects
Adult, Male, Aortic valve, medicine.medical_specialty, Adolescent, RD1-811, India, Context (language use), Regurgitation (circulation), 030204 cardiovascular system & hematology, Acquired degenerative aortic stenosis, Tertiary Care Centers, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Bicuspid aortic valve, Mitral valve, Internal medicine, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, 030212 general & internal medicine, Child, Aged, Retrospective Studies, Isolated aortic valve stenosis, Aged, 80 and over, business.industry, Incidence, valvular heart disease, Aortic Valve Stenosis, Middle Aged, medicine.disease, Transcatheter aortic valve replacement, Valvular heart disease, Stenosis, medicine.anatomical_structure, Echocardiography, Aortic Valve, RC666-701, Etiology, Cardiology, cardiovascular system, Female, Original Article, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract

Background Isolated aortic valve disease (IAVD) has traditionally been a disease of elderly, etiology being either senile degeneration of a tricuspid aortic valve or calcification of a bicuspid aortic valve. However, there is scarcity of Indian data regarding demographic distribution and etiological patterns of IAVD in context of emerging therapies like transcatheter aortic valve implantation (TAVR). Methods & results A retrospective observational analysis of 60,560 echocardiograms over three years revealed 3728 newly diagnosed cases of valvular heart disease (VHD). Isolated mitral valve disease (IMVD) constituted 48.7% (n = 1815) of all VHD, including 1104 (29.6%) cases of pure mitral stenosis (MS) which was the commonest single lesion followed by combined mitral and aortic valve disease (CMAVD) (n = 1320, 34.5%), mixed aortic valve disease (MAVD) (n = 349, 9.4%), isolated aortic stenosis (IAS) (n = 179, 4.8%) and isolated aortic regurgitation (IAR) (n = 75, 2.0%). IAS patients had bimodal age distribution with peaks in first and sixth decade, contributed by congenital and acquired IAS respectively. Acquired IAS comprised of degenerative tricuspid aortic valve (n = 79, 58.1%; mean age: 63.2 ± 8.8 years), bicuspid aortic valve (BAV) (n = 34, 25.0%; mean age: 36.0 ± 8.3 years), rheumatic (n = 4, 2.9%; mean age: 55.3 ± 3.4 years) and non-rheumatic IAS with unclear morphology (n = 19, 14%; mean age: 48.5 ± 9.3 years). 65.6% patients with acquired non-rheumatic isolated aortic stenosis were less than 60 years of age. Conclusion In Indian population, senile valvular degeneration is the commonest cause of acquired IAS with majority of them presenting before 60 years of age, thereby bereaving them with the option of TAVR as a treatment modality., Highlights • Study predicts and deliberates over limited penetration of TAVR in Indian population. • Among acquired IAS, senile degeneration and bicuspid valve calcification is common. • Lower age of patients with acquired IAS becomes major hindrance to advocate TAVI.

Published
2020

9. Immediate and long-term outcomes of balloon mitral valvotomy in pregnancy

Author

Sudeep Kumar, Pravin K. Goel, Ankit Kumar Sahu, Satyendra Tewari, Krishnarpan Chatterjee, Aditya Kapoor, Naveen Garg, and Roopali Khanna

Subjects
Adult, Balloon Valvuloplasty, medicine.medical_specialty, Cardiac Catheterization, Time Factors, RD1-811, Adolescent, Pregnancy Complications, Cardiovascular, Diastole, 030204 cardiovascular system & hematology, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Restenosis, Pregnancy, Internal medicine, medicine, Balloon mitral valvotomy, Diseases of the circulatory (Cardiovascular) system, Humans, Mitral Valve Stenosis, 030212 general & internal medicine, Survival analysis, Retrospective Studies, Fetus, Mitral stenosis, business.industry, Gestational age, medicine.disease, Stenosis, Treatment Outcome, Echocardiography, RC666-701, Cardiology, Mitral Valve, Surgery, Maternal death, Original Article, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Objectives: To study the immediate maternal and fetal outcomes and long term maternal outcomes in pregnant women undergoing balloon mitral valvotomy. Methods: We retrospectively analyzed balloon mitral valvotomy during pregnancy performed between January 2008 and July 2018. Results: BMV was carried out in 97 pregnant women with mean age of 26.1 ± 4.5 years, at mean gestational age of 23.1 ± 4.6 weeks. The procedure was successful in 95 patients (97.9%). There was one maternal death post procedure due to intra-uterine death and disseminated intravascular coagulation. Adverse immediate fetal outcome was seen in 2 cases with one intra-uterine fetal demise and one preterm labour. Mitral valve area increased from mean of 0.82 ± 0.12 cm to 1.66 ± 0.14 cm (p

Published
2020

10. Procedural and short-term clinical outcomes post-PCI using newer generation ultrathin sirolimus-eluting stent with biodegradable polymer coating in real-world population

Author

Roopali Khanna, Pravin K. Goel, and Ankit Kumar Sahu

Subjects
medicine.medical_specialty, RD1-811, business.industry, medicine.medical_treatment, Stent, engineering.material, Biodegradable polymer, Surgery, Term (time), Coating, Sirolimus, RC666-701, Conventional PCI, medicine, engineering, Diseases of the circulatory (Cardiovascular) system, Cardiology and Cardiovascular Medicine, business, medicine.drug
Published
2021

11. Efficacy of RADPAD protection drape in reducing radiation exposure in the catheterization laboratory—First Indian study

Author

Pujan J Shah, Aditya Kapoor, Pravin K. Goel, and Roopali Khanna

Subjects
Male, Cardiac Catheterization, medicine.medical_treatment, LM, left main artery, Left anterior oblique, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Percutaneous coronary intervention, 0302 clinical medicine, Clinical endpoint, Medicine, Fluoroscopy, 030212 general & internal medicine, medicine.diagnostic_test, Incidence, rem, roentgen equivalent man, Equipment Design, Middle Aged, Interventional Cardiology, Surgery, Computer-Assisted, Left main artery, Female, Cardiology and Cardiovascular Medicine, Roentgen equivalent man, RD1-811, India, cath lab, catheterisation laboratory, 03 medical and health sciences, Gy, grey, Radiation Protection, Diseases of the circulatory (Cardiovascular) system, Humans, Radiation Injuries, Retrospective Studies, PCI, percutaneous coronary intervention, business.industry, Protective Devices, Radiation dose, Radiation exposure, Chronic total occlusion, LAO, left anterior oblique, CTO, chronic total occlusion, RC666-701, Conventional PCI, Surgery, Radiation protection, business, Nuclear medicine, Follow-Up Studies
Abstract

Background: Occupational radiation exposureis a growing problem due to increasing number and complexity of interventional procedures.The RADPAD is a lead-free sterile drape containing bismuth and barium that reduces scatter radiation during fluoroscopic procedures. We aimed to study the radiation exposure reduction to operators with the use of RADPAD and also measureradiation doses in different angiographic projections. Methods: 65 randomly selected patients undergoing elective complex percutaneous coronary intervention (PCI) procedures from January 2017 to 2017 were randomized in a 1:1 pattern with or without the RADPAD. Primary endpoint was the ratio of operator received dose in mrem to total radiation in Gyat the end of the procedure which was designated ‘’Relative operator exposure’’, with or without RADPAD. Results: Despite similar fluoroscopy times (20.4 ± 9.4 min with RADPAD vs. 19.4 ± 9.2 min without RADPAD, P = 0.871) and total radiation dose (3.4 ± 4.3 Gy with RADPAD vs. 2.3 ± 1.4 Gy, P = 0.198), the relative operator exposure was significantly less with RADPAD (1.39 ± 0.95) as compared to no RADPAD group (2.27 ± 1.4) (p = 0.004) amounting to a 39% reduction. Additionally mean radiation dose per shoot of recorded Left anterior oblique (LAO) oriented projections was 34.4 ± 15.7mGyvs 24.9 ± 12.9 mGy for a non LAO oriented projection. (p

Published
2018

12. Heart rate manipulation in dilated cardiomyopathy: Assessing the role of Ivabradine

Author

Sudeep Kumar, Archana Sinha, Deep Chandh Raja, Aditya Kapoor, Satyendra Tewari, Roopali Khanna, Pravin K. Goel, Shiridhar Kashyap, and Naveen Garg

Subjects
Male, 030213 general clinical medicine, Dilated cardiomyopathy, 030204 cardiovascular system & hematology, Ventricular Function, Left, 0302 clinical medicine, Ivabradine, Ejection fraction, Middle Aged, Global strain, Treatment Outcome, Walk test, Echocardiography, Cardiology, Drug Therapy, Combination, Female, Cardiology and Cardiovascular Medicine, medicine.drug, Cardiomyopathy, Dilated, medicine.medical_specialty, RD1-811, Heart Ventricles, Heart rate, Adrenergic beta-Antagonists, Cyclic Nucleotide-Gated Cation Channels, Heart failure, Nyha class, 03 medical and health sciences, Internal medicine, medicine, Diseases of the circulatory (Cardiovascular) system, Humans, cardiovascular diseases, Beta blocker, Retrospective Studies, Dose-Response Relationship, Drug, business.industry, Cardiovascular Agents, Stroke Volume, Benzazepines, medicine.disease, RC666-701, Quality of Life, Surgery, Clinical and Preventive Cardiology, business, Follow-Up Studies
Abstract

Background: Heart rate (HR) reduction is of benefit in chronic heart failure (HF). The effect of heart rate reduction using Ivabradine on various echocardiographic parameters in dilated cardiomyopathy has been less investigated. Methods: Of 187 patients with HF (DCM, NYHA II–IV, baseline HR > 70/min), 125 patients were randomized to standard therapy (beta blockers, ACEI, diuretics, n = 62) or add-on Ivabradine (titrated to maximum 7.5 mg BD, n = 63). Beta-blockers were titrated in both the groups. Results: At 3 months both groups had improvement in NYHA class, 6 min walk test, Minnesota Living With Heart Failure (MLWHF) scores and fall in BNP, however the magnitude of change was greater in Ivabradine group. Those on Ivabradine also had lower LV volumes, higher LVEF (28.8 ± 3.6 vs 27.2 ± 0.5, p = 0.01) and more favorable LV global strain (11 ± 1.7vs 12.2 ± 1.1, p =

Published
2017

14. Analogy and metareasoning: Cognitive strategies for robot learning

Author

Tesca Fitzgerald, Priyam Parashar, and Ashok K. Goel

Subjects
Analogical reasoning, Cognitive science, Computer science, Novelty, Robot, Analogy, Context (language use), Cognition, Robot learning
Abstract

Robots share a conundrum central to all intelligence. Like humans, robots not only must address novel situations but also must start from what they already know: how, then, can any robot deal with novelty? In this chapter, we examine two cognitive strategies for addressing novelty: analogy and metareasoning. Analogy addresses new problems in a manner similar to a familiar problem; the familiar problem is part of the context of addressing the new problem. We show how a cognitive robot may use analogy to learn from a small number of initial demonstrations. However, analogical reasoning and reasoning more generally do not necessarily guarantee success in an open, dynamic world. This brings metareasoning into play. We show how a cognitive robot may use metareasoning to recover and learn from failure; here, failure forms part of the context for metareasoning. In the other direction, we discuss how these experiments in robot learning inform the development of cognitive theories of analogy and metareasoning.

Published
2020
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15. Contributors

Author

Olivier Bartheye, Jonathan Barzilai, Tyler Bath, Genevieve Bell, Caitlin M. Bentley, Derek Brock, Daniel J. Brooks, Sophie Brusniak, Beth Cardier, Niccolo Casas, Laurent Chaudron, Shu-Heng Chen, Richard Ciavarra, Michael Crowell, Dalton J. Curtin, Katherine A. Daniell, Noel Derwort, Saikou Diallo, Zac Hatfield Dodds, Sheng Dong, Tesca Fitzgerald, Hesham Fouad, Boris Galitsky, Ashok K. Goel, H.T. Goranson, Ariel M. Greenberg, Brian Jalaian, Joseph Knierman, James T. Kuczynski, William F. Lawless, Kobi Leins, John Licato, James Llinas, Patrick Lundberg, Amy K. McLennan, D. Douglas Miller, Ranjeev Mittu, Ira S. Moskowitz, Ehsan Nabavi, Alex Nielsen, Walt Panfil, Priyam Parashar, Sooyoung Park, Ryan Quandt, Ali K. Raz, Joshua J. Rodriguez, Stephen Russell, Geoffrey W. Rutledge, Larry D. Sanford, Mitchell Schmidt, Michael Scott, John Shull, Donald A. Sofge, Aaron Steinfeld, Adit Suvarna, Lisa Troyer, Elizabeth T. Williams, Michael Wollowski, Elena A. Wood, Joseph C. Wood, and Holly A. Yanco

Published
2020
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16. Pigtail assisted tracking of guide catheter for navigating the difficult radial: Overcoming the 'razor effect'

Author

Naveen Garg, Praveen K. Goel, and Dhabaleswar Sahoo

Subjects
Coronary angiography, Pigtail, medicine.medical_specialty, RD1-811, Successful completion, 030204 cardiovascular system & hematology, Tracking (particle physics), 03 medical and health sciences, Transradial angioplasty, 0302 clinical medicine, medicine.artery, Research Letter, Medicine, Diseases of the circulatory (Cardiovascular) system, Computer vision, 030212 general & internal medicine, Radial artery, Radial artery loop, Guide catheter, business.industry, Tortuous radial artery, food and beverages, Catheter, RC666-701, Radial artery spasm, Surgery, Artificial intelligence, Radiology, Cardiology and Cardiovascular Medicine, business
Abstract

During transradial procedures, sharp edge of the guide catheter tip may act like a “razor-blade” and can prevent the catheter navigation. It is especially common with radial artery loop, tortuous radial artery and radial artery spasm. We describe a cost effective and easy technique which overcomes this “razor-blade” effect and helps in tracking the guide catheter in complex radial anatomy for the easy and successful completion of procedure.

Published
2016

17. Left main PCI: An observational analysis from large single-centre experience

Author

Roopali Khanna, Chandra M. Pandey, Pravin K. Goel, and Suman Jatain

Subjects
Male, medicine.medical_specialty, RD1-811, medicine.medical_treatment, Observational analysis, India, Coronary artery bypass grafting, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, Percutaneous intervention, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Risk Factors, Internal medicine, medicine, Clinical endpoint, Left main, Humans, Diseases of the circulatory (Cardiovascular) system, 030212 general & internal medicine, Myocardial infarction, Survival rate, Drug-eluting stents, business.industry, Percutaneous coronary intervention, Middle Aged, medicine.disease, Coronary Vessels, Indian subcontinent, Survival Rate, Single centre, Treatment Outcome, RC666-701, Conventional PCI, Cardiology, Original Article, Female, Surgery, business, Cardiology and Cardiovascular Medicine, Forecasting
Abstract

Background Although trials have shown efficacy of unprotected left main percutaneous coronary intervention (uLMPCI), data from Indian subcontinent are lacking. Hence, we planned this observational analysis of single-center uLMPCI data. Objectives To study long-term outcome after uLMPCI and identify predictors of adverse outcome. Methods Case details of 62 consecutive patients of uLMPCI between 2006 and 2013 were retrieved from a computerized database wherein detailed records were maintained. Results Mean follow-up duration was 669.8 ± 404.2 days. Procedural success rate was 98.4%. Primary endpoint was composite of major adverse cardiovascular and cerebrovascular events (MACCE), which included cardiac death (CD), cerebrovascular accident (CVA), myocardial infarction (MI), and need for repeat intervention (RI) at three years. MACCE occurred in 13 (20.9%) patients. Cardiac death (CD), (including possible stent thrombosis), RI, and CVA occurred in 6 (9.7%), 5 (8%), and 2 (3.2%) patients, respectively. Overall three-year MACCE-free survival rate was 76.7%. Event-free survival rate was similar among patients who underwent uLMPCI alone and patients who underwent uLMPCI along with additional one-vessel PCI [(88.9% vs 81.8%), p = 0.492], while survival rate was lower in patients who underwent uLMPCI along with PCI of additional two or more vessels (40%, p = 0.036). Patients with syntax score ≤32 had higher event-free survival rate than those with syntax score >32 [(87.1% vs 33.3%), p = 0.001]. Syntax score >32 was the only independent predictor of adverse outcome. Conclusion uLMPCI is safe and effective alternative to CABG for LM alone and LM plus single-vessel disease with syntax score ≤32.

Published
2016

18. Pharmacodynamic evaluation of clopidogrel reloading vs. switching to prasugrel or ticagrelor in clopidogrel resistant Indian patients

Author

Sandeep Khasa, Fauzia Ashfaq, Roopali Khanna, and Pravin K. Goel

Subjects
medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, Prasugrel, medicine.medical_treatment, 030204 cardiovascular system & hematology, ADP-LTA — adenosine diphosphate light transmission aggregometry, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, MPA — maximum platelet aggregation, Platelet, In patient, 030212 general & internal medicine, cardiovascular diseases, PCI — percutaneous coronary intervention, business.industry, Percutaneous coronary intervention, Clopidogrel, lcsh:RC666-701, Pharmacodynamics, Anesthesia, Conventional PCI, Cardiology, HTPR — high on treatment platelet reactivity, Cardiology and Cardiovascular Medicine, business, Ticagrelor, medicine.drug, circulatory and respiratory physiology
Abstract

Objectives To compare the pharmacodynamic effects of clopidogrel reloading vs. switching to prasugrel or ticagrelor in high on treatment platelet reactivity (HTPR) patients undergoing percutaneous coronary intervention (PCI). Methods Prospective, single-centre study wherein consecutive patients undergoing nonemergent PCI showing HTPR on 600 mg clopidogrel loading were randomized to either clopidogrel reloading (300 mg load, 75 mg OD) or prasugrel (60 mg load, 10 mg OD-in patients > 60 kg) or ticagrelor (180 mg load, 90 mg BD). HTPR is defined as maximum platelet aggregation (MPA) > 46% assessed by 5 μmol/L adenosine diphosphate light transmission aggregometry (ADP-LTA) assay after more than 6 h of clopidogrel loading. Platelet function were assessed at baseline, 6 h or more after clopidogrel loading, 2 h after reloading, day 1 and day 30 post-PCI. Results 107 patients enrolled in the study, 32 (29.9%) were found to have HTPR. 10 (9.3%) patients were reloaded with clopidogrel, 10 (9.3%) with prasugrel and 12 (11.2%) with ticagrelor. Mean MPA in clopidogrel, prasugrel and ticagrelor reloaded patients was 42.6 ± 12.5%, 15.8 ± 8.6% and 14.6 ± 7.2% respectively at 2 h after reloading and was 43.7 ± 13.5%, 15.4 ± 5.6% and 12.6 ± 4.6% on day 1 post-PCI. The MPA significantly reduced in prasugrel and ticagrelor cases and not in clopidogrel, also prasugrel and ticagrelor had almost similar MPA after the reload. There was no patient with continued HTPR with ticagrelor or prasugrel while 50% (5/10) of clopidogrel reloaded patients had HTPR. The pharmacodynamic efficacy of maintenance with prasugrel or ticagrelor was better than clopidogrel (MPA at day 30 post-PCI; 15 ± 9.7%, 13.9 ± 5.1% and 50.4 ± 13.1% respectively). Conclusion In patients undergoing PCI exhibiting HTPR after clopidogrel loading, ticagrelor or prasugrel reloading produced improved platelet inhibition which was better than clopidogrel reload and this effect was sustained during maintenance phase.

Published
2016

19. Occupational health hazards of trichloroethylene among workers in relation to altered mRNA expression of cell cycle regulating genes (p53, p21, bax and bcl-2) and PPARA

Author

C. Keshava Chandran, Rajeev Jain, Abhijit Chandra, Vipin Bihari, Riaz Ahmad, Sudhir K. Goel, Meenu Varshney, Mohana Krishna Reddy Mudiam, and Satykam Patnaik

Subjects
medicine.medical_specialty, Trichloroethylene, Health, Toxicology and Mutagenesis, Mrna expression, Dichloroacetic acid, Toxicology, Article, chemistry.chemical_compound, lcsh:RA1190-1270, Internal medicine, medicine, Trichloroacetic acid, Gene, lcsh:Toxicology. Poisons, Cell cycle, Molecular biology, Reverse transcription polymerase chain reaction, Endocrinology, chemistry, miRNA let-7c, Peroxisome proliferator-activated receptor alpha, Dehydroepiandosterone sulfate, Peroxisome proliferator activated receptor alpha
Abstract

Trichloroethylene (TCE) is widely used as a metal degreaser in industrial processes. The present study reports on the effects of TCE exposure on workers employed in the lock industries. To ensure exposure of the workers to TCE, its toxic metabolites, trichloroacetic acid (TCA), dichloroacetic acid (DCA) and trichloroethanol (TCEOH) were detected in the plasma of the subjects through solid phase microextraction-gas chromatography-electron capture detection. TCA, DCA and TCEOH were detected in the range of 0.004–2.494 μg/mL, 0.01–3.612 μg/mL and 0.002–0.617 μg/mL, respectively. Quantitative reverse transcription polymerase chain reaction analysis revealed up-regulated expression of p53 (2.4-fold; p

Published
2015

21. Contributors

Author

Khalid M. Abbed, Kalil G. Abdullah, Paul D. Ackerman, Yunus Alapan, Vincent J. Alentado, Matthew D. Alvin, Christopher P. Ames, Neel Anand, Paul A. Anderson, Lilyana Angelov, Alireza K. Anissipour, John A. Anson, Ronald I. Apfelbaum, Michael Archdeacon, Paul M. Arnold, Mike W.J. Arun, Harel Arzi, Ahmed J. Awad, Basem I. Awad, Biji Bahuleyan, Mark D. Bain, Lissa C. Baird, Jamie Baisden, Nevan G. Baldwin, Perry A. Ball, Karl E. Balsara, Eli M. Baron, H. Hunt Batjer, Andrew M. Bauer, Thomas W. Bauer, Joshua M. Beckman, Gordon R. Bell, Carlo Bellabarba, E. Emily Bennett, Edward C. Benzel, Darren L. Bergey, Tarun Bhalla, Karin S. Bierbrauer, Mark Bilsky, Harjus Birk, Erica F. Bisson, Christopher Bono, Richard J. Bransford, Darrel S. Brodke, Nathaniel Brooks, Cristian Brotea, Jared R. Brougham, Samuel R. Browd, Robert T. Buckley, Shane Burch, John Butler, Mohamad Bydon, Steven Casha, Jeroen Ceuppens, Andrew K. Chan, Thomas C. Chen, Joseph Cheng, Dean Chou, Tanvir Choudhri, Aaron J. Clark, Adam M. Conley, Paul R. Cooper, Domagoj Coric, Mark Corriveau, Ian P. Côté, Jean-Valery C.E. Coumans, Charles H. Crawford, William T. Curry, Scott D. Daffner, Sedat Dalbayrak, Russell C. DeMicco, Harel Deutsch, Sanjay S. Dhall, Denis J. DiAngelo, Curtis A. Dickman, Shah-Nawaz M. Dodwad, Siena M. Duarte, Zeyd Ebrahim, Gerald W. Eckardt, Bruce L. Ehni, Kurt M. Eichholz, Marc Eichler, Samer K. Elbabaa, Benjamin D. Elder, James B. Elder, Richard G. Ellenbogen, Nancy Epstein, Thomas J. Errico, Yoshua Esquenazi, Daniel K. Fahim, Ehab Farag, Chad W. Farley, Michael G. Fehlings, Frank Feigenbaum, Eoin Fenton, Lisa A. Ferrara, R. David Fessler, Richard G. Fessler, Michael A. Finn, Ryan Finnan, Jeffrey S. Fischgrund, Kevin T. Foley, Ricardo B.V. Fontes, Todd B. Francis, Brett A. Freedman, Frederick Frost, John George, John W. German, Peter C. Gerszten, George M. Ghobrial, Zoher Ghogawala, Justin L. Gibson, Christopher C. Gillis, Vijay K. Goel, Jan Goffin, Ziya L. Gokaslan, Sohrab Gollogly, C. Rory Goodwin, Carlos R. Goulart, Vadim Goz, Yair M. Gozal, Randall B. Graham, Gerald A. Grant, Jian Guan, Ilker Gulec, Yazeed M. Gussous, Richard D. Guyer, David Gwinn, Sung Ha, Eldad Hadar, Clayton L. Haldeman, Alexander Y. Halim, Kimberly M. Hamilton, Christine L. Hammer, Fadi Hanbali, Shannon W. Hann, Jurgen Harms, James S. Harrop, Blaine L. Hart, David J. Hart, Daniel Harwell, Reyaad A. Hayek, Robert F. Heary, Fraser C. Henderson, Patrick W. Hitchon, Daniel J. Hoh, Paul J. Holman, Noboru Hosono, Clifford Houseman, John K. Houten, Joseph C. Hsieh, Wellington K. Hsu, Meng Huang, R. John Hurlbert, Lee Hwang, Steven Hwang, Serkan İnceoğlu, Libby Kosnik Infinger, Tatiana von Hertwig Fernandes de Oliveira, Devesh Jalan, Neilank Jha, J. Patrick Johnson, Charles I. Jones, G. Alexander Jones, Michael Jones, Rupa G. Juthani, Christopher D. Kager, Maziyar A. Kalani, M. Yashar S. Kalani, Iain H. Kalfas, Ricky R. Kalra, Reza J. Karimi, Osama Kashlan, Manish K. Kasliwal, Vikas Kaul, Mayank Kaushal, Tyler J. Kenning, Saad Khairi, Tagreed Khalaf, Jad G. Khalil, Larry T. Khoo, Ali Kiapour, Daniel H. Kim, David H. Kim, Kristopher T. Kimmell, Steven Kirshblum, Sameer A. Kitab, Paul Klimo, Eric O. Klineberg, Tyler R. Koski, Thomas A. Kosztowski, Robert J. Kowalski, Ajit A. Krishnaney, Kelly Krupa, Kristin Krupa, Varun R. Kshettry, Sunil Kukreja, Charles Kuntz, Shekar N. Kurpad, Srinivasu Kusuma, Michael LaBagnara, Frank La Marca, Ilya Laufer, Elizabeth Demers Lavelle, William F. Lavelle, W. Thomas Lawrence, Darren R. Lebl, Bryan S. Lee, Sun-Ho Lee, Lawrence G. Lenke, Steven P. Leon, Amy Li, Yiping Li, Isador H. Lieberman, James K.C. Liu, Victor P. Lo, S. Scott Lollis, Miguel Lopez-Gonzalez, Daniel Lubelski, Mark G. Luciano, Andre G. Machado, Raghu Maddela, Ravichandra A. Madineni, Casey Madura, Dennis J. Maiman, David G. Malone, Antonios Mammis, Satyajit Marawar, Nicolas Marcotte, Joseph C. Maroon, Michael D. Martin, Eduardo Martinez-del-Campo, Eric M. Massicotte, Tobias A. Mattei, Paul K. Maurer, Eric A.K. Mayer, Miguel Mayol del Valle, Daniel J. Mazanec, Paul C. McCormick, William McCormick, Zachary A. Medress, Ehud Mendel, Umesh S. Metkar, Vincent J. Miele, Ahmed Mohyeldin, Jad Bou Monsef, Timothy A. Moore, Hikaru Morisue, Peter Morone, Thomas E. Mroz, Jeffrey P. Mullin, F. Reed Murtagh, Ryan D. Murtagh, Sait Naderi, Usha D. Nagaraj, Charles C. Nalley, Anil Nanda, Richard J. Nasca, Anick Nater, Matthew T. Neal, Russ P. Nockels, John A. Norwig, Solomon M. Ondoma, Akinwunmi Oni-Orisan, Jonathan H. Oren, Jennifer Orning, R. Douglas Orr, Katie Orrico, Joseph A. Osorio, Ernesto Otero-Lopez, John O'Toole, Paul Park, Vikas Parmar, Robert S. Pashman, Rakesh D. Patel, Smruti K. Patel, Mick J. Perez-Cruet, Noel I. Perin, David B. Pettigrew, H. Westley Phillips, Rick Placide, Paul Porensky, Joshua P. Prager, Srinivas Prasad, Mark L. Prasarn, Rakesh Ramakrishnan, Ashwin G. Ramayya, Y. Raja Rampersaud, Peter A. Rasmussen, John K. Ratliff, Wolfgang Rauschning, Glenn R. Rechtine, Pablo F. Recinos, Daniel K. Resnick, Jay Rhee, Laurence D. Rhines, Alexander R. Riccio, Marlin Dustin Richardson, Bertram Richter, Ron Riesenburger, K. Daniel Riew, Matthew Rogers, Fanor M. Saavedra, Mina G. Safain, Rajiv Saigal, Paul D. Sawin, Justin K. Scheer, Joshua Scheidler, David W. Schippert, Richard Schlenk, Bradley Schmidt, Meic H. Schmidt, Daniel M. Sciubba, Christopher I. Shaffrey, Mark E. Shaffrey, Anoli Shah, Alok Sharan, Ashwini D. Sharan, Daniel Shedid, Steven Shook, Michael P. Silverstein, Venita M. Simpson, Anthony Sin, Harminder Singh, Donald A. Smith, Gabriel A. Smith, Justin S. Smith, Kyle A. Smith, Volker K.H. Sonntag, Hector Soriano-Baron, Robert F. Spetzler, W. Ryan Spiker, Blake Staub, Michael P. Steinmetz, Charles B. Stillerman, Andrea Strayer, Gandhivarma Subramaniam, Hamdi G. Sukkarieh, Andrew Sumich, Derrick Y. Sun, Tarek P. Sunna, Durga R. Sure, Richard A. Tallarico, Lee A. Tan, Claudio E. Tatsui, Fernando Techy, Nicholas Theodore, Alexander A. Theologis, Nicholas W.M. Thomas, Brian D. Thorp, Scott Tintle, Stavropoula Tjoumakaris, William D. Tobler, Daisuke Togawa, David Traul, Vincent C. Traynelis, A. Sophia Tritle, Gregory R. Trost, Eve C. Tsai, Kene Ugokwe, Kutlauy Uluc, Juan S. Uribe, Alexander R. Vaccaro, Alex Valadka, Aditya Vedantam, Anand Veeravagu, Kushagra Verma, Todd Vitaz, Jean-Marc Voyadzis, Scott Wagner, Trevor C. Wahlquist, Robert Waldrop, Kevin M. Walsh, Jeffrey C. Wang, Michael Y. Wang, Patrick T. Wang, John D. Ward, Zabi Wardak, Connor Wathen, Philip R. Weinstein, Michael Weisman, William C. Welch, Simcha J. Weller, L. Erik Westerlund, Jonathan A. White, Robert G. Whitmore, Jack E. Wilberger, Kim A. Williams, Ethan A. Winkler, Christopher D. Witiw, Christopher E. Wolfla, Jean-Paul Wolinsky, Cyrus Wong, Eric J. Woodard, Vijay Yanamadala, Daniel S. Yanni, Philip A. Yazbak, Chun-Po Yen, Mesut Yilmaz, Narayan Yoganandan, Kenneth S. Yonemura, Kazuo Yonenobu, Hansen A. Yuan, John K. Yue, Adam M. Zanation, Salvatore M. Zavarella, Seth M. Zeidman, Mehmet Zileli, Scott Zuckerman, and Holly Zywicke

Published
2017
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22. A study of clinical presentation and delays in management of acute myocardial infarction in community

Author

Pravin K. Goel, Naveen Garg, Aditya Kapoor, Saurabh Kumar Srivastava, Sudeep Kumar, Satyendra Tewari, Rajeev Agarwal, Fauzia Ashfaq, P.R. Gupta, and P.C. Saxena

Subjects
Adult, Male, medicine.medical_specialty, Pediatrics, lcsh:Diseases of the circulatory (Cardiovascular) system, Delayed Diagnosis, Time Factors, Clinical presentation, medicine.medical_treatment, Myocardial Infarction, MEDLINE, lcsh:Surgery, India, Community study, Risk Factors, Diabetes mellitus, medicine, Humans, Myocardial infarction, Retrospective Studies, business.industry, Retrospective cohort study, Thrombolysis, lcsh:RD1-811, Middle Aged, medicine.disease, Surgery, lcsh:RC666-701, Myocardial infarction complications, Female, Original Article, Myocardial infarction diagnosis, Presentation (obstetrics), Cardiology and Cardiovascular Medicine, business, Acute MI
Abstract

To assess the medico social demographics of acute myocardial infarction (AMI) in our community we studied 609 patients presenting between January 2008 to December 2008 with a detailed questionnaire in four centres of UP. Medical attention was sought late (> 6 hours) in 316 (51.6%), thrombolysis was obtained in 45.2% (275) and presentation was atypical in 16.3% (99). 36.2% (221) had pre-monitory symptoms of which 68% (150) ignored the same while of 32% (71) who did seek medical attention 47.9% (37) were brushed away as non-cardiac in origin. 20.3% (46/226) of hypertension, 23.2% (43/185) of diabetes and 83.4% (91/109) of hyperlipidaemia was diagnosed post event. We conclude that at least half of patients with AMI do not get definitive therapy, at least one in 10 patients do not have the classical symptoms, reasonable proportion are unaware of their risk factors, and a good majority have pre-monitory symptoms which get overlooked.

Published
2012

23. Comparison of eight published static finite element models of the intact lumbar spine : predictive power of models improves when combined together

Author

Hans-Joachim Wilke, Christian M. Puttlitz, Won Man Park, Antonius Rohlmann, Kevin M. Labus, Thomas Zander, Yoon Hyuk Kim, Aboulfazl Shirazi-Adl, Clayton J. Adam, Vijay K. Goel, Hendrik Schmidt, J.P. Little, Y.H. Wang, Ata M. Kiapour, Marcel Dreischarf, and C.S. Chen

Subjects
musculoskeletal diseases, 090302 Biomechanical Engineering, predictive power, Compressive Strength, Rotation, Finite Element Analysis, Posture, Population, Biomedical Engineering, Biophysics, intersubject variability, Zygapophyseal Joint, Facet joint, Couple, Pressure, Range (statistics), medicine, Humans, Orthopedics and Sports Medicine, Range of Motion, Articular, education, Simulation, Probability, Mathematics, validation, finite element model, education.field_of_study, Lumbar Vertebrae, lumbar spine, Rehabilitation, Biomechanics, Reproducibility of Results, Mechanics, Models, Theoretical, sensitivity, Finite element method, medicine.anatomical_structure, Lumbar spine, Material properties, Algorithms, 110314 Orthopaedics
Abstract

Finite element (FE) model studies have made important contributions to our understanding of functional biomechanics of the lumbar spine. However, if a model is used to answer clinical and biomechanical questions over a certain population, their inherently large inter-subject variability has to be considered. Current FE model studies, however, generally account only for a single distinct spinal geometry with one set of material properties. This raises questions concerning their predictive power, their range of results and on their agreement with in vitro and in vivo values. Eight well-established FE models of the lumbar spine (L1-5) of different research centres around the globe were subjected to pure and combined loading modes and compared to in vitro and in vivo measurements for intervertebral rotations, disc pressures and facet joint forces. Under pure moment loading, the predicted L1-5 rotations of almost all models fell within the reported in vitro ranges, and their median values differed on average by only 2° for flexion-extension, 1° for lateral bending and 5° for axial rotation. Predicted median facet joint forces and disc pressures were also in good agreement with published median in vitro values. However, the ranges of predictions were larger and exceeded those reported in vitro, especially for the facet joint forces. For all combined loading modes, except for flexion, predicted median segmental intervertebral rotations and disc pressures were in good agreement with measured in vivo values. In light of high inter-subject variability, the generalization of results of a single model to a population remains a concern. This study demonstrated that the pooled median of individual model results, similar to a probabilistic approach, can be used as an improved predictive tool in order to estimate the response of the lumbar spine.

Published
2014

24. List of Contributors

Author

Satinder Ahuja, Susan Amrose, Siva Bandaru, Tuhin Banerji, Lee Blaney, M.S. Bootharaju, Nicole R. Campbell, Kartik Chandran, Sanjeev Chaudhari, B. Jiménez Cisneros, Beatrice Darko, Caroline Delaire, Steven K. Dentel, Pacia Diaz, A. Durán-Moreno, Ashok Gadgil, Tyler Gallion, Ramesh K. Goel, Shikha Gulati, Tyler Harrison, Kiril Hristovski, Robert Hulverson, Jani C. Ingram, Jia-Qian Jiang, Olya S. Keen, Hyunook Kim, P. Ratna Kumar, Karl G. Linden, M.I. Litter, Nancy G. Love, Libor Machala, Solmaz Marzooghi, Garrett McKay, B.M. Mercado-Borrayo, Stephen P. Mezyk, C.V. Montoya-Bautista, A.A. Morales, Amir Mohaghegh Motlagh, M. Navarrete, Julie R. Peller, T. Pradeep, Aditi Puri, R.M. Ramírez-Zamora, F. Rigas, R. Schouwenaars, R.K. Sharma, Virender K. Sharma, M. Solís-López, Andrew Torkelson, Case van Genuchten, Emily Watson, Daniel Yeh, and Radek Zboril

Published
2014
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25. A unique and unexplained ricochet leak post PCI – Successfully treated with intra-coronary glue

Author

Sanjeev K. Syal and Pravin K. Goel

Subjects
Male, Leak, medicine.medical_specialty, RD1-811, Intra-arterial glue, medicine.medical_treatment, Case Report, Coronary Angiography, Risk Assessment, law.invention, law, Angioplasty, Cardiac tamponade, medicine, Diseases of the circulatory (Cardiovascular) system, Humans, ISR, Angioplasty, Balloon, Coronary, GLUE, PTCA, Coronary Artery Perforation, Aged, business.industry, Coronary Stenosis, medicine.disease, Coronary Vessels, Surgery, Electrocardiogram, Cardiac Tamponade, Treatment Outcome, Injections, Intra-Arterial, Cyanoacrylate, RC666-701, Conventional PCI, Ricochet, Stents, Tissue Adhesives, Radiology, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

We herein describe a unique case of coronary artery perforation treated with covered stent with repeat cardiac tamponade resulting out of a fresh unexplained leak from a remote vessel (Ricochet) and successfully treated with intra-coronary injection of sterile synthetic glue, cyanoacrylate.

Published
2013

26. Lumbaler Facettenersatz

Author

William F. Lavelle, Bryan W. Cunningham, Vijay K. Goel, Robert W. Hoy, Carlos E. Oliveira, and Allen L. Carl

Subjects
business.industry, Medicine, business
Published
2011
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27. Autoren

Author

Todd F. Alamin, Marco Bérard, null Rudolf Bertagnoli, Jason D. Blain, Scott L. Blumenthal, Nicholas R. Boeree, David S. Bradford, Jacob M. Buchowski, Allen Carl, Boyle C. Cheng, Robert J. Chomiak MD, Christine Coillard MD, Andrew H. Cragg MD, Bryan W. Cunningham, Frank Daday, Reginald J. Davis, Rick B. Delamarter, Roberto Díaz, Thomas J. Errico, Teddy Fagerstrom, Daniel R. Fassett, Rolando García, Ihab Gharzeddine, Vijay K. Goel, Matthew F. Gornet, Geneste Guilhaume, Giancarlo Guizzardi, Nader M. Habela, Horace Hale, Nadim James Hallab, David Hannallah, Matthew Hannibal, Alan S. Hilibrand, Robert W. Hoy, Kenneth Y. Hsu, Cary Idler, Joshua J. Jacobs, Jorge Jaramillo, Shiveindra B. Jeyamohan, Larry T. Khoo, Scott H. Kitchel, Carl Lauryssen, William Lavelle, James P. Lawrence, Juliano Lhamby, Gary L. Lowery, George Malcolmon, Thierry Marnay, Larry Martin, Paul C. McAfee, Alvin H. McKenzie, Lionel N. Metz, Hazem Nicola, Donna D. Ohnmeiss, Carlos E. Oliveira, Brett A. Osborn, Carlos Fernando Arias Pesántez, Piero Petrini, Luiz Pimenta, Ben B. Pradhan, K. Daniel Riew, Mildred B. Simon, Souad Rhalmi, Charles H. Rivard, Ashish Sahai, Samer Saiedy, Rick Sasso, Thomas Schaffa, Matthew Scott-Young, Rajiv K. Sethi, Kristina Spate, Jonathan R. Stieber, Bauer E. Sumpio, Jens Peter Timm, P. Justin Tortolani, Vincent C. Traynelis, Patrick Tropiano, Alexander R. Vaccaro, Archibald von Strempel, Peter G. Whang, William C. Welch, Bradley J. Wessman, Andrew P. White, Markus Wimmer, James J. Yue, and James F. Zucherman

Published
2011
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28. Other Methods in Nonlinear Regression

Author

Bhavik R. Bakshi, Bin Li, and Prem K. Goel

Subjects
Mathematical optimization, Multivariate adaptive regression splines, business.industry, Machine learning, computer.software_genre, Partition (database), Regression, Nonlinear system, Projection pursuit regression, Hyperplane, Artificial intelligence, business, Projection (set theory), computer, Nonlinear regression, Mathematics
Abstract

This chapter covers some of the other nonlinear regression methods including classification and regression trees (CART), projection pursuit regression (PPR), and multivariate adaptive regression splines (MARS). These methods can provide attractive alternatives to more common methods and can also provide a useful insight into the nature of the data and relationship between the variables. CART and MARS are partition-based methods since they choose the most relevant variables. PPR is a projection-based method since it projects all the input variables on a linear hyperplane before application of the nonlinear activation function. The chapter provides theoretical and methodological insights into these methods, discusses their pros and cons from a practical point of view, and illustrates their features with the help of simulated examples.

Published
2009
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29. Contributors

Author

Jean-Jacques Abitbol, Michael Ahrens, Todd F. Alamin, Todd J. Albert, Jérome Allain, Marc Ameil, Howard S. An, Ravi Ananthan, Paul A. Anderson, S.A. Andrew, Lucie Aubourg, Stephane Aunoble, Jonathon R. Ball, Qi-Bin Bao, Jacques Beaurain, Marco Bérard, Ulrich Berelmann, Pierre Bernard, Rudolf Bertagnoli, Robert S. Biscup, Jason D. Blain, Jon E. Block, Scott L. Blumenthal, Nicholas R. Boeree, Iohan Bogorin, David S. Bradford, Jacob M. Buchowski, Karin Büttner-Janz, Andrew G. Cappuccino, Allen Carl, Antonio E. Castellvi, Joseph C. Cauthen, Hervé Chataigner, Boyle C. Cheng, Robert J. Chomiak, Christine Coillard, Christopher Cole, Dennis Colleran, Domagoj Coric, G. Bryan Cornwall, Etevaldo Coutinho, Andrew H. Cragg, Bryan W. Cunningham, David Cutter, Frank Daday, Reginald J. Davis, Rick B. Delamarter, Joël Delécrin, Malan DeVilliers, Roberto Díaz, Juan M. Dipp, Gary A. Dix, Thomas B. Ducker, Thierry Dufour, Jacob Einhorn, Lukas Eisermann, Thomas J. Errico, Teddy Fagerstrom, Daniel R. Fassett, Jeffrey S. Fischgrund, Ricardo Flores, Jean-Marc Fuentes, Josue Gabriel, Rolando García, Fred H. Geisler, Ihab Gharzeddine, Vijay K. Goel, Jeffrey A. Goldstein, Matthew F. Gornet, Steven L. Griffith, Geneste Guilhaume, Giancarlo Guizzardi, Richard D. Guyer, Nader M. Habela, Ulrich Reinhard Hähnle, Horace Hale, Nadim James Hallab, David Hannallah, Matthew Hannibal, Victor M. Hayes, Alan S. Hilibrand, John A. Hipp, Stephen H. Hochschuler, Gordon Neil Holen, Istvan Hovorka, Robert W. Hoy, Kenneth Y. Hsu, Jean Huppert, Cary Idler, Andre Jackowski, Joshua J. Jacobs, Jorge Jaramillo, Shiveindra B. Jeyamohan, James D. Kang, Larry T. Khoo, Seok Woo Kim, Scott H. Kitchel, Gregory G. Knapik, Manoj Krishna, Greg Lambrecht, Carl Lauryssen, William Lavelle, James P. Lawrence, Jean-Charles Le Huec, Juliano Lhamby, Gary L. Lowery, George Malcolmon, Thierry Marnay, William S. Marras, Larry Martin, Joseph M. Marzluff, Koichi Masuda, Paul C. McAfee, Jeffrey R. McConnell, Alvin H. McKenzie, Alan McLeod, Lionel N. Metz, Richard Blondet Meyrat, Scott Dean Miller, Joji Mochida, Richard Navarro, Hazem Nicola, Daniel M. Oberer, Donna D. Ohnmeiss, Carlos E. Oliveira, Douglas G. Orndorff, Brett A. Osborn, Corey A. Pacek, Charles Park, Avinash G. Patwardhan, Carlos Fernando Arias Pesántez, Piero Petrini, Luiz Pimenta, Vinod K. Podichetty, Kornelis A. Poelstra, Ben B. Pradhan, Ann Prewett, James P. Price, James Robert Rappaport, Christopher Reah, Alejandro A. Reyes-Sánchez, Souad Rhalmi, K. Daniel Riew, Charles H. Rivard, German Rodríguez, Thomas F. Roush, Scott A. Rushton, Ashish Sahai, Samer Saiedy, Daisuke Sakai, Rick Sasso, Thomas Schaffa, Othmar Schwarzenbach, Matthew Scott-Young, Lali H.S. Sekhon, Dilip K. Sengupta, Rajiv K. Sethi, Farhan N. Siddiqi, Kern Singh, Matthew N. Songer, Gwendolyn A. Sowa, Kristina Spate, Jean Stecken, Jean-Paul Steib, Jonathan R. Steiber, Brian J. Sullivan, Bauer E. Sumpio, Andelle L. Teng, Randall Theken, Jens Peter Timm, P. Justin Tortolani, Vincent C. Traynelis, Patrick Tropiano, Anthony Tsantrizos, Alexander W.L. Turner, Alexander R. Vaccaro, Jean-Marc Vital, Archibald von Strempel, Corey J. Wallach, Jeffrey C. Wang, Douglas Wardlaw, Scott A. Webb, Ian R. Weinberg, William C. Welch, Bradley J. Wessman, Peter G. Whang, Nicholas D. Wharton, Andrew P. White, Thomas Wilson, Markus Wimmer, Oscar Yeh, Anthony T. Yeung, Christopher A. Yeung, Hansen A. Yuan, James J. Yue, and James F. Zucherman

Published
2008
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32. Theken eDisc

Author

Richard Navarro, Randall Theken, Ravi Ananthan, Christopher Cole, James P. Price, Charles Park, Vijay K. Goel, Scott Dean Miller, and Hansen A. Yuan

Published
2008
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33. Contributors

Author

Bernard M. Abrams, A.V. Apkarian, Charles E. Argoff, Kjell Axelsson, Mani Batra, Benoy Benny, Honorio T. Benzon, Klaus Bielefeldt, David M. Biondi, Hemmo Bosscher, Randall P. Brewer, David L. Brown, Chad M. Brummett, Allen W. Burton, Asokumar Buvanendran, Alex Cahana, Kenneth D. Candido, David Casarett, Kwai-Tung Chan, Susan L. Charette, Steven P. Cohen, Megan H. Cortazzo, Edward C. Covington, Nessa Coyle, Timothy R. Deer, Oscar de Leon-Casasola, Bonnie Deschner, Robert H. Dworkin, Michael Erdek, Bruce A. Ferrell, Perry G. Fine, Scott M. Fishman, Kenneth A. Follett, G.F. Gebhart, Shiv K. Goel, Martin Grabois, Brock Gretter, Anil Gupta, Admir Hadzic, Naeem Haider, Alicia Heapy, James E. Heavner, Matthew D. Hepler, Marc A. Huntoon, Robert W. Hurley, Kenneth C. Jackson, Benjamin Johnson, Robert D. Kerns, Timothy L. Lacy, Irfan Lalani, Thomas M. Larkin, Elaina E. Lin, Yuan-Chi Lin, Spencer S. Liu, Raymond Maciewicz, David N. Maine, Khalid Malik, Timothy P. Maus, Brenda C. McClain, Gary McCleane, Brian McGeeney, Nashir R. Mehta, Nagy Mekhail, Douglas G. Merrill, Harold Merskey, Marjorie Meyer, James R. Miner, Beth H. Minzter, Robert E. Molloy, Antoun Nader, Patrick Narchi, Joseph M. Neal, Krystof J. Neumann, Jon B. Obray, Marco Pappagallo, Xavier Paqueron, Winston C.V. Parris, Fred Perkins, Sudhir Rao, James P. Rathmell, Scott S. Reuben, Christopher Robards, Richard W. Rosenquist, I.Jon Russell, Francis V. Salinas, Michael D. Sather, Michael F. Schafer, Steven J. Scrivani, Stelian Serban, Stephen D. Silberstein, François Singelyn, Menno Sluijter, Amol Soin, Steven P. Stanos, Santhanam Suresh, Kimberly S. Swanson, Sally Tarbell, Knox H. Todd, Dennis C. Turk, Mark D. Tyburski, M.van Kleef, J.Van Zundert, Renata Variakojis, Jeanine A. Verbunt, Christopher M. Viscomi, Mitchell Wachtel, Howard J. Waldman, David Walega, Daniel T. Warren, Tabitha Washington, Karin N. Westlund High, Brian A. Willams, Kayode A. Williams, Harrië Wittink, Christopher L. Wu, Daquan Xu, Tony L. Yaksh, and Anthony Yarussi

Published
2008
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34. Spine Disorders

Author

Nabil A. Ebraheim, Vijay K. Goel, Sri Lakshmi Vishnubhotla, Koichi Sairyo, and Ashok Biyani

Subjects
Rib cage, business.industry, Intervertebral disc, Scoliosis, Anatomy, Degeneration (medical), musculoskeletal system, medicine.disease, Spinal column, medicine.anatomical_structure, Degenerative disease, Coronal plane, Deformity, medicine, medicine.symptom, business
Abstract

This chapter presents an overview of the several spinal disorders from a mechanical perspective. An understanding of these disorders can assist in the design and development of spinal instrumentation. Normal function of the human spine is possible due to a complex interaction of its components (i.e., vertebrae, ligaments, discs, rib cage, and muscles). One of the spinal disorders is scoliosis. It is the structural deformity of the spine in the frontal plane. The usual vertical orientation of the spine in the frontal plane is disturbed, leading to a lateral curvature of spine. This chapter also discusses intervertebral disc disease. It is a broad term used to describe alteration of the bio-mechanical properties of the disc through degenerative disease. It occurs due to aging, or may be caused by overloading or underloading. Moreover, Once degeneration sets in, the intervertebral disc goes through a cascade of degenerative changes that result in biomechanical alteration of load transfer through the disc. The spinal column is one of the most common sites of cancer metastasis. Therefore, for pain management of the spine metastasis, radiotherapy is conducted and when radiotherapy is not effective, surgical intervention is considered.

Published
2006
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35. Contributors

Author

Mark F. Abel, Kuniyoshi Abumi, Mark S. Adams, Cary D. Alberstone, Joseph T. Alexander, John A. Anson, Ronald I. Apfelbaum, Paul M. Arnold, L. Brett Babat, Julian E. Bailes, Jamie Baisden, Nevan G. Baldwin, Perry A. Ball, Giancarlo Barolat, H. Hunt Batjer, Thomas W. Bauer, James R. Bean, Brion J. Beerle, Gordon R. Bell, Gregory J. Bennett, Edward C. Benzel, Darren Bergey, Marc L. Bertrand, Mark H. Bilsky, Barry D. Birch, Robert S. Biscup, Kevin Blaylock, Oheneba Boachie-Adjei, Maxwell Boakye, Scott D. Boden, Henry Bohlman, Michael Bolesta, Mary B. Bondy, Christopher M. Boxell, Keith H. Bridwell, Darrell S. Brodke, James Butler, David W. Cahill, Robert C. Cantu, Allen L. Carl, John A. Carrino, John R. Caruso, Andrew G. Chenelle, Joseph S. Cheng, Yong-Jun Cho, Tanvir F. Choudhri, Frank Conguista, Edward S. Connolly, Paul R. Cooper, Jean-Valéry C.E. Coumans, Albert E. Cram, H. Alan Crockard, Richard Crownover, Bryan W. Cunningham, William T. Curry, Joseph F. Cusick, Scott D. Daffner, Mark D. D'Alise, Vinay Deshmukh, Denis DiAngelo, Curtis A. Dickman, Thomas B. Ducker, Scott T. Dull, Stewart B. Dunsker, Michael J. Ebersold, Jason Eckhardt, Bruce L. Ehni, Matthew Eichenbaum, Kurt M. Eichholz, Marc E. Eichler, Samer K. Elbabaa, Sanford E. Emery, Nancy E. Epstein, Jennifer Erdos, Thomas J. Errico, Tom Faciszewski, Michael G. Fehlings, Lisa A. Ferrara, Richard G. Fessler, Kevin T. Foley, Robert M. Galler, John W. German, Alexander J. Ghanayem, Zoher Ghogawala, Vijay K. Goel, Jan Goffin, Ziya L. Gokaslan, Sohrab Gollogly, Jorge Gonzalez-Martinez, James E. Greensmith, Jeffrey D. Gross, Regis W. Haid, Andrea L. Halliday MD, Allan J. Hamilton, Fadi Hanbali, Jürgen Harms, James S. Harrop, Blaine I. Hart, Robert A. Hart, Robert F. Heary, Fraser C. Henderson, Patrick W. Hitchon, James P. Hollowell, Paul J. Holman, John K. Houten, Robert E. Isaacs, Manabu Ito, John A. Jane, J. Patrick Johnson, Christopher Kager, Iain H. Kalfas, George J. Kaptain, Saad Khairi, Daniel H. Kim, David H. Kim, Thomas A. Kopitnik, Robert J. Kowalski, Ajit A. Krishnaney, John A. Lancon, Giuseppe Lanzino, Sanford J. Larson, Jorge Lastra-Power, Nathan H. Lebwohl, Isador H. Lieberman, Donlin M. Long, Mark G. Luciano, Charles A. Luevano, Parley M. Madsen III, Dennis J. Maiman, Jacek M. Malik, David G. Malone, Joseph C. Maroon, Eric M. Massicotte, Shunji Matsunaga, Daniel J. Mazanec, Paul C. McAfee, Bruce M. McCormack, Paul C. McCormick, William E. McCormick, Robert A. McGuire, Robert F. McLain, Nagy Mekhail, D. Mark Melton, Carole A. Miller, Jared H. Miller, Sung Min, William Mitchell, Junichi Mizuno, Michael T. Modic, Howard W. Morgan, Robert J. Morlock, Michael A. Morone, Wade M. Mueller, Praveen V. Mummaneni, John S. Myseros, Sait Naderi, Dileep Nair, Hiroshi Nakagawa, Jaime H. Nieto, Russ P. Nockels, Bruce E. Northrup, Chima Ohaegbulam, Tunc Oktenoglu, Bernardo Jose Ordonez, Jeffrey H. Owen, A. Fahir Özer, Stephen M. Papadopoulos, Christopher G. Paramore, Robert S. Pashman, Warwick J. Peacock, Stanley Pelofsky, Noel I. Perin, Christopher J. Pham, Rick J. Placide, Branko Prpa, Gregory J. Przybylski, Ashraf A. Ragab, Y. Raja Rampersaud, Peter A. Rasmussen, Richard B. Raynor, Gary L. Rea, Glenn R. Rechtine, John Regan, Setti S. Rengachary, Daniel K. Resnick, Laurence D. Rhines, Albert J. Rhoton, Donna J. Rodriguez, Gerald E. Rodts, Michael J. Rosner, Alexander Sah, Jared P. Salinsky, Paul Santiago, Mehdi Sarkarati, Richard L. Saunders, Paul D. Sawin, Edward H. Scheid, Meic H. Schmidt, Michael Schneier, Dilip K. Sengupta, Christopher I. Shaffrey, Mark E. Shaffrey, Alok D. Sharan, Ashwini D. Sharan, Christopher B. Shields, Frederick A. Simeone, Kern Singh, Ran Vijai P. Singh, Donald A. Smith, Maurice M. Smith, Volker K.H. Sonntag, Ivan J. Sosa, Micheal J. Speck, Robert F. Spetzler, Sudhakar T. Sridharan, Loretta A. Staudt, Michael P. Steinmetz, Charles B. Stillerman, Kota Suda, Sonia Suys, George W. Sypert, Charles H. Tator, Nicholas Theodore, Ajith J. Thomas, Nicholas W.M. Thomas, Robert E. Tibbs, Daisuke Togawa, Frank J. Tomecek, Richard M. Toselli, Vincent C. Traynelis, Gregory R. Trost, Eeric Truumees, Gary W. Tye, Abm Salah Uddin, Alexander R. Vaccaro, Ceslovas Vaicys, Alex Valadka, Arnold B. Vardiman, Anthony A. Virella, Elizabeth Vitarbo, Todd W. Vitaz, Dennis G. Vollmer, Jean-Marc Voyadzis, John D. Ward, Joseph Watson, John K. Webb, Philip R. Weinstein, Martin W. Weiser, William C. Welch, Simcha J. Weller, L. Erik Westerlund, Jonathan A. White, Melvin D. Whitfield, Gregory C. Wiggins, Jack E. Wilberger, William S. Wilke, Diana Barrett Wiseman, W. Putnam Wolcott, Eric J. Woodard, Philip Yazback, Narayan Yoganandan, Kenneth S. Yonemura, Kazuo Yonenobu, Hansen A. Yuan, Seth M. Zeidman, Barry M. Zide, and Mehmet Zileli

Published
2005
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38. Cervical Spine Construct Design

Author

Vijay K. Goel, Kurt M. Eichholz, Vincent C. Traynelis, and Paul D. Sawin

Subjects
Orthodontics, business.industry, Medicine, business, Construct (philosophy), Cervical spine
Published
2005
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40. PREGNANCY IN A RUDIMENTARY HORN OF BICORNUATE UTERUS

Author

J K Goel and M Chandrashekhar

Subjects
Bicornuate uterus, Pregnancy, medicine.medical_specialty, Ectopic pregnancy, business.industry, Cornual Pregnancy, Gestational sac, Uterus, Case Report, General Medicine, medicine.disease, Surgery, medicine.anatomical_structure, medicine, Vaginal bleeding, Uterine cavity, medicine.symptom, business
Abstract

Ectopic pregnancy was first recognized by Busiere in 1663 on examining the body of an executed prisoner in Paris. Gifford made a more complete report in 1731 in England, describing the condition in which the fertilised ovum was implanted anywhere outside the uterine cavity [1]. During this decade the number of hospitalisations for ectopic pregnancy has tripled and ectopic pregnancy has emerged as a leading cause of maternal morbidity [2, 3]. Fortunately the risk of death has declined despite increasing incidence of disease. The incidence of ectopic pregnancy in non-white patients is approx 12/1000. Out of all ectopic pregnancies, 98.5% are singleton tubal pregnancies and rest is at other sites, which create diagnostic problems and have been associated with greater morbidity and mortality than tubal pregnancies. Pregnancy in the rudimentary horn of a bicornuate uterus is a very rare condition and Johnsen reported the incidence of this pregnancy at approx. one in one lakh pregnancies [4]. The case is being reported because of its rarity. Case Report 18 year old lady was admitted on 10 Nov 1998 at 1230 hrs with history of amenorrhoea of 14 weeks duration and pain left iliac fossa since 0930 hrs. She had one vomiting, gave history of giddiness. She denied history of any vaginal bleeding/urinary/bowel problems. Past menstrual cycles had been 3–4/1–2 months, irregular with average flow and without any dysmenorrhoea, LMP-05 Aug 98. Obstetric History – Married for one year had been staying with husband for last six months. On Examination – There was no pallor, no tachycardia, and blood pressure was 100/60 mm of Hg. Per Abdomen Examination – revealed tenderness in supra pubic region and left iliac fossa however no palpable mass/guarding was present. Pelvic examination showed uterus of parous size and pushed to the right. There was a palpable mass of about 12 weeks size pregnant uterus, soft, mobile and acutely tender on the left. Cervical rocking was positive and there was brownish staining on the examining finger. Haemogram done was within normal limits. With a provisional diagnosis of cornual pregnancy left, an urgent ultra sonography was asked for, which also showed an un-ruptured cornual ectopic pregnancy. Emergency exploratory laparotomy done showed uterus slightly enlarged with right tube and ovary normal. The gestational sac was seen bulging from the superior surface of left rudimentary horn of uterus. Left tube and ovary were apparently normal. However, attachment of left round ligament was unusual and confusing, as it was attached medially to the gestational sac on the main uterus just below the pedicle of rudimentary horn. Rudimentary horn along with gestational sac was removed. Histopathological examination confirmed the gestational sac in the myometrium of the rudimentary horn of the uterus. Patient made an uneventful postoperative recovery and was discharged to home on the 10th day.

Published
2000

41. CASE-BASED DESIGN: A TASK ANALYSIS

Author

Ashok K. Goel and B. Chandrasekaran

Subjects
Computer science, business.industry, Task analysis, Case based design, Artificial intelligence, business, Machine learning, computer.software_genre, computer
Published
1992
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42. Model Revision: A Theory of Incremental Model Learning

Author

Ashok K. Goel

Subjects
Structure (mathematical logic), business.industry, Computer science, Process (engineering), Incremental build model, Artificial intelligence, Plan (drawing), Reuse, Model revision, Type (model theory), business
Abstract

We describe an adaptive method for qualitative modeling of physical devices in which the behaviors of a device are acquired by locally revising the structure-behavior model of a structurally similar device. The structure-behavior model of the known device explicitly represents its structure, its output behaviors, and its internal causal behaviors that specify how its structure produces its output behaviors. The model is revised by model-revision plans, where each plan accommodates a specific type of structural difference between the new and the known devices. The process of model revision is focused by the knowledge of the internal causal behaviors of the known device. The revised structure-behavior model for the new device is stored in a model memory for potential reuse in future. We call this incremental model learning.

Published
1991
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44. Impact of COVID-19 on heart failure hospitalization and outcome in India – A cardiological society of India study (CSI–HF in COVID 19 times study – 'The COVID C–HF study')

Author

Jayagopal P. B, Ramakrishnan S, Mohanan P. P, Jabir A, Venugopal K, M.K. Das, Santhosh K, Syam N, J. Ezhilan, Rajeev Agarwal, Vaidyanathan P R, Ahmed Hussain Choudhary, Meena C B, Amit Malviya, Arun Gopi, Chopra V K, Stigi Joseph, Krishna Kishore Goyal, John F. John, Sandeep Bansal, Harikrishnan S, Praveen Nagula, Johny Joseph, Ajit Bagawat, Sandeep Seth, Urmil Shah, Pravin K. Goel, P.K. Asokan, K.K. Sethi, Satyavan Sharma, (Lt.Gen)Anup Banerji, Sunandan Sikdar, ManojKumar Agarwala, Sharad Chandra, BishwaBhushan Bharti, S.M. Ashraf, Smit Srivastava, B. Kesavamoorthy, Harinder Kumar Bali, Dipak Sarma, Rajendra Kumar Jain, Sameer I. Dani, B.H. Natesh, Rabindra Nath Chakraborty, Vivek Gupta, Narendra Nath Khanna, Dipankar Mukhopadhyay, Subroto Mandal, Biswajit Majumder, Sridhar L, Meennahalli Palleda Girish, DipakRanjan Das, Tom Devasia, Bhavesh Vajifdar, Tanuj Bhatia, Zia Abdullah, Sanjeev Sharma, Sudeep Kumar, Mathew Lincy, Nitish Naik, Dhiman Kahali, Dhurjati Prasad Sinha, Dipankar Ghosh Dastidar, Gurpreet Sing Wander, Rakesh Yadav, Satyendra Tewari, Suman Bhandari, Pratap Chandra Rath, Vijay Harikisan Bang, Debabrata Roy, ParthoSarathi Banerjee, S. Shanmugasundaram, and Geevar Zachariah

Subjects
COVID-19, Acute heart failure, Acute decompensated heart failure, GDMT in heart failure, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Objectives: The presentation and outcomes of acute decompensated heart failure (ADHF) during COVID times (June 2020 to Dec 2020) were compared with the historical control during the same period in 2019. Methods: Data of 4806 consecutive patients of acute HF admitted in 22 centres in the country were collected during this period. The admission patterns, aetiology, outcomes, prescription of guideline-directed medical therapy (GDMT) and interventions were analysed in this retrospective study. Results: Admissions for acute heart failure during the pandemic period in 2020 decreased by 20% compared to the corresponding six-month period in 2019, with numbers dropping from 2675 to 2131. However, no difference in the epidemiology was seen. The mean age of presentation in 2019 was 61.75 (±13.7) years, and 59.97 (±14.6) years in 2020. There was a significant decrease in the mean age of presentation (p = 0.001). Also. the proportion of male patients decreased significantly from 68.67% to 65.84% (p = 0.037). The in-hospital mortality for acute heart failure did not differ significantly between 2019 and 2020 (4.19% and 4.,97%) respectively (p = 0.19). The proportion of patients with HFrEF did not change in 2020 compared to 2019 (76.82% vs 75.74%, respectively). The average duration of hospital stay was 6.5 days. Conclusion: The outcomes of ADHF patients admitted during the Covid pandemic did not differ significantly. The length of hospital stay remained the same. The study highlighted the sub-optimal use of GDMT, though slightly improving over the last few years.

Published
2023
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45. COVID-19 infected ST-Elevation myocardial infarction in India (COSTA INDIA)

Author

Abdullakutty Jabir, Geevar Zachariah, Padinhare Purayil Mohanan, Mohit Dayal Gupta, Sivasubramanian Ramakrishnan, Chandra Bhan Meena, L. Sridhar, Meennahalli Palleda Girish, Dipak Ranjan Das, Anshul Gupta, Praveen Nagula, Tom Devasia, Bhavesh Vajifdar, Kamlesh Thakkar, Urmil Shah, Tanuj Bhatia, Smit Srivastava, Sanjeev Sharma, Priya Kubendiran, Pathiyil Balagopalan Jayagopal, Sudeep Kumar, Deepthy Sadanandan, Lincy Mathew, Nitish Naik, Anup Banerji, S.M. Ashraf, P.K. Asokan, Bishwa Bhushan Bharti, Biswajit Majumder, Dhiman Kahali, Dhurjati Prasad Sinha, Dipak Sharma, Dipankar Ghosh Dastidar, Dipankar Mukhapdhyay, Gurpreet Sing Wander, Harinder Kumar Bali, B. Kesavamoorthy, Manoj Kumar Agarwala, Narendra Nath Khanna, B.H. Natesh, Pravin K. Goel, Rabindra Nath Chakraborty, Rajendra Kumar Jain, Rakesh Yadav, L. Sameer Dani, Satyavan Sharma, Satyendra Tewari, K.K. Sethi, Sharad Chandra, Subrato Mandal, Suman Bhandari, Sundandan Sikdar, Vivek Gupta, Pratap Chandra Rath, Vijay Harikisan Bang, Debabrata Roy, Mrinal Kanti Das, and Partho Sarathi Banerjee

Subjects
COVID positive STEMI, MI during COVID, STEMI and COVID, STEMI during COVID, STEMI management, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Objective: To find out differences in the presentation, management and outcomes of COVID-19 infected STEMI patients compared to age and sex-matched non-infected STEMI patients treated during the same period. Methods: This was a retrospective multicentre observational registry in which we collected data of COVID-19 positive STEMI patients from selected tertiary care hospitals across India. For every COVID-19 positive STEMI patient, two age and sex-matched COVID-19 negative STEMI patients were enrolled as control. The primary endpoint was a composite of in-hospital mortality, re-infarction, heart failure, and stroke. Results: 410 COVID-19 positive STEMI cases were compared with 799 COVID-19 negative STEMI cases. The composite of death/reinfarction/stroke/heart failure was significantly higher among the COVID-19 positive STEMI patients compared with COVID-19 negative STEMI cases (27.1% vs 20.7% p value = 0.01); though mortality rate did not differ significantly (8.0% vs 5.8% p value = 0.13). Significantly lower proportion of COVID-19 positive STEMI patients received reperfusion treatment and primary PCI (60.7% vs 71.1% p value=< 0.001 and 15.4% vs 23.4% p value = 0.001 respectively). Rate of systematic early PCI (pharmaco-invasive treatment) was significantly lower in the COVID-19 positive group compared with COVID-19 negative group. There was no difference in the prevalence of high thrombus burden (14.5% and 12.0% p value = 0.55 among COVID-19 positive and negative patients respectively) Conclusions: In this large registry of STEMI patients, we did not find significant excess in in-hospital mortality among COVID-19 co-infected patients compared with non-infected patients despite lower rate of primary PCI and reperfusion treatment, though composite of in-hospital mortality, re-infarction, stroke and heart failure was higher.

Published
2023
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46. Left main coronary artery diameter – A correlation between intravascular ultrasound and quantitative coronary angiography

Author

Pravin K. Goel, Parshva Liladhar Vora, Ankit Kumar Sahu, and Roopali Khanna

Subjects
Coronary artery diameter, Intravascular ultrasound, Quantitative coronary angiography, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Coronary angiography mostly underestimates coronary artery size. Indian data is scarce on correlating quantitative angiographic coronary diameter (DQCA) to intravascular ultrasound derived coronary diameter (DIVUS). We retrospectively analyzed 10-year data (2008–2017) of patients undergoing IVUS guided left main percutaneous coronary intervention (LM-PCI). LM, ostio-proximal LAD (op-LAD), and ostio-proximal LCX (op-LCX) were analyzed in 186, 177 and 44 patients, respectively. A linear correlation was noted between D IVUS and D QCA with derived equations for LM DIVUS = 1.68 + 0.69 × DQCA, op-LAD DIVUS = 1.91 + 0.53 × DQCA, op- LCX DIVUS = 1.93 + 0.49 × DQCA. We conclude that our equations could be used for an approximate estimation of true vessel size in the absence of IVUS assessment.

Published
2021
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47. Acromegaly: Cardiovascular risk factors, cardiovascular manifestations and early vascular alterations in relation to disease activity

Author

Mullusoge Mariappa Harsha, Satyendra Tewari, Sushil Kumar Gupta, Roopali Khanna, Sudeep Kumar, Naveen Garg, Aditya Kapoor, and Pravin K. Goel

Subjects
Acromegaly, CIMT, Flow mediated dilatation, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Acromegaly is associated with increased cardiovascular morbidity and mortality. 49 acromegaly patients were evaluated for presence of cardiovascular risk factors and manifestations using 2D-Echocardiography, strain, strain-rate, carotid intima media thickness (CIMT) and flow mediated dilatation (FMD) and correlated with disease activity. 32 patients with growth hormone (GH) level >1 ng/ml were considered active. Patients with active disease have more LV dysfunction as assessed by strain(p-0.031) and strain rate(p-0.001); trend towards lower ejection fraction(p-0.11) with significant correlation to GH(cc −0.252,p-0.05). Patient with active disease have reduced FMD(p- 0.042); with no difference in prevalence of cardiovascular risk factors and CIMT inrelation to disease activity.

Published
2021
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48. Maternal and fetal outcomes in pregnant females with rheumatic heart disease

Author

Roopali Khanna, Deepti Chandra, Sangeeta Yadav, Ankit Sahu, Neeta Singh, Sudeep Kumar, Naveen Garg, Satyendra Tewari, Aditya Kapoor, Mandakini Pradhan, and Pravin K. Goel

Subjects
Rheumatic heart disease, Pregnancy, Balloon mitral valvotomy, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: Cardiac diseases are seen in 1–3% of pregnancies. In developing countries rheumatic heart disease (RHD) contributes a major cause of cardiac disorders. Objective: To study the maternal and fetal outcome in women with valvular heart disease or prosthetic heart valve replacement secondary to RHD in a tertiary care center. Method: The consecutive pregnant women with RHD attending our institute from May 2018 to August 2019 were included. A maternal adverse outcome was defined as cardiac death, new onset arrhythmia, heart failure, thromboembolic event, hospitalization for other cardiac reasons or cardiac intervention, aortic dissection, infective endocarditis and acute coronary syndrome. Fetal adverse outcome defined as fetal death, preterm birth, and low birth weight. Result: Total 80 patients were included in this study, native RHD in 60(75%) and 20(25%) had mechanical prosthetic valve replacement. Maternal adverse event occurred in 34(42.5%), comprising of death in 1(1.2%), new onset AF 2(2.5%), 20(25%) underwent balloon mitral valvotomy, 3(3.7%) underwent mitral valve replacement, heart failure hospitalization in 7(8.7%). 1(1.2%) patient developed mitral valve infective endocarditis. Preterm delivery occurred in 19(23.7%), 7(8.7%) abortions and 1(1.2%) intrauterine death. Fetuses with low birth weight were 43(53.7%). Pregnancy with live birth occurred in 57(95%) women with valvular heart disease but no prosthesis and 16(80%) women with prosthetic valve disease. Conclusion: Women with rheumatic heart disease carry a high risk both for mother and fetus. Early diagnosis, close follow-up during pregnancy, early recognition of deterioration in symptoms and timely cardiac intervention can lead to good maternal or fetal outcome.

Published
2021
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49. Intravascular lithotripsy in heavily calcified unprotected left main with involvement of LAD ostium taking-off at extreme angulation - Taking upon an ‘Armageddon’

Author

Pravin K. Goel and Ankit Kumar Sahu

Subjects
Coronary calcification, Intravascular lithotripsy, Left main disease, Multivessel PCI, Difficult wiring, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Calcific left main disease poses a tricky situation for various atherectomy devices including rota-ablation, orbital and directional atherectomy. However, with the advent of intravascular lithotripsy (IVL) in the armamentarium for complex percutaneous coronary intervention (PCI), left main calcium has been relatively easier to tackle. We encountered one of such situation wherein calcific left main disease along with ostial left anterior descending (LAD) artery involvement had to be dealt with in addition to the challenge faced in wiring LAD due to a peculiar anatomical hindrance. To the best of our knowledge, this wiring trick is not described in the literature yet.

Published
2021
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50. Transcatheter heart valve implant in bicuspid aortic valves with large annuli

Author

Pravin K. Goel, Roopali Khanna, Ankit Kumar Sahu, and Neeraj Jain

Subjects
Transcatheter aortic valve implantation, Bicuspid aortic valve, Large aortic annulus, Cardiovascular computed tomography, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

We describe our initial experience with four consecutive cases of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) anatomy with an annular perimeter in range of 100 mm which is beyond the range of any of the recommended sizes as per instructions for use (IFU) for an appropriate size valve from any of the commercially existing makes of transcatheter valves. The techniques used and principles applied for doing a successful transcatheter procedure in these cases are presented.

Published
2021
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