90 results on '"Asthana AK"'
Search Results
2. Evaluation of Race by Cranial Index of Adult Human Skull in Maharastra Population
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Howale, DS, Mishra, A, Asthana, AK, Sharma, D, and Gaikwad, PG
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- 2012
- Full Text
- View/download PDF
3. Standardisation of intestinal ultrasound scoring in clinical trials for luminal Crohn's disease
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Goodsall, TM, Jairath, V, Feagan, BG, Parker, CE, Nguyen, TM, Guizzetti, L, Asthana, AK, Begun, J, Christensen, B, Friedman, AB, Kucharzik, T, Lee, A, Lewindon, PJ, Maaser, C, Novak, KL, Rimola, J, Taylor, KM, Taylor, SA, White, LS, Wilkens, R, Wilson, SR, Wright, EK, Bryant, RV, Ma, C, Goodsall, TM, Jairath, V, Feagan, BG, Parker, CE, Nguyen, TM, Guizzetti, L, Asthana, AK, Begun, J, Christensen, B, Friedman, AB, Kucharzik, T, Lee, A, Lewindon, PJ, Maaser, C, Novak, KL, Rimola, J, Taylor, KM, Taylor, SA, White, LS, Wilkens, R, Wilson, SR, Wright, EK, Bryant, RV, and Ma, C
- Abstract
BACKGROUND: Intestinal ultrasound (IUS) is a valuable tool for assessment of Crohn's disease (CD). However, there is no widely accepted luminal disease activity index. AIMS: To identify appropriate IUS protocols, indices, items, and scoring methods for measurement of luminal CD activity and integration of IUS in CD clinical trials. METHODS: An expert international panel of adult and paediatric gastroenterologists (n = 15) and radiologists (n = 3) rated the appropriateness of 120 statements derived from literature review and expert opinion (scale of 1-9) using modified RAND/UCLA methodology. Median panel scores of 1 to ≤3.5, >3.5 to <6.5 and ≥6.5 to 9 were considered inappropriate, uncertain and appropriate ratings respectively. The statement list and survey results were discussed prior to voting. RESULTS: A total of 91 statements were rated appropriate with agreement after two rounds of voting. Items considered appropriate measures of disease activity were bowel wall thickness (BWT), vascularity, stratification and mesenteric inflammatory fat. There was uncertainty if any of the existing IUS disease activity indices were appropriate for use in CD clinical trials. Appropriate trial applications for IUS included patient recruitment qualification when diseased segments cannot be adequately assessed by ileocolonoscopy and screening for exclusionary complications. At outcome assessment, remission endpoints including BWT and vascularity, with or without mesenteric inflammatory fat, were considered appropriate. Components of an ideal IUS disease activity index were identified based upon panel discussions. CONCLUSIONS: The panel identified appropriate component items and applications of IUS for CD clinical trials. Empiric evidence, and development and validation of an IUS disease activity index are needed.
- Published
- 2021
4. A double-blind placebo-controlled trial of azithromycin to reduce mortality and improve growth in high-risk young children with non-bloody diarrhoea in low resource settings: the Antibiotics for Children with Diarrhoea (ABCD) trial protocol
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Alam, T, Ahmed, D, Ahmed, T, Chisti, MJ, Rahman, MW, Asthana, AK, Bansal, PK, Chouhan, A, Deb, S, Dhingra, P, Dhingra, U, Dutta, A, Jaiswal, VK, Kumar, J, Pandey, A, Sazawal, S, Sharma, AK, McGrath, C, Nyabinda, C, Okello, M, Pavlinac, PB, Singa, B, Walson, JL, Bar-Zeev, N, Dube, Q, Freyne, B, Ndamala, C, Ndeketa, L, Badji, H, Booth, JP, Coulibaly, F, Haidara, F, Kotloff, K, Malle, D, Mehta, A, Sow, S, Tapia, M, Tennant, S, Hotwani, A, Kabir, F, Qamar, F, Qureshi, S, Shakoor, S, Thobani, R, Yousufzai, MT, Bakari, M, Duggan, C, Kibwana, U, Kisenge, R, Manji, K, Somji, S, Sudfeld, C, Ashorn, P, Bahl, R, De Costa, A, Simon, J, and Team, ABCD Study
- Subjects
Male ,Pediatrics ,Time Factors ,Antibiotics ,Placebo-controlled study ,Medicine (miscellaneous) ,Organism Hydration Status ,Growth ,030204 cardiovascular system & hematology ,Azithromycin ,Randomised ,Study Protocol ,0302 clinical medicine ,Child Development ,Risk Factors ,Infant Mortality ,Multicenter Studies as Topic ,Pharmacology (medical) ,030212 general & internal medicine ,Infant Nutritional Physiological Phenomena ,Randomized Controlled Trials as Topic ,2. Zero hunger ,lcsh:R5-920 ,Dehydration ,Age Factors ,Dysentery ,Water-Electrolyte Balance ,Cholera ,Paediatric diarrhoea ,Infant Nutrition Disorders ,3. Good health ,Anti-Bacterial Agents ,Treatment Outcome ,Female ,lcsh:Medicine (General) ,medicine.drug ,Diarrhea ,medicine.medical_specialty ,medicine.drug_class ,Nutritional Status ,Placebo ,Risk Assessment ,03 medical and health sciences ,Antibiotic resistance ,Double-Blind Method ,medicine ,Asia, Western ,Humans ,Mortality ,Developing Countries ,Africa South of the Sahara ,business.industry ,Malnutrition ,Infant ,medicine.disease ,business - Abstract
Background Acute diarrhoea is a common cause of illness and death among children in low- to middle-income settings. World Health Organization guidelines for the clinical management of acute watery diarrhoea in children focus on oral rehydration, supplemental zinc and feeding advice. Routine use of antibiotics is not recommended except when diarrhoea is bloody or cholera is suspected. Young children who are undernourished or have a dehydrating diarrhoea are more susceptible to death at 90 days after onset of diarrhoea. Given the mortality risk associated with diarrhoea in children with malnutrition or dehydrating diarrhoea, expanding the use of antibiotics for this subset of children could be an important intervention to reduce diarrhoea-associated mortality and morbidity. We designed the Antibiotics for Childhood Diarrhoea (ABCD) trial to test this intervention. Methods ABCD is a double-blind, randomised trial recruiting 11,500 children aged 2–23 months presenting with acute non-bloody diarrhoea who are dehydrated and/or undernourished (i.e. have a high risk for mortality). Enrolled children in Bangladesh, India, Kenya, Malawi, Mali, Pakistan and Tanzania are randomised (1:1) to oral azithromycin 10 mg/kg or placebo once daily for 3 days and followed-up for 180 days. Primary efficacy endpoints are all-cause mortality during the 180 days post-enrolment and change in linear growth 90 days post-enrolment. Discussion Expanding the treatment of acute watery diarrhoea in high-risk children to include an antibiotic may offer an opportunity to reduce deaths. These benefits may result from direct antimicrobial effects on pathogens or other incompletely understood mechanisms including improved nutrition, alterations in immune responsiveness or improved enteric function. The expansion of indications for antibiotic use raises concerns about the emergence of antimicrobial resistance both within treated children and the communities in which they live. ABCD will monitor antimicrobial resistance. The ABCD trial has important policy implications. If the trial shows significant benefits of azithromycin use, this may provide evidence to support reconsideration of antibiotic indications in the present World Health Organization diarrhoea management guidelines. Conversely, if there is no evidence of benefit, these results will support the current avoidance of antibiotics except in dysentery or cholera, thereby avoiding inappropriate use of antibiotics and reaffirming the current guidelines. Trial registration Clinicaltrials.gov, NCT03130114. Registered on April 26 2017.
- Published
- 2020
5. Reactivation of latent viruses after treatment with biological therapies
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Asthana AK and Lubel JS
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lcsh:QR1-502 ,lcsh:Microbiology - Abstract
Anil Kumar Asthana,1 John Samuel Lubel2,31Department of Gastroenterology, The Alfred Hospital, Melbourne, 2Department of Gastroenterology and Hepatology, Eastern Health, 3Eastern Health Clinical School, Monash University, Melbourne, VIC, AustraliaAbstract: Biological therapies are used extensively for malignant (eg, lymphoma) and autoimmune (eg, rheumatoid arthritis) conditions. These agents include anti-tumor necrosis factor antagonists, such as infliximab, and B-cell-depleting therapies, such as rituximab. In the past decade, there has been an explosion in the types and numbers of agents being used. One of the known risks with these agents is infection. In particular, there is increasing awareness regarding latent virus reactivation. This occurs when a latent virus is reactivated into its active replicative phase as a result of an internal or external trigger, such as immunosuppression. It is challenging, however, to quantitatively attribute the risk of reactivation to biological therapy alone because the underlying malignant or autoimmune condition could also be a contributing factor. There is well documented evidence regarding the reactivation of viruses such as hepatitis B virus and cytomegalovirus with drugs such as rituximab. Long-term data are lacking; such data are essential to guide risk stratification and chemoprophylaxis. Universally accepted viral screening guidelines prior to commencement of immunosuppression are lacking. As an example, the US Centers for Disease Control and Prevention have published recommendations regarding hepatitis B virus screening prior to commencing immunosuppression, but this action has not translated into universally accepted guidelines. Some of the other relevant viruses involved include cytomegalovirus, hepatitis C virus, varicella zoster virus, Epstein–Barr virus, and other members of the herpes family. This article reviews the current literature on the risk of latent viral reactivation with biological therapy, such as anti-tumor necrosis factor and anti-B-cell drugs, with an emphasis on autoimmune conditions.Keywords: latent viruses, autoimmune conditions, biological therapies, reactivation
- Published
- 2014
6. Retrospective analysis of patients with cancer of the cervix attending a radiotherapy outpatient department: experience from a university-based hospital in eastern Uttar Pradesh, India
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Nandi, M, primary, Mandal, A, additional, and Asthana, AK, additional
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- 2015
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7. Mixed pulmonary infection in an immunocompromised patient: A rare case report
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Qureshi, S, primary, Pandey, A, additional, Sirohi, TR, additional, Verma, SR, additional, Sardana, V, additional, Agrawal, C, additional, Asthana, AK, additional, and Madan, M, additional
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- 2014
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8. Accidental intestinal myiasis caused by genus Sarcophaga
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Das, A, primary, Pandey, A, additional, Madan, M, additional, Asthana, AK, additional, and Gautam, A, additional
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- 2010
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9. Sedimentation Method, A Good Alternative to Centrifugation for Concentration of Acid Fast Bacilli in Developing Countries: A Preliminary Study from Western Uttar Pradesh
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Pandey, A, primary and Asthana, AK, additional
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- 2009
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10. PULMONARY HYDATIDOSIS: AN UNUSUAL CAUSE OF HAEMOPTYSIS
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Pandey, A, primary, Arya, CL, additional, and Asthana, AK, additional
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- 2007
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11. Vancomycin-resistant Enterococcus faecium: Report of two cases
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Ahuja, S, Pandey, A, Asthana, AK, Chauhan, K, Ritika, and Madan, M
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- 2014
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12. Neonatal candidemia: A changing trend.
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Sardana V, Pandey A, Madan M, Goel SP, and Asthana AK
- Published
- 2012
13. Beta-lactamase producing Acinetobacter species in hospitalized patients.
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Kansal R, Pandey A, and Asthana AK
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- 2009
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14. Unveiling the molecular mechanisms of arsenic tolerance and resilience in the primitive bryophyte Marchantia polymorpha L.
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Dutta P, Prasad P, Indoilya Y, Gautam N, Kumar A, Sahu V, Kumari M, Singh S, Asthana AK, Bag SK, and Chakrabarty D
- Subjects
- Ecosystem, Saccharomyces cerevisiae, Arsenic toxicity, Marchantia genetics, Resilience, Psychological, Bryophyta
- Abstract
This study addresses the pressing issue of high arsenic (As) contaminations, which poses a severe threat to various life forms in our ecosystem. Despite this prevailing concern, all organisms have developed some techniques to mitigate the toxic effects of As. Certain plants, such as bryophytes, the earliest land plants, exhibit remarkable tolerance to wide range of harsh environmental conditions, due to their inherent competence. In this study, bryophytes collected from West Bengal, India, across varying contamination levels were investigated for their As tolerance capabilities. Assessment of As accumulation potential and antioxidant defense efficiency, including SOD, CAT, APX, GPX etc. revealed Marchantia polymorpha as the most tolerant species. It exhibited highest As accumulation, antioxidative proficiency, and minimal damage. Transcriptomic analysis of M. polymorpha exposed to 40 μM As(III) for 24 and 48 h identified several early responsive differentially expressing genes (DEGs) associated with As tolerance. These includes GSTs, GRXs, Hsp20s, SULTR1;2, ABCC2 etc., indicating a mechanism involving vacuolar sequestration. Interestingly, one As(III) efflux-transporter ACR3, an extrusion pump, known to combat As toxicity was found to be differentially expressed compared to control. The SEM-EDX analysis, further elucidated the operation of As extrusion mechanism, which contributes added As resilience in M. polymorpha. Yeast complementation assay using Δacr3 yeast cells, showed increased tolerance towards As(III), compared to the mutant cells, indicating As tolerant phenotype. Overall, these findings significantly enhance our understanding of As tolerance mechanisms in bryophytes. This can pave the way for the development of genetically engineered plants with heightened As tolerance and the creation of improved plant varieties., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)
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- 2024
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15. Evaluation of survival outcomes and prognostic factors of carcinoma anal canal at a tertiary cancer center.
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Mishra H, Mishra R, Singh A, Mandal A, Singh TB, and Asthana AK
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- Humans, Middle Aged, Prognosis, Disease-Free Survival, Progression-Free Survival, Anal Canal, Carcinoma, Squamous Cell therapy
- Abstract
Context: Concurrent chemoradiotherapy is considered a standard of care for patients with carcinoma anal canal. Being an unusual malignancy, there is limited Indian data regarding survival outcomes and prognostic factors., Aim: To evaluate survival outcomes and associated prognostic factors in patients with carcinoma anal canal treated with radical intent., Methods and Material: Patients with squamous cell carcinoma of the anal canal, treated with radical intent between 2015 and 2019 were included in the study. Data regarding the baseline characteristics of the patients and treatment outcomes were collected and analyzed. Survival rates were estimated using Kaplan-Meier method. To determine survival difference between the groups, log-rank test was used. Multivariate analyses were performed with Cox proportional hazard models and P value < 0.05 was considered significant., Results: Forty-two patients were identified after applying suitable eligibility criteria. The median age was 55 years (range: 26-80 years).The median follow-up duration was 23.5 months (range: 1.9-51.9 months). The 3-year overall survival (OS), disease-free survival (DFS), and locoregional (LRC) were 78.5%, 53.1%, and 66.4%, respectively. On multivariate analysis, inferior DFS was significantly affected by lack of concurrent chemotherapy (CT) (hazard ratio [HR], 11.50; 95% confidence interval [CI], 1.92-68.78; P = 0.007) and radiotherapy (RT) dose of 45 Gy or less (HR, 35.96; 95% CI, 6.32-204.56; P = 0.000)., Conclusion: For patients of carcinoma anal canal, concurrent CT and RT dose are independent prognostic factors influencing DFS., (Copyright © 2023 Copyright: © 2023 Journal of Cancer Research and Therapeutics.)
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- 2023
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16. Clinico-epidemiological profile and treatment outcome in adolescents and young patients of rectal cancer attending a tertiary cancer center.
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Mishra R, Pandey A, Mishra H, Singh TB, Mandal A, and Asthana AK
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- Young Adult, Humans, Adolescent, Aged, Adult, Retrospective Studies, Treatment Outcome, Administration, Rectal, Gastrointestinal Hemorrhage epidemiology, Gastrointestinal Hemorrhage etiology, Rectal Neoplasms epidemiology, Rectal Neoplasms therapy
- Abstract
Introduction: The incidence of colorectal cancer in young adults is on an increasing trend. It is observed that this subgroup of patients has an aggressive disease and carries a poorer prognosis compared to its older counterpart. This study aimed to analyze the incidence, treatment outcome, and prognostic factors in adolescents and young adults with rectal cancer attending a tertiary cancer center in North India., Materials and Methods: We retrospectively analyzed 50 patients of histologically proven rectal cancer, aged up to 30 years, treated at our center between 2015 and 2019. The clinical, demographic, and pathological parameters were studied in all these patients. Kaplan-Meier survival analysis was used to find out survival. Univariate analysis was performed to assess prognostic factors., Results: The incidence was 26.4% at our center with a median age of 28 years. Bleeding per rectum was the commonest complaint. Most of them had signet ring cell histology (26%). The median overall survival was 16 months. Survival was significantly better in patients having bleeding per rectum as an initial complaint (P = 0.009), absence of lymphovascular invasion (LVI) (P = 0.005), and perineural invasion (PNI) (P = 0.002), who received complete planned treatment compared to patients who could not receive either of the modality (P < 0.001). Patients who did not receive radiotherapy (RT) had the worst outcomes compared to those who received RT in any form. RT dose of 50.4 Gy was found to be superior as compared to other schedules. There was no significant difference in survival with gender, tumor stage, grade, type of surgery, or chemotherapy regimen., Conclusion: The majority of patients presented in an advanced stage. Therefore, bleeding per rectum should be properly and timely investigated in all these young patients. Early detection and complete treatment are paramount to improving the outcome., (Copyright © 2023 Copyright: © 2023 Journal of Cancer Research and Therapeutics.)
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- 2023
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17. Influence of adjuvant therapy on pattern of failure and survival in curatively resected gallbladder carcinoma.
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Choudhary S, Gupta N, Verma CP, Das A, Aggarwal LM, Tewari M, Mandal A, and Asthana AK
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- Adult, Aged, Combined Modality Therapy, Female, Follow-Up Studies, Gallbladder Neoplasms pathology, Gallbladder Neoplasms therapy, Humans, India, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local therapy, Prognosis, Retrospective Studies, Survival Rate, Young Adult, Chemotherapy, Adjuvant methods, Cholecystectomy methods, Gallbladder Neoplasms mortality, Neoplasm Recurrence, Local mortality, Radiotherapy, Adjuvant methods
- Abstract
Purpose: The study was done to evaluate the role of adjuvant therapy in curatively resected Stage II and III gallbladder carcinoma (GBC)., Materials and Methods: This was a retrospective analysis of patients of GBC registered between 2008 and 2017 in outpatient department of a tertiary cancer hospital in India. Patients who had any of the following adjuvant treatment after radical surgery: (a) external beam radiotherapy (RT) alone, (b) chemotherapy (CT) alone, and (c) RT with CT (CRT) were considered for the study., Results: A total of fifty patients could meet the selection criteria. It was seen that seven patients were treated with RT, 20 with CT, and 23 with CRT. Median follow-up for patients who were alive was 26.7 months. Nineteen patients had locoregional failure while eight had distant failure. Patients treated with CRT had a significantly better mean overall survival compared to those treated with RT or CT (44.0 months, 12.5 months, and 15.1 months, respectively; P = 0.003). Similarly, mean disease-free survival was superior in CRT arm compared to RT and CT arms (43.6 months, 9.6 months, and 12.4 months, respectively; P = 0.002)., Conclusions: Adjuvant CRT had better survival outcome compared to patients treated with either RT or CT with Stage II and III disease after curative cholecystectomy., Competing Interests: None
- Published
- 2021
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18. Standardisation of intestinal ultrasound scoring in clinical trials for luminal Crohn's disease.
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Goodsall TM, Jairath V, Feagan BG, Parker CE, Nguyen TM, Guizzetti L, Asthana AK, Begun J, Christensen B, Friedman AB, Kucharzik T, Lee A, Lewindon PJ, Maaser C, Novak KL, Rimola J, Taylor KM, Taylor SA, White LS, Wilkens R, Wilson SR, Wright EK, Bryant RV, and Ma C
- Subjects
- Adult, Child, Humans, Intestines, Reference Standards, Ultrasonography, Crohn Disease diagnostic imaging
- Abstract
Background: Intestinal ultrasound (IUS) is a valuable tool for assessment of Crohn's disease (CD). However, there is no widely accepted luminal disease activity index., Aims: To identify appropriate IUS protocols, indices, items, and scoring methods for measurement of luminal CD activity and integration of IUS in CD clinical trials., Methods: An expert international panel of adult and paediatric gastroenterologists (n = 15) and radiologists (n = 3) rated the appropriateness of 120 statements derived from literature review and expert opinion (scale of 1-9) using modified RAND/UCLA methodology. Median panel scores of 1 to ≤3.5, >3.5 to <6.5 and ≥6.5 to 9 were considered inappropriate, uncertain and appropriate ratings respectively. The statement list and survey results were discussed prior to voting., Results: A total of 91 statements were rated appropriate with agreement after two rounds of voting. Items considered appropriate measures of disease activity were bowel wall thickness (BWT), vascularity, stratification and mesenteric inflammatory fat. There was uncertainty if any of the existing IUS disease activity indices were appropriate for use in CD clinical trials. Appropriate trial applications for IUS included patient recruitment qualification when diseased segments cannot be adequately assessed by ileocolonoscopy and screening for exclusionary complications. At outcome assessment, remission endpoints including BWT and vascularity, with or without mesenteric inflammatory fat, were considered appropriate. Components of an ideal IUS disease activity index were identified based upon panel discussions., Conclusions: The panel identified appropriate component items and applications of IUS for CD clinical trials. Empiric evidence, and development and validation of an IUS disease activity index are needed., (© 2021 John Wiley & Sons Ltd.)
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- 2021
- Full Text
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19. Search of an ideal location of isocenter in intensity-modulated radiotherapy treatment plans: A dosimetrical approach.
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Mandal A, Asthana AK, Pradhan S, Shahi UP, and Choudhary S
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- Algorithms, Humans, Neoplasms radiotherapy, Patient Positioning, Phantoms, Imaging, Radiometry, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted methods, Radiotherapy, Intensity-Modulated methods
- Abstract
Aim: The aim of this study is to identify an ideal location of isocenter in intensity-modulated radiotherapy (IMRT) treatment plans., Materials and Methods: A total of 28 clinical target volumes and 4 English capital letters (C, L, T, and H) target volumes were considered in this study. Two IMRT treatment plans were generated for each target volume in the ECLIPSE
TM treatment planning system (TPS), first one with isocenter automatically placed (ISOAUTO ) by TPS and the second one with geometric center-based isocenter (ISOGEOM ). The geometric center of a cuboid volume, which was formed encompassing around the target volume in sagittal, transverse, and frontal planes, is considered as the geometric center of the target volume as well as the isocenter (ISOGEOM ) of the IMRT plans. While performing the IMRT treatment plans using the beam angle optimization and dose volume optimization, the normal tissue objectives and target volume objectives were kept similar in both the plans. The dosimetrical parameters between the two groups of plans were compared., Results: The distance between ISOGEOM and ISOAUTO ranged from 0.16 cm to 3.04 cm with a mean and median of 0.85 cm and 0.69 cm, respectively. The ISOGEOM -based IMRT plans exhibited statistically significant advantages in total monitor units reduction (100% of cases, P ≤ 0.001), total number of field reduction (66% of cases, P ≤ 0.001), and reduction of patient mean dose (69% of cases, P ≤ 0.001) over ISOAUTO -based IMRT plans. The conformity index, homogeneity index and target mean dose were comparable between both group of plans., Conclusion: Significant dosimetrical advantages may be observed, when the geometric centroid of target volume is considered as isocenter of IMRT treatment plan., Competing Interests: None- Published
- 2019
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20. How to perform gastrointestinal ultrasound: Anatomy and normal findings.
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Atkinson NSS, Bryant RV, Dong Y, Maaser C, Kucharzik T, Maconi G, Asthana AK, Blaivas M, Goudie A, Gilja OH, Nuernberg D, Schreiber-Dietrich D, and Dietrich CF
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- Humans, Gastrointestinal Tract diagnostic imaging, Ultrasonography
- Abstract
Gastrointestinal ultrasound is a practical, safe, cheap and reproducible diagnostic tool in inflammatory bowel disease gaining global prominence amongst clinicians. Understanding the embryological processes of the intestinal tract assists in the interpretation of abnormal sonographic findings. In general terms, the examination principally comprises interrogation of the colon, mesentery and small intestine using both low-frequency and high-frequency probes. Interpretation of findings on GIUS includes assessment of bowel wall thickness, symmetry of this thickness, evidence of transmural changes, assessment of vascularity using Doppler imaging and assessment of other specific features including lymph nodes, mesentery and luminal motility. In addition to B-mode imaging, transperineal ultrasonography, elastography and contrast-enhanced ultrasonography are useful adjuncts. This supplement expands upon these features in more depth., Competing Interests: Conflict-of-interest statement: No potential conflicts of interest. No financial support.
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- 2017
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21. Transperineal Ultrasound for Perianal Fistulas and Abscesses - A Systematic Review and Meta-Analysis.
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Maconi G, Greco MT, and Asthana AK
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- Abscess classification, Adolescent, Adult, Aged, Aged, 80 and over, Anus Diseases classification, Child, Child, Preschool, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Rectal Fistula classification, Retrospective Studies, Sensitivity and Specificity, Treatment Outcome, Young Adult, Abscess diagnostic imaging, Anus Diseases diagnostic imaging, Endosonography, Rectal Fistula diagnostic imaging
- Abstract
Purpose Transperineal ultrasound (TPUS) is a practical tool for assessing perianal inflammatory lesions. We systematically review its accuracy for detecting and classifying perianal fistulae and abscesses. Method The National Library of Medicine and Embase were searched for articles on TPUS for the assessment of idiopathic and Crohn's perianal fistulae and abscesses. Two reviewers independently reviewed eligible studies and rated them for quality using the QUADAS tool. The primary outcome measure was the accuracy of TPUS as measured by its sensitivity and positive predictive value (PPV) in detecting and classifying perianal fistulae, internal openings and perianal abscesses. Results We included 12 studies (565 patients). Overall, the methodological quality of the studies was suboptimal. 3 studies were retrospective and 4 showed significant risks of bias in the application of the reference standard. The sensitivity of TPUS in detecting perianal fistulae on a per-lesion basis was 98 % (95 % CI 96 - 100 %) and the PPV was 95 % (95 % CI 90 - 98 %). The detection of internal openings had a sensitivity of 91 % (95 % CI 84 - 97 %) with a PPV of 87 % (95 % CI 76 - 95 %). The classification of fistulae yielded a sensitivity of 92 % (95 % CI 85 - 97 %) and a PPV of 92 % (95 % CI 83 - 98 %). TPUS had a sensitivity of 86 % (95 % CI 67 - 99 %) and PPV of 90 % (95 % CI 76 - 99 %) in the detection of perianal abscesses. Conclusion The current literature on TPUS illustrates good overall accuracy in the assessment of perianal fistulae and abscesses. However, many studies had methodological flaws suggesting that further research is required., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)
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- 2017
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22. How efficacious are Neem , Tulsi , Guduchi extracts and chlorhexidine as intracanal disinfectants? A comparative ex vivo study.
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Bhardwaj A, Srivastava N, Rana V, Adlakha VK, and Asthana AK
- Abstract
Introduction: In endodontics, despite careful instrumentation and antimicrobial irrigation, root canals still harbor cultivable microorganisms. Such cases require intra canal medicament that eliminates the microbial inhabitants from the canals. Recent trend advocates the use of herbal extracts due to easy availability, cost-effectiveness, low toxicity, and lack of microbial resistance. Hence, in the present study, Neem , Tulsi , and Guduchi extracts were used as intracanal medicaments., Aim: This study aimed to evaluate and compare the antibacterial efficacy of Neem , Tulsi , Guduchi extracts, and chlorhexidine against Enterococcus faecalis , when used as intracanal medicaments., Materials and Methods: One hundred and twenty-five extracted human teeth, inoculated with E. faecalis , were divided into four experimental groups and a control group ( n = 25 in each group). The experimental groups were treated with chlorhexidine, Neem , Tulsi , and Guduchi extracts and their antibacterial property was evaluated by estimating microbial counting (CFU/ml)., Results: The reduction in bacterial count for chlorhexidine, Neem , Tulsi , and Guduchi groups was 60.76%, 51.98%, 37.73%, and 34.93%, respectively. Statistically significant difference in reduction of bacterial count was observed in all the groups, when compared with the control group., Conclusion: Among all the herbal extracts, Neem was found to be the most potent medicament followed by Tulsi and Guduchi . However, chlorhexidine was found to be at epic., Competing Interests: There are no conflicts of interest.
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- 2017
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23. WFUMB Position Paper. Learning Gastrointestinal Ultrasound: Theory and Practice.
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Atkinson NS, Bryant RV, Dong Y, Maaser C, Kucharzik T, Maconi G, Asthana AK, Blaivas M, Goudie A, Gilja OH, Nolsøe C, Nürnberg D, and Dietrich CF
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- Clinical Competence, Humans, Practice Guidelines as Topic, Societies, Medical, Gastrointestinal Diseases diagnostic imaging, Gastrointestinal Tract diagnostic imaging, Ultrasonics education, Ultrasonography methods
- Abstract
Gastrointestinal ultrasound (GIUS) is an ultrasound application that has been practiced for more than 30 years. Recently, GIUS has enjoyed a resurgence of interest, and there is now strong evidence of its utility and accuracy as a diagnostic tool for multiple indications. The method of learning GIUS is not standardised and may incorporate mentorship, didactic teaching and e-learning. Simulation, using either low- or high-fidelity models, can also play a key role in practicing and honing novice GIUS skills. A course for training as well as establishing and evaluating competency in GIUS is proposed in the manuscript, based on established learning theory practice. We describe the broad utility of GIUS in clinical medicine, including a review of the literature and existing meta-analyses. Further, the manuscript calls for agreement on international standards regarding education, training and indications., (Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)
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- 2016
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24. Bio-Medical Waste Managment in a Tertiary Care Hospital: An Overview.
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Pandey A, Ahuja S, Madan M, and Asthana AK
- Abstract
Introduction: Bio-Medical Waste (BMW) management is of utmost importance as its improper management poses serious threat to health care workers, waste handlers, patients, care givers, community and finally the environment. Simultaneously, the health care providers should know the quantity of waste generated in their facility and try to reduce the waste generation in day-to-day work because lesser amount of BMW means a lesser burden on waste disposal work and cost saving., Aim: To have an overview of management of BMW in a tertiary care teaching hospital so that effective interventions and implementations can be carried out for better outcome., Materials and Methods: The observational study was carried out over a period of five months from January 2016 to May 2016 in Chhatrapati Shivaji Subharti Hospital, Meerut by the Infection Control Team (ICT). Assessment of knowledge was carried out by asking set of questions individually and practice regarding awareness of BMW Management among the Health Care Personnel (HCP) was carried out by direct observation in the workplace. Further, the total BMW generated from the present setup in kilogram per bed per day was calculated by dividing the mean waste generated per day by the number of occupied beds., Results: Segregation of BMW was being done at the site of generation in almost all the areas of the hospital in color coded polythene bags as per the hospital protocol. The different types of waste being collected were infectious solid waste in red bag, soiled infectious waste in yellow bag and sharp waste in puncture proof container and blue bag. Though awareness (knowledge) about segregation of BMW was seen in 90% of the HCP, 30%-35% did not practice. Out of the total waste generated (57912 kg.), 8686.8 kg. (15%) was infectious waste. Average infectious waste generated was 0.341 Kg per bed per day. The transport, treatment and disposal of each collected waste were outsourced and carried out by 'Synergy' waste management Pvt. Ltd., Conclusion: The practice of BMW Management was lacking in 30-35% HCP which may lead to mixing of the 15% infectious waste with the remaining non-infectious. Therefore, training courses and awareness programs about BMW management will be carried out every month targeting smaller groups.
- Published
- 2016
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25. Novel association of achalasia with hereditary sensory and motor neuropathy with sensorineural deafness.
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Asthana AK, Lubel JS, and Kohn GP
- Subjects
- Adolescent, Esophageal Achalasia diagnosis, Esophageal Achalasia physiopathology, Esophageal Achalasia therapy, Esophageal Sphincter, Lower physiopathology, Esophageal Sphincter, Lower surgery, Humans, Male, Manometry, Esophageal Achalasia complications, Hearing Loss, Sensorineural complications, Hereditary Sensory and Motor Neuropathy complications, Twins, Monozygotic
- Abstract
Achalasia is a primary esophageal motility disorder. Unlike diffuse esophageal spasm, it has not previously been described in association with hereditary sensory and motor neuropathy (HSMN). An 18-year-old-male with HSMN with sensorineural deafness presented with a 2-day history of dysphagia to solids and liquids. Achalasia was diagnosed after extensive investigations, and his symptoms resolved with endoscopic and definitive surgical management. His monozygotic twin brother had also been diagnosed with HSMN and suffered from chronic dysphagia, which was also subsequently diagnosed with achalasia. This is the first case to illustrate an association between HSMN with sensorineural deafness and achalasia., (© 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.)
- Published
- 2016
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26. Intestinal ultrasound in inflammatory bowel disease.
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Asthana AK
- Subjects
- Humans, Inflammatory Bowel Diseases diagnostic imaging, Intestines diagnostic imaging, Ultrasonography methods
- Published
- 2016
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27. Splanchnic Hemodynamics and Intestinal Vascularity in Crohn's Disease: An In Vivo Evaluation Using Doppler and Contrast-Enhanced Ultrasound and Biochemical Parameters.
- Author
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Maconi G, Asthana AK, Bolzacchini E, Dell'Era A, Furfaro F, Bezzio C, Salvatore V, and Maier JA
- Subjects
- Adolescent, Adult, Blood Flow Velocity physiology, Crohn Disease blood, Crohn Disease physiopathology, Female, Hemodynamics physiology, Humans, Intestines blood supply, Intestines physiopathology, Male, Mesenteric Artery, Superior diagnostic imaging, Mesenteric Artery, Superior physiopathology, Middle Aged, Nitric Oxide blood, Tumor Necrosis Factor-alpha blood, Vascular Endothelial Growth Factor A blood, Young Adult, Contrast Media, Crohn Disease diagnostic imaging, Image Enhancement, Intestines diagnostic imaging, Splanchnic Circulation physiology, Ultrasonography, Doppler
- Abstract
Crohn's disease (CD) is characterized by inflammation and angiogenesis of affected bowel. We evaluated the correlation among vascularity of intestinal wall in CD, splanchnic hemodynamics, clinical activity and biochemical parameters of inflammation and angiogenesis. Sixteen patients with ileal CD and 10 healthy controls were investigated by means of Doppler ultrasound of the superior mesenteric artery and color Doppler and contrast-enhanced ultrasound of the ileal wall. In parallel, serum levels of vascular endothelial growth factor, tumor necrosis factor-α (TNF-α) and nitric oxide, before and 30 min after a standard meal, were evaluated. In CD patients, there was a significant post-prandial reduction in the resistance index and pulsatility index of the superior mesenteric artery, associated with increased levels of nitric oxide and decreased amounts of TNF-α. A correlation was observed between vascular endothelial growth factor and contrast-enhanced ultrasound parameters of intestinal wall vascularity (r = 0.63-0.71, p < 0.05) and between these parameters and superior mesenteric artery blood flow after fasting (resistance and pulsatility indexes: r = -0.64 and -0.72, p < 0.05). Our results revealed a post-prandial increase in nitric oxide and decrease in TNF-α in CD patients in vivo. They also confirm the role of vascular endothelial growth factor in angiogenesis and in pathologic vascular remodeling of CD and its effect on splanchnic blood flow., (Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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28. Irritable bowel syndrome in quiescent inflammatory bowel disease: a review.
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Burgell RE, Asthana AK, and Gibson PR
- Subjects
- Brain physiology, Humans, Hypothalamo-Hypophyseal System physiology, Inflammatory Bowel Diseases therapy, Intestines innervation, Intestines microbiology, Irritable Bowel Syndrome therapy, Microbiota, Pituitary-Adrenal System physiology, Quality of Life, Inflammatory Bowel Diseases physiopathology, Irritable Bowel Syndrome physiopathology
- Abstract
Ongoing troublesome bowel symptoms despite quiescent inflammatory disease are a frequent management challenge when caring for patients with inflammatory bowel disease (IBD). Even when active disease has been excluded the prevalence of residual gastrointestinal symptoms is surprisingly high and the cause often obscure. The presence of a concurrent functional disorder such as irritable bowel syndrome (IBS) is associated with worse quality of life, worse physical functioning, higher prevalence of anxiety and greater health care utilization. Potential etiological mechanisms leading to the development of IBS like symptoms include the development of visceral hypersensitivity following the original inflammatory insult, alteration in cortical processing, dysbiosis and residual subacute inflammation. Therapeutic options for managing IBS in patients with IBD include dietary modification, interventions targeted at correction of visceral sensory dysfunction or cortical processing and modulation of the gut microbiota. As there are few studies specifically examining the treatment of IBS in patients with IBD, the majority of therapeutic interventions are extrapolated from the IBS literature. Given the frequency of residual functional symptoms in IBS, significantly more research is warranted in this field.
- Published
- 2015
29. Impact of Adjuvant Therapy on Survival in Curatively Resected Gallbladder Carcinoma.
- Author
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Choudhary S and Asthana AK
- Abstract
Background: Gallbladder carcinoma (GBC) has the propensity to fail at loco-regional (LR) and distant sites despite aggressive radical surgery. Adjuvant therapy in the form of radiotherapy (RT), systemic chemotherapy (CT) and chemoradiation (CRT) is the usual practice. Due to rarity of this disease, there is limited evidence to suggest the type of adjuvant treatment which should be offered to the patients., Aim: The study was conducted to evaluate the impact of adjuvant treatment on curatively resected GBC patients., Settings and Design: Histological proven patients of GBC registered between June, 2008 and July, 2014 were identified from our hospital database and retrospective analysis was done., Materials and Methods: Patients of GBC who had curative resection followed by adjuvant treatment as RT alone, CT alone or CRT were included in the study., Statistical Analysis: Adverse prognostic factors and the effect of adjuvant treatment on overall survival (OS) and disease free survival (DFS) were evaluated using Cox Regression Method and Kaplan Meier plot., Results: We identified 33 patients of which 23 were Stage I or II disease (Early disease) and the remaining 10 were Stage III or IV disease (Advanced disease). All except one patient had adenocarcinoma. A total of 5 patients were treated with RT alone while 16 patients received CT alone. The remaining 12 patients were treated with CRT. Median follow-up period was 8.5 months. At analysis 4 were alive while the remaining 29 were dead due to disease. With regard to "Early disease" patients who had RT alone, CT alone and CRT, the median OS was 22.3, 10.3 and 15.2 months respectively (p = .440). Cohort of patients with "Advanced disease" who were treated with CT alone and CRT the median OS was 7.5 and 7.0 months respectively (p = .643). On multivariate analysis none of the prognostic factors had an adverse impact on survival., Conclusion: The impact of adjuvant treatment in the form of RT, CT or CRT after curative resection in GBC patients was seen in terms of improved survival but was not statistically significant.
- Published
- 2015
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30. The impact of symptoms, irritable bowel syndrome pattern and diagnostic investigations on the diagnostic delay of Crohn's disease: A prospective study.
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Maconi G, Orlandini L, Asthana AK, Sciurti R, Furfaro F, Bezzio C, and de Franchis R
- Subjects
- Abdominal Pain etiology, Adolescent, Adult, Aged, Crohn Disease complications, Diarrhea etiology, Fatigue etiology, Feces chemistry, Female, Fever etiology, Gastroenterology, Humans, Irritable Bowel Syndrome complications, Leukocyte L1 Antigen Complex analysis, Male, Middle Aged, Patient Acceptance of Health Care, Prospective Studies, Risk Factors, Weight Loss, Young Adult, Crohn Disease diagnosis, Delayed Diagnosis, Symptom Assessment
- Abstract
Background: We investigated symptoms and tests performed prior to a formal diagnosis of Crohn's disease and the reasons for diagnostic delay., Methods: Consecutive patients recently diagnosed with Crohn's disease were enrolled between October 2012 and November 2013. Clinical data, symptoms including Rome III criteria at onset and at diagnosis, location and disease phenotype were recorded. Faecal calprotectin, radiological and endoscopic examinations performed prior to diagnosis were analysed. Diagnostic delay, stratified into tertiles and median time, was analysed using parametric and nonparametric tests., Results: 83 patients (49.4% males, median age 31 years) were enrolled. The median diagnostic delay was 8 (0-324) months. Twenty-six patients did not consult a general practitioner until diagnosis (31.3%), 18 presented to the emergency department (21.7%) and 8 directly to a gastroenterologist (9.6%). Diagnostic delay was not associated with specific symptoms. However, patients with bloating at presentation had a longer delay compared to those who did not (median, 6.1 vs. 16.8 months, respectively; p=0.016). Nineteen patients underwent incomplete ileocolonoscopies (22.9%) and 7 had no biopsies (8.4%), with a consequent diagnostic delay (median, 24 and 24 vs. 6 months, respectively; p=0.025 and p=0.008)., Conclusion: Diagnostic delay for Crohn's disease is significantly associated with incomplete ileocolonoscopies, but not with symptoms, except bloating at presentation., (Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2015
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31. Failure of gastroenterologists to apply intestinal ultrasound in inflammatory bowel disease in the Asia-Pacific: a need for action.
- Author
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Asthana AK, Friedman AB, Maconi G, Maaser C, Kucharzik T, Watanabe M, and Gibson PR
- Subjects
- Asia epidemiology, Cost of Illness, Cost-Benefit Analysis, Europe, Gastroenterology education, Gastroenterology methods, Humans, Inflammatory Bowel Diseases economics, Pacific Islands epidemiology, Ultrasonography trends, Inflammatory Bowel Diseases diagnostic imaging, Inflammatory Bowel Diseases therapy, Intestines diagnostic imaging, Ultrasonography statistics & numerical data
- Abstract
Intestinal ultrasound (IUS) is a cheap, noninvasive, risk-free procedure that is significantly underutilized in the diagnosis and management of patients with inflammatory bowel disease (IBD) in the Asia-Pacific region. More cost-effective methods of monitoring disease activity are required in light of the increasing global burden of IBD (especially in Asia), the advent of personalized medicine, and the rising cost of healthcare. IUS is a prime example of a technique that meets these needs. Its common clinical applications include assessing the activity and complications of IBD. In continental Europe, countries such as Germany and Italy use this imaging tool as the standard of care and have integrated it into management protocols. There are formal training programs in these countries to train gastroenterologists in IUS, and it is used in an outpatient setting during patient consultations. Barriers to its use in the Asia-Pacific region include lack of experience and research data, and there are few established centers with active training programs. These concerns can be addressed by investing more in IUS service provision and by increasing allocation of resources toward local research and training. Increased uptake of IUS will ultimately benefit patients with IBD., (© 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.)
- Published
- 2015
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32. Evaluation of phenotypic tests for detection of Klebsiella pneumoniae carbapenemase and metallo-beta-lactamase in clinical isolates of Escherichia coli and Klebsiella species.
- Author
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Chauhan K, Pandey A, Asthana AK, and Madan M
- Subjects
- Anti-Bacterial Agents pharmacology, Escherichia coli drug effects, Escherichia coli isolation & purification, Escherichia coli Infections microbiology, Humans, Klebsiella Infections microbiology, Klebsiella pneumoniae drug effects, Klebsiella pneumoniae isolation & purification, beta-Lactams pharmacology, Bacterial Proteins analysis, Bacteriological Techniques methods, Escherichia coli enzymology, Klebsiella pneumoniae enzymology, beta-Lactamases analysis
- Abstract
Context: Carbapenemase production is an important mechanism responsible for carbapenem resistance., Aims: Phenotypic detection and differentiation of types of carbapenemase in carbapenem resistant Enterobacteriaceae is important for proper infection control and appropriate patient management., Settings and Design: We planned a study to determine the occurrence of Class A Klebsiella pneumoniae carbapenemase (KPC type) and Class B Metallo-β-lactamase (MBL type) carbapenemase in hospital and community., Materials and Methods: Clinical isolates of Escherichia coli and Klebsiella species and simultaneously evaluate different phenotypic methods for detection of carbapenemases., Results: It was observed that 20.72% clinical isolates of E. coli and Klebsiella spp. were resistant to carbapenem on screening of which, 14.64% were E. coli and 29.69% were Klebsiella spp. Using phenotypic confirmatory tests the occurrence of carbapenemase production was found to be 87.01% in E. coli and 91.51% in Klebsiella spp. using both modified Hodge test (MHT) and combined disk test (CDT) using imipenem-ethylenediaminetetraacetic acid., Conclusions: Both MBL and KPC type carbapenemases were seen among clinical isolates of E. coli and Klebsiella spp. CDT is simple, rapid and technically less demanding procedure, which can be used in all clinical laboratories. Supplementing MHT with CDT is reliable phenotypic tests to identify the class A and class B carbapenemase producers.
- Published
- 2015
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33. Perianal disease is associated with psychiatric co-morbidity in Crohn's disease in remission.
- Author
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Maconi G, Gridavilla D, Viganò C, Sciurti R, Asthana AK, Furfaro F, Re F, Ardizzone S, and Ba G
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Anxiety Agents therapeutic use, Antidepressive Agents therapeutic use, Anxiety drug therapy, Comorbidity, Crohn Disease complications, Crohn Disease epidemiology, Depression drug therapy, Female, Humans, Male, Middle Aged, Prevalence, Prospective Studies, Quality of Life, Rectal Fistula complications, Rectal Fistula psychology, Remission Induction, Risk Factors, Sex Factors, Young Adult, Anxiety epidemiology, Crohn Disease psychology, Depression epidemiology
- Abstract
Background and Aim: Crohn's disease is a life-long inflammatory disease which can impair quality of life, in particular in patients with psychiatric co-morbidities such as depression and anxiety. The aim of this prospective cohort study was to assess the prevalence of depression and anxiety and related risk factors in patients with quiescent Crohn's disease., Methods: A consecutive series of adult patients with confirmed diagnosis of Crohn's disease, in clinical remission, were included and investigated during ambulatory visits using a standard questionnaire assessing demographic and clinical features of the disease. Within 1 month after the ambulatory visit, all patients were interviewed by phone to assess the presence of psychiatric disorders using standardized questionnaires. The questionnaire assessed the development of psychiatric disorders after the diagnosis of Crohn's disease, the use of antidepressant or antianxiety therapy and current anxiety or depression by means of the Hospital Anxiety and Depression Scale., Results: One hundred and ninety-five patients were included. Seventy-two (36.9 %) patients showed anxiety and/or depression symptoms, 46 (23.6 %) patients showed anxiety symptoms, 6 (3.1 %) patients showed depression symptoms and 20 (10.3 %) patients showed both symptoms. Forty-eight of these patients (58 %) were without any antidepressive or antianxiety treatment. Anxiety with or without depression was significantly correlated with female sex (p = 0.017), history of perianal disease (p = 0.003) and perianal surgery (p = 0.042)., Conclusion: Anxiety is a frequent, often untreated, condition in patient affected by Crohn's disease in clinical remission. Female sex, history of perianal disease and perianal surgery are major risk factors for anxiety.
- Published
- 2014
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34. Ulcerative colitis: current pharmacotherapy and future directions.
- Author
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Bezzio C, Furfaro F, de Franchis R, Maconi G, Asthana AK, and Ardizzone S
- Subjects
- Animals, Colitis, Ulcerative complications, Colitis, Ulcerative immunology, Colon immunology, Colorectal Neoplasms etiology, Disease Progression, Humans, Tumor Necrosis Factor-alpha immunology, Anti-Inflammatory Agents therapeutic use, Colitis, Ulcerative drug therapy, Colitis, Ulcerative pathology, Colon drug effects, Colon pathology, Immunosuppressive Agents therapeutic use
- Abstract
Introduction: Ulcerative colitis (UC) is a chronic relapsing disease, characterised by alternating of acute and remission phases. Although the aetiology is unknown, in recent years, there has progressively been greater knowledge of the various pathogenetic mechanisms underlying the disease itself. Thus, from therapy based on generically anti-inflammatory or immunosuppressive agents, treatment is gradually moving towards drugs that selectively block specific inflammatory mediators, such as TNF-α., Areas Covered: This review provides the most significant data about the therapeutic role of different drugs currently available for the treatment of UC. In addition, the critical therapeutic areas on which research could focus in the near future are discussed., Expert Opinion: UC is a disease affecting young patients, whose quality of life may be strongly compromised by the progression of disease. Over time, the disease may lead to an impairment of the normal anatomy and physiology of the colon, and the cumulative incidence of dysplasia and colorectal cancer increases with the time. Thus, the main aims of the near future should be both a better definition of patients at risk for a poor clinical course and progression of disease, and the development of a much more aggressive treatment for patients with a poor prognosis.
- Published
- 2014
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35. Extended spectrum beta lactamase producing Proteus penneri: a rare missed pathogen?
- Author
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Pandey A, Verma H, Asthana AK, and Madan M
- Subjects
- Accidents, Traffic, Adult, Bacteriological Techniques, Diagnostic Errors, Humans, Male, Proteus Infections microbiology, Wound Infection microbiology, Wounds and Injuries complications, Drug Resistance, Multiple, Bacterial, Proteus Infections diagnosis, Proteus penneri enzymology, Proteus penneri isolation & purification, Wound Infection diagnosis, beta-Lactamases metabolism
- Abstract
Indole negative Proteus species are invariably incorrectly identified as Proteus mirabilis, often missing out isolates of Proteus penneri. We report a case of extended spectrum beta lactamase producing and multidrug-resistant P. penneri isolated from pus from pressure sore of a patient of road traffic accident. Correct and rapid isolation and identification of such resistant pathogen are important as they are significant nosocomial threat.
- Published
- 2014
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36. C-Reactive Protein (CRP) and its Association with Periodontal Disease: A Brief Review.
- Author
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Bansal T, Pandey A, D D, and Asthana AK
- Abstract
Periodontal disease is a chronic infection of the gums characterised by a loss of attachment between the tooth and bone, and bone loss. C-reactive protein (CRP) elevation is a part of the acute phase response to acute and chronic inflammation. Many epidemiological studies have shown that serum CRP levels were elevated in patients with chronic periodontitis. CRP levels increase to hundreds of μg/ml within hours following infection. It out-performs erythrocyte sedimentation rate (ESR) in terms of responsiveness and specificity for inflammation. While CRP elevation is suggestive of inflammation or infection in the appropriate clinical context, it can also occur with obesity and renal dysfunction. Conversely, a lack of CRP elevation in inflammation may be seen with hepatic failure, as well as during flares of conditions such as systemic lupus erythematosus.
- Published
- 2014
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37. Genotype MTBDR plus assay for molecular detection of rifampicin and isoniazid resistance in Mycobacterium tuberculosis.
- Author
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Sharma S, Madan M, Agrawal C, and Asthana AK
- Subjects
- Bacterial Proteins genetics, Catalase genetics, DNA-Directed RNA Polymerases genetics, Humans, Microbial Sensitivity Tests methods, Mycobacterium tuberculosis genetics, Oxidoreductases genetics, Sputum microbiology, Time Factors, Tuberculosis, Multidrug-Resistant diagnosis, Tuberculosis, Multidrug-Resistant microbiology, Tuberculosis, Pulmonary diagnosis, Tuberculosis, Pulmonary microbiology, Antitubercular Agents pharmacology, Genotyping Techniques methods, Isoniazid pharmacology, Mycobacterium tuberculosis drug effects, Mycobacterium tuberculosis isolation & purification, Rifampin pharmacology
- Abstract
Aim: This study was performed for the rapid identification of Mycobacterium tuberculosis complex and its resistance to rifampicin and isoniazid, directly from the sputum samples of pulmonary tuberculosis patients., Materials and Methods: A commercially available genotype MTBDR plus assay was used for the identification and detection of mutations in Mycobacterial isolates. A total of 100 sputum samples of pulmonary tuberculosis patients were analyzed by using the genotype MTBDR plus assay. The MTBDR plus assay is designed to detect the mutations in the hotspot region of rpoB gene, katG and regulatory region of inhA gene., Results: The genotype MTBDR plus assay detected 22% multidrug resistant (MDR), 2% rifampicin (RMP) monoresistant and 1% isoniazid (INH) monoresistant isolates. In 22 MDR isolates, the codons most frequently involved in RMP-associated mutations were codon 531 (54.55%), 516 (31.82%) and 526 (13.63%), and 90.90% of MDR isolates showed KatG S315T mutations and 9.1% showed inhA C-15T mutations associated with INH resistance., Conclusion: The new genotype MTBDR plus assay represents a rapid, reliable tool for the detection of MDR-TB, wherein results are obtained in 5 h allowing early and appropriate treatment, which is essential to cut the transmission path and reduce the spread of MDR-TB. The genotype MTBDR plus assay can readily be included in a routine laboratory work for the early diagnosis and control of MDR-TB.
- Published
- 2014
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38. Optimizing conventional medical therapies in inflammatory bowel disease in 2014.
- Author
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Asthana AK, Sparrow MP, and Peyrin-Biroulet L
- Subjects
- Biological Products administration & dosage, Clinical Trials as Topic, Humans, Immunologic Factors administration & dosage, Inflammatory Bowel Diseases immunology, Inflammatory Bowel Diseases pathology, Treatment Outcome, Drug Monitoring methods, Inflammatory Bowel Diseases drug therapy
- Abstract
Goals of therapy for inflammatory bowel disease have advanced beyond symptom control to the normalization of biomarkers of inflammation, and mucosal healing in particular, with the expectation that this will change the natural history of these diseases. Concurrent with higher treatment expectations has come an expanded therapeutic armamentarium to achieve these goals, and a greater ability to optimize each therapeutic class to maximize therapeutic benefits and minimize unnecessary treatment failures. In addition to these advances has come the evolution of therapeutic drug monitoring which is increasingly being utilized to optimize the use of immunomodulators and biologic therapies in particular. This review will outline the principals of optimization of the conventional medical therapies available to the clinician today.
- Published
- 2014
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39. Evaluation of phenotypic tests for the detection of AmpC beta-lactamase in clinical isolates of Escherichia coli.
- Author
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Handa D, Pandey A, Asthana AK, Rawat A, Handa S, and Thakuria B
- Subjects
- Anti-Bacterial Agents pharmacology, Community-Acquired Infections microbiology, Cross Infection microbiology, Escherichia coli drug effects, Escherichia coli isolation & purification, Escherichia coli Infections microbiology, Humans, Microbial Sensitivity Tests methods, beta-Lactams pharmacology, Bacterial Proteins metabolism, Escherichia coli enzymology, beta-Lactamases metabolism
- Abstract
Background: AmpC beta lactamases are cephalosporinases that confer resistance to a wide range of beta lactam drugs thereby causing serious therapeautic problem. As there are no CLSI guidelines for detection of AmpC mediated resistance in Gram negative clinical isolates and it may pose a problem due to misleading results, especially so in phenotypic tests. Although cefoxitin resistance is used as a screening test, it does not reliably indicate AmpC production., Materials and Methods: We planned a study to determine the occurrence of AmpC beta lactamase in hospital and community, clinical isolates of Escherichia coli and simultaneously evaluate different phenotypic methods for detection of AmpC beta lactamases., Results: It was observed that 82.76% isolates were ESBL positive and 59% were cefoxitin screen positive. Using phenotypic confirmatory tests the occurrence of Amp C beta lactamases was found to be 40% and 39% by inhibitor based method using boronic acid (IBM) and modified three dimensional test (M3D) respectively., Conclusion: Both the test showed concordant result. Co-production was observed in 84.62% isolates Screening of ESBL and Amp C can be done in routine clinical microbiology laboratory using aztreonam and IBM respectively as it is a simple, rapid and technically less demanding procedure which can be used in all clinical laboratories.
- Published
- 2013
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40. Audit of cancer patients from eastern Uttar Pradesh (UP), India: a university hospital based two year retrospective analysis.
- Author
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Nandi M, Mandal A, and Asthana AK
- Subjects
- Adenocarcinoma epidemiology, Adenocarcinoma pathology, Adenocarcinoma therapy, Adolescent, Adult, Age Distribution, Aged, Bone Neoplasms epidemiology, Bone Neoplasms pathology, Bone Neoplasms therapy, Brain Neoplasms epidemiology, Brain Neoplasms pathology, Brain Neoplasms therapy, Breast Neoplasms epidemiology, Breast Neoplasms pathology, Breast Neoplasms therapy, Carcinoma pathology, Carcinoma therapy, Carcinoma, Squamous Cell epidemiology, Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell therapy, Child, Child, Preschool, Cohort Studies, Female, Geography, Head and Neck Neoplasms epidemiology, Head and Neck Neoplasms pathology, Head and Neck Neoplasms therapy, Humans, Incidence, India epidemiology, Infant, Infant, Newborn, Lung Neoplasms epidemiology, Lung Neoplasms pathology, Lung Neoplasms therapy, Male, Middle Aged, Neoplasm Staging, Neoplasms pathology, Neoplasms therapy, Retrospective Studies, Sarcoma pathology, Sarcoma therapy, Sex Distribution, Soft Tissue Neoplasms epidemiology, Soft Tissue Neoplasms pathology, Soft Tissue Neoplasms therapy, Uterine Cervical Neoplasms epidemiology, Uterine Cervical Neoplasms pathology, Uterine Cervical Neoplasms therapy, Young Adult, Carcinoma epidemiology, Hospitals, University, Neoplasms epidemiology, Patient Compliance statistics & numerical data, Sarcoma epidemiology
- Abstract
Background: A retrospective analysis of all cancer patients attending the radiotherapy outpatient department (OPD) of a single unit during the period of January 2005 till December 2006 was conducted to know the geographical distribution and incidence of the most common cancers, their stage of presentation, treatment compliance among the patients and follow-up., Materials and Methods: A total of 4,484 patients were registered in the Institute of Medical Sciences, Banaras Hindu University during the period of January 2005- December 2006; of which 1,975 registered in an individual unit were included for the retrospective analysis., Results: Most of the patients hailed from the various districts of UP and Bihar. Females outnumbered males with a ratio of 1.33:1. Females mostly belonged to the age group of 40-59 years; whilst males were a decade older. Major cancer sites in females were cervix and breast followed by head and neck. Leading cancer sites in males were head and neck, brain, bone, soft tissue and lung. Most of the cases presented in advanced stage of disease (74%). Squamous cell carcinoma was the most common histopathology (56%). A significant proportion of patients defaulted after undergoing preliminary investigations (16%). Only 53.9% of females and 58.5% of males took treatment out of which 68% and 63% completed the prescribed treatment. Compliance with follow-up was poor., Conclusions: The outcome of this study will significantly help us to define region specific strategies needed for cancer management in eastern Uttar Pradesh.
- Published
- 2013
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41. Variations in the formation of the median nerve and its clinical correlation.
- Author
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Budhiraja V, Rastogi R, and Asthana AK
- Subjects
- Aged, Axillary Artery abnormalities, Axillary Artery physiology, Axillary Artery surgery, Brachial Artery abnormalities, Brachial Artery physiology, Brachial Artery surgery, Brachial Plexus physiology, Brachial Plexus surgery, Cadaver, Female, Humans, Male, Median Nerve physiology, Median Nerve surgery, Middle Aged, Neurosurgical Procedures adverse effects, Neurosurgical Procedures standards, Vascular Surgical Procedures adverse effects, Vascular Surgical Procedures standards, Arm innervation, Brachial Plexus abnormalities, Median Nerve abnormalities
- Abstract
Variations in the formation of the median nerve are of interest to anatomists, radiologists, and surgeons. These variations may be vulnerable to damage in surgical operations, but their knowledge also helps in the interpretation of a nervous compression having unexplained clinical symptoms. We studied the variation in the formation of the median nerve in 87 cadavers, i.e. 174 upper limbs of formalin preserved cadavers at the department of Anatomy, Subharti medical college. We observed an additional root taking part in the formation of the median nerve in 26.4% of upper limbs, unusual low formation of the median nerve in the arm in front of the brachial artery in 18.4% of upper limbs, and median nerve formation medial to the axillary artery in 10.3% of upper limbs. Knowledge of such anatomical variations is of interest to the anatomist and clinician alike. Surgeons who perform procedures involving neoplasm or trauma repair need to be aware of these variations.
- Published
- 2012
42. Colonic perforation during percutaneous endoscopic gastrostomy tube insertion with subsequent bumper migration into colon.
- Author
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Ward M, Rees C, Asthana AK, and Lubel J
- Subjects
- Aged, Humans, Male, Radiography, Abdominal, Radiography, Thoracic, Tomography, X-Ray Computed, Colon pathology, Endoscopy adverse effects, Gastrostomy adverse effects, Intestinal Perforation diagnosis, Intestinal Perforation pathology
- Published
- 2011
- Full Text
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43. Variant origin of superior polar artery and unusual hilar branching pattern of renal artery with clinical correlation.
- Author
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Budhiraja V, Rastogi R, and Asthana AK
- Subjects
- Cadaver, Dissection, Female, Genetic Variation, Humans, Kidney surgery, Male, Kidney blood supply, Renal Artery anatomy & histology
- Abstract
Classically, a single renal artery arising from the abdominal aorta supplies the respective kidney on each side. Near the hilum of the kidney each renal artery divides into anterior and posterior branchs, which in turn divide into segmental arteries supplying the different renal segments. A total of 84 formalin fixed cadavers (73 male and 11 female, 168 kidneys in total) constituted the material for the study. During routine abdominal dissection conducted for medical undergraduates, the kidneys and their arteries were explored and variations in morphological patterns of renal arteries were noted. We observed superior polar renal artery in 22.6% cases. Superior polar renal arteries had different sources of origin. In 10.7% of cases it came directly from the abdominal aorta as an accessory renal artery; in 5.4% of cases as a direct branch from the main renal artery; in 3.6% of cases from the superior hilar renal artery (from one of the duplicated renal arteries); and in 3.0% of cases from a segmental branch of the renal artery. We also observed unusual hilar branching patterns of renal arteries, which included a fork pattern in 11.3% of cases, ladder pattern in 7.7% of cases, net pattern in 5.9% of cases, and triplicate in 3.0% of cases. Understanding the anatomy of vascular variations of the kidney is essential for the clinician to be able to perform procedures such as renal transplantation, interventional radiological procedures, and renal vascular operations more safely and efficiently.
- Published
- 2011
44. Micropathological changes in the sub-epidermal zone of normal appearing skin in leprosy.
- Author
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Rastogi R, Budhiraja V, Babu CS, Madan M, Krishna A, and Asthana AK
- Subjects
- Child, Female, Granuloma pathology, Humans, Leprosy microbiology, Male, Mycobacterium leprae physiology, Epidermis pathology, Leprosy pathology
- Abstract
Leprosy is a chronic inflammatory disease caused by Mycobacterium leprae, which affects not only the peripheral nerves and skin but also various internal viscera through the hematogenous spread, especially in lepromatous cases. The micropathological changes in epidermis, nerves and skin appendages from lesioned skin reported by various authors but reports of involvement of apparently normal sites are few. We investigated skin biopsy material taken from 130 patients with clinically diagnosed leprosy. Biopsies were taken at least 10 cm away from site of lesion. Hematoxylin and Eosin staining and Harada's modified Allochrome method for acid-fast bacilli were applied for histological investigations. The pattern of leprosy among the patients were indeterminate in 53 cases (40.8%), tuberculoid in 29 cases (22.3%), borderline tuberculoid in 14 cases (10.8%), borderline leprosy in ten cases (7.7%), borderline lepromatous in nine cases (6.9%) and lepromatous leprosy in 15 cases (11.5%). The changes were seen in sub-epidermal zone of normal appearing skin in all type of leprosy, but involvement was greater at the lepromatous end of the spectrum compared to tuberculoid end. Acid-fast bacillus (AFB) was seen in subepidermal zone of normal appearing site. Presence of AFB is significant as far as dissemination and transmission of disease is concerned.
- Published
- 2011
45. Concurrent variations of median and musculocutaneous nerves and their clinical correlation--a cadaveric study.
- Author
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Budhiraja V, Rastogi R, Asthana AK, Sinha P, Krishna A, and Trivedi V
- Subjects
- Adult, Aged, Brachial Plexus physiology, Brachial Plexus surgery, Cadaver, Dissection methods, Female, Humans, Male, Median Nerve physiology, Median Nerve surgery, Middle Aged, Muscle, Skeletal innervation, Musculocutaneous Nerve physiology, Musculocutaneous Nerve surgery, Neurosurgical Procedures methods, Postoperative Complications diagnosis, Postoperative Complications etiology, Postoperative Complications prevention & control, Skin innervation, Arm innervation, Brachial Plexus abnormalities, Median Nerve abnormalities, Musculocutaneous Nerve abnormalities
- Abstract
Variations of median nerve, musculocutaneous nerve and their communicating branches are of interest for anatomists and surgeons. These variations may be vulnerable to damage in surgical procedures. We examined median nerve and musculocutaneous nerve concurrently in 58 cadavers, i.e. 116 superior extremities, and found median nerve innervating muscle of the anterior compartment of arm in the absence of musculocutaneous nerve in 11.2% superior extremities, splitting of median nerve in the arm into median nerve proper and musculocutaneous nerve in 5.12% superior extremities, and communication between median and musculocutaneous nerves in 20.7% superior extremities. Knowledge of such anatomical variations is helpful for surgeons treating neoplasm or repairing trauma.
- Published
- 2011
46. Maxillary osteomyelitis by mucormycosis: report of four cases.
- Author
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Pandey A, Bansal V, Asthana AK, Trivedi V, Madan M, and Das A
- Subjects
- Adult, Aged, Diabetes Complications therapy, Female, Humans, Male, Middle Aged, Mucormycosis therapy, Opportunistic Infections therapy, Tooth Extraction adverse effects, Diabetes Complications diagnosis, Maxillary Sinus microbiology, Maxillary Sinus pathology, Mucormycosis complications, Mucormycosis diagnosis, Opportunistic Infections complications, Opportunistic Infections diagnosis, Osteomyelitis etiology
- Abstract
Mucormycosis is a fungal infection commonly affecting structures in the head and neck, such as the air sinuses, orbits, and the brain. Common predisposing factors include diabetes mellitus and immunosuppression. We describe our clinical experience with four cases of mucormycosis of the maxillary antrum associated with uncontrolled diabetes mellitus managed at our centre. Early diagnosis and prompt treatment can significantly reduce the mortality and morbidity of this lethal fungal infection., (Copyright © 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
47. Physician accessories: doctor, what you carry is every patient's worry?
- Author
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Pandey A, Asthana AK, Tiwari R, Kumar L, Das A, and Madan M
- Subjects
- Cross Infection prevention & control, Hand Disinfection standards, Humans, Infection Control methods, Infectious Disease Transmission, Professional-to-Patient prevention & control, Bacteria classification, Bacteria isolation & purification, Environmental Microbiology, Physicians
- Abstract
Background: Nosocomial infections are on the rise worldwide and many a times they are carried by the health care personnel. Accessories used by physicians and healthcare personnel can be a potential source of nosocomial infection., Materials and Methods: We designed a survey with the aim to investigate the prevalence of microbial flora of accessories such as pens, stethoscopes, cell phones and white coat used by the physicians working in a tertiary care hospital., Observations: It was observed that 66% of the pens, 55% of the stethoscopes, 47.61% of the cell phones and 28.46% of the white coats used by the doctors were colonized with various microorganisms. Staphylococcus spp. was the predominant isolate followed by Escherichia coli. Methicillin resistance in Staphylococcus aureus was also found, which was a matter of concern., Conclusions: Awareness of appropriate hand hygiene is important in order to prevent potential transmission to patients.
- Published
- 2010
- Full Text
- View/download PDF
48. Experience of wireless local area network in a radiation oncology department.
- Author
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Mandal A, Asthana AK, and Aggarwal LM
- Subjects
- Humans, Software, Systems Integration, User-Computer Interface, Local Area Networks, Quality Assurance, Health Care, Radiation Oncology organization & administration, Radiology Information Systems organization & administration
- Abstract
The aim of this work is to develop a wireless local area network (LAN) between different types of users (Radiation Oncologists, Radiological Physicists, Radiation Technologists, etc) for efficient patient data management and to made easy the availability of information (chair side) to improve the quality of patient care in Radiation Oncology department. We have used mobile workstations (Laptops) and stationary workstations, all equipped with wireless-fidelity (Wi-Fi) access. Wireless standard 802.11g (as recommended by Institute of Electrical and Electronic Engineers (IEEE, Piscataway, NJ) has been used. The wireless networking was configured with the Service Set Identifier (SSID), Media Access Control (MAC) address filtering, and Wired Equivalent Privacy (WEP) network securities. We are successfully using this wireless network in sharing the indigenously developed patient information management software. The proper selection of the hardware and the software combined with a secure wireless LAN setup will lead to a more efficient and productive radiation oncology department.
- Published
- 2010
- Full Text
- View/download PDF
49. Workload modeling for teletherapy unit.
- Author
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Mandal A, Asthana AK, Singh R, and Aggarwal LM
- Subjects
- Algorithms, Hospital Units organization & administration, Hospital Units statistics & numerical data, Humans, Neoplasms radiotherapy, Radiation Oncology statistics & numerical data, Software, Models, Theoretical, Radiation Oncology organization & administration, Radioisotope Teletherapy statistics & numerical data, Workload
- Abstract
Aims: This study aims to derive a radiotherapy workload model using a prospectively collected dataset of patient and treatment information from a teletherapy treatment unit., Materials and Methods: Information about all individual radiotherapy treatment was collected for two weeks from the Phoenix unit in our department. This information included diagnosis, treatment site, treatment time, fields per fraction, technique, use of blocks and wedges. Data were collected for two weeks (10 working days) in January 2008. During this time, 45 patients were treated with 450 fractions of external beam radiotherapy in Phoenix unit., Results: The mean fraction duration, irradiation time and setup time were 9.55 minutes, 1.84 minutes and 7.66 minutes respectively. A mathematical workload model was derived using the average fraction duration time, total irradiation time and setup time of different types of treatment. A simple software program (Workload Calculation Chart) was also constructed in Microsoft Excel using the derived algorithm. The model based software program was tested and applied for one year and found that it can be used effectively to describe workload of teletherapy unit., Conclusion: Proposed methodology for workload modeling of teletherapy unit and the workload calculation software is very effective to quantitatively plan/calculate the optimal workload which will satisfy both the patient care administrator and radiation therapy technologists.
- Published
- 2010
- Full Text
- View/download PDF
50. Renal artery variations: embryological basis and surgical correlation.
- Author
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Budhiraja V, Rastogi R, and Asthana AK
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Renal Artery surgery, Renal Artery abnormalities, Renal Artery embryology
- Abstract
Understanding anatomy of the vascular variations of kidney is essential for the clinician to perform procedures such as renal transplantation, interventional radiological procedures and renal vascular operations more safely and efficiently. In order to facilitate the clinical approaches, we studied renal arterial pattern in 50 formalin-fixed cadavers, on 100 kidneys. We observed prehilar multiple branching patterns in 11 (11.66%) cases, duplication of renal artery in eight (8.33%) cases and superior polar artery in seven (6.66%) cases. In the present study findings discussed with its clinical correlation.
- Published
- 2010
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