220 results on '"Bhagavatula Indira Devi"'
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2. Challenges in Indian Neurosurgical Education and Infrastructure: A Call for Strategic Reforms
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Bhagavatula Indira Devi, Chirag Jain, Dhaval P. Shukla, Dhananjaya I. Bhat, and Gopalakrishnan Madhavan Sasidharan
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Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Published
- 2024
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Catalog
3. Prof. Vijay K. Kak—In Memoriam: October 15, 1937–August 15, 2024
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Bhagavatula Indira Devi, Chirag Jain, Dhaval P. Shukla, Dhananjaya I. Bhat, and Gopalakrishnan Madhavan Sasidharan
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Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Published
- 2024
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4. Predicting Tumor Type and Residual Status of Suprasellar Lesions Using Indian Discharge Summaries
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Priyanka C. Nair, Deepa Gupta, Bhagavatula Indira Devi, Vani Kanjirangat, and P. Deepak
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Brain tumor ,suprasellar lesions ,discharge summaries ,residual tumor ,fine-tuning ,large language model ,Electrical engineering. Electronics. Nuclear engineering ,TK1-9971 - Abstract
A suprasellar lesion is an unusual mass in the suprasellar region in the brain. Some common suprasellar lesions include Pituitary Adenoma, Craniopharyngioma and Meningioma. Patients may present with significant visual and other symptoms like headache, and hormonal imbalances. The proposed study utilizes 553 discharge summaries of suprasellar patients admitted during 2013–2019 at NIMHANS hospitals, Bangalore. Classification of discharge summary was conducted using 11 different word embedding techniques, including word2vec, FastText, Glove, and transformer-based embeddings. Tumor type is predicted using advanced ML classifiers like AdaBoost, Random Forest, and XGBoost. The highest F-score of 0.91 was reported for XGBoost when implemented along with SMOTE based data balancing and PCA based feature reduction. To enhance the classification performance of the best performing model, ClinicalBioBERT, a pre-trained BERT model that demonstrated superior results, was finetuned with domain-specific clinical data and resulted in an improvement of the F-score to 0.93. Classification of presence/absence of residual tumor post surgery is also carried out using transformer models and achieved a macro F1-score of maximum 1, after handling the class imbalance using SMOTE. Different combinations of experiments with PCA and SMOTE were carried out in both classification problems. Two Large Language Models: FlanT5 and Bloom, are also investigated in this work for both classification problems Initially, the LLM is employed with a zero-shot classification pipeline, resulting in poor performance. Consequently, fine-tuning of the LLM models are attempted using the discharge summary text, resulting in performance improvements. more...
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- 2024
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5. Bilateral Brown-Sequard syndrome regressing to anterior cord syndrome in spinal impalement: 2 unique cases with management pearls
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Hardik Lalit Siroya, Mohit Juneja, Anirudh J. Rao, Sonal Chauhan, Dhananjaya Ishwar Bhat, and Bhagavatula Indira Devi
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Spine impalement ,Penetrating spine ,Brown Sequard ,Anterior cord ,Surgery ,RD1-811 ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Abstract Background Non-missile impalement spine injuries are quite uncommon. Most of these patients either present with impaling agent in situ or with a part of retained offending agent. Both the scenarios present unique management challenges especially if patients are clinically stable. The injury becomes more complex if multiple compartments like lung and abdomen also get involved. Non-missile penetrating spinal injury is rarely seen in the Indian settings. The world over it approximately accounts for 0.3–2.1% of spinal injuries. In view such meagre occurrence management decisions are usually driven based on surgeons’ experience and patient’s condition. Although conservative approaches for retained products have less complications as compared to surgery, long-term outcomes are not available for comparison. Unique management challenges are noted and described. Physical doctrines for management principles of such injuries are also attempted. Noteworthy is that their regression from complete cord syndrome to anterior cord syndrome is extremely short period. Case presentation We present 2 unique cases presenting as complete cord transection regressing from bilateral brown Sequard syndrome to anterior cord syndrome following decompression. Conclusion Spinal impalements are very rare especially now with strict societal regulations and criminal justice in place. Still now and then we do come across some staggering cases as described above. To establish a treatment protocol and management guidelines in such scarce scenarios is difficult. We attempt to underlie few basic doctrines in this regard with our experience in a tertiary centre. more...
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- 2022
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6. A comparative study between preoperative and postoperative conventional autonomic functions in congenital craniovertebral junction anomalies
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Hardik L Siroya, Dhananjaya Ishwar Bhat, Bhagavatula Indira Devi, and Dhaval P Shukla
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congenital craniovertebral junction anomalies ,parasympathetic and sympathetic dysfunction subclinical conventional autonomic dysfunction ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Background: Autonomic nervous system (ANS) is invariably affected by craniovertebral junction (CVJ) anomalies. The usual presentation is sudden after trivial trauma. When symptomatic, most of this autonomic dysfunction is clearly elicited clinically with bedside tests. Nonetheless, ANS functionality in relatively less symptomatic or asymptomatic patients is not known as no studies exist. Methodology: We performed a longitudinal prospective study of 40 less symptomatic patients who underwent surgery with conventional autonomic function tests (AFT) in pre- and post-operative periods. Correlation of its association with such anomalies is studied. Results: All 40 had both pre- and post-operative clinical follow-up, pre-operative AFT, whereas only 22 patients had follow-up AFT. The mean age for the group was 32 years and male: female ratio was 2.3:1. Mean Nurick's grade was 1.8, whereas Barthel's index was 83.75%. Clinical improvement was seen in almost 98% at follow-up. Orthostatic test showed a significant association with Nurick's grade. Barthel's index was significantly associated with degree of compression. The mean follow-up was 17.4 months. Most conventional AFTs were significantly decreased in the preoperative period (P ≤ 0.01). Both parasympathetic and sympathetic tone improved on follow-up with better improvement later. Overall clinical involvement of ANS was seen in 22.5% whereas subclinical involvement in the form of AFT impairment was seen in 100%. Conclusion: There is a definite involvement of subclinical ANS in all patients of CVJ anomalies irrespective of their symptomatology. Knowing the extent of involvement in the preoperative period can help prognosticate, prioritize regarding surgery as well as correlate with the extent of improvement. more...
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- 2022
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7. Six-year longitudinal prospective comparative study between preoperative and postoperative heart rate variability indices in congenital craniovertebral junction anomalies
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Hardik Lalit Siroya, Dhananjaya Ishwar Bhat, Bhagavatula Indira Devi, Dhaval P Shukla, Talakad Narasappa Sathyaprabha, and Thota Sai Laxmi Alekhya
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congenital craniovertebral junction anomalies ,heart rate variability ,subclinical autonomic dysfunction ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Background: Craniovertebral junction (CVJ) anomalies involve mosaic interaction of multifaceted neurovascular and bony elements. Most of them present late in the course of illness usually as acute presentations following trivial trauma. Knowing subclinical autonomic dysfunction in such anomalies when managed medically can not only indicate progression but also provide en route to early intervention for better outcomes, especially in relatively asymptomatic patients. Materials and Methods: We conducted a 6-year longitudinal prospective study including 40 consecutive patients of CVJ anomalies with clinical, radiological, and heart rate variability (HRV) parameters and found their correlation in preoperative and follow-up period. Results: Twenty-eight patients were male and the rest were female. The mean age was 32 years with the least age being 8 years and maximum age being 75 years old. Mean Nurick's grade and Barthel's index were 1.8 and 83.75, respectively. 38% had severe-to-moderate compression. The mean follow-up was 17.4 months. Both sympathetic and parasympathetic oscillator HRV indices were significantly affected in the preoperative period (P ≤ 0.001) with no association with Nurick's grade or degree of compression although there was association with grade of Barthel's index. Poincare plots showed “fan,” “complex,” or “torpedo” patterns in 36 patients. Forty patients had both preoperative and follow-up clinical grade whereas 22 patients HRV tests in the above periods. None of the HRV indices showed significant improvement at follow-up. Nonetheless both sympathetic and parasympathetic did improve at follow-up with sympathetic tone registering better scores. Poincare plots showed improvement toward “comet” patterns in all patients. Conclusion: HRV indices not only help in prognosticating but may also help in predicting outcomes. more...
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- 2022
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8. Vertebral artery dissection in acute cervical spine trauma
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Rahul Gupta, Hardik Lalit Siroya, Dhananjaya Ishwar Bhat, Dhaval P Shukla, Nupur Pruthi, and Bhagavatula Indira Devi
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cervical spine trauma ,infarcts ,vertebral artery dissection ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Objective: The aim of this study was to study mechanism, risk factors, and prognosis of patients with vertebral artery dissection (VAD) from acute cervical spine trauma (CST). Methods: A total of 149 consecutive patients were chosen from 2014 to 2019 from our institute data base, and their records were retrospectively studied. Morphology of fracture and subluxation were studied in detail with respect to the presence or absence of VAD. Results: Patients were divided in subsets of axial spine injury and subaxial spine injury. Subgroup and group analysis was performed and computerized tomography angiogram, MR angiogram and T1/T2 axial scans were studied to identify VAD, an incidence of 14.1% was found. Patients having infarcts in posterior circulation were also identified. Conclusion: There is a significant contribution of biomechanics of CST and evolution of VAD. This is an important consideration to prevent significant morbidity and mortality. Hence, a diagnostic algorithm which can be applied in any hospital setup is the need of the hour. more...
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- 2022
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9. Traumatic brain injury during COVID-19 pandemic—time-series analysis of a natural experiment
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Krishna Prasad, Pratima Murthy, Bhagavatula Indira Devi, Banu Manickam Rajalu, Dhaval P Shukla, Lekhansh Shukla, Mini Jayan, Deepak Jayarajan, and Arun Kandasamy
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Medicine - Abstract
Objectives This study aims to find if the incidence and pattern of traumatic brain injury (TBI) changed during the COVID-19pandemic. We also aim to build an explanatory model for change in TBI incidence using Google community mobility and alcohol sales data.Design A retrospective time-series analysis.Setting Emergency department of a tertiary level hospital located in a metropolitan city of southern India. This centre is dedicated to neurological, neurosurgical and psychiatric care.Participants Daily counts of TBI patients seen between 1 December 2019 and 3 January 2021 (400 days); n=8893. To compare the profile of TBI cases seen before and during the pandemic, a subset of these cases seen between 1 December 2019 and 31 July 2020 (244 days), n=5259, are studied in detail.Results An optimal changepoint is detected on 20 March 2020 following which the mean number of TBI cases seen every day has decreased and variance has increased (mean 1=29.4, variance 1=50.1; mean 2=19.5, variance 2=59.7, loglikelihood ratio test: χ2=130, df=1, p more...
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- 2022
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10. Neurotrauma clinicians’ perspectives on the contextual challenges associated with traumatic brain injury follow up in low-income and middle-income countries: A reflexive thematic analysis
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Brandon G. Smith, Charlotte J. Whiffin, Ignatius N. Esene, Claire Karekezi, Tom Bashford, Muhammad Mukhtar Khan, Davi J. Fontoura Solla, Bhagavatula Indira Devi, Wellingson S. Paiva, Franco Servadei, Peter J. Hutchinson, Angelos G. Kolias, Anthony Figaji, and Andres M. Rubiano more...
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Medicine ,Science - Abstract
Background Traumatic brain injury (TBI) is a major global health issue, but low- and middle-income countries (LMICs) face the greatest burden. Significant differences in neurotrauma outcomes are recognised between LMICs and high-income countries. However, outcome data is not consistently nor reliably recorded in either setting, thus the true burden of TBI cannot be accurately quantified. Objective To explore the specific contextual challenges of, and possible solutions to improve, long-term follow-up following TBI in low-resource settings. Methods A cross-sectional, pragmatic qualitative study, that considered knowledge subjective and reality multiple (i.e. situated within the naturalistic paradigm). Data collection utilised semi-structured interviews, by videoconference and asynchronous e-mail. Data were analysed using Braun and Clarke’s six-stage Reflexive Thematic Analysis. Results 18 neurosurgeons from 13 countries participated in this study, and data analysis gave rise to five themes: Clinical Context: What must we understand?; Perspectives and Definitions: What are we talking about?; Ownership and Beneficiaries: Why do we do it?; Lost to Follow-up: Who misses out and why?; Processes and Procedures: What do we do, or what might we do? Conclusion The collection of long-term outcome data plays an imperative role in reducing the global burden of neurotrauma. Therefore, this was an exploratory study that examined the contextual challenges associated with long-term follow-up in LMICs. Where technology can contribute to improved neurotrauma surveillance and remote assessment, these must be implemented in a manner that improves patient outcomes, reduces clinical burden on physicians, and does not surpass the comprehension, capabilities, or financial means of the end user. Future research is recommended to investigate patient and family perspectives, the impact on clinical care teams, and the full economic implications of new technologies for follow-up. more...
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- 2022
11. Conversion of Thesis to Peer-Reviewed Publication
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Dhaval Shukla, Manjul Tripathi, and Bhagavatula Indira Devi
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thesis ,dissertation ,publication ,residency training ,peer review ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Introduction Writing a thesis or dissertation during a postgraduate medical or surgical training is a part of curriculum, which is considered a major component of training during residency. We aimed to analyze and find out the fate of thesis of our residents, their outcome, and impact. We have also evaluated the reasons for not publishing the thesis in a peer-reviewed paper. Methods This study was conducted at a neurosurgical department of a premier training institute. PubMed and Google Scholar were searched for the topics of thesis and names of residents to find out whether any paper was published similar to topic of thesis. The faculties and residents were also personally contacted to evaluate the publication status of their thesis. A questionnaire was sent to the students who did not publish their thesis to find out the reasons for not submitting for publication. Results Total 56 residents submitted 85 thesis. The conversion rate to peer-reviewed publication was 32.5%. There was decreasing trend of conversion to publication over 10 years. The most common reasons for not publishing was a bad design of study, or deemed worthless for publication. Conclusion Conversion rate of thesis to paper is poor. In addition to writing thesis, candidates should be encouraged to have publications in indexed journal as full-length articles. Such publications carry more significance in long-term career of a resident. more...
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- 2019
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12. Neurotrauma clinicians’ perspectives on the contextual challenges associated with long-term follow-up following traumatic brain injury in low-income and middle-income countries: a qualitative study protocol
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Angelos G Kolias, Tom Bashford, Andres M Rubiano, Anthony Figaji, Brandon George Smith, Charlotte Jane Whiffin, Ignatius N Esene, Claire Karekezi, Muhammad Mukhtar Khan, Davi Jorge Fontoura Solla, Bhagavatula Indira Devi, and Peter John Hutchinson more...
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Medicine - Abstract
Introduction Traumatic brain injury (TBI) is a global public health concern; however, low/middle-income countries (LMICs) face the greatest burden. The WHO recognises the significant differences between patient outcomes following injuries in high-income countries versus those in LMICs. Outcome data are not reliably recorded in LMICs and despite improved injury surveillance data, data on disability and long-term functional outcomes remain poorly recorded. Therefore, the full picture of outcome post-TBI in LMICs is largely unknown.Methods and analysis This is a cross-sectional pragmatic qualitative study using individual semistructured interviews with clinicians who have experience of neurotrauma in LMICs. The aim of this study is to understand the contextual challenges associated with long-term follow-up of patients following TBI in LMICs. For the purpose of the study, we define ‘long-term’ as any data collected following discharge from hospital. We aim to conduct individual semistructured interviews with 24–48 neurosurgeons, beginning February 2020. Interviews will be recorded and transcribed verbatim. A reflexive thematic analysis will be conducted supported by NVivo software.Ethics and dissemination The University of Cambridge Psychology Research Ethics Committee approved this study in February 2020. Ethical issues within this study include consent, confidentiality and anonymity, and data protection. Participants will provide informed consent and their contributions will be kept confidential. Participants will be free to withdraw at any time without penalty; however, their interview data can only be withdrawn up to 1 week after data collection. Findings generated from the study will be shared with relevant stakeholders such as the World Federation of Neurosurgical Societies and disseminated in conference presentations and journal publications. more...
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- 2021
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13. Reorganization of central auditory pathways in vestibular schwannoma: a diffusion tensor imaging study
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Patel, Kautilya R., Bhagavatula, Indira Devi, Konar, Subhas K., Kaushal, Shubham, and HR, Aravinda
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- 2024
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14. Urinary Sodium Loss following Hypertonic Saline Administration Curtails its Superior Osmolar Effect in Comparison to Mannitol in Severe Traumatic Brain Injury: A Secondary Analysis of a Randomized Controlled Trial
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Aniruddha Tekkatte Jagannatha, Kamath Sriganesh, Bhagavatula Indira Devi, and Ganne Sesha Umamaheswara Rao
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traumatic brain injury ,mannitol ,hypertonic saline ,urine sodium ,Anesthesiology ,RD78.3-87.3 - Abstract
Background Mannitol and hypertonic saline (HTS) are used as boluses during episodes of raised intracranial pressure (ICP) in severe traumatic brain injury (TBI). We recently demonstrated that ICP reduction and neurological outcomes are similar with mannitol and HTS in TBI. In the current post hoc analysis, we hypothesized that this lack of difference between mannitol and HTS is due to increased urinary sodium losses after HTS. Methods In this post hoc analysis of our earlier randomized controlled trial, we analyzed serum and urine osmolarity and sodium levels in 38 patients with severe TBI over 6 days. Equiosmolar boluses of mannitol and HTS were administered whenever ICP increased above 20 mm Hg. Seven hundred sixty samples each of serum sodium, urine sodium, serum osmolarity, and urine osmolarity were analyzed during this period. Results Three hundred and one and 187 boluses of mannitol and HTS, respectively, were required to maintain ICP below 20 mm Hg. The urinary osmolarity was similar between mannitol and HTS groups (p = 0.63). The urinary sodium excretion was significantly higher in HTS group compared with mannitol group (p = 0.002). Serum sodium and osmolarity values were similar between mannitol and HTS groups (p = 0.16 and 0.31, respectively). There was no difference in the mean ICP between the groups (p = 0.31). Conclusion Increased urinary sodium loss after HTS contributes to its lack of superiority over mannitol in controlling raised ICP. more...
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- 2018
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15. Unusual cause of high cervical myelopathy-C1 arch stenosis
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Lokesh S Nehete, Dhananjay I Bhat, M S Gopalakrishnan, Dhaval Shukla, Subhas Konar, Prashant Singh, and Bhagavatula Indira Devi
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Anomalies of atlas ,bifid posterior arch ,C1 arch stenosis ,high cervical myelopathy ,Morquio's syndrome ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Introduction: High cervical myelopathy can be rarely caused by the developmental anomalies of atlas. Patients with C1 arch stenosis can present in early childhood or later in life. In symptomatic patients, posterior decompression at atlas is mandatory. We report the first clinical series of 20 patients of C1 arch stenosis in the English literature. Materials and Methods: This is retrospective case series having a cohort of 20 patients with congenital C1 arch stenosis. Results: There were 12 pediatric (age more...
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- 2018
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16. Clinical, radiological, surgical, and pathological determinants of olfactory groove schwannoma
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Andi Sadayandi Ramesh, Jagath Lal Gangadharan, Anita Mahadevan, Aravinda Hanumanthapura Ramalingaiah, and Bhagavatula Indira Devi
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leu7 (cd57) ,olfactory ensheathing cell schwannoma ,olfactory groove schwannoma ,olfactory tract ,smooth muscle α-actin ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background Olfactory groove schwannomas (OGS) are rare anterior cranial fossa base tumors with only 41 cases reported in literature. Olfactory ensheathing cell schwannoma (OECS) has similar clinico-radiological features as OGS, but a different cell of origin. In recent years, there is growing interest in OECS as more cases are being reported. Aims The objective was to study the clinico-radiological features of OGS and define the histological differentiation from OECS. Materials and Methods We retrospectively analyzed clinical, radiological, surgical and histopathological picture of all cases of OGS managed in our institute. Immuno histochemical studies were performed in these tumors for differentiating from OECS. A comprehensive review of articles published until date describing the operative treatment was done. Results All three cases had presented with seizures, two had anosmia and papilledema. Gross-total resection was achieved in all our patients. One patient expired in the postoperative period due to septicemia. Positive expression to newer immuno histochemical biomarker CD57 (Leu7), with negative staining to smooth muscle α-actin (SMA) was helpful in confirming the diagnosis of OGS and differentiating it from OECS in all our cases. Conclusions OECS, though rare has to be differentiated from OGS using immuno histochemistry. Gross-total resection of OGS with preservation of olfactory function is often possible and curative. Although these tumors are commonly treated with microsurgical skull base approaches, an endoscopic endonasal approach can be considered in some cases, with repair using mucoperiosteal pedicled flap to prevent cerebrospinal fluid leak. more...
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- 2014
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17. The Role of Neurosurgery in Global Health Head Trauma
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Clark, David, Cheserem, Jebet Beverly, Bhagavatula, Indira Devi, Figaji, Anthony, Hutchinson, Peter, and Germano, Isabelle M., editor
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- 2022
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18. Complex Chiari Malformation: Proposal of a New Set of Diagnostic Criteria and Outcomes After fusion Surgery
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Asghar Ali Turabi, Mazhar Abbas, Pruthi, Nupur, Bhat, Dhananjaya, and Bhagavatula, Indira Devi
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- 2021
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19. Performance of a new portable near-infrared spectroscopy device for detection of traumatic intracranial hematoma
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Dhaval Shukla, Subhas Konar, Bhagavatula Indira Devi, Gorantla Padmasri, Ranjan Jayanna, Monisha Suresh, and Bhura Lakshita
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General Earth and Planetary Sciences ,General Environmental Science - Published
- 2023
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20. Building an Explainable Diagnostic Classification Model for Brain Tumor using Discharge Summaries
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Priyanka C. Nair, Deepa Gupta, Bhagavatula Indira Devi, and Vani Kanjirangat
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General Earth and Planetary Sciences ,General Environmental Science - Published
- 2023
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21. Biomarkers in Traumatic Brain Injuries: Narrative Review
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Vishram Pandey, Dhaval Shukla, Shubham Nirmal, Bhagavatula Indira Devi, and Rita Christopher
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General Engineering ,General Earth and Planetary Sciences ,General Environmental Science - Abstract
Traumatic brain injury (TBI) is a multistep interaction of brain antigens, cytokine-mediated humeral, and cellular immune reactions. Because of the limitations of clinical and radiological evaluation in TBI, there has been a considerable advancement toward the need for developing biomarkers that can predict the severity of TBI. Blood-based brain biomarkers hold the potential to predict the absence of intracranial injury and thus decrease unnecessary brain computed tomographic scanning. Various biomarkers have been studied that detects neuronal, axonal, and blood–brain barrier integrity. Biomarkers are still under investigation and hold promise in the future evaluation of TBI patients. They can be used for grading as well as a prognostication of head injury. more...
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- 2022
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22. Patients with Invasive Tumors and eNOS Gene Polymorphisms with Subarachnoid Hemorrhage Tend to Have Poorer Prognosis
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Hardik Lalit Siroya, Bhagavatula Indira Devi, Prasanthi Aripirala, Shruthi Shimoga Ramesh, Dhananjaya Ishwar Bhat, Dhaval Prem Shukla, Subhash Kanti Konar, and Rita Christopher
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General Medicine - Abstract
Context Endothelial nitric oxide synthase (eNOS) gene polymorphisms are found to predict predisposition to aneurysmal rupture and development of vasospasm in a patient of subarachnoid hemorrhage (SAH). eNOS gene polymorphisms are also found to predict invasiveness of malignant cells. Studies are not available in literature to describe the effect of eNOS gene polymorphisms and correlation between aneurysm and carcinoma. This study aims to investigate whether positive cancer history influences clinical outcome following SAH and eNOS gene polymorphisms. Materials and Methods The eNOS gene polymorphisms were analyzed in seven consecutive patients (mean age, 52.28 ± 20 years) with a diagnosis of invasive systemic tumors from 2011 to 2017. The eNOS 4a/4b eNOS -786T> eNOS894G > T polymorphisms of the eNOS gene were determined by polymerase chain reaction and restriction fragment length polymorphism. Results Seven patients of aneurysmal SAH in association with malignancies were studied for eNOS polymorphisms expression and outcome. Three patients had carcinoma cervix: one patient of carcinoma breast and one each of transitional cell carcinoma of urinary bladder, spindle cell carcinoma of left kidney, and untreated patient of atypical pituitary (adenoma). A genotype study of eNOS gene polymorphisms in these patients shows common polymorphisms are involved in the determination of disease progression in malignancies and aneurysmal SAH. Conclusion Patients who expressed 4ab, eNOS -786T > TT/CC/TC, eNOS894G > T GG/GT polymorphisms did better than patients who expressed only 4bb, though both were associated with poor prognosis. more...
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- 2022
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23. Complications Associated With Surgery for Intracranial Infectious Lesions
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Savardekar, Amey R., primary, Bhat, Dhananjaya I., additional, and Bhagavatula, Indira Devi, additional
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- 2019
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24. List of Contributors
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Abd-El-Barr, Muhammad M., primary, Agarwal, Vijay, additional, Albuquerque, Felipe C., additional, Aliabadi, Hamidreza, additional, Al-Khalili, Yasir, additional, Almefty, Rami O., additional, Amin-Hanjani, Sepideh, additional, Angileri, Filippo F., additional, Arraez, Cinta, additional, Arraez, Miguel A., additional, Baranoski, Jacob F., additional, Barrow, Daniel L., additional, Bendok, Bernard R., additional, Benzel, Edward C., additional, Berger, Mitchel S., additional, Bhagavatula, Indira Devi, additional, Bhat, Dhananjaya I., additional, Bilsky, Mark, additional, Binning, Mandy J., additional, Boop, Frederick A., additional, Bramall, Alexa N., additional, Bruce, Jeffrey N., additional, Buchholz, Avery L., additional, Burchiel, Kim J., additional, Burkhardt, Jan-Karl, additional, Cardali, Salvatore M., additional, Chang, Hsuan-Kan, additional, Charbel, Fady T., additional, Chen, Yi-Ren, additional, Chuang, Jimmy Ming-Jung, additional, Cohen, Alan R., additional, Conti, Alfredo, additional, Corliss, Brian M., additional, D'Amico, Randy S., additional, Daniel, Roy Thomas, additional, DeCarvalho, Stephanie A., additional, Digiorgio, Anthony M., additional, Fargen, Kyle M., additional, Fehlings, Michael G., additional, Fernandez-Miranda, Juan C., additional, Flores, Bruno C., additional, Fridley, Jared, additional, Friedman, Allan, additional, Galgano, Michael A., additional, Ganau, Mario, additional, Gardner, Paul A., additional, Germanò, Antonino F., additional, Ghobrial, George M., additional, Gibani, Siraj, additional, Gillick, John L., additional, Gokaslan, Ziya L., additional, Gooch, M. Reid, additional, Grant, Gerald A., additional, Grassia, Fabio, additional, Groff, Michael W., additional, Grossbach, Andrew J., additional, Harrop, James S., additional, Heary, Robert F., additional, Hedayat, Hirad S., additional, Heilman, Carl B., additional, Heller, Robert S., additional, Fennell, Vernard S., additional, Hervey-Jumper, Shawn L., additional, Hoh, Brian L., additional, Howard, Brian M., additional, Hughes, Joshua D., additional, Hussain, Ibrahim, additional, Iaccarino, Corrado, additional, Iqbal, M. Omar, additional, Jabarkheel, Rashad, additional, Josiah, Darnell T., additional, Kalakoti, Piyush, additional, Keen, Joseph R., additional, Kemp, William J., additional, Kim, Irene, additional, Kura, Bhavani, additional, La Torre, Domenico, additional, Lang, Michael J., additional, Laufer, Ilya, additional, Lawton, Michael T., additional, Levy, Elad I., additional, Link, Michael J., additional, Lo, William B., additional, Lunsford, L. Dade, additional, Maduri, Rodolfo, additional, Magown, Philippe, additional, Maiti, Tanmoy Kumar, additional, Mansfield, Kevin, additional, Nasser, Mohammed, additional, Monaco, Edward, additional, Mummaneni, Praveen V., additional, Narayan, Vinayak, additional, Niranjan, Ajay, additional, Oakes, W. Jerry, additional, Ojemann, Jeff, additional, Oyesiku, Nelson M., additional, Pabaney, Aqueel, additional, Patra, Devi Prasad, additional, Pollock, Bruce E., additional, Quinn, John C., additional, Ratliff, John K., additional, Rehder, Roberta, additional, Rekito, Andy, additional, Resnick, Daniel K., additional, Ros, Bienvenido, additional, Rosenfeld, Jeffrey V., additional, Rosenwasser, Robert H., additional, Rutka, James T., additional, Sabourin, Victor, additional, Sampson, John H., additional, Sattur, Mithun G., additional, Savardekar, Amey R., additional, Servadei, Franco, additional, Shaffrey, Christopher I., additional, Shakur, Sophia F., additional, Snyderman, Carl H., additional, Soliman, Hesham, additional, Spetzler, Robert F., additional, Spinner, Robert J., additional, Stadler, James A., additional, Sun, Hai, additional, Tee, Jin W., additional, Tenorio, Alexander, additional, Tomasello, Francesco, additional, Traynelis, Vincent C., additional, Veznedaroglu, Erol, additional, Viaroli, Edoardo, additional, Virk, Michael S., additional, Wang, Eric W., additional, Wang, Michael Y., additional, Welz, Matthew E., additional, West, James L., additional, Wilson, John A., additional, Wilson, Thomas J., additional, Winkler, Ethan A., additional, and Wolfe, Stacey Quintero, additional more...
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- 2019
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25. Consensus-Based Development of a Global Registry for Traumatic Brain Injury: Establishment, Protocol, and Implementation.
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Joannides, Alexis J., Korhonen, Tommi K., Clark, David, Gnanakumar, Sujit, Venturini, Sara, Mohan, Midhun, Bashford, Thomas, Baticulon, Ronnie, Bhagavatula, Indira Devi, Esene, Ignatius, Fernández-Méndez, Rocío, Figaji, Anthony, Gupta, Deepak, Khan, Tariq, Laeke, Tsegazeab, Martin, Michael, Menon, David, Paiva, Wellingson, Park, Kee B., and Pattisapu, Jogi V. more...
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- 2024
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26. Intracranial high-grade glioma with malignant progression of spinal intramedullary metastasis: an atypical presentation with review of literature.
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Siroya, Hardik Lalit, Bhagavatula, Indira Devi, Bhat, Dhanjaya Ishwar, and Sadashiva, Nishanth
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GLIOMAS , *METASTASIS , *SPINE diseases , *DIAGNOSIS , *ERDHEIM-Chester disease , *BRAIN tumors - Abstract
Purpose: High-grade gliomas (grade 3 and grade 4) are known to be highly locally invasive and distant metastasis though known, rarely manifest clinically due to poor survival. Recently, due to increasing survival in view of early diagnosis at relatively young age, more cases of extra neural symptomatic metastasis are being diagnosed and treated. Among these, symptomatic spinal metastasis is even more rare. Dissemination of GBM to the spinal compartment, albeit uncommon, has an even poorer outcome, with most patients dying within 2-3 months after diagnosis of metastatic disease. Materials and Methods: Here, we present a rare case report of a 25-year-old female with transformed/ histologically progressed tumour in cranial region along with ultra-rapid progression of the spinal disease following metastasis. Proper consent of the patient relatives was taken prior to production of material as patient had expired by the time of writing of this paper. We also present an extensive review of spinal metastasis secondary to intracranial high-grade gliomas starting from 1950. We conducted a thorough and exhaustive systematic search and review of the indexed databases available in PUBMED, COCHRANE and GOOGLE SCHOLAR with key words 'spinal metastasis of glioma', 'spinal metastasis', 'glioma progression', 'secondary glioma', multicentric glioma', 'secondary spinal metastasis' and formulated a comprehensive table of the studies that met the set standards. The studies that included (a) Number of cases, (b) Age and sex of patients, (c) operated primary or non-operated primary with spinal metastasis, (d) time period from the index cranial surgery, (e) outcome after diagnosis of spine metastasis and (f) histopath-ology of both cranial and spinal tumour either following surgery or autopsy have been elucidated herewith. We searched the databases with no particular time period. Out of 42 case reports and series, 28 studies were selected for our publication as they met the standards set, starting from 1950 to 2020. Results: In this case, the primary histopathological diagnosis post cranial tumour removal was Grade-3 anaplastic astrocytoma, whereas Spinal autopsy report done 16 months after the primary diagnosis showed Grade-4 GBM suggestive of secondary transformation (Secondary GBM), it showed same genome of IDH mutation and ATRX loss, neoplastic fibrillary and gemistocytic astrocytes with de-differentiation, foamy histiocytes as seen in primary lesion suggestive of progression and metachronicity rather than multicentricity or synchronicity. What is more peculiar and rare in our case is that the spinal disease was very malignant and it progressed in course of just two days to involve the whole spine. [ABSTRACT FROM AUTHOR] more...
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- 2023
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27. Chaotic lipoma with proximal syrinx --a (not so) rare variant - review of the literature, possible embryology and management.
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Siroya, Hardik Lalit, Madhugiri, Venkatesh S., Shukla, Dhaval Premchand, Uppar, Alok Mohan, and Bhagavatula, Indira Devi
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LIPOMA ,EMBRYOLOGY - Abstract
Chaotic lipomas are an extremely rare variant of spinal lipomas. This entity was first defined in 2009 by Pang and colleagues. Not much has been written about this variant. Its characteristic is the haphazard distribution of DREZ (Dorsal root entry zone), nerve roots and placode-lipoma interface. Thus complete/near-total excision of this lesion is quite difficult. We describe a case of chaotic spinal lipoma and elucidate the challenges faced in the management of this entity and review the literature. We performed a thorough systematic review with the keyword 'chaotic', 'Lipomyelomeningocele', 'Complex Lipomyelomeningocele', 'LMMC', 'Lumbar lipoma', 'spinal lipoma' in the google scholar and PUBMED data system for indexed literature on the above topic with no particular time frame. The studies quoted range earliest from 1970 till currently. Additional potential relevant articles were further retrieved through a manual search of references from original reports. Out of 42 studies, a total of 21 publications were selected which could have encountered a chaotic variant, but due to the term introduced only recently in 2009, may have been described differently. Studies encompassing true lipomeningomyelocele were excluded from our review. What we found out? Chaotic lipoma may not be a new entity. The scarce description in literature may be in part due to non-introduction and unclear description of this term earlier. The management of this variant is particularly challenging with basic principles remaining the same. Meticulous near-total excision and placode-lipoma construct are the major obstacles. [ABSTRACT FROM AUTHOR] more...
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- 2023
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28. Casemix, management, and mortality of patients receiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study
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David Clark, Alexis Joannides, Amos Olufemi Adeleye, Abdul Hafid Bajamal, Tom Bashford, Hagos Biluts, Karol Budohoski, Ari Ercole, Rocío Fernández-Méndez, Anthony Figaji, Deepak Kumar Gupta, Roger Härtl, Corrado Iaccarino, Tariq Khan, Tsegazeab Laeke, Andrés Rubiano, Hamisi K Shabani, Kachinga Sichizya, Manoj Tewari, Abenezer Tirsit, Myat Thu, Manjul Tripathi, Rikin Trivedi, Bhagavatula Indira Devi, Franco Servadei, David Menon, Angelos Kolias, Peter Hutchinson, Ghayur Abbas, Omar Ibrahim Abdallah, Ahmed Abdel-Lateef, Khalif Abdifatah, Awfa Abdullateef, Ruvini Abeygunaratne, Mostafa Aboellil, Abass Adam, Robert Adams, Amos Adeleye, Augustine Adeolu, Novan Krisno Adji, Nur Afianti, Sudarsan Agarwal, Ifeanyi Kene Aghadi, Paúl Martín Méndez Aguilar, Syeda Rida Ahmad, Daniyal Ahmed, Nafees Ahmed, Haider Aizaz, Yunus Kuntawi Aji, Alex Alamri, Augusto Jacinto Mussindo Alberto, Luis Alcocer Alcocer, Lesly Gonzales Alfaro, Amro Al-Habib, Ahmad Alhourani, Syed Muhammad Rafay Ali, Fahad Alkherayf, Ahmed AlMenabbawy, Aliyah Alshareef, Muhammad Adil s/o Aminullah, Madeha Amjad, Robson Luis Oliveira de Amorim, Sathiaprabhu Anbazhagan, Almir Andrade, Waleed Antar, Theophilus T.K. Anyomih, Salah Aoun, Tedy Apriawan, Daniele Armocida, Paul Arnold, Miguel Arraez, Temesgen Assefa, Andres Asser, S.P. Athiththan, Deepal Attanayake, Maung Maung Aung, Allan Avi, Victor Enrique Antolinez Ayala, Mohammed Azab, Gaousul Azam, Mohd Azharuddin, Olukemi Badejo, Mohamed Badran, Azam Ali Baig, Rehman Ali Baig, Ankur Bajaj, Paul Baker, Renu Bala, Artur Balasa, Ross Balchin, James Balogun, Vin Shen Ban, Bharath Kumar Reddy Bandi, Soham Bandyopadhyay, Matthew Bank, Ernest Barthelemy, Mohammed Talha Bashir, Luciano Silveira Basso, Surajit Basu, Auricelio Batista, Marlies Bauer, Devi Bavishi, Abi Beane, Shmuel Bejell, Anteneh Belachew, Antonio Belli, Amani Belouaer, Najia El Abbadi Bendahane, Okanga Benjamin, Youssef Benslimane, Chaymae Benyaiche, Claudio Bernucci, Luigi Valentino Berra, Arnold Bhebe, Alexios Bimpis, Diana Blanaru, Jean Claude Bonfim, Luis A B Borba, Alp Ozgun Borcek, Erika Borotto, Ahmad Elmabri Mohammad Bouhuwaish, Facundo Bourilhon, Gioia Brachini, Joshua Breedon, Maximilian Broger, Giacoma Maria Floriana Brunetto, Placido Bruzzaniti, Natalia Budohoska, Hira Burhan, Maximiliano Luis Calatroni, Catherine Camargo, Pier Francesco Cappai, Salvatore Massimiliano Cardali, Ana M Castaño-Leon, David Cederberg, Mikel Celaya, Marco Cenzato, Lakshmi Madhavi Challa, Dhanny Charest, Bipin Chaurasia, Rabah Chenna, Iype Cherian, Juliana Henry Ching'o, Tejas Chotai, Ajay Choudhary, Nabeel Choudhary, Florence Choumin, Tomislav Cigic, Juan Ciro, Carlo Conti, Antônio Carlos de Souza Corrêa, Giulia Cossu, Maíra Piani Couto, Aurora Cruz, Divya D'Silva, Giuseppe Antonio D'Aliberti, Lamin Dampha, Roy Thomas Daniel, Andrew Dapaah, Aneela Darbar, Gabriel Dascalu, Happy Amos Dauda, Owain Davies, Andrea Delgado-Babiano, Markus Dengl, Marko Despotovic, Indira Devi, Celeste Dias, Mohamed Dirar, Melina Dissanayake, Hananiah Djimbaye, Simon Dockrell, Ali Dolachee, Julija Dolgopolova, Muge Dolgun, Abdalrouf Dow, Davide Drusiani, Artjom Dugan, Dinh Tuan Duong, Trung Kien Duong, Tomasz Dziedzic, Ali Ebrahim, Nizar El Fatemi, Antonios El El Helou, Rachid El El Maaqili, Brahim El El Mostarchid, Abdessamad El El Ouahabi, Mohammad Elbaroody, Ahmed El-Fiki, Ahmed El-Garci, Nasser M.F. El-Ghandour, Muhammed Elhadi, Vanessa Elleder, Safa Elrais, Mohamed El-shazly, Mohamed Elshenawy, Hesham Elshitany, Omar El-Sobky, Marwa Emhamed, Basil Enicker, Onur Erdogan, Sebastian Ertl, Ignatius Esene, Omar Ocampo Espinosa, Tarig Fadalla, Mohammed Fadelalla, Rodrigo Moreira Faleiro, Nida Fatima, Charbel Fawaz, Assefa Fentaw, Carla Eiriz Fernandez, Ana Ferreira, Francesco Ferri, Tony Figaji, Emerson L B Filho, Loic Fin, Benjamin Fisher, Fitra Fitra, Alexis Palpan Flores, Ioan Stefan Florian, Vincenzo Fontana, Lauren Ford, Daniel Fountain, Jose Maria Roda Frade, Antonio Fratto, Christian Freyschlag, Aranzazu Sánchez Gabin, Clare Gallagher, Mario Ganau, Maria Luisa Gandia-Gonzalez, Andoni Garcia, Borja Hernandez Garcia, Sanjeewa Garusinghe, Biniam Gebreegziabher, Adrian Gelb, Jerome St George, Antonino Francesco Germanò, Ilaria Ghetti, Prajwal Ghimire, Alessandro Giammarusti, Jose Luis Gil, Panagiota Gkolia, Yoseph Godebo, Prakash Rao Gollapudi, Jagos Golubovic, Jeremias Fernando Gomes, Javier Gonzales, William Gormley, Alexander Gots, Giulia Letizia Gribaudi, Dylan Griswold, Paolo Gritti, Ruan Grobler, Rudy Gunawan, Birhanu Hailemichael, Elmehdi Hakkou, Mark Haley, Alhafidz Hamdan, Ali Hammed, Waeel Hamouda, Nurul Ashikin Hamzah, Nyein Latt Han, Sahin Hanalioglu, Rashan Haniffa, Martin Hanko, John Hanrahan, Timothy Hardcastle, Fahd Derkaoui Hassani, Volkmar Heidecke, Eirik Helseth, Miguel Ángel Hernández-Hernández, Zachary Hickman, Le Minh Chau Hoang, Alexa Hollinger, Lenka Horakova, Kismet Hossain-Ibrahim, Boru Hou, Samer Hoz, Janine Hsu, Martin Hunn, Madiha Hussain, Giorgia Iacopino, Mylena Miki Lopes Ideta, Irene Iglesias, Ali Ilunga, Nafiz Imtiaz, Rafiza Islam, Serge Ivashchenko, Karim Izirouel, Mohamed Sobhi Jabal, Soubhi Jabal, John Nute Jabang, Aimun Jamjoom, Irfan Jan, Landing BM Jarju, Saad Javed, Bojan Jelaca, Sukhdeep Singh Jhawar, Ting Ting Jiang, Fernando Jimenez, Jorge Jiris, Ron Jithoo, Walt Johnson, Mathew Joseph, Rameshman Joshi, Eija Junttila, Mubashir Jusabani, Stephen Akau Kache, Satyavara Prasad Kadali, Gabriela F Kalkmann, Usman Kamboh, Hitham Kandel, Ahmet Kamil Karakus, Mengistu Kassa, Ari Katila, Yoko Kato, Martin Keba, Kristy Kehoe, Huseyin Hayri Kertmen, Soha Khafaji, Monty Khajanchi, Mohammed Khan, Muhammad Mukhtar Khan, Sohail Daud Khan, Ahtesham Khizar, Amir Khriesh, Sara Kierońska, Paul Kisanga, Boniface Kivevele, Kacper Koczyk, Anna-Lucia Koerling, Danielle Koffenberger, Kennet Kõiv, Leho Kõiv, Branislav Kolarovszki, Marton König, Dilek Könü-Leblebicioglu, Santhoshi Devi Koppala, Tommi Korhonen, Boguslaw Kostkiewicz, Kacper Kostyra, Srinivas Kotakadira, Arjun Reddy Kotha, Madhu Narayana Rao Kottakki, Nenad Krajcinovic, Michal Krakowiak, Andreas Kramer, Selvamuthukumaran Krishnamoorthy, Ashok Kumar, Pankaj Kumar, Pradhumna Kumar, Nilaksha Kumarasinghe, Gowtham Kuncha, Raja K. Kutty, Ghazwan Lafta, Simon Lammy, Pierfrancesco Lapolla, Jacopo Lardani, Nebojsa Lasica, Giancarlo Lastrucci, Yoann Launey, Laura Lavalle, Tim Lawrence, Albert Lazaro, Vitalii Lebed, Ville Leinonen, Lawrence Lemeri, Leon Levi, Jia Yi Lim, Xiao Yi Lim, Jorge Linares-Torres, Laura Lippa, Lurdes Lisboa, Jinfang Liu, Ziyuan Liu, William B Lo, Jan Lodin, Federico Loi, Daniella Londono, Pedro Antonio Gomez Lopez, Cristina Barceló López, Madeleine De Lotbiniere-Bassett, Rihards Lulens, Facundo Hector Luna, Teemu Luoto, Vijaya Sekhar M.V., Ndyebo Mabovula, Matthew MacAllister, Alcina Americo Macie, Rodolfo Maduri, Moufid Mahfoud, Ashraf Mahmood, Fathia Mahmoud, Dominic Mahoney, Wissam Makhlouf, George Malcolm, Adefolarin Malomo, Toluyemi Malomo, Manoranjitha Kumari Mani, Tomás Gazzinelli Marçal, Jacopo Marchello, Nicolò Marchesini, Franz Marhold, Niklas Marklund, Rubén Martín-Láez, Vickneswaran Mathaneswaran, David José Mato-Mañas, Helen Maye, Aaron Lawson McLean, Catherine McMahon, Saniya Mediratta, Mehreen Mehboob, Alisson Meneses, Nesrine Mentri, Hagos Mersha, Ana Milena Mesa, Cristy Meyer, Christopher Millward, Salomao Amone Mimbir, Andrea Mingoli, Parashruram Mishra, Tejesh Mishra, Basant Misra, Siddharth Mittal, Imran Mohammed, Ioana Moldovan, Masechaba Molefe, Alexis Moles, Preston Moodley, Mario Augusto Narváez Morales, Lucy Morgan, German Del Castillo Morillo, Wahab Moustafa, Nikolaos Moustakis, Salma Mrichi, Satya Shiva Munjal, Abdul-Jalilu Mohammed Muntaka, Denver Naicker, Paulo E H Nakashima, Pratap Kumar Nandigama, Samantha Nash, Ionut Negoi, Valetina Negoita, Samundra Neupane, Manh Hung Nguyen, Fajar Herbowo Niantiarno, Abbi Noble, Mohd Arman Muhamad Nor, Blazej Nowak, Andrei Oancea, Frazer O'Brien, Oghenekevwe Okere, Sandra Olaya, Leandro Oliveira, Louise Makarem Oliveira, Fatma Omar, Okezi Ononeme, René Opšenák, Simone Orlandini, Alrobah Osama, Dorcas Osei-Poku, Haytham Osman, Alvaro Otero, Malte Ottenhausen, Shuli Otzri, Oumaima Outani, Emmanuel Abem Owusu, Kevin Owusu-Agyemang, Ahmad Ozair, Baris Ozoner, Elli Paal, Mauro Sérgio Paiva, Wellingson Paiva, Sharad Pandey, Gastone Pansini, Luigi Pansini, Tobias Pantel, Nikolaos Pantelas, Konstantinos Papadopoulos, Vladimir Papic, Kee Park, Nick Park, Eric Homero Albuquerque Paschoal, Mylla Christie de Oliveira Paschoalino, Rajesh Pathi, Anilkumar Peethambaran, Thiago Andrade Pereira, Irene Panero Perez, Claudio José Piqueras Pérez, Tamilanandh Periyasamy, Stefano Peron, Michael Phillips, Sofía Sotos Picazo, Ertugrul Pinar, Daniel Pinggera, Rory Piper, Pathmanesan Pirakash, Branko Popadic, Jussi P. Posti, Rajmohan Bhanu Prabhakar, Sivanesalingam Pradeepan, Manjunath Prasad, Paola Calvachi Prieto, Ron Prince, Andrea Prontera, Eva Provaznikova, Danilo Quadros, Nezly Jadid Romero Quintero, Mahmood Qureshi, Happiness Rabiel, Gabriel Rada, Sivagnanam Ragavan, Jueria Rahman, Omar Ramadhan, Padma Ramaswamy, Sakina Rashid, Jagath Rathugamage, Tõnu Rätsep, Minna Rauhala, Asif Raza, Naga Raju Reddycherla, Linus Reen, Mohamed Refaat, Luca Regli, Haijun Ren, Antonio Ria, Thales Francisco Ribeiro, Alessandro Ricci, Romana Richterová, Florian Ringel, Faith Robertson, Catarina Mayrink Siqueira Cabral Rocha, Juvenal de Souza Rogério, Adan Anibal Romano, Sally Rothemeyer, Gail Rousseau Gail Rousseau, Ranette Roza, Kevin David Farelo Rueda, Raiza Ruiz, Malin Rundgren, Radoslaw Rzeplinski, Raj S.Chandran, Ramesh Andi Sadayandi, William Sage, André Norbert Josef Sagerer, Mustafa Sakar, Mohcine Salami, Danjuma Sale, Youssuf Saleh, Cristina Sánchez-Viguera, Saning'o Sandila, Ahmet Metin Sanli, Laura Santi, Antonio Santoro, Aieska Kellen Dantas Dos Santos, Samir Cezimbra dos Santos, Borja Sanz, Shabal Sapkota, Gopalakrishnan Sasidharan, Ibrahim Sasillo, Rajeev Satoskar, Ali Caner Sayar, Vignesh Sayee, Florian Scheichel, Felipe Lourenzon Schiavo, Alexander Schupper, Andreas Schwarz, Teresa Scott, Esther Seeberger, Claudionor Nogueira Costa Segundo, Anwar Sadat Seidu, Antonio Selfa, Nazan Has Selmi, Claudiya Selvarajah, Necmiye Şengel, Martin Seule, Luiz Severo, Purva Shah, Muhammad Shahzad, Thobekile Shangase, Mayur Sharma, Ehab Shiban, Emnet Shimber, Temitayo Shokunbi, Kaynat Siddiqui, Emily Sieg, Martin Siegemund, Shahidur Rahman Sikder, Ana Cristina Veiga Silva, Ana Silva, Pedro Alberto Silva, Deepinder Singh, Carly Skadden, Josef Skola, Eirini Skouteli, Pawel Słoniewski, Brandon Smith, Guirish Solanki, Davi Fontoura Solla, Davi Solla, Ozcan Sonmez, Müge Sönmez, Wai Cheong Soon, Roberto Stefini, Martin Nikolaus Stienen, Bogdan Stoica, Matthew Stovell, Maria Natalia Suarez, Alaa Sulaiman, Mazin Suliman, Adi Sulistyanto, Şeniz Sulubulut, Sandra Sungailaite, Madlen Surbeck, Tomasz Szmuda, Graziano Taddei, Abraham Tadele, Ahmed Saleh Ahmed Taher, Riikka Takala, Krishna Murthy Talari, Bih Huei Tan, Leonardo Tariciotti, Murad Tarmohamed, Oumayma Taroua, Emiliano Tatti, Olli Tenovuo, Sami Tetri, Poojan Thakkar, Nqobile Thango, Satish Kumar Thatikonda, Tuomo Thesleff, Claudius Thomé, Owen Thornton, Shelly Timmons, Eva Ercilio Timoteo, Campbell Tingate, Souhil Tliba, Christos Tolias, Emma Toman, Ivan Torres, Luis Torres, Youness Touissi, Musa Touray, Maria Pia Tropeano, Georgios Tsermoulas, Christos Tsitsipanis, Mehmet Erhan Turkoglu, Özhan Merzuk Uçkun, Jamie Ullman, Gheorghe Ungureanu, Sarah Urasa, Obaid Ur-Rehman, Muhammed Uysal, Antonios Vakis, Egils Valeinis, Vaishali Valluru, Debby Vannoy, Pablo Vargas, Phillipos Varotsis, Rahul Varshney, Atul Vats, Damjan Veljanoski, Sara Venturini, Abhijit Verma, Clara Villa, Genaro Villa, Sofia Villar, Erin Villard, Antonio Viruez, Stefanos Voglis, Petar Vulekovic, Saman Wadanamby, Katherine Wagner, Rebecca Walshe, Jan Walter, Marriam Waseem, Tony Whitworth, Ruwani Wijeyekoon, Adam Williams, Mark Wilson, Sein Win, Achmad Wahib Wahju Winarso, Abraão Wagner Pessoa Ximenes, Anurag Yadav, Dipak Yadav, Kamal Makram Yakoub, Ali Yalcinkaya, Guizhong Yan, Eesha Yaqoob, Carlos Yepes, Ayfer Nazmiye Yılmaz, Betelehem Yishak, Farhat Basheer Yousuf, Muhammad Zamzuri Zahari, Hussein Zakaria, Diego Zambonin, Luca Zavatto, Bassel Zebian, Anna Maria Zeitlberger, Furong Zhang, Fengwei Zheng, and Michal Ziga more...
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casemix ,management ,mortality ,emergency neurosurgery ,traumatic brain injury ,prospective observational cohort study ,Neurology (clinical) - Abstract
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. Methods: We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)—a composite of life expectancy, education, and income measures—into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. Findings: Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24–51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34–69) and the youngest in the low HDI tier (median 28 years, IQR 20–38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6–32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55–5·2) and high HDI tier (2·26, 1·23–4·15), but not the low HDI tier (1·66, 0·61–4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17–2·49). Interpretation: Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. Funding: National Institute for Health Research Global Health Research Group. more...
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- 2022
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29. Predictors of Remission of Acromegaly following Surgical Treatment in Growth Hormone-Secreting Pituitary Adenoma
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Subhas Konar, Ujwal Yeole, Dhaval Shukla, Dhananjaya I. Bhat, Nishanth Sadashiva, and Bhagavatula Indira Devi
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Neurology (clinical) - Abstract
Background and Objective Surgery is the treatment of choice for growth hormone (GH)-secreting pituitary adenoma. The remission of random GH depends on various factors. We aimed to evaluate the predictors related to remission of random GH following surgical treatment. Methods We collected the data retrospectively from the chart review from a single unit of neurosurgery. The diagnostic criteria for remission were a random GH Results Data from a total of 110 (females 62 [56.4%]) patients were available for follow-up and were analyzed. The mean age was 36.5 years (14–69 years). Vision impairments were seen in 39 (35.5%) patients. The mean duration of symptoms before surgery was 34 months. The mean volume of the tumor was 7.2 mL (0.44–109.8 mL). Knosp grade 3 and 4 tumors were seen in 41.5% of cases. The mean preoperative random GH level was 68.9 ng/mL. Transsphenoidal surgery was done in 107 (97.3%) cases. The gross total resection could be done in 36 (32.7%) cases. At 3 months, 25 (26%) patients had a biochemical remission. In univariable analysis, lower Knosp grade, preoperative GH level Conclusion The preoperative GH level more...
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- 2023
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30. Heartbroken Child: A Rare Case Report of Neurogenic Pulmonary Edema and Takotsubo Cardiomyopathy following Recurrent Medulloblastoma Excision with Possible Aetio-Patho-Bio-Physiological Mechanisms
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Hardik Lalit Siroya, Alok Mohan Uppar, Venkatesh S. Madhugiri, and Bhagavatula Indira Devi
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Pediatrics, Perinatology and Child Health ,Surgery ,Neurology (clinical) ,General Medicine - Abstract
Introduction: Takotsubo (Japanese fishing pot for trapping octopus) cardiomyopathy is a rare phenomenon of acute coronary syndrome presenting usually with the presence of transient apical ballooning of the left ventricle in the absence of obstructive coronary artery disease. It is mainly seen in women of older age secondary to emotional, physical, or psychological stress. In age less than 18 years, it is mainly seen in adolescents suffering from psychiatric disorders and substance abuse. In children, it is rarely described. Case Presentation: We present here a peculiar case of a 12-year-old child with neurogenic pulmonary oedema and takotsubo cardiomyopathy syndrome after surgery for recurrent medulloblastoma. Also, management challenges are discussed. Discussion/Conclusion: Takotsubo cardiomyopathy is not just a classical or inverted type but indeed a spectrum. It can be seen in any case, be it a child or adult secondary to handling or injury to the ponto-medullary junction, rostral pons, or dorsolateral medulla. The density and distribution of beta-adrenergic receptors may be different in children and adults which needs further research. Prognosis is usually excellent across all ages. more...
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- 2022
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31. A Rare Case Series of Cerebral Venous Thrombosis and Stroke in Young Male COVID-19 Positive Patients without Significant Comorbidities and Importance of Various Laboratory Investigations
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Hardik Lalit Siroya, Bhagavatula Indira Devi, Sachin Jose Pulickal, and Dhanjaya Ishwar Bhat
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- 2022
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32. Delayed Posttraumatic Tension Pneumocephalus: Case Report and Review of Literature
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Chirag Jain, Ajinkya Rewatkar, Anup Kumar Roy, and Bhagavatula Indira Devi
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General Engineering ,General Earth and Planetary Sciences ,General Environmental Science - Abstract
Delayed tension pneumocephalus is a rare entity. Twelve cases of posttraumatic delayed tension pneumocephalus have been reported. This study is a case report of a patient presenting with delayed posttraumatic tension pneumocephalus, and highlights the nuances of management. more...
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- 2023
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33. Altered MicroRNA Expression in Intracranial Aneurysmal Tissues: Possible Role in TGF-β Signaling Pathway
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Rita Christopher, Bhagavatula Indira Devi, Dhaval Shukla, Manjunath Supriya, Dhananjaya I Bhat, and S.R. Kalpana
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0301 basic medicine ,MAPK/ERK pathway ,MAPK3 ,Extracellular matrix ,Mothers against decapentaplegic homolog 2 ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Transforming Growth Factor beta ,microRNA ,Humans ,RNA, Messenger ,MAPK1 ,biology ,Kinase ,Gene Expression Profiling ,Intracranial Aneurysm ,Cell Biology ,General Medicine ,Transforming growth factor beta ,MicroRNAs ,030104 developmental biology ,biology.protein ,Cancer research ,030217 neurology & neurosurgery ,Signal Transduction - Abstract
The molecular mechanisms behind the rupture of intracranial aneurysms remain obscure. MiRNAs are key regulators of a wide array of biological processes altering protein synthesis by binding to target mRNAs. However, variations in miRNA levels in ruptured aneurysmal wall have not been completely examined. We hypothesized that altered miRNA signature in aneurysmal tissues could potentially provide insight into aneurysm pathophysiology. Using a high-throughput miRNA microarray screening approach, we compared the miRNA expression pattern in aneurysm tissues obtained during surgery from patients with aneurysmal subarachnoid hemorrhage (aSAH) with control tissues (GEO accession number GSE161870). We found that the expression of 70 miRNAs was altered. Expressions of the top 10 miRNA were validated, by qRT-PCR and results were correlated with clinical characteristics of aSAH patients. The level of 10 miRNAs (miR-24-3p, miR-26b-5p, miR-27b-3p, miR-125b-5p, miR-143-3p, miR-145-5p, miR-193a-3p, miR-199a-5p, miR-365a-3p/365b-3p, and miR-497-5p) was significantly decreased in patients compared to controls. Expression of miR-125b-5p, miR-143-3p and miR-199a-5p was significantly decreased in patients with poor prognosis and vasospasm. The target genes of few miRNAs were enriched in Transforming growth factor-beta (TGF-β) and Mitogen-activated protein kinases (MAPK) pathways. We found significant negative correlation between the miRNA and mRNA expression (TGF-β1, TGF-β2, SMAD family member 2 (SMAD2), SMAD family member 4 (SMAD4), MAPK1 and MAPK3) in aneurysm tissues. We suggest that miR-26b, miR-199a, miR-497and miR-365, could target multiple genes in TGF-β and MAPK signaling cascades to influence inflammatory processes, extracellular matrix and vascular smooth muscle cell degradation and apoptosis, and ultimately cause vessel wall degradation and rupture. more...
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- 2021
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34. Development of a Prognostic Model to Predict Mortality after Traumatic Brain Injury in Intensive Care Setting in a Developing Country
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Bhagavatula Indira Devi, Mini Jayan, Subhas Konar, Dhaval Shukla, and Dhananjaya I Bhat
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medicine.medical_specialty ,Randomization ,Traumatic brain injury ,Neurosciences. Biological psychiatry. Neuropsychiatry ,intensive care unit ,outcome prediction ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Intensive care ,medicine ,Third ventricle ,business.industry ,General Neuroscience ,traumatic brain injury ,Head injury ,Glasgow Coma Scale ,030208 emergency & critical care medicine ,medicine.disease ,Intensive care unit ,medicine.anatomical_structure ,Emergency medicine ,Original Article ,Neurology (clinical) ,Neurosurgery ,business ,030217 neurology & neurosurgery ,RC321-571 - Abstract
Objectives We aimed to develop a prognostic model for the prediction of in-hospital mortality in patients with traumatic brain injury (TBI) admitted to the neurosurgery intensive care unit (ICU) of our institute. Materials and Methods The clinical and computed tomography scan data of consecutive patients admitted after a diagnosis TBI in ICU were reviewed. Construction of the model was done by using all the variables of Corticosteroid Randomization after Significant Head Injury and International Mission on Prognosis and Analysis of Clinical Trials in TBI models. The endpoint was in-hospital mortality. Results A total of 243 patients with TBI were admitted to ICU during the study period. The in-hospital mortality was 15.3%. On multivariate analysis, the Glasgow coma scale (GCS) at admission, hypoxia, hypotension, and obliteration of the third ventricle/basal cisterns were significantly associated with mortality. Patients with hypoxia had eight times, with hypotensions 22 times, and with obliteration of the third ventricle/basal cisterns three times more chance of death. The TBI score was developed as a sum of individual points assigned as follows: GCS score 3 to 4 (+2 points), 5 to 12 (+1), hypoxia (+1), hypotension (+1), and obliteration third ventricle/basal cistern (+1). The mortality was 0% for a score of “0” and 85% for a score of “4.” Conclusion The outcome of patients treated in ICU was based on common admission variables. A simple clinical grading score allows risk stratification of patients with TBI admitted in ICU. more...
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- 2021
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35. Transventricular Endoscopic Approach for Cystic Craniopharyngioma: Case Series
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Akshay Kulkarni, Subhas Konar, Dhaval Shukla, Nishanth Sadashiva, and Bhagavatula Indira Devi
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Neurology (clinical) - Abstract
Background and Study Aims The treatment of craniopharyngioma is varied. The treatment ranges from radical excision to direct radiotherapy. As the morbidity of excision is high, more conservative approaches are used. Transventricular endoscopy is a minimally invasive treatment for cystic craniopharyngiomas. The objective of this study is to describe a personal experience with this method of treatment. Material and Methods This is a retrospective review of a series of patients managed with endoscopic catheter and reservoir placement for cystic craniopharyngiomas. Results Twenty-nine patients presented with clinical features of raised intracranial features. Imaging showed a predominantly cystic craniopharyngioma extending into the third ventricle with hydrocephalus. All patients underwent transcortical transventricular endoscopic biopsy, and catheter placement connected to a reservoir. There was no morbidity ascribed to the endoscopic procedure when fenestration and aspiration or fenestration and reservoir were placed. Twelve patients underwent radiotherapy. The median duration of follow-up was 18 months (3–72 months). Eight (27.5%) cases had recurrences. Five (17.2%) could be managed with only reaspiration, two (6.8%) required craniotomy and resection, and one (3.4%) could be managed only with ventriculoperitoneal shunt. Conclusion The neuroendoscopic fenestration, aspiration of cyst, and placement of catheter reservoir followed by radiation is an optional treatment for predominantly cystic craniopharyngiomas arising within or extending into the third ventricle causing hydrocephalus. more...
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- 2022
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36. Prediction of Surgical Outcome for Acute Traumatic Brain Injury in Older Adults
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Pooja, Hazare, Dhaval, Shukla, Dhananjaya, Bhat, Bhagavatula Indira, Devi, Mini, Jayan, Subhas, Konar, Nikhil, Ratna, Vibhor, Pateriya, Kautilya, Patel, and Bhushan, Thombre
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Male ,Treatment Outcome ,Brain Injuries ,Brain Injuries, Traumatic ,Humans ,Female ,Craniotomy ,Aged ,Retrospective Studies - Abstract
Increasing patient age is strongly associated with a rising incidence of traumatic brain injury (TBI) and a higher mortality and morbidity rates.This study aimed to identify the predictors of mortality after craniotomy for TBI in elderly patients.Data of all patients aged ≥65 years who underwent craniotomy for acute TBI, over a period from January 2015 to October 2019, were retrospectively reviewed. The standard clinical and imaging variables for TBI were recorded. The medical comorbidities, indication for surgery, and intraoperative complications were also recorded. The outcome of interest was survival at 6 months after surgery.A total of 206 patients were available for analysis. The age of patients ranged from 65 to 80 years. The most frequent surgical procedure performed was craniotomy and evacuation of supratentorial subdural hematoma with or without evacuation of the traumatic parenchymal lesion. The in-hospital mortality was 46 out of 206 (22.3%), and 6 months mortality was 116 out of 206 (56.3%). Among the survivors at 6 months, good recovery was seen in 70.5%, moderate disability in 19.8%, and severe disability in 8.6% patients. Only 1.2% patients survived in a vegetative state at 6 months. The odds of death are nearly three times more for patients with dilated and nonreactive pupillary reaction. The odds of death are less by 72% for a unit increase in motor score. In older adults, the main determinants of survival after surgery for TBI are pupillary reaction and motor score. more...
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- 2022
37. Validity of Glasgow outcome scale-extended (GOSE) mobile application for assessment of outcome in traumatic brain injury patients.
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Shukla, Dhaval, Thombre, Bhushan Diwakar, Baby, Priya, Palaninathan, Jayanthi, Subramanian, Sivakami, Prathyusha, PV, and Bhagavatula, Indira Devi
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RESEARCH methodology evaluation ,MOBILE apps ,HEALTH outcome assessment ,PATIENTS ,INTERVIEWING ,TERTIARY care ,COMPARATIVE studies ,EMERGENCY medical services ,QUESTIONNAIRES ,BRAIN injuries ,OUTPATIENT services in hospitals ,ALGORITHMS ,EVALUATION - Abstract
To develop the Glasgow Outcome Scale-Extended (GOSE) mobile application and examine the validity of the application against GOSE scoring based on traditional interview method. Concurrent validity was determined by comparing two independent raters' scoring for GOSE of 102 patients with traumatic brain injury, who had attended outpatient department of a tertiary neuro hospital. Agreement was assessed between the traditional interview-based pen and paper scoring and algorithm based mobile application scoring of GOSE. Agreement was tested using Cohen's kappa, and the analysis revealed near perfect agreement between two raters (0.89) (p < 0.01). The GOSE mobile application can measure GOSE Score similar to the traditional interview method. This application may help fasten the process of assessing outcome in TBI patients in clinical practice and in research. [ABSTRACT FROM AUTHOR] more...
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- 2023
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38. Circulating MicroRNAs as Potential Molecular Biomarkers for Intracranial Aneurysmal Rupture
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Manjunath Supriya, Dhaval Shukla, Rita Christopher, Bhagavatula Indira Devi, and Dhananjaya I Bhat
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Adult ,Male ,0301 basic medicine ,Subarachnoid hemorrhage ,Aneurysm, Ruptured ,Real-Time Polymerase Chain Reaction ,Bioinformatics ,Sensitivity and Specificity ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,microRNA ,Genetics ,medicine ,Humans ,Circulating MicroRNA ,KEGG ,Gene ,Polymerase chain reaction ,Aged ,Pharmacology ,business.industry ,Gene Expression Profiling ,Computational Biology ,Disease Management ,Reproducibility of Results ,Intracranial Aneurysm ,Molecular Sequence Annotation ,General Medicine ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,Molecular medicine ,Human genetics ,MicroRNAs ,Gene Ontology ,030104 developmental biology ,ROC Curve ,030220 oncology & carcinogenesis ,Molecular Medicine ,Female ,RNA Interference ,Disease Susceptibility ,business ,Biomarkers - Abstract
Diagnosis of the rupture of an intracranial aneurysm (IA) relies on sophisticated neuro-imaging studies, and molecular biomarkers to identify an IA or predict its rupture are still unavailable. Our objective was to determine the plasma microRNA (miRNA) expression profile in patients with ruptured IA presenting as aneurysmal subarachnoid hemorrhage (aSAH) and identify potential biomarkers of aneurysmal rupture. Plasma miRNA profiling was carried out using quantitative real-time polymerase chain reaction (qRT-PCR) in 20 patients with aSAH and 20 age- and sex-matched healthy controls. Eight differentially expressed miRNAs were validated by qPCR in a larger cohort of 88 patients with aSAH and 110 healthy controls. A receiver operating characteristic (ROC) curve was constructed to evaluate the overall performance of the miRNA-based assay. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was used to determine the potential pathway of miRNA-target genes. The miRNA profiles were clearly distinct in patients compared with controls. Validation studies showed that three upregulated miRNAs (miR-15a-5p, miR-34a-5p, miR-374a-5p) and five downregulated miRNAs (miR-146a-5p, miR-376c-3p, miR-18b-5p, miR-24-3p, miR-27b-3p) could distinguish patients with aSAH from healthy controls with high predicted probability (0.865 and 0.995, respectively). Further, the expression levels of the eight candidate miRNAs were significantly dysregulated only in aSAH cases and not in patients with SAH due to other causes. Plasma miR-146a-5p and miR-27b-3p were associated with clinical outcomes in patients with aSAH. Functional analysis of the eight differentially expressed miRNA showed that the target genes involved in signaling pathways were related to inflammation. Our study determined the plasma miRNA signature of ruptured IAs and identified eight candidate miRNAs that could be useful biomarkers for this condition. We hypothesize that these differentially expressed miRNAs may play pivotal roles in IA pathology. more...
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- 2020
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39. Percutaneous Embolization of Spinal Epidural Arteriovenous Fistulae: Report of 2 Cases and Technical Considerations
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Nihar V. Kathrani, Richa S. Chauhan, Arvinda H. Ramalingaiah, Jitender Saini, and Bhagavatula Indira Devi
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2022
40. Traumatic brain injury during COVID-19 pandemic-time-series analysis of a natural experiment
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Banu Manickam Rajalu, Bhagavatula Indira Devi, Dhaval P Shukla, Lekhansh Shukla, Mini Jayan, Krishna Prasad, Deepak Jayarajan, Arun Kandasamy, and Pratima Murthy
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Brain Injuries, Traumatic ,Communicable Disease Control ,COVID-19 ,Humans ,General Medicine ,Pandemics ,Retrospective Studies - Abstract
ObjectivesThis study aims to find if the incidence and pattern of traumatic brain injury (TBI) changed during the COVID-19pandemic. We also aim to build an explanatory model for change in TBI incidence using Google community mobility and alcohol sales data.DesignA retrospective time-series analysis.SettingEmergency department of a tertiary level hospital located in a metropolitan city of southern India. This centre is dedicated to neurological, neurosurgical and psychiatric care.ParticipantsDaily counts of TBI patients seen between 1 December 2019 and 3 January 2021 (400 days); n=8893. To compare the profile of TBI cases seen before and during the pandemic, a subset of these cases seen between 1 December 2019 and 31 July 2020 (244 days), n=5259, are studied in detail.ResultsAn optimal changepoint is detected on 20 March 2020 following which the mean number of TBI cases seen every day has decreased and variance has increased (mean 1=29.4, variance 1=50.1; mean 2=19.5, variance 2=59.7, loglikelihood ratio test: χ2=130, df=1, p2=58.1). A significant decrease in traffic accidents, falls, mild/moderate injuries and, an increase in assault and severe injuries is seen during the pandemic period.ConclusionsDecongestion of roads and regulation of alcohol sales can decrease TBI occurrence substantially. An increase in violent trauma during lockdown needs further research in the light of domestic violence. Acute care facilities for TBI should be maintained even during a strict lockdown as the proportion of severe TBI requiring admission increases. more...
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- 2022
41. Estrogen receptor alpha gene variant, PvuII (rs2234693), as a potential pharmacogenetic biomarker for aneurysmal subarachnoid hemorrhage in postmenopausal women
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Dhananjaya I Bhat, Rita Christopher, Bhagavatula Indira Devi, Dhaval Shukla, and Shruthi Shimoga Ramesh
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Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Genotype ,Pharmacogenomic Variants ,medicine.drug_class ,Population ,Estrogen receptor ,Risk Assessment ,030226 pharmacology & pharmacy ,03 medical and health sciences ,Exon ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Genetics ,medicine ,Humans ,Allele ,education ,Genetic Association Studies ,Aged ,Pharmacology ,education.field_of_study ,Estradiol ,business.industry ,Estrogen Receptor alpha ,Middle Aged ,Subarachnoid Hemorrhage ,Postmenopause ,Phenotype ,030104 developmental biology ,Endocrinology ,Estrogen ,Case-Control Studies ,Molecular Medicine ,Female ,business ,Estrogen receptor alpha ,Pharmacogenetics - Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) occurs more often in postmenopausal women than in men. Estrogen plays an important role in vascular homeostasis. Our aim was to elucidate whether a drop in circulating estradiol in conjunction with variants of estrogen receptor genes have a role in female gender susceptibility to aSAH. A total of 709 subjects were enrolled (349 aSAH patients, 360 controls) and genotyped for rs2234693 or PvuII (intron 1, T>C) in the ESR1 gene and rs4986938 or AluI (exon 8, 1730G>A) of ESR2 gene by PCR-RFLP. Serum estradiol was estimated by ELISA. Estrogen receptor gene expression was studied by qRT-PCR. Logistic regression analysis indicated a significant recessive effect of the T allele of PvuII on aSAH in females, and this association remained statistically significant even after adjusting for confounders (OR 1.702, CI 95% 1.062, 2.726, P value = 0.027). ESR1 gene expression was significantly reduced (P value = 0.0089) in subjects carrying PvuII T allele. In postmenopausal women with TT genotype and low serum estradiol, the odds for developing aSAH were found to be 3.5-fold increase compared with premenopausal women (CI 95% 1.424–8.828, P value = 0.0074). However, this variant showed no significant association with aSAH in men. No significant difference was found in genotype and allelic distribution of AluI polymorphism in ESR2 gene, between patients and controls. We propose that the PvuII T allele could be a potential pharmacogenetic marker for strategizing personal medicine for preventing aSAH in postmenopausal women with low circulating estradiol. Further larger studies in other population are warranted. more...
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- 2020
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42. Persistent Trigeminal Artery: Neuroanatomic and Clinical Relevance
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Dhaval Shukla, Nishanth Sadashiva, Bhagavatula Indira Devi, Gaurav Tyagi, Hanumanthapura R. Aravinda, Subhas Konar, and Jitender Saini
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Magnetic resonance angiography ,Arteriovenous Malformations ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Trigeminal neuralgia ,medicine.artery ,medicine ,Humans ,Child ,Stroke ,Aged ,Retrospective Studies ,Transsphenoidal surgery ,medicine.diagnostic_test ,business.industry ,Angiography, Digital Subtraction ,Intracranial Aneurysm ,Digital subtraction angiography ,Cerebral Arteries ,Middle Aged ,Trigeminal Neuralgia ,Neurovascular bundle ,medicine.disease ,body regions ,medicine.anatomical_structure ,Trigeminal Ganglion ,Child, Preschool ,030220 oncology & carcinogenesis ,Trigeminal artery ,Female ,Surgery ,Neurology (clinical) ,Radiology ,Internal carotid artery ,business ,Magnetic Resonance Angiography ,030217 neurology & neurosurgery - Abstract
Introduction Persistent trigeminal artery (PTA) is the most common remnant of primitive circulation communicating the developing carotid and vertebrobasilar junction. Although discovered incidentally, an altered hemodynamic may lead to an increased association of aneurysms, vascular malformations, and stroke. Neurosurgeons should be aware of the presence and significance of PTA when interpreting imaging and planning interventions. Methods We retrospectively reviewed all magnetic resonance angiography and cerebral digital subtraction angiography performed between 2012 and 2017 for the presence of PTA. The radiologic and anatomic details were noted and analyzed along with the clinical profiles. We categorized the radiologic findings with respect to the available classification systems. A review of the available literature was done comparing our results. Results We found 33 cases of incidentally detected PTA. The average age of the patients was 45.42 years. The lateral surface of the proximal cavernous internal carotid artery was the most common origin (n = 23). Only 3 cases had a medial/transsellar course. Most cases were Saltzman/Weon type I (19/33). Intracranial aneurysms were associated with 6 patients (18.18%). Trigeminal neuralgia (TN) was a presenting feature in 5 patients. None had a direct neurovascular conflict at the root entry zone. Conclusions Our study is one of the largest to describe the incidence of PTA. We emphasized the importance of PTA to the neurosurgeons; increased association of aneurysms, as a route for intervention in occlusive disease of the posterior fossa; risk of injury and bleeding during transsphenoidal surgery; and the association with TN. However, we found that only PTA variants are likely to be associated with TN because of their cisternal course causing NV conflict. more...
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- 2020
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43. Cosmetic Outcome of Cranioplasty After Decompressive Craniectomy—An Overlooked Aspect
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Mohammed Nadeem, Dhaval Shukla, Diptiranjan Satapathy, Bhagavatula Indira Devi, and A R Prabhuraj
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Adult ,Male ,Decompressive Craniectomy ,Bone flap ,medicine.medical_specialty ,Adolescent ,Esthetics ,medicine.medical_treatment ,Outcome (game theory) ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Child ,Retrospective Studies ,Fixation (histology) ,Univariate analysis ,business.industry ,Trauma center ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Cranioplasty ,Surgery ,Venous thrombosis ,Brain Injuries ,030220 oncology & carcinogenesis ,Female ,Decompressive craniectomy ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background Cranioplasty (CP) is an obligatory surgery after decompressive craniectomy (DC). The primary objective is to protect the brain from external injury and prevent syndrome of trephined. In a government hospital, such cases pose a significant burden to a trauma center. Because of this reason, cosmetic outcome is never taken into account for the CP. We present results of CP performed at our hospital. Methods This is a retrospective review of the cases of CP performed over the past 3 years at our hospital. The cosmetic outcome was divided into 3 grades: 1—good symmetrical, 2—irregularities, 2a—elevated and 2b depressed, and 3—bad cosmetic outcome requiring reoperation. Results A total of 133 patients with acute brain injury underwent CP during the study period. The outcome was good in 74 (55.6%) and bad, requiring reoperation, in 2 (1.5%) cases. Various types of the CP materials like autologous bone flap, titanium mesh, and customized titanium plates were used. Methods of fixation were threads or miniplates and screws. In univariate analysis, cerebral venous thrombosis as an indication for DC, use of autologous bone flap, and fixation with thread were associated with poor outcome. However, in multivariate analysis only the method of implant fixation was associated with poor outcome. It was found that if screws and plates are used for fixation of bone flap, the chances of bad outcome are reduced by 74.6%. Conclusions The cosmetic outcome is overlooked for CP. The bone flap fixation has to be rigid for a good outcome. more...
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- 2019
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44. Multiple Remote Sequential Supratentorial Epidural Hematomas—An Unusual and Rare Complication After Posterior Fossa Surgery
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Bhagavatula Indira Devi, Gaurav Tyagi, Dhananjaya I Bhat, and Dhaval Shukla
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Hematoma, Epidural, Cranial ,Male ,Reoperation ,medicine.medical_specialty ,Decompression ,Posterior fossa ,Neurosurgical Procedures ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Hematoma ,Epidural hematoma ,medicine ,Humans ,Intracranial pressure ,Fourth Ventricle ,business.industry ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,Shunt (medical) ,Cranial Fossa, Posterior ,030220 oncology & carcinogenesis ,Radiological weapon ,Neurology (clinical) ,Tomography, X-Ray Computed ,Complication ,business ,030217 neurology & neurosurgery ,Hydrocephalus - Abstract
Background Postoperative hemorrhage is a serious complication of intracranial surgery. Epidural hematomas (EDHs) are one of the common forms of bleeding after surgery, with ≤12% of patients requiring re-exploration. However, distant or remote site EDHs have been rare, in particular, those in a supratentorial location after infratentorial surgery. Case Description We report an unusual complication of surgery for fourth ventricular outlet obstruction. A young male patient developed multiple sequential supratentorial EDHs after posterior fossa surgery. He required 2 re-explorations after the primary surgery for evacuation of the EDHs within 24 hours. In the available data, we found only 28 such reported cases previously. Only 2 additional cases have been reported to have sequential EDHs after surgery. Various theories have been postulated, ranging from sudden intracranial pressure decompression, pin site hematoma, and shunt site bleeding due to dural stripping. None has been proven to definitively explain the complication. Conclusions We wished to highlight this unusual complication of posterior fossa surgery, with an emphasis on rapid computed tomography scanning of the brain for patients in the early postoperative period with any neurological deterioration. Early radiological detection and timely intervention can be lifesaving. more...
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- 2019
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45. The vascular protective role of oestradiol: a focus on postmenopausal oestradiol deficiency and aneurysmal subarachnoid haemorrhage
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Dhananjaya I Bhat, Bhagavatula Indira Devi, Shruthi Shimoga Ramesh, and Rita Christopher
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0106 biological sciences ,medicine.medical_specialty ,medicine.medical_treatment ,Hemodynamics ,Vasodilation ,medicine.disease_cause ,010603 evolutionary biology ,01 natural sciences ,General Biochemistry, Genetics and Molecular Biology ,Nitric oxide ,03 medical and health sciences ,chemistry.chemical_compound ,Internal medicine ,Humans ,Medicine ,Vascular Diseases ,030304 developmental biology ,0303 health sciences ,Estradiol ,business.industry ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,Postmenopause ,Menopause ,Steroid hormone ,Endocrinology ,chemistry ,Apoptosis ,Female ,General Agricultural and Biological Sciences ,business ,Oxidative stress ,Hormone - Abstract
The steroid hormone, oestradiol, has pleiotropic functions. The protective effects of oestradiol are attributed to its anti-inflammatory, antioxidant, anti-atherogenic, anti-apoptotic, vasodilatory activities and regulation of micro RNA. Oestradiol upregulates endothelial nitric oxide synthase gene expression and increases the production of nitric oxide, an important vasodilator. It suppresses the renin-angiotensin system and monitors haemodynamic stress. The hormone maintains the integrity of blood vessels by reducing oxidative stress while upregulating the expression of antioxidant enzymes and prevents vascular inflammation by regulating pro- and anti-inflammatory cytokines. Aneurysmal subarachnoid haemorrhage (aSAH) occurring as a consequence of the rupture of an intracranial aneurysm is a devastating cerebrovascular event, representing 5-7% of all strokes. Postmenopausal women are more susceptible to aSAH compared to men in the same age group. This gender disparity has been attributed to reduced levels of the vascular protective hormone oestradiol following menopause. This review is focused on the protective role of oestradiol on vasculature and how the drop in oestradiol levels after menopause dramatically increases the incidence of aSAH in women. During menopause, oestradiol deficiency may affect vascular integrity causing dysregulation of vascular homeostasis by affecting the renin-angiotensin-aldosterone system (RAAS) and inflammatory and apoptotic cascades, resulting in the weakening of the cerebral arterial wall and potentially to development of an aneurysm and its rupture. In view of the role of oestradiol in maintaining vascular integrity, treatments involving hormone replacement could be a promising approach in postmenopausal women who are at risk of developing or rupturing an intracranial aneurysm. more...
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- 2019
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46. Duplication of Ventral Dura as a Cause of Ventral Herniation of Spinal Cord—A Report of Two Cases and Review of the Literature
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A R Prabhuraj, Dhananjaya I Bhat, Bhagavatula Indira Devi, Gaurav Tyagi, and Malla Bhaskara Rao
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Adult ,Male ,medicine.medical_specialty ,Cord ,Brown-Séquard syndrome ,Spinal disease ,Asymptomatic ,Spinal Cord Diseases ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Herniorrhaphy ,Aged ,business.industry ,medicine.disease ,Spinal cord ,Hernia, Ventral ,Surgery ,Pseudomeningocele ,Treatment Outcome ,medicine.anatomical_structure ,Spinal Cord ,030220 oncology & carcinogenesis ,Etiology ,Female ,Dura Mater ,Neurology (clinical) ,medicine.symptom ,Presentation (obstetrics) ,business ,030217 neurology & neurosurgery - Abstract
Background Idiopathic spinal cord herniation (ISCH) is a treatable spinal disease. It is rare and often misdiagnosed, causing a delay in management. The etiology is multifactorial, with one of the causes being duplication of the ventral dura. The spinal cord herniates within this defect and becomes strangulated, causing neurological deficits. We report the duplication of a ventral spinal cord as an important cause of ISCH in our review. Case Description We present 2 cases of ISCH with duplication of the dura, including their relevant clinical and imaging features. The patients underwent surgical reduction of the herniated spinal cord with enlargement of the defect and placement of a dural substitute ventral to the cord. We have also reported the outcomes of the 2 patients, with an emphasis on the factors predictive of poor outcomes (i.e., long-standing symptoms, a delay in intervention, poor neurological status at presentation, and a thinned out atrophic spinal cord found during surgery). We also reviewed the available data for duplication of the dura with ISCH. Conclusions Very few asymptomatic patients can be treated conservatively. The surgical outcomes have been favorable for symptomatic patients. Proper exposure, gentle manipulation while reducing the herniated spinal cord, enlargement of the defect, and the use of intraoperative monitoring will help limit the postoperative deficits. Duplication of the ventral dura is an important cause of ISCH. It prevents the formation of an anterior pseudomeningocele after surgery. Owing to the rarity of the disease and the lack of follow-up data with recurrence rates, it has not been possible to form clear guidelines for management. more...
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- 2019
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47. Comparison of equiosmolar dose of hyperosmolar agents in reducing intracranial pressure—a randomized control study in pediatric traumatic brain injury
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Madhusudan Reddy, S Arun Kumar, Bhagavatula Indira Devi, and Dhaval Shukla
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Male ,Adolescent ,Traumatic brain injury ,medicine.medical_treatment ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Bolus (medicine) ,Randomized controlled trial ,law ,Brain Injuries, Traumatic ,Humans ,Medicine ,Mannitol ,Prospective Studies ,030212 general & internal medicine ,Child ,Saline ,Intracranial pressure ,Saline Solution, Hypertonic ,business.industry ,Glasgow Outcome Scale ,Infant ,General Medicine ,medicine.disease ,Diuretics, Osmotic ,Hypertonic saline ,Treatment Outcome ,Child, Preschool ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Female ,Neurology (clinical) ,Intracranial Hypertension ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
There are no comparative studies available for hyperosmolar therapy in children. The present study is a prospective open label randomized control trial to compare the effect of equiosmolar doses of mannitol and hypertonic saline in reducing intracranial pressure in children who sustained severe traumatic brain injury. This is a prospective open-label randomized controlled trial. Thirty children aged less than or equal to 16 years with severe traumatic brain injury and raised intracranial pressure as measured by ventricular catheter insertion were enrolled. Sixteen children received 20% mannitol, and 14 children received 3% saline as 2.5 ml/kg bolus for episodes of intracranial pressure above cutoff value for age. The mean reduction in intracranial pressure and Glasgow outcome scale at 6 months after injury was measured. The mean reduction in intracranial pressure in mannitol group was 7.13 mmHg and in hypertonic saline group was 5.67 mmHg, and the difference was not statistically significant, p = 0.33. The incidence of death or survival in vegetative state was 23.07% in mannitol group and 16.66% in hypertonic saline group, and the difference was not statistically significant, p = 0.69. Both mannitol and hypertonic saline were equally effective for treatment of raised intracranial pressure in children with severe traumatic brain injury. more...
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- 2019
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48. Neurotrauma Care Delivery in a Limited Resource Setting—Lessons Learned From Referral and Patient Flow in a Tertiary Care Center
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Dhananjaya I Bhat, Nagesh C Shanbhag, Anne L. Stake, Bhagavatula Indira Devi, Ruchika Singhal, Subhas Konar, Manjul Tripathi, Amara Warren, and Dhaval Shukla
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medicine.medical_specialty ,Referral ,Traumatic brain injury ,Population ,India ,Severity of Illness Index ,Time-to-Treatment ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Brain Injuries, Traumatic ,Health care ,Humans ,Medicine ,Prospective Studies ,education ,Referral and Consultation ,education.field_of_study ,business.industry ,Head injury ,Emergency department ,medicine.disease ,Triage ,Telemedicine ,030220 oncology & carcinogenesis ,Radiological weapon ,Emergency medicine ,Health Resources ,Surgery ,Neurology (clinical) ,Emergency Service, Hospital ,Tomography, X-Ray Computed ,business ,030217 neurology & neurosurgery ,Total Quality Management - Abstract
Background With the increasing population, motorization, and road traffic accidents, neurotrauma has been increasing in India. Inadequate triage and underusage of locally available resources at all healthcare levels has led to nonuniform neurotrauma care delivery. We present our experience at a tertiary care hospital. We evaluated the referral pattern of mild traumatic brain injury (mTBI) cases to enable adequate care to patients with moderate and severely injured TBI. Methods All patients with head injury (n = 3891) referred to the emergency department of our institution during a 4-month period were evaluated. The demographic characteristics, ambulance usage, and time management during in-hospital patient flow were evaluated using the Lean Six Sigma approach. We have also provided solutions for optimal usage of available resources. Results Patients with mTBI comprised 77% of head injury referrals. Of all the patients referred from peripheral hospitals, 48% had normal head computed tomography (CT) scan findings. The CT waiting and lead (arrival-to-discharge) times were 35 ± 44 minutes and 114 minutes, respectively. No clinical to radiological correlation was found between the head CT scan findings and a decision to refer a patient to our institute. Only 10% of the patients with abnormal head CT scans (41%) required neurosurgical intervention. The mean duration from CT imaging to the initiation of surgery was 192.7 ± 172.1 minutes. Conclusions Most of the patients with mTBI were referred to a tertiary care center, leading to secondary overtriage and overburdening of the existing resources at a specialized care hospital, possibly owing to ineffective triage at the primary and secondary healthcare centers. This would limit the adequate management of moderate to severe TBI cases in such a hospital. more...
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- 2019
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49. Chaotic lipoma with proximal syrinx –a (not so) rare variant - review of the literature, possible embryology and management
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Siroya, Hardik Lalit, primary, Madhugiri, Venkatesh S., additional, Shukla, Dhaval Premchand, additional, Uppar, Alok Mohan, additional, and Bhagavatula, Indira Devi, additional
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- 2021
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50. Posterior Circulation Intervention but Mind the Spinal Cord!
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Siddiqui, Shahyan Mohsin, additional, Prasad, Chandrajit, additional, Pendharkar, Hima, additional, Bhagavatula, Indira Devi, additional, and Kulanthaivelu, Karthik, additional
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- 2021
- Full Text
- View/download PDF
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