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1. A Decadal Trend Analysis of Measles Cases in Rajasthan and Future Prediction using ARIMA Model: An Observational Study

Author: Sunita Agarwal, Shivra Batra, Pushpendra Bairwa, Parul Sinha, Pooja Choudhary, DInesh Kumar Jain, Malvika Sharma, and Sushil Kumar Singh
Subjects: auto-regressive integrated moving average, coronavirus disease-2019, influenza-like illness, monthly index, Medicine
Abstract: Introduction: Measles, a highly transmissible disease marked by fever and a maculopapular rash, posed a substantial threat to life in the 1960s. Nevertheless, the advent of the measles vaccine had a profound impact, significantly diminishing its toll on mortality. Similarly, through effective influenza surveillance and early epidemic warning systems, public health officials can timely identify influenza trends and provide crucial scientific support for prevention and control measures. This proactive approach holds great public health significance. Aim: To analyse the long-term trend of measles cases in Rajasthan, India, and the impact of Coronavirus Disease-2019 (COVID-19) on it, with future predictions using Auto-Regressive Integrated Moving Average (ARIMA) modelling. Materials and Methods: The present study was a retrospective, descriptive observational study in which monthly diagnosed measles cases were collected from the Measles Rubella Laboratory, Department of Microbiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India, for the period of April 2010 to April 2023. An ARIMA model was developed using data from 2010 to 2020 to predict the monthly number of measles cases in 2021. The predicted values were then compared to the actual cases in 2021 to assess the model’s accuracy. Results: Out of the total positive cases, males were slightly more prone to acquire infection than females (1734 males, 54%; 1477 females, 46%). The monthly index for new measles cases ranged from 0.11 to 2.6. It reached its lowest point in July (0.106) and August (0.25) and peaked in March (2.594) and April (1.84). The overall trend was fluctuating; however, the incidence of measles cases clearly increased after the year 2021. The difference between observed cases and predicted cases for the period of April 2020 to December 2021 was not statistically significant (t-value=0.261 and p-value=0.797). Conclusion: The fluctuating trend of measles was observed during the last decade; however, the observed cases of measles showed an upward trajectory during and after the COVID-19 outbreak. This study also highlighted the monthly index of the measles cases, which peaked in March to April and was lowest in July to August.
Published: 2024
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2. Mucormycosis Associated with Global Coronavirus Disease-19 Pandemic: A Study of Fungal Profile from a Tertiary Health-care Center

Author: Snigdha Purohit, Kavita Mourya, Nazneen Pathan, Sunita Agarwal, Vithika Vyas, and Aruna Vyas
Subjects: aspergillus, coronavirus disease-19, diabetes mellitus, invasive fungal infection, mucormycosis, Medicine
Abstract: Background and Aim: In this era of the coronavirus disease (COVID) pandemic, new health issues appear quickly and cause an outbreak in India. Here, we focus on invasive fungal infections (IFA), namely mucormycosis, aspergillosis, and candidiasis. Hence, in this article, we focus on conventional techniques for early diagnosis of fungus to help clinicians start empirical treatment for the patient and take necessary steps thereby. Materials and Methods: This observational study was conducted for 1 month, from May 2021 to June 2021, on 200 patients admitted to our mucormycosis ward. Samples were first examined microscopically using potassium hydroxide (KOH) wet mounts followed by culture on sabouraud dextrose agar and the gross appearance of the growth was observed. Further identification of species was achieved through the use of lactophenol cotton blue mounts and slide culture technique. Results: Out of 200 patients, 65.5% were male and 34.5% female. We divided these patients into three age groups, i.e., 20–30 years (15%), 40–60 years (54%), and 60–80 years (31%). Seventy-four percent of patients presented with a history of diabetes mellitus, 50% had a history of steroids taken in their past, and 48% had a history of oxygen therapy taken at the time of COVID-19 positivity (52%) samples positive for mucormycosis. Forty-one percent were KOH-positive for Mucorales and 35.5% were culture positive. The most commonly isolated fungus was Rhizopus, followed by Mucor, Lichthemia, Aspergillus spp., and Candida spp. Conclusion: To improve test sensitivity and enable early diagnosis, other serum biomarkers such as galactomannan, beta-D-glucan, cryptococcal antigenemia, and blood quantitative polymerase chain reaction for Aspergillus or Mucorales should be implemented.
Published: 2024
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3. Enhancement of Health-related Quality of Life among School-going Adolescent Girls with Improvement in Menstrual Hygiene Knowledge and Practices

Author: Akanksha Goyal and Sunita Agarwal
Subjects: adolescent, health, hygiene, menstrual, Medicine
Abstract: Background and Aim: In India, among adolescent girls, the problem associated with menstrual hygiene management (MHM) has a deep impact on health-related quality of life (HRQoL). Improvement in knowledge and menstrual hygiene practices may lead to enhancement in HRQoL. Therefore, the aim of the study was to enhance the HRQoL of adolescent school girls by improvement in menstrual hygiene knowledge and practices. Materials and Methods: The present study was an interventional, cross-sectional, questionnaire study conducted among adolescent school-going girls. The study was conducted among randomly selected five government secondary schools in Ajmer city and was conducted among adolescent girls of 7th–10th Class with the age group of 14–16 years. A total of 538 adolescent girls were surveyed in the pretest, and 503 was the sample size in the posttest with an attrition of 6.5%. Moreover, after the pretest, a workshop was conducted to educate adolescent girls about MHM. Results: A majority of the study participants (328 [61%]) had poor HRQoL after the pretest, which was improved to 195 (39%) of the study participants with good HRQoL after 3 months of the workshop during the posttest. The mean general health scores ([15.35 ± 0.38]) after 3 months of the workshop were significantly (P = 0.01*) higher among the study participants compared to the pretest scores ([10.93 ± 1.63]). Conclusion: From the above results, it has been concluded that there has been a significant improvement in knowledge, practice, and HRQoL among adolescent school-going girls of age 14–16 years when assessed after 3 months of the workshop on MHM.
Published: 2024
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4. Is thyroid excision mandatory with laryngectomy in carcinoma larynx?

Author: Surendra Singh Baghel, Pawan Singhal, Namita Verma, Ritu Sehra, Rajeev Yadav, Sunita Agarwal, Man Prakash Sharma, and D. P. Gupta
Subjects: Laryngeal carcinoma, Thyroid invasion, Malignancy larynx, Thyroidectomy, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Abstract Background Advanced stage operable cancers of larynx are treated with total laryngectomy including thyroid resection in most of the cases, which may expose patient to hypothyroidism and hypoparathyroidism. The requirement of thyroidectomy during Total Laryngectomy is controversial. Methods A cross sectional observational study was set out to review preoperative clinical and radiological assessment; intraoperative and histopathological findings; and follow-up data to predict thyroid gland invasion in the setting of squamous cell carcinoma of the Larynx. Results 11 (16%) out of 69 patients had thyroid gland involvement on histopathological examination with mean age 63 years. Out of these 11 cases, 8 (72%) underwent primary total laryngectomy. 90% patients with thyroid gland involvement were male. 9 cases with thyroid gland involvement were staged as T4a preoperatively. Conclusion Invasion of thyroid gland by laryngeal cancer is uncommon. Unnecessary hemithyroidectomies lead to hypothyroidism and hypoparathyroidism. The study points out the clear indications of thyroid excision in patients undergoing total laryngectomy. We can suggest that total thyroidectomy should be done with total laryngectomy in cases which have gross clinical, radiological or intraoperative thyroid gland involvement, subglottic extension and thyroid cartilage invasion. This can save the patients from the brunt of unnecessary morbid hypothyroidism and hypoparathyroidism.
Published: 2020
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5. Association between health-related quality of life and sense of coherence among health professionals working in primary health centers consuming tobacco in Jaipur, India

Author: Ashish Sharma, Kumar Gaurav Chhabra, Sunita Agarwal, Suman Bhansali, Pooja Singh, and Renuka G Nagrale
Subjects: health, health-related quality of life, sense of coherence, tobacco, Medicine
Abstract: Background: Health-related quality of life (HRQOL) and senses of coherence (SoC) can be affected by the use of tobacco. Hence, the aim of the present study was to explore the association between HRQOL and SoC among health professionals working in primary health centers (PHCs) consuming Tobacco. Materials and Methods: It was a cross-sectional descriptive study where sampling technique used was systematic stratified random sampling. Jaipur District has 37 PHCs retrieved from site of NRHM Rajasthan. A close-ended questionnaire was prepared to conduct the interview. Results: Majority of study participants (57; 37.01%) were of 36–40 years of age. Males respondents (86; 55.85%) consuming tobacco were more in number than female respondents. Majority of study subjects (91; 59.09%) consumed smoked kind of tobacco, in which most contributed were nurses (49; 62.82%). On applying a linear regression model, it was determined that all subscale of SF-36 was significantly (P ≤ 0.000) associated with SoC. Conclusion: From above, it was concluded that there was a strong association between HRQOL and SoC among health professionals working in primary health centers consuming tobacco.
Published: 2020
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6. Fourth Annual Summer Research Summit on Health Equity Organized by the Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas 77030, USA on May 20, 2021

Author: Aanand Naik, Abbhirami Rajagopal, Adam Floyd, Adriana Gil, Aisha Tepede, Aisha Koroma, Aisha Deslandes, Akua Graf, Alejandra Ruiz-Velasco, Alexa Reyna-Carrillo, Alexandra Alvarenga, Alexia Awoseyi, Alexis Hernandez, Alexis Lawrence, Ali Asghar-Ali, Allyssa Abacan, Alyce Adams, Alyna Khan, Alyson McGregor, Alyssa Hansen, Amari Johnson, Andrea Coj, Andrea Vick, Andria Tatem, Anjali Aggarwal, Anjali Deendyal, Ann Blake, Annabella Awazi, Anne VanHorn, Anuj Marathe, Anusha Jayaram, April Adams, Arabella Hall, Ariana Heredia, Ariana Chavarria, Asha Morrow, Ashley Butler, Asia Hodges, Aura Mejia, Avani Patel, Ayleen Hernandez, Benjamin Akande, Blessing Felix-Okoroji, Brisa Garcia, Buckleitner Jenna, Callie Fischer, Camden Hallmark, Cara Coren, Carlos Ramos, Cecilia Gambala, Charleta Guillory, Chelsea Livingston, Chioma Onyejiaka, Chishinga Callender, Christina Aldrich, Christopher Largaespada, Claire Bocchini, Craig Cochran, Danielle Sherman, Danielle Gonzales, David Venzon, David Wittkower, Debbe Thompson, Deborah Thompson, Debra Eseonu, Deepa Dongarwar, Delia Rospigliosi, Denise Smart, Denisse Velazquez, Derek Lockett, Eberechi Nwogu-Onyemkpa, Elizabeth Byrne, Elyse Lopez, Eric Dybbro, Eric Storch, Erica Onwuegbuchu, Erica Valdes, Erin Donovan, Eunique Williams, Evan Keil, Faith Ihekweazu, Felicia Rosiji, Gabriela Espinoza-Candelaria, Gabriella Chmaitelli, Gabriella Tavera, Gail Oneal, Gal Barbut, Gauvain Tonpouwo, George Carrum, Gina DeFelice, Hamisu Salihu, Heather Haq, Helen Heslop, Houston Lester, Ifeoma Ezenwabachili, Ila Gautham, Jacquelin Powell, Jaime Alleyn, Jasmine King, Jaydira Rivero, Jayer Chung, Jayna Dave, Jean Raphael, Jen Bryan, Jendi Haug, Jennifer Bryan, Jenny Blau, Jerry Bellamy, Jessica Medrano, Jessica Ramirez, Jocelyn Greely, Jonnae Atkinson, Jorge Miranda, Jose Dominguez, Jose Roca, Joseph Mills, Joshua Hamer, Joshua Muñiz, Julliet Ogu, Karen Gibbs, Karen Johnson, Karen Riggins, Karla Fredricks, Keila Lopez, Kellie Williams, Keyishi Peters, Kil Hyein, LaQuisa Hill, Lee Weinstein, Lena Shay, Lentz Lefevre, Lindy Ross, Lisa Noll, Lois Akpati, Lorin Crear, Lucy Puryear, Maame Coleman, Madhuri Vasudevan, Malachi Miller, Maria Vigil-Mallette, Maria Jaramillo, Mariam Chacko, Mariana Baroni, Mariana Murillo, Maricarmen Marroquin, Marina Masciale, Marlene McNeese, Martinez Austin, Matthew Koller, Maya Lee, Maziar Nourian, Megan Abadom, Meghna Sebastian, Meheret Adera, Mei-Lei Laracuente, Michelle Lopez, Michelle Wright, Miguel Montero-Baker, Monica Gonzalez, Morrow Adelene, Mosope Adeyeye, Muzaffar Qazilbash, Namrata Walia, Nancy Shenoi, Natalia Rodriguez, Naya Mukdadi, Neeraj Saini, Norma Olvera, Ololade Chris-Rotimi, Paige Hoyer, Parisa Fallah, Peggy Smith, Premal Lulla, Priscilla Ehieze, Priyanka Murali, Rachel Head, Rachel Nwaneri, Rachelle Wanser, Racquel Lyn, Rammurti Kamble, Ramyar Gilani, Raquel Martinez, Rathi Asaithambi, Reginald Hatter, Rhanna Wilson, Ria Brown, Robert Shulman, Robert Mbilinyi, Robert Levine, Roe Avery, Romil Patel, Roslyn Aduhene-Opoku, Ruth Mizu, Saad Usmani, Sadia Usmani, Saeed Ahmed, Samantha Moore, Samer Hadidi, Sana Erabti, Sana Javed, Sana Younus, Sanders Mar’Quenda, Sandy Samaan, Sara Alam, Sara Welty, Sergio Navarro, Shad Deering, Shaine Morris, Shana Alford, Shangir Siddique, Shantyka Walton, Shayan Bhathena, Shelease O’Bryant, Shital Patel, Sindhu Idicula, Sophia Banu, Sophie Albert, Sophie McCullum, Sophie Lin, Star Okolie, Sunita Agarwal, Susan Gillespie, Syed Hussaini, Sylvia Hysong, Tammy Kang, Tara Everett, Taylor Ottesen, Tiana DiMasi, Tien Nguyen, Toi Harris, Tzu-An Chen, Vicki Mercado, Victoria Michael, Victoria Xie, William Simonds, Yesenya Gonzalez, Yicenia Aviles, Ynhi Thomas, and Zachary Pallister
Subjects: Public aspects of medicine, RA1-1270
Abstract: The fourth annual summer research summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM) was held on May 20, 2021. The theme of this year’s summit was ‘Strengthening Our Commitment to Racial and Social Justice to Improve Public Health.’ Given the ongoing pandemic, the summit was conducted virtually through digital platforms. This program was intended for both BCM and external audiences interested in advancing health equity, diversity and inclusion in healthcare among healthcare providers and trainees, biomedical scientists, social workers, nurses, individuals involved in talent acquisition and development such as hiring managers (HR professionals), supervisors, college and hospital affiliate leadership and administrators, as well as diversity and inclusion excellence practitioners. We had attendees from all regions of the United States, India, Pakistan and the Demographic Republic of the Congo. The content in this Book of Abstracts encapsulates a summary of the research efforts by the BCM COE scholars (which includes post-baccalaureate students, medical students, clinical fellows and junior faculty from BCM) as well as the external summit participants. The range of topics in this year’s summit was quite diverse encompassing disparities in relation to maternal and child health (MCH), immigrant heath, cancers, vaccination uptakes and COVID-19 infections. Various solutions were ardently presented to address these disparities including community engagement and partnerships, improvement in health literacy and development of novel technologies and therapeutics. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research and cultural competence as they relate to minority health issues and social determinants of health. The summit received very positive response in terms of zealous participation and outstanding evaluations; and overall, it was a great success. Copyright © 2021 Lopez et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.
Published: 2021
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7. Antibiotic stewardship in a tertiary care NICU of northern India: a quality improvement initiative

Author: Yatish Singh, Varun Sharma, Sunita Agarwal, Jyoti Patodia, Jaikrishan Mittal, and Vaibhav Agnihotri
Subjects: Medicine (General), R5-920
Published: 2021
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8. A Study of Haemostatic Parameters in Patients of Chronic Myeloid Leukaemia

Author: Ankur Jain, Naresh Gupta, Tejinder Singh, and Sunita Agarwal
Subjects: acquired von willibrand’s disease, haemostasis, hyperleucostasis, myeloproliferative neoplasm, Medicine
Abstract: Introduction: Chronic Myeloid Leukaemia (CML) is characterized by derangement of various components of the haemostatic system resulting in thrombo-haemorrhagic complications. Although less common than other myeloproliferative neoplasms, derangement of various components of the haemostatic system is observed in CML. Haemostatic abnormalities have been described in relation to hyperleucostasis and drugs used to treat CML. However, the correlation between haemostatic derangements and phase of CML is unclear in the literature. Aim: The purpose of this cross-sectional study was to assay various haemostatic parameters in patients of CML receiving Imatinib and to determine any correlation between them and phases of disease as well as the status of remission. Materials and Methods: The study included 30 patients with CML (17 males, 13 females, mean age of 35.53 ± 8.92 years) receiving imatinib mesylate. Haemostatic parameters including platelet counts, Prothrombin Time (PT), activated Partial Thromboplastin Time (APTT), fibrinogen, D-dimers and Factor VIII levels were assayed for all patients using standard methods. Bcr-abl gene product (quantitative) was determined on the peripheral blood by reverse transcriptase polymerase chain reaction (RT-PCR). Patients were grouped into phases of disease (chronic, accelerated and blast) and their response to imatinib was determined in the form of remission (clinical, haematological and molecular). Correlations were drawn between them using spearman’s coefficient. Results: A significant positive correlation was found between PT (p=0.002), fibrinogen (p=0.011), D-dimers (p=0.050), Factor VIII levels (p=0.006) with the phase of CML and a significant negative correlation was observed between PT (p=0.003, 0.006), fibrinogen (p=0.010, 0.005), D-dimers (p=0.035, 0.017), Factor VIII levels (p=0.005, 0.001) and clinical and haematological remission respectively. No significant correlation of platelet counts and APTT was seen with the phase of CML or remission status. Conclusion: Haemostatic system is significantly disturbed in CML and correlate positively with the progression of the disease. Imatinib treatment leads to improvement in some of these parameters.
Published: 2016
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9. Waste Management for Environmental Sustainability

Author: Dr. Aligina Anvitha Sudheshna, Prof. Sunita Agarwal, Anukrati Sekhri, Shivangi Sultania, Siddhant Agarwal, Dr. Shweta Singh, Prof. Rajiv K. Sinha, Kamlesh Haritwal, Kartik Kapoor, Ms. Neha Gupta, Dr. Jaya Sharma, Dr. Mamta Sharma, Amrata Vyas, Rakesh Natwadia, Dr. Aligina Anvitha Sudheshna, Prof. Sunita Agarwal, Anukrati Sekhri, Shivangi Sultania, Siddhant Agarwal, Dr. Shweta Singh, Prof. Rajiv K. Sinha, Kamlesh Haritwal, Kartik Kapoor, Ms. Neha Gupta, Dr. Jaya Sharma, Dr. Mamta Sharma, Amrata Vyas, and Rakesh Natwadia
Abstract: Welcome to the book titled "WASTE MANAGEMENT FOR ENVIRONMENTAL SUSTAINABILITY." This comprehensive volume stands as a collaborative effort to address one of the most pressing challenges of our time - the effective management of waste in pursuit of a more sustainable world. Waste, in its diverse forms, has emerged as a critical global issue that demands immediate attention, innovative solutions, and collective action. As the editors of this book, we have invited several scholars, experts, and enthusiasts from diverse backgrounds whose expertise is in the varied field of waste management to contribute their knowledge, insights, and research findings to this collective endeavor. This book aims to encapsulate a holistic view of waste management by navigating the areas of methodologies, technologies, applications, and the imperative for change. In a world, where there is an escalating environmental concern, resource scarcity, and climate change, adopting sustainable waste management practices has never been more critical. This book attempts to bridge the gap between both theory and practice, offering a repository of information, strategies, and case studies that inspire actions and pave the way for a cleaner and greener future. Our vision for this book is to create a valuable resource that not only sheds light on the existing challenges in waste management but also researches the opportunities that lie within those challenges. By exploring the methodologies for waste characterization, the intricacies of waste treatment, and the implementation of innovative technologies, we hope to empower readers to make informed decisions, engage in meaningful discussions, and drive positive change within their spheres of influence. Each chapter in this book represents a piece of the puzzle which is waste management. From sustainable waste management systems to specific topics like food waste collection, organic waste treatment, and futuristic technologies, the chapters collectively off
Published: 2023

10. Supplementary file from Metformin Targets Mitochondrial Glycerophosphate Dehydrogenase to Control Rate of Oxidative Phosphorylation and Growth of Thyroid Cancer In Vitro and In Vivo

Author: Joanna Klubo-Gwiezdzinska, Sunita Agarwal, Electron Kebebew, Sheue-Yann Cheng, Jeff Reece, Carole Sourbier, Dhaval Patel, Myriem Boufraqech, Vasyl V. Vasko, Kelli Gaskins, Brianna Daley, and Shilpa Thakur
Abstract: Supplementary figures and tables
Published: 2023
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11. APPENDIX 3 from Metformin Targets Mitochondrial Glycerophosphate Dehydrogenase to Control Rate of Oxidative Phosphorylation and Growth of Thyroid Cancer In Vitro and In Vivo

Author: Joanna Klubo-Gwiezdzinska, Sunita Agarwal, Electron Kebebew, Sheue-Yann Cheng, Jeff Reece, Carole Sourbier, Dhaval Patel, Myriem Boufraqech, Vasyl V. Vasko, Kelli Gaskins, Brianna Daley, and Shilpa Thakur
Abstract: IMPACT II
Published: 2023
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12. Appendix 1 from Metformin Targets Mitochondrial Glycerophosphate Dehydrogenase to Control Rate of Oxidative Phosphorylation and Growth of Thyroid Cancer In Vitro and In Vivo

Author: Joanna Klubo-Gwiezdzinska, Sunita Agarwal, Electron Kebebew, Sheue-Yann Cheng, Jeff Reece, Carole Sourbier, Dhaval Patel, Myriem Boufraqech, Vasyl V. Vasko, Kelli Gaskins, Brianna Daley, and Shilpa Thakur
Abstract: TCGA normal vs tumor raw data
Published: 2023
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13. Data from Metformin Targets Mitochondrial Glycerophosphate Dehydrogenase to Control Rate of Oxidative Phosphorylation and Growth of Thyroid Cancer In Vitro and In Vivo

Author: Joanna Klubo-Gwiezdzinska, Sunita Agarwal, Electron Kebebew, Sheue-Yann Cheng, Jeff Reece, Carole Sourbier, Dhaval Patel, Myriem Boufraqech, Vasyl V. Vasko, Kelli Gaskins, Brianna Daley, and Shilpa Thakur
Abstract: Purpose: Mitochondrial glycerophosphate dehydrogenase (MGPDH) is the key enzyme connecting oxidative phosphorylation (OXPHOS) and glycolysis as well as a target of the antidiabetic drug metformin in the liver. There are no data on the expression and role of MGPDH as a metformin target in cancer. In this study, we evaluated MGPDH as a potential target of metformin in thyroid cancer and investigated its contribution in thyroid cancer metabolism.Experimental Design: We analyzed MGPDH expression in 253 thyroid cancer and normal tissues by immunostaining and examined its expression and localization in thyroid cancer–derived cell lines (FTC133, BCPAP) by confocal microscopy. The effects of metformin on MGPDH expression were determined by qRT-PCR and Western blot analysis. Seahorse analyzer was utilized to assess the effects of metformin on OXPHOS and glycolysis in thyroid cancer cells. We analyzed the effects of metformin on tumor growth and MGPDH expression in metastatic thyroid cancer mouse models.Results: We show for the first time that MGPDH is overexpressed in thyroid cancer compared with normal thyroid. We demonstrate that MGPDH regulates human thyroid cancer cell growth and OXPHOS rate in vitro. Metformin treatment is associated with downregulation of MGPDH expression and inhibition of OXPHOS in thyroid cancer in vitro. Cells characterized by high MGPDH expression are more sensitive to OXPHOS-inhibitory effects of metformin in vitro and growth-inhibitory effects of metformin in vitro and in vivo.Conclusions: Our study established MGPDH as a novel regulator of thyroid cancer growth and metabolism that can be effectively targeted by metformin. Clin Cancer Res; 24(16); 4030–43. ©2018 AACR.
Published: 2023
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14. APPENDIX 2 from Metformin Targets Mitochondrial Glycerophosphate Dehydrogenase to Control Rate of Oxidative Phosphorylation and Growth of Thyroid Cancer In Vitro and In Vivo

Author: Joanna Klubo-Gwiezdzinska, Sunita Agarwal, Electron Kebebew, Sheue-Yann Cheng, Jeff Reece, Carole Sourbier, Dhaval Patel, Myriem Boufraqech, Vasyl V. Vasko, Kelli Gaskins, Brianna Daley, and Shilpa Thakur
Abstract: STR PROFILE
Published: 2023
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15. Outcomes of Acoustic and Linguistic Performances Following Cochlear Implantation in Large Vestibular Aqueduct Syndrome (LVAS)

Author: Sunita Agarwal, Neha Shakrawal, Nishi Sonkhya, and Mohnish Grover
Subjects: Auditory perception, Vestibular aqueduct, Head neck surgery, medicine.medical_specialty, business.industry, Mean age, Tertiary care, Linguistics, medicine.anatomical_structure, Otorhinolaryngology, otorhinolaryngologic diseases, medicine, Surgery, Infants toddlers, Cochlear implantation, business
Abstract: Aim: This study aims to collate the outcomes in acoustic and linguistic performances after cochlear implantation in LVAS. Methods: In a hospital-based prospective interventional study, seven prelingual children with bilateral profound sensorineural hearing loss (SNHL) with LVAS were recruited. They underwent unilateral cochlear implantation between December 2013 and December 2015 in the Department of Otorhinolaryngology and Head Neck Surgery at a tertiary care center. Outcomes of auditory and speech performances were assessed in the form of revised categories of auditory perception (CAP), infant toddler meaningful auditory integration scale (IT-MAIS) and speech intelligibility rating (SIR) scores preoperatively, at one and two years follow up. Results: The mean age of implantation was 4 years. The median revised CAP, IT-MAIS, and SIR scores after one and two years of follow-up were 6, 27, 3, and 11, 36, 5 respectively. The mean follow-up duration was 21.3 months. Conclusion: Pre op median revised CAP, IT-MAIS, and SIR scores of 0, 1, 1 showed improvement to 11, 36, 5 at two years follow up which was statistically significant. Hence, we conclude that good functional outcomes post-operatively advocate the significance of cochlear implantation in LVAS.
Published: 2021
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16. An Observational Study on Association of Clinical Outcome of Diphtheria Cases with Immunization Status: A Tertiary Care Hospital, Jaipur

Author: Yogendra Kumar Pareek, Sunita Agarwal, Saket Kumar Jammar, Tanmaya Kataria, Ajay Gupta, Shashank Nath Singh, and Shraddha Sharma
Subjects: Pediatrics, medicine.medical_specialty, Myocarditis, Referral, business.industry, animal diseases, Diphtheria, chemical and pharmacologic phenomena, Disease, Booster dose, biochemical phenomena, metabolism, and nutrition, medicine.disease, Otorhinolaryngology, Immunization, medicine, bacteria, Surgery, Complication, business
Abstract: Background. Diphtheria is an important vaccine preventable disease with varied outcome from mild to death. It was observed that the outcome also gets affected with status of immunization. The outcome is relatively milder in immunized children. Objective. To find out the clinical presentation and outcome of diphtheria cases and its association with the immunization status. Methods. A descriptive analysis of 64 diphtheria cases admitted from January 2019 to May 2020 at SMS hospital, a tertiary care referral hospital in Jaipur. Results. Half of (51.56%, 33/60) patients were in the age group of 6–10 years. The peak load (48.44%) of diphtheria cases was seen in the monsoon season. Around 60% of the patients were fully immunized and around 10% partially immunized, every third case was un-immunized. The most common complication was neurological in 13 cases (20.31%), followed by cardiac complications in 11 cases (17.19%), and respiratory (7.81%). The proportion of complication was much lower (26.3%) in immunized cases as compare to partially immunized and un immunized. The proportion of myocarditis was significantly higher in un immunized cases (40%) than partially immunized (16.7%) and filly immunized group (5.3%). Similarly, Bronchopneumonia was also significantly higher (20%) in unimmunized. Conclusion. Our study depicted that there has been a shift of age above 5 years for diphtheria which suggests the need for the booster dose. Also high chances of complications are seen in unimmunized and partially immunized calling for public awareness regarding complete immunization.
Published: 2021
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17. Spectrum of Neurological Outcomes in Diphtheria: A Case Series

Author: Saket Kumar Jammar, Deepak Jain, Shraddha Sharma, Ajay Gupta, Shashank Nath Singh, Sunita Agarwal, Ritu Sehra, Tanmaya Kataria, and Prem Singh Jat
Subjects: Corynebacterium diphtheriae, medicine.medical_specialty, Palsy, biology, business.industry, Diphtheria, medicine.disease, biology.organism_classification, Surgery, Otorhinolaryngology, medicine, Facial nerve palsy, Acute infectious disease, business, Complication, Contact tracing
Abstract: Diphtheria is an acute infectious disease caused by the exotoxin produced by Corynebacterium diphtheriae, a gram positive bacteria. It has propensity to affect mainly cardiac muscle and nervous system. To study the percentage, spectrum of patients with various neurological complications and the pattern of recovery in followed up confirmed cases of diphtheria. Single centre prospective analysis of neurological complications in diphtheria patients from June 2019 to September 2020 at SMS Medical College and hospital,Jaipur. In this study, 60 cases were included. Immunised cases were 60% (36 out of 60 cases) whereas unimmunised constituted the rest 40% (24 out of 60 cases). Neurological complications were observed in 15% of the cases (9 out of 60). Isolated palatal palsy was the most common complication (4 out of 9 cases, 44.44%), succeeded by lower limb LMN palsies (2 out of 9 cases, 22.22%) with unilateral facial nerve palsy, bilateral abductor palsy and paralytic ileus constituting the rest (1 out of 9 cases each, 11.11% each). Onset of complications ranged from 10 to 36 days whereas recovery was complete and without any residual sequelae between 60 to 240 days. Our study concluded that neurological complications form a sizeable portion of post diptheritic complications and carries good prognosis, hence timely diagnosis and differentiation from other neuropathies is a pre requisite for rational management and contact tracing.
Published: 2021
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18. A Study of Pulmonary Function Tests in Patients with Chronic Rhinosinusitis Following Endoscopic Sinus Surgery

Author: Shraddha Sharma, Ramlakhan Meena, Ankita Chaudhary, Rekha Harshvardhan, Sunita Agarwal, Ritu Sehra, and Bharat Bhushan Sharma
Subjects: medicine.medical_specialty, business.industry, Functional endoscopic sinus surgery, respiratory system, Asymptomatic, respiratory tract diseases, Surgery, Pulmonary function testing, FEV1/FVC ratio, medicine.anatomical_structure, Otorhinolaryngology, medicine, In patient, medicine.symptom, business, Airway, Sinus (anatomy), circulatory and respiratory physiology
Abstract: Chronic inflammatory disorders of the upper airways are extremely prevalent and they have a major impact on public health.To assess the change in pulmonary function tests in patients of chronic rhinosinusitis undergoing functional endoscopic sinus surgery pre operatively and post operatively.To evaluate the difference in mean of FEV1, FEV1%, FVC, FVC%, FEV1/FVC in patients of chronic rhinosinusitis undergoing functional endoscopic sinus surgery.Prospective observational study.From July 2019 to September 2020 in Department of ENT and Head & Neck surgery, SMS Medical College, Jaipur.There was a significant improvement in the mean FEV1, FEV1%, FVC, and FVC% values post-surgically (p
Published: 2021
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19. Role of Vimentin and E-cadherin Expression in Premalignant and Malignant Lesions of Oral Cavity

Author: Pawan Singhal, Shashank Nath Singh, Prem Singh Jat, Ritu Sehra, Sunita Agarwal, and Sandesh Kumar Gupta
Subjects: Pathology, medicine.medical_specialty, biology, medicine.diagnostic_test, business.industry, Cadherin, Vimentin, medicine.disease, Metastasis, Lesion, 03 medical and health sciences, 0302 clinical medicine, Otorhinolaryngology, 030220 oncology & carcinogenesis, Biopsy, medicine, biology.protein, Immunohistochemistry, Surgery, Lymph, medicine.symptom, 030223 otorhinolaryngology, business, Rest (music)
Abstract: To determine the role of Vimentin and E-cadherin expression in oral premalignant and malignant lesions. 68 histopathologically confirmed cases of premalignant and malignant oral cavity lesions enrolled. Biopsy specimens were taken from lesion of all cases and subjected to immunohistochemical evaluation of expression of E-cadherin and Vimentin. We examined the relationships between the expression of these markers and specific clinicopathological features were analyzed. Out of 68 cases 28 showed high vimentin expression (3 + and 4 + grade) and 40 showed low vimentin expression (1 + and 2 + grade). 20 cases out of 68 presented with high E-cadherin expression (3 + and 4 +) and rest 48 with low expression (1 + and 2 +) of the same. Smoking and tobacco chewing reflected non-significant association with their expression. In this study all 28 patients (100%) with high vimentin expression had malignant lesions and 17 (60.7%) presented with metastatic lymph nodes Out of 20 patients with high E-cadherin expression 8(40.0%) had malignant lesions and 12 (60.0%) had pre malignant lesions and 4 (20%) showed nodal metastasis. As tumor stage (TNM) progresses, it showed increased vimentin and decreased E-cadherin expression and vice versa. We concluded that increased vimentin and decreased E-cadherin expression in oral cancers are associated with metastasis and disease progression in terms of upstaging of disease. We can use cellular expression of vimentin and E-cadherin for early diagnosis of disease.
Published: 2021
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20. Olfactory Neuroblastoma: A Novel Site of Presentation

Author: S N Singh, Nand Kishor Lohar, and Sunita Agarwal
Subjects: Nasal cavity, medicine.medical_specialty, Olfactory Neuroblastoma, business.industry, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Otorhinolaryngology, Esthesioneuroblastoma, Body of maxilla, 030220 oncology & carcinogenesis, medicine, Surgery, Nasal administration, Radiology, Differential diagnosis, Presentation (obstetrics), 030223 otorhinolaryngology, business
Abstract: Olfactory neuroblastoma (ONB) or esthesioneuroblastoma is a rare malignant intranasal tumor, commonly originated from upper part of nasal cavity. Majority of cases presented with nasal obstruction or epistaxis. ONB is rarely reported in ectopic locations. Here we present the first-ever documented case of an olfactory neuroblastoma situated anterior to body of maxilla, presented as left sided facial swelling. This case report is aimed at achieving the consideration of this rare tumour as a differential diagnosis in the lesions of the anatomical region surrounding the commonly known site of origin i.e. the sinonasal cavity.
Published: 2021
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21. Assessment of Accuracy of Fine Needle Aspiration Cytology and Ultrasonography in Relation to Histopathology in Cases of Solitary Thyroid Nodule

Author: Shubhangi Gupta, Vikas Jorwal, Rekha Harshvardhan, Ritu Sehra, Vivek Sharma, and Sunita Agarwal
Subjects: Thyroid nodules, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Thyroid, Malignancy, medicine.disease, Palpation, Thyroid carcinoma, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Otorhinolaryngology, 030220 oncology & carcinogenesis, medicine, Carcinoma, Surgery, Histopathology, Radiology, 030223 otorhinolaryngology, business
Abstract: The thyroid gland is an endocrine gland situated in the lower part of front and the sides of the neck. Thyroid nodules are very common with estimated prevalence that ranges from 4% by palpation to 67% by Ultrasonography. The main purpose of our study was to detect cases of thyroid carcinoma preoperatively in patients with solitary thyroid nodules and subsequently advise surgery in these selected patients only, without missing any malignancy. The goal of the investigating modalities used was that they should detect maximum (ideally all) cases of carcinoma and minimize the number of patients who might end up with unnecessary surgery. The present study was to be undertaken for assessment of accuracy of FNAC & USG in relation to Histopathology in cases of solitary thyroid nodule (accuracy in terms of sensitivity, specificity, positive predictive value, negative predictive value). In our series of total 102 pateints, 90 patients were females (88.2%) and 12 cases were males (11.8%). The overall incidence of malignancy in solitary thyroid nodules is 15.68%. In our series the sensitivity and specificity of Fine needle aspiration cytology and Ultrasonography was 81.25% & 98.84% and 75% and 77.91% respectively. The closest method to ideal was fine needle aspiration cytology. However, a combination of techniques, rather than a single technique, give optimum results & avoid unnecessary surgery in a greater number of patients without missing any malignancy.
Published: 2020
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22. An Observational Study Depicting Role of p16 in Detecting Human Papilloma Virus in Oral and Oropharyngeal Cancer and Associated Factors

Author: Shashank Nath Singh, Ritu Sehra, Pawan Singhal, Sunita Agarwal, Ramkalyan Meena, and Suresh Yadav
Subjects: Oncology, Sexually transmitted disease, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Incidence (epidemiology), HPV infection, Cancer, Disease, medicine.disease, stomatognathic diseases, 03 medical and health sciences, 0302 clinical medicine, Otorhinolaryngology, 030220 oncology & carcinogenesis, Internal medicine, Biopsy, Etiology, Biomarker (medicine), Medicine, Surgery, 030223 otorhinolaryngology, business
Abstract: The longstanding phrase, traditional risk factors like-smoking, tobacco and alcohol are the only causative agents of oral and oropharyngeal squamous cell carcinoma (SCC) is changing now. Etiological divergence is taking place which we have to know to reach upon an exact cause of the disease. Human papilloma virus (HPV) infection is a well-established cause of oral cancer. Escalating incidence of HPV associated cancer has a strong impact on its management. So, a concern clinician needs to get aware for it. Among various types of HPV, HPV-16 is more frequently associated with oral cancers. HPV detection will become a game changer in management of oral cancers. HPV infection and p16 protein expression has a strong and consistent correlation. Therefore, immunohistochemical analysis of p16 protein can be a surrogate biomarker in high risk groups. This hospital based prospective observational study recruited 180 subjects of oral and oropharyngeal SCC. We underwent immunohistochemical analysis of p16 in biopsy specimen of subjects and studied HPV status and associated environmental, clinical and behavioral factors. We observed 9.4% (17/180) incidence of p16 positivity with female predominance. Our observations showed that its prevalence was higher in urban patients who were non tobacco users, had sexually transmitted disease, early stage (T1-T2), poorly differentiated SCC with nodal metastasis. We conclude that keeping in mind HPV as a cause of oral and oropharyngeal SCC, p16 should be use as a biomarker for its detection in high risk cases.
Published: 2020
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23. The Effect of Age at Cochlear Implantation on Speech and Auditory Performances in Prelingually Deaf Children

Author: Sunita Agarwal, Neha Shakrawal, Nishi Sonkhya, and Mohnish Grover
Subjects: Auditory perception, medicine.medical_specialty, education.field_of_study, Rehabilitation, business.industry, medicine.medical_treatment, Population, Audiology, 03 medical and health sciences, 0302 clinical medicine, Otorhinolaryngology, Age groups, Rating scale, 030220 oncology & carcinogenesis, Cochlear implant, otorhinolaryngologic diseases, medicine, Surgery, 030223 otorhinolaryngology, business, Cochlear implantation, education
Abstract: To understand the effect of age at implantation on speech and auditory performances of 74 prelingually deaf Indian children after using cochlear implants for 3, 6 and 12 months. We also evaluate the causes of late implantation in this population. Seventy four children who underwent cochlear implantation from December 2013 to December 2015 in the Department of Otorhinolaryngology and Head Neck Cancer in SMS Medical College, Jaipur were participated in this study. To compare the efficacy of cochlear implant, candidates are classified into 2 groups according to the age at the time of implantation: 1-4 years and 4.1-7 years. The sample size is 37 in both age groups. Their auditory performance and speech intelligibility were rated using the Revised Categories of Auditory Perception scales, Speech Intelligibility Rating scales and Meaningful Auditory Integration Scale. The evaluations were made before implantation and 3, 6 and 12 months after implantation. The scores when compared in both the groups revealed that the results were comparable and significant after 12 months of follow up while the scores were not significant after 3 and 6 months. The results were statistically significant when baseline is compared with different postoperative stages. The children implanted before the age of 4 years had significantly better auditory and linguistic performances. At least 12 months of audio-verbal rehabilitation and speech and language therapy are required to compare the effects of cochlear implant in any set of children. Our study shows that hearing impaired children who receive cochlear implantation below 4 years of age acquires better auditory ability for developing language skills.
Published: 2020
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24. Association between health-related quality of life and sense of coherence among health professionals working in primary health centers consuming tobacco in Jaipur, India

Author: Pooja Singh, Kumar Gaurav Chhabra, Sunita Agarwal, Suman Bhansali, Ashish S Sharma, and Renuka G Nagrale
Subjects: Health related quality of life, Health professionals, business.industry, lcsh:R, lcsh:Medicine, 030209 endocrinology & metabolism, health, sense of coherence, tobacco, Stratified sampling, health-related quality of life, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Environmental health, Primary health, Medicine, Original Article, 030212 general & internal medicine, Association (psychology), business, Sense of coherence
Abstract: Background: Health-related quality of life (HRQOL) and senses of coherence (SoC) can be affected by the use of tobacco. Hence, the aim of the present study was to explore the association between HRQOL and SoC among health professionals working in primary health centers (PHCs) consuming Tobacco. Materials and Methods: It was a cross-sectional descriptive study where sampling technique used was systematic stratified random sampling. Jaipur District has 37 PHCs retrieved from site of NRHM Rajasthan. A close-ended questionnaire was prepared to conduct the interview. Results: Majority of study participants (57; 37.01%) were of 36–40 years of age. Males respondents (86; 55.85%) consuming tobacco were more in number than female respondents. Majority of study subjects (91; 59.09%) consumed smoked kind of tobacco, in which most contributed were nurses (49; 62.82%). On applying a linear regression model, it was determined that all subscale of SF-36 was significantly (P ≤ 0.000) associated with SoC. Conclusion: From above, it was concluded that there was a strong association between HRQOL and SoC among health professionals working in primary health centers consuming tobacco.
Published: 2020

25. Determinants of Tobacco Use among Children of a Rural Village in India: An Exploratory Qualitative Study

Author: Chaya Chhabra, Akanksha Goyal, Sunita Agarwal, Suman Bhansali, Ashish Sharma, and Kumar Gaurav Chhabra
Subjects: 0301 basic medicine, Adult, Male, Parents, Rural Population, Health Knowledge, Attitudes, Practice, Adolescent, India, Context (language use), Social issues, Social Environment, tobacco, 03 medical and health sciences, Habits, Tobacco Use, Young Adult, 0302 clinical medicine, Role model, Environmental health, Humans, Family, Peer pressure, Child, Social Behavior, Functional illiteracy, Determinants, Qualitative Research, Smoking, General Medicine, Focus group, 030104 developmental biology, Cross-Sectional Studies, 030220 oncology & carcinogenesis, Female, Thematic analysis, Psychology, Qualitative research, Research Article
Abstract: Background Tobacco is one of the leading causes of preventable deaths. It is both a major social and health problem. According to National Sample Survey Organization of Government of India about 20 million children of ages 10-14 are estimated to be tobacco-addicted. There are grave consequences of tobacco both socially and also on health thus it is of utmost importance to understand the factors leading to its use and to plan strategies to reduce its intake. However, the health implications of this social issue in a rural context have not been explored. Aims and objective this study makes an attempt to explore the health and social implications of tobacco usage by the children below the age of 14 years in hamlet. Materials and methods The present study employed a qualitative study design. Data was collected using focus group discussion and in-depth interview of key informants. Thematic analysis for exploring the explicit and implicit meanings within the data was done. The themes which emerged were knowledge about tobacco and the various products available, children and parents' tobacco use and habits, the health and social implication of tobacco use, reasons for tobacco use by the children. Results It was found tobacco use by the children was very common in the community. Parent, peer pressure, sibling pressure were found to be playing important role in the initiation of tobacco habit by the child. Further illiteracy and lack of awareness was also lead to tobacco use among children. Conclusion The study identifies education and awareness of parents about the ill-effects of tobacco play an important role as parents act as role model for their children, thus equal stress should be laid in improving the parental habits. Even raising the prices of tobacco products can help in controlling this habit. .
Published: 2020

26. Invasive Fungal Infections in Dengue Recovered Patients: A New Phenomenon in the Covid-19 Era

Author: Pawan Singhal, Anshu Rawat, Shivam Sharma, Anjani Kumar Sharma, Kailash Singh Jat, Shubham Agarwal, Sunil Samdani, Sunita Agarwal, Man Prakash Sharma, and Sudheer Bhandari
Subjects: Otorhinolaryngology, Surgery
Abstract: Invasive fungal rhinosinusitis was seen to rise to epidemic levels after the 2nd wave of ongoing Covid pandemic, especially in tropical countries, maximally in India. A similar trend is being observed for cases who have recently recovered from dengue virus infection. Post dengue invasive fungal infection is a new presentation and any associations between it and Covid pandemic need to be studied in detail to help prepare for any complications. 3 patients presented to the out-patient department of E.N.T at a tertiary level teaching hospital in East India with complains similar to rhinosinusitis. These patients were then evaluated and diagnosed to be infected from Mucormycosis and Aspergillosis fungal sinusitis after which they were managed with surgical debridement and systemic antifungal therapy. All had a recent history of recovery from Dengue virus infection and a possible association could be suspected. 3 patients presented with complains of pain over upper jaw with orbital swelling and loss of vision developing over a period of 24 days. Two of them had ulceration of hard palate. They were then subjected to Contrast MRI along with CT scan of the Paranasal sinuses which depicted pansinus involvement with intracranial extension in two patients. These were then planned for diagnostic nasal endoscopies along with biopsies which turned out to be Invasive fungal sinusitis in the form of Aspergillosis and Mucormycosis. All the 3 patients had recent history of recovery from Dengue virus infection and did not have any other co-morbidities. Covid Associated Mucormycosis (CAM) is a well-known entity now but no reports of Dengue associated Invasive fungal sinusitis are yet reported. Whether this new phenomenon has anything to do with the interactions between dengue virus and coronavirus is not known at present and needs to be studied in detail so appropriate management protocols can be formulated.
Published: 2022

27. Lateral Skull Base Lesions: Our Experience of 15 Years

Author: Pawan Singhal, Shivam Sharma, Amreen Singh, Anjani Kumar Sharma, Mahendra Hada, Shashank Nath Singh, Kailash Singh Jat, Shubham Agarwal, Mohnish Grover, Sunita Agarwal, and Man Prakash Sharma
Subjects: Otorhinolaryngology, Surgery
Abstract: To analyse and report various aspects of lateral skull base surgery by describing the incidence and demographic variables, diagnostic and management challenges, surgical choices along with complications and their management and the long term morbidity and survival outcomes in our experience of 15 years. Retrospective review of complete records of all cases operated for lateral skull base tumors at a tertiary care teaching institution in India between timespan of 15 years from 2003 to 2018 was undertaken. 53 cases were selected and analysed. Those having follow up of less than 6 months were excluded. Outcomes were assessed in terms of incidence of types of tumors, benign or malignant, age and sex variation of the patients, staging status at presentation, status of facial and other lower cranial nerves pre-operatively, surgical techniques with complications if any, recurrences and survival. Of 35 benign tumors, tympanojugular paragangliomas were most common. Average age for these was 53 years with 19 females and 14 males. All were non-functional. Tinnitus and hearing loss were most common presentations. Class B2 and C1 tumors were most commonly encountered and the ITF A approach was most commonly used. Hearing loss and Facial palsy were commonest complication post-operatively. There were 2 recurrences. 18 malignancies were observed. Most were stage IV at presentation. Otorrhea and otalgia were most common presenting symptoms followed by hearing loss. 5 year survival was 55%. Successful treatment of lateral skull base lesions requires a multimodality therapy with team approach. Surgical resection is the primary management choice with variable approaches. ICA status related to the tumor is the most important consideration. Malignancies require more aggressive treatment for obtaining clear margins along with pre/post-op chemoradiation. Good results with acceptable complications can be obtained even with advanced tumors.
Published: 2022

28. Total annulus excision tympanoplasty - a solution to recurrent myringitis: double blind randomised trial

Author: Namita Verma, Bhawani Singh Aeron, Sudeep Munjal, Ritu Sehra, Rajeev Yadav, Sunita Agarwal, K. P. Surendra Prabhu, Pawan Singhal, Man Prakash Sharma, and Arshad Hussain
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, India, law.invention, Double blind, Young Adult, Tympanoplasty, Randomized controlled trial, Double-Blind Method, law, Medicine, Humans, Annulus (mycology), Tympanic Membrane Perforation, business.industry, Auditory Threshold, General Medicine, Middle Aged, Surgery, Otitis Media, Treatment Outcome, Otorhinolaryngology, Chronic Disease, Female, business
Abstract: ObjectiveIn spite of continuous refinements in tympanoplasty techniques, results are variable, and it is not uncommon to see a discharging eardrum even after a good graft uptake. This study aimed to evaluate the efficacy of total annulus excision tympanoplasty in comparison with conventional underlay tympanoplasty.MethodThis was a double blinded, randomised, controlled trial performed at a tertiary care centre. After inclusion and exclusion criteria were met, 56 patients were enrolled and randomised, and 28 patients were allocated to each group (group A (conventional tympanoplasty) and group B (total annulus excision)). Patients and evaluators were blind to the procedure performed.ResultsPatients in group B (total annulus excision) showed better graft uptake and no discharge with better gains in air conduction thresholds (p < 0.05) when compared with group A (conventional tympanoplasty).ConclusionIn view of the advantages it offers, total annulus excision tympanoplasty may be preferred over the conventional techniques in patients with central perforations.
Published: 2021

29. COVID-19, Diabetes and Steroids: The Demonic Trident for Mucormycosis

Author: Vishnu Sharma, Sudhir Bhandari, Man Prakash Sharma, Shivankan Kakkar, Amitabh Dube, Bharat Bhushan Sharma, Srikant Sharma, Shruti Bhargava, Sunil Samdhani, Mohnish Grover, Sunita Agarwal, and Shashank Nath Singh
Subjects: Pediatrics, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Mucormycosis, Newly diagnosed, COVID associated mucormycosis, medicine.disease, Hba1c level, Diabetes mellitus, Otorhinolaryngology, Methylprednisolone, medicine, Head and neck surgery, Surgery, Original Article, business, COVID 19, Steroid, medicine.drug
Abstract: Coronavirus disease 2019 (COVID-19) has been found to be associated with mucormycosis in few parts of the world, especially India. It is important to look for reasons for this upsurge of cases so that other countries may take proper steps to prevent it. A prospective clinico-demographic study was conducted in SMS Medical College, Jaipur, India from April to May 2021. All patients (235) with COVID associated mucormycosis (CAM) were studied in detail with reference to their diabetic status and steroid intake during treatment of COVID-19. Steroid usage was in 84.3% of patients with methylprednisolone being the most commonly used steroid (66.8%). Majority of the patients had taken steroids for 7-14 days. Diabetes was found in 204 patients and 42.1% of patients were newly diagnosed during/after COVID-19 treatment. The HbA1c levels of diabetic patients ranged from 6.0% to 16.3%. This is perhaps the biggest study in the world shows that the triad of COVID-19, diabetes and steroid usage is a major contributing factor towards mucormycosis. Proper steps should be taken to prevent CAM.
Published: 2021

30. Antibiotic stewardship in a tertiary care NICU of northern India: a quality improvement initiative

Author: Vivek Sharma, Yatish Singh, Jyoti Patodia, Sunita Agarwal, Jaikrishan Mittal, and Vaibhav Agnihotri
Subjects: medicine.medical_specialty, Medicine (General), Neonatal intensive care unit, Quality management, Leadership and Management, medicine.drug_class, Quality Improvement Report, Antibiotics, Sepsis, 03 medical and health sciences, Antimicrobial Stewardship, 0302 clinical medicine, control charts/run charts, R5-920, Intensive Care Units, Neonatal, Medicine, Humans, 030212 general & internal medicine, Adverse effect, business.industry, Tertiary Healthcare, 030503 health policy & services, Health Policy, Public Health, Environmental and Occupational Health, Infant, Newborn, medicine.disease, Quality Improvement, Anti-Bacterial Agents, Emergency medicine, Vancomycin, Antibiotic Stewardship, antibiotic management, 0305 other medical science, business, PDCA, medicine.drug
Abstract: BackgroundThe overuse of antibiotics in newborns leads to increased mortality and morbidities. Implementation of a successful antibiotic stewardship programme (ASP) is necessary to decrease inappropriate use of antibiotics and its adverse effects.ProblemOur neonatal intensive care unit (NICU) is a tertiary referral centre of north India, consisting of all outborn babies mostly with sepsis caused by high rate of multidrug-resistant organisms (MDROs). So antibiotics are not only life-saving but also used excessively with a high antibiotic usage rate (AUR) of 574 per 1000 patient days.MethodA quality improvement (QI) study was conducted using the Plan–Do–Study–Act (PDSA) approach to reduce AUR by at least 20% from January 2019 to December 2020. Various strategies were made : such as making a unit protocol, education and awareness of NICU nurses and doctors, making check points for both starting and early stoppage of antibiotics, making specific protocol to start vancomycin, and reviewing yearly antibiotic policy as per antibiogram.ResultsThe total AUR, AUR (culture negative) and AUR (vancomycin) was reduced by 32%, 20% and 29%, respectively, (pConclusionIn a centre such as ours, where sepsis is a leading cause of neonatal deaths, restricting antibiotic use is a huge challenge. However, we have demonstrated implementation of an efficient ASP with the help of a dedicated team and effective PDSA cycles. Also, we have emphasised the importance of sustainability in success of any QI study.
Published: 2021

31. New SMS classification of cochleovestibular malformation and its impact on decision-making

Author: S N Singh, S Sharma, Sunil Samdani, Gaurav Gupta, Sunita Agarwal, Chappity Preetam, Mohnish Grover, and Man Prakash Sharma
Subjects: Male, medicine.medical_specialty, business.industry, Hearing Loss, Sensorineural, Clinical Decision-Making, India, Retrospective cohort study, General Medicine, Audiology, Cochlear Implantation, Tertiary care, Cochlea, Tertiary Care Centers, Otorhinolaryngology, Clinical decision making, Child, Preschool, Outcome Assessment, Health Care, medicine, Humans, Female, Vestibule, Labyrinth, Child, business, Cochlear implantation, Retrospective Studies
Abstract: ObjectiveTo propose a new classification of inner-ear anomalies that is more clinically oriented and surgically relevant: the SMS (Sawai Man Singh) classification of cochleovestibular malformations.MethodsA retrospective multicentric study was conducted of 436 cochlear implantations carried out in 3 Indian tertiary care institutes. Patients with anomalous anatomy were included and classified, as per the new SMS classification, into cochleovestibular malformation types I, II, III and IV, based on cochlear morphology, modiolus and lamina cribrosa.ResultsThere were 19, 23, 8 and 4 patients with cochleovestibular malformation types I, II, III and IV, respectively. Two-year post-operative Meaningful Auditory Integration Scale scores were statistically analysed.ConclusionThis new classification for inner-ear anomalies is a simpler, more practical, outcome-oriented classification that can be used to better plan the surgery. These merits make it a more uniform classification for recording results.
Published: 2019
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32. Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand

Author: Swarna Baskar Sharma, Mansoor Sange, Michael Girgis, Joanne Humphreys, Vishal Patil, Nick Greenwood, Sai Tim Yam, Santhana Kannan, Marc Slorach, Julian Giles, Suman Shrestha, Philippa Marshall, Vinanti Cherian Mcivor, Moore Joanna, Elizabeth Thomas, Stuart M. White, James Hanison, Suhail Zaidi, Andrew Burtenshaw, Douglas Campbell, Jaya Nariani, Ross Freebairn, Omar Alex Pemberton, Davina Ross-Anderson, Lisa M. Barneto, Shabir Qadri, Giles Bond-Smith, Pallavi Kumar, Khaled Razouk, M. Amir Rafi, Dermot Moloney, Ashok Raj, Kirtida Mukherjee, Vasheya Naidoo, Sonia Sathe, Jason Cupitt, Priya Shanmuganathan, Andrew Brammar, David Saunders, Anna Batchelor, James R. Anderson, Hew D.T. Torrance, Catriona Barr, Helen Melsom, Adrian Taylor, Jon Bramall, Sumant Shanbhag, Jenny Ritzema, Winston Cheung, Alexandra Frankpitt, David Shan, Killian McCourt, Chiraag Talati, Richard Kennedy, Ravishankar Jakkala Saibaba, Abigail Hine, Cathryn Matthews, Christian Frey, Laurin Allen, Gary Minto, Thomas Fitzgerald, James Bain, Dominik Teisseyre, Stephen Hill, M. Dickinson, Subhamay Ghosh, J.A. Ezihe-Ejiofor, Vincent Hamlyn, Karuna Kotur, Joyce Yeung, Helen Roberts, Johann Harten, Stefan Schraag, Jonathan Aldridge, Alexander Garden, Carol McArthur, Louis Guy, John Orr, Tom Pettigrew, Atideb Mitra, Cindy Persad, Abhinav Kant, Robin Alston, Nicolas Price, Sarang Puranik, Jacqueline Howes, Ritoo Kapoor, Peter Knowlden, Mai Wakatsuki, Charles Allen, Deepa Jumani, Mark MacGregor, Prashant Kakodkar, Dhir Bhattacharya, Valerie J. Page, Narendra Siddaiah, Dick Ongley, Vandana Goel, Sibtain Anwar, Bronwyn Posselt, Rebecca Sutton, David Scott, Danny J.N. Wong, Austin Rattray, Paul S. Myles, Mrutyunjaya Rao Rambhatla, Richard Dobson, Kathryn Jenkins, Tim J. Smith, Helen Bromhead, Zhana Ignatova, Katheryn Fogg, Lynne Williams, Sanjeev Garg, Nikhil Patel, Gary Lau, Sock Huang Koh, Stephen Merron, David Robinson, Nagendra Natarajan, Seema Charters, Mark Welch, Laura Farmer, Simon Young, Susan Kirby, Madhushankar Balasubramaniam, Robert Wonders, Paul Glyn Jones, Satyanarayana Jakkampudi, Mizan Khondoker, Paul Rowe, Andrew Jones, Monica Diczbalis, Manju Agarwal, Andrew Robinson, Emert White, Catherine Hunter, Stephen T. Webb, Srikanth Chukkambotla, Jenny Henry, Catriona Ferguson, Manish Kakkar, Waisun Kok, Colin Williams, Vijayakumar Gopal, Vidhya Nagaratnam, Shafi Ahmed, Melinda Same, Doug Campbell, Stuart P. D. Gill, Scott Popham, Gabor Debreceni, Dancho Ignatov, D. L. Williams, I.J. Wrench, Andrew Claxton, Eleanor Ford, Shondipon Laha, Laurie Dwyer, Christopher Littler, Stephan Clements, David Gillespie, Ceri Lynch, Lillian Coventry, Paul Clements, Paul Foley, Claire Ireland, Vikramjit Singh, M. H. Nathanson, R. Jonathan T. Wilson, Shilpa Rawat, Pieter Bothma, David Pritchard, Victor Birioukov, Robert Campbell, Brien Hennessy, Stephanie Bell, Robert Smith, Muhammad Usman Latif, Nicolas Hooker, Anand Kulkarni, Chelsea Hicks, Steve Harris, Caroline Reavley, Claire Botfield, Christopher Nutt, Andrew Gorman, Peter J O'Brien, Murray Geddes, Carlos Kidel, Samar Al-Rawi, atyas Andorka, John John, Stephen Washington, Peter Csabi, Anil Hormis, Emily Dana, Sharon Hilton-Christie, Brian Spain, Suganthi Joachim, Richard Partridge, Tony Miller-Greenman, Andrew Marshall Wilson, Samuel Perrin, Carol Bradbury, Christopher Goddard, Paul Cooper, Simon Williams, Iain K. Moppett, Han Truong, Stephen J. Brett, Robert Orme, Alexandra Matson, Michael P.W. Grocott, Sunita Agarwal, Jonathan Chambers, Georgina Prassas, Rachel Markham, Kevin Hamilton, Jane Wright, Julian Sonksen, Robert Spencer, James Limb, Tehal Kooner, James Tozer, Sujesh Bansal, Fiona Graham, Suresh Singaravelu, Adrienne Stewart, Sophie Gormack, Buzz Shephard, Julian Berry, Nick Spittle, Philip Blackie, Richard Stewart, R. Sneyd, Laura Kwan, Ben Chandler, Helen Lindsay, Wendy Lum Hee, Vivien Edwards, David Highton, Helen A. Lindsay, Tendai Ramhewa, Daphne Varveris, Liam McLoughlin, Duncan Brown, Justin Woods, Annabelle Whapples, Jonathan Panckhurst, Garry Henry, Kate Campbell, Jeremy Henning, Stephanie Sim, Baigel Gary, Nam Le, Joellene Mitchell, Laura Tasker, Geoff Wright, Con Papageorgiou, Simon Whiteley, Richard Pugh, Joel Matthews, Suneetha Ramani Moonesinghe, Andrew M. Wilson, Sandeep Varma, Chris Hargreaves, Malcolm Gunning, Agnieszka Kubisz-Pudelko, Richard Shawyer, N. M. Wharton, Janette Moss, Gurunath Hosdurga, Catherine Plowright, Jane Montgomery, Stuart McLellan, Emma Gent, Patrick Dill-Russell, James Craig, Nirav Shah, Julius Dale-Gandar, Geoff Thorning, Lawrence Wilson, Roddy Chapman, Andrew Gratrix, Kate Bailey, Sunil kumar Chaurasia, Sophie Wallace, Rob Dawson, Richard Siviter, Christine Range, Helen McNamara, Tim Cook, Khong Tan, Michael Brett, Alan Kakos, Samuel Armanious, Liana Zucco, Sam Clark, Laura Troth, Rajeev Jha, Michael Weisz, James Pennington, Chris Bowden, Jeremy Drake, David Rogerson, Ritesh Maharaj, Alison Jackson, Sophie van Oudenaaren, Rohit Juneja, and Naomi Goodwin
Subjects: medicine.medical_specialty, Critical Care, Population, Staffing, Care provision, Patient safety, Postoperative Complications, medicine, Per capita, Humans, education, Postoperative Care, Response rate (survey), education.field_of_study, Tertiary Healthcare, business.industry, Australia, Health services research, Emergency department, United Kingdom, Intensive Care Units, Anesthesiology and Pain Medicine, Hospital Bed Capacity, Health Care Surveys, Emergency medicine, Health Services Research, business, New Zealand
Abstract: Background Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional ‘high-acuity' beds capable of managing high-risk patients outside the ICU/HDU environment. Methods We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ. Hospital- and ward-level data were collected, including bed numbers, tertiary services offered, presence of an emergency department, ward staffing levels, and the availability of critical care facilities. Results We received responses from 257 UK (response rate: 97.7%), 35 Australian (response rate: 32.7%), and 17 NZ (response rate: 94.4%) hospitals (total 309). Of these hospitals, 91.6% reported on-site ICU or HDU facilities. UK hospitals reported fewer critical care beds per 100 hospital beds (median=2.7) compared with Australia (median=3.7) and NZ (median=3.5). Additionally, 31.1% of hospitals reported having high-acuity beds to which high-risk patients were admitted for postoperative management, in addition to standard ICU/HDU facilities. The estimated numbers of critical care beds per 100 000 population were 9.3, 14.1, and 9.1 in the UK, Australia, and NZ, respectively. The estimated per capita high-acuity bed capacities per 100 000 population were 1.2, 3.8, and 6.4 in the UK, Australia, and NZ, respectively. Conclusions Postoperative critical care resources differ in the UK, Australia, and NZ. High-acuity beds may have developed to augment the capacity to deliver postoperative critical care.
Published: 2019
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33. Modified Veria Technique for Cochlear Implantation by Postaural Approach

Author: Namita Verma, Sushmita Nagaraj, Amit Goyal, Amit Keshri, Rajeev Kumar Kapila, Sunita Agarwal, Man Prakash Sharma, and Pawan Singhal
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Soft tissue, Mastoidectomy, Facial nerve injury, Surgery, 03 medical and health sciences, 0302 clinical medicine, Otorhinolaryngology, 030220 oncology & carcinogenesis, Air cell, Cochlear implant, medicine, Operating time, Original Article, Postaural approach, 030223 otorhinolaryngology, Cochlear implantation, business
Abstract: There are various surgical techniques for cochlear implantation, classical one being mastoidectomy and posterior tympanotomy which has some disadvantages and complications like extensive bone work, violation of mastoid air cell system and fear of injury to vital structures like facial nerve. To minimize these problems, various modifications in cochlear implantation surgery has been done which includes introduction of Veria technique which also has certain disadvantages like extensive dissection and prolonged surgical time. In this article we are introducing an innovative technique of cochlear implantation where we have modified the pre-existing Veria technique that has been described in detail in the coming sections. Total 9 cases have been done so far with this modified Veria technique. This technique includes postaural approach with minimal soft tissue and bone work, making the cochlear implantation simple, easily doable, with less operating time, with minimal morbidity, faster healing due to smaller incision and avoiding facial nerve injury.
Published: 2020

34. Orbital magnetic resonance imaging profile and clinicoradiological correlation in COVID-19-associated rhino-orbital-cerebral mucormycosis: A single-center study of 270 patients from North India

Author: Maya Hada, Parul Gupta, Meenu Bagarhatta, Koushik Tripathy, Anita Harsh, Kamlesh Khilnani, Kuldeep Mendiratta, Sunita Agarwal, JugalKishore Chouhan, and Sudhir Bhandari
Subjects: Male, Ophthalmology, Cross-Sectional Studies, SARS-CoV-2, Orbital Diseases, COVID-19, Humans, India, Mucormycosis, Female, Middle Aged, Orbital Cellulitis, Magnetic Resonance Imaging
Abstract: To study the clinical profile and magnetic resonance imaging (MRI) features in patients of COVID-19-associated rhino-orbital-cerebral mucormycosis (CA-ROCM) with orbital involvement and perform a clinicoradiological correlation.A cross-sectional study was performed at a tertiary care center in north India from May 2021 to June 2021. Consecutive patients with clinical, nasal endoscopic, and/or microbiological evidence of CA-ROCM underwent MRI of paranasal sinuses, orbit, and brain as per the study protocol. Orbital MRI findings were studied in detail and were correlated with clinical signs.Two hundred and seventy patients were studied. The mean age was 48.4 (± 16.82) years. A male predilection was noted (male:female = 1.77). Orbital involvement was seen in 146 (54%) patients on clinical evaluation and in 184 (68%) patients on MRI. Unilateral orbital involvement was more common (134; 92%). The most common presenting symptom was periorbital and/or facial pain (141; 52.2%) and the most common clinical sign was periorbital edema (116; 43%). The most common MRI finding was suggestive of orbital cellulitis (160; 59%). Orbital compartment syndrome was found in 17 (6.3%) patients. The inter-rater agreement between clinical and radiological assessments to detect the involvement of infraorbital nerve and frontal nerve was found to be 85.56%, (κ 0.621) and 93.70% (κ 0.776), respectively. The diagnostic accuracy, sensitivity, and specificity of MRI to detect medial orbital wall defect were found to be 87.9%, 65%, and 97%, respectively.Orbital imaging features of a cohort of ROCM patients have been presented with clinicoradiological correlation.
Published: 2022
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35. Per Operative Study of Relation of Zuckerkandl Tubercle with Recurrent Laryngeal Nerve in Thyroid Surgery

Author: Sunita Agarwal, Kalpana Sharma, and Priyanka Singh
Subjects: medicine.medical_specialty, Tubercle, business.industry, medicine.medical_treatment, Thyroid, Thyroidectomy, Anatomy, Thyroid lobe, Surgery, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Otorhinolaryngology, 030220 oncology & carcinogenesis, Recurrent laryngeal nerve, medicine, Head and neck surgery, Original Article, 030223 otorhinolaryngology, business
Abstract: To identify Zuckerkandl tubercle and to determine relationship between the recurrent laryngeal nerve and Zuckerkandl tubercle (ZT). Peroperative study. Intraoperatively Zuckerkandl tubercle was identified. Size of the thyroid lobe and Zuckerkandl tubercle were co-related and direction of tubercle in relation to recurrent laryngeal nerve was examined. Grading of tubercle on the basis of size was done. We studied its direction and relation with recurrent laryngeal nerve. ZT was identified in 87.86% (179 out of 206) of cases. In the study amongst the 179 cases in whom ZT could be identified, ZT was found on the right side (85.41% i.e. 123 out of 144), 81.41% (92 out of 113) to the left side and 15.68% (8 out of 51) were B/L. ZT was found posterior to the tubercle in 97.22%(175 out of 179) cases and anterior to the tubercle in 2.77% (5 out of 179) cases. The relationship between recurrent laryngeal nerve and ITA was studied. ITA was anterior to RLN (in 70.89%) and posterior to RLN in 29.10%. Thus, ZT is an important landmark for identification of RLN during thyroidectomy (p value 0.001). Level of evidence III.
Published: 2017
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36. Vitamin D: A Modulator of Allergic Rhinitis

Author: Shashank Nath Singh, Rohtash Kumar, Ritu Sehra, and Sunita Agarwal
Subjects: medicine.medical_specialty, business.industry, medicine.disease, Gastroenterology, Symptomatic relief, vitamin D deficiency, 03 medical and health sciences, 0302 clinical medicine, Otorhinolaryngology, 030220 oncology & carcinogenesis, Drop out, Internal medicine, Eosinophilic, Oral vitamin, Etiology, medicine, Vitamin D and neurology, Surgery, Original Article, 030223 otorhinolaryngology, business, Nasal Drops
Abstract: Allergic rhinitis is a topic of concern among clinicians. Despite of being treated in form of oral medicines, nasal drops and sprays several patients come back with complaint of no relief. This necessitates to review and focus on etiology and to find some other treatment regimen. Established relation of serum vitamin D level and various allergic conditions attracts us to use it as a therapeutic agent for allergic rhinitis. It is a case–control observational study recruited 80 subjects with 40 cases and 40 controls. There was drop out of two subjects among cases. Cases were supplement with oral vitamin D (cholecalciferol-1000 IU OD) and controls received no treatment. Serum vitamin D level, Total nasal symptom score (TNSS) and total eosinophilic count (TEC) were calculated at 0, 1 and 3 months and compared. Pre-treatment average serum vitamin D level of cases was 20.15 + 10.26 ng/ml and of control was 27.94 + 13.38 ng/ml. The TNSS score of cases was 7.43 + 1.87 and of controls was 5.00 + 1.52. TEC of cases was 546.15 + 113.39 and of controls was 313.33 + 125.08. Post-treatment serum vitamin D level of cases was 38.05 + 14.62 and of controls was 27.43 + 12.76. TNSS of cases was 3.53 + 0.68 and 4.43 + 1.17 in control group, TEC of cases was 68.13 + 38.95 and of controls was 197.03 + 123.36. This study concludes that vitamin D acts as disease modulator in allergic rhinitis In case of allergic rhinitis with vitamin D deficiency its supplementation gives symptomatic relief and also lowers down the values of TNSS and TEC.
Published: 2019

37. Free flaps – Are they a boon? A quality of life analysis

Author: Pawan Singhal, Mohnish Grover, S N Singh, Man Prakash Sharma, S Sharma, and Sunita Agarwal
Subjects: Quality of life (healthcare), business.industry, Medicine, Operations management, business
Published: 2019
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38. Factors associated with increased blood loss during delivery

Author: Sangeeta Kamra, Ashu Jain, Paridhi Jain, Sunita Agarwal, Nisha Thakur, and Shyla Jacob
Subjects: Blood loss, business.industry, Physiology, Medicine, business
Abstract: Background: The present study was done to assess the blood loss during delivery even after active management of third stage of labor with oxytocin and the maternal outcomes of PPH.Methods: We studied 100 pregnant women were either in spontaneous labor or admitted for induction of labor, underwent vaginal delivery or caesarean section in our institute. Active management of third stage of labor in all 100 cases included 10 IU intramuscular oxytocin or 10 to 20 IU intravenous in 500 ml of Ringer’s Lactate. Blood loss in all cases was noted.Results: Of the included cases, 27 had to be given extra-uterotonics for atonic uterus, of which 12 parturient still had PPH. Atonic uterus was the cause of PPH in 11 of the 12 cases, while one case was of atonic uterus plus trauma. Half of all PPH cases responded to medical management alone, five cases had to undergo tamponade/stepwise devascularization and one case had to undergo obstetric hysterectomy. Blood loss was significantly higher in women aged more than 35 years, primigravida, not in labor, oligohydramnios or post-datism, elective LSCS, scarred uterus in and had more than 1 high risk factor. Among various high-risk conditions, significantly higher blood loss was observed in patients with chronic hypertension, gestational hypertension, pre-gestational diabetes mellitus, multipara with prior PPH, placenta previa, preeclampsia and sickle cell trait.Conclusions: Fifteen women avoided PPH by using a reliable method of blood loss measurement and initiating interventions early. Organized PPH management protocol morbidity and mortality of the mother and neonate can be prevented.
Published: 2020
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39. Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals

Author: Jennifer Morrish, Emily J Robson, Georgina Ashfield, Karuna Kotur, Jashmin Maria, Charlotte Downes, Shweta Patro, Mark Scrutton, George Gladstone, Andy Burton, Paula Mulligan, Wei Lin Allen, Michael McCusker, Dee Leonard, James Edwards, Sarah Dolling, Katherine Pass, Hywel Garrard, Francis Young, Paul Edgar, Elaine Matthews, Douglas Findlay, Helen Whittle, Aillison MacLean, Chris Levett, Claire-Marie Agius, Kim Porter, Nurse Charlotte White, Bridget Campbell, Gemma Scotland, Patrick Haywood, Liz Shenton, Tom Hatton, Laura McAffrey, Jane Hunt, Jaime Carungcong, Sara Owen, Fiona Christie, Lesley Milne, Liza Tharakan, Ruth Smith, Henry Nash, Timothy Gould, Jodie Fitzgerald, Wael Zghaibe, Mark Gaskell, Dushyanthi Jayasekera, Elana Owen, Kinga Dwornik, Amr Ali, Donna Cotterill, Martyn Cain, Peter Wicks, Daniel West, Catriona Walker, Rebecca Lee, Amanda Isaac, Naresh Rajasekar, Sally Collins, Laura Hammon, Tim Hendra, Yemi Adelaja, Mike Pollard, Ellen L. Brown, Matt Clayton, Rachel Bown, Sally Moore, Keyury Desai, Tony Kinsey, Charlotte Dunn, Li Lian Loh, Emelia Passaro, Timothy Faccini, Stephen Linter, Sumant Shanbhag, David Lee, David Restall, Angela Cook, Simon Ripoll, Rachael Bird, Vicky Murray, Alex Wollaston, Daniel Yarwood, Sonia Bhangu, Sahar Biuk, Jenny Ferry, Alexander Michael Stewart, Ceri Lynch, Lucy Sheppard, Denise Webster, Jamie Allen, Merle Cohen, James Hanison, Shilpa Rawat, Prabhakaran Premraj, Gamunu Ratnayake, Clare Bird, Lorna Filby, Clare Allcock, Babak Sedghi, Celly Weegenaar, Dawn Collier, Sreekanth Rayalu Uppugonduri, Amanda Whileman, Su Ying Ong, Jack Carmichael, Victoria O'Loughlin, Barbara Linklater-Jones, Maria Lackmann, Vitul Manhas, Albert Brennan, Alasdair Waite, Andrew Smallwood, Salvatore Bruni, Catriona Barr, Thomas Murphy, Gemma Hudson, Khalid Hasan, Alison J. Campbell, Radu Chiravasuta, Charlotte Maden, Roddy Chapman, Jon Clark, Nauman Iftikhar, Sarah Hagyard, Denis O'Leary, Steven Forde, Joanne Webb, Ryan W Haines, Andrea Galloway, Richard Siviter, Heidi Lightfoot, Hew D.T. Torrance, Christopher Smith, Hollie Robinson-Perrie, Josh Wall, Carina Cruz, Andrew Song, Stephen T. Webb, Nurse Sara-Beth Sutherland, Carol-Ann Woolley, Susan Martin, S.L.M. Walker, George Koshy, Renee Ford, Mona Mubarak, Robert Stuart, Keshava Reddy Burijinti Chenna, Rizana Ghafoor, Katie Hanlon, Fiona Faulds, Hiba Khaled, Richard Jones, Karin Duckett, Cathryn Matthews, Charles Chan, Sanjeewa Ranaweera, Nurse Rebecca Hinch, Richard Shawyer, Jo Cudlip, Marion Ashe, Steve Harris, Ravi K. Alagar, Jonathan Hetherington, Sara Churchill, Yolanda Baird, Maria Tritean, Gabriela Wong, Dermot Moloney, Lee Tbaily, Jonathan Finnity, Norbert Bokor, Peter Indoe, Lucy Stelfox, Simon Marcus, Bryony Burrill, Ellie Roderick, Carina Lilley, Alex Yusaf, Lucy Corbett, Esther Neilly, Christine Ryan, Amon Wijunamai, Katie Atterbury, Abigail Clarke, Josh Patch, Otto Mohr, Ronan Mukherjee, Asokan Krishnaier, Chen Yun-Han, Prasan Panagoda, Polly Rice, Katherine Jones, James Hudson, Sophie Uren, Peter Sutton, Evangelia Poimenidi, Tracy Marsden, Veronica Barnes, Alice Drysdale, Tara Lawrence, Lisa Sharpe, John G. Francis, N. M. Wharton, Claire Kurasz, Marina Iaverdino, Caradog Thomas, Emma Gold, Raj McNab, Tom E.F. Abbott, Claire Dowse, Jane Hamilton, Tony Sutherland, Robert P. Jones, Peter Alston, Daniel Haslam, Philippa Marshall, Bernadette Tilley, Cathleen Chabo, Adam Carpenter, Steve Cole, Nicholas Hooper, Kate Arrow, Alka Shah, Rosie Furness, Susie Chapman, Sachini Dhamaratne, Constandinos Papageorgiou, Michael Girgis, Sandra Pearson, Andrew W. Wood, Jaya Nariani, Sonia White, Christopher Godden, Mary Bellamy, Indra Chadbourn, Laura Parker, Peter Knowlden, Cat Griffiths, Jeanette Smith, David Brooks, Jonathan Smith-Williams, Elizabeth Barnes, Sunil Jamadarkhana, Andrew Feneley, Maria Croft, Tom Disney, Paramesh Kumara, Anna Warrington, Seetal Aggarwal, Zackriah Badsha, Suman Biswas, Suzanne Shuttleworth, Ben Jones, Jose Lourtie, Mark Stubbington, Asya Mussad, Patrick Johnson, Sister Amanda Cowton, James Spargo, Kelly Hard, Annette Fraine, William Weston, Farrukh Ameer, Andrew Prenter, Lisa Bacon, Sunil kumar Chaurasia, Claire Nicholas, Amy Kitching, Sneha Prasad, Catriona Ferguson, Martin P. Huntley, Claire Cameron, Hugh Cutler, Anne Harrison, Kunal Joshi, Anna Cormack, Rebecca Jones, Martin Paul, Jean Bage, Stephen Cole, Usman Razaque, Robert Lewis, David O'Callaghan, Samantha Strong, Victoria Frost, Peter Ip, Victoria Male, Mat Molyneux, Christopher Worth, Michael Brett, Megan Smith, Shayan Arshed, Timothy McMillan, Lorri James, Frances Lay, Jennifer Bennett-Britton, Patrick Colhoun, Alison Shaw, Michael Stewart, Maie Templeton, Karin Gupwell, Mujeeb Khan, Elena Stanton, Chandini Chuni, Janette Brown, Mariam Latif, Rebecca L. Wilson, Felix Fombon, Jo Novaga, Cindy Persad, Matthew Thomas, Maryna Garmash, Metod Oblak, Sarah Maher, Rahul Muddanyake, Morgan Foster, Kris Parker, Tim Sutton, Ndi Ekwere, Samuel Armanious, Mohammad Bhatti, Steve Phillips, Maria Rivero-Bosch, Nick Spittle, David Harding, Henry Hammerbeck, Rose Buckley, Jonathan Hatton, Ahmed Gilani, Ali Watts, Neeraj Bhardwaj, Lesley McShane, Simon Ridler, Martin Murphy, Vandana Goel, S Ramani Moonesinghe, Sophie Scutt, Sanniah Hussain, Hannah Donaldson, Tom Bennett, Helen Boys, David Steven Davies, Bev Hammond, Bryan Yates, Victoria Hawley, Chris Gibb, Ulrika Winstone, Keith Couper, Benedict Williams, Louise Duncan, Georgina Wilson, Anil Hormis, Emily Dana, Jens Full, Amina Chohan, Amanda Ebejer, Sian McKillop, Tomas Bakonyi, Georgina Bird, George Davies, Christina Penny, Helen Thornley, Karen Jewers, Kingsin Ang, Mishell Cunningham, Conny Blunt, Ronald Carrera, Kay Finney, Alvin Soosay, Nagaraj Rao, Jason Mann, Carol Edwards, Richard Lowe, Paul Stevens, Hilary Ashton, Rachel Codling, Rhys Davies, Muthuraj Kanakaraj, Zoe Apple, Kirsty Meats, Tammy Smith, Charmaine Beirnes, John Gardner, Peter Featherstone, Claire Williams, Rohit Mittal, Emma Shinn, Alex Moore, Michael Whitear, Hannah Rose, Paul Kelly, Megan Thomas, Matthew Gibbins, Jack Reid, Caroline Clarke, Victoria Irvine, Bhavesh Pratap, Ella Buchanan, Nurse Francesca Wright, Vatsharlan Santhirapala, Richard Gould, Dionne Dervin, Behzad Sohail, Lauren Duraman, Thecla Scully, Adnaan Qureshi, Muditha Peiris, Thomas Ratcliffe-Law, Samuel J. Clark, Ben Vowles, Sam Keable, Hoda Abou Ghoneim, Becky Morris, Aidan Hulbert, Rachael Craven, Ashish Kundu, Emma M. Casely, Maya Kommer, Tom Poulton, Greg Nussbaum, Ahmad Huda, Caroline Davis, Suzanne Gleeson, Paul Clements, Matt Willis, Isobel Amey, David J. Perry, Rachel Harford, Bianca Hulance, Kirsty Baron, Charlotte Grove, Sergio Dominguez, Susanna Richie-Mclean, John Stones, Ioana Simionescu, Khaled Razouk, Cristina Niciu, Ben Hyams, Mark Doran, Carolyn Colvin, Jonathan Rivers, Raluca Ene, Rebecca Jackson, Jonathan Edgar, Ben Robinson, Lisa Wilkinson-Guy, Aji Mathew, Christopher Patrick, Gauhar Sharih, Ismail Tariq, Andrea Kay, Joshua O'Donnell, Dafydd Watterson, Lail Zaheer, Fiona Reed, Tom Johnson, Christopher Oscier, Mirain Phillips, Edmund Gerrans, Joanna Hackney, Sally M. Dunlop, Elizabeth Willetts, Jiang Yuchen, Lizzie Ashton, Theresa Cooper, Paul W. Davies, Carly Brown, James Small, Julie Lowe, Amarjeet Patil, Filipe Helder, Joshua Cuddihy, Faisal Sheikh, Hayley Tarft, Enid Leung, Adrian Percuin, Paolo Mazzone, Rochelle Rhodes, Jane Pilsbury, Kerry Cullis, Peter Brook, Helen McNamara, Carin Swanevelder, Claire Frith, Adrian Clarke, Stuart Watson, Glenn Vetuz, Zoe Riddell, Drew Welch, Geoff Warnock, Lalani Induruwage, Paul Mallett, Elizabeth Cervi, Santinder Dalay, Supriya Antrolikar, Sinead O'Kane, Toby Hoskins, Stephen Duberley, Sophie Parcell, Jayne Sutherland, Lynn Fairless, Dave Parkinson, Matron Beryl Davis, Abigail Patrick, Jithu Jayan, Nicola Harvey, Catherine Pitman, Donata Banni, Samuel Passey, Omar Alex Pemberton, Becky Sands, Hon Sum Liu, Alexandra Mudd, Sheldon Zhang, Ange Lise John-Baptiste, Thomas Clayton, Charlotte Marriot, Tom Reevell, Nicola Mackenzie, Temitope Aiyedun, Andy Cruickshanks, Jacqueline Gunn, Alison Moss, Martyn Clark, Swetha Rambhatla, Claire Matata, Ben Cracknell, Pauline Mercer, Matthew Morgans, Catrin Williams, Shareef Madhi, Jane Montgomery, George Kohler, Yasir Hameed, Muneeba Ahmed, Glenn Saunders, Anand Kulkarni, Craig Pinner, Lauren Pearce, Vishnu Bhardwa, Judi Ramsey, Meghna Sharma, Rob Hull, Srinivasan Perumal, Julia Critchley, Stephen Hill, Bethany Fitzmaurice, Robert Crichton, Cormac O'Connor, M. Dickinson, Alison Pearce-Smith, Julie Toms, Kathleen Horan, Ammy Dodd, Rachel Crone, Graeme Finnie, Suman Shrestha, Saul Sundayi, Shamini Sivakumaran, Robert Collin, Janine Musselwhite, Yuvaraj Kummur, Mariana Bernardo, Amrinda Sayan, Gabrielle De Selincourt, Laura Bridge, Melissa Rosbergen, Philip Barclay, Garry Davenport, Daniel Murrell, Andrew Drummond, Eireann Allen, Emma Fadden, Subha Arunachalam, David Robinson, Stephanie Dukes, Catherine Jardine, Sunny Bhat, Hemantha Shiva, Amy Kerr, Henry Elms, Anam Asif, Sandra Evans, Girish Rangaswamy, Laura Thomson, Asad Javed, Jenny Shuttleworth Davies, Maren Kleine-Brueggeney, Sian Edwards, Jean-Paul Zahra, Jo simpson, Priya Verma, Bhamini Tharmalingam, Matthew Edmunds, Stephen Adshead, Hannah Luckhurst, Lara Allen, Colin Merrill, Fiona Lyle, Falguni Choksey, Mohyman El Habishi, Holly Notman, Lisa Murthen, Christiana Georgiou, Georgina Singleton, Tim Cook, Melba Knighton, Shirley Pyke, Amit Gadre, Maria Rehnstrom, Helen Hothersall, Anja Kuttler, Anita Boltres, Sarah Williams, Sarah Welch, Yamuna Madhu, Pramod Nalwaya, Alistair Coleman, Jeanie Worthington, Jasmine Samuel, Rajashekar Gowni, Karen Burt, Shamim Haque, Reynard Knoetze, Hakeem Yusuff, Tom Taylor, Val Parkinson, Sheik Pahary, Jonathan Fortune, Natalie Long, David Gilhooly, Karthick Duraisamy, Duncan Baines, Shondipon Laha, Marie Appleby, Jyothi Hosahalli, Christine Catley, Jasmine Jose, Damien Mantle, Dinkar Gowda, Permendra Singh, Ramesh Khoju, Carol Bradbury, Sarah Hazeldine, Karan Kanal, Sonal Lodhi, James Craig, Rachel Wong, Teresa Ferreira, Charis Banks, Ben Chandler, Asia Sarwar, Sivaprakash Vaitheeswaran, Sam Bews, Katie Hunter, Sohan Bisonoothan, Lauren Hunt, Melony Hayes, Nilesh Chauhan, Janet Pickett, Sharon Dealing, Jamie Plumb, Thomas Hollins, Claire Hill, Claire Hindmoor, Nicolas Hooker, Hannah Davis, Laura Mee, Elizabeth Thomas, James Self, Jenny May-Ling Cheung, Jane Varin, Manish Kakkar, Anuj Wali, Omar Siddique, Sophie Earl, Elizabeth Longdon, Alison Meadows, Shafi Ahmed, David MacPherson, Shaima Elnour, Suzi Hale, Ramez Ibrahim, Fei Long, Orlanda Allen, Alice Groves, Mohammed Wahid, Angela Stevens, Carl Ilyas, Richard Robley, Nichola Bleasby, Peter Havalda, Ursula McHugh, Judith Brade, Georgia Monantera, Stuart Younie, Brian Johnston, Jamie Brookes, Linda Park, Graeme Wilson, Mark Greasley, Lohita Nanda, Vineetha Jayakumar, Ian M. Lyons, Ayman Abdu, Paul Athanasopoulos, Justin Woods, Kariem El-Boghdadly, Diane Simpson, Georgina Williamson, Jonathan McCarter, Anil Golhar, Alicia Waite, Claire Halligan, Sarah Anne Leir, Joanne Turner, Matthew O'Meara, Claire Atkinson, Adam Yarnold, Mark Fernie, Rhiann Marie O'Shaughnessy, Jamie Elwood, Laura Harvey, Ali Atrah, Helen Terrett, Sam Scholes, Rebecca E. Saunders, Vin Vyapury, Amir Rafi, Peter Bradley, Srikant Ganesh, Zehrin Nassa, Ulf Buhmann, Laura Carrick, Natalie Rogers, Said Seifalan, Ian Ryder, Jennifer Partridge, Tim Lovell, Martin Priestley, Caroline Wrey Brown, Joanna Moore, Vidhya Nagaratnam, Saba Iqbal, Francesca Mazzola, Samantha Weller, Laura Gould, Helen Johnston, Jenny Spimpolo, Carmen Scott, Stephen J. Brett, Paul Cripps, Amit Kurani, Alexander Knight, Nirav Shah, Pushkar Patankar, Fraser Waterson, Sarah Martindale, Johannes Mellinghoff, Joanne Wootton, Sarah McCormick, Sameer Somanath, Bilal Yasin, Christopher Skeoch, Toby Jacobs, Katrina Eaton, Lynne Connell, Harry Soar, Yvonne Bramma, Tom Gately, Renjith Joseph, Anish Gupta, Lucie Hobson, Charindri Wariyapola, Maryam Zaky, Nimu Varsani, Gerhardus Van Rensberg, Jackie Evans, Rosahn Saleh, William Sutcliffe, Louise Potter, Harvey Dymond, Catherine (Katie) Patton, Andrew Selman, Stephen Traynor, Kate Tizzard, Rumyana Nyathi, Caroline Reavley, Saima Hashmi, Kerry Hughes, Isabelle Sykes, Kate Slade, Anne Troy, David Castillo, Jennifer Quinton, Anne Adams, Joanne Gresty, Stella Wright, Victoria Christenssen, Iain Mooney, Fiqry Fadhlillah, Seema Pai, Gabor Debreceni, Aleinmar Winthein, Denise Griffin, Hannah Beadle, Elisa Kam, Marie Williams, Helen Howes, Tariq Tabiner, Saxon Prentice, James Bedford, Emma Craig, Peter Standen, Stephen Petley, Janaki Pearson, Cheryl Marriott, Harry Barclay, Alexandra Matson, Michael P.W. Grocott, Alison Thorne, Joanne Humphreys, Vishal Patil, Nick Greenwood, Richard Wassall, S.K. Harris, Valpuri Luoma, Dancho Ignatov, Rebecca Fry, Anamika Sehgal, Antonio Paredes-Guerra, Manjula Yadagiri, Yuvraj Doriaswami, Benjamin O'Donovan, Adam Mounce, Stephanie Wright, Linda Webber, Tracy Hazelton, Ethan Bateson, Theresa Garrett, Chris Honstvet, John Scriven, Rahul Dimber, Phillip Lo, Jenny Stead, Catherine Plowright, Rachel Morris, Pallavbhai Desai, Nicola Johnson, Neil Muchatuta, Vijayakumar Gopal, Sherma Turner, Karina Fitzgibbon, John B. Davis, Sarah Patch, Erica Jolly, Rob Gregory, Christopher Lochrin, Geoffrey Ryder, Sam Michlig, Liana Zucco, Susan Nimmo, Jessica Whiston, Sarah Goellner, Rohan Babla, Deborah Skelton, Lucy Mcmanoman, Darcy Pearson, Diane Forrest, Sanjeev Garg, Joanne Bradley-Potts, Joel Perfitt, Danny J.N. Wong, Mike Weisz, Caroline Lowrie, Timothy Alce, Alice Michell, Charlotte Soulsby, Dominic Hayes, Arnab Mandal, Stephanie Ridgway, Angela Willberry, Alka Grover, Simran Minhas, Kerwei Tan, Sharon Jones, Sam Marcangelo, Ben Millette, Hilary Thatcher, Greg Foster, Krishna Balachandar, Megan McAtear, Richard Shellard, Chris Littler, Thunga Setty, Kavita Sasi-Kumar, Theodore Floyd, Duncan Adshead, Stephen Hickey, South Yorkshire Hospitals Audit, Amy Barker, Ewen Cameron, Dawn Trodd, Wendy Nichols, Beth Farr, Mike Salmon, Naomi Fleming, Umairali Ikram, Ben Straughan, Peter J O'Brien, Laura Purandare, Janine Thomas, Elizabeth Wood, Kate Bosworth, Stewart Mckie, Samantha Evans, Tamilselvan Rajamanickam, Srinivasan Dhileepan, Paul Hindmarch, Colin Bergin, Sange Mansoor, Lisa Armstrong, Nagendra Natarajan, Irmeet Banga, Fiona Osborne, Lynne Williams, Pieter Bothma, Jade Woolley, Joanne Finn, Bernd Oliver Rose, Shaman Jhanji, Bennur Katyayani, Gillian Robertson, Laura Bird, Pauline Fitzell, Sally Anne Smith, Serena Yen, Stuart Clelland, Thomas Urwin, Luff Delme, Rocio Ochoa Ferraro, Nurse Cheryl Padilla Harris, Asad Naqvi, Andy Cumpstey, Natalie C. Wood, Samar Al-Rawi, Pulak Padhi, Claire Botfield, Bhavesh Raithatha, Michael Briskoe, Jolyon Cohen, Ben Gibbison, John John, Stephen Washington, Jayne Foot, Karen Chadwick, Naomi Cochrane, Sophie Spencer, Alexandra Gatehouse, Susan Smolen, Aaron D'Sa, John Sturrock, Christopher P Bourdeaux, Kumud Bhandari, Neil Kellie, Elizabeth Denman, Samson Tou, Laura Kettley, Alex Eros, Stuart McLellan, Nicola Ball, Emily Kirk, Sue Smyth, Kim Gibson, Oliver Barker, Mohammad Masood, Dabeeruddeen Ahmed, Geoff Thorning, Jennifer Van Ross, Esme Elloway, Kat Rhead, Sei Nishimura, Maximiliane Kellner, Benjamin Jacobs, Sanjoy Shah, Matthew Stubbs, Faye Moore, Greg Cox, Nishita Patel, Ashok Nair, Elizabeth Hawes, A Espinosa, Kavita Wankhade, Vladimir Bashliyski, Carina Bautista, Susan Lyjko, Michelle Rowe, Nikita Whotton, Julie Temple, Inthu Kangesan, Gemma McIntosh, Samir Nazir, R. N. Kumar, Jen Warren, Alex Coombs, Marilyn Boampomaa, Kaya Jeyarajah, Heather Savill, Claudette Jones, Vinayak Vanjari, Caroline Tierney, Santhana Kannan, Jennifer Aston, Helen Melsom, Valantine Woodham, Nichola White, Niraj Barot, Paolo Perella, Mayumi Vianzon, Padmanabhan Vatsala, Claire Boynton, Alexandra Edwards, Elisa Masoni, Jayne Edwards, Julie Edwards, Thomas Garth, Amanda Skinner, Kate Blethyn, Jonathan Chambers, Katie Ramm, Rosada Jackson, Thomas Coleman, Tracey White, Emma McKenna, Kanchan Umbarje, Thomas Sheppard, Deepa Jumani, Emma Murphy, Peter Lawley, David Howe, Daisy Alston, Ania Dean, Prasun Mukerjee, Julian Hood, Mahmoud Alkholany, Sarah Goff, Gillian Rennie, Bridget Fuller, Ciara Walker, Jonathan Pipe, Alex Eeles, Wai Soon, Catherine McMillan, Martha Wrigley, Neil Brown, Peter Sandbach, Claire McCahill, Anna Wilson Charlotte Yates, Paul Sampson, Natasha Muzengi, Colum Slorach, Moyra Hynd, Arjun Ardeshna, Trish Boateng, James C. Geoghegan, Rhys Williams, Karoline Middleton, Brian Campbell, Srikanth Chukkambotla, Daniel Leslie, Sherrie Samuels, Michael Allan, Ruth Clarke, Christopher Nutt, Kirsten Reid, Hannah Smith, Surabhi Jain, Stephanie Reed, Hywel Evans, Irene Gardner, Ben Griffiths, Guy Shinner, Marek Frenkiel, Jacek Zeber, Gary Minto, Simon Parrington, Louise Harrison, Carlos Kidel, Hawa Desai, Lois Steuart, Claire Hirst, Johann Harten, Marc Slorach, Angela Christofides, Claire Macey, Helen Moore, Chantal Busby, Andrew Robertson, Leanne Milner, Catherine Chapman, Rebecca Reeves, Lawrence Wilson, Alice Aarvold, Lizzie Irvine, Narayanan Suresh, Kirsteen Brown, James Dalton, Sam Miller, Yasir Rashid, Andrew Swain, Liliana Czukowska, Natasha Permall, Carys Durie, Peter Carroll, Lauren Cooper, Prerna Mehrotra, Sarah Clayton, Martina McMonagle, Sarah Buckley, Enoch Onya, Elizabeth Perritt, Domonique Georgiou, Manjeet Save, Lauren Friedman, David W. Hewson, Katherine McAndrew, Simon Morton, James Morgan, Susan Underwood, Helen Bowyer, Avninder Chana, Lucy Sootheran, Kieron Rooney, Pooja Patel, Jessica Summers, Laura Farmer, Kiran Keshvara, Victoria Richardson, Hannah Crowther, Geejo Rappai, Adam E. Green, Sarah Willcock, Smitangshu Mukherjee, Samuel Tyrrell, Geraldine Landers, Claire McAteer, Jennifer Awolesi, Sarah Higgin, Orla O'Neill, Chrissie Chevis, Paul Winwright, Vikram Malhotra, Jonathan Ogor, Maria Muelmenstaedt, Richard Stead, Lindsay Roughley, Sara Balliston, Nevena Kalcheva, Marc Wittenberg, Adrian Taylor, Lydia Shatanda, Anjali Soodan, Angela Moon, Sarah Elgarf, Matthew Roche, Sanchita Bhatia, Clare Howcroft, Emma Butterfield, Emily Gannon, Matthew Needham, Jacqueline McCormick, Daniel Bendel, Victoria Martinson, David Hall, Richard A. Armstrong, Lara Herbert, Beverly Kilner, Kathy Dent, Victoria Thwaites, Issy Thomas, Maggie Peat, Lisa Macbeth, Alex James, Rachel Flight, Nick Black, Elizabeth Boyd, Catherine Gedling, Suzanne Body, Nadine Farrell, Samantha Clayton, Paula Hiltout, Richard Haddon, Bethany Philpott, Victoria A Burgess, John Jackson, Anita Patil, Chris Platt, Lindsey Iles, Chrissy Braybrook, Katherine Morris, Emma Karsten, Minna Meritahti, Anastasia Lynn-Smith, Dorothy Hutchinson, Rebecca Darbyshire, Joanne Riches, Astri Luoma, Andy Gibson, Dushanthi Thurairasa, Roisin Baker, Xantha Holmwood, Alda Remegoso, Trusha Mistry, Sarah Hennell, Suganthi Joachim, Stephen Harris, Sam Eggleston, Melanie Morrison, Boon Ang, Natalie Jackson, Nicola Jones, Zena Haslam, Beata Iwanicka, Laura Graham, King Dhar, Melanie Kent, Daniel Wirth, Umakanth Kempanna, Laura Troth, Robert Orme, D. Campbell, Raquel Duarte, Muzaffar Sheik, Robert Maher, Jon Bramall, Rebecca Coates, Tracey Cosier, Sarah Vest, Kajan Kamalanathan, Graeme Foggo, Amanda Mohabir, Ritoo Kapoor, Precious Basvi, Jamie McCanny, Christian Frey, Bruce Emerson, Anantharaman Venkataraman, Karen Burns, Gail Pottinger, Mohamed Elwkhiee, Farkhunda Waqas, Alison Loftus, Amanda Kirrage, Ilma Songaile, Craig Smith, Jo Mullender, Hannah McPhee, Miriam Namih, Linda Gregson, Rachel K. Walker, Iain K. Moppett, Christine Adamson, Katie Flower, Tina Stoycheva, Beena Parker, Caroline Thompson, Kootharajan Kamraj, Vignesh Ashok, Ranjit Gidda, Istvan Koczka, Sadie Perkin, Vandita Ralhan, Arun Sengottaiyans, Ruth Hodgson, Peter Valentine, David Nunn, John Hickman, Molly Waldron, Lauren Elliott, Irene Echaveznaguicni, Lisa Dunlop, Julian Sonksen, Robert Fallon, Huw Griffiths, Thoy Ruth, Olivia Clancy, Lucy Dudgeon, Alicia Rodgers, Pamela Oracki, Phoebe Syme, Maria Newton, Stuart P. D. Gill, Julie Foxton, Jane Perez, Liam Gleeson, Richard Green, Sally Beer, Rohit Juneja, Loretta Barnett, Alex Bonner, Eunice Emeakaroha, Andrew V. Bradley, Ravishankar Jakkala Saibaba, Dipali Verma, J. Joseph Kinsella, Swee Ang Tung, Anju Raina, Verity Calder, Andrea Ortu, Chris Walmsley, Suneal Sharma, Michelle Reichman, Tom Stocks, Annika Smith, Ross Cruikshank, Sharon Storton, Matyas Andorka, Abhishek Kakkar, Allison Daniels, Priya Datar, Nichola Wakeford, Sheila Black, Usman Choudhry, Stephen Hackett, Huw Wilkins, Kirtida Mukherjee, Tim Green, Rebecca Hill, Ishan Dharmarathna, Jennifer Crooks, Serah Mungai, Luisa Howlett, Niveen El-Wahab, Linda Prasad, Amy Sadler, David Sharpley, Daphne Varveris, Victoria Ashton, Rajeev Jeevananthan, Safia Begum, Helen Anderson, Katherine Nahajski, Vanessa Linnett, Laura Morland, Stephen Mowat, Nenette Abano, Kathryn James, Ian Butler, Madelaine Ocampo, D. Williams, Gabriella Frunza, Wendy Deamer, Dominic Espitalier-Noel, Sian Liddle, Jane McConniffe, Anthony E. Pickering, Lisha Aju, Catherine Morgan, Hao Ern Tan, Jemma Tate, Emma Dooks, Anna Moore, Alison Hardwick, Liam Scott, Zak Rob, Rajeev Jha, Sujesh Bansal, Lynda Connor, Seliat Sanusi, Sophie Mason, Nipun Agarwal, James Woodier, Julian Giles, Lauren Collis, Jill Brown, Natalie Constable, Nichola Cahill, Anne Cowley, Mai Wakatsuki, Kelly Mintrim, Glenn Arnold, Donna Doyle, Ryhs Millington, Richard Dobson, Monica Serrano, Saqib Naji, Walid Hammad, Jacob Osbourne-Wylde, David Rollins, Claudia Paoloni, Nathan Anderson, Rachel Ingham, Alison Whitcher, Vicky Hills, Nina Toms, Jon Witby, Amy Nash, Marcus Fletcher, Jane Gibson, Martin Warin, Katherine McDowall, William Malein, Madhurima Das, Wael Abdelrhamen, Tom Neal, Sister Jenny Ritzema, James Collins, Chandana Rao, Joyce Yeung, Nadeem Shakir, Andrea Weigert, Atideb Mitra, Hari Arunachalam, Amy Morgan, Richard J. Jackson, Julie Chadwick, Debbie Callaghan, Frank Swinton, Lorraine Lock, Rahul Wakhle, Krish Kapoor, Ryan Humphries, Sarah Beavis, John-Paul Cutts, Julie Wilson, Keith Kelly, James Gill, Angela Loughlin, Rhys Rhidian, Christopher McGovern, Tom Hickish, Rachel Campbell, James Pennington, James Tozer, Philip Coakley, Lynn Fenner, Sally Tomkins, Lester Ribeiro, Shabir Qadri, Hristina Petkova, Christina Timmons, Katy Smith, Jonathan Perry, Stephen Crotty, Tanmay Patil, Mayavan Abayalingam, Ahmed Foly, Anna Wahed, Lewys Winfield-Young, Naomi Goodwin, Mark Verlander, Clare Donovan, Milena Vannahme, David Helm, Murali Vallabhaneni, Clare Ingram, Neil Moreland, Lorraine Stephenson, Jenny Jackson, Lindsay McOwat, Sathya Visvendra, Rhiannon Jones, Sarah Bird, M. H. Nathanson, Beryl Jones, Claire Davies, Beena David, Ian Sheldrake, Jeremy Guilford, Sister Bryony Storey, Rajeev Mishra, Irina Halfacree, Kiran Rait, Sameer Ahmed, Victoria Poyntz, Pamela Birks, Tom Kennedy, Angiy Michael, Michael McEvoy, Ian Davies, James Chan, Sajjad Ahmed, Laura Sweeney, Anne Whaley, Andrew Moores, Stella Gillies, Gearoid Crosbie, Antoinette Wilson, Iain Walker, Fiona Brailsford, Virginia Solanki, Elizabeth Turnbull, Lyndon Harkett, Sarah Ramsay, Thomas Syratt, Pushpaj Gajendragadkar, Cathal Small, Joanna Poole, Annabelle Whapples, Raghavendran Krishnaiyan, Elizabeth Smee, Richard Pierson, Taslima Rabbi, Alexandra Murphy, Angela Rooney, Sarah Crawford, Peter Bamford, Stephen Worthy, Sarah Munsie, Lucy Venyo, Henry Wang, Aditya Kuravi, Dennis Barnes, Ruth Han, Benjamin Gupta, Nurse Lynn Wren, Robert Hartley, Emma Edmunds, Laura Blood, Valerie J. Page, Thomas Judd, Puvan Suppiah, Emma Jenkins, Kate Gallagher, Fionnuala Lenehen, Rashidat Adeniba, Julius Cranshaw, Julie Wollaston, Kathryn Allison, Richard Kirkdale, Samantha Griffith-Norris, Jenna Kelly, Snehasish Guha, Stefan Schraag, Joy Dearden, Elizabeth Bell, Stephen Smith, Sarah Longhurst, Elizabeth Wilby, Annaliza Sevillano, Raksha Mistry, Aalisha Mariam Karimi, Kaung Pyae, Sarang Puranik, Maggie Collingborn, Karen Cranmer, Chandrashekhar Vaidyanath, M. Chincholkar, Narendra Siddaiah, Gillian Bell, Edward Rintoul, Nicki Devooght-Johnson, Tom Lovejoy, Eleanor Roscoe, Zoe Neilson, Joanne Hill, Kamal Sharif, Sharon Meehan, Bassey Nkanang, Thomas Georgiou, Martin Goodman, Prashant Kakodkar, Rebecca Martin, Philip Roddam, Evanna McEvoy, Peter Tsim, Janakan Anandarajah, Shub Gupta, Oliver Pratt, Yang Ng, Francesca Th'ng, Linda Kent, Graham Soulsby, Danielle Kirk, Ramana Govindaraju, Rebecca McClean, Samantha Harkett, Obaid Tarin, Shalini Chinna, Susan Gallagher, Laura Gardiner, Marc Turnbull, James Briscoe, Anna McSkeane, Melanie Claridge, Gillian Fleming, Thomas Huttley, Elaine Spruce, Lianne Hufton, Susan Hendy, Adrian Barry, Jeremy Drake, Cody Allen, James Hillier, Manju Patel, C. Gray, Nasreen Iqbal, Karen Markwell, Linzi Heaton, Michelle Nicholas, Gary Lau, Laura Catchpole, Nurse Sonia Walia, Kerry Elliott, Jake Hartford-Beynon, Amee Samani, Kathryn King, José William Martínez, Skylar Paulich, Ifan Patchell, Killian McCourt, Rebekah Rodgers, Christine Wood, Richard Wan, Karan Verma, H. W. Cain, Eleonore Quinn, Lisa Richardson, Muhammad Usman Latif, Nicholas Hingley, Rajesh Gilla, Roopa McCrossan, Mayeth Recto, Russell Hedley, Lucy McClelland, Suzie Marriott, Deepak Seharawat, Gururaj Mudimadagu, Claire Jones, Michelle Yare, Sophia Henderson, Rupinder Kaur, Emily Spence, David Wright, Bhaskar Dutta, Tom Pettigrew, Vikki Atkinson, Lorna Sissons, Segun Oladele, Sue Thomas, Hani Ali, Rebecca Robson, David Buckley, Kevin Hamilton, Amanda Hall, Anaesthetic Audit, Anna Watkin, Donna Kelly, Graham White, Sarah Sanders, Henry Boyle, Joao Galente, Thomas Williams, Justin Ang, Sarah Horton, Abdelrahman Soliman, Vijay Jeganath, Kavita Upadhyaya, Plamen Stoyanov, Murray Geddes, Alan Pope, Khaled Ellisy, Thomas Walker, Emma Finlay, Penny Parsons, McDonald Mupudzi, Adam Duffen, James Goodwin, Rob Penson, Laura O'Sullivan, Vinesh Mistry, Ravindra Mallavalli, Krzysztos Guz, Deepti Bhuwanee, Eleanor Andrews, Justine Burns, Sarah Kirk, Faith Kibutu, Sam Stafford, Julia Blackburn, Joellene Mitchell, Robert Spencer, Helen Williams, Karen Riley, Gabbie Young, Tom Williams, James Wu, Emma Wheatley, Alistair Johnstone, Rachel Stoeter, Timothy Cominos, Guy Coady, Ruth Mawhinney, Sam Spinney, ruthy Arumugam, Myura Nagendram, Jason Lie, Sian Hughes, Linda Bairkdar, Peter Evans, Daniel Pygall, Graeme Brown, Susan Livingstone, Norbert Skarbit, Amit Pruthi, Zakaulla Belagodu, Ben Linton-Willoughby, Richard A Cowan, Helena Prady, Mike Raffles, Sonia Rasoli, Katherine Cullen, Jessica Lees, Peter Lax, Ashok Puttapa, Fran Millinchamp, Aneta Oborska, Benita Adams, Kathryn Newton, Mrutyunjaya Rao Rambhatla, Sunny Nayee, Madlena Ivanova Vrazhalska, Jonathan Clarke, Aariana Sohal, Siobhan King, James Bain, Jessica Wilson, Anthony Carver, Jack Davies, Lucy Connolly, Samuel Morrish, Robyn Lee, Lucia Stancombe, Satyanarayan Jakkampudi, Kath Rosedale, Philip Hopkins, Clovis Rau, Katherine Hunter, Amy Farrow, Kathleen Holding, Elizabeth Vassell, Oliver Boney, Julia Icke, Ewa Prusack, Osi Egole, Fiona Linton, Suresh Eapen, Wendy Goddard, Ayda Borjian Boroojeny, Simon J. Davies, Jackie Terry, Fiona Graham, Thomas Pratt, Hanzla Naeem, Viv Colclough, Yeng Yap, Tejuswi Patel, Susan Midgley, Mark MacGregor, Ben Marshall, Talitha Devries, Cheng Ong, Katie Molloy, Kat Walker, Katy Irwin, Abbas Majeed, Mark Pinkerton, Nicki Russell, Sibtain Anwar, Ian A Jenkins, Lucy Allen, Elaine Coulborn, Ganesh Nair, Stewart Brown, Melissa Addy, Matt Milner, Amr Hassan, Victoria Millar, Sarah Turner, Gary Baigel, Amanda Lyle, Simon Young, Kathy Malinovszky, Heather Short, Mary Newmarch, Colin McAdam, Andrew Robert Bailey, Kevin Draper, Michael Agyemang, Kieran Oglesby, Clare Mewies, Ruth Ugochukwu, Shibu Jacob, Susan O'Connell, Charlotte Topham, Xiao Zhao, Shay Willoughby, Ossian Aukland Child, Manish Torne, Ben Wetherell, Divya Veluvolu, Dominic Wu, Elizabeth Evans, Daniel Eden, Suzannah Peggler, Lucy Emmett, Romit Samanta, Ravi Parekh, Jane Hermanowski, Will Shankey-Smith, Sam Papadopoullos, Julie Camsooksai, Sara Mistry, James Wigley, Anna Todd, Bally Purewal, Natalie Baldry, Kate Wilkinson, Aalia Sange, Kirsty Baillie, Joanne Topliffe, Denise McSorland, Saheli Das, Nikki Staines, Catherine Harris, Anna-Marie Boniface, Gemma Milne, Tessa Rowlands, Leanne Quinn, Svetlana Kulikouskaya, Christopher Bull, Angus Sutherland, Mihir Desai, Hannah Goodhand, Meenal Rana, John Bugo, Maria Chazapis, Sarah Kent, Sarah Siew, Marcin Pachucki, Tim Forsyth-Jones, John McKenna, Sarah Driscoll, Laura Hunter, Penny Bedoes, Natasha Santana-Vaz, Sandra Latham, Robert Coe, Sharon Christie, Lawrence R Kidd, Katy Redington, Alastair Sawyer, Abdalla Ali, Rekha Jayapal, Manfred Staber, Emma Pearson, Stuart Reilley, Tom Bird, Kristofor Inkpin, Annette Haines, Manish Verma, Naomi Wee, Ozerah Choudhry, Daniel Tucker, Euan Campbell, Aaron Stokes, Ashley Allan, Emma Reeves, Helen Fenner, Melanie Cockroft, Tom Nicholls, Sinan Bahlool, Sharon Drake, Nalini Sethia, Lesley Jordan, Martin Northey, Paul Glyn Jones, Lara Jeanes, Emma Simpson, Julia Brown, Samantha Coetzee, James Nicholas, Adam Samways, Ritesh Ganesh, Martin Ward Platt, Mizan Khondoker, Helen Wibberley, Lauren Simmonds, Sunita Agarwal, Linda Titinchi, Fran O'Higgins, David Pritchard, Laura Beard, Yvonne Lester, Charlotte Hirst, Louise Wills, Kevin Windsor, Haren Jyothiraj, Carmela Martella, Stephanie Bell, Christopher Nwaefulu, Hemamangala Venkatesh, Camilla Stagg, Soumi Ghosh, Thomas Dawes, Jennifer Lockhart, Stavros Papadopoulos, Nanci Doyle, Gillian Whalley, Rachael Britton, James Goddin, Maggie Dawson, Carole Holder, Elaine Morsman, Rachel Lovatt, Venu Mehta, John J.B. Allen, Anna Perham, Stephanie Wallis, Dmitry Zabauski, Peter Hart, Tracy Sharp, Martin Pope, Jo Knight, Jane Wright, Nageena Hussain, Josie Snell, Thomas Knight, Philippa Hill, Nic Martins, Robin Williams, Beverley Stidolph, Beth Peers, Brian Lafferty, Alicja A'Court, Joanna Collins, Charlie Kennedy, Andy Bates, Graham Walkden, Mia Marsden, Lauren Shillito, Poonam Bopanna, Raheel Ahmed, Ada Ezihe-Ejiofor, Kate Driver, Mevan Gooneratne, Carolyn Smith, Caroline Abernethy, Kathy Shammas, Chanice Alcock, Yin Yong Choo, Mark Vertue, Ratna Makker, Victoria C. Smith, Sachin Mehta, Clare Denford, Wint Mon, Jose Miguel Sabugueiro, Liz Varghese, Mohamed Ahmed, Rebekah Chan, Alexandra Williams, Stephanie Pauling, Maria Faulkner, Ryan Wilkins, Sara Stevenson, Kathryn Simpson, Moiz Alibhai, Patricia Williams, Pascal Defeyter, Siva Sangaralingham, Lucy Evans, Shirley Cocks, Simon Dyer, William Rea, Caroline Renton, Karl Braid, Ranjit Bains, Holly Owen, Sue Brixey, Calum Taylor, Laura Coleman, Andrew Peeling, Daniel Solomon, Christopher Perman, Roisin McCallum, Helen Church, Martin Watson, Amy Bamford, Elizabeth Bradshaw, Elizabeth Turner, Owen Vale, Suneetha Ramani Moonesinghe, Preeti Mahidik, Lynsey Cubitt, Catherine Hunter, Eleanor Warwick, Sam McAleer, Suresh Singaravelu, James Hilton, Rebecca Aspinall, Icel Souleimanova, Muna Elsheikh Idris, Wei Teo, Sarah El-Sheika, Adrienne Stewart, Sadia Habib, Emily Wade, Liesl Despy, Sharmin Shohelly, Colin Williams, Louise Shaw, Shree Voralia, Dafydd Lloyd, Barbara A. Crooks, Laura D Howe, Una Gunter, Edward Hare, Louise Nimako, Ruth Young, Helen Doherty, Sock Huang Koh, Stephen Merron, Martina Coulding, Agilan Kaliappan, Clare Bolton-Hill, Jill Wain, Maria O'Callaghan, Catherine Cartmell, Nicola Pemberton, Hannah Bennett, Lynda Garcia, Riquella Abbott, Sally Jeffrey, Thomas McLoughlin, Andrew Gratrix, Christopher Harrison, Matt Mackenzie, Jayshree Gracey, Chris Moore, Benjamin Parsons, Nehal Patel, Stephanie Brooks, Catherine Riley, Jemma Gilmore, Ilya Kantsedikas, Simon Whiteley, Emily Pallister, Angie Organ, Yohinee Rajendran, Gopinath Selvraj, Priya Thorat, Ilona Schmidt, Pauline Austin, Nitin Madhukar Sadavarte, James Haddock, Alastair Duncan, Richard Bateman, Elaine Chinery, Martin Gray, Felicity Corcoran, Shanelle Tharuka Wijesuria, Bryany Bond, Charlene Otieno, Sion Lewis, Cieron Roe, Dan Freshwater-Turner, Annette Bolger, Sarah Steynberg, Louie Saclot, Charlotte Busby, Jack Roberts, Richard Dagnan, Jasna Comara, Krishnakar Melachuri, Sian Gibson, Joanne Taylor, Manju Agarwal, Mark Sheils, Matthew Bell, Rosemary Anna Lewis, Kiran Patel, Mansoor Siddiqui, Christopher J. Groves, Mini Thankachen, Sharon Turney, Viral Dalal, Pele Banugo, Andrew Baird, Euan Kerr, Simon Tomlins, Laura Osbourne, Nicola Pattison, Stuart Joy, Susan Merotra, Lorna Ryan, Lisa-Jayne Cottam, Chye Siaw, Keelan Jerram, Nurse Diane Scarletta, Carole Paley, Jennie Smith, Will Gatfield, Stephen Alderson, Claire Swarbrick, Amelia van Manen, Stephan Clements, Sophia Strong-Sheldrake, Jake Drinkwater, John McLenachan, Lucinda Williams, Dianne Heaton, Sandor Orosz, Chloe O'Hara, Nina Barratt, Justine Elliot, Michael Gardner, Nicola Crowther, Bharati Rajdev, Linda Hall, Youssef Girgis, Michael Kinsella, Alison Potter, Matthew Martin, Rosie Reece-Anthony, Richard Pugh, Tracey Taylor, Esme Marshall, Wendy Stoker, Helen Worrell, Kay Housley, Rebecca Leslie, Helen Jewitt, Sandeep Sharma, Maire Gallagher, Jon Fenn, Jade Harrison, Hannah Watson, Natalie Morris, Lewis Schofield, Nisha Pattni, Charlotte Thomas, Eleanor Walshe, Richard Snooks, Ruth Murphy, Emily Pickford, Gnanshree Krishnamurthy, Donna McIntosh, Rachel Dolan, Emma Stoddard, Kelly Goffin, Shady Elhallous, Adrian Butler, Ildiko Nemeth, Hannah Wilson, James Sylvester, Melanie Sahni, James Wardlow, Ann Lachana, Emma Barr, Kayleigh Gilbert, Yazzim Hammoud, Peter Csabi, Maqsood Bajwa, James D Turner, Alex Hunt, Samantha Moore, Stephanie Hii, Philip Atkinson, Michelle Walter, Elizabeth Bailey, Frances Tait, Annie Newby, Jane Martin, Greg Forshaw, Bert Quartermain, Sally Humphreys, Aoife Hegarty, Caroline Bennett, Satyajeet Ghatge, Charles Prior, Kribashnie Nundlall, Priaykam Chowdhury, Jill Fitchett, Daiva Bernotaitis, Sandeep Varma, Alex Dunn, Rebecca Dooley, Mahamed Mostafa, Shelly Wood, James Humphreys, Anna Celnik, John Bailes, Mark Snazelle, Christina McCarroll, Matthew Govier, Emert White, Matthew Taylor, Alastair Rose, Brigid Hairsine, Natalie Whybro, Allen George, Robin Wilson, Filipe Vieira, Leon Cohen, Jonathan Womack, Thomas Woodward, Nimali Lochanie, Ben Howes, Joshua Nelson, Preea Gill, Gayle Clifford, Lushani Suntharanathan, Duncan Wagstaff, Steve Pryn, Lalindra Bandara, Sneh Shah, Nowfal Rahman, Iolo Roberts, Mirriam Sangombe, Shaik Subhani, Hannah Phelan, William Udall, Katy Allan, Nicola Zondo, Tim J Peters, James Roe, Catherine Addleton, Angus McKnight, James McCaul, Flora Kormendy, Anil Rao, Luke Vamplew, Andrew Rees, Jeanette Gilbert, Mandy Austin, Thomas Hunt, Sian Birch, Catherine Lloyd, Stewart D'Sylva, Jill Smith, Wendy Lum Hee, Michael Munro, Jean Denton, Julia Hindle, Alice Brown, Ursula Kirwan, Dinithi Yogya, Maria Mclaughlin, Nurse Louise Moran, Larysa Duniec, Sophie Benoliel, Gail Evans, Linda Bailey, Colin Hall, Katie Rowland, Krupali Patel, Ashwini Keshkamat, Zorba Begum, Resti Varquez, Victoria Apps, Giles Bond-Smith, Shirin Dastur, Andy Chapman, Amy Smith, Sarada Gurung, Ruth Delascasas, Nicole Issit, Pauline Sibley, Jaina Parmar, George Madden, Eveliina Nurmi, Katja van de Snepscheut-Jones, Louise Peacock, Vanja Srbljak, Kellie Allen, Andy Chamberlain, Suhail Zaidi, Andrew Boyle, Daniel Stolady, Rita Saha, Mark Clayton, Mitul Patel, Emily King, Hannah Oliver, Ewa Werpachowska, Holly Coles, John Dereix, Agnieszka Kubisz-Pudelko, Clare Watkinson, David Rogerson, Laurence Inman, Jaspreet Rayet, Jenny Finch, Emma Stewart, K. E. Wilson, Emma Tyson, Asif Gani, Reni Jacob, Neil Smith, Johnny Holland, Max Richardson, Mark Chen, Richard George, Helen Laycock, Anoushka Winton, Emily Hignell, Li Fang, Emma Welfare, Rochelle Velho, Fayaz Baba, Finbar O'Sullivan, Lisa Zeidan, N. Beauchamp, Neil Rasburn, Guy Rousseau, Victoria Roberts, Hollie Bancroft, Holly Maguire, Mechele Couch-Upite, Rahul Kumar, Chandra Bhimarasetty, Matt Lovell, Sujata Anipindi, Charlotte Small, Matthew Faulds, Alex Mattin, Alice O'Donnell, James Jack, Richard Boulding, Tarek Mostafa, Rhian Bull, Corinne Pawley, Ruth Killen, Jessica Lowe, Frances Taylor, Ethel Black, Michael F. M. James, Jenny Child, Lisa Emery, Kim Hoyland, David Hay, Janet Cotta, Josephine Stewart, Sue Spearritt, Laura MacNally, Fatma Lahloub, Katie Welham, Sanjoy Bhattacharyya, Shanteela McCooty, Heena Bidd, Hugo Buckley, Ervin Shpuza, Zaid Ahmed, Emily Craven, Amanda Cook, Caroline Dixon, Tara Pauley, Tariq Azad, Helena Barcraft-Barnes, Sindy Lee, Kate Penhaligon, Bernice Dudkowsky, Karen Ellis, Laura Montague, Ching Pang, Elsie Bickmore, Veronica Marsh, Toby Winterbottom, Marta Campbell, Rhys Hughes, Issie Gardner, Elizabeth Steel, Ramai Santhirapala, Katie Sweet, Michelle Scott, John Ekpa, Bhavia Janardhana, Catriona Frankling, Julia Ottaway, Alexander Middleditch, Elna Cifre, Annabel Pearson, Amanda Cotterill, Sarah Raut, Hannah Blanshard, Sara Eddy, Garry Henry, Elizabeth Hood, Maria Loy, Matthew Campbell, Marc Gimenez, Jessica Thrush, Jeremy Henning, Vlad Kushakavsky, Nikolaos Makris, Deborah Fradkin, Karen Fan, Fiona Hammonds, Kathryn Jackson, John Hadfield, Pyda Venkatesh, David Read, Daniel Zeinali, Ryan Hynd, James Carvell, Richard McCormick, Emily Dodds, Sana Rizvi, Amelia Daniel, Dan Sellers, Thomas E. Miller, Daniel Haigh, Nicky Moss, Patrick Dill-Russell, Priya Shekar, Teresa Melody, Randeep Dhaliwal, Nigel Hollister, Andrew Burtenshaw, Adrian Wagstaff, Ben Scoones, Eduardo Osorio, Joanna Allison, Lucy Willsher, Carol McArthur, Stephan Dalchow, Elaine Winkley, Eleanor Reeves, Ben Eden Green, Andrea Ingham, Mohammad Auldin, Freda Amoakwa-Adu, Jonathan Adams, Fiona Oglesby, Charlotte Steeds, Nurse Sara Greig, Obla Suganthi, Puja Chhaniyara, Clare De'Ath, Chandrakant Gosavi, Bart Ordys, Adele Flowerdew, Doug Tunney, Rachel Alexander, Oliver Griffith, Thomas Saunders, Matthew Maton-Howarth, Gabi Metiu, Akmal Shakoor, Elizabeth Willard, Katherine Russell, Matthew Robinson, Emma O'Kane, Meera Raja, Phillippa Falkner, Kerry Colling, Natasha Joshi, Laura Pearse, Tim J. Smith, Anitha James, Mona Mohamed, Richard Kennedy, Samson Ma, Tasmeen Ghafoor, Matthew N. Davies, Henry Lewith, Samuel Mindel, Sarah-Jane Dunn, Hemangini Barot, Sadie Diamond-Fox, Jenny Macallan, Arun Menon, Helen Farrah, Emma Plunkett, Brendon Spooner, Sorana White, Katie Samuel, David Crabtree, Katherine Cheshire, Gareth Harrop, Dionne Wortley, Tim Warrener, Joanne Mullen, Peter Taysum, John Whitaker, Kathy Wilkinson, Jean Dent, Nicola Farmer, Thelma Darian, Guru Hosdurga, Phillipa Wakefield, Christopher W Horner, Julie Steen, Elena Teh, Helen Gerrish, Betty Travasso, Mhairi Jhugursing, Michelle Gardener, Alexandra Crook, Edward W. Miles, Patricia Doble, Ashok Raj, Hanna Wong, Kay Protheroe, Chiraag Talati, Banher Sandhu, Cara Marshall, Matt Holl, Julie Sheriff, Frances Forrest, Adam Mitchell, Hindusha Keerthikumar, Mohamad Mahmoud, Simon Ben-Nathan, Janice Hartley, Danielle Ormandy, Hayleigh Morris, Steven Tran, Imogen Hayes, Trudy Smith, Kirsty Duell, Jennifer Cunningham, Richard Appleton, Lucy Pippard, Debroah Beeby, Hayley Bridger, Manuel Pinto, Susan Beames, Huiqi Wang, Cain Hunter, Flora Darch, Debbie Weller, Jonathan Hulme, Jacqueline Howes, Michael Kriger, Badrinath Manikundalam, D.J.N. Wong, Tim Arnold, Belinda Wroath, Rachel McKendry, Harry Knight, Caroline Bushell, Victoria Siddons, Louise Humphries, Joanne Vere, Vinanti Cherian, Janine Birch, Kate Blyth, Tatyana Bolonenkova, Meredith Harris, Alice Sisson, Sarah Clark, Sandeep Saxena, Samira Green, Amit Ranjan, Gillian Bennett, Chris Smales, Laura Ferguson, Ash Bharti, Francisca Mautadin, Katherine Brown, Lydia Jones, Christopher Adeney, Nikkita Carden, Sanjay Behl, Sonia Sathe, Elizabeth Neale, Helen French, Charlotte Mundy, Anna Batchelor, David Morris, Nithin Roy, Evelyn Philip, P.A.-A. Marc Hastie, Andrea Cole, Edmund Quak, Claire Totten, Karen McIntosh, Fiona Davis, Søren Kudsk-Iversen, Vanessa Unsworth, Andrew McIndoe, Jeremy Bewley, Sarbpreet Sarao, Laura Wood, Elaine Walker, Egidio Da Silva, Danielle Gilmour, Richard Yardley, Zara Eagle, Vijay Ragothaman, Sean Rayappu, Moira Tait, Alex Hamilton, Chris Gillett, Adeel Majeed, John Elton, Arlo Whitehouse, Fiona Robertson, Tim Martindale, Kin So, Kathryn Dixon, Toby Shipway, Fiona Mcneela, Simon Cousins, Brian Conway, Merate Place, Phil Duggleby, Rhian Morgan, Racquel Carpio, Carina Casey, Edward Mew, Jo Han Gan, Caroline Clark, Natasha Sharma, Kay Anne Mak, Gahan Bose, Chris Ford, Ruoling Yan, Anand Sathiapillai, Panagiotis Sgardelis, Sue Redhead, Arjun Alva, Cathy Jones, Vincent Hamlyn, Gemma Squires, Karen Smallshaw, John Whitwell, Sarah Shaw, Paul Watson, Michelle Cheeseman, Kimberley Netherton, Juneenath Karattuparambil, Niyesa Ranasinghe, Jeet Patel, Rob Lyons, Gemma Bown, Helen Bromhead, Zhana Ignatova, Kudakwashe Nyangoni, Linden Baxter, Thomas Moody, Sachin Valap, Esme Sleap, Mario Fernandes, Kinga Bodo, Jane Silk, Charlie Pope, Donna Ferraioli, Chloe Billingham, Rachel Butterworth, Andrew Kelly, Lesley Hawkins, Issac Gill, Hannah Greenlee, Sue Kirby, Jessica Giles, Anna Pierson, Roxana Sandhar, Claire Smyth, Rhona Younger, Ciara Coary, Arif Qureshi, Tahir Abbas, Corinne Rimmer, James Evans, Ida Ponce, Fenner Christoper, Buzz Shephard, Sophie Tang, Lauren Milian, Joanne Hiden, Dhania Haron, Jamie Calderwood, David Freeman, Virginia McTaggart, Carla Lewis, Chai Obeysekera, Alan H. Cohen, Melvin Leong, Jenni Law, Noor Elahi, Kim Holland, Victor Maduekwe, James Garwood, Lizzie Dawson, Virginia Iqbal, Thomas J Craig, Daniel Shuttleworth, Anand Perumal, Mahmood Saad, Seema Charters, Bethany Tookey, P Gunning, Suresh Panchakshariah, I.J. Wrench, Mayur Murali, Susan McInerney, Paul Foley, Charlotte Perkins, Marie-Louise Svensson, Karen Birnie, Samantha Hagan, Emily Hetherington, Anna-Marie Love, Annette Woods, Karen Green, Steve Hillier, Hannah Conway, Rebecca Reilly, Laura Bubb, Amy Ashford, Andrew Savva, Melody MacGregor, Stephen Lord, Ahmed Hassanin, Ramdas Howard, Laura Ashton, Arihant Jain, Simon Williams, Michael Shaw, Jill Deane, Abbie Singleton, Catriona Routley, Christopher Hall, Robin Webber, Tressy Pitt-Kerby, Stuart M. White, Shannon Gawley, Nick Heseltine, Christina Lalani, Claudia Dulea, Arindam Biswas, Rebecca Harris, Aislinn Brown, Nicholas Francis, Ben Holst, Ryan Perry, Cathie Melvin, Mark Darbyshire, Stephen Mulvany, Amy Ashton, Petrus Fourie, Emma Temlett, Jason Cupitt, Vanisha Patel, Alice Trimble, Andrew Brammar, Sarah Grayland, Eleanor Pett, Tom Standley, Carly Webb, Manamohan Rangaiah, Laura Peltola, Leanne Darwin, Yvonne Grimes, Elizabeth Brodier, Scott Berwick, Adam Janeczko, Madeleine McKee, Katherine Davidson, Jan Woodward, Saurabh Mehotra, Tara Keogh, Kofi Mensah, Joyce Guy, James King, Matt Aldridge, Nicolas Price, Alaine Done, Teresa Jones, Julia Sampson, Smita Bapat, Lauren Perkins, Tamas Szelei, Ryan Kingan, Suleman Mulla, Celia Montgomery, Alex Belcher, Salma Kadiri, Bryan Singizi, Peter Chater-Lea, Jennifer Claire Taylor, Lauren Oswald, Stephanie L. Lee, Rhys Griffiths, Samuel Pestell, John Livesy, Sarah Ciechanowicz, Alexander Stephen Harrison, Richard Partridge, Alex Daniels, Beth Penhaligan, Lyndsay Bibb, Jonathan Little, Margaret Cullen, Anya Eijk, Charlotte Earnshaw, Elena Lynes, Nicholas Jenkins, Inthekab Mohammed Ali, Madhu Balasubramaniam, Vusumuzi Shabangu, Paul-Simon Whitney, Rebecca Denyer, Kathryn Potts, Andrew Ray, Jonny Guy, Mike (Stephen) Kinsella, Pearl Baker, Olga Fernandez, Julian Berry, Callum Forbes, Southcoast Peri-operative Audit, Rebecca Rice, Lisa Horner, Sally Pitts, Kirat Panesar, Joe Stevens, Timothy Molitor, Oon Chiu, Piers Murphy, Sudeshkumar Muniyappa, David George, Jonathan Veitch, Shifa Yaruk, Lynn O'Donohoe, Theresa Murray, Laura Tasker, Johanna Wales, Diane Mellers, Robert Sparrow, Olivia Ward, Emma Shacklock, Janet Middle, Sarah MacLennan, Martin Knight, Lindsay Dawson, Teodora Orasanu, Jo Fletcher, Sarah Martin, Pnt Laloë, Gregor Imrie, Harriet Pudge, Tamsin Gregory, Andrea Wood, Colin Christie, James Penketh, Mia Andrews, Nicky Ford, Ellie Fisher, Sophie Robin, Richard Stewart, Steve Williams, Harriet Gardiner, Alison Evans, Guanmei Luo, Urmila Ratnasabapathy, Ruth Joslyn, R. Sneyd, John Westwood, Naomi Cassells, Olivia Kay, Jordi Margalef, S Butler, Hari Nageswaran, Chloe Searles, Geoffrey Wright, Thomas Potter, Drew Norwood-Green, Jonathan Ramsden, Sarah Bean, Emma Sadler, Anaesthetic Trainees, Stephanie Lewis, Kevin E. Thorpe, Sarah MacLean, Paul Ogle, Mary O'Sullivan, Diane Whitehouse, Mandy Oakley, Rachel Coathup, Harisg Venkatesh, Lisa Burgess, Daniela Smith, Kimberley Plummer, Hilary Robb, Jeanette Grocott, Rebecca Mairs, Helen Gilfillan, Moira Morrison, Sharon Garner, and Tammy Towers
Subjects: Adult, medicine.medical_specialty, Adolescent, State Medicine, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, 030202 anesthesiology, Pregnancy, Risk Factors, Neoplasms, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Young adult, Prospective cohort study, health care economics and organizations, Aged, Aged, 80 and over, Health Facility Size, Postoperative Care, Models, Statistical, business.industry, Incidence (epidemiology), Incidence, Health services research, Operating room management, Odds ratio, Middle Aged, Confidence interval, United Kingdom, Surgery, Obstetrics, Anesthesiology and Pain Medicine, Hospital Bed Capacity, General Surgery, Female, business, Emergency Service, Hospital, human activities, Cohort study
Abstract: Background: cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. Methods: we conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity. Results: we analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12–4.02; PConclusions: a significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.
Published: 2018

40. Historical Development of Biofuels

Author: Ashwani Kumar and Sunita Agarwal
Subjects: business.industry, 020209 energy, Fossil fuel, Biomass, 04 agricultural and veterinary sciences, 02 engineering and technology, Energy security, Renewable energy, Waste-to-energy, Environmental protection, Biofuel, Bioenergy, 040103 agronomy & agriculture, 0202 electrical engineering, electronic engineering, information engineering, 0401 agriculture, forestry, and fisheries, Environmental science, business, Energy source
Abstract: Biofuel, also called as agrofuel, is derived from biomass and may exist in solid, liquid, or gaseous form. The use of waste biomass to generate energy may reduce waste management problems like pollution, greenhouse gas emissions, and the use of limited amount of fossil fuels. Unlike fossil fuels, biofuels are a renewable energy source. Because they are derived from crops that can be harvested annually, or in the case of algae monthly, biofuels are theoretically unlimited. There is a potential for bioenergy obtained from waste to decrease the speed of global warming. Biofuels have emerged as an ideal choice to meet these requirements. Huge investments in research and subsidies for production are being done in most of the developed countries. The choice of raw material for biofuel production ranges from molasses for bioethanol and nonedible oil for biodiesel depending on nations. Global initiatives started in 1970s with pioneer work by Melvin Calvin in the United States, D.O. Hall in King’s College London, Stewart in CSIRO, Australia, and Prof. Sato and Yamada were some leading groups to undertake biofuel work. Melvin Calvin inspired us (AK and team) to take work on laticifers in Rajasthan. We were among the pioneers to start work on biofuels in Rajasthan with support from Department of Non Conventional Energy Sources (DNES) Govt of India in early 1980’s. Initial researches were confined to discover candidate crop species, the agrotechnological zones in which they might be grown and predicted yields. Cost of production of feedstock was assessed in relation to cost of alternative crops such as wheat and grain sorghum in southern and eastern Australia. At present, governments have initiated the use of alternative sources of energy for ensuring energy security, generating employment, and mitigating CO2 emissions. Attempts were also made to produce energy from waste. One waste management strategy is anaerobic digestion. In anaerobic digestion, any sort of biomass can be utilized. This waste breaks down and gives rise to methane. This methane is harvested and burned to create heat and power to run some automobiles and vehicles.
Published: 2018
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41. Metformin Targets Mitochondrial Glycerophosphate Dehydrogenase to Control Rate of Oxidative Phosphorylation and Growth of Thyroid Cancer

Author: Shilpa, Thakur, Brianna, Daley, Kelli, Gaskins, Vasyl V, Vasko, Myriem, Boufraqech, Dhaval, Patel, Carole, Sourbier, Jeff, Reece, Sheue-Yann, Cheng, Electron, Kebebew, Sunita, Agarwal, and Joanna, Klubo-Gwiezdzinska
Subjects: Mice, Cell Line, Tumor, Animals, Heterografts, Humans, Glycerolphosphate Dehydrogenase, Thyroid Neoplasms, Glycolysis, Metformin, Oxidative Phosphorylation, Cell Proliferation, Mitochondria
Published: 2017

42. Newborn Hearing Screening: Time to Act!

Author: Shitanshu Sharma, Surendra Singh Baghel, Sunita Agarwal, and Ramchander Bishnoi
Subjects: Pediatrics, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Hearing loss, Hospital based, Tympanometry, Hearing screening, 03 medical and health sciences, 0302 clinical medicine, Risk groups, Otorhinolaryngology, 030225 pediatrics, otorhinolaryngologic diseases, Medicine, Surgery, Observational study, Original Article, 030212 general & internal medicine, medicine.symptom, Audiometry, business
Abstract: The present study was carried out with the aim of assessing the outcomes of otoacoustic hearing screening in newborns coupled with the three stage protocol. It was a hospital based observational study which was conducted over a time period of twelve months at a tertiary care institute to screen 2000 live neonates for congenital hearing impairment using OAE, followed up by tympanometry and BERA, if required. 2000 neonates were screened for hearing impairment. 406 were in high risk group and the rest in non-high risk group. Seven neonates had absent V wave on BERA. Five of them were high risk babies and the rest two were non-high risk ones. In order to ensure that early detection and effective intervention are possible for all neonates with hearing impairment, UNHS should be performed. Three stage UNHS protocol using OAE and BERA showed that the implementation of UNHS for congenital childhood hearing loss for all neonates would be beneficial.
Published: 2017

43. NEW RESOURCES OF TEACHING: BLOG WRITING AS A PEDAGOGICAL TOOL

Author: Sunita Agarwal
Subjects: Class (computer programming), Asynchronous communication, business.industry, Dynamics (music), Process (engineering), Pedagogy, Teaching writing, ComputingMilieux_COMPUTERSANDEDUCATION, The Internet, business, Collaborative pedagogy, Psychology, Qualitative research
Abstract: The paper will investigate efficacy and problems of using new internet linguistic resources especially Blog writing as a pedagogical tool for teaching writing skill to Indian students of M.A. First semester of (English Literature). A qualitative research will be undertaken to explore success/drawbacks of this learning/teaching tool to enhance their English writing skill. A group of 50 students of the above mentioned class will be registered on a Blog platform shared by teacher and students to facilitate continuous interaction, assessment, and evaluation. In this kind of teaching, learning will take place synchronously and asynchronously allowing teacher and learners to get engaged in an academic discussion. As this collaborative pedagogy promotes a different type of communicative dynamics, students feel free to share, comment and compliment and the feedback provided by the teachers prove motivating to the students for improvement. The case study will interrogate the applicability of this collaborating blog pedagogy in enhancing the learning process and find out the relationship between blogging behavior, learning outcomes and academic performance?
Published: 2017
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44. Vermiculture for Organic Horticulture: Producing Chemical-Free, Nutritive & Health Protective Foods by Earthworms

Author: George Hahn, Sunita Agarwal, Rajiv Kumar Sinha, Binod Shankar, and Brijalkumar K. Soni
Subjects: Agrochemical, business.industry, fungi, Earthworm, General Engineering, food and beverages, Organic horticulture, Pesticide, Biology, engineering.material, biology.organism_classification, Humus, Agronomy, Soil water, engineering, General Earth and Planetary Sciences, Soil fertility, business, Vermicompost, General Environmental Science
Abstract: Earthworms have fed the world as ‘farm managers’ since mankind arrived on earth. Earthworm's vermicompost is scientifically proving to be an ‘extraordinary powerful growth promoters and protectors’ for crops (5-7 times over other bulky organic fertilizers and 20-40 % higher over chemical fertilizers). They are rich in NKP, micronutrients, beneficial soil microbes like ‘nitrogen-fixing’ and ‘phosphate solubilizing’ bacteria, ‘mycorrhizal fungi’, humus and growth hormones – auxins, gibberlins and cytokinins. It has very high ‘porosity’, ‘aeration’, ‘drainage’ and ‘water holding capacity’. It also protects plants against various pests and diseases either by suppressing or repelling them or by inducing biological resistance in plants. ‘Vermiwash’ (liquid from the body of worms) and the ‘vermicompost tea’ (solution of vermicompost) also work as very ‘powerful bio-pesticides’ eliminating the use of toxic chemical pesticides. Presence of live earthworms in soils has been found to significantly influence the development of quality of fruits in vegetable and fruit crops. Earthworms and vermicompost can boost horticultural production without agrochemicals. It will provide several social, economic and environmental benefits to the society by way of producing ‘chemical-free’ safe, ‘nutritive and health protective’ (rich in minerals and antioxidants) foods (even against some forms of cancers) for the people; salvaging human wastes and replacing the dangerous ‘agrochemicals’ from the face of earth. Use of vermicompost in farms also ‘sequester’ huge amounts of atmospheric carbon (assimilated by green plants during photosynthesis) and bury them back into the soil improving the soil fertility, preventing erosion or compaction and also reducing greenhouse gas and mitigating global warming.
Published: 2013
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45. Safety and efficacy of gas-forced infusion (air pump) in coaxial phacoemulsification

Author: Sunita Agarwal, Gaurav Prakash, Smita Narasimhan, Amar Agarwal, Prashaant Chaudhry, and Soosan Jacob
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Visual Acuity, Cell Count, Surgical time, Postoperative Complications, medicine, Humans, Prospective Studies, Infusion Pumps, Aged, Phacoemulsification, Equipment Safety, business.industry, Endothelium, Corneal, Middle Aged, Sensory Systems, Surgery, Ophthalmology, Treatment Outcome, Infusion group, Anesthesia, SPECULAR MICROSCOPY, Female, Visual gain, Coaxial, business, Perfusion, Fluid volume
Abstract: Purpose To evaluate the safety and efficacy of gas-forced infusion (air pump) in uncomplicated coaxial phacoemulsification. Setting Dr. Agarwal's Eye Hospital, Chennai, India. Design Comparative case series. Methods Specular microscopy and optical coherence tomography were used to analyze the endothelium, central macular thickness (CMT), and peripapillary retinal nerve fiber layer (RNFL) thickness before and approximately 1, 7, 30, and 90 days after coaxial phacoemulsification with (infusion group) or without (control group) gas-forced infusion. Surgical time, surge, phaco energy, irrigation fluid volume, surgical ease, complications, and visual gain in the 2 groups were compared. Results The mean endothelial cell loss was lower in the infusion group than in the control group (6.98% ± 8.46% [SD] versus 10.54% ± 11.24%; P = .045) and the irrigation/aspiration time significantly shorter (54 ± 39 seconds versus 105 ± 84 seconds; P = .0001). The surgery was rated as easier with gas-forced infusion (scale 1 to 10: mean 8.3 ± 2.1 versus 6.6 ± 1.6; P = .00002). However, the amount of irrigating fluid volume was higher in the infusion group (117 ± 37 mL versus 94 ± 41 mL; P = .003). No surge occurred in the infusion group; it occurred a mean of 3.00 ± 4.16 times in the control group ( P Conclusion Gas-forced infusion was safe and effective in controlling surge and increased the safety, ease, and speed of coaxial phacoemulsification. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.
Published: 2010
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46. Vermiculture Technology: Reviving the Dreams of Sir Charles Darwin for Scientific Use of Earthworms in Sustainable Development Programs

Author: Sunita Agarwal, Brijal Kiranbhai Soni, Krunal Chauhan, Rajiv Kumar Sinha, and Vinod Chandran
Subjects: Industrial wastewater treatment, Sustainable development, Waste management, Wastewater, Compost, Environmental remediation, engineering, Environmental science, Sewage treatment, engineering.material, Raw material, Vermicompost
Abstract: Vermiculture technology is emerging as an “environmentally sustainable”, “economically viable” and “socially acceptable” technology all over the world. 1) Vermi-composting Technology (to manage most organic wastes); 2) Vermi-filtration Technology (to treat municipal & several industrial wastewater); 3) Vermi- remediation Technology (to treat & clean up contaminated lands); 4) Vermi-agro-production Technology (to produce chemical-free organic foods by worms & vermicompost); 5) Vermi-industrial Production Technology (to produce valuable industrial raw materials from worms). The use of earthworms as “waste managers” for efficient “composting of food and farm wastes” and as “soil managers” for “fertility improvement” and enhanced “farm production” were known for ages but now it is being more scientifically and also commercially revived. The other uses of earthworms for the benefits of environment and society (wastewater treatment, land remediation & production of valuable medicines even to combat cancer and heart diseases; raw materials for rubber, lubricant, soap, detergent & cosmetic, industries and protein rich feed materials for fishery, dairy & poultry industries are some “new discoveries”. We have successfully experimented with the first four technologies for management of “municipal solid wastes”, treatment of “municipal & industrial wastewater”, remediation of “PAHs contaminated soils” and production of “wheat & corn crops” by use of vermicompost at Griffith University, Australia, with excellent results. Wastes are degraded by over 75% faster than conventional systems and compost produced are disinfected, detoxified, richer in nutrients & beneficial soil microbes; BOD loads & TSS of wastewater is reduced by over 95%; PAHs from contaminated soils are removed by over 80% in just 12 weeks; and crops growths are promoted by 30-40% higher as compared to chemical fertilizers. Earthworms are both “protective” & “productive” for environment and society.
Published: 2010
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47. Wavefront- and topography-guided ablation in myopic eyes using Zyoptix

Author: Asish Doshi, Nilesh Kanjani, Soosan Jacob, Athiya Agarwal, Sunita Agarwal, Tahira Agarwal, Sonika Doshi, and Amar Agarwal
Subjects: Refractive error, medicine.medical_specialty, Visual acuity, genetic structures, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Eye disease, LASIK, Keratomileusis, medicine.disease, Corneal topography, eye diseases, Sensory Systems, Vision disorder, Ophthalmology, Medicine, Surgery, sense organs, medicine.symptom, business, Dioptre
Abstract: Purpose: To evaluate the results of wavefront- and topography-guided ablation in myopic eyes using Zyoptix (Bausch & Lomb). Setting: Eye Research Center and Dr. Agarwal's Eye Hospital, Chennai, India. Methods: This observational case study comprised 150 eyes with myopia and compound myopic astigmatism. Preoperatively, the patients had corneal topography with Orbscan® IIz (Bausch & Lomb) and wavefront analysis with the Zywave® aberrometer (Bausch & Lomb) in addition to the routine workup before laser in situ keratomileusis (LASIK). The results were assimilated using Zylink® software (Bausch & Lomb), and a customized treatment plan was formulated. Laser in situ keratomileusis was performed with the Technolas® 217 system (Bausch & Lomb). The patients were followed for at least 6 months. Results: The mean preoperative best corrected visual acuity (BCVA) (in decimal equivalent) was 0.83 (20/25) ± 0.18 (SD) (range 0.33 to 1.00) and the mean postoperative (6 months) BCVA, 1.00 (20/20) ± 0.23 (range 0.33 to 1.50). Three eyes (2%) lost 2 or more lines of best spectacle-corrected visual acuity. The safety index was 1.20. The mean preoperative uncorrected visual acuity (UCVA) was 0.06 (20/350) ± 0.02 (range 0.01 to 0.50) and the mean postoperative UCVA, 0.88 (20/25) ± 0.36 (range 0.08 to 1.50). The efficacy index was 14.66. The mean preoperative spherical equivalent (SE) was −5.25 ± 1.68 diopters (D) (range −0.87 to −15.00 D) and the mean postoperative SE (6 months), −0.36 ± 0.931 D (range −4.25 to +1.25 D). At 6 months, the UCVA was 1.00 (6/6) or better in 105 eyes (69.93%) and 0.5 (6/12) or better in 126 eyes (83.91%). The postoperative aberrations were decreased compared with the preoperative aberrations. One eye (0.66%) had a free cap during LASIK with subsequent loss of 2 lines of BCVA and induced higher-order aberrations (HOAs). Nine patients (11.2%) complained of halos at night. Conclusions: Wavefront- and topography-guided LASIK leads to improve visual performance by decreasing HOAs. Scotopic visual complaints may be reduced with this method.
Published: 2004
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48. Clear lens extraction with intraocular lens implantation for hyperopia

Author: Amar Agarwal, Jaiveer Agarwal, Athiya Agarwal, Parul Goel, Nishant Patel, Tahira Agarwal, Sunita Agarwal, and Rajasekaran Preetha
Subjects: Adult, Male, Refractive error, medicine.medical_specialty, genetic structures, Eye disease, medicine.medical_treatment, Visual Acuity, Intraocular lens, Refraction, Ocular, Vision disorder, Lens Implantation, Intraocular, Ophthalmology, Lens, Crystalline, medicine, Humans, Prospective Studies, Dioptre, Lenses, Intraocular, Clear lens extraction, Phacoemulsification, business.industry, Middle Aged, medicine.disease, Capsulorhexis, eye diseases, Sensory Systems, Posterior chamber intraocular lens, Hyperopia, medicine.anatomical_structure, Lens (anatomy), Female, Surgery, sense organs, Safety, medicine.symptom, business, Follow-Up Studies
Abstract: Purpose To analyze the results of clear lens extraction (CLE) with posterior chamber intraocular lens (IOL) implantation to correct hyperopia. Setting Eye Research Center and Dr. Agarwal’s Eye Hospital, Chennai, India. Methods This prospective study comprised 20 hyperopic eyes of 12 patients between 19 and 50 years who had CLE with posterior chamber IOL implantation. Five patients had peripheral iridectomy during CLE as the angles were occludable. The mean hyperopic spherical equivalent refraction was +6.66 diopters (D) ± 2.17 (SD) (range +4.75 to +13.00 D). The IOL power was calculated using the Holladay 2 formula. The mean follow-up was 16.96 months (range 6 to 35 months). Results The mean postoperative uncorrected visual acuity was 0.45 ± 0.25 (range 0.10 to 1.00), a mean improvement of 3 Snellen lines from preoperatively. The mean postoperative best corrected visual acuity (BCVA) was 0.63 ± 0.30, a mean improvement of 1 Snellen line. Three patients gained 2 lines of BCVA and 2 patients, 1 line. One patient lost 1 line of BCVA. Seventy percent of patients were within ±0.50 D of the intended refraction. Conclusion The results indicate that CLE with posterior chamber IOL implantation is safe, predictable, and effective.
Published: 2003
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49. An extension of the edge covering problem.

Author: Sunita Agarwal, Prabha Sharma, and A. K. Mittal
Published: 1982
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50. A decomposition algorithm for linear relaxation of the weighted r-covering problem.

Author: Sunita Agarwal, A. K. Mittal, and Prabha Sharma
Published: 1985
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