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Paradoxical Low Flow Low Gradient Severe Aortic Stenosis—An Under-Recognized Entity

Case Reports in Clinical Medicine 2022年第2期11卷 31-36页

作者： Phillip Crane Mandeep Singh Kalsi Matias Yudi naveen sharma Department of Cardiology The Northern Hospital Melbourne Australia Department of Cardiology Austin Health Melbourne Australia

Some patients with severe aortic stenosis (AS), due to restrictive cardiac physiology, paradoxically have relatively low flow and low gradients across stenotic aortic valves despite preserved left ventricular (LV) systolic function. It results in symptoms and reduced quality of life and carries a high mortality. Whilst this form of severe AS, termed paradoxical low flow low gradient (pLFLG), is well reported, patients with this diagnosis experience inappropriate barriers to aortic valve replacement (AVR), the only efficacious treatment. We present the case of an 88-year-old female with 12 months of exertional dyspnoea on a background of hypothyroidism and hypercholesterolemia. Transthoracic echocardiogram (TTE) revealed LV hypertrophy, with a small LV cavity size and reduced stroke volume, yet normal systolic function. A heavily calcified aortic valve was identified with severe aortic stenosis, based on valve area, yet with incongruous mean transvalvular gradient of 25 mmHg (severe ≥ 50 mmHg). Following exclusion of other differential diagnoses, her symptoms were attributed to paradoxical LFLG severe AS. She was however declined definitive transcatheter aortic valve implantation (TAVI) due to her paradoxically low mean aortic gradient. Following further deterioration in her symptoms and supportive quantification of poor exercise performance, she was ultimately re-referred, accepted, and underwent TAVI. Following her AVR, the patient experiences significant improvement in both symptoms and quality of life after only one month. Paradoxical LFLG severe AS remains a well-documented yet under recognized disease. It carries high morbidity and mortality if untreated, yet is significantly less likely to be referred and accepted for intervention. With its prevalence expected to rise with an ageing population, this case serves as a timely reminder for clinicians to address the under recognition of important pathology.

关键词： Paroxysmal Low Flow Low Gradient Doppler Echocardiography Aortic Valve Stenosis Aortic Valve Implantation Valvular Heart Disease

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Outcome of patients with traumatic cranial nerve palsy admitted to a university hospital in Nepal

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中华神经外科杂志(英文) 2024年第2期10卷 1-7页

作者： Kumari Khusbu Gautam naveen Parajuli Monika Singh Shreejana Pradhananga Amit Sedai Gopal Shilpakar Sushil sharma Mohan Raj Maharajgunj Medical Campus Institute of Medicine Tribhuvan University Maharajgunj Kathmandu Nepal Department of Research Institute of Medicine Maharajgunj Kathmandu Nepal Department of Neurosurgery Tribhuvan University Teaching Hospital Maharajgunj Kathmandu Nepal

Background Cranial nerve palsy (CNP) is a common complication of traumatic brain injury (TBI). Despite a high incidence of TBI in Nepal (382 per 100,000), literature on the specific management and outcome of CNP is lacking. This study aimed to examine the outcomes of TBI patients involving single versus multiple *** A retrospective chart review of 170 consecutive TBI patients admitted to the tertiary neurosurgical center in Nepal between April 2020 and April 2022 was conducted. Demographic, clinical, and etiological characteristics; imaging findings; and management strategies were recorded, compared, and analyzed using descriptive statistics. The Glasgow Outcome Scale Extended (GOSE) was used to measure the outcomes in two groups of patients (single and multiple CNP) at 3 *** Out of 250 eligible patients, 80 were excluded and CNP was noted in 29 (17.1%) of the remaining 170. The median age was 34.9 years, and falls (60.6%) were the most common cause of trauma. TBI severity was categorized based on GCS: mild (82.4%), moderate (15.9%), and severe (1.8%). Cranial nerve involvement was seen in 29 (17.05%) patients: single cranial nerve involvement in 26 (89.65%) and multiple nerve involvement in 3 (10.34%). The most common isolated cranial nerve involved was the oculomotor nerve (37.9%). CT findings revealed a maximum of skull fractures with no significant association between CNP and CT *** CNP is a common consequence of TBI with the most common etiology being falls followed by RTA. Single CNP was more common than multiple CNP with no significant difference in the outcome in the 3-month GOSE score. Further research is needed to determine the burden of traumatic CNP and establish specific management guidelines for different types of CNP.

关键词： Cranial nerve palsy Nepal Outcome Traumatic brain injury

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Determination of asenapine in presence of its inactive metabolites in human plasma by LC-MS/MS

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Journal of Pharmaceutical Analysis 2018年第5期8卷 341-347页

作者： Nirav R Patel Mallika Sanyal naveen sharma Dinesh S.Patel Pranav S.Shrivastav Bhavin N.Patel Bioanalytical Laboratory Uiantha Research India Ltd.BodakdevAhmedabad 380054GujaratIndia Kadi Sarva Viswavidyalaya Sector-15Ghandhinagar 382715GujaratIndia Department of Chemistry St.Xavier's CollegeNavrangpuraAhmedabad 380009GujaratIndia Department of Chemistry School of SciencesGujarat UniversityNavrangpuraAhmedabad 380009GujaratIndia

A highly selective and sensitive liquid chromatography-tandem mass spectrometry （LC-MS/MS） assay has been described for the determination of asenapine （ASE） in presence of its inactive metabolites N-desmethyl asenapine （DMA） and asenapine-N-glucuronide （ASG）. ASE, and ASE 13C-d3, used as internal standard （IS）, were extracted from 300 μL human plasma by a simple and precise liquid-liquid extraction procedure using methyl tert-butyl ether. Baseline separation of ASE from its inactive metabolites was achieved on Chromolith Performance RPse （100 mm ×4.6 mm） column using acetonitrile- 5.0 mM ammonium acetate-10% formic acid （90：10：0.1, v/v/v） within 4.5 min. Quantitation of ASE was done on a triple quadrupole mass spectrometer equipped with electrospray ionization in the positive mode. The protonated precursor to product ion transitions monitored for ASE and ASE 13C-d3 were m/z 286.1 → 166.0 and m/z 290.0 → 166.1, respectively. The limit of detection （LOD） and limit of quantitation （LOQ） of the method were 0.0025 ng/mL and 0.050 ng/mL respectively in a linear concentration range of 0.050-20.0 ng/mL for ASE. The intra-batch and inter-batch precision （% CV） and mean relative recovery across quality control levels were 〈 5.8% and 87.3%, respectively. Matrix effect, evaluated as IS-normalized matrix factor, ranged from 1.03 to 1.05. The stability of ASE under different storage conditions was ascertained in presence of the metabolites. The developed method is much simpler, matrix free, rapid and economical compared to the existing methods. The method was suc- cessfully used for a bioequivalence study of asenapine in healthy Indian subjects for the first time.

关键词： Asenapine Asenapine 13C-d3 Metabolites LC-MS/MS Bioequivalence study Human plasma

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Highly sensitive LC–MS/MS method to estimate doxepin and its metabolite nordoxepin in human plasma for a bioequivalence study

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Journal of Pharmaceutical Analysis 2018年第6期8卷 378-385页

作者： Nirav P.Patel Mallika Sanyal naveen sharma Dinesh S.Patel Pranav S.Shrivastav Bhavin N.Patel Bio-Analytical Laboratory Cliantha Research India Ltd.BodakdevAhmedabad 380054GujaratIndia Kadi Sarva Viswavidyalaya Sector-15Ghandhinagar 382715GujaratIndia Department of Chemistry St.Xavier's CollegeNavrangpuraAhmedabad 380009GujaratIndia Department of Chemistry School of SciencesGujarat UniversityNavrangpuraAhmedabad 380009GujaratIndia

A selective, sensitive and rugged liquid chromatography–tandem mass spectrometry(LC–MS/MS) assay has been developed for the simultaneous determination of doxepin(Dox) and its pharmacologically active metabolite, nordoxepin(NDox) in human plasma. The analytes and their internal standards(IS)were extracted from 500 m L of human plasma by liquid-liquid extraction using methyl tert-butyl *** separation was achieved on Hypurity C8 column(100 mm ? 4.6 mm, 5 mm) using a mixture of acetonitrile-methanol(95:5, v/v) and 2.0 mM ammonium formate in 93:7(v/v) ratio. Detection was accomplished by tandem mass spectrometry in the positive ionization and multiple reaction monitoring acquisition mode. The protonated precursor to product ion transitions studied for Dox, NDox,and their corresponding ISs, propranolol and desipramine, were m/z 280.1-107.0, 266.0-107.0,260.1-116.1 and 267.1-72.1, respectively. A linear dynamic range of 15.0–3900 pg/mL for Dox and 5.00–1300 pg/mL for NDox was established with mean correlation coefficient(r2) of 0.9991 and 0.9993, respectively. The extraction recovery ranged from 86.6%–90.4% and 88.0%–99.1% for Dox and NDox, respectively. The intra-batch and inter-batch precision(% CV) across quality control levels was r 8.3% for both the analytes. Stability evaluated under different storage conditions showed no evidence of degradation and the % change in stability samples compared to nominal concentration ranged from 4.7% to12.3%. The method was successfully applied to a bioequivalence study of 6 mg doxepin hydrochloride orally disintegrating tablet in 41 healthy Indian subjects under fasting and fed conditions.

关键词： Doxepin Nordoxepin LC–MS/MS Liquid-liquid extraction Human plasma Bioequivalence study

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Ethnic differences in inflammatory bowel disease: Results from the United Kingdom inception cohort epidemiology study

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World Journal of Gastroenterology 2019年第40期25卷 6145-6157页

作者： Ravi Misra Jimmy Limdi Rachel Cooney Samia Sakuma Matthew Brookes Edward Fogden Sanjeev Pattni naveen sharma Tariq Iqbal Pia Munkholm Johan Burisch Naila Arebi Gastroenterology St.Mark’s Hospital and Academic InstituteLondon HA13UJUnited Kingdom The Pennine Acute Hospitals NHS Trust Institute of Inflammation and RepairUniversity of ManchesterManchester BL97TDUnited Kingdom Gastroenterology University Hospitals BirminghamBirmingham B122THUnited Kingdom Gastroenterology Royal Wolverhampton NHS TrustLondon WV100QPUnited Kingdom Gastroenterology Sandwell and West Birmingham HospitalsBirmingham B714HJUnited Kingdom Gastroenterology University Leicester HospitalsLeicester LE15WWUnited Kingdom Gastroenterology Heartlands HospitalBirmingham B95SSUnited Kingdom Department of Gastroenterology North Zealand University HospitalFrederikssund 3600Denmark

BACKGROUND The current epidemiology of inflammatory bowel disease(IBD)in the multiethnic United Kingdom is *** last incidence study in the United Kingdom was carried out over 20 years *** To describe the incidence and phenotype of IBD and distribution within ethnic *** Adult patients(>16 years)with newly diagnosed IBD(fulfilling Copenhagen diagnostic criteria)were prospectively recruited over one year in 5 urban catchment areas with high South Asian *** demographics,ethnic codes,disease phenotype(Montreal classification),disease activity and treatment within 3 months of diagnosis were recorded onto the Epicom *** Across a population of 2271406 adults,339 adult patients were diagnosed with IBD over one year:218 with ulcerative colitis(UC,64.3%),115 with Crohn's disease(CD,33.9%)and 6 with IBD unclassified(1.8%).The crude incidence of IBD,UC and CD was 17.0/100000,11.3/100000 and 5.3/100000 *** age adjusted incidence of IBD and UC were significantly higher in the Indian group(25.2/100000 and 20.5/100000)compared to White European(14.9/100000,P=0.009 and 8.2/100000,P<0.001)and Pakistani groups(14.9/100000,P=0.001 and 11.2/100000,P=0.007).The Indian group were significantly more likely to have extensive disease than White Europeans(52.7%vs 41.7%,P=0.031).There was no significant difference in time to diagnosis,disease activity and *** This is the only prospective study to report the incidence of IBD in an ethnically diverse United Kingdom *** Indian ethnic group showed the highest age-adjusted incidence of UC(20.5/100000).Further studies on dietary,microbial and metabolic factors that might explain these findings in UC are underway.

关键词： Inflammatory bowel disease Ethnicity Epidemiology Incidence Phenotype

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Comparative evaluation of artificial intelligence systems'accuracy in providing medical drug dosages:A methodological study

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World Journal of Methodology 2024年第4期14卷 121-130页

作者： Swaminathan Ramasubramanian Sangeetha Balaji Tejashri Kannan naveen Jeyaraman Shilpa sharma Filippo Migliorini Suhasini Balasubramaniam Madhan Jeyaraman Department of Orthopaedics Government Medical CollegeOmandurar Government EstateChennai 600002Tamil NaduIndia Department of Orthopaedics ACS Medical College and HospitalDr MGR Educational and Research InstituteChennai 600077Tamil NaduIndia Department of Paediatric Surgery All India Institute of Medical SciencesNew Delhi 110029India Department of Life Sciences HealthLink Campus UniversityRome 00165Italy Department of Orthopaedic and Trauma Surgery Academic Hospital of Bolzano(SABES-ASDAA)Teaching Hospital of the Paracelsus Medical UniversityBolzano 39100Italy Department of Radio-Diagnosis Government Stanley Medical College and HospitalChennai 600001Tamil NaduIndia

BACKGROUND Medication errors,especially in dosage calculation,pose risks in *** intelligence(AI)systems like ChatGPT and Google Bard may help reduce errors,but their accuracy in providing medication information remains to be *** To evaluate the accuracy of AI systems(ChatGPT 3.5,ChatGPT 4,Google Bard)in providing drug dosage information per Harrison's Principles of Internal *** A set of natural language queries mimicking real-world medical dosage inquiries was presented to the AI *** were analyzed using a 3-point Likert *** analysis,conducted with Python and its libraries,focused on basic statistics,overall system accuracy,and disease-specific and organ system *** ChatGPT 4 outperformed the other systems,showing the highest rate of correct responses(83.77%)and the best overall weighted accuracy(0.6775).Disease-specific accuracy varied notably across systems,with some diseases being accurately recognized,while others demonstrated significant *** system accuracy also showed variable results,underscoring system-specific strengths and *** ChatGPT 4 demonstrates superior reliability in medical dosage information,yet variations across diseases emphasize the need for ongoing *** results highlight AI's potential in aiding healthcare professionals,urging continuous development for dependable accuracy in critical medical situations.

关键词： Dosage calculation Artificial intelligence ChatGPT Drug dosage Healthcare Large language models

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LC-MS/MS assay for olanzapine in human plasma and its application to a bioequivalence study

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Acta Pharmaceutica Sinica B 2012年第5期2卷 481-494页

作者： Dinesh S.Patel naveen sharma Mukesh C.Patel Bhavin N.Patel Pranav S.Shrivastav Mallika Sanyal Chemistry Department Pramukh Swami Science and H.D.Patel Arts CollegeSarva Vidyalaya CampusKadi 382715GujaratIndia Bio-Analytical Laboratory BA Research India Ltd.BodakdevAhmedabad 380054GujaratIndia Department of Chemistry School of SciencesGujarat UniversityNavrangpuraAhmedabad 380009GujaratIndia Department of Chemistry St.Xavier’s CollegeNavrangpuraAhmedabad 380009GujaratIndia

This paper describes a selective and sensitive assay for the determination of olanzapine(OLZ)in human plasma based on liquid chromatography-tandem mass spectrometry(LC-MS/MS).The analyte and quetiapine as internal standard(IS)were extracted from 200μL plasma via solid phase extraction on Waters Oasis HLB *** separation was achieved on an ACE 5C18-300 column(100 mm × 4.6 mm,5μm)under isocratic conditions in a run time of 3.5 *** spectrometric detection involved electrospray ionization in the positive ion mode followed by multiple reaction monitoring(MRM)of the transitions at m/z 313/256 for OLZ and m/z 384/253 for the *** assay was linear in the range 0.10-40.0 ng/mL with a lower limit of quantitation and limit of detection of 0.10 and 0.012 ng/mL,***-and inter-day precision(as coefficient of variation)and relative recovery were90%,*** method was succesfully applied to a bioequivalence study of 5 and 10 mg OLZ disintegrating tablets in 40 healthy Indian males with reproducibility by incurred sample reanalysis in the range-7.43 to 8.07%.

关键词： Olanzapine LC-MS/MS Solid phaseextraction Bioequivalence Incurred sample reanalysis

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Quantum Particle Swarm Optimization Based Convolutional Neural Network for Handwritten Script Recognition

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Computers, Materials & Continua 2022年第6期71卷 5855-5873页

作者： Reya sharma Baijnath Kaushik naveen Kumar Gondhi Muhammad Tahir Mohammad Khalid Imam Rahmani School of Computer Science and Engineering SMVDUJ&KIndia College of Computing and Informatics Saudi Electronic UniversityRiyadhSaudi Arabia

Even though several advances have been made in recent years,handwritten script recognition is still a challenging task in the pattern recognition *** field has gained much interest lately due to its diverse application ***,different methods are available for automatic script *** most of the reported script recognition techniques,deep neural networks have achieved impressive results and outperformed the classical machine learning ***,the process of designing such networks right from scratch intuitively appears to incur a significant amount of trial and error,which renders them *** approach often requires manual intervention with domain expertise which consumes substantial time and computational *** alleviate this shortcoming,this paper proposes a new neural architecture search approach based on meta-heuristic quantum particle swarm optimization(QPSO),which is capable of automatically evolving the meaningful convolutional neural network(CNN)*** computational experiments have been conducted on eight different datasets belonging to three popular Indic scripts,namely Bangla,Devanagari,and Dogri,consisting of handwritten characters and ***,the results imply that the proposed QPSO-CNN algorithm outperforms the classical and state-of-the-art methods with faster prediction and higher accuracy.

关键词： Neuro-evolution quantum particle swarm optimization deep learning convolutional neural networks handwriting recognition

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Revitalizing case reports: Standardized guidelines and mentorship

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World Journal of Clinical Cases 2023年第19期11卷 4729-4733页

作者： Madhan Jeyaraman Swaminathan Ramasubramanian naveen Jeyaraman Arulkumar Nallakumarasamy Shilpa sharma Department of Orthopaedics ACS Medical College and HospitalChennai 600056Tamil NaduIndia Department of General Medicine Government Medical CollegeOmandurar Government EstateChennai 600018Tamil NaduIndia Department of Orthopaedics Shri Sathya Sai Medical College and Research InstituteSri Balaji VidyapeethChengalpet 603108Tamil NaduIndia Department of Orthopaedics All Indian Institute of Medical SciencesBhubaneswar 751019OdishaIndia Department of Paediatric Surgery All India Institute of Medical SciencesNew Delhi 110029India

Despite a decrease in publication,case reports remain essential in medical literature as they offer detailed descriptions of individual patient cases and valuable insights for future *** reports adhere to a standardized structure comprising sections such as abstract,introduction,case report,discussion,and *** informed consent and adhering to guidelines is *** reports contribute to evidence-based medicine by detecting new therapies and adverse *** also facilitate clear reporting,guideline adherence,and mentorship *** reports are vital for documenting rare occurrences,assisting clinicians in timely management,and communicating novel information to busy medical *** case report guidelines ensures comprehensive and standardized reporting,enhancing the acceptance and quality of case reports,and advancing medical knowledge.

关键词： Case report Case report guidelines Literature Research

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Energy loss at bends in the pneumatic conveying of fly ash

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Particuology 2015年第4期13卷 65-73页

作者： naveen Tripathi Atul sharma S.S.Mallick P.W.Wypych Department of Mechanical Engineering Thapar University Faculty of Engineering and Information Sciences University of Wollongong

An accurate estimation of the total pressure drop of a pipeline is important to the reliable design of a pneumatic conveying system. The present paper presents results from an investigation into the modelling of the pressure drop at a bend in the pneumatic conveying of fly ash. Seven existing bend models were used （in conjunction with solids friction models for horizontal and vertical straight pipes, and initial acceleration losses） to predict the total pipeline pressure drop in conveying fly ash （median particle diameter： 30 }zm; particle density： 2300 kg/m^3; loose-poured bulk density： 700 kg/m3） in three test rigs （pipelines with dimensions of 69 mm inner diameter （I.D.） × 168 m length; 105 mm I.D. × 168 m length; 69 mm I.D. × 554 m length）. A comparison of the pneumatic conveying characteristics （PCC） predicted using the seven bend models and experimental results shows that the predicted total pipeline PCC and trends depend on the choice of bend model. While some models predict trends that agree with the experimental results, other models predicted greater bend pressure drops for the dense phase of fly ash than for the dilute phase. Models of Pan, R. （1992）. Improving scale-up procedures for the design of pneumatic conveying systems. Doctoral dissertation, University of Wollongong, Australia, Pan, R., ＆ Wypych, P.W. （1998）. Dilute and dense phase pneumatic conveying of fly ash. In Proceedings of the sixth International Conference on Bulk Materials Storage and Transportation （pp. 183-189）, Wollongong, NSW, Australia and Chambers, A.J., ＆ Marcus, R.D. （1986）. Pneumatic conveying calculations. In Proceedings of the second International Conference on Bulk Materials Storage and Transportation （pp. 49-52）, Wollongong, Australia reliably predicted the bend losses for systems conveying fly ash over a large range of air flows.

关键词： Pneumatic conveying Fluidised dense phase Bend Pressure drop Bend model

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