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Simultaneous breast and ovarian metastasis from gallbladder carcinoma

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Hepatobiliary & Pancreatic Diseases International 2010年第5期9卷 553-554页

作者： Sanjay Singh puneet gupta Rahul Khanna Ajay K Khanna Department of General Surgery Institute of Medical SciencesBanaras Hindu University

BACKGROUND:Gallbladder carcinoma is a common malignancy in the Indian subcontinent.It commonly metastasizes through lymphatics,direct invasion,and hematogenous spread.A common extra-abdominal site of metastasis is the lungs.Simultaneous metastasis to breast and ovary is extremely rare.METHOD:This report describes an unusual case of carcinoma gallbladder metastasizing to the breast and ovary at the same time.RESULTS:A 45-year-old woman came to us with complaints of flatulent dyspepsia associated with weight loss and anorexia.Ultrasound of the abdomen revealed hepatomegaly with thick-walled gallbladder with multiple stones and a mass at the fundus,but normal uterus and ovary.Contrast-enhanced computer tomography of the abdomen showed a gallbladder mass infiltrating the liver parenchyma.The patient underwent radical cholecystectomy.Histopathological examination revealed a poorly-differentiated adenocarcinoma with margins free from tumor infiltration.One month after surgery she developed a breast lump.Ultrasound of the abdomen for metastatic workup revealed an ovary mass.Simple mastectomy and salphingo-opherectomy were performed,and histopathological examination revealed a metastatic adenocarcinoma.The patient is now on chemotherapy with gemcitabin.CONCLUSION:This is an unusual case of carcinoma of the gallbladder with metastasis to the breast and ovary,which has not been documented before.

关键词： gallbladder carcinoma breast metastasis ovary metastasis

Electrocardiographic changes in Emphysema

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World Journal of Cardiology 2021年第10期13卷 533-545页

作者： puneet gupta Hitangee Jain Misbah Gill Gurpreet Bharaj Nauman Khalid Waseem Chaudhry Lovely Chhabra Department of Interventional Cardiology Northeast Ohio Medical UniversityCantonOH 44272United States BA-MD Brooklyn CollegeBrooklynNY 11210United States Department of Family Medicine Memorial Hospital of CarbondaleCarbondaleIL 62901United States Psychiatry Loretto HospitalChicagoIL 60644United States Department of Interventional Cardiology St.Francis Medical CenterMonroeLA 71201United States Department of Cardiology Westchester Medical Center Network Advanced Physician ServicesPoughkeepsieNY 12601United States

Chronic obstructive lung disease(COPD),predominantly emphysema,causes several thoracic anatomical and hemodynamic changes which may cause changes in various electrocardiographic parameters.A 12-lead electrocardiogram(ECG),which is often a part of routine evaluation in most clinical settings,may serve as a useful screening modality for diagnosis of COPD or emphysema.Our current article aims to provide a comprehensive review of the electrocardiographic changes encountered in COPD/emphysema utilizing published PubMed and Medline literature database.Several important ECG changes are present in COPD/emphysema and may serve as a good diagnostic tool.Verticalization of Pvector,changes in QRS duration,pattern recognition of precordial R-wave progression and axial shifts can be considered some of the most valuable markers among other changes.In conclusion,12-lead surface electrocardiogram can serve as a valuable tool for the diagnosis of COPD and/or emphysema.An appropriate knowledge of these ECG changes can not only help in the diagnosis but can also immensely help in an appropriate clinical management of these patients.

关键词： Emphysema Chronic obstructive pulmonary disease Electrocardiogram Pwave axis Sensitivity Specific

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再见,主板!你好,硅直连结构!

科技纵览 2019年第10期 32-37页

作者： puneet gupta Subramanian S.Iyer 不详

长期以来,人们对硬件系统小型化和其他系统大型化的要求越来越高,成为电子产品创新的驱动力。从笔记本电脑到智能手机,再到智能手表、耳戴式设备和其他“看不见的”电子产品的演变过程中,我们即可以看到一些硬件系统小型化的发展。而其... 详细信息

长期以来,人们对硬件系统小型化和其他系统大型化的要求越来越高,成为电子产品创新的驱动力。从笔记本电脑到智能手机,再到智能手表、耳戴式设备和其他“看不见的”电子产品的演变过程中,我们即可以看到一些硬件系统小型化的发展。而其他系统大型化的要求则定义了如今商业数据中心,这些兆瓦级的能耗大户塞满了世界各地那些为特定目的而建造的仓库。

关键词：笔记本电脑数据中心电子产品智能手表智能手机能耗大户主板系统小型化

Knowledge, attitude, and practice towards coronavirus disease 2019 (COVID-19) among medical students: A cross-sectional study

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Journal of Acute Disease 2020年第3期9卷 100-104页

作者： Sonam Maheshwari puneet Kumar gupta Richa Sinha Pravesh Rawat Department of Community Medicine Government Doon Medical CollegeDehradunIndia ICFAI Business School The ICFAI UniversityDehradunIndia Government Doon Medical College DehradunIndia

Objective:To assess knowledge,attitude,and practice of medical students towards coronavirus disease 2019(COVID-19).Methods:A self-designed questionnaire was developed and given to the students of a government medical college in Uttarakhand.The demographics,mean knowledge,attitude,and practice of the participants were investigated,and the scores were calculated.t-test and ANOVA were used for statistical analysis.Results:Out of the total participants(n=354),50.3%were male and 54.5%were 21-23 years.Almost all the participants(96.6%)increase the frequency of washing hands under the influence of COVID-19.Although no significant relationship was found between different religions,age-categories in terms of knowledge,the participants who were aged 21-23 years had higher knowledge.In addition,gender had a significant impact on practice scores(P0.05).Conclusions:The majority of the participants had good knowledge,positive attitude,and sufficient practice.Females and males have significantly different practices.Although the results are very positive,it is suggested that people should continue to strengthen knowledge,attitude,and practice towards COVID-19,so that India can win the battle against the disease.

关键词： COVID-19 Noval coronavirus Knowledge Attitude Practice Social distancing Lockdown

Bone Elimination Technique of Cerebral Vessels with 64 Slice CT: Comparision of Volume CT DSA ＆ Conventional CTA

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Bone Elimination Technique of Cerebral Vessels with 64 Slice...

作者： Kumar puneet gupta 重庆医科大学

学位级别：硕士

OBJECTIVE: The aim of this study was to investigate the differences in the time and image quality of reconstructed cerebral angiograms between volume CT digital subtraction angiography （VCTDSA） and conventional CT angiography（CTA） with bone elimination technique. MATERIALS AND METHODS: Thirty-two patients with cerebrovascular diseases, who underwent VCTDSA in our department, were further remodeled cerebral vessels with both VCTDSA and conventional CTA. Cerebral vessels were displayed with 3D volume rendering （3D VR） and 3D maximum intensity projection （3D MIP）, respectively. The post-processing time and the image quality were then compared. RESULTS: The image quality with VCTDSA vessel reconstruction was excellent. Compared with conventional CTA, VCTDSA had an advantage in displaying the integrity of vessels, the range of intracranial arteries and veins, and also in lessening the remained high density shadows （ p＜0.001）. The time of post-processing by VCTDSA （mean: 6.87±2.96 min） was much shorter than that of conventional CTA （mean: 14.37±1.66 min）（ p＜0.001）. There was a significant positive correlation between the post-processing time and the subtraction image quality with VCTDSA （ r=0.79, p＜0.001）. CONCLUSION: VCTDSA is a fast, accurate and feasible method for the sensitive assessment of cerebrovascular structures and can be used as a powerful tool in the diagnosis of cerebrovascular diseases. Compared with conventional CTA, VCTDSA has an advantage in displaying the integrity of vessels, the range of intracranial arteries and veins, and also in lessening the remained high density shadow. The post-processing time of VCTDSA is significant shorter than that of conventional CTA.

关键词： Slice DSA CTA conventional image quality The and high density significant time volume rendering the differences

Comparison of Sensitivity and Specificity of ZN and Fluorescent Stain Microscopy with Culture as Gold Standard

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Journal of Tuberculosis Research 2017年第2期5卷 118-128页

作者： Rekha Bansal Parveen Kumar Sharma Subhash Chand Jaryal puneet Kumar gupta Dinesh Kumar Department of Pulmonary Medicine Dr. RP Government Medical College Kangra at Tanda (HP) India Department of Pharmacology SLBS Government Medical College Mandi at Nerchowk (HP) India Department of Microbiology SLBS Government Medical College Mandi at Nerchowk (HP) India Department of Microbiology All India Institute of Medical Sciences Rishikesh Uttarakhand India Department of Community Medicine Dr. RP Government Medical College Kangra at Tanda (HP) India

Introduction: Reports indicate that fluorescent staining of smears increases sensitivity of direct microscopy;so ZN staining is being replaced with fluorescent microscopy in RNTCP in India. Chemical processing and sputum concentration may also improve sensitivity of microscopy. Objective: To compare the sensitivity and specificity of microscopy for AFB using ZN and fluorescent stains in direct and concentrated specimen with culture as gold standard. Methods: Morning sputum specimen of patients, suspected of having pulmonary tuberculosis, over a period of 6 months was subjected to direct microscopy using fluorescent stain;the same slide was over-stained with ZN stain. Same sputum sample was concentrated by Petroff’s method and subjected to fluorescent microscopy followed by ZN microscopy and finally to culture for AFB. Results: Sensitivity of fluorescent stained concentrated sputum samples was maximum and of ZN stained unprocessed sputum samples was minimum. Specificity of three of the methods was equal at 0.96 but of ZN stained concentrated sputum smears was 0.97. Sensitivity of total fluorescent stains was 0.85 (Specificity 0.96) and sensitivity of total ZN stained smears was 0.80 (Specificity 0.96). Discussion: We used same smear for fluorescent and ZN stains, so smear related variability is decreased. Blinding for microscopy was practically complete. Conclusion: The sensitivity of sputum microscopy for AFB can be increased by concentrating the sputum and using fluorescent microscopy. The specificity remains high in all the methods.

关键词： Sensitivity and Specificity Microscopy for AFB ZN Staining Fluorescent Stain Concentration of Sputum

化学反应对粗糙边界和被动控制微极性纳米流体热稳定性的影响:神经网络

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Journal of Central South University 2023年第5期30卷 1581-1600页

作者： gupta Vishal RANA puneet KUMAR Lokendra Department of Mathematics Jaypee Institute of Information TechnologyNoida 201309India School of Mathematical Sciences College of ScienceMathematics and TechnologyWenzhou-Kean UniversityWenzhou 325060China

本文在无通量和粗糙边界的情况下演示了化学反应对微极性纳米流体中热对流初始状态的影响。本研究应用Saffman界面条件求解粗糙边界。考虑在许多工业应用中具有重要作用的微极性非牛顿纳米流体。对于线性稳定性,利用正态模态技术(NMT)... 详细信息

本文在无通量和粗糙边界的情况下演示了化学反应对微极性纳米流体中热对流初始状态的影响。本研究应用Saffman界面条件求解粗糙边界。考虑在许多工业应用中具有重要作用的微极性非牛顿纳米流体。对于线性稳定性,利用正态模态技术(NMT)将控制系统的偏微分方程(PDE)转化为特征值问题(EVP),并采用基于有限差分的三阶段LobattoⅢa方法进行数值求解。发现对流的主要模式是静止模式。增加纳米流体中热流通量与自旋霍尔效应的耦合系数(δ)、自旋霍尔效应与涡度的耦合系数(K)、粗糙度参数(λ_(1),λ_(2))、化学反应参数(Cr)、修正扩散比(NA)和微极性参数(A)的取值,可以降低对流,从而稳定系统。然后,在81个数据点的基础上,利用嵌入多人感知的人工神经网络(ANN)确定四个控制参数与Rayleigh临界数之间的关系。

关键词：纳米流体 Rayleigh-Benard对流 FDM法粗糙表面化学反应神经计算

An unusual cause of simultaneous common bile and pancreatic duct dilation

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Gastroenterology Report 2015年第3期3卷 258-261页

作者： puneet Chhabra Surinder Singh Rana Vishal Sharma Ravi Sharma Rajesh gupta Deepak Kumar Bhasin Department of Gastroenterology Postgraduate Institute of Medical Education and Research(PGIMER)ChandigarhIndia Department of Surgery Postgraduate Institute of Medical Education and Research(PGIMER)ChandigarhIndia

Simultaneous dilation of both the common bile duct and the pancreatic duct(double-duct sign)is usually because of ampullary or pancreatic tumours.Here we report an unusual cause of double-duct dilation;we describe the case of a 49-year-old female who developed afferent loop syndrome after pylorus-preserving pancreaticoduodenectomy:crosssectional imaging of the abdomen revealed a double-duct sign.

关键词： afferent loop syndrome pylorus preserving pancreaticoduodenectomy

Arterial pH,bicarbonate levels and base deficit at presentation as markers of predicting mortality in acute pancreatitis:a single-centre prospective study

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Gastroenterology Report 2014年第3期2卷 226-231页

作者： Vishal Sharma Thingbaijam Shanti Devi Ravi Sharma puneet Chhabra Rajesh gupta Surinder S.Rana Deepak K.Bhasin Department of Gastroenterology Post Graduate Institute of Medical Education and ResearchChandigarhIndia Department of Surgery Post Graduate Institute of Medical Education and ResearchChandigarhIndia

Background.Arterial blood gas(ABG)parameters such as pH form part of multi-parameter scoring systems for predicting severe acute pancreatitis;however,literature on detailed evaluation of ABG alone in this context is scarce.Methods.Patients with acute pancreatitis presenting to our unit between January 2012 and November 2013 were prospectively studied.ABG analysis was done at admission and development of organ failure,any need for intervention,and mortality were noted.The association between various parameters of ABG analysis and the development of organ failure or local complications,need for interventions(endoscopic/radiological/surgical)and mortality were analysed.Results.Two hundred and five patients(mean age:39.33-13.85 years;61.0%males)were prospectively studied.The aetiology of acute pancreatitis was alcohol in 93 patients(45.4%)and gall stone disease in 73(35.6%).Organ failure developed in 71.2%patients and 83.9%had local complications.In 18%of patients,endoscopic/radiological/surgical interventions were needed and 14.6%died.The patients(n=35)with metabolic acidosis(pH4 meq/L for prediction of mortality were 0.771(95%CI:0.664–0.878),0.707(95%CI:0.622–0.791)and 0.780(95%CI:0.693–0.867),respectively.Conclusion.Arterial pH,bicarbonate levels,and base deficit at presentation are useful early markers for predicting adverse outcome in acute pancreatitis.

关键词： acute pancreatitis base deficit MA organ failure