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Endoscopic management of postoperative bile leaks

Hepatobiliary & Pancreatic Diseases International 2006年第2期5卷 273-277页

作者： Naresh Agarwal Barjesh Chander Sharma sanjay garg Rakesh Kumar Shiv K Sarin Department of Gastroenterology GB Pant Hospital New DelhiIndia

BACKGROUND: Significant bile leak as an uncommon complication after biliary tract surgery may constitute a serious and difficult management problem. Surgical management of biliary fistulae is associated with high morbidity and mortality. Biliary endoscopic procedures have become the treatment of choice for management of biliary Gstulae. METHODS: Ninety patients presented with bile leaks after cholecystectomy ( open cholecystectomy in 45 patients, cholecystectomy with common bile duct exploration in 20 and laparoscopic cholecystectomy in 25). The presence of bile leaks was confirmed by ERCP and the appearance of bile in percutaneous drainage of abdominal collections. Of the 90 patients with postoperative bile leaks, 18 patients had complete transaction of the common bile duct by ERCP and were subjected to bilioenteric anastomosis. In the remaining patients after cholangiography and localization of the site of bile leaks. therapeutic procedures like sphinctero-tomy, biliary stenting and nasobiliary drainage ( NBD ) were performed. If residual stones were seen in the common bile duct, sphincterotomy was followed by stone extraction using dormia basket. Nasobiliary drain or stents of 7F size were placed according to the standard techniques. The NBD was removed when bile leak stopped and closure of the fistula confirmed cholangiographically. The stents were removed after an interval of 6-8 weeks. RESULTS: Bile leaks in 72 patients occurred in the cystic duct (38 patients), the common bile duct (30 ), and the right hepatic duct (4). Of the 72 patients with post-operative bile leak, 24 had associated retained common bile duct stones and 1 had ascaris in common bile duct. All the 72 patients were subjected to therapeutic procedures including sphincterotomy with stone extraction followed by biliary stenting (24 patients), removal of ascaris and biliary stenting (1), sphincterotomy with biliary stenting (18), sphincterotomy with NBD (12), biliary stenting alone (12), and NBD

关键词： biliary fistulae endoscopic retrograde cholangiopancreatography sphincterotomy biliary stent nasobiliary drain common bile duct stones

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Design and Development of an <i>in Vitro</i>Assay for Evaluation of Solid Vaginal Dosage Forms

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Pharmacology & Pharmacy 2011年第4期2卷 289-298页

作者： Jyoti Gupta Jason Qihai Tao sanjay garg Raida Al-Kassas 不详

Vaginal dosage forms are seen as a viable option for empowering women to protect themselves from the risk of HIV transmission. Because of limited research in the field, there is a lack of suitable dissolution methods established for determination of drug release from vaginal formulations inside the vaginal tract. The main aim of this study was to develop a simple, reliable and reproducible in vitro release method for evaluation of solid vaginal dosage forms (VDFs) which was hoped to exhibit a close in vitro-in vivo correlation. Dapivirine, a drug being developed as a microbicide and a well established marketed anti fungal drug, Clotrimazole were used as model drugs. Two doses (0.5 mg and 1.25 mg) of Dapivirine were prepared as novel rapidly disintegrating, bioadhesive tablets. Clotrimazole 100 mg, prepared in house as conventional release tablets and commercially available Canesten (Clotrimazole tablet 100 mg) were used. The in vitro drug release testing of these tablets was carried out using a designed system which consisted of modified USP dissolution Apparatus II in conjunction with Enhancer cell (as sample holder) in 150 ml capacity flasks instead of the standard 900 ml flasks. The suitability of the system was investigated for variable parameters such as formulation types, drug concentration, stirring speeds, media volume and comparison of in house product with marketed product. The method was successfully optimized at a volume of 100 ml and a low speed of 25 rpm at pH 4 and was found sensitive enough to distinguish between formulations and evaluate products of different strengths. A linear drug release profile (R2 = 0.99) was obtained in case of Dapivirine, indicating that drug release is controlled by diffusion. The developed dissolution system has a potential to exhibit a good in vitro-in vivo correlation in addition to carrying out routine dissolution tests for solid VDFs.

关键词： Vaginal Solid Dosage Forms Enhancer Cell Dapivirine Clotrimazole

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In-hospital outcomes in COVID-19 patients with non-alcoholic fatty liver disease by severity of obesity:Insights from national inpatient sample 2020

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World Journal of Hepatology 2024年第6期16卷 912-919页

作者： Sashwath Srikanth Vibhor garg Lakshmi Subramanian Jyoti Verma Hansika Sharma Harroop Singh Klair Shrenil A Kavathia Jithin Kolli Teja Nikhil Sai Vasireddy Kumar Anmol Dhanush Kolli Shruti sanjay Bodhankar Sobya Hashmi Shaylika Chauhan Rupak Desai Department of Medicine ECU Health Medical CenterGreenvilleNC 27834United States Department of Medicine Jacobi Medical Center/Albert Einstein College of MedicineBronxNY 10461United States Department of Medicine North Alabama Medical CentreFlorenceAL 35630United States Department of General Medicine Gandhi Medical CollegeSecunderabad 500003TelanganaIndia Department of Medicine Government Medical CollegePatiala 147001PunjabIndia Department of Medicine B.J.Medical CollegeAhmedabad 380016GujaratIndia Department of Medicine JSS Medical CollegeMysore 570015KarnatakaIndia Department of Internal Medicine Gandhi Medical CollegeSecunderabad 500003TelanganaIndia Department of Medicine Kasturba Medical CollegeManipal 575001KarnatakaIndia Clinical Extern Department of Internal MedicineBeaumont HospitalDearbornMI 48124United States Department of Internal Medicine Geisinger Health SystemWilkes-BarrePA 18702United States Independent Researcher AtlantaGA 30079United States

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular diseases independently of other risk ***,data on its effect on cardiovascular outcomes in coronavirus disease 2019(COVID-19)hospitalizations with varied obesity levels is *** management and patient care depend on understanding COVID-19 admission results in NAFLD patients with varying obesity *** To study the in-hospital outcomes in COVID-19 patients with NAFLD by severity of *** COVID-19 hospitalizations with NAFLD were identified using International Classification of Disease-10 CM codes in the 2020 National Inpatient Sample *** and Obesity Classes Ⅰ,Ⅱ,and Ⅲ(body mass index 30-40)were *** adverse cardiac and cerebrovascular events(MACCE)(all-cause mortality,acute myocardial infarction,cardiac arrest,and stroke)were compared between *** regression analyses adjusted for sociodemographic,hospitalization features,and *** Our analysis comprised 13260 hospitalizations,7.3% of which were overweight,24.3% Class Ⅰ,24.1% Class Ⅱ,and 44.3% Class Ⅲ.Class Ⅲ obesity includes younger patients,blacks,females,diabetics,and hypertensive *** multivariable logistic analysis,Class Ⅲ obese patients had higher risks of MACCE,inpatient mortality,and respiratory failure than Class Ⅰ obese *** Ⅱ obesity showed increased risks of MACCE,inpatient mortality,and respiratory failure than Class I,but not *** obesity classes had non-significant risks of MACCE,inpatient mortality,and respiratory failure compared to the overweight *** Class Ⅲ obese NAFLD COVID-19 patients had a greater risk of adverse outcomes than class Ⅰ.Using the overweight group as the reference,unfavorable outcomes were not significantly *** obesity had a greater risk of MACCE regardless of the referent group(overweight or Class Ⅰ obese)compared to overweight NAFLD patients admitte

关键词： Non-alcoholic fatty liver disease Obesity Obese Body mass index Major adverse cardiac and cerebrovascular events Mortality Acute myocardial infarction Cardiac arrest Stroke

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Influence of Putrescine on Enzymes of Ammonium Assimilation in Maize Seedling

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American Journal of Plant Sciences 2013年第2期4卷 297-301页

作者： Vineeta Awasthi Indreshu Kumar Gautam Rakesh Singh Sengar sanjay Kumar garg Department of Plant Science M.J.P. Rohilkhand University Bareilly India Sardar Vallabh Bhai Patel University of Agriculture and Technology Meerut India

The effect of different concentrations of putrescine on biochemical changes in root and shoot of six days old maize seedlings in terms of enzymes of ammonium assimilation were examined. The results revealed that glutamate dehydrogenase (GDH) activity was enhanced at lower concentration of putrescine but at higher concentration, the activity of this enzyme was declined. Glutamine synthetase (GS) activity decreased with increase in concentration of putrescine and it was highest at 1000 μm concentration. Howe ver, glutamate synthase (GOGAT) activity increased with increase in concentration of putrescine upto 100 μm in root and upto 50 μm in shoot and further increase in concentration resulted in decline of enzymatic activity. Protein and total nitrogen content increased upto 10 μm concentration of putrescine and it decreased further with increase in concentration both in root and shoot of maize seedling.

关键词： Glutamate Dehydrogenase Glutamine Synthetase Glutamate Synthase Maize Seedlings Putrescine Zea mays

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Bilateral traumatic patellar fracture： a case report and review of literature

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Chinese Journal of Traumatology 2012年第3期15卷 188-191页

作者： Gupta Vinay Kundu Zile garg Rakesh sanjay Gaurav Department of Orthopaedics Pandit B.D. Sharma Post Graduate Institute of Medical Sciences Rohtak India

Abstract：Simultaneous isolated bilateral patellar fractures are very rare injuries and most often associated with systemic disorders such as hyperparathyroidism,osteoporosis,stress fracture and kidney *** bilateral traumatic fracture of patella following an unusual mode of injury is seldomly reported in the *** reported such a case following a road traffic accident without any associated injuries or co-morbid *** patella on the right side had transverse open fracture which was fixed with two Kirschner wires following tension band principle,and that on the left side sustained upper pole comminution which was treated by partial *** patient achieved good outcome:at 6 months he was able to squat and sit cross legged; at one year he obtained nearly normal muscle strength and full range of *** discussed the injury mechanism,management and rehabilitation in such a case and reviewed the available literature regarding such a presentation。

关键词： Fractures bone Patella Wounds and injuries

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Transcranial lateral perforating gunshot injury through skull base presenting without residual damage:A fortunate survivor

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Chinese Journal of Traumatology 2021年第3期24卷 183-186页

作者： Amit garg Abhishek Mandal Ipsita Aggarwal Anmol Galhotra Shouvik Das sanjay Marwah Department of General Surgery Pt BD Sharma Post Graduate Institute of Medical SciencesRohtakHaryanaIndia

We reported a case of a 32 years old male presenting with a perforating gunshot injury in craniocerebral region 3 h after the *** bullet entered above the right zygomatic arch,travelling through the coronal plane,and exited from the left zygomatic *** patient was fully conscious at presentation and developed facial nerve palsy during his hospital ***-contrast CT scan of the head revealed fractures of the right orbit,bilateral maxilla,bilateral pterygoid plates,ethmoid air cells,vomer and left zygoma,and without any cerebral *** was treated conservatively and the facial palsy was *** patient survived without any *** case has not been described in the available literature till date.

关键词： Gunshot injury Perforating injury Craniocerebral region

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Comparative evaluation of microscopy,OptiMAL® and 18S rRNA gene based multiplex PCR for detection of Plasmodium falciparum & Plasmodium vivax from field isolates of Bikaner,India

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Asian Pacific Journal of Tropical Medicine 2013年第5期6卷 346-351页

作者： Deepak Pakalapati Shilpi garg Sheetal Middha Abhishek Kochar Amit Kumar Subudhi Boopathi Pon Arunachalam sanjay Kumar Kochar Vishal Saxena Pareek RP Jyoti Acharya Dhanpat Kumar Kochar Ashis Das Center for Biotechnology Dept of Biological SciencesBirla Institute of Technology and SciencePilani-333031RajasthanIndia Department of Medicine Sardar Patel Medical CollegeBikaner-334003RajasthanIndia Medical Centre Birla Institute of Technology and SciencePilani-333031RajasthanIndia Kothari Medical and Research Institute BikanerRajasthan-334003India

Objective:To evaluate microscopy,OptiMAL? and multiplex PCR for the identification of Plasmodium falciparum（***） and Plasmodium vivax（***） from the field isolates of Bikaner,Rajasthan（Northwest India）.Methods:In this study,a multiplex PCR（*** and ***） was further developed with the incorporation of Plasmodium malariae（***） specific primer and also a positive *** performance of microscopy,plasmodium lactate dehydrogenase（pLDH） based malaria rapid diagnostic test OptiMAL? and 18S rRNA gene based multiplex PCR for the diagnosis of *** and *** was ***:The three species multiplex PCR ***,*** and ***) with an inbuilt positive control was developed and *** comparison with multiplex PCR,which showed the sensitivity and specificity of 99.36%（95%CI,98.11%-100.00%） and 100.00%（95%CI,100.00%-100.00%）,the sensitivity and specificity of microscopy was 90.44%（95%CI,88.849-95.04%） and 99.22%（95% CI,97.71%-100.00%）,and OptiMAL? was 93.58%（95%CI,89.75%-97.42%） and 97.69%（95%CI, 95.10%-100.00%）.The efficiencies were 99.65%,95.10%and 95.45%for multiplex *** and OptiMAL?.***:Our results raise concerns over the overall sensitivities of microscopy and OptiMAL?,when compared to the multiplex PCR and thus stress the need for new molecular interventions in the accurate detection of the malarial *** further highlights the fact that further developments are needed to improve the performance of rapid diagnostic tests at field level.

关键词： Malaria diagnosis Microscopy OptiMAL® Multiplex PCR 18S rRNA gene Plasmodium

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Common Fixed Point Theorems for Compatible and Weakly Compatible Maps in G-Metric Spaces

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Applied Mathematics 2012年第10期3卷 1128-1134页

作者： Asha Rani sanjay Kumar Naresh Kumar S. K. garg Departement of Mathematics Deenbandhu Chhotu Ram University of Science and Technology Murthal Sonepat Haryana India Department of Applied Sciences B. M. Institute of Engineering and Technology Raipur Sonepat Haryana India

In this paper first we prove common fixed point theorems for compatible and weakly compatible maps. Secondly, we prove common fixed point theorems for weakly compatible maps along with property (E.A.) and (CLRg) prope... 详细信息

关键词： G-metric Spaces Compatible Maps Weakly Compatible Maps Property (E.A.) (CLRg) Property

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One fifth of hospitalizations for peptic ulcer-related bleeding are potentially preventable

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World Journal of Gastroenterology 2014年第30期20卷 10504-10511页

作者： Ray Boyapati Sim Ye Ong Bei Ye Anuk Kruavit Nora Lee Rhys Vaughan sanjay Nurkar Peter Gibson Mayur garg Gastroenterology and Liver Transplant Unit Austin HospitalMelbourneVictoria 3128Australia Department of Gastroenterology and Hepatology Eastern Health and Monash UniversityMelbourneVictoria 3128Australia Department of Gastroenterology The Alfred Hospital and Monash UniversityMelbourneVictoria 3128Australia

AIM:To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease(PUD),erosive gastritis(EG)or duodenitis(ED).METHODS:Retrospective cohort study using ICD-10codes to identify all patients with upper gastrointestinal hemorrhage secondary to endoscopically proven PUD,EG or ED during the period from March 2007 to October 2010 in three major metropolitan hospitals in Melbourne,*** were divided into"high risk"(those who would benefit from gastroprotection)and"not high risk"groups as defined by established *** Rockall score,transfusion requirement,length of stay,rebleeding rates,need for surgery and in-hospital mortality was compared between"high risk"and"not high risk"*** the"high risk"group,those on gastroprotection and those with no gastroprotection were also ***:Five hundred and seven patients were included for analysis of which 174 were classified as high *** values of complete Rockall Score(5vs 4,P=0.002)and length of stay(5 d vs 4 d,P=0.04)were higher in the high risk group but in-hospital mortality was lower(0.6%vs 3.9%,P=0.03).130out of the 174 patients in the high risk group were not taking recommended gastroprotective therapy prior to *** history of PUD(OR=3.7,P=0.006)and clopidogrel use(OR=3.2,P=0.007)significantly predicted prescription of gastroprotective *** proton pump inhibitor protection rates of 50%-85%from published studies,an estimation of13%to 22%of the total number of the hospitalizations due to PUD or EG/ED related bleeding may have been ***:Up to one fifth of all hospitalizations for bleeding secondary to PUD or EG/ED are potentially preventable.

关键词： Peptic ulcer Gastrointestinal hemorrhage Preventio

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mpaired flow-mediated vasodilatation in Asian Indians with erectile dysfunction

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Asian Journal of Andrology 2013年第5期15卷 652-657页

作者： Tanuj Bhatia Aditya Kapoor Jatinder Kumar Archana Sinha Priyadarshi Ranjan Sudeep Kumar Naveen garg Satyendra-Tewari Aneesh Srivastava Rakesh Kapoor Pravin K Goel Departments of Cardiology Sanjay Gandhi PGIMS Lucknow 226014 India Urology and Renal Transplantation Sanjay Gandhi PGIMS Lucknow 226014 India

Endothelial dysfunction is the postulated link between coronary artery disease （CAD） and erectile dysfunction （ED）. Brachial artery flow-mediated vasodilatation （FMD） is a non-invasive surrogate marker for endothelial function assessment. Despite Asian Indians representing a considerable global CAD burden, data on FMD and ED in these patients are lacking. Of the 225 patients undergoing coronary angiography, 72% had ED （assessed using the International Index of Erectile Function （IIEF-5） questionnaire）; ED was moderate to severe in 61% of the patients. ED patients had a higher incidence of severe and diffuse angiographic CAD, a greater number of coronary vessels involved and a lower mean brachial artery FMD （6.40%±4.60% vs. 9.10%±4.87%, P〈0.001） compared to non-ED patients. A progressive reduction in FMD was noted with increasing severity of ED. Impaired FMD （ ≤ 5.5%） was twice as common in ED patients （52% vs. 24% without ED）. Patients with impaired FMD had higher ED prevalence （85% vs. 62%） and lower mean I IEF-5 scores compared to those with normal FMD. Impaired FMD was a significant ED predictor independent of other risk factors （odds ratio, 2.33; 95% confidence interval： 0.59-9.23; P=0.03）. An inverse correlation between FMD and ED severity was observed （r=-0.22; P=0.004）. ED is common among Asian Indians with angiographically documented CAD. Patients with ED have impaired FMD independent of other risk factors, suggesting that endothelial dysfunction is the underlying pathophysiology. Urologists and cardiologists need to be aware of the association between ED, CAD and endothelial dysfunction.

关键词： Asian Indians brachial artery flow mediated vasodilatation erectile dysfunction (ED)

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