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Computerised tomography vs magnetic resonance imaging for modeling of patient-specific instrumentation in total knee arthroplasty

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World Journal of Orthopedics 2015年第2期6卷 290-297页

作者： Paul Stirling Rejith Valsalan Mannambeth Agustin Soler Vineet Batta rajeev kumar malhotra Yegappan Kalairajah Department of Orthopaedic Surgery Luton and Dunstable University Hospital Catterall Unit Royal National Orthopaedi Hospital University College of Medical Sciences

AIM: To summarise and compare currently available evidence regarding accuracy of pre-operative imaging, which is one of the key choices for surgeons contemplating patient-specific instrumentation(PSI) ***: The MEDLINE and EMBASE medical literature databases were searched, from January 1990 to December 2013, to identify relevant studies. The data from several clinical studies was assimilated to allow appreciation and comparison of the accuracy of each modality. The overall accuracy of each modality was calculated as proportion of outliers > 3% in the coronal plane of both computerised tomography(CT) or magnetic resonance imaging(MRI). RESULTS: Seven clinical studies matched our inclusion criteria for comparison and were included in our study for statistical analysis. Three of these reported series using MRI and four with CT. Overall percentage of outliers > 3% in patients with CT-based PSI systems was 12.5% vs 16.9% for MRI-based systems. These results were not statistically significant. CONCLUSION: Although many studies have been undertaken to determine the ideal pre-operative imaging modality, conclusions remain speculative in the absence of long term data. Ultimately, information regarding accuracy of CT and MRI will be the main determining factor. Increased accuracy of pre-operative imaging could result in longer-term savings, and reduced accumulated dose of radiation by eliminating the need for post-operative imaging and revision surgery.

关键词： Patient-specific instrumentation Arthroplasty Alignment Accuracy Cost-effectiveness

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Predictors of cerebrospinal fluid GeneXpert MTB/RIF positivity in patients with tuberculous meningitis:A prospective cohort study

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Asian Pacific Journal of Tropical Medicine 2024年第10期17卷 465-472页

作者： Priyanka Gupta Neeraj kumar Ravindra kumar Garg Hardeep Singh malhotra Imran Rizvi Rajesh Verma Praveen kumar Sharma Ravi Uniyal Shweta Pandey Amita Jain Parul Jain Department of Neurology King George’s Medical UniversityLucknowIndia Department of Microbiology King George’s Medical UniversityLucknowIndia

Objective:To identify the clinical,laboratory,and radiological markers that could predict a positive GeneXpert result in patients suspected of tuberculous ***:In this prospective,observational study,patients with tuberculous meningitis were systematically *** clinical,laboratory[including cerebrospinal fluid(CSF)microscopy,culture,and GeneXpert],and neuroimaging factors were *** participants were administered anti-tuberculous treatment and corticosteroids.A six-month follow-up was done to evaluate the ***:Of the 116 patients studied,54(46.6%)tested positive for GeneXpert,while 62(53.4%)were *** cranial nerve involvement(OR 3.71,95%CI 1.052-13.09,P=0.04)and the presence of basal exudates on neuroimaging(OR 5.22,95%CI 2.03-13.42,P=0.001)emerged as independent predictive factors for a positive GeneXpert result.A positive CSF GeneXpert result(P=0.002)and drug resistance(P=0.004)were significantly linked to adverse ***,a high score on the Medical Research Council stageⅢ(OR 5.64,95%CI 1.18-26.87,P=0.03)and elevated CSF cell counts(OR 1.002,95%CI 1.00-1.001,P=0.03)were identified as independent predictors of poor ***:Third cranial nerve involvement and the presence of basal exudates were significant indicators of a positive GeneXpert *** stageⅢdisability and elevated CSF cell counts predicted poor outcomes.

关键词： Tuberculous meningitis Mycobacterium tuberculosis Cerebrospinal fluid Ziehl-Neelsen staining GeneXpert

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Disseminated cysticercosis presenting with bilateral proptosis: A case report

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Asian Pacific Journal of Tropical Medicine 2019年第7期12卷 337-338页

作者： Ravindra kumar Garg Neeraj kumar Imran Rizvi Hardeep Singh malhotra Department of Neurology King George’s Medical University Uttar Pradesh

Rationale: Disseminated cysticercosis is characterized by presence of cysts in multiple body organs, like brain, skin, eyes, muscles and rarely heart and *** concerns: A 22-year-old man presented with bilateral proptosis of 1-year duration. He also had two episodes of cysticercosis encephalitis. In the second episode of encephalopathy, the patient ***: Disseminated ***: Corticosteroids(Initially intravenous dexamethasone 0.4 mg/kg/day for 2 weeks, followed by oral prednisolone 1.0 mg/kg/day).Outcomes: The patient died of cysticercosis encephalitis approximately 2 months ***: Disseminated cysticercosis in our case presented only with proptosis as he had very heavy infestation of the brain and eyes. Heavy larval infestation in a patient with disseminated cysticercosis can be life-threatening.

关键词： Neurocysticercosis Cysticercosis encephalitis Proptosis

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Total hip replacement for arthritis following tuberculosis of hip

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World Journal of Orthopedics 2015年第8期6卷 636-640页

作者： Vijay kumar Bhavuk Garg Rajesh malhotra Department of Orthopaedics All India Institute of Medical Sciences

AIM: To present the results of total hip arthroplasty(THA) for post tubercular arthritis of the hip ***: Sixty-five patients(45 male, 20 female) with previously treated tuberculosis of the hip joint underwent cementless THA for post tubercular arthritis. The average age at the time of THA was 48 years(range 29 to 65 years). Erythrocyte sedimentation rate, C reactive protein, chest X-ray and contrast enhanced magnetic resonance imaging were done preoperatively to confirm resolution of the disease and to rule out any residual disease. Intra-operative samples were taken for microbiological examination, polymerase chain reaction(PCR) and histological examination. Patients were started on anti-tubercular drugs one week before the operation and continued for 6 mo post operatively. The patients were followed up clinically using the Harris hip score as well as radiologically for any loosening of the implants, osteolysis and any recurrence of tuberculosis. Any complications especially the recurrence of the infection was also ***: The mean interval from completion of antitubercular therapy for tuberculosis to surgery was 4.2 years(range, 2-6 years). Preoperatively, 17 patients had ankylosis whereas 48 patients had functional but painful range of motion. The mean surgical time was 97 min(range, 65-125) whereas the mean blood loss was 600 m L(range, 400-900 m L). The average follow up was 8.3 years(range 6-11 years). The average Harris Hip score improved from 27 preoperatively to 91 at the final follow up. Seventeen patients had acetabularprotrusion which was managed with impaction grafting and cementless acetabular cup. The bone graft had consolidated in all these 17 patients at the follow up. Two patients developed discharging sinuses at 9 and 11 mo postoperatively respectively. The discharge tested positive for tuberculosis on the PCR. Both these patients were put on antitubercular therapy for another year. Both of them recovered and had no evidence of

关键词： Total hip replacement Cementless hip replacement Tuberculosis hip Post-tubercular arthritis hip Total hip arthroplasty

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Correlations of Stream Flow and Climatic Variables for a Large Glacierized Himalayan Basin

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Journal of Water Resource and Protection 2014年第14期6卷 1326-1334页

作者： Manohar Arora Rakesh kumar Jatin malhotra Naresh kumar National Institute of Hydrology Roorkee India

Streamflow represents the integrated response of a watershed to climatic variables, particularly precipitation and air temperature. In this study, relationships between discharge and hydro meteorological parameters near the snout of Gangotri Glacier were investigated. The auto correlations and multi day influence of temperature and rainfall on discharge can provide valuable information about the Glacier response which can be helpful for estimating discharge in data scarce regions. The data for eight continuous ablation seasons (2000-2007) were used investigating correlations, lag cross correlations and multivariate regression analysis between daily mean discharge, daily mean temperature and daily rainfall, whereas last four years data (2008-2011) was used to simulate the daily discharge from the established relations. Snowmelt discharge varies during the rise in the annual temperature cycle in response to the combination of temperature variation and the amount of water held in the evolving snowpack. The discharge and temperature is highly auto correlated. It was found that discharge of a particular day (Qi) is well represented by the regression equation having Qi-1, Ti, and Ri. Such developed regression equation can be used for computing discharge once its input variables are available. The regression equation developed using the eight year data i.e. Qi = 2.962 + 1.011Qi-1?- 0.422Ti + 0.203Ri is used for forecasting of discharge. For all the years discharge was computed with high accuracy (R2?-?0.93).

关键词： Gangotri Glacier Correlations Hydro Meteorological Variables Storage Characteristics Discharge

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Primary biliary cirrhosis in India

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Hepatobiliary & Pancreatic Diseases International 2006年第1期5卷 105-109页

作者： Shiv kumar Sarin Rajnish Monga Bimaljeet Singh Sandhu Barjesh Chander Sharma Puja Sakhuja Veena malhotra Department of Gastroenterology Department of Pathology G. B. Pant Hospital

BACKGROUND: Primary biliary cirrhosis (PBC) is a rare cause of chronic liver disease in India. We analyzed the clinical, biochemical, serological and histological features of patients with PBC for over a 10-year period. METHODS: PBC was diagnosed by the presence of raised level of serum alkaline phosphatase (ALP), anti-mitochondrial antibody (AMA) positivity (1:40 dilution), and/or diagnostic liver histology. RESULTS:Fifteen female patients with mean age of 46.5±11 years were studied. Pruritis (80%) followed by jaundice (67%), skin changes (pigmentation, coarsening, xanthelesma and vitiligo) (67%) and fatigue (60%) were common symptoms. The mean duration of the symptoms was 3.5± 5.4 years (3 months to 20 years). Dryness of eyes was observed in only 2 patients. Hepatomegaly was noted in 87% of the patients and ascites at presentation in 40%. Mean levels of bilirubin and albumin at the time of diagnosis were 3.4±3.3 mg/dl and 3.5±0.8 g/dl, respectively. The level of serum ALP ranged from 54 to 2400 IU/L, with a median being 552 IU/L (2×ULN). In all the 15 patients with AMA positive, 8(53%) were also positive for either anti-nuclear or anti-smooth muscle antibodies. Two patients presented with persistently elevated SAP after an acute hepatitic illness. Liver biopsy was available in 13 patients, diagnostic of PBC Ⅱ & Ⅲ(8) and with evidence of cirrhosis (5). Associated autoimmune disorders were observed in 5 patients (33%). The mean time for follow-up was 26±21 months (1 to 87 months). In 4 deaths, 3 were due to liver related causes. CONCLUSION: PBC is a rare cause of chronic liver disease in India. PBC in India, unlike in the West, presents late, often with features of cirrhosis and decompensation.

关键词： primary biliary cirrhosis chronic cholestatic liver disease India

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A randomized trial of a 4- vs 12-week daily interferon dose regimen combined with ribavirin in treatment of patients with chronic hepatitis C

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Hepatobiliary & Pancreatic Diseases International 2004年第1期3卷 42-48页

作者： Shiv K. Sarin Ankur Goyal Sudheer kumar Rajkumar C. Guptan Abid Zaffar Hashmi Pooja Sakhuja Veena malhotra Departments of Gastroenterology G. 13. Pant Hospital New Delhi 110002 India Departments of Pathology G. 13. Pant Hospital New Delhi 110002 India

BACKGROUND: Standard combination-therapy of ribavi- rin with alternate day interferon (IFN) in patients with chronic hepatitis C ( CHC) has been reported to achieve 30%-55% sustained viral response. Early reduction of viral load by daily dosage of IFN could enhance viral clearance. However, the duration of daily dosage protocol and the likely side-effects have not been well studied. We compared the efficacy and safety of a 4- vs 12-week daily IFN dosage in patients with CHC. METHODS: Fifty-nine, histologically proven CHC patients having ALT levels >1.5 ×ULN were divided randomly into 2 groups, group I was given IFN 3 MIU daily for 4 weeks, followed by tiw up to 12 months and group was given IFN 3 MIU daily for 12 weeks, followed by tiw up to 12 months. Ribavirin was given in a dose of 800-1200 mg/d for 12 months. RESULTS: Fifty-two of the 59 patients (group group completed the study. The pretreatment vari- ables and the prevalence of HCV genotype 1 were compara- ble between the groups. Nine patients (29%) in group and 6 (25%) in group had stage 3, 4 fibrosis. At the end of 4, 12, 24 and 52 weeks, HCV RNA negativity was ob- served in 27%, 54%, 65% and 71% in group I and 38%, 54%, 71% and 75% in group respectively (P =ns). Four of the eight (50%) patients with genotype 1 and 30 (69.8%) of 43 patients with genotype non-1 responded to therapy (P =ns). Sustained viral response was achieved in 61% and 71% in groups respectively. None of the variables predicted non-response precisely. No serious adverse effects were observed and they were comparable between the two groups. CONCLUSION: Daily IFN dosage with ribavirin is safe and can achieve response in up to 65% patients. Since the effica- cy of a 4-week daily dosage of IFN is comparable to a 12- week schedule, we recommend the former regimen.

关键词： hepatitis C virus hepatitis C interferon ribavirin induction dosage sustained viral response chronic hepatitis combination therapy

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Feasibility and efficacy of gentamicin for treating neonatal sepsis in community-based settings:a systematic review

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世界儿科杂志:英文版 2016年第4期12卷 408-414页

作者： Nishant Jaiswal Meenu Singh Ritika Kondel Navjot Kaur Kiran K.Thumburu Ajay kumar Harpreet Kaur Neelima Chadha Neeraj Gupta Amit Agarwal Samir malhotra Nusrat Shafiq ICMR Advanced Centre for Evidence Based Child Health Postgraduate Institute of Medical Education and ResearchChandigarhIndia Department of Pharmacology Postgraduate Institute of Medical Education and ResearchChandigarh160012India Department of Pediatrics Postgraduate Institute of Medical Education and ResearchChandigarhIndia Dr.Tulsi Das Library Postgraduate Institute of Medical Education and ResearchChandigarhIndia Department of Library University Business SchoolPunjab UniversityChandigarhIndia Department of Pediatrics AIIMSJodhpurRajasthanIndia

Background:Neonatal sepsis is a leading cause of neonatal deaths in developing *** current recommended in-hospital treatment is parenteral ampicillin(or penicillin)and gentamicin in young infants for 10-14 days;however,very few could access and *** current review is to evaluate the feasibility of gentamicin in community based ***:Both observational and randomized controlled trials were ***,Embase,Cochrane Central Register of Controlled Trials and Central Trial Register of India were searched until September *** assessed the risk of bias by Cochrane Collaboration’s"risk of bias"***:Two observational studies indicated feasibility ensuring coverage of population,decrease in case fatality rate in the group treated by community health *** an RCT,no significant difference was observed in the treatment failure rates[odds ratio(OR)=0.88],and the mortality in the first and second week(OR=1.53;OR=2.24)between gentamicin and ceftriaxone *** the gentamicin group,the combination of penicillin and gentamicin showed a lower rate of treatment failure(OR=0.44)and mortality at second week of life(OR=0.17)as compared to the combination of gentamicin and oral ***:Gentamicin for the treatment of neonatal sepsis is both feasible and effective in community-based settings and can be used as an alternative to the hospitalbased care in resource compromised *** there was less evidence in the management of neonatal sepsis in hospitals as was seen in this review in which we included only one RCT and three observational studies.

关键词： gentamicin neonatal sepsis neonates

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Compartmentalized Metabolic Engineering for Artemisinin Biosynthesis and Effective Malaria Treatment by Oral Delivery of Plant Cells

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Molecular Plant 2016年第11期9卷 1464-1477页

作者： Karan malhotra Mayavan Subramaniyan Khushboo Rawat Md. Kalamuddin M. Irfan Qureshi Pawan malhotra Asif Mohmmed Katrina Cornish Henry Daniell Shashi kumar1 Metabolic Engineering Group Malaria Research Group International Centre for Genetic Engineering and Biotechnology Aruna Asaf Ali Marg New Delhi 110067 India Department of Biotechnology Jamia Millia Islamia New Delhi 110025 India Department of Horticulture and Crop Science The Ohio State University Wooster OH 44691 USA Department of Biochemistry School of Dental Medicine University of Pennsylvania Philadelphia PA 19104 USA

Artemisinin is highly effective against drug-resistant malarial parasites, which affects nearly half of the global population and kills 〉500 000 people each year. The primary cost of artemisinin is the very expensive process used to extract and purify the drug from Artemisia annua. Elimination of this apparently unnecessary step will make this potent antimalarial drug affordable to the global population living in endemic regions. Here we reported the oral delivery of a non-protein drug artemisinin biosynthesized （~0.8 mg/g dry weight） at clinically meaningful levels in tobacco by engineering two metabolic pathways targeted to three different cellular compartments （chloroplast, nucleus, and mitochondria）. The doubly transgenic lines showed a three-fold enhancement of isopentenyl pyrophosphate, and targeting AACPR, DBR2, and CYP71AV1 to chloroplasts resulted in higher expression and an efficient photo-oxidation of di- hydroartemisinic acid to artemisinin. Partially purified extracts from the leaves of transgenic tobacco plants inhibited in vitro growth progression of Plasmodium falciparum-infected red blood cells. Oral feeding of whole intact plant cells bioencapsulating the artemisinin reduced the parasitemia levels in challenged mice in comparison with commercial drug. Such novel synergistic approaches should facilitate low-cost production and delivery of artemisinin and other drugs through metabolic engineering of edible plants.

关键词： bioencapsulation oral delivery of plant material dihydroartemisinic acid isopentenyl pyrophosphate,plant transformation drug biosynthesis

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Mild oxidative stress is beneficial for sperm telomere length maintenance

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World Journal of Methodology 2016年第2期6卷 163-170页

作者： Swetasmita Mishra rajeev kumar Neena malhotra Neeta Singh Rima Dada Laboratory for Molecular Reproduction and Genetics Department of Anatomy All India Institute of Medical Sciences Department of Urology All India Institute of Medical Sciences Department of Obstetrics and Gynaecology All India Institute of Medical Sciences

AIM:To evaluate telomere length in sperm DNA and its correlation with oxidative stress(normal,mild,severe).METHODS:The study included infertile men(n=112)and age matched fertile controls(n=102).The average telomere length from the sperm DNA was measured using a quantitative real time PCR based *** reactive oxygen species(ROS)and 8-Isoprostane(8-IP)levels were measured by chemiluminescence assay and ELISA ***:Average sperm telomere length in infertile men and controls was 0.609±0.15 and 0.789±0.060,respectively(P35 RLU/s/million sperm)average telomere length was decreased to 0.595±***:Mild oxidative stress results in lengthening of telomere length,but severe oxidative stress results in shorter *** telomere maintenance is a complex trait,the study shows that mild oxidative stress is beneficial in telomere length maintenance and thus a delicate balance needs to be established to maximize the beneficial effects of free radicals and prevent harmful effects of supra physiological *** molecular evaluation of telomere structure,its correlation with oxidative stress would aid in elucidating the cause of accelerated telomere length attrition.

关键词： Telomere Oxidative stress Reactive oxygen species Infertility 8-Isoprostane

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