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Dushyant S Dahiya,Sumant Inamdar,Abhilash Perisetti,Hemant Goyal,Amandeep Singh,Rajat Garg,Chin-I Cheng,Asim Kichloo,Mohammad Al-Haddad,Neil Sharma 대한소화기 기능성질환∙운동학회 2022 Journal of Neurogastroenterology and Motility (JNM Vol.28 No.4
Background/Aims We aim to assess the influence of obesity on gastroparesis (GP) hospitalizations in the United States (US). Methods The National Inpatient Sample was analyzed from 2007-2017 to identify all adult hospitalizations with a primary discharge diagnosis of GP. They were subdivided based on the presence or absence of obesity (body mass index > 30). Hospitalization characteristics, procedural differences, all-cause inpatient mortality, mean length of stay (LOS), and mean total hospital charge (THC) were identified and compared. Results From 2007-2017, there were 140 293 obese GP hospitalizations accounting for 13.75% of all GP hospitalizations in the US. Obese GP hospitalizations were predominantly female (76.11% vs 64.36%, P < 0.001) and slightly older (51.9 years vs 50.8 years, P < 0.001) compared to the non-obese cohort. Racial disparities were noted as Blacks (25.49% vs 22%, P < 0.001) had higher proportions of GP hospitalizations with obesity compared to the non-obese cohort. Furthermore, we noted higher rates of inpatient upper endoscopy utilization (6.05% vs 5.42%, P < 0.001), longer mean LOS (5.71 days vs 5.32 days, P < 0.001), and higher mean THC ($53 373 vs $45 040, P < 0.001) for obese GP hospitalizations compared to the non-obese group. However, obese GP hospitalizations had lower rates of inpatient mortality (0.92% vs 1.33%, P < 0.001), and need for nutritional support with endoscopic jejunostomy (0.25 vs 0.56%, P < 0.001) and total parenteral nutrition (1.46% vs 2.33%, P < 0.001) compared to the non-obese cohort. Conclusions In the US, compared to non-obese, a higher proportion of obese GP hospitalizations were female and Blacks. Obese GP hospitalizations also had higher THC, LOS, and rates of upper endoscopy.
Radiation Proctitis and Management Strategies
Dushyant Singh Dahiya,Asim Kichloo,Faiz Tuma,Michael Albosta,Farah Wani 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.1
Radiotherapy (RT) is a treatment modality that uses high-energy rays or radioactive agents to generate ionizing radiation againstrapidly dividing cells. The main objective of using radiation in cancer therapy is to impair or halt the division of the tumor cells. Over the past few decades, advancements in technology, the introduction of newer methods of RT, and a better understanding of thepathophysiology of cancers have enabled physicians to deliver doses of radiation that match the exact dimensions of the tumor forgreater efficacy, with minimal exposure of the surrounding tissues. However, RT has numerous complications, the most commonbeing radiation proctitis (RP). It is characterized by damage to the rectal epithelium by secondary ionizing radiation. Based onthe onset of signs and symptoms, post-radiotherapy RP can be classified as acute or chronic, each with varying levels of severityand complication rates. The treatment options available for RP are limited, with most of the data on treatment available from casereports or small studies. Here, we describe the types of RT used in modern-day medicine and radiation-mediated tissue injury. Wehave primarily focused on the classification, epidemiology, pathogenesis, clinical features, treatment strategies, complications, andprognosis of RP.
A nationwide analysis on the influence of obesity in inflammatory bowel disease hospitalizations
Dushyant Singh Dahiya,Asim Kichloo,Farah Wani,Jagmeet Singh,Dhanshree Solanki,Hafeez Shaka 대한장연구학회 2022 Intestinal Research Vol.20 No.3
Background/Aims: Proinflammatory cytokines released from adipocytes can influence the development, progression, and treatment of inflammatory bowel disease (IBD), and may be associated with worse clinical outcomes. Methods: For 2016–2018, we analyzed data from the Nationwide Inpatient Sample to identify adult (≥18 years) hospitalizations with a primary discharge diagnosis of IBD. The study sample was divided based on the presence or absence of obesity. The primary outcomes included inpatient mortality, while the secondary outcomes consisted of system-based complications and disease implications on the United States healthcare system.Results: We identified 282,005 hospitalizations of IBD from 2016 to 2018. Of these hospitalizations, 26,465 (9.4%) had a secondary diagnosis of obesity while 255,540 (90.6%) served as controls. IBD hospitalizations with obesity had a higher mean age (47.9 years vs. 45.2 years, <i>P</i><0.001), middle age (range, 40–65 years) predominance (37.7% vs. 28.9%, <i>P</i><0.001), female predominance (64.1% vs. 52.5%, <i>P</i><0.001) and higher proportion of patients with comorbidities compared to the non-obese cohort. White predominance was observed in both subgroups. No difference in the odds of inpatient mortality was noted between the 2 subgroups; however, IBD hospitalizations with obesity had higher mean total hospital charge ($50,126 vs. $45,001, <i>P</i><0.001), longer length of stay (5.5 days vs. 4.9 days, <i>P</i><0.001) and higher proportion of complications compared to the non-obese cohort.Conclusions: Obese IBD hospitalizations had higher length of stay, total hospital charge, and complications compared to the non-obese cohort.
Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States
Dushyant Singh Dahiya,Abhilash Perisetti,Hemant Goyal,Sumant Inamdar,Amandeep Singh,Rajat Garg,Chin-I Cheng,Mohammad Al-Haddad,Madhusudhan R. Sanaka,Neil Sharma 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.3
Background/Aims: Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. Methods: We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. Results: From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p<0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. Conclusions: Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.
Morphology of the Esophageal Hiatus: Is It Different in 3 Types of Hiatus Hernias?
( Dushyant Kumar ),( Ali Zifan ),( Gary Ghahremani ),( David C Kunkel ),( Santiago Horgan ),( Ravinder K Mittal ) 대한소화기 기능성질환·운동학회 2020 Journal of Neurogastroenterology and Motility (JNM Vol.26 No.1
Background/Aims The esophageal hiatus is formed by the right crus of the diaphragm in the majority of subjects. Contraction of the hiatus exerts a sphincter-like action on the lower esophageal sphincter (LES). The aim is to study the hiatal anatomy (using CT scan imaging) and function (using high-resolution manometry [HRM]), and esophageal motor function in patients with sliding and paraesophageal hiatal hernia. Methods We assessed normal subjects (n = 20), patients with sliding type 1 hernia (n = 18), paraesophageal type 2 hernia (n = 19), and mixed type 3 hernia (n = 19). Hernia diagnosis was confirmed on the upper gastrointestinal series. The hiatal morphology was constructed from the CT scan images. The LES pressure and relaxation, percent peristalsis, bolus pressure, and hiatal squeeze pressure were assessed by HRM. Results The CT images revealed that the esophageal hiatus is formed by the right crus of the diaphragm in all normal subjects and 86% of hernia patients. The hiatus is elliptical in shape with a surface area of 1037 mm<sup>2</sup> in normal subjects. The hiatal dimensions were larger in patients compared to normal subjects. The HRM revealed impaired LES relaxation and higher bolus pressure in patients with paraesophageal compared to the sliding hernia. The hiatal pinch on HRM was recognized in significantly higher number of patients with sliding as compared to paraesophageal hernia. Conclusions Using a novel approach, we provide details of the esophageal hiatus in patients with various kinds of hiatal hernia. Impaired LES relaxation in paraesophageal hernia may play a role in its pathophysiology and genesis of symptoms.
LCDs : Lane-Changing Aid System Based on Speed of Vehicles
Jetendra Joshi,Manash Jyoti Deka,Saurabh Jha,Dushyant Yadav,Devjeet Singh Choudhary,Yash Agarwal,Kritika Jain 대한전자공학회 2016 IEIE Transactions on Smart Processing & Computing Vol.5 No.3
Lane change is an important issue in microscopic traffic flow simulations and active safety. Overtaking and changing lanes are dangerous driving maneuvers. This approach presents a lane-changing system based on speed and a minimum gap between vehicles in a vehicular ad hoc network (VANET). This paper proposes a solution to ensure the safety of drivers while changing lanes on highways. Efficient routing protocols could play a crucial role in VANET applications, safeguarding both drivers and passengers, and thus, maintaining a safe on-road environment. This paper focuses on the development of an intelligent transportation system that provides timely, reliable information to drivers and the concerned authorities. A test bed is created for the techniques used in the proposed system, where analysis takes place in an on-board embedded system designed for vehicle navigation. The designed system was tested on a four-lane road in Neemrana, India. Successful simulations were conducted with real-time network parameters to maximize quality of service and performance using Simulation of Urban Mobility and Network Simulator 2 (NS-2). The system implementation, together with the findings, is presented in this paper. Illustrating the approach are results from simulation using NS-2.
Jwalant K. Bhatt,Chirag M. Ghevariya,Dushyant R. Dudhagara,Rahul K. Rajpara,Bharti P. Dave 한국미생물학회 2014 The journal of microbiology Vol.52 No.11
For the first time, Cochliobolus lunatus strain CHR4D, amarine-derived ascomycete fungus isolated from historicallycontaminated crude oil polluted shoreline of Alang-Sosiyaship-breaking yard, at Bhavnagar coast, Gujarat has beenreported showing the rapid and enhanced biodegradationof chrysene, a four ringed high molecular weight (HMW)polycyclic aromatic hydrocarbon (PAH). Mineral Salt Broth(MSB) components such as ammonium tartrate and glucosealong with chrysene, pH and trace metal solution have beensuccessfully optimized by Response Surface Methodology(RSM) using central composite design (CCD). A validated,two-step optimization protocol has yielded a substantial93.10% chrysene degradation on the 4th day, against unoptimized56.37% degradation on the 14th day. The resultsdepict 1.65 fold increase in chrysene degradation and 1.40fold increase in biomass with a considerable decrement intime. Based on the successful laboratory experiments, C. lunatusstrain CHR4D can thus be predicted as a potentialcandidate for mycoremediation of HMW PAHs impactedenvironments.