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Poster Session : PS 0293 ; Geriatrics : Pulmonary Embolism in the Very Elderly
( Nihar Pandit ),( Kausalia C ),( Vivek Bansal ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: The incidence of venous thromboembolism (VTE; combined deep vein thrombosis-DVT and pulmonary embolism- PE) rises with age, especially over 65 years. Immobilization and cancer are important etiologies. There are no studies in the subset of very elderly patients (>90 years). Methods: We undertook a retrospective observational study for PE in patients above 90 years, to study the presenting symptoms, etiology and outcomes. Results: 20 patients over 90 years of age were referred for VTE over one year, of which 7 had PE. Tachypnoea (4/7; 57%) observed by the carer was the most common symptom. All patients had hypoxia on monitoring. Electrocardiogram showed sinus tachycardia with no changes of right ventricular strain; despite four of the seven patients having massive/ submassive PE. Asymptomatic proximal DVT was found in 3 of the 7 patients. The other patients likely had an insitu PE. None had a prior history of VTE. 6 of the 7 patients had immobility (> 3 months) as the risk factor. Only one patient was found to have a newly diagnosed colon cancer, investigated for iron defi - ciency anemia. Age related cancer screening was not performed in view of advanced age and poor functional status. The patient with colon cancer had a Inferior vena cava fi lter inserted, while the rest received Warfarin or Low molecular weight heparin with careful monitoring for a period of three months. None had a major bleed. Conclusions: Increased respiratory rate and hypoxemia is the commonest clinical presentation. Increased awareness by the carer is essential. Immobility remains a major non modifi able risk factor. Despite this, none were given extended duration of anticoagulation. We propose a data registry from different institutions given the small subset of patients to further study this vulnerable group.
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Poster Session:PS 0556 ; Oncology : Pulmonary Tumor Thrombotic Microangiopathy; The Elusive Entity
( Nihar Pandit ),( Jackie Tan ),( Kausalia Chinniah ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Case: A 60 year old community ambulant male, diagnosed with adenocarcinoma of the esophagus with intra-abdominal metastasis and was undergoing chemotherapy. He presented with progressive breathlessness and lower limb swelling of two weeks duration. On examination, he had normal blood pressure, tachypnea, hypoxia. His electrocardiogram showed sinus tachycardia, chest Xray was clear. Progress: D dimer was elevated and hence a Computed tomogram, pulmonary angiogram protocol was performed. It revealed a tiny fi lling defect in the right upper lobe pulmonary artery with right ventricular strain. Trans-thoracic echo showed normal left ventricular function, severely dilated right chambers, with impaired systolic function and severe pulmonary hypertension, systolic pressure of 77mmHg. Compression ultrasonography did not reveal deep vein thrombosis in the lower limbs. He was treated with oxygen and low molecular weight heparin. Over the next 72 hours, his condition progressively worsened and eventually had a cardiac arrest due to a ventricular asystole. Conclusion: The tiny pulmonary embolus could not account for the severe pulmonary hypertension and progressive shortness of breath despite treatment. Acute cor pulmonale due to pulmonary tumor thrombotic microangiopathy (PTTM) should be considered in the differential diagnosis of patients presenting with acute or subacute shortness of breath, particularly with known cancer. A close differential is microscopic pulmonary tumor embolism. Lung biopsy remains the gold standard but there is little information on the safety in acutely ill patients with pulmonary hypertension. At present, treatment targeting the primary tumor is the only therapeutic option. An algorithm proposed by Patragnini A (J Cardiovasc Med; 2012) to improve the antemortem PTTM diagnosis is useful.
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Nihar Ranjan Dash,Mohammad Tahseen Al Bataineh 대한당뇨병학회 2021 Diabetes and Metabolism Journal Vol.45 No.1
Background Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease with a high prevalence worldwide, especially among overweight and obese populations. T2DM is multifactorial with several genetic and acquired risk factors that lead to insulin resistance. Mounting evidence indicates that alteration of gut microbiome composition contribute to insulin resistance and inflammation. However, the precise link between T2DM and gut microbiome role and composition remains unknown. Methods We evaluated the metabolic capabilities of the gut microbiome of twelve T2DM and six healthy individuals through shotgun metagenomics using MiSeq platform. Results We identified no significant differences in the overall taxonomic composition between healthy and T2DM subjects when controlling for differences in diet. However, results showed that T2DM enriched in metabolic pathways involved in menaquinone (vitamin K2) superpathway biosynthesis (PWY-5838) as compared to healthy individuals. Covariance analysis between the bacterial genera and metabolic pathways displaying difference in abundance (analysis of variance P<0.05) in T2DM as compared to healthy subjects revealed that genera belonging Firmicutes, Actinobacteria, and Bacteroidetes phyla contribute significantly to vitamin K2 biosynthesis. Further, the microbiome corresponding to T2DM with high glycosylated hemoglobin (HbA1c) (>6.5%) exhibit high abundance of genes involved in lysine biosynthesis and low abundance of genes involved in creatinine degradation as compared to T2DM with lower HbA1c (<6.5%). Conclusion The identified differences in metabolic capabilities provide important information that may eventually lead to the development of novel biomarkers and more effective management strategies to treat T2DM.
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Sahoo, Nihar Ranjan,Kumar, Pushpendra,Bhushan, Bharat,Bhattacharya, T.K.,Sharma, Arjava,Dayal, Sanker,Pankaj, Prabhat Kumar,Sahoo, Monalisa Asian Australasian Association of Animal Productio 2010 Animal Bioscience Vol.23 No.8
Serum lysozyme gene is one of the important genes influencing the immune system as its product can cause lysis of bacterial cell wall by cleaving the peptidoglycan layer. The present investigation on the serum lysozyme gene of Indian riverine buffalo was undertaken with the objectives to identify and characterize single nucleotide polymorphic patterns by PCR-SSCP method as well as to study the effect of different genotypes on serum lysozyme activity and somatic cell count. A total of 280 animals comprising four different famous bubaline breeds (Murrah, Mehsana, Surti and Bhadawari), spread over six different farms across the country were used for this study. A 276 bp (partial intron 2, complete exon 3 and partial intron 3) fragment of lysozyme gene was screened for polymorphism using the SSCP technique. Four genotypes namely AA, AB, BC and AC were observed, out of which BC genotype was found to be the most frequent. Among these three alleles, C allele (0.38) was most prevalent in these populations. Various SSCP allelic variants were cloned for sequencing and sequences were submitted to NCBI Genbank. From the alignment of the nucleotide sequences of various allelic variants, it was found that there were differences in 12 positions among the alleles, out of which maximum variation (at 8 places) was found in the intronic region. The allele A was closer to allele-C than allele-B. Allele B was phylogenetically equidistant from both of the other alleles. Mean lysozyme activity determined in serum samples of different animals of Murrah buffalo was $27.35{\pm}2.42\;{\mu}g$ per ml of serum, whereas the mean somatic cell count was $1.25{\pm}0.13{\times}10^5$ cells per ml of milk. The SSCP pattern-wise effects of various genotypes on lysozyme activity and SCC were analyzed. Although the mean values were apparently different in various genotypes, these differences were statistically non-significant. It can be concluded that the riverine buffaloes are sufficiently polymorphic with respect to serum lysozyme gene. The absence of AA genotype in Bhadawari breed of buffalo can be considered as a marker for breed characterization. The difference of four nucleotides in exon-3 indicates high selection pressure on the gene.
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Dash, Nihar,Chipem, Francis A.S.,Krishnamoorthy, G. Korean Society of Photoscience 2009 Photochemical & photobiological sciences Vol.8 No.12
The effect of $\beta$-cyclodextrin ($\beta$-CD) inclusion complex formation on the hydrogen bond-induced intramolecular charge transfer (ICT) of 2-(4'-N,N-dimethylamino)phenylimidazo[4,5-b]pyridine (DMAPIP-b) has been examined by fluorescence excitation, emission and time-resolved fluorescence techniques. The study reveals that DMAPIP-b forms 1 : 1 inclusion complex with $\beta$-CD. The host-guest complex is formed by partial inclusion of DMAPIP-b, i.e. only the dimethylaminophenyl ring is encapsulated inside the core of the $\beta$-CD nanocavity. The imidazopyridine ring of the guest molecule resides outside CD cavity and forms H-bonds with the water molecules that are present near the rim and in the bulk phase. $^1H$ NMR studies are used to confirm the inclusion complex. The H-bond of water with the pyridine nitrogen ensures the formation of the ICT state and both normal and ICT emissions are enhanced inside the $\beta$-CD cavity. Fluorescence lifetime measurements suggest that the formation of the ICT state from the locally excited state is irreversible. Dual emission is observed in the presence of $\beta$-CD at pH ~ 3.5, due to emission from monocations formed by the protonation of pyridine nitrogen (MC1) and imidazole nitrogen (MC2).
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Modeling challenges affecting the performance of major ports of India
Nanyam V.P.S. Nihar,Kumar Jha Neeraj 한국해운물류학회 2023 The Asian journal of shipping and Logistics Vol.39 No.3
Despite several initiatives taken by government of India since 2013 to improve the performance of major ports, growth was not as anticipated. Hence, there is a need to understand the performance of these major ports during 2013–2020 and to identify the critical challenges that affect their performance. Design/methodology/approach: Performance analysis was conducted using Malmquist productivity index (MPI) and critical challenges were identified using interpretive structural modelling (ISM) technique as well as the cross-impact matrix multiplication (MICMAC). Findings: Ten major ports in terms of operational, 12 ports in terms of service quality, and six ports in terms of financial performance have been categorised as high performers, based on the MPI values. 19 challenges affecting the performance were identified in an eight layered ISM model. Research limitations: This research is limited to major ports of India and does not cover the non-major ports of India due to unavailability of data Practical implications: This study will enable the port decision-makers to identify the ports which are high performers in terms of operational, service quality, and financial performance, and thereby the best practices followed across can be replicated. Originality/value: This study explored the multi dimensions of performance of Major ports of India and there was no such study in the past. Despite the existence of performance studies in the literature, none of them explored the challenges faced by the major ports
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Operational performance model for Indian container terminals using qualitative comparative analysis
Nanyam V.P.S. Nihar,Jha Kumar Neeraj 한국해운물류학회 2022 The Asian journal of shipping and Logistics Vol.38 No.4
Trend forecasting shows that Indian container terminals will handle 25 million twenty-foot equivalent units (TEUs) by 2025. However, improving operational performance is the best strategy to achieve this target. Many factors have adversely affected the Indian container terminal's operational performance despite the fact that the Indian government has undertaken several initiatives. This study identifies factors and interactive effects of the factors influencing the operational performance of Indian container terminals. A conceptual model is developed using fuzzy qualitative comparative analysis (QCA) encompassing the successful factors. The conceptual model developed through QCA includes the physical characteristics, driving factors, and challenges. This study reveals the combined and individual effects of the identified factors. The results show that the most common factors are the quay infrastructure, yard infrastructure, infrastructure up-gradation, system initiatives, reefer systems, and logistics advantage. This study adds to the existing literature regarding the Indian container terminals' performance and supports the decisionmakers in improving the operational performance of container terminals. © 2022 The Authors. Production and hosting by Elsevier B.V. on behalf of The Korean Association of Shipping and Logistics, Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Satyakam Mohapatra,Nihar Ranjan Rath 대한정신약물학회 2017 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.15 No.1
Disulfiram is the commonly prescribed drug for the treatment of alcohol dependence. It’s major metabolite (diethyldithiocarbamate) is an inhibitor of dopamine-betahydroxylase, an enzyme that catalyzes the metabolism of dopamine to norepinephrine resulting in psychosis. We recommend that disulfiram should be used at the lowest effective dose, possibly 250 mg daily and caution should be taken while prescribing disulfiram for patients with personal and familial antecedents of psychosis.
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