Relation between heart rate variability and spectral analysis of electroencephalogram in chronic neuropathic pain patients

Rajan John,Gaur Girwar Singh,Shanmugavel Karthik,S Adinarayanan 대한약리학회 2024 The Korean Journal of Physiology & Pharmacology Vol.28 No.3

Chronic neuropathic pain (CNP) is a complex condition often arising from neural maladaptation after nerve injury. Understanding CNP complications involves the intricate interplay between brain-heart dynamics, assessed through quantitative electroencephalogram (qEEG) and heart rate variability (HRV). However, insights into their interaction in chronic pain are limited. Resting EEG and simultaneous electrocardiogram (lead II) of the participants were recorded for qEEG and HRV analysis. Correlations between HRV and qEEG parameters were calculated and compared with age, sex, and body mass index (BMI)-matched controls. CNP patients showed reduced HRV and significant increases in qEEG power spectral densities within delta, theta, and beta frequency ranges. A positive correlation was found between low frequency/ high frequency (LF/HF) ratio in HRV analysis and theta, alpha, and beta frequency bands in qEEG among CNP patients. However, no significant correlation was observed between parasympathetic indices and theta, beta bands in qEEG within CNP group, unlike age, sex, and BMI-matched healthy controls. CNP patients display significant HRV reductions and distinctive qEEG patterns. While healthy controls exhibit significant correlations between parasympathetic HRV parameters and qEEG spectral densities, these relationships are diminished or absent in CNP individuals. LF/HF ratio, reflecting sympathovagal balance, correlates significantly with qEEG frequency bands (theta, alpha, beta), illuminating autonomic dysregulation in CNP. These findings emphasize the intricate brain-heart interplay in chronic pain, warranting further exploration.

Economics and safety of continuous and interrupted suture hepaticojejunostomy: An audit of 556 surgeries

Rajan Saxena,Nalini Kanta Ghosh,Saurabh Galodha 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.4

Backgrounds/Aims: Hepaticojejunostomy (HJ) for bilioenteric continuity is generally performed with interrupted sutures. This study compares the safety, economics, short- and long-term outcomes of continuous suture hepaticojejunostomy (CSHJ) and interrupted suture hepaticojejunostomy (ISHJ). Methods: A retrospective cohort analysis involving all HJs between January 2014 and December 2018 was conducted. Patients with type IV or V biliary strictures, duct diameter < 8 mm and/or associated vascular injury, and liver transplant recipients were excluded. Patient demographics, preoperative parameters including diagnosis, intra-operative parameters including type and number of sutures, suture time, and postoperative morbidity (based on Clavien-Dindo classification) were recorded. Patients were followed up to 60 months. McDonald’s Grade A and B outcomes were considered favorable. Cost according to suture type and number (polydioxanone 3-0/5-0 mean cost, US$ 9.26/length; polyglactin 3-0/4-0 mean cost, US$ 6.56/length), and operation room charge (US$ 67.47/hour) were compared between the two techniques. Statistical analysis was performed using IBM SPSS ver. 22 software. Results: A total of 556 eligible patients (468 patients undergoing ISHJ and 88 undergoing CSHJ; 47% [n = 261] with malignant and 53% [n = 295] with benign pathology) were analyzed. The two groups were similar. Number of sutures, cost, time, and postoperative bile leak were significantly higher in the ISHJ group. Bile leak occurred in 54 patients (6 CSHJ, 48 ISHJ). Septic shock-induced death occurred in 16 cases (3 CSHJ, 13 ISHJ). Morbidity and the anastomotic stricture rates were comparable in both groups. Conclusions: CSHJ is a safe, economical, and worthy of routine use.

Mullerian adenosarcoma (heterologous) of the cervix with sarcomatous overgrowth: a case report with review of literature

Rajan Duggal,Raje Nijhawan,Neelam Aggarwal,Pooja Sikka 대한부인종양학회 2010 Journal of Gynecologic Oncology Vol.21 No.2

Mullerian adenosarcoma is a rare biphasic malignant neoplasm of the cervix characterized by an admixture of benign epithelial elements and a malignant sarcomatous stromal component, which may be either homologous or heterologous. An aggressive variant of adenosarcoma, mullerian adenosarcoma with sarcomatous overgrowth (MASO) is extremely rare, with only two such cases being reported in the English literature to date. In this report we present a case of MASO of uterine cervix with heterologous elements in a 15-year-old unmarried girl presenting with foul smelling menstrual bleeding and passage of fleshy masses. Because MASO with heterologous elements seems to appear at the earliest stages of reproductive lifespan in women, and have an uncertain malignant potential, gynecologists and pathologists should be aware and think about the possibility of this tumor.

Invited Lecture

Rajan Nataraajan 한국마케팅과학회 2006 한국마케팅과학회 학술대회 발표 논문집 Vol.- No.-

Achalasia Is Associated With eNOS4a4a, iNOS22GA, and nNOS29TT Genotypes: A Case-control Study

( Rajan Singh ),( Uday C Ghoshal ),( Asha Misra ),( Balraj Mittal ) 대한소화기기능성질환·운동학회 2015 Journal of Neurogastroenterology and Motility (JNM Vol.21 No.3

Background/Aims: Achalasia is known to result from degeneration of inhibitory neurons, which are mostly nitrinergic. Characteristic features of achalasia include incomplete lower esophageal sphincter (LES) relaxation and esophageal aperistalsis. Nitric oxide (NO), produced by NO synthase (NOS), plays an important role in peristalsis and LES relaxation. Therefore, we evaluated genetic polymorphisms of NOS gene isoforms (endothelial NOS [eNOS], inducible NOS [iNOS], and neuronal NOS [nNOS]) in patients with achalasia and healthy subjects (HS). Methods: Consecutive patients with achalasia (diagnosed using esophageal manometry) and HS were genotyped for 27-base pair (bp) eNOS variable number of tandem repeats (VNTR), iNOS22G/A (rs1060826), nNOS C/T (rs2682826) polymorphisms by polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (RFLP), respectively. Results: Among 183 patients (118 [64.5%] male, age 39.5 ± 13.0 years) with achalasia and 366 HS (254 [69.4%] male, age 40.8 ± 11.0 years), eNOS4a4a genotype of 27-bp VNTR was more common among achalasia than HS (20 [10.9%] vs 13 [3.6%]; P < 0.001; OR, 3.72; 95% CI, 1.8-7.7). Patients with achalasia had iNOS22GA genotypes more often than HS (95 [51.9%] vs 93 [25.4%]; P < 0.001; OR, 3.0; 95% CI, 2.1-4.4). Frequency of genotypes GA + AA was higher in patients than HS (97 [53%] vs 107 [29.2%]; P < 0.001; OR, 2.7; 95% CI, 1.8-3.9). Also, nNOS29TT variant genotype in rs2682826 was more com - mon among patients compared to HS (14 [7.7%] vs 6 [1.6%]; P < 0.001; OR, 5.91; 95% CI, 2.2-15.8). Conclusions: Achalasia is associated with eNOS4a4a, iNOS22GA, and nNOS29TT genotypes. This may suggest that polymorphisms of eNOS, iNOS, and nNOS genes are risk factors for achalasia. (J Neurogastroenterol Motil 2015;21:380-389)

Primary amelanotic melanoma of the cervix: case report with review of literature

Rajan Duggal,Radhika Srinivasan 대한부인종양학회 2010 Journal of Gynecologic Oncology Vol.21 No.3

Primary malignant melanoma of the uterine cervix is a rare neoplasm with poor prognosis. It may be misdiagnosed especially when amelanotic, in which case immunohistochemistry is useful in reaching the diagnosis. We present one such case of a 65-year-old postmenopausal female patient presenting with bleeding per vaginum. Speculum examination revealed an ulcero-proliferative growth involving the cervix. On histopathological examination it was originally suspected to be a poorly differentiated carcinoma or a non-epithelial malignant tumor, but was subsequently correctly diagnosed by immunohistochemical staining with the HMB-45 antibody and S-100 protein.

Contact Dermatitis : Recognition and Management

Rajan, V.S.,Moorthy, T.T. Medical Publications Korea 1978 Medical Progress Vol.5 No.7

Continuous Suture Hepaticojejunostomy Is Economical Eith Similar Long Term Results as Interrupted Suture Technique: An Audit of a Prospective Database of 556 Hepaticojejunostomies

( Rajan Saxena ),( Nalini Kanta Ghosh ),( Saurabh Galodha ) 대한간학회 2021 춘·추계 학술대회 (KASL) Vol.2021 No.1

Cost-based design of residential steel roof systems: A case study

Rajan, S.D.,Mobasher, B.,Chen, S.Y.,Young, C. Techno-Press 1999 Structural Engineering and Mechanics, An Int'l Jou Vol.8 No.2

The cost effectiveness of using steel roof systems for residential buildings is becoming increasingly apparent with the decrease in manufacturing cost of steel components, reliability and efficiency in construction practices, and the economic and environmental concerns. While steel has been one of the primary materials for structural systems, it is only recently that its use for residential buildings is being explored. A comprehensive system for the design of residential steel roof truss systems is presented. In the first stage of the research the design curves obtained from the AISI-LRFD code for the manufactured cross-sections were verified experimentally. Components of the truss systems were tested in order to determine their member properties when subjected to axial force and bending moments. In addition, the experiments were simulated using finite element analysis to provide an additional source of verification. The second stage of the research involved the development of an integrated design approach that would automatically design a lowest cost roof truss given minimal input. A modified genetic algorithm was used to handle sizing, shape and topology variables in the design problem. The developed methodology was implemented in a software system for the purpose of designing the lowest cost truss that would meet the AISI code provisions and construction requirements given the input parameters. The third stage of the research involved full-scale testing of a typical residential steel roof designed using the developed software system. The full scale testing established the factor of safety while validating the analysis and design procedures. Evaluation of the test results indicates that designs using the present approach provide a structure with enough reserve strength to perform as predicted and are very economical.

Gut Microbial Dysbiosis in the Pathogenesis of Gastrointestinal Dysmotility and Metabolic Disorders

( Rajan Singh ),( Hannah Zogg ),( Lai Wei ),( Allison Bartlett ),( Uday C Ghoshal ),( Singh Rajender ),( Seungil Ro ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2021 Journal of Neurogastroenterology and Motility (JNM Vol.27 No.1

Of all microorganisms in the human body, the largest and most complex population resides in the gastrointestinal (GI) tract. The gut microbiota continuously adapts to the host environment and serves multiple critical functions for their hosts, including regulating host immunity, procuring energy from food, and preventing the colonization of pathogens. Mounting evidence has suggested gut microbial imbalance (dysbiosis) as a core pathophysiology in the development of GI motility and metabolic disorders, such as irritable bowel syndrome and diabetes. Current research has focused on discovering associations between these disorders and gut microbial dysbiosis; however, whether these associations are a consequence or cause is still mostly unexplored. State-of-the-art studies have investigated how gut microbes communicate with our body systems through microbiota-derived metabolites and how they are able to modulate host physiology. There is now mounting evidence that alterations in the composition of small intestinal microbes have an association with GI dysmotility and metabolic disorders. Although treatment options for gut microbial dysbiosis are currently limited, antibiotics, fecal microbiota transplantation, probiotics, and dietary interventions are currently the best options. However, treatment with broad-spectrum antibiotics has been viewed with skepticism due to the risk of developing antibiotic resistant bacteria. Studies are warranted to elucidate the cellular and molecular pathways underlying gut microbiota-host crosstalk and for the development of a powerful platform for future therapeutic approaches. Here, we review recent literature on gut microbial alterations and/or interactions involved in the pathophysiology of GI dysmotility and metabolic disorders. (J Neurogastroenterol Motil 2021;27:19-34)