The role of capsule endoscopy in etiological diagnosis and management of obscure gastrointestinal bleeding

( Vikas Pandey ),( Meghraj Ingle ),( Nilesh Pandav ),( Pathik Parikh ),( Jignesh Patel ),( Aniruddha Phadke ),( Prabha Sawant ) 대한장연구학회 2016 Intestinal Research Vol.14 No.1

To investigate the various etiologies, yields, and effects of capsule endoscopy (CE) on management and complications, along with follow up of patients with obscure gastrointestinal (GI) bleeding. Methods: The study group of patients included those having obscure, overt, or occult GI bleeding. The findings were categorized as (A) obvious/definitive, (B) equivocal, or (C) negative. Any significant alteration in patient management post CE in the form of drug or surgical intervention was noted. Results: Total patients included in the study were 68 (48 males and 20 females). The ratio of male:female was 2.4:1. The age ranged between 16 years to 77 years. Mean age for males was 62±14 years, for females 58±16 years. The total yield of CE with definitive lesions was in 44/68 (65.0%) of patients. In descending order (A) angiodysplasia 16/68 (23.53%), (B) Crohn’s disease 10/68 (14.70%), (C) non-steroidal anti-inflammatory drug enteropathy 8/68 (11.76%), (D) small bowel ulcers 4/68 (5.88%), (E) jejunal and ileal polyps 2/68 (2.94%), (F) intestinal lymphangiectasis 2/68 (2.94%), and (G) ileal hemangiomas 2/68 (2.94%) were followed. Equivocal findings 12/68 (17.65%) and negative study 12/68 (17.65%) was found. Complications in the form of capsule retention in the distal ileum were noted in 2/68 (2.94%) subjects. Statistically, there was a higher probability of finding the etiology if the CE was done during an episode of bleeding. Conclusions: CE plays an important role in diagnosing etiologies of obscure GI bleeding. Its role in influencing the management outcome is vital. (Intest Res 2016;14:69-74)

Endoscopic Ultrasonography Can Prevent Unnecessary Diagnostic Endoscopic Retrograde Cholangiopancreatography Even in Patients with High Likelihood of Choledocholithiasis and Inconclusive Ultrasonography: Results of a Prospective Study

Ruchir Patel,Meghraj Ingle,Dhaval Choksi,Prateik Poddar,Vikas Pandey,Prabha Sawant 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.6

Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the initial therapy recommended for patients with high likelihood of choledocholithiasis. To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in patients with high probability of choledocholithiasis and inconclusive ultrasonography (US). Methods: All patients with high likelihood of choledocholithiasis and negative US underwent EUS. ERCP was performed for the patients who showed a definite stone/sludge on EUS. Patients without choledocholithiasis were followed up for 3 months. The primary outcome was avoidance of diagnostic ERCP. Results: We included 78 patients (51 women; 27 men). Of these, 25 and 7 (total 41%) were diagnosed with choledocholithiasis and sludge, respectively; stone/sludge was removed in 96.9% of the patients. EUS ruled out choledocholithiasis in 38 patients (48.7%). Two of them were found to have choledocholithiasis on follow-up. The sensitivity, specificity, positive and negative predictive value of EUS for detecting choledocholithiasis were 93.9%, 97.3%, 96.9%, and 94.7%, respectively. Unnecessary ERCP was avoided in 57.7% of the patients by using the EUS-first approach. Conclusions: EUS is a highly accurate and safe procedure. EUS can replace ERCP as the initial investigation in patients with a high probability of choledocholithiasis. It avoids unnecessary ERCP; hence, decreasing related costs and complications.

Difficult colonoscopy: air, carbon dioxide, or water insufflation?

( Alisha Chaubal ),( Vikas Pandey ),( Ruchir Patel ),( Prateik Poddar ),( Aniruddha Phadke ),( Meghraj Ingle ),( Prabha Sawant ) 대한장연구학회 2018 Intestinal Research Vol.16 No.2

Background/Aims: This study aimed to compare tolerance to air, carbon dioxide, or water insufflation in patients with anticipated difficult colonoscopy (young, thin, obese individuals, and patients with prior abdominal surgery or irradiation). Methods: Patients with body mass index (BMI) less than 18 kg/㎡ or more than 30 kg/㎡, or who had undergone previous abdominal or pelvic surgeries were randomized to air, carbon dioxide, or water insufflation during colonoscopy. The primary endpoint was cecal intubation with mild pain (less than 5 on visual analogue scale [VAS]), without use of sedation. Results: The primary end point was achieved in 32.7%, 43.8%, and 84.9% of cases with air, carbon dioxide and water insufflation (P<0.001). The mean pain scores were 5.17, 4.72, and 3.93 on the VAS for air, carbon dioxide, and water insufflation (P<0.001). The cecal intubation rate or procedure time did not differ significantly between the 3 groups. Conclusions: Water insufflation was superior to air or carbon dioxide for pain tolerance. This was seen in the subgroups with BMI < 18 kg/m2 and the post-surgical group, but not in the group with BMI >30 kg/㎡. (Intest Res 2018;16:299-305)

Analysis of stress block parameters for high strength concrete

Brijesh Singh,Vikas Patel,P. N. Ojha,V. V. Arora 아시아콘크리트학회 2020 Journal of Asian Concrete Federation Vol.6 No.1

In Indian Standard code IS: 456-2000 for concrete of grades higher than M55, the design parameters given may not be applicable as structural behaviour of concrete changes as strength of concrete increases. Different international standards give different stress block parameters which can be reduced to these two basic factors. In this paper, stress block parameters K (strength reduction factor) and k2 (factor for the depth of resultant compressive force) were calculated from experimental strain values considering the stress-strain curve as parabolic for lower grades and as linear for higher grades. Also, the method and approach for the calculation of stress block parameters have been worked out. The method so proposed is compared with the model proposed in European design standard EC: 02-2004 by trans-forming the European stress block parameters to the basic parameters used. Also, the effect of the shape of the stress-strain curve and value of ultimate strain in concrete on stress block parameters and moment capacity of the members was analyzed by working on the representative section. The method or approach so proposed will be useful to understand and compare flexural design philosophies used in different international standards by reducing the stress block parameters to two basic factors.

Impact of COVID-19 on spatio-temporal variation of aerosols and air pollutants concentration over India derived from MODIS, OMI and AIRS

Yashwant B. Katpatal,Vikas K. Patel,Digambar S. Londhe 대한공간정보학회 2023 Spatial Information Research Vol.31 No.6

The atmospheric aerosols and air pollutants affect the earth's atmosphere, human health and climate system. Human-induced aerosols and air pollutants are the major causes of the deterioration of air quality. The COVID-19 lockdown restricted the movement of people and vehicles, stopped industrial and agricultural activities and may have impacts on the aerosols in the atmosphere. Spatio-temporal map of MODIS Terra AOD_550 nm, OMI Aura UVAI, Ozone, NO2, SO2 and AIRS CO during the lockdown illustrates the significant reduction in their concentration. During the lockdown, the North India shows a record reduction of over 20% in Aerosol Optical Depth and Aerosol Index values. A substantial decrease in AOD and AI was also observed in Eastern and Western parts of India. The average AOD value were reduced from 1.36 (2016–2019) to 1.09 (2020) over India during the lockdown. The satellite-retrieved aerosol variables over India recorded lowest AOD values on 29th March, 2020 (0.2566) and 21st April 2020 (0.2591). Similarly, air pollutants CO, NO2 and SO2 also significantly reduced in India. Despite all variables showing a reduction in concentration, Ozone recorded an increase in value during lockdown primarily over North and North-eastern parts of India. Western India recorded a substantial reduction in SO2 (47%) followed by Central India (31%). As pan India is considered, CO was reduced by 1%, NO2 reduced by 15.29% and SO2 was reduced by 26.82% during the lockdown period. This abrupt reduction in aerosol and air pollutants concentration over India was mainly due to the lockdown of COVID-19.

A Nationwide Assessment of the “July Effect” and Predictors of Post-Endoscopic Retrograde Cholangiopancreatography Sepsis at Urban Teaching Hospitals in the United States

Rupak Desai,Upenkumar Patel,Shreyans Doshi,Dipen Zalavadia,Wardah Siddiq,Hitanshu Dave,Mohammad Bilal,Vikas Khullar,Hemant Goyal,Madhav Desai,Nihar Shah 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.5

Background/Aims: To analyze the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) sepsis in the early (Julyto September) and later (October to June) academic months to assess the “July effect”. Methods: The National Inpatient Sample (2010–2014) was used to identify ERCP-related adult hospitalizations at urban teachinghospitals by applying relevant procedure codes from the International Classification of Diseases, 9th revision, Clinical Modification. Post-ERCP outcomes were compared between the early and later academic months. A multivariate analysis was performed to evaluatethe odds of post-ERCP sepsis and its predictors. Results: Of 481,193 ERCP procedures carried out at urban teaching hospitals, 124,934 were performed during the early academicmonths. The demographics were comparable for ERCP procedures performed during the early and later academic months. A higherincidence (9.4% vs. 8.8%, p<0.001) and odds (odds ratio [OR], 1.07) of post-ERCP sepsis were observed in ERCP performed during theearly academic months. The in-hospital mortality rate (7% vs. 7.5%, p=0.072), length of stay, and total hospital charges in patients withpost-ERCP sepsis were also equivalent between the 2 time points. Pre-ERCP cholangitis (OR, 3.20) and post-ERCP complications suchas cholangitis (OR, 6.27), perforation (OR, 3.93), and hemorrhage (OR, 1.42) were significant predictors of higher post-ERCP sepsis inprocedures performed during the early academic months. Conclusions: The July effect was present in the incidence of post-ERCP sepsis, and academic programs should take into considerationthe predictors of post-ERCP sepsis to lower health-care burden.

Comparison of creep models and experimental verification of creep coefficients for normal and high strength concrete

P. N. Ojha,Brijesh Singh,Abhishek Singh,Vikas Patel 아시아콘크리트학회 2020 Journal of Asian Concrete Federation Vol.6 No.2

A concrete structure when subjected to sustained load presents progressive strain over time, which is associated with the creep phenomenon. The creep characteristic of high strength concrete as-sumes importance in the back drop of increase in prestressed concrete constructions. The paper covers the comparison of creep coefficients with different creep models like Bazant’s B-3, ACI, AASHTO, GL-2000 and FIB model code 2010 for concrete mixes having water to cementitious ratio of 0.47, 0.36, 0.27 and 0.20. The comparison of different models are done for a relative humidity of 60 percent and design life of 100 years. For comparison of creep coefficient using different models the age at loading are kept as 7, 28 and 365 days. Thereafter, values are compared with experimentally obtained results of concrete mixes having water to cementitious ratio of 0.47 and 0.20 for age at loading of 28 days and up to 180 days loading period. Time induced creep strain of high strength concrete is determined using creep rig of capacity 2000 kN. Creep strains are measured at regular time intervals on concrete designed with water to cementitious ratio of 0.47 and 0.20 wherein fly ash and silica fume were also used.

Empirical equation and experimental validation of shear parameters for high strength concrete (HSC)

Brijesh Singh,Ojha P N,Patel Vikas,Trivedi Amit,Singh Abhishek 아시아콘크리트학회 2021 Journal of Asian Concrete Federation Vol.7 No.2

With many benefits of the high strength concrete (HSC) the more brittle behaviour that leads to sudden failure makes it important for proper understanding of its behaviour and safe and efficient estimation of capacities. Research on the behaviour of HSC has been extensively carried out since last decade. HSC has higher tensile strength hence a higher cracking shear can be expected. This paper analyzes the different international standards available for estimating concrete’s component of shear strength for reinforced cement concrete (RCC) beam. Different important factors mainly strength in compression, steel reinforcement (dowel action), ratio of shear span and depth, size effect i.e. depth along with the aggregate type (density of concrete) contributing to shear stress (Tc) of concrete has been also analyzed and thereafter, an equation has been proposed to compute or predict Tc value for concrete of both normal and higher grade or strength. The proposed equation has been validated by experimental results wherein 12 RCC beams (with and without reinforcement for shear) were cast and tested to fail in shear. The experimental results validated the proposed equation with considerable factor of safety keeping in view the sudden and brittle nature of failure in concrete in case of shear.

2D materials: increscent quantum flatland with immense potential for applications

Ranjan Pranay,Gaur Snehraj,Yadav Himanshu,Urgunde Ajay B.,Singh Vikas,Patel Avit,Vishwakarma Kusum,Kalirawana Deepak,Gupta Ritu,Kumar Prashant 나노기술연구협의회 2022 Nano Convergence Vol.9 No.26

Quantum flatland i.e., the family of two dimensional (2D) quantum materials has become increscent and has already encompassed elemental atomic sheets (Xenes), 2D transition metal dichalcogenides (TMDCs), 2D metal nitrides/carbides/carbonitrides (MXenes), 2D metal oxides, 2D metal phosphides, 2D metal halides, 2D mixed oxides, etc. and still new members are being explored. Owing to the occurrence of various structural phases of each 2D material and each exhibiting a unique electronic structure; bestows distinct physical and chemical properties. In the early years, world record electronic mobility and fractional quantum Hall effect of graphene attracted attention. Thanks to excellent electronic mobility, and extreme sensitivity of their electronic structures towards the adjacent environment, 2D materials have been employed as various ultrafast precision sensors such as gas/fire/light/strain sensors and in trace-level molecular detectors and disease diagnosis. 2D materials, their doped versions, and their hetero layers and hybrids have been successfully employed in electronic/photonic/optoelectronic/spintronic and straintronic chips. In recent times, quantum behavior such as the existence of a superconducting phase in moiré hetero layers, the feasibility of hyperbolic photonic metamaterials, mechanical metamaterials with negative Poisson ratio, and potential usage in second/third harmonic generation and electromagnetic shields, etc. have raised the expectations further. High surface area, excellent young’s moduli, and anchoring/coupling capability bolster hopes for their usage as nanofillers in polymers, glass, and soft metals. Even though lab-scale demonstrations have been showcased, large-scale applications such as solar cells, LEDs, flat panel displays, hybrid energy storage, catalysis (including water splitting and CO2 reduction), etc. will catch up. While new members of the flatland family will be invented, new methods of large-scale synthesis of defect-free crystals will be explored and novel applications will emerge, it is expected. Achieving a high level of in-plane doping in 2D materials without adding defects is a challenge to work on. Development of understanding of inter-layer coupling and its effects on electron injection/excited state electron transfer at the 2D-2D interfaces will lead to future generation heterolayer devices and sensors.

Platelet-rich plasma injection in the treatment of patellar tendinopathy: a systematic review and meta-analysis

( Apurba Barman ),( Mithilesh K. Sinha ),( Jagannatha Sahoo ),( Debasish Jena ),( Vikas Patel ),( Suman Patel ),( Souvik Bhattacharjee ),( Debanjan Baral ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Purpose: The objective of the study was to assess the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of patellar tendinopathy. Methods: The PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases were searched for clinical trials which compared PRP injection with other ‘active treatment’ interventions (‘Non-PRP’ injection and ‘No-injection’ treatments) or ‘No-active treatment’ interventions. Randomized and non-randomized clinical trials that had been published up to 15 November 2021, were included in the meta-analysis. The primary outcome, pain relief, was measured on a ‘visual analog scale.’ Secondary outcomes were knee functional activities and quality of life (QoL). The PRISMA guidelines were followed throughout the study. Results: Eight comparative studies were identified for inclusion in the meta-analysis. Assessment of these studies revealed that there were no significant differences in pain relief, functional outcomes, and QoL in the short, medium, and long term between PRP injection and Non-PRP injection interventions. Similarly, comparison of PRP injection to the No-active treatment intervention showed no differences in short- and medium-term pain relief. However, when PRP injection was compared to the No-injection treatment intervention extracorporeal shock wave therapy (ECWT), the former was found to be more effective in terms of pain relief in the medium term (mean difference [MD] - 1.50; 95% confidence interval [CI] - 2.72 to - 0.28) and long term (MD - 1.70; 95% CI, - 2.90 to - 0.50) and functional outcomes in the medium term (MD 13.0; 95% CI 3.01-22.99) and long term (MD 13.70; 95% CI 4.62-22.78). Conclusions: In terms of pain relief and functional outcomes, the PRP injection did not provide significantly greater clinical benefit than Non-PRP injections in the treatment of patellar tendinopathy. However, in comparison with ESWT, there was a significant benefit in favor of PRP injection.