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91.
92.
BACKGROUND/AIMS: Most countries with high hepatitis B (HB) virus endemicity and most high-income countries have introduced immunization programmes against this infection. However, several low-income countries with intermediate HB endemicity have not done so. We performed a cost-effectiveness analysis of universal childhood HB immunization in such countries using India as an example, since available data on this aspect are limited. METHODS: Marginal cost of every life-year and quality-adjusted life-year (QALY) gained with universal HB vaccination was calculated using a Markov model. Two types of analyses (including and excluding expenditure on treatment of long-term complications of HB infection) were done. Several sensitivity analyses and Monte-Carlo simulation were performed. RESULTS: Universal immunization reduced the HB carrier rate by 71%, and increased the number of years and QALY lived by a birth-cohort by 0.173 years (61.072 vs. 60.899 years) and 0.213 years (61.056 vs. 60.843 years), respectively. Marginal costs were US$16.27 per life-year gained and US$13.22 per QALY gained, much lower than annual per capita income. One-way sensitivity analysis and Monte-Carlo simulation confirmed the robustness of the conclusions. CONCLUSIONS: Universal HB immunization is highly cost-effective in low-income countries with intermediate endemicity rates. 相似文献
93.
A cross‐cultural investigation of attachment style,catastrophizing, negative pain beliefs,and symptom severity in irritable bowel syndrome
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94.
Madhumita?MukhopadhyayEmail author Sankar?Das?Chattopadhyay Nisith?Chandra?Karmakar Rina?Mukherjee Partha?Sarathi?Ghosh Krishna?Pada?Rakshit Sanjay?Kumar?Mondal Soumya?Ghoshal 《Hellēnikē cheirourgikē. Acta chirurgica Hellenica》2015,87(4):342-344
Aim
To report the rare case of a primary peritoneal hydatid cyst in a 65-year-old lady.Case Report
A 65-year-old female presented with a 3-month history of a painless progressive swelling in the right lower abdomen. The lump was 10 cm × 8 cm in size, non-tender, cystic in consistency, and was located in the right iliac fossa and part of the right lumbar region; mobility was restricted in all directions. CECT showed a large septated cystic lesion 14 × 9 × 8 cm in size with enhancement, and sharp regular outline in the right lower abdomen along the anterior aspect of the right psoas muscle. The liver and spleen were not affected.Result
During surgery, a cystic swelling was exposed. Aspiration revealed a clear fluid with some floating material. The cyst wall was incised and fluid along with daughter cysts were removed keeping the pericyst in situ. Histopathological examination confirmed hydatid disease.Conclusion
Primary peritoneal hydatid cysts, though very rare, should be kept in mind in the differential diagnosis of a right iliac fossa lump in areas where hydatid disease is endemic.95.
Quantitative Ultrasound Comparison of MAT and 4T1 Mammary Tumors in Mice and Rats Across Multiple Imaging Systems
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Lauren A. Wirtzfeld PhD Goutam Ghoshal PhD Ivan M. Rosado-Mendez PhD Kibo Nam PhD Yeonjoo Park MS Alexander D. Pawlicki MS Rita J. Miller DVM Douglas G. Simpson PhD James A. Zagzebski PhD Michael L. Oelze PhD Timothy J. Hall PhD William D. O'Brien PhD Jr 《Journal of ultrasound in medicine》2015,34(8):1373-1383
96.
Anuja Damani Arunangshu Ghoshal Naveen Salins Jayita Deodhar Mary Ann Muckaden 《Indian Journal of Palliative Care》2015,21(1):72-75
Hemichorea hemiballismus (HCHB) is a rare and debilitating presentation of hyperglycemia and subcortical stroke. Early identification, proper assessment and management of HCHB can lead to complete symptom relief. We describe a case of HCHB presenting to a palliative care setting. A 63-year-old diabetic and hypertensive lady, with history of ovarian cancer presented to Palliative Medicine outpatient clinic with two days history of right HCHB. Blood investigations and brain imaging showed high blood sugar levels and lacunar subcortical stroke. Blood sugar levels were controlled with human insulin and Aspirin. Clopidogrel and Atorvastatin were prescribed for the management of lacunar stroke. HCHB reduced markedly post-treatment, leading to significant reduction in morbidity and improvement in quality of life. The symptoms completely resolved within one week of starting the treatment and the patient was kept on regular home and outpatient follow up for further monitoring. Acute palliative care (APC) approach deals with the management of comorbidities and their complications along with supportive care. Prompt assessment and management of such complications lead to better patient outcomes. 相似文献
97.
Arunangshu Ghoshal Anuja Damani Naveen Salins Jayita Deodhar Mary Ann Muckaden 《Indian Journal of Palliative Care》2015,21(1):76-78
Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence of Levofloxacin-associated anaphylaxis is rare and delirium secondary to Levofloxacin is a seldom occurrence with only few published case reports. It is an extremely rare occurrence to see this phenomenon in combination. Early identification and prompt intervention reduces both mortality and morbidity. A 17-year-old male with synovial sarcoma of right thigh with chest wall and lung metastasis and with no prior psychiatric morbidity presented to palliative medicine outpatient department with community-acquired pneumonia. He was initiated on intravenous (IV) Ceftriaxone and IV Levofloxacin. Post IV Levofloxacin patient developed anaphylaxis and acute delirium necessitating IV Hydrocortisone, IV Chlorpheneramine, Oxygen and IV Haloperidol. Early detection and prompt intervention helped in complete recovery. Patient was discharged to hospice for respite after 2 days of hospitalization and then discharged home. Acute palliative care approach facilitated management of two life-threatening medical complications in a palliative care setting improving both quality and length of life. 相似文献
98.
Ghoshal UC Tiwari S Dhingra S Pandey R Ghoshal U Tripathi S Singh H Gupta VK Nagpal AK Naik S Ayyagari A 《Digestive diseases and sciences》2008,53(5):1215-1222
Background Despite association between H. pylori and gastric neoplasm (GN) from the developed world, studies from India, where infection is more common and acquired early,
are scant and contradictory. Methods Two hundred and seventy-nine patients with GN from two northern and one eastern Indian centers during the period 1997–2005,
101 non-ulcer dyspepsia (NUD), and 355 healthy volunteers (HV) were evaluated for H. pylori [rapid urease test (RUT), histology and anti-H. pylori, and CagA IgG serology]. Results Patients with GN [263 gastric carcinoma and 16 (6%) primary gastric lymphoma, 208 male] were older than HV (n = 355, 188 male) and NUD (n = 101, 54 male) patients (53 ± 12 versus 44 ± 17 and 43 ± 13 years, respectively; P < 0.001). Eastern Indian patients with GN (n = 145) were younger than those from northern India (n = 134; 52 ± 12 versus 55 ± 12 years; P < 0.007, t-test). In GN and NUD patients H. pylori positivity by RUT [86/225 (38%) versus 46/101 (46%)], anti-H. pylori IgG [154/198 (78%) versus 85/101 (84%)], and histology [136/213 (64%) versus 55/101 (55%)] were comparable (χ
2-test). Serum IgG anti-H. pylori antibody was more common among HV than among GN patients [300/355 (85%) versus 154/198 (78%); P = 0.04, χ
2-test]. Intestinal metaplasia was more common in GN than in NUD patients [101/252 (40%) versus 2/98 (2%), P < 0.000, χ
2-test]. CagAIgG was more common in GN than in NUD patients [124/163 (76%) versus 64/101 (63%)] but comparable to that in HV
patients [87/98 (89%), P = NS]. Conclusion Frequency of H. pylori as detected using endoscopy and serology-based tests is not higher among patients with GN as compared with controls in India. 相似文献
99.
Ghoshal UC Kumar S Saraswat VA Aggarwal R Misra A Choudhuri G 《The American journal of gastroenterology》2004,99(12):2304-2310
BACKGROUND: Though most patients with achalasia cardia (AC) respond to pneumatic dilation (PD), one-third experienced recurrence. Long-term follow-up studies on factors associated with various outcomes are scanty. METHODS: In this retrospective study, 126 patients (36.5 +/- 14.6 yr, 76 male) with AC (diagnosed by esophagoscopy, barium esophagogram, and/or manometry) were followed up in person or through mail. The median dysphagia-free duration was calculated by Kaplan-Meier analysis. Factors associated with nonresponse and recurrence after PD were determined using univariate and multivariate analyses. RESULTS: Symptoms were dysphagia (126, 100%), chest pain (21, 17%), regurgitation (61, 48%), weight loss (33, 26%), and pulmonary symptoms (23, 18%); 5 of 126 (4%) had megaesophagus (> or =7 cm). The mean lower esophageal sphincter (LES) pressure was 38.7 +/- 16.8 mmHg. One hundred and fifteen of 126 (91%) patients responded to PD (90 (71%) to first session); 25 of these had recurrence of dysphagia after 15 +/- 17 months. Post-PD chest pain requiring hospitalization occurred in 21 of 126 (17%; one had an esophageal perforation). Post-PD LES pressure, which was assessed in 48 of 126 patients, had decreased by >50% from baseline in 14 of 29 responders, 0 of 11 nonresponders (p= 0.004, chi(2) test), and 5 of 8 relapsers. The median dysphagia-free duration by Kaplan-Meier analysis was 60 months (SE 2.7, 95% CI 54.7-65.3). On univariate analysis, male gender, pulmonary symptoms (nocturnal coughing spell, history of respiratory infection), absence of chest pain, and failure to achieve a reduction in LES pressure >50% after PD were associated with poor outcome; whereas age, grade of dysphagia, regurgitation, megaesophagus, and LES pressure before PD were not. Male gender was associated with poor outcome by multivariate-analysis. CONCLUSIONS: PD is an effective and safe treatment for AC. Post-PD LES pressure measurement may be helpful in assessing response. Male patients have poorer outcomes following PD. 相似文献
100.