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Paunipagar B.K.,Global Hospitals | Rasalkar D.D.,Kokilaben Dhirubhai Ambani Hospital
Indian Journal of Radiology and Imaging | Year: 2014

We tried to review the role of magnetic resonance imaging (MRI) in understanding microscopic and morphologic structure of the articular cartilage. The optimal protocols and available spin-echo sequences in present day practice are reviewed in context of common pathologies of articular cartilage. The future trends of articular cartilage imaging have been discussed with their appropriateness. In diarthrodial joints of the body, articular cartilage is functionally very important. It is frequently exposed to trauma, degeneration, and repetitive wear and tear. MRI has played a vital role in evaluation of articular cartilage. With the availability of advanced repair surgeries for cartilage lesions, there has been an increased demand for improved cartilage imaging techniques. Recent advances in imaging strategies for native and postoperative articular cartilage open up an entirely new approach in management of cartilage-related pathologies.


Debnath T.,Transplant Immunology and Stem Cell Laboratory | Shalini U.,Transplant Immunology and Stem Cell Laboratory | Kona L.K.,Global Hospitals | Vidya Sagar J.V.S.,Aware Global Hospitals | And 3 more authors.
Journal of Arthroscopy and Joint Surgery | Year: 2015

Aim: Alternate strategies to regenerate the damaged tissue require exogenous supply of several chondrocyte implants. There are inherent challenges to optimize an appropriate tissue culture methodology that can aid in enrichment of chondrocytes. The aim of the study was to explore the differentiation potential, expansion and growth kinetics of the human adipose derived stem cells (hADSCs) in alginate microspheres in comparison to chondrogenesis from the cartilage tissue. Methods: Isolated hADSCs and cartilage derived chondrocytes were cultured and characterized. The distribution of stem cells within alginate bead was imaged by scanning electron microscopy (SEM). Encapsulated hADSCs were monitored for their cell viability, cell proliferation and apoptosis via JC-1 staining, MTT assay and Annexin V assays respectively. The alginate cell constructs were analyzed for chondrogenic gene expression by RT-PCR. Results: The chondrocyte pellet culture from cartilage demonstrated lower growth potential as compared to alginate encapsulation. hADSCs were successfully encapsulated within alginate matrix with >80% cell viability. Apoptotic assays provided safety profile for the alginate during cell growth. The up-regulation of cartilage specific genes like TGF-β, collagen type-X, COMP was observed during the entire period of culture. Conclusion: The chondrogenesis in pellet culture from cartilage tissue conserved the chondrocyte phenotype better with rich GAG polysaccharides. However, owing to an enriched chondrocyte requirement, alginate as a scaffold design would aid in the treatment of large focal defects. © 2015 International Society for Knowledge for Surgeons on Arthroscopy and Arthroplasty.


Nagendranath C.,Colorectal Unit | Saravanan M.N.,Colorectal Unit | Sridhar C.,Global Hospitals | Varughese M.,Colorectal Unit
Techniques in Coloproctology | Year: 2014

Background: In complex fistula-in-ano, preoperative imaging can help identify secondary tracts and abscesses that can be missed, leading to recurrence. We evaluated hydrogen peroxide-enhanced endoanal ultrasound (PEEUS) in the characterization of fistula compared with standard clinical and operative assessment. Methods: Patients with complex fistula-in-ano treated between February 2008 and May 2009 at our institution were prospectively evaluated by PEEUS with recording of the preoperative clinical examination and intraoperative details of the fistula. Of the 135 patients with fistula-in-ano, 68 met the inclusion criteria for complex fistula-in-ano. Correlation of clinical findings and PEEUS to the gold standard intraoperative findings was assessed in characterizing the fistula. The percent agreement between the clinical and PEEUS findings against the gold standard was derived, and the kappa statistic for agreement was determined. Results: The mean age of the cohort was 42.54 ± 10.86 years. The fistula tracts were curvilinear, high, and transsphincteric in 16 (23.53 %), 8 (11.76 %), and 42 (61.76 %) patients, respectively. Secondary tracts and associated abscess cavities were seen in 28 (33.82 %) and 35 (51.47 %) patients, respectively. PEEUS correlated better than clinical examination with regard to site (92.65 vs 79.41 %; p < 0.001) and course (91.18 vs 77.94 %; p < 0.001) of secondary tract and associated abscesses (89.71 vs 80.88 %; p = 0.02). There was a trend of better correlation of PEEUS compared to clinical examination in classifying the primary tract as per Park's system (88.24 vs 79.41 %; p = 0.06), but it did not reach statistical significance. PEEUS and clinical examination were comparable in correlation of the level of the primary tract (kappa: 0.86 vs 0.78; p = 0.22) and the site of internal opening (kappa: 0.97 vs 0.89; p = 0.22). The operative decision was changed in 13 (19.12 %) subjects based on PEEUS findings. Conclusions: PEEUS is a feasible and efficient tool in the routine preoperative assessment of complex fistula-in-ano. © 2013 Springer-Verlag.


Pawlotsky J.-M.,University Paris Est Creteil | Pawlotsky J.-M.,French Institute of Health and Medical Research | Flisiak R.,Medical University of Bialystok | Sarin S.K.,Institute of Liver and Biliary science | And 15 more authors.
Hepatology | Year: 2015

Alisporivir is a cyclophilin inhibitor with pan-genotypic anti-hepatitis C virus (HCV) activity and a high barrier to viral resistance. The VITAL-1 study assessed alisporivir as interferon (IFN)-free therapy in treatment-naïve patients infected with HCV genotype 2 or 3. Three hundred forty patients without cirrhosis were randomized to: arm 1, alisporivir (ALV) 1,000 mg once-daily (QD); arm 2, ALV 600 mg QD and ribavirin (RBV); arm 3, ALV 800 mg QD and RBV; arm 4, ALV 600 mg QD and pegylated IFN (Peg-IFN); or arm 5, Peg-IFN and RBV. Patients receiving IFN-free ALV regimens who achieved rapid virological response (RVR) continued the same treatment throughout, whereas those with detectable HCV RNA at week 4 received ALV, RBV, and Peg-IFN from weeks 6 to 24. Overall, 300 patients received ALV-based regimens. In arm 1 to arm 4, the intent-to-treat rates of sustained virological response (SVR) 24 weeks after treatment (SVR24) were from 80% to 85%, compared with 58% (n=23 of 40) with Peg-IFN/RBV. Per-protocol analysis showed higher SVR24 rates in patients who received ALV/RBV, IFN-free after RVR (92%; n=56 of 61) than with ALV alone after RVR (72%; n=13 of 18) or with Peg-IFN/RBV (70%; n=23 of 33). Both RVRs and SVRs to ALV IFN-free regimens were numerically higher in genotype 3- than in genotype 2-infected patients. Viral breakthrough was infrequent (3%; n=7 of 258). IFN-free ALV treatment showed markedly better safety/tolerability than IFN-containing regimens. Conclusions: ALV plus RBV represents an effective IFN-free option for a proportion of patients with HCV genotype 2 or 3 infections, with high SVR rates for patients with early viral clearance. Further investigations of ALV in IFN-free combination regimens with direct-acting antiviral drugs deserve exploration in future trials. © 2015 by the American Association for the Study of Liver Diseases.


Patra S.,Global Hospitals and Health City | Vij M.,Global Hospitals and Health City | Sukanya B.,Global Hospitals | Kapoor D.,Global Hospitals
Indian Journal of Pathology and Microbiology | Year: 2012

Mycophenolate mofetil (MMF) is a commonly used immunosuppressive drug in the management of transplant recipients. Gastrointestinal (GI) toxicity (diarrhea) is the most frequently reported adverse event in MMF-treated transplant patients. MMF-induced Graft versus Host Disease has rarely been reported in literature. We report a case of MMF-induced colitis with Graft versus Host Disease-like features, to highlight the importance of high clinical suspicion for its diagnosis, and that appropriate management in such a setting can reduce morbidity and mortality. We also review the relevant literature.

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