karan patel | George Brown College (original) (raw)

Papers by karan patel

Cureus

In order to prescribe an antibiotic, a physician must go through a series of decision-making proc... more In order to prescribe an antibiotic, a physician must go through a series of decision-making processes that involve both the drug and the host. In this review article, we outline exactly what those decision-making processes are and some of their limitations. Before a medication can be prescribed, a physician has to determine if the antibiotic works against the host pathogen. To do this, basic science techniques are employed including phenotypic methods such as broth dilution methods, Kirby-Bauer susceptibility testing, Epsilometer test (E-test), and genotypic methods such as the new and upcoming automated tests. After determining if a drug has potential to work, the physician must consider the drug's mechanism of action in order to determine a dosing regimen. Some groups of drugs should be administered at high concentrations infrequently, others should be given more frequently in smaller doses, and others lie somewhere between this spectrum. Finally, external factors such as the patient's age, especially for pediatrics and geriatrics patients, need to be considered, as these groups have the highest health care burden but are among the most vulnerable when it comes to the side effects of drugs.

On a business level, everyone wants to get hold of the business value and other organizational ad... more On a business level, everyone wants to get hold of the business value and other organizational advantages that big data has to offer. Analytics has arisen as the primitive path to business value from big data. Hadoop is not just a storage platform for big data; it's also a computational and processing platform for business analytics. Hadoop is, however, unsuccessful in fulfilling business requirements when it comes to live data streaming. The initial architecture of Apache Hadoop did not solve the problem of live stream data mining. In summary, the traditional approach of big data being co-relational to Hadoop is false; focus needs to be given on business value as well. Data Warehousing, Hadoop and stream processing complement each other very well. In this paper, we have tried reviewing a few frameworks and products which use real time data streaming by providing modifications to Hadoop.

Journal of Shoulder and Elbow Surgery, 2020

Journal of Cardiology Research Review & Reports, 2021

The mesolimbic system has been demonstrated to have a major role in the perception of pain, but t... more The mesolimbic system has been demonstrated to have a major role in the perception of pain, but the mechanisms by which this occurs are poorly understood. In this paper, we review selected landmark studies that have contributed to our present understanding of the role of the mesolimbic system. The included studies outline the molecular mechanisms of the mesolimbic system's role in analgesia, pain relief, and feelings of decreased motivation and depression as a result of chronic pain. Because chronic pain is among the most highly-cited reasons for decreased quality of life, advancing our understanding of the function and mechanism of the mesolimbic system may be critical to improving the quality of life for millions of people around the globe.

To utilize the resources at hand and for solving the issue of energy security in India, focus on ... more To utilize the resources at hand and for solving the issue of energy security in India, focus on various ways of using the naturally available unconventional energies has been intensifying for last couple of decades. This is fuelled by the augmenting awareness about Global Warming and hazards of pollution. Renewable energies like wind power, solar energy, nuclear energy, geothermal energy, biomass and hydro energy need to be given the upper hand. This paper discusses the integrated systems of solar and geothermal energies and proposes design for heating, ventilation and air cooling system for use in Gujarat on commercial basis for domestic and commercial buildings. Winters in Gujarat see an average of about 22C while in summers, temperatures peak to around 42C. The average ground temperature remains constant at around 30C all around the year being warmer than atmosphere in winter and cooler in summer by around 10C. Thus, ground can be used as a heat source or sink respectively. Powe...

The City of Buffalo Comprehensive Plan 2038 focuses on factors of growth and development includin... more The City of Buffalo Comprehensive Plan 2038 focuses on factors of growth and development including: public participation, development considerations, transportation, economic development, housing, and community facilities. The plan includes a Future Land Use Map, which increases development opportunities and indicates preferred or suitable land use for the city.

The development and growth, particularly for developing countries depends on successful implement... more The development and growth, particularly for developing countries depends on successful implementation of new projects. The construction industry in India is the second largest industry next to agriculture in terms of providing employment. The construction industry is dynamic in nature due to the increasing uncertainties in technology, budgets, and development processes. Unfortunately, some projects were completed successfully but some were not completed on time, over budget or being cancelled. Nowadays, building projects are becoming much more complex and difficult. The project team is facing unprecedented changes. The study of project success and the critical success factors (CSFs) are considered to be a means to improve the effectiveness of project.

Orthopaedic Journal of Sports Medicine, 2021

Objectives: Recent research has shown that implanting a patellar osteochondral allograft with a n... more Objectives: Recent research has shown that implanting a patellar osteochondral allograft with a non-matched surface morphology (i.e., Wiberg classification) does not create increased chondral surface deviation or circumferential step-off in the donor plug compared to the native patella. While much of the research on patellar osteochondral allografts has been focused on chondral surface matching, little has been done to determine if the subchondral bone alignment at the donor:native interface plays a role in graft healing, local force distribution, and long term success of the allograft transplant. Previous work in our lab demonstrated that even when the patellar cartilage surface was well matched, notable differences in subchondral bone alignment were observed. The purpose of this study was therefore to use surface contour mapping of subchondral bone to determine if differences in Wiberg classification play a role in the ability of donor patellar osteochondral allograft subchondral ...

Cureus, 2021

Over the last decade, opioid use around the world has risen considerably and is projected to cont... more Over the last decade, opioid use around the world has risen considerably and is projected to continue to rise at an alarming rate. As opioid use rises, so too does the number of people who suffer from opioid use disorder (OUD) and opioid overdose-related deaths. As science and medicine progresses, new medications and therapies have arisen in order to help treat patients suffering from addiction. Treatment can be split into two main domains: pharmacological and non-pharmacological. Buprenorphine and methadone, currently the most prescribed medications for patients suffering from OUD, have been shown to be extremely effective in clinical trials but have significant real-world limitations. Geographical disparities between various locations, physician stigma with prescribing these medications, and training required to prescribe medication can make access to these treatments difficult for patients. Non-pharmacological interventions have also been shown to help with limited efficacy when combined with pharmacological interventions. However, the time and resources required to implement these strategies may be a difficult barrier to overcome. In this review, we assess pharmacological interventions, non-pharmacological treatments, examine barriers to treatment for patients, and propose solutions to bypass these barriers.

Foot & Ankle International, 2021

Background: Microfracture (MF) has been used historically to treat osteochondral lesions of the t... more Background: Microfracture (MF) has been used historically to treat osteochondral lesions of the talus (OLTs), with favorable outcomes reported in approximately 80% to 85% of cases. However, MF repairs have been shown to degrade over time at long-term follow-up, suggesting that further study into optimal OLT treatment is warranted. The use of adjuvant extracellular matrix with bone marrow aspirate concentrate (ECM-BMAC) has not been extensively evaluated in the literature. We present a comparison of patient-reported and radiographic outcomes following ECM-BMAC repair vs traditional MF. Methods: Patients who underwent MF (n = 67) or ECM-BMAC (n = 62) treatment for an OLT were identified and their charts were retrospectively reviewed. Postoperative magnetic resonance imaging (MRI) was evaluated and patient-reported outcome scores, either Foot and Ankle Outcome Scores (FAOS) or Patient-Reported Measurement Information System (PROMIS) scores, were collected. MRIs were scored by a radiolo...

SN Comprehensive Clinical Medicine, 2021

Since the coronavirus disease 2019 (COVID-19) pandemic has hit the entire world, there is ample k... more Since the coronavirus disease 2019 (COVID-19) pandemic has hit the entire world, there is ample knowledge regarding its clinical course and prognostic biomarkers. Still, the pathophysiology of COVID-19 is poorly understood. Since the first guidelines published in February 2020 for autopsy of both confirmed and suspected COVID-19 cases, there has been an increasing number of autopsies and literature reporting histopathological findings. However, our knowledge about the immunological response of various organ systems to the virus, as well as response patterns, is inadequate but is essential to understand and initiate timely and targeted antiviral, anti-inflammatory, or anticoagulative therapy. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily considered a respiratory virus, current evidence shows that it causes life-threatening complications in almost all organ systems including the heart, brain, kidney, spleen, liver, and eyes. Hence, in this article, we reviewed the published case reports and case series in order to increase our understanding of COVID-19 pathophysiology. The main histopathological findings of the lungs include diffuse alveolar damage with activated type II pneumocytes, fibroblasts, protein-rich exudate, and hyaline membranes. Other significant histopathological findings include cardiomegaly, right ventricular dilation, splenic pulp atrophy, kidneys with severe podocytopathy, and collapsing glomerulopathy, and the brain showed hypoxic changes in the cerebellum and cerebrum. Furthermore, in this review, we also explained different pathological findings of SARS-CoV and MERS and compared them to SARS-CoV-2. This comprehensive review will improve our understanding of COVID-19 pathophysiology and various disease stages, hence promoting the application of targeted therapy.

Cureus, 2021

Elder abuse can present in many forms, including physical abuse, psychological/emotional abuse, s... more Elder abuse can present in many forms, including physical abuse, psychological/emotional abuse, sexual abuse, financial abuse, and neglect. Many studies estimate that about 10% of all people over the age of 65 experience some form of abuse. These rates are often higher in long-term care facilities such as nursing homes, despite government regulations aimed toward addressing this issue. Because patients who experience abuse tend to have higher rates of hospitalization and mortality, it is important for physicians to be able to accurately identify cases of abuse. However, many studies have found that healthcare professionals are often undertrained and ill-equipped in diagnosing elder abuse. In this article, we outline tools that may be able to aid healthcare professionals in their diagnoses, such as survey-based methodology and common physical signs of abuse. In addition, we propose evidence-based solutions, including the use of multidisciplinary teams and increased training on the subject, so that healthcare professionals can more easily identify victims of abuse. Essentially, it is our hope that this article further spotlights elder abuse and its challenges, while serving as a guide to healthcare professionals.

International Journal of Agriculture & Environmental Science, 2020

Stroke, 2018

Background: At least one-fourth of all stroke survivors experience language impairments. Many rec... more Background: At least one-fourth of all stroke survivors experience language impairments. Many recover within a few months after the stroke, but up to 60% still have language impairments more than six months after a stroke, known as chronic aphasia. We aimed to look the outcomes, cost, a length of stay (LOS), and predictors of utilization of speech rehabilitation therapy (SRT) in stroke patients. Methods: We performed a cross-sectional study using the Nationwide Inpatient Sample (NIS) (years 2003-2013) in adult hospitalizations for AIS who had undergone SRT. We performed weighted analyses using chi-square, Cochran-Armitage Trend-test, and t-test to find outcomes, trend, and cost and LOS respectively. Multivariate survey logistic regression was done to evaluate the predictors of utilization of SRT. Results: Amongst 4,566,282 AIS hospitalizations, 23,597 had SRT. There was a decrease in trend (0.9% in 2003 to 0.55% in 2013, p<0.001). The mean LOS was longer by 2 days, the cost of ho...

CARTILAGE, 2020

Objective The purpose of this study was to determine if differences in Wiberg classification play... more Objective The purpose of this study was to determine if differences in Wiberg classification play a role in the ability of donor patellar osteochondral allografts to match the native patellar surface when treating osteochondral defects of the patellar apex. Design Twenty (10 Wiberg I and 10 Wiberg II/III) human patellae were designated as the recipient. Each recipient was size-matched to both a Wiberg I and a Wiberg II/III patellar donor. A 16-mm circular osteochondral “defect” was created on the central ridge of the recipient patella. The randomly ordered donor Wiberg I or Wiberg II/III plug was harvested from a homologous location and transplanted into the recipient. The recipient was then nano-CT (computed tomography) scanned, digitally reconstructed, registered to the initial nano-CT scan of the recipient patella, and processed to determine root mean squared circumferential step-off heights as well as surface height deviation. The process was then repeated for the other allograf...

Journal of Clinical Neurology, 2020

Several indexes are used to classify physician burnout, with the Maslach Burnout Inventory curren... more Several indexes are used to classify physician burnout, with the Maslach Burnout Inventory currently being the most widely accepted. This index measures physician burnout based on emotional exhaustion, detachment from work, and lack of personal achievement. The overall percentage of physicians with burnout is estimated to be around 40%, but the proportion varies between specialties. Neurology currently has the second-highest rate of burnout and is projected to eventually take the top position. The purpose of this review is to provide a comprehensive overview focusing on the causes and ramifications of burnout and possible strategies for addressing the crisis. Several factors contribute to burnout among neurologist, including psychological trauma associated with patient care and a lack of respect compared to other specialties. Various interventions have been proposed for reducing burnout, and this article explores the feasibility of some of them. Burnout not only impacts the physician but also has adverse effects on the overall quality of patient care and places a strain on the health-care system. Burnout has only recently been recognized and accepted as a health crisis globally, and hence most of the proposed action plans have not been validated. More studies are needed to evaluate the long-term effects of such interventions.

The Journal of Arthroplasty, 2020

BACKGROUND The ideal femoral component in revision total hip arthroplasty (rTHA) remains undeterm... more BACKGROUND The ideal femoral component in revision total hip arthroplasty (rTHA) remains undetermined; however, tapered, fluted, titanium (TFT) stems are now widely used with favorable results in all types of revision scenarios. With both modular and monoblock TFT stem options, neither has been proven to be superior. Femoral stem subsidence has been linked to aseptic loosening, instability, and leg length discrepancy. This study aims to assess stem subsidence of modular and monoblock TFT stems at a single urban orthopedic specialty hospital within a tertiary academic medical center. METHODS Electronic medical records of rTHAs performed between January 2013 and March 2018 utilizing modular and monoblock TFT stems were examined. Data collected included baseline demographics, surgical indication, femoral Paprosky classification, and stem subsidence at most recent follow up (3 months to 3 years). Two-sample t-tests and chi-squared tests were used for statistical analysis. RESULTS A total of 186 patients (106 modular, 80 monoblock) were included in the analysis. Modular stems underwent significantly greater subsidence than monoblock stems at latest radiographic follow-up (3.9 ± 2.6 vs 2.3 ± 2.5 mm, P < .001). A significantly greater proportion of modular stems underwent >5 mm of subsidence at latest follow-up (29.2% vs 11.3%, P < .001). CONCLUSION Monoblock TFT stems have displayed promising clinical results in prior studies, and now have been shown to decrease the incidence of postoperative subsidence. With the potential for stem subsidence to lead to aseptic loosening, limb length discrepancy, and instability, the orthopedic surgeon should weigh the risks and benefits of utilizing modular vs monoblock TFT stems in rTHA.

International Journal of Advance Engineering and Research Development, 2015

The aim of this study is to investigate the effects of DME as an additive on engine performance &... more The aim of this study is to investigate the effects of DME as an additive on engine performance & emission characteristics in 4 stroke diesel engine. An investigation will occur on engine with supplying different flow rate of DME wi th intake air & vary the injection pressure of diesel fuel injector. Due to high cetane number of DME co mpared with diesel will improve ignition quality. Also DME has a superior vaporization quality than conventional diesel. So, it has an advantageous effect on combustion & emission compare with neat diesel.

Petroleum Research, 2018

Conventionally oil recovery factor is too low, which leaves great prospects for the application o... more Conventionally oil recovery factor is too low, which leaves great prospects for the application of enhanced oil recovery (EOR) methods to increase recovery factor. EOR methods are capital intensive and few are environmentally hazardous. So the paper discusses on the alternate enhanced oil recovery technique which has tremendous potential to curb the challenges of conventional EOR methods. Plasma pulse technology (PPT) aided EOR treatment is administered with an electric wireline conveyed plasma pulse generator tool that is run in the well and positioned alongside the perforations. Using energy stored in the generator's capacitors, a plasma arc is created that emits a tremendous amount of heat and pressure for a fraction of a second. This in turn creates a broad band of hydraulic impulse acoustic waves that are powerful enough to clean perforations and near wellbore damage. These waves continue to resonate deep into the reservoir, exciting the fluid molecules and increasing the reservoirs natural resonance to the degree that it can break larger hydrocarbon molecules to smaller one and simultaneously reducing adhesion tension which results in increased mobility of hydrocarbons. The plasma pulse technology has been successfully used on production as well as injection wells. It has been used often as a remedial procedure to increase well's productivity that has been on production for a period of time. This paper throws light on fundamentals of this advancing plasma pulse technology, contrasting it with recent EOR techniques. Effectiveness of treatment in increasing oil recovery, it's applicability to different reservoir types and results achieved so far are also covered in the paper.

Current Sports Medicine Reports, 2019

Cryotherapy has gained popularity among athletes across many sports. The main goals of cryotherap... more Cryotherapy has gained popularity among athletes across many sports. The main goals of cryotherapy, and specifically whole-body cryotherapy, are for injury prevention and counteracting negative inflammatory symptoms following athletic performance in hopes of improving recovery. Application Cryotherapy is defined as body cooling for therapeutic purposes. It has traditionally been performed using ice packs or cold-water immersion baths. More recently, whole-body cryotherapy (WBC) has become a popular technique of this modality. Although considerably more expensive than traditional forms of cryotherapy, WBC has become widely popular for athletes and in sports medicine. It is often used with the intention for injury prevention and to counteract inflammatory symptoms after athletic performance, thus improving recovery. WBC is typically delivered in two ways. First, an individual can stand in a chamber that is open at the top. The body and torso are exposed to frigid temperatures in the chamber, while the head remains out at room temperature. Second, an individual, or a group of individuals, may sit in a chamber that is then filled with cool air. The entire body, including the head, is exposed to frigid temperatures (Fig. 1). WBC is performed in an environment that consists of brief exposure to extremely cold air in a custom temperature and humidity controlled cryochamber (Fig.). These chambers are maintained at j110-C to j140-C (j166-F to 220-F), depending on the specific cooling system (electrical or nitrogen). However, while the chambers are meant to cool to this temperature, due to convection from human subjects, the temperature at the skin is much warmer in human subjects (j35-C) compared with a manikin placed in the chamber (j150-C) (1). Also, individuals with a higher adiposity in their tissues tend to cool to lower temperatures (2). Prior to entering the cryochamber, each participant undergoes 30 to 60 s of temperature adaptation in a vestibule at a temperature of j60-C. During exposure, a minimal amount of clothing (shorts, socks, shoes, gloves, and a hat/headband) is worn to avoid frost bite injury. A surgical mask also is worn when the chamber includes the participant's head to avoid exhalation of humid air. Removal of sweat from each participant is required before entry into the cryochamber to avoid the risk of skin burning and necrosis. While in the cryochamber, the subjects also have to move their fingers and legs and avoid holding their breath. Exposure duration is usually 2 to 3 min (3). Selfe et al. (4) examined the effect of three different cryotherapy exposure durations in 14 professional rugby players and reported 2 min, the optimum exposure length at j135-C. This was determined based on gastrocnemius tissue oxyhemoglobin, deoxyhemoglobin, tissue oxygenation index, and skin temperature (4).

Cureus

In order to prescribe an antibiotic, a physician must go through a series of decision-making proc... more In order to prescribe an antibiotic, a physician must go through a series of decision-making processes that involve both the drug and the host. In this review article, we outline exactly what those decision-making processes are and some of their limitations. Before a medication can be prescribed, a physician has to determine if the antibiotic works against the host pathogen. To do this, basic science techniques are employed including phenotypic methods such as broth dilution methods, Kirby-Bauer susceptibility testing, Epsilometer test (E-test), and genotypic methods such as the new and upcoming automated tests. After determining if a drug has potential to work, the physician must consider the drug's mechanism of action in order to determine a dosing regimen. Some groups of drugs should be administered at high concentrations infrequently, others should be given more frequently in smaller doses, and others lie somewhere between this spectrum. Finally, external factors such as the patient's age, especially for pediatrics and geriatrics patients, need to be considered, as these groups have the highest health care burden but are among the most vulnerable when it comes to the side effects of drugs.

On a business level, everyone wants to get hold of the business value and other organizational ad... more On a business level, everyone wants to get hold of the business value and other organizational advantages that big data has to offer. Analytics has arisen as the primitive path to business value from big data. Hadoop is not just a storage platform for big data; it's also a computational and processing platform for business analytics. Hadoop is, however, unsuccessful in fulfilling business requirements when it comes to live data streaming. The initial architecture of Apache Hadoop did not solve the problem of live stream data mining. In summary, the traditional approach of big data being co-relational to Hadoop is false; focus needs to be given on business value as well. Data Warehousing, Hadoop and stream processing complement each other very well. In this paper, we have tried reviewing a few frameworks and products which use real time data streaming by providing modifications to Hadoop.

Journal of Shoulder and Elbow Surgery, 2020

Journal of Cardiology Research Review & Reports, 2021

The mesolimbic system has been demonstrated to have a major role in the perception of pain, but t... more The mesolimbic system has been demonstrated to have a major role in the perception of pain, but the mechanisms by which this occurs are poorly understood. In this paper, we review selected landmark studies that have contributed to our present understanding of the role of the mesolimbic system. The included studies outline the molecular mechanisms of the mesolimbic system's role in analgesia, pain relief, and feelings of decreased motivation and depression as a result of chronic pain. Because chronic pain is among the most highly-cited reasons for decreased quality of life, advancing our understanding of the function and mechanism of the mesolimbic system may be critical to improving the quality of life for millions of people around the globe.

To utilize the resources at hand and for solving the issue of energy security in India, focus on ... more To utilize the resources at hand and for solving the issue of energy security in India, focus on various ways of using the naturally available unconventional energies has been intensifying for last couple of decades. This is fuelled by the augmenting awareness about Global Warming and hazards of pollution. Renewable energies like wind power, solar energy, nuclear energy, geothermal energy, biomass and hydro energy need to be given the upper hand. This paper discusses the integrated systems of solar and geothermal energies and proposes design for heating, ventilation and air cooling system for use in Gujarat on commercial basis for domestic and commercial buildings. Winters in Gujarat see an average of about 22C while in summers, temperatures peak to around 42C. The average ground temperature remains constant at around 30C all around the year being warmer than atmosphere in winter and cooler in summer by around 10C. Thus, ground can be used as a heat source or sink respectively. Powe...

The City of Buffalo Comprehensive Plan 2038 focuses on factors of growth and development includin... more The City of Buffalo Comprehensive Plan 2038 focuses on factors of growth and development including: public participation, development considerations, transportation, economic development, housing, and community facilities. The plan includes a Future Land Use Map, which increases development opportunities and indicates preferred or suitable land use for the city.

The development and growth, particularly for developing countries depends on successful implement... more The development and growth, particularly for developing countries depends on successful implementation of new projects. The construction industry in India is the second largest industry next to agriculture in terms of providing employment. The construction industry is dynamic in nature due to the increasing uncertainties in technology, budgets, and development processes. Unfortunately, some projects were completed successfully but some were not completed on time, over budget or being cancelled. Nowadays, building projects are becoming much more complex and difficult. The project team is facing unprecedented changes. The study of project success and the critical success factors (CSFs) are considered to be a means to improve the effectiveness of project.

Orthopaedic Journal of Sports Medicine, 2021

Objectives: Recent research has shown that implanting a patellar osteochondral allograft with a n... more Objectives: Recent research has shown that implanting a patellar osteochondral allograft with a non-matched surface morphology (i.e., Wiberg classification) does not create increased chondral surface deviation or circumferential step-off in the donor plug compared to the native patella. While much of the research on patellar osteochondral allografts has been focused on chondral surface matching, little has been done to determine if the subchondral bone alignment at the donor:native interface plays a role in graft healing, local force distribution, and long term success of the allograft transplant. Previous work in our lab demonstrated that even when the patellar cartilage surface was well matched, notable differences in subchondral bone alignment were observed. The purpose of this study was therefore to use surface contour mapping of subchondral bone to determine if differences in Wiberg classification play a role in the ability of donor patellar osteochondral allograft subchondral ...

Cureus, 2021

Over the last decade, opioid use around the world has risen considerably and is projected to cont... more Over the last decade, opioid use around the world has risen considerably and is projected to continue to rise at an alarming rate. As opioid use rises, so too does the number of people who suffer from opioid use disorder (OUD) and opioid overdose-related deaths. As science and medicine progresses, new medications and therapies have arisen in order to help treat patients suffering from addiction. Treatment can be split into two main domains: pharmacological and non-pharmacological. Buprenorphine and methadone, currently the most prescribed medications for patients suffering from OUD, have been shown to be extremely effective in clinical trials but have significant real-world limitations. Geographical disparities between various locations, physician stigma with prescribing these medications, and training required to prescribe medication can make access to these treatments difficult for patients. Non-pharmacological interventions have also been shown to help with limited efficacy when combined with pharmacological interventions. However, the time and resources required to implement these strategies may be a difficult barrier to overcome. In this review, we assess pharmacological interventions, non-pharmacological treatments, examine barriers to treatment for patients, and propose solutions to bypass these barriers.

Foot & Ankle International, 2021

Background: Microfracture (MF) has been used historically to treat osteochondral lesions of the t... more Background: Microfracture (MF) has been used historically to treat osteochondral lesions of the talus (OLTs), with favorable outcomes reported in approximately 80% to 85% of cases. However, MF repairs have been shown to degrade over time at long-term follow-up, suggesting that further study into optimal OLT treatment is warranted. The use of adjuvant extracellular matrix with bone marrow aspirate concentrate (ECM-BMAC) has not been extensively evaluated in the literature. We present a comparison of patient-reported and radiographic outcomes following ECM-BMAC repair vs traditional MF. Methods: Patients who underwent MF (n = 67) or ECM-BMAC (n = 62) treatment for an OLT were identified and their charts were retrospectively reviewed. Postoperative magnetic resonance imaging (MRI) was evaluated and patient-reported outcome scores, either Foot and Ankle Outcome Scores (FAOS) or Patient-Reported Measurement Information System (PROMIS) scores, were collected. MRIs were scored by a radiolo...

SN Comprehensive Clinical Medicine, 2021

Since the coronavirus disease 2019 (COVID-19) pandemic has hit the entire world, there is ample k... more Since the coronavirus disease 2019 (COVID-19) pandemic has hit the entire world, there is ample knowledge regarding its clinical course and prognostic biomarkers. Still, the pathophysiology of COVID-19 is poorly understood. Since the first guidelines published in February 2020 for autopsy of both confirmed and suspected COVID-19 cases, there has been an increasing number of autopsies and literature reporting histopathological findings. However, our knowledge about the immunological response of various organ systems to the virus, as well as response patterns, is inadequate but is essential to understand and initiate timely and targeted antiviral, anti-inflammatory, or anticoagulative therapy. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily considered a respiratory virus, current evidence shows that it causes life-threatening complications in almost all organ systems including the heart, brain, kidney, spleen, liver, and eyes. Hence, in this article, we reviewed the published case reports and case series in order to increase our understanding of COVID-19 pathophysiology. The main histopathological findings of the lungs include diffuse alveolar damage with activated type II pneumocytes, fibroblasts, protein-rich exudate, and hyaline membranes. Other significant histopathological findings include cardiomegaly, right ventricular dilation, splenic pulp atrophy, kidneys with severe podocytopathy, and collapsing glomerulopathy, and the brain showed hypoxic changes in the cerebellum and cerebrum. Furthermore, in this review, we also explained different pathological findings of SARS-CoV and MERS and compared them to SARS-CoV-2. This comprehensive review will improve our understanding of COVID-19 pathophysiology and various disease stages, hence promoting the application of targeted therapy.

Cureus, 2021

Elder abuse can present in many forms, including physical abuse, psychological/emotional abuse, s... more Elder abuse can present in many forms, including physical abuse, psychological/emotional abuse, sexual abuse, financial abuse, and neglect. Many studies estimate that about 10% of all people over the age of 65 experience some form of abuse. These rates are often higher in long-term care facilities such as nursing homes, despite government regulations aimed toward addressing this issue. Because patients who experience abuse tend to have higher rates of hospitalization and mortality, it is important for physicians to be able to accurately identify cases of abuse. However, many studies have found that healthcare professionals are often undertrained and ill-equipped in diagnosing elder abuse. In this article, we outline tools that may be able to aid healthcare professionals in their diagnoses, such as survey-based methodology and common physical signs of abuse. In addition, we propose evidence-based solutions, including the use of multidisciplinary teams and increased training on the subject, so that healthcare professionals can more easily identify victims of abuse. Essentially, it is our hope that this article further spotlights elder abuse and its challenges, while serving as a guide to healthcare professionals.

International Journal of Agriculture & Environmental Science, 2020

Stroke, 2018

Background: At least one-fourth of all stroke survivors experience language impairments. Many rec... more Background: At least one-fourth of all stroke survivors experience language impairments. Many recover within a few months after the stroke, but up to 60% still have language impairments more than six months after a stroke, known as chronic aphasia. We aimed to look the outcomes, cost, a length of stay (LOS), and predictors of utilization of speech rehabilitation therapy (SRT) in stroke patients. Methods: We performed a cross-sectional study using the Nationwide Inpatient Sample (NIS) (years 2003-2013) in adult hospitalizations for AIS who had undergone SRT. We performed weighted analyses using chi-square, Cochran-Armitage Trend-test, and t-test to find outcomes, trend, and cost and LOS respectively. Multivariate survey logistic regression was done to evaluate the predictors of utilization of SRT. Results: Amongst 4,566,282 AIS hospitalizations, 23,597 had SRT. There was a decrease in trend (0.9% in 2003 to 0.55% in 2013, p<0.001). The mean LOS was longer by 2 days, the cost of ho...

CARTILAGE, 2020

Objective The purpose of this study was to determine if differences in Wiberg classification play... more Objective The purpose of this study was to determine if differences in Wiberg classification play a role in the ability of donor patellar osteochondral allografts to match the native patellar surface when treating osteochondral defects of the patellar apex. Design Twenty (10 Wiberg I and 10 Wiberg II/III) human patellae were designated as the recipient. Each recipient was size-matched to both a Wiberg I and a Wiberg II/III patellar donor. A 16-mm circular osteochondral “defect” was created on the central ridge of the recipient patella. The randomly ordered donor Wiberg I or Wiberg II/III plug was harvested from a homologous location and transplanted into the recipient. The recipient was then nano-CT (computed tomography) scanned, digitally reconstructed, registered to the initial nano-CT scan of the recipient patella, and processed to determine root mean squared circumferential step-off heights as well as surface height deviation. The process was then repeated for the other allograf...

Journal of Clinical Neurology, 2020

Several indexes are used to classify physician burnout, with the Maslach Burnout Inventory curren... more Several indexes are used to classify physician burnout, with the Maslach Burnout Inventory currently being the most widely accepted. This index measures physician burnout based on emotional exhaustion, detachment from work, and lack of personal achievement. The overall percentage of physicians with burnout is estimated to be around 40%, but the proportion varies between specialties. Neurology currently has the second-highest rate of burnout and is projected to eventually take the top position. The purpose of this review is to provide a comprehensive overview focusing on the causes and ramifications of burnout and possible strategies for addressing the crisis. Several factors contribute to burnout among neurologist, including psychological trauma associated with patient care and a lack of respect compared to other specialties. Various interventions have been proposed for reducing burnout, and this article explores the feasibility of some of them. Burnout not only impacts the physician but also has adverse effects on the overall quality of patient care and places a strain on the health-care system. Burnout has only recently been recognized and accepted as a health crisis globally, and hence most of the proposed action plans have not been validated. More studies are needed to evaluate the long-term effects of such interventions.

The Journal of Arthroplasty, 2020

BACKGROUND The ideal femoral component in revision total hip arthroplasty (rTHA) remains undeterm... more BACKGROUND The ideal femoral component in revision total hip arthroplasty (rTHA) remains undetermined; however, tapered, fluted, titanium (TFT) stems are now widely used with favorable results in all types of revision scenarios. With both modular and monoblock TFT stem options, neither has been proven to be superior. Femoral stem subsidence has been linked to aseptic loosening, instability, and leg length discrepancy. This study aims to assess stem subsidence of modular and monoblock TFT stems at a single urban orthopedic specialty hospital within a tertiary academic medical center. METHODS Electronic medical records of rTHAs performed between January 2013 and March 2018 utilizing modular and monoblock TFT stems were examined. Data collected included baseline demographics, surgical indication, femoral Paprosky classification, and stem subsidence at most recent follow up (3 months to 3 years). Two-sample t-tests and chi-squared tests were used for statistical analysis. RESULTS A total of 186 patients (106 modular, 80 monoblock) were included in the analysis. Modular stems underwent significantly greater subsidence than monoblock stems at latest radiographic follow-up (3.9 ± 2.6 vs 2.3 ± 2.5 mm, P < .001). A significantly greater proportion of modular stems underwent >5 mm of subsidence at latest follow-up (29.2% vs 11.3%, P < .001). CONCLUSION Monoblock TFT stems have displayed promising clinical results in prior studies, and now have been shown to decrease the incidence of postoperative subsidence. With the potential for stem subsidence to lead to aseptic loosening, limb length discrepancy, and instability, the orthopedic surgeon should weigh the risks and benefits of utilizing modular vs monoblock TFT stems in rTHA.

International Journal of Advance Engineering and Research Development, 2015

The aim of this study is to investigate the effects of DME as an additive on engine performance &... more The aim of this study is to investigate the effects of DME as an additive on engine performance & emission characteristics in 4 stroke diesel engine. An investigation will occur on engine with supplying different flow rate of DME wi th intake air & vary the injection pressure of diesel fuel injector. Due to high cetane number of DME co mpared with diesel will improve ignition quality. Also DME has a superior vaporization quality than conventional diesel. So, it has an advantageous effect on combustion & emission compare with neat diesel.

Petroleum Research, 2018

Conventionally oil recovery factor is too low, which leaves great prospects for the application o... more Conventionally oil recovery factor is too low, which leaves great prospects for the application of enhanced oil recovery (EOR) methods to increase recovery factor. EOR methods are capital intensive and few are environmentally hazardous. So the paper discusses on the alternate enhanced oil recovery technique which has tremendous potential to curb the challenges of conventional EOR methods. Plasma pulse technology (PPT) aided EOR treatment is administered with an electric wireline conveyed plasma pulse generator tool that is run in the well and positioned alongside the perforations. Using energy stored in the generator's capacitors, a plasma arc is created that emits a tremendous amount of heat and pressure for a fraction of a second. This in turn creates a broad band of hydraulic impulse acoustic waves that are powerful enough to clean perforations and near wellbore damage. These waves continue to resonate deep into the reservoir, exciting the fluid molecules and increasing the reservoirs natural resonance to the degree that it can break larger hydrocarbon molecules to smaller one and simultaneously reducing adhesion tension which results in increased mobility of hydrocarbons. The plasma pulse technology has been successfully used on production as well as injection wells. It has been used often as a remedial procedure to increase well's productivity that has been on production for a period of time. This paper throws light on fundamentals of this advancing plasma pulse technology, contrasting it with recent EOR techniques. Effectiveness of treatment in increasing oil recovery, it's applicability to different reservoir types and results achieved so far are also covered in the paper.

Current Sports Medicine Reports, 2019

Cryotherapy has gained popularity among athletes across many sports. The main goals of cryotherap... more Cryotherapy has gained popularity among athletes across many sports. The main goals of cryotherapy, and specifically whole-body cryotherapy, are for injury prevention and counteracting negative inflammatory symptoms following athletic performance in hopes of improving recovery. Application Cryotherapy is defined as body cooling for therapeutic purposes. It has traditionally been performed using ice packs or cold-water immersion baths. More recently, whole-body cryotherapy (WBC) has become a popular technique of this modality. Although considerably more expensive than traditional forms of cryotherapy, WBC has become widely popular for athletes and in sports medicine. It is often used with the intention for injury prevention and to counteract inflammatory symptoms after athletic performance, thus improving recovery. WBC is typically delivered in two ways. First, an individual can stand in a chamber that is open at the top. The body and torso are exposed to frigid temperatures in the chamber, while the head remains out at room temperature. Second, an individual, or a group of individuals, may sit in a chamber that is then filled with cool air. The entire body, including the head, is exposed to frigid temperatures (Fig. 1). WBC is performed in an environment that consists of brief exposure to extremely cold air in a custom temperature and humidity controlled cryochamber (Fig.). These chambers are maintained at j110-C to j140-C (j166-F to 220-F), depending on the specific cooling system (electrical or nitrogen). However, while the chambers are meant to cool to this temperature, due to convection from human subjects, the temperature at the skin is much warmer in human subjects (j35-C) compared with a manikin placed in the chamber (j150-C) (1). Also, individuals with a higher adiposity in their tissues tend to cool to lower temperatures (2). Prior to entering the cryochamber, each participant undergoes 30 to 60 s of temperature adaptation in a vestibule at a temperature of j60-C. During exposure, a minimal amount of clothing (shorts, socks, shoes, gloves, and a hat/headband) is worn to avoid frost bite injury. A surgical mask also is worn when the chamber includes the participant's head to avoid exhalation of humid air. Removal of sweat from each participant is required before entry into the cryochamber to avoid the risk of skin burning and necrosis. While in the cryochamber, the subjects also have to move their fingers and legs and avoid holding their breath. Exposure duration is usually 2 to 3 min (3). Selfe et al. (4) examined the effect of three different cryotherapy exposure durations in 14 professional rugby players and reported 2 min, the optimum exposure length at j135-C. This was determined based on gastrocnemius tissue oxyhemoglobin, deoxyhemoglobin, tissue oxygenation index, and skin temperature (4).