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Article: The ISCCM/IAPC Position Statement: Ending the Sisyphean Struggle to Practice Ethical End-of-life Care in India.

Rajagopalan, Ram E / Kapadia, Farhad

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2024 Volume 28, Issue 3, Page(s) 189–190

Abstract: Rajagopalan RE, Kapadia F. The ISCCM/IAPC Position Statement: Ending the Sisyphean Struggle to Practice Ethical End-of-life Care in India. Indian J Crit Care Med 2024;28(3):189-190. ...

Abstract	Rajagopalan RE, Kapadia F. The ISCCM/IAPC Position Statement: Ending the Sisyphean Struggle to Practice Ethical End-of-life Care in India. Indian J Crit Care Med 2024;28(3):189-190.
Language	English
Publishing date	2024-02-16
Publishing country	India
Document type	Editorial
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.5005/jp-journals-10071-24660
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: CPIS Lung Ultrasound and the Erratic March toward Diagnostic Certainty in VAP.

Rajagopalan, Ram E

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2021 Volume 25, Issue 3, Page(s) 255–257

Abstract: How to cite this article: ...

Abstract	How to cite this article:
Language	English
Publishing date	2021-03-31
Publishing country	India
Document type	Editorial
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.5005/jp-journals-10071-23751
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Article ; Online: Convolutional neural network deep learning model accurately detects rectal cancer in endoanal ultrasounds.

Carter, D / Bykhovsky, D / Hasky, A / Mamistvalov, I / Zimmer, Y / Ram, E / Hoffer, O

Techniques in coloproctology

2024 Volume 28, Issue 1, Page(s) 44

Abstract: Background: Imaging is vital for assessing rectal cancer, with endoanal ultrasound (EAUS) being highly accurate in large tertiary medical centers. However, EAUS accuracy drops outside such settings, possibly due to varied examiner experience and fewer ... ...

Abstract	Background: Imaging is vital for assessing rectal cancer, with endoanal ultrasound (EAUS) being highly accurate in large tertiary medical centers. However, EAUS accuracy drops outside such settings, possibly due to varied examiner experience and fewer examinations. This underscores the need for an AI-based system to enhance accuracy in non-specialized centers. This study aimed to develop and validate deep learning (DL) models to differentiate rectal cancer in standard EAUS images. Methods: A transfer learning approach with fine-tuned DL architectures was employed, utilizing a dataset of 294 images. The performance of DL models was assessed through a tenfold cross-validation. Results: The DL diagnostics model exhibited a sensitivity and accuracy of 0.78 each. In the identification phase, the automatic diagnostic platform achieved an area under the curve performance of 0.85 for diagnosing rectal cancer. Conclusions: This research demonstrates the potential of DL models in enhancing rectal cancer detection during EAUS, especially in settings with lower examiner experience. The achieved sensitivity and accuracy suggest the viability of incorporating AI support for improved diagnostic outcomes in non-specialized medical centers.
MeSH term(s)	Humans ; Endosonography/methods ; Deep Learning ; Ultrasonography/methods ; Neural Networks, Computer ; Rectal Neoplasms/diagnostic imaging
Language	English
Publishing date	2024-04-01
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-024-02917-3
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Article: Author Response.

Vijayakumar, M / Selvam, Velmurugan / Renuka, M K / Rajagopalan, Ram E

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2024 Volume 28, Issue 5, Page(s) 515

Abstract: How to cite this article: ...

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Language	English
Publishing date	2024-05-08
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.5005/jp-journals-10071-24701
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Article: Combined 3D Endoanal Ultrasound and Transperineal Ultrasound Improves the Detection of Anal Sphincter Defects.

Carter, Dan / Ram, Edward / Engel, Tal

Diagnostics (Basel, Switzerland)

2023 Volume 13, Issue 4

Abstract: Introduction: Anal sphincter injury, mainly due to obstetric or iatrogenic etiology, is the most common cause of fecal incontinence (FI). Three-dimensional endoanal ultrasound (3D EAUS) is used for assessment of the integrity and the degree of anal ... ...

Abstract	Introduction: Anal sphincter injury, mainly due to obstetric or iatrogenic etiology, is the most common cause of fecal incontinence (FI). Three-dimensional endoanal ultrasound (3D EAUS) is used for assessment of the integrity and the degree of anal muscle injury. However, 3D EAUS accuracy may be hampered by regional acoustic effects, such as intravaginal air. Therefore, our aim was to examine whether a combination of transperineal ultrasound (TPUS) and 3D EAUS would improve the accuracy of detection of anal sphincter injury. Methods: We prospectively performed 3D EAUS followed by TPUS in every patient evaluated for FI in our clinic between January 2020 and January 2021. The diagnosis of anal muscle defects was assessed in each ultrasound technique by two experienced observers that were blinded to each other's assessments. Interobserver agreement for the results of the 3D EAUS and the TPUS exams was examined. A final diagnosis of anal sphincter defect was based on the results of both ultrasound methods. Discordant results were re-analyzed by the two ultrasonographers for a final consensus on the presence or absence of defects. Results: A total of 108 patients underwent ultrasonographic assessment due to FI (mean age 69 ± 13). Interobserver agreement for the diagnosis of tear on EAUS and TPUS was high (83%) with Cohen's kappa of 0.62. EAUS confirmed anal muscle defects in 56 patients (52%), while TPUS confirmed them in 62 patients (57%). The final consensus agreed on the diagnosis of 63 (58%) muscular defects and 45 (42%) normal exams. The Cohen's kappa coefficient of agreement between the results of the 3D EAUS and the final consensus was 0.63. Conclusions: The combination of 3D EAUS and TPUS improved the detection of anal muscular defects. The application of both techniques for the assessment of the anal integrity should be considered in every patient going through ultrasonographic assessment for anal muscular injury.
Language	English
Publishing date	2023-02-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics13040682
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Article ; Online: The possible involvement of sema3A and sema4A in the pathogenesis of multiple sclerosis.

Eiza, N / Garty, M / Staun-Ram, E / Miller, A / Vadasz, Z

Clinical immunology (Orlando, Fla.)

2022 Volume 238, Page(s) 109017

Abstract: Background: Immune semaphorins are widely accepted to have functional impact on autoimmune diseases.: Objectives: To assess the status of sema3A and sema4A in the pathogenesis of Multiple Sclerosis (MS).: Results: Sema3A expression on (T ... ...

Abstract	Background: Immune semaphorins are widely accepted to have functional impact on autoimmune diseases. Objectives: To assess the status of sema3A and sema4A in the pathogenesis of Multiple Sclerosis (MS). Results: Sema3A expression on (T regulatory cells)Tregs was decreased in MS patients, compared to healthy controls (35.85 ± 16.7% vs 88.27 ± 3.8%; p ≤ 0.001). Serum levels of sema3A were decreased in MS patients 2.95 ± 0.43 vs 18.67 ± 5.7 ng/ml in healthy individuals; p ≤ 0.001. Sema4A serum levels were increased in MS patients compared to healthy individuals (12.99 ± 8.6 vs 5.83 ± 3.91 ng/ml; p ≤ 0.001). Sema3A and sema4A serum levels were found to be in negative/positive correlation with MS disease severity (r Conclusion: We show that sema3A is a regulatory molecule in MS, whereas sema4A is a stimulatory one. Targeting sema3A and sema4A could become a potential therapeutic approach in MS.
MeSH term(s)	Humans ; Multiple Sclerosis ; Semaphorin-3A ; Semaphorins ; Severity of Illness Index ; T-Lymphocytes, Regulatory/metabolism
Chemical Substances	SEMA3A protein, human ; SEMA4A protein, human ; Semaphorin-3A ; Semaphorins
Language	English
Publishing date	2022-04-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	1459903-x
ISSN	1521-7035 ; 1521-6616
ISSN (online)	1521-7035
ISSN	1521-6616
DOI	10.1016/j.clim.2022.109017
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Zs.A 880: Show issues

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Article ; Online: Comparison of etiological and physiological characteristics of fecal incontinence in men and women.

Margalit-Yehuda, Reuma / Maradey-Romero, Carla / Davidov, Yana / Ram, Edward / Carter, Dan

American journal of physiology. Gastrointestinal and liver physiology

2024 Volume 326, Issue 3, Page(s) G274–G278

Abstract: Fecal incontinence (FI) is often underreported and underestimated in men. Our aims were to clarify the causes and the physiological characteristics of FI in men and to underline the differences between etiological and physiological factors in men and ... ...

Abstract	Fecal incontinence (FI) is often underreported and underestimated in men. Our aims were to clarify the causes and the physiological characteristics of FI in men and to underline the differences between etiological and physiological factors in men and women diagnosed with FI. The study cohort encompassed 200 men and 200 women who underwent anatomical and physiological evaluation for FI in a tertiary referral center specializing in pelvic floor disorders. All patients underwent endoanal ultrasound and anorectal manometry. Evacuation proctography was performed in some patients. Demographic, medical, anatomical, and physiological parameters were compared between the two study groups. Urge incontinence was the most frequent type of FI in both genders. In men, anal fistula, history of anal surgeries, rectal tumors, and pelvic radiotherapy were common etiologic factors, whereas history of pelvic surgeries was more common in women. Associated urinary incontinence was reported more frequently by women. External anal sphincter defects, usually anterior, were more common in women (M: 1.5%, F: 24%,
MeSH term(s)	Female ; Humans ; Male ; Anal Canal/pathology ; Ataxia/complications ; Fecal Incontinence/epidemiology ; Fecal Incontinence/etiology ; Manometry ; Rectum/pathology
Language	English
Publishing date	2024-01-09
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	603840-2
ISSN	1522-1547 ; 0193-1857
ISSN (online)	1522-1547
ISSN	0193-1857
DOI	10.1152/ajpgi.00113.2023
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Article: Concomitant Cardiac Surgical Procedures in Patients Undergoing HeartMate 3 Left Ventricular Assist Device Implantation.

Eisenberger, Jonathan / Somer, Shmuel / Nachum, Eyal / Ram, Eilon / Lavee, Jacob / Sternik, Leonid / Morgan, Jeffrey

The Israel Medical Association journal : IMAJ

2024 Volume 26, Issue 5, Page(s) 278–282

Abstract: Background: Long-term support with a HeartMate 3 (HM3) left ventricular assist device (LVAD) has improved outcomes of patients with end-stage heart failure. However, there is a paucity of data on the outcomes of patients who underwent concomitant ... ...

Abstract	Background: Long-term support with a HeartMate 3 (HM3) left ventricular assist device (LVAD) has improved outcomes of patients with end-stage heart failure. However, there is a paucity of data on the outcomes of patients who underwent concomitant cardiac surgical procedure (CCSP) during HM3-LVAD implantation. Objectives: To assess our single-center experience with patients who underwent CCSP during the implantation of an HM3-LVAD. Methods: From December 2016 until April 2022, 131 adult patients underwent HM3-LVAD implantation. A total of 23 patients underwent CCSP during the HM3-LVAD implantation+CCSP, and 108 underwent only HM3-LVAD implantation (HM3-only). Results: The median age was 59 ± 11 years (range 54-67), 82% (n=108) were male, and 76% (n=100) were implanted as a bridge-to-transplant. The concomitant procedures performed during the implantation included 8 aortic valve repairs/replacements, 14 tricuspid valve repairs, 4 patent foramen ovales or atrial septal defect closures, and 3 other cardiac procedures. The mean cardiopulmonary bypass time was 113 ± 58 minutes for the HM3-only group and 155 ± 47 minutes for the HM3+CCSP group (P = 0.007). The mortality rates at 30 days, 6 months, and 12 months post-implantation were 2 (9%), 5 (22%), and 6 (26%) respectively for the HM3+CCSP group, and 7 (6%), 18 (17%), and 30 (28%) for the HM3-only group (P = 0.658, 0.554, and 1.000). Conclusions: Our experience demonstrated no significant difference in the 30-day, 6-month, and 12-month mortality rates for patients who underwent a CCSP during HM3-LVAD implantation compared to patients who did not undergo CCSP during HM3-LVAD implantation.
MeSH term(s)	Humans ; Heart-Assist Devices/statistics & numerical data ; Male ; Female ; Middle Aged ; Heart Failure/surgery ; Heart Failure/mortality ; Heart Failure/therapy ; Aged ; Cardiac Surgical Procedures/methods ; Retrospective Studies ; Treatment Outcome ; Prosthesis Implantation/methods
Language	English
Publishing date	2024-05-13
Publishing country	Israel
Document type	Journal Article
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Zs.A 5470: Show issues

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Article ; Online: Surgical outcomes of minimally invasive trephine surgery for pilonidal sinus disease with and without laser therapy: a comparative study.

Horesh, N / Maman, R / Zager, Y / Anteby, R / Weksler, Y / Carter, D / Nachmany, I / Ram, E

Techniques in coloproctology

2023 Volume 28, Issue 1, Page(s) 13

Abstract: Background: Over the last decades, novel therapeutic options have emerged for the surgical treatment of pilonidal sinus disease (PSD). The aim of this study was to evaluate the outcomes of trephine/pit excision surgery with or without laser therapy in ... ...

Abstract	Background: Over the last decades, novel therapeutic options have emerged for the surgical treatment of pilonidal sinus disease (PSD). The aim of this study was to evaluate the outcomes of trephine/pit excision surgery with or without laser therapy in patients with PSD. Methods: A retrospective cohort study was conducted at a large tertiary medical center, including all adult patients with PNS who underwent trephine surgery with/without laser therapy between 2016 and 2021[AUTHORS TO INSERT MONTH]. Propensity score matching was used to address confounding factors, and the primary outcome was the 1-year recurrence rate. Results: The study included 221 patients with PSD, with a mean age of 23.73 years (87.7% male). In the unmatched cohort (130 trephine surgery alone, 91 trephine surgery + laser therapy), significant differences were observed in mean age (23 vs. 25 years; p < 0.01)[AUTHROS TO USE MEDIAN PLUS RANGE OR ADD SD] and surgeons' experience (p = 0.014). Propensity score matching was applied to overcome confounding factors, resulting in a matched cohort including 73 patients in each group. The addition of laser therapy demonstrated a significantly lower recurrence rate (8.2% vs. 32.9%; p < 0.001) compared to pit excision without laser therapy. Logistic regression analysis showed that the addition of laser was significantly associated with a lower risk for recurrence (OR 0.23; 95% CI 0.089-0.633; p < 0.01). Conclusion: The incorporation of laser therapy along with trephine/pit excision surgery significantly reduces the recurrence rate in patients with PNS. Further prospective studies are needed to confirm our findings.
MeSH term(s)	Adult ; Humans ; Male ; Young Adult ; Female ; Treatment Outcome ; Pilonidal Sinus/surgery ; Retrospective Studies ; Neoplasm Recurrence, Local/surgery ; Laser Therapy ; Recurrence
Language	English
Publishing date	2023-12-13
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-023-02897-w
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Zs.A 5842: Show issues

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Article: Author Response.

Vijayakumar, M / Selvam, Velmurugan / Renuka, M K / Rajagopalan, Ram E

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2023 Volume 28, Issue 5, Page(s) 512

Abstract: How to cite this article: ...

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Language	English
Publishing date	2023-09-01
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.5005/jp-journals-10071-24699
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