Browse Health
14 years of experience
Accepting new patients


Education ?

Medical School Score Rankings
Virginia Commonwealth University (1998)
Top 50%

Awards & Distinctions ?

place at Chicago Urologic Irving J. Shapiro X-ray conference, 2004
Resident Achievement Award from The Society of Laparoendoscopic
Chief Administrative Resident, Universi
Castle Connolly's Top Doctors™ (2013)
American Board of Urology
American Urological Association

Affiliations ?

Dr. Kalra is affiliated with 3 hospitals.

Hospital Affiliations



  • Pottstown Memorial Medical Center
    1600 E High St, Pottstown, PA 19464
  • Phoenixville Hospital University PA Health System
    140 Nutt Rd, Phoenixville, PA 19460
  • Phoenixville Hospital
  • Publications & Research

    Dr. Kalra has contributed to 39 publications.
    Title Cardiorenal Medicine: Partners in Practice?
    Date September 2011
    Journal Journal of Renal Care

    Cardiorenal medicine is an exciting and evolving area of medicine. There is still much to learn about the complex pathophysiological process of the cardiorenal syndrome. The latest ideas and research were discussed at the 5th Annual Cardiorenal Forum on 15th October 2010.

    Title Episodic Hyperhydrosis with Corpus Callosum Agenesis: a Rare Case of Shapiro Syndrome.
    Date May 2011
    Journal Neurology India
    Title Structural Basis for the Recognition of Cellular Mrna Export Factor Ref by Herpes Viral Proteins Hsv-1 Icp27 and Hvs Orf57.
    Date May 2011
    Journal Plos Pathogens

    The herpesvirus proteins HSV-1 ICP27 and HVS ORF57 promote viral mRNA export by utilizing the cellular mRNA export machinery. This function is triggered by binding to proteins of the transcription-export (TREX) complex, in particular to REF/Aly which directs viral mRNA to the TAP/NFX1 pathway and, subsequently, to the nuclear pore for export to the cytoplasm. Here we have determined the structure of the REF-ICP27 interaction interface at atomic-resolution and provided a detailed comparison of the binding interfaces between ICP27, ORF57 and REF using solution-state NMR. Despite the absence of any obvious sequence similarity, both viral proteins bind on the same site of the folded RRM domain of REF, via short but specific recognition sites. The regions of ICP27 and ORF57 involved in binding by REF have been mapped as residues 104-112 and 103-120, respectively. We have identified the pattern of residues critical for REF/Aly recognition, common to both ICP27 and ORF57. The importance of the key amino acid residues within these binding sites was confirmed by site-directed mutagenesis. The functional significance of the ORF57-REF/Aly interaction was also probed using an ex vivo cytoplasmic viral mRNA accumulation assay and this revealed that mutants that reduce the protein-protein interaction dramatically decrease the ability of ORF57 to mediate the nuclear export of intronless viral mRNA. Together these data precisely map amino acid residues responsible for the direct interactions between viral adaptors and cellular REF/Aly and provide the first molecular details of how herpes viruses access the cellular mRNA export pathway.

    Title Adding Antibiotics to the "time-out" Process Improves Compliance.
    Date January 2011
    Journal Journal of Clinical Anesthesia
    Title Elevated Heart Rate and Cardiovascular Outcomes in Patients with Coronary Artery Disease: Clinical Evidence and Pathophysiological Mechanisms.
    Date December 2010
    Journal Atherosclerosis

    There is an established body of evidence from epidemiological studies which indicates that an elevated resting heart rate is independently associated with atherosclerosis and increased cardiovascular morbidity and mortality, in both the general population and in patients with established cardiovascular disease. Clinical trial data suggest that in patients with coronary artery disease, an elevated heart rate identifies those at increased risk of adverse cardiovascular outcomes, and that lowering of heart rate may reduce major cardiovascular events in patients with an elevated heart rate and symptom-limiting angina. These results suggest that an increased heart rate may have an adverse impact on the atherosclerotic process and increase the risk of a cardiovascular event in patients with coronary artery disease. The precise pathophysiological mechanisms that link heart rate and cardiovascular outcomes have yet to be defined. Possibilities may include indirect mechanisms related to autonomic dysregulation and those due to an increase in heart rate per se, which can increase the ischaemic burden and exert local haemodynamic forces that can adversely impact on the endothelium and arterial wall. For these reasons, heart rate should be considered as a therapeutic target in the treatment of patients with coronary artery disease.

    Title Novel Use of the Gelport to Expedite Transition to Robot-assisted Partial Nephrectomy.
    Date September 2010
    Journal Journal of Endourology / Endourological Society

    Robot-assisted partial nephrectomy is associated with a learning curve, necessitating proficiency in robotic renal dissection, hilar control, and subsequent mass excision and renorrhaphy. The Gelport can be used during these procedures to expedite initial control of the renal pedicle and to add to the surgeon's comfort level while transitioning to this procedure.

    Title Limited Venous Access and Pacemaker Insertion in a Haemodialysis Patient: Case Report.
    Date February 2010
    Journal International Journal of Cardiology

    The population of haemodialysis patients is increasing as is their age. There is a higher risk of cardiac comorbidities in these patients. Pacing is increasingly common in this group. We present a case highlighting the difficult issues and exemplifies the need for careful planning preprocedure. Haemodialysis patients often have difficult and limited vascular access. Insertion of pacing leads is associated with subclavian vein stenosis. If this is on the side of an AV fistula there is significant risk of losing the fistula with obvious consequences to the patient. Careful consideration of site and route of access needs to be made prior to pacing. The need for involvement of renal and vascular teams before starting the procedure is essential as it is paramount that the best route of access for pacing wires is selected.

    Title A Randomized, Crossover Design Study of Sevelamer Carbonate Powder and Sevelamer Hydrochloride Tablets in Chronic Kidney Disease Patients on Haemodialysis.
    Date February 2010
    Journal Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association

    Sevelamer carbonate is an improved, buffered form of sevelamer hydrochloride developed for the treatment of hyperphosphataemia in CKD patients. Sevelamer carbonate formulated as a powder for oral suspension presents a novel, patient-friendly alternative to tablet phosphate binders. This study compared the safety and efficacy of sevelamer carbonate powder with sevelamer hydrochloride tablets in CKD patients on haemodialysis.

    Title Going for Gold, from Beijing to Munich, Highlights from the Esc 2008 Congress: Beautiful, Gissi-hf, and Potential New Therapies for Acute Decompensated Heart Failure.
    Date February 2009
    Journal Cardiovascular Therapeutics
    Title Amiodarone--avoid the Danger of Torsade De Pointes.
    Date April 2008
    Journal Resuscitation

    We present two patients who had life-threatening arrhythmias, which are highly likely to be secondary to amiodarone. This class III anti-arrhythmic is commonly prescribed for the acute presentation of supra-ventricular and ventricular arrhythmias. However, occasionally its use can transform arrhythmias from benign to dangerous. These cases highlight the need for careful attention to the indications, cautions and contra-indications of amiodarone as well as the need for vigilance following initiation of anti-arrhythmic therapy.

    Title Care Coordination to Increase Referrals to Smoking Cessation Telephone Counseling: a Demonstration Project.
    Date March 2008
    Journal The American Journal of Managed Care

    OBJECTIVE: To test the effectiveness of a care coordination program for telephone counseling in raising referral and treatment rates for smoking cessation. STUDY DESIGN: A demonstration project implementing a smoking cessation care coordination program offering telephone counseling and medication management to patients referred from primary care. METHODS: The study was performed at 18 Veterans Health Administration (VA) sites in California. Participants were VA patients receiving primary care. We randomly allocated 10 of 18 sites to receive the Telephone Care Coordination Program, which included simple 2-click referral, proactive care coordination, medication management, and 5 follow-up telephone calls. Each patient received a 30- to 45-minute counseling session from the California Smokers' Helpline. Patients at control sites received usual care. RESULTS: During 10 months, we received 2965 referrals. We were unable to reach 1156 patients (39%), despite at least 3 attempts. We excluded 73 patients (3%), and 391 patients (13%) were not interested. We connected the remaining 1345 patients (45%) to the Helpline. At 6-month followup, 335 patients (11% of all referrals and 25% of participating patients) were abstinent. Providers at intervention sites reported referring many more patients to telephone counseling than providers at control sites (15.6 vs 0.7 in the prior month). CONCLUSIONS: The program generated a large number of referrals; almost half of the patients referred were connected with the Helpline. Long-term abstinence was excellent. These results suggest that managed care organizations may be able to improve tobacco control by implementing a similar system of care coordination.

    Title Critical Care Nurses Responses to Patient Photographs Displayed at the Bedside.
    Date November 2007
    Journal Heart & Lung : the Journal of Critical Care
    Title Leptin Gene Transfer in the Hypothalamus Enhances Longevity in Adult Monogenic Mutant Mice in the Absence of Circulating Leptin.
    Date September 2007
    Journal Neurobiology of Aging

    Leptin, a product of the ob gene, is a pleiotropic signal implicated in regulation of multiple physiological functions in the periphery and centrally, including hypothalamic integration of energy homeostasis. Recessive mutations of ob gene result in early onset of hyperphagia, morbid obesity, metabolic disorders, early mortality and shortened life-span. Intracerebroventricular injection of recombinant adeno-associated virus vector (rAAV) encoding the leptin gene in adult obese ob/ob mice enhanced leptin transgene expression only in the hypothalamus, normalized food intake, body weight and more than doubled the life-span as compared to control cohorts and extended it to near that of normal wild type mice. These life-extending benefits were associated with drastic reductions in visceral fat, and blood glucose and insulin levels, but elevated ghrelin levels, the anti-aging biomarkers. Thus, bioavailability of leptin transduced by ectopic gene in the hypothalamus alone is both necessary and sufficient to normalize life-span. Evidently, site-specific ectopic gene expression with rAAV is durable and safe for alleviating neural disorders that stem from missing or functional disruption of a single gene.

    Title Effect of Pulse Width on Object Movement in Vitro Using Holmium:yag Laser.
    Date April 2007
    Journal Journal of Endourology / Endourological Society

    The holmium:YAG laser is an effective modality for intracorporeal lithotripsy. The fiber tip needs to be in contact with the calculus for maximal effect. Laser energy can cause stone retropulsion, necessitating cumbersome repositioning of the fiber. We examined the effect of varying the laser pulse width on object movement in vitro.

    Title Meconium Periorchitis.
    Date August 2006
    Journal Urology
    Title Outcomes of Hand-assisted Laparoscopic Nephrectomy in Technically Challenging Cases.
    Date March 2006
    Journal Urology

    OBJECTIVES: To evaluate the outcomes of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. METHODS: We performed a retrospective review of 322 hand-assisted laparoscopic nephrectomy cases that were completed at a single institution from 1998 to 2004. Patients with a history of extensive abdominal surgery or prior procedures on the affected kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombus were included. RESULTS: A total of 42 patients were included in this series. Of these, 16 patients had a lesion 10 cm or larger, 10 had a renal vein thrombus, and 10 had undergone prior major abdominal surgery. Many patients had more than one complicating factor. Another 6 patients had a history of prior renal procedures or chronic inflammatory processes involving the affected kidney. One Stage T4 renal tumor with paraspinous muscle invasion was successfully managed without conversion. The overall mean operative time and estimated blood loss was 235 minutes and 439 mL, respectively, with a mean hospital stay of 4 days. Four patients (9.5%) required open conversion (one renal hilar injury, two failure to progress, and one persistent bleeding from the renal fossa). Postoperative complications included pulmonary embolism in 1, ileus in 1, and chronic obstructive pulmonary disease exacerbation in 1 patient. One patient developed an incarcerated port site hernia requiring reoperation. CONCLUSIONS: Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option in the setting of significant complicating factors. This technique may facilitate the successful laparoscopic completion of these challenging cases with reasonable operative times, blood loss, and complication rates.

    Title Bone Marrow Abnormalities in Hiv Disease.
    Date February 2006
    Journal The Journal of the Association of Physicians of India

    Bone marrow abnormalities are frequently observed in HIV infected individuals at all stages of the disease. The most common abnormal finding is dysplasia affecting one or more cell lines. Erythroid dysplasia is the most common type of dysplasia and is recognized in over 50% of HIV infected patients, abnormal granulocytic and megakaryocytic development is encountered in one-third of patients. Plasma cells are strikingly increased in bone marrow of HIV infected patients. It may represent a physiological response to antigenic stimulation by viruses, other infective agents or secondary to dysregulated B-cell proliferation due to HIV. Herein we present a review discussing the various bone marrow abnormalities associated with the HIV disease.

    Title Early Tracheostomy in Closed Head Injuries: Experience at a Tertiary Center in a Developing Country--a Prospective Study.
    Date November 2005
    Journal Bmc Emergency Medicine

    BACKGROUND: An important factor contributing to the high mortality in patients with severe head trauma is cerebral hypoxia. The mechanical ventilation helps both by reduction in the intracranial pressure and hypoxia. Ventilatory support is also required in these patients because of patient's inability to protect the airway, persistence of excessive secretions, and inadequacy of spontaneous ventilation. Prolonged endotracheal intubation is however associated with trauma to the larynx, trachea, and patient discomfort in addition to requirement of sedatives. Tracheostomy has been found to play an integral role in the airway management of such patients, but its timing remains subject to considerable practice variation. In a developing country like India where the intensive care facilities are scarce and rarely available, these critical patients have to be managed in high dependency cubicles in the ward, often with inadequately trained nursing staff and equipment to monitor them. An early tracheostomy in the selected group of patients based on Glasgow Coma Score(GCS) may prove to be life saving. Against this background a prospective study was contemplated to assess the role of early tracheostomy in patients with isolated closed head injury. METHODS: The series consisted of a cohort of 50 patients admitted to the surgical emergency with isolated closed head injury, that were not considered for surgery by the neuro-surgeon or shifted to ICU, but had GCS score of less than 8 and SAPS II score of more than 50. First 50 case records from January 2001 that fulfilled the criteria constituted the control group. The patients were managed as per ATLS protocol and intubated if required at any time before decision to perform tracheostomy was taken. These patients were serially assessed for GCS (worst score of the day as calculated by senior surgical resident) and SAPS scores till day 15 to chart any changes in their status of head injuries and predictive mortality. Those patients who continued to have a GCS score of <8 and SAPS score of >50 for more than 24 hours (to rule out concussion or recovery) underwent tracheostomy. All these patients were finally assessed for mortality rate and hospital stay, the statistical analysis was carried out using SPSS10 version. The final outcome (in terms of mortality) was analyzed utilizing chi-square test and p value <0.05 was considered significant. RESULTS: At admission both tracheostomy and non-tracheostomy groups were matched with respect to GCS score and SAPS score. The average day of tracheostomy was 2.18 +/- 1.0038 days. The GCS scores on days 1, 2, 3, 4, 5, 10 between tracheostomy and non-tracheostomized group were comparable. However the difference in the GCS scores was statistically significant on day 15 being higher in the tracheostomy group. Thus early tracheostomy was observed to improve the mortality rate significantly in patients with isolated closed head injury. CONCLUSION: It may be concluded that early tracheostomy is beneficial in patients with isolated closed head injury which is severe enough to affect systemic physiological parameters, in terms of decreased mortality and intubation associated complications in centers where ICU care is not readily available. Also, in a selected group of patients, early tracheostomy may do away with the need for prolonged mechanical ventilation.

    Title Hiv Disease Presenting As Parotid Lymphoepithelial Cysts: a Presumptive Diagnosis of Diffuse Infiltrative Lymphocytic Syndrome (dils).
    Date July 2005
    Journal The Journal of the Association of Physicians of India

    Diffuse infiltrative lymphocytic syndrome (DILS), is a rare manifestation of human immunodeficiency virus (HIV) disease which is characterized by a diffuse visceral CD8 lymphocytic infiltration, a persistent CD8 lymphocytosis, bilateral parotid swelling and cervical lymphadenopathy. We describe a case of a HIV positive female, who had bilateral parotid swelling and CD8 lymphocytosis, to illustrate this rare clinical entity.

    Title New Approaches to the Minimally Invasive Treatment of Kidney Tumors.
    Date June 2005
    Journal Cancer Journal (sudbury, Mass.)

    The incidence of renal cortical neoplasms has dramatically increased with the widespread use of abdominal imaging over the past 20 years. Coincidentally, the proportion of tumors that are smaller and incidentally detected has risen as well, indicative of a stage migration. The widespread application of minimally invasive and laparoscopic techniques to other organ systems has spurred the development of minimally invasive approaches to the management of renal tumors. The available data regarding laparoscopic nephrectomy, laparoscopic partial nephrectomy, and tissue ablative techniques, such as renal cryoablation, radiofrequency ablation, and high-intensity focused ultrasound are reviewed.

    Title Study of Bone Marrow Abnormalities in Patients with Hiv Disease.
    Date June 2005
    Journal The Journal of the Association of Physicians of India

    Present work was carried out to study the bone marrow abnormalities in patients with HIV/AIDS and to find their association with peripheral hematological abnormalities.

    Title Cardiovascular Health Among Asian Indians (chai): a Community Research Project.
    Date May 2005
    Journal Journal of Interprofessional Care

    The object of this research was to assess cardiovascular (CV) risks in Asian Indians in California. We conducted eight focus groups and a pilot survey using community-based participatory research (CBPR) methods. Focus groups were held in six communities. Surveys were conducted by telephone or in person in areas selected for high population densities of Asian Indians. We selected focus group subjects by snowball sampling (n = 57). We held six English and two Punjabi groups. We used a surname-based phone list from three area codes for telephone interviews (n = 254). We added 50 in-person interviews for comparison (total n = 304) and did 50 interviews in Punjabi. We held community meetings for dissemination. Focus groups discussed CV risks; themes developed aided survey development. In-person and telephone surveys were feasible. Telephone surveys were more gender-balanced and people more often answered alcohol, tobacco, and income questions. Self-reported prevalences for hypertension, hypercholesterolemia, and diabetes were 20.4, 35.3 and 10.6%, respectively. Only 11.9% of persons reported ever smoking cigarettes. It was concluded that CBPR methods were effective in this exploratory study assessing CV risks in Asian Indians. Hypertension, high cholesterol, and diabetes were more prevalent in participants than the population average; other risk factors were less common (tobacco).

    Title Knowledge and Practice: the Risk of Cardiovascular Disease Among Asian Indians. Results from Focus Groups Conducted in Asian Indian Communities in Northern California.
    Date May 2005
    Journal Ethnicity & Disease

    OBJECTIVE: The focus groups were utilized to gather information on the perceptions of cardiovascular risk within the Asian Indian community, and to identify opportunities to design health promotion and intervention programs for Asian Indian communities. DESIGN: Qualitative methods were utilized to obtain perceptions of cardiovascular risk within 3 Asian Indian communities. Eight focus groups were conducted in either English or Punjabi. SETTING: These focus groups were conducted as part of a 3-year community-based participatory research project examining cardiovascular risk factors among the Asian Indian population in Northern California. PARTICIPANTS: Focus group participants were selected through referrals from community-based organizations, postings in local community centers, and businesses. Fifty-seven men and women were recruited using snowball sampling. RESULTS: Six themes emerged from the focus groups: knowledge of cardiovascular disease, health and cultural concerns regarding diet, physical activity levels, stress as a factor for cardiovascular disease, acculturation concerns, and cardiovascular prevention ideas. CONCLUSIONS: The use of focus groups was an effective method for gathering information on perceptions of cardiovascular risk, and collecting information on risk behaviors within these Asian Indian communities. In this study, we found that psychosocial and cultural factors, especially cultural issues concerning stress and acculturation, surfaced as key elements across all 8 focus groups.

    Title Septic Emboli from Aortic Valve Endocarditis.
    Date September 2004
    Journal Heart (british Cardiac Society)
    Title A Computational Skin Model: Fold and Wrinkle Formation.
    Date July 2004
    Journal Ieee Transactions on Information Technology in Biomedicine : a Publication of the Ieee Engineering in Medicine and Biology Society

    This paper presents a computational model for studying the mechanical properties of skin with aging. In particular, attention is given to the folding capacity of skin, which may be manifested as wrinkles. The simulation provides visual results demonstrating the form and density of folds under the various conditions. This can help in the consideration of proper measures for a cosmetic product for the skin.

    Title A Neurocomputational Model for Prostate Carcinoma Detection.
    Date November 2003
    Journal Cancer

    BACKGROUND: Current guidelines for prostate carcinoma screening rely primarily on the digital rectal examination (DRE) and prostate specific antigen (PSA). Well described patient risk factors for prostate carcinoma also include age, ethnicity, family history, and complexed PSA. However, due to the nonlinear relation of each of these variables with prostate carcinoma, it is difficult to predict reliably each patient's risk based on linear univariate analysis. The authors investigated a neural network to model the risk of prostate carcinoma by seven readily available clinical features. METHODS: The database for the current study comprised 3268 men recently evaluated for the early detection of prostate carcinoma. The seven clinical features evaluated included age, race, family history, International Prostate Symptom Score (IPSS), DRE, and total and complexed PSA. Three hundred forty-eight subjects in the dataset included men with determined prostate biopsy outcomes and for whom at least 6 of 7 features were available. The dataset was divided randomly into a training set (60%) and a test set (40%), with n1/n2 cross-validation used to evaluate model accuracy, and was modeled with linear and quadratic discriminant function analysis and a neural computational system. After a model with acceptable goodness of fit was achieved, reverse regression analysis using Wilks's generalized likelihood ratio test was performed to evaluate the statistical significance of each input variable. RESULTS: The receiving operating characteristic (ROC) area for the neural computational system in the test set was 0.825, whereas total PSA and complexed PSA alone had ROC areas of 0.678 and 0.697, respectively. The ROC area of logistic regression in the test set was 0.510, linear discriminant function analysis was 0.674, and quadratic discriminant function analysis was 0.011. All were significantly less than the ROC area of the neural computational model (all Ps < 0.002). Reverse regression based on Wilks's generalized likelihood ratio test demonstrated each input feature to be highly significant to the model (all Ps << 0.000001). CONCLUSIONS: The authors modeled a combination of well described patient risk factors for prostate carcinoma using a neural computational system with acceptable goodness of fit. They demonstrated that each of the seven variates on which the model was based was critically significant to model performance. The authors presented this model for clinical use and suggested that clinicians use it in deciding to perform prostate biopsy.

    Title European Society of Cardiology--xxiiird Congress. Stockholm, Sweden, September 1-5, 2001.
    Date April 2003
    Journal Heart Failure Monitor
    Title Free-energy Analysis of Enzyme-inhibitor Binding: Aspartic Proteinase-pepstatin Complexes.
    Date June 2002
    Journal Applied Biochemistry and Biotechnology

    Expeditious in silico determinations of the free energies of binding of a series of inhibitors to an enzyme are of immense practical value in structure-based drug design efforts. Some recent advances in the field of computational chemistry have rendered a rigorous thermodynamic treatment of biologic molecules feasible, starting from a molecular description of the biomolecule, solvent, and salt. Pursuing the goal of developing and making available a software for assessing binding affinities, we present here a computationally rapid, albeit elaborate, methodology to estimate and analyze the molecular thermodynamics of enzyme-inhibitor binding with crystal structures as the point of departure. The complexes of aspartic proteinases with seven inhibitors have been adopted for this study. The standard free energy of complexation is considered in terms of a thermodynamic cycle of six distinct steps decomposed into a total of 18 well-defined components. The model we employed involves explicit all-atom accounts of the energetics of electrostatic interactions, solvent screening effects, van der Waals components, and cavitation effects of solvation combined with a Debye-Huckel treatment of salt effects. The magnitudes and signs of the various components are estimated using the AMBER parm94 force field, generalized Born theory, and solvent accessibility measures. Estimates of translational and rotational entropy losses on complexation as well as corresponding changes in the vibrational and configurational entropy are also included. The calculated standard free energies of binding at this stage are within an order of magnitude of the observed inhibition constants and necessitate further improvements in the computational protocols to enable quantitative predictions. Some areas such as inclusion of structural adaptation effects, incorporation of site-dependent amino acid pKa shifts, consideration of the dynamics of the active site for fine-tuning the methodology are easily envisioned. The present series of studies, nonetheless, creates potentially useful qualitative information for design purposes on what factors favor protein-drug binding. The net binding free energies are a result of several competing contributions with 6 of the 18 terms favoring complexation. The nonelectrostatic contributions (i.e., the net van der Waals interactions) and the differential cavitation effects favor binding. Electrostatic contributions show considerable diversity and turn out to be favorable in a consensus view for the seven aspartic proteinase-inhibitor complexes examined here. Implications of these observations to drug design are discussed.

    Title Hemopericardium After Superior Vena Cava Stenting for Malignant Svc Obstruction: the Importance of Contrast-enhanced Ct in the Assessment of Postprocedural Collapse.
    Date March 2002
    Journal Cardiovascular and Interventional Radiology

    We report the complication of hemopericardium following superior vena cava (SVC) stenting with an uncovered Wallstent in a patient with malignant SVC obstruction. The patient collapsed acutely 15 min following stent placement with hypoxemia and hypotension. A CT scan demonstrated a hemopericardium which was successfully treated with a pericardial drain. The possible complications of SVC stenting, including hemopericardium, pulmonary embolism, mediastinal hematoma, and pulmonary edema from increased venous return resulting from improved hemodynamics, ensure a wide differential diagnosis in the postprocedural collapsed patient and this case emphasizes the important role of contrast-enhanced CT in the peri-resuscitation assessment of these patients.

    Title Free Energy Component Analysis for Drug Design: a Case Study of Hiv-1 Protease-inhibitor Binding.
    Date January 2002
    Journal Journal of Medicinal Chemistry

    A theoretically rigorous and computationally tractable methodology for the prediction of the free energies of binding of protein-ligand complexes is presented. The method formulated involves developing molecular dynamics trajectories of the enzyme, the inhibitor, and the complex, followed by a free energy component analysis that conveys information on the physicochemical forces driving the protein-ligand complex formation and enables an elucidation of drug design principles for a given receptor from a thermodynamic perspective. The complexes of HIV-1 protease with two peptidomimetic inhibitors were taken as illustrative cases. Four-nanosecond-level all-atom molecular dynamics simulations using explicit solvent without any restraints were carried out on the protease-inhibitor complexes and the free proteases, and the trajectories were analyzed via a thermodynamic cycle to calculate the binding free energies. The computed free energies were seen to be in good accord with the reported data. It was noted that the net van der Waals and hydrophobic contributions were favorable to binding while the net electrostatics, entropies, and adaptation expense were unfavorable in these protease-inhibitor complexes. The hydrogen bond between the CH2OH group of the inhibitor at the scissile position and the catalytic aspartate was found to be favorable to binding. Various implicit solvent models were also considered and their shortcomings discussed. In addition, some plausible modifications to the inhibitor residues were attempted, which led to better binding affinities. The generality of the method and the transferability of the protocol with essentially no changes to any other protein-ligand system are emphasized.

    Title A Molecular Dynamics Study Based Post Facto Free Energy Analysis of the Binding of Bovine Angiogenin with Ump and Cmp Ligands.
    Date October 2001
    Journal Indian Journal of Biochemistry & Biophysics

    Angiogenin is a protein belonging to the superfamily of RNase A. The RNase activity of this protein is essential for its angiogenic activity. Although members of the RNase A family carry out RNase activity, they differ markedly in their strength and specificity. In this paper, we address the problem of higher specificity of angiogenin towards cytosine against uracil in the first base binding position. We have carried out extensive nano-second level molecular dynamics(MD) computer simulations on the native bovine angiogenin and on the CMP and UMP complexes of this protein in aqueous medium with explicit molecular solvent. The structures thus generated were subjected to a rigorous free energy component analysis to arrive at a plausible molecular thermodynamic explanation for the substrate specificity of angiogenin.

    Title Right-sided Non-bacterial Thrombotic Endocarditis in a Chronic Hemodialysis Patient with Muir-torre Syndrome.
    Date September 2001
    Journal Clinical Nephrology

    Endocarditis is a recognised complication ofhemodialysis. This is generally only thought of in terms of infective vegetations. We present a case of right-sided NBTE in a patient with an indwelling venous catheter who also had advanced pelvic malignancy. The unusual side of this patient's endocarditic lesions implicates a role for the venous catheter in determining the site of non-bacterial thrombus formation. It is also a reminder that endocarditis is always a risk when using central venous catheters, even after appropriate sterile precautions have been taken.

    Title Liver of the "visible Man".
    Date December 1997
    Journal Clinical Anatomy (new York, N.y.)

    Endoscopic surgery, also called minimally invasive surgery, is presumed drastically to reduce postoperative morbidity and thus to offer both human and economic benefits. For the surgeon, however, this approach leads to a number of gestural challenges that require extensive training to be mastered. In order to replace experimentation on animals and patients, we developed a simulator for endoscopic surgery. To achieve this goal, a first step was to develop a working prototype, a "standard patient," on which the informatic and microengineering tools could be validated. We used the visible man dataset for this purpose. The external shape of the visible man's liver, his biliary passages, and his extrahepatic portal system turned out to be fully within the standard pattern of normal anatomy. Anatomic variations were observed in the intrahepatic right portal vein, the hepatic veins, and the arterial blood supply to the liver. Thus, the visible man dataset reveals itself to be well suited for the simulation of minimally invasive surgical operation such as endoscopic cholecystectomy.

    Title Infectious Endocarditis and Sudden Unexpected Death: Incidence and Morphology of Lesions in Intravenous Addicts and Non-drug Abusers.
    Date June 1997
    Journal The Journal of Heart Valve Disease

    BACKGROUND: Intravenous drug (IVD) use is a wellknown risk factor for infectious endocarditis (IE), but there are few morphologic and epidemiologic data comparing IVD-related and non-IVD-related IE in cases of sudden death. MATERIAL AND RESULTS: Between 1992 and 1994, acute IE was diagnosed in 13 IVD users at the Office of the Chief Medical Examiner in Maryland, indicating a yearly incidence of IE-related sudden unexpected deaths of 12 per 100,000. Eleven (85%) cases of acute IE occurred on apparently previously normal valves, and there was one unicuspid valve and one infected porcine prosthesis. There were three right-sided (tricuspid) lesions (23%), nine left-sided lesions (69%), and one multivalvular lesion (8%). During the same period, there were five cases of healed IE in IVD abusers, three of which involved the tricuspid valve. The prevalence of incidental healed lesions in autopsies of IVD users was 0.2%. The healed tricuspid lesions consisted of smooth-edged defects in the valve leaflet without perforations characteristic of mitral or aortic IE. The mean age of the deceased with healed lesions was 45 +/- 6 years versus 34 +/- 10 years for those with acute endocarditis (p = 0.03). During the same time period, there were six cases of acute IE among non-drug users, indicating a yearly incidence of sudden unexpected death of 0.04 per 100,000. Acute IE occurred on congenitally malformed (n = 5) or prosthetic (n = 1) valves. There were two cases of incidental healed IE (mitral and aortic valves), indicating a prevalence of 0.02%. CONCLUSION: IVD users are 300 times more likely to die suddenly with IE than non-IVD users, and healed lesions are 25 times more common. Healed IE of the tricuspid valve is associated with IVD abuse, and has a characteristic gross appearance that differs from healed left-sided IE.

    Title Human Trophoblast Cell Resistance to Decidual Nk Lysis is Due to Lack of Nk Target Structure.
    Date May 1990
    Journal Cellular Immunology

    We have previously shown that human cultured trophoblast cells are resistant to lysis by natural killer (NK) cells from both peripheral blood and decidua although cells are present in decidua which do exhibit NK activity against K562(1). Using a cold-target inhibition assay and a single-cell conjugate assay we have now examined whether these trophoblast cells have NK target structures on their surfaces. Our findings indicate that first-trimester human trophoblast cells do not express surface structures recognized by decidual Leu19+ (CD56+) large granular lymphocytes (LGLs) isolated from human decidua. Immunostaining of the conjugates formed between decidual NK effectors and K562 cells confirmed that these effector cells are CD56+ LGLs.

    Title Familial Thyroid Disease: Grave's Disease and Non-toxic Goitre (a Case Report).
    Date May 1984
    Journal Journal of Postgraduate Medicine
    Title Involvement of Catecholamines in Feedback Mechanisms.
    Date July 1974
    Journal Progress in Brain Research
    Title Parathyroid Function in Menstrual Cycle.
    Date January 1973
    Journal Indian Journal of Physiology and Pharmacology
    Title Abdominal Fat Distribution and Insulin Resistance in Indian Women with Polycystic Ovarian Syndrome.
    Journal Fertility and Sterility

    The relationship between insulin resistance and abdominal fat distribution was studied in Indian patients with PCOS. Subcutaneous fat, together with a family history of type 2 diabetes mellitus, was the best marker of insulin resistance.

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