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Schindler H, Lusky F, Gaissmaier L, Daniello L, Elshiaty M, Bozorgmehr F, Kuon J, Shah R, Schneider M, Eichhorn F, Baum P, Angeles A, Janke F, Kriegsmann M, Kazdal D, Stenzinger A, Sültmann H, Thomas M, Christopoulos P. 65P Blood cytokine changes in patients with advanced NSCLC receiving immunotherapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Jiao L, Kourkoumpetis T, Hutchinson D, Ajami NJ, Hoffman K, White DL, Graham DY, Hair C, Shah R, Kanwal F, Jarbrink-Sehgal M, Husain N, Hernaez R, Hou J, Cole R, Velez M, Ketwaroo G, Kramer J, El-Serag HB, Petrosino JF. Spatial Characteristics of Colonic Mucosa-Associated Gut Microbiota in Humans. Microb Ecol 2022; 83:811-821. [PMID: 34223947 DOI: 10.1007/s00248-021-01789-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
Limited data exist on the spatial distribution of the colonic bacteria in humans. We collected the colonic biopsies from five segments of 27 polyp-free adults and collected feces from 13 of them. We sequenced the V4 region of the bacterial 16S rRNA gene using the MiSeq platform. The sequencing data were assigned to the amplicon sequence variant (ASV) using SILVA. Biodiversity and the relative abundance of the ASV were compared across the colonic segments and between the rectal and fecal samples. Bacterial functional capacity was assessed using Tax4fun. Each individual had a unique bacterial community composition (Weighted Bray-Curtis P value = 0.001). There were no significant differences in richness, evenness, community composition, and the taxonomic structure across the colon segments in all the samples. Firmicutes (47%), Bacteroidetes (39%), and Proteobacteria (6%) were the major phyla in all segments, followed by Verrucomicrobia, Fusobacteria, Desulfobacterota, and Actinobacteria. There were 15 genera with relative abundance > 1%, including Bacteroides, Faecalibacterium, Escherichia/Shigella, Sutterella, Akkermansia, Parabacteroides, Prevotella, Lachnoclostridium, Alistipes, Fusobacterium, Erysipelatoclostridium, and four Lachnospiraceae family members. Intra-individually, the community compositional dissimilarity was the greatest between the cecum and the rectum. There were significant differences in biodiversity and the taxonomic structure between the rectal and fecal bacteria. The bacterial community composition and structure were homogeneous across the large intestine in adults. The inter-individual variability of the bacteria was greater than inter-segment variability. The rectal and fecal bacteria differed in the community composition and structure.
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Affiliation(s)
- Li Jiao
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA.
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA.
- Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, 77030, USA.
- Center for Translational Research On Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA.
| | - Themistoklis Kourkoumpetis
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Diane Hutchinson
- The Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Nadim J Ajami
- The Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Kristi Hoffman
- The Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Donna L White
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA
- Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, 77030, USA
- Center for Translational Research On Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
| | - David Y Graham
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA
| | - Clark Hair
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA
| | - Rajesh Shah
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA
| | - Maria Jarbrink-Sehgal
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA
| | - Nisreen Husain
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA
| | - Ruben Hernaez
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA
| | - Jason Hou
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA
| | - Rhonda Cole
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Maria Velez
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Gyanprakash Ketwaroo
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA
| | - Jennifer Kramer
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA
- Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Joseph F Petrosino
- Texas Medical Center Digestive Disease Center, Houston, TX, 77030, USA
- Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, 77030, USA
- The Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
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Shah R, Dai DWT, Alsweiler JM, Brown GTL, Chase JG, Gamble GD, Harris DL, Keegan P, Nivins S, Wouldes TA, Thompson B, Turuwhenua J, Harding JE, McKinlay CJD. Association of Neonatal Hypoglycemia With Academic Performance in Mid-Childhood. JAMA 2022; 327:1158-1170. [PMID: 35315886 PMCID: PMC8941348 DOI: 10.1001/jama.2022.0992] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Neonatal hypoglycemia is associated with increased risk of poor executive and visual-motor function, but implications for later learning are uncertain. OBJECTIVE To test the hypothesis that neonatal hypoglycemia is associated with educational performance at age 9 to 10 years. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of moderate to late preterm and term infants born at risk of hypoglycemia. Blood and masked interstitial sensor glucose concentrations were measured for up to 7 days. Infants with hypoglycemic episodes (blood glucose concentration <47 mg/dL [2.6 mmol/L]) were treated to maintain a blood glucose concentration of at least 47 mg/dL. Six hundred fourteen infants were recruited at Waikato Hospital, Hamilton, New Zealand, in 2006-2010; 480 were assessed at age 9 to 10 years in 2016-2020. EXPOSURES Hypoglycemia was defined as at least 1 hypoglycemic event, representing the sum of nonconcurrent hypoglycemic and interstitial episodes (sensor glucose concentration <47 mg/dL for ≥10 minutes) more than 20 minutes apart. MAIN OUTCOMES AND MEASURES The primary outcome was low educational achievement, defined as performing below or well below the normative curriculum level in standardized tests of reading comprehension or mathematics. There were 47 secondary outcomes related to executive function, visual-motor function, psychosocial adaptation, and general health. RESULTS Of 587 eligible children (230 [48%] female), 480 (82%) were assessed at a mean age of 9.4 (SD, 0.3) years. Children who were and were not exposed to neonatal hypoglycemia did not significantly differ on rates of low educational achievement (138/304 [47%] vs 82/176 [48%], respectively; adjusted risk difference, -2% [95% CI, -11% to 8%]; adjusted relative risk, 0.95 [95% CI, 0.78-1.15]). Children who were exposed to neonatal hypoglycemia, compared with those not exposed, were significantly less likely to be rated by teachers as being below or well below the curriculum level for reading (68/281 [24%] vs 49/157 [31%], respectively; adjusted risk difference, -9% [95% CI, -17% to -1%]; adjusted relative risk, 0.72 [95% CI, 0.53-0.99; P = .04]). Groups were not significantly different for other secondary end points. CONCLUSIONS AND RELEVANCE Among participants at risk of neonatal hypoglycemia who were screened and treated if needed, exposure to neonatal hypoglycemia compared with no such exposure was not significantly associated with lower educational achievement in mid-childhood.
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Affiliation(s)
- Rajesh Shah
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Darren W. T. Dai
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane M. Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Gavin T. L. Brown
- Faculty of Education and Social Work, University of Auckland, Auckland, New Zealand
| | - J. Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | | | - Deborah L. Harris
- Liggins Institute, University of Auckland, Auckland, New Zealand
- School of Nursing, Midwifery, and Health Practice, Victoria University of Wellington, Wellington, New Zealand
| | - Peter Keegan
- Te Puna Wānanga, University of Auckland, Auckland, New Zealand
| | - Samson Nivins
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Trecia A. Wouldes
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- Centre for Eye and Vision Research, Hong Kong
| | - Jason Turuwhenua
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Utekar T, Shah R. 49 Comparative study of manual vacuum aspiration syringe versus electrical suction for management of miscarriage and abortion. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Taylor M, Whittaker G, Grant SW, Booton R, Shah R. Risk prediction for lung cancer surgery in the current era. Video-assist Thorac Surg 2022. [DOI: 10.21037/vats-21-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Oates TW, Guy V, Ni K, Ji C, Saito H, Shiau H, Shah R, Williams MA, Blasi G, Goloubeva O. Meta-regression Analysis of Study Heterogeneity for Systemic Outcomes after Periodontal Therapy. JDR Clin Trans Res 2022; 8:23800844211070467. [PMID: 35037489 DOI: 10.1177/23800844211070467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The contribution of periodontal disease to adverse systemic consequences remains controversial. This analysis examined 2 well-investigated conditions independently and combined-adverse pregnancy outcomes and glycemic control for patients with diabetes-based on shared pathogenic mechanisms of periodontal infection and inflammation. It was proposed that inconsistencies in study design significantly contribute to outcome discrepancies found between periodontal intervention studies undergoing meta-analysis. METHODS Meta-analyses evaluating periodontal interventions on the rate of preterm birth and changes in glycated hemoglobin A1c in type 2 diabetes populations were conducted based on a systematic review of randomized controlled trials. Meta-regression covariates for exploring heterogeneity included sample size, level of medical management, and bias risk as moderator variables in a random-effects meta-regression. RESULTS Systematic review identified 17 studies of diabetes and 13 of pregnancy outcomes. Analyses of these studies identified 0.50% reduction in HbA1c and 0.78 odds ratio for preterm births. The heterogeneity associated with the models was high (I2 = 92.4 and I2 = 62.7%, respectively). The adjusted models evaluating each systemic condition separately accounted for 52.2% of the effect for diabetes and 81.4% for pregnancy outcome effects independently, and 63.5% collectively, across interventional studies. CONCLUSION This systematic review with meta-regression analysis of heterogeneity demonstrates that disparate results seen in randomized controlled trials of periodontal therapy affecting systemic outcomes may be explained in large part by study design, specifically stringency in consideration of medical management and sample size. The potential for confounding factors to influence outcomes remains a concern in understanding the implications of oral health on systemic conditions. KNOWLEDGE TRANSFER STATEMENT The findings of this study demonstrate that much of the benefits seen from periodontal therapy on adverse systemic outcomes for diabetes and pregnancy are due to limitations in study design.
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Affiliation(s)
- T W Oates
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - V Guy
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: Private practice, Summerville, SC, USA
| | - K Ni
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: Private practice, Lancaster, PA, USA
| | - C Ji
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: Division of Periodontology and Implant Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - H Saito
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - H Shiau
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - R Shah
- University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: UCSF School of Dentistry, University of California, San Francisco, San Francisco, CA, USA
| | - M A Williams
- Health Sciences & Human Services Library, University of Maryland, Baltimore, MD, USA
| | - G Blasi
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: Private practice, Barcelona, Spain
| | - O Goloubeva
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Baker JM, Hammond M, Dungwa J, Shah R, Montero-Fernandez A, Higham A, Lea S, Singh D. Red Blood Cell-Derived Iron Alters Macrophage Function in COPD. Biomedicines 2021; 9:biomedicines9121939. [PMID: 34944755 PMCID: PMC8698324 DOI: 10.3390/biomedicines9121939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022] Open
Abstract
Lung macrophage iron levels are increased in COPD patients. Lung macrophage iron levels are thought to be increased by cigarette smoke, but the role of red blood cells (RBCs) as a source of iron has not been investigated. We investigate RBCs as a potential source of alveolar iron in COPD, and determine the effect of RBC-derived iron on macrophage function. We used lung tissue sections to assess RBC coverage of the alveolar space, iron and ferritin levels in 11 non-smokers (NS), 15 smokers (S) and 32 COPD patients. Lung macrophages were isolated from lung resections (n = 68) and treated with hemin or ferric ammonium citrate (50, 100 or 200 μM). Lung macrophage phenotype marker gene expression was measured by qPCR. The phagocytosis of Non-typeable Haemophilus influenzae (NTHi) was measured by flow cytometry. Cytokine production in response to NTHi in iron-treated macrophages was measured by ELISA. Lung macrophage iron levels were significantly correlated with RBC coverage of the alveolar space (r = 0.31, p = 0.02). Furthermore, RBC coverage and lung macrophage iron were significantly increased in COPD patients and correlated with airflow obstruction. Hemin treatment downregulated CD36, CD163, HLA-DR, CD38, TLR4, CD14 and MARCO gene expression. Hemin-treated macrophages also impaired production of pro-inflammatory cytokines in response to NTHi exposure, and decreased phagocytosis of NTHi (200 μM: 35% decrease; p = 0.03). RBCs are a plausible source of pulmonary iron overload in COPD. RBC-derived iron dysregulates macrophage phenotype and function.
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Affiliation(s)
- James M. Baker
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester M13 9PL, UK; (A.H.); (S.L.); (D.S.)
- Correspondence: ; Tel.: +44-16-1219-5920
| | - Molly Hammond
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester M23 9QZ, UK; (M.H.); (J.D.)
| | - Josiah Dungwa
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester M23 9QZ, UK; (M.H.); (J.D.)
| | - Rajesh Shah
- Department of Thoracic Surgery, Manchester University Hospital NHS Foundation Trust, Manchester M13 9WL, UK;
| | - Angeles Montero-Fernandez
- Department of Histopathology, Manchester University Hospital NHS Foundation Trust, Manchester M13 9WL, UK;
| | - Andrew Higham
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester M13 9PL, UK; (A.H.); (S.L.); (D.S.)
| | - Simon Lea
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester M13 9PL, UK; (A.H.); (S.L.); (D.S.)
| | - Dave Singh
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester M13 9PL, UK; (A.H.); (S.L.); (D.S.)
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester M23 9QZ, UK; (M.H.); (J.D.)
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Brunswicker A, Taylor M, Grant SW, Abah U, Smith M, Shackcloth M, Granato F, Shah R, Rammohan K. Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation. Interact Cardiovasc Thorac Surg 2021; 34:1054-1061. [PMID: 34871415 PMCID: PMC9159428 DOI: 10.1093/icvts/ivab340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/27/2021] [Accepted: 11/07/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Despite the increased rate of adverse outcomes compared to lobectomy, for selected patients with lung cancer, pneumonectomy is considered the optimal treatment option. The objective of this study was to identify risk factors for mortality in patients undergoing pneumonectomy for primary lung cancer. METHODS Data from all patients undergoing pneumonectomy for primary lung cancer at 2 large thoracic surgical centres between 2012 and 2018 were analysed. Multivariable logistic and Cox regression analyses were used to identify risk factors associated with 90-day and 1-year mortality and reduced long-term survival, respectively. RESULTS The study included 256 patients. The mean age was 65.2 (standard deviation 9.4) years. In-hospital, 90-day and 1-year mortality were 6.3% (n = 16), 9.8% (n = 25) and 28.1% (n = 72), respectively. The median follow-up time was 31.5 months (interquartile range 9-58 months). Patients who underwent neoadjuvant therapy had a significantly increased risk of 90-day [odds ratio 6.451, 95% confidence interval (CI) 1.867-22.291, P = 0.003] and 1-year mortality (odds ratio 2.454, 95% CI 1.079-7.185, P = 0.044). Higher Performance Status score was associated with higher 1-year mortality (odds ratio 2.055, 95% CI 1.248-3.386, P = 0.005) and reduced overall survival (hazard ratio 1.449, 95% CI 1.086-1.934, P = 0.012). Advanced (stage III/IV) disease was associated with reduced overall survival (hazard ratio 1.433, 95% CI 1.019-2.016, P = 0.039). Validation of a pneumonectomy-specific risk model demonstrated inadequate model performance (area under the curve 0.54). CONCLUSIONS Pneumonectomy remains associated with a high rate of perioperative mortality. Neoadjuvant chemoradiotherapy, Performance Status score and advanced disease emerged as the key variables associated with adverse outcomes after pneumonectomy in our cohort.
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Affiliation(s)
- Annemarie Brunswicker
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Udo Abah
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Matthew Smith
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Felice Granato
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Kandadai Rammohan
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
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Shah R, Brown GTL, Keegan P, Harding JE, McKinlay CJD. School readiness screening and educational achievement at 9-10 years of age. J Paediatr Child Health 2021; 57:1929-1935. [PMID: 34138500 DOI: 10.1111/jpc.15616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 04/26/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
AIM To determine whether a multi-domain school readiness screening, the Before School Check (B4SC), identifies children at risk of low educational achievement and to compare the educational outcomes between those referred for intervention and those with B4SC concerns who were not referred. METHODS In this longitudinal cohort study of children born at risk of neonatal hypoglycaemia (N 331), the B4SC was performed at 4.5 years of age and a standardised curriculum-based measure of educational achievement was completed at 9-10 years of age. Outcomes of school readiness screening were categorised into 'school readiness concern' or 'no school readiness concern' while 'below standard' and 'well below standard' ratings of educational achievement were combined into a single category of 'low educational achievement'. RESULTS Overall, 52% of children had ≥1 school readiness concerns at the B4SC, predominantly about behaviour (46%). Having ≥1 school readiness concern was associated with a nearly twofold increase in the likelihood of low academic achievement (OR 1.85, 95% CI 1.14, 3.02), which was apparent only for behaviour concerns. Of the 128 children with behaviour concerns, only 10 (8%) were referred for further interventions. There was a statistically non-significant increase in the rates of low academic achievement among those referred than those non-referred (60% vs. 47%). CONCLUSION Identification of behaviour concerns during B4SC is associated with a moderate increase in the likelihood of low academic achievement at 9-10 years. Further, research is needed to determine how academic achievement can be improved in children with behaviour concerns at school entry.
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Affiliation(s)
- Rajesh Shah
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Gavin T L Brown
- Learning, Development and Professional Practice, University of Auckland, Auckland, New Zealand
| | - Peter Keegan
- Te Puna Wānanga, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Christopher J D McKinlay
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand
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McCarthy A, Shah R, John JV, Brown D, Xie J. Understanding and utilizing textile-based electrostatic flocking for biomedical applications. Appl Phys Rev 2021; 8:041326. [PMID: 35003482 PMCID: PMC8715800 DOI: 10.1063/5.0070658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/23/2021] [Indexed: 05/10/2023]
Abstract
Electrostatic flocking immobilizes electrical charges to the surface of microfibers from a high voltage-connected electrode and utilizes Coulombic forces to propel microfibers toward an adhesive-coated substrate, leaving a forest of aligned fibers. This traditional textile engineering technique has been used to modify surfaces or to create standalone anisotropic structures. Notably, a small body of evidence validating the use of electrostatic flocking for biomedical applications has emerged over the past several years. Noting the growing interest in utilizing electrostatic flocking in biomedical research, we aim to provide an overview of electrostatic flocking, including the principle, setups, and general and biomedical considerations, and propose a variety of biomedical applications. We begin with an introduction to the development and general applications of electrostatic flocking. Additionally, we introduce and review some of the flocking physics and mathematical considerations. We then discuss how to select, synthesize, and tune the main components (flocking fibers, adhesives, substrates) of electrostatic flocking for biomedical applications. After reviewing the considerations necessary for applying flocking toward biomedical research, we introduce a variety of proposed use cases including bone and skin tissue engineering, wound healing and wound management, and specimen swabbing. Finally, we presented the industrial comments followed by conclusions and future directions. We hope this review article inspires a broad audience of biomedical, material, and physics researchers to apply electrostatic flocking technology to solve a variety of biomedical and materials science problems.
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Affiliation(s)
- Alec McCarthy
- Department of Surgery-Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 668198, USA
| | - Rajesh Shah
- Spectro Coating Corporation, Leominster, Massachusetts 01453, USA
| | - Johnson V. John
- Department of Surgery-Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 668198, USA
| | - Demi Brown
- Department of Surgery-Transplant and Mary & Dick Holland Regenerative Medicine Program, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 668198, USA
| | - Jingwei Xie
- Author to whom correspondence should be addressed:
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Paudel R, Bhatta NK, Shah R, Shah L, Poudel A. Intrauterine Meconium Peritonitis: An Unusual Case of Foetal Ascites. J Nepal Paedtr Soc 2021. [DOI: 10.3126/jnps.v41i2.35294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Meconium peritonitis is defined as aseptic chemical inflammation caused by an intrauterine bowel perforation. Its incidence is 1 in 35,000 live births. We present a case of meconium peritonitis presented at second day of postnatal life with isolated gross fetal ascites. Exploratory laprotomy was performed, suggestive of gross ascites with fecal contamination and perforation at terminal ileum for which ileal resection with double barrel ileostomy had been done. Postoperatively patient condition had improved and discharged. We would like to highlight this rare presentation of meconium peritonitis following intrauterine bowel perforation in fetus.
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Krishna M, Engevik M, Queliza K, Britto S, Shah R, Ruan W, Wang H, Versalovic J, Kellermayer R. Maternal
Lactobacillus reuteri
supplementation shifts the intestinal microbiome in mice and provides protection from experimental colitis in female offspring. FASEB Bioadv 2021; 4:109-120. [PMID: 35141475 PMCID: PMC8814561 DOI: 10.1096/fba.2021-00078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 12/26/2022] Open
Abstract
The purpose of our experiment was to explore how stochastic (inter‐individual variation) gut microbiome composition may link to inflammatory bowel disease (IBD) susceptibility and guide the development of a perinatal preventative probiotic. Dextran sodium sulfate (DSS) was introduced to C57BL/BJ mice to induce acute colitis as a model of IBD. Potentially protective bacteria were identified using a discovery‐validation cohort approach toward stochastic DSS susceptibility. Lactobacilli (two different cocktails of L. reuteri and L. johnsonii strains) or control media were supplemented by mouth to dams prior to delivery and during lactation (i.e., perinatal probiotic). The pups were evaluated for DSS susceptibility at young adulthood. Fecal Lactobacillus was increased in the DSS‐resistant mice in both the discovery and validation cohorts. Maternal supplementation of female offspring with an L. reuteri cocktail (strains 6798‐1, 6798‐jm, and 6798‐cm) induced progressive microbiome separation and protection against colitis by young adulthood. Maternal supplementation of L. reuteri could confer protection against DSS colitis in young adult female mice. This work is the first to exploit stochastic mammalian microbiome variation to guide microbial therapeutic identification. Our findings underscore neonatal microbiome plasticity and set the stage for the potential development of perinatally deliverable protective probiotics against human IBD.
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Affiliation(s)
- Mahesh Krishna
- Johns Hopkins School of Medicine Baltimore Maryland USA
- Section of Pediatric Gastroenterology Baylor College of Medicine Houston Texas USA
| | - Melinda Engevik
- Department of Pathology & Immunology Baylor College of Medicine Houston Texas USA
| | - Karen Queliza
- Pediatric Gastroenterology, Hepatology and Nutrition Memorial Sloan Kettering Cancer Center New York New York USA
| | - Savini Britto
- Section of Pediatric Gastroenterology Baylor College of Medicine Houston Texas USA
| | - Rajesh Shah
- Department of Medicine Baylor Scott and White Austin Texas USA
| | - Wenly Ruan
- Section of Pediatric Gastroenterology Baylor College of Medicine Houston Texas USA
| | - Hongtao Wang
- Section of Pediatric Gastroenterology Baylor College of Medicine Houston Texas USA
| | - James Versalovic
- Department of Pathology & Immunology Baylor College of Medicine Houston Texas USA
| | - Richard Kellermayer
- Section of Pediatric Gastroenterology Baylor College of Medicine Houston Texas USA
- USDA/ARS Children's Nutrition Research Center Texas Children's Hospital Houston Texas USA
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Karn RR, Acharya R, Rajbanshi AK, Singh SK, Thakur SK, Shah SK, Singh AK, Shah R, Upadhya Kafle S, Bhattachan M, Abrahamyan A, Shewade HD, Zachariah R. Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal. Public Health Action 2021; 11:1-5. [PMID: 34778008 PMCID: PMC8575382 DOI: 10.5588/pha.21.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022] Open
Abstract
SETTING Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM). OBJECTIVE In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance. DESIGN A cohort study using hospital data, January 2018-January 2020. RESULTS Of 117 patients with CSOM and awaiting surgery, 64% were in the 18-35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (n = 7, 50%), cortical mastoidectomy with tympanostomy (n = 4, 29%) and modified radical mastoidectomy (n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery. CONCLUSION Patients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.
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Affiliation(s)
- R R Karn
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - R Acharya
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - A K Rajbanshi
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - S K Singh
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - S K Thakur
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - S K Shah
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - A K Singh
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - R Shah
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - S Upadhya Kafle
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - M Bhattachan
- World Health Organization, Country Office, Kathmandu, Nepal
| | - A Abrahamyan
- Tuberculosis Research and Prevention Center, Yerevan, Armenia
| | - H D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union, South East Asia, New Delhi, India
| | - R Zachariah
- United Nations Children's Fund/United Nations Development Programme/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
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Duggins M, Shah R, Baker M, Marget M, Oxford M, Hoyt A. P001 ALLERGISTS LEAD ANAPHYLAXIS PREPAREDNESS VIRTUAL WORKSHOPS FOR EARLY CHILDHOOD PROFESSIONALS AMIDST THE COVID-19 PANDEMIC. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Taylor M, Evison M, Clayton B, Grant SW, Martin GP, Shah R, Krysiak P, Rammohan K, Fontaine E, Joshi V, Granato F. Adequacy of Mediastinal Lymph Node Sampling in Patients With Lung Cancer Undergoing Lung Resection. J Surg Res 2021; 270:271-278. [PMID: 34715539 DOI: 10.1016/j.jss.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/06/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intraoperative mediastinal lymph node sampling (MLNS) is a crucial component of lung cancer surgery. Whilst several sampling strategies have been clearly defined in guidelines from international organizations, reports of adherence to these guidelines are lacking. We aimed to assess our center's adherence to guidelines and determine whether adequacy of sampling is associated with survival. MATERIALS AND METHODS A single-center retrospective review of consecutive patients undergoing lung resection for primary lung cancer between January 2013 and December 2018 was undertaken. Sampling adequacy was assessed against standards outlined in the International Association for the Study of Lung Cancer 2009 guidelines. Multivariable logistic and Cox proportional hazards regression analyses were used to assess the impact of specific variables on adequacy and of specific variables on overall survival, respectively. RESULTS A total of 2380 patients were included in the study. Overall adequacy was 72.1% (n= 1717). Adherence improved from 44.8% in 2013 to 85.0% in 2018 (P< 0.001). Undergoing a right-sided resection increased the odds of adequate MLNS on multivariable logistic regression (odds ratio 1.666, 95% confidence interval [CI]: 1.385-2.003, P< 0.001). Inadequate MLNS was not significantly associated with reduced overall survival on log rank analysis (P= 0.340) or after adjustment with multivariable Cox proportional hazards (hazard ratio 0.839, 95% CI 0.643-1.093). CONCLUSIONS Adherence to standards improved significantly over time and was significantly higher for right-sided resections. We found no evidence of an association between adequate MLNS and overall survival in this cohort. A pressing need remains for the introduction of national guidelines defining acceptable performance.
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Affiliation(s)
- Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, UK.
| | - Matthew Evison
- Department of Respiratory Medicine, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Bethan Clayton
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospital Foundation Trust, Manchester, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Piotr Krysiak
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Kandadai Rammohan
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Eustace Fontaine
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Vijay Joshi
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Felice Granato
- Department of Cardiothoracic Surgery, Manchester University Hospital Foundation Trust, Wythenshawe Hospital, Manchester, UK
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Khuda-Bukhsh AR, Mondal J, Shah R. Erratum: Therapeutic Potential of HIV Nosode 30c as Evaluated in A549 Lung Cancer Cells. HOMEOPATHY 2021; 106:e1-e3. [PMID: 34619793 DOI: 10.1055/s-0041-1739047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anisur Rahman Khuda-Bukhsh
- Cytogenetics and Molecular Biology Laboratory, Department of Zoology, University of Kalyani, Kalyani 741235, India
| | - Jesmin Mondal
- Cytogenetics and Molecular Biology Laboratory, Department of Zoology, University of Kalyani, Kalyani 741235, India
| | - Rajesh Shah
- Life Force, 411 Krushal Commercial Complex, G.M. Road, Chembur, Mumbai 400 089, India
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Aigner C, Brüning T, Eberhardt WEE, Härter M, Kaelberlah HP, Metzenmacher M, Shah R, Taube C, Thomas M. [The Current Therapy of Asbestos-Associated Malignant Pleural Mesothelioma - An Expert Consensus Paper]. Pneumologie 2021; 75:776-794. [PMID: 33946118 PMCID: PMC8523221 DOI: 10.1055/a-1404-1562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/26/2021] [Indexed: 11/15/2022]
Abstract
Asbestos-related mesotheliomas belong to the group of the most frequent occupational diseases in Germany, reaching about 1,000 new cases per year. The disease has a dismal prognosis because most tumors remain asymptomatic for a long time and therefore are diagnosed as incidental findings at later stages.During the last decade the German Social Accident Insurance (DGUV) has made considerable efforts to prepone the diagnosis in order to detect the disease at earliest possible stages. These efforts resulted in new findings showing that, in a high-risk group, a combination of the biomarkers calretinin and mesothelin was able to advance the diagnosis up to 12 months.Ideally, the diagnosis of a mesothelioma at an early stage has to be accompanied by the best possible individualized therapy. Standard therapeutic strategies are surgery and chemotherapy, added by radiotherapy and psycho-oncology. In recent years, several new therapeutic avenues are being explored. This review comprehensively presents both old and new therapeutic options in mesothelioma, based on international Leitlinien and new studies.
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Affiliation(s)
- C Aigner
- Klinik für Thoraxchirurgie und thorakale Endoskopie, Universitätsmedizin Essen - Ruhrlandklinik
| | - T Brüning
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung (DGUV) - Institut der Ruhr-Universität Bochum
| | - W E E Eberhardt
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Ruhrlandklinik, Universitätsmedizin Essen
| | - M Härter
- Institut und Poliklinik für Medizinische Psychologie und Institut für Psychotherapie (IfP), Universitätsklinikum Hamburg-Eppendorf
| | | | - M Metzenmacher
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Ruhrlandklinik, Universitätsmedizin Essen
| | - R Shah
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik - Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)
| | - C Taube
- Klinik für Pneumologie, Universitätsmedizin Essen - Ruhrlandklinik
| | - M Thomas
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik - Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)
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Ghosh S, Wazir SS, Shah R, Upadhyay MK, Gupta R, Singh HM. Detection of Human Papilloma Virus in Oral Potentially Malignant Disorders and Oral Squamous Cell Carcinoma. J Coll Med Sci-Nepal 2021. [DOI: 10.3126/jcmsn.v17i3.38765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Human Papilloma Virus 16 and 18 affects the keratinocytes of oral mucosa and skin and can lead to the development of dysplastic lesions and ultimately into invasive oral squamous cell carcinoma. The objective of the present study was to evaluate the presence of human Papilloma virus 16 and 18 DNA in already diagnosed oral potentially malignant disorders and oral squamous cell carcinoma.
Methods: 200 biopsy specimens (50 each) of already diagnosed leukoplakia, oral lichen planus (OLP), oral submucous fibrosis (OSMF) and oral squamous cell carcinoma was included for the study. A total 50 control tissue sections, which were obtained during removal of impacted teeth were also included in the study. All 250 specimens were subjected to polymerase chain reaction (PCR) for the identification of HPV 16 and 18. The results are analyzed using Statistical Package of Social Sciences (SPSS) version 16 software and Pearson’s chi square test was used for statistical analysis.
Results: HPV 16 and 18 was noted in all the OPMDS and oral cancer specimens but the results were not statistically significant. However, not even a single case of control tissue showed the presence of HPV 16 and 18.
Conclusions: The results of the present study shows HPV 16 and 18 is present in oral cancer as well as OPMDS, therefore it could be implicated in the pathogenesis of the above mentioned conditions.
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Talele G, Vaidhya S, Chowdhary A, Herscu P, Shah R. Randomized Double-Blind, Placebo-Controlled Feasibility Study, Evaluating the Efficacy of Homeopathic Medicines in the Prevention of COVID-19 in a Quarantined Population. HOMEOPATHY 2021; 111:49-56. [PMID: 34592778 DOI: 10.1055/s-0041-1735235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Exploring preventive therapeutic measures has been among the biggest challenges during the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We explored the feasibility and methods of recruitment, retention, and potential signal of efficacy, of selected homeopathic medicines as preventive measure for developing COVID-19 in a multi-group study. MATERIALS AND METHODS A six-group, randomized, double-blind, placebo-controlled prophylaxis study was conducted in a COVID-19 exposed population in a quarantine facility in Mumbai, India. Each group received one of the following: Arsenicum album 30c, Bryonia alba 30c, a combination (Arsenicum album 30c, Bryonia alba 30c, Gelsemium sempervirens 30c, and Influenzinum 30c), coronavirus nosode CVN01 30c, Camphora 1M, or placebo. Six pills twice a day were administered for 3 days. The primary outcome measure used was testing recruitment and retention in this quarantined setting. Secondary outcomes were numbers testing positive for COVID-19 after developing symptoms of illness, number of subjects hospitalized, and days to recovery. RESULTS Good rates of recruitment and retention were achieved. Of 4,497 quarantined individuals, 2,343 sought enrollment, with 2,294 enrolled and 2,233 completing the trial (49.7% recruitment, 97.3% retention). Subjects who were randomized to either Bryonia alba or to the CVN01 nosode signaled (p <0.10) a lower incidence of laboratory-confirmed COVID-19 and a shorter period of illness, with evidence of fewer hospitalizations, than those taking placebo. The three other groups did not show signals of efficacy. CONCLUSION This pilot study supports the feasibility of a larger randomized, double-blind, placebo-controlled trial. Bryonia alba 30c and CVN01 30c should both be explored in disease prevention or shortening the course of disease symptomatology in a COVID-19-exposed population.
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Affiliation(s)
- Gitanjali Talele
- Research Department, Life Force Foundation Trust, Chembur, Mumbai, Maharashtra, India
| | - Shashikant Vaidhya
- Haffkine Institute, Microbiology Department, Haffkine Institute for Training Research and Testing, Parel, Mumbai, Maharashtra, India
| | - Abhay Chowdhary
- Department of Microbiology, DY Patil University, Navi Mumbai, Maharashtra, India
| | - Paul Herscu
- Division of Research, Herscu Laboratory, Amherst, Massachusetts, United States
| | - Rajesh Shah
- Research Department, Life Force Foundation Trust, Chembur, Mumbai, Maharashtra, India
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Chand S, Rrapi R, Gabel C, Nguyen E, Ko L, Dobry A, Garza-Mayers A, Shah R, St. John J, Strazzula L, Kroshinsky D. LB780 Risk factors predicting Cellulitis diagnosis in a prospective cohort undergoing dermatology consultation in the Emergency Department. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shah R, Blasi M, Kuon J, Christopolous P, Chung I, Stenzinger A, Kriegsmann M, Glade J, Klotz L, Eichhorn M, Wessels S, Muley T, Herth F, Bischoff H, Thomas M. 1739P Survival outcomes in patients with sarcomatoid pleural mesothelioma: A retrospective analysis from the last two decades. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tard A, Arcella D, Boon P, Cascio C, Castle L, Gergelova P, Horvath Z, Leblanc JC, Lindtner O, Riolo F, Shah R. Dietary exposure assessment of sweeteners within their re-evaluation by the European Food Safety Authority (EFSA). Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chand S, Rrapi R, Gabel C, Nguyen E, Dobry A, Garza-Mayers A, Ko L, Shah R, St. John J, Strazzula L, Nigwekar S, Kroshinsky D. LB779 Comparison of outcomes for intravenous and intralesional administration of sodium thiosulfate for treatment of Calciphylaxis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Shah R, Ali FM, Finlay AY, Salek MS. Correction to: Family reported outcomes, an unmet need in the management of a patient's disease: appraisal of the literature. Health Qual Life Outcomes 2021; 19:211. [PMID: 34461928 PMCID: PMC8406578 DOI: 10.1186/s12955-021-01839-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- R Shah
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.
| | - F M Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - M S Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Institute of Medicines Development, Cardiff, UK
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Taylor M, Abah U, Hayes T, Eadington T, Smith M, Shackcloth M, Granato F, Shah R, Booton R, Grant SW. Preoperative Anemia is Associated With Worse Long-Term Survival After Lung Cancer Resection: A Multicenter Cohort Study of 5,029 Patients. J Cardiothorac Vasc Anesth 2021; 36:1373-1379. [PMID: 34538557 DOI: 10.1053/j.jvca.2021.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/28/2021] [Accepted: 08/18/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Although some evidence to suggest an association between preoperative anemia and reduced overall survival exists, contemporary studies investigating the impact of preoperative anemia on outcomes after resection for primary lung cancer are lacking. DESIGN A multicenter retrospective review. SETTING Two tertiary cardiothoracic surgery centers in the Northwest of England. PARTICIPANTS A total of 5,029 patients between 2012 and 2018. INTERVENTIONS All patients underwent lung resection for primary lung cancer. Patients were classified as anemic based on the World Health Organization definition. Men with hemoglobin <130 g/L and women with hemoglobin <120 g/L were considered to be anemic. MEASUREMENTS AND MAIN RESULTS Outcomes assessed included perioperative mortality, 90-day mortality, and overall survival. Multivariate logistic and Cox regression analyses were used to assess the impact of preoperative anemia on 90-day mortality and overall survival, respectively. Overall, preoperatively, 24.0% (n = 1207) of patients were anemic. The 90-day mortality for anemic and nonanemic patients was 5.6% and 3.1%, respectively (p < 0.001). After multivariate adjustment, preoperative anemia was not associated with increased 90-day mortality. However, a log-rank analysis demonstrated reduced overall survival for anemic patients (p < 0.001). After multivariate adjustment, preoperative anemia was found to be independently associated with reduced overall survival (hazard ratio 1.287, 95% confidence interval 1.141-1.451, p < 0.001). CONCLUSIONS Although anemia was not an independent predictor of short-term outcomes, it was independently associated with significantly reduced survival for patients undergoing resection for lung cancer. Further work is required to understand why anemia reduces long-term survival and whether pathways for anemic patients can be adapted to improve long-term outcomes.
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Affiliation(s)
- Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom.
| | - Udo Abah
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Tim Hayes
- Department of Cardiothoracic Anaesthesia, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Thomas Eadington
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Matthew Smith
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Felice Granato
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Richard Booton
- Department of Respiratory Medicine, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom
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Noor M, Bivins E, Manchec B, Contreras F, Shah R, Ward TJ. Current Interventional Radiology-Related Benchmarked Clinical Quality Measures Are Less Likely to be "Capped" Than Diagnostic Radiology Clinical Quality Measures. J Vasc Interv Radiol 2021; 32:677-682. [PMID: 33933250 DOI: 10.1016/j.jvir.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
In the merit-based incentive payment system (MIPS), quality measures are considered topped out if national median performance rates are ≥95%. Quality measures worth 10 points can be capped at 7 points if topped out for ≥2 years. This report compares the availability of diagnostic radiology (DR)-related and interventional radiology (IR)-related measures worth 10 points. A total of 196 MIPS clinical quality measures were reviewed on the Center for Medicare and Medicaid Services MIPS website. There are significantly more IR-related measures worth 10 points than DR measures (2/9 DR measures vs 9/12 IR measures; P = .03), demonstrating that clinical IR services can help mixed IR/DR groups maximize their Center for Medicare and Medicaid Services payment adjustment.
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Shah R, Ali FM, Finlay AY, Salek MS. Family reported outcomes, an unmet need in the management of a patient's disease: appraisal of the literature. Health Qual Life Outcomes 2021; 19:194. [PMID: 34353345 PMCID: PMC8339395 DOI: 10.1186/s12955-021-01819-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A person's chronic health condition or disability can have a huge impact on the quality of life (QoL) of the whole family, but this important impact is often ignored. This literature review aims to understand the impact of patients' disease on family members across all medical specialities, and appraise existing generic and disease-specific family quality of life (QoL) measures. METHODS The databases Medline, EMBASE, CINHAL, ASSIA, PsycINFO and Scopus were searched for original articles in English measuring the impact of health conditions on patients' family members/partner using a valid instrument. RESULTS Of 114 articles screened, 86 met the inclusion criteria. They explored the impact of a relative's disease on 14,661 family members, mostly 'parents' or 'mothers', using 50 different instruments across 18 specialities including neurology, oncology and dermatology, in 33 countries including the USA, China and Australia. These studies revealed a huge impact of patients' illness on family members. An appraisal of family QoL instruments identified 48 instruments, 42 disease/speciality specific and six generic measures. Five of the six generics are aimed at carers of children, people with disability or restricted to chronic disease. The only generic instrument that measures the impact of any condition on family members across all specialities is the Family Reported Outcome Measure (FROM-16). Although most instruments demonstrated good reliability and validity, only 11 reported responsiveness and only one reported the minimal clinically important difference. CONCLUSIONS Family members' QoL is greatly impacted by a relative's condition. To support family members, there is a need for a generic tool that offers flexibility and brevity for use in clinical settings across all areas of medicine. FROM-16 could be the tool of choice, provided its robustness is demonstrated with further validation of its psychometric properties.
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Affiliation(s)
- R. Shah
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - F. M. Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - A. Y. Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - M. S. Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Institute of Medicines Development, Cardiff, UK
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Taylor M, Martin GP, Abah U, Sperrin M, Smith M, Bhullar D, Shackcloth M, Woolley S, West D, Shah R, Grant SW. Development and internal validation of a clinical prediction model for 90-day mortality after lung resection: the RESECT-90 score. Interact Cardiovasc Thorac Surg 2021; 33:921-927. [PMID: 34324664 DOI: 10.1093/icvts/ivab200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 06/24/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The ability to accurately estimate the risk of peri-operative mortality after lung resection is important. There are concerns about the performance and validity of existing models developed for this purpose, especially when predicting mortality within 90 days of surgery. The aim of this study was therefore to develop a clinical prediction model for mortality within 90 days of undergoing lung resection. METHODS A retrospective database of patients undergoing lung resection in two UK centres between 2012 and 2018 was used to develop a multivariable logistic risk prediction model, with bootstrap sampling used for internal validation. Apparent and adjusted measures of discrimination (area under receiving operator characteristic curve) and calibration (calibration-in-the-large and calibration slope) were assessed as measures of model performance. RESULTS Data were available for 6600 lung resections for model development. Predictors included in the final model were age, sex, performance status, percentage predicted diffusion capacity of the lung for carbon monoxide, anaemia, serum creatinine, pre-operative arrhythmia, right-sided resection, number of resected bronchopulmonary segments, open approach and malignant diagnosis. Good model performance was demonstrated, with adjusted area under receiving operator characteristic curve, calibration-in-the-large and calibration slope values (95% confidence intervals) of 0.741 (0.700, 0.782), 0.006 (-0.143, 0.156) and 0.870 (0.679, 1.060), respectively. CONCLUSIONS The RESECT-90 model demonstrates good statistical performance for the prediction of 90-day mortality after lung resection. A project to facilitate large-scale external validation of the model to ensure that the model retains accuracy and is transferable to other centres in different geographical locations is currently underway.
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Affiliation(s)
- Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK
| | - Udo Abah
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK
| | - Matthew Smith
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Dilraj Bhullar
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Steve Woolley
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Doug West
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospital NHS Foundation Trust, Manchester, UK
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Taylor M, Hashmi SF, Martin GP, Shackcloth M, Shah R, Booton R, Grant SW. A systematic review of risk prediction models for perioperative mortality after thoracic surgery. Interact Cardiovasc Thorac Surg 2021; 32:333-342. [PMID: 33257987 DOI: 10.1093/icvts/ivaa273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Guidelines advocate that patients being considered for thoracic surgery should undergo a comprehensive preoperative risk assessment. Multiple risk prediction models to estimate the risk of mortality after thoracic surgery have been developed, but their quality and performance has not been reviewed in a systematic way. The objective was to systematically review these models and critically appraise their performance. METHODS The Cochrane Library and the MEDLINE database were searched for articles published between 1990 and 2019. Studies that developed or validated a model predicting perioperative mortality after thoracic surgery were included. Data were extracted based on the checklist for critical appraisal and data extraction for systematic reviews of prediction modelling studies. RESULTS A total of 31 studies describing 22 different risk prediction models were identified. There were 20 models developed specifically for thoracic surgery with two developed in other surgical specialties. A total of 57 different predictors were included across the identified models. Age, sex and pneumonectomy were the most frequently included predictors in 19, 13 and 11 models, respectively. Model performance based on either discrimination or calibration was inadequate for all externally validated models. The most recent data included in validation studies were from 2018. Risk of bias (assessed using Prediction model Risk Of Bias ASsessment Tool) was high for all except two models. CONCLUSIONS Despite multiple risk prediction models being developed to predict perioperative mortality after thoracic surgery, none could be described as appropriate for contemporary thoracic surgery. Contemporary validation of available models or new model development is required to ensure that appropriate estimates of operative risk are available for contemporary thoracic surgical practice.
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Affiliation(s)
- Marcus Taylor
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester, UK
| | - Syed F Hashmi
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester, UK
| | - Richard Booton
- Department of Respiratory Medicine, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospitals Foundation Trust, Manchester, UK
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Shah R, Daudi AA, Nahar P, Misar P, Patidar S, Patidar S. A Comparative Evaluation of Sealing Ability of Five Different Materials for Furcation Perforation Repair Using UV-Spectrophotometric Analysis: An In-Vitro Study. Mymensingh Med J 2021; 30:840-845. [PMID: 34226477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This in-vitro study was done to compare the sealing ability of Mineral trioxide aggregate (MTA), Biodentine, a mixture of MTA and Glass ionomer cement (GIC) in 2:1 and 1:1 ratio and MTA CEM, as furcation repair material using a dye extraction leakage model in the department of Conservative Dentistry and Endodontics from January 2020 to December 2020. Eighty five extracted molars with divergent and well formed roots were selected for study and were randomly divided according to the material used for perforation repair. Group A: MTA, Group B: Biodentine, Group C: MTA mixed with GIC in 2:1 ratio. Group D: MTA mixed with GIC in 1:1 ratio. Group E: MTA CEM and 2 control groups. All samples were subjected to orthograde and retrograde methylene blue dye challenge followed by dye extraction with 70 weight % nitric acid. Samples were then analyzed using Ultra violet (UV) Visible Spectrophotometer at 550nm wavelength. The data were subjected to statistical analysis One Way ANOVA (level of significance <0.05) and post-hoc tukey test. MTA, Biodentine, Mixture of MTA and GIC in 2:1 ratio and MTA CEM showed significant less dye absorbance than MTA and GIC in 1:1 ratio. Within the limitation of the study, the newer mixture of MTA and GIC in 2:1 ratio showed promising sealing ability and was comparable to MTA, Biodentine and MTA CEM.
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Affiliation(s)
- R Shah
- Dr Ruchi Shah, Senior Lecturer, Department of Conservative Dentistry and Endodontics, KM Shah Dental College and Hospital. Sumandeep Vidhyapeeth, Vadodara, Gujarat. India; E-mail:
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Vigneswaran N, Wu J, Shah R, Holland J, Narendran S, Williams M, Lou Y. ROLES OF PROGRAMMED DEATH LIGAND-1 (PDL-1) AND ANTIGEN-PRESENTING NATURAL KILLER (AP-NK) CELLS IN PROMOTING IMMUNOSUPPRESSIVE TUMOR MICROENVIRONMENT (TME) IN ORAL CANCER (OC). Oral Surg Oral Med Oral Pathol Oral Radiol 2021. [DOI: 10.1016/j.oooo.2021.03.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wilson BN, Sun M, Shah R, Murrell DF, Murase JE. Purposeful inclusion of skin of colour in published literature for improved dermatology education: a call to action. Clin Exp Dermatol 2021; 47:409-410. [PMID: 34189766 DOI: 10.1111/ced.14821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- B N Wilson
- Department of Dermatology, School of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - M Sun
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R Shah
- Department of Dermatology, School of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - D F Murrell
- Department of Dermatology, The George Institute of Global Health, Sydney, NSW, Australia.,Department of Dermatology, University of New South Wales, Sydney, NSW, Australia
| | - J E Murase
- Department of Dermatology, School of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.,Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA.,Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, CA, USA
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83
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Eleftheriadou V, Atkar R, Batchelor J, McDonald B, Novakovic L, Patel JV, Ravenscroft J, Rush E, Shah D, Shah R, Shaw L, Thompson AR, Hashme M, Exton LS, Mohd Mustapa MF, Manounah L. British Association of Dermatologists guidelines for the management of people with vitiligo 2021. Br J Dermatol 2021; 186:18-29. [PMID: 34160061 DOI: 10.1111/bjd.20596] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- V Eleftheriadou
- Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - R Atkar
- Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - J Batchelor
- Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, NG7 2NR, UK
| | - B McDonald
- The Royal London Hospital, Whitechapel Road, Whitechapel, London, E1 1FR, UK
| | - L Novakovic
- Queen Elizabeth Hospital, Department of Dermatology, Lewisham and Greenwich NHS Trust, London, SE18 4QH, UK.,St John's Institute of Dermatology, Department of Photodermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | | | | | - E Rush
- Patient representative.,Vitiligo Support UK, London, UK
| | - D Shah
- Amersham Hospital, Amersham, HP7 0JD, UK
| | - R Shah
- Central & North West London NHS Trust, London, NW1 2PL, UK.,British Psychological Society, Leicester, LE1 7DR, UK
| | - L Shaw
- Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - A R Thompson
- British Psychological Society, Leicester, LE1 7DR, UK.,South Wales Clinical Psychology Training, Cardiff University, Cardiff, CF10 3AT, UK
| | - M Hashme
- British Association of Dermatologists, Willan House, London, W1T 5HQ, UK
| | - L S Exton
- British Association of Dermatologists, Willan House, London, W1T 5HQ, UK
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, London, W1T 5HQ, UK
| | - L Manounah
- British Association of Dermatologists, Willan House, London, W1T 5HQ, UK
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Munshi R, Talele G, Shah R. Preparation and Standardization of Nosodes Sourced from Klebsiella Pneumoniae, Salmonella Typhi, Neisseria Gonorrhoeae and Candida Albicans Strains. HOMEOPATHY 2021; 110:263-270. [PMID: 34107540 DOI: 10.1055/s-0041-1726009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Homeopathic nosodes prepared from organisms and pathological tissues have shown biological effects, encouraging more research. There is a need to develop some new nosodes systematically and to re-make others that were developed over a century ago. In our program of work on nosodes, the bacterial strains Klebsiella pneumoniae (BAA 2146), Salmonella typhi and Neisseria gonorrhoeae (ATCC 43069), and the single-celled fungus Candida albicans (24433, 26790, and 60193) have been identified for preparation. MATERIALS AND METHODS The systematic and scientific method of preparation of nosodes includes identification, culture, quantification, characterization, preparation, and standardization. Under laminar flow, a suspension of respective bacterial and fungal cells (20 billion cells/mL) was processed as per the Homoeopathic Pharmacopoeia of India (HPI). Culture tests, sterility tests and molecular testing (polymerase chain reaction) were performed to establish the absence of contamination, live organisms and DNA material. RESULTS K. pneumoniae, S. typhi (single, bivalent, or polyvalent), N. gonorrhoeae, and C. albicans nosodes (single and polyvalent) were sourced and prepared from different strains of respective cultures. The nosode preparations were processed by serial dilution and potentization, normally following the HPI guidelines. Molecular test results showed the absence of live organisms or DNA material; culture and sterility test results demonstrated the safety profile of the potentized nosodes. CONCLUSION K. pneumoniae, S. typhi, N. gonorrhoeae and C. albicans nosodes were successfully prepared. Their therapeutic potential may now be evaluated.
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Affiliation(s)
- Renuka Munshi
- Department of Clinical Pharmacology, TNMC and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Gitanjali Talele
- Research Department, Life Force Foundation Trust, Mumbai, Maharashtra, India
| | - Rajesh Shah
- Research Department, Life Force Foundation Trust, Mumbai, Maharashtra, India
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Abstract
A 63-year-old man presented to the emergency department with low back pain, perineal and genital numbness, together with bilateral lower limb paraesthesia and urinary retention. He was admitted under the orthopaedic service for investigation of suspected cauda equina syndrome. Magnetic resonance imaging of his spine did not reveal any evidence of cauda equina compression. Magnetic resonance imaging of his brain demonstrated nonspecific multiple hyperintensities in the right frontotemporal and left temporo-occipital regions. Computed tomography of his chest, abdomen, and pelvis did not identify any evidence of malignancy. Cerebrospinal fluid from a lumbar puncture showed a high leucocyte count (predominantly lymphocytes). Viral cerebrospinal fluid polymerase chain reaction was positive for varicella zoster virus. A diagnosis of varicella zoster virus myeloradiculitis (Elsberg syndrome) was established and the patient was treated with intravenous aciclovir. Unfortunately, the patient succumbed to a devastating intracerebral haemorrhage during his inpatient stay, probably due to vasculopathy from the underlying varicella zoster virus infection. This case describes a rare infectious mimic of cauda equina syndrome. Elsberg syndrome is an infectious syndrome characterised by bilateral lumbosacral myeloradiculitis, with varicella zoster virus being a well-recognised aetiological agent. We discuss the relevant literature in detail and identify the key, cautionary lessons learned from this case.
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Affiliation(s)
- R Shah
- Lister Hospital, Stevenage, UK
| | - N Jayakumar
- Queen's Hospital Burton, Burton on Trent, UK
| | - S Athar
- Queen's Hospital Burton, Burton on Trent, UK
| | - N Ashwood
- Queen's Hospital Burton, Burton on Trent, UK
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Eng D, Chute C, Khandwala N, Rajpurkar P, Long J, Shleifer S, Khalaf MH, Sandhu AT, Rodriguez F, Maron DJ, Seyyedi S, Marin D, Golub I, Budoff M, Kitamura F, Takahashi MS, Filice RW, Shah R, Mongan J, Kallianos K, Langlotz CP, Lungren MP, Ng AY, Patel BN. Automated coronary calcium scoring using deep learning with multicenter external validation. NPJ Digit Med 2021; 4:88. [PMID: 34075194 PMCID: PMC8169744 DOI: 10.1038/s41746-021-00460-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/26/2021] [Indexed: 02/05/2023] Open
Abstract
Coronary artery disease (CAD), the most common manifestation of cardiovascular disease, remains the most common cause of mortality in the United States. Risk assessment is key for primary prevention of coronary events and coronary artery calcium (CAC) scoring using computed tomography (CT) is one such non-invasive tool. Despite the proven clinical value of CAC, the current clinical practice implementation for CAC has limitations such as the lack of insurance coverage for the test, need for capital-intensive CT machines, specialized imaging protocols, and accredited 3D imaging labs for analysis (including personnel and software). Perhaps the greatest gap is the millions of patients who undergo routine chest CT exams and demonstrate coronary artery calcification, but their presence is not often reported or quantitation is not feasible. We present two deep learning models that automate CAC scoring demonstrating advantages in automated scoring for both dedicated gated coronary CT exams and routine non-gated chest CTs performed for other reasons to allow opportunistic screening. First, we trained a gated coronary CT model for CAC scoring that showed near perfect agreement (mean difference in scores = -2.86; Cohen's Kappa = 0.89, P < 0.0001) with current conventional manual scoring on a retrospective dataset of 79 patients and was found to perform the task faster (average time for automated CAC scoring using a graphics processing unit (GPU) was 3.5 ± 2.1 s vs. 261 s for manual scoring) in a prospective trial of 55 patients with little difference in scores compared to three technologists (mean difference in scores = 3.24, 5.12, and 5.48, respectively). Then using CAC scores from paired gated coronary CT as a reference standard, we trained a deep learning model on our internal data and a cohort from the Multi-Ethnic Study of Atherosclerosis (MESA) study (total training n = 341, Stanford test n = 42, MESA test n = 46) to perform CAC scoring on routine non-gated chest CT exams with validation on external datasets (total n = 303) obtained from four geographically disparate health systems. On identifying patients with any CAC (i.e., CAC ≥ 1), sensitivity and PPV was high across all datasets (ranges: 80-100% and 87-100%, respectively). For CAC ≥ 100 on routine non-gated chest CTs, which is the latest recommended threshold to initiate statin therapy, our model showed sensitivities of 71-94% and positive predictive values in the range of 88-100% across all the sites. Adoption of this model could allow more patients to be screened with CAC scoring, potentially allowing opportunistic early preventive interventions.
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Affiliation(s)
- David Eng
- grid.168010.e0000000419368956Department of Computer Science, Stanford University School of Medicine, Stanford, CA USA ,Bunkerhill, Palo Alto, CA USA
| | - Christopher Chute
- grid.168010.e0000000419368956Department of Computer Science, Stanford University School of Medicine, Stanford, CA USA
| | | | - Pranav Rajpurkar
- grid.168010.e0000000419368956Department of Computer Science, Stanford University School of Medicine, Stanford, CA USA
| | - Jin Long
- grid.168010.e0000000419368956Department of Pediatrics, Stanford University School of Medicine, Stanford, CA USA
| | - Sam Shleifer
- grid.168010.e0000000419368956Department of Computer Science, Stanford University School of Medicine, Stanford, CA USA
| | - Mohamed H. Khalaf
- grid.168010.e0000000419368956Department of Radiology, Stanford University School of Medicine, Stanford, CA USA
| | - Alexander T. Sandhu
- grid.168010.e0000000419368956Division of Cardiovascular Medicine and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA USA
| | - Fatima Rodriguez
- grid.168010.e0000000419368956Division of Cardiovascular Medicine and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA USA
| | - David J. Maron
- grid.168010.e0000000419368956Division of Cardiovascular Medicine and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA USA
| | - Saeed Seyyedi
- grid.168010.e0000000419368956Department of Radiology, Stanford University School of Medicine, Stanford, CA USA
| | - Daniele Marin
- grid.189509.c0000000100241216Department of Radiology, Duke University Medical Center, Durham, NC USA
| | - Ilana Golub
- grid.239844.00000 0001 0157 6501Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA USA
| | - Matthew Budoff
- grid.239844.00000 0001 0157 6501Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA USA
| | - Felipe Kitamura
- Diagnósticos da América SA (Dasa), Alphaville Barueri, SP Brazil ,grid.411249.b0000 0001 0514 7202Department of Diagnostic Imaging, Universidade Federal de São Paulo (Unifesp), São Paulo, SP Brazil
| | | | - Ross W. Filice
- grid.411663.70000 0000 8937 0972Department of Radiology, MedStar Georgetown University Hospital, Washington, DC USA
| | - Rajesh Shah
- grid.280747.e0000 0004 0419 2556Radiology Service, VA Palo Alto Health Care System, Palo Alto, CA USA
| | - John Mongan
- grid.266102.10000 0001 2297 6811Department of Radiology and Biomedical Imaging and Center for Intelligent Imaging, University of California, San Francisco, School of Medicine, San Francisco, CA USA
| | - Kimberly Kallianos
- grid.266102.10000 0001 2297 6811Department of Radiology and Biomedical Imaging and Center for Intelligent Imaging, University of California, San Francisco, School of Medicine, San Francisco, CA USA
| | - Curtis P. Langlotz
- grid.168010.e0000000419368956Department of Radiology, Stanford University School of Medicine, Stanford, CA USA
| | - Matthew P. Lungren
- grid.168010.e0000000419368956Department of Radiology, Stanford University School of Medicine, Stanford, CA USA
| | - Andrew Y. Ng
- grid.168010.e0000000419368956Department of Computer Science, Stanford University School of Medicine, Stanford, CA USA
| | - Bhavik N. Patel
- grid.417468.80000 0000 8875 6339Department of Radiology, Mayo Clinic, Scottsdale, AZ USA
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Tse JR, Shen J, Shah R, Fleischmann D, Kamaya A. Extravasation Volume at Computed Tomography Angiography Correlates With Bleeding Rate and Prognosis in Patients With Overt Gastrointestinal Bleeding. Invest Radiol 2021; 56:394-400. [PMID: 33449577 DOI: 10.1097/rli.0000000000000753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Despite the identification of active extravasation on computed tomography angiography (CTA) in patients with overt gastrointestinal bleeding (GIB), a large proportion do not have active bleeding or require hemostatic therapy at endoscopy, catheter angiography, or surgery. The objective of our proof-of-concept study was to improve triage of patients with GIB by correlating extravasation volume of first-pass CTA with bleeding rate and clinical outcomes. MATERIALS AND METHODS All patients who presented with overt GIB and active extravasation on CTA from January 2014 to July 2019 were reviewed in this retrospective, institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study. Extravasation volume was assessed using 3-dimensional software and correlated with hemostatic therapy (primary endpoint) and with intraprocedural bleeding, blood transfusions, and mortality as secondary endpoints using logistic regression models (P < 0.0125 indicating statistical significance). Odds ratios were used to determine the effect size of a threshold extravasation volume. Quantitative data (extravasation volume, aorta attenuation, extravasation attenuation and time) were input into a mathematical model to calculate bleeding rate. RESULTS Fifty consecutive patients including 6 (12%) upper, 18 (36%) small bowel, and 26 (52%) lower GIB met inclusion criteria. Forty-two underwent catheter angiography, endoscopy, or surgery; 16 had intraprocedural active bleeding, and 24 required hemostatic therapy. Higher extravasation volumes correlated with hemostatic therapy (P = 0.007), intraprocedural active bleeding (P = 0.003), and massive transfusion (P = 0.0001), but not mortality (P = 0.936). Using a threshold volume of 0.80 mL or greater, the odds ratio of hemostatic therapy was 8.1 (95% confidence interval, 2.1-26), active bleeding was 11.8 (2.6-45), and massive transfusion was 18 (2.3-65). With mathematical modeling, extravasation volume had a direct and linear relationship with bleeding rate, and the lowest calculated detectable bleeding rate with CTA was less than 0.1 mL/min. CONCLUSIONS Larger extravasation volumes correlate with higher bleeding rates and may identify patients who require hemostatic therapy, have intraprocedural bleeding, and require blood transfusions. Current CTAs can detect bleeding rates less than 0.1 mL/min.
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Affiliation(s)
- Justin R Tse
- From the Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles
| | | | - Rajesh Shah
- Interventional Radiology, Stanford University School of Medicine, California
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Munshi R, Talele G, Shah R. In-Vitro Evaluation of Antimicrobial Activities of Escherichia coli, Klebsiella pneumoniae, Salmonella typhi, Neisseria gonorrhoeae, and Candida albicans Nosodes. HOMEOPATHY 2021; 111:42-48. [PMID: 34020481 DOI: 10.1055/s-0041-1727149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study presents the results of the minimum inhibitory concentration (MIC) assay of a series of nosodes: namely Escherichia coli, Klebsiella pneumoniae, Salmonella typhi, Neisseria gonorrhoeae, and Candida albicans. Each was tested against its corresponding infection as well as cross infections. METHODS In-vitro efficacy of polyvalent nosodes was tested using the MIC assay technique. The nosodes, namely C. albicans polyvalent nosode (35c, 100c), N. gonorrhoeae (35c), K. pneumoniae (35c, 100c), E. coli polyvalent nosode (35c, 100c) and Salmonella typhi polyvalent nosode (30c, 100c), were tested along with positive and negative controls. Nosodes were studied in different potencies and at 1:1 dilution. RESULTS C. albicans polyvalent nosode 35c, 100c, N. gonorrhoeae 35c, and positive control amphotericin B showed inhibition of the growth of C. albicans species. K. pneumoniae 35c, E. coli polyvalent nosode 100c, and meropenem (positive control) showed inhibition of the growth of K. pneumoniae; this effect was not seen with ceftriaxone, ofloxacin and amoxicillin antibiotics. E. coli polyvalent nosode 30c in 10% alcohol (direct and dilution 1:1) and the positive controls ciprofloxacin, ofloxacin, and amoxicillin showed inhibition of the growth of E. coli. The S. typhi polyvalent nosode 30c in 10% alcohol showed inhibition of growth of S. typhi. CONCLUSION This study reveals that the tested nosodes exhibited antibacterial potential against the corresponding micro-organisms and against other selected organisms studied using this assay.
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Affiliation(s)
- Renuka Munshi
- Department of Clinical Pharmacology, TNMC & BYL Nair Ch. Hospital, Mumbai, India
| | - Gitanjali Talele
- Research department, Life Force Foundation Trust, Chembur, Mumbai, Maharashtra, India
| | - Rajesh Shah
- Research department, Life Force Foundation Trust, Chembur, Mumbai, Maharashtra, India
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Rrapi R, Chand S, Song S, Gabel CK, Shah R, El Saleeby C, Kroshinsky D. Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization predicts MRSA infection in inpatient paediatric cellulitis. Br J Dermatol 2021; 185:842-844. [PMID: 33959941 DOI: 10.1111/bjd.20439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- R Rrapi
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - S Chand
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - S Song
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - C K Gabel
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - R Shah
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - C El Saleeby
- Department of Paediatrics, Divisions of Hospital Medicine and Infectious Disease, Massachusetts General Hospital for Children, Boston, MA, USA
| | - D Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
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Creasy H, Westley S, Shah R, Mistry R. 496 The Use of Virtual Trauma Clinics (VTC) In the Assessment of Acute Hand Trauma; A Service Evaluation. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
As a UK tertiary referral centre for hand trauma the current COVID outbreak has led to the reconfiguration of trauma services. We evaluate the impact of our newly introduced VTC on our hand trauma service, comparing a cohort of patients who were managed pre-COVID, with our current revised pathway.
We carried out a service evaluation of all those patients processed by the VTC over 14 days in April 2020 (n = 184). We collected prospective data on timing of referral to assessment and surgery. This data was compared to a matched period in April 2019 (n = 162).
Post VTC there has been a significant reduction in time to clerking and time to surgery (p = < 0.001), with 98.1% being clerked within 1 day of referral. Post VTC 12.9% of patients were discharged directly from VTC, all other patients had definitive treatment in a single trip.
VTC has shown a clear benefit to patients with definitive management provided in a single trip in all cases. Whilst we have been able to clerk patients earlier any improvement in time to surgery depends on theatre staffing and availability, which differed in the two cohorts and certainly will as we move forward into normal services.
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Affiliation(s)
- H Creasy
- Queen Victoria Hospital, East Grinstead, United Kingdom
| | - S Westley
- Queen Victoria Hospital, East Grinstead, United Kingdom
| | - R Shah
- Queen Victoria Hospital, East Grinstead, United Kingdom
| | - R Mistry
- Queen Victoria Hospital, East Grinstead, United Kingdom
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Carty I, Shah R. 533 The Use of Virtual Reality Simulation to Facilitate Surgical Ward-Based Learning in Medical Students During the Covid-19 Pandemic. Br J Surg 2021. [PMCID: PMC8135718 DOI: 10.1093/bjs/znab134.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction The Covid-19 pandemic quickly resulted in the removal of all non-essential personnel from surgical wards. It also resulted in suspending medical student placements which are heavily relied upon to provide the students with necessary “hands-on” experience. Virtual Reality (VR) simulation was employed in order to ensure that the students had a comparable experience. Method VR simulations were used to simulate the ward environments and the students were able to gain valuable experience with common scenarios encountered on surgical wards. Each student was allocated a 1-hour time slot per session with a debriefing session after each. The digital immersive environment allowed students to build upon their didactic preparation and previously acquired knowledge base. Results Feedback was given at the end of each simulation by the simulation facilitator. Using the technical proficiency that they had acquired in the first scenario; the students went on to employ these skills directly in their next scenarios thereby capitalising on the repetition of core skills to maximize their learning. Conclusions In this instance, VR was successfully used to enhance both knowledge acquisition and experience. Feedback from the participating students was overwhelmingly positive with many suggesting that they were more comfortable learning in a simulated environment.
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Affiliation(s)
- I Carty
- DVH, Dartford, United Kingdom
| | - R Shah
- NHS, London, United Kingdom
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Chand S, Rrapi R, Gabel C, Song S, Shah R, El Saleeby C, Kroshinsky D. 443 Clinical risk factors associated with MRSA incidence in inpatient pediatric cellulitis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lane NE, Saag K, O'Neill TJ, Manion M, Shah R, Klause U, Eastell R. Real-world bone turnover marker use: impact on treatment decisions and fracture. Osteoporos Int 2021; 32:831-840. [PMID: 33236195 PMCID: PMC8043891 DOI: 10.1007/s00198-020-05734-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/05/2020] [Indexed: 12/20/2022]
Abstract
UNLABELLED The use of bone turnover marker (BTM) testing for patients with osteoporosis in the USA has not been well characterized. This retrospective US-based real-world data study found BTM testing has some association with treatment decision-making and lower fracture risk in patients with presumed osteoporosis, supporting its use in clinical practice. INTRODUCTION The purpose of this study was to characterize bone turnover marker (BTM) testing patterns and estimate their clinical utility in treatment decision-making and fragility fracture risk in patients with osteoporosis using a retrospective claims database. METHODS Data from patients aged ≥ 50 years with newly diagnosed osteoporosis enrolled in the Truven MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Co-ordination of Benefits databases from January 2008 to June 2018 were included. Osteoporosis was ascertained by explicit claims, fragility fracture events associated with osteoporosis, or prescribed anti-resorptive or anabolic therapy. BTM-tested patients were 1:1 propensity score matched to those untested following diagnosis. Generalized estimating equation models were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for testing versus no testing on both treatment decision-making and fragility fracture. RESULTS Of the 457,829 patients with osteoporosis, 6075 were identified with ≥ 1 BTM test following diagnosis; of these patients, 1345 had a unique treatment decision made ≤ 30 days from BTM testing. The percentage of patients receiving BTM tests increased significantly each year (average annual % change: + 8.1%; 95% CI: 5.6-9.0; p = 0.01). Patients tested were significantly more likely to have a treatment decision (OR: 1.14; 95% CI: 1.13-1.15), and testing was associated with lower odds of fracture versus those untested (OR: 0.87; 95% CI: 0.85-0.88). CONCLUSION In this large, heterogeneous population of patients with presumed osteoporosis, BTM testing was associated with treatment decision-making, likely leading to fragility fracture reduction following use.
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Affiliation(s)
- N E Lane
- Department of Internal Medicine, UC Davis Health, Sacramento, CA, USA.
| | - K Saag
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - T J O'Neill
- Data Science and Services, Diagnostics Information Solutions, Roche Diagnostics, F. Hoffmann-La Roche, Belmont, CA, USA
| | - M Manion
- Roche Diagnostics, Indianapolis, IN, USA
| | - R Shah
- Data Science and Services, Diagnostics Information Solutions, Roche Diagnostics, F. Hoffmann-La Roche, Belmont, CA, USA
| | - U Klause
- Roche Diabetes Care, Roche Diagnostics, Indianapolis, IN, USA
| | - R Eastell
- Metabolic Bone Centre, Northern General Hospital, Sheffield, UK
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Abstract
INTRODUCTION
The Homeopathy nosodes are the preparations sourced from organisms and diseased material such as warts and other cancerous tissues. The nosodes such as Psorinum (1826-30), Tuberculinum (1879), Medorrhinum (1880-85), Syphillinum (1880) and others have been in use in homeopathy practice since early 19th century. In the recent years, certain new nosodes such as HIV nosode, Hepatitis C nosode, Mycobacterium Tuberculosis nosode, Plasmodia Falciparum Nosode, Swine Flu and more have been systematically introduced.
MATERIALS AND METHODS
The scrapping and the tissues from the genital warts clusters were collected carefully and were tested for the evaluation of STD (Sexually Transmitted Diseases) panel and HPV-DNA-PCR for screening high risk type followed by genotype determination. The collected tissue sample was processed as per the procedure defined developing the Nosodes, in the Homeopathy Pharmacopoeia of India. Sterility testing and PCR tests were carried out for safety purpose.
RESULT
Human papillomavirus (HPV Genotype 6) Nosode sourced from the genital wart tissues; detected positive for Human papillomavirus genotype 6 was prepared and standardized for future research and clinical exploration.
DISCUSSION AND CONCLUSION
The HPV (Genotype 6) nosode contained the whole organisms in pure form. The therapeutic potential of HPV (Genotype 6) Nosode may be explored against viral warts affecting the genitals, anus, mouth, and respiratory tract.
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Venado A, Singer J, Leard L, Shah R, Kleinhenz M, Golden J, Perez A, Kolaitis N, Calabrese D, Maheshwari J, Trinh B, Kukreja J, Hays S. Measuring Quality in Lung Transplant Care: The QUILT Initiative. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Tambakis G, Lee T, Shah R, Wright E, Connell W, Miller A, Demediuk B, Ryan M, Howell J, Tsoi E, Lust M, Basnayake C, Ding N, Croagh C, Hong T, Kamm M, Farrell A, Papaluca T, MacIsaac M, Iser D, Mahady S, Holt B, Thompson A, Holmes J. Low failure to attend rates and increased clinic capacity with Telehealth: A highly effective outpatient model that should continue beyond the COVID-19 pandemic. J Gastroenterol Hepatol 2021; 36:1136-1137. [PMID: 33338284 DOI: 10.1111/jgh.15379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/09/2022]
Affiliation(s)
- G Tambakis
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Lee
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - R Shah
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - E Wright
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - W Connell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Miller
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - B Demediuk
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Ryan
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - J Howell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - E Tsoi
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Lust
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Basnayake
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - N Ding
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Croagh
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Hong
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Kamm
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Farrell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Papaluca
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M MacIsaac
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - D Iser
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - S Mahady
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - B Holt
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Thompson
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - J Holmes
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
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Odisho A, Singer J, Perez A, Leard L, Shah R, Golden J, Kleinhenz M, Kolaitis N, Maheshwari J, Liu A, Trinh B, Kukreja J, Greenland J, Calabrese D, Hays S. Implementation of a Chatbot Mobile Health Intervention with Home Spirometry to Monitor Lung Transplant Recipients Remotely. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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98
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Refat MS, Sayqal A, Abumelha HM, Alzahrani S, Shah R, Alkhatib F, Morad M, Katouah H, El-Metwaly N. Synthesis of Novel Mononuclear Lanthanide (Ln3+) Complexes with Indole-3-acetic Acid Hormone, Their Structure and Properties Based on Spectroscopic and In Silico Studies. RUSS J GEN CHEM+ 2021. [DOI: 10.1134/s1070363221040228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lane NE, Saag K, O'Neill TJ, Manion M, Shah R, Klause U, Eastell R. Correction to: Real-world bone turnover marker use: impact on treatment decisions and fracture. Osteoporos Int 2021; 32:609. [PMID: 33464393 PMCID: PMC7929952 DOI: 10.1007/s00198-021-05828-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N E Lane
- Department of Internal Medicine, UC Davis Health, Sacramento, CA, USA.
| | - K Saag
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - T J O'Neill
- Data Science and Services, Diagnostics Information Solutions, Roche Diagnostics, F. Hoffmann-La Roche, Belmont, CA, USA
| | - M Manion
- Roche Diagnostics, Indianapolis, IN, USA
| | - R Shah
- Data Science and Services, Diagnostics Information Solutions, Roche Diagnostics, F. Hoffmann-La Roche, Belmont, CA, USA
| | - U Klause
- Roche Diabetes Care, Roche Diagnostics, Indianapolis, IN, USA
| | - R Eastell
- Metabolic Bone Centre, Northern General Hospital, Sheffield, UK
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100
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Alvarez E, Nair KV, Gorritz M, Bartolome L, Maloney H, Ding Y, Golan T, Wade RL, Kumar R, Su W, Shah R, Russo P. Identification and diagnosis of Secondary Progressive Multiple Sclerosis during the clinical encounter: Results from a physician survey. Mult Scler Relat Disord 2021; 50:102858. [PMID: 33799068 DOI: 10.1016/j.msard.2021.102858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/09/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is difficult to characterize the transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive MS (SPMS), due to symptomatic variability across patients. Diagnosis of SPMS is prolonged and often established retrospectively, as it is based on patient clinical history and symptoms. This cross-sectional study aimed to identify MS neurologist reported clinical indicators deemed important in diagnosing SPMS in clinical practice. METHODS A web-based quantitative survey was conducted among MS-treating neurologists across the United States in January 2019. The questionnaire comprised of 17 questions evaluating primary clinical indicators used by neurologists in assessing patient progression to SPMS. Treatment approach and factors influencing treatment decision-making following SPMS diagnosis were also analyzed in the survey. RESULTS Overall, 300 neurologists completed the survey; most of the respondents were general MS-treating neurologists (63%) and from private care setting (58%). The overall respondents as well as MS-focused neurologists ranked patient history (45% and 42%, respectively) and patients' neurological exam (39% and 44%, respectively) as -primary clinical indicators of SPMS diagnosis. 57% of neurologists always or mostly switched disease modifying therapies after progression to SPMS, and mostly considered 3-6 months' assessment interval to diagnose SPMS. CONCLUSION The survey indicated that neurologists are able to recognize signs of SPMS within six months of symptomatic assessment. The diagnosis is primarily based on patient history among MS-treating neurologists. Therefore, continued education to neurologists may facilitate early diagnosis and timely introduction of effective treatment to manage the progression of SPMS.
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Affiliation(s)
- E Alvarez
- Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, USA
| | - K V Nair
- Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, USA
| | - M Gorritz
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - L Bartolome
- Thomas Jefferson University, Philadelphia, PA, USA
| | - H Maloney
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - Y Ding
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - T Golan
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - R L Wade
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - R Kumar
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - W Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - R Shah
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - P Russo
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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