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Agarwal S, Galindo RJ, Shah AV, Abreu M. Diabetes Technology in People with Type 2 Diabetes: Novel Indications. Curr Diab Rep 2024; 24:85-95. [PMID: 38421505 DOI: 10.1007/s11892-024-01536-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE OF REVIEW Diabetes technology has been continuously evolving. Current versions of continuous glucose monitors (CGM) use minimally invasive designs, monitor glucose values with high accuracy, and can be used to guide insulin dosing. Extensive evidence supports the use of diabetes technology for monitoring and insulin administration in people with type 1 diabetes. However, there is emerging evidence for people with type 2 diabetes. In this review, we present the different technological devices used to monitor glucose and deliver insulin and the evidence supporting their use in people with type 2 diabetes. RECENT FINDINGS The use of CGMs in people with type 2 diabetes treated with insulin or non-insulin therapies has been associated with improvements in glycemic control and time spent in hypoglycemia. Smart insulin pens and smart connected devices are options to track compliance and guide insulin delivery in people who do not require insulin pump therapy. Mechanical patch pumps can be used to reduce the burden of multiple daily insulin injections. Automated insulin delivery algorithms improve glycemic control without an increase in hypoglycemia. The use of technology in the management of type 2 diabetes generates glycemic data previously inaccessible, reduces barriers for insulin initiation, improves glycemic control, tracks adherence to therapy, and improves user satisfaction.
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Affiliation(s)
- Shubham Agarwal
- The University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Rodolfo J Galindo
- University of Miami Miller School of Medicine, 1450 NW 10th Ave, Miami, FL, 33136, USA
| | - Amy V Shah
- The University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Marconi Abreu
- The University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Hanlon P, Butterly E, Shah AV, Hannigan LJ, Wild SH, Guthrie B, Mair F, Dias S, Welton NJ, McAllister DA. 955 ANALYSIS OF RANDOMISED CONTROLLED TRIAL SERIOUS ADVERSE EVENT RATES AS A MARKER OF TRIAL REPRESENTATIVENESS. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The applicability of randomised controlled trials of pharmacological agents to older people with frailty/multimorbidity is often uncertain, due to concerns that trials are not representative. However, assessing trial representativeness is challenging and complex. We explore an approach assessing trial representativeness by comparing rates of trial Serious Adverse Events (SAEs: most of which reflect hospitalisations/deaths) to rates of hospitalisation/death in routine care (which, in a trial setting, would be SAEs be definition).
Method
We identified 483 trials (n = 636,267) from clinicaltrials.gov across 21 index conditions. A routine care comparison was identified from SAIL databank (n = 2.3 M). SAIL data were used to derive the expected rate of hospitalisations/deaths by age, sex and index condition. We then calculated the expected number of SAEs for each trial compared to the observed number of SAEs (observed/expected SAE ratio). We then re-calculated the observed/expected SAE ratio additionally accounting for comorbidity count in 125 trials for which we accessed individual participant data.
Results
For 12/21 index conditions the observed/expected SAE ratio was <1, indicating fewer SAEs in trials than expected given community rates of hospitalisations and deaths. A further 6/21 had point estimates <1 but the 95% CI included the null. The median observed/expected SAE ratio was 0.60 (95% CI 0.56–0.65; COPD) and the interquartile range was 0.44 (0.34–0.55; Parkinson’s disease) to 0.88 (0.59–1.33; IBD). Higher comorbidity count was associated with SAEs and hospitalisations/deaths across index conditions. For most trials, the observed/expected ratio was attenuated but remained <1 after additionally accounting for comorbidity count.
Conclusion
Trial participants experience fewer SAEs than expected based on age/sex/condition specific hospitalisation/death rates in routine care, confirming the predicted lack of representativeness. This difference is only partially explained by differences in multimorbidity. Assessing observed/expected SAE may help assess applicability of trial findings to older populations in whom multimorbidity and frailty are common.
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Affiliation(s)
- P Hanlon
- Institute for Health and Wellbeing, University of Glasgow
| | - E Butterly
- Institute for Health and Wellbeing, University of Glasgow
| | - A V Shah
- London School of Hygiene and Tropical Medicine
| | - L J Hannigan
- Nic Waals Institute, Lovisenberg Diaconal Hospital , Oslo, Norway
- Population Health Sciences , Bristol Medical School,
- University of Bristol , Bristol Medical School,
- Department of Mental Disorders, Norwegian Institute of Public Health
| | - S H Wild
- Usher Institute for Population Health Sciences, University of Edinburgh
| | - B Guthrie
- Usher Institute for Population Health Sciences, University of Edinburgh
| | - F Mair
- Institute for Health and Wellbeing, University of Glasgow
| | - S Dias
- Centre for Review and Dissemination, University of York
| | - N J Welton
- Population Health Sciences , Bristol Medical School,
- University of Bristol , Bristol Medical School,
| | - D A McAllister
- Institute for Health and Wellbeing, University of Glasgow
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Moss AJ, Zuling ET, Adamson PD, Freestone MR, Shah AV, Cruden NL. P4607Left ventricular thrombus in patients after primary percutaneous coronary intervention for ST-elevation myocardial infarction: incidence and 12-month clinical outcomes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4607] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- A J Moss
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - E T Zuling
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - P D Adamson
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - M R Freestone
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A V Shah
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - N L Cruden
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
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Abstract
Biliary conduits are constructed in operations for choledochal cysts. A wide variety of options are available for biliary tract reconstruction. We present our experience of treating six children with choledochal cysts by using the appendix as a biliary conduit. After mobilizing the appendix on its vascular pedicle, nonrefluxing, tunneled anastomosis was made with the 2nd part of the duodenum and the appendix. The operative procedure was simple and less time-consuming. Postoperative evaluation was done with the help of HIDA scan and ultrasound examination. Postoperative cholangitis was conspicuously absent in the two years of follow-up. One child has been lost to follow-up. From our preliminary experience, the operation seems simple and satisfying. Though the long-term efficacy still remains to be proven, the appendix should prove durable as a functional conduit.
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Affiliation(s)
- A A Shah
- Department of Pediatric Surgery, K. M. School of Postgraduate Medicine and Research, N. H. L. Municipal Medical College, V. S. Hospital, Ahmedabad, India
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Shah AV, Jathal BS. Evaluation of Freeze-Dried Dura Mater Allograft as a Collagen Based Barrier (an experimental animal study). Cell Tissue Bank 2004; 4:133-9. [PMID: 15256850 DOI: 10.1023/b:catb.0000007039.98845.bd] [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: 11/12/2022]
Abstract
Freeze-dried dura mater allograft (FDDMA) was evaluated as a cost-effective collagenous barrier using an experimental animal model to determine its biocompatibility and 'cell-occlusivity' potential. The FDDMA was processed at the Civil Hospital Ahmedabad, in accordance with the guidelines provided by the South-Eastern Organ Procurement Foundation, U.S.A. Fifteen Charles Foster rats were selected for a study period of 9 weeks. The 1st set graft procedure was performed in an abdominal pouch and after 1 week bilateral mandibular defects were created. One defect was covered by the FDDMA barrier (2nd set graft procedure) and the other defect served as the control. The post operative autopsy and morphological and histological assessments were carried out at 2 and 4 weeks for the 1st set graft, and 3, 6 and 9 weeks for the 2nd set graft procedure. There was acceptance of the 2nd set graft in a pre-exposed animal and no significant inflammatory response. The processed FDDMA demonstrated optimal 'cell-occlusivity' potential for guided bone regeneration to take place in Charles Foster rats.
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Affiliation(s)
- A V Shah
- Private Practice Gum Care Centre, 413 Lalbhai Contractor Complex, Opp. Parsi library, Old Court Road, Nanpura, Surat. -395001, Gujarat - India (Tel.: 912612462536; e-mail: )
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Abstract
A 26-day-old male neonate presented with an acute gastric volvulus which was reduced with a nasogastric catheter. The patient was then subjected to laparoscopic anterior gastropexy. Six months after the procedure, the child is thriving and completely free of symptoms. We present this case as the first wherein a laparoscopic gastropexy has been done for gastric volvulus in a neonate. We have found the procedure acceptable for the treatment of neonates with gastric volvulus.
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Affiliation(s)
- A Shah
- Department of Pediatric Surgery, K.M. School of Postgraduate Medicine & Research, N.H.L. Municipal Medical College, V.S. Hospital, Ahmedabad, India
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Lobo Gajiwala A, Shah AV. Clinical Evaluation of Irradiated, Freeze-Dried Dura Mater Allograft as a Collagen-Based Barrier in Periodontal Osseous Defects. Cell Tissue Bank 2003; 4:101-7. [PMID: 15256846 DOI: 10.1023/b:catb.0000007028.46139.c7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The objective of this study was to clinically evaluate freeze-dried dura mater allograft (FDDMA) provided by the Tata Memorial Hospital Tissue Bank, in various periodontal osseous defects and to observe any unwanted healing pattern or adverse reaction.Eleven systemically healthy patients with one infrabony/furcation defect and at least 6 mm or more loss of attachment at selected sites, were scheduled for surgery. At base-line, patients had a good maintenance regime, minimal gingival inflammation and mobility not more than 1 mm in the buccolingual plane (grade 2). The measurements taken were probing pocket depth, clinical attachment level, intrasurgical level of bone and radiographic level of bone. Instead of surgical re-entry, transgingival probing was performed after 12 months of surgery. After debridement the defects were filled with demineralised freeze-dried bone allograft and covered with FDDMA barrier. The results after 12 months were satisfactory (mean gain of attachment 4.33 mm and mean defect fill 3.91 mm). No adverse reaction, infection or delayed wound healing was noted throughout the study.
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Abstract
The conformations of cyclooctadecane, cyclononadecane, and cycloicosane were generated by a stochastic program that works in conjunction with MM2. The shapes of the rings are analyzed in terms of previous work by Dale and others, and in terms of distributions of energies, torsion angle distributions, and torsion angle sequences. A new shape element called the 'nick' has been discovered, and it seems to be increasingly important with 18-membered and larger rings. Previously suggested relationships between ring size and energy distribution were observed, and a geometrical explanation is provided for the relative distributions of stable conformations in 16-, 18-, and 20-membered rings.
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Affiliation(s)
- A V Shah
- Department of Chemistry, University of Arizona, Tucson 85721
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Bhatia SJ, Deshmukh H, Abraham P, Shah AV, Vontivillu JA, Jagasia DH, Kothari RH. Effect of sublingual isosorbide dinitrate in portal hypertension. Indian J Gastroenterol 1990; 9:113-5. [PMID: 2323797] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nitrates decrease portal pressure by decreasing portal venous inflow and resistance. We studied over 20 minutes the effect of 10 mg isosorbide dinitrate sublingual on intrasplenic pulp pressure, mean arterial pressure and heart rate, in 13 patients with cirrhotic or non-cirrhotic portal hypertension. The pulp pressure fell progressively over 20 minutes, from mean 43.6 +/- 2.4 (SEM) to 35.6 +/- 1.8 cm H2O (p less than 0.001). This was accompanied initially by a significant fall in mean arterial pressure (85.8 +/- 1.9 to 80.4 +/- 2.7 mmHg at 4 minutes; p less than 0.01) and rise in heart rate (92.5 +/- 5.0 to 102.6 +/- 5.9 per minute at 6 minutes; p less than 0.02), following which these parameters remained stable. One patient developed giddiness due to hypotension at 15 minutes. We conclude that sublingual isosorbide dinitrate decreases pulp pressure in cirrhotic and non-cirrhotic portal hypertensives, but this is initially accompanied by significant hemodynamic changes.
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Affiliation(s)
- S J Bhatia
- Department of Gastroenterology, K E M Hospital, Bombay
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Chakraborty PK, Shah AV, Parikh NK. Psychiatric factors in ulcerative colitis. Indian J Psychiatry 1983; 25:219-22. [PMID: 21847291 PMCID: PMC3012322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Controlled study on 20 patients of ulcerative colitis was conducted at Gastroenterology Department of Civil Hospital, Ahmedabad. It has been observed that in three fourth of the cases, age of onset is before 40 years; & male, female ratio 4:1. No significant trend emerged in marital status, type of family, birth order, dietary habit and parental profile. The disease is common in lower socio-economic status. Ulcerative colitis patients are particularly exposed to stressful life situations and more prone to develop illness.
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Affiliation(s)
- P K Chakraborty
- Classified Specialist (Psychiatry), Military Hospital, Ahmedabad
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Shah VC, Krishna Murthy DS, Roy S, Contractor PM, Shah AV. True hermaphrodite: 46, XX/46, XY, clinical cytogenetic and histopathological studies. Indian J Pediatr 1982; 49:885-90. [PMID: 7182365 DOI: 10.1007/bf02976984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Desai NG, Gandhi HA, Shah AV. Emotional factors in bronchial asthma. Indian J Psychiatry 1981; 23:104-8. [PMID: 22058527 PMCID: PMC3013158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Controlled study on 30 patients of bronchial asthma was conducted at General Medicine Dept. of Civil Hospital, Ahmedabad. It has been observed that parental loss or deprivation in childhood per se is a significantly important factor in asthmatics. Asthmatics are found to be reserved, detached, affected by feelings, emotionally less stable, mild, accommodating, shy, timid, tender-minded, dependent, tense and frustrated in comparison to the control cases.
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Affiliation(s)
- N G Desai
- Post Graduate Student, Dept. of Psychiatry, B. J. Medical College & Civil Hospital, Ahmedabad
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Shah AV, Goswami UA, Maniar RC, Hajariwala DC, Sinha BK. Prevalence of psychiatric disorders in ahmedabad (an epidemiological study). Indian J Psychiatry 1980; 22:384-9. [PMID: 22058505 PMCID: PMC3013608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A psychiatric survey was carried out in an urban area of Ahmedabad which consisted mainly of middle class population. 461 families were surveyed which consisted of a total number of 2712 persons.The data was collected in a predetermined form. The index cases were individually evaluated in detail with the help of a structured Psychiatric proforma, case work and psychiatric examination by a consultant for psychiatric diagnosis. Out of the total of 2712 persons surveyed, 128 were found to be suffering from psychiatric disorders, the prevalance rate being 4.7% (47.2 per thousand).
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Affiliation(s)
- A V Shah
- Head & Hon. Prof. Dept. of Psychiatry, B.J. Medical College & Civil Hospital, Ahmedabad-380 016
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Hyder M, Shah AV, Hartree AS. Methallibure studies on Tilapia. III. Effects of Tilapian partially purified pituitary gonadotrophic fractions on the testes of methallibure-treated Sarotherodon spirulus (= Tilapia nigra). Gen Comp Endocrinol 1979; 39:475-80. [PMID: 520809 DOI: 10.1016/0016-6480(79)90234-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Hyder M, Shah AV, Campbell CM, Dadzie S. Methallibure studies on Tilapia. II. Effect of Tilapia pituitary homogenate (TPH), human chorionic gonadotropin (HCG) and testosterone propionate (TP) on the testes of methallibure-treated Tilapia nigra. Gen Comp Endocrinol 1974; 23:245-55. [PMID: 4853193 DOI: 10.1016/0016-6480(74)90068-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Asquith RS, Shah AV. The photochemical degradation of cystine in aqueous solutions in the presence of nitrogen. Biochim Biophys Acta 1971; 244:547-56. [PMID: 5160419 DOI: 10.1016/0304-4165(71)90071-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Hyder M, Shah AV, Kirschner MA. Effect of chorionic gonadotrophon on testicular histology and testosterone production in Tilapia Leucosticta (Teleostei: Cichlidae). Endocrinology 1970; 87:819-22. [PMID: 5465721 DOI: 10.1210/endo-87-4-819] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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