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Adleberg J, Benitez CL, Primiano N, Patel A, Mogel D, Kalra R, Adhia A, Berns M, Chin C, Tanghe S, Yi P, Zech J, Kohli A, Martin-Carreras T, Corcuera-Solano I, Huang M, Ngeow J. Fully Automated Measurement of the Insall-Salvati Ratio with Artificial Intelligence. J Imaging Inform Med 2024; 37:601-610. [PMID: 38343226 PMCID: PMC11031523 DOI: 10.1007/s10278-023-00955-1] [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] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 04/20/2024]
Abstract
Patella alta (PA) and patella baja (PB) affect 1-2% of the world population, but are often underreported, leading to potential complications like osteoarthritis. The Insall-Salvati ratio (ISR) is commonly used to diagnose patellar height abnormalities. Artificial intelligence (AI) keypoint models show promising accuracy in measuring and detecting these abnormalities.An AI keypoint model is developed and validated to study the Insall-Salvati ratio on a random population sample of lateral knee radiographs. A keypoint model was trained and internally validated with 689 lateral knee radiographs from five sites in a multi-hospital urban healthcare system after IRB approval. A total of 116 lateral knee radiographs from a sixth site were used for external validation. Distance error (mm), Pearson correlation, and Bland-Altman plots were used to evaluate model performance. On a random sample of 2647 different lateral knee radiographs, mean and standard deviation were used to calculate the normal distribution of ISR. A keypoint detection model had mean distance error of 2.57 ± 2.44 mm on internal validation data and 2.73 ± 2.86 mm on external validation data. Pearson correlation between labeled and predicted Insall-Salvati ratios was 0.82 [95% CI 0.76-0.86] on internal validation and 0.75 [0.66-0.82] on external validation. For the population sample of 2647 patients, there was mean ISR of 1.11 ± 0.21. Patellar height abnormalities were underreported in radiology reports from the population sample. AI keypoint models consistently measure ISR on knee radiographs. Future models can enable radiologists to study musculoskeletal measurements on larger population samples and enhance our understanding of normal and abnormal ranges.
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Affiliation(s)
- J Adleberg
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - C L Benitez
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N Primiano
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Patel
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - D Mogel
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R Kalra
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Adhia
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Berns
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Chin
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Tanghe
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - P Yi
- University of Maryland, Baltimore, MD, USA
| | - J Zech
- Columbia University Medical Center, New York, NY, USA
| | - A Kohli
- UT Southwestern, Dallas, TX, USA
| | | | - I Corcuera-Solano
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Huang
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Ngeow
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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2
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Kaleva AI, Patel A, Sooriyamoorthy T, Dimitriadis PA, Rajaguru K, Mochloulis G. Utility of intra-operative ultrasound in revision neck dissection for loco-regional thyroid cancer recurrence. Clin Otolaryngol 2024. [PMID: 38468458 DOI: 10.1111/coa.14153] [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: 10/31/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/13/2024]
Affiliation(s)
- A I Kaleva
- Department of Otorhinolaryngology, Lister Hospital, Stevenage, Herts, UK
| | - A Patel
- Department of Otorhinolaryngology, Lister Hospital, Stevenage, Herts, UK
| | - T Sooriyamoorthy
- Department of Otorhinolaryngology, Lister Hospital, Stevenage, Herts, UK
| | - P A Dimitriadis
- Department of Otorhinolaryngology, Lister Hospital, Stevenage, Herts, UK
| | - K Rajaguru
- Department of Radiology, Lister Hospital, Stevenage, Herts, UK
| | - G Mochloulis
- Department of Otorhinolaryngology, Lister Hospital, Stevenage, Herts, UK
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3
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Patel A, Bandino F, Achanta M, Walker SL, Joseph JA. Ear, nose and throat manifestations of leishmaniasis: Case series from a tertiary centre in the United Kingdom. Clin Otolaryngol 2024; 49:258-263. [PMID: 37997482 DOI: 10.1111/coa.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/12/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023]
Affiliation(s)
- A Patel
- Department of Rhinology, Royal National Ear, Nose and Throat Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - F Bandino
- Department of Rhinology, Royal National Ear, Nose and Throat Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Achanta
- Department of Rhinology, Royal National Ear, Nose and Throat Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - S L Walker
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | - J A Joseph
- Department of Rhinology, Royal National Ear, Nose and Throat Hospital, University College London Hospitals NHS Foundation Trust, London, UK
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4
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Sherazi S, Patel A, Hsu K, Schleede S, Watts A, McNitt S, Aktas MK, Goldenberg I. Risk of Sudden Cardiac Death in Patients Undergoing Cancer Treatment. Am J Cardiol 2024; 214:136-141. [PMID: 38134978 DOI: 10.1016/j.amjcard.2023.12.012] [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] [Received: 09/11/2023] [Revised: 10/30/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023]
Abstract
The risk of sudden cardiac death (SCD) in patients with cancer receiving cancer therapies is not well defined. In this study we aimed to (1) evaluate the risk of SCD during the first 6 months of cancer treatment and (2) identify risk factors (RFs) for SCD in patients who underwent active cancer treatment. The study population comprised 8,356 patients who received any cancer treatment at the University of Rochester Medical Center from 2011 to 2020. The primary end point was the occurrence of SCD within 6 months of cancer treatment. SCD was defined by using the modified Hinkle-Thaler classification. The mean age at the time of cancer treatment was 64 ± 14 years and 49% were women. All-cause mortality occurred in 834 patients (10%), of whom 51 (6%) were identified as SCD. The cumulative probability of SCD at 6 months was 0.6%. Age <74 years (0.042), history of congestive heart failure (0.058) and lung cancer (0.004) were identified as independent RFs for SCD in the multivariate Cox regression models. The cumulative probability of SCD at 6 months from cancer treatment initiation was significantly higher in patients with ≥2 RFs (1.6%) than in patients with 0 or 1 RF (0.5%) (log-rank p <0.001). In conclusion, our findings suggest that active cancer treatment is associated with SCD risk that is more pronounced in younger patients (< 74 years), patients with cancer and a history of heart failure, and those who underwent treatment for lung cancer. Future studies should address appropriate modalities for prevention and protection in this high-risk population.
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Affiliation(s)
- Saadia Sherazi
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Arpan Patel
- Division of Hematology/Oncology and Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Kimberly Hsu
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Susan Schleede
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Arthur Watts
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Scott McNitt
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Mehmet Kemal Aktas
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Devaprasad M, Rastogi N, Satish R, Patel A, Dabhi A, Shivam A, Bhushan R, Meena R. Dual carbon isotope-based brown carbon aerosol characteristics at a high-altitude site in the northeastern Himalayas: Role of biomass burning. Sci Total Environ 2024; 912:169451. [PMID: 38143007 DOI: 10.1016/j.scitotenv.2023.169451] [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] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/10/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
PM2.5 samples (n = 34) were collected from January to April 2017 over Shillong (25.7°N, 91.9°E; 1064 m amsl), a high-altitude site situated in the northeastern Himalaya. The main aim was to understand the sources, characteristics, and optical properties of local vs long-range transported carbonaceous aerosols (CA) using chemical species and dual carbon isotopes (13C and 14C). Percentage biomass burning (BB)/biogenic fraction (fbio, calculated from 14C) varied from 67 to 92 % (78 ± 7) and correlated well with primary BB tracers like f60, and K+, suggesting BB as a considerable source. Rain events are shown to reduce the fbio fraction, indicating majority of BB-derived CA are transported. Further, δ13C (-26.6 ± 0.4) variability was very low over Shillong, suggesting it's limitations in source apportionment over the study region, if used alone. Average ratio of absorption coefficient of methanol-soluble BrC (BrCMS) to water-soluble BrC (BrCWS) at 365 nm was 1.8, indicating a significant part of BrC was water-insoluble. A good positive correlation between fbio and mass absorption efficiency of BrCWS and BrCMS at 365 nm with the higher slope for BrCMS suggests BB derived water-insoluble BrC was more absorbing. Relative radiative forcing (RRF, 300 to 2500 nm) of BrCWS and BrCMS with respect to EC were 11 ± 5 % and 23 ± 16 %, respectively. Further, the RRF of BrCMS was up to 60 %, and that of BrCWS was up to 22 % with respect to EC for the samples with fbio ≥ 0.85 (i.e., dominated by BB), reflecting the importance of BB in BrC RRF estimation.
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Affiliation(s)
- M Devaprasad
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India; Indian Institute of Technology, Gandhinagar, Gujarat 382355, India
| | - N Rastogi
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India.
| | - R Satish
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India
| | - A Patel
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India
| | - A Dabhi
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India
| | - A Shivam
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India
| | - R Bhushan
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India
| | - R Meena
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India
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Kumar T, Patel A, Chaffin AE. Use of Suprapubic Panniculus for Split-Thickness Skin Graft in Buried Penis Repair. Eplasty 2024; 24:e6. [PMID: 38476520 PMCID: PMC10929065] [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] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Background In the United States, acquired buried penis deformity is an increasingly more common condition. Management of the buried penis deformity is accomplished with removal of macerated skin and subcutaneous tissue from the panniculus and prepubic region, and replacement of denuded penile skin. If local tissue advancement is insufficient to cover the defect, a skin graft may be required. Though the anterior thigh is commonly used, this creates a second defect. Here we describe 2 cases of split-thickness skin grafts harvested from the panniculus to cover buried penis deformities. Methods Two patients with a buried penis deformity were identified. The denuded suprapubic tissue was elevated. Using inferior traction, split-thickness skin grafts were harvested and placed onto the shaft of the penis. The remaining excess tissue was resected. Results One patient had a fungal rash that resolved with topical treatment. The other patient had a hematoma requiring surgical evacuation. Neither patient had any other complications, and both had over 95% take of the split-thickness skin grafts. Conclusions These cases demonstrate the successful use of pannicular skin grafts for buried penis deformity correction. This donor site avoids creation of a second defect. As demonstrated here, the grafts are a durable option, even in the setting of local infection and hematoma.
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Affiliation(s)
- Taruni Kumar
- Tulane University School of Medicine, New Orleans, Louisiana
| | - A Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Abigail E. Chaffin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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7
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Patel A, Walling A, Kanwal F, Serper M, Hernaez R, Sundaram V, Kaplan D, Taddei T, Mahmud N. Rates, patterns, and predictors of specialty palliative care consultation among patients with acute-on-chronic liver failure. JHEP Rep 2024; 6:100976. [PMID: 38274489 PMCID: PMC10808910 DOI: 10.1016/j.jhepr.2023.100976] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 01/27/2024] Open
Abstract
Background & Aims There is growing acceptance that principles of palliative care should be integrated into the management of serious illnesses affecting the liver, such as acute-on-chronic liver failure (ACLF). However, rates, patterns, and predictors of specialty palliative care consultation among patients with ACLF have not been well-described. Methods We performed a retrospective cohort study of patients hospitalized with ACLF between 1/1/2008 and 12/31/2018 using the VOCAL cohort. Patients were followed until 6/2021. We used mixed-effects regression analyses to identify significant patient and facility factors associated with palliative care consultation. We examined timing of consultation, the influence of ACLF characteristics, and facility-level variation on receipt of palliative care consultation. Results We identified 21,987 patients hospitalized with ACLF, of whom 30.5% received specialty palliative care consultation. Higher ACLF grade (ACLF-2 [odds ratio (OR) 1.82, 95% CI 1.67-1.99], ACLF-3 [OR 3.06, 95% CI 2.76-3.40]), prior specialty palliative care consultation (OR 2.62, 95% CI 2.36-2.91), and hepatocellular carcinoma (OR 2.10, 95% CI 1.89-2.33) were associated with consultation. Consultation occurred latest and closest to the time of death for patients with ACLF-3 compared to ACLF-1 and ACLF-2. Significant facility-level variation in consultation persisted among patients with ACLF-3, despite adjusting for multiple patient and facility factors. Conclusion In this large cohort of hospitalized patients with ACLF, specialty palliative care consultation was rare, more common in patients with higher grade ACLF, and tended to occur closer to the time of death for the sickest patients. Greater attention should be placed on earlier integration of palliative care during acute hospitalizations in patients with ACLF. Impact and implications Though palliative care consultation is recommended for patients with acute-on-chronic liver failure, there is no data demonstrating how often this occurs during hospitalizations, on a population level. We found that consultation occurs in only 30.5% of patients and occurs later for patients with grade 3 acute-on-chronic liver failure. Our data should provoke clinicians to urgently consider quality improvement efforts to integrate palliative care into the management of these seriously ill patients.
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Affiliation(s)
- Arpan Patel
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Department of Medicine, Greater Los Angeles VA Healthcare System, Los Angeles, CA, United States
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Anne Walling
- Department of Medicine, Greater Los Angeles VA Healthcare System, Los Angeles, CA, United States
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, United States
- Department of Internal Medicine, Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Marina Serper
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
- Leonard David Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Ruben Hernaez
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, United States
- Department of Internal Medicine, Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Vinay Sundaram
- Karsh Division of Gastroenterology and Hepatology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - David Kaplan
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Tamar Taddei
- Division of Digestive Diseases, Yale University School of Medicine, New Haven, CT, United States
- VA Connecticut Healthcare System, West Haven, CT, United States
| | - Nadim Mahmud
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
- Leonard David Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Hany U, Watson C, Liu L, Nikolopoulos G, Smith C, Poulter J, Brown C, Patel A, Rodd H, Balmer R, Harfoush A, Al-Jawad M, Inglehearn C, Mighell A. Novel Ameloblastin Variants, Contrasting Amelogenesis Imperfecta Phenotypes. J Dent Res 2024; 103:22-30. [PMID: 38058155 PMCID: PMC10734210 DOI: 10.1177/00220345231203694] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Amelogenesis imperfecta (AI) comprises a group of rare, inherited disorders with abnormal enamel formation. Ameloblastin (AMBN), the second most abundant enamel matrix protein (EMP), plays a critical role in amelogenesis. Pathogenic biallelic loss-of-function AMBN variants are known to cause recessive hypoplastic AI. A report of a family with dominant hypoplastic AI attributed to AMBN missense change p.Pro357Ser, together with data from animal models, suggests that the consequences of AMBN variants in human AI remain incompletely characterized. Here we describe 5 new pathogenic AMBN variants in 11 individuals with AI. These fall within 3 groups by phenotype. Group 1, consisting of 6 families biallelic for combinations of 4 different variants, have yellow hypoplastic AI with poor-quality enamel, consistent with previous reports. Group 2, with 2 families, appears monoallelic for a variant shared with group 1 and has hypomaturation AI of near-normal enamel volume with pitting. Group 3 includes 3 families, all monoallelic for a fifth variant, which are affected by white hypoplastic AI with a thin intact enamel layer. Three variants, c.209C>G; p.(Ser70*) (groups 1 and 2), c.295T>C; p.(Tyr99His) (group 1), and c.76G>A; p.(Ala26Thr) (group 3) were identified in multiple families. Long-read AMBN locus sequencing revealed these variants are on the same conserved haplotype, implying they originate from a common ancestor. Data presented therefore provide further support for possible dominant as well as recessive inheritance for AMBN-related AI and for multiple contrasting phenotypes. In conclusion, our findings suggest pathogenic AMBN variants have a more complex impact on human AI than previously reported.
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Affiliation(s)
- U. Hany
- Leeds Institute of Medical Research, University of Leeds, St. James’s University Hospital, Leeds, UK
| | - C.M. Watson
- Leeds Institute of Medical Research, University of Leeds, St. James’s University Hospital, Leeds, UK
- North East and Yorkshire Genomic Laboratory Hub, Central Lab, St. James’s University Hospital, Leeds, UK
| | - L. Liu
- Leeds Institute of Medical Research, University of Leeds, St. James’s University Hospital, Leeds, UK
- School of Dentistry, Clarendon Way, University of Leeds, Leeds, UK
| | - G. Nikolopoulos
- Leeds Institute of Medical Research, University of Leeds, St. James’s University Hospital, Leeds, UK
| | - C.E.L. Smith
- Leeds Institute of Medical Research, University of Leeds, St. James’s University Hospital, Leeds, UK
| | - J.A. Poulter
- Leeds Institute of Medical Research, University of Leeds, St. James’s University Hospital, Leeds, UK
| | - C.J. Brown
- Birmingham Dental Hospital, Mill Pool Way, Edgbaston, Birmingham, UK
| | - A. Patel
- LCRN West Midlands Core Team, NIHR Clinical Research Network (CRN), Birmingham Research Park (West Wing), Edgbaston, Birmingham, UK
| | - H.D. Rodd
- Academic Unit of Oral Health Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, S Yorks, UK
| | - R. Balmer
- School of Dentistry, Clarendon Way, University of Leeds, Leeds, UK
| | - A. Harfoush
- School of Dentistry, Clarendon Way, University of Leeds, Leeds, UK
| | - M. Al-Jawad
- School of Dentistry, Clarendon Way, University of Leeds, Leeds, UK
| | - C.F. Inglehearn
- Leeds Institute of Medical Research, University of Leeds, St. James’s University Hospital, Leeds, UK
| | - A.J. Mighell
- School of Dentistry, Clarendon Way, University of Leeds, Leeds, UK
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9
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Reynolds CA, Nair V, Villaflores C, Dominguez K, Arbanas JC, Treasure M, Skootsky S, Tseng CH, Sarkisian C, Patel A, Ghassemi K, Fendrick AM, May FP, Mafi JN. Developing an electronic health record measure of low-value esophagogastroduodenoscopy for GERD at a large academic health system. BMJ Open Qual 2023; 12:e002363. [PMID: 38135304 DOI: 10.1136/bmjoq-2023-002363] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Low-value esophagogastroduodenoscopies (EGDs) for uncomplicated gastro-oesophageal reflux disease (GERD) can harm patients and raise patient and payer costs. We developed an electronic health record (EHR) 'eMeasure' to detect low-value EGDs. DESIGN Retrospective cohort of 518 adult patients diagnosed with GERD who underwent initial EGD between 1 January 2019 and 31 December 2019. SETTING Outpatient primary care and gastroenterology clinics at a large, urban, academic health centre. PARTICIPANTS Adult primary care patients at the University of California Los Angeles who underwent initial EGD for GERD in 2019. MAIN OUTCOME MEASURES EGD appropriateness criteria were based on the American College of Gastroenterology 2012 guidelines. An initial EGD was considered low-value if it lacked a documented guideline-based indication, including alarm symptoms (eg, iron-deficiency anaemia); failure of an 8-week proton pump inhibitor trial or elevated Barrett's oesophagus risk. We performed manual chart review on a random sample of 204 patients as a gold standard of the eMeasure's validity. We estimated EGD costs using Medicare physician and facility fee rates. RESULTS Among 518 initial EGDs performed (mean age 53 years; 54% female), the eMeasure identified 81 (16%) as low-value. The eMeasure's sensitivity was 42% (95% CI 22 to 61) and specificity was 93% (95% CI 89 to 96). Stratifying across clinics, 62 (74.6%) low-value EGDs originated from 2 (12.5%) out of 16 clinics. Total cost for 81 low-value EGDs was approximately US$75 573, including US$14 985 in patients' out-of-pocket costs. CONCLUSIONS We developed a highly specific eMeasure that showed that low-value EGDs occurred frequently in our healthcare system and were concentrated in a minority of clinics. These results can inform future QI efforts at our institution, such as best practice alerts for the ordering physician. Moreover, this open-source eMeasure has a much broader potential impact, as it can be integrated into any EHR and improve medical decision-making at the point of care.
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Affiliation(s)
- Courtney A Reynolds
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Vishnu Nair
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Chad Villaflores
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Katherine Dominguez
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Julia Cave Arbanas
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Madeline Treasure
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Samuel Skootsky
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Chi-Hong Tseng
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Catherine Sarkisian
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Veterans' Administration Greater Los Angeles Healthcare System, Geriatric Research Education & Clinical Center (GRECC), birmingham, Alabama, USA
| | - Arpan Patel
- The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kevin Ghassemi
- The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - A Mark Fendrick
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Folasade P May
- UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, Los Angeles, Calif, USA
| | - John N Mafi
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- RAND Health, RAND Corporation, Santa Monica, California, USA
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Patel A, Bowman CA, Prause N, Kilaru SM, Nguyen A, Kogekar N, Cohen C, Channen L, Harty A, Perumalswami P, Dietrich D, Schiano T, Woodrell C, Agarwal R. Outcomes of a 3-Year Quality Improvement Study to Improve Advance Care Planning in Patients With Decompensated Cirrhosis. Am J Gastroenterol 2023; 119:00000434-990000000-00924. [PMID: 37934193 PMCID: PMC10904002 DOI: 10.14309/ajg.0000000000002570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/26/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION To report outcomes of a 3-year quality improvement pilot study to improve advance directive (AD) completion. METHODS The pilot consisted of champions, education, electronic health record templates, and workflow changes. We assessed changes, predictors, and effects of AD completion. RESULTS The pilot led to greater (8.3%-36%) and earlier AD completion, particularly among those divorced, with alcohol-associated liver disease, and with higher Model of End-Stage Liver Disease-Sodium score. Decedents whose AD specified nonaggressive goals experienced lower hospital lengths of stay. DISCUSSION Advance care planning initiatives are feasible and may reduce health care utilization among decedents requesting less aggressive care.
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Affiliation(s)
- Arpan Patel
- Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Department of Gastroenterology, Hepatology, and Nutrition, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Chip A. Bowman
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University New York Presbyterian Hospital, New York, New York, USA
| | - Nicole Prause
- Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Saikiran M. Kilaru
- Division of Gastroenterology and Hepatology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Andrew Nguyen
- Department of Gastroenterology and Hepatology, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Nina Kogekar
- Division of Gastroenterology, Montefiore Medical Center, Bronx, New York, USA
| | - Cynthia Cohen
- Division of Gastroenterology and Hepatology, Westchester Medical Center
| | - Lindsay Channen
- Warren Alpert Medical School of Brown University in Providence, Providence, Rhode Island, USA
| | - Alyson Harty
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ponni Perumalswami
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas Dietrich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Schiano
- Recanati Miller Transplant Institute, Mount Sinai Hospital, New York, New York, USA
| | - Christopher Woodrell
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Ritu Agarwal
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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11
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Patel A, Reynolds G, Stitgen A, Ghanem E, Nuelle C. Gravity-Assisted Manipulation (GAM) Technique for the Treatment of Knee Arthrofibrosis. Arthrosc Tech 2023; 12:e2181-e2185. [PMID: 38196856 PMCID: PMC10772969 DOI: 10.1016/j.eats.2023.07.046] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/28/2023] [Indexed: 01/11/2024] Open
Abstract
Arthrofibrosis is a known complication after knee surgery, resulting in stiffness and decreased range of motion for patients. Manipulation under anesthesia is a commonly used technique to address postoperative arthrofibrosis after knee surgery. Often, direct pressure is applied to the knee during the manipulation. This can be difficult and can place undue stress above and below the joint. This Technical Note presents the technique for manipulation under anesthesia using gravity and the native knee motion alone to improve knee range of motion.
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Affiliation(s)
- Arpan Patel
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Grace Reynolds
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Andrea Stitgen
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Elie Ghanem
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Clayton Nuelle
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
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12
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Desai A, Sharma A, Sundar SJ, Hsieh JK, Kondylis E, Patel A, Bulacio J, Gupta A, Jehi L, Bingaman W. The impact of skull thickness on pediatric stereoencephalography electrode implantation and technical considerations. J Neurosurg Pediatr 2023; 32:562-568. [PMID: 37728404 DOI: 10.3171/2023.6.peds2351] [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] [Received: 02/05/2023] [Accepted: 06/08/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE One consideration in pediatric stereoencephalography (SEEG) is decreased skull thicknesses compared with adults, which may limit traditional bolt-based anchoring of electrodes. The authors aimed to investigate the safety profile, complication rates, and technical adaptations of placing SEEG electrodes in pediatric patients. METHODS The authors retrospectively reviewed all patients aged 12 years or younger at the time of SEEG implantation at their institution. Postimplantation CT scans were used to measure skull thickness at the entry point of each SEEG lead. Postimplantation lead accuracy was also assessed. RESULTS Fifty-three patients were reviewed. The median skull thickness was 4.1 (interquartile range [IQR] 3.15-5.2) mm. There were 5 total complications: 1 retained bolt fragment, 3 asymptomatic subdural hematomas, and 1 asymptomatic intracranial hemorrhage. Median radial error from the lead target was 3.5 (IQR 2.24-5.25) mm. Linear regression analysis revealed that increasing skull thickness decreased the deviation from the intended target, implying an improved accuracy to target at thicker skull entry points; this trended towards improved accuracy, but did not achieve statistical significance (p = 0.54). CONCLUSIONS This study found a 1.9% hardware complication rate and a 9.4% asymptomatic hemorrhage rate. Suturing electrodes to the scalp may represent a reasonable option if there are concerns of young age or a thin skull. These data indicate that invasive SEEG evaluation is safe among patients 12 years old or younger.
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Affiliation(s)
- Ansh Desai
- 1Case Western Reserve University School of Medicine, Cleveland
| | - Akshay Sharma
- 2Department of Neurosurgery, Cleveland Clinic, Cleveland; and
| | - Swetha J Sundar
- 2Department of Neurosurgery, Cleveland Clinic, Cleveland; and
| | - Jason K Hsieh
- 2Department of Neurosurgery, Cleveland Clinic, Cleveland; and
| | | | - Arpan Patel
- 2Department of Neurosurgery, Cleveland Clinic, Cleveland; and
| | - Juan Bulacio
- 3Charles Shor Center for Epilepsy, Cleveland Clinic, Cleveland, Ohio
| | - Ajay Gupta
- 3Charles Shor Center for Epilepsy, Cleveland Clinic, Cleveland, Ohio
| | - Lara Jehi
- 3Charles Shor Center for Epilepsy, Cleveland Clinic, Cleveland, Ohio
| | - William Bingaman
- 2Department of Neurosurgery, Cleveland Clinic, Cleveland; and
- 3Charles Shor Center for Epilepsy, Cleveland Clinic, Cleveland, Ohio
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13
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Tandon D, Curlewis K, Vusirikala A, Subramanian P, Patel A. The impact of electronic pathways and digital systems on neck of femur fracture outcomes globally: a systematic review. Ann R Coll Surg Engl 2023; 105:685-691. [PMID: 36927067 PMCID: PMC10618033 DOI: 10.1308/rcsann.2022.0152] [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] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Electronic pathways (e-pathways) and digital systems are novel interventions with several uses in healthcare, ranging from clinical decision support systems to checklists for care delivery. Their application in the management of neck of femur (NOF) fractures is evolving and they may play a key role in facilitating improvements in care delivery. The primary aim of this review was to outline the impact of e-pathways/digital systems on NOF fracture outcomes. METHODS A systematic literature search was performed using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A total of 698 citations were evaluated, of which 38 passed the inclusion/exclusion criteria. Six studies were then finalised following full-text review. Heterogenous data meant a narrative synthesis was undertaken. Risk of bias for each paper was assessed using the Downs and Black scale. RESULTS A statistically significant improvement was demonstrated for time to theatre (3/6 studies), length of hospital stay (2/6 studies) and secondary fracture prevention (2/6 studies). Although postoperative delirium and mortality improved with the introduction of e-pathways/digital systems, statistical significance was not achieved. No outcome measures were adversely affected. CONCLUSIONS This systematic review of the literature demonstrates that e-pathways and digital systems are promising novel interventions, displaying a significant positive impact on several NOF fracture outcomes. Owing to the novel nature of e-pathways and digital systems in orthopaedics, a limited number of studies were identified for review, each with variable study design. More high quality homogenous prospective cohort studies with a standardised primary outcome measure are required for more definitive conclusions of efficacy to be drawn.
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Affiliation(s)
| | - K Curlewis
- Royal Free London NHS Foundation Trust, UK
| | - A Vusirikala
- Royal National Orthopaedic Hospital NHS Trust, UK
| | | | - A Patel
- University College London, UK
- Royal Free London NHS Foundation Trust, UK
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Mohtashemi NZ, Teng CY, Benhammou J, Dong T, Goetz MB, Patel A, Kawamoto J, Bhattacharya D. Evaluation of and implications for a novel hepatitis C e-consult direct-to-treatment pilot program. Sci Rep 2023; 13:17241. [PMID: 37821437 PMCID: PMC10567689 DOI: 10.1038/s41598-023-43052-7] [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] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
A Hepatitis C (HCV) e-Consult Direct-To-Treatment (DTT) program managed by midlevel providers was developed at the Veteran Affairs Greater Los Angeles Healthcare System (VAGLAHS) which provided remote referral and, in some, remote management of HCV. DTT patients were more likely to be initiated on HCV treatment compared to standard of care (SOC), lending support for similar programs of remote engagement in HCV care.
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Affiliation(s)
- Neaka Z Mohtashemi
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA.
| | - Crystal Y Teng
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jihane Benhammou
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Tien Dong
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Matthew Bidwell Goetz
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Arpan Patel
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Jenna Kawamoto
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Debika Bhattacharya
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
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15
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Shamsesfandabadi P, Ponnapalli S, Spencer K, Patel A, Yin Y, Abel S, Beriwal S, Wegner RE, Patel AK, Horne ZD. CT vs. MRI: Which is More Accurate in Grading Rectal Wall Infiltration after Hydrogel Spacer Placement for Prostate Cancer Patients? Int J Radiat Oncol Biol Phys 2023; 117:e436-e437. [PMID: 37785418 DOI: 10.1016/j.ijrobp.2023.06.1608] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The purpose of this study was to evaluate the incidence and severity of rectal wall infiltration (RWI) in prostate cancer patients after rectal hydrogel spacer implantation, a commonly used procedure to minimize rectal radiation exposure during prostate radiotherapy. The study aimed to determine correlation of RWI using computed tomography (CT) scans and magnetic resonance imaging (MRI) scans in order to determine the optimal post-placement imaging modality. MATERIALS/METHODS This retrospective study was conducted on 370 patients diagnosed with localized prostate cancer who underwent rectal hydrogel spacer placement from 2020 to 2022. CT scans were performed on all patients, with a smaller subset also undergoing MRI scans. The images were independently evaluated by three radiation oncologists to grade RWI levels using a standardized scoring system based on CT and MRI images after hydrogel placement. The levels were categorized as 0 (no RWI), 1 (focal RWI), 2 (moderate RWI), and 3 (significant RWI). RESULTS Any grade of RWI was identified in 79.8% of men with the majority (41%) being RWI grade 1. The median time for CT scans was 9 days after hydrogel spacer placement and 14.5 days for MRI scans. For the subset of patients with both CT and MRI scans after spacer (mostly SpaceOAR Vue), RWI was detected in 58.33% of patients based on CT and 61.11% of patients based on MRI. Table 1 shows the mean percentage of patients with each score of RWI for each imaging modality. MRI was more likely to lead to a designation of RWI of any grade compared to CT and more often led to detection of RWI grades 2-3. CONCLUSION Our findings demonstrate that the incidence and severity of RWI may be higher than previously reported in clinical trials and that MRI may be a more sensitive imaging modality. Caution is needed in the utilization of rectal spacer gels given the potential for complications with misplacement prior to radiation therapy. Further study is warranted to determine the potential impact of low-grade RWI on the safety of subsequent treatment.
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Affiliation(s)
- P Shamsesfandabadi
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - S Ponnapalli
- Drexel University College of Medicine, Philadelphia, PA
| | - K Spencer
- Drexel University College of Medicine, Philadelphia, PA
| | - A Patel
- Drexel University College of Medicine, Philadelphia, PA
| | - Y Yin
- Allegheny Health Network, Pittsburgh, PA
| | - S Abel
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - S Beriwal
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - R E Wegner
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - A K Patel
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - Z D Horne
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
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Chen P, Simonetto DA, Paul S, Patel A. Health disparities experienced by sexual and gender minority individuals living with or at risk of chronic liver disease. Clin Liver Dis (Hoboken) 2023; 22:152-156. [PMID: 37908866 PMCID: PMC10615390 DOI: 10.1097/cld.0000000000000073] [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: 11/15/2022] [Accepted: 04/28/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Phillip Chen
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Douglas A. Simonetto
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sonali Paul
- Department of Gastroenterology, Hepatology, and Nutrition, Center for Liver Diseases, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Arpan Patel
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Gastroenterology, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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17
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Parsons HA, Blewett T, Chu X, Sridhar S, Santos K, Xiong K, Abramson VG, Patel A, Cheng J, Brufsky A, Rhoades J, Force J, Liu R, Traina TA, Carey LA, Rimawi MF, Miller KD, Stearns V, Specht J, Falkson C, Burstein HJ, Wolff AC, Winer EP, Tayob N, Krop IE, Makrigiorgos GM, Golub TR, Mayer EL, Adalsteinsson VA. Circulating tumor DNA association with residual cancer burden after neoadjuvant chemotherapy in triple-negative breast cancer in TBCRC 030. Ann Oncol 2023; 34:899-906. [PMID: 37597579 PMCID: PMC10898256 DOI: 10.1016/j.annonc.2023.08.004] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND We aimed to examine circulating tumor DNA (ctDNA) and its association with residual cancer burden (RCB) using an ultrasensitive assay in patients with triple-negative breast cancer (TNBC) receiving neoadjuvant chemotherapy. PATIENTS AND METHODS We identified responders (RCB 0/1) and matched non-responders (RCB 2/3) from the phase II TBCRC 030 prospective study of neoadjuvant paclitaxel versus cisplatin in TNBC. We collected plasma samples at baseline, 3 weeks and 12 weeks (end of therapy). We created personalized ctDNA assays utilizing MAESTRO mutation enrichment sequencing. We explored associations between ctDNA and RCB status and disease recurrence. RESULTS Of 139 patients, 68 had complete samples and no additional neoadjuvant chemotherapy. Twenty-two were responders and 19 of those had sufficient tissue for whole-genome sequencing. We identified an additional 19 non-responders for a matched case-control analysis of 38 patients using a MAESTRO ctDNA assay tracking 319-1000 variants (median 1000 variants) to 114 plasma samples from 3 timepoints. Overall, ctDNA positivity was 100% at baseline, 79% at week 3 and 55% at week 12. Median tumor fraction (TFx) was 3.7 × 10-4 (range 7.9 × 10-7-4.9 × 10-1). TFx decreased 285-fold from baseline to week 3 in responders and 24-fold in non-responders. Week 12 ctDNA clearance correlated with RCB: clearance was observed in 10 of 11 patients with RCB 0, 3 of 8 with RCB 1, 4 of 15 with RCB 2 and 0 of 4 with RCB 3. Among six patients with known recurrence, five had persistent ctDNA at week 12. CONCLUSIONS Neoadjuvant chemotherapy for TNBC reduced ctDNA TFx by 285-fold in responders and 24-fold in non-responders. In 58% (22/38) of patients, ctDNA TFx dropped below the detection level of a commercially available test, emphasizing the need for sensitive tests. Additional studies will determine whether ctDNA-guided approaches can improve outcomes.
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Affiliation(s)
- H A Parsons
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston.
| | - T Blewett
- Broad Institute of MIT and Harvard, Cambridge
| | - X Chu
- Data Science, Dana-Farber Cancer Institute, Boston
| | - S Sridhar
- Broad Institute of MIT and Harvard, Cambridge
| | - K Santos
- Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - K Xiong
- Broad Institute of MIT and Harvard, Cambridge
| | | | - A Patel
- Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - J Cheng
- Broad Institute of MIT and Harvard, Cambridge
| | - A Brufsky
- University of Pittsburgh School of Medicine, Pittsburgh
| | - J Rhoades
- Broad Institute of MIT and Harvard, Cambridge
| | | | - R Liu
- Broad Institute of MIT and Harvard, Cambridge
| | - T A Traina
- Memorial Sloan Kettering Cancer Center, New York
| | - L A Carey
- The University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill
| | - M F Rimawi
- Baylor College of Medicine Dan L. Duncan Comprehensive Cancer Center, Houston
| | - K D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
| | - V Stearns
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore
| | - J Specht
- Seattle Cancer Care Alliance, Seattle
| | - C Falkson
- The University of Alabama at Birmingham, Birmingham
| | - H J Burstein
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston
| | - A C Wolff
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore
| | - E P Winer
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston
| | - N Tayob
- Data Science, Dana-Farber Cancer Institute, Boston
| | - I E Krop
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston
| | | | - T R Golub
- Broad Institute of MIT and Harvard, Cambridge
| | - E L Mayer
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston.
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Leiter RE, Bischoff KE, Carey EC, Gelfand SL, Iyer AS, Jain N, Kramer NM, Lally K, Landzberg MJ, Lever N, Newport K, O'Donnell A, Patel A, Sciacca KR, Snaman JM, Tulsky JA, Rosa WE, Lakin JR. Top Ten Tips Palliative Care Clinicians Should Know About Delivering Specialty-Aligned Palliative Care. J Palliat Med 2023; 26:1401-1407. [PMID: 37001173 DOI: 10.1089/jpm.2023.0116] [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] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Specialty-aligned palliative care (SAPC) refers to interprofessional palliative care (PC) that is delivered to a specific population of patients in close partnership with other primary or specialty clinicians. As evolving PC models address physical, psychosocial, and spiritual suffering across illnesses and settings, PC clinicians must acquire advanced knowledge of disease-specific symptoms, common treatments, and complications that impact prognosis and outcomes. The tips provided in this article draw on the experience and knowledge of interprofessional PC and other specialist clinicians from diverse institutions across the United States who have developed and studied SAPC services across different disease groups. Recommendations include focusing on approaching specialty team partnerships with humility, curiosity, and diplomacy; focusing on patient populations where PC needs are great; clarifying how work and responsibilities will be divided between PC and other clinicians to the extent possible; using consults as opportunities for bidirectional learning; and adapting workflows and schedules to meet specialty team needs while managing expectations and setting limits as appropriate. Furthermore, to provide effective SAPC, PC clinicians must learn about the specific symptoms, prognoses, and common treatments of the patients they are serving. They must also build trusting relationships and maintain open communication with patients and referring clinicians to ensure integrated and aligned PC delivery.
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Affiliation(s)
- Richard E Leiter
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kara E Bischoff
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Elise C Carey
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samantha L Gelfand
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anand S Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nelia Jain
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Neha M Kramer
- Department of Neurology and Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Kate Lally
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael J Landzberg
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Natasha Lever
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kristina Newport
- Section of Palliative Medicine, Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Arden O'Donnell
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Arpan Patel
- Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Kate R Sciacca
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer M Snaman
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - James A Tulsky
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joshua R Lakin
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Winans T, Oaks Z, Choudhary G, Patel A, Huang N, Faludi T, Krakko D, Nolan J, Lewis J, Blair S, Lai Z, Landas SK, Middleton F, Asara JM, Chung SK, Wyman B, Azadi P, Banki K, Perl A. mTOR-dependent loss of PON1 secretion and antiphospholipid autoantibody production underlie autoimmunity-mediated cirrhosis in transaldolase deficiency. J Autoimmun 2023; 140:103112. [PMID: 37742509 PMCID: PMC10957505 DOI: 10.1016/j.jaut.2023.103112] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
Transaldolase deficiency predisposes to chronic liver disease progressing from cirrhosis to hepatocellular carcinoma (HCC). Transition from cirrhosis to hepatocarcinogenesis depends on mitochondrial oxidative stress, as controlled by cytosolic aldose metabolism through the pentose phosphate pathway (PPP). Progression to HCC is critically dependent on NADPH depletion and polyol buildup by aldose reductase (AR), while this enzyme protects from carbon trapping in the PPP and growth restriction in TAL deficiency. Although AR inactivation blocked susceptibility to hepatocarcinogenesis, it enhanced growth restriction, carbon trapping in the non-oxidative branch of the PPP and failed to reverse the depletion of glucose 6-phosphate (G6P) and liver cirrhosis. Here, we show that inactivation of the TAL-AR axis results in metabolic stress characterized by reduced mitophagy, enhanced overall autophagy, activation of the mechanistic target of rapamycin (mTOR), diminished glycosylation and secretion of paraoxonase 1 (PON1), production of antiphospholipid autoantibodies (aPL), loss of CD161+ NK cells, and expansion of CD38+ Ito cells, which are responsive to treatment with rapamycin in vivo. The present study thus identifies glycosylation and secretion of PON1 and aPL production as mTOR-dependent regulatory checkpoints of autoimmunity underlying liver cirrhosis in TAL deficiency.
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Affiliation(s)
- T Winans
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - Z Oaks
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - G Choudhary
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - A Patel
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - N Huang
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - T Faludi
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - D Krakko
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - J Nolan
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - J Lewis
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - Sarah Blair
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - Z Lai
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - S K Landas
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - F Middleton
- Departments of Neuroscience, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - J M Asara
- Division of Signal Transduction, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S K Chung
- Faculty of Medicine, Macau University of Science and Technology, Taipa, Macau
| | - B Wyman
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - P Azadi
- University of Georgia, Athens, GA 30602, USA
| | - K Banki
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA
| | - A Perl
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Microbiology and Immunology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA; Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, 13210, USA.
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Patel A, Tiwari K, Asrani P, Alothaid H, Alahmari AFA, Mirdad R, Ajmal MR, Tarique M. Glutaredoxin proteins from E. coli isoforms were compared in terms of energy frustration. BRAZ J BIOL 2023; 83:e273091. [PMID: 37729314 DOI: 10.1590/1519-6984.273091] [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: 03/14/2023] [Accepted: 06/05/2023] [Indexed: 09/22/2023] Open
Abstract
Glutaredoxin (GRXs) protein plays a vital role inside the cell, including redox control of transcription to the cell's antioxidant defense, apoptosis, and cellular differentiation regulation. In this study, we have investigated the energy landscape and characterized the pattern of local frustration in different forms and states of the GRX protein ofE. coli.Analysis was done on the conformational alterations, significant changes in the frustration pattern, and different GRXs such as GRX-II, GRX-III, GRX-II-GSH, and GRX-III-GSH complex. We have found the practice of frustration, and structure was quite similar in the same isoform having different states of protein; however, a significant difference was observed between different isoforms. Moreover, oxidation of GRX-I introduced an extra α-helix increasing the destabilizing interactions within the protein. The study of frustrated contacts on oxidized and reduced GRX and with bound and unbound Glutathione indicates its potential application in activating and regulating the behavior of GRXs.
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Affiliation(s)
- A Patel
- King Khalid University, College of Medicine, Department of Clinical Biochemistry, Abha, Kingdom of Saudi Arabia
| | - K Tiwari
- King Khalid University, College of Medicine, Department of Clinical Biochemistry, Abha, Kingdom of Saudi Arabia
- Amity University, Amity Institute of Microbial Biotechnology, Noida, UP, India
| | - P Asrani
- Amity University, Amity Institute of Microbial Biotechnology, Noida, UP, India
| | - H Alothaid
- Al Baha University, Faculty of Applied Medical Sciences, Department of Basic Medical Sciences, Al Baha, Al Baha Province, Saudi Arabia
| | - A F A Alahmari
- King Khalid University, College of Medicine, Department of Clinical Biochemistry, Abha, Saudi Arabia
| | - R Mirdad
- King Khalid University, Department of Surgery, Abha, Saudi Arabia
| | - M R Ajmal
- University of Tabuk, Faculty of Science, Biochemistry Department, Physical Biochemistry Research Laboratory, Tabuk, Saudi Arabia
| | - M Tarique
- Almanac Life Science India Private Limited, New Delhi, India
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Patel A, Guntin J, Sobh A, Gerlinger TL. Offset Acetabular Liners: Safer Than Previously Thought. Orthopedics 2023; 46:e298-e302. [PMID: 36921222 DOI: 10.3928/01477447-20230310-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
High offset liners help to restore soft tissue tension after primary total hip arthroplasty (THA). However, prior research has reported increased rates of aseptic loosening when using offset components. The purpose of this study was to examine the postoperative complication and revision rates of neutral vs offset acetabular liners at our institution. Two hundred eight primary THAs in 206 patients performed between 2016 and 2018 using neutral or offset liners were reviewed. All patients had a minimum 2-year clinical follow-up (mean, 3.3 years; range, 2.0-5.7 years). Postoperative complications and revision surgeries were reviewed. All offset liners were 4 mm in thickness. Twelve (10.0%) complications occurred in the neutral liner group, and 13 (14.8%) complications occurred in the offset liner group. Two cases of aseptic loosening occurred in the neutral liner group, with no cases reported in the offset liner group. Nine cases (7.5%) in the neutral group required revision surgery, whereas 3 cases in the offset group required revision surgery. Chi-square analysis found no difference between the groups in the rate of postoperative complications, χ2 (1, N=208)=1.09 (P>.05), or the rate of revision, χ2 (1, N=208)=1.56 (P>.05). We found no significant differences between the neutral and offset groups regarding the rates of postoperative complications, aseptic loosening, or revision surgery. Our findings suggest that contemporary high offset liners, up to 4 mm, are safe and effective when attempting to restore native hip mechanics after THA. [Orthopedics. 2023;46(5):e298-e302.].
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Patel TK, Geha R, Patel A, Benhammou J, Manesh R, Patel S. A real dilemma. J Hosp Med 2023; 18:748-752. [PMID: 37338114 DOI: 10.1002/jhm.13152] [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: 11/20/2022] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Tirth K Patel
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rabih Geha
- San Francisco VA Medical Center, Medicine, San Francisco, California, USA
| | - Arpan Patel
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jihane Benhammou
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Reza Manesh
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Satya Patel
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Gruffi T, Echevarria G, Balot M, Patel A. Social media usage by ACGME-accredited obstetric anesthesia fellowship programs: an observational study. Int J Obstet Anesth 2023; 55:103892. [PMID: 37169663 DOI: 10.1016/j.ijoa.2023.103892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023]
Affiliation(s)
- T Gruffi
- Icahn School of Medicine at Mount Sinai Medical Center, Department of Anesthesiology, Perioperative, and Pain Medicine, Mount Sinai West and Morningside Hospitals, New York, NY, USA.
| | - G Echevarria
- Icahn School of Medicine at Mount Sinai Medical Center, Department of Anesthesiology, Perioperative, and Pain Medicine, Mount Sinai West and Morningside Hospitals, New York, NY, USA
| | - M Balot
- Icahn School of Medicine at Mount Sinai Medical Center, Department of Anesthesiology, Perioperative, and Pain Medicine, Mount Sinai West and Morningside Hospitals, New York, NY, USA
| | - A Patel
- Icahn School of Medicine at Mount Sinai Medical Center, Department of Anesthesiology, Perioperative, and Pain Medicine, Mount Sinai West and Morningside Hospitals, New York, NY, USA
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24
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Muzyka L, Pugazenthi S, Lavadi RS, Shah D, Patel A, Rangwalla T, Javeed S, Elsayed G, Greenberg JK, Pennicooke B, Agarwal N. Geographic Distribution in Training and Practice of Academic Neurological and Orthopedic Spine Surgeons in the United States. World Neurosurg 2023; 176:e281-e288. [PMID: 37209918 DOI: 10.1016/j.wneu.2023.05.050] [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] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/22/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE This study aimed to stratify the geographic distribution of academic spine surgeons in the United States, analyzing how this distribution highlights differences in academic, demographic, professional metrics, and gaps in access to spine care. METHODS Spine surgeons were identified using American Association of Neurological Surgeons and American Academy of Orthopedic Surgeons databases, categorizing into geographic regions of training and practice. Departmental websites, National Institutes of Health (NIH) RePort Expenditures and Results, Google Patent, and NIH icite databases were queried for demographic and professional metrics. RESULTS Academic spine surgeons (347 neurological; 314 orthopedic) are predominantly male (95%) and few have patents (23%) or NIH funding (4%). Regionally, the Northeast has the highest proportion per capita (3.28 surgeons per million), but California is the state with the highest proportion (13%). The Northeast has the greatest regional retention post-residency at 74%, followed by the Midwest (59%). The West and South are more associated with additional degrees. Neurosurgery-trained surgeons hold more additional degrees (17%) than orthopedic surgeons (8%), whereas more orthopedic surgeons hold leadership positions (34%) than neurosurgeons (20%). CONCLUSIONS Academic spine surgeons are found at the highest proportion in the Northeast and California; the Northeast has the greatest regional retention. Spine neurosurgeons have more additional degrees, whereas spine orthopedic surgeons have more leadership positions. These results are relevant to training programs looking to correct geographic disparities, surgeons in search of training programs, or students in pursuit of spine surgery.
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Affiliation(s)
- Logan Muzyka
- Department of Neurosurgery, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Sangami Pugazenthi
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Raj Swaroop Lavadi
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Darsh Shah
- Department of Neurosurgery, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Arpan Patel
- Department of Neurosurgery, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Taiyeb Rangwalla
- Department of Neurosurgery, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Saad Javeed
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Galal Elsayed
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jacob K Greenberg
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Brenton Pennicooke
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nitin Agarwal
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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25
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Erskine J, Abrishami P, Charter R, Cicchetti A, Culbertson R, Faria E, Hiatt JC, Khan J, Maddern G, Patel A, Rha KH, Shah PC, Sooriakumaran P, Tackett S, Turchetti G, Chalkidou A. BEST PRACTICE CONSIDERATIONS ON THE ASSESSMENT OF ROBOTIC-ASSISTED SURGICAL SYSTEMS: RESULTS FROM AN INTERNATIONAL CONSENSUS EXPERT PANEL. Int J Technol Assess Health Care 2023:1-28. [PMID: 37272397 DOI: 10.1017/s0266462323000314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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26
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Badal BD, Silvey S, Dragilev L, O'Leary JG, Morgan TR, Cheung R, Patel A, Rogal S, Patton H, Nobbe A, Jakab SS, Liu J, Patel N, Bajaj JS. Primary prophylaxis for spontaneous bacterial peritonitis is linked to antibiotic resistance in the Veterans Health Administration. Hepatology 2023; 77:2030-2040. [PMID: 36645215 DOI: 10.1097/hep.0000000000000184] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 08/17/2022] [Accepted: 11/18/2022] [Indexed: 01/17/2023]
Abstract
Spontaneous bacterial peritonitis (SBP) is a major cause of mortality. Although SBP primary prophylaxis (SBPPr) with fluoroquinolones and trimethoprim-sulfamethoxazole (TMP-SMX) is often used, resistance could reduce its benefit. AIM Analyze peritoneal fluid resistance patterns in patients with a first SBP episode with/without SBPPr using the Veterans Health Administration corporate data warehouse and to evaluate national antibiograms. Corporate data warehouse data were extracted using validated International Classification of Disease-9/10 codes, culture, resistance data, and outcomes of 7553 patients who developed their first inpatient SBP between 2009 and 2019 and compared between those with/without SBPPr. Escherichia coli ( E. coli ) and Klebsiella pneumoniae ( K. pneumoniae ) sensitivity to ciprofloxacin and TMP-SMX was calculated using 2021 Veterans Health Administration antibiogram data from all states. The most common isolates were E. coli , K. pneumoniae , and Staphylococcus species. Veterans taking ciprofloxacin SBBPr had higher fluoroquinolone resistance (34% vs 14% no SBPPr, p <0.0001); those taking TMP-SMX had higher TMP-SMX resistance (40% vs 14%, p <0.0001). SBPPr patients showed higher culture positivity, greater length of stay, higher second SBP, and higher probability of liver transplant rates versus no SBPPr. Multivariable models showed SBBPr to be the only variable associated with gram-negative resistance, and SBPPr was associated with a trend toward longer length of stay. E. coli ciprofloxacin sensitivity rates were 50%-87% and 43%-92% for TMP-SMX. K. pneumoniae ciprofloxacin sensitivity was 76%-100% and 72%-100% for TMP-SMX. CONCLUSION Among patients who developed their first SBP episode, there was a higher prevalence of antibiotic resistance in those on SBPPr, with a high rate of fluoroquinolone resistance across the Veterans Health Administration sites.
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Affiliation(s)
- Bryan D Badal
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Health Care System, Richmond, Virginia, USA
| | - Scott Silvey
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lyuba Dragilev
- Department of Pharmacy, Captain James A Lovell Federal Health Care Center, North Chicago, Illinois, USA
| | | | - Timothy R Morgan
- Gastroenterology Service, VA Long Beach Health Care System, Long Beach, California, USA
| | - Ramsey Cheung
- VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Arpan Patel
- Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Shari Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania, USA
- Departments of Medicine and Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Heather Patton
- Gastroenterology Section, VA San Diego Health Care System, San Diego, California, USA
| | - Anna Nobbe
- Digestive Diseases Section, Cincinnati VA Medical Center, Cincinnati, Ohio, USA
| | - Sofia S Jakab
- Section of Digestive Diseases, VA Connecticut Health Care System, West Haven, Connecticut, USA
| | - Jinze Liu
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nilang Patel
- Division of Nephrology, Virginia Commonwealth University and Central Virginia Veterans Health Care System, Richmond, Virginia, USA
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Health Care System, Richmond, Virginia, USA
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27
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Patel A, Bhattacharyay R. 3D Thermo-fluid MHD simulation in a complex flow geometry. Fusion Engineering and Design 2023. [DOI: 10.1016/j.fusengdes.2023.113558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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28
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Movassaghi K, Patel A, Ghulam-Jelani Z, Levine BR. Modern Total Knee Arthroplasty Bearing Designs and the Role of the Posterior Cruciate Ligament. Arthroplast Today 2023; 21:101130. [PMID: 37151403 PMCID: PMC10160699 DOI: 10.1016/j.artd.2023.101130] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/04/2023] [Accepted: 03/08/2023] [Indexed: 05/09/2023] Open
Abstract
The role of the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) surgery continues to be a source of debate among the adult reconstruction community. In native knee flexion, the PCL is comprised of an anterolateral and posteromedial bundle that work together to limit posterior tibial translation and allow adequate femoral rollback for deep flexion. In the arthritic knee, the PCL can often become dysfunctional and attenuated, which led to the development of posterior stabilized (PS) TKA bearing options. PS TKAs implement a cam-post construct to functionally replace a resected PCL. While PS designs may facilitate balancing knees with significant deformity, they are associated with complications such as postfracture, increased wear, and patellar clunk/crepitus. In recent years, newer designs have been popularized with greater degrees of congruency and incorporation of medial and lateral pivoting to better recreate native knee kinematics. The American Joint Registry has confirmed the recent predilection for ultra-congruent and cruciate-retaining TKA inserts over PS TKAs during the last decade. Studies have failed to identify an overall clinical superiority between the cruciate substituting and sacrificing designs. The literature has also failed to identify clinical consequences from PCL resection with modern, more conforming TKA designs. In this article, we review modern PCL sacrificing designs and discuss the impact of each on the kinematics after TKA. We also will delineate the role of the PCL in modern TKA in the hopes to better understand the recent surge in sacrificing but not substituting knee implants.
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Affiliation(s)
- Kamran Movassaghi
- Department of Orthopaedic Surgery, University of California, San Francisco Fresno, Fresno, CA, USA
- Corresponding author. University of California, San Francisco Fresno, 2823 Fresno Street, Fresno, CA 93721, USA. Tel.: +1 818 640 5244.
| | - Arpan Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Zohal Ghulam-Jelani
- Department of Orthopaedic Surgery, University of California, San Francisco Fresno, Fresno, CA, USA
| | - Brett R. Levine
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Coe C, Patel A, Lawrence D. Pharmacotherapy options for alcohol use disorder in patients with alcohol-associated liver disease: a brief guide for clinicians. Clin Liver Dis (Hoboken) 2023; 21:125-129. [PMID: 37936927 PMCID: PMC10627592 DOI: 10.1097/cld.0000000000000033] [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: 11/14/2022] [Accepted: 01/21/2023] [Indexed: 11/09/2023] Open
Affiliation(s)
- Christopher Coe
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Arpan Patel
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Medicine, Greater Los Angeles VA Healthcare System, Los Angeles, California, USA
| | - David Lawrence
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Psychiatry, Greater Los Angeles VA Healthcare System, Los Angeles, California, USA
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Adejuyigbe EA, Agyeman I, Anand P, Anyabolu HC, Arya S, Assenga EN, Badhal S, Brobby NW, Chellani HK, Chopra N, Debata PK, Dube Q, Dua T, Gadama L, Gera R, Hammond CK, Jain S, Kantumbiza F, Kawaza K, Kija EN, Lal P, Mallewa M, Manu MK, Mehta A, Mhango T, Naburi HE, Newton S, Nyanor I, Nyako PA, Oke OJ, Patel A, Phlange-Rhule G, Sehgal R, Singhal R, Wadhwa N, Yiadom AB. Evaluation of the impact of continuous Kangaroo Mother Care (KMC) initiated immediately after birth compared to KMC initiated after stabilization in newborns with birth weight 1.0 to < 1.8 kg on neurodevelopmental outcomes: Protocol for a follow-up study. Trials 2023; 24:265. [PMID: 37038239 PMCID: PMC10088121 DOI: 10.1186/s13063-023-07192-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/20/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Preterm birth or low birth weight is the single largest cause of death in newborns, however this mortality can be reduced through newborn care interventions, including Kangaroo Mother Care (KMC). Previously, a multi-country randomized controlled trial, coordinated by the World Health Organization (WHO), reported a significant survival advantage with initiation of continuous KMC immediately after birth compared with initiation of continuous KMC a few days after birth when the baby is considered clinically stable. Whether the survival advantage would lead to higher rates of neurodevelopmental morbidities, or the immediate KMC will also have a beneficial effect on cognitive development also, has not been investigated. We therefore propose to test the hypothesis that low-birth-weight infants exposed to immediate KMC will have lower rates of neurodevelopmental impairment in comparison to traditional KMC-treated infants, by prospectively following up infants already enrolled in the immediate KMC trial for the first 2 years of life, and assessing their growth and neurodevelopment. METHODS This prospective cohort study will enroll surviving neonates from the main WHO immediate KMC trial. The main trial as well as this follow-up study are being conducted in five low- and middle-income countries in South Asia and sub-Saharan Africa. The estimated sample size for comparison of the risk of neurodevelopmental impairment is a total of 2200 children. The primary outcome will include rates of cerebral palsy, hearing impairment, vision impairment, mental and motor development, and epilepsy and will be assessed by the age of 3 years. The analysis will be by intention to treat. DISCUSSION Immediate KMC can potentially reduce low-birth-weight-associated complications such as respiratory disease, hypothermia, hypoglycemia, and infection that can result in impaired neurocognitive development. Neuroprotection may also be mediated by improved physiological stabilization that may lead to better maturation of neural pathways, reduced risk of hypoxia, positive parental impact, improved sleep cycles, and improved stress responses. The present study will help in evaluating the overall impact of KMC by investigating the long-term effect on neurodevelopmental impairment in the survivors. TRIAL REGISTRATION Clinical Trials Registry-India CTRI/2019/11/021899. Registered on 06 November 2019. Trials registration of parent trial: ACTRN12618001880235; Clinical Trials Registry-India: CTRI/2018/08/015369.
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Affiliation(s)
- E A Adejuyigbe
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - I Agyeman
- Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - P Anand
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - H C Anyabolu
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - S Arya
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - E N Assenga
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - S Badhal
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - N W Brobby
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - H K Chellani
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India.
| | - N Chopra
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - P K Debata
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - Q Dube
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - T Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - L Gadama
- Department of Obstetrics and Gynaecology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - R Gera
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - C K Hammond
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - S Jain
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - F Kantumbiza
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - K Kawaza
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - E N Kija
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - P Lal
- Atal Bihari Vajpayee Institute of Medical Sciences &, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - M Mallewa
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - M K Manu
- Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - A Mehta
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - T Mhango
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - H E Naburi
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - S Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - I Nyanor
- Research and Development, Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - P A Nyako
- Department of Psychiatry, Child And Adolescent Mental Health, Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - O J Oke
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - A Patel
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
- Division of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - G Phlange-Rhule
- Clinical Development Services Agency (CDSA), Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, PO Box #04, Faridabad, 121001, India
| | - R Sehgal
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - R Singhal
- Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, PO Box #04, 121001, Faridabad, India
| | - N Wadhwa
- Faridabad-Gurgaon Expressway, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3Rd MilestonePost Box #04, Faridabad, Haryana, 121001, India.
| | - A B Yiadom
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Patel A, Egbulefu F, Berger RA, Gerlinger TL. Reevaluating isolated polyethylene revision for instability after total knee arthroplasty. Knee 2023; 42:186-192. [PMID: 37023586 DOI: 10.1016/j.knee.2023.03.007] [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: 09/14/2022] [Revised: 02/07/2023] [Accepted: 03/09/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Instability is a common mode of failure after primary total knee arthroplasty (TKA). Surgical management includes total revision and isolated polyethylene exchange. This study aimed to evaluate outcomes after isolated polyethylene exchange for instability in one of the largest cohorts reported to date. METHODS This is a retrospective study of 87 patients and 93 cases of isolated polyethylene exchange after TKA for instability at a tertiary academic center. Preoperative and postoperative Knee Society Scores were compared using paired T-testing with a significance level set at p = .05. Secondary outcomes included satisfaction, complications, rates of additional surgery, and recurrent instability. RESULTS Of the 87 patients, 61 patients had both pre and post-operative KSS-Knee scores and 60 with matched KSS-Functional scores. KSS-Knee scores significantly increased from 63.78 to 83.13 (p < .05), and KSS-Functional scores increased from 63.80 to 84.00 (p < .05). Seven of 93 cases (7.78%) cases required additional surgery at an average of 3.8 years, including two for recurrent instability. Nine (10%) cases were initially satisfied but developed recurrent instability at an average of 27.6 months. CONCLUSION Isolated polyethylene exchange after TKA for instability resulted in significantly increased reported clinical outcome scores. Isolated polyethylene exchange after TKA for recurrent instability may be a viable option but surgeons should consider the rate of complications requiring surgery as well as high rate of recurrent instability. More studies with longer-term follow-up are required to further identify which patients may benefit the most from isolated polyethylene exchange after TKA for recurrent instability.
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Affiliation(s)
- Arpan Patel
- University of Missouri-Columbia Department of Orthopaedics, Columbia, MO, USA.
| | | | - Richard A Berger
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Tad L Gerlinger
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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32
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Zaaimi B, Turnbull M, Hazra A, Wang Y, Gandara C, McLeod F, McDermott EE, Escobedo-Cousin E, Idil AS, Bailey RG, Tardio S, Patel A, Ponon N, Gausden J, Walsh D, Hutchings F, Kaiser M, Cunningham MO, Clowry GJ, LeBeau FEN, Constandinou TG, Baker SN, Donaldson N, Degenaar P, O'Neill A, Trevelyan AJ, Jackson A. Closed-loop optogenetic control of the dynamics of neural activity in non-human primates. Nat Biomed Eng 2023; 7:559-575. [PMID: 36266536 PMCID: PMC7614485 DOI: 10.1038/s41551-022-00945-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 08/14/2022] [Indexed: 11/08/2022]
Abstract
Electrical neurostimulation is effective in the treatment of neurological disorders, but associated recording artefacts generally limit its applications to open-loop stimuli. Real-time and continuous closed-loop control of brain activity can, however, be achieved by pairing concurrent electrical recordings and optogenetics. Here we show that closed-loop optogenetic stimulation with excitatory opsins enables the precise manipulation of neural dynamics in brain slices from transgenic mice and in anaesthetized non-human primates. The approach generates oscillations in quiescent tissue, enhances or suppresses endogenous patterns in active tissue and modulates seizure-like bursts elicited by the convulsant 4-aminopyridine. A nonlinear model of the phase-dependent effects of optical stimulation reproduced the modulation of cycles of local-field potentials associated with seizure oscillations, as evidenced by the systematic changes in the variability and entropy of the phase-space trajectories of seizures, which correlated with changes in their duration and intensity. We also show that closed-loop optogenetic neurostimulation could be delivered using intracortical optrodes incorporating light-emitting diodes. Closed-loop optogenetic approaches may be translatable to therapeutic applications in humans.
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Affiliation(s)
- B Zaaimi
- Biosciences Institute, Newcastle University, Newcastle, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - M Turnbull
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - A Hazra
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Y Wang
- School of Computing, Newcastle University, Newcastle, UK
| | - C Gandara
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - F McLeod
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - E E McDermott
- Biosciences Institute, Newcastle University, Newcastle, UK
| | | | - A Shah Idil
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - R G Bailey
- School of Engineering, Newcastle University, Newcastle, UK
| | - S Tardio
- School of Engineering, Newcastle University, Newcastle, UK
| | - A Patel
- School of Engineering, Newcastle University, Newcastle, UK
| | - N Ponon
- School of Engineering, Newcastle University, Newcastle, UK
| | - J Gausden
- School of Engineering, Newcastle University, Newcastle, UK
| | - D Walsh
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - F Hutchings
- School of Computing, Newcastle University, Newcastle, UK
| | - M Kaiser
- School of Computing, Newcastle University, Newcastle, UK
- NIHR, Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - M O Cunningham
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - G J Clowry
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - F E N LeBeau
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - T G Constandinou
- Department of Electrical and Electronic Engineering, Imperial College, London, UK
| | - S N Baker
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - N Donaldson
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - P Degenaar
- School of Engineering, Newcastle University, Newcastle, UK
| | - A O'Neill
- School of Engineering, Newcastle University, Newcastle, UK
| | - A J Trevelyan
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - A Jackson
- Biosciences Institute, Newcastle University, Newcastle, UK.
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Blake D, Patel A, Hopkins S, Pozo AD, Marx J, Ibrahim M, Hamad E. Pseudo Cardiomyopathy in End-Stage Lung Disease With Elevated Pulmonary Vascular Resistance and/or Right Ventricular Dysfunction That Improves Following Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.040] [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: 04/05/2023] Open
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Chen PH, Han SH, Bhattacharya D, Patel A. Leveraging a community-based participatory approach to improve linkage to care for HBV. Clin Liver Dis (Hoboken) 2023; 21:117-121. [PMID: 37197221 PMCID: PMC10184990 DOI: 10.1097/cld.0000000000000032] [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: 09/20/2022] [Accepted: 02/08/2023] [Indexed: 05/19/2023] Open
Affiliation(s)
- Phillip H. Chen
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Steven-Huy Han
- Pfleger Liver Institute, UCLA Medical Center, Los Angeles, California, USA
- Greater Los Angeles VA Healthcare System, Los Angeles, California, USA
| | - Debika Bhattacharya
- Greater Los Angeles VA Healthcare System, Los Angeles, California, USA
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Arpan Patel
- Greater Los Angeles VA Healthcare System, Los Angeles, California, USA
- Division of Digestive Diseases, Vatche and Tamar Manoukian David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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35
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Sherazi S, Schleede S, McNitt S, Casulo C, Moore JE, Storozynsky E, Patel A, Vidula N, Aktas MK, Zent CS, Goldenberg I. Arrhythmogenic Cardiotoxicity Associated With Contemporary Treatments of Lymphoproliferative Disorders. J Am Heart Assoc 2023; 12:e025786. [PMID: 36892046 PMCID: PMC10111520 DOI: 10.1161/jaha.122.025786] [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] [Indexed: 03/10/2023]
Abstract
Background There are limited data on risk of arrhythmias among patients with lymphoproliferative disorders. We designed this study to determine the risk of atrial and ventricular arrhythmia during treatment of lymphoma in a real-world setting. Methods and Results The study population comprised 2064 patients included in the University of Rochester Medical Center Lymphoma Database from January 2013 to August 2019. Cardiac arrhythmias-atrial fibrillation/flutter, supraventricular tachycardia, ventricular arrhythmia, and bradyarrhythmia-were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. Multivariate Cox regression analysis was used to assess the risk of arrhythmic events with treatments categorized as Bruton tyrosine kinase inhibitor (BTKi), mainly ibrutinib/non-BTKi treatment versus no treatment. Median age was 64 (54-72) years, and 42% were women. The overall rate of any arrhythmia at 5 years following the initiation of BTKi was (61%) compared with (18%) without treatment. Atrial fibrillation/flutter was the most common type of arrhythmia accounting for 41%. Multivariate analysis showed that BTKi treatment was associated with a 4.3-fold (P<0.001) increased risk for arrhythmic event (P<0.001) compared with no treatment, whereas non-BTKi treatment was associated with a 2-fold (P<0.001) risk increase. Among subgroups, patients without a history of prior arrhythmia exhibited a pronounced increase in the risk for the development of arrhythmogenic cardiotoxicity (3.2-fold; P<0.001). Conclusions Our study identifies a high burden of arrhythmic events after initiation of treatment, which is most pronounced among patients treated with the BTKi ibrutinib. Patients undergoing treatments for lymphoma may benefit from prospective focused cardiovascular monitoring prior, during, and after treatment regardless of arrhythmia history.
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Affiliation(s)
- Saadia Sherazi
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester School of Medicine and Dentistry Rochester NY
| | - Susan Schleede
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester School of Medicine and Dentistry Rochester NY
| | - Scott McNitt
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester School of Medicine and Dentistry Rochester NY
| | - Carla Casulo
- Division of Hematology/Oncology and Wilmot Cancer Institute University of Rochester School of Medicine and Dentistry Rochester NY
| | - Jeremiah E Moore
- Division of Hematology/Oncology and Wilmot Cancer Institute University of Rochester School of Medicine and Dentistry Rochester NY
| | | | - Arpan Patel
- Division of Hematology/Oncology and Wilmot Cancer Institute University of Rochester School of Medicine and Dentistry Rochester NY
| | - Neelima Vidula
- Massachusetts General Hospital Cancer Center Harvard Medical School Boston MA
| | - Mehmet K Aktas
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester School of Medicine and Dentistry Rochester NY
| | - Clive S Zent
- Division of Hematology/Oncology and Wilmot Cancer Institute University of Rochester School of Medicine and Dentistry Rochester NY
| | - Ilan Goldenberg
- Division of Cardiology Clinical Cardiovascular Research Center University of Rochester School of Medicine and Dentistry Rochester NY
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Devaprasad M, Rastogi N, Satish R, Patel A, Singh A, Dabhi A, Shivam A, Bhushan R, Meena R. Characterization of paddy-residue burning derived carbonaceous aerosols using dual carbon isotopes. Sci Total Environ 2023; 864:161044. [PMID: 36572314 DOI: 10.1016/j.scitotenv.2022.161044] [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] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/24/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
A large scale paddy-residue burning (PRB) happens every year in the northwest Indo-Gangetic Plain (IGP) during the post-monsoon season, and winds transport pollutants from the source region up to the northern Indian Ocean affecting air quality of the IGP and marine region. In this study, day-night pairs of fine aerosol samples (n = 69) were collected during October-November over Patiala (30.2°N, 76.3°E, 250 m amsl), a site located in the source region of PRB. Carbonaceous aerosols (CA) were characterised using chemical species and dual carbon isotopes (13C and 14C) to estimate bio vs non-bio contributions and understand their characteristics. Percentage of bio fraction (fbio, estimated using 14C) in CA varied from 74 % to 87 % (avg: 80 ± 3) during days and 71 % to 96 % (avg: 85 ± 7 %) during nights. Further, the fbio was found to be better correlated with aerosol mass spectrometer derived f60 compare to levoglucosan (LG) or nssK+, suggesting f60 a useful proxy for PRB. The δ13C varied from -27.7 ‰ to -26.0 ‰ (avg: -27.0 ± 0.4 ‰) and - 28.7 ‰ to -26.4 ‰ (avg: -27.5 ± 0.7 ‰) during day and night, respectively. Measured δ13C of the samples was found to be more enriched than expected by 0.3 to 2.0 ‰, indicating the presence of aged CA also in Patiala even during PRB period. From fbio versus δ13C correlation, and from Miller-Trans plot, δ13C of PRB is found to be -28.9 ± 1.1 ‰, which also infers that Miller-Trans plot can be used to understand source isotopic signature in the absence of radiocarbon measurements in aerosols. Further, the characteristics ratios of organic carbon (OC) to elemental carbon (EC) (11.9 ± 4.1), LG to potassium (K+) (0.84 ± 0.15), OC/LG (19.7 ± 2.0) and K+/EC (0.75 ± 0.27) were calculated by considering samples with fbio higher than 0.90, which can be used for source apportionment studies. Such studies are crucial in assessing the effects of PRB on regional air quality and climate.
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Affiliation(s)
- M Devaprasad
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India; Indian Institute of Technology, Gandhinagar, Gujarat 382355, India
| | - N Rastogi
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India.
| | - R Satish
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India
| | - A Patel
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India
| | - A Singh
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India; Department of Physics, Punjabi University, Patiala 147002, India
| | - A Dabhi
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India
| | - A Shivam
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India
| | - R Bhushan
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India
| | - R Meena
- Geosciences Division, Physical Research Laboratory, Ahmedabad 380009, India
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37
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Patel A, Targownik L, Zelinsky S, Daley K, Jeffs L, Zeng L, Tabatabavakili S. A213 UNDERSTANDING PATIENT AND PHYSICIAN ATTITUDES AND EXPECTATIONS REGARDING IDENTIFYING AND MANAGING ANXIETY AND DEPRESSION IN IBD. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991360 DOI: 10.1093/jcag/gwac036.213] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Patients living with Inflammatory Bowel Disease (IBD) commonly experience a number of mental health-related challenges, specifically anxiety and mood disorders (AMDs). Although there has been an awareness of the relationship between IBD and AMD within the GI research and clinical space; detection, treatment, and management amongst care providers is limited. Therefore, we are seeking to explore the overall experiences of patients living with Inflammatory Bowel Disease to identify and evaluate their experiences in interactions with GI clinicians around mental health in diverse care settings in order to determine how to best support mental health care amongst IBD patients. Purpose We aimed to explore perspectives, experiences and barriers to engaging with mental health-related challenges amongst IBD patients when interacting with gastroenterologists over the course of their health journey. Method We conducted 5 semi-structured online focus groups co-facilitated by patient researchers in early 2020 through Zoom which spanned for a total of 2.5 hours each. Participants were recruited through social media channels, GI clinics, the IMAGINE-SPOR unit, and Crohn’s and Colitis Canada. A semi-structured interview guide was developed for patient researchers to follow during the focus groups which provided guided questions that would allow patient participants to explore and reflect on: their experiences living with IBD, their expectations around mental health support, their perception of the engagement of GIs in mental health discussions, and their expectations for mental health support and services moving forward. Audio recordings from the semi-structured focus groups were then transcribed and thematic analysis was used to identify emerging themes and patient expectations. Result(s) We identified the following key themes: 1) experiences with IBD: difficulties related to reintegrating into social settings, feelings of loneliness; 2) expectations around mental health support: the need to develop their own resiliency strategies due to the lack of structural resources regarding mental health and IBD in the clinical space; 3) GI engagement: HCPs were dismissive of mental health symptoms, often gaslighting patients when mentioning mental health concerns during clinical encounters; and 4) expectations: a need to standardize mental health care across IBD care practice with a focus on potentially integrating healthcare providers of diverse care settings to help address the need for mental health support in such a vast patient population. Conclusion(s) Our study suggests that effective detection, management and awareness, along with the integration of feedback from patient lived experiences can help inform the development of mental health support and services which cater to the needs of people living with IBD. Results from this study will be interpreted in line with insight gathered from upcoming interviews of gastroenterologists and HCPs. Please acknowledge all funding agencies by checking the applicable boxes below CIHR, Other Please indicate your source of funding; IMAGINE SPOR INCUBATOR Grant Disclosure of Interest None Declared
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Affiliation(s)
- A Patel
- Gastroenterology, Mount Sinai Hospital, Toronto
| | - L Targownik
- Gastroenterology, Mount Sinai Hospital, Toronto
| | | | - K Daley
- IMAGINE SPOR Network, Hamilton
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38
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Szeto H, Graif A, Patel A, Vance A, Molavi S, Grilli C, Kimbiris G, Leung D. Abstract No. 37 The Perigraft Approach for Type II Endoleak Embolization. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.079] [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: 02/27/2023] Open
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39
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Patel A, Kozlowski K, Richardson K, Jalaeian H, Venkat S. Abstract No. 225 Comparison of Outcome of CT-Guided Lung Biopsy Using a 17-Gauge vs. 19-Gauge Biopsy Gun System. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.286] [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: 02/27/2023] Open
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40
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Patel A, Casini G, Hagan J, Gollins L, Hair AB, Fernandes C, Premkumar MH. Determinants of outcome in neonatal intestinal failure and ostomy following reanastomosis. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00453-6] [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: 01/28/2023]
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41
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Oaks Z, Patel A, Huang N, Choudhary G, Winans T, Faludi T, Krakko D, Duarte M, Lewis J, Beckford M, Blair S, Kelly R, Landas SK, Middleton FA, Asara JM, Chung SK, Fernandez DR, Banki K, Perl A. Publisher Correction: Cytosolic aldose metabolism contributes to progression from cirrhosis to hepatocarcinogenesis. Nat Metab 2023; 5:349. [PMID: 36755183 DOI: 10.1038/s42255-023-00752-8] [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: 02/10/2023]
Affiliation(s)
- Z Oaks
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - A Patel
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - N Huang
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - G Choudhary
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - T Winans
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - T Faludi
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - D Krakko
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - M Duarte
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - J Lewis
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - M Beckford
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - S Blair
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - R Kelly
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - S K Landas
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - F A Middleton
- Departments of Neuroscience, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - J M Asara
- Division of Signal Transduction, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S K Chung
- Faculty of Medicine, Macau University of Science and Technology, Taipa, China
| | - D R Fernandez
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - K Banki
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - A Perl
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
- Departments of Microbiology and Immunology, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
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Chambers P, Forster MD, Patel A, Duncan N, Kipps E, Wong ICK, Jani Y, Wei L. Development and validation of a risk score (Delay-7) to predict the occurrence of a treatment delay following cycle 1 chemotherapy. ESMO Open 2023; 8:100743. [PMID: 36542904 PMCID: PMC10024092 DOI: 10.1016/j.esmoop.2022.100743] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The risk of toxicity-related dose delays, with cancer treatment, should be included as part of pretreatment education and be considered by clinicians upon prescribing chemotherapy. An objective measure of individual risk could influence clinical decisions, such as escalation of standard supportive care and stratification of some patients, to receive proactive toxicity monitoring. PATIENTS AND METHODS We developed a logistic regression prediction model (Delay-7) to assess the overall risk of a chemotherapy dose delay of 7 days for patients receiving first-line treatments for breast, colorectal and diffuse large B-cell lymphoma. Delay-7 included hospital treated, age at the start of chemotherapy, gender, ethnicity, body mass index, cancer diagnosis, chemotherapy regimen, colony stimulating factor use, first cycle dose modifications and baseline blood values. Baseline blood values included neutrophils, platelets, haemoglobin, creatinine and bilirubin. Shrinkage was used to adjust for overoptimism of predictor effects. For internal validation (of the full models in the development data) we computed the ability of the models to discriminate between those with and without poor outcomes (c-statistic), and the agreement between predicted and observed risk (calibration slope). Net benefit was used to understand the risk thresholds where the model would perform better than the 'treat all' or 'treat none' strategies. RESULTS A total of 4604 patients were included in our study of whom 628 (13.6%) incurred a 7-day delay to the second cycle of chemotherapy. Delay-7 showed good discrimination and calibration, with c-statistic of 0.68 (95% confidence interval 0.66-0.7), following internal validation and calibration-in-the-large of -0.006. CONCLUSIONS Delay-7 predicts a patient's individualised risk of a treatment-related delay at cycle two of treatment. The score can be used to stratify interventions to reduce the occurrence of treatment-related toxicity.
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Affiliation(s)
- P Chambers
- Department of Practice and Policy, School of Pharmacy, University College London, London, UK; The Centre for Medicines Optimisation Research and Education, University College London NHS Foundation Trust, London, UK.
| | - M D Forster
- University College London Cancer Institute, London, UK
| | - A Patel
- The Royal Marsden Hospital, London, UK
| | - N Duncan
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - E Kipps
- The Royal Marsden Hospital, London, UK
| | - I C K Wong
- Department of Practice and Policy, School of Pharmacy, University College London, London, UK; The Centre for Medicines Optimisation Research and Education, University College London NHS Foundation Trust, London, UK
| | - Y Jani
- Department of Practice and Policy, School of Pharmacy, University College London, London, UK; The Centre for Medicines Optimisation Research and Education, University College London NHS Foundation Trust, London, UK
| | - L Wei
- Department of Practice and Policy, School of Pharmacy, University College London, London, UK; The Centre for Medicines Optimisation Research and Education, University College London NHS Foundation Trust, London, UK
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Curtis F, Li L, Kolanko M, Lai H, Daniels S, True J, Del Giovane M, Golemme M, Lyall R, Raza S, Hassim N, Patel A, Beal E, Walsh C, Purnell M, Whitethread N, Nilforooshan R, Norman C, Wingfield D, Barnaghi P, Sharp D, Dani M, Fertleman M, Parkinson M. 1362 ANTICHOLINERGIC PRESCRIBING HABITS AND ITS ASSOCIATIONS IN A COMMUNITY POPULATION OF PEOPLE LIVING WITH DEMENTIA. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.039] [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: 01/18/2023] Open
Abstract
Abstract
Introduction
Many commonly prescribed medications have inadvertent anticholinergic effects. People with Dementia (PwD) are more vulnerable to these effects and at risk of adverse outcomes, the risk being higher with a greater degree of anticholinergic exposure. We investigated prescribing patterns and Anticholinergic burden (ACB) in a cohort of community-dwelling older adults with dementia and aimed to explore the effect of ACB on cognition, mood, and quality of life(QoL).
Method
The medication and demographic information for 87 (39 female) community-dwelling PwD were obtained from Electronic Care Summaries. We used the German Anticholinergic Burden Scale (GABS) to measure ACB. Additionally, we investigated associations between ACB and cognitive (ADAS-Cog), functional (BADL) and QoL (DemQoL) assessments.
Results
28.7% of participants had a clinically significant score (ACB> 2). The most commonly prescribed medications with ACB were Lansoprazole(18.3%), Mirtazapine(12.6%) and Codeine(12.6%). ACB was higher in males and negatively correlated with age, r(87)=-.21,p=.03. There was no association between ACB and cognition, QoL, functional independence, and neuropsychiatric symptoms. Over six months, PLWD with no ACB had a greater negative change in neuropsychiatric symptoms[t(18)=2.27,p=.04] and functional independence[t(23)=-3.8,p=.001], indicating greater dependence and worsening neuropsychiatric symptoms.
Conclusion
A third of PLWD in the community had clinically significant ACB. No ACB was associated with worsening neuropsychiatric symptoms and functional dependence over a six-month period. Community prescribers should consider regular medication reviews with PLWD and carers to ensure medications are prescribed safely and appropriately.
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Affiliation(s)
- F Curtis
- Imperial College London , Department of Brain Sciences
| | - L Li
- Imperial College London , Department of Brain Sciences
| | - M Kolanko
- Imperial College London , Department of Brain Sciences
| | - H Lai
- Imperial College London , Department of Brain Sciences
| | - S Daniels
- Imperial College London , Department of Brain Sciences
| | - J True
- Imperial College London , Department of Brain Sciences
| | - M Del Giovane
- Imperial College London , Department of Brain Sciences
| | - M Golemme
- Imperial College London , Department of Brain Sciences
| | - R Lyall
- Imperial College London , Department of Brain Sciences
| | - S Raza
- Imperial College London , Department of Brain Sciences
| | - N Hassim
- Imperial College London , Department of Brain Sciences
| | - A Patel
- Imperial College London , Department of Brain Sciences
| | - E Beal
- Imperial College London , Department of Brain Sciences
| | - C Walsh
- Imperial College London , Department of Brain Sciences
| | - M Purnell
- Imperial College London , Department of Brain Sciences
| | - N Whitethread
- Imperial College London , Department of Brain Sciences
| | | | - C Norman
- Imperial College London , Department of Brain Sciences
| | - D Wingfield
- Imperial College London , Department of Brain Sciences
| | - P Barnaghi
- Imperial College London , Department of Brain Sciences
| | - D Sharp
- Imperial College London , Department of Brain Sciences
| | - M Dani
- Imperial College London , Department of Brain Sciences
| | - M Fertleman
- Imperial College London , Department of Brain Sciences
| | - M Parkinson
- UK DRI Centre for Care Research and Technology
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Oh GY, Gibson M, Khanom S, Jaiswal P, Patel A. Validating low-fidelity arthroscopic simulation in medical students: a feasibility trial. Ann R Coll Surg Engl 2023; 105:28-34. [PMID: 35446721 PMCID: PMC9773295 DOI: 10.1308/rcsann.2022.0008] [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] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION With surgical opportunities becoming increasingly restricted for orthopaedic trainees, simulation training is a valuable alternative at providing sufficient practice. This pilot study aims to assess the potential effectiveness of low-fidelity simulation in teaching medical students basic arthroscopic skills and the feasibility of its incorporation into formal student training programmes. METHODS Twenty-two medical students completed pre- and post-training tests on the Probing (Task 1) and Maze (Task 2) exercises from the Sawbones 'Fundamentals of Arthroscopy Surgery Training' (FAST) programme. Training consisted of practising horizon control, deliberate linear motion and probing within 25min over a period of days. Completion time and error frequency were measured. The difference in performance was assessed using a paired two-tailed t-test. Qualitative data were collected. RESULTS Test completion time decreased significantly by a mean of 83s (±46s, 95% confidence intervals [CI] 37 to 129) for Task 1 (p=0.001) and 105s (±55s, 95% CI 50 to 160) for Task 2 (p=0.0007). Frequency of direct visualisation errors decreased significantly by a mean of 1.0 errors (±1.0 errors, 95% CI 0.1 to 2.0) for Task 1 (p = 0.04) and 0.8 errors (±0.8 errors, 95% CI 0.1 to 1.6) for Task 2 (p = 0.04). At post-training, 82% of participants were willing to incorporate FAST into formal training. CONCLUSIONS Low-fidelity simulators such as FAST can potentially teach basic arthroscopic skills to medical students and are feasible for incorporation into formal training. They also give students a cost-effective and safe basic surgical training experience.
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Affiliation(s)
- GY Oh
- University College London (UCL), UK
| | - M Gibson
- Royal Free London NHS Foundation Trust, UK
| | - S Khanom
- Royal Free London NHS Foundation Trust, UK
| | - P Jaiswal
- Royal Free London NHS Foundation Trust, UK
| | - A Patel
- Royal Free London NHS Foundation Trust, UK
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Patel A. Metal nanoparticles produced by plants with antibacterial properties against Staphylococcus aureus. BRAZ J BIOL 2023; 82:e268052. [PMID: 36888798 DOI: 10.1590/1519-6984.268052] [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] [Received: 09/21/2022] [Accepted: 12/15/2022] [Indexed: 03/08/2023] Open
Abstract
Staphylococcus aureus (S. aureus) is a pathogenic bacteria that causes a variety of potentially fatal infections. The emergence of antibiotic-resistant strains of S. aureus has made treatment even more difficult. In recent years, nanoparticles have been used as an alternative therapeutic agent for S. aureus infections. Among various methods for the synthesis of nanoparticles, the method utilizing plant extracts from different parts of a plant, such as root, stem, leaf, flower, seeds, etc. is gaining widespread usage. Phytochemicals present in plant extract are an inexpensive, eco-friendly, natural material that act as reducing and stabilization agent for the nanoparticle synthesis. The utilization of plant-fabricated nanoparticles against S. aureus is currently in trend. The current review discusses recent findings in the therapeutic application of phytofabricated metal-based nanoparticles against Staphylococcus aureus.
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Affiliation(s)
- A Patel
- King Khalid University, College of Medicine, Department of Clinical Biochemistry, Abha, Kingdom of Saudi Arabia
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Molero-Senosiain M, Tiew S, Patel A, Houben I, Dhillon N. Impact of face mask wear on bacterial keratitis. J Fr Ophtalmol 2023; 46:e37-e39. [PMID: 36443112 PMCID: PMC9698048 DOI: 10.1016/j.jfo.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/27/2022]
Affiliation(s)
- M Molero-Senosiain
- Department of Ophthalmology, University Hospitals of Leicester NHS Trust, Infirmary Square, LE1 5WW, Leicester, United Kingdom.
| | - S Tiew
- Department of Ophthalmology, University Hospitals of Leicester NHS Trust, Infirmary Square, LE1 5WW, Leicester, United Kingdom
| | - A Patel
- Department of Ophthalmology, University Hospitals of Leicester NHS Trust, Infirmary Square, LE1 5WW, Leicester, United Kingdom
| | - I Houben
- Department of Ophthalmology, University Hospitals of Leicester NHS Trust, Infirmary Square, LE1 5WW, Leicester, United Kingdom
| | - N Dhillon
- Department of Ophthalmology, University Hospitals of Leicester NHS Trust, Infirmary Square, LE1 5WW, Leicester, United Kingdom
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Oaks Z, Patel A, Huang N, Choudhary G, Winans T, Faludi T, Krakko D, Duarte M, Lewis J, Beckford M, Blair S, Kelly R, Landas SK, Middleton FA, Asara JM, Chung SK, Fernandez DR, Banki K, Perl A. Cytosolic aldose metabolism contributes to progression from cirrhosis to hepatocarcinogenesis. Nat Metab 2023; 5:41-60. [PMID: 36658399 PMCID: PMC9892301 DOI: 10.1038/s42255-022-00711-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/11/2022] [Indexed: 01/21/2023]
Abstract
Oxidative stress modulates carcinogenesis in the liver; however, direct evidence for metabolic control of oxidative stress during pathogenesis, particularly, of progression from cirrhosis to hepatocellular carcinoma (HCC), has been lacking. Deficiency of transaldolase (TAL), a rate-limiting enzyme of the non-oxidative branch of the pentose phosphate pathway (PPP), restricts growth and predisposes to cirrhosis and HCC in mice and humans. Here, we show that mitochondrial oxidative stress and progression from cirrhosis to HCC and acetaminophen-induced liver necrosis are critically dependent on NADPH depletion and polyol buildup by aldose reductase (AR), while this enzyme protects from carbon trapping in the PPP and growth restriction in TAL deficiency. Both TAL and AR are confined to the cytosol; however, their inactivation distorts mitochondrial redox homeostasis in opposite directions. The results suggest that AR acts as a rheostat of carbon recycling and NADPH output of the PPP with broad implications for disease progression from cirrhosis to HCC.
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Affiliation(s)
- Z Oaks
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - A Patel
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - N Huang
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - G Choudhary
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - T Winans
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - T Faludi
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - D Krakko
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - M Duarte
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - J Lewis
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - M Beckford
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - S Blair
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - R Kelly
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - S K Landas
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - F A Middleton
- Departments of Neuroscience, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - J M Asara
- Division of Signal Transduction, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S K Chung
- Faculty of Medicine, Macau University of Science and Technology, Taipa, China
| | - D R Fernandez
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - K Banki
- Departments of Pathology, State University of New York, Norton College of Medicine, Syracuse, NY, USA
| | - A Perl
- Departments of Medicine, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
- Departments of Biochemistry and Molecular Biology, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
- Departments of Microbiology and Immunology, State University of New York, Norton College of Medicine, Syracuse, NY, USA.
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Patel A, Mohtashemi N, Motwani Y, Tseng CH, Kawamoto J, Chen P, Celedon MA, Benhammou J, Dong T, May F, Goetz MB, Bhattacharya D. 1247. Primary Care Teams in Veterans Health Administration Have High Knowledge of Universal HCV Screening But Favor System-Level Interventions to Close Care Gaps. Open Forum Infect Dis 2022. [PMCID: PMC9752455 DOI: 10.1093/ofid/ofac492.1078] [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: 12/23/2022] Open
Abstract
Background In 2020, the United States Preventive Services Taskforce recommended one-time Hepatitis C virus (HCV) screening for all adults aged 18-79. As the largest provider of HCV treatment in the US the Veterans Health Administration (VA) is committed to implementing these recommendations; thus, understanding perspectives of primary care teams towards this is critical. Methods We disseminated a 24-item online survey to PCPs at the VA Greater Los Angeles Healthcare System (VAGLAHCS), serving 1.5 million Veterans within an area that spans five counties. Our sample included physicians, pharmacists, nurse practitioners, and physician assistants on primary care teams. Our survey contained questions on demographics, provider knowledge of HCV testing, practice patterns and beliefs, and preferences for new screening tools. Descriptive statistics were completed and we compared item responses across demographics. Hypothesis testing was performed using Wilcoxon rank sum test for continuous variables and Fisher’s exact or Chi-square tests for categorical variables. Results In total, 107 PCPs responded to the survey (107/385=28% response rate), with 100 complete responses. Most respondents were women (63%) with median age of 42 years, physicians (53%), Internal Medicine-trained (47%), and of Asian descent (45%). A majority (59%) were aware of new screening recommendations. Most PCPs reported confidence (71%), intent (77%), and commitment towards (82%) HCV screening. Only 38% reported remembering to screen Veterans regularly. Physicians were most aware of new recommendations (73%), compared to pharmacists (55%) and nurse practitioners (42%). The most strongly preferred strategies to enhance screening included automatic test orders during physician visits (71%), automatic electronic-consults (68%), clinician reminders for HCV screening (57%), and opt-out phlebotomy (48%). Conclusion In a sample of providers within a large and diverse VA, 3 in 5 PCPs were aware of new universal HCV screening recommendations. There is high motivation among PCPs to perform screening, but forgetting to screen is still common. Several strategies to augment universal HCV screening were acceptable towards PCPs. Disclosures Debika Bhattacharya, MD, MSc, Gilead: Grant/Research Support|Regeneron: Grant/Research Support.
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Affiliation(s)
- Arpan Patel
- University of California, Los Angeles and VA Greater Los Angeles Healthcare System, Los Angeles, California
| | | | | | | | - Jenna Kawamoto
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | | | - Manuel A Celedon
- Assistant Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Tien Dong
- University of California, Los Angeles, Los Angeles, California
| | | | - Matthew B Goetz
- VA Greater Los Angeles Healthcare System, Los Angeles, California
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Harjono L, Motwani Y, Mohtashemi N, Chen P, Tamkus G, Dong T, Benhammou J, Goetz MB, Kawamoto J, Patel A, Bhattacharya D. 1234. Analysis of an Automated Letter HCV Screening Program within a Veterans Affairs Health System: Implications for Universal HCV Screening. Open Forum Infect Dis 2022. [PMCID: PMC9752434 DOI: 10.1093/ofid/ofac492.1066] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Although universal Hepatitis C Virus (HCV) Screening in the US was recommended in 2020, the optimal implementation method is unknown. We characterized the efficacy of an automated letter HCV screening program at the Veteran’s Affairs (VA) Greater Los Angeles Healthcare System (VAGLAHS) and evaluated associations with linkage to care. Methods From January 2017 to May 2020, 14,804 Veterans born between 1945-1965 who did not have an HCV antibody (Ab) test result within the last 10 years and who were within the VAGLAHS catchment area were identified. Veterans were mailed a letter recommending HCV screening via a centralized process. Veterans then used the letter to present to a VA laboratory for HCV Ab testing, which included reflex HCV viral load. Those who were HCV viremic were referred to Hepatology/Infectious Diseases clinics for initiation of HCV treatment. Baseline characteristics of those with subsequent HCV viremia were collected. To determine associations with the first HCV visit (linkage to care), we performed independent chi-squared tests. Flowchart of Automated Letter HCV Screening for Veterans
![]() Results A total of 12,875 Veterans were identified, 4,011 (31%) Veterans presented for HCV Ab testing, 167/4011 were HCV Ab + (4.2%), and 69/167 (41.3%) had HCV viremia. Of those viremic, 94 % were male, 26% were African-American, 62% had stable housing, 24% lived >90 miles from the nearest VA clinic, and 17% had cirrhosis. Fifty-five Veterans (80%) were evaluated in a viral hepatitis clinic and 84 % (46/55) initiated HCV treatment (Figure 1). Patients’ housing status (p = 0.02), cirrhosis (p< 0.0001), and distance to clinic (p=0.063) were associated with non-linkage to an initial HCV appointment. Conclusion One third of Veterans approached via mail participated in HCV Ab testing. Overall HCV Ab positivity rates were 4% and nearly half had HCV viremia. The majority of Veterans were linked to care but housing status, cirrhosis, and distance to clinic were associated with non-linkage to care. Automated letter screening is a promising approach to HCV screening, including universal screening. Future research should include investigations of telehealth and e-consults for linkage to care, especially for those who have marginalized housing status and live far from clinic. Disclosures Debika Bhattacharya, MD, MSc, Gilead: Grant/Research Support|Regeneron: Grant/Research Support.
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Affiliation(s)
| | | | | | | | | | - Tien Dong
- University of California, Los Angeles, Los Angeles, California
| | - Jihane Benhammou
- University of California, Los Angeles and Greater Los Angeles Veteran Affairs, Los Angeles, California
| | - Matthew B Goetz
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jenna Kawamoto
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Arpan Patel
- University of California, Los Angeles and VA Greater Los Angeles Healthcare System, Los Angeles, California
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Linn YL, Choke ETC, Yap CJQ, Tan RY, Patel A, Tang TY. Utility of sirolimus coated balloons in the peripheral vasculature – a review of the current literature. CVIR Endovasc 2022; 5:29. [PMID: 35748962 PMCID: PMC9232675 DOI: 10.1186/s42155-022-00308-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/09/2022] [Indexed: 12/24/2022] Open
Abstract
AbstractSirolimus-coated balloons (SCB) have demonstrated much promise as an alternative drug eluting device to the existing paclitaxel coated balloon platforms for the treatment of peripheral arterial disease (PAD). They have been well tested pre-clinically and have demonstrated anti-restenotic effects as well as clinical safety in its use for treatment of coronary artery disease. The existing approved SCBs have thus far demonstrated good short-term patency (12-months) and did not exhibit any major adverse events or device related shortcomings in its use for treatment of PAD. There are several studies ongoing which aim to further investigate the efficacy of existing SCBs and establish a direct comparison of its outcomes compared with plain balloon angioplasty. Also, SCB utility to salvage failing arteriovenous fistulas for haemodialysis patients has also been explored. We review the current progress made in the establishment of SCB in the treatment of PAD as well as highlight ongoing studies investigating the role of SCB in various settings.
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