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Tyagi M, Shah U, Patel G, Toshniwal V, Bhongade R, Sharma P. THE IMPACT OF SLEEP ON PHYSICAL AND MENTAL HEALTH: IMPORTANCE OF HEALTHY SLEEP HABITS. Georgian Med News 2023:89-94. [PMID: 37522781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Sleep is an important part of health, and when you go to sleep, how long you sleep, and how well you sleep all have a big impact on your health. Sleep may be required for regulating the body's metabolism, feelings, function, memory storage, brain recovery, and learning. Because of how important these processes are, sleep should be seen as just as important to health as what you eat and how much you exercise. Adults' sleep generally gets shorter and less restful, their sleep starts later and is more broken up, they have more sleep problems, and their rest-activity rhythms get weaker. In addition to receiving enough sleep (quality), healthy sleep habits also include maintaining a consistent sleep schedule. Ninety male college students with varying sleep schedules were analyzed for their physical and emotional well-being. By using factor analysis to categorize individuals' sleeping patterns across three dimensions regularity, quality, and quantity. We were able to develop sleep-habit measures. Clustering identified four distinct patterns of sleep behavior: good sleep was defined by regular, high-quality sleep despite being of comparatively brief duration; long sleep was predictable, fairly lengthy, but of minimal quality; short sleep was of excellent quality despite being short and irregular; and poor sleep was erratic, low-quality, and relatively long. The excellent sleepers also had reduced diastolic and systolic and a smaller means waist measurement. In addition, the poor sleepers had the lowest average MCS scores of all of the study groups. Poor sleepers also had the lowest mean scores on the Subjective Depression Scale (SDS). Issues involving glucose or lipid absorption were also more common in the short-term and long poor-sleep categories. Without restful sleep and a regular bedtime routine, it is impossible to maintain excellent mental and physical wellness, even if time and sleep are maintained constantly. Therefore, to produce suitable sleep recommendations for enhanced mental and physical health, we evaluated not only the quantity of sleep but also its consistency and high quality.
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Affiliation(s)
- M Tyagi
- 1Department of Psychitary, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
| | - U Shah
- 2Department of Genetics, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
| | - G Patel
- 3Department of Community Medicine, Parul University, PO Limda, Tal. Waghodia, District Vadodara, Gujarat, India
| | - V Toshniwal
- 4Department of Nursing, IIMT University, Meerut, Uttar Pradesh, India
| | - R Bhongade
- 5Department of Ayurveda, Sanskriti University, Mathura, Uttar Pradesh, India
| | - P Sharma
- 6Department of Pharmacy, Vivekananda Global University, Jaipur, India
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Arun J, Singh A, Shashidhar E, Patel G, Verma Y, Sapcota S. THE ROLE OF IMMUNOTHERAPY IN CANCER TREATMENT: CHECKPOINT INHIBITORS, CAR-T CELLS, AND VACCINES. Georgian Med News 2023:105-112. [PMID: 37522784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Immunotherapy causes cancer patients' immune systems to activate in search of and eliminate cancer cells. As a therapeutic area for cancer, it has expanded in importance and demonstrated promising results in treating many cancers. Checkpoint blockade (CPB) therapy may stimulate a suppressed immune response to provide long-lasting therapeutic results. However, the absence of a tumor-reactive immune infiltration is probably why response rates are still low. Using chimeric antigen receptor (CAR)-modified T cells to fight cancer may significantly impact immunology. This study explored using checkpoint inhibitors, car-T cells, and vaccines in immunotherapy to treat cancers. Drugs used for CPB aim to reduce immunological suppression, allowing for more effective CAR T cells and dendritic cell (DC) vaccines, providing some optimism that this may be increased, both of which have proven therapeutic efficacy in specific cancers. However, drug-induced side effects and the tumor microenvironment's propensity for immunosuppression mean treatment effectiveness is still inadequate. The outcomes of current preclinical tests suggest that novel therapies targeting lymphocyte-activation gene 3 (LAG3), T cell immunoglobulin and mucin-domain containing-3 (TIM3), cytotoxic T lymphocyte-associated protein 4 (CTLA-4), and programmed cell death protein 1 (PD-1) could be used as adjuvant therapies to modify the tumor microenvironment.
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Affiliation(s)
- J Arun
- 1Department of Pharmacy, Vivekananda Global University, Jaipur, India
| | - A Singh
- 2Department of General Surgery, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
| | - E Shashidhar
- 3Department of Forensic Science, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
| | - G Patel
- 4Department of Community Medicine, Parul University, PO Limda, Tal. Waghodia, District Vadodara, Gujarat, India
| | - Y Verma
- 5Department of Nursing, IIMT University, Meerut, Uttar Pradesh, India
| | - S Sapcota
- 6Department of Ayurveda, Sanskriti University, Mathura, Uttar Pradesh, India
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Patel G, Feng J, Chow T, Khan D. PENICILLIN ALLERGY DELABELLING IN A PEDIATRIC PRIMARY CARE SETTING. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chhiba K, Burnett-Stinson A, Patel G. A CASE OF ANAPHYLAXIS TO FOSAPREPITANT. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Newell P, Kudlaty E, Patel G, McGrath K. A RARE CASE OF PROTRACTED ANAPHYLAXIS CAUSED BY ACETAMINOPHEN. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bali V, Schelfhout J, Sher M, Peters A, Patel G, Mayorga M, Cook T, Romano C. PATIENT-REPORTED SYMPTOMS, IMPACTS, AND TREATMENT PREFERENCES IN REFRACTORY OR UNEXPLAINED CHRONIC COUGH: A QUALITATIVE STUDY. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kashyap A, Singh N, Malhotra N, Mahey R, Perumal V, Vatsa R, Patel G, Saini M. O-292 Comparison of effect of two different trigger regimens; single (hCG) versus dual (hCG + Leuprolide) on outcome of fresh IVF cycles: A randomized controlled trial. Hum Reprod 2022. [PMCID: PMC9384440 DOI: 10.1093/humrep/deac106.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Does adding gonadotropin-releasing hormone agonist (GnRHa) to hCG trigger increases the number of high-grade embryos in GnRH antagonist protocol in fresh non-donor IVF?
Summary answer
Final oocyte maturation triggered by dual trigger increases the number of MII oocytes thus transferring good-quality embryos and cryopreserving surplus embryos compared to hCG trigger.
What is known already
hCG has been conventionally used as a ‘faux’ LH surge to bring about final oocyte maturation due to structural similarity between the two. GnRH agonist, on the other hand, induces a more physiological gonadotropin surge for follicular maturation, but is associated with luteal phase deficiency. Recent studies have shown that combining GnRHa with hCG trigger improves oocyte maturation and embryo quality with the added benefit of a luteal phase support, thereby improving IVF outcomes in terms of both embryological and reproductive outcomes.
Study design, size, duration
A single-center, open labelled, randomized controlled trial including 100 normal responder patients between 21-38 years undergoing IVF using GnRH antagonist protocol between January 2020 to August 2021. The study excluded patients with the presence of other variables of adverse outcomes like diminished ovarian reserve (AFC < 5 or AMH < 1.2 ng/ml), endocrine disorders, thin endometrium (<6mm), previous history of uterine surgeries, and high responders.
Participants/materials, setting, methods
100 patients undergoing fresh IVF cycle using GnRH antagonist protocol were randomized after informed consent to receive either dual trigger (Leuprolide acetate 1 mg + rhCG 250 mcg, n = 50) or single hCG trigger (rhCG 250 mcg, n = 50). Oocyte retrieval was done 35-37 hours after trigger followed by IVF/ICSI, as indicated. Oocyte and embryo grading was done using Istanbul consensus. Analysis was done by ITT. Outcomes were analyzed using Independent t-test and Chi-square test.
Main results and the role of chance
The baseline characteristics were comparable in both arms. the number of MII oocytes retrieved (7.82 versus 5.92, p = 0.003) and the number of day-3 grade-1 embryos (4.24 versus 1.8, p < 0.001) were higher in the dual trigger group, whereas fertilization rates between the two groups (91.82% versus 88.51%, p=NS) were comparable. Consequently, the number of embryos cryopreserved (2.68 versus 0.94, p < 0.001) were significantly higher in the dual trigger group. However, the implantation rate between the two groups (21% versus 19.6%, p = 0.770) was comparable. The serum LH levels 12 hours post trigger were measured in both the arms and as expected, high serum LH values were documented in the dual trigger group (46.23 mIU/ml vs 0.93 mIU/ml, p < 0.0001).
Limitations, reasons for caution
Due to the impact of the Covid-19 pandemic causing an intermittent pause in IVF services at our center, a smaller sample size of 100 patients could be enrolled in the study, and reproductive outcomes in terms of live births and cumulative live births could not be assessed
Wider implications of the findings
This study, though small, has contributed to some evidence of redesigning the dual trigger in all antagonist cycles, with the exception of high responders and PCOS patients. The addition of GnRHa to hCG trigger has led to the possibility of cryopreserving surplus embryos thereby increasing the cumulative live births.
Trial registration number
CTRI/2020/08/027030
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Affiliation(s)
- A Kashyap
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - N Singh
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - N Malhotra
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - R Mahey
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - V Perumal
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - R Vatsa
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - G Patel
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - M Saini
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
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Singh N, Patel G, Dogra Y, Mohanty S, Seth T. P-795 Comparison of intra-ovarian platelet rich plasma versus autologous bone marrow derived stem cell instillation in women with diminished ovarian reserve for ovarian rejuvenation. Hum Reprod 2022. [PMCID: PMC9384354 DOI: 10.1093/humrep/deac107.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
To compare role of intra-ovarian platelet rich plasma (PRP) versus marrow derived stem cell (SC) instillation for improvement in ovarian reserve (AFC, AMH and FSH)
Summary answer
Both PRP and SC therapy improves the ovarian reserve however, response to PRP is superior to SC post intervention
What is known already
With increasing incidence of females with diminished ovarian reserve (DOR), posing a serious challenge in terms of limited treatment options for these couples. Clinicians are trying to find effective strategies besides oocyte donation or adoption Of late, novel ovarian rejuvenation approaches has been investigated which are currently available for research purposes only. Multiple studies are evaluating effect of intra-ovarian PRP or autologous SC instillation, the results are encouraging as they are showing improvement in ovarian reserve thus bringing a paradigm shift in treatment options. None of the published studies so far have compared PRP versus SC in DOR population.
Study design, size, duration
A prospective comparative study was conducted at Division of Reproductive Medicine of a tertiary care institute. 72 infertile females (20-39 years) with poor ovarian reserve (AMH <1.2 ng /ml; AFC<5) were enrolled in the study between January 2020 to December 2021. The two comparative groups underwent either intra-ovarian PRP instillation (n = 42) or autologous SC transplantation (n = 30).
Participants/materials, setting, methods
After the two groups were matched (PRP vs SC) for baseline characteristics (Age, AMH, AFC, FSH, Estradiol), 30 subjects in each group were compared for change in serum FSH/AMH/Estradiol levels, AFC, right and left ovarian volume at 1st month and 3rd month post intervention from the baseline. This was also compared between the two groups using Student t-test. The cost and procedural pain measured using Visual analog scale (VAS) were also compared between the groups.
Main results and the role of chance
After matching for baseline characteristics, significant ∼ 1.8/2 and ∼1.5/1.6 fold increase in AFC at 1st/3rd month post intervention (p<0.001) was observed after PRP instillation and SC transplantation respectively. This significant improvement was observed more in PRP group than SC group at 3rd month post intervention (7.07 vs 5.60, p=0.02), while no significant difference existed at 1st month of follow up. However, there was no significant improvement in serum FSH, AMH and Estradiol levels (p0.05) from the baseline at 1st and 3rd month post intervention in both the groups. Similarly, there was no significant difference between the two groups in serum FSH level (7.98 IU/ml vs 9.62 IU/ml, p=0.062; 8.26 IU/ml vs 9.50 IU/ml, p=0.15), AMH level (1.62 ng/ml vs 1.02 ng/ml, p=0.27; 1.35 ng/ml vs 0.95 ng/ml, p=0.24), Estradiol level (49.12 pg/ml vs 56.48 pg/ml p=0.443; 54.7 pg/ml vs 61.12 pg/ml, p=0.44), right ovarian volume (3.13 cm3 vs 2.49 cm3, p=0.06; 3.37 cm3 vs 2.74 cm3,p=0.063) and left ovarian volume (2.98 cm3 vs 2.47 cm3, p=0.102; 2.87 cm3 vs 2.34 cm3,p=0.103) at 1st and 3rd month post intervention respectively. PRP was more cost-effective and associated with less pain (32.5 mm vs 28.13 mm, p=0.02), and better patient compliance.
Limitations, reasons for caution
This was a comparative study and the participants were not randomized but were matched for the baseline characteristics. Also due to impact of Covid-19 causing intermittent pause in nonessential facilities like IVF services, a smaller sample size could be enrolled and also clinical outcomes could not be evaluated
Wider implications of the findings
This study, although comparative, for the first time highlights the beneficial role of PRP over SC, thus can establish superiority of PRP as minimally invasive, economical, patient friendly and a recommended therapy for ovarian rejuvenation and folliculogenesis, providing the DOR females an opportunity to produce their own offspring.
Trial registration number
CTRI/2020/01/022726
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Affiliation(s)
- N Singh
- All India Institute Of Medical Sciences AIIMS, Department of Obstetrics & Gynaecology , New Delhi, India
| | - G Patel
- All India Institute Of Medical Sciences AIIMS, Department of Obstetrics & Gynaecology , New Delhi, India
| | - Y Dogra
- Indira Gandhi Institute of Medical Sciences, Reproductive Medicine , Shimla, India
| | - S Mohanty
- All India Institute Of Medical Sciences AIIMS, National Stem Cell Facility , New Delhi, India
| | - T Seth
- All India Institute Of Medical Sciences AIIMS, Department of Haematology , New Delhi, India
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Patel G, Singh N, Malhotra N, Mahey R, Saini M, Sethi A. P-799 To evaluate the effect of Intra-ovarian platelet rich plasma instillation on the clinical outcome of women with diminished ovarian reserve: A prospective interventional study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Does intra-ovarian instillation of platelet rich plasma (PRP) improves the clinical outcome of IVF cycles in women with Diminished Ovarian reserve (DOR)?
Summary answer
PRP instillation leads to consistent improvement in Antral follicle count (AFC), thus achieving clinical pregnancy rate of 33.3% per cycle in women with DOR.
What is known already
There is rising incidence of females with diminished ovarian reserve (DOR) especially among Asian ethnicity. With the emergence of regenerative medicine, multiple studies have evaluated the role of intra-ovarian PRP, demonstrating a beneficial role in improving ovarian reserve parameters (serum Follicular stimulating hormone (FSH), serum anti-Mullerian hormone (AMH), AFC). Despite its’ favorable effects on biochemical markers and AFC, data regarding improvement in clinical outcome remains elusive and led to inception of this study.
Study design, size, duration
A prospective interventional study was conducted at Division of Reproductive Medicine of a tertiary care institute. 41 infertile females aged 20-39 years with DOR (AMH <1.2 ng /ml; AFC<5) were enrolled in the study during a 6-month period beginning from August 2021.
Participants/materials, setting, methods
After informed consent, patients received fresh autologous PRP, prepared from 30 ml venous blood. 1.5ml of PRP instilled in each ovarian stroma between day 7-10 of menstrual cycle under sedation. Patients were followed up for three-consecutive months to assess ovarian reserve parameters including serum FSH, AMH and AFC. Patients showing significant improvement in parameters were recruited for fresh IVF cycles using Antagonist protocol with 1% transdermal testosterone. Outcomes were analysed using linear mix effect model.
Main results and the role of chance
The average platelet concentration in PRP was ∼10,00,000 platelets/µL. The mean age of enrolled patients was 31.22±4.16 years. Linear improvement in AFC (3.63 vs 6.98 vs 7.97 vs 6.90, p<0.001) was observed from baseline to three consecutive follow-up months with maximal response witnessed in second month in 57.1% of those undergoing IVF cycle. However, there was no significant difference in Serum FSH (p=0.11) and AMH (p=0.16) from the baseline post intervention. Of the 41 patients, 35 (85.3%) responded to the treatment and underwent IVF antagonist cycle. 5 out of 35 IVF cycles were cancelled mid-cycle due to poor ovarian response. The mean dose of gonadotropin requirement was 2667.5±281.1 IU (Follicular stimulating hormone) and 1400±337.3 IU (Human menopausal gonadotropin). The average number of oocytes retrieved was 5.7±2.2 whereas mean number of MII oocytes was 4.63±1.85. The fertilization rate and the cleavage rate were 92.4% and 74.1% respectively. Of the thirty patients, eight patients underwent day 2 transfer due to poor grade of embryos. Mean number of grade 1- day 3 embryos was 1.25±0.55 with surplus embryos available for cryopreservation in 14 patients. The overall clinical pregnancy rate per transfer was 33.33%. No adverse events were reported.
Limitations, reasons for caution
This was a prospective single arm study. A randomized controlled trial comprising a “no-treatment” arm would establish a Level-I evidence. However, “no-treatment” arm in a developing country like ours, imposes financial burden on the couple with no guaranteed clinical success and thus raising ethical concern and need for ovarian rejuvenation.
Wider implications of the findings
With the impetus to provide a biological child to these DOR women, intra-ovarian PRP instillation as a method of ovarian rejuvenation holds promising results. Evidently, PRP is not only effective in improving ovarian reserve but this translates into an improved reproductive outcome in a population, previously limited to oocyte donation.
Trial registration number
REF/2022/01/051033
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Affiliation(s)
- G Patel
- All India Institute of Medical Sciences- New Delhi, Division of Reproductive Medicine- Department of Obstetrics and Gynaecology , New Delhi, India
| | - N Singh
- All India Institute of Medical Sciences- New Delhi, Division of Reproductive Medicine- Department of Obstetrics and Gynaecology , New Delhi, India
| | - N Malhotra
- All India Institute of Medical Sciences- New Delhi, Division of Reproductive Medicine- Department of Obstetrics and Gynaecology , New Delhi, India
| | - R Mahey
- All India Institute of Medical Sciences- New Delhi, Division of Reproductive Medicine- Department of Obstetrics and Gynaecology , New Delhi, India
| | - M Saini
- All India Institute of Medical Sciences- New Delhi, Division of Reproductive Medicine- Department of Obstetrics and Gynaecology , New Delhi, India
| | - A Sethi
- All India Institute of Medical Sciences- New Delhi, Division of Reproductive Medicine- Department of Obstetrics and Gynaecology , New Delhi, India
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Sethi A, Singh N, Gupta R, Dwivedi T, Patel G. P-656 Effect of COVID-19 vaccination on clinical outcome in fully vaccinated infertile women undergoing IVF/ICSI cycles at tertiary care centre: prospective observational study. Hum Reprod 2022. [PMCID: PMC9384392 DOI: 10.1093/humrep/deac107.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Study question Does immune response to COVID-19 vaccination affect the clinical outcome in fully vaccinated infertile women undergoing IVF/ICSI cycles? Summary answer COVID-19 IgG antibodies are present in follicular fluid post vaccination and higher immune response increases duration of gonadotrophins required and negatively impacts the IVF outcome. What is known already Recent studies assessed the influence of COVID-19 infection and mRNA COVID-19 vaccine on the stimulation cycle characteristics and embryological variables of patients undergoing IVF cycle and found no effect on the IVF outcome in their immediate IVF cycle after recovery, except for a decreased number of top quality embryos. One study reported infection or mRNA vaccine results in rapid formation of anti-COVID IgG which can be detected in follicular fluid. This immune response did not lead to any significant negative effect on ovarian follicular function. There is a possibility that COVID-19 infection might affect numerous fertility-linked proteins. Study design, size, duration Prospective observational study, conducted at Division of Reproductive Medicine of tertiary care institute. After taking informed consent, 32 patients who satisfy the inclusion and exclusion criteria with history of receiving two doses of Covishield or Covaxin vaccine with at-least 2 weeks from last dose, were recruited for IVF/ICSI cycles from December 2021 to January 2022, for assessing COVID-19 IgG antibodies in their follicular fluid. Participants/materials, setting, methods Women of 21-40 years with normal ovarian reserve and normal uterine cavity were included, those with history of COVID infection were excluded. All patients underwent GnRH antagonist protocol. Follicular fluid was collected at time of oocyte retrieval. After collecting oocytes, 400 microlitre of follicular fluid was stored at -80 and later thawed and analysed for SARS-CoV-2 IgG antibodies (ADVIA Centaur COV2G assay, Germany) which are expressed in index value and reported as reactive (≥1 index). Main results and the role of chance Out of 32, 21 (65.6%) of the participants had received COVISHIELD (V1)and 11 (34.3%) received COVAXIN (V2). The mean gap between vaccine and the IVF cycle was 84.94 ± 52.65 days. The mean COVID IgG antibody titres (Index) were significantly higher in V1, 28.77±33.50 (0.34 -100), than V2 2.28±3.74(0.05-13.23), p<0.001. Patients with higher antibody titres, required longer duration of ovarian stimulation, rho=0.42, p = 0.017. Patients with higher COVID IgG antibodies were negatively correlated with clinical pregnancy rate (20.9 0± 29.68 vs 4.60 ± 6.28, p = 0.153). The time gap from the last dose of vaccine to IVF cycle had moderate negative correlation with percentage of grade-I embryos out of the total embryos fertilised (%), rho= -0.33, p = 0.068. Furthermore, higher gonadotropins doses were required in patients with high antibody titres, rho=0.25, p = 0.160, and amongst V1 vs V2, total dose of gonadotropins required was 3802.38±742.92 vs 3422.73±564.52, respectively, p=0.115. COVID IgG antibody titres had weak negative correlation with number of grade-I embryos, rho= -0.16, p = 0.396. The time gap from the last dose of vaccine to IVF cycle had a weak negative correlation with number of grade-I embryos, rho=-0.28, p = 0.124. Limitations, reasons for caution The main limitation of this study is small sample size. However, the study is currently ongoing, and these are the interim results of the same. As prospective studies with larger sample size would be required to assess the effect of different COVID-19 vaccines in different populations on the IVF outcomes. Wider implications of the findings The present study confirms the presence of COVID IgG antibodies in follicular fluid in vaccinated women, and proves that COVISHIELD vaccinated patients had higher antibody titres. Higher antibody titres require longer duration of stimulation and result in poorer outcomes so a longer interval from vaccine to IVF should be recommended. Trial registration number NA
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Affiliation(s)
- A Sethi
- All India Institute of Medical Sciences, Obstetrics and Gynaecology , New Delhi, India
| | - N Singh
- All India Institute of Medical Sciences, Obstetrics and Gynaecology , New Delhi, India
| | - R Gupta
- All India Institute of Medical Sciences, Lab Oncology , New Delhi, India
| | - T Dwivedi
- All India Institute of Medical Sciences, Lab Oncology , New Delhi, India
| | - G Patel
- All India Institute of Medical Sciences, Obstetrics and Gynaecology , New Delhi, India
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Martinez Saez O, Felip Falgas E, Cappelletti M, Tolosa P, Brasó-Maristany F, Sanfeliu Torres E, Pascual T, Chic N, Vidal M, Adamo B, Munoz M, Faull I, Odegaard J, Patel G, McEwen R, Carroll D, Ciruelos E, Generali D, Margeli Vila M, Prat A. 10P Survival according to early ctDNA dynamics in advanced breast cancer (ABC) treated with endocrine therapy (ET) and a CDK4/6 inhibitor (CDK4/6i). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ramasamy S, Fazel M, Patel G. 260 Comparison of Patient Satisfaction and Outcomes of Day Case Mastectomy Versus Inpatient Model, Using a Validated Questionnaire. Br J Surg 2022. [PMCID: PMC9383525 DOI: 10.1093/bjs/znac039.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Many women undergoing simple mastectomy have an overnight hospital stay. Offering a day case procedure for simple mastectomy has the potential to improve outcomes in terms of patient safety, feasibility, and reduction in associated costs. We aimed to study the proportion of day case mastectomies over a 2-year period and assessed relative readmission and complication rates alongside patient reported outcome measures (PROMs). Following this, we wanted to analyse whether a day case procedure should be routinely offered. Method A retrospective audit was conducted on all patients undergoing a simple mastectomy. Data were collected from patient and pathology records. PROMs were obtained via telephone conversation using the validated BREAST-Q survey. Patient demographics, reason for mastectomy and readmission for complications were all assessed. Results Out of the 202 patients analysed, over 75% had an overnight stay. The most common complications for both groups of patients were readmission due to infection and haematoma evacuation, with similar rates across the two (p = 0.26, p = 0.69). Data from PROMs also suggested that patients had similar outcome and satisfaction levels (p = 0.27). Conclusions The result from this study shows that it is safe as well as acceptable to patients to offer simple mastectomies as a day case procedure. This has become more important since COVID-19 reduced inpatient theatre capacity, and it is anticipated that these outcomes will allow a routine day case mastectomy pathway to be established even when normal operations recommence as encouraged by the association of day case surgery.
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Affiliation(s)
- S. Ramasamy
- Milton Keynes University Hospital, Milton Keynes, United Kingdom
| | - M. Fazel
- Northampton General Hospital, Northampton, United Kingdom
| | - G. Patel
- Milton Keynes University Hospital, Milton Keynes, United Kingdom
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Sacco R, Woolley J, Patel G, Calasans-Maia MD, Yates J. Systematic review of medication related osteonecrosis of the jaw (MRONJ) in patients undergoing only antiangiogenic drug therapy: surgery or conservative therapy? Br J Oral Maxillofac Surg 2022; 60:e216-e230. [PMID: 35115201 DOI: 10.1016/j.bjoms.2021.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 12/31/2020] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Osteonecrosis of the jaw is a severe adverse condition affecting patients exposed to specific types of medications. Previous studies have highlighted that osteonecrosis of the jaw is triggered by invasive dental procedures and can be very challenging to manage, especially in patients with cancer. The primary aim of this review was to analyse all available evidence on the management (surgical and/or conservative) of medication related osteonecrosis of the jaws (MRONJ) in patients with a history of antiangiogenic drugs therapy and who had not been previously exposed to any antiresorptive drug treatments. A multi-database search (PubMed, MEDLINE, EMBASE and CINAHL) was performed to identify related multi-language papers published from January 2003 until November 2020. Data were extracted from relevant papers and analysed according to the outcomes selected in this review. The search generated 28 studies eligible for the analysis. The total number of patients included in the analysis was 36. Sixteen patients were treated with anti-vascular endothelial growth factor drugs (anti-VEGF) while the remaining patients were administered a combination of antiangiogenic drugs. The most common MRONJ site was the mandible in 29 patients. MRONJ recurrence after treatment was only reported in six patients, the majority of which were treated conservatively. The data reviewed confirmed that an invasive procedure was the most common trigger of MRONJ with relatively high frequency of postoperative recurrence following treatment. However, due to the low quality of available research in the literature, it is difficult to draw a definitive conclusion on the validity of the presented treatment to manage patients affected by MRONJ associated with angiogenic therapy.
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Affiliation(s)
- R Sacco
- Clinical Lecturer, University of Manchester Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK; Clinical Teacher, King's College Hospital, Oral Surgery Department, London, UK.
| | - J Woolley
- Dental Core Trainee, Northwick Park Hospital - London North West University Healthcare NHS Trust, Oral and Maxillofacial Surgery Department, London, UK
| | - G Patel
- Dental Core Trainee, Eastman Dental Hospital, Paediatric Dentistry Department, London, UK
| | - M D Calasans-Maia
- Professor of Oral and Maxillofacial Surgery, Fluminense Federal University, Dental School, Oral Surgery Department, Rio de Janeiro, Brazil
| | - J Yates
- Professor of Oral and Maxillofacial Surgery and Implantology, University of Manchester Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK
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Patel G, Rivera A, Brodin P, Velten C, Ye J, Hsu S, Mehta K. Outcomes of Definitive Radiation Therapy for Inoperable Endometrial Cancer and Dosimetric Comparison Study of HDR Brachytherapy vs. SBRT Boost. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lee A, Girling B, Patel G, Sawhney P, Luong M, Ohana D, Forster M, Lee S. MA13.06 Improved Outcomes for Patients Developing Any Immune-Related Adverse Events in Advanced NSCLC Treated With Pembrolizumab Monotherapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Pinato D, Patel M, Lambertini M, Colomba E, Pommeret F, Van Hemelrijick M, Zambelli A, Newsom-Davis T, Salazar R, Bertuzzi A, Gaidano G, Rizzo G, Patel G, Felip E, Prat A, Aguilar-Company J, Tabernero J, Diamantis N, Gennari A, Cortellini A. 1565MO Time-dependent improvement in the clinical outcomes from COVID-19 in cancer patients: An updated analysis of the OnCovid registry. Ann Oncol 2021. [PMCID: PMC8454391 DOI: 10.1016/j.annonc.2021.08.1558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Syeed Z, Forster M, Boukovinas I, Nutting C, Carnell D, Guerrero Urbano T, Sibtain A, Kalavrezos N, Patel G, Al Bakir M, Arkenau HT, Levva S, Gonnet P, Morelli C, Guerriero S, Rofei M, Formica V, Patrikidou A. 889P Development of a head and neck immune prognostic index (HN-IPI) classification for patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) who received immune checkpoint inhibitors (ICIs). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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Mutyala S, Patel G, Rivera AC, Brodin PN, Saigal K, Thawani N, Mehta KJ. High Dose Rate Brachytherapy for Inoperable Endometrial Cancer: a Case Series and Systematic Review of the Literature. Clin Oncol (R Coll Radiol) 2021; 33:e393-e402. [PMID: 34312020 DOI: 10.1016/j.clon.2021.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/14/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
Endometrial cancer is a common gynaecological cancer, is typically early stage and treated with surgery. For patients where surgery is difficult or dangerous, definitive radiation therapy is the next best option. This study included a single institution case series (step 1) and a systematic review of the literature (step 2). In step 1, all endometrial cancer cases that were treated with definitive image-guided brachytherapy at a single institution from 2008 to 2020 were retrospectively analysed. In step 2, a systematic review of Medline (PubMed) from 1975 to 2020 was carried out using the key words around endometrial cancer and brachytherapy, followed by a narrative synthesis. In total, in step 1, 31 cases were included in this study, stages I-IV, with 96.7% receiving external beam radiation. All patients received three fractions of 7.5 Gy or five fractions of 6 Gy high dose rate brachytherapy, with a median EQD2 of 75.55 (40-84.3). The 2-year Kaplan-Meier (KM) local control was 83.1% and the 2-year KM overall survival was 77.4%. There was no late toxicity ≥grade 3. In step 2, 19 articles were included in the final analysis, with between six and 280 patients. The local control ranged from 70 to 100%, with low toxicity. Definitive radiation therapy with image-guided brachytherapy seems to have good local control with low toxicity for patients who are poor surgical candidates.
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Affiliation(s)
- S Mutyala
- University of Arizona College of Medicine - Phoenix, Arizona Oncology Associates, Phoenix, Arizona, USA.
| | - G Patel
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York, USA
| | - A C Rivera
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York, USA
| | - P N Brodin
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York, USA
| | - K Saigal
- Florida Cancer Specialists and Research Institute, Sarasota Memorial, Brian D. Jellison Cancer Center, Sarasota, Florida, USA
| | - N Thawani
- University of Arizona College of Medicine - Phoenix, Creighton University School of Medicine, Dignity Health Cancer Institute, Phoenix, Arizona, USA
| | - K J Mehta
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York, USA
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Sawhney P, Patel G, Ohana D, Luong M, Wong Y, Lee A, Lee SM, Forster M. 208P Safety and efficacy of immune checkpoint inhibitors in NSCLC patients with autoimmune disease: A UK tertiary cancer centre experience. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)02050-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Patel G, Sawhney P, Ohana D, Luong M, Wong Y, Lee A, Forster M. 31P Safety and efficacy of immune checkpoint inhibitors in cancer patients with pre-existing autoimmune disease: A UK tertiary cancer centre experience. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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Cho B, Piotrowska Z, Le X, Goldberg S, Goldman J, De Langen A, Okamoto I, Smith P, Mensi I, Maidment J, Hartmaier R, Li M, Doughton G, Patel G, Pease J, Szekeres P, Riess J, Yu H. P76.27 ORCHARD: A Biomarker-Directed Phase 2 Platform Study in pts with Advanced EGFRm NSCLC Progressing on First-Line Osimertinib. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Patel G, Mandal A, Choudhary S, Mishra R, Shahi U, Mishra H. Myths, facts and scope of spinal cord tolerance dose revision in Intensity modulated SIB treatment of locally advanced head and neck cancer: A dosimetrical and radiobiological demonstration. Cancer Radiother 2020; 25:8-12. [PMID: 33293203 DOI: 10.1016/j.canrad.2020.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/02/2020] [Accepted: 05/09/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To explore the possibility of revising the spinal cord tolerance dose in Simultaneously Integrated Boost (SIB) intensity modulated treatment plan of locally advanced head and neck (H&N) cancer and assessment of achieved planning gain due to the revision. In SIB regimen, the Organ at Risk (OARs) tolerance dose is equally distributed throughout the treatment. Clinicians have usually considered the spinal cord tolerance to be the same as in conventional technique. However, in SIB fractionation regimen with intensity modulation treatment, the spinal cord may receive a physical dose of 45Gy, with much lesser dose per fraction than 2Gy per fraction. So when the dose of spinal cord is distributed throughout the treatment, the tolerance dose limit of physical dose can be considered higher than the usual conventional dose limits. In this study, an attempt has been made to explore the possibilities of dose escalation and treatment planning benefits while exploiting this "Window of Opportunity (WoO)" of increase in spinal cord and Planning Risk Volume (PRV) spinal cord tolerance dose. MATERIAL AND METHODS A total of 12 patients CT data set along with approved structure set of H&N cancer used for treatment planning in. Three independent SIB VMAT plans named as SPC, SPR and SPDE were generated for the 12 patients. First plan (SPC) was generated by considering standard spinal cord tissue constraint of maximum dose of 45Gy and PRV spinal cord maximum dose 50Gy as per QUANTEC summary and second plan (SPR) was generated considering spinal cord tissue constraint of maximum dose 52.50Gy and PRV spinal cord maximum dose 56.35Gy while optimization and dose calculation. The objectives for rest of the Organ at Risk (OAR) were kept same in both the plans during optimization and dose calculation. The SPC plan was copied for creation of third plan (SPDE) in which dose was escalated by increasing dose per fraction for target volumes such that dose to spinal cord reached a maximum dose of 52.50Gy and PRV spinal cord maximum dose of 56.35Gy. In this plan there have been changes to only dose per fraction, however dose optimization and dose calculation have not been performed. Radiobiological parameters TCP and NTCP were also calculated by using indigenously developed software. RESULTS Considering the increase of spinal cord tolerance dose as "window of opportunity", a sufficient escalation in physical dose, Biological Effective Dose (BED) and Tumor Control Probability (TCP) was observed for all target volumes with acceptable level of NTCP values. CONCLUSION Sufficient dose escalation and increased in TCP for target volumes or effective planning benefits can be achieved by revising the spinal cord tolerance dose in intensity modulated SIB treatment of locally advanced H&N cancers.
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Affiliation(s)
- G Patel
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, BHU, Varanasi, India.
| | - A Mandal
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, BHU, Varanasi, India.
| | - S Choudhary
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, BHU, Varanasi, India.
| | - R Mishra
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, BHU, Varanasi, India.
| | - U Shahi
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, BHU, Varanasi, India.
| | - H Mishra
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, BHU, Varanasi, India.
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Patel S, Garg T, Patel G, Roshani, Chaudhury B, Maiti TK. Motion Retargeting and Machine Learning for Humanoid Robotics. 2020 International Symposium on Devices, Circuits and Systems (ISDCS) 2020. [DOI: 10.1109/isdcs49393.2020.9263022] [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: 07/19/2023]
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24
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Yu H, Goldberg S, Le X, Piotrowska Z, Smith P, Mensi I, Kirova B, Chmielecki J, Li-Sucholeicki X, Szekeres P, Doughton G, Patel G, Jewsbury P, Riess J. P2.01-22 ORCHARD: A Phase II Platform Study in Patients with Advanced NSCLC Who Have Progressed on First-Line Osimertinib Therapy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1366] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Patel G, Brodin P, Ohri N, Kaubisch A, Bellemare S, Kinkhabwala M, Kalnicki S, Garg M, Guha C, Kabarriti R. A Clinical Outcomes Analysis for Resectable Intrahepatic Cholangiocarcinoma in an Urban Academic Medical Center. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bayne K, Splan D, Patel G, Ravindhar J, Spruiel A, Haq T, Szczypka M, Capone J. A novel, single-use bioreactor system for expansion of human mesenchymal stem/stromal cells. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Patel G, Tase A, Caplin S, Barry J. Public cost of privately inserted laparoscopic adjustable gastric bands. BJS Open 2019; 3:314-316. [PMID: 31183447 PMCID: PMC6551392 DOI: 10.1002/bjs5.50141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/13/2018] [Indexed: 12/04/2022] Open
Abstract
Background Laparoscopic adjustable gastric banding (LAGB) remains a commonly performed procedure for morbid obesity. Concerns regarding its long‐term consequences include high rates of band removal from complications and failure to lose weight. Many private practices continue to perform LAGB but, owing to short follow‐up periods, the burden of surgical complications falls upon National Health Service (NHS) bariatric units. This study aimed to review the NHS treatment of patients for complications related to privately performed LAGB. Methods All surgical complications following bariatric surgery referred to the Welsh Institute of Metabolic and Obesity Surgery (WIMOS) between September 2010 and September 2014 were reviewed. Type of complication, procedures performed, and number of outpatient attendances and inpatient stays were recorded. Costs of treatment were estimated using standard tariffs. Results A total of 78 patients presented with complications after privately performed bariatric surgery. Sixty had undergone LAGB; the remainder had had other bariatric procedures. Median age was 45 (range 22–78) years, and 65 (83 per cent) were women. Urgent band deflation was undertaken in 53 patients. Band removal surgery was required in 32 patients; one patient needed a subtotal gastrectomy. There was a total of 123 outpatient/ward attendances and 340 days of inpatient care, including 10 days of intensive care. The estimated total cost to the NHS of managing these patients was €337 400 (€84 350 per annum). Conclusion The cost burden to the NHS of managing the complications of bariatric surgery performed in the private sector is considerable. Although it is imperative that such complications be managed in well equipped specialist units, private surgery providers should have better follow‐up plans and/or contractual agreements with the NHS.
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Affiliation(s)
- G Patel
- Welsh Institute of Metabolic Disease and Obesity Surgery Morriston Hospital Swansea UK
| | - A Tase
- Welsh Institute of Metabolic Disease and Obesity Surgery Morriston Hospital Swansea UK
| | - S Caplin
- Welsh Institute of Metabolic Disease and Obesity Surgery Morriston Hospital Swansea UK
| | - J Barry
- Welsh Institute of Metabolic Disease and Obesity Surgery Morriston Hospital Swansea UK
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Patel G, Pasha M. SCREENING FOR HEREDITARY ANGIOEDEMA IN INFANCY. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.286] [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: 10/27/2022]
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Patel G, Pasha M. USE OF OMALIZUMAB IN FOUR-YEAR-OLD WITH SEVERE PERSISTENT ALLERGIC ASTHMA. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Agnihotri N, Patel G, Greenberger P. HYPERSENSITIVITY PNEUMONITIS DUE TO AN OUTDOOR ANTIGEN IN THE HOME. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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DeSouza K, Zammit R, Simpson L, Watson L, Bracewell K, Whitfield C, Bloomfield D, Simcock R, Sinha R, Westwell S, Moss C, Moss A, Sham J, Patel G. Defining the Older Patient Population (>65 Years) Treated for Metastatic Breast Cancer (mBC) Within the Sussex Cancer Network. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Splan D, Ravindhar J, Spruiel A, Bayne K, Liu J, Patel G, Szczypka M. Single-use system for expansion of human mesenchymal stem/stromal cells for preclinical process development. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Losos M, Biller E, Li J, Blower L, Hamad D, Patel G, Scrape S, Cataland S, Chen J. Prolonged platelet storage associated with increased frequency of transfusion-related adverse events. Vox Sang 2017; 113:170-176. [DOI: 10.1111/vox.12622] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/19/2017] [Accepted: 11/07/2017] [Indexed: 12/14/2022]
Affiliation(s)
- M. Losos
- Department of Pathology and Immunology; Baylor College of Medicine; Houston TX USA
| | - E. Biller
- Department of Pathology; The Ohio State University Wexner Medical Center; Columbus OH USA
| | - J. Li
- College of Pharmacy; The Ohio State University Wexner Medical Center; Columbus OH USA
| | - L. Blower
- Department of Pathology; The Ohio State University Wexner Medical Center; Columbus OH USA
| | - D. Hamad
- Department of Pathology; The Ohio State University Wexner Medical Center; Columbus OH USA
| | - G. Patel
- Department of Pathology; The Ohio State University Wexner Medical Center; Columbus OH USA
| | - S. Scrape
- Department of Pathology; The Ohio State University Wexner Medical Center; Columbus OH USA
| | - S. Cataland
- Department of Internal Medicine; Division of Hematology; The Ohio State University Wexner Medical Center; Columbus OH USA
| | - J. Chen
- Department of Pathology; The Ohio State University Wexner Medical Center; Columbus OH USA
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Patel G, Kellner E, Saltoun C. P176 A case of acute urticaria and angioedema from an underlying bacterial infection. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Patel G, Chandar A, Rehman H, Guo S. P385 A case of immune thrombocytopenia (itp) and acquired factor viii inhibitor refractory to immunosuppression. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fallowfield L, May S, Matthews L, Jenkins V, Mackay J, Arbon A, Hack B, Hall J, Harper-Wynne C, Hinde S, Moss A, Thanopoulou E, Westwell S, Wlaszly D, Simcock R, Patel G, Bloomfield D. Enhancing decision-making about adjuvant chemotherapy in ER+, HER2- early breast cancer (EBC) following EndoPredict testing. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Patel G, Tanskanen V, Hujala E, Hyvärinen J. Direct contact condensation modeling in pressure suppression pool system. Nuclear Engineering and Design 2017. [DOI: 10.1016/j.nucengdes.2016.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Koll B, Patel G, Anderson R, LoPachin V. ISQUA17-2869HOW TO C A DIFFERENCE: A MULTIDISCIPLINARY APPROACH TO C. DIFFICILE. Int J Qual Health Care 2017. [DOI: 10.1093/intqhc/mzx125.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moreno-Ortega M, Rowny S, Prudic J, Kangarlu A, Lee S, Patel G, Grinband J, Javitt D. Differential coupling of the dorsolateral prefrontal cortex with default network and visual cortex in patients recovered from depression after convulsive therapy. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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40
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Patel G, Liu J, Splan D, Szczypka M. Simple and efficient cell harvest methods for microcarrier cultures in bioreactors. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Lanfredini S, Powel K, Gore J, Patel G. 110 Basal cell carcinoma cancer stem cells promote immune evasion. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vallabhaneni S, Kallen A, Tsay S, Chow N, Welsh R, Kerins J, Kemble SK, Pacilli M, Black SR, Landon E, Ridgway J, Palmore TN, Zelzany A, Adams EH, Quinn M, Chaturvedi S, Greenko J, Fernandez R, Southwick K, Furuya EY, Calfee DP, Hamula C, Patel G, Barrett P, Lafaro P, Berkow EL, Moulton-Meissner H, Noble-Wang J, Fagan RP, Jackson BR, Lockhart SR, Litvintseva AP, Chiller TM. Investigation of the First Seven Reported Cases of Candida auris, a Globally Emerging Invasive, Multidrug-Resistant Fungus-United States, May 2013-August 2016. Am J Transplant 2017; 17:296-299. [PMID: 28029734 DOI: 10.1111/ajt.14121] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
November 11, 2016/65(44);1234-1237. What is already known about this topic? Candida auris is an emerging pathogenic fungus that has been reported from at least a dozen countries on four continents during 2009-2015. The organism is difficult to identify using traditional biochemical methods, some isolates have been found to be resistant to all three major classes of antifungal medications, and C. auris has caused health care-associated outbreaks. What is added by this report? This is the first description of C. auris cases in the United States. C. auris appears to have emerged in the United States only in the last few years, and U.S. isolates are related to isolates from South America and South Asia. Evidence from U.S. case investigations suggests likely transmission of the organism occurred in health care settings. What are the implications for public health practice? It is important that U.S. laboratories accurately identify C. auris and for health care facilities to implement recommended infection control practices to prevent the spread of C. auris. Local and state health departments and CDC should be notified of possible cases of C. auris and of isolates of C. haemulonii and Candida spp. that cannot be identified after routine testing.
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Affiliation(s)
- S Vallabhaneni
- Mycotic Diseases Branch, Division of Food Water and Environmental Diseases, CDC, Atlanta, GA
| | - A Kallen
- Division of Healthcare Quality Promotion, CDC, Atlanta, GA
| | - S Tsay
- Mycotic Diseases Branch, Division of Food Water and Environmental Diseases, CDC, Atlanta, GA.,Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, CDC, Atlanta, GA
| | - N Chow
- Mycotic Diseases Branch, Division of Food Water and Environmental Diseases, CDC, Atlanta, GA
| | - R Welsh
- Mycotic Diseases Branch, Division of Food Water and Environmental Diseases, CDC, Atlanta, GA
| | - J Kerins
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, CDC, Atlanta, GA.,Chicago Department of Public Health, Chicago, IL
| | - S K Kemble
- Chicago Department of Public Health, Chicago, IL
| | - M Pacilli
- Chicago Department of Public Health, Chicago, IL
| | - S R Black
- Chicago Department of Public Health, Chicago, IL
| | - E Landon
- University of Chicago, Chicago, IL
| | | | - T N Palmore
- National Institutes of Health Clinical Center, Bethesda, MD
| | - A Zelzany
- National Institutes of Health Clinical Center, Bethesda, MD
| | - E H Adams
- New York State Department of Health, New York, NY
| | - M Quinn
- New York State Department of Health, New York, NY
| | - S Chaturvedi
- New York State Department of Health, New York, NY
| | - J Greenko
- New York State Department of Health, New York, NY
| | - R Fernandez
- New York State Department of Health, New York, NY
| | - K Southwick
- New York State Department of Health, New York, NY
| | - E Y Furuya
- Columbia University College of Physicians & Surgeons, New York, NY
| | | | - C Hamula
- Mount Sinai Health System/Icahn School of Medicine at Mount Sinai, New York, NY
| | - G Patel
- Mount Sinai Health System/Icahn School of Medicine at Mount Sinai, New York, NY
| | - P Barrett
- New Jersey Department of Health, Trenton, NJ
| | - P Lafaro
- Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - E L Berkow
- Mycotic Diseases Branch, Division of Food Water and Environmental Diseases, CDC, Atlanta, GA
| | | | - J Noble-Wang
- Division of Healthcare Quality Promotion, CDC, Atlanta, GA
| | - R P Fagan
- Division of Healthcare Quality Promotion, CDC, Atlanta, GA
| | - B R Jackson
- Mycotic Diseases Branch, Division of Food Water and Environmental Diseases, CDC, Atlanta, GA
| | - S R Lockhart
- Mycotic Diseases Branch, Division of Food Water and Environmental Diseases, CDC, Atlanta, GA
| | - A P Litvintseva
- Mycotic Diseases Branch, Division of Food Water and Environmental Diseases, CDC, Atlanta, GA
| | - T M Chiller
- Mycotic Diseases Branch, Division of Food Water and Environmental Diseases, CDC, Atlanta, GA
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Bobek H, Baldwin R, Miller V, Patel G, Shah S. P086 Silicone allergy and implantable cardioverter defibrillators: a patch test case study. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kabarriti R, Patel G, Ohri N, Haynes H, Ow T, Tassler A, Packer S, Schiff B, Smith R, Haigentz M, Guha C, Kalnicki S, Garg M. Outcomes for Patients With Locally Advanced Hypopharyngeal Squamous Cell Carcinoma Treated With Definitive Radiation Using Intensity Modulated Radiation Therapy With Adaptive Planning. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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45
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Sullivan T, Taimur S, Rana M, Patel G, Pinney S, Anyanwu A, Huprikar S. Successful Heart Transplantation in Patients with Active Staphylococcus Bloodstream Infection and Suspected Mechanical Circulatory Support Device Infection. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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46
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Taimur S, Sullivan T, Rana M, Patel G, Ashley K, Roldan J, Griffin B, Pinney S, Anyanwu A, Huprikar S. Successful Heart Transplantation in Patients with Total Artificial Heart Infections. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Daib S, Sedlacek S, Hamlington B, Brzeskiewicz L, Goetsch B, Tedesco K, Patel G, Sudhoff K, Mullineaux L, Langer L. Abstract P2-09-19: The performance of next generation panel testing in individuals assessed by a community-based genetics program. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-09-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION: Genetic testing identifies patients with an increased risk for hereditary cancer and assists in development of clinical management or cancer prevention strategies. Utilization of multigene panels for patients with a personal or family history of cancer has the ability to identify a significant number of pathogenic variants in high risk and moderate risk genes. Importantly, at-risk patients with previously negative single gene testing can be retested with multigene panels. We characterized the mutations found in patients who had inherited cancer multi-gene panel testing, including patients with negative BRCA testing, and explored the phenotypes associated with the most prevalently mutated gene.
METHODS: Patients were identified by a Community-Based Genetics Program and sent to a commercial laboratory for multi-gene panel testing. A retrospective query of multi-gene oncology tests was performed: patient history, family history and previous genetic test results were reported on the requisition. The following Genes were Utilized in the Inherited Cancer Panels: High risk genes (APC, BMPR1, BRCA1, BRCA2, CDH1, CDKN2A, EPCAM, MLH1, MSH2, MSH6, MUTYH, PMS2, PTEN, SMAD4, STK11, TP53, VHL), moderate risk genes (ATM, CHEK2, PALB2), and genes with increase risk of unknown magnitude (AXIN2, BARD1, BRIP1, CDK4, FANCC, NBN, RAD51C, RAD51D, XRCC2). The combination of genes analyzed was depends on the panel ordered.
RESULTES:
529 individuals were tested with 38 individuals with pathogenic variant (PV) or variant expected to be pathogenic (VEP). Of the 529 individuals, 154 (29%) had previous testing and 12 (7.8%) had PV/VEP. Interestingly, 48% of PV/VEP were in the moderate risk genes ATM, PALB2, CHEK2, and CHEK2 being the most commonly mutated gene. The following table details the genes with Positive and VEP Results:
Table 1: Gene Distribution Patients with PV/VEPGeneN%CHEK21333.3BRCA2512.8BRCA1410.2MUTYH512.8PALB2410.2ATM25.13RAD51C12..56MLH112.56MSH212.56MSH612.56PTEN12.56BRIP112.56
The majority of patients with CHEK2 mutations had a personal history of breast cancer (69%), but the family histories exhibited varied phenotypic expression.
Personal and Family History for Patients with CHEK2 PV/VEP or VUS (N=26)SitePersoanl historyFamily historyBreast1819Uterine11Ovarian16Colon 9Lung 1Pancreatic 3Gastric 2Renal 2Lymphoma 4Brain 2Skin 2Esophageal 1Prostate 6Thyroid 2Gynecologic 1
CONCLUSION: Inherited cancer panels provide patients with genetic information that would otherwise be missed by single gene testing and provides access to risk assessment and medical management. Using multigene panels, PV/VEP were discovered in 7.8% of patients with previous negative BRCA testing. CHEK2, a moderate risk gene, was identified in 33% of patients with a PV/VEP. The phenotypic expression for CHEK2 is primarily breast cancer with a wide spectrum of solid and hematological tumors.
Citation Format: Daib S, Sedlacek S, Hamlington B, Brzeskiewicz L, Goetsch B, Tedesco K, Patel G, Sudhoff K, Mullineaux L, Langer L. The performance of next generation panel testing in individuals assessed by a community-based genetics program. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-19.
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Affiliation(s)
- S Daib
- Rocky Mountain Cancer Centers, Denver, CO; 207 Perry Parkway, Gaithersburg, MD; Texas Oncology; Compass Oncology; New York Oncology/Hematology
| | - S Sedlacek
- Rocky Mountain Cancer Centers, Denver, CO; 207 Perry Parkway, Gaithersburg, MD; Texas Oncology; Compass Oncology; New York Oncology/Hematology
| | - B Hamlington
- Rocky Mountain Cancer Centers, Denver, CO; 207 Perry Parkway, Gaithersburg, MD; Texas Oncology; Compass Oncology; New York Oncology/Hematology
| | - L Brzeskiewicz
- Rocky Mountain Cancer Centers, Denver, CO; 207 Perry Parkway, Gaithersburg, MD; Texas Oncology; Compass Oncology; New York Oncology/Hematology
| | - B Goetsch
- Rocky Mountain Cancer Centers, Denver, CO; 207 Perry Parkway, Gaithersburg, MD; Texas Oncology; Compass Oncology; New York Oncology/Hematology
| | - K Tedesco
- Rocky Mountain Cancer Centers, Denver, CO; 207 Perry Parkway, Gaithersburg, MD; Texas Oncology; Compass Oncology; New York Oncology/Hematology
| | - G Patel
- Rocky Mountain Cancer Centers, Denver, CO; 207 Perry Parkway, Gaithersburg, MD; Texas Oncology; Compass Oncology; New York Oncology/Hematology
| | - K Sudhoff
- Rocky Mountain Cancer Centers, Denver, CO; 207 Perry Parkway, Gaithersburg, MD; Texas Oncology; Compass Oncology; New York Oncology/Hematology
| | - L Mullineaux
- Rocky Mountain Cancer Centers, Denver, CO; 207 Perry Parkway, Gaithersburg, MD; Texas Oncology; Compass Oncology; New York Oncology/Hematology
| | - L Langer
- Rocky Mountain Cancer Centers, Denver, CO; 207 Perry Parkway, Gaithersburg, MD; Texas Oncology; Compass Oncology; New York Oncology/Hematology
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Kumar R, Patel G, Kichenadasse G, Sukumaran S, Roy A, Koczwara B, Bowden JJ, Leung J, Woo T, Karapetis CS. Delayed onset of benign pleural effusion following concurrent chemoradiotherapy for inoperable non-small-cell lung cancer. Intern Med J 2015; 45:218-21. [PMID: 25650537 DOI: 10.1111/imj.12658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/25/2014] [Indexed: 11/26/2022]
Abstract
Chronic benign pleural effusion (BPE) is a rare complication of concurrent chemoradiotherapy (CRT) for inoperable stage IIIA non-small-cell lung cancer (NSCLC). This report presents three cases of BPE, the workup to differentiate this benign condition from recurrence of cancer and recommends a pleural biopsy as part of the diagnostic process. These inflammatory exudates often remain indolent, and may not require drainage or surgical intervention. In the absence of clinical, radiological and pathological evidence of recurrent disease, we recommend clinicians manage these patients expectantly, using regular clinical assessment and imaging.
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Affiliation(s)
- R Kumar
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia
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Sheikh O, Patel S, Jabbar S, Patel G, Logan G, Ayliffe P. Bilateral proptosis, a worrying sign in the paediatric patient. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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King T, Patel G, Dutta S, Korb S, Wade J, Foulds P, Sumeray M. Evaluation of the effects of the weak CYP3A4 inhibitors atorvastatin and ethinyl estradiol/norgestimate on lomitapide pharmacokinetics in healthy subjects. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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