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Patel H, Drinkwater K, Stewart A. National Survey of Current Follow-up Protocols for Patients Treated for Endometrial Cancer in the UK. Clin Oncol (R Coll Radiol) 2024; 36:e146-e153. [PMID: 38548582 DOI: 10.1016/j.clon.2024.03.001] [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: 04/27/2023] [Revised: 12/12/2023] [Accepted: 03/08/2024] [Indexed: 05/06/2024]
Abstract
AIMS The aim of this study was to establish a baseline of national practice for follow-up after treatment for endometrial cancer in the UK. MATERIALS AND METHODS An online cross-sectional survey was developed and distributed through the Royal College of Radiologists via an email link to the audit leads of radiotherapy centres in the UK. The survey was conducted from November 2021 to 5 January 2022. The main themes assessed in the survey were the form, frequency and duration of follow-up practices. RESULTS There were a total of 43/61 (70%) complete responses. 93% of centres had a standard follow-up protocol and 7% who did not have a follow-up protocol discharged patients after the post-operative review. Five centres (13%) used molecular profiling to inform follow-up practices. Patient-initiated follow-up was mainly used in the cohort of patients who had surgery alone with no adjuvant treatment (68%, (19/28)). In the cohort who had face-to-face follow-up, the majority had pelvic examinations as part of their review and total follow-up for five years. 93% of respondents are interested in a national follow-up protocol. CONCLUSION Our data shows that there is national variation in practise with regard to follow-up of women treated for endometrial cancer. Many of the follow-up practises are based on conventional follow-up regimens and these may fail to address the more holistic needs of cancer survivors. Recent publication of updated guidance from the British Gynaecological Cancer Society may help standardise practise and provide a more relevant approach to follow-up for women treated for endometrial cancer.
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Affiliation(s)
- H Patel
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK.
| | | | - A Stewart
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; University of Surrey, Guildford, UK
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Nishizaki D, Kurzrock R, Miyashita H, Adashek JJ, Lee S, Nikanjam M, Eskander RN, Patel H, Botta GP, Nesline MK, Pabla S, Conroy JM, DePietro P, Sicklick JK, Kato S. Viewing the immune checkpoint VISTA: landscape and outcomes across cancers. ESMO Open 2024; 9:102942. [PMID: 38503143 PMCID: PMC10966162 DOI: 10.1016/j.esmoop.2024.102942] [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: 09/01/2023] [Revised: 12/18/2023] [Accepted: 02/16/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Optimizing immune checkpoint inhibitor (ICI) therapy may require identification of co-targetable checkpoint pathways via immune profiling. Herein, we analyzed the transcriptomic expression and clinical correlates of V-domain immunoglobulin suppressor of T-cell activation (VISTA), a promising targetable checkpoint. PATIENTS AND METHODS RNA sequencing was carried out on 514 tissues reflecting diverse advanced/metastatic cancers. Expression of eight immune checkpoint markers [lymphocyte-activation gene 3 (LAG-3), tumor necrosis factor receptor superfamily 14 (TNFRSF14), programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), programmed death-ligand 2 (PD-L2), B- and T-lymphocyte attenuator (BTLA), T-cell immunoglobulin and mucin domain-containing protein 3 (TIM-3), cytotoxic T-lymphocyte antigen 4 (CTLA-4)], in addition to VISTA, was analyzed, along with clinical outcomes. RESULTS High VISTA RNA expression was observed in 32% of tumors (66/514) and was the most common highly expressed checkpoint among the nine assessed. High VISTA expression was independently correlated with high BTLA, TIM-3, and TNFRSF14, and with a diagnosis of pancreatic, small intestine, and stomach cancer. VISTA transcript levels did not correlate with overall survival (OS) from metastatic/advanced disease in the pan-cancer cohort or with immunotherapy outcome (progression-free survival and OS from the start of ICI) in 217 ICI-treated patients. However, in ICI-treated pancreatic cancer patients (n = 16), median OS was significantly shorter (from immunotherapy initiation) for the high- versus not-high-VISTA groups (0.28 versus 1.21 years) (P = 0.047); in contrast, VISTA levels were not correlated with OS in 36 pancreatic cancer patients who did not receive ICI. CONCLUSION High VISTA expression correlates with high BTLA, TIM-3, and TNFRSF14 checkpoint-related molecules and with poorer post-immunotherapy survival in pancreatic cancer, consistent with prior literature indicating that VISTA is prominently expressed on CD68+ macrophages in pancreatic cancers and requiring validation in larger prospective studies. Immunomic analysis may be important for individualized precision immunotherapy.
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Affiliation(s)
- D Nishizaki
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla.
| | - R Kurzrock
- MCW Cancer Center and Genomic Sciences and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, USA; WIN Consortium, Paris, France
| | - H Miyashita
- Dartmouth Cancer Center, Hematology and Medical Oncology, Lebanon
| | - J J Adashek
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore
| | - S Lee
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla
| | - M Nikanjam
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla
| | - R N Eskander
- Center for Personalized Cancer Therapy and Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla
| | - H Patel
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla
| | - G P Botta
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla
| | | | | | | | | | - J K Sicklick
- Division of Surgical Oncology, Department of Surgery, Center for Personalized Cancer Therapy, University of California San Diego, La Jolla, USA
| | - S Kato
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla.
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Webber C, Patel H, Cunningham A, Fox A, Vousden J, Castles A, Shapiro L. An experimental comparison of additional training in phoneme awareness, letter-sound knowledge and decoding for struggling beginner readers. Br J Educ Psychol 2024; 94:282-305. [PMID: 37984992 DOI: 10.1111/bjep.12641] [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: 12/05/2019] [Revised: 10/05/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Despite evidence that synthetic phonics teaching has increased reading attainments, a sizable minority of children struggle to acquire phonics skills and teachers lack clear principles for deciding what types of additional support are most beneficial. Synthetic phonics teaches children to read using a decoding strategy to translate letters into sounds and blend them (e.g., c-a-t = "k - ae - t" = "cat"). To use a decoding strategy, children require letter-sound knowledge (LSK) and the ability to blend sound units (phonological awareness; PA). Training on PA has been shown to benefit struggling beginning readers. However, teachers in English primary schools do not routinely check PA. Instead, struggling beginner readers usually receive additional LSK support. AIMS Until now, there has been no systematic comparison of the effectiveness of training on each component of the decoding process. Should additional support for struggling readers focus on improving PA, or on supplementary LSK and/or decoding instruction? We aim to increase understanding of the roles of LSK and PA in children's acquisition of phonics skills and uncover which types of additional training are most likely to be effective for struggling beginner readers. SAMPLE AND METHOD We will compare training on each of these components, using a carefully controlled experimental design. We will identify reception-age children at risk of reading difficulties (target n = 225) and randomly allocate them to either PA, LSK or decoding (DEC) training. We will test whether training type influences post-test performance on word reading and whether any effects depend on participants' pre-test PA and/or LSK. RESULTS AND CONCLUSIONS Two hundred and twenty-two participants completed the training. Planned analyses showed no effects of condition on word reading. However, exploratory analyses indicated that the advantage of trained over untrained words was significantly greater for the PA and DEC conditions. There was also a significantly greater improvement in PA for the DEC condition. Overall, our findings suggest a potential advantage of training that includes blending skills, particularly when decoding words that had been included in training. Future research is needed to develop a programme of training on blending skills combined with direct vocabulary instruction for struggling beginner readers.
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Affiliation(s)
- Charlotte Webber
- Institute of Health and Neurodevelopment, School of Psychology, Aston University, Birmingham, UK
- Moray House School of Eucation and Sport, University of Edinburgh, Edinburgh, UK
| | - Hetal Patel
- Institute of Health and Neurodevelopment, School of Psychology, Aston University, Birmingham, UK
| | - Anna Cunningham
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Amy Fox
- Institute of Health and Neurodevelopment, School of Psychology, Aston University, Birmingham, UK
- Psychology and Human Development, Institute of Education, Faculty of Education and Society, University College London, London, UK
| | - Janet Vousden
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Anne Castles
- Australian Centre for the Advancement of Literacy, Australian Catholic University, Sydney, New South Wales, Australia
| | - Laura Shapiro
- Institute of Health and Neurodevelopment, School of Psychology, Aston University, Birmingham, UK
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Bailey JA, Morton AJ, Jones J, Chapman CJ, Oliver S, Morling JR, Patel H, Humes DJ, Banerjea A. 'Low' faecal immunochemical test (FIT) colorectal cancer: a 4-year comparison of the Nottingham '4F' protocol with FIT10 in symptomatic patients. Colorectal Dis 2024; 26:309-316. [PMID: 38173125 DOI: 10.1111/codi.16848] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 01/05/2024]
Abstract
AIM The aim of this work was to evaluate colorectal cancer (CRC) outcomes after 'low' (sub-threshold) faecal immunochemical test (FIT) results in symptomatic patients tested in primary care. METHOD This work comprised a retrospective audit of 35 289 patients with FIT results who had consulted their general practitioner with lower gastrointestinal symptoms and had subsequent CRC diagnoses. The Rapid Colorectal Cancer Diagnosis pathway was introduced in November 2017 to allow incorporation of FIT into clinical practice. The local '4F' protocol combined FIT results with blood tests and digital rectal examination (DRE): FIT, full blood count, ferritin and finger [DRE]. The outcome used was detection rates of CRC, missed CRC and time to diagnosis in local 4F protocols for patients with a subthreshold faecal haemoglobin (fHb) result compared with thresholds of 10 and 20 μg Hb/g faeces. RESULTS A single threshold of 10 μg Hb/g faeces identifies a population in whom the risk of CRC is 0.2%, but this would have missed 63 (10.5%) of 599 CRCs in this population. The Nottingham 4F protocol would have missed fewer CRCs [42 of 599 (7%)] despite using a threshold of 20 μg Hb/g faeces for patients with normal blood tests. Subthreshold FIT results in patients subsequently diagnosed with a palpable rectal tumour yielded the longest delays in diagnosis. CONCLUSION A combination of FIT with blood results and DRE (the 4F protocol) reduced the risk of missed or delayed diagnosis. Further studies on the impact of such protocols on the diagnostic accuracy of FIT are expected. The value of adding blood tests to FIT may be restricted to specific parts of the fHb results spectrum.
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Affiliation(s)
- J A Bailey
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Queens Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - A J Morton
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Queens Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - J Jones
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C J Chapman
- Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Oliver
- NHS Nottingham and Nottinghamshire Integrated Care Board, Nottingham, UK
| | - J R Morling
- NHS Nottingham and Nottinghamshire Integrated Care Board, Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, UK
| | - H Patel
- NHS Nottingham and Nottinghamshire Integrated Care Board, Nottingham, UK
| | - D J Humes
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - A Banerjea
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Savage H, Pareek S, Lee J, Ballarò R, Minussi DC, Hayek K, Sadullozoda M, Lochmann BS, McQuade JL, LaVoy EC, Marmonti E, Patel H, Wang G, Imanishi M, Kotla S, Abe JI, Schadler K. Aerobic Exercise Alters the Melanoma Microenvironment and Modulates ERK5 S496 Phosphorylation. Cancer Immunol Res 2023; 11:1168-1183. [PMID: 37307577 PMCID: PMC10527747 DOI: 10.1158/2326-6066.cir-22-0465] [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: 06/08/2022] [Revised: 12/16/2022] [Accepted: 06/06/2023] [Indexed: 06/14/2023]
Abstract
Exercise changes the tumor microenvironment by remodeling blood vessels and increasing infiltration by cytotoxic immune cells. The mechanisms driving these changes remain unclear. Herein, we demonstrate that exercise normalizes tumor vasculature and upregulates endothelial expression of VCAM1 in YUMMER 1.7 and B16F10 murine models of melanoma but differentially regulates tumor growth, hypoxia, and the immune response. We found that exercise suppressed tumor growth and increased CD8+ T-cell infiltration in YUMMER but not in B16F10 tumors. Single-cell RNA sequencing and flow cytometry revealed exercise modulated the number and phenotype of tumor-infiltrating CD8+ T cells and myeloid cells. Specifically, exercise caused a phenotypic shift in the tumor-associated macrophage population and increased the expression of MHC class II transcripts. We further demonstrated that ERK5 S496A knock-in mice, which are phosphorylation deficient at the S496 residue, "mimicked" the exercise effect when unexercised, yet when exercised, these mice displayed a reversal in the effect of exercise on tumor growth and macrophage polarization compared with wild-type mice. Taken together, our results reveal tumor-specific differences in the immune response to exercise and show that ERK5 signaling via the S496 residue plays a crucial role in exercise-induced tumor microenvironment changes. See related Spotlight by Betof Warner, p. 1158.
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Affiliation(s)
- Hannah Savage
- Department of Pediatric Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center UTHealth, Houston, TX, USA
| | - Sumedha Pareek
- Department of Pediatric Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center UTHealth, Houston, TX, USA
| | - Jonghae Lee
- Department of Pediatric Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Riccardo Ballarò
- Department of Pediatric Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Darlan Conterno Minussi
- Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center UTHealth, Houston, TX, USA
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karma Hayek
- Faculty of Science, McGill University, Montreal, Quebec, Canada
| | - Mumina Sadullozoda
- Department of Pediatric Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brooke S. Lochmann
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer L. McQuade
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily C. LaVoy
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Enrica Marmonti
- Department of Pediatric Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hetal Patel
- Department of Pediatric Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guangyu Wang
- Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, Texas, USA
| | - Masaki Imanishi
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sivareddy Kotla
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- These authors contributed equally
| | - Jun-ichi Abe
- Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center UTHealth, Houston, TX, USA
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- These authors contributed equally
| | - Keri Schadler
- Department of Pediatric Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center UTHealth, Houston, TX, USA
- These authors contributed equally
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6
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Bella S, Salo D, Delong C, Patel H, Rometti M, Bryczkowski C, Patwa A. Agreement on Interpretation of Point-of-Care Ultrasonography for Cardiac Tamponade Among Emergency Physicians. Cureus 2023; 15:e41913. [PMID: 37457602 PMCID: PMC10349541 DOI: 10.7759/cureus.41913] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 07/18/2023] Open
Abstract
STUDY OBJECTIVE Cardiac tamponade is an impending calamitous disorder that emergency physicians need to consider and diagnose rapidly. A pericardial effusion with right atrial systolic collapse (earliest sign) or right ventricular diastolic collapse (most specific sign) and a plethoric inferior vena cava are indicators of cardiac tamponade physiology and may be identified with point-of-care ultrasonography (POCUS). The goal of this study is to assess the agreement among emergency physicians with varying levels of sonographic training and expertise in interpreting echocardiographic signs of cardiac tamponade in adult patients. Methods: Emergency physicians at different levels of training as sonographers were surveyed at didactic conferences at three major academic medical centers in northern New Jersey. Two cardiologists were also included in the study for comparison. Survey respondents were shown 15, 20-second video clips of patients who had presented to the emergency department (ED) with or without significant pericardial effusions and were asked to rate whether tamponade physiology was present or not. Data were collected anonymously on Google Forms (Google LLC, Mountain View, CA) and included self-reported levels of POCUS expertise and level of training. Data were analyzed using Fleiss' kappa (k). All patients had an echocardiogram performed by the department of cardiology within 24 hours of the POCUS, and the results are presented in the paper. Results: There were 97 participant raters, including attendings, fellows, and resident physicians specializing in adult emergency medicine and two cardiologists. There was a fair degree of inter-rater agreement among all participants in interpreting whether tamponade physiology was present or not. This low level of agreement persisted across self-reported training levels and self-reported POCUS expertise, even at the expert level in both emergency medicine and cardiology specialties. CONCLUSION According to the results of our study, there appears to be a low level of agreement in the interpretation of cardiac tamponade in adult patients. The lack of agreement persisted across specialties, self-reported training levels, and self-reported ultrasonographic expertise. This low level of agreement seen among both specialists indicates that emergency physicians are not limited in their ability to determine cardiac tamponade on POCUS. This highlights the technical nature of POCUS clips and strengthens the importance of physical exam findings when diagnosing cardiac tamponade in emergency department patients. Further research utilizing POCUS for the diagnosis of tamponade is warranted.
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Affiliation(s)
- Sarah Bella
- Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, New York, USA
| | - David Salo
- Emergency Medicine, Morristown Medical Center, Morristown, USA
| | - Claire Delong
- Emergency Medicine, Morristown Medical Center, Morristown, USA
| | - Hetal Patel
- Emergency Medicine, Newark Beth Israel Medical Center, Newark, USA
| | - Mary Rometti
- Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | | | - Amy Patwa
- Emergency Medicine, Morristown Medical Center, Morristown, USA
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Hladik W, Stupp P, McCracken SD, Justman J, Ndongmo C, Shang J, Dokubo EK, Gummerson E, Koui I, Bodika S, Lobognon R, Brou H, Ryan C, Brown K, Nuwagaba-Biribonwoha H, Kingwara L, Young P, Bronson M, Chege D, Malewo O, Mengistu Y, Koen F, Jahn A, Auld A, Jonnalagadda S, Radin E, Hamunime N, Williams DB, Kayirangwa E, Mugisha V, Mdodo R, Delgado S, Kirungi W, Nelson L, West C, Biraro S, Dzekedzeke K, Barradas D, Mugurungi O, Balachandra S, Kilmarx PH, Musuka G, Patel H, Parekh B, Sleeman K, Domaoal RA, Rutherford G, Motsoane T, Bissek ACZK, Farahani M, Voetsch AC. The epidemiology of HIV population viral load in twelve sub-Saharan African countries. PLoS One 2023; 18:e0275560. [PMID: 37363921 DOI: 10.1371/journal.pone.0275560] [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: 09/19/2022] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND We examined the epidemiology and transmission potential of HIV population viral load (VL) in 12 sub-Saharan African countries. METHODS We analyzed data from Population-based HIV Impact Assessments (PHIAs), large national household-based surveys conducted between 2015 and 2019 in Cameroon, Cote d'Ivoire, Eswatini, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Blood-based biomarkers included HIV serology, recency of HIV infection, and VL. We estimated the number of people living with HIV (PLHIV) with suppressed viral load (<1,000 HIV-1 RNA copies/mL) and with unsuppressed viral load (viremic), the prevalence of unsuppressed HIV (population viremia), sex-specific HIV transmission ratios (number female incident HIV-1 infections/number unsuppressed male PLHIV per 100 persons-years [PY] and vice versa) and examined correlations between a variety of VL metrics and incident HIV. Country sample sizes ranged from 10,016 (Eswatini) to 30,637 (Rwanda); estimates were weighted and restricted to participants 15 years and older. RESULTS The proportion of female PLHIV with viral suppression was higher than that among males in all countries, however, the number of unsuppressed females outnumbered that of unsuppressed males in all countries due to higher overall female HIV prevalence, with ratios ranging from 1.08 to 2.10 (median: 1.43). The spatial distribution of HIV seroprevalence, viremia prevalence, and number of unsuppressed adults often differed substantially within the same countries. The 1% and 5% of PLHIV with the highest VL on average accounted for 34% and 66%, respectively, of countries' total VL. HIV transmission ratios varied widely across countries and were higher for male-to-female (range: 2.3-28.3/100 PY) than for female-to-male transmission (range: 1.5-10.6/100 PY). In all countries mean log10 VL among unsuppressed males was higher than that among females. Correlations between VL measures and incident HIV varied, were weaker for VL metrics among females compared to males and were strongest for the number of unsuppressed PLHIV per 100 HIV-negative adults (R2 = 0.92). CONCLUSIONS Despite higher proportions of viral suppression, female unsuppressed PLHIV outnumbered males in all countries examined. Unsuppressed male PLHIV have consistently higher VL and a higher risk of transmitting HIV than females. Just 5% of PLHIV account for almost two-thirds of countries' total VL. Population-level VL metrics help monitor the epidemic and highlight key programmatic gaps in these African countries.
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Affiliation(s)
- Wolfgang Hladik
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Paul Stupp
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Stephen D McCracken
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Jessica Justman
- ICAP at Columbia University, New York, New York, United States of America
| | - Clement Ndongmo
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Judith Shang
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Emily K Dokubo
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | | | | | - Stephane Bodika
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Roger Lobognon
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Hermann Brou
- ICAP at Columbia University, New York, New York, United States of America
| | - Caroline Ryan
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Kristin Brown
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | | | - Leonard Kingwara
- National AIDS and STI's Control Programme, Ministry of Health, Nairobi, Kenya
| | - Peter Young
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Megan Bronson
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Duncan Chege
- ICAP at Columbia University, New York, New York, United States of America
| | - Optatus Malewo
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Yohannes Mengistu
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Frederix Koen
- ICAP at Columbia University, New York, New York, United States of America
| | | | - Andrew Auld
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Sasi Jonnalagadda
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Elizabeth Radin
- ICAP at Columbia University, New York, New York, United States of America
| | | | - Daniel B Williams
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Eugenie Kayirangwa
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Veronicah Mugisha
- ICAP at Columbia University, New York, New York, United States of America
| | - Rennatus Mdodo
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Stephen Delgado
- ICAP at Columbia University, New York, New York, United States of America
| | | | - Lisa Nelson
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Christine West
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Samuel Biraro
- ICAP at Columbia University, New York, New York, United States of America
| | | | - Danielle Barradas
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | | | - Shirish Balachandra
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Peter H Kilmarx
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Godfrey Musuka
- ICAP at Columbia University, New York, New York, United States of America
| | - Hetal Patel
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Bharat Parekh
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Katrina Sleeman
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Robert A Domaoal
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - George Rutherford
- University of California San Francisco, San Francisco, California, United States of America
| | | | - Anne-Cécile Zoung-Kanyi Bissek
- Division of Operational Research for Health, Ministry of Health, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Mansoor Farahani
- ICAP at Columbia University, New York, New York, United States of America
| | - Andrew C Voetsch
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
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8
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Martin CE, Patel H, Dzierewski JM, Moeller FG, Bierut LJ, Grucza RA, Xu KY. Benzodiazepine, Z-drug, and sleep medication prescriptions in male and female people with opioid use disorder on buprenorphine and comorbid insomnia: an analysis of multistate insurance claims. Sleep 2023; 46:zsad083. [PMID: 36970994 PMCID: PMC10262036 DOI: 10.1093/sleep/zsad083] [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: 12/02/2022] [Revised: 03/19/2023] [Indexed: 03/29/2023] Open
Abstract
STUDY OBJECTIVES In adult populations, women are more likely than men to be prescribed benzodiazepines. However, such disparities have not been investigated in people with opioid use disorder (OUD) and insomnia receiving buprenorphine, a population with particularly high sedative/hypnotic receipt. This retrospective cohort study used administrative claims data from Merative MarketScan Commercial and MultiState Medicaid Databases (2006-2016) to investigate sex differences in the receipt of insomnia medication prescriptions among patients in OUD treatment with buprenorphine. METHODS We included people aged 12-64 years with diagnoses of insomnia and OUD-initiating buprenorphine during the study timeframe. The predictor variable was sex (female versus male). The primary outcome was receipt of insomnia medication prescription within 60 days of buprenorphine start, encompassing benzodiazepines, Z-drugs, or non-sedative/hypnotic insomnia medications (e.g. hydroxyzine, trazodone, and mirtazapine). Associations between sex and benzodiazepine, Z-drug, and other insomnia medication prescription receipt were estimated using Poisson regression models. RESULTS Our sample included 9510 individuals (female n = 4637; male n = 4873) initiating buprenorphine for OUD who also had insomnia, of whom 6569 (69.1%) received benzodiazepines, 3891 (40.9%) Z-drugs, and 8441 (88.8%) non-sedative/hypnotic medications. Poisson regression models, adjusting for sex differences in psychiatric comorbidities, found female sex to be associated with a slightly increased likelihood of prescription receipt: benzodiazepines (risk ratio [RR], RR = 1.17 [1.11-1.23]), Z-drugs (RR = 1.26 [1.18-1.34]), and non-sedative/hypnotic insomnia medication (RR = 1.07, [1.02-1.12]). CONCLUSIONS Sleep medications are commonly being prescribed to individuals with insomnia in OUD treatment with buprenorphine, with sex-based disparities indicating a higher prescribing impact among female than male OUD treatment patients.
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Affiliation(s)
- Caitlin E Martin
- Department of Obstetrics and Gynecology and VCU Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Hetal Patel
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - F. Gerard Moeller
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J Siteman Cancer Center, Barnes Jewish Hospital, St. Louis, MO, USA
| | - Richard A Grucza
- Departments of Family and Community Medicine and Health and Outcomes Research, St. Louis University, St. Louis, MO, USA
| | - Kevin Y Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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9
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Acosta CJ, Diaz C, Nordio F, Han HH, Moss KJ, Bohning K, Kumar P, Liu M, Patel H, Pacciarini F, Mwangi V, Walter E, Powell TD, El Sahly HM, Baldwin WR, Santangelo J, Anderson EJ, Dubin G. Persistence of Immunogenicity of a Purified Inactivated Zika Virus Vaccine Candidate in Healthy Adults: 2 Years of Follow-up Compared With Natural Infection. J Infect Dis 2023; 227:1303-1312. [PMID: 36484441 PMCID: PMC10226659 DOI: 10.1093/infdis/jiac482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/09/2022] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND We report 2-year persistence of immune response to Takeda's prophylactic purified formalin-inactivated whole Zika virus vaccine candidate (TAK-426) compared with that observed after natural infection. METHODS A randomized, observer-blind, placebo-controlled, dose-selection, phase 1 trial was conducted in 18-49-year-old adults at 9 centers (7 in the United States, 2 in Puerto Rico) from 13 November 2017 to 24 November 2020. Primary objectives were safety, tolerability, and immunogenicity of 3 increasing doses of TAK-426 administered as 2 doses 28 days apart to flavivirus (FV)-naive and FV-primed adults. Here, we report on safety and persistence of immunity up to 2 years after primary vaccination with 10-μg TAK-426, the highest dose, and compare neutralizing antibody responses with those observed after natural infection. RESULTS TAK-426 at 10-μg had an acceptable safety profile in FV-naive and FV-primed adults up to 24 months after dose 2. Seropositivity for neutralizing antibodies was 100% at 1 year, and 93.8% and 76.2% at 2 years in FV-naive and FV-primed groups, respectively. TAK-426 responses were comparable in magnitude and kinetics with those elicited by natural Zika virus infection. CONCLUSIONS These results support the further clinical development of TAK-426 for both FV-naive and FV-primed populations. CLINICAL TRIALS REGISTRATION NCT03343626.
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Affiliation(s)
| | - Clemente Diaz
- Puerto Rico Clinical and Translational Research Consortium, San Juan, Puerto Rico
| | | | | | | | | | - Pradeep Kumar
- Takeda Pharmaceuticals International AG, Zürich, Switzerland
| | - Mengya Liu
- Takeda Vaccines Inc, Cambridge, Massachusetts, USA
| | - Hetal Patel
- Takeda Vaccines Inc, Cambridge, Massachusetts, USA
| | | | | | - Elke Walter
- Takeda Pharmaceuticals International AG, Zürich, Switzerland
| | - Tim D Powell
- Takeda Vaccines Inc, Cambridge, Massachusetts, USA
| | | | | | | | | | - Gary Dubin
- Takeda Pharmaceuticals International AG, Zürich, Switzerland
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10
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Patel H, Ulloa A, Buchan S, Abdulnoor M, Gubbay J, Murti M. COVID-19 farm outbreaks in Ontario, January-December 2020. Can Commun Dis Rep 2023; 49:206-212. [PMID: 38414536 PMCID: PMC10898618 DOI: 10.14745/ccdr.v49i05a06] [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] [Indexed: 02/29/2024]
Abstract
Background Farm workers are critical to Ontario's food supply chain as they grow and harvest the food that Ontario relies on; however, they are subject to several occupation-related coronavirus disease 2019 (COVID-19) transmission risk factors. We describe the epidemiology of farm outbreaks in Ontario over the first calendar year of the pandemic and explore trends in outbreaks by season and type of farm. Methods Data pertaining to farm outbreaks in Ontario from January 1 to December 31, 2020, and their associated laboratory-confirmed cases were extracted from the provincial database. Outbreaks were characterized by size, season, farm type and duration. Cases were characterized by age, gender, medical risk factors, clinical presentation and outcomes. Results There were 64 farm outbreaks associated with 2,202 confirmed cases of COVID-19 in Ontario during 2020. The majority of outbreaks occurred in spring (n=25, 39.1%) and fall (n=25, 39.1%). The fewest outbreaks occurred in the summer (n=6, 9.4%), corresponding with low community rates during that time, and the majority of these were in greenhouse farms (n=5, 83.3%). The median outbreak size was 14.5 cases (range: 1-240), and the median duration was 23 days (range: 0-128). Among cases, most were male (83.2%), the median age was 35 years, 10.0% had one or more comorbidities, 31.2% were asymptomatic, 16 required hospitalization and three died. Conclusion Farm outbreaks were a source of COVID-19 transmission and illness in 2020, particularly in the spring and fall. Outbreaks continued in greenhouse farms despite lower summer community transmission.
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Affiliation(s)
- Hetal Patel
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - Sarah Buchan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
- Public Health Ontario, Toronto, ON
| | - Mariana Abdulnoor
- Department of Laboratory Medicine and Pathology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Jonathan Gubbay
- Public Health Ontario, Toronto, ON
- Department of Laboratory Medicine and Pathology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Michelle Murti
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
- Public Health Ontario, Toronto, ON
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11
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Hughes D, Ng SM, Smyth D, Patel H, Kent S, Henry A, Blore C, Dawoud B, Kumar D, Jefferies C, Kyzas P, Collaborators MTR. Emergency versus semi-elective management of mandible fractures: a Maxillofacial Trainee Research Collaborative (MTReC) study. Ann R Coll Surg Engl 2023; 105:461-468. [PMID: 35904336 PMCID: PMC10149241 DOI: 10.1308/rcsann.2022.0063] [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: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Recent evidence suggests that acute emergency management of mandible fractures does not improve surgical outcomes yet is associated with increased financial burden. Current NHS policy advocating for increased adoption of day-case and semi-elective surgical procedures to reduce bed strain must be balanced with providing timely, effective treatment. Our research aims to determine patient groups currently managed via semi-elective admission and whether this can be extended to other groups to provide safe and effective management of mandible fractures. METHODS A multi-national trainee-led audit of mandibular fractures across 49 units was completed by the Maxillofacial Trainee Research Collaborative (MTReC). Each unit prospectively collected data on fractures on admission and at follow-up. Data collected included patient demographics, behaviour, health, injury, timing to intervention and surgical complications. RESULTS Data were collected on 947 mandibular fractures. Of the surgically managed patients, 649 (90%) were managed via acute emergency admission at the time of presentation, while 68 (10%) were managed semi-electively. Patient demographics, injury pattern and mechanism appeared to significantly affect timing of management, whereas patient behaviour, health status, timing of injury and presentation did not. Semi-elective management was associated with a significantly shorter inpatient duration (0.9 versus 1.9 days, p=0.000) with no differences in readmission, antibiotic usage or surgical complications (p=1.000, RR 1.030). CONCLUSION Our study demonstrates the efficacy of planned admissions and semi-elective management of mandibular fractures. Simple mandibular fractures in compliant patients are suitable for semi-elective treatment. Holistic patient assessment and tailored surgical planning is crucial in determining admission modality to effectively manage mandibular trauma.
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Affiliation(s)
| | - SM Ng
- Kings College Hospital, UK
| | | | | | - S Kent
- University Hospital of Wales, UK
| | - A Henry
- Cwm Taf Morgannwg University Health Board, Merthyr Tydfil, UK
| | - C Blore
- University Hospitals of North Midlands NHS Trust, UK
| | | | - D Kumar
- Liverpool Medical School, UK
| | | | - P Kyzas
- East Lancashire Hospitals NHS Trust, UK
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12
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Faisaluddin M, Ahmed AZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Gender Disparities in LVAD Utilization: A NIS Database Analysis 2009-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.442] [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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13
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Faisaluddin M, Ahmed AZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Racial and Regional Disparities in Lvad Utilization: A Nis Database Analysis 2009-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.789] [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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14
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Faisaluddin M, Ahmed AIZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Burden of Arrythmias and Hospital Outcomes Among Patients with Heart Transplant: A Nis Database Analysis from 2015-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.530] [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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15
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Faisaluddin M, Ahmed AZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Burden of Arrythmias and Hospital Outcomes Among Patients with Left Ventricular Assisted Device Patients: A Nis Database Analysis from 2015-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.790] [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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16
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Faisaluddin M, Ahmed AZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Gender Disparities in the Heart Transplant Implantation: A Nationwide Study from 2009-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.788] [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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17
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Tereshchenko LG, Pourbemany J, Haq KT, Patel H, Hyde J, Quadri S, Ibrahim H, Tongpoon A, Pourbemany R, Khan A. An electrophysiological substrate of COVID-19. J Electrocardiol 2023; 79:61-65. [PMID: 36963283 PMCID: PMC10027233 DOI: 10.1016/j.jelectrocard.2023.03.010] [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: 11/22/2022] [Revised: 02/28/2023] [Accepted: 03/11/2023] [Indexed: 03/24/2023]
Abstract
SARS-CoV-2 infection is associated with an increased risk of late cardiovascular (CV) outcomes. However, more data is needed to describe the electrophysiologic (EP) manifestation of post-acute CV sequelae of COVID-19. We compared two cohorts of adult patients with SARS-CoV-2 polymerase chain reaction (PCR) test and an electrocardiogram (ECG) performed between March 1, 2020, and September 13, 2020, in a retrospective double-cohort study, "Cardiovascular Risk Stratification in Covid-19" (CaVaR-Co19; NCT04555187). Patients with positive PCR comprised a COVID-19(+) cohort (n = 41; 61% women; 80% symptomatic), whereas patients with negative tests formed the COVID-19(-) cohort (n = 155; 56% women). In longitudinal analysis, comparing 3 ECGs recorded before, during, and on average 40 days after index COVID-19 episode, after adjustment for demographic and socioeconomic characteristics, baseline CV risk factors and comorbidities, use of prescription medications (including QT-prolonging drugs) before and during index COVID-19 episode, and the longitudinal changes in RR' intervals, heart rhythm, and ventricular conduction type, only in the COVID-19(+) cohort QTc increased by +30.2(95% confidence interval [CI] 0.1-60.3) ms and the spatial ventricular gradient (SVG) elevation increased by +13.5(95%CI 1.2-25.9)°. In contrast, much smaller, statistically nonsignificant changes were observed in the COVID-19(-) cohort. In conclusion, post-acute CV sequelae of SARS-CoV-2 infection manifested on ECG by QTc prolongation and rotation of the SVG vector upward.
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Affiliation(s)
- Larisa G Tereshchenko
- Cleveland Clinic Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland, OH, USA.
| | - Jafar Pourbemany
- Cleveland Clinic Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland, OH, USA
| | - Kazi T Haq
- Children's National Hospital, Washington, DC, USA
| | - Hetal Patel
- Chicago Medical School at Rosalind Franklin University, North Chicago, IL, USA
| | - Jessica Hyde
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Suha Quadri
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Habiba Ibrahim
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Aaron Tongpoon
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Akram Khan
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
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18
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Young PW, Musingila P, Kingwara L, Voetsch AC, Zielinski-Gutierrez E, Bulterys M, Kim AA, Bronson MA, Parekh BS, Dobbs T, Patel H, Reid G, Achia T, Keter A, Mwalili S, Ogollah FM, Ondondo R, Longwe H, Chege D, Bowen N, Umuro M, Ngugi C, Justman J, Cherutich P, De Cock KM. HIV Incidence, Recent HIV Infection, and Associated Factors, Kenya, 2007-2018. AIDS Res Hum Retroviruses 2023; 39:57-67. [PMID: 36401361 PMCID: PMC9942172 DOI: 10.1089/aid.2022.0054] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Nationally representative surveys provide an opportunity to assess trends in recent human immunodeficiency virus (HIV) infection based on assays for recent HIV infection. We assessed HIV incidence in Kenya in 2018 and trends in recent HIV infection among adolescents and adults in Kenya using nationally representative household surveys conducted in 2007, 2012, and 2018. To assess trends, we defined a recent HIV infection testing algorithm (RITA) that classified as recently infected (<12 months) those HIV-positive participants that were recent on the HIV-1 limiting antigen (LAg)-avidity assay without evidence of antiretroviral use. We assessed factors associated with recent and long-term (≥12 months) HIV infection versus no infection using a multinomial logit model while accounting for complex survey design. Of 1,523 HIV-positive participants in 2018, 11 were classified as recent. Annual HIV incidence was 0.14% in 2018 [95% confidence interval (CI) 0.057-0.23], representing 35,900 (95% CI 16,300-55,600) new infections per year in Kenya among persons aged 15-64 years. The percentage of HIV infections that were determined to be recent was similar in 2007 and 2012 but fell significantly from 2012 to 2018 [adjusted odds ratio (aOR) = 0.31, p < .001]. Compared to no HIV infection, being aged 25-34 versus 35-64 years (aOR = 4.2, 95% CI 1.4-13), having more lifetime sex partners (aOR = 5.2, 95% CI 1.6-17 for 2-3 partners and aOR = 8.6, 95% CI 2.8-26 for ≥4 partners vs. 0-1 partners), and never having tested for HIV (aOR = 4.1, 95% CI 1.5-11) were independently associated with recent HIV infection. Although HIV remains a public health priority in Kenya, HIV incidence estimates and trends in recent HIV infection support a significant decrease in new HIV infections from 2012 to 2018, a period of rapid expansion in HIV diagnosis, prevention, and treatment.
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Affiliation(s)
- Peter Wesley Young
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Maputo, Mozambique.,Address correspondence to: Peter Wesley Young, U.S. Embassy Maputo, Avenida Marginal nr 5467, Sommerschield, Distrito Municipal de KaMpfumo, Caixa Postal 783, CEP 0101-11 Maputo, Mozambique
| | - Paul Musingila
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Leonard Kingwara
- National AIDS & STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Andrew C. Voetsch
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily Zielinski-Gutierrez
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya.,Central America Regional Office, U.S. Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Marc Bulterys
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Andrea A. Kim
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan A. Bronson
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bharat S. Parekh
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trudy Dobbs
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hetal Patel
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Giles Reid
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | - Thomas Achia
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Alfred Keter
- National AIDS & STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Samuel Mwalili
- Department of Statistics and Actuarial Sciences, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Raphael Ondondo
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Herbert Longwe
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | - Duncan Chege
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | - Nancy Bowen
- National Public Health Laboratory, Ministry of Health, Nairobi, Kenya
| | - Mamo Umuro
- National Public Health Laboratory, Ministry of Health, Nairobi, Kenya
| | | | - Jessica Justman
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | | | - Kevin M. De Cock
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
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19
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Hussein K, Patel H, Drew T. Total spinal anaesthesia and respiratory arrest during patient transfer following unrecognised subdural catheter placement during labour. Int J Obstet Anesth 2023; 53:103621. [PMID: 36634447 DOI: 10.1016/j.ijoa.2022.103621] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/07/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Affiliation(s)
- K Hussein
- The Rotunda Hospital, Dublin, Ireland.
| | - H Patel
- The Rotunda Hospital, Dublin, Ireland
| | - T Drew
- The Rotunda Hospital, Dublin, Ireland; Beaumont Hospital, Dublin, Ireland
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20
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Aliyu GG, Lawton JG, Mitchell AB, Abimiku AG, Jelpe T, Bassey O, Riedel DJ, Swaminathan M, Chang JCW, DeVos JR, Patel H, Charurat ME, Stafford KA. Prevalence of HIV drug resistance in Nigeria: results from a cross-sectional, population-based survey of Nigerian adults with unsuppressed viral load. AIDS 2023; 37:333-339. [PMID: 36541644 DOI: 10.1097/qad.0000000000003413] [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: 12/24/2022]
Abstract
BACKGROUND HIV drug resistance (HIVDR) surveillance is an important tool to monitor threats to progress towards epidemic control. The characterization of HIVDR in Nigeria at the national level is needed to inform both clinical decisions and population-level HIV policy strategies. This study uses data obtained from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) to describe the prevalence and distribution of HIVDR in Nigeria. METHODS NAIIS was a cross-sectional, population-based survey of households throughout Nigeria in 2018. NAIIS was designed to provide estimates of HIV prevalence and related health indicators from a nationally representative sample. The study population included participants aged 15-64 years who tested positive for HIV, had a viral load at least 1000 copies/ml, and had available HIV drug resistance genotypes. HIV isolates were genotyped to detect drug resistance mutations. Individual characteristics of study participants associated with HIVDR were identified using a weighted multivariable logistic regression model. RESULTS Of 1355 respondents with available HIV genotypes, 293 (19%) had evidence of drug-resistant mutations (DRMs) that conferred resistance to at least one antiretroviral drug. The majority of DRMs observed conferred resistance to NNRTIs (17.6%) and NRTIs (11.2%). HIVDR was associated with being ART-experienced, longer duration on ART, and lower CD4+ count but not sociodemographic characteristics. CONCLUSION The population level DRM prevalence in Nigeria was consistent with what would be expected in a mature HIV treatment landscape. The continued roll out of dolutegravir-anchored regimens should mitigate the impact of NNRTI resistance on population viral load suppression and progress towards epidemic control.
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Affiliation(s)
- Gambo G Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Jonathan G Lawton
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Andrew B Mitchell
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alash'le G Abimiku
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.,Institute of Human Virology-Nigeria
| | - Tapdiyel Jelpe
- Division of Global HIV & TB, Department of Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Orji Bassey
- Division of Global HIV & TB, Department of Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - David J Riedel
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mahesh Swaminathan
- Division of Global HIV & TB, Department of Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Joy Chih-Wei Chang
- International Laboratories Branch, Department of Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua R DeVos
- International Laboratories Branch, Department of Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hetal Patel
- International Laboratories Branch, Department of Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Man E Charurat
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristen A Stafford
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.,Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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21
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Hernandez J, Patel H, Biddlecome P, Kildea M, Dwivedi R, Sridhara S, Silvestry S, Cavarocchi N, Francis JL, Ventura D. Evaluation of Latex Immunoturbidimetric Assay Thresholds and HIT in Cardiothoracic Surgery. Clin Appl Thromb Hemost 2023; 29:10760296231166370. [PMID: 37069794 PMCID: PMC10123911 DOI: 10.1177/10760296231166370] [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: 01/11/2023] [Revised: 03/01/2023] [Accepted: 03/12/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Heparin-induced thrombocytopenia (HIT) is a common differential diagnosis in cardiothoracic surgery. The latex immunoturbidimetric assay (LIA) is an enhanced immunoassay that has recently been introduced for the detection of total HIT immunoglobulin and retains a higher specificity of 95% compared to the enzyme-linked immunosorbent assay. OBJECTIVES To investigate if a semiquantitative relationship exists between increasing LIA levels beyond the current positivity threshold and its correlation to positive serotonin release assay results in cardiothoracic surgery. METHODS This was a multicenter, observational cohort of cardiothoracic surgery patients initiated on anticoagulation with heparin-based products. To conduct sensitivity and specificity analysis of LIA values, HIT positive was defined as a LIA value ≥1 unit/mL and HIT negative was defined as a LIA level <1 unit/mL. A receiver operating characteristic (ROC) analysis was utilized to evaluate the predictive performance of the LIA. RESULTS At manufactures' cutoffs of ≥1.0 unit/mL, LIA sensitivity and specificity was 93.8% and 22%, respectively, yielding a false positive rate of 78%. At a higher cutoff of 4.5 units/mL, LIA sensitivity and specificity was 75% and 71%, respectively, yielding a false positive rate of 29% and an area under the ROC curve of 0.75 (P = .01; 95% confidence interval: 0.621-0.889). Bivalirudin was initiated in 84.6% of false positive LIA results. CONCLUSION This study suggests that the diagnostic accuracy of the LIA can be optimized by increasing the LIA positivity threshold. Proposing a higher LIA cutoff, may mitigate unwarranted anticoagulation and bleeding outcomes.
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Affiliation(s)
- Jessica Hernandez
- Ascension Via Christi St. Francis, Wichita, KS, USA
- Department of Pharmacy, AdventHealth Orlando, Orlando, FL, USA
- College of Pharmacy, University of Kansas, Lawrence, KS, USA
| | - Hetal Patel
- Department of Pharmacy, AdventHealth Orlando, Orlando, FL, USA
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Phil Biddlecome
- Department of Pharmacy, AdventHealth Orlando, Orlando, FL, USA
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Megan Kildea
- Department of Pharmacy, AdventHealth Orlando, Orlando, FL, USA
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Ruti Dwivedi
- Department of Pharmacy, AdventHealth Orlando, Orlando, FL, USA
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Shashank Sridhara
- Department of Pharmacy, AdventHealth Orlando, Orlando, FL, USA
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | | | - Nicholas Cavarocchi
- Department of Critical Care Medicine, AdventHealth Medical Group, Orlando, FL, USA
| | - John L. Francis
- AdventHealth Hemostasis and Thrombosis Laboratory, Orlando, USA
| | - Davide Ventura
- College of Pharmacy, University of Kansas, Lawrence, KS, USA
- College of Pharmacy, University of Florida, Gainesville, FL, USA
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22
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Chen H, Durinck S, Patel H, Foreman O, Mesh K, Eastham J, Caothien R, Newman RJ, Roose-Girma M, Darmanis S, Warming S, Lattanzi A, Liang Y, Haley B. Population-wide gene disruption in the murine lung epithelium via AAV-mediated delivery of CRISPR-Cas9 components. Molecular Therapy - Methods & Clinical Development 2022; 27:431-449. [DOI: 10.1016/j.omtm.2022.10.016] [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] [Received: 06/14/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022]
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23
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Bollenbecker S, Patel Z, Punjani Z, Charania A, Patel H, Saleh M, Budhwani K. PP054 Simultaneous rapid preclinical therapeutic evaluation in a novel ex vivo bioreactor. ESMO Open 2022. [DOI: 10.1016/j.esmoop.2022.100729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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24
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Dasgupta S, Das P, Pan A, Ghosh C, Roy P, Mukherjee S, Barua M, Patel H, Biswas A. Chlorhexidine (2.5%)–alcohol versus povidone-iodine (10%) alcohol for surgical site antisepsis in cesarean section in a tertiary care hospital – A prospective observational and analytical study. Asian J Med Sci 2022. [DOI: 10.3126/ajms.v13i12.46971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Rising trends of cesarean section globally demand identification of most suitable pre-operative antiseptic agent to minimize surgical site infections (SSI) and its consequences.
Aims and Objectives: The aims of this study were to determine, compare, and analyze SSI developing following the use of chlorhexidine (2.5%)–alcohol and povidone-iodine (10%) alcohol as pre-operative antiseptic agents in cesarean section.
Materials and Methods: A prospective, observational, and analytical study was conducted in a tertiary care center for 1 year, where 300 women receiving pre-cesarean surgical site antisepsis with chlorhexidine (2.5%)–alcohol were compared with another 300 receiving povidone-iodine (10%) alcohol.
Results: The two study groups were compared in terms of various sociodemographic and clinical parameters which might act as confounding factors and were found to be similar. As compared to women receiving povidone-iodine (10%) alcohol, women receiving chlorhexidine (2.5%)–alcohol had significantly lesser incidence of overall (P<0.001), superficial (P<0.001), and deep (P<0.05) SSI, infections developing at 48 h–5 days (P<0.001) and at 5 days–30 days (P<0.05). There was no significant difference among the two groups with respect to wound swab culture reports and post-SSI inflammatory markers. As compared to the povidone-iodine group, in the chlorhexidine group, a significantly (P<0.05) greater percentage healed with meager dressing and a significantly (P<0.05) lesser percentage required secondary suturing and readmissions and had a significantly (P<0.05) lesser mean duration of hospital stay.
Conclusion: Chlorhexidine (2.5%)–alcohol appears to be a better pre-operative surgical site anti-septic agent than povidone-iodine (10%) alcohol in cesarean section.
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25
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Gill J, Jeelani H, Patel H. The utilization and mortality benefits of pulmonary artery catheterization in patients with cardiogenic shock. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1500] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Pulmonary artery catheterization (PAC) can provide essential hemodynamic data to assist in managing critical patients with cardiogenic shock. The use of PAC has been controversial as clinical studies have shown a lack of benefit. However, with the recent widespread availability of mechanical circulatory assists devices, the application and benefits of PAC are expected to rise.
Purpose
To determine the impact of PAC on inpatient outcomes and the utilization of advanced heart failure devices in these patients.
Methods
The National Inpatient Sample from 2016 to 2018 was queried to identify patients with cardiogenic shock. Of these patients, we compared those who received invasive hemodynamic monitoring (IHM) with PAC to those who did not receive PAC. Patients under age 18 and those undergoing surgical or transcatheter cardiac procedures during the same admission were excluded. Multivariate logistic regression was used to select matched samples between groups accounting for patient/hospital demographics and medical comorbidities. The primary endpoint was a comparison of in-hospital mortality, length of hospitalization, and medical costs. The secondary endpoints compared the utilization of mechanical circulatory assists devices: percutaneous ventricular assist devices (pVAD), extracorporeal membrane oxygenation (ECMO), and left ventricular assist device (LVAD), and the incidence of post-PAC complications: pneumothorax, sepsis, and hemorrhage/hematoma.
Results
We identified a total of 279,619 patients admitted with cardiogenic shock, of these patients 25,166 (9%) received IHM with PAC. Patients who had PAC had decreased in-hospital mortality (22.3% vs 29.7%; p<0.001), increased length of hospitalization (12 days vs 9 days; p<0.001), and increased medical costs ($65,884 vs $47,983; p<0.001). Furthermore, in patients with PAC there was increased utilization of pVAD (4.5% vs 1.9%; p<0.001), ECMO (0.07% vs 0.01%; p<0.001), and LVAD (2.2% vs 0.3%; p<0.001). There was no difference in the prevalence of post-PAC complications between both groups.
Conclusions
The use of IHM with PAC was associated with improved mortality and utilization of mechanical circulatory assist devices in patients with cardiogenic shock without increasing risk for post-procedural complications. Therefore, the increased average duration and medical costs of hospitalization with PAC patients likely resulted from improved patient survival. Therefore, the present study indicated that IHM with PAC is safe and beneficial for patients with cardiogenic shock.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Gill
- Rosalind Franklin University , North Chicago , United States of America
| | - H Jeelani
- Rosalind Franklin University , North Chicago , United States of America
| | - H Patel
- Rosalind Franklin University , North Chicago , United States of America
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26
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Victor V, Thakkar S, Patel H, Deshmukh A, Desimone C, Feitell SC, Blankstein R. A nationwide analysis of cardiac sarcoidosis and related in-hospital outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2647] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Sarcoidosis is a multisystem disorder characterized by an autoimmune response to an unidentified antigen in genetically susceptible persons. Despite clinically detectable cardiac manifestations of sarcoidosis occurring in approximately 5% of patients, recent studies have revealed cardiac involvement to be at 25% in patients with the disease, highlighting the fact that cardiac involvement in sarcoidosis is much more common than was once thought to be.
Purpose
With cardiac involvement in sarcoidosis being increasingly recognized due to the availability of advanced cardiac imaging, large scale data regarding in-hospital mortality and clinical outcomes of patients admitted with cardiac sarcoidosis (CS) is lacking. Our study aimed to fill this knowledge gap by analyzing demographics and in-hospital outcomes of a large cohort of patients admitted with CS across the United States (US).
Methods
We analyzed data from the national inpatient sample (NIS) database between October 2015 to December 2018 to identify patients who had been admitted with primary and secondary diagnoses of CS. The NIS is an administrative database sponsored by the Agency for Healthcare Research and Quality consisting of data from 46 participating states, representing more than 95% of the US population and providing nationwide estimates of over 35 million hospitalizations annually. The NIS uses de-identified hospital discharges as samples and hence no additional ethical committee approval was required. International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code D86.85 was used to identify hospitalizations with CS in patients aged 18 years or older. SAS 9.4 (SAS Institute, Inc, Cary, NC) was used for statistical analyses.
Results
A total of 4275 patients were included in the analysis. A higher proportion of patients with CS were females (62.43% vs. 37.57%). Hypertension was the most common comorbidity (43.99%), followed by hyperlipidemia (39.21%) and chronic kidney disease (26.95%). All-cause in-hospital mortality was 2.57%. Atrial fibrillation (AF) was the most common arrhythmia (28.12%), followed by ventricular tachycardia (VT) (22.52%). About 16% of CS patients underwent implantable cardioverter-defibrillator (ICD) implantation during hospital stay. About 42% of patients had concurrent heart failure, out of whom 33.84% had heart failure with reduced ejection fraction (HFrEF). Mean length of hospital stay was 5 days (3–8 days), and the mean cost of hospitalization was $14,177 ($7,121–35,993).
Conclusion
Given the low prevalence of CS, most of the available studies have been retrospective in nature, based on small sample sizes. Despite being retrospective and cross-sectional, our study has the advantage of being based on a nationally representative sample population, providing key formation on the demographics and in-hospital outcomes of patients with CS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Victor
- Aultman Hospital , Canton , United States of America
| | - S Thakkar
- Rochester General Hospital, Internal Medicine , Rochester , United States of America
| | - H Patel
- Louis A. Weiss Memorial Hospital, Internal Medicine , Chicago , United States of America
| | - A Deshmukh
- Mayo Clinic, Electrophysiology , Rochester , United States of America
| | - C Desimone
- Mayo Clinic, Electrophysiology , Rochester , United States of America
| | - S C Feitell
- Rochester General Hospital, Advanced Heart Failure and Transplant Cardiology , Rochester , United States of America
| | - R Blankstein
- Brigham and Women'S Hospital, Harvard Medical School, Cardiology , Boston , United States of America
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27
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Elbatarny M, Trimarchi S, Korach A, Di Eusanio M, Pacini D, Bekeredijan R, Myrmel T, Bavaria J, Desai N, Sultan I, Patel H, Peterson M. OUTCOMES OF AXILLARY VS FEMORAL ARTERIAL CANNULATION IN ACUTE TYPE A DISSECTION REPAIR: AN INTERNATIONAL MULTICENTRE STUDY. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.193] [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: 11/02/2022] Open
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28
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Tereshchenko LG, Bishop A, Fisher-Campbell N, Levene J, Morris CC, Patel H, Beeson E, Blank JA, Bradner JN, Coblens M, Corpron JW, Davison JM, Denny K, Earp MS, Florea S, Freeman H, Fuson O, Guillot FH, Haq KT, Kim M, Kolseth C, Krol O, Lin L, Litwin L, Malik A, Mitchell E, Mohapatra A, Mullen C, Nix CD, Oyeyemi A, Rutlen C, Tam AE, Van Buren I, Wallace J, Khan A. Risk of Cardiovascular Events After COVID-19. Am J Cardiol 2022; 179:102-109. [PMID: 35843735 PMCID: PMC9282909 DOI: 10.1016/j.amjcard.2022.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 12/15/2022]
Abstract
We aimed to determine absolute and relative risks of either symptomatic or asymptomatic SARS-CoV-2 infection for late cardiovascular (CV) events and all-cause mortality. We conducted a retrospective double cohort study of patients with either symptomatic or asymptomatic SARS-CoV-2 infection (COVID-19+ cohort) and its documented absence (COVID-19- cohort). The study investigators drew a simple random sample of records from all patients under the Oregon Health & Science University Healthcare (n = 65,585), with available COVID-19 test results, performed March 1, 2020 to September 13, 2020. Exclusion criteria were age <18 years and no established Oregon Health & Science University care. The primary outcome was a composite of CV morbidity and mortality. All-cause mortality was the secondary outcome. The study population included 1,355 patients (mean age 48.7 ± 20.5 years; 770 women [57%], 977 White non-Hispanic [72%]; 1,072 ensured [79%]; 563 with CV disease history [42%]). During a median 6 months at risk, the primary composite outcome was observed in 38 of 319 patients who were COVID-19+ (12%) and 65 of 1,036 patients who were COVID-19- (6%). In the Cox regression, adjusted for demographics, health insurance, and reason for COVID-19 testing, SARS-CoV-2 infection was associated with the risk for primary composite outcome (hazard ratio 1.71, 95% confidence interval 1.06 to 2.78, p = 0.029). Inverse probability-weighted estimation, conditioned for 31 covariates, showed that for every patient who was COVID-19+, the average time to all-cause death was 65.5 days less than when all these patients were COVID-19-: average treatment effect on the treated -65.5 (95% confidence interval -125.4 to -5.61) days, p = 0.032. In conclusion, either symptomatic or asymptomatic SARS-CoV-2 infection is associated with an increased risk for late CV outcomes and has a causal effect on all-cause mortality in a late post-COVID-19 period.
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Affiliation(s)
- Larisa G Tereshchenko
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon; Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio.
| | - Adam Bishop
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Nora Fisher-Campbell
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jacqueline Levene
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Craig C Morris
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Hetal Patel
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon; Chicago Medical School at Rosalind Franklin University, Chicago, Illinois
| | - Erynn Beeson
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jessica A Blank
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jg N Bradner
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Michelle Coblens
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jacob W Corpron
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jenna M Davison
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kathleen Denny
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Mary S Earp
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Simeon Florea
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Howard Freeman
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Olivia Fuson
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Florian H Guillot
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kazi T Haq
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Morris Kim
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Clinton Kolseth
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Olivia Krol
- Chicago Medical School at Rosalind Franklin University, Chicago, Illinois
| | - Lisa Lin
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Liat Litwin
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Aneeq Malik
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Evan Mitchell
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Aman Mohapatra
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon; Chicago Medical School at Rosalind Franklin University, Chicago, Illinois
| | - Cassandra Mullen
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Chad D Nix
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Ayodele Oyeyemi
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Christine Rutlen
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Ashley E Tam
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Inga Van Buren
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jessica Wallace
- Knight Cardiovascular Institute and Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Akram Khan
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
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Allam A, Alfahmi O, Patel H, Sugino C, Harding M, Ruzzene M, Erturk A. Ultrasonic testing of thick and thin Inconel 625 alloys manufactured by laser powder bed fusion. Ultrasonics 2022; 125:106780. [PMID: 35716606 DOI: 10.1016/j.ultras.2022.106780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Additive manufacturing of alloys enables low-volume production of functional metallic components with complex geometries. Ultrasonic testing can ensure the quality of these components and detect typical defects generated during laser powder bed fusion (LPBF). However, it is difficult to find a single ultrasonic inspection technique that can detect defects in the large variety of geometries generated using LPBF. In this work, phased array ultrasonic testing (PAUT) is suggested to inspect thick LPBF components, while guided waves are explored for thin curved ones. PAUT is used to detect cylindrical lack of fusion defects in thick LPBF rectangular parts. Practical defects are generated by reducing the laser power at prespecified locations in the samples. The defects' shape and density are verified using optical microscopy and X-ray computed tomography. Partially fused defects down to 0.25 mm in diameter are experimentally detected using a 10 MHz PAUT probe with the total focusing method post-processing. The experimental results are compared to defect images predicted by finite element simulations. For thin components with curved geometry, guided waves are used to detect powder-filled cylindrical defects. The waves are generated using piezoelectric transducers, and the spatiotemporal wavefield is measured using a scanning laser Doppler vibrometer. Using root-mean-square imaging of the wavefield, defects down to 1 mm are clearly detected despite the complex internal features in the samples.
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Affiliation(s)
- A Allam
- G.W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA.
| | - O Alfahmi
- G.W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA
| | - H Patel
- G.W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA
| | - C Sugino
- G.W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA
| | - M Harding
- Tronosjet Manufacturing, Charlottetown, C1C 1N2, PE, Canada
| | - M Ruzzene
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, 80309, CO, USA
| | - A Erturk
- G.W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA
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Mittal A, Hegde U, Rajapurkar M, Gang S, Konnur A, Patel H. POS-076 PARVOVIRUS B19 DISEASE POST-RENAL TRANSPLANT PRESENTING AS REFRACTORY ANEMIA - CASE SERIES OF 20 PATIENTS. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.07.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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31
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Akinbobola O, Faris N, Smeltzer M, Ray M, Fehnel C, Pacheco A, Saulsberry A, Dortch K, Wiggins H, Talton D, Eubanks R, Stevenson D, Valaulikar G, Patel H, Wolf B, Koury A, Levy P, Ng T, Robbins T, Osarogiagbon R. EP02.03-022 Evolution of Lung Cancer Resection Quality: A Prospective Staggered Implementation Quality Improvement Study. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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32
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Kim E, Jonnalagadda S, Cuervo-Rojas J, Jahn A, Payne D, West C, Ogollah F, Maida A, Kayira D, Nyirenda R, Dobbs T, Patel H, Radin E, Voetsch A, Auld A. Toward elimination of mother-to-child transmission of HIV in Malawi: Findings from the Malawi Population-based HIV Impact Assessment (2015–2016). PLoS One 2022; 17:e0273639. [PMID: 36048781 PMCID: PMC9436140 DOI: 10.1371/journal.pone.0273639] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Malawi spearheaded the development and implementation of Option B+ for prevention of mother-to-child transmission of HIV (PMTCT), providing life-long ART for all HIV-positive pregnant and breastfeeding women. We used data from the 2015–2016 Malawi Population-based HIV Impact Assessment (MPHIA) to estimate progress toward 90-90-90 targets (90% of those with HIV know their HIV-positive status; of these, 90% are receiving ART; and of these, 90% have viral load suppression [VLS]) for HIV-positive women reporting a live birth in the previous 3 years. Methods MPHIA was a nationally representative household survey; consenting eligible women aged 15–64 years were interviewed on pregnancies and outcomes, including HIV status during their most recent pregnancy, PMTCT uptake, and early infant diagnosis (EID) testing. Descriptive analyses were weighted to account for the complex survey design. Viral load (VL) results were categorized by VLS (<1,000 copies/mL) and undetectable VL (target not detected/below the limit of detection). Results Of the 3,153 women included in our analysis, 371 (10.1%, 95% confidence interval [CI]: 8.8%–11.3%) tested HIV positive in the survey. Most HIV-positive women (84.2%, 95% CI: 79.9%–88.6%) reported knowing their HIV-positive status; of these, 94.9% (95% CI: 91.7%–98.2%) were receiving ART; and of these, 91.2% (95% CI: 87.4%–95.0%) had VLS. Among the 371 HIV-positive women, 76.0% (95% CI: 70.4%–81.7%) had VLS and 66.5% (95% CI: 59.8%–73.2%) had undetectable VL. Among 262 HIV-exposed children, 50.8% (95% CI: 42.8%–58.8%) received EID testing within 2 months of birth, whereas 17.9% (95% CI: 11.9%–23.8%) did not receive EID testing. Of 190 HIV-exposed children with a reported HIV test result, 2.1% (95% CI: 0.0%–4.6%) had positive results. Conclusions MPHIA data demonstrate high PMTCT uptake at a population level. However, our results identify some gaps in VLS in postpartum women and EID testing.
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Affiliation(s)
- Evelyn Kim
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
- * E-mail:
| | - Sasi Jonnalagadda
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Juliana Cuervo-Rojas
- ICAP at Columbia University, New York, NY, United States of America
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Andreas Jahn
- Division of HIV and AIDS, Ministry of Health, Government of Malawi, Lilongwe, Malawi
| | - Danielle Payne
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Christine West
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Francis Ogollah
- ICAP at Columbia University, New York, NY, United States of America
| | - Alice Maida
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Dumbani Kayira
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Rose Nyirenda
- Division of HIV and AIDS, Ministry of Health, Government of Malawi, Lilongwe, Malawi
| | - Trudy Dobbs
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Hetal Patel
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Elizabeth Radin
- ICAP at Columbia University, New York, NY, United States of America
| | - Andrew Voetsch
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Andrew Auld
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
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Jahun I, Ehoche A, Bamidele M, Yakubu A, Bronson M, Dalhatu I, Greby S, Agbakwuru C, Baffa I, Iwara E, Alagi M, Asaolu O, Mukhtar A, Ikpeazu A, Nzelu C, Tapdiyel J, Bassey O, Abimiku A, Patel H, Parekh B, Aliyu S, Aliyu G, Charurat M, Swaminathan M. Evaluation of accuracy and performance of self-reported HIV and antiretroviral therapy status in the Nigeria AIDS Indicator and Impact Survey (2018). PLoS One 2022; 17:e0273748. [PMID: 36037201 PMCID: PMC9423665 DOI: 10.1371/journal.pone.0273748] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/15/2022] [Indexed: 12/03/2022] Open
Abstract
Background Data on awareness of HIV status among people living with HIV (PLHIV) are critical to estimating progress toward epidemic control. To ascertain the accuracy of self-reported HIV status and antiretroviral drug (ARV) use in the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), we compared self-reported HIV status with HIV rapid diagnostic test (RDT) results and self-reported ARV use with detectable blood ARV levels. Methods On the basis of responses and test results, participants were categorized by HIV status and ARV use. Self-reported HIV status and ARV use performance characteristics were determined by estimating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Proportions and other analyses were weighted to account for complex survey design. Results During NAIIS, 186,405 participants consented for interview out of which 58,646 reported knowing their HIV status. Of the 959 (weighted, 1.5%) who self-reported being HIV-positive, 849 (92.1%) tested HIV positive and 64 (7.9%) tested HIV negative via RDT and polymerase chain reaction test for discordant positive results. Of the 849 who tested HIV positive, 743 (89.8%) reported using ARV and 72 (10.2%) reported not using ARV. Of 57,687 who self-reported being HIV negative, 686 (1.2%) tested HIV positive via RDT, with ARV biomarkers detected among 195 (25.1%). ARV was detected among 94.5% of those who self-reported using ARV and among 42.0% of those who self-reported not using ARV. Overall, self-reported HIV status had sensitivity of 52.7% (95% confidence interval [CI]: 49.4%–56.0%) with specificity of 99.9% (95% CI: 99.8%–99.9%). Self-reported ARV use had sensitivity of 95.2% (95% CI: 93.6%–96.7%) and specificity of 54.5% (95% CI: 48.8%–70.7%). Conclusions Self-reported HIV status and ARV use screening tests were found to be low-validity measures during NAIIS. Laboratory tests to confirm self-reported information may be necessary to determine accurate HIV and clinical status for HIV studies in Nigeria.
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Affiliation(s)
- Ibrahim Jahun
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
- * E-mail:
| | - Akipu Ehoche
- Maryland Global Initiatives, Abuja, Federal Capital Territory, Nigeria
| | - Moyosola Bamidele
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Aminu Yakubu
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Megan Bronson
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health Atlanta, GA, United States of America
| | - Ibrahim Dalhatu
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Stacie Greby
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Chinedu Agbakwuru
- Maryland Global Initiatives, Abuja, Federal Capital Territory, Nigeria
| | - Ibrahim Baffa
- Maryland Global Initiatives, Abuja, Federal Capital Territory, Nigeria
| | - Emem Iwara
- Maryland Global Initiatives, Abuja, Federal Capital Territory, Nigeria
| | - Matthias Alagi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Olugbenga Asaolu
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Ahmed Mukhtar
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Akudo Ikpeazu
- Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Charles Nzelu
- Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Jelpe Tapdiyel
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Orji Bassey
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Alash’le Abimiku
- Maryland Global Initiatives, Abuja, Federal Capital Territory, Nigeria
| | - Hetal Patel
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health Atlanta, GA, United States of America
| | - Bharat Parekh
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health Atlanta, GA, United States of America
| | - Sani Aliyu
- National Agency for the Control of AIDS, Abuja, Federal Capital Territory, Nigeria
| | - Gambo Aliyu
- Maryland Global Initiatives, Abuja, Federal Capital Territory, Nigeria
| | | | - Mahesh Swaminathan
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health-Nigeria, Abuja, Federal Capital Territory, Nigeria
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Schwitters A, McCracken S, Frederix K, Tierney R, Koto M, Ahmed N, Thin K, Dobbs T, Sithole S, Letsie M, Parekh B, Patel H, Birhanu S, Wiesner L, Low A. High HIV prevalence and associated factors in Lesotho: Results from a population-based survey. PLoS One 2022; 17:e0271431. [PMID: 35901094 PMCID: PMC9333200 DOI: 10.1371/journal.pone.0271431] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Despite extensive global efforts, sub-Saharan Africa remains disproportionately affected by the HIV epidemic. This generalized epidemic can be seen in Lesotho which in 2014 the HIV prevalence rate of those aged 15–49 years was 24.6%, with and incidence of 1.9 new infections per 100-person-year exposures. To better understand the impact of Lesotho’s national HIV response and significant predictors associated with HIV infection, the Lesotho Population-based HIV Impact Assessment was conducted. This survey provided a nationally representative sample of individuals aged 15–59 years old in which participants were tested for HIV and given an individual questionnaire that included socio-demographic and behavioral risk questions. The association of factors between survey questions and HIV incident was assessed using logistic regression. Multivariate logistic regression models for men and women were constructed for each outcome using variables known to be or plausibly associated with recent or chronic infection. Overall annualized incidence among people aged 15–49 was 1.19% (95% CI 0.73–1.65) per year. The overall prevalence of HIV was 25.6% with women having significantly higher prevalence. Multiple variables, including decreased wealth status, lower education levels, marital status, condom use at first sex, and circumcision (men only) were identified as being significantly associated with HIV infection for both men and women. In combination with improving the awareness of HIV status, an increased focus is needed on AGYW and men 35–49 years old to prevent new infections. HIV education and prevention programs should focus heavily on younger age groups prior to and soon after sexual debut to prevent HIV transmission. The findings of the survey showed significant room for improvement in increasing awareness of HIV status and reinforcing the need for continued HIV prevention and treatment efforts in Lesotho to prevent new infections.
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Affiliation(s)
- Amee Schwitters
- Centers for Disease Control and Prevention, Maseru, Lesotho
- * E-mail:
| | - Stephen McCracken
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States of America
| | - Koen Frederix
- ICAP in Lesotho, Mailman School of Public Health, Columbia University, Maseru, Lesotho
| | - Reese Tierney
- School of Public Health at Georgia State University, Atlanta, GA, United States of America
| | | | - Nahima Ahmed
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Kyaw Thin
- Lesotho Ministry of Health, Maseru, Lesotho
| | - Trudy Dobbs
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Sakhile Sithole
- ICAP in Lesotho, Mailman School of Public Health, Columbia University, Maseru, Lesotho
| | | | - Bharat Parekh
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States of America
| | - Hetal Patel
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States of America
| | - Sehin Birhanu
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States of America
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Andrea Low
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Low A, Gummerson E, Schwitters A, Bonifacio R, Teferi M, Mutenda N, Ayton S, Juma J, Ahpoe C, Ginindza C, Patel H, Biraro S, Sachathep K, Hakim AJ, Barradas D, Hassani AS, Kirungi W, Jackson K, Goeke L, Philips N, Mulenga L, Ward J, Hong S, Rutherford G, Findley S. Food insecurity and the risk of HIV acquisition: findings from population-based surveys in six sub-Saharan African countries (2016-2017). BMJ Open 2022; 12:e058704. [PMID: 35820770 PMCID: PMC9277378 DOI: 10.1136/bmjopen-2021-058704] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To assess the potential bidirectional relationship between food insecurity and HIV infection in sub-Saharan Africa. DESIGN Nationally representative HIV impact assessment household-based surveys. SETTING Zambia, Eswatini, Lesotho, Uganda and Tanzania and Namibia. PARTICIPANTS 112 955 survey participants aged 15-59 years with HIV and recency test results. MEASURES Recent HIV infection (within 6 months) classified using the HIV-1 limited antigen avidity assay, in participants with an unsuppressed viral load (>1000 copies/mL) and no detectable antiretrovirals; severe food insecurity (SFI) defined as having no food in the house ≥three times in the past month. RESULTS Overall, 10.3% of participants lived in households reporting SFI. SFI was most common in urban, woman-headed households, and in people with chronic HIV infection. Among women, SFI was associated with a twofold increase in risk of recent HIV infection (adjusted relative risk (aRR) 2.08, 95% CI 1.09 to 3.97). SFI was also associated with transactional sex (aRR 1.28, 95% CI 1.17 to 1.41), a history of forced sex (aRR 1.36, 95% CI 1.11 to 1.66) and condom-less sex with a partner of unknown or positive HIV status (aRR 1.08, 95% CI 1.02 to 1.14) in all women, and intergenerational sex (partner ≥10 years older) in women aged 15-24 years (aRR 1.23, 95% CI 1.03 to 1.46). Recent receipt of food support was protective against HIV acquisition (aRR 0.36, 95% CI 0.14 to 0.88). CONCLUSION SFI increased risk for HIV acquisition in women by twofold. Heightened food insecurity during climactic extremes could imperil HIV epidemic control, and food support to women with SFI during these events could reduce HIV transmission.
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Affiliation(s)
- Andrea Low
- ICAP at Columbia, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
| | - Elizabeth Gummerson
- ICAP at Columbia, Columbia University Mailman School of Public Health, New York, New York, USA
- Bill and Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amee Schwitters
- Strategic Information, Division of Global HIV and Tuberculosis, Ctr Dis Control, Maseru, Lesotho
| | | | - Mekleet Teferi
- ICAP at Columbia, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
| | - Nicholus Mutenda
- Directorate for Special Programs, Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Sarah Ayton
- ICAP at Columbia, Columbia University Mailman School of Public Health, New York, New York, USA
| | - James Juma
- The Ministry of Health, Community Development, Gender, Elderly and Children, National AIDS Control Program, Dar es Salaam, United Republic of Tanzania
| | - Claudia Ahpoe
- Needs Assessment and Analysis, World Food Programme, Rome, Italy
| | | | - Hetal Patel
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Samuel Biraro
- ICAP at Columbia, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Karam Sachathep
- ICAP at Columbia, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Avi J Hakim
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Danielle Barradas
- Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Ahmed Saadani Hassani
- Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - Keisha Jackson
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Leah Goeke
- Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | - Neena Philips
- ICAP at Columbia, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lloyd Mulenga
- Zambia Ministry of Health, Lusaka, Zambia
- School of Medicine, University of Zambia, Lusaka, Zambia
| | - Jennifer Ward
- Centers for Disease Control and Prevention, Kampala, Uganda
| | - Steven Hong
- Centers for Disease Control and Prevention, Windhoek, Namibia
| | - George Rutherford
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sally Findley
- Population and Family Health, Mailman School of Public Health, New York, NY, USA
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Burris N, Nguyen C, Deeb G, Yang B, Patel H, Kim K, Fukuhara S. 447 Early Experience With Ct Evaluation Of Valve Incorporation Prior To Tavr Explant. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.052] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fortune JD, Coppa NE, Haq KT, Patel H, Tereshchenko LG. Digitizing ECG image: A new method and open-source software code. Comput Methods Programs Biomed 2022; 221:106890. [PMID: 35598436 PMCID: PMC9286778 DOI: 10.1016/j.cmpb.2022.106890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVE We aimed to develop and validate an open-source code ECG-digitizing tool and assess agreements of ECG measurements across three types of median beats, comprised of digitally recorded simultaneous and asynchronous ECG leads and digitized asynchronous ECG leads. METHODS We used the data of clinical studies participants (n = 230; mean age 30±15 y; 25% female; 52% had the cardiovascular disease) with available both digitally recorded and printed on paper and then scanned ECGs, split into development (n = 150) and validation (n = 80) datasets. The agreement between ECG and VCG measurements on the digitally recorded time-coherent median beat, representative asynchronous digitized, and digitally recorded beats was assessed by Bland-Altman analysis. RESULTS The sample-per-sample comparison of digitally recorded and digitized signals showed a very high correlation (0.977), a small mean difference (9.3 µV), and root mean squared error (25.9 µV). Agreement between digitally recorded and digitized representative beat was high [area spatial ventricular gradient (SVG) elevation bias 2.5(95% limits of agreement [LOA] -7.9-13.0)°; precision 96.8%; inter-class correlation [ICC] 0.988; Lin's concordance coefficient ρc 0.97(95% confidence interval [CI] 0.95-0.98)]. Agreement between digitally recorded asynchronous and time-coherent median beats was moderate for area-based VCG metrics (spatial QRS-T angle bias 1.4(95%LOA -33.2-30.3)°; precision 94.8%; ICC 0.95; Lin's concordance coefficient ρc 0.90(95%CI 0.82-0.95)]. CONCLUSIONS We developed and validated an open-source software tool for paper-ECG digitization. Asynchronous ECG leads are the primary source of disagreement in measurements on digitally recorded and digitized ECGs.
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Affiliation(s)
| | | | - Kazi T Haq
- Oregon Health and Science University, Knight Cardiovascular Institute, Portland, OR, United States
| | - Hetal Patel
- Oregon Health and Science University, Knight Cardiovascular Institute, Portland, OR, United States; Chicago Medical School at Rosalind Franklin University, IL, United States
| | - Larisa G Tereshchenko
- Oregon Health and Science University, Knight Cardiovascular Institute, Portland, OR, United States; Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Larisa Tereshchenko, 9500 Euclid Ave, JJN3-01. , Cleveland, OH 44195, United States.
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Abstract
IMPORTANCE In the US, suicide is the 10th leading cause of death and a serious mental health emergency. National programs that address suicide list access to mental health care as key in prevention, and more large-scale policies are needed to improve access to mental health care and address this crisis. The Patient Protection and Affordable Care Act (ACA) Medicaid Expansion Program was implemented in several states with the goal of increasing access to the health care system. OBJECTIVE To compare changes in suicide rates in states that expanded Medicaid under the ACA vs states that did not. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, state-level mortality rates were obtained from the National Center for Health Statistics for US individuals aged 20 to 64 years from January 1, 2000, to December 31, 2018. Data analysis was performed from April 18, 2021, to April 15, 2022. EXPOSURES Changes in suicide mortality rates among nonelderly adults before and after Medicaid expansion in expansion and nonexpansion states were compared using adjusted difference-in-differences analyses via hierarchical bayesian linear regression. MAIN OUTCOMES AND MEASURES Suicide rates using death by suicide as the primary measure. RESULTS Of the total population at risk for suicide, 50.4% were female, 13.3% were Black, 79.5% were White, and 7.2% were of other races. The analytic data set contained suicide mortality data for 2907 state-age-year units covering the general US population. A total of 553 912 deaths by suicide occurred during the study period, with most occurring in White (496 219 [89.6%]) and male (429 580 [77.6%]) individuals. There were smaller increases in the suicide rate after 2014 in Medicaid expansion (2.56 per 100 000 increase) compared with nonexpansion states (3.10 per 100 000 increase). In adjusted difference-in-differences analysis, a significant decrease of -0.40 (95% credible interval, -0.66 to -0.14) suicides per 100 000 individuals was found, translating to 1818 suicides that were averted in 2015 to 2018. CONCLUSIONS AND RELEVANCE In this cross-sectional study, although suicide rates increased in both groups, blunting of these rates occurred among nonelderly adults in the Medicaid expansion states compared with nonexpansion states. Because this difference may be linked to increased access to mental health care, policy makers should consider suicide prevention as a benefit of expanding access to health care.
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Affiliation(s)
- Hetal Patel
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Justin Barnes
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Nosayaba Osazuwa-Peters
- Deputy Editor, Diversity, Equity, and Inclusion, JAMA Otolaryngology–Head and Neck Surgery
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Laura Jean Bierut
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
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Laich A, Patel H, Zarantonello A, Sim R, Inal J. C2 by-pass: cross-talk between the complement classical and alternative pathways. Immunobiology 2022; 227:152225. [DOI: 10.1016/j.imbio.2022.152225] [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] [Received: 02/20/2022] [Revised: 04/12/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022]
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Patel H, Rafiq Q, Archibald P. Gene Editing/Gene Therapies: DEVELOPING A NOVEL FEEDING STRATEGY FOR ENHANCED LENTIVIRAL VECTOR PRODUCTION. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00378-4] [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: 11/03/2022]
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Movassaghi M, Ahmed F, Patel H, Luk L, Hyams E, Wenske S, Shaish H. Association of Patient and Imaging-Related Factors with False Negative MRI-Targeted Prostate Biopsies of Suspicious PI-RADS 4 and 5 Lesions. Urology 2022; 167:165-170. [DOI: 10.1016/j.urology.2022.04.026] [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] [Received: 10/31/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
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Wilden A, Sannareddy A, Patel H, Kansagra S, Kaur G, Ramakrishnan P, Patel P, Mehta A, Kansagra A. HSR22-178: Real World Outcomes of Cancer Patients With SARS-CoV-2 Infection Receiving Monoclonal Antibodies. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Hetal Patel
- 1 UT Southwestern Medical Center, Dallas, TX
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Ruangtragool L, Silver R, Machiha A, Gwanzura L, Hakim A, Lupoli K, Musuka G, Patel H, Mugurungi O, Tippett Barr BA, Rogers JH. Factors associated with active syphilis among men and women aged 15 years and older in the Zimbabwe Population-based HIV Impact Assessment (2015–2016). PLoS One 2022; 17:e0261057. [PMID: 35298475 PMCID: PMC8929562 DOI: 10.1371/journal.pone.0261057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Ulcerative STIs, including syphilis, increase the risk for HIV acquisition and transmission due to the presence of ulcers/chancres that serve as a point-of-entry and exit for HIV. In Zimbabwe, diagnosis of syphilis often occurs in pregnant women who seek ANC services where syphilis testing is offered, and among men and women who seek health care for STIs. Zimbabwe’s national syphilis estimates are based on these diagnosed cases, with little information available about the prevalence of untreated syphilis among the general population. This analysis uses data from ZIMPHIA (2015–2016) to describe factors associated with active syphilis among men and women ages 15 years and older. Methods ZIMPHIA collected blood specimens for HIV and syphilis testing from 22,501 consenting individuals (ages 15 years and older). Household HIV testing used the national HIV rapid-testing algorithm with HIV-positive results confirmed at satellite laboratories using Geenius HIV-1/2 rapid test (Bio-rad, Hercules, California, USA). Point-of-care non-Treponemal and Treponemal syphilis testing was performed using Chembio’s Dual-Path Platform Syphilis Screen & Confirm Assay. Factors associated with active syphilis were explored using multiple variable, weighted logistic regression and were stratified by gender. Results The likelihood of active syphilis in HIV-positive females was 3.7 times greater in HIV-positive females than HIV-negative females (aOR: 3.7, 95% CI 2.3–5.9). Among males odds of having active syphilis was 5 times higher among those that engaged in transactional sex than those who did not have sex or transactional sex (aOR: 5.3, 95% CI 1.9–14.7), and 6 times higher if HIV positive versus negative (aOR: 5.9, 95% CI 3.0–12.0). Urban residence, province, education (highest attended), marital status, number of sex partners, consistency of condom use, pregnancy status (females), and circumcision status (males) were not significant in the adjusted model for either females or males. Conculsion HIV status was found to be the only factor associated with active syphilis in both females and males. Given the persistent link between HIV and active syphilis, it is prudent to link individuals’ diagnoses and treatments, as recommended by the WHO. Enhanced integration of STI and HIV services in health delivery points such as ANC, reproductive services, or male circumcision clinics, combined with consistent, targeted outreach to high-risk populations and their partners, may assist the MOHCC to eliminate active syphilis in Zimbabwe.
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Affiliation(s)
- Leala Ruangtragool
- Public Health Institute / CDC Global HIV Surveillance Fellow, Harare, Zimbabwe
| | - Rachel Silver
- Public Health Institute / CDC Global HIV Surveillance Fellow, Harare, Zimbabwe
| | - Anna Machiha
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Avi Hakim
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Katie Lupoli
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Hetal Patel
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Beth A. Tippett Barr
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - John H. Rogers
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
- * E-mail:
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Nsanzimana S, Rwibasira GN, Malamba SS, Musengimana G, Kayirangwa E, Jonnalagadda S, Fazito Rezende E, Eaton JW, Mugisha V, Remera E, Muhamed S, Mulindabigwi A, Omolo J, Weisner L, Moore C, Patel H, Justman JE. HIV incidence and prevalence among adults aged 15-64 years in Rwanda: Results from the Rwanda Population-based HIV Impact Assessment (RPHIA) and District-level Modeling, 2019. Int J Infect Dis 2022; 116:245-254. [PMID: 35066161 PMCID: PMC9069967 DOI: 10.1016/j.ijid.2022.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The 2018-2019 Rwanda Population-based HIV Impact Assessment (RPHIA) was conducted to measure national HIV incidence and prevalence. District-level estimates were modeled to inform resources allocation. METHODS RPHIA was a nationally representative cross-sectional household survey. Consenting adults were interviewed and tested for HIV using the national diagnostic algorithm followed by laboratory-based confirmation of HIV status and testing for viral load (VL), limiting antigen (LAg) avidity, and presence of antiretrovirals. Incidence was calculated using normalized optical density ≤ 1·5, VL ≥ 1,000 copies/mL, and undetectable antiretrovirals. Survey and programmatic data were used to model district-level HIV incidence and prevalence. RESULTS Of 31,028 eligible adults, 98·7% participated in RPHIA and 934 tested HIV positive. HIV prevalence among adults in Rwanda was 3·0% (95% CI:2·7-3·3). National HIV incidence was 0·08% (95% CI:0·02-0·14) and 0·11% (95% CI:0·00-0·26) in the City of Kigali (CoK). Based on district-level modeling, HIV incidence was greatest in the 3 CoK districts (0·11% to 0·15%) and varied across other districts (0·03% to 0·10%). CONCLUSIONS HIV prevalence among adults in Rwanda is 3.0%; HIV incidence is low at 0.08%. District-level modeling has identified disproportionately affected urban hotspots: areas to focus resources.
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Affiliation(s)
| | | | | | | | | | | | | | - Jeffrey W Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | | | - Eric Remera
- Ministry of Health, Rwanda Biomedical Centre
| | | | | | - Jared Omolo
- US Centers for Disease Control and Prevention
| | - Lubbe Weisner
- UCT Pharmacology Research Laboratory, City of Cape Town, Western Cape, South Africa, Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Hetal Patel
- US Centers for Disease Control and Prevention
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Girase R, Ahmad I, Pawara R, Patel H. Optimizing cardio, hepato and phospholipidosis toxicity of the Bedaquiline by chemoinformatics and molecular modelling approach. SAR QSAR Environ Res 2022; 33:215-235. [PMID: 35225110 DOI: 10.1080/1062936x.2022.2041724] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Abstract
The FDA granted expedited approval for Johnson and Johnson's Bedaquiline to treat pulmonary multidrug resistant tuberculosis on 28 December 2012 which is more common in China, Russian Federation and India. Bedaquiline is the first anti-tubercular drug approved by the FDA in the last 40 years, and it has become a cynosure in the circles of synthetic chemists researching new anti-tubercular drugs. Bedaquiline's highly lipophilic nature raises major concerns like suppression of the hERG gene, hepatotoxicity, and phospholipidosis despite its potential antitubercular profile. To address these toxicity concerns, in the present work, we have employed the structural optimization of Bedaquiline using the ADMETopt web server, which optimizes lead with scaffold hopping and ADMET screening. The ADMETopt web server yielded the 476 structures through optimization of three sites in Bedaquiline. Further, we have validated the optimized structures for their activity by performing molecular docking and molecular dynamics (MD) simulations against the mycobacterial ATP synthase enzyme and density functional theory (DFT) study further provides insight into the reactivity of the compounds. After screening and analysis, compound #449 was observed to be the most promising mycobacterial ATP synthase inhibitor with minimal cardiotoxicity, hepatotoxicity and phospholipidosis.
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Affiliation(s)
- R Girase
- Division of Computer Aided Drug Design, Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur Maharashtra, India
| | - I Ahmad
- Division of Computer Aided Drug Design, Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur Maharashtra, India
| | - R Pawara
- Division of Computer Aided Drug Design, Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur Maharashtra, India
| | - H Patel
- Division of Computer Aided Drug Design, Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur Maharashtra, India
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Patel C, Suthar D, Patel H, Movaliya V, Parejiya P. Preformulation Study of Glimepiride: An Insight for Formulation and Development of Parenteral Formulation. JPRI 2022. [DOI: 10.9734/jpri/2022/v34i15b35718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aim: The objective of preformulation study is to develop the elegant, stable, effective and safe dosage form by establishing kinetic profile, compatibility with other formulation excipients and physico-chemical parameters of new drug substance. This could provide important information for formulation design or support the need for molecular modification. So, in the present study preformulation studies were performed on Glimepiride (GMP) to assess its suitability for parenteral formulation. Glimepiride is the first IIIrd generation sulphonyl urea used to treat type –II diabetes mellitus.
Methods: The authenticity of GMP was established by DSC and FTIR spectra. A UV spectrophotometric method and HPLC method were employed for determination of GMP in bulk active pharmaceutical ingredient (API).
Results: The UV method was linear in the range of 3-10 μg/ml. The low % CV values of intra-day and inter-day variations revealed that the proposed method is robust. The retention time of GMP in HPLC method was found to be 1.9 min. The method was proven robust by obtaining very high regression coefficient value (0.999).
Conclusions: The results of the physicochemical study of drug revealed suitability of GMP for parenteral route. Moreover, the drug was found stable in both solid as well as liquid state at different conditions.
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Low S, Tan Y, Patel H, Johnson K. Four-year experience of paediatric penetrating injuries: findings from a paediatric major trauma centre in the UK. Clin Radiol 2022; 77:244-254. [DOI: 10.1016/j.crad.2022.01.037] [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] [Received: 02/02/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
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Qin ES, Patel H, Montagnino J, Pham K, Lam NY. Behavioral dysregulation exacerbated by intrathecal baclofen in an adolescent with severe traumatic brain injury. J Pediatr Rehabil Med 2022; 15:383-387. [PMID: 35466913 DOI: 10.3233/prm-210018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/15/2022] Open
Abstract
This is a case of a 19-year-old male with a history of remote severe traumatic brain injury (TBI) with an intrathecal baclofen (ITB) pump for dystonia management. Given concern for lack of efficacy despite increasing doses of ITB, his catheter was evaluated and found to be epidural rather than intrathecal. The baclofen dose was down-titrated and he underwent catheter revision. Post-op, his baclofen dose was up-titrated and complicated by significant behavioral changes including aggressive physical and verbal behaviors resulting in hospitalization. Work-up was negative for infection, new neurologic pathology, and epileptic activity. Psychiatric medications were adjusted but the behaviors persisted. Due to concern that the increased baclofen dose was causing his mood instability, his pump was down-titrated. As the dosage decreased, the frequency of outbursts also decreased. Throughout these dose adjustments, his dystonia remained stable and overall functional status improved. This is one of the first cases demonstrating that ITB may exacerbate mood instability in patients with TBI.
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Affiliation(s)
- Evelyn S Qin
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Hetal Patel
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jami Montagnino
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Kelly Pham
- Department of Rehabilitation Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Ny-Ying Lam
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Jumaah H, Kistler P, Mariani J, Patel H, Hare J, Kaye D, Taylor A, Voskoboinik A. Cardiac MRI Findings in Patients presenting With Advanced Conduction System Disease. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.233] [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: 10/16/2022]
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Haas AD, Radin E, Birhanu S, Low AJ, Saito S, Sachathep K, Balachandra S, Manjengwa J, Duong YT, Jonnalagadda S, Payne D, Bello G, Hakim AJ, Smart T, Ahmed N, Cuervo-Rojas J, Auld A, Patel H, Parekh B, Williams DB, Barradas DT, Mugurungi O, Mulenga LB, Voetsch AC, Justman JE. Prevalence of and factors associated with late diagnosis of HIV in Malawi, Zambia, and Zimbabwe: Results from population-based nationally representative surveys. PLOS Glob Public Health 2022; 2:e0000080. [PMID: 36962254 PMCID: PMC10021857 DOI: 10.1371/journal.pgph.0000080] [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] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Late diagnosis of HIV (LD) increases the risk of morbidity, mortality, and HIV transmission. We used nationally representative data from population-based HIV impact assessment (PHIA) surveys in Malawi, Zambia, and Zimbabwe (2015-2016) to characterize adults at risk of LD and to examine associations between LD and presumed HIV transmission to cohabiting sexual partners. METHODS We estimated the prevalence of LD, defined as CD4 count <350 cells/μL, among adults newly diagnosed with HIV during the surveys and odds ratios for associated factors. We linked newly diagnosed adults (index cases) to their household sexual partners and calculated adjusted odds ratios for associations between LD of the index case, viral load of the index case, and duration of HIV exposure in the relationship, and the HIV status of the household sexual partner. RESULTS Of 1,804 adults who were newly diagnosed with HIV in the surveys, 49% (882) were diagnosed late. LD was associated with male sex, older age, and almost five times the odds of having an HIV-positive household sexual partner (adjusted odds ratio [aOR], 4.65 [95% confidence interval: 2.56-8.45]). Longer duration of HIV exposure in a relationship and higher viral load of the index case were both independently associated with higher odds of having HIV-positive household sexual partners. Individuals with HIV exposure of more than 5 years had more than three times (aOR 3.42 [95% CI: 1.63-7.18]) higher odds of being HIV positive than those with less than 2 years HIV exposure. The odds of being HIV positive were increased in individuals who were in a relationship with an index case with a viral load of 400-3499 copies/mL (aOR 4.06 [95% CI 0.45-36.46]), 3,500-9,999 copies/mL (aOR 11.32 [95% CI: 4.08-31.39]), 10,000-49,999 copies/mL (aOR 17.07 [95% CI: 9.18-31.72]), and ≥50,000 copies/mL (aOR 28.41 [95% CI: 12.18-66.28]) compared to individuals who were in a relationship with an index case with a viral load of <400 copies/mL. CONCLUSIONS LD remains a challenge in Southern Africa and is strongly associated with presumed HIV transmission to household sexual partners. Our study underscores the need for earlier HIV diagnosis, particularly among men and older adults, and the importance of index testing.
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Affiliation(s)
- Andreas D Haas
- ICAP, Columbia University, New York, New York, United States of America
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elizabeth Radin
- ICAP, Columbia University, New York, New York, United States of America
| | - Sehin Birhanu
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrea J Low
- ICAP, Columbia University, New York, New York, United States of America
| | - Suzue Saito
- ICAP, Columbia University, New York, New York, United States of America
| | | | | | - Julius Manjengwa
- ICAP, Columbia University, New York, New York, United States of America
| | - Yen T Duong
- ICAP, Columbia University, New York, New York, United States of America
| | - Sasi Jonnalagadda
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Danielle Payne
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - George Bello
- Government of Malawi, Ministry of Health, Lilongwe, Malawi
| | - Avi J Hakim
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Theo Smart
- ICAP, Columbia University, New York, New York, United States of America
| | - Nahima Ahmed
- ICAP, Columbia University, New York, New York, United States of America
| | - Juliana Cuervo-Rojas
- ICAP, Columbia University, New York, New York, United States of America
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Andrew Auld
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Hetal Patel
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bharat Parekh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Daniel B Williams
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Owen Mugurungi
- Government of Zimbabwe, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Andrew C Voetsch
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica E Justman
- ICAP, Columbia University, New York, New York, United States of America
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