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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Lister P, Sudharson NA, Joseph M, Kaur P. Cloud intelligence in diagnosis? Br Dent J 2023; 235:843. [PMID: 38066123 DOI: 10.1038/s41415-023-6617-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Affiliation(s)
- P Lister
- Junior Lecturer, Department of Endodontics, Christian Dental College, Ludhiana, India.
| | - N A Sudharson
- Assistant Professor, Department of Prosthodontics, Christian Dental College, Ludhiana, India.
| | - M Joseph
- Lecturer, Department of Endodontics, Christian Dental College, Ludhiana, India.
| | - P Kaur
- Alumna of Christian Dental College, Ludhiana, India.
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Sudharson NA, Joseph M, Kaur P, Lister P, Jangde MK, Sudharson NG. NHS dentists and pension sustainability. Br Dent J 2023; 235:669. [PMID: 37945837 DOI: 10.1038/s41415-023-6509-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
Affiliation(s)
| | - M Joseph
- Christian Dental College, Ludhiana, India.
| | - P Kaur
- Christian Dental College, Ludhiana, India.
| | - P Lister
- Christian Dental College, Ludhiana, India.
| | - M K Jangde
- Department of Dentistry, Govt Medical College Kanker, Chhattisgarh, India.
| | - N G Sudharson
- Department of Community Medicine, KEM Medical College, Mumbai, India.
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Dworkin M, Agarwal-Harding KJ, Joseph M, Cahill G, Konadu-Yeboah D, Makasa E, Mock C. Indicators for the evaluation of musculoskeletal trauma systems: A scoping review and Delphi study. PLoS One 2023; 18:e0290816. [PMID: 37651448 PMCID: PMC10470913 DOI: 10.1371/journal.pone.0290816] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Trauma is a leading cause of mortality and morbidity, disproportionately affecting low- and middle-income countries. Musculoskeletal trauma results in the majority of post-traumatic morbidity and disability globally. The literature has reported many performance indicators relating to trauma care, but few specific to musculoskeletal injuries. STUDY OBJECTIVES The purpose of this study was to establish a practical list of performance indicators to evaluate and monitor the quality and equity of musculoskeletal trauma care delivery in health systems worldwide. METHODS A scoping review was performed that identified performance indicators related to musculoskeletal trauma care. Indicators were organized by phase of care (general, prevention, pre-hospital, hospital, post-hospital) within a modified Donabedian model (structure, process, outcome, equity). A panel of 21 experts representing 45 countries was assembled to identify priority indicators utilizing a modified Delphi approach. RESULTS The scoping review identified 1,206 articles and 114 underwent full text review. We included 95 articles which reported 498 unique performance indicators. Most indicators related to the hospital phase of care (n = 303, 60%) and structural characteristics (n = 221, 44%). Mortality (n = 50 articles) and presence of trauma registries (n = 16 articles) were the most frequently reported indicators. After 3 rounds of surveys our panel reached consensus on a parsimonious list of priority performance indicators. These focused on access to trauma care; processes and key resources for polytrauma triage, patient stabilization, and hemorrhage control; reduction and immobilization of fractures and dislocations; and management of compartment syndrome and open fractures. CONCLUSIONS The literature has reported many performance indicators relating to trauma care, but few specific to musculoskeletal injuries. To create quality and equitable trauma systems, musculoskeletal care must be incorporated into development plans with continuous monitoring and improvement. The performance indicators identified by our expert panel and organized in a modified Donabedian model can serve as a method for evaluating musculoskeletal trauma care.
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Affiliation(s)
- M. Dworkin
- Department of Orthopaedic Surgery, The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, United States of America
- Harvard Global Orthopaedics Collaborative, Boston, Massachusetts, United States of America
| | - K. J. Agarwal-Harding
- Harvard Global Orthopaedics Collaborative, Boston, Massachusetts, United States of America
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - M. Joseph
- Global Health and Social Medicine Department, Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - G. Cahill
- Global Health and Social Medicine Department, Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - D. Konadu-Yeboah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - E. Makasa
- Wits-SADC Regional Collaboration Centre for Surgical Healthcare, Department of Surgery, Faculty of Health Sciences, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
- Department of Surgery, School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Surgery, Ministry of Health, University Teaching Hospitals (UTHs), Lusaka, Republic of Zambia
| | - C. Mock
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
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Sudharson NA, Roy N, Daniel AY, Mathew RS, Joseph M, Renji JE. Quantum computing in dentistry. Br Dent J 2023; 235:79. [PMID: 37500837 DOI: 10.1038/s41415-023-6143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/08/2023] [Indexed: 07/29/2023]
Affiliation(s)
| | - N Roy
- Christian Dental College, Ludhiana, India.
| | - A Y Daniel
- Christian Dental College, Ludhiana, India.
| | - R S Mathew
- Christian Dental College, Ludhiana, India.
| | - M Joseph
- Christian Dental College, Ludhiana, India.
| | - J E Renji
- Christian Dental College, Ludhiana, India.
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Munro SP, Dearden A, Joseph M, O'Donoghue JM. Reducing donor-site complications in DIEP flap breast reconstruction with closed incisional negative pressure therapy: A cost-benefit analysis. J Plast Reconstr Aesthet Surg 2023; 78:13-18. [PMID: 36739647 DOI: 10.1016/j.bjps.2022.08.003] [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: 02/07/2022] [Revised: 06/06/2022] [Accepted: 08/01/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Deep inferior epigastric perforator (DIEP) flaps are considered the gold standard for autologous breast reconstruction but create large abdominal incisions that risk donor-site morbidity during harvest. Closed incision negative pressure therapy (ciNPT) is emerging as an effective alternative to standard postoperative dressings, but there is a paucity of data in DIEP flap donor sites. METHODS We conducted a retrospective case-control study investigating the use of ciNPT in DIEP flap donor sites at a single institution between March 2017 and September 2021. Patients who underwent microsurgical autologous breast reconstruction with DIEP flaps were included. Patients were divided into those with donor incision sites managed with ciNPT (n = 24) and those with conventional postoperative wound dressings (n = 20). We compared patient demographics, wound drainage volumes and postoperative outcomes between the two groups. A cost-benefit analysis was employed to compare the overall costs associated with each complication and differences in length of stay between the two groups. RESULTS There was no statistically significant difference in age, body mass index (BMI), comorbidity burden or smoking status between the two groups. Both groups had similar lengths of stay and wound drainage volumes with no readmissions or reoperations in either group. There was a statistically significant reduction in donor-site complications (p = 0.018), surgical site infections (p = 0.014) and seroma formation (p = 0.016) in those with ciNPT. Upon cost-benefit analysis, the ciNPT group had a mean reduction in cost-per-patient associated with postoperative complications of £420.77 (p = 0.031) and £446.47 (p = 0.049) when also accounting for postoperative length of stay CONCLUSION: ciNPT appears to be an effective alternative incision management system with the potential to improve complication rates and postoperative morbidity in DIEP flap donor sites. Our analysis demonstrates improved cost-benefit outweighing the increase in costs associated with ciNPT. We recommend a multicentre prospective trial with formal cost-utility analysis to strengthen these findings.
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Affiliation(s)
- S P Munro
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, NE1 4LP United Kingdom.
| | - A Dearden
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, NE1 4LP United Kingdom
| | - M Joseph
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, NE1 4LP United Kingdom
| | - J M O'Donoghue
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, NE1 4LP United Kingdom
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Sudharson NA, Joseph M, Kurian N, Varghese KG, Wadhwa S, Thomas HA. AI-powered neural implants. Br Dent J 2023; 234:359-360. [PMID: 36964340 DOI: 10.1038/s41415-023-5698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/26/2023]
Affiliation(s)
| | - M Joseph
- Christian Dental College, Ludhiana, India.
| | - N Kurian
- Christian Dental College, Ludhiana, India.
| | | | - S Wadhwa
- Christian Dental College, Ludhiana, India.
| | - H A Thomas
- Christian Dental College, Ludhiana, India.
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Pham K, Hecker T, Joseph M, Gunton J. Transthoracic Echocardiographic Predictive Probability of Pulmonary Hypertension in Liver Transplant candidates: Implications for Clinical Practice. Journal of Liver Transplantation 2022. [DOI: 10.1016/j.liver.2022.100090] [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: 10/18/2022] Open
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Pham K, Hecker T, Joseph M, Gunton J. Accuracy of Pulmonary Arterial Systolic Pressure by Echocardiography in Patients With Advanced Liver Disease. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.213] [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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NGakoutou R, Nemian M, Allawaye L, Joseph M, Ahmat A, Ali B, Adjougoulta K, Mihimit A, Ali M. [Clinical, diagnostic and evolutionary profile of peritoneal tuberculosis at the national reference general hospital of Ndjamena about 69 cases]. Mali Med 2022; 37:16-20. [PMID: 38196263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Peritoneal tuberculosis is not uncommon in Chad. Its diagnosis of certainty is difficult and is based on the analysis of ascites fluid and abdominal ultrasound. Our aim was to contribute to the study of the various clinical, diagnostic and progressive aspects of peritoneal tuberculosis in the internal medicine department of the HGRN. METHODOLOGY This is a retrospective and prospective study spread over 39 months covering the period from January 2014 to March 2017 including all patients hospitalized for peritoneal tuberculosis in the internal medicine department of the HGRN. The diagnosis was made, on a bundle of anamnestic, clinical, ultrasound, cytological and evolutionary arguments. RESULTS During the study period, 69 patients were included, or 9.77% of all hospital admissions. The average age was 42 years (range 18 to 83 years). The female sex represented 52.2% of the cases. The main reasons for hospitalization were ascites (87% of cases), associated with fever (92.5% of cases). The clinical signs were dominated by abdominal pain, deterioration of general condition and transit disorders. The ascites fluid was citrus yellow, rich in lymphocytes (81.6% of cases) and protein (94.2% of cases). Abdominal ultrasound, performed in all patients, demonstrated ascites with deep, mesenteric lymphadenopathy, portal in 62.3% of cases and compartmentalized in 37.7% of cases. Tuberculosis treatment was started in all patients and the outcome was favorable in 65.2% of cases. We deplored 20.3% mortality; all were patients who were severely immunosuppressed with HIV. CONCLUSION Peritoneal involvement in tuberculosis is common in Chad. The diagnosis is not always easy, but the clinic associated with the exudative and lymphocytic characters of the ascites fluid as well as the abdominal ultrasound are elements which can direct towards a peritoneal localization of tuberculosis. The course is generally favorable under early treatment and well conducted.
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Affiliation(s)
- R NGakoutou
- Faculté des sciences de la santé humaine (N'Djamena) et Hôpital Général de Référence Nationale (N'Djamena)
| | - M Nemian
- Faculté des sciences de la santé humaine (N'Djamena) et Hôpital Général de Référence Nationale (N'Djamena)
| | - L Allawaye
- Faculté des sciences de la santé humaine (N'Djamena) et Hôpital Général de Référence Nationale (N'Djamena)
| | - M Joseph
- Faculté des sciences de la santé humaine (N'Djamena) et Hôpital Général de Référence Nationale (N'Djamena)
| | - A Ahmat
- Faculté des sciences de la santé humaine (N'Djamena) et Hôpital Général de Référence Nationale (N'Djamena)
| | - Bolti Ali
- Faculté des sciences de la santé humaine (N'Djamena) et Hôpital Général de Référence Nationale (N'Djamena)
| | - K Adjougoulta
- Faculté des sciences de la santé humaine (N'Djamena) et Hôpital Général de Référence Nationale (N'Djamena)
| | - A Mihimit
- Faculté des sciences de la santé humaine (N'Djamena) et Hôpital Général de Référence Nationale (N'Djamena)
| | - M Ali
- Faculté des sciences de la santé humaine (N'Djamena) et Hôpital Général de Référence Nationale (N'Djamena)
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Kim K, Hecker T, Perry R, Ullah S, Gunton J, Joseph M. Assessment of Myocardial Work Using Echocardiography in Predicting Major Adverse Cardiac Events in Patients With Acute Coronary Syndrome. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.221] [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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Quah J, Jenkins E, Dharmaprani D, Tiver K, Smith C, Kutieleh R, Hecker T, Joseph M, Selvanayagam J, Tung M, Stanton T, Ahmad W, Stoyanov N, Lahiri A, Chahadi F, Singleton C, Ganesan A. Renewal Theory: A Statistical Approach to Improve Patient Selection for Pulmonary Vein Isolation-Only Strategy in Atrial Fibrillation Ablation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.190] [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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Kim K, Hecker T, Perry R, Ullah S, Gunton J, Joseph M. Baseline Myocardial Work on Echocardiography Reflects the Severity of Coronary Disease in Patients Presenting with Acute Coronary Syndrome. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.228] [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: 11/27/2022]
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Jayendhra S, Manuskandan SR, Joseph M, Navaneethakrishna M, Karthick PA. Analysis of Facial Electromyography Signals Using Linear and Non-Linear Features for Human-Machine Interface. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:1149-1152. [PMID: 34891491 DOI: 10.1109/embc46164.2021.9630036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this work, an attempt has been made to analyze the facial electromyography (facial EMG) signals using linear and non-linear features for the human-machine interface. Facial EMG signals are obtained from the publicly available, widely used DEAP dataset. Thirty-two healthy subjects volunteered for the establishment of this dataset. The signals of one positive emotion (joy) and one negative emotion (sadness) obtained from the dataset are used for this study. The signals are segmented into 12 epochs of 5 seconds each. Features such as sample entropy and root mean square (RMS) are extracted from each epoch for analysis. The results indicate that facial EMG signals exhibit distinct variations in each emotional stimulus. The statistical test performed indicates statistical significance (p<0.05) in various epochs. It appears that this method of analysis could be used for developing human-machine interfaces, especially for patients with severe motor disabilities such as people with tetraplegia.
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Augustin A, Joseph M, Abraham A, Nair R, Sudharsan PV, Yenukoti R. 455 A Case of An Unusual Penetrating Brain Injury. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Penetrating brain injuries (PBI) are less common than closed head traumas. Interest in frontal lobe injuries dates back to 1848’s famous Phineas Gage incident. Here, we report a case of a construction worker, who showed a remarkable neuropsychiatric outcome following a workplace accident.
Case Presentation
45year old gentleman came with complaint of a foreign body accidentally lodged in his forehead. He had no neurological deficits or CSF leak. X-ray revealed that a 5.5cm metallic screw was penetrating his skull, headfirst; CT revealed that approximately 3cm of the screw was in the frontal sinus. He was given antiepileptics and antibiotics prophylactically. Surgically the screw was removed by raising a bone flap and mobilizing the screw carefully by cutting the dura and adequate irrigation, causing minimal damage to the brain parenchyma. The dural deficits were repaired and the frontal sinus was canalized, then a drain was placed, and the patient was shifted to ICU for postoperative monitoring.
Discussion
It is important to prognosticate PBI as they can have neurological deficits that may be lifelong. Understanding the mechanism of injury, aggressive medical management and immediate surgical intervention may lead to improved outcomes. A foreign object of the size of 5.5cm, completely penetrating the skull would have otherwise resulted in extensive parenchymal damage. Literature suggests that no two people have an identical frontal sinus. In our patient the size the frontal sinus has served the purpose of protection against PBI and has resulted in minimal parenchymal injury (of only about 1cm).
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Affiliation(s)
- A Augustin
- Christian Medical College, Vellore, India
| | - M Joseph
- Christian Medical College, Vellore, India
| | - A Abraham
- Christian Medical College, Vellore, India
| | - R Nair
- Christian Medical College, Vellore, India
| | | | - R Yenukoti
- Christian Medical College, Vellore, India
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Ding J, Joseph M, Yau N, Khosa F. Underreporting of race and ethnicity in paediatric atopic dermatitis clinical trials: a cross-sectional analysis of demographic reporting and representation. Br J Dermatol 2021; 186:357-359. [PMID: 34480338 DOI: 10.1111/bjd.20740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/28/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- J Ding
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M Joseph
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - N Yau
- Faculty of Medical Sciences, University College London, London, UK
| | - F Khosa
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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18
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Roe C, Safic S, Mwaipopo L, Dotchin C, Klaptocz J, Gray K, Joseph M, Walker R. 426 PREVALENCE OF, AND RISK FACTORS FOR, DEMENTIA IN ADULT OUTPATIENT REFERRALS TO A REGIONAL REFERRAL HOSPITAL IN ARUSHA, TANZANIA. Age Ageing 2021. [DOI: 10.1093/ageing/afab118.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The global burden of dementia is increasing, with the greatest increase predicted to occur in sub-Saharan Africa (SSA). Despite this there are limited previous data on the prevalence of, and risk factors for, dementia in SSA. This study aimed to estimate the prevalence of dementia, and investigate its associations, in those aged 60 years and older attending the outpatient department of Mount Meru Hospital in northern Tanzania. This is the first hospital-based outpatient dementia prevalence and risk factors study to be conducted in an east African population.
Methods
This was a one-phase cross-sectional study. Adults aged 60 years and over attending medical outpatients were screened for dementia using The Identification and Intervention for Dementia in Elderly Africans cognitive screening tool. Those who scored ≤9 were clinically assessed using the DSM-IV criteria. Demographic, medical comorbidity and lifestyle information were collected during a clinical assessment.
Results
Prevalence of dementia was 5.0% (95% confidence interval: 3.7–6.3). Binary logistic regression found female sex (odds ratio (OR) = 2.778), having no formal education (OR = 6.088), quantity of alcohol consumption (units/week) (OR = 1.080), uncorrected visual impairment (OR = 4.260), body mass index <18.5 kg/m2 (OR = 6.588) and stroke (OR = 15.790 with wide 95% confidence interval (3.48–74.475)) to be significantly, independently associated with dementia.
Conclusions
The prevalence of dementia in this population is lower than previously reported community-based rates in Tanzania, and similar to those in high-income countries. This is the first time the association between uncorrected visual impairment and dementia has been reported in SSA. Other associations identified are in keeping with previous literature. Further research on the management of dementia and its risk factors, and the support and education of carers and patients in east African populations is required.
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Affiliation(s)
- C Roe
- Newcastle University; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust; Newcastle University; Northumbria Healthcare NHS Foundation Trust; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust
| | - S Safic
- Newcastle University; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust; Newcastle University; Northumbria Healthcare NHS Foundation Trust; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust
| | - L Mwaipopo
- Newcastle University; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust; Newcastle University; Northumbria Healthcare NHS Foundation Trust; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust
| | - C Dotchin
- Newcastle University; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust; Newcastle University; Northumbria Healthcare NHS Foundation Trust; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust
| | - J Klaptocz
- Newcastle University; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust; Newcastle University; Northumbria Healthcare NHS Foundation Trust; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust
| | - K Gray
- Newcastle University; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust; Newcastle University; Northumbria Healthcare NHS Foundation Trust; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust
| | - M Joseph
- Newcastle University; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust; Newcastle University; Northumbria Healthcare NHS Foundation Trust; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust
| | - R Walker
- Newcastle University; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust; Newcastle University; Northumbria Healthcare NHS Foundation Trust; Mount Meru Hospital; Newcastle University and Northumbria Healthcare NHS Foundation Trust
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19
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Affiliation(s)
- G. Wolske
- Medical University Vienna, Vienna, Austria
| | - M. Joseph
- Medical University Vienna, Vienna, Austria
| | - H. Rosenauer
- Medical University Vienna, Vienna, Austria
- Austrian Academic Institute for Clinical Nutrition, Vienna, Austria
| | - K. Widhalm
- Medical University Vienna, Vienna, Austria
- Austrian Academic Institute for Clinical Nutrition, Vienna, Austria
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20
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Modan S, Joseph M, Parvar S, Sinhal A, Perry R, Kashkavij S. Percutaneous Left Atrial Appendage Closure: A Single-Centre Experience Using 2D and 3D Transoesophageal Echocardiography. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Wu X, Perry R, Hecker T, Gunton J, Joseph M. Left Atrial Reservoir Strain: An Emerging Non-Invasive Differentiator of Pre- and Post-Capillary Pulmonary Hypertension? Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Pham K, Upadhyaya S, Hecker T, Ullah S, Joseph M, Gunton J. Utility of Transthoracic Echocardiogram in Detecting Pulmonary Hypertension in Patients Awaiting Liver Transplant. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Wernery U, Kinne J, Jose S, Gupta AD, Taha A, Ismail AA, Joseph M, Nagy P, Juhasz J. ‘Alpaca Fever’ in Dromedary Camel Calves–A Case Report. J CAMEL PRACT RES 2021. [DOI: 10.5958/2277-8934.2021.00045.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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24
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Mishra S, P VA, Sridhar M, Pandey N, Sankaran K, Joseph M. Characterization of gamma irradiated PUREX solvent – A systematic study. SEP SCI TECHNOL 2020. [DOI: 10.1080/01496395.2019.1594895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - M. Sridhar
- Fluoroorganics Division, CSIR-Indian Institute of Chemical Technology, Hyderabad, India
| | - N.K. Pandey
- Reprocessing R&D Division, IGCAR, Kalpakkam, India
| | - K. Sankaran
- Materials Chemistry & Metal Fuel Cycle Group, IGCAR, Kalpakkam, India
| | - M. Joseph
- Materials Chemistry & Metal Fuel Cycle Group, IGCAR, Kalpakkam, India
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25
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Tiver K, Horsfall M, De Pasquale C, Horsfall E, Joseph M, Russell A, Bridgman J, McGavigan A, Vaile J, Chew D, De Pasquale C. 334 Effect of Cardiologist Echocardiography Experience on Interpretation of Highly Limited Echocardiographic Screening Images for Diagnosis of Heart Disease. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.341] [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: 10/23/2022]
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26
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Jones D, Chew D, Horsfall M, Sinhal A, Chuang A, Baker R, Bennetts J, Selvanayagam J, Joseph M, Lehman S. 607 Frailty Improves After Aortic Valve Intervention for Severe Aortic Stenosis. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Hecker T, Kashkavij S, Mcleod A, Wu K, Perry R, Gunton J, Ganesan A, Joseph M. 292 Assessment of Novel Left Atrial Strain Software in Healthy Volunteers to Obtain Normal Ranges and Assess for Feasibility and Reproducibility. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.299] [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: 10/23/2022]
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28
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Jones D, Chew D, Horsfall M, Sinhal A, Chuang A, Baker R, Bennetts J, Selvanayagam J, Joseph M, Lehman S. 597 Augmentation Index Predicts Poor Symptomatic Recovery After Aortic Valve Intervention. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.604] [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: 10/23/2022]
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29
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Murray L, Mugwagwa A, Horsfall M, Tam P, Teh J, Gordon D, Bennetts J, Joseph M. 504 Infective Endocarditis at a Tertiary Hospital in Adelaide, Australia. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Swinson D, Hall P, Lord S, Marshall H, Ruddock S, Allmark C, Cairns D, Waters J, Wadsley J, Falk S, Roy R, Joseph M, Nicoll J, Kamposioras K, Tillett T, Cummins S, Grumett S, Stokes Z, Waddell T, Chatterjee A, Garcia A, Khan M, Petty R, Seymour M. OPTIMIZING CHEMOTHERAPY FOR FRAIL AND/OR ELDERLY PATIENTS WITH ADVANCED GASTROESOPHAGEAL CANCER (AGOAC): THE GO2 PHASE III TRIAL. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31133-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Joseph M, Szafron V, Yang B, Srivaths L, Anvari S, Castells M, Noroski L. M030 FERRIC CARBOXYMALTOSE DESENSITIZATION IN REFRACTORY IDIOPATHIC IRON-DEFICIENCY ANEMIA, IRON-INFUSION ANAPHYLAXIS, SEVERE ATOPY AND HYPERTRYPTASEMIA. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.099] [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: 10/25/2022]
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32
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Marrouche N, Joseph M, Godfrey J, Phillips P, Piazza D, Macnamara F, Harari D. P2866Automated ultrasound ablation parameters predict lesion depth in a perfused thigh model. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1175] [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
Background
The accuracy and safety of lesions created during catheter ablation of cardiac tissue rely on the user's ability to predict the size of lesions that form under variable conditions during treatment. A user-directed robotic system was developed that uses Low-Intensity Collimated Ultrasound (LICU) for cardiac imaging and to produce linear lesions without tissue contact. Molecular absorption of mechanical energy induced in the tissue by LICU causes a temperature rise resulting in thermal tissue necrosis.
Purpose
By varying the speed of the LICU beam as it traces the desired lesion path, while considering the beam intensity, distance from catheter tip to tissue, and relative motion of the target tissue, we demonstrate the capability to deposit lesions of known depth according to a predictive model.
Methods
The LICU catheter was mounted in a servo-controlled, 3 axis stage suspended above a perfused porcine thigh that simulates the thermodynamic properties of the myocardium such as acoustic attenuation, thermal conduction, and specific heat capacity. Therapy was delivered along a linear path while varying the distance to tissue, speed of the beam, and motion of the catheter relative to the tissue in 3 dimensions. Programmed relative motion was representative of typical and extreme motion in humans. Pathological analysis after necropsy was used to quantify lesion depth which was then compared to lesion depth as predicted by a mathematical model from approx. 4–12 mm.
Results
Data from 66 samples were categorized according to typical and extreme motion at 4 different distances (3, 8, 9 and 13 mm). Measured vs predicted lesion depth was well correlated (R = 0.898) with 98.5% of the samples within ±2 mm.
Assessment of LICU lesion depth
Conclusion
Lesion depth using LICU is well controlled in an animal model for the range of distances and relative motion typically encountered in a human subject. The range of acoustic beam speeds and acoustic power density with LICU predictably produces lesions up to 12 mm deep. The LICU thermal model may be useful to create lesions of known depth thus ensuring transmurality of lesions while potentially avoiding unintended extra-cardiac injury.
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Affiliation(s)
- N Marrouche
- University of Utah, Comprehensive Arrhythmia and Research Management Center, University of Utah, Salt Lake City, Salt Lake City, United States of America
| | - M Joseph
- Vytronus, Inc., Sunnyvale, CA, United States of America
| | - J Godfrey
- Vytronus, Inc., Sunnyvale, CA, United States of America
| | - P Phillips
- Vytronus, Inc., Sunnyvale, CA, United States of America
| | - D Piazza
- Vytronus, Inc., Sunnyvale, CA, United States of America
| | - F Macnamara
- Vytronus, Inc., Sunnyvale, CA, United States of America
| | - D Harari
- Vytronus, Inc., Sunnyvale, CA, United States of America
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33
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Becker A, Aggarwal P, Ebrahim M, Joseph M, Kondamudi N. 300 Identification of Social Determinants of Health in a Pediatric Emergency Department. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.258] [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: 10/25/2022]
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34
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Kumar S, King EC, Christison AL, Kelly AS, Ariza AJ, Borzutzky C, Cuda S, Kirk S, Ali L, Armstrong S, Binns H, Brubaker J, Cristison A, Fox C, Gordon C, Hendrix S, Hes D, Jenkins L, Joseph M, Heyrman M, Liu L, McClure A, Hofley M, Negrete S, Novick M, O'Hara V, Rodrue J, Santos M, Stoll J, Stratbucker W, Sweeney B, Tester J, Walka S, deHeer H, Wallace S, Walsh S, Wittcopp C, Weedn A, Yee J, Grace B. Health Outcomes of Youth in Clinical Pediatric Weight Management Programs in POWER. J Pediatr 2019; 208:57-65.e4. [PMID: 30853195 DOI: 10.1016/j.jpeds.2018.12.049] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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] [Received: 09/28/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe treatment outcomes of children and adolescents enrolled in the Pediatric Obesity Weight Evaluation Registry, a consortium of multicomponent pediatric weight management programs in the US. STUDY DESIGN This multicenter prospective observational cohort study, established in 2013, includes youth (2-18 years of age) with obesity enrolled from 31 Pediatric Obesity Weight Evaluation Registry (POWER) sites over a 2-year period and followed up to 12 months. Weight status was evaluated by the percentage of the 95th percentile for body mass index (%BMIp95). Associations of weight status outcomes with patient characteristics and program exposure were analyzed with multivariable mixed effects modeling. RESULTS We included 6454 children and adolescents (median age, 11 years; IQR, 9-14 years; 53% white, 32% Hispanic; 73% with severe obesity) who were enrolled in POWER. Median changes in %BMIp95 for this cohort were -1.88 (IQR, -5.8 to 1.4), -2.50 (IQR, -7.4 to 1.8), -2.86 (IQR, -8.7 to 1.9), at 4-6, 7-9, and 10-12 of months follow-up, respectively (all P < .05). Older age (≥12 years), greater severity of obesity, and Hispanic race/ethnicity were associated with better improvement in %BMIp95. A 5-percentage point decrease in %BMIp95 was associated with improvement in cardiometabolic risk factors. CONCLUSIONS Overall, treatment in pediatric weight management programs is associated with a modest median decrease in BMI as measured by change in %BMIp95. Further studies are needed to confirm these findings, as well as to identify additional strategies to enhance the effectiveness of these multicomponent interventions for youth with severe obesity. TRIAL REGISTRATION ClinicalTrials.gov: NCT02121132.
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Affiliation(s)
- Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Eileen C King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Amy L Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Aaron S Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Adolfo J Ariza
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Claudia Borzutzky
- Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA; Diabetes and Obesity Program, Children's Hospital Los Angeles, Los Angeles, CA
| | - Suzanne Cuda
- Department of Pediatrics, Pediatric Weight Management, Children's Hospital of San Antonio, Baylor College of Medicine, Houston, TX
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH; The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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35
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Scherer RD, Hansen EC, Joseph M, Wack RF. Estimating relationships between size and fecundity in the threatened giant garter snake in seminatural and agricultural wetlands. POPUL ECOL 2019. [DOI: 10.1002/1438-390x.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Eric C. Hansen
- Consulting Environmental Biologist Sacramento California
| | - Max Joseph
- Earth Lab University of Colorado Boulder Colorado
| | - Raymund F. Wack
- Wildlife Health Center, School of Veterinary Medicine University of California Davis California
- Sacramento Zoo Sacramento California
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36
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Ashok Kumar GVS, Venkata Subramani CR, Kumar R, Sivakumar S, Murugan S, Varadharajan S, Sureshkumar KV, Ananthasivan K, Joseph M, Srinivasan G. Design, installation and preliminary flux measurements at the Fast Flux Experimental Facility (FFEF) of the Fast Breeder Test Reactor (FBTR). J Radioanal Nucl Chem 2019. [DOI: 10.1007/s10967-019-06463-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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37
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Hassan F, Wernery U, Joseph M, Anouassi A, Mariena K, Rangsun P. Molecular identification of 20 Escherichia coli isolates from dead neonatal camel calves (Camelus dromedarius) in the United Arab Emirates. J CAMEL PRACT RES 2019. [DOI: 10.5958/2277-8934.2019.00041.9] [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: 10/25/2022]
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38
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Swan A, Wai TS, Mugwagwa G, Khan E, Lau G, Joseph M. Global Longitudinal Strain in Exercise Stress Echo; are there Different Responses Based on Cardiac Risk? Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.272] [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: 11/28/2022]
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39
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Shivakumar S, Joseph M, Swan A, Chew D, Jones D, Hecker T, Sinhal A. Is the Improvement in Mitral Regurgitation Post TAVR an Acute Phenomenon? Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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40
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Kumar S, Maji S, Gopakumar G, Joseph M, Sundararajan K, Sankaran K. Luminescent versus non-luminescent uranyl–picolinate complexes. J Radioanal Nucl Chem 2018. [DOI: 10.1007/s10967-018-6305-3] [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: 10/28/2022]
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41
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Joseph M, Noroski L, Watkin L. TYPE 2 ALLERGIC DISORDERS UNIQUELY IDENTIFIED WITHIN PEDIATRIC PRIMARY IMMUNODEFICIENCIES AS NOVEL CO-EXISTING MASQUERADERS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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42
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King A, Gunton J, Perry R, Depasquale C, Chew D, Joseph M. Can Takotsubo Cardiomyopathy be Differentiated from Anterior Myocardial Infarction Using Echocardiography and Patient Demographic Features Without Coronary Angiogram? Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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43
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Laroucau K, Lucia de Assis Santana V, Girault G, Martin B, Miranda da Silveira P, Brasil Machado M, Joseph M, Wernery R, Wernery U, Zientara S, Madani N. First molecular characterisation of a Brazilian Burkholderia mallei strain isolated from a mule in 2016. Infection, Genetics and Evolution 2018; 57:117-120. [DOI: 10.1016/j.meegid.2017.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 11/02/2017] [Accepted: 11/12/2017] [Indexed: 11/30/2022]
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44
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Perry R, Patil S, Horsfall M, Marx C, Chew D, Joseph M, Ganesan A, McGavigan A, Nucifora G, Selvanayagam J. Mechanical Dispersion and Global Longitudinal Strain Improve Risk Stratification of Malignant Ventricular Arrhythmias and Sudden Cardiac Death Over Ejection Fraction Alone. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.030] [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: 10/28/2022]
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45
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Tara S, Swan A, Lau G, Gunton J, Khan E, Joseph M. Automated Function Imaging in Exercise Stress Echocardiography of Low-Risk Patients. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.399] [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: 10/28/2022]
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46
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Kinne J, Maio E, Joseph M, Anas S, Wernery U. Dromedary mastitis caused by Clostridium septicum: A case report. J CAMEL PRACT RES 2018. [DOI: 10.5958/2277-8934.2018.00039.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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47
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Jones D, Lehman S, Chew D, Bennetts J, Selvanayagam J, Horsfall M, Chuang A, Sinhal A, Joseph M, Baker R. Effect of Expanded Aortic Stenosis Management Services on Outcomes. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1020] [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: 10/28/2022]
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48
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Ajani J, Udrea A, Sarosiek T, Shenker M, Morgan C, Pikiel J, Wojcik E, Swinson D, Joseph M, Luft A, Salek T, Tournigand C, Ferry D, Zhang Y, Long A, Kuo WL, Gao L, Kauh J, Mansoor W. A dose-response study of ramucirumab treatment in patients with gastric cancer/gastroesophageal junction adenocarcinoma: Primary results of 4 dosing regimens in the phase 2 trial I4T-MC-JVDB. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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49
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Ramasamy S, Kapoor N, Joseph M, Jiwanmall S, Kattula D, Abraham V, Subramaniam I, Paul T, Thomas N. Health Related Quality of Life in Morbidly Obese Women Attending a
Tertiary Care Hospital in India. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.403] [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: 10/19/2022] Open
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Pitchaiah KC, Sivaraman N, Joseph M, Mohapatra PK, Madras G. Solubility of tri-iso-amyl phosphate in supercritical carbon dioxide and its application to selective extraction of uranium. SEP SCI TECHNOL 2017. [DOI: 10.1080/01496395.2017.1287737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- K. C. Pitchaiah
- Chemistry Group, Indira Gandhi Centre for Atomic Research, HBNI, Kalpakkam, India
| | - N. Sivaraman
- Chemistry Group, Indira Gandhi Centre for Atomic Research, HBNI, Kalpakkam, India
| | - M. Joseph
- Chemistry Group, Indira Gandhi Centre for Atomic Research, HBNI, Kalpakkam, India
| | - P. K. Mohapatra
- Radiochemistry Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Giridhar Madras
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
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