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Domingo-Relloso A, Makhani K, Riffo-Campos AL, Tellez-Plaza M, Klein KO, Subedi P, Zhao J, Moon KA, Bozack AK, Haack K, Goessler W, Umans JG, Best LG, Zhang Y, Herreros-Martinez M, Glabonjat RA, Schilling K, Galvez-Fernandez M, Kent JW, Sanchez TR, Taylor KD, Johnson WC, Durda P, Tracy RP, Rotter JI, Rich SS, Van Den Berg D, Kasela S, Lappalainen T, Vasan RS, Joehanes R, Howard BV, Levy D, Lohman K, Liu Y, Fallin MD, Cole SA, Mann KK, Navas-Acien A. Arsenic Exposure, Blood DNA Methylation, and Cardiovascular Disease. Circ Res 2022; 131:e51-e69. [PMID: 35658476 DOI: 10.1161/circresaha.122.320991] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Epigenetic dysregulation has been proposed as a key mechanism for arsenic-related cardiovascular disease (CVD). We evaluated differentially methylated positions (DMPs) as potential mediators on the association between arsenic and CVD. METHODS Blood DNA methylation was measured in 2321 participants (mean age 56.2, 58.6% women) of the Strong Heart Study, a prospective cohort of American Indians. Urinary arsenic species were measured using high-performance liquid chromatography coupled to inductively coupled plasma mass spectrometry. We identified DMPs that are potential mediators between arsenic and CVD. In a cross-species analysis, we compared those DMPs with differential liver DNA methylation following early-life arsenic exposure in the apoE knockout (apoE-/-) mouse model of atherosclerosis. RESULTS A total of 20 and 13 DMPs were potential mediators for CVD incidence and mortality, respectively, several of them annotated to genes related to diabetes. Eleven of these DMPs were similarly associated with incident CVD in 3 diverse prospective cohorts (Framingham Heart Study, Women's Health Initiative, and Multi-Ethnic Study of Atherosclerosis). In the mouse model, differentially methylated regions in 20 of those genes and DMPs in 10 genes were associated with arsenic. CONCLUSIONS Differential DNA methylation might be part of the biological link between arsenic and CVD. The gene functions suggest that diabetes might represent a relevant mechanism for arsenic-related cardiovascular risk in populations with a high burden of diabetes.
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Affiliation(s)
- Arce Domingo-Relloso
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (A.D.-R., R.A.G., K.S., M.G.-F., T.R.S., A.N.-A.).,Integrative Epidemiology Group, Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain (A.D.-R., M.T.-P., M.G.-F.).,Department of Statistics and Operations Research (A.D.-R.), University of Valencia, Spain
| | - Kiran Makhani
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada (K.M., K.O.K., K.K.M.)
| | - Angela L Riffo-Campos
- Department of Computer Science, ETSE (A.L.R.-C.), University of Valencia, Spain.,Millennium Nucleus on Sociomedicine (SocioMed) and Vicerrectoría Académica, Universidad de La Frontera, Temuco, Chile (A.L.R.-C.)
| | - Maria Tellez-Plaza
- Integrative Epidemiology Group, Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain (A.D.-R., M.T.-P., M.G.-F.)
| | - Kathleen Oros Klein
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada (K.M., K.O.K., K.K.M.)
| | - Pooja Subedi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville (P.S., J.Z.)
| | - Jinying Zhao
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville (P.S., J.Z.)
| | - Katherine A Moon
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.A.M.)
| | - Anne K Bozack
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley (A.K.B.)
| | - Karin Haack
- Population Health Program, Texas Biomedical Research Institute, San Antonio' TX (K.H., J.W.K., S.A.C.)
| | - Walter Goessler
- Institute of Chemistry - Analytical Chemistry for Health and Environment, University of Graz, Austria (W.G.)
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD. Now with Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC (J.G.U., B.W.H.).,Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC (J.G.U., B.V.H.)
| | - Lyle G Best
- Missouri Breaks Industries and Research, Inc, Eagle Butte, SD (L.G.B.)
| | - Ying Zhang
- Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center (Y.Z.)
| | | | - Ronald A Glabonjat
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (A.D.-R., R.A.G., K.S., M.G.-F., T.R.S., A.N.-A.)
| | - Kathrin Schilling
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (A.D.-R., R.A.G., K.S., M.G.-F., T.R.S., A.N.-A.)
| | - Marta Galvez-Fernandez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (A.D.-R., R.A.G., K.S., M.G.-F., T.R.S., A.N.-A.).,Integrative Epidemiology Group, Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain (A.D.-R., M.T.-P., M.G.-F.)
| | - Jack W Kent
- Population Health Program, Texas Biomedical Research Institute, San Antonio' TX (K.H., J.W.K., S.A.C.)
| | - Tiffany R Sanchez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (A.D.-R., R.A.G., K.S., M.G.-F., T.R.S., A.N.-A.)
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA (K.D.T., J.I.R.)
| | - W Craig Johnson
- Department of Biostatistics, University of Washington, Seattle (W.C.J.)
| | - Peter Durda
- Department of Pathology Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT (P.D., R.P.T.)
| | - Russell P Tracy
- Department of Pathology Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT (P.D., R.P.T.)
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA (K.D.T., J.I.R.)
| | - Stephen S Rich
- Center for Public Health Genomics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA (S.S.R.)
| | - David Van Den Berg
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles' CA (D.V.D.B.)
| | - Silva Kasela
- New York Genome Center (S.K., T.L.).,Department of Systems Biology, Columbia University' NY (S.K., T.L.)
| | - Tuuli Lappalainen
- New York Genome Center (S.K., T.L.).,Department of Systems Biology, Columbia University' NY (S.K., T.L.)
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.S.V.).,Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Department of Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.)
| | - Roby Joehanes
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.J., D.L.).,Framingham Heart Study, MA (R.J., D.L.)
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, MD. Now with Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC (J.G.U., B.W.H.).,Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC (J.G.U., B.V.H.)
| | - Daniel Levy
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.J., D.L.).,Framingham Heart Study, MA (R.J., D.L.)
| | - Kurt Lohman
- Department of Medicine, Duke University Medical Center, Durham, NC (K.L., Y.L.)
| | - Yongmei Liu
- Department of Medicine, Duke University Medical Center, Durham, NC (K.L., Y.L.)
| | - M Daniele Fallin
- Departments of Mental Health and Epidemiology, Johns Hopkins University, Baltimore, MD (M.D.F.)
| | - Shelley A Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio' TX (K.H., J.W.K., S.A.C.)
| | - Koren K Mann
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada (K.M., K.O.K., K.K.M.).,Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada (K.K.M.)
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY (A.D.-R., R.A.G., K.S., M.G.-F., T.R.S., A.N.-A.)
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Subedi P, Limbu N, Maskey R, Baral DD. Visual Evoked Potentials (VEPs) in Patients with Type 2 Diabetes Mellitus. Kathmandu Univ Med J (KUMJ) 2022; 20:70-73. [PMID: 36273295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Type 2 diabetes constitutes about 85-95% of all diabetes in developed countries, and accounts for an even higher percentage in developing countries. Diabetic retinopathy is probable the most characteristic, easily identifiable and treatable complication of diabetes, but remains an important cause of visual loss. Objective To study P100 latencies and inter ocular latency difference in diabetic group and compared it with a control group and study the correlation between P100 and inter ocular latency difference with the duration of disease in diabetic group. Method A comparative, cross sectional study was done from September 2016 to January 2018 in Neurophysiology Lab, Basic and Clinical Physiology, BP Koirala Institute of Health Sciences. The sample size was 64 and random sampling technique was used. Subjects were divided into three groups according to the duration of disease. Anthropometric and visual evoked potentials were recorded. Descriptive analysis, analysis of covariance and Post Hoc multiple comparison analyses were done using SPSS 11.5. Pearson's correlation was applied between P100 latency and inter ocular latency difference with the duration of disease. Result On using analysis of covariance, P100 latencies were significantly prolonged in diabetic as compared to healthy controls (p < 0.001). Post Hoc multiple comparison showed significant differences in both left and right P100 latencies within diabetic groups and between diabetic groups and healthy controls. Left inter ocular latency difference showed positive correlation with the duration of disease. Conclusion P100 latencies are significantly prolonged in diabetes patients and is positively correlated with duration of disease. Visual evoked potential test can be useful for detecting retinal dysfunction before the appearance of symptoms of retinopathy.
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Affiliation(s)
- P Subedi
- Department of Basic and Clinical Physiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - N Limbu
- Department of Basic and Clinical Physiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - R Maskey
- Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - D D Baral
- Department of Community Medicine and School of Public Health, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Navas-Acien A, Domingo-Relloso A, Subedi P, Riffo-Campos AL, Xia R, Gomez L, Haack K, Goldsmith J, Howard BV, Best LG, Devereux R, Tauqeer A, Zhang Y, Fretts AM, Pichler G, Levy D, Vasan RS, Baccarelli AA, Herreros-Martinez M, Tang WY, Bressler J, Fornage M, Umans JG, Tellez-Plaza M, Fallin MD, Zhao J, Cole SA. Blood DNA Methylation and Incident Coronary Heart Disease: Evidence From the Strong Heart Study. JAMA Cardiol 2021; 6:1237-1246. [PMID: 34347013 DOI: 10.1001/jamacardio.2021.2704] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 12/14/2022]
Abstract
Importance American Indian communities experience a high burden of coronary heart disease (CHD). Strategies are needed to identify individuals at risk and implement preventive interventions. Objective To investigate the association of blood DNA methylation (DNAm) with incident CHD using a large number of methylation sites (cytosine-phosphate-guanine [CpG]) in a single model. Design, Setting, and Participants This prospective study, including a discovery cohort (the Strong Heart Study [SHS]) and 4 additional cohorts (the Women's Health Initiative [WHI], the Framingham Heart Study [FHS], the Atherosclerosis Risk in Communities Study ([ARIC]-Black, and ARIC-White), evaluated 12 American Indian communities in 4 US states; African American women, Hispanic women, and White women throughout the US; White men and White women from Massachusetts; and Black men and women and White men and women from 4 US communities. A total of 2321 men and women (mean [SD] follow-up, 19.1 [9.2] years) were included in the SHS, 1874 women (mean [SD] follow-up, 15.8 [5.9] years) in the WHI, 2128 men and women (mean [SD] follow-up, 7.7 [1.8] years) in the FHS, 2114 men and women (mean [SD] follow-up, 20.9 [7.2] years) in the ARIC-Black, and 931 men and women (mean [SD] follow-up, 20.9 [7.2] years) in the ARIC-White. Data were collected from May 1989 to December 2018 and analyzed from February 2019 to May 2021. Exposure Blood DNA methylation. Main Outcome and Measure Using a high-dimensional time-to-event elastic-net model for the association of 407 224 CpG sites with incident CHD in the SHS (749 events), this study selected the differentially methylated CpG positions (DMPs) selected in the SHS and evaluated them in the WHI (531 events), FHS (143 events), ARIC-Black (350 events), and ARIC-White (121 events) cohorts. Results The median (IQR) age of participants in SHS was 55 (49-62) years, and 1359 participants (58.6%) were women. Elastic-net models selected 505 DMPs associated with incident CHD in the SHS beyond established risk factors, center, blood cell counts, and genetic principal components. Among those DMPs, 33 were commonly selected in 3 or 4 of the other cohorts and the pooled hazard ratios from the standard Cox models were significant at P < .05 for 10 of the DMPs. For example, the hazard ratio (95% CI) for CHD comparing the 90th and 10th percentiles of differentially methylated CpGs was 0.86 (0.78-0.95) for cg16604233 (tagged to COL11A2) and 1.23 (1.08-1.39) for cg09926486 (tagged to FRMD5). Some of the DMPs were consistent in the direction of the association; others showed associations in opposite directions across cohorts. Untargeted independent elastic-net models of CHD showed distinct DMPs, genes, and network of genes in the 5 cohorts. Conclusions and Relevance In this multi-cohort study, blood-based DNAm findings supported an association between a complex blood epigenomic signature and CHD that was largely different across populations.
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Affiliation(s)
- Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Arce Domingo-Relloso
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York.,Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain.,Department of Statistics and Operations Research, University of Valencia, Valencia, Spain
| | - Pooja Subedi
- College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville
| | | | - Rui Xia
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston
| | - Lizbeth Gomez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Karin Haack
- Population Health Program, Texas Biomedical Research Institute, San Antonio
| | - Jeff Goldsmith
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | | | - Lyle G Best
- Missouri Breaks Industries Research Inc, Eagle Butte, South Dakota
| | | | - Ali Tauqeer
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City
| | - Ying Zhang
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City
| | - Amanda M Fretts
- Department of Epidemiology, University of Washington, Seattle
| | - Gernot Pichler
- Department of Cardiology, Heart Center Clinic Floridsdorf, Vienna, Austria
| | - Daniel Levy
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts.,Section of Preventive Medicine and Epidemiology and Section of Cardiovascular Medicine, Department of Medicine, Department of Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts.,Section of Preventive Medicine and Epidemiology and Section of Cardiovascular Medicine, Department of Medicine, Department of Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
| | | | - Wan-Yee Tang
- Department of Occupational and Environmental Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jan Bressler
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston.,Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston
| | - Jason G Umans
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York.,Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC
| | - Maria Tellez-Plaza
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - M Daniele Fallin
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.,Department of Mental Health, Johns Hopkins University, Baltimore, Maryland
| | - Jinying Zhao
- College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville
| | - Shelley A Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio
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Paul TK, Alamin AE, Subedi P, Zhang M, Diab MM, Alamian A, Wang L, Blackwell G, Mamudu HM. Association between cardiovascular risk factors and the diameter of the main pulmonary artery in asymptomatic population in the Appalachian region. J Thorac Dis 2019; 11:3435-3442. [PMID: 31559048 DOI: 10.21037/jtd.2019.08.09] [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] [Indexed: 11/06/2022]
Abstract
Background Pulmonary artery (PA) diameter may be altered in association with cardiovascular (CV) risk factors as noted in aorta in systemic hypertension. The flow of blood from the right ventricle to the PA and all the way to the capillary level depends on the pulmonary vascular resistance and to a lesser extent compliance and impedance of the PA, which are the fundamental conduit for maintenance of the right heart hemodynamics. Our objective is to determine the association between CV risk factors and the main pulmonary artery (MPA) diameter. Methods The study population are asymptomatic individuals with no known diagnosis of CV diseases in central Appalachia (n=1,282). Adults aged 18 years or older were eligible for the screening if they were referred by a physician. For self-referral, only males aged ≥45 years and females aged ≥55 years were eligible. Unadjusted and adjusted linear regression analyses were performed. Results The mean MPA diameter was significantly higher among males compared to females (27.19±4.20 vs. 24.99±3.91 mm, P<0.0001). Participants with diabetes also had wider MPA diameter (26.79±4.56 mm) compared to those without diabetes (25.93±4.11 mm) (P=0.015). Further, hypertensive (26.42±4.15 vs. 25.71±4.21 mm, P=0.002) and obese (27.25±4.11 vs. 25.28±4.07 mm, P<0.0001) participants had significantly wider MPA diameter compared to non-hypertensive and non-obese participants, respectively. Multivariable model showed that age, sex and body mass index (BMI) were significantly associated with MPA diameter. A 1-year increase in age increased MPA diameter by 0.046 mm (P<0.0001). The diameter of MPA was wider among males by 2.16 mm compared to females (P<0.0001). Finally, with one unit increase in BMI, the MPA diameter increased by 0.16 mm (P<0.0001). Conclusions MPA diameter was significantly associated with age, sex, and BMI. Further prospective studies are needed to correlate computed tomography (CT) measurement of MPA diameter with pulmonary pressure as assessed by echocardiogram to diagnose pulmonary hypertension (PH).
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Affiliation(s)
- Timir K Paul
- Division of Cardiology, James. H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Ali E Alamin
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Pooja Subedi
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Michael Zhang
- Department of Internal Medicine, James. H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37604, USA
| | - Mohamed M Diab
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Arsham Alamian
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Liang Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Gerald Blackwell
- Executive Vice President and Chief Clinical Officer, Ballad Health, Johnson City, TN, USA
| | - Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, USA
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Subedi P, Nembrini S, An Q, Zhu Y, Peng H, Yeh F, Cole SA, Rhoades DA, Lee ET, Zhao J. Telomere length and cancer mortality in American Indians: the Strong Heart Study. GeroScience 2019; 41:351-361. [PMID: 31230193 DOI: 10.1007/s11357-019-00080-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/08/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022] Open
Abstract
The objective of this study was to investigate whether leukocyte telomere length (LTL) predicts the risk for cancer mortality among American Indians participating in the Strong Heart Study (1989-1991). Participants (aged 45-74 years) were followed annually until December 2015 to collect information on morbidity/mortality. LTL was measured by qPCR using genomic DNA isolated from peripheral blood. The association between LTL and risk for cancer mortality was examined using a multivariable Cox proportional hazard model, adjusting for age, gender, education, study site, smoking, alcohol use, physical activity, systolic blood pressure, fasting blood glucose, obesity, and low- and high-density lipoprotein. Of 1945 participants (mean age 56.10 ± 8.17 at baseline, 57% women) followed for an average 20.5 years, 220 died of cancer. Results showed that longer LTL at baseline significantly predicts an increased risk of cancer death among females (HR 1.57, 95% CI 1.08-2.30), but not males (HR 0.74, 95% CI 0.49-1.12) (p for interaction 0.009). Specifically, compared with the women with the longest LTL (fourth quartile), those in the third, second, and first quartiles showed 53%, 41%, and 44% reduced risk for cancer death, respectively. The findings highlight the importance of sex-specific analysis in future telomere research.
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Affiliation(s)
- Pooja Subedi
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Stefano Nembrini
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Qiang An
- Department of Orthopaedics and Rehabilitation, University of Iowa Health Care, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01066 JPP, Iowa City, IA, 52242, USA
| | - Yun Zhu
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Hao Peng
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.,Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Fawn Yeh
- College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK, 73104, USA
| | - Shelley A Cole
- Texas Biomedical Research Institute, San Antonio, TX, 78245, USA
| | - Dorothy A Rhoades
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, OK, 73104, USA
| | - Elisa T Lee
- College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK, 73104, USA
| | - Jinying Zhao
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
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Dowling-McClay K, Mospan CM, Subedi P, Hagemeier NE. Explaining Pharmacy Students' Dispensing Intentions in Substance Abuse-Related Gray Areas Using the Theory of Planned Behavior. Am J Pharm Educ 2019; 83:6767. [PMID: 31333256 PMCID: PMC6630868 DOI: 10.5688/ajpe6767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/30/2017] [Accepted: 04/09/2018] [Indexed: 06/10/2023]
Abstract
Objective. To examine the extent to which theory of planned behavior (TPB) constructs and demographic characteristics explain pharmacy students' dispensing intentions in ethically or legally gray areas involving potential substance misuse or abuse. Methods. Two cohorts of third-year Doctor of Pharmacy (PharmD) students (n=159) were provided with five written cases describing common "gray area" dispensing scenarios in community practice involving medications and devices with potential for misuse or abuse (eg, long-term buprenorphine maintenance prescription without evidence of tapering, early refill of a narcotic for an out-of-town patient, non-prescription sale of pseudoephedrine). Students completed a 12-item survey instrument for each case. Items assessed whether the student would dispense the medication or device in the given scenario, how many times in 10 similar scenarios the student would dispense the medication or device, attitudes regarding dispensing, and subjective norm and perceived behavioral control beliefs. Results. Wide variation in the percentages of students who would dispense the medications or devices was noted across the five scenarios (14% in the buprenorphine scenario to 61% in the pseudoephedrine scenario). Attitude scores significantly predicted dispensing decisions in all scenarios (p<.001), whereas subjective norm and perceived behavioral control beliefs were significant predictors of dispensing only in select case scenarios. Gender and community pharmacy work experience did not consistently predict dispensing intentions. Conclusion. Student attitudes consistently predicted intent to dispense across five gray practice scenarios. These findings can be used to inform development of educational interventions that influence students' attitudes and self-awareness in community practice decision-making scenarios involving potential substance misuse or abuse.
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Affiliation(s)
| | | | - Pooja Subedi
- East Tennessee State University College of Public Health, Johnson City, Tennessee
| | - Nicholas E. Hagemeier
- East Tennessee State University Bill Gatton College of Pharmacy, Johnson City, Tennessee
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Hagemeier NE, Gentry CK, Byrd DC, Cross LB, Rose D, Ansari N, Subedi P, Branham T. Student Pharmacists' Personal Finance Perceptions, Projected Indebtedness Upon Graduation, and Career Decision-making. Am J Pharm Educ 2019; 83:6722. [PMID: 31223155 PMCID: PMC6581354 DOI: 10.5688/ajpe6722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 08/14/2017] [Accepted: 11/02/2017] [Indexed: 05/30/2023]
Abstract
Objective. To evaluate the extent to which Doctor of Pharmacy students' personal finance perceptions, projected student loan indebtedness, and demographic characteristics predict postgraduation career intentions. Methods. Students at three pharmacy colleges completed a 31-item survey instrument that assessed personal finance perceptions, self-efficacy beliefs, anticipated student loan debt upon graduation, postgraduate intentions, anticipated practice setting upon graduation, and demographic characteristics. Logistic regression models were used to examine the extent to which personal finance perceptions, student loan indebtedness, and demographic characteristics predicted postgraduate intentions and anticipated practice setting. Results. There were 763 usable responses obtained (response rate=90.3%). Students reported an anticipated personal student loan debt at graduation of $162,747 (SD=$87,093) and an estimated 7.4 (SD=5.8) years to pay off non-mortgage debt postgraduation. Fifty-three percent of students reported planning to practice in a community pharmacy setting postgraduation, and 54% indicated they intended to enter practice directly. Student loan indebtedness was not a significant predictor of whether students planned to pursue postgraduate training. There was a significant association between debt influence and pressure perceptions and students' plans to pursue postgraduate training (aOR=0.78; 95% CI=0.65-0.94). The odds of indicating hospital (vs chain community) pharmacy as the anticipated setting decreased 36% with every one point increase in debt influence and pressure perceptions (aOR=0.64; 95% CI=0.50-0.81). Conclusion. Pharmacy students' perceived debt pressure and influence predicted their intention to enter practice directly (vs pursuing postgraduate training) and to select a career in chain community pharmacy (vs hospital pharmacy). Student loan indebtedness was not a significant predictor of postgraduate training intentions. These findings suggest that interventions that equip students to manage the pressure associated with large student loan debts should be explored.
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Affiliation(s)
| | - Chad K. Gentry
- Lipscomb University College of Pharmacy, Nashville, Tennessee
| | - Debbie C. Byrd
- East Tennessee State University Gatton College of Pharmacy, Johnson City, Tennessee
| | - L. Brian Cross
- East Tennessee State University Gatton College of Pharmacy, Johnson City, Tennessee
| | - Daniel Rose
- East Tennessee State University Gatton College of Pharmacy, Johnson City, Tennessee
| | - Nasar Ansari
- East Tennessee State University Gatton College of Pharmacy, Johnson City, Tennessee
| | - Pooja Subedi
- East Tennessee State University Gatton College of Pharmacy, Johnson City, Tennessee
| | - Tandy Branham
- East Tennessee State University Gatton College of Pharmacy, Johnson City, Tennessee
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Subedi P. The Interplay between Experiences of Abuse, Physical Activity, and Falls in Older Adults. J Am Geriatr Soc 2019; 67:1097. [PMID: 30629735 DOI: 10.1111/jgs.15744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Pooja Subedi
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL
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Mamudu HM, Subedi P, Alamin AE, Veeranki SP, Owusu D, Poole A, Mbulo L, Ogwell Ouma AE, Oke A. The Progress of Tobacco Control Research in Sub-Saharan Africa in the Past 50 Years: A Systematic Review of the Design and Methods of the Studies. Int J Environ Res Public Health 2018; 15:E2732. [PMID: 30518024 PMCID: PMC6313754 DOI: 10.3390/ijerph15122732] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 01/25/2023]
Abstract
Over one billion of the world's population are smokers, with increasing tobacco use in low- and middle-income countries. However, information about the methodology of studies on tobacco control is limited. We conducted a literature search to examine and evaluate the methodological designs of published tobacco research in Sub-Saharan Africa (SSA) over the past 50 years. The first phase was completed in 2015 using PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. An additional search was completed in February 2017 using PubMed. Only tobacco/smoking research in SSA countries with human subjects and published in English was selected. Out of 1796 articles, 447 met the inclusion criteria and were from 26 countries, 11 of which had one study each. Over half of the publications were from South Africa and Nigeria. The earliest publication was in 1968 and the highest number of publications was in 2014 (n = 46). The majority of publications used quantitative methods (91.28%) and were cross-sectional (80.98%). The commonest data collection methods were self-administered questionnaires (38.53%), interviews (32.57%), and observation (20.41%). Around half of the studies were among adults and in urban settings. We conclud that SSA remains a "research desert" and needs more investment in tobacco control research and training.
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Affiliation(s)
- Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Pooja Subedi
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Ali E Alamin
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555, USA.
| | - Daniel Owusu
- Tobacco Center of Regulatory Science (GSU TCORS), Georgia State University, Atlanta, GA 30340, USA.
| | - Amy Poole
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Lazarous Mbulo
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - A E Ogwell Ouma
- Tobacco Control Division, WHO Regional Office for Africa, P.O.Box 06 Brazzaville, Congo.
| | - Adekunle Oke
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
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10
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Mamudu HM, Alamian A, Paul T, Subedi P, Wang L, Jones A, Alamin AE, Stewart D, Blackwell G, Budoff M. Diabetes, subclinical atherosclerosis and multiple cardiovascular risk factors in hard-to-reach asymptomatic patients. Diab Vasc Dis Res 2018; 15:519-527. [PMID: 30113211 DOI: 10.1177/1479164118791654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM To examine the association of cardiovascular disease risk factors with and their cumulative effect on coronary artery calcium in hard-to-reach asymptomatic patients with diabetes. METHODS A total of 2563 community-dwelling asymptomatic subjects from Central Appalachia participated in coronary artery calcium screening at a heart centre. Binary variable was used to indicate that coronary artery calcium was either present or absent. Independent variables consisted of demographic and modifiable risk factors and medical conditions. Descriptive statistics and multinomial logistic regression analyses were conducted. RESULTS In total, 55.8% and 13.7% of study participants had subclinical atherosclerosis (coronary artery calcium ⩾1) and diabetes, respectively. The presence of coronary artery calcium was higher in subjects with diabetes (68.5%) than those without (53.8%). Compared to subjects without diabetes with coronary artery calcium = 0, obesity, hypertension, hypercholesterolaemia and smoking increased the odds of the presence of coronary artery calcium (coronary artery calcium score ⩾1) regardless of diabetes status; however, with larger odds ratios in subjects with diabetes. Compared to subjects without diabetes with coronary artery calcium score = 0, having 3, 4 and ⩾5 risk factors increased the odds of presence of coronary artery calcium in subjects with diabetes by 14.06 (confidence interval = 3.26-62.69), 32.30 (confidence interval = 7.41-140.82) and 47.12 (confidence interval = 10.35-214.66) times, respectively. CONCLUSION There is a need for awareness about subclinical atherosclerosis in patients with diabetes and more research about coronary artery calcium in subpopulations of patients.
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Affiliation(s)
- Hadii M Mamudu
- 1 Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Arsham Alamian
- 2 East Tennessee State University, Johnson City, TN, USA
| | - Timir Paul
- 2 East Tennessee State University, Johnson City, TN, USA
| | - Pooja Subedi
- 2 East Tennessee State University, Johnson City, TN, USA
| | - Liang Wang
- 2 East Tennessee State University, Johnson City, TN, USA
| | - Antwan Jones
- 3 The George Washington University, Washington, DC, USA
| | - Ali E Alamin
- 2 East Tennessee State University, Johnson City, TN, USA
| | - David Stewart
- 2 East Tennessee State University, Johnson City, TN, USA
| | - Gerald Blackwell
- 4 Wellmont Health System (now part of Ballad Health), Kingsport, TN, USA
| | - Matthew Budoff
- 5 University of California, Los Angeles, Los Angeles, CA, USA
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Mamudu HM, Subedi P, Paul T, Alamin AE, Alamian A, Wang L, Stewart D, Jones A, Harirforoosh S, Blackwell G, Budoff M. The associated risk factors for coronary artery calcium in asymptomatic individuals with and without diabetes in rural Central Appalachia. J Diabetes Complications 2018; 32:900-905. [PMID: 30082173 DOI: 10.1016/j.jdiacomp.2018.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 11/29/2022]
Abstract
AIM To examine the risk factor of coronary artery calcium (CAC) in individuals with diabetes and those without diabetes in Central Appalachia. METHODS Study population included 2479 asymptomatic participants who underwent CAC screening between August 2012 and November 2016. CAC score was classified into four categories [0 (no plaque), 1-99 (mild plaque), 100-399 (moderate plaque), and ≥400 (severe plaque)]. Multinomial logistic regression analyses were conducted to test the association between CAC and cardiovascular disease (CVD) risk factors among participants with diabetes, age and gender matched controls, and randomly selected controls. RESULTS 13.6% of total participants had diabetes. Around 69%, 59.8%, and 57.7% of the participants with diabetes, matched controls, and randomly selected controls had CAC score ≥1, respectively. Participants with diabetes had higher prevalence of all CVD risk factors than controls. Among participants with diabetes, hypertension and physical inactivity increased the odds of CAC = 100-399, while among those without diabetes, hypertension and hypercholesteremia increased the odds of having CAC = 1-99 and CAC ≥ 400. CONCLUSION Half of study participants had subclinical atherosclerosis (i.e., CAC), and individuals with diabetes had higher CAC scores. This study suggests that individuals with diabetes in Central Appalachia might benefit from screening for CAC.
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Affiliation(s)
- Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Pooja Subedi
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA; Department of Epidemiology, College of Public Health and Health Professions College of Medicine, University of Florida, Gainesville, FL 32610, USA.
| | - Timir Paul
- Division of Cardiology, James. H. Quillen College of Medicine, East Tennessee State University, 329 N State of Franklin Rd, Johnson City, TN 37604, USA.
| | - Ali E Alamin
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Arsham Alamian
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Liang Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - David Stewart
- Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Antwan Jones
- Department of Sociology, George Washington University, Washington, DC 20052, USA.
| | - Sam Harirforoosh
- Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA.
| | | | - Matthew Budoff
- Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance, CA 90502, USA.
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Subedi P, Limbu N, Thakur D, Khadka R, Gupta S. A Study of F Wave Latencies, Chronodispersion and Persistence in Healthy Medical Undergraduates at BPKIHS. Kathmandu Univ Med J (KUMJ) 2018; 16:211-215. [PMID: 31719308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background The F wave is a CMAP (compound muscle action potential) evoked by a supramaximal stimulation of a motor nerve. F waves are particularly useful for the diagnoses of polyneuropathies at a very early stage and proximal nerve lesions. F waves have a very high diagnostic role in neurophysiology; we would like to study different F wave parameters and effect of anthropometric variables on F wave parameters in normal healthy individuals. Objective To study the effect of anthropometric variables on F wave latencies, chronodispersion and persistence Method Healthy males (n=64) and females (n=26) medical students of BPKIHS with age 21.64±1.19 years were enrolled in the study. Anthropometric parameters and maximum and minimum F wave latencies, F persistence and chronodispersion of bilateral median, ulnar and tibial nerves were recorded in Neurophysiology Lab II of BPKIHS. Descriptive analysis was done for anthropometric and F wave parameters. Unpaired t test was applied for comparing anthropometric and F wave variables between males and females. Pearson correlation was applied between anthropometric variables and F wave parameters. Result Age, height and weight of the subjects were 21.64±1.19 years, 165.61±5.4 cms and 64.07±5.5 kg respectively. Minimum F wave latencies (ms) of right median, ulnar and tibial nerves were 24.09±1.95, 24.02±1.76 and 44.34±3.02 while on the left side were 23.92±1.96, 24.11±1.92 and 44.07±2.83 respectively. Anthropometric variables of male and females were statistically significant. Also, F wave latencies between groups were different which were statistically significant. F persistence was above 80% for all tested peripheral nerves. Height and weight showed a significant effect on F wave latencies (p<0.001). However, age did not show any significant effect on F wave parameters. Conclusion Males have prolonged latencies as compared to females. Height and weight showed a significant relationship with the F wave latencies of the tested peripheral nerves.
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Affiliation(s)
- P Subedi
- Department of Clinical Physiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - N Limbu
- Department of Clinical Physiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - D Thakur
- Department of Clinical Physiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - R Khadka
- Department of Clinical Physiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - S Gupta
- Department of Clinical Physiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
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13
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Agbenyikey W, Wellington EK, Asante-Nkrobea Jnr K, Mamudu H, Subedi P, Ouma A, Duah MA, Rijo J. Compliance with tobacco control laws before and after the enactment of a national Tobacco Control Act in Ghana. Tob Induc Dis 2018. [DOI: 10.18332/tid/84733] [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: 11/24/2022] Open
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14
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Mamudu HM, Jones A, Paul T, Subedi P, Wang L, Alamian A, Alamin AE, Blackwell G, Budoff M. Geographic and Individual Correlates of Subclinical Atherosclerosis in an Asymptomatic Rural Appalachian Population. Am J Med Sci 2018; 355:140-148. [DOI: 10.1016/j.amjms.2017.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 06/26/2017] [Accepted: 08/18/2017] [Indexed: 01/13/2023]
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15
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Luitel BR, Chalise PR, Nathani S, Gupta DK, Subedi P, Chapagain S, Sharma UK, Gyawali PR, Shrestha GK, Joshi BR. Risk-based Management of Non-muscle Invasive Bladder Cancer: Experience from Tribhuvan University Teaching Hospital. Kathmandu Univ Med J (KUMJ) 2016; 14:352-356. [PMID: 29371493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Background Most of the recent evidences suggest for risk-based management of non muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence and progression. Objective This study was conducted to assess the recurrence and progression of non muscle invasive bladder cancer in Nepalese patients using European Organization for Research and Treatment of Cancer (EORTC) risk tables and to assess the effectiveness of intravesical therapy to reduce the risk of recurrence. Method A prospective observational single centre study was conducted at Tribhuvan University Teaching Hospital from January 2010- December 2012. Forty six patients with non muscle invasive bladder cancer who underwent transurethral resection of bladder tumor and completed two years follow up were included. According to the European Organization for Research and Treatment of Cancer (EORTC) risk table, the patients were divided into low, intermediate and high risk groups. The patients received postoperative adjuvant therapy and surveillance as per the European Association of Urology guidelines. Result Among the 46 patients, the overall two year recurrence and progression rate was 8 (17%) and 1 (2%) respectively. Out of seven patients in low risk category, none of them developed recurrence or progression of disease. Out of 15 patients in intermediate risk category the one year and two year recurrence rate was 13% and 20% respectively. Out of 24 patients in high risk category the one and two year recurrence rate was 17% and 21% respectively. The risk reduction by use of intravesical Bacillus Calmette Guerin (BCG) for recurrence in high risk category was 58% and 60% in first and second year respectively. In our study, the overall and individual risk group, the one and two year recurrence rate was lower than that predicted by European Organization for Research and Treatment of Cancer risk table. Conclusion Risk-based management of non muscle invasive bladder cancer by using the European Organization for Research and Treatment of Cancer risk table is a useful method of management, though its prediction rates are lower in Nepalese population.
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Affiliation(s)
- B R Luitel
- Department of Surgery, Urology Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - P R Chalise
- Department of Surgery, Urology Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - S Nathani
- Department of Surgery, Urology Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - D K Gupta
- Department of Surgery, Urology Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - P Subedi
- Department of Surgery, Urology Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - S Chapagain
- Department of Surgery, Urology Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - U K Sharma
- Department of Surgery, Urology Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - P R Gyawali
- Department of Surgery, Urology Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - G K Shrestha
- Department of Surgery, Urology Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - B R Joshi
- Department of Surgery, Urology Unit, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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Luitel BR, Gupta DK, Chalise PR, Subedi P, Chapagain S, Sharma UK, Gyawali PR, Shrestha GK, Joshi BR. Change in storage symptoms after transurethral resection of prostate: a prospective observational study. J Soc Surg Nepal 2016. [DOI: 10.3126/jssn.v17i1.15179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Patients with enlarged prostate generally rate their storage symptoms (frequency, urgency and nocturia) as the most bothersome as these symptoms interfere more with daily activities and have huge impact on quality of life. Effect of transurethral resection of prostate (TURP) on storage symptoms is unknown. Objective of the study is to assess the change in storage symptoms in patients undergoing TURP.Methods: A prospective observational study was conducted at the author’s institute from August 2011 to July 2012. Patients undergoing TURP for moderate to severe lower urinary tract symptoms (LUTS) secondary to benign enlargement of prostate were included. Patients were evaluated by International prostate symptom score (IPSS) questionnaires. The question number 2, 4 and 7 of the IPSS questionnaire gave the storage symptom subscore (0-15). After initial evaluations, the patients underwent TURP. After 3 months, the IPSS was reevaluated and the change in storage symptom was analyzed.Results: A total of 57 patients who had undergone TURP were eligible for final data analysis. Majority of the patients had severe bothersome LUTS with mean IPSS score of 24.6±6. The baseline storage symptom subscore was 11.1±3. After 3 months of follow-up, there was significant decrease in total IPSS score and both of its subscores. On comparing the mean change in storage and voiding subscore, there was less decrement in storage subscore which was statistically significant (p=0.001). Conclusions: This study showed that after TURP change in voiding subscore occurs more than storage subscore and storage symptoms may not revert to normal.
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Mamudu HM, Paul T, Wang L, Veeranki SP, Panchal HB, Alamian A, Subedi P, Budoff M. Abstract 615: Association Between Multiple Modifiable Risk Factors of Cardiovascular Disease and Hypertension in a Rural Population of the United States. Arterioscler Thromb Vasc Biol 2016. [DOI: 10.1161/atvb.36.suppl_1.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Hypertension (HTN) is one of the major risk factors for cardiovascular diseases (CVD) that afflicts one-third of the population in United States (US). This study examined the association between multiple modifiable risk factors for HTN in a rural hard-to-reach population.
Methods:
During January 2011 and December 2012, 1629 community-dwelling asymptomatic individuals from central Appalachia participated in screening for subclinical atherosclerosis, during which the participants were asked to report whether a physician or health worker has informed them that they had HTN (yes/no). Additionally, baseline data consisting of two non-modifiable risk factors (sex, age) and 5 modifiable risk factors (obesity, diabetes, hypercholesterolemia, smoking, and sedentary lifestyle) were collected. Descriptive statistics involving prevalence of risk factors and multivariate logistic regression analyses to determine the strength of association between hypertension and the number of risk factors were conducted.
Results:
Of the 1629 study participants, about half (49.8%) had hypertension. Among hypertensive patients, 31.4% were obese and 62.3% having hypercholesterolemia. Overall, having 2 risk factors consisted the largest group of participants with HTN. After adjusting for the non-modifiable risk factors (sex, age), obesity and diabetes increased the odds of having HTN by more than two folds ([OR=2.02, CI=1.57-2.60] and [OR=2.30, CI=1.66-3.18], respectively) and hypercholesterolemia and sedentary lifestyle increased the odds for HTN by more than one fold ([OR=1.26, CI=1.02-1.56) and [OR=1.38, CI=1.12-1.70], respectively). Compared to those without HTN, having 2, 3, and 4 or 5 modifiable risk factors were significantly associated with increased odds of having HTN by about two-folds [OR=1.72, CI=1.21-2.44], two and half folds [OR=2.55, 1.74-3.74], and six folds [OR=5.96, 3.42-10.41], respectively.
Conclusion:
The study suggests that odds of having HTN increases with the number of modifiable risk factors for CVD. Hence, by implementing an integrated CVD program for treating and controlling modifiable risk factors of HTN would decrease the future risk of CVD and help to achieve the
2020 Impact Goal
of the American Health Association.
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Affiliation(s)
- Hadii M Mamudu
- Health Services Management ad Policy, East Tennessee State Univ, Johnson City, TN
| | - Timir Paul
- Div of Cardiology, East Tennessee State Univ, Johnson City, TN
| | - Liang Wang
- Biostatistics and Epidemiology, East Tennessee State Univ, Johnson City, TN
| | - Sreenivas P Veeranki
- Preventive Medicine and Community Health, East Tennessee State Univ, Johnson City, TN
| | | | - Arsham Alamian
- Biostatistics and Epidemiology, East Tennessee State Univ, Johnson City, TN
| | - Pooja Subedi
- Biostatistics and Epidemiology, East Tennessee State Univ, Johnson City, TN
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Mishra SK, Pant BP, Subedi P. The Prevalence of Diabetic Retinopathy Among Known Diabetic Population in Nepal. Kathmandu Univ Med J (KUMJ) 2016; 14:134-139. [PMID: 28166069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Background The worldwide prevalence of diabetic retinopathy (DR) was found to be 34.6%. WHO estimates that DR is responsible for 4.8% of the 37 million cases of blindness throughout the world. In a study undertaken in urban population in Nepal, M.D. Bhattarai found the prevalence of diabetes among people aged 20 years and above to be 14.6% and the prevalence among people aged 40 years and above to be 19%. Studies on DR, to our knowledge, have mostly been hospital based in Nepal. Little information is available about prevalence of DR at the community level in Nepal. Objective To investigate the prevalence of diabetic retinopathy and associated risk factors among known diabetic population of Nepal. Method A descriptive cross sectional study was conducted among individuals aged 30 and more using cluster sampling method. The study sites were Kathmandu metropolitan city and Birgunj sub-metropolitan city. A sample size of 5400 was calculated assuming 5% prevalence rate with 95% confidence level, 5% worst acceptable level and 1.5 cluster sampling design effect. Study participants were interviewed, anthropometric measurements and fundus photograph was taken from participants with diabetes. Fundus photographs were used to grade retinopathy. Result Around 12% of the respondents were diabetic, mean age 55.43±11.86 years, of which slightly more than half were females (50.2%). Among these diabetic respondents 9.9% had some forms of diabetic retinopathy, mean age 54.08±10.34 years, 56.7% were male. When severe grade of retinopathy in any eye was considered as overall grade of retinopathy for the individual, prevalence of Non-proliferative Diabetic Retinopathy, Proliferative Diabetic Retinopathy and complete vision loss was found to be 9.1%, 0.5% and 0.3%. Prevalence of Diabetic Macular Edema was 5.5%. Duration of diabetes, family history of diabetes and blood pressure at the day of survey was found to be associated with having any retinopathy. Conclusion Diabetic retinopathy is emerging as a public health threat in Nepal. With increasing diabetes, DR can be expected to increase more. Existing eye care services may require upgrading to provide quality and affordable retinopathy services to address this emerging problem.
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Affiliation(s)
- S K Mishra
- Nepal Netra Jyoti Sangh, Tripureshwor, Kathmandu, Nepal
| | - B P Pant
- Nepal Netra Jyoti Sangh, Tripureshwor, Kathmandu, Nepal
| | - P Subedi
- Nepal Netra Jyoti Sangh, Tripureshwor, Kathmandu, Nepal
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Subedi P, Drezner KA, Dogbey MC, Newbern EC, Yun K, Scott KC, Garland JM, Altshuler MJ, Johnson CC. Evaluation of latent tuberculous infection and treatment completion for refugees in Philadelphia, PA, 2010–2012. Int J Tuberc Lung Dis 2015; 19:565-9. [DOI: 10.5588/ijtld.14.0729] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gupta DK, Luitel BR, Chalise PR, Chapagain S, Subedi P, Thakur DK, Sharma UK, Gyawali PR, Shrestha GK. Nephron sparing surgery in a tertiary care center in Nepal--an initial experience. J Nepal Health Res Counc 2014; 12:109-111. [PMID: 25575003] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Malignant renal mass accounts for 2 to 3% of all malignant diseases in adults. Radical surgery used to be the treatment of choice with high propensity to develop chronic kidney disease in the compromised contralateral kidney. Currently, nephron sparing surgery is considered to be the standard of care with equivalent oncological outcome. METHODS This was a retrospective chart review of patients with renal mass less than seven cm in size who had open nephron sparing surgery from July 2012 to Sep 2013 at Tribhuvan university teaching hospital, Nepal. Latest follow up either from record or over telephone was documented. RESULTS Eight patients (mean age 45 years, male: female ratio1:1.6) underwent nephron sparing surgery over the specified period. Mean size of tumor was 4.75 cm. Mean ischemia time was 16.37 min. Histopathological diagnosis was benign in two and renal cell carcinoma in six patients. CONCLUSIONS Nephron sparing surgery is safe in low stage renal tumors. It also prevents unnecessary nephrectomy in benign lesions and prevents negative sequelae of long term chronic renal impairment in remaining contralateral kidney.
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Affiliation(s)
- D K Gupta
- Urology unit, Department of Surgery, Tribhuvan University Teaching Hospital, Nepal
| | - B R Luitel
- Urology unit, Department of Surgery, Tribhuvan University Teaching Hospital, Nepal
| | - P R Chalise
- Urology unit, Department of Surgery, Tribhuvan University Teaching Hospital, Nepal
| | - S Chapagain
- Urology unit, Department of Surgery, Tribhuvan University Teaching Hospital, Nepal
| | - P Subedi
- Urology unit, Department of Surgery, Tribhuvan University Teaching Hospital, Nepal
| | - D K Thakur
- Urology unit, Department of Surgery, Tribhuvan University Teaching Hospital, Nepal
| | - U K Sharma
- Urology unit, Department of Surgery, Tribhuvan University Teaching Hospital, Nepal
| | - P R Gyawali
- Urology unit, Department of Surgery, Tribhuvan University Teaching Hospital, Nepal
| | - G K Shrestha
- Urology unit, Department of Surgery, Tribhuvan University Teaching Hospital, Nepal
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Subedi P, Vélez S, Macià F, Li S, Sarachik MP, Tejada J, Mukherjee S, Christou G, Kent AD. Onset of a propagating self-sustained spin reversal front in a magnetic system. Phys Rev Lett 2013; 110:207203. [PMID: 25167444 DOI: 10.1103/physrevlett.110.207203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Indexed: 06/03/2023]
Abstract
The energy released in a magnetic material by reversing spins as they relax toward equilibrium can lead to a dynamical instability that ignites self-sustained rapid relaxation along a deflagration front that propagates at a constant subsonic speed. Using a trigger heat pulse and transverse and longitudinal magnetic fields, we investigate and control the crossover between thermally driven magnetic relaxation and magnetic deflagration in single crystals of Mn(12)-acetate.
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Affiliation(s)
- P Subedi
- Department of Physics, New York University, New York, New York 10003, USA
| | - S Vélez
- Grup de Magnetisme, Departament de Física Fonamental, Universitat de Barcelona, Barcelona 08028, Spain
| | - F Macià
- Department of Physics, New York University, New York, New York 10003, USA
| | - S Li
- Department of Physics, City College of New York, CUNY, New York, New York 10031, USA
| | - M P Sarachik
- Department of Physics, City College of New York, CUNY, New York, New York 10031, USA
| | - J Tejada
- Grup de Magnetisme, Departament de Física Fonamental, Universitat de Barcelona, Barcelona 08028, Spain
| | - S Mukherjee
- Department of Chemistry, University of Florida, Gainesville, Florida 32611, USA
| | - G Christou
- Department of Chemistry, University of Florida, Gainesville, Florida 32611, USA
| | - A D Kent
- Department of Physics, New York University, New York, New York 10003, USA
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Pradel FG, Subedi P, Varghese AA, Mullins CD, Weis KA. Does earlier headache response equate to earlier return to functioning in patients suffering from migraine? Cephalalgia 2006; 26:428-35. [PMID: 16556244 DOI: 10.1111/j.1468-2982.2005.01043.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study explored the association between headache response and return to functioning, and identified migraine-associated symptoms related to functional status and acceptability of migraine treatment as reported by patients. Data from migraineurs enrolled in the active arms of a randomized, double-blind, parallel group, placebo-controlled, clinical trial were analysed. The relationships between headache response and functional response, and clinical factors and treatment acceptability were assessed using chi(2) tests of proportions and logistic regressions. A greater proportion of patients with headache response at 0.5 h were functioning at 0.5, 1 and 2 h compared with patients who did not attain a headache response at 0.5 h (P < 0.0001). These patients also were more likely to find their treatment acceptable (P < 0.05). The results suggest a direct temporal relationship among the key determinants of migraine resolution. Rapid headache response is associated with faster return to functioning; rapid headache and functional responses are significant attributes of treatment acceptability.
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Affiliation(s)
- F G Pradel
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD 21201, USA.
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Perfetto EM, Mullins CD, Subedi P, Li-McLeod J. Selection of clinical, patient-reported, and economic end points in acute exacerbation of chronic bronchitis. Clin Ther 2001; 23:1747-72. [PMID: 11726009 DOI: 10.1016/s0149-2918(01)80142-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute exacerbation of chronic bronchitis (AECB) places tremendous burden on patients, providers, employers, and health care systems. OBJECTIVE The purpose of this paper is to (1) review the clinical, patient-reported, and economic measures used to evaluate disease burden and treatment effectiveness in AECB in clinical trials and (2) propose a guide for selecting study end points in AECB that will help capture all the relevant disease outcomes. METHODS Two literature searches of the PubMed database were conducted to identify studies of clinical trials in bronchitis and evaluate the clinical, patient-reported, and economic end points used in these studies. RESULTS Previous studies have focused primarily on clinician-assessed outcomes, which do not capture the full impact of AECB on patients' lives. Reporting mechanisms for most end points have been inconsistent, limiting the ability to compare information or interpret differences. Previous studies have given limited attention to patient-reported outcomes and the economic implications of AECB. Patient-reported outcomes such as speed of symptom relief and work productivity are important parameters for assessing treatment effectiveness and provide practical information for treatment evaluation. CONCLUSIONS Additional research is needed to develop, examine, and validate patient-reported outcomes and the indirect costs of AECB. Measuring the relevant clinical, economic, and patient-reported outcomes in AECB patients using standardized methods may lead to a clearer understanding of the disease burden and the role, effectiveness, and cost-effectiveness of antibiotic treatment.
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Affiliation(s)
- E M Perfetto
- Healthcentric Associates, Stevensville, Maryland, USA
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