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Debay A, Shah P, Lodha A, Shivananda S, Redpath S, Seshia M, Dorling J, Lapointe A, Canning R, Strueby L, Beltempo M. Association of 24-Hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants. Am J Perinatol 2024; 41:747-755. [PMID: 35170012 DOI: 10.1055/a-1772-4637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to assess if 24-hour in-house neonatologist (NN) coverage is associated with delivery room (DR) resuscitation/stabilization and outcomes among inborn infants <29 weeks' gestational age (GA). STUDY DESIGN Survey-linked cohort study of 2,476 inborn infants of 23 to 28 weeks' gestation, admitted between 2014 and 2015 to Canadian Neonatal Network Level-3 neonatal intensive care units (NICUs) with a maternity unit. Exposures were classified using survey responses based on the most senior provider offering 24-hour in-house coverage: NN, fellow, and no NN/fellow. Primary outcome was death and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, and retinopathy of prematurity). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders. RESULTS Among the 28 participating NICUs, most senior providers ensuring 24-hour in-house coverage were NN (32%, 9/28), fellows (39%, 11/28), and no NN/fellow (29%, 8/28). No NN/fellow coverage and 24-hour fellow coverage were associated with higher odds of infants receiving DR chest compressions/epinephrine compared with 24-hour NN coverage (adjusted odds ratio [aOR] = 4.72, 95% confidence interval [CI]: 2.12-10.6 and aOR = 3.33, 95% CI: 1.44-7.70, respectively). Rates of mortality/major morbidity did not differ significantly among the three groups: NN, 63% (249/395 infants); fellow, 64% (1092/1700 infants); no NN/fellow, 70% (266/381 infants). CONCLUSION 24-hour in-house NN coverage was associated with lower rates of DR chest compressions/epinephrine. There was no difference in neonatal outcomes based on type of coverage; however, further studies are needed as ecological fallacy cannot be ruled out. KEY POINTS · Lower rates of DR cardiopulmonary resuscitation with 24h in-house NN coverage. · The type of 24h in-house coverage was not associated with mortality and/or major morbidity.. · High-volume centers more often have 24h in-house neonatal fellow coverage.
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Affiliation(s)
- Anthony Debay
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Prakesh Shah
- Departement of Pediatrics, Toronto University, Toronto, Ontario, Canada
| | - Abhay Lodha
- Departement of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Sandesh Shivananda
- Departement of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Redpath
- Departement of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Seshia
- Departement of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jon Dorling
- Departement of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anie Lapointe
- Departement of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Rody Canning
- Departement of Pediatrics, Moncton Hospital, Moncton, Alberta, Canada
| | - Lannae Strueby
- Departement of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marc Beltempo
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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Kanagaraj U, Tan J, Soraisham A, Lodha A, Shah P, Kulkarni T, Shivananda S. Postnatal Steroids Use for Bronchopulmonary Dysplasia in a Quaternary Care NICU. Am J Perinatol 2024. [PMID: 38350641 DOI: 10.1055/a-2267-4363] [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: 02/15/2024]
Abstract
OBJECTIVE Intercenter variation and trends in postnatal steroids (PNS) use among preterm infants for prevention or treatment of bronchopulmonary dysplasia (BPD) is known. Understanding intracenter PNS use patterns facilitate implementation of center-specific change interventions to optimize outcomes.This study aimed to (i) quantify the proportion of infants who received PNS, and describe the timing, type, trends over time, regimen used, and deviations, and (2) describe the clinical characteristics and unadjusted outcomes of infants who received PNS. STUDY DESIGN This was a cohort study in a quaternary neonatal intensive care unit including infants born at less than 33 weeks, and who received PNS for prevention or treatment of BPD between 2011 and 2021. Following data were included: proportion of babies who received PNS; type of PNS; age at initiation and duration; trends over time; deviation from published regimen; morbidity, mortality, and cointerventions. RESULTS One hundred and eighty four infants (8% of <33 week' infants) received PNS. The median (interquartile range [IQR]) gestational age and birth weight were 25 (24-26) weeks and 720 (625-841) grams, respectively. The median (IQR) day of initiation and duration of PNS use were 29 (19-38) and 10 (10-22) days, respectively. One hundred and fifty-seven (85%) infants received dexamethasone (DX) and 22 (12%) received hydrocortisone as the first PNS course, and 71 (39%) infants received multiple courses. The proportion of infants receiving PNS remained unchanged, but the cumulative median dose received for BPD per patient increased by 56%. Nearly one-third of cumulative PNS dose came from PNS used for non-BPD indications. Forty-six percent infants had a deviation from published regimen (±20% deviation in duration or ±10% deviation in dose). Survival, survival without major morbidity, moderate-to-severe BPD, and technology dependence at discharge were 87, 2, 91, and 67%, respectively. CONCLUSION Increased variation in PNS use, deviation from published regimen, and concurrent PNS exposure from non-BPD indication offer insights into implementing interventions to improve processes. KEY POINTS · In this quaternary NICU, 8% of infants born before 33 weeks were administered postnatal steroids (PNS).. · The percentage of infants given PNS remained stable; however, the cumulative dose per patient for BPD rose.. · The study identified targeted interventions to minimize clinical practice variations at the center..
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Affiliation(s)
- Uthayakumaran Kanagaraj
- Department of Pediatrics, Neonatal Division, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Tan
- Department of Pediatrics, Neonatal Division, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amuchou Soraisham
- Department of Pediatrics, Neonatal Division, University of Calgary, Calgary, Alberta, Canada
| | - Abhay Lodha
- Department of Pediatrics, Neonatal Division, University of Calgary, Calgary, Alberta, Canada
| | - Prakesh Shah
- Department of Pediatrics, Neonatal Division, University of Toronto, Toronto, Ontario, Canada
| | - Tapas Kulkarni
- Department of Pediatrics, Neonatal Division, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandesh Shivananda
- Department of Pediatrics, Neonatal Division, University of British Columbia, Vancouver, British Columbia, Canada
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Shah K, Deshpande M, Shah P. Healthcare-associated fungal infections and emerging pathogens during the COVID-19 pandemic. Front Fungal Biol 2024; 5:1339911. [PMID: 38465254 PMCID: PMC10920311 DOI: 10.3389/ffunb.2024.1339911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024]
Abstract
Historically, fungi were mainly identified as plant and insect pathogens since they grow at 28°C. At the same time, bacteria are known to be the most common human pathogens as they are compatible with the host body temperature of 37°C. Because of immunocompromised hosts, cancer therapy, and malnutrition, fungi are rapidly gaining attention as human pathogens. Over 150 million people have severe fungal infections, which lead to approximately more than one million deaths per year. Moreover, diseases like cancer involving long-term therapy and prophylactic use of antifungal drugs in high-risk patients have increased the emergence of drug-resistant fungi, including highly virulent strains such as Candida auris. This clinical spectrum of fungal diseases ranges from superficial mucocutaneous lesions to more severe and life-threatening infections. This review article summarizes the effect of hospital environments, especially during the COVID-19 pandemic, on fungal infections and emerging pathogens. The review also provides insights into the various antifungal drugs and their existing challenges, thereby driving the need to search for novel antifungal agents.
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Affiliation(s)
- Krish Shah
- Biological Sciences Bellarmine College Preparatory, San Jose, CA, United States
| | | | - P. Shah
- Science Ambassador/Bio-Rad Laboratories, Hercules, CA, United States
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Khanal N, Subedi R, Shrestha N, Pradhan SB, Shah P, Shrestha S, Wagle S. Cecal volvulus following appendectomy in a teenage patient: A case report. Clin Case Rep 2024; 12:e8480. [PMID: 38328489 PMCID: PMC10847060 DOI: 10.1002/ccr3.8480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
Patients mimicking appendicitis symptoms in a rural setting or those post-appendectomy, indicating cecal volvulus, should always be considered. Swift action can prevent catastrophic consequences. Abstract We present a case of a 14-year-old female who initially underwent open appendectomy for acute appendicitis and subsequently experienced symptoms of abdominal distention, vomiting, and fever. Her condition deteriorated following the appendectomy, despite a prior appendectomy for similar symptoms at a different facility. A computed tomography (CT) scan identified cecal volvulus as the underlying issue. This led to the performance of a laparotomy, cecopexy, and decompressive ileostomy. After six weeks, ileostomy closure was successfully carried out, and the patient currently enjoys good health. This case highlights the significance of considering uncommon factors as potential contributors to postoperative complications in young patients.
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Affiliation(s)
- N. Khanal
- Department of SurgeryHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
| | - R. Subedi
- Department of SurgeryHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
| | - N. Shrestha
- Department of SurgeryHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
| | - S. B. Pradhan
- Department of SurgeryHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
| | - P. Shah
- Department of SurgeryHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
| | - S. Shrestha
- Department of SurgeryHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
| | - S. Wagle
- Department of RadiologyHetauda Hospital, Madan Bhandari Academy of Health SciencesHetaudaNepal
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Mahant S, Ling SC, Williams S, Shah P, Fayyaz J, Lim-Shue C, Irwin MS, Huang A. Developing a Faculty Awards Strategy in an Academic Department: Recognizing Faculty and Promoting the Department. J Pediatr 2024:113899. [PMID: 38181977 DOI: 10.1016/j.jpeds.2024.113899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Sanjay Mahant
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada.
| | - Simon C Ling
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
| | - Suzan Williams
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
| | - Prakesh Shah
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada
| | - Jabeen Fayyaz
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
| | - Catherine Lim-Shue
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
| | - Meredith S Irwin
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
| | - Annie Huang
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
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Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Deken M, Niewola-Staszkowska K, Peyruchaud O, Mikulčić N, Antolić M, Shah P, Cheasty A, Tagliavini A, Nizzardo A, Pergher M, Ziviani L, Milleri S, Pickering C, Lahn M, van der Veen L, Di Conza G, Johnson Z. Characterization and translational development of IOA-289, a novel autotaxin inhibitor for the treatment of solid tumors. Immunooncol Technol 2023; 18:100384. [PMID: 37234285 PMCID: PMC10205783 DOI: 10.1016/j.iotech.2023.100384] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Background Autotaxin-lysophosphatidic acid (ATX-LPA) signaling has a predominant role in immunological and fibrotic processes, including cancer. Several ATX inhibitors and LPA receptor antagonists have been clinically evaluated, but none in patients with solid tumors. Many cancers are burdened with a high degree of fibrosis and an immune desert phenotype (so-called 'cold' tumors). In these cold tumors, the fibrotic stroma provides an intrinsic cancer-supporting mechanism. Furthermore, the stroma prevents penetration and limits the effectiveness of existing therapies. IOA-289 is a novel ATX inhibitor with a unique chemical structure, excellent potency and an attractive safety profile. Materials and methods In vitro and in vivo pharmacology studies have been carried out to elucidate the pharmaceutical properties and mechanism of action of IOA-289. A phase I clinical study in healthy volunteers was carried out to determine the pharmacokinetics and pharmacodynamics of IOA-289 following a single oral dose. Results In vitro and in vivo studies showed that IOA-289 is a potent inhibitor of ATX and, as a monotherapy, is able to slow progression of lung fibrosis and tumor growth in mouse models. In a clinical study, IOA-289 showed a dose-dependent increase in plasma exposure levels and a corresponding decrease in circulating LPA. Conclusions Our data show that IOA-289 is a novel ATX inhibitor with a unique chemical structure, excellent potency and an attractive safety profile. Our data support the further development of IOA-289 as a novel therapeutic approach for the treatment of cancer, particularly those with a high fibrotic and immunologically cold phenotype.
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Affiliation(s)
| | | | - O. Peyruchaud
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | | | | | - P. Shah
- Cancer Research Horizons, Therapeutic Discovery Laboratories, Cambridge, UK
| | - A. Cheasty
- Cancer Research Horizons, Therapeutic Discovery Laboratories, Cambridge, UK
| | | | | | | | - L. Ziviani
- Centro Ricerche Cliniche di Verona srl, Verona, Italy
| | - S. Milleri
- Centro Ricerche Cliniche di Verona srl, Verona, Italy
| | | | - M. Lahn
- iOnctura, Geneva, Switzerland
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Cuthbert JJ, Pellicori P, Rigby AS, Abel AAI, Kalvickbacka-Bennet A, Shah P, Kearsley JW, Kazmi S, Cleland JGF, Clark AL. Are non-invasive estimations of plasma volume an accurate measure of congestion in patients with chronic heart failure? Eur Heart J Qual Care Clin Outcomes 2023; 9:281-292. [PMID: 35723241 DOI: 10.1093/ehjqcco/qcac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 05/17/2023]
Abstract
AIMS We report associations between different formulae for estimating plasma volume status (PVS) and clinical and ultrasound markers of congestion in patients with chronic heart failure (CHF) enrolled in the Hull Lifelab registry. METHODS AND RESULTS Cohort 1 comprised patients with data on signs and symptoms at initial evaluation (n = 3505). Cohort 2 included patients with ultrasound assessment of congestion [lung B-line count, inferior vena cava (IVC) diameter, jugular vein distensibility (JVD) ratio] (N = 341). Two formulae for PVS were used: (a) Hakim (HPVS) and (b) Duarte (DPVS). Results were compared with clinical and ultrasound markers of congestion. Outcomes assessed were mortality and the composite of heart failure (HF) hospitalisation and all-cause mortality. In cohort 1, HPVS was associated with mortality [hazard ratio (HR) per unitary increase = 1.02 (1.01-1.03); P < 0.001]. In cohort 2, HPVS was associated with B-line count (HR) = 1.05 [95% confidence interval (CI) (1.01-1.08); P = 0.02] and DPVS with the composite outcome [HR = 1.26 (1.01-1.58); P = 0.04]. HPVS and DPVS were strongly related to haemoglobin concentration and HPVS to weight. After multivariable analysis, there were no strong or consistent associations between PVS and measures of congestion, severity of symptoms, or outcome. By contrast, log[NTproBNP] was strongly associated with all three. CONCLUSION Amongst patients with CHF, HPVS and DPVS are not strongly or consistently associated with clinical or ultrasound evidence of congestion, nor clinical outcomes after multivariable adjustment. They appear only to be surrogates of the variables from which they are calculated with no intrinsic clinical utility.
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Affiliation(s)
- J J Cuthbert
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
| | - P Pellicori
- Robertson Centre for Biostatistics, Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A S Rigby
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - A A I Abel
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
| | - A Kalvickbacka-Bennet
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - P Shah
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - J W Kearsley
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - S Kazmi
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - J G F Cleland
- Robertson Centre for Biostatistics, Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A L Clark
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
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Kamath M, Shah P, Fu Y, Qu K, Kobashigawa J. Trends in HeartCare Values Following the Development of De Novo Donor Specific Antibodies. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Cochrane A, Nable M, Barber A, Shah P, Kennedy J, Isseh I, Rollins A, Thatcher A, Bussa K, Mauro K, Maydosz M, Sinha S, Desai S, Psotka M. An Overlooked Contributor to CAV. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Singer L, Neely M, Tsuang W, Budev M, Shah P, Belperio J, Reynolds J, Palmer S, Snyder L. Towards a Patient-Centered Definition of Baseline Lung Allograft Dysfunction: A Multicenter Cohort Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Schaenman J, Weigt S, Pan M, Zhou X, Elashoff D, Shino M, Reynolds J, Budev M, Shah P, Singer L, Snyder L, Palmer S, Belperio J. Peripheral Blood Cytokines Predict Primary Graft Dysfunction after Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Kyriakopoulos C, Taleb I, Wever-Pinzon O, Selzman C, Bonios M, Dranow E, Wever-Pinzon J, Yin M, Tseliou E, Stehlik J, Alharethi R, Kfoury A, Hanff T, Fang J, Koliopoulou A, Sideris K, Krauspe E, Nelson M, Elmer A, Singh R, Psotka M, Birks E, Slaughter M, Koenig S, Kyvernitakis A, Hoffman K, Guglin M, Kotter J, Campbell K, Silvestry S, Vidic A, Raval N, Mehra M, Cowger J, Kanwar M, Shah P, Drakos S. Multicenter Development and Validation of a Machine Learning Model to Predict Myocardial Recovery During LVAD Support: The UCAR Score. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Casillan A, Larson E, Ruck J, Zhou A, Ha J, Shah P, Merlo C, Bush E. Combined Lung-Kidney Transplantation Yields Better Survival Than Isolated Lung Transplantation in Recipients with Underlying Renal Failure. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Kanwar M, Uriel N, Jorde U, Tian W, Pinney K, Shen L, Shah P. Impact of Rejection Surveillance Practices on Outcomes after Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Xu J, Dai W, Goldberg J, Shah P, Hu I, Chen C, deFilippi C, Sun J. Explainable Machine Learning to Improve Donor-Recipient Matching at Time of Heart Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Manrique K, Raphael K, Griffiths S, Miano T, Kalman L, Oyster M, Xie D, Clausen E, Shah P, Lama V, Dhillon G, Snyder L, Cantu E, Diamond J, Christie J, Shashaty M. Preoperative Plasma SuPAR Levels are Associated with AKI after Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Shah P, Neujahr D, Cherikh W, Lewis A, Chan J, Parilla G, Javidfar J, Hunt W, Daneshmand M, Chandrashekaran S. Association Between Acute Rejection Within First Year and Post-Transplant Mortality after Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Teuteberg J, Pinney S, Khush K, Fei M, Yue J, Shen L, Patel S, Kanwar M, Shah P, Uriel N. A “Negative” Endomyocardial Biopsy after an Elevated Donor-Derived Cell Free DNA is Associated with Worse Survival after Heart Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Tsuang W, Neely M, Palmer S, Singer L, Budev M, Shah P, Belperio J, Reynolds J, Snyder L. Defining the Temporal Relationship Between Peak Lung Function and Quality of Life Trajectories after Lung Transplantation in a Large Multi-Center Cohort. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Patel S, Knierim J, Goldstein D, Lamba H, Sun B, Schmitto J, Lowes B, Shah P, Kanwar M, Wald J, Ravichandran A, MacGowan G, Ton V, Silvestry S, Sera F, Farooq M, Jorde U, Stehlik J, Selzman C, Potapov E, Drakos S. Long-Term Clinical Trajectory after Durable Lvad Weaning: An International Registry Report. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Mehta A, Goldberg J, Bagchi P, Marboe C, Shah K, Najjar S, Hsu S, Rodrigo M, Jang M, Cochrane A, Tchoukina I, Kong H, Lohmar B, Mcnair E, Valantine H, Agbor-Enoh S, Berry G, Shah P. Cell-Free DNA Enhances Pathologist Interrater Reliability at the Assessment of Acute Rejection on Endomyocardial Biopsy, on Behalf of the GRAfT Investigators. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Hamad Y, Charya A, Kong H, Jang M, Andargie T, Shah P, Mathew J, Orens J, Aryal S, Nathan S, Agbor-Enoh S. Anellovirus: A Novel Marker for Overimmunosuppression and Risk of Infection in Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Mizrahi I, Shah P, Huang R, Nagamine T, Gozun M, Lee D, Shimabuku L, Khan Z, Lum C, Brodsky M. Echocardiographic Findings in Patients with Methamphetamine Cardiomyopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Hofmeyer M, Haas G, Kransdorf E, Ewald G, Morris A, Owens A, Lowes B, Stoller D, Tang W, Garg S, Trachtenberg B, Shah P, Pamboukian S, Sweitzer N, Wheeler M, Wilcox J, Katz S, Pan S, Jimenez J, Smart F, Wang J, Gottlieb S, Judge D, Moore C, Huggins G, Jordan E, Kinnamon D, Ni H, Hershberger R. Genetic Signature of Dilated Cardiomyopathy Severity: The DCM Precision Medicine Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Guglielmi A, Hristakos N, Ndiaye C, LaRoy V, Victor N, Shah P, Pauwaa S, Sunbuli M, Macaluso G, Dia M. Effective Transition from Continuous Parenteral Treprostinil to Oral Prostacyclin Pathway-Based Therapies in Pulmonary Arterial Hypertension. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Nable M, Kumar S, Goldberg J, Cochrane A, Psotka M, Tang D, Isseh I, Desai S, Rollins A, Klein K, Bussa K, Mauro K, Maydosz M, Thatcher A, Kennedy J, Shah P. Does Echocardiography-Guided Endomyocardial Biopsy Reduce the Incidence of Tricuspid Regurgitation after Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Grewal J, Bortner B, Gregoski M, Cook D, Britt A, Hajj J, Rofael M, Sheidu M, Montovano M, Mehta M, Hajduczok A, Rajapreyar I, Brailovski Y, Genuardi M, Kanwar M, Atluri P, Lander M, Shah P, Hsu S, Kilic A, Houston B, Tedford R. Validation of the Heartmate 3 Risk Score in a Real World Patient Cohort. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Goldberg J, deFilippi C, Lockhart C, McNair E, Sinha S, Kong H, Najjar S, Lohmar B, Tchoukina I, Shah K, Feller E, Hsu S, Rodrigo M, Jang M, Marboe C, Berry G, Valantine H, Agbor-Enoh S, Shah P. Dysregulated Circulating Proteins in Cellular and Antibody-Mediated Rejection, on Behalf of the Graft Investigators. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Goldman RD, Hart RJ, Bone JN, Seiler M, Olson PG, Keitel K, Manzano S, Gualco G, Krupik D, Schroter S, Weigert RM, Chung S, Thompson GC, Muhammad N, Shah P, Gaucher NO, Hou M, Griffiths J, Lunoe MM, Evers M, Pharisa Rochat C, Nelson CE, Gal M, Baumer-Mouradian SH. Willingness to vaccinate children against COVID-19 declined during the pandemic. Vaccine 2023; 41:2495-2502. [PMID: 36889992 PMCID: PMC9977620 DOI: 10.1016/j.vaccine.2023.02.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 02/08/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES To document the level of vaccine hesitancy in caregivers' of children younger than 12 years of age over the course of the pandemic in Pediatric Emergency Departments (ED). Study design Ongoing multicenter, cross-sectional survey of caregivers presenting to 19 pediatric EDs in the USA, Canada, Israel, and Switzerland during first months of the pandemic (phase1), when vaccines were approved for adults (phase2) and most recently when vaccines were approved for children (phase3). RESULTS Willingness to vaccinate rate declined over the study period (59.7%, 56.1% and 52.1% in the three phases). Caregivers who are fully vaccinated, who have higher education, and those worried their child had COVID-19 upon arrival to the ED, were more likely to plan to vaccinate in all three phases. Mothers were less likely to vaccinate early in the pandemic, but this hesitancy attenuated in later phases. Older caregivers were more willing to vaccinate, and caregivers of older children were less likely to vaccinate their children in phase 3. During the last phase, willingness to vaccinate was lowest in those who had a primary care provider but did not rely on their advice for medical decisions (34%). Those with no primary care provider and those who do and rely on their medical advice, had similar rates of willingness to vaccinate (55.1% and 52.1%, respectively). CONCLUSIONS COVID-19 vaccine hesitancy is widespread and growing over time, and public health measures should further try to leverage identified factors associated with hesitancy in order to enhance vaccination rates among children.
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Affiliation(s)
- R D Goldman
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
| | - R J Hart
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, KY, USA
| | - J N Bone
- Research Informatics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - M Seiler
- Emergency Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - P G Olson
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - K Keitel
- Pediatric Emergency Medicine, Inselspital University Hospital of Bern, Bern, Switzerland
| | - S Manzano
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - G Gualco
- Pediatric Emergency Department, Pediatric Institute of Italian part of Switzerland, Ticino, Switzerland
| | - D Krupik
- Pediatric Emergency Unit, Ziv Medical Center, and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - S Schroter
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of California, San Diego, La Jolla, California and Rady Children's Hospital San Diego, San Diego, CA, USA
| | - R M Weigert
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN, USA
| | - S Chung
- Pediatric Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - G C Thompson
- Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - N Muhammad
- Division of Pediatric Emergency Medicine, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - P Shah
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - N O Gaucher
- Department of Pediatric Emergency Medicine and Research Center, Department of Pediatrics, CHU Sainte-Justine, 3175 Ch Cote Sainte-Catherine, Montreal, Canada
| | - M Hou
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - J Griffiths
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - M M Lunoe
- Division of Pediatric Emergency Medicine, UPMC Children's Hospital of Pittsburgh, PA, USA
| | - M Evers
- Division of Pediatric Pediatric Emergency Medicine, UH Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, OH, USA
| | - C Pharisa Rochat
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - C E Nelson
- Division of Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Wilmington, DE, USA
| | - M Gal
- Pediatric Emergency Department, Kaplan Medical Centre, Rehovot, Israel
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Howell J, Gulizia D, Shah P, Khan A, Trivedi A, Attanasio S, Tabriz D. Abstract No. 18 Radiology as the Impetus for Multidisciplinary Care Team Activation: One-Year Analysis After Implementation of a Novel Pulmonary Embolism Response Team. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Linzer M, Shah P, Nankivil N, Cappelucci K, Poplau S, Sinsky C. The Mini Z Resident (Mini ReZ): Psychometric Assessment of a Brief Burnout Reduction Measure. J Gen Intern Med 2023; 38:545-548. [PMID: 35882711 PMCID: PMC9905519 DOI: 10.1007/s11606-022-07720-0] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/17/2022] [Indexed: 10/16/2022]
Affiliation(s)
- M Linzer
- Hennepin Healthcare, Minneapolis, MN, USA.
| | - P Shah
- American Medical Association, Chicago, IL, USA
| | - N Nankivil
- American Medical Association, Chicago, IL, USA
| | | | - S Poplau
- Hennepin Healthcare, Minneapolis, MN, USA
| | - C Sinsky
- American Medical Association, Chicago, IL, USA
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Parekh P, Shah P, Bhaisara B. Beaver tail variant of liver: A radiographic mimic of left lower lobe pneumonia in a neonate. J Postgrad Med 2023:368461. [PMID: 36695250 PMCID: PMC10394524 DOI: 10.4103/jpgm.jpgm_657_22] [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: 01/26/2023] Open
Affiliation(s)
- P Parekh
- Department of Pediatrics, Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr. R. N. Cooper Municipal General Hospital, Mumbai, Maharashtra, India
| | - P Shah
- Department of Pediatrics, Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr. R. N. Cooper Municipal General Hospital, Mumbai, Maharashtra, India
| | - B Bhaisara
- Department of Pediatrics, Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr. R. N. Cooper Municipal General Hospital, Mumbai, Maharashtra, India
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Prabhakar A, Shah P, Gautham U, Natarajan V, Ramesh V, Chandrachoodan N, Tayur S. Optimization with photonic wave-based annealers. Philos Trans A Math Phys Eng Sci 2023; 381:20210409. [PMID: 36463927 DOI: 10.1098/rsta.2021.0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/14/2022] [Indexed: 06/17/2023]
Abstract
Many NP-hard combinatorial optimization (CO) problems can be cast as a quadratic unconstrained binary optimization model, which maps naturally to an Ising model. The final spin configuration in the Ising model can adiabatically arrive at a solution to a Hamiltonian, given a known set of interactions between spins. We enhance two photonic Ising machines (PIMs) and compare their performance against classical (Gurobi) and quantum (D-Wave) solvers. The temporal multiplexed coherent Ising machine (TMCIM) uses the bistable response of an electro-optic modulator to mimic the spin up and down states. We compare TMCIM performance on Max-cut problems. A spatial photonic Ising machine (SPIM) convolves the wavefront of a coherent laser beam with the pixel distribution of a spatial light modulator to adiabatically achieve a minimum energy configuration, and solve a number partitioning problem (NPP). Our computational results on Max-cut indicate that classical solvers are still a better choice, while our NPP results show that SPIM is better as the problem size increases. In both cases, connectivity in Ising hardware is crucial for performance. Our results also highlight the importance of better understanding which CO problems are most likely to benefit from which type of PIM. This article is part of the theme issue 'Quantum annealing and computation: challenges and perspectives'.
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Affiliation(s)
- A Prabhakar
- Indian Institute of Technology Madras, Chennai 600036, India
| | - P Shah
- Indian Institute of Technology Madras, Chennai 600036, India
| | - U Gautham
- Indian Institute of Technology Madras, Chennai 600036, India
| | - V Natarajan
- Indian Institute of Technology Madras, Chennai 600036, India
| | - V Ramesh
- Indian Institute of Technology Madras, Chennai 600036, India
| | | | - S Tayur
- Carnegie Mellon University, Pittsburgh, PA 15213, USA
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Shah P, Sah R, Sharma A, Khanal B, Bhattarai NR. Evaluation of Latex Agglutination Test for Rapid Identification of Staphylococcus aureus Isolated from Pyogenic Wound Infections at a Tertiary Care Hospital. Kathmandu Univ Med J (KUMJ) 2023; 21:13-16. [PMID: 37800419] [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: 10/07/2023]
Abstract
Background Staphylococcus aureus infections are increasingly reported worldwide. It is a major clinical problem and imposes significant morbidity and mortality due to widespread emergence of multidrug resistant pathogens like methicillin resistant Staphylococcus aureus. Thus, rapid and reliable identification of Staphylococcus aureus is essential for timely and effective management of patient. Objective The performance of Latex agglutination test (Staphaurex Plus) was compared to conventional method tube coagulase test which is gold standard too for the identification of Staphylococcus aureus. Method This study was conducted at B.P. Koirala Institute of Health Sciences. Following standard microbiological methods, isolation and identification was done in the Department of Microbiology. MRSA detection was performed following Clinical and Laboratory Standard Institute. All the isolates of Staphylococci were subjected for Latex agglutination test and was performed according to manufacturer's instructions using Staphaurex Plus kit. Result Out of 377 (methicillin sensitive Staphylococcus aureus - 142; methicillin resistant Staphylococcus aureus - 233; Coagulase Negative Staphylococci -2) isolates of Staphylococci, Latex agglutination test was found to be positive in 138 (97.1%) of methicillin sensitive Staphylococcus aureus (MSSA) and 220 (94.4%) of methicillin resistant Staphylococcus aureus (MRSA). Overall sensitivity, specificity, positive predictive value and negative predictive value of Latex agglutination test was found to be 95.46%, 100%, 100%, 10.52% respectively. Conclusion In conclusion, Latex agglutination test is a rapid and reliable test for the identification of Staphylococcus aureus.
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Affiliation(s)
- P Shah
- Department of Microbiology B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - R Sah
- Department of Microbiology B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - A Sharma
- Department of Microbiology B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - B Khanal
- Department of Microbiology B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
| | - N R Bhattarai
- Department of Microbiology B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal
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Tokgöz S, Boss M, Prasad S, Shah P, Laverman P, van Riel M, Gotthardt M. Protocol for Clinical GLP-1 Receptor PET/CT Imaging with [ 68Ga]Ga-NODAGA-Exendin-4. Methods Mol Biol 2022; 2592:143-153. [PMID: 36507990 DOI: 10.1007/978-1-0716-2807-2_9] [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: 12/15/2022]
Abstract
Imaging with radiolabeled exendin enables detection and characterization of glucagon-like peptide 1 receptors (GLP-1Rs) in vivo with high specificity. The novel radiotracer [68Ga]Ga-NODAGA-exendin-4 forms a stable complex after a simple and fast labeling procedure. Beta-cell mass in the islets of Langerhans can be visualized using [68Ga]Ga-NODAGA-exendin-4, which is promising for research into diabetes mellitus (DM) pathophysiology. Furthermore, this radiotracer enables very sensitive detection of insulinomas, resulting from vast overexpression of GLP-1Rs, and seems promising for the detection of focal lesions in congenital hyperinsulinism (CHI). Here, we describe the procedures involved in [68Ga]Ga-NODAGA-exendin-4 positron emission tomography (PET)/computed tomography (CT) imaging including the radiolabeling of the NODAGA-exendin conjugate with 68Ga, quality controls, and PET/CT.
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Affiliation(s)
- S Tokgöz
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Boss
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Prasad
- Department of Nuclear Medicine, Radiopharmacy, Berlin Experimental Radionuclide Imaging Center (BERIC), Berlin, Germany
| | - P Shah
- Department of Pediatric Endocrinology, Barts Health NHS Trust (The Royal London Childrens Hospital), London, UK
| | - P Laverman
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M van Riel
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Gotthardt
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
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Chan CKY, Shah P. An audit of high oral broad-spectrum antibiotic prescribing within a Bristol-based general practice. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac089.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Abstract
Introduction
Oral broad-spectrum antibiotics (OBSAs), defined here as cephalosporins, fluoroquinolones and co-amoxiclav, are associated with AMR and adverse events in the elderly (ie. over 60s). Despite stringent national and local system-wide approaches aimed at reducing their inappropriate prescribing, the regional care commissioning group (CCG) alerted that OBSA prescribing within this practice between February and August 2021 at up to 14% of antibiotics prescriptions, has exceeded both the national and CCG limit which is 10%.1,2 This necessitates minimising OBSA prescribing among the over 60s in this practice.
Aim
To identify the percentage of inappropriate prescribing of OBSAs at Downend Health Group and investigate factors leading to their high prescribing rates using the following standard: 0% of OBSAs were prescribed inappropriately within a 7-month period, which includes prescribing outside of regional guidance without specialist input or evidence of infection.
Methods
The study design, data collection and analysis were conducted by the foundation trainee, supervised by the lead pharmacist. A retrospective population reporting search was run on our prescribing system (EMIS) to identify active patients over 60 years prescribed OBSAs between February and August 2021. To produce our IT data collection tool, the inclusion criteria were ages over 60 years, name of antibiotic, location of consultation, authorising user and prescribing indication. The search was piloted with 235 patients and narrowed down to 208 patients by adding acute (ie. one-off) prescription type as another inclusion criteria. Inactive and deceased patients at the time of the search were excluded. Data from the search was then compared against the regional guidance and further analysed. Ethics approval was not required for this audit.
Results
The results did not meet the set standard. Out of 208 active patients over 60 years prescribed OBSAs on acute during the defined period, 107 (51%) prescriptions were inappropriate. 63 (30%) prescriptions had the wrong antibiotic choice whereas 44 (21%) prescriptions had no evidence of infection. The top conditions with inappropriate OBSA prescriptions include UTI (22%), diverticulitis without pyrexia (15%) and cellulitis (11%). Furthermore, remote consultations had higher inappropriate prescribing as the error bar comparison between face-to-face vs remote consultations on influencing inappropriate OBSA prescribing showed statistical significance (p < 0.05). Although GPs authorised 188 (90%) of OBSA prescriptions, 15 out of the 20 (75%) OBSA prescriptions authorised by non-GPs were inappropriate. Despite the similar rates of appropriate (51%) and inappropriate (49%) OBSA prescribing among the GPs, four GPs had disproportionately high inappropriate OBSA prescribing.
Discussion/Conclusion
Further to excluding deceased patients from the sample size, another limitation is the lack of investigations to rule out the confounding variables of researcher bias and the potential influence of lockdowns in the high levels of remote consultations. Regardless, the results suggest that the practice can meet the national and CCG OBSA prescribing limit by reducing inappropriate OBSA prescribing from 51% to 0%. Following an internal clinical governance meeting with the authorising users, we will update relevant internal EMIS alerts and antimicrobial stewardship protocols, followed by a reaudit 7-months after implementing the updates.
References
1. Nice.org.uk. 2015. Overview | Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use | Guidance | NICE. [online] Available at: https://www.nice.org.uk/guidance/ng15/ (accessed 14 March 2022).
2. Remedy.bnssgccg.nhs.uk. 2021: REMEDY. Available at: https://remedy.bnssgccg.nhs.uk/media/5026/antimicrobial-rx-guidelines-for-bnssg2019-version-83-including-covid.pdf/ (accessed 14 March 2022).
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Affiliation(s)
| | - P Shah
- Downend Health Group , Bristol , UK
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Linzer M, Shah P, Nankivil N, Cappelucci K, Poplau S, Sinsky C. Correction to: The Mini Z Resident (Mini ReZ): Psychometric Assessment of a Brief Burnout Reduction Measure. J Gen Intern Med 2022:10.1007/s11606-022-07934-2. [PMID: 36385414 DOI: 10.1007/s11606-022-07934-2] [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: 11/17/2022]
Affiliation(s)
- M Linzer
- Hennepin Healthcare, Minneapolis, MN, USA.
| | - P Shah
- American Medical Association, Chicago, IL, USA
| | - N Nankivil
- American Medical Association, Chicago, IL, USA
| | | | - S Poplau
- Hennepin Healthcare, Minneapolis, MN, USA
| | - C Sinsky
- American Medical Association, Chicago, IL, USA
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Basu T, Senapati M, Saxena U, E R, Rajurkar S, Mathur Y, Mahuvakar A, Karpe A, Dsouza H, Shah P. Carotid Sparing Modulated Radiotherapy (CSMRT) for Early Glottic Cancers: Single Institution Feasibility and Safety Assessment. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1359] [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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Rotstein D, Solomon JM, Sormani MP, Montalban X, Ye XY, Dababneh D, Muccilli A, Saab G, Shah P. Association of NEDA-4 With No Long-term Disability Progression in Multiple Sclerosis and Comparison With NEDA-3: A Systematic Review and Meta-analysis. Neurol Neuroimmunol Neuroinflamm 2022; 9:9/6/e200032. [PMID: 36224046 PMCID: PMC9558627 DOI: 10.1212/nxi.0000000000200032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022]
Abstract
Background and Objectives No evidence of disease activity (NEDA)-4 has been suggested as a treatment target for disease-modifying therapy (DMT) in relapsing-remitting multiple sclerosis (RRMS). However, the ability of NEDA-4 to discriminate long-term outcomes in MS and how its performance compares with NEDA-3 remain uncertain. We conducted a systematic review and meta-analysis to evaluate (1) the association between NEDA-4 and no long-term disability progression in MS and (2) the comparative performance of NEDA-3 and NEDA-4 in predicting no long-term disability progression. Methods English-language abstracts and manuscripts were systematically searched in MEDLINE, Embase, and the Cochrane databases from January 2006 to November 2021 and reviewed independently by 2 investigators. We selected studies that assessed NEDA-4 at 1 or 2 years after DMT start and had at least 4 years of follow-up for determination of no confirmed disability progression. We conducted a meta-analysis using random-effects model to determine the pooled odds ratio (OR) for no disability progression with NEDA-4 vs EDA-4. For the comparative analysis, we selected studies that evaluated both NEDA-3 and NEDA-4 with at least 4 years of follow-up and examined the difference in the association of NEDA-3 and NEDA-4 with no disability progression. Results Five studies of 1,000 patients (3 interferon beta and 2 fingolimod) met inclusion criteria for both objectives. The median duration of follow-up was 6 years (interquartile range: 4–6 years). The prevalence of NEDA-4 ranged from 4.2% to 13.9% on interferon beta therapy and 24.9% to 25.1% on fingolimod therapy. The pooled OR for no long-term confirmed disability progression with NEDA-4 vs EDA-4 was 2.14 (95% confidence interval: 1.36–3.37; I2 = 0). We did not observe any significant difference between NEDA-4 and NEDA-3 in the comparative analyses. Discussion In patients with RRMS, NEDA-4 at 1–2 years was associated with 2 times higher odds of no long-term disability progression, at 6 years compared with EDA-4, but offered no advantage over NEDA-3.
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Affiliation(s)
- Dalia Rotstein
- From the Department of Medicine, (D.R., A.M., G.S.), University of Toronto, Ontario, Canada; St. Michael's Hospital (D.R., A.M., G.S.), Toronto, Ontario, Canada; Department of Medicine, (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Department of Health Sciences (M.P.S.), Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology and Cemcat (X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Canada; Columbia University Irving Medical Center (D.D.), Department of Neurology, New York City; York Presbyterian Hospital (NYP) (D.D.), New York City; and Institute of Health (P.S.), Policy, Management and Evaluation, University of Toronto, Canada.
| | - Jacqueline M Solomon
- From the Department of Medicine, (D.R., A.M., G.S.), University of Toronto, Ontario, Canada; St. Michael's Hospital (D.R., A.M., G.S.), Toronto, Ontario, Canada; Department of Medicine, (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Department of Health Sciences (M.P.S.), Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology and Cemcat (X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Canada; Columbia University Irving Medical Center (D.D.), Department of Neurology, New York City; York Presbyterian Hospital (NYP) (D.D.), New York City; and Institute of Health (P.S.), Policy, Management and Evaluation, University of Toronto, Canada
| | - Maria Pia Sormani
- From the Department of Medicine, (D.R., A.M., G.S.), University of Toronto, Ontario, Canada; St. Michael's Hospital (D.R., A.M., G.S.), Toronto, Ontario, Canada; Department of Medicine, (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Department of Health Sciences (M.P.S.), Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology and Cemcat (X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Canada; Columbia University Irving Medical Center (D.D.), Department of Neurology, New York City; York Presbyterian Hospital (NYP) (D.D.), New York City; and Institute of Health (P.S.), Policy, Management and Evaluation, University of Toronto, Canada
| | - Xavier Montalban
- From the Department of Medicine, (D.R., A.M., G.S.), University of Toronto, Ontario, Canada; St. Michael's Hospital (D.R., A.M., G.S.), Toronto, Ontario, Canada; Department of Medicine, (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Department of Health Sciences (M.P.S.), Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology and Cemcat (X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Canada; Columbia University Irving Medical Center (D.D.), Department of Neurology, New York City; York Presbyterian Hospital (NYP) (D.D.), New York City; and Institute of Health (P.S.), Policy, Management and Evaluation, University of Toronto, Canada
| | - Xiang Y Ye
- From the Department of Medicine, (D.R., A.M., G.S.), University of Toronto, Ontario, Canada; St. Michael's Hospital (D.R., A.M., G.S.), Toronto, Ontario, Canada; Department of Medicine, (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Department of Health Sciences (M.P.S.), Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology and Cemcat (X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Canada; Columbia University Irving Medical Center (D.D.), Department of Neurology, New York City; York Presbyterian Hospital (NYP) (D.D.), New York City; and Institute of Health (P.S.), Policy, Management and Evaluation, University of Toronto, Canada
| | - Dina Dababneh
- From the Department of Medicine, (D.R., A.M., G.S.), University of Toronto, Ontario, Canada; St. Michael's Hospital (D.R., A.M., G.S.), Toronto, Ontario, Canada; Department of Medicine, (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Department of Health Sciences (M.P.S.), Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology and Cemcat (X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Canada; Columbia University Irving Medical Center (D.D.), Department of Neurology, New York City; York Presbyterian Hospital (NYP) (D.D.), New York City; and Institute of Health (P.S.), Policy, Management and Evaluation, University of Toronto, Canada
| | - Alexandra Muccilli
- From the Department of Medicine, (D.R., A.M., G.S.), University of Toronto, Ontario, Canada; St. Michael's Hospital (D.R., A.M., G.S.), Toronto, Ontario, Canada; Department of Medicine, (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Department of Health Sciences (M.P.S.), Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology and Cemcat (X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Canada; Columbia University Irving Medical Center (D.D.), Department of Neurology, New York City; York Presbyterian Hospital (NYP) (D.D.), New York City; and Institute of Health (P.S.), Policy, Management and Evaluation, University of Toronto, Canada
| | - Georges Saab
- From the Department of Medicine, (D.R., A.M., G.S.), University of Toronto, Ontario, Canada; St. Michael's Hospital (D.R., A.M., G.S.), Toronto, Ontario, Canada; Department of Medicine, (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Department of Health Sciences (M.P.S.), Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology and Cemcat (X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Canada; Columbia University Irving Medical Center (D.D.), Department of Neurology, New York City; York Presbyterian Hospital (NYP) (D.D.), New York City; and Institute of Health (P.S.), Policy, Management and Evaluation, University of Toronto, Canada
| | - Prakesh Shah
- From the Department of Medicine, (D.R., A.M., G.S.), University of Toronto, Ontario, Canada; St. Michael's Hospital (D.R., A.M., G.S.), Toronto, Ontario, Canada; Department of Medicine, (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Department of Health Sciences (M.P.S.), Section of Biostatistics, University of Genova, Italy; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology and Cemcat (X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Canada; Columbia University Irving Medical Center (D.D.), Department of Neurology, New York City; York Presbyterian Hospital (NYP) (D.D.), New York City; and Institute of Health (P.S.), Policy, Management and Evaluation, University of Toronto, Canada
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Defilippi C, Shah SJ, Alemayehu W, Lam CSP, Butler J, Reimann S, O'Connor CM, Shah P, Westerhout CM, Armstrong PW. Targeted discovery proteomics to identify clinical phenotypes in heart failure with preserved ejection fraction: a proteomics substudy of VITALITY-HFpEF. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure with preserved ejection fraction (HFpEF) is a heterogenous syndrome that may emerge from overlapping systemic processes associated with several medical co-morbidities, often within an inflammatory milieu. Identification of unique proteins associated with distinct phenotypes may yield insight into novel therapeutics.
Purpose
Determine if unique clusters of circulating proteins are associated with specific clinical characteristics in patients with HFpEF.
Methods
A targeted discovery proteomics approach with 358 unique proteins associated with cardiovascular disease and inflammation (Olink) was used at baseline in VITALITY-HFpEF among 789 participants with documented left ventricular EF ≥45% and recent decompensation (<6 mos). Proteins were clustered applying the weighted correlation network analysis (WCNA). The associations of the clinical characteristics and frailty and clusters were estimated with linear regression adjusted for age and eGFR. Frailty was characterized as normal, pre-frail, and frail using the Fried criteria. KCCQ was the primary and 6-minute walk distance (6MWD) the secondary endpoint of VITALITY-HFpEF.
Results
Four unique clusters were identified containing 24, 66, 197, and 81 proteins, respectively. Figure 1 shows the adjusted association of the 4 protein clusters, shown with their hub proteins, with the clinical characteristics. The color (red: positive, green: negative relationship) and intensity indicate the magnitude of the standardized difference (relative to the variation [i.e., T-value]); p-value shown in boxes. Cluster 3, with tumor necrosis factor receptor 1 as a hub protein that mediates apoptosis and inflammation, was associated with greater frailty and physical limitation along with shorter 6MWD. In contrast, cluster 4, with protein C as a hub protein that regulates anticoagulation and exerts a protective function on endothelial cells, is associated with less frailty and younger age, and more frequently male sex. Cluster 2 was associated with only younger age and cluster 1 with no clinical characteristics.
Conclusions
Proteomics appear to identify specific clinical phenotypes associated with HFpEF. Further exploration of this approach may provide insight into the diverse pathophysiology characterizing this disorder and a more targeted approach to therapy.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): VITALITY-HFpEF was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA and Bayer AG, Wuppertal, Germany.
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Affiliation(s)
- C Defilippi
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - S J Shah
- Northwestern University , Chicago , United States of America
| | - W Alemayehu
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - C S P Lam
- National University Heart Centre, Duke-NUS , Singapore , Singapore
| | - J Butler
- Baylor University Medical Center , Dallas , United States of America
| | | | - C M O'Connor
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - P Shah
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - C M Westerhout
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - P W Armstrong
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
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Sigal A, Tauscher S, Trupp R, Singh H, Deaner T, Sandhu C, Shah P, Mene-Afejuku T, Shrestha B, Weiss S. 131 Adulterated Heroin: Presentations and Outcomes of a Large Case Series of Contaminated Heroin. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Rutella S, Muth J, Vadakekulathu J, Mathyer M, Tumala B, Foster M, Baughman J, Comune Pennacchi P, Tolstikov V, Carter A, Primo D, Gorrochategui J, Magee K, Shah P, Kiebish M, Ballesteros J, Cooper M, Berrien-Elliott M, Fehniger T, Davidson-Moncada J. 11P WU-NK-101: An enhanced NK cell therapy optimized for function in the tumor microenvironment (TME). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Mehta N, Shah P, Bhide A. Neonatal encephalopathy-controversies and evidence. Acta Obstet Gynecol Scand 2022; 101:938-940. [PMID: 35922900 DOI: 10.1111/aogs.14416] [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: 05/23/2022] [Revised: 06/13/2022] [Accepted: 06/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Nishita Mehta
- Department of Obstetrics and Gynecology, St George's University Hospital NHS Foundation Trust, London, UK
| | - Prakesh Shah
- Department of Neonatology, Mount Sinai Hospital, Toronto, Canada
| | - Amar Bhide
- Department of Obstetrics and Gynecology, St George's University Hospital NHS Foundation Trust, London, UK
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Rotstein D, Solomon JM, Sormani MP, Montalban X, Ye XY, Dababneh D, Muccilli A, Shah P. Association of No Evidence of Disease Activity With No Long-term Disability Progression in Multiple Sclerosis: A Systematic Review and Meta-analysis. Neurology 2022; 99:e209-e220. [PMID: 35473761 DOI: 10.1212/wnl.0000000000200549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/02/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We conducted a systematic review and meta-analysis to evaluate the relationship between no evidence of disease activity (NEDA) and no long-term disability progression on low- and high-efficacy therapy in relapsing-remitting multiple sclerosis (RRMS). METHODS MEDLINE, Embase, and the Cochrane Database were searched from January 1, 2006, to January 26, 2021. We selected studies that evaluated NEDA-3 (no relapse, new MRI lesion, or confirmed disability progression) at 1 or 2 years and had a minimum of 4 years of follow-up for determination of disability progression. Data were extracted by 2 independent reviewers and were meta-analyzed with a random-effects model. Primary outcome of no disability progression was defined as no confirmed progression on the Expanded Disability Status Scale during follow-up. We assessed the odds ratio (OR) for no disability progression with NEDA vs evidence of disease activity (EDA). Positive predictive value (PPV) of NEDA for no disability progression was summarized for studies with prevalence of no progression >80% vs ≤80% separately. RESULTS We included 29 studies in our qualitative synthesis, of which 27 (16 low efficacy, 11 high efficacy) were included in the meta-analysis (N = 10,935 participants). Median follow-up was 5.6 years (interquartile range 4.3-8.0 years). The pooled ORs for no progression with NEDA-3 vs EDA were 2.32 (95% CI 1.58-3.42; I 2 = 73%) for low-efficacy therapy and 3.19 (95% CI 1.86-5.47; I 2 = 86%) for high-efficacy therapy. Among studies with prevalence of no progression at follow-up >80%, the pooled PPV for low efficacy therapy was 91% (95% CI 89%-93%) and for high-efficacy therapy was 92% (95% CI 88%-94%). Among studies with prevalence of no progression ≤80%, the pooled PPV for low-efficacy therapy was 81% (95% CI 75%-86%) and for high-efficacy therapy was 86% (95% CI 80%-90%). DISCUSSION NEDA-3 is associated with no long-term disability progression in RRMS on both low- and high-efficacy therapies. Further studies of early composite outcome measures incorporating easily measurable biomarkers and longer follow-up may help to improve the prognostic value of NEDA-3 in RRMS. TRIAL REGISTRATION INFORMATION International Prospective Register of Systematic Reviews Identifier: CRD42020189316.
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Affiliation(s)
- Dalia Rotstein
- From the Department of Medicine (D.R., A.M.), University of Toronto; St. Michael's Hospital (D.R., A.M.), Toronto; Department of Medicine (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Section of Biostatistics (M.P.S.), Department of Health Sciences, University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology (X.M.), Cemcat, Hospital Universitari Vall d-Hebron, Universitat Autonoma de Barcelona, Spain; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Neurology (D.D.), Columbia University Irving Medical Center; New York Presbyterian Hospital (D.D.), New York City; and Institute of Health, Policy, Management and Evaluation (P.S.), University of Toronto, Ontario, Canada.
| | - Jacqueline Madeleine Solomon
- From the Department of Medicine (D.R., A.M.), University of Toronto; St. Michael's Hospital (D.R., A.M.), Toronto; Department of Medicine (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Section of Biostatistics (M.P.S.), Department of Health Sciences, University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology (X.M.), Cemcat, Hospital Universitari Vall d-Hebron, Universitat Autonoma de Barcelona, Spain; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Neurology (D.D.), Columbia University Irving Medical Center; New York Presbyterian Hospital (D.D.), New York City; and Institute of Health, Policy, Management and Evaluation (P.S.), University of Toronto, Ontario, Canada
| | - Maria Pia Sormani
- From the Department of Medicine (D.R., A.M.), University of Toronto; St. Michael's Hospital (D.R., A.M.), Toronto; Department of Medicine (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Section of Biostatistics (M.P.S.), Department of Health Sciences, University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology (X.M.), Cemcat, Hospital Universitari Vall d-Hebron, Universitat Autonoma de Barcelona, Spain; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Neurology (D.D.), Columbia University Irving Medical Center; New York Presbyterian Hospital (D.D.), New York City; and Institute of Health, Policy, Management and Evaluation (P.S.), University of Toronto, Ontario, Canada
| | - Xavier Montalban
- From the Department of Medicine (D.R., A.M.), University of Toronto; St. Michael's Hospital (D.R., A.M.), Toronto; Department of Medicine (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Section of Biostatistics (M.P.S.), Department of Health Sciences, University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology (X.M.), Cemcat, Hospital Universitari Vall d-Hebron, Universitat Autonoma de Barcelona, Spain; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Neurology (D.D.), Columbia University Irving Medical Center; New York Presbyterian Hospital (D.D.), New York City; and Institute of Health, Policy, Management and Evaluation (P.S.), University of Toronto, Ontario, Canada
| | - Xiang Y Ye
- From the Department of Medicine (D.R., A.M.), University of Toronto; St. Michael's Hospital (D.R., A.M.), Toronto; Department of Medicine (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Section of Biostatistics (M.P.S.), Department of Health Sciences, University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology (X.M.), Cemcat, Hospital Universitari Vall d-Hebron, Universitat Autonoma de Barcelona, Spain; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Neurology (D.D.), Columbia University Irving Medical Center; New York Presbyterian Hospital (D.D.), New York City; and Institute of Health, Policy, Management and Evaluation (P.S.), University of Toronto, Ontario, Canada
| | - Dina Dababneh
- From the Department of Medicine (D.R., A.M.), University of Toronto; St. Michael's Hospital (D.R., A.M.), Toronto; Department of Medicine (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Section of Biostatistics (M.P.S.), Department of Health Sciences, University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology (X.M.), Cemcat, Hospital Universitari Vall d-Hebron, Universitat Autonoma de Barcelona, Spain; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Neurology (D.D.), Columbia University Irving Medical Center; New York Presbyterian Hospital (D.D.), New York City; and Institute of Health, Policy, Management and Evaluation (P.S.), University of Toronto, Ontario, Canada
| | - Alexandra Muccilli
- From the Department of Medicine (D.R., A.M.), University of Toronto; St. Michael's Hospital (D.R., A.M.), Toronto; Department of Medicine (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Section of Biostatistics (M.P.S.), Department of Health Sciences, University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology (X.M.), Cemcat, Hospital Universitari Vall d-Hebron, Universitat Autonoma de Barcelona, Spain; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Neurology (D.D.), Columbia University Irving Medical Center; New York Presbyterian Hospital (D.D.), New York City; and Institute of Health, Policy, Management and Evaluation (P.S.), University of Toronto, Ontario, Canada
| | - Prakesh Shah
- From the Department of Medicine (D.R., A.M.), University of Toronto; St. Michael's Hospital (D.R., A.M.), Toronto; Department of Medicine (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Section of Biostatistics (M.P.S.), Department of Health Sciences, University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology (X.M.), Cemcat, Hospital Universitari Vall d-Hebron, Universitat Autonoma de Barcelona, Spain; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Neurology (D.D.), Columbia University Irving Medical Center; New York Presbyterian Hospital (D.D.), New York City; and Institute of Health, Policy, Management and Evaluation (P.S.), University of Toronto, Ontario, Canada
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Alshaikh B, Yusuf K, Dressler-Mund D, Mehrem AA, Augustine S, Bodani J, Yoon E, Shah P. Rates and Determinants of Home Nasogastric Tube Feeding in Infants Born Very Preterm. J Pediatr 2022; 246:26-33.e2. [PMID: 35301017 DOI: 10.1016/j.jpeds.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine rates and determinants of home nasogastric (NG)-tube feeding at hospital discharge in a cohort of very preterm infants within the Canadian Neonatal Network (CNN). STUDY DESIGN This was a population-based cohort study of infants born <33 weeks of gestation and admitted to neonatal intensive care units (NICUs) participating in the CNN between January 1, 2010, and December 31, 2018. We excluded infants who had major congenital anomalies, required gastrostomy-tube, or were discharged to non-CNN facilities. Multivariable logistic regression analysis was used to identify independent determinants of home NG-tube feeding at hospital discharge. RESULTS Among the 13 232 infants born very preterm during the study period, 333 (2.5%) were discharged home to receive NG-tube feeding. Rates of home NG-tube feeding varied across Canadian NICUs, from 0% to 12%. Determinants of home NG-tube feeding were gestational age (aOR 0.94 per each gestational week increase, 95% CI 0.88-0.99); duration of mechanical ventilation (aOR 1.02 per each day increase, 95% CI 1.01-1.02); high illness severity at birth (aOR 1.32, 95% CI 1.01-1.74); small for gestational age (aOR 2.06, 95% CI 1.52-2.78); male sex (aOR 0.61, 95% CI 0.49-0.77); severe brain injury (aOR 1.60, 95% CI 1.10-2.32); and bronchopulmonary dysplasia (aOR 2.22, 95% CI 1.67-2.94). CONCLUSIONS Rates of home NG-tube feeding varied widely between Canadian NICUs. Higher gestational age and male sex reduced the odds of discharge home to receive NG-tube feeding; and in contrast small for gestational age, severe brain injury, prolonged duration on mechanical ventilation and bronchopulmonary dysplasia increased the odds.
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Affiliation(s)
- Belal Alshaikh
- Neonatal Nutrition and Gastroenterology Program, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Kamran Yusuf
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donna Dressler-Mund
- Occupational Therapy, Alberta Children's Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | - Ayman Abou Mehrem
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sajit Augustine
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Section of Neonatology, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Jaya Bodani
- Department of Pediatrics, Regina General Hospital, Regina and College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Eugene Yoon
- Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prakesh Shah
- Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; Departments of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al Bahri T, Bhoombla N, Rao BM, Titu L, Chatha S, Field C, Gandhi T, Gulati R, Jha R, Jones Sam MT, Karim S, Patel R, Saunders M, Sharma K, Abid S, Heath E, Kurup D, Patel A, Ali M, Cresswell B, Felstead D, Jennings K, Kaluarachchi T, Lazzereschi L, Mayson H, Miah JE, Reinders B, Rosser A, Thomas C, Williams H, Al-Hamid Z, Alsadoun L, Chlubek M, Fernando P, Gaunt E, Gercek Y, Maniar R, Ma R, Matson M, Moore S, Morris A, Nagappan PG, Ratnayake M, Rockall L, Shallcross O, Sinha A, Tan KE, Virdee S, Wenlock R, Donnelly HA, Ghazal R, Hughes I, Liu X, McFadden M, Misbert E, Mogey P, O'Hara A, Peace C, Rainey C, Raja P, Salem M, Salmon J, Tan CH, Alves D, Bahl S, Baker C, Coulthurst J, Koysombat K, Linn T, Rai P, Sharma A, Shergill A, Ahmed M, Ahmed S, Belk LH, Choudhry H, Cummings D, Dixon Y, Dobinson C, Edwards J, Flint J, Franco Da Silva C, Gallie R, Gardener M, Glover T, Greasley M, Hatab A, Howells R, Hussey T, Khan A, Mann A, Morrison H, Ng A, Osmond R, Padmakumar N, Pervaiz F, Prince R, 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Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Arevalo AB, Zala H, Shah P, Majmundar M, Ramirez Gomez A. POS0819 RACIAL DIFFERENCES IN CARDIOVASCULAR AND INFECTIOUS MORBIDITY AMONG PATIENTS WITH GIANT CELL ARTERITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGiant cell arteritis (GCA) is the most common primary vasculitis in adults. It presents with signs of vascular insufficiency of the extracranial arteries of the head, but may also affect the aorta and its primary and secondary branches. GCA is more prevalent in Caucasians of Scandinavian and Northern European descent, and is considered to be less common in African, Asian, Arab and Latin American populations.1,2 However, this may reflect a lack of formal epidemiological data in these populations rather than a true lower incidence. This is evidenced by extensive studies in white populations and a significant paucity of data in other ethnic groups. The most frequent causes of death in GCA are cardiovascular disease (CVD) (39%) followed by cerebrovascular disease (CVA) (14%), infection (13%), and malignancy (12%).3 Overall, the mortality rate is increased in the first two years and is associated with the disease severity, extent, ischemic, and treatment complications, particularly from glucocorticoids.4,5ObjectivesThe aim of this study was to compare the rate of cardiovascular and infectious complications in GCA patients among different ethnicities.MethodsIn this retrospective cohort study, we identified patients with biopsy proven GCA based on ICD-10 codes, using the Nationwide Inpatient Sample database (NIS) from 2016 to 2019. We included acute coronary syndrome (ACS), CVA, thoracic ascending aneurysm rupture (TAA), and infection (composite of UTI, sepsis and pneumonia) as our outcomes of interest and compared them between Caucasian, African American (AA), and Hispanic ethnicities. We implemented logistic regression analysis in the univariable and multivariable models. In the multivariable model, we adjusted all outcomes for potential confounders, including age, sex, obesity, hyperlipidemia, congestive heart failure, peripheral vascular diseases, diabetes, hypertension, renal failure, history of smoking or alcohol abuse, history of other drug abuse, prior history of MI, primary coronary intervention, or coronary artery bypass grafting, coagulopathy, liver disease, chronic pulmonary disease, ischemic cardiomyopathy, Elixhauser comorbidity index, type of insurance, bed size of hospital, history of defibrillator or pacemaker, and long-term use of steroids. The analysis was done using the STATA software, version 17.0 (MP2).ResultsWe identified 7,750 patients with GCA, of whom 5,710 (74%) were Caucasian, 1,335 (17%) were AA, and 705 (9%) were Hispanic. Our results showed that Hispanics had both a higher prevalence (16.30% vs 9.80% vs 7.50%, p-value = 0.017) and risk for infections (OR: 2.74; 95%-CI 1.4-5.5; p-value = 0.004) when compared to the other racial groups. There was no difference in the risk of ACS among Caucasians (OR: 2.72; 95%-CI 0.6-12.4; p-value = 0.2) and Hispanics (OR: 2.72; 95%-CI 0.4-17.4; p-value = 0.004) when compared to AA population. Similarly, risk of CVA was not different between racial groups (Caucasians: OR: 1.04; 95%-CI 0.6-1.7; p-value = 0.87; Hispanics: OR: 0.8; 95%-CI 0.4-1.7; p-value = 0.567). The prevalence for TAA was only reported in the Caucasian group (0.50%).ConclusionACS and CVA are known complications of GCA. There does not appear to be a difference in the risks of these common cardiovascular complications among racial groups. However, there was a significantly higher rate of infections in the Hispanic population. This may be explained by biologic differences in susceptibility and racial disparities in insurance coverage and access to care.References[1]Tehrani, R., et al. Seminar in Ophthalmology. 2008[2]Gruener, A., et al. JAMA Ophthalmol. 2019[3]Hill, C., et al. Semin Arthritis Rheum. 2017[4]Mackie S., et al. Nat Rev Rheumatol. 2014[5]Therkildsen, P., et al. Rheumatology (Oxford). 2021Table 1.Multivariable logistic regression comparing clinical outcomes across races*CaucasianHispanicOR95% CIP-valueOR95% CIP-valueACS2.720.6-12.40.22.720.4-17.40.291CVA1.040.6-1.70.870.80.4-1.70.567TAANANAInfection1.550.9-2.60.112.741.4-5.50.004*AA are taken as referenceDisclosure of InterestsNone declared
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