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Cai CX, Nishimura A, Bowring MG, Westlund E, Tran D, Ng JH, Nagy P, Cook M, McLeggon JA, DuVall SL, Matheny ME, Golozar A, Ostropolets A, Minty E, Desai P, Bu F, Toy B, Hribar M, Falconer T, Zhang L, Lawrence-Archer L, Boland MV, Goetz K, Hall N, Shoaibi A, Reps J, Sena AG, Blacketer C, Swerdel J, Jhaveri KD, Lee E, Gilbert Z, Zeger SL, Crews DC, Suchard MA, Hripcsak G, Ryan PB. Similar risk of kidney failure among patients with blinding diseases who receive ranibizumab, aflibercept, and bevacizumab: an OHDSI Network Study. Ophthalmol Retina 2024:S2468-6530(24)00118-0. [PMID: 38519026 DOI: 10.1016/j.oret.2024.03.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE OR PURPOSE A) To characterize the incidence of kidney failure associated with intravitreal anti-vascular endothelial growth factor (VEGF) exposure, and B) compare the risk of kidney failure in patients treated with ranibizumab, aflibercept, or bevacizumab. DESIGN Retrospective cohort study across 12 databases in the Observational Health Data Sciences and Informatics (OHDSI) network. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS Subjects aged ≥18 years with ≥3 monthly intravitreal anti-VEGF medications for a blinding disease (diabetic retinopathy, diabetic macular edema, exudative age-related macular degeneration, or retinal vein occlusion). METHODS, INTERVENTION, OR TESTING A) The standardized incidence proportions and rates of kidney failure while on treatment with anti-VEGF were calculated. B) For each comparison (e.g., aflibercept versus ranibizumab), patients from each group were matched 1:1 using propensity scores. Cox proportional hazards models were used to estimate the risk of kidney failure while on treatment. A random-effects meta-analysis was performed to combine each database's hazard ratio (HR) estimate into a single network-wide estimate. MAIN OUTCOME MEASURES Incidence of kidney failure while on anti-VEGF treatment, and time from cohort entry to kidney failure. RESULTS Of the 6.1 million patients with blinding diseases, 37,189 who received ranibizumab, 39,447 aflibercept, and 163,611 bevacizumab were included; the total treatment exposure time was 161,724 person-years. The average standardized incidence proportion of kidney failure was 678 per 100,000 persons (range 0 to 2389), and incidence rate 743 per 100,000 person-years (0 to 2661). The meta-analysis HR of kidney failure comparing aflibercept to ranibizumab was 1.01 (95% confidence interval (CI) 0.70, 1.47, p=0.45), ranibizumab to bevacizumab 0.95 (95% CI 0.68, 1.32, p=0.62), and aflibercept to bevacizumab 0.95 (95% CI 0.65, 1.39, p=0.60). CONCLUSIONS There was no substantially different relative risk for kidney failure between those who received ranibizumab, bevacizumab, or aflibercept. Practicing ophthalmologists and nephrologists should be aware of the risk for kidney failure among patients receiving intravitreal anti-VEGF medications and that there is little empirical evidence to preferentially choose among the specific intravitreal anti-VEGF agents.
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Affiliation(s)
- Cindy X Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Akihiko Nishimura
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mary G Bowring
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD
| | - Erik Westlund
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Diep Tran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jia H Ng
- Division of Kidney Diseases and Hypertension, Donald and Barbara School of Medicine at Hofstra/Northwell, NY
| | - Paul Nagy
- Department of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD
| | | | | | - Scott L DuVall
- VA Informatics and Computing Infrastructure, US Department of Veterans Affairs, Salt Lake City, UT; and Department of Internal Medicine Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
| | - Michael E Matheny
- VA Informatics and Computing Infrastructure, Tennessee Valley Healthcare System, Nashville, TN; and Department of Biomedical Informatics, Vanderbilt University, Nashville, TN
| | - Asieh Golozar
- Odysseus Data Services, Inc., Cambridge, MA, OHDSI Center at the Roux Institute, Northeastern University, Boston, MA
| | | | - Evan Minty
- O'Brien Center for Public Health, Department of Medicine, University of Calgary, Canada
| | - Priya Desai
- Technology / Digital Solutions, Stanford Health Care and Stanford University School of Medicine, Palo Alto, United States
| | - Fan Bu
- Department of Biostatistics, University of California - Los Angeles, Los Angeles, CA
| | - Brian Toy
- Roski Eye Institute, Keck School of Medicine, University of Southern California; Los Angeles, CA
| | - Michelle Hribar
- National Eye Institute, National Institutes of Health, Bethesda, MD; and Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | | | - Linying Zhang
- Department of Biomedical Informatics, Columbia University
| | - Laurence Lawrence-Archer
- Odysseus Data Services, Inc., Cambridge, MA, OHDSI Center at the Roux Institute, Northeastern University, Boston, MA
| | | | - Kerry Goetz
- National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Nathan Hall
- Janssen Research and Development, Titusville, NJ
| | - Azza Shoaibi
- Janssen Research and Development, Titusville, NJ
| | - Jenna Reps
- Janssen Research and Development, Titusville, NJ
| | - Anthony G Sena
- Janssen Research and Development, Titusville, NJ, Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Joel Swerdel
- Janssen Research and Development, Titusville, NJ
| | - Kenar D Jhaveri
- Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Donald and Barbara School of Medicine at Hofstra/Northwell, NY
| | - Edward Lee
- Roski Eye Institute, Keck School of Medicine, University of Southern California; Los Angeles, CA
| | - Zachary Gilbert
- Roski Eye Institute, Keck School of Medicine, University of Southern California; Los Angeles, CA
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Marc A Suchard
- VA Informatics and Computing Infrastructure, US Department of Veterans Affairs, Salt Lake City, UT; and Department of Biostatistics, University of California Los Angeles, Los Angeles, CA
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Sarilita E, Rafisa A, Desai P, Mossey PA. Utilising massive open online courses to enhance global learning dissemination in cleft lip and palate: a case report of penta helix collaboration. BMC Med Educ 2024; 24:301. [PMID: 38500073 PMCID: PMC10949738 DOI: 10.1186/s12909-024-05225-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 02/24/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Educating and raising awareness in cleft lip and palate future generations is one vital effort to ensure the improvement of cleft care and research in the future. This study reported the overview in organising and evaluating the Massive Open Online Course (MOOC) in Cleft Lip and Palate as the alternative way for students' capacity building outside their study program whilst also earning credits towards their studies. METHODS Smile Train cleft charity generously donated recorded lectures from cleft experts around the world in which each of the experts agreed to provide one-hour live discussion sessions. The learning activities ranging from lectures, pre- and post-course evaluation, forum, live discussion sessions, virtual visits to Indonesian Cleft Centre, self-reflection assignments and final project. A survey was released to the participants to collect their feedback. RESULTS The course mainly attracted dental students, and several allied health professional students. In total, 414 out of 717 participants registered for this MOOC managed to finish the course and received a certificate of completion which was run between August-October 2021. In general, participants positively received the course. CONCLUSIONS The MOOC model and its objective of disseminating widespread information across geographical boundaries to enhance learning about cleft lip and palate treatment was achieved. This report serves as an example for other educational institutions and stakeholders who plan to use online educational engagement platforms to provide high-quality education and capacity building to participants in lower-middle income countries.
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Affiliation(s)
- Erli Sarilita
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Anggun Rafisa
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia.
| | - Priya Desai
- Research and Innovation, Smile Train, New York, USA
| | - Peter A Mossey
- Division of Oral Health Sciences and WHO Collaborating Centre for Oral Health & Craniofacial Anomalies, University of Dundee, Dundee, Scotland, UK
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Sarilita E, Rafisa A, Desai P, Mossey PA. Age at primary surgery among orofacial cleft individuals in Indonesia. Orthod Craniofac Res 2023. [PMID: 38149758 DOI: 10.1111/ocr.12751] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES To observe the age at primary cleft surgery among charity organizations such as Smile Train in helping Indonesia manage patients with OFC. MATERIALS AND METHODS A retrospective analysis of medical records was conducted to identify patients with orofacial clefts who underwent primary surgery between 2001 and 2021. The age at the time of surgery was recorded for each patient. Descriptive statistics were used to analyse the data and determine the average age at primary surgery. RESULTS In the period between 2001 and 2021, a total of 34 239 individuals in Indonesia underwent primary lip surgery, while 16 768 individuals received primary palatal surgery, as recorded in the Smile Train database. Notably, a significant proportion of these surgeries were classified as delayed primary repairs. Approximately 65.3% of primary lip surgeries were performed beyond the recommended timeline of 6 months of age, indicating a delay in the surgical intervention. Similarly, 67% of primary palatal surgeries were also delayed, occurring after the recommended timeline of 18 months of life. CONCLUSIONS This study provides insights into the age at primary surgery among individuals with orofacial clefts in Indonesia. The findings highlight the need for timely intervention and the importance of considering individualized treatment plans based on the specific type of orofacial cleft. Further research is warranted to explore factors influencing the age at primary surgery and their impact on treatment outcomes and long-term functional outcomes in this population.
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Affiliation(s)
- Erli Sarilita
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Anggun Rafisa
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Priya Desai
- Research and Innovation, Smile Train, New York, New York, USA
| | - Peter A Mossey
- Division of Oral Health Sciences and WHO Collaborating Centre for Oral Health & Craniofacial Anomalies, University of Dundee, Dundee, UK
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Desai P, Awatiger MM, Angadi PP. Geometrics Morphometrics in Craniofacial Skeletal Age Estimation - A Systematic Review. J Forensic Odontostomatol 2023; 41:57-64. [PMID: 37149754 PMCID: PMC10319097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Geometric morphometrics is a novel statistical shape based technique used as an additional approach to the currently used methods in forensics for the assessment of age. Various craniofacial units are used for the estimation of age using this technique. The aim of this systematic review was to assess if Geometric Morphometrics is an accurate and reliable method in craniofacial skeletal age estimation. A literature search was conducted for cross-sectional studies on geometric morphometrics in craniofacial skeletal age estimation using various search engines such as Pubmed, Google Scholar, and Scopus using specific MESH terms. AQUA (Anatomical Quality Assessment) tool was used for the quality assessment. A total of 4 articles were included for qualitative synthesis as they met the objectives of this review. The results of all the included studies suggested that geometric morphometrics can be used for craniofacial skeletal age estimation. The centroid size calculated using digitized images or CBCT scanned images is said to be the highest predictor of age.This systematic review summarises the merits and demerits of this technique and suggests that it is rapid and accurate method for age estimation even in instances of single skeletal remains of craniofacial units and can be performed on a digitized image or a CBCT scanned images. However, further studies are needed to derive reliable data and meta-analysis can be performed effectively.
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Affiliation(s)
- P Desai
- Department of Oral Pathology and Microbiology, KLE VK Institute of Dental Sciences and Hospital, Constituent Unit of KLE Academy of Higher Education and Research Belgaum. Karnataka - India
| | - M M Awatiger
- Department of Oral Pathology and Microbiology, KLE VK Institute of Dental Sciences and Hospital, Constituent Unit of KLE Academy of Higher Education and Research Belgaum. Karnataka - India
| | - P P Angadi
- Department of Oral Pathology and Microbiology, KLE VK Institute of Dental Sciences and Hospital, Constituent Unit of KLE Academy of Higher Education and Research Belgaum. Karnataka - India
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Kamst O, Desai P. Evaluation of HyperArc™ using film and portal dosimetry quality assurance. Phys Eng Sci Med 2023; 46:57-66. [PMID: 36454430 DOI: 10.1007/s13246-022-01197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2022]
Abstract
HyperArc™ is a stereotactic radiotherapy modality designed for targeting multiple brain metastases using a single isocenter with multiple non-coplanar arcs. This study aimed to assess the efficacy of two patient-specific quality assurance methods, film and the Varian Portal Dosimetry System with Varian's HyperArc™ technique and raise important considerations in the customisation of patient-specific quality assurance to accommodate HyperArc™ delivery. Assessment criteria included gamma analysis and mean dose at full width half maximum. The minimum metastasis size, maximum off-axis distance and suitable energy were identified and validated. Patient-specific quality assurance procedures were applied to a range of clinically relevant brain metastasis plans. Initial investigation into energy selection showed no significant differences in gamma pass rates using 6MV, 6MV FFF, or 10MV FFF for metastasis sizes greater than 15 mm diameter at the isocenter. Gamma pass rates (2%/2mm) for 15 mm metastases at the isocenter for all energies were greater than 96.0% for portal dosimetry and greater than 98.7% for film. Fields of size 15 mm placed at various distances (10-70 mm) from the isocenter resulted in a maximum mean dose difference of 1.5% between film and planned. Clinically relevant plans resulted in a maximum mean dose difference for selected metastases of 1.0% between film and plan and a maximum point dose difference of 2.9% between portal dose and plan. Portal dose image prediction was a quick and convenient quality assurance tool for metastases larger than 15 mm near the isocenter but provided diminished geometrical relevance for off-axis metastases. Film QA required exacting procedures but offered the ability to assess the accuracy of geometrical targeting for off-axis metastases and provided dosimetric accuracy for metastases to well below 15 mm diameter.
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Affiliation(s)
- Onno Kamst
- ICON Cancer Care, Gold Coast University Hospital, Southport, Australia.
| | - P Desai
- ICON Cancer Care, Gold Coast University Hospital, Southport, Australia
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Marhamati S, Qu L, Kangotra I, Desai P, Klein J, Bagla S, Singh I. Does prostate artery embolization prior to Aquablation® reduce peri-operative morbidity and increase the likelihood of same day discharge? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00076-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Lin CC, Kim T, Desai P, Lee K, Feng YH, Ngamphaiboon N, Kim SB, Yang MH, Muzaffar J, Chmielowski B, Swiecicki P, Bowyer S, Brahmer J, Chisamore M, Goyal R, Nasrah N, Ho W, Cho B. 187P Phase I/II study of the oral CCR4 antagonist, FLX475, as monotherapy and in combination with pembrolizumab in advanced cancer. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Chung Y, Carr T, Ambrose C, Lindsley A, Collacott H, Schulz A, Desai P, Rane P, Williams M. PATIENT AND CLINICIAN PREFERENCES WITH BIOLOGIC TREATMENTS FOR SEVERE ASTHMA: A DISCRETE CHOICE EXPERIMENT. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lu J, Sattler A, Wang S, Khaki AR, Callahan A, Fleming S, Fong R, Ehlert B, Li RC, Shieh L, Ramchandran K, Gensheimer MF, Chobot S, Pfohl S, Li S, Shum K, Parikh N, Desai P, Seevaratnam B, Hanson M, Smith M, Xu Y, Gokhale A, Lin S, Pfeffer MA, Teuteberg W, Shah NH. Considerations in the reliability and fairness audits of predictive models for advance care planning. Front Digit Health 2022; 4:943768. [PMID: 36339512 PMCID: PMC9634737 DOI: 10.3389/fdgth.2022.943768] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
Multiple reporting guidelines for artificial intelligence (AI) models in healthcare recommend that models be audited for reliability and fairness. However, there is a gap of operational guidance for performing reliability and fairness audits in practice. Following guideline recommendations, we conducted a reliability audit of two models based on model performance and calibration as well as a fairness audit based on summary statistics, subgroup performance and subgroup calibration. We assessed the Epic End-of-Life (EOL) Index model and an internally developed Stanford Hospital Medicine (HM) Advance Care Planning (ACP) model in 3 practice settings: Primary Care, Inpatient Oncology and Hospital Medicine, using clinicians' answers to the surprise question (“Would you be surprised if [patient X] passed away in [Y years]?”) as a surrogate outcome. For performance, the models had positive predictive value (PPV) at or above 0.76 in all settings. In Hospital Medicine and Inpatient Oncology, the Stanford HM ACP model had higher sensitivity (0.69, 0.89 respectively) than the EOL model (0.20, 0.27), and better calibration (O/E 1.5, 1.7) than the EOL model (O/E 2.5, 3.0). The Epic EOL model flagged fewer patients (11%, 21% respectively) than the Stanford HM ACP model (38%, 75%). There were no differences in performance and calibration by sex. Both models had lower sensitivity in Hispanic/Latino male patients with Race listed as “Other.” 10 clinicians were surveyed after a presentation summarizing the audit. 10/10 reported that summary statistics, overall performance, and subgroup performance would affect their decision to use the model to guide care; 9/10 said the same for overall and subgroup calibration. The most commonly identified barriers for routinely conducting such reliability and fairness audits were poor demographic data quality and lack of data access. This audit required 115 person-hours across 8–10 months. Our recommendations for performing reliability and fairness audits include verifying data validity, analyzing model performance on intersectional subgroups, and collecting clinician-patient linkages as necessary for label generation by clinicians. Those responsible for AI models should require such audits before model deployment and mediate between model auditors and impacted stakeholders.
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Affiliation(s)
- Jonathan Lu
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
- Correspondence: Jonathan Hsijing Lu
| | - Amelia Sattler
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Samantha Wang
- Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Ali Raza Khaki
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Alison Callahan
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Scott Fleming
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Rebecca Fong
- Serious Illness Care Program, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Benjamin Ehlert
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Ron C. Li
- Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Lisa Shieh
- Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Kavitha Ramchandran
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Michael F. Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, United States
| | - Sarah Chobot
- Inpatient Palliative Care, Stanford Health Care, Palo Alto, United States
| | - Stephen Pfohl
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Siyun Li
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Kenny Shum
- Technology / Digital Solutions, Stanford Health Care and Stanford University School of Medicine, Palo Alto, United States
| | - Nitin Parikh
- Technology / Digital Solutions, Stanford Health Care and Stanford University School of Medicine, Palo Alto, United States
| | - Priya Desai
- Technology / Digital Solutions, Stanford Health Care and Stanford University School of Medicine, Palo Alto, United States
| | - Briththa Seevaratnam
- Serious Illness Care Program, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Melanie Hanson
- Serious Illness Care Program, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Margaret Smith
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Yizhe Xu
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Arjun Gokhale
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Steven Lin
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Michael A. Pfeffer
- Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
- Technology / Digital Solutions, Stanford Health Care and Stanford University School of Medicine, Palo Alto, United States
| | - Winifred Teuteberg
- Serious Illness Care Program, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
| | - Nigam H. Shah
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, Palo Alto, United States
- Technology / Digital Solutions, Stanford Health Care and Stanford University School of Medicine, Palo Alto, United States
- Clinical Excellence Research Center, Stanford University School of Medicine, Palo Alto, United States
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McCabe C, Desai P, Nijm L, Osher R, Weinstock R. Real-World Experience with Intracapsular Administration of Dexamethasone Intraocular Suspension 9% for Control of Postoperative Inflammation. Clin Ophthalmol 2022; 16:1985-1992. [PMID: 35757021 PMCID: PMC9231534 DOI: 10.2147/opth.s361146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022] Open
Abstract
Corticosteroids and non-steroidal anti-inflammatory drugs are commonly used prophylactically to control inflammation after ocular surgery. When prescribed as eye drops, as has been longstanding tradition, anti-inflammatory success is out of surgeons’ hands, dependent on patient compliance and proper instillation technique. Sustained-release, intraoperatively administered anti-inflammatory drugs are emerging as another option. DEXYCU (dexamethasone intraocular suspension) 9% is the first and only intraocular corticosteroid FDA-approved for postoperative inflammation, whose sustained-release formulation provides a high initial release of drug, followed by a gradual tapering. Administration of the drug directly into the capsular bag following cataract surgery enables reliable placement proximal to target tissues, ensuring surgeon control and visibility of delivery, safety, and efficiency. This technique also minimizes contact with metabolically active tissues such as the corneal endothelium, iris, and ciliary body. In this paper, we review the available literature on dexamethasone intraocular suspension and summarize surgeons’ consensus on best practices for intracapsular administration.
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Affiliation(s)
- Cathleen McCabe
- The Eye Associates; Eye Health America, Sarasota Memorial Hospital, Sarasota, FL, USA
- Correspondence: Cathleen McCabe, The Eye Associates; Eye Health America, Sarasota Memorial Hospital, Sarasota, FL, USA, Tel +1 941 792-2020, Email
| | - Priya Desai
- Matossian Eye Associates, Pennington, NJ, USA
| | - Lisa Nijm
- Warrenville Eye Care and LASIK Center, Northwestern Medicine, Warrenville, IL, USA
| | - Robert Osher
- Cincinnati Eye Institute, University of Cincinnati, Cincinnati, OH, USA
| | - Robert Weinstock
- The Eye Institute of West Florida, Weinstock Laser Eye Center, Largo, FL, USA
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Kuang W, Desai P, Voloshko A, Jayasekara D. COVID-19-Associated Miller Fisher Syndrome With Long Latency Period: A Case Report. Cureus 2022; 14:e24638. [PMID: 35663687 PMCID: PMC9156344 DOI: 10.7759/cureus.24638] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 11/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has been known to affect multiple organ systems, aside from the respiratory system. Increasing reports of post-infection neurological complications have been reported. Miller-Fisher syndrome, a rare variant of Guillain-Barré syndrome (GBS), has been reported after COVID-19 infection. We present the youngest known adult (26-year-old male) reported to have had COVID-19-associated Miller Fisher syndrome (MFS) with also the longest reported latency period (10 weeks) between infection and development of neurological symptoms (including dysphagia, horizontal diplopia, facial weakness, upper and lower extremity weakness, paresthesia). This is currently the second youngest reported case after the case of a seven-year-old child. The patient was treated with intravenous immunoglobulin and was ultimately transferred to a different facility for higher level of care. Most symptoms were resolved within four days. The patient reported resolution of neurologic symptoms with the exception of left-sided facial weakness at the one-year follow-up. As more reports of COVID-19-associated GBS and MFS appear in the future, we are likely to discover more variability than was previously known in GBS and MFS. With COVID-19 potentially affecting multiple systems, there could be increased variability to previously known conditions. Future studies may need to closely examine long-term follow-ups of patients previously diagnosed with COVID-19 as post-COVID complications become more prevalent.
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Affiliation(s)
- Wayne Kuang
- Pediatrics, Los Angeles County+University of Southern California Medical Center, Los Angeles, USA
- Internal Medicine, Western University of Health Sciences, Pomona, USA
| | - Priya Desai
- Internal Medicine, Scripps Mercy Hospital, San Diego, USA
- Internal Medicine, Western University of Health Sciences, Pomona, USA
| | - Alexander Voloshko
- Internal Medicine, Santa Barbara Cottage Hospital, Santa Barbara, USA
- Internal Medicine, Western University of Health Sciences, Pomona, USA
| | - Deepthi Jayasekara
- Infectious Disease, Emanate Health Queen of the Valley Hospital, West Covina, USA
- Internal Medicine, Western University of Health Sciences, Pomona, USA
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Chalakh S, Desai P. Assessment of PAM (Pesticide Awareness Module) as Community Teaching Tool. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i60b35096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: The ability of students to understand and support the needs of the community is at the heart of community-based education. Because India is a developing country with a large proportion of the population living in villages, the medical education system must guarantee that learners who serve as health care providers acquire the necessary skills and venture out into the community as needed. In today’s scenario pesticide poisoning in farmer's communities is an issue of high concern with this aim PAM (pesticide awareness module) is designed and is assessed as a community teaching tool. The pesticide Awareness module (PAM) was prepared as per the need of the community. The pretest of the student was conducted. Module was implemented by the student in the community with Flex, Charts, and Video. After implementation of the module post-test of students was conducted after one month. With the help of a Checklist, students were assessed for community teaching. Students’ perception of community teaching was obtained using a feedback questionnaire. The average Pre-test score was 23.35% and in Post-test it was increased to 86.85%. This indicates students gain desired level of knowledge for a longer period & Students also get benefitted by acquiring self-confidence, behavioral and attitudinal skill. The intervention of PAM as a community teaching tool was highly effective for the student in gaining knowledge & different skills.
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Sanyaolu A, Dzando G, Okorie C, Jaferi U, Marinkovic A, Prakash S, Patidar R, Desai P, Younis K. Anemia prevalence in mothers with children under five years of age in Dodi Papase, Volta region of Ghana and preventive practices. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Sociodemographic factors influence the prevalence of anemia in endemic areas. The purpose of this study is to establish the prevalence and causes of anemia and to determine anemia preventive practices carried out by mothers with children under five years of age in the Kadjebi District of the Volta region of Ghana.
Methods/Case Report
This homogenous sampling study involved women of reproductive age with children less than five years of age from Saint Mary Theresa Hospital. Interview guides were administered, and the data collected were analyzed using the Statistical Package for Social Sciences (SPSS) version 21.
Results (if a Case Study enter NA)
A total of 150 participants were studied. 52.7% of the mothers indicated that their children had never been diagnosed with anemia; however, Hb levels recorded for these children showed that 73.3% were anemic, even though 93.8% of the mothers had been given iron supplements during their pregnancy. Furthermore, anemia prevention practices comprised of whether the child had been given any anti-malaria prophylaxis (98.4% denied / 1.6% confirmed) if the child had been dewormed in the last three months (89.9% denied / 10.1% confirmed), whether the child was given iron supplements in the last three months (59.7% denied / 40.3% confirmed), if the child had been given vitamin supplements in the last three months (24.0% denied / 76.0% confirmed).
Conclusion
Nutritional deficiencies, worm infestation, and malaria were identified as the major causes of anemia among the children. Mothers were educated about the possible causes and prevention methods of anemia.
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Affiliation(s)
- A Sanyaolu
- Communicable Diseases, AMOOF Healthcare Consulting, Calgary, Alberta, CANADA
| | - G Dzando
- University of Cape Coast, Cape Coast, GHANA
| | - C Okorie
- Union County College, Plainfield Campus, New Jersey, UNITED STATES
| | - U Jaferi
- All Saints University School of Medicine, Roseau, DOMINICA
| | - A Marinkovic
- Saint James School of Medicine, The Quarter, ANGUILLA
| | - S Prakash
- Saint James School of Medicine, The Quarter, ANGUILLA
| | - R Patidar
- Saint James School of Medicine, The Quarter, ANGUILLA
| | - P Desai
- American University of Saint Vincent School of Medicine, Leeward Hwy, SAINT VINCENT AND THE GRENADINES
| | - K Younis
- Mount Royal University, Calgary, Alberta, CANADA
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Krez A, Lane J, Heilbronner A, Park-Min KH, Kaneko K, Pannellini T, Mintz D, Hansen D, McMahon DJ, Kirou KA, Roboz G, Desai P, Bockman RS, Stein EM. Risk factors for multi-joint disease in patients with glucocorticoid-induced osteonecrosis. Osteoporos Int 2021; 32:2095-2103. [PMID: 33877383 PMCID: PMC8056829 DOI: 10.1007/s00198-021-05947-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/01/2021] [Indexed: 12/24/2022]
Abstract
UNLABELLED This study investigated risk factors for osteonecrosis involving multiple joints (MJON) among glucocorticoid-treated patients. The best predictor of MJON was cumulative oral glucocorticoid dose. Risk of MJON was 12-fold higher in patients who had a second risk factor for osteonecrosis. Further research is needed into strategies for prevention of MJON. INTRODUCTION Osteonecrosis (ON) is a debilitating musculoskeletal condition in which bone cell death can lead to mechanical failure. When multiple joints are affected, pain and disability are compounded. Glucocorticoid treatment is one of the most common predisposing factors for ON. This study investigated risk factors for ON involving multiple joints (MJON) among glucocorticoid-treated patients. METHODS Fifty-five adults with glucocorticoid-induced ON were prospectively enrolled. MJON was defined as ON in ≥ three joints. Route, dose, duration, and timing of glucocorticoid treatment were assessed. RESULTS Mean age of enrolled subjects was 44 years, 58% were women. Half had underlying conditions associated with increased ON risk: systemic lupus erythematosus (29%), acute lymphoblastic leukemia (11%), HIV (9%), and alcohol use (4%). Mean daily oral dose of glucocorticoids was 29 mg. Average cumulative oral dose was 30 g over 5 years. The best predictor of MJON was cumulative oral glucocorticoid dose. For each increase of 1,000 mg, risk of MJON increased by 3.2% (95% CI 1.03, 1.67). Glucocorticoid exposure in the first 6 months of therapy, peak dose (oral or IV), and mean daily dose did not independently increase risk of MJON. The risk of MJON was 12-fold in patients who had a second risk factor (95% CI 3.2, 44.4). CONCLUSIONS Among patients with glucocorticoid-induced ON, cumulative oral dose was the best predictor of multi-joint disease; initial doses of IV and oral glucocorticoids did not independently increase risk. Further research is needed to better define optimal strategies for prevention and treatment of MJON.
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Affiliation(s)
- A Krez
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - J Lane
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - A Heilbronner
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - K-H Park-Min
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomic Research Center, Hospital for Special Surgery, New York, NY, USA
| | - K Kaneko
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomic Research Center, Hospital for Special Surgery, New York, NY, USA
| | - T Pannellini
- Research Division, Hospital for Special Surgery, New York, NY, USA
| | - D Mintz
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - D Hansen
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - D J McMahon
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - K A Kirou
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - G Roboz
- Department of Hematology and Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - P Desai
- Department of Hematology and Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - R S Bockman
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - E M Stein
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA.
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Rosenberg J, Jacob J, Desai P, Park J, Donovan L, Kim JY. Incretin Hormones: Pathophysiological Risk Factors and Potential Targets for Type 2 Diabetes. J Obes Metab Syndr 2021; 30:233-247. [PMID: 34521773 PMCID: PMC8526293 DOI: 10.7570/jomes21053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes (T2D) is a multifaceted metabolic disorder associated with distinctive pathophysiological disturbances. One of the pathophysiological risk factors observed in T2D is dysregulation of the incretin hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). Both hormones stimulate insulin secretion by acting postprandially on pancreatic β-cell receptors. Oral glucose administration stimulates increased insulin secretion in comparison with isoglycemic intravenous glucose administration, a phenomenon known as the incretin effect. While the evidence for incretin defects in individuals with T2D is growing, the etiology behind this attenuated incretin effect in T2D is not clearly understood. Given their central role in T2D pathophysiology, incretins are promising targets for T2D therapeutics. The present review synthesizes the recent attempts to explain the biological importance of incretin hormones and explore potential pharmacological approaches that target the incretins.
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Affiliation(s)
- Jared Rosenberg
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Jordan Jacob
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Priya Desai
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Jeremy Park
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Lorin Donovan
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Joon Young Kim
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
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Chalakh S, Desai P, Rajput D. Impact of Pesticide Awareness module (PAM) in Improving the knowledge of Farmers Community about Pesticide Poisoning: A Pre- and Post- Intervention Study in Wardha District in Maharashtra, India. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i38b32111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background:Pesticide poisoning is a major concern in developing countries like India due to a lack of knowledge about its hazardous effect. It can be minimised by creating awareness among the farmers .This study was conducted to assess the impact of pesticide awareness module in improving the awareness among the farmers' community about pesticide poisoning.
Methodology: This was a pre and Post-intervention study in six villages in the Wardha district in Maharashtra. Forty farmers from six villages were interviewed regarding the knowledge, about pesticide poisoning before and after the sensitization with pesticide awareness module with the predesigned questionnaire.
Result: Statistically high significant difference is detected in pre and post-test. It was found that average Pre-test score was 1.84 (out of 10) which was increased in post-test score to 6.52(out of 10). The observed change was 46.79%.
Conclusion: The intervention of PAM was highly effective in knowledge gaining of farmer community
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Chirenda J, Nhlema Simwaka B, Sandy C, Bodnar K, Corbin S, Desai P, Mapako T, Shamu S, Timire C, Antonio E, Makone A, Birikorang A, Mapuranga T, Ngwenya M, Masunda T, Dube M, Wandwalo E, Morrison L, Kaplan R. A feasibility study using time-driven activity-based costing as a management tool for provider cost estimation: lessons from the national TB control program in Zimbabwe in 2018. BMC Health Serv Res 2021; 21:242. [PMID: 33736629 PMCID: PMC7977596 DOI: 10.1186/s12913-021-06212-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Insufficient cost data and limited capacity constrains the understanding of the actual resources required for effective TB control. This study used process maps and time-driven activity-based costing to document TB service delivery processes. The analysis identified the resources required to sustain TB services in Zimbabwe, as well as several opportunities for more effective and efficient use of available resources. Methods A multi-disciplinary team applied time-driven activity-based costing (TDABC) to develop process maps and measure the cost of clinical pathways used for Drug Susceptible TB (DS-TB) at urban polyclinics, rural district and provincial hospitals, and community based targeted screening for TB (Tas4TB). The team performed interviews and observations to collect data on the time taken by health care worker-patient pairs at every stage of the treatment pathway. The personnel’s practical capacity and capacity cost rates were calculated on five cost domains. An MS Excel model calculated diagnostic and treatment costs. Findings Twenty-five stages were identified in the TB care pathway across all health facilities except for community targeted screening for TB. Considerable variations were observed among the facilities in how health care professionals performed client registration, taking of vital signs, treatment follow-up, dispensing medicines and processing samples. The average cost per patient for the entire DS-TB care was USD324 with diagnosis costing USD69 and treatment costing USD255. The average cost for diagnosis and treatment was higher in clinics than in hospitals (USD392 versus USD256). Nurses in clinics were 1.6 time more expensive than in hospitals. The main cost components were personnel (USD130) and laboratory (USD119). Diagnostic cost in Tas4TB was twice that of health facility setting (USD153 vs USD69), with major cost drivers being demand creation (USD89) and sputum specimen transportation (USD5 vs USD3). Conclusion TDABC is a feasible and effective costing and management tool in low-resource settings. The TDABC process maps and treatment costs revealed several opportunities for innovative improvements in the NTP under public health programme settings. Re-engineering laboratory testing processes and synchronising TB treatment follow-up with antiretroviral treatments could produce better and more uniform TB treatments at significantly lower cost in Zimbabwe.
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Affiliation(s)
- J Chirenda
- College of Health Sciences, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - B Nhlema Simwaka
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland.
| | - C Sandy
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - K Bodnar
- Harvard Business School, Boston, MA, USA
| | - S Corbin
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - P Desai
- Harvard Business School, Boston, MA, USA
| | - T Mapako
- College of Health Sciences, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.,National Blood Service, Harare, Zimbabwe
| | - S Shamu
- College of Health Sciences, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - C Timire
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - E Antonio
- Price Waterhouse Coopers (PWC), Harare, Zimbabwe
| | - A Makone
- Price Waterhouse Coopers (PWC), Harare, Zimbabwe
| | - A Birikorang
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - T Mapuranga
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - M Ngwenya
- World Health Organisation, Harare, Zimbabwe
| | - T Masunda
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - M Dube
- Ministry of Health and Child Care, National TB Control Program, Harare, Zimbabwe
| | - E Wandwalo
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - L Morrison
- The Global Fund to Fight TB, HIV and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - R Kaplan
- Harvard Business School, Boston, MA, USA
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18
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Maheshwari R, Qadri SY, Rakhul LR, Chaturvedi S, Desai P, Grover R, Chhabra G, Khullar D, Kumar A. Prospective Nonrandomized Comparison Between Open and Robot-Assisted Kidney Transplantation: Analysis of Midterm Functional Outcomes. J Endourol 2020; 34:939-945. [PMID: 32600060 DOI: 10.1089/end.2020.0213] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction: To compare short- and midterm outcomes of the first 55 patients undergoing robot-assisted kidney transplant (RAKT) with patients undergoing open kidney transplant (OKT) during the same period in a tertiary care hospital. Materials and Methods: Data of all end-stage renal disease patients undergoing renal transplant were prospectively maintained. All graft kidneys were harvested laparoscopically. Both RAKT and OKT were performed using standardized techniques, and all RAKTs were performed by a single experienced robotic surgeon. Chi-square test/Fisher exact test was done for categorical data, and Mann-Whitney U test was done for continuous data. Discrete variables were expressed in absolute numbers and percentages. For all tests, p < 0.05 was considered significant. All results were expressed as mean ± standard deviation or median with range. Results: Between April 2016 and September 2018, 55 patients underwent RAKT. The same was compared with 152 patients who underwent OKT. The two groups were comparable in terms of age, gender, and body mass index. Duration on hemodialysis was significantly higher in the RAKT group, and hemoglobin and donor kidney glomerular filtration rate was significantly better in the RAKT group. Requirement of perioperative analgesia was significantly less in the RAKT group. Rewarm ischemia time was significantly longer in the RAKT group. The fall in serum creatinine was slower in RAKT group till 3 months. The serum creatinine levels were statistically similar in the two cohorts at 3 months (p = 0.082), which was maintained at median 29 months of follow-up (p = 0.067). Tacrolimus levels on postoperative day 2 were found to be significantly higher in RAKT cohort (17.98 ± 14.41) vs OKT cohort (11.38 ± 6.93). Surgical-site infections were rare in the RAKT group. Conclusions: RAKT confers advantage of decreased wound morbidity with similar functional outcomes compared with OKT in midterm. It looks promising; however, long-term follow-up of larger numbers of patients is needed.
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Affiliation(s)
- R Maheshwari
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - S Y Qadri
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - L R Rakhul
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - S Chaturvedi
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - P Desai
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - R Grover
- Department of Nephrology and Transplant Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - G Chhabra
- Department of Nephrology and Transplant Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - D Khullar
- Department of Nephrology and Transplant Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - A Kumar
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
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Spencer ET, Richards E, Steinwand B, Clemons J, Dahringer J, Desai P, Fisher M, Fussell S, Gorman O, Jones D, Le A, Long K, McMahan C, Moscarito C, Pelay C, Price E, Smith A, VanSant A, Bruno JF. A high proportion of red snapper sold in North Carolina is mislabeled. PeerJ 2020; 8:e9218. [PMID: 32617188 PMCID: PMC7321663 DOI: 10.7717/peerj.9218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/28/2020] [Indexed: 11/20/2022] Open
Abstract
Seafood mislabeling occurs when a market label is inaccurate, primarily in terms of species identity, but also regarding weight, geographic origin, or other characteristics. This widespread problem allows cheaper or illegally-caught species to be marketed as species desirable to consumers. Previous studies have identified red snapper (Lutjanus campechanus) as one of the most frequently mislabeled seafood species in the United States. To quantify how common mislabeling of red snapper is across North Carolina, the Seafood Forensics class at the University of North Carolina at Chapel Hill used DNA barcoding to analyze samples sold as "red snapper" from restaurants, seafood markets, and grocery stores purchased in ten counties. Of 43 samples successfully sequenced and identified, 90.7% were mislabeled. Only one grocery store chain (of four chains tested) accurately labeled red snapper. The mislabeling rate for restaurants and seafood markets was 100%. Vermilion snapper (Rhomboplites aurorubens) and tilapia (Oreochromis aureus and O. niloticus) were the species most frequently substituted for red snapper (13 of 39 mislabeled samples for both taxa, or 26 of 39 mislabeled total). This study builds on previous mislabeling research by collecting samples of a specific species in a confined geographic region, allowing local vendors and policy makers to better understand the scope of red snapper mislabeling in North Carolina. This methodology is also a model for other academic institutions to engage undergraduate researchers in mislabeling data collection, sample processing, and analysis.
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Affiliation(s)
- Erin T Spencer
- Environment, Ecology, and Energy Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Emilie Richards
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Blaire Steinwand
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Juliette Clemons
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jessica Dahringer
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Priya Desai
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Morgan Fisher
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Sloane Fussell
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Olivia Gorman
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Diamond Jones
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Amanda Le
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Kayla Long
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Cammie McMahan
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Caitlin Moscarito
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Catherine Pelay
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Erica Price
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Anna Smith
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Allison VanSant
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - John F Bruno
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Maheshwari R, Chaturvedi S, Desai P, Panwar P, Singh V, Bansal D, Bansal A, Kumar A. Comparison of outcomes between open and robot assisted kidney transplant in paediatric population - initial results. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33668-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Cleft lip and/or palate (CLP) is a common congenital anomaly with a global impact. One organization attempting to decrease global burden of CLPs is Smile Train. Since 1999, Smile Train has empowered local medical providers to provide comprehensive and sustainable cleft care. Partner surgeons have performed more than 1.5 million operations for patients with CLPs in more than 90 countries. This article outlines the history and mission of Smile Train and details the organization's efforts to increase hospital-wide safety, provide education and training opportunities for partners, and use technology to improve the delivery of cleft care on a global scale.
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Affiliation(s)
- Angela S Volk
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Street, Suite 610.00, Houston, TX 77030, USA
| | - Matthew J Davis
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Street, Suite 610.00, Houston, TX 77030, USA
| | - Priya Desai
- Smile Train, 633 Third Avenue 9th Floor, New York, NY 10017, USA
| | - Larry H Hollier
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Street, Suite 610.00, Houston, TX 77030, USA.
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22
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Desai P, Donovan L, Janowitz E, Kim JY. The Clinical Utility of Salivary Biomarkers in the Identification of Type 2 Diabetes Risk and Metabolic Syndrome. Diabetes Metab Syndr Obes 2020; 13:3587-3599. [PMID: 33116710 PMCID: PMC7553598 DOI: 10.2147/dmso.s265879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022] Open
Abstract
Type 2 diabetes is traditionally diagnosed by the use of an oral glucose tolerance test and/or HbA1c, both of which require serum collection. Various biomarkers, which are measurable biological substances that provide clinical insight on disease state, have also been effective in the early identification and risk prediction of inflammatory diseases. Measuring biomarker concentrations has traditionally been obtained through serum collection as well. However, numerous biomarkers are detectable in saliva. Salivary analysis has more recently been introduced into research as a potential non-invasive, cost-effective diagnostic for the early identification of type 2 diabetes risk in adults and youth. Therefore, the purpose of this review was to compare 6 established inflammatory biomarkers of type 2 diabetes, in serum and saliva, and determine if similar diagnostic effectiveness is seen in saliva. A lack of standardized salivary analysis, processing, and collection accounts for errors and inconsistencies in conclusive data amongst studies. Proposing a national standardization in salivary analysis, coupled with increased data and research on the utility of saliva as a diagnostic, poses the potential for salivary analysis to be used in diagnostic settings.
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Affiliation(s)
- Priya Desai
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
| | - Lorin Donovan
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
| | | | - Joon Young Kim
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
- Correspondence: Joon Young KimDepartment of Exercise Science, Syracuse University, Women’s Building 204E, 820 Comstock Ave, Syracuse, NY13244, USATel +1 315-443-1411Fax +1 315-443-9375 Email
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Kazmi SH, Caprio M, Boolchandani H, Mally P, Bailey S, Desai P. The value of routine laboratory screening in the neonatal intensive care unit. J Neonatal Perinatal Med 2020; 13:247-251. [PMID: 31796688 DOI: 10.3233/npm-190239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Healthcare spending is expected to grow faster than the economy over the next decade, and the cost of prematurity increases annually. The aim of this study was to investigate the frequency of intervention after routine laboratory testing in preterm infants. METHODS This was a retrospective study of preterm infants (≤34 weeks) admitted to the NYU Langone Health NICU from June 2013 to December 2014. Data collected included demographics, results of laboratory tests, and resulting interventions. Intervention after a hemogram was defined as a blood transfusion. Intervention after a hepatic panel was defined as initiation or termination of ursodiol or change in dose of vitamin D. Subjects were stratified into 3 groups based on gestation (<28 weeks, 28-31 6/7 weeks, 32-34 weeks). Chi-square analysis was used to compare the frequency of intervention between the groups. RESULTS A total of 135 subjects were included in the study. The frequency of intervention after a hemogram was 8.4% in infants <28 weeks, 4.6% in infants 28-31 6/7 weeks, and 0% in infants 32-34 weeks; this difference was found to be statistically significant (p = 0.02). The frequency of intervention after a hepatic panel was 4.2% in infants <28 weeks, 5.7% in infants 28-31 6/7 weeks, and 0% in infants 32-34 weeks, which was not found to be a statistically significant different. CONCLUSION No interventions were undertaken post-routine laboratory testing in any infant 32-34 weeks and routine testing in this population may be unnecessary. Further studies are needed to elucidate if routine testing affects neonatal outcomes.
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MESH Headings
- Alkaline Phosphatase/blood
- Anemia/blood
- Anemia/diagnosis
- Anemia/therapy
- Bilirubin/blood
- Bone Density Conservation Agents/administration & dosage
- Bone Diseases, Metabolic/blood
- Bone Diseases, Metabolic/diagnosis
- Bone Diseases, Metabolic/drug therapy
- Cholagogues and Choleretics/therapeutic use
- Cholestasis/blood
- Cholestasis/diagnosis
- Cholestasis/drug therapy
- Cholestasis/etiology
- Diagnostic Tests, Routine/economics
- Diagnostic Tests, Routine/methods
- Erythrocyte Transfusion/statistics & numerical data
- Female
- Gestational Age
- Health Care Costs
- Health Expenditures
- Hematocrit/economics
- Hematocrit/methods
- Humans
- Infant, Extremely Premature
- Infant, Newborn
- Infant, Premature
- Intensive Care Units, Neonatal
- Liver Function Tests/economics
- Liver Function Tests/methods
- Male
- Mass Screening/economics
- Mass Screening/methods
- Parenteral Nutrition, Total/adverse effects
- Patient Selection
- Retrospective Studies
- Ursodeoxycholic Acid/therapeutic use
- Vitamin D/administration & dosage
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Affiliation(s)
- S H Kazmi
- Department of Pediatrics, Division of Neonatology, New York University School of Medicine, NY, USA
| | - M Caprio
- Department of Pediatrics, Division of Neonatology, New York University School of Medicine, NY, USA
| | - H Boolchandani
- Department of Pediatrics, Division of Neonatology, New York University School of Medicine, NY, USA
| | - P Mally
- Department of Pediatrics, Division of Neonatology, New York University School of Medicine, NY, USA
| | - S Bailey
- Department of Pediatrics, Division of Neonatology, New York University School of Medicine, NY, USA
| | - P Desai
- Department of Pediatrics, Division of Neonatology, New York University School of Medicine, NY, USA
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Goyal P, Andrade C, Kataria L, Desai P. Transcranial Direct Current Stimulation For Severe, Persistent, Treatment-Refractory Auditory Hallucinations In Schizophrenia. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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25
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Khashab M, Masckauchan M, Familiari P, Draganov P, Dakour Aridi H, Cho J, Ujiki M, Rio Tinto R, Louis H, Desai P, Velanovich V, Albéniz E, Haji A, Marks J, Costamagna G, Devière J, Perbtani Y, Hedberg M, Estremera F, Martin Del Campo L, Yang D, Bukhari M, Brewer O, Sanaei O, Fayad L, Agarwal A, Kumbhari V, Chen Y. A4 PERORAL ENDOSCOPIC MYOTOMY IS EFFECTIVE AND SAFE IN NON-ACHALASIA ESOPHAGEAL MOTILITY DISORDERS: AN INTERNATIONAL MULTICENTER STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.004] [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: 11/13/2022] Open
Affiliation(s)
- M Khashab
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - P Familiari
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - J Cho
- CHA Bundang Medical Center, Seongnam, Korea (the Republic of)
| | - M Ujiki
- NorthShore University Health System, Evanston, IL
| | - R Rio Tinto
- Erasme University Hospital, Bruxelles, Belgium
| | - H Louis
- Erasme University Hospital, Bruxelles, Belgium
| | - P Desai
- Surat Institute of Digestive Sciences, Surat, India
| | - V Velanovich
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - E Albéniz
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - A Haji
- Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - J Marks
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - G Costamagna
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - J Devière
- Erasme University Hospital, Bruxelles, Belgium
| | | | - M Hedberg
- NorthShore University Health System, Evanston, IL
| | - F Estremera
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - D Yang
- University of Florida, Gainesville, FL
| | - M Bukhari
- Johns Hopkins Medical Institutions, Baltimore, MD
| | - O Brewer
- Johns Hopkins Medical Institutions, Baltimore, MD
| | - O Sanaei
- Johns Hopkins Medical Institutions, Baltimore, MD
| | - L Fayad
- Johns Hopkins Medical Institutions, Baltimore, MD
| | - A Agarwal
- Johns Hopkins Medical Institutions, Baltimore, MD
| | - V Kumbhari
- Johns Hopkins Medical Institutions, Baltimore, MD
| | - Y Chen
- McGill University, Montreal, QC, Canada
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Munster PN, Park J, Desai P, Garcia E, Cheng S, Greier S, Pawlowska N, Chaudhuri AR, Thomas S. Abstract P5-14-04: A novel implant to deliver localized hormonal therapy to prevent and treat breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-14-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Most cancer treatment and prevention strategies include removal of the respective organ or systemic therapy. Early interception and cancer prevention is fraught with uncertainties in individual risk assessment and the absence of early surrogate markers to monitor efficacy. Hence, cancer prevention studies typically require large patient numbers. They are performed in unselected populations without clearly defined risk and benefits are often small or diluted. Hence, even successful strategies with documented benefit such as tamoxifen, have found only poor uptake in the at-risk population. Many women and providers are deterred by the low benefits to risk ratio of systemic tamoxifen exposure. The opportunity to selectively treat with an effective agent would limit the need for surgery and circumvent systemic exposure.
We propose a less toxic and less debilitating approach to prevent and treat early stage breast cancer by utilizing the slow release of anti-estrogens from silastic tubing as a local drug delivery device to the breast. Our in vitro and in vivo data demonstrate consistent release of active fulvestrant through at least 52 weeks. Extrapolating from the amount of residual drug left in the tubing after 52 weeks suggests that drug release could be maintained sufficiently to and beyond 5 years. Silastic tubing released fulvestrant at clinically relevant concentrations and associated with inhibition of ER signaling and cell proliferation in vitro. In vivo anti-tumor activity was comparable to systemic administration of the anti-estrogen. The silastic tubing preferentially delivered the anti-estrogen to mammary tissue with minimal accumulation in major organs and 20-fold lower concentrations in adjacent (abdominal) and distant fat (thoracic) pads. Consistent with fulvestrant penetrance through tumors, local delivery was more effective in reducing Ki-67 immediately adjacent to the tubing but maintained concentrations comparable to systemic therapy throughout the entire tumors. We further demonstrated that human fat cells readily take up fulvestrant and then transfer the drug to breast cancer cells. These findings support the use of local drug delivery through the human breast tissue and surrounding fatty tissue. Mammary tissues are rapidly cleared of fulvestrant upon removal of the drug-loaded tubing. This would allow the long term implantation of a drug delivery device designed to be emptied or refilled.
Local drug delivery is ideally suited in a setting of local disease or recurrence with minimal risk for systemic metastases with the goal of producing high concentrations without systemic application of the drug. Our data support the concept of a local silastic tubing device as a means to locally deliver an anti-estrogen in three major applications: early interventions for localized tumors, such as ductal carcinoma in situ (DCIS) or early stage breast cancer with low metastatic potential, prevention of breast cancer in women at higher risk due genetic predisposition, or used in concert with systemic therapy to provide a localized therapeutic boost. Overall, the use of implantable silastic tubing for local drug delivery represents a promising approach and introduces a potential paradigm shift in prevention and treatment of breast cancer.
Citation Format: Munster PN, Park J, Desai P, Garcia E, Cheng S, Greier S, Pawlowska N, Chaudhuri AR, Thomas S. A novel implant to deliver localized hormonal therapy to prevent and treat breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-14-04.
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Affiliation(s)
- PN Munster
- University of California, San Francisco, CA; University of California, Berkeley, CA
| | - J Park
- University of California, San Francisco, CA; University of California, Berkeley, CA
| | - P Desai
- University of California, San Francisco, CA; University of California, Berkeley, CA
| | - E Garcia
- University of California, San Francisco, CA; University of California, Berkeley, CA
| | - S Cheng
- University of California, San Francisco, CA; University of California, Berkeley, CA
| | - S Greier
- University of California, San Francisco, CA; University of California, Berkeley, CA
| | - N Pawlowska
- University of California, San Francisco, CA; University of California, Berkeley, CA
| | - AR Chaudhuri
- University of California, San Francisco, CA; University of California, Berkeley, CA
| | - S Thomas
- University of California, San Francisco, CA; University of California, Berkeley, CA
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Sam C, Desai P, Laber D, Patel A, Visweshwar N, Jaglal M. Pegylated bovine carboxyhaemoglobin utilisation in a thrombotic thrombocytopenic purpura patient. Transfus Med 2017; 27:300-302. [DOI: 10.1111/tme.12407] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 12/14/2022]
Affiliation(s)
- C. Sam
- Department of Hematology; University of South Florida Morsani College of Medicine; Tampa Florida USA
| | - P. Desai
- Department of Hematology; University of South Florida Morsani College of Medicine; Tampa Florida USA
| | - D. Laber
- Department of Hematology; University of South Florida Morsani College of Medicine; Tampa Florida USA
- Department of Hematology & Oncology; Moffitt Cancer Center; Tampa Florida USA
| | - A. Patel
- Department of Hematology; University of South Florida Morsani College of Medicine; Tampa Florida USA
- Department of Hematology & Oncology; Moffitt Cancer Center; Tampa Florida USA
| | - N. Visweshwar
- Department of Hematology; University of South Florida Morsani College of Medicine; Tampa Florida USA
| | - M. Jaglal
- Department of Hematology; University of South Florida Morsani College of Medicine; Tampa Florida USA
- Department of Hematology & Oncology; Moffitt Cancer Center; Tampa Florida USA
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Desai P, Yagnik B, Sharma D, Khan A, Desai N, Padh H. Transfecting CHO-K1 Cells: Comparison of CaPO4, Electroporation and Lipoplex Method with In-house Prepared Polyplex. Indian J Pharm Sci 2017. [DOI: 10.4172/pharmaceutical-sciences.1000276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Yagnik B, Sharma D, Padh H, Desai P. Immunization with r-Lactococcus lactis expressing outer membrane protein A of Shigella dysenteriae type-1: evaluation of oral and intranasal route of administration. J Appl Microbiol 2016; 122:493-505. [PMID: 27860045 DOI: 10.1111/jam.13353] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/24/2016] [Accepted: 11/11/2016] [Indexed: 02/07/2023]
Abstract
AIMS To evaluate the comparative immunogenic potential of food grade Lactococcus lactis expressing outer membrane protein A (OmpA) of Shigella dysenteriae type-1 (SD-1) when administered either orally or intranasally. METHODS AND RESULTS OmpA of SD-1 was cloned and expressed first in Escherichia coli and then in L. lactis. Presence of recombinant gene was confirmed by restriction enzyme digestion and immunoblot analysis. Using immobilized metal affinity chromatography, OmpA was purified from recombinant E. coliBL21 (DE3) and subcutaneously administered in BALB/c mice. Detection of OmpA-specific IgG antibodies by enzyme-linked immunosorbent assay (ELISA) confirmed the immunogenicity of OmpA. In order to establish r-L. lactis as a mucosal delivery vehicle, it was administered orally and nasally in BALB/c mice. Serum IgG and faecal IgA were assessed through ELISA to compare the relative potential of immunization routes and immunogenic potential of r-L. lactis. Immunization via the oral route proved superior to intranasal exposure. CONCLUSION Recombinant L. lactis expressing OmpA of SD-1 was found to be immunogenic. Oral administration of r-L. lactis elicited higher systemic and mucosal immune response when compared with the nasal route. SIGNIFICANCE AND IMPACT OF THE STUDY Using food grade recombinant L. lactis has implications in the development of a prophylactic against multidrug-resistant Shigella, which can be used as a prospective vaccine candidate. Evaluating mucosal routes of immunization demonstrated that the oral route of administration elicited better immune response against OmpA of Shigella.
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Affiliation(s)
- B Yagnik
- Department of Cell and Molecular Biology, B. V. Patel Pharmaceutical Education and Research Development (PERD) Centre, Ahmedabad, 380054, Gujarat, India.,B. R. D School of Biosciences, Sardar Patel University, Vallabh Vidhyanagar, 388120, Gujarat, India
| | - D Sharma
- Department of Cell and Molecular Biology, B. V. Patel Pharmaceutical Education and Research Development (PERD) Centre, Ahmedabad, 380054, Gujarat, India.,B. R. D School of Biosciences, Sardar Patel University, Vallabh Vidhyanagar, 388120, Gujarat, India
| | - H Padh
- Sardar Patel University, Vallabh Vidhyanagar, 388120, Gujarat, India
| | - P Desai
- Department of Cell and Molecular Biology, B. V. Patel Pharmaceutical Education and Research Development (PERD) Centre, Ahmedabad, 380054, Gujarat, India
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Desai P, Parikh R, Deshpande R. 57. Total esophagectomy is not always necessary in the treatment of squamous carcinoma & adenocarcinoma of the distal third of the esophagus & the cardia. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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31
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Parikh R, Desai P. 311. Selection criteria for definitive chemo-radiotherapy (CT-RT) in low rectal cancers: A preliminary data from a single centre, India. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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32
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Shetty S, Kennea N, Desai P, Giuliani S, Richards J. Length of stay and cost analysis of neonates undergoing surgery at a tertiary neonatal unit in England. Ann R Coll Surg Engl 2016; 98:56-60. [PMID: 26688402 DOI: 10.1308/rcsann.2016.0034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction There is a lack of knowledge on the average length of stay (LOS) in neonatal units after surgical repair of common congenital anomalies. There are few if any publications reporting the activity performed by units undertaking neonatal surgery. Such activity is important for contracting arrangements, commissioning specialist services and counselling parents. The aim of this study was to describe postnatal LOS for infants admitted to a single tertiary referral neonatal unit with congenital malformations requiring surgery. Methods Data on nine conditions were collected prospectively for babies on the neonatal unit over a five-year period (2006-2011). For those transferred back to their local unit following surgery, the local unit was contacted to determine the total LOS. Only those babies who had surgery during their first admission to our unit and who survived to discharge were included in the study. Cost estimates were based on the tariffs agreed for neonatal care between our trust and the London specialised commissioning group in 2011-2012. Results The median LOS for the conditions studied was: gastroschisis 35 days (range: 19-154 days), oesophageal atresia 33 days (range: 9-133 days), congenital diaphragmatic hernia 28 days (range: 7-99 days), intestinal atresia 24 days (range: 6-168 days), Hirschsprung's disease 21 days (range: 15-36 days), sacrococcygeal teratoma 17 days (range: 12-55 days), myelomeningocoele 15.5 days (range: 8-24 days), anorectal malformation 15 days (range: 6-90 days) and exomphalos 12 days (range: 3-228 days). The total neonatal bed day costs for the median LOS ranged from £8,701 (myelomeningocoele) to £23,874 (gastroschisis). The cost of surgery was not included. Conclusions There is wide variation in LOS for the same conditions in a single neonatal unit. This can be explained by different types and severity within the same congenital anomalies, different surgeons and other clinical confounders (eg sepsis, surgical complications, associated anomalies). These data will enable us to give more detailed information to families following prenatal or postnatal diagnosis. They also allow more detailed planning of resource allocation for neonatal admissions.
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Affiliation(s)
- S Shetty
- St George's University Hospitals NHS Foundation Trust , UK
| | - N Kennea
- St George's University Hospitals NHS Foundation Trust , UK
| | - P Desai
- St George's University Hospitals NHS Foundation Trust , UK
| | - S Giuliani
- St George's University Hospitals NHS Foundation Trust , UK
| | - J Richards
- St George's University Hospitals NHS Foundation Trust , UK
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Bishop TF, Ryan AM, Chen MA, Mendelsohn J, Gottlieb D, Shih S, Desai P, Wolff EA, Casalino LP. A Randomized, Controlled Trial of a Shared Panel Management Program for Small Practices. Health Serv Res 2016; 51:1796-813. [PMID: 26846591 DOI: 10.1111/1475-6773.12455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine whether a shared panel management program was effective at improving quality of care for patients with uncontrolled chronic disease. DATA SOURCES Data were extracted from electronic health records. STUDY DESIGN Randomized controlled trial of a panel management program initiated by New York City Department of Health and Mental Hygiene. Patients from 20 practices with an uncontrolled chronic disease and a lapse in care were assigned to the intervention (a phone call requesting that the patient schedule a physician appointment) or usual care. Outcomes were visits to physician practices, body mass index measurement, blood pressure measurement and control, use of antithrombotics, and low-density lipoprotein measurement and control. PRINCIPAL FINDINGS Panel managers were able to successfully speak with 1,676 patients (14.7 percent of the intervention group). There were no significant differences in outcomes between the intervention and usual care groups. Successfully contacted patients were more likely to have an office visit within 1 year of randomization (45.6 percent [95 percent CI: 22.8, 26.9] vs. 38.1 percent [95 percent CI: 36.8, 39.3]) and more likely to be on antithrombotics (24.4 percent [95 percent CI: 17.7, 31.0]) versus those in the usual care group (17.0 percent [95 percent CI: 13.9, 20.0]) but had no other difference in quality. CONCLUSIONS A shared, low-intensity panel management program run by a city health department did not improve quality of care for patients with chronic illnesses and lapses in care.
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Affiliation(s)
- Tara F Bishop
- Division of Healthcare Policy and Economics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY. .,Department of Medicine, Weill Cornell Medical College, New York, NY.
| | - Andrew M Ryan
- Department of Health Management and Policy, University of Michigan School of Public Health, Anna Arbor, MI
| | - Melinda A Chen
- Division of Healthcare Policy and Economics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY
| | | | - Daniel Gottlieb
- Bureau of the Primary Care Information Project, New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Sarah Shih
- Bureau of the Primary Care Information Project, New York City Department of Health and Mental Hygiene, Long Island City, NY
| | | | | | - Lawrence P Casalino
- Division of Healthcare Policy and Economics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY
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Desai P, Springer GF. Lower limit of blood group H(O) specific combining site of some heterologous reagents. Bibl Haematol 2015; 23:500-4. [PMID: 5867134 DOI: 10.1159/000384298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Wise-Draper T, Moorthy G, Salkeni M, Thomas H, Mercer C, Kozma S, Thomas G, Rixe O, Desai P, Morris J, Olowokure O. A Dose Escalation Single Arm Phase Ib Combination Study of BEZ235 with Everolimus in Patients with Advanced Solid Malignancies. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv090.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Desai P, Kruger E, Trolio R, Tennant M. Western Australian schools access to dentally optimal fluoridated water. Aust Dent J 2015; 60:112-8. [DOI: 10.1111/adj.12260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 12/01/2022]
Affiliation(s)
- P Desai
- Department of Anatomy, Physiology and Human Biology; International Research Collaborative - Oral Health and Equity; The University of Western Australia; Nedlands Western Australia
| | - E Kruger
- Department of Anatomy, Physiology and Human Biology; International Research Collaborative - Oral Health and Equity; The University of Western Australia; Nedlands Western Australia
| | - R Trolio
- Department of Anatomy, Physiology and Human Biology; International Research Collaborative - Oral Health and Equity; The University of Western Australia; Nedlands Western Australia
| | - M Tennant
- Department of Anatomy, Physiology and Human Biology; International Research Collaborative - Oral Health and Equity; The University of Western Australia; Nedlands Western Australia
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Snedecor SJ, Sudharshan L, Cappelleri JC, Sadosky A, Desai P, Jalundhwala Y, Botteman M. Systematic review and meta-analysis of pharmacological therapies for pain associated with postherpetic neuralgia and less common neuropathic conditions. Int J Clin Pract 2014; 68:900-18. [PMID: 24698515 DOI: 10.1111/ijcp.12411] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To estimate the relative efficacy of pharmacological therapies for the treatment of postherpetic neuralgia (PHN), multiple sclerosis (MS)-related pain, posttraumatic pain, central poststroke pain (CPSP) and human immunodeficiency virus (HIV)-related neuropathic pain (NeP). METHODS This systematic review (through June 2011) identified randomised, controlled trials of treatments for these conditions. Bayesian mixed treatment comparison (MTC) methods were used to determine the relative efficacy and safety among the treatments within each pain condition. RESULTS Fifty studies were identified: 33 PHN, 2 MS-related pain, 3 CPSP, 3 posttraumatic pain and 9 HIV-related NeP. Data from 28 PHN studies including 21 interventions and 4317 patients were included into the PHN MTC. Of treatments studied in ≥ 50 patients, opioids had the greatest mean pain reduction of -1.70 vs. placebo on an 11-point numeric rating scale. Pregabalin ≥ 300 mg/day was most effective for ≥ 30% and ≥ 50% pain reduction [relative risk (RR) vs. placebo = 2.44 and 2.13, respectively]. Data identified for MS-related pain, CPSP, posttraumatic pain and HIV-related NeP were sparse; only 7 of 17 studies had ≥ 50 patients. Adverse events (AEs) and discontinuations for most treatments were not significantly greater than placebo except in PHN, where 8 of 12 treatments had higher risks of AEs compared with placebo and tricyclic antidepressants and opioids had higher risk of discontinuation compared with placebo. CONCLUSIONS Guideline-recommended treatments for PHN were more effective than placebo on the pain NRS and for ≥ 30% and ≥ 50% pain reduction. Although guidelines exist for the management of less common NeP conditions, little published evidence supports them. These results highlight the need for additional evaluations and more complete reporting of outcomes to help guide physicians' treatment selections.
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Desai P, Caroprese B, McKellar H. SU-E-T-281: Reduction of Treatment Times in CyberKnife Prostate SBRT Using a Water Filled Rectal Balloon. Med Phys 2014. [DOI: 10.1118/1.4888612] [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: 11/07/2022] Open
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Morris DS, Willis S, Minassian D, Foot B, Desai P, MacEwen CJ. The incidence of serious eye injury in Scotland: a prospective study. Eye (Lond) 2013; 28:34-40. [PMID: 24097120 DOI: 10.1038/eye.2013.213] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 08/05/2013] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Ocular trauma remains an important cause of visual morbidity worldwide. A previous population-based study in Scotland reported a 1-year cumulative incidence of 8.14 per 100 000 population. The purpose of this study was to identify any change in the incidence and pattern of serious ocular trauma in Scotland. METHODS This study was a 1-year prospective observational study using the British Ophthalmological Surveillance Unit reporting scheme among Scottish ophthalmologists. Serious ocular trauma was defined as requiring hospital admission. Data were collected using two questionnaires for each patient 1 year apart. RESULTS The response rate from ophthalmologists was 77.1%. There were 102 patients reported with complete data giving an incidence of 1.96 per 100 000 population, four times less than in 1992. In patients younger than 65 years, the age-adjusted incidence ratio (males/females) indicated a ninefold higher risk of trauma in males. In 25 patients (27.2%), the injured eye was blind (final visual acuities (FVA) <6/60), 24 being attributable to the eye injury. Standardised morbidity ratios suggested a threefold decrease in risk of poor visual outcome in 2009 compared with 1992. CONCLUSIONS The incidence of serious ocular trauma has fallen; this study has shown hospital admission for serious eye injury in Scotland has decreased fourfold in 17 years. Young adult males continue to be at highest risk, which needs to be specifically addressed in future health-prevention strategies. This study also observed a reduction in visual loss from serious ocular injuries, although the reasons for this require further exploration.
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Affiliation(s)
- D S Morris
- Cardiff Eye Unit, University Hospital of Wales, Cardiff, UK
| | - S Willis
- University of Cardiff Medical School, Cardiff, UK
| | - D Minassian
- The Institute of Ophthalmology, University College of London, London, UK
| | - B Foot
- British Ophthalmic Surveillance Unit, The Royal College of Ophthalmologists, London, UK
| | - P Desai
- Moorfields Eye Hospital, London, UK
| | - C J MacEwen
- University Department of Ophthalmology, Ninewells Hospital, Dundee, UK
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Nagar H, Boothe D, Ginter P, Stessin A, Desai P, Sison C, Vahdat L, Chao K, Nori D, Hayes M. Predictors of All Recurrence for Breast Cancer Patients Treated With Neoadjuvant Chemotherapy and Surgery With and Without Radiation Therapy. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Boothe D, Chang J, Desai P, Nagar H, Zhou L, Smith M, Nori D, Chao K, Wernicke A, Parashar B. The Dosimetric Advantage of Stereotactic Hypofractionation Over Conventional Radiation for Postprostatectomy Patients: NTCP Modeling of Intensity Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) Treatment Plans. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gugulothu D, Desai P, Patravale V. A Versatile Liquid Chromatographic Technique for Pharmacokinetic Estimation of Curcumin in Human Plasma. J Chromatogr Sci 2013; 52:872-9. [DOI: 10.1093/chromsci/bmt131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jain R, Choudhury N, Chudgar U, Harimoorthy V, Desai P, Perkins J, Johnson ST. Detection and identification of red cell alloantibodies in multiply transfused thalassemia major patients: a prospective study. Indian J Hematol Blood Transfus 2013; 30:291-6. [PMID: 25435730 DOI: 10.1007/s12288-013-0282-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 06/01/2013] [Indexed: 10/26/2022] Open
Abstract
Life long red blood transfusion remains the main treatment for β thalassemia major patients. The development of alloantibodies complicates transfusion therapy in thalassemia patients. Alloimmunization to red cell antigens is one of the most important immunological transfusion reaction and causes delayed type of transfusion reaction. A prospective study was conducted from January 2007 to January 2010. This was a cohorts of 115 patients were selected from regular transfusion group and they were followed for two and half year. They were followed up for the effect of transfusion during study period. There was a decline in patient number from 115 to 96 due to mortality and transfer of patient. A total of 96 multiply transfused thalassemia patients were prospectively included in this study and three consecutive samples collected after every 6 months and investigated for the development of alloantibody to red cell antigens. Tests for antibody screening and identification were performed on preserved sample to investigate prevalence and development of red cell alloimmunization by standardized laboratory techniques by same person at Prathama Blood Centre. A total of 96 patients were included in the study. 63 patients were males and 33 females. A total of five single alloantibodies were formed in five patients out of them four (80 %) belonged to Kell blood group system and one (20 %) from Rh system. It was observed that two (1.92 %) of new thalassemia patients developed red cell alloantibodies during study period. Red cell alloimmunization should be kept in mind in the patients receiving multiple transfusions. In present study, alloimmunization rate was 5.21 %. Mean transfusion duration in these patients was 23.90 days, probably due to presence of alloantibody. RBC alloantibody detection on regular interval and corresponding antigen negative blood transfusion is strongly recommended in transfusion dependent thalassemia patients.
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Affiliation(s)
| | - N Choudhury
- TATA Medical Centre, Rajarhat, Kolkata, India
| | - U Chudgar
- Prathama Blood Centre, Ahmedabad, India
| | | | - P Desai
- TATA Memorial Hospital, Parel, Mumbai, India
| | - Jim Perkins
- ENH Blood Centre, Evanstan Hospital, Chicago, IL USA
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Desai P, Caroprese B, McKellar H. SU-E-T-482: Novel Planning Technique for Treating Large Volume Arteriovenous Malformations Using SRS. Med Phys 2013. [DOI: 10.1118/1.4814915] [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: 11/07/2022] Open
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Snedecor S, Sudharshan L, Cappelleri J, Sadosky A, Desai P, Jalundhwala Y, Botteman M. Systematic review and meta-analysis of pharmacological therapies for pain associated with post-herpetic neuralgia. The Journal of Pain 2013. [DOI: 10.1016/j.jpain.2013.01.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spector JM, Reisman J, Lipsitz S, Desai P, Gawande AA. Access to essential technologies for safe childbirth: a survey of health workers in Africa and Asia. BMC Pregnancy Childbirth 2013; 13:43. [PMID: 23421767 PMCID: PMC3637084 DOI: 10.1186/1471-2393-13-43] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 02/12/2013] [Indexed: 11/25/2022] Open
Abstract
Background The reliable availability of health technologies, defined as equipment, medicines, and consumable supplies, is essential to ensure successful childbirth practices proven to prevent avoidable maternal and newborn mortality. The majority of global maternal and newborn deaths take place in Africa and Asia, yet few data exist that describe the availability of childbirth-related health technologies in these regions. We conducted a cross-sectional survey of health workers in Africa and Asia in order to profile the availability of health technologies considered to be essential to providing safe childbirth care. Methods Health workers in Africa and Asia were surveyed using a web-based questionnaire. A list of essential childbirth-related health technologies was drawn from World Health Organization guidelines for preventing and managing complications associated with the major causes of maternal and newborn mortality globally. Demographic data describing each birth center were obtained and health workers reported on the availability of essential childbirth-related health technologies at their centers. Comparison analyses were conducted using Rao-Scott chi-square test statistics. Results Health workers from 124 birth centers in 26 African and 15 Asian countries participated. All facilities exhibited gaps in the availability of essential childbirth-related health technologies. Availability was significantly reduced in birth centers that had lower birth volumes and those from lower income countries. On average across all centers, health workers reported the availability of 18 of 23 essential childbirth-related health technologies (79%; 95% CI, 74%, 84%). Low-volume facilities suffered severe shortages; on average, these centers reported reliable availability of 13 of 23 technologies (55%; 95% CI, 39%, 71%). Conclusions Substantial gaps exist in the availability of essential childbirth-related health technologies across health sector levels in Africa and Asia. Strategies that facilitate reliable access to vital health technologies in these regions are an urgent priority.
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Affiliation(s)
- Jonathan M Spector
- Department of Internal Medicine-Pediatrics, Harvard - Massachusetts General Hospital, Boston, MA, USA
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Desai P, Jay A, Wu C, Cauley JA, Manson J, Peters U, Agalliu I, Abdul-Hussein M, Bock C, Budrys N, Chlebowski R, Cote M, Lane D, Luo J, Martin L, Park H, Petrucelli N, Rosenberg CA, Thomas F, Wactawski-Wende J, Simon MS. Abstract PD03-09: Statins and breast cancer risk: A follow-up analysis of the Women's Health Initiative Cohort. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-pd03-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Statins (HMG CoA reductase inhibitors) are a class of cholesterol lowering drugs that affect many intracellular pathways and have implications for chemopreventive activity against cancer. Epidemiological data on statins and breast cancer risk are conflicting. We analyzed updated data from the Women's Health Initiative (WHI) to assess the relationship between statins and breast cancer risk.
Methods: This analysis included 154,587 post-menopausal women ages 50–79 years at baseline, in which 7,430 incident cases of invasive breast cancer were identified over an average of 10.8 (SD 3.3) years of follow-up. All cases of breast cancer were confirmed by review of medical records and pathology reports. Participants were asked to bring all current medications to their baseline visits and information on statin use was recorded. Statins were classified as lipophilic (lovastatin, simvastatin, fluvastatin) or hydrophilic (pravastatin and atorvastatin). Self and interviewer-administered questionnaires were used to collect information on other breast cancer risk factors. Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Analyses investigated the association of any statin use as well as, type of statin (lipophilic vs. hydrophilic), statin potency, and duration of use with breast cancer. To evaluate the effect of change in statin use over time, statin use was examined as a time-dependent exposure using updated information on statin use gathered during follow-up visits. Separate analyses were conducted by hormone receptor and HER2neu status, other tumor characteristics and use of postmenopausal hormone therapy. All statistical tests were two-sided.
Results: Statins were used at baseline by 11,584 (7.5%) women in the cohort of whom 7,840 used lipophilic statins. The annualized rate of breast cancer was 0.42% among statin users and 0.42% among nonusers. The multivariable adjusted HR of breast cancer for statin users compared with non-users was 0.93 (95% C.I. 0.83–1.05), however for women using lipophilic statins the HR was 0.86 (95% CI, 0.74–1.00). Statin use for < 1 year was associated with a reduction in risk (HR 0.79, 95% C.I. 0.63–0.99) however there was no trend for overall duration of use. In the stratified analysis by tumor size, there was a marginal reduction in risk for tumors between 10 and 30 mm but not in smaller or larger tumors. There were no effect modifications by tumor stage, hormone receptor or HER2neu status, hormone therapy use, family history of breast cancer or body mass index. In the multivariable adjusted time-dependent model, the HR for simvastatin was 0.80 (95% CI, 0.64–0.99).
Conclusion: Simvastatin was associated with a reduced risk of invasive breast cancer, and as a class, lipophilic statins were associated with a marginal benefit. This provides further evidence for possible class differences in statins with regard to chemo-preventive effects in breast cancer.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD03-09.
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Affiliation(s)
- P Desai
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - A Jay
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - C Wu
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - JA Cauley
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - J Manson
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - U Peters
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - I Agalliu
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - M Abdul-Hussein
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - C Bock
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - N Budrys
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - R Chlebowski
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - M Cote
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - D Lane
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - J Luo
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - L Martin
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - H Park
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - N Petrucelli
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - CA Rosenberg
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - F Thomas
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - J Wactawski-Wende
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
| | - MS Simon
- Providence Hospital Medical Center, Southfield, MI; Wayne State University, Detroit, MI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Pittsburgh, PA; Harvard School of Medicine, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Lakeland Regional Medical Center, MI; Karmanos Cancer Institute, Wayne State University, Detroit, MI; University of Texas Health Science Center San Antonio, TX; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Stony Brook University Medical Center, Stony Brook, NY; West Virginia University, Morgantown, WV; George Washington University, Washington, DC; University of California, Irvine, CA; NorthShore University Health System, Evanston, IL; University of Tennessee Health Science Center, Memphis, TN; University at Buffalo, NY
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Jain R, Perkins J, Johnson ST, Desai P, Khatri A, Chudgar U, Choudhury N. A prospective study for prevalence and/or development of transfusion-transmitted infections in multiply transfused thalassemia major patients. Asian J Transfus Sci 2012; 6:151-4. [PMID: 22988380 PMCID: PMC3439754 DOI: 10.4103/0973-6247.98919] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the rate of seropositivity to hepatitis B and C and Human Immunodeficiency Virus (HIV) infections among children with β-thalassemia major receiving multiple transfusions in Ahmedabad, India, compared with healthy controls. MATERIALS AND METHODS The study was performed during January 2007 to January 2009 on multi-transfused children suffering with β-thalassemia major registered in the Prathama Blood Centre, Ahmedabad; Jeevandeep hospital, Ahmedabad; and Red Cross Blood Centre, Ahmedabad, and investigated for the prevalence and development of transfusion-transmitted infections. Hepatitis B surface Antigen (HBsAg), anti-Hepatitis C Virus (HCV) Antibodies (Ab), and HIV Ab were checked using a fourth-generation Enzyme-Linked Immunosorbent Assay (ELISA). Positive tests were confirmed by western blots. Healthy blood donors were used for the control group. RESULTS Hepatitis B surface antigen, anti-HCV Ab, and HIV Ab were positive in one of 96 (1.04%; 95% Confidence Interval (CI) = 0.17-1.3), 24 of 96 (25%; 95% CI = 11.4-14.2), and one of 96 (1.04%; 95% CI = 0.12-1.3), respectively. The rate of anti-HCV Ab was significantly higher in multi-transfused children suffering with β-thalassemia major. In thalassemia patients, the rate of positive anti-HCV Ab was significantly higher than that for positive HBsAg (P<0.001) and HIV Ab (P<0.001). CONCLUSION It is concluded that HCV is the current major problem in multi-transfused children with thalassemia major and more careful pretransfusion screening of blood for anti-HCV must be introduced in blood centers.
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Affiliation(s)
- Roopam Jain
- Department of Pathology, R D Gardi Medical College, Ujjain, India
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Mounasamy V, Fulco P, Desai P, Adelaar R, Bearman G. The successful use of vancomycin-impregnated cement beads in a patient with vancomycin systemic toxicity: a case report with review of literature. Eur J Orthop Surg Traumatol 2012; 23 Suppl 2:S299-302. [PMID: 23412194 DOI: 10.1007/s00590-012-1062-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 07/28/2012] [Indexed: 12/19/2022]
Abstract
We report the use of vancomycin laden antibiotic cement beads in a patient with calcaneal osteomyelitis who had prior acute kidney injury (AKI). The patient experienced non-oliguric renal failure after exposure to intravenous vancomycin and recovered well after antibiotic discontinuation and adequate hydration. We are not aware of any similar case report where vancomycin laden antibiotic cement has been used in a patient with AKI to vancomycin.
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Affiliation(s)
- V Mounasamy
- Department of Orthopedics, Infectious Diseases, Virginia Common Wealth University Health System, 1200 East Broad Street, 9th floor West Hospital, PO Box 980153, Richmond, VA, 23298-0153, USA,
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