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MacLachlan H, Antonakaki A, Bhatia R, Fyazz S, Chatrath N, Androulakis E, Marawaha S, Basu J, Miles C, Dhutia H, Zaidi A, Chandra N, Sheikh N, Gati S, Malhotra A, Finocchiaro G, Sharma S, Papadakis M. Prevalence and Clinical Significance of Electrocardiographic Complete Right Bundle Branch Block in Young Individuals. Eur J Prev Cardiol 2024:zwae082. [PMID: 38412448 DOI: 10.1093/eurjpc/zwae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/17/2024] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND AND AIMS There is limited information on the clinical significance of complete right bundle branch block (CRBBB) in young individuals. The aim of this study was to determine the prevalence and significance of CRBBB in a large cohort of young individuals aged 14-35 years old. METHODS From 2008 to 2018, 104,369 consecutive individuals underwent a cardiovascular assessment with a health questionnaire, electrocardiogram, clinical consultation, and selective echocardiography. Follow-up was obtained via direct telephone consultations. Mean follow-up was 7.3 ± 2.7 years. RESULTS CRBBB was identified in 154 (0.1%) individuals and was more prevalent in males compared with females (0.20% vs. 0.06%; p<0.05) and in athletes compared with non-athletes (0.25% vs. 0.14%; p<0.05). CRBBB-related cardiac conditions were identified in 7 (5%) individuals (4 with atrial septal defect, 1 with Brugada syndrome, 1 with progressive cardiac conduction disease and 1 with atrial fibrillation). Pathology was more frequently identified in individuals with non-isolated CRBBB compared with individuals with isolated CRBBB (14% vs 1%; p < 0.05) and in individuals with a QRS duration of ≥130 milliseconds (ms) compared with individuals with a QRS of <130ms (10% vs 1%; p<0.05). CONCLUSION The prevalence of CRBBB in young individuals was 0.1% and was more prevalent in males and athletes. CRBBB-related conditions were identified in 5% of individuals and were more common in individuals with non-isolated CRBBB and more pronounced intraventricular conduction delay (QRS duration of ≥130ms). Secondary evaluation should be considered for young individuals with CRBBB with symptoms, concerning family history, additional electrocardiographic anomalies or significant QRS prolongation (≥130ms).
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Affiliation(s)
- H MacLachlan
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
| | - A Antonakaki
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
| | - R Bhatia
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
| | - S Fyazz
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
| | - N Chatrath
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
| | - E Androulakis
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
| | - S Marawaha
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
| | - J Basu
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
| | - C Miles
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
| | - H Dhutia
- Department of Cardiology, Glenfield Hospital, Leicester, UK
| | - A Zaidi
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - N Chandra
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
- Department of Cardiology, Frimley Park Hospital, London, UK
| | - N Sheikh
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
- Department of Cardiology, Guy's and St Thomas's Hospital, London, UK
| | - S Gati
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
- Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - A Malhotra
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
- Institute of Sport, Manchester Metropolitan University and University of Manchester, Manchester, UK
| | - G Finocchiaro
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
| | - S Sharma
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
| | - M Papadakis
- Cardiovascular Clinical Academic Group, St George's, University of London, London, UK
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Bhatia R, Mai A, George J, Cao Y, Siu C, Lee EE, Redmond KJ, Jackson C, Lim M, Bettegowda C, Kleinberg LR. Outcomes of Brain Metastases with Suspicious Imaging Undergoing Resection to Evaluate for Radionecrosis vs. Tumor Progression. Int J Radiat Oncol Biol Phys 2023; 117:e88. [PMID: 37786204 DOI: 10.1016/j.ijrobp.2023.06.843] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In patients treated with stereotactic radiosurgery (SRS) for brain metastases, radiographic changes on surveillance imaging may result from treatment effect/radionecrosis (RN) or tumor progression. Distinguishing between these processes is critical to appropriate management. We report long-term outcomes for a cohort of patients who demonstrated radiographic progression on serial imaging after initial radiation and ultimately underwent resection to inform further management. MATERIALS/METHODS A retrospective chart review identified 76 patients with an associated 82 brain lesions between 2009 and 2022 that were initially treated with SRS, then demonstrated suspicious imaging changes developing through at least two scan time points that led to pathologic confirmation of either tumor or RN. We report clinical outcomes and details of further treatments. RESULTS Of the 82 lesions, 55 (67.1%) were found to be pathologically-confirmed viable tumor and were treated with repeat radiation and 27 (32.9%) were found to be strictly RN and conservatively managed. Over half of the lesions (14/27) ultimately found to be radionecrotic required use of steroids pre-operatively due to neurologic symptoms. Among the 27 that were found to be RN, the most common histology was melanoma (33.3%, n = 9). The most common dose fractionation regimen was 20 Gy in 1 fx (n = 11, 40.7%; range: 16-20 Gy x 1Fx), and the median BED (10) was 50.4 Gy (IQR 41.6 - 50 Gy). None of these lesions required further intervention with median post-surgery follow up of 24.4 months (range 1-104 months). There were 55 instances (in 51 patients) of pathologically-confirmed recurrent/progressive tumor who were consequently treated with repeat radiation with either Cs-131 brachytherapy (12 (21.8%)) or SRS (43 (78.2%)). The most common histology was NSCLC (37.2%, n = 19). The most common fractionation for repeat irradiation with SRS was 8 Gy x 3 fx (n = 15, 27.3%), followed by 5 Gy x 5 fx (n = 10, 18.2%), and 4 Gy x 5 fx (n = 8, 14.6%). Four individuals each had two lesions that were re-irradiated for local recurrence. Among patients treated with re-irradiation, the median follow-up to local failure was 15.2 months (95% CI 7.3-26.6 months). Radionecrosis was confirmed on pathology in 4/55 (7.2%) of lesions. The median follow-up from date of SRS2 to local failure was 14.1 months (95% CI 7.6-24.3 months). The 2-yr local control rate was 74.8% (95% CI 61.7-90.7%). CONCLUSION We recommend cautious monitoring of possible progression after radiosurgery, with consideration of resection for continuous progression, as a significant proportion of radiographic progression are ultimately pure RN. Management determined by pathology (observation for RN; additional radiation for confirmed tumor) leads to excellent control.
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Affiliation(s)
- R Bhatia
- Johns Hopkins University, Baltimore, MD
| | - A Mai
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J George
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA
| | - Y Cao
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Siu
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - E E Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - K J Redmond
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Jackson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Lim
- Department of Neurosurgery, Stanford University, Stanford, CA
| | - C Bettegowda
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - L R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Bhatia R, Chen R, Monare B, Nsingo M, Ralefala T, Setlhako D, Martei Y, Ramogola-Masire D, Vuylsteke P, Ngwa W, Rendle K, Grover S. Trends in the Use of Hypofractionation in Treatment of Breast Cancer in Botswana. Int J Radiat Oncol Biol Phys 2023; 117:e568. [PMID: 37785735 DOI: 10.1016/j.ijrobp.2023.06.1894] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Clinical trials have shown that moderate hypofractionation (HF) is clinically effective as adjuvant treatment to breast conserving surgery or following mastectomy with advanced disease. ASTRO issued updated guidelines in 2018, expanding the population eligible to receive HF to all patients, regardless of age and tumor stage. Use of HF can promote efficient resource utilization for over-burdened health care systems; however, global adoption of HF has been previously only reported via ESTRO survey of individual physicians. These data note that HF following lumpectomy is 40% in Africa vs. >90% in North America, with limited data on the uptake of HF within individual African countries. In this study, we characterize temporal trends and clinical, socio-demographic factors associated with the use of HF in breast cancer in Botswana. MATERIALS/METHODS We retrospectively analyzed a cohort of breast cancer patients receiving curative intent radiation between 2015 and 2022 at the only radiation clinic in Botswana. We compared patients' characteristics between those who received HF vs. standard fractionation (SF) and report chi-square statistics when appropriate. We fit a multilevel mixed-effects logistic regression model with a random intercept for district while adjusting for fixed effects such as HIV infection status, laterality, hormone receptor status, and marital status. RESULTS A total of 234 patients were prescribed curative intent radiation between 2015 and 2022 in Gaborone, Botswana. Median age at diagnosis was 51 years old, and the majority of patients presented with stage III disease (61.9%, 109/234). 26.9% of this population were women living with HIV (WLWH), and 71% lived >100km from the hospital. HF was utilized overall in 59.4% (139/234) of patients. Most common fractionation patterns included: 4005cGy/15fx and 4267cG/16fx. One patient received ultra-HF (2600cGy/5fx). In unadjusted chi-square analysis, a higher proportion of HF was seen in right vs left-sided breast cancer (65.8% vs. 50.9%, p = 0.02), increasing year of diagnosis from 2015 - 2022 (p<0.001), and among patients >/ = 40 years of age vs. those <40 years of age (62.8% vs 42.1%, p = 0.017). Temporal trends show a significant increase in the utilization of HF starting from 23.8% (5/21) in 2015, to 61.5% (32/52) in 2018, and finally 100% (11/11) of cases in 2022. Our regression analysis shows that there is no statistically significant between-district variance or patient-level factors that associate with the uptake of HF. The overall utilization rate for HF between 2015-2022 was 59.4% (95% CI: 53.0%-65.5%). CONCLUSION Based on recent survey results the uptake of HF among African countries is lower than that of North America. To our knowledge, this is the first quantitative analysis of the utilization of HF over 5 years in an African country. Further analysis on factors related to physician prescription of hypofractionation is warranted, including influence of breast laterality, age, and primary surgery type.
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Affiliation(s)
- R Bhatia
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R Chen
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - B Monare
- Botswana -UPenn Partnership, Gaborone, Botswana
| | - M Nsingo
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | - T Ralefala
- Princess Marina Hospital, Gaborone, Botswana
| | - D Setlhako
- Princess Marina Hospital, Gaborone, Botswana
| | - Y Martei
- University of Pennsylvania, Philadelphia, PA
| | - D Ramogola-Masire
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA
| | - P Vuylsteke
- Princess Marina Hospital, Gaborone, Botswana
| | - W Ngwa
- John Hopkins University Hospital, Baltimore, MD
| | - K Rendle
- Department of Family Medicine & Community Health & Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA
| | - S Grover
- Princess Marina Hospital, Gaborone, Botswana
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Chang L, D'Amiano A, Bhatia R, Pratilas CA, Ladra M, Acharya S. Impact of Consolidative Radiation on Overall and Progression Free Survival in Pediatric, Adolescent and Young Adult Metastatic Sarcoma. Int J Radiat Oncol Biol Phys 2023; 117:S132-S133. [PMID: 37784340 DOI: 10.1016/j.ijrobp.2023.06.484] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To determine the association between consolidative radiation and survival in pediatric, adolescent, and young adult (AYA) metastatic sarcoma MATERIALS/METHODS: Eligible patients included those diagnosed with metastatic bone or soft tissue sarcoma at ≤39 years of age. Patients whose cancer progressed prior to the time of local control were excluded. Consolidative radiation (RT) was defined as RT to all sites of metastatic disease. Kaplan Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Cox proportional hazards was used to account for confounding variables. To adjust for immortal time bias (ITB), end of local control was chosen as a landmark time. RESULTS Patients (n = 77) had a median age at diagnosis of 14.5 years (range: 1.7-29.7 years). The most common histology was Ewing sarcoma (49%), followed by rhabdomyosarcoma (30%). Median follow up was 28.5 months, without significant difference between patients treated with and without consolidative RT (23.7 vs. 21.5 months, p = 0.270). Median time to completion of consolidative RT from diagnosis was 8.5 months. Ewing sarcoma was more likely to be treated with consolidative RT compared to other histologies (p<0.001). Consolidative RT was associated with improved OS (2yr OS: 81.9% vs. 57.9%, p = 0.009) and PFS (2yr PFS: 71.2% vs. 30%, p = 0.001). On multivariate analysis, after accounting for age, histology, number, and type of metastases (lung, bone or other), consolidative RT remained independently associated with improved OS (hazard ratio (HR):0.36, 95% confidence interval [CI]: 0.17, 0.78, p = 0.010) and improved PFS (HR = 0.34, 95% CI = 0.16, 0.73, p = 0.006). The OS benefit for consolidative RT persisted after adjusting for ITB (1yr OS post-local control: 80.9% vs. 89.7%, p = 0.016). The effect of consolidative RT was validated in a dataset consisting of patients who were diagnosed with localized disease but had metastatic progression (n = 30). In this metachronous population, consolidative RT remained independently associated with improved OS (HR = 0.11, 95% CI = 0.03, 0.51, p = 0.004) after accounting for age. CONCLUSION ConsolidativeRT was independently associated with improved OS and PFS in pediatric and AYA patients with metastatic sarcoma at diagnosis. The OS benefit extended to those who underwent consolidative RT for metastatic progression. Future work should evaluate biomarkers to optimize patient selection and timing and dose of consolidative RT.
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Affiliation(s)
- L Chang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - A D'Amiano
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R Bhatia
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C A Pratilas
- Department of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Ladra
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - S Acharya
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Bhatia R, Ke S, Hu C, Debs P, Chang L, Gross J, Pratilas CA, Ladra M, Acharya S. Patterns of Failure in Pediatric and Young Adult Rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2023; 117:e504. [PMID: 37785583 DOI: 10.1016/j.ijrobp.2023.06.1752] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To characterize patterns of failure in pediatric and young adult patients with rhabdomyosarcoma (RMS) from a single institution with over 20 years of experience. MATERIALS/METHODS Patients diagnosed with RMS from 2000 to 2022 were identified retrospectively. Time to failure was calculated from diagnosis. Local only failure was defined as first failure at the primary site without distant failure. Distant failure was defined as first failure outside of the primary site with or without local failure. Cumulative incidence (CI) of failure was calculated using death as a competing risk. Fine-Gray regression was used to evaluate impact of prognostic factors. RESULTS Ninety-five patients were eligible. Median age was 7.28 years (range 0 - 35 years), 41% of patients were >10 years old. Median follow up was 33.3 months. Approximately half (n = 47, 49.5%) of the tumors demonstrated alveolar histology. FOXO1 fusion status was available in 76 (80%) patients, of which 7 out of 37 alveolar tumors (18.9%) were FOXO1 fusion negative. The majority of tumors presented with unfavorable primary site (n = 72, 75.8%) and advanced stage (Stage III and IV, n = 72, 75.8%). The 5-yr CI of local only failure and distant failure for the entire cohort was 19.0% (95% CI 11.3, 28.3) and 34.6% (24.0, 45.5%), respectively. The predominant pattern of failure by Group was: Groups 1&2: Local only (5yr CI 14.8%), Group 3: Distant (5yr CI: 25.9%), Group 4: Distant (5yr CI: 67.6%). CI of distant failure by primary site was higher in perianal/gluteal (n = 2/5, 5yr CI 60.0%) and extremity (n = 8/19, 5yr CI 45.9%) sites. Of the 28 distant failures, 10 (36%) also had a local failure component. CI of local only failure by primary site was higher in parameningeal head and neck (n = 6/25, 5yr CI 30%) and bladder/prostate (n = 2/12, 5yr CI 23%) sites. The following were associated with an increased CI of distant failures: increasing age (HR 1.08, p<0.01), alveolar vs. embryonal histology (HR 3.01, p = 0.0095), FOXO1 fusion positive vs. negative (HR 2.8, p = 0.02) and Group IV vs. Groups I/II (HR 7.7, p = 0.0007). FOXO1 fusion and alveolar histology were associated with older age and Group IV, both of which were independently associated with increased distant failure on multivariate analysis. CONCLUSION Failures were predominantly distant in older patients and patients with Group IV RMS, both of which were associated with FOXO1 fusion and alveolar histology, highlighting the need to improve therapies in this population. Local only failures were highest in parameningeal head and neck and bladder/prostate primaries, highlighting the need to improve local control strategies at these sites.
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Affiliation(s)
- R Bhatia
- Johns Hopkins University, Baltimore, MD
| | - S Ke
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Hu
- Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - P Debs
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - L Chang
- Johns Hopkins University, Baltimore, MD
| | - J Gross
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C A Pratilas
- Department of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Ladra
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC
| | - S Acharya
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Bhatia R, Zhang S, Nsingo M, Chiyapo S, Balang D, Ralefala T, Zetola N, Ramogola-Masire D, Markovina S, Robertson ES, Grover S. SCCAg as a Biomarker of Advanced Stage and OS in Limited Resource Setting for Cervical Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S80-S81. [PMID: 37784581 DOI: 10.1016/j.ijrobp.2023.06.399] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Elevated serum squamous cell antigen (SCCAg) has been previously correlated with poor survival, extensive tumor involvement, and recurrence for cervical cancer. Failure of serum SCCAg to normalize after treatment completion has also been studied as a poor prognostic indicator. This is the first study describing the association of SCCAg with stage and outcomes in patients diagnosed with cervical cancer in Botswana, in a population with a majority of women who are living with HIV (WLWH). MATERIALS/METHODS Patients with histologically confirmed cervical cancer were enrolled in a prospective observational study between August 2016 and April 2020 in Botswana. Among all patients undergoing definitive chemoradiation, serum SCCAg was determined at pre-treatment baseline, end of treatment (EOT), and 3-month follow-up (normal reference range 0.3 -1.9 ng/ml). Normalization of SCCAg was defined as return to the reference range after treatment (SCCAg response), and was measured first at EOT; if EOT values were not available, 3-month values were utilized. Patients were staged according to FIGO 2009 criteria, early stage was defined as Stage I-II; while advanced stage was defined as Stage III-IV. Median follow-up was 44 months. A significant cut-off point for baseline and SCCAg response correlated with overall survival (OS) was calculated utilizing a log-rank test RESULTS: Among 234 patients who were diagnosed with histologically confirmed cervical cancer, 73.5% were WLWH (mean CD4 count 466 cells/mL). 92.9% of all cancers were squamous cell carcinoma. 68.8% of patients had elevated SCCAg at time of diagnosis. There was no significant difference in mean baseline SCCAg between WLWH (13.3 ng/mL) and women living without HIV (9.07 ng/mL), p = 0.1052. There was a significant difference seen in mean SCCAg between early (7.9 ng/mL ± SD 13.4) and advanced (18.9 ng/mL, ± SD 29.8) stage disease at diagnosis, p < 0.0001. Baseline SCCAg > 7.9 ng/mL was found to be associated with worse OS (p < 0.001). 5-year OS was significantly different among patients with SCCAg response < = 2.8 (5-year OS 66.2%), vs. SCCAg >2.8 ng/mL (5-year OS 42.4%). There was no significant difference in average SCCAg values between EOT (p = 0.68) and 3-month follow-up (p = 0.24). There was no difference in the proportion of patients who experienced normalized SCCAg by HIV status (p = 0.67). CONCLUSION There was no significant difference in SCCAg among WLWH and women living without HIV. Among patients with elevated SCCAg above normal at baseline, SCCAg was associated with early vs. advanced stage disease. Additionally, there was a significant difference seen in overall survival by two measurement points: baseline SCCAg >7.9 ng/mL and response SCCAg >2.8 ng/mL. SCCAg may be utilized as a biomarker in low-resource settings to refine prognosis. Further studies will be needed to determine utility and validation in predicting recurrence risk and/or lymph node metastases.
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Affiliation(s)
- R Bhatia
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - S Zhang
- Biostatistics Analysis Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - M Nsingo
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | - S Chiyapo
- Gaborone Private Hospital, Gaborone, Botswana
| | - D Balang
- Gaborone Private Hospital, Gaborone, Botswana
| | - T Ralefala
- Princess Marina Hospital, Gaborone, Botswana
| | - N Zetola
- School of Medicine, University of Botswana, Gaborone, Botswana; Augusta University School of Medicine, Augusta, GA
| | - D Ramogola-Masire
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA
| | - S Markovina
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - E S Robertson
- Departments of Otorhinolaryngology-Head and Neck Surgery, and Microbiology, and the Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - S Grover
- Princess Marina Hospital, Gaborone, Botswana
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Bhatia R, George J, Siu C, Baker B, Lee E, Redmond K, Jackson C, Bettegowda C, Lim M, Kleinberg L. Outcomes of Brain Metastases Managed with Resection and Aggressive Reirradiation after Initial Radiosurgery Failure. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.781] [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: 10/31/2022]
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8
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Bhatia R, Malhotra A, MacLachlan H, Gati S, Kasiakogias A, Marwaha S, Chatrath N, Fyyaz S, Cooper R, Rakhit D, Varnava A, Esteban M, Finocchiaro G, Papadakis M, Sharma S. Prevalence and diagnostic significance of novel 12-lead ECG patterns following COVID-19 infection in elite soccer players. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Identification of athletes with cardiac inflammation following COVID-19 can prevent exercise fatalities. The efficacy of pre and post COVID-19 infection electrocardiograms (ECGs) for detecting athletes with myopericarditis has never been reported. We aimed to assess the prevalence and diagnostic significance of novel 12-lead ECG patterns following COVID-19 infection in elite soccer players.
Methods
We conducted a multicentre study over a 2-year period involving 5 centres and 34 clubs and compared pre COVID and post COVID ECG changes in 455 consecutive athletes. ECGs were reported in accordance with the International recommendations for ECG interpretation in athletes. The following patterns were considered abnormal if they were not detected on the pre COVID-19 infection ECG: (a) biphasic T-waves; (b) reduction in T-wave amplitude by 50% in contiguous leads; (c) ST-segment depression; (d) J-point and ST-segment elevation >0.2 mV in the precordial leads and >0.1 mV in the limb leads; (e) tall T-waves ≥1.0 mV (f) low QRS-amplitude in >3 limb leads and (g) complete right bundle branch block. Athletes exhibiting novel ECG changes underwent cardiovascular magnetic resonance (CMR) scans. One club mandated CMR scans for all 28 (6%) athletes, despite the absence of cardiac symptoms or ECG changes.
Results
Athletes were aged 22±5 years (89% male and 57% white). 65 (14%) athletes reported cardiac symptoms. The mean duration of illness was 3±4 days. The post COVID ECG was performed 14±16 days following a positive PCR. 440 (97%) athletes had an unchanged post COVID-19 ECG. Of these, 3 (0.6%) had cardiac symptoms and CMRs resulted in a diagnosis of pericarditis. 15 (3%) athletes demonstrated novel ECG changes following COVID-19 infection. Among athletes who demonstrated novel ECG changes, 10 (67%) reported cardiac symptoms. 13 (87%) athletes with novel ECG changes were diagnosed with inflammatory cardiac sequelae; pericarditis (n=6), healed myocarditis (n=3), definitive myocarditis (n=2), and possible/probable myocarditis (n=2). The overall prevalence of inflammatory cardiac sequelae based on novel ECG changes was 2.8%. None of the 28 (6%) athletes, who underwent a CMR, in the absence of cardiac symptoms or novel ECG changes revealed any abnormalities. Athletes revealing novel ECG changes, had a higher prevalence of cardiac symptoms (67% v 12% p<0.0001) and longer symptom duration (8±8 days v 2±4 days; p<0.0001) compared with athletes without novel ECG changes. Among athletes without cardiac symptoms, the additional yield of novel ECG changes to detect cardiac inflammation was 20% (n=3).
Conclusions
3% of elite soccer players demonstrated novel ECG changes post COVID-19 infection, of which almost 90% were diagnosed with cardiac inflammation during subsequent investigation. Most athletes with novel ECG changes exhibited cardiac symptoms. Novel ECGs changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Bhatia
- St George's University of London , London , United Kingdom
| | - A Malhotra
- Manchester University NHS Foundation Trust , Manchester , United Kingdom
| | - H MacLachlan
- St George's University of London , London , United Kingdom
| | - S Gati
- Royal Brompton and Harefield NHS Foundation Trust , London , United Kingdom
| | - A Kasiakogias
- Royal Brompton and Harefield NHS Foundation Trust , London , United Kingdom
| | - S Marwaha
- St George's University of London , London , United Kingdom
| | - N Chatrath
- St George's University of London , London , United Kingdom
| | - S Fyyaz
- St George's University of London , London , United Kingdom
| | - R Cooper
- Liverpool Heart and Chest Hospital , Liverpool , United Kingdom
| | - D Rakhit
- University Hospital Southampton NHS Foundation Trust , Southampton , United Kingdom
| | - A Varnava
- Imperial College Healthcare NHS Trust , London , United Kingdom
| | - M Esteban
- St George's University of London , London , United Kingdom
| | - G Finocchiaro
- St George's University of London , London , United Kingdom
| | - M Papadakis
- St George's University of London , London , United Kingdom
| | - S Sharma
- St George's University of London , London , United Kingdom
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9
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Bhatia R, Khoury S, Westaby J, Behr E, Papadakis M, Sharma S, Finocchiaro G, Sheppard M. Mitral valve abnormalities in decedents of sudden cardiac death due to hypertrophic cardiomyopathy and idiopathic left ventricular hypertrophy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The sole identification of left ventricular hypertrophy (LVH) in a young individual that died suddenly may often lead to an erroneous diagnosis of hypertrophic cardiomyopathy (HCM). Emerging data suggests that idiopathic LVH (ILVH) and HCM may be separate entities.
Aim
We aimed to report on the prevalence and nature of mitral valve (MV) abnormalities, in a cohort of sudden cardiac death (SCD) victims with a post-mortem examination consistent with HCM and ILVH.
Methods
We reviewed 6860 consecutive cases of SCD referred to our specialist cardiac pathology centre between 1994 and 2020. SCD was defined as death from a cardiovascular cause within 12 hours of apparent well-being. HCM was defined by the presence of LVH, in the absence of abnormal loading conditions and characterised by myocyte disarray at histology. ILVH was defined as unexplained LVH (heart weight >500 g in males and >400 g in females) and left ventricular (LV) wall thickness >15mm, in the absence of myocardial disarray or secondary causes of LVH. The MV was examined for patency, circumference, thickening, nodularity, ballooning, bulging between cords, perforation, and the presence of impact lesions in the LV outflow tract (LVOT) and aortic outlet.
Results
Of the total cases of SCD, 264 (4%) were due to HCM (mean age 41±18 years, 78% males, LV maximal wall thickness 19±6 mm) (Figure 1). Ante-mortem symptoms were reported in 44 (17%) cases and for the majority (n=217, 82%) HCM was established at post-mortem. Death was attributed to ILVH in 253 (3%) cases (mean age 43±16 years, 80% males, LV maximal wall thickness 18±4 mm). MV abnormalities were found in 58 (22%) decedents with HCM (mean age 38±17 years; 72% males) and in 13 (5%) decedents with ILVH (mean age 55±15 years; 77% male), p<0.001. Amongst the 58 (22%) cases with HCM and MV abnormalities, 15 (6%) cases had multiple MV abnormalities. These included impact lesions associated with thickening of the anterior leaflet of the MV (n=39) and degenerative changes (n=34) such as bulging and ballooning; and thickening and nodularity. Decedents with HCM exhibiting MV abnormalities were younger than decedents with a normal MV (38±17 versus 45±19 years; p=0.08). Among the 253 decedents with ILVH, 13 (5%) cases exhibited MV abnormalities, which largely included degenerative changes (n=12). Among decedents with HCM and ILVH exhibiting MV abnormalities, the former was significantly younger (38±17 versus 55±15; p=0.001). Myocardial fibrosis was observed in 162 (61%) cases of HCM and 99 (39%) cases of ILVH, p<0.001.
Conclusions
MV abnormalities are over four-fold more common in individuals with HCM than those with ILVH and may be considered as additional macroscopic features to differentiate between these two entities. Furthermore, the inherent descriptive terminologies used when assessing the MV, support a greater emphasis on the standardisation and quantification of MV abnormalities as part of the autopsy in victims of SCD.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Acknowledgements: We thank the charitable organisation, Cardiac Risk in the Young (CRY) who fund and support the CRY Cardiovascular Pathology Unit and CRY database.
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Affiliation(s)
- R Bhatia
- St George's University of London , London , United Kingdom
| | - S Khoury
- St George's University of London , London , United Kingdom
| | - J Westaby
- St George's University of London , London , United Kingdom
| | - E Behr
- St George's University of London , London , United Kingdom
| | - M Papadakis
- St George's University of London , London , United Kingdom
| | - S Sharma
- St George's University of London , London , United Kingdom
| | - G Finocchiaro
- St George's University of London , London , United Kingdom
| | - M Sheppard
- St George's University of London , London , United Kingdom
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10
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Bhatia R, Westaby J, Behr E, Papadakis M, Sharma S, Finocchiaro G, Sheppard M. Sudden cardiac death during exercise in young individuals with hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sudden cardiac death (SCD) in young individuals and athletes is generally caused by hereditary cardiac conditions, including cardiomyopathies such as hypertrophic cardiomyopathy (HCM). Although historically HCM has been reported as the predominant cause of SCD in young athletes, it is unclear as to what degree exercise is a trigger for possible fatal arrhythmias.
Aim
We aimed to report on the circumstances of SCD in a cohort of young individuals aged ≥10 and <30 whose autopsy was consistent with HCM.
Methods
We reviewed 6860 consecutive cases of SCD referred to our specialist cardiac pathology centre 1994 and 2020. SCD was defined as death from a cardiovascular cause within 12 hours of apparent well-being. All cases underwent detailed autopsy evaluation of the heart, including histological analysis, by expert cardiac pathologists. A minimum of 10 blocks of tissue were taken for histological analysis. HCM was defined by the presence of increased heart weight or increased wall thickness and significant myocyte disarray at histological examination.
Results
Of the total cases of SCD, 264 (4%) were due to HCM. Our cohort of young decedents comprised of 66 individuals (average age 21±5 years, males 76%). For the majority (n=52, 79%) SCD was the first manifestation of HCM. The average heart weight was 507±152 grams and left ventricular (LV) fibrosis was found in 28 (42%) cases (Figure 1A). Death was more common between 16 and 20 years of age (n=24) (Figure 1B). Death occurred during exertion in 25 (38%) individuals and at rest or during daily activities in the remaining 41 (62%), including 5 individuals who died during sleep. Male sex was more represented among decedents who died during exertion (88% compared with 68% in the group that died at rest, p=0.07); LV fibrosis was more commonly observed in individuals who died during exertion (56% compared with 34% in the group who died at rest, p=0.08). Younger individuals between 10–15 years of age died mostly during exercise (80%), in other age groups death occurred mainly at rest (33% in age group 16–20 years, 30% in age group 21–25 years, 33% in age group 26–30 years) (Figure 1B).
Conclusions
We observed a high age-related variability in terms of circumstances of death. In the context of HCM, our findings suggest that individuals aged 10–15 years are the most vulnerable in terms of exercise-related-SCD. This exemplifies the importance of preventative cardiac screening in young individuals who might be harbouring quiescent cardiac conditions associated with young SCD.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Acknowledgements: We thank the charitable organisation, Cardiac Risk in the Young (CRY) who fund and support the CRY Cardiovascular Pathology Unit and CRY database.
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Affiliation(s)
- R Bhatia
- St George's University of London , London , United Kingdom
| | - J Westaby
- St George's University of London , London , United Kingdom
| | - E Behr
- St George's University of London , London , United Kingdom
| | - M Papadakis
- St George's University of London , London , United Kingdom
| | - S Sharma
- St George's University of London , London , United Kingdom
| | - G Finocchiaro
- St George's University of London , London , United Kingdom
| | - M Sheppard
- St George's University of London , London , United Kingdom
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11
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Woodworth C, Linehan V, Hache N, Bhatia R, Bartlett P. Challenges in Initiating a Cerebral Aneurysm Coiling Programme in a Small Centre: Our Experience after the First 100 Cases. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- C Woodworth
- Discipline of Radiology, Faculty of Medicine, Memorial University of Newfoundland, Canada
| | - V Linehan
- Department of Diagnostic Radiology, Faculty of Medicine, Dalhousie University, Canada
| | - N Hache
- Discipline of Radiology, Faculty of Medicine, Memorial University of Newfoundland, Canada
| | - R Bhatia
- Discipline of Radiology, Faculty of Medicine, Memorial University of Newfoundland, Canada
| | - P Bartlett
- Discipline of Radiology, Faculty of Medicine, Memorial University of Newfoundland, Canada
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12
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Maclachlan H, Castelletti S, Bhatia R, Chatrath N, Fyazz S, Marwaha S, Thurdnampetch K, Gilchrist J, Adil S, Chang V, Basu J, Miles C, Sharma S, Papadakis M. Prevalence and outcomes of WPW pattern in the young: a report from a nationwide cardiac screening programme. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Individuals with accessory pathways, also referred as the Wolff-Parkinson-White pattern (WPWp), are usually asymptomatic and fatal arrhythmias may be the first presentation. Risk stratification is recommended, with electrophysiological study (EPS) being the gold standard. Catheter ablation offers a widely available, curative option, and provides incentive for screening, particularly in high-risk populations such as athletes.
Purpose
We sought to assess the prevalence, real-world clinical practice and outcomes of WPWp in young individuals identified through a nationwide cardiac screening programme.
Method
Between 2008 and 2018, 113,209 consecutive individuals (14 to 35 years old, 38% female) underwent cardiac screening with a health questionnaire, 12-lead electrocardiogram (ECG) and cardiology consultation. Individuals with suspected cardiac disease were referred for further investigations as necessary. Clinical outcomes were obtained via an online questionnaire and matched de-identified records from the Office of National Statistics database. Individuals were classified as elite athletes, non-elite athletes and non-athletes.
Results
A total of 214 (0.2%) individuals were referred for secondary evaluation with a suspected WPWp (Figure 1). Clinical outcomes were unavailable for 30 (14%) individuals. Follow-up confirmed an additional 13 individuals with a WPWp who were deemed to have normal investigations at screening, of which 8 (61%) had reported cardiovascular symptoms on their HQ and, in retrospect, 4 (30%) demonstrated subtle WPWp on their ECG. A WPWp was confirmed in 187 individuals (0.2%), of which 149 (80%) individuals were considered non-athletes, 114 (61%) reported cardiovascular symptoms, 116 (62%) underwent risk stratification with an EPS and 95 (43%) underwent catheter ablation. Report of palpitation was significantly greater in non-athletes than athletes (p=0.034). In asymptomatic individuals, those engaging in sports at elite level were more likely to be referred for an EPS (p=0.04). Four adverse cardiac events were reported over a follow up period of 7.4 years (IQR 4.9 to 9.2), including 3 individuals (16 years, 20 years, 40 years) with life-threatening arrhythmic events (LAE) requiring cardioversion, and 1 individual (20 years) with sudden cardiac death. Of these 4 individuals, only 1 with a LAE had undergone risk stratification with EPS.
Conclusions
The incidence of SCD in this young screened population was 0.72 per 1000 person-years. Clinical practice was variable and EPS was not offered to a significant proportion of patients, despite inadequate non-invasive risk stratification. The indication to EPS was driven by the athletic status in the asymptomatic individuals. The WPW syndrome may manifest with subtle ECG changes, posing a diagnostic challenge to interpreting physicians.
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Affiliation(s)
- H Maclachlan
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Castelletti
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit and department of Cardiovascular, Neural and Metabolic Science, MIlan, Italy
| | - R Bhatia
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - N Chatrath
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Fyazz
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Marwaha
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - K Thurdnampetch
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Gilchrist
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Adil
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - V Chang
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Basu
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - C Miles
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Sharma
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Papadakis
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
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13
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MacLachlan H, Dhutia H, Bhatia R, Boden K, Forenc K, Basu J, Miles C, Osborne R, Chandra N, Malhotra A, Stuart G, Peirce N, Sharma S, Papadakis M. Results of a nationally implemented cardiac screening programme in elite cricket players in England and Wales. J Sci Med Sport 2021; 25:287-292. [PMID: 35016820 DOI: 10.1016/j.jsams.2021.12.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/30/2021] [Accepted: 12/05/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We assessed the diagnostic yield and costs of an electrocardiogram-based national screening programme in elite cricket players and the incremental value of transthoracic echocardiography and periodic evaluation. DESIGN Cross-sectional study. METHODS Between 2008 and 2019, 1208 cricketers underwent screening with a health questionnaire, 12-lead electrocardiogram and cardiology consultation. Athletes with concerning findings underwent on-site transthoracic echocardiography and further investigations as necessary. In addition, despite a normal health questionnaire and electrocardiogram, 342 (28.3%) athletes had a transthoracic echocardiogram and 493 (40.8%) underwent repeat evaluations. RESULTS After initial evaluation, 47 (3.9%) athletes underwent on-site transthoracic echocardiography of whom 35 (2.8%) were referred for further evaluation. Four athletes (0.3%) were diagnosed with major cardiac conditions; hypertrophic cardiomyopathy (n = 1), arrhythmogenic cardiomyopathy (n = 1) and Wolff-Parkinson-White pattern (n = 2). Two athletes were identified with minor valvular abnormalities. Repeat evaluation of 493 athletes identified hypertrophic cardiomyopathy in a 22-year-old athlete, two years after his initial normal screening. During a follow-up of 5.8 ± 2.9 years no additional diagnoses or adverse cardiac events were reported. The cost of the electrocardiogram-based programme was £127,844, translating to £106 per athlete and £25,569 per major cardiac condition identified.Routine transthoracic echocardiography in 342 athletes identified two athletes with major cardiac conditions (bicuspid aortic valve with severe aortopathy and aortic regurgitation and an atrial septal defect associated with right ventricular volume overload) and 10 athletes with minor abnormalities. CONCLUSIONS An electrocardiogram-based national screening programme identified a major cardiac condition in 0.3% of athletes. Routine transthoracic echocardiography and periodic evaluation increased the diagnostic yield to 0.6%, at an incremental cost.
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Affiliation(s)
- H MacLachlan
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - H Dhutia
- Department of Cardiology, Glenfield Hospital, United Kingdom
| | - R Bhatia
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - K Boden
- England and Wales Cricket Board and National Centre for Sports and Exercise Medicine and National Cricket Performance Centre, Loughborough University, United Kingdom
| | - K Forenc
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - J Basu
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - C Miles
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - R Osborne
- Cardiac Risk in the Young, United Kingdom
| | - N Chandra
- Department of Cardiology, Frimley Park Hospital, United Kingdom
| | - A Malhotra
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - G Stuart
- National Institute of Health Research Cardiovascular Biomedical Research Centre, Bristol Heart Institute, United Kingdom
| | - N Peirce
- England and Wales Cricket Board and National Centre for Sports and Exercise Medicine and National Cricket Performance Centre, Loughborough University, United Kingdom
| | - S Sharma
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - M Papadakis
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom.
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14
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Morcos M, Bhatia R, Li K, Viswanathan A. Prospective Trial of Hydrogel Visualization and Dosimetric Effects on Rectum and Tumor Dose in Gynecologic Brachytherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Bhatia R, Ramogola-Masire D, Friebel-Klingner T, Monare B, Grover S. Cervical Cancer Screening in Botswana: An Urgent Call for Guideline Change. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Babu A, Eden N, Meng Z, Lamb D, Bhatia R, Voon V. Can echocardiographic parameters predict mortality in COVID-19? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), otherwise known as the coronavirus (COVID-19) pandemic presents one of the greatest medical challenges of our generation. Whilst commonly causing a viral pneumonitis, myocardial damage has also been suggested by elevated serum troponin values greater than the 99th centile in up to 30% of individuals who require hospitalisation and correlates with increased mortality.
Purpose
We aim to identify whether transthoracic echocardiography (TTE) parameters can elucidate the phenomenon of abnormal troponin levels. Furthermore, we seek to characterise the most frequent demographic, biochemical, echocardiographic features and co-morbidities associated with adverse outcomes in this cohort.
Methods
A retrospective analysis was conducted utilising electronic patient records of consecutive hospitalised patients with a positive COVID-19 swab between 1st March and 31st October 2020 who underwent a TTE at our institution. Pertinent variables were collected including: the clinical indication, demographics including cardiovascular (CV) risk factors, peak troponin values and fundamental echocardiographic parameters.
Results
During this 8-month period, a total of 90 patients underwent a TTE. The mean age of the cohort was 63 years of age and 56% were male. More than half (56.6%) were admitted to the intensive care unit (ICU). A salient 41.1% (n=37) of our cohort succumbed to this devastating virus. Notably, 38.9% (n=35) were of black and minority ethnic origin (BAME). A striking 64.9% (n=24) of patients who died had hypertension. The mean troponin levels were 168.7 ng/L and 176.6 ng/L (0–34 ng/L) in the survivors and non-survivors group respectively. With regards to TTE, the left ventricular parameters were similar between both groups with a mean left ventricular ejection fraction (LVEF) of 60.6% in the non-survivors. Conversely, both right ventricular (RV) dysfunction (37.8%) and raised pulmonary artery systolic pressures (PASP) (51.4%) were markedly more frequent in the patients who perished due to COVID-19 infection.
Conclusion
Remarkably, in this extremely ill group of patients who died, 91.9% of patients had a preserved LVEF. There were no overt differences between troponin levels in the survivors and non-survivors. However, hypertension, RV dysfunction and raised PASP were distinctly more prominent in the non-survivors. Thus, providing insight that a normally functioning left ventricle does not preclude to poor outcomes. Overall, this single-centre retrospective study demonstrates that the echocardiographic phenotype associated with mortality is consistent with a severe respiratory illness rather than direct myocardial injury from COVID-19. A multi-modality imaging approach may facilitate the identification of adverse tissue characterisation changes associated with this novel virus as well as guiding further risk stratification and patient management on a case-by-case basis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Babu
- Homerton University Hospital, London, United Kingdom
| | - N Eden
- Homerton University Hospital, London, United Kingdom
| | - Z Meng
- Homerton University Hospital, London, United Kingdom
| | - D Lamb
- Homerton University Hospital, London, United Kingdom
| | - R Bhatia
- St George's University Hospital NHS Foundation Trust, Cardiology, London, United Kingdom
| | - V Voon
- Homerton University Hospital, London, United Kingdom
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17
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Saigal G, Pisani L, Allakhverdieva E, Aristizabal J, Lehmkuhl D, Contreras F, Bhatia R, Sidani C, Quencer R. Utility of Microhemorrhage as a Diagnostic Tool in Distinguishing Vestibular Schwannomas from other Cerebellopontine Angle (CPA) Tumors. Indian J Otolaryngol Head Neck Surg 2021; 73:321-326. [PMID: 34471620 DOI: 10.1007/s12070-021-02372-8] [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: 10/22/2020] [Accepted: 01/04/2021] [Indexed: 11/24/2022] Open
Abstract
Although a majority of tumors in the Cerebellopontine Angle (CPA) are vestibular schwannomas (VS), other masses can also be seen in the region and differentiation of various CPA tumors, particularly meningiomas can be difficult on imaging alone. Treatment options may vary based on specific pathology of the CPA tumor. In this study, the presence of microhemorrhage (MH) and other imaging features such as size of lesion, cystic features and pattern of IAC extension, were evaluated as a tool in distinguishing VS from other CPA masses. A review of CPA masses in the last 11 years at our institution was performed. All the pathology proven tumors with at least 1 pre-operative MRI were considered for analysis. A T2* GRE or SWI sequence was used to assess presence of MH within the lesion. Pattern of IAC extension ('centric' versus 'eccentric') of tumor was also evaluated. A total of 147 patients were reviewed out of which 102 patients (with T2* GRE or SWI) were included for analysis of MH. 57 patients (56%) had VS as the final histopathological diagnosis and 45 patients (44%) had other types of tumor. A sensitivity of 82% and a specificity of 98% was noted for the presence of MH favoring the diagnosis of VS from other tumors (p < 0.001). All meningiomas with IAC extension (25/31) showed an 'eccentric' pattern of extension into the canal. Visualization of MH and pattern of IAC extension is useful in the differentiation of schwannomas from other CPA masses, particularly meningiomas.
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Affiliation(s)
- G Saigal
- Department of Radiology, WW279, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL 33136 USA
| | - L Pisani
- Emory University, 1364 Clifton Road Northeast, Atlanta, GA 30322 USA
| | - E Allakhverdieva
- Department of Radiology, WW279, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL 33136 USA.,Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL 33136 USA
| | - J Aristizabal
- University of Antioquia, Cl. 67 ##53-108, Medellín, Antioquia, , CO USA
| | - D Lehmkuhl
- Department of Radiology, WW279, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL 33136 USA.,Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL 33136 USA
| | - F Contreras
- Department of Radiology, WW279, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL 33136 USA.,Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL 33136 USA
| | - R Bhatia
- Department of Radiology, WW279, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL 33136 USA
| | - C Sidani
- Department of Radiology, WW279, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL 33136 USA
| | - R Quencer
- Department of Radiology, WW279, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL 33136 USA
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18
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Khoury S, Bhatia R, Marwaha S, Bunce N, Papadakis M, Sharma S, Tome M. Race, gender and clinical presentation in apical hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The apical variant of hypertrophic cardiomyopathy (ApHCM) has male predominance and is a relatively rare phenotype in Western population. Characteristics of female and black patients diagnosed with ApHCM are very limited in the existing literature.
Purpose
We aimed to investigate whether gender and race are associated with a different clinical presentation and CMR findings in apical HCM.
Methods
We retrospectively analysed 150 patients (113 males and 37 females) with a diagnosis of apical HCM who have been followed in our inherited cardiac conditions (ICC) clinic between 2010 and 2020. Only patients with a CMR study and apical hypertrophy defined as ≥ 13mm at the time of diagnosis were included.
Demographics and clinical characteristics were obtained from electronic records. Volumetric CMR data were taken from confirmed reports while other parameters were measured by standard protocol. "Pure" ApHCM was defined as isolated apical hypertrophy and "mixed" with both apical and septal hypertrophy but with the apex thickest (1). Apical displacement of papillary muscles (PM) was defined when the base of PM originated from the apical one-third of the left ventricle (LV) in the apical 4- or 2-chamber views. Giant T-wave inversion was defined as T-wave inversion that is equal or greater than 10 mm (1 mV) in any electrocardiogram lead.
Results
Our study population included patients of White (55, 37%), Black (37, 25%), Asian (36, 24%) and Mixed/Others (22, 15%) ethnicity. Black patients were more likely to have a diagnosis of hypertension at presentation when compared to White (70% vs 40%, p = 0.01) and to Asian and Mixed/Other patients (70% vs 48%, p = 0.03). Similarly, they were more likely to have "mixed" ApHCM than White (49% vs 20%, p = 0.003) and Asian and Mixed/Other (49% vs 26%, p = 0.02) patients.
Females were diagnosed at an older age (63 ± 12 vs 52 ± 14, p < 0.001) and were less likely to have deep T-wave inversion on their ECG at presentation (14% vs 32%, p = 0.03) compared to their male counterparts. Females in this cohort also had higher representation of black ethnicity and were more likely to have hypertension (68% vs 47%, p = 0.03). Apart from the expected gender related differences in volumes and LV mass, there were no differences in cardiomyopathy-specific parameters we investigated.
Conclusions
In our cohort, females with ApHCM presented at an older age and were less likely to have giant T-wave inversion on ECG. Black patients with ApHCM were more likely to have hypertension and the "mixed" type of the disease.
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Affiliation(s)
- S Khoury
- St George"s University Hospital NHS Foundation Trust, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - R Bhatia
- St George"s University Hospital NHS Foundation Trust, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - S Marwaha
- St George"s University Hospital NHS Foundation Trust, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - N Bunce
- St George"s University Hospital NHS Foundation Trust, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - M Papadakis
- St George"s University Hospital NHS Foundation Trust, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - S Sharma
- St George"s University Hospital NHS Foundation Trust, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - M Tome
- St George"s University Hospital NHS Foundation Trust, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, London, United Kingdom of Great Britain & Northern Ireland
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Darivemula S, Bhatia R, Bhumi S. Dancing doctors: exploring the potential of cultural dance education to improve cultural competency and clinical communication. Public Health 2021; 195:22-23. [PMID: 34034001 DOI: 10.1016/j.puhe.2021.03.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE One of the largest barriers towards the utilization and overall success of health interventions for minority communities is the difference between the cultures of healthcare services and service users. Medical students, physicians, and healthcare systems are taught to be culturally competent, yet multiple studies demonstrate the persistence of differences in perception of care and disparities in outcomes for communities of colour. This article aims to offer a patient-centred, culturally nuanced medium for teaching cultural competency. STUDY DESIGN This is a brief report based on experiential learning, observations, and a short literature review on understanding culture through traditional dances. METHODS To address cultural disconnect between clinical medicine and diverse patients, we recommend encouraging patients from diverse backgrounds to teach physicians how to perform cultural dances. RESULTS Traditional dance appears to be a culturally rich source for holistically educating physicians on cultural competency. CONCLUSION This process of learning a cultural dance can improve cultural humility and cultural competency, and clinical communication between the provider and public.
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Affiliation(s)
- S Darivemula
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Dept of OBGYN, Lebanon, NH 03756, USA.
| | - R Bhatia
- Johns Hopkins Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, 401 North Broadway Baltimore, MD, 21287, USA.
| | - S Bhumi
- University of Connecticut Health, Department of Internal Medicine, 263 Farmington Avenue, Farmington, CT 06030-1235, USA.
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Bains L, Bhatia R, Lal P, Bhagria G. Giant bilateral angiomyolipoma of the kidney. Ann R Coll Surg Engl 2021; 103:e184-e188. [PMID: 33955281 DOI: 10.1308/rcsann.2020.7036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Angiomyolipoma is a benign solid renal neoplasm. A giant angiomyolipoma is more than 10cm by size, but it can grow to huge proportions. Our case appears to be the third largest angiomyolipoma and the largest among bilateral giant renal angiomyolipoma in the indexed literature. A 26-year-old man presented with large right abdominal swelling for the past three years, which was occupying his right flank and iliac region, extending beyond the midline. Computed tomography of the abdomen revealed a large well-defined mass in the right side of the abdomen, crossing the midline and measuring 35 × 20 × 12cm. The left kidney showed a similar fatty lesion of 14 × 6cm. The findings were consistent with angiomyolipoma. Further evaluation for tuberous sclerosis by magnetic resonance imaging the brain demonstrated multiple subependymal nodules. Giant renal angiomyolipoma is an uncommon tumour with bilateral giant angiomyolipoma being a rare entity. Preoperative embolisation helps in reducing size of the tumour. In case of giant and bilateral angiomyolipoma, evaluation for tuberous sclerosis should always be done.
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Affiliation(s)
- L Bains
- Maulana Azad Medical College, New Delhi, India
| | - R Bhatia
- Maulana Azad Medical College, New Delhi, India
| | - P Lal
- Maulana Azad Medical College, New Delhi, India
| | - G Bhagria
- Maulana Azad Medical College, New Delhi, India
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21
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Tanwar S, Mattoo B, Kumar U, Dada R, Bhatia R. Does human serotonin-1A receptor polymorphism (rs6295) code for pain and associated symptoms in fibromyalgia syndrome? Reumatismo 2021; 73:24-31. [PMID: 33874644 DOI: 10.4081/reumatismo.2021.1312] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 02/23/2021] [Indexed: 11/22/2022] Open
Abstract
Genetic predisposition may play an important role in the development of fibromyalgia syndrome (FMS). Serotonin is known to be involved in pain modulation and serotonin-1A receptor plays a considerable role in determining the central 5-HT tone. Consequently, variation in 5-HT1A receptor gene (HTR1A) may be responsible for inter-individual variability in pain sensitivity and other clinical symptoms of FMS. Therefore, the objectives of this research work were to study the gene polymorphism of 5-HTR1A gene and to explore the correlation between rs6295 genotype (-1019C/G HTR1A) and duration of pain, pain intensity and pain related depression and anxiety, if any, in FMS. 5-HTR1A genotype for the C(-1019)G polymorphism was typed in 62 patients with FMS and 42 healthy subjects. Present pain intensity, components of pain and pain related depression and anxiety were assessed using the numerical pain rating scale, McGill pain questionnaire and Hamilton depression and anxiety rating scale respectively. 5-HTR1A gene was represented by three different genotypes, homozygous C/C, heterozygous C/G and homozygous G/G. Analysis of the 5-HTR1A gene showed a frequency of 58%, 31% and 11% for the C/C, C/G and G/G genotypes, respectively in FMS group. This proportion was 69%, 23% and 8% in healthy subjects. No significant correlation was observed between 5-HTR1A gene polymorphism and pain and related symptoms in FMS patients. To the best of our knowledge this is the first study which investigated the correlation between the 5-HTR1A gene polymorphism and pain intensity, the affective component of pain, pain related depression and anxiety in FMS.
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Affiliation(s)
- S Tanwar
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - B Mattoo
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - U Kumar
- Department of Rheumatology, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - R Dada
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi.
| | - R Bhatia
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi.
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22
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Sharma H, Vishnu V, Kumar N, Sreenivas V, Rajeswari M, Bhatia R, Sharma R, Srivastava MP. Efficacy of Low-Frequency Repetitive Transcranial Magnetic Stimulation in Ischemic Stroke: A Double-Blind Randomized Controlled Trial. Arch Rehabil Res Clin Transl 2021; 2:100039. [PMID: 33543068 PMCID: PMC7853333 DOI: 10.1016/j.arrct.2020.100039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the role of low-frequency repetitive transcranial magnetic stimulation (rTMS) along with conventional physiotherapy in the functional recovery of patients with subacute ischemic stroke. Design Double-blind, parallel group, randomized controlled trial. Setting The outpatient department of a tertiary hospital participants: first ever ischemic stroke patients (N=96) in the previous 15 days were recruited and were randomized after a run-in period of 75±7 days into real rTMS (n=47) and sham rTMS (n=49) groups. Intervention Conventional physical therapy was given to both the groups for 90±7 days postrecruitment. Total 10 sessions of low-frequency rTMS on contralesional premotor cortex was administered to real rTMS group (n=47) over a period of 2 weeks followed by physiotherapy regime for 45-50 minutes. Main Outcome Measures The primary efficacy outcomes were change in modified Barthel Index (mBI) score (pre- to postscore) and proportion of participants with mBI score more than 90, measured at 90±7 days postrecruitment. The secondary outcomes were change in Fugl-Meyer Assessment–upper extremity, Fugl-Meyer Assessment–lower extremity, Hamilton Depression Scale, modified Rankin Scale, and National Institute of Health and Stroke Scale (pre- to post-rTMS) scores at 90±7 days post recruitment. Results Modified intention to treat analysis showed a significant increase in the mBI score from pre- to post-rTMS in real rTMS group (4.96±4.06) versus sham rTMS group (2.65±3.25). There was no significant difference in proportion of patients with mBI>90 (55% vs 59%; P=.86) at 3 months between the groups. Conclusion In patients with subacute ischemic stroke, 1-Hz low-frequency rTMS on contralesional premotor cortex along with conventional physical therapy resulted in significant change in mBI score.
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Key Words
- BI, Barthel Index
- EEG, electroencephalogram
- HAMD, Hamilton Depression Scale
- MCID, minimal clinically important difference
- MEP, motor evoked potential
- NIHSS, National Institutes of Health and Stroke Scale
- RCT, randomized controlled trial
- Rehabilitation
- Stroke
- TMS, transcranial magnetic stimulation
- Transcranial magnetic stimulation
- mBI, modified Barthel Index
- mRS, modified Rankin Scale
- rTMS, repetitive transcranial magnetic stimulation
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Affiliation(s)
- H. Sharma
- Department of Neurology, All India Institutes of Medical Sciences, New Delhi
| | - V.Y. Vishnu
- Department of Neurology, All India Institutes of Medical Sciences, New Delhi
| | - N. Kumar
- Department of Psychiatry, All India Institutes of Medical Sciences, New Delhi
| | - V. Sreenivas
- Department of Biostatistics, All India Institutes of Medical Sciences, New Delhi
| | - M.R. Rajeswari
- Department of Biochemistry, All India Institutes of Medical Sciences, New Delhi, India
| | - R. Bhatia
- Department of Neurology, All India Institutes of Medical Sciences, New Delhi
| | - R. Sharma
- Department of Neurology, All India Institutes of Medical Sciences, New Delhi
| | - M.V. Padma Srivastava
- Department of Neurology, All India Institutes of Medical Sciences, New Delhi
- Corresponding author M.V. Padma Srivastava, MD, DM, Department of Neurology, RN 708, CN Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India.
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23
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Cuschieri K, Pan J, O Donnell M, Kirkwood K, Kavanagh K, Pollock KG, Bhatia R, Graham SV, Wakeham K. Penile cancer and the HPV attributable fraction in Scotland; A retrospective cohort study. J Clin Virol 2020; 134:104717. [PMID: 33360857 DOI: 10.1016/j.jcv.2020.104717] [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: 10/01/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Penile cancer (PeC) is a highly morbid disease which is rising in certain settings including Scotland. A component of PeC is associated with Human Papillomavirus (HPV) although its influence on clinical outcomes is debatable as is whether the fraction attributable to HPV is increasing. METHODS A total of 122 archived tissue samples derived from patients diagnosed with PeC between 2006-2015 were collated and tested for HPV DNA using molecular PCR. HPV positivity was determined for the overall population and by calendar year of diagnosis to determine any temporal trends. The influence of age, deprivation, smoking, tumour stage and tumour grade on likelihood of HPV positivity was determined by logistic regression. In addition, the influence of HPV status and the other clinical and demographics variables on all-cause death and death from PeC was assessed. RESULTS HPV was detected in 43 % (95 % CI: 34-52) of penile cancers and the majority of infections were HPV 16. The HPV component of PeC did not increase over the time period (p for linear trend - 0.226). No demographic or clinical variables were associated with HPV positivity neither was HPV status associated with improved all-cause or cancer-specific survival during the follow up period. CONCLUSION The rise in PeC in Scotland may not be attributable to a rise in HPV-associated cancer; this is consistent with oropharyngeal cancer (OPC) in the UK where there is an increase in both HPV positive and negative cancer. This work calls for a larger multi centre study to enable further detailed investigation into the implications of HPV infection in PeC.
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Affiliation(s)
- K Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, EH16 4SA, Scotland, United Kingdom; HPV Research Group, Queens Medical Research Institute, University of Edinburgh, EH16 4TJ, Scotland, United Kingdom.
| | - J Pan
- Department of Mathematics and Statistics, Strathclyde University, 26 Richmond Street, Glasgow, G1 1XH, Scotland, United Kingdom
| | - M O Donnell
- Department of Pathology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - K Kirkwood
- Department of Pathology, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, United Kingdom
| | - K Kavanagh
- Department of Mathematics and Statistics, Strathclyde University, 26 Richmond Street, Glasgow, G1 1XH, Scotland, United Kingdom
| | - K G Pollock
- School of Health and Life Sciences, Glasgow Caledonian University, G4 6OA, Scotland, United Kingdom
| | - R Bhatia
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, EH16 4SA, Scotland, United Kingdom; HPV Research Group, Queens Medical Research Institute, University of Edinburgh, EH16 4TJ, Scotland, United Kingdom
| | - S V Graham
- MRC-University of Glasgow Centre for Virus Research, Institute of Infection Immunity and Inflammation, University of Glasgow, G61 1QH, Scotland, United Kingdom
| | - K Wakeham
- MRC-University of Glasgow Centre for Virus Research, Institute of Infection Immunity and Inflammation, University of Glasgow, G61 1QH, Scotland, United Kingdom; Sussex Cancer Centre, Brighton and Sussex University Hospital NHS Trust, 2 Bristol Gate, Brighton, BN2 5BD, United Kingdom
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24
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Mir H, Chu C, Bouck Z, Sivaswamy A, Austin P, Dudzinski D, Nesbitt G, Edwards J, Yared K, Wong B, Hansen M, Weinerman A, Thavendiranathan P, Johri A, Rakowski H, Picard M, Weiner R, Bhatia R. IMPACT OF APPROPRIATE ECHOCARDIOGRAPHY USE ON UTILIZATION OF CARDIAC SERVICES AND OUTCOMES IN PATIENTS WITH HEART FAILURE OR CORONARY ARTERY DISEASE: A RETROSPECTIVE COHORT STUDY OF THE ECHO WISELY RANDOMIZED CONTROLLED TRIAL. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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25
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Dorian P, Bhatia R, Lebovic G, Leblanc K, Meshkat N, Mamdani M, Timofeeva M, Ha A, Morra D. TRANSITIONING EMERGENCY ATRIAL FIBRILLATION MANAGEMENT (TEAM): INTERIM ANALYSIS OF IMPACT ON CLINICAL OUTCOMES. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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26
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Agarwal A, Yadav D, Gupta A, Vishnu VY, Rajan R, Singh MB, Bhatia R, Srivastava Mv P. Delayed bilateral internal carotid artery dissection following motor vehicle accident: time to make its screening a part of trauma protocol? QJM 2020; 113:672-673. [PMID: 32096863 DOI: 10.1093/qjmed/hcaa037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - D Yadav
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - A Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - V Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - R Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - M B Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - R Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - P Srivastava Mv
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
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27
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Bhatia R, Sindhuja T, Bhatia S, Dev T, Gupta A, Bajpai M, Gupta S. Iatrogenic dermatitis in times of COVID-19: a pandemic within a pandemic. J Eur Acad Dermatol Venereol 2020; 34:e563-e566. [PMID: 32495393 PMCID: PMC7300601 DOI: 10.1111/jdv.16710] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 12/20/2022]
Affiliation(s)
- R Bhatia
- Department of Dermatology, All India Institute of Medical Sciences, Rishikesh, India
| | - T Sindhuja
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - S Bhatia
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - T Dev
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - A Gupta
- Skin Aid Clinic, Gurugram, India
| | - M Bajpai
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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28
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Abstract
Bictegravir (BIC), a second-generation integrase strand transfer inhibitor (INSTI) approved for HIV treatment in fixed-dose combination with emtricitabine and tenofovir alafenamide, has potent antiviral activity in vitro to wild-type virus and strains with resistance to first-generation INSTIs. As part of combination therapy, BIC's virologic suppression rates in clinical trials are comparable to those of first-line combination antiretroviral drug regimens. BIC has demonstrated a high genetic barrier to resistance development in vitro, can be administered with or without food, and has a bioavailability of > 70%. A median plasma half-life of 18 hours allows once-daily dosing. Clearance is primarily hepatic through cytochrome P450 3A4 (CYP3A4) oxidation and UDP-glucuronosyltransferase 1A1 (UGT1A1) glucuronidation. Thus, potent inducers of UGT1A1 and CYP3A4 (e.g., rifamycins/anticonvulsants) should be avoided due to significantly decreased BIC serum exposure. Chelation with polyvalent cations can decrease absorption; otherwise, drug-drug interactions are few. BIC is well tolerated; diarrhea, nausea and headache are the main adverse effects associated with its use.
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Affiliation(s)
- J Zeuli
- HIV Program, Division of Infectious Diseases and Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - S Rizza
- HIV Program, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - R Bhatia
- Department of Infectious Diseases, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Z Temesgen
- HIV Program, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.
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29
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Rajta A, Bhatia R, Setia H, Pathania P. Role of heterotrophic aerobic denitrifying bacteria in nitrate removal from wastewater. J Appl Microbiol 2019; 128:1261-1278. [PMID: 31587489 DOI: 10.1111/jam.14476] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [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: 06/11/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/27/2022]
Abstract
With the increase in industrial and agricultural activities, a large amount of nitrogenous compounds are released into the environment, leading to nitrate pollution. The perilous effects of nitrate present in the environment pose a major threat to human and animal health. Bioremediation provides a cost-effective and environmental friendly method to deal with this problem. The process of aerobic denitrification can reduce nitrate compounds to harmless dinitrogen gas. This review provides a brief view of the exhaustive role played by aerobic denitrifiers for tackling nitrate pollution under different ecological niches and their dependency on various environmental parameters. It also provides an understanding of the enzymes involved in aerobic denitrification. The role of aerobic denitrification to solve the issues faced by the conventional method (aerobic nitrification-anaerobic denitrification) in treating nitrogen-polluted wastewaters is elaborated.
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Affiliation(s)
- A Rajta
- Department of Biotechnology, University Institute of Engineering and Technology, Panjab University, Chandigarh, India
| | - R Bhatia
- Department of Biotechnology, University Institute of Engineering and Technology, Panjab University, Chandigarh, India
| | - H Setia
- Department of Biotechnology, University Institute of Engineering and Technology, Panjab University, Chandigarh, India
| | - P Pathania
- Department of Biotechnology, University Institute of Engineering and Technology, Panjab University, Chandigarh, India
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30
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Sisodia P, Bhatia R, Bali P, Singh N, Chauhan A, Hooda R, Saxena R, Srivastava M, Prasad K, Vishnubhatla S, Sharma G, Singh M. Aspirin resistance with mortality in patients with ischemic stroke. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Kaur H, Kumaran S, Bhatia R, Chopra S, Nehra A. Effectiveness of homebased comprehensive neuropsychological rehabilitation for post stroke aphasia in limited resource settings: An fMRI based randomized controlled trial. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Sharma J, Srivastava P, Bhatia R, Rajan R, Singh R, Goyal V, Singh M, Garg A, Vishnu V. ‘Prehospital’ delay in acute stroke reperfusion therapy in Delhi: Time for introspection. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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33
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MacDuffie E, Bvochara-Nsingo M, Wang Q, Ralefala T, Chiyapo S, Balang D, Bhatia R, Shin S, Zetola N, Grover S. Treatment Patterns of Vulvar Cancer in Women Living with HIV in Botswana. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Bhatia R, Balogun O, Simonds H, Vanderpuye V, Shah M, Yamoah K, Dominello M, Hanna N, Grover S. Radiation Therapy Current Practice Capacity and Needs Assessment in Africa. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1500] [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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35
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Abstract
Ibalizumab, a humanized monoclonal antibody to CD4, was recently approved by the United States Food and Drug Administration (FDA) for the treatment of HIV-1 infection in heavily treatment-experienced adults with multidrug-resistant HIV-1 infection failing their current antiretroviral regimen. Ibalizumab is the first in a new class of antiretroviral drugs designated as post-attachment inhibitors. It exerts its antiviral effect by noncompetitive binding of CD4, thereby blocking conformational changes in the CD4-gp120 complex that are essential for viral entry. Clinical studies have demonstrated ibalizumab's significant antiviral activity in patients with advanced HIV disease and extensive treatment experience, who had limited treatment options. Ibalizumab is administered intravenously at a dose of 800 mg every 2 weeks following a single intravenous loading dose of 2000 mg. The most common adverse reactions reported with the use of ibalizumab are diarrhea, dizziness, nausea and rash.
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Affiliation(s)
- S A Rizza
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - R Bhatia
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - J Zeuli
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Z Temesgen
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.
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Jeffs L, Jamieson T, Saragosa M, Mukerji G, Jain AK, Man R, Desveaux L, Shaw J, Agarwal P, Hensel JM, Maione M, Onabajo N, Nguyen M, Bhatia R. Uptake and Scalability of a Peritoneal Dialysis Virtual Care Solution: Qualitative Study. JMIR Hum Factors 2019; 6:e9720. [PMID: 30990460 PMCID: PMC6488957 DOI: 10.2196/humanfactors.9720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/27/2017] [Revised: 11/29/2018] [Accepted: 01/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background Early research in the area of virtual care solutions with peritoneal dialysis (PD) patients has focused on evaluating the outcomes and impact of these solutions. There has been less attention focused on understanding the factors influencing the uptake, usability, and scalability of virtual care for chronic kidney disease (CKD) patients receiving PD at home. Objective In this context, a study was undertaken to (1) assess and understand the factors influencing the uptake of a virtual care solution and (2) provide recommendations for the scalability of a virtual care solution aimed at enhancing CKD patients’ outcomes and experiences. Methods This study used a qualitative design with semistructured interviews and a thematic analysis approach. A total of 25 stakeholders—6 patients and 3 caregivers, 6 health care providers, 2 vendors, and 8 health system decision makers—participated in this study. Results The following three primary mechanisms emerged to influence the usability of the virtual care solution: (1) receiving hands-on training and ongoing communication from a supportive team, (2) adapting to meet user needs and embedding them into workflow, and (3) being influenced by patient and caregiver characteristics. Further, two overarching recommendations were developed for considerations around scalability: (1) co-design locally, embed into the daily workflow, and deploy over time and (2) share the benefits and build the case. Conclusions Study findings can be used by key stakeholders in their future efforts to enhance the implementation, uptake, and scalability of virtual care solutions for CKD and managing PD at home.
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Affiliation(s)
- Lianne Jeffs
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Trevor Jamieson
- St. Michael's Hospital, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Marianne Saragosa
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Geetha Mukerji
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Arsh K Jain
- London Health Sciences Centre, London, ON, Canada
| | - Rachel Man
- London Health Sciences Centre, London, ON, Canada
| | - Laura Desveaux
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - James Shaw
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Payal Agarwal
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer M Hensel
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | | | - Nike Onabajo
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Megan Nguyen
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - R Bhatia
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
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37
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Nanda S, Arya S, Tiwari V, Srikumar V, Kumar U, Bhatia R. Transcranial Magnetic Stimulation (TMS) induced Motor Evoked Potential (MEP) in Chronic Pain Patients. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.623] [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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38
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Tiwari V, Nanda S, Mattoo B, Kumar U, Kumaran S, Bhatia R. Effect of rTMS therapy on pain descriptors and corticomotor excitability in fibromyalgia: a randomized control trial. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.620] [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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39
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Bhatia R, El Atrouni W, Shweta F, Zeuli J, Rizza S, Temesgen Z. Update on HIV infection: A report from CROI 2019. Seattle, Washington, USA - March 4-7, 2019. DRUG FUTURE 2019. [DOI: 10.1358/dof.2019.44.5.2999434] [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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40
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Anakwenze C, Bhatia R, Rate W, Bakwenabatsile L, Ngoni K, Rayne S, Dhillon P, Narasimhamurthy M, Foster A, Grover S. Factors Related to Advanced Stage of Cancer Presentation in Botswana. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Turner J, Pond G, Tremblay A, Johnston M, Goss G, Nicholas G, Martel S, Bhatia R, Liu G, Schmidt H, Tammemagi M, Puksa S, Atkar-Khattra S, Tsao M, Lam S, Goffin J. P2.11-23 Risk Perception Among a Lung Cancer Screening Population. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42
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Nambirajan A, Sashidharan A, Garg A, Dash D, Bhatia R, Sharma MC, Mathur SR. Cytological diagnosis of cerebrotendinous xanthomatosis in two siblings presenting with bilateral ankle swellings and neurological decline. Cytopathology 2018; 29:482-485. [DOI: 10.1111/cyt.12573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- A. Nambirajan
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - A. Sashidharan
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - A. Garg
- Department of Neuroradiology; All India Institute of Medical Sciences; New Delhi India
| | - D. Dash
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - R. Bhatia
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - M. C. Sharma
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - S. R. Mathur
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
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43
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Schuld M, Perez J, Anderson C, Bhatia R, Ehlers M, Leger K, Lentz H, Marsh S, Haralson B, Puls A, Sheikh S, Smith A, Spellecy M, Sweeney M, Ya A, Antony E. ABCD: The Language of Replication Protein A (RPA). FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.lb210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - R. Bhatia
- Ronald Reagan High SchoolMilwaukeeWI
| | - M. Ehlers
- Ronald Reagan High SchoolMilwaukeeWI
| | - K. Leger
- Ronald Reagan High SchoolMilwaukeeWI
| | - H. Lentz
- Ronald Reagan High SchoolMilwaukeeWI
| | - S. Marsh
- Ronald Reagan High SchoolMilwaukeeWI
| | | | - A. Puls
- Ronald Reagan High SchoolMilwaukeeWI
| | - S. Sheikh
- Ronald Reagan High SchoolMilwaukeeWI
| | - A. Smith
- Ronald Reagan High SchoolMilwaukeeWI
| | | | | | - A. Ya
- Ronald Reagan High SchoolMilwaukeeWI
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44
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Rizza S, Bhatia R, Temesgen Z. Novel HIV drugs and drug delivery strategies. A report from the 2018 Conference on Retroviruses and Opportunistic Infections. Boston, Massachusetts, USA - March 4-7, 2018. DRUG FUTURE 2018. [DOI: 10.1358/dof.2018.043.04.2809259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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45
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Affiliation(s)
- V.K. Sharma
- Department of Dermatology and Venereology All India Institute of Medical Sciences New Delhi India
| | - R. Bhatia
- Department of Dermatology and Venereology All India Institute of Medical Sciences New Delhi India
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46
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Bhatia R, Mattoo B, Tanwar S, Jain S, Kumar U, Bhatia R. Transcranial magnetic stimulation of dorsolateral prefrontal cortex in chronic pain management. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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47
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Ha VL, Luong A, Li F, Casero D, Malvar J, Kim YM, Bhatia R, Crooks GM, Parekh C. The T-ALL related gene BCL11B regulates the initial stages of human T-cell differentiation. Leukemia 2017; 31:2503-2514. [PMID: 28232744 DOI: 10.1038/leu.2017.70] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/16/2017] [Accepted: 02/15/2017] [Indexed: 02/07/2023]
Abstract
The initial stages of T-cell differentiation are characterized by a progressive commitment to the T-cell lineage, a process that involves the loss of alternative (myelo-erythroid, NK, B) lineage potentials. Aberrant differentiation during these stages can result in T-cell acute lymphoblastic leukemia (T-ALL). However, the mechanisms regulating the initial stages of human T-cell differentiation are obscure. Through loss of function studies, we showed BCL11B, a transcription factor recurrently mutated T-ALL, is essential for T-lineage commitment, particularly the repression of NK and myeloid potentials, and the induction of T-lineage genes, during the initial stages of human T-cell differentiation. In gain of function studies, BCL11B inhibited growth of and induced a T-lineage transcriptional program in T-ALL cells. We found previously unknown differentiation stage-specific DNA binding of BCL11B at multiple T-lineage genes; target genes showed BCL11B-dependent expression, suggesting a transcriptional activator role for BCL11B at these genes. Transcriptional analyses revealed differences in the regulatory actions of BCL11B between human and murine thymopoiesis. Our studies show BCL11B is a key regulator of the initial stages of human T-cell differentiation and delineate the BCL11B transcriptional program, enabling the dissection of the underpinnings of normal T-cell differentiation and providing a resource for understanding dysregulations in T-ALL.
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Affiliation(s)
- V L Ha
- Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - A Luong
- Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - F Li
- MiNGS Core Laboratory, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - D Casero
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine University of California, Los Angeles, Los Angeles, CA, USA
| | - J Malvar
- Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Y M Kim
- Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R Bhatia
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - G M Crooks
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine University of California, Los Angeles, Los Angeles, CA, USA.,Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - C Parekh
- Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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48
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Rizza S, El Atrouni W, Bhatia R, Temesgen Z. Advances in HIV therapeutics. A report from the 2017 Conference on Retroviruses and Opportunistic Infections (CROI). Seattle, Washington, USA - February 13-16, 2017. DRUG FUTURE 2017. [DOI: 10.1358/dof.2017.042.04.2625317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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49
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Gupta V, Bhatia R, Singh UB, Ramam M, Gupta S. Penile 'tuberculid': could it be sexually acquired primary inoculation tuberculosis? J Eur Acad Dermatol Venereol 2016; 30:e164-e166. [PMID: 26515329 DOI: 10.1111/jdv.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- V Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - R Bhatia
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - U B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - M Ramam
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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50
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Cuschieri K, Kavanagh K, Moore C, Bhatia R, Love J, Pollock KG. Impact of partial bivalent HPV vaccination on vaccine-type infection: a population-based analysis. Br J Cancer 2016; 114:1261-4. [PMID: 27115467 PMCID: PMC4891516 DOI: 10.1038/bjc.2016.97] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/06/2016] [Accepted: 03/13/2016] [Indexed: 02/01/2023] Open
Abstract
Background: Data on the effectiveness of one dose of HPV vaccine are lacking, particularly in population-based settings. Data from a national HPV immunisation catch-up programme of 14–18-year-old girls were used to assess the effectiveness of<3 doses of the bivalent vaccine on vaccine-type and cross-reactive-type HPV infection. Methods: Cervical samples from women attending for their first cervical smear, which had been genotyped for HPV as part of a longitudinal HPV surveillance programme were linked to immunisation records to establish the number of vaccine doses (0, 1, 2 and 3) administered. Vaccine effectiveness (VE) adjusted for deprivation and age at first dose, was assessed for prevalent HPV 16/18 and HPV 31/33/45 infection. Results: VE for prevalent HPV 16/18 infection associated with 1, 2 and 3 doses was 48.2% (95% CI 16.8, 68.9), 54.8% (95% CI 30.7, 70.8) and 72.8% (95% CI 62.8, 80.3). Equivalent VE for prevalent HPV 31/33/45 infection was −1.62% (95% CI −85.1, 45.3), 48.3% (95% CI 7.6, 71.8) and 55.2% (95% CI 32.6, 70.2). Conclusions: Consistent with recent aggregated trial data, we demonstrate the potential effectiveness of even one dose of HPV vaccine on vaccine-type infection. Given that these women were immunised as part of a catch-up campaign, the VE observed in this study is likely to be an underestimate of what will occur in girls vaccinated at younger ages. Further population-based studies which look at the clinical efficacy of one-dose schedules are warranted.
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Affiliation(s)
- K Cuschieri
- Scottish HPV Reference Laboratory, Division of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, Scotland.,HPV Research Group, Queens Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, 26 Richmond Street, Glasgow G1 1XH, Scotland
| | - C Moore
- Scottish HPV Reference Laboratory, Division of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, Scotland
| | - R Bhatia
- HPV Research Group, Queens Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland
| | - J Love
- Health Protection Scotland, Meridian Court, Glasgow G2 6QE, Scotland
| | - K G Pollock
- Health Protection Scotland, Meridian Court, Glasgow G2 6QE, Scotland
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