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Kortbeek S, Anderson SG, Alonso EM, Rand EB, Bucuvalas J, Mazariegos GV, Campbell KM, Lobritto SJ, Feldman AG, Mysore KR, Anand R, Selzner N, Ng VL. Immunosuppression-Free Life after Pediatric Liver Transplant: A Case-Control Study from the Society of Pediatric Liver Transplant (SPLIT) Registry. J Pediatr 2024; 264:113744. [PMID: 37726087 DOI: 10.1016/j.jpeds.2023.113744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To compare long-term outcomes of pediatric liver transplant (LT) recipients off immunosuppression (IS) with matched controls on IS using data from the Society of Pediatric Liver Transplant (SPLIT) registry. STUDY DESIGN This was a retrospective case-control study. SPLIT participants <18 years of age, ≥4 years after isolated LT, and off IS for ≥1 year (cases) were age- and sex-matched 1:2 to patients with the same primary diagnosis and post-LT follow-up duration (controls). Primary outcomes included retransplantation, allograft rejection, IS comorbidities, and prevalence of SPLIT-derived composite ideal outcome (c-IO) achieved at the end of the follow-up period. Differences were compared using multiple linear regression for continuous outcomes and logistic regression for dichotomous data. RESULTS The study cohort was composed of 33 cases (42.4% male, 60.6% biliary atresia, median age at LT of 0.7 [P25, P75, 0.5, 1.6] years, median IS withdrawal time of 9 [P25, P75, 6, 12] years after LT) and 66 age- and sex-matched controls. No cases required retransplantation. Cases and controls had similar growth parameters, laboratory values, calculated glomerular filtration rates, rates of post-transplant lymphoproliferative disease, graft rejection, and attainment of c-IO. CONCLUSIONS No differences in allograft rejection rates, IS complications, or c-IO prevalence were seen between SPLIT patients off IS and age- and sex-matched controls remaining on IS. Discontinuation of IS most commonly occurred in the context of rigorously designed IS withdrawal trials. The available sample size was small, affecting generalizability to the broader pediatric LT population.
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Affiliation(s)
- Simone Kortbeek
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Estella M Alonso
- Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth B Rand
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA
| | - John Bucuvalas
- Division of Pediatric Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George V Mazariegos
- Division of Transplantation Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kathleen M Campbell
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Steven J Lobritto
- Division of Gastroenterology, Hepatology, and Nutrition, Columbia University Irving Medical Center, New York, NY
| | - Amy G Feldman
- Division of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Krupa R Mysore
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | | | - Nazia Selzner
- Ajmera Transplant Center, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vicky L Ng
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Shemesh E, Duncan-Park S, Mazariegos G, Annunziato R, Anand R, Reyes-Mugica M, Mitchell J, Shneider BL. The improving Medication Adherence in Adolescents and young adults following Liver Transplantation (iMALT) multisite trial: Design and trial implementation considerations. Clin Trials 2023; 20:528-535. [PMID: 37269062 PMCID: PMC10524899 DOI: 10.1177/17407745231176834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS Medication non-adherence is a leading cause of transplant rejection, organ loss, and death; yet no rigorous controlled study to date has shown compelling clinical benefits from an adherence-improving intervention. Non-adherent patients are less likely to participate in trials, and therefore, most studies enroll a majority of adherent patients who do not stand to benefit from the intervention, as they do not have the condition (non-adherence) under investigation. The improving Medication Adherence in adolescent Liver Transplant recipients trial specifically targets non-adherent patients to investigate whether a remote intervention to improve adherence results in reduced incidence of biopsy-confirmed rejection. METHODS Improving Medication Adherence in adolescent Liver Transplant is a randomized single-blind controlled multisite, multinational National Institutes of Health-funded trial involving 13 pediatric transplant centers in the United States and Canada. An innovative, objective adherence biomarker-the Medication Level Variability Index, which is the standard deviation of a series of medication blood levels for each patient, is used to identify non-adherent patients at risk for rejection. The index is computed using electronic health record information for all potentially eligible patients based on repeated reviews of the entire clinic's roster. Identified patients, after consent, are randomized to intervention versus control (treatment as usual) arms. The remote intervention is delivered for 2 years by trained interventionists who reside in various locations in the United States. The primary outcome is the incidence of biopsy-confirmed acute cellular rejection, as confirmed by a majority vote of three pathologists who are masked to the study allocation and clinical information. DISCUSSION Improving Medication Adherence in adolescent Liver Transplant includes several innovative design elements. The use of a validated, objective adherence index to survey a large cohort of transplant recipients allows the teams to avoid bias inherent in both convenience sampling and referral-based recruitment and enroll only patients whose computed index indicates substantially increased risk of rejection. The remote intervention paradigm helps to engage patients who are by definition hard to engage. The use of an objective, masked medical (rather than behavioral) outcome measure reduces the likelihood of biases related to clinical information and ensures broad acceptance by the field. Finally, monitoring for potential adverse events related to increased medication exposure due to the adherence intervention acknowledges that a successful intervention (increasing adherence) could have detrimental side effects via increased exposure to and potential toxicity of the medication. Such monitoring is almost never attempted in clinical trials evaluating adherence interventions.
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Affiliation(s)
- Eyal Shemesh
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Rachel Annunziato
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Fordham University, Bronx, NY, USA
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Kannan R, Rajasekaran S, Stallon SD, Anand R. Improved indirect instantaneous torque control based torque sharing function approach of SRM drives in EVs using hybrid technique. ISA Trans 2023; 139:322-336. [PMID: 37147220 DOI: 10.1016/j.isatra.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 05/07/2023]
Abstract
This manuscript proposes an improved indirect instantaneous torque control (IITC) based torque sharing function (TSF) method of switched reluctance motor (SRM) drives in electric vehicles (EVs) using a hybrid system. The proposed hybrid techniques are joint performance of both Reptile Search Algorithm (RSA) and Honey Badger Algorithm (HBA), hence it is named as Enhanced RSA (ERSA) method. Here, an IITC method of SRMs for EVs is utilized. It achieves the requirements of the vehicle, like minimum torque ripple, improved speed range, high effectiveness, and maximal torque per ampere (MTPA). To precisely specify the switched reluctance motor and its magnetic features are measured by the proposed method. The modified Torque sharing function compensates the torque error along with incoming phase, which contains the minimal rate of change of flux linkage. Finally, the ERSA method is implemented to define the best control parameters. Then, the proposed ERSA system is performed on the MATLAB platform and the performance is compared to different existing systems. The MSE for case 1 and case 2 using proposed system attains 0.01093 and 0.01095. The voltage deviation for case 1 and case 2 using proposed system reaches 5 and 5. The power factor for case 1 and case 2 reaches a value of 50 and 40 using the proposed system.
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Affiliation(s)
- R Kannan
- Department of Electrical and Electronics Engineering, Nehru Institute of Engineering and Technology, Coimbatore, Tamil Nadu, India.
| | - S Rajasekaran
- Department of Electrical and Electronics Engineering, KSR Institute for Engineering and Technology, Tiruchengode, Tamil Nadu, India
| | - S Daison Stallon
- Department of Electrical and Electronics Engineering, Nehru Institute of Engineering and Technology, Coimbatore, Tamil Nadu, India
| | - R Anand
- Department of Electrical and Electronics Engineering, Nehru Institute of Engineering and Technology, Coimbatore, Tamil Nadu, India
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4
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Keerthika R, Narwal A, Kamboj M, Devi A, Anand R, N S, Singh V, Agarwal V, Gupta A. Mucormycosis infection associated with global COVID-19 pandemic - an institutional histopathological study. Med Oral Patol Oral Cir Bucal 2023; 28:e99-e107. [PMID: 36806020 PMCID: PMC9985935 DOI: 10.4317/medoral.25130] [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] [Received: 09/29/2021] [Accepted: 02/10/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) in the recent times have instilled signs of immunosuppression globally which has further precipitated increasing range of opportunistic infections. Mucormycosis is a distressing opportunistic fungal infection with a high incidence and is the third commonest acute invasive infection following candidiasis and aspergillosis. The aim of the present observational study is to delineate the enigmatic histopathological profile between mucormycosis cases seen prior to pandemic (PPM) and pandemic associated mucormycosis (PAM). MATERIAL AND METHODS Tissue archives of 105 histopathologically diagnosed cases of mucormycosis were included and analysed for demographical details and histopathological parameters like fungal load and localization, granuloma formation, necrosis, inflammatory infiltrate and tissue invasion. RESULTS 0ut of 105 included cases, 11/105 (10.48%) were reported PPM and 94/105 (89.52%) PAM. Among 94 cases of PAM, 51/94 (54%) cases also showed COVID-19 positivity, while 43/94 (46%) did not. Of all the histological variables, increased fungal load and necrosis were observed in PAM relative to PPM cases. CONCLUSIONS The histopathological variables like fungal load, necrosis, granuloma formation and tissue invasion, could help the clinician in assessing the clinical status at the time of tissue diagnosis and improve the treatment accordingly.
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Affiliation(s)
- R Keerthika
- Department of Oral and Maxillofacial Pathology and Microbiology Pt. Bhagwat Dayal Sharma University of Health Sciences Post Graduate Institute of Dental Sciences (PGIDS) Rohtak, Haryana-124001, India
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5
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McElroy LM, Martin AE, Feldman AG, Ng VL, Kato T, Reichman T, Valentino PL, Anand R, Anderson SG, Sudan DL. An appraisal of technical variant grafts compared to whole liver grafts in pediatric liver transplant recipients: Multicenter analysis from the SPLIT registry. Pediatr Transplant 2023; 27:e14415. [PMID: 36303260 PMCID: PMC10184704 DOI: 10.1111/petr.14415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Shortages of liver allografts for children awaiting transplantation have led to high LT waitlist mortality. Prior studies have shown that usage of TVG can reduce waiting time and waitlist mortality, but their use is not universal. We sought to compare patient and graft survival between WLG and TVG and to identify potential associated risk factors in a contemporary pediatric LT cohort. METHODS We performed a retrospective analysis of patient survival, graft survival, and biliary and vascular complications for LT recipients <18 years old entered into the Society of Pediatric Liver Transplantation prospective multicenter database. RESULTS Of 1839 LT recipients, 1029 received a WLG and 810 received a TVG from either a LD or a DD. There was no difference in patient survival or graft survival by graft type. Three-year patient survival and graft survival were 96%, 93%, and 96%, and 95%, 89%, and 92% for TVG-LD, TVG-DD, and WLG, respectively. Biliary complications were more frequent in TVG. Hepatic artery thrombosis was more frequent in WLG. Multivariate analysis revealed primary diagnosis was the only significant predictor of patient survival. Predictors for graft survival included time-dependent development of biliary and vascular complications. CONCLUSIONS There were no significant differences in patient and graft survival based on graft types in this North American multi-center pediatric cohort. Widespread routine use of TVG should be strongly encouraged to decrease mortality on the waitlist for pediatric LT candidates.
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Affiliation(s)
- Lisa M McElroy
- Division of Abdominal Transplant Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Abigail E Martin
- Division of Solid Organ Transplantation, Department of Surgery, Nemours Children's Hospital Delaware, Wilmington, Delaware, USA
| | - Amy G Feldman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Vicky L Ng
- Division of Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Tomoaki Kato
- Division of Abdominal Organ Transplantation, Department of Surgery, New York Presbyterian-Morgan Stanley Children's Hospital, Columbia University, New York, New York, USA
| | - Trevor Reichman
- Multi Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Pamela L Valentino
- Division of Gastroenterology and Hepatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - Debra L Sudan
- Division of Abdominal Transplant Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
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Nalini Joseph L, Anand R. Intelligent cloud agent based action recognition detection using machine learning. IFS 2022. [DOI: 10.3233/jifs-223018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
On the lap of this present-day epoch, Human Activity Recognition (HAR) has been of considerable assistance in case of health monitoring and recovery. The utilization of machine learning approach integration with intelligent agent in the area of health informatics collected via Human Activity Recognition enhances the decision making quality and significance. Its specific homogenization into the Smart Healthcare Monitoring permits gathering, examining and learning from Internet of Things (IoT) wearable devices, undoubtedly achieving knowledge and making analysis on the patient’s state. Despite several research works conducted on Smart Healthcare Monitoring, there remains certain amount of pitfalls, like, time, overhead involved in analysis and also the falsification of analysis. To focus on these issues, a Statistical Partial Regression and Support Vector Intelligent Agent Learning (SPR-SVIAL) for Smart Healthcare Monitoring is proposed. The SPR-SVIAL method is split into two stages. First, data pre-processing along with the dimensionality reduced features are extracted by employing Statistical Partial Regression Feature Extraction model. Here, with the ceaseless thump to-pulsate heart information, triaxial accelerometer information, rest quality, actual work and mental attributes obtained from the input dataset acquired from IoT wearable devices, Partial Least Square is applied to extract the dimensionality reduced features, therefore contributing to Smart Healthcare Monitoring time and accuracy. Next, with these resultant features, Support Vector Intelligent Agent Learning is proposed for Smart Healthcare Monitoring that with the aid of Machine Learning and Intelligent Agent not only reduces the falsification of analysis but also reduces the overhead incurred. The SPR-SVIAL method is tested on simulators and the obtained results indicated better performance upon comparison with the other methods. The results show that we can reduce the time, overhead, false positive rate for healthcare monitoring and achieve a high accuracy rate by performing feature extraction for each of the data recording.
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Affiliation(s)
- L. Nalini Joseph
- Department of Computer Science and Engineering, Bharath Institute of Higher Education and Research, Chennai, Tamilnadu, India
| | - R. Anand
- Department of Computer Science and Engineering, KCG College of Technology, Chennai, Tamilnadu, India
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7
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Squires JE, Bilhartz J, Soltys K, Hafberg E, Mazariegos GV, Gupta NA, Anand R, Anderson SG, Miloh T. Factors associated with improved patient and graft survival beyond 1 year in pediatric liver transplantation. Liver Transpl 2022; 28:1899-1910. [PMID: 35555876 DOI: 10.1002/lt.26502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 01/13/2023]
Abstract
With advances in surgical techniques, medical management, and more equitable allocation systems, children who receive a liver transplantation (LT) today can expect remarkable outcomes early after LT. However, beyond 1 year after transplant, attrition rates have not improved. We reviewed two separate eras (Era 1: January 1995-June 2004 vs. Era 2: July 2004-March 2018) of the Society of Pediatric Liver Transplantation registry to explore the evolution and associated factors contributing to late graft loss (LGL) and late mortality (LM). The fraction of long-term pediatric LT recipients surviving after 1 year with their first graft significantly improved (81.5% in Era 1 vs. 85.7% in Era 2; p < 0.0001). This improvement occurred despite significant changes in patient selection toward higher risk populations (p < 0.001) and without notable improvement in perioperative complications such as hepatic artery thrombosis (p = 0.24) and early posttransplant reoperation (p = 0.94) that have historically contributed to poor late-allograft outcomes. Improved outcomes were associated with changes in patient characteristics and perioperative practices, which subsequently impacted both early post-LT complications as well as other sequalae known to contribute to adverse events in long-term pediatric LT recipients. In conclusion, despite significant changes in patient selection toward higher risk populations, and without notable improvement in several perioperative complications known to contribute to poor late-allograft outcomes, significant improvements in LGL and a trend toward improvement in LM was seen in a more contemporary cohort of children receiving an LT.
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Affiliation(s)
- James E Squires
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jacob Bilhartz
- C. S. Mott Children's Hospital, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Kyle Soltys
- Hillman Center for Pediatric Transplantation, Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Einar Hafberg
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nitika A Gupta
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Tamir Miloh
- Department of Pediatrics, University of Miami, Miami, Florida, USA
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8
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Anand R. Trust based COVID-19 vaccine distribution using blockchain technology. IFS 2022. [DOI: 10.3233/jifs-220614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The COVID-19 outbreak has impacted huge number of individuals all around the world and has caused a great economic loss all over the world. Vaccination is most effective solution to prevent this disease. It helps in protecting the whole community. It improves the human immune system and fights against corona virus reducing the death rate. This paper deals with the different types of COVID-19 vaccine and their related distribution, it includes measures to ensure safe and secured distribution of the vaccine through block chain technology with the help of supply chain. Any malfunction in the chain is identified by the trust value of the function point method and the value of the Markov Chain.
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Affiliation(s)
- R. Anand
- Department of Computer Science and Engineering, KCG College of Technology, Chennai, Tamilnadu, India
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9
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Anand R. Blockchain security in virtual environment. IFS 2022. [DOI: 10.3233/jifs-212619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper is to improve the privacy and security in the distributed virtual environment using blockchain technology. One of the feature it provides is greater security in the decentralized virtual environment. A key aspect of this technology is used for various fields like healthcare, finance, business and cloud environment. Key issue of the virtual environment is to protect the data privacy and security which is difficult to handle. To overcome this issue, a new security model to protect the virtual environment is created and will focus on different types of attacks in blockchain technology.
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Affiliation(s)
- R. Anand
- Department of Computer Science and Engineering, KCG College of Technology, Chennai, Tamilnadu, India
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Gerhart JG, Carreño FO, Ford JL, Edginton A, Perrin EM, Watt KM, Muller WJ, Atz AM, Al‐Uzri A, Delmore P, Gonzalez D, Benjamin DK, Hornik C, Zimmerman K, Kennel P, Beci R, Dang Hornik C, Kearns GL, Laughon M, Paul IM, Sullivan J, Wade K, Delmore P, Taylor‐Zapata P, Lee J, Anand R, Sharma G, Simone G, Kaneshige K, Taylor L, Al‐Uzri A, Hornik C, Sokol G, Speicher D, Sullivan J, Mourani P, Mendley S, Meyer M, Atkins R, Flynn J, Vaughns J, Sherwin C, Delmore P, Goldstein S, Rathore M, Melloni C, Muller W, Delmore P, Tremoulet A, James L, Mendley S, Blackford M, Atz A, Adu‐Darko M, Mourani P, Watt K, Hornik C, Al‐Uzri A, Sullivan J, Laughon M, Brian Smith P, Watt K, Cheifetz I, Atz A, Bhatt‐Mehta V, Fernandez A, Lowry J. Use of
physiologically‐based
pharmacokinetic modeling to inform dosing of the opioid analgesics fentanyl and methadone in children with obesity. CPT Pharmacometrics Syst Pharmacol 2022; 11:778-791. [PMID: 35491971 PMCID: PMC9197535 DOI: 10.1002/psp4.12793] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/12/2022] Open
Abstract
Obesity is an increasingly alarming public health threat, with nearly 20% of children classified as obese in the United States today. Children with obesity are commonly prescribed the opioids fentanyl and methadone, and accurate dosing is critical to reducing the risk of serious adverse events associated with overexposure. However, pharmacokinetic studies in children with obesity are challenging to conduct, so there is limited information to guide fentanyl and methadone dosing in these children. To address this clinical knowledge gap, physiologically‐based pharmacokinetic models of fentanyl and methadone were developed in adults and scaled to children with and without obesity to explore the interplay of obesity, age, and pharmacogenomics. These models included key obesity‐induced changes in physiology and pharmacogenomic effects. Model predictions captured observed concentrations in children with obesity well, with an overall average fold error of 0.72 and 1.08 for fentanyl and methadone, respectively. Model simulations support a reduced fentanyl dose (1 vs. 2 μg/kg/h) starting at an earlier age (6 years) in virtual children with obesity, highlighting the importance of considering both age and obesity status when selecting an infusion rate most likely to achieve steady‐state concentrations within the target range. Methadone dosing simulations highlight the importance of considering genotype in addition to obesity status when possible, as cytochrome P450 (CYP)2B6*6/*6 virtual children with obesity required half the dose to match the exposure of wildtype children without obesity. This physiologically‐based pharmacokinetic modeling approach can be applied to explore dosing of other critical drugs in children with obesity.
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Affiliation(s)
- Jacqueline G. Gerhart
- Division of Pharmacotherapy and Experimental Therapeutics, The University of North Carolina Eshelman School of Pharmacy The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Fernando O. Carreño
- Division of Pharmacotherapy and Experimental Therapeutics, The University of North Carolina Eshelman School of Pharmacy The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Jennifer L. Ford
- Division of Pharmacotherapy and Experimental Therapeutics, The University of North Carolina Eshelman School of Pharmacy The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | | | - Eliana M. Perrin
- Department of Pediatrics, School of Medicine and School of Nursing Johns Hopkins University Baltimore Maryland USA
| | - Kevin M. Watt
- Division of Pediatric Clinical Pharmacology, School of Medicine University of Utah Salt Lake City Utah USA
| | - William J. Muller
- Ann and Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Andrew M. Atz
- Medical University of South Carolina Children's Hospital Charleston South Carolina USA
| | - Amira Al‐Uzri
- Oregon Health and Science University Portland Oregon USA
| | | | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, The University of North Carolina Eshelman School of Pharmacy The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
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11
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Taylor SA, Venkat V, Arnon R, Gopalareddy VV, Rosenthal P, Anderson SG, Anand R, Daniel JF. Organ-Specific Comorbidities Are Associated With Distinct Complications After Liver Transplantation for Biliary Atresia. Liver Transpl 2022; 28:855-866. [PMID: 34821466 DOI: 10.1002/lt.26376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/22/2021] [Accepted: 11/12/2021] [Indexed: 01/24/2023]
Abstract
Although transplant outcomes for biliary atresia (BA) have improved, there are few data to predict the risk of specific posttransplant complications. We therefore defined the impact of comorbidities in BA on posttransplant outcomes. Patients enrolled in the Society of Pediatric Liver Transplantation registry from 2011 to 2019 (n = 1034) were grouped by comorbidities of >1.0% incidence: any supplemental feeding, dialysis, other abdominal surgery (not Kasai portoenterostomy [KPE]), hepatopulmonary syndrome, and cardiac disease requiring intervention. Demographic and outcome data were compared using the Kruskal-Wallis, chi-square, and log-rank tests. Cox proportional hazards models and binary logistic regression were performed for modeling. Patients with BA with comorbidities comprised 77% (n = 799) of our cohort and had evidence of greater medical acuity, including higher calculated Pediatric End-Stage Liver Disease scores and hospitalizations in the intensive care unit before transplant (P < 0.001 for both) versus those without comorbidities. After transplant, patients with BA with comorbidities had more graft loss (P = 0.02), longer initial hospitalization and intubation (P < 0.001 for both), and increased rates of reoperation (P = 0.001) and culture-proven infection (P < 0.001) within 30 days after transplant. Only patients with BA with comorbidities on supplemental feed had increased rates of patient death (P = 0.02). Multivariate analysis identified lower z weight and higher creatinine as risk factors for graft and patient loss in patients with BA with comorbidities. Prior KPE was protective against culture-proven infection and vascular complications within 30 and 90 days, respectively. Patients with BA with comorbidities have evidence of higher medical acuity at transplant and reduced graft survival; however, they overall did not experience greater incidence of patient death. Our data provide organ-system-specific data to risk-stratify patients with BA and posttransplant outcomes.
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Affiliation(s)
- Sarah A Taylor
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Veena Venkat
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ronen Arnon
- Department of Pediatrics, Mount Sinai School of Medicine, New York, NY
| | - Vani V Gopalareddy
- Department of Pediatrics, Levine Children's Hospital at Atrium Health, Charlotte, NC
| | - Philip Rosenthal
- Department of Pediatrics and Surgery, University of California San Francisco, San Francisco, CA
| | | | | | - James F Daniel
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO
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Yadav A, Chopra A, Thomas S, Jain M, Anand R. T151 Hormone profile in benign breast disorder. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.630] [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: 11/03/2022]
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13
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Boster JM, Superina R, Mazariegos GV, Tiao GM, Roach JP, Lovell MA, Greffe BS, Yanni G, Leung DH, Elisofon SA, McDiarmid SV, Gupta NA, Lobritto SJ, Lemoine C, Stoll JM, Vitola BE, Daniel JF, Sayed BA, Desai DM, Martin AE, Amin A, Anand R, Anderson SG, Sundaram SS. Predictors of survival following liver transplantation for pediatric hepatoblastoma and hepatocellular carcinoma: Experience from the Society of Pediatric Liver Transplantation (SPLIT). Am J Transplant 2022; 22:1396-1408. [PMID: 34990053 DOI: 10.1111/ajt.16945] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 01/25/2023]
Abstract
Management of unresectable pediatric hepatoblastoma (HB) and hepatocellular carcinoma (HCC) remains challenging. The Society of Pediatric Liver Transplantation (SPLIT) database was used to study survival predictors in pediatric liver transplantation (LT) for HB and HCC. Event-free survival (EFS), associated risk factors, and postoperative complications were studied in children requiring LT for HB/HCC at 16 SPLIT centers. Three-year EFS was 81% for HB (n = 157) and 62% for HCC (n = 18) transplants. Of HB transplants, 6.9% were PRETEXT II and 15.3% were POST-TEXT I/II. Tumor extent did not impact survival (p = NS). Salvage (n = 13) and primary HB transplants had similar 3-year EFS (62% versus 78%, p = NS). Among HCC transplants, 3-year EFS was poorer in older patients (38% in ≥8-year-olds vs 86% <8-year-olds) and those with larger tumors (48% for those beyond versus 83% within Milan criteria, p = NS). Risk of infection (HR 1.5, 95% CI 1.1-2.2, p = .02) and renal injury (HR 2.4, 95% CI 1.7-3.3, p < .001) were higher in malignant versus nonmalignant LT. Survival is favorable for pediatric HB and HCC LT, including outcomes after salvage transplant. Unexpected numbers of LTs occurred in PRE/POST-TEXT I/II tumors. Judicious patient selection is critical to distinguish tumors that are potentially resectable; simultaneously, we must advocate for patients with unresectable malignancies to receive organs.
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Affiliation(s)
- Julia M Boster
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado, Aurora, Colorado, USA
| | - Riccardo Superina
- Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - George V Mazariegos
- Department of Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gregory M Tiao
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jonathan P Roach
- Department of Surgery, Children's Hospital Colorado and University of Colorado, Aurora, Colorado, USA
| | - Mark A Lovell
- Department of Pathology, Children's Hospital Colorado and University of Colorado, Aurora, Colorado, USA
| | - Brian S Greffe
- Department of Pediatric Oncology, Children's Hospital Colorado and University of Colorado, Aurora, Colorado, USA
| | - George Yanni
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Daniel H Leung
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Scott A Elisofon
- Department of Pediatrics, Boston Children's Hospital, Massachusetts, USA
| | - Suzanne V McDiarmid
- Department of Pediatrics, University of California and Los Angeles Mattel Children's Hospital, Los Angeles, California, USA
| | - Nitika A Gupta
- Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Steven J Lobritto
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
| | - Caroline Lemoine
- Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Janis M Stoll
- Department of Pediatrics, St. Louis Children's Hospital and Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bernadette E Vitola
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - James F Daniel
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Blayne A Sayed
- Department of Surgery, University Health Network and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dev M Desai
- Department of Surgery, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas, USA
| | - Abigail E Martin
- Department of Surgery, Nemours Children's Hospital Delaware and Sidney Kimmel Medical College of Thomas Jefferson University, Wilmington, Delaware, USA
| | - Arpit Amin
- Department of Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | - Shikha S Sundaram
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado, Aurora, Colorado, USA
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Kharbanda S, Anand R. Authors' response. Indian J Med Res 2021; 154:896-897. [PMID: 35662096 PMCID: PMC9347246 DOI: 10.4103/0971-5916.346065] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Sidharth Kharbanda
- Department of Respiratory Medicine, Kasturba Medical College, Mangaluru, Manipal Academy of Higher Education, Manipal 576 104, Karnataka, India
| | - R. Anand
- Department of Respiratory Medicine, Kasturba Medical College, Mangaluru, Manipal Academy of Higher Education, Manipal 576 104, Karnataka, India,For correspondence:
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Muthu Raja M K, Anand R, Vinod V, Rajagopalan B, Chandrasekar C, Dhanasekar T. Clinical usefulness of eosinopenia in differentiating COVID-19 versus other flu-like illness in outpatient set-up. Biomedicine (Taipei) 2021. [DOI: 10.51248/.v41i2.1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction and Aim:Corona virus disease 2019 (Covid-19) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has affected over 200 countries and territories. The aim of the present study is to evaluate the role of eosinopenia in differentiating COVID-19 suspect from other flu-like illnesses in an outpatient setting.
Materials and Methods:It was a retrospective case control study in which data of 1252 suspected COVID 19 patients who visited the fever clinic were enrolled. Among this, 701 patients were found to have COVID-19 pneumonia and 551 had other flu-like illnesses. CBC (complete blood count) and CRP(C- reactive protein) were taken in all patients along with chest x-ray as routine protocol.
Results:Among the 701 positive patients, eosinopenia was seen in 527 patients and had a sensitivity of 75.2 % and specificity of 68.6 %. When combined with other lab parameters such as the increased CRP and lymphopenia, the specificity rises up to 78.6 %.
Conclusion:Our study shows that eosinopenia as an independent variable, is a reliable marker to differentiate COVID-19 suspect patients from other flu-like illnesses on outpatient basis, however when combined with other parameters like lymphopenia and CRP the specificity increases further.
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Abstract
Background & objectives: Chronic obstructive pulmonary disease (COPD) adversely affects various functional and structural domains of the lungs, in addition to having an array of extra-pulmonary effects which affect overall well-being of a patient. This study was aimed at measuring the health-related quality of life (HRQOL) in COPD patients and relating the severity of disease and other factors with the degree of impairment of HRQOL. Methods: This cross-sectional study was conducted on 100 individuals with established COPD aged 45 yr or above. COPD severity was graded based on the Global Initiative for Obstructive Lung Disease (GOLD) staging system. Pulmonary function test was carried out as per the American Thoracic Society and European Respiratory Society task force standardised lung function testing guidelines. The quality of life was measured using the COPD-specific version of the St. George's Respiratory Questionnaire (SGRQ). The three component scores (activity, impact and symptoms) and the total score were compared across the various categories of age, gender and COPD grades. Using multivariable linear regression analysis, the relationship between COPD grades and various component scores, adjusting for age and gender, was determined. Results: The mean total SGRQ Classification score was found to be 48.5±17.1. There was a significant increase in the symptom, activity and impact component scores and the total scores of the participants with worsening of COPD grade. The activity, impact component scores and total score showed an increasing trend with age. However, the values of these three scores were lower in participants in the age group of 56-65 yr in comparison to those in the 45-55 yr age group. There was a significant increase in the symptom component score with increasing age across the study population. The difference in the various scores between males and females was not significant. Interpretation & conclusions: HRQOL is impaired in patients with COPD, and it deteriorates with increasing severity of the disease. The onset of COPD at a younger age has a much more significant deterioration of HRQOL, due to the early onset of symptoms and complications. These findings call for better early care and integration of pulmonary rehabilitation programmes into current health policies.
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Affiliation(s)
- Sidharth Kharbanda
- Department of Respiratory Medicine, Kasturba Medical College, Mangaluru, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - R Anand
- Department of Respiratory Medicine, Kasturba Medical College, Mangaluru, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Affiliation(s)
- R Anand
- Department of Radiodiagnosis, Lady Hardinge Medical College ; Department of Neurology, Jaipur Golden Hospital, New Delhi, India
| | - R Anand
- Department of Radiodiagnosis, Lady Hardinge Medical College ; Department of Neurology, Jaipur Golden Hospital, New Delhi, India
| | - A Verma
- Department of Radiodiagnosis, Lady Hardinge Medical College ; Department of Neurology, Jaipur Golden Hospital, New Delhi, India
| | - P Jagmohan
- Department of Radiodiagnosis, Lady Hardinge Medical College ; Department of Neurology, Jaipur Golden Hospital, New Delhi, India
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Anand R, Thittai AK. Towards practical implementation of the compressed sensing framework for multi-element synthetic transmit aperture imaging. Ultrasonics 2021; 112:106354. [PMID: 33450526 DOI: 10.1016/j.ultras.2021.106354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
Compressed sensing (CS) has been adapted to synthetic aperture (SA) ultrasound imaging to improve the frame-rate of the system. Recently, we proposed a novel CS framework using Gaussian under-sampling to reduce the number of receive elements in multi-element synthetic transmit aperture (MSTA) imaging. However, that framework requires different receive elements to be chosen randomly for each transmission, which may add to practical implementation challenges. Modifying the scheme to employ the same set of receive elements for all transmissions of MSTA leads to degradation of the recovered image quality. Therefore, this work proposes a novel sampling scheme based on a genetic algorithm (GA), which optimally chooses the receive element positions once and uses it for all the transmission of MSTA. The CS performance using GA sampling schemes is evaluated against the previously proposed CS framework on in-vitro and in-vivo datasets. The obtained results suggest that not only does the GA-based approach allows the use of the same set of sparse receive elements for each transmit, but also leads to the lowest CS recovery error (NRMSE) and 14% overall improvement in image contrast, in comparison to the previously-proposed Gaussian sampling scheme. Thus, using the CS framework along with GA, can potentially reduce the complexity in implementation of CS-framework to MSTA based systems.
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Affiliation(s)
- R Anand
- Biomedical Ultrasound Laboratory, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, India
| | - Arun K Thittai
- Biomedical Ultrasound Laboratory, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, India.
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Jain AK, Anand R, Lerret S, Yanni G, Chen JY, Mohammad S, Doyle M, Telega G, Horslen S. Outcomes following liver transplantation in young infants: Data from the SPLIT registry. Am J Transplant 2021; 21:1113-1127. [PMID: 32767649 PMCID: PMC7867666 DOI: 10.1111/ajt.16236] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023]
Abstract
Liver transplantation (LT) in young patients is being performed with greater frequency. We hypothesized that objective analysis of pre-, intra-, and postoperative events would help understand contributors to successful outcomes and guide transplant decision processes. We queried SPLIT registry for pediatric transplants between 2011 and 2018. Outcomes were compared for age groups: 0-<3, 3-<6, 6-<12 months, and 1-<3 years (Groups A, B, C, D respectively) and by weight categories: <5, 5-10, >10 kg; 1033 patients were available for analysis. Cholestatic disease and fulminant failure were highest in group A and those <5 kg; and biliary atresia in group C (72.8%). Group A had significantly higher life support dependence (34.6%; P < .001), listing as United Network for Organ Sharing status 1a/1b (70.4%; P < .001), and shortest wait times (P < .001). The median (interquartile range) for international normalized ratio and bilirubin were highest in group A (3.0 [2.1-3.9] and 16.7 [6.8-29.7] mg/dL) and those <5 kg (2.6 [1.8-3.4] and 13.5 [3.0-28.4] mg/dL). A pediatric end -stage liver disease score ≥40, postoperative hospital stays, rejection, and nonanastomotic biliary strictures were highest in group A with lowest survival at 93.1%. Infants 0 to <3 months and those <5 kg need more intensive care with lower survival and higher complications. Importantly, potential LT before reaching status 1a/1b and aggressive postoperative management may positively influence their outcomes.
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Affiliation(s)
- Ajay K. Jain
- Saint Louis University, Saint Louis, Missouri, USA
| | | | - Stacee Lerret
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - George Yanni
- Pediatrics, Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | | | - Saeed Mohammad
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Majella Doyle
- Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Greg Telega
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Simon Horslen
- Liver and Small Bowel Transplantation, Seattle Children’s Hospital, Seattle, Washington, USA
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Mohammed CA, Anand R, Saleena Ummer V. Interprofessional Education (IPE): A framework for introducing teamwork and collaboration in health professions curriculum. Med J Armed Forces India 2021; 77:S16-S21. [PMID: 33612927 DOI: 10.1016/j.mjafi.2021.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 10/22/2022] Open
Affiliation(s)
- Ciraj Ali Mohammed
- Professor, Microbiology & Course Director, MAHE FAIMER Institute, KMC Health Sciences Library, EDU Building, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - R Anand
- Professor (Respiratory Medicine) & Coordinator (Medical Education), KMC Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - V Saleena Ummer
- Associate Professor, Medical Lab Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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21
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Mazariegos GV, Shneider BL, Shemesh E, Schady D, Melin-Aldana H, Cho SJ, Anand R, Erinjeri J, Annunziato R, Reyes-Mugica M. Approaches to Research Determination of Late Acute Cellular Rejection in Pediatric Liver Transplant Recipients. Liver Transpl 2021; 27:106-115. [PMID: 32978871 PMCID: PMC7785571 DOI: 10.1002/lt.25903] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/10/2020] [Accepted: 08/19/2020] [Indexed: 01/13/2023]
Abstract
A central pathology or site reading of biopsy slides is used in liver transplant clinical trials to determine rejection. We evaluated interrater reliability of readings of "rejection or not" using digitized slides from the Medication Adherence in Children who had a Liver Transplant (MALT) study. Four masked experienced pathologists read the digitized slides and then reread them after a study-specific histologic endpoint development program. Agreement was expressed throughout as a Kappa or Fleiss Kappa statistic (ҡ). A ҡ > 0.6 was predefined as desirable. Readings were correlated with immunosuppressant adherence (the Medication Level Variability Index, [MLVI]), and maximal liver enzyme levels during the study period. Interrater agreement between site and central review in MALT, and between 4 pathologists later on, was low (ҡ = 0.44, Fleiss ҡ = 0.41, respectively). Following the endpoint development program, agreement improved and became acceptable (ҡ = 0.71). The final reading was better-aligned with maximal gamma-glutamyl transferase levels and MLVI as compared with the original central reading. We found substantial disagreement between experienced pathologists reading the same slides. A unique study-specific procedure improved interrater reliability to the point it was acceptable. Such a procedure may be indicated to increase reliability of histopathologic determinations in future research, and perhaps also clinically.
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Affiliation(s)
- George V. Mazariegos
- Hillman Center for Pediatric Transplantation, Thomas E. Starzl Transplantation Institute, UPMC Children's Hospital of Pittsburgh, PA
| | | | - Eyal Shemesh
- Icahn School of Medicine at Mount Sinai and the Department of Pediatrics, Mount Sinai Health System, New York, NY
| | - Deborah Schady
- Department of Pathology, Baylor College of Medicine, Houston, TX
| | - Hector Melin-Aldana
- Department of Pathology and Laboratory Medicine, Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children’s Hospital, Chicago, IL
| | - Soo-Jin Cho
- Department of Pathology, UCSF, San Francisco, CA
| | | | | | - Rachel Annunziato
- Icahn School of Medicine at Mount Sinai and the Department of Pediatrics, Mount Sinai Health System, New York, NY
| | - Miguel Reyes-Mugica
- Hillman Center for Pediatric Transplantation Department of Pathology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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22
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N M, Soni P, Anand R, Bali S. Cardiorenal Amyloidosis. J Assoc Physicians India 2020; 68:74-76. [PMID: 32602686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Amyloidosis is a conglomeration of diseases due to production and deposition of amyloid, a proteinaceous substance, into organs, tissues, nerves and other places in the body affecting their normal function. This case report is of a 65 year old gentleman, resident of Bihar admitted with a short history of two months. He came with chief complaints of swelling in both lower limbs associated with heaviness in legs, shortness of breath, dizziness, fatigue and passage of frothy urine for two months. He was investigated and found to have proteinuria, low voltage ECG, Echocardiography showed left ventricular hypertrophy, diastolic dysfunction, mitral regurgitation. Cardiac MRI showed dilated cardiomyopathy due to amyloidosis.
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Affiliation(s)
- Meenakshi N
- Senior Resident, Family Medicine, Max Superspeciality Hospital, Saket, New Delhi
| | - P Soni
- Senior Consultant, Medicine, Max Superspeciality Hospital, Saket, New Delhi
| | - R Anand
- Senior Consultant, Radiology, Max Superspeciality Hospital, Saket, New Delhi
| | - S Bali
- Senior Consultant, Medicine, Max Superspeciality Hospital, Saket, New Delhi
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Mehdizadeh R, Baynes W, Aldridge T, Al-Gholmy M, Srinivasan B, Anand R. Initial experience of DCTs. Br Dent J 2020; 228:567. [PMID: 32332932 PMCID: PMC7180650 DOI: 10.1038/s41415-020-1537-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Elisofon SA, Magee JC, Ng VL, Horslen SP, Fioravanti V, Economides J, Erinjeri J, Anand R, Mazariegos GV, Martin A, Mannino D, Flynn L, Mohammad S, Alonso E, Superina R, Brandt K, Riordan M, Lokar J, Ito J, Elisofon S, Zapata L, Jain A, Foristal E, Gupta N, Whitlow C, Naik K, Espinosa H, Miethke A, Hawkins A, Hardy J, Engels E, Schreibeis A, Ovchinsky N, Kogan‐Liberman D, Cunningham R, Malik P, Sundaram S, Feldman A, Garcia B, Yanni G, Kohli R, Emamaullee J, Secules C, Magee J, Lopez J, Bilhartz J, Hollenbeck J, Shaw B, Bartow C, Forest S, Rand E, Byrne A, Linguiti I, Wann L, Seidman C, Mazariegos G, Soltys K, Squires J, Kepler A, Vitola B, Telega G, Lerret S, Desai D, Moghe J, Cutright L, Daniel J, Andrews W, Fioravanti V, Slowik V, Cisneros R, Faseler M, Hufferd M, Kelly B, Sudan D, Mavis A, Moats L, Swan‐Nesbit S, Yazigi N, Buranych A, Hobby A, Rao G, Maccaby B, Gopalareddy V, Boulware M, Ibrahim S, El Youssef M, Furuya K, Schatz A, Weckwerth J, Lovejoy C, Kasi N, Nadig S, Law M, Arnon R, Chu J, Bucuvalas J, Czurda M, Secheli B, Almy C, Haydel B, Lobritto S, Emand J, Biney‐Amissah E, Gamino D, Gomez A, Himes R, Seal J, Stewart S, Bergeron J, Truxillo A, Lebel S, Davidson H, Book L, Ramstack D, Riley A, Jennings C, Horslen S, Hsu E, Wallace K, Turmelle Y, Nadler M, Postma S, Miloh T, Economides J, Timmons K, Ng V, Subramonian A, Dharmaraj B, McDiarmid S, Feist S, Rhee S, Perito E, Gallagher L, Smith K, Ebel N, Zerofsky M, Nogueira J, Greer R, Gilmour S, Robert C, Cars C, Azzam R, Boone P, Garbarino N, Lalonde M, Kerkar N, Dokus K, Helbig K, Grizzanti M, Tomiyama K, Cocking J, Alexopoulos S, Bhave C, Schillo R, Bailey A, Dulek D, Ramsey L, Ekong U, Valentino P, Hettiarachchi D, Tomlin R. Society of pediatric liver transplantation: Current registry status 2011-2018. Pediatr Transplant 2020; 24:e13605. [PMID: 31680409 DOI: 10.1111/petr.13605] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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: 05/31/2019] [Revised: 08/08/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND SPLIT was founded in 1995 in order to collect comprehensive prospective data on pediatric liver transplantation, including waiting list data, transplant, and early and late outcomes. Since 2011, data collection of the current registry has been refined to focus on prospective data and outcomes only after transplant to serve as a foundation for the future development of targeted clinical studies. OBJECTIVE To report the outcomes of the SPLIT registry from 2011 to 2018. METHODS This is a multicenter, cross-sectional analysis characterizing patients transplanted and enrolled in the SPLIT registry between 2011 and 2018. All patients, <18 years of age, received a first liver-only, a combined liver-kidney, or a combined liver-pancreas transplant during this study period. RESULTS A total of 1911 recipients from 39 participating centers in North America were registered. Indications included biliary atresia (38.5%), metabolic disease (19.1%), tumors (11.7%), and fulminant liver failure (11.5%). Greater than 50% of recipients were transplanted as either Status 1A/1B or with a MELD/PELD exception score. Incompatible transplants were performed in 4.1%. Kaplan-Meier estimates of 1-year patient and graft survival were 97.3% and 96.6%. First 30 days of surgical complications included reoperation (31.7%), hepatic artery thrombosis (6.3%), and portal vein thrombosis (3.2%). In the first 90 days, biliary tract complications were reported in 13.6%. Acute cellular rejection during first year was 34.7%. At 1 and 2 years of follow-up, 39.2% and 50.6% had normal liver tests on monotherapy (tacrolimus or sirolimus). Further surgical, survival, allograft function, and complications are detailed.
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Affiliation(s)
- Scott A Elisofon
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - John C Magee
- Division of Surgery, University of Michigan Transplant Center, Ann Arbor, Michigan
| | - Vicky L Ng
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Simon P Horslen
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Vicki Fioravanti
- Section of Hepatology and Liver Transplantation, Children's Mercy Hospital, Kansas City, Missouri
| | | | | | | | - George V Mazariegos
- Division of Pediatric Transplant Surgery, Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Annunziato RA, Stuber ML, Supelana CJ, Dunphy C, Anand R, Erinjeri J, Alonso EM, Mazariegos GV, Venick RS, Bucuvalas J, Shemesh E. The impact of caregiver post-traumatic stress and depressive symptoms on pediatric transplant outcomes. Pediatr Transplant 2020; 24:e13642. [PMID: 31880384 DOI: 10.1111/petr.13642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 11/26/2022]
Abstract
PTSS as well as symptoms of depression have been reported in children who experience a serious medical adversity as well as their caretakers. The adverse effects of PTSS, when experienced by the patients, on medical outcomes have been clearly documented. However, the impact of those symptoms, if any, when experienced by the caretakers on child outcomes has not been investigated prospectively. We evaluated whether caregiver PTSS and depression symptoms predict adherence to medications and medical outcomes in a prospective multisite study. Four hundred children participated in MALT. Caretaker PTSS were assessed by the IES and depressive symptoms by CES-D. During 2 years of follow-up, the MLVI was used to determine adherence. Centrally read, biopsy-confirmed organ rejection was the primary medical outcome. IES scores were not associated with either adherence or rejection outcomes. In contrast, there were significant correlations between CES-D (depression) scores and lower adherence, r = .13, P < .001, and a trend toward higher scores on the CES-D among those whose children had experienced rejection, 12.4 (SD = 10.9) versus 9.1 (SD = 8.6), P = .077. Caregivers' PTSS were not a risk factor for poor child outcomes in this cohort, whereas depression symptoms were associated with non-adherence and possibly increased rates of rejection. Further study can validate if caregivers' depression as opposed to PTSS confers greater risk and should be a focus during the clinical care of medically ill children.
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Affiliation(s)
- Rachel A Annunziato
- Icahn School of Medicine at Mount Sinai, New York, New York
- Fordham University, Bronx, New York
| | | | - Christina J Supelana
- Icahn School of Medicine at Mount Sinai, New York, New York
- Fordham University, Bronx, New York
| | - Claire Dunphy
- Icahn School of Medicine at Mount Sinai, New York, New York
- Fordham University, Bronx, New York
| | | | | | - Estella M Alonso
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | | | - John Bucuvalas
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eyal Shemesh
- Icahn School of Medicine at Mount Sinai, New York, New York
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26
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Pranav JV, Anand R, Shanthi T, Manju K, Veni S, Nagarjun S. Detection and identification of COVID -19 based on chest medical image by using convolutional neural networks. International Journal of Intelligent Networks 2020. [PMCID: PMC7843251 DOI: 10.1016/j.ijin.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Covid-19 pandemic has caused major out-break all around the world. This pandemic out-break requires lot of testing, which is a tedious process. Deep learning is a successful method that has evolved in image category in the past few years. In this work to detects the presence of coronavirus by using deep learning approach. Here, convolutional neural networks with specific focus on to classify Covid-19 chest radiography images. The database comprises Covid-19, normal and viral pneumonia chest X-ray images with 800 different samples under each class. We evaluated the model on 500 images and the networks has achieved a sensitivity rate of 95% and specificity rate of 97%. The DenseNet121 Architecture performed slightly better, compared to other state of art networks. The performance achieved by the method proposed is very encouraging and the accuracy rates can be improved further with larger datasets. Apart from sensitivity and specificity rates, the proposed model is also compared on receiver operating characteristic (ROC), and area under the curve (AUC) of each model. The model is implemented on the TensorFlow framework with the datasets that are publicly available for research community.
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27
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Indur Wadhwani S, Hsu EK, Shaffer ML, Anand R, Lee Ng V, Bucuvalas JC. Predicting ideal outcome after pediatric liver transplantation: An exploratory study using machine learning analyses to leverage Studies of Pediatric Liver Transplantation Data. Pediatr Transplant 2019; 23:e13554. [PMID: 31328849 PMCID: PMC7980252 DOI: 10.1111/petr.13554] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 12/18/2018] [Revised: 05/21/2019] [Accepted: 06/27/2019] [Indexed: 12/15/2022]
Abstract
Machine learning analyses allow for the consideration of numerous variables in order to accommodate complex relationships that would not otherwise be apparent in traditional statistical methods to better classify patient risk. The SPLIT registry data were analyzed to determine whether baseline demographic factors and clinical/biochemical factors in the first-year post-transplant could predict ideal outcome at 3 years (IO-3) after LT. Participants who received their first, isolated LT between 2002 and 2006 and had follow-up data 3 years post-LT were included. IO-3 was defined as alive at 3 years, normal ALT (<50) or GGT (<50), normal GFR, no non-liver transplants, no cytopenias, and no PTLD. Heat map analysis and RFA were used to characterize the impact of baseline and 1-year factors on IO-3. 887/1482 SPLIT participants met inclusion criteria; 334 had IO-3. Demographic, biochemical, and clinical variables did not elucidate a visual signal on heat map analysis. RFA identified non-white race (vs white race), increased length of operation, vascular and biliary complications within 30 days, and duct-to-duct biliary anastomosis to be negatively associated with IO-3. UNOS regions 2 and 5 were also identified as important factors. RFA had an accuracy rate of 0.71 (95% CI: 0.68-0.74), PPV = 0.83, and NPV = 0.70. RFA identified participant variables that predicted IO-3. These findings may allow for better risk stratification and personalization of care following pediatric liver transplantation.
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Affiliation(s)
| | - Evelyn K. Hsu
- University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA
| | | | | | - Vicky Lee Ng
- Hospital for Sick Children, Transplant and Regenerative Medicine Center, University of Toronto, Toronto, Canada
| | - John C. Bucuvalas
- Icahn School of Medicine at Mount Sinai, Kravis Children’s Hospital New York, NY
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28
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Srinivasan B, Al- Asaadi Z, Anand R, Brennan P. Rapidly progressing myofibroma of the gingiva - a rare occurrence. Br J Oral Maxillofac Surg 2019; 57:707-708. [DOI: 10.1016/j.bjoms.2019.05.019] [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] [Received: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 11/30/2022]
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29
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Black DD, Mack C, Kerkar N, Miloh T, Sundaram SS, Anand R, Gupta A, Alonso E, Arnon R, Bulut P, Karpen S, Lin CH, Rosenthal P, Ryan M, Squires RH, Valentino P, Elsea SH, Shneider BL. A Prospective Trial of Withdrawal and Reinstitution of Ursodeoxycholic Acid in Pediatric Primary Sclerosing Cholangitis. Hepatol Commun 2019; 3:1482-1495. [PMID: 31701072 PMCID: PMC6824074 DOI: 10.1002/hep4.1421] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/27/2019] [Indexed: 12/15/2022] Open
Abstract
Ursodeoxycholic acid (UDCA) is commonly used to treat several liver disorders in adults and children, including primary sclerosing cholangitis (PSC) for which it is not U.S. Food and Drug Administration approved. UDCA treatment has an uncertain impact on disease outcomes and has been reported in high doses to be associated with worse outcome in adults with PSC. In this context, controlled withdrawal and reintroduction of UDCA in children with PSC were studied. Prior to study initiation, participants were required to have alanine aminotransferase (ALT) and gamma‐glutamyl transpeptidase (GGT) <2 times the upper limit of normal on stable UDCA dosing. The study included four phases: I (stable dosing), II (50% UDCA reduction), III (UDCA discontinuation), IV (UDCA reintroduction), with a primary endpoint of change in ALT and GGT between phases I and III. We enrolled 27 participants (22 completed) between March 2011 and June 2016. Changes in mean ALT and GGT between phases I and III were ALT, +29.5 IU/L (P = 0.105) and GGT, +60.4 IU/L (P = 0.003). In 7 participants, ALT and GGT ≤29 IU/L did not rise above 29 IU/L (null response group). Eight participants had increases of ALT or GGT >100 IU/L (flare group). None developed elevated bilirubin. All flares responded to UDCA reinstitution. Serum GGT, interleukin‐8, and tumor necrosis factor α levels were higher in the flare group at baseline. Liver biochemistries increased in children with PSC during controlled UDCA withdrawal; one third increased above 100 IU/L and one third remained normal during UDCA withdrawal. Conclusion: The impact of prolonged UDCA use in childhood PSC and the significance of a biochemical flare are unclear. Further studies of the natural history and treatment of pediatric PSC and UDCA use are needed.
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Affiliation(s)
- Dennis D Black
- Pediatrics University of Tennessee Health Science Center Memphis TN
| | - Cara Mack
- Pediatrics University of Colorado School of Medicine Aurora CO
| | - Nanda Kerkar
- Pediatrics University of Rochester Medical Center Rochester NY.,Pediatrics Keck School of Medicine of University of Southern California Los Angeles CA
| | - Tamir Miloh
- Pediatrics Baylor College of Medicine Houston TX
| | | | | | | | - Estella Alonso
- Pediatrics Northwestern University College of Medicine Chicago IL
| | - Ronen Arnon
- Pediatrics Mount Sinai Icahn School of Medicine New York NY
| | - Pinar Bulut
- Pediatrics Phoenix Children's Hospital Phoenix AZ
| | - Saul Karpen
- Pediatrics Emory University School of Medicine Atlanta GA
| | - Chuan-Hao Lin
- Pediatrics Keck School of Medicine of University of Southern California Los Angeles CA
| | - Philip Rosenthal
- Pediatrics School of Medicine University of California, San Francisco San Francisco CA
| | - Matthew Ryan
- Pediatrics Children's Hospital of Philadelphia Philadelphia PA
| | - Robert H Squires
- Pediatrics University of Pittsburgh School of Medicine Pittsburgh PA
| | | | - Sarah H Elsea
- Molecular and Human Genetics Baylor College of Medicine Houston TX
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Anand R, Thittai AK. Lateral Resolution Improvement in Ultrasound Imaging System using Compressed Sensing: Initial Results. Annu Int Conf IEEE Eng Med Biol Soc 2019; 2019:2727-2730. [PMID: 31946458 DOI: 10.1109/embc.2019.8857216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Compressed-Sensing (CS) has been applied to ultrasound imaging to reduce data or to reduce the data acquisition time. There appears to be no report that uses CS framework to reduce the number of active receive elements in Conventional Focused Beamforming (CFB). Thus, in our previous work, a novel undersampling scheme based on Gaussian distribution was investigated and reported for reducing the number of active receive elements and data in CFB. In this paper, we exploit the Gaussian sampling based CS framework to improve the lateral resolution (LR) of the ultrasound system without increasing the system's complexity and cost. A notable difference from our previous work being the use of waveatom as the sparsifying basis, instead of 2D-Fourier basis, and analysis of the proposed framework for different receive aperture sizes. Simulation data for this study were generated using Field II, and experimental data were acquired from an in-vitro cyst phantom using Verasonics V-64 ultrasound scanner. The results indicate that the proposed framework of choosing a limited number of receive elements from a receive aperture length that is three or four times the corresponding active aperture size obtained from the same number of consecutive receive elements yields nearly twice an improvement in LR and about 27% increase in contrast to that of CFB reference image. Thus, the findings suggest a possibility to improve the LR of the current ultrasound system without increasing the system complexity, which will be significant for affordable point-of-care ultrasound systems.
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31
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Smith PB, Cotten CM, Hudak ML, Sullivan JE, Poindexter BB, Cohen-Wolkowiez M, Boakye-Agyeman F, Lewandowski A, Anand R, Benjamin DK, Laughon MM. Rifampin Pharmacokinetics and Safety in Preterm and Term Infants. Antimicrob Agents Chemother 2019; 63:e00284-19. [PMID: 30910891 PMCID: PMC6535522 DOI: 10.1128/aac.00284-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/16/2019] [Indexed: 01/14/2023] Open
Abstract
Rifampin is active against methicillin-resistant staphylococcal species and tuberculosis (TB). We performed a multicenter, prospective pharmacokinetic (PK) and safety study of intravenous rifampin in infants of <121 days postnatal age (PNA). We enrolled 27 infants; the median (range) gestational age was 26 weeks (23 to 41 weeks), and the median PNA was 10 days (0 to 84 days). We collected 102 plasma PK samples from 22 of the infants and analyzed safety data from all 27 infants. We analyzed the data using a population PK approach. Rifampin PK was best characterized by a one-compartment model; drug clearance increased with increasing size (body weight) and maturation (PNA). There were no adverse events related to rifampin. Simulated weight and PNA-based intravenous dosing regimens administered once daily (<14 days PNA, 8 mg/kg; ≥14 days PNA, 15 mg/kg) in infants resulted in comparable exposures to adults receiving therapeutic doses of rifampin against staphylococcal infections and TB. (This study has been registered at ClinicalTrials.gov under identifier NCT01728363.).
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Affiliation(s)
- P Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Neonatal-Perinatal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - C Michael Cotten
- Division of Neonatal-Perinatal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark L Hudak
- Division of Neonatology, University of Florida College of Medicine-Jacksonville, UF Health and Wolfson Children's Hospital, Jacksonville, Florida, USA
| | - Janice E Sullivan
- University of Louisville, Kosair Charities Pediatric Clinical Research Unit and Norton Children's Hospital, Louisville, Kentucky, USA
| | - Brenda B Poindexter
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Felix Boakye-Agyeman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Matthew M Laughon
- Department of Pediatrics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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32
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Wang T, Pan Y, Lin J, Anand R, Wang D, Johnston SC, Meng X, Li H, Zhao X, Liu L, Wang Y, Wang Y. Influence of smoking on
CYP
2C19 genetic variants and clopidogrel efficacy in patients with minor stroke or transient ischaemic attack. Eur J Neurol 2019; 26:1175-1182. [PMID: 30974489 DOI: 10.1111/ene.13962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 04/03/2019] [Indexed: 12/12/2022]
Affiliation(s)
- T. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Y. Pan
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - J. Lin
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - R. Anand
- Department of Neurosurgery Wayne State University School of Medicine Detroit MIUSA
| | - D. Wang
- INI Stroke Network OSF Healthcare System University of Illinois College of Medicine Peoria ILUSA
| | - S. C. Johnston
- Dell Medical School University of Texas at Austin Austin TX USA
| | - X. Meng
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - H. Li
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - X. Zhao
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - L. Liu
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Y. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Y. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
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33
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Zimmerman KO, Benjamin DK, Becker ML, Anand R, Hornik CP. Product Labeling of Drugs Commonly Administered to Children and Adults with Obesity. Pharm Regul Aff 2019; 8:219. [PMID: 37220561 PMCID: PMC10201954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Obesity is a major public health problem that can affect drug disposition and dosing, particularly in vulnerable pediatric populations. Despite potentially detrimental consequences from inappropriately dosed drugs in children with obesity, drug product labels largely fail to include dosing or guidance specific to this population. Failure to include this information results in an increased incidence of adverse events, and concerns from treating physicians regarding their ability to provide appropriate care for children with obesity. Using data from the National Institute of Child Health and Human Development-funded Pediatric Trials Network (PTN), we explore possible ways to improve drug labeling in children with obesity. In order to improve health outcomes of children with obesity, carefully designed and executed PK trials and comprehensive PK analysis strategies are needed. Early collaboration with the Food and Drug Administration may be helpful in developing studies and analyses that are most beneficial for child health. This collaboration is particularly important for drugs that treat potentially life-threatening diseases, where inclusion of PK and dosing on the drug label is vital. We hope that increasing the body of knowledge on drug dosing in children with obesity will open the door to regulatory guidance based on extrapolation or population-specific PK studies, similar to other currently-recognized special populations. Given the magnitude of the pediatric obesity pandemic, recognition as a special population will offer substantial public health value.
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Affiliation(s)
- Kanecia O. Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Mara L. Becker
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO
| | | | - Christoph P. Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
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34
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Watt KM, Hornik CP, Balevic SJ, Mundakel G, Cotten CM, Harper B, Benjamin DK, Anand R, Laughon M, Smith PB, Cohen-Wolkowiez M. Pharmacokinetics of ticarcillin-clavulanate in premature infants. Br J Clin Pharmacol 2019; 85:1021-1027. [PMID: 30710387 DOI: 10.1111/bcp.13882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/04/2018] [Revised: 01/17/2019] [Accepted: 01/20/2019] [Indexed: 01/20/2023] Open
Abstract
Ticarcillin-clavulanate covers a broad spectrum of pathogens that are common in premature infants. In infants <30 weeks gestational age, pharmacokinetic data to guide ticarcillin-clavulanate dosing are lacking. We enrolled 15 premature infants <30 weeks gestational age, determined pharmacokinetic parameters, and performed dosing simulations to determine optimal dosing for ticarcillin-clavulanate. The infants had a median (range) postnatal age (PNA) of 18 days (6-44 days) and gestational age of 25 weeks (23-28 weeks). Clearance was lower in infants with a PNA <14 days (0.050 L/kg/h [range 0.043-0.075]) compared with a PNA ≥14-45 days (0.078 L/kg/h [0.047-0.100]), consistent with maturation of renal function. Dosing simulations determined that ticarcillin 75 mg/kg q12h (PNA <14 days) or q8h (PNA ≥ 14-45 days) achieved the target exposure for organisms with a minimum inhibitory concentration ≤16 μ/mL in >90% of simulated infants. For highly resistant organisms (minimum inhibitory concentration 32 μg/mL), increased dosing frequency or extended infusion are necessary.
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Affiliation(s)
- Kevin M Watt
- Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Christoph P Hornik
- Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Stephen J Balevic
- Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | | | | | | | - Daniel K Benjamin
- Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | | | - Matthew Laughon
- University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - P Brian Smith
- Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Michael Cohen-Wolkowiez
- Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
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Bundy J, Hage A, Srinivasa R, Gemmete J, Srinivasa R, Jairath N, Anand R, Dasika N, Chauhan N, Chick J. 03:09 PM Abstract No. 249 Intra-arterial ampicillin and gentamicin and the incidence of splenic abscesses following splenic artery embolization: a 20-year case control study in 213 patients. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.310] [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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36
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Findling RL, McNamara NK, Pavuluri M, Frazier JA, Rynn M, Scheffer R, Kafantaris V, Robb A, DelBello M, Kowatch RA, Rowles BM, Lingler J, Zhao J, Clemons T, Martz K, Anand R, Taylor-Zapata P. Lithium for the Maintenance Treatment of Bipolar I Disorder: A Double-Blind, Placebo-Controlled Discontinuation Study. J Am Acad Child Adolesc Psychiatry 2019; 58:287-296.e4. [PMID: 30738555 PMCID: PMC6414078 DOI: 10.1016/j.jaac.2018.07.901] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 02/21/2018] [Revised: 07/23/2018] [Accepted: 08/15/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study examined the role of lithium in the maintenance treatment of pediatric patients with bipolar I disorder (BP-I). METHOD Participants aged 7 to 17 years who presented with a manic or mixed episode received 24 weeks of lithium treatment in one of two multiphase studies, the Collaborative Lithium Trials (CoLT 1 and CoLT 2). Responders were randomized to continue lithium or to be cross-titrated to placebo for up to 28 weeks. The primary outcome measure was relative risk of study discontinuation for any reason. RESULTS A Cox regression analysis found that those who continued treatment with lithium (n = 17) had a lower hazard ratio compared to those who received placebo (n = 14) (p = .015)]. The vast majority of discontinuations were due to mood symptom exacerbations, with most of these occurring in the placebo-treated group. Discontinuation for other reasons occurred at similarly low rates across both group. Most adverse events were mild to moderate in severity, and only one study participant was discontinued from the trial owing to a serious adverse event (aggression). There was no statistically significant difference with respect to weight gain in participants receiving lithium compared to those receiving placebo. CONCLUSION This randomized, double-blind, placebo-controlled Discontinuation Trial builds support for the role of lithium as a maintenance treatment in pediatric patients with bipolar disorder and for the safety and tolerability of 28 weeks of maintenance lithium treatment. CLINICAL TRIAL REGISTRATION INFORMATION Lithium for the Treatment of Pediatric Mania; https://clinicaltrials.gov/; NCT00442039 (CoLT 1). Safety and Efficacy Study of Lithium for the Treatment of Pediatric Mania; https://clinicaltrials.gov/; NCT01166425 (CoLT 2).
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Affiliation(s)
| | | | | | | | | | | | - Vivian Kafantaris
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Adelaide Robb
- George Washington University School of Medicine & Health Sciences, Washington, DC
| | | | | | | | | | - Jian Zhao
- The EMMES Corporation, Rockville, MD
| | | | | | | | - Perdita Taylor-Zapata
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
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38
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Ku LC, Hornik CP, Beechinor RJ, Chamberlain JM, Guptill JT, Harper B, Capparelli EV, Martz K, Anand R, Cohen-Wolkowiez M, Gonzalez D. Population Pharmacokinetics and Exploratory Exposure-Response Relationships of Diazepam in Children Treated for Status Epilepticus. CPT Pharmacometrics Syst Pharmacol 2018; 7:718-727. [PMID: 30267478 PMCID: PMC6263663 DOI: 10.1002/psp4.12349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/08/2018] [Indexed: 11/19/2022]
Abstract
Diazepam is labeled for status epilepticus (SE) in children, but there are limited data characterizing its disposition in pediatric patients. We developed a population pharmacokinetic (PK) model of i.v. diazepam in children with SE. We evaluated relationships between PK parameters and both safety and efficacy, and simulated exposures using dosing regimens from the product label and clinical practice. The model was developed using prospective data from a pediatric clinical trial comparing diazepam to lorazepam for treatment of SE. Altogether, 87 patients aged ≥ 3 months to < 18 years contributed 162 diazepam concentrations. Diazepam PKs were well characterized by a two‐compartment model scaled by body size. No significant or clinically important relationships were observed between diazepam PKs and safety or efficacy. Simulations demonstrated that, compared with label dosing, the study dose (0.2 mg/kg i.v., maximum 8 mg) resulted in greater frequency in rapidly achieving the target therapeutic range of 200–600 ng/mL.
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Affiliation(s)
- Lawrence C Ku
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christoph P Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ryan J Beechinor
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James M Chamberlain
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC, USA
| | - Jeffrey T Guptill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Barrie Harper
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Edmund V Capparelli
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California, USA
| | | | | | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Yu D, Daddacha W, Koyen A, Bastien A, Head P, Dhere V, Nabeta G, Connolly E, Werner E, Madden M, Daly M, Minten E, Whelan D, Zhang H, Anand R, Shepard C, Sundaram R, Deng X, Dynan W, Wang Y, Bindra R, Cejka P, Rothenberg E, Doetsch P, Kim B. OC-0377: Targeting a Novel Function for SAMHD1 in DNA Repair for Radiation Therapy and PARP Inhibition. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30687-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shemesh E, Duncan S, Anand R, Shneider BL, Alonso EM, Mazariegos GV, Venick RS, Annunziato RA, Bucuvalas JC. Trajectory of adherence behavior in pediatric and adolescent liver transplant recipients: The medication adherence in children who had a liver transplant cohort. Liver Transpl 2018; 24:80-88. [PMID: 28779546 PMCID: PMC5739966 DOI: 10.1002/lt.24837] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 05/22/2017] [Revised: 06/30/2017] [Accepted: 07/31/2017] [Indexed: 12/12/2022]
Abstract
Knowledge of the longterm trajectory of nonadherence to immunosuppressants can inform decisions regarding organ allocation, adherence monitoring, and intervention efforts. The Medication Adherence in Children Who Had a Liver Transplant (MALT) prospective multisite study followed 400 pediatric and adolescent liver transplant recipients for 2 years, using the Medication Level Variability Index to monitor adherence. We hypothesized that adherence is an unstable (fluctuating) phenomenon: that patients who are adherent in year 1 may become nonadherent in year 2, and vice versa. However, we also hypothesized that a majority (more than 50%) of nonadherent patients remain nonadherent over time. We further hypothesized that the longer nonadherence lasts, the higher the likelihood of adverse events (rejection). Finally, we explored the effect of socioeconomic factors on the evolution of adherence over time. Most (59.7%) of the MALT patients who were nonadherent in year 1 remained so in year 2; 18.5% of patients who were adherent in year 1 became nonadherent in year 2. Only 4.4% of patients who were adherent in both year 1 and year 2 had a rejection, compared with 22.9% of patients who were nonadherent during 1 of the years, and 34.9% of those who were nonadherent in both years (P < 0.001), establishing a "dose-dependent" effect of adherence on transplant outcomes. Single-parent households were associated with worsening adherence. Our results suggest that good baseline adherence does not guarantee adherence later on, that nonadherence is likely to persist in the absence of interventions, and that monitoring of adherence and interventions to improve it should be expected to last for years if transplant outcomes are to be improved. Liver Transplantation 24 80-88 2018 AASLD.
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Affiliation(s)
- Eyal Shemesh
- Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Sarah Duncan
- Fordham University, Department of Psychology, New York, NY USA
| | | | | | - Estella M Alonso
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | | | - Rachel A Annunziato
- Icahn School of Medicine at Mount Sinai, New York, NY USA,Fordham University, Department of Psychology, New York, NY USA
| | - John C Bucuvalas
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Chandra G, Shenoi RA, Anand R, Rajamma U, Mohanakumar KP. Reinforcing mitochondrial functions in aging brain: An insight into Parkinson's disease therapeutics. J Chem Neuroanat 2017; 95:29-42. [PMID: 29269015 DOI: 10.1016/j.jchemneu.2017.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 06/21/2017] [Revised: 12/16/2017] [Accepted: 12/17/2017] [Indexed: 12/19/2022]
Abstract
Mitochondria, the powerhouse of the neural cells in the brain, are also the seat of certain essential gene signaling pathways that control neuronal functions. Deterioration of mitochondrial functions has been widely reported in normal aging as well as in a spectrum of age-associated neurological diseases, including Parkinson's disease (PD). Evidences accumulated in the recent past provide not only advanced information on the causes of mitochondrial bioenergetics defects and redox imbalance in PD brains, but also much insight into mitochondrial biogenesis, quality control of mitochondrial proteins, and genes, which regulate intra- and extra-mitochondrial signaling that control the general health of neural cells. The mitochondrial quality control machinery is affected in aging and especially in PD, thus affecting intraneuronal protein transport and degradation, which are primarily responsible for accumulation of misfolded proteins and mitochondrial damage in sporadic as well as familial PD. Essentially we considered in the first half of this review, mitochondria-based targets such as mitochondrial oxidative stress and mitochondrial quality control pathways in PD, relevance of mitochondrial DNA mutations, mitophagy, mitochondrial proteases, mitochondrial flux, and finally mitochondria-based therapies possible for PD. Therapeutic aspects are considered in the later half and mitochondria-targeted antioxidant therapy, mitophagy enhancers, mitochondrial biogenesis boasters, mitochondrial dynamics modulators, and gene-based therapeutic approaches are discussed. The present review is a critical assessment of this information to distinguish some exemplary mitochondrial therapeutic targets, and provides a utilitarian perception of some avenues for therapeutic designs on identified mitochondrial targets for PD, a very incapacitating disorder of the geriatric population, world over.
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Affiliation(s)
- G Chandra
- Inter University Centre for Biomedical Research & Super Speciality Hospital, Mahatma Gandhi University Campus at Thalappady, Rubber Board P.O., Kottayam, Kerala - 686009, India.
| | - R A Shenoi
- Inter University Centre for Biomedical Research & Super Speciality Hospital, Mahatma Gandhi University Campus at Thalappady, Rubber Board P.O., Kottayam, Kerala - 686009, India
| | - R Anand
- Inter University Centre for Biomedical Research & Super Speciality Hospital, Mahatma Gandhi University Campus at Thalappady, Rubber Board P.O., Kottayam, Kerala - 686009, India
| | - U Rajamma
- Inter University Centre for Biomedical Research & Super Speciality Hospital, Mahatma Gandhi University Campus at Thalappady, Rubber Board P.O., Kottayam, Kerala - 686009, India
| | - K P Mohanakumar
- Inter University Centre for Biomedical Research & Super Speciality Hospital, Mahatma Gandhi University Campus at Thalappady, Rubber Board P.O., Kottayam, Kerala - 686009, India
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Shemesh E, Mitchell J, Neighbors K, Feist S, Hawkins A, Brown A, Yin W, Anand R, Stuber ML, Annunziato RA. Recruiting a representative sample in adherence research-The MALT multisite prospective cohort study experience. Pediatr Transplant 2017; 21:10.1111/petr.13067. [PMID: 28984072 PMCID: PMC5698095 DOI: 10.1111/petr.13067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 01/26/2023]
Abstract
Medication adherence is an important determinant of transplant outcomes. Attempts to investigate adherence are frequently undermined by selection bias: It is very hard to recruit and retain non-adherent patients in research efforts. This manuscript presents recruitment strategies and results from the MALT (Medication Adherence in children who had a Liver Transplant) multisite prospective cohort study. MALT sites recruited 400 pediatric liver transplant patients who agreed to be followed for 2 years. The primary purpose was to determine whether a marker of adherence, the Medication Level Variability Index (MLVI), predicts rejection outcomes. The present manuscript describes methods used in MALT to ensure that a representative sample was recruited, and presents detailed recruitment results. MALT sites were able to recruit a nationally representative sample, as determined by a comparison between the MALT cohort and a national sample of transplant recipients. Strategies that helped ensure that the sample was representative included monitoring of the outcome measure in comparison with a national sample, drastically limiting patient burden, and specific recruitment methods. We discuss the importance of a representative sample in adherence research and recommend that future efforts to study adherence pay special attention to sample characteristics.
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Affiliation(s)
- Eyal Shemesh
- Icahn School of Medicine at Mount Sinai, New York, NY USA
| | | | - Katie Neighbors
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Susan Feist
- Mattel Children’s Hospital at UCLA, Los Angeles, CA, USA
| | - Andre Hawkins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Amanda Brown
- Hillman Center for Pediatric Transplantation, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | | | | | | | - Rachel A Annunziato
- Icahn School of Medicine at Mount Sinai, New York, NY USA,Fordham University, Department of Psychology, New York, NY USA
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Shemesh E, Bucuvalas JC, Anand R, Mazariegos GV, Alonso EM, Venick RS, Reyes-Mugica M, Annunziato RA, Shneider BL. The Medication Level Variability Index (MLVI) Predicts Poor Liver Transplant Outcomes: A Prospective Multi-Site Study. Am J Transplant 2017; 17:2668-2678. [PMID: 28321975 PMCID: PMC5607074 DOI: 10.1111/ajt.14276] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [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: 09/16/2016] [Revised: 03/03/2017] [Accepted: 03/11/2017] [Indexed: 01/25/2023]
Abstract
Nonadherence to immunosuppressant medications is a leading cause of poor long-term outcomes in transplant recipients. The Medication Level Variability Index (MLVI) provides a vehicle for transplant outcome risk-stratification through continuous assessment of adherence. The MALT (Medication Adherence in children who had a Liver Transplant) prospective multi-site study evaluated whether MLVI predicts late acute rejection (LAR). Four hundred pediatric (1-17-year-old) liver transplant recipients were enrolled and followed for 2 years. The a-priori hypothesis was that a higher MLVI predicts LAR. Predefined secondary analyses evaluated other outcomes such as liver enzyme levels, and sensitivity analyses compared adolescents to pre-adolescents. In the primary analysis sample of 379 participants, a higher prerejection MLVI predicted LAR (mean prerejection MLVI with LAR: 2.4 [3.6 standard deviation] versus without LAR, 1.6 [1.1]; p = 0.026). Fifty-three percent of the adolescents with MLVI>2 in year 1 had LAR by the end of year 2, as compared with 6% of those with year 1 MLVI≤2. A higher MLVI was significantly associated with all secondary outcomes. MLVI, a marker of medication adherence that uses clinically derived information, predicts LAR in pediatric liver transplant recipients.
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Affiliation(s)
- Eyal Shemesh
- Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - John C Bucuvalas
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | | | | | - Rachel A Annunziato
- Icahn School of Medicine at Mount Sinai, New York, NY USA,Fordham University, Department of Psychology, New York, NY USA
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Anand R, Graham S, Hartman R, Forrest E. Sarizotan for the treatment of severe apnea in patients with rett syndrome (RTT): Rationale and design of international 6-month, randomized, placebo-controlled phase III trial (STARs). J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Prakash SS, Muthuraman N, Anand R. Short-duration podcasts as a supplementary learning tool: perceptions of medical students and impact on assessment performance. BMC Med Educ 2017; 17:167. [PMID: 28923046 PMCID: PMC5604391 DOI: 10.1186/s12909-017-1001-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/05/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND Use of podcasts has several advantages in medical education. Podcasts can be of different types based on their length: short (1-5 min), moderate (6-15 min) and long (>15 min) duration. Short-duration podcasts are unique since they can deliver high-yield information in a short time. The perceptions of medical students towards short-duration podcasts are not well understood and this study aimed to analyze the same. An exploratory analysis of students' podcast usage and performance in summative assessments was also undertaken. METHODS First-year medical students (N = 94) participated in the study. Eight audiovisual podcasts, each ≤3 min duration (3-MinuTe Lessons; 3MTLs) were developed for two topics in biochemistry. The podcasts were made available for students after didactic lectures on the topics. Feedback was collected from students about their perceptions to 3MTLs using a self-reported questionnaire. The scores of students in summative assessments were compared based on their usage of 3MTLs. RESULTS Feedback revealed that 3MTLs were well received by students as a useful and convenient supplementary tool. Students used 3MTLs for topic review, to get an overview, as well as for quick revision and felt that 3MTLs were helpful in improving their understanding of the topic, clarify concepts and focus on important points and in turn, in preparation for assessments. A significant proportion (49%) felt that 3-min duration was optimal while, an equal proportion suggested an increase in the duration to 5 min with more information. The overall mean scores in assessments were not different between students based on 3MTLs usage. The pairwise comparisons revealed better scores amongst students who used 3MTLs for both topics. CONCLUSION Overall, short-duration podcasts were perceived by students as useful supplementary learning tools that aided them for revision and in preparation for assessments.
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Affiliation(s)
- S S Prakash
- Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, 632002, India
| | - N Muthuraman
- Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, 632002, India
| | - R Anand
- Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, 632002, India.
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Raj PB, Harikrishnan BL, Mampilly R, Anand R. Macrophage Activation Syndrome. J Assoc Physicians India 2017; 65:91-92. [PMID: 28598057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Macrophage Activation Syndrome (MAS) occurs as a severe life-threatening complication of several chronic rheumatic diseases. It is more frequent with systemic onset juvenile arthritis and adult onset Still's disease.1 It can be primary, infection related, malignancy associated or autoimmune3. We report a case of Macrophage Activation Syndrome presenting as pyrexia of unknown origin (PUO) and pancytopenia in the absence of any known triggering factor.
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Affiliation(s)
| | | | - Roshan Mampilly
- Junior Resident, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala
| | - R Anand
- Junior Resident, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala
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Brennan P, Elhamshary A, Alam P, Anand R, Ammar M. Anastomosis between the transverse cervical nerve and marginal mandibular nerve: how often does it occur? Br J Oral Maxillofac Surg 2017; 55:293-295. [DOI: 10.1016/j.bjoms.2016.08.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/04/2016] [Indexed: 11/28/2022]
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Smith MJ, Gonzalez D, Goldman JL, Yogev R, Sullivan JE, Reed MD, Anand R, Martz K, Berezny K, Benjamin DK, Smith PB, Cohen-Wolkowiez M, Watt K. Pharmacokinetics of Clindamycin in Obese and Nonobese Children. Antimicrob Agents Chemother 2017; 61:e02014-16. [PMID: 28137820 PMCID: PMC5365720 DOI: 10.1128/aac.02014-16] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/12/2017] [Indexed: 12/12/2022] Open
Abstract
Although obesity is prevalent among children in the United States, pharmacokinetic (PK) data for obese children are limited. Clindamycin is a commonly used antibiotic that may require dose adjustment in obese children due to its lipophilic properties. We performed a clindamycin population PK analysis using data from three separate trials. A total of 420 samples from 220 children, 76 of whom had a body mass index greater than or equal to the 95th percentile for age, were included in the analysis. Compared to other metrics, total body weight (TBW) was the most robust measure of body size. The final model included TBW and a sigmoidal maturation relationship between postmenstrual age (PMA) and clearance (CL): CL (liters/hour) = 13.8 × (TBW/70)0.75 × [PMA2.83/(39.52.83+PMA2.83)]; volume of distribution (V) was associated with TBW, albumin (ALB), and alpha-1 acid glycoprotein (AAG): V (liters) = 63.6 × (TBW/70) × (ALB/3.3)-0.83 × (AAG/2.4)-0.25 After accounting for differences in TBW, obesity status did not explain additional interindividual variability in model parameters. Our findings support TBW-based dosing for obese and nonobese children.
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Affiliation(s)
- Michael J Smith
- Division of Pediatric Infectious Diseases, University of Louisville, Louisville, Kentucky, USA
- Kosair Charities Pediatric Clinical Research Unit, University of Louisville, Louisville, Kentucky, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Ram Yogev
- Northwestern University, Chicago, Illinois, USA
| | - Janice E Sullivan
- Kosair Charities Pediatric Clinical Research Unit, University of Louisville, Louisville, Kentucky, USA
| | | | | | | | - Katherine Berezny
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
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Samanta A, Chandra J, Kaur R, Anand R, Shukla S, Mandal P. “Clinical profile and microbiological spectrum of Febrile neutropenic episodes in children with severe aplastic anemia: A single cente prospective study”. Pediatric Hematology Oncology Journal 2017. [DOI: 10.1016/j.phoj.2017.11.094] [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: 11/15/2022] Open
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Affiliation(s)
- Vishak K Acharya
- Department of Pulmonary Medicine, Kasturba Medical College Hospital, Manipal University, Attavar, Mangalore, Karnataka, India. E-mail:
| | - Santosh Rai
- Department of Radiology, Kasturba Medical College Hospital, Manipal University, Attavar, Mangalore, Karnataka, India
| | - Sachin Shirgavi
- Department of Internal Medicine, Kasturba Medical College Hospital, Manipal University, Attavar, Mangalore, Karnataka, India
| | - Radha R Pai
- Department of Pathology, Kasturba Medical College Hospital, Manipal University, Attavar, Mangalore, Karnataka, India
| | - R Anand
- Department of Pulmonary Medicine, Kasturba Medical College Hospital, Manipal University, Attavar, Mangalore, Karnataka, India. E-mail:
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