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Cochrane A, Wahl M, Fregoso M, Schreffler M, Nathan S, Aryal S. The Interaction Between CfDNA and Gerd. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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2
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Salas-De-Armas I, Bhardwaj A, Bergeron A, Gilley C, Reeves K, Kumar S, Aponte MP, Patel M, Patel J, Marcano J, Seal Z, Nathan S, Gregoric I, Kar B. Prehabilitation Maximizing Functional Mobility in Patient with Cardiogenic Shock Supported on Axillary Impella. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Hamad Y, Charya A, Kong H, Jang M, Andargie T, Shah P, Mathew J, Orens J, Aryal S, Nathan S, Agbor-Enoh S. Anellovirus: A Novel Marker for Overimmunosuppression and Risk of Infection in Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Thomas C, Klein K, Kennedy J, Psotka M, Isseh I, Tang D, Aryal S, Khangoora V, Nyquist A, Singhal A, Cantres-Fonseca O, Shlobin O, Nathan S, King C. Heart-lung Transplantation for Restrictive Cardiomyopathy and Pulmonary Hypertension Due to Emery-Dreifuss Muscular Dystrophy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Khetrapal P, Catto J, Ambler G, Williams N, Al-Hammouri T, Khan M, Thurairaja R, Nair R, Nathan S, Sridhar A, Ahmed I, Charlesworth P, Blick C, Cumberbatch M, Hussain S, Kotwal S, Bains P, Rowe E, Koupparis A, Noon A, Vasdev N, Hanchanale V, Mcgrath J, Kelly J. Comparing objective recovery of activity levels using wearable devices in open vs. intracorporeal robotic cystectomy: An analysis of the secondary outcomes of the iROC randomized trial. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Nathan A, Ng A, Mitra A, Davda R, Sooriakumaran P, Patel S, Fricker M, Kelly J, Shaw G, Rajan P, Sridhar A, Nathan S, Payne H,. Comparative effectiveness analysis of oncological and functional outcomes after salvage radical treatment with surgery or radiotherapy following primary focal or whole-gland ablative therapy for localised prostate cancer. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bhat K, Nathan A, Covas Moschovas M, Nathan S, Patel V. Outcomes of salvage robotic-assisted radical prostatectomy comparing patients with primary focal therapy versus whole gland ablation: A multicentric collaborative data. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01039-9] [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: 11/04/2022]
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Nathan A, Ng A, Mitra A, Sooriakumaran P, Davda R, Patel S, Fricker M, Kelly J, Shaw G, Rajan P, Sridhar A, Nathan S, Payne H. Comparative Effectiveness Analyses of Salvage Prostatectomy and Salvage Radiotherapy Outcomes Following Focal or Whole-Gland Ablative Therapy (High-Intensity Focused Ultrasound, Cryotherapy or Electroporation) for Localised Prostate Cancer. Clin Oncol (R Coll Radiol) 2021; 34:e69-e78. [PMID: 34740477 DOI: 10.1016/j.clon.2021.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/27/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022]
Abstract
AIMS Ablative therapy, such as focal therapy, cryotherapy or electroporation, aims to treat clinically significant prostate cancer with reduced treatment-related toxicity. Up to a third of patients may require further local salvage treatment after ablative therapy failure. Limited descriptive, but no comparative, evidence exists between different salvage treatment outcomes. The aim of this study was to compare oncological and functional outcomes after salvage robot-assisted radical prostatectomy (SRARP) and salvage radiotherapy (SRT). MATERIALS AND METHODS Data were collected prospectively and retrospectively on 100 consecutive SRARP cases and 100 consecutive SRT cases after ablative therapy failure in a high-volume tertiary centre. RESULTS High-risk patients were over-represented in the SRARP group (66.0%) compared with the SRT group (48.0%) (P = 0.013). The median (interquartile range) follow-up after SRARP was 16.5 (10.0-30.0) months and 37.0 (18.5-64.0) months after SRT. SRT appeared to confer greater biochemical recurrence-free survival at 1, 2 and 3 years compared with SRARP in high-risk patients (year 3: 86.3% versus 66.0%), but biochemical recurrence-free survival was similar for intermediate-risk patients (year 3: 90.0% versus 75.6%). There was no statistical difference in pad-free continence at 12 and 24 months between SRARP (77.2 and 84.7%) and SRT (75.0 and 74.0%) (P = 0.724, 0.114). Erectile function was more likely to be preserved in men who underwent SRT. After SRT, cumulative bowel and urinary Radiation Therapy Oncology Group toxicity grade I were 25.0 and 45.0%, grade II were 11.0 and 11.0% and grade III or IV complications were 4.0 and 5.0%, respectively. CONCLUSION We report the first comparative analyses of salvage prostatectomy and radiotherapy following ablative therapy. Men with high-risk disease appear to have superior oncological outcomes after SRT; however, treatment allocation does not appear to influence oncological outcomes for men with intermediate-risk disease. Treatment allocation was associated with a different spectrum of toxicity profile. Our data may inform shared decision-making when considering salvage treatment following focal or whole-gland ablative therapy.
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Affiliation(s)
- A Nathan
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK; The Royal College of Surgeons of England, London, UK.
| | - A Ng
- University College London, London, UK
| | - A Mitra
- University College London Hospitals NHS Trust, London, UK
| | - P Sooriakumaran
- University College London Hospitals NHS Trust, London, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - R Davda
- University College London Hospitals NHS Trust, London, UK
| | - S Patel
- University College London, London, UK
| | | | - J Kelly
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - G Shaw
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - P Rajan
- University College London Hospitals NHS Trust, London, UK
| | - A Sridhar
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - S Nathan
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - H Payne
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
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9
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Shirkhodaie C, Venturini JM, Shah AP, Nathan S, Paul J, Kalathiya R, Blair JEA. Retrospective comparison of percutaneous balloon pericardiotomy with pericardiocentesis versus pericardiocentesis alone for management of symptomatic pericardial effusions. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac tamponade is a potentially life-threatening complication of pericardial effusion. Pericardiocentesis with drainage is the mainstay of treatment for patients with pericardial effusion and cardiac tamponade. Percutaneous balloon pericardiotomy (PBP) is an adjunct to pericardiocentesis that may alleviate the risk for recurrent effusion and repeat procedures. However, the efficacy of PBP plus pericardiocentesis compared to pericardiocentesis alone is not clear.
Purpose
We sought to determine whether PBP plus pericardiocentesis was associated with less recurrence of pericardial effusion than pericardiocentesis alone.
Methods
We conducted a single-centre retrospective analysis of patients ≥18 years old with non-iatrogenic pericardial effusion undergoing either pericardiocentesis alone or PBP plus pericardiocentesis for the first time. For PBP, a balloon was advanced over a guidewire until it crossed the pericardium and was then inflated until the balloon profile was fully expanded. Type of balloon used, and single or double balloon technique were left up to the operator. Recurrent pericardial effusion was defined as a large pericardial effusion on echocardiogram, pericardial effusion that caused hemodynamic compromise, or pericardial effusion that necessitated another intervention to drain at any time after initial procedure. Risk factors for recurrent pericardial effusion were also assessed.
Results
There were 208 patients who underwent pericardiocentesis, with 33 patients receiving PBP plus pericardiocentesis. In all patients, the rate of recurrent pericardial effusion was 15.9% and 15.2%, respectively (p=0.92). In patients with a cancer diagnosis at time of procedure, the rate of recurrent pericardial effusion was 17.8% and 16.7%, respectively (p=0.89). In patients with malignant pericardial effusion as confirmed by cytology, the rate of recurrent pericardial effusion was 20.4% and 13.3%, respectively (p=0.72). Patients with a connective tissue disease (CTD) had an increased odds ratio (OR) of recurrent pericardial effusion when compared to patients without a CTD (OR 3.19, 95% CI 1.31–7.77).
Conclusions
The results of this study suggest that PBP plus pericardiocentesis offers no significant benefit over pericardiocentesis alone at preventing recurrent pericardial effusion. This finding was true in all sub-groups, including patients with cancer and patients with malignant pericardial effusion. Patients with a CTD were three times more likely than patients without a CTD of having a recurrent pericardial effusion, independent of treatment strategy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Shirkhodaie
- University of Chicago Medicine, Pritzker School of Medicine, Chicago, United States of America
| | - J M Venturini
- Edward Hospital, Naperville, United States of America
| | - A P Shah
- University of Chicago Medicine, Section of Cardiology, Chicago, United States of America
| | - S Nathan
- University of Chicago Medicine, Section of Cardiology, Chicago, United States of America
| | - J Paul
- University of Chicago Medicine, Section of Cardiology, Chicago, United States of America
| | - R Kalathiya
- University of Chicago Medicine, Section of Cardiology, Chicago, United States of America
| | - J E A Blair
- University of Chicago Medicine, Section of Cardiology, Chicago, United States of America
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10
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Fricker M, Cleaveland P, Kasivisvanathan V, Williams N, Miah S, Shah N, Hines J, Collins J, Sridhar A, Kelkar A, Briggs T, Kelly J, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. 141 New Guidelines to Reduce Unnecessary Blood Tests, Delayed Discharge and Costs Following Robot Assisted Radical Prostatectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objectives
Routine postoperative blood tests (POBT) following robot assisted radical prostatectomy (RARP) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.
Method
The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed to form new guidelines. The new guidelines were prospectively validated in a sample of 300 patients.
Results
Derivation Dataset: 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 day due to delayed or incomplete blood tests. Validation Dataset: No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. Number of POBT requested reduced by 73% (p < 0.001). The new guidelines improved POBT sensitivity for complications from 98% to 100% and specificity from 0% to 74%. Discharge delays reduced from 6% to 0% (p = 0.008). Cost savings were £178 per patient.
Conclusions
Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.
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Affiliation(s)
- A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - N Hanna
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
| | - A Rashid
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - Y Phuah
- University College London, London, United Kingdom
| | - K Flora
- University College London, London, United Kingdom
| | - M Fricker
- Newcastle University, Newcastle, United Kingdom
| | - P Cleaveland
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - N Williams
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - S Miah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - N Shah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - J Hines
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Collins
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A Kelkar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - B Lamb
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Patel S, Kasivisvanathan V, Sridhar A, Shaw G, Kelly J, Briggs T, Rajan P, Sooriakumaran P, Nathan S. 283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1075] [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: 11/12/2022]
Abstract
Abstract
Aim
Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy.
Method
1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre.
Results
There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p < 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p < 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145).
Conclusions
SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.
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Affiliation(s)
- A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - M Fricker
- University of Newcastle, Newcastle, United Kingdom
| | - R De Groote
- Department of Urology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium
| | - A Arora
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | - Y Phuah
- University College London, London, United Kingdom
| | - K Flora
- University College London, London, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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12
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Fricker M, Nathan A, Hannah N, Rashid A, Patel S, Phuah Y, Flora K, Cleaveland P, Kasivisvanathan V, Williams N, Miah S, Shah N, Hines J, Collins J, Sridhar A, Kelkar A, Briggs T, Kelly J, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. O50 New guidelines to reduce unnecessary blood tests, delayed discharge and costs following robot assisted radical prostatectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.055] [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: 11/12/2022]
Abstract
Abstract
Introduction
Routine postoperative blood tests (POBT) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.
Method
The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed, and new guidelines were designed. The guidelines were prospectively validated in a cohort of 300 patients.
Result
Derivation Dataset 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 days due to delayed or incomplete blood tests.
Validation Dataset No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. New guidelines improved sensitivity for complications from 98% to 100% and specificity from 0% to 74%. The number of blood tests requested reduced by 73% (P < 0.001). Discharge delays reduced from 6% to 0% (P = 0.008). Cost savings were £178 per patient.
Conclusion
Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.
Take-home Message
Routine postoperative blood tests following robot assisted radical prostatectomy are often unnecessary. A guideline-based approach can reduce costs and optimise patient care.
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Affiliation(s)
| | - A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- University College London
| | - N Hannah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
- University of Cambridge
| | - A Rashid
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
- University of Cambridge
| | | | | | | | - P Cleaveland
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - N Williams
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - S Miah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - N Shah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - J Hines
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - J Collins
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - A Kelkar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- Nuffield Department of Surgical Sciences, University of Oxford
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London
| | - B Lamb
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
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Dinneen E, Grierson J, Haider A, Allen C, Heffernan-Ho D, Clow R, Freeman A, Briggs T, Nathan S, Brew-Graves C, Mallett S, Williams N, Persad R, Aning J, Oxley J, Oakley N, Morgan S, Tahir F, Ahmad I, Dutto L, Salmond J, Marzena R, Ben-Salha I, Kelly J, Shaw G. NeuroSAFE PROOF. Update on a multi-centre, pragmatic, RCT for men undergoing robot-assisted radical prostatectomy: Trial in progress. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01245-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Pavan N, Kasivisvanathan V, Collins J, Kelkar A, Sridhar A, Shaw G, Rajan P, Kelly J, Briggs T, Sooriakumaran P, Nathan S. Salvage versus primary robot-assisted radical prostatectomy: A propensity-matched comparative effectiveness study from a high-volume tertiary center. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Sharma A, Cleaveland P, Kasivisvanatha V, William N, Mia S, Collin J, Sridha A, Kelka A, Sha N, Kell J, Briggs T, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. 236 Novel Guidelines to Avoid Routine Blood Tests After Robotic Assisted Radical Prostatectomy (RARP). Br J Surg 2021. [DOI: 10.1093/bjs/znab134.388] [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: 11/13/2022]
Abstract
Abstract
Introduction
Patients undergoing RARP commonly require routine post-operative blood tests. This practice dates from an era of open surgery, with increased blood loss and complications. We aim to improve specificity of blood test requests with novel guidelines.
Method
1039 consecutive RARP patients at two tertiary urology centres in the UK were audited. Novel guidelines constructed based on risk stratified evidence from the initial audit were used to prospectively audit 133 patients.
Results
16% had clinical concerns post-operatively. 1% and 4% had an intra- and post-operative complication. Intra- or post-operative clinical judgement flagged post-operative complications in 99.9%. 80% had routine blood tests with no clinical concerns. 6% had delayed discharge due to delayed processing of blood tests. 0.9% received a peri-operative transfusion.
Re-Audit Novel guidelines reduced the number of blood tests requested from 100% to 36%. Specificity in diagnosing a complication improved from 0% to 67%. Discharge delays reduced from 6% to 0% and no post-operative complications were missed (sensitivity 100%).
Conclusions
Routine blood tests, without an indication, did not flag any additional post-operative complications. Blood transfusion is rare for RARP. Novel guidelines to request post-operative blood tests will reduce costs and discharge delays whilst maintaining appropriate patient safety and care.
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Affiliation(s)
- A Nathan
- University College London Hospitals, London, United Kingdom
| | - N Hanna
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - A Rashid
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - S Patel
- University College London Hospitals, London, United Kingdom
| | - Y Phuah
- University College London Hospitals, London, United Kingdom
| | - K Flora
- University College London Hospitals, London, United Kingdom
| | - A Sharma
- University College London Hospitals, London, United Kingdom
| | - P Cleaveland
- University College London Hospitals, London, United Kingdom
| | | | - N William
- University College London Hospitals, London, United Kingdom
| | - S Mia
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - J Collin
- University College London Hospitals, London, United Kingdom
| | - A Sridha
- University College London Hospitals, London, United Kingdom
| | - A Kelka
- University College London Hospitals, London, United Kingdom
| | - N Sha
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - J Kell
- University College London Hospitals, London, United Kingdom
| | - T Briggs
- University College London Hospitals, London, United Kingdom
| | - G Shaw
- University College London Hospitals, London, United Kingdom
| | | | - P Rajan
- University College London Hospitals, London, United Kingdom
| | - B Lamb
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - S Nathan
- University College London Hospitals, London, United Kingdom
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Charya A, Jang M, Sun J, Mutebi C, Luikart H, Shah P, Matthews J, Brown A, Kong H, Tunc I, Berry G, Marboe C, Iacono A, Nathan S, Khush K, Orens J, Valantine H, Agbor-Enoh S. Racial Differences in Immunosuppression and Lung Transplant Outcomes. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.474] [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] Open
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17
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Mutebi C, Ponor L, Cochrane A, Levine D, Jang M, Luikart H, Shah P, Mathew J, Brown A, Kong H, Berry G, Marboe C, Iacono A, Nathan S, Khush K, Orens J, Valantine H, Agbor-Enoh S. Impact of AMR Treatment: Responders vs Non-Responders Characteristics. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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18
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Belkin M, Shah A, Nathan S, Kalathiya R, Song T, Ota T, Jeevanandam V, Nguyen A, Chung B, Smith B, Kalantari S, Sarswat N, Kim G, Pinney S, Grinstein J. Performing under Pressure: Invasive Hemodynamics to Diagnose and Guide Treatment of LVAD Outflow Graft Stenosis. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.2116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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19
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Charya A, Jang M, Mutebi C, Luikart H, Shah P, Matthews J, Brown A, Kong H, Tunc I, Berry G, Marboe C, Iacono A, Nathan S, Khush K, Orens J, Valantine H, Agbor-Enoh S. Cell-Free DNA to Monitor Immunosuppression Adequacy in Lung Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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20
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Cleaveland P, Kasivisvanathan V, Miah S, Collins J, Sridhar A, Kelkar A, Hines J, Kelly J, Shah N, Briggs T, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. Novel guidelines to avoid routine blood tests after Robot Assisted Radical Prostatectomy (RARP). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35850-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: 10/23/2022] Open
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21
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De Groote R, Nathan A, De Bleser E, Pavan N, Sridhar A, Kelly J, Sooriakumaran P, Briggs T, Nathan S. Techniques and Outcomes of Salvage Robot-Assisted Radical Prostatectomy (sRARP). Eur Urol 2020; 78:885-892. [PMID: 32461073 DOI: 10.1016/j.eururo.2020.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 03/01/2020] [Accepted: 05/03/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Salvage Robot-Assisted Radical Prostatectomy (sRARP) has been described as feasible treatment for the management of localised prostate cancer (PCa) recurrence after primary treatment. However, no large reports have published cancer and quality outcomes. OBJECTIVE To report perioperative, functional and oncologic outcomes of sRARP in patients with localised PCa recurrence. DESIGN, SETTING, AND PARTICIPANTS We retrospectively evaluated 106 patients with local recurrence eligible for sRARP. SURGICAL PROCEDURE Surgery was performed using the DaVinci Si system similar to the standard approach but with adaptation to the primary treatment. MEASUREMENTS Peri-operative outcomes included 90-day complication rate. Functional outcomes included rates of incontinence and erectile dysfunction. Oncological outcomes included tumour staging, margin rate and recurrence. RESULTS AND LIMITATIONS Primary treatment was High Intensity Focused Ultrasound (HIFU) in 59 (56%) patients, 27 (25%) radiotherapy, 10 (9%) seed brachytherapy, 8 (8%) solitary androgen deprivation therapy (ADT), one (1%) cryotherapy and one (1%) electroporation / Nanoknife. Median follow-up was 2.1 years. 90-day complication rate was 8%. At two years or more, 50% were fully continent and 33% were socially continent. Continence rates tended to be better after focal compared to whole-gland treatments. Erectile dysfunction was present in 95%. Positive surgical margin rate was 39%. Biochemical recurrence occurred in 13% and local or metastatic recurrence in 11%. CONCLUSIONS sRARP is technically more challenging but is a feasible option in high-volume centres for treatment of recurrent PCa. Patients should be counselled that functional outcomes are inferior to primary RARP. Adjustment of surgical technique according to the primary treatment is key for good surgical outcomes. PATIENT SUMMARY We report our experience with sRARP for the management of localised PCa recurrence after primary treatment. This represents a feasible approach with acceptable peri-operative complications and cancer outcomes. Functional outcomes are inferior to RARP in the primary setting.
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Affiliation(s)
- R De Groote
- Department of Urology, University College London Hospital. NHS Foundation Trust. London. UK; Department of Urology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium.
| | - A Nathan
- Department of Urology, University College London Hospital. NHS Foundation Trust. London. UK
| | - E De Bleser
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - N Pavan
- Department of Urology, University College London Hospital. NHS Foundation Trust. London. UK; Department of Medicine, Surgery and Health Sciences, Urological Clinic, University of Trieste, Trieste, Italy
| | - A Sridhar
- Department of Urology, University College London Hospital. NHS Foundation Trust. London. UK
| | - J Kelly
- Department of Urology, University College London Hospital. NHS Foundation Trust. London. UK
| | - P Sooriakumaran
- Department of Urology, University College London Hospital. NHS Foundation Trust. London. UK
| | - T Briggs
- Department of Urology, University College London Hospital. NHS Foundation Trust. London. UK
| | - S Nathan
- Department of Urology, University College London Hospital. NHS Foundation Trust. London. UK
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Gamlath L, Nandasena S, Silva PD, Morrell S, Linhart C, Lin S, Sharpe A, Nathan S, Taylor R. Community intervention for cardiovascular disease risk factors in Kalutara, Sri Lanka. BMC Cardiovasc Disord 2020; 20:203. [PMID: 32345219 PMCID: PMC7187517 DOI: 10.1186/s12872-020-01427-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/12/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The effectiveness of a 2015-17 community intervention to reduce cardiovascular disease (CVD) and type 2 diabetes (T2DM) risk factors is assessed in a Sri Lanka adult population, using a before-and-after study design. METHODS Four contiguous Public Health Midwife (PHM) areas in Kalutara district (Western Province) were exposed to a Sri Lankan designed community health promotion initiatives (without screening) to lower CVD and T2DM risk factors. Pre- and post-intervention surveys (2014, n=1,019; 2017, n=908) were of 25-64 year males (M) and females (F) from dissimilar randomly selected clusters (villages or settlements) from PHMs, with probability of selection proportional to population size, followed by household sampling, then individual selection to yield equal-probability samples. Differences in resting blood pressure (BP), fasting plasma glucose (FPG), total cholesterol, body mass index and tobacco smoking, adjusting for cluster sampling, age and socio-economic differences, were examined. RESULTS Hypertension prevalence declined from 25% to 16% (F) (p<.0001), and 21% to 17% (M). Both mean systolic and diastolic BP declined. T2DM declined from 18% to 13% (F), and 18% to 15% (M), as did mean fasting plasma glucose. Elevated total cholesterol declined from 21% to 15% in women (p=0.003) and mean cholesterol declined. Frequency distributions, medians and means of these continuous CVD risk factors shifted to lower levels, and were mostly statistically significant (p< 0.05). CONCLUSIONS Community health promotion can lower key CVD and T2DM risk factors. Lowering tobacco consumption in males and obesity remain challenges in Sri Lanka.
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Affiliation(s)
- L Gamlath
- Ministry of Health, Colombo, Sri Lanka; formerly Director, National Institute of Health Sciences, Kalutara, Sri Lanka
| | - S Nandasena
- Office of the Regional Director of Health Services, Kalutara, Sri Lanka
| | | | - S Morrell
- School of Public Health and Community Medicine, University of NSW, Sydney, Australia
| | - C Linhart
- School of Public Health and Community Medicine, University of NSW, Sydney, Australia
| | - S Lin
- School of Public Health and Community Medicine, University of NSW, Sydney, Australia
| | - A Sharpe
- School of Public Health and Community Medicine, University of NSW, Sydney, Australia
| | - S Nathan
- School of Public Health and Community Medicine, University of NSW, Sydney, Australia
| | - R Taylor
- School of Public Health and Community Medicine, University of NSW, Sydney, Australia.
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Keller M, Shah P, Bush E, Diamond J, Matthews J, Brown A, Timofte I, Fideli U, Kong H, Marishta A, Bhatti K, Yang Y, Tunc I, Luikart H, Berry G, Marboe C, Iacono A, Nathan S, Khush K, Orens J, Jang M, Valentine H, Agbor-Enoh S. Donor-Derived-Cell-Free DNA to Identify Primary Graft Dysfunction Patients at Risk of Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.959] [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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24
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Agbor-Enoh S, Ponor I, Shah P, Levine D, Cochrane A, Philogene M, Matthews J, Brown A, Timofte I, Fideli U, Kong H, Marishta A, Bhatti K, Tunc I, Yang Y, Luikart H, Marboe C, Berry G, Iacono A, Nathan S, Khush K, Orens J, Jang M, Valantine H. To Treat or Not to Treat: DSA Positive Lung Transplant Recipients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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25
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Bazemore K, Permpalung N, Rohly M, Timofte I, Brown A, Orens J, Iacono A, Nathan S, Avery R, Valentine H, Agbor-Enoh S, Shah P. Characterization of Respiratory Pathogens in Contemporary Lung Transplant Recipients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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26
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Ponor I, Levine D, Cochrane A, Philogene M, Shah P, Mathew J, Brown A, Timofte I, Fideli U, Kong H, Marishta A, Yang Y, Tunc I, Luikart H, Berry G, Marboe C, Iacono A, Nathan S, Khush K, Orens J, Jang M, Valentine H, Agbor-Enoh S. Lung Transplantation: DSA to AMR Trajectory. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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27
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Nathan S, Maru K, Williams M, Palmer K, Rawstorne P. Koori voices: self-harm, suicide attempts, arrests and substance use among Aboriginal and Torres Strait Islander adolescents following residential treatment. Health Justice 2020; 8:4. [PMID: 32034568 PMCID: PMC7007640 DOI: 10.1186/s40352-020-0105-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/10/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Complex interacting social, economic and historical factors influence the availability and uptake of alcohol and drugs, including among Indigenous communities. Self-harm and suicide as well as homelessness and incarceration, can both precede and result from drug and alcohol use. Rates of self-harm, suicide and incarceration among Aboriginal and Torres Strait Islander people in Australia are among the highest in the world and drug and alcohol treatment programs need to address these underlying complexities. This study examines whether an 'holistic' residential drug and alcohol treatment program for adolescents, with over 30% of clients identifying as Aboriginal and Torres Strait Islander, can improve outcomes post-discharge, including reducing self-harm, suicide attempts, arrests and alcohol and drug use. The program addresses substance use, mental health, employment, accommodation, social/community and family life. Program admission and 3 months' post-discharge data from 2007 to 2016 were analysed. RESULTS From 2007 to 2016, 619 Aboriginal and Torres Strait Islander young people were admitted to the program; 247 stayed in the program for 30 days or more; 89 were successfully followed up three months post-discharge to determine whether there was a significant improvement from baseline using the McNemar's Test and the Wilcoxon Signed Ranks Test. On admission, 18 people (20%) of the study population reported attempting suicide in the last 3 months and 23 people (30%) reported self-harm. Most had been engaged in the criminal justice system, with 67 people (75%) having been to court and 62 people (70%) arrested one or more times in the past 3 months, with 35 people (41%) in unstable housing, reporting having lived in three or more places in the previous 6 months. At 3 months post-treatment, all (n = 18) who reported suicide attempts in the 3 months prior to admission reported no attempts in the prior 3 months at follow-up. There was also a significant reduction in self-harm with 23 young people out of the 27 who reported self-harm at baseline not reporting self-harm at follow up (85%) and in the proportion of adolescents who reported using cannabis, amphetamines and alcohol, as well as a reduction in the proportion who reported being arrested. CONCLUSIONS The findings provide support for an 'holistic' residential treatment program as an approach to improve health and related outcomes for Aboriginal and Torres Strait Islander young people. In addition to a focus on multiple aspects of a young person's life in treatment, culturally relevant modes of treatment and support should be a future focus to further strengthen programs when Aboriginal and Torres Strait Islander young people are over-represented in the client group.
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Affiliation(s)
- S Nathan
- School of Public Health and Community Medicine, UNSW, Sydney, Australia.
| | - K Maru
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | - M Williams
- Graduate School of Health, University of Technology, Sydney, Australia
| | - K Palmer
- Ted Noffs Foundation, Sydney, Australia
| | - P Rawstorne
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
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Belkin M, Imamura T, Kanelidis A, Holzhauser L, Ebong I, Narang N, Blair J, Nathan S, Paul J, Shah A, Chung B, Nguyen A, Smith B, Kalantari S, Raikhelkar J, Sarswat N, Kim G, Sayer G, Uriel N. TAVI in LVAD Patients with Aortic Insufficiency. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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29
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Sobhanian M, Saltarrelli J, Weeks P, Nathan S, Radovancevic R, Kar B, Gregoric I. Comparative Efficacy of Bortezomib and Carfilzomib Desensitization Protocols in Highly Sensitized Cardiac Transplant Candidates. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.070] [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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30
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Nathan S, Wershof Schwartz A. ENGAGING LEARNERS THROUGH ARTS AND HUMANITIES: RURRICULAR INNOVATIONS AT VA BOSTON AND HARVARD MEDICAL SCHOOL. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Nathan
- Boston Healthcare System, Newton, Massachusetts, United States
| | - A Wershof Schwartz
- Division of Geriatrics and Palliative Care, VA Boston Healthcare System; VA New England GRECC - Geriatric Research Education and Clinical Center, Harvard Medical School
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Ahmad K, Agbor-Enoh S, Shah P, Timofte I, Orens J, Iacono A, Lemma M, Aryal S, Cochrane A, Soares F, Nathan S, Brown A, Valantine H. Predicting Risk of Early Readmission in Lung Transplant Recipients Using dd-cfDNA. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1166] [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: 10/17/2022] Open
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32
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Jackson A, Cochrane A, Nathan S, Brown A, Shah P, Orens J, Iacono A, Timofte I, Agbor-Enoh S, Valantine H. Elevated Donor-Derived Cell-Free DNA (ddcfDNA) as an Early Risk Factor for the Development and Persistence of De Novo Donor Specific HLA Antibody. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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33
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Shah P, Rohly M, Brown A, Timofte I, Nayyar M, Gandhi A, Kim N, Joshi A, Iacono A, Nathan S, Avery R, Orens J, Agbor-Enoh S, Valantine H. Donor Derived Cell Free DNA is Elevated With Pathogens That are Risk Factors For Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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34
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Agbor-Enoh S, Tunc I, Gorham S, Jang M, Fideli U, Marishta A, Zhu J, Pirooznia M, Yang Y, Davis A, Grimm D, Cao Z, Luikart H, Shah P, Timofte I, Brown A, Iacono A, Nathan S, Orens J, Khush K, Valantine H. Clinically-unrecognized Allograft Injury is Common After Lung Transplantion. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.059] [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: 11/24/2022] Open
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35
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Agbor-Enoh S, Jackson A, Berry G, Cochrane A, Tunc I, Jang M, Bhatti K, Marishta A, Gorham S, Yang Y, Fideli U, Zhu J, Pirooznia M, Grimm D, Luikart H, Shah P, Timofte I, Iacono A, Cao Z, Brown A, Shah P, Orens J, Marboe C, Nathan S, Khush K, Valantine H. Antibody-mediated Rejection: Should We Wait for Clinical Diagnosis? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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36
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Mohd-Shaharuddin N, Lim YAL, Hassan NA, Nathan S, Ngui R. Soil-transmitted helminthiasis among indigenous communities in Malaysia: Is this the endless malady with no solution? Trop Biomed 2018; 35:168-180. [PMID: 33601789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Soil-transmitted helminths (STHs) are the most common intestinal parasitic infections of medical importance in human. The infections are widely distributed throughout the tropical and subtropical countries including Malaysia particularly among disadvantaged and underprivileged communities. This study was conducted to determine the prevalence and pattern of STH infections among Temuan indigenous subgroup. A cross sectional study was conducted among five villages in Peninsular Malaysia. Faecal samples and socioeconomic data were collected from each consented participant. Faecal samples were processed using formalin-ether sedimentation and examined under microscope. Data analysis was carried out using SPSS software programme for Windows version 24. A total of 411 participants voluntarily participated in this study. The overall prevalence of STH infections was 72.7% (95% CI = 68.2 - 77%). The most common STH species recorded was Trichuris trichiura (58.4%, 95% CI = 53.5 - 63.2%) followed by Ascaris lumbricoides (45.5%, 95% CI = 40.6 - 50.5%) and hookworm (23.1%, 95% CI = 19.1 - 27.5%). Multivariate analysis demonstrated that using untreated water was a significant predictor of STH infections in these communities. Our findings demonstrated that STH infections are still prevalent and co-exist with the low SES among this subgroup. Poverty and poor sanitation are the leading factors contributing to this malady. Hence, the reassessments of the existing control measures are needed.
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Affiliation(s)
- N Mohd-Shaharuddin
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Y A L Lim
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - N-A Hassan
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - S Nathan
- School of Bioscience and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Selangor, Malaysia
| | - R Ngui
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kreuter M, Maher TM, Swigris J, Wijsenbeek MS, Axmann J, Ireland L, Nathan S. Differences in Patients and Physician Viewpoints of the Management of Idiopathic Pulmonary Fibrosis (IPF). Pneumologie 2018. [DOI: 10.1055/s-0037-1619185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Kreuter
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik; Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (TLRC); Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - TM Maher
- Royal Brompton Hospital; NIHR Biological Research Unit, London
| | - J Swigris
- National Jewish Health, Denver, Colorado, USA
| | | | - J Axmann
- F. Hoffmann-La Roche Ltd., Basel
| | | | - S Nathan
- Inova Fairfax Hospital, Falls Church, USA
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Nathan S, Salimin N, Shahril M. A comparative analysis of badminton game instructions effect of non-linear pedagogy and linear pedagogy. J Fundam and Appl Sci 2018. [DOI: 10.4314/jfas.v9i6s.94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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39
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Quintana-Quezada RA, Rajapreyar I, Postalian-Yrausquin A, Yeh YC, Choi S, Akkanti B, Sieg A, Weeks P, Patel M, Patel J, Nathan S, Kar B, Loyalka P, Gregoric I. Clinical Factors Implicated in Primary Graft Dysfunction After Heart Transplantation: A Single-center Experience. Transplant Proc 2017; 48:2168-71. [PMID: 27569965 DOI: 10.1016/j.transproceed.2016.02.073] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/16/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Primary graft dysfunction (PGD) is a frequent complication after cardiac transplantation and remains one of the leading causes of mortality in these patients. The objective of this case-control study is to identify donor and surgical procedure's factors associated with PGD, and further guide possible strategies to prevent PGD. METHODS Retrospective analysis of the medical records of patients who underwent cardiac transplantation at Memorial Hermann Hospital at Texas Medical Center between October 2012 and February 2015. RESULTS The study population included 99 patients, of which 18 developed PGD. Univariate analysis of donor characteristics revealed opioid use (P = .049) and death owing to anoxia (P = .021) were associated with PGD. The recipient/donor blood type match AB/A was significantly associated with PGD (P = .031). Time from brain death to aortic cross clamp (TBDACC) of ≥3 and ≥5 days were also found to be associated with PGD (P = .0011 and .0003, respectively). Multivariate analysis confirmed that patients with a time from brain death to aortic cross clamp ≥3 and ≥5 days had lesser odds of developing PGD (odds ratio, 0.098 [P = .0026] and OR, 0.092 [P = .0017], respectively]. CONCLUSIONS Our study showed that a longer time from brain death to aortic cross clamp was associated with lower odds of developing PGD. Therefore, postponing heart procurement for a few days after brain death seems to be beneficial in preventing PGD.
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Affiliation(s)
- R A Quintana-Quezada
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas.
| | - I Rajapreyar
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - A Postalian-Yrausquin
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Y C Yeh
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - S Choi
- Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas
| | - B Akkanti
- Division of Critical Care, Pulmonary and Sleep, University of Texas Medical School at Houston, Houston, Texas
| | - A Sieg
- Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, Texas
| | - P Weeks
- Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, Texas
| | - M Patel
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - J Patel
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - S Nathan
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - B Kar
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - P Loyalka
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - I Gregoric
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
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40
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John R, Keebler M, Stulak J, Emani S, Klodell C, Nathan S, Brieke A, Uriel N, Chin J, Eckman P, Nsair A, Agarwal R, Thenappan T, Adamson R, Chuang J, Farrar D, Sundareswaran K, Katz J. Incidence and Risk Factors of Late Bleeding in Patients Enrolled in the PREVENT Study. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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41
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Kar B, Prathipati P, Macedo F, Nathan S, Radovancevic R, Loyalka P, Gregoric I. Transcatheter Aortic Valve Replacement Management of Aortic Insufficiency in Patients with Left Ventricular Assist Device Support. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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42
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Rajapreyar I, Nathan S, Ghotra A, Nolan M, Weeks P, Sieg A, Kar B, Loyalka P, Paruthi C, Gregoric I. Early Antibody Mediated Rejection Post Orthotopic Heart Transplantation: A Single Center Experience. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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43
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Weeks P, Sieg A, Rajapreyar I, Nathan S. Bivalirudin for Suspected Pump Thrombosis in Patients with Left Ventricular Assist Devices: A Single-Center Experience. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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44
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Katz J, Emani S, Egnaczyk G, Adler E, Chin J, Shah P, Brieke A, Keebler M, Nathan S, Gregoric I, Crandall D, Farrar D, Sundareswaran K, Maltais S. Impact of Adherence to Standard Practice Guidelines for Patients Receiving a Left Ventricular Assist Device - Insights from the PREVENT Study. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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45
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Adatya S, Egnaczyk G, Katz J, Brieke A, Stulak J, Nathan S, Rich J, Emani S, Kilic A, Ransom J, DePasquale E, Crandall D, Farrar D, Sundareswaran K, Uriel N. The Effect of Pre-Existing Hypercoagulable Disorders on Outcomes in Patients with LVADs. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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46
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Lokanathan Y, Mohd-Adnan A, Kua BC, Nathan S. Cryptocaryon irritans recombinant proteins as potential antigens for sero-surveillance of cryptocaryonosis. J Fish Dis 2016; 39:1069-1083. [PMID: 27086498 DOI: 10.1111/jfd.12474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/29/2015] [Revised: 02/01/2016] [Accepted: 02/04/2016] [Indexed: 06/05/2023]
Abstract
Cryptocaryonosis is a major problem for mariculture, and the absence of suitable sero-surveillance tools for the detection of cryptocaryonosis makes it difficult to screen Cryptocaryon irritans-infected fish, particularly asymptomatic fish. In this study, we proposed a serum-based assay using selected C. irritans proteins to screen infected and asymptomatic fish. Eight highly expressed genes were chosen from an earlier study on C. irritans expressed sequence tags and ciliate glutamine codons were converted to universal glutamine codons. The chemically synthesized C. irritans genes were then expressed in an Escherichia coli expression host under optimized conditions. Five C. irritans proteins were successfully expressed in E. coli and purified by affinity chromatography. These proteins were used as antigens in an enzyme-linked immunosorbent assay (ELISA) to screen sera from experimentally immunized fish and naturally infected fish. Sera from both categories of fish reacted equally well with the expressed C. irritans recombinant proteins as well as with sonicated theronts. This study demonstrated the utility of producing ciliate recombinant proteins in a heterologous expression host. An ELISA was successfully developed to diagnose infected and asymptomatic fish using the recombinant proteins as antigens.
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Affiliation(s)
- Y Lokanathan
- School of Biosciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor Darul Ehsan, Malaysia
| | - A Mohd-Adnan
- School of Biosciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor Darul Ehsan, Malaysia
| | - B-C Kua
- National Fish Health Research Centre (NaFisH), Fisheries Research Institute, Batu Maung, Penang, Malaysia
| | - S Nathan
- School of Biosciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor Darul Ehsan, Malaysia
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47
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Maltais S, Kilic A, Nathan S, Keebler M, Emani S, Ransom J, Katz J, Sheridan B, Brieke A, Egnaczyk G, Entwistle J, Adamson R, Stulak J, Uriel N, O’Connell J, Farrar D, Sundareswaran K, Gregoric I. PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management (PREVENT). J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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48
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Cochrane A, LoRusso M, Fregoso M, Bowen M, Nathan S, Brown A. Hepatitis B Immunity Prior to Lung Transplantation: Three Shots and You’re Out? J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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49
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Agbor-Enoh S, Fideli U, Doveikis J, Zhu J, Tunc I, Shah P, Russell S, Feller E, Shah K, Rodrigo M, Shah P, Pham S, Iacono A, Nathan S, Orens J, GRAfT Investigators N, Valantine H. Genomic Research Alliance for Transplantation (GRAfT): A Model for Long Term Transplant Studies in Thoracic Organ Transplantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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50
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Kennedy E, Vanichanan J, Rajapreyar I, Gonzalez B, Nathan S, Gregoric I, Kar B, Loyalka P, Weeks P, Chavez V, Wanger A, Ostrosky Zeichner L. A pseudo-outbreak of disseminated cryptococcal disease after orthotopic heart transplantation. Mycoses 2015; 59:75-9. [PMID: 26627342 DOI: 10.1111/myc.12433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/13/2015] [Accepted: 10/18/2015] [Indexed: 12/23/2022]
Abstract
Cryptococcal infection is the third most common invasive fungal infection (IFI) among solid-organ transplant (SOT) recipients and is considered an important opportunistic infection due to its significant morbidity and mortality. To determine whether a cluster of cryptococcosis in heart transplant patients was of nosocomial nature, three cases of orthotopic heart transplant recipients with postoperative disseminated cryptococcal infection were investigated and paired with an environmental survey in a tertiary care hospital. The infection prevention department conducted a multidisciplinary investigation, which did not demonstrate any evidence of health care-associated environmental exposure. Moreover, multilocus sequence typing showed that one isolate was unique and the two others, although identical, were not temporally related and belong to the most common type seen in the Southern US. Additionally, all three patients had preexisting abnormalities of the CT chest scan and various degrees of acute and chronic rejection. Reactivation was suggested in all three patients. Screening methods may be useful to identify at risk patients and trigger a prophylactic or preemptive approach. However, more data is needed.
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Affiliation(s)
- E Kennedy
- Infection Prevention Department, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - J Vanichanan
- Division of Infectious Diseases, UT Health Medical School at Houston, Houston, TX, USA
| | - I Rajapreyar
- Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.,Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - B Gonzalez
- Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - S Nathan
- Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.,Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - I Gregoric
- Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.,Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - B Kar
- Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.,Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - P Loyalka
- Program of Advanced Heart Failure, UT Health Medical School at Houston, Houston, TX, USA.,Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - P Weeks
- Program of Advanced Heart Failure, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - V Chavez
- Department of Pathology, UT Health Medical School at Houston, Houston, TX, USA
| | - A Wanger
- Department of Pathology, UT Health Medical School at Houston, Houston, TX, USA
| | - L Ostrosky Zeichner
- Infection Prevention Department, Memorial Hermann Texas Medical Center, Houston, TX, USA.,Division of Infectious Diseases, UT Health Medical School at Houston, Houston, TX, USA
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